4/07 "Masking" and Neurodivergent Burnout

Most neurodivergent people know the experience before they know the word for it. Laughing at the right moment. Making eye contact on purpose. Suppressing the stim in public. Scripting a conversation in your head before you have it. Performing a version of yourself that takes significantly more energy than just existing.

This week we're reading the research on what that actually costs, where it comes from, and why the mental health consequences may be less about autism itself and more about what it takes to survive in spaces that weren't built for you.

Discussion Questions:

• What is camouflaging, and is it one thing or three? Hull et al. interviewed 92 autistic adults and found that camouflaging isn't a single behavior but a three-stage process: motivation (wanting to fit in or avoid rejection), the camouflaging itself (a combination of masking and compensation techniques), and consequences (exhaustion, identity confusion, and threats to self-perception). Masking and compensation are actually distinct: masking is hiding autistic traits, compensation is finding cognitive workarounds to perform neurotypical behavior despite still having the underlying differences. (Hull et al., 2017)

• Why do people camouflage if it causes this much harm? Hull et al. found two key motivations: assimilation and connection. People camouflage both to avoid discrimination and to access genuine social belonging, and the relative weight of those motivations differs between individuals. This creates a real bind: the same behavior that allows connection also depletes the person doing it. We'll ask whether that bind is individual or structural. (Hull et al., 2017) 

• Is poor mental health in autism inevitable, or is it produced by social conditions? This is Botha and Frost's central argument. Traditional research treats anxiety and depression in autistic people as symptoms of autism itself. Botha and Frost tested whether minority stress, the excess stress burden experienced by stigmatized identity groups, could explain mental health disparities instead. Minority stressors including everyday discrimination, internalized stigma, and concealment significantly predicted poorer mental health, even after controlling for general stress exposure. That shifts the question from "what is wrong with autistic people" to "what is wrong with the environment autistic people have to navigate." (Botha & Frost, 2020) 

• What does internalized stigma actually do to a person over time? Botha and Frost found that stressors like victimization, internalized stigma, and expectation of rejection predicted lower wellbeing outcomes, suggesting that some of the mental health disparities observed among autistic populations may be preventable. Internalized stigma isn't just feeling bad about yourself: it's a chronic stress exposure that accumulates. We'll connect this back to what we read on immune function and allostatic load. (Botha & Frost, 2020) 

• What is autistic burnout, and how is it different from regular burnout? Raymaker et al. found that autistic adults described the primary characteristics of autistic burnout as chronic exhaustion, loss of skills, and reduced tolerance to stimulus, often following extended periods of masking and social demands. Loss of skills is the part that makes autistic burnout clinically distinct: people describe losing the ability to speak, to make decisions, to do things they could do before. That's not typical work burnout. (Raymaker et al., 2020) 

• What are the dangers of teaching masking as a skill? Raymaker et al. highlighted the potential dangers of teaching autistic people to mask or camouflage their autistic traits, and recommended including burnout education in suicide prevention programs. A lot of behavioral interventions, including ABA, explicitly train masking. We'll sit with what it means that the research on burnout points back to those interventions as a contributing cause. (Raymaker et al., 2020) 

• Design a study for future directions All three papers have methodological limitations worth discussing. Hull et al. is qualitative. Botha and Frost's sample is small and self-selected. Raymaker et al. used community interviews and internet sources. What would a longitudinal study of masking and burnout actually need to include to establish causation rather than correlation?

Papers we're reading

• Hull, L., Petrides, K. V., Allison, C., Smith, P., Baron-Cohen, S., Lai, M.-C., & Mandy, W. (2017). "Putting on my best normal": Social camouflaging in adults with autism spectrum conditions. Journal of Autism and Developmental Disorders, 47(8), 2519–2534.

• Botha, M., & Frost, D. M. (2020). Extending the minority stress model to understand mental health problems experienced by the autistic population. Society and Mental Health, 10(1), 20–34.

• Raymaker, D. M., Teo, A. R., Steckler, N. A., Lentz, B., Scharer, M., Delos Santos, A., Kapp, S. K., Hunter, M., Joyce, A., & Nicolaidis, C. (2020). "Having all of your internal resources exhausted beyond measure and being left with no clean-up crew": Defining autistic burnout. Autism in Adulthood, 2(2), 132–143.