I once heard a story about the famous composer Igor Stravinsky describing how as he lay on his deathbed he kept knocking with the ring of his finger at a nearby rail. The behavior somewhat perturbed his wife who was in his company until the very end. “Why are you knocking at the rail with your finger?”, she asked. “You don’t have to worry, I am here,” she added. To which Stravinsky answered, “I know you are here, but wanted to make sure that I was also still here.” The story may be apocryphal and I may have paraphrased the original wording. Still it reminds me a little bit of some of the sensory integration disturbances observed in autism. Losing your body plan and its relationship to space seems to be commonplace among autistic individuals, and the cause for many tantrums.

“Losing your center” is an expression often applied to a person who is not satisfied with his/her situation in life. They may be discontent with what is going on in their lives, their priorities, and where they seem to be headed. For people with mental disorders the phrase may acquire a completely different meaning, making reference to a fragmentation of your sensory experience.

Many years ago I had the opportunity of listening to a lecture by Elyn Saks a rather famous lawyer who narrated her struggle with schizophrenia in the best selling book, “The Center Cannot Hold”. During the lecture Ms. Saks eloquently described experiences during her childhood and adolescence when her perception became fragmented. Simple things like slipping sand between her fingers at the beach acquired a different meaning as she could apparently concentrate on only one or another aspect of her sensory experience. Indeed she could appreciate and finely tune her attention to the reflections of light coming from the grains of sand but otherwise miss its texture and could not foretell where the sand grains were going to fall. This type of experience greatly alarmed her and were difficult to describe or convey to those around her.

Sensory processing difficulties have long been described by autistic individuals. They were part of the clinical histories provided in the original case reports of Leo Kanner and have been later emphasized in varied accounts by Bernard Rimland, Temple Grandin, Tito Mukhopadhyay, and Olga Bogdashina. It was only recently that the medical establishment caught wind of these historical accounts and included them in the new diagnostic classification, the DSM5.

In previous blogs I have written about sensory abnormalities in autism (see http://bit.ly/1FtgGRj and http://bit.ly/1L9OM4j ).Tito Mukhopadhyay said something to this regard in his book: “How can I talk if my lips don’t move?” In explaining some of his problems in learning to play badmington, he says, “I could not tolerate the game for longer than fifteen minutes. My body would feel scattered and my head would be dizzy, which happens even now when I have to be outdoors for long. My body feels more grounded indoors, protected by the four walls of a room. Standing in front of a mirror helps secure my scattered senses.” The explanation also revels why he feels more at ease indoors, in a familiar surrounding, and proposes a type of intervention offered by the security of his reflection in a mirror. For other autistic individuals reassurance may come from receiving pressure throughout their body as with a squeeze/hug machine or pressure jacket. I have also found that aquatherapy or simply spending time in a swimming pool may similarly have a calming and reassuring effect in many autistic individuals.