Astrid’s Journal

When I wrote my report on 2006, it mostly concerned what I expected to change in 2007 - because I ended the year on a crossroad in my life in many respects, and with many uncertainties about the next year. Particularly, 2006 ended just after I had had my admission interview at mental health Apeldoorn. In the yearly review, I wrote:

There is that other side, of course, that emotional or behavioural part of my situation. I used different terms for that in 2005, but mostly just called them “some of my difficulties” and wondered about their significance. I said that would likely be an important issue in 2006, and it did, and indeed, mostly just like it’s ever been since 1998. I hope that in 2007 it can be an important issue in some other ways than it’s always been ever since 1998, but I’m pretty skeptical as it requires communication that I lack.

Now, of course, I know that my mental health and behavioral difficulties did become a significant issue in 2007, and not at all like they’d always been ever since 1998. Communication played a significant role, although that was by far not always appropriate communication.

On January 3, I had Renee ask my family doctor for a referral to mental health Apeldoorn. She let me go to the appointment on my own on January 16, and I managed to answer the doctor’s not too open-ended questions. Same with the February 2 discussion with her and the psychiatrist. After this appointment, the admission team discussed me amongst themselves and decided they wanted to interview my parents. To my surprise, even after we’d had a major argument, they came to the appointment and answered the doctor’s questions seriously. This got me diagnosed as autistic on March 16 and started in treatment on April 25 - or April 19, if you count in the one discussion I had with another psychiatric nurse who hadnt’cared to read my file..

There was no immediate improvement, and a few months ago Arda even told me that I deteriorated after having been diagnosed. I doubt my diagnosis had anything to do with it, other than in some respects. Like, I admitted to needing more structure, but this is not deterioration in my opinion, just getting what works. She meant that I freaked out more, but I attribute this mostly to the stress of the upcoming move to Nijmegen. I believe that, had I been able to continue my discussions iwht Jeanine, I would likely actually have improved, even though it’d needed to mean not just my learning to control my behavior - which is important, of course -, but others learning how to react. There’s an E-mail from Gerda in which she reacts to criticism from me by stating that she “just sets limits”. She meant to say that she didn’t mean to treat me unfairly, but some behavior just isn’t appropriate and she’s going to hold me accountable for that. I agree, but sometimes also realize that it isn’t just about limit-setting. I’m slowly learning to use alternative means of communicating, but many do require someone else to accept the alternative means. For example, recently, a nurse here gave me a card that has “Do you have time for a talk?” on it, for me to use when I want to speak with a nurse but cannot ask for it. This requires all nurses to accept that I use this card. Now it is fairly likely that they would, but very often in my discussions with Jeanine, there first was a lot of talking about my side of the behavior, and then Arda jumped in to say that it still wasn’t acceptable, and there was no time left to find ways in which I could navigate Arda’s limits while taking into account my own difficulties.

I had my last discussion with Jeanine on July 4, but after this, had a major relapse, so Jeanine arranged for me to see a psychiatrist on July 25, who prescribed me the risperdal. Taking that medication was hell from day three on, first because of possible side effects that weren’t being taken seriously, and then on top of it because of its lack of effectiveness. Because I had no psychiatrist in Nijmegen yet, my family doctor prescribed my risperdal after the August 1 move, and she thought I ought to control myself behaviorally. Well, duh! If I’d been in a state of mind to do so, I hadn’t taken this medication in the first place! Eventually, I tapered my risperdal starting September 27 and was completely off it on October 8.

The move itself was very poorly arranged. I learned from that that I should’ve jumped in right from the start on February 14, when I was told that I was done training and needed to move out by June 1. The correct order of events should’ve been that you first determine what sort of living situation and help a client needs, and then make arrangements to seek one, not the other way around. I should’ve jumped in and asked directed questions the day Arda told me that I had to move. Instead, Arda wrote “my” letter to student housing in early March, E-mailed the student counselor my preference of living place, while I hadn’t chekced it out, and had Marjan find service providers in Nijmegen. At the same time, she kept telling me that I actually needed to be in housing with support available within walking distance, but such places don’t exist in Nijmegen. I don’t know if such places exist outside of supported living facilities - we never actually sought any -, but I also know that, if anything, I was to stay out of supported living. There’s this idea in training home staff’s minds, that your living arrangement defines your level of independence, with supported living being the least independent form of living and living on your own with itinerant support being the most independent living form. This is, of course, only dependent on how well you can handle unexpected events, which may be one skill of independence, but is not the only one.

