Amelia Woods-
Author’s note: The following essay was written for Joel Krueger’s second year module Body and Mind. In the first section, I argue that the split-self metaphors used to describe post-traumatic experience are minimally explanative when it comes to autistic people’s experiences post-trauma. I go on to give a very brief explanation of how a predictive processing framework may provide more of insight.
I am going to build on the later section of this essay in my dissertation this year which will (hopefully) show how predictive processing can explain the over prevalence of PTSD in the autistic population.
Introduction
In this essay, I will argue that the phenomenological distinction between body as subject and body as object is not the most helpful explanatory framework through which to understand the embodied experiences of autistic people with PTSD (Post-Traumatic Stress Disorder). I will consider Dorothy and Hughes’s work on “death of the self” and conclude that while an enlightening explanatory account of single-event trauma in adulthood’s effect on the self, it does not apply to autistic people with PTSD. This is significant since autistic people are more likely to experience PTSD following a traumatic event than allistic[1] people. One study found that 61% of autistic people self-report PTSD[2] in their lifetime vs 4.5% of the general population (Rumball, et al., 2020). Autism is a developmental condition characterised by differences in social communication, social interaction, and sensory, cognitive, and emotional processing. Existing phenomenological accounts of autistic experience and post-traumatic experience are so similar that they cannot contribute to our understanding of how autistic people’s lives may change after trauma. Non-traumatised autistic people already experience differences in their sense of self such that their “split-self” is already less unified than the allistic person’s pre-trauma. Thus, autistic people are less likely to experience “death of the self”. I suggest that a predictive processing account of PTSD in autistic people is the best lens through which to view the distinct way in which autistic people experience the world post-trauma.
The “split self”
A core idea in phenomenology is that embodied experience combines having a body that is passively affected (the objective body) and being a body that actively understands (the subjective body). In day-to-day-life, we experience the two as more or less unified pre-reflectively. This unified self has memories of the past, engages meaningfully with the present, and can envision a future. Waldenfels notes that the united objective and subjective self is fragile by necessity (Waldenfels, 2011, p. 3). Waldenfels also suggests that traumatic events are an example of the way that this “split self” is a liability that can be exploited to the point that the tension between the objective and subjective bodies is explicit in a way that is deeply distressing and painful (Waldenfels, 2011). Dorothy and Hughes aim to provide a theoretical interpretation of the phenomenon in which individuals who have survived trauma feel as though a part of them has died. When the harm inflicted on the objective body resists the subjective body’s attempts to gather the bodily experience into a narrative experience of the body as a whole, this can lead to feelings of self-alienation. The self is no longer a unified entity with a past, present and future; it is split. They draw on Waldenfels to argue that when the split self is profound enough, the lack of subjective self can be so significant that the survivor/victim may feel a strong sense that part of them has died (Dorothy & Hughes, 2023). They argue that the “death of the self” can manifest in three ways: dissociation, indescribability, and repetition and fragmentation of time (Dorothy & Hughes, 2023).
Highlighting the similarities between accounts of autism and PTSD
In this section, I will unpack the three ways Dorothy and Hughes argue that “death of the self” can manifest, and highlight the similarities between their analysis of post-traumatic experience and aspects of autistic experience.
- Dissociation
The first way death of the self can manifest is dissociation. Dissociation is not exclusively a feature of PTSD and is common in both diagnoses. It involves depersonalisation (a feeling of detachment from one’s mental processes, viewing your body from the outside as though you were an observer) and derealisation (feeling as though the world is a dream, is distant, or is otherwise distorted). Alterations in embodied experience are at the foreground of dissociative experiences (Dorothy & Hughes, 2023, p. 5). For example, many victims of child sexual abuse describe viewing themselves in the third person. In The Body Keeps The Score one victim recounts how she would “put her head in the clouds”. During the abuse, this individual would perceive that she was in the ceiling watching some other child in the bed (van der Kolk, 2015, p. 158). We can see here how the relationship between the subjective and objective body has been disturbed. The individual has been separated from both being and having a body, which creates self-alienation (Dorothy & Hughes, 2023, p. 5).
“Masking” refers to the autistic tendency to suppress autistic traits to appear that they are not autistic. Masking is sometimes referred to as “camouflaging” but the two terms mean the same thing. Autistic masking can affect autistic people’s ability to feel that they are their “true self” (Hull, et al., 2017). When talking about how they feel when they have been masking for a long time one participant in a study by Hull et al. said:
“I feel as though I’ve lost track of who I really am, and that my actual self is floating somewhere above me like a balloon” (Hull, et al., 2017, p. 2529)
There is a similarity between this quote and the example in the earlier paragraph. In both examples, the individual experiences their self as separate to their body. This loss of security in who they were was a common theme in responses in the study. Showing experiences of self-alienation are common in autistic experience without the involvement of traumatic experience.
