Latest news with #neurodivergence
ABC News
5 days ago
- Health
- ABC News
GPs welcome ADHD reforms but say cost and prescription barriers remain
When GP Naomi Rutten found out she would soon be able to diagnose patients with attention deficit hyperactivity disorder (ADHD), she was "delighted". For a long time, the diagnosis of ADHD has largely been restricted to psychiatrists and paediatricians. Dr Rutten specialises in mental health in the South Australian town of Gawler, about an hour's drive north of Adelaide. She has a personal investment in neurodivergence, with three neurodivergent children and her own diagnosis of ADHD. "I've got a half a dozen patients who can't afford the assessment, so [my patients and I] are super excited," said Dr Rutten, who is also president of the Australian Society for Psychological Medicine. "They'll be able to get diagnosed, trial some medication, and if it helps improve their function, it's going to make a world of difference to their capability to work, parent and be well in themselves." South Australia, where Dr Rutten practices, is one of several states to recently announce changes to ADHD management, which will allow GPs to diagnose the condition and, in some cases, initiate medication in the future. Changes in South Australia come into effect next year, while governments in NSW and Western Australia have committed to training up ADHD "specialist" GPs, and there is bipartisan support in Tasmania ahead of the state election for GP-led ADHD care. But with so much policy change afoot, doctors have warned that patients may still face out-of-pocket costs for assessments, as well as barriers to accessing medication, without further reform. One of the main barriers to ADHD assessments is cost, with some patients being charged thousands of dollars for appointments with psychiatrists, and others simply being priced out. Dr Rutten says patients will probably pay much less to see a GP for an ADHD assessment, but warns these consults are unlikely to be bulk-billed. That's because ADHD assessments require longer GP consultations, for which doctors receive a smaller reimbursement (from the government) than if they provide multiple, shorter appointments. For example, if a GP sees 10 patients in an hour, for six-minute appointments each, they earn around $690 in rebates. But if they see a single patient for one hour, they receive $158. As a result, Dr Rutten says GPs are financially disincentivised from providing longer appointments and more comprehensive care, and when they do, are forced to charge patients higher out-of-pocket fees. At her own clinic, Dr Rutten's patients pay $135 out of pocket for a 70-minute appointment. She says with a thorough ADHD diagnosis likely to take two or three long appointments, patients could face up to $405 in fees. In 2023, the federal government tripled the incentives GPs receive for bulk-billing patients. From November, these incentives will be applied to consultations with all Australians (not just pensioners, concession cardholders, and families with children). GP practices that bulk-bill every patient will also be eligible for an additional payment. But Dr Rutten says that for GPs to bulk-bill ADHD assessments, they need to be better reimbursed for longer appointments. The Royal Australian College of General Practitioners (RACGP), which welcomed the government's bulk-billing changes earlier this year, has also advocated for increased rebates for longer consultations, as well as an increase to mental health-related Medicare items. ADHD Foundation director Christopher Ouizeman also wants to see GPs better compensated for the work of diagnosing and treating ADHD, to help address the current "bottleneck" of people trying to access affordable care. "We think there should be some formalised structures in place to prevent the general public from being overcharged, and certainly to ensure that GPs are properly incentivised," Mr Ouizeman said. But in order to improve affordability and accessibility of ADHD care, he says more investment is needed in public psychiatry and paediatric services. It's an issue Tim Jones, a GP practising in rural Tasmania, is also passionate about. He spent two years working on a pilot program at Royal Hobart Hospital to try and improve access and timeliness of care for children with possible ADHD. Dr Jones said the program was successful — dropping wait times for kids from two years down to less than four months — but was cut short due to lack of funding. He believes a similar model, in which specialist GPs are placed in public outpatient clinics, could be implemented to improve access to ADHD assessments for vulnerable populations. "The only way I can see the equity gap being fully addressed is getting more GPs working in collaborative partnerships in public healthcare services," he said. "Private GPs and paediatricians have worked together as long as we've existed, but that has not been enough to meet the needs of the majority of our population." Another issue consumers currently face is difficulty accessing stimulant medication when travelling between states and territories. In Tasmania, patients are unable to get scripts filled if they are issued interstate, although there is bipartisan support to change this after the upcoming election. Elsewhere in Australia, scripts can be filled interstate, but this is an onerous process, given stimulant medications (the most common medicine used to treat ADHD) are classified as schedule 8 or "controlled" drugs. John Kramer, who chairs the RACGP's special interest group on ADHD, autism and neurodiversity, argues stimulant medication should be reclassified as a schedule 4 drug, with less stringent legislative controls. Schedule 4 drugs are considered less likely