Wednesday, February 10, 2021

Glass Straw

 The Engine and the Glass Straw

When I work with people I often am struck by the power of their minds. Here are people so good at thinking, so good at analyzing, and so sure of their correctness (maybe desperately so) that involving myself in a cognitive wrestling match proves often….well, futile.

This leaves me in a bit of a conundrum. As a therapist, I’ve been trained to work in lots of ways using lots of techniques, most of which are aimed towards one goal: changing thinking.

Changing thinking is a noble and sometimes effective aim. Identifying cognitive distortions and working to correct thinking to reflect reality more accurately can help an individual limit the anxiety and sadness distortions cause. This work can help organize sane responses to stressors. Who would argue with that?

I would. But not because there’s a fundamental problem with cognitive approaches. I would argue that, ultimately, they prove mostly ineffective with people I work with.

Working with a mind both powerful and certain can prove exhausting and frustrating. Early in my work with patients I often thought to myself, “Can’t you see the way you’re thinking is the problem? Can’t you take a different perspective that might work better?”

The answer was….no. Despite my best efforts, and dare I say, the best efforts of my clients, the thinking persisted, unmoved by any force of logic or persuasion.
I liken it now to interacting with a mind that operates as a powerful car engine, roaring towards some undesired destination, yet absolutely committed to its direction. It took me a long time to realize that this engine was designed to drive the car away. 

Away from what? Away from the place remembered, but not known.  The mind here is a machine, designed to race towards forgetting. No mental effort of mine was going to change that. No mental effort of the patient’s was, either.

And so, with no way to change the map, our work became a kind of daring journey towards the place escaped from. This psychic destination was often so filled with pain and panic that any movement towards it appeared slow and difficult, often accompanied by a sense of terror and futility.

After a bit of time clients often become aware of a thin glass straw up around the corner of the engine. Its fragility in the face of a bumpy road and a hot, exhaust spewing machine seems the essence of absurdity; in fact, encountering it seems to lead only to the intermittent detection of a slight breeze across the top of this straw, a breeze gentle enough to carry a white feather by. 

Learning to pay attention to that breeze is like learning to receive a wisp of a breath in the midst of a raging storm or like straining to discern a whisper offered from a far corner of a hall filled with a cacophony of voices. 

The attention narrows, the whisper is heard, the cacophony silences. 

The glass straw is, after all, no silly remnant, no appendix of the psyche. It serves as a vertical tunnel of sorts, to another way of being, unmapped. 
The mind roars its objection.

But the call home has not been silenced. Only repeated, infinitely to ones own ear, until, finally heard.

Wednesday, October 11, 2017

Treatment, Love and Limits

I have treated so many adults on the spectrum. A few successfully.

And what I learned in school has proven barely relevant to the process.

Clients who come in trapped in the prison of their mind are in a fight for their lives. No clinician, no person, can ever win a battle to break into the fortress.

It's what the fortress is guarding against that needs addressing. Most clients I've met are dying of loneliness.

Most are guarding, full time, against a pervasive and nameless panic, or, in Sylvia Plath's words, the "o-gape of complete despair".

To imagine I might outsmart a client's mind, as it builds and rebuilds its walls of protection, is to have no understanding of my own limits.

I hope that, as we develop more and more complicated ways to name and talk about symptoms, we will eventually come to the simple understanding that to learn to give and receive love, after one has learned to live without it, is the bravest, most heroic journey.

It is the only journey. The rest is walking in circles.

Thursday, January 29, 2015

Adults, Autism and Snipping

We’ve probably all heard about (or felt) imposter syndrome. In my work with adults on the spectrum, I notice that many of my clients struggle with some version of it. Even those who have achieved success in academic, professional, financial, and even social contexts struggle privately with the sense that none of it is real.

In contexts they’ve mastered they can appear socially adept (or so good at their jobs that social deficits are pardoned). But outside of a mastered context (whether the context is reddit or academia seems of little relevance), many struggle with something beyond social anxiety. I call it social panic.

How then are these adults able to function so well in these mastered contexts? It baffles both my clients and their loved ones. There are probably a number of ways to understand the discrepancy, and one way I describe it is via the idea of snipping.

Snipping is my way of describing how people with certain default styles cope with emotions that are beyond his or her capacity to handle. Under extreme stress, some of us snip the connections that bind us to parts of our own experience. It might be a foreign concept to someone who has never experienced it, but many of my clients recognize the phenomenon, though they’ve been unaware of it or unable to describe it.  

For instance, many of my clients are intellectually gifted. Their methods for processing reality may already differ a bit from those with less specialized brains. If the emotional load involved in processing reality in this way is too large to handle (as can be the case with those who perceive patterns and detail that remain out of awareness for most of us), adults on the spectrum have the option of snipping their awareness of the emotions. 

This is not necessarily a neurological reality (though I wouldn’t be surprised if it gets backed up by imagery sometime soon), but it is a way to describe the emotional shutdown so many clients experience, an experience they always describe as involuntary. I’m guessing if I had the option to do some snipping to avoid painful emotions I might rely heavily on that technique for managing everything from boredom to stress to grief.

