If you don't realize that you are autistic, your intellectual, sensory, social, and emotional differences are a mystery, even to you.
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Psychiatry has added to my mental health burden, not lessened it. I’m a psychiatric gaslighting and abuse survivor whose mischaracterization began in early childhood. Healing from developmental and adult trauma has included healing from psychiatry itself.
I’m autistic. It’s the reason for my psychiatric misdiagnoses, most notably borderline personality disorder. I have Ehlers Danlos Syndrome. I am also nonbinary and bisexual. These are all traits that commonly overlap with autism and other neurodivergent traits like ADHD and synesthesia, both of which I also experience.
I learned early on in life that adults perceived my natural traits as evidence of psychiatric problems. I was considered weird growing up. I’m a semi-nonspeaker. My mother, a consumer of popular psychiatric literature, believed my nonspeaking and emotional and sensory sensitivities were evidence of neuronormative social anxiety. My neurogenic stuttering was viewed as a social anxiety issue as well; neurogenic stuttering is now known to be caused by a basal ganglia injury, in my case, likely from an injury to my hypermobile neck. I first received psychiatric care in a kindergarten speech therapy program. Picking my fingers has always been my biggest autistic stim; that behavior was likewise classified as an anxiety reaction.
Being mostly nonspeaking in school, and a stutterer when I did speak, made me a school bullying target. Teachers, schooled in contemporary psychiatry of the 1970s and 1980s, believed that they should not intervene in the bullying. They didn’t classify bullying as abuse. They labeled me a loner, rather than a bullying target trying to avoid more abuse. My bullies were boys who couldn’t quite put their finger on what othered me in their eyes. I didn’t perform femininity correctly. Boys were upset that I never deferred to them or showed much interest in them at all. Sexual harassment of girls by boys was rampant throughout my junior high and high school. Three boys sexually abused me at school. One abused me daily for an entire semester. I began self-harming at age 14, in secret at first.
I had a scientific mollusk collection by age 11, with proper Latin labels for each specimen. I read about Ancient Egyptians, astronomy, physics, anthropology and archeology and much more. I had a telescope and microscope. I dug up clay from the banks of my local creek to make pottery. Having unusual interests for a child led to high teacher expectations, as did my high scores on standardized tests. Teachers classified me as gifted and talented. I became a Merit Scholarship finalist in high school. Yet, those same teachers also considered me an underperforming student because I rarely talked in class, seemed bored, developed reactive depression to the school abuse that they never recognized, and because of my constant fatigue due to my undiagnosed physical and social disabilities and resultant sleep deprivation. By seventh grade, most teachers had decided I was lazy and disobedient.
My parents and teachers pushed me very hard academically. I never had school accommodations for my disabilities or received any protection from the bullying and sexual harassment and sexual abuse. I had to perform academically as best I could in a hostile and overwhelming school environment. The stress they placed on me added to my constant state of overwhelm. My reactions to the stress and overwhelm were interpreted as psychiatric problems rather than as trauma responses.
Like most autists who are not white boys, my traits went unidentified for decades. And if you don’t realize that you are autistic, your intellectual, sensory, social, and emotional differences are a mystery, even to you.
I saw my first child psychiatrist at age 13. She diagnosed anxiety and major depression. She interpreted my nonspeaking in therapy as confirmation of her assessment.
Beginning at age 18, the psychiatric misdiagnoses and abuse became even more harmful. I was subject to verbal and emotional abuse by multiple psychiatrists. Their attitudes and behavior negatively affected my sense of self for decades. It’s only been in the last few years that I have been able to reframe my negative experiences with psychiatry and begin to heal from it.
When I left high school and chose to attend a university several thousand miles away from my parents, I discovered quickly that leaving my abusive experiences behind did not relieve me of my trauma. I had difficulty adapting to college life. My mother arranged for me to see a psychiatrist in 1984.
Like most older female-bodied autists, I was soon misdiagnosed with borderline personality disorder, which has significant overlapping symptoms with autism, like self-injury, meltdowns misinterpreted as tantrums, and an inability to form solid, emotionally healthy relationships with allistic and neuronormative people. My BPD diagnosis led to significant psychiatric abuse for many years. An inability to articulate emotional states (common to autists), especially traumatized ones, is misinterpreted as manipulation, as is being nonspeaking. Psychiatrists considered me to be the problem, not my interpersonal trauma.
The university psychiatrist, whose name I wish I had now (I’ve done some sleuthing and have found nothing), apparently gave me the BPD label. Soon after I began meeting with him, he began treating me as if I was a nuisance. He was short-tempered with me. He frequently laughed at me, made sarcastic, mean comments, and was upset that I talked very little in our sessions. His behavior hurt me.
“Do you need to be hospitalized in an inpatient psychiatric facility?” he taunted a number of times over two trimesters.
Looking back today, I see his behavior as rooted in a belief that nothing was “really” wrong with me; I was just being difficult. He thought my nonspeaking was manipulation.
I indicated suicidal ideation at one point, by showing him a cartoon about the peace obtained in death.
He laughed sarcastically, “How do you know what happens after death?”
He was the opposite of a healer. He re-traumatized me. He manipulated a vulnerable 18-year-old with developmental trauma. He tried to convince me that I was psychiatrically ill.
Then, one day, we had another session in which I was barely speaking. This time, he became very angry at me.
“Leave. Get out of here and don’t come back until you’re willing to talk!” he yelled.
I was shocked and deeply hurt. I went outside and sat on a bench a dozen yards from the psychiatry services building. I waited 45 minutes for someone, anyone—him, a secretary—to come out and see if I was there. No one appeared. Finally, I walked back to my dorm, stopping on the way to buy a bottle of acetaminophen. Back at my dorm, I swallowed the entire bottle of 200 pills. I waited a while. Then I decided that I didn’t want to die. I called the psychiatrist. He picked up. I couldn’t speak.
“Did you hurt yourself?”
Yes, I told him. I now think that he goaded me into my suicide attempt. That psychiatrist created a self-fulfilling prophecy through his abusive behavior.
Soon, I was in an emergency room near campus receiving ipecac syrup and the acetaminophen antidote. Then I was sent to a small psychiatric inpatient hospital unit and placed on a 72-hour hold. The facility was old and shabby. Patients with many different diagnoses were placed together. I remember seeing a woman suffering from deep depression. I recognized that the depression I experienced was different somehow.
I was placed in the observation room, an unpainted gray cement room with metal bars on the one small window. A small, uncomfortable bed, a stainless-steel medical cart on which I ate my food, a small sink without a mirror and a toilet were the only pieces of furniture. Once an hour throughout the night, an orderly shined a flashlight through the window in the door onto me, waking me up every time, leading to further sleep deprivation. It felt like I was in prison, that my suicide attempt had made me a criminal. I knew that I had to behave well to avoid being trapped there. I wanted to go home.
The staff treated me as a nuisance. They kept telling me that I needed to be more social. Too many strangers at once, even if most of the other patients seemed like nice people, is overwhelming for autistic people, especially traumatized ones. One night I refused to attend a documentary film in the common room when I recognized the film as a nature documentary frequently shown to children at the natural history museum with a mollusk wing where I had spent so much time as a child and teen. The film choice felt condescending to me, as if the staff considered psychiatric patients to be childlike. “Non-compliant,” said the staff.
A male orderly was assigned to me to be my personal therapist. After all the abuse from boys and men I had experienced, I wasn’t going to make myself emotionally vulnerable around him. No one recognized that assigning a traumatized 18-year-old female-bodied person to a male-bodied therapist was poor judgment. So many female-bodied people have a sexual trauma history by age 18, me included. “Non-compliant,” said the staff.
I saw the head psychiatrist just once. He swaggered into the observation room wearing a brown leather jacket, his arms crossed impassively. He faced away from me as he spoke briefly.
“It is still possible for you to grow up, find a husband and have children, to have a normal family life,” as if that was my only acceptable life choice.
It wasn’t until after I was back at my parents’ house that I discovered the psychiatric facility’s receipt. Borderline personality disorder was the only diagnosis listed. I had bought and read an official American Psychiatric Association book on personality disorders months earlier, out of curiosity. I knew what the label meant. It didn’t feel right to me.
My new psychiatrist, again my mother’s choice, took my parents’ money week after week without informing them that I was barely speaking during sessions. Once, he left the room for ten minutes after receiving a phone call that was, apparently, more important than me. I stood up, walked over to his bookshelf and took a look at his book collection. Freudian. What a scammer, I thought to myself.
Once again, I had to deal with my years of trauma by myself.
After a second suicide attempt four months after the first, this psychiatrist gave up and transferred me to his wife for family therapy. I rarely talked in family therapy, either. During those few months of therapy with my parents and sister, the therapist felt entitled to yell at me on a regular basis. I thought she was particularly cruel.
A couple of years later, a year and a half after I was raped in a car in the parking lot of an archeology center in Cortez, Colorado, I ended up in a second psychiatric facility, the sprawling Victorian Sheppard and Enoch Pratt psychiatric hospital outside Baltimore, Maryland. This was after a few months of outpatient therapy with the head psychiatrist of what was then the BPD unit. He also felt entitled to yell at me for not talking. After I showed him cuts on my arm, he recommended a three-week stay in the BPD unit.
