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“Fake it ‘till you make it”: Authenticity and wellbeing in late diagnosed
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DOI: 10.1177/09593535221101455

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Article

Feminism & Psychology

“Fake it ‘till you make it”: 1–19

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women

Kate Seers and Rachel Hogg

Charles Sturt University, Australia

Abstract
The diagnosis of autism spectrum condition (ASC) in women is increasing, prompting
research into the gendered experience and presentation of female ASC. To complement
this growing body of research, the current study utilised a qualitative approach informed
by a feminist disability framework to explore how the intersecting dimensions of differ-
ence, gender, and ASC influence autistic women’s subjectivity and wellbeing. Drawing on
the experiences of eight late-diagnosed autistic women, thematic analysis highlighted
experiences of early marginalisation, challenges of living outside gendered social
norms, the psychological and emotional consequences of masking, and the impact of
diagnosis on subjectivity, identity, and wellbeing. Participants developed their authenticity
and personhood within a performative social context that required masking of the self, a
complex process with wide-ranging consequences. Findings also highlight the import-
ance of acceptance, representation, and community for the wellbeing of autistic
women. This research challenges the dominant, masculinised construction of ASC. It
highlights the need for the ontological status of ASC to be reconceptualised to incorp-
orate diverse experiences of the condition across the gender spectrum. Future research
should explore how psychology can facilitate this reconceptualisation.

Keywords
female autism, wellbeing, masking, gender, Australia

Corresponding author:
Kate Seers, School of Psychology, Charles Sturt University, Boorooma Street, Locked Bag 588, Wagga Wagga,
NSW, 2678, Australia.
Email: kseers@csu.edu.au
2 Feminism & Psychology 0(0)

Autism spectrum condition (ASC) is defined and diagnosed through the presence of beha-
viours related to communication and repetitive and restrictive actions (APA, 2013).
While ASC affects both sexes, girls and women are more likely to be diagnosed later
in life (Gould & Ashton-Smith, 2011; Zener, 2019). Reasons for this gender discrepancy
in early diagnosis include lack of recognition of ASC traits in girls due to the historical
male-focus of research. Androcentric research findings have influenced the development
of the ASC construct, diagnostic tools, and the preconceptions of health professionals,
including psychologists, who report unfamiliarity with female ASC presentations and
are dismissive of women who present with ASC traits (Bargiela et al., 2016; Zener,
2019). For women, the timing of diagnosis may have significant consequences.
Autistic girls who do not meet the conventional construction of ASC are frequently ostra-
cised, denied support, and labelled with other diagnoses such as learning disorders, per-
sonality disorders, depression, anxiety, and eating disorders (Cridland et al., 2014;
Loomes et al., 2017).
Psychology has been complicit in this exclusionary framework by maintaining an
apolitical stance towards gendered diagnostic practices despite evidence women are sys-
tematically disadvantaged, stereotyped, and pathologised by “scientific practices” within
psychology (Marecek & Gavey, 2013). Current “gold standard” diagnostic tools for ASC
include the ADOS-2 (Autism Diagnostic Observation Schedule, Second Edition) and
ADI-R (Autism Diagnostic Interview-Revised), both of which are normed upon a pre-
dominantly male sample population (Ratto et al., 2017; Zener, 2019), reinforcing the
exclusion of women from ASC diagnosis by discounting or undervaluing traits more typ-
ically observed in autistic women (Head et al., 2014; Kreiser & White, 2014).
Furthermore, gatekeepers such as parents and teachers employ different gendered
expectations for girls, adding a layer of complexity when identifying ASC traits
(Cheslack-Postava & Jordan-Young, 2012; Cook et al., 2017). Autistic girls report
being chastised for misunderstanding social rules, committing social faux pas, or being
outspoken. This negative response reinforces their need or desire to mask (Bargiela
et al., 2016; Seers & Hogg, 2021). Other, more gender-conforming ASC traits such as
shyness or restricted interests in books or animals are commonly overlooked by teachers
and parents (Dean et al., 2017; Ratto et al., 2017).
When autistic girls believe they are to blame for their “difficult” or “abnormal” beha-
viours, their self-worth and efficacy are likely to be reduced and such beliefs may result in
mental health issues (Bargiela et al., 2016; Cridland et al., 2014). Without appropriate
diagnosis and self-understanding, experiences of relationships can be complex, confus-
ing, and potentially abusive (Baldwin & Costley, 2015; Cridland et al., 2014).
To reduce their vulnerability and to cope with everyday life, some autistic girls
develop compensatory strategies commonly referred to as “masking” or “camouflaging”
(Dean et al., 2017; Gould, 2017; Hull et al., 2017; Lai & Baron-Cohen, 2015). Masking
may involve social imitation and adaption, and a subconscious mimicking of social
behaviour (Lai et al., 2017), where a persona is adopted to appear “neurotypical”
(Bargiela et al., 2016). Masking appears to be more prevalent among autistic women
than autistic men, suggesting the performance of femininity is more scrutinised and
Seers and Hogg 3

