2. What’s at stake

Before we proceed, it is important to clarify what is at stake. Masking is the process by which autistic individuals (often women, people who were assigned female at birth or AFAB, and BIPOC autistics) consciously or unconsciously behave in ways that conform to neuronormative standards. ^{Footnote 3} Masking should not be construed as an attempt to deceive but rather as an attempt to follow the observed conventions of everyday interactions, behaviors, or practices that prevail in a neuronormative environment (more on neuronormativity later). Masking thus requires both hiding and performing (Lai et al. Reference Lai, Lombardo, Ruigrok, Chakrabarti, Auyeung, Szatmari, Happé and Baron-Cohen2017): suppressing one’s discomfort, stims, social anxiety, and other difficulties that arise in the context of neuronormative interactions and communication; and acting, as much as possible, in a neuronormative way by engaging in small talk, making eye contact, controlling stims in public settings, attending large social events, or putting up with loud, bright, crowded, or excessively cold or warm environments. Masking often takes a significant toll on autistics and can lead to various forms of collapse, such as autistic meltdowns (saturation from environmental stimuli leading to hyper-reactivity), autistic shutdowns (saturation from environmental stimuli leading to hypo-reactivity), or autistic burnout (the sheer exhaustion that results from living in a world that is not made for you).

Despite these negative effects, we propose that masking is a way of trying to reduce the harm vulnerability that autistics face in a neuronormative world at the cost of denying openness vulnerability.Footnote ⁴ Yet there is tremendous value to be gained from accepting and recognizing openness vulnerability. More specifically, for autistics openness vulnerability is intimately connected to the refusal of shame, the promotion of self-acceptance, and the crucial understanding that one does not need to exhibit perfect self-mastery, to contain one’s autistic traits, or to be perfectly masked. In other words, embracing openness vulnerability for autistics involves the freeing realization that one does not need to perform a (supposedly) invulnerable neurotypicality in order to “fit in” and avoid making neurotypicals uncomfortable.Footnote ⁵ Indeed, having to stifle their openness vulnerability to avoid harm vulnerability creates an unjust state of affairs for autistics. That is, the neuronormative status quo produces and maintains differential allocations of vulnerability between autistics and neurotypicals. Within the constraints of intersectional factors such as race, gender, socio-economic status, and cisnormativity, neurotypical people are overall at less risk of harm when they embrace openness vulnerability, with those closer to what Rosemarie Garland Thomson calls “the normate” (Garland Thomson Reference Garland Thomson1997, 8) at least risk; they may even be applauded for their authenticity. Autistics, for whom masking is harmful and who therefore stand to benefit more from embracing openness vulnerability through unmasking, are more likely to be shamed, excluded, or harmed for doing so.

To alleviate this undue burden placed on autistics, we advocate for a shift in the vulnerability economy or how dominant norms and practices (here, neuronormativity) allocate differential levels or burdens of vulnerability based on one’s group’s position in the social structure (here, autistic versus non-autistic people). We propose that, instead of autistics having to mask in order to appease neurotypicals and giving up the positive aspects of openness vulnerability in order to be shielded from externally imposed harm vulnerability, autistics and neurotypicals alike ought to reconnect with the positive aspects of our openness vulnerability and the openness to the world or to being affected that this type of vulnerability involves. For autistics, openness to the world or to being affected can certainly entail negative experiences like sensory or social overload, but it can also be conducive to the thorough enjoyment procured by sensory play, for example when the sheer comfort of stimming opens up spaces for reveling in the sensory, yielding what is known in the community as autistic joy. For neurotypicals, embracing the positive aspects of openness vulnerability involves recognizing that autistic traits like stimming or avoiding eye contact, small talk, or social overload are not only harmless but fundamental to autistic self-regulation, well-being, and flourishing. Importantly, embracing openness vulnerability requires that neurotypicals work on overcoming their neurotypical fragility,Footnote ⁶ that is, that they welcome, rather than reject, the discomfort they often feel when encountering autistic traits or behaviors such as flapping or stimming, or different ways to engage in conversations or to navigate social interactions and environments. Finally, by becoming less uncomfortable with autistic traits, neurotypicals might also come to embrace the sense of joy and liberation that can come from breaking away from strict neuronormative rules.

To the extent that neuronormativity shapes the expectations and behaviors of both neurotypicals and autistics, reconnecting with our openness vulnerability will require, for both autistics and neurotypicals, unlearning the many, often unconscious daily habits and unquestioned everyday practices—ways of acting and reacting, of treating and engaging with each other—that neuronormativity imposes on all of us, and learning new habits and practices that foster greater neuroinclusion.Footnote ⁷