This experience was the first time I had met so many people with similarities to me. Half the patients were childhood sexual abuse survivors. Most had made suicide attempts or were chronic self-injurers. It seems clear to me now that the other patients were also trauma survivors and that some were autistic as well.
The psychiatric milieu was behaviorist. The unit was noisy and chaotic, characteristics that overwhelm autistic people. In addition, I was punished for not talking by being kept imprisoned in the unit for more than a week. I had to eat alone. The staff seemed to believe that isolating me would get me to open up, rather than shut me down.
Patients were allowed to smoke in those days, so I was forced to breathe secondhand smoke. I found the smoke intolerable.
I often stayed in my room to breathe cleaner air and get some peace and quiet. Staff saw my behavior as isolationist. I now know that I have asthma, bronchiectasis, and atelectasis, as well as mast cell activation issues, all common medical problems for EDSers. The sensory and social overwhelm I experienced in the common area were also reasons why I preferred to stay in my room that I shared with three other patients.
I made friends with a younger woman who had recently turned 18. The staff and other patients considered her immature. I now suspect that she was autistic. My one other friend was a patient who was a nurse from Canada and an incest survivor who had made multiple suicide attempts. Both women were nice people, and nice to me. The three of us hung out together frequently.
I discovered one day that the in-ward art room had food (there was an official art therapy room elsewhere in the hospital): sliced bread, peanut butter, and jelly. I got up my courage to ask a nurse if I could access the art room by myself and make a sandwich. Eating that sandwich in peace and quiet was such a relief. Finally, I could relax. I was proud of myself for advocating for my needs. “Asocial” and “non-complaint” said the nurses during the weekly group therapy session for everyone in the ward. They did not recognize that asking for what I needed was a sign of mental health. Neither did they recognize that I had sensory and social overload issues, or interpersonal trauma.
I had to complete a personality test, an IQ test, and a pregnancy test, none of which were therapeutic for me.
My inpatient psychiatrist was a woman who was more caring than previous psychiatrists. Not enough so, however.
One morning I was in the shower. A nurse banged on the door, yelling, “Get your ass out here, you know you have a technician waiting to take a blood sample.”
No, I did not know that. No one had informed me. Obviously, she assumed I knew and was being non-compliant.
While in the lab room, the tech left for a few minutes. I grabbed the blood test papers. That’s how I learned they were giving me a pregnancy test. No one had asked me if I was sexually active or if I had been sexually assaulted. I wasn’t pregnant. I could have told them that. I was not sexually active.
I told my new psychiatrist how the nurse had treated me abusively.
“Maybe you should see that experience as how the real world works.”
As if I didn’t know that the “real world” often treated people like me abusively? That was her response to my report of verbal abuse by a staff member? I viewed telling her about the incident as a healthy sign of self-protection and seeking help. How appalling that she does not understand, I thought to myself.
Today, thankfully, Sheppard Pratt has retired its BPD unit. Instead, it has a “Trauma Disorders Program” and an “Intellectual Disabilities and Autism Unit.” I think trauma responses are a natural spectrum of response to trauma and should not be labeled as intrinsically “disordered.” And their “severe autism” unit uses Applied Behavioral Analysis, a form of conversion therapy that does nothing to help people but instead focuses on changing one’s outward behavior to suit others, even if it further harms the conversion therapy subjects.
It wasn’t until I was able to move out of my parents’ house a second time that I was able to shed the BPD label. I’m lucky that medical records were not electronic in the 1990s.
For more than 20 years, 1999 to 2020, I thought I had only PTSD and complex developmental trauma from school bullying, sexual assault, domestic abuse and medical and psychiatric gaslighting. The only therapy that made sense to me was self-introspection and a lot of reading about trauma from compassionate trauma experts like Dr. Judith Herman and the psychiatrists she mentored.
It wasn’t until two and a half years ago that I discovered I was autistic. I was diagnosed with Ehlers Danlos Syndrome. I soon learned about the Ehlers-Danlos Syndrome/autist overlap. Suddenly, my entire life made sense. Since then, I have learned how the deficit model of autism, as defined by the Psychiatric Diagnostic and Statistical Manual, mischaracterizes autists, especially female-bodied people and people of color. I am now part of the Neurodivergent Movement. Empowering myself as an autist who has experienced extensive interpersonal trauma is what has helped me to heal.
Because of the daily microaggressions and larger traumas that autists experience every day of our lives, I don’t believe that autistic people should be diagnosed with both BPD and autism. And BPD itself is clearly tied to interpersonal trauma that affects relationships and one’s sense of self, though that connection is still not acknowledged frequently enough by psychiatry.
Most psychiatrists have long believed that people with a BPD diagnosis are manipulative, and that therefore it is acceptable to abuse anyone with that label.
No trauma survivor, or anyone else, should have to experience and heal from psychiatric gaslighting and abuse.
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