|
|
2#
楼主 |
发表于 2010-10-29 10:53:46
|
只看该作者
re:Kanner (pronounced “...
Kanner (pronounced “Connor”) had written the book, literally, on child psychiatry. Aptly titled Child Psychiatry, this definitive 1935 work immediately became the standard medical-school text, and was reprinted through 1972. No doubt Kanner’s stature was enhanced by his pedigree—he was an Austrian Jew with a medical degree from the University of Berlin—while his nearly impenetrable accent perfectly fit the image Americans had in mind when they used the word psychiatrist.
Kanner would always seem slightly perplexed by the intensity of the letter he had received from Donald’s father in advance of their meeting. Before departing Mississippi, Oliver had retreated to his law office and dictated a detailed medical and psychological history covering the first five years of his elder son’s life. Typed up by his secretary and sent ahead to Kanner, it came to 33 pages. Many times over the years, Kanner would refer to the letter’s “obsessive detail.”
Excerpts from Oliver’s letter—the outpourings of a layman, but also a parent—now hold a unique place in the canon of autism studies. Cited for decades and translated into several languages, Oliver’s observations were the first detailed listing of symptoms that are now instantly recognizable to anyone who knows autism. It is not too much to say that the agreed-upon diagnosis of autism—the one being applied today to define an epidemic—was modeled, at least in part, on Donald’s symptoms as described by his father.
Their little boy, Oliver wrote, had almost never cried to be with his mother. He appeared to have withdrawn “into his shell,” to “live within himself,” to be “perfectly oblivious to everything about him.” Entirely uninterested in human beings—including his parents, for whom he displayed “no apparent affection”—he nevertheless had several obsessions, including “a mania for spinning blocks and pans and other round objects.” He was fascinated with numbers, musical notes, pictures of U.S. presidents, and the letters of the alphabet, which he enjoyed reciting in reverse order.
Physically awkward, he also had intense dislikes: milk, swings, tricycles—“almost a horror of them”—and any change in routine or interruption of his internal thought processes: “When interfered with he has temper tantrums, during which he is destructive.” Generally nonresponsive when his name was called—he seemed not to have heard—he instead had “to be picked up and carried or led wherever he ought to go.” When asked a question, if he answered at all, he generally kept his response to one word, and then only if it derived from something he had memorized. Certain words and phrases captivated him, and he would loop them aloud endlessly: trumpet vine, business, chrysanthemum.
At the same time, Donald exhibited some prodigious, if isolated, mental skills. By the age of 2, he could recite the 23rd Psalm (“Yea though I walk through the valley of the shadow of death …”) and knew 25 questions and answers from the Presbyterian catechism by heart. And the random humming he engaged in while spinning blocks turned out not to be quite so random after all. Rather, he always picked three notes that, if played simultaneously on a keyboard, would blend into a perfect chord. Alone in thought, Donald gave the impression of a quite intelligent little boy, working through some sort of problem. “He appears to be always thinking and thinking,” his father wrote. He was, in a heartrendingly comprehensive phrase, “happiest when left alone.”
When Kanner finally met Donald, he confirmed all this, and more. Donald entered the room, Kanner later recalled, and headed straight for the blocks and toys, “without paying the least attention to the persons present.” Kanner had a trick up his sleeve that today would draw disapproval: he pricked Donald with a pin. The result was revealing. Donald didn’t like it—it hurt—but he didn’t like Kanner any less for doing it. To Kanner, it seemed that he could not attach the pain to the person who’d inflicted it. Throughout the visit, in fact, Donald remained completely indifferent to Kanner, as uninterested in him as in “the desk, the bookshelf, or the filing cabinet.”
The surviving medical records of that initial visit contain a notation preceded by a question mark: schizophrenia. It was one of the few diagnoses that came even close to making sense, because it was clear that Donald was essentially an intelligent child, as a person exhibiting schizophrenia might easily be. But nothing in his behavior suggested that Donald experienced the hallucinations typical of schizophrenia. He wasn’t seeing things that weren’t there, even if he was ignoring the people who were.
