schizotypal or ASD?

I have been meaning to write about this one for a long time. Since as far back as when I first started this blog. It’s a topic I find rather complex and at the same time somewhat near to my heart since I now identify rather strongly both with ASD and schizotypal disorder. My original intention was to include as much actual research as I could. But I’ve had to admit that the whole research angle just isn’t going to happen with me. So it’s just going to be little old me speculating on the topic as best I can. There’s a good chance this is going to be a bit long and a little rambly, but I hope I’ll still be able to get something relatively useful out on the page.

Schizotypal disorder and autism spectrum disorders both cause social awkwardness and can in some cases seem very similar. I’ve encountered at least one other person with schizotypal disorder who was assessed for autism spectrum disorders before landing on schizotypal disorder. I was too. Although it needs to be said that it is entirely possible to have schizotypal disorder or schizophrenia without having any of the “autistic traits”. I’ll elaborate on what these traits might look like later in the post.

Before I was diagnosed with schizotypal disorder, I was assessed for autism spectrum disorders. After the assessment I was told that I did in fact cover the criteria for an ASD diagnosis. This was quite a revelation to me.

I’d never thought of myself as possibly autistic. Sure, I’ve always been socially awkward, keeping to my closest friends as much as possible and acting much the shy wallflower any time I found myself without my friends. But the problems I was having didn’t really feel like the problems an autistic person might deal with. They were “me” problems.  I was unfortunately influenced by the misconceptions about ASD and simply couldn’t connect my own experiences with what little I’ve seen of autistic people in movies and tv.

People with Asperger’s were “weird” – that’s to say, not my brand of weird. As a kid, I played just fine with other kids my age. Sure, I was a mostly solitary child, who preferred to sit inside and draw rather than play outside with the other kids. But that’s because I’m introverted. I have no problem keeping eye contact, I just sometimes find faces distracting when I’m talking or thinking. I can’t seem to follow schedules and find routine boring. I hate math, love metaphors and have an excellent sense of humor, thank you very much. And I don’t have what one could consider “a special interest”. In fact, I tend to skim over many different topics and enjoy many different hobbies without fully immersing into a single one. I thought for a long time that “a special interest” in a topic automatically made you an expert, knowing every possible little thing, able to recite facts as if you’ve memorized every last detail. Just goes to show how little I knew.

I’ve later learned that all these things were misconceptions perpetuated by media that simply didn’t understand autism at all. I, like many others, had almost all my knowledge from movies and tv shows. The autistic character is usually either the completely non-communicative child who sits there, rocking back and forth fixated on spinning wheels and throwing epic tantrums when disturbed, or it’s the savant who’s autism is more like a superpower. So, basically either Rainman or the kid in that one Bruce Willis movie I forgot the name of. And the rest are more or less variations of the same two tropes.

In truth, those are only two flawed examples of a whole spectrum. The vast majority are relatively “normal”. Their brains simply function a little differently from the norm. It’s natural they would have some difficulties. A bit like a left-handed person living in a world made for right-handed people. And just like left-handed people, there isn’t really just one type of autistic person. They’re all different with their own thoughts and feelings and personal interests.

Furthermore, there were other autistic traits I never knew existed, such as sensitivity to certain stimuli like textures, sounds, smells, visual stimuli such as strobing lights – which who in their right mind even enjoys all that obnoxious flashing anyway?! As it turns out, I do have some sensitivity to some stimuli. I’ve always had a strong preference for soft fabrics over course and scratchy. I detest the smell of cigarette smoke and I find both visual and auditory “noise” exhausting. But I’ve always considered these things as normal – and they generally are. We all have things we like and dislike. They don’t have to be indicative of a disorder or disability.

Special interests are often the hallmark of an autistic person. But to say they work like a kind of superpower, giving them superhuman awareness and mastery of a topic they take a special interest in, is plain ridiculous. It’s true savants exist, but they’re incredibly rare. Special interests are more of a thing that brings joy and relaxation to the autistic person – even facilitates human connection, giving a sort of framework through which one can communicate with others, much like a hobby. But unlike a mere hobby, it can also arrest one’s attention to the exclusion of everything else including bodily functions such as the need to eat and sleep, and can make it difficult to focus on anything else.

