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Marginalised groups should not be responsible for ending stigma

When we think of stigma, we often think of awareness campaigns and personal disclosure of our struggles. On the face of it, these appear to be helpful in stigma reduction. However, as with all things like this, it is not nearly as simple as that. Autism has been the focus of many stigma reduction campaigns, but people are rarely Autistic as a standalone identity, and there are (more often than not) multiple marginalities within Autistic lives.

Autism is not the only sources of stigma in neurodivergent lives

When considering my own experience, one identity of mine that is particularly relevant to this conversation is Schizophrenia. Psychotic disorders have been positioned as the most “dangerous” of mental health concerns. People assume a poor prognosis with a high potential for violence.

Schizophrenia, in my opinion, is a good measure of saneism and ableism in society. Despite Schizophrenic people only having a modestly increased risk of violence, the media fails to report responsibly. Nuances such as the socioeconomic factors of violence in this population are rarely accounted for. In the same way, much of the stigma surrounding neurodivergence and other marginalised identities is driven by poor understanding of colonial oppression and sloppy reporting by journalists. When considering the sources of stigma in a person’s life, we have to consider intersectionality and minority stress.

Individualism and the stigma surrounding neurodivergence

When considering the role of individualism in the perpetuation of stigma surrounding neurodivergence, we have to first understand the role of psychiatry. The field of psychiatric medicine centres most neurodivergence ad “mental illness”. It places the issue within the body of an individual and requires them to “recover”. This individualisation is responsible not just for the coercion that occurs within the psychiatric profession. It is also responsible for the use of quack cures such as MMS and chelation “therapy” that do a great deal of harm.

The ableism and sanism that surround neurodivergence means that we are often coerced into harmful “treatment” or abused by those closest to us. We are dehumanised by stigma and forced to endure a world that views our existence as an abberation rather than a natural part of human diversity.

Why is it wrong to expect victims of stigma to tackle their own stigma?

When we consider marginalised groups, we have to consider that, for most of us, dismantling stigma is usually an expectation of free labour. Far too often, we are expected to expose the most vulnerable parts of ourselves to a world that, in most cases, will respond with vitriol. Raising awareness through vulnerability can be life threatening for many of us.

We also have to note the effect of privilege in stigma reduction efforts. White people such as myself are better able to expose the less acce0ted parts of themselves. If a BIPOC Autistic or Schizophrenic (considering my own neurodivergence) person were to lay bare their most hidden parts, their life could be endangered. For me, the stigma I face is dangerous, but not nearly as life-threatening as that of my further marginalised neurokin.

Conclusion

Marginalised people are left to raise awareness in a world that does not want to listen. It should not be us doing the work to dismantle stigma. Instead, those perpetuating it should be practising enough introspection to realise the conditioning that our neoliberalism world has used to dehumanised people such as myself. The expectation that we will do the work is fundamentally flawed in a world that does not care enough to practice insight.

Until such a time that wider society is ready and willing to see its own role in our oppression and marginalisation, we will continue to be mistreated. It should not be our job to tackle structural oppression while also trying to survive it. That is what most of us are pouring our energy into; survival.

Five things that help me when I’m experiencing Autistic burnout

Autistic burnout can present itself in many different ways, not just the depressive state that observational models have taught us to expect. Despite assertions to the contrary, sometimes burnout is more than a need to withdraw.

Conceptualising Autistic Burnout

One might describe burnout as

“Having All of Your Internal Resources Exhausted Beyond Measure and Being Left with No Clean-Up Crew”

Raymaker et al (2020)

Of course, due to the infinite possible interactions with one’s Self and environment, there are infinite ways that Autistic burnout can present. Raymaker et al (2020) go on to conceptualise the mechanics of burnout.

Figure taken from Raymaker et al (2020)

Using this, I can begin to explain the things that help me when I am experiencing Autistic burnout.

What helps me with Autistic burnout?

  • Sensory Input
    • A good sensory diet is helpful to myself. I use dark rooms with colourful lighting and star projectors. I also use an oil diffuser. Besides the typically expected sensory input, I might mention that physical activity that engages my proprioceptive sense can also help with waning interoceptive accuracy.
  • Nesting
    • I have discussed in a previous article my AuDHD habit of nesting. While having a sensory safe space is a part of this, what is also important is that this space is safe from intrusion by the outside world. Sometimes, I need space to think and process whatever is going on in my mind in order to function in a world that can be quite hostile.
  • Boundaries
    • This one follows on quite nicely. We have to not only understand our strengths and struggles, but also enforce boundaries that compliment them. Learning to say no can feel quite villainous at first, but only when we make space for ourselves can we properly energy account. It is okay to make space for yourself.
  • Trust yourself
    • As Autistic people, we are constantly invalidated and gaslit about our experience. It is vital that we learn to trust ourselves on matter that pertain to ourselves. Nothing will drain you quicker than constant self-management. It is also impossible to enforce boundaries when we believe they are uneccessary or an overreaction.
  • Slow and Planned transitions
    • Autistic people experience cognitive trauma when they are forced to rapidly disengage and re-engage with different tasks and demands (more on this here and here). It is important that we slow down our transitions during burnout as in my experience we are more prone to that cognitive trauma during these time.

