I’ve been trying to determine what makes an environment more accessible or inaccessible to autistic people — or at least to me. I just got one clue this morning, when I almost swallowed a medication that I was meant to inhale.
I finally got in to see the asthma doctors I made the appointment for in January during the asthma crisis. They were, by the way, really good, determined a good goal for my peak flows and gave me an asthma plan. They also gave me a new medication called Foradil.
Foradil comes in gelatin capsules like many medications do, filled with a white powder. The difference is that Foradil comes with a strange contraption. You stick the capsule in the contraption. You squeeze the contraption to puncture holes in the capsule. Then you turn the contraption on its side and inhale the Foradil, discarding the capsule when it’s over.
Where the trouble comes in, is that I seem to learn things like this on a different level than most people do.
Most people seem to have little trouble applying a particular way of comprehending the world all the time. If they see Foradil, then unless their cognitive abilities are suddenly compromised in a major way, they know it as Foradil, an inhaled product, because they have put it into that category without even trying. They know that with Foradil, you take the capsule out of the foil wrapper, stick the capsule into the contraption, poke holes in the capsule, and inhale through the mouthpiece of the contraption. They know this because they’re constantly applying the category of Foradil or of inhalable to these things they’re looking at, this is effortless or close to it.
I have to be thinking about it to get to that point. By thinking about it I mean exerting a fair bit of cognitive force behind sustaining the idea of Foradilness. It’s not (as some people seem to imagine it) a matter of learning what Foradil is, it’s a matter of access to that knowledge being in place at the exact time when I’m going to need it.
I don’t learn to do things that way, I learn to do things by actions in response to certain general types of things. If something looks like a pill, the associated action is to swallow it, particularly if the pill is situated in my hand. I am relieved that I no longer have to give my cat pills because of the amount of effort it took to suppress the associated action of swallowing them myself. And it’s effort against a tide that feels totally natural. So it’s even one moment of distraction and I could swallow cat pills. Or in this case an inhaled capsule. Today I got it almost in my mouth before I realized.
I do regularly screw up which inhaler I use (because marking one red and one blue doesn’t change the way they feel in my hand), but that’s less problematic than swallowing a pill meant to be inhaled.
Part of what makes an environment inaccessible to me — in the most extreme sense — is that things in it are set up (such as pills that should not be swallowed, or drinking cups used to hold toxic or noxious substances) so that an automatic reaction to my environment (without engaging abstraction enough to check things like that) could put me in danger. A more accessible environment to me (and I suspect this is more accessible to most people, too, and just happens to be more extreme for me in the dangers of it not being this way) is one that promotes automatic reactions that I should be taking and discourages automatic reactions that I shouldn’t be taking.
For instance, my apartment has all one sort of flooring — tile. My last apartment had alternations between tile and rug that made it hard for me to get around. This one little change has made me more capable of using the refrigerator, microwave, and toilet even on foot. I also have clear locations for different activities, which allows me to associate different sets of actions with different parts of my apartment. Things like the computer and bed are out in the open so it is easy to get to and from them. But it is not particularly easy to get out a window.
These things also have to take place in the absence of signs. Here’s some illustrations I once did of the assorted fun variations words can take:
The actual text:
This is how it would be read by most people:
This is where I can tell it’s letters and am processing them as symbols, but don’t actually decode the letters. (They do not, for me, actually turn into such seemingly hieroglyphic characters, I was just picking a collection of things that are both clearly symbols and not readable to most people.)
This is where I can pick out the letters but they clearly don’t really conform into words in my mind.
This is them looking like real words that I can sound out and everything but I don’t get any meaning out of the words even if it sometimes feels like I should.
Part of a letter
This is a small part of a letter, I wanted to do an animated version sort of scoping around the letters but I didn’t. I could get wrapped up in the aesthetics of this curve for ages.
One by one, in order.
This is meant to be like reading one letter at a time, but the letters at least staying in order so there’s a relatively high chance of following at least a little of it with a lot of concentration.
One by one, scrambled order.
This is meant to be like reading one letter at a time, but not retaining the order too well.
This is when the forms of the letters are visible as squiggles but not as a readily recognizable set of symbols of any kind.
And none of that even gets into the sort of stuff that Helen Irlen and Alison Hale and stuff have written about with perceptions text, this is other stuff besides that. (And yes I already wear colored glasses.)
If I put a sign up, it’s generally squiggles until deliberately focused on. Sometimes it can be some of the others, but mostly squiggles. Signs have never worked all that well for me because of this exact problem, they simply aren’t read without conscious application of cognitive force, and you have to know they’re there before you apply that force. If I know they’re a sign I’ll probably read them (for form if not for meaning), but I have to know they’re a sign first.
Rather than signs it’s far more effective to put in various environmental cues that lead me towards some things and away from others. But what the best way to implement that is, especially in the matter of something like Foradil, is a mystery to me at times.