Chapter 5. The neurodivergent masking crisis

From my forthcoming book, 'Death of a Gentleman'

The question

I was sitting on the end of my bed in my house in Gawler, South Australia, laptop balanced on my knees, a Zoom window open, and a psychologist called Gaye was asking me questions from a room three thousand kilometres away in Brisbane.

Gaye had been appointed by Veterans Affairs. The Department of Veterans Affairs, which exists in the particular administrative limbo reserved for agencies that are simultaneously essential and underfunded, had looked at my file and concluded that a man of my vintage with my symptom pattern ought to be talking to someone. Gaye was the someone. She specialised in veterans, and in the kind of neurodivergence that arrives disguised as everything else.

I was sixty-six. Old enough to have given up hope of being anything other than an exhausting project to myself. Old enough to have stopped expecting new information about who I was, because I had worked through what I assumed was the full inventory some time around the turn of the millennium and had been adjusting the furniture in the same rooms ever since.

Gaye asked me a question I was not expecting.

‘Do you think you might be neurodivergent?’

I laughed, because it was a funny question to be asked at sixty-six after a lifetime of diagnoses that had each explained something real without explaining the thing actually happening. Depression. Anxiety. Bipolar II. Generalised anxiety disorder. A small parade of labels that had arrived over forty years, each one a half-truth in a sensible outfit, each one fixing the crisis it was applied to and leaving the underlying system intact.

Then I stopped laughing, because she was not joking, and the silence that followed had the particular quality of a silence in which several doors you had assumed were walls are quietly being pointed out.

‘I don’t know,’ I said. ‘Should I?’

What followed was not a diagnosis in the clinical sense, because I could not afford a clinical diagnosis. The formal process requires an assessment that costs somewhere between two and four thousand Australian dollars, which is an interesting figure for a disability pension to contemplate, in the same way a bicycle is an interesting figure for a caravan to contemplate. Gaye conducted an informal assessment over several sessions, using the tools she had and the clinical judgement her years of practice had given her, and at the end of it she was satisfied, and so was I, that what I had been living with for sixty-six years was autism and ADHD in combination, the profile the research now calls AuDHD. I was unofficially termed a limited edition collector’s item within the neurodivergent community.

The informal nature of the diagnosis is itself a small indictment of the system. A man on a disability pension cannot afford the formal assessment that would entitle him to the supports the pension is supposed to make possible. The system requires proof of the condition that the condition makes it impossible to purchase. This is the kind of loop you get when an administrative logic has never been required to encounter the bodies it is administering.

I accepted Gaye’s assessment and I moved on, which is to say I sat with it for a few days while my sense of my own history quietly reorganised itself without my supervision.

The archaeological discovery

People talk about late diagnosis as though late is a descriptor of timing. At sixty-six, late is a descriptor of archaeology.

The diagnosis revealed that the country I had been walking through for six decades was on a map I had never been given. Every room I had entered, every conversation I had navigated, every meeting I had performed in, every relationship I had attempted and failed at and attempted again, had been conducted without access to the operating instructions other people had been handed as children and never thought to mention they possessed.

Late diagnosis carries a particular kind of grief. The grief is for the sixty years in which you believed the problem was you.

I had been, across those decades, variously described as: too intense, too sensitive, too difficult, too much, too little, too quiet, too loud, unmotivated, overly motivated, flaky, rigid, brilliant, exhausting, charming, aloof, warm, cold, and, by one particularly tired friend in 1998, ‘a bit of a project’. Every one of those descriptions was accurate and incomplete. Every one of them attached the diagnosis to the man, rather than to the gap between the man and the environment he was being asked to operate in.

The relief that arrives with late diagnosis is the relief of a misfiled document finally being filed correctly. You are still the same document. You are still full of the same content. But you are no longer in the wrong drawer.

The clinical literature describes late diagnosis using terms like identity reconstruction and post-diagnostic adjustment, which are accurate but have the prose texture of a departmental meeting. Archaeology is closer to what actually happens. You dig through your own layers. You find objects whose purpose suddenly clarifies. You re-date the strata. You understand, finally, why that particular decade had the particular colour it did.

The maths of two masks

Most of the public conversation about neurodivergent masking assumes one mask. You perform neurotypicality. You suppress the stim. You watch the eye-contact meter. You run a constant background process that translates your experience into an output the surrounding nervous systems can metabolise without alarm.

This is hard. It costs energy. It produces burnout of a specific kind that Raymaker and colleagues documented in a 2020 study that should have been more widely discussed than it was (Raymaker et al., 2020). The paper names what autistic adults had been telling each other for years. Masking is not harmless mimicry. It is a sustained physiological performance that wears the performer down at a rate the performer cannot always perceive until the wear becomes structural.