policed (McQuaid et al., 2021). Bargiela et al. (2016) demonstrated that autistic women
experience pressure to play certain traditional and expected feminine roles such as wife,
mother, or girlfriend, despite this being incompatible with how they wished to live.
Milner et al. (2019) found autistic women feel more pressure to mask in social situations
and are often more successful at doing so than autistic men.
For autistic girls and young women, the social monitoring and policing of gendered
behaviour through dominant social norms, relational bullying, and shaming is a strong motiv-
ator to maintain the appearance of “normal”. However, these protective behaviours are a
cause of delayed diagnosis. Autistic girls and young women are often disregarded for
ASC assessment as they display some level of neuro-normative social competence
(Bargiela, 2015; McQuaid et al., 2021; Zener, 2019). They may also be denied access to
support due to their unconscious and conscious masking behaviours (Bargiela et al., 2016).
Autistic women describe camouflaging their autistic traits to improve employment
opportunities or social connections and to avoid verbal and emotional abuse (Hull
et al., 2017). However, autistic women report losing their authentic self and betraying
the autistic community when masking (Bagatell, 2007; Hull et al., 2017), signifying
that masking comes at a psychological cost. Masking is similar to the practice of
“passing”, which has been conceptualised as the act of adopting or performing in line
with normative identity roles (Kanuha, 1999) and, like masking, usually occurs within
a context of social oppression.
The experience of masking ASC traits may create deep internal conflict that warrants
careful consideration and exploration, particularly given the lack of clinical knowledge
surrounding such experiences. While masking may uphold assumptions of neuro-
normativity, concealment may occur at some cost, particularly to the psychological func-
tioning of autistic women, in terms of both social isolation and wellbeing.
In the current study, we sought to understand the impact of cultural norms on women’s
construction of the self within the context of an ASC diagnosis and to gain insight into the
strategies that autistic women use to navigate societal standards and develop connections
with others. We consider how these strategies impact the mental wellbeing of late-
diagnosed autistic women.

Methodology
Our qualitative study draws upon feminist disability theory and the social model of dis-
ability. Feminist disability theory acknowledges the similarities between the constructs of
woman and disability as “other” and the intersections of gender and disability
(Garland-Thomson, 2002). These critical methodologies allowed for reflection on the
dominant cultural narratives of gender and the meanings imposed upon female behaviour
that does not conform with gendered expectations. However, tensions exist between the
apolitical stance psychology attempts to inhabit as a discipline and the explicitly political
lens of feminism. These tensions shaped this research and presented challenges for us as
researchers in navigating a research process primarily established around traditional fra-
meworks of knowledge creation, which can further silence women whose experiences of
autism sit outside of the heteronormative, patriarchal centre of psychology.
4 Feminism & Psychology 0(0)

Deploying qualitative feminist research methods allowed us to centre the voices of

autistic women (Willig, 2013), and acknowledge the intersections between power
structures within psychology and societal constructions of “dysfunction” and gender.
Feminist research challenges normative, hegemonic assumptions with a gendered
lens and considers the perspectives of diverse groups previously rendered invisible
(Bailey, 2011).
In line with a social model of disability, we do not deny biogenic causes of ASC, but
also focus on the role played by societal morals and cultural norms in shaping the mani-
festation and experience of difference. In the context of this study, the social model of
disability is used alongside feminist disability theory, which offers a means of critiquing
how the medical model creates knowledge that influences dominant perceptions and
experiences of ASC.

Methods
Following ethics approval from the Charles Sturt University Human Research Ethics
Committee, a purposive sampling technique was employed to recruit a relatively homo-
genous sample. The call for participants specified that women should be aged 18 and
over, residing in Australia, and have a formal diagnosis of ASC or Asperger’s
Syndrome. Recruitment processes were guided by sensitivity to communication and
sensory needs and participants were allowed to select the interview’s location and
format (i.e., face-to-face online interviews or written responses) (Haas et al., 2016). No
incentives were offered for participation. After written consent was obtained, a single
semi-structured interview was conducted with each participant. Open-ended questions
allowed participants freedom to discuss issues they felt essential to the topic.
Interviews were anonymised and transcribed verbatim.
Data were analysed using reflexive thematic analysis (TA) (Braun & Clarke, 2021)
informed by critical feminist theory. Our analysis attempted to honour participants’
lived experiences; however, epistemological integrity requires critical reflection, not
just on the participants’ accounts, but also on researchers’ interpretations of these. It
was in this subjective but conscious, critical space that the themes were created.
We familiarised ourselves with the interview data through multiple readings and tran-
scripts were coded for similarities and differences of experiences. Through an iterative
process, codes were described, refined, amalgamated, and connected to feminist theoret-
ical frameworks. The codes were grouped, and themes were constructed that addressed
the intersections of gender and ASC. Consistent with feminist research practices,
power dynamics and the politics of representation were considered throughout the
coding phases and analysis (Bailey, 2011). We invited participants to review their inter-
view transcripts and provide feedback to ensure accuracy.