Arguing for the above claims, however, should not detract attention from the very real obstacles that autistics might encounter in the process of unmasking and reconnecting with our openness vulnerability. Indeed, a picture that minimized these obstacles would be a simplistic one. Two points are worth noting here. First, the capacity to develop and gain the self-confidence or self-trust necessary to embrace our openness vulnerability and to engage in the process of unmasking requires community support. That is, it requires communities that provide a safe space and encouragement, such as those provided by autistic communities and found in autistic self-advocacy. Of course, support from autistic communities alone cannot remove neuronormative barriers. Without the collaboration of neurotypicals, neuronormative barriers will remain. It is therefore crucial that neurotypicals, and not only autistics, learn to embrace and work on the discomfort they might feel when encountering unmasked autistics. Second, even with a secure sense of self-confidence or self-trust, embracing our openness vulnerability and engaging in the process of unmasking will depend on our particular social location. Whereas a cis white woman might feel safe stimming in certain public spaces, a BIPOC, trans, or non-binary person might feel utterly unsafe doing so because of the risk of being perceived as a threat or even subjected to physical restraint or violence, including from law enforcement (Simmonds Reference Simmonds2020; Garcia Reference Garcia2021; Walker Reference Walker2021; Price Reference Price2022). Unmasking as an autistic who is privileged along other axes of social identity such as gender identification, race, or class is very different from unmasking as someone who is oppressed along these other axes of social identity. This is why it is crucial to adopt an intersectional perspective: in advocating for reconnecting with our openness vulnerability, we must take into account that neuroableism intersects with other systems of oppression such as racism or cisheterosexism, for example.Footnote ⁸

3. Neuronormativity and its harms in the vulnerability economy

In order to fully appreciate the risks involved in unmasking, it is important to expand on the context of neuronormativity and its contributions to harm vulnerability. Neuronormativity refers to the dominant set of norms, assumptions, expectations, and practices that posits neurotypical modes of cognition as the only acceptable and hence superior ones, and that unduly stigmatizes and marginalizes neurodivergent ways of being, doing, communicating, and processing as deviant and inferior. Neuronormativity pervades most public or shared contexts and imposes its standards upon everyone in these contexts. Neuronormativity thus shapes the various assumptions, norms, practices, and expectations that dictate the way things work in all these contexts: what is “normal” or not, required or not, permissible or not, appropriate or not. In these contexts, neuronormativity structures everything from space and temporality to interactions and communication.

Neuronormativity structures space by, for example, imposing environments that are often brightly lit, loud, crowded, or excessively air-conditioned. It structures temporality by, for example, determining how much time it should take to accomplish various tasks, such as completing an assignment, a degree program, an application, an administrative form, or a conversation. Neuronormativity also structures interactions and communication by, among other things, “uphold[ing] standards regarding, for example, (what is neurotypically considered) appropriate eye contact, facial expressions, prosody, conversational flow, processing, and responsiveness” (Catala et al. Reference Catala, Faucher and Poirier2021, 9016).Footnote ⁹

In structuring space, time, interactions, and communication in these ways, neuronormativity utterly disregards autistic people’s different ways of being, doing, communicating, and processing. Many autistics experience sensory processing difficulties, meaning that we often experience the brightness, noise, crowd, and temperature of a given environment as much more intense than neurotypical people typically do. Many autistics also experience temporality differently, for example due to hyperfocus, inertia, or other executive difficulties. Finally, many autistics experience social interactions and communication differently. For example, many of us do not like speaking on the phone (due to auditory processing or expressive differences); making direct eye contact (which is often experienced as deeply intrusive and unsettling); or being expected to respond or process information quickly in unstructured or unexpected exchanges, or in unfamiliar, often fast-paced settings.

Neuronormativity also includes various stereotypes and misconceptions about autism and autistic people that stigmatize us as deficient—for example, as lacking social motivation, theory of mind, empathy, or humor, or as unable to have a job, be in a relationship, or lead a happy and fulfilling life. Other misunderstandings about autistic traits might for example include an interpretation of flapping as weird, unnecessary, or meaningless body movements, rather than as a harmless, important, and meaningful expression of autistic joy or a useful way to process emotion and other internal or external stimuli; an explanation of challenges in initiating, switching, or completing tasks as laziness, akrasia, or incompetence, rather than as the result of autistic inertia, hyperfocus, or executive difficulties; and a description of the need to regularly spend some time alone as a lack of interest in social interactions rather than as a necessary way to recharge.

Unsurprisingly, because of these pervasive neuronormative expectations and widespread misconceptions about autism, and in order to be able to take advantage of various opportunities and to avoid various types of penalty in a neuronormative world (e.g., be taken seriously and not ostracized or mocked; secure recommendation letters; have a job; receive healthcare; not be subjected to violent treatment; not be arrested), autistics often consciously or unconsciously force ourselves to fit into the preexisting neuronormative mold that neither matches nor welcomes our ways of being and doing. Specifically, many autistics—often women, AFAB, and BIPOC people—consciously or unconsciously learn to mask by hiding our autistic traits and conforming to the neuronormative expectations of our environments.

