Thursday, January 28, 2010

"Where is my Personality?"

"Why doesn't anyone recognize that I do not have a personality? I know that I do not. The other day I realized that I could sneak out some words and that nobody knew that I was sneaking. Are people so stupid that they cannot tell when someone does not have a personality, when someone cannot cry, when someone is sneaking? I guess if they cannot tell, I will sneak out and practice being a person. The pain of not being is scary and all consuming. I have to work real hard so to get to the other side where happiness lives."

What is this autistic boy telling us? He knows he does not have a personality and is not a person. He is very aware that other people are different. He seems envious of their ability to exist and to be a person. He seems determined to get a personality by what he calls sneaking out words. He also notices that others do not know the difference when he does this. He seems very lonely, in a lot of psychic pain and desperately wants to be like others.

What does it mean to have a personality? This autistic boy is opening up an important issue. I would like to delve into this subject briefly. The definition of personality from Webster's Dictionary (1989)*: "the visible aspect of, one's character, the sum total of the physical mental, emotional and social characteristics of an individual and the quality of being a person; existence as a self-conscious human being. Some might also think about personality as what we call our self.

According to Adams (1954, cited in Schultz & Schultz, 1994) * personality is 'I'. Adams suggests that when an individual uses 'I' he is expressing his personality, which describes who he is. Thus we are always describing ourselves and showing our personalities when we use the word 'I'. Furthermore, "The word I is what defined you as an individual, as a person separate from all others." (Schultz & Schultz, 1994, p.8)

This is important based on what we know about autism from an incomplete attachment. It is my belief that the child with autism does not have access to his 'I' because he does not have access to the different parts of himself because those parts are dissociated. He also does not have what I call self-agency which allows him to use those parts of himself in relationship to others. Thus we can now make sense of what this autistic boy means when he says he "wants a personality." He wants to have access to those dissoicated parts of himself and more importantly he wants to talk about himself using 'I'. As we know some people with autism refer to themselves using 'you' or echolalia. It is not until an individual has a completed attachment will he be able to use 'I' in relationship to others. It is also important to note, that individuals with autism do want relationships. A lack of self-agency and dissociation make this difficult to accomplish.

Most 'typical' individuals do not have to think about what it means to have a personality or to talk from the 'I' position (see my blog on communication and autism). The person with autism struggles with these ideas on a daily basis.

*Webster's Encyclopedic Unabridged Dictionary of the english language (1989), The dictionary entries are based on the first edition of the Random House Dictionary of the English Language (1983). New York/New Jersey: Gramercy Books.

*Schultz, D., & Schultz, S.E. (1994). Theories of Personality (5th ed.), Pacific Grove, CA: Brooks/Cole.

Sunday, January 24, 2010

Anger and Rage

"I am very angry and filled with rage. I cannot express my anger, but I feel it. This anger permeates into every part of my being. It helps me to stay alive. It gives me energy to exist. It seems to be functioning to protect me. It is like a person standing over me and protecting me. It feels as if the rage has torn me apart and allows one part of myself to take care of the parts that cannot take care of themselves. My anger and rage are being put to work to function in a way that is helping me inside. This anger and rage is inside waiting to come out. It cannot come out now because it has an important job to do, but when it does it will fill a very large room."

What is this autistic boy telling us? We can break up his message into two parts: 1) the dissociation experienced by individuals with autism and 2) how emotions such as rage and anger function within the individual with autism.

He seems to be telling us that he can feel his anger and rage, but more importantly cannot express it. From his vantage point, these emotions seem to be functioning as an internal protective mode. They protect the weaker parts of himself that cannot protect themselves. It is like they are functioning as people to protect him.

In some regards this can make sense. The individual with autism has not had a completed attachment and thus is left in a dissociated unconscious state (lowest functioning child with autism). This changes as the child develops. Thus he can become more conscious and less dissociated and then we would call him high functioning or with Asperger's. Eventually he may not be identified as being on the autism spectrum at all.

It is important to note that from the perspective of an incomplete attachment the child is functioning in a normal state of dissociation. Parts of the self are not conscious to or available to the child to use in his communications with others. It is this state that the child with autism lives. Bromberg (1994)* believes all individuals begin life made up of multiple self-states. Our wholeness develops through a relationship with another person. Because the person with autism lacks an attachment, he remains in a non-whole state. Thus the individual has different parts of himself that have not been validated, remain unconscious and are also not integrated.

In this situation, this autistic boy not only is in a normal state of dissociation, but also as he lives in this state of dissociation and as he develops, he learns to adapt to the situation and parts of himself (in this case his rage and anger) become internal methods to handle and cope with his dilemma.

I believe that as he develops a significant relationship with a person who understands his predicament, together they can forge an attachment which will help him to become less dissociated. He will be able to communicate his rage and anger and other emotions as he becomes less dissociated. As this occurs, he will be able to communicate his feelings that up to this point have only been internalized.

It is important to note that some individuals with autism are filled with rage and anger and that as they do develop we see more of the explosive anger coming out. Some individuals seem to be filled with inordinate amounts of anger. I think of this from three perspectives: 1) the excessive anger might be due to his rage at not having had a direct outlet for these emotions. In other words, he had to live without access to his emotions so he is filled with anger that has never previously seen the light of day, 2) when anger is dissociated the child does not have control over this emotion. Until the angry feelings are understood, they will come out as intermittent explosive acts of rage and 3) he probably has lots of angry feelings towards others that may not have helped him to express his anger. This may not seem logical, but I would imagine the child with autism looks to the caregivers and others to know how to solve his dilemma and when this does not occur in a reasonable period of time, his anger may grow. When he finally has access to his emotions, there is what I think of as a lot of residual anger to deal with. Thus it would be important that when working with individuals with autism from a relational perspective, to expect this build up of anger to come forward. This will be a positive move for the individual with autism, but caregivers and others may not know how to manage their own feelings when they are bombarded with these angry emotions.

