Paul Isaacs' Blog

Autism from the inside


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A Tall Tail Of Somotisation Disorder

The Beginning

I started getting symptoms of this in late infancy around 11 years old this was related to mitigating factors both to do with neurological processing such as aphasia, alexithymia and visual agnosias, environmental factors bullying and emotional triggering.

Psycho-Somatic Trauma Based Response to Negative Environment Experiences?

I would get sensations of my body “melting”, headaches, stomachaches, tingling in limbs, face and lips and by the time secondary school came and chronic bullying persisted in the first two weeks the pain would start again as stated above.

In particular, the pattern of shrinking was observed in two parts of the brain called the putamen and the caudate, a change oddly reminiscent of adults who have experienced early life stress, such as childhood maltreatment.

These sensations would cause me to have intestinal discomfort ranging from chronic constipation to nausea.

I would go to the school reception during lunch break sometimes on a almost daily basis saying either about a stomachache and/or headache. I would sit in floods of tears wanting to go home this went on for approximately 18 months as my nervous system was also being pushed as panic attacks usually followed before and/or after an episode of pain.

This meant that obsessive-compulsive disorder manifested in persistent hand-washing, counting, checking and reassurance around illness and disease began which last from the ages of 12 to 15.

Psychological Pain Presenting as Physical Pain?

What is Somatic Symptom Disorder

People with somatic symptom disorder experience real physical symptoms — they are not imagined. These symptoms can vary in intensity from mild to severe and often include breathlessness, exhaustion, or weakness, though pain is the most commonly reported symptom. Doctors may be unable to pinpoint a medical reason, or there may be a clear and diagnosable medical cause. However, people with somatic symptom disorder are likely to experience the symptoms of their illness more severely than is common.

 

Fast forward to this year and very recently I woke up in tremendous pain it started with an “itching” sensation in my lower arms and legs, then they felt like they were on fire, I got up and moved my legs persistently for 40 mins trying to “release” the sensation

I went to the GP this week who confirmed somatisation disorder secondary to an anxiety disorder, PTSD, depression and hypercondriasis which makes sense.

Pain would be triggered by talking about illness in any context,so for example people on the bus sat behind me and in the GP waiting room for example the described pain would migrate and move from my lower back, to my upper back from upper limbs to my lower limbs my body would begin to shake and adrenaline fired through my body, my stomach muscles would cramp up and it would gurgle.

I went for a walk two nights ago and my feet went “numb” this caused great distress and panic as I walked home however bursting into tears was a great release for me.

Conclusion

Now most of pain has subsided but what does psycho-somatic pain represent? For me I feel it is unprocessed emotions, recent environmental distress and need for my body and brain to calm down.

Paul Isaacs 2019


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When The Clouds Move In

In the universe of the social media what does one put when someone is so low and depressed? Is it a false currency to type your feelings? Is it not correct to extract your thoughts onto a wider medium? Is it merely seen as a chance to get some sort of gratification or social supply from the amount of reactions and comments that come under your status?

I am depressed at the moment and the depression doesn’t seem to give me time to get grounded, its saps my energy, tailors my perceptions, distorts my mood and thought processes yet I still come out with a smile, a false sense of connecting, being in a room full of people and the walls come crashing in as the bleaked aloneness comes towards your words become ash, people become shadows and you wish to run away from the vessel you live in from day to day.

I have never since my teens felt such a state of melancholy, despair or detachment from the world around, pessimism rises from its tomb, nihilism jabs at my mind and hopelessness dominates as I plunder into the void once again. Maybe if I spoke up more about such feelings I would be privy to a listening ear? Maybe if I shed more tears I would get a sense of comfort from a friend? I know not what the future holds none of us do but at this moment in time the darkness follows me everywhere the omnipresence suffocates my soul and creativity.

Maybe all I want is for someone to see me as a human being, not a catalogue of facts about autism, maybe I would like someone to recognise my challenges and difficulties as I am made to understand theirs? Maybe I just want my perspective to acknowledged and validated regardless of it being right or wrong.

I do not like living a “half-life” between the void and the false pretence of happiness in my current state. If people think I am seeking a hollow sense of attention so be it but writing for me does extract the cusp of the matters, so I say to you if you feel down, low, depressed or otherwise please tell someone it may not sort out the root of the problem but it could be the start of doing so.

