Content Warning: this post contains a bit of a rant about the extreme male brain theory of autism and a bit about the gender disparity and challenges of seeking a diagnosis as an adult, born female person in the US.
Disclaimer: I am not an autism expert. The information presented here is based on my own research and independent study. These are my opinions and not meant as authoritative on the subject. Take from it what you will….
To start, I understand that the field of psychology is not a monolith. There are many schools of thought with many of those practicing within it doing wonderful work which is helping many people. Having said that, there are parts of the field that are problematic. One area is the ongoing pathologizing of and discrimination against women and minorities. This is exemplified in the wide acceptance within the field of the extreme male brain theory of autism.
The extreme male brain theory of autism was developed by Simon Baron-Cohen in the 1990’s which theorizes that there is a fundamental difference between male and female brains to explain the disparity in diagnostic rates in autism between males and femalesat that time.
Speaking frankly, this theory is severely flawed. It ignored known medical science in order to justify a highly gender biased assumption: More males were being diagnosed with autism than females and nonbinary folk. Baron-Cohen theorized that this must mean there was a basic difference in female brains that kept them from being autistic. (Anyone else see a basic flaw with this?)
Sadly, wide acceptance of the extreme male brain theory has meant is that research into how autism presents for women, girls, nonbinary people and atypical males has been slow coming. And, changes to the diagnostic and testing tools has been even slower.There is a very real cost here paid in human suffering. Uncounted numbers have had to grow up and into adulthood without support or understanding themselves and often facing bias and misdiagnosis within the mental health field.
It has taken longer than it should, butgrowing evidence that there are other presentations of autism has finally overwhelmed the extreme male brain’s hold and allowed for a shift in understanding of the subtler presentations of autism more often experienced in women, girls, non-binary people and atypically presenting males. Although, the theory has been debunked in recent yearsby this new understanding and rising numbers of diagnoses in the corresponding populations, since extreme male brain had been accepted wisdom for more than 20 years, the theory has been slow to die. :'(
To this day, psychological research is in effect ignoring autistic adults and their experiences instead focusing the bulk of the research in the field on children with autism. Any number of myths and misunderstanding about the autistic experience have been perpetuated as a result. This is a real point of contention for the adult autistic community. By excluding adult autistic voices and only discussing autism amongst those within the field, a very skewed picture emerged.One that allowed theories like extreme male brain to thrive.(To put this into perspective, imagine this paragraph with Black people, Indigenous people or LGBTQ+ people in it instead of autistic people and this injustice may become even clearer.)
The DSM5, the official diagnostic manual for the US, allows psychologists to take into account the more subtle presentation of autism; however, little to none of the gender biased testing and diagnostic tools have been renovated. Instead, it is left up to individual psychologists to determine if there is enough evidence to diagnose based on the self reporting of a population whose main difficulty is a communication deficit. This just seems arbitrary and extremely unfair.
And, this does not even begin to take into account issues such as cost (which, unless you are privileged enough to be covered by insurance or other programs, is astronomical), access, and social disparities such as implicit bias for minorities and LGBTQ+ (especially Trans) folx, etc...
So, the cards are stacked. For all with an atypical presentation of autism when seeking diagnosis. It cannot be stated enough how important it is to find the right diagnostician. This is easier said than done and often comes down to luck more than anything.
I got lucky. I found a practitioner who recognized my autism readily. I recognize this for the privilege that it is (and that it is a privilege that I was able to access diagnosis at all).
I will be real and share that I was scared to seek diagnosis. It took a great deal of fortitude especially since I have faced misdiagnosis within the mental health field in the past.
It was a time of great uncertainty. I wrote this post in part as a way to cope with that uncertainty.In the end, I chose to embrace that identity and diagnosis are not the same. I decided that since the cards were stacked, I would embrace my identity as an autistic person regardless of the outcome.
Within the next 5 years there is likely to be a big shift in the way autism is assessed in adults. Especially for the atypical presentation more likely in born female people. I was ready to wait and seek diagnosis again later if I had to. Luckily, it was not necessary in my case.
