Autistic Women: The Lessons They Can Teach Us About Sensitivity and Empathy

The autistic woman is a woman first.

I watched Pris (Priscilla) run excitedly across the room from the stage to an audience member ticket holder, enjoying her duty of checking the lucky winner’s raffle ticket. She’d read the ticket aloud and if it matched the number held by the announcer on stage, she would squeal with delight and say, “Oooo! We have a winner!” She would wait for the applause and then with a ceremonial flourish, hand the prize to the happy winner. Then audience members would ooh and aw over the winner’s prize and their good fortune.

Pris was having a wonderful time, if the flush on her cheeks and the bounce in her step were any indication. And she didn’t stop running back and forth with each raffle ticket announced and claimed. The audience loved it too. Even though we all checked our tickets for a possible winner — and even if the prize went to someone else — the excitement grew because Pris infused us with her joy. We all felt like winners to bask in the open heartedness sunshine of this woman who gave people the gift of her giddy joy.

The joy was interrupted for only a moment, but it was powerfully disrupting. A person in the audience yelled out for all to hear: “Well you don’t see that every day! My wife is running across the room.” Pris’ spouse, Donny looked smug as he surveyed the audience and laughed. His comment caught Pris in mid-air and she landed hard on one step. Looking startled, Pris turned toward her husband. As she caught his eye, she laughed a silent laugh — the kind of laugh that is not really a laugh — and then started running toward the stage again. But I wonder, I wonder what she was thinking at this micro-aggression by Donny. And I wonder if he caught her look, or the fact that the rest of us picked up on the unkind comment. The room was silent for a moment, with Pris in mid-air and that silent laugh. Then we all drew a breath and returned to the fun.

The next day Pris came up to me at breakfast and confided that she suspected she was Autistic. She said, “I hope you don’t mind that I Googled you, but when I heard you use that term, “NeuroDivergent” — a word I had never heard before — I had a feeling I should learn more. I can’t believe it but at 58 I am finally figuring out who I am!”

I smiled and assured her that I didn’t mind. Even though we were attending a weekend charity fund raiser — when it comes to this topic — I am never off duty. People seek me out because it is a relief to know — to know who you are after so many years of living a NeuroDivergent mystery.

“Of course I don’t mind Pris. I am happy to help.” Then I waited, waited for the characteristic NeuroDiverse pause, as the Autist finds her way into the conversation.

Pris was full of questions about how to get a diagnosis and where to start in therapy. Then a really big pause. I waited. “Well, you know that my husband is a psychologist and the director of several clinics in town don’t you?”

“Yes” I answered. I waited.

“Well, why hasn’t he ever suggested this to me — you know that I may be NeuroDiverse? Shouldn’t he know these things, especially if it could help his own wife — and us?” She didn’t look hurt, but she was puzzled. She obviously had registered Donny’s microaggression from the night before. And she was aware of a pattern of relationship problems that caused suffering for both of them. It’s logical to ask her question, but the answer isn’t simple.

I needed to tread lightly in a personal situation between husband and wife, especially since they are not my clients. But I didn’t want to leave her hanging with such a life changing awareness. “Well, you know Pris, it’s not easy even for us psychologists to peer into our inner workings and examine our loving relationships. And then there is the fact that your husband probably never studied high functioning autism in graduate school. But now that you know, you could take the lead.”
Before I could finish the last sentence, Pris was impatient to leave. “I’m running late and Donny will be angry with me if I am late. So, we can talk later, OK?”

“OK.” I said and put the incident at the back of my mind to percolate.

Eventually what percolated to the top is the vision of Priscilla’s happy face, radiating that sunny glow, as she ran among the audience members checking raffle tickets. She was genuinely happy to help with the fund-raising effort. She was also deeply puzzled by her spouse’s ridicule. I am not sure if she recognized the ridicule consciously, and Pris tells me that she can’t read between the lines, but it was enough of a microaggression to register later. Later, when she wanted to share her discovery that she is autistic, she also revealed that she lacked the empathy to quickly track what is going on in conversation. She opined that this Empathy Dysfunction (EmD) may be the underlying reason her marriage was so oppressive.