Paul Isaacs 2019


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A Lesson in Time – Mental Health Assessment Pre-Diagnosis

Paul 7 Years Old

Family Assessment

Tuesday 11th February 1997

Presenting Problems

Mr. Isaacs was unable to attend today as he is a shift worker and since accordingly this date he has been changed to day work. My initial impression of Paul was of a much younger lad (he is eleven in May) physically and psychologically.

Paul was eager to explain his concerns to me and at times was very insistent on not letting his mother give a more comprehensible explanation of the situations that had occurred.

Paul’s major sense of unhappiness and the reason for his referral is that he feels he is verbally bullied at school. he gave examples of being taunted primarily about 1.) The he way walks. 2.) Shuffling his feet. 3.) He wears glasses – and he has been called “four eyes”. However, he feels that the teaching staff are against him . In year 4 he had an unhappy relationship with his form teacher. It does seem one particular occasion he was humiliated – but to the infants so they could show him how to behave.

Mrs Isaacs also incited another incident which seemed to have upset her more than Paul. It became apparent that when Paul was explaining his situation at school his explanations tented to be repetitions of his parents points of view.

Paul after became muddled and it seemed there gaps in connecting and associating. It was also significant that when Paul referred to “she!”- his pronunciation was really that of “he” – I did check several times, but it appears that both Paul and his mother were unaware of this – which was marked. (receptive hearing problem? speech difficulties?).

Mrs Isaacs pointed out that Paul always had difficulties “concentrating” and settling down to work – she remembers this as stemming as far back as three year of age – When he attended play-group. she also recalls at this age and ever since that has had problems with “interacting with others” (her words). Paul has not many friends and it was brought to Mrs Isaacs’ attention by the teaching staff that he was a “solitary figure” in the playground. His mother also pointed out that they lived close of approx ten houses and that there were other children of Paul’s age, but he tended to say in.

Her explanation for this was that he felt safe and secure behind closed doors. Paul did mention some of his friends, but found it hard to articulate what he felt about his friendships with them. He did admit to hitting out at people at times is was significant that he mentioned his father hit him when he was angry. Mrs Isaacs denied this. Paul’s response was “I suppose Mum must embarrassed that I said that.”

Paul’s self-perception is that his “fairly sensible” , however he admits to being influenced by others into “being silly”, but he feels other children are being “sillier” the than him – “going over the top”. He feels he doesn’t go over “the top”. Paul has recently had to go back to the very basics in Maths with one other pupil. Mrs Isaacs conveyed concern and irritation that the teaching staff had not picked up on Paul’s severe difficulties with Maths; especially in view of him starting upper school at Lord Williams East in the new academic year (Sept 1997). Paul’s reading age is estimated as that of a nine year old. it appears the only positive subject that could of was Paul’ art. Mrs Isaacs believes and feels the teaching staff convey negative messages surround Paul’s overall performance. Mrs Isaacs explained that Paul gets very “worked up” over homework assignments, Paul also stated that he cries very easily hence his vulnerability at school in being bullied. It appears Paul suffers from anticipatory anxiety and expressed his fear of commencing upper school as he has heard he will get “beaten up”. Is is of significance that Mrs Isaacs was unhappy at ‘Long Crendon Primary School’ and suffered “bullying” at ‘Lord Williams’ East’. Mr Isaacs is also being scapegoated at work – he is being ‘verbally bullied’ (Mrs Isaacs’ words) and harassed and feels under a lot of pressure.

Family History

When referring to the history of the pregnancy Mrs Isaacs requested to speak separately – she explained she told no one of the pregnancy – only her partner (whom she is married to). She had been rushed into the JR as Paul “was distressed” – he was a month premature and was in SBCU post birth. She was unable to breast -feed Paul remarking they had said “she was too big”. Transition to weening had been unproblematic. Had been slow in walking – 18 months? He was sleepy baby and had to be woken up for feeds – He had been a “good baby”. However Mrs Isaacs had fond toddlerhood difficult – his “boisterousness”. Paul has had three operations 1.) Circumcision at 2 years 2.) Grommets 3.) Adenoidectomy at 4 years – at the JR and Radcliffe. Tonsillitis – query – Tonsillectomy otherwise healthy. Mother with Paul for all operations – no significant complications

Paul would like help with “the teasing” – he said it although it had been easier recently he wants to be able to cope with it better if it worsens again. He also says he is very sensitive and works himself into a state easily. There is also much anticipatory anxiety regarding this move to Lord Williams’ East in the Autumn. In ascertaining his mood he expresses no helplessness or hopeless feeling and denies suicidal ideation or such thoughts. He does covey and sense of confusion and bewilderment over the treating of staff’s “rude words” (his words) about his self-presentation. (persistent anxiety).