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Note: It must also be said that, at different points in history, the field of psychology has pathologized the Black, Indigenous and LGBTQ+ communities to justify their marginalization. As example, homosexuality was a mental illness warranting institutionalization until the 1970’s, it was considered mental illness for slaves to want to escape from the brutality of slavery and indigenous peoples were considered mentally ill for wanting to remain close to the land rather than “progressing” into industrialized society.
For any interested in learing more about the extreme male brain theory, here is a paper criticizing it in much greater detail. Read it at your leisure if so inclined:
Wow, ok. So, I am going to be real here. This one is hard.
It’s hit me, after editing and re-editing this post (and writing several iterations), that the difficulty is centered around my fear of not being believed.
The experience of not being believed is central to the autistic lived experience. Especially for those of us who have discovered our autism late and who have adopted masking as a survival strategy.
(for those of you reading this who do not know what masking is, Wikipedia defines it as “a process in which an individual changes or “masks” their natural personality to conform to social pressures, abuse, and/or harassment.”)
So, I will attempt to share a bit about what autism looks like from my lived experience. But, I will be honest. This is going to be tricky.
If you are neurodivergent, welcome. I hope this post speaks to you in some way. If you are neurotypical, I ask you to keep an open mind.
In a nutshell, the view from inside looks like constantly tripping over my feet (literally as my proprioception is poor), being socially challenged and anxious, running after my life like a bus that left the stop moments before I got there, experiencing the world with all of the senses turned up to 11, and having difficulty emotionally regulating because all of this is happening at once.
Add to this the unintentional gaslighting of the allistic (non-autistic) people around me convinced that I am exaggerating my experience or just need to try harder as well as the intentional bullying and downright abuse from some and the toll on my mental health may become apparent.
I have sensory differences which cause me to experience the world more acutely and need to be more aware of the environments around me. When I cannot manage these needs, I experience shutdown, meltdown or burnout.
My life is dominated by missed appointments, lost keys, chronic lateness, and a struggle with basic tasks like household chores and personal grooming thanks to poor executive function. This is as exhausting as it sounds and a great source of shame for me. A dirty little secret that I have been attempting to hide with varying degrees of success.
A great deal of my difference is centered around the fact that my eyes, face and voice do not naturally do what others suppose they should. My flat affect, inappropriate facial expression, tone of voice, or lack of eye contact are seen as rude, intentionally unkind, and/or filled with subtext when none of these are my intention.
I struggle to understand people. In truth they baffle me. They are such a mix of contradiction and unpredictability. I can never be sure if what they say is really how they will behave. I am lousy at reading others intentions, and even when I can see red flags, I have difficulty seeing how to extricate myself.
I have always understood and felt far more than I was able to express. Often, the higher the stakes or the more emotions involved, the less successful I become at expressing myself. (thus the writing and rewriting of this post.)
But these are just the ways that I find my differences challenging, and many of these have to do with how others are perceiving and responding to me.
The view from the inside is that I am shy. I am vulnerable. I am caring. I have a rich internal world that often takes up much of my attention. I am a good friend. And, when my needs can also be brought into the relationship, I thrive in it. I have a deep sense of integrity and loyalty. I have incredible empathy for others and care much more than it shows sometimes. I need longer to process than others because I often don’t know exactly how I think and feel about things in the moment. I tend to think in absolute and concrete terms and have a hard time being flexible especially in areas that confuse or frighten me. When it comes to what I believe is right, I have very little patience for listening to others’ differing opinions. It can take me a long time to realize when I’m wrong about something, but when I do, I will work very hard to make it right.
I have a singular mind. I have no genius IQ, but I can see the big picture and make connections others miss without losing the details. I have the ability to hyperfocus and enjoy it when a project I have been putting my heart and soul into, is completed with excellence. I like the way I think. I wish there was a way my mind could be valued in our world because it could contribute so much.
Something to understand is that my autism is not a problem for me. I quite enjoy the way I think and how I experience the world. There is beauty in it. For me, the world is full of wonder and mystery set to music in my mind seen as patterns forming from the void.
It is the intolerance of the neurotypical standard and its assumptions, exclusions, and punishments which cause me pain.
