Clinically Poor Spatial Awareness
on mapping the brain
“...huh” is not typically the response one hopes to elicit from a psychologist, but it’s what mine said just as she ushered me out at the end of my complete neuropsychological analysis. She had just told me that, in her opinion, my suspicions that I’m autistic were likely unfounded. The tests I’d completed weren’t wholly conclusive one way or the other, but she thought it was more likely that the traits I’d described to her (lifelong emotional regulation challenges, small but compulsive physical stims and sensory sensitivities, constant uncertainty in social situations) were indicative of a personality disorder.
Then, as a final salvo, I said, “I just don’t think I’ll ever know if my understanding of human nature is in any way innate, or if it’s because I literally have a degree in ‘how to behave like a person’.”
She looked at me, her head cocked, and I watched her try to process my statement. After a few seconds of ponderous silence, she said “...huh. I don’t know that I’ve ever thought about it like that.”
For as long as I can remember, I’ve wanted to know everything. I’m sure there’s a more elegant way to say that, and one that accounts for the nuance of accepting mystery into one’s life, but when it comes down to it, curiosity has had me by the throat from a very young age. And one of my biggest Curiosity Projects has always been myself.
Yeah, I recognize how insufferable that sounds. But for a lot of my life (especially my creative life) I’ve felt like my own little puzzle box - unsure what parts of me were innate and immutable, which were inherited but just as permanent, which were put on to help me blend into my surroundings like a jungle frog. So, after years of telling my therapist, “Well, yeah, but everybody feels that way/does that/thinks that” and having her very kindly but very repeatedly tell me, “...they don’t, actually”, I decided to crack open the damn box.
Completing a full neuropsych analysis is an involved process - mine took around six hours. I’d sought it out after spending about a year in growing certainty that I have ADHD. The past five years or so have involved a lot of family members getting their neurodiversity diagnosed, and a lot more of me subsequently going “...wait, but I do that thing too”. My therapist recommended that a neuropsych panel could be useful for me to map out what exactly was Going On With Me. And I have to be honest, I love getting things categorized.
SIDEBAR: These evaluations are also not cheap, I feel obligated to tell you. Mine was not covered by insurance, and in total cost about $1,400. I happened to have the resources and the focused desire to go through with it anyway, but having done it, I don’t know that I would have found it life-alteringly necessary if I were in a tighter financial situation. The caveat to that, of course, being that I’d already been diagnosed with clinical depression and generalized anxiety disorder several years prior, so was not coming to the process with a clean diagnostic slate but rather a desire to get a fuller, more complete picture of my mind and all its weird little nooks and crannies.
So in 2022, after a consult and several weeks of waiting, I arrived at a nondescript little office in Skokie to figure out what specific ways my brain had been assembled backwards or upside down. Over the course of those hours, I was asked to do math problems out loud and repeat long strings of numbers backward (I was bad at this), to rearrange pieces on a series of wooden pegs in a specified order and as few moves as possible (I was strangely VERY bad at this), and to list as many multisyllabic words as I could for a given letter (I did not tell the psychologist that this is literally a game my father and I used to play for fun when I was little, but let’s just say I crushed this one). I had to click a button at exactly the right moment, many many times in a row (I honestly don’t know how I did on this, because it stressed me out so completely). I had to fill out a 500-item questionnaire, self-reporting on symptoms for basically the totality of the DSM-V. I felt, in every single moment, like I was taking a dream-logic version of the SAT where the test booklet talked back and said “there are no right or wrong answers” with a demented little wink.
I was not diagnosed with autism, though I continue to have my suspicions (and, for what it’s worth, this psychologist was not an autism specialist, the process for diagnosing autism in adult women is still woefully lacking, and the one autism-specific test I was given during my evaluation, the Autism Spectrum Quotient, yielded a score of 33, which is more than double the average for allistic women - BUT I DIGRESS). I was diagnosed with ADHD, which provided me some measure of relief. My depression was also recategorized as Persistent Depressive Disorder, which feels appropriate given that one of my most memorable “wait, what” moments with my therapist was me saying “I mean, sure, I’m a little sad 100% of the time, but so is everybody”, to which she very reasonably replied, “...no, they aren’t”. My verbal and linguistic processing are exceedingly high, while my visual and spatial reasoning are “very poor” - the latter certainly a vindication to my parents, who used to say that I could find every sharp corner in a room with my body within 30 seconds of arriving in it.
I got the full written report a couple of weeks after my appointment. It is, I have to confess, deeply weird to read an elaborate third-person narrative about your innermost workings written by someone who knew you for one calendar day. I think there’s a part of me (an annoying part) that had spun my 30-odd-year inability to fully understand myself into an idea that maybe I’m just one of those ineffably, beautifully mysterious people who’s not meant to be understood. And then a psychologist watched me move beads around on pegs for an afternoon and was able to come back with a description as cutting and accurate as “You’re extremely intelligent and very afraid of making mistakes, and thusly have trouble allocating your attention because you spend most of your energy on your anxiety.”
Well, fuck, when you put it like that.
As I’ve racked up diagnoses over time, slowly giving name to all the strange chemical factors that make up my brain, I realized at some point that I had a strangely isolationist view of the whole thing. I’d pictured each condition, each individual label, occupying its own little room with a firmly closed door. But going over this evaluation, I started seeing all those little doors propped open, with tin can phones running across the hall. There is no silo, no dead zone, no place where the disparate parts of you are not whispering secrets to one another. You are all the things you are, all at once.
I guess the spoiler here is that getting my brain analyzed did not suddenly make me completely legible to myself. It did not provide a complete and unimpeachable archaeology of me. I’ve come to accept that perhaps such a thing does not exist, and perhaps that’s good. Perhaps if it did, I would lose my desire to make art. Perhaps if I understood everything about myself with perfect clarity, that clarity would cut the throat of my curiosity. Who knows.
What getting my brain analyzed did do was help me put up road signs inside my head. Give me a clearer, more definable picture of what was behind each door, even with the knowledge that doors never stay closed. Give me the language to understand the macro, while leaving the micro in the hands of ever-evolving mystery.
It also allowed me to say, upon crashing into something, tripping up the stairs, or getting hopelessly lost:
“Leave me alone, I have clinically poor spatial awareness! It’s a condition!”