Episode 14: Autistic Masking: The Impact on Mental Health, Identity, Safety, and Privilege

Show Notes

There are a lot of nuances of Autistic masking, and it's become a sensitive and polarizing topic these days online and in social media.

With all the various opinions, information, and anecdotes out there, it can be confusing to understand what masking is, and how privilege and different social identities intersect with the experience of unmasking. Masking and unmasking impacts mental health, identity, and relationships in significant ways. 

In this episode, Dr. Megan Anna Neff and Patrick Casale, two AuDHD mental health professionals, delve deep into the concept of Autistic masking as well as share their personal experiences with masking.

Top 3 reasons to listen to the entire episode:

1. Understand how autistic masking is not just about blending in, as well as how it can be both beneficial and harmful.
2. Identify ways that privilege, safety, and race intersect with masking.
3. Learn strategies to address burnout caused by masking and, if desired, to unmask if you are in a position and place to do so.

Masking can be a very charged and complex topic, so now, more than ever, we need to delve deeper into the complexities of autistic masking and promote understanding, empathy, and inclusivity.

Resources:

Blog Post: https://neurodivergentinsights.com/blog/what-is-masking-in-autism

You can also grab the Autistic masking checklist when you sign up for Dr. Neff’s newsletter: https://neurodivergentinsights.ck.page/51e276c041

 

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Transcript

PATRICK CASALE: Hey, everyone, you are listening to the Divergent Conversations Podcast. We are two neurodivergent mental health professionals in a neurotypical world. I'm Patrick Casale.

MEGAN NEFF: And I'm Dr. Neff.

PATRICK CASALE: And during these episodes, we do talk about sensitive subjects, mental health, and there are some conversations that can certainly feel a bit overwhelming. So, we do just want to use that disclosure and disclaimer before jumping in. And thanks for listening.

PATRICK CASALE: In today's episode, we are going to talk about autistic masking and unmasking. And we want to just put out a warning that there are a lot of sensitive topics that are discussed and we just want everyone to be really mindful of that before starting to listen. And we just want to add that disclaimer to this episode. So, before Megan and I ever hit record, we always talk about, like, what do you want to talk about today? Because we never know until we hit record. 

But I think this is a good topic. And it's definitely one that we could, probably, have like a whole series on it in a lot of different… there's a lot of nuance here.

MEGAN NEFF: Yes, nuance. That's a good word for it. And I hope that's what we can have today is a nuanced conversation on masking. Okay, this is autistic. I mean, but here's how I'm like if I was to put an agenda for our podcast, which we never do, but if I were, it would be like, define autistic masking, talk about the costs of it, and talk about the benefits of it. I think those are three, like, key anchor points for us to hit in our conversation today. Why I'm I the one bringing structure today?

PATRICK CASALE: [CROSSTALK 00:00:57] episode. You are going to take away these three key takeaways just like an NBCC-approved training. And I like it. I think that we should define it. I think that's important. I think that, you know, because there's a lot of conversation about masking going on right now. So, I think it's important to define it, and I will let you do that.

MEGAN NEFF: Yeah. So, it comes from the research of Laura Hall, who is, I believe, based in the UK. And again, I think her pronouns are she, her. I've tried to like learn about her, I've tried to figure out if she's autistic or not, but I don't see that anywhere. But I assume people doing a lot of research on autism are interested in it for a reason. 

But she's the one that did the research that got the female autistic phenotype kind of on the map, which we now know there's some problems with that phenotype. But that work is so fundamental for understanding non-stereotypical presentations of autism. 

And her and her research team also developed the CAT-Q, which is the Camouflaging Autistic Traits. And what is really cool about this is it's psychometrically robust. What that means is, it's past kind of the standards for something to be considered a reliable and valid assessment. So, this isn't just some, like, social media thing that's been talked about. This is something that is validated in the psychological research that this is, in fact, a thing. 

So, what is it? It's the kind of deliberate, well, there's three components. It's the deliberate suppressing of autistic traits. And so, that might be repressing, stemming, and repressing things that we do to self-soothe ourselves. 

And that's really important because we, as autistic, people have a lot of kind of natural things we do to self-soothe. Like, right now you're fidgeting with your hands. Yep, I will probably start pacing soon. And there's things we do that regulate our bodies. So, one component of autistic camouflaging is suppressing those traits. 

Another component is something called assimilation and that's where we're assimilating into neuro-normative culture. So, that might be like forcing small talk, or forcing ourselves to do things that aren't natural. People often describe them like they're pretending when they're in social roles. 

And then, the last one is compensation. And that's where we're learning social skills through watching people, watching TV. Perhaps, like for me, I'm sorry, I need to catch my breath. 

PATRICK CASALE: Okay.

MEGAN NEFF: My long COVID is making it so it's hard to breathe and talk at the same time. So, I'm just going to catch my breath. 

