Like most days at work, I’ve been hanging out on the autism hub reading; like very few days, I’m actually responding to something I read.

So, Sarah talked about self-diagnosis and the hate that seems to come with that word (or similar, like self-identifying or self-labelling). Some of what she said I found really meaningful, like:

I also know several people who have derived great personal benefits from self-identification. (Some have since been professionally diagnosed.) I am talking about people who have spent their entire lives wondering why they were different from other people, why they experienced certain difficulties. I am talking about people who have had all sorts of psychiatric diagnoses which didn’t fit, people who may have been institutionalized and spent years feeling depressed and suicidal. For many of them, self-identifying as autistic has provided significant help, self-esteem, and self-understanding.

Oh, hi, me. Yeah, I identify with that–becoming autistically obsessed with autism has given me some serious insight into how I work; it hasn’t fixed everything and made it sunshine and rainbows, but it’s at least given me a framework for my self-construction that I don’t have to patch up. I understand why I’m anxious, now. I understand why I don’t understand my friends, my family, even Kit, and why I get so frustrated. Parts of my childhood, like blind rages due to social and communicative frustrations that I could not get my head around that left others hurt (emotionally or otherwise), or how I’ve always felt most at home in print, or my lack of stranger-fear as a toddler, or even hyperlexia all fit into a sense of “this may not be normal for everyone, but it’s normal for me and these other people.” Self-identifying as autistic has helped me.

And if you’re thinking “well, those self-diagnosed people should just get a diagnosis,” then I’d point out that things really aren’t that simple for most people. Here are some common reasons why autistic people do not have official diagnoses:

1. Age. The current autism criteria did not come into being until the late 80s/early 90s, and awareness of the autism spectrum has lagged even further behind. The older an autistic person is, the more likely he/she is to be undiagnosed.

2. Money. I’m not as familiar with the countries outside of the U.S., but I do know that there are significant financial barriers to obtaining a professional evaluation and diagnosis. Insurance companies typically do not cover adult autism evaluations–and, of course, not all Americans are lucky enough to even have insurance. A comprehensive autism evaluation can cost as much as $2,000–if not even more. This is a significant expense for most people, let alone autistic people who may be unemployed or underemployed.

I know there are a lot of adults who would love to be evaluated for autism, but can’t for financial reasons. So to anyone who complains about self-diagnosis: Unless you’re willing to pay for every adult who wants an evaluation to receive one, you don’t have much room for criticism.

I’ve been struggling to get a professional diagnosis for about six months, now. I’ve outlined why I’d like it before, and if anyone really cares I could go into how I meet DSM criteria and all that crap. The first psychologist I saw was crap, and while my therapist absolutely agrees with me, she isn’t comfortable giving an “official” diagnosis due to her own training (she’s an LSCW and awesome, but I do understand her hesistation).

Unfortunately, my hope to get that taken care of ASAP is ruined by the part where I’m broke, broke, so broke. While the psychologist with whom I had been emailing has quite reasonable hourly fees, once you start to consider the testing to be done (an IQ test–hinky as they may be, I still feel sort of fond of them?–and at least one major autism inventory), plus an official write up, a reasonable hourly fee suddenly becomes “Fuck! Where am I going to get $700?” With no serious hope of reimbursement from my insurance, it’s unaffordable (see point 2 in the block quote above)–and this is an inexpensive clinician who happens to have an interest in autism, not someone trained specifically in such. I’m left frustrated and will probably ask my therapist to write me an official diagnosis either way, just so I have the paperwork for school for now.

Continuing with quoting a lot of text:

3. Professional ignorance. Professionals keep working to diagnoses autistic people at earlier and earlier ages–because we’re all doomed if we’re not diagnosed by the age of two, you know–but tend to know very little about evaluating adults. Indeed, there aren’t even any specific criteria for evaluating adults–a problem when many autistic adults learn to “pass” as neurotypical to varying degrees. And while consultation with parents or others who knew the autistic adult as a younger child can help provide corroborating evidence for a diagnosis, this isn’t always practical, for a variety of reasons. I know autistic adults–particularly women–who have had difficulties finding qualified professionals to evaluate them even in well-populated areas. How much worse might it be for autistics in sparsely populated areas?

4. Stereotypes. This is particularly an issue for women, but it’s certainly not limited to us. Talk to enough autistic adults and you’ll find tons of stories of professionals telling them they couldn’t be on the spectrum because…

-They’re female
-They can talk
-They have a job or have graduated college
-They are in a long-term relationship
-They have a friend–may sometimes be plural, but sometimes only singular
-They can make (or fake) eye contact
-They aren’t like this other autistic person known to the professional
-They are an adult! If they were really autistic, they would have been diagnosed as a kid.

The last one is particularly high on tautological “logic.”

These two really touch raw nerves for me. I live in a pretty rural area, though I’m within about 2 hours of two moderately sized metro areas (including the state capital) and within 4 for DC. Combine lack of knowledge of how adults–especially bright adults who have learned to fit in or else–present on the spectrum and especially ALL of point 4 (each and every one of those BUTS was used against me by the first psychologist), and I know personally how difficult this shit is.

And yet…

I also partly agree with some of the comments that disagree with her post (mostly because I think they aren’t speaking to the point of the post, which is institutional difficulties with obtaining a diagnosis as an adult). I think it’s disengenuous to ignore the theme of the post, but the comments also do make some valid points. For one, Stephanie Lynn Keil’s comment:

It’s hard for me to take self-diagnosed people seriously because I knew a few who self-diagnosed and when they went to the doctor to get the self-diagnosis confirmed they were told they didn’t have an ASD. So they just decided that they doctors were wrong and they were right.

Sorry, I can’t endorse this.

People don’t self-diagnose diabetes, cancer, schizophrenia, etc. If you self-diagnose yourself with diabetes and then your doctor tell you that you don’t have it you don’t go around telling everyone that your doctor is wrong and really do have it, do you?

At first glance, this seems pretty okay to me–she’s right, self-diagnosing medical issues is called hyperchondria and is not cool. Then I thought about it some more.

First of all, comparing diagnosis of autism (or any psychological abnormality) to diseases is NOT on–even if only for the fact that we can test reliably for things like diabetes or cancer, but we cannot for ASDs or most mental healh issues. This isn’t even to touch on the fact that comparing autism to a disease is insulting for anyone, self-diagnosed or not.

What she appears to assume is that all professionals are the same (ignoring points 3 and 4 of Sarah’s post, essentially). They aren’t. I chose to go to a psychologist who was accepted by my insurance. No other reason. I can’t afford to go outside of insurance (I could barely afford him as he was), so I didn’t have the luxury to choose a doctor with significant knowlege of autism. Additionally, it’s pretty easy to test for diabetes, but diagnosing autism is tricky in the first place and just gets harder the older the diagnosee is. There is no “Yep, you have it!” test like there is with diabetes, and the older someone undergoing evaluation is, the more likely they are to present as “normal”–kids who are more severely affected by their autism are diagnosed much younger, it’s easily visible in the average age of diagnosis gap between “autism” and “Asperger’s syndrome” (around 3 for autism, but 7 or 8 for Asperger’s). I understand and really appreciate that it can be hard to take people seriously, especially after they’ve been dismissed by a doctor, but it seems like a rejection of reality to dismiss them out of hand. Repeated doctors, perhaps? But having been told I was wrong (and given two inappropriate diagnoses that I don’t fit the criteria for–if he had been a good doctor, he’d at least have sent me away with nothing!), I can’t whole-heartedly support the belief that because a doctor said NO, it’s forever or even likely a NO.

I also liked part of the comment by Nightstorm (who makes a joke about Otherkin in the full comment, but seriously seems to be…nevermind):

Self-diagnosis has no social advantage, you can’t get governmental support SSI or any social help. So it becomes more of a personal thing which is fine. I see no problem with self-dxing as a place holder, but my big issue are the little rags who use it as a replacement for an actual diagnosis. No. It isn’t. There is no actual advantage to it. It just ends up being way for some people to fit in which for me is insulting. I didn’t pick this label, because I was lonely and I wanted a group to participate in. And the problem is, when people self-diagnosis and then act like douches, it does make us official diagnosed look bad. I can’t use the term “asperger autist’ or “has asperger syndrome” online because of the douches who abuse their label.

She’s right. There’s no social advantage to a self-diagnosis of Asperger’s…there’s really no advantage at all. It makes your friends think you’re sort of nuts (hi, Dilly!) and can cause rifts with your family. I have a hard time seeing a use for it except as the place-holder he describes, which is where I am now. On the internet, anyone can claim to have anything–anyone who has participated in a largish forum has known people to fake pregnancies, suicidal ideation, marriages, anything, whole lives. There’s no requirement for veracity. So a lot of people (hello, livejournal Asperger’s group) self-diagnosis without any real cause except that they heard it’s for socially awkward people and act like jerks and get the whole group misunderstood.

But…there are all those reasons that someone might not be able to get professionally diagnosed. I think there is an important distinction to be made between those who want an official diagnosis and those who do not (the former says, to me, that it’s not something trendy but real underlying issues, unlike the latter), and even the reasons why someone wants a diagnosis and how willing they are to accept hearing “no, sorry” (exhaustive research and education paired with self-understanding and need for supports is much more worthy than an excuse to be a jerk). I can’t dismiss all people who are self-diagnosed because I don’t know their reasons.

I’m no longer sure where I’m going with this, actually.

Edit: The awesome comments of awesomeness by Julian^Amorpha are totally worth checking out. They are too long to quote from, but involve a thorough dissection of privilege and minority group status that I feel really refutes the complaints Stephanie Lynn Weil and Nightstar both have (and that I partially sympathized with above).

I think my point is that getting a diagnosis is a fucking pain and even I, relatively privileged to be well educated, verbal, with a few friends, and a job, can’t afford it even though I desperately want it and believe it to be appropriate.

In lieu of a conclusion, I give you a kitten: