Saturday 8 May 2021

"Positive psychoeducation" and ableism in academia

There has been quite a lot of discussion in academia recently about using “positive psychoeducation” to address the mental health crisis in students. The most headline-grabbing example of this is a module, offered at the University of Bristol, entitled ‘The Science of Happiness. Here’s a video about it.

This clearly has a basis in solid psychological research and is delivered in a novel way which has demonstrably benefitted many of the students who have taken part. The science of happiness is also an intrinsically interesting topic that is relevant to a wide range of disciplines so, on the face of it, this would seem to be a welcome contribution. Surely, anything which improves student wellbeing has to be a good idea, right?

When this first came to my attention, alarm bells instantly rang. What would an autistic experience of this module be like? As I investigated further, I realised that my instincts were correct. This doesn’t just present autistic people with some challenges: it is actively ableist in a way which I am sure the authors do not intend. Let me explain.

The research which underpins the course is described in Hood, B, Jelbert, S., and Santos, L. R., ‘Benefits of a psychoeducational happiness course on university student mental well-being both before and during a COVID-19 lockdown’, Health Psychology Open January-June 2021: 1–12. This sets out both the evidence for benefits, which are significant, and the contents of the module itself. No mention is made of diversity in the paper and when it refers to a “university student”, it obviously means any university student. In other words, this is a ‘one-size-fits-all’ solution. We learn that:

“[…] in order to earn course credit, students had to participate in weekly ‘happiness hubs’ (maximum of 11 meetings total) which were led by a postgraduate student or senior psychology student mentor. During these ‘happiness hub’ meetings, students were encouraged to discuss the course content and to take part in a series of positive psychology interventions (PPIs). […] These interventions involved (1) performing acts of kindness (2) forming social connections (3) savouring an experience, (4) increased exercise, (5) trying to achieve several nights of at least 7 hours sleep, (6) meditation and (7) writing a gratitude letter. […]”.

I’m going to criticise this from an autistic perspective, but I think what I have to say also applies to other disabilities. As a person with Ménière’s, I can see several obstacles to achieving ‘happiness’ in this list. But let’s focus on autism.

Both “(1) performing acts of kindness” and “(2) forming social connections” immediately present a serious problem. The standard diagnostic criteria for autism refer to “deficits in social communication”. I dislike “deficit” language, so I would phrase that differently, but the point remains that social interaction is one of the most challenging areas for autistic people. I cannot imagine approaching a stranger to perform an act of “kindness” (what might that be?) or randomly strike up a conversation. That would take a lot of spoons and most likely be unsatisfactory or even dangerous.

“(3) Savouring an experience” and “(6) meditation” involve opening oneself up to sensory overload. In some circumstances, this may be possible or even desirable, but it would need very careful management. If done wrong, the damage could be considerable. Speaking personally, I find ‘mindfulness’ close to torture. I spend a lot of time and effort trying to avoid mindfulness!

“(5) Trying to achieve several nights of at least 7 hours sleep”. There has been a lot of research into the problems that autistic people have with sleep. The National Autistic Society has published some guidance about this. Obviously, it would be beneficial if everybody could get a good night’s sleep, but we should be realistic about what is possible. Making this a required component of an academic course is more likely to disrupt autistic sleep than encourage it.

“(4) increased exercise” seems relatively uncontroversial, inasmuch as increased exercise is likely to bring health benefits to any human being. Even so, this may not be straightforward. The point is that the many benefits of exercise for autistic people are not exactly the same as those for neurotypical people. This is another aspect of the module that would require careful monitoring, especially if it involves changing routines.

“(7) writing a gratitude letter”. Well, this may be beneficial to both writer and recipient, but I know that I would find it difficult to write such a letter unless I had a clear reason to be grateful. I would need to understand the social conventions of such a letter. My belief is that you write a gratitude letter when somebody sends you a gift. Beyond that, there seems to be no social convention for writing one, unless you feel a sudden surge of gratitude for some reason. This is unclear and could become quite a stumbling-block.

Overall then, it is the normalising conception of what the students are required to do that is ableist. The proposition is that an autistic person should do what they find most difficult, even impossible, in order to achieve happiness, just because neurotypical people find these things pleasant and easy. The requirement to achieve normalised happiness is likely to have severely negative repercussions. If autistic people are given an opt-out, then that is problematic too, because it will look like they are unable to achieve happiness at all.

