Watch on BBC iPlayer from 16th March 2023
Eloquent, successful, engaging, intelligent, empathic.
This is the female presentation of autism.
This is an extremely insightful documentary and should be essential watching for all clinicians who think they know autism.
The debilitating impact of continual masking and camouflaging in order to fit in and be who you think everyone wants you to be is described so well , however it is the impact of this on ‘sense of self’ that has the greatest impact. Being so focused on ‘getting by’, watching copying imitating, you forget who you truly are.
This remarkable skill of ‘blending in’ has further consequences on mental health. Mental health difficulties are more common in the autistic community. When autistic people, especially female autistic people first present in mental health services then they are treated for the presenting complaint and the masking covers up the deeper issue. In Christine’s case an emerging eating disorder was identified and the opportunity to discover her deeper self, as an autistic person was missed.
The programme very cleverly and with compassion, shows Christine, being successful and engaging, while simultaneously showing glimpses of her true vulnerability. It is invaluable to see the panic in her eyes, anxiety, uncertainty and hypervigilance, giving way, as the masking performance successfully takes over.
Christine is able to recognise other people’s emotions when they are obvious. She knows when individuals are happy, sad, irritated or angry however she is unable to pick up on the subtle aspects that indicate an individual may be moving from being contented towards being irritated. This inability to pick up subtle signs leads to a situation where Christine can be shocked by someone’s emotional expression as she has been unable to ‘see it coming’. This results in individual’s emotional responses feeling quite random and unpredictable. Christine reports hypersensitivity to any changes that occur in another person’s demeanour however she can have difficulty in truly appreciating what that change means. Change in another person’s tone or facial expression, when Christine cannot work out the meaning leads to significant anxiety for Christine.
This difficulty in understanding the mental states of others can make telling friend from foe challenging and can lead to Christine being vulnerable to being taken advantage of by others. She describes her autistic vulnerability and need to fit in resulting in unwanted sexual encounters and how this puts autistic women in dangerous situations. Boundaries and rules of engagement were being taught explicitly at the only school in the UK exclusively educating autistic girls. She highlighted why, educating our autistic girls requires a different approach from that taken to educate our autistic boys.
Finally, Christine reports that her journey to living her authentic self, where she is able to recognise and meet her own needs began with her formal diagnosis of an autism spectrum disorder. She is at the start of her journey but already she feels happier being herself and freed from the need to be what she thinks everyone else wants.
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