What the foregoing shows is that autistic people, in a neuronormative world, mostly have little choice but to constantly accommodate neurotypical people, that is, to abide by their norms and practices—and this, to avoid making neurotypical people feel uncomfortable. Avoiding or reducing neurotypical discomfort in turn makes it possible for autistics to avoid or reduce stigmatization, marginalization, and even violence—and thereby to avoid or reduce these specific manifestations of harm vulnerability. But while accommodating neurotypical people may shield autistics from harm vulnerability to some extent, it does not remove harm vulnerability altogether for autistics, since it also comes at a considerable cost to them, for example in the form of autistic meltdowns, shutdowns, or burnout. Otherwise put, neuronormativity directly contributes to maintaining an unjust vulnerability economy, as it places undue burdens of harm vulnerability on autistics in order for neurotypical people to avoid having to confront their own openness vulnerability.

Neuronormativity further serves to maintain an unjust vulnerability economy by restricting access to openness vulnerability for autistics. As explained below, for Danielle Petherbridge openness vulnerability involves a corporeal, a psychological, and an interpersonal dimension. Neuronormativity obstructs corporeal openness by prohibiting or stigmatizing the kind of body movements or sensory delights involved in flapping or stimming, for example. Neuronormativity also undermines psychological openness by making it difficult, if not impossible, for autistics to secure a positive relation-to-self and by imposing a sense that one must achieve perfect self-mastery. Finally, neuronormativity hinders interpersonal openness by obscuring the needs of autistics.

Having spelled out the concept of neuronormativity, let’s now turn to the two forms of vulnerability that will be at the heart of our argument for a shift in the vulnerability economy among autistics and neurotypicals.

4. Two forms of vulnerability

In order to consider the processes and effects of neuronormativity and how to resist them, we make a distinction between openness and harm vulnerability. Most approaches to vulnerability frame it as a susceptibility to or risk of harm. There is a variety of approaches here, from those that specifically identify groups or individuals who are particularly vulnerable (as is common within bioethics and research ethics), to those that argue that vulnerability to harm is universally shared among humans insofar as we are embodied, relational agents (Fineman Reference Fineman2008). Meanwhile, Rogers, Mackenzie, and Dodds Reference Rogers, Mackenzie and Dodds2012 argue for a taxonomy of vulnerability: inherent vulnerability, which stems from our corporeality and dependence on others; situational vulnerability, which may be temporary or chronic and is context-specific; and pathogenic vulnerability, which stems from harmful, oppressive, disrespectful and prejudiced responses to vulnerability (Rogers et al. Reference Rogers, Mackenzie and Dodds2012, 24–25).

One of the most useful and flexible approaches within this harm-oriented group is that of Florencia Luna, who describes vulnerability as occurring in layers, so that the interrelations between different sources of vulnerability can be better appreciated and guarded against (Luna Reference Luna2009; Victor et al. Reference Victor, Luna, Guidry-Grimes and Reiheld2022). These layers can be understood as dispositions, which may be triggered by a stimulus. As dispositions, they are present even when the person is not actively experiencing harm. Luna has also noted that some layers may have consequences that create or exacerbate existing vulnerabilities, which she describes as cascading layers of vulnerability (Luna Reference Luna2019, 92). Examples are readily found in public health ethics, where lack of access to health services can be connected to lack of early diagnosis, leading to problems in treatment, lack of workplace protections and accommodations, etc. (Luna Reference Luna2019, 92; Victor et al. Reference Victor, Luna, Guidry-Grimes and Reiheld2022, 3). Luna’s approach can then be used to help policymakers and researchers to identify and evaluate layers, triggers, and cascading effects, focusing on the most harmful first. The ensuing ethical obligations are thus to “avoid exacerbating layers,” and eradicate and mitigate layers, “through different strategies such as protections, safeguards, as well as empowerment and the generation of autonomy” (Luna Reference Luna2019, 93). As Victor et al. point out, Luna’s approach “allows granularity in both our analysis and our solutions: we can look at the particulars of situations and ask, how can we remove at least some of these layers of vulnerability?” (Victor et al. Reference Victor, Luna, Guidry-Grimes and Reiheld2022, 4).

This kind of analysis is useful in the case of autistics. Rather than attribute, for example, lower employment rates or worse health outcomes to apparently intrinsic autistic traits, we can analyze how cascade layers of vulnerability and increased risk all play a role. This can help us to identify targets for change and improvement. Luna’s suggestion that generating empowerment and autonomy can also act as a safeguard against harm dovetails well with a concern for autistics’ agency.

Another important approach to considering how vulnerability develops is found in recent discussions of vulnerabilization. On this account, as Shelley Tremain writes:

Writing within the context of the COVID-19 pandemic, Larios and Paterson note that “the concept of vulnerabilization has gained traction, as a number of scholars and activists have contested ‘vulnerable populations’ as taken-for-granted categories” (Larios and Paterson Reference Larios and Paterson2022, 139). These scholars and activists argue that “vulnerability is not a natural phenomenon, but rather a political process of becoming vulnerabilized” through social and policy arrangements (Larios and Paterson Reference Larios and Paterson2022, 139). This approach resists the individualizing tendency of some vulnerability discourse, which “attaches vulnerability and risk to the bodies of certain subjects, ensuring that they will be regulated and disciplined by virtue of this individualization and, in most cases, will be enlisted to become self-regulating and self-disciplining” (Tremain Reference Tremain2021, 28). One example of vulnerabilization can be the ways in which complex bureaucracies and policies within healthcare systems can generate confusion, frustration, distress, and delay or denial of appointments or treatment (Carel and Kidd Reference Carel and Kidd2021, 485). When patients struggle with this or respond defensively, blame is individualized on them (being deemed “disruptive” or “difficult”) rather than recognizing the process of vulnerabilization that has occurred (Carel and Kidd Reference Carel and Kidd2021, 486–87).

