Masking & Unwritten Rules

I was brought up in Newcastle Upon Tyne, a city known in no small part for its football prowess. I am not even slightly interested in football, but if I were forced against my will to attend a football match I may look slightly unusual stood there amongst my pint-waving, black-and-white-stripe-clad comrades in a Scooby-Doo t-shirt and skinny jeans. No, I might decide to dress for the occasion in – at the very least – the colours of ‘my’ football team. This is exactly what masking is; by behaving like the people around me I avoid suspicion and sideways glances, blending in like a magpie at a Newcastle game.

I suppose it could be argued that masking – to an extent – is something we all as humans do, the difference with Autistic masking is the extent (more), and the resulting impact (high). Masking is named as such due to the idea that Autistic people ‘put on a mask’; pretend to be something or someone they are not. This could involve: forcing eye contact; suppressing any negative emotional reaction; moderating answers to questions; anything that doesn’t come naturally. Although I prefer to think of it more like camouflage than outright deception, the goal in masking is to suppress your thoughts, emotions, and traits to appear as un-Autistic as you possibly can. It isn’t really about choice of dress, it’s about behaviour, presentation, attitude, aura. The reasons why the Autistic person masks are dependent upon the person; I think the heart of it is a reason not too far away from: it’s easier to fit in.

Typically, in situations which involve the presence of other people, it is far easier for me to make changes to myself, than make changes to my environment; to change my reaction, than my stressor; to change my performance, than my audience. It doesn’t help that the world we live in is to a very large extent not made for people with Autism. It’s busy; it changes suddenly and with no warning; it’s illogical. Sometimes, the way I survive an environment that makes me feel uncomfortable, is to act like it doesn’t that it doesn’t. Fake it ‘til you make it.

I’m a square peg being hammered into a round hole just trying to make myself more square so that I fit in nicely.

I’ve found there to be a very strict set of unwritten rules within nursing, a particular way in which one must behave or else attract the harshest of judgement. Unfortunately, my ability to detect such unwritten rules is about as non-existent as my ability to follow them, but I’ve thought about it, and using my analytical and observational abilities I aim to list these rules that exist no-where else but in the heads of some people. I aim to do the unthinkable – to write a list of what I deem to be the main, and most ridiculous, unwritten rules.

Unwritten-written rule no. 1 – Never tell a nurse they’re wrong (even when they are). If they want to put the arrest call out because the pulse-ox is telling them their patient’s sats are 73%; even though you’ve noticed that the patient is actually wearing bright blue nail polish and is otherwise sat up in bed looking like the healthiest person in the room, let them crack on.

Unwritten-written rule no. 2 – ‘Lazy’ is the ultimate insult in nursing, closely followed by ‘rude’. You can and will be called both, even if you are Winnie-the-Pooh incarnate.

Unwritten-written rule no. 3 – Most hospital procedure is written to make as little sense as possible to the more rational of us. No more explanation needed.

Unwritten-written rule no. 4 –Nurses are very stuck in their ways, they don’t want to be told how to do things differently, even if that makes it easier.

Unwritten-written rule no.5 – If you ask for the evidence behind the evidence-based practice, you’re labelled a troublemaker. I found this out when I read a study which found that wearing nail varnish may actually reduce the number of microbes proliferating on a person’s nails (something to do with the chemicals in the nail varnish creating an inhospitable environment). So, when I just so happened to be in a room with someone who works for PHW and I told them about this study I’d read and asked them to forward me the study they base their advice on, the response I got was so disproportionately frosty that it made me very suspicious of if such evidence even exists.

If you’re on the ward trying not to present as an autistic, the above are some pretty good starting points to bear in mind. Don’t rock the boat. That’s all I have for now, I’m sure the list will increase as more and more situations present themselves.. check back frequently!