anxiety - Emergent Divergence

Jun 6 2023

What is meerkat mode and how does it relate to AuDHD?

This article was authored by Tanya Adkin

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Lovingly dubbed “meerkat mode” by Tanya due to the heightened state of vigilance and arousal it presents, it involves constantly looking for danger and threat. It is more than hyper-arousal, Tanya believes that it is actually an overwhelmed monotropic person desperately looking for a hook into a monotropic flow-state.

This is not just sensory hyper-arousal, it is the tendency of monotropic [AuDHD] minds to seek out a natural and consuming flow-state to aid recovery from burnout and/or monotropic split. Because of the heightened sensory-arousal and adrenal response that comes with it, monotropic flow becomes difficult to access, leading into monotropic spiral.”
Adkin & Gray-Hammond (2023)

Recently David and myself have written a few articles on atypical burnout (Adkin & Gray-Hammond, 2023) and the burnout to psychosis cycle (Adkin & Gray-Hammond, 2023). In those articles I’ve mentioned something that I refer to as “meerkat mode”. People seem to relate to the concept as discussed in the articles, so I thought it may be wise to dedicate a whole article to what I mean by this concept.

Firstly, I want to explain that I am a very visual thinker, who happens to be plagued with good ol’ imposter syndrome. Said imposter syndrome tells me I should have thought of a more academic terminology, but that’s not the way my brain works. Truthfully, I can’t think of a much better visual representation for what i’m about to describe.

Meerkat modes presents an answer to the diverse forms of burnout I have witnessed through my work with a wide range of neurodivergent people. David agrees with the assessment as a fellow “autism professional”. I don’t set out to reinvent the wheel or change entire paradigms, this is and was a way for me to simply explain a phenomenon that is more common than people realise. A phenomenon that I see described on an almost daily basis as hypervigilance or a trauma response, but in my experience is more than that.

What is meerkat mode?

Hypervigilance
- Hypervigilance is not a diagnosis. Rather, it is the brains biological adaptation to ongoing stress and trauma, which we know that Autistic people experience at a higher rate than non-Autistic people (Gray-Hammond & Adkin, 2023). It is the way it maintains a state of high alert on the look out for threat. It’s a description of a state of being that is commonly seen in diagnostic criteria for things such as PTSD, anxiety disorders, schizophrenia spectrum disorders, psychosis and psychotic phenomena, some personality disorders, and much more.
- Interestingly, a lot of these mentioned diagnoses are seen to be co-occurring with Autistic experience.
Seeking a monotropic flow-state (Hyperfocus)
- Flow-state in terms of monotropism refers to the tendency for monotropic brains to fall into deep attention tunnels that are intrinsically motivating. It has been reported by Autistic people that entering this flow-state is beneficial to monotropic peoples mental wellbeing.
- Flow-state and hyperfocus are often used interchangeably and there is a general acceptance of it’s occurrence but no solid definition.
- Anecdotally, when we see this as a person seeking to be in a constant flow-state, it can often indicate dysregulation or adaptations needed within the environment. Sometimes (when dysregulated) this flow state can be quite negative and turn into a monotropic spiral.
- Because of hypervigilance people experiencing “meerkat mode” have a significantly more difficult time accessing flow-state.
- Hyperfocus/flow-state is reported in autism, ADHD, and schizophrenia (Ashinoff & Abu-Akel, 2021).

“Refers to a state of being engrossed in a task that is intrinsically motivating during which task performance improves, there is a tendency to shut out external environmental stimuli, and internal signals”
Ashinoff & Abu-Akel (2021)

