At the Doctor's

 Too often I feel the Cassandra. What I perceive as truth and lived experience fall on deaf ears. Professional deaf ears.

It's not a new senario. The sterile walls of the doctor's office, filled with diplomas or an overview of the human body, either in musclewrapped or bare bones. Perhaps a skeleton in the corner. An office chair for the doctor, a chair for the patient. Some hierarchies never truly change. One doctor's office I was at, had a couch.

I clutch my little list of points I wish to bring to her attention. Things I perhaps struggle with, perhaps feel overwhelm me, perhaps are silly little things. I trace a pebble soothingly.

My mask stays in place.

“I'm having some trouble with melancholy.” I say at last. One of several conditions on my list, the most common, I think. One comorbidity seldom arrives unchaperoned, and the melancholy has been a consistent for years. My own dreary dark dog, to borrow a phrase. Such a thing that is a constant day in and day out, hardly appearing on doctor or shrink charts or scales of depression 1 to 10. A monotone condition, if anything.

“What sort of depression?”

I tell her. Her fingers type awkwardly on the keyboard. I do not see what she enters into my journal. I wish I could. Too often, autistic patients are infantilized, dismissed and dehumanized in doctor-patient relationships. We are too odd to know ourselves, to know our own bodies and aches and ills. Girls, women (Saporito 2022) and nonbinary people especially (Neurolauch 2025). People who seem to have it together, to keep it together, but who are struggling in ways society do not recognize. In a way we ourselves do not recognize. A medical curiosity to ableminded physicans, too often neurotypical themselves. All too often deemed unhelpable by those selfsame physicians, a textbook example of medical ableism (Janz 2019). 

“Your depression can be cured if you find employment.”

What sort of employment? Be specific, woman. My depression will be tenfold amplified if I even find a smidge of regular employment. Unaccomodated employment, most likely, as I'll be to afraid to speak up. Be one of the lucky ones. The high-functioning ones. My skin crawls just at the thought. The open office space, the panoptic feeling, the eating-lunch-where-everyone-can-see-you, the humming of florescent lights, the exhausting commute home and back again. I recoil. Try to explain the feeling of dread in the bottom of my stomach. I want employment, yes. But on my terms and accomodated to my needs. Not some brain rot which ends in burnout because I was too timid or anxious or frightened of speaking out and disrupting The System. My depression will be tenfold amplified and end in burnout most foul.

My mask stays in place.

Time to advocate for myself. Time to rouse the dragon. I glance at my list. 

“I know I wish to persue a different course.”

Dragon for ‘You are way off course and heading into territory you know nothing about’. 

“I've even found a potential clinic.”

I show her the web page. Seems to fit like a glove, this place. It has everything I could need to stop my ever-chattering-refusing-to-drown-demons. 

The doctor skims the page. Reports that I do not, in fact, have the correct address, or indeed, live in the relevant part of the country, to warrant such help. She refers me to the local non-urgent psych-help. The one with forest walks, lake views and yoga. In groups, of course. As though my autistic self would do any better in groups than in one-on-one sessions with a proper shrink. As if my melancholy is a dull splinter, rather than an open wound. The ever present toll of masking. We appear too well, too aware of our own plights and problems to actually require urgent help, after all. An ever present refrain of my life, really.

She smiles thinly. 

“Employment would be gainful. Give you structure. Provide learning opportunities and growth.”

Neurotypical for ‘shut up and submit.’

“I have structure...”

And I know my routines would lie in ruin if I were to have regular employment 9-5. I would be beyond exhausted once the day was over, not to mention all the energy I would drain getting to and from the job... And the masking draining me even faster and make me burn out within half a year. During school I masked because I knew no better, but now, with the opportunity to receive accomodation in accordance with rules and regulations, I don't need to mask if the environment supports me. A good work environment ought to do just that. Lend support and good will to autistic people and endavor them to lead well enough lives. Diagnostic overshadowing is another issue, wherein “It's just the autism” becomes your sole defining feature and everything is either linked to or stemming from your condition. Migraines from a long day? Autism! Overstimulation and exhaustion? Autism! Lingering feelings of inadequacy because you are perceived as blundering through life? Autism, naturally. Neurotypical doctors and shrinks are both guilty of this view and it stunts advocacy, doctoral trust and causes real clinical harm. 