Some clients snip not just their awareness of their emotions, but their awareness of their bodies, of time, of events taking place around them, of identity itself. Because of this snipping, they may be (in ways that seems almost genius – and maybe are) able to transcend typical limitations associated with the body (think of the busy programmer who forgets to eat or go to the bathroom), time (think of the musician who has been trying to master a piece for 12 hours straight), events around them (think of the cool mindedness of the non-reactive stance you’ve seen in the midst of conflict) and even identity (think of the adult who transcends typical limitations of gender, and even ego).

The snipping phenomenon can be a great tool, obviously, but like most coping styles, it appears to come with both benefits and costs. The benefits seem obvious: untethered from ego and emotion, my clients can often think in ways others can’t. Awareness of ego and emotion, especially, compete for attention and energy; divorced from these sources of internal resource depletion, clients on the spectrum can immerse themselves in music, programming, philosophy, etc. in ways that a more diversified brain might find out of reach. Clients often dazzle me with their perspectives and intellect.

The costs involved in snipping are sometimes immediate (such being unable to participate in a charged emotional situation that demands emotional engagement) and more often long-term (a life that runs like a machine but lacks vitality). Clients sometimes store negative emotions, such as fear and grief, in their bodies – digestive problems, sleep disturbances, jaw clenching, etc. – and even more often suffer symptoms such as difficulty harnessing attention and swings in motivation, as well as compulsive productivity alternating with periods of disassociation. Snipping can allow a bright person to block out fear so s/he can develop and express intelligence and think in ways that are exciting, but the fear has not truly been dealt with and transcended. It has been avoided, and - out of sight - it may even have grown.

The adult who has built not just coping mechanisms, but a life and a career (or even an identity) on a foundation of snipping maybe very wary of changing the system. I think this wariness is wise! When changing how one processes and interacts with reality, things tend to get shaken up. Who is to say it will be worth it in the end? A therapist who promises that it will be “worth it” is promising something she cannot know, and certainly cannot ensure. The client who ventures forth to change the snipping system must want something that s/he might not even be able to name. And s/he must have, to some extent, faced the reality that the system is breaking down, or is limited in ways that have come to be unacceptable.

When working with clients on the spectrum who have a snipped connection, I don’t make promises and I try to remain cognizant of the reality that I can’t sell the worth of knitting together that snipped connection. Realizing that a beautiful system of rationality and logic is limited or inadequate can be both painful and frightening. I have compassion for the pain of the realization, a respect for the difficulty of the path, and a willingness to walk with the client who dares to embark on the journey.

Sunday, April 20, 2014

Adults on the Spectrum - and the Ted Bundy Question

I have heard – many times – from new clients, as they try to explain their predicament, sentences like this: 

"I am not like Ted Bundy – but I could be."

I used to be very puzzled by this – after all, I’d hear these proclamations from the very best of people. In fact, most of my adult clients could be described as conflict-avoidant, even in situations in which they feel threatened (rare in adulthood, maybe, but more common under the label of “bullying” in childhood). These clients are gentle, never cruel to animals, and certainly not the type to take pleasure in the suffering of any sentient being. Yet they come in so unsure of their basic nature, and they tell me this: “I am not Ted Bundy, but I don’t know why.”

A knee-jerk reaction in this case might lead a well-meaning friend or even therapist to brush aside such concerns as silly. But I think clients sense they are different – that though they don’t act in ways to deliberately harm others, the reasons behind their non-violent nature are different than the reasons shared by most. I think they may be right.

Many of us rely on a kind of shared emotional experience to guide their ethical behavior. It’s easy to imagine another’s fear, or pain, in the moment – it conjures up our own feelings of fear and pain, and that alone is enough to serve as a deterrent. But what if that kind of imagined experience wasn’t so automatic, or instant? This is the case for many clients. They find another path for managing their ethics in the moment – sometimes these look like the “rules” so often mentioned in ASD literature.

It’s the autistic adult’s wonderful workaround for a system (social, emotional) that’s not available and instant enough to guide ethical behavior. And this compensating system can really shine in moments when what’s ethical may cause another pain or discomfort – think of the last M.A.S.H. episode – so wedged in our minds because many of us could understand the horror of being faced with having to choose between the survival of many and the survival of an infant. There are times when ethics must be applied in ways that violate our sense of that automatic empathy we rely on for a moral compass function. So many clients on the spectrum can operate in settings (corporate, etc) in ways that transcend the emotional comfort of others, and even themselves, to do what’s right. This makes for less inclusion and social comfort for the client, but they endure (when many empaths do not).

As I’ve written before, I often find that adults on the spectrum are highly sensitive. But that doesn’t mean that the sensitivity is available in the moment, especially in social situations. Relying on ethical “rules” is a wonderful compensation, when immediacy is important. But this doesn’t mean that inside, many of the same feelings that move most of us aren’t alive and well.

