Benjamin Nugent believes he had Asperger’s Syndrome (a milder form of austim).
Who made this diagnosis? His mom.
His mom was so convinced that her then 17-year-old teenage son had this disorder, she put in him in an educational video about Asperger’s. Asperger’s is usually diagnosed in childhood or as a young teenager, and is characterized by a severe degree of social impairment, isolation, and what others might see as eccentric behavior.
While I commend Mr. Nugent for sharing his story with the world, I have to really question his understanding of how mental disorders are diagnosed by mental health clinicians.
Here’s his story…
Benjamin Nugent appeared in an educational video about Asperger’s, created by his mom, apparently an expert in Asperger’s:
The film was a research project directed by my mother, a psychology professor and Asperger specialist, and another expert in her department. It presents me as a young man living a full, meaningful life, despite his mental abnormality. […]
Both my mother and her colleague believed I met the diagnostic criteria laid out in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.
First of all, it’s highly unethical to go around diagnosing your family members — much less your children. Any first-year graduate student knows this.
Nugent was apparently only “diagnosed” by these two academicians — his mom and his mom’s colleague working alongside her in her own department.
I don’t care if your mom was the equivalent of Einstein in Asperger’s research — it’s just not ethical for a mental health clinician to diagnose someone they know (at least not in any official capacity). It’s also not very ethical for researchers or academicians to make clinical judgments about people they know.
That’s what licensed clinical psychologists do. I wonder if Nugent ever saw one of those?
You also can self-diagnose according to the DSM criteria as much as you’d like. But such self-diagnosis is also not valid or equivalent to a clinical diagnosis from a mental health professional.
I’m sorry to be the bringer of bad news, but the only person who could objectively diagnose Nugent — a mental health clinician — never did (at least according to the limited information he provided in his blog entry).
Mental disorder diagnoses are not simple things. An experienced clinician brings all of their wisdom and years of seeing similar children and young adults into play when deciding whether a mental disorder diagnosis is appropriate. So while you can indeed screen yourself to see if it’s something that you should go see a professional about (for instance, using one of our screening quizzes), it’s not something you can do to yourself — or your family members — with any degree of accuracy or objectivity.
Asperger’s, like most mental disorders, must also cause significant distress and impairment in at least one area of your life. In other words, YOU have to actually feel like this is a serious problem. If you are you, and you’re okay with whatever “you” is, it is virtually never appropriate to diagnose a mental disorder (there are some exceptions to this, but for most people, it’s the general rule).
So while I’m sorry to hear of Nugent’s young adult Asperger’s diagnosis — and I agree, such diagnoses should be made more conservatively — I think this story best illustrates the dangers of unqualified (or biased) professionals making mental disorder diagnoses. If your mom or dad thinks you might have a problem, go see a clinician who is experienced and a specialist in the area of your concern.
I would include most family physicians and general practitioners in this category of professionals who shouldn’t be diagnosing mental disorders as well — the folks responsible for prescribing the majority of anti-depressants in the U.S.
The best person to get a mental health diagnosis from? A qualified mental health professional, preferably a psychiatrist or psychologist.
Learn more about Asperger’s Syndrome.
Read the full blog entry: I Had Asperger Syndrome. Briefly.
9 comments
John,
You make a bunch of valid point here. Some may not be so obvious. So here is a question that might highlight them. Why can’t a family member diagnose a mental illness? If parent is a doctor, they can sure diagnose a broken arm, skin rashes, read X-rays, or listen for a heart murmur. So why not diagnose depression? The answer to me would be something complex to grasp. While our physical bodies are ours and ours alone, our psyche and resulting behavior is shared with our friends and family members.
You also point out, “you can’t self diagnose accurately.” Yet, when it comes to mental health, isn’t that exactly what we are forcing people to do as a result of HIPAA and doctor/ patient confidents. The P.I. on every SSRI says to “remain in contact with patients family and caregiver to observe for any changes in behavior.†(think manic. Cause a patient will tell you if they feel more depressed most of the time. But a manic incident will never be reported by the patient.) If you had asked Andrea Yates to diagnose herself on the day before she took her 5 children’s lives, she would not have reported dysfunctional thinking. Her husband did, and he was rejected as “over reactingâ€.
Last, this shows the impact a parent can have on the psyche of a child, even at the age of 17. If child’s life is spent with your parent telling her that she is “worthless”, “bad”, “crazy”,
“uncontrollable”, or “stupid” guess what it most likely that you will turn out to be. If they don’t say it to the child, but think it, and act accordingly towards you, the result will be the same. This woman probably decided that she would have a child with Asperger’s subconsciously 17 years before that diagnosis. She molded and influenced him until he actually demonstrated signs of it. Parents are making dysfunctional children in this manor all the time.
I made some absolute statements for the sake of efficiency and simplicity, but I agree, the issues here are a bit more complex.
When I said family members can’t diagnose one another, I didn’t mean it couldn’t be done informally — as it is done informally all the time. The line one can cross is moving from a “I think you might have depression” to “I think you might have depression, so let’s diagnose you as such and put you in a video about it.” I would find it tremendously difficult to believe Nugent wasn’t seen by a clinical professional for treatment, but he makes no mention of it.
So while sure, a doc who is also a dad or mom can say, “Hey, that looks like a broken arm” and take you to the ER to have it looked at, the doc there isn’t just going to take the dad or mom’s word for it. They’re going to assess and make their own clinical judgment in the end, independent of what the family member thinks. This is also true in the mental health field. (The analogy doesn’t hold up as well for complex medical problems, since most times they aren’t diagnosed until lab tests come back and the doc has more information…)
I’m not sure I follow the point about self-diagnosis you’re trying to make and would appreciate any clarification you might have… People can and do self-diagnose all the time, of course, but my point was that it wasn’t going to be always accurate (nor should it be relied on as the same as an actual diagnosis by a mental health professional).
Last, I agree, one good takeaway from Nugent’s story is that labels are a very powerful thing and parents have a lot of influence over the upbringing of their children. The last thing a parent should ever look to do is to label their child with anything before trying out all the alternatives.
John,
Thanks for the response. That is exactly my point. The comment about the “self diagnosis” is a slant at the issue that haunts me daily. That is how we ask patients who start treatment plans to tell the doctor when they are mentally and emotionally fictional. This understanding that a therapist can not always trust a patient to report when they are acting dysfunctional is really big. I wish that could be explained and let to sink in to every doctor who has put a pen to paper in order to relive somebody’s depression. Asking a person if they are experiencing a manic episode is like asking a drunk if he is “ok to drive?” The most important thing I have learned in my quest for answers is that I don’t know me as well as I think I do and must trust outside perspective to keep myself in check and the picture of myself whole.
Thanks again for you time and consideration.
As a parent I almost find it offensive that you feel we are not qualified to make a diagnosis on our children…I would say many of us are even more qualified than many clinicians, we are just not licensed to do it. Over the coarse of the past 20 years and with having 2 children with autism, 1 with aspergers, and another with bi-polar I have been involved with a multitude of said clinicians and rarely can even 2 of then agree with even a diagnosis. My oldest autistic child received 4 different diagnosis’s in a matter of 3 months.
1) AD/HD
2) Autism
3) PDD-NOS
4)cured of Autism with just language based LD and OT/PT deficits.
Thank goodness I to know how to read and was able to obtain a copy of the then DSM III-R
My child was Autistic.
Then when the second child with Autism came along I didn’t want to jump to conclusions and push a diagnosis onto her so I sat back and let the “experts” do their job. Yet I knew what I was seeing even when the first clinician told me she had an IQ of no more than 52. I found it hard to believe that a child with an IQ that low would be capable of some of the mental skills that she displayed and so I went to another clinician that gave her the diagnosis of Autism. It was only after we started her on therapies designed for Autistic children that the first clinician was willing to admit, that in the explosive meeting we had both attended where I challenged his qualifications to make such a diagnosis, was he willing to say that I was right…By the way he also has never admitted he was wrong.
The fact is clinicians have a tendency to diagnosis the things that they see most often and really should not be held as experts in all mental health diagnostics…The DSM is a really big book to have 100% memorized especially when it keeps changing.
Fire,
I am not sure how to approach this. It is going to sound, and probably is offensive. But, I feel the need to point out the obvious because we are as a race loosing touch with reality because people are afraid to say the “emperor has no cloths.”
Here are some things you might not know. To date Autism (like many other personality disorders such as bipolar, BPD, OCD, and depression) has not been tied with the results of scientific method to anything genetic. Restated there is no, “if this gene exist, then autism exist.” As stated by the NIH, “Scientists aren’t certain about what causes ASD, but it’s likely that both genetics and environment play a role.” The “scientists believe” is important here. Many studies are being produced to show that environmental factors (external influences from chemical to parental/ emotional interaction) are more profound then once thought. Too often scientist look at family members who not only share genetics but environmental factors and boldly make the statement that “genetics must be a factor.†Even when suspicious genes exist, for the personality disorder to come to fruition, environmental factors are also suspected.
A parent who has one child diagnosed with a disorder or syndrome, can make it worse by worrying about it so much in the second it the fear becomes the prophesy. Freud called this “Projection” or a defense mechanism that involves taking our own unacceptable qualities or feelings and ascribing them to other people. Projection works by allowing the expression of the desire or impulse, but in a way that the ego cannot recognize, therefore reducing anxiety.”