Kanner kept Donald under observation for two weeks, and then the Tripletts returned to Mississippi—without answers. Kanner simply had no idea how to diagnose the child. He would later write to Mary Triplett, who had begun sending frequent updates on Donald: “Nobody realizes more than I do myself that at no time have you or your husband been given a clear-cut and unequivocal … diagnostic term.” It was dawning on him, he wrote, that he was seeing “for the first time a condition which has not hitherto been described by psychiatric or any other literature.”
He wrote those lines to Mary in a letter dated September 1942, almost four years after he’d first seen Donald. The family had made three follow-up visits to Baltimore, all equally inconclusive. Perhaps hoping to allay her frustration, Kanner added that he was beginning to see a picture emerge. “I have now accumulated,” he wrote, “a series of eight other cases which are very much like Don’s.” He hadn’t gone public with this, he noted, because he needed “time for longer observation.”
He had, however, been working on a name for this new condition. Pulling together the distinctive symptoms exhibited by Donald and the eight other children—their lack of interest in people, their fascination with objects, their need for sameness, their keenness to be left alone—he wrote Mary: “If there is any name to be applied to the condition of Don and those other children, I have found it best to speak of it as ‘autistic disturbance of affective contact.’”
Kanner did not coin the term autistic. It was already in use in psychiatry, not as the name of a syndrome but as an observational term describing the way some patients with schizophrenia withdrew from contact with those around them. Like the word feverish, it described a symptom, not an illness. But now Kanner was using it to pinpoint and label a complex set of behaviors that together constituted a single, never-before-recognized diagnosis: autism. (As it happens, another Austrian, Hans Asperger, was working at the same time in Vienna with children who shared some similar characteristics, and independently applied the identical word—autistic to the behaviors he was seeing; his paper on the subject would come out a year after Kanner’s, but remained largely unknown until it was translated into English in the early 1990s.)
Kanner published his findings in 1943, in a journal called The Nervous Child. Since writing to Mary the previous year, he had added two more cases to this total: 11 children, 11 histories. But he started the story with Donald.
For all the progress that Donald has made in the decades since—the driving, the golfing—conversation is an art that continues to elude him. He initiates on occasion, but his purpose is generally to elicit a piece of information he needs (“What time is lunch?”) or to make a passing observation (his comment about the sticker on our car). A regular chat, the casual back-and-forth of kicking around an idea, is something he has never experienced.
When asked questions—even questions that invite some elaboration—he responds in a terse, one-way manner, like a man working his way through a questionnaire.
Topic: Donald’s sense of achievement at being able to multiply in his head
“Donald, how does it make you feel that it just comes out of your head?”
“It just comes out.”
“Does it make you feel good?”
“Oh yes, oh yes.”
“Can you describe it?”
“No, I can’t describe it.”
Topic: Donald’s memory of meeting the mentalist Franz Polgar
“Donald, do you remember Franz Polgar?”
“Yes, I do remember Franz Polgar.”
[Silence.]
“When did he come?”
“Actually he came twice. He came in 1950 and 1951.”
[Another long lapse.]
“Who was he?”
“He was a hypnotist.”
“Can you tell me what he was like? Was he an old man?”
“He was probably 55 years old. And he’d be 110 if he were living.”
As is clear from these exchanges, Donald’s thinking likes to go to numbers—even when, as in this case, his arithmetic appears faulty—to dates and calculations and constants that order the world concretely and do not require interpretation. He even has a habit of assigning numbers to people he encounters, a sort of internal indexing system. An old acquaintance named Buddy Lovett, who resides one town over, in Morton, Mississippi, told us that Donald had assigned him the number 333 sometime in the late 1950s. Though he had not seen Donald for several years, he urged, with a hint of mischief, “Next time you see him, go ahead: ask him what my number is.”
Indeed, the next day Donald nailed Lovett’s number almost before hearing the end of the question. We ran this test several times, presenting the names of people all over Forest who had told us of being “numbered” over the years. Donald recalled every one, without hang or hiccup, though he can’t explain the underlying system. The numbers just come to him, he says, and then stay forever.
Likewise, those who receive a Donald Number seem to remember it for the rest of their lives. An indelible distinction, a recognition they’ll never have to share—it may feel akin to an honor.