to lead to misuse, abuse or dependence than schedule 8 drugs, but still require more stringent controls than regular prescription medication. Dr Kramer says re-classifying stimulants would mean "people can move freely from state to territory and back again, and their prescriptions would be valid everywhere". He argues any potential risks could be managed through Australia's real-time prescription monitoring service, which allows GPs to see how often a patient gets their medication dispensed, and how many repeats they have left. However, others are more cautious. Dr Jones argues that stimulant prescribing — and any change to it — needs to be carefully considered in adults, as adverse effects can be "significant". The ADHD Foundation would also take a "very conservative position" on any re-classification, Mr Ouizeman said. "I'm not sure it's the right thing to do at this stage," he said. "Let's see how it goes with the existing [reform] frameworks, and if it's something that should be revisited later perhaps." Doctors in some states are also waiting on information about how GPs will be able to prescribe stimulant medication going forward. While regulations vary from state to state, GPs are generally required to "re-apply" for the right to re-prescribe stimulant medications (or make changes to prescriptions). Currently, in South Australia, GPs can prescribe stimulant medication for patients who have been diagnosed by psychiatrists, but to do so, must apply for approval to the Drugs and Dependency Unit. When approval is granted, it is generally only for a limited period, such as 12 months. Once this period is up, Dr Rutten must send patients back to a psychiatrist for review, leaving them further out of pocket. She hopes the shift to allow GPs to diagnose will circumvent this problem, but these details are not yet available. In NSW, GPs who have undergone training will be able to resupply ADHD medication to patients (without seeking re-approval) from September, with some able to initiate medication, though it's unclear when this will begin. RACGP vice president Ramya Raman says any changes to ADHD prescribing rules will be finalised at a state and territory level, but working towards a national approach is ideal. "I think [prescribing changes] will be part of the reform and progress that we are making," she said. "There have already been some changes in WA, and there will probably be [further changes] moving forward if we're working towards a national consistency model."
Forbes
5 days ago
- Health
- Forbes
Fatigue, Brain Fog And A Racing Heart — What Doctors Are Learning About Post-COVID Neurodivergence
FAIRFAX, VA- February 3 : Eve Efron, who has been struggling with long covid for nearly a year, ... More frequently has to rest on the couch in her home in Fairfax, VA on February 3, 2022. She was denied temporary disability by Mutual of Omaha from her job at a PR firm after her doctor recommended she take time off. Her symptoms include significant fatigue, brain fog, anxiety and depression. (Photo by Carolyn Van Houten/The Washington Post via Getty Images) Have you ever made people gasp by bending your knees backwards or touching your thumb back to your arm? Does your pulse race when you stand up? Do you have a history of gastric issues or irritable bowel syndrome? Are you also neurodivergent, by any chance? There is emerging, but compelling, evidence that the overlap between neurodivergence, hypermobility syndromes, mast cell activation syndrome, postural orthostatic tachycardia and dysautonomia is not a coincidence, and has a lot to do with COVID. The impact of these conditions can be severe on their own, though hard to diagnose and lacking in conclusive biomarkers. They lead to chronic fatigue, serious gastro-intestinal distress, brain fog and concentration difficulties, anxiety and depression. People drop out of the labor force, education and careers are curtailed. Prevalence rates are very hard to come by reliably, but estimates range up to 20% of the population affected by one or more of these conditions. Physicians have noticed that these diagnoses are also rising exponentially since COVID, which appears to trigger or exacerbate symptoms. An Invisible Problem Hiding In Plain Sight A special meeting at the Royal Society of Medicine (RSM) in London has concluded that neurodivergent people, who are more likely to have hypermobility, connective tissue and autoimmune conditions, have been disproportionately impacted by COVID, and that this is having a significant impact on our ability to go to school and work. The rise in neurodivergence since 2020 that is placing so much strain on education and health services, the tax payer and not forgetting the individuals themselves and their families, is indeed partly due to increased awareness and more accessible diagnostic criteria – as has already been argued. However, this does not explain why these high rates of diagnosis are accompanied by such vastly increased rates of school absence and inability to work. If neurodivergent people have always existed, why are we only now so unwell that we can't work? The presentations to the RSM suggested that the effects of COVID on the brain could be contributing to the skyrocketing ADHD and Autism diagnosis waiting lists and to the absence epidemic. Since COVID we've needed to ask for help, whereas before we could fly under the radar. Some people have dropped out of work or school altogether and are now battling to have their illness recognized. Others are still attending, but battling their own bodies, trying to force themselves to work through increasing difficulties with memory, unpredictable energy levels, pain, unstable pulse rates and various allergic inflammation. Their capacity for their work