Could A Savvy Surgeon Have Autism & Savant Syndrome?
By Robin Jay
Compelled like many Americans by ABC’s The Good Doctor TV series, I researched whether the premise of the storyline was possible in the real world. I found the answer in a recent issue of Scientific American: “Could Someone with Autism Be a Superstar Surgeon?”
Remarkably, the author, Darold A. Treffert, M.D., is the psychiatrist who served as the medical consultant for the iconic 1988 movie Rain Man starring Dustin Hoffman – a story that shed tremendous awareness about savant syndrome. Dr. Treffert is also author of Islands of Genius: The Bountiful Mind of the Autistic, Acquired, and Sudden Savant and founder of The Treffert Center, a savant institute in Fond du Lac, Wisconsin, dedicated to better understanding the exceptional mind. I was thrilled when he accepted my invitation for an interview.
Q: Dr. Treffert, please describe what savant syndrome is and how it relates to autism. What causes the brain to have both aspects of genius and disability simultaneously?
Dr. Treffert: Savant syndrome is a rare but remarkable condition in which astonishing “Islands of Genius” and ability exist in striking juxtaposition with underlying disability. In about 75 percent of cases, the underlying disability is autism, but it can also be dementia, cognitive disability, head injury, tourettes, or other central nervous system disorders. The special abilities, such as music, art, mathematics and calendar calculating are superimposed on the underlying disabilities.
In both congenital and acquired savants, the etiology is what I call the “three Rs.” There is brain damage most often in the left brain. Then there is Recruitment of undamaged brain tissue elsewhere, most often in the right brain; then there is Rewiring to that newly recruited undamaged brain tissue; and finally Release of dormant abilities from the undamaged tissue.
We all have buried, dormant abilities, what I call ‘the little Rain Man’ within us all. We don’t start life with a blank slate and become only what we put on our brain with learning and experience. The brain comes loaded at birth with factory installed software in various amounts and types – placed there through genetic, inherited knowledge.
Q: In Scientific American, you write that it could be possible for a person with savant syndrome and high-functioning autism to achieve a career as a physician/surgeon. Please explain why this is possible.
Dr. Treffert: The limitation in persons with savant syndrome is the underlying disability. But that disability can range from mild to severe, and when the autism or other underlying disability is in the mild range, the person can be very high functioning. IQ can range from the 50s to 140+. And the abilities likewise can be mild to prodigious. In the case of the prodigious savant, if there was not any disability present the person would be classified as a ‘genius.’
In most cases, the skills are music, art or mathematics, and most savants excel in those areas. I know of three savants who have graduated from the Berklee College of Music and are pursuing successful music careers. Another savant in Australia has his Ph.D. in mathematics. He works now in a high level in government in a security position. Temple Grandin has her Ph.D. in animal science and has designed a majority of animal handling feedlots in the world. So it is not unexpected that if a high-level functioning savant chooses to go to medical school that he or she could graduate from there and move on to a residency. Whether the chosen specialty would be surgery would depend on the same variables that other medical students use to choose their specialty. There would not be any special calling to surgery on the part of savants.
Q: Have you seen an episode of The Good Doctor? How accurately do you feel the portrayal of the lead character with autism and savant syndrome is?
Dr. Treffert: In my view, the portrayal of the lead character in The Good Doctor is a very satisfactory one, both the underlying autism and the always superimposed savant syndrome. When I was asked to be a script consultant to Rain Man, it was because the executive producer wanted the film to be accurately and sensitively done. She did not want to upset or disrespect family or caregivers, or persons with savant syndrome, nor have the film in some way have savants be comical or made fun of.
Rain Man succeeded on both counts. The film throughout treated the relationship between the two brothers sensitively. Some scenes and particularly some savant abilities were changed to accurately depict savant abilities in real, living savants rather than concocted abilities. I was especially concerned that the savant abilities not be embellished beyond credibility or belief. The real savant abilities – memorizing the phone book, counting fallen toothpicks, computing square roots, counting cards, remembering airline crashes etc. etc. – are astonishing enough. No need to invent or embellish.
One concern I have about The Good Doctor (and originally in Rain Man) is that scenes or events should not be embellished beyond belief. I would be cautious about sidewalk surgery, miracle cures, magical procedures etc. Applying his encyclopedic memory to obscure conditions, or his ability to recognize patterns to MRIs, or linking history to symptoms in uncommon ways, could be astonishing, yet credible. Unusual bedside manner could be depicted with unexpected medical results. So far, I think over embellishing and inventing has been generally avoided and I hope that will continue.
A second concern is that with some unanticipated successes as a doctor in certain cases, and continual interaction and acceptance by (most) peers, there should be change and emotional growth in the good doctor over time. Rather than the typical autistic symptoms of rigidity, ritual, need for sameness and emotional distancing continuing unabated, there should be gradual improvement in those symptoms so the main character doesn’t remain indefinitely type cast and unchanged in traits and behaviors. Some of those changes occur just with successful interactions. Some require work on the good doctor’s part (for example, if there is lack of eye contact, the good doctor works specifically at that). So over time, the good doctor will become an even better doctor.
Overall, I think The Good Doctor is a positive portrayal of autism and savant syndrome and provides better identification and education about both conditions, along with a just generally good entertainment objective. The movie Rain Man is the best thing that ever happened to autism. It put that condition solidly on the international radar screen and ‘autistic savant’ became household terms. It did that better than any other formal public education effort could have done. The Good Doctor highlights more savant syndrome than autism, and I welcome that exposure toward better understanding and appreciation of savant syndrome for the extraordinary and exceptional condition of the human brain and mind that it is.
With savant syndrome, we have come a long way from the original term ‘idiot savant.’ In a 1988 paper in the American Journal of Psychiatry titled The Idiot Savant, A Review Of The Syndrome, I reviewed all the medical literature on that condition to that date. In it, I suggested the term ‘idiot savant,’ which was outdated and unkind, be given a decent burial and ‘savant syndrome’ be substituted. That happened and I think the accurate and sensitive, unembellished portrayal of savant syndrome by The Good Doctor elevates information about and appreciation of savant syndrome to new heights in its role of better understanding both the brain and human potential.