By: Heather Dimmitt, DO
You’d be hard pressed to find an autistic person who hasn’t been labeled with a mental illness in their lifetime. To clarify, autism is an identity and not a mental illness in and of itself. It’s a social disparity to the point of disability, but not an illness. I always see something along the lines of “Autism spectrum disorder is commonly associated with mental illness, such as anxiety, depression, C-PTSD, BPD, bipolar disorder, etc.” These labels make it sound like there’s something medically wrong with us, that we are mentally ill, in need of fixing. Even those who are well meaning autistics reflecting on their own experiences will note that it seems the challenges faced by autistics induce extreme stress, and therefore lead to anxiety and mood disorders. However, the fundamental reason we even treat anxiety and mood, are specifically only when they are “disorders”. Disorder implies functioning improperly. But what if autistics are just responding rationally to a harsh environment?
My whole life, I’ve always felt like I have anxiety. My stress level was sometimes disabling and certainly fit with that diagnosis, but none of the treatments really seemed to work for me the way they should. There’s always been something different about my anxiety that didn’t quite fit, but I was never able to put my finger on why. After learning that I am autistic in adulthood, the more I research and think about it, the more I realize my “anxiety” is just a rational fear response to the stress of constant discrimination and abuse against my autistic neurotype.
If we call fear a rational reaction to stress, anxiety is an irrational amount of fear, an overreaction to stress. It’s a pathological, unwarranted fear response to something that should not induce so much fear. That’s why treatments like CBT, which promote rational thought to interrupt irrational emotional responses, have been demonstrated to be helpful for anxiety – in a likely majority neurotypical and otherwise privileged sample size not dealing with the same level of discrimination in everyday life. I think autistics are naturally more rational thinkers, often gaslit, and told they are irrational for thinking or reacting the way they do because it’s “different” from the “norm”.
For me, chronic fear is primarily caused by trying to live in a world that does not respect an autistic neurotype, a world that’s become increasingly louder, brighter, smellier, chaotic, and fake superficial socializing. My fear response is warranted. Bright lights, loud irritating sounds, and strong smells literally assault me and cause dizziness and fatigue every day while I’m trying to do errands and get work done. I sometimes can’t function at all if I don’t wear earplugs, a hat, and sunglasses outside of my home. Rationally, wouldn’t that make anyone afraid?
Positive affirmations and CBT trying to interrupt my emotional response to a physical assault on my senses with some rational thought about separating myself from emotions and finding acceptance? That’s only going to help so much. Whenever I’ve tried CBT or DBT, I always seem to have correct instincts. It’s not really teaching me anything new. I have learned the most perfect coping skills and practice them all the time. It may help some, but never seems to be treating the problem, which I now know is primarily sensory related.
If you had a broken arm, you wouldn’t try to rationalize your way out of pain, you would deal with the physical problem. In the case of autism, you would deal with sensory issues as if they were entirely physical in nature. When I take care of my sensory needs and let myself be who I am without masking or trying to do more than I can, I have ZERO fear, no anxiety. I can think positive affirmations and CBT till I’m blue in the face, but it won’t fundamentally help. Wearing earplugs, sunglasses, a hat, and stimming helps.
That’s why it can be harmful to go on thinking of mental illness as just part of the autistic package. We shouldn’t be focusing on treating individuals with CBT to further develop their rational responses to stress. Autistics have rational responses in spades. We just need everyone to accept those responses as justified and improve the environment to suit us better, the way it already suits neurotypicals. To do that, it’s imperative to continue the amazing shift already happening in the community towards acceptance of autism as an identity to be proud of.