We Used to Moralise Over Otherness. Now We Pathologise it

'A' is for Autism (and Ambivalence). An exclusive extract from Some Of Our Parts

---

My book, Some of Our Parts: Why We Are More Than the Labels We Live By is out now! If you’d like to order the hardback, audio or Kindle editions, they’re linked below.

---

---

It’s tempting, as the therapist describes what she imagines to be my experience, to adopt her account of my internal world. Her story of my mechanics. Because I’ve felt the rusty grind of the cogs juddering, clutching and catching where I imagine things could potentially roll smoothly, every waking moment of my life. A sense that perhaps I’m missing something important here in almost every interaction with other people.

To demur now, to absorb this new story, would be so soothing. Moonlight on still water. A cup of warm milk clutched in a child’s chubby little starfish hands. It would feel like surrendering to something bigger and give me that lens through which to understand myself and the world. A sort of meaning, and, with Nietzsche’s God dead as skinny jeans, don’t we all need a spot of that? So why not? Well . . . because there’s more to an individual than any single identity label, and this one is distinctly pinching under the arms.

‘People like us can have a hard time working in an office environment,’ the therapist says as we talk about my job. That phrase ‘people like us’ bothers me for some reason. It evokes that feeling of walking quickly past an open door in a loose jacket and being yanked backwards with agonising self-consciousness when the fabric gets caught in the handle. Embarrassment. A tiny flicker of self-directed rage. A longing to be anywhere else.

Perhaps I’m uncomfortable because it’s not yet clear to me that we have anything meaningfully in common and her presumption registers as a lack of intellectual curiosity.

That isn’t what she means, though. My new therapist means that we are both diagnosed autistic, and presumably she is acting on the belief that because of this, we can presume to share some further, deep commonality of experience. Mutual challenges, perhaps, in navigating what she describes as a ‘neurotypical world’? A common neurology, maybe? But doesn’t everyone, in some respect or other, move through the world as though their shirt has shrunk in the wash?

Though the diagnostic test for autism is conducted by a clinical psychologist and is descriptive – a question-and-answer affair based on the experience of the person being tested and, when possible, the close family members or friends who have known them since childhood – nobody scanned my brain. The literature suggests that if someone did undergo the faff and expense of conducting such a test using the infrastructure of our already terminally overwhelmed healthcare system, they would find evidence that my functional brain organisation differs from that of what is called a ‘neurotypical’ person. Or at least that, according to recent research published in The British Journal of Psychiatry, there is ‘robust evidence that the brains of females and males with ASD are functionally organized differently’. So the brain systems involved in motor, language and visuospatial attention differ in women with ASD (autism spectrum disorder) as opposed to men. And both differ from those of men and women who can be described as neurotypical.

By this definition, autism is evidenced in the differing brain activity of those who are diagnosed with it, but this is not the means by which people are actually diagnosed. After the diagnosis I read everything I could get my hands on. A smartarse would describe this sort of deep-diving as typically autistic, but they can shove off. If a psychologist gives you a socially laden medicalised label claiming your brain function differs from the ‘norm’ and tells you that it is a major factor in the story of how you came to be where you are and the one you will now construct of where you are going, a bit of reading seems downright sensible. As does asking questions before you absorb an external narrative of who and what you are.

Autism looks very different in women and men, while diagnosis rates are rising in adults and among women in particular. The umbrella of diagnostic criteria widens and as a result, more diverse sorts of people stand together beneath it. The same goes for ADHD, which the new therapist now says breezily she’s confident I also have. After a pause in which I say nothing, she adds, ‘But I can’t assess that formally myself. I can connect you with the right resources, though, if you like?’ I’m baffled by the certainty with which she speaks, how easily and casually she labels me – a stranger – after what is now a twenty-something minute conversation and some online tests she asked me to do before our appointment. This, surely, is not a serious interaction.

---

---

When you think of autism, you probably think of a male person – perhaps that nonverbal child wearing noise-cancelling headphones in the bread aisle who won’t make eye contact when you have to awkwardly reach past him for the crumpets, or a socially incompetent, taciturn man in creased trousers who is spectacularly unsuccessful on the dating scene. He collects Magic: The Gathering cards and has an unnerving amount of ready knowledge about trains (he’s only taciturn until you ask him about trains). Or, if you’re particularly badly informed, and a lot of us are, you’ll think of a Rain Man type.

By this tired assumption, there are broadly two common autistic tropes: weird, kooky, socially inappropriate genius with little inclination to function ‘normally’; and weird, unsettling, socially incapable recluse with little capacity to function ‘normally’. Both are men or boys. When there’s talk of autism, you probably won’t think of a woman or girl at all, and if you do, you won’t think of a writer who must network with gregarious, socially adept people for work and is extremely particular about who she goes to for highlights.

Autism is categorised as a neurodevelopmental disorder. But as the umbrella broadens, I wonder whether that is an accurate characterisation, especially given the descriptive nature of the diagnostic testing and the fact that another Irish clinic I enquired with informed me that ‘nine out of ten’ adults who paid them for an autism assessment left with an autism diagnosis. Is this what I, and other relatively high functioning people who nonetheless carry a belief from childhood that they never quite comfortably fit and sometimes don’t want to, have? Is this what we are? If a significant and growing proportion of the population broadly falls under this umbrella or possesses traits that do, who is to say that they are abnormal or that something in their neurological development, rather than making some of them a bit aloof and very good at tabletop role-playing games, has gone wrong? This might be a problem with our collective understanding and the story we tell about neurodiversity rather than neurodiverse people (whatever they are) in themselves.

