more_vert
Being neurodivergent involves a combination of superpowers and challenges, which allows for a unique perspective in the world of medicine, writes Dr Israel Berger …
I am a Child and Adolescent Psychiatry Registrar.
I am also Jewish and a member of the LGBTI community. Perhaps even more fundamental to my personality and way of thinking is that I am autistic and have attention-deficit/hyperactivity disorder (ADHD).
Many people have asked me why I don’t talk more about being autistic and having ADHD when I have been so open about depression and my treatment as a psychiatrist-in-training (here, here and here).
The answer is simply that these are things that have always been there and are a part of me. So, what is it like to be a neurodivergent doctor?
Although there is minimal formal research in this area, it is widely understood among mental health professionals that many people with ADHD are drawn to high adrenaline careers, and emergency physicians are thought to very frequently have ADHD (here and here).
Autistic doctors often follow their special interests. For me, I had been interested in psychopharmacology since I was an adolescent, and did a PhD in psychology, focusing on health care in my research. When I was in medical school, I developed an interest in reconstructive urology and had a lot of potential to be a great surgeon.
Due to life circumstances, surgical training was not a pathway I could take. I fell back on my background and decided to become a psychiatrist. Much of what I reflect on in this article is related, but not limited, to my experience in psychiatry.
I have spent the past 20 years consciously learning social skills. I have also done a PhD on human communication. This means that I am actively looking for those things that I have in my conscious awareness.
I still miss things that I have never actively learned, very subtle things I am told. This conscious use of communication leads me to use my empathy more obviously than others, and I am indeed regarded as being extremely empathetic.
Having lived experience also imparts a certain connection and empathy that one can never achieve otherwise. Just as those of us who have not experienced psychosis can be as understanding and empathetic as possible with someone who does but cannot truly understand their experience, a neurotypical clinician cannot truly understand a neurodivergent patient’s experience or way of thinking.
This does not limit their ability to work with patients who do not share their experiences, but having a shared experience enhances the exchange.
Autistic superpowers and challenges are not just theoretical to me. I have them both myself. Despite struggling with change, new social situations, and sensory sensitivities, I am extremely organised (by necessity!), plan ahead for multiple possible outcomes, and am very good at assessment and report writing.
I of course did a variety of hospital rotations before becoming a psychiatrist-in-training. I have noticed during this time that pattern recognition is a general strong suit for me. When I was an intern, I had a patient with what had been regarded a mystery disease — hepatitis, headaches, and respiratory symptoms and had had what people thought was every test under the sun.
It just looked like Q fever to me. In true House fashion, I asked them if they had any animals on their property. Lo and behold, they were a sheep farmer and subsequently tested positive for Q fever and recovered well with treatment. To me, this example reflects the power of autistic pattern recognition. If someone can use this skill while being open to being wrong, they can be an incredible diagnostician.
My discussions with patients who may be newly diagnosed or struggling with their neurodivergent challenges about development, maturation, and achieving in life are not based on statistics. They are based on interactions with neurodivergent people from a variety of backgrounds and professions as well as my own experiences.
I generally make an instant connection with other autistic people. People used to ask me about rapport and conclude that the patient could not possibly be autistic. This is incorrect for two reasons: i) autistic people can have very highly developed learned social skills, and ii) because we are both autistic, we do not rely on the same cues as neurotypical people to achieve rapport. I carry a bit of pride in my accuracy. Given that this has been an almost automatic perception, it has in the past been somewhat difficult to articulate the reasons. This is something I have been honing with support from my supervisors.
So, this is what it is like to be this neurodivergent doctor. This is my story, and others may have very different experiences, challenges and superpowers. Whatever your interests and abilities, there is a place for every doctor in the wide world of medicine.
Dr Israel Berger is a Child and Adolescent Psychiatry Advanced Trainee at Goulburn Valley Health and is involved in medical and public health education at the University of Sydney and Monash University.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
Subscribe to the free InSight+ weekly newsletter here. It is available to all readers, not just registered medical practitioners.
If you would like to submit an article for consideration, send a Word version to mjainsight-editor@ampco.com.au.
Resources:
https://www.autismspectrum.org.au
Books:
Unmasking autism: the power of embracing neurodiversity by Dr Devon Price
NeuroTribes: the legacy of autism and the future of neurodiversity by Steve Silberman
The power of neurodiversity by Thomas Armstrong
Being twice exceptional by Melanie Hayes
Thanks for coming out- I think of all the less supportive specialities where this would still likely be career suicide..
However to get accepted for specialist training in many areas, then stay employed at registrar and consultant level, requires high level acting skills in impersonating a NT for those who are not, and for this reason most autistic people these days are excluded (unlike a lot of the older surgeons, when it was ok to have no social skills when they trained).
Similar with most other fields, maybe not GP, but I would consider this to be one job where being autistic or ADHD would be extra hard, given the high turnover and changing requirements, and lack of movement (compared to ED at least).
Also medical school selection these days likely requires a convincing impersonation of a NT person!
I love this!. I am also autistic with ADHD.
A NT female has enough trouble being taken seriously so being a neurodivergent female makes it almost impossible to be taken seriously with any eclectic or out of the box ideas and diagnosis, no matter how good our diagnostic and clinical stats are.
Coming out at work has given me some relaxation managing my sensory differences however at the price of patronising brush off remarks. I do not think this happens so much to ND males.
Autistic Doctors International is a life saving, validating organisation of extraordinarily capable and intelligent people that has helped many of us navigate the NT medical workforce.
I’m reminded of Eric Berne’s “Games People Play”, published in 1964, which I read in 3rd year med, 1973. In it, he portrays psychiatry as a life game where, once you are in the game, you can change roles but never leave. Is it still essential reading for med students? In my 40 years in practice, I saw examples of it all the time, very often among my colleagues.
Thank you for sharing your story so generously. It is comforting to hear that we have doctors of all skills and experiences caring for our community.
A marvellous insight into the neurodivergent world that is so often dismissed: I quote the Psychiatrist who said “ADHD is not real, it’s a fad” quite often.
Your Q-fever story resonates: as a medical student, I was directed by my IFD Consultant to see a patient with the same cluster of symptoms. They lived alongside the road from Queensland on which the cattle trucks constantly passed by. At the round afterwards, nervous because I could not make any sense of the pattern other than Q-fever, I announced my hesitant diagnosis…bingo! The first recorded case in the NT!!!!!!!!
Good luck and thanks for choosing psychiatry.