Autism, and What Psychotherapy Can't Do

In the 1940s, Leo Kanner, the psychiatrist who first coined the term 'autism' postulated the cause as cold, intellectual mothers, nicknamed 'Refrigerator Mothers". This idea was then further developed into the 1970s by Chicago professor Bruno Betelheim who perceived autism as a psychological disorder in children, caused by mothers he compared to Nazi camp guards (as a child, Betelheim had spent time in a concentration camp and compared such children to camp survivors).

These days, it is accepted that autism is a neurobiological, lifelong, developmental disorder, with almost certainly originates before birth. Autism is how our brains are wired; it is not just a difference in our psychology, it is not a psychiatric disorder, it is not an emotional disorder and it is not caused by cold parenting or subconsciously hostile mothers.

Well, I say it is accepted... there are some hold outs in the world of counselling and psychotherapy.

Only the other day, I came across a psychotherapist talking about the 'controversy around autism', by which they didn't mean the controversy over how badly treated autistic people are, or how far we need to go to get total acceptance, they meant the 'controversy' over whether High Functioning Autism existed as a disability at all! The myth of autism as a mental illness persists.

I have yet to find a psychotherapist or counsellor who will admit to this directly, however. Maybe they are worried I’ll ask them for evidence of their theories (there isn’t any) or maybe they don’t even realise this is what they’re thinking? On the other hand:

• *A trainee asked me "Yes, but surely, with therapy your autism should improve, shouldn't it?"
• A fully qualified psychotherapist said to me "I'd be interested to know why you cling to this concept of yourself as autistic?".
•  I was contacted by another, offering to introduce me to someone who had 'recovered' from their autism.
• And most common of all, people who have self-diagnosed themselves with autism (usually shy, introverts who resemble the stereotype) and later declared themselves cured! (Such people rarely accept an extrovert like me as autistic).

Not Fitting the Stereotype

I don’t fit their stereotypes: I’m not introverted, I like people, I enjoy socialising. I often wonder how confident I’d be in my diagnosis had I not been diagnosed by a world-renowned neuropsychology professor who said I was absolutely typical for high functioning autism.

So, what am I doing that leads people to doubt my mental health? Some of my neurotypical friends suggested the following:

1. My body language, tendency to talk a bit too fast and a bit too loud, and my obvious effort to ‘track’ large groups (hard work!) can be mistaken for anxiety by people who don't know me.
2. Tendency to be extremely open and honest about how I'm thinking, and feeling can be somewhat startling to people, who may experience false empathy. For example, I say, “I’m worried…” and they think “Wow, I wouldn’t say that unless I was really, really worried” [Note: neurotypicals often feel it it polite to under-state their feelings and only mention them if seriously pressing.] But unlike neurotypicals, I am not understating, I’m saying it how it is. And I’m probably only saying it now because you asked me how I was feeling! (see ’Can I be honest with you?’ below).
3. I can be muddled and disorganised. It's called ‘executive dysfunction’ and is a little-known feature of autism (also found in dyslexics). It is part of the way my brain works, but since neurotypicals can get like this when stressed, it adds to the assumption is I’m seriously stressed! But no, I’ve just lost my pen and am distracted by looking for it, that’s all. No biggie.

So false empathy may lead people to mistake a mentally healthy autistic from a mentally unwell neurotypical. But that false empathy is underpinned by the myths peddled by Kanner and Bettelheim, who offered psychotherapy as a cure for autism.

In their day, the psychotherapy was offered to the mothers (I shudder to think of the harm that did); these days, the autistic person themselves may be offered psychotherapy for their ‘mother issues’. But in neither case did it change one jot of the person’s autism, it just increases the social pressure on the autistic person to ‘perform’ neurotypically, if they can.

Finally, as a lesbian woman I am struck by the similarities between this and this dismal history of psychotherapy and homosexuality. To this day, there are so-called ‘therapists’ who claim to be able to ‘cure’ homosexuality. It destroys lives and leads to incredibly low self-esteem, depression and anxiety. And for all that, it doesn’t even work! All it does is encourage a person to hide their true self.

This is why all of the major mental health professional bodies – the British Psychological Society, the Royal College of Psychiatrists, the BACP, the NCS, the UKCP... have signed agreements, such as the Memorandum of Understanding published by the BACP, banning so called ‘Conversion Therapy’ being offered by their members.

Counselling LGBTQ+ people should be about helping them become comfortable with who they are, not trying to change them. Likewise, counselling autistic people should be able helping them be a ‘fully functioning autistic person’, not trying to change them into neurotypicals (firstly, that would fail, and secondly, in failing it signals to the autistic person that who they fundamentally are, is flawed, broken).

Maybe we need a Memorandum of Understanding for autistic people?

Of course, there is not an exact equivalence between sex and gender diversities and being autistic. Many autistic people may have behaviours they wish to change, which are causing them difficulties - behavioural therapies, applied sensitively and respectfully may be useful interventions.

And autistic people are more prone to all sorts of mental health conditions than the general population – growing up autistic is a neuro-conforming society is a strongly ‘adverse event’ But it is essential counsellors and therapists know what is possible, and what is desirable to achieve – and don’t fall into the trap of colluding with those who demand autistic people conform, no matter what the cost.

I can’t tell you how many times I’ve known autistic people to present for therapy to ‘fix’ themselves after they’ve been bullied. The wrong people are in the therapy room!

As for me, I have had years of being told to go into therapy because clearly, I had mental health problems. No sane person could be like me! So I went into therapy, and a couple of years later, I’ve realised I’m mentally very resilient and I’ve finally started to question the assumptions that better = neurotypical.

I am embracing my autism. Which wasn’t exactly the result my naysayers expected.