Aspergers Syndrome and Depression: the masking effect

Aspergers Syndrome and Depression: the masking effect

In the first part of this series on autism spectrum disorder (ASD) and depression, I offered a broad description of how depression operates (click here for that post). This time around I’d like to get into more specifics.
What makes depression so dangerous for someone on the spectrum is that it can actually hide behind autistic traits. My fear is that too few people realize: depression and ASD have several features in common, creating a kind of “masking effect”. A trait commonly associated with ASD can in some cases be depression masquerading as that trait, thus allowing it go undetected.
In my own life, I’ve found 3 features that ASD and depression have in common: absolute, black and white thinking; repetitive/obsessive thoughts; and, finally, intense feelings of alienation.
To better understand the interplay between ASD and depression, let’s take a closer look a these traits.

I. Absolute, black and white thinking.

My mind seeks out patterns. I think it helps provide me with a sense of stability, but there’s also an element of play involved. Just looking around and identifying patterns in different facets of the world, it’s something I enjoy.
One thing I’ve noticed: in order to hold patterns in my mind, be it with small things like a film, or big concepts like human behavior, I generally think in broad absolutes. Good, bad; right, wrong. Patterns are easier to establish if I can group things into easily identifiable categories; so, possibly for this reason, I am a fairly rigid thinker. Not rigid in a bad way; I just find that I habitually think in very black and white terms as a way of navigating the world. It’s how I see things, and for the most part, it works for me. “This factor should always work this way. This other factor should always work that way.” It can lead to conceptual ruts, but again, it works pretty well for the most part.
I’m on the spectrum, and I think this habit is an outgrowth of my neurological differences. The problem I’ve run into is that depression is also characterized by very absolute, black and white thinking. And because of this, I can have a difficult time identifying the onset of a depressive state.
Many people describe depression as a feeling…a kind of numb sadness that creates a physical sensation of fatigue. And while that is true, I think this feeling is a symptom, not the core factor. To me, depression is first and foremost a pattern of negative thoughts. Thoughts that frame the world as meaningless…that make ones life feel damaged beyond repair. It’s the thought patterns that drive this bleak world view and create a powerful sense of futility
Depression is effective at creating a sense of hopelessness precisely because it utilizes rigid, black and white categories. “My life is pointless. The world is meaningless. Nothing will ever change,” and so on. These rigid absolutes can control ones perceptions and make it very hard to see any light at the end of the tunnel.
As a result, someone on the spectrum can transition from their normal thought patterns into a depressive state without realizing it…and it can also be invisible to others, due to the similarities in these thought patterns.

2. Repetitive/obsessive thoughts.

Depressive thoughts tend to be black and white in nature, but they can also be brutally repetitive, to the point of obsession. Endlessly repeating thoughts about hopelessness, thoughts about the need to die: depression can be a relentless mental treadmill that repeats the same dire thoughts on a never ending loop.
When I was depressed, anything and everything from my daily life went under the depressive microscope: “this is pointless, this serves no purpose.” Everything I did, saw, was completely drained of meaning by these negative observations. I also applied this negativity to the bigger picture of life itself: people, the world, the universe; all of the broad categories that make up existence went into the mental grinder of depression. Mentally, it was exhausting, but I continued to think the same thoughts, over and over.
Asperger’s/ASD can also be characterized by obsessive thoughts. When I’m not depressed, I spend most of my day dwelling on whatever my current obsessive interest is. It can be a book, a theory, a hobby. For me, obsessive interests aren’t a bad thing…it’s just the way that I engage with the world.
Once again, these similarities can make it very hard to see the arrival of depression. My thoughts do not go through some radical shift. Obsessive thoughts about my interests become obsessive thoughts about hopelessness. The topic changes…but the overall thought pattern stays exactly the same.
It’s the masking effect, allowing depression to hide behind autistic traits like a parasite.