  1. Assessment from Psychologist (educational?) to check on cognitive abilities and overall school performance.

  2. Social skills group at “The Park Hospital for Children”. (mother drives) for interaction with class.

  3. Possible Family Therapy – concerns regarding Paul;s parents and levels of depression. Re-enactment of mother’s unhappy school experience and father’s “bullying” at his workplace, especially regarding “authority figures”

Cognitive Abilities , Cognitive Impairment & “Mental Retardation”

“It became noticeable he had very slow speech”

There was a massive transition in 1993/1994 prior to this interaction before this I was echolalic, meaning deaf to large degree around 80 to 90 percent and unable to speak in a fluid manner. Having visual agnosias, oral apraxia and challenges around receptive language meant that getting an interpretive and expressive framework was slow, stilted and lengthy. I went through bouts of selective mutism and hating my “connected” voice which then in turn triggered exposure anxiety.

there appeared to be a gap in connecting and association.

Still having complex visual and verbal blockages meant that my “cognitive abilities” were hidden and therefore not “seen”. I have no doubt that the lady in question had her own frame of reference on how I was processing the information so thinking I was “retarded” was just the tip of the processing iceberg.

Bursting into tears quickly’ – Alexithymia, Body Agnosias and Trauma

There are many overlapping reasons why this was happening at this point – the reason in which I was at this assessment was the persistent and verbal bullying from a senior member of staff at the primary school which I attended.

Having body agnosias meant that I couldn’t gauge or manage my own emotional states this would be related to alexithymia the inability to “know” your own states of emotion, the ability to “internalise” them and mentalise them on a “conscious” level. However many years later when I wrote my first book I came to realise that on a “unconscious level” all my experiences were unlocked through typing.

(receptive hearing problem? speech difficulties?)

I was traumatised from an early age by expressive language (but at times would be intermittently intrigued) due to a language processing disorder (aphasia).

I was triggered by exposure anxiety, dissociated easily and would struggle to get incoming information with “meaning”. Living in the world of the system of “sensing” before awareness mind and the ability to make interpretive connections.

Battling Books & Formulas & Artism

He has severe difficulties in maths.

His reading age has been estimated at an average age of nine.

Not being able to mentalise in a visual – verbal way meant that I had challenges around comprehension and getting meaning from books, written words and maths. (dyslexia, dyscalculia and visual-verbal agnosias). I found the process of writing very difficult the way in which I held the pencil, the ability to concentrate on each letter and sentence formation. The same goes for maths.

My solace for extraction and distraction was art which was were my mind was freed and felt “at home”. I started from a very young around 5 smearing paint on to a piece of paper and I was hooked from that point on then transitioning to drawing by route during this period of my development.

Prematurity & Height
“There is some evidence that babies who were born premature tend to be shorter in childhood, but they usually catch up with those born at term in late adolescence. But our study shows that women who were born very preterm fail to reach the stature you’d expect based on their parents’ and siblings’ heights.”12 Dec 2016

She noted that developmentally and that I seemed “younger” than my age from a psychological and psychical perspective. There is a link between having a short stature and prematurity, currently I am only about 5’8′ I do not think I will be growing vertically anytime soon.

Did I Have An Attachment Disorder?

I can assure you I was lucky that my parents gave me love, support and grounding even though they didn’t know that I was on the autism spectrum. Did they both have difficult childhoods and upbringings? Yes they did for many different reasons.

My Father had parents his whom were his primary caregivers who didn’t not show him love, affection, boundaries or a sense of meaningful inclusion. Both of his parents were cold and aloof and didn’t seem to understand (be it wanting or otherwise) the serious practicalities of what parenthood meant for in a child’s development and emotional well-being.

