‘The Battery’s Dead’: Burnout Looks Different in Autistic Adults
nytimes.com
nytimes.com
In Germany, leading politicians are currently debating on forcing young adults to work in elderly healthcare after finishing school, to at least deal with the most obvious signs of a declining workforce in the healthcare sector. [1]
Employers are trying to turn towards cheap migrant labor due to shrinking applicant pools from inside the country. We too have the infamous "Fachkräftemangel" (skilled labor shortage) which is just a hoax - obviously employers are looking for skilled labor, that is also cheap.
Eventually, you get anxiety and burnout, because there is this sense of ever lasting competition. When in reality, there will be less and less, because boomers will eventually die.
[0] https://www.spiegel.de/politik/deutschland/anfang-vom-ende-d...
[1] https://www.spiegel.de/politik/deutschland/olaf-scholz-aeuss...
I think where the autism factors into this is that she literally doesn't realise exactly how she's harming herself, or what she needs to do to "recharge her batteries".
I know for a fact I wasn't even cognizant of the fact that I had physical and emotional needs until I was in the latter half of my 20's, and even now a lot of my "self-awareness" is second-hand observations from others.
Currently working with a 22 year old on the spectrum going through exactly the same thing, and the hardest part is seeing her repeat my mistakes. I guess that's just life...
How much of that do you had more to do with upbringing or environment?
Honestly, I'd be surprised if it had much to do with upbringing at all. Even in healthy families, Autistics just don't have the sense of self that Neurotypicals do.
If anything, introspection skills in Autistics are worse than being able to read the emotions at others. It's at least possible to visually and audibly perceive changes in the body language/tone of others.
> At what point are we going to say that expecting people to do so much is not realistic
The problem from my standpoint is that some autistic people just want to do so much, they have a variety of very intense interests that simply override basic things like personal health, and there is no conscious awareness of those things, that requires someone outside the loop to intervene
I was trapped in the exact same situation for years, being an autistic and constantly hyperfocusing on what made me happy, during all that time the most I cared about was my own hobbies and nearly everything I thought about somehow led back to a new idea I could apply to one of them, the whole time anything about sleep exhaustion or eating properly was just not in my headspace. It was like I was blind to those things
And the hardest thing? We are led to believe that some things in life are "one's calling", that they fulfill us or make us the happiest, etc. I got into the state of believing that for my hobbies to the point that they overtook me. With my kind of focus there's no such thing as guard rails, Ill look up after "two hours of work" and it will actually be 4:00AM and I wouldn't have even realized it
Its really the definition of "too much of a good thing", it got to the point where I was asking my parents or my therapists to help keep me accountable by gently reminding me to go to bed at a certain time, but all they offered me was the equivalent of "well you're a grown adult so you're going to have to learn to deal with basic life needs by yourself, good luck." It was no less than two minutes of their time a day yet it was seen as so trivial that those people believed I had no choice but to understand what I could not understand if left to my own devices
That is the kind of thing that is misunderstood about autistic people I think, others underestimate the support that they will need to function at the same level as normal people, but when offered the idea of keeping them accountable they overestimate the supposed burden it places on them, when its really not that much in my eyes
I'll be sure to bring it up with the missus tonight. Thanks for the perspective.
I also have a huge caution of making autism look like it has a lot of unique and special mental phenomena going on, literally anything that can cause autistic like symptoms can result in an autism diagnosis because it's a heterogenous diagnosis defined by others perception of you. There is if anything an especially diverse amount of reasons why autistic people would feel "burnt out" relative to most people.
The person in the article is working multiple jobs and when she breaks down her conclusion is she's a victim of her mental disorder. No that's stupid. What she experienced is simply what happens when you work multiple jobs, your body tries to protect itself from the damage by making you stop. There is nothing wrong or aberrant going on, what's wrong is peoples desire to live lifestyles that only hurt them and their self-perception that they're mentally disordered if they can't force themselves to do them.
Yes working three jobs leads to being overworked. It only turns into burnout if you keep going regardless. Autism can definitely be a cause here.