That is almost certainly not what Donald intends. Honor is one of those concepts—an abstraction arbitrating between the ideal and the actual—unlikely to come easily to someone like Donald, who is far more comfortable in a world ordered by established facts, by what literally is. This is why it is generally believed that people with autism have difficulty lying, or appreciating a joke. Although Donald obviously enjoys pondering lists of people, places, and things, he does not engage easily with implication, mood, or emotion.
Topic: The death of his mother, Mary Triplett, who took care of Donald for 52 years
“Donald, when did your mother die?”
“It was 1985. May 1985.”
“Do you remember where you were?”
“I was at the bank. Her doctor had said it was just a matter of time … and I got the word saying that she had passed away with congestive heart failure.”
“Do you remember how you felt?”
“It was rather expected. I wasn’t really downhearted or weeping or anything like that.”
“Were you not downhearted because … ?”
“I just don’t react. Different people react differently to situations like that.”
Asked whether he missed his mother, he replied—questionnaire again—“Yes, I miss her.” He said he also misses his father, whose death in a 1980 car accident he described in a similarly matter-of-fact manner. He recalls that his dad’s accident was a shock and, again, that he didn’t cry.
Peter Gerhardt tells the story of his friend Tony, who was 55 years old when he got a crash course in the condolence hug. Tony, diagnosed with autism as an adult, had lived all his life under the same roof as his mother. Then she died.
The funeral marked the first time in his life that Tony had been placed in the category of “the bereaved,” and, as he mingled among the other funeral-goers, he learned that people in his position must be prepared to accept some intense and lingering hugs. He handled it fine, observing how his brother was responding to the same sorts of approaches, and comprehending that the people doing this were trying to help him not feel sad. Then he went home, hugged his neighbor, and nearly got arrested.
It was the day after the funeral, and the elderly woman who lived next door—not a close family friend, but someone kindly observing the custom of bringing meals when there’s been a death—came to his door with food she’d prepared. Tony thanked her, and she offered condolences.
According to Peter Gerhardt, what happened next is a textbook example of the kind of misunderstanding that bedevils people with autism. “Tony thought, Well, she offered condolences. I’m supposed to hug her. So he went to hug her.” Gerhardt notes that the woman undoubtedly sent off strong social signals that she did not want to be embraced. But Tony failed to pick up on them: “He hugged her, probably somewhat awkwardly—a little too long, a little too hard, a little too low—because she went home and called the police [reporting] a sexual assault by the man next door.”
To Gerhardt, this serves as a parable for interactions between people who have autism and those who don’t: neither party did anything wrong, but neither knew enough to get it right. Tony, a man bright enough to have earned a college degree, simply lacked the instinctive experience—the teachable experience, Gerhardt contends—to tell whether or not a person wants a hug. He was sufficiently self-aware to understand that he was missing vital cues, but he had no idea what they were. He later explained to Gerhardt: “The rules keep changing on me. Every time I think I learn a new rule, you change it on me.”
The answer to this problem, Gerhardt argues, is the right kind of education for the many Tonys out there. At present, he contends, schooling for children with high-functioning levels of autism overemphasizes traditional academic achievement—trying to learn French or the state capitals—at the expense of what someone like Tony really needs, a set of social skills that keep him from making mistakes such as hugging his neighbor the wrong way. These skills—like knowing how to swipe a Visa card—are not generally taught to kids with autism. And once they become adults, the teaching, in all too many cases, stops completely. In general, state-funded education ends the day a person with autism turns 21. Beyond that, there are no legal mandates, and there is very little funding. “It’s like giving someone a wheelchair on a one-month rental,” Gerhardt says, “and at the end of the month, they have to give it back, and walk.”
But there was another side to the equation in the hug incident: the neighbor’s lack of education on the character of autism. Had she been more aware of Tony’s condition, and what it might occasionally entail, she might not have felt so threatened. At the very least, had she understood the situation, she could have simply told Tony that she’d like him to let go, rather than hoping he’d read social cues that were invisible to him.
As it was, the whole situation was quickly defused: Tony’s brother arrived and offered both the neighbor and the police an explanation of Tony’s disability, and she declined to press charges. But, as Gerhardt notes, a little more information on both sides might have prevented this misunderstanding in the first place.
Donald lives alone now, in the house where his parents raised him. Enshrined in honeysuckle and shaded by several old oaks, a few minutes’ walk from Forest’s faded business district, the house needs some paint and repairs. Several of its rooms—including the dining and living rooms, where his parents welcomed visitors—are dark and musty with disuse. Donald rarely enters that part of the house. The kitchen, bathroom, and bedroom are home enough for him.
Except for once a month, that is, when he walks out the front door and leaves town.
Perhaps the most remarkable aspect of Donald’s life is that he grew up to be an avid traveler. He has been to Germany, Tunisia, Hungary, Dubai, Spain, Portugal, France, Bulgaria, and Colombia—some 36 foreign countries and 28 U.S. states in all, including Egypt three times, Istanbul five times, and Hawaii 17. He’s notched one African safari, several cruises, and innumerable PGA tournaments.
It’s not wanderlust exactly. Most times, he sets six days as his maximum time away, and maintains no contact afterward with people he meets along the way. He makes it a mission to get his own snapshots of places he’s already seen in pictures, and assembles them into albums when he gets home. Then he gets to work planning his next foray, calling the airlines himself for domestic travel, and relying on a travel agent in Jackson when he’s going overseas. He is, in all likelihood, the best-traveled man in Forest, Mississippi.
This is the same man whose favorite pastimes, as a boy, were spinning objects, spinning himself, and rolling nonsense words around in his mouth. At the time, he seemed destined for a cramped, barren adulthood—possibly lived out behind the windows of a state institution. Instead, he learned to golf, to drive, and to circumnavigate the globe—skills he first developed at the respective ages of 23, 27, and 36. In adulthood, Donald continued to branch out.
Autism is a highly individualized condition. The amount of room the brain makes available for growth and adaptation differs, often dramatically, from one person to the next. One can’t presume that duplicating Donald’s circumstances for others with autism would have the effect of duplicating his results.
Still, it’s clear that Donald reached his potential thanks, in large part, to the world he occupied—the world of Forest, Mississippi—and how it decided to respond to the odd child in its midst. Peter Gerhardt speaks of the importance of any community’s “acceptance” of those who have autism. In Forest, it appears, Donald was showered with acceptance, starting with the mother who defied experts to bring him back home, and continuing on to classmates from his childhood and golfing partners today. Donald’s neighbors not only shrug off his oddities, but openly admire his strengths—while taking a protective stance with any outsider whose intentions toward Donald may not have been sufficiently spelled out. On three occasions, while talking with townspeople who know Donald, we were advised, in strikingly similar language each time: “If what you’re doing hurts Don, I know where to find you.” We took the point: in Forest, Donald is “one of us.”
For a time, Donald’s care was literally shifted out into the community. Kanner believed that finding him a living situation in a more rural setting would be conducive to his development. So in 1942, the year he turned 9, Donald went to live with the Lewises, a farming couple who lived about 10 miles from town. His parents saw him frequently in this four-year period, and Kanner himself once traveled to Mississippi to observe the arrangement. He later said he was “amazed at the wisdom of the couple who took care of him.” The Lewises, who were childless, put Donald to work and made him useful. “They managed to give him [suitable] goals,” Kanner wrote in a later report.
They made him use his preoccupation with measurements by having him dig a well and report on its depth … When he kept counting rows of corn over and over, they had him count the rows while plowing them. On my visit, he plowed six long rows; it was remarkable how well he handled the horse and plow and turned the horse around.
Kanner’s final observation on this visit speaks volumes about how Donald was perceived: “He attended a country school where his peculiarities were accepted and where he made good scholastic progress.”
Likewise, during high school, when Donald was again living back home with his parents, it appears his ways were mostly taken in stride. Janelle Brown, who was a few classes behind Donald (and the recipient of Donald Number 1,487), remembers that although he was teased a few times, he was generally regarded as a student who was enviably intelligent, even “brilliant”—again a legacy of his famous multiplication skills and brick-counting act. She recalls his sitting with a notebook and filling page after page with numbers, and her impression, as well as that of others, that they were seeing evidence of a superior mind at work.
It’s clear in all this that with the passage of time, Donald’s focus gradually turned outward. He increasingly came to terms with how his world was shaped, at the same time that his world was adjusting to him.