3. Feelings of alienation.

This one is self explanatory, but it’s worth focusing on since the feelings of alienation with both depression and ASD can be eerily similar.
If you look at personal stories from folks on the spectrum, they often share a common theme: feeling like an alien around others. I know that I struggle with social pragmatics, and during interactions, it can definitely feel like being in a land where the customs are strange and I don’t speak the language.
I have a hard time perceiving non-verbal communication and, as a result of this, I experienced significant delays with basic social milestones when I was growing up.
To make matters worse, I could see other kids interacting with ease, making connections. The world seemed like it was designed specifically for them, for other people; I didn’t seem to have a place in their world. Put all of these factors together- confusion during social interactions; the resulting social delays; loneliness- and you’re left with a powerful sense of alienation. By the time I was a teenager, this feeling was just a normal part of my every day life. I put a lot of effort into observing others, trying interpret the social realm…even before I was depressed, I felt like an alien visitor hiding behind a human mask.
Depression similarly creates a feeling of being on the “outside” of the world. What basically happens as a person sinks into depression is that the mind attempts to let go of life. It wants to fully detach itself from a world that has caused it so much pain and confusion. It’s a frightening state of being that leaves one with the impression…just like with Aspergers…that the world is a place for other people, not for you.
I remember being at the grocery store one day. This was during a particularly bleak time in my life. And I basically became trapped inside of the store, because I could no longer remember why I was there. My mind just blanked out. I roamed around, trying to recall what I needed. I walked up and down aisles. I sat on benches, tried to wait out the confusion. But everything felt so incredibly pointless that I couldn’t articulate what I might need or why I was even there. I just stared at soup cans and apples and the wheels on shopping carts and thought about how everything here was just shapes, empty of content. Meaningless. The people wandering past seemed like wind-up toys bobbling through ridiculous tasks. “They’re just shapes buying shapes,” I thought. I was overwhelmed with a sense that the world was something very far away…and it was as world for the wind-up toys, not for me.
I never bought anything that day; eventually, I just went home. It was something that happened from time to time. I would find myself “lost” in familiar places due to the lethargy and mental confusion of depression.
The interplay between Asperger’s and depression can be a constant, subtle thing. Subtract depression and social interactions still feel very confusing, strange. Subtract Asperger’s and depression still makes the world feel like it’s drifting away. Put the two together and you get a perfect storm for alienation and emotional detachment.
Once again, the transition to a depressive state can be invisible, due to these similarities. If you’re accustomed to feeling odd around people, the sense of being “outside” of the world caused by depression just seems like a natural fit.

Conclusion

At the age of 30- after nearly a decade of social isolation- I spoke with a psychologist. I was diagnosed with both Asperger’s Syndrome and clinical depression. We began the process of discussing, distinguishing and untangling the two factors from one another. The idea of going to therapy was something I hated, but I can safely say: it was necessary. I wasn’t going to survive on my own. It was ultimately a beneficial, constructive process, and I do feel that with something like depression, professional help is the best way to go.
Two diagnoses and multiple traits have been discussed here, but the take-away is pretty straightforward: as a result of the similarities described above, a potentially lethal mood disorder can hide behind the neurological differences of the autism spectrum. Hopefully, the more we talk about this- and the more personal stories we share- the more we will better understand these issues and create solutions. In future posts, I’ll discuss some of the techniques that helped me to balance ASD and depression.
[Note: these observations are based on my personal experiences with these issues. Autistic traits can and do vary from person to person; and depression can manifest in different ways, depending on the person. Learning to differentiate depression and ASD will require knowing the individual, and understanding their unique personality and needs. I'm on the spectrum, but I can't speak for others and I am not a mental health professional; this post is intended as a starting point for thinking about these issues. And to clarify: the DSM VI was recently released, with changes to spectrum terminology; for the time being, I am using the terms Aspergers and ASD interchangeably.]
M Kelter is currently making a mess of things on Twitter and Facebook; click to follow along and watch the confusion unfold.

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