Participants
Participants reported a formal diagnosis of Asperger’s Syndrome or ASC, with the
average age at diagnosis of 36.75 years. Ages ranged from 24 years to 53 years (
x =
Seers and Hogg 5

39.12, SD = 9.3). Confirmation of formal diagnosis was not obtained, nor was a screening
assessment conducted. The study did not record socioeconomic status, ethnicity, or
nationality; however, one participant identified as culturally diverse. Relevant demo-
graphics are displayed in Table 1.

Table 1. Participant demographics.

Participant Age (at Reported diagnosis (previous Marital/familial

pseudonym diagnosis) diagnosis) status Employment

Charlotte 54 (53) Asperger’s Single; divorcee Part-time,

with no working from
children home
Sally 41 (38) Asperger’s Single mother; Part-time work
three and tertiary
children, two study
of whom are
on the
spectrum
Jenny 24 (23) Autism spectrum disorder Not stated Not stated
(anxiety, depression, eating
disorder, social anxiety,
obsessive-compulsive
disorder, attention deficit
hyperactive disorder)
Sarah 47 (40) Autism spectrum disorder Single Full-time
(bipolar, depression and
anxiety)
Jane 39 (39) Asperger’s or autism spectrum Married with Not stated
disorder children
Ella 35 (34) Autism spectrum disorder Married with Healthcare
(post-natal depression, two children. worker and
anxiety) All family self-employed
members are
on the
spectrum.
Maisy 31 (28) Autism spectrum disorder Married with Healthcare
two children; worker
one child on
the spectrum
Piper 44 (39) Autism spectrum disorder and Married with Contract office
ADHD one child; all work
family
members are
on the
spectrum
6 Feminism & Psychology 0(0)

Findings and discussion

This paper presents two core themes representing participants’ experiences of the inter-
section between social norms and marginalisation, managing the authentic self, and the
importance of diagnosis and connection. Core to this was the notion of internalised
blame for difference and the need to develop coping mechanisms to manage the social
consequences of difference. This self-blame was released once a diagnosis was obtained
and participants connected with other autistic women, thereby taking an active role in
their identity development.

Theme 1: “Managing and masking the self”

This theme encompasses participants’ attempts to perform social norms and reduce visi-
bility within the (neurotypical) community; the physical and psychological consequences
of this performance, and the coping strategies participants used to manage these conse-
quences. To understand an individual’s use of masking, it is vital to consider the sanction-
ing of cultural norms as a critical motivating force for concealment. Ella positioned her
masking as a choice contingent on social survival:

I knew that I was different, I knew that I wasn’t like other people, and I sort of tried to blend
in as much as was humanely possible. Society’s not kind. If I had of stood out, then maybe I
would have been bullied.

The consequences of being made visible are foregrounded here. Ella’s self-
construction implies a level of control over how she is perceived in social contexts.
Such control may create a double bind, whereby individuals must manage not only
their “difference” but also others’ perceptions of it. This strong sense of difference
was often reported as having developed throughout childhood, with Jenny noting, “I
always was aware of, from as young as I can remember, where I felt like I was
different.”
Intensifying this sense of difference was confusion about the “arbitrarily enforced”
rules and “confusing protocols” of social engagements in the neurotypical world. Such
explanations were consistent across participants and reflect extant research findings
about autistic girls and adolescents (Davidson, 2007; Gould & Ashton-Smith, 2011;
Jones et al., 2013). Rejection by the dominant culture, combined with a lack of under-
standing of the mechanisms with which to engage with the dominant culture, revealed
a justifiable sense of vulnerability. Jenny described feeling insecure throughout her
life, and Jane provided a vivid image of a “terrified inner child” hiding within her,
stating, “I rarely talk more than a simple greeting to people, except those I know well
because I am afraid of feeling the rejection again and again.”
Concerns of insecurity and vulnerability are not unwarranted. Research has identified
high rates of abuse of autistic girls and women (Bargiela, 2015; Cridland et al., 2014;
Hurlbutt & Chalmers, 2002). Five participants disclosed instances of serious abuse
during their lifetime. One woman experienced an emotionally abusive marriage, and
Seers and Hogg 7

three suffered child physical and sexual abuse, with one participant believing her autistic
traits increased her vulnerability to sexual abuse. To reduce vulnerability and increase
acceptance, participants modified or masked their behaviours, “because you very
quickly learn, that if you behave in unacceptable ways, you’re not accepted” (Sally).
Masking behaviours included gestures, rehearsed phrases to facilitate conversation
and suppression of non-normative behaviours such as flapping of arms or repetitive
noises (Hull et al., 2017; Lai et al., 2017; Tierney et al., 2016), as Sally describes below:

I’ve been conditioned to do it [in] non-visible ways, so I clench my toes, I press my toes into
the floor or into my shoes, I mash my teeth together, [that] is one of my stims [demonstrates],
clicking, socially acceptable things, like clicking my pen, or chewing.

