Showing posts with label pain. Show all posts
Showing posts with label pain. Show all posts

The Protective Gift of Meltdowns

Maxfield Sparrow
unstrangemind.com

Photo © 2017, Maxfield Sparrow
[image description: a turtle in the middle of the road on a hot, sunny day.
His skin is dark with bright yellow stripes and his shell is ornate,
covered with swirls of dark brown against a honey-yellow background.
The turtle is rushing to get across the street and his back leg
is extended from the speed and force of his dash toward freedom.]
I hate meltdowns. I hate the way they take over my entire body. I hate the sick way I feel during a meltdown and I hate the long recovery time—sometimes minutes, but just as often entire days—afterward, when everything is too intense, and I am overwhelmed and exhausted and have to put my life on hold while I recover.

I hate the embarrassment that comes from a meltdown in front of others. I hate the fear that bubbles up with every meltdown. Will this be the one that gets me arrested? Committed? Killed?

Meltdowns, Like Shutdowns, Are Harmful But Necessary

We Autistic adults and teens put a lot of energy into figuring out what will lead to a meltdown and working to avoid those things whenever possible. Parents of younger Autistics also put a lot of energy and work into figuring these things out, both to try to keep triggering events out of their child’s life, and to try to help their child learn how to recognize and steer around those triggers themselves. Outsiders who don’t understand autism will make accusations of being overly avoidant and self-indulgent, and accuse our parents of spoiling and coddling us.

I have written about how shutdown can alter brain function in unwanted ways. Meltdowns also have their dangers, and can alter brain function over time. A meltdown is an extreme stress reaction, and chronic stress can damage brain structure and connectivity.

But meltdowns serve a purpose, just as another unpleasant experience that can also re-wire the brain if it continues chronically and unabated—pain—also serves an important and very necessary purpose.

Pain is an alarm system that helps us avoid bodily damage, and urges us to try to change something to protect our body. While pain is usually unwanted and something we seek to avoid, without pain we would not live very long because we would not have such a strong drive to eliminate sources of damage to our bodies.

Meltdowns are alarm systems to protect our brains.

That idea is so important I gave it its own paragraph. And I’ll say it again: without meltdowns, we autistics would have nothing to protect our neurology from the very real damage that it can accumulate.

So often, I see researchers and other writers talking about meltdowns as if they were a malfunction or manifestation of damage. I strongly disagree. It is easy for an outsider to view a meltdown that way, because all they see is an unpleasant outburst that makes their lives more unpleasant or difficult. They see someone who appears to be over-reacting to something that they don't consider such a big deal. They see someone "immature," someone who needs to grow up, snap out of it, or get a “good spanking” to teach them to behave.

When a person doesn’t themselves experience the hell of having a meltdown, that person can easily misunderstand and misjudge what it actually happening.

Meltdowns Are A Normal Response To Sensitivities

Let me ask you something (this is a thought experiment and you don’t have to actually do this, but you might understand me better if you follow along physically): Take your finger and poke the softer flesh on the inside of your thigh with it so that you are pressing the tip of your fingernail into your thigh. Don’t actually damage yourself! You’re just looking for a reference sensation. Poke it about as hard as you might press a button to ring someone’s doorbell.

If you have long, sharp fingernails that might have hurt a little bit (I hope you were careful. The goal here is not to injure yourself—just to create a physical sensation.) It was a quick poke, so it probably didn’t even leave a mark behind, no matter how long your fingernails are.

Now do the same thing to your gums, either above or below your teeth, in that area between your teeth and the inside of your lips. Oh! You couldn’t even poke it as hard, could you? (Do be gentle with your gums, please. I repeat, this is not about harming yourself. You don’t even have to poke yourself at all if you don’t want to. You know your thighs and gums.) You know, without lifting a finger, that I am telling you the truth when I say your gums are much more sensitive than your inner thigh.