What could be done instead? How about a module that is based on autistic joy? One that actively encourages specific interests. That allows for repetition and embraces stimming. That accepts social isolation and non-standard communication. That removes barriers such as the need to use body language. That develops sensory spaces that autistic people find pleasant. That addresses anxiety by observing and analysing its causes. That reduces demand and translates autistic neurology so that neurotypicals may understand. That accepts autism as a reality rather than problematising it.

Universities are full of autistic staff and students. It is high time that this group be  properly included when developing new approaches to wellbeing.

Wednesday 5 May 2021

Emerging from lockdown

A year in lockdown has affected everyone in ways which will only become fully apparent over time. There are the immediately obvious issues of mental and physical health, loneliness and grief, which are a sharp reality for many. But beyond those is a profound change in every aspect of human society and culture. Returning to ‘normal’ is not only undesirable, it is actually impossible.

From my autistic perspective, one of the biggest changes has to do with ‘masking’, that is: performing or presenting as neurotypical in order to fit into society. I learned to do this as a child and have been doing it ever since, to the point that it is impossible for me to remove ‘the mask’ because I do not understand where it begins and ends. Most of the time, I pass as assured and socially capable. People never see the mask, which is a sign of just how well I have learned to wear it.

Since being professionally identified in 2018, a few close friends/family have commented that I seem to be acting more autistic. This is a complicated thing to unpick, not least because I don’t feel my behaviour has changed much, if at all. It may be that their awareness of the diagnosis makes them see things in me that they did not notice before, or it may be that having acknowledged my autism I am now trying less hard to appear non-autistic, or it may actually be that I am indeed ‘acting more autistic’ or performing my autism in the same way that I used to perform neurotypicality. Probably it’s a combination of all three. 

But this is where the lockdown has had an effect. A year of interacting face to face with very few people is making me forget how to do it. I am losing confidence in my ability to behave appropriately. I have a strong suspicion that, when I do start returning to the neurotypical world, people will notice a difference, not because I am ‘acting more autistic’ but because I am not acting so non-autistic. Eye contact, for example, was something that I did with relative ease before lockdown. Now I am finding it harder to do again, in a way which harks back to childhood. Similarly, my ability to read facial expressions has been  compromised both by online interaction and by the wearing of physical masks. When I observe body language on TV or in the street, I am once again starting to struggle with deciphering what it means.

There have been occasions recently where I have been very aware of echoing back to people the way they are talking to me. It’s something I have always done. In the past, once I have felt confident enough with the person, I can move out of that mode and even redirect the interaction somewhat. But now I have forgotten that skill and will probably come across in ways that are not ideal, just because I am reflecting back the mannerisms of my interlocutor.

It’s not that lockdown is making me more autistic. Autism is a steady-state kind of thing. It’s just that masking requires constant practice and I have always had plenty of opportunities for that over the years. The university recently sent me a request to come to campus when lockdown ends, in order to show prospective students and their parents around our splendid new computer labs. I have to admit I find that prospect very daunting. I am getting anxious about my ability to cope in that kind of social situation. I think I need some less ‘mission-critical’ practice before I start re-engaging with the world in that way.

In ten days from now my second vaccination (which happened last Saturday) will have given me full protection. Covid is at a low level locally, so there is really nothing to stop me re-emerging into the world. But I am unsure about it. I think some limited forays will be a first step. Perhaps a visit to the office for an hour, maybe with a coffee thrown in, to get familiar again with that environment. Some low-anxiety social interactions with trusted colleagues too. 

During lockdown I have barely been out of the house. I have only visited the chemist once a month to collect my prescription and, on fewer than five occasions, I have gone to the Co-op to buy one or two items. I have always had a shopping list and have entered and exited as quickly as possible. Although the pubs have reopened, at least outside, I have avoided going back there, even though I do enjoy a pint. I have even become reluctant to consider moving house, something that actually would be a good thing because the present place is inadequate in many respects. I think I want to protect myself from the world. I know this has to change, but the anxieties of doing so are considerable.