Let me say good evening. Welcome to Bearpond Books. Can everybody hear me OK? I'd like to invite you. If you're in the back and you'd like to sit in the front, please feel free to do so. I'm very excited to present Kathleen Carr, author of Miraculum Monstrum, a unique narrative tale that blends poetry, prose, what I kind of think is science fictiony and fantasy, and original artwork. I for one am in awe of this work the layers of fable upon fable and how the tale unfolds through poetry and cataloged fictional documents. It just astounds me. And I love the idea of the museum of ladder hybrids and the post-climate disaster collection. Just that idea alone, I was so enthralled with that kind of idea. It's so creative and unique. This book is truly a brilliant contribution to contemporary dystopic literature, to quote the author, Jan Kahn, who has a blurb on the back. If you haven't read Miraculum Monstrum yet, I urge you to pick up your copy tonight. We have them at the front desk. And then you can have it signed by Kathleen tonight. She joins us from North Adams, Massachusetts. Tonight's talk and reading will be about an hour, including time for Q&A. And I'd like to remind you to please mute or turn off your cell phones. And to let you know I was mentioning the front door is now locked. So if you need to leave during the reading, please use the back door, which is that way. The front door will open again after the reading. If you need a bathroom, it's located at the back of this door to the right of the back door. And please help yourself to refreshments. We have cookies and juice and seltzer. I'd like to thank the Vermont Arts Council for featuring tonight's event as a Vermont Arts 2018 program. And you can help yourself to a Vermont Arts Council sticker there at the refreshment table. I'd also like to thank Orca Media. They're here filming the event tonight. And if you'd like to see this video or learn about other events, I'm going to pass around our newsletter signage. We'll have the video in the next newsletter. Let me tell you about a few events coming up for National Poetry Month in April. We have a terrific lineup. We have our annual open poetry reading, which is next week, Tuesday at 7 PM. You can sign up at the door and read your original work for about three to five minutes. We also have Allison Prine, who was a Vermont Book Award finalist last year with her book, Steel. She'll be reading with Bianca Stone, who's the author of this newly published, The Mobius Strip Club of Grief. They'll both be here on Tuesday, April 17. And you can find all of that information in the poem city program. You can pick one up at the counter or find them around town. We're also featuring an author. She's a poet, but this is her first collection of short stories. Eleanor Giorgio, and this is the Immigrant's Refrigerator. She'll be here April 24. And she'll be reading from her book and speaking with a member of the Vermont Refugee Resettlement Program. And sales from the book go as donations to the Vermont Refugee Resettlement Program. So that'll be a really fascinating talk. So for now, let's welcome the winner of the 2015 Clarissa Dalloway Book Prize from Aroho Foundation and the Best Book Award finalist in the fiction cross-genre category. She's a writer and visual artist. Please help me welcome Kathleen Carr. Thank you, Samantha. So happy to be here and feel so very welcome to buy this bookstore and everybody here. Thank you for coming out. Can everybody hear me OK? Because there is a mic. And sometimes people can't hear me, so let me know. So I think Sam did a pretty good job of describing what the book is essentially what's happening. So I might just start reading and interject some comments as I'm reading. And if you have any questions after, I'd be happy to answer them. There is a curator character, and she comes in. I'll just tell you when that's happening. And there's also notes throughout and visual art. So sometimes I wish I'd figured out a way to show the images while I'm reading, but it's kind of, you know, I'd have to project them. And it might be distracting, but anyway. But that's how it's laid out. I wanted it to feel like an exhibit catalog. My husband and I are visual artists. We look at, we read exhibit catalogs all the time, and they're really getting better and better. And I feel like that's a form to be explored for sure. I'm a Goddard alum. And somebody that I worked with there wrote the introduction, Jill Maggie. And she offers, I have to say this, she writes, Joy exclaims the flying Tristia Vogel of Kathleen Karr's Miraculum Monstrum, who is an artist living at the beginning of a world without oxygen and who grows wings. And the confusion of who and the grammar I chose is indicative of the book's fiction biography, autobiography. The joy of flight in the actions of the protagonist and in this book soaring genre abandon is possible despite an overwhelmingly inhospitable context. I almost wrote In Hospital Context, which is one of this book's truths. Institutions rarely serve the ones who are meant to fly. Yet it is inevitable that some should spread wings. If it chooses you, I think the book argues you are called on to be susceptible. So be susceptible. Miraculum, a wonderful thing, prodigy, a miracle, monstrum, a significant supernatural event, a wonder, portent, alternatively a monster. Words are artifacts, relics, symbols. In Spring, a rabbit opened by a crow. Dark-edged fear writes the rabbit death. It happens in the spring. Lilac-centered air in the park turns pages of her book as she eats her lunch, little wings and bright sun. An April afternoon lies on the grass, not hearing the murder of crow's shrill gate. The leaves knife sharp against the sable trunks, high-pressure finite lines written across a landscape. She hears a bird's serenade, tiny hammers on bells. Airborne notes punctuating vestiges of clouds, now thinned to gray scraps, her back itches. Curator, this all happened before I was born. I imagine her, she might have been before her transformation, before the annals of Miraculum, the monstrum, the lost years when she was presumably living as any human woman would. There was breathable air then. This was before the atmospheric catastrophe, before the birds died, before the winds and earthquakes, when there was waste and leisure, whole days of temperate radiation. In retrospect, her mutation was prophesied. As many things are reckoned in hindsight, her temples hewn and texts produced. Contrary to natural law, she was born out of herself in the April month, already fused to a mythology that had yet to be created. Anomaly, the persistence of peripheral vision. I imagine her in time in the weave of every moment, regardless of fact or record. On April 25th, she wakes up with a single hair thick as a bristle growing out of her left scapula. With a hand mirror, she examines over her shoulder. The sinister, portentious vine looks like a wire. She can't pull it out. It seems to be fused to the bone under the skin it erupts from. Is a dream the real world? This hair, a blackened bone being born. Beneath her skin, she feels herself leaning toward flight patterns of bird cloud, lifting off a tree to the east of where she sits. She isn't aware of implications, a small irritation on the west side of her back, a black hair. Walking home from the park, her senses heighten, she feels like running. Breathing hard, though walking, walking at a tilt vertiginous sidewalks in motion. The sensation on her back, several more wiry black hairs and bony protrusions on shoulder blade makes an appointment to see her doctor. Sarcoma could be ewing sarcoma, blood sample, white paper, pale cheek to vinyl stretcher, nude from waist up on your stomach, please. Abnormalities and chromosomes. Ewing is notably found in the bone shaft, rare. Inside her chest, the ribs rest over her peritoneal sack, housing heart, lungs. Once she saw a bird heart still beating in a ribbon carcass. The bird had been struck, turned in ragged cartwheels, glanced off a car. The body curled like a continuous apple peel. She walked from her porch where she had been sitting to look at the moist shards of gelatinous red, wanted to put her finger in the chest to touch the velvety blood charged with ebbing life, thrashing pulse, flailing wing. She can't be dying on your stomach, please. Is there pain? Vivis sectio, alive cutting, migration and song phenomena to be dissected. X-ray shows there is a consistency with, perhaps fibrous dysplasia. Origins are mysterious, monostatic in one bone, left scapula, spinal bone cysts, semen related, inconsistent with fibrous dysplasia. The X-ray shows pitting in the bone. Two are like growths consistent with dysplasia. Magillary bone becomes fibrous tissue. There are growths, non-consistent. Benign, let's hope. The X-ray, the beating heart caged, this part looks like a feather shaft. We're not sure what this means. Your temperature is running below normal. Is that part of dysplasia? No, unrelated. Do you feel cold? No. On this night, she dreams a dead pond, frogs belly up but the storks aren't feeding. It rains an oily spatter. Starling wings speckled the black, runs down her glass porch door. She looks closer, bird after bird, pounding soft bodies into the glass. Stunned, they recover vertical poise and launch into the door again. Again, the pile grows. She thinks she will vomit. Her mouth opens, she almost breaks from the dream here. Feels, sees a bird beak writhing in her throat, rising from her throat hole, pushing along the esophageal passage, trying to be born, trying to escape, trying to herald. It is shrieking then begins to wail and infant in the dream her bile rises, propels the bird out, leaving her flaccid. The bones of her crushed. She wakes, vomitting, shoulder throbbing, sarcoma. The moonlight's translucent snakes in her vomit, like tapeworms, maybe string or hair. She takes the bus to the emergency room. It is 2 a.m. Medical form, I can't read this. Control number, district, am I dying worker, phone? You are upset. Please calm, number, date, client ID. This information provided temperature dropping. On this form may be used to determine eligibility, pressure on chest for federal, and we want you to speak to state programs using dead birds, social security, disability criteria one. Patient information, how long have you been? I am not address, phone, date of birth, physicians. There is a research lab name, address, phone, specialty, dates of exam. First visit, last, will not live in a cage. Visit, presenting symptoms, height, weight, blood pressure, muscle strength, one, five to five, five, two. Diagnosis, you must attach, HIV infection. Diagnostic, made comfortable. Test, performed, attached. They look like feathers. Can you explain results? Psychiatric evaluations, psychological evaluations. Treatment and response, tests and conclusive. Please include past treatments. We need more tests and response. Be advised. This is blurry. Please sign here. We want to help. Herendo rustica.  Turns milk to blood, flying under the herd. Flying over your house, your death, he portends. If he lands on your shoulder, your life will end. This is a reading from the letter from Tara from Miraculum Monsimum, verse 8, chapter 8, verse 21. As Tristia and the broken women walked the path to the walled city, the Christians followed and one of them shouted behind, these women are the slaves of contrivances. See the monster they follow. And the demon seed still swimming in its eyes. Tristia told her apostate, Tara, this annoying harassment should stop. And so they turned to the faithful and spat oil onto their skin. They ran away in fear but continued to throw rocks from a distance. When they reached the city, Tristia spoke through Tara. The wall they've constructed won't keep the water out. So find higher ground. The water will wash the cities away. In the caves we will breed new life. This is the word. This is fragmentary because there's, the scripture is from the text of Miraculum Monsimum, which is, it's a religious text based around the prophecy that this bird woman is going to come. Just so you know. They superimpose the stature of a god over her.  