Paul Isaacs' Blog

Autism from the inside

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The Problem with Somatisation Disorder

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Note this is from a personal perspective

Certain personality types (such as mercurial/borderline) are more akin to having somatisation type disorders in which person feels they are becoming increasingly ill and/or have serious and multiple symptoms that indicated a serious illness and/disease.

“The main features are multiple, recurrent and frequently changing physical symptoms of at least two years duration. Most patients have a long and complicated history of contact with both primary and specialist medical care services, during which many negative investigations or fruitless exploratory operations may have been carried out. Symptoms may be referred to any part or system of the body. The course of the disorder is chronic and fluctuating, and is often associated with disruption of social, interpersonal, and family behaviour.”

Awareness of Emotional States and Somatic Pain

The persistence is the pain and the feeling that invokes, having alexithymia means that I have problems identifying what my inner states are leading to often painful and chronic psychosomatic symptoms which in my life time have included as follows

  • Nausea
  • Tension Headaches
  • Toothaches
  • Jaw aches
  • Lower back Pain
  • Arm and Shoulder Pain
  • Pins and Needles in Legs and Feet

The recent bout is having a pulsating tinnitus in my left ear which is anxiety/stress related and is not due cardiovascular disorder and or stroke related symptoms but never the less is persistent at the moment. Age and awareness in my case have helped with these areas of anxiety and “getting on with it” as means to move on and look towards the psychological/developmental aspects they have on me in terms and working from there.

Paul Isaacs 2018



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Autism, Shy Bladder Syndrome and Body Agnosias

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Parcopresis, also termed psychogenic fecal retention, is the inability to defecate without a certain level of privacy. The level of privacy involved varies from sufferer to sufferer. The condition has also been termed shy bowel. This is to be distinguished from the embarrassment that many people experience with defecation in that it produces a physical inability, albeit of psychological origin.


Environmental Origins and Processing Event

When I was eight years old and was going to the toilet at primary school in came two students were playing out side the toilets and preceded to kick the door in unison until it forced opened they looked upon me a laughed it took me a long to the process the event due to visual perceptual and language processing disorders.

Reactionary PTSD

This has has a dramatic impact albeit subconsciously on going to the toilet in public forums I cannot defecate until I am in places of familiarity leaving a level of bodily tension.

Body Disconnection & Delayed Perception/Processing

Visual analysis of faces and nonfacial body stimuli brings about neural activity in different cortical areas. Moreover, processing body form and body action relies on distinct neural substrates. Although brain lesion studies show specific face processing deficits, neuropsychological evidence for defective recognition of nonfacial body parts is lacking. By combining psychophysics studies with lesion-mapping techniques, we found that lesions of ventromedial, occipitotemporal areas induce face and body recognition deficits while lesions involving extrastriate body area seem causatively associated with impaired recognition of body but not of face and object stimuli. We also found that body form and body action recognition deficits can be double dissociated and are causatively associated with lesions to extrastriate body area and ventral premotor cortex, respectively. Our study reports two category-specific visual deficits, called body form and body action agnosia, and highlights their neural underpinnings.

Dipartimento di Psicologia e Antropologia Culturale, Università di Verona, Verona, Ital

I have had a level of body agnosia and pain agnosia in my life which have caused, social emotional disconnect, alexithymia, language processing disorder and so forth. This can also cause problems with understanding and perceiving “pain”, “discomfort” and my case “being full”. Staying over a friends house made me realise the problems that still resonate eating food and then forcing your bowels not to move then caused an unfamiliar “sensation” which I was able to then realise was “nausea” in the pub.

The second the delayed response was in the home when my body moving without understanding why or where climbing up the stairs I projected vomit but had no understanding of what, why or how. A wave of exposure anxiety came over me I had to stop myself from self-harming wanting to hit my head and arms. I said sorry repeatedly for the mess which was made however they were very understanding and caring.


I luckily have a sense of humour and hold these things with a level of comedic reality and I was lucky to have like minded people in my company. 😉

Paul Isaacs 2017



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Autism and Asperger’s Different Trajectories and Different Presentations?


