it turns out I do have something to say about autism and trauma, surprise

[kaberett]

I recently linked to an article pointing out that the "symptoms" used as diagnostic criteria for autism are... actually symptoms of trauma, in many cases.

I don't actually have much to say, now, but I ended up reading the NAS's page on pathological demand avoidance, which notes that one of the reasons it's useful to have a specific dx of demand-avoidant profile because... it avoids incorrect assumptions and diagnoses, such as Personality Disorder.

("Although a person might have these as well," it concedes.)

Which, given that at least Borderline Personality Disorder can in a very great many cases be usefully modelled as an entirely predictable result of prolonged and cumulative trauma... seems to me to be missing the point, rather, actually. In that: allistic parents (& allistic society) aren't actually, by and large, very good at raising autistic children without traumatising them (with the best of intentions! and a great deal of love!); the failure to provide appropriate engagement and reciprocity throughout childhood is unequivocally known to be profoundly (and cumulatively!) traumatising; and, per the above, (i) the diagnostic criteria for autism rely to an alarming extent on trauma, and (ii) at least one "personality disorder" clearly results from prolonged trauma.

I'm just... really not convinced that "let's pretend autistic-flavoured long-term trauma is meaningfully and clearly distinct from this other (differently stigmatised) way we traumatise people" is a useful approach.

Comments

[angelofthenorth]

On the subject of Autism, the Tories tried to introduce a bill into the Senedd to help those with Autism. It failed because certain Labour AMs won't back 'opposition' bills, even though there was cross-party support for the legislation from all those on the health select committee.

[child_of_the_air]

Huh. It definitely makes sense to recognize that trauma is trauma and is likely similar despite different sources. On the other hand, it does worry me that a "logical" conclusion that allists could derive from it is that autism isn't real, it's just trauma.

(I may be paranoid about this because my mom doesn't believe autism exists.)

[recessional]

No it's not unreasonable: even otherwise intelligent people have already tried this one with ADHD.

I mean sadly it doesn't mean that pretending they're totally different is the answer, just that yeah.

[child_of_the_air]

*nods*

[ewt]

Anecdata:

I have an ADHD diagnosis and I frequently get stuck in a sort of chicken-or-egg thing with "but would I have these executive function problems if I had not had significant trauma?" vs "but would my very traumatic experiences have been so very traumatic if I were neurotypical?" and it's... not straightforward to unpick, for me. And part of that is because a lot of medical types don't deal with overlaps very well, but part of it is because the effects of trauma are vastly under-recognised and discounted, and part of it is that my trauma was early enough that I don't really remember what it's like not to have experienced it. That doesn't mean that all ADHD or even my ADHD is "just trauma" and it doesn't mean that my ADHD symptoms aren't hugely exacerbated or, in some cases, caused by trauma.

To borrow the broken arm analogy (which I think has some bunch of problems in the way it's used as an analogy for depression, but nevermind): you can have a broken arm because you fell really hard and broke it, or you can have a broken arm because you have some kind of congenital brittle bone thing and you bumped your elbow at the wrong angle. They're both still broken bones, they both need appropriate care, and having the congenital brittle bone condition doesn't mean you won't ever fall hard enough that it would cause a broken arm even in someone with more average bone strength.

[recessional]

Oh believe me, I know: it so happens that I actually genuinely do have in fairly close social spheres all three possibilities: people whose trauma results in ADHD-like ~*stuff*~ but who genuinely do not have ADHD, people who have ADHD and trauma and whose ADHD and trauma have complex interrelationships and causative relationships with one another (and whose do not), and ADHD people who have no particular trauma.

The problem becomes that some people have decided that ADHD doesn't exist, and it's All Trauma. Which has seriously unfortunate implications. What makes it difficult is that, of course, that doesn't mean that trauma ISN'T a thing, that the comorbidity of trauma and ADHD isn't significant when it happens, that they can't be linked in complicated ways (including "this probably wouldn't've been long-term traumatic if I hadn't been ADHD, but I was"), etc.

So one can't just take up the FIRM OPPOSITE POSITION, that No ADHD And Trauma Are Totally Different From Trauma-Qua-Trauma and so on and so forth, one has to take the "well actually Nuance Is A Thing" position, which is always harder to work with when dealing with people who are all No ADHD Is Not A Thing It's Misdiagnosed Trauma (PUT DOWN THAT STIMULANT!).

So it's not unreasonable to be concerned that the same kinds of thing could be a problem with ASD and trauma. Just, unfortunately, so is the same "Nuance Is A Thing" reality of it.

