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Hello! And welcome to this week’s edition of Self Help for Sceptics. This is a quick and dirty, unpolished note arising from some thoughts that emerged while I was updating a training I have been developing for Dragonfly Mental Health on Neurodiversity in Academia. The brief for this presentation was to select a few choice nuggets of wisdom from recent research findings in mental health that would be particularly useful for neurodivergent academics and researchers - that is to say, people who are or believe they may be autistic or ADHD (or AuDHD), or who have specific learning difficulties and neurodevelopmental conditions such as dyslexia, dyscalculia, dyspraxia (or DCD). Firstly, I felt a lot of sympathy for academics and researchers who grapple with these sorts of briefs full-time, for a living, as I tried to square the circle of creating something concise and punchy, while offering a breadth and depth and richness of content and some genuinely helpful takeaways for everyone. It was difficult making decisions about what to cover and what to exclude, and what caveats I needed to make about these choices (spoiler alert: there is so much that could potentially be included under the banner of ‘neurodivergence’ at the moment that I decided anything that is considered primarily a mental health condition rather than a neurodevelopmental difference could be better and more thoroughly addressed elsewhere. I also cut much of the material on specific learning difficulties, as many of these are comorbid with ADHD / ASD and it becomes difficult to discern where one ‘condition’ ends and another begins). I also found myself running into the same issue many clinicians encounter when we are asked for evidence-based suggestions and interventions to enhance quality of life for our clients: Research does inform practice as neatly as we, or anyone else, would like. A lot of the research that gets funded focuses on correlation and causation at a biological level: e.g. what genetic and epigenetic factors are involved in the development of this or that neuropsychiatric condition? A lot of research sets out to investigate the efficacy (/cost efficiency) of one very particular therapeutic, behavioural or pharmacological intervention for one particular presenting problem - and the intervention may only be available in some countries or healthcare systems, or in inpatient settings. A lot of research focuses on a particular point in the lifespan - it’s about children, or older adults. Although this is changing a lot in recent years, much of the research where neurodiversity is concerned assumes a male patient. A lot of the research that is most pragmatically useful to clinicians is based on case studies, rather than the types of quantitative, or larger-study qualitative research that generate what we understand as data, which then informs evidence. And what counts as evidence is a whole other story, particularly given that mental health and quality of life outcomes are measured through self-reporting - which is subjective and inexact by its very nature, and becomes particularly tricky when the population in question experiences high levels of alexithymia and difficulty with social and emotional communication and may therefore struggle to identify and articulate feeling states. There are also sometimes political factors at play, such as the widespread, and generally well-intentioned, practice within the NHS of manipulating client self-reports to show better outcomes for short-term, manualised therapies (the only therapies endorsed by the Increasing Access to Psychological Therapies programme) in order to keep the relatively few mental health services we have from being decommissioned in a time of ruthless, ongoing austerity. Now doon’t get me wrong - research is great. We need research! But the bottom line is that research does not (and can’t possibly) start from the particular set of circumstances and problems each of our clients is facing. Our clients are individuals, not averages or populations. They are members of communities and families and cultures, they have had an infinite variety of different experiences, they have different interests and tastes, goals and wishes, they inhabit different bodies in states of constant change, their sensory and perceptual experiences of the world are much more different than most people realise, their beliefs are different… their whole contexts are different. Equine-assisted therapy is absolutely transformative for some people, but there will be others who don’t find it any more useful than going for a walk - and it certainly won’t help if you’re allergic to horses. Many of my autistic clients have had absolutely fantastic experiences with manualised cognitive behaviour therapies. Just as many of them have found these approaches unhelpful, and on top of that, were enormously disappointed, having been led to believe that CBT was the failsafe, gold-standard treatment that would cure their OCD, panic or generalised anxiety. Many of my clients with ADHD have found stimulant medication to be life-changing - whereas others have found it’s not the magic bullet they’d hoped, causing significant problems with sleep and appetite, and ceasing to work at all during times of hormonal fluctuation. So I find myself very wary of coming across as yet another person peddling a variation on Try This One Simple Hack For Your Neurodivergent Mental Health! Particularly because the people I tend to work with - systems thinkers with problem-solving, pattern-loving minds - are already, through no choice of their own, cognitively inclined to seek and expect a perfectly efficient solution. Many want to believe in a world, and a scientific (or spiritual, or philosophical) community that has The Answers. And I see people end up disappointed again and again when their problems are not durably solved by the one simple hack they’ve been asked to put their trust in.
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