Increased Sensory Dysregulation
- Interoception
  - Interoceptive differences do not only occur in Autistic people. They are thought to be largely caused by early-life stress (Löffler et al, 2018) and trauma (Schulz, Schultchen & Vögele, 2021).
  - Interestingly, interoceptive differences are seen to occur in ADHD people, Schizophrenic people, eating disorders, anxiety disorders, emotionally unstable personality disorder (EUPD), and more.
  - I am not stating that Autistic interoceptive differences are created by trauma, rather that the generic understanding of interoceptive differences is attributed to stress and trauma.
- Alexithymia
  - Alexithymia refers to the difficulty or inability to sense or decipher one’s own emotions or the emotions of others. It could be described as a subcategory of interoceptive differences.
  - The general view is that alexithymia is created or arises from extreme stress or trauma, some research does suggest it could have biological or developmental links (Thompson, 2009).
  - Again, alexithymia occurs in more or less every diagnostic category I have pointed out previously, including ADHD, or any situations that create stress or trauma.
- Link between interocetion (alexithymia), vestibular, and proprioception
  - Those that are displaying “meerkat mode” (in my experience) will generally seek proprioceptive and vestibular input, e.g. bouncing on a trampoline, rough play, being upside down. They may be “clumsy” or meet criteria for developmental coordination disorder (dyspraxia).
  - Interestingly, the above sensory profile is highlighted in guidance to be of clinical significance with a PDA profile of autism (PDA Society).
  - Generic advice for someone experiencing “meerkat mode” would be to increase proprioceptive and vestibular input in order to regulate interoception.
  - Interoception takes the leading role in emotional regulation.

“Interoception works the vestibular and proprioceptive senses to determine how an individual perceives their own body. Well-modulated interoception helps the individual detect proprioceptive and vestibular sensation normally.”
sensoryhealth.org

May be unable to stop or rest
- As David and I have discussed previously in our articles on atypical burnout and the burnout to psychosis cycle those that appear to be meerkatting may not be in a position to stop and recover.
- This could be due to co-occuring ADHD (AuDHD) or life demands such as parenting or work, maybe interoceptive differences mean that the person does not “feel exhausted”. They could be in a monotropic spiral of flow-state which is shutting out everything else.

Concluding thoughts

There are infinite possible interactions between an AuDHD person and their environment. And this is why I think we often struggle to define our experiences through something that can be outwardly observed and measured.

This is just one explanation for something that I have witnessed in a sea of possibilities.

References

Adkin, T. & Gray-Hammond, D. (2023) Creating Autistic Suffering: The AuDHD Burnout to Psychosis Cycle- A deeper look. emergentdivergence.com

Adkin, T. & Gray-Hammond, D. (2023) Creating Autistic Suffering: What is atypical burnout? emergentdivergence.com

Ashinoff, B. K., & Abu-Akel, A. (2021). Hyperfocus: The forgotten frontier of attention. Psychological Research, 85(1), 1-19.

Gray-Hammond, D. & Adkin, T. (2021) Creating Autistic Suffering: In the beginning there was trauma. emergentdivergence.com

Löffler, A., Foell, J., & Bekrater-Bodmann, R. (2018). Interoception and its interaction with self, other, and emotion processing: implications for the understanding of psychosocial deficits in borderline personality disorder. Current Psychiatry Reports, 20, 1-9.

Schulz, A., Schultchen, D., & Vögele, C. (2021). Interoception, stress, and physical symptoms in stress-associated diseases. European Journal of Health Psychology.

Thompson, J. (2009). Emotionally dumb: An overview of alexithymia.

Tanya Adkin 4 Comments

Feb 13 2023

Mental health and the diagnostic process: A neurofuturist perspective

As I discussed in my recent article about co-occurring conditions, the diagnostic process in psychiatry is inherently flawed on the basis that we have failed to find any meaningful relationship between the so-called “symptoms” of psychiatric conditions, and physical biomarkers which can be measured. Despite this lack of physiological cause, we are still diagnosing people as mentally “ill”. Despite this model not improving outcomes for around half a century.

So now we are faced with the issue of how diagnosis is not just given, but also how it is given responsibly.

One of the biggest flaws of psychiatry is the circular logic that dominates the diagnostic process. A person is Schizophrenic because they have symptoms of Schizophrenia, and they have those symptoms because they are Schizophrenic. This logic does not allow for a nuanced understanding of why a person may experience this particular cluster of traits, it simply follows that A = B, which is because of A.

If this is the case, how does one escape from circular logic?

We have to look for causes for traits and “symptoms” outside of the realm of medicine. While I have often remarked that external factors are the only thing with a meaningful relationship to these experiences, medicine is yet to catch up. It seems reasonable to assume that traumatic experiences are the cause of psychiatric conditions and not a problem within the body. This has ramifications for the future of psychiatry.

If people are not “unwell”, psychiatry now has a moral duty to advocate for it’s patients. Psychiatry needs to evolve into a tool for social change, and cease to be a weapon wielded by normative society. Beyond this, psychiatry needs an understanding of the relationships between neurodivergence, trauma, and psychological distress. It is not enough for psychiatrists to bandage the wound, they need to remove the knife from the hand of society.

