I ran into Lionel (not his real name) the other day on Route 116 as I turned down Amherst Road to go Dave's Natural Gardens to pick up some potatoes, beets and eggs. I used to see him all the time, riding his bicycle, his guitar slung on his shoulder, but I hadn't seen him during the pandemic.
I stopped and rolled down the window. We both put on our masks. He had been my patient for years, but I accidentally called him by his brother, Patrick's name. He corrected me. He remembered mine. And my birthdate.
"You were born on December 21, 1954," he recalled. "That was a Tuesday." he continued.
"You still remember Lionel!" I said. "How have you been?" I asked.
"Fine," he said, his expression unchanged. "At first I thought this pandemic was bullshit, but then I realized it was for real."
He still had a job as a janitor in a warehouse. And he was playing his guitar. And also, some exciting news: "My caregivers took me on a trip to Cape Verde".
I thought about that for a moment, wondering if that took place before the pandemic, or if he had somehow been lucky enough to get to this small island nation before the world decided it was not safe to let anyone from the United States cross its borders.
I asked him about his brother, and his parents who had been so patient and loving with him and his brother, despite their autism, learning difficulties, anxieties and problems with emotional regulation. I remembered when Lionel was "fired" by his psychiatrist for making threatening remarks to her. I took over the prescription for his medications which included an atypical anti-psychotic medication.
As is true for most teens on the autism spectrum, psychotherapy offered by mental health clinicians was of little help for him. So I was not only the med prescriber for Lionel but the de facto therapist for him and his brother.
And though I did not have much of the formal training in psychotherapy that licensed clinical social workers or psychologists have, I had several advantages. As his pediatrician, I had known Lionel and his family all his life. And I have had lots of experience teaching him how mind and body worked together.
I had learned in my hypnosis training that young people on the autism spectrum, are not good subjects for clinical hypnosis. They don't have the social skills, I was told, the ability to form the kind of therapeutic relationship necessary for the hypnosis process to occur. They don't have the imaginative skills necessary to access the inner mind in a way to accomplish therapeutic goals - whether it be relief from headache pain, or escaping the stranglehold of panic, anxiety, or anger.
These were myths, I discovered. Not true. Certainly kids on the spectrum are "differently abled." They may not think nor act in the same ways as their "normal" peers. But "normal" kids often do not like to sit still as a clinician instructs them, according to a standard script, to "fix your eyes on the ceiling, now let them close, breathe deeply, feel your shoulders relax... go to your favorite place," etc.
Anyone working with kids, and adolescents must be quick on his/her/their feet. We must meet the patient where they are. If a patient, whether he is on the autism spectrum or not, does not want to close his eyes, that is ok. If he does not want any part of the hypnosis process, but is into computers, I can introduce him or her to a computerized biofeedback game like Heart Math. In this program, used widely by police departments, teachers, corporations, and clients alike, one learns to control heart rate variability - to sync the parasympathetic and sympathetic nervous systems, with the use of the breath. The individual follows her or his progress, as lights change colors, and the sound changes -- with the aide of a graph, or various fun games --- all based in the changes in ones heart rate and respiration.
Lionel enjoyed this game, but he enjoyed even more his ability to help his dumb doctor, a real technophobe, figure out the glitches in the program. He had had lots of teachers and counselors before but never had the experience of teaching THEM how to solve a problem.
In additions, we talked about music and his fascination with numbers, especially his so-called "savant" ability to figure out the day of the week on which any date fell in history, and what day that date will fall on next year! I encouraged him to be proud of this skill, even as he struggled in standard academic curricula, and social skills. And though he dis not play sports, like me he loved cycling around town; when I would see him, I reminded him about wearing a helmet, until, finally, my advice sunk him.
My conversations with Lionel were not the conversations I might have with a typical teen. But who, exactly, is typical these days? One thing I've discovered that even more than most teens, young people on the spectrum do not like a phony, and are very direct about their opinions, without the filters many of us have between feelings and verbal expression.
Another young man on the spectrum told me once, towards the end of a visit for his annual physical,
"You know, you're the worst doctor I ever met."
"Well you're one of my worst patients," I replied, barely hiding a smile.
Part of me was insulted, but part of me liked his frankness. I remained his doctor. He later allowed that perhaps I wasn't so bad, or "had gotten better." I helped advice him about college, where he worked hard and achieved a BS in engineering and landed a good job afterwards.
However, when I saw him for his last annual PE with me, at age 21, he allowed that he had not changed that much. He was still was a loner, a thinker, and not one who was comfortable with his body. In fact, he said after I examined him, "You know it's inconvenient to have a body. Why couldn't we just be made with heads..."
Lionel was different. He enjoyed having a body. And being with people. Though learning, and relationships and emotional regulation continued to be a struggle. I was able to help him by teaching him how to relax his mind and body taking deep breaths, in through his nose, out slowly through his mouth, as I had taught countless others.
But all the other stuff had to come first -- the time spent learning about him, his interests, honoring his strengths and his idiosyncrasies. Only then could I teach him how to recognize his feelings in his body, and to use one to help the other. He was able to decrease his medication dose, make some friendships, and develop his music skills -- though he still needed lots of support from some of the wonderful social service organizations we have in this area, and of course, his patient, loving parents.
"Do you still use the relaxation breathing I taught you?" I asked Lionel, as he glanced at his watch. His dad was coming soon to pick him up.
"Oh yeah, all the time," he smiled.
"Thank you."
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