Autism, Anxiety, And Pathologizing Control

After almost 2 decades of working with people with OCD and anxiety “disorders”, I always felt uneasy about how the DSM delineates between what is a “disorder” vs non-disordered human conditions.

Who gets to decide this?

And then we have so much training and modalities based on the foundational belief that there is disorder within an individual that needs to be treated.

I am not saying that I don’t believe in mental illness, because I most definitely do believe that humans can have internal experiences that are excruciatingly hard and “disordered” in the sense that it causes them immense pain and they want it to stop.

That being said, there are many disorders based on how worried and anxious a person is and how much they attempt to control their life or the world around them. Adding in autism, a neurotype that is famous for wanting things a “certain way” which is, at it’s core, an attempt at control, makes this even more fascinating.

There is a lot of talk about differentiating between autism and anxiety or other disorders in the DSM. There is concern that autism gets pathologized when it is confused or conflated with OCD or other disorders. As someone who specializes in working with people who are both autistic and have OCD, I can tell you that it is very hard to differentiate the two when working with someone. It is also hard to differentiate internally.

This is because both conditions have a strong need to control a dangerous, unpredictable world. Because that world legitimately is terrifying, if you think about it a lot. And when you’re autistic, chances are you might have thought about it a lot.

Therapies that tell us that we are overreacting don’t help because we aren’t overreacting, at least I don’t believe we are and I don’t approach it like we are.

The truth is that the stakes of being alive are disturbing to me and to many other autistic people. Life is too overwhelming, including it’s risks and uncertainty.

Some of us don’t give up so easily but I don’t see that as pathology necessarily, it seems to be a perfectly reasonable response for a terrified person who understands how life actually works.