Then, once housing had been arranged, a service provider had to be found. That was another battle. First, Philadelphia refused me because they had no experience with autistics living in their own apartments, and next, the agency for psychiatric patients, called RIBW, suggested we go to Werkenrode instead because they had more experience with blind autistics - as if I couldn’t instruct an RIBW support worker on how to handle my blindness. Werkenrode agreed to provide support, and we arranged for me to get to know my new support worker. Getting funding was another thing, but we ended up with sixteen hours of independent living support a week - which was said to be quite a lot, in fact, pretty much the most one can get who lives in their own apartment.

After the move, my former support worker quit after only a little over two weeks, and two new ones came around, plus Gerda. I have very little memory of how things went while I lived in my house in Nijmegen. I remember that there was a support worker almost every day, that mobility went horribly, that I had phone calls with Gerda every night, E-mailed her a daily evaluation, and felt that I couldn’t hold on. My support workers really tried the best they could. I don’t want to suggest, with one of my previous comments, that all they did was setting limits. They tried to help. They - well, especially Gerda -, wanted to keep me at home. In fact, in my treatment plan, someone has written that Gerda said that living alone seemed best for me until now. I cannot remember Gerda actually having said that during the discussion, but she may’ve thought so. In any case, she did all she could to prevent me from being committed to the psychiatric hospital. I am not sure at what point she called the psychiatric emergency service in Nijmegen to ask them to please take me seriously if I made it to there. I never made it to Nijmegen, because I was picked up by the police on Apeldoorn station after having threatened to run in front of a train, and subsequently committed to the hospital in Apeldoorn. I was transferred by ambulance the next Monday.

Meanwhile, there’d not been much mental health contact apart from the psychiatric emergency service being called several times and the psychologist in whose admission procedure I was stuck repeatedly informing them that he wouldn’t recommend I be committed. After I’d become suicidal and had been committed anyway, he proceeded with his diagnostic procedures. Here, everyone pretty much decided that my old autism diagnosis was incorrect, and there was little wrong with me psychiatrically apart from having an adjustment problem (as it’s called) after having lost my old structure and started at university. University, by the way, was once again fine academically, but otherwise hell, despite my taking a half courseload. In any case, I felt my diagnosis taken into question and everything that went with it, was gone. Even though I got re-diagnosed after having “lost” my diagnosis for only a month, I still have difficulty putting together all the pieces of the way my mind works that I used to remember and threw out the window the day my diagnosis was being questioned.

Am I making progress now that I’m here? Not really. I play cards a lot here, and last night, I made up a card game analogy to how it’s going with me. There’s a game we often play - I don’t know its English name -, in which each player first gets a number of cards (seven if you play with one pack), and the goal is to get rid of all your cards, but if the other player lays out a certain card, you gain a certain number of cards. For me, it seems that I keep laying out one or two cards at a time, then the other player lays out a card and I have to take five cards - or nine or twelve or fifteen, depending on whether I had a card to lay on theirs and which one they laid on mine. In the end, I have a half pack of cards and cannot oversee it at all, and give up because I’ve lost track of which cards I can lay out in what order. In the card game, I’m getting better in keeping track of my cards. In life, I seem to have gotten worse - or I’ve gotten more on my plate. This lack of view of the big picture is, by the way, a characteristic of both of my disabilities.

