From 2018 to 2023, I experienced a series of episodes that I came to understand as autistic burnout, of varying degrees of intensity and persistence. Until 2022, I was self-diagnosed with autism but had not received a professional diagnosis, and neither I nor anyone else connected my symptoms of autistic burnout with autism. After a year of profound exhaustion, I began to undergo episodes of "brain fog" or semi-consciousness, which I eventually came to call dissociation, as a kind of personal shorthand. A friend of mine eventually called 911 for me (with my permission) and I was admitted to the hospital for a week, where they ruled out absent seizures, and then a wide range of mental health conditions, before sending me home without an answer. It was clear to the hospital's psychiatrists that I had PTSD, but for what reason no one could say. During the course of these five years, I strove to keep a demanding full-time job, with mixed success at best. I was often on leave and unable to work. At the same time, my workplace refused to give me almost any kind of meaningful accommodation while I was at work; the approach of HR was quite black-and-white. My situation was made more difficult since, for the majority of this time, I had no formal diagnosis other than PTSD. 

Over time, I began to link my speech delays, my difficulties with executive function and with dissociation, first to autism, and then to autistic burnout. Late in this interval (around 2022), I underwent an autism assessment and received a formal diagnosis. Over the course of the next twelve months, I attempted once more to return to work full-time, and found myself gradually sliding into a deeper period of exhaustion and autistic burnout than I had ever before experienced. I had been struggling to speak quickly for a long time; in the spring of 2023, however, I lost the ability to speak at all, and then I lost my ability to use my AAC. First, my struggles with ARFID (a restrictive eating disorder) became more pronounced; over time, I lost the ability to prepare meals, then to get out of bed, and then to feed myself. I was too exhausted and too lacking in motor skills to get out of bed. I worried that, if my condition continued to deteriorate, I would begin to have trouble breathing. At one point, I was able to call an RN hotline and was told to go to the hospital immediately, but I did not feel it was possible. Fortunately for me, my family had been checking on me regularly for a while, and when they visited me in this state, they packed me into a car and drove me the two thousand miles home. They doubted that I could handle an airport or a flight. 

While it was clear that my autism was in many ways the root of these troubles, it was not clear whether autism could fully explain what had happened to me; many or most autistic people, after all, do not experience such a spiral. In the last week, however, I began to have the glimmers of a possible answer. The first glimmer occurred when a new psychiatrist asked if it were possible that I had been so depressed that I had been catatonic. The term "catatonic" seemed like a fit, as a close family member had referred to one of my prior episodes as an "almost catatonic" state. But it didn't seem to me that depression was the cause. Not long after, I came across the term "autistic catatonia" in a very helpful discussion on reddit: one user suggests that autistic catatonia is the most likely cause of mutism among autistic people who are not nonverbal (apologies for the double negative; referring to some people as "verbal" would likely be confusing). As someone with a Level 1 diagnosis, who is not typically nonverbal, but who has had protracted periods of being nonspeaking, nonwriting, and noncommunicative, the phrase "autistic catatonia" really made me perk my ears up. I was especially intrigued because I had been referred to as quasi-catatonic or possibly catatonic by multiple people with ties to the medical field. I was very fortunate that a quick internet search for "autistic catatonia" led me to a number of useful sites and resources. Before too long, I had learned about the work of Dr. Amitta Shah, a leading scholar of autistic catatonia, whose earliest work on the subject had already been published by 2000. Since then, Dr. Shah--a distinguished clinical psychologist--has written numerous articles, in a range of venues, as well as a monograph entitled Catatonia, Shutdown and Breakdown in Autism. Dr. Shah's work has already been immensely helpful, and intriguing, to me, as so much of it seems describe my own recent condition (I'm basing this statement not only on my own subjective experiences, but also several others' observations and opinions of the matter).

Here I arrive at the point of this autobiographical note: I am confident at this point that, in my own case, my transition from moderate to severe "autistic burnout" was actually the onset of mild catatonia, which was steadily worsening as I was refusing to treat it seriously, and which eventually reached quite a dangerous stage--not only because it produced trauma and suicidal ideations, but because catatonia in itself carries a high risk of morbidity and mortality.

