This is the first part in a new series. Future posts will look at specific ways that Autism Spectrum Disorder, Aspergers and depression can intertwine, but I wanted to start things off with a more general discussion. (Click here for Part 2 or here for a post that collects and summarizes every article in this series.)
This is taken from a 2007 therapy session between myself and an autism specialist. I think her articulation of how depression operates is a nice starting off point for this series.
From June, 2007.
A session is in progress.
After years of social isolation, depression, I’ve begun to leave the house more and work on making connections with people. Therapy has been: making game plans, developing coping strategies, learning to decode body language, etc.
Today, I’m frustrated. I explain that going out more just means seeing other people who do not struggle with their social lives. It leaves me feeling angry, resentful.
I pull my hair, seethe. I tell the doctor that the odds of me making a friend or romantic partner is non-existent.
“Therapy is a waste of time,” I tell her.
She doesn’t respond. With inhuman patience, she just quietly waits out these reactions.
I’m out of words. We sit in silence for a time. Eventually, she asks, “Can I tell you what I’m thinking? If not, that’s okay.”
I open my hands, a “go ahead” gesture.
She says, “Depression wants you to quit. But if you realize that these are just depressive reactions, you’ll be able to label them and then manage them. So, it’s trying to re-package itself as other things…things you’ll be more likely to buy into. Anger, frustration, pessimism; the depression is taking different forms, hoping one of them will trick you into giving up. My hope is that if you can see how it operates, you’ll have an easier time gaining control over it.”
“I don’t buy that,” I tell her. “I think the pessimism is coming from a pretty reasonable place.”
She nods, sits back.
She says, “This is…yeah. This is tough.”
She pauses, lost in thought; then she continues:
“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…and I’m talking about severe, clinical depression…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 can be right there in front of you, yet you can’t truly communicate with them. They are so locked into this reality, that they can’t really hear you or absorb your words. When I tell a depressed person that things can be different, do you know what the most common reaction is?
Without hesitation, I reply “I’m guessing they laugh at you.”
“That’s exactly right,” she says. “They laugh. You’ve laughed at me, right?”
I don’t say anything.
“That world is so bleak even the suggestion that things can be different sounds ridiculous. So what I’m hearing today is that you’re sort of caught between these two realities. You’re leaving a depressive state, entering the real world…and it feels strange, because you didn’t expect to be back here. The real world is throwing new, unexpected challenges at you. And it hurts.”
She adds, “I know that if I tell you we’ll get through this, it won’t sound believable. What if I tell you that maybe we need to slow down, take a break from working on some of these goals. It’s important to me that you not feel pressured.”
“No, no. If we slow down, nothing will ever happen. I’m frustrated, but I want to just keep working on this.”
She nods. “Good.”
I think about it, say, “Wait…was that reverse psychology? Did you just reverse psychology me?”
She folds her arms, replies, “I’m pleading the fifth.”