It's a bugger.


(And like: I say this as an autie who has a couple layers of trauma but the first and deepest is absolutely entirely rooted in growing up in NT society as an undiagnosed autie. Soooo. >.>)

[ewt]

nod I didn't explicitly make clear: it's a very reasonable concern to have.

I think this is especially the case given that neurotypical people often seem to seriously struggle with nuance around this sort of thing.

[kaberett]

<3

(whyyyyyy are they like this)

[kaberett]

why are the neurotypicals like this, M >:(

(it is a source of ENDLESS FRUSTRATION to me that we are apparently the ones bad at nuance/holding complex ideas in our heads/etc.)

[recessional]

Lack of practice. e.e

Also terror of being Defective, because Defective means being absolutely vulnerable to the tolerance and patience of other humans which they are well aware is an incredibly dangerous place to be, so embedded that it's hard to even get them to admit it.

See also "when parenting advice isn't trying to sell you actual merch, it's PROBABLY trying to sell you How Not To Be Defective Trash, and THAT is about social politics, prejudices and bullshit, not actually about How To Be An Ethical, Stable, Base-Contented Person."

talk to your kids about psychoanalytical psychotherapy before someone else does

[vass]

My ex-psych tried that one with me and autism.

His position (which he did not fully explain to me until I had told him I was quitting and finding a new therapist and was clearly actually making it stick this time) was that my autistic traits were either the result of constant anxiety due to deep-seated trauma OR they were Asperger's.

If it was Asperger's, there was nothing to be done but give up. But if it was constant anxiety secondary to trauma, then resolving the trauma would resolve the anxiety. And this was the only way to tell which it was: keep trying the same therapy indefinitely, and if the patient responds then it's trauma; if the patient doesn't respond then it might be Asperger's or it might just mean they still need more therapy. (He did in fact officially diagnose me with Asperger's. Twice. But there was always an asterisk in his mind about it.)

So I didn't need accommodations or supports or to learn skills to deal with my very real and very much screwing up my life memory and concentration and task-switching etc etc problems, and indeed getting those things might make me complacent and no longer interested in working on my real issues by talking with him about my relationship with my mother in infancy.

So, how long would resolving the trauma take? An indefinite amount of time. (And money.) I am ashamed to give an exact number of years, but I stuck in there longer than a decade.

Oh yeah, also, any practical adaptation to dyspraxia (like drinking from a normal water bottle like every adult who goes to the gym takes with them, instead of a cup I can knock over, got framed as infantile regression. "A bottle? Like a baby?" actual quote, and he was not trying to mock me, that was him analysing.

In our last session, he told me that he had suspected right from the beginning that it was the Asperger's not the trauma, but he "didn't want it to prejudice his treatment of me." Quote unquote. That's right, this psychiatrist (no, not psychologist or psychotherapist. The one that usually requires a medical degree.) did not want to be so "prejudiced" as to give me a different therapeutic treatment based on what condition I had.

He was very sad that I was so damaged and untrusting and traumatised that I was unable to let him help me.

Re: talk to your kids about psychoanalytical psychotherapy before someone else does

[recessional]

I can light him on fire for you!

Re: talk to your kids about psychoanalytical psychotherapy before someone else does

[vass]

Thank you for the offer. It'd be at least be effective. (Five years later, I'm still madder at myself for staying so long than I am at him for gaslighting and manipulating and misleading and sometimes outright lying to me, but not by as much.)

Re: talk to your kids about psychoanalytical psychotherapy before someone else does

[staranise]

If it helps any, through you, he has served me as a wonderful example of How Not To Be.

Re: talk to your kids about psychoanalytical psychotherapy before someone else does

[kaberett]

I have so many fucking feelings about all the ways you were coerced into that immensely damaging situation by people who'd already coerced you plenty, and how they kept you there by telling you that you were a fuckup who'd keep fucking other people up if you didn't stay where they'd put you, and just... you get all my compassion and absolutely none of my seething anger. And a lot of I'm Impressed, too, and relieved, that you finally got out.

(It was an abusive relationship, with a power dynamic in which you were being explicitly infantilised. No WONDER you got stuck trying to do what the adults told you would be best.)

Re: talk to your kids about psychoanalytical psychotherapy before someone else does

[recessional]

I respect the difficulty of the space of figuring out how to be angry at the people that harmed one rather than at oneself for not being invulnerable and escaping.

I however am happy to remain totally un-mad/entirely understanding of why you were stuck there, and totally light-on-fire furious at him, because he is shit and should not be allowed to practice.