Today I was doing autism training and in the team was lovely and inquisitive man with Asperger’s Syndrome as the session went on he shared some of his experiences from not picking up verbal cues, being literal and having sensory integration disorder as well as issues with emotional regulation and possible alexithymia.

It amazes me still that people think that “Autism” and “Asperger’s Syndrome” are still considered to some to be the “same thing” when is clear that even if on the surface some of the issues may be similar many of underlying components are very different. If I use both the gentlemen in question and myself as examples so here goes.


  • The gentleman seemed to display a level of Social Emotional Agnosia which meant he struggles with non-verbal cues, tone of voice and facial expression he acknowledged that he use past experiences to build up a format of how to understand someone
  • He didn’t have Prosopagnosia (30% of people with social emotional agnosia do so)
  • He was literal in processing of verbal language and seemed to have less impaired visual-verbal processing
  • Possible Alexithymia which is “knowingness of your own emotional states”
  • Seemed to mentalise in a more logical, literal and pragmatic manner which suggests the use of the “left brain” person.

With Myself


  • I have a mixture of Simultagnosia (Object Blindness) and Semantic Agnosia (Meaning Blindness) which means my visual field is fragmented, distorted and incoming visual information does not have any meaning, context or reasoning
  • I have Prosopagnosia (Faceblindness) as an extending of the already existing issues around visual perception meaning I “recognise people” primarily by patterns of movement and voice
  • I have a level of Receptive and Expressive Aphasia (Meaning Deafness) which even in its current residual form means I “lose” the ability to keep up with interpretive verbal information and struggle with visual-verbal processing
  • I have less literal, logical and pragmatic style of thinking or organised thoughts  I am very much a “right brain” person.



I was asked what I thought the main different feature was between Autism and Asperger’s. I think you’ll maybe find in reading through the site on brain hemisphere specialisation that there are many Aspies who may be better at left brain stuff and many Auties who may be more right brain but not nearly recognised for the abilities they do have as much as they are recognised for the left-brain abilities they don’t have. Whilst most people have a balance of both abilities, being extremely one side or the other clearly means the abilities of that other side are far less practiced. Processing incoming information in a non-Autie manner usually involves using a good balance of the two. So feel free to try the test yourself.

Donna Williams

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Different Trajectories 

Maybe its is because I spent large part of my infanthood exploring through my senses and/or through patterning, theming and feeling struggling to get a sense of what “interpretive information” is and what it means? To be around such information and how to connect all the dots within in my mind. However I appreciated and acknowledged the validity of it in my previous blog post.

I flourish in areas of typing, writing poetry and creativity I love wordplay, sounds,  pitches and the seemingly infinite kaleidoscope colours, shapes, textures and shines they “talk to me” as much as next person.

Things Foundly Remembered

I saw your face with my hands

A voice a distant echo but foundly acknowledged

The smell of the wise tree in the garden the leaves did dance

A new place everywhere to be eagerly explored upwards and onwards

Flomping along the globblyness unstuck and unshackled my hands are free

Looking at the gloaming and silvering shape what plotunes and envelopes my soul

I thank you old friends you are me and I am likewise swashing around in the ink clouds


Paul Isaacs 2017


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Managing Grief and Loss with Visual Perceptual Disorders

Note this is from a personal perspective

Grief is a normal state to be in when you lose someone you love and have connected to and I know that this feeling or more accurately abundance of differing feelings that accompany it are part of the process.


Visual Agnosias – Deficits In Memory Perception & Visual Association? 

I have no pictures of my Gramp none that “spring to mind” I cannot “visualise” or have pictures in my mind my “meta-reality” (a person’s inner world/consciousness)  is not made of pictures or movies as a form of association. It is made of of smells and textures I made a point when I said goodbye to my Gramp at the chapel of rest to stroke his face and hair so would have a physical association of the firstly the bond we had and secondly my way of saying goodbye to him and his body.

Paul Isaacs communication profile 2017

Bereavement Counselor 

I went to see a bereavement counselor today and I was thankful that he was able to assist me not only in the human element of my grief but also adapt his way of describing different interventions and explanations to me.

 This is what he used in  the session 

  • Contextual telegraphic language “painting his words” with gesture and placement and meaning
  • Allowed time for me to do “all self no other” and “all other no self” in order for me to express and receive the information
  • Compartmentalised my  own emotional states giving them a reference point and also suggestions in how to manage my emotions
  • Understood I have a history of mood, compulsive and anxiety disorders associated with somatisation disorder
  • Allowed me to be creative in expressing my emotions through creative writing, poetry and art




Addressing The “Pieces” Of The Jigsaw

So what parts of my “autism” are being addressed?

  • I would say firstly his looking at a level of information processing delay and giving me time
  • The next would be that fact that because of visual perceptual disorders having a level of visual agnosia in the areas of meaning (semantic), object (simultagnosia) and faces (prosopagnosia) means that using gesture, placement and telegraphic language backed up with word emphasis in the right areas helps me internalise the words better assisting with the level of aphasia I have
  • Looking at my own emotional states is assisting with alexithymia and overall giving me time to integrate “self and other”.



I would say that my grief is human and that I will get through this with at times very basic but meaningful interventions I do however hope this helps people with similar issues to my myself regardless of being on the autism spectrum or not.


Paul Isaacs 2017



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Autism, Alexithymia, Body Disconnection, Mental Health & Loss



Note – This is from a personal perspective

In short space of time two people dear to me had sadly passed away my Gramp Gilbert Harpwood and my friend Donna Williams (Polly Samuel).

I knew that because of alexithymia I would find this process lag and that I wouldn’t be “emotionally connected” straight away this led me to going day to day with no sort of emotional context at all despite showing on the surface seemingly “connective” emotions they were not connecting with me on the inside.

Alexithymia /ˌlɛksəˈθmiə/ is a personality construct characterized by the subclinical inability to identify and describe emotions in the self.[1] The core characteristics of alexithymia are marked dysfunction in emotional awareness, social attachment, and interpersonal relating.[2

Expression Of Grief

After the month and half since my Gramp’s loss and not long after Polly’s I started getting pains in my arm, stabbing and throbbing like a vice was clamped on my left arm. I quickly ruled out tetanus (which is serious bacterial infection) this then progressed into neuropathic – like  pain which was shooting from my neck, jaw, arms, legs, feet and groin “settling” in places for minutes and hours with a “warm”, “tingling” feeling as it moved.

I know this based on having a family history of mood, compulsive and anxiety disorders many things came into place as well as somatisation disorder which is a pseudo pain diversion.

Anxiety and Somatic Disorder

Somatic symptom disorder occurs when a person feels extreme anxiety about physical symptoms such as pain or fatigue. The person has intense thoughts, feelings, and behaviors related to the symptoms that interfere with daily life.

Anxiety Neuropathic-like Symptoms

Anxiety doesn’t actually create peripheral neuropathy. While anxiety and stress have been thrown around as possible issues that lead to neuropathy, peripheral neuropathy is about nerve damage, not nerve symptoms, and since anxiety is unlikely to cause nerve damage, it can’t technically be peripheral neuropathy.

Dermatillomania (skin picking disorder)

Dermatillomania may be a reflection of a mental health problem. Psychological and behavioural theories suggest that skin picking may be a way of relieving stress or anxiety.

A Dolly Mixture Of Mental Health Conditions

I  know that I have mixture of differing overlapping co-conditions going with my mood disorder being an understandable and normal reaction to grief, skin picking and impulse control disorder which has resulted in my hair being riddled with scabs which is my sub-concious at work, to having excess adrenaline  that is being “stuck” in my body from time to time.

Externalising To Process My Own Emotional States

The alexithymia and associated problems that go with such as body disconnectivty (body agnosias and hemiplegia)  leaving me detached from my own emotional states leaves me also waiting for the emotions to come at a frantic, unprocessed rate leaving me to pick up the pieces of the jigsaw puzzle. I have created my own strategies such as writing, poetry and art which help me externalise and thus connect with my own emotional states, thoughts and feelings.