I had assumed it was all just anxiety and depression but no treatment seemed to work.
Ten years later I get prescribed Ketamine for depression and things start to change. After reading some articles that talked about myths around autism I realised that I had been dismissing it as a possibility. Now that I have started talking about it with family, psychologist and psychiatrist it all starts to make sense.
It was a reasonable amount of corporate work combined with way too many intense interests. I wanted to pursue them all alone despite having the work shared by community members being typical (OSS)
Its like the feeling of wanting to embrace burnout just because the things you pursue are that fulfilling and make you that much happier, and that was despite me knowing I would not find happiness as a corpo and deliberately working less hours whenever I could.
Now there is a constant film of tiredness, I sleep 10 hours a day and wake up exhausted, for a while I was worried I was doing permanent damage to my brain with how terrible my short-term memory was.
At least its reassuring the condition has a name, I always assumed autistic burnout was just the same as regular burnout, well I stand corrected.
I also tried ketamine but didn't react well to it so the doc didn't let me sign up for more sessions.
I slept for 8h30/9h per night. A better routine (earlier wake up time, 8 hours of sleep max, some intense physical exercice - weight lifting in my case) put me back on track after about 7/8 months.
But I tend to go back to my bad habits by taking too much workload on my sole shoulders...
I had huge problems with chronic fatigue before I got treated and it helped for a bit and then I realized I didn't have the mask tight enough (trying not to damage the seals) and tightening them down helped again.
I used to be in that "I need 10-12 hours a night" camp and now I am pretty OK on 8-9. I dream every night now, I obviously wasn't hitting REM sleep before.
The other thing is exercise does help regulate it as well. Even if I am otherwise active, I need to do some cardio at least a couple times a week, just cleaning the house or working outside doesn't do it. Again perhaps something related to heavy breathing and lung capacity.
When I am not doing as well I find myself having to take a nap in the afternoon etc and while I don't mind that as a thing, it is a sign or even a contributing factor to an overall pattern of fatigue.
So can self diagnosis and over diagnosis.
The theory is that it is all the same underlying thing, just with different severity and presentation.
No, there is no underlying thing in the DSM-classification. There are the "same" symptoms.
The most obvious evidence for this is that "pervasive developmental disorder-not otherwise specified (PDD-NOS)" and "childhood disintegrative disorder" both merged into "autism". Autism now means "anything with this symptom basket that is not covered by s more specific diagnosis".
> with different severity and presentation.
This part is true.
DSM classification is not fact, it is a diagnostic tool to assist with treatment. The theory of monotropism is an interesting area of research which potentially explains the underlying mechanism.
Although it is still real. The people who present completely normal are still autistic, because behind the scenes they have some unusual way of thinking or strong obsession or strong reaction to the mild stimuli, they just don't show it.
Hard agree with this. As someone who was diagnosed with Asperger's back when that was still a thing, it was a lot easier for me to say "I have mild Asperger's" on the rare occasion that I felt a need to explain than it is to quantify where I am on the huge swath of area now occupied by the term "autistic".
[Caveat: I'm super uninterested in hearing about big pharma conspiracies or whatever, please don't send me this.]
Well, except for the severely disabled who can't advocate for themselves because they can't speak or communicate online, and now find themselves crowded out for the very benefits that were created to support them in the first place. But they're not the ones that vote or sound off on social media, so they're easier to ignore.
edited to add: wait, so if there are accomodations for autism, were there not accomodations for aspergers or other developmental disorder? why not expand the accomodation and not the diagnosis?? The same professionals that determine autism from other disorders should be able to prescribe similar accomodations??
Accommodation is not good for everybody. I've had to get into serious conversations with people with serious disabilities about divvying up responsibilities because we worked the same shift, if they accommodated me they were fucked, if I accommodated them I was fucked, if we complained and tried to get accommodation elsewhere we would both be fucked and we both knew it. Accommodation is often hard as shit and sucks ass, it's grinding work, it's not something that falls from the sky, it's something actual people spend their days working on. Further people aren't unaware that they're accommodating you, that you rely on them, and thus they have power over you, people aren't stupid and they will take advantage when they need to and think they can get away with it, and feel morally justified in doing so.
