Dropping my mask

In 2017 I received a diagnosis of autism. During my diagnostic assessment, the Psychiatrist asked me a simple question with surprising consequences: 

'How do you feel about eye contact?'

'Well', I explained, 'I look at someone for a few seconds, then take my cue to look away for a second, then I look back at them. But sometimes it is painful to make eye contact so I can't always do it.'

The Psychiatrist explained to me that regulating your eye contact consciously, using rules and algorithms gleaned from experience, is not the 'neurotypical' (non-autistic) way of doing things. Neurotypical people, she explained, don't usually think about their eye contact, it just happens.

Why do I feel the need to regulate my eye contact?

Social camouflaging 

The answer is, I am camouflaging. Camouflaging is a term which means modifying behaviour in an attempt to conform to conventions of non-autistic or neurotypical social behaviour (Mandy, 2019). You may have heard it referred to as 'social camouflaging', 'masking', or 'compensation' or even simply 'pretending to be normal'.

I have engaged in social camouflaging ever since I can remember starting at Junior School aged four. Filled with a desire to have friends and companionship, I remember studying intently to understand how other children my age dressed in cool patchwork jeans at parties, adorned their hair with colourful hair clips for school, and greeted each other with a 'Hi' rather than my preferred mode of opening conversation with a question about my special interests (i.e. 'Did you see the latest My Little Pony called Firefly?'). Through carefully observing others, I managed to create a 'normal' self that I could present to the world. This façade only worked temporarily though, melting off me like an ice cream on a hot summer's day as the day progressed and my energy subsided.

Of course, everyone, autistic or not, camouflages to a certain extent. In 1956, Erving Goffman penned the influential book The Presentation of Self in Everyday Life, using a theatrical metaphor to conceptualise human social interaction. Just as performers in a theatrical production, Goffman discussed how during social interaction, both individuals will attempt to control or guide the impression that others might make of them through their behaviour. 

I had a recent conversation with a non-autistic person about camouflaging, and they asked me why I would want to stop camouflaging and come across as my autistic self, and whether appearing neurotypical might not be better for my friendships and career. To this I answered an emphatic no, and the reason for this harks back to the opening quote by Carl Rogers: camouflaging is not satisfying. Let's explore why.

Many autistic people report experiencing camouflaging as an obligation, rather than a choice (Mandy, 2019). It is often motivated by the need to avoid standing out, which may provoke bullying or ostracism, or simply by a feeling of being different and wanting to feel that you belong. All individuals, neurodiverse or not, face the conflict between authenticity and pragmatism, as Mandy highlights, but for the autistic person, this conflict is often heightened by living in a world in which you are a minority.

Indeed, the consequences of camouflaging can be very negative. In a qualitative study by Hull et al. (2017), they asked 92 autistic adults to answer several questions about their camouflaging behaviours, and its consequences. They report that the most consistent response from participants was that camouflaging is simply 'exhausting'. In the study, camouflaging was repeatedly depicted as being mentally, physically, and emotionally tiring; requiring intense attentiveness, self-control, and the continued management of a felt sense of discomfort. Some individuals expressed feeling extreme anxiety and stress following an interaction where they felt a pressure to camouflage. It is also commonly believed that camouflaging may prevent timely and accurate diagnoses of autism, thus precluding support and perhaps precipitating poor mental health. 

For myself, I find camouflaging sometimes helpful, but often encumbering. On the one hand, I have camouflaged for the first 27 years of my life, with a fair amount of success along the way. On the other hand, it has sometimes proven to be a debilitating strategy. For instance, I suffered an 'autistic burnout' in the first year of my DPhil at Oxford, which has been described in one scientific study as 'having all of your internal resources exhausted beyond measure and being left with no clean-up crew' (Raymaker et al., 2020). My well-being was at an all-time low due to keeping up a façade of normality for years, while internally struggling with the feeling that something was 'different' about me that I couldn't name. In the aforementioned study on autistic burnout, one of the potential solutions for preventing its occurrence was 'an earlier diagnosis, which potentially could have meant less need to camouflage'.

Exploring authenticity

As a contrast to camouflaging (although some individuals report positive consequences) the concept of being authentic is viewed as a healthy attribute in both contemporary psychology and society (Smallenbroek, Zelenski, & Whelan, 2017). Authenticity is tricky to define, but has been neatly conceptualised as the unimpeded operation of one's true, or core, self in one's daily life (Goldman & Kernis, 2002). People with high authenticity are believed to be able to act in accordance with their specific interests and values. As a result, these behaviours enhance their overall subjective well-being. Kernis and Goldman (2006) further separate authentic functioning into four distinct components:

1)    Awareness and knowledge of one's self

2)    Unbiased processing of evaluative information

3)    Behaviour that is aligned by one's true self

4)    A relational orientation with close others that fosters openness and connectivity

Carl Rogers, psychologist and one of the founders of the humanist approach to psychology, described a similarly authentic state as one of 'fully functioning' (Rogers, 1963). Importantly, Rogers defined this state partly by 'movement' or decisive action away from 'facades' and from 'oughts', from meeting expectations and from pleasing others (Joseph, 2017). In response to moving away from such pressures, the individual can move towards self-direction, openness to experience, acceptance and trust, thus following their own intrinsic motivations rather than acting for the benefit of others. It struck me that this wish for authenticity or a 'fully functioning' state is pretty similar to the desire that many autistic people have to stop camouflaging.