Furthermore--and here is the most important part--I have come to suspect in the last week that "autistic burnout," as a phrase and as a colloquialism within the autistic community, sometimes (not always) describes the onset of mild autistic catatonia, and that the overlap has not been recognized by researchers. Autistic catatonia is a much more well-established clinical term, but research on the phenomenon is nonetheless quite limited, with relatively few clinical studies on it having been published. "Autistic burnout," on the other hand, is quite well-established within the vernacular of autistic people and autistic communities, but it has only been introduced to formal academic study within the last few years. 

In what follows I will begin the work of drawing a comparison between "autistic burnout" and "autistic catatonia," to show their quite suggestive similarities. My point here is not to make a conclusive case--I am not a medical researcher, or a public health researcher, and in any case I only thought of all these things this past weekend. It is only to provide food for thought, and perhaps some casual "aha!" moments, for other people, and maybe to provide a basis for my own and others' further reading and writing. 

Research into autistic catatonia is well-established; early work in the field had been published by the year 2000, and study of the topic has continued since. As recently as 2022, a major overview of the topic was published in the journal Nature--which, as many know, is one of the most prestigious scientific journals in the world, with a readership of three million unique readers per month. (The article is titled "Catatonia in autism and other neurodevelopmental disabilities: a state-of-the-art review.") As a result, it is easy to find descriptions of autistic catatonia online. 

Here are a few basic facts about autistic catatonia. (I should note that the following list is in a draft form and requires better attribution):

* Somewhere between 5% and 20% of autistic people are said to present with catatonic features at any given time.

* Autistic catatonia may apparently be triggered by stress or trauma, but its onset does not always have an obvious cause. 

* Autistic catatonia is often hard to recognize, even for clinicians, because its presentation is quite gradual; as a result it seems very different from the sudden-onset stupor that is more familiar and instantly recognizable as catatonia.

* Possible warning signs of the onset of autistic catatonia include a "marked and obvious deterioration" in movement, volition (will), level of activity, or speech; or a regression in self-care, practical skills and independence compared to previous levels. 

* All of the following are also indicators: marked reduction in speech or complete mutism; increased slowness; freezing during actions; increase in hesitations; difficulty in crossing thresholds and completing movements; increased reliance on physical or verbal prompts for functioning; reversal of day and night sleep patterns;

* Autistic catatonia obviously shares many features with autism itself, to the extent that the two can be very difficult to distinguish sometimes. The difference is often simply that autism is a congenital condition appears in early childhood, whereas the disorder of autistic catatonia is not congenital but can appear among autistic people at any time: "the symptoms in catatonia are typically new-onset ... or due to a considerable worsening of existing symptoms." In other words, a person experiencing autistic catatonia may describe themselves, or be described by others, as "more autistic." 

* Another way to spot catatonia, as distinct from autism itself, has to do with "a change in the type and pattern of premorbid functioning (Ghaziuddin, Quinlan, & Ghaziuddin, 2005)." In other words, "reliance on prompting may significantly increase while the ability to execute previously mastered tasks, such as dressing oneself or completing a meal within a reasonable amount of time, significantly decreases."

* Finally, autistic catatonia--especially in its more severe forms--is sometimes diagnosed by means of the “lorazepam challenge test”  (Dhossche, 2014; Sienaert, Dhossche, Vancampfort, De Hert, & Gazdag, 2014). "An individual suspected of having catatonia is administered one or two milligrams of lorazepam intravenously or intramuscularly. The test should be conducted when a diagnosis of catatonia is suspected (Sharma, Jena, Sharma, & Agrawal, 2014). A positive response to the test, which is rapid resolution of all catatonic symptoms, strongly supports a diagnosis of catatonia (Sienaert et al., 2014). Similarly, zolpidem, a non-benzodiazepine, is also used to diagnose and treat catatonia when there is a lack of response to lorazepam (Sienaert et al., 2014)." Lorazepam (common trade name Ativan) is often used to treat catatonia in a variety of forms. I can attest that, when I took Ativan late in the progression of my deterioration, it produced a sudden and surprising lucidity and a kind of return to self; it was very different from my experience of taking Ativan earlier in my life, when it had a sedative effect. 