Both the layers approach and the vulnerabilization approach draw attention to the relational contexts of vulnerability in useful ways, while also consistently conceiving of vulnerability in terms of harm. On the layers approach, our task is to minimize, diminish, or eliminate vulnerabilities illuminated by our analysis (Luna Reference Luna2009, 132–33). On a vulnerabilization account, we can work to identify the processes by which people are vulnerabilized in order to resist or change them. In both cases, our overall goal is to reduce vulnerability, insofar as it is associated with harm.

On our view, however, a focus on harm vulnerabilities, while necessary, is insufficient on its own. Rather, one of the key ways of mitigating the harm vulnerabilities created by neuronormativity involves a more general cultivation of acceptance of a different kind of vulnerability altogether, a kind that would also contribute to empowerment by opening up possibilities. This alternative approach frames vulnerability in terms of openness. As Erinn Gilson writes, “vulnerability is a basic kind of openness to being affected and affecting in both positive and negative ways, which can take diverse forms in different social situations (for example, bodily, psychological, economic, emotional, and legal vulnerabilities)” (Gilson Reference Gilson2011, 310). Within this framing, vulnerability is ambivalent: we could be open to harm or benefit. Gilson describes it as a “condition of potential that makes possible other conditions”: “Being vulnerable makes it possible for us to suffer, to fall prey to violence and be harmed, but also to fall in love, to learn, to take pleasure and find comfort in the presence of others, and to experience the simultaneity of these feelings” (Gilson Reference Gilson2011, 310).

As mentioned above, Petherbridge describes three dimensions to this conception of vulnerability:

These three dimensions relate to our concerns in several ways. The first, corporeal dimension is particularly relevant for autistics who often have heightened sensory reactions, both positive and negative. Cultivating the ability to accept openness vulnerability can help in fully embracing and accepting these sensory relations with the world. This can help autistics explore and nurture sources of autistic joy, such as reveling in sensory play and engagement with the materiality of the world through stimming (Petty and Ellis Reference Petty and Ellis2024). As one autistic blogger describes it, “I feel the urge to move my hands and when I do, when I move my hands rapidly back and forth, I’m expressing this joy. I’m generating it, it creates it, it uplifts it even.” She notes, “Stimmy joy is something that I don’t think non-autistic people experience and it’s one of the most beautiful parts of being autistic” (CBC 2017). Other forms of autistic joy include engaging with and responding to the world via echolalia. As one autistic writer describes, “I like to echo. I have always liked to echo. I have a fascination with words, and sounds, and the way they feel as they leave my mouth, and so I say them” (Taitt Reference Taitt and Dale2023). Both stimming and echolalia are often pathologized and can therefore trigger harm vulnerability via others’ negative responses, but on their own they can be forms of joyful explorations of openness vulnerability.

The second, psychological dimension, has particular resonance given classical descriptions of autism that were framed precisely in terms of autistic individuals being closed off. For example, Simon Baron-Cohen’s popular theory of autistic “mindblindness” argues that autistics lack Theory of Mind, the ability to understand and ascribe mental states to others. Remi Yergeau has pointed out that this Theory of Mind discourse around autism implies that “To lack a theory of mind is not simply to lack a theory of others’ minds—it is also to lack an awareness of one’s own mind” (Yergeau Reference Yergeau2018, 12). The narratives around autism regularly frame it as “unknowable, unnarratable” (Yergeau Reference Yergeau2018, 7). The lived experience of autistic people has often been misunderstood precisely as presuming a “psychic closure.” While this is a misunderstanding, it is a widespread one that can have a pernicious effect on autistics and their treatment by others. Because of the prevalence of this misunderstanding, it is important to clarify what we are arguing for when we advocate for an embrace of openness vulnerability. We are not endorsing the notion that autistics need to embrace openness vulnerability in order to be psychologically “fixed” or “cured” of their autism. Rather, to embrace openness vulnerability is to encourage the exploration of ways of relating to self and the world that lead to greater self-acceptance as autistics, including valuing and engaging in practices like stimming or flapping that are otherwise pathologized.Footnote ¹⁰

The third, interpersonal dimension, is also important for our purposes. Deborah Barnbaum argues that “autism cuts people off from people” (Barnbaum Reference Barnbaum2008, 174). But this significantly misunderstands what is happening from the perspective of autistics themselves, and underplays the effects of neuronormative structures and practices. In discussing the interpersonal dimension, Petherbridge notes the risk of “exposure to forms of power and abuses of vulnerability” (Petherbridge Reference Petherbridge2016, 598). Autistics often have support needs for which they require the assistance of others, which can render them vulnerable to abuse and manipulation. Autistics can also be subjected to bullying and social exclusion, particularly if they are perceived as behaving differently from allistics. Given these risks, it might seem as though interpersonal relations would best be approached in terms of harm vulnerability, exploring cascading layers of vulnerability, or through analyses of vulnerabilization and power imbalances.Footnote ¹¹

