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Autism, suicide, mental health 

I want to discuss the sorts of pressures that push so many autistic people toward suicide. Take my content warning seriously, please.

There are also very few research studies that do not use problematic language and terms to describe us. If you are sensitive to that right now, don't read the studies I link.

Take care of yourself first. Always.

Autism, suicide, mental health 

There are not a lot of studies on suicide among autistic people, but it's beginning to get more attention. I think I'll just link one in this thread. It's a decent one and representative of other findings.

sciencedirect.com/science/arti

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Autism, suicide, mental health 

Among all adults, two-thirds reported suicidal ideation and one-third reported attempting suicide. Those rates rival the suicidality rates among transgender persons, which if I recall correctly is the group at highest risk.

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Autism, suicide, mental health 

Others have written on this topic, more eloquently than I can. I'll share a recent article by Sarah Kurchak. If you are not autistic and care at all about us, please read it.

vox.com/first-person/2018/2/19

"Think about how hard we’re working to exist in your world and consider meeting us halfway."

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Autism, suicide, mental health 

I mentioned the transgender community for a reason. They experience social exclusion and isolation, both actively and passively, at similarly high levels. In many ways, their experience is probably even more actively hostile.

Of course, there may also be significant overlap between our two groups. The data are unclear but lean that direction.

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Autism, suicide, mental health 

We've also only recently begun to recognize and understand autism. Until 1980 it was considered an extremely rare form of childhood schizophrenia and awareness even in the medical community was extremely limited. From 1980-1987, the only diagnosis was "infantile autism" which had to be made in the first three years and was also highly restrictive.

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Autism, suicide, mental health 

That was expanded in 1987 to allow diagnosis later in life, but pretty much based on the same criteria focused primary on those first three years. Our current understanding of autism did not begin to be reflected in the diagnoses and criteria until 1994.

I turned 29 years old in 1994.

And it took quite a few more years for the diagnoses to even begin to be more broadly and vaguely consistently applied.

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Autism, suicide, mental health 

And our understanding of autism is very much still developing. However, both physical studies of the brain and fMRI studies consistently show one thing -- autistic brains function significantly differently than non-autistic brains.

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Autism, suicide, mental health 

Most of the time there is a lot more variation in our results than in the predominant neurotype controls, but our results are pretty much always different from the controls in significant ways.

My hypothesis is that autistic people all adapt to the demands the world places on us in different ways and the neuroplasticity of the human brain reflects those adaptations in the fMRI results.

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Autism, suicide, mental health 

So why the high rates of suicidality? I don't know if I can express how hostile the world feels to an autistic person. Yes, our sensory differences are always a factor, but the hardest part is trying to find some place in the human social world. That is absolutely essential for human well-being, we are social creatures, and a constant struggle for us.

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Autism, suicide, mental health 

It is also true, of course, that an autistic adult who is still managing life okay is unlikely to research autism for a self diagnosis, receive an informal diagnosis, or seek formal assessment.

I haven't encountered anyone diagnosed in adulthood who was not struggling in significant ways.

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Autism, suicide, mental health 

That does not mean those around us will see those struggles. Every autistic adult I've encountered learned to mask or hide to one degree or another. Some of us do it to the point of passing, but almost everyone does it some degree.

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Autism, suicide, mental health 

Nobody accepts our natural responses and they can generate hostile responses. When people talk of bullies, there are usually periods where it happens, it's from peers, and and there might be a specific bully leading the attacks.

That's not usually how it works for autistic children (and to some degree adults, though adults have more agency). It's not how it worked for me.

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Autism, suicide, mental health 

First, looking back at my childhood, I have no idea who among the people I considered friends really were friends. If someone was willing to listen to me, let me hang around them, and would talk to me, I tended to call them my "friend".

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Autism, suicide, mental health 

But I don't even remember the general haze of hostility and bullies I routinely ignored or escaped. Those were background noise.

The incidents I remember are when "friends" suddenly yelled at me, taunted me, or hit me for reasons I never understood and then were fine with me again the next day.

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Autism, suicide, mental health 

And my struggles were not just with peers. Teachers did not ... appreciate me, with rare exceptions. Other adults would react negatively to me. Every person was a potential threat. I kept trying but I was in 8th grade before I trained myself to be pretty decent at camouflaging enough of my differences that the hostility lessened significantly.

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Autism, suicide, mental health 

And then, of course, you are living a life where you keep significant aspects of yourself managed, suppressed, and hidden. In order to do that, your brain has to deflect your own attention away from them while also managing them. It's really hard to describe to someone who hasn't lived it.

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Autism, suicide, mental health 

And you keep doing that. Every day. Trying to find a place in the world. Trying to connect with people. Trying and failing over and over again.

Or you give up and retreat and become completely socially isolated.

But every day you get up, put on the face you need to wear and do the things you need to do.

Until you simply can't anymore.

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Autism, suicide, mental health 

For me it got harder and harder and harder every year throughout my 40s. I got to the point where I felt completely overwhelmed, barely able to function, and had no idea why.

Anti-depressants made it worse. Therapy did nothing. I was stuck.

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Autism, suicide, mental health 

But I still got up. Went to work. Managed household responsibilities. Did whatever the kids needed me to do. Participated in everything I was expected to do.

The only outward sign even anyone in my family could see was when I self-medicated with alcohol when it became completely unbearable.

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Autism, suicide, mental health, bullying 

@tmorizot Thank you for this. I've always felt like I was bullied especially in elementary school, but I can't point to specific instances and it was never physical. It's hard not to second guess myself, but I know the people who were unsafe, who I was afraid of. I know that period of my life felt dark and I felt alone and I cried often, which people would then make fun of me for. And I remember a friend telling me I wouldn't be bullied if I was normal

Autism, suicide, mental health, bullying 

@Laura_I I generally preferred to hang out on the outskirts of groups of girls and play whatever games they were playing. However else it went, they were much less likely to push, hit, or kick me. 😫

And usually adults were no more safe for me. And yes, it's not like everyone around us doesn't tell us either bluntly or indirectly that we aren't normal.

It doesn't have to be that way.

gernsbacherlab.org/wp-content/

Autism, suicide, mental health 

@tmorizot 😭👌🏽

Autism, suicide, mental health 

@tmorizot I'm studying the connection right now, and several independent studies have shown that there is a statistically significant overlap of transgender identy and autism. I think it's fair to say that it's conclusive. The 'why' is still theoretical.

Autism, suicide, mental health, trans identities 

@Michaelcraddock @tmorizot This is entirely my own speculation, but I wonder if the connection involves the fact that autistic people tend to care less about social norms including gender norms, so it's easier for us to recognize we are trans or we are less likely to suppress it just to fit in if we already don't

Autism, suicide, mental health, trans identities 

@Laura_I @Michaelcraddock I'm not entirely sure that we care less as much as we simply don't naturally absorb as much social information. In my case, I've always been gender-conforming because I absorbed less and thus a lot of my gender performance is actually part of my camouflage. And the parts I find too dissonant I simply don't perform.

Autism, suicide, mental health, trans identities 

@tmorizot @Michaelcraddock Yep. Today I've been realizing that maybe I'm nonbinary and I'm like wow that makes a lot of sense. Like I'm just not that concerned with what my gender is so I just go along with the way I was socialized because it's the path of least resistance, but I reject the things that are too hard. So basically exactly what you just said haha

Autism, suicide, mental health, trans identities 

@Laura_I @Michaelcraddock The gender I was assigned at birth doesn't cause me any particular distress. I'm generally comfortable with being perceived and treated as that gender. I reject the parts I've never liked and embrace other things where they feel more comfortable. So I consider myself cis.

Autism, suicide, mental health, trans identities 

@tmorizot @Michaelcraddock Wow yep. I'm pretty much feeling exactly the same. Although I'm in a women in leadership class right now and kinda wishing I wasn't, because idk the way they talk about stuff makes me uncomfortable. As if all women are inherently one way and all men are the opposite

Autism, suicide, mental health, trans identities 

@Laura_I @Michaelcraddock In those sorts of stereotyped gender role discussions, I usually identify more with the things they ascribe to "women" than to "men". But I definitely don't feel like a woman. I may not strongly identify as a man, but I'm mostly comfortable with that or nothing.

Autism, suicide, mental health, trans identities 

@tmorizot @Laura_I I feel this thread so hard! I too am just ambivalent about my gender. I feel no attachment and very little identification with "man-ness" and less so with "woman-ness."

Autism, suicide, mental health, trans identities 

@Michaelcraddock @tmorizot Same but in the opposite direction haha. Like I'm definitely not a man, but I'm not particularly attached to being a woman

Autism, suicide, mental health, trans identities 

@Michaelcraddock @tmorizot But the experiences I have had and the way I am treated all make me have something at least in common with the narrative of womanhood.

Autism, suicide, mental health, trans identities 

@Laura_I @Michaelcraddock Yeah, and I'm generally comfortable with a form of manhood. I'm definitely very comfortable with the identity labels 'husband' and 'father'.

Autism, suicide, mental health, trans identities 

@tmorizot @Laura_I Old theories of autism talked about the "male-brain" hypothesis, thinking that male-stereotyped patterns of thought were associated with autism. Studies now are suggesting a closer link between autism and androgyny or gender-ambivalence.

Autism, suicide, mental health, trans identities 

@Michaelcraddock @tmorizot Apparently that theory is still going strong with a lot of researchers. Ugh it's such a bad take. On gender, on autism, on human beings in general

Autism, suicide, mental health, trans identities 

@Michaelcraddock @Laura_I Yeah, and then tried to come up with 'female phenotype' for autism, which helped counter some of the bias toward recognizing autistic girls and women. I found those efforts personally helpful because of them described my autistic experience to a tee. I'm hardly 'extreme male' anything. 😂

Autism, suicide, mental health, trans identities 

@Laura_I @Michaelcraddock If I hadn't been assigned a gender at birth and been treated as that gender, I don't know that I ever would have cared enough to identify with one. That sort of hypothetical is hard to determine. I do know that "autistic" feels a whole lot more like a core aspect of my identity than "man" ever has.

Autism, suicide, mental health, trans identities 

@Laura_I @Michaelcraddock Hmm. That should be "gender-nonconforming". Details, details, details.

Autism, suicide, mental health 

@Michaelcraddock I've read some of them. I tend to be careful before I express things as conclusive, especially in population studies where it is notoriously difficult to control for all relevant variables or even correctly identify the ones that need to be controlled. The linkage is compelling and appears strong, though.

Autism, suicide, mental health 

@Michaelcraddock And in this instance, both groups tend to be under-identified. Both face immense social pressure to mask or hide and autism especially is still not well known or recognized.

Autism, suicide, mental health 

@tmorizot thank you so much for this thread. I was diagnosed with aspergers syndrome at the age of nine. I’m 32 now and despite so many of the coping mechanisms I’ve created for myself, despite being able to pass as NT when I need to, I still feel like I’m lost. Helplessly lost sometimes.

I’m bookmarking this thread and sharing it with my friends on the instance I’m on.

You are immensely strong and I admire you very much for that. 💚💚💚

Autism, suicide, mental health 

@RussellTheFox I lived, though sometimes it was a close call. I got very lucky and found enough support that stuck with me to survive. I hope you have or find enough to help you get through as well. Far too many of us today don't make it.

And you're still here and still going too. That's what counts, even or perhaps especially during those times when you don't feel strong at all.

Autism, suicide, mental health 

@tmorizot you’re right, I am still here and while I still have my bad days, I manage.

I hope that I’ll live to see that those on the spectrum get better help, better understanding but most of all, being treated more humanely.

I’ve put my hot takes on this on twitter and got immense hate for it, but I feel another reason for the suicide rate and overall negativity is (mainly internet culture) using autism as an insult and a negative trait.

Autism, suicide, mental health 

@RussellTheFox That's one form of amplification, absolutely. But even when I was a child and it was largely unknown and nameless and nobody knew that's why I was different, the negative social reactions from both peers and adults were pervasive. And studies on thin slice judgments, the unconscious reactions people make in an instant, with a picture, a bit of audio, or even a second of video confirm the negative reactions we receive.

Autism, suicide, mental health 

@tmorizot hit the nail on the head there.

When I was diagnosed, I was living in the state of Massachusetts at the time. That state’s knowledge of autism in the public school system was practically non existent. My childhood in MA was awful and other than living in a small apartment for a year next to a playground that I used to escape and be myself a lot, I have no fond memories outside of that...

Teachers and peers belittling you is awful

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