Sometimes people hold apparently contradictory beliefs. Like in class someone might clearly be able to explain why anecdotes are not data, and that you should not use anecdotes to make purchasing decisions. Then after class a friend says to them, “I’ve been thinking of getting a Palm Pre because it performed well in the tests I read about”. So they talk their friend out of it, because they bought a Palm once and the screen stopped working after three days.

In class, they totally believe that anecdotes are not data. Out of class, they totally believe that their personal anecdote trumps data. They’re being completely truthful to what they believe and it probably would not occur to them to compare the two beliefs.

The reason they don’t experience conflict is because the two beliefs are never active at the same time. The right belief for a situation comes to mind only in that situation, which is usually similar to the situation in which you learned it. You learn about anecdotes vs. data in the context of a class; you learn about how to give advice in the context of your friendships.

This is how beliefs frequently work (I’ll spare you the social cognitive science unless you really want it in which case I’ll have to go and look it up). It’s pretty normal, and it’s hard for me to think of it as hypocrisy or negligence when it’s socially adaptive for all parties involved.

There’s nothing wrong with it, but it drives me up the fucking wall. I know it’s not cheating, but it feels like cheating even though it’s not because:

1. They are performing well in class and will get good grades
2. They are strengthening a friendship by giving valued advice to a friend
3. They will never have to know, think about, or resolve any inconsistency in their beliefs. They really do get to have their cake and eat it too.

All the advantages of choosing the right response for the right situation, and none of the cognitive dissonance that comes with being aware that you’re doing that.

I don’t know how to do that to the same degree. I certainly have conflicting beliefs that I let conflict, and beliefs that I haven’t realized conflict, but when I learn something that’s directly applicable to specific real life situations, it doesn’t get filed under “Things To Believe In a Class Context”, it gets filed under “Things That Are True About Anecdotes Versus Data”, which isn’t tagged with a specific context.

I’d like to think about this in some way that doesn’t frustrate me but I don’t know what that would be.

I was expecting to spend $700-1100 for a formal assessment that might or might tell me something useful and I am glad that I have this because I think it will make it easier to get an effective specialized therapist.

Psychiatrist said that’s probably why therapy hasn’t been very helpful for me, and that therapy here (rural area) would probably not be helpful and she recommended waiting until I moved to CA in early December.  It was incredibly good to hear that.  The tension between my experiences with therapy and the experiences I’m supposed to have with therapy messes me up when I think about it.

I’m using some DIY cognitive therapy for some of my thought patterns.  This is the only time I’ve ever found cognitive therapy useful but it actually is.

1. List your feelings and rate their intensity:

* Safe (I wasn’t expecting this but it was the first thing that came to mind), 80% of max

* Guilty, 40% of max

* Confused, 20% of max

* Relieved, 80% of max

2. list automatic thoughts:

a) “I don’t deserve this” (i.e. don’t have adequately severe problems to deserve a label that will facilitate my getting help”

b) “It will look like I sought it out” (even though I didn’t ask for an assessment and only told her in response to her asking about what stressors I was having, but I still worry that I might have reframed what I said to “fit” a diagnosis)

c) “It’s a conciliatory diagnosis, like when you go to the doctor and they give you antibiotics you don’t need”

d) “It’s like not having real problems, like Asperger’s lite”

3. My responses to those thoughts:

a) feeling like I don’t deserve it: regardless of diagnosis, I damn well deserve respectful therapy

b) answer to “I sought it out” is “hell yeah I did, I’ve been trying to get help for seventeen years.  I’ve rephrased how I talked about things during those seventeen years, but my most recent way of rephrasing was based on analysis of personal experience, talking with my mother and my former babysitter, and reading the experiences of people with similar diagnoses. It is a sign of me being healthy that I kept looking for a way to explain what was happening that would help me get the right kind of therapy.”

c) answer to “conciliatory diagnosis”: “If it didn’t fit, she wouldn’t have diagnosed me.”

d) “It’s like Asperger’s lite”:  the DSM-IV states that PDD-NOS (pervasive developmental disorder not otherwise specified) “should be used when there is a severe and pervasive impairment in the development of reciprocal social interaction or verbal and nonverbal communication skills or when stereotyped behavior, interests, and activities are present but the criteria are not met for a specific pervasive developmental disorder, schizophrenia, schizotypal personality disorder, or avoidant personality disorder. For example, this category includes “atypical autism’ – presentations that do not meet the criteria for autistic disorder because of late age at onset, atypical symptomatology, or subthreshold symptomatology, or all of these.”

