Dr. Rachel Moseley: Autism, Suicide, Masking, and the Mental Health Crisis Too Few People Understand

Tony Mantor: Why Not Me ?

In this powerful episode of 'Why Not Me?', Tony Mantor sits down with Dr. Rachel Moseley, an autistic researcher and expert on autism, mental health, and suicide.

Key takeaways

• Autistic individuals are nine times more likely to die by suicide, with up to 66% having considered it.
• Masking—camouflaging autistic traits to fit in—is a survival mechanism that leads to burnout, depression, and suicidal ideation.

Main topics

• Autism and suicide risk
• The impact of masking and camouflaging

Notable quotes

"I thought I might be a psychopath because I knew there was something terribly bad and wrong about me."

Conclusion

Dr. Moseley emphasizes that while autism can increase vulnerability to mental health crises, societal

Transcript preview

Speaker 1 (0:00) 30 years ago, an island off Manhattan almost brought down New York City. Who will you trust? Your friends and neighbors? Or will you trust the people five miles overseas? This is a story about neighbors turning on each other and what happens when a forgotten place decides it's had enough. But we're not stopping, are we? Listen to Revisionist History, The Staten Island Problem on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. New school year, same beautiful mess. Good Mom's Bad Choices is back to talk back-to-school realness. The guilt, the giggles, and the choices no other show is brave enough to admit. Mom life is calling, and I have my last motherfucking volleyball tournament of Irie's Club Team Volleyball, and I can't wait for this to be over, because I don't like... Speaker 1 (0:55) participating and having to drive far distances. Shout out to the moms and my mom who made it happen. Listen to Good Moms Bad Choices from the Black Effect Podcast Network on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. What if everything you thought you knew about autism and mental health wasn't the full story? Today's conversation might change the way you see it. Welcome to Why Not Me? Embracing Autism and Mental Health Worldwide. where real conversations and lived experiences inspire understanding and hope. I'm Tony Mantor. This is where understanding begins. If this kind of conversation matters to you, then follow the show so you don't miss what comes next. Today's subject is going to be a very tough one. It is said to be the hidden crisis for autistic people. The subject is suicide. Some of the statistics are staggering. Speaker 1 (1:51) nine times more likely to die from suicide, second leading cause of death for autistic people, up to 66% have considered suicide. That, with 1% of the population, means that 11% of suicides are those which are autistic. This is a subject that my guest and I will be talking about today. Dr. Rachel Mosley, she is autistic, a researcher, she focuses on mentally ill health and suicide. So welcome to the show, Rachel. I think it's amazing work that you're doing and it's so wonderful that you're raising attention and awareness to this. So thank you. Oh, it's my pleasure. Speaker 1 (2:31) I really appreciate you taking your time to come on the podcast and give this information. So let's kick it off with, I understand that you're autistic and at what age was you diagnosed? So I was 28 years old, so quite late. There were signs way back when I was a baby and my mother took me to many, many specialists throughout my childhood and teenage years. But back in the 90s and the 2000s, Knowledge about non-stereotypical presentations of autism was really poor. So although this label autism was mentioned to my mother, the doctor said, you know, I don't think that's the case. They wouldn't put me forward for an assessment. So I grew up without that label, always knowing there was something, just not having a name for it. Speaker 1 (3:26) And then I only found out when I did my PhD and my mum happened to mention to me, oh, people said you might be autistic when you were a child. And we went through this process of getting you checked out, only, you know, they didn't want to take it ahead. But I'd never had that word. I knew that I'd been taken to all these specialists, but I'd never had that word attached to it. So once I knew. that word, it made a lot of things make sense. And hence, I went for a proper diagnostic interview and got the label. Speaker 1 (4:01) So once you were diagnosed and they actually said that you are autistic, did that allow you to look at your life, things that you'd gone through, and then it made more sense to you now that you're older? Absolutely. Absolutely. Because my childhood and teenage years were very difficult. And the thing I always think is that even if you don't have that autistic identity that you know about, you're very aware that you're different. and everyone around you is aware that you're different and you can't fit in. You can't do the things that everyone else seems to do easily. So if no one gives you an explanation for that, you have to find your own explanation. And I had various ideas about what was, in inverted commas, wrong with me. For instance, for a long time, I thought I might be... Speaker 1 (4:55) a psychopath because I knew there was something terribly bad and wrong about me. And as I got a bit older and I came to understand a bit more about