Being passionate about a topic doesn’t necessarily mean you know every little thing about it. Sometimes a special interest can even be an annoyance rather than a passion, a niggling detail that you just can’t help but focus on until it grows on you and you realize that it’s become a part of you and this is just your life now. Someone caught up in their special interest genuinely can’t keep themselves from thinking and talking about it, even when it bores the people around them to death, or when they need to focus on homework instead. And as long as it’s bringing joy and meaning to their lives, why would they want to focus on anything else? I don’t believe I have any special interests like that. More often than not, I’m not particularly interested in talking about my hobbies all that much. Unless someone gets me going on a topic I’m particularly passionate about, I’m happiest simply quietly engaging in my hobbies by myself. I do tend to focus a lot on one thing at a time until I get bored of it and start looking for something else to focus on. But I can put those things away when I need to. I use them mostly to fill the silence, so my head doesn’t start filling it with things I don’t want.

Another big feature of ASD is the meltdowns. I’m sure most of us have seen at least one video of a kid having a screaming, crying meltdown somewhere on the internet. It can look like an epic temper tantrum, or a big emotional breakdown. But it’s not. It’s not something they can fully control. It’s a bodily reaction to stress and/or over-stimulation. The specifics and severity can vary quite a bit and can sometimes depend on the situation. I don’t think I’ve ever had a meltdown like that. Although I’ve had situations where I felt overwhelmed and my mind would just shut down on me and I’d either disappear into my favorite books for days or do nothing but play solitaire for hours until I’m able to face the world again.

The last autistic well-known autistic trait I want to mention here is “stimming”. This can be rocking, fidgeting, rubbing your arms or legs, or other forms of movement with a repetitive nature. People stim for many reasons, typically during strong emotion, such as to get rid of excess energy when excited or to self-soothe when anxious. I’ve sometimes had periods where I’d do something like this. I’d bounce my leg when excited or anxious, at one point I had a little “delicious food dance” where I’d rock from side to side, sometimes I’ll tap my foot. When I was little I’d have this bedtime ritual were I had to rub a corner of my comforter all over my body before I went to sleep.

So, as it turns out, I was never aware of just how many autistic traits I actually do have. Besides the aforementioned examples, I learned at the age of 27 that I can’t actually take a hint. So many things just fly straight over my head and I never really noticed before. Later I asked my mom if she knew and she said: “Oh, yeah.” Like it was the most natural thing in the world! It apparently never occurred to her in all those years to, y’know, mention that to me. It would have been nice to know sometime during my teen years, when I felt like I was somehow stuck behind a glass wall that I couldn’t figure out how to get past, or later when I started wondering if maybe words didn’t mean the same thing to others as they did to me. Knowing my mother, she simply acknowledged this fact about me and quietly adjusted her own behavior to accommodate my ‘quirk’ without thinking too much about it. Unconditional love and acceptance can apparently have its downsides too.

Anyway, as I was saying, the social awkwardness of schizotypal disorder is very reminiscent of that of ASD’s. At least on the surface. It made me think that perhaps the two are somehow related. I’m certainly not the only one who’s noticed the similarities. I’m half-convinced that I was born with ASD which somehow evolved into schizotypal disorder as I grew older. Perhaps my aspie brain couldn’t cope with the strain of trying to live life as if I was normal, and the stress of it developed into a mental disorder? Although on the other hand, I don’t think people with ASD are necessarily more likely to develop STPD than anyone else. Both do have a genetic element, making each more likely to surface in some families, but I don’t think the actual genes involved are the same.

I’ve heard some people mention the possibility of autism and whatever causes schizophrenia and schizophrenia-like disorders belonging to the same broad spectrum, simply residing on opposite ends of the bell-curve. Sort of like this:

Human Spectrum Bell-Curve

Although in reality the colors would probably blur together a lot more.

So, the reason those who suggest the two reside on opposite ends of a spectrum give for the theory is that while both are characterized by social awkwardness, the underlying reason for the awkwardness appears to differ. Where those with ASD, roughly speaking, tend to be more oblivious whereas those with schizotypal disorder and paranoid thinking, in particular, tend to be more hyperaware of other people’s intentions to the point they over-interpret and basically assume the worst. In this regard, perhaps my brain works more like that of ASD than the schizotypal, so I don’t know that this is necessarily true. The truth is probably rather more complicated than what a neat, little model can fully explain.

