Iris A. Croft uses poetry to untangle the relationship between neurodivergence, being articulate, and receiving care.
It is widely acknowledged that patients who struggle to communicate their experiences and needs can face additional barriers to accessing essential healthcare, including mental health care. Whether such challenges are rooted in insufficient support for individuals with communication disabilities (Morris, 2022), challenges such as the triple empathy problem (Carravallah et al., 2023), or diverse social communication abilities (Dall et al., 2022), these patients consistently face barriers to accessing adequate care.
The triple empathy problem builds on British sociologist Damian Milton’s double empathy problem, a theory used to describe the unique challenges of communication and empathy that can arise when autistic people and non-autistic people interact with each other (Milton, 2012). The triple empathy problem considers an additional dimension of communication and empathy challenges that can arise when an autistic patient interacts with a non-autistic healthcare professional and vice versa (see Carravallah et al. for a more detailed explanation).
However, much less attention has historically been placed on the challenges that can fall at the opposite end of this spectrum. There is a real but seemingly invisible barrier that some women and girls are facing when attempting to access care for mental health issues and neurodivergence. Women and girls can experience mental health issues and neurodivergence differently to men and boys (McLean, 2025). They can also present very differently when they enter clinical settings seeking to access care and treatment. There are many women and girls that are labelled as articulate, high-functioning and self-aware individuals who are also navigating the significant effects of mental health conditions and unsupported neurodiversity. This suffering can be severe and is not always packaged in a way that makes for neat presentation or fits within an often gender biased diagnostic precedent or guidelines.
Sadly, this has led to clinical barriers emerging as an obstacle to accessing appropriate treatment, too frequently resulting in misdiagnosis (Craddock, 2024), delayed diagnosis (Harmens et al., 2022), and impediments to accessing necessary treatments. Many women and girls face years of unintended but preventable harm, sometimes stemming from gender biases or lack of knowledge relating to diverse presentations. This is exacerbated further still when considering how intersecting identities such as race (Dela Cruz, 2023) or additional disabilities (Beketova, 2024) can negatively impact clinical biases. Years of further suffering can rack up for these individuals and inappropriate treatment plans can lead to further harm to mental health and wellbeing.
Articulate is a poem that explores the tension between the expected external presentation and the internal struggle of women navigating mental health and neurodivergence. It challenges clinical biases that assume articulate, self-aware, or high-achieving women and girls are less likely to experience severe distress. It also addresses how their ability to express themselves can surprisingly prevent their suffering from being taken seriously. The poem reflects the way these biases inadvertently create barriers to accessing essential care. It highlights how they can foster doubt, scepticism, and dismissal amongst clinicians and healthcare workers, which can ultimately lead to preventable harm. I hope this offers healthcare professionals, educators, and students cause for reflection, encourages critical thought and fosters greater trust in patient narratives, regardless of how “well” (or not) those experiences are presented.
Articulate
Articulate
An admired ability to express oneself
Thoughts, ideas, feelings, needs
Come pouring out of me
Wondrous, how so many assert this
And yet, don’t hear a single word I say
*
Self-aware
A desirable quality denoting self-evaluation
Interactions, reflections, expressions, words
Attentive and intuitive in ways that affect
And yet, still not trusted to perceive
Myself
*
High achieving
A demonstrated record of success from every angle
Grades, awards, recognition, acceptance
Capable and dedicated beyond the ordinary
And yet, a flicker of confusion clouding expressions
As the ground trembles around me under the weight
Of it all
*
Perfectionist
A refusal to accept any less than flawless
Precision, consistency, unattainable rigour
Fighting to keep up and stand out
Finding new limits to push beyond as I hold my breath
And yet, as the façade fractures behind closed doors
Written off to be universal
*
Articulate is fine until wielded like
Locked gates to the palace of treatment and care
As though convincing command of language
Is proof of a prototypical brain
Triggering scepticism that reeks from the mouth when the inevitable words come out
‘But you’re so articulate’
*
Grade A student until,
she isn’t
Adapting to this alarming reality she re-commits
Works the hardest, learns the fastest, stays the latest,
Not enough hours in the day? Not a problem
Because don’t you know there are also hours in the night?
*
Painfully self-aware paralysis
Driving inaction or perhaps
Overaction
Overexplaining, overanalysing and vivid memories that haunt with unexpected shame
The overdrive of self somehow evidencing impossibility
Of severity
*
Almost inevitable
*
Crisis
*
A time of intense difficulty or danger
Not gradual, but all at once
Heart pumping blood too quickly, inhale catching in my throat
Bowing pillars crumble as personal and professional collide
Containment no longer viable
*
Buried now,
beneath the rubble
Clinical arms reluctantly enfold, like handling an uncertain species, but also
As if they knew all along
Only this time, with both gifts and curses stripped away
The double silencing ensues, gagged twice over
*
In any case
An unreliable source
About the author
Iris A. Croft is a Master’s student studying International Law, Ethics and Politics and an emerging writer. Her poetry and creative writing explore the intersections of mental health, gendered experiences, institutional barriers and injustice. https://substack.com/@irisacroft; https://bsky.app/profile/irisacroft.bsky.social
References
Beketova, Z. 2024. “Ableism cited as major barrier to mental health care for people with disabilities.” Accessed: April 7, 2025. https://medicine.yale.edu/news-article/ableism-cited-as-major-barrier-to-mental-health-care-for-people-with-disabilities/
Carravallah, L., Chown, N., Doherty, M., Johnson, M., C., Neilson, S., O’Sullivan, J. and Shaw, S. 2023. ‘Barriers to healthcare and a ‘triple empathy problem’ may lead to adverse outcomes for autistic adults: A qualitative study’, Autism. 28 (7): 1746-1757. https://doi.org/10.1177/13623613231205629
Craddock, E. 2024. ‘Being a Woman Is 100% Significant to My Experiences of Attention Deficit Hyperactivity Disorder and Autism: Exploring the Gendered Implications of an Adulthood Combined Autism and Attention Deficit Hyperactivity Disorder Diagnosis’, Qualitative Health Research. 34 (14): 1442-1455. https://doi.org/10.1177/10497323241253412
Dall, M, Fellinger, J. and Holzinger, D. 2022. ‘The link between social communication and mental health from childhood to young adulthood: A systematic review’, Front Psychiatry. 13: 1-18. https://doi.org/10.3389/fpsyt.2022.944815
Dela Cruz, G. A., George, T. P., Kant, T., Sorkhou, M., Katz, J. L. and Sharif-Razi, M. “Mental Health Care for Women of Color: Risk Factors, Barriers, and Clinical Recommendations.” Accessed: April 8, 2025. https://www.psychiatrictimes.com/view/mental-health-care-for-women-of-color-risk-factors-barriers-and-clinical-recommendations
Harmens, M., Hobson, H. and Sedgewick, F. 2022. ‘Autistic women’s diagnostic experiences: Interactions with identity and impacts on well-being’, Womens Health (Lond). 18. https://doi.org/10.1177/17455057221137477
McLean. “Why We Need To Pay Attention to Women’s Mental Health.” Accessed: April 8, 2025. https://www.mcleanhospital.org/essential/why-we-need-pay-attention-womens-mental-health
Milton, D. E.M. 2012. “On the Ontological Status of Autism: The ‘Double Empathy Problem.’” Disability & Society, 27 (6): 883–87. https://doi-org.bham-ezproxy.idm.oclc.org/10.1080/09687599.2012.710008
Morris, M. A. 2022. ‘Striving Toward Equity in Health Care for People With Communication Disabilities’. Journal of Speech, Language, and Hearing Research. 65 (10): 3623-3632.https://pubs.asha.org/doi/10.1044/2022_JSLHR-22-00057?utm_source
