Double Slits, Double Binds

“I think I am autistic.” How could an analyst respond to this sort of statement from a patient? On the one hand, analysis is a practice of critical reflection on any statement a person might make about themselves. An analyst might consider: “why are they saying this to me now?” On the other hand, the analyst may feel discomfort or a lack of familiarity with what it means to be autistic. And while an analyst does well to respect the patient's statement, they would be remiss not to consider the context in which it is said.

Assessing adults to determine whether an autism diagnosis is indicated is a fraught process. Assessment is a less common intervention than therapy—less familiar to the public. It is also a costly process that carries all of the barriers endemic to mental health in the United States. The assessment of autism has also largely focused on assessing children. There are clearer processes for assessing autism in children than in adolescents and adults. Autism assessment is also a specialized skill and there just are not sufficient providers to respond to the patient's statement that opened this paper. And if they could, the patient may be part of one or more groups that may be under identified in autism assessment practices. For so many reasons, an assessment may not reflect the truth of the patient.

Enter self-diagnosis. Self-diagnosis generally refers to the practice of identifying with the diagnosis of autism or, more broadly, the experiences of autistic people. Sensory sensitivity, differences in social communication, executive functioning challenges, deep interests, and a need for the familiar and predictable are the experiences that bridge self and clinical diagnosis of autism. Autism is a disabling condition—whether one locates this in the autistic individual or adopts a social model of disability that attends to the ways society is built in ways that limit or devalue autistic functioning. The functional impairments an autistic person experiences may