Wentworth Miller, Mental Health Stigma, and Masked Autism
Autism is underdiagnosed in people of color and queer folks, and the life of Wentworth Miller is a great illustration of why.
Autism is wildly underdiagnosed in people of color and queer folks. The life of Wentworth Miller is a great illustration of why.
This week, actor Wentworth Miller (best known for his roles as Michael Scofield in Prison Break and Captain Cold on The Flash and Legends of Tomorrow) came out publicly as Autistic. The 49-year-old performer, who has been a vocal LGBTQ activist and mental health advocate for years, revealed in an Instagram post that he discovered he was neurodivergent a year ago. In the time since discovering his status as an Autistic person, Miller has clearly been doing a lot of reading and reflecting. He wrote:
Right now my work looks like evolving my understanding. Re-examining 5 decades of lived experience thru a new lens.
That will take time.
Meanwhile, I don’t want to run the risk of suddenly being a loud, ill-informed voice in the room. The #autistic community (this I do know) has historically been talked over. Spoken for. I don’t wish to do additional harm. Only to raise my hand, say, “I am here. Have been (w/o realizing it).”
In his coming-out post, Miller shared that despite spending the first 48 years of his life not realizing he was disabled, Autism has already become a core part of his identity, one he would never wish to cure or change. He also mentions that years of mental health struggles suddenly have a new context for him.
Like a lot of undiagnosed Autistic adults, Miller suffered from profound depression throughout his life. He’s been open in the past about frequently feeling anxious, disconnected, and filled with despair. He first attempted suicide at the age of 15, and survived several more after that. In 2010, depression forced him to enter semi-retirement from acting. Miller has described this period as the lowest point in his adult life, with food providing the only highlight to his days.
In retrospect, this sudden, profound breakdown in energy and motivation sounds a lot like Autistic burnout. It is particularly common for neurodiverse people to experience burnout following an intense period of activity and social performance. Hot off the heels of Prison Break’s massive success in the mid-2000sit’s no wonder Miller was exhausted.
A gay, biracial man, Miller already had multiple reasons to feel adrift in society, and fear for the future of his career. Yet despite the huge risks, he has been outspoken in his mental health advocacy and in championing queer rights. Rather than shying away from conversations about gaining weight during his semi-retirement, he chose to shine a spotlight on mental health stigma and fatphobia instead. When he was invited to be a guest of honor at the St. Petersburg International Film Festival in 2013, he turned the offer down and outed himself, in open protest of Russia’s anti-gay laws. Last year, he made waves by announcing he would never play a straight character on screen again. In a statement, Miller described acting as a straight man to be an artistic “dead end.” It was an apt observation for him to make, considering he had just learned that his entire life up to that point had also been a performance of neurotypicality.
Learning that you are Autistic well into adulthood can be an earth-shattering revelation — I know that all too well. And in Wentworth Miller’s story, I see echoes of my own life, and the lives of many other adult Autistics like me. For years, many of us cope with having an undiagnosed disability by hiding who we truly are. To avoid sticking out like a sore thumb, we don a façade of quiet normality and conformity. To cope with the world around us being too bright, too loud, and too socially unpredictable, we turn to self-harm, eating disordered behaviors, substance addictions, and other means of dulling our senses. We work ourselves to the point of collapse, in the pursuit of acceptance and security. Eventually though, our ability to white-knuckle through life reaches its limit, and our carefully constructed neurotypical personas crumble. Those of us who are lucky discover, at around this point, that we’ve actually been nursing a hidden disability all along.
Many Autistics are exactly like Wentworth Miller and me, gender-nonconforming gay men whose Autistic traits don’t fully line up with the “white boys who are obsessed with trains” stereotype of the condition. But even within the Autistic community, experiences like ours get downplayed, in favor of discussing another group that also tends to get diagnosed late in life: women (usually white cisgender ones) with “female Autism.”
In many people’s eyes, female Autism is a gentler, softer version of the disorder that is much harder to recognize. Female Autistics supposedly are more emotional and sensitive than their male counterparts. They cry easily and come across as delicate and overwhelmed. They cut themselves, or starve themselves, or they drink, rather than having visible meltdowns. Female Autistics are often described as likeable, agreeable, and sweet, if a bit shy and withdrawn. Because they suffer quietly, in a way people don’t find threatening, female Autistics don’t get help when they’re young. They fly under the radar, with no other option but to smile through the pain.
