Asperger’s / autism + PTSD…

Asperger’s/autistic people are like fresh-water fish who must, for most of the time, function in a salt-water environment (meaning, the rest of the world).  We desire/need to (and we function much better when we can) create a fresher-water environment of our own, moulding our work or other daily activities around our neurotype.

We can do this in a variety of ways; we often carefully plan out the day.  We like to work alone, relaxed, hyperfocused, in tunnel vision and complex thought-cloud.

So far, no problem.

Personally, my water gets saltier when I have to meet with clientele.  Or when I have to switch mental gears faster than I’m comfortable with.  Or when I have to think fast to come up with an answer or make a judgment call on the spot.

The water gets dicier still when I get the sense that I’m not communicating effectively.  Or when the recipient isn’t satisfied with my answer.  Or when I sense boredom or apathy toward what I know is important information that I’m trying to give.

And that water gets downright toxic when I have to deal with a complaint.  Unfortunately, knowing that the other person is incorrect or being unreasonable doesn’t always help.  Sure, I feel more solidified in my position or viewpoint when I know I’m right, but it doesn’t make the situation any less stressful; I still have to deal with it.

That would be a difficult situation for most people, and incredibly so for any Aspie/autistic person.

Enter PTSD…

I have PTSD; it overlays my Asperger’s neurotype like rotten icing on what would otherwise be a tasty cake…


Mine was primed by my parents’ near-fatal car wreck, and then subsequently fully-blown activated by the sheer prolonged hell of starting up our own practice, fresh out of school, roughly nine months later.  The process of starting practice, with finite resources, in a hostile and barren economic climate, in a completely unfamiliar town, was unparalleled stress for us.  It was accompanied by terror and unprecedented uncertainty surrounding our very survival, which was nowhere guaranteed.

The desire to please everyone (members of the early clientele) was all-consuming.  Any notion that anyone was less-than-absolutely-thrilled-and-awed was devastating…and also all-consuming.  And I was wet-behind-the-ears, scared stiff without an overseeing faculty physician to lean on.

I thought people would appreciate the extra time I put into their cases, the extra time I didn’t charge for, the time that I spent that I shaved off their total bill instead of charging for, the extra educational materials and epiphany-generating explanations I provided that I knew that no other doctor did.

Was it appreciated?  Nope.  OK, fine, I’ll live with that; people aren’t used to appreciating doctors anymore.  But what I didn’t expect was that instead of generating goodwill and camaraderie, I got the opposite: I was shit on.  Disrespected.  I was teaching people to feel entitled to all the extras, without giving any due respect or even adhering to healthy professional boundaries.

I stopped sleeping.

I started sneezing.

I hated weekends, because the office couldn’t be open (no one would’ve come anyway; being open on weekends is a sure-fire way to attract a less-than-desirable crowd, who really doesn’t take you seriously).  I loved Mondays, because we were back in the office again, with the whole week ahead of us.  I would be fine during the day, when I had things to do, something to focus on.  At night, for no known reason, my heart would speed up, the adrenaline would kick in, and I would suddenly become very uneasy.  The only way I could get to sleep was work on my laptop until I literally passed out on the couch.  The amount of sleep varied; three hours here, a half-hour there.  A great night was four hours.  No naps, by the way.

I never rested.  I never stopped working.  I never stopped thinking, deciding (“how should I handle…?”), trying (“maybe this’ll work…”), ruminating (“I know I already said this, but…”), self-checking (“well, maybe I did something wrong”), self-criticizing (“I shouldn’t have…”), and self-driving, driving, driving (“do it, do it now, do it right the first time”).  To rest was to let time slip away and seal our own deadly fate.  No way.

I felt like I was spinning my wheels, kicking up gravel behind me, redlining my internal engine, but never gaining traction or speed or altitude.  I felt like I was going to crash.

This went on for a few years.  Yes, years.

Fast-forward to the present day.

The stress has lifted, somewhat.  It’s about two-thirds to three-quarters better than it was before.  But that kind of trauma doesn’t self-correct.  My nervous system got used to generating that panicked response…to everything.

Like I mentioned in the beginning, I’m happiest when I can plan my day, settle in, relax, and work.  Alone, on my terms, at my pace, with my own set intensity, in my office, in my element/environment, without interruption, without switching gears.  Hyperfocused, diving deep down, without having to come back up for any reason.  That is my fresh-water environment.

And as luck would have it, I’m an Aspie, so this type of work makes perfect sense to–and perfect harmony with–me.  So imagine that you have such a day planned out, with a realistic to-do list in front of you, and all is calm, all is bright…

…and you get a message that someone (one of the clientele) is less-than-happy (whether legitimate or not), or they have a concern that could very realistically result in their dropping out of care.

The task-switching involved in shifting from “relaxed, independent work” mode to “crisis-management, will probably have to (eek!) talk to someone to (eek again!) smooth ruffled feathers” mode is hard enough.  Now factor in the PTSD described above, generated by starting practice and consequently being shit on by impossible-to-satisfy crazy people.  I’m preoccupied with the anxiety of the Difficult Unknown that will weigh on me and plague me until the issue is fully resolved.

Hopefully, it gets resolved quickly and successfully.  That’s the ideal.  But that doesn’t always happen.

If the outcome is less-than-ideal, such as an unreasonable expectation, irreconcilable differences, or an impossible impasse, it may leave me fatigued, depressed, hurt, “broken”, and resentful.

Add to that the fact that my plans-for-the-day were completely disrupted.  And with the stress and the subsequent exhaustion (and if the resolution was incomplete, throw in an overwhelming sense of defeat), this may all trigger a shutdown.

