Dear Therapist:

Thank you so much for your informative column. I really enjoy it, especially as I am currently in school for social work. My younger brother was recently diagnosed with autism “spectrum” disorder. I think my parents always had a hard time with him and they seem relieved that they found a “name” for his issues. I am worried because I really don’t see that much that is wrong with him and I am concerned he is going to be stuck with this label for the rest of his life. I mean he certainly is a bit rigid and sensory, but he seems to function very well. I understand that this kind of diagnosis has become much broader but, in your opinion, has it become too broad? Is it being overused? Is there a downside to this? I am also wondering what my options are for approaching my parents with my concerns. No one asked my opinion and maybe it’s just not my business, but I do feel like I have some thoughts that they should take into consideration. Thank you for your help and your weekly column.

Response:

You are touching on an issue that is broader than ASD (autism spectrum disorder) alone. In fact, the proliferation and normalization of mental health diagnoses has entirely changed the entirety of the emotional landscape. As with most things, this is something of a double-edged sword.

There is certainly still something of a stigma related to mental health diagnosis and treatment, though this varies greatly from one community (as well as family and social and other groups) to another. Additionally, a mental health diagnosis can, for some, be an excuse not to work on issues that they might otherwise view as part of life’s normal process. Some people may feel overwhelmed by the designation of a diagnosis, feeling that this, in some way, defines them.

Of course, an official diagnosis does not define anyone. In fact, for the most part it is simply an official label. I have often been asked by clients for a succinct diagnosis so that they could  understand what their problem is. Though I have no problem offering this information, I typically explain that a diagnosis is simply a designation based on symptoms. Therefore, knowing the name of that designation does not often help them to understand their issues. After all, they are the ones who described their symptoms to me in the first place.

With regard to ASD in particular, as you mentioned, this diagnosis has broadened significantly. The DSM (Diagnostic and Statistical Manual of Mental Disorders) is a product of the times, and therefore subject to ever-changing norms. Thus, it sometimes walks a fine line between what is currently considered normal and what is popularly identified as a problem. ASD is a disorder that has been popularized by the media (both traditional and social). This is likely part of the reason that the disorder has been broadened. However, the more broadly the net is cast, the more diluted the diagnosis becomes, theoretically including many of those who should be excluded because they fall within normal limits. This, in turn, can lead to the diagnosis being taken less seriously.

I understand the draw of the term “spectrum;” it allows for more latitude with regard to diagnosis. I would argue, however, that there is a spectrum for many disorders. Depression exists on a spectrum, as do anxiety, obsessions, hyperactivity, problems focusing, and many other symptoms. Yet we do not speak of a depression spectrum or an OCD spectrum. These disorders are identified based on specific symptoms and their affect on the person’s life.

I wonder what made your parents feel that a diagnosis was necessary. Perhaps there are specific areas that they believe are problematic, and on which they believe your brother can work. If this is the case, they may feel relief at the prospect of finally having a diagnosis, and ostensibly a treatment path.

If, however, your parents’ involvement begins and ends with diagnosis, this may relate more to their own needs than to your brother’s. For instance, they may have felt that your brother’s problems were somehow their fault. Or they may have felt a strong sense of responsibility, and believed that it was their duty to help him to resolve his issues. In these examples, their need for a diagnosis would have been self-serving, absolving them of feelings of guilt or their sense of responsibility. However, very little in life is so cut and dried. It is likely that were multiple motivations, some of which are difficult to pin down or to quantify.

The most important factor, of course, is neither your parents’ motivation nor your concerns. It is your brother’s thoughts, feelings, and reactions to being diagnosed. Perhaps there is an advantage to discussing your concerns with your parents. You haven’t, however, mentioned your brother’s perspective. Have you discussed any of this with him? Has he said anything to you? I don’t know his age, level of maturity, or other pertinent factors. I also don’t know the nature of your relationship with him. Perhaps your concerns could be shared with him rather than with your parents.

As with many decisions, a cost-benefit analysis can be helpful. Part of your inquiry relates to identifying the advantages and disadvantages of being diagnosed. For your brother, however, that is in the past. At this juncture, your consideration of advantages and disadvantages can be applied to possible discussions with your brother, as well as any with your parents. Acknowledging and evaluating these can help you to determine whether—and how—to approach them.  

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200

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