PATRICK CASALE: Megan and I are both sick right now. And so, just a real glimpse into our day to days when we're here, we [CROSSTALK 00:03:57]-

MEGAN NEFF: So, long-winded info dumps when your lung capacity is limited, apparently, doesn't go well.

PATRICK CASALE: We are going to do an episode on autism, and chronic health conditions, and illness. So, I think that is something to just stay tuned for as well.

MEGAN NEFF: Okay, yeah, so the last one is compensation. And that's probably what most people think, or actually, it's the first one, but I'm just saying the last. That's probably what most people think of when they think about autistic camouflaging or masking. That's where you are mimicking kind of neurotypical ways of communicating. 

I always have talked about it. Like, I have a running Google doc in my head. Like, I would watch people and when they would say a phrase I liked or they would use a hand gesture I liked, I would kind of take note of that, put it in my Google Doc, and then, I would copy that in different situations. 

So, those are the three components of autistic camouflaging. It's typically called autistic masking, but camouflaging is the more umbrella term that captures those three distinct components of what it means to camouflage your autistic traits.

PATRICK CASALE: Thanks for giving that overview. I think that's really helpful when you have the terminology and the language to put to some of these experiences. And to really identify those three components. 

And I can think of so many examples for myself with, you know, doing exactly what you just said. I like that you mentioned it that way, like a Google doc that's constantly running, that you can constantly refer back to, that you almost have on like copy and paste mode where you're like, "Oh, it's this situation, paste this hand gesture, paste this phrase. Like, when I say this thing I notice people laugh, or I notice that people nod their heads. That makes me feel more comfortable in the settings." 

So, like, my immediate reaction to masking and camouflage, my immediate thought is exhaustion. That's always where my brain goes is exhaustion because I think so often, and you do a great job of describing like, sensory soothing, and safely unmasking, and techniques and strategies to do so. My immediate reaction is like this is constant for us people. Like, this is a thing that you're doing 24/7, a lot of the time, and I just think about how much energy is spent moving through the world like that.

MEGAN NEFF: Yeah, I mean, it's really a double whammy, and like that feels like a child, like, I need a new phrase because whammy feels so childlike. But it's really a double whammy because on one hand… so the compensation part requires a ton of prefrontal cortex energy and that's where executive function lives, where our mind is making decisions because we're analytically deciding, okay, what does this situation need in this moment? We're not intuitively doing it like allistic brains. That requires a ton of prefrontal cortex energy. 

At the same time, we are repressing the things that self-soothe us, and that would self-soothe our amygdala and self-soothe our nervous system. So, we're both putting more tasks on the nervous system and on the brain while diminishing the things that would restore our energy and self-soothe.

PATRICK CASALE: It's really a challenging Catch-22 because those things really don't go hand in hand, right? So, if you're repressing, if you're suppressing, if you're assimilating, if you're camouflaging, if you're trying to do any of the things that you listed, and you're suppressing your need to stem, you're suppressing your need to do any of the things that soothe your nervous system, the internal, like, push/pull, it's like tug of war in a way is really hellacious and it can be so, so, what's the word I'm looking for? It's so emotionally overwhelming. 

And I think that for so many of us, myself included, I experienced most of my world like that, where it's just constant, like, I can't find the words, but it feels like you're constantly thinking about every single action that you do, you're thinking about every single way that you respond, you're thinking about everything. And sometimes you're not even aware of the thought processes that are happening. And it's just so much energy.

MEGAN NEFF: So, do you still do that, Patrick? Like, I know, you and I both have talked about the privilege of being self-employed and working from home, like, and I know a lot of the people you work with are neurodivergent, but not all. So, do you still… like, I would say, in my old life, what you just described, absolutely. And I'd come home exhausted and literally feeling sick. But I don't feel that anymore. But it sounds like you still do.

PATRICK CASALE: Yeah, I think I still do. I don't think I feel it as intensely as I used to. But I noticed that there are a lot of interactions that I have to have throughout the day, even being self-employed, where I have to come in contact with a lot of people who I have to, or I feel like I need to present a certain way, or that in certain meetings I have to act a certain way. There's a lot of, as you usually use the phrase like pings and pings going on throughout the day. And I think there's just a lot of constant thinking about how I'm responding to things. 

I use the example of like writing an email, and then, like having to add punctuation, and having to add exclamation marks, and almost wanting to insert an emoji to like soften how I'm communicating and like even those little things build up, and it's certainly not as exhausting as it used to be when I had to go to an actual office and spend time with a large amount of people. I have much more control over what my day-to-day looks like and the sensory input that comes in. But like, I do notice it in a lot of interactions still throughout the day where it just takes an enormous amount of energy and capacity to get through them.

MEGAN NEFF: So, okay, is there software developers listening to this podcast? I really think this is a good business idea. I mean, it perpetuates neuronormative standards. So, you know, that's my disclaimer, but developing like some sort of filter or app where you could use ChatGPT and have it translate, like autistic to allistic speech in the moment, like via text or via email because I think I've talked about that on the podcast before, I'll do that, I'll put it in ChatGPT. But if you had something where you could do that on Google, like, "Now allistic this email."