But the miraculous feathers leak out. People come to see. Tests mutate to experiment. Papers are published. The published papers metastasize a kind of greed. A tracking device under left wing. Disruptive, they move her to a locked room with one small window to make her comfortable. A whole intolerable bird. She was stainless in herself, wished everything away like space. She could grow a far of purity, fly out again, young and included to somewhere. In pericula rectus, she will fly. Leather straps against her arms, uncoiled feathers sprung from the bone meat. This feather of undaunted blood-water arches she sees in the dark, the morphine drip. The songbirds whose songs are stolen for research. Migratory birds who are funneled and disoriented. Disoriented. Where is their gyroscope? Arthur Cleveland. RNA. Employed a county general for six years. Employment terminated on X. Incident involving a patient X. Released without discharge. Patient terminally ill. On morphine drip. Hospice. Ascination. Patient released from locked ward by Mr. Cleveland on X. He informed staff that patient was uncomfortable and unnecessarily restrained and incedated. Patient in advanced stage of bone disease. Unknown origin. Cleveland claimed patient was a mystic. Induced his cooperation. Termination enacted. Psychiatric evaluation recommended. Up on the roof. Up on the hospital roof. Shaking the morphine off. Tristius arms. Our lead sticks. Covered with bones first. Dying, she thinks. Last she knew. There is one arm mostly gone. Weight loss. She feels fine. Hungry. My body in revolt, she thinks. These look like wings, not tumors. Bone disease. She runs the roof. Like an infant tied to a kite. Hands intact. Wearing a ragged snap down. She rears her wings and dives. Like painting the next stroke. There. Like a net. A brace. Every feather. Moves. She is tired. Lands too quick. Bloody knees. Laughs. Where do I go now? She knows where it lies by air. I'm just going to read a little about what she looks like. She's meeting somebody who's going to help her and flies into her house.  The beauty of her ivory under feather cloaked with black, slick like tar. Tara tries to hit the bird thing. Throws a plate, her boot. Pulls a lamp from the socket and smashes. Points the jagged end at the howling figure. Crouching. Makes her weep. Tara sits on the floor, cradling glass. Closes her eyes. The adrenaline disrupting the high.  Listens while it speaks. That's fixed. Can't move. Curator. I'm often asked how long it took for the wing growth transition to reach completion. How long did she lie drugged in the hospital? This would seem to be a simple matter of record, except many of the records were destroyed. We don't know why. We do know her cottage was emptied out and her things forwarded to her aunt, Percy, Vogel. Her relative was then informed that Trissie had volunteered for a long-term research project, which her aunt disbelieved. Later she was told Trissie had fallen from the roof of the hospital. From a complete inquiry into all existing records, my estimation is that it took six months for her wings to grow in and become usable. As soon as she realized she had wings, she escaped. Though they attempted to find her through a previously implanted tracking device, this was apparently destroyed or surgically removed. Trissie in nervous motion had jerks to trailing edge of wing after attempts at recapture. Gaunt covered with fine definitive down. Contour feathers lay flat and gray on her chest and belly. The fur swells on her breasts, nipples darkened flinty, her calves in atrophy. She hunkers into a squat. The plumula on her back blanket the network of stars where each primary feather tore through her skin. There is bat-like bone, fingers growing alula into the wing bend. Sharp and will-dee after-shaft, semi-plumes. Skin ribbon with feather picks. The glowing red pill sends out real-time signal to data-logging medics. The mechanized body, a trader of flesh, machine propagandizes animal. She flies to the roof, dives to the top of the tree, glides then back down, swimming. Wants to carry Tara on her back just to the top of the garage. No way, Tara laughs. She watches there. One more plunge, leap, shiver, howl, this joy. Fluff pants as she winds down. Later she'll need meds. Tristia's pain, white needles, stitch in her bones, singe fire, rip and bind. The violent flesh-tip heals and quill. Nail heads back in, barb-wise, welter sores. She dreams in a restless opiate fume, women who will come for talons. She dreams also of a half-faced man. Where word reaches, masses come to witness the bird woman, first the bridge, revival-like, then meetings-revolve, graffiti-house squatters, vacant lots, dirt-sellers, writhing the abscess-armed desperata, internet code forwards the flock. The nascent legendary attracts another kind of fire. The raptus began writing of a bird woman messiah in a natural-text, miraculous monster during the latter years of the 20th century. There is great rejoicing at the news of Tristia. They send Dr. Kure to bring her home. So I'm going to stop there and encourage you to heed on. But there's one quote from Anne Waldman, which I really love, from manatee humanity, as things really heat up in the environmental crisis.    Thank you. Happy to answer questions about this. Yeah, well, there were a couple of things really. I'm as a writer interested in hybridity and I work in a lot of different forms and I'm also a visual artist. So I thought I wanted to make a work that sort of included all of that and also my mother was dying of early onset Alzheimer's at the time and so that her transitions were sort of inspiring to me as well and sort of the kind of research that I was doing for her condition sort of ran alongside the research I did with different bone diseases and what it might actually look like if somebody were to grow wings because they wouldn't just appear something would happen it would be it would be crazy and shocking and scary so I wanted to build that out. So looking at this work I'm interested in any parts of the book already existed as like these different little projects like did you have a bunch of illustrations that you wanted that you knew were going to go somewhere or did you start with like letters themselves I'm interested in the process Yeah, that's a good question I was working on them sort of alongside and some of them I didn't really know where the things were going to go at all I was just making a lot of bird related work which if you go to my website it's pretty much all abstraction so it was so like the swallow I probably painted that first and then wrote the it's kind of rustic but it's some of the work was already done and just lying around so so it kind of evolved they grew together I'd say but then of course the idea of putting something in a catalog for an exhibit was very appealing like that the way when you're looking at a catalog there's other people's work and then there's the artist's work or there's things that they were never that were never meant to see you know they're on the like here's some junk from the Saw & Saw studio you know what I mean so I wanted it to be a real container for that Did you do an outline of the book first or did it just kind of flow together No, I've never written an outline in my life and if I did probably wouldn't people do that and I can see the value of it but I kind of sort of knew what was going to happen I just didn't know how A to B was going to go but definitely grew around the story that was evolving you know it's sort of writing is a lot like painting that you write something and then you think about it and respond to it you know it's kind of a I wish I could just sit down and work off an outline or probably make things a lot easier you know in some ways of course as a writer artist you can always change your thing so it's really just a game like okay I have this outline does that answer your question Yeah Do you write in the morning do you write in the morning do you write in the morning I worked on it for a year and a half and pretty steadily let's say I worked on it every day I mean as an artist I work on something every day I've really been doing more visual art lately because I just had a show but then you know I always feel like whatever I'm not doing in a very concentrated way becomes the escape from the work you know so I feel like I always have some like I'm going to go procrastinate and go make some prints now you know but I'm still working so it's a I feel like that's it took a while and the ending was we were just talking about this the other day my mother had died and I had sold our houses and the people who bought them allowed us to stay while we were cleaning out it was her house, my house and this barn that had like a hundred years of stuff in it and so while we were staying there in this plasticed off room they were ripping the house to shreds that I lovingly rebuilt myself you know and so at the end of the day after we'd like to drag things to the dumpster it was horrifying snowed every day so we're dragging things my mother's house was up on this hill and there's a picture of it in here actually in the very beginning as Tristia's cottage and Sears house and so yeah Sears Roebuck house on this hill and there was all this snow and it was just so at the end of the day it would be totally exhausted and emotionally drained and it was like throwing away all my stuff from my entire life and in these dumpsters they were covered with snow and I'd sit down to write so I was probably in a sort of a morbid state of mind because your editing process looked like your editing process looked like oh um I'm fairly rigorous but I allow myself to just write whatever at first and then and then I'll go back at it later as sort of another person so otherwise I could never write anything I'd just be like oh that word no oh my god I can't imagine having to do that kind of thing all at once the editing and the creative process probably nobody I'm talking about there's this dreadful editor who's like you have to shut it off you have extra visuals and stuff that you created during the work on this that you are now sort of you have to sort of figure out what is this and what will it go with later or do you show other work in a different context I well I have tons of stuff in fact sort of hilarious that I have most of the pieces in here still but I mean I've sold a lot of work subsequently but never really you know so I kind of like to have a show sometime in conjunction with the book that would be fun yeah so there's always things that I mean I'm making things and I think well could this be part of another book or you know I'm because I'm I'm writing things but I haven't really I haven't even figured out if there will be visuals or how they will be but I feel like that's sort of something that comes together in a kind of a magical way that I don't need to know right now but it will sort of it will occur you know if it's supposed to but I didn't want the the art in here to feel illustrative yeah although sometimes it might be slightly illustrative of what's going on in that section yeah the theme of transformation is you know widely through literature do you think you know the other texts like I'm thinking of the is there any introductionality is there any introductionality were you thinking of how your book fits within the realm of the theme oh yes I mean there's certainly a lot of literature to consider that sort of makes use of that sort of hybridity right is that what you so and my idols do it really well like Benooka Pill and Anne Waldman is a great hybrid writer I mean there's a