The ongoing Aspergers Syndrome (AS) and depression series been staggered out here over the course of two years, so I wanted to provide an overview of the entire discussion in one location. This will include a brief synopsis of each segment, as well as a links to each post.
On an almost weekly basis I receive questions from family members who describe having a loved one on the autism spectrum who is struggling with depression. In most of these situations, the autistic individual feels bitter about their neurological differences…they don’t feel like there is a place for them in this world…and they are deeply embedded in a negative, self-loathing mindset. Every age range is represented in these stories, from very young children to the elderly.
This series developed in response to these questions from readers and my own experiences struggling with depression and social isolation. But it’s important to note that I can only offer personal impressions about what happened and how I was able to find my way to a better place. I’m not a mental health professional and nothing here can function as a replacement for therapeutic counsel. For those needing help, the intention with these posts is simply to offer a starting place for discussions about these painful and very complicated issues.
The Interplay Between Aspergers and Depression
The first thing I would emphasize is that certain autism spectrum traits and depressive traits can look strikingly similar to one another. This has the potential to create a dynamic where depression actually hides behind autistic features, thus allowing it to go undetected.
In many cases, Aspergers can be characterized by black and white, absolute thinking (“The world should work this way, and that way, always”). And depression is effective at creating a sense of hopelessness precisely because it also utilizes rigid, black and white categories (“My life is pointless. The world is meaningless. Nothing will ever change,” and so on). As a result, someone on the spectrum can transition from their normal thought patterns into a depressive state without realizing it.
That’s what happened to me: at a point in my life when I had been depressed and socially isolated for many years and was beginning to consider suicide, I did not feel depressed. I felt analytical. I felt “accurate”, like I was seeing things far more clearly than other people. I think most depressives feel this way, on or off the spectrum, but I missed the transition into depression precisely because I was so used to that black and white style of thinking.
Please visit the full post for additional traits that can mimic one another. (And I’ve heard from many autistics who say the reverse was true in their case: they were diagnosed with or perceived as having depression, and it prevented others from identifying spectrum traits that were also present.)
Stereotypes relating to autism are another factor that can make it difficult to identify the onset of a depressive state.
Here’s what I mean by that: the way autistics behave when depressed? It can actually fit the way many people view autistics on a regular basis due to damaging, negative stereotypes. Examples: autistics are supposed to be shut down; they’re supposed to be “in their own world”, rigid, anhedonic, anti-social. These are outdated views that have no basis in reality…but with depression in effect, an autistic can appear to fit these stereotypes, which makes it very easy for people to look the other way. A serious mental illness can go unchecked because of the view “That’s just what autism looks like”.
Please know: this is not what autism looks like. Self-hate, chronic negativity, feeling like you don’t have a place in life, and so on: this is depression. We need to carefully distinguish autism spectrum traits from the co-morbid conditions that too often hide behind them.
Failing to separate the two: this is how people fall between the cracks; this is how we lose them. Parents frequently write in and describe the depression their autistic child is grappling with. They see how much their kid is hurting, but they also see that their situation is completely invisible to everyone else. In my view, this is because we’re failing to make proper distinctions. We’re assuming that those on the autism spectrum can’t be happy, that they’re supposed to be “in their own world”. The truth is that, once we identify co-morbids and find constructive treatment options for them, people on the spectrum can and do find a more fulfilling place in life.
The Inner Workings of Depression
Two posts in this series look specifically at the impact depression has on one’s thinking. For me, learning to manage depression first required learning to identify it. I mentioned earlier, I never really felt “depressed”, I always felt like I was simply being honest and accurate about my life. The negativity had tricked me into viewing distorted valuations as a reliable source of information.
It took a lot of discussion and work with a mental health professional to slowly piece together how exactly depression operated within my thoughts and statements. Doing this was just step one, but seeing the nuts and bolts of depression did help (over time) to remove some of its power.
– In this post, I first begin to discuss depression with a psychologist. These are just vague, initial thoughts, but it’s an example of how discussions about the inner workings of depression can be an important first step in gaining awareness of these issues.
“Depression is complex. It’s not a feeling. It’s not a sensation. It’s an entire reality…a sort of artificial world. And what this artificial world does, is…it slowly takes the place of the real world. When someone is depressed…the person doesn’t realize that they are now living in this false reality. It’s a reality that is dark and bleak and hopeless. Someone living there looks around at the world and they can see absolutely no reason to live, no possibility of change. It’s a world of absolutes: ‘Things are terrible; things will never change’. I find depression to be frightening because you can see someone living in this false world…and they’re right there in front of you, yet you can’t communicate with them. They are so locked into this reality, that they can’t really hear you or absorb your words.”