However, thinking of autistic relations with others solely in terms of harm vulnerability risks obscuring the positive modalities that are possible within openness vulnerability. The same openness that renders abuse possible also makes possible strong bonds of love and acceptance. These bonds can serve as powerful supports in and of themselves in overcoming shame and in cultivating allies in carving out spaces for autistics to fully be themselves. Disability theorists have long pointed out the need to center conceptions of human interdependence,Footnote ¹² which involve forms of mutual openness vulnerability. This can be difficult for many autistics, particularly given past experiences of harm from others (even well-intentioned others). This is precisely why it is important to advocate for the possibility of openness vulnerability, and enable support for it, rather than essentializing autism itself as a source of interpersonal closure (as Barnbaum does).

Openness vulnerability is an existential feature of human lives. Judith Butler describes it in terms of a “primary human vulnerability” that we all live with (Butler Reference Butler2004, 28–29).Footnote ¹³ As such, it cannot be minimized, so much as it can be disavowed, repressed, or denied. The particular features of autistic lives make it especially important to recognize. At the same time, however, neuronormativity and its pressures obscure and distort the potential of openness vulnerability, forcing a closed-off policing of one’s own and others’ behaviors. Resisting neuronormativity means attending to the potential for harm vulnerability while embracing openness vulnerability. Let’s now see more concretely how this plays out in the contexts of higher education (section 5) and of healthcare (section 6).

5. Higher education contexts

In all its omniscience and omnipotence, neuronormativity pervades inter alia higher education, where it upholds pedagogical and academic standards that do not take into account our different ways of processing sensory stimuli, new information, and social interactions. While academia hosts many autistics who may appreciate the opportunity to specialize in specific interests and to direct their capacity for hyperfocus to relevant tasks and pursuits, many autistics in academia also encounter countless obstacles on a regular basis (Jones Reference Jones2022). Classrooms and auditoriums are typically lit with bright neon lights and are often excessively air conditioned (Jones Reference Jones2022); hallways, staircases, cafeterias, and restrooms can be crowded, loud, dirty, and smelly. Students often lack access to an always available, always quiet, clean, and comfortable space where they can recover from sensory or social overstimulation at any given moment, on any given day. Students are often expected to sit still, and moving about to stim or flap, while crucial to autistic self-regulation, is often perceived as disruptive (Walker Reference Walker2021). Students are also often expected to partake in group exercises or projects and class discussions, or to attend office hours and departmental events, all of which might be less accessible to autistic students who often find unplanned, live discussions and social interactions quite stressful and taxing on the mind, the body, and the senses (Catala Reference Catala2022). Autistics often report difficulties in both receptive and expressive communication, that is, in understanding others and being understood by others, respectively (Jones Reference Jones2022). Academia tends to value quick reactions, such as responding immediately in class, or grading papers and exams fast: “For people who process information carefully and conscientiously, with a focus on determining the most articulate response, this expectation can result in missing out on opportunities or not being heard” (Jones Reference Jones2022, 5). The lack of clear instructions from teachers or supervisors can be confusing for people who appreciate specific guidance (Jones Reference Jones2022). When executive challenges make it difficult to complete assignments or to meet deadlines, a lack of flexible policies often penalize autistic students (Jones Reference Jones2022). Finally, many autistics in academia encounter disparaging comments regarding autism either in social interactions or in course materials (Jones Reference Jones2022).

The foregoing shows how neuronormativity structures academic space, temporality, communication, and interactions—thereby vulnerabilizing autistics and making it difficult for many of them to feel like they belong and to succeed or thrive.Footnote ¹⁴ While having a formal diagnosis might help to secure adaptive measures to help toward greater neuroinclusion (Chandrasekhar Reference Chandrasekhar2020), this is far from a perfect solution, for at least three reasons. First, not everyone can have access to a professional diagnosis, for various reasons related to age, income, geographical region, language, immigration status, gender, and race. For example, wait times and fees for a professional assessment can be considerable; and those who do undergo a professional assessment may be missed due to the gender and racial biases in diagnostic criteria and instruments (Catala Reference Catala and Tremain2023a). Moreover, not everyone might want to seek a professional diagnosis, especially in contexts where patient confidentiality or data privacy are not protected or enforced. Women, BIPOC, and trans or non-binary people, for example, “may even be vigorously opposed to seeking a professional diagnosis because of a deep distrust of the professional system due to past adverse experiences with medical, clinical, and other practitioners, such as institutional violence or gaslighting” (Catala Reference Catala and Tremain2023a, 258). Finally, those who do have a professional diagnosis may choose not to disclose it for fear of negative consequences, given the many misconceptions and the general antipathy, if not outright hostility, toward autistics (Cai and Richdale Reference Cai and Richdale2016; McLeod et al. Reference McLeod, Meanwell and Hawbaker2019; Cage and Howes Reference Cage and Howes2020; Jones Reference Jones2022). In this sense, relying on a professional diagnosis for greater neuroinclusion in higher education is not a panacea, as it effectively fails to take into account intersectionality and the range of additional and compounding difficulties faced by autistics who are not cis, straight, white, middle-to-upper class males. These difficulties around diagnosis are a further illustration of the sort of cascading effect outlined earlier.

