When Amara Brook was training to be a clinical psychologist, a supervisor offered some advice before an important meeting about a patient: Stay quiet and listen to your superiors.
In the hierarchical medical field, deferring to authority figures and navigating big egos is the norm. But for Dr. Brook, who has attention-deficit hyperactivity disorder and autism, the unwritten social rules were tough to follow.
So Dr. Brook clamped down on a Jolly Rancher. The candy formed a type of cement between the teeth — a “muzzle,” Dr. Brook said; without it, the strong urge to speak up would have prevailed and “definitely ruffled feathers.”
Dr. Brook was using a coping skill called masking: concealing thoughts or behaviors to fit in.
“Sometimes we just have to do what’s effective, you know?” Dr. Brook said, but there’s a downside — when you’re “putting on a show all the time, it’s exhausting.”
Masking can help anyone navigate challenging environments, like the workplace. But for people with autism and A.D.H.D., covering up unconventional social behavior can become a nonstop survival strategy. And when masking feels constant and unavoidable, it can create or exacerbate mental health problems.
What is ‘masking’ and where did the term come from?
Masking, sometimes referred to as camouflaging, is a way of managing how we present ourselves by hiding things that others might find objectionable in order to create a more positive impression.
In academia, the idea first gained traction in the ’60s when the social psychologist Erving Goffman revealed how stigma pushed people to conceal certain parts of their identity, like sexual orientation or religious affiliation, that weren’t immediately visible.
But the term “masking” wasn’t used prominently until later, in the ’70s, when the psychologists Paul Ekman and Wallace V. Friesen used it to refer to the act of concealing emotions.
More recently, members of the autistic community started using the phrase “autistic masking” online to describe the way they hid behaviors like hand-flapping, or how they studied and imitated social norms like maintaining eye contact.
And in 2013, the manual used by mental health providers nodded to the concept, saying that autistic symptoms “may be masked by learned strategies in later life.”
Autistic masking is now an emerging area of research, and in 2019 researchers developed a measure of masking called the Camouflaging Autistic Traits Questionnaire.
When is masking useful?
Everyone, whether neurodivergent or not, needs to mask sometimes. It helps people feel accepted by a group. And believing that you belong is “one of the best predictors of well-being,” said Mark Leary, a professor emeritus of psychology and neuroscience at Duke University who has studied social motivation.
Masking can be empowering when it’s done according to a person’s own values and by choice, said Iris Mauss, a professor of psychology and director of the Institute of Personality and Social Research at the University of California, Berkeley.
For example, if you value being kind and patient, then you might choose to avoid expressing boredom and frustration during a seemingly interminable work meeting, Dr. Mauss explained.
In this way, she added, masking can allow for “a deeper and more nuanced understanding of what authenticity really means” by helping people adhere to their core principles.
When is masking problematic?
Sometimes masking goes too far. Concealing important parts of ourselves can harm close relationships and cause shame or guilt, said John Pachankis, a professor of social and behavioral sciences at the Yale School of Public Health.
Masking can lead to depression, anxiety, burnout, missed mental health diagnoses and even suicidal behavior.
Masking all the time “suggests that the way you fundamentally are is a problem,” said Sara Woods, a clinical psychologist at the University of Washington Autism Center and in private practice at Discover Psychology. She added: “There’s a lot of effort that goes into that on a daily basis.”
Some people may rightly fear social or professional consequences from masking less, Dr. Woods said, and those concerns can be heightened if they’re at risk of discrimination for other reasons, like racism.
If you’re wondering whether you’re masking too much, Dr. Mauss suggested asking yourself: Does masking help me in general? Does it help my relationships? Or is it causing more harm?
If the cons are outweighing the pros, then you may want to explore masking less often, Dr. Mauss said.
How do you start to unmask?
Devon Price, a social psychologist at Loyola University Chicago, and the author of “Unmasking for Life,” recommended finding “pockets of safety” and gradually letting your mask down with supportive family members or friends.
Dr. Price, who has autism, advised testing the waters first with the help of a mental health provider, like the ones listed in the directory Neurodivergent Therapists.
Finding a group that matches your identity is particularly important to develop self-acceptance, whether it is a self-advocacy group for autistic people or a comic book club. When you look around, you might think, “Well, there’s nothing wrong with them, maybe there’s nothing wrong with me,” Dr. Price said.
And if you let down your mask and don’t get the support that you were expecting, consider trying again later — things can change for the better.
“It’s important to remember that people can become more accepting over time, especially if they can come to understand the issue through the perspective of an important person in their lives,” Dr. Pachankis said.
Christina Caron is a Times reporter covering mental health.
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