PATRICK CASALE: That's a great idea. Like, almost like Google Translate, and then, you just hit that button. 

MEGAN NEFF: Yep, yep. 

PATRICK CASALE: Then my direct-like statement turns into this really like…

MEGAN NEFF: Beautiful flowery. Like, "I hope this email finds you well." Like, every time I do it on ChatGPT, "I hope this email finds you well. I'm writing to…"

PATRICK CASALE: "Best wishes, Patrick." Oh, man. Maybe a PS, "PS, I hope that your family is also having a great week." Oh, my God, yeah, yeah, but-

MEGAN NEFF: So, does it, oh, did I interrupt? 

PATRICK CASALE: No, I don't know where I was going.

MEGAN NEFF: I mean, this actually kind of is a natural segue into some of the costs of masking is that when we mask we perpetuate neuronormative culture because we're kind of normalizing that those are the standards, versus when we're visibly autistic, we're introducing the world to a different way of being, which I think moves society toward a more neuro-inclusive world.

PATRICK CASALE: Yeah. And I think that, you know, you and I have, and you just alluded to this, too, is that when you're not privileged in the way of employment, in terms of owning your own business, creating your own hours, when you have to show up to a job, when you have to show up and maybe pick up your kids at school, or when you have to have interactions throughout the day or meetings that you did not create for yourself or agree to, there is so much mental anguish that goes into that, too, because you're physiologically, and emotionally, and psychologically preparing for each individual interaction. And I think that when you start looking at it that way, the barometer goes like way up, and the thermometer almost gets to like the boiling point, in my opinion.

MEGAN NEFF: Yeah, yeah, that made a huge difference in our household and in my mental well-being, you know, as the mom or woman in a cishet marriage, when kids have birthday parties it's often expected to the mom takes the kids. Once we realized I was autistic, my husband started taking the kids to birthday parties. And it doesn't require the same energy for him as it does for me because birthday parties, taking my kids to them were like so sensory overloading, all of the socializing, the awkwardness of like, I mean, there's context shifting, or it's just terrible. I feel so much empathy for any autistic parent taking their kids to birthday parties. And once we knew that, we were able to shift, to do that, and reduce some of those situations, which has been really, really helpful.

PATRICK CASALE: That's got to be helpful and that's fantastic for you both to be able to navigate that. I also think like you and I were texting because we just went through the Fourth of July. And that's another thing, like holidays, right? And gatherings, and family events, and work parties, and any situation where you are expected to show up, and expected to participate, and expected to be present. And I just think about how much I just do everything in my power to avoid those situations because I really can't handle them unless I have mentally prepared for months at a time.

MEGAN NEFF: Yeah, no, I'm with you. And I think if it wasn't for my kids I would probably never go to things like that. And that's where, especially, for autistic parents, I talk about kind of value hierarchies, and there's going to be conflicting values. And so, for me, giving my kids the experience of family gatherings is a higher value than avoiding overwhelming situations.

I associated to this so it's like going to be, there's not even a link here, I'm just sharing an association I had because it was a thought I had last night that… because my workbook this month is on masking and I've been reading on masking more. And I had this thought, I think there's two kinds of unmasking. We haven't even introduced the concept of unmasking yet. But I think there's two kinds of unmasking, probably more, but here's what's in my head. 

The first kind of a masking is what we do with ourself. So, especially, if you're a late-in-life diagnosed person, a lot of us don't know ourselves very well because one of the costs of masking is having a diffused sense of self because we're almost always kind of responding to the needs of others in the room, picking up what does this person need me to be? Okay, I'm going to adapt and I'm going to become that. So, we often don't know ourselves very well. 

So, I would say, that form of unmasking with ourselves where we're getting to know like, what brings me pleasure? What are my delights? What are my preferences? Like, what do I like? What do I value? I think every autistic person would benefit from doing that. 

Then there's unmasking that happens in public. And that is, okay, do I send this email in an unmasked version? Do I go to this meeting in an unmasked version or masked? And that I think becomes a lot more complicated of a question. And a person might choose to do that in some situations, but not in other situations. For some people, it's never safe to unmask in public. So, in my brain, it felt helpful to differentiate these two different kinds of unmasking, self-unmasking, and public unmasking. 

PATRICK CASALE: I think it's crucial to differentiate. So, number one, like self-unmasking, I think that's really important, like you mentioned, that diffused sense of self and really not having a sense of who I am? What do I enjoy? What brings me comfort? Any of those things. And it's interesting to start identifying those things later on in life too because you're like, looking back, like you're stepping outside of yourself, and like looking at this timeline? Like, did I enjoy any of this? Was this something that I wanted to be included in? Was this something I wanted to participate in? Or did I feel like this was a necessary thing for, you know, social adaptation and survival in a lot of ways? And that's interesting to pay attention to. 

