Autism and Mental Health: The Autistic Operating System
By Judy Endow, MSW, LCSW –
As an adult with autism, knowing what will happen during each day is important to me. For children, who have much less life experience, it is often a deal breaker in terms of them being able to participate in life around them. Using visual schedules supports this need both at school and on ordinary days at home, but what about those times when life gets hectic or when spontaneity is in order?
Mental health diagnosis and treatment has evolved over time according to what makes sense and what works for most people. We have an increasing body of research around mental health issues that informs us today. However, when it comes to autistic people, we do not have a body of research that informs us about diagnosis and treatment of mental health disorders. Autistic people are not like most people. This means we need to understand the underlying autism neurology along with its impacts in the realm of diagnosing and treating mental health disorders in clients also diagnosed with Autism Spectrum Disorder (ASD).
Autism is an Operating System
For clinicians, it is important to understand that autism is much more than a diagnosis. Autism is a way of being. It is like being blind in that we cannot separate the blindness from the person, but the blindness – or in this case, the autism – defines the person. As an autistic I see, experience, interact with and give back to the world as an autistic. Autism is my operating system.
Autistics have a different operating system than typical people. This is not good or bad. It is just different. Think of PlayStation and Xbox gaming systems. Some gamers prefer one to the other, but most gamers like owning both. This is because some games can only be played on PlayStation while other games need an Xbox system. Neither gaming system is good or bad. They are just different systems.
The majority of the people in the world, because they represent the biggest number, are defined as “typical,” and we can say they have a typical operating system. Those with autism are in the minority. They are not wired with a typical operating system. Instead, they are wired autistic.
Medically and diagnostically speaking, anything not typical is atypical. This is most of the time helpful, but when it comes to autism, it has not proven to be very helpful. Most of the times in the medical field when atypical can be changed into typical this is a good thing, so that is the goal whenever feasible. Thus, for years we have tried to change autistic people (whom we assumed to be atypical) into typical people by trying to make them behave like typical people. In the process, we have learned that we cannot change the operating system. Autistic people have an autistic operating system.
When Clinicians Don’t See the Autism
Today, autistic people, just like the population at large, find their way to therapy when symptoms of depression, anxiety, obsessive-compulsive disorder (OCD) and other diagnoses become problematic to them in their daily lives.
Clinicians need to understand the autistic operating system – in other words, to see the autism – if they are to be helpful to their autistic clients. When they do not have a strong grasp on this, the results are that their clients are not served well. Clinicians without a good understanding of autism generally sort things out in one of two ways:
It’s All the Autism
When a client has been previously diagnosed with ASD, it is common for mental health clinicians to attribute all psychiatric symptomatology to the autism, which often results in autistics not being diagnosed or treated for comorbid mental illnesses when warranted.
Can’t See the Forest for the Trees
Another example is clients who have multiple psychiatric diagnoses for which none of the typical treatments have been effective in lessening symptoms. These clients’ individual symptoms are sometimes collectively better known as autism, but because the autism hasn’t been recognized, clinicians miss the boat in rendering effective treatment.
When clinicians do not have a good understanding of the autistic operating system, they tend to lean toward one of the two above examples, neither one being helpful in supporting the therapeutic progress of autistic clients.
Author note: In my practice, I see clients who happen to be autistic. Their autism is usually not the reason they seek therapy, but it certainly affects how the therapy for their depression, anxiety or other presenting symptoms is delivered. When mental health therapy is delivered in a usual manner and not based upon the autistic operating system of the client, it generally is not very effective.
This article is part of a series on Autism and Mental Health. To follow the entire series, please visit www.judyendow.com, Aspects of Autism Translated
This article appeared in the Winter 2017 print edition of Spectrums Magazine which can also be read online at this website or through Issuu.
Judy Endow, MSW, LCSW maintains a private practice in Madison, WI, providing consultation for families, school districts, and other agencies. Besides having autism herself, she is the parent of three now grown sons, one of whom is on the autism spectrum. Judy can be reached through her website, www.judyendow.com.