has been drastically reduced, they don't know why and try as they might to get better, it's not working. They are likely to be prescribed anxiety or depression medication in primary care and go looking for psychological answers to physical problems. Indeed, many of the markers we look for in diagnosing anxiety are, in fact, expressions of our nervous system – pounding heart rate, dizziness, hot / cold flushes. It is too easy to assign symptoms to stress and very difficult to identify the connections across the whole system. The Solution Is Also Hiding In Plain Sight It has taken a mixed group of medical experts in immunology, rheumatology, cardiology, urology, psychiatry and neuro-gastroenterology to connect the dots. At the RSM, they presented clear data indicating that for people with this overlapping group of conditions, neurocognitive and emotional symptoms have indeed increased. We're not making it up! Physical symptoms that were triggered by COVID infections have lowered our tolerance for sensory sensitivity in noise, smell, temperature, texture, light, food allergens, mould and all the toxicity in our environment. People who were neurodivergent a decade ago but coping in education and careers are now too ill to do so, and the effects of neuroinflammation could tip a sub-clinical neurotype into diagnosis territory. The meeting further presented the extraordinary evidence that effective treatments for these issues are already available, such as anti-histamines, probiotics, mast cell stabilisers – simple, cheap, low risk medications which have made the difference between someone working and not working. One of the presenters, Dr Stephanie Barrett, MBChB, MD, FRCP, a Consultant Rheumatologist, reported that non pharmacological and non-invasive treatment such as repeated transcranial magnetic stimulation (rTMS) has also been found to be beneficial. She reports: "RTMS (neuromodulation) was an extraordinary breakthrough for the treatment of depression. Now using a different protocol, we have shown that we can treat severe fibromyalgia with associated fatigue and dysautonomia, in patients who are stuck for decades in the pain/ fatigue prison. The additional challenge for our patients is 80% prevalence of neurodivergence. All the complex physical conditions and associations are treatable but they need to be recognised first. We could set up hubs with the government, at low cost to treat all these conditions and return people of all ages to education and the workforce." Each specialist presented various statistics, using many of the same treatments, indicating that a clear majority of their patients who were neurodivergent and unable to work before treatment are now back in work following an affordable protocol. Careers resumed, stories of people who feel they have 'got their life back'. Believe People When They Say They Are Ill In a country where productivity has dived since the financial crisis, and the health of the nation has not recovered from COVID, The Royal Society of Medicine are trying to understand the root causes, rather than paper over the end results. Neurodivergent people are at risk of losing their support from welfare payments due to changes to the benefits system, which could underrate the presence of multiple, mid-level symptoms, even though these all add up to a significant drain. Whilst political circles are arguing over the extent to which the population is malingering versus 'genuinely' ill, this group of physicians have come above the squabbling with a potential lever to tip the system from decline to healing. Following their proposed protocols, we can believe people who say that they can't cope, treat them and support their recovery to living a full life again. Neurodivergent people of all ages have been stopped in their tracks, creating career and educational hiatuses that cause long term damage. We are at risk of a lost generation of working age people who cannot understand their fatigue, who are trying their hardest but just cannot get moving, the more they try the harder it is (see: post-exertion malaise). If you think you might be affected by any of these conditions, take an inventory of your symptoms, however disjointed they are, and talk to your primary care physician. Even if they can't refer you to a specialist, they owe you an explanation for your difficulties, so remember to be clear about what's happening. It is so easy to write off fatigue and poor concentration as 'stress' – but stress existed before the pandemic. If your capacity has changed, and you feel like it's increasingly hard to cope with work you previously enjoyed or found easy, then this could be a physiological problem and you should speak to your doctor. Is COVID to blame for the rise in neurodivergence? The answer is complex. We have higher levels of awareness and improved diagnostic criteria. For children, we have failing schools where rigid curricula and draconian discipline disproportionately disadvantage neurodivergent children. In workplaces we have increasing demands for productivity rises and endless escalation of technology and surveillance. All this undoubtedly contributes to the absence epidemic, but all of it started before the pandemic. It doesn't fully explain the stark differences some studies showing that school absence has doubled from 2017 to 2023. The Royal Society of Medicine took some time to come at this problem from a less obvious angle, and in doing so have brought a cost effective solution into the light. It's time to stop assuming that people are lazy and time to stop putting multi-system health issues in the 'too difficult box.' As employers, as a country and as individuals with families to support, we can't afford to ignore the rising absence any longer.