This requires us to radically rethink our entire perspective on normality and cultural normative standards. We can not just medicate people and expect them to assimilate into society. We need to help them understand their own unique space in the environment and how to embrace their journey through that space.

As I discuss in my book A Treatise on Chaos, identity is a shifting and ever changing value. We are, at our core, beings of chaos. Psychiatry needs to be a tool for supporting us in the more challenging parts of that chaos, and not serve as a ring-fence around the Self.

Psychiatry is not completely off the trail. Medication can serve as an important tool to support a person’s wellbeing, and can be very helpful for reducing the more troubling and distressing aspects of psychological distress. The most important thing is that we all put in the work to evolve psychiatry and mental health support into a means to challenge the oppressive systems that exist within our world.

It’s time to stop the navel-gazing, and build a better future.

David Gray-Hammond 0 Comments

Jul 28 2022

Neuroqueer: Depathologising psychiatric “conditions”

This article was co-authored by David Gray-Hammond and Katie Munday

Trigger Warning: Ableism, pathology paradigm, sanism, use of words insane and madness, medication, therapy and trauma.

Neuroqueer theory evolved out of the neurodiversity paradigm. It was a logical progression in the field of depathologising natural variations in the human bodymind. This concept appreciates the neutrality of neurodivergence, as neither good or bad, it simply is.

While this concept has been widely explored in the area of intrinsic neurodivergence, (such as autism and ADHD), there is less discussion regarding acquired neurodivergence; neurodivergence that is typically acquired through trauma or the intentional alteration of ones bodymind (such as through the use of psychedelic drugs). Specifically, we wish to discuss the concept of psychiatric “conditions”.

Psychiatry itself is one of the youngest branches of medicine, first mentioned by name in the late 19th century. Due to its infancy the field still remains fallible, and is largely governed by the contents of a single textbook; the Diagnostic and Statistical Manual of Mental Disorders (DSM) currently on its fifth edition, and the recipient of a recent text-revision (DSM V-TR). Unsurprisingly, this textbook is based entirely in the pathology paradigm, with all bodyminds described in its pages as “disorders”.

The use of the word “disorder” is important. This word places a level of responsibility on the individual to return to a more “ordered” state, dictated by cultural norms. This has historically been achieved through the use of psychoactive drugs, which are often prescribed before the use of talking therapies.

Psychiatry has a place in the world, but currently relies too heavily on the use of medication, without understanding the context around individuals. This is why it is important for psychiatrists to take a more trauma-informed, neurodiversity-affirming approach. There is a balance to be found between the use of medication, and the introduction of talking therapies that encourage the individual to co-exist with the traits of their neurodivergence.

It is important to understand and work with people holistically to reduce their distress, as many of us are seeking support due to ongoing trauma.

We are living in a world that overwhelms our senses, ignores our social communication differences, and treats us as second class citizens. Autistic people are made to adapt to norms that are both uncomfortable and harmful, and this creates complex-trauma for an increasing number of us. Once we experience bullying, isolation, and neglect, our self-worth takes a nose-dive. Often we mask our Autistic differences for fear of ridicule, perpetuating the low self-esteem that arises from forced conformity and assimilation. This becomes a cycle of shame that encourages us to hide our true selves, in return for a semblance of dignity.

So where does neuroqueer theory fit into this?

Cultural expectations of mental health are based heavily in sanist ideas of “normal”, and define our understanding of “madness” as anything that departs from these expectations.

Taking a neuroqueer approach allows us to embrace our differences, whilst appreciating that many of us still need accommodations. This is why emerging talking therapies that teach co-existence (rather than interventions that aim to change us) are an important step forward.

Subverting the expectations of our societies predominant culture, we reclaim ourselves, and learn to co-exist with our “psychiatric” self. No longer are we “insane” by normative standards, but neurologically queer, and refusing to be ashamed of that.

David Gray-Hammond 3 Comments

Jun 8 2022

Coping with psychiatric medication when Autistic

For many of us, medication is a necessary part of life. For a huge portion of the Autistic population, that medication is prescribed by a psychiatrist.

