my current journey started because of more than half a decade of being in a constant state of burnout.

Ah that makes a lot of sense then.

I would do recommend trying out the general advice for burnout management and see if that improves things for you

i have, and have been, for about three years now. it's made the bad less bad, but it hasn't made the good any more good

I think that's a really positive sign. I know how badly it sucks. Intimately. I've reached depths of burnout that I didn't realise I was capable of.

Imo the worst parts have to be reduced in severity before you start seeing glimpses of improvement in the good.

Hang in there.

what i already know is that i have autism and cPTSD. i've been in a constant state of stress for over a decade.

This makes a ton of sense.

so, the second journey was of course court-ordered applied behavioural analysis and institutionalisation for suicidal depression. i've been on just about every single antidepressant and antipsychotic and been thru every CBT-derivative psychotherapy you could probably name. y'know: treating symptoms (chronic depression, 'conduct disorder') rather than causes (horrible environment, trauma, executive dysfunction). the consistent effect was that it made everything worse (and in some ways: permanently).

This is a familiar story. Any therapist I see, I basically tell them straight-up that I'm allergic to CBT and that I ain't fucking with that shit anymore.

I'm not opposed to CBT if it works for someone but I've heard so many bad reports about CBT from autistic people, not to mention having things made a whole lot worse for me because of it. It might be confirmation bias but if someone is autistic and thinking about CBT-based treatment I'm always going to tell them to approach it with extreme caution.

Also CBT I think is pretty bad for people who have CPTSD. Put CPTSD and autism together and CBT is horribly counterproductive.

Also antidepressants tend to be pretty garbage for autistic people generally. I can't tolerate most of them. I've had some degree of success with mirtazapine, which is an unusual antidepressant in how it works, and same with agomelatine, which is a particularly unusual antidepressant (although I believe that it isn't available in the US). Otherwise? I've only had awful experiences with antidepressants.

now, in my current country, the barrier is that my doctors are suspicious of how direct and articulate i am with what evaluations and treatment options i'm considering. they're all either incompetent or their knolwedge is 40 years behind, and they've seemingly decided that i seem too introspective and too selfaware to possibly be feeling like shit. their prescription? join a book club and go back to work. and of course postcovid and burnout and shit sleep are making it hard to find the energy to argue with these people. so, that's cool.

I feel this. "You've got a lot of insight" is like a trigger phrase for me lol. I had to find a really good psychiatrist before I could make progress - one that was genuinely interested in working in partnership with me, and it's only since that point that I've developed an understanding of psychopharmacology, because I've been able to bounce ideas off of them and we've been able to talk about targeting specific things and to assess the effects of medication to be able to hone in on particular symptoms to find better medications.

Even then, my psychiatrist isn't very knowledgeable about ADHD or autism and yet they're better on these matters than any other doctor, psychiatrist, or psychologist that I've ever come across.

It sucks that it has to be like this. It sucks that I had to become my own amateur psychiatrist. But this is something that motivates my posting, especially in this comm - it was really fucking hard for me to bootstrap myself into understanding these things (I never paid any attention in science class) but I'm lucky that I have enough of the right factors that I can approach this subject and understand it to some degree. Not to shit on anyone else but I think I am extremely privileged to have the circumstances I do (e.g. I have a stable home life, I don't have to work 3 jobs to make ends meet, I can bend a special interest to my will enough to learn things sorta on demand, I've done a lot of groundwork to learn how to do autodidacticism properly, I have a psychiatrist who I can bounce ideas off of and who's willing to prescribe me most things if I can provide a decent case for it etc.) that make it possible to be knowledgeable about this stuff. And if I can make this stuff a little bit more accessible to other people who need it then I feel like it's really important work since so many of us are just caught in a massive drought of services, support, and information.

i understand being direct can make doctors get defensive, but i've tried the coy social engineering approach and it got me involuntarily hospitalised. *shrug*

That double bind really sucks, doesn't it?

I think two things that have been really useful in this situation is to come off as jaded - I've been stuck in this damn system for years and I've been through so much of it, so I'm going to let clinicians know that I'm a veteran. If that makes them feel threatened or defensive then I know I need to find someone willing to work with me on my level.

The other thing is that I'm just extremely honest - if I have misgivings about a treatment I'm going to voice them, if I think a clinician is wrong I'm going to tell them. This rubs some people up the wrong way but that's fine because if they can't deal with me unfiltered then we won't be able to make much progress.

If that puts some clinicians off from working with me then all the better. I'd rather identify the shit ones so I can move them along than to be stuck long-term with a clinician who I only realise is shit after investing a lot of time and effort.

anyway, thanks for the information and support.

No worries.

Sorry for rambling so much. I've started drafting a post on autistic burnout/catatonia in my head so I'm hoping that I'll be able to produce something on this topic soonish. I should be able to put some stuff in there that will be useful to you which will be more than the boilerplate advice about managing burnout.