While looking up the possible relationship between ASD and schizotypal disorder/schizophrenia, I found a research article that startled me quite badly. It was about how schizophrenics with autistic traits had a bleaker prognosis than those without autistic traits. I wish I’d saved the article as I never got to read the whole of it, nor can I remember where I found it. I was too busy going “oh, crap. I’m so screwed!” And have been a little leery of seeking out more articles like it.

Despite my initial scare, the interesting thing for me here is that autistic traits + schizotypal traits makes for a slightly more complicated progression compared to only having one or the other. This suggests to me that the two are different, but can sometimes overlap. Thankfully, it’s not as bad as I initially thought when I first saw that one article. At least in my own case.

In practice, rather than looking at it as an “either-or” situation, I consider myself as having both ASD and schizotypal disorder and try to make concessions in my life to accommodate both. I know for a fact that I struggle with social relations, that my hobbies sometimes take up a little too much time, and that stress causes my mental state to deteriorate. So, it’s basically about knowing my own vices and weaknesses and taking steps to compensate for them so I can live as normal and comfortable a life as possible. It’s not so much about putting myself in one box or the other. It’s taking the elements of each that match my own life and try to learn from them.

Stress management

I find that the most important thing when living with a mental disorder is stress management. Stress is something that can affect anyone working under too much strain for too long. The more strain we live under already the less we’re able to deal with unexpected events and emergencies. You might recognize when you’re having a bad day, your mood is already bad from the moment you drag yourself out of bed, and after that, every little thing that goes wrong just stacks up until you reach a point where you just want to give up on life, go home and bury yourself under your comforter for the rest of the day and possibly the next too.

Each little thing that goes wrong could be packed into a box and labeled as “a stressor” and each new box stacked on top of your mind represents the strain on your psyche. Balancing one box on top of your head is obviously a lot easier than balancing five or six. At one point or another, you will reach a point where even one more tiny box might send everything tumbling down over your head. Some people might naturally be able to balance more boxes than others, but we all have a breaking point.

My psychologist explained stress to me with a model similar to the the cute drawing above. I think the model was developed to help people with ASD and their families understand what causes meltdowns and how to manage their lives in a way that minimizes chances of such things occurring. But I think it’s an excellent model to explain stress and burnout as well. For us living with a mental disorder simply managing day to day life is already a strain and so it takes less boxes to push us to our breaking point. Luckily, we can make use of our symptoms to gauge where we’re at on the scale. Typically, symptoms worsen the more stressors we’re dealing with.

So, the first step in stress management is to sit down and try to identify the stressors in our lives. These are the things that drain our energy, that cause frustration, or put pressure on us. For instance, as an introvert social interaction tends to drain me, so I need to make time for myself to spend on my own in order to recharge. Even having to manage chores and deciding what to have for dinner can become draining when I’m already bogged down by other things. Another thing that puts a strain on me is uncertainty. Especially if I know there’s a chance something unpleasant is going to happen. When I worked for this grocery store delivering wares from storage and various providers to the two stores, I found I started to increasingly dread when we had to deliver to one of the stores in particular. Because there was a chance we would have to park the van on the opposite side of a busy road from the store and there was no crosswalk where we had to cross. I was always scared to death crossing the road, afraid of getting run over. The more times I had to deal with this unpleasant situation, the more I sought to avoid it until I stopped working for that company altogether.

One thing I was a little surprised to realize was that one of my favorite hobbies: gaming, actually contributed more to my stress. This is because games are typically goal-oriented and having to overcome challenges tends to encourage adrenaline production, which is very detrimental to getting your body to relax. I even had to quit playing Animal Crossing: New Horizons because the time-locked nature of the game stressed me out so much. I did not deal well with having to play the game on certain days in order to participate in events and gain items and recipes that I wanted for my island. Oftentimes, the events unfortunately often coincided with periods where I was too busy with other things to even think about spending hours playing Animal Crossing just so I could look for the recipes I wanted, which would appear at random – which was incredibly frustrating. Having to participate in combat is obviously also detrimental to getting your body to relax and most games tend to have some kind of combat element.

