Autism and (the Many Barriers to) Psychological Healthcare

Trigger warning: mentions of self harm, forced hosptalization, and suicide


It has been said that we don’t know what autism looks like on its own – only what autism plus trauma looks like. As long as we live in a world that is is set up to face forced neurotypical behavior, existing as a neurodivergent person will always be traumatic. Many believe that this truth offers some explanation for the high rates of anxiety and depression that often accompany autism. Even neurodivergent people who have had the fortune of growing up in situations that are intentionally crafted to support them often desire psychological healthcare at some point. Psychological healthcare is perhaps as important as it is inaccessible.  

Like physical healthcare, one of the greatest downfalls of psychological healthcare often seems to be that professionals can really only ever scratch the surface or get a snapshot of anyone’s full, complex, and lived reality. That’s not as much of an issue if you have strep throat or need psychological healthcare only to support you through a life event that our society generally accepts as challenging. For a person who has lived their entire life with complex experiences of guilt, anxiety, trauma, and unmet needs, though, accessing psychological healthcare can feel like a race through a maze. How can anyone sum up an entire lifetime of experiences and needs succinctly while also giving enough details to avoid the formation of other entirely untrue conclusions? Even more, how do we convey the nuances of human experience in a series of yes-no questionnaires without losing control?

Psychological health professionals have an extraordinary amount of power. On first meeting with a stranger, how many people can truly feel comfortable admitting to recent feelings of suicidality or instances of self-harm? When everything feels precarious, opening up the possibility of being forced into hospitalization often seems like a risk worth avoiding for the price of a simple lie. But even more commonplace truths can also feel dangerous to share. When you go in with a diagnosis, hoping it will be used as a tool to support you, many psychological health professionals take it upon themselves to analyze and even question that diagnosis immediately upon learning about it. Neurologies are identities for many, and to have every new professional incite an identity crisis within minutes of meeting them is not ideal. Medical and psychological knowledge is vast and complex in such a way that even highly-regarded professionals can have vastly different opinions and understandings. Furthermore, a shocking number of people who are behind the times are very set on staying that way.

Even once a psychological healthcare relationship has extended beyond first meetings and impressions, many factors can get in the way of good services. Articulating thoughts, feelings, and experiences can be difficult for many, and even more difficult when these realities are met with doubt and assertions that one’s perceptions are incorrect. (There’s a fine line here. Essentially, it is ok to support someone in exploring and even reframing perceptions. It is not ok to tell someone that their perceptions are incorrect, particularly with little evidence.) Finally, psychology and related fields seem to increasingly be categorized under “behavioral health.” To focus only on behaviors – which focuses on others’ experiences of one’s reality – often glosses over deeper realities, “treating” the “symptoms” rather than supporting the person.

This article hasn’t even touched on some of the more basic ways that psychological healthcare is inaccessible, like financial concerns, transportation difficulties, and a surprising lack of non-phone-based methods of appointment scheduling. Those matter as much as the other points, but delving into them is beyond the scope of this article. Unfortunately, as with most problematic systems, opting out until the system improves just isn’t practical for most people. Need for psychological healthcare doesn’t vanish just because psychological healthcare as a field is so far from where it needs to be. A crucial part of meeting psychological healthcare needs within a largely unsatisfactory system is knowing what characteristics to look for (and what to avoid). Stay tuned for next week’s article, which will provide tips for seeking out better psychological healthcare.