Written in May 2022

I wrote recently about shutdowns, making reference to the Loos Miller study of SD child who experienced what I called an unusual presentation of a shutdown, in that the child became unresponsive, limp, and eventually fell asleep when a shutdown was experienced. Over the weekend I had one of the worst shutdowns I have ever had and although I am not going to discuss all the contributing factors here, I experienced something similar to the SD child.

I believe what I and SD child experienced was a catatonic shutdown. Catatonia is a complex neuropsychological state (or response) which has usually been considered to be part of schizophrenia and other psychological disorders including as a trauma response. A catatonic state is characterised by an inability to move with limpness and pliability – the person may not be able to initiate movement themselves, but can be moved and physically manipulated into a new position in which they will remain (probably due to inertia/inability to move). Catatonia is also typified by inability to initiate or complete movements, or the compulsion to repeat certain movements with an inability to stop.

In autism, catatonia has an unusual onset and is not always recognised by clinicians, which can be dangerous as untreated catatonia can become a complicated and life-threatening condition due to problems with breathing and swallowing. Autistic catatonia includes some of the following:

• Inability to initiate movement
• Inability to cross thresholds (i.e. cannot leave or enter a room)
• Inability to complete tasks or movements
• Mutism or reduced speaking capacity
• Slowness and freezing during movements
• Becoming locked/frozen in postures or positions
• Reliance on verbal prompts to initiate or complete tasks
• Repetitive behaviours and movements

I experienced all of these except for repetitive behaviours and movements. I also found it hard to breathe (as in hard to take a full breath and like breathing was becoming a voluntary action rather than an involuntary action). I could still understand speech and direction and was able to watch TV, and intake some liquid during the day. There were periods of complete paralysis and a lot of freezing and becoming stuck when trying to complete a task or movement.

I realised that I have had shades of catatonia in many of my shutdowns, and that my limited movement during and after shutdowns is a symptom of catatonia. I was able to get out of this state by taking diazepam, which I had been prescribed after a severe mental health episode last year. The treatment for autistic catatonia is benzodiazepines and/or ECT (electroconvulsive therapy). Both act as a sort of reset for the brain. It may seen counterintuitive that a sedative drug can relieve what appears to be a state of extreme sedation, but when we understand that a catatonic shutdown (or catatonic breakdown) is an extreme reaction to stress and overwhelm it makes perfect sense. The thing that had helped me get out of a shutdown state in the past has also been diazepam, so it seems that it is the go-to treatment for catatonic shutdowns.

This piece is intended as a coda/complement to my previous piece on shutdowns, so the overall impacts, strategies for avoidance, treatment and recovery still stand. More information on autistic catatonia can be found here; it is clear that more understanding is needed.