In practice, it seems to get used both for children who are so severely impaired you can’t tell whether they have autism, and for people who don’t meet enough criteria for autism or Asperger’s.  It probably does get used as “Asperger’s lite” sometimes, in the same way that Asperger’s diagnoses are sometimes misused to mean “Autism lite”, when the only difference between the two is presence or lack of language delay.

It looks like the DSM-V will fix that in 2010, by adjusting diagnostic criteria to better fit how people are actually diagnosed. And to better represent the fact that it’s a spectrum.

Anyway. Regardless of all that.  I think I’m more comfortable with a PDD-NOS diagnosis than an Asperger’s diagnosis because a lot of representations of Asperger’s don’t seem to me much like me.

I know someone who went through a period of time where she was expecting an asperger’s diagnosis, and she spent a lot of time gradually adjusting to it and talking about what it meant for her.  Then she actually got assessed, and they said she had some traits, but not a diagnosis’ worth. She didn’t talk about it again.

I think I would feel horribly embarrassed and guilty if I did that.  I’m not saying I think she should have, but it would feel like that for me.

And I think I was more ok when the narratives I had of autism spectrum disorders were different from my experience.

I moved at the start of July, away from a job that I took because it was portrayed as innovative and exciting, but that turned out to be a job where nobody did much work and no one would give “young” people work (I’m 30) and I was told that I needed to stop worrying about producing work and that my job was to “get to know people”. I did have a fantastic job description, on paper.  Which I kept thinking was my actual job description because it was written down.

So I moved away.  I’m actually on a temporary work assignment somewhere else and I’m supposed to go back there but I’m not going to.

Shortly before I moved, I got a medication raise.  I take a stimulant for ADHD, and the biggest thing it does in my life is reduce sensory overwhelm.  Forget the fact that it lets me follow meetings and stick with most conversations; it lets me spend time around other people without being unbearably exhausted at the end.

I moved here and I socialized a lot and I met a lot of people and I thought things were fixed.  Like, that my ongoing social skills issues were mostly a result of not being able to attend consistently enough to what was going on, and being too overwhelmed to tolerate much social interaction.

And things are still a lot better.  But they’re still broken.  I’m still getting too many channels when I interact with people – all the body language and facial expressions and tone of voice and word choice and prosody and everything, and I still can’t figure out what to do when I get mixed messages, and I can’t stop getting them.  None of my social perception turns off until I get so tired I start missing bits of conversation and not knowing what we’re talking about.

I still fall apart when someone does something completely unexpected.  I get lost, because up till that point it’s like I had a working map of how to tell what was going on, and then it just completely fails.  Like when Windows used to bluescreen – everything’s running fine, and then bang.

I have done lots of thinking and talking about identity with respect to sexuality (which I used to be clear on, and am now confused about), bipolar disorder (which I used to be clearer on, and am now uncomfortable with), ADHD (which I have always been extremely conflicted about), and religion (which I’m not even going to go into right now).  And I don’t want to do it any more.  I don’t want to spend lots and lots of time thinking about me and what it means to be whatever and how it affects my interaction with the world.  I don’t want to do this thing again.

I want to get up, and go to work, and do my work, and come home, and talk with my friends on the internet.  I want a while without surprises.  I want a regular schedule.  I don’t want to be understimulated or overstimulated and I don’t want to think about myself. I just don’t.  I’m too tired.

The third (or possibly fourth) way is to respond in the same implicit emotional language.  I don’t think most people are conscious of that; I think it’s often subconscious, unrecognized arguing that bypasses your conscious limits on what you consider acceptable to talk about.  But if your receptive and expressive communication is primarily conscious, you have to deliberately choose whether you’re going to act in contradiction to your values; you don’t get the option of getting more of your way while still believing that you’re being ethical.  You know that you’re doing something wrong.  (Which also opens you up to being accused of having overly stringent moral standards for yourself, when the primary problem is that you’re more aware of having violated them.)

Worse, though, you might not be able to get the signals right – you don’t know what you’re supposed to send or how you’re supposed to send it, and if you try to send it consciously, it might break into the other person’s awareness and they’ll feel accused of something they’re not aware of doing.

It’s one-way communication and can be one-way intimidation.  Which wouldn’t be intimidation if you could play the game in the same way – it would just be a run-of-the-mill, unnoticed background aspect of communication.  The other person might even be happier that way, since you would be negotiating their nonverbal and verbal expectations to a workable compromise, instead of leaving them with contradictory desires where whatever happens, one of those desires won’t get met. i.e. when you play the game properly, you get their conscious and subconscious expectations to match up so that it’s actually possible to make them happy.  And if you don’t play the game properly, they’ll want conflicting things and they’ll be unhappy because it won’t actually be possible to meet their contradictory expectations.

