In
a New York Times op-ed
piece, Benjamin Nugent, author of
American Nerd: The Story of My People, recounts how “for a
brief, heady period in the history of autism spectrum diagnosis, in
the late ’90s, I had Asperger syndrome.” His symptoms: 

I exhibited a “qualified impairment in social interaction,”
specifically “failure to develop peer relationships appropriate to
developmental level” (I had few friends) and a “lack of spontaneous
seeking to share enjoyment, interests, or achievements with other
people” (I spent a lot of time by myself in my room reading novels
and listening to music, and when I did hang out with other kids I
often tried to speak like an E. M. Forster narrator, annoying
them). I exhibited an “encompassing preoccupation with one or more
stereotyped and restricted patterns of interest that is abnormal
either in intensity or focus” (I memorized poems and spent a lot of
time playing the guitar and writing terrible poems and novels).

The general idea with a psychological diagnosis is that it
applies when the tendencies involved inhibit a person’s ability to
experience a happy, normal life. And in my case, the tendencies
seemed to do just that. My high school G.P.A. would have been
higher if I had been less intensely focused on books and music. If
I had been well-rounded enough to attain basic competence at a few
sports, I wouldn’t have provoked rage and contempt in other kids
during gym and recess.

These characteristics not only convinced Nugent’s mother, “a
psychology professor and Asperger specialist,” that he suffered
from a mental disorder but landed him a role in the 2000
instructional video Understanding Asperger’s. A
few years later, something embarrassing happened:

After college I moved to New York City and became a writer and
met some people who shared my obsessions, and I ditched the
Forsterian narrator thing, and then I wasn’t that awkward or
isolated anymore. According to the diagnostic manual, Asperger
syndrome is “a continuous and lifelong disorder,” but my symptoms
had vanished.

Since the American Psychiatric Association’s Diagnostic and
Statistical Manual of Mental Disorders (DSM),
which was the basis for Nugent’s diagnosis, rules out the
possibility of recovery, it seems he was misdiagnosed. Then again,
as Nugent notes, telling a friendless adolescent nerd he suffers
from a lifelong social impairment that will make it impossible to
function normally in the world could have a tendency to impede
recovery, making the label to some extent a self-fulfilling
prophecy. The diagnosis is also self-validating: People with
Asperger’s never recover because anyone who does recover did not
really have Asperger’s to begin with (just as people who insist
alcoholism is an incurable disease say problem drinkers who learn
to drink responsibly were never really alcoholics). Nugent
emphasizes that at age 17 he “fit the bill,” so if he was
misdiagnosed it was apparent only when his life turned out better
than the experts thought it would.

Based on his own experience, Nugent welcomes the proposed
redefinition of Asperger’s in the upcoming revision of the
DSM, which calls for putting it in the same category as
autism and tightening the criteria. Assuming that happens, many
people who currently have Asperger’s will, like Nugent, no longer
have it. But it would not be correct to say they never really had
it, assuming they met the behavioral criteria set forth in the
current DSM. As with drawing
a line between normal grief and “major depression,” there is no
biological test that can verify the diagnosis. It is all a matter
of how psychiatrists choose to label (or not label) certain
patterns of behavior, which nevertheless can have a serious impact
how people perceive themselves and live their lives. 

For more in this vein, see my 2011 Reason essay
“Diagnosing
in the Dark.”