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An in-depth analysis of the representation and perception of people with autism spectrum disorder in the television show The Good Doctor. The study explores how the show constructs an image of autism and the impact it has on the rhetorical disability of individuals with autism. The document also discusses the need for a more inclusive research orientation on autism and the potential for aligning commercially viable entertainment content with prosocial representations of people with autism.
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A Thesis Presented to the Faculty of the College of Graduate Studies and Research Angelo State University In Partial Fulfillment of the Requirements for the Degree MASTER OF ARTS by IAN SCOTT STARK May 2020 Major: Communication
by IAN SCOTT STARK APPROVED: Dr. JongHwa Lee Dr. Herman Howard Dr. June Smith Dr. Satvir Singh May 2020 APPROVED: Dr. Micheal W. Salisbury Dean, College of Graduate Studies and Research
ABSTRACT ............................................................................................................................. iii
The Good Doctor is a contemporary American medical drama that follows the life of its autistic savant protagonist Dr. Shaun Murphy as he navigates his surgical residency at the San Jose St. Bonaventure Hospital. Autism spectrum disorder, though increasingly common in the general population (Baio et al., 2018), may appear out of place in the medical field, as it embodies communication difficulties that could be considered dangerous (Zuger, 2018). This dissonance between Dr. Murphy’s explicit qualifications and implicit neurological qualities serves as the foundation for the program. Curiously, however, Dr. Murphy also has savant syndrome, which is a rare neurological condition in which affected individuals develop incredible levels of skill at specific tasks (Treffert, 2009). In Dr. Murphy’s case, these tasks include perfectly memorizing anatomical structures, immediately recalling diagnostic criteria, and various other abilities that are highly useful in a medical context. While an otherwise neurotypical surgeon with savant syndrome would be placed at the top of their field, Dr. Murphy faces significant pushback due to its coincidence with his autism spectrum disorder. This tension between Dr. Murphy’s two conditions is a constant tug of war in the show. Throughout his residency, Dr. Murphy interacts with many supporting characters, including his questionable love interest, his stickler of a supervisor, his cohort in surgical residency, and a variety of compelling patients. The Good Doctor explores these social interactions from both Dr. Murphy’s neurodivergent perspective and from the neurotypical perspectives of his companions. By comparing and contrasting these views, these interactions illustrate the program’s conflict and its gradual path to resolution. Review of Communication
Ironically, some of the harshest critics of The Good Doctor’s portrayal of autism spectrum disorder are the very people that the program ostensibly represents. People with autism have used platforms like blogs to convey their dissatisfaction with their representation in The Good Doctor (Lin, 2017; Skudra, 2018). These feelings are not universal (Magro, 2018), but they resonate with larger disagreements in the autistic community about how harshly autism ought to be depicted (Saunders, 2018). Although individual critiques vary, the recurring point of dispute regards whether or not The Good Doctor’s glowing representation of autism (admittedly a best-case scenario) is ultimately socially beneficial or detrimental. Considering this dissatisfaction from actual people with autism, it is quite curious that The Good Doctor is so well regarded for its autistic representation from critical voices in academia and industry. Intuitively, the individuals who live with autism spectrum disorder in their day-to-day lives should be the people best positioned to critique said disorder’s representation in media. And yet, years after its release, the extant academic literature has still largely failed to acknowledge this group’s counter-interpretation of the controversial piece of work. This literature gap represents a troubling problem for both the inclusivity and the accuracy of autism research. Thus, the following chapters will seek to fill this gap by mending the disconnection between the academically oriented perspectives of autism researchers and the experientially oriented perspectives of people with autism. First, the sociohistorical development of these perspectives will be documented in the existing literature. Next, these perspectives will be synthesized into two distinct methodologies of analysis. Then, The Good Doctor will be viewed and analyzed separately through both lenses. Finally, the emergent consonances and dissonances of the two viewings will be used to guide implications for future work.
