The conceptual or theoretical knowledge cannot give a true picture of a matter unless it is practiced or viewed personally. The movie Rain Man (Morrow & Levinson, 1988), likewise, has given an insight about autistic disorder in a way which evidently presents most of behaviors exhibited by the autistic people and people around them. This movie started with a character named ‘Charlie Babbit’ performed by Tom Cruise and the story turned around the main character ‘Raymond’ played by Dustin Hoffman , residing in a hospital, who had been granted full powers to acquire the entire wealth of Charlie’s father. Charlie felt as he had been deprived of his family share and he planned to kidnap the person who later was disclosed as his real brother. The character’s further interactions were created through a journey of events in which Charlie not only learned many facts about the main character character (his elder brother) but he also developed emotional attachment with him that happened to be futile in the end as his elder brother could show no emotional reciprocity. Raymond, who was in his forties, played a role as a psychological patient; having a disease mostly rooting in biological causes, known as Autistic disorder. He could be entitled as an Autistic Savant (Blackburn, 1997) considering his added individuality in the movie like an eccentric and genius. He spent early years of his life with his parents and then admitted to a hospital Wall Brook after the birth of his younger brother. As per defined by the Diagnostic and Statistical Manual of Mental Disorders (2000), for Autism, an individual should meet the following Diagnostic Criteria (Criterion B & C - absent in movie). 1. Qualitative impairment in social interaction (Criterion A1), 2. Qualitative impairment in communication (Criterion A2), 3. Restricted repetitive and stereotyped patterns of behavior, interests and activities (Criterion A3). It has been observed from the movie that the qualitative impairment in social interaction ’; marked impairment in the use of exhibited by Raymond included: ‘disability in sensing input ’; multiple nonverbal behavior (such as he could not develop and maintain eye contact with anyone; his facial expressions were flat most of the time; he made no use of relative body postures as well.) He had no friend nor had any other relation rest of his life. He did have his 1
interests such as keeping cards, reading, writing etc but he never enjoyed to be interrupted by anyone. For example, in the first encounter in Wall Brook when Sus anna picked up Raymond’s cards, he did not like it and pulled away her hand when she approached him. Moreover, he became ‘anxious’ when Charlie picked up his book. He also lacked emotional and social reciprocity, for example, he did not respond when he was told about his fa ther’s death; he did not often respond when called as during his first meeting with Charlie, he did not turn back when Charlie called him for introduction and then for a walk. Raymond was unable to initiate and sustain communication in a formal way, for example, his responses like ‘ I yeah ’; ‘ I I am an excellent driver ’, irrespective of the conversation I don’t know ’;’ yeah showed that he did not want to continue the conversation or was unable to understand it. He used the expression ‘who’ s on first ’ and put his hands on ear whene ver he got nervous and ‘anxious’. I am an excellent Moreover, he made repetitive use of language throughout the film (e.g. ‘ I
’; ‘We were counting cards, counting cards, counting cards…’ etc). driver ’; Restricted repetitive and stereotyped patterns of behavior, interests and activities of Raymond included: lights out sharp at 11 pm; keeping his bed by the window at sleep; hyperactivity ; emotional outburst on the sight of loud noises and intense lights, etc ; watching ‘People’s Court Program’ sharp at 3 pm and ‘ Jeopardy’ (the T.V show); having same kind of food in breakfast, lunch, dinner and in weekdays ( such as pancakes, maple syrup, tapioca pudding, Cheetos cheese balls, pepperoni pizza-Tuesday dinner, fish sticks, green lime jello-Wednesday) ; having food with toothpicks; reading and writing etc. His routine had become a ‘ritual’ for him. He had little ‘G’), interest in people (notified by his psychologist). This savant learnt Telephone Book (up to ‘G’), when provided with this out of his interest and ability and counted 246 spread toothpicks at a motel in a glimpse. There was also a lack of fear in response to real dangers and excessive fearfulness in response to harmless objects (DSM-IV, 2000), such as standing at the middle of the road, fear of travelling by air and hearing of loud voices and intense lights. According to Raymond’s doctor, when he joined Wall Brook, Raymond was already residing there having age of approximately 18-20 years (this information was later revealed otherwise). Symptoms might have aggregated after his mother’s death but when they actually started started,, it has not been shown in the movie.