Today, I had such a situation.  One of the clientele (the kind who secretly wishes Google University would grant them a medical license) had called yesterday, claiming to have a “personal” problem that “was keeping them up nights”, and refusing to tell my assistant (and healthy protective boundary/barrier from the rest of the world) what that problem was.  Instead, they wanted to talk to me.

Ohhhh, boy.

This is the type of thing that would trigger a flashback.

Usually when I hear about a call like that, I know that eventually, it’s going to lead to a blindsiding discussion, probably about something regarding a financial complaint (i.e. playing a sympathy card for a discount, when they live better than I do) or a policy or procedure they want to skirt around–basically, the message they have to send me is that what I offer is somehow not worth whatever time, effort, or money I’m asking from them.  In short, a slap in the face.

And it’s this unpleasant discussion during which I’m going to have to make a judgment call in which my choices are A) “look like an anal-retentive, unreasonable hard-ass”, or B) “look like timid pushover who will kowtow at the slightest suggestion”.  Yeah…no.  Neither of those options are very attractive.  And these people are keenly aware of this, so they typically want to confront me personally with this, of course without giving me time to prepare or think rationally in any way, hoping that I’ll cave under pressure (which is the ultimate goal: to get what they want).

And in the past, it worked.

In the past, I would usually receive this complaint via email after hours, not by a phone message taken by my assistant during office hours.  I would freak out (execute flashback)…

In the past, I would have curled up into a little ball and gotten very cold (in terms of body temperature), distant, and either mute or incessant chatterbox (there was no in-between).

In the past, I would have agonized, self-doubted, tried to find a way to smooth things over, even if it meant compromising my own self-respect.

In the past, I would have buttered and massaged their ego so that they wouldn’t leave me, actually ending the conversation with a thank-you for essentially insulting me in a half-hour-long bitch-session.

Today was different.

I didn’t flash back.

Sure, I got on the phone with that person.  I listened.  I made notes.  I took them (partially) seriously (I couldn’t take them completely seriously because some of their expectations were unreasonable, impossible, and had never been provided at any other healthcare entity).  I listened some more.  I nodded and empathized as much as I could.  Even after they repeated themselves.  And repeated themselves some more.  I apologized for the misunderstanding.  And there it was: the request for a credit toward their next bill.  I stated that I would review this information with my partner (we work in the same office) and we would render a decision and have a solution ready by early next week.  I thanked her for her honesty.

But there was no ego-stroking.

There was no curling up in a little ball.

There was no snap-to to offer an office credit (yet).

There was no self-criticism.

There was no curling up in a little ball, under a blanket.

There was no agony, and I will not agonize about it over the weekend.

I did indeed talk to my partner.  We realized it was a genuine misunderstanding, and we will do our part to make it right.  We will make our offer, and that offer will be contingent upon a few reasonable factors.

And that will be all.

The PTSD is still there, but I’m learning to manage it.  I’m learning to confine it to a mental box.  I’ve come a long way.  There’s still a bit more to go.  It’s really hard not to automatically respond with a knee-jerk reaction and lay flat, ready to be walked on.

But I’m getting better.  My water is getting fresher.  Some of it will always be a little salty, whenever I have to meet with people, which will be fairly often.  But we teach people how to treat us, and I had been going about it all wrong.  I’m not doing that anymore.  In the Real World, “Not Everyone Gets a Trophy”, meaning that we don’t always get what we want.  Up until this point, I had been the one doing all the giving.  That really salted my water.

Those days are done.

Happy birthday to me.  🙂


(Image Credit: “What It Takes To Fly” by Yuumei)


  1. Did you come up with the freshwater/saltwater fish analogy yourself or did you borrow it from elsewhere?

    Do you realize that Simon Baron-Cohen referenced this analogy in an editorial published in the Journal of Child Psychology and Psychiatry (Volume 58, Issue 6; June 2017)? “And to expand on the quote attributed to a person with autism, ‘we are fresh water fish in salt water. Put us in fresh water and we are fine. Put us in salt water and we struggle to survive’.”

    Citation: Baron-Cohen, S. (2017), Editorial Perspective: Neurodiversity – a revolutionary concept for autism and psychiatry. J Child Psychol Psychiatr, 58: 744–747. doi:10.1111/jcpp.12703

    Liked by 1 person

    1. Wow! As far as I know I can honestly say that I don’t recall having seen it anywhere before writing about it. Thank you for the heads up! Personally, I’m happy that he is keeping tabs on the Asperger’s/autistic community, continuing to listen to what we’re saying, even if there is dissent among the community regarding people’s feelings toward–and support of/for–SBC’s work. (True to usual form, I see both sides. His work is among the better peer-reviewed-published work, although there have been weaknesses/mistakes made along the way. I think it’s sort of two-sided coin.)

      That’s pretty cool, though, what you found 😊💞


    1. Cool! 🙂 🙂 Google likes you better than it does me, I think (lol! 🙂 ) all it gave me was something about using fish genes to explore genetic roots of autism. :O (doh!) Thank you so much for providing these! I really appreciate that ❤ ❤


    2. One thing that amazes me is how often I either write something or come up with an idea to write about (and then start jotting down the notes), only to find that someone else either writes about it in the interim or has already written about it a long time ago. LOL 🙂 I guess it just solidifies the idea that there actually are other people out there with whom I share thought processes, and that’s both eerie/unfamiliar and really reassuring all at the same time ❤

      Liked by 1 person

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