It is worth bearing in mind that all of these warning signs, with the exception of the last, are merely the markers of mild or moderate catatonia. They do not trace the whole progress of catatonic deterioration, which can become quite severe. In other words, while the onset of autistic catatonia may be gradual, and while mild forms of catatonia do exist, it is not necessarily a "less severe" or less acute form of catatonia. A resource page at the Association for Science in Autism Treatment, written by Jan M. Downey (MA, CCC-SLP, TSHH) and Mary E. McDonald (PhD, BCBA, LBA) helpfully distinguishes among the mild, moderate, and severe forms of autistic catatonia. Most of the indicators in the list above below to Downey and McDonalds "mild" or "moderate" forms of autistic catatonia, which they describe as follows: 

Individuals with moderate autistic catatonia present with limited mobility and a decrease in speech-language and communication skills, self-help skills and activities of daily living. These individuals exhibit extreme slowness in the ability to initiate, continue, and complete a task. The autonomic system may or may not be affected to some degree. The mild form of autistic catatonia is similar to the moderate form, but presents as less severe and does not typically involve the autonomic system.

Troubling as these symptoms may be, autistic catatonia may develop into a yet more dangerous form. As Downey and McDonald note, 

In [the] most severe form [of autistic catatonia], the stability of the individual’s autonomic system is affected, potentially impacting heart rate, blood pressure, body temperature, digestion, metabolism (thus affecting body weight), urination and defecation (individuals become incontinent), breathing and swallowing. Total immobility is also a possibility, with reliance on others for all previously mastered self-help skills and activities of daily living. Individuals previously demonstrating some verbal skills may also become mute. The individual is at risk to lose a substantial amount of weight and experience dehydration due to decreased food and fluid intake. This severe presentation of catatonia-like deterioration in ASD necessitates hospitalization as the individual is at significant risk for serious medical morbidity and mortality (Shah & Wing, 2006).

In other words, because autistic catatonia often worsens progressively, signs of mild catatonic deterioration (loss of speech, loss of coordination, regression in independence, et al.) should be taken  seriously. Catatonic deterioration can be reversed most easily when it is caught early; on the other hand, if allowed to run its course, it can become severely debilitating and even life-threatening, and in these more advanced cases, it is also much more difficult to treat. 

Clinicians frequently note that catatonic deterioration is often made worse by the misdiagnosis or misunderstanding of clinicians and caretakers, who may mistake the symptoms of catatonia to be laziness or recalcitrance. As Maureen Bennie writes, at the Autism Awareness Centre ("Autism-Related Catatonia: Shut Downs, Mobility, and Speech Difficulties After Early Childhood"), "It is important to understand that the effects of movement are not under voluntary control. The person is not deliberately being manipulative, aggressive, stubborn, willful, obstructive, or lazy."

There are a number of suggestive connections between mild/moderate catatonic deterioration and what autistic people frequently call "autistic burnout." Both autistic people writing about burnout and clinicians writing about catatonia frequently discuss loss of speech, either partial or total: at times this might take the form of difficulty finding the right word (anomia), of slowed speech or of partial speech; at other times, the autistic person might become completely nonspeakaing. (The anonymous author of the blog "Musings of an Aspie" offers a compelling record of their own experience of partial speech loss, in "Uncooperative Words and Where Do I Go From Here.") 

Other shared features might be more subtle. As an example, I've included a simple graphic made by @actuallyautisticalien and circulated on reddit.com/autisminwomen. 

The telltale features of "autistic burnout," according to @ActuallyAutisticAlien, include "loss of skills," "seeming more 'clumsy'" (loss of motor skills or coordination), profound exhaustion, memory loss, "not getting things done" (loss of volition/loss of independence), "seeming more autistic" (a vague catch-all which was nonetheless noted, in more clinical language, by the scientists quoted on the previous page), and "digestive issues," which can be a sign of dysautonomia. There is an obvious and profound similarity between @ActuallyAutisticAlien's "signs of autistic burnout" and the clinical descriptions of autistic catatonia given on the previous page.

At times, descriptions of autistic burnout go beyond loss of speech, loss of coordination, loss of volition, and other typical features to describe more severe experiences that may well be catatonia. Kieran Rose, of The Autistic Advocate, writes of his experiences with severe autistic burnout as follows: 

Autistic Burnout is exactly that: the shutting down of mind and body. ... If you’ve ever had a problem with a computer and it’s had to go into safe mode--that would describe what happens to the brain – it runs on limited function, not all services are available--its access to the Internet... denied and unable to connect. ... Physically I often imagine it as the need for hibernation, where the body effectively stops all but the most important functions, the heart rate slowed, breathing distributed evenly and slowly, hovering on the precipice between sleep and death.

