Did you see the movie Rain Man? Dustin Hoffman is said to have spent a great deal of time shadowing a man with autism so as to learn to impersonate successfully his tone of voice, posture, gestures, and the content of his speech.
The dust jacket of the novel The Curious Incident of the Dog in the Night-Time states that Mark Haddon worked with autistic individuals as a young man. To be able to pull off this remarkable short novel, he must have spent a great deal of time with them. Surely, he is a keen observer, and has done considerable homework, because he successfully puts himself in the skin of the lightning calculator and logically gifted, socially inept but engaging Christopher John Francis Boone – 15 years 3 months and 2 days old – whose counselor Siobhan suggests he write a book he himself would find interesting.
AN AUTISTIC TEEN
Christopher's favorite books, besides mathematics and astrophysics, are murder mysteries, especially The Hound of the Baskervilles. He considers Sherlock Holmes and Doctor Watson proper detectives who base their chain of reasoning on carefully observed clues and ignore red herrings. Their prime suspect is someone known to the victim.
The book starts with Christopher – who gives us, in Greek characters, the etymology of his name – finding his neighbor's dog quite dead but still warm, impaled on a pitchfork. The owner of the dog calls the police, who take Christopher into custody. He is asked to remove his shoe laces and empty his pockets – and out comes his Swiss army knife with 13 attachments, including a saw with which he could defend himself by sawing an attacker's finger off, a piece of string, three pellets of food for his pet rat, Toby, and other miscellany.
Because he must know the time to the minute, he screams so loudly when they want to remove his watch that the police give up. He enjoys the police cell because it is a perfect cube, two by two by two meters filled with eight cubic meters of air. He also likes it that he is alone and can think of how he might escape using his glasses to start a fire by focusing sunlight on his clothes.
His father rescues him at 1:28 AM and tells him to stay out of other people's business when Christopher declares he will solve the mystery of the dog's murder. You will not be surprised to learn that he goes ahead anyway, draws up a Holmesian plan, and lands in a series of tragicomic situations.
They begin as he finds his way to London curled up behind a big bag on the train's luggage rack, even though he is never allowed out alone, except to the corner shop. He sits for seven hours in a Bakerloo tube station because he is terrified of the noise of trains; he covers his eyes and ears each time one comes by until he figures out the regularity of the schedule. Then he is rescued by a stranger when he jumps down on the tracks to catch Toby, who has escaped from his temporary home in the sleeve of his coat.
ECCENTRICITIES AND GIFTS
Figure. The fictitio...Image Tools
We learn that Christopher sees every detail of what is around him and remembers everything, including the scripts Siobhan has taught him to help him cope with the unintelligible unpredictability of people. We also learn that a “super good day” is when he sees five red cars in a row from the bus on the way to school, that he eats mostly red and green foods, and that he cannot eat yellow or brown foods or wear yellow or brown clothes. He likes white noise because it drowns out unpleasant sounds. He may not speak for days, and groans, rolled up in a ball, when life becomes too much for him.
Christopher is loyal, incapable of lying and, except for fear, does not experience the feelings Siobhan demonstrated by drawing smiley or sad faces. I will spare you the many other eccentricities, formulas, schedules, maps, and other quirks, such as numbering the chapters of his book with prime numbers, all entirely logical from his point of view, excruciatingly funny from ours, quasi-intolerable for those who live with this incredibly scientifically gifted and densely obtuse boy, and a hopeless puzzle for those who do not know autism.
Autism, and in particular people with remarkable skills like lightning calculation, perfect pitch, and flypaper memories, has finally come to the forefront of public and neurologic awareness. Most neurologists by now know about the autistic spectrum disorders, including Asperger syndrome, a label for individuals at the upper end of the spectrum who may be capable of high achievement provided they find a suitable vocational niche, like Christopher, who aces the advanced math placement exam and wants to enter the university after he does equally well on the physics test.
INSIGHTS INTO AUTISM
Haddon has produced a masterpiece of insight into the minds of such individuals and captured the politically correct lingo of the field. (Christopher knows mentally retarded is “Special Needs,” for example.) Individuals like him exist in real life, as Simon Baron-Cohen 1 discovered when the self-administered questionnaire he designed to enable high-functioning adults on the spectrum to identify themselves netted a number of students in mathematics, physics, and engineering at Cambridge University (none in the humanities, all male!), only some of whom had been spotted as children, but all of whom recounted their difficulties navigating the shoals of intolerant peers in school.
Brain imaging and electrophysiology are starting to yield clues on differences in brain function in non-retarded persons on the spectrum without the confound of the mental retardation that is such a frequent part of autism.
Christopher's outstanding talent for mathematics and abstract reasoning and other talents of living individuals with autism still challenge our understanding. Temple Grandin 2 has a PhD in animal science; she visualizes and designs novel slaughterhouse chutes that prevent cattle from panicking on seeing the cow in front of them fall.
Stephen Wiltshire 3, 4 and Jessy Park 5, both “intellectually challenged” yet gainfully employed at menial jobs, readily sell their artwork for good money. Stephen creates his vertical drawings of scenes and buildings he has scanned for a few minutes, and Jessy, her gaily-colored acrylic paintings of windows, houses, and starry skies. The historian Rab Houston and psychologist Uta Frith 6 were able to determine from his characteristically weird behavior that the mid-18th-century Scottish landowner Hugh Blair of Borgue, whose brother tried unsuccessfully to disown him in court, was also autistic. He was echolalic, and spoke little and indistinctly; although intellectually limited, he was able to read and write and to carry on in every day life at home, where he remained married for 19 years and fathered two children. (They were unaware of the genetics of autism in those days.)
To the neurologist, autism poses fascinating research and clinical challenges. Like Rain Man, the fictitious Christopher is credited with almost every characteristic ever described in autism. You are bound to encounter bits and pieces of them in the children or adults (yes, they do survive and do not fade away) on the spectrum who come knocking on your office door because of their seizures or headaches.
If you know autism well, you will like this book and laugh as you resonate with the ludicrous situations Christopher's rigidity and literalness get him into. If you do not know autism, read the book and you too will chuckle. Either way, this is a short novel that any neurologist, or neurologist's spouse or teenage child, will enjoy and can learn from.
1. Baron-Cohen S, Wheelwright S, Skinner R, Martin J, Clubley E. The Autism-Spectrum Quotient (AQ): evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. J Autism and Dev Disord 2001;31:5–17.
2. Grandin T. Thinking in Pictures and Other Reports from My Life with Autism. New York: Doubleday; 1995.
3. Wiltshire S. Floating Cities. New York: Summit Books; 1991.
4. Hermelin B. Bright Splinters of the Mind: A Personal History of Research with Autistic Savants. Philadelphia: Jessica Kingsley; 2001.
5. Park CC. Exiting Nirvana: A Daughter's Life with Autism. Boston: Little Brown; 2001.
6. Houston R, Frith U. Autism in History: The Case of Hugh Blair of Borgue. Oxford UK: Blackwell; 2000.