Along with my autism diagnosis, I received another diagnosis: depression.
I don’t remember when I started my personal battle with depression. It always seemed to be there – like those memory balls on Inside Out tinged with the color of emotion. Most of my memories are tinged with blue.
It was a constant companion.
Since my mother was abusive, therapy in childhood was never an option. As an adult, I entered therapy on and off again – when I had the money and time. It didn’t matter when I went or who I saw; their answers were the same: take an antidepressant.
But medication didn’t work for me – it made my depression worse.
It wasn’t until my autism diagnosis at the age of 39 that I discovered the truth about my depression. The antidepressants didn’t work because the depression was related to how I interacted with the neurotypical world.
Here are some statistics from the Autistica site to consider:
- More than 5 in 10 autistic adults have had depression.
- Autistic adults (without an intellectual disability) are over nine times more likely to consider suicide than the general population.
For many autistics, depression can stem from our interaction with a society that doesn’t accept us for who we are and requires us to hide our autistic traits.
Masking
Masking is what autistics do to hide or suppress our autistic traits and, speaking for myself, is the most significant contributing factor to depression. Although masking occurs in both women and men, it is found more often in women, which may explain why girls are undiagnosed. Hiding our autistic traits makes it more difficult to diagnose us.
Girls and women feel pressured to be more social and often mimic other girls or women. Speech patterns, tone, inflection, body language, special interests, etc., can be masked to a certain extent.
You probably wonder what this has to do with our depression discussion. Well, several things.
Let’s start here:
- Masking is an exhausting process.
I’ll start with a conversation between two people: one neurotypical and one autistic. For neurotypical people, much of their unspoken social cues are automatic. But for the autistic person, most of the conversation is a conscious effort.
As described by Healthline, “Masking consumes huge amounts of energy. In a 2016 study, Trusted Source, women who used masking to satisfy neurotypical standards said they felt exhausted by the constant effort.”
The neurotypical can focus on the conversation and give little attention to everything else. Not only does the autistic person try to participate in the conversation, but they must also actively regulate their facial expressions and body language while also monitoring the flow of the conversation and the topic covered.
While attempting to focus on what is said, we are also processing this in our heads:
- What are my arms doing? Are they crossed?
- Am I looking at the person?
- Is that a pause for my turn to talk?
- Was that a joke?
- She made a weird face. Is my tone off?
- Perhaps I should nod my head, so she knows I’m listening.
- And much, much more.
This extreme exercise in mental processing and multitasking is exhausting.
The overwhelming burden of masking while socializing can often lead autistics to take breaks from socializing or avoid it altogether. This can increase our isolation and decrease our ability to make friends, both of which influence our levels of depression.
2. Masking means we are living a lie and not being our authentic selves.
Growing up without an autism diagnosis made me feel like I was leading a double life. And many autistics – especially the late-diagnosed women – feel this way.
To be socially accepted, we must pretend to be someone we are not, but the mask we put on is at odds with our authentic selves.
“…many [autistic women] stat[ed] their experience of masking has been emotionally taxing and that they feel they embody a persona outside of themselves.”
Andréas RB Deolinda, BA, BSc
The more pressure we feel to mask our authentic selves, the less we know about ourselves.
When I received my diagnosis, I felt like I had to look in the mirror and introduce myself…to myself. I didn’t know who I was and finally understood why. But, more importantly, how could I expect others to accept me for who I am if I don’t know who I am?
When you feel that you must constantly hide who you are from the world to be accepted, your mental health will suffer. We need deep connections with friends and family to feel like we belong.
Communication Misinterpretation
Our communication style is quite different from neurotypicals. We are more direct, blunt, honest, and don’t pick up on the smaller unspoken social cues like tone, body language, and facial expressions. It’s not uncommon for an autistic’s body language or facial expression to be mismatched with our emotional state or the tone of our voice.
Think about it: If you can’t effectively decipher social cues, you can’t effectively use them. Mimicking others can only go so far.
This apparent mismatch can cause neurotypicals to misinterpret what we are saying.
For a quick example, let’s look at the response to unwrapping a gift. I can be thrilled about my gift, but my neutral face and flatly delivered “thank you” will undoubtedly, be misinterpreted as not happy with the gift. My parents accused me of not showing enough excitement and appreciation for gifts as a child. “You’re being rude,” was often said to me by my mother.
Now, when I receive a gift, I consciously make an effort to express my gratitude outwardly. But this is hard. Am I overdoing it? Do they understand how excited I am? Do I come across as fake in my enthusiasm?
Even when masking, our autistic traits can sometimes leak through. And in a highly standardized world, our differences make us stand out from the norm. We all know what happens if you aren’t ‘normal’ enough.
Being different or ‘weird’ makes you a target for bullying and gossip.
Because our brains don’t work ‘normally,’ we can often be told that our actions, words, and thoughts are wrong.
Believing everything you do and say will be wrong can cause you to hold back and not participate in life and significantly affect your self-confidence.
Autistics struggle to balance masking for acceptance and maintaining our authentic selves. We need access to appropriate mental health services to help us through these issues and depression.
More than anything, we need affordable access to therapists specializing in autism. Therapists with the expertise to support adult women are hard to come by (there are only three in my city) and very expensive.
More than anything, we need affordable access to therapists specializing in autism. It’s not uncommon for autistic adults – especially women – to be misdiagnosed with depression, and the source or reason for that depression is completely missed, overlooked, or ignored. Medications may help some, but we also need support in addressing the underlying causes of depression and anxiety related to our inactions in society.