Rather, activities that are actually relaxing can be quiet, creative hobbies such as knitting, painting, or reading. Even just sitting on youtube just watching cute animal videos for a while is quite relaxing. Apparently, looking at cute fur-babies doing cute and funny things makes our brains produce the happy-relaxy juice.

A cute quokka to put a smile on your face.

Some might also find journal-writing quite relaxing with the added effect of putting your thoughts and emotions into words to help offload worries. Exercise is another thing that can help the body relax better and lower blood pressure. Obviously, doing the exercise itself might feel awful and straining, but it does help in the long run. One could even use the exercise as a way to channel anger and frustration in a healthy way. For an extrovert, something like going out to a dance club might be considered relaxing. But if so, one might consider holding back on the alcohol consumption.

Speaking of alcohol, certain foods and drinks might put more of a strain on your body, which in turn puts a strain on your psyche. For my own part, I have a couple of food intolerances which causes my intestines to protest quite painfully and often times even keeps me awake at night.

Sleep is another important thing to consider, which is quite a problem and a source of worry for an insomniac like myself. Stress management blends neatly into managing your sleep cycle as things that stress you out often contribute to terrible sleep, which in turn adds even more to your stress.

So, once you’ve identified the things that put a strain on you and the things you find pleasant and relaxing, the challenge comes in successfully balancing the two. You can’t simply remove all your stressors, but making the effort to reduce them will in turn reduce the time you need to dedicate to recharging. When you know what activities put a strain on you, you can take steps to plan some especially pleasant activities to balance things out when you know you have to do something particularly strenuous. Or when you have to deal with an unexpected stressor, taking steps to decompress afterward will help lessen the impact quite significantly.

Once you start to successfully manage your stress levels, your symptoms should also lessen. Perhaps even to a point medication is no longer necessary. Although your symptoms can return as soon as you’re put under more strain again, so you might have to make permanent concessions in your life in order to stay healthy and happy. Prioritizing is an absolute necessity.

For my part, there are jobs I’ve had to realize I can’t ever do as they’re simply too stressful. I’ve also had to change my diet quite a bit, of which the hardest part has been having to go without my favorite treats and snacks. In turn, I haven’t had to cut down on my gaming too much, which is nice.

On decency and dealing with an emergency

I had to call an ambulance for a complete stranger today.

I was at work when I heard drunken rambling. I couldn’t see the person and having the problems I do interacting with other human beings at the best of times, I did my best to ignore it and focus on my work. Then I was approached by a young girl of maybe 12 at the most, asking for help. She said there was a man who had collapsed on the ground and couldn’t get back up.

As an adult, there’s only one thing you can do, when a kid asks you for help. And that’s to put on your adult pants and deal with the situation. Even if you don’t want to. And I really, really didn’t want to. But I knew the guilt of doing nothing would eat me up. So, I went with her to see the man. He was conscious, if not entirely lucid. He was obviously drunk and lay on the ground where he’d fallen, unable to even sit up. I tried to ask him if he was hurt. He insisted he wasn’t, but he couldn’t get up and couldn’t quite get his legs to work right. I thought I saw what looked like blood seeping through his pants at one knee, but I couldn’t be sure. I didn’t want to be and figured it could just as well have been something he’d spilled on himself as he fell.

I did my best to at least get him up to sit, because he was lying awkwardly on his side. But he was big and heavy. Thankfully a woman, who looked to be some kind of social worker came over and between the two of us, we managed to get him to sit up, at least. He kept insisting that he just needed help getting back up onto his bench, but the woman suggested I should call an ambulance. I’d been considering it myself, but I was grateful for her saying it out loud. It might have taken me longer to get to it if she hadn’t. I stayed with the man until the paramedics arrived. Then, booked it. I thought about mentioning the wet patch I’d seen over one knee, but I figured the paramedics would do their job without my input.