More promising than the reliance on adaptive measures that are contingent on a professional assessment, moving away from neuronormativity’s exclusionary norms, assumptions, expectations, and practices opens up a greater range of possibilities and greater inclusion for autistics. Transformations that could help foster openness vulnerability and allow greater inclusion in terms of space, temporality, communication, and interactions might include: adjusting the physical environment in ways that allow greater control over sensory input and self-regulation, via light-dimmers, quiet rooms, and spaces to stim and flap, for example (Walker Reference Walker2021; Jones Reference Jones2022); more flexible and inclusive modes of participation and deadlines (Catala Reference Catala2022) as well as adherence to principles of nonnormative communication (Catala Reference Catala2024); and, last but not least, mandatory training for allistic (i.e., non-autistic) members of the academic community to educate themselves to foster greater understanding and acceptance of autism and autistics (Jones Reference Jones2022).Footnote ¹⁵ All of these steps, however, will require allistics to get comfortable with discomfort and to embrace their own openness vulnerability in order to decrease the considerable harm vulnerability that neuronormativity imposes on autistics, and thereby to move toward a more just vulnerability economy.

6. Healthcare contexts

Let’s now consider how neuronormativity and the differential levels of vulnerability it generates play out in healthcare contexts. The bureaucracy and common practices of healthcare often involve several layers of barriers and vulnerabilizing processes. Research by Doherty at al. (Reference Doherty, Neilson, O’Sullivan, Carravallah, Johnson, Cullen and Shaw2022) found that the most significant barriers for autistic adults in visiting a general practitioner (GP) were “deciding if symptoms warrant a GP visit (72%), difficulty making appointments by telephone (62%), not feeling understood (56%), difficulty communicating with their doctor (53%) and the waiting room environment (51%).” Raymaker et al. (Reference Raymaker, McDonald, Ashkenazy, Gerrity, Baggs, Kripke, Hourston and Nicolaidis2017) found that the top barriers cited by autistic participants were “fear or anxiety (35%), can’t process information fast enough (32%), concern about cost (30%), facilities cause sensory issues (30%), and difficulty communicating with providers (29%).”Footnote ¹⁶ Since the beginning of the COVID-19 pandemic, wait times in ERs and clinics in many areas have substantially increased, adding to the amount of time spent in a crowded waiting room and subject to judgment by staff and other patients (Doherty et al. Reference Doherty, Neilson, O’Sullivan, Carravallah, Johnson, Cullen and Shaw2022, 3). Further, the very uncertainty about how long the wait itself will be poses a difficulty. These barriers indicate layers of externally imposed harm vulnerability for autistic people navigating the system: if autistic people are not able to access care, or if care is delayed, then they may be susceptible to harm. Barriers to healthcare, and thus poorer quality healthcare experiences, can be correlated with poorer health outcomes (Weir et al. Reference Weir, Allison and Baron-Cohen2022; Doherty et al. Reference Doherty, Neilson, O’Sullivan, Carravallah, Johnson, Cullen and Shaw2022). In addition to measurable, specific health outcomes, there are also hard to quantify effects of masking itself, such as ongoing and cumulative effects of exhaustion, stress, and frustration. The neuronormative context, practices, and expectations serve to vulnerabilize autistic patients.

The cumulative effects of these barriers—the cascading layers of harm vulnerability—make ongoing masking more demanding: dealing with each one of them requires energy, leaving less energy for performing neurotypicality and anything else we might like to do that week. However, the failure to perform neurotypicality by masking adequately can also interfere with health care insofar as it may interfere with being taken seriously as a patient. Kidd and Carel (Reference Kidd and Carel2018) document the epistemic injustice that patients in general may encounter. Behaviors like stimming, which might help an autistic person self-regulate and self-soothe in a time of overwhelm, may feel risky in a crowded waiting room or while trying to convince a health professional to take one’s concerns seriously. And indeed, this risk aversion may be warranted: Doherty et al. found that “autistic respondents reported that unusual behavior or stimming elicited negative reactions from other patients (15%), reception staff (9%) or medical staff (7%)” (Doherty et al. Reference Doherty, Neilson, O’Sullivan, Carravallah, Johnson, Cullen and Shaw2022, 3).

