Autistic Spectrum, Highly Sensitive Person, and
the Porous Personality
Autistic Spectrum, Highly Sensitive Person, and
the Porous Personality
People on the autistic spectrum, or with characteristics of 'highly sensitive person', may have an exceptionally highly powered brain, with greater than normal neuronal connections, and the potential capacity to register and process much more information than those who are 'neurotypical'. A relevant neurobiological model to account for this is the Markham's 'intense world theory'. According to this perspective, such a person can easily become overwhelmed by their own brain processing - the experience of too much going on - too much stimulation - and too intense. All this can give rise to chronic high anxiety. As a result, the person may engage in many activities and strategies functioning to reduce this intensity. Interactions with others may be strictly limited and regulated. Sensory stimulation and aesthetic qualities of the environment may be carefully curated. Emotional experience may similarly be titrated to avoid being overwhelmed. Routine and predictability of work and lifestyle may be valued over spontaneity.
One variant of these constellations is the 'porous personality'. Here is an extract from my book on ADHD and Autistic Spectrum:
The Porous Personality (and the ‘apparently normal’ persona)
[An extract from chapter 7 of my book The Disintegrating Self: Psychotherapy with Adult ADHD and Autistic Spectrum (Karnac/Routledge: London: 2015)]
From time to time, in a clinical practice of seeing several thousand patients
over a period of over 40 years, I have encountered people with what I
eventually recognised to be a particular constellation of characteristics that I
have come to think of a ‘Porous Personality’, because of the combination of
inadequate boundaries between self and other and between conscious and
unconscious mind. It has taken a very long time for me to grasp the nature of
this constellation – but eventually I realised that many of the more puzzling
and apparently obscure personality presentations seem to correspond in
certain ways to this description.
The patients I have in mind often present with a pattern of regular or
occasional self-harm, but this is not always the case. Such episodes of self-harm may seem to occur without any obvious precipitating event. The person
may seem very disturbed in ways that are not easy to understand. States of
extreme self-loathing, associated with self-harm or vomiting, might suggest
the possibility of repeated adverse experiences during childhood, such as
sexual abuse – but none is found in the patient’s narrative. Whilst aspects of
the person’s childhood experience might seem less than ideal, these do not
seem sufficient to account for the severity of disturbance. The person may
seem in some ways quite communicative, but in other ways rather private.
Gradually, she or he may reveal some odd states of mind, with unusual
imagery, fantasies or thought processes. These may appear to follow the
Freudian ‘primary process’, the language and thought patterns of dreams and
the unconscious.
The emerging impression (perhaps developing over a considerable period of
psychotherapeutic time) is that the person’s boundaries – between self and
other, and between conscious and unconscious mind – are porous. Primary
process material, that in other people is screened off from the conscious
awake mind, tends to leak into awareness, giving rise to cognitive experience
that does not easily find a place in social discourse and is thus essentially
autistic. For example, a patient reported a fantasy (accompanied by much
reticence and shame) of slicing her arms in multiple places and walking down
the street dripping with blood – and, on another occasion, of cutting out her
eye ball. Another described an aversive fantasy that the plate of food she was
eating had turned into a plate of faeces. Yet another reported an urge to
swallow a handful of sewing pins. The person’s humour may appear quirky. At
times, his or her perceptions, and interpretations of perceptions, may be
eccentric, bordering on the psychotic and paranoid – but never enough to
attract a diagnosis of schizophrenia. In some cases, however, the concept of
schizotypal personality may be of relevance. Sometimes hallucinatory voices
may be experienced, during childhood as well as when adult – but, again, not
in way that would typically lead to a diagnosis of schizophrenia (although
occasionally such an illness may develop). When highly stressed, brief
periods of more florid psychosis or hallucinosis may occur, but these are
rarely sustained. The person may present outwardly, and superficially, as
‘normal’, yet hidden autistic and psychotic characteristics can gradually be
discerned. In these ways, the boundary between conscious and unconscious
mind, secondary and primary processes, is more porous than in other people.
The second area of ‘porosity’ is in relation to other people. Boundaries
between self and other seem flimsy, and a quality of appearing ‘thin skinned’
is apparent (Rosenfeld, 1987). The person with a ‘Porous Personality’ may
correspond, in part, to the concept of ‘highly sensitive person’ (Aron, 1999),
and Eigen’s (2004) account of the ‘sensitive self’, as well as Kohut’s (1971)
description of narcissistically vulnerable people who are easily upset and
wounded by seemingly small slights, criticisms, or rejections by others. These
wounding events may be so subtle that their impact may seem puzzling.
