Unmasked: Autism openness and improving mental health

The Burden of Masking

If you're autistic, opening up can reduce the daily stress and anxiety of masking your autism diagnosis while also generating greater understanding from those around you. Keeping fully masked—or hiding a significant part of your identity and how you experience the world—is tiring and can be an extra burden to whatever stress you are already feeling. 

In hiding their condition, autistic people often deny the needs, impulses, and inclinations that are innate to their brain’s wiring—traits that exist regardless of whether they or society approves of them. I recognize that many autistic people are not doing this by choice; the pressure to mask often comes from broader society or, in some cases, even popular social skills training programs.

Autistic people tend to have deep interests in specific things. I, for one, have been passionate about aviation from a very young age. Everything from identifying the type of aircraft flying overhead to understanding all the intricacies of how major international airports operate fascinates me. But if you had met me between second grade and my senior year of high school, you'd have never known. That's because by first grade, I realized that nobody else at school shared my interest. I got the sense that being openly myself—like knowing the difference between a 747-300 and a 747-400—would lead to fewer friends, not more. It would have been, in elementary-school parlance, weird. 

Over the years, I developed a deep feeling of shame, like having this interest was inherently wrong because it was related to autism. Rather than seeing it as a benign part of my personality, I saw it as a symptom of an illness. 

At night on my phone, I might have been looking up Wikipedia pages on the history of an airline, but if anyone came in, I would close the window and clear my history because I didn't want them to know my secret interest. The lengths I went to in order to hide my interest in aviation reflected an implicit assumption of shame for having the interests I did. Not surprisingly, that didn't help my self-esteem. 

Beyond their true interests, autistic people are often pressured by society to ignore or downplay another core aspect of themselves: their sensory needs. If you're fully masking, you might forgo ear protection while taking in fireworks with friends for fear of outing yourself. Or you might force yourself to sit completely still at work or school even though you'd be more focused and productive playing with a fidget toy. All in all, chronic denial of your brain's needs is harmful to mental health. 

Again, I recognize that masking often stems from external social pressures rather than an intrinsic desire to appear non-autistic; therefore, tackling these issues also requires a broader movement toward destigmatization. 

Authenticity, Self-Acceptance and Mental Health

According to a 2024 study led by Pepperdine University's Joshua A. Evans, high levels of masking are associated with authenticity and self-esteem challenges as well as negative mental health impacts overall. Evans et al.'s quantitative results about masking echo qualitative results from various other studies. They find that, while it may initially seem that passing as non-autistic would lead to better mental health outcomes by avoiding the stigma of a marginalized group, this overlooks the critical role of self-perception. Regarding this point, the researchers note: "Our findings suggest autistic masking is associated with higher depression and anxiety symptoms, lower self-esteem, and less personal authenticity." 

Living honestly and more authentically, by contrast, improves self-acceptance, which, in turn, improves mental health and reduces the risk of poor mental health outcomes. 

Authenticity is one of the strengths that autistic people often have in spades, and authentic living can come in many sizes and shapes depending on your comfort level. You might make an effort to embrace your true interests and passions with the people you trust. It might even be something that brings people closer together. 

On one long car ride to the beach last year, my friends were awestruck when they realized how many airport codes I knew from memory. Today, I have grown enough from the previous masking of my interest in aviation to put a "Fly TWA Jets" sticker on my computer for all to see. This didn't happen overnight—my own process toward openness took over a decade—but it was worth it in the long run. 

When an autistic person recognizes and validates their own sensory needs—by buying a pair of earplugs, for instance—they can take in a fireworks show with wonder and awe rather than fear and anxiety. 

Moreover, I have found that when I mention my diagnosis, people are more likely to appreciate the weight and importance of my needs. They are more likely to understand that my sensory needs are not simply a preference. As a result, when you become more comfortable talking about your diagnosis with the people you trust, your support network becomes larger and more supportive. 