In order to contextualize the development of autism research and its impact on social perceptions of autism spectrum disorder, one must first acknowledge the field’s troubled beginnings. At its inception, autism research was fraught with misconceptions regarding the nature of the newly identified diagnosis, with early researchers frequently lumping in autism cases with unrelated conditions like mental retardation or schizophrenia (Parisi & Parisi, 2019). While the academic community did eventually retract these ideas, the damage of the initial misinformation had already been done, resulting in widespread societal misunderstandings about the disorder and its nature (Reading, 2018). Fast forwarding to the present day, autism diagnoses have become increasingly common in the United States of America, with roughly 2% of the adult population currently identified with the disorder (Baio et al., 2018). Unfortunately, despite the condition’s relative prevalence, the same fundamental misconceptions about the disorder still persist (Treweek, Wood, Martin, & Freeth, 2018). This stagnation is somewhat of a chicken and egg problem; it is hard to say whether popular culture must better translate autism research (Maich, 2014), or whether autism researchers must better engage with the same (Morgan, 2019). Further complicating this debate is the fact that the question of how to define autism, and how limited this definition should be, remains unresolved in academic circles. Much of this disagreement concerns how to quantify and articulate the specific symptoms that a person must demonstrate in order to qualify as autistic (Lord & Jones, 2012). Although this paper recognizes the existence of this controversy, it does not seek to resolve it. Instead, for the purpose of this particular research endeavor, autism will be discussed in the most general sense, recognizing a variety of autism experiences, symptoms, and needs.
The complex intersection of positive and negative stereotypes surrounding autism has created a peculiar set of social expectations for individuals with the condition. In the case of autistic individuals who do not fall into either the functional or the dysfunctional extreme of the disorder, these expectations can be wildly out of touch with reality and impossible or undesirable to fulfill (Treweek et al, 2018). For example, these people may be expected to display supreme levels of ability in abstract feats of mathematical memorization, while, in the same breath, struggle indefinitely with the act of speaking up for themselves when bullied. Rhetorical scholars have described this phenomenon as “rhetorical disability,” which can be articulated as an individual’s social disenfranchisement as a result of mental and/or physical limitations (Johnson, 2010). This disenfranchisement can take many forms depending on the specific disabilities of the individuals in question. Individuals who are physically unable to speak due to a condition rendering them mute, individuals who cannot speak their thoughts clearly due to social anxiety, and individuals who cannot walk up to the podium to speak due to some kind of movement disorder would all be examples of different forms of rhetorical disability. This versatility functions because the core concept of enforced nonparticipation in civil discourse is largely context-agnostic, in the sense that it is applicable to a wide variety of subject groups and is not theoretically enamored with what specific factor is enforcing the non-participation of these groups. For example, in part owing to its inclusion of a wide variety of disability statuses, this notion of rhetorical disability is an important concern for scholars studying the many different conditions that are grouped under mental and developmental psychological disorders (Lewiecki-Wilson, 2003).
In addition to inherent conditions of disability, such as mental and physical disadvantages, rhetorical disability can also be impacted by social judgments and stereotypes (Johnson, 2010). In other words, individuals that are pre-judged before they begin speaking may be considered rhetorically disabled – assuming that they are even presented the opportunity to speak in the first place. The impact of this transient form of rhetorical disability may be particularly potent in combination with an inherent form of disability (Johnson, 2010). People with autism spectrum disorder, as it fits into both the transient and inherent forms of disability, are one such group. However, one aspect of rhetorical disability that has not been thoroughly explicated, at least within the context of autism, is the role of media representation as an overarching influence upon how and which social groups are relegated to nonspeaking roles. In light of this gap in the literature, it may be prudent to examine media programming that represents people with autism for its potential contribution to the rhetorical disability of said people. Such a program would ideally feature the internal thoughts of an autistic character and depict their external interactions within a system of rhetorically abled individuals. Fortunately, this prospect is more than just an elaborate hypothetical, and such a program can be readily found in The Good Doctor – the aforementioned television show featuring an autistic savant protagonist named Dr. Shaun Murphy who serves on a team of surgeons at a hospital. Because this program primarily explores the various trials and tribulations Dr. Murphy encounters in his workplace due to his condition, as well as his attempts to navigate this neurotypically-dominated environment, it is well-suited for the exploration of autistic rhetorical disability. Of course, having selected this artifact, the next task becomes one of structuring the investigation.