And you are not “over-reacting” when you have more pain response in your gums than in your thigh, right? It’s easier to hurt your gums, so your reaction to the same stimulus is much more intense when it is applied to your gum than to your thigh. You are not self-indulgent or spoiled. You don’t need a good spanking to get over how sensitive your gums are. You just need to take extra care that things don’t poke you in the gums.

So what’s my point? If you are not Autistic—and even more so if you are pretty close to neurotypical —your neurological wiring is more like your thigh. Life pokes at you a lot, and you don’t even notice it. Much of life’s poking is fun for you. Some pokes are less recreational, but present satisfying challenges. So when you see an Autistic person having a meltdown you might not even recognize the pokes they have been processing all day long, because you as a non-autistic person don’t even feel them.

But our Autistic neurological wiring is more like your gums, except not even that predictable. Some of our senses may be “hyporesponsive,” and we need to stimulate them to be aware that they are even functioning. Some of us spin around, or pace in circles. Some of us move our hands or fingers in ways that make us feel better. Some of us blast loud music with a heavy bass and drum component to it. Some of us rock back and forth. Our wiring demands more input than the world’s regular pokes can give us.

Some of our senses are “hyperresponsive”  and we need much less stimulation. Life’s pokes are like fingernails grinding into our gums and we need to make it stop because we cannot bear the pain. Loud sounds or high-pitched sounds get to some of us. Others are overwhelmed by the struggle to understand speech when more than one person is talking at the same time. Some can’t stand textures of fabrics, or foods.

Most Autistic people I know experience a complex mixture of hyporesponsiveness and hyperresponsiveness. Most have some senses that are both hypo and hyper responsive, changing over time. I can’t give you any single idea of a sensory pattern for an Autistic neurology, because we each have our own combinations of needs.

Normal Human Variation Includes Variant Emotional Sensitivity Levels

But when it comes to meltdowns, it’s not just sensory input (or lack thereof) that will set off an Autistic’s neurological warning system and throw us into meltdown. What inspired me to write about this topic was reading something I had written last year, after spending a few months living in an emotionally abusive situation. The man I was living with figured out very quickly how to manipulate my compliance triggers; he even commented specifically on how easy it was for him to physically subdue me once he spotted the compliance “fish-hooks” that childhood had left embedded in me.

I’m not going to go into much detail about what he did, for the same reason I shy away from going into much detail about my decade of childhood therapy: I am working on removing those hooks from my flesh. The last thing I want to do is instruct others as to where those hooks are embedded, and how to use them to steer me like a puppet.

My only point in mentioning my abuse is that I realized—after the fact—that my meltdowns had been sending me a very clear message, one I should have heeded immediately. Instead, I did what I always do: I interpreted my meltdowns as a sign of how damaged I was, and how much I needed help to gain self-control. Most of my life, I’ve allowed lovers to convince me to try to medicate my meltdowns into submission. I hated those meltdowns, because they seemed to illustrate how flawed and awful I was. My thought process went like this: I melt down because I’m Autistic and meltdowns are frightening and horrible and who would want to be my romantic partner? I can’t blame people for treating me badly and wanting to get away from me, because look at these meltdowns!

My experience last year helped me to finally realize that I was looking at things backwards.

I don’t melt down because I’m Autistic.

I melt down because something in my environment is intolerable, and I am having a normal reaction of pain and/or anxiety. That pain can be from something physical, like an intolerable temperature in the room or a sound that is piercing my eardrums and making me nauseated. Or it can be something emotional, like internal feelings of frustration or external abuse.

Everyone has meltdowns. It’s not just an Autistic thing. But our wiring is different, just like the wiring is different between your thighs and your gums. Some things that make neurotypicals meltdown don’t bother me. A whole heaping lot of things that don’t bother neurotypicals make me meltdown terribly. I’m not deficient in some way; I’m wired differently.

Meltdowns Protect Us From Harmful Situations and People

One of the things I learned last year is that, even when I can’t recognize abuse because I have alexithymia, and even when I can’t recognize abuse because my compliance training is kicking in full-force, my body and nervous system will send me the message via repeated meltdowns.

What I wrote a year ago:
"If I have lots of shouting, freak-out, PTSD meltdowns when we spend time alone with each other, yes it’s an Autistic thing. But it also means you’re regularly doing something messed up. 
"An isolated meltdown could just be a random convergence of awful that has nothing to do with you, but if a pattern develops, you’re probably gaslighting me, mistreating me, abusing me, or generally taking nastily unfair advantage of that same Autistic neurology that makes me unable to recognize I’m being abused or mistreated until I see the pattern of meltdowns. 
"All my life I’ve been told, and believed, that losing my shit was a personal shortcoming I should work to overcome. 
"I now realize it’s actually my body/brain’s alarm system letting me know something’s seriously wrong in my life. Something bad that needs to be fixed, like yesterday, if not sooner. 
"I finally realized all this today. Everything suddenly connected. 
"And in an instant, I no longer hate my meltdowns. I think I might actually love them. They protect me.
So… I still do hate meltdowns. More specifically, I hate having meltdowns. They are hard on me, physically and emotionally. They are embarrassing, messy, frightening.

But I am grateful that my body has a way to tell me when I’m in a bad situation, even if my mind is not capable of figuring it out yet. I vow to respect and honor my meltdowns. This is not the same as excusing my behavior. This is not the same as giving myself free reign to do whatever, whenever.

I still want to do whatever I can to avoid having a meltdown. I still want to work on my ability to detect a meltdown on the horizon, and remove myself to safety before things go too far.

But I also vow to listen to my meltdowns and pay closer attention to my triggers. Meltdowns teach me what my nervous system can handle and what is too much for me. Meltdowns teach me how to take care of myself. Meltdowns teach me what my nervous system needs. Meltdowns highlight areas of my life that are not on track.

Sometimes my depression shows me that something is wrong in my life, but sometimes depression is just like a wildfire, burning out of control. The same is true of my anxiety. But I have learned that meltdowns are always highlighting something I need to address.

Meltdowns protect me. Some aspects of my neurology make me more vulnerable. Some remnants of childhood experiences leave me more vulnerable. Meltdowns fill that gap and send me messages about my life that can help me protect myself.

While I will never enjoy having a meltdown, I promise I will always value the protective gift meltdowns bring me
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Autistic People Move Differently, Too

hold me closer tiny dancer
Photo © Janine | Flickr / Creative Commons
[image: Photo of a person from mid-thighs down, standing on tippy toes,
wearing red over-the-knee socks spangled with pink and black swooshes.]
Sarah Kurchak
www.riskyfuel.com

As an autistic person who used to work as a personal trainer and fitness instructor, I have a lot of complicated opinions on the way that autistic people are taught to work with their bodies in our society.

I have, at best, a healthy distrust of the way that the fitness industry is currently run for people of all neurotypes, and worry that its focus on aesthetics, weight loss, and dangerous all-pain-no-gain workouts like CrossFit often undermine its potential to genuinely help people. Instead of teaching us to accept ourselves and learn to love and to work with the bodies we have in a healthy and productive way, current fitness trends reinforce ideas of punishing ourselves and pushing ourselves past in our limits in the quest of some superhuman ideal form. And I worry about how this philosophy has the potential to combine with treatments that are focused on on eradicating any sign of autistic behaviors to further alienate autistic people from our bodies, and cause us more harm in the name of ostensibly making up better.

On the other hand, I’ve also experienced some positive changes in my life as a result of my own physical fitness training. Learning how to run—a process which took a few decades and cost me my favorite pair of pink running shoes, as I detailed in a 2016 article for Refinery29—taught me how to connect with my body in a way that I hadn’t known was possible for someone as clumsy and confused as I was. Taking up weightlifting and martial arts helped me to feel better about my body and feel better in it. And I truly believe that, if taught properly and with a great deal of compassion, physical training for autistic people can genuinely be beneficial for us. But it has to be done by caring professionals who have the right idea and the right ideals.

As such, I’m always interested in connecting with thoughtful and at least somewhat like-minded professionals who are still in the field of physical fitness and therapy to see what their thoughts on the matter are—and how their philosophy is reflected in their current work. Which is why I was thrilled to be able to interview MacKenzie DeLoren, BS/MS, OTR/L, an Occupational Therapist who works with autistic children at Laughing Giraffe Therapy and autistic adolescents at a special needs school in the San Francisco Bay area. Here’s what she had to say about her career, nutrition, obesity panic, her own struggles to master certain physical tasks, and how that’s influenced her empathy for her students’ journeys.

Sarah Kurchak: When we were scheduling this interview, you mentioned that my article about developing body awareness well into my adulthood helped you to understand some things about your own development. Would you be willing to talk about your own challenges with sports and physical issues growing up?

MacKenzie DeLoren: I was always that kid who was the slowest runner in the class every time we had to run the mile. I hated team sports because I was always the weakest, the slowest, the clumsiest on the team.

In high school, I was really lucky because our school offered three different types of PE classes to finish our PE credits: team sports, individual sports, weightlifting, and dance. I took dance purely to get away from all of the other things. I knew I wasn’t good at any of those, but I hadn’t tried dance yet. So I ended up in dance and it ended up being … it was probably one of the more humiliating experiences of my life, but it also [made me realize that] if I just do this over and over and over again, I can actually get it. That helped a lot to kind of get a sense of my body.

We had these giant rooms with floor to ceiling mirrors, and having that visual feedback helped me to understand where my body was in space, what it was doing, and what it was supposed to be doing. Having that opportunity for the visual feedback really helped, but I still didn’t feel good about doing any time of physical activity, because I was sixteen and super self-conscious.

When I got out of high school, I found a yoga class through my junior college and I got into yoga through that, just trying to get me out of my head and get me into my body a little bit, because I was so stressed out with college. Yoga actually was where … I remember in your article you said something about how running was the place where you kind of found peace with your body and you started to understand it and get into a little more. That was yoga for me. I’ve been doing yoga for ten years now, and I actually just got certified as an instructor last year. I love it because I feel like similar to how you were in your journey of being able to offer that service to other people to help them get into their bodies, and not judge their bodies in the same way. That’s where I wanted to be with yoga.

Kurchak: What would you say are the most common issues and needs that you see when you are working with autistic clients?

DeLoren: I would say the most common issue is dyspraxia. Dyspraxia is when you have a lot of trouble with motor planning, which is our ability to learn new movements. So it’s not the practicing part of it, it’s the learning part. When you’re introduced to [a new movement], how smoothly can your brain understand what the demands are and get your body to do that?

I would say that’s the number one reason I get kids into the clinic: because of that type of dyspraxia. It causes a lot of other issues, too, with their ability to regulate, and to be able to work functionally in their school environment, and in their home environment, because if you don’t have a sense of where your body is, it’s really hard to interact with anything else.

Kuchak: That’s not exactly the same as what you went through growing up, but does your own history with movement help you to sympathize with your clients? Does it ever take you back to those dance classes in front of the mirror?

DeLoren: Oh, totally. Totally. I have a lot of empathy for the kids I’m working with, especially my high schoolers. I work at a school specifically for kids with autism, and I work a lot with the 14-22 age range over there and I’m definitely like, “Man, I’ve been you. I know how hard this is.”

A lot of our kids are severely impacted by their autism, so some of them have an awareness of where typically developing kids are and some of them don’t. And, for my students who do have that awareness, I’m very aware of how I speak to them about what we’re doing and what we’re trying to get their body to do because I know that’s a struggle. Just having that awareness that “I see all of the other kids doing this and I’m not.” That’s a hard realization for anybody, and I think being in that dance class and seeing classmates of mine do these perfect pirouettes and me just looking like “I can lift my foot off the floor and put it down again…” There is a huge empathy for that learning curve because that learning curve really does feel steep when you’re having a hard time feeling your body.

Kurchak: On the subject of communication and being attuned to your clients’ concerns and needs, there are a lot of autistic people who might not necessarily experience pain in the same way that non-autistic people do, and also autistic people who might not be able to recognize and communicate what they are feeling in a way that is instantly recognizable to non-autistic people. How do you deal with those issues?