Through conversation with Professor Francesca Happé, one of the world's leading autism experts, I discussed how camouflaging can prevent an autistic person from feeling that they have a strong sense of self-identity. She told me that this is something that she often hears about from autistic people, with a narrative that if you spend your whole life pretending to be 'normal', how can you know who you really are? Read more from Professor Happé below.

Using mindfulness to explore my social camouflaging

In the summer of 2017, around the same time as my autism diagnosis, I embarked upon an 8-week Mindfulness Based Cognitive Therapy course at the University of Oxford, designed especially for busy students with a to-do list comprising 101 or more items and a brain full of facts and ideas. Mindfulness is most commonly defined as 'paying attention in a particular way: on purpose, in the present moment, and non-judgementally' (Kabat-Zinn, 1994). I had heard that mindfulness was the latest panacea and I was duly sceptical. 

One of the first exercises that we did was to eat a single raisin over a period of about 10 minutes. We smelt the raisin, felt the raisin, explored it with our fingertips, held it in our mouths, and experienced a greater awareness of the raisin and its sensorial experience through reflecting on it in this way. Now I am not normally a fan of raisins, but I felt that I had been so focused upon the experience and exploring every facet of knowledge that arose from the exploration that I had truly 'lived' those 10 minutes. 

As the course progressed, numbers of attendees reduced, but during the meditations we practiced during classes, I was finding a new awareness. Rather than being consumed by my thoughts and feelings, I was stepping back and noticing them. It was certainly not plain sailing – I had many, many moments of frustration, such as when we meditated for 10-minutes and I only realised that I had swam off into my own thoughts for the majority of the session. When completing the 'body scan' where you pay attention to each body part separately and the aligned sensations, I was often frustrated that I couldn't feel my knees 'properly' or that my stomach was grumbling because it was almost teatime. 

However, for me, the pivotal point of learning was understanding the difference between 'intrusions' and 'appraisals'. Intrusions can be thoughts, images, worries, or emotions that flood our conscious experience. But what I had crucially learnt is that regardless of the content of the intrusion, I could then choose how I made sense of the information in my consciousness and how I wished to respond. Now I am by no means a mindfulness expert, I sometimes forget to practice for days at a time when weeks get busy. I am very much still exploring and learning. 

But one of my explorations into mindfulness struck me as potentially important. As a seasoned professional at social camouflaging who often questions my authenticity, I felt strongly that I wanted to learn how to 'drop my mask' and act more in accord with my authentic, autistic self. Now if you are autistic too, you'll probably understand this irritation. Camouflaging can be great, but it's often burdensome and exhausting, and if I am honest, I have spent years, a lifetime even, not knowing how to stop. But the very mechanism that helps me to camouflage – learning rules, algorithms and processes to follow – may actually be the key here. 

For me, mindfulness can offer me one way to reach the four components of authenticity outlined earlier by Kernis and Goldman (2006). If I am able to notice my instincts to camouflage through mindful awareness (authenticity component 1), for instance, "Jane just made a joke, you should laugh", then I can stop, pause, and evaluate the information with a non-judgemental eye (authenticity component 2). With the fortune of appraising my intrusion and instinct, I am then able to choose my subsequent behaviour to act according to my true self or true instinct (authenticity component 3), for instance, I might choose not to laugh because I didn't understand the joke or find it funny. I could then ask Jane what the joke was supposed to convey and how the punch line operated, thus fostering a more open and connected relationship (authenticity component 4). 

Now this is nowhere near as easy as it sounds. I do not habitually go through the motions of adhering to these four steps, and then flawlessly drop my mask and proceed authentically. It is taking practice, it even often takes just as much awareness as to camouflage in the first place. Sometimes, the process of being aware, appraising and evaluating the information, and then choosing how to respond, does not tally with the pace of conversation. Before you know it, the conversation has moved on and you haven't had a chance to contribute or respond. I found this frustrating at first, but gradually I have learnt that it becomes a faster, more automatic process over time and with practice.

The scientific literature does seem to support a relationship between mindfulness, authenticity and well-being. One study that combined cross-sectional and time-lagged measurements found that the association between authenticity and subjective well-being was in fact mediated by mindfulness skills (Zheng, Sun, Huang, & Zou, 2020). Two of the specific facets of mindfulness were accountable for the majority of this association, namely, mindfulness-describing (the use of words to describe inner experience) and acting with awareness (attending to the present moment). This finding suggests that mindfulness, and specifically the two components above, may underlie the psychological mechanism linking authenticity and well-being. The authors suggest that mindfulness-describing is linked to authentic self-awareness, while acting with awareness is more relevant to authentic self-expression or action. This is an important finding, as although there may be multiple pathways from authenticity to well-being, mindfulness may offer one mechanism that can be tested experientially.

