Please don't ask me "R U OK?"

This is not a criticism of the R U OK charity or campaign. I think it is overall a good campaign, with a message that is helpful in many cases

I meant to publish this on Sunday, 10 October 2021, World Mental Health Day . Unfortunately, I was busy providing feedback on a thesis and preparing a tender submission. There may be a message in that alone. Missing the exact day is not a big deal, though. It seems like there are so many declared days, weeks or months at the moment that I could have written this article at any time of year and found a convenient hook. Awareness of mental health as an aspect of overall health is receiving a lot of attention. But, awareness of mental health and acceptance of mental health issues are quite different goals, and through this article I encourage you to think about the difference. I'm going to share a couple of personal things that may be a bit distressing for some readers.

The way we treat mental health is not at all comparable to other health issues. As a simple parallel, consider the "R U OK " campaign in Australia, encouraging peer conversations about depression and anxiety. This is a positive and valuable campaign - but in workplace safety terms, it is equivalent to asking workers to check in with colleagues when they notice that they are bleeding, and encourage them to report the injury and go get medical attention. In the case of a physical injury, we would want things to go much further. We would want to know what conditions at work gave rise to the injury, and how we could improve things to reduce the likelihood of future similar injuries. We would also, sadly untrue for most mental health issues, assume that once the worker was referred for medical attention that they would receive appropriate and timely treatment, and be returned to work in way consistent with a path to recovery. It's a shame that we don't do a better job for the full lifecycle of mental injuries.

Even this comparison assumes that mental injuries have a similar lifecycle to physical injuries. I think it is a fair analogy for a single episode of anxiety, depression, or substance abuse, or for harms like stress and burnout that might not give rise to a medical diagnosis. For most people, mental injuries occur over their lifetime in a similar pattern to physical injuries - one or two particularly severe events that might be disabling for weeks or months, and lots of smaller occurrences that they might work through, or need a day or two away from work to recover from. But I think it's useful and important to separate this common experience from long term experience of mental illness, where the analogy to physical injury is less useful, and even the idea of "illness" may not be appropriate.

Some personal background here. I am autistic. Autism is a developmental disorder - present from early childhood, and continuing throughout life. Due to changes in awareness, formal definitions, and availability of diagnosis, the number and range of people diagnosed as autistic has changed markedly over the last forty years. Along with some major autism awareness campaigns, and a fraudulent but viral claim linking vaccines to autism, I think that most people have at least a vague understanding of what autism is, but that awareness has not translated into acceptance of autistic adults.?

Portrayals of autistic people in the media or in diagnostic manuals tend to focus on how the autism appears to other people. Autistic individuals are shown as socially unaware, tactless, poor communicators, and prone to sudden outbursts, shutdowns, or incapacitating fixations on unimportant topics or details. Purportedly “positive” portrayals often suggest that autistic people should be tolerated despite their autism, because of other qualities. It is unfortunate both for reality-in-television and the lived experience of autistic adults that autism is far more likely to be co-morbid with ADHD or dyslexia than with savant-level mathematics, memory or visualisation skills.

So what is it like to be autistic? Autism is a broad diagnosis, and no two autistic individuals are the same, but when we talk with each other we recognise a lot of common experiences. As an illustration for how I experience things, what would happen if someone at work asked me “Are you okay?”

Firstly, I’d have to stop and work out if I was “okay”.

If I’m not totally alone in my own space, I’m always at a heightened state of awareness. I am acutely conscious of background noise, and I can’t tune it out. Sometimes a ticking clock, a hissing air conditioner or a fluorescent light buzz that is inaudible to other people will be completely distracting. When multiple conversations are happening in the same room, I can’t selectively focus on the conversation I am in; all of the sounds overlap with the same salience. I am also light sensitive, so unless I am wearing sunglasses, it is probably too bright.

This is all baseline stress. In my early career it would sometimes be overwhelming enough to cause a complete shutdown or meltdown, but now I’m just used to the exhaustion. Still, I’m not very aware of my own emotional state, so it’s entirely plausible that I’m more stressed than I’ve realised. I'd need a moment to think about that.

Secondly, I’d have to consider whether the person was really asking if I was okay. I know it would make sense to do this before the first step, but my brain doesn’t work like that.

I produce and “read” subtext such as sarcasm and body language differently to most people. This catches me coming and going – I sometimes miss what other people are trying to say (usually by taking them too literally), and other people sometimes assume that I am saying something that I am not (usually by not taking me literally enough). To complicate matters, I have forty years of experience with this happening, and I’m not stupid.

So my first instinct is to take the person literally, and wonder if I was okay. My second instinct is to question my own interpretation of the encounter, and to try to decipher if maybe it wasn’t intended as a genuine request for information. I’d mentally rewind their tone of voice and body language looking for clues about their intention in asking the question.

Thirdly, I’d start to worry about what rule I had broken.

I navigate most social situations by consciously following rules and patterns, rather than by instinct. I have a very large library of these rules in my head, mostly learned through trial and error; i.e. getting things wrong, and then working out what I was supposed to do instead.

If someone were to ask "Are you okay?”, this would echo a lifetime of challenges, confrontation, and outright bullying because I haven’t managed to perfectly imitate neurotypical behaviour. “Where are you from?” (because my speech patterns have never matched the local accent). “What’s your problem?” (because I’ve made too much or too little eye contact) “What’s your damage?” (because I’ve paused too long to work out what I’m supposed to say) “Stop interrupting!” (because I’m struggling to navigate conversational turn taking) “Don’t just stand there!” (because I’m trying to follow the instruction to stop interrupting)

If you’ve ever seen the cartoon of a duck moving smoothly across the water whilst their feet are paddling madly underneath, that’s me in every social situation. I’m studying what everyone else is doing, working out what I am supposed to be doing, and planning the next few steps in my head. The more people are in a room, the more complex these calculations get, and the longer I need to pause and process before making each move.

Fourthly, I’d have to work out what my relationship was with the person asking the question, and what the appropriate level of self-disclosure was for that relationship.

Learning surface social skills by trial and error is difficult, but not impossible. There are many opportunities, and the mistakes seldom have long-term consequences. Learning interpersonal relationships as a set of rules and patterns is genuinely traumatic. Mistakes cost jobs and friendships.

When someone asks “Are you okay?”, they are inviting a level of disclosure and connection that is dangerous for me. I am grateful that they have asked, I desperately want the connection, and I want to reciprocate by showing that I genuinely care about how they are too. But I never know if we have a have a close enough relationship for it to be permitted for me to give an honest answer.

So overall, what would happen if someone at work asked me “Are you okay?”

I would pause, looking confused, for slightly longer than expected. Then I would tell them, with my best imitation of neurotypical sincerity, that I was fine. I would then spend the rest of the day unproductive, as I mulled over the interaction, worrying that I hadn’t said the right thing. Another key part of my experience of autism is that I alternate between hyperfocus and inertia. Once I start thinking hard about something, I find it very difficult to stop, and once I am distracted, I find it very hard to regain focus.

The bottom line here is that for many people at work, mental health is a chronic issue rather than an acute circumstance, and expecting the average person to successfully intervene when it becomes acute is asking way too much. This doesn’t just apply to autism, it applies to a whole range of developmental conditions, as well as long-term anxiety or affective disorders such as depression.

Dealing successfully with long term mental health involves acceptance rather than awareness and acute response. For me, acceptance means having people understand that bright lights and background noises aren't just irritating, they are overwhelming, rather than waiting until I am uncontrollably sobbing underneath my desk to realise that maybe I'm not just casually griping. Acceptance means recognising that unstructured social interaction drains both my wellbeing and my productivity, rather than the two separate organisations who singled me out for a joke award during teambuilding exercises for not fitting in with my teammates.

Acceptance means helping me to navigate social ambiguity – thank you to here to the boss who always says “thank you for asking” so that I’m not in doubt about whether I am doing the right thing by expressing interest in their health and family. Acceptance means recognising that my rule-based thinking isn’t “wrong”, just neurodivergent – a genuine thank you to the colleague who says that they “love my engineering brain” whenever I talk about things in unusual ways.

If you’re following me on LinkedIn, you probably have some responsibility for workplace safety or well-being. Here’s one simple thing I’d like you to take away from this article. The default for almost everything in a work environment is set to what makes a neurotypical person comfortable. Everything from the social interactions at morning tea through to the lighting levels in the hallways might seem “normal” to you, or at worst mildly irritating, but may be an exhausting uphill battle for someone with different senses or neural pathways.

Maybe sometimes, before it gets to the point of needing to ask “R U OK?”, ask people “What do you need to feel more comfortable at work?” And remember that the answer will not be the same for everyone – and that really is okay. ??