Examples might include: an absence of a sufficiently warm smile, or lack of
sufficient enthusiasm in responding to the person or mild criticism or teasing.
These may trigger strong internal reactions of shame, withdrawal, and rage.
The person’s narcissistic vulnerability and sensitivity seems raw, with little of
the normal buffering that allows others to weather the emotional rough and
tumble of social interactions.
A crucial period for the development of disturbance in response to this
vulnerability seems to be primary school, from age 7. At this time, children are
becoming more concerned with the peer group, and rejections and other
narcissistic wounds experienced within peer social life take on greater
significance. The child may come home each day full of intolerable and toxic
feelings of shame and rage, as a result of repeated painful interactions – but
will not be able to explain to parents or teachers what is wrong.
The adults who develop the porous self constellation described here seem
always to have felt (but not always perceived by others as) somehow odd – as
different – not fitting it. The idea of feeling like ‘an alien in a human body’ is
often apt – but this can also, paradoxically, coexist with a capacity for unusual
empathy. As a result, the person can experience understanding of others, but
not by others. The ‘oddness’ is essentially part of the autistic spectrum –
which in females can be less apparent overtly than in males, since it is
covered by a greater social skill and relational seeking (Attwood, et al., 2006).
Social interactions are stressful for these people, at the same time as some
contact with others is needed. The claustro-agoraphobic conflict is dominant,
of experiencing too much contact as oppressive and ‘claustrophobic’, whilst
finding too little contact results in loneliness. Disrupted expectations and
changes of routine are also a source of stress and anxiety. All of this means
that the child, and later the adult, with these problems exist in a chronic state
of high anxiety. This may not be apparent to others because it is so constant,
albeit with periodic intensification. It is therefore a ‘normal’ part of that
person’s experience. In an attempt to cope, the child learns to override the
anxiety – creating a split between the outward, socially performing persona,
and the inner state of chronic intense anxiety combined with shame. The
outward, ‘apparently normal’ persona will lack grace and ease, appearing at
times slightly brittle or awkward. Sometimes, tell-tale signs of the underlying
autistic spectrum qualities may be glimpsed – such as repetitive bodily
movements, including hair stroking or pulling, and compulsive smoking,
particularly when stressed.
Although traumatic experiences may have occurred during childhood, in the
case of these patients the adverse events seem not to have been the primary
cause of the disturbance, but function more to emphasise and entrench the
sense of being different – or of being inadequate because of not coping – and
to intensify the shame.
A third area of porous sensitivity is in relation to sensory stimulation. In
keeping with their characteristics as ‘highly sensitive person’, these people
feel easily impinged upon by noises, smells, unaesthetic sights, commotion,
and ‘too much going on’. When overwhelmed with sensory and emotional
stimulation in this way, the ‘porous’ person feels a need to withdraw and be
alone. Too much contact with others is experienced as over-stimulating and
emotionally and energetically draining. Change or disruption of routines or
expectations may be highly aversive and disturbing.
Yet another area of porosity that is sometimes present is a tendency towards
‘clairvoyant’, ‘telepathic’, or other ‘psychic’ abilities (Brottman, 2011; Williams,
1998). An unusual awareness of other people’s thoughts, feelings, and
intentions, or of future events, can be confusing to both self and others.
Autistic writer, Donna Williams, comments:
One can respond to the body-mapped pattern of energy sensed and
that response may demonstrate a ‘knowing’ that is seen as ‘psychic’.
So, for example, I seemed constantly to surprise people who were
closely involved with me when I would phone them up out of the blue –
very often this would coincide with their just having mentioned me or
been writing to me or thinking of me. By contrast with their other friends
or acquaintances, the number of such occurrences was very high,
leading people to believe there was some kind of psychic occurrence
happening. Someone summed this up by saying, ‘you don’t have to call
Donna, you just have to think loudly about her.’ I would have said it
was not about thinking loudly but feeling strongly. In those days my
‘doors’ were wide open, too open, and too often. I’ve fortunately
learned how to shut those doors and to use them at least more by
choice than purely by resonance. [Williams, 1998, pp. 121-122]
The ego of the ‘Porous Personality’ feels threatened by both internal and
external stimuli. This vulnerability evokes shame and rage, usually directed
against the self.
The ‘Porous Personality’ has struggled with this sensitivity and vulnerability
from the beginning. Some develop what is recognised relatively easily as
overt autistic spectrum qualities, such as extreme shyness, social avoidance,
preference for routine and predictability, and aversion to strong emotions. Of
these, a smaller proportion may attempt to create a mode of being that is
based entirely on rational considerations and an avoidance of emotions and
attachment. One such person remarked that she did not want anything to do
with people or emotions because these cause pain – and she did not want to
be attached to anyone because people “either hurt you or they die”. Not
surprisingly, she struggled with a constant sense that life held no meaning,
purpose, or pleasure.
However, the patients I am focusing on in this account are those who develop
an extensive concealment of their sensitive autistic core. Outwardly, they
present as ‘normal’. Teachers may not identify any abnormality, and may
perceive the child as happy and outgoing. Family too may not recognise the
problem, until some degree of disturbance becomes overt during
adolescence. What appears to develop is a split between an ‘apparently
normal’ outer persona and the inner realm of shame and rage.
The inner realm is indeed a cauldron of toxic shame. By ‘toxic’, I mean shame
of a quality and intensity that cannot be psychologically metabolised. This is
hidden. It is in the nature of shame that the wish to hide is evoked – and also
that shame is itself shameful (Mollon, 2002). The person’s sensitivity is
concealed, covered by a social façade. However, the sensitivities,
vulnerabilities, and narcissistic wounds experienced in the course of ordinary
social and relational interaction, evoke not only intense shame but also rage.
The target of rage is the self (although there are some who express this
outwardly at others, such as toward the mother or a partner). A tirade of self-directed abuse may in this way be continually stimulated, resulting in hostile
inner self-talk and attacks on the body (which may also be hidden, such as
cuts on parts covered by clothing, self-inflicted blows, or overdoses that do
not require hospital treatment). The attacks on both body and mind cause
further shame, although the assaults on the body may be experienced as
soothing. This spiralling and intensifying ‘shame about shame’, with its
associated self-directed rage, may reach panic proportions – but all of a
nature that the person finds near impossible to explain to others, or indeed to
gain any clarity or distance for internal understanding. All the person feels is
panic, shame, and compulsions to self-harm.
Introspection into these states of mind may be alarming for the person
experiencing them – creating panic about panic, and shame about shame. It
is a self-fuelling system of disturbance, whereby each increment in shame
distress evokes a further increment, somewhat akin to a nuclear explosion
and with similar, but psychological, devastation.
Giving up the torrents of shame-fuelled rage against the self is not a simple
matter. This self-directed aggression may have formed a crucial structuring
function within the personality – providing a kind of ‘strength’ and keeping the
person’s behaviour in line. Thus the messages of internal abuse may be along
the lines of “you are pathetic – they will think you are stupid – you must not
show how you feel – stop being such a wimp” (albeit with more colourful and
vicious language). The person believes such voices are correct and that he or
she needs them. One patient described her voices as like an exoskeleton –
without them she would be formless and would have no direction. In extreme
cases, the streams of self-abuse take on stable forms as quasi (or even
actual) hallucinatory voices that appear to assume effective control over the
personality. Such voices never take kindly to being discussed. They are like a
military junta that has taken control of an otherwise weak or disintegrating
country, maintaining order and power through aggression, cruelty, and
intimidation.
Self-harm and the Prey-Predator dynamic
Self-harm, such as cutting the body, is often driven by shame, rage, and
anxiety, and apparently can provide immediate relief for some. This relief
appears to result from a sudden shift from the position of ‘prey’ to that of
‘predator’. Some hints concerning this dynamic are provided in a remarkable
book Blood Rites, by Barbara Ehrenreich (1997). She traces the history of
humankind, exploring the roots of fears of the predator, deriving from
primordial terrors of being eaten by carnivores:
The transformation from prey to predator, in which the weak rise up
against the strong, is the central ‘story’ in the early human narrative. [p.
83]
According to her thesis, the hard-wired terror of predators of other species
gradually shifted to a fear of human predators – fuelling the human
compulsion to engage in continual warfare and in other ways playing out the
prey-predator dynamic.
An awareness of this came to me during a particular session with a young
woman who fitted the Porous Personality pattern. She spoke of her feelings of vulnerability and shame about these. As I tried, with misguided empathy, to give further elaboration of what she seemed to be conveying, she became increasingly agitated and said she was experiencing escalating urges to self-harm at that very moment. Guided by her urgent feedback, I began to appreciate that her feelings of sensitivity and vulnerability were completely intolerable for her because in that state she felt herself to be in the position of ‘prey’. Self-harm has its relieving effect because it instantly shifts the person’s identity from that of ‘prey’ to that of ‘predator’. By harming the body, the person steps into the position of predator, even though it is her or his own body that is the prey. Once I had articulated this to her, she began to calm down.
