Putting My Mask On

Neurodivergent Doctor At Work

Like all doctors I’ve been wearing a facemask to work since the start of the COVID-19 pandemic. One of my pleasures is taking off my mask after I leave for the day. Cool fresh air on my face. It’s like being set free!

But unlike most doctors, my face mask goes on top of my other mask.

My neurotypical mask.

I adapt my autistic way of doing things to appear neurotypical. It’s called “camouflage” or “masking”. Camouflage is a highly effective way to succeed as a neurodivergent person in neurotypical society, but it comes at a cost.

You might be wondering: what autistic differences am I camouflaging?

The motor skills of communication

Tone of voice, facial expressions and body language. My natural autistic tone and facial expressions are quite muted, so I consciously make them more obvious. My natural body language is a stooped posture with arms, legs and hands folded or wrapped around each other. This body language is for my sensory needs – it gives me deep pressure and proprioceptive input. To camouflage I stop doing my sensory seeking, and instead copy the body language of my conversation partner.

Conversation style

Part of what the autism diagnostic criteria call “inflexible thinking” means many autistic people communicate in a direct, or more literal way. Neurotypical communication style on the other hand uses a lot of implied, indirect requests. This is considered a more polite way of getting what you want. I consciously edit what I’m about to say or write in emails to be less direct.

Neurological regulation

“Neurological regulation” is a fancy way of saying “calming the brain”. Unfortunately, autistic people are very prone to brain dysregulation (not calm). It happens when our senses get overloaded, or understimulated. Anxiety bubbles up with unexpected change. Our brains get tired by tasks that use up our limited executive function, motor coordination and auditory processing. To move our brains from dysregulated back to regulated, we engage in activities that increase brain energy, decrease anxiety, and restore balance to our sensory inputs. This includes “stimming”, sensory seeking or avoidance, and predictable routines. To camouflage I will avoid stimming, put up with uncomfortable sensory experience, and change my lovely routines to suit others’ preferences.

Camouflage means actively trying to appear neurotypical on the outside and hiding the fact you’re autistic. Camouflage is honed over a lifetime of active effort, practise and observation of successful neurotypical behaviour. It is NOT something autistic people do because they like doing things the neurotypical way, it is uncomfortable, and tiring.

So if camouflage is such hard work, why do autistics even do it?

Camouflage is a defence response. It’s a reaction to constant negative judgement. Research shows this negative judgement is very real. What’s more, it happens within seconds of a neurotypical person seeing an autistic person. These judgements are called “thin slice judgements” and can be measured, like in this research study. Compared to neurotypical people, autistic people are straightaway judged as more awkward, less approachable, and lacking in friendship potential.

Individuals with ASD (red) are immediately judged more negatively than typically developing controls (blue) across each of the three rating categories (all ps < 0.001) Scientific Reports (Sci Rep) ISSN 2045-2322 (online)

Other autistic camouflage techniques include:

• Avoiding appearing knowledgeable about specific topics

• Maintaining the appearance of eye contact

• Avoiding topics of conversation that could be controversial

• Sticking to conversation topics that are of interest to the social partner

(Link to study here: Self-reported camouflaging behaviours used by autistic adults during everyday social interactions - Julia Cook, Laura Crane, Laura Hull, Laura Bourne, William Mandy, 2022 (sagepub.com))

Some of these techniques are also used by neurotypical people, some of the time. The difference with autistic camouflage is the amount we need to use, and the discomfort we put up with. Over time, this can lead to serious mental health consequences.

Have you ever gone through a really sad time, but you pretended you were fine when you were at the shops? That’s what autistic masking can feel like.

My wish is for autistic people to feel comfortable being our autistic selves in public. I love seeing authentic autistic representation, like the casting of autistic actor Chloe Hayden as autistic character Quinni in Heartbreak High. The more of this in the public sphere, the closer autistic people get to being able to take off our masks.