Autistic scholar Damian Milton's Double Empathy Problem (2012) frames neurodivergent and neurotypical breakdowns as mutual, not only the fault of the autistic person. Neurodivergent individuals try their utmost to explain their symptoms, but the neurotypical doctor or listener hears it as rattling off complaints or self-diagnosis. In healthcare, according to scholar Sebastian C K Shaw (2022), this becomes a Triple Empathy Problem, where even clinical systems fail to bridge the gap. The inherent power dynamic, masking tactics and structural biases are all pitfalls in communiation. Such pitfalls are not limited to telephoning the doctor's office, deciding what symptoms are worth notifying the GP about, the waiting room enviroment and difficulty communicating (Shaw et al. 2022). These are all barriers to accessing proper healthcare, as the system is still geared toward The Neurotypical Patient. 

Autistic patients are also dismissed by neurotypical healthcare workers when expressing concerns due to either their tone of voice (monotone, flat or perceived as aggressive, hostile or quarrelsome) or their disposition, including emotional dysregulation. Autistic scholars Kieran Rose and Amy Pearson (2022) connect this to the frequent misinterpretations of autistic communication by neurotypical listeners, either as manipulative, immature or aggressive. 

Fellow autistic scholar Dora Raymaker (2020) points out that autistic people all to frequently mask in order to translate their experiences into neurotypical frameworks, reinforcing alienation and invalidation. When an autistic patient attempts to articulate long-term trauma, sensory sensitivities or autistic burnout, the doctor may hear complaining, self-diagnosing aka undermining clinical authority or general whinging. Which in turn leads to patronizing phrasing such as ‘but everybody experiences that’ or ‘this [event] will soon be over’. Such dismissal of needs or concerns that do not match the neurotypical expectation of pain, distress or trauma are simply left to their own devices and told to return in a month or so, should symptoms worsen. Such actions causes an erosion of trust, and outright refusal to go to someone who do not listen when you tell them you're in pain.

“But having employment would give you a break from your depression.”

My mask slips, ever so slightly.

“Would it? How so?”

I allow the frost into my words. Just a tinge.

She has no answer to that. Other than, it would quiet my mind. If my mind were neurotypical, mayhaps. It would break my mind, having a job. Make me too exhausted to think, care, or act within the living present. So would certain medications, I'm told. Make it so I'm not witnessing the biggest crime of our time being perpetrated before our eyes. Make it so work dulls my mind and my empathy and makes me complacent. A horror beyond belief. At least she's not suggesting I purchase flowers or light candles to keep suicide at bay, that would be a joke.

According to both disability scholar Alison Kafer (2013) and critical autism scholar Monique Botha and Robert Frost (2020) employment-centric models of recovery are exlusionary and the systemic invalidation is precicely what leads to both autistic burnout and depression. The notion that depression can be cured by work is ableist and frankly harmful, reinforcing the medical model of disability and dismisses the neurodivergent realities, as a constant bootstrap mentality.

I decide not to tell her of my worries for eating conditions. Doctors loathe when you self-diagnose, after all. And autistic patients are underbelieved and infantilized enough already for us to even make a dent in that cannister. Who knows your body and mind better, I ask. Me, who live in it daily, or you, who see me maybe thrice a year with my mask on and my troubles lined up like pebbles after careful consideration? I know my own breaking mind better than you would ever do, your prestigious education be damned. 

Sources

• Janz, Heidi L. “Ableism: the undiagnosed malady afflicting medicine”. Canadian Medical Association Journal. PubMed Central. 2019 <https://pmc.ncbi.nlm.nih.gov/articles/PMC6488478/>
• Neurolaunch. “Nonbinary Phobia: Unpacking Fear and Discrimination Against Gender Diversity”. 2025 <https://neurolaunch.com/nonbinary-phobia/>
• Saporito, Karen. “Why Autism Has Been Underdiagnosed in Girls and Women”. Psychology Today. <https://www.psychologytoday.com/us/blog/understanding-the-diversity-in-neurodiversity/202202/why-autism-has-been-underdiagnosed-in>.
• Shaw, Sebastian C. K.; Neilson, Stuart; O'Sullivan, Jane; Carravallah, Laura; Johnson, Mona, Cullen, Walter and Doherty, Mary. “Barriers to healthcare and self-reported adverse outcomes for autistic adults: a cross-sectional study”. BMJ Open. < https://pmc.ncbi.nlm.nih.gov/articles/PMC8883251/?utm_source=chatgpt.com >. 2022