Component 9. Activity and stimulation therapy.


9. In Dr. Shah's book, this component is called "activity and stimulation therapy." As always--you should buy and consult the book. As a representative sample, I will quote an account from a family member: who was supporting an autistic son with catatonia.

"My son has had various therapies such as cognitive behavior therapy, solution focused therapy and exposure techniques and counselling. None of these have had any benefits and have often caused more harm than good. By far the most powerful 'therapy' for him has always been being involved in enjoyable activities, for example, lunch out, cream teas, cinema, walks in the woods, bowling, voluntary work with animals, etc."

Dr. Shah elaborates on this account as follows:

"It is all too common and easy for the individual's activities to reduce so that gradually their activity level and quality of life drop significantly. Many people with catatonia-related breakdown start spending gradually longer times in bed, in their bedroom, in the bathroom or toilet, or on only self-directed repetitive activities on which they get 'stuck'. Parents and carers often report that the individual concerned is 'refusing' to come out to participate in activities or outings which they used to enjoy."

I am very much of two minds about this advice. On the one hand, I have benefited enormously from DBT (and from other forms of therapy more generally). I would also hesitate to trust myself to lunch out, cinema, and cream teas in place of solid, behaviorally-informed approaches to trauma--and here I'm trying to be light rather than cynical. But I will say that nothing, literally nothing, has been better for me than connecting to my own versions of lunch out and cream teas.

Also--I had a long post, at some point, about how this approach is called "psycho-ecological" and how we should take the word "ecology" seriously, and remember that it invites us to reorient ourselves toward non-human life as much as human life, as many autistic people connect deeply to nonhuman life, and thrive by reorienting themselves away from human institutions and toward the nonhuman world. I will omit that diatribe, solely because it wasn't well-enough expressed, but I really, really think it's a huge part of the solution to catatonia. We need our relationships to living things in the nonhuman world--plant and animal and insect--and we need our carers to remember that most of our own routines and rituals don't even make it into the ken of people perceiving us through an institutional lens.

There's a great story in Dr. Shah's book about how someone walking with their parent, in the depth of severe catatonia, sees a crab on the beach and is brought back to themselves and is happy for the rest of the walk. In her book, Dr. Shah needs to explain what has happened, and how/why the person has become happy/non-catatonic, but I feel that autistic people already understand what has happened, so I will not explain.

(This, above, is 9--b. Prompting, cognitive refocusing (distraction), and other activities. )


 

Comments

Post a Comment

Popular posts from this blog

Map of Autism Assessment Providers

Here is a map of assessment providers , if anyone is looking for an assessment provider in their area. I went through all these listings and double checked them for accuracy about a year ago, so I hope that it's reasonably up-to-date, although I'm sure some entries have shifted a bit. (Note: this map is not a map of clinicians specializing in catatonia; it is only a map of autism assessment providers.) If you have had a positive experience with any assessment providers who are not on this list, please feel free to add it to the map or let me know and I will add it to the map. 
Read more

The New York Times: Autistic Burnout as a "Secondary Pandemic" (Autistic Catatonia, Part 1 of 5)

In the middle of COVID-19, the New York Times ran an article which I have since sent to more people than I can count, as it explains, in part, what happened to me during the pandemic (and which never stopped). The title of the article was "'The Battery’s Dead': Burnout Looks Different in Autistic Adults." In autistic communities, the term "burnout" generally means something almost entirely different, and radically more severe, than in neurotypical communities. In the Times article, the reporter--Beth Winegarner--attempts to explain the phenomenon of "autistic burnout" for a lay audience. As she writes, "[A]utistic people, at some point in their lives, experience [burnout] on a whole different level. Autistic traits can amplify the conditions that lead to burnout, and burnout can cause these traits to worsen. They may become unable to speak or care for themselves, and struggle with short-term memory." Winegarten reports on the experiences ...
Read more

Component 10. Reducing decision making.

10. In Dr. Shah's book, this component is called "reducing decision making." I want to focus on this advice as I understand it. She writes,  "The ability to make decisions and choose between options seems to get worse in many autistic individuals when they develop catatonia. It is helpful and actually beneficial to the individual if other people make the decisions on their behalf. The dilemma of making a choice or a decision seems to cause stress and anxiety and can increase shutdown and freezing. Reducing or removing choice goes against the principles of humanistic, positive support and care providing so understandably, carers and professionals feel unsure and uncomfortable applying this recommendation. However, this becomes easier when they understand the reasons and are reassured that it will help the individual and that they can gradually increase choices when they make progress. A gradual approach of limited options can be introduced and progressed according to ...
Read more