By Nomi Kaim
A large proportion of people with Asperger’s Syndrome–perhaps especially those who are higher functioning–suffer from some form of depression. It is unclear whether this depression emerges as a result of the struggles, exhaustion, rejection and failures so often present in a life with Asperger’s Syndrome, or whether the mysterious neurology of AS somehow invites, or includes, a hard-wired affective disorder. What is clear is that people with Asperger’s Syndrome can end up particularly entrenched in their depression, and be difficult to treat or “cure.” Like many of the viewpoints and needs of individuals with Asperger’s Syndrome, this depression can be extremely rigid and hard to budge. To use the sensory terminology of Autism Spectrum Disorder: the “weighted blanket” of despair is immobilizing, smothering, paralyzing–and it most certainly does not provide deep pressure relief!
My own personal struggles with Asperger’s Syndrome and depression have also revealed some seeming paradoxes in the juxtaposition of these two conditions. It seems that many of the thoughts, feelings and impulses associated with depression are practically incompatible with the definitive mindset of Asperger’s Syndrome. Depression arouses desires that the person with AS does not need or want–and vice versa. And yet the conditions do coexist, and often; so I, like many with AS, am forced to live the paradox.
Below are some of the contradictory forces I find myself battling daily.
The Dissolution of Special Interests. Since early childhood, my Asperger’s Syndrome has endowed me with powerful, engrossing “special interests” that I turn to for comfort and de-stimulation. But anyone familiar with depression knows how it can suck the pleasure out of interests, hobbies, and just about anything that was once enjoyable. Specifically, when I am depressed, I do not want to do anything fun; nothing seems fun or worthwhile any longer. It is hard to go from having strong interests to having none at all; it leaves an empty space where I don’t know what to make of myself, who I am. What used to intrigue and engross now bores and even repels me. Yet behind this apathy and this despair hides the image of something essential being walled off: my interests are still an enormous part of who I am, but I cannot get at them.
Sacrificing Ideas for Feelings. As a person with AS, I’d rather focus on ideas than on feelings. I have traditionally held the realm of feelings to be wishy-washy, cheesy, “touchy-feely,” frustratingly indefinite and imprecise. But as depression overwhelmed me, I had to alter this stance. I have had to face the unfamiliar, sticky feelings that crept in to dictate my daily experiences. I have had to isolate and put names to these emotions so they would not isolate and put an end to me. And, often, I have had to abandon my ideas and theories by the wayside. Now, I do not regret having learned to speak “feeling talk;” it tempers my annoyance with our highly emotionally oriented world. Still, when I pause to remember the person I was before depression first hit, I sense a loss beyond the dissolution of easy happiness: I miss my theories, my ideas.
The Loss of Constructive Solitude. I value my solitude. Time spent with others often feels awkward, anxious, and disingenuous. In the quiet of my own mind, my calm, true self emerges. But when I am depressed, that true self is obscured by thoughts of self-loathing and destruction. So I need, and seek out, the company of others–if not for comfort, at least for distraction. Solitude becomes painful, even intolerable. I love my solitude and miss it horribly, but sometimes I just can’t have it–not for a moment. When I am depressed, the very aloneness that usually sustains me threatens to destroy me.
Compromising Self-Sufficiency. I want, and have always wanted, to be intellectually and emotionally (if not materially) self-sufficient. I strive to be a self-contained, self-controlled unit comprising my unique values, ideas, and overall world-view. I do not always like the world that surrounds me, and do not wish to become too deeply enmeshed in it. Of course, on the other side of this self-reliance is a profound, if conflicted, desire to connect with other human beings and even–can I write it?–love. Depression compounds this longing with terrible impulses to share my pain, to be validated and nurtured and consoled and comforted, and to surrender my prized individuality to the care of another person–because caring for myself becomes just too burdensome. These impulses feel foreign to my true self, and I am uncomfortable having them.
Physical/Sensory Conflicts. Along the same lines, depression arouses in me an inescapable yearning to be held, rocked, and comforted like a baby. But I basically hate being touched. Even a light tap on the arm can overwhelm me with a convulsive horror, and hugs feel like forced drowning. Often I come away from experiences of touch feeling disassembled and violated; I want to ward off, to retreat. This conflict persists regardless of how depressed I am feeling, but the depression introduces an additional urgent, helpless (and foreign) need for physical nurturance which confounds me more than ever.
Health care workers have correctly identified some of the difficulties inherent in applying traditional methods of psychodynamic therapy to the Asperger mind. The main problem is that it usually doesn’t work. People with AS may thrive on the opportunity for one-on-one conversation provided by the therapeutic interaction, but we often don’t benefit much past this happy occasion to be listened to. We don’t carry things with us beyond the weekly session. This problem may stem from a difficulty in understanding and applying abstract symbolism and metaphors (though I’m not sure exactly how that would work), or it may arise because people with Asperger’s are so verbal we can “talk the talk” without necessarily ever learning to “walk the walk”–both inside and outside of therapy sessions. Or there may be some other reason entirely. If anything is becoming clear in this age of neuropsychology, it is that “just talking about it” doesn’t work for everyone.
So, for those who might still benefit from some form of psychotherapy, what kind of treatment should be pursued? There are several modern alternatives to talk therapy, but I find they all fall short of satisfying my particular Asperger needs. Two lauded treatments for severe depression–Cognitive Behavioral Therapy (CBT) and its offshoot, Dialectical Behavioral Therapy (DBT)–focus on reassessing and reconstructing one’s thoughts in the hopes of indirectly altering the feelings they invoke. Well I, for one, do not like to be told how to think. I value my own forceful beliefs and ubiquitous questions, my own Utilitarian sense of morality. Many of the theories espoused by cognitive therapists I simply do not agree with–and yet I am told what I must believe if I wish to get better. (Incidentally, “getting better” is one of those concepts I don’t believe in. I think people experience rising and falling levels of despair throughout their lives, and dubbing depression an illness that can be permanently “cured” is, in most cases, a ludicrous oversimplification.) Anyway…I cannot begin to say how much all of this frustrates me. While therapists gently suggest that I am “not cooperating fully,” I want to scream: Stop trying to control my thoughts! Leave my mind alone!
Of course, one way to sidestep the mind altogether (or try to!) is to follow the strictly behavioral therapies often employed to shape the behavior of autistic children. Unfortunately, such techniques may be all but useless for the higher-functioning person with Asperger’s Syndrome. I personally find behavioral therapy maddening: my cognitions–desires, judgments and questions–always creep in anyway. In most cases, I cannot be issued a command or even a suggestion without instantly wondering: Why should I do that? What’s the benefit? How do you know it will work? Who says? What if I think something else will work better? What are the consequences of my doing what you want me to do instead of what I feel is right? Just because it worked on some other people, how do you know it will work on me? Am I not a unique individual? Have you even thought about this?!
Purely behavioral psychology is on the wane simply because thoughts and ideas cannot be overlooked–and nowhere is this truer than inside the mind of a person with Asperger’s Syndrome. I don’t know what therapy or therapies will work best for depressed people with AS, but I do know that rationales, logic, and reasoned discussion will have to be as integral a part of the solution as cognitive or behavioral directives. To feel at all empowered, a person with Asperger’s Syndrome must always be allowed to offer opinions and ask questions–most especially the question “Why?”