One mask is expensive enough. For a man of my generation and conditioning, there were not one but two masks running concurrently, each taxing resources the other was already consuming, and the cost was the compound cost of that simultaneous operation.

The first mask was the neurotypical one. Don’t flap. Don’t fidget. Hold the gaze but not too long. Calibrate facial expression against the emotional register of the room. Process the spoken content whilst also processing the unspoken content whilst also processing the sensory load whilst also suppressing every natural response that might draw attention. If you get any of this wrong you will be labelled strange, and strange, in a neurotypical environment, is a cost nobody quite names but everyone quietly charges.

The second mask was the masculine one. Don’t emote. Don’t ask. Don’t admit. Hold the load. Perform competence under all conditions. Never indicate the internal weather. If you get any of this wrong you will be labelled weak, and weak, in a masculine environment like Australia, is a cost nobody quite names but everyone quietly charges.

Both masks share a syllabus. Both require the suppression of signals the body is attempting to send. Both require the production of signals the body is not naturally producing. Both reward performance and punish honesty. Both are learned early, reinforced constantly, and, after a few decades of practice, operate below the level of conscious intent, so that by the time you are in your forties you are no longer aware you are performing anything, because the performance has become the baseline and the baseline is the thing you would have to stop doing in order to notice you were doing it.

Where the masks diverge is the specific content of the suppression. The neurotypical mask suppresses stimming, sensory overwhelm, cognitive rhythm. The masculine mask suppresses emotion, need, fear. Put them on the same nervous system at the same time and what you have is not two masks. You have a single, elaborate piece of architecture, laminated, reinforced, and running on a metabolic budget that would have been generous for one mask and is catastrophic for two.

I did this for roughly fifty years before the structure began to fail in ways I could no longer ignore.

What the body remembered

The first evidence that something structural had gone wrong was not psychological. It was physical, which is inconvenient for a man who has spent fifty years treating his body as a life support system for his opinions.

Mr Trung is my massage therapist in Đà Lạt. He is small, extraordinarily strong, and possessed of the kind of matter-of-fact clinical gaze that Vietnamese bodywork practitioners tend to acquire after a certain amount of exposure to the bodies of Westerners who have arrived in his country carrying several decades of structural tension they are only now becoming aware of.

Mr Trung tells me, often, that I am the worst client he has ever had. He does not mean this as an insult. He means it as a clinical observation, delivered with the small smile of a man who is informing you that the car you have brought in for a service is held together in ways its owner had not quite appreciated. Every point he touches produces agony at two out of ten pressure. His thumbs find hard, painful nodules scattered throughout muscles where blood has, at some indeterminate point in the past, simply given up on the idea of circulating and decided to wait things out. Little stones of suffering is how I have come to think of them, distributed through my back, thighs, arms, legs, feet, hands, and neck with the quiet persistence of an ancient mineral deposit.

My blood tests are fine. Cholesterol fine. Liver fine. Kidneys fine. A manageable Type 2 Diabetes, controlled with medication. By any standard panel, I am a healthy sixty-seven-year-old man who should be able to walk up a hill.

I cannot reliably walk up a hill.

Between the blood test and the body lies the thing the blood test does not measure, which is what happens to a nervous system when it spends sixty-six years running at combat speed under two masks simultaneously. Raymaker’s work on autistic burnout documents some of this (Raymaker et al., 2020). McEwen’s decades of research on allostatic load, the physiological toll of chronic stress accumulation, documents the rest (McEwen, 1998; McEwen & Stellar, 1993). The phrase is not a metaphor. Allostatic load names the measurable wear on organ systems, endocrine function, cardiovascular tissue, and immune regulation that accumulates when the stress response is activated more often and more intensely than the body was built to sustain.

The literature has a specific word for what happens when that accumulation becomes chronic: ‘weathering’. Originally developed to describe the premature biological ageing observed in populations living under sustained racialised stress (Geronimus, 1992), the concept generalises. A body that has never been allowed to stand down ages at a rate that exceeds its chronology. The clock is still reporting your age. The tissue is reporting something older.

Mr Trung’s thumbs are mapping that something older. My thighs are in their eighties. My back is in its eighties. My organs are in their sixties, obligingly. The man sitting on the massage table is in his sixty-seventh year, but the body’s accounting is done in a different currency, and the books have been cooked.

I make no medical claim about the specific aetiology of my current physical state. The observational claim is enough: my body is evidently carrying something, the research suggests such bodies tend to carry exactly this, and a lifetime of double masking makes the carrying unsurprising in retrospect.

The body kept the receipts. It kept them in tissue. It is now presenting the invoice, and the invoice is detailed, and the accounting department is not open to negotiation.

