Diagnosis Shopping

The following story is fictional, but inspired by several real cases that I’ve been involved in.

A child is brought to Child and Adolescent Mental Health Services (CAMHS) by his parents. Mother is convinced he has aspergers. The child is clearly troubled, and shows signs of palpable distress. However, he shows no signs whatsoever of being on the autistic spectrum. On the contrary, he’s sociable, emotionally responsive, with no ritualistic behaviours and no sensory issues.

The school report he’s emotionally fragile, with low self-esteem. His teachers report that Mum seems very negative towards him.

The family spend some time with the family therapist. Themes emerge that Mum is strongly rejecting of the lad. She seems to be projecting something onto him, but we don’t get to find out what because Mum promptly sacks the family therapist as soon as he starts exploring that particular route.

Mum tells the consultant that he needs individual work on anger management and social skills, not this family therapy rubbish. The CPN gives him some individual sessions. For some unfathomable reason, the CPN has a habit of ensuring that Mum is in the room during the “individual therapy”. This is what is known as family therapy by stealth.

The boy is reviewed by the consultant. He’s now doing better, and there’s no evidence of mental illness or developmental disorder. Mum insists he has asperger’s, and demands a second opinion.

Another consultant provides a second opinion. No evidence of asperger’s or any other problems. Mum declares that she is outraged by this shabby treatment at the hands of the NHS.

The case is discussed in our team meeting. We feel we’ve done as much as we can. There’s nothing wrong with the boy, but Mum won’t take no for an answer. A team decision is made to discharge him from CAMHS.

As the discharge letter is being typed up, we get a phone call from the school. Mum has taken him to a child psychiatrist in private practice. After a single appointment, the private shrink has diagnosed him with asperger’s.

It seems that in a free market, even diagnoses are for sale.

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