CW: psych shittery, persistent misgendering
So, I finally got back the report from my autism assessment process and I’m sharing some highlights here because I think it’s important to illustrate the extent to which many (most?) psych professionals wilfully misunderstand and misinterpret even the most explicit things that neurodivergent people tell them.
I sought out this assessment in order to be able to access accommodations and supports, so I don’t feel I have the ability to dispute the diagnostic labels they’ve applied because ultimately they’ve framed them in terms of my access to accommodations, which is what I asked for. However, it’s important to note this is also a common practice among psychiatric professionals, at least here in Ontario – a psych I saw previously said “you show signs of autism but that could also be social anxiety and obsessive compulsive disorder, and since we have more resources to treat those, it makes more sense to diagnose you with them.” (For the record, I have some close friends who are socially anxious – I know now that is absolutely, unequivocally not what I ‘have’.)
Also, while I am misgendered throughout (my pronouns are ‘they’) this is because I did not disclose my gender because that was so not an avenue of conversation I wanted to go down with them. This is still a huge problem, of course, but just wanted to note that. I did, however, disclose my asexuality.
So, here goes:
“She indicated that she is not currently involved in a romantic relationship, as she and her partner ended their relationship in 2011 after being together for four years. She stated that she is very rarely interested in people; however, while she indicated that she has the desire to fit in with others, she has now accepted that she prefers to be alone.”
What I said was that my last and only relationship ended in 2011, that I am on the asexual spectrum and very rarely become romantically or sexually interested in anyone, and that on the rare occasions that I am, my geographic isolation as a poor, unemployed, disabled person make romantic and sexual relationships impossible for me to pursue.
I also said that the neurotypical and neurotypically-focused therapist I saw briefly while doing my Master’s had misidentified my social challenges as social anxiety and when I had attempted to clarify that I do not feel anxious in social situations and that simply exposing myself to more of them to practice as she’d suggested was unlikely to address the specific problems I was having, that therapist replied, “well, you need to make a choice. Either you’re willing to put the work in to becoming more comfortable in social situations, or you need to be willing to accept the possibility of being alone forever.” I explained that, contrary to what she had probably been expecting, after evaluating the two options, I’d decided that if those were indeed my only options, I would prefer to remain alone, rather than exposing myself to uncomfortable and unrewarding social situations on an ongoing basis.
According to Ms. Haagaard, if she tries to “function
normally”, she will crash and can sleep for up to 16 hours, resulting in a 27-hour sleep cycle, rather
than a 24-hour cycle.
That’s literally backwards; I said that I seem to have a 27 hour sleep cycle, which results in me crashing when I attempt to function on a 24 hour cycle. I also said 16-20 hours, but sure ok.
She indicated that prior to her teenage years, she would “go into her shell”.
I definitely didn’t. I remember her using this phrase and asking me if that was what I did, and being confused by what it meant, and telling her that.
Alex’s verbal comprehension abilities, as measured by the Verbal
Comprehension Index (VCI), are in the Very Superior range and above those of 99% of her peers.
The VCI is designed to measure verbal reasoning and concept formation. Alex’s nonverbal
reasoning abilities, as measured by the Perceptual Reasoning Index (PRI) are in the High Average range and above those of approximately 88% of her peers. The PRI is designed to measure fluid
reasoning in the perceptual domain with tasks that assess nonverbal concept formation, visual
perception and organization, visual-motor coordination, learning, and the ability to separate figure
and ground in visual stimuli. Alex’s ability to sustain attention, concentrate, and exert mental
control, as measured by the Working Memory Index (WMI), is in the Superior range and she
performed better than approximately 96% of her peers in this area. Alex’s ability to processing
simple or routine visual material without making errors is in the Average range, as measured by the
Processing Speed Index (PSI). She performed better than approximately 42% of her peers in this
WITH THE CAVEAT that IQ tests are racist, ableist bullshit, can we take a second to note that I’m in the high 90s for verbal reasoning and working memory, the high 80s for perceptual reasoning (notably including “visual perception and organization”, “visual-motor coordination”, and “the ability to separate figure and ground in visual stimuli”), and…the 42% percentile for processing speed? That seems noteworthy.
and Communication, Alex used some words or phrases that tended to be more formal than that of most
individuals at the same level of expressive language, but this was not obviously odd.
…Because formal language is valuated in relation to racial and class biases. Also noteworthy – I mentioned to them that my propensity for formal language has been problematic in terms of others’ ability or willingness to recognise when I am in emotional or physical distress.
Reciprocal Social Interaction, Alex used poorly modulated eye contact to initiate, terminate or regulate
her social interactions. Alex showed responsiveness to most social contexts, but this was somewhat
limited or socially awkward. Alex’s score on the ADOS-2 interview does not meet the criteria for an
So. Literally on the basis of one standardised score, they asserted that they could not diagnose me with autism. In my follow-up interview, they told me that while I show “characteristics of autism” they overlap with depression and Giftedness, so it’s impossible to diagnose me with autism. They also asserted that my social difficulties were likely due to avoidant tendencies as a result of PTSD. When I told them that I very strongly disagreed with this, they said “well, that is the difficulty with standardised scores. They can misread things.” I replied that yes, this is exactly why I have a deep dislike for the widespread use of standardised criteria in psychiatry and medicine. And then they declined to diagnose me. One the basis of a single standardised score. (Also, don’t even get me fucking started on their apparent perception that you cannot be both Gifted and Autistic.)
