Hannah grabbed the flowers from her neighbours’ hands. As their eyes met, the recognition of her illness and the journey ahead, meant more to Hannah than the Australian natives she began placing in a vase. That unspoken connection between two which simply said “I know this is big and I’m here for you”. Hannah’s husband Gavin walked in and noticed the flowers. “What’s this for then?” he asked curiously. “For Hannah’s diagnosis” their neighbour responded, thrown back by the question.
“It’s only stage 1, it’s not like it’s fully fledged cancer…”
Hannah felt that familiar thud. Right in her chest, hard and sharp like a physical manifestation of the way Gavin’s words wacked her. Time stood still for a moment, as it always did when his word’s wacked. It bought her a moment to breathe, collect her thoughts and make a space for the intense feeling that followed. Whether it was shame or anger, it enveloped her. Whether or not it was shame or anger, depended on how strong she was in herself at the time.
Today it was shame, she hadn’t slept all night and the exhaustion made her a great candidate for self-doubt. “Had she exaggerated her condition?” “Did her neighbour only bring the flowers because Hannah had been a Drama Queen?” "Was she regretting spending the money now she knew it was only Stage 1?”
It wasn’t until her neighbour glared at Gavin and said “Are you serious? Hannah has cancer Gavin, that is as fully fledged as it gets”, that Hannah felt her body relax. The intensity and gravity with which her neighbour articulated the words may have caused tension in someone else, but for Hannah they were a relief. She wasn’t crazy, this was real, she wasn’t a ‘Drama Queen’. The shame dissipated and she turned on the tap to fill the vase.
When Hannah began therapy, she was convinced she was married to a narcissist. Gavin was continually minimising her world, often dismissing her thoughts as misguided and wrong while finding significant merit to his own, even when they appeared rudimentary and erroneous. He was hyper-focused on his own pursuits, saltwater diving being a particular hobby that would take him away regularly on weekends, weekends he would not miss for her birthday, their children’s sporting finals or the days she was grieving intensely after her mother’s funeral. Gavin would abruptly end conversations when he was no longer interested, and he would often not even look at her while he engaged in a predictable after work monologue about his day’s events.
Narcissists are crazy making. They use techniques such as ‘gaslighting’ to undermine their partner’s sense of reality and purposefully and maliciously manipulate the truth to meet their own needs. They teach others that they are superior, and they show little interest in topics that don’t centre around them. Hannah felt Gavin ticked all of the boxes. But Gavin wasn’t a narcissist…After a few sessions of couple’s therapy it was evident that Gavin had undiagnosed high functioning Autism Spectrum Disorder (ASD).
Autism is a neurodevelopmental condition that is characterised by particular difficulties in social and emotional reasoning skills, narrow or obsessive interests, and discomfort with certain sensory stimuli. People with autism can miss social cues, can have ridged, rule bound behaviour and can have difficulty seeing the whole context of a situation. They can, however, have an acute eye for detail which serves in many professions. As individuals with autism can have a tendency towards an obsessive approach to work and hobbies, they can often become more highly skilled in these areas than many neurotypicals.
Individuals with high functioning autism, which was known as Asperger’s until 2013, are by definition, of average or above-average intelligence and have therefore been able to mask many of their symptoms by learning socially appropriate behaviours. While some may present as shy, many are able to play the role of charismatic charmers which often makes diagnosis difficult.
Gavin’s eventual diagnosis was both confronting and a relief to the couple. Hannah and Gavin could all of a sudden see their journey through a new lens and from that they could make decisions. In counselling I often refer to neurodiverse couples (where one is neurotypical and one presents with autism) as individuals from two very different cultures that need to step back from everything they thought they knew about each other and, instead, become curious as to the customs, rituals, tendencies and needs of the other culture.
For example, individuals with autism tend to have a bottom up approach to thinking while neurotypicals tend to have a top down approach. Bottom up refers to perception being driven from the smallest pieces of sensory information. Top-down refers to perception that is driven by cognition, whereby your brain knows what to expect and fills in the pieces to create an overall picture.
To demonstrate the difference, I often draw the numbers 10 to 15 with the number 13 looking more like the capital letter B, rather than the numeral is it meant to represent. Usually, the neurotypical partner will identify the number 13 (using their top down processing to make an assumption that the B was meant to be a 13 because of its position). On the other hand, the client with autism will usually argue that it is a letter B, regardless of its context because the markings are joined whereas they would be separated in a number 13. If it was a debate, both sides could argue their points with equal merit.
So, when Gavin sees Stage 1 cancer, he sees that it is small, treatable and hasn’t spread anywhere else, therefore it’s not “fully fledged”. This becomes his literal truth and he responds according to it. When Hannah sees Stage 1 cancer, she sees the fact that her mother had Stage 1 cancer before it progressed to Stage 4 and she is scared. This is as big as it gets for her and there are dozens of micro-subtleties to her story that are stirring her emotions. She wants reassurance from the person whose role it is to give it to her, her husband.
For many neurotypicals in relationships with autistic partners, having their truth reflected back inaccurately, over the years, begins to undermine their confidence and leaves the scars of self-doubt, shame and a complete inability to trust their own perceptions, similar to those who have been the victims of gaslighting by a narcissist. Others feel contempt and frustration toward their partner and enter counselling with the aim of it being the beginning of the end of their relationship.
Although the identification and recognition of neurodiversity in their relationship doesn’t result in all couples choosing to stay together, the lens through which they see each other, and their mutual history changes. Compassion, understanding and many “Ah ha’ moments occur. For those choose to stay together the work begins. As their therapist, I find myself taking on the interpreter role for the couple while we explore their differences in relation to processing tendencies, expectations, values and social, emotional and intimate needs.
As Hannah and Gavin became the ‘curious scientists’ of their relationships and learnt effective ways to communicate with and validate each other, their lives became less frustrating and painful. Hannah was able to recognise that her viewpoint was valid and regain her confidence. Gavin was able to recognise that referring to the social and emotional context of a situation served in terms of connection. Both recognised that this was difficult for Gavin to do, so Hannah was able to concretely communicate that need when it was important to her and Gavin would honour it by bring reverence to these contexts. Hannah no longer saw Gavin as sinister and controlling and could see the efforts he made and the strengths he brought to the relationship.
Two years into therapy, when Hannah went to her oncologist for follow up test results after she was cleared of her cancer 12 months earlier, she was surprised to see Gavin in the waiting room. Although Gavin was certain that there would be no issues with Hannah’s health, he had recognised that she wasn’t certain and had learnt that she benefited from comfort and support (more than minimisation via his version of the facts). As they sat together in the waiting room, they realised something in union. Neither was right and neither was wrong, they were simply two good people who were doing the best they could to learn the language of each other.
Hannah and Gavin are fictional representations of themes in the clinical setting.