Another way Dorothy and Hughes point out that dissociation can affect embodied experience is that it can lead to the subject not feeling at home in the world. This may manifest in feeling disorientated in familiar, previously unproblematic settings (Dorothy & Hughes, 2023, p. 6). Everyday experience is made up of “finding our way” through shared spaces (Ahmed, 2006, as cited in Kruger, 2021, p. 23). We sense that it is possible to negotiate our way through these spaces. “Disorientation” happens when we no longer feel like we’re finding our way, or that it is possible to do so. This isn’t an epistemic experience of disorientation (getting lost because we don’t know how to get from A to B). Disorientation in this sense refers to feeling bodily out-of-sync with or limited by the space we are in (Ahmed, 2006; Krueger, 2021). Robert Stolorow describes feeling disorientation after his trauma:
“… as I looked around the ballroom, they all seemed like strange and alien beings to me. Or more accurately, I seemed like an strange and alien being – not of this world. The others seemed so vitalised, engaged with one another in a lively manner. I, in contrast, felt deadened and broken up” (Stolorow, 2015, pp. 13-14)
Here Stolorow is describing feeling bodily out-of-sync in a place where he previously would have felt at home, surrounded by his loved ones. He is more aware of his body as an object due to the diminished possibilities his lived, subjective, body now affords (Dorothy & Hughes, 2023, p. 7). This analysis is however hard pushed to explain how autistic people’s lives change after trauma due to how this framework has led to very similar depictions of autism and PTSD. Krueger applies Ahmed’s work on “disorientation” to autism to argue that many social impairments in autism are a result of bodily disorientation (Krueger, 2021).
- Indescribability
Narratable experiences are grounded in being a body that actively understands. Whereas when we experience having a body that is passively affected by an event it becomes unnarratable (Køster, 2017). The split self comes about when the trauma inflicted on the objective body is beyond the subjective body’s ability to describe or narrate (Dorothy & Hughes, 2023, p. 9). An important factor to consider when it comes to autistic people’s post-traumatic experience is that up to 50% of autistic people have alexithymia (Kinnaird, et al., 2020).
Many of the stereotypical depictions of autism are based on individuals with severe alexithymia. Alexithymia is the inability to differentiate between or describe one’s emotions. It has been suggested that the emotional symptoms of autism can be explained by alexithymia, not autism itself (Bird & Cook, 2013). Described through the split self metaphor, alexithymia is a disturbance in the objective self in that subjects may not be able to tell the difference between sensations in their corporeal body (for example the difference between how their stomach feels when they are hungry versus when they are anxious). It can also be a disturbance in the subjective self since much of their emotional experience is completely indescribable. Being unable to describe your feelings and emotions directly impairs the subjective self’s attempts to organise experiences into a continuous narrative since a whole realm of experience cannot be described.
- Repetition and fragmentation of time
Dorothy and Hughes suggest that when conceptualised into the split self, fragmentation and repetition of time reflect the reduced capacity of the subjective body to organise the objective body into a coherent timeline (Dorothy & Hughes, 2023, p. 11). In the case of trauma, the subjective body is overwhelmed by the objective body. As a result, fragmentation happens. This prevents the traumatic event being assigned to the past.
Multiple studies have found that autistic people have difficulties with forming episodic memory (Bennetto, et al., 1996; Griffin, et al., 2021). Such difficulties with episodic memory mean that autistic people’s subjective bodies already have difficulty organising their objective body’s experiences into a coherent timeline pre-trauma. Episodic memory is the memory of our unique personal experiences of everyday things. They contain specific information about the event and its context. These memories can be explicitly recollected and help us create a sense of self. Episodic memory is also impacted by traumatic experience (Ehlers & Clark, 2000; van der Kolk & Fisler, 1995; Tromp, et al., 1995). For example, Tromp et al found that in contrast to other memories accounts of rape were less vivid, detailed and clear suggesting that people have trouble forming episodic memories of traumatic events (Tromp, et al., 1995). It has also been suggested that helping subjects form narratives of their trauma is an effective treatment for PTSD (van der Kolk & Fisler, 1995). Autistic individuals have difficulty forming episodic memories in general, which means they are less likely to experience a deterioration of their split self because of traumatic memory fragmentation. Consequently, they may not respond as effectively to the therapy proposed by van der Kolk and Fisler.