So… I may always trip over my feet at nothing, but I can be kinder to myself about it. I may always be socially challenged, but I can now educate those around me (and limit contact with those who can’t be understanding). I may always run after my life like a bus that left the stop moments before I got there, but I’m learning to change the standard I’m attempting to live up to. I may always experience the world with all of the senses turned up to 11, but I am stimming and putting my sensory needs first. And, I may always have difficulty emotionally regulating, but, at least now I know why. And, just maybe I can ask for some understanding.
In my last post I wrote a little bit about autistic masking. Autistic masking is a dangerous compensatory strategy some autistic people adopt in order to appear more neurotypical for at least some period of time.
It’s important to note that not every autistic person is capable of masking or chooses to mask.
Wikipedia defines masking as “a process in which an individual changes or “masks” their natural personality to conform to social pressures, abuse, and/or harassment.”
I say this strategy is dangerous because it is a sword that cuts both ways. Masking requires an autistic person to sacrifice their mental and physical health and authentic self in exchange for social capital. This social capital can mean the difference between being able to access basic survival needs of employment, housing, and even community or not.
Access to this social capital cannot be discounted when you consider the statistics: Nearly 80% of autistic people are unemployed and only 1 in 9 marry.
But, masking is not benign. It comes at a terrible price. It extracts a cost in health and stamina. It stresses the autistic person’s neurology and sensory system far beyond its limits. This has a cumulative neurological affect over time leading to loss of function and eventually burnout. It also takes a terrible toll on one’s mental health and happiness.
It is a sign of our deeply ableist society that autistic people must pit their survival needs against their mental health in order to access basic societal functions. It’s an untenable choice.
And, while all of the focus is going to meeting the demands of neurotypical norms and avoiding the devastating social consequences for breaking social rules, one cannot develop a real solid sense of self. Fear, anxiety, shame, embarrassment and humiliation are such common social experiences that the impact on one’s sense of self and self esteem is incalculable.
For me, masking was not a choice but rather a series of responses to a hostile environment. It was necessary for survival. I learned early that other humans don’t really want to be around me as I am. I have gone to great lengths to hide my difference in hopes of an acceptance which has never quite come except in a very few hard won exceptions. Instead, I learned to act – not in the ways that were best and came naturally to me – but in the ways that made those around me most comfortable.
These compensatory strategies were internalized at such a young age that I was unaware of them. I was always aware I was not sharing my full self with the world, but I had other narratives to explain this and never saw the depth or the full cost of masking until I discovered my autism and began taking off the mask.
Here is a bit of what it’s like to mask from my own experience:
The mask is heaviest in social situations especially in groups and most especially new groups. I have to use my hyperfocus skills to navigate social situations. This means social situations are draining. This doesn’t mean I never take pleasure in them. I find people fascinating and enjoy their company when I can find my niche. But, (and this is a big but) if social obligation exceeds my capacity for socialization, it can quickly become a misery. (and it is always draining regardless of how much I am enjoying the interaction.)
MASKING IN SOCIAL COMMUNICATION
The first hurdle is small talk. I despise it and am not good at it. It’s not just that I find it incredibly awkward and I run out of things to say quickly. It’s also how shallow it is. What interests me is connecting with people on a real human level, but that’s not how neurotypical communication works.
Alongside the challenges with small talk is the constant internal monitoring I must do: Am I monopolizing the conversation? Is the other person becoming bored? What is my body language like? Are my arms crossed? Am I relaxed or tense? Am I making enough eye contact? Too much eye contact? Am I following what they are saying?
For most people, these processes are internalized and take no conscious effort, but for me, It takes monumental effort.
There are times when I am doing better than others and this can feel like a dance that I’ve mastered: check body language, make eye contact, look interested, check other person’s level of interest, reflect on my part and intensity in conversation and adjust levels as needed, stay engaged in what other person is saying. make appropriate facial expressions.
(Hah! Nailed it!)
Sometimes I am in blissful ignorance believing all is going well only to find later that I have unintentionally offended or been misunderstood or rubbed someone the wrong way 🙁
During times of burnout, these conversations are less like a dance and more like an anxiety ridden train wreck or (worse for me), a total clueless interaction where harm is caused to relationships without my knowing until later when the inevitable spiral of shame and disappointment ensues.