If this portrait of Autism sounds like the lovely, soft-spoken, reflective Wentworth Miller, it’s not a coincidence. He has the exact same profile of traits people typically associate with “female Autism.” In some ways, so do I, and so do many of my non-female Autistic friends. And that’s because what people call “female Autism” is not actually a phenomenon of gender. It’s a phenomenon of erasure. What people usually refer to as female Autism is in actuality something I like to call masked Autism — a manifestation of the disorder that arises from racism, homophobia, transphobia, and classism just as easily as it arises from sexism.
It’s true that Autism is under-diagnosed in girls. When a girl does get diagnosed, it occurs at a significantly later age, on average, than a boy would. There are several reasons for this. First is the fact that all Autism assessments were designed with white male children from well-off families in mind. All early clinical profiles of the disability focused on that population too. The over-representation of white male patients led psychiatrists to theorize that Autism was caused by having an “extremely male brain.” This theory, in turn, made it pretty much impossible to recognize Autism in anyone who wasn’t conventionally masculine.
But from the very beginning, our understanding of Autism wasn’t just gendered; it was also raced, and tainted by homophobia, transphobia, and classism. Early Autism researcher Hans Asperger was a eugenicist who collaborated with the Nazi regime. Asperger only cared about saving the lives of bright, white male Autistics who could prove useful to the fascist government, so his work excluded anyone who didn’t fit that image. The founder of Applied Behavioral Analysis Therapy for Autism, Ivar Lovaas, was also the pioneer of gay conversion therapy. He had no respect for the humanity of gender non-conformity or queer people, or for any Autistic person who behaved in socially awkward ways. Both ABA therapy and anti-gay conversion therapy were designed to buff out all the non-conforming traits of the marginalized, rendering them compliant, typical, and easy to deal with.
The men who played a foundational role in defining Autism had a deeply white supremacist, sexist, and homophobic view of the world. That legacy lingers, and still affects how professionals screen for and assess Autism today. Research shows that even when an Autistic girl has the exact same traits as an Autistic boy, she is less likely to receive a diagnosis. Even Autistic scientist Temple Grandin (who has many stereotypically Autistic traits, such as speaking in a monotone voice and being good at STEM) was not diagnosed until she was an adult. Gender didn’t make her Autism milder (whatever that would even mean) nor did it make her presentation of Autistic traits more “feminine.” Rather, sexism meant that no one took her clear-cut signs of disability seriously.
Similarly, comedian Chris Rock was only diagnosed as being on the Autism spectrum last year, despite a lifetime of social challenges and hidden mental health difficulties. Racism didn’t make his Autism milder either, but racism sure put more barriers between him and the truth. It’s still incredibly difficult for Black Americans to access competent, culturally aware mental health care, and by Rock’s own admission, the mental health stigma he faced as a Black man was immense. Eventually though, the cost of this profound self-alienation got to be too much, so he sought out an Autism assessment on his own. This sounds very much in line with how half-Black, openly gay actor Wentworth Miller describes his experienced. Neither man has “female Autism” — but they did have their Autism overlooked due to racism, forcing them to mask.
We already know from extensive data collection that Autism is, in fact, under diagnosed in people of color and people in poverty. One reason for this is access: Black and brown families and families in poverty are far less likely to have access to healthcare coverage. But we also know from research that racial stereotypes and white supremacy figure into how Autistic traits are viewed. A white child who hits himself in the head and screams in class may be sent by a sympathetic teacher into special education services. In contrast, a Black child behaving the exact same way may get sent home, get a detention, or even be put on the school-to-prison pipeline.
Add into this equation the fact that half of all people shot by the police have a disability, and you can quickly see why many Black Autistics face very intense, yet unspoken pressure to hide their neurodivergence. Violating social norms may cause a white Autistic boy to be viewed as rude but eccentric; for a Black Autistic child it can be downright deadly. Being aloof and withdrawn may get a white Autistic girl labeled “shy,” but a Black Autistic girl viewed as hostile or “angry.”
All of these factors have seriously effects on how “severe” Autism appears in people of color. The less freedom of movement and expression you have in society, the more you’ll be required to stifle your sensory issues, depressive episodes, burnout symptoms, and other complaints. Medical doctors routinely disbelieve Black patients when they are in physical pain. The same is true for mental health providers and Black patients’ complaints of psychological pain. If you’re a Black person in America, there’s simply no reason to trust that the white structures of power around you will care about your needs.
It makes sense, in light of all this, that Autistic men of color like Wentworth Miller would not seem visibly or obviously Autistic. Instead, he seems to have mostly experienced what psychologists call internalizing symptoms — private expressions of anguish like depression, suicidality, body image issues, and social isolation. Rather than requesting assistance from a world that will be hostile to them, people with internalizing symptoms turn their pain within. In an interview with the Sydney Morning Herald, Miller described his adolescent depression and suicide attempts this way:
“When someone asked me if that was a cry for help, I said no, because I told no one. You only cry for help if you believe there’s help to cry for.”
Among Autistic people of color, women, transgender people, and gay folks, it’s far more common to hide our discomfort within rather than express it and inconvenience anyone else. We often get rewarded for this. As children, teachers call us a “pleasure to have in class” and parents praise us for being “mature” and “well behaved.” Unlike more visibly disabled kids, we don’t get admonished for sticking out. This comes with certain social advantages, but it’s also emotionally and psychologically corrosive.
Many masked Autistics never learn to listen to our own feelings, or assert ourselves in the world. Camoflauging Autistic traits and passing as ‘neurotypical’ is a leading predictor of suicide ideation in our population. Having to mask who you are creates a deep existential wound. It’s psychologically very similar to being a closeted gay person, in my experience, requiring incredible amounts of hyper-vigilance and producing just as much shame. Suppressing your tics and self-stimulatory behaviors, feigning social comprehension that isn’t there, mimicking others’ actions, and never voicing your sensory pain are all deeply alienating experiences. It makes it impossible to really connect with other people in a genuine way, or even to understand who you truly are.
Again, it comes as no surprise that Wentworth Miller, a talented actor who clearly can present as non-disabled (and who was in the closet about being gay at the time), was at a low point in his mental health when his career was nearing its peak. He had reached the logical end point of a lifetime of masking, and the disconnect between the man he was and the man he was pretending to be proved too much to bear.
In Wentworth Miller’s story, we can also see the effect that hypermasculine images of Autism have on gay and gender-nonconforming men. When Miller was debilitated with depression in 2010, he says he looked to food as his sole source of comfort. This fact was relentlessly mocked in viral memes at the time, both because of fatphobia and because eating for comfort is often viewed in our culture as a feminine, frivolous trait. At the absolute most painful period of his life, Miller’s only emotional outlet was enjoying the pleasure of a good meal, yet even that basic act of self-care was held against him because it wasn’t consistent with his image at the time as a masculine TV star.
Fortunately, in Miller’s life, we can also see a pretty common trajectory of Autistic unmasking and post-traumatic growth. It was only after recovering from his depressive episode in 2010 that Miller became an vocal advocate for mental health. Rather than feeling shamed about his inactivity and burnout, he learned to use his experiences to connect with other people. He also came out publicly as gay, and became the outspoken LGBTQ rights activist that he is today. When photos of his post-depression weight gain resurfaced in 2016, Miller said he was proud to see these old images of his depressed self, fighting like hell to survive. And now, in 2021, he is openly embracing his Autistic identity, and taking his place as a new member to the community with humility, grace, and an eagerness to learn more.
Miller’s authenticity and courage is itself a quality common to Autistics. Though masked Autistics spend much of our time pretending to be neurotypical and fearing rejection from others, once we get more comfortable asserting ourselves we can be incredibly principled and defiant in the face of injustice. Research shows that Autistics stick to our personal morals more consistently than non-Autistic people do, and are less willing to go along with social expectations that strike us as unfair or wrong. Embracing our identities as outsiders (and joining forces with other neurodiverse and oppressed people) can help us take a stand for what we believe in from a position of strength, rather than hiding away from the world in constant fear.
Looking from the outside in, it sure appears that Miller has been on a decade-long journey of unmasking himself, slowly unveiling every unfairly stigmatized, vulnerable side of who he is and finding great healing along the way. Instead of hiding his pain away, as most masked Autistics are encouraged to do all our lives, Miller has repeatedly turned his vulnerability into a strength. That journey toward greater self-acceptance and self-knowledge is a painful and slow one, particularly for someone also affected by racism, homophobia, and other forces of oppression. But as Miller’s own life and work really clearly illustrates, the benefits of finding safe ways to open up are massive.
It’s incredibly refreshing and heartening to see an openly Autistic person model such grace and emotional development, especially after Elon Musk’s eyeroll-inducing announcement that he has Asperger’s earlier this year. The Autistic community desperately needs to walk away from our public image as a disorder only observed in wealthy white men and sensitive, gender-conforming white women. We deserve to be appreciated in our racially diverse, queer, resilient glory. I know that as a relatively new member to the community who is still learning and reflecting, Wentworth Miller wouldn’t want to be the face of the Autistic self-advocacy movement just yet. But in a world where our best qualities and most marginalized members are so often overlooked, it’s galvanizing to have someone like him in our corner.
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My next book, Unmasking Autism: Discovering the New Faces of Neurodiversity is now available for preorder at this link.