My Mother was seen as a disappointment to her Mother who was constantly comparing my Mum to other people explaining that she needed to be more like other people as opposed to building up her own sense of self identity, self-worth and autonomy.

The truth is I am and try to be a objective judge of character when it’s presented to me and the answer is no I did not have an attachment disorder and my parents were not to blame for anything.

My Mother fits the solitary, serious and self-sacrificing personality types. She is giving, emotionally connective and generous.

My Father fits the conscientious, mercurial and adventurous personality types. He is assertive, pragmatic and forthright.

I love and value them as human beings because despite their own “shit” they didn’t fling it consciously or otherwise on to me.

Paul Isaacs 2019


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Elderly Paraphrenia and Atypical Grief

Nan and I 1990s

My Nan has been diagnosed with Paraphrenia a form of late onset schizophrenia that effects 0.1 percent of the elderly. This is secondary to an atypical form of grief.

She has had auditory hallucinations for 2 years along with complex visual hallucinations the most recent episode was in the morning seeing flames all around her. Others she has experienced are of people, animals and objects. This is related to urinary tract infections.

 

She has experienced psychosis and delusional thinking it is clear from my views of this states that she is very scared, confused during the lead to these events and afterwards she quite rightly views them as ego-dystonic (separate and in conflict with “self”).

Paul Isaacs 2019

 


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Most Common “Pieces” in People’s Autism “Fruit Salad”

Autism Most Common Image
Donna Williams’ (Polly Samuel) set a legacy in what the adjective “autism” meant it was like a bowl of fruit and different pieces of fruit mean different things in this overview she covered in the image above the most common aspects of someone autism “fruit salad.”

Social Emotional Agnosia – Not perceiving body language, tone of voice and facial experiences means that person only “sees” and “hears” facts that means that the person maybe socially anxious and may need information shared to them (including emotional supply) in factual/pragmatic way.

Faceblindness – A person who doesn’t recognise people by their faces this means the person may connect more with the what the person is wearing, hairstyles, jewellery, voice patterns, walking gait. context is also an issue such as meeting people and/or getting used to seeing someone one context may not translate to another. You may need to ask them is they struggle with faces.

Simultagnosia – (Object Blindness) – A person who only see’s pieces of a their visual field and not wholes this could mean that the person finds certain environments difficult to navigate, people, places, objects may be hard to track causing anxiety, overload and on the opposite end euphoria and “sensory highs” that is person who is addicted to their own “chemical highs”. Lightening, colours, patterns, colours, stairs (surface changes), shadows will all have an impact on perception.

Alexithymia – A person who does not process and/or perceive their emotions in “real-time” this can cause a reactionary delay meaning the person is always “trailing behind” to some degree and may give surface “responses” rather than “connected” responses. Give the person time to respond.

Dyspraxia & Overload – A person is struggles to motor-ordination issues, the movement of their body and limbs in and around their environment being prone to overload could be due to the brain and bodies movement not being in tandem causing/triggering chemical imbalances.

Lack of Simultaneous – Self and Other – A person who can do either “all self no other” and/or “all other no self” this means the a shared sense of “social” may be delayed and the mono-tracked way of conversing may have to be adapted to allow time between “switching”.

Language Processing Disorder – A language processing disorder can come in many forms and presentations the ability to find words (anomia), the ability to construct sentences (pragmatics) and the ability to receive and express meaning with interpretation some people may be “meaning deaf” (aphasia, verbal auditory agnosia) and need for example object of references gesture and tone and other who are literal in their perception and have atonia may need facts and to limit body language.

Communication Disorders – Some people may get tongue tied, stammer, are “tone-deaf”, have tourette’s, have verbal agnosia and talk through echolalia (TV shows, Jingles, DVDs and TV shows), some people have oral apraxia (the ability to use their tongue and facial muscles) having visual perceptual issues and associated personality types which in turn have an impact on style and/presentation.

Exposure Anxiety – A person who is triggered by direct communication and “exposure” triggering compulsive, avoidance, retaliation and diversion responses meaning that “direct communication” you may need to use a “indirectly confrontational response” such as focusing on the object, situation not the person, humanising objects.

Lack Of Mentalising – The inability to “juggle” information with a level of coherence this could be to do with information processing delays, sensory perceptual disorders, social perception and/or language processing this means that you need to work out the person’s “system” of integrating information with associated meaning.