To me--speaking only as a single reader, and by no means as an authority--Rose's account resonates with many descriptions I have read of autistic catatonia, as also my own experiences of (what I believe to be) the disorder. This is all the more true as Rose describes his encounter with "autistic burnout" (or catatonia) in its most severe form: 

my physical body and mind started shutting down.  I could feel each system in my body closing off as gravity got heavier than it had ever been.  I didn’t know what to do – did not understand what was happening to me – I had no way to communicate this.

I cannot speak for Rose, of course, but to my subjective ear, this account speaks--with devastating specificity--to the loneliness, trauma, and terror of the autistic person who is experiencing progressive catatonia and has no way to describe this experience to others, much less to be taken seriously. This experience of complete isolation, of a lack of language to cry out for help, is not uncommon to such accounts.

Recognizing the overlaps between autistic burnout and autistic catatonia may help us to "pool" our knowledge about these disorder(s), in order to better understand how to prevent their onset. While clinicians writing about catatonia generally claim little knowledge of how and why catatonia might emerge, autistic people often have a very well articulated sense about what things might bring on autistic burnout. If in fact burnout and catatonia overlap, then it falls to reason that the autistic community has a well developed collaborative understanding of the natural causes and precursors of mild catatonia. These causes include major life changes, illness, and other well recognized stressors, just as clinicians have speculated, but they also include features that clinicians might be less prone to spot themselves. Autistic people, for example, are much more likely to focus on the demands of masking as a major source of autistic burnout. They are likewise much more likely to focus on unmasking as a source of recovery. 

Just as significantly: recognizing this overlap may help us to pool our knowledge in such a way as to treat these disorders more effectively. Autistic people have produced a wealth of treatment advice internal to their community, which often focuses on rest, on unmasking, and on taking leaves from work, school, and play wherever possible--sometimes much longer leaves than would seem normally advisable. Clinical psychology offers environmental and psycho-ecological approaches to catatonia, which underscore the wisdom of conventional autistic treatments for burnout, while simultaneously emphasizing the risks of letting burnout go unchecked. It also offers potential pharmaceutical treatments, as clinical studies have shown that lorezapam is very commonly effective among people with catatonia. A person suffering from extreme autistic burnout might inquire with a physician about trying a course of Ativan in order to help treat or to help rule out catatonia (although of course not all catatonia responds to lorezapam). Patients suffering from burnout might benefit from reading Dr. Shah's Catatonia in Autism, which emphasizes the catatonic patient's intensive need for intensive care and support, and outlines what kind of support might be most helpful--in contrast to some writings on burnout, which emphasize the importance of independence and self-sufficiency. Patients suffering from mild to moderate catatonia might benefit from reading Dr. Raymaker's "Defining Autistic Burnout," and in particular the wonderful and moving recommendations on pp. 138-139, as to how to recover from burnout.

Dr. Raymaker's work on autistic burnout contains an invaluable table of suggestions for surviving or avoiding burnout. It bears noting that, elsewhere, Dr. Raymaker has explicitly distinguished between autistic burnout and catatonia, suggesting that catatonia may be feature in burnout but that burnout itself is a distinct, and generally broader, phenomenon. Yet these suggestions (found on pp. 138-139 of her 2020 article) may help those suffering from catatonia as well as those suffering from less severe forms of burnout. I also list them here in order to synthesize them with some of Dr. Shah's recommendations, discussed below.  

Many people suggest finding communities and social connections where masking is unnecessary, or otherwise finding ways to unmask:

"[My burnout] might have even come sooner than it did had I not been around some communities of people who were generally more accepting of ‘‘quirkiness,’’ and so provided some periods of time where I likely was needing to mask less, or less intensely."

"The biggest thing of all you can do to prevent, or at least mitigate burnout, is to start identifying what you do when you Mask and stop. Even just little things like eye contact, which so many of us do, or at least pretend to do. Allow yourself not to be sociable if you don’t want to be."

Many people also suggested withdrawing for a while, by self-isolating or by finding other ways to decompress: 

"Give yourself a break, go hole up in a cupboard under a blanket for a few hours, or.run or cycle really, really fast (sometimes the wind rush can literally help clear away the cobwebs because so much sensory information is cut out). A big sensory break every few days, or weeks, coupled with smaller sensory breaks throughout the day could make the world of difference."