And then, number two is very, very important to notate. And I'm glad that you named that. And there are situations where it's just simply never safe to unmask, and there are populations of people who are going to have significantly more risk unmasking as well.

MEGAN NEFF: Yeah, yeah. And that's where, I think, the nuance is really important. So, part of why we're doing this podcast today is because I posted an infographic I made that I knew was going to be provocative, but I wasn't quite prepared for some of the feedback I got, especially, on LinkedIn, where I talk about the benefits of masking. And the reason I made that infographic is because I'm seeing a lot of kind of… I don't like using this word, but like a lot of rigid narratives around masking, a lot of universal statements. 

Like, someone was sharing how they were shamed for being a masking autistic, or statements like masking's always bad. And those conversations, I think, are really problematic because it's not leaving space to talk about the complexity of race, and power, and privilege, and safety. Or even the fact… and people will disagree with this, but I identify the ability to mask as a privilege. Like, there's plenty of autistic people I've connected with who have said, "You know, I would love the ability to mask. It would have protected me from blowing, it would have…"

And so, I think the conversation around masking, I'd love to see a lot more nuance to be able to consider, like the issue of safety and race, for example. For a black person, unmasking is rarely safe.

PATRICK CASALE: Yeah, not just for a black person, for a trans person. Then we start talking about multiply marginalized identities, and we're talking about very rarely safe spaces to unmask.

MEGAN NEFF: Yeah, yeah. And I do want to credit, so a lot of my thinking around this has come from listening to voices like Sandra, @nd.narratives, Tiffany, @fidget.and.fries. They have got great… @nigh.functioning.autism is another one. And they did like an Instagram live, together, the three of them where they talked about some of these issues. So, I just want to credit that like, this is not me coming up with my own enlightened thinking. But the labor of black autistic people who have put a lot of thought into this.

PATRICK CASALE: The nuances, so, one, just want to give you props for doing that, for crediting where credit is due. We hope to have some of you on the podcast, at some point in time, if you ever come across this podcast.

MEGAN NEFF: Please come on.

PATRICK CASALE: I think the nuance is so important and the nuances where things get really murky where people can, like you said, take some pretty rigid stance and make some pretty rigid blanket statements. And I don't think that gives room to have some of these difficult conversations about different experiences. And I'm trying to really choose my words carefully right now. But I do think that there is privilege in making statements like that as well, to have rigid blanket, black-and-white concrete statements about some of these experiences.

MEGAN NEFF: You think that that is… Yeah, no, I think I know where you're going. Like, things like being anti-racist, or anti-transphobic, black and white statements are welcome there. Is that your train of thought?

PATRICK CASALE: No. So, I guess what I'm saying is, I think there's privilege in saying, like, masking is just bad in general, or like-

MEGAN NEFF: I thought you were saying that sometimes rigid narratives were good. So, I was-

PATRICK CASALE: Those are good if we're like, I think, if we're, like, talking about, like, anti-racism is a good philosophy.

MEGAN NEFF: Yeah, okay.

PATRICK CASALE: Right? Yeah [CROSSTALK 00:21:24]-

MEGAN NEFF: That's where I was like, okay, I'm trying to make sure I'm-

PATRICK CASALE: Right, yeah. I'm sorry, I wanted to be clear, and I was not. But I think there's some privilege in saying some of the things that-

MEGAN NEFF: There's privilege yes, absolutely. If you're going to make a blanket statement like that there's privilege in that. It's often, again, I don't want to make sweeping statements, but I do find it is often white people who make those sweeping statements who aren't considering their white privilege in the conversation. 

Okay, I just want to, well, maybe I want to say it. If I do say it, this will be triggering content, which maybe we will cut, Patrick. But what got me so upset yesterday was white people comparing, like telling people to mask is, and then, they made comparisons to race-based trauma. I won't say what they said. But they're making a comparison to a race-based trauma for telling autistic people to mask. 

And like, it kind of broke my heart that people who are in disability advocacy spaces, A, would like use that metaphor. Like, I'm shocked anyone is using comparisons to race-based trauma at this point, and B, that they want to be thinking about their identities from an intersectional frame. I just think there can be so much harm done in advocacy spaces when you aren't also thinking about your areas of privilege.

PATRICK CASALE: Yeah, I mean, I agree 100%. And I hope we don't cut that. I understand why there's considering.

MEGAN NEFF: I decided not to share specifics so that it, yeah.