It's only a SUBSET of accommodation which is good for everybody, and those are the truly special accommodations, those are the cases where we remove systemic barriers. Work from home is the best contemporary example of this which has simply made the employment opportunities for the disabled fucking explode while increasing their quality of life and importantly the disabled aren't usually being perceived as getting any sort of special treatment or favouritism because everybody gets the same benefit (unless you have a work in office mandate). The idealistic and impossible goal of disability rights is not accommodation, it's the total breaking down of systemic barriers to create a utopia where everybody lives equally and independently with no need for accommodation, but we have accommodation because that shit is an impossible ideal.
To summarise though, accommodation is a lesser evil to the alternative which tends to be better for all parties involved, breaking down systemic barriers is the ideal which can actually create true equality. I tend to see curb cuts as falling into the latter category more than the former.
https://disneyparks.disney.go.com/blog/2013/10/guest-assista...
http://babesindisneylandblog.com/my-thoughts-on-the-disabled...
My take on why accommodations were not expanded to different diagnoses is that there is, rightly or wrongly, a perception of lesser severity with a diagnosis of PDD-NOS or Asperger's that would stratify the level of services available. And since people always want more, you'd have ended up with more push into the "autism" category anyway.
It’s not as simple as ‘no intellectual disability’ because there are non-verbal autistic people who have no intellectual disability.
If the article is correct, and the behaviors are quite unique to people labeled autistic, it actually supports autism as a diagnosis rather than just a label. Labels with predictive power regarding psychological behavior have some semblance of a diagnosis.
This is what science does -- we continuously challenge what we know and change our definitions when we learn. The people who are experiencing diagnosis with autism and ADHD today will seem totally different than the diagnoses 50 years from now.
You cannot hold on to one, old definition for something like autism (or any other non-neurotypical behavior) and expect it to remain the definition, unchanging.
If I'm autistic I absolutely will.
(This is not meant with sarcasm, only a slight nod at programming language version numbers)
How SPECIFICALLY are these additional people getting diagnosed? Is there special training diagnosticians get to unveil the secret masked signs of autism? What are these scientific advances I've heard vaguely cited for the rise in autism diagnosis over the years? Why is it even possible for a diagnostic criteria that hasn't changed to result in dramatically different diagnostic rates over time, doesn't that prove the diagnostic process is fundamentally unreliable and thus fundamentally scientifically invalid?
The fundamental cause of the rise of Autism is that both schools and parents both financially benefit from a child being labelled as "Autistic" and because the diagnostic criteria is so vague to begin with you can interpret it as it suits you. The driver isn't "science", there aren't scientists and doctors marching into schools outraged at improper diagnostic practices and making changes happen. It's driven by parents and schools looking for money, money is the dynamo driving this, autistics are rainmakers. Then schools will often restrict some of their resources to those with special needs or whatever, which only drives up the need for other parents to play the same game. I've seen how the sausage is made too, with parents and teachers and doctors outright committing fraud to ensure a child looked appropriately disabled on paper, downplaying their ability as much as possible, which further jades me regarding how "scientific" this all is. I've also seen no analysis on if this practice actually helps kids, which you really think there should be because all these kids we labelled as disordered all reported being suicidal later in life.
> If somebody has coping strategies that effectively mask their autism (in the early childhood/developmental stage specifically), they DO NOT HAVE autism
The DSM V diagnoses autism much more broadly -- https://www.cdc.gov/ncbddd/autism/hcp-dsm.html -- and it's very plausible that a child might not be identified. (For example, my parents were drunkards, I was not assessed as a child.) A child might also learn that they are punished for some behaviors such as stimming, and learn not to do it publicly, but still engage in that behavior privately.
Autism diagnoses only require that person needs 'support', and explicitly calls out that symptoms may be masked by coping strategies.
> How SPECIFICALLY are these additional people getting diagnosed?
Psychologists and psychiatrists usually start with a series of screening questions, followed by several in person discussions sessions where they probe into both your own self perceptions and the perceptions of others.