Forbes
5 days ago
- Health
- Forbes
The Exponential Rise In Neurodivergence: Is COVID To Blame?
FAIRFAX, VA- February 3 : Eve Efron, who has been struggling with long covid for nearly a year, ... More frequently has to rest on the couch in her home in Fairfax, VA on February 3, 2022. She was denied temporary disability by Mutual of Omaha from her job at a PR firm after her doctor recommended she take time off. Her symptoms include significant fatigue, brain fog, anxiety and depression. (Photo by Carolyn Van Houten/The Washington Post via Getty Images) Have you ever made people gasp by bending your knees backwards or touching your thumb back to your arm? Does your pulse race when you stand up? Do you have a history of gastric issues or irritable bowel syndrome? Are you also neurodivergent, by any chance? There is emerging, but compelling, evidence that the overlap between neurodivergence, hypermobility syndromes, mast cell activation syndrome, postural orthostatic tachycardia and dysautonomia is not a coincidence, and has a lot to do with COVID. The impact of these conditions can be severe on their own, though hard to diagnose and lacking in conclusive biomarkers. They lead to chronic fatigue, serious gastro-intestinal distress, brain fog and concentration difficulties, anxiety and depression. People drop out of the labor force, education and careers are curtailed. Prevalence rates are very hard to come by reliably, but estimates range up to 20% of the population affected by one or more of these conditions. Physicians have noticed that these diagnoses are also rising exponentially since COVID, which appears to trigger or exacerbate symptoms. An Invisible Problem Hiding In Plain Sight A special meeting at the Royal Society of Medicine (RSM) in London has concluded that neurodivergent people, who are more likely to have hypermobility, connective tissue and autoimmune conditions, have been disproportionately impacted by COVID, and that this is having a significant impact on our ability to go to school and work. The rise in neurodivergence since 2020 that is placing so much strain on education and health services, the tax payer and not forgetting the individuals themselves and their families, is indeed partly due to increased awareness and more accessible diagnostic criteria – as has already been argued. However, this does not explain why these high rates of diagnosis are accompanied by such vastly increased rates of school absence and inability to work. If neurodivergent people have always existed, why are we only now so unwell that we can't work? The presentations to the RSM suggested that the effects of COVID on the brain could be contributing to the skyrocketing ADHD and Autism diagnosis waiting lists and to the absence epidemic. Since COVID we've needed to ask for help, whereas before we could fly under the radar. Some people have dropped out of work or school altogether and are now battling to have their illness recognized. Others are still attending, but battling their own bodies, trying to force themselves to work through increasing difficulties with memory, unpredictable energy levels, pain, unstable pulse rates and various allergic inflammation. Their capacity for their work has been drastically reduced, they don't know why and try as they might to get better, it's not working. They are likely to be prescribed anxiety or depression medication in primary care and go looking for psychological answers to physical problems. Indeed, many of the markers we look for in diagnosing anxiety are, in fact, expressions of our nervous system – pounding heart rate, dizziness, hot / cold flushes. It is too easy to assign symptoms to stress and very difficult to identify the connections across the whole system. The Solution Is Also Hiding In Plain Sight It has taken a mixed group of medical experts in immunology, rheumatology, cardiology, urology, psychiatry and neuro-gastroenterology to connect the dots. At the RSM, they presented clear data indicating that for people with this overlapping group of conditions, neurocognitive and emotional symptoms have indeed increased. We're not making it up! Physical symptoms that were triggered by COVID infections have lowered our tolerance for sensory sensitivity in noise, smell, temperature, texture, light, food allergens, mould and all the toxicity in our environment. People who were neurodivergent a decade ago but coping in education and careers are now too ill to do so, and the effects of neuroinflammation could tip a sub-clinical neurotype into diagnosis territory. The