I also have a real problem with disclosure: knowing who to disclose how much information to and when it’s appropriate. I tend to overshare too soon and then get really hurt by people who use my private feelings and information against me.
IN RELATIONSHIPS
I have spent too many (of my too few) resources attempting to live up to neurotypical norms for social behavior and communication (which are very different than autistic social behavior and communication). Anxiety becomes a constant companion as I have lived with the continual fear that I will mess up – that the mask will slip because I cannot maintain the energy to hyperfocus on it all of the time.
I cannot describe the portion of my life and my thinking which has gone to dissecting conversations after the fact to see where I might have failed or beating myself up for where I did. Or, practicing for hours what I will say to someone, especially if it is something difficult.
The more people involved or the more complex the situation, the more likely I am to fail. I miss nuance and cannot keep track of and please multiple people at once. It becomes too much for me to track and process. I loose my own boundaries and needs in the chaos of it all.
THE MASKING PARADOX
The paradox of masking is that it’s a losing game. The better I am at it the more it keeps me from the acceptance I crave. To find love and belonging, people need to be seen. Autistic masking is the opposite of this. The better I am at masking, the more my own needs have to go neglected and the less I am seen. The more I strive to fit in, the less I belong. Masking will always leave me hulled out and burned out.
Masking has taken a terrible toll on my sensory system, my mental and physical health and my state of mind. Itis exhausting. It takes the essential energy necessary to live a successful and contented life. The mask was put in place so young that it has hidden my authentic self from me and even prevented me from being able to fully develop an authentic self. Masking has left an indelible mark on my being.
I am taking off the mask and letting the beautiful person beneath it fully develop and flourish. I have no idea what I am truly capable of free of the burden of masking, but I’m determined to find out.
However, this has had a deep impact on my existing relationships. People are used to me showing up a certain way and being of certain utility. Unmasking means changing that social contract. In unmasking, I am not sure how many of these relationships will survive.
I am excited to know that the relationships that do will probably be the most authentic and sustainable of my life.
I am very privileged to have an amazing family. I have a supportive children who are incrediblyaccepting and amazing humans and a spouse who is rolling with the many changes of a late autism diagnosis. Their love and support means so much.
I have a few friends who have humbled me with their understanding and acceptance.
Content Warning: ableism, statistics on suicide and autism, mention of trauma, disability, bullying, gaslighting, oppression
DISCLAIMER: I am not an autism expert. These are my opinions based on my research and lived experiences. Take from it what you will. This is a post about ableism. However, I do not intend this post to be definitive of all of the ways ableism impacts autistic lives. I am still learning, uncovering the layers of my own experience and listening deeply to the experience of other autistic people. This post is reflective of that learning. It should also be said that autistic people with higher support needs and comorbid conditions are likely to be hardest hit by the dehumanizing effects of ableism and in ways other than described in this post. Theirs and other autistic peoples’ experiences of ableism are valid. There is also the matter of intersectionality. Not everyone experiencing oppression will experience it in the same way. [Intersectionality takes into account that a person might be experiencing discrimination from more than one system of oppression at the same time depending on their particular identity/ies. The more marginalized an autistic person’s identity is, (either by race, sexual or gender identity/expression, class, religion, etc.), the more likely it is that they will experience discrimination from multiple systems of oppression (in addition to ableism)]. With this in mind, this blogpost is an attempt to speak about ableism and the ways it shows up in autistic people’s lives – or at least in my life.
Recently on Instagram, @neurodivergentactivist made the following post, “People need to stop perpetuating the idea that ableism is not that serious. It has a real impact on disabled people’s lives and rights. It is important to talk about, as other forms of oppression are.” … “It’s disappointing that ableism is rarely discussed outside of the disability community. And when it is, people often try to downplay it.”https://www.instagram.com/p/CJmDIhjMrDK/?igshid=1d4ce0kfpnt0p
ABLEISM:
Wikipedia defines ableism as: “discrimination and social prejudice against people with disabilities and/or people who are perceived to be disabled… In ableist societies, disabled people are considered less valuable, or they are even seen as expendable…“
WHAT CAN BE DONE?
