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Has autism found a place in mainstream TV?

2018; Elsevier BV; Volume: 18; Issue: 2 Linguagem: Inglês

10.1016/s1474-4422(18)30236-9

1474-4465

Jules Morgan,

Autism Spectrum Disorder Research

Thomas is 25; he has a first class honours degree in games and graphic hardware technology. “Off the top of my head, I have made 196 [job] applications”, he says. 40-year old Louisa has two degrees in advanced mathematics, but since leaving education she has only had a few jobs, all ending in dismissal within months, predominately for not fitting in. Both Thomas and Louisa have technical abilities but lack the social skills to get and keep a job due to a shared condition: Thomas is a so-called high-functioning person with autism, and Louisa has Asperger's syndrome. Thomas fears he will never get a job and will end up on the streets. Louisa finds “signs in mathematics easier to read than people”, and says: “life is like a game, and I don't know the rules”. They both want to work, but how can they convince an employer at the job interview stage that autism is not a disability but an asset? The second series of BBC's documentary Employable Me (2017–2018) shows Thomas, Louisa, and others up against the inescapable job requirements to be a good fit for the team, be a good communicator, and have good interpersonal skills. Naturally, documentary films need to entertain and captivate their audiences, but the genre is historically renowned for its social impact—promoting discussion and critical thinking, and being catalysts for change. So, did this particular documentary series deliver on its social impact? Clinical psychologist and autism expert Simon Baron-Cohen (University of Cambridge, Cambridge, UK) thinks so. He was invited to participate in the first series of Employable Me and told The Lancet Neurology: “I was pleased that the BBC shone a light on how 90% of autistic adults are unemployed and how this is creating secondary mental health difficulties, since unemployment leads to low self-esteem, reduced autonomy, increased isolation, and a sense of marginalisation and exclusion.” Thomas wants to “contribute to society”, but has had little opportunity to do so. However, along with the other programme participants, he is offered a chance, and proves himself in a role testing for bugs in games graphics. When he is offered the job he is delighted, although from his facial expression and body language you never would have guessed: this reduced affect display is typical in people on the spectrum. A truly triumphant moment. For Louisa though, the job market is still a minefield. Going for a technical test with no face-to-face interaction initially builds her confidence, but she becomes fixated on the first question and fails the test. Her frustration leads to tears, and she describes her embarrassment at daring to believe in herself. The moment is crushing and painful for the viewer to watch, but even more so for Louisa to experience. In the first series of Employable Me, Baron-Cohen explains that his role was “to show how a clinical psychologist can reveal talents that are present, but may not be visible at first meeting; and what small tweaks in the workplace may make the person able to not just get a job but also keep a job”. 34-year-old Brett has no academic qualifications, but he does possess a superior understanding of organised systems and processes. Finally employed, he prepares a thank-you speech to his colleagues, which could be one “tweak” that Baron-Cohen advocates for. In his speech, Brett explains what he struggles with, and how he might appear to others; he introduces autism-awareness into the workplace. Such labelling may not be right for everyone, but providing education to an uninformed group might still hold some benefit for an individual with autism. Although Brett's brain processes information in a different-from-typical way, the “computer-brain” association with autism is a bugbear that has existed since the seed was planted in the Barry Levinson's 1988 Academy Award-winning film Rain Man. It stars Tom Cruise as self-absorbed Charlie, and Dustin Hoffman as Raymond, his brother with savant syndrome, a condition on the autism spectrum with which a person displays exceptional and prodigious abilities. Although Rain Man was, and still is, applauded for catapulting autism into the public eye, Baron-Cohen agrees that while “Rain Man and [the film] X+Y have value in highlighting remarkable talent that is seen in some autistic individuals…these need to be balanced by other programmes [with those] who do not have such ‘savant’ skills. Such balance can ensure we avoid misrepresentation and stereotyping”. The A-word is a TV drama first aired on BBC in 2016. It is written by Peter Bowker, who taught children with learning difficulties for many years, an experience that is evident in his characterisation of a family coming to terms with 5-year-old Joe's autism. Baron-Cohen classified it as “outstanding”, and sees the two genres—drama and documentary—as an “excellent complement…since both will engage audiences in different ways but will help the conversation to move forward”. The audience is taken on a rollercoaster of emotions: denial, fear, and anxiety pre-diagnosis, and conflict, sadness, love, acceptance and determination afterwards. Joe's mother, Alison (portrayed by Morven Christie) together with father Paul (Lee Ingleby), grandfather Maurice (Christopher Eccleston), and their extended family thrash out the highs and lows of family life, with Joe (an impressive Max Vento). The A-word is undeniably a rich, intelligent, and moving drama that does not isolate autism, but explores the condition in a multifaceted context: through parent-child relationships, in the playground at school, within the family unit, or even just out shopping. However, for the sake of balanced representation, might Joe be too gifted? With his ability to recite the lyrics, dates of release, and songwriters from multiple music playlists, could this be another example of a savant? An offering from USA-based Netflix, Atypical, created by Robia Rashid, could