Autistic Burnout

I first mentioned autistic burnout here where I emphasized its importance without any explanation. I have come back to the idea in several other posts, and it is brought up in many of the books I have read.

But what exactly is meant by autistic burnout? It is not (yet) a formal diagnosis, but a phenomenon widely recounted in the autistic community. Research into autistic burnout is in its early days, but is emerging. Descriptions of autistic burnout usually involve phrases like exhaustion, overwhelm, an inability to cope, increased presentations of autistic traits, and loss of skills. It can result in suicidal ideation and suicide attempts. It can last on timescales from months to years.

Autistic burnout is the result of prolonged stress that can be experienced by an autistic person trying to make their way through a world designed for the neurotypical, often with relentless masking and little support or understanding.

Autistic Burnout Versus Depression

Although autistic burnout can co-occur with depression, it is distinct from depression.

In the same way that distress is often miscast as avoidant anxiety in autistic individuals, autistic burnout seems to be frequently misdiagnosed as depression.

Why the Distinction Matters

The distinction between autistic burnout and depression matters because the root causes differ. Depression as a diagnosis does not do a good job of answering the "why" of the behaviours observed with autistic burnout.

During the peak of her own period of autistic burnout, Oranguette was given a sort of luke-warm unspecified depression diagnosis. I don't think that was incorrect, as there was an element of depression or something very similar that absolutely needed to be illuminated. However, I think all parties involved felt that something was lacking or incomplete with that label; that diagnosis just didn't quite mesh as effortlessly with her presentation as one would hope. There was no loss in engagement with Oranguette's favourite activities, for example, as one might expect with depression. This was frustratingly cited on one occasion as evidence that she was recovering, when in fact she continued to be wildly and dangerously distressed.

Later, the concept of autistic burnout, even with a side of recurring depression, filled in the gaps and provided a much more holistic and integrated picture.

The distinction between autistic burnout and depression also matters because treatment approaches differ.

Recovery

In much the same way that unsupported exposure therapy was unrelentingly pushed on us in response to Oranguette's so-called "school refusal", the default approach to treating a child struggling with depression seems to be to just push them to engage. To the extent that this kept Oranguette participating in well-loved activities, that wasn't entirely wrong. But, notably, she didn't actually need any arm-twisting to do that (quite the opposite, in fact). Furthermore, that approach was very wrong when it led to pushing her back into environments that she could not function in.

In short, treating autistic burnout as depression combined with avoidant anxiety led to a drastic worsening in mental health.

What then does work for autistic burnout?

Strategies for recovery from autistic burnout are centered around understanding a person's unique strengths and challenges due to their autistic brain, and mitigating those challenges by making use of appropriate supports as necessary. Instead of mindless pushing through, which is inevitable in short bursts here and there for anyone, but only drives continued autistic burnout when done on a continual basis, the focus is on self-advocacy and creating a sustainable, lower-stress life.

In the book Unmasking Autism, the author Devon Price articulates this philosophy with his usual clarity, writing that:

Almost every Autistic person I spoke to has found that in order to build a life that suits them, they’ve had to learn to let certain unfair expectations go, and withdraw from activities that don’t matter to them. It’s scary to allow ourselves to disappoint other people, but it can be radical and liberating, too. Admitting what we can’t do means confronting the fact we have a disability, and therefore we occupy a marginalized position in society — but it also is an essential part of finally figuring out what assistance we need, and which ways of living are best for us.

From my own experiences, understanding, living within, and working with one's limits (and strengths!) seems to be an essential part of functioning well as a neurodiverse individual. I'll even posit that this approach can make the difference between thriving and struggling, or even -- provocatively -- between being "high functioning" and "low functioning".

Really, is this not good advice for anyone?