I’m going to start with what can be done. At the heart of any oppression is implicit bias – the bias invisible to us. Implicitbias is overcome with awareness – by listening to and believing the lived experiences of autistic people. With awareness (and the compassion it inevitably builds), implicit bias can be overwritten with new information. Information that allows autistic people to be accepted as they are. I hope by the end of this post, some understanding and empathy will have been achieved.
Disabled people deserve to be seen as fully human for many reasons, but the biggest is this: If we live long enough, all of us will be disabled eventually. How do you want to be treated when you get there??
I hope you will join me in helping dismantle ableism as a system of oppression. Perhaps this post will build some awareness or start a dialogue or help someone not feel quite as alone.
WHAT IS ABLEISM?
It is incredibly difficult to talk about and point at your own oppression from inside it. Oppression is often crystal clear to those experiencing it, but invisible to others. Even those who would be allies.
A good place to start is to tell you that the life expectancy of an autistic person is just 54 years.
A series of studies done spanning the last 25 years show that there is a more than 20 year gap in the life expectancy of an autistic person compared with that of the average population. This holds true across the spectrum regardless of “functioning labels”. The causes are systemic – 1) a more than 9 times higher than average suicide rate due to the constant rejection, harrassment and exclusion faced by autistic people, 2) systemic discrimination within the medical system combined with higher risks for disease, and 3) systemic violence at the hands of law enforcement. (See sources below)
This is ableism and it is killing autistic people.
In addition, there is a nearly 80% unemployment rate. The majority of these unemployed are not from a population incapable of work but of those being denied employment because of social exclusion and isolation. This social isolation also means that less than 10% of autistic people marry.
Underpinning ableism is stigma, the deep misunderstanding of what autism is, and a dominant culture that requires autistic people to conform to neurotypical standards regardless of the harm inflicted.
One way to describe this is to compare autistic people to the proverbial square peg being forced into the round hole of the unforgiving neurotypical standard. Damage is caused the more this is forced onto the autistic person.
It’s painful to think about how aversion therapies and having autistic children ingest bleach is seen as preferable to accepting autistic traits. How pushing autistic people to act neurotypical until they surpass their body’s capabilities and burnout or become too depressed to continue (or both) is commonplace. Or, after constant isolation, bullying, exclusion, harassment, they become hopeless and commit suicide.
SOME WAYS ABLEISM PRESENTS FOR AUTISTIC PEOPLE:
HARMFUL MESSAGES
Autistic people face a nearly constant barrage of messages shaming their autistic traits and telling them that the answer is to just act more neurotypical – no matter the personal cost.
This is not a viable solution, though. The lived experiences of autistic people show the poor mental health outcomes of such a strategy.
MISUNDERSTANDINGS AND MISJUDGEMENTS
Misunderstandings and misjudgments are commonplace as autistic people do not present, respond or react as expected. Autistic behavior causes the “uncanny valley” response triggering unconscious repulsion.
The “uncanny valley” is a term coined by the robotics field to describe the irrational repulsion and hatred people respond with towards robots which appear too human. Some within the autistic community have adopted the term to describe the irrational response often aimed at autistic people.
This response of uncanniness and repulsion makes it difficult for autistic people to be seen as sympathetic or needing help and compassion even though we are some of the most at risk within the Rejection is so common to the autistic lived experience that it is difficult community.
TRAUMA
Trauma is so common within the autistic experience that there is no psychiatric model for an autistic person in good mental health.
In general, the autistic person’s system is more susceptible to stress, more easily traumatized, often more sensitive to sensory input and pain (although hypo-sensitive is equally valid), and takes longer to recover than a neurotypical person. When you combine this with the continual effects of living with the impact of ableism, the results can be devastating.
MASKING
In order to survive in a hostile world many autistic people, including me, have adopted a dangerous survival strategy called masking. Masking includes hiding stims (the self stimulatory behaviors which help regulate the autistic nervous system), mimicking neurotypical social behaviors and eye contact, hiding painful or uncomfortable sensory input, hiding confusion and distress. For those capable of doing so, masking can mean access to employment, housing, and even community and friendships. But, it comes at a great cost as doing so means deeply denying their true self and hiding all their struggles. This is exhausting and ultimately unsustainable as it leads to burnout and an impact on the autistic person’s mental health, sense of self and self confidence.(It’s important to note that not all autistic people are capable of masking or hiding their autistic traits).
