Expressing pain autistically

Suppose you were undergoing a medical procedure and you were aware the medic was doing something that was causing you a serious problem. Suppose you’d tried to draw their attention to what it was but they weren’t listening because you didn’t express yourself in the way they expected? Sadly that’s not an uncommon experience for autistic people. The supposedly universal human communication of things going badly wrong is to scream – but for an autistic person their response may be to shut down, or to go hyper-reasonable, bland and logical. You can just imagine how a doctor might be a bit wrong-footed. If the patient said: “I’m really sorry but the anaesthetic doesn’t seem to be working and I can feel you putting the stiches in – would you mind using some more local anaesthetic?” the doctor would most likely imagine they weren’t really in pain. If you can speak calmly like that, you’re not really in distress, they would think. Sadly, that doesn’t work if you’re autistic.

Getting your needs met

It’s difficult enough to get the world to listen if you’re autistic and express your physical pain in a way neurotypical wouldn’t expect. But if you’re suffering mental, emotional or spiritual pain as a result of someone else’s actions, it’s particularly hard to speak up and be heard. Complaining can lead to blow back as the person complained against defends themselves. If you’re autistic, you may be quite used to things seeming to be your fault, and prone to mis-identifying the underlying issue because perhaps you’re not great at identifying sensations. So it’s quite likely that the prospect of expressing your distress is just going to cause more distress and so you don’t.

Do I need to scream?

Expressing physical pain feels to me like just one more communication that has to be managed. As a child if I injured myself I instinctively hid the injury because I could cope with my own sensations or other peoples’ reactions, not both. Then I learned that if you conceal an injury you tend to get found out and then people react even more, putting even more strain on your abilities to meet social norms. So a socially acceptable response to (say) falling over in the playground was the best way to minimise attention – you had to endure a certain amount of people insisting on communicating but that was the least you could get away with. As an adult, if I need medical help, I have to work out a way to express myself that will be heard rather than as feels natural to me, which is a burden I could do without.

Expressing pain

Suppose you were undergoing a medical procedure and you were aware the medic was doing something that was causing you a serious problem. Suppose you’d tried to draw their attention to what it was but they weren’t listening because you didn’t express yourself in the way they expected? Sadly that’s not an uncommon experience for autistic people. The supposedly universal human communication of things going badly wrong is to scream – but for an autistic person their response may be to shut down, or to go hyper-reasonable, bland and logical. You can just imagine how a doctor might be a bit wrong-footed. If the patient said: “I’m really sorry but the anaesthetic doesn’t seem to be working and I can feel you putting the stiches in – would you mind using some more local anaesthetic?” the doctor would most likely imagine they weren’t really in pain. If you can speak calmly like that, you’re not really in distress, they would think. Sadly, that doesn’t work if you’re autistic.