Jamie knows very well he has a disability, and he identifies readily with his "group" — the couple dozen adults and young adults with intellectual disabilities in Centre County. He knows that these people in these state and county offices are trying to help him, and during his school years he became thoroughly familiar with the Individualized Educational Program drill, where any number of professionals would meet with him and his parents to go over a ream of paperwork. Whenever we talked about his employment prospects after the age of 21, we reminded Jamie that he did not want to live a life of watching YouTube, wrestling videos and Beatles Anthology DVDs in the basement. He always agreed; the idea of watching YouTube in the basement was preposterous. But the ICAP turned out to be a very difficult hurdle for him.

It took about 45 minutes; I talked Jamie through it, and answered most of the questions for him (as I was supposed to do — I was not usurping his role). And as the process dragged on, Jamie became visibly depressed and withdrawn.

First, the questions covered a very wide spectrum of behavior, including some quite severe symptoms of mental illness. They would start mildly — has this person ever been in trouble with the law? (No!) — and mount to a point at which they would begin to get scary: Has this person ever harmed someone? Has this person ever assaulted a police officer? (No! certainly not! how ridiculous!) Since these were things that Jamie could not even conceive of doing, I could tell that he was starting to think, after about 10 minutes, is this my group? Is this the category to which I belong? Worse still, far worse, were the multiple questions to which I had to answer yes; these weren’t disaggregated, so that at one point the exchange went something like this:

MH/ID: Does this person talk to him/herself? Does this person hear voices? Has he/she had any episodes of violent behavior? Is he/she a danger to self or others?

Me: Yes. [Jamie cringes.] He talks to himself. But he has never heard voices or become violent.

I added, also, that he talks to himself because he is imaginative and creative, not because he is delusional. I did not add that he talks to himself because he is lonely.

Jamie’s caseworker and the other MH/ID person left the room to tabulate the results and render an assessment of Jamie’s eligibility for "competitive employment" (paid work). Jamie curled into himself on his chair. I had never seen him like this; even when he was sad about his brother or his hanging-out skills, he was always feisty. Now he just seemed defeated.

I came over to sit next to him and put my arm around his shoulders. "Jamie, sweetie," I began. "You are such a wonderful kid and I am so proud that you are my son. This is why I always say 'Je suis tres, tres fier.' Because I am.

"And it is OK to talk to yourself! You do, you know. You imagine entire conversations. Like last night, when you came upstairs, I could hear you saying, 'And you know who else was born in Hawaii? Obama!' 'Really, Obama was born in Hawaii? How do you know that?' 'My father told me!' 'That is so cool.' Right? You were thinking about talking to someone who was from Hawaii?"

Jamie nodded sullenly.

"Well, that's totally fine. You know you are never violent and never mean — you are a good, good kid with a sweet, sweet heart. Everybody knows that. That is why everybody you have ever worked with, in school or at work, has enjoyed being with you. You are funny and bright and full of ideas. And I am sure that when [they come] back, that is exactly what they will say. You would be a good employee. That test is really for people who have much more severe disabilities and mental illnesses that make them behave dangerously sometimes. It is not for you."

At this he seemed to cheer up a little, but it took the rest of the afternoon for him to fully recover. And the assessment was very much what I had expected: He is not quite capable of living independently and needs help with various life tasks, especially with things involving small motor skills, but otherwise he is good to go, with appropriate supervision. He was cleared for a Community Based Work Assessment. Now all we had to do was to figure out what kind of job he might be able to do.