"Take a spiritual retreat [laughs] like that’s not a definite way of curing it but that’s the only way I came up with is give yourself a break, withdraw into your own world and give yourself a break."

"I have gone through a few distinct periods of burnout and have successfully managed them by withdrawing from the world as best I could."

At the same time, those interviewed frequently emphasize reaching out to others and being able to request and accept support. Frequently, they emphasize the importance of a supportive and understanding network: 

"Have a healthy support system set up of people who will accept you as you are and not try to change, fix or shame you."

"Having a supportive person or persons who understood my anxieties in their complexity and helped me face what I could not change by understanding why it was so difficult for me. Having a loving support system that would respect and allow me to just be how I was until I could sort out the issues."

"Try to find people who.accept you and I know that’s not always, you know, not always possible but community is out there you know, if the person has a way to connect to it, the community, that’s a good source of support."

"Learning to be able to ask and accept help from trusted authorities (Ask and Tell by Stephen Shore is a good book)."

"Asking for help and accepting help is an important skill to succeed through autistic burnout."

This emphasis on finding and receiving help is also found in Dr. Amitta Shah's recommendations in Catatonia, Shutdown and Breakdown in Autism. Shah's book is an invaluable read, and cannot be summarized here. Shah is very transparent that the book is designed for clinicians and caretakers; it is definitely not a DIY guide to recovering from autistic catatonia. Some autistic people may even find its language (including use of terms like "high-functioning") to be a bit off-putting.  Shah is very direct about the challenges of living alone for those who might be recovering from catatonia; one of the strongest recommendations of this book might be for the person in burnout to find a way to get as much direct support as possible. She suggests that a great deal of support may be necessary for recovery, and that even one-on-one support might be necessary in the early stages of healing.

Many of Shah's recommendations for managing catatonia echo those provided by autistic people for managing autistic burnout. This is so both at the level of individual suggestions and at the level of broad themes. The studies of Shah and of Raymaker et al. are united in recommending lots of support. They differ, however, in two major ways. First, while (as I am suggesting) there is substantial overlap between burnout and catatonia, the overlap is not total, and catatonic breakdown is frequently much more severe than other forms of breakdown or burnout, requiring much higher levels of support. Second, while the advice collected by Raymaker's study was directed toward autistic adults, Shah's advice is intended for those who support them.

Perhaps as a result of these functional differences, the recommendations of Shah and of Raymaker can sometimes diverge in important ways. In those cases, I typically found Shah's work to be counterintuitive and sometimes even corrective of my own approach to healing. One example had to do with its attitude toward total rest. Shah also points out that the wrong kind of rest and immobility can actually make the problem of catatonia much worse, especially when it produces too much withdrawal and isolation. The divergence of Shah and Raymaker's advice may suggest that many of the strategies which are useful in states of mild autistic burnout can in fact become counterproductive, or even dangerous, in cases of catatonic burnout. 

Far from secluding themselves in order to rest until they are fully recovered, Shah suggests, the catatonic person should receive as much support as possible in order to help them maintain their day-to-day physical routines. In fact, much of the role of the one-on-one carer as envisioned in Dr. Shah's book is to help catatonic people to maintain as much of these daily routines as possible. She writes, 

“It is extremely important that the person should be given support, assistance, and as much help as they need to complete activities and to keep to their routine as much as possible. Although this seems obvious, parents and staff are often unsure as to how much help to give a person and how much to leave them to their own devices. I have come across very well-meaning parents, carers, or teachers who have left the individual to complete activities like eating, washing and dressing even if it is taking hours to complete. They, understandably, find it difficult to provide help and assistance to an individual who has been independent previously. I cannot emphasize enough how important it is to provide the help and support and to keep the person moving through their routine of activities throughout the day.”

Elsewhere as well, Shah cautions her readers against either a) too much passive rest or b) too much focus on independence and self-sufficiency. Instead, she proposes that people in catatonic breakdown might seek all necessary and possible support in order to continue going about their daily round, and especially to participate in their favorite activities, rather than be homebound as a result of their growing catatonia. She suggests that it is better for people in catatonic breakdown to travel to favorite places, in supported ways--for instance, by being driven, or even using a wheelchair as necessary--than simply to stay homebound. She suggests that caretakers

"[t]ry activities which are more physical, outdoors and active rather than table-top activities. Many autistic individuals find it therapeutic to spend time outdoors and connecting with nature and animals. Often, when someone develops catatonia-related breakdown, they become more housebound due to difficulties in walking and so on."