2. It’s really hard for me to separate other peoples’ beliefs about how the world works from my own, like about how if you go to a lot of therapists and can’t get effective help it’s your own fault, versus my experience of having actual, severely life-impacting problems that get ignored or dismissed by therapists.

3. Even though I can’t separate other peoples’ beliefs about how the world works from my own, I also can’t resolve serious contradictions. So I wind up saying them both over and over and getting more and more upset, because on some level I’m desperately hoping that someone will say “yeah, those two worldviews really are in severe contradiction with each other” and “here is why that is happening” so that I’m not alone and I’m not the only one who can see it and it makes sense in a way that has been put into words. It is extremely, extremely distressing, because it is frightening to me that I do not have a way to resolve the two and feel intense pressure to make the other person’s worldview be true, but I am unable to do so because it is not true, and I am frightened that I will never be able to resolve the tension or even get anyone else to notice or care that it exists, and it is extremely distressing to me to be abandoned to what for me is a task that is impossible to solve but that I cannot be ok with until I have solved it, because it puts my ability to trust in a coherent, predictable reality into question.

4. I’m not making this up. I’m not exaggerating. This is the first time I’ve been able to verbalize what the problem is in this way. I am actually aware that you almost certainly find this bizarre, irrational, and wrong. That doesn’t make it less painful for me.

5. When I cannot trust in a predictable reality, it doesn’t mean that I experience a less predictable reality. It means that I am frightened and in pain, and am unable to force myself to cease believing in my own reality, but if I have been abandoned to the task of having to make things right for other people, and my attempts to communicate have not resulted in the other person even recognizing that my reality is not the same as theirs, I don’t have anything else I can do other than keep the two beliefs circulating in my head. If I’m capable of responding in a healthier way, I start stating both as if I believed they were both true. If I’m not capable of responding in a healthier way, I take it out on myself.

6. When I get extremely irrational and start flipping back and forth between extreme accounts of what I believe or what I think is happening, it’s because I cannot come up with any other way in which to talk about what’s going on and also can’t cope with a reality in which the unresolvable contradiction is not observed or acknowledged no matter how bizarre and unbelievable it is, or the existence of the unresolvable contradiction is being attributed to me as though I’d come up with it on my own.

7. When that doesn’t work, I am sometimes able to verbalize that I’m in a great deal of pain, and having that acknowledged helps. At other times, I physically hurt myself, emotionally hurt other people, or break stuff.

8. It would be really nice to be able to talk to a therapist about this, but it’s very hard to do that when a therapist has a strong belief in my capacity to overcome difficulties, and is trying to treat me by pressuring me to share that belief. It’s also very difficult when I try to talk about this and I’m ignored or refocused on something else, because that replicates the problem. I’m still not able to deal with the problem, the therapist doesn’t believe it exists or could exist, and it’s now falling to me to fix the contradiction between their beliefs and my own.

9. I feel very angry and very whiny about the fact that I want the therapist to be helping me, instead me being placed in the position of making the therapist’s worldview come true for them. I feel extremely entitled to the belief that this is a morally wrong thing for me to be asked to do, but I also feel very immoral for holding a belief that strong.

10. You can tell me some variant of the belief that no one can actually do anything “to” another person without their permission. That’s great. Can I come live in your world where things like this don’t happen to me? I’d like to get there, but I can’t seem to get out of my own world.

I think the flip side is that the lack of words makes worlds unreal, and when I can’t get my words together, the world becomes unreal and that is very frightening because it feels like it is actually happening to me when that happens. The world becoming unreal.

Even though experience encourages me to know better, I still go in to mental health appointments expecting that what will happen will be based on explicit, often written, accumulated knowledge – I think I keep expecting authorities to do things the way I think is the “right” way, by evaluating deep (rather than surface) attributes against criteria and research.

And when they don’t, I fall apart. Because if I can’t trust authorities to know when their own intuitions aren’t right to apply, then no explicit knowledge means anything, because it takes place in a world of statements that doesn’t intersect with the world of actions. They run parallel to each other but don’t correspond, and the one that I can read properly is the world of statements.

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In this post, the description of how females with Asperger’s gain social skills  (starts about halfway down) resonates very strongly with me.   I read every book I could find on social skills during high school and I have two masters’ degrees that involve the study of normal people.

Likewise in this post. When people say things that describe a reality completely out of sync with my own experiences, it takes on a life of its own; nothing means anything anymore and I’m endlessly caught between my reality and theirs, unable to resolve the conflicts.