What makes psychotherapeutic work with this kind of Porous Personality
organisation very difficult is that the whole structure of inner disturbance, with
its core of vulnerability around which is organised a ‘mafia-like’ patrol,
engaging in self-directed aggression, is hidden – split off from the ‘apparently
normal personality’ presented to the world, including the therapist. It is
possible to work with a patient for a long time without getting much glimpse of
this hidden structure.
Moreover, the ‘voices’ will emphasise to the person the foolhardiness of
trusting anyone other than them – particularly the therapist. This message is
easily received internally, since the person with a Porous Personality will have
spent years in childhood of feeling inwardly very alone, not understood, and
subject to rejections or bullying from peers (or even teachers). Even a kindly
and loving mother may be experienced as failing to understand or protect the
child.
Sometimes the impression is that the person’s emotional connections with
others have been so severed, through pervasive distrust, that hallucinatory
voices have become their only real companion. Their link with earlier
precursors, such as imaginary friends, may become apparent.
Summary of characteristics
The people I am describing may or may not potentially attract a diagnosis of
Aspergers or High Functioning Autism. In general, I am wary of categorical
diagnosis, since mental and behavioural states exist along continuums.
Moreover, the developmental and compensatory overlay and adaptations
complicate the clinical picture enormously. However, it is possible tentatively
to state the characteristics of the hidden autistic-hypersensitive core as
follows:
• Chronic high levels of anxiety – often unfocused, but exacerbated in
social situations, particularly in response to demands for social
performance
• A preference for order, routine, and predictability
• A life-long unease and inherent awkwardness in social interactions and
relationships – strongly concealed in some who have learned social
skills through observation, mimicry, and practice
• A life-long sense of being ‘different’ – like an alien in a human body
• Puzzlement at the motives, emotions, and thought processes of others
– although, paradoxically, this can co-exist in some with a marked
capacity for empathy
• Hypersensitivity – to both social and sensory stimuli
• Hypersensitivity to emotional injury, rejections, slights, humiliations
(narcissistic injuries) – ‘thin skinned’
• A tendency to ‘decompensate’ – severe (but usually temporary)
deteriorations in mental state, with psychotic, paranoid, or suicidal
reactions – in response to rejections or narcissistic injuries
• A tendency to avoid relationships because of this sensitivity
• Porous boundaries – easily affected by other people’s moods and
emotions – sometimes resulting in high levels of empathy and
interpersonal sensitivity
• Intrusions of ‘primary process’ thinking – images, fantasies, and
‘thoughts’ that are difficult to translate into social discourse
• A great propensity for shame
• Some propensity for rage (often hidden and directed toward the self)
• Clairvoyant and other ‘psychic’ or ‘paranormal’ abilities
Some people show these characteristics overtly – and thus can more easily
be recognised as falling within the autistic or ‘highly sensitive’ spectrum. It is
possible to achieve a healthy adaptation and self-acceptance in relation to
these core traits. However, the people I am particularly describing have
overlain this core with an ‘apparently normal’ personality which makes
recognition of the hidden problem much more difficult. This apparently normal
personality shows the following characteristics:
• Outwardly sociable – may be pleasant and charming
• Functions to conceal and protect the hidden autistic-hypersensitive
core
• Can be sensitive to others, displaying empathy and tact (but not
always)
• At times may display behaviour or reactions that strike others as ‘odd’
The ‘outwardly normal’ personality functions as a cover for the autistic hypersensitive core. It is what most people, including, for a long time, the therapist, will encounter. Hidden behind it is not only the autistic hypersensitive core itself, but also the shame, rage, and sense of inadequacy associated with this core. These are only gradually, if at all, revealed to the therapist. Family members, who have had most exposure to the patient from
the beginning, may have some partial awareness of the more hidden aspects
of the personality – but much may also be concealed from them.
Whilst this formulation may appear superficially similar to Winnicott’s (1960b)
theory of the ‘false self’, the difference is that this is a response not to an
intrusive or insufficiently adaptive mother but to the inherent vulnerability of
the autistic-hypersensitive core and its difficulties in the sensory and social
world.