The situation gets further complicated when factoring in the variety of conditions that can co-occur with autism (so-called “comorbidities”), many of which are under-studied or under-recognized, such as Ehlers-Danlos syndrome (Casanova et al. Reference Casanova, Baeza-Velasco, Buchanan and Casanova2020) or mast cell disorders (Theoharides et al. Reference Theoharides, Angelidou, Alysandratos, Zhang, Asadi, Francis, Toniato and Kalogeromitros2012). These may also be subject to their own set of stigmatizing assumptions. Chronic illness patients regularly report difficulty in being taken seriously (Kidd and Carel Reference Kidd and Carel2018). The combination of stereotypes around chronic illness patients combined with judgments around autistic presentation further contributes to harm vulnerability. Further concerns arise around intersections of gender, race, socio-economic status, and weight.

In this context, with layers of harm vulnerability involved in seeking health care, masked autistics may seem to have little reason to unmask. So much of a successful appointment involves being perceived as worthy of being taken seriously that it can seem vital to comply with neuronormative expectations of being a “proper” patient, a requirement that is particularly problematic for some autistics depending on social location. And yet the cognitive, embodied, and affective effort of masking may either be too much to maintain during a time of illness, or generate additional levels of exhaustion and needed recovery time, which may complicate processes of treatment. Further, masking practices may also complicate communication of symptoms; for instance, trying to figure out how best to communicate a significant amount of pain. Given that many autistics have a flat affect generally, the usual work of masking may be combined with the labor of having to compensate and perform a social script of “what it looks like to be in pain,” or risk not having pain taken seriously because it has not been sufficiently demonstrated to the observer. This is further complicated through a longstanding belief that autistics are indifferent to pain (Hoffman et al. Reference Hoffman, Tami Bar-Shalita, Gal, Merry Kalingel-Levi, Buxbaum, Yarovinsky and Weissman-Fogel2023).

For this reason, it is vital that healthcare practices participate in shifting the burden in the vulnerability economy. At a very basic level, healthcare practices ought to try to remove barriers where they can. For example, the ability to book a visit online can help significantly. Another helpful practice is to provide “safe spaces” to unmask, such as quiet rooms, a separate area, or the ability to leave the waiting room and be contacted when it is their turn. Predictability and clear communication also help reduce energy demands (Doherty et al. Reference Doherty, Neilson, O’Sullivan, Carravallah, Johnson, Cullen and Shaw2022, 8). As Doherty et al. write, “Adjustments for communication needs are as necessary for autistic people as ramps for wheelchair users” (Reference Doherty, Neilson, O’Sullivan, Carravallah, Johnson, Cullen and Shaw2022, 8). Doherty et al. also suggest that healthcare practices conduct a sensory audit. Johnson et al. note that there is not a one-size-fits-all solution but make several suggestions for autism-friendly healthcare practices, emphasizing clarity and predictability, as well as the need to be attentive to sensory differences (Johnson et al. Reference Johnson, Doherty and Shaw2022).

This can help reduce harm vulnerability from cascading external sources. However, maintenance of masking itself requires energy. In addition to removing barriers, healthcare practices should signal to patients that it is OK to stim and OK to be themselves, and should educate reception and medical staff so that they are not surprised by or hostile to stimming or other autistic traits. In other words, the neuronormative expectations of medical environments themselves should be challenged. Given that some members of staff are also likely neurodivergent, this might help provide a better workplace for them as well.

With respect to openness vulnerability, the benefits of unmasking within healthcare contexts can include, at the individual level, a reduction in shame and exhaustion. Acceptance and facilitation of this unmasking can help make it easier for autistics to be taken seriously and to receive adequate care. It can also promote a community effect of creating an expectation of care regardless of proximity to neuronormative norms. This can contribute to a shift in thinking about health that recognizes our inability to completely control our body-minds.

7. In the unjust meantime: masking as resistance

Having argued for the importance of unmasking in order to embrace openness vulnerability, it is equally important to recognize that, while openness vulnerability is the ideal long-term goal to which we should aspire, in the non-ideal short term (or in the unjust meantime, to borrow Tooley’s (Reference Tooley, Wolf-Devine, Devine and Jaggar2009) phrase), masking can interestingly also be used as a form of strategic resistance. Here we follow Erinn Gilson’s understanding of strategic resistance, which involves “strategic denial through which one refuses … the roles that are prescribed or expected in relation to those who maintain an oppressive status quo. Thus, the eschewal of vulnerability that is sought appears quite different from that sought as part of a logic of oppression” (Reference Gilson2011, 322). Because masking involves conformity with dominant, neuronormative standards and expectations, it might at first seem like masking perpetuates a logic of oppression, instead of challenging it. However, we submit that masking and attempting to pass as neurotypical can serve as strategic resistance to the extent that what we refuse to do by masking is not so much performing neuronormativity (which is precisely what masking consists in). Rather, we submit that the relevant and powerful refusal at play here is the refusal to be legible as “different” and therefore to be assailed by endless neuronormative questioning that forces autistics to explain themselves or justify their presence or ways of being and doing. In this sense, we propose that masking is a way to avoid or refuse epistemic exploitation as Nora Berenstain (Reference Berenstain2016) has defined it. According to Berenstain, epistemic exploitation arises (i) when non-dominant groups are forced by dominant groups to explain or justify themselves (their experiences or perspectives); (ii) when this burden of explanation or justification imposed by dominant groups involves an opportunity cost for non-dominant groups because the time and energy they spend answering dominant groups cannot be dedicated to their own projects; and (iii) when their epistemic labor of explanation or justification is still met with persistent skepticism from dominant groups, which ends up maintaining the status quo. Masking, then, can be a powerful way to refuse to be answerable to persistent and intrusive neuronormative inquiries. Otherwise put, what autistics refuse to do by masking is to play the neuronormative role or fulfill the neuronormative expectation of “tell me everything” or “explain yourself or justify your different ways of being.” In this sense, the refusal involved in masking is the refusal to be assigned a certain epistemic role (that of having to answer to neuronormative queries), rather than a certain social role (which, on the contrary, masking by definition enacts by adopting certain neuronormative ways of navigating the world).