I spoke of communication in the 2006 post. That is still not what it should be. In fact, I never communicated well enough that I needed help, then ended up in a situation where appropriate communication wasn’t needed anymore. Of course, my suicidal threat was communication, but it isn’t how one is supposed to communicate - but at the point where you’ve become suicidal, it doesn’t take a lot of communication to make clear that you need help. I didn’t want it to get to this point. In fact, when I said that I hoped my difficulties would be significant in some other ways than they’d been ever since 1998, I probably didn’t mean a psychiatric hospitalization. It strikes me that, a year ago, I imagined staying out of mental health because I wouldn’t be able to ask the family doctor for a referral, and now I’m on the closed ward. I didn’t want it this way. I wanted 2007 to have gone radically differently. Now it’s over and all I want is for 2008 to be a better year, in which I can take steps to improve my life.

A while back, Joel of NTs Are Weird had a post about how police treat you differently once they find out you’re autistic. I responded with a comment about the way police treat me once they find out I’m blind. Ever since I started going places on my own, I’ve had the fear of encountering the police. It happened often when I got lost and walked the same path twice, but there were several occasions when I knew perfectly well where I was going and, as far as I could tell, hadn’t done anything unusual except for walking while blind.

It’s more complicated now. I think I myself told the police that I’m autistic and used to be in the mental health system in Apeldoorn - that is, I told the Nijmegen police. I don’t know how the Apeldoorn police found out, but they know. I think I never should’ve told them so. Not because the police got me committed to the psychiatric hospital - being suicidal is a reason for hospitalization even for people with no former psychiatric contact -, but because, when I can go out on the streets alone again, my reputation will forever follow me, and I’ll be seen as “wandering” even sooner than I was when I still lived in Apeldoorn and hadn’t had anything to do with mental health.

Another thing is that everyone believes the police can judge a person’s state accurately. At least, the people here believe so, even though the police were told off by the psychiatric emergency service - presumably the people who can judge one’s state accurately - twice. Consequently, getting involved with the police indicates the seriousness of my behavior - while simply walking while blind could’ve gotten the police involved.

It’s still as bad as it always was - at least, on average. When I was first committed, most of the time I felt just plain numb, and there were a few moments when I felt really depressed and a very few when I felt relatively good. Now, there are more moments when I feel relatively good, but the moments that I feel really depressed have also increased - to the point that my suicidal thoughts are worse. One of the nurses today accused me of not taking the matter seriously, cause I often come across as if I get suicidal out of nowhere. Well, if you mean that I am not convinced that I want to die, you’re right. You can be pretty sure that if you have a patient committed to the psych ward after they threatened to kill themselves, or very often even if they made an attempt, they don’t really want to die. Someone who truly wants to die, isn’t going to inform anyone and will find a surefire way to kill themselves. For one thing, I am pretty well aware that there probably was a voice inside me saying that I didn’t want to die, when I cried while on the bus that I wanted to run in front of a train, because if I’d actually done so, there’d been only a 7% chance of survival - according to a fellow patient. In fact, I seem to remember saying this to the psychiatrist who spoke with me the night I was committed in Apeldoorn: it isn’t that I want to die, it’s that I don’t want my life anymore - and there apparently still was a voice in my mind saying these were two different things. Unfortunately, during the times when I’m really depressed, I often find it hard to see the difference.

Today, I had a relatively good discussion with the same nurse who accused me of not taking suicide seriously. I explained that it wasn’t that I want to die, but that I am stuck in a cycle of negative feelings and thoughts and worries and cannot get myself out, and have by now become tired of this cycle - I was exhausted nearly two months ago when I was committed already. And I used to think it was all because of the stress of living on my own and going to college - but I’ve been out of my house and out of school for nearly two months. The nurse said that being committed wouldn’t change my way of thinking. I agree, but how am I actually going to change that? I try to stop negative thoughts or worries, but cannot think of positive thoughts to replace them with, and I go to various therapies to distract myself, only to return to the ward again after a while because I cannot concentrate on therapy. I know pretty much about what should help someone who is feeling blue to feel better, but for some reason, it isn’t working.