Exploring further

The relationship between mindfulness, authenticity and well-being may be far more complex than a simple mediation of mindfulness between the other two, and perhaps that is because most research to-date in this field has been conducted with neurotypical participants. In my experience, mindful awareness and the stepping back that comes with it allows me to appraise my instinct to camouflage, and also to be aware of my real, often conflicting, instincts. If I have time and capacity, I then have the choice about my behavioural response and whether or not it conflicts with the social norm. I can choose to try to reach a semblance of my authentic, autistic self, or choose to blend in and try again another time. 

Of course, we are all individuals, and what works for some may not work for others. I have learnt to be accepting of my efforts to socially camouflage – I cannot break the habit of a lifetime in a couple of years. But I am also learning to be open to new experiences, try to drop the mask when it is safe to do so, and appreciate that the consequences of not camouflaging, of being more authentic, can improve my overall wellbeing. As Rogers said, "am I living in a way that truly expresses me?" I'm not sure, but I am excited to explore it further. 

Note: This article originally appeared online in June 2020

Eroding the sense of self – from Professor Francesca Happé

"I have lovely friends, who are very supportive…but it's not me they like, they don't know me at all – just the mask that I wear". These words, from a 16-year-old girl who received her autism diagnosis a few years earlier, brought home to me the impact that camouflaging can have on autistic people. As well as being exhausting – like speaking a foreign language 24/7 – masking and camouflaging can erode the sense of self. And if no one sees who you really are, how can you develop self-esteem?

In our recent research on compensating and camouflaging, led by Dr Lucy Livingston (who recently won the BPS Neil O'Connor Prize), we've found that autistic young people who compensate a lot – i.e. appear more 'neurotypical' despite persisting difficulties understanding others' minds (failing theory of mind tests) – report more anxiety than those who compensate less (Livingston, Colvert et al., 2019). Our qualitative study of compensatory strategies also highlighted the costs of camouflaging: 'I feel like I am acting most of the time and when people say that I have a characteristic, I feel like a fraud because I've made that characteristic appear', said one female participant in her 40's (Livingston et al., 2019). 'Putting on a performance', as many participants described compensation, was linked to 'a diminished and uncertain sense of self'. 

The wider cost to mental health also emerged as a major theme; autistic people, and particularly women without intellectual disability, are at greatly elevated risk of suicide (Hirvikoski et al., 2019). Given that camouflaging is thought to slow recognition and diagnosis of autism, and therefore provision of support, helping autistic people to drop the mask – as Eloise discusses – seems important. That's where we can all play our part, since camouflaging is often driven by negative responses, ostracism and bullying by neurotypical people. A greater understanding and appreciation of autistic differences might mean that autistic people could take off the mask. 

Livingston, L.A., Colvert, E., Social Relationships Study Team, Bolton, P. and Happé, F., (2019). Good social skills despite poor theory of mind: exploring compensation in autism spectrum disorder. Journal of Child Psychology and Psychiatry, 60, 102-110.

Livingston, L.A., Shah, P. and Happé, F., 2019. Compensatory strategies below the behavioural surface in autism: a qualitative study. The Lancet Psychiatry, 6(9), pp.766-777.

Hirvikoski, T., Boman, M., Chen, Q., D'Onofrio, B.M., Mittendorfer-Rutz, E., Lichtenstein, P., Bölte, S. and Larsson, H., 2019. Individual risk and familial liability for suicide attempt and suicide in autism: a population-based study. Psychological Medicine, pp.1-12. 

References

Goffman, E. (1956). The presentation of self in everyday life. Garden City, N.Y.: Doubleday.

Goldman, B. M., & Kernis, M. H. (2002). The role of authenticity in healthy psychological functioning and subjective well-being. Annals of the American Psychotherapy Association, 5(6), 18-20. 

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. 

Joseph, S. (2017). The real deal. Psychologist, 30(1), 34-37. 

Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. Hyperion, 78-80. 

Kernis, M. H., & Goldman, B. M. (2006). A multicomponent conceptualization of authenticity: Theory and research. Advances in experimental social psychology, 38, 283-357. 

Mandy, W. (2019). Social camouflaging in autism: Is it time to lose the mask? In: SAGE Publications Sage UK: London, England.

Raymaker, D. M., Teo, A. R., Steckler, N. A., Lentz, B., Scharer, M., Delos Santos, 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. 

Rogers, C. R. (1963). The concept of the fully functioning person. Psychotherapy: Theory, research & practice, 1(1), 17. 

Smallenbroek, O., Zelenski, J. M., & Whelan, D. C. (2017). Authenticity as a eudaimonic construct: The relationships among authenticity, values, and valence. The Journal of Positive Psychology, 12(2), 197-209. 

Zheng, S., Sun, S., Huang, C., & Zou, Z. (2020). Authenticity and subjective well-being: The mediating role of mindfulness. Journal of Research in Personality, 84, 103900.