These similarities are distressing to me for many reasons:

1. I have described major social-related problems to almost every mental health practitioner I’ve seen, and have gone to multiple therapists asking for help with those specifically. I’ve always described them as major issues that seriously impact my life. I’ve been ignored or gently refocused, and, when I finally started refusing to just drop the issue and insisting over and over like a socially-insensitive repetitive robot, been reassured that there was nothing wrong with me but (unjustified) anxiety.

2. Several friends and family members have told me that they think I have undiagnosed Asperger’s. If that were true, surely some of my mental health providers would have been willing to talk with me about social skills issues rather than assuring me they didn’t exist?

3. Online autism communities can be social minefields if you don’t get the rules right. Rules sometimes include things like stay out if you don’t have a diagnosis, don’t act like you know anything unless you’re speaking from personal experience of being autistic, and don’t stand up for anyone autistic you care about if you’re not (diagnosed) autistic yourself.

4. I would fit in very poorly to most online autism communities for being so pro-scientist, for valuing social niceties because they are important to many people, for thinking that autism spectrum disorders are disorders and not different ways of being, and for thinking that people with Asperger’s and high functioning autism really are very different from autistic people who are invisible because they do not have communication and/or are institutionalized.

5. I sympathize very much with parents who are raising autistic children.

6. I can hold conversations, make eye contact, and implement a variety of other social skills. It takes me a great deal of effort and concentration, but it’s something I can do. It’s largely for the other person’s benefit, and often results in them feeling an emotional connection with me that I don’t feel with them. Therapy replicates this. I think therapists think I’m making progress because I’m able to simulate this for them.

7. I don’t have problems picking up on what other people feel and think. My problem is that I pick them ALL up and I pick them all up consciously and it’s very hard for me to figure out which ones I’m supposed to respond to and how versus which ones I’m supposed to respond to but not acknowledge. I’ve run into some discussion of this, but it’s not the right kind of problem.

8. Sometimes it’s extremely effortful for me to manage conversations and sometimes it’s easy.

9. I feel socially required because of identity politics to insist that I cannot have Asperger’s because I do not have a diagnosis. It’s something I really want to talk about but the social-minefield social rules issue is very difficult for me to cope with.

10. After years of therapy, I don’t have any hope that anyone would either believe me or humor me or be willing to treat past experiences as indicative of future experiences. I go to therapy and ask for help and have my problems ignored or normalized, and every time that happens it’s worse. (Added to by my repeated attempts to get help for dealing with fallout from an abusive work relationship, which also results in being ignored or refocused or told that my problems are anxiety.)

11. I feel like I’m decompensating with respect to social stuff as though I were borrowing symptoms.

12. Many of the skills I’ve developed are unsustainable. They’re skills, but they’re the wrong ones. It’s like being a college who can sleep four hours a night during finals week and pull off straight A’s, and having the ability to do that taken as evidence that I can do that every night for the rest of my life. I don’t know how to back down. I don’t know how to negotiate workable compromises.

13. In grad school I got an ADD/math problems issues evaluation from students with disabilities services. I was told my problems were only weak spots, given the impression that I was wasting time and resources that would have been better spent on people with real problems, told that it was part of bipolar, and even though I said over and over that what I was looking for were resources that would help me deal with the problems I was having, all he would do was ask me what accommodations I wanted.

14. Every time something upsetting happens it’s worse than the last time because I have more and more previous bad experiences. This makes me look especially unreasonable.

15. I want to go to a specialist and be assessed after I finish up my current work assignment and move, but I worry that no diagnosis will mean no help.

After eleven years, I was able to sustain casual conversation.  I do this by knowing the general format, having a mental library of stock responses, reflecting others’ emotions, and constantly monitoring myself and the other person.

I’m 30 now.  I can read emotions and intentions, but it’s hard to figure out what I’m supposed to acknowledge and respond to, what I’m supposed to respond to and not acknowledge, and what I’m supposed to do when they conflict.

This is intensely effortful, and it is not sustainable.  I want a workable compromise that is sustainable for me and for the people I interact with. I don’t know how to negotiate this.

I’ve asked for help in therapy many times, but the effort I put into social interactions is not visible and the anxiety I have over having to do that day after day without help is very visible.

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I don’t have an autism spectrum diagnosis, or any other social-skills-related diagnosis. Several family members and friends have tried to convince me that I have Asperger’s.  I don’t think I meet the criteria and it is getting harder and harder to deal with having my experiences and concerns ignored.

I do have a bipolar diagnosis and an ADHD diagnosis and take medication for both.  They are very helpful.  Stimulants make it easier for me to follow conversation because I miss fewer chunks of it, but they don’t give me the ability to process social interactions normally.