So while I can understand why clients come in with an unsettled feeling that they could be Ted Bundy, I know that, via one system or another, they aren’t, and won’t be.

Saturday, April 5, 2014

Adults on the Spectrum: The Emotion Exoskeleton

Emotions are funny things.  They can be a source of immense joy, as well as immense pain.  I think of them like a deck of cards we each have; trading positive cards can be a lot of fun. The healthier your relationships are (with others and yourself), the more enjoyable this trading becomes, the safer the game.

Like most things, how people experience emotions seems to run along a spectrum.  Some people feel emotions powerfully and readily.  Others feel emotions less readily, and when they do, the emotions are muted.  When I think of how my clients experience emotions, I think about what happens when emotions are unpredictable, indefinable, uncontrollable.

Many of us have a kind of internal “emotion skeleton” we use to arrange emotions; part of development involves a kind of coalescing of emotional experiences (between the individual and the environment, the individual and others and the individual and self).  Factors like experience, relationship modeling, attachment and physiology help us understand what emotions we hang close to the heart, what emotions are more peripheral.  This internal structure helps us organize and control emotion, such that over time we have a sense of solidity and control.

But sometimes this process of bone building is interrupted.  Emotions are too powerful or chaotic, or one’s environment requires a level of development not yet reached.  When this happens, the development of an internal mechanism for structure does not proceed as it should.  The internal skeleton needed to manage and understand emotions has not developed as it has needed to, leaving the individual feeling an internal sense of chaos.  It prevents a cause and effect kind of understanding of emotions from emerging, and leaves the individual vulnerable to emotional overload, and therefore a kind of mistrust of emotions.  Without that internal structure with which to organize emotions, feelings become hugely disorganizing, and even scary.

To cope with this phenomena, clients do a few things.  They may limit their access to emotions (“shutting down”)  in order to increase their sense of structure and control.  Keeping feelings out of awareness is one way to preserve what internal sense of calm and order there is.  Many clients erect exoskeletons of one sort or another. Examples are:

  • Visualizing what’s to come
  • Withdrawal
  • Constant engagement in emotionless systems
  • Substance abuse

One of the most common I hear about is visualizing what’s coming next – by having a vision for events, a kind of imagining of the future, many control to the extent they can the element of surprise (nothing ushers in emotions quite like surprise!).  This exoskeleton serves to shield from environmental triggers, and can work great, except that (by definition) an exoskeleton is not flexible.  Changes of plans can be jarring, cracks that allow emotions to flow in unexpectedly.  And when you’re depending on an exoskeleton to protect you from the emotional impact of your environment, it can feel scary to encounter those cracks.

Another kind of exoskeleton is withdrawal.  Clients talk about withdrawal in lots of ways; some withdraw into their own mind when potentially overwhelmed or bored, some withdraw physically into their homes or rooms.  Some use machines to withdraw – gaming systems, computers, etc. 

When in relationship with someone who has erected an exoskeleton, it can be confusing.  The individual might seem more interested in controlling the schedule than in connecting, or more motivated to game in the evenings than to talk.  I’ve seen so many couples struggling with this, seeming at war – one partner trying to pry the structure from the other’s hands in order to connect.  This always backfires of course – the structure is needed to make connecting even possible.  The more one partner pries, the harder the other clings to the structure.

Sometimes it seems couples have made an unconscious agreement with one another – one intends to provide the structure and benefit from the emotional life provided by the other. The other agrees to provide the emotional life for both, while benefitting from the structure provided by the other. This could be a great arrangement, and it is in theory. Usually, however, each partner actually craves more balance than this system provides. Most healthy relationships require a working skeleton on the part of both partners.

When addressing the challenges with personal emotions so many clients on the spectrum seem to face, one difficulty in particular arises: almost all of my clients have a well-developed understanding of emotions in theory. They’re all intelligent, so the idea they don’t know the difference between frustration and rage is a little insulting. What’s difficult is not theoretical knowledge – it’s recognizing emotions on a personal level. And here they do tend to struggle: if I’m hungry, I might be angry. If I’m sad, I might be depressed. If I’m anxious, I might be hungry. And so on. You can imagine what a challenge this is when, say, a partner is asking for emotional feedback on the fly.

But learning how to identify personal emotions is a process akin to learning to drive – no matter how bright, you can’t do it in one day. It involves a kind of brain conditioning, and starting with the basics is a must. That theoretical knowledge of emotions won’t help when you’re trying to figure out what you’re feeling in the moment; in fact, in can get in the way. So adults on the spectrum are faced with having to resist the temptation of traveling down a well-worn super efficient highway, and choose instead to travel down a rocky and erratic back road they’re unfamiliar with. This is tough to do when you’re a perfectionist!

If you were saddled with a big intellect, and also with difficulty identifying and understanding personal emotions, would you be able to set aside your ego and learn the basics?

It may be the only way to grow an emotion skeleton.