by Nanny Aut
CW: Talk of trauma, bullying, self-harm and suicide
It is three a.m. I have just come out of a severe meltdown and I am leaning as far as I can out of a third story window assessing the ground below. There is a narrow pavement below. If I can successfully hit that head first, I can guarantee I will go cleanly. However, right next to it are bike racks. If I hit those or start rotating on my fall, I may only severely injure myself, or worse end up a quadriplegic and become more a burden on others than I am now. I am trying frantically to calculate whether there is any way I can be certain that I will hit the pavement cleanly. Reluctantly, I conclude there isn’t and review all my other options for exit. One after one, they are assessed and dismissed for various reasons. Eventually I give up and resign myself to being trapped here. Post-meltdown lethargy is starting to take hold as the fight/flight chemicals from the meltdown subside, and I sleep.
Next morning, while I am still severely distressed from the events that caused my severe meltdown, all suicide ideation is gone and I am shocked that any part of me even considered this a viable option. That, at the time, suicide not only seemed a logical option, but was the only logical option to the situation I was in. That I felt so calm and confident in my decision, that I was so certain that not only was it was the best solution for me, it was the best solution for my loved ones as well.
This happened four years ago and is not the first time I have been at this point. Previously, I have considered suicide on multiple occasions, and actually attempted suicide four times, luckily without success. Recognising that luck runs out, this time, for the first time, I sought help, and for all the actual help that was offered, I may as well not have bothered to say anything.
The suicide support team were called. ‘Are you planning to commit suicide right now?’
‘Well, no. Or I wouldn’t have asked for help to avoid it happening again.’
‘Great, then you aren’t at risk, so we can’t help you. If you feel suicidal again, call 111.’
This would not have helped – under stress I become non-speaking – so a phone call isn’t exactly accessible, even if I could overcome my discomfort of talking to a stranger on a phone.
I spoke to those who caused the original severe trauma. I thought that if they understood the damage they had caused, they would cease treating me the way they were and begin acting with even a little compassion. Nope.
‘You are a grown adult. You should have called for help at the time, the porters were right at the end of a phone.’
A. Non- speaking under stress. B. While the porters were exceptionally helpful people, I feel they would have drawn the line at holding my feet so I could get a clean drop to the pavement. Which was the only help I considered I needed at the point of trying to exit.
I spoke to Student Support. Who were sympathetic but severely overloaded. They could offer me a counselling slot in three to six months. The only way to be viewed as an emergency and get moved up was to actually attempt suicide.
I spoke to my doctor, who had the same story. Mental Health Services are overloaded, it could take between six months to two years. Meanwhile, we can give you the number of a suicide refuge. However, they are also overloaded so if you think you are going to be suicidal that night, you need to book a slot by 9 a.m. If you want to speed up the counselling process, then you had better self-refer as it is quicker than through the doctor’s recommendation.
I spoke to self-referral. Nothing available right now, but we can get you into an online support group, where you have access to therapists. We don’t know if any of them know anything about autism and mental health. (The online therapists didn’t know anything about autism and mental health, nor were they willing to talk to an autistic patient.) And we will put you on the wait list to be called for assessment if anyone cancelled last minute.
I spoke to the assessor. The only available counselling was CBT. She felt it very unlikely that the therapist knew anything about autism as it wasn’t something really covered in training. He didn’t.
We lasted one session, ended by mutual agreement. I explained that I often experienced hostile negative responses from people around me, even though I did everything I could to be pleasant, helpful and kind. He called me paranoid and said I was imagining it. Until we went through a few instances. He sat there eagerly waiting to show where I had misinterpreted the situation and each time, he was forced to agree there was no misinterpretation. While it made no sense for them to act that way, they did.
At the end of the session, to my relief, he cancelled my therapy. He said CBT was designed to help people recognise that events they believed were traumatic were not actually so. In my case, these events were actually traumatic. He said, unfortunately, nothing else was available in the area through the NHS and he couldn’t even advise me on what may be helpful or where to look.
