Musings on mad autistry - where autism and psychosis meet

Collage designed by Helio Caward.

When I was 14, I woke up one day from an afterschool nap and entered a sinister alternate timeline of my life. It felt like the fabric of reality had shifted and stretched while I was asleep. When I went to use my voice, it sounded different. Words didn’t feel like they were my own, and the noises that came out were rasped and strained. My blood felt like hot lava.

I quickly realised I was possessed by ‘devils’. 

Part of me was terrified, and another part of me was giving in to it, like when you relax to let yourself die in a dream. I was too scared to ask my dad for help because I knew it would be the devils talking to him, not me. I could feel the fire of their tongues licking and burning the inside of my throat. Their fingernails pierced my eyelids like needle splints. I still have my scrawled diary entries describing the experience, time-stamped like a captain’s log, and voice recordings of my altered voice. Recently, after coming out of a months-long psychosis, I dug out that diary. I realised that possession was probably my first salient memory of psychosis. 

“The sickness eats, devouring my starved body and licking at my tasty unravelling mind”, I wrote in my diary. “I feel like I’m being crucified. The devils are in my voice moaning to be released.”

I found out I was autistic at 27, but I’ve known that I’m mad since I was a kid. As I’ve grown older I’ve learned more about the links between autism and psychosis, and the frequency with which many autistics also experience psychotic states.

Our unique sensory experiences already make it feel like we’re living in a different reality to others, even when we’re at our baseline. And our creative styles of thinking (predictive pattern recognition, for example) can make it much easier for us to get swept away when we aren’t at our baseline.

Let me explain. 

When I was a child, I used to think there was an evil spirit inside me that was eventually going to kill someone, and that it was my job to keep it at bay. I compulsively wrote graphic depictions of violence about various family members, kids at school and strangers because I found it soothed my urges. My dreams were always so intense and enmeshed with reality that I couldn’t tell if something happened in dreamlife or wakelife, and sometimes my dreams were premonitions. 

Since I was 10, I’ve had this movie playing in my head that shows me dying over and over, projected onto the landscape around me. Wherever I look, I am impaled on fences, snapped in half, crushed, run over, stabbed, tortured in the most creative ways – I find it far less disturbing now in my third decade. 

Amidst all the furniture of my psyche, I’ve also been a traveller of more episodic altered states. This year, for instance, my partner and I got a puppy (Ernie) and from about 2 days into the sleep deprivation I was hallucinating every day. I was in this state for a month straight. The sleep dep bent me in half, broke me open and served me up as a feast for circling frazzled mind vultures. My intrusive thoughts were dark and loopy. The more Ernie cried, the more I felt a visceral gag reflex, the more I felt enraged, disgusted and violent. I heard him screaming constantly when he wasn’t there, like at the doctor. My brain needed sleep but whenever I napped I had sleep paralysis episodes where mice were crawling all over me. One day my partner Luka bought me a massage for self-care because I’d gotten so unwell that everything in our house was falling apart and I’d stopped eating. I was laying on the massage table tripping balls, seeing Ernie and Luka run around on the ceiling. I could hear Ernie crying out for me and I just kept repeating in my head over and over, “you're in a massage room right now, don’t listen to the sound of his bell, he’s not here, don’t fall asleep, you’re safe.” I couldn’t trust my friends, my house was full of shadow people, and I thought it would never end – like a bad acid trip.

Coincidentally, right after that episode I got to participate in a university study on psychosis. I was shocked how hard the validation hit me about just qualifying for inclusion. I realised it’s taken me until my thirties to feel fully comfortable using the word psychosis – mostly because I have no diagnosis of it and I haven’t been totally sure the word was mine to use. ‘Psychosis’ also tends to be a limiting term, used by western psychiatry to demonise and coerce people into complying with life-long mind bending psychiatric drugs. Many studies have doubted the efficacy of these drugs by the way, especially long term.

Many folks prefer the umbrella term ‘altered states’ instead, adopted by the Mad Pride movement. Altered states of consciousness include everything from profoundly spiritual to utterly terrifying psychotic experiences, mania, dissociation, autistic meltdowns and monotropic spiral, trance and hypnosis, ancestral communications, even psychedelic experiences. I like the term psychosis to describe a very specific reality departure. It carries a weight that I find effective, and perhaps, I like to think, using it on myself while defying someone’s image of a Crazy Person helps to destigmatise the language.

It turns out autism and psychosis regularly go hand in hand – a 2022 study found that more than a third of autistics experience psychotic symptoms. 

To me, autistic psychosis feels like a sensory cocktail where all my senses are in overdrive, blending into each other. I have intense locked focus on a single line of thinking, even if it’s distressing (a thought pattern shrinks call “monotropism”). I experience intrusive thoughts as moving images and I have an insane style of cognition that links unrelated phenomena. I get paranoid about being watched when I’m alone pretty regularly; it’s something I’ve felt for most of my life. Part of what kicks it off is that when my internal sensory experience is too high my self-awareness gets externalised. I start perceiving myself in the third person, like I’m someone else watching me. The louder my internal experience gets, the more people I feel are watching. My body starts generating evidence for the presence of anonymous watchers, like goosebumps, shadows in the corners of my vision or images of eyes and strangers popping up in my vision. My stomach drops. My mind then locks on, metastasising around the meaning of why I might be being watched, or what they might be trying to warn me of. I can’t always ‘disprove’ things with my eyes, because I see my thoughts. And I can’t always use ‘logical’ thinking, because the world taught me to reason with reality by disregarding my own experience of it. 

Being socialised to mask my autism from a young age set me up to live in multiple realities, and to fundamentally distrust my own ability to make sense of what’s going on. It’s taken me years to restitch the torn pieces of my intuition, and will probably take me many more. I think in many ways though the ironclad welding of my autistic mask and the paranoia-fuelled secrecy surrounding my madness protected me from being diagnosed with psychosis. One of the problems with living in a paradigm of pathology and medicalisation is that you can feel lost, or even unreal, without a diagnostic stamp of approval to frame your experiences. I’ve been critical of psychiatry for many years now, but, having been a psychiatric patient since I was 15, I still get snagged by desires to have my neurodivergence legitimised by a doctor.

This strange yearning feels so displaced, not just because I’ve seen the kinds of harm and exclusion that come with a medical psychosis label, but because ‘sane’ western doctors are not the arbiters of ancient insane material. What I actually yearn for is mad eldership. Some of the greatest legacies of white supremacy are sanism and ableism, which have allowed generations of mad and disabled peoples to be institutionalised, lobotomised, sterilised and killed. That’s what happened to my elders, and my elders’ elders. 

I long for the kind of initiation, understanding and community that ought to be wrapped around people who traverse altered states. You only have to look to Indigenous cultures across time for examples of mad/spiritual eldership, where people born into special gifts receive guidance by gifted others – and often carry sacred duties in their communities. I wish I’d had the guidance of mad autistic adults around me when I was young, teaching me how to understand, use and live with these experiences, like people have always done.

Maybe, just maybe, this essay will function like a lighthouse for the young mad folks out there adrift in the choppy seas of psychosis. Offering up these experiences is my way of giving back to those who have guided me.