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.