Between diagnosis and belonging: navigating emotional bureaucracies in Indian autism care

This article examines how families in India experience autism care as an emotional bureaucracy rather than a coordinated service system. Based on practitionerresearcher reflections within a hospital-based autism centre, it traces the fragmented pathways of diagnosis, therapy access and institutional encounters where caregivers, most often mothers, must repeatedly demonstrate patience, gratitude and compliance to secure support. Inclusion emerges as contingent not on need alone but on how well families perform eligibility in clinical, bureaucratic and social settings. Class, caste, gender and language further shape these dynamics, privileging middle-class fluency and presentation while marginalizing others. Such conditionality produces what this paper calls “invisible exits,” as families quietly withdraw from services under the cumulative strain of exhaustion, financial pressures and emotional fatigue. By foregrounding absence, silence and attrition as forms of evidence, the article reframes belonging beyond access or enrolment. It argues for autism care systems that prioritize dignity, continuity and liveability rather than conditional inclusion.