The pain and fatigue caused by a sensory aversion can definitely add more misery to a depressive state, which can in turn fuel the mechanisms of depressive thinking.
And the reverse is also true: depressive states can make it much harder to endure the discomfort caused by sensory aversions. If you’re starting from a place of depressive fatigue, the impact of sensory issues will be felt much sooner, more intensely and can lead to an even greater feeling of lethargy.
These are fairly obvious points, but people can often overlook the degree to which sensory issues impact all other areas of functioning.
Several posts here look at concepts that I personally found to be helpful. Again, I am not an expert, I can only hope that these ideas can be useful as a starting point for discussions.
If someone is angry about their diagnosis, or depressed about their “differences”, I recommend the following…please read the full post for more details with each of these:
– Avoid repeatedly pressuring someone to accept their spectrum diagnosis. If they are expressing a lot of negativity about it, pressure can make someone less likely to accept the diagnosis, not more likely.
– If you find that offering upbeat descriptions triggers angry reactions, it can be helpful to avoid words/phrases that might be perceived as “positive” and replace them with alternate phrases that are more generic and neutral (at least early on).
– Listen, not only to how a person describes their own life, but to how they describe other people. If it sounds like they are idealizing others, that is going to be a major source of self-loathing. To the extent that you can, try to bring some clarity to these issues by countering with neutral, objective explanations for social behavior.
– Prioritize. If the diagnosis is a source of anger, but it’s lumped in with depression and other emotional difficulties…consider working through some of the other issues first. Diagnosis acceptance may very well be easier if it is preceded by self-acceptance.
– Be patient; acceptance of diagnosis/differences may take some time. I know it’s deeply painful to see someone you love struggle with self hatred, but (to the appropriate degree) it’s important to give them the freedom and emotional space to just be so that they can sort through these shifting internal landscapes.
Additional posts looking at constructive ways forward:
– Ten things I wish I’d been told when I was a child. I think, had I been able to grasp these concepts at an earlier age, I would have been able to avoid the worst of the depression. Easier said than done, of course.
– A discussion on building self-acceptance for spectrum teens. A parent wrote in with a question on this topic; fellow autistic bloggers weighed in with their thoughts, so this discussion looks at self-acceptance from a variety of perspectives.
– Volunteering on the autism spectrum. Personally, I found volunteer work to be a nice counter to depression. Now, this required that I be doing well enough to both focus on the work and make others the priority- volunteering is 100% about service to others. I only recommend this for those who may be exiting a depressive state and are looking for activities that can be a beneficial part of that transition. For me, volunteering was a great way to get in a different head space and find a more balanced perspective about myself and others.
The following are day-in-the-life posts from this series about the ebb and flow of depression, its impact on social experiences.
First, challenges feeling connected with family members:
– I try to navigate the holidays, which are reliably the hardest time of the year in terms of family gatherings.
Posts about feeling lost in social environments:
Autistic traits can and do vary from person to person; and depression can manifest in different ways, depending on the person. In short: I can’t speak for others. Learning to differentiate depression and ASD will require knowing the individual, and understanding their unique personality and needs.
And as mentioned, nothing in these posts can take the place of professional help. I was able to get to a better place with depression precisely because I found a mental health professional who had experience in these areas. (With spectrum issues, it is highly recommended to find a clinician with a background in autism, if you do choose to seek help.)
Terminology– The diagnosis Aspergers Syndrome was discontinued in the most recent edition of the DSM and merged into the broader category Autism Spectrum Disorder. I am using AS here for a few reasons. For one, most of these posts were written in response to questions asked specifically about Aspergers. In some cases, these individuals were diagnosed before the switch to Autism Spectrum Disorder occurred, so they continue to identify as AS. In other cases, the people sending in questions were from countries where Aspergers remains in place as a diagnosis. (In a few instances, readers were from countries with very few autism resources available and spectrum diagnoses of any kind are a rarity; these readers chose Aspergers as the term to use in our discussions).
Point being: I’m conflicted about the best terminology to use, but have decided to go with AS due to the nature of these discussions and the reasons people cite for visiting this page. (Even though I was diagnosed with Aspergers in 2005, I personally no longer self-describe with the label following the DSM changes.)
The search terms that bring people here provide additional information about the wording in these posts. For me, they are painful reminder about why we need to be having more discussions about the autism spectrum and depression.
These were the 10 most searched phrases that brought people to the blog last month. It’s like this every month: