ADHD Primer, Part 1

As October is ADHD Awareness Month, we will be taking a detailed look at ADHD – what it is, what it isn’t, what it means, and what to do about it.

ADHD is an initialism that translates to Attention Deficit Hyperactivity Disorder. It’s a terrible name that only describes the behavioural characteristics of a few percent of the people who are or can be labelled with ADHD. That is, the initialism is based on a description that is very out of date.

Consider that ADHD was first noted in medical literature about 250 years ago. German physician Melchior Adam Weikard, wrote the first known medical textbook description of a disorder with the hallmarks of what we would now call ADHD in 1779, in a chapter titled “Mangel der Aufmerksamkeit”, (literally “Lost Attention”), in his fourth volume in his series “Der Philosophice Artz”, pages 114 to 120. This wasn’t the first reference to ADHD, just the first modern medical reference. Hippocrates (460-375 BC), considered the father of modern medicine, described patients who had “… quickened responses to sensory experience, but also less tenaciousness because the soul moves on quickly to the next impression” approximately in 493 BCE.

Picture from the page of Der Phisophice Artz, Vol 4, 779, Melchior Adam Weikard, page 114

Every 50 or so years, various European medical texts have re-described the behaviour patterns, often with new names. None of these diagnostic descriptions persisted until 1902 when Sir George Frederic Still, considered the father of British Paediatrics, described some struggling children. He described mostly boys, and how they seemed to move too much. He called this category of people “hyperkinetic”. Hyper means “above the average” and kinetic means “movement”, that is, they move too much.He described it as “an abnormal defect of moral control in children” and that these children “couldn’t control their behaviour the way a normal child would” even though some of “these children were intelligent”. Thankfully we no longer try to use the idea of “moral control” as a medical description!

Medicine evolved and so did the name. Hyperactive/Hyperkinetic Syndrome, Maladjusted Children, Minimal Brain Dysfunction and ADD (Attention Deficit Disorder) are some of the names that ADHD has been historically called in the past. 

Up until relatively recently, ADHD had been recognised as a neurological disorder. It was thought to be “untreatable”.

This changed when Leandro Panizzon, an Italian Chemist in the employ of Swiss pharmaceutical company Ciba, now known as Novartis, synthesised a new chemical in 1944 called methylphenidate. He named the compound Ritalin after his wife Rita (short for Marguerite). Methylphenidate was found to help blood pressure and performance. It was also found to help calm down the hyperactive children such that their movements were muted, their concentration improved and there behaviour improved. This was the first medicine that reliably helped hyperactive people who fit Sir Still’s behavioural description. This first medication was followed by an amphetamine treatment in the early 1960’s, originally compounded to treat breathing difficulties.

We now know that both of these medications work in different ways to produce a similar effect – they increase the available chemical Dopamine in the brain. This gives us some clues as to what we are really dealing with. More about that later.

Even at the point of these medications being discovered to work, ADHD, currently called Hyperkinetic Syndrome, was a neurological condition.

It wasn’t until the American Manual for Mental Disorders’ second release, the DSM II, that the condition and treatment entered mainstream medicine awareness.

On the one hand, this inclusion meant that people struggling with ADHD could be recognised, diagnosed and given some kind of medical treatment. On the other hand, it recategorised a neurological problem into a mental illness in both the medical and social perception. Even with this greater awareness, ADHD was frequently not diagnosed, and due to Sir Still’s early perceptions of it being a boys disease, it was even less likely to be diagnosed in females.

The medical definition for ADHD is very loose. “Attention-deficit/hyperactivity disorder (ADHD) is marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development” [source: https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd]. That describes what to look for in some people, but not what ADHD is or why people have ADHD brains. Worse, it also fails to include a larger number of people who don’t show this trait/symptom.

Recall that the original reason for ADHD behaviour was considered to be a moral failing of the patient. This idea continues to persist in messages like “try harder”, “focus more”, “write lists”, “you are just lazy”, or “stop using ADHD as an excuse”. The more modern inclusion of ADHD in a list of mental illnesses has a new twist, – people think they are crazy and are often gaslit into thinking that they are just mentally ill. “Well, I can’t focus well, because I have a mental illness”. This completely ignored the many ADHDers who live fully functioning, high quality and fulfilling lives.

While ADHD can be disabling, it is not in and of itself a disability. Many people use the creativity and energy of their ADHD to accomplish many great things. Take a look at the entertainment industry – most of that is powered by ADHD. Take a look at the emergency services – again, mostly powered by ADHD. There are pros and cons to ADHD.

The modern take on ADHD is that this is still a neurological difference, as it was first classified after medicine started to let go of the moral aspect of disease. I’m using the literal definition of disease here – dis – ease. When things aren’t right, and you can’t be at ease. The ADHD community identified as Neurodivergent from the mainstream Neurotypical population. Much like left handed people, different but not broken.

The poor medical definition of what ADHD is, and how it works, has led to very badly designed studies. This often confused exactly what the scientist is actually testing, measuring and understanding; which then frequently leads to erroneous conclusions and people using scientific contradictions to handwave that “ADHD isn’t real”, “it is just a label for naughty people”, or other excuses to be negligent in helping or disenfranchising a decent percentage of the population.

Speaking of a percentage of the population, because the definition of inclusion for ADHD is so vague, it is next to impossible to get a rational scale of prevalence for ADHD in the world population, or country populations and genetic populations. My estimate is about 10 to 15 percent of all humans are ADHDers.

So what is ADHD?

Currently, ADHD is diagnosed based on behaviours that persist for more than 6 months and look either inattentive, and or hyperactive. That’s it. Most countries will include that the behaviours must have been noted before the age of 12 years of age (which can make a late adult diagnosis tricky when the professionals didn’t notice or record relevant difficulties), but not all countries. Some countries refuse to consider that ADHD is even a thing at all! This poor medical and scientific definition has led to the inclusion of anything that can lead to attention struggles, such as acquired or congenital brain damage, metal toxicity and other neurological conditions. This makes international prevalence, diagnosis and treatment comparisons like trying to compare apples and bananas. Yes, they are both fruit, but that’s about three only point of similarity.

In my opinion, this is very wrong. We have tests for those other conditions, and while ADHD medication may help those conditions too, methylphenidate also helps blood pressure, and that clearly isn’t ADHD.

In my professional opinion, ADHD is a very strongly heritable congenital neurological difference characterised primarily by low dopamine supply issues not otherwise described by other better forging conditions, and a secondarily related adrenaline imbalance in most ADHDers. The Dopamine issue can present as brain fog, struggles with Executive Function problem resolution, dissociation and eating disorders. The adrenaline issues can present as anxiety, aggression, extreme moodiness, self harming behaviours, sleep problems, kinesthetic hyperactivity and impulsivity.

Stay tuned for a more in depth explanation of all of this.

Stay tuned for a more in depth explanation of all of this.

Average Jo Envy and Divergent Pride

I was talking to a client today about “Average Jo Envy”.

TL:DR – The most common group is the “average” group. Peer group pressure makes us feel like we have to conform. Not fitting in to the most common group triggers fears of rejection. Fatigue and a lack of guidance on how to fit in can trigger envy, which I call “Average Jo Envy”. It is important to acknowledge this natural feeling, then move on to becoming proud of yourself for your differences.

Your local society is set up for the average person who is using it; it’s more efficient to aim for the majority and let the minority sort themselves out. It’s a bit exclusive, but not intentionally so. That is, if you aren’t “average”, then society is set up for them (Average Jo’s), not against you.

Society has some excellent guidelines for how to be “a person in this world”, which is aimed at average people to do average things. If you are not in that group, or don’t want to do those things, then examples and guidelines are a bit sparse to non-existent. 

Instead of recognising and legitimising differences, there is a great deal of default pressure to be an Average Jo doing an Average Thing ™. This can leave us feeling lost and disincluded.

It is easy to start to feel envious of how easy it is for many people to do the average things they do, how easy it is for them to learn the skills that are taught in a default way, to feel welcomed by average people into their average groups, and feel a part of the average community.

It is important to recognise that this feeling is a normal response to feeling like an outsider; which can happen when you look different, feel different or are directly told “you can’t do that/join us because ‘reason’”.

Peer group pressure is often misrepresented. We are told in school that peer group pressure is your peers pushing you to do bad things, like drink alcohol, take drugs or do riskey actions. While this does happen, this is actually a fairly weak force for us. Peer group pressure is actually an internal process of conformity. Once you have identified enough with a group, we want to be included and welcomed by the group. A strong driver of inclusion is conforming to the average behaviours and appearance of the group, and that is achieved by mimicry. You mimic what you see, and whatever you aren’t mimicking feels like you are going to be judged badly and ostracised. We fear that look of either pity, or disgust as that is the prelude to rejection.

People who have a difference to the group will struggle to mimic effectively and feel genuine in themself. This can foster imposter syndrome – the feeling that you don’t really fit and the fear of being found out.

We can feel fatigued by the effort to force ourselves into someone else’s model, one that is hard for us and easy for them. We can feel like failures. We can feel rejected, mistaking their impatience and ignorance expressed via disgust and pity as evidence that we are disgusting, pitiful and a burden. We can hate ourselves. We can feel very alone.

In response to this, we can feel envious about how easy it is for average people to do average things. 

We forget, though, that we can do some amazing things that average people are envious of. There is envy in both directions. We forget that we can find people like ourselves and find our group that we just fit in with better, even easily. We forget that humanity is a huge diverse population, and being different is an awesome thing.

Divergent Pride is where you reclaim feeling proud about your difference.

It is important to separate the difference from the judgement about the difference. As an analogy, no tool is inherently good or bad, so judging a tool as a “morally good” or “morally bad” tool makes no sense. What defines the tool is how it is used. Similarly, no difference is inherently good or ill. Using the trait for ill can bring judgement about the use, and perhaps that can inspire shifting how you use this difference for good. 

Be proud of your difference, and how you can use this for good, instead of internalising that someone else has defined it as bad.

Once we start to be proud of our differences, we increase our ability to be our genuine self. Instead of trying to minimise ourselves, our differences, our traits and thus ourselves, we stand up tall and be strong, healthy versions of us.

It is far better to be your best self, than a half successful mimicry of someone else.

Toxic People – Mind Toolset

People can be hard. It can be difficult to work out what who to trust and who to distrust. Some people need special care in handling, some people are just toxic. Here is a series of ideas that helps you to get from meeting with the assumption that they are decent, to a potential recognition that this person may need to be treated with lots of caution.

Principle of Charity: “Interpreting a speaker’s statements/actions in the most rational way possible and, in the case of any argument, considering its best, strongest possible interpretation.”

[More]

When you meet a person, or are not aware of all of the facts, assume they are trying to do the right thing with the information and abilities they have, that they are trying to say the right thing and don’t know how to say things better, and any ill consequence is hopefully ignorance.

Hanlon’s Razor: “Never attribute to malice that which is adequately explained by stupidity.” attributed to Robert J. Hanlon

[More]

Mallice is actually quite rare. When you are confronted by an anomolous (rare) situation that seems mallicious, in the absense of concrete evidence that this likely to be a stupid error.

Margaret Atwood ‘…the difference between stupid and ignorant was that ignorant could learn.”

Alias Grace Quotes by Margaret Atwood

If you’ve talked to the person about what went wrong and why that was a problem, then ignorant people will learn and not repeat the rationally explained and reasonably evidenced error. You shouldn’t have to explain too much or go into too much detail to be able to tell the difference between someone trying to learn what went wrong and someone refusing to engage (mallice), or incapable of engaging (limited capacity aka stupid) in the process.

Grey’s Law: “Any sufficiently advanced incompetence is indistinguishable from malice”, unknown author

[Gooden, Philip (2015). Skyscrapers, Hemlines and the Eddie Murphy Rule: Life’s Hidden Laws, Rules and Theories. Bloomsbury Publishing. p. 83. ISBN 978-1-47291503-0.]
While this is a useful idea, the original author is not known. It borrows both Clarke's Three Laws regarding sufficiently advanced science being indistinguishable from magic, and Hanlon's Razor from above.

At some point, it doesn’t matter if the person is mallicious or stupid, if they keep hurting you, they are toxic to you. Get away from them.

This sounds easy, but can be very hard – especially if the person is a parent or child and there is a dependent relationship between the two.

If you need some help to navigate if a situation is toxic or not, speak to a trusted friend, or see a therapist to help get a reality check. Therapists are also generally good at helping you find a way out of messy situations with toxic people, even families.

Autism is not Overdiagnosed

I’ve heard quite a lot of people state that they think that Autism is overdiagnosed, and a few stating we are in an Autism Pandemic.

No. This is not true.

Part of the problem lies in comprehending what a diagnosis actually means, because most people don’t understand what Autism actually is. The stigma is that Autism is a disability, an illness, a problem. While it is true that Autism can disable, is often comorbid (existing as well as) illnesses and can creates problems; Autism does not always disable, is not an illness, and doesn’t require problems to happen.

Being Autistic is not a bad thing.

People who assume that Autism is a medical label for a type of disability, illness or problem find it hard to understand why knowing you are Autistic if you don’t experience any of these is important. These people will argue against labelling people because labels are stigmatising, while ironically making the label stigmatising.

Knowing that you are Autistic is empowering. When you know that you are Autistic, it helps you understand traits that you live with, the traits that affect you, and that these traits are normal and okay; just different to people who are not Autistic. It helps you know that you can drop the mask when safe to do so, and it is relieving to doso. It enables you to comprehend why neurotypical people struggle to do some things, and why they do so many odd and illogical things. It helps you compensate for some of your own specific weak areas that you previously thought were failure or some kind of darkness.

You don’t need to have a “medically significant problem” to know your heritage and be empowered by that knowledge.

Chris from “Autistic Not Weird” surveyed many people to accumulate some very interesting statistics. Those who are diagnosed with Autism and the professionals who help diagnose both agree that Autism is not over diagnosed.

Survey indicating that most autistic and professionals agree that Autism is not over diagnosed
Source: Autistic Not Weird, https://autisticnotweird.com/autismsurvey/

In my professional work as a therapist, I think that Autism is woefully underdiagnosed, and that under-diagnoses is blinding people to important information about themselves. That lack of information can be very harmful and lead to complications that just are not necessary.

Don’t let the stigma others carry block you from either getting your own diagnosis, self-diagnosing, or facilitating the diagnosis of a loved one.

—————

Original text

[From the Facebook Group “Autistic Not Weird”]

Yes, there may be a striking difference in the level of disagreement, but the results are fairly unambiguous: both autistic respondents AND non-autistic professionals generally believe that autism is NOT over-diagnosed.

And honestly, it’s an idea that’s very damaging to autistic people (especially those who find diagnostic services inaccessible), so it’s encouraging to see the professional recognition of what most of us already acknowledge. -Chris

[Link to Full results and analysis]

Eye Contact is Overrated

When we look at an object, light reflects off that surface, strikes our eyes, goes through our lens, triggers photo-receptors on our retinas, triggers an ion cascade through nerve fibres to our brain, branches through our limbic early warning system and up through to our occipital region to paint an hallucination of the object within our mind that doesn’t exist.

To understand what this image is, elements of it go to various parts of our brain, a network to identify the base category [table]. Once identified, another network of brain parts starts to inform you of basic properties [sturdy but not strong, need a coaster, not a weapon]. For anything that is within your catalogue of known items and fits closely enough to things you’ve seen before, this process is so quick and automatic that you don’t even consciously think about what it is that you see, you just know.

When we look at someone’s face, we are supposed to pick up the cues of pupil location, changes in eye shape, colouring of the cheeks, muscle configuration, amount of teeth shown, wrinkling of the brow, wrinkling of the nose, flare of the nose, twitching of certain muscles, activity of the ears, orientation of the head, stiffness of the neck and so much more – to try to figure out both if we know this person, and also what is their internal state.

Many studies have shown that the amount of brain activity needed to determine if you recognise a face and identify a person – and the amount of brain activity to determine what the internal state of that human is – is very high.

For most people, determining faces and that person’s internal state is considered a priority task. Humans are tricksy beasts, often hiding what they are truly feeling, masking their moods and deceiving others. Often this deception is for their own protection, but enough of the time, it is to take advantage of or harm another. In this era where most of the wildlife has been tamed or killed, the predators that are actually dangerous to us are humans.

Additionally, to work together as a team, it is important to know what your team is doing without having to explicitly be told, and it is helpful for them to know your state without you having to tell them. This non-verbal communication not only avoids cluing in the prey animal we are hunting, it allows for communication in a noisy environment, at a range, or in a hostile situation.

So it makes sense that humans evolved an internal brain network that is not only good at detecting faces to recognise them as friend or foe, but also to register the internal state and intent of those we see, so that we can either brace for attack, or work more effectively as a team on collaborative tasks. For most, it only takes a few key signals to quickly and efficiently determine someone’s mood and intent. Each person viewing another’s face will use a different combination of cues, but it is enough to get there. Consider how much of a table you need to see to guess accurately at the rest.

It is a great pity that many autistic people have not got this automatic process (some do). Often it is “yes that is a face, that seems happy?” much like you would for a table. The process doesn’t have that extra nuance of “happy with the food, upset at something else – from the stiffness of their partner, I’d say they have a disagreement”.

Determining a person’s internal state and intent can be learned as a manual skill. Like all acquired skills, it is slow and cumbersome at first, and in time can be improved to the point of being an automatic process. In this regard, it is similar to learning any manual skill, such as tennis, judo or driving. We were not born knowing these manual skills, but we can acquire them after birth from manual learning, and get so good at them that we can be very proficient. Some people, though, are only ever mediocre.

It is important to recognise that even those who hone the skills to an expert level are doing a non-natural task, which makes it more taxing to the brain system than automatic tasks like breathing, or beating your heart. Consider when you’ve pulled over your car, turned the radio down so that you can look at the map, or missed a turn because the conversation was too distracting. How often have you forgotten to beat your heart?

Manually learned tasks are inherently inefficient. Determining internal states and recognising faces is already a highly taxing mental task in those who have the evolved automatic process; for those who manually had to learn it, it is even more taxing.

For many autistic people, eye contact is hard. It takes a lot of processing to “read a person”. Due to a history of errors, there are a lot of features the autistic person will use to try to gauge and error-correct an impression. Even so, doubt will exist as the differences between earnest and honest expressive people, nuances and deceptive people is subtle. A deceptive person who is bad at it won’t get very far.

If the autistic person has got good at this task and isn’t too stressed or fatigued, they can fake eye contact fairly well. Even so, there are likely to be lots of calculations in the background of “am I making too much eye contact?”, “am I making too little eye contact?”, “what does that twitch mean?” and “I think I’ve missed something”. As stress and or fatigue rise, eye contact becomes harder. If the person hasn’t got good and efficient at this manual task, it was already hard to begin with.

This hasn’t even yet included adding ensuring that your own face is conveying “I’m not a threat” and enough of your own mood to help them help you, or not help them harm you.

Many western cultures run under the practice of “eye contact is honest”. Too little eye contact implies “deception / disrespect / uncertainty / subservience / inattentive etc”. Too much eye contact can be read as “invasive / challenge / threat”. It can be a systemic enculturated discrimination of autistic people.

Many autistic people describe the feeling of forcing themselves to make eye contact as “uncomfortable / a pressure behind my eyes / disorienting / dumbifying”. Each of these describes the increased cognitive load trying to process a face and how that can reduce the resources to do other things, like hear what the person is saying, think of a response, still stims and other movements etc.

When an autistic person stops looking at your face, but continues to talk to you, especially engaging in your conversation or talking about a subject they are passionate about, they are conveying to you respect, affection and enjoyment. They have likely stopped eye/face visual contact to give you more attention, because they want to understand you and what you are saying and meaning. You can help them by adding in verbal descriptions about how you feel about what they have said, and being more explicit in verbally stating your intent and checking that you have both understood the other.

Eye contact is overrated.

Sensory Sensitivity

The standards to which we create things are based on the average wants and comfort levels of people. The biggest group is called “typical”, and since perception is about how your brain perceives things, we refer to their neurology as neurologically typical; shortened to neurotypical. Importantly, all people have a limit to what sensory they can process before their functional capacity declines.

Average is nice, but tends to exclude a good number of people.

For example, the loudest that electrical equipment can be is based on the average loudest dB that doesn’t cause pain or damage – which means that it does cause pain and damage for some. Additionally, domestic (home) equipment doesn’t sell well when it is too loud or sounds too obnoxious to people – you’d rather buy the brand that sounds less bad.

At some point in manufacturing, industries get lazy. For example, most vacuum cleaners sound about the same – that is, they are about the same loudness, and about the same pitch. It is the natural meeting point of “legal”, “sells well” and “cheap”. If you want to purchase a vacuum cleaner, and you aren’t very rich, you will settle on the least objectionable item – and they are all basically the same.

It is not uncommon for an autistic person to be more sensitive to some types of loud sounds and some types of pitches than neurotypical people. This sensitivity can be felt as physical pain, or mood pain such as anger, sadness or anxiety. Do you hear the electronic devices screaming in a super high pitch? Perhaps you hear the deep hum of the refrigerator and it irritates you. 

Too much sensory input

Not all autistic people will struggle with loud sounds, or with certain pitches. 

I’ve picked on audio as a place to start from. All of our senses have these issues, whether you are neurotypical or neurodivergent. There is a limit to how much or how little a phenomenon can be for any person to perceive. If you detect beyond the average range (eg very high sound, or very low sound) then you are hypersensitive; if you detect below the average range (eg can’t taste that food where others can) you are hyposensitive. You may note the phenomena, love the phenomena (philic response), or hate/fear the phenomena (phobic response).

I want to emphasise that being hyper or hypo sensitive isn’t necessarily a good or bad thing. Each are useful and hindering in the right context. I was supporting an autistic person to purchase a phone. They wanted to feel the texture of the phone before purchasing it, to minimise a sensory rejection of the item. When the sales assistant returned the phone to its cradle, they accidentally set off the burglar alarm. This was very, very loud and warbled at a particular pitch that was quite unpleasant. The store was emptied within seconds. The sales assistant was shaking as they tried very hard to focus enough to return the phone to the cradle properly and deactivate the alarm – the alarm was making it very hard for them to think. The autistic person I was supporting just stood there and waited, seemingly unperturbed by the sound. I checked to see if they were ok, and they responded that while the noise wasn’t fun, they were perfectly fine. We then held a conversation for a few minutes while waiting for the sales assistant to finally deactivate the noise, which confirmed that my person was not flustered or discombobulated. While the hyposensitivity to this particular noise wasn’t useful in this instance (beyond not having to run out of the store like all of the others), I can imagine a setting where it would be. This could have also gone the other way, where if my person was hypersensitive to that sound combination, I may have had a sobbing or aggressive person on my hands.

There is an excellent argument that if we, as a society, made some additional considerations of sensory sensitivities, then everyone would benefit. Imagine, being able to purchase a cheap and effective vacuum cleaner that was half as loud and less obnoxiously pitched. Imagine each room in the office building having their own climate control, so that the person in the room can pick the temperature that works best for them.

In my opinion, everyone would gain from society requiring more consideration to sensory limits, not just autistic people.

Rejection Sensitivity

Rejection Sensitivity is a strong reaction to perceived or actual rejection. It can often be triggered by fearing having done something tenuous wrong that another person will then act upon, or by the perception of negative feedback.

It often starts as a result to poor masking. Masking is a mechanism that neurodivergent people, such as autistic and adhders, use to seem like others, to fit in with the crowd and be accepted. The problem with this method is that neurodivergent person is not actually accepted, only their mask is.

When this fails and the person is rejected anyway, it triggers a spiral of “was it me”, “was it my mask”, “did they see the real me?” and “what do they want from me?”. Being seen behind the mask, not knowing how to fix the mask, and not understanding why you’ve been rejected is terrifying.

Image of male indicating rejection with the "thumbs down" hand sign
Being Rejcted

When it works, neurodivergent people can mistake themselves for the mask, or always feel empty, dishonest and false. Neurodivergent people can feel that they are what they produce and lose themselves in their identities such as work, rescuer and provider. These are all roles, and are not you.

When entering a group, the neurodivergent person wants to know what role they fulfil to “fit in”. What do you, the group, need? How will I be able to add value, so that you will value me? To decrease the risk of immediate rejection from the group, the neurodivergent person may bring gifts, services and work extra hard. It is not uncommon for the neurodivergent person to put so much work in, that they are doing the work of 2 or more people. Just don’t reject me!

Abusive people love to take advantage of this sensitivity and extra goods from the neurodivergent person.

Rejection Sensitivity is a thing. RSD aka Rejection Sensitivity Dysphoria, is not.

Rejection sensitivity comes with some cousins.
– Rejection sensitivity
– Imposter Syndrome
– Fear of Betrayal
– Fear of Abandonment
– FOMO (Fear of Missing Out)
– Fear of Failure
– Fear of Being Alone
– Conflict avoidance

To manage each of these, people form “People Pleasing” behaviours, avoid ever pointing out someone else’s mistakes and take on far, far, far too much responsibility. Until the neurodivergent person collapses in exhaustion and experiences burnout.

The central error in this is mistaking your worth as your product – gifts, services and sacrifice.

Your worth is in you as a person, not what you do for others. You are a Human Being, not a Human Doing.

This reorientation of worth allows the Human to make mistakes without being a mistake, and from those mistakes, learn, grow and change.

This allows you to produce a reasonable amount, instead of a superhuman amount. After all, the person in the team who does the least is still getting paid just as much as you are.

This makes it easier to spot those who are abusing your generosity and cutting them off. This allows you to walk away from that toxic situation.

When a neurodivergent person begins to arc up with extra sensitivity from any of the above trigger situations, they can query themselves – am I experiencing Rejection Sensitivity? Then take a pause and separate the feeling of personal failure from the situation. You haven’t changed – the situation has.

Sometimes the neurodivergent person has made a mistake, and if so, it will be clear and obvious. We don’t lose friendships over subtle problems, and a person who claims we made a subtle or illogical and non-evidenced error is someone to be aware of – they are likely toxic and may also be abusive (take the opportunity to get out of that relationship). Once we have identified the error, what can we learn from it? Can we adapt and adjust our actions, plans etc to factor in this new information? How can we grow?

We have turned a mistake into a growth opportunity.

Learning how to identify toxic people is very important. The odds are that if you have a high rejection sensitivity response and it is frequently triggered, then you are likely “surrounded by arseholes (TM)” [a ‘diagnosis’ I sometimes give my anxious people in hostile social situations].

I find the red, amber, green flag system useful for doing evaluations of the person/people who trigger the Rejection Sensitivity.

Red flags are “red alert” style behaviours (double standards, moving goal posts, claims of error without evidence, faulting you for not reading their mind).

Amber flags are “wake up and take a close look” behaviours, where something seems off, but it isn’t clearly a red flag, but it might be. This is the time to take the rose tinted filters off our eyes and take a cold hard look. Is this odd behaviour an anomaly, or is it actually a trend? Everyone has the right to a bad day.

Green flags are indications that our relationship (work, intimate, friend) is on the green – aka good. Things like “does what they say”, “informs you of the important bits in a timely fashion”, “asks for reasonable things”, “believes you”, “has a single standard”, “understanding”.

Once you’ve started to learn about how to spot the toxic people, and that their behaviour isn’t your fault or responsibility, you can start to yeet the toxic people.

Then, with a bit of retraining, your Rejection Sensitivity can calm down.

There is a strong caveat here. Even after internalising the above, you can still struggle with rejection sensitivity. Two main causes for that is past trauma – get some trauma counselling; and an adrenaline/mood problem – investigate medication.

If you want, I can go into those two in more detail. For now though, see a professional.

Social Scripts and Social Contracts

Introduction

Social Scripts are a good way to shape social behaviour and small talk. 

Social Contracts are agreements that you feel obligated to uphold. 

Each of these allow society to be civil with low effort.

Errors in either of these can cause social awkwardness. Additionally, some people exploit Social Scripts and Social Contracts for their own gain.

We are going to define these terms and explore some of the ways they can be exploited, and what you can do about it.

Video

Social Scripts

We have enough to do in society without having to manually come up with a solution for everything. Often we learn a way of doing things that is efficient and good enough, that we then make into a general habit. Consider how you make your favourite hot drink. You will likely have a preferred order that you do the parts, which allows you to make a good enough drink in a specific way without having to experiment further and this means that you expend little effort in making that hot drink.

This idea of efficient habits can be applied to many things that you do. In this case, we are going to look at how communication habits have evolved certain Social Scripts. 

In theatre, scripts were developed so that the actors knew what they were supposed to say, have some idea about how the lines are supposed to be delivered and also what kinds of actions are needed to accompany those lines. When interacting with other actors on the stage, the other people are supposed to follow the same scripts and respond to your lines and actions in an appropriate way. The same script can be interpreted in a number of ways, changing the look and feel. Even so, the script works, and actors who pick up on that look and feel, can use the same script to interact.

Imagine for a moment that you have two actors who are following the scripts that they have learned, but through some comedic error, they have each studied different plays. Their scripts are not going to align and the interaction is going to be very disjointed and erroneous.

When we refer to Social Scripts, what we are talking about leans heavily on this script metaphor. Rather than acting out a scene in Hamlet, we are acting out a scene of the “Greeting Script”. We often refer to this one as “small talk”.

While there is flexibility in how the interaction can occur, there is an expected sequence of questions and responses that still fit within the basic parameters of the Social Script. This allows the people who are meeting to feel comfortable in how the interaction is going without having to put too much effort into thinking about exactly what they are doing. They are just following the script and script response.

When they work, the benefits of having these scripts is that standard communication becomes simple, safe and easy. A problem is that for some, scripts becomes formulaic and boring. 

When people complain about having to do “small talk”, this formulaic and boring aspect is often what they are referring to.

If the scripts misalign too much, then chaos and confusion can occur. This is fine if the intent is a comedy sketch on stage, but far less fun in real life. It is important to notice when the script is failing and stop running on autopilot and take manual control of the conversation. 

Sometimes the script goes off course because the other party is exploiting the script. More on that later, but the brief solution is to again take manual control of what you are saying instead of relying on the automatic script.

Social Contracts

Hopefully we all know what a contract is.

[Aside] A contract is a formal agreement between two or more parties to achieve a specific outcome.

Once both parties have agreed to the contract, then they are bound to complete their part of the contract, and should both do so. In doing so, it is expected that the planned outcome should occur. The nature of this being formal is that all parties explicitly agree to the parts and often there is paperwork or some other record to back that agreement up.

[Aside] Explicit means it is “stated clearly and in detail, leaving no room for confusion or doubt“. Implicit means that it is “suggested though not directly expressed”.

When interacting with people, it is not feasible to formally discuss, negotiate and record every agreement. Nor is there time to make agreements over everything. As such, many of our interactions rely heavily on implied agreements, or informal but discussed agreements. Similar to Social Scripts and Templates, Social Contracts save us a great deal of time and effort in manually working things out.

[Aside] Political philosophy has a social contract that relates to the authority of the rulers over the ruled, and that they need to look after the ruled to avoid them rising up against the rulers. This is not what we are talking about here. 

In this context, a Social Contract refers to the feeling of obligation you may feel to another party because of an explicit or implicit contract you feel that you have made with them.

Much like a formal contract, if you and the other party or parties do the parts you have all implicitly or explicitly agreed to, then the outcome should be good. 

What is concerning is when parties do not do their parts. This can be because they fail to do what they said, they change the terms of the agreement, or some other external thing interferes.

Consider an agreement I make with a Car Yard. I go in to purchase a vehicle. I spot the car I want, and negotiate a price and ask for some modifications to be made, such as added tinting. A contract is written up that states that I will deliver the agreed upon monetary value and in response they will sell me the specific car with the modifications by a certain date – let’s say next Friday.

I go to the Car Yard on the specified date with my cash. I pull out my copy of the contract and ask to pick up my car, ready to hand the cash over. The sales person confirms understanding and organises for my car to be brought around to the pick up point. Up drives the wrong car. Not only is the car not the one I purchased, it is an inferior car.

I point out to the sales person that this is not the car I purchased and humorous as it is, please go and get my car. The sales person informs me they have sold that car to someone else, but they do have a car here, and as I am under contract, can I now hand over the money?

Am I under contract? 

[Aside] Not any more. 

The Sale Yard has breached their side of the agreement, so I am no longer obliged to follow through with my side of the agreement. I can turn around and leave with my cash. They didn’t deliver their end of the deal, and worse, they tried to change the terms. 

[Aside] I could agree to the new deal if I consider it a better deal – but I don’t, and I have that choice. The choice to say “No”.

I hope that is fairly clear on the formal legal contract side.

What is odd is the number of people that I see who are trying to stick to their end of the Social Contracts they have made with people, when the other party has breached their end of the contract. These breaches can be due to changes of terms without notice, failure to do their agreed upon actions, or simply breaking the social etiquette rules.

Bringing it all together

Consider you are walking down a shopping mall, talking to a friend about some deep philosophical questions, such as is choc mint ice cream a good or bad flavour combination. 

[Aside] Mileage may vary.

Into your conversation intrudes a sales person for an environmental outfit asking “Do you care about the environment?”

“Well of course I do”, I respond.

“That is great! We are working on helping the environment and if you care about the environment, you should help us to do so! It’s really easy to help us to help what you love” says the sales person.

The conversation becomes quite awkward at this point as I try to figure out how to escape this logic trap. I want to help the environment, I have just publicly stated that I do care and here is a person showing that if I care, I should help them – financially of course.

I feel trapped, because I’m trying to maintain my end of being civil while the other person is not.

First of all, I’m script like responding to a reasonable question “Do you care about the environment?”, to which the only reasonable answer to the question seems to be “yes”.

The Sales Person has used a common social script to trap me into a conversation and taking a specific position. It would feel rude ignoring them or telling them to shove off.

The Sales Person further exploits the Social Script of being consistent and honest and to aid in pushing me into feeling obliged to fulfil the Social Contract of “help out”.

This is a nefarious trap.

[Aside] Hash tag, not all sales people.

Let us consider the breaches of Social Script and Social Contract.

First – The sales person stepped into my private conversation, intruding themselves into our discussion and changing the topic from ice cream to theirs. I am under no Social Contract Obligation to answer their uninvited first question. My response can be 

[Aside] “Not interested”.

Second – It is not required that I continue on their script – I can break the script too. 

[Aside] “I’m not interested in contributing to your endeavor – I have my own means of supporting the environment that I love. Best of luck with your sales”.

Third – I don’t have to continue the forced behaviour. The sales person, through their tactic of sales, has pushed me to show a behaviour that they are exploiting. I can simply get off the pedestal that they tried to place me on and say something like 

[Aside] “I am not the sale you are looking for” *hand gesture*

Should the person try to persist in breaching Social Scripts or Social Contracts to exploit me, I can now become “more rude”. 

However, I do recommend doing a brief cost benefit analysis. 

Yelling at the salesperson is not really going to help either of your days. Just walking away from a pushy sales person is going to benefit yours. Reporting pushy sales people to the shopping management will make their day much worse.

Lastly, sometimes the contract is breached not by you, or the other party, but by an external circumstance. Consider that the reason the Car Yard can’t deliver the vehicle I purchased because one of the signs in the Car Yard fell on the vehicle and it is no longer in the condition that I purchased it in. This is technically no one’s fault. In similar ways, social contracts may be breached by external things too.

Conclusion

Social scripts are time savers. They allow for simple communication and check ins to occur without too much cognitive overhead. Thoughtless scripts can lead to problems, if either the script goes off track, is not appropriate to the circumstance, or someone else exploits it.

Social Contracts are things that you have explicitly or implicitly agreed to. So long as the agreement was made in good faith, and the other party is doing their part, and no external circumstances have invalidated it, then by default do your part.

However, if the outcome is not what you thought you agreed to, the other party breaches their end of the deal, or the circumstances have changed, you are not obliged to follow your end of the contract. 

Ideally you would renegotiate, but sometimes you should just walk away.

Anxiety – Part 1

Anxiety is a feeling of worry, nervousness, or unease about something with an uncertain outcome. At low levels it prepares us for an experience with low predictability in case the outcome is not good for us and we need to act quickly and decisively to become safe. This is a good thing.

Video link to the video this is a transcript for

Anxiety heightens our perception of change and harm so that we can better prepare for emergency action. That action is usually driven via the fear reflex – freeze, flight and fight.

Anxiety is supposed to be short term, and give us a clear idea about what we need to be cautious about, even if you can’t see it. Anxiety is generally about known situations that should pass.

Ongoing anxiety keeps you at a level of alertness all of the time. It drives hyper vigilance, hyper reactivity and can cause misperception of the circumstances, leading to poor decisions.  

At higher levels, anxiety can incapacitate one’s quality of life, as the anxious person is frequently enacting the freeze and flight fear response, and less commonly the fight fear response.

If you are responding to a simple problem, like a wild animal, then freeze, flight and fight are excellent responses. These often don’t work well with modern civilisation, where it is rare that you need to fight off animals or act in an emergency situation. In modern civilisation you need more nuanced and subtle solutions to life.

The difference between a fear response and an anxiety response is that with fear, the threat really is there and the consequences are that bad. An anxiety response is in the absence of a tangible threat, after the tangible threat has passed, or the response is in excess of the threat.

It is natural to feel anxiety when entering into a new situation, or where the outcome of an action is perceived to be very important to one’s future. It is not normal to feel anxious in the absence of such a situation. If someone is feeling anxious most of the time, there may be a disorder involved. 

The word “disorder” is a medical term we use to describe when something has got in the way of living your life.

We are going to take a whirlwind tour of a few different types of anxiety disorder.

General Anxiety

General Anxiety describes how someone can feel anxious in most places – whether it be the privacy of their own home, safely in their own room; or at work/school; or at a peaceful park. The feeling of anxiety is independent of the location. If this level of anxiety is a core component of your decisions to or not to do tasks, it is likely going to be called a disorder and be labelled General Anxiety Disorder, or GAD for short. It is frequently positively responsive to a class of medications called “SSRI”, which stands for Selective Serotonin Reuptake Inhibitors and generally benefits from talking therapies. If you experience general anxiety and it is interfering with your life, please talk to your doctor about this.

Social Anxiety

Social Anxiety describes how someone can feel anxious in the presence of strangers, acquaintances, friends and family. While not all people will necessarily trigger anxiety for a person with social anxiety, the feelings of anxiety diminish when alone and not thinking about other people’s judgments, reactions or negative experience of the person with social anxiety. In essence, in the absence of others, there is little to no anxiety. 

Social Anxiety is usually a side effect of some other category of problem and is commonly found with autism, ADHD, PTSD or trauma. For some of these, medication can help reduce the symptoms, for some talking therapies are more effective, often a combination of both. Once it has been established that the type of anxiety is social, the therapist should check to see if one of these other conditions (Autism, ADHD, PTSD or trauma) are also present and better explain the anxiety experience.

OCD

OCD stands for Obsessive Compulsive Disorder. Many people mistake OCD for other psychological traits. Let us debunk a few of those.

A person who can’t stand a tile being out of place in the bathroom, for example, or some other broken pattern has a keen Sense of Correctness or Sense of Pattern. While a Sense of Correctness is common in with Autistic people, it is not exclusive to Autistic people, and is quite helpful when accuracy is needed in your job. It is not OCD.

Someone who hyperfixates on a particular interest, or person, or object, can seem obsessive, but this is not OCD either. Again, this is not uncommon with Autistic people, and again this character trait is not exclusive to Autistic people. 

Ritualistic behaviour is a trait in common with OCD, but is not exclusive to OCD. Consider people who follow a particular religion that has specific set of rituals involved, or someone who just really likes the milk poured in their coffee first, not second, or maybe the other way around. Familiar patterns are commonly found with Autistic people, and again are not exclusive to Autistic people. 

I have mentioned autism a few times in connection to OCD. That is because in my experience, autistic people are frequently mistaken for having OCD. While it is possible to be Autistic and have OCD, the OCD diagnosis has to be carefully done by not assuming a sense of correctness, fixation on details or comfort in patterns/rituals means OCD.

OCD is a combination of Obsessive and Compulsive traits that are either beyond the control of the individual or very difficult to resist. Here, obsessive describes a thought or idea that seems to intrude upon the person’s mind and seems like it comes from elsewhere. It is not a pleasant thought or idea; and compulsive describes actions or rituals taken that are repetitive and perceived to prevent an unlikely or disconnected event, generally of a catastrophic nature. As mentioned before, it is a disorder because the thought intrusion and the requirement to do the action interfere in one’s life.

I have included OCD here because of the anxiety component involved. The person will feel very anxious about the future catastrophe and extreme anxiety and fear in the absence of doing the ritual that staves it off, or if the ritual is incomplete or no longer effective.

Some OCD is a learned behaviour, where a person fears an outcome that is generally beyond their control. They perform some kind of unusual action and in so doing, find a feeling of relief. As the fearful outcome has not actually been effected by this relieving action, the anxiety mounts again, so the action is repeated again with a soothing outcome. This cycle repeats and the training of the behaviour becomes stronger.

Most OCD has a neurological component and some medications are quite effective at relieving the symptoms. 

Generally a combination of talking therapies to address the perception of fear and find non-ritualistic methods to self sooth combined with pharmacological treatment are the best solution.

PTSD

PTSD stands for Post Traumatic Stress Disorder. It is one of the best initialisms in the psychiatric part of medicine as it literally tells you what it is in plain language. This is the Stress one feels after a traumatic situation, where that stress has reached the level of a disorder – that is, it interferes with your quality of life.

One person’s bad experience can be another person’s trauma, and that other person’s bad day can be the first person’s trauma. What I am trying to say here is that trauma is personal. Most of us would agree on some common themes of what should be a traumatic experience for most people, such as war, death, pain etc; but not everyone will agree on uncommon themes, such as a long term adversarial experience with a parent, or workplace bullying, or being misnamed. 

PTSD is generally diagnosed after a person has had a reasonable time to process an experience and adjust, but hasn’t. PTSD is characterised by flashbacks, difficulties sleeping, avoidance of certain stimuli related to the traumatic event, decline in mood, hypervigilance, disassociation and a number of other traits. Not all of these need to be present in the person’s post trauma stress. 

I have included PTSD here as a common aspect of the condition is anxiety about when symptoms are going to occur, anxiety regarding a recurrence of the traumatic event and the avoidance of certain stimuli. 

PTSD can be exaggerated by untreated and undiagnosed ADHD, various Personality Disorders and/or anxiety disorder. Sometimes a traumatic event can exaggerate the symptoms of these and be mistaken for PTSD. For those who are assessing, it is important to do a careful investigation of when traits first appeared and not stop looking when a traumatic event has been identified. In my experience, it is not uncommon that behaviours and traits pre-date the traumatic event, and the traumatic experience has dysregulated a management method.

Treating PTSD requires talking therapy and is frequently supported by medications, especially if there is a background condition identified that was not previously being treated.

Phobia

Phobia comes from the greek root word Phobos, meaning “fear” and is used to refer to an avoidance or running away from that which we irrationally fear. Most people have a thing that they are more uncomfortable around than most, and when that level of discomfort drives the individual to an action or makes other actions near the object of fear difficult, the discomfort is considered to have become a phobia. Generally there is little to no logic behind the source of fear. There are long lists of things that people irrationally fear and we are not going to list them.

Earlier I outlined that anxiety is a fear response to thing that is not present, but is anticipated to cause potential harm, and that an anxiety disorder is where that anxiety is either persistent, or disproportional to the event or object.

With phobia, the anxiety is disproportionate to the object that inspired fear. The person with the phobia will frequently try to justify their fear of the thing so that it seems reasonable and rational. However if no one else (or very few) fears it, even when comprehending it, then the likelihood is that the fear is disproportionate or misattributed to a thing that does not deserve it.

Sometimes the fear is secondary to a disgust reflex, where the individual has learned at some level that “that is wrong” and is thus disgusted in the presence or thought of the thing. This disgust is hard to reconcile, so the feeling is quickly changed to fear. This fear can then be hard to socially demonstrate, and so it is then transformed into anger. When we append the word “phobe” to the end of a noun describing a particular group of people, we are often referring to people that are aggressive about that group. When we look at the source of that anger, it is fear, and when we look at the source of that fear, it is disgust. This disgust is irrational and hard for someone to reconcile.

Phobias and phobes can be managed via talking therapies, which will frequently use various forms of exposure therapy after upskilling the person to manage their mood around the source of fear, and upskilling the person’s mind frame about the thing. This may include some careful use of sedatives to decrease the feelings of anxiety such that the lack of consequence from the thing is observed and internalised. Because the phobia is often based on a fundamental illogical disgust reflex, refreshers of exposure may be needed for many years.

It is important to note the difference between a phobic response to a stimulus and a pain response to a stimulus, such as what Autistic people experience. You can desensitise from the fear / aggressive response to a thing, but you cannot desensitise from a pain reaction to stimulus (such as loud noises). That pain response can trigger aggression and avoidance, and can easily be mistaken for anxiety or phobia. This pain response requires a different method of management, which may include some of the same tools as noted before – reframing and exposure, but will often implement sensory aids such as earphones, gloves and tinted glasses, depending on the source of the sensory overload.

Conclusion

While this is not an extensive list, we have covered some of the more common forms of anxiety, why they are different to each other and some of the common errors in diagnosis and treatment.

These forms of anxiety respond well to talking therapies and some benefit from medication. Most of the talking therapies will use similar methods to address the anxiety component.

The Power of Choice

The past has happened

We can’t change it, but we can learn from it

The present is happening

This is the time that we can act, this is where we can make a change … but to what?

The future is yet to happen

We can look forwards and chose a pathway to the future we want.

If you decide what future you want, you can make future plans that change the actions you make now in the present, based on what you have learned from the past

This is the power you have

Use it wisely

Text of image is as above

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