Tuesday, September 26, 2017

The Good Doctor: One Autistic's Review

Maxfield Sparrow
unstrangemind.com

Freddie Highmore as "The Good Doctor" | photo via IMDB
[image: Young white man with short dark hair and dark eyes,
wearing a surgeon's cap, with a surgical mask around his neck.
Before last night, the only fictional Autistic surgeon I had seen on television was Dr. Virginia Dixon, the heart surgeon portrayed by Mary McDonnell, who appeared in three episodes of season five of ABC’s Grey’s Anatomy. As Lynne Soraya described Dr. Dixon, “the way the character was written was exploitative, unrealistic, over the top, and insulting.” I completely agree with Soraya’s assessment of Dr. Dixon.

So it was with great trepidation that I sat down to watch the first episode of ABC’s new show, The Good Doctor, starring the perennially boyish Freddie Highmore as Dr. Shaun Murphy, a new resident at St. Bonaventure Hospital in San Jose, California. Despite my resistance, I did enjoy the show ... though I do have criticisms.

Before I go any further, I caution you that my opinion is not to be taken as representing any Autistic person’s opinion other than my own. I have not yet read any reviews from the Autistic community, but I have a history of liking shows other Autistics do not like, like Parenthood. I loved that show and I loved Max, the Autistic character on the show. I felt a lot of kinship with Max’s struggles as the character grew through six seasons of the show, even as I hated the Autism Speaks influence on the show and wished the creators had chosen adult Autistics as advisors instead. Other characters said plenty of offensive things about and to Max, but I gave that a pass because it was such a realistic reflection of what people in the real world say about and to Autistics.

But when talking with other Autistics or reading essays they’ve written, I notice that I’m almost alone: The majority of Autistics appear to have hated Parenthood. So don’t take what I write here as representing autistic opinions other than my own.

What I want to see when I watch a television character who has been identified as Autistic is:
  • An accurate representation of what autism can look like
  • An accurate representation of how the world treats Autistic people
  • Some effort to move the public understanding of autism and Autists to a new level
Plenty of people will argue that fiction is meant to entertain, not educate. As a character says in the preview for another new show that aired last night, Young Sheldon, “it’s TV. We aren’t supposed to learn!” But story has always been a tool for shaping society and educating others. Watch any Joseph Campbell lecture if you don’t believe me. Fiction has a social obligation, and anyone who creates or consumes story is kidding themselves if they believe that stories do not change people’s thoughts, feelings, and actions.

With that in mind, I believe that The Good Doctor has the potential to shift people’s thoughts about autism. I also believe that much of the way the show is working toward that goal is problematic.

The clear message I came away from the first episode with was, “Autistic people have much to offer and should be given a chance to show their strengths.” The problem that went hand-in-hand with that was the perpetuation of an ableist concept: “savant syndrome.” Dr. Glassman defends Dr. Murphy’s ability to work as a resident at St. Bonaventure by saying that Dr. Murphy has savant syndrome, giving him perfect recall and high intelligence.

Joseph Straus points out  that the term “savant syndrome” began life as “idiot savant.” The label was originally applied to people with an intellectual disability and one exceptional “splinter skill.” I wrote about Straus’ work in my book The ABCs of Autism Acceptance, saying:
“The point of the label was to highlight the juxtaposition of 'extreme incompetence' and 'extreme competence.' Not only were the term and the ideas behind it offensive and ableist, it was a way of stating what society finds valuable or worthless about a person. The brilliant musicianship, for example, was valuable because people liked to hear the music and would pay money to listen. The 'idiot' nature of the rest of the person’s life was considered worthless.” 
Steve Silberman writes in his book NeuroTribes that Hans Asperger re-framed skills as “autistic intelligence,” defining it as that trait anyone, autistic or not, draws upon when thinking with a creativity that re-shapes some aspect of science or the arts. In contrast, Silberman describes Édouard Séguin, the man who coined the phrase “idiot savant” as having “described his patients in terms more befitting a malignant tumor.”