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Raymond’s life life was affected due to this disorder, as he had to spend his life in parts. He could not enjoy any family life after the birth of his brother; as their parents thought, he might harm his younger brother. . He could not acquire formal education nor could work for his living. During his stay in Wall Brook, he could develop no relations with anyone. All he could have was his attorney, a medical professional and Wall Brook. He had no clear insight of his disorder, nor he was briefed anywhere in the film that he had some problem. However, his attorney and later his brother took decisions for him. At the end of the film, during psychiatric evaluation, he was only asked if he wished to stay with his brother or return to Wall Brook but was not told directly about his inability to have a normal social life or about his inability to make his own decisions (The discussion was discontinued as he got nervous with frequent questions and the consensus was made for Wall Brook). Raymond did get some behavioral treatment during his stay in Wall Brook such as T.V sessions. He was given a separate room for his living, in which he was allowed to carry out his activities. They were effective in a sense that he could accept other people around him (maintaining distance). But it seemed as if his stay in Wall Brook, contributed in maintaining his condition as his routine became a ritual for him, and he accepted no change in it at first when started living with Charlie. Later, during his stay with his brother he was informally behaviorally trained. Since, most of the behavioral treatment (1980s-1990s) for autism includes, clear instructions; prompting to perform specific behaviors; immediate praise and rewards for performing those behaviors; a gradual increase in the complexity of reinforced behaviors; and definite distinctions of when and when not to perform the learned behaviors (The Health Central Network Ins, 2010). Compliance towards such briefings by Raymond, for counting cards in black jack at casino; briefing about House Rules of casino; Susanna ’s kiss in the lift; dance with Charlie etc , thus, reflected that he could survive other than his rigid and fixed routine. The significant change in him was his response to simple jokes, made by Charlie. Before this he used to show preoccupation with the part of such jokes without understanding them. The movie portrayed many features as symptoms of Autism but the exact information about etiology was missing if it was purely due to medical conditions or association of it with neurological condition (DSM- IV, 2000); and what life events aggravated the symptoms, apart from the death of Raymond’s mother and the time when he was shifted to Wall Brook (the fact 3
realized by Charlie on the incident of hot bath, when he came to know that ‘Rain Man’ his imaginary childhood friend, his brother Raymond, was with him in his early childhood but sent to Wall Brook after similar incident). In the light of DSM-IV-TR, multi axial system in support of cited information is recorded as: Axis I
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Autistic Disorder
Axis II
V71.09 No diagnosis
Axis III
None
Axis IV
Problems with primary support group (death of mother, removal from the home), problems related to the social environment (inadequate social support, living alone, same routine)
Axis V
GAF = 46 (current)
With reference to the given assignment and the symptoms and features shown, the disorder portrayed in the film was Autistic disorder, other than Personality Disorder and Mental Retardation; therefore, it was being mentioned on Axis I. No diagnosis was found for Axis II. General medical condition contributing to this disorder was also not being discussed in the film, thus Axis III is labeled as ‘None’. Information to be filled in Axis IV was not markedly present in the movie, but it seemed that death of his mother and being pulled away by family might have aggravated the condition. Moreover, monotony in his social environment (Wall Brook) and being left alone in a separate room contributed in maintaining the factors. Current GAF as 46 was suggested keeping in view the impairment in functioning and symptom severity (obsessional rituals) on average. This is because his symptom severity and impairment in functioning slightly improved at the end of the film (e.g. Raymond did not take routine breakfast, did not outburst on Charlie’s kiss, kiss, wore formal dress, and made a joke etc). By definition, the onset of Autistic Disorder is prior to age 3 years and it follows a continuous course (Criterion B). But evidence about Raymond’s early childhood was missing which could verify this disorder. Some components of the movie misled in meeting the criteria for Autistic Disorder, and gave an impression as if Raymond was having Asperser’s disorder . For instance, there appeared to be a motivation for approaching others (e.g. date with a lady in casino), one of a differential diagnosis of Asperser’s Disorder with Autistic disorder ( DSM-IV, 2000). But considering other diagnostic features, it was labeled as Autistic Disorder. 4
References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders. (Revised 4th ed.). Washington, DC: Author.
Blackburn, J. (1997). Autism. Retrieved October 23, from http://www.autistics.org/library/whatis.html Hirsch, D. (2009). History of autism. Retrieved October, 29, 2010, from www.webmd.com/brain/autism/history-of-autism Morrow, B. (Writer)., & Levinson, B. (Director). (1988). Rain Man [Motion Picture]. United States: United Artists The Health Central Network, Inc. (2010). Autism. Retrieved October 25, 2010 form http://www.healthscout.com/ency/68/317/main.html#TreatmentofAutism
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