what a psychopath is, I kind of moved away from this idea of thinking I was a psychopath. But there was this fundamental idea that I was fundamentally bad, worthless, unlovable, a terrible person. And that belief just because I had no other explanation for why I was bullied, why I didn't have any friends, why I... was bad at lots of things. I had to find my own explanations and they all tended to be really negative ones, which means if you're growing up with these beliefs, you're really on your way to develop quite serious mental health problems and possibly suicidality. Speaker 1 (5:41) So you basically found out about your autism because you was going to college to get your PhD. Is that correct? I was learning all about the way autism presents differently in people of different sexes and genders. And I'd wanted to go into autism research in the first place because I felt a great empathy for autistic people. Because I too had felt like I never fitted in and I got bullied and I couldn't make friends and so forth. So I felt this great empathy with... Speaker 1 (6:10) with people who struggled with these things. Right. I learned quite a bit about myself when I did this. Sure. Now that you've been diagnosed autistic, you've gone to college, got your PhD, has everything that you've learned helped you not only with others, but help you accept yourself? I would say so, yes. I did a study once where someone had a fantastic analogy. They said that they'd gone through their life believing that they were like a broken horse. They couldn't do all the things that other people Speaker 1 (6:39) could do, life was really difficult for them. But now they realize they were actually a zebra, however you say it. And it frees you from all these things that I likewise thought, it's my fault that I got that wrong and that I deserve to be treated badly there. It sort of frees you from the weight of all that self-criticism and all these sort of expectations, all I should be, all the shoulds. you know, I should be independent by now, I should be doing this, I should be doing that. When you know you're autistic, you know that neurotypical expectations don't necessarily apply to you. And there's a reason why it's more difficult for you. It's not just that you're stupid or rubbish or any of the things I believed. Right, right. So once you completed your PhD and you started getting into Speaker 1 (7:32) the doctorate part of it. We're going to go into something that a lot of people don't like to talk about, but it's something that needs to be put out there. And that's one in four diagnosis are female. Even though I've talked with other people that think that the number is much greater than that, but it's because females tend to mask it more. they try to fit in, they look at every single way that they can to avoid whatever they're trying to avoid. And then ultimately, because sometimes they can't fit in their mental state, they get depressed and then they think about suicide. What's your relationship with that and how do you approach it? My personal relationship or my professional take on it. I suppose I can maybe talk a bit about both if you like. Speaker 1 (8:20) Yeah, yeah, absolutely. I would say that I was personally not a very good campus life track. If I had been, maybe I would have had more friends and I wouldn't have been bullied so much. But certainly suicidality was growing up in my life when I was 13 onwards, ever since really. And I think that a lot of autistic people who have missed the diagnosis, which as you say, very often these are... people who either identify as female or maybe they on the surface present as female maybe have less stereotypical presentations of autism. They're picked up. As you say, they may be very good at learning techniques which allow you to blend in so that you're not bullied, so that you're not, so you don't stand out. And it's unfortunate in a way because it protects you at the time. We know that autistic people Speaker 1 (9:14) camouflage because they're trying to protect themselves from stigma, from victimization. But it comes at this terrible cost, firstly, of being less likely to be identified as autistic and hence not given any support. But secondly, we know research-wise that camouflaging is very much associated with burnout. It's exhausting. And it seems to also really strengthen this belief that I'm not good enough as I am. I have to pretend to be someone else because if they knew the real me, they wouldn't like me. Camouflaging seems to kind of reinforce these ideas and many of us do it and we can't switch it off because it's safety and it's automatic, but it seems to incur a real cost in terms of the energy it takes from us. And hence there is this link between camouflaging and burnout and suicidality. I've spoken Speaker 1 (10:12) with a few that have said they think about suicide almost on a daily basis. They actually set dates of when they're going to do it. And then as it gets closer, they'll talk themselves out of it and then maybe set another date. Have you run across that at all? Personally, myself, I think to a degree. There's some really interesting research about suicidal thoughts and what they do to you mentally. So I think to some extent, thinking about suicidal thoughts can sometimes help someone to kind of regulate their emotions. I think for me, throughout my