4) Terms have meaning. Masking is a lay concept, that seems to have a negative connotation.
"Masking" as a term and concept (at least in regards to ASD) has increasingly appeared in the peer-reviewed literature, and thus it probably would now qualify as a professional term. As with many terms/concepts in psychology (especially relatively new areas of focus), definitions of masking are not always consistent and, as you have pointed out, there may be some overlap with other terms/concepts (such as "coping"). There are also "lay" perspectives and definitions that can differ from the professional definition. From a recent research article (
The workplace masking experiences of autistic, non-autistic neurodivergent and neurotypical adults in the UK), masking is defined as "hiding or concealing one’s traits during social interactions." Note that the authors do suggest that it may be including a function in the definition (e.g., "in order to fit in" or "in order to avoid ostracization") may be important for future studies and understanding.
In the case of signs, decreasing pathological behaviors is likely a treatment goal.
This has been a big change in my field- Historically, things like hand flapping were consistently labeled as "pathological behaviors" and thus targets for reduction. It is now increasingly common to not put a default "pathological" label on every characteristic associated with ASD, and thus not-
de facto- target them for reduction.
In diagnoses of deficits, such as ASD, it makes sense that decreasing the frequency of a behavior is not solving an underlying deficit. However, in affective diagnoses, the idea that masking is negative is a antithetical to the intervention literature. It doesn't follow the 1/4 smile literature, the CBT literature, the behavioral activation literature, or general behavioral literature.
Based on the article in the OP, there does seem to be a different "flavor" to what is going on with affective disorders. For example, with the current criteria for a Major Depressive Episode
requiring that the symptoms " represent a change from previous functioning", it kind of goes against the "trait" part of the masking definition I provided above.
If we are using behavioral techniques to reduce signs and symptoms, aren't we essentially teaching people how to "mask"? If so, why is this negative?
If these signs/symptoms are truly causing undue harm or distress to the individual or others in their environment, the individual both desires and consents to interventions to reduce them, and there is empirical evidence that these interventions are not immediately or ultimately harmful in other ways, then I would argue that we are not actually teaching the individual to mask. However, if the signs/symptoms are not causing undue harm or distress to that individual or others and there is at least emerging evidence that our treatments are harmful in other ways, and the end result of the treatment is not an actual reduction in the sign/symptom, but rather a displacement of it to another time and place, it is at least a negative. If the sign/symptom is a relatively common and life-long behavior (e.g., repetitive body movements in individuals with ASD), then I'd say that meets the above definition of masking. If the individual does not have the ability or agency to self-advocate, consent, or clearly report on negative experiences and side effects of the treatment, we should be extra cautious. If many (not all, but at least some) individuals who experienced the treatment when they did not have this ability/agency at the time later- when they do have the ability and agency to do so- describe the treatment as harmful, report that they hid the target behavior despite the extreme distress other negative side effects of doing so, and say that this treatment interfered with their benefitting from other treatments that they actually found somewhat helpful, then we need to be extra extra cautious.
And what are the other options?
In the case of repetitive body movement and ASD, here's what I and many of my colleagues have done:
-Stopped
de facto labeling of the behavior as pathological, and thus stopped any
de facto reductive treatments
-Began a default labeling of the behaviors as adaptive and necessary for the individual engaging in them
-Spending more time educating families, caregivers, educators, and peers on the adaptive nature of the behavior for the individual
-Where indicated, helping the individual to develop strategies for explaining their behavior to others
-Where the behavior is actually harmful to the individual or others (and it RARELY is), teaching the individual less harmful strategies that serve the same adaptive function as the behavior.
-Where the behavior is actually disruptive to the environment (and it RARELY actually is), first exhausting all attempts to modify the environment to accommodate current topography, rates, and intensity of the behavior (up to and including desensitization interventions with others). Where this is not possible (and it almost always is!) teaching the individual less disruptive strategies that serve the same adaptive function as the behavior.
-Include the perspectives of individuals who have undergone such treatments in the past into our own continuing education (e.g. invited speakers at our conferences) or the education of future clinicians (I teach a Behavioral Interventions graduate course, and we spend a good bit of time discussing this topic and reviewing things like blog posts, articles, videos, etc. of individual reporting on their experiences with our interventions).
-Encourage individuals who have undergone such treatments in the past to become clinicians and researcher so that their perspectives and experiences are more directly included the development, implementation, and evaluation of our clinical techniques.
Honestly, with the young (toddler) population that I work with, I find that "normalizing" the behavior for the parents ("that's just something he does now") and explaining that we don't really need to focus on that because right now because we have a whole bunch of other meaningful, exciting, and easier things to focus on is pretty much all it takes.
Again- the stuff regarding affective disorders in the OP may be a different animal that what I'm talking about, but there may be some similarities. The evidence for the detrimental effects of symptom masking in ASD, while still emerging, is consistent enough that attention and change is warranted. Not every individual- or even a majority- reports masking and detrimental effects, but enough do to require caution when addressing these types of signs/symptoms.
As to the OP- though I don't work professionally with college students, I live with a few of them. It is almost inconceivable to me how things changed overnight for them a few years ago. My daughter went from me picking her up to come home for Spring Break on a Friday to, within a week, being told that she wouldn't be returning to school and the she couldn't get any of her stuff from school until further notice, if at all. my son spent the last two years of high school attending "class" while lying in his bed. Meanwhile, a circus of politicians, pundits, and "experts" played out on the TV everyday. At a time when they should be experiencing new, exciting, stimulating social experiences, they got to hang out with mom and dad and watch Tiger King. I don't think we yet know the actual long term effects of any of that on the current college-aged population, but my hunch is that a lot of what we knew about their mental health before the pandemic does not apply anymore. They are different than the cohorts who came before them in magnitudes much greater that we were than the cohorts that came before us. I suspect that that has something to do with what's going on in the article in the OP.