Masking behaviour may seem problematic when enacted in a neurotypical world.

However, for participants, masking was presented as a natural, subconscious perform-
ance and a deliberate, strategic behavioural tool used to manage and cope with social
interactions. Participants learned phrases, prepared topics of conversation, and actively
performed neurotypical, gender-conforming gestures to avoid social sanctioning:

Back in school, I used to have my hand up a lot in class, and so I learnt to not put my hand up
so much because I got told it was the reason I was being bullied because I knew too much and
don’t put yourself out there so often and then, that is when I stopped putting myself out there.
(Piper)

Jane highlights the complexity of authenticity and gender performance: “I disregard

others’ opinions on how a woman should appear, but at times I do resent that others
might be thinking I don’t dress or apply makeup in a suitable womanly way.” Ella pur-
posely used masking to cope with the demands of motherhood, suggesting deliberate
engagement with the mask to psychologically distance herself from emotional
discomfort:

At the time, I couldn’t cope, so I did what I could. I spent a lot of time out and about … I
would just go out because I felt like I was so good at masking, I guess … I felt like a better
parent when I was out and about … I’d crumble when I got home.

In line with the notion that masking may be enacted to avoid stigmatisation, or con-
versely, as an actual act of stigmatising the self, Ella’s exhaustion speaks to a kind of
existential depletion. This depletion is incurred through the act of rigid self-management
whereby the need to manage the self, and the social expectations of others in the context
of one’s behaviour, may serve as a latent reminder of “defectiveness”. One might argue
Ella’s use of masking allows her to successfully achieve the social performance of gender
and motherhood. However, the language of “success” may not be appropriate if an indi-
vidual can “pass” the “test” of “concealment”, but at significant cost to their psycho-
logical welfare and wellbeing.
8 Feminism & Psychology 0(0)

Descriptions of masking behaviours suggest participants are self-aware, engaged in

active self-monitoring, and have a meta-representation of how the self is perceived by
others, traits not usually associated with conventional constructs of ASC, suggesting
current understandings of ASC may need expanding. Yet not all participants chose to
mask. Piper explained she did not mask: “I suck at that, I wish I could [mask]”,
adding, “I don’t do the copying thing, at least in recent years. I’ve just gone, well,
bugger you if you don’t like me, and I’ll just be me, and I’ll just speak to someone
else.” Nevertheless, for Piper, such openness carried consequences, with her outspoken
behaviour in social settings contravening feminine gender norms, leading to ostracism:

I was just never invited; I was just never invited to things. So, people look back at their
photos from their late teens and early twenties of photos … of parties and weddings, and
nope, nup, none of it’s me. I don’t have those photos; I didn’t have any of those experiences.
I got bullied out of an autistic mums’ group. Bullied. Out of an autistic mums’ group.

The desire to assimilate and the use of masking and camouflaging behaviours has been
documented extensively in ASC literature (Bargiela, 2015; Davidson & Henderson,
2010; Gould, 2017; Hull et al., 2017; Müller et al., 2008; Punshon et al., 2009; Ryan
& Räisänen, 2008).
Masking is a tool deployed by autistic women to enact gendered and social expecta-
tions. It reflects sophisticated social behaviour, given the self-awareness, self-discipline,
and understanding of others’ evaluative responses, raising questions about the female
ASC phenotype. While masking was motivated by a desire to reduce vulnerability and
“otherness”, participants often failed to achieve these social goals. Participants reported
ongoing marginalisation in the community, their relationships, and workplaces:

[I mask] in every situation at work and in social settings with people I don’t know, so I don’t
embarrass friends or look stupid to potential employers or work colleagues. I’m very aware
of it, as it exhausts me, and I find it hard to concentrate on anything anyone says. I miss what
people say all the time, and some think I’m stupid or uninterested and uncaring. (Sarah)

Sally masked “all the time” yet retained a strong sense of self as the outsider in relation
to her hometown experiences: “people already disliked me and excluded me, I was just a
bit too much to take, a bit too different, a bit too loud, a bit too, a bit too me.” Like Sally,
participants relied heavily upon concealment, yet concealment was not necessarily effect-
ive in rendering their differences invisible. Where neuro-differences are concealed in
social contexts over a period of time, it may be that women begin to experience a
degree of identity confusion, creating further identity work for the individual.
While masking is framed as both natural and planned, it was, at times, an arduous,
exhausting process for participants. They reported modifying their schedules around
public encounters to meet the emotional and physical demands of masking behaviours.
Surprisingly, participants did not attribute their mental health concerns to masking beha-
viours, but rather used masking behaviours to conceal mental health issues, as Jenny
Seers and Hogg 9

notes in context to social anxiety: “I get very anxious talking to people, but I kind of know
how to cover it up and not appear nervous, whereas really, on the inside, I’m freaking
out.”
The exhaustion of masking is thoroughly documented (Hull et al., 2017; Lai et al.,
2017; Tierney et al., 2016; Tint & Weiss, 2017). Participants’ accounts suggest the per-
formance of masking does not ease with time or practice, and a significant consequence of
masking was loss of self. Jane identifies the permeable boundary between the self and the
mask, describing confusion over time as to where the mask starts and stops:

Maybe I simply am the wall. I don’t really know who I am. When I think about the mask, I
don’t know which bit is the mask, which bit is myself, and which parts of the mask have
fused to myself and become indistinguishable from it. It is only in the privacy of my own
mind that I allow myself to express what might be the real me.