Since being on the psychiatric ward, I’ve been accused of throwing objects for fun, or being funny about serious issues such as suicidal ideation, because I had a smile on my face when coming to the nurse. And today, I laughed a short while after a fellow patient had told us he has cancer. In none of these cases did I feel happy or did I see any fun in what was happening or what I was thinking about. It gets me thinking about the way I express emotions.

It happens quite often that I express the “wrong” emotion, or that the expression on my face or in my voice does not agree with the expression that would be appropriate in that situation - and, in my opinion, not with the actual emotion I experience, either. A few years ago, I read somewhere - I think in one of Tony Attwood’s papers -, that this is common in people with Asperger’s Syndrome. An example that was mentioned was when a child giggles when in pain, while NT children would cry. This is the reason I’ve come to dislike the “for fun” statements made by nurses: just because the child giggles, doesn’t mean they like pain, does it? It just means that they have a different way of expressing emotions.

There is something else, that I wanted to write about after reading a forum discussion on a Dutch autism forum. It started with a man referring to himself as unconsciencious. The reason is that there might be a huge airplane crash with hundreds of deaths, but he would laugh because one of the dead man had such a funnily ugly watch. While I could understand that this would come across as unconsciencious, and I would consider the man this based on the other examples he gave (for instance, being able to stab someone to death without feeling any regret), there is another possible explanation: that of being so detail-oriented tha tone little funny thing can catch all the person’s attention to the point of losing the big picture of grave sadness. This was what happened yesterday with the fellow patient informing us of his cancer diagnosis: while I did realize the seriousness of the big picture - someone I knew had a life-threatening disease -, I laughed as another patient forgot one of the nurse’s names and called her by her (by the way insulting) nickname - that has become funny as patients used it in other contexts than the original one. Hence, I didn’t feel funny about the one patient’s cancer, but a detail within the situation, caused me to laugh.

There is someone on my ward who is very physically ill, but it’s pretty much being ignored because the doctors aren’t sure whether it’s a general medical condition causing the problem, or if it’s a result of her psychiatric illness. A few months ago, there was a TV show on medical malpractice, and they had a case on it of a woman dying from a lung condition, which was blamed on somatization because of her borderline personality disorder. In my opinion, doctors pretty easily blame patients’ physical complaints on their mental illness.

Obviously, somatization - where mental distress causes physical symptoms - happens. Especially with vague physical ailments, this is a possibility. We all know how we may get headaches or constipation from stress - and this even occurs to mentally healthy people. However, actual physical causes are also possible, and may pose a significant danger to a person’s health and even life, as happened with the woman in the TV show and possibly with the one on my ward. And just because a person has a mental illness, doesn’t mean they can’t get physically ill.

When people without a history of psychiatric illness come into the doctors’office with symptoms, it’s first determined whether a physical condition causes the problems. This is done pretty extensively, and only if the doctors truly cannot find a physical cause for the person’s symptoms, is somatization considered. But this is very different when a psychiatric patient enters the doctor’s office. One of the doctors who were asked to comment on the TV case, an otolagyngologist, admitted that his opinion on possible causes for his patient’s problems is colored when he learns that the patient has a psychiatric illness. I am not sure yet if this is the case with my family doctor - who knew from the beginning on that I have a psychiatric problem, because she prescribed my risperdal -, too. I asked her about four different physical symptoms so far, and she at least did a physical examination for all four. With three of them, she ended up finding a physical cause - nothing serious -, and with one, she suggested stress. I hope, of course, that she will take me and other psychiatric patients in her care seriously when we come in with physical symptoms. Ideally, as with mentally healthy patients, doctors would first rule out physical causes before jumping to conclusions about possible somatization - because it may save the patient’s life.

Of course, patients aren’t being informed, but as far as I can tell, a girl on my ward was medicated involuntarily today. It’s not that I agree with her on the accuracy of her diagnosis. She hasn’t told me her diagnosis, but she disputes it, and, judging from what she’s told me and other people, I can tell that she’s so psychotic that she doesn’t realize it. But that’s not the point: involuntary drugging is wrong.

