Walking toward the front door of a local occupational therapy studio near my house, with my hoodie cozied over my head, I feel a bit in awe at the wonder of my path—from a research perspective and from a personal perspective. I had been a gymnast throughout childhood, and images of swinging around bars often dangled in my mind while I was on walks or long drives. Now here I am walking into familiar territory, with bright blue and red mats sprawled across a large warehouse-style room and swings made from shimmering fabrics hanging from the ceiling. A kind of “full circle” feeling washes over me.
Leigh, the owner of the studio, shakes my hand and shows me to a meeting room with child-size tables and chairs. (Occupational therapy offices focused on sensory integration rarely receive adult visitors.) Leigh explains the basics of occupational therapy to me before we hold a couple of sessions over the next few weeks. She teaches me about pushing against the wall for a deep pressure effect and puts me into a huge body sock so I can feel the weighted relief. I immediately go out and buy one. Notably, what I learn the most from my time with her is how well I respond to simply being given more information.
I found the same when I was first learning about somatic therapies—knowing the language of the nervous system helped me better imagine and comprehend the mechanisms by which my body and mind interact with my environment. It’s as though the missing piece has been mere knowledge about my insides—my internal makeup—the life of my organs. I later learn in an interview with leading interoception researchers in the UK that one reason autistic women are more likely to be anxious is because of this very disconnect—not being able to detect one’s own heartbeat, for example, and that merely being able to feel one’s heartbeat after exercise can be a soothing and reassuring activity.
Ultimately, there is no one-size-fits-all approach to improving well-being, “wellness,” or “therapies” for sensitive neurodivergent folks, but building a tapestry is important. In the remaining chapters we will take what we’ve learned in Parts I and II and apply insights to daily life and real-world situations in work, relationships, and wellness practices.
Altering Course
The question of where to go from here as regards to understanding and integrating neurodiversity thinking needs to begin with new insights into the nature of sensitivity and the impact of psychology on education, workplaces, family life, and more. It’s crucial to understand where neurodiversity thinking fits within the larger context and evolution of psychology. We’ll take a quick historical detour before meeting modern-day practitioners, researchers, and other pioneers and activists.
A primary resource to help shape our understanding of psychology’s evolution is Duane and Sydney Schultz’s A History of Modern Psychology, first published in 1969, which traces the origins of modern Western psychology. It designates 1879 as a particular turning point, when the German physician Wilhelm Wundt established the first laboratory dedicated to research in experimental psychology. Schultz and Schultz understand the history of psychological thought as movements that emerge within historical contexts, noting the importance of “contextual forces,” such as intellectual, political, economic, and social factors that influence the currents of psychology. The authors also acknowledge the fluid nature of the field, noting that it is always changing and growing. A preoccupation with having a scientific basis for the field is apparent, as well as differentiating it from others, particularly the older discipline of philosophy. They note that understanding the human mind was once thought of as an intuitive exercise, but with the incorporation of methodical tools and inquiries into biological understandings of ourselves, that same approach could finally be transferred to the study of the human mind and human behavior. And so the history of psychology is largely the history of the evolution of such tools and methods.
Mechanistic Thinking
The seventeenth century was the era of the machine. People began to think that if one could take apart a mechanism and understand its functioning, perhaps the same could be possible with the human brain. Philosophers of the time believed that “the harmony and order of the universe could now be explained in terms of the clock’s regularity—which is built into the machine by the clockmaker just as the regularity of the universe was thought to be built into it by God.” During this era, determinism and reductionism came to rule. Determinism is the idea that every consecutive act determines the next; reductionism is the idea and belief that an object (or person) of inquiry could be disassembled to ascertain exactly how it (or she) operated. Hence the scientific method was born, and the dominant “mechanistic” outlook within the sciences, including psychology, was that of humans as machines.
A host of influential thinkers—all white males—came to dominate psychological thinking, from René Descartes to John Locke, David Hume, John Stuart Mill, and others. One individual in particular, Johannes Müller, interjected a more physiological take on human behavior with his theory of the specific energies of nerves. This is in line with the medicalized notion of human behavior that we learned about in Chapter 1 in tracing the history of psychiatry. Schultz and Schultz write that Müller “proposed that the arousal or stimulation of a given nerve always gives rise to a characteristic sensation, because each sensory nerve has its own specific energy. This idea stimulated a great deal of research that sought to localize functions within the nervous system and to delimit sensory receptor mechanisms on the periphery of the organism.”