Final thoughts

As with everything, different things will help different people. The most important thing is that we treat ourselves with the same kindness that we would another. Humans of any neurocognitive style were designed for the cognitive equivalent cruising speed, it is not sustainable to move at maximum velocity without a break.

More than anything, you need to know that Autistic burnout is a logical consequence of our intensely hostile world. You are not worth less for struggling, and you are not alone.

AuSocial: Towards an understanding of Autistic social culture

In my book The New Normal: Autistic musings on the threat of a broken society I have a chapter about Autistic social nature. Autistic people have widely been represented as being asocial, which is patently absurd. Autistic people have a rich and diverse social culture that has been ignored for a long time.

“One of the prevailing misconceptions is that as Autistic people we are overtly asocial beings. It is taken as common knowledge that we are the friendless weirdos who don’t understand social cues but can recite every train we’ve ever seen.”

Quote from The New Normal

A brief look at the research

Upon perusing the existing literature surrounding Autistic sociality, there is limited research into the social nature of our community. I might first start by situating us within the remit of The Double Empathy problem.

“It is also vital to remember how the double empathy problem as initially conceived was heavily influenced by sociological theory and that such social interactions happen within a continually negotiated and mutually constructed context”

Milton et al (2022)

The double empathy problem within the context of Autistic communication essentially positions us as having a different way of communicating and relating to language rather than a deficit. This difference arises from cultural differences and the relationships we have with the world power structures.

Due to structural oppression, our style of communication is often centred as an issue to be fixed.

“The notion that autistic people lack sociality is problematised, with the suggestion that autistic people are not well described by notions such as the ‘social brain’, or as possessing ‘zero degrees of cognitive empathy’. I then argue, however, that there is a qualitative difference in autistic sociality, and question to what extent such differences are of a biological or cultural nature, and to what extent interactional expertise can be gained by both parties in interactions between autistic and non-autistic people.”

Milton (2014)

So we now have a position whereby Autistic people do not lack sociality but instead experience a different form of sociality. This is what I refer to as AuSocialility or being AuSocial.

Despite indications to the contrary, the emphasis is often directed towards teaching Autistic people to learn non-Autistic social culture, despite this being uncomfortable or even harmful for us. Some research has argued that this should be the other way round.

“We recommend teaching not autistic people but rather non-autistic individuals about autistic sociality, in order to lower the burden on autistic interlocutors in cross-neurotype interactions and socialization”

Keates, Waldock & Dewar (2022)

What does being AuSocial mean?

Autistic sociality or the AuSocial presence of Autistic people can be conceptualised by the growing cultural practices of Autistic people. We have our own customs, use of language, moral values, and even recognise what would be the cultural equivalent of public holidays in the existence of things such as Autistic pride day and the reclamation of Autistic acceptance month.

Such cultural practices as body-doubling (a firm favourite for AuDHD people) where we use video platforms such as zoom to be present and parallel with others while working on separate tasks are a key feature of Autistic professional culture and sociality. One might also look towards our differences in the way we understand and process language as the formation of a dialect.

A key feature of AuSociality is the cultural practice of moral defence of minority groups. While the Autistic community is far from devoid of bigotry, there is a general atmosphere of protectiveness towards the multiply marginalised that isn’t experienced within the non-Autistic cultural space.

In summary, AuSocial culture is a complex and highly developed set of communication, language, and socialisation skills that can only be witnessed between Autistic people. Rather than being deficient in our social exchanges, we often achieve a great deal and naturally fight to try and improve the world for our neurokin.

Conclusion

Autistic people, like most humans, are inherently social beings. Despite testimony to the contrary (usually by non-Autistic professionals and researchers) we have developed our own AuSocial culture that stands diametrically opposed to those who would label us as asocial. Such cultural practices as those within the Autistic community serve to diminish the burden of existing with in a systemically violent society and serve an important protective function for our wellbeing.

I invite people to add their own examples of AuSocial culture .

How CAMHS tier system obstructs Autistic young people from accessing support

Child and Adolescent Mental Health Services (CAMHS) have, for a long time, failed to provide support to Autistic children and young people. When it comes to autism, there is perhaps no service more infamous for it’s failures than CAMHS. Despite this, every year more and more Autistic people try in vain to access the support they are legally entitled to, often having their situation made worse in the process.

The CAMHS Tier System

CAMHS is modelled on a system of tiers, with tier 1 being at the bottom of a pyramid that grows to tier 4.

healthyyoungmindsinherts.org.ukhttps://healthyyoungmindsinherts.org.uk

Tier 1 is where most people enter the system. They approach GP’s (for example) because their mental health is declining. This is where one of the key issues can first be witnessed. Diagnostic overshadowing.

What is diagnostic overshadowing?

Diagnostic overshadowing refers to a type of medical failure where a healthcare professional attributes a physical of mental health concern to a patients pre-existing diagnosis (in this case, autism). The Royal College of Nursing goes into more depth about it here.