Daniel Kahneman’s 2011 book, Thinking, Fast and Slow brought awareness of intuitive and deliberative thinking to people outside the field of psychology. Intuitive thinking is the automatic, non-conscious ‘implicit processing that is independent of working memory and cognitive ability’, according to Mark Brosnan and Chris Ashwin in the journal Autism, while deliberative processing ‘involves slower, effortful, sequential, conscious, explicit processing and is heavily dependent on working memory and related to individual differences in cognitive ability’. Brosnan and Ashwin argue that this difference is a key one in people with autism and autistic traits. These people, their research suggests, engage ‘in (slow) deliberative processing, rather than reflecting normative biases associated with (fast) intuitive processing’.

Brosnan and Ashwin put forward the theory that autistic people tend to use deliberative thinking in situations where the majority of people will use intuitive thinking – the sort of implicit, reactive thought that allows us to make quick decisions but which can involve cutting logical corners. As Kahneman puts it, ‘This is the essence of intuitive heuristics: when faced with a difficult question, we often answer an easier one instead, usually without noticing the substitution.’ Well, many autistic people apparently notice the substitution. No matter who you are, you will have encountered a disagreement or conversation in which intuitive thinking clashes with deliberative.

Autistic people, it’s suggested, tend to utilise the slower, more deliberate form of thinking that most people save for complex problems, a tricky algorithm, or comprehending or constructing a philosophical argument. Cognitively, as it were, autistic people check their work as they go rather than favouring intuitive reasoning, which is something most brains engage in automatically. It’s energy- and time-efficient but makes us more likely to commit errors in reasoning and take cognitive shortcuts.

There are disadvantages to thinking deliberatively most or all of the time too, and plenty of them. However, there are also real benefits. The autistic brain is an innovative problem-solver, and it doesn’t follow that people with autism cannot think intuitively. Research suggests that many can or can be encouraged to (in the case of children with autism). They simply appear to prefer not to in some cases, or to find a more involved and sometimes labour-intensive process of thought more conducive to reaching the desired level of understanding. And yet, so much is not understood in relation to autistic people and how they interact with the world. Meanwhile, this dearth of knowledge coincides with rising rates of diagnosis. According to Ashwin and Bronson:

‘Many questions remain concerning the underlying mechanisms related to the reasoning differences in autism. One possibility is that the mechanisms for intuitive processing are impaired in autism, resulting in deliberation being the default and dominant form of reasoning. If the intuitive mechanisms are impaired, this would lead to pervasive deficits in any processing requiring rapid and unconscious processing across different domains and functioning, such that even if an autistic individual tried to utilise intuitive processing, they would have difficulties in doing so. An alternative possibility is that the mechanisms for intuitive processing are intact, but that autistic individuals do not typically or spontaneously utilise this specific style of reasoning, or that the information processing style in autism does not involve or require intuitive processing.’

This is the key question I carry as a person with an autism diagnosis, and it is a question to which everyone from the layperson on the street to the scoffing therapist seems to have presupposed an answer. Accommodating difference, one could argue, renders irrelevant the fact of the matter of whether my brain is incapable (or less capable) of intuitive reasoning or just better at, or prefers, deliberative reasoning. There is a crucial difference between this is the only way I can be and this is the way I am. The former is – practically, socially and in some cases officially – considered a disability. The latter is a preference or a strength.

 And, of course, we set aside in all this the slightly terrifying implication that neurotypical people appear to be so very deeply awful, on average, at deliberative reasoning – at identifying and generating conclusions that have any logical link to their premises. Which is, I suppose, why I know so many university-educated women who keep crystals in their designer handbags in the hope of being calmer or luckier or whatever. Why so many people’s disagreements with their partner over laundry or groceries cede into point scoring exercises over something unrelated that happened at their work Christmas party nine years ago. Why most people, in a debate over one point, will routinely move the goalposts until they’re actually discussing another or refuse to change their mind despite the evidence not going their way. It may explain why conversations under Facebook posts look the way they do and possibly also why the mullet is fashionable again. (That last one might be a stretch but I think there is significant evidence that we haven’t thought deliberatively about the mullet.)

As I sit in the therapy session, I think about that. Not the mullet thing, though someone should fund studies into whatever that’s about as a matter of the public good. I think about the roots of liberalism, and how the therapeutic tradition has emerged from rationalism. The idea that therapy should not just affirm a person’s emotional state but is meant to equip them to see the world through a rational perspective. That radical subjectivity is ultimately disempowering. I think about systems and individuals. Labels and generalisations. Horses and people with weird, velvety voices. Is versus ought. Prince Harry and dancing sunflowers and a small girl who can’t have friends over in case her dad turns up drunk and tries to break the door down again, and what her chances of being socially adept ever really were.

I think of the labels I’ve been handed and instructed to use to describe myself since I was old enough to voice them, and the fact that no matter what I’ve said about my feelings and experiences in the course of this particular session, this therapist has more or less affirmed them even when they directly contradict concrete statements she has just made as though they are objectively true. All cocoon, no push. All emotion, no rationality. Apart from the scoff, which I respect, but a scoff is unconstructive. There’s the issue. I don’t need to be swaddled, accepted, told what I am and encouraged to celebrate it. I need help to see how I might help myself. Not with ‘self-care’ and multivitamins that turn my pee livid yellow and taking note of who ‘shows up’ for me and constantly repeating that staring weirdly at people and making them uncomfortable just because I can or because I feel like it is great, actually. I need to see myself beyond this one label or any other, because the interior furniture of my mind is what it has always been. I don’t need affirmation. Absolution. I need more discomfort. More actualisation.

‘Same time again next week?’ the therapist asks eventually. The session has ended and she’s looking at me curiously, her pen held aloft like the sword of Damocles. I inhale sharply, considering my answer.