Such a physiological take gave rise to a host of ideas, theories, and experimentations, including electrical stimulation of the brain and, later, lobotomies. The Berlin Physical Society was formed in the 1840s to explain to the world how mechanistic thinking could be applied to all sciences, including the mind. Around this same time, insights about the nervous system, neurons, and brain function were being described in mechanistic terms, forming, along with empiricism, experimentation, and measurement, the backbone of modern science and psychology.
Around the turn of the twentieth century, Sigmund Freud developed his theories of the mind and psychoanalysis. His ideas were distinct and less reactionary compared to those of the earlier schools of psychological thought. He wasn’t a clinical laboratory scientist or academic, and his focus on the unconscious made his ideas less prone to mechanistic thinking and less able to be studied using empirical inquiry. He favored inquiry into “catharsis,” dreams, and sexual impulses. It’s noteworthy that Freud regularly used cocaine and touted its “miracle” features until his middle age, when he was met with backlash and scorned for such assertions.
As psychiatry took shape as its own independent field within medicine, so too did psychology take shape as an independently respected field apart from what was earlier thought of as philosophical inquiry. In the late nineteenth century the first psychology journals appeared out of Europe and the United States. Laboratories started popping up, and the American Psychological Association (APA) was formed in 1892. The field became known as the “science of behavior” but remained low on funding rungs compared with other scientific disciplines.
With a population explosion at the turn of the twentieth century, psychologists turned their attention to universities and education, where funding was being directed. Psychology had been limited to clinical laboratory settings and was now growing outward into schools and the wider culture, so funding and prestige were finally coming its way. World Wars I and II would also invite more extensive involvement from psychologists.
Since Freud, a host of other thinkers and theories have made their mark—notably Carl Jung and Abraham Maslow, humanistic and cognitive psychology, and most recently what is referred to as “positive psychology.” Spearheaded by Martin Seligman in the late 1990s, positive psychology aims for “optimal human flourishing” and focuses on enhancing people’s strengths. It’s worth noting that the same demographic that led psychology’s history—white males—is also responsible for the growth of positive psychology, which, in combination with “mindfulness,” has grown to dominate not only the field but also popular psychology books and blogs. It has been criticized, however, for resting on individualistic and capitalist notions of happiness and well-being and taking a uniquely Western perspective on personhood and notions of thriving.
A neurodiversity approach to psychology, however, does not seek to mute those aspects of ourselves deemed “less positive,” unhelpful, or “less productive.” Instead, as we have seen, the neurodiversity framework rests upon reframing the experience of humanity, particularly our notions of “disorder.” Rather than trying to rid people of anxiety, neurodiversity proponents seek to uncover the source of the anxiety as having to do with how an experience of cognitive difference in our society creates that anxiety—and feelings of insecurity, alienation, loneliness, and depression.
Sensitive Women
“Most people who come to me are highly sensitive and have been feeling misunderstood and not well heard by previous therapists,” San Francisco Bay Area therapist Grace Malonai tells me. “I’m often people’s eleventh or twelfth therapist that they’ve tried. They’ve been seeking support and help, so when they get to me they feel pretty raw as they are hurt and have been in need for a while.” Malonai specializes in clients who experience high sensitivity across neurotypes, whether autistic, ADHD, HSP, or SPD.
“Things often come up at work or home” for her clients, Malonai says, “and they are not being well met or understood and they themselves have a hard time understanding why they are a certain way.” They may wonder why no one else is so sensitive or sad at work. For instance, a colleague will say something to one of Malonai’s clients, and the client will wonder what that person means and then begin to second-guess and third-guess and start to spin out into self-doubt. The client wonders and doubts because she doesn’t see most people doing that sort of questioning. “But when clients come to understand themselves,” Malonai says, “they begin to discern what information they are receiving is subtle or big as compared to what others are getting.”
This last point is essential to how neurodivergent folks can be helped within a therapeutic neurodiversity-focused setting. Understanding and reframing difference becomes the key to shifting experience and relieving anxiety. Instead of your difference being what holds you back, its gifts can be uncovered. Some refer to this as unlocking a kind of “superpower,” and discerning difference as power can be invigorating.