While authenticity was central to the way participants desired to approach the world,
masking reflects a direct inhibition of such frankness of self, as Jane’s narrative suggests:

I was hidden behind a wall, a solid wall that keeps me in and hides me from the world. It was
a wall of self-control that didn’t let emotions through like joy, excitement, love, hate, anger;
it was blank and tended to reflect back to someone whatever they were expressing them-
selves … I worry that one day it will come tumbling down and completely overwhelm me.

Without authentic interactions, cognitive dissonance develops concerning how the

individual sees themselves and how they see themselves presented to others (Hull
et al., 2017), resulting in psychological anguish.
To recover from the emotional cost of masking, participants described using self-care
strategies. They created “micro spaces” in their environment. For example, Charlotte dis-
cussed arranging extra designated breaks at work to ensure she was not overwhelmed by
the environment and Piper used headphones to reduce external stimulation. Maisy
described relaxing with her family, challenging the assumption autistic individuals shy
away from social interaction, and suggesting the need for masking may be reduced in
close, safe, and accepting familiar environments.
The need to create space as a coping mechanism is supported by previous research
(Davidson, 2007; Gould, 2017; Ryan & Räisänen, 2008; Whitley & Denise Campbell,
2014). The current study demonstrated participants’ self-awareness pertaining to their
psychological boundaries and capacity to implement appropriate strategies to manage
their experiences of ASC, something not usually associated with ASC, wherein the indi-
vidual is rarely understood as possessing self-awareness nor seen as capable of acting
strategically in accordance with this awareness. This may reflect the sample obtained
for this study; however, these findings raise questions around the defining features of
ASC in general and the phenotype for autistic women.
10 Feminism & Psychology 0(0)

Theme 2: Lost identity found: Finding the authentic self

The second theme concerns the impact of diagnosis on an individual’s subjectivity and
wellbeing. For participants, an ASC diagnosis allowed them to construct a coherent nar-
rative of their past experiences and strengthen their identity. Diagnosis allowed partici-
pants to embrace their ASC traits and live authentically, reducing the need for
masking and improving wellbeing. This positivity towards diagnosis is contrary to the
negative portrayal of an ASC diagnosis usually seen in mainstream media. However,
the long process of obtaining the diagnosis and the attitude of clinicians was not per-
ceived positively, as expressed by Maisy, who stated: “I found the process of getting a
diagnosis is [focused] on the negative. It’s giving bad news, and less hope for the
future.” Piper and Jenny both discuss the implications of the dominant, deficit model
on clinicians’ understanding of ASC presentation in women:

I had a hell of a time getting diagnosed cause I had any number of clinicians go, “Oh look,
you’re a parent, and you got married, and you have a job; therefore, you can’t be autistic.”
(Piper)

The GP dismissed me with, “I think if you finished university, you can’t have Asperger’s”,
but decided I was depressed enough to see a psychologist anyway. (Jenny)

That diagnosis was experienced and constructed positively by most participants is

interesting to note, given diagnostic tools and processes relating to autism were not
designed with women in mind. Participants were aware they were not the “target audi-
ence” of an ASC diagnosis, and interestingly, this created a sense of freedom in contex-
tualising their own ASC presentation. Participants did not position themselves as feeling
pressured to conform to ASC stereotypes or to present in narrow alignment with diagnos-
tic criteria. They framed the experience of being diagnosed as a liberating moment
imbued with explanatory power.
Women represent a non-normative category of ASC in terms of gender, and this
allowed participants greater space to create meaning around their experiences of ASC,
subverting the diagnostic process while also relying on it for validation. Participants
largely rejected medical and stereotypical male constructs of ASC but nonetheless
drew upon formalised diagnostic processes and understandings. Diagnosis served only
to confirm to participants they were different, and this difference was beyond their
control, and this may be more important than how “difference” is defined experientially
or via diagnostic frameworks.
Prior to diagnosis, the lack of a framework to rationalise feelings of difference, com-
bined with ostracisation from the dominant culture, led participants to believe they were
intrinsically flawed. Women labelled themselves as “broken” (Piper), “worthless”
(Jenny), “a failure” (Ella), while Maisy described herself as “the freak child”. This lan-
guage reflects an internalised sense of blame and sense of personal responsibility for self-
improvement that continued into adulthood, reinforced by societal and psychological dis-
courses related to self-help, as Sally explicates:
Seers and Hogg 11

I spent the entire half, first half of my adult life trying to fix these things that were wrong with
me, and, especially at the behest of my emotionally abusive, now ex-husband who thought I
was lazy. I went on a crusade against myself. I read all the self-help books, the seven habits
of highly effective people, and stuff, but nothing ever really stuck because it’s all for neuro-
typical people.