meeting further presented the extraordinary evidence that effective treatments for these issues are already available, such as anti-histamines, probiotics, mast cell stabilisers – simple, cheap, low risk medications which have made the difference between someone working and not working. One of the presenters, Dr Stephanie Barrett, MBChB, MD, FRCP, a Consultant Rheumatologist, reported that non pharmacological and non-invasive treatment such as repeated transcranial magnetic stimulation (rTMS) has also been found to be beneficial. She reports: "RTMS (neuromodulation) was an extraordinary breakthrough for the treatment of depression. Now using a different protocol, we have shown that we can treat severe fibromyalgia with associated fatigue and dysautonomia, in patients who are stuck for decades in the pain/ fatigue prison. The additional challenge for our patients is 80% prevalence of neurodivergence. All the complex physical conditions and associations are treatable but they need to be recognised first. We could set up hubs with the government, at low cost to treat all these conditions and return people of all ages to education and the workforce." Each specialist presented various statistics, using many of the same treatments, indicating that a clear majority of their patients who were neurodivergent and unable to work before treatment are now back in work following an affordable protocol. Careers resumed, stories of people who feel they have 'got their life back'. Believe People When They Say They Are Ill In a country where productivity has dived since the financial crisis, and the health of the nation has not recovered from COVID, The Royal Society of Medicine are trying to understand the root causes, rather than paper over the end results. Neurodivergent people are at risk of losing their support from welfare payments due to changes to the benefits system, which could underrate the presence of multiple, mid-level symptoms, even though these all add up to a significant drain. Whilst political circles are arguing over the extent to which the population is malingering versus 'genuinely' ill, this group of physicians have come above the squabbling with a potential lever to tip the system from decline to healing. Following their proposed protocols, we can believe people who say that they can't cope, treat them and support their recovery to living a full life again. Neurodivergent people of all ages have been stopped in their tracks, creating career and educational hiatuses that cause long term damage. We are at risk of a lost generation of working age people who cannot understand their fatigue, who are trying their hardest but just cannot get moving, the more they try the harder it is (see: post-exertion malaise). If you think you might be affected by any of these conditions, take an inventory of your symptoms, however disjointed they are, and talk to your primary care physician. Even if they can't refer you to a specialist, they owe you an explanation for your difficulties, so remember to be clear about what's happening. It is so easy to write off fatigue and poor concentration as 'stress' – but stress existed before the pandemic. If your capacity has changed, and you feel like it's increasingly hard to cope with work you previously enjoyed or found easy, then this could be a physiological problem and you should speak to your doctor. Is COVID to blame for the rise in neurodivergence? The answer is complex. We have higher levels of awareness and improved diagnostic criteria. For children, we have failing schools where rigid curricula and draconian discipline disproportionately disadvantage neurodivergent children. In workplaces we have increasing demands for productivity rises and endless escalation of technology and surveillance. All this undoubtedly contributes to the absence epidemic, but all of it started before the pandemic. It doesn't fully explain the stark differences some studies showing that school absence has doubled from 2017 to 2023. The Royal Society of Medicine took some time to come at this problem from a less obvious angle, and in doing so have brought a cost effective solution into the light. It's time to stop assuming that people are lazy and time to stop putting multi-system health issues in the 'too difficult box.' As employers, as a country and as individuals with families to support, we can't afford to ignore the rising absence any longer.
The Guardian
04-07-2025
- Health
- The Guardian
After an ADHD and autism diagnosis, I now find the world more confusing. How do I make sense of this?
