Monday, January 28, 2013

When Autism and Schizoaffective Converge

Cissi Tsang

There have been various studies and speculation abounding regarding the relationship between the autism spectrum and the schizophrenia spectrum. That is not surprising because there are some similarities in behaviours between the two. Both conditions feature such things as social withdrawal, difficulty with empathy and difficulty with reading verbal and non-verbal cues.

What happens if both conditions collide and exist together within a person?

This is an area that is not often explored. It is almost as if the population of people who have both an autism spectrum diagnosis and a schizophrenia spectrum diagnosis do not exist in the minds of most people. However -- such people do exist.

I am one of them. I have Asperger's syndrome, as well as Schizoaffective Disorder.

How can it be, though? I must note that the DSM-IV-TR does note this possibility. Although rare, it does happen.

With this article, I hope to raise greater awareness of people who have both conditions. We do exist and we do have a voice as well.

My story

I knew from a young age that I was different to my peers. I had obsessive interests that my peers did not share, such as Australian horseracing. I would religiously follow the form guides in the newspaper, and I could rattle off the layout of all the metropolitan racetracks around the country, as well as some country ones. I knew when each major race was held, where and their distances and I would spend my spare time reading about the history of horseracing.

I also enjoyed such pursuits as sorting out coins, lining up my toys in neat lines, and I had such a deep and abiding love for a certain actor that I would spend hours watching and practicing his various mannerisms.

To say I was socially awkward would be correct. I didn't understand nonverbal communication and would constantly misread people. I didn't understand how to hold conversations. I didn't understand people, and people didn't understand me. As a result, I was teased and ostracised - which apparently is an unfortunate experience shared by many on the autism spectrum. I tried to make friends, but most of my attempts would end in disappointment.

When I was a teenager, my experiences began to change. Not only was I socially awkward, but I began to develop strange beliefs. One of them involved believing that my mind was like a human radio, broadcasting all my thoughts and secrets to everyone in my vicinity against my will. Whenever this happened, I would see my mind as a sieve, with me endlessly trying to "plug" the "holes" in my mind while my thoughts and secrets leaked away.

I also experienced these voices within my head that felt alien to me, and were beyond my control. They felt like other entities who were living in my head and sometimes they would converse with each other and comment on my actions. I alternated between thinking of them as God conversing with me, as malevolent spirits in my head or as "internal monologue."

As I hit my 20s and began university, I began to experience deep bouts of depression. I had experienced depression as a teenager, but these depressions were deeper and more pervasive. I began to develop suicidal ideation. My depression also made me apathetic and drained of energy, so I would spend great amounts of time in bed. There were periods where I fell behind on my work, and I suffered the indignity of facing exclusion from the university due to poor grades.

These periods were broken by times when I felt fantastic. During these periods, I was more sociable, and I would talk in a rapid-fire manner. I would sleep perhaps three or four hours a night, but I didn't feel the lack of sleep. I was confident, and my mind had many thoughts all fighting for supremacy. Most importantly, I felt very happy. I was highly productive and I felt I was able to accomplish anything.

For most of my 20s, I alternated between those two areas. Eventually, I went to see a doctor, who referred me onto a psychologist who thought I was bipolar. Then I went to a psychiatrist who confirmed the diagnosis of bipolar.

The strange beliefs, however, still remained. There were times when the beliefs would coincide with a mood episode. They would usually occur when I was depressed. The concept that my thoughts were being broadcasted was one reoccurring theme. There was another reoccurring theme where I believed malevolent spirits were monitoring me.

I began to see a new psychiatrist and found myself developing more bizarre ideas. One time I developed the belief that there were hidden messages written specifically for me in print articles. Another time I believed my psychiatrist was secretly attempting to kill me with medication, so I stopped taking them. My diagnosis changed from bipolar to schizoaffective disorder-bipolar type, which is when a person has symptoms of both schizophrenia and a mood disorder at the same time.

Eventually I stabilised. Meanwhile, my autistic behaviours remained. I had moved onto new obsessions by now, and one of my obsessions at the time was (and still is) guitars. I was able to talk at length about guitar models and guitar makers and would spend long periods reading about guitars. My psychologist began to advocate that I had Asperger's syndrome, but my psychiatrist seemed unwilling to accept that premise. According to my psychologist, I exhibited all the signs of Asperger's syndrome: I had obsessive beliefs, I had issues with social communication, and I had impaired empathy. While I cared about people, I saw people from an intellectual standpoint, and therefore people were more "objects that spoke to me" rather than "a person with emotions." Emotions were not something I understood very well.

One of the difficulties in getting a clear picture is the similarity of some of the behaviours and thought between autism and schizophrenia. My psychiatrist believed that all my difficulties could be explained by the schizoaffective label. He wasn't entirely convinced that my autistic behaviour was a separate phenomenon to the schizoaffective, while my psychologist thought otherwise.

This continued for two years until my schizoaffective had remitted to the point where it became clear my autistic behaviour was not being caused by it, and I received the diagnosis of Asperger's syndrome. I was glad when I heard, because it put two years of limbo to an end. I had spent two years being confused by what I was hearing and I was glad to have finally received a straight answer.

I also felt that the Asperger's diagnosis was correct. During the two years of limbo, I had spent time researching Asperger's and realised I could relate to the literature. I also knew that some of my behaviour, such as social withdrawal, was not caused by a lack of motivation. Instead, it was caused by repeated rejections from my peers. I had wanted friends, which is different than the mechanism for the schizophrenia spectrum where there is a disinterest in having and maintaining friendships due to a general apathy towards life itself.

How does it feel like to live with both Asperger's syndrome and schizoaffective? It can be challenging in some ways, although for the most part I'm lucky that my schizoaffective manifests itself largely as "positive" symptoms. That is, I have delusions and hallucinations, but none of the "negative" symptoms such as lack of motivation or blunted affect. In a nutshell, I experience both conditions separately. My Asperger's affects me in my every day life, while my schizoaffective will rear its ugly head now and again like some monster from the deep.

There are times when both conditions seem to affect each other. Sometimes I will become depressed due to an issue caused by my Asperger's -- for instance, being told I had been socially inappropriate and had hurt someone's feelings. Then the depression will deepen and the psychosis begins, with me going from believing I was a bad person for hurting someone to being an object of God's wrath who deserved to die. While the logic can seem far-fetched, the rigidity of thinking that sometimes accompanies my Asperger's means that I find it hard to think of alternatives when my thinking becomes dark.

In a way, I'm glad to have received both diagnoses because it makes my world make more sense. I finally had an answer as to why I found social interactions so difficult, and I also found the answer regarding my moods and thinking. Also, I discovered that having both conditions didn't necessarily mean my life was over. Looking back, I managed to obtain a degree while I was undiagnosed and unmedicated, despite the challenges of both conditions. I think it's important to note that while conditions can circumscribe your life, they don't prescribe it.