8:38am August 4, 2014

Weird conversation with my psychiatrist about ‘cultural psychosis’, culture shock, and psychotic disorder NOS.

I just remembered, since talking about all the NOS diagnoses…

…he insisted that the reason he diagnosed psychotic disorder NOS, was culture shock.

He said that to me, the entire culture I was born into was foreign. And that every day of my life, I was experiencing the stresses of severe culture shock, while other people were expecting me to simply get by as if this actually was my normal culture. And that many people showed transient psychotic symptoms if culture shock was severe enough or went along long enough, and he was sure that’s what it was going to turn out to be for me.

It’s weird… he said a lot of things to me back then that made absolutely no sense at the time, but that now I can understand why he said them. I don’t necessarily agree with him about the culture shock. But I understand where he got it: I’m autistic, and that’s supposed to (especially with what was known about autism when I was diagnosed in the nineties) mean that my own culture is a foreign culture to me. And to some extent that may actually be true, although not in the sensationalistic ways you see portrayed in literature.

As in… yes, I’m actually part of my culture. Yes, my culture actually means a lot to me. (No, my culture is not the same culture my psychiatrist is from. He was descended from an upper-class Southern culture, I was descended from a poor and working-class Okie culture, quite different. And neither of those are the “mainstream” American cultures that I found myself confronting at school and the like.) And yet, I do think there are some things that autistic people don’t automatically absorb from our own cultures, although which things are different from person to person. And we can definitely feel alien even in our own cultures.

So I feel like he was maybe half right and half wrong. But the idea of autistic people being in constant culture shock… this is an idea I later heard in the autistic community, but for some random psychiatrist to start saying it in 1995 is pretty ahead of his time and impressive. As well as an interesting reason to diagnose someone with a psychosis. He called it “cultural psychosis” and said it happened to people with the most severe forms of culture shock, but that I would eventually be able to adjust to this foreign culture and get over it.

So even the psychosis diagnosis turned out to have a connection back to the autism diagnosis. And the funny thing is I’d forgotten about this at all, to this day. I think it’s because my psychiatrist said so many things. I mean he practically never shut up. To the point… his way of dealing with people who couldn’t or wouldn’t speak to him, was to talk, and talk, and talk, and come back every day and talk to them, over and over, not caring if they answered back. And eventually they’d start answering back. I always wondered if he realized that with the amount he talked, people probably started talking just to shut him up! So at any rate, he talked a lot, and he talked even more the less I was capable of talking that day. A lot of what he said was repetition. (I’ve got the Helen Keller At the Water Pump story memorized thanks to his misguided efforts to help me connect better with language by telling me stories about other people connecting with language for the first time.) But he also just said a whole lot of stuff.

And a lot of it went in one ear and out the other, but a lot of it must also be stored somewhere in my head. Because occasionally I’ll be walking along not thinking of anything in particular, or I’ll read something that reminds me, and I’ll think “Did my shrink tell me that?’ And then I remember the whole conversation. In this case, a book is likening autism to traveling to a foreign country, and suddenly the whole conversation came flooding back to me.

So yeah, my actual diagnosis was ‘cultural psychosis’ i.e. 'severe culture shock’ and that’s what 'psychotic disorder NOS’ was about. And all this time I’d just assumed it was the usual mistaking seizures + my behavior for psychotic behavior, which may have been in there too. But he thought all that stuff was stemming from culture shock of a really weird autistic variety.

I’m not sure what to think, honestly. I never like the idea that autistic people are entirely separate from our own cultures. But at the same time, I have never been able to shake the idea that, for instance, English is a foreign language to me, even though it’s the first language I was exposed to and I grew up speaking it. So I understand why even autistic people can feel like strangers in our own cultures. At the same time, stranger in my culture I might be, but my roots in my culture go deep and I can feel them, and they are meaningful to me. Even if I had trouble picking up a lot of the "obvious” elements of my culture and surrounding cultures growing up. So I don’t know. Maybe my shrink was at least half-accurate – he often was, even without intending to be accurate at al.