The Diagnosis

"Symmetry seems appropriate".

Me, Autism Assessment, 2024

Transcript

The Diagnosis

Untypically for him, he was wearing underwear, but he told himself not to dwell on this fact. It was early September. John didn’t like having to navigate his way to places that were unknown to him. He grumbled as he trudged up the long and busy road that ran from the station into town. He was looking for a particular turning, a particular right turn up a street with a name he found bizarre. He had no faith that it would be where the digital map said it would be. The worst thing in the world was to have to turn around, retrace one’s steps to the very beginning: to have to admit to being lost. But, thankfully, John found the street he was looking for. He recognised its detested syllables, went up it, and swiftly found himself standing before the façade of the clinic to which he had been summoned.

            He wasn’t very sure of his reason for taking the test. It was a thorough examination and he had already spent many hours providing written answers to questions about his childhood, his development, his early adulthood, as well as his responses to a miscellany of specific psychological stimuli and cognitive conundrums, all of which had been asked of him in the lengthy document his mother had emailed through about three weeks prior to the interactive, in-person test itself. John studied his own desires, what he wanted to happen next, what he wanted to get out of this experience, and found little that was sure or concrete.

            Eleven o’clock. That was the time he arrived: his appointment was at twenty past. At reception, he announced his presence and it was acknowledged, fairly courteously he thought, and he was offered a seat in the waiting room. He took it and waited. His eyes took in the room, the soft green of the walls, the front pages of what magazines he could see stacked in the centre of the central coffee table, the fishtank on the ledge across from him under the clock, the few, well-distanced others in the room with him, dark and vague in their coats. 

Then, the receptionist behind the desk with whom he had communicated was joined by a young woman, with bobbed black hair, who never said a word. John watched her move about, and he perused her as best he was able, finding her solemn. He sensed and felt her solemnity deeply. He kept his eyes fixed on the brightly-lit office where she moved and worked. She was visible, profiled, through an open section of sliding window. 

            John realised that he was nervous, that he had butterflies in his stomach. He wondered why, and came to the conclusion that his nerves were the nerves of a performer. He was anxious because, though he understood that his task was anything but, he was readying himself to perform. This was a performance he had to give, and he knew it. That’s why he was nervous as he waited to be called into the office where the test would be carried out. 

When this moment came, John felt relief at not having to wait any longer. He came to life abruptly and followed the woman who had said “If you’d like to follow me, please”, (preceded by his name), intuiting that the examination was already in progress, that his way of dressing, his way of speaking, his way of greeting, his way of walking, his way of shaking hands were all being noticed and carefully taken into account. Already an eye was upon him. He felt intensely looked at, regarded. At the last chance he was able, nearing a downward flight of stairs which he didn’t yet know he was to descend, he looked over his shoulder, for what would be the last time until he was released, at the young, dark-haired receptionist.

John was led to the consultation room. It was a white room with wooden floors and wooden, white-washed window-sill. It was minimally furnished. Bushes, restless with an inclement breeze, waved violently, and knocked at the window from time to time. 

The summoning woman, whose name and credentials were preceded by the style “Doctor” in her introduction, had a companion who had been waiting in the consultation room all the time. This companion called herself Jill.

            By way of what was apparently courteous overture but was in fact a useful cross-examination, general small-talk was conducted. The questions were asked with a probing, deliberate curiosity, the tone of talking nearly authentic but not quite, and the answers were listened to with a strained, over-zealous interest. 

            Activities followed. Open-ended puzzles with geometric shapes and tessellations. Then questions about relationships, friendships, habits, hobbies, marriage. Then, the doctor divulged and unfolded flat on the table a huge, ugly map of the United States with garish cartoon figures and equally tawdry depictions of landmarks printed in the places on the map where they might be found. She asked John to talk about the map, to describe what was on it, and he did. The doctor said she had recently visited America, which John guessed was not simply an untruth contrived for the purposes of the test, and he enquired which state. He soon forgot which. 

            The most complex task he was required to carry out was to narrate a wordless story in a children’s book, portrayed entirely in pictures. John’s words describing it were weak and faltering, his telling prone to irrelevant tangents and focus-disrupting detail. But he responded deeply to the story, even felt himself invigorated by the story’s uneasy strangeness, and eerie tone: he felt he got all he needed to across. The picture book whose narrative he was required to extemporise was called “Thursday” and on this particular Thursday, in the story, a whole host of frogs rose on levitating lily-pads from the lake where they lived and into the sky, where they went on to frighten all the other creatures with whom they shared an eco-system and to cause havoc and disruption in a nearby suburban street.

In general, John felt that he represented himself well. That he was friendly, engaging, enquiring when he needed to be, meticulous, honest but tactful in his answers…exactly what the test called for. Gradually, he found that he was enjoying himself, that he was enjoying the feeling of ease and superiority with which he sailed through this test, that the look of satisfaction and approval in the faces of the two women examining him evidenced his excellence, this successful calibration of characteristics. He was enjoying this feeling he felt, this feeling of non-autism. There was none of the sullen struggle, none of the obstinacies and proud dismissals, deprecations, disapprovals that usually came with an autistic nature. He was well. This search for a diagnosis of something other than what he was, other that he thought himself to be, proved how right he was about himself, that he was seen as he saw himself, in all its clarity and function.  

            Finally, after performing, perfectly he thought, the instruction of explaining to a person who had never used a toothbrush how to brush their teeth, he was asked to tell a story with objects. He wasn’t sure how to interpret this instruction at first. For the first time he felt challenged. He had felt challenged by the task of narrating the picture book but hadn’t found the task itself, the rubric, hard to understand. To realise the task of telling what he saw depicted on the glossy paper pages was difficult but it was a task that anyone would find difficult, he told himself. Now, and for the first time, he was veritably at sea. He asked how he should interpret the task, tell a story involving these objects, or tell (as in convey) a story using these objects. If the second was the task, then were the objects themselves the characters or were they simply representative of them? He was assured that he could interpret the task any way he liked. 

First he had to select his objects, six from a pool of ten. He was drawn to the objects that he found the most aesthetically, that is to say optically, satisfying. He felt his choices being noted. He selected a plain disc of white cardboard thinking it looked exactly like a slightly miniature eucharistic host (he inwardly congratulated himself on the cleverness of this choice: that the body of Christ in the eucharist was a perfect reconciliation of a character and an object); he selected also a tiny pair of lens-less glasses, a little pair of red shoes with black laces, a diminutive pair of angel-wings; a piece of bowed pink ribbon, and a microscopic magician’s wand. He found the associative ties between the objects pleasing: the glasses, shoes, hair ribbon were all sartorial, the angel wings and the wand existed if not within the same one sphere, then in comparable, proximate spheres. And the angel wings and the body of Christ were related in their way. John thought of the piles that were not only generated by the Jewish holocaust but came to define and emblematise it. These piles included piles of spectacles, monocles, lenses. And also piles of shoes.  To John, the ownerless shoes and glasses summoned and signified death. They easily became its cypher, two possible symbols, powerful together. And the host, whether one thought of it as bread or Christ or both: it too was death. And the wand and the host were miracles. The four items John did not select were a little green lizard, a palm tree, what looked to him like a grinning lunchbox, and a door with a big number eight in the middle of it. The story John timorously told was as bizarre to him as it was to the two women he told it to. 

            “Finally” was the word the doctor had used. There was in fact one more test following this final one, though it wasn’t presented to John as such. Her colleague, clearly her subordinate, had been scribbling intently all the while. Now the doctor wanted to pen some notes of her own. The doctor was able, with a sense of some flourish each time, to make one test disappear from the table and another to take its place. From the surface of the table, the props would stare up at John, beseechingly. Now, from a bag by her feet, the doctor produced an abacus, three magazines, a pad and pencil, a stuffed elephant, and two or three tactile-sensory toys. She told John that she had to take five minutes to write some of her observations down. While she did so he was welcome to occupy himself with whatever he wanted on the table before him. He read various magazines but these magazines didn’t interest him, though he noticed that one of them had a scantily clad woman on the front. Of the articles presented to him, he found himself drawn to none of them in particular. He spoke in desultory bursts, describing what was there and why it wasn’t of interest.   

            At last, he was dismissed. He was asked if there was anything he wanted to ask. When he said there wasn’t, the doctor thanked him cordially and said he should come back in an hour to hear the result of their deliberations: whether he was to receive a diagnosis of autism, or no diagnosis. He wasn’t eager to learn their conclusions because he was confident that he already knew the answer. 

John sat in a café, not too far from the clinic. It was off but close to the street of peculiar name that the clinic was on. He contemplated and mentally magnified the notion, the possibility that he might be autistic and found that it didn’t stand up. It seemed to him an impossibility. 

Time passed. He strolled, he idled. He was preoccupied. He found that this time he had, this empty hour, wasn’t his. He was at a loose end, but tied, tethered. It was time that had been taken from him, isolated, trapped, certainly recoloured a strange and unfamiliar colour. The hour was an unhappy one and he wished to wriggle free of it. 

Then, just a little before the end of that hour, he found himself back at the clinic. The young, pretty receptionist was still there, silent as ever. A different woman to the one before acknowledged him and let him into the waiting room. He felt at ease in the waiting room but he detested this section of the process, this wait. He followed the movements of the single, lonely fish that was swimming about in its fishtank. It went back and forth, back and forth, serenely floating across what space there was, then turning in a sudden reel with a slow, smooth leap of its fins. The fishtank John had noticed the first time he sat in the waiting room but largely ignored; now he was concerned intimately with it, and gripped by its sole, glowing inhabitant. He wasn’t absolutely aware of how much time had passed but he was sure it had been an hour since the end of the test. For the entirety of the final four minutes before the doctor’s assistant came to summon him, John was fully, sternly aware of the passage of time, the precise beginning, middle, end, the extent and temporal dimensions of that felt four minutes.

            As he followed the assistant down the stairs, he listened to his will and understood that what he wanted was to not be autistic. While walking, he wished for the diagnosis of autism to be withheld, withheld as something they couldn’t offer him and mark him with. But when he was actually seated, sitting before the same two women as before but in a different room, an office room this time, far more cluttered than the immaculate consultation room, he found quite suddenly, quite startlingly that he didn’t know what he wanted. 

            It didn’t take long for him to learn the result.

Emphasising “Are”, the doctor said: “We are going to give you a diagnosis of autism”. 

When the diagnosis of autism was pronounced, the woman delivered it as bad news, with the same intonation and solemn fanfare as a blow, like she was wording something sorry and regretful. This wasn’t intentional. A diagnosis of autism was positive just as a diagnosis of cancer was positive but the two were not the same, John told himself. Why should they sound the same? He didn’t think of a diagnosis of autism as bad news, and yet the tone of voice in which the doctor worded aloud his diagnosis him made him want to cry. It was also the paradox he minded: the paradox that he had expected and longed for a different result and yet he sat there, in that chair, in the downstairs office of that clinic on that strange-sounding street, utterly unsurprised. His first few seconds of consciously autistic existence were lived in a state of melancholy relief, acceptance, and dull knowing. He was, at last, his expected, confirmed, consolidated self. He had been blessed and given a badge. His state was made official, he was crowned by ceremony.

He went outside, leaving the clinic for the last time. He was followed by something, and that he knew its name was not a comfort to him. Birds were singing in a tree over his head. They were not bickering. They were singing about his autism. They were aware. The world saw it in him, recognised it on him. He carried it with him wherever he went. He felt intensely exposed, unable to conceal his identity. He made an effort to diminish the diagnosis’ importance but wasn’t successful in his endeavour to do so. He wasn’t sure where to direct these efforts. 

Out of the blue, a swarthy man approached him and asked him with husky courtesy if he had the time. How acute the panic that John felt surge within him as he rummaged for a courteous greeting to acknowledge the man, scrabbled in his sleeve for his watch, and read the time with difficulty- suddenly finding the watch face and the position of its hands an arcane, unfathomable riddle. How clear and sharp and well-defined the intensity he received, the panic the encounter engendered, now, now that he had something to call this whelm of fumbling anxiety. And now that he had something to call it, now that he had a diagnosed condition, it was an act of charity to give this man the time. To tolerate him at all, to look him in the eye, to stay rather than running off angrily, it was charity. Because between them was this hot, newly-clarified thing, this thing which arrested and contained his will, and it had the means and substance of destruction, sabotage.

It had always been there. John had always been there; autism had always been there. Diagnosis was their wedding day. He spun on the dancefloor, holding his autism tight to him. They pressed together with conjugal closeness, attended by nuptial cheer.    

John walked on. He passed human scenes and found himself unworthily delivered up to them, unworthily set against them: he found himself darkly foregrounded against their brightness. He consoled himself with the false consolation that they were bright with ignorance. These bright beings were bright with the bliss of their unknowing, and he was the knowledgeable darkness behind which their frivolity told. Then he was bitter and saw their brightness as a kind of blessing, his darkness as a curse.

            John lingered awhile on the bridge over the river, the river that ran through that town. Trees on both banks either side of the slowly journeying water loosed their leaves. Sycamore seeds fell like stars, fluttering down to the water which was bright with the overcast whiteness of the sky. They became this glossy brightness, disappearing as they were absorbed into its stillness. Leaves slid like tears from the branches of large trees, trees that weren’t sycamore trees nor oaks but one of the other species of trees, unremarkable in their own remarked-upon way, the sort of tree one would stop by, take shade under, or just stand looking at and simply think to oneself: tree.

            John regarded what lay imaged in the water, those images the water took on. Some of what was there lay, double, in the water; and much did not, avoiding reflection as if in shyness. The shallow leap of the old stone bridge was able to become an O with the help of the water, and its curved eye yawned the wider for it. 

            Diagnosed. Positive. Yes: to the condition and all its qualities. Well, some of them. Most? What did he have to say about all this? What did anyone have to say about it? Though it was asked of him by the world, there was nothing to express. He was merely aware, aware merely and yet hugely of a melancholy, a quietness and gathering like evening in the daytime streets. Autistic. It went where he went. That was all he had to say for a while. It went where he went and was not separate from him. 

He remembered when it had been a thing outside himself. He was dizzy with prepositions, a great burning here, a me, a now. Over there: no. No longer. Once outside himself, now it was an adjective for his self, an adjective with an island beneath it. One palm tree visible on the surface of the sea: beneath, a whole civilisation of problems and wounds and creatures.

If he had been a betting man, which given his puritan inheritance he was not, how would he have betted? Would he rather have money or not have autism? Would he rather reap the rewards of being right; or be wrong and receive no diagnosis. That was the non-surprise he’d felt when the diagnosis was named, granted, bestowed, pronounced. He’d been diagnosed with autism and felt unsurprised by this diagnosis, and he had never consciously admitted that he had expected to be diagnosed autistic. He could not find a way to declare himself. It was better to hide. 

What he knew about his own inner life others could now know, could now know through the one-word name, and the adjective by which his aggregate complexity was summed up. The sum. The sum of a part of him, thrust forward like a nose. But why this feeling of hiddenness when even the pigeons seemed to know something about it? His autism was announced and yet more covert than ever. He coyly guarded his nature. It had always been reserved but he had never felt this feeling of being above his own nature, of flying above it like a bird, looking down and being ashamed of it, wishing to conceal its most genuine attributes.  

He had wanted to cry when her lips said it, when she uttered the words of the incantation- (though he’d already forgotten what precisely they were). He wanted to cry then and he wanted to cry now, because his heart told him it was a sad fact of his existence. It was a discovery, recent, and sad. Even if it wasn’t sad according to any objective measure of sadness, crying was a valid response to emotional provocations other than sadness, wasn’t it? That original urge to cry had thrown him into a state of strange, intent self-interest. He was interested in himself, stopping by the river-bridge one moment, walking on the next, interested in these potential tears of which he was now full, with which he quivered in anticipation. 

And then John began to find that he didn’t entirely believe in his autism, his being autistic. Had he dreamed the diagnosis? The more he reflected on it, the more it seemed to possess this extraordinarily irreal quality, as though it hadn’t happened. Maybe if he just didn’t tell anyone, didn’t think about it, pretended it wasn’t there, pretended the test and the diagnosis had never occurred, then it would cease to exist. It did not have objectivity on its side, autism, it could lay claim to so little that was truly objective. John consoled himself with this notion. 

For the first time since the morning, he acknowledged the underwear he was wearing. He didn’t, (no he did not!)- get on with underwear. He found it heavy, he found it an irritant, its texture and its tightness around the crotch.

He brought this sensation and its precise quality of discomfort into his awareness. He began to feel intensely sad, intensely full of life’s most inescapable essence. He couldn’t stop the tears, and he couldn’t hide them. He stopped, in the empty street, hardly aware of where he had walked. He felt the light of the sky, bright, on his wet and shining face. Then, soaked in the sticky courses of those tears, he began to smile. And that smile, poignant and tearful, on his unusual, unpretty face, became a laugh. He laughed, full of a pure, sad lightness. What was he laughing at? he asked himself. He was able to answer and so he did. It was…his own naivety. He laughed that he had been so naïve, at how few mysteries there are, at how much people know about you and how little you know about yourself. There was comedy in it. And it was in his ability to find amusement in this, in his ability to find his own naivete funny that he placed such stock, and felt able to go on living with a sense of hope in his heart, with a sane sense of nothing gained and nothing lost.