Ms. Haagaard’s responses suggest a degree of somatic concerns in line with ruminative preoccupations
with physical functioning and health matters and severe impairment arising from somatic symptoms.
These somatic complaints are likely to be chronic and accompanied by fatigue and weakness that
renders Ms. Haagaard incapable of performing even minimal role expectations, including day-to-day
functioning. She views her health as being not as good as that of her age peers and likely believes that
her health problems are complex and difficult to treat successfully. She is likely to be continuously
concerned with her health status and physical problems, and social interactions and conversations tend
to focus on her health problems. In addition, her self-image may be largely influenced by a belief that
she is handicapped by her poor health. (emphasis mine)
a) No fucking shit.
b) I actually specifically noted that I do not believe I am ‘handicapped’ by my health but rather by the pervasive ableism and inaccessibility of Western industrial capitalist society, and tried to explain the social model of disability to them, but clearly that went in one ear and out the other.
Her social isolation and detachment may serve to decrease a
sense of discomfort that interpersonal contact fosters.
Uhh no. I did tell them this was high-key inaccurate.
Ms. Haagaard’s interpersonal style seems best
characterized as controlling and rather distant, and she likely views relationships more as an
opportunity than as a source of enjoyment. She may tend to be skeptical of close attachments and she will avoid commitment, perhaps viewing it as a sign of dependency or weakness.
(I mean, though…I snark, but believing this about myself because of what neurotypicals told me really fucked me up for a long, long time. I thought I was awful for not participating in normative relationships with normative people. Since finding my community among other freaks like myself, I’ve realised that I love very deeply and passionately and I will fucking cut a bitch who hurts or wilfully participates in the oppression of my chosen family.)
describes herself as having the tendency to closely monitor her environment for evidence that others
are attempting to harm her or discredit her and questions and mistrusts the motives of others around
Funny how living with abuse and also being a marginalised person will do that huh.
Dissociation (DIS), scale, Ms. Haagaard’s responses indicate dissociative symptomatology, such as
depersonalization, out-of-body experiences, and psychic numbing and the score falls in the Clinically
Significant range. (emphasis mine)
I. HAVE. NARCOLEPSY.
The Beck Anxiety Inventory (BAI) is a 21-question multiple-choice self-report inventory that is used
for measuring the severity of an individual’s anxiety. Ms. Haagaard’s current score of 31 places her in
the Severe range. Ms. Haagaard reported that moderate to severe concerns with numbness or tingling,
feeling hot, wobbliness in legs, fear of the worst happening, feeling dizzy or lightheaded, heart
pounding or racing, shakiness, feeling scared, indigestion or discomfort in abdomen, face flushed and
sweating (not due to heat). (emphasis mine)
I. HAVE. AUTONOMIC. DYSFUNCTION.
The Beck Depression Inventory (BDI) is a 21-question multiple-choice self-report inventory for
measuring the severity of depression in individuals aged 13 and over. Ms. Haagaard’s current score of
21 places her in the Moderate range. Ms. Haagaard reports moderate to severe concerns with
concentration, tiredness or fatigue, sleeping most of the day, loss of energy, sadness, pessimism,
feelings of past failure, and self-criticalness. (emphasis mine)
I. HAVE. NARCOLEPSY.
Though Ms. Haagaard’s reported sensory and social concerns indicated
above reflect those of Autism Spectrum Disorder, she does not meet the criteria for this diagnosis due
to the lack of repetitive behaviours and preoccupations.
Concerns expressed on the Trauma Symptom Inventory (TSI), and information provided by Alex
during the intake interview, fall in line with a diagnosis of Unspecified Trauma- and StressorRelated
Disorder (309.9), and she exhibits Cluster C personality traits (i.e. obsessive-compulsive). (emphasis mine)
Behavioural Therapy (DBT) approach may be most effective with a focus on emotion regulation,
distress tolerance, interpersonal connectedness, and mindfulness.
I specifically told them that I am never ever willing to try CBT again, and elucidated the reasons for this – reasons which also rule out DBT, or anything else involving the letters BT.
Alex may need encouragement to learn ways of handling social situations appropriately and
successfully without conflict.
Alex could be assisted by others who model socially appropriate behaviours, such as initiating a
conversation, maintaining appropriate eye contact, and body distancing during conversations.
No seriously, fuck you.
Tl;dr neurotypicals are really bad at psychiatry and also mainstream psych services are stunningly unequipped to respond to marginalised people living within contexts of oppression and also it’s absolute shit that we need to acquiesce to such an awful paradigm in order to have a chance at accessing supports and accommodations.
WTF. Reminds me of the quack who diagnosed my brother with ADHD. One of the highlights of that assessment – apparently showing evidence of the Stroop interference effect is a sign of ADHD.* And so is saying that toasters toast toast (“they toast bread, it’s not toast yet”).
* For anyone who doesn’t know this, an explanation: The Stroop interference effect is a tendency to be slower to respond to one dimension when contradictory information is given on another dimension, most commonly tested by asking people to name what color of text words are written in and comparing neutral items (“XXXX” written in various colors) or congruent items (“RED” written in red text) with incongruent items (“RED” written in blue text). Literally anyone who can automatically perceive the contradiction (ie, anyone who automatically reads text they see) will show an interference effect. This is something you learn about in 1st year psych courses in university, and often in high school psych classes, as a feature of neurotypical cognition.