Autism and Psychosis

Talking to a friend who suffered a psychotic breakdown made me curious. I know how it feels to suffer an autistic meltdown and I therefore know it feels nothing like it looks like. If only because it may well look like nothing is the matter. So how then would a psychotic breakdown feel like? Is that feeling as inaccessible to me as the grandiose schizophrenia stories make it out to be? I can’t be curious without feeling like the little kid Aristotle has talked about in his book alpha: I just need to open the box to see how it works. Here I go.

The first thing which struck me is that where people on the autism spectrum are proudly coming out as autistic, the opposite is the case with people who are deemed to be on the schizophrenia spectrum. They want to get rid of their schizophrenia label, not because of shame but because it misrepresents them as chronically ill in some fantastic stereotyped way. They’re just human beings who happen to have a specific vulnerability to psychosis. On closer inspection what seems the opposite then is actually quite the same. Autistics do embrace their label but precisely because they want to rescue it from all dull stereotyped connotations. We don’t want to be seen as chronically ill even if we know full well we are vulnerable to autistic meltdowns. We’re just human beings with some quirks but nothing in our weirdness predetermines us to comply to some preformed mold others want to try to fit us in.

The difference between autism and psychosis obviously is that the former is early onset, a matter of child development, and the latter is late onset, a first psychosis normally only occurs in adulthood. The former is a matter for child psychiatrists, schools, parents and developmental psychology. The latter something for hospitals, psychiatrists, couples and cognitive psychology. There was a time though when child psychiatry didn’t yet exist (not a good thing as atypical children were just considered to be unfortunate degenerates). At that time autism and schizophrenia were not different. In fact, for instance according to Minkowski, autism was the core phenomenon of schizophrenia (not the fantastic aspects of hallucinations and delusions, they were real enough but ultimately just a consequence of something more fundamental). In this view, the core element was “loss of vital contact with reality” which can as well function as a description of an autistic meltdown as of the psychotic breakdown. Minkowski even differentiated schizophrenia in 2 types of autism, based on the outward manifestation of outward (positive) symptomatic behavior, on one hand “poor or empty autism” and on the other hand “rich autism”. The difference was, in short, between losing contact with reality and subsequently spiraling away in one’s own dream world – or losing contact with reality and subsequently being unable to be carried away out of one’s idiosyncratic reality.

I think the similarity between autistic meltdowns and psychotic breakdowns then are as convincing as the differences are. These experiences are not mutually inaccessible at all – far from it. They are probably accessible to the most stable and typical of people because, such is the world, one can be confronted with realities which seem simply out of touch of one’s normal understanding. Aristotle would say everybody know the feeling of “aporia”, of having to reach for something which for some reason defies being caught. It is what in book alpha makes humans humans as animals reasoning their way out of predicaments. But where the feeling of the moment may be the same, both the run-up to it and the way it unfolds can be very different. If a child has been reaching a whole life for a reality that always seems to escape beyond the next corner, this is one thing. If the adult suddenly is confronted with this eery feeling that what is naturally within reach now evaporates in thin air, that is quite another. The child is trying to develop itself. The adult feels she gets sucked into a rabbit hole.

But children become adults and, however difficult it was, these autistic adults have made contact with reality.  Some even were lucky enough, because of their environment or this or that other talent, never to be deemed autistic as a child. When they meltdown there is, maybe, not that big of a difference anymore with a psychotic breakdown. Sure they will be different people but then again: everybody is different to some extent. The main thing in both cases anyway seems to be to re-establish contact with a shared reality – and that’s something which takes at least two to tango instead of calling one out as being insane, or ill or what have you. Maybe the reason for losing contact was that typical people just lose sight of the fact that what they take to be self-evident is no longer so. Maybe it is because typical people don’t see that something has become self-evident that they previously saw as problematic. Anyway, a little bit of charity in mutual understanding may avoid losing contact and may help in re-establishing contact. Certainly, I think doing this effort will be inspiring for all involved so instead of attacking or eradicating this diversity with pills or therapy (which might, to be certain, be unavoidable if the distance has become too great) we will be greatly helped by trying to see the other as principally accessible to us (i.e. not insane, or chronically ill, or radically different).

This is not to romanticize autistic and psychotic experiences. They are stressful and not a matter for envy. Still, if there are people who carry this additional burden but in carrying it can sometimes provide some real creative insight, why not just be grateful we exist? Is it really helpful to cast us apart because we sometimes behave differently? I think it’s not and I think this is what both groups of self-advocates are trying to get through your thick normally armored skulls.

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