session: april 2006 (0)

Doctor: Last week we discussed comfort in the presence of other people. We're trying to define what that would mean for you.

M: It's frustrating. That should be an easy thing to define, but it's one of the more difficult issues I struggle with. I feel so strange around people, my body does. I can enjoy a conversation, personalities, thoughts, but I always feel so physically detached.

I tug at my wrist.

M: My body just doesn't seem to fit very well. So I've been thinking about this but it's confusing.

Doctor: How do you feel in here?

M: It's pretty bad. I would have to say much worse than usual. Because...you're right there. You're just sitting there and looking at me for an hour, it's very awkward. Usually when I'm around someone I become hyper-aware of my body and every muscle feels like this foreign object. But in here, since we sit facing one another, the weirdness is intensified. I've mentioned before: that's why I bring my coffee mug each week. I need a way of inconspicuously hiding my hands, just giving them some place to be without it being obvious that that's what I'm doing. I use this throw-pillow as a make-shift armrest so that my elbows will have a place to be. I have to consciously arrange myself each week in the same way that someone arranges trinkets in a display case.

Doctor: What's it like with other people? Let's say someone you're used to being around like your roommate or a family member.

M: It's slightly more bearable in cases like that. It never goes away but with a handful of people, it's bearable. In general...I'm trying to think how to describe it.

I pause, chase words around.

M: The sensation is comparable to what most people experience when they are giving a speech. Because on any other day, a person does not have to put conscious effort into the placement of their hands. The gestures they use, or when their hands are by their side: these things happen without the person ever having to think about it. But if a person is standing in front of an audience, suddenly they are aware of their hands in a conscious way. They can actually feel them dangling there and they think, "Er, what should I do with them? Should I cross my arms? Stick them in my pocket?" Which is interesting. In those moments, people are experiencing their hands as objects...things. A posture they might normally hold in an unconscious way- hands by their side for example- now feels unnatural. So let's say that the person decides, in front of the audience, to just keep their hands by their side...they are actually acting out their normal posture. They are making a conscious calculation, "Here's what I normally do" and then placing their hands in that posture. Mimicking themselves. Re-enacting their own normalcy.

Doctor: And this is what you typically experience.

M: I have to do that with my entire body any time I am around any person. I can feel my facial expression, my shoulders, arms, hands, all of it, and I have to consciously think about where to put them all. My body is a marionette. And I'm good at it now. It's still awkward but I've done this long enough that I've developed what are essentially programs, coordinated groupings of movements. Sub-routines. Schtick.

Doctor: This sounds so unpleasant.

M: No fun. Miserous.

Doctor: Has it felt that way consistently? Has it ever been different?

M: The sense of my body as an object really only happened once I taught myself how to mimic body language. Prior to the marionette...it was very weird. I've never really talked about it before. I'm not sure how to talk about it.

Silence. I think and think.

M: Body Dimorphic disorder...is that what it's called? When a person has a pathologically distorted self-image?

(Anorexics have this...they look in a mirror and actually see huge amounts of fat even though they may be very thin. )

Doctor: Yes.

M: When I was a kid I don't think I had a self-image. I'm trying to think of ways to describe it. It's like some sort of dimorphic issue was at work only instead of having a distorted self image, I was unable to form one at all. When a person looked at me...my body felt like liquid. If they looked at my nose, it began to feel hot, distended, wrong. If they then looked at my hand, it started feeling weird and my nose would go back to feeling normal. My body image was extremely fluid...it would shift and change constantly; and it didn't always feel bad. Sometimes things felt fine...but it was this random, unpredictable thing. I had no control over it. I think the sensory confusion...the way everything impacted me so strongly...it preventing me from feeling at home in my own body. And early on, social-data...the way people move all over, create so many different types of input...it was one of the more confusing, uncomfortable sources of stimuli. Oy. Does this make any sense at all?

Doctor: Definitely.

M: I've never said some of this.

Doctor: It sounds like you had a very reactive self-image.

M: Reactive, that's a good word. That's exactly how it felt. It was terrible. Eventually- by the time I was in junior high- the feeling became so overwhelming that I began to vomit several times a day. I had trouble keeping food down; my weight dropped quite a bit...I think it was around 8th grade. The doctors couldn't figure it out. They thought maybe I was a tad "anxious"...needed to work on breathing exercises. I was always getting this completely inadequate response from people.

We sit for awhile, no one says anything. Which is okay, I could use the slower pace.

M: You have a new purse.

Doctor: I do.

M: It's pink! Doctor...it's pink. No, no.

More silence.

M: I've never been able to figure out what caused that. The Asperger's label is too new to me. I'm having trouble understanding it in relation to things that have happened. I was hyper-aware at an early age...did that cause it? Or did feeling so detached cause the hyper-awareness?

Doctor: What are some of your earlier memories?

M: I remember a lot of smells. I guess that's normal, there's a strong connection between memory and smell. I remember around two or three years old noticing that each crayon had it's own distinctive smell. Instead of coloring with them, I would spend hours just breathing them in. The red one smelled like rich soil, the blue one like a car's bumper...the smell of the green crayon always made me feel nauseous, I had to hide that one. I haven't thought about this in years, but I remember feeling intensely nostalgic as a kid. Textures and smells would be so intense that I knew I would remember them my entire life. I remember being around 7 or 8 and standing at the pencil sharpener, turning it, grinding my pencil, and that smell- pencil shavings, they have that peppery smell, and I realized that for the rest of my life this smell would remind me of this moment. I immediately became nostalgic for the moment that I was in. I almost cried because I knew I would be haunted by that moment. I thought: "I'm going to finish sharpening my pencil and then this intense smell will be over...I'll have the memory of this moment forever but the moment itself is about to end." The same thing happened with bricks. I loved the rough texture of bricks and one day I was in the lunch room just feeling this one brick thinking, "When I'm grown up I'll remember this lunch room but I'll never be able to recall the exact texture of this particular brick. I'll forget, because I won't be able to touch it." It's like with the pencil: that one brick made me nostalgic for the moment I was in. I was having a perception and an imagined memory of that perception all at once.

Doctor: I don't think we need to categorize everything, but that certainly sounds like AS. Most kids never think about the pencil shaving and bricks around them, but many people with Asperger's have a strong sensory intelligence.

M: Huh. I just tended to think I was off-kilter. I can't even imagine what my teachers must have thought, seeing me sniffing the pencil sharpener and caressing bricks. I'm lucky they didn't medicate the hell out of me.

Doctor: It's just a different kind of awareness.

M: You know, a few weeks ago your cell phone was on the desk and it was pink. This is a troubling pattern.

Doctor: If you want to change topics, that's perfectly okay.

I don't say anything.

Doctor: Pink is my favorite color.

M: You're supposed to be building trust with me.