This is not the kind of language I want to see used about an Autistic man who has overcome childhood abuse from parents and peers, homelessness, and grief in order to achieve great things with little apparent support beyond Dr. Glassman’s gentle encouragement. Dr. Murphy has made it through high school, college, and medical school—no small feats. His logical mind, focus of will (strengthened by autism, no doubt), and eidetic visual thinking have served him well. He has worked hard—as has anyone who graduates medical school. The character does not deserve to have his discipline and hard work, augmented by his autistic intelligence, described with an antiquated and ableist phrase that should have been jettisoned generations ago.

I do want a show about an Autistic character to start where the world currently is, however, so while I am not at all pleased to have heard the S-word on The Good Doctor, I am willing to let that go—for now. The show needs to eventually re-visit the S-word and help re-shape society’s understanding of the savant concept, and why it is not the way to praise autistic intelligence.

But that same scene—a scene of a meeting at the hospital where Dr. Glassman’s choice to accept Dr. Murphy as a resident is hotly contested by doctors and board members who know only that Dr. Murphy has been diagnosed with autism—had another exchange that I found quite heartening. First, some backstory:

I am used to autism and Autistic characters being the butt of the joke on television shows. While no one is officially identified as Autistic on The Big Bang Theory, I find the show intolerable to watch because the majority of the jokes on the show involve the audience laughing at the characters when they exhibit autistic traits. Hans Espenson, the Autistic lawyer on Boston Legal, was presented as comical, due to his many autistic traits. Autistic actor Mickey Rowe wrote about the use of humor on the new Netflix series Atypical, saying the “first episode features an entire scene devoted to Sam's headphones in a restaurant, but the audience is conditioned to laugh at him for it.” In the first episode of Community, Pierce Hawthorne mocks Abed Nadir’s behavior. When it’s suggested that Abed has Asperger’s, Troy Barnes laughs at the word. Annie Edison exclaims, “it’s a serious disorder!” but Hawthorne scoffs, “if it’s so serious, why don’t they call it meningitis?”

The Good Doctor broke that long-standing tradition of making autism funny by laughing at Autistic people. Dr. Murphy is described as “high functioning” (another term, like “savant syndrome,” that is more harmful than useful) and another doctor scoffs, “High functioning? Is that our new hiring standard?” Dr. Glassman quickly retorts, “if it were, you wouldn’t be here.” I loved that line! I loved that, for once, someone else was the butt of the autism joke. That one line made my night.

The overall storyline of the show was not very realistic, but again my mind turned to Grey’s Anatomy, a show I love in spite of those three horrible episodes with Dr. Dixon. I imagined the doctors of Grey’s Anatomy dealing with an accident in an airport, like the one the first episode of The Good Doctor pivots around, and remembered how many times the doctors of that show's Grey-Sloan Memorial hospital have been through scenarios far more outlandish than some broken glass and a hand-made pleural vacuum drain. 

The main difference is that, on Grey’s Anatomy, the airport security guards would have believed one of those doctors, and scrambled to get them the supplies they needed. Dr. Murphy was treated with suspicion (probably due to his low eye contact and the lack of authority in his voice), and tackled when he tried to take what he needed to save his patient’s life.

In fact, Dr. Murphy’s body language marks him so clearly as an outsider that he spends much of the episode simply trying to get inside his new workplace and stay there. It is only through the actions of another doctor who is struck by Dr. Murphy’s comments (despite finding him “really weird”) that he finally gets inside the hospital.