Now, since we understand masking as (i) protecting autistics from harm vulnerability by conforming to neuronormativity, and as (ii) preventing autistics from embracing openness vulnerability, and since only openness vulnerability challenges the neuronormative status quo and neuro-ableist oppression, there is a sense in which masking or passing seems not to truly qualify as strategic resistance. In other words, it looks like we are claiming both that (i) challenging the status quo via openness vulnerability and embracing autistic traits is strategic resistance (by refusing a certain social role dictated by neuronormativity), and that (ii) not challenging the status quo or masking autistic traits, thereby reducing harm vulnerability, is strategic resistance (by refusing a certain epistemic role imposed by neuronormative queries). Again, we submit that this apparent tension can be resolved by contrasting the long-term goal in an ideal context (i.e., openness vulnerability where masking is no longer necessary) and a short-term strategy for our non-ideal contexts (i.e., reducing harm vulnerability by masking and thereby refusing to be subjected to endless neuronormative questioning). Moreover, it is also important to note that, even while the larger context of society remains structured by neuronormativity and hence continues to yield non-ideal circumstances, even in the short term, it is possible and important for autistics to form or find spaces and communities where they can stim, flap, and communicate and interact freely and safely, thereby creating their own ideal circumstances, without being vulnerabilized by neuronormative norms, expectations, or reactions.

8. Moving forward: vulnerability and liberation

Popular discourse is full of exhortations to embrace one’s vulnerability, from RuPaul’s Drag Race (and its demand that contestants show “that vulnerability the judges are looking for”Footnote ¹⁷ ) to Brené Brown’s empire of TED talks, podcasts, YouTube videos, and books. These exhortations, however, often downplay the structural, social, cultural, and economic factors that make it riskier or more difficult for some than for others. Our paper has focused specifically on the neuronormative dynamics hindering openness vulnerability for autistics. We have argued for the need to shift the vulnerability economy so that those with less susceptibility to harm vulnerability can help make space and relieve neuronormative pressures. Recognizing the role of solidarity and community effort in making space for openness vulnerability has the potential to lead to broader liberation.Footnote ¹⁸

As mentioned above, our aim in centering the notion of openness vulnerability has not been to replace or displace the notion of harm vulnerability. Indeed, it is essential to address the causes of harm vulnerability. Rather, our point in arguing for the benefits of openness vulnerability has been to reinvest some of the positive aspects of vulnerability in order to call attention to its transformative and constructive potential, rather than only its harmful or destructive potential. Specifically, we have endeavored to show that embracing our openness vulnerability and appreciating its benefits can provide a much-needed shift in the vulnerability economy to contribute to resisting and undoing the neuronormative order. Undoing the neuronormative order requires both autistics and allistics to embrace vulnerability. Embracing openness vulnerability for autistics and allistics alike might involve valuing and being comfortable with autistic joys like stimming, flapping, or other forms of autistic playfulness and communication. For many autistics, operating this shift by embracing our openness vulnerability means reconnecting with ways of being, doing, feeling, and reveling in the sensory that we have often consciously or unconsciously unlearned through our neuronormative social upbringing and conditioning. For most allistics, operating this shift by embracing their openness vulnerability means becoming aware of and actively resisting neurotypical fragility by being open to the discomfort that being around autistic ways of doing or witnessing autistic practices like stimming or flapping might bring about without imposing judgment nor constraints—and even welcoming this discomfort as a sign of this much-needed shift in the vulnerability economy.

Again, for autistics to embrace openness vulnerability requires community support. Shifting the vulnerability economy as suggested here will likely conversely result in the broadening of the community that offers support, since autistics might be able to rely on support not only from fellow autistics but also from allistics who are likewise embracing openness vulnerability by letting go of neuronormative standards, habits, and judgments. The practice of cultivating openness vulnerability alongside ensuring its possibility for others can contribute to a more general challenging of pernicious forms of normativity. As Nick Walker writes:

Openness vulnerability also points to the possibility of cross-group solidarity and allyship in bringing about the sort of transformative change that will dismantle neuronormative habits, expectations, and structures: the very same habits, expectations, and structures that can be sources of harm vulnerability.