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Neurodivergent Doctor

Love, truth and rigid thinking


cupcake in a silver paper liner topped with a meringue drop, vanilla buttercream icing and rainbow sprinkles.
Birthday Cupcake

Diagnostic criteria for all kinds of medical conditions tend to be deficit based. They aim to work out what a person is lacking, compared to people with typical brains, minds and bodies.


Across the world, most of the big societal systems - healthcare, social services, education, medical research and academia – use the DSM-V diagnostic criteria when it comes to defining autism. Under the DSM-V one of the things a person has to have to get a diagnosis of autism is: “restricted, repetitive patterns of behaviour, interests or activities”.


One example of this is inflexible, or rigid, thinking patterns. People with rigid thinking tend to see things in “black and white” instead of “shades of grey”.


Inflexible thinking.

The DSM description makes it sound really miserable, describing “extreme distress at small changes”.


Yes, inflexible thinking can be disabling. A need to bend the rules, or change my plans, that wouldn’t bother a neurotypical person can really upset me.


But.

Inflexible thinking can also be beautiful.

It can also be authentic.

It can be love, and truth.


Examples:

  • If you ask me a question, I will only be satisfied if I can give you a truthful answer. I will feel inauthentic if I withhold information, even if that information may upset others or cause me to lose social capital. In my relationships this is how I show love. I want you to be able to rely on me to be honest, and to know I will work hard to give you the information you need.


The flipside to that is: I will feel deeply dishonest and inauthentic if I knowingly say something untrue. This means it is highly likely my actions will match my words, instead of being lip-service.


  • If I understand why a rule is useful I will follow it. I embrace rules that keep us safe and create fairness. I am very unlikely to bend the rules or break them just because they may cause a personal cost to me.


  • If I am faced with a choice between morals, and personal gain, I am very likely to go with the moral choice because my rigid thinking ties this deeply to my personal integrity.


This is backed by recent research. A study compared non-autistics, who they called “healthy controls” ("HCs"), to autistics, who they called "ASDs". The results: autistics were far more likely to avoid moral transgressions. Even if it meant a personal loss, and even if they knew no-one else would find out. The researchers discovered “…a drastically enhanced probability of behaving morally in the ASD group (vs HC group) when deciding privately OR=64.25.” For those new to medical research statistics, an Odds Ratio (OR) of 64.25 means a HUGE difference between the autistic and non-autistic groups. Link to the study here: Right Temporoparietal Junction Underlies Avoidance of Moral Transgression in Autism Spectrum Disorder | Journal of Neuroscience (jneurosci.org)


Perhaps you can see the value in this kind of rule-abiding, honest, authentic thinking. Even if it is rigid.


But, it can look unconventional in real life. Because the majority of people are neurotypical, flexible thinkers, with behaviour to match.


For example, my rigid thinking in neurotypical workplaces might look like:

  • Offending someone, by being “a little too honest”.

  • Reluctance to apologise for causing offence by being honest.

  • Hesitance to join in with the group when false praise is being given to those in positions of power.

I can do all those things at work if needed. But they feel... disgusting. I’ve noticed my neurotypical colleagues more easily see the “shades of grey” in these situations, which protects them from feeling upset. Over time, a need to be inauthentic or disregard your own moral values can lead to burnout at work. This is true for all employees, but seems especially prominent among autistics.


Remembering that autism is a lifelong neurodevelopmental difference, it is also not surprising that my rigid thinking patterns can be seen all the way back to my childhood. Thanks to my strong autistic memory, I have intense visual and emotional recollections of the times this showed up in sometimes unconventional ways.


When I was in kindergarten, I remember it was someone’s birthday. They had brought cupcakes, in colourful paper cupcake liners. My teacher told me “Sarah, you can choose one and eat it.”. I was excited because they looked SO delicious. But I’d never had a cupcake in a liner before. I started to eat it, and I could tell straightaway: something was wrong. I couldn’t chew the liner, and I could tell that it was paper not food. But the instruction I had been given was “choose one and eat it.”. My autistic rigid thinking made me become stuck. I was 3 years old and stuck with a mouthful of cupcake liner. Unable to eat it, but also unable to not eat it, because I'd been instructed to do so and I truly wanted to do as my teacher had asked me to do. Eventually my perplexed teacher noticed me frozen and unhappy with a mouthful of paper and told me to spit it out. I knew straightaway from her voice, and the fact all the other kids were enjoying their cupcakes, that I’d done something weird. It was one of the first times I remember consciously thinking: “my way of doing things isn’t right, so I’d better hide that and try harder to be like everyone else” which is probably how a lot of autistic camouflage begins.


The DSM V may be good at picking up disability, but it doesn’t recognise neurodiversity and the value of autistic thinking differences. My hope is that one day we will have diagnostic criteria that recognise disability AND are not deficit based.


For neurotypical readers with autistic kiddos or adults in your lives, please know this: autistic rigid thinking might look unconventional, but underneath is an ocean of love, truth and authenticity.

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9 comentários



caroline.kruger01
29 de ago. de 2022

While reading this blog post, I was struck by the many positives of how your brain thinks and works. The wording of the diagnostic criteria saddens me as it reads negatively, when actually, there’s a lot to be proud of! Is there any work going on in this space that you’re aware of to change the criteria?

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Neurodivergent Doctor
30 de ago. de 2022
Respondendo a

Thank you for this wonderful comment! I agree whole heartedly, I’d love to see the diagnostic criteria become neurodiversity affirming. I don’t know of any specific projects looking at that, but I hope it will happen one day. One great thing I have seen though, is more therapists who are offering autism assessments which are more neurodiversity affirming. They still have to satisfy the current diagnostic criteria but they try and frame their reports and feedback in a strengths-based way. Davida Hartman in the UK is a good researcher/service developer in this area 😊

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horsebaby5
28 de ago. de 2022

Thank you for your great article! I am glad to share the same rigid thinking that you’ve described. I don’t think moral integrity can ever be made up of shades of grey and dont mind being rigid in my thinking. There are benefits to society and family and friends by holding to higher standards which are not deficits!

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Neurodivergent Doctor
28 de ago. de 2022
Respondendo a

Thank you 😊 Nice to “meet” a fellow rigid thinker! I like how you describe it too.

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k.rabenstein
26 de ago. de 2022

Congrats on a really well written piece that deserves to be widely read - especially by members of the leadership of the Medical Royal Colleges ...!

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Neurodivergent Doctor
26 de ago. de 2022
Respondendo a

Thank you, that means a lot to me 🙏 I would LOVE medical college leaders to read this. Neurodiversity makes our profession stronger!

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NK B
NK B
26 de ago. de 2022

thank you so much for another thoroughly enjoyable read!

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Neurodivergent Doctor
26 de ago. de 2022
Respondendo a

Thank you for the encouragement! 😃

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