provide a look at autism from a different perspective. The fictional show follows Sam (Keir Gilchrist), an 18-year-old who wants a sexual and romantic relationship. His autism is more in line with a text-book diagnosis of Asperger's syndrome, which is explained early on in the series through somewhat awkward lessons written into the script on the traits of the condition. Sam talks in monotone and rarely smiles, doesn't understand social cues, and his understanding is literal. He has obsessions, and feels safest when his imagination transports him to Antarctica, among penguins. However, as he himself acknowledges, “it turns out I couldn't do anything”, referring to his lack of autism-related superior cognitive skills. The show brings some nuance to the conversation around autism in the form of Sam's supposedly typical best friend, who is questionably “normal”; presumably a deliberate nod to the “normal” versus “not normal, just different” dialectic. Overall Atypical has packed in humour and autism-awareness, and it is fun to watch. But it is somewhat limited, perhaps because it feels compelled to both educate and entertain, which are not easy tasks for mainstream drama. The 2018 Channel 4 documentary Are you autistic? is a little bit different, as Anna Richardson, the presenter, is joined by campaigners Georgia Harper and Sam Ahern, who both have autism. With their own experiences of autism they hope to smash misconceptions and destigmatise autism: “Autistic people aren't broken or weird or anything to be scared of. We're just ordinary people like you. Our brains are just wired a bit differently, that's all.” The idea of wanting to be a neurotypical person—”not an autistic swearword, just not one of us”—is turned on its head. As we are told by the presenters, “everyone has a right to be their own version of normal”. Although autism is recognised as a spectrum, an axiom bandied about in the autism community—”if you've met one person with autism, you've met one person with autism”—reflects the complexity of clinical diagnosis and of receiving autism-specific support that is accessible and constructive. Are you autistic? follows two people, musician JP Horsely and 35-year old mother of three Joanna Hoskin, who are tested for autism after having experienced feeling like an outsider their whole lives. Their clinical interviews that are shown on camera, explains Baron-Cohen—who Harper describes “as much as a neurotypical can be an expert on autism”—follows the diagnostic method used in his Cambridge Lifespan Asperger Syndrome Service (CLASS) clinic in Cambridge, UK. The CLASS clinic uses a schedule called the Adult Asperger Assessment, which makes use of three screening instruments: the Autism Spectrum Quotient, the Empathy Quotient, and the Childhood Autism Spectrum Test. An online questionnaire, comprising these and other tests, was made available on the Channel 4 website simultaneously with Are you autistic?; 700 000 people participated, and the results will be submitted for peer-reviewed publication. Towards the end of the programme, we discover that JP is autistic and Jo has Asperger's syndrome. They both feel an enormous sense of relief at these diagnoses. Autism is an under-diagnosed condition, and people like JP and Jo belong to what is now known as the “undiagnosed generation”. The results from the online questionnaire could be defining, and perhaps, even suggest an algorithm that could accurately predict the likelihood of an autism diagnosis. The documentary Neurotypical (2013), directed by Adam Larsen, is a film about autism from the perspective of people with autism. Wolf Dunaway, one of the presenters, was born in 1959 to an educated, middle-class black family who were told to “forget about him”, a common medical opinion of that time. Dunaway is proud of himself, his achievements, and his autism. In fact, he doesn't want to be neurotypical. “Systems [are] how I survive”, he says, and he has successfully developed many workaround solutions for surviving, successfully, in a neurotypical environment. Neurotypical also features 4-year old Violet, teenage Nicholas, and mixed neurotypical-autistic couples. Through this diverse group, there is some exploration around the mystery of romance (full of innuendo and unreadable cues); puzzlement over the rules of tag (the game where being “it” is desirable, but you pretend it is not); and shared experiences of creating pseudo-typical-selves to get by, and to fit in. In a subtle way, this documentary also shows us that differences in the neurotypical population could also be on a spectrum. We all have a uniquely wired brain, and we are all trying to make sense of the world, and fit in somehow. Although the majority of these programmes are meant for an adult audience, autism is also represented in children's television. Sesame Street, the long-running American puppet show that spawned the likes of globally known icons Kermit the Frog and Miss Piggy, has recently introduced the character of Julia. She says very little, and struggles to understand social interaction, but is creative and joyful. Julia might be a relatable character to children who feel different, and could open the minds of other children. Representations of autism are just beginning to make their way into the entertainment business, but more are needed to normalise autism, and to avoid enforcing a standard of “normal” in a society that has many shades of difference. A physician with autism in a TV seriesWe read with interest the In Context article1 by Jules Morgan on the increasing presence of autism in mainstream television (TV), discussing some examples from documentary series and TV dramas. We would like to add another relevant example from an American TV series: The Good Doctor, which considers the life of a young physician with autism and savant syndrome, Shaun Murphy (played by British actor Freddie Highmore), who is starting his training as a resident in surgery. The series enables viewers to appreciate how a physician with autism can be a good professional, even sometimes outshining his colleagues. 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