This begins with dismantling assumptions surrounding neurodivergent people. Stereotypes include the perception that such people are aloof or unaware of social cues. But in fact, as we have seen, what is actually happening is a hyperawareness of things that most people never notice. Malonai shares an example of a highly sensitive, gifted, and anxious woman who can become preoccupied if she sees her boss give a big sigh. The woman wonders about her boss, “Is she having a bad day? Does she have a stomach ache? Is she crying? Is she sad? Is she tired?” Then she wonders, “Did I do something?” Malonai explains, “There’s a lot of doubt and a lot of insecurities.”
But all that wondering can be a gift. I see this in my own life with my husband, who often calls me a “wounded healer,” because I’ll think I know how he’s feeling when he says or does something, but I’ll sometimes forget to just ask him. “So that way it’s a gift, because you can use that information to connect,” says Malonai. “On the other hand when you don’t understand what’s going on, you just think you did something wrong.” She says that if we can begin to ask ourselves how to use this subtle information in a useful way, we may be able to avoid feeling overwhelmed. We don’t need to react, but to notice.
I ask Malonai about “best practices” because so few practitioners focus on high sensitivity and neurodiversity. One that she practices is this: When people come to her after seeing a dozen other therapists, she reassures them that the subtleties they may observe from her in their sessions, such as a tired face, is simply that—she is tired. She doesn’t want her clients to use up valuable energy, personal coping, worrying, and guessing trying to figure out what’s happening with her. When she tells them this, “they are more at ease,” she explains. It’s a small gesture, but it’s meaningful, and it’s part of being a genuine and authentic human being. Normalizing their experience is important, because sensitive people are not getting feedback and validation within our culture. “I want them to know that it’s okay to feel a lot. So many people have gotten the message that it’s not okay to feel so much, emotionally or physically.”
Giftedness is also part of our shared human neurodiversity, Malonai says. The word gifted conjures up images of little Einsteins, but in fact the psychological study of “giftedness” has focused on a whole personality profile of gifted and talented individuals—and high sensitivity is often a part of it. There is also the term asynchronous development, which refers to exceptional growth and talent in some areas of life or study but delay in others. For some, this may be more along the lines of what’s called “twice exceptional,” where a person experiences both giftedness and autism, ADHD, or dyslexia, for example.
“I think part of giftedness is taking in a lot of information and then thinking about what to do with that information,” Malonai says. “It’s a form of asynchronous development,” because the individuals are far ahead of their peers. “But they may be more developed in some areas and also less developed in some areas. And often less development has to do with social coping, and there can be overlap with high sensitivity, gifted, and autistic, so we want to help them understand their traits.”
Regulating emotions is sometimes challenging, says Malonai. A person may say something negative, and the sensitive, gifted, or neurodivergent person will react defensively to the comment and may even scream or get into a rage. So then there’s a behavior challenge, which makes a boss, partner, parent, or teacher respond with a negative consequence. “If you treat this behaviorally, you’re not going to get to the root problem, which is understanding,” Malonai says. Intellectual explanations for why a misunderstanding has occurred or why feelings are hurt often work more successfully because there is a deep need and craving to understand the “why” of a situation.
On a practical level, I begin to wonder what it’s like to be in Grace Malonai’s office. Physical environments influence sensitive people in particular, and so I ask her what makes her working environment different or more comfortable for her clientele. Weighted blankets, fidget toys, soft materials, skin brushes, water beads, sand, pillows, electric candles, and other sensory accessories adorn her office. Also, the office has no overhead lights and strong-smelling foods are not allowed. Some of her adult clientele are visually sensitive, so she has set up her office carefully and intentionally. Solid doors keep noise out and quiet ventilation has been installed. Warm colors and clean interiors are important in creating a soothing atmosphere for her clients.
And what about the women who walk through her doors? Do they know they are autistic or HSP? Or are most on a journey of discovery? “I think when people come to me they realize they are different—some people know, some don’t, some are misdiagnosed, some aren’t. Some have been diagnosed as ADHD and autistic, when I might say they are actually highly sensitive and SPD, with accompanying anxiety. It could also be some amount of OCD. When we understand a diagnosis and we are able to treat the correct one, then the quality of life is increased.”
