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What happened when Janet McNamara asked her psychiatrist about a possible autism diagnosis?

August 24, 2026 This American Life

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When Janet McNamara raised the possibility of autism with her psychiatrist, he administered a test — then told her that people with Asperger's generally have above-average IQs, implying she was not smart enough to be mildly autistic. She decided to let the matter go. This happened in the 2010s, when adults seeking autism diagnoses was far less common than it is today.

A test administered, then a door quietly closed

McNamara did not dismiss the idea of autism out of hand. She brought it to her psychiatrist — a professional whose role was precisely to take such questions seriously. He did administer a test, which suggests the concern was treated as at least worth examining.

But the conclusion he offered was strikingly dismissive. He framed Asperger's as a condition associated with high intelligence, and the implication was clear: she did not meet that bar. The diagnosis was effectively ruled out through an IQ proxy, not through a thorough clinical process. This story is explored in depth in This American Life, episode 895, "Label Maker!"

The 2010s: a moment before adult autism diagnosis became normalized

McNamara's decision to drop the matter was also shaped by context. In the 2010s, the notion of an adult — especially an adult woman — pursuing an autism diagnosis was still unusual. The cultural and clinical landscape had not yet shifted to recognize how frequently autism in adults, and particularly in women, goes unidentified for decades.

That context matters. Her psychiatrist's response did not occur in a vacuum; it reflected a broader clinical moment when adult autism diagnosis was rarely on the table. As covered in this episode of This American Life, McNamara's story illustrates how easily a legitimate question can be shut down by a single dismissive interaction.

The IQ framing her psychiatrist used — that Asperger's requires above-average intelligence — is a common misconception. It conflates one historically observed pattern with a diagnostic requirement, and it has caused real harm by gatekeeping diagnosis from people who might genuinely benefit from the label. This American Life dedicates the episode to exactly these kinds of labeling moments, and McNamara's psychiatrist encounter is one of the most pointed examples — a case where the label was denied before it could even be properly considered.

If you want to hear how McNamara describes this moment in her own words, the full episode is available on Listenly.

McNamara's account, as told in episode 895 of This American Life, is a reminder that the path to self-understanding can be blocked not by lack of evidence, but by a single clinician's offhand remark.