Enough.

Author's note: I write this as an equine-assisted therapist, educator, researcher in development, and as someone with lived experience of high-masking neurodivergence.

Every year, too many neurodivergent people die by suicide.

Not because they lacked resilience. Not because they did not try. Not because they did not receive therapy.

Many of them did everything we asked. They learned to regulate. They learned to communicate. They learned to understand themselves. They learned to adapt. Some became exceptionally good at it.

And still, they died.

I know what it is to see no other way out. Fortunately I am still here. That is why I use this word, and not another.

Enough.

Recently, a colleague lost a neurodivergent client to suicide. This article is not about that individual. It is about the question that death leaves behind.

What if we have mistaken survival for recovery?

What if the person in front of us is not failing treatment?

What if treatment, despite the best intentions, keeps asking the same nervous system to carry the burden of adaptation over and over again, until it can no longer sustain the load?

For decades, autistic people have been telling us something remarkably consistent.

"I don't become less autistic around people who understand me. I become less exhausted."

Many of us have heard these words before. We have acknowledged them. Yet our clinical frameworks have often struggled to translate those experiences into different ways of observing, understanding and working.

Recent research offers a possible biological perspective on why this may matter.

Using functional near-infrared spectroscopy (fNIRS) hyperscanning during real group conversations, Feng and colleagues found that people with similar autistic traits were more strongly attracted to one another and showed different patterns of neural synchronisation than mixed neurotype groups.

The study does not propose a new clinical model. Nor does it prove that all neurodivergent profiles function in the same way. Its findings concern autism specifically.

Comparable work has not yet been conducted across other neurodevelopmental profiles. At the same time, many high-masking individuals present with overlapping neurodevelopmental characteristics. Together with the broader literature on masking, the Double Empathy Problem, predictive processing and embodied cognition, these findings invite a broader research question rather than a premature conclusion.

Perhaps social suffering is not located solely within the individual. Perhaps it also emerges in the space between nervous systems.

This possibility is not a fringe idea.

It follows a growing body of work suggesting that social interaction cannot always be understood by examining one individual in isolation.

For many autistic people, masking functions as a threat-management strategy. It is what a nervous system learns to do when authenticity has repeatedly proven socially unsafe.

It is costly. And remarkably effective.

Until it isn't.

Other researchers have described how misunderstanding can arise not because one person lacks social ability, but because two different cognitive systems attempt to understand each other using fundamentally different assumptions.

If this body of work is even partially correct, it changes something fundamental about where we direct our clinical attention. The clinical framework many of us inherited naturally places the difficulty inside the patient.

The diagnosis is theirs. The treatment is theirs. The adaptation is theirs.

When treatment fails, we refine the intervention. Or we adjust our expectations of the patient. What we rarely adjust is the question itself.

How many more people must become experts at surviving before we dare to ask whether the environment itself also requires our attention?

This is not an accusation.

The professionals reading this did not create the systems they work within. Many entered this profession precisely because they wanted to alleviate suffering.

This is a question about what clinical responsibility looks like in light of what we are beginning to understand.

A nervous system that must continuously compensate, mask, translate and socially rewrite itself simply to belong pays a price. We see that price in our consulting rooms.

We see it in the recurring referrals of neurodivergent people who have completed intervention after intervention, only to return more exhausted than before.

We see it in the striking discrepancy between how capable someone appears and the immense physiological effort it took simply to arrive at the appointment.

Perhaps we have overestimated adaptation as an indicator of recovery. Perhaps we have become exceptionally good at measuring survival. And perhaps we have sometimes mistaken that survival for healing.

Safety is not merely a treatment outcome. For many neurodivergent people, it is a prerequisite for meaningful therapeutic change.

A nervous system living in persistent threat does not easily learn. It does not easily integrate. It does not easily heal. It adapts.

And adaptation, sustained long enough, can look remarkably similar to recovery. Right up until the moment it collapses.

The research does not yet tell us exactly how to build environments that consistently support rather than correct.

It would be intellectually dishonest to claim otherwise.

But it tells us enough to take seriously the possibility that some of the environments in which we ask people to recover may themselves be part of what they need to recover from.

We have spent decades asking neurodivergent people to become safer for the world around them.

Perhaps the next chapter is asking how the world can become safer for them.

Not out of kindness.

Out of scientific curiosity.

Out of clinical responsibility.

And because too many people have already paid the price.

We owe neurodivergent people more than increasingly sophisticated ways of enduring environments that exhaust them.

We owe them the courage to ask whether those environments can change too.

Perhaps that question is no longer optional.

References

• Feng, S., Wang, M., Zhang, J., Ding, L., Yuan, Y., Zhang, P., & Bai, X. (2026). Attraction through similarity in autistic traits: A group communication study using the social relations model and functional near-infrared spectroscopy hyperscanning. Biological Psychiatry, 99(5), 418–427. https://doi.org/10.1016/j.biopsych.2025.06.031
• Milton, D. E. M. (2012). On the ontological status of autism: The "double empathy problem". Disability & Society, 27(6), 883–887. https://doi.org/10.1080/09687599.2012.710008
• Pearson, A., & Rose, K. (2021). A conceptual analysis of autistic masking: Understanding the narrative of stigma and the illusion of choice. Autism in Adulthood, 3(1), 52–60. https://doi.org/10.1089/aut.2020.0043
• Van de Cruys, S., Evers, K., Van der Hallen, R., Van Eylen, L., Boets, B., de-Wit, L., & Wagemans, J. (2014). Precise minds in uncertain worlds: Predictive coding in autism. Psychological Review, 121(4), 649–675. https://doi.org/10.1037/a0037665

If you are thinking about suicide or are worried about someone else: in the Netherlands you can call 113 Zelfmoordpreventie, free of charge, on 0800-0113 or chat at 113.nl, day and night.