lot Jill Maggy for that matter who wrote the introduction and you know there's a lot of there's a lot more artists that are writing and using that form which is really nice but at the same time I didn't I haven't really seen too many fictional art catalogs like monographs so I was kind of like is anybody else doing that maybe not and so maybe that will you know Kumiko Han she's sort of a writer who's very conscious of inventing forms you know sort of based on Japanese ancient Japanese forms and and she bought my book at AWP I'm so excited and she's like can you sign this for me it's like the weirdest thing oh my god no you sign my hand or something you know and so there's you know being aware of it is hard you know when you're writing something so be aware of other work that's come before and want to be separate from that and yet you're you can't help sort of being influenced by everything that you consume you know so but of course you can't worry about that you just have to do your thing you know and that's the rest of us to do because it's like the human nature of wanting to define those connections and patterns yeah and it is the nature of the bookstore to want to define what you've written so it's sort of like you do need to have a shelf at the end of the day like where are you gonna you know like we were just talking about this that was I went to a bookstore and it was under assays and I was like well you know that's not really right but I hope it could be under science fiction or fantasy or poems or you know maybe just by itself or in a sort of a glass case with a light on it it would be okay too but yeah you know that's one of the pratfalls of hybrid literature and if anybody's anybody writing sort of looking at hybridity and yeah it's kind of like you know it makes it it's a hard sell you know the publisher I worked with they've been really really great and they've been so supportive but Kate Gale said maybe you want to write a novel and I thought yeah that would be really great I'd like to write a romance novel like a set of them so that I could then write my weird thing over here but you know if that's actually possible you know you do have to like your wax as what you feel will find its own form so so you kind of stuck with yourself at the end of the day although romance novels like detective novels I think about it sometimes I think could I, should I, would I I think about the same thing the crime novels sometimes I like crime, I could do that but I'm not sure I could really do it play it straight the hybrid form is really growing do you know Lydia Yutnovich the author she's an amazing author so she just had a little thread on her Facebook page the other day about tell me if I'm making a big giant list in a group she's compiling like a resource for her students of hybrid publishers and hybrid books and I was like oh I know some I mentioned Kathleen even like and Red Hat I think is doing a great job of publishing a lot of hybrid there's a book of lyrical essays Chelsea even I met her they're different they are, they're different and I think publishers are more apt to jump on that now it's kind of like a growing thing so you know you write what you write and you hope the book store is going to shelf it somewhere we'll find it yeah yeah this is the kind of store where we would put it I do the science fiction book club so when I sent out the newsletter I said hey this is getting read how could you not put that under science fiction but I also do poetry you know to be in both places I'm happy to see it growing because I wrote this almost you know it's getting on ten years ago now you know took a while to write it and then took four years to submit it to places and all that time every time I got rejected I thought should I take the images out or should I change this or nah I'm just going to keep sending it out and you know I I was sending it to both contests and also just calls and you know writing queries but I got this letter from a room of her own that said have you given up on your manuscript I said yeah actually I have one of those because it was so it felt like a long time and then it was two more years before it came out so I mean it's you know you have to be persistent especially if and you have to believe in your thing I mean it's so easy to go some writing teacher had told me she had sent out stories thirty times and I was like oh wow I thought four was a lot okay you know so persistence you know also red hand press respected the way you constructed it they kept my original manuscript the way it was laid out they really didn't change hardly anything they changed the font a little bit to make this feel like they did something do you also teach? teach? yeah I do I'd like to teach writing more but I actually have my graduate degrees in visual art so I end up teaching that more but I'm trying I keep like I'll run the class and it's really weird no one will sign up and that's been happening come to VCFA I'd love to get an actual job that would be great because you know you just have to do whatever to pay the rent so teaching would be great but and greenhouses and teach at our crazy school that we're teaching at crazy well I know a couple of students up there that would benefit from your wisdom and this specific style that you've written in oh thank you yeah well just tell your tell the faculty that I'll be right over I'll be right over it is yeah I looked at that school actually but we ended up going to powdered so so any any other anybody? well thank you so much it's been


Good day and welcome back to the Forty Auty podcast with your host Mr. Thomas Henley as usual. Today I have a very, very special episode as always. I'm talking to Dr. Megan Neff all about autism and PTSD. For those of you who don't know Megan and her work, Megan is a clinical psychologist who produces a lot of work over on Instagram. One thing that I'd really love to highlight about Megan's work is the amazing Venn diagram, graphs that she does, she gets like different diagnoses, different neurodivergencies and sort of compares and contrasts the overlap. So today, as I said, we're going to talk about PTSD, but before we do that, Megan, would you like to tell us a little bit more about what you do? Yeah. Yeah. So I, you summarized it really well. I'm a clinical psychologist in private practice in the States in Oregon. And I specialize working with neurodivergent adults to mostly late in life identified and diagnosed adults. I also do neurodivergent and firming assessments. And then, so I do that about half time and then half time I do really content creation where I think visually. So I love making infographics and turning these really complex ideas into visual pixels. So, and that is kind of my special interest. It's what recharges me. So I feel really lucky that I get to do that pretty much half time. Get the both, the, the dough for best ones. Yeah, yes, yes. Exactly. I was just going to say I'm autistic ADHD myself. Forgot to mention that. And as an ADHDR, I've noticed I have to have a lot of different projects I do in a given week to keep my brain engaged. So that's part of why my work is structured with kind of assessments, clients, content creating, structured with variety. Yes, the autistic ADHD wave. I'm actually thinking I've actually been forwarded for an assessment for ADHD or ADD, something like that, because executive functioning for me is such a massive part. And I've always quite struggled quite a lot with my focus. But it's only like, for certain certain things, like I found I could focus really, really easily on certain things that I enjoyed, but as soon as I stopped enjoying them, the focus went away. And I kind of talked to my mom about it, because she she's a special needs teacher, and she's she's gone quite high up in and stuff. And she works with a lot of ADHD and autistic children. And I think my reservations about going for a diagnosis was mostly because of my presentation, because I'm quite slow with how I think and feel. So I'm kind of on the fence about whether I am or not. You know, it presents really differently. So it's interesting, because I typically think it's easier for people to embrace their ADHD than their autism. But I'm finding, like, for me, it was opposite with autism. It was like, Oh, yes, this this fist, this makes sense. The ADHD I saw after the autism. And it was harder to see because I live in hyperfixation, like my highest, you know, those wheels of traits for autism, my highest trait is hyperfixation. I love my special interests. And I can I go into what my spouse and I call the vortex, and I can go there for hours. So but exactly what you're saying outside of interest outside of special interest, my focus is really pretty poor. But I just don't spend much time there. That it was harder for me to see the ADHD initially. And I noticed it presents really differently in autistic people, especially I kind of think of like autistic dominant people with ADHD or ADHD dominant people. Yeah. And some people it's really it's very mixed, there's not a dominant, but I often find it seems like there's a dominant neuro type with the other mixed in. So it's really complex. Yeah, I think one of the things that really drew me to your work that you because you focus on neurodivergencies, you talk a lot about like, you know, your bed diagrams do a lot of for showing like the overlap between the two. And going through them, I think the thing that that got me to get in contact with you is because I saw one about like autism and ADHD. And I was like, hmm, this is actually really, really, really helpful. Because there are there are some crossovers between the two when, you know, as we as we chatted before, we were talking about misdiagnosis and sort of the effects that that can have on someone's like identity as well as the functioning and treatment and medication. And I know it's a little bit off topic, but it's, you know, I think it's something that's really playing on my mind at the moment. And I wanted to talk a little bit about it. But I suppose going into sort of the main topic that we're here to talk about PTSD, post-traumatic stress and stress disorder, right? Yeah, yeah, I'm speaking sure. I know we're gonna, we're gonna touch a little bit on complex PTSD, as well as the overlap between autism and PTSD, what someone might want to do in terms of finding treatment, as well as what mental health providers should know about sort of the overlap between the two. So the first question that I want to ask is, what is PTSD? Such a big question. I think, okay, so I'm gonna do the linear thing, but I'm also gonna, before I do the linear, like this is the criteria, I kind of want to give us a conceptual map of what it is. So first of all, I think sometimes people don't realize, and I think this is a really important part of the conversation, is that not everyone who experiences a trauma goes on to develop PTSD. In fact, most people don't. It is the minority that experiences a trauma and moves on to it, then develop PTSD. So this is a simplification, but a simplified conceptualization of what is happening with PTSD. So the way the trauma gets encoded in the mind and the body, it is often not in a cohesive whole. It is like pieces, fragments. So particularly when a person doesn't have a cohesive narrative of the trauma. The body is encoding that in fragments. And so what can happen is the body is particularly the amygdala, which is like the fear center of the brain, I think of it as the safety alarm.    Understandably, the amygdala can be, oh, I was going to swear, but it can be a little beast. We'll say beast. The amygdala is not always fun to live with. So the amygdala, the fear center, doesn't know it's no longer in danger. It doesn't know it's no longer in the trauma. So with PTSD, the body is kind of re-remembering. It's still working to metabolize the trauma to create a cohesive whole. And so memories, associations, intrusive memories can flare up that memory of the trauma. And so this is why the person's body is so hyper-vigilant, because it's constantly on alert. So that's a simplification, but I feel like that's a helpful broad frame of what's happening to the body in PTSD. I really like the analogy of the fragmenting of the event, because we talked a little bit about it before we started recording, but there's particular trauma that I've had recently, which it's really been set off by the most random things at the most random times. Absolutely. And it is always sort of in somehow connected to the event, but it's like I'm responding to the whole event rather than that particular part of it. Exactly, exactly. But your body doesn't know it's not responding to the whole thing. So it feels like you're responding to the whole thing. So something as simple as hearing a certain voice that sounds like a person that was associated with the trauma can like the body's back in it. And that's why life becomes so intolerable, because all of these little things, it's like bombarding the body with taking it back to the trauma. And that's why life is incredibly difficult with PTSD. Well, thank you very much. Yeah, would it be helpful? Oh, we're doing the autistic thing, where like, do I talk to Utah? Oh, I might not realize that you're so accused of trying to speak or not. Would it be helpful for me to go through the DSM? Well, ICD, DSM criteria, like the linear, this is what, okay. That would be great. And I actually think this is a helpful reference point. I don't have it up yet, but I'm working. So I'm doing a series called the DSM 5 in pictures. And I actually have one for PTSD. I haven't put it up yet, but maybe we could add that to the show notes, because I just think this is helpful in visuals. Yeah, yeah, definitely. So, and the DSM 5, that's America, but like the ICD 10, which is used more globally, there's a lot of overlap. Like they're pretty much typically the same criteria. So, and for any of these conditions, there's like criteria A, B, C, D, and typically all of them have to be met for diagnosis. So for PTSD, there's, I'm going to walk through kind of the five core like buckets of criteria. So criteria A, there has to be some sort of traumatic event. For a long time, it was thought this had to be like a near death experience or a fear of death. They've added, you know, in the last like 20, 30 years, not sure actually when it was added, but they've added sexual assault and victimization. Here's what's really interesting about criteria A, which we can talk more about when we talk about what I wish medical providers knew. Autistic people sometimes don't meet criteria A, but still PTSD, meaning a less traumatic experience happens, but they still develop PTSD. So typically kind of the classic traumas are violence, hearing about a violent death of a loved one, or some sort of assault are kind of the classic. But for autistic people, we can have less traumas and still, and I don't like the language of less traumas, but yeah, yeah, this is diagnostically, yeah, exactly categorizing. Exactly. Yeah, yeah. So that that's criteria A, criteria B, intrusion symptoms. So these are things like flashbacks, nightmares. This is the memory of the trauma coming back to the person, again, those fragments coming back and creating a pretty intense response for the person. It could be intrusive memories, or just intense reactions to things that remind the person of the trauma. And then avoidance. So an intrusion and avoidance, those are really key pieces of PTSD. Avoidance is actively avoiding thoughts about the trauma or emotions related to it. This is harder to gauge because it's a really internal experience or external things. So for example, if someone has something traumatic happen in a grocery store, maybe then they avoid all grocery stores. But their world is getting smaller and smaller as they're avoiding those triggers that take their body back to the trauma. So that's a key part of it. Any questions so far as I've gone through? No, it's just a few thoughts as well because I completely get what you mean about the autistic people being a lot more sensitive to the development of it because a lot of my mental health difficulties have come from negative experiences in teenage and childhood adolescence. And on paper, they're not particularly that bad. There was a lot of different factors and different things involved, and there was a lot of anxiety and paranoia from me just because of the school environment, the sensory stuff. Although, I feel sometimes quite silly if I'm sort of conversing to a loved one what I'm struggling with, the memories and stuff because it's not on paper the worst thing that anyone's ever heard. It's like emotional bullying for example, for a long period of time, just intermittent. And then I hear about individuals who have had a really rough time. One of my friends, particularly that I won't name, they've gone through a lot of stuff, a lot of different really intense traumatic events and they've had some PTSD related to one particular part of that, but the other stuff like they never had any issue with. I suppose it's quite confusing because I always have this picture of PTSD of being this military related thing that happens when people are after war, and something that perhaps is a bit more definite. It's like, this is what caused my PTSD or like. Right. Yeah. And this we're kind of jumping ahead to complex trauma, but part of what you're describing is diffuse trauma. And by diffuse, you know, if I think about steam, like when you're boiling something, like you can't point to something concrete with classic PTSD, there's typically like one concrete event you can point to. So diffuse trauma can in some ways be more disorienting because there's not that concrete thing to point to. It's like, well, why am I having such an intense reaction? But it's like a lifetime of sensory trauma or a lifetime of emotional bullying is incredibly traumatic. But it's so diffuse that it can be hard. Like, how do I process that? How do I point to that? I think we internalize a lot more weakness. So like, I must be weak that I'm not coping with this, especially if we're then comparing ourselves to like, oh my goodness, that person went through something really traumatic and they're okay. Yeah. Yeah. Yeah. But there's I think a lot of reasons, which we'll get into later, I think about why we're more vulnerable to develop PTSD, both because of our experiences, but also just our neurology makes us more vulnerable. Sure. Sure. Well, you mentioned a little bit about complex PTSD. Is that something that you could maybe break down a little bit for us? Yes.  I know exactly what you mean. So so D and E are the last two criteria I'll cover. And I actually think D is really important. It's alterations to cognition. That could just mean that you don't have the full memory of the trauma, which is common, you know, kind of that amnesia around the event. But it can also mean like exaggerated negative beliefs about yourself or the world. This I often feel like is one of the more traumatic parts of PTSD is a person's worldview gets shattered. It's like their view of themself or the view of the world becomes incredibly shattered. You know, I also work a lot in the intersection of spirituality and therapy. And so I see this a lot where a person's spiritual frame breaks down as part of post trauma. And so they're dealing with the trauma, but then they're dealing with the trauma of their whole way of orienting to the world is broken. And again, I think about autistic person. Oh, go ahead. So like a fourth wall break, like when the glass shutters and the veil is lifted. Yeah. Yeah. And the thing about how disorienting that is for an autistic person, right? Because all of a sudden, all the things I thought were certain either by myself or the world are now broken. Like that's it. That's so traumatizing of and now I don't even know what I believe about XYZ. You kind of have to build build yourself up from grand zero, I suppose. Yeah. So D was that cognition thing. And a lot of times it's really negative views about self.  I think this happens a lot for autistic people. And then E is alterations in arousal or reactivity. So that's that hyperactivity. Autistic and ADHD people already have more reactive nervous systems. So this is going to be even more exaggerated with PTSD. So like a bigger startle response, this ties back to the amygdala. The amygdala is just firing of like you have to be on guard for signals of threat. And so the body is just like so much energy, so much cortisol, which is our stress hormone, just pulsing through our bodies. So that heightened reactivity, which also makes sleep hard. And then sleep is already like baseline hard for autistic people. So if you're throwing PTSD on top of it, like, it's very important for like, breaking sleep cycles and stuff, isn't it? Yeah, yeah, massive and being able to get out of our stress response is really important for sleep. Yeah, yeah.  Yeah. Yeah, I so I shared with you before we started recording in my early twenties, I had PTSD. And I for a year, didn't, oh, I can't say I didn't sleep. Of course, I slept, but like I would be up until 5am, not sleeping. And then I would get, I was in grad school at the time and I'd get like, maybe two or three hours, like my sleep was so dysregulated. And I think it was like autistic sleep, I've always had sleep issues. But then when the PTSD was on top of that, like my body was just like my systems were not operating well, especially sleep. Like it just didn't happen very often. Well, one question I want to ask, because I know that there's, you know, with PTSD, there's an action of, you know, trauma being sort of included. But if someone's struggling for that, perhaps with like memory blocks and stuff, and they, they don't really sort of process or remember this, this event, I know this has happened with my friends. How are you supposed, like, is there any sort of distinguishing factors that you can draw upon to know if it's just you feeling stressed and anxious or whether it's just or whether it's related to some kind of PTSD? Yeah. I mean, that's a good question, because stress and anxiety can also impact memory. And then ADHD can also impact memory. So I mean, I think you'd, you'd want to look outside of memory, you'd want to look at some of these other criteria points I've mentioned, like, are those also present? And that's how you would tease out, is this ADHD memory fog, is this stress memory fog, or is this traumatic, you know, is there the hyper, like hyperactivation? Is there the flashbacks that those intrusive symptoms? Is there avoidance happening? So you would look to see if other pieces of the puzzle were present. Could you, I know, I know it's, could you clarify a bit more on that aspect of my brain is still so slow from, yes, from the, from recently, yeah, totally. I'm just wondering about God, I don't know what's happening to me. Flashbacks. Because, you know, when we think of flashbacks, we think of like the movie example, you know, you flashback to event, you play through like 10 to 30 seconds of the clip of the event. But what, what, what does a flashback actually sort of present as what does it feel like? Because sometimes it can quite hard for people to visualize exactly what that means. Yeah, that's a good question, especially if someone has aphantasia, like the inability to see images, which that's higher among neurodivergent people. So it's, and it is kind of a vague description. It's the like re-experiencing of the trauma. So I don't know if you've ever had a night tear. I, as a child, I had night tears where you wake up and you think it's different than a nightmare because it feels like it's happening. I feel like that's kind of a helpful reference point of you feel like you're back in the experience and your, your body's reacting and your, your disoriented because it's, and there, it might, it might just be a moment, but that's where strategies like grounding is really helpful for PTSD, grounding strategies or strategies that help you re-anchor in this moment because it kind of helps you pull back to like, no, this is what's happening. This is what's real. So a flashback would be something that it's pulling you back and it, it's physically and cognitively disorienting because it, it's feeling like you're back in the experience. It might not have. You can sort of flip back and forth between what's happening now and what's happening in the past. And it's often triggered by something. So it could be triggered by a sound.  