These beliefs had a significant impact on participants’ emotional and psychological

wellbeing as Jane voiced: “My sense of self, self-worth, confidence, and self-esteem
were eroded over years of not feeling like I was good enough. I am still trying to over-
come the belief in my brokenness and unworthiness to be loved.” Participants expressed
feelings of depression, shame, insecurity, and a sense of not achieving their full potential
or being offered the opportunity to live their authentic life.
Interestingly, two women described their past lives as relatively non-problematic in
their experience of growing up with ASC traits. Charlotte, whose father displayed
ASC traits, and Sarah, who was raised in a diverse community, did not identify with
the negative stigma attached to their perceived difference. Identifying the self in
others, experiencing acceptance, and living in a community with flexible cultural
norms appeared to serve as a buffer from the sanctioning of the dominant culture, redu-
cing identity confusion and self-blame. Charlotte and Sarah’s experiences highlight the
importance of representation and inclusion and support the social model of disability,
whereby “the self materialises in response to its engagement with its environment”
(Garland-Thomson, 2002, p. 20). When the environment is inclusive, the sense of isola-
tion and difference reduces, and an autistic individual’s sense of belonging and wellbeing
is likely to improve regardless of diagnosis.
Post diagnosis, all women described a sense of relief and release. Maisy remarked,
“just knowing, that is quite a relief and the other sense or feeling I got after I had pro-
cessed the whole diagnosis was one of joy, and it wasn’t just your everyday happiness,
it was a very heighten[ed] joyfulness.” Diagnosis was a pivotal point in participants’
negotiations of and with the self as they were able to embrace their unique traits and
take control of the interpretation of their experiences. Once diagnosed, participants
re-evaluated their lives and reframed past experiences with a compassionate lens.
Internalised feelings of failure and shame shifted to an external arena, and participants’
self-perception and understanding improved. Diagnosis created a framework in which
to process a coherent self-narrative and no longer pathologise thoughts and behaviours.
With a diagnosis, participants were released from others’ expectations of them, and they
did not have to try and assimilate into society. Sally stated, “So now I can work around it
and stop trying to change things that I’m not going to be able to change.”
Participants spoke of creating a more authentic life post-diagnosis, revealing previ-
ously concealed personality characteristics, despite implicating themselves in significant
stories of masking, suggesting that masking and authenticity are not necessarily posi-
tioned as antithetical to one another within the context of ASC. They became less protect-
ive of themselves and gained the confidence to disclose their diagnosis. Diagnosis
legitimised participant requests for provisions in the workplace, and participants were
12 Feminism & Psychology 0(0)

able to discuss their traits and needs with close friends, reducing the need for masking.
Sally demonstrates the self-acceptance and peace that follows from diagnosis:

I’ve come to accept, especially since getting my diagnosis, I’m not the same as other people,
and knowing it on a deep level since I was very young, and now understanding why that’s the
case, I’m pretty happy with the way I am, I’m not everybody’s cup of tea, and that’s okay.

This positive response to diagnosis is reflected in the literature (Bagatell, 2007;

Punshon et al., 2009). Positive responses to late diagnosis may reflect a maturity and self-
acceptance that comes with age. In this study, most participants had somewhat success-
fully navigated the milestones of life such as moving out of home, completing tertiary
education, marriage, children, and employment, and therefore did not harbour the trepi-
dation parents of autistic children or autistic adolescents may have about their future. This
highlights the importance of visible autistic female role models in the community for clin-
icians, families, and autistic girls navigating the future.
Despite such positivity, the stigma of ASC was, to some degree, internalised, with par-
ticipants often reframing ASC traits as those of another disorder. Piper informs people she
has attention deficit hyperactivity disorder (ADHD), and Sally self-selects traits perceived
as less problematic:

I don’t always disclose my entire diagnosis; I use language like, I have some facial blindness,
which means I often recognise your face, and I will recognise names if I see them written
down, but I have a great deal of trouble putting them together.

Active reconstruction of ASC traits is consistent with research findings (Davidson &
Henderson, 2010). This strategy provides participants with a sense of control and may
lessen the impact of stigma and create a sense of ease for others. The desire to put
others at ease aligns with socialised, gendered expectations for women and speaks to a
two-fold impetus for masking. On the one hand, this may be an act of social survival
for the individual; on the other, it may be a strategy enacted to cause the least amount
of possible disruption to others.
Diagnosis was a complex subject. Several participants expressed sadness at not receiv-
ing an early diagnosis. They believed an earlier diagnosis would have allowed them to
live better lives. Others suggested early diagnosis may not have been beneficial and
could have suppressed their growth and development due to the dominant deficit
model of ASC:

If I was diagnosed as a child and the clinician saw me at three years of age, I was nonverbal,
what would they diagnose me with? They would diagnose me with an autistic disorder, and I
would just be labelled as a nonverbal child who didn’t have much hope of integrating, who
didn’t have much hope of learning social skills, and you kind of … what I mean by “damage”
[of labelling] is all the assumptions that came [sic] with the diagnosis. (Maisy)
Seers and Hogg 13

Ella and Jane questioned the benefits of early diagnosis, with Jane expressing gratitude
she was not subjected to historical treatments for ASC. Maisy expressed similar senti-
ments to Jane, explaining how the adult autistic community refers to childhood treat-
ments, known formally as Applied Behavioural Analysis (ABA) therapy, as “torture”.
Current clinical approaches to ASC emphasise early diagnosis to ensure children
receive appropriate treatment. Women in this study highlighted important, potentially
deleterious implications for early diagnosis that require careful consideration. Early
diagnosis can result in an understanding of challenging behaviours, access to
funding, and early intervention support services and may provide the individual
with a sense of belonging to an autistic community. However, labelling informs
how a person is perceived and treated (Klotz, 2004). This can be troublesome for chil-
dren who have little agency over their interactions with others and, as such, internalise
responses and messages from others about their “disability”, potentially constructing
a pathology-oriented identity. As children’s characteristics are often filtered through
their diagnosis, the label of ASC and the stigma of deficiency may result in parents
and teachers lowering their expectations of the child, reducing opportunities, and
diminishing life chances (Bumiller, 2008).
Despite negative experiences with support services that adopt the deficit model of
ASC, participants identified many rewards of ASC. They indicated if they had their
time again, they would want their traits supported and celebrated rather than feeling pres-
sure to conform, as Jane describes: “I want to be valued for who I am and contribute my
gifts in my own way without being asked to fit someone else’s idea of who I should be
and what I should do.” Most participants also reported that their diagnosis gave them “a
licence to legitimately interact with the ASC community” (Maisy). Community, mentors,
and friendship were important for autistic women in developing connections and explor-
ing and cementing identity.
In particular, engagement with online communities enabled participants to meet their
need for connection and belonging and provided a virtual space for attachment.
Participants were able to further understand themselves, their experiences, and ASC
away from the deficit-focused medical model (Haney & Cullen, 2017; Molloy &
Vasil, 2002; Ryan & Räisänen, 2008). This is illustrated by Ella’s report: “I’m in quite
a few groups with autistic women which has helped a lot to know who I am.” Online com-
munities also allowed the women to control the level and type of interaction with others
with minimal focus required for their self-presentation, as described by Jane: “I’ve
managed quite well online, as I enjoy writing, and to me, the time to order my thoughts
and edit what I am saying to make sure it means what I want it to mean.”
Online communities may offer protection when the media and general population mis-
represent ASC (Crabtree et al., 2010) and provide an avenue for feminist autistic advo-
cacy and activism. Online support and protection are essential for clinicians to
consider when working with autistic females interested in developing their identity and
ASC understanding. Online communities challenge the normative, deficit understanding
of autism, may provide mentors to adolescent autistic girls who are vulnerable to bullying
and abuse, and may offer a place of safety and connection where attachment needs are
met and opportunities for advocacy are provided.
14 Feminism & Psychology 0(0)

Implications, limitations, and future directions

This study had a small, self-selecting sample of autistic women. It cannot be assumed
their experiences are representative of every autistic female, particularly those with
co-morbidities or cognitive difficulties. This study did not include self-diagnosed indivi-
duals or those just below the diagnostic threshold. The experiences of these women are
pertinent to understanding the power of social and patriarchal institutions, such as gender
and medicine, on the experiences of ASC, particularly as undiagnosed women do not
have the validation of a label. Future research may explore the experiences of diagnosed
and non-diagnosed ASC women simultaneously.
The results of this study suggest autistic women are aware of and internalise societal
expectations and norms and engage in disciplinary techniques such as masking.
Participants engaged in masking behaviours to meet social expectations, manage interac-
tions, reduce discrimination, and increase assimilation. Masking was not conceptualised
as a form of inauthenticity but rather a form of social survival, yet it carried psychological
consequences, and the mental toll of concealment was not inconsequential.
It may be argued that a patriarchal society asks all women to internalise and meet soci-
etal expectations. This is not new or novel. However, the experiences of autistic women
reflect the intersection between disability stigma and the gendered discrimination that
women experience in daily life. As well as performing gender, autistic women were
required to perform neurotypicality, with an added layer of concealment, self-monitoring,
and ultimately, surrendering of self to the norms of the dominant class. The women did
not attribute masking behaviours to poor mental health, noting the experience of subject-
ive difference, discrimination, and isolation in their younger years led to experiences of
depression and anxiety. However, masking was an effortful task requiring participants to
plan and implement self-care strategies to recover from engagement with public life.
From a feminist perspective, the need to engage in self-care is akin to the need for
resilience; both constructs align with neoliberal ideals around self-improvement.
Rather than encouraging periods of “recovery” from daily life as an individual responsi-
bility, psychology may be better placed in attending to societal structures that delegitim-
ise the lives of women across the neurodiversity spectrum (Joseph, 2013).
Diagnosis provided the participants with a socially and medically accepted framework
to comprehend one’s experiences and consolidate one’s identity. These autistic women
no longer positioned themselves as failures in need of relentless self-improvement but
rather expressed compassion towards themselves and their needs. Diagnosis improved
wellbeing as it gave the women permission to embrace their ASC traits and choose
when and how to disclose them, thereby reducing the need for masking behaviours.
Participants’ experiences highlight the importance of education and training for clini-
cians in recognising ASC presentation in females; in particular, the importance of clini-
cians’ understandings of the traumatic and emotional experiences of autistic women
throughout their lifespan and the role of psychology as a discipline contributing to the sub-
jugation and trauma of autistic women. It would be valuable for clinicians to provide
support to autistic women during times of transition, such as entering employment and
motherhood and forming and negotiating significant interpersonal relationships, rather
Seers and Hogg 15