There is a 2018 paper that specifically identifies camoflauging traits and a screener that can be used to help identify adults (and others) who have built systems to survive in the world. It's called the CAT-Q. See the paper: https://link.springer.com/article/10.1007/s10803-018-3792-6
> Is there special training diagnosticians get to unveil the secret masked signs of autism?
Yes. Typically a psych degree (doctorate) with an emphasis on ASD, but sometimes masters level mental health professionals working in concert with an MD.
> What are these scientific advances I've heard vaguely cited for the rise in autism diagnosis over the years?
Well, see the 2018 paper I linked above. If it would be helpful, there are many other papers from 2000 onward that specifically address everything from repetitive behaviors to social isolation to meltdowns, etc. Mostly, we've improved our screening processes, which means we've got better, more accurate criteria.
> Why is it even possible for a diagnostic criteria that hasn't changed to result in dramatically different diagnostic rates over time, doesn't that prove the diagnostic process is fundamentally unreliable and thus fundamentally scientifically invalid?
The DSM criteria have changed between DSM 4 and DSM 5, in 2013. The DSM used to separate Autism and Aspergers as categorically different, but they've removed the Asperger's category and adjusted the criteria for a diagnosis.
It's also important to remember that science is never stable. The point of science is to revise over time our criteria. The point is to evaluate what new information we have.
And observed rates have risen, from about 1% to about 2% over the past decade, which you've correctly identified, but you would expect that because screenings have improved, diagnosticians have evolved, and we've put more emphasis on testing people.
That's not a huge number of people, and it's fairly reasonable to assume that as we've developed the science, we're catching people who previously would have been missed by less accurate tests.
It could also be that whatever causes autism is also happening more. There's a whole lot of factors, but no, that doesn't mean the science is bad it just means we haven't answered all the questions we have yet.
> The fundamental cause of the rise of Autism is that both schools and parents both financially benefit from a child being labelled as "Autistic"
That's a pretty conspiratorial claim for an increase in diagnoses that can adequately be explained by "we're better at testing for it now."
> It's driven by parents and schools looking for money, money is the dynamo driving this, autistics are rainmakers.
This is likewise a conspiratorial claim. Can you provide evidence of this? Because "I've seen it" is at best anecdotal, and runs counter to the prevailing idea that being labelled as autistic by the medical community can deny you agency in academic, medical, and social contexts.
It's kind of like infection with a coronavirus: could be a mild cold, could be long COVID, depending on the type of coronavirus and the susceptibility of the patient. The spectrum for autism is similarly wide.
It just resulted in the teachers calling them disordered and sending extra staff to smother and socially stunt the students they deemed to have Aspergers, and then stopping this before puberty occurred, resulting in even more wedgies and swirlies. However, we started calling these students disordered, and let everybody know certain students who got bullied weren't victims of school neglect or other students or cultural norms, but of their disordered brains. So woke!
We live in such enlightened times.
I see many traits in me that are consistent with various forms of autism but I've always struggled to express them to others in a way that doesn't cause them to say "well can't you just not do that then?".
I'm now realizing this could've been a mistake, but it also might just be a crisis of realizing autism has basically nixed my ability to live a life that I enjoy.
What changed everything for me, was finding the right stimulant medication. Turns out it wasn't the socialising, it was the big groups. I can't understand what people are saying, get distracted by background noises, lose my train of thought and then get anxious about how I'm acting (and how the person I'm talking to thinks of it). With medication it's just... normal. I still lose my train of thought or get distracted by background noises, but I'm able to return to the conversation much easier. More importantly, I'm not getting anxious in social environments anymore. Even the understanding that its ADHD related has helped my mental health a lot.
I understand this doesn't quite relate to autism, but if you aren't diagnosed and only suspect it, I'd recommend investigating ADHD (as well as AUT+ADHD, which is its own thing entirely).
For me, my social problems are usually just not caring enough about being interesting to the other person or misreading facial expressions and thinking they're annoyed I'm talking to them.