Certain ways of being touched on the body could activate a flashback, but it might, again, it might be very fragmented. It might not be this cohesive picture of like, oh, I'm, I'm seeing it. It might just, it might be the body responding in that visceral way of being back in the trauma. Yeah. It's really interesting. Was there, was there any of a sort of criteria of that, of PTSD or should we move into complex? Yeah, we can, yeah, we can move on. There's a few other like, there's always a few disclaimers like not attributed to this or that, but these are the core. Yeah, these are the core criteria. So complex PTSD. There's a lot of fantastic trauma advocates who have been saying, we've got to get this into the DSM or into the diagnostic criteria. I don't know if, maybe it's different in England. In the US, it's not recognized as an official diagnosis, which is really, really unfortunate because it is different in nature than PTSD. So with complex trauma, it is more of that diffuse trauma that there's not that one concrete trauma to point to. It's often associated with like complex trauma and childhood. So often when there's abuse in the home or other situations can cause it as well, but it's living in an environment that is perpetually unsafe. In this situation, the amygdala becomes very protective by becoming very, very heightened. I think a common metaphor, so if we think about the amygdala as kind of, you know, the fire alarm, a healthy amygdala, a healthy fire alarm will go off when there's fire in the home. Yeah. When you've grown up in an environment that is perpetually unsafe, it actually becomes really protective to have a really sensitive alarm. But what happens, it's like while cooking pancakes or putting something in the microwave will make the fire alarm go off. Like if the fire alarm thinks it's in danger when it's not, because thinking about a child, if they're in a chronically stressful, unsafe environment, it is really protective to know, well, when is my parent maybe going to flip and become dangerous? I need to be able to have like a really fine detection of that. So it starts as a protective mechanism, but then it creates so much suffering. It can become paranoia, but it's more in that bodily kind of hyper aware of your environment, hyper vigilant. It's again, in that stress state, chronically, which is just really hard on a person's body and mental health. That's really interesting. I think throughout my life, I've been experiencing quite severe mental health since I was 14, so about 11 years now. Quite often, my memory is very good and I can remember things very well. But I do sometimes, particularly around school or around talking about school, I have gaps in my memory. It's like I try to talk about something and then my brain shuts off and then I can't retrieve what I was going to say again. And it's something that I've talked about or tried to talk about in the past with like therapist and stuff, but it's very difficult to actually form a cohesive sentence that describes it because every it's like my brain retaliates to me trying to actively put myself in a situation. Because I really identify with the idea of diffuse PTSD because there definitely has been a lot of mental health difficulties in my life and a lot of things that I guess aren't very explainable, like random spurts of anxiety for seemingly very, very small things. And I really like that sort of concept of the diffuse because it's just, you know, for me, if I was to try and identify exactly what was my issue, I couldn't really do that. It's a mix of the environment and people and the things that are happening and how I was feeling at the time. And it's all very much a blur. And I have to make a little bit of a confession when you were talking about the diagnostic criteria and the flashbacks and stuff. I was getting a little bit of those flashbacks. And it kind of, it's kind of, it's very, very strange because it's almost like I related it to more of like, when I was trying to explain it to other people and to more of like an absence seizure where I just kind of my brain sort of blacks out. But I do have like different images cut prop up in my mind and it kind of strays me away from reality. And then I come back. And I definitely, definitely identify with the sort of the fourth wall break, the reality crashing down because, no, throughout most of my life, I've been having quite a few like existential crises. I don't know what the plural term for it is, but. So I'm really, I'm really not sure. I mean, autism is something that I'm very comfortable with and I'm very aware of and I know a lot about. But it's the other things that, and sort of the crossover between them that's really hard, especially when in therapy for neurotypical individuals. Yeah. Yeah. And there's so much crossover. I think it's 70% of us have, you know, a co-occurring mental health condition. I'm actually surprised it's that low. Many of us have more than one. Yeah.  It's autism and what like what is it intersecting with? Autism and what? Yeah. Yeah. I'm having an association. So one thing I often say is, you know, autistic people, you know, it's a lot of us are very existential. I hadn't yet, I hadn't connected that to trauma before, but I wonder how many of us are existential because it's trauma driven, like because we need to be existential to survive. And we need to like create a worldview that works for us, a self concept that works for us. Like, what if that is one way that we survive this world is by becoming deeply existential?   And he decided to just live in a bin or something on the side of the street. I can't remember what his name was. I identified with that a lot. And I've been in situations where I just kind of, you know, what are my thoughts real? I mean, how do I know that that what I'm thinking is concrete? So then how can I actually have anything in certainty? And I think there is a real desire for certainty and stability and very complex things that don't inherently have that like existence and like understanding and perceiving the world. There's so many avenues which are just completely subjective, which are just like, you know, massive parts of how we sort of process things, like mm-hmm. Yeah, yeah. Very, very, very interesting. I think I saw a paper on it before about existentialism, but I might want to brush up a bit more about that. It's always been. It's a fascinating combo. I recently had the thought that I wonder, so I didn't realize I was autistic till my daughter was diagnosed. So I was 37 when I was diagnosed that I've sometimes wondered if like, I knew I just couldn't figure out myself, like I was just going to be a mystery to me. So I spent all my energy trying to figure out kind of existence. So I, before I became a psychologist, I actually did my Masters of Divinity at Princeton and I studied theology and I was like deep into theology, philosophy. I was spending so much energy trying to figure out the meaning of life, trying to figure out what is the one best way to live. And I think it was a reaction to it. Well, I can't figure myself out, but maybe I can figure out this whole existence religion thing. Work from the outside in. Yeah, maybe, maybe. And my existential anxiety has gone down since discovering my autism, because it's like, oh, I can understand myself now. So it's okay if I can't understand the universe. It's a weird thing. Yeah, there's a lot of things when I was I was diagnosed when I was 10, 10 years old. So it was quite, I mean, it's not early, but it's it's not a late diagnosis per se. And I used to have very, very strange ways of, used to have very, very strange ways of sort of conceptualizing things about myself. So like, for example, I thought that I had different personalities because I had different emotions. So like, when I was in a certain emotional state, I didn't identify like the person that I was before in that emotional state, because because of the elixir of I'm here, not being able to feel it. I just saw that my personality was changing on a day to day basis. So I was like, like that. And there was little things like that that have occurred during my life that, you know, learning a bit more and especially about elixir of I'm here is absolutely life changing for me kind of understanding, hey, actually, this perception of my reality has, there's a reason why I'm seeing it like this, where other people are just kind of taking it for granted, it's just a part of things. And I think that a sort of different experience and not being able to fully grasp exactly what's going on because autism is not really in the picture, not really thinking about autism as you're not aware of every single aspect of it. So I find that really interesting, especially when I was young, I used to think I was an alien, genuinely. I've heard that one so much. Yeah, it's so interesting that kind of myths and stories we come up with until we realize it's autism. I would love to see like a collection of all of the different stories autistic people told themselves until they until they got the right language to understand themselves. Well, I'm really, really enjoying talking about this because obviously, I am so into philosophy, ethics, I love, I listen in my spare time, I tend to watch a lot of YouTube stuff around different philosophies and different sort of concepts and ways of looking at the world. But I know that we're talking specifically about PTSD today. So I guess now that we have sort of a broad and sort of a rough understanding of PTSD, a little bit about see PTSD, could you tell us a little bit about like the overlap between autism and PTSD and whether it's different for an autistic person or not? Yeah. So it's interesting, older studies used to think that autistic people experience PTSD at like a similar rate to non autistic people, thankfully, there's some emergent research, some newer research that is looking at it. Now, it's hard. If you see my infographics, you'll notice that the prevalence rates are like huge gaps. So like I have an infographic on trauma and autism, and it's 32 to 60% of autistic people report PTSD. That's a huge gap. And it's because it's from two different studies. And every study is going to have a different sample. So of course, it's hard to get a really accurate capturing of it. But what we are seeing is that autistic people are more prone to develop PTSD. So we experience it at much higher rates. For reference, about 4%, maybe 4.5% of the general population experiences PTSD. So even if it's that more conservative number of 30, that is still like a huge increased risk of PTSD. It's like low population, but a large amount of the PTSD diagnoses are still going to that one. Well, it's not 1%, but the minority of autistic people. Or just art, if you took any one individual autistic person, their risk of developing PTSD would be, I mean, this is an estimate, but like 10 fold the risk or potentially higher. Yeah. There's different theories. And I have some of my own theories. You mentioned earlier, having a really good memory. I do too. A lot of autistic people have really good autobiographical memory. So if you think about a traumatic event, we might encode it with more intensity, especially if we have hypersensitivities, the sensory experience of the trauma is going to be encoded with more intensity. So that's one of the theories as to why we might be more prone to PTSD. Another one is we have, so I've done, I have a series on this, the neurodivergent nervous system, but we just, we have more reactive nervous systems. What that means is, so we have, everyone has like a window of tolerance. And that's how much can I take in, how much stressors can I take in both from internal and from my environment and stay within a regulated window of tolerance. Still function. Still function, exactly. Autistic people tend to have a more narrow window. So do ADHD, window of tolerance, meaning we more easily flip into a stress state. So that's either hypermobility, so fight or flight stress response or hypomobility, like that free state. So we're more likely to flip into one of those two stress states more easily. So it takes less for us to get into our stress response. And I think that is probably a pretty significant contributor to why we're more prone to develop PTSD after traumas. Our nervous systems are going to have a harder time regulating and recovering afterward. And we have higher rates of victimization. So those are kind of the, the factors and there's more, but those are the big ones. That's, that's interesting about like the more likely to freeze more likely to hypermobility, hypermobility. As you said, mobility, right? Yeah. Or I might be confusing words there because it mobilizes us for action, hyperreactivity or hyperreactivity. Sure. So I was thinking joints like. Yeah, I think I was because it mobilizes us for action, or we've kind of freeze.  No, no, I do that as well. It's how you think of new things. Yeah, exactly. And create new words. Yeah. But in terms of the hyperreactivity or underreactivity, would you say that because autistic people, you know, we tend to get into one of two states when we get stressed, we've shut down or we melt down. And what one is very introverted, sort of internal shutting down and functioning, freezing. The other very, very erratic, all of the place lots of emotions, lots of physical movements. And would you say that there's a kind of like the a good ways of thinking about that sort of hyperactivity? Yeah, yeah. It's the same concept exactly of either shutting down or going to stress states. And there's some research that suggests autistic people may be more, not necessarily more likely to do one or the other, but more likely than non-autistic people to go into the shutdown mode. So there's a study of autistic children who had their blood drawn, and they measured cortisol throughout the day before the blood draw, during the blood draw, after they did different measures of cortisol. And they found, no surprise, autistic children had more cortisol, higher peaks, they excreted cortisol for longer, and it took them longer to get back to their baseline. But what they also found is that some of those children who were having big cortisol spikes, they weren't showing hyperreactive behavior. They looked calm, meaning they were entering more of that shutdown stress state. So this is what, I get this language from Finn Gradan, who's a fantastic autistic advocate, full regulation, that this is full regulation. You look regulated to the outside world, but actually your body's in a very stressed state, but it's that shutdown. So you look calm, you look very regulated, but you're not, your body's in a stress state. And that seems to be more common for autistic people to do that. I love that word. Isn't it a great word? Yeah, it is. I kind of feel in like a constant state of, like I've got restless legs all the time. It's not like the restless leg syndrome, but it's like a mild, like that. I always feel sort of, I always felt like there's ants crawling on my bones, or there's like, or something related to energy or something like that. I feel I feel like that most of the time. And I like that word, because I think, you know, hiding, especially when you've, when you've had like anxiety for a long time, it's like hiding that anxiety so well, even though, you know, I could be like on the scale of one to 100, I could be like 60, 70 most of the day. But as soon as I flip into that 80, and above, then that's when it becomes like the fight off light, the shut down on that down. And for the rest of the day, I kind of just, even sometimes I pay to myself that I'm regulated and just normal, because that's what I'm used to. Cortisol. I don't know why I'm reset. Cortisol and the amygdala, if we could just put it aside, I hate that stuff. Yeah, I always, I always, that's how I explain it to people, I say, I'm okay, my cortisol is just very high. Oh, I love that. I'm okay. I'm like, I love that. That's a great way. Because it's a way of saying I'm not okay, but I'm okay. Like I'm okay, not being okay. Like I'm like, my body's having this experience and I can tolerate it. Yeah, I find it very useful to use like names for things that cause things because if you say that I feel anxious, some people, they don't really take that on board. They're saying that, oh, you feel anxious, just like, okay. But if you say, my cortisol is raised a lot and, you know, cortisol is like the thing that sort of makes you active. It activates the body. Yeah, absolutely. It goes up and you get too much of it and you get over stimulated and you hyper aware of everything. People find it a lot easier to grasp that there's this molecule in my body causing me to act or feel like this rather than me just saying I feel like this. Well, and people, it's less character based. People so often hear things like I'm anxious is like a character statement or like, oh, just calm down. Or like, I mean, then you get all kinds of unhelpful comments, right?  It's like, okay. Yeah. I'm going to steal that one. That's really good. The other stuff you can talk about, oh, that opening is not here for me. I can't do that thing. I don't feel like that awful. The serotonin, you know, I'm up and down so much. I need a bit more of that.  What if we just responded with like neurochemicals? Like, you know, my serotonin feels a little bit low today. This is what I do. I love it. Well, it's good to kind of grab these concepts in physicality because, you know, people do, you know, take it as a character trait or a personality trait. Are you feeling depressed? Oh yeah, I felt depressed. It's like, okay, well, my brain is completely depleted of serotonin. Which does this, this and that. My God, that must be awful. It's like, it was the same as saying that I'm feeling depressed. But you don't get advice, I bet. Like, if you say I'm depressed and anxious, typically you get advice. Whereas if you ground it in neurochemistry. Yeah. Well, mine is, it's most, you know, you have that, there's an infographic that I came on, came across, sort of like a YouTube video, but it's talking like the causes of depression. There's like situational, neuro neurochemical, psychological existential.  And it seems to be, although it's worsened by events happening, it seems to just drop and rise as it will. Yeah. Sometimes. So, yeah, I find it very, very useful to like, think about it in neurochemicals and like, things like that. Yeah. And that's going back to like the PTSD overlap. I'm sure that's a factor too, if we have more vulnerable, like, neurology, more vulnerable neurochemicals. So if we're predisposed to depression, and then we experienced something traumatic, like, yeah, we're going to be way more vulnerable to developing PTSD afterwards. Well, I guess we've talked a lot about, like, the issues around it and sort of maybe the ways, the strange ways that Thomas describes his emotions, and speaks about himself in the first person. And I guess what I want to know is, you know, we know, we know about PTSD is very complex. Obviously, you need a professional to help you understand if it is the case. But if you feel like you sort of identify with what we're talking about, the person listening, I did find what we're talking about. What can they do? What should they do if they feel like they might be struggling with PTSD? Yeah. I mean, there's absolutely treatment for PTSD. And before we start recording, we talked about innate neurodivergence versus acquired neurodivergence. So autism isn't innate, like you're born without neurology. PTSD is acquired. And so it's an acquired neurodivergence that can be treated, can be supported, we can heal from it. I think for a lot of people, the combination of pharmaceuticals and medication support and therapy tends to be the ideal equation. This gets much more complicated for autistic people for reasons. We don't have it so far anyway, just for helping autistic people with mild anxiety. Yeah. Partly, like therapists are scared of us. If you go to a therapist and you're like, I'm autistic and I'm PTSD, a lot of therapists, if they don't have like extensive training in autism, they're like, Oh, I don't do autism. Like it feels, I mean, talk about alien, like a lot of therapists treat it like this alien other of like, Oh, you have to go to a specialist for that. So finding support. So finding someone who's not scared of you, and we'll take you on. But then also finding someone who understands your neurology. So for example, alexithymia, someone who's autistic could be in therapy and suffering a great deal. But their mood is flat. They're maybe talking about incredibly traumatic things, but not showing a lot of emotion. So a therapist might misinterpret that as they're not suffering because they're not displaying their emotion in the typical way. I suppose you have the lack of using the indirect communication as well. That as well. And yes, and also then with trauma work, really considering the sensory profile, a lot of trauma work, not all trauma work, but a lot of trauma work involves exposure to some extent, because one of the core symptoms of PTSD is avoidance. And avoidance actually perpetuates the anxiety around the trauma, and it makes it grow. So trauma treatments, different levels of exposure, some it's like really intense exposure, like a lot of kind of military PTSD treatments are very intense exposure. It's not all that intense, but there's some element of exposure to talking about it. So considering the sensory profile of the person, when you're doing exposure based work, I think that is one of the tricky things. You asked me what people could do, and I'm telling you like all the heart things about getting. So let me flip to something more helpful.  There is no one like therapy that works for all autistic people because we're an incredibly diverse group. Some of the therapies that I often hear autistic people have positive experiences with include internal family systems or parts work. And that can also be really powerful for trauma. So IFS is the acronym, internal family systems. EMDR is effective. Yeah, it's I do some IFS. And I really like it. It's you're talking about different parts of yourself, which makes it it takes this kind of abstract idea of the fact that we have multiple parts of us in terms of concrete, which I like. So I like it for autistic people for a lot of reasons. And I like it for trauma. And so I think it can go really well in the combination of autistic trauma. Some people respond really well to EMDR. Other people don't. Cognitive processing therapy is kind of the gold standard for PTSD in a lot of circles. I think that's where you really want to be considering the person's sensory profile. I think some autistic people can certainly respond well to it. Some have a really strong reaction to it. But I think I think so yeah, there's all these different theories. I think finding a therapist that you feel really safe with connected to is probably the most important part is is this someone who is curious about your experience, who you feel connected to, because that co regulation that happens in therapy, as you're working through your trauma, like, I don't want to be dismissive of what kind of therapy you do. But I actually think that's probably the most important is finding a person that you can connect with and feel safe with.  You don't feel like, hey, I'm getting sensory overloaded or like, I'm shutting down. I know I look regulated, but I'm shutting down. We need to like, hit the brakes here, somewhere where you can safely communicate that. Yeah. Yeah, I'm not going to kind of look at you with an inquisitive. Like, what do you mean? Like, what do you mean? You're fine. Yeah, I've had lots of lots of ones like that before. But yeah, I'm just my head's going off on like all the barriers in therapy and stuff. And yeah, it's the I think finding someone that you can genuine genuinely connect with it's is the best because like if you if you're always closed off and you're trying to like, present in a certain way, then it's going to be really hard to to open up about things. And I've actually like, throughout all the years of therapy that I did when I was younger, and, you know, some of the therapy that I've done in adulthood, really, it's it's it's really tough. It's it's hard to find anyone. We already have an issue with employment and pretty much all of the autism specialists that I can find in the UK. Like there's no like, general health care version of it. Like it's just you go there for them to help you treat with your depression anxiety. But not in the context of autism. If I was to say, Alex, if I knew to them, they would have no idea exactly at all what I mean. They're even just the basic concepts. So the majority of the actual therapy that's done is me explaining to them bits about autism. So it's like almost I'm educating them rather than telling, you know, yeah, absolutely experiences and having it sort of dissected and broken off process them. Yeah, yeah. Yeah, there's so much education that happens. There's a really interesting article. It's a qualitative study. It talked about autistic people's experiences with therapy. And I think that was one of the themes that came up. I just feel like they were educating their therapists about what autism is, which I mean, on one hand, if it's a long term therapist, and like they're curious, I think, you know, I think that makes sense that we do some of that. And that can be part of explaining our internal world. But if it's like a shorter term therapy, and if a person's feeling like they're spending the bulk of the hour educating versus like actually diving into the work, yeah, I mean, that's just not a great equation. So it's also awareness of the overlap of things as well, like sort of the different reactions that we can have to different conditions, different narrative agencies, acquired narrative agencies, right, right, like PTSD. I mean, panic, panic disorder for me, I probably say that acquired. I don't know if it's, it's a hard world to have a game. Yeah. Can I skip I'm starting to feel guilty that I was so negative. Can I skip back to some practical suggestions for people who are maybe listening to this and like feeling so deflated now? Yeah, yeah. I think, so I know for me just learning the science of what was happening to my body with PTSD was so regulating, similar to like, like, oh, my dopamine's low. And I think for autistic people, if we can understand what's happening to our bodies, it's really helpful. A good therapist can do this, but you can also actually do this with like YouTube of the anatomy of PTSD, or just understanding the fight or fight response, and then being able to kind of like, okay, my amygdala is going haywire right now. So I think for autistic people learning what's happening is really helpful. And you, and people can do that on their own. The second thing is grounding strategies. People hear a lot about relaxation strategies, which helps get us, get us out of our stress response. I think the two like basic ingredients of a good trauma treatment starts with grounding, and then relaxation strategies. But I actually prioritize grounding first. And that is, again, those practices that help us relocate ourselves in the here and the now. So it can be as simple as going and washing your hands with cold water and focusing your attention like, this is what the water feels like on my hands or creating pressure, or like, there's the classic five, four, three, two, one, like list five things you see going through the senses. I actually have some grounding strategies up on my website available for free, like a PDF, or you can YouTube or Google grounding strategies, but education of what the heck is happening to your body, grounding strategies, and then getting some like medication support, I think for a lot of people, especially if they can't sleep, those would be kind of until you find a unicorn therapist that knows how to work with you. Well, in terms of the medication front, I mean, I don't know much about PTSD medications. I imagine it would be similar to anxiety, would it? Or is it kind of more what's like the type of thing? It depends on the person depends on the provider depends on what they're like presenting with, if they're more dominantly like shut down to breast versus if they're more in that activated state, but getting like good pharmaceutical support just to help your body kind of be able to absorb some of it, especially because like I mentioned, I think our sleep gets really dysregulated for autistic people. Sure. But yeah, there's a variety of different medication options. Well, it's just out of the interest because I know that I mean, obviously, autism is, we have all these co-occurring things. And one of the particular things that has propped up a lot for myself and a lot of people that I've talked to is substance use. Like, is that is there any particular, I know in general, the advice is to avoid substances like alcohol, you know, marijuana, I think, illegal drugs. Is there any particular sort of drugs that you know about in that sense that are really, really bad for people who have PTSD? Is it like a specific? So I mean, I don't know about like, really specifically bad because of the autism, but like alcohol is a common, it commonly co occurs with PTSD, it commonly co occurs with high masking autistic people. And it's a way of kind of alcohol gives the nervous system like it feels like a moment of relief from some of that hyperactivity. So it makes sense why people go to alcohol with PTSD, especially if they don't have like pharmaceutical support, they're kind of they're self-medicating. The risks with when you have a substance use disorder and something like PTSD, and if the person's ADHD also impulsivity goes way up. So if someone's experiencing suicidality, you know, thoughts about wanting to die or wanting to kill themself, which can be common with PTSD, and you've got substance on top of that and autism, I would say that's a very dangerous triad. And that again, that's another reason why I'm a big fan of getting pharmaceutical support, so that it makes people less vulnerable to self-medicate through substances that would increase other vulnerabilities. So I think it makes a lot of sense that a lot of us go to substances. I think it's, it's, it's another, like, to me, that's another one of the really sad pieces about my feel not understanding autism better is that they're not understanding a lot of the people that they're treating with substance use and PTSD are actually like undiagnosed autistic and ADHD people who They're kind of self-medicating because the medications they produce for a neurotypical brain and then optically, like for me, like, you know, doctors always say, oh, as is our eyes, great for depression and anxiety. Great for depression. Anxiety makes it a lot worse for me. Yeah, yeah, yeah. Yes, it's tricky. It's tricky because some of those medications activates the central nervous system. So if someone's prone to anxiety, some, some medications will actually make their anxiety worse. So yeah, which is why working with someone and we also more sensitive to medication. So a lot of times it's recommended autistic people started a lower dose. I'm not a prescriber just for like consent, but it's recommended people started a lower dose often. And sometimes it takes more medication trials to find the medication that works for us because our bodies are more 11 years and counting. I still go out with a train going through the pharmaceutical list. There's not as much. I don't think there's as much leniency with the types of medications used in the UK. I know there's a lot of medications which I hear about taught talked about more, like from American individuals. Whereas in the UK, it seems to be like SSRIs or the tricyclics or like the to pull the benzos, the health, health related drugs. But there's not there's not a lot of like explorative or all sorts of specialized medications being like tried and tested. And it's, I mean, what you're saying about the sensitivity to medication, I really, really identify with that. And it's also very strange because I'm always an under responder to like certain certain types of drugs, particularly painkillers. So like, you know, if I was to go to the dentist to get my teeth done, they would need to put like twice the normal dose in order for me to numb myself. But then with medication, that like has an impact on my brain, it's like, oh gosh, very sensitive to it. And I talked to Dr. Temple Grandin, I don't know if you know of her. Yeah, I saw that podcast. Yeah, yeah. She was she was talking about antidepressants. She was advocating for a very, very sort of low dose and stuff. And I definitely have tried that tried those low doses. They haven't been, they haven't had enough of an effect for me. And at the moment, just as a, no, I like to be open about medication, because there's no reason to feel bad about what you absolutely just as what you would say about your physical, you know, ailments and their medications. At the moment, I'm on about 40 milligrams of citalopram, which is relatively high dose. And for, and it was, I have to take it with metazapine, which is like a really weird class of drugs. It's like an NES. That's that I don't know. And that it's very, very sedative. And it's a very long acting so it takes a while to get out of your system and stuff. And that's really, really helped with the anxiety aspect of psoriasis. So it's always like a, it's a weird combination. It's like, I go too high on the metazapine. My depression gets worse because I'm so sluggish all the time and sedated. And then the opposite side, if this citalopram gets too high and too wired and I'm too anxious and all of these benefits I'm getting from the depression are just completely absolved from all the anxiety that I'm experiencing. It's like a teeter totter of like the more you address this and you've got it. Yeah, absolutely. Absolutely.  Yeah, it's like the whole thing with delicate bodies of ours and ours being autistic bodies. It's like the whole thing with that, you know, you treat one ailment and that drug comes with side effects and then you treat the individual side effects and they have the branching out. Which that, you know, that's actually, so I've been saying I think medications can be really helpful, especially because it can help offset risk of substances. But it's also not great for everyone for these reasons. So another treatment, I would say biofeedback, I actually think autistic people tend to respond really well to you because it makes something abstract, concrete. So it's in, there's different kinds of biofeedback, but like one might be you're hooked up to a monitor and you can actually see like your nervous system activation, your breath rate, like these different measures.  And that again, with PTSD, it's that like over reactivity. So biofeedback can be, and other body based interventions that aren't medication, I, it's not widely popular, but I'm a safe and sound provider. And it's a vagal nerve stimulator. I love it. I've done it myself. I've done it with several clients. Yeah, it's the vagal nerves, it's the parasympathetic. Yep. The base. Yeah, I'd be really interested in that more. So there's body based and they're like every year we're coming out with more, there's body based interventions that aren't medication, but also aren't talk therapy. So if you're struggling with these two, there's this like kind of somatic body based biofeedback world that I think can also be really supportive for autistic people with PTSD. Well, I think I will definitely have a little bit more look into that. I have had one experience with biofeedback and it was at my university, they had like these little sensory pods that you could go into. And they had these, well, it's kind of like a band, they're sort of supposed to do the same thing as you need to do, like checking your brainwaves and stuff. And the exercise was to meditate. And the more that you thought about things, the more like stormy the weather would become in your ears. And the more that you calm down and stop thinking about things, it's starting to become like, yeah, like sound of birds and that was really, really helpful for particularly for meditation and sort of centering myself a bit more definitely. Mm hmm. Yeah. Yeah. So I know we've been talking for quite a while. There was one last thing and I know we have also talked about sort of those difficulties with mental health practitioners, providers not really understanding autism on its own. But what about the really key things for any mental health providers out there to take away around sort of the overlap between PTSD and autism? Yeah. So if there were a few things that I really wish mental health providers understood, one, that even if the person doesn't meet criteria A, they might still have PTSD. And that goes back to what we're talking about, that maybe there's not this really concrete trauma to point to, but still treat the PTSD if they're having like all the other PTSD symptoms. So, so yes, that's one. Two, I think understanding the nervous system piece of like having more reactive nervous systems. So doing a lot of education, grounding, like training of the nervous system to get back into a regulated space. I think that's pretty integral to PTSD treatment. Understanding that we're victimized at higher rates, I think is a really important part of understanding the intersection and knowing how to work with that. And then the fourth thing is not attributing everything to trauma. I have met so many people, more women and gender queer people than men, but this certainly happens with men too, where their autistic traits are dismissed because of the trauma. So it's like, no, that's trauma. And then they're getting treatment for PTSD, but their underlying neurology is being missed. So they're not recovering in the same way. And I think, so just the avoidance of kind of that confirmation bias that this is trauma, and actually considering that it might be both autism and trauma is something I wish more therapists did. I often hear autism and ADHD dismissed because there's trauma, when it can often be a both end. And that sort of crossover is very difficult, isn't it, to kind of tease out, I suppose there needs to be quite a long process, like with anything like that. I mean, another way that the UK that my sort of medical system works is that I have to identify whether there is something wrong with me. And then I go to a specialist who specializes in that exact thing. There's no sort of like middleman that I can go to and say, I'm struggling, what have I got? Can we talk through like what may be happening here? Because the knowledge that GPs have, it's so, you know, they have a lot of knowledge and practical experience and all that, but they're very busy. And they also specialise in certain areas. And a lot of the time, they don't really understand autism that much, apart from sort of the stereotypical presentations. And, you know, sort of awareness of things like, as I said, the lexifier and different things, like it's sometimes really, really, really complex, because it's like, I don't want to keep going for different diagnoses to try and find out. I just want to go to one person and just like, absolutely. Yeah. Yeah. Well, because it's it all intersects.  And so yeah, that reminds me that'd be the other thing I wish mental health providers would understand is alexithymia and that don't, don't, if you have a client with PTSD and autism, don't go off of their facial expressions for trying to like figure out how much stress they're under and know that they're a very elevated risk for suicide or baseline suicide risk is way higher. PTSD and suicide risk is higher.  So you're throwing in PTSD and autism, have your eye out for, for suicidality and don't base it off of are they crying, like ask the person. Besides for me, I never cry. Well, I hardly ever cry. They definitely don't cry when I'm feeling very, very depressed. Right, right, right. It is. So we're emotionally dysregulated. We might not look to a therapist like we're emotionally dysregulated. Because it's not like this. And then we get missed. Factual concrete sort of interaction was the you input what's happening, they output what's happening in the circuit, there's a conversation. There's a interpersonal understanding is trying to understand their emotions. But they forget about the autism and the alexithymia. You know, sometimes they overlook that. And like, you know, it's a classic example, you go into a doctor's, I'm in extreme pain. And you don't look like you're in extreme pain. And like, okay, well, we're going to sort it out. But if you went in screaming, kicking, it's like, oh, my God, it's so much pain. Jesus, I excretion. Right, we'll get you to the ER. Absolutely. Yeah, yeah. That's a great metaphor. And the same thing happens in mental health all the time, because we don't, like, show our psychic pain in the same way all the time. You say, I'm really depressed. I'm thinking about suicide all the time. I'm so anxious. I can't function. I look like I can. And my friends don't really take me seriously. And now you don't take me seriously. Yeah. And I think that's, Thomas, that's a great example of how to advocate. So for the people listening who are clients, it's a great example of how to advocate for yourself with your therapist of say, say where you're struggling, make it explicit and say, I know I might not look like this. This is part of the autism. And make it explicit. That's such a powerful way to self advocate. Because I suppose you need, you need some kind of basis in order to help them understand a certain thing, especially if it's not fitting into sort of the basic sort of the neurotypical stereotypes. Yeah, yeah. Yeah, definitely. Well, it's been absolutely amazing to chat to you and would like to talk more. Definitely. Same. This time has flown. Yeah, it has definitely. This is a sign of a good podcast, I would say. Oh, good. So what I'm gonna do, I'm gonna do a song of the day. Do you remember what your song of the day was? I do. Yeah, it was Green Day, Boulevard of Broken Dreams. When I was recovering from PTSD, I would walk around Princeton that night. Like walking around at night has always been really soothing for me. Me too. Yeah, especially in the rain. And I would, really? Yeah, same. Same. And I would listen to that song on repeat. It was my stim song. And I think it just, it captured something that I couldn't quite articulate. But I probably listened to that song on repeat for like a year or two when I had PTSD and when I was recovering from PTSD. That's really, really good. So that's why I chose it. I mean, amazing song anyway. Great addition to the 40 or two podcast playlist, song of the day playlist as you can, you can always find it down in the description just for anybody listening. I don't know why you say anybody's listening because the people who are listening would only be able to hear me say that. And then the people who are listening. It's like if a tree falls. Brilliant. Well, I guess, you know, we've gone through, we've looked at PTSD, we've looked at sort of the Herbal Outwards and some of the difficulties in sort of therapy, some of the things that people can do to help, you know, some of the ways that might be supportive for autistic people struggling with PTSD. And also some of the things that, you know, mental health practitioners should be really aware of. It's been great to talk to you. And I guess what I want to ask now is, have you enjoyed the episode? Have you enjoyed the 40 or two experience? I have. I very much so I've been looking forward to this conversation. And it's, it's kind of what I imagined it would be.  So it felt very neurodivergent in that way, which I always love those conversations the most. So thank you. What can people find you? They can find me on Instagram neurodivergent insights on my website, www.neurodivergentinsights.com. I have a Patreon. I make workbooks every month around like wellness and mental health. So like I just did one on Alexa Thymia recently. And so Patreon as well. Those are probably the top three places. I know I definitely encourage you if anything at least go and follow Megan over on on Instagram neurodivergent insights. Absolutely amazing resource for me, especially when trying to sort of understand both myself, sort of the crossover between things and also, you know, understanding sort of the broad complexity of it all.  And it's still things are changing things, things are being learned very, very slowly as we humans do. But there are some, you know, great people like Megan who are sort of heading sort of our awareness of different things specifically around the stuff around misdiagnosis, I think was really impactful on me. So if you have enjoyed this episode and you want to hear more of it, I have a playlist of, you know, upwards of 30 plus songs. Season one and two. Season one, it's a little bit on the, the new coming podcasting style. It's not very well produced or presented, but definitely go check out some of the more recent episodes of season two and season one. You can find the 4080 podcast, of course, on Spotify, Apple Podcast, Google Podcast, and of course on my YouTube channel, Thomas Henley under the 4080 podcast. All the video versions are available on there. And yeah, if you want to check out all of the other work that I do, head over to my social medias, particularly my Instagram at Thomas Henley UK. And if you want to get in contact about workplace training, public speaking events, interviews, modeling, getting contact with me via my website, www.thomashenley.co.uk and go through the contact form on that. I think that's everything. Been, been like a bit over a month since I've done the podcast sounds. Trying to remember exactly what. The muscle memory. The muscle memory is gone. Yeah. It's like a little, it's like a little social script, but just like with the facial expressions and the body language. Yep. Yep. Well, thank you so much, Megan for coming on. Absolutely. I did really enjoy this conversation. Great deal. For me, I hope you all have a very, very lovely day.


Day one of the use of a best warrior competition challenged the competitors with obstacles of physical endurance pushing them to their limits. They went over and under furls on their way to the situational exercises where they tested their mental toughness and knowledge evacuating a casualty. From there the competitors moved as a fire team reacting to contact in an urban environment. Follow all of the action of the European Best Warrior Competition on the 21st Theater Sustainment Command's Facebook page. From Graphenwehr, Germany, I'm Staff Sergeant Adran Patoka.