DeLoren: It’s interesting that you say that, because I was just working with a teacher on a goal for a student: “She’s going to recognize when something painful has happened to her body on 1 out of 5 occasions.” That kind of thing.

It is actually a goal that we write, because it’s a skill that we have to teach our students that I work with, because they don’t have the innate ability. One of the things that I love about the school is that it’s so strengths-based, and you never say never. You never say “this kid is never going to do this,” because, every time you say that, they’re going to come out of the woods and surprise you.

It is a challenge to figure out [how to explain something like] “Ok, you are probably getting upset with me now because, a minute ago, you slammed your hand on the table and it probably hurt, but you didn’t register that it hurt then, but you know something’s off.” With some of our kids, we can have those verbal conversations.

For those kids who don’t have that awareness yet, or that same verbal comprehension to be able to understand those kinds of conversation, it does end up being more about how we can structure the environment so that it’s as safe as it can be. And then, from there, how can we as staff and teachers help these kids if they do something that does hurt their body and they start getting dysregulated? How can we give them strategies to help them bring their body back to a good place? We work a lot with sensory strategies to calm the body, but we also work with regulation programs to teach those skills of how to recognize that your body is getting pretty ramped up and how can you bring it back down.

Kurchak: As an autistic person who worked in the fitness industry, I’ve often wondered if our repetitive movements and stimming could lead to repetitive strain injuries later in life. Is this something that you’ve noticed or considered at all?

DeLoren: That’s a good question. I personally haven’t seen them yet, but I also work with kids. As you age, you would probably get into those a little bit more. If you’re working with a geriatric autistic population, then that would probably show up a little more frequently.

I have a lot of guys who jump around on their toes a lot, and I love seeing how their musculature has developed. I have one guy who is always bouncing on his toes and his arms are scrawny and his legs are like … he never misses leg day. He has such defined musculature in his legs because of that type of stim and I do wonder if it’s… this is all hypothetical, because I have no research on this, but I do wonder, if it’s a behavior that started in childhood, if he developed the musculature to support that, maybe that could actually prevent you from getting a repetitive strain injury. But if it’s something that you start later in life, after your body has finished developing, maybe that would compromise it?

But I don’t know about that, because a couple of our kids can do these hypermobile things with their fingers and I haven’t seen them get dislocated. But again, I’m working with pediatric populations, so arthritis, that kind of thing where you have repetitive wear and tear on the joint, that’s going to show up later in adulthood. So I don’t know. That’s a really good question.

Kurchak: Something else I’ve noticed in fitness is that most training programs developed for autistic people are based around a fear of obesity, and that any other goal or need that isn’t specifically about making autistic people thinner tends to be ignored or pushed to the side. Is this something you’ve seen at all in OT?

DeLoren: I feel like that’s a thing in health care in general right now. Any time there is any potential risk of obesity, everybody just loses their minds and focuses on that instead of any actual health concerns. It’s awful that we are seeing that kind of fat shaming progressing into our work with children, who should be told that they are beautiful and wonderful all time. Kids grow best when they receive positive feedback as opposed to “ooh … I’m really scared that you’re gonna get fat!” That’s really awful to hear as a child. It’s awful to hear as an adult, but especially as a child.

I do think that the fitness industry is hyper-concerned with obesity, and we do see that concerned mirrored in the medical field as well. I am predominantly in the education field, as most of my time is spent at a non-public school specifically for student with autism. A lot of concerns in education right now in terms of obesity are that kids are sitting for too long and not moving enough. This is an issue that we've pretty much brought upon ourselves with the ways we've set up our schools. P.E. times and recess times have been cut or pushed back as an increased focus on academics has surfaced. The long-term issues of this type of sedentary lifestyle include obesity, but plenty of short-term issues also emerge. We see increased distractibility, behavioral issues like not following directions or acting out, emotional regulation issues like aggression or crying, and poor performance on academic tasks (including testing). In our quest to address obesity in schools, we have the opportunity to correct all of these other issues that we're creating as well.