Even with EmD, Pris is a sensitive, loving, big-hearted woman. When she gets into her emotions, and is truly enjoying herself, everyone around her is happier too. When she feels the intense emotions of others (such as her husband’s negativity) she is startled and struck dumb. Good for her, that she only took a moment to feel the verbal abuse, and then returned to her delight in the raffle process. But there are only so many times that a beautiful soul like this can take these comments and still survive. I have seen this many times, when sensitive ASD women do not know how to assert themselves.

The lesson I learned from Priscilla is that even though she is an autistic woman, she still wants what most women want — to be heard, to connect, and to be loved by their partners. Priscilla has abundant sensitivity without a way to balance it with the skills to manage a relationship with a strong-willed NeuroTypical. And like many women, her curiosity about NeuroDivergence will most likely be the impetus to resolve the couple’s relationship problems. She is a woman on a mission now that autism is no longer a mystery.

The autistic woman is a woman first.

Unlike Priscilla, Anna gets fighting mad right out of the gate. She is autistic and aware of being misunderstood. As she wrote to me on a blog post entitled “Can Autistics Lie?,” she wrote “. . .I am so sick and tired of this stereotype that autistic people don’t feel and aren’t capable of empathy.”

She goes on to write, “If anything I feel too much, too intensely. I can express my feelings and emotions better than my neurotypical boyfriend.”

Anna’s sensitivity is obvious. Empathy — not so much. She mistakes her sensitivity for empathy. And she mistakes a lack of empathy as having no feelings. In an effort to get around her defiant response, and offer a more positive perspective, I wrote back.

“Thank you [Anna] for your candid response to this blog. First, it is certainly no shame that Autists do not have empathy. It is just a neurological detail. With Alexithymia there is a delay between cognitive and emotional processing, so the resulting lack of integration is Empathy Dysfunction. For example, when you mention that you “feel too much, too intensely,” this is an example of Alexithymia. The intensity of emotion that has nowhere to go is problematic. NTs can regulate the interaction of emotional and cognitive elements as they go, whereas those on the Spectrum need time to process before they can make sense of what is going on for them, or others.”

Anna showed even more defiance in the second half of her written comments (and before receiving my response). “I also do not lie, not even when it would benefit me to. People get offended by me sometimes because I’m too honest. It is completely offensive to compare autistic individuals to psychopaths. Autistic people have a moral compass and sense of social justice.”

I don’t blame Anna for being angry and even her defiance is a strength — one that is good to have if you are a woman with autism who is frequently misunderstood and gaslighted (as Pris experienced with her husband). Just as sensitivity is not empathy, and defiance does not define a sense of justice, Anna needs help facing the inevitable collision of worlds that is a result of NeuroTypicals and NeuroDiverse interactions. I tried my best to help her understand these basics of human nature in the next part of my response.

“As to the lying, it is quite characteristic for those on the Spectrum to lie about totally inconsequential things, not just the big stuff. The lying is probably a masking or PTSD reaction to the Empathy Dysfunction. When an Autist has spent a lifetime covering for their lack of emotional integration (i.e. not understanding what is being discussed, or over-reacting/under-reacting emotionally) often they have learned to get by socially by fibbing.

“In some ways it is admirable that you pride yourself on never lying but the fact that you mention that people get “offended” because you are “too honest,” is an indication that you are not quickly recognizing the social cues. These social cues tell the rest of us when to speak up and when to be silent or when would be the best time to finally “be honest.” This is not to say that NTs are better at being honest. For sure, lying is a common human trait. But being “too honest” just means that you are not reading the intention of the moment — empathy enables us to read the intention in the moment.