Shah gives the example of a young woman named "Ria," who, after she had  

"developed catatonia-related breakdown, .... was unable to attend day services and enjoy the interaction with others and her favorite craft activities. She became housebound as she became increasingly fearful of going outdoors. Ria was also unable to enjoy nature and community activities which had previously brought her a lot of joy. Staff were advised to use any strategies possible to enable Ria to pursue nature and community activities. The main problem was Ria’s mobility due to muscle wasting and fear. Once this was made a priority, staff found various ways to transport Ria to places where she could engage in activities which gave her joy. This had a huge beneficial effect generally on Ria’s catatonia symptoms which decreased substantially and improved her quality of life.”

Helping the catatonic person maintain physical routines should not necessarily require the catatonic person to speak extensively: “It is more important to relate to the individual through physical activities than through verbal discussions." At times, expecting too much spoken communication--especially around decision-making--can actually increase the pressure on the catatonic person, in a way that can lead to further deterioration. Prompting the catatonic person to act can often be extremely important in helping a suffering person go about their daily round, especially if they are prone to freeze or to get "stuck," but this prompting is often most effective when it takes the form of a gentle touch or a nonverbal form of signaling. She writes, for instance, that if the autistic person is "standing still and staring into space," an effective prompt might be "a light touch," rather than explicit verbal direction. The picture that emerges from many of Shah's examples is that of a friendly, companionable, even communicative silence. 

Significantly, while Shah is explicit about the risks of pressuring autistic people to speak or to relate to other primarily through speaking, she says very little about other forms of social performance such as masking, whereas autistic people themselves frequently put a very great degree of emphasis on masking as a factor in all forms of burnout. Patients suffering from catatonia might also be encouraged to unmask, as by stimming freely, by feeling free or having "permission" to avoid eye contact even in social situations, or in whatever ways feel safe and comfortable to them. Some autistic people choose to wear a face mask, even when not at risk of respiratory illness, because it lessens some of the burden on them to manage their facial expressions. Many autistic people are hyperaware of the ways that they mask in social situations and might welcome a chance to discuss these masking strategies, with a goal of figuring out how to circumvent them in order to avoid or lessen burnout. 

In general, Dr. Shah emphasizes the importance of helping the autistic person maintain physical activity; relating to them through physical activity (rather than excessive verbal demands); and helping them stay connected to the things and places they most enjoy. She cautions the reader against over-emphasizing independence or self-sufficiency, as long as the person is suffering from catatonia. Instead, she suggests that the caretaker or helper should do whatever they can to help the sufferer maintain consistent, timely, fluid physical routines, and to maintain strong attachments to their favorite things in life.  The words "joy" and "favorite" emerge several times in Shah's work: the catatonic person should be directed toward activities and venues which have previously brought them maximal joy, and they should be provided with any assistance necessary to help them seek out their favorite things: favorite activities, favorite meals, favorite social settings. Shah even suggests that, where an autistic person's mobility prevents them from going out into nature or visiting favorite restaurants in the way that they ordinarily might, they should be supported in any way they can to make this visit safely. 

Dr. Shah's writing also does a lot to underscore the value of even silent or relatively passive companionship for those struggling with catatonia. She writes,

“Providing one-to-one support to the individual is effective and beneficial at various levels. It provides security and reassurance to the person that they will not be left in a ‘paralytic’ state (which must be very frightening and stressful in itself)." 

The traumatic and traumatizing aspects of catatonia are not always well understood, but it is my view any my experience that PTSD is a very likely outcome of autistic catatonia, especially among people who are not supported and who are accustomed to living independently.  Undiagnosed and untreated PTSD among sufferers of catatonia may also contribute to the risk of suicide, which is a documented risk of catatonia. 