[silveradept]

The reason I could see to treat those traumas differently is in the way you try to help someone not be regularly traumatized or hurt by those traumas of the past, to the extent that's possible. And really, only if to make sure that a person who is supposed to be helping actually does help in a way that might be effective.

[staranise]

I can see why they want PAD, since ODD is such a stigmatized diagnosis, but oof. It's hard not to read it as "ODD for rich peoples' children".

Part of what I'm seeing with trauma-informed paradigm shifts is people trying to say, "This isn't like those BAD mental illnesses, this is the result of TRAUMA, ours are the GOOD patients," in a way that's just rolling the shit downhill.

[kaberett]

YUP. That is very much the impression I'm getting, and it's respectability assimilationism bullshit (that underlies my political decision to say "I'm autistic" and "I have BPD").

[ludy]

This is all true. Pulling your group out if stigma shouldn't involve making things worse for another group

But my experience of being around Smalls with a variety of diagnoses and "traits of" not diagnoses i can (not very helpfully) say that there's a hard to explain but noticeable difference in flavour between PDA and ODD...

Meanwhile my main diagnosis (NLD) is that's not generally used in the UK so no one has unhelpful stereotypes about it but also they have no idea what it means.
(I wasn't diagnosed until i was nearly 30 and unsurprisingly also have a PTSD diagnosis, among others)

[recessional]

I am also so frustrated with how ODD is framed in GENERAL, in ways that really do come down to "before you're allowed to deal with children any longer I really do insist that you get rid of the idea that they OWE YOU obedience and deference as moral-interaction-qualities, EVEN IF you're in a position where you have to exercise authority over actions and behaviours for various solid reasons."

Because underlying the entire problem is in fact this idea that somehow kids should be deferent and "respectful" because of adult authority and position*, because to the right adults kids should be docile and obedient, rather than any actual relationship of power/authority that is based around the practical facts of "smol humans need adult humans to run a lot of things because smol humans are terrible at picturing what the world will look like in half an hour and so can't be made to manage themselves, and also they need to be taught how to not be douchecanoes, and other social skills."

Like the actual conditions of ODD will totally interfere with the latter kind too! It's a valid problem, I've worked with ODD kids. But where the stigma/etc gets gross, it arises from that wrong version. It's even embedded in the name.



*this is separate from a use of "respectful" that actually DOES mean "not treating anyone, including their peers, like absolute shit" - it's "respect" where that idea is indivisible from deference.

[ludy]

Very much agreeing.

The Smalls i spend most time with have been ages that have needed a lot of the practical-adults-running-stuff and as they get older and more capable it can be tricky to know when to (and when not to) begin letting go of that... But i think (hope) that's a different thing to toxic adults-are-owed-obeidence-ness

[recessional]

I think it is? And I mean that's the huge challenge of kids, right: you CAN'T actually just . . . not have authority and power at play, because they don't have the capacity to look after themselves. And despite what some rather silly people on tumblr think, yes I actually DO need the three-year-old to do as I say by default if I'm gonna take her out in public because I need to be able to (say) notice the car and shout GET OUT OF THE WAY and have her do it RIGHT THEN without needing to take her three-year-old-brain and try to parse the danger herself, because she'll FAIL.

And you can't give a small child total bodily autonomy because a small child will, for example, totally choose to leave the splinter in and let it fester because it Hurts to dig it out! And so on.

It just puts a HUGE burden of responsibility on adults looking after kids to actually, you know. Use that power for the purpose of what's genuinely best for the kid, and that's a lot! And it can indeed be a case of "oh god now she also needs to LEARN how to look after her shit which means I have to let her look after some shit how do I know which shit she can look after when without it all going to shit . . .!" and so on.

Part of our job is in fact to mediate the mass chaos of the world for them until they have a hope of doing it themselves without being Damaged, and that requires us, well, being in charge.

Which is why ODD is a problem! even if you the current caregiver are not crap like that!

But yeah. The deep deep theme of "respect mah authoritay" that also exists in our child-rearing consciousness is a Problem and a huge one with that kind of kid. *sigh*

[recessional]

Bingo. And it's gross and actually harmful, as you know bob.

Sigh.

[flippac]

I'm seeing a hell of a lot of pretending that our undiagnosed parents are Definitely Allistic and thus that this isn't in any way a multi-generational trauma issue, too.

[recessional]

hahah lolsob intergenerational trauma as a factor and how it all goes wahey yes this this is also a thing (and a thing where they then decide to Simplify, and . . . )