I received an ADHD and autism diagnosis at the end of 2024 after a period of stress and depression. I thought that my profession was to blame (I work, however unfittingly, in finance) but have come to appreciate that I am sensitive to many kinds of environmental stressors. It has been difficult to navigate the world since the diagnosis. At first I was ecstatic, finding many of my life's complexities could be easily answered by a natural neurodivergence, but have since found the world to be even more confusing, especially where relationship dynamics are concerned. Some people I have told about my diagnosis have started to baby me slightly. Whereas before the diagnosis I might have struggled along in certain social situations, feeling myself a little bit slow off the mark, or bored, now I am starting to notice a pronounced sense of my 'otherness', which is quite scary. Do you have any advice on how to keep things in proportion after receiving news that can force you to look at life through a completely different lens? Eleanor says: What do we learn when we get a diagnosis? You say to a doctor I have experiences A through F. They say, ah, it sounds like you have condition X. And you say interesting, what's condition X? And they say well one important hallmark of condition X is where you have experiences A through F. A diagnosis can be so helpful and so emancipatory, but it doesn't necessarily leave us knowing what causes or explains our experiences. In lots of mental health diagnoses, we still don't know those things. Nor do we learn that we experience the world a particular way – we already knew that. Much of the force of the discovery is learning that the experience isn't universal, that medicine has needed to categorise them so they can be helped, explained, accommodated, and so on. Many of us feel the duality you describe after a diagnosis: understood, since we can finally name the patterns, but isolated, since we learn those names at the cost of learning they're unusual. It feels like good news and bad news at the same time. You mentioned the pronounced sense of otherness. Like being on the outside of a fishbowl looking in. One response is to resist that: othered from whom? Lots of people learn as adults that they're autistic, or have ADHD, or both; lots of people find new ways of understanding their mental experiences. As a result, there's a lot more understanding of these things than maybe ever before. That's not to say you have to take up residence in communities of the literally like-minded. It's just to say that when you meet new people, it may be that their experiences are not so different to yours. We never know what's happening in other people's minds; if it's otherness we're worried about we may be in the company of more others than we realise. Another response, though, is to allow that feeling of otherness. Similarity is helpful for connection, it's true. To that extent, it's frightening to learn that we're not so similar to others. That will make some things harder. But similarity isn't the only way to connect. You can feel reverence, awe, cherishment, for things that aren't much like you at all. Indeed, being in front of things unlike you can make you more aware of and reverent towards the contrasts in yourself. We feel this all the time with the natural world: lots of people feel deep love for, feel most themselves around, the ocean, the night sky, an animal. It's not because they seem the same as us. All that is to say: it can be precisely by standing in contrast, and not similarity, that you can simultaneously appreciate what is true of others and what is true of you. There's a kind of connection available here based on a true vision of each other, not just on being similar.
The Guardian
03-07-2025
- Health
- The Guardian
After an ADHD and autism diagnosis, I now find the world more confusing. How do I make sense of this?
I received an ADHD and autism diagnosis at the end of 2024 after a period of stress and depression. I thought that my profession was to blame (I work, however unfittingly, in finance) but have come to appreciate that I am sensitive to many kinds of environmental stressors. It has been difficult to navigate the world since the diagnosis. At first I was ecstatic, finding many of my life's complexities could be easily answered by a natural neurodivergence, but have since found the world to be even more confusing, especially where relationship dynamics are concerned. Some people I have told about my diagnosis have started to baby me slightly. Whereas before the diagnosis I might have struggled along in certain social situations, feeling myself a little bit slow off the mark, or bored, now I am starting to notice a pronounced sense of my 'otherness', which is quite scary. Do you have any advice on how to keep things in proportion after receiving news that can force you to look at life through a completely different lens? Eleanor says: What do we learn when we get a diagnosis? You say to a doctor I have experiences A through F. They say, ah, it sounds like you have condition X. And you say interesting, what's condition X? And they say well one important hallmark of condition X is where you have experiences A through F. It can be so helpful and so emancipatory, but it doesn't necessarily leave us knowing what causes or explains our experiences. In lots of mental health diagnoses, we still don't know those things. Nor do we learn that we experience the world a particular way – we already knew that. Much of the force of the discovery is that it isn't the experience of many others, but medicine has needed to categorise those experiences so they can be helped, explained, accommodated, and so on. Many of us feel the duality you describe after a diagnosis: understood, since we can finally name the patterns, but isolated, since we learn those names at the cost of learning they're unusual. There's relief if it all makes sense; but also dread that it'll always be like this. You mentioned the pronounced sense of otherness. Like being on the outside of a fishbowl looking in. One response is to resist that: othered from whom? Lots of people learn as adults that they're autistic, or have ADHD, or both; lots of people find new ways of understanding their mental experiences. As a result, there's a lot more understanding of these things than maybe ever before. That's not to say you have to take up residence in communities of the literally like-minded. It's just to say that as you meet new people, you may find their experiences are only slightly different to yours. We never know what's happening in other people's minds; if it's otherness we're worried about we may be in the company of more others than we realise. Another response, though, is to allow that feeling of otherness. Similarity is helpful for connection, it's true. To that extent, it's frightening to learn that we're not so similar to others. That will make some things harder. But similarity isn't the only way to connect. You can feel reverence, awe, cherishment, for things that aren't much like you at all. Indeed, being in front of things unlike you can make you more aware of and reverent toward the contrasts in yourself. We feel this all the time with the natural world: lots of people feel deep love for, feel most themselves around, the ocean, the night sky, an animal. It's not because they seem the same as us. All that is to say: it can be precisely by standing in contrast, and not similarity, that you can simultaneously appreciate what is true of others and what is true of you. There's a kind of connection available here based on a true vision of each other, not just on being similar.