The opposite is also true when women come to her thinking they are extremely sensitive but she sees a missing diagnosis of autism. “So we’ll do an assessment and they will be bawling, saying, ‘Oh my gosh, my whole life I was like this and I thought something was wrong with me. I didn’t know.’” One woman in particular came to Malonai who struggled in college and had to stop going to school, but after getting the correct diagnosis of autism and requesting accommodations, she was able to finish her degree. Then there are other women who do fine in college, but they struggle when they get out into the work world.
Yet another group is serial job hoppers. With each career, they reach a level of success where they feel they’ve mastered what they want and then get bored and move on. But they think something is wrong with them. “What we’ve found is that they need to find a job or career that is not static,” Malonai says, “or they need to have supplementary activities and hobbies. Or they have to be okay with the change and transition, but then there is the question of everyday life and paying bills.” Many of these women are likely ADHD and gifted, often referred to as having “multipotentialities.” Malonai points out that this kind of movement from job to job is more accepted in men, but she sees it all the time in women.
Introversion and High Sensitivity
“I’m doing a lot of work with companies and schools and organizations these days, and I hear a lot of personal stories from people,” Susan Cain tells me. “And some of the people who I talk to or work with are straight-up introverts, and then an awful lot would describe themselves as highly sensitive, so I’d say I work with both types.” We are both parked in our cars during this conversation, and we giggle at the shared fact of loving to work from our cars because of the quiet and serene solitude they offer. Her debut book, Quiet: The Power of Introverts in a World That Can’t Stop Talking (2012), was life-changing for me when I read it. I had also published my own initial “coming out” personal essay about neurodiversity on her website, Quiet Revolution, and now after months of emailing back and forth, we were finally catching up by phone. (Quiet Revolution has since evolved as a resource for educators, workplace leaders, and individuals to help them navigate introversion and leadership, and more. What Cain calls “introversion” she sees as a constellation of traits, often including high sensitivity and sometimes shyness.)
We all know by now that if workplaces, families, friends, bus drivers, rideshare service drivers, front desk people, and others knew about diverse temperaments, traits, and neurological makeups, then we might be far less anxious interacting with them and much better able to “perform.” And I mean actually do stuff and get stuff done—without crashing, melting down, shutting down, or developing severe migraines. Most of the time we can’t get every person in our ecosystem on board, and so it is partly up to us to figure out our own hacks, best practices, and other activities that help us navigate our days.
“It’s helpful that people now have some self-awareness about these traits,” Cain says. “We can’t overestimate how important that is. A lot of people tell me this—that once people became aware of themselves as sensitive people or introverts or both, that gave them the permission to be themselves and carve out the space they needed to protect themselves. And it also gave them the confidence to use their gifts the way they were meant to be used.” People are now emotionally giving themselves permission to be, she says. “And there’s a weird paradox that happens—that the more people give themselves the permission, the more proficient they become in settings that you would think of as not suited to their best strengths.” So, she says, the more people feel okay about being sensitive, the better they’ll do in a stressful situation because they show up as their full self, instead of being full of self-doubt.
I’m nodding in agreement. “The keyword here is integration,” I say. “Yes!” Cain responds, filling me with that good vibe that we are on the same wavelength. And then she explains how just being able to name something can be powerfully healing. “When I first started speaking to companies, they only wanted to hear about stuff that was relevant to people as workers or productivity or leadership. But now I’ve noticed they’re really wanting to be helpful to their employees in a more whole-person type of way. Now they’ll tell me, ‘Spend time talking about raising introverted children.’ I think there’s more openness in general, especially in inclusion spaces.”
Cain expresses delight at the way companies have started to open up about temperament being another form of diversity. And it’s true—when such difference is respected and accepted, people feel more free to be themselves, and their best work comes out. Well-being and “wellness” are inextricably linked to work, productivity, and leadership. It’s important that we understand ourselves and our own diverse bodies and temperaments so we can avoid outdated anxieties and thrive.
Hearing My Body
Speaking of bodies, to give you some context, at the time of the following interview I had come to a personal realization that I crave a deeper bodily sense of who I am, where I am in space, and how I process people and the world around me—and how all of this affects my happiness, well-being, and relationships. I love heavy thick blankets, as many sensitive, neurodivergent people do. But more than that, spreading throughout my life—childbirth, friendship, love, grief, community—I had come to the realization that I crave processing events and experiences with my whole sense of body and self. Talking with a group of women isn’t enough—I want to dance and drum alongside all the chatting. Exercise classes aren’t enough—I want deep philosophical conversations as we are sweating it out in a gym. Being a journalist, I went straight to the experts and researchers who can explain some of this from a scientific standpoint.
