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Autism, the mental health professions, gaslighting, and trauma

[ Originally posted in a private space, 2022-09-07; lightly edited, links added.]

i recently mentioned that the mental health professions have gaslit and traumatised us autistics. Someone quite reasonably asked “In what way?” My reply got long, so i've decided to instead put it up as a post. tl;dr: If you're at all concerned about the mental health professions' historical and current attitudes towards us queers, you should definitely be concerned about their historical and current attitudes towards us autistics.

There are several interconnected things involved.

Diagnostic failures

Firstly, there are the ongoing failures to even acknowledge the _possibility_ that we're autistic, together with failures to recognise that we _are_ autistic. This has been (and still is) often due to failures to explore / learn about what autism can (and does) look like in people other than cis boys, with the result that it's not recognised/diagnosed in girls, and only ends up getting recognised/diagnosed in women after many years (like me at the age of 47).

Psychosomatic and sensory differences

The preceding might be less of an issue if it weren't for the fact that being autistic means we usually perceive and relate to the world in quite different ways from non-autistics. One instance of this is that our systems usually take in - and thus have to process - a significantly larger amount of sensory input, such that it's much easier for us to get overwhelmed in contexts that are ‘no big deal’ to most people. However, this is typically not acknowledged or accepted. Instead, we're told what is and isn't ‘really’ overwhelming, as though everyone should have the same sensory boundaries, or that there is an ‘objective’ level at which it's ‘appropriate’ to be overwhelmed, and that we should have ‘distress tolerance’ for anything prior to that level. Imagine having a headache and being exhausted, and being told that if you can't handle being at a dance party, that you're being oversensitive and need to stay in that situation and learn distress tolerance. You might eventually lose your shit, at which point you'll be told you're ‘overreacting’ and that you need to learn ‘emotional regulation’. This is one way in which we get gaslit, and traumatised. (Cf. the recent short book on this issue, "Sensory Trauma: Autism, Sensory Difference And The Daily Experience Of Fear"[a].)

Prejudice and discrimination

More generally, since our ways of relating to the world are regarded as inherent defects, rather simply human diversity, we're consistently not listened to, understood, or treated with respect by the world at large. Both this and the preceding point negatively impacts our mental health significantly - in the same way queer and tgd people are analogously affected by analogous treatment. But it _also_ means that mental health tools that might be appropriate for neurotypical people not only might not work, but be actively harmful/traumatising to autistic people. Imagine someone being told to “walk off” a broken leg because there's no recognition that their leg is not in the usual state legs are found in.

Being blamed for tool failures

All the preceding might be less of an issue were we not _blamed_ (by both health professionals and the general public) for neurotypical mental health tools not necessarily working for us regardless of how much we actively try. It can be implied (or stated explicitly!) that if the tools aren't working, it must be because we're just “resistant”, or “not really trying” or that we're “not putting in the effort”. So not only is our mental health not helped, and the original issues not addressed; it can actually have been made _worse_, as we end up feeling that we're at fault, that we're not good enough, that we're failures, that we're shit. This is another way in which we get gaslit, and again traumatised.

Damaging ‘treatments’

Even when it's recognised that we're autistic, and that autism-appropriate mental health approaches are thus required, the _actual_ approaches actively supported and applied can be, and are, damaging. The ‘gold standard’ for autism ‘treatment’ is still ABA, Applied Behaviour Analysis[b], despite the fact that many autistic adults who have gone through it, either as children or as an adult, have suffered as a result. ABA is basically ‘conversion therapy’, involving punishing someone unless and until they adopt certain behaviours - ‘masking’ - again because it's presumed we're inherently ‘defective’ rather than simply ‘different’. (For example, it's presumed that we have communication 'deficit' because our communication style isn't characteristic of neurotypical people, like how being nonmonogamous is presumed to be a ‘deficit’.) In fact, one of the leading lights of ABA, Ole Ivar Lovaas[c], has also done work on applying ABA to gender-variant children. And in the US, the Judge Rotenberg Center in Massachusetts has been using electroshock treatment on children and adults as part of ABA 'treatment' for the past 30 years[d]. This is yet another way in which the mental health professions have traumatised us.

Conclusion

Basically: think about how queerphobic perspectives in the mental health professions, and 'conversion therapies', have affected queer people over the years. And now think about how the analogous things are still considered valid when it comes to autism.

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🏷 neurodiversity,psychology

Glossary

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[a] Amazon: “Sensory Trauma: Autism, Sensory Difference And The Daily Experience Of Fear”

[b] Wikipedia: ‘Applied Behaviour Analysis’

[c] Wikipedia: ‘Ole Ivar Lovaas’

[d] “Ban Electroshock Therapy”