“Sick and tired” of hearing that Autists lack empathy is certainly understandable and I feel for those who struggle with empathy. But if the NeuroDiverse are to find new ways to communicate with their NeuroTypical sisters and brothers — and vice versa — then it is important to deal with reality. Just because an Autist is slow to pick up the nuance of the moment or appears abrupt or too harsh — or just because NTs rattle on with what appears to be irrelevant chit/chat — doesn’t mean we should judge each other harshly. These differences should give us pause to pay attention to the inner world of the other. Instead of worlds colliding, we could try to create complementary worlds.”

I may never know if Anna changed her mind. She did write one more time, stepping up the vitriol. She wrote, “She’s [Dr. Marshack]a bully. She’s no better than other neurotypicals who judge and misunderstand us only it’s worse because as a psychologist she should know better.”

You may be able to relate to Anna’s deep wounding. You don’t have to be an autistic woman, to have felt overwhelmed with distress by some wrong doing — so overwhelmed that you wanted either to crumble or lash out in defiance. Both are understandable emotional responses. Just not very productive. Certainly not effective at resolving problems between people.

The lesson I learned from Anna is that psychological wounds can run so deeply for an Autistic woman that it is not easy to let go of the anger and hurt. I thought I could send Anna a reasoned response as if her pain was not paramount. Her pain is the center of her response and needs to be acknowledged as real. Of course, it is real as it is for many women on the Autism Spectrum. Many have struggled for a lifetime to manage their distress. To get angry enough to reclaim their worth is a huge step. Anna took that step and will not be deterred. Good for her.

The autistic woman feels like an imposter.

“When I get applause at the end of a performance, I feel like an imposter!” Marlee tells me during one of her sessions. “I keep thinking that the audience will know I am an Autist and just faking it. I am teetering on depression again.”

Marlee is a singer, songwriter who came to this career later in life, after having spent three decades of her adult life thinking that all she was worth was to do menial office work. She had no idea she was on the Autism Spectrum until she walked into my office one day, seeking therapy. She had seen many therapists and psychiatrists over the years but none had recognized that this bright, creative woman was also autistic.

On our first encounter I could see some tell-tale signs of high functioning autism but I waited to hear her story. I asked her what she was looking for in scheduling with a new psychologist. She said, “I am 45 and I am at the end of my rope. I have been to psychiatrists and social workers and psychologists from coast to coast, and I am still no better. In fact, I am sick and exhausted and desperate. I know that you do hypnosis and NLP, so I hoped those techniques could help me. I am just miserable.” Marlee looked at me with fear in her eyes, as if she knew I would judge her harshly.

“Marlee, I know you are unhappy and want a new approach. I am also pleased that you haven’t given up yet. However, before we try a technique, I’d like you consider a new diagnosis that may help you better understand the troubles that have plagued you. Have you ever considered that you may have ”Asperger Syndrome”?

Marlee had never heard of the diagnosis before so I explained it. As I walked her through some of the symptoms, particularly the ones that seemed to fit her self-description of her life, her eyes widened in amazement. “What the hell!” she exclaimed. “Do you mean to tell me that no one every figured this out before, and that my life has been dangling by a thread, when there is an answer? Are you saying I’m autistic?”

I leaned into Marlee’s amazement. “Yes Marlee. I think this might explain it. I want you to read more about it and I am referring you to a psychiatrist so that he can adjust those terrible medications you have been using. Then we are going to talk some more about what to do to help you.”

The look of fear crept back onto Marlee’s face. “Are you sure you can help me? I have lived like this for so long. How does knowing about autism make a difference.?” Marlee had an ounce of hope but a ton of skepticism.

I said, “It will take us some time to unravel the beliefs and behaviors you have developed to adapt to your life. Lots of things aren’t true about you and it is time to let them go. You accepted what your parents and teachers and others have told you is the truth about yourself, but I suspect they never understand the autism that you live with.”