Lisa Quadt is running a new clinical trial on improving heartbeat perception and measuring whether anxiety might be reduced through such perception. It’s a simple yet powerful proposition. The trial is based on the research of her colleague Sarah Garfinkel at the University of Sussex.
People can measure their body signals in different ways, Quadt explains, such as sweating palms, feeling the heartbeat, or measuring the pulse. “We have found in autistic people, they tend to not be very accurate. But they think they are perceiving these signals all the time. Their perception gets overwhelmed with signals coming in all the time, so there’s a mismatch.” Quadt and her colleagues found out that the bigger the mismatch, the higher the anxiety—and the level of the mismatch predicts anxiety levels. “If we can match this—make the signals and perceptions more accurate, then maybe the anxiety will go down,” she says. Again, the theme of anxiety is paramount.
So Quadt and Garfinkel are teaching study participants how to more accurately read heartbeat sensations—and monitor corresponding reductions in anxiety. This seems to echo the simple yet powerful realization I had been having around the importance of bodily awareness and how it relates to my feeling more centered in my daily life. It’s as simple as counting heartbeats. Eventually Quadt and Garfinkel want to develop an app or have this kind of monitoring be a part of smart watches. She says certain types of mindfulness training could also adapt and incorporate interoception-focused therapy and heartbeat-counting.
They were still in the clinical trial phase when I spoke with Quadt, so she didn’t yet know the final results, but in the meantime people can try timing themselves at home with and without a finger on their pulse and then compare the two results. This is easier to do if you do a couple of jumping jacks or other exercise just before you measure—if you stand up right now and try to merely sense your pulse, it will be tough. But if you stand up and do a few jumping jacks first and then try to sense your pulse, you may notice it’s much easier.
When I ask Quadt about interoception in general and why it’s perhaps more challenging for sensitive neurodivergent women, especially autistic women, she mentions sensory overload and high anxiety. Bus rides, for instance, present challenges with noise and dizziness. “The interoceptive signals that go from the body to the brain are kind of led in a different direction,” she says. She adds that sometimes autistic and other neurodivergent individuals may notice their heartbeat and then overreact. Whereas a neurotypical person may simply notice it and then move on, a highly anxious autistic person may become alarmed and worried.
Cognitive behavioral therapy doesn’t work for everyone, though I have found it somewhat helpful for reframing situations, behaviors, and interactions—and understanding my past. But after living in multiple cities, trying different talk therapists, and then trying more somatic ones—which did help with bodily awareness—it was clear that none of it would comprehensively address questions of autism, ADHD, sensory challenges, and more. That kind of improvement came from doing the research—reading studies, interviewing researchers, writing articles—and writing this book. As I have already said, simply having information can be life-changing—and one of the best sources of help, healing, and growth.
Something that has been working for me lately is imagining my amygdala—the part of my brain that helps process fear and anger—“cooling down,” like shrinking or going from red-hot-fire red to a cool-calm-soothing blue. It really works! I always wanted to be one of those people who could find little hacks for myself, since so many mainstream approaches don’t quite fit with me, and this has been one of my proudest breakthroughs. So when I start to get overstimulated or irritated, I imagine my brain, my brain stem, and the whole of my nervous system. I picture the entire system cooling down and the whole of my body filled with a velvety ocean blue. And I feel as though my body thanks me in the form of calming down. It’s as though my internal body parts have been wanting my attention—wanting to be acknowledged. And once I acknowledge them, I can signal them, through vivid visualization and color, to calm down.
Not surprisingly, these intense bodily perceptions—of our own senses and those of others—are especially powerful in the lives of women. Quadt confirms much of what we have explored in this book already: women are usually diagnosed much later in life than men/boys, and the societal pressure to mask is much bigger for girls. Autism and other neurodivergent traits thus become expressed differently in men and women. And Quadt confirms what so many others have told me and I have related in this book: “For most women I see who got their diagnoses late, it was such a relief because finally they knew what was different about them and they could get information about it and meet other autistic women and see they’re not so different after all and there’s a community they can be in and just understand themselves better.”