PATRICK CASALE: Yeah, but I think that's spot on. And that's what we have to try so hard in these advocacy spaces to have these complex conversations. But I try to see every side of things in these spaces, in these conversations because I don't want to, you know, I'm going to get it wrong at times, I'm going to say the wrong thing, and I want to hold myself accountable to that, want to learn as we go. And I just think that when you can get so entrenched in like, advocacy, and defending your own reality and identity, and it's, especially, newer, it's very polarizing. Like, it can take over and consume. So, I think it's very easy to just overlook certain things. And it just can create a lot of conflict. And I'm sorry that you had to experience that and… 

MEGAN NEFF: I mean, yes, I experienced it, but I feel more sorry for like what it represents in the autistic advocacy community. And, again, I've heard black autistic people speak about how racist disability advocacy spaces are. And I think because I've probably curated who I follow on Instagram, and who follows me, I've been kind of protected from that. But then when I had this post go viral on LinkedIn, I was exposed to that, and it was just really disheartening to like see it. But no, I mean, like I'm impacted by it, but my identity isn't on the line. 

PATRICK CASALE: Right, absolutely. And I think that this topic of masking, like I think we could do a whole series on masking honestly, and we could find, you know, anyone that could come on and talk about their own experiences, if they feel safe enough to do so, especially, for black autistic people or people of color in this community. I think it's so important to get all these different perspectives, too.

MEGAN NEFF: Oh.

PATRICK CASALE: Go ahead, sorry. 

MEGAN NEFF: Well, especially, like the added layer of when someone is code switching and masking that, like, we talk about how exhausting masking is. Honestly, I can't even imagine trying to run another software under that of code-switching. And yeah, I think it'd be great if someone felt safe enough to come on and talk about that experience because it is a really different experience than white masking.

PATRICK CASALE: I think about my wife, like, you know, who's a black woman in America who works in law enforcement, and code switches constantly as someone in the south, and how exhausting that is, and like listening to her change her dialect, listening to her change, you know, her accent, listening to where she feels comfortable, and then, just adding that additional layer on top of it and just thinking about that. It also circles back to like me thinking about my privilege and my ability to unmask as safely as I've been able to do so. Like, I am a cishet white, and with a master's degree in America. Like, I have every privilege aside from the religious one, and my neurodivergent piece. 

But I think it's just so challenging to pick and choose your spots too, even to this day, where, you know, sometimes I don't want to openly disclose why I'm communicating the way I'm communicating, why I'm reacting the way I'm reacting. But I've noticed that when I'm able to safely do so, and this, again, is privileged ability to do so, that it makes a lot of interactions a lot easier for me. And it makes getting through the day more tolerable. And that I felt really grateful for because for so long I just had no idea what the hell was going on, and why I was engaging the way I was engaging, and why I was avoiding the way I was avoiding.

MEGAN NEFF: Yeah, and that's where the lens of autistic masking, I think, is so helpful as it explains a lot. And for a lot of people when I'm working with them, and they're new to the diagnosis or for myself, I remember the like, it both just kind of disbelief and relief of like, "You mean like everyone isn't doing this?" Because that's the assumption, right? Like, we're not in other people's brains. 

So, of course, I'm assuming everyone else is coaching their body through social interactions or like having hours of pre-scripted conversations in private, and like plug-and-play scripts. Like, I assumed everyone was doing that, and sort of to realize that is not a normative experience is so eye-opening.

PATRICK CASALE: It's eye-opening. I mean, I think it creates a multitude of emotions when you start to think about it that way because I do think when you assume like everyone goes through life like this, and then, you start to acknowledge, like, "Oh, this is not how everyone interprets social interactions, or how they go to work, or how they…" 

Like, one thing that stands out to me, and this is probably one of my most obvious autistic traits and tendencies when I'm in a neurotypical work environment is like meetings, I can't fucking stand them. And when they were happening, and people just want to talk, and it just seemed like people just wanted to meet, to meet, I'll be like, "Can we be done? Like, are we at the point where we're done?" 

MEGAN NEFF: Like, you would say that?

PATRICK CASALE: And then, my supervisor would look at me and be like, "Don't say that." I'm like, "Oh, okay." I didn't realize I wasn't okay but why are we still talking? I don't understand why we are just sitting here to have this conversation. And why couldn't this just been an email? I don't understand.

MEGAN NEFF: So, I think I get a little bit more tact than you. But I would also often be the person be like, "Okay, so it sounds like you're saying this, and you're saying this. So, like, maybe we can do this." Like, I would just be trying to like pull together the strands so that we could like be done because, yeah, meetings are so painful. 

Okay, I brought the structure, but I feel like we have diverged. I do want to… I mean, I realize that right now, recency bias, I'm more focused on the privileges of masking because of my experience this week. But there are really real costs of masking that I think are also important to identify.

PATRICK CASALE: I wanted to name like four times already that you're the one bringing the structure today and I just really appreciate that so…

MEGAN NEFF: Oh, cool. I'm glad you appreciate it and don't feel like I'm like cutting down the organic [CROSSTALK 00:30:02].

PATRICK CASALE: When I'm sick, when my brain is not, like, online as much as I would like it to be I need that. So, thank you. But yes, let's talk about the cost.

