Paul Isaacs' Blog

Autism from the inside


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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 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 steaming 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. (percistanty anxiety).

  1. Assessment from Psychologist (educational?) to check ot 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 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 hating my “connected” voice which then in turn triggered exposure anxiety.

there appeared to be a gap in connecting and association.

Still have 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 verbal bullying from a senior member of staff at the primary school 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 manner years later when I wrote my first book I came to realise that on a “unconscious” all my experiences were unlocked through typing.

(receptive hearing problem? speech difficulties?)

I was traumed 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) found the process of writing very difficult the way in which I held the pencil, the ability to concentrate on 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 upbrings? 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 the parents were cold and aloof and didn’t seem to understand (be it wanting or otherwise) the serious practicalities of what parenthood meant for a child’s development and emotional wellbeing.

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 and 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 a 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 Dad 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

Image may contain: 3 people

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 with people, animals, objects.

 

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


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Mental Health: Reflections Of Moving On From Negative Environments

ShortsNote: This is from a personal perspective

Negative environments

Negative environments can leave “hidden difficulties” that become about to the mix of things that may not of been there when the person entered them. Mental health is tempestuous subject in itself but looking after one’s own mental health and being aware of the “warning signs” of mental health issues can be a very difficult one to acknowledge and accept that is happening.

Slow escalation of events

Sometimes events can slowly build up from behaviours of others, this may have a slow gradient like effect that initially may seem quite “mild” in the sense that the overall impact is small and may well be just secluded to the event which happened and the person is able to get on with their day with no trouble at all.

Sometimes “resolve” doesn’t come in the form you expect

What if that situation lacks resolve but you yourself want a resolve? What is the situation is being mishandled? And you yourself want it to be handled correctly?

With a moral compass for feelings to not only be acknowledged but to withhold a balanced and healthy level of objectivity.

If those basic foundations aren’t in place for whatever reason and you feel trapped and/or obliged to keep going, there is going to be a tipping point and decision making that needs to be addressed, surely for the benefit of the parties involved.

Let go of the situation and the people within it

My reflections are only from a personal perspective on whence they happened but I believe that one of the primary mistakes that were made by me was to keep staying for the long term – I know why I did. It was primary because I didn’t want to leave; it made me feel uncomfortable for the future and what that meant in the long term.

Positivity and new experiences are valued

When I left the situation my mental health improved gradually to a point where my mental health was on an even keel and was not impacted by mood disorders, emotional regulation problems, clinical depression, and personality disorders. The “invisible chains” that had shackled me where gone I had gained a level of control, autonomy, roundedness with the ability to look back not in shame, self-pity but that a lesson was learned.

Paul Isaacs 2016


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Alexithymia, Somatisation Disorder, Emotional Regulation & the Loss of a Dog

Sometimes words cannot express in times the grief those thoughts, feelings and wants that you had for a loved one once they have passed on. This is from a personal perspective.

Emotions within “the self”

Being aware that such an emotion exists within at all can be difficult to decode and grasp in the end interpret within the context of its own reality and within its own significance one can witness and event that was seen to happening and not “connect” with it in a way which feels that is “correct” , “just” and “suitable” to me that is fine I understand why this happens within my “internal” self this is a road that I cross with not being able to “filter” or “interpret” my emotional states in “real time” or course one would expect a level of delay in such circumstances – but over many years I have noticed patterns my own behaviour that manifest during these times of grief.

Alexithymia and “emotional perception”

In my first book I document times of emotional perceptual difficulty either displaying an emotion and not connecting its own context or significance (such as crying from an emotive reason for example but not “naming” the reason or reasons behind it) or having delayed emotional perception which means a situation could be happening on a constant basis and it could take me years to filter how “I” felt about it like a wave of raw emotion hitting me all at once, in my teenager years I feel as if being “attacked” by my own emotions hitting my arms and legs, tensing my face and knuckling the temples of my head.

Emotional regulation

Regulating ones mood I have found to be difficult because the “origin” or “starting point “may take to time to be seen, understood and processed within the significance of the “self” and then the “other” (if other specific parties are involved) this loop once stared may well be overwhelming so the filtering starts on a difficult level now understanding and significance come into play.

Somatisation disorder

DSM-IV-TR
The DSM-IV-TR diagnostic criteria are:
• A history of somatic complaints over several years, starting prior to the age of 30.
• Such symptoms cannot be fully explained by a general medical condition or substance use OR, when there is an associated medical condition, the impairments due to the somatic symptoms are more severe than generally expected.
• Complaints are not feigned as in malingering or factitious disorder.

This has manifested itself in many different forms over the years it could be a headache, stomach ache, back pain, limb tenderness the list goes on but it seems to have running theme within my “decoding of emotions” with the death of my dog recently I started to have what I perceived as a toothache this pain last for well over three months (have problems with perceiving pain and trauma) I recently went to the dentist for a check-up and low and behold the wisdom tooth which I thought was “decayed” was healthy and no problems persisted.

Days after the dentist appointment the “pain” disappeared – I believe there is a connection between personality types, my emotional perception, and mood management and somatisation disorder and how I deal with grief and deep emotional states.

Emotions are human

Human beings are emotional beings and there are many different ways in which a person shall decode, evaluate, self-reference, and acknowledge and ultimately “deal” with their own emotional states is seems there are many emotional roads to Rome.

Paul Isaacs 2016