It isn’t a safety issue. If someone is a danger to themselves or other people - mind you, not property -, a nurse may justly place them in time-out. One of the nurses here on the ward has told me that it’s policy that they try to use the time-out room as little as possible, but I’m pretty sure the staff here use broader guidelines than the ones I would advocate. But then, if even in time-out a patient continues to be violent, physical restraint may be appropriate - though I am not sure if nurses here are allowed to physically restrain a patient, or if it needs to be a security officer doing so. But that is it as far as preventing a patient from causing physical harm to themselves or others is concerned. Forced drugging is messing with another person’s brain without their consent.

The point is not even that this girl couldn’t make her wishes clear, so that some “she would have wanted this” nonsense logic could be used, like what is being used on children and “low-functioning” adults - because people don’t bother to adjust their communication. No, this girl screamed from time-out that she wasn’t sick and didn’t want treatment. Of course, if you see schizophrenia as a disease because schizophrenic perceptions (delusions as we call them) deviate from the norm, she needs treatment. A few years ago, I read a book written by a psychiatrist, who explained that sometimes the resistance to treatment is part of a person’s disease - for example, paranoid schizophrenics seeing their anti-psychotic medication as poison. But this is enforcing a majority opinion - that the patient’s perception of reality is wrong and undesirable and should be treated with anti-psychotics - upon a minority. So what *is* a good reason to medicate a patient against their will? I’m tempted to ask a nurse about formal guidelines on this, but I’m afraid they won’t answer me cause they don’t want me to be involved with the other girl’s case, and I still don’t have Internet access so can’t look it up. In any case, in my opinion, there is none.

Last Thursday, I had my treatment plan discussion. Gerda and the psychologist were present, besides the ward psychiatrist, my doctor, one of my primary care nurses, the recreational therapist and me. I at first wasn’t too happy having the psychologist present - since I hadn’t expected him -, but his opinion was a strong factor in there actually being attention for the problem of my meltdowns. This is a good thing, cause I believe they are still so severe that it isn’t even an issue of whether other people will take them from me: I still have such poor coping strategies that I’ve repeatedly wanted to run off and run in front of moving cars or trains if not for the locked doors of the closed ward where I’m still.

Unfortunately, thanks to Gerda and the psychologist, it did become quite a bit an issue of whether other people would tolerate this behavior from me - and it even became a point of discussion. I guess the ward psychiatrist didn’t mean it literally, when she asked whether there are living places where I’m allowed to freak out. Obviously, there are none. Even on a psychiatric ward, where people are used to inappropriate behavior, a nurse will tell you to stop and go to your room if you slam a door or scream or throw an object, and some nurses even criticize me for having an irritable tone of voice. But this is not what the discussion is about. If only it were!

What I - and, I assume, the other people present - think the psychiatrist meant to ask, when asking about places where you’re allowed to freak out, is whether there are places where I can live even if I continue to have disruptive meltdowns. She first asked whether Gerda’s staff would be willing to take this behavior from me, and got a firm “No”. She later commented that we might find a place where I can have meltdowns, and Gerda commented that there are none, because you cannot behave like I do if you want to live in society. In other words, people who experience significantly disruptive meltdowns, even if they don’t physically harm anyone - cause I never did -, don’t belong in society? Sometimes, this idea causes me to have suicidal thoughts, but I also wonder where I lived for all the 21 years until my commitment to the psychiatric hospital - and I wasn’t committed because of disruptive meltdowns -, and, when I don’t think of myself, I even consider it discriminatory to exclude people from living in society for the simple reason of disruptive meltdowns.

I have been active in neurodiversity for years, fighting for the right of autistic individuals - and, in my opinion, people with other psychiatric or developmental disabilities -, to live in the community with as much or as little support as they want or need. I have advocated de-institutionalization, and often thought that today’s disability service agencies were on my side. But, when confronted with Gerda’s statements about the demands society supposedly places on people, I’ve apparently missed the reasoning behind the fact that disabled people are increasingly often placed within society, even though I’ve writen about it several times and continue to oppose this type of reasoning: “They have capabilities.” So what? That’s not the point.