MEGAN NEFF: So, yeah, the Rainmaker study, which I cite a lot when I'm talking about burnout, one of the things that that study showed was that autistic masking was one of the leading causes of burnout. And this is really important for mental health professionals to know, it is a kind of a pathway to depression and suicidality. And again, this makes so much sense based on what we were talking about earlier about the demands placed on the prefrontal cortex. 

So, very real mental health costs, something I often say, and I don't know, maybe I'll change my thinking on this later, but when I'm talking about high masking autistic people, I'll say, you know while we don't necessarily have the high support needs that people classically think of with autism, we have very high mental health support needs. And I think a lot of that's related to masking because it can result in depression, it does result in a more diffuse sense of self. If you think about the connections you're forging when you're masking, they're not going to be as authentic or meaningful, so our sense of belonging and connectedness suffers. I'm sure there's more costs I'll think of once I stop talking. What are some costs that come to your mind?

PATRICK CASALE: Immediately what comes to mind is in the correlation in comorbidity with substance use, as we've referenced so many times.

MEGAN NEFF: Oh, yeah. 

PATRICK CASALE: Just the reliance upon substances because of how much of an impact masking has, whether that be reliance in social situations, or when you get home from social situations. And I think that that also is a major contributing factor into increased depression and suicidality as well and they all go hand in hand.

MEGAN NEFF: Yeah, and we know that from like suicide studies that if someone has a co-occurring substance abuse problem, they're unfortunately way more likely to complete or attempt suicide because when you have the ideation happening, and then, you take something that kind of impairs inhibition and put it in your system, that person is going to be at a much higher risk of attempting or completing. And we know autistic suicidality is incredibly high. And again, not talked about nearly enough in mental health field.

PATRICK CASALE: Makes me want to do an episode on that, too. 

MEGAN NEFF: Yeah. 

PATRICK CASALE: We know that's a triggering subject and want to be sensitive around that. But it does need to be talked about. Yeah, so substance use immediately comes to mind for me. That's something that like, just feels very much like an extension. You already mentioned burnout, you mentioned depression, the isolation factor. I think your anxiety ramps up significantly. I think that you can start to see obsessive tendencies start to increase pretty drastically too when all of this starts to ramp up. So, your mental health is just going to start to deteriorate because you're working so hard, there's so much output, and there's so much input at the same time so it's just… 

And then, that's a good reason why we're going to see increased illness, right? Like, we're going to see increased chronic illness when this starts to happen too. You and I have talked about this before, and I've been sick all my life, I think about it constantly. Like, it's starting to become really apparent to me. Who the hell gets mono in third grade? And then like, is sick for a month? I didn't kiss anyone. Like, what is happening? 

But, yeah, so I start thinking about illness, I start thinking about just unhealthy relationship dynamics, unhealthy partnerships that start to get created.

MEGAN NEFF: Absolutely. Okay, so this is kind of a side note, like I think we should add a disclaimer to episodes or to like all of our episodes, like is there a way to say like, all of our episodes are going to have potentially triggering content, this being no exception, intimate partner violence is much higher among autistic people. 

Also, the studies are a little bit different for ADHD, but also, for ADHDers. Some ADHDers can be perpetrators of intimate partner violence so that's why the studies are a little bit more nuanced for ADHD, but also, more likely to be victims. 

And so, yeah, absolutely, I think, I mean, if we think about masking as a trauma response that is a form of the fawn response. That makes a person incredibly vulnerable to victimization. There's a really painful study that showed nine out of 10 autistic women have been victim of sexual victimization. I'm not surprised by that at all. And I'm sure it's also high among autistic trans people. 

And partly masking teaches us to override our instincts, to override our boundaries, to override our ways of self-soothing, and it makes us so vulnerable in those situations.

PATRICK CASALE: Yep, yep. I was going to talk about just being really susceptible, to being vulnerable, to being taken advantage of in a variety of reasons, in ways. And when you don't have that sense of self, and when you almost feel like you can't trust your natural instincts, or your natural instincts and reactions can't show up in a way that is safe to do, you're almost starting to second guess everything in a lot of ways too, how you move through the world.

MEGAN NEFF: Absolutely. And so, then, if someone comes into your life who's like this, and gives you like a kind of way of thinking to orbit, which is what abusive people often do is they want you to orbit kind of their subjectivity or their world, then that's going to be really, in some ways, enticing of like, well, I can't trust my world but here's someone who's telling me I can trust their perspective on the world. So, I'm going to buy into theirs.

PATRICK CASALE: Yeah, and I think, you know, we've talked a little bit about this here and there, and I know we're going to eventually do an episode. But we could go down that religious pathway with that, too, you can go down a lot of… there's just a lot of possibility to be taken advantage of when you feel like I cannot rely on my own thinking or reaction, or I have to suppress how I'm thinking or reacting to something.

MEGAN NEFF: Yeah, absolutely, absolutely.