Within this context, a GP may refuse to escalate a young person’s position within the CAMHS tier model because they believe, for example, that their anxiety is “a part of their autism”. Diagnostic overshadowing remains a significant issue not only because it obstructs pathways into support but also because it obscures the ability of researchers to investigate co-occuring mental health issues in Autistic people.

Tier 2

Tier 2 involves access to early help services, but for a lot of Autistic people, this looks like safeguarding concerns. Rather than provide mental health support, we enter into a world of parent/carer blame and systemic hostility. It is because of these institutional practices of moving the goal posts that so many Autistic people skip right over tier 3 and enter into tier 4 care.

Inpatient Treatment

I title this section with more than a hint of irony. As I mentioned in a previous article, 93% of under 18’s under inpatient treatment are Autistic, despite the Mental Health Act code of practice stating how inappropriate this particular setting is. The irony comes from referring to it as treatment. For many Autistic people, being an inpatient can mean spending years locked away from society for no better reason than the lack of appropriate resources in the community. Let us not forget the horrific abuses that Autistic people have experienced in inpatient settings.

How do we fix this?

Meeting a young person’s needs at tiers 1 and 2 or having more specialised resources available at tier 3 could help to mitigate these failures. Having appropriate knowledge within tier 1 services as well as less emphasis on safeguarding in tier 2 could have a significant positive impact on the wellbeing of our Autistic young people.

Tier 3, in particular, could benefit from services that specialise in Autistic presentations of mental health. I would argue that tier 3 should not just involve child psychiatry but also implement a roll out of peer mentoring programmes that employ knowledgeable Autistic people to work with young people around understanding their strengths and struggles, and subsequent boundaries. Until these things are done, CAMHS will remain unfit for purpose.

Click here to sign the petition regarding CAMHS refusal to see Autistic young people.

“How do I help my Autistic child?”

I have recently found myself being asked quite often about how parents can help their Autistic children. It sounds like a simple question, but as with most things in parenting, there is no simple, one-size-fits-all approach to parenting. I can, however, tell you what helps me support your Autistic child in my day-to-day professional life.

Monotropism

This has become the theoretical lens through which most of my work functions. Part of my day job is working to support Autistic young people, many of whom are quite traumatised by the wider world, in particular the mainstream education setting. So, what’s the deal with monotropism?

Monotropism as a theory works to explain a great deal of Autistic experience. Through understanding monotropism, I have come to understand a great deal. One of the main ways this influences my work is that it directs me to use gradual transitions between tasks and to know that abruptly changing activities is cognitively traumatic.

For people who want to know more about monotropism, I highly recommend reading the following articles.

If you engage better with video content, try this one

Monotropism 101

The Double Empathy Problem

Autistic children experience a great deal of communication invalidation, and this contributes to the clustered injustice that befalls so many Autistic people. Essentially, Autistic people are told that their communication style is a deficit, a flaw to be erased. We have to recognise and validate the communication of Autistic children if we want to be a part of their world.

In terms of reading, I really recommend A mismatch of salience By Damian Milton. For our video lovers, I have this offering-

The weaponisation of Autistic communication

Burnout and energy accounting

This is a big one. Autistic people living beyond the limits of their cognitive resources for extended periods of time can and will experience Autistic burnout. Burnout can cause a great deal of complications for the Autistic child. We have to work with them to make sure they have the resources they need to cope with the demands in their life (and yes, Autistic children have a lot of demands in their life).

Essential reading for this topic-

And of course I have a video for you-

Atypical Burnout

Interoception

Believe it or not, there are not five senses. There are eight. They are visual, tactile, gustatory, olfactory, audio, vestibular, proprioception, and interoception. While having a good knowledge of Autistic experiences of all of these will help you, interoception is a big one. Interoception is the sense that tells you what is happening in your body. Whether you need the toilet, are hungry, or feeling anxiety, all of this is informed by your interoceptive sense.

When working with an Autistic child, I have to remember that sensory differences mean that they may be alexithymic, preventing them from answering questions about their emotional state.

Reading around this topic that is important follows-

Masking

Masking is perhaps one of the most commonly misunderstood aspects of Autistic experience. It’s best understood by considering it a projection of acceptability; we show people what we think they want to see. This is why your Autistic child might be fine at school and then completely meltdown at home. We have to be aware that Autistic children often don’t feel safe fully expressing themselves.

Anyone wanting to know more about masking should read the following-

And here is a video!

Autistic Masking in my experience

These are all essential foundations that come together to create the competency that people need to start to start understanding the individual experiences of Autistic people. Remember, you won’t get it right every time. You won’t learn everything overnight. What matters is that you spend time in and around Autistic community and culture. Nothing will teach you better how to support your Autistic child better than Autistic adults.

Katie Munday and I are currently co-authoring a blog series together that looks at the experience of being an Autsitic parent. Find it here.

If you want to learn more about the challenges that Autistic people and their families face, check out the Creating Autistic Suffering series I co-author with Tanya Adkin. Find it here.

Don’t forget to check out my books here!

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