Why 'The Good Doctor' Is Bad Medicine for Autism (Guest Column)

The Good Doctor Still 22 Steps Episode - Publicity - Embed 2017
Courtesy of ABC

April 2 is World Autism Awareness Day — the perfect time for three experts to explain what Hollywood gets wrong about this complex and widespread disorder.

At the moment, Dr. Shaun Murphy is TV’s most popular surgeon. With near-perfect recall, a photographic memory, and savant-like diagnostic abilities, he is the poster boy of “Hollywood Autism.”

But the reality of autism is very different from depictions on TV and film, where autistic people are almost always portrayed as awkward white male geniuses. In addition to Dr. Murphy (Freddie Highmore) on ABC’s The Good Doctor, there's theoretical physicist Sheldon Cooper (Jim Parsons) on CBS’ The Big Bang Theory and Sherlock Holmes (Benedict Cumberbatch) on BBC’s Sherlock.

At its core, autism is a neurodevelopmental disorder characterized by social or communication impairments, and patterns of repetitive or restrictive behavior. Autism is more than awkwardness, and savant skills are seldom seen in real life. About 2.5 percent of children and adolescents have the disorder, more common than previously thought, according to a 2017 report from the National Center for Health Statistics.

To improve clinical diagnosis and individualize treatment, psychiatry turned away from discrete diagnoses such as Autistic Disorder, Asperger’s Syndrome, and Pervasive Developmental Disorder, and embraced a spectrum-based approach. This evolved conceptualization coincidentally aligns with society’s increasing acceptance of gender and sexuality as nonbinary.

So what’s wrong with Hollywood representing only one end of the autism spectrum?

Ignoring the modern psychiatric view of autism, film and TV repeatedly depict autism as a sort of disability “superpower.” Such representations do a disservice to autistic people by creating the new myth of the “model neurominority.”

Sociologist William Petersen coined the term “model minority” to describe positively stereotyped demographic groups that achieve success despite marginalization. For instance, Asian Americans transformed from the “yellow peril” and “brown horde” of the late 19th century to a respected and industrious group that closed the wage gap by the 1970s — not because of educational gains, economist Nathaniel Hilger found, but because of less racist public perceptions. Contrast The Mask of Fu Manchu — the infamous pre-Code film where Myrna Loy and Boris Karloff don yellowface for the roles of dragon lady and evil criminal genius — to Bruce Lee’s martial arts films of the ’70s in which Asian protagonists are idealized.

Idealizing “traditional Asian values” conveniently upheld the racist status quo. Asian Americans were elevated while other minorities, especially African Americans, were denigrated because they were not perceived to be as hard-working or self-sufficient. This undermined the call for systemic anti-racist changes demanded by the Civil Rights Movement.

The Hollywood production of the “model neurominority” elevates some while excluding others on the spectrum, and creates a mythical autistic superhero who deceives the public by misrepresenting how disabling autism can be in this society. Furthermore, Hollywood depictions underscore the false belief that autistic people only have value if they have savant skills that can benefit non-autistic people, and offset their supposed societal burden.

For example, in The Good Doctor pilot, Dr. Murphy exists to enlighten his neurotypical peers. In an exchange with a skeptical hospital board, the president of San Jose St. Bonaventure Hospital justifies hiring the autistic surgeon because of Dr. Murphy’s “genius-level skills” and because it will “feel good” — “We hire Shaun and we make this hospital better for it. We hire Shaun, and we are better people for it.”

While positive depictions can be beneficial in reducing stigma, inaccuracies — including idealization — leave many behind. Autistic people who don’t resemble the savants on TV, such as those who require 24-hour supervision in group homes or assistance from home health aides, encounter major barriers to self-advocacy and are erased from public life. Indeed, for many on the spectrum, an autism spectrum diagnosis (ASD) is critical because it grants access to intensive resources and treatment options that they may otherwise not have.

In addition to disempowering through invisibility, Hollywood deals a double injustice when film's and television's autism depictions lead neurotypical people to associate autism with white men. While some characters like Julia, Sesame Street’s autistic Muppet, break the mold, autistic characters who are also female or people of color are exceedingly rare.

The association of autism with white men could manifest as underdiagnosis and delayed diagnosis among women and people of color. A 2017 report from the National Center for Health Statistics estimates the prevalence of ASD as 3.63 percent in boys versus 1.25 percent in girls. Experts agree that autism could be underdiagnosed in girls because they use “social camouflaging” to blend in better than boys. The report also found that Hispanic children were diagnosed with ASD significantly less than non-Hispanic white children, noting that racial and ethnic disparities are commonly reported in research. Underdiagnosis limits access to resources such as early intervention, which is linked to better outcomes.

Nixing the Hollywood model neurominority isn’t political correctness. Improved autism representation goes beyond creating a culture of inclusivity — the tangible benefits of more nuanced characters and varied storytelling are a win-win for everyone. By transcending the awkward white male genius trope, Hollywood can begin to more accurately represent all autistic people, showing that’s there’s more than one end to the autism spectrum.

Christy Duan, M.D., is a psychiatry resident physician at Zucker Hillside Hospital in New York City. Vasilis Pozios, M.D., and Praveen R. Kambam, M.D., are forensic psychiatrists and founders of Broadcast Thought.