Predictive processing
In this section, I will argue that a predictive processing account of autism and PTSD is less pathologising than the split self-account is. This account also provides a simpler way of explaining how the two (autism and PTSD) can coexist in one individual. I now need to show how predictive processing can be used to explain the changes in autistic people’s embodied experiences following the development of PTSD. Symptoms/characteristics that can be new for autistic people with PTSD include avoidance behaviours, intrusive memories/ flashbacks, hypervigilance, nightmares, and negative self-belief[3]. For now, I will focus on intrusive memories and flashbacks.
Rather than viewing the nervous system as only responding to sensory input, it can be seen as actively predicting what will happen next. The brain both alters the predictions to fit the world and alters the world to fit predictions (Pickering & Clark, 2014). Predictions are both based on past experiences and incoming sensory input. Conscious experiences made up of your nervous system’s best predictions are always a step ahead of what is happening in the outside world. Our nervous system’s task is to interpret ambiguous input and form a hypothesis. It considers how statistically likely the hypothesis is, based on experience, and how well it fits the input (the prior probability). A hypothesis could be a good fit for the input but could have such a low prior probability that it isn’t considered. On the other hand, it could have such a high prior probability that it is settled on despite not fitting the input well at all. The nervous system aims to do this quickly, accurately and with as little energy as possible. It is often difficult to balance speed, accuracy, and energy expenditure, requiring a compromise. Predictive strategies are used to maximise efficiency in these decisions.
Rather than presenting people with PTSD as having a broken self or a part of them missing, which to the lay person the split self view would imply. A predictive processing account lets us see people with PTSD as having a rational (if overprotective) mind. When the traumatic event happens, a hypothesis is made corresponding to the conscious experience of the event. Significantly, an aspect of both the conscious experience and the hypothesis is that the event was life-threatening. Your nervous system cannot miss selecting that hypothesis in future, so due to its necessity for survival, the hypothesis is given an extremely high prior probability (Wilkinson, et al., 2017). This leads to a bias in favour of that hypothesis meaning it will be selected in future even when the sensory input is a poor fit. The hypothesis our brain chooses determines our conscious experience of the world at all times. Something even the slightest bit reminiscent of the event can trigger intrusive memories or flashbacks (Wilkinson, et al., 2017).
Pellicano and Burr suggest that the reason autistic people perceive things differently is because they construct priors differently or link priors to different sensory information. Autistic people have broader, “hypo-priors” (Pellicano & Burr, 2012). Hypo-priors can explain the sense of being overwhelmed by sensory information. Hypo-priors result in more unexpected variation even in response to familiar sensory input. Regular priors sacrifice accuracy for improved precision which leads to an overall reduction in error. Hypo-priors distort sensory information less which leads to reduced generalisation or overfitting (Pellicano & Burr, 2012). Reduced generalisation leads to experiencing everything as brand new rather than moderated by prior knowledge and how we expect things to be (Pellicano & Burr, 2012). One individual describes how they struggle to channel out irrelevant sensory information:
“I mean the talking to people I struggle with if there’s the stripy shirt distraction issue, because it’s something that’s grabbing your attention away from what they’re saying. At the same point as there’s five different people behind them whose conversations you’re listening to at the same time because you can’t screen them out.” (Parmar, et al., 2021, p. 6).
We can assume that since most of the incoming data is newsworthy information that impinges on the senses, in the event of a traumatic experience, more irrelevant information at the time is considered to be relevant. This increases the likelihood of that person being reminded of the original traumatic event and experiencing a flashback in the future. Predictive processing can therefore explain why autistic people are much more prone to developing PTSD[4]. It can also explain what is going on in the minds of autistic people with PTSD which can help us make sense of their experiences.
Conclusion
In this essay, I have argued that existing work using the phenomenological distinction between the objective body and the subjective body struggles to deepen our understanding of post-traumatic experience in autistic people. I have applied Dorothy and Hughes’ “death of the self” account to the experiences of autistic people. My analysis has shown that within this phenomenological framework, autistic people do not experience the profound split self that allistics might following a traumatic event, since they have experienced bodily disorientation and a weaker sense of self their whole lives. I suggest that a predictive processing account of both autism and PTSD could be a better framework through which to understand the embodied experiences of autistic people with PTSD.
[1] Allistic refers to all people who are not autistic.
[2] This statistic only includes traumatic events that are accepted by the DSM-5 for a diagnosis of PTSD.
[3] Many autistic people already struggle with noise sensitivity, sleep, executive dysfunction (including problems with concentration), dissociation, and interpersonal relationships.
[4]The difference between autistic and allistic neurotypes in their responses to trauma is not the only reason autistic people are more prone to developing PTSD/c-PTSD. Autistic people are also more likely to have experienced homelessness, domestic abuse, sexual violence, and bullying among other negative life experiences (Douglas & Sedgewick, 2023).
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