A hundred moments in autism - First attempts at diagnosis

“What is the meaning of ‘it's no skin off my nose’?” 

In my late teens I suffered from depression, and was treated at a local outreach centre. I had confounded the doctors, there were no life events to explain my sudden descent into depression. I was fit and healthy, financially secure, from a stable family background. I had friends, though my depression meant I no longer had the energy to see them.  

After working with me for several months, my doctors (it transpires) hit upon a theory. They thought I might be autistic. They didn’t tell me this, but they tried to diagnose me. They tried to diagnose me – except there were no diagnostic tools available forty years ago, so they were basically winging it.   

Some autistics can take words too literally and struggle understanding metaphors and similes, which is why they hit upon the idea of diagnosing me by testing whether or not I understood the meaning of common metaphors.  

In those days, low IQ was inexplicably part of the autism diagnosis, so the medical profession was diagnostically unprepared for a relatively intelligent, high masking autist like myself.  The ‘low-functioning’ (yes, hateful term) autists that made up the majority of diagnosed autistics of that time may have struggled to translate common metaphors and expressions, but most of us autists have no problem. 

I’d heard the expression ‘It’s no skin off my nose’ used, so I explained that it meant ‘it doesn’t affect me’.  

They tried again. “What is the meaning of the phrase “I was a million miles away.”? 

I was still focused and paying attention, so I answered: “My mind was wandering.” 

The younger, less senior, of the two doctors had a try. “You’re building castles in the air?” he said. 

 “It means your plans are without foundation,” I said. A bit like your diagnostic methodology, I didn’t add. 

“To cut corners?” he ventured. 

“To do something poorly so as to save time or money,” I said. A bit like your diagnostic methodology, I didn’t add. 

The two doctors looked at each other. They’d gone through their list and I’d explained the meaning every single metaphor accurately. This meant that I couldn’t be autistic.  

I was never diagnosed and they gave up on me entirely not long after that.  

Of course, it turns out that the doctors had been right all along. Not just to think that I was autistic, but to think that autism would explain my depression, which was almost certainly a bad case of autistic burnout, a prolonged state of intense fatigue, a lack of energy and a loss.  

Still, it’s all a long time ago now, so no skin off my nose.