Visual Perceptual Disorders and Mentalising

Another aspect is the visual perceptual disorders which includes simultagnosia (object blindness) assoicated with prosopagnosia (face blindness) and semantic agnosia (meaning blindness) which I have that means my memory isn’t “visual-assoicative ” and I have no “pictures” of “emotional association” so my “meta-reality” (which all people have) has to be externalised.


I know that with the slow realisation of my internal states will aid me in the this journey which is a normal journey for human beings, remembering people fondly, the good times, the laughs, the smiles and interactions.

Paul Isaacs 2017

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Autism, Processing Emotions & Alexithymia


Note this is from a personal perspective 

Alexithymia is a condition in which person cannot find words to express inner emotional feelings, now this doesn’t mean that the person is devoid or lacking in emotion however it can from a outside perspective look like that despite the inner mechanics being quite different.


I shall give you a personal account of this and look at other potential factors. I have a processing and recognition delay of emotion feelings in the context of the event that has happened – in other words from the time the event has happened to the time I get a self response is delayed this can come in the form of

  • Words for the the bodily messages that I am feeling 
  • Being able to piece the situation together from a emotional standpoint
  • Talking and having a conversation about a situation that in real-time has long since past
  • Having raw emotions that through time, experience, awareness and age I am able to better filter them

As a teenager I would harm myself when these raw emotions would take hold like attacking one’s self for their own emotions because the person in question hasn’t yet pieced together they are coming from themselves this to me a that point in time a a paradox but a worthy one to working through.


Other factors would depend on the person’s autism profile and fruit salad that would have an impact on the presentation of alexithymia such as

  • Visual perceptual disorders and not having a visual memory to process people, situations, words and mentalise thoughts.
  • Language processing disorders such as aphasia and verbal auditory agnosia needing time to find and extract words that have inner meaning to the person.
  • Body disconnectivity and not sensing or perceiving their own bodily messages
  • Diet and food intolerances are undiagnosed food intolerances having an impact on their functioning?

Paul Isaacs 2017

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Not All People With Autism Are Logical Or Literal In Thought Or Presentation

20160730_102005 (2)Note This is from a personal perspective 

What Autism IS and ISN’T

Looking at the broaden the aspects of presentation in autism it is about understanding what autism is and just as importantly what it isn’t.

It isn’t is a generic stacking of black and white linear symptoms that present in every person in the same way, what it is is a stacking of conditions that are specific and personal to the individual.

The Hidden Strands Of Information

I can of course be logical that is natural human variant of thought and has nothing to do with autism (and also various personality types will overlap with overall presentation), however  I struggle with intense over a analytical  logical decoding of a situation as it is happening that leaves many things up in the air for me.

Such as emotional perception, (not knowing my bodies own reactions to the the incoming information) receptive and expressive language (word formation, extraction, relevance, understanding), lack of visual association (no pictures for words), information processing delays (incoming information not being “sorted” quickly enough to be “understood”).

Taking Things To Heart? 

As a child more prominently and now as adult the residual issues are still there such as not seeing the significance of what is being said this is before the literal. 

That means I am less likely to take things on a personal level even if I am being spoken too in a personal way.

I was asked what I thought the main different feature was between Autism and Asperger’s. I think you’ll maybe find in reading through the site on brain hemisphere specialisation that there are many Aspies who may be better at left brain stuff and many Auties who may be more right brain but not nearly recognised for the abilities they do have as much as they are recognised for the left-brain abilities they don’t have.

© Donna Williams

Introspection & External Mentalisation

I use my senses and introspection to “decode” things and sort them out from there, I don’t have pictures in my head sorting things out I have to do the reverse I have to get everything out FIRST by doing, gesture, tone, inference, movement and then go from there.

I struggle to mentalise plans so I just “do” this means that on a unconscious level I sort things out with no conscious thought at the time. When I wrote my first book I just typed and typed and typed with the basic premise being it is a book about my life.

However I am sure there are people in the world who are not on the autism spectrum who can relate this. I have of course  “non-autistic” moments of clarity for me just as there will be “autistic” moments for people off the spectrum.

Paul Isaacs 2016