Depression and Autism: More on Finding Kansas
As I read Aaron Likens' essays, I'm keep returning to something mentioned early in the text by his father: depression. Aaron mentions his mother briefly in an essay, stating that she's had something of an emotional breakdown. At the same time, it is clear that Aaron recognizes his own depression and its illogical nature.
I tell families and individuals with autism spectrum disorders that they should work with the best clinicians they can locate (and, sadly, afford). When an ASD is accompanied by depression, anxiety disorders, or other conditions, a relationship with a medical professional with neuropsych knowledge is essential. Be careful, though — psychologists and other clinicians tend to develop biases and blinders based on their areas of expertise. Bad neurological care might be worse than no care.
Aaron's depression, which I struggle to grasp, has some elements I cannot avoid calling "narcissism." Not as in a celebration of self, but a negative narcissism: life, luck, fate, whatever it is, always goes against me. Aaron's view of life borders on "I'm doomed! My life is horrible and no one else could ever understand how horrible!" Maybe Aaron will mature, or maybe his neurological conditions will restrict his perspective for life.
His despair is part of his identity. That saddens me, a bit, but it also angers and frustrates me. "Get over it!" isn't an answer, I know, but it is what I feel as I read his essays. That's not fair, of course, since there are many things I cannot move beyond — but I try to move around those challenges and negative thoughts.
While traveling in Kenya with his father, Aaron recognizes that the lives of the people in the slums are difficult — more difficult than his life in the United States. He is aware that compared to others, his situation is not bad. He hasn't lost his family, having a supportive father in his life. He hasn't lacked for the basic needs, unlike the children he observed in Africa. Yet, he also knows he is unhappy, anxious, and depressed.
Readers of this blog might assume I'm unhappy or depressed, mainly because those things worth writing about tend to be the extremes in life. Most of life simply is; it is not depressing or thrilling. The joys of daily life are basic: purring cats, quiet dinners, walks through gardens, drives through the countryside. But, I write about the challenges and struggles more often than walks with my wife.
Aaron, however, doesn't allude to or mention the simple days. He is consumed by the negative: negative memories and negative anticipations. He dwells on the negative past, something many of us do, but he also dwells on the negative future — a future with minimal hopes and dreams. There's one dream (auto racing) and I'm not sure what else might motivate Aaron.
I do dwell on the negative, and like Aaron I am stuck reliving the negative daily. But, for whatever reason, I refuse to surrender to the negatives most days. As Aaron describes it, I see the photos and film of past events several times each day, but even with those memories I move forward. It is difficult to convey the difference, but it is important.
Why are many of the teens and adults I meet with ASDs paralyzed with anxiety and depression, often linked to their inability to "get around" the memories burned into their minds? What is it that allows me, even with a similar "stuck" or "trapped" sensory-based memory system, to move ahead much of the time?
Because there are some memories so negative, so ingrained, that I cannot function around them, I do understand the challenge. I cannot deal with some people, no matter what, because I have such negative memories and emotions associated with them. There are places and things I avoid, too. If my job mandates taking an action that I cannot accomplish, there's little I can do to overcome the anxiety and anger. Fortunately, I don't surrender to the negative — I plot a new path.
To avoid stressors, I've quit classes. I've quit jobs. That doesn't mean I "failed" — it means I had to find situations that were a better match to my physical and neurological limitations. Sure, it can be depressing to look back, but I'm not paralyzed by the past. Most people have had to change jobs or take new paths in life. My reasons might be different, but revising plans is part of life.
Aaron, and many of the autistics I've met, cannot revise plans without an emotional collapse.
In the essay "Las Vegas" Aaron ends his time as a driving instructor with a fall and concussion — in the classroom, unrelated to racing. For Aaron, this fall means he will never return to the racing school. Never. While most of us, myself included, would simply assume this was a freak accident and plan a return to the school, Aaron surrenders. He gives up, suddenly and without any possibility for revision.
When we first moved to Pennsylvania, I missed the exit to Cranberry Township and was stuck on the turnpike. I hate the turnpike and I hated missing the exit. I didn't return for two months. And I still despise that section of toll road. Driving to Cranberry still causes anxiety and fear that I'll miss the exit, but in my mind the benefits (retailers and restaurants I like) outweigh the memory of missing the exit. The memory is there, and it annoys me. I relive it with every drive. But, I'm not going to stop shopping at Costco for stuffed salmon and steaks.
In Minnesota, I fell many times and ended up on crutches twice. I slipped in the crosswalk going to the Mall of America to catch my train to campus, bruising ribs. I fell on campus, which was accompanied by someone calling me a "gimp" (very bad memory). Yet, I kept going to the MOA and, though there were many negative memories associated with the university, I did finish the degree. I finished with the help of many people, and I finished *for* those people, especially my wife and parents.
Because of depression, and this is only my opinion, Aaron cannot use his duty to others to pull himself through difficult times and bad memories. Depression is a serious medical condition. It is a neurological condition that is crippling; it is a disability. Reliving negative memories, including physically painful sensations, is hard to describe, and I know that autism is challenging enough.
I do feel sympathy for Aaron. I know people with depression and they struggle in ways I don't understand. They feel things I don't feel and are stuck in ways I'm not stuck.
Is Aaron's depression hereditary? Is depression related to some forms of autism? Are the treatments effective? Does treating the depression help with the autism symptoms? I don't know the answers, but after reading Aaron's essays it is clear that effective treatments for depression and anxiety are needed.
Aaron is not alone, but he feels that way. I'd estimate he is similar to at least half the adults with Asperger's Syndrome I've met. Curiously, they all feel alone and alienated. I suppose that's why support groups are common.
Because I am always dreaming, always planning, I quickly replace the bad "now" with a better "tomorrow / someday." For Aaron, he writes that "Tomorrow" is a scary, anxiety-inducing concept. Tomorrow is uncertain, but he's certain it will be bad. If I couldn't imagine a better future, I'd be unable to get out of bed. My belief is that my wife and family give me this strength. But what could help Aaron? I hope something, someone can help.