I started on slow-release Rubifen which is generic methylphenidate, at 20mg/day. This was increased to 20mg/morn+20mg/afternoon, then 40mg/morn+20mg/afternoon. My issue was it would always wear off early and leave me unable to do anything basically from 4pm onwards.
I recently switched over to Concerta, which is still methylphenidate but lasts 12hrs instead of the 6hrs from Rubifen (which was really closer to 4hrs for me). I started on 74mg/day and am now on 92mg/day with the option to go up, but I think this works for me.
My psych did mention I'd be better on dextroamphetamine as methylphenidate doesn't seem strong enough for me, but we only have instant release here and I need the full day/consistent effect.
In regards to social problems, mine are basically identical! That was then causing me to stress over what the other person thought of me, which lead to pretty bad anxiety. With medication this is much easier to handle. I still have trouble if I'm not overly interested, but have a much better time dealing with the situation, especially the anxiety part. Just knowing the cause is (mostly) ADHD helps a lot too.
Absolutely life changing stuff, and a month's supply is under $20.
Just keep in mind it's a circadian rhythm stabiliser, and not a sedative. Take it at the same time every day, even if you're not going to bed (but are around home; never take it while out of home), and keep the dosage lower than you'd think.
Wow these seem like high numbers for both groups.
My tendency is to push myself far beyond my limits. When I get exhausted I start blowing up and yelling at people.
Do you consume caffeine?
After over a decade of regular caffeine use, I stopped it entirely last year. The benefits were tremendous. The "decaf" subreddit is full of people with similar experiences.
For me, rounding out the end of my 20's it feels like my energy / motivation is reaching an era of "wondering if I should press the gas as I'm careening towards a yellow light on the highway going about 78mph in a 60mph zone".
In the past, I've had trouble really laying out complex tasks in a way I can get them done, and encountered crippling procrastination and blocks to just starting things. Stimulants have helped but only marginally, it's quickly becoming kind of a existential crisis as friends have accomplished more than me and I largely attribute my lack of success to a lack of focus and well... just being unable to get that much done in any given day. Comparing to friends in my group who think I'm smart is the most painful. I definitely make below average as a dev in the US, and for two years of a roaring economy I did okay but feel like I've largely been passed by my friends / colleagues who can actually force themselves to try.
I'm starting to worry that as time goes on, I'm actually moving down the class ladder and it's starting to really scare me. Curious if anyone else has dealt with this? Preferably in a way that isn't just "accepting you don't know how to improve"?
This time, it was three weeks of struggling before I realized I was burnt out, and after some minor adjustment I got through it just fine.
The trick is knowing that you're burnt out. One of the big features of autism is being unaware of or unable to interpret your own internal state. That makes it way, way too easy to slide all the way down the slippery slope of burnout until you're in such a bad place mentally and physically that there's no longer a way out. In previous jobs, this turned into a deep seething resentment for my workplace and either quitting or getting fired spectacularly. Last time it happened to me I ended up lashing out at everyone and everything around me. I lost my job, my friends, my boyfriend, and my house. I had to start a new life in a different city.
Being autistic and being unaware that you're autistic is actual hell. You know you're different, but you don't know why or how. You don't know that you have different needs from your peers, so you try to get by with what everyone else is doing, and it usually doesn't work. Endless frustration and self-doubt. You just can't do what everyone else seems to be able to do easily, it's like taking a test on a subject you've never heard of and everyone but you is given a textbook to work from.
One of the hardest and most important things is to be aware of yourself and your mind. It does things on its own and you're along for the ride most of the time, but you can steer it if you know how. Problem is you don't know how, and you don't know that you even can.
> While most people undergo periods of burnout — physical, cognitive and emotional depletion caused by intense, prolonged stress — [depressed] people, at some point in their lives, experience it on a whole different level. [Depressive] 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. This harms their ability to perform well at jobs, in school or at home.
Imagine using this to dismiss the lived experience of, say, a PoC, and not getting instantly banned. But say it about autistic people and you will be lauded. This is the world we live in.
In other respects, this title is the result of liars and cheats who following the doctrine "bullshit baffles brains".
A perfectly legal way to abuse people which happens to make money.