The laundering of a life

The thing I find hardest to forgive, when I look back at the forty years before Gaye’s Zoom call, is not the masking itself. It is the sequence of diagnostic labels that arrived in its place.

Depression. Anxiety. Bipolar II. Generalised anxiety disorder. Each label was applied with clinical seriousness by practitioners who were doing their best with the information available to them. Each label named a pattern that was really occurring. Each label got the shape of the distress right and the source wrong.

The problem was not the labels. The problem was the sequence.

Depression arrived first, in my pre-teens, as an explanation for why my capacity for the mundane had collapsed. It was real. I was depressed. The medication helped. What the diagnosis did not ask, because diagnoses tend not to, was why a nervous system that had been performing above its rated capacity might be running low on the neurotransmitters that get used up performing above rated capacity. The question was roughly the same as asking why the fuel tank keeps emptying when you drive the car every day, and the answer was roughly the same too, except nobody was inspecting the car. They were adjusting the driver.

Anxiety followed. Also real. Also treated. Also missing the prior question of whether a body that had been pattern-matching every social environment for signs of danger for sixty years might be reasonably described as anxious, and whether the anxiety was the disorder or the body’s accurate reporting on the effort it was expending. A smoke detector that has been shrieking for six decades is not a broken smoke detector. It is a smoke detector that has noticed something.

Bipolar II is the one I think about most, because it cost me the most, and because the overlap between hypomania and ADHD hyperfocus is one of the specific clinical cul-de-sacs that late-diagnosed AuDHD adults often get routed through. The bipolar diagnosis was not wrong exactly. I did cycle. The cycles were real. The research now recognises that ADHD-driven hyperfocus, particularly when combined with autistic special-interest intensity, can produce periods of elevated productivity, reduced sleep, rapid idea generation, and inflated confidence that look, from the outside and from a clinical interview, very much like hypomania. The treatment for the two conditions is different. I was treated for the one I did not have, for longer than I care to calculate, and the treatment for the one I did not have did nothing to address the one I did. This is the clinical equivalent of taking your car to a mechanic who confidently diagnoses a problem with the gearbox, fixes the gearbox beautifully, and waves you off down the road with the same flat tyre you came in on.

I do not say this in the spirit of complaint.

What happened to me was pattern matching against a pattern book that did not yet include the combined profile. The clinical literature on AuDHD as a distinct neurological profile, rather than as two comorbidities happening to share accommodation, is still in the process of establishing itself. In the 1970s, when my symptoms first drew clinical attention, the literature barely and hesitantly suggested that autism and ADHD might, possibly, could coexist. By the 2010s it admitted they could. By the 2020s it was beginning to admit that their coexistence produced a different profile than either condition alone.

My diagnostic history ran at the pace of the literature, which meant that by the time the literature arrived somewhere useful, I was in my sixties and had spent innumerable years being treated for symptoms of a condition that was being described by three different wrong names across six different decades.

None of the clinicians who gave me those wrong names were wrong on purpose.

The masculine filter added its own layer of mislabelling on top of the clinical one. Every clinical diagnosis I received was, in my own head and in the heads of the men around me, translated into a character judgment. Depression meant weakness. Anxiety meant cowardice. Bipolar II meant a lack of discipline. AuDHD, had anyone thought to name it, would have been translated into whatever the current masculine slur for difference was. The diagnostic names changed across the decades. The masculine translation engine remained remarkably consistent.

The relief that is not a cure

Relief, in the post-diagnostic literature, is often treated as though it were an end state. It is not.

The relief of receiving the AuDHD label at sixty-six is not the relief of being cured. There is nothing to cure. AuDHD is a neurological profile, a way of being wired, with its own strengths, its own costs, and its own particular incompatibilities with environments designed around a different wiring.

The relief is the relief of having been handed the map. You have been walking the territory anyway. You are still the same walker. The terrain is still the same terrain. You now have a document that tells you why certain paths were exhausting and certain landmarks were illegible, and you are no longer obliged to interpret your exhaustion and illegibility as personal failings. The map, admittedly, arrives a bit late. The useful moment for the map was somewhere around 1971. The map arriving in January 2025 is less a navigation aid than an explanation for why so much of the journey involved walking into hedges.

I spent the six months after Gaye’s diagnosis in a quiet process of reinterpretation. The school years, the military years, the corporate years, the speaking career, the marriage, the breakdowns, the productivity, the crashes, the periods of extraordinary output, the periods of inexplicable collapse. Each of them looked different under the new reading. Not heroic. Not tragic. Just legible. It was like re-reading a novel you thought you understood at sixteen and discovering, at sixty-six, that you had been reading it upside down the whole time and the plot actually made a great deal more sense the other way up.