Quadt concludes our conversation by reiterating the heightened empathy autistic people have, as well as the need for society to make room for autistic and neurodivergent people. “I hope that the neurodiversity movement gets bigger and seen more,” she says. “I don’t see autism as a disorder at all. It’s a difference in perception, emotion, cognition, and action, but it’s just different, not lesser in any sense. I hope that the new research that shows high empathy, for example, will lead to societal change. We need to make space for everyone. And I hope research can help push that forward.”
The Other Side of Wellness: Medication
Medication is of course another route that many people consider when looking for ways to deal with heightened sensitivity and the impact it can have on their lives. I took Prozac (fluoxetine) for a year, and it seemed to dampen my sensitivities a bit, particularly the rageful feelings I had during logistical conversations with my husband. That was the only feature I really wanted some support with, since I love how my sensitivities inform the rest of my life, even if challenging at times. I tapered off the Prozac just as my career was picking up steam. (As a side note, a key personal observation I have been able to make is how central my professional life is to my healing. Knowing how I like to hyperfocus and become absorbed in meaningful material has allowed me to embrace that even more, and the energy of it has kept me in a steady place.)
Psychiatrist Lawrence Choy’s story parallels mine in some ways. A UC Berkeley graduate who then went to Stanford Medical School, he didn’t find out that he had ADHD until after he’d finished his psychiatry residency. He started digging further into new neuroscience studies and piecing things together, all the while getting treated for the ADHD. This new information drastically altered his perspective on psychiatry, and the DSM, and he launched an entire clinic in Silicon Valley devoted to entrepreneurs with ADHD.
“My approach is understanding symptoms and behaviors based on how our brain works, as opposed to what the DSM says,” Choy says. “For example, with ADHD, if you meet a certain number of symptoms and depending on your age and functioning, you get the diagnosis. It’s not based on neuroscience. But by looking at how the brain works and how the prefrontal cortex gets activated, we use medication to hack the functions of the brain.”
He feels his approach is destigmatizing because he’s not looking at ADHD as a disorder. But I noticed that the website for his clinic uses the term “disorder,” so I asked him further about this. “Right now insurance compensates through the language of disorder. I wanted to make a radical shift, but I also have a business partner who reined me in and serves as a check and balance. We’re operating between two models.”
This is a challenge for many practicing physicians, therapists, and psychiatrists who are also neurodiversity advocates. There is a push and pull between diagnostic requirements and what the in-person experience is between patient and doctor. Straddling progressive approaches with current medical system requirements, Choy has learned to ride the waves. “I have ADHD myself, and when I went through this discovery, I was basically in this born-again mode where I was telling everyone about this. I realized I needed to start telling people about this new approach—over time, my intensity diminished and I learned that change takes time.”
The current system and model treat symptoms and “disorders” with medications, Choy says, but they aren’t really helping people get to the “next level” in their lives with meaningful goals and accomplishments. Medication can help a person focus, and once a patient is able to focus better, Choy looks at what the patient wants and helps that person “optimize” and move toward those goals and accomplishments. “Stimulants are still the mainstay of treatment [for ADHD],” Choy says, “but most clinicians use stimulants based on symptom improvement like being attentive and less forgetful. But on a macro scale it’s about using these medications to develop the prefrontal cortex, which is where executive functions are”—such as attention regulation, impulse control, reality testing, and judgment. “If that part of the brain is more online, people can start seeing more things about themselves that they didn’t see before.” He says the more you use the brain, the stronger it becomes, “and then a transformation is made.”
It’s refreshing to chat with Choy. Language and vocabulary choices still echo those of pathologization, but he and others are trying to move beyond that paradigm.
Expanding Definitions of Mental Health Care
Chris Cole is a therapist for people in addiction recovery who specializes in the intersection of bipolar disorder and an alternative framing of mental health challenges called “spiritual emergence.” This views “mental illness” as a process whereby deeper artistic and intellectual gifts begin to stir and ultimately manifest in innovative contributions to society. Cole hosts a popular podcast called Waking Up Bipolar, and we spoke one morning after months of emailing back and forth.
“I got into working in mental health via wilderness therapy, coaching, and instructing in a variety of mental health settings,” he tells me. A self-identified HSP, he has helped spur awareness and action in his local professional community around embracing the neurodiversity framework within therapy practices and educational settings. In particular, he says, “I appreciate the intersection of queerness and neurodiversity,” as he identifies as gender queer.