Psychiatric medication can be a troublesome topic, psychiatry itself is a relatively young discipline, and can often be found to be neuronormative in nature. It relies on the idea that the human mind can become ill and require medicine to fix it, and yet no test can definitively prove the presence of this illness in the body. It seems logically absurd, and yet, mental health issues can cause immense suffering.

One of the most stressful parts of taking these kinds of medications is finding the right one. Each person brings a different neurology to the table, so when using psychiatric medications, which by their nature act on the brain, it is important to remember that there is no “one size fits all” approach. Each person will have a different experience with medication, and this issue is compounded when you consider the Autistic population, for whom little to know research is done on the efficacy and safety of medications.

This moves us neatly onto my next point, which is side effects. Autistic people often experience rare or paradoxical reactions to medications in my experience. A recent medication change for me actually turned the skin on my hands blue! This is why I always ask my psychiatrist to take the harm reduction approach of start low, go slow. In other words, start with the lowest reasonable dose, and very slowly titrate the dose up. I find that for me, this has helped me avoid many of the less tolerable side effects, and better tolerate the ones that I do get.

An interesting point raised by twitter user @lilririah is access to food. Many of these medications rely on the idea that people can eat regular, healthy meals. Something that prescribers should consider is that the world over is experiencing a huge rise in the cost of living which is having a huge impact on the disabled community at large. Telling someone they have to eat when they take their medicine can essentially be the same as telling people that they can not take the medicine. When the world is trying to decide between heating or eating, a life or death decision over important medications is not going to help their anxiety.

Once you have overcome all of this, there is the issue of maintaining the treatment. Medication comes with a lot of stigma that many of us internalise, and some people simply do not want the medication in the first place. While personal choice is important, and should come from an informed position, prescribers need to do more to help people maintain a healthy relationship with their medication. When you consider the Autistic and ADHD bodymind, it is easy to see how remembering to take a set dose at the same time every day could become problematic.

Assuming all of this isn’t an issue, there is one more problem I want to discuss. Sometimes medication just stops working. Sometimes we can be stable for years, and out of the blue, we fall apart. It is the unfortunate truth of psychiatric medication. This is why we have to be willing to go over this battle time and time again to stay balanced. I personally struggle with this part. I often wish for a magic pill that would make my psychosis go away forever, unfortunately, that does not exist. Besides, mental health is part of who we are, good or bad, it plays a role in our experience of the world.

Whether your mental health is in a good or bad place, we all have something to give to the world, we are all important in our own way. It’s easy to lose sight of that when you have grown up Autistic, constantly being invalidated and told that everything about you is wrong. I want to assure you that the world is better for having you in it, and the battle is worth it.

Stay strong.

David Gray-Hammond 1 Comments

May 21 2021

Autistically medicated: the journey to find what works

My name is David, and I have to take a ton of medication to stay healthy.

It’s taken years to find the balance, and recently, one of the main medications has had to be changed.

Currently I am taking aripiprazole, paliperidone, mirtazapine, trazodone, promethazine and propranolol for my mental health (although the paliperidone will soon be discontinued, and the aripiprazole dose increased).

I also take procyclidine and rosuvastatin for the side effects of my medications.

I’m autistic and have complex mental health conditions. I’m stable, but it’s taken a long journey through various medications and talking therapies to get here. My autistic brain is sensitive to changes, so I have endured a lot of side effects.

Why did I endure it?

I wanted to get better.

I realised that if I wanted to feel better and be better, I had to listen to what the experts were telling me. There has been a lot of trial and error, but I am now in a place where, even though difficult things are still happening due to outside forces, I am happy.

I have walked away from people who shame me for taking meds. I don’t need them in my life. For some of us, medication is a prerequisite of life. Finding that balance however, can be a nightmare.

My autistic brain doesn’t react typically to anything, and there is little to no research on many of these medications in autistic people. For this reason, it’s taken me over a decade to get to where I am.

My psychiatrist deserves a bloody Nobel prize. He has worked in the dark to make me well again. What we have achieved together is nothing short of a miracle.

My advice for anyone struggling with mental health is to work with your doctor. Use their expertise. Discuss how it makes you feel. It’s tricky, but you have to give a certain level of trust.

Medication is a lifeline that everyone should have access to, and I will never allow people to be shamed for it on my platforms.

We need to work together to destroy the stigma surrounding medication.