Autism in Film
A Family's View of Asperger Syndrome
Autism is in the news. Not only are technical books and research papers multiplying at a dizzying rate, but also the stories about autism spectrum disorders have become favorite subjects for the media, short stories, novels, and movies. Barry Levinson's Oscar-winning 1988 Rain Man, starring Dustin Hoffman, was the pioneer film of the genre.
This movie must be credited with taking autism out of the closet and into the public's eye by showing an ordinary-looking individual with some astounding talents and laughable quirks rather than a hopelessly handicapped, mute rocking freak. Dustin Hoffman is reported to have shadowed a high-functioning savant with autism for many weeks in multiple venues in order to prepare himself to impersonate veridically a verbal Asperger-type man's awkward body language, masked facial expression, robot-like speech, and mannerisms.
My major criticism of the movie, which I liked a great deal at the time, is that Raymond Babbitt was shown as having most, if not all, of the characteristics of autism rolled up into one character, whereas most of the patients I see have only a few of them. As you no doubt recall, Rain Man views autism through the eyes of Raymond's younger brother Charlie, who did not know his brother and discovers through the zany incidents of their travels together what autism is all about. As the movie unfolds, he goes from incredulity to genuine affection, if not full understanding.
Today's Man is also a movie about a young man with Asperger-type autism spectrum disorder viewed through the eyes of a sibling, an older sister in this case. A major difference is that this movie depicts the real thing: Nicky is Lizzy Gottlieb's little brother who grew up with her. It is a more modest enterprise than Rain Man, which had all the resources of Hollywood at its disposal.
Today's Man was filmed in the familiar contemporary New York of middle-class brownstones neighboring on glass-clad Fifth Avenue skyscrapers. It starts with Nicky peering quizzically at the quiet tree-lined street out of the window of his family's apartment, clad in the suit purchased for his failed — albeit in his eyes, glamorous — job trial as mail sorter at CHASE. His parents recount that even as an infant he related poorly, had delayed language, was more interested in letters and numbers than toys, and became a calendar calculator in preschool, all familiar characteristics to families and to professionals who evaluate children on the autism spectrum. Whereas today such features would hopefully lead to a prompt diagnosis and referral to an Early Intervention program, as mandated by Federal Law (Individuals with Disabilities Education Act [IDEA]-Part C of 1997) for infants under age 3 years, Nicky's parents — physicians and educators — were befuddled two decades ago. It is only when he was 20 that his mother came across the Asperger label, which provided a fit for his odd mixture of remarkable talents and blatant deficiencies.
DEFINING ASPERGER SYNDROME
Asperger syndrome refers to the mild end of the autism spectrum, known as pervasive developmental disorder (PDD) in the Diagnostic and Statistical Manual of Mental Disorders/International Classification of Diseases (DSM/ICD) system we all live under. Autistic disorder refers to classic, Kanner-type autism, the more severe end of the spectrum. To purists, Asperger does not quite apply to Nicky because he spoke late, whereas the DSM specifies that these children must not have been language-delayed, must not be retarded — that is, not have a full scale IQ below 70 — yet must have disabling deficiencies in social skills and be rigid, perseverate, and lack imagination. They may or may not be clumsy or have other developmental problems such as attention deficits or a variety of academic and other behavioral problems. PDD-not-otherwise-specified (PDD-NOS) would have been the purist's label for Nicky, but in my eyes the labels we apply should not be considered distinct “diseases” as not one of them has the sharp boundaries of dichotomous diagnoses like a fracture or rash. They are useful labels with some pragmatic validity for deciding what services are needed.
Nicky describes his difficulty interpreting the subtleties of facial expression that mirror actual feelings, the so-called theory of mind blamed today for many of the problems individuals on the autism spectrum encounter in everyday situations. With child-like innocence, Nicky lacks the insight to avoid making a remark that might be interpreted as racist within earshot of co-workers, doesn't understand why, if you have no work to do, you cannot read a book at the reception desk, or go home briefly after all the mail has been sorted to watch “Mr. Rogers,” which comes on inconveniently during the work day. He is dismissed from two jobs for this type of faux pas, another one of which is looking in the president's mailbox at the draft of a future announcement to the workers, or agreeing with a phone caller that a movie his company has produced is not very good. The job failures are of course painful and discouraging not just to him but to his job coach who explains patiently to him better ways to behave, but acknowledges, as does his mother, that one cannot foresee every possible misstep. Nicky would like to live independently and have a romance but is comfortable at home where his parents still supervise his shaving and proper dress, where he can decorate his 21st birthday cake messily with icing on his fingers and lapel, and where he is unconditionally accepted and loved.
NEED FOR EDUCATIONAL PROGRAMS
The film underscores the dire need for educational programs suitable for intelligent children with autistic features and, especially, for jobs in which affected adult's blind spots will not jeopardize their chances of success. Receptionist is clearly not one of them, but mail sorter, file clerk, elevator operator, messenger, or salad maker in a company cafeteria are among more suitable ones that may be discharged with long-time perfection, provided explicit expectations and detailed procedures are spelled out in detail and close monitoring is coupled with understanding supervisors and co-workers. The movie shows a training and support group meeting, a step in the right direction but of uncertain effectiveness outside the provision of peers.
The movie lasts a small hour, and is both amusing and touching to watch. The photography is good, but looking at it on my laptop I did not find all of the dialogue easily intelligible. The film is not preachy, does not drag, and the situations depicted are typical of the ones those of us who work with people with autistic spectrum disorders have come to expect.
It will be insightful to physicians who have not encountered this disorder in the flesh; but as so much has been written recently about autism, its tragicomedies will not come as complete surprises. Because it provides a graphic yet pleasant way of making its points, I think it will be particularly useful for helping teenagers and other students become more aware and tolerant of differences in others. Hopefully it will also introduce professionals who only know classic autism to the less severe variants of the autism spectrum so that they can give parents an early diagnosis, thereby preventing their being left clueless as to what to do for as many years as were the Gottliebs.