“I got really curious about having a different emotional experience and the positivity of sensitivity.” He tells me how he started to understand more about the HSP label through research articles and found it a positive reframing of sensitivity. “The positive side is that I’m very in touch with what it’s like to be emotionally attuned to people,” he says. “My barometer for the insight into another person’s nervous system is a little more keyed up, which serves me in a therapy setting as someone who is trying to help people articulate an experience or emotion. And as a parent in a family setting, I feel much more able to respond because of that sensitivity. I can give my two boys the gift of reading their emotional landscape and the micro expressions of how they’re experiencing the world.”
Cole says there is a harder part, though, which is that the level of self-care and boundaries he needs to have in place are much greater. On a practical level, he has to carefully manage his schedule, sleep, and food, and he practices mindfulness meditation. The “negative” part, he says, is having to accommodate the fast-paced nature of our culture, which burns him out quickly. “My sensitivity affords me a great passion for helping people and creating transformation in the world, but that has to be balanced with the unplugging and settling back into what feels more natural for my nervous system.”
I ask Cole how he works with highly sensitive clients, and he tells me about both the practical and the philosophical aspects. “Being able to really validate the person for their sensitivity is important. There’s such a tendency to be pathologized for being sensitive, and this pathologization—because we are social creatures—makes it vital to have another person reflecting back the positivity and wisdom of the sensitivity. I’m not very prescriptive, and I’m really asking open-ended, curious, motivational questions so that the therapeutic experience is personalized to them.” He also helps people navigate seeking care and services, such as psychiatric medication. He wants to educate and empower people in the medical system, since so many patients quickly become pathologized.
“For example, if someone is diagnosed bipolar and they see a doctor for help, many people don’t have enough information about what [the diagnosis] really means. A diagnosis is just a list of symptoms, and if you meet those symptoms for a certain duration of time, then you qualify for the diagnosis. So that’s the first thing people need to understand: it’s an appraisal of symptoms.” He then discusses the utility of a diagnosis and points out that it’s only as effective as the treatment it helps provide. One of the reasons to have a diagnosis is to know what kind of treatment to give, he says. This information helps people orient to what is actually happening. “My job as an advocate for helping people to think about this through a neurodiversity lens is to ask the person to consider which symptoms are a problem. That restores agency. Symptoms like agitation or irritability are often named. And then figure out steps toward basic harm reduction and improving quality of life.”
Cole details the complex position he finds himself in at times when he is operating in traditional neurotypical psychology settings where pathologization is rampant. “I have compassion for folks who have power—parents and doctors, among others,” he says. “I know many psychiatrists who are really big-hearted, well-meaning people.” But he acknowledges the painful psychological symptoms that often arise for sensitive neurodivergent people in what he calls a “society that is so disconnected from its nature.” Such people are expected to live their lives out in “such a callous world.” He says it takes extra effort to operate in pathology-dominant settings. “It grates on me,” he says. As a sensitive person, “I feel like I’m doing a lot more work than others in the room, because I’m holding the pain of the person who has this diagnosis and it’s being discussed in a way that doesn’t take into account the greater context of humanity. It’s a kind of microaggression or subversive quality that takes a lot of effort to stay present with.”
So then the question arises of how therapists and doctors at the cusp of neurodiversity-infused clinical care are to go about their work. As Joel Salinas said, the idea is to treat distress, not difference. And with any new approach or movement, there is a period of transition and the merging of new and old ideas. Practically speaking, says Cole, “In order to work with Medicaid, there has to be a medical jargon and treatment orientation in order to serve the person who needs services. So there’s a challenge—I want people to have greater access to good psychotherapy, and at the same time in order to do that they have to find psychotherapy within a medically dominant paradigm. So it’s a catch-22, because in order to abandon the medical system, the financial burden falls on the consumer. To pay out of pocket for therapy that is anti-oppression, that is hard. I want to serve, but I am also forced to diagnose.”
So Cole says he has been taking charge of integrating neurodiversity with mental health approaches in counseling and is hopeful in his “little community” in Colorado, as he calls it. “Our community counseling centers are talking with me about my work around this. I have seen how counselors, therapists, social workers, and psychiatrists are very excited about the way that the neurodiversity paradigm could be implemented into mental health in a way that still allows people to get the services that they need. I think that’s the growing edge.”