The school I work at is kind of unique, in that its goal is for our students to live engaged and productive lives. Instead of having several hours of sitting work for our high schoolers, they change work stations every fifteen minutes, so there's a walking break built in right there. They have 30 minutes of PE every day, not just once or twice a week. They go for trail walks (30-45min) every other day, and they go on community outings for several hours every week. They have access to three different play structures, four hammocks, and bikes whenever they need a break. They participate in campus clean up every week and we have seasonal gardening activities as well.

While these activities aren't all traditionally "exercise" they do get our students out and moving around. We refer these types of activities as "heavy work" and are a way to help our students regulate their level of alertness and their emotions, but they have the added benefit of being physically healthy on top of being emotionally healthy. If more schools were able to incorporate this kind of hands-on learning approach, we would probably see a decrease in our obesity rates because we'd be establishing healthy movement habits right from the start.

So many of the clients that I work with are very picky eaters and they’ll only eat certain foods. So I think that, from the OT perspective, we come at it less from a fear of obesity and more from a nutritional standpoint. Are they getting the vitamins and minerals they need? I do see the concern with the nutritional aspect because of those super hypersensitivies to different textures and different flavors and that kind of thing. There is a pretty limited diet that some of our kids have. And so many of our kids can’t swallow pills, so they can’t take vitamins.

Kurchak: Swallowing pills is still a challenge for me.

DeLoren: It’s a really big challenge.Thankfully we have gummy vitamins, which are really good for a lot of our kids because that chewiness is actually really good for proprioception in the jaw.

Kurchak: I’m actually taking gummy vitamins now.

DeLoren: They’re great! And they make them for adults now. Which is really good, because we’re seeing that, with those types of supplements, we can start getting more of that nutritional part, that little piece of the puzzle can start to get worked out. There is starting to be more research into gut issues with autism, and whether or not you’re able to process the stuff that you’re taking in. How you’re processing it seems to be different if you have autism vs if you don’t have autism.

I personally have not read a ton of research on that yet, but I do know that it is being conducted right now.  I think that we’ll probably see some more research into that and the viability of those things in the next few years.

Kurchak: You mentioned earlier that you were recently certified as a yoga instructor. Has that training influenced your OT work with autistic people at all?

DeLoren: I think it definitely has. I frequently incorporate breathing exercises into my self-regulation training with my kids. I have one kid in particular where yogic breathing and diaphragmatic breathing, in addition to pursed lip breathing, helps him calm down a lot. And when he can’t get into that, he will engage with me doing basic stretching exercises because that gets him into his body a little more. This is a kid who struggles with anxiety to the point where he will walk into a room and we can’t tell what it is that has set him off, and he can’t communicate it with us, and he will just start bawling and yelling and running all over the room because he can’t sit still because something has gone wrong. His anxiety’s through the roof. So the fact that he can, in that space, where the nervous system is totally fight or flight, be able to still have that awareness to breathe through pursed lips—and that brings him down—is huge.

Also, part of my training as a yoga instructor incorporated a little bit of Thai massage. Thai massage is also called lazy man’s yoga, which is really wonderful for my guys who can’t their bodies into a position, but I can help them get their bodies into a position and I can keep my body safe moving their giant limbs around. Because I’m working with six-foot-tall guys who are twice my weight. So I can keep my body safe when I’m helping them get into those positions that are going to help open the hip, or are going to open up a little into the shoulders. It’s going to get their hands to work a little better so that they can do academic work, that kind of a thing.

And, for my kids who are more aware of the outside world and their interactions with people, I do talk a lot about kindness to yourself and thinking good thoughts for yourself before you can treat others with kindness. A couple of my kids have stims where they’re hitting their heads or [other] self-injurious behavior and, whenever I’m trying to encourage them to stop, I remind them you have to be kind to yourself to start with. That’s the baseline. The important part is that you love you. And then you can love other people.
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