Thoughts on Autism and PTSD
By Sean M Inderbitzen APSW, Member of MINT
Autism and PTSD through a neurodiversity lens
Recently I lost a loved one to addiction. I’m not going to get into who, but one day they woke up and walked out of my life. They have never turned back, never looked back, and now I’m left with their ghost. To quote the musician Blackbear, “I’m not alone, it’s just me and your ghost, and this crippling depression, I thought I learned my lesson.” (Me and Ur Ghost, 2020).
He gets it right to the heart of it, “It’s just me and your ghost”, because it is.
Me and your ghost.
Not the kind of ghost that floats through the walls but the kind of memory that haunts you.
For example, recently I had coffee with a friend. Totally normal.
However, when this friend went to leave, everything inside of me jumped to try and stop them. It was as if I was saying to this ghost of a loved one, “Don’t go. I’ll do whatever it takes to make you stay.” But no number of reactions will ever change the past.
Despite what my limbic system might believe.
These reactions often referred to as fight/flight/freeze tend to come up as base survival instincts and are keyed up by the limbic system. For millions of years these instincts helped us survive however, now, like when I’m having coffee, they are a little less helpful. The limbic system is a bit like a dog barking at the door thinking its a burglar when it turns out it’s just the mailman. Sometimes there are real threats, more often they are just the mailman.
Or in my case, the intersection of my Autism Spectrum Disorder and a history of trauma.
When autism and trauma meet
Autism makes trauma interesting to say the least. It tends to intersect in the way that my brain will go on repeat trying to disprove events as if somehow getting the history right will change the past. It never does. Part of the diagnostic criteria of Autism is repetitive and ruminative type patterns of thought. This tends to intersect with flashbacks or nightmares in my case. Thus just increasing my suffering because of the way my brain normally works so beautifully. Instead my brain causes me to suffer twice.
Another way that ASD and my trauma history intersect is what I often refer to as binary thinking. Binary thinking is a tendency to engage in what Aaron Beck (Founder of CBT) refers to as black and white thinking. Much like it sounds people with ASD tend to think and engage in all or nothing thinking pattern. Easy examples of this include: good or bad, right or wrong, left or right, etc. Now consider how that might play out in the larger context of reliving a traumatic event. PTSD often involves reliving moments of a traumatic memory which results in emotional dysregulation. When that ghost I described is brought up, I will find myself arguing with it, trying to prove it wrong. I’ll say to her, “If I had a thousand chances to prove you wrong, how come I have no idea why you left?” As if somehow raising the point to this ghost would change the outcome. It won’t and likely never will but my brain is stuck on needing to be right to resolve the pain.
Being right about a traumatic event, repeating a traumatic memory, unfortunately does not solve the depth of the wound left behind that tends to reopen. Healing however is much more elusive. As a clinician, I would argue there are a number of good ways to go about healing, however, as a person with ASD I’m not sure it’s so easy. If I were speaking to you as a clinician, I’d recommend treatment via Eye Movement Desensitization and Reprocessing (EMDR), Sensorimotor Psychotherapy, or Trauma Focused Cognitive Behavioral Therapy (TF-CBT). All of which are proven effective to treat PTSD within the general population, however, with ASD the only demonstrated effective intervention in the research for treating PTSD in this population is TF-CBT. As a clinician, researcher, and person with ASD gravitate towards other methods.
As a person with ASD and history of trauma I find healing is elusive. As a practitioner I am trained in Sensorimotor Psychotherapy. Visit here to learn more about it. One of the keys to Sensorimotor Psychotherapy is that clients are encouraged to become mindful of their bodies to process the trauma. I think this very basic concept of being present, or fully in the moment is the only way I as a therapist and person can think of how to calm down the barking of my dog brain (limbic system).
The phrase that I have found the most healing through this abject horror, is
It’s a long story, but the short version is that in being still means doing things like laundry, playing golf, or going for a walk. In my body, in the moment, not worried about anything beyond the moment. Thus not reacting and reliving the past, and not trying to be right or even to argue with my loved ones ghost.
To quote another line from the great prophet Blackbear,
I miss you even though it’s over
You cared when it was convenient
You say that you didn’t mean it
You rather be alone, you rather be a ghost
And I don’t wanna believe it (IMU, Blackbear 2021)
Trauma is a bit like this when you have ASD. It’s a bit like you don’t want to believe it because how can you? Part of living with ASD, is living in a society that somehow you are taught over and over again you are a mistake, or that there is something wrong with you because you are neurologically different (kudos to Dr. Ivar Lovaas for this). So to miss a ghost, is better than to face the sheer horror the belief, “You suck” actually being true.
So to those of you on the spectrum with trauma, may you Be Still. Be here. Be now. Because there is no other time than the present.
And to quote the great poet Mod Sun, “The present is a gift.”
Sean is a Behavioral Health Therapist, and lives with an Autism Spectrum Disorder. He has a caseload with 33% of his patients that live with ASD and varying comorbid psychiatric conditions. Prior to being a mental health clinician, he was a Vocational Rehabilitation Specialist for Wisconsin Division of Vocational Rehabilitation for 3 years. He was also appointed by Governor Walker to the Statewide Independent Living Council of Wisconsin. He is an incoming member to the Motivational Interviewing Network of Trainers, and provides training on motivational interviewing, ASD and employment, and ASD and comorbid psychiatric conditions. For more info, find him at Seaninderbitzen.com or on LinkedIn.