Personality, Identity and Attachment – This is how the person sees themselves, differing personality types will colour a person’s interpersonal wants and needs and communication styles, sexuality and gender

Mental Health – These associated conditions will have an impact on presentation such as mood, impulse control, anxiety, dissociation and attachment disorders.

Physical Issues – They may have auto-immune disorders, disorders of metabolism, dietary disabilities, genetic anomalies which have an impact on overall functioning.

Paul Isaacs 2018


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The Problem with Somatisation Disorder

Image result for Somatization disorder

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 & Personality Disorders – A Personal Perspective

Compasition Photos17Note: this is from a personal perspective and doesn’t represent all people on autism spectrum

Personality Disorders & Autism

Yes they can co-occur and yes it does happen, personality disorders and autism these are types/trait which are “extreme” and “disordered” versions of “normal” personality type this can happen for variety of different reasons an environmental trigger, isolation and alienation, victimisation or genetic predisposition to having such extremes but is idiopathic in nature. (these can happen to ANYONE).

I Have “Been There”

I am a person who has “been there” in terms of personality disorders and it was during my early 2os, at this time I was being bullied at my workplace and into between hanging on there and leaving (which I did soon enough) it was a mixture of additional mental health conditions, unipolar depression, mood disorder (low mood dysthoria), self harming and suicidal ideation.

1. Schizotypal Personality Disorder

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (American Psychiatric Association, 1994, pg. 645) describes Schizotypal Personality Disorder as a pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  • ideas of reference (excluding delusions of reference);
  • odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”; in children and adolescents, bizarre fantasies or preoccupations);
  • unusual perceptual experiences, including bodily illusions;
  • odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped);
  • suspiciousness or paranoid ideation;
  • inappropriate or constricted affect;
  • behavior or appearance that is odd, eccentric, or peculiar;
  • lack of close friends or confidants other than first-degree relatives;
  • excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self.

2. Borderline Personality Disorder

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (American Psychiatric Association, 1994, pg. 654) describes Borderline Personality Disorder as a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  • frantic efforts to avoid real or imagined abandonment;
  • a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation;
  • identity disturbance: markedly and persistently unstable self-image or sense of self;
  • impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating);
  • recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior;
  • affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days);
  • chronic feelings of emptiness;
  • inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights);
  • transient, stress-related paranoid ideation or severe dissociative symptoms.

What Are YOUR Personality Types?

When you look at these two sets of personality disorders from a person perspective they at both ends of the spectrum with one being marked by non-conformity and the other a sub-conscious wanting  how did I get through this ? Firstly knowledge – understanding my autism “fruit salad” meant looking at the whole package and that included personality types of which I have 4 these two above in there “normal” variants are 1. idiosyncratic and 2. mercurial balanced and have bettered my functioning along with my tinted lenses for visual perceptual disorders for example.

It Can Be Apart Of The “Bigger Picture”

By picking these aspects of functioning I think is important when looking at an autism diagnosis could be that undiagnosed or unrecognised personality disorders could hinder functioning of a person but could be just be thought as “the autism”. For me dissociation, suicidal ideation, interpersonal issues (compacted by the pds), auditory hallucinations and psychosis were the tip of the iceberg not only in my “autism fruit” salad at the point but also the development of my identity and personality as a whole.

Trying Introspection

I have learnt over time to take control and autonomy of my emotions despite having problems with mentalising and alexithymia, I have learnt to not be too intense with people I like and if sense that I am back away and “turn the volume down”, I have learnt the importance of autonomy and not fearing aloneness chronically, I have learnt and accepted that dissociation and being “borderline” gives my problems with “self identity” along with other issues such as “self and other” processing, alexithymia, visual perception, I have learnt that being “odd” means that something is up and I need focus of getting grounded again. I have learnt that overall with all the interacting pieces I know of that balance is the place to be that is message of hope.

Last Question

I challenge politely people on autism spectrum who think that autism is “all of them” with so many interwoven personality types in human beings would it really make sense for autism to be “all of the person?” considering autism is made up of pre-existing conditions anyway? I wonder in the future will they diagnose or recognise personality types in people on the autism spectrum? I certainly think that would beneficial.

Paul Isaacs 2016