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Rain Man Meets Gene Therapy
Autism in the Media

"Weepinbell, w-e-e-p-i-n-b-e-l-l; Tentacool, t-e-n-t-a-c-o-o-l ; Geodude . . . ," yelled Connor. We were playing his favorite game - identify and spell the names of all 156 Pokêmon characters. Connor is a three-year-old boy I worked with as part of the SonRise therapy that his mother organized after he was diagnosed with autism. During my thrice-weekly Connor-directed playtime visits, I entered his world instead of making him enter mine and encouraged eye contact to strengthen Connor's connection with others.

I begin this critique of autism depiction in mass media relating my relationship with Connor because he informs my understanding of autism and colors my critique of media representations. For people who do not know autistic individuals personally, however, perceptions of autism have been shaped, by and large, by character depictions in a series of feature films over the last fifteen years, most notably Rain Man (1988), House of Cards (1993), and Molly (1999). I here examine these three films, each with an autistic main character, to evaluate the image of autism presented to the public and to discuss how that image has changed in the last fifteen years. However, before an analysis of the films, I will briefly overview autism as it is currently diagnosed and treated.

Autism is the label given to a set of behaviors summarized by the International Classification of Disease ICD-10 Handbook as1:
1. Impairment in reciprocal social interaction.
2. Impairment in verbal and non-verbal communication and in imaginative activity.
3. Markedly restricted variety in activities and interests.

Generally, autistic children are first identified by their delayed language development and underdeveloped social responses.2 Autistic behaviors occur over a wide range of severity and, as a result, several sub-syndromes of autism, such as Asperger's and Landau-Kleffner's, are now diagnosed.1 Early identification and developmental therapy help autistic children learn social behaviors and integrate into their peer group, but each autistic child is different. Currently, seventeen in every 10,000 children is diagnosed with autism, and reported rates of autism are increasing.3

Experts disagree about what causes autism.2 Genetics appear to play an important role-autistic individuals have a series of documented brain structure abnormalities (see Grandin, 1995)--but environment is also important. Teasing apart the specific etiology of this disorder is difficult, because genetics and environment play off one another. For example, infants with a genetic predisposition to pull away from touch and refuse eye contact tend to receive less stimulation.2 Developmental deficiencies that result could therefore be attributed to either genetics or environment because their effects are intertwined.

Parents of autistic children, eager for a 'cure,' drive much of the current research on autism. To date, research has focused on the identification of autism 'genes,' and the furthering of the effectiveness of human gene therapy. Until such genes are fully characterized, serious questions remain about appropriate medication of autistic children and more broadly about social definitions of normal behavior. Broad policy decisions which address these questions are made in a public forum where public perceptions of the nature of autism have significant influence on the outcome of debates about whether autism is genetic, permanent, curable, or environmentally caused. I here examine critically three films to evaluate the image of autism presented to the public and how that image has changed over the past fifteen years.

Autism broke into public consciousness with the release of Rain Man in 1989. In Rain Man Charlie Babbage (Tom Cruise) discovers he has an older, autistic brother Raymond (Dustin Hoffman), and attempts to claim his inheritance through kidnap and bribery. Autism is introduced as a disorder that confers upon Raymond a variety of genius-like skills, but leaves him totally unable to care for himself and dependent on the Brooksville Mental Institution, where he is a resident. Raymond's fellow residents are depicted as vacant, drooling non-persons who pass the days staring at inane game shows. Patients shuffle around and the camera lingers on their distorted facial expressions. When we are introduced to Raymond, he avoids eye contact, speaks in a monotone voice, and recoils from human touch. In explaining the disorder to Charlie (and the audience), Dr Burming describes autism as a disability that impairs the processing and regulation of sensory input-"Raymond is unable to feel emotions in a normal way." Daily rituals and a regimented, regulated existence are, according to the doctor, all Raymond has to protect him from the terrifying uncertainty of personal choice. Unable to understand concepts of money, sex, or humor, Dr. Burming declares that the institution is the best place for Raymond, in perpetuity. Throughout the film, Charlie refers to Raymond alternately as, "an idiot . . . a fucking retard . . . a genius" and asserts, "I know what's best for him." Raymond is not an agent capable of making decisions and he is portrayed as an idiot savant who does not know when people are using him. No cures to autism are presented and no blame for Raymond's autism is leveled. At the end of the movie, the institutional authority of the facility triumphs over the desires of his family and Raymond goes back to live in the institution for the rest of his life.

By 1993, the depiction of autism changed dramatically. House of Cards presents autism as a disorder that can be triggered by emotional trauma and alleviated by good parenting. In House of Cards, we meet Sally (Asha Menina), a happy and curious young girl who lives with her parents in Peru, and witness the fallout that occurs after her architect father is killed in a fall. In response to her father's traumatic death and her mother's (Kathleen Turner) demand that "she not cry" afterward, Sally "comes down" with autism. Suddenly her body movements become passionless and jerky, she avoids eye contact, and no longer displays emotion. She does not play with other kids, does not speak, becomes a fantastic artist, can throw a ball "like a boy," and builds an amazing house of cards. As her behavior becomes more erratic, Sally's mother is depicted as being in denial about her daughter's autism, and institutional authority (the mental home) succeeds in pulling Sally away for "treatment." Treatment, in this film, is depicted as a rather sad process of forcing gifted, but "different" children to reward their parents with mechanical expressions of love and appreciation. Sally's psychologist, Dr. Beerenbrock, dismisses Sally's mother's suggestion to look for the uniqueness in these children by saying, "Miracles wear awfully thin around here. Normal is awesome." Not surprisingly, Sally's treatment at the institution fails to identify the real problem, which is the emotional coldness and distance of her mother, and her autism continues to worsen. Eventually, Sally's mother catches on and attempts to enter Sally's world by building a life-size 'house of cards' out of plywood. When Sally's mother finally reaches out emotionally to her daughter, Sally is instantly cured of autism. In a matter of thirty seconds, Sally reverts to her "old self" -- affectionate, happy, and verbal. Through good parenting, Sally's mother saves her daughter from a life of misdiagnoses and cruel, dehumanizing treatments. This depiction of autism signals a dramatic change from the depiction of Raymond Babbitt in Rain Man. Institutional authority is the bad guy here, because doctors focus on the symptoms of the problem, rather than the cause. Autism is redefined as an emotionally-induced condition that parents can cause and cure if they stand up to the established medical authority and reach out to their children.