I wasn’t certain by your post whether you had 4 children with different personality complexes or 2 with very complex personality diagnosis. If genetic, both situations would be the result of nearly insurmountable odds. I have also learned that doctors in this country will give you any diagnosis you want if you hound them enough. Especially if there is a parent in their face screaming that they want their child to have a problem. The subconscious is a powerful thing. Freud said and it is generally accepted today that 80% of our personality is driven by things we are not ware of. Parents are too connected to the things that shape their children’s subconscious to make a healthy functional judgment about their personalities. Truth be told, one can get a better understanding of what is driving a child’s subconscious by observing their parents, then observing the child. Thus the cliché psychological question, “how was your relationship with your parents†in nearly every intake interview.
I have diagnosed every malady and condition my kids have experienced. From ear infections to Autism, it was me. Sure I took them to the doctors and specialists, but, they only confirmed my diagnosis. I brought concerns and related symptoms – what I thought was going on in my mind was then confirmed by the specialists. So I think more credit for his mother and all mothers is due. Sure some Moms don’t have the capacity to be discriminating or the intelligence but some do. It would be good to remember too that early Autism diagnosis relies heavily on parental observation and input. Particularly considering none of the experts can agree … I think invested, thinking, focused parents deserve more credit. It took me three years to find a helpful doctor to assist us. In those three years I alone helped my kid grow and develop into a communicating, loving, interacting, toilet trained if still quite quirky and sensitive and fixated … Kid.
the closest situation I’ve come to what is describe din this article – and one that I still wonder about – is a friend’s mother, who is a psychiatrist, who diagnosed herself with depression and wrote herself a prescription for anti-depressants.
Are there no professional rules about this? Wouldn’t the pharmacist look at the names and say – wait a minute?
I think mental health should be a special case. I fully understand that with GPs in remote locations, there may only be one, so they certainly treat themselves and their families, but I don’t have faith that anyone should be writing their own psych prescriptions.
I have an 18 year old son that seemingly fell through the cracks in many respects growing up. I always knew something was wrong, but I did not understand what. I knew nothing about Asperger’s syndrome, therefore his inability to tie his shoes, throw a ball, run, speak clearly at an appropriate age, or write legibly were put on the back burner because he walked very early, read his first book at 3 and could entertain himself for hours at a time. He could memorize each character’s lines in movies after watching only a couple of times. Jake lacked social skills and seemed to need my protection from boisterous kids in playgrounds. He did not try to join them. I attributed it to his being shy and isolated…He did not have relatives his age. I had no comparison to gauge his behavior by. Along the way, I had radical changes in my moods. It wasn’t until I was past 40 that I was diagnosed with bipolar disorder. When Jake was 16 his friend (one of only 2) told him she saw a movie called “Adam” that reminded her of him a little. I saw the movie, and although Jake’s symptoms are milder, it prompted me to look into it further. I was surprised to see that he had approximately 90% of the possible symptoms. His strengths are with language-he wrote complex stories when he was only 9 years old, and has continued to excel in that subject. He has terrible math skills, however, and has failed algebra 4 years in a row. He will likely not graduate because of this one subject.
To get to the point, I took him to get an evaluation when he was 16–and the counselor tentatively diagnosed him with high functioning autism. Once he heard that he became enraged and refused to hear the word or admit there was anything wrong with him ever since. As a single mom with issues of my own I am in desperate need of help. I am on social security disability and have no insurance for him. Jake can’t live on his own. He has many nights of insomnia. He won’t answer the door, keeps all the blinds drawn, cannot touch anything remotely hot, won’t go near the stove, and can’t follow through on anything. I worry all the time. He will have no one once I am gone. What will become of him? No one talks about how one falls through the cracks as a child, and worse, how they can exist without the only person who took care of them since birth. I can’t exhale, if you know what I mean. Does anyone have any words of wisdom for me? Is there any where I can go? Anyone, please help.
Gail,
i have recently been looking into aspergers after my stepson was diagnosed with high functioning autism. I myself have always been different than most people that i have met or have worked with. I have taken a few different online aspergers tests and scored pretty high on each of them. I am looking to talk with anyone that may be going through in life what I am. I am a head manager of a restaurant with 30 employees. I have a very very hard time getting to know people or even really caring about people in general. Over the last few months i have had my eyes and ears really open to how i treat people. Even though i would like to change… i just cannot seem to find a way to do it. I am hoping that talking with others may help me. I know that your son doesnt want to hear that he may be different than others but Im sure he probably already knows it. pass along my email if you like. Zach