I find it hard to write about this new form of disablism when my own situaiton is concerned, even though I have no problem writing about it in general terms or when other people are involved - and have often done so. I cannot say that Gerda provided poor care. She did everything within her power to support me in living in my apartment, and, when I discovered that I couldn’t live in this place anymore, she tried to make arrangements so that I could eventually live in one of Werkenrode’s supported living facilities. And it is not the fact that these living facilities are not suited for someone with disruptive meltdowns, that causes me to oppose her position. Heck, the facility we planned on having me move into, caters to intellectually capable people with severe physical disabilities. And it is not that I don’t want to change my behavior, to try to learn to have fewer meltdowns. What I am angry about - and which, when considering my own case, sometimes leads me to have suicidal thoughts -, is the generalized statement Gerda made: if you experience disruptive meltdowns, you can’t live in society.

Why is it so hard for me to write this entry that I’ve deleted and rewritten several paragraphs and can’t seem to finish this entry? I’ve always had such strong opinions on this issue: there is no reason to place disabled people outside of society, no matter the severity of their impairments. Yet there is a voice in my head that says that this doesn’t apply to me. I was committed to the hospital voluntarily. If I don’t say I’m suicidal, I can go back into society whenever I want. I can kick Gerda and her staff out of the door and prove that I’m capable enough to live within the community. No, that wasn’t my point. Now I use the same logic I always defeated again. I’m confused. I don’t know what is the right way of thinking. I don’t want to be angry with Gerda, who tried so hard to provide me good care, but at the same time, she says the most horrible things one can say regarding people with developmental or psychiatric disabilities: that their right to live within society is dependent on some standard of appropriate behavior.

I regularly write about unethical treatment of people with developmental disabilities, such as inappropriate use of restraints or aversives. However, it is mostly far away in the United States where these things happen, and I hear about them from online friends, and write about them because I don’t care where in the world disabled people are treated unethically - the point is that it should end. Now, unfortunately, it’s in my own country that a woman is subjected to harmful and unethical treatment. And, even though I’m afraid it’s by far not the worst case of abuse of the disabled that’s happened, it’s the worst one I’ve written about.

The case concerns a woman with Down Syndrome, who lives in a residential facility. After not being allowed to do an activity she is normally allowed to do, she acted out with aggression. This was not uncommon for her, and usually she’d be locked up into her room for up to an hour if she displayed this behavior. Not now: this time, she was placed in seclusion for 24 days.

I have seen the time-out room of the psychiatric ward where I currently stay. People are not placed in it very easily for disruptive behavior, but one of the ward’s unethical practices is placing people in time-out simply because of lack of space, so I got to see the room when another patient was there. It was better than I’d expected: it has a regular bed and wardrobe, bahtroom and its own window and it’s only slightly smaller than a regular room. However, it still isn’t a place I’d want to be locked up into for weeks.

And this is not the type of room the girl was placed in. On the other closed ward, there is an isolation cell that is very small and only has a mattress and a potty in it. This is the type of place the girl was put in, and, as I said, locked up in for 24 days.

In the Netherlands, people cannot be locked up into the “quiet room”, as these places are called euphemistically, for longer than about a week. Also, a specialized doctor should be consulted to determine if isolation is really needed. This happened, but not on time. Also, the appropriate authority wasn’t informed that this girl had been placed in seclusion - while this should have happened. The girl’s treating educator has been made to resign temporarily. I absolutely wonder how qualified the treatment provider really was, if they thought that putting a person in time-out for 24 days is appropriate in any situation.

