Content note: since this post is about autistic meltdowns in adults, it’ll go into detail about how I experience meltdowns, and briefly reference self-harm.
The shopping centre is too busy. Too noisy. The lights are painfully bright. Every smell is violently nauseating. I try to push through; I have things to buy.
Two shops into my three-shop plan, I am disoriented. I’m in Clinton’s for a card, I know that, but everything is an assault to my senses. The cards are indistinguishable from one another. I am losing the ability to read. This sounds hyperbolic but it isn’t. I can recognise individual letters and, with a great deal of effort, entire words, but not phrases. Contextualising the words on the cards is near to impossible.
My breaths are short and sharp and I feel like not enough air is reaching my lungs but I don’t know how to rectify that. My joint pain, usually distracting but bearable, is now so close to the front of my mind that I could cry with it. I feel like I can feel every stitch of my clothing, scratching my skin, rubbing it raw. Simultaneously, I can’t quite feel any of my extremities – a combination of dissociation, and the very last of my proprioception abandoning me. My feet are too heavy and they thud clumsily underneath me as I stumble around the shop, unsure whether to ask for help or walk out but unable to soldier on like this. I know people are generally unfamiliar with autistic meltdowns in adults, so I know they all just think I’m weird.
I identify the shop’s exit. Leaving the shop means re-entering the shopping centre, which is busier. It takes several long moments to remind myself of the route out of the shopping centre and into fresh air. I sway on the spot in Clinton’s, vaguely aware that I look as crazy as I feel. I stare at the exit.
I leave the shop without buying anything but my chest and throat tighten as I enter the mass of people navigating the main body of the shopping centre, all desperate to reach their destinations. People brush past me and the sensory input makes me want to scream; I can’t discern whether that’s because it’s painful or because I simply cannot process anything any more. I make a series of guttural noises in the back of my mouth, a combination of humming and grunting, as I walk towards the exit onto the pavement outside. I don’t know it, but I’m weaving, unable to walk in a straight line. My vision is a tunnel but still a bright, ugly one. People’s faces are menacing blobs – if my own mother were to approach me now, I wouldn’t recognise her, and I would probably shriek at her proximity to me. (Fortunately, she is an entire county over and at home, so this will not happen.)
It’s only when I make it outside that I realise quite why my eyes were stinging – tears. I draw a deep, shaky breath and pull my phone out. By the time my partner answers my call, I am already sobbing.
Meltdowns related to Autism Spectrum Disorders (ASDs) look different in everybody, and autistic meltdowns in adults look different than those in children. For me, they are additionally complicated by my other mental health problems (namely: depression, anxiety, PTSD, borderline personality traits and as-yet-undiagnosed paranoia). But it’s impossible to separate the symptoms out from one another, by halves because of my own alexithymia and because of the frequent co-morbidity of autism with other mental health issues. To an extent, it doesn’t matter: a meltdown I’m having which features anxiety symptoms is still an autistic meltdown, because I am autistic and because I would be able to manage my anxiety more effectively if not for my ASD.
I am curled up in a ball on my partner’s sofa, my head on his knee. My eyes are so tightly shut that later I will complain of muscle fatigue in my forehead.
After every breath I draw in, I scream.
I wail at various pitches and volumes for what seems like hours. A steady stream of snot coats both my face and my partner’s jeans. He knows better than to touch me unless I directly ask him to, but he tells me, again and again, “It’s okay. You can make as much noise as you like. I’m right here. You’re safe.”
I don’t feel safe or unsafe. I just feel overwhelmed. So indescribably overwhelmed that the only way I can release any of it is to scream, and scream, and scream.
I don’t have these screaming meltdowns often. I suppress them in favour of other, less obnoxious coping strategies, like excessive stimming (in the best case) or self harm (in the worst). But I have gone too long without any form of self-regulation and I feel like I could break in two. So I scream.
Eventually, I run out of screams. I revert to vocalising in the back of my throat with my mouth shut. My partner keeps kitchen roll by the sofa in part for these occasions; ordinary toilet roll won’t do the job. I scrub as much of my face dry as I can and pull myself into a sitting position, still humming.
He makes the same suggestion he made half an hour ago: “Do you think you could take a promethazine?”
Promethazine hydrochloride (brand name: Phenergan) is an antihistamine that has a sedative effect. My doctor prescribed them on a PRN basis once she realised that handing diazepam (brand name: Valium) to someone with a history of substance misuse was a spectacularly bad idea, but getting me to take them is a struggle every single time. When I’m sufficiently overwhelmed, I become paranoid. When I’m sufficiently paranoid, I think medications with sedative effects are poisoning me slowly and that everyone who suggests I use them wants me dead.
But now I have no energy left to be paranoid. My throat and face hurt and tiredness cuts straight down to my bones. I nod, and my partner springs out of his seat to find a little blue tablet for me to take. He is gracious enough not to mention the huge patch of my snot that darkens his jeans.
When people tell me that I “don’t look autistic”, I have to restrain myself from slapping them. The truth is that whenever I “don’t look autistic”, I am living on borrowed time. I am suppressing stims, carefully regulating the volume of my voice, calculating the appropriate length of time to make or fake eye contact, and fending off countless sensory inputs imperceptible, insignificant and occasionally even pleasant to the neurotypicals around me.
I expend a great deal of energy to look just not-autistic enough to get through my day without being harassed, belittled or made fun of, and then I spend evenings hurting myself or screaming. I live in a prison of sensory overload and lack of self-regulation for the comfort of, and to avoid bother from, neurotypicals. And then they have the fucking gall to tell me I “don’t look autistic” as though they’re telling me I “don’t look ugly”, as though it’s a compliment.
I don’t look autistic because looking autistic, in this world, is less safe than looking neurotypical, blending in, and then melting down in private. This is why autistic meltdowns in adults aren’t represented all that often: they’re hidden from view.
But you can bet your ass I look autistic when I rock back and forth in my seat, sobbing and unable to verbalise to my partner that I need to blow my nose but have forgotten how, waiting for my promethazine to kick in.
And he thinks I’m cute as hell.