Aphantasia And Trauma Redux
For years now in these pages I’ve wondered about trauma absent memory, by which I meant the impact of the sensory envelope of aphantasia upon the laying down of trauma in the brain. It’s of interest to me not just as an aphantasic but as an autistic adult in a world of normativity, and what’s more as someone who was unknowingly autistic in that world for four decades. Basically: is just being autistic in these ways a kind of traumatic experience, but then how does that play out when you don’t have mental imagery?
Interestingly, this is a topic of research as detailed by J.B. Smith for Psyche last week, in an examination of the idea that “living without mental imagery may shield against trauma’s impact”.
While PTSD can affect any element of a patient’s psychological and emotional wellbeing, intrusive visual imagery has often been referred to as a cardinal symptom. So, Pearson and his colleagues, Rebecca Keogh and Marcus Wicken, wanted to explore the susceptibility of people with aphantasia to PTSD. Their study, which is currently out as a preprint, showed a film featuring a traumatic incident to a group of aphantasics. The individuals were asked to fill in questionnaires directly afterwards and over the following week, describing how often they had intrusive thoughts about the film. The results, when compared with a control group with full mental imagery, were pronounced. ‘In pretty much everything we measured, we saw that those with aphantasia had significantly fewer intrusive thoughts about the film,’ Pearson tells me. And there’s certainly a logic to it. Visual imagery has been described as an emotional amplifier in the brain, with studies linking dysfunctional mental imagery to both depression and bipolar disorder. ‘When it comes to linking emotion with thoughts, there are clear differences with or without the image there,’ Pearson says. ‘And it does seem that being able to turn a thought into a sensory simulation provides a stronger emotional response.’
I’ve resisted, in the past, applying PTSD to any of my experiences as an autistic person in a world built for the normative neurotype precisely because of my aphantasia-inflected severely deficient autobiographical memory. This despite the fact that there aren’t very many ways to label or discuss what for awhile I’d taken to calling “subclinical trauma”. Various aspects of trauma language have been useful to varying and at least metaphorical degrees, but without that “intrusive visual imagery [that] has often been referred to as a cardinal symptom”, PTSD itself was right out.
This has been on my mind again in recent days because today I had to go in for a chest CT almost exactly two years after experiencing a panic attack during my first such scan, compounded by being yelled at by a technician for holding up the people he had waiting outside. By dint of the aphantasia, I can’t and don’t vividly re-experience that attack, and, to be clear, this wasn’t just anxiety, or even an anxiety attack. It was a straight panic attack that trigger ed both fight and flight in a way that almost had my ripping out the contrast dye IV as I flailed to get out of the machine. It was like nothing else I’d ever had my nervous system put me through, and had I a brain possessed of mental imagery I imagine it would have been ripe for such vivid re-experiencing.
Today went fine, partly because my doctor had contacted the department ahead of time and partly because of the very detailed-oriented nurse in the room with me who literally gave me the length of each scan in seconds ahead of time. Knowing is half the battle and all that. This is entirely consistent with my contention that for my brain, at least, anticipatory control always is better than compensatory. What’s interesting to me about this is that I wonder if mental imagery would help or hinder using anticipatory control (which includes scripting, which includes catastrophizing) as a means of self-regulation.
Anyway, in addition to this Thursday being two years since that panic attack, today marks six years since the long “consultive exam” by a state-hired psychologist which yielded the error-prone report (that took me forever to obtain) which Oregon’s disability determination people used to declare that I was not disabled—colloquially known to me as Adjustment Disorder Day.
What was interesting to me after receiving the diagnosis of acute Adjustment Disorder out of that consultive exam was that I discovered that it doesn’t only come in that acute variety. It also comes in a persistent, or chronic, type as well.
Being actually-autistic in many ways is a kind of chronic stress, but, as I said, my lived experience is not re-experienced in the way we seemingly consider it to be necessary to discuss trauma. My subjective reality, though, to take one example, is that while I do not re-experience my vocational rehabilitation job placement, thinking about it, or thinking about returning to work at all, does conjure up into the present my fight, flight, or freeze response.
For all intents and purposes, my therapist and I agree that the ways in which my impairments disable me amount to persistent adjustment disorder stemming from the ongoing stressor. of being autistic in a non-autistic world, both pre- and post-diagnosis. It’s not just about the crash-and-burn of that job placement. That incident simply was the experience of being autistic in a non-autistic world writ emotionally large and right in my face.
I’ve sometimes in the past deliberately avoided using trauma language, for example, because I don’t want to come across as appropriative—and also because the aphantasia and SDAM essentially preclude things such as vivid recollection of events, although they get laid down in my nervous system in other ways)—but also because I consider the things I’d want to discuss to fall within the diagnostic language gap. My therapist and I have talked about chronic or persistent Adjustment Disorder, and I’ve sometimes used terms like Sub-Clinical Trauma and Complex Chronic Stress as ways of trying to get at what I’m trying to say.)
(Insert here as well the idea of the “mini-traumas” of the autistic brain due in apart due to its lack of habituation and increased threat response.)
I’ve suggested before that psychotherapy either can be a tool for social work or social control, and here’s where I highlight something from that post of November last year:
It didn’t take me long to wonder whether or not living first as an undiagnosed autistic and then as a diagnosed but mediocre one who qualified neither as high support needs or savant polymath might not arguably yield a diagnosis of chronic Adjustment Disorder, in which the inciting life event is, well, life as such an autistic person.
The idea here is that a diagnosis of persistent or chronic Adjustment Disorder is a way to smuggle the social model of disability into the individualist confines of the medical model’s Bible, the DSM, because viewing chronic or persistent Adjustment Disorder through a lens such as “the inciting life event is, well, life as such an autistic person” suggests that we can do this for all manner of impairments whose ensuing disabilities implicate the social world in which one has them.
I take as a given Audre Lorde’s caution that “the master’s tools will never dismantle the master’s house”, and the DSM certainly is a tool of the normative, medical model of disability. Making use of the diagnosis of chronic or persistent Adjustment Disorder, though, might at least open a few new windows in the master’s house through which we can see other possibilities.
At any rate, my thoughts heading into this post were simply this: living as (in my case) an autistic in a world suffused with and steeped in normative bindings and ways of being itself is a disabling event, as described by the social (or the social-relational) model of disability, and brings with it a sort of daily subclinical trauma, especially for those of us with aphantasia and SDAM preventing and precluding clinical-level re-experiencing, yielding very much the sorts of things described by a diagnosis of Adjustment Disorder.
When I’d first thought I needed to put something down here in the midst of this temporal confluence of dealing with a “trauma”-recollecting diagnostic procedure on the one hand and anniversary of a useful, new diagnostic category, what I’d wanted to do was much more in line with that post from November of last year.
Instead, this mish-mash, because in the existential mire of that stretch between my birthday in October and New Year’s Day in January (with the added stressors of the election at one end and the inauguration at the other), I seem to have lost the ability to wordcraft quite that finely, and quite that elegantly.
In the end, in these long, dark stretches of days ending one revolution and starting the next, I’m just not very well adjusted.