Keep Clear
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Despite many clinicians expressing doubts about his paper Dr Wakefield continued to defend it. However, a robust British Medical Association study, which examined research from a hundred and eighty countries, eventually found no evidence for the proposition that the MMR jab was associated either with autism or inflammatory bowel disease.
Ten of the study’s twelve co-authors finally disowned its conclusions, and the Lancet announced that it was retracting the 1998 paper. In January 2010, twelve years after Wakefield’s initial report, Britain’s General Medical Council called his work ‘irresponsible’ and ‘dishonest’. The British Medical Journal said the whole fiasco was ‘an elaborate fraud’, and Dr Wakefield was struck off the medical register.
Although Andrew Wakefield’s findings could not be, and never were, repeated by others, he has long continued to reject all the criticisms made about him, and despite repeated studies exonerating the MMR jab from any link with autism, a survey revealed that ten years after the first doubts were raised a quarter of Americans still believed that the triple vaccine could cause autism. There again, a 2011 Associated Press–GfK poll showed that more than three-quarters of them believed that angels are real. Research into autism, its causes, and its fascinatingly mysterious nature deserves better than wishful thinking, dishonesty, and wilful ignorance.
Many treatments for autism have been tried over the years, including special diets, various drugs, and, one suspects, more best-quality snake oil. Almost all have proved entirely useless. People have tried wrapping autistics in wet towels, burying them up to their necks in sand, and, of course, a range of Freudian whimsies. One Swiss parent wondered whether his son’s condition might have been occasioned by his grandfather having gone to bed with a nun.
What is needed here is proper scientific investigation, not hopeless piffle like this. The research field is vast, ranging from the science of the brain, to social behaviour, to the huge variety of presenting profiles across the spectrum, from the speechless, intellectually impaired epileptic girl who bites her mother and cannot look after herself, to the brilliant oddballs in the Asperger’s part of the spectrum: the strange but dazzling film director, the weird but inspired interpreter of Bach on the piano, or the very odd, focused, and incredibly brainy politician.
A remarkable case of success in the arts coupled with social imagination problems and late diagnosis of Asperger’s is nicely illustrated by the case of the boy from a smoky Welsh steel town who became a Hollywood actor.
Anthony ‘Tony’ Hopkins was born on New Year’s Eve 1937, in a suburb of Port Talbot, an industrial seaside town on the eastern margin of Swansea Bay. ‘I was a poor learner,’ he says, ‘which left me open to ridicule and gave me an inferiority complex … I grew up absolutely convinced I was stupid.’ He told Franz Lidz of the New York Times that he was ‘an angry, unsettled boy full of rage’ and that he’d had a ‘useless and thoroughly confusing childhood’. ‘I couldn’t understand what everybody was talking about,’ he said. Much of this rings bells with me.
In a 2017 interview with Bruce Fessier of the Desert Sun, Hopkins mentioned in passing that he had been diagnosed in his seventies with Asperger’s syndrome. To many people this must have sounded implausible. How could this successful, articulate, witty man, who looked and seemed perfectly normal, be autistic?
Hopkins describes himself as a ‘high end’ Asperger, meaning that his distinctive troubles and their cause were not immediately apparent under the gloss of ‘normality’ and professional success. Even so, his underlying problems are classically autistic.
He was a very isolated child who was never really close to anyone, and for the most part this has lasted into adulthood. ‘I don’t have many friends,’ he says, ‘I’m very much a loner … I don’t go to parties.’
Having failed to shine academically, Anthony Hopkins sought refuge in painting and drawing. He was also a very good pianist. He says that if he had been ‘clever enough’ he would have gone to music college. ‘As it was,’ he continues, ‘I had to settle for being an actor.’
He studied at the Royal Academy of Dramatic Art in London before earning a crust in a repertory company, where he was spotted by Laurence Olivier, who asked him to join the National Theatre.
Perhaps inevitably, Hopkins never fitted in with the theatrical establishment. ‘I was never sure what the hell I was,’ he said. ‘That led to years of deep insecurity and curiosity. I could never settle anywhere. I was troubled and caused trouble, especially in my early years.’ Though I have never caused trouble — at least not on purpose — this sums up the way I felt as a young man.
Hopkins got on more happily in films, his portrayal of serial killer Hannibal Lecter in The Silence of the Lambs (1991) earning him great popular acclaim. On seeing the film his mother reportedly told him, ‘I always knew you were strange.’
As well as strangeness, Anthony Hopkins has been blessed with some other remarkable endowments. He is a good composer and has written his own film music. When John Crace of The Guardian asked him what kind of conductor he might have made he replied, ‘One who knew the names of every member of the orchestra …’
His phenomenal memory is well known in the film business. In Steven Spielberg’s Amistad Hopkins astounded director and crew with his one-take, word-perfect performance of a seven-page monologue.
You might object that any stage actor would be used to memorising lengthy speeches, but Hopkins’ memory is more curious than this. For example, he has a great facility for recalling times and dates. Gaby Wood, interviewing him for The Guardian in 1998, remarked that he was, ‘an addict of detail’ and referred to his ‘intricate, rigorous method’ and his ‘rigid control’.
Rigid control and attention to detail are attributes typical of Aspergers, who are, for instance, often consumed by their need to keep good time. Anthony Hopkins is always crisply punctual. This too we have in common.
Among his other interests are painting, driving alone in his car for thousands of miles at a time, and watching the same Carry On films and Tommy Cooper shows over and over.
On casting him in his 1995 film Nixon, Oliver Stone said he had noticed Hopkins’ ‘aloneness’ and wanted him for that reason. In using the word employed by Leo Kanner to characterise his autistic boys half a century before, Stone was homing in on something central to Hopkins’ human makeup.
He was perfectly cast in The Remains of the Day (1993) as an apparently unempathic, diffident, buttoned up, rigid, rule-mad, fastidious, pedantic butler, a man who, when the woman he secretly loves offers to put flowers in his room, says flatly, ‘I prefer to keep things as they are.’
Hopkins was once a heavy drinker, but he no longer drinks and has mellowed since his troublesome youth. Perhaps finding his niche has done it