An implication of Shah's advice is that autistic people in catatonic burnout might have to make peace with relying on others and even giving up some independence and self-determination for a short time--a sacrifice that can be very difficult for many of us to make, for a range of reasons both good and bad.  On reflection, I feel that Shah's recommendations--with their emphasis on giving and receiving support--offer those with lower support needs a chance to interrogate some of their own internalized ableism. Independence and self-sufficiency are sometimes treated as self-evidently valuable by those who write about autism. Yet valuing independence can be a way that people with minimal support needs aim--often subconsciously--to distinguish themselves from those with higher support needs, typically because of unexamined and internalized prejudice against more visibly disabled people. An excessive focus on "independence" can thus divide the autistic community along lines drawn by internalized ableism. These kinds of distinctions--and a subconscious drive, common among some autistic people, to differentiate themselves from those who need too much help, too much support--may not ultimately be the best foundation for autistic activism or autistic politics, since they exclude so many people for whom self-sufficiency is neither possible nor desirable. A politics of seeking and giving help might not only be the best for our community; it might also serve as the best basis for the recovery from burnout, especially burnout so profound that it has become catatonia. 

Recognizing that autistic burnout and autistic catatonia are related are related phenomena could have many benefits for autistic people. Here are a few that come to mind. 

* The first is simple safety. Catatonia is a dangerous condition, and autistic catatonia is progressive if unchecked, often moving from mild to severe. Autistic people experiencing burnout should understand the signs of autistic catatonia so that they can self-monitor. They should know when to request medical supervision or even go to a hospital for care.

* Another benefit has to do with disability rights and disability advocacy. People with autistic catatonia frequently have a hard time seeking or explaining their need for accommodations, which may differ from the accommodations needed by other autistic people in the same workplace, or from the accommodations needed by the same person before the onset of catatonia. Recognizing autistic catatonia as a disorder with its own prognosis, separate from the autism itself, may help sufferers of catatonia to articulate their needs better and to get better supports at school or at work. 

*Likewise, understanding the link between autistic burnout and autistic catatonia might help autistic people to seek better medical care. Autistic people are used to being turned down, minimized, and even gaslit when they bring their concerns about autistic burnout to doctors. The term "burnout," which is commonly used to refer to a depressive lack of interest in work or to a period of normal strain and fatigue, may obscure the seriousness of the medical problems that autistic catatonia actually entails. It is possible that, if autistic people were to inform their doctors or psychologists about medical catatonia/catatonic deterioration, and to use the language of catatonia/catatonic deterioration, they might be able to have an easier time communicating their medical concerns, and thus to have more helpful conversations with their doctors. The risk of further deterioration might thereby be avoided. 

* By recognizing "burnout" as the onset of catatonia, we could better understand why so many autistic people experience burnout with dread or terror, and we could better understand how and why autistic people in burnout may be at risk of suicide, even though burnout is not at all the same thing as depression. Catatonia is a medically dangerous condition, one which can and should lead to hospitalization if it becomes severe enough, and which is often associated with morbidity and mortality. In my own case, I found myself experiencing increasingly severe and dangerous catatonia without any language to describe what was happening to me, or even any understanding of what I could say to an EMT if I called an ambulance: "I'm autistic? I'm too tired to get out of bed?" This fear, confusion, and ignorance about my own experience kept me from calling 911 as soon as I should have. It also led to the resurgence of my PTSD symptoms and the onset of new ones, as one primary cause of PTSD is the fear of major harm or death. Without the possible label of catatonia, I knew that I was afraid I would eventually stop breathing, but had no idea why I might be afraid of such a thing, and dismissed it out of hand. Reading about autistic catatonia, however, has shown me that untreated catatonia can, in fact, lead to the cessation of breathing. This knowledge helps me to understand my fear, and to commit to managing any such risk in future, which in turn enables my PTSD symptoms to retreat, as I can understand this dangerous and isolated state of growing catatonia as a thing of the past. By providing autistic people with the language of catatonia, we may lessen their isolation and thereby even their PTSD symptoms and suicidality. 

* Studying the link between autistic burnout and catatonia might help autistic people draw distinctions among the wide range of experiences and conditions sometimes described as burnout, especially among online communities, and to distinguish between milder forms of autistic burnout and catatonic burnout. If this link were better understood, it might also enable many self-diagnosed and self-diagnosing people to understand exactly what is meant by "autistic burnout," as they seek to assess their own experiences of fatigue as it might be relevant to a potential autism diagnosis. The term "catatonic burnout" might usefully enter the lexicon of phrases to describe these conditions (along with "catatonic-type breakdown" or "catatonic deterioration") in order to help bridge the language of these two communities (autistic people and clinicians).