Much of the episode seems like direct reparations for the errors made with Dr. Dixon. I felt like the show’s creators were at least doing internet research (though I would prefer they hire one or more Autistic consultants). Here's how the two doctors' autistic traits contrast:
  • Dr. Dixon had a meltdown when she was suddenly hugged. Dr. Murphy showed clear displeasure with being hugged, but tolerated it. This is important because a surgeon will often encounter random touch from others.
  • Dr. Dixon spouted random, non-related cardiac trivia. Dr. Murphy’s detailed knowledge of anatomy only came out as it pertained to the case he was working on.
  • Dr. Dixon’s constant level of high anxiety made viewers wonder how she even made it through medical school. Dr. Murphy only lost his cool after a full day of being denied, questioned, and tackled (twice) by security guards. And then he only briefly couldn’t find his words but recovered when it was made clear that the two doctors really wanted to hear what he had to say.
  • While both exhibited “child-like” mannerisms, Dr. Dixon felt like someone had cobbled together every symptom in the DSM, while Dr. Murphy had a more cohesive collection of traits that felt more like a combination a real person might exhibit.
  • Dr. Dixon showed no empathy, calling the death of a child “good news,” and alienating the parents with blunt and insensitive demands for the child’s organs. Dr. Murphy frequently shows empathy on many levels, right down to being the only person to know the name (Adam) of the child whose life he saved.
I was expecting Dr. Murphy to defend himself to the skeptical hospital board, because television has predictable structures and The Good Doctor is no exception. Near the end of the episode, Dr. Murphy is asked why he wanted to be a doctor. He responds by briefly getting lost in another of the show’s many flashbacks, then coming out of it and answering with surprisingly child-like language, describing both his pet rabbit and his brother as “going to heaven” instead of dying.

But while his word choice was not what one might expect from a doctor, the sentiment behind them was what we all hope for from our physicians: railing at the injustice of lives unfairly cut short, dedicating himself to saving those lives, and giving people the futures they deserve. At the end he tacks on, “and I want to make a lot of money so I can have a television,” a line that goes a bit over the top for me, but I let it go because by that point I had fallen for Dr. Murphy’s charm.

The creators of The Good Doctor have succeeded in creating a character I can root for. The show is not perfect. The character is not perfect. The villain (a doctor who bullies everyone around him, especially Dr. Murphy) was too one-dimensionally jerky, and Dr. Glassman’s inspirational speech about hiring Dr. Murphy giving hope to people with limitations, and making those who hired Dr. Murphy “better people,” was syrupy to the point of inspiration porn. But I am emotionally invested in Dr. Shaun Murphy’s success now.

Freddie Highmore carries the show, and creates the character of an Autistic surgical resident that feels internally consistent to me. I love that Dr. Murphy’s quiet strength has carried him through so much. I love his pride in his accomplishments. I love the confidence that shines through Highmore’s portrayal of low eye contact and faltering speech. Dr. Murphy is one embodiment of what it can mean to become “the best Autistic one can be.” He has achieved success and is reaching for more accomplishments, while still being clearly Autistic and unashamed of it.

The show could go many directions from here. Some of those directions would drag down what the pilot has accomplished. Other directions would serve to teach society how to respond to Autistics with dreams and talents. There is much that The Good Doctor is not positioned to teach us. It doesn’t address intersections between autism and race or gender because Dr. Murphy is the classic white cis male that is nearly universally pictured when discussing autism. It doesn’t address the needs of those Autistics who do not have startling genius in some respected field of science or the arts. Like many television shows, the main character is exceptional—not just for an Autistic person, but for anyone of any neurology. Dr. Murphy is not ordinary in any sense of the word and his story will not help us understand the everyday life of the average Autistic...or will it?

I’ll continue to tune in, and—whether the show addresses the issues of my own life or not—I’m eager to get to know Dr. Murphy better. I’m rooting for the character’s success as a surgeon and I’m rooting for the show to fulfill its potential and become a vehicle for social changes that improve the lives of under-employed, under-appreciated, misunderstood Autistics. Whether The Good Doctor can live up to what the pilot episode seems to be promising, that remains to be seen. Should that happen, I am one viewer who will be there to see it.