* For more information on dissociation see: Bromberg, P.M. (1994) "Speak! That I May See You" Some Reflections on Dissociation, Reality, and Psychoanalytic Listening. Psychoanalytic Dialogues, 4 (4): 517-547.

Saturday, January 16, 2010

Feeling Sick: Communication, Obsession and Autism

"I like being sick with the flu. It's not that I really like being sick, but I like the attention I get when I am sick. My mother is the perfect mother when I am sick. I even feel that I can talk when I am sick. Usually I don't like to sleep with the light off at night and the door shut, but when I am sick I just do not care about those things. The pain of sickness seems to create a situation where I feel more normal than I usually do. This is something I have thought about a lot. I have figured out that when I am sick it is my one chance to talk about the pain that I feel inside. So when I talk about the pain due to fever, I am really also talking about the pain inside. It is not socially acceptable to talk about my inside pain and besides I don't believe others including my parents would understand my inside pain. The pain inside is my secret and I must handle it by myself. That is one of my rules. When I am sick it is an opportunity to talk indirectly without revealing myself too much."

What is this autistic boy telling us? He seems to feel more 'normal' when he is sick with the flu. He can do things during this time that he feels he cannot do otherwise. He also realizes that he can use his flu symptoms as a vehicle to talk about his deep internal feelings. He knows he cannot talk because he does not have the ability to use himself with others. This is what I call a lack of self-agency. He also knows that by using something that is really happening he can in some sense talk out of two sides of his mouth. On the one hand, he is talking about how he feels with the flu, but more importantly he is also talking about his deep psychic pain and feelings.

This is a common phenomenon for those with autism. They cannot talk about themselves or represent themselves to others, but they can talk (if they have words) about what they see outside of themselves. Thus some people with autism can be seen to talk on two different levels. The obvious level (in this case about his flu) and the less obvious which is a much deeper feeling state.

Another example may be helpful to explain this phenomenon. As we know children with autism are known to have obsessions. These obsessions seem to be unique to each child. It is my belief that if we take any one obsession, we can understand it from two different levels. For example, a child may be preoccupied with cars, trains and other modes of transportation. One level of understanding is the obvious. Typically, one would say, "he is obsessed with cars and trains." On a deeper level, I believe is is also saying, "I cannot move and I am trying to figure out how things move and I need you to help me move."

Why does the child with autism use this very indirect way of talking about what his needs are? It is important to remember that people with autism have anywhere from none to very little self-agency. Self-agency is what gives us the ability to represent ourselves in relationship to others. Thus, these children do not have a way to represent themselves with others, but their bodies still need to communicate. Thus the child with autism communicates through his body in a way that most people are unfamiliar with. Once the child feels his obsession is understood and recognized, he can let go of that particular obsession. Thus the obsession serves as a vehicle to communicate ideas and feelings that the child cannot otherwise communicate.

Friday, January 1, 2010

“Please Help Me to be Separate”

“There is this “gluey-gooey” feeling I have with my mother. I feel stuck to her as if someone is playing a joke on us. I cannot exist without her. It is as if we are one. I cannot move unless I know where she is. I cannot talk unless I hear her first. I watch her very closely to know what I am supposed to do. I can only move my body after she moves her body. It is like we are glued together. Never to be separated. In my mind, I try to separate and pull myself from her, but my body will not let me. We are stuck, never to go our separate ways.”

“Sometimes I feel so connected to my mother that I cannot tell the difference between her and me. As much as I try to separate from her, I can't. It is like we are two peas in a pod. I have to know how my mother feels about everything. If I know how she feels then I can do what she says and everything will be okay. It is not as if I want things to be this way. They just have to be. It is like her opinion is mine. I am obsessed with how she feels even if it is at the expense of my own opinion. When I find out what she feels then I feel safe. Where are my opinions? Where is myself? I am not independent from my mother and from others. I feel doomed to live this way. I am obsessed with thinking about how to undue this predicament. How do I get unstuck? If I stand far away from her and talk to her I still feel connected to her. If I talk to her on the phone I still feel connected to her. This connection is like a rope around my neck that is choking me. I want to be a separate person, but I can't. How do I separate from my mother? This idea torments me daily. It causes me to have a lot of pain. I cry myself to sleep thinking about how to be separate and how to be a person.”

What is this autistic boy telling us? He seems to be telling us that he is not an independent person and cannot function separately from his mother. He definitely is saying he wants to be separate, but feels he cannot make this happen. Most people do not have to think about being separate from others. He is very aware of his dilemma, but has no ability to make his situation different.

This boy is giving us an example of what it is like to live without self-agency. Self-agency is the ability of the self to take initiative, to regulate oneself and to be the source of one’s behavior. A sense of self-agency is developed within a relationship with another person. The autistic person has an incomplete attachment thus does not have the advantage of self-agency. The functioning levels of those with Autism Spectrum Disorders correspond with the degree of self-agency the individual has. The lower functioning individual has very little self-agency and thus is nonverbal or can only use echolalia. As the individual gains more self-agency we start to see the use of words such as “me” and “I” as well as more interactive behaviors. Then we start to call the person high functioning.