By 1957, he was a fraternity brother—Lambda Chi Alpha—at Millsaps College in Jackson, Mississippi, majoring in French and performing in the men’s a cappella choir. (The choir director, we were told by one member, never used a pitch pipe, because he took any note he needed directly from Donald.)
The Reverend Brister Ware, of the First Presbyterian Church in Jackson, was a fraternity brother and roommate of Donald’s. “He was a dear friend,” Ware says, recalling that he tried in various ways to give Donald a hand up socially, though “it was challenging to integrate him.” While training to be a water-safety instructor, he set out to teach Donald how to swim, “but the coordination was not so good for him.” Undaunted, Ware set another goal: “I thought I would try to open up his personality,” by introducing Donald to what was then a cool verbal affectation making the rounds, a way to pronounce the word yes as “yeeeeeeees.” Ware’s encouragements—to “put a little emotion and feeling and savoir faire into it”—again proved futile.
Ware was clearly rooting for his classmate, as were, he says, the other members of the fraternity. “I knew he was a little bit strange,” he admits. “But he’s genuine … I feel so lucky to have had him as a friend”—a friend, by the way, who gave Ware a number: 569.
Throughout Donald’s youth, it helped, no doubt, that the Tripletts had money—the money to get Leo Kanner’s attention in Baltimore, the funds to pay room and board at the Lewises’ farm. As the town’s bankers, they also had status, which may have discouraged the sort of cruelty that can come to people like Donald. One insightful resident of Forest put it this way: “In a small southern town, if you’re odd and poor, you’re crazy; if you’re odd and rich, all you are is a little eccentric.” When Donald was grown, the family bank employed him as a teller, and an irrevocable trust fund established by his family pays his bills to this day. The fund, according to his younger brother, Oliver, was designed with controls that ensure, as he put it, “some gal wouldn’t be able to talk Don into marrying her and then abscond.” In fact, Donald has never expressed any interest in girlfriends, nor has he had one.
But he has his brother—they dine together every Sunday, along with Oliver’s wife—and he has a community that has always accepted him, since long before people in town had heard the word autism. Tranquility, familiarity, stability, and security—if we were talking about healing, these would create an ideal environment. Forest provided all of them for Donald, who didn’t need to heal. He needed only to grow, and that he did, spectacularly. In one of her later letters to Leo Kanner, Mary Triplett reported: “He has taken his place in society very well, so much better than we ever hoped for.” There were still difficulties, of course—she confessed to the psychiatrist, by this time a friend, “I wish I knew what his inner feelings really are”—but her fears of having borne a “hopelessly insane child” were long past. By the time she died, Donald had grown into manhood, learning more about the world and his place in it than she could ever have imagined in those early years.
But he never could count bricks. This, it turns out, is a myth.
Donald explained how it had come about only after we’d been talking for some time. It had begun with a chance encounter more than 60 years ago outside his father’s law office, where some fellow high-school students, aware of his reputation as a math whiz, challenged him to count the bricks in the county courthouse across the street. Maybe they were picking on him a little; maybe they were just seeking entertainment. Regardless, Donald says he glanced quickly at the building and tossed out a large number at random. Apparently the other kids bought it on the spot, because the story would be told and retold over the years, with the setting eventually shifting from courthouse to school building—a captivating local legend never, apparently, fact-checked.
A common presumption is that people with autism are not good at telling fibs or spinning yarns, that they are too literal-minded to invent facts that don’t align with established reality. On one level, the story of Donald and the bricks demonstrates again the risks inherent in such pigeonholing. But on another level, it reveals something unexpected about Donald in particular. At the time of that episode, he was a teenager, barely a decade removed from the near-total social disconnect that had defined his early childhood. By adolescence, however, it seems he’d already begun working at connecting with people, and had grasped that his math skills were something that others admired.
We know that, because we finally asked him directly why he’d pulled that number out of the air all those years ago. He closed his eyes to answer, and then surprised us a final time. Speaking as abruptly as ever, and with the usual absence of detail, he said simply, and perhaps obviously, “I just wanted for those boys to think well of me.” |
|
IP卡
狗仔卡
发表于 2010-10-29 10:53:18
收藏
分享
提升卡
置顶卡
沉默卡
喧嚣卡
变色卡
显身卡