So that was that. I was on my own. And while the bullying and gaslighting continued, I had to suck it up and cope by myself. Fortunately, while I was severely stressed and in massive mental distress from their behaviour, suicide ideation did not reappear. Which seemed strange to me, as the trauma that I believed triggered it was still very much there.
Over time, having left that situation, I recovered. Having just been identified autistic immediately before the bullying started (and, no, it wasn’t a coincidence), I knew very little about how the autistic brain works. And neither do the professionals, as it turns out. I researched about autism from autistics since the knowledge available from professionals was skimpy at best and downright wrong at worst. And I learnt about overwhelms, meltdowns and burnouts. And how living in an NT environment can cause cPTSD in autistics from an early age.
And I reviewed my past history with this new understanding of a late-diagnosed autistic. And I realised that each and every time I had thought about or attempted suicide previously, it was directly after a severe meltdown caused by a traumatic event. And each and every time, the ideation was gone by the next day, while the trauma remained. And when I floated this phenomenon with the autistic community, it seemed that I was not the only autistic who experienced suicide ideation occurring only post-meltdown. That for quite a large proportion of those who answered, this was the only time suicide ideation occurred.
And when you think about the process of a severe meltdown, it starts to make logical sense. A meltdown itself is highly traumatic. It is chaos. It is overwhelming pain. It is overwhelming multiple emotions flooding through at top volume. We may bang our heads, bite ourselves, cut ourselves to create a focal point of pain to narrow down the chaos and gain some respite. And if severe enough, it can trigger a compulsion to escape – permanently.
During the meltdown, our logic brain is locked out. Our self-protecting lizard brain (or Dino brain as I prefer to call it), is fully in charge. Post-meltdown, however, logic brain is back with an overriding compulsion to escape and still overdosed on all the fight/flight chemicals that Dino brain released to fire our protective reflexes. And it can now process and act upon ways to obey that compulsion.
This is the danger time. This is the time that autistics need to be protected. Be kept somewhere safe, secure, calm and reassuring. As scary as it is to witness a loved one threaten or attempt suicide, be aware that your anxiety is very likely going to be mirrored by us. If you can’t be calm and reassuring, stay out of the room. Make sure we don’t have access to anything that could be used to cause harm. And rather than leaping to Mental Health Services, we should be given time to see if the ideation subsides as we recover from the meltdown. That doesn’t mean let your guard down, it just means give us time.
And over the next few days, allow our brains to recover. Zero demand, positive stimming, safe foods. Look for the stressors that led up to the severe meltdown and address them, remove them wherever possible. Recognise that meltdowns are not ‘normal’ autistic behaviour but a giant red flag of an over-stressed nervous system.
Not recognising this post-meltdown effect as a cause of suicide ideation can lead to misinterpretation and adverse mental health treatments which can increase distress and trauma and not reduce it. Too many autistics have experienced the severe damage that mental health treatment, without understanding of autism, causes. This needs to stop.
The post-meltdown effect is very much not the only reason that autistics commit suicide. Suicide ideation for autistics as a response to long-term trauma or mental health issues is the same as in the NT (neurotypical) population. And because we are more exposed to trauma on a daily basis from living and working in an environment not designed for out neurology, and from being misunderstood, bullied and attacked simply for being different, our risk of suicide is much higher than the general population. Figures from research studies range from three times to 28 times higher than the general population. There is a particularly high incidence among the early teens to young adult age group.
The post-meltdown effect on suicide ideation is something that I and an increasing number of autistics are talking about. Sadly, researchers, in the field of autism and suicide, have yet to examine this with academic rigour, something I very much hope may be done in the future.
It is shameful that eighty years on from Kanner’s first diagnosis that we still know so little and there is still so little effective and practical mental health support for autistics. And what is there is, is designed in the main part by researchers and practitioners who are neurotypical and interpret their observations based on how their own brains work, even today.
This is where research money should be going, not into cures, or deletion of our identity. Effective research in how to support us, speaking to and working with autistics, and learning directly about our experience. #NothingAboutUsWithoutUs.