“I’ve always felt like an imposter, Dr. Marshack. I could never quite do things right. I was always messing up. And even when I studied the behaviors that my mother and grandmother wanted of me, I never did them quite right. Then they would scold me for not trying harder. It has been a nightmare.”

“That’s the problem Marlee. By pretending to be normal, in a way you were an imposter. You were mimicking life or what we call masking in order to fit in and belong. But these behaviors weren’t coming from the real Marlee, so you felt like an imposter. Time to free Marlee to be all that she is meant to be.”

I can’t tell you that Marlee resolved her severe depression quickly, but little by little she started to know who she really is, separate and distinct from those masking behaviors. The complex PTSD that haunts her continues to crash into her awareness from time to time, but we are working on methods to shut it down as quickly as it comes on. Even though Marlee feels like an imposter almost every day of her life, she now knows this is an artifact of the lessons she learned from the NeuroTypicals around her.

Not long ago I had a Zoom conference with Marlee. With a very serious expression she announced, “It’s our fifteen-year anniversary Dr. Marshack.” She paused and waited for my response.

I said “Congratulations Marlee. Have you and Fred been together that long? That’s wonderful.” I thought she was referring to her long-term boyfriend.

“No. That’s not it. It has been fifteen years since you first diagnosed me. Can you believe it?” She didn’t bat an eye or offer a smile.

“Oh, my goodness Marlee. Is that true? How amazing. Look how far you have come. You have written dozens of songs, have a one woman show, and an album near completion. You have finally surpassed your wildest dreams for your life. What an amazing and wonderful journey.” I wanted to help Marlee celebrate her accomplishment, not just our time together.

Marlee looked at me with a bit of sadness. “But will I ever stop feeling like an imposter?”

The lesson I have learned from my 15 years with Marlee is that the imposter syndrome is tough to quash after a lifetime of autism without guidance on becoming a person. Desperate to please and to fit in most people on the Autism Spectrum figure out how to mask by age four or five. Most of us learn a modicum of masking in order to navigate the social world, but never should we accept masking as the truth about who we are. In spite of those feelings of being an imposter, discover who you are and be the truth of who you are. The world needs your talents and your love of those talents shines a bright light for the rest of us.

Autistic women who loved me.

I have written extensively about the Autistic women in my personal life, my mother Irene and my daughter Bianca. However, it has taken a long time for me to fully appreciate how much they loved me. It was tough to feel their love because of their Empathy Dysfunction and transactional style of communication. Now, after all of these years I am coming to appreciate their love, especially after meeting so many women on the Autism Spectrum and learning of their struggles to be loved and to give love.

My mother was a practical woman. When she volunteered to manage the elementary school safety patrol program, she didn’t host parties for the kids, or hang out with us at the school crossings. Instead, she rallied the community to buy brand new equipment for the students. She wanted us to be safe so she bought us water proof reflective gear.

Likewise, my daughter Bianca was creative in her endeavors to be helpful. For example, she recommended my professional services to some of her classmates at Clark Community College, when they revealed that they had ASD like her.

I recognize these behaviors for what they are, a transactional attempt to do the right thing by someone they loved. However, these actions didn’t feel loving at the time. I could be proud of my mother’s accomplishment for the safety patrol. I could feel honored that Bianca shared my credentials with her friends. But it didn’t feel like love to me, an NT who needs to be touched and affirmed for who I am — and who would like to touch and affirm back. I needed them to hug me and look into my eyes and tell me how much they loved me.

The lessons learned from my mother and Bianca took many years for me to learn. After meeting women like Priscilla, Anna and Marlee (and many others) I gained a fuller appreciation of the experience of being female on the Autism Spectrum – and what my mother and daughter had to live with. I only wish I had learned sooner about the sweet sensitive strength and tenacity of these women, so that I could have loved my mother and my daughter better. Now I know that they held their love for me deeply in their hearts, locked up by a life of Autism in a NeuroTypical world — waiting for me to love them unconditionally.