I’m still in the psychiatric hospital. Still on the closed ward, because the open one is full - so I will be moved there once there’s a bed for me. A few weeks ago, it was pretty much decided that I would stay in the hospital till we’ve found a better living solution. I’m not sure if that’s still the plan, since now everyone here seems pretty much convinced that the problem is not with my living situaiton but with my freaking out. This has its advantages, of course. For one thing, we seem to be getting a real treatment plan discussion next Thursday. I’m not sure if it will be an actual treatment plan to be discussed, or if that’s just what they call it to satisfy the insurance company. Depending on this, I may or may not get my ideas for how to make progress across. It all depends on whether whoever is in charge of such things, truly understands that I have a problem with freaking out / handling stress that is pretty seriously limiting me, besides the problem with my living situation. I hope they won’t underestimate either issue.

One of the nurses who is primarily in charge of my care, seemed to understand my issue with freaking out even before I freaked out significantly within the last two weeks. He is now helping me to write a crisis signaling plan, which is a plan in which you write how you can recognize an upcoming crisis and what you and others can do to prevent it from escalating. Some days, I like the plan, and on others, I dislike it because its current version isn’t working in 75% of instances.

The nurse also got the doctor to reconsider medication. Before last week, I was only on 20mg temazepam PRN to help with sleep, but I’ve experienced habituation for weeks so it hasn’t been working for a long time, and I’m now not using it anymore. Last week Tuesday during a major meltdown, the doctor gave me 25mg promethazine (brand name Phenergan, a low-potency neurleptic), and it worked really well: caused the overload storm in my head to decrease while making me only slightly drowsy. My opinion on neuroleptics is becoming a little more nuanced as I have more experience, but please realize that I don’t seem to have the extreme sensitivity to medications that many autistics do have. Later, another doctor prescried levomepromazine (Nosinan, which seems to be a similar agent) to help with sleep, but it absolutely isn’t working and only makes me sleepy during the day and causes me to have a hard time getting up in the morning. The -azine part makes me assume this is a neurleptic, too, and I’m well aware that prescribing neuroleptics for insomnia, is pretty stupid. Someone, I have not the slightest idea who, also prescribed me 10mg oxazepam PRN (a benzodiazepine) to use when I have a meltdown. I used it once with absolutely no effect and declined it the two other times a nurse offered it.

I spoke with the psychologist yesterday. He’d been speaking extensively with my parents and is considering speaking with my sister as well. So far, it seems I’ve not lost my diagnosis after all. He says he thinks I have Asperger’s Syndrome. The rest of the discussion - besides a pretty brief diangostic interview, which was little more than an outline of DSM-IV criteria with the question if I thought I met them and why -, consisted of him nagging about how I needed to unlearn to freak out and twirl my hair. Regarding freaking out: agreed, but not just because it’s a “social handicap” (as he worded it) but because it’s an unproductive way of handlign stress. I mean, if all it was about is that others are bothered when I freak out, I could decide to self-injure (when I’m alone and on body parts normally covered by clothing) instead of screaming or slamming doors or throwing objects. Would that be appropriate? Not quite. So the goal should be for me to learn to respond to overload/stress in an appropriate way, not to simply unlearn to scream or throw objects or slam doors. He seemed to think that I should first unlearn to freak out before anything else. Well, he’s the psychologist, but that seems strange to me: how am I going to behave during the times when I would usually freak out? But well, he liked crisis signaling plans, and my current one is basically a already more than that it simply commands me to control my impulse to freak out, even in its early stage (I started writing it less than two weeks ago), so I am slightly optimistic. And as for hair twirling: not my priority. Let me first work on the freaking out thing, and then, maybe, I might choose to work on decreasing my hair twirling habit. Of course, I understand that part of the reason why it’s not a priority for me, is that it’s mostly just other people that are bothered by this habit, and more specifically, it’s people who can see. It takes more than a little theory of mind to recognize the social problem in my hair twirling tic. However, at this moment, I’m particulalry unmotivated to work on behaviors that are only troubling because they bother others - and the “You suffer from the behavior cause of the way people react to it” strategy, even when used in reference to freaking out, has led to a stream of thoughts ending in suicidal ideation more than once within the last two weeks. Besides, on the moments when I’m not suicidal, I generally hardly care about how my meltdowns affect others, let alone something as futile as hair twirling. I might choose to work on decreasing this habit when I’m stable, not now.