In 1999, Molly was released. In this film, the definition and treatment of autism clearly reflects society's increasing hopes for biotechnological quick fixes. In Molly, an autistic young woman (Elizabeth Shue) goes to live with her thirty-something-up-and-coming advertising executive brother (Aaron Eckhart) after government funding for her nursing home facility is cut off. He is reluctant to look after Molly, whose jerky movements, eye contact avoidance, and adherence to routine complicate his life. Naïve and utterly clueless, Molly is presented as a woman-child who still wets herself and feels no shame - she at one point strips naked in the middle of a senior business meeting because she's "hot". Frustrated, Molly's brother consents for her to receive a controversial new treatment to "cure" her autism. A probe inserts genetically reengineered stem cells into her brain and succeeds in "restoring the dormant area of the brain to partial utilization." Almost overnight Molly is able to care for herself, develops a sense of humor, and re-learns to speak and read. She is curious, smart, witty, and suddenly sexual, proposing marriage and sex to her brother. Unfortunately, just as she is revealing what her brother repeatedly calls, "the real Molly", her immune system begins to attack the new cell growth and Molly slowly reverts back to her old, autistic self. Nevertheless (but not before a great deal of melodrama), her brother re-evaluates his idea of what it means to be a real person and invites Molly to continue to live with him. This film differs from Rain Man and House of Cards in that it redefines autism as a disorder resulting from the dormancy of essentially intact brain areas. The techno-fix of stem cells turns on Molly's "personhood" as a one would turn on a car engine and allows her to reveal the "real person" inside her autistic shell. Biotechnology sets Molly free. The institution relied upon in this film is science, not medicine. Family members are expected to provide primary care, but they don't necessarily know best.

Each film presents information about autism by focusing on the personal narrative of autistic characters. Although the traits displayed by Raymond, Sally, and Molly are a roughly accurate portrayal of autistic behaviors, each film redefines the nature, permanence, causes, and cures of autism and reflects changing socially accepted 'treatments.' All three films assert that autism distorts an individual's ability to be a "real person", but each offers a different etiology and treatment. Raymond was born with autism and will rely on institutional care for the rest of his life - he is not going to "get better." Sally's autism was the temporary result of poor parenting following the tragic death of her father. Her mother had to reject institutional authority to save her. For Molly, autism also began at birth, but biotechnology freed her "real" personhood from her autistic jail, if only for a brief while.

Of the three films, I think that Rain Man provides the most accurate portrayal of the intricacies of autism. Watching Raymond onscreen, I could hear almost hear Connor's voice. However, his institutionalization, facilitated by a three million dollar estate, is not an option for many parents, nor need it be. Connor attends public school, and through continued work and contact with his peer group, he has consistently improved his communication skills. Segregating him from society exacerbates the very condition it is designed to treat.

House of Cards falls into the well-tread trap of blame-the-parents. Although I imagine that parents of autistic children watching this film might be angered, I was not troubled by this depiction, as the movie made no attempt to be believable non-fiction. All the "political" statements about parents having control over the emotional well-being of their children, of the moral imperative of acting as their children's advocate, and of the need to treat autistic children with respect were transparent and clumsily made. The poor mix of mystical imagery and psychiatric medicine de-emphasized Sally's story as a plausible narrative.

Most troubling of the three films was Molly. I support stem cell use and the development of human gene therapy, but the patently fictitious presumption that simply injecting stem cells into "dysfunctional" brains will create geniuses is a dangerous assertion. Narratives, such as Molly's, which legitimate the use of biotechnology to set individuals "free" from that which makes them "abnormal," seem like fairytales but ignore far more complicated realities. Such morally simplified narratives gloss-over complicated issues related to the definition of normal and the acceptance of difference. Stories like Molly also strip the individuality from people like Connor by defining autism simply as a disease in need of a cure.

From a permanent, incurable processing disorder to one that can look forward to a quick fix, representations of autism over the last fifteen years reflect popular notions and hopes for cures to psychological disorders. Because mass media representations of autism reach a thousand fold the number of individuals who ready Psychology Review Today and other academic journals, films are an important source of information and a possible forum for advocacy and should be used as such.

Bibliography
1. Frith, U. 1989. Autism; Explaining the Enigma. Cambridge: Basil Blackwell.
2. Hobson, P. 1993. Autism and the Development of Mind. Hillsdale: Lawrence Erlbaum Associates.
3. Mesibov, G., Lynn, A. and Klinger, L. 1997. Autism; Understanding the Disorder. New York: Plenum Press
4. Grandin, T. 1995. "An Inside View of Autism." http://www.autism.org/temple/inside.html Feature Films:
Rain Man (1989)
Molly (1999)
House of Cards (1993)