The Psychiatric Self-Diagnosis of Seinfeld

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PSYCHIATRIC VIEWS ON THE NEWS

As a psychiatrist, the hairs on my back rise just a little bit when I hear public remarks by celebrities on their alleged psychiatric illnesses. A perfect example is when Jerry Seinfeld claimed he was “a bit autistic” to Brian Williams on NBC Nightly News on Thursday, November 6. Not surprisingly, Mr Seinfeld later clarified to Access Hollywood that he “is not on the spectrum.”

Realistically, anyone can give themselves an informal psychiatric diagnosis. The criteria in the DSM-5 and the international ICD-9 are available to the public. They are relatively clear-cut, and deceptively simple enough in their recipe-like cookbook ingredients for making a diagnosis.

In my experience, many patients come to their first session with an idea of what is wrong with them. Often, too, in association with a self-assessment, patients will come in with a requested medication, given what they’ve seen on television, online, and in print ads. As many times as not, their diagnoses turn out to be incorrect. That is where our skills as professionals come in, as we work together to come to a mutually acceptable understanding of what the essential problem is.

Usually, there is a spike in self-diagnosis and referrals when a disorder is featured in the news. This was the case a few years back when the media presented to the public simple checklists for adults who may have ADHD, but who, for one reason or another, were not diagnosed as children.

This may be occurring with autism spectrum disorder (ASD), which was one of the most controversial new diagnostic changes in DSM-5. Separate diagnoses-Asperger syndrome and pervasive developmental disorder-merged into one spectrum of increasing severity, respectively. In the earlier manual (DSM-IV), autism per se meant having major problems in language and some cognitive functions.

In the NCB interview, Mr Williams asked Mr Seinfeld what makes him tick. Now 60 years old, his surprise answer was that perhaps he had ASD, or at least that spectrum drawn out beyond meeting a diagnosis. Among his personal symptoms he listed:

• difficulty paying attention to the right things
• hard to socialize
• lack of understanding what others say, especially what their non-verbal expressions mean

As far as I know, he did not say that he ever received an official diagnostic evaluation. And, especially due to the Goldwater ethical rule not to diagnose someone publicly without having personally evaluated them (and even then, not without their permission due to our confidentiality ethic), I will not try to confirm or disagree with his assessment.

Fascinatingly, though, in his hit sitcom “Seinfeld,” which he co-wrote with Larry David, he played a semi-fictional version of himself. This strikes me as almost an Asperger way of viewing others in sort of a funhouse mirror way, only this time he was looking at himself instead of at somebody else. Who knows? If that makes sense, perhaps his alleged autism helped his career.

Another reason we cannot make a diagnosis in this (or any other) situation is that we do not know enough about Mr Seinfeld’s personal life and how loved ones view him. For most psychiatric disorders, in addition to the required symptoms, major problems are a consequence of the disorder, in work and/or love. We know his work did not suffer, but we don’t know about his love life.

The responses have been mixed. Some seemed to feel that he was making light of the serious disabilities associated with ASD. Others conclude that Mr Seinfeld is a model for what others can accomplish, and thereby his claim reduces stigma.

There is much controversy about whether a line can be drawn between normality and disorder in many conditions, such as when depression or normal grief ends, when subclinical depression begins, and then when a full clinical depression can be diagnosed. As far as the public goes, was it helpful or not for him to say that he had “a bit of autism” to a national audience-especially now that he has retracted the statement?