The “edge” that is hard for clinicians to hold is how to still talk about the problematic or painful symptoms of such experience—and Cole says there has to be a new sophistication in how to hold the complexity of both the liberation of alleviating pain and suffering and the liberation that comes through the “anti-oppression of confronting the cultural, medical, and societal assumptions of these symptoms.”
Since “trauma-informed care” has become a recent buzzword, I also bring up the topic of trauma. The awareness of trauma and how it affects people’s lives has been fundamental and important, but problems have sprung up—mainly a kind of mind-set that wants to attribute everything to trauma, as though some kind of “normal” exists that everyone would return to if they just resolved all their trauma or didn’t experience any childhood hardship to begin with. This perspective is in danger of replicating the simplicity of past theoretical frameworks. There can be natural variation in the human species—as the neurodiversity framework suggests—and on top of that, some people may experience trauma. The integration of both viewpoints and frameworks is what is important and necessary.
The Sound of Sensitivity
During the course of my interviews, especially with occupational therapists and those working in the trauma field, the topic of sound came up again and again. It may not be the first thing we think of when we think about sensitivity or trauma, but neurodivergent folks are affected more intensely by sound than neurotypical individuals. The role that hearing plays in our experience of the world cannot be understated.
At the heart of current thought and concern around sound is the effect that noise has on our nervous systems. Recent research into sound and well-being suggests that extreme low frequency sounds, like the hum of a refrigerator, and extreme high frequency sounds, like a car horn, trigger our nervous systems into fight-or-flight states. But what researchers and practitioners do with this information differs greatly.
Take Stephen Porges, a professor of psychiatry at the University of North Carolina, who developed a music-based intervention for people with auditory sensitivity, including those with SPD and ADHD, and those on the autism spectrum. The Safe and Sound Protocol (SSP) is an approach that helps steer people away from triggering sounds in order to rewire the nervous system and how it interacts with the middle ear structure. The SSP is based on research showing that establishing a sense of safety in the nervous system will result in calmer, more regulated behavior. The intervention involves a gradated music system heard through headphones that progressively sensitizes an individual to sounds—removing triggering sounds—and gets the person back to a state of regulation. Many adults and children have expressed intense satisfaction and overall reduced anxiety with the intervention.
Bill Davies, a professor of acoustics in the UK who is also autistic, would have us focus much more on the role of the environment, policy, and societal structures as opposed to individual interventions. He notes the role of noise pollution and new regulations emerging from governing bodies like the World Health Organization, for example. As an autistic person, he is much more concerned with inequality in sound design and thinking about how soundscapes affect people in unequal ways. He says cars, for example, are the biggest contributor to noise pollution. So his is a macro viewpoint on the policy of noise and how sound design can more intentionally help foster well-being.
Then there is Lindy Joffe, an occupational therapist who raises particular concerns about how schools are designed and built. For instance, they often rely on linoleum floors, exposing preschoolers to noise bombardment because of how sound bounces off such floors. She tells me about the importance of getting kids out into nature to be exposed to the sounds humans were designed to hear. Anxiety has become one of the biggest issues that people come to see her for—a newer development, she says. As for adults, much like the other occupational therapists I interviewed for this book, Joffe says that most who come to her for depression or anxiety have never had their underlying sensory challenges addressed. And so simple interventions in nature, such as brief camping trips, can be just as helpful for adults as children because of how natural sounds help regulate the nervous system.
So hearing, sound, and the middle ear structures are all points at which neurodiversity, occupational therapy, and the trauma field meet. Some may view auditory sensitivity as the result of trauma—which for certain cases it could be—but for many of us, the trauma comes from a world that is simply too loud. There are different kinds of trauma—the very nature of being human is to be subjected to life experiences that shape us, in both challenging and uplifting ways. Everyday life etches into our being, informing our personality and characteristics. As Teresa May-Benson said, everyday life is sometimes a trauma for folks with SPD, for example. So sound is important to think about in our daily lives and as we take steps toward improved well-being. Regardless of how it may come about, many of us just want a society and daily routine that feel more compatible with who we are and who we want to grow into being.
Divergent Wellness: Tips for Taking Care of Yourself
You can take steps to begin making this shift into a sensory-compatible lifestyle. The following suggestions are taken directly from my own experience. Because I’m a journalist and not a therapist, I can’t prescribe to you what you should do, but I can help synthesize what I’ve seen, observed, researched, and experienced.