I have a lovely psychiatrist who sadly passed away last year. I have an extensive history of accessing mental health care and have come across my fair share of arrogant medicos. So the first time I saw this psychiatrist I posed a question. This is about as tricky as I get – and probably isn’t very tricky anyway as I tend to operate on only one level…but here is what I did. I said to my new psychiatrist that as I was paying for his services he was my employee. I told him that if he didn’t live up to my expectations I would withdraw my payment and employ another psychiatrist. After saying this I asked him what he thought. The tricky bit fo this was that I was more interested in how he responded to the question than what his answer was. He passed the test and I saw him as a patient for the next five years.
Clinicians can be a big problem for autistic folks. Often they have a fair whack of arrogance and don’t listen to what we or our allies and carers say. Sometimes they are ignorant about autism and refuse to listen to anyone trying to educate them. Sometimes they take a ‘one size fits all’ approach to autism which is highly unhelpful and doesn’t support anyone really.
One of the biggest issues around clinicians and autism is accurate diagnosis. A huge number of autistic people get a misdiagnosis. Some of them don’t even realise they are autistic so go along with the wrong diagnostic ‘label’ Others know they are autistic so find its dismissal and their misdiagnosis to be highly invalidating and often traumatic. What is the issue with misdiagnosis? Well for one thing a diagnosis determines what treatments and supports a person receives. Wrong diagnosis = wrong treatment and supports. And when we talk about autism and other neurodivergences there can be a big identity consideration too. Being neurodivergent is often a core part of a person’s identity and how they view and understand themselves. So giving someone the wrong diagnosis will most likely mean they get inappropriate and unhelpful treatment and that they struggle with their sense of identity.
I have a Yennski story about misdiagnosis. I was diagnosed with autism in 1994 when I was 20 and then I was diagnosed with schizophrenia a year later. These are my current diagnoses – alongside ADHD and generalised anxiety disorder. Every competent psychiatrist I have met has given me a similar diagnosis – autism and schizophrenia or some other kind of psychosis. Sadly not all psychiatrists are helpful. I found myself in hospital in 1996. I was living with my parents at the time. They told my hospital psychiatrist that I was autistic and have schizophrenia. This doctor would have won the award for patronising and arrogant. He refused to listen to my parents mostly I think because my autism diagnosis had come from a young female clinical physiologist and this doctor was quite misogynist. He diagnosed my with borderline personality disorder. In fact he appeared to have diagnosed all the female-presenting patients in the hospital with borderline personality disorder. He said my self-destructive behaviour was ‘for attention’ and other very unhelpful things of a similar nature. I used to think of it as the diagnosis male doctors give to women they perceive as histrionic! Thos doctor haunted me. He kept popping up unexpectedly and telling me and the other workers that I wasn’t autistic. It was awful.
The last time I saw this psychiatrist was at a local area mental health clinic where he was the chief doctor. He was adamant that I wasn’t autistic so I went private. I saw a doctor who specialised in autism and adults. He said to me that if the psychologist who diagnosed me had given me an autism diagnosis then I was definitely autistic as she was such a proficient autism clinician and expert. It was very affirming and nice to meet a doctor who I could actually work with.
It is important to foster and promote a collaborative relationship with any clinicians you are seeing. They are your employee or – if they are publicly funded too – you are the person accessing the service so they should be on your side and trying to help. I always liken a clinician who is unhelpful as being like a plumber you have hired to fix a leak and instead they smash your toilet. You really don’t want to have the metaphorical plumber who smashed up your toilet work with you on your mental health.
A lot of people ask me for recommendations for clinicians. I live in Canberra, Australia and I have collected recommendations for clinicians which I send around fellow Canberra residents – with the caveat that a clinician who is helpful for one person may not be for others. I do not have lists of clinicians in other areas. However a lot of people belong to autism or mental health groups online. It can be a great idea to ask for recommendations (or warnings!) about clinicians people have found helpful (or those they would never recommend).
I love when I get a good clinician. My current psychiatrist is really lovely – and has affirmed my autism, ADHD and schizophrenia diagnoses. It can be quite hit and miss finding a good one so I am very grateful to have one I can work with. It is a collegiate relationship with the focus on keeping me healthy. I think that is exactly what a therapeutic relationship should be like.