This was actually my second time as an adult having to deal with finding a stranger collapsed in public. The first time, I witnessed a young woman suffering some kind of seizure just outside my local mall. I’d just gone out for takeout, that’s all. Then I saw her, just slowly sliding down to the ground as she started convulsing. I think she might have had to deal with it before, because she’d managed to put herself in the recovery position. But she was alone, and I was the first one there. I had absolutely no idea what to do. I think I tried to check on her, see if I could get a response or anything. She was unresponsive. I was lucky that the mall was full of people. I remember there was a woman, who appeared to be somewhat in shock. She kept repeating: “I don’t know what to do.” I didn’t have my phone on me, so I couldn’t call an ambulance. Luckily there was a man who did. I didn’t want to just stand there doing nothing, so I suggested the woman go fetch mall security, assuming they would have had some first aid training. As soon as there was someone there who appeared to know what they were doing, I was out of there.

I hated not knowing what to do. I hated feeling helpless. So, I half resolved to take some first aid class, just in case I got into a similar situation. I never did. That was a few years ago.

I don’t know if things had gone differently today if I’d taken a first aid class. I don’t think I’d have acted differently. I don’t think it would have affected me any different either. Seeing another person in distress, is very distressing in and of itself. Unfortunately, many people choose to look the other way. They don’t know how to deal with the situation and choose simply not to. I myself would be inclined to choose this option. It’s not something I’m proud of, but I shy away from any kind of responsibility. I still manage to “man up” when necessary, but as long as I don’t deem it necessary, I’m happier to run away. See no evil, hear no evil and all that. No need to play hero when there’s no need to.

Regardless of what I choose to do about the situation though, once I see what I’d rather not, I can’t un-see it. It sticks with me regardless of what I do. I take everything to heart and it’s better to be able to tell myself: I did everything I could, given the situation. Rather than have to beat myself up over what I did or didn’t do.

As I sat waiting for the ambulance, I had to interact with the old man. He was in such a sorry state. Filthy from lying in the mud and disheveled. To put it bluntly, he looked like a bum. He even called himself a bum at one point. He was wearing a hospital shirt underneath his jacket and told me he’d been hospitalized more than once. He said it was no use, that they couldn’t do anything for him. He said they couldn’t give him what he wanted. I didn’t ask what it was he wanted. I didn’t really want to know. He said he was all alone. No parents. He’d been waiting for a man to deliver his medication. But he didn’t want to sit alone in his messy apartment. So he’d come to the bench to sit and had himself some beer. “To make myself feel a little better”, he said. He tried to light a cigarette, but he could barely move his hands properly and misjudged the distance between the lighter and the end of his cigarette. And the wind kept blowing the flame out. So I helped him light it by shielding the flame and guiding his hands. His hands and arms were so stiff. He asked if I could just light it for him, but I told him I couldn’t. I assume he meant by putting the cigarette to my own mouth, which wasn’t going to happen with the pandemic and besides, I hate cigarette smoke. Eventually though, we got it lit.

It was such a short exchange. But so absolutely heartbreaking. I’d like to think that I acted with compassion and did some good for the poor guy. He was just so lonely and hurting. I still feel like I should have been able to do more somehow. I still feel bad for running for the hills the moment the paramedics arrived. I excuse myself by telling myself I had work to do. But in truth, I just couldn’t bring myself to do more than I’d already done.

Experiences like these tend to stay with you. Especially if you’re the sort to agonize over everything. It got me thinking about what I could do to help alleviate some of the agonizing. Being able to tell myself I did a decent thing, that I was brave enough to face an awful situation and treat an old man with a bit of compassion and dignity helps a great deal. Giving myself some time to recover and just process things probably helps too. I considered making myself a relaxing cup of tea. Which would probably have been a whole lot better than cramming as much sugary goodness into my mouth the minute I got home. Turning to sweets is almost as unhealthy as turning to alcohol to cope. Next time, I’ll make an effort to make myself turn to tea instead. A nice cup of tea and some quiet relaxation.

I did want to make a point with this post, besides simply sharing an experience that weighs heavily on my mind. It is that if and when you find yourself in a stressful and unwanted position where another person needs your help, it doesn’t have to be a choice between compassion and self-preservation. But whatever you do, it is important to take the time to take care of yourself after the fact and acknowledge when you find yourself out of your depth. As long as you make sure to take care of your own needs, it’s possible to extend your limit as necessary – but only for a short time.

And you don’t have to be perfect. You don’t have to be super to be a hero, you don’t even have to be a hero to be a decent human being.