The Good Doctor is an episodic television program that is organized into seasons of 18 episodes in length, with each episode lasting between 41 and 44 minutes. Narratively speaking, each episode tells a self-contained story while simultaneously developing an overarching story that takes place throughout the season, though the extent to which episodes focus on episodic or seasonal stories varies greatly. Although several such seasons exist, extant critiques seem to focus on the program’s first season (Cambra-Badii & Baños, 2018; Moore, 2019; Zuger, 2018); as such, for the sake of comparison, so too will this study. Specifically, the researcher will critically analyze the first season of The Good Doctor through two opposing lenses relative to a hypothetical viewer’s familiarity with autism: (1) a perspective that is rooted in theoretical knowledge “from the outside in” and (2) a perspective that is rooted in experiential knowledge “from the inside out.” The intersections therein will harmonize academic wisdom and personal narrative, particularly through their illumination of agreements and disagreements between the two viewpoints. In structuring these criticisms, the researcher will draw upon Foucauldian discourse analysis and autoethnography. This process will necessitate two continuous viewing periods of The Good Doctor conducted through the mindset of each rhetorical structure. In order to achieve a distinct analytical focus in each viewing, as well as to preempt unnecessary eye-strain due to the prolonged viewing of a computer monitor, the researcher will separate these viewing periods with a cooldown period of one week, during which time they will occasionally watch other television programs as normal. This scheduled break should enable the researcher to rest their eyes, separate their personal and academic perspectives, and ultimately approach each viewing of the program with a clear head.
Foucauldian Discourse Analysis Thirty-six years after his death, the scholar Michel Foucault remains one of the most polarizing figures in contemporary academia. Though Foucault is frequently grouped in with postmodernist and/or post-structuralist scholars by academic historians, his ideas were widely panned by the other leading academics in those schools of thought (Baudrillard & Sylvère, 2007). Likewise, the man himself rejected the very notion of disciplinary classification and categorization, as he believed that these labels served to reinforce the status quo and limit the expression of critical ideas (Foucault, 2002). While Foucault’s interests transcended subjects of history, philosophy, rhetoric, and even sociology, one of his central academic tenets was the idea of a causal relationship between access to knowledge and access to social power (Gutting, & Oksala, 2018). For the purpose of conducting rhetorical analysis, this concept of knowledge can be understood within the notion of linguistic free expression and/or the absence thereof. In this way, Foucault’s scholarship provides a means to recognize and describe how speech and its consequences may serve to subjugate particular cultural groups or present a path by which those same groups can resist subjugation (Foucault, 2001). Although Foucault is better known for his later eclecticism, his early work was actually quite focused in nature. Through his first three books (Mental Illness and Psychology, Madness and Civilization, and The Birth of The Clinic), Foucault develops a holistic criticism of knowledge-power relationships within the context of mental illnesses (Foucault, 2008), the social perception thereof (Foucault, 2006), and the medicalization thereof (Foucault, 2010). These concepts serve as a strong foundation for discourse analysis on the subject of mental and developmental abnormality.
Autoethnographic Reflection Autoethnography is a research method that focuses on situating the author’s lived experiences of a given phenomenon within the extant academic literature on that same topic (Glesne, 2011). Though the specific organization of autoethnographic reflections vary somewhat from author to author, the general structure takes the form of personal narratives that revolve around some significant life event. Sometimes these narratives are presented from the first-person perspective, other times from the third-person perspective, and occasionally in a manner that interweaves both first-person and third-person accounts as is narratively appropriate (Secklin, 2001). Rather than take the perspective of an external and objective observer, as would be typical of social scientific scholarship, autoethnographic scholars reject the artificial separation of researcher and research topic (Ellis & Bochner, 2000). To the contrary, researchers who practice autoethnography embrace subjectivity in its ability to deepen the meaningfulness of unique lived perspectives. This lack of objectivity in autoethnographic methods has created significant resistance to their acceptance in mainstream academic circles, with some individuals even questioning whether or not autoethnographic works technically qualify as research (Campbell, 2017). This resistance is not entirely unjustified. After all, by grounding itself in experiential knowledge rather than experimental rigor, the autoethnographic method does incur a few unique disadvantages. For example, autoethnographic results are not inherently generalizable to any population other than the individual they describe, and autoethnographic papers are often structured toward telling compelling and concise stories rather than providing exact historical accounts of events (Méndez, 2014).