The grief arrived in a manageable, recurring form, usually late at night, and it was not the grief of discovering I was neurodivergent. It was the grief of realising how much of my life had been spent not knowing, and how many decisions I had made under the false assumption that the exhaustion was my fault. I made peace with the grief in the way you make peace with weather. You do not negotiate with it. You notice when it has arrived, you allow it the afternoon it requires, and you get on with the rest of your day.

The environmental argument

The central claim I keep returning to across this book is that masculine suffering is often an intelligent response to unsuitable environments. The AuDHD layer sharpens that claim rather than complicating it.

Place an AuDHD nervous system in an environment designed for a neurotypical one, in a culture that also demands masculine stoicism, and the system will do exactly what a sensitive, overloaded, double-masked system should do under those conditions. It will work harder than it was designed to. It will produce output at a rate that earns rewards. It will incur costs that do not appear on any balance sheet the system is being evaluated against. And, eventually, it will begin to fail in ways that the surrounding culture will interpret as individual defects rather than as the foreseeable result of the environment it has been operating in. Rather like blaming a racehorse for getting tired on the fortieth consecutive lap, whilst ignoring the fact that you are the one holding the stopwatch and the rider is the one with the whip.

This is not a novel argument. Disability scholars have been making a version of it for decades, under the banner of the social model of disability (Oliver, 1990). The social model distinguishes between impairment, which is the actual neurological or physical difference, and disability, which is what the environment does to a person with an impairment by refusing to accommodate it. Under this frame, I am not disabled by being AuDHD. I am disabled by environments and cultural expectations that require me to perform as though I were not.

The implications are uncomfortable for a therapy industry that makes its money from adjusting the individual to the environment, and for a masculine culture that treats the individual as solely responsible for his own outcomes. Both benefit from the assumption that the problem is internal. Neither is especially motivated to entertain the possibility that the problem is where the person is being required to stand. There is, admittedly, less of a business model in telling a man that his nervous system is fine and he should consider moving countries.

Internal work has its place. Medication helps. Therapy helps. Understanding helps. But the internal work has a ceiling that the external work does not, and for most of my life I was being offered the internal work as a complete solution when it was, at most, a partial one. The external work, which would have involved changing where I lived, what I did, who I was expected to perform for, and how the days were structured, was not available because the culture had not conceived of it as an option.

It became an option only when I had exhausted the alternatives and had nothing left to perform.

What the next environment revealed

The most serviceable definition of masking I have come across is this: masking is the production of signals your body is not naturally producing, and the suppression of signals your body is naturally producing, for the benefit of observers whose comfort depends on not receiving the signals your body would otherwise send. Which is a technical way of saying that masking is impersonating someone the observers find easier to be in a room with than you.

By that definition, masking is culturally specific. It depends on which signals the surrounding observers require and which they find unacceptable. Move the body to a different observing population, and the mask changes shape. Move it to a population whose requirements happen to overlap less awkwardly with the body’s natural outputs, and some portion of the mask becomes redundant.

Five months after Gaye’s diagnosis I moved to Đà Lạt.

The move was already in motion before the diagnosis. It was financial at first, then climatic, then, by the time I actually got on the plane, something closer to experimental. I did not move to cure my AuDHD. AuDHD is not the kind of thing you cure by relocating, any more than you cure being six-foot tall by walking into a different room. I moved because Australia had become structurally unaffordable and because Vietnam was where my life was going to happen next.

What the move revealed, in its first months, was that a non-trivial proportion of what I had been experiencing as my condition was in fact my condition interacting with a specific environment. The environment had been constant. The condition had been constant. The interaction between them had been the variable doing most of the work, and I had not been able to see it because the interaction had never been allowed to change.

What happened to the masks when the environment changed, and what that experiment revealed about the relationship between brain and place, belongs in the next chapter.

References

Geronimus, A. T. (1992). The weathering hypothesis and the health of African-American women and infants: Evidence and speculations. Ethnicity & Disease, 2(3), 207–221.

McEwen, B. S. (1998). Stress, adaptation, and disease: Allostasis and allostatic load. Annals of the New York Academy of Sciences, 840(1), 33–44. https://doi.org/10.1111/j.1749-6632.1998.tb09546.x

McEwen, B. S., & Stellar, E. (1993). Stress and the individual: Mechanisms leading to disease. Archives of Internal Medicine, 153(18), 2093–2101.

Oliver, M. (1990). The politics of disablement. Macmillan.

Raymaker, D. M., Teo, A. R., Steckler, N. A., Lentz, B., Scharer, M., Delos Santos, A., Kapp, S. K., Hunter, M., Joyce, 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, 2(2), 132–143. https://doi.org/10.1089/aut.2019.0079