UNINTENTIONAL GASLIGHTING
Unintentional gaslighting is a daily part of the autistic reality. This is the well meaning advice and straight up judgments of the neurotypical gaze. The “why didn’t you just’s. The “you should just try harder’s. The rewriting of the autistic person’s every reality, action and thought based on neurotypical norms. This gaslighting is so pernicious and pervasive that it leads to constantly questioning one’s own mind, reality and sense of worth and has a deep impact on many autistic people’s mental health. A common side affect of this gaslighting is alexithymia, a condition involving difficulty identifying and processing emotions. When one has been told their emotions are invalid or inappropriate their entire life, it creates confusion and difficulty identifying how one feels about things. This can have a deep impact on relationships and sense of self.
NOT BEING BELIEVED
Not being believed is central to the autistic lived experience. It’s hard to find words to describe the impact of this. It causes loneliness and isolation for sure and makes asking for help and support or pointing at problems which directly involve the autistic person an act of risking emotional harm or rejection.
INFANTILIZATION
Infantilization is the speaking/acting for and assuming less of the autistic person. It does not ask or listen to their lived experience or allow them to speak for themselves. Ultimately, infantilization is a weapon of silencing. It should also be pointed out that infantilization has been used against many oppressed groups in the past including women, minorities, queer and young people, and the elderly. Infantilization ultimately means erasure and silencing of autistic voices which cannot stand.
THE INTENTIONALLY MALICIOUS
This is the bully, the abuser, the manipulator. They can be subtle or aggressive, but always toxic and corrosive. The intentionally malicious are especially harmful in a population who often cannot ascertain people’s intentions. The autistic person is easily separated from the group and singled out for bullying and mistreatment. And, because they are less likely to be believed, getting help once this happens can be difficult.
All of the above are examples of ableism. And, it is unbearable as all oppressions are.
Pointing at ableism in this way has done nothing to communicate the devastating effects of it. I have lost living situations, jobs, had to leave school, lost relationships, friendships and more due to these ableist patterns.I have had any number of bizarre social experiences marked by a kind of cruelty I will never understand.I do not know how to describe the fear curled in my belly because I cannot read other’s intentions. Nor can I describe the hours of my life I have spent worried that I may fail or have failed at some social interaction. Or the way I must practice carefully what I need to say if I have to share something difficult even with my most trusted and beloved.
Then there are the everyday indignities of not being believed in small and large ways. The being misjudged and misunderstood (which erodes my relationships). The living in a world not made with my neurology or my extra sensitive sensory system in mind. These take a toll over time and leave a deep mark on the psyche and spirit.
I am one of the lucky ones. My mental health has suffered, but remains remarkably intact. I have a family who love and accept me. I have a small handful of friends who have been supportive through the discovery and diagnosis of my autism. I know I am blessed compared to many neurodivergent people.
And, still my life has been marked with an isolation and loneliness that is hard to describe to the neurotypical.
And, I have seen the dark side of human behavior – not just in the ways it isolates, excludes and others, but in the ways it hates and hurts. It baffles me.
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Note: * microaggressions are defined as: brief, commonplace, daily indignities that communicate bigotry, slights or insults.
Examples of the kind of microaggressions faced by autistic people include:
the constant misjudgments, misunderstandings and not being believed common to the autistic experience
small or ongoing acts of isolation, exclusion,rejection,
speaking for/assuming the experience of an autistic person rather than listening to their experience
infantilizing autistic people or treating them in any way less than
putting the autistic person in a situation which they would have to risk emotional harm to navigate,
putting the autistic person in situations they are incapable of navigating (such as complex social situations),
misreading autistic stress and autistic anxiety as behavioral issues
misreading autistic shutdowns and meltdowns and emotional sensitivity (these are signs of extreme duress but are often interpreted as something else),
etc..
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RESOURCES:
Below are links to information regarding the studies on autism life expectancy: