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The Sinuous Roads of Diagnosis
Lizbeth Ahumada Yanet*
In recent interviews[1], psychologist Uta Frith expressed with a sense of disappointment that she no longer believes in the diagnosis of autism spectrum disorder that she herself helped forge, sparking a discussion that transcends the clinical realm and permeates the cultural movements of our current era. In this regard, at 84 years old, she warns that the concept of the “spectrum” has broadened to the point that it may have lost its clinical value. The phenomenon of an exponential growth in late autism spectrum diagnoses—often stemming from self-perception, especially among adolescents and adults—is what concerns and alarms Frith.
Let us focus now on the concerns Frith raises, which reveal despair over the loss of scientific authority and a feeling of helplessness regarding the devaluation of scientific knowledge, research, and findings as they enter the public domain. Tension arises between the truth dictated by science and the truth proclaimed by those claiming the right to name themselves and actively participate in matters concerning their own needs and requirements. A winner and a loser emerge based on who holds the agency to nominate a subjective reality. It boils down to something like: Who speaks the truth about my being—science or myself?
Consequently, despite the evidence backing Frith’s statements, we must try to specify where the autistic subject stands after the accumulation of sayings from shifting cultural movements that promote a resolute activism. Because that is what this is: activism resulting from the push toward fraternity based on turning a proper name into a common noun. It´s a clear illustration of what Jacques-Alain Miller has called the “depathologization of the clinic”: “It is up to us to align our practice with the rhythm of this new era, without nostalgia, without bitterness, without a spirit of revenge”[2]—which seems like good advice for Uta Frith.
The diagnostic concept of autism spectrum disorder inherently carries the decision not to yield to a common cause, yet it dilutes autism within the imprecise gradation of subsets of symptoms and behaviors. We then have autistic associations forming in numerous different countries across both Europe and the Americas. They are fundamentally characterized by the act of announcing that one self-identifies as autistic; this constitutes the admission requirement: being autistic. What seems clear, however, is that self-proclaiming as autistic does not solve the enigma of the impossible bond with others; it does, nevertheless—and this is no small thing—give meaning to the experience of inadequacy with the world. In this context, whether such self-perception aligns with a clinical diagnosis does not seem to be the essential issue.
Autistic associations make their voices heard on the stage of the enactment of laws and the pursuit of rights. Good for them! At the same time, they fight a new battle with State-authorized healthcare and social protection institutions responsible for establishing diagnoses and treatments. It can be framed this way: state health organizations adjust their own evaluation protocols, but what happens when a diagnosis comes to be established as an identity? How can such a diagnosis be made operational to obtain the benefits the State ought to provide? Indeed, these are the terms such a diaagnosis which opposing forces currently clash.
A Colombian autistic association reached out to me to ask what help psychoanalysis can offer to those who lack the means required for admission into the Association (effective language skills, a more or well-defined life project, etc.). That is, they testify to the fact that the group serves specific purposes in order to claim a way of being in the world and fight battles that emerge within trench; but, to approach a knowledge of how each subject lives their autistic condition, and how they defend themselves from the torment of their being, is something that is not in their hands. And it is there that the possibility of a modest and decisive encounter opens up, which values the singular conquests; and it is in the Lacanian orientation that we find the conditions for this to happen.
[1] The 22 September edition of the Argentine newspaper CLARIN INTERNACIONAL collects interviews from media such as The Times and The Telegraph. Cfr: http://www.clarin.com/internacional/giro-historicoautismo
[2] Miller, J.-A. Everyone is crazy. In: Revista Lacaniana de Psicoanálisis No. 32. Publication of the School of Lacanian Orientation. Ed. Grama. Buenos Aires, December 2022. Page 16.
In recent interviews[1], psychologist Uta Frith expressed with a sense of disappointment that she no longer believes in the diagnosis of autism spectrum disorder that she herself helped forge, sparking a discussion that transcends the clinical realm and permeates the cultural movements of our current era. In this regard, at 84 years old, she warns that the concept of the “spectrum” has broadened to the point that it may have lost its clinical value. The phenomenon of an exponential growth in late autism spectrum diagnoses—often stemming from self-perception, especially among adolescents and adults—is what concerns and alarms Frith.
Let us focus now on the concerns Frith raises, which reveal despair over the loss of scientific authority and a feeling of helplessness regarding the devaluation of scientific knowledge, research, and findings as they enter the public domain. Tension arises between the truth dictated by science and the truth proclaimed by those claiming the right to name themselves and actively participate in matters concerning their own needs and requirements. A winner and a loser emerge based on who holds the agency to nominate a subjective reality. It boils down to something like: Who speaks the truth about my being—science or myself?
Consequently, despite the evidence backing Frith’s statements, we must try to specify where the autistic subject stands after the accumulation of sayings from shifting cultural movements that promote a resolute activism. Because that is what this is: activism resulting from the push toward fraternity based on turning a proper name into a common noun. It´s a clear illustration of what Jacques-Alain Miller has called the “depathologization of the clinic”: “It is up to us to align our practice with the rhythm of this new era, without nostalgia, without bitterness, without a spirit of revenge”[2]—which seems like good advice for Uta Frith.
The diagnostic concept of autism spectrum disorder inherently carries the decision not to yield to a common cause, yet it dilutes autism within the imprecise gradation of subsets of symptoms and behaviors. We then have autistic associations forming in numerous different countries across both Europe and the Americas. They are fundamentally characterized by the act of announcing that one self-identifies as autistic; this constitutes the admission requirement: being autistic. What seems clear, however, is that self-proclaiming as autistic does not solve the enigma of the impossible bond with others; it does, nevertheless—and this is no small thing—give meaning to the experience of inadequacy with the world. In this context, whether such self-perception aligns with a clinical diagnosis does not seem to be the essential issue.
Autistic associations make their voices heard on the stage of the enactment of laws and the pursuit of rights. Good for them! At the same time, they fight a new battle with State-authorized healthcare and social protection institutions responsible for establishing diagnoses and treatments. It can be framed this way: state health organizations adjust their own evaluation protocols, but what happens when a diagnosis comes to be established as an identity? How can such a diagnosis be made operational to obtain the benefits the State ought to provide? Indeed, these are the terms such a diaagnosis which opposing forces currently clash.
A Colombian autistic association reached out to me to ask what help psychoanalysis can offer to those who lack the means required for admission into the Association (effective language skills, a more or well-defined life project, etc.). That is, they testify to the fact that the group serves specific purposes in order to claim a way of being in the world and fight battles that emerge within trench; but, to approach a knowledge of how each subject lives their autistic condition, and how they defend themselves from the torment of their being, is something that is not in their hands. And it is there that the possibility of a modest and decisive encounter opens up, which values the singular conquests; and it is in the Lacanian orientation that we find the conditions for this to happen.
[1] The 22 September edition of the Argentine newspaper CLARIN INTERNACIONAL collects interviews from media such as The Times and The Telegraph. Cfr: http://www.clarin.com/internacional/giro-historicoautismo
[2] Miller, J.-A. Everyone is crazy. In: Revista Lacaniana de Psicoanálisis No. 32. Publication of the School of Lacanian Orientation. Ed. Grama. Buenos Aires, December 2022. Page 16.
