Thursday, July 13, 2017

Disentangling diagnosis.

Diagnosis is a difficult concept for the radical autist to deal with. It is so enmired in the medical model (which for people like me serves only to identify and remedy where possible broken bones and physical maladies) It has always seemed wrong to me that Doctors of Medicine (who are not even real “Doctors” in the sense that I am, Doctor being merely a conventional appellation, but I digress) that Physicians, should have such a powerful goal in gatekeeping those important definitions that have an impact both on selfhood and on social and legal “realities” in the world beyond that having nothing whatsoever to do with bed rest, medication and surgical intervention.

A lot of us talk not about diagnosis in our personal self constructs so much as about discovery. Diagnosis from the Greek means a learned opinion, discovery means the uncovering of something that was not known before, and usually discovery leads to  change in some way or another.
I am not sure Martijn Dekker agrees with some of the things he wrote about many years ago when I was on that discovery path of exploration but they meant something to me then, so I keep the ideas alive. The ideal was of peer validated diagnosis. In common speech you might put it as “it takes one to know one” or you might see it as the Autistic analogue of Gaydar. (Which incidentally I wrote about in my Thesis) for to me the diagnosis wasn’t enough, I wanted to know other people like me and to see if we really did have anything in common beyond the label, and I think we do.

However from the realm of ideal societies and utopias to what can really change, there is certainly a clear and present problem that is being exacerbated by Austerity.

A recent quick survey of the news revealed these two articles. .

Those concern children, but believe you me, the failure to discover the inner autistic is going to have a major impact on that childs education and everything that follows after that.

For adults it is no better, there is a movement, not a new one alas, but increasingly justified by the bean counters that there is no point in referring adults for diagnosis when there are no services available for them. You could say it is a total dereliction of duty, given that the NHS at the moment whether or not they are the right or wrong people to administer the diagnostic process because they are at present the de facto gatekeepers.

What I am ultimately coming to is the change I would like to see, and the change I would hope I can influence in some small way, and that is the demedicalisation of diagnosis that is actually possible within the current constraints of our society, without having to evoke those revolutionary changes towards the ideal world, where like in William Morrises Nowhere it never rains.

I think at the very least that Autism is within the capability of a decently trained psychologist to evaluate, indeed at a practical level you don’t even need that prior qualification (other than as a socially constructed gateway) to train in the current diagnostic schedules, lay people could easily do it.

Dyslexia and other specific learning difficulties (to use the conventional terminology whether I approve of it or not) have long been the domain of suitably qualified education psychologists to evaluate, Autism isn’t any more complex, and if you say it is, well you know if you identify in the course of the process something that needs another specialty then of course you refer to it, just like an optometrist who comes across glaucoma or macular degeneration in their practice.

I am writing this because of what I know about processes going on in the NAS at the moment, and I want to be both a catalyst and a part of this change. I am hoping if I am given the cold shoulder, that you will all be behind me when I come back from the ropes for another round of boxing.

Watch this space folks, Dr Larry is back in the blogging business.

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