than focusing on behavioural management and modification. The nature of this support
must be carefully evaluated to avoid reinforcing neoliberal frameworks of self-
empowerment that ultimately fail to acknowledge the social context in which an individual
makes choices and acts upon their social environment. Furthermore, autistic women may be
key stakeholders in developing feminist-led agendas for equality and human rights.
This study also supports research indicating the importance of autistic communities for
belonging and identity formation. Communities provide another frame of meaning-
making that can be interposed over traditional deficit models of ASC found in medicine
and psychology. For autistic women, these communities appear to bypass the traditional,
masculinised spaces of medicine and psychology, allowing space for a more nuanced
understanding of the intersections of autism and gender. These spaces may allow autistic
women to resist critical boundaries in mainstream feminist thought. As such, the experi-
ences shared, and knowledge created, in these spaces have implications for the discipline
of psychology and liberatory feminist movements and are worthy of further exploration.
Our study extends current research seeking to understand autistic women and how
they navigate a predominantly neurotypical society. It also demonstrates the significance
of the voices of autistic women in the development of the construct of ASC and under-
scores the importance of attending to gender in the debate as to what constitutes a disabil-
ity. This is particularly salient in the context of the role of psychology as the arbiter of
diagnostic categories and processes, and in pathologising and stigmatising women’s
experiences in insidious, far-reaching ways (Ussher, 2011). In understanding women’s
experiences of ASC, it is critical to reflect upon how “normality” and “diagnosis” are
intractably tied to gender, social class, and power.
In this way, our findings support the social model of disability that highlights the role
of the cultural context in autistic women’s challenges. These findings offer support for the
movement away from the medical model view of ASC and towards an understanding of
neurodiversity. However, further theoretical development may be required to refine the
use of this theoretical lens to understand women’s experiences of power, ableism, and
gender in the context of autism. To this end, our findings contribute to a growing under-
standing of the autistic female phenotype and provide insights that can inform the assess-
ment, diagnosis, and support of autistic women. We, therefore, recommend reviewing
and reconfiguring extant diagnostic tools to better recognise autistic women, as well as
autistic-led and autistic-informed training for clinicians and other gatekeepers.

Acknowledgements
We would like to acknowledge the women who volunteered for this project. We are humbled by
your generosity, honesty, resilience, and passion. Thank you for your courage and for sharing
your experiences with us.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/
or publication of this article.
16 Feminism & Psychology 0(0)

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this
article.

ORCID iD
Kate Seers https://orcid.org/0000-0003-4863-4400

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Author Biographies
Kate Seers completed a Bachelor of Social Science (Honours) at Charles Sturt University
in 2018. Her research explored the lived experiences of late-diagnosed autistic women.
This research focused on the intersections of gender and the construction of ASD.
Seers and Hogg 19

Kate is currently a PhD candidate with the School of Psychology at CSU. She is explor-
ing the role of neoliberal discourse in psychotherapy. Her research interests include crit-
ical psychology, gender, autism, and community psychology.

Rachel Hogg is a Lecturer of Psychology at Charles Sturt University. Rachel’s PhD

research focused on horse-rider relationships in elite equestrian sport. Rachel’s research
addresses discourses around animal lives, gender and feminism, the environment,
Indigenous perspectives, and the psychology of work. She conducts both qualitative
and quantitative research and has published research on human-animal interaction,
elite equestrian sport, autism, social media use, and mental health in veterinarians. Her
work focuses on social, sport, and industrial-organisational psychology, informed by a
critical psychology perspective attendant to the ways in which power frameworks are
enacted in psychology and in scientific research.

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