PATRICK CASALE: And that goes into assimilation, right? It's like assimilation, how do I stay safe? How do I stay a part of? How do I belong? And…

MEGAN NEFF: So, this is what is just kind of wild, right? So, the costs of masking are significant, right? Like, I feel a heaviness just having us listen to them. And for some people, it is safer to mask than unmask. Like, how much averseness, how much, like, the words are not coming to me, but how much systemic imbalance of power must a person be experiencing that it is better to mask than unmask?

PATRICK CASALE: Yeah, that's heavy stuff. 

MEGAN NEFF: I see it on your face.

PATRICK CASALE: It's just, you know, I think when we start talking about these subjects, you start experiencing the enormity and the heaviness that we both can understand. Like, you and I have gone through our own experiences and we know the heaviness and I know that you and I can both almost mind meld an experience. What am I trying to say? I know how we kind of have an understanding of our own worldview and our own inner experiences because we talk about them a lot. We're friends, we talk, we share this stuff, then you start to take on the understanding that it's so much heavier than that when you start to think about all of the people who are experiencing this stuff, all the people who don't necessarily know how to define this or identify what's happening beneath the surface, or someone who just, like you mentioned, cannot ever unmask. It's just heavy, it's a heavy topic.

MEGAN NEFF: Yeah, yeah, I saw it come over your face. Hey, I feel it too right now as we're talking.

PATRICK CASALE: I think autistic burnout, and autistic masking, and unmasking are just really important topics that we could have continuations of as we start to see the neurodivergent movement become more of a focal point in society because these things have to be talked about in order for things to change, in order for things to shift. But it's also just so freaking heavy to do that.

MEGAN NEFF: I think because they're heavy that's why I feel, well, frankly, angry when they're not talked about with nuance because these things can't be boiled down to one sentence acclamations, or to one infographic, or and I realized that's what I do for a living. I distill complex informations to like bite-sized pieces. But there's so many real limits when we try to take such a complex, and nuanced, and multifaceted topics such as this and boil it down into a sound bite. 

PATRICK CASALE: Yeah, and that's why I think that when you and I approached one another about starting a podcast, that was the real excitement factor for me because you're never going to be able to get this information out there in one social media reel, right? Like, this could be endlessly discussed for hours and hours and hours and hours.

MEGAN NEFF: Have we done the benefits or the privileges of masking? I know we kind of talked about it, where we talked about like, I feel like we've talked about more as the negative, in regards to, like, what groups sometimes don't have the privilege of unmasking. But I'm not sure we've covered, like, what are the benefits of masking? 

PATRICK CASALE: Yeah, let's do it. 

MEGAN NEFF: So, the things that I put on my infographic that, you know, got a lot of heat this week, things like, you know, job, job security, and again, this is a minute I've heard from a lot of autistic people talk about is access to jobs. 

And this is why I talk about it as a privilege, is masking has given me access to systems of power and privilege. So, access to jobs, access to education, being less targeted for bullying. Now, as we talked about, a person might be more targeted for victimization, actually, not more because like all autistic people are targeted for victimization. And if you're not masked, you could be targeted for other reasons. 

But less bullying, for your social differences, less kind of outward stigma, there might be more internalized ableism, but less of that outward discrimination that you're experiencing, less likely for your actions, your neurodivergent traits to be misinterpreted by the public or law enforcement, which again, this is where that intersectionality piece becomes so important. That doesn't guarantee safety for black autistic people or people of color who are autistic. But it could increase safety if… I'm not saying it well, my words. So, those are some of the benefits of masking. 

PATRICK CASALE: I think that was clear. Yeah, what I'm hearing is safety, potential security, potential access-

MEGAN NEFF: Economic security. 

PATRICK CASALE: Yeah. Yeah, absolutely. And it's just a shame because the benefits of masking directly correlate to the detriments of masking in a lot of ways, too.

MEGAN NEFF: Totally, which is why… like it's not as simple. And like early in my kind of content creation, I talked a lot about like unmasking. But then I realized like, it's not as simple as like just unmask because then you have these new complexities to deal with, you have people looking at you, you have to address negative comments. Those are also sensory experiences. So, the answer isn't unmask, I think, the goal often is to be able to strategically unmask. And of course, the goal is to build a more neuro-inclusive society. But that takes time and we're not there yet.

PATRICK CASALE: Yeah. One thing I think we could talk about, also, is just some strategies, maybe some techniques to safely unmask when you're able to do so, even if it's at home. You talk about a lot of these things on your Neurodivergent Insights Instagram account a lot of the time

MEGAN NEFF: I haven't yet but that is exactly what I'm working on this month. And that's where kind of the concept of self-unmasking versus public unmasking feels helpful for me. I think self-unmasking, like any sort of inventory that helps you figure out, again, your delights, your pleasures, that takes your desire seriously, other exercises I've seen are things like, find a memory of the last time you were happy, or the last time you felt connected to yourself. 

So, a lot of it's also about going back into memories. And for a lot of us that involves going back to childhood because that's when we can access a more unmasked version of us, thinking through, you know, what do we love? What do we love to talk about? What are our interests? What are our collections? If we have them. 

And, again, masking often we feel the need to hide our interests. So, actually, intentionally spending time with our interests, and celebrating them not as things of shame, but things that bring us delight and pleasure and meaning.

PATRICK CASALE: Yeah, I love that. That's why, like, I still stand by my statement about parts work and IFS being really helpful for autistic people in therapy [CROSSTALK 00:45:43]-

MEGAN NEFF: Because that helps you do some of that unmasking.

PATRICK CASALE: Yeah because you're able to at… if you can really get into that childhood part, you can have some really good access to some of those memories that can feel really fragmented at times, too. I, myself feel very disconnected from childhood and that childhood part of me, but if I can get back into that place where, like you just mentioned, I can remember having that Garfield collection, I can remember having all of these things that brought me joy, then it's like, okay, I can access that part of myself and I know that that memory is a positive one.

MEGAN NEFF: If someone hasn't already created this, like, even just like a 60-minute masterclass on using IFS to help a person unmask that would be a great, like, clinical training, or just a training for neurodivergent people because I hadn't connected that before, but you're right, I can see how that would be such a powerful tool.

PATRICK CASALE: Yeah, it's so powerful, especially, like, I don't want to diverge too much right now. But it's powerful, it's useful, especially, if you have a really hard time accessing present self or even like, past self that wasn't, you know, within the last couple of years. I have a very hard time with that. Like, I have a hard time with accessing and to be able to break it down in parts. Let's just say, like, the entire teen me doesn't remember this but I know there's a part of me there that like can access this that's really helpful.

MEGAN NEFF: Yeah, yeah. And then, figuring out, like, what are the things that kind of pullback that part? Like, pull it back like a thread you're pulling out. So, it might be like a sensory experience or like, you've talked about Garfield. Like, I could imagine just looking at Garfields that you have, probably, helps you come back into that part. 

PATRICK CASALE: Oh, totally.

MEGAN NEFF: Yeah. 

PATRICK CASALE: Absolutely.

MEGAN NEFF: Makes me want to go find some Blazer basketball cards, see what part I could access.

PATRICK CASALE: I love that that was such a special interest for you. Also, by the way, at some point in time, during an episode, we will definitely shout out all the responses we got for special interests on our Instagram because there were some really cool ones on there. I thought it was really unique to just hear everyone's special interest, the things that you collected as kids, things that you really remember very viscerally, very real that that brought you joy and some fulfillment. I thought that was really kind of a beautiful little engagement on there. 

MEGAN NEFF: I love that. Patrick, that's something I've been thinking about too, is like, as we've been talking about this heaviness, I really, like the feedback we've gotten, the exchanges. I know you've had exchanges, I've had with listeners, not that either of us need more on our to-do list, but I'd love to find a way of building community around what we're doing and our listeners. 

Again, back to that idea of people are craving and needing connections and I think, especially, autistic spaces that hold space for nuance and complexity, I think. I've heard a lot of autistic people kind of go into social media and then burn out because it feels like too activated which it makes sense, like it's going to be an activated space. But okay, now I'm diverging and tangenting, did I just throw that into a verb?

PATRICK CASALE: Sounds like a new Megan Anna-ism right there. Tangenting, no, I agree. I think that we could put our heads together about creating some space that feels really supportive and affirmative, and has room for nuance, and just connection, and conversation like this. So, I'm happy to try to figure out what that could look like.

MEGAN NEFF: 2024 goals.

PATRICK CASALE: Right, everything in my life right now is 2024. That is not a today me problem, that is a next year or 2025 [INDISCERNIBLE 00:49:38].

MEGAN NEFF: I do that all the time. I think my future self is going to have all this spaciousness. I think it was my husband who, I don't know where he heard this, but he was like, if you want to commit to it in the next three weeks, you should say no to it. Like, that's a mental exercise you should do. Because I do that all the time where I say yes to things that are like four months out because I'm like, "Oh, future Megan Anna will have all the time in the world, I hope." 

PATRICK CASALE: Yep, that's what we've talked about, that our ADHD selves are like, "This is a good idea." And then, it gets to that point on your calendar, and you're like, "What was I thinking?"

MEGAN NEFF: That was a terrible idea. 

PATRICK CASALE: Also, I just want to give myself props for not cursing a single time today. I'm trying to be really mindful of that. So, yeah. Anyway, I think it's time for our awkward goodbye. I hope this conversation was helpful. It was heavy, but I do think it's important. 

And Megan, I just want to say thank you for sharing that space and just sharing that heaviness too. 

And to everyone listening to the Divergent Conversations Podcast, new episodes are out every single Friday on all major podcast platforms and YouTube. You can like, download, subscribe, and share.