Unlocking Better Care

Now that we see how openness can help reduce the daily masking-related stress and anxiety experienced around the people who matter most to you, let's explore mental health treatment. 

Greater openness leads to better mental health treatment when you are more comfortable discussing your diagnosis openly with a trusted medical professional, whether it's a therapist or psychiatrist. Since mental health challenges are prevalent among autistic people, one's connection with a therapist or psychiatrist matters a lot. 

Let’s contrast the difference between an autistic person excluding or including their diagnosis when they present themselves to a trusted provider. Excluding your diagnosis can leave you at risk of being misunderstood. Without this context, things like taking frequent breaks in your dorm room with the lights off might be misinterpreted as a depression symptom. 

Including your diagnosis, on the other hand, opens the door to deeper understanding. Once you've opened up to a trusted provider, you can discuss the role of your social and sensory battery and how to pace yourself in the future so you don't burn yourself out. Opening up  also deepen your connection with your provider by increasing mutual trust and rapport, which makes for more meaningful care relationships. 

By opening up to your therapist or psychiatrist, you can get yourself mental health care and support that's better tailored to the way your brain is wired. This delivers more value for the time, money and energy you put into therapy and can lead to your receiving more practical advice that's easier and more effective to apply in real life. It goes without saying that improved mental health treatment leads to better mental health. It also adds a new person to your support network. 

Humanizing Autism

Finally, greater autism openness delivers better collective mental health to all autistic people through stigma reduction. The first step in this process occurs between you and others around you. 

Adding a name and face to the condition—especially when the person who's opening up is a valued friend, partner, student or employee—helps humanize the diagnosis for the person on the receiving end. That person may now be more likely to become an ally or advocate for autistic people in general. 

For instance, imagine that one day you open up about your diagnosis to a close friend. Two months later, in an interaction miles away that doesn't involve you, your friend is talking to someone else who makes a disparaging remark about autistic people. Thinking of you, your friend might be more likely to offer a correction. 

When more autistic people open up, those around them increasingly realize that autistic people aren't a distant group of weird people, but friends and colleagues they already know and like. This model of destigmatization through openness has been effective in the past for the gay rights and acceptance movement. Additionally, it empowers autistic people's non-autistic friends to become more active advocates or allies, even in small ways, to help move forward the cause of understanding and acceptance.

The second step in the process occurs between other people and society at large. Recall that for many autistic people, masking is an interpersonal trauma response; they may have been shamed, criticized, or bullied because of their autistic traits. In this column's second article, we discussed the domino effect of openness, which creates a feedback loop: as more people open up, the surrounding environment becomes a little more accepting. And as the environment becomes more accepting, others who might have previously felt uncomfortable opening up may now feel more willing to do so.

Your openness is one small step toward making the world a more welcoming and accepting place for yourself and other autistic people. By taking a step toward reducing stigma, your mental health—as well as that of others on the spectrum, including those who are still closeted—can improve. 

The domino effect of openness has been one of the most effective models for small minority communities to win acceptance, which benefits the entire group's overall self-esteem and mental health. One of my favorite parts of opening up is that, when you’re open in a given setting, you create the opportunity to pay it forward and become someone who others can confide in.

We know from research that individual and collective self-esteem are both key predictors of mental well-being. While full masking may deliver short-term benefits, it threatens to create significant, long-term harms––self-esteem issues, anxiety, depression, and chronic autistic burnout––that don't easily go away. 

Some level of openness can help autistic people reduce or avoid these harms while also developing a stronger sense of self-acceptance and validation of their neurodiversity. Even if you're not ready, or it doesn't make sense to live authentically with everyone you meet, letting yourself be a little more authentic with the people you trust can go a long way toward general well-being and life satisfaction. 

Instead of feeling anxious about whether your autism-related needs will be accommodated, building strong connections with a support network of friends, family, medical professionals, or whoever else you trust empowers you with the confidence that your needs are valid and will be respected.