These disadvantages are mitigated, however, when the user’s research objective is not to produce universal and generalizable truths, but rather to raise awareness of individual experiences and issues (Bortolotti & Jefferson, 2019). From this point of view, the inherent subjectivity of autoethnographic reflections becomes desirable rather than disadvantageous. Specifically, by embracing and highlighting subjectivity, autoethnographic research methods are particularly effective in raising the voices of subject groups that would otherwise go underrepresented in the extant academic literature (Méndez, 2014). Autoethnographic reflection is thus well suited for the study of autism spectrum disorder and the individuals with it (Benham & Kizer, 2016). Precious little autoethnographic research exists on the subject of autism, and that which does exist is primarily situated on non-autistic individuals’ experiences of autism from their side of the relationship (Devlin, 2018). There is a clear and present need for the explicit inclusion of autistic voices into academic spaces – the likes of which autoethnography is best positioned to answer. Thus, in this paper, I will be lending my autoethnographic reflections about my autism to the academic space. For the autoethnographic portion of this analysis, I will present a biographic account of my lived experiences with autism, followed by a discussion of how those experiences mirror or contradict the experiences of Dr. Shaun Murphy in The Good Doctor. This account will be presented in a first-person narrative structure with an emphasis on key events, individuals, and conceptual points of transition regarding my identification with autism and what it entails. Though I will strive for historical accuracy in my retelling of these events, I will be consciously omitting the names of other people in my stories such as to protect their privacy.
Rule Imposition As an “autistic surgeon,” Dr. Murphy is held to a wildly different set of workplace expectations than the other members of his medical residency. Every slightest social faux paus he commits is thrown into sharp relief and connected to his autism spectrum disorder, even if the mistake could be otherwise attributed to stress, anxiety, or simple human imperfection. As a result, Dr. Murphy is forced to perform at a constantly higher level of social functioning than would ordinarily be expected of someone at his position and level of training – even though his disorder actually places him at a disadvantage in this regard in comparison to neurotypical others. One might expect that Dr. Murphy’s advocates would reject this label and defend his performance as a human, rather than as an autist. Unfortunately, the defense presented for Dr. Murphy’s acceptance as a “surgeon with autism” is the fact that, on top of his autism spectrum disorder, he also has savant syndrome, which gives him remarkable technical abilities (e.g. memory, analysis, etc.) that are useful for medical practice. Thus, Dr. Murphy is not accepted with his autism, but granted an exception for his potential usefulness. In effect, this notion of exceptionalism as a requirement for entry problematizes both the “autistic surgeon” and the “surgeon with autism” labels. In either case, people with autism are only accepted in the event that they are so useful to neurotypical people that rejecting them would be actively inconvenient for their interests, i.e. “He may be autistic, but he’s such a good surgeon that we include him anyway.” As a result, the bar for autistic participation in the neurotypical society is set so high that these individuals are forced to overperform, in a discipline that is already inherently more difficult for them, in order to even have a chance to speak up for themselves and achieve their goals.
Space Establishment This is not to say, however, that Dr. Murphy’s autism is a central point in all aspects of the program. It is an underlying theme, yes, but it is not always so thoroughly embedded into the narrative as to quash other thematic elements. To the contrary, The Good Doctor frequently presents Dr. Murphy without emphasis of his autism in social situations outside of his workplace – facilitating a discussion of spatial regulation. Specifically, by contrasting the rules applied to Dr. Murphy in these situations from the rules applied to him in the workplace, one can articulate where the boundaries lie in regard to autistic-accepting spaces. For example, the most resonant and recurring non-work engagement that Dr. Murphy has is his semi-romantic relationship with his apartment neighbor Lea Dilallo. Lea is pictured as a reckless character that has a tendency to make shortsighted and emotional decisions. Despite her flaws, however, Lea has a markedly positive impact on Dr. Murphy’s wellbeing. When Dr. Murphy is with Lea, he appears much more well-adjusted in comparison and is allowed to make mistakes without compromising his well-being. Her apartment is thus a space in which being autistic is passively accepted rather than actively acknowledged. When Dr. Murphy attempts to take the confidence he builds with Lea into his workplace, however, he is met with harsh criticism and social rejection. While Lea is far from a wholesome character, she is framed in these scenes in a dangerous and destructive light in comparison to the clean and rigorous environment of Dr. Murphy’s medical residence. The effect of this juxtaposition is to insinuate that individuals with autism can only “be themselves” in spaces that are isolated from their public-facing responsibilities – even to the point that carrying positive aspects of their identity into the workplace can be detrimental to them.
