Autism thoughts from the top of my head after reading the first few chapters of “Cracked” by James Davies – because critical psychiatry has become a special interest this year when my mental health has allowed the energy to read about it. I guess my head will be back to another of its obsessions by lunch time!
According to the criteria of DSM-III (a previous edition of the diagnostic and statistical manual, almost a Bible of psychiatry, published in 1980) I do not have autism.
According to the criteria of DSM-IV, released in 1994, I do not “have full-blown autism but” have “considerable problems with autistic-like symptoms” and thus have Asperger’s. (The quote is from Dr Allen Frances who led the team that produced DSM-IV. Aspergers was included for people like me who, in his words, don’t have full-blown autism.)
Dr Frances says that Asperger’s was added not as a type or sub-type of autism but as something that was autism-like without being autism. Most people now say it’s a type of autism, autism existing as a spectrum that includes Asperger’s. Definitions change. I often wonder though whether I really have the same condition that some of the severely affected people I’ve met have. We’re pretty different. Is it really right to place us with exactly the same diagnosis? Current wisdom says yes.
According to the criteria of DSM-V, released in 2013, I do not have Asperger’s because it’s no longer a diagnosis. I now have autism. The definition of autism has been expanded to include Asperger’s. (DSM contains known issues and was released early, without sorting them or adequately responding to critiques of drafts, because the American Psychiatric Association needed the cash – at least according to Robert Spitzer, head of the team that produced DSM-III when discussing problems with all the editions.)
The autism rate rose by twenty times in fifteen years. Many call it an epidemic. But is the rise due to a change in people or a change in a book? Are the people included under DSM-V any more common than they were. We’re more recognised and diagnosed but are we more common?
What rise would be seen, if any, under the criteria of DSM-III, covering those people who now get called severely autistic or low-functioning? (both imperfect terms)
I could be said to be part of that so-called epidemic. As a child I wasn’t autistic, because definitions said I wasn’t, and now I am because definitions changed. I am part of that dramatic rise in diagnostic rates. But I didn’t change. If the child I was existed now she would be diagnosed as autistic. She might also be diagnosed with various comorbidities that wouldn’t have been given to her in the 1970s and 80s.
So am I autistic? (What is autism anyway? A question that could be asked of diagnostic criteria for many conditions in DSM.)
Well that depends on whether the definition is broad enough to include me.
As much as diagnosis allowed me to understand some facets of myself it’s a question that worries me less and less.
I think the diagnosis became too important to me and for a while I boxed myself in with it, even acquiring some extra autistic traits for my collection, absorbing them by osmosis from a list which is something all of us are prone to do to some extent. Unboxing myself and working out which traits were there all along, openly or repressed, and which weren’t ever me has been a job and a half. I know for a fact though that I became more autistic by reading lots of books about autism. I’ve seen others behave in similar ways, quite unconsciously. People who could do something learn about the autism they have and suddenly they can’t do it anymore. In theory a diagnosis should change nothing about a person’s capabilities. In practice it quite often does. But talking about that very normal human way of being and suggestion is controversial and can bring damnation upon me from parts of the autism community. I’ve seen the same in various mental health spheres. I’ve seen people who already have substantial difficulties becoming more “borderline” after learning about BPD. I started to fall into that trap too last year which was horrible. It’s easy for anyone to live out a diagnosis much more fully than they ever would if they had never heard of that diagnosis. It’s easy to make diagnosis into identity – especially so with autism which we say is an important part of identity in the first place.
I am now less autistic than I was a year ago. Also less depressive. Less borderline. Less schizophrenic. Less lots of things. Far more accepting of the person who exists without any of those diagnostic labels and has triumphs but also massive psychological struggles. And while I’m currently mid-assessment for dissociative disorders I’m actually less dissociative than I was too. That may be an odd thing to say while producing art for the first time, signed by some kind of dissociative alter/personality in my head. Self acceptance means that any autistic traits I now have are the ones I’d have if I’d never read a single book or article on the subject. Regarding autism, I’m still autistic but I’m back to being me. Hoorah!
Certainly I ace the current criteria and get spotted by other autistic people in no time at all. Without a doubt, under DSM-V I am autistic. Under all diagnostic criteria currently used in the UK I’m autistic too which is why my personal diagnostic process was so quick. It consisted of one session. It was a lot shorter than they said it would be because I was pretty damn obvious! I do merit the current diagnosis and autistic traits have and do cause me difficulties.
I wonder what DSM-VI will say. I wonder that while at the same time having very little respect for DSM or for the organisation that produces is.
I wonder how many of the real and dangerous problems of the previous editions – in regard to many conditions and the often unsubstantiated assumptions and working methods that have been essential to the production of each edition – it will carry forward.
Some people in the field of critical autism studies go so far as to claim that by the end of this century there will officially be no autistic people at all. Because the entire category of diagnosis of autism will no longer exist. Perhaps other diagnoses will fall by the wayside too.
That won’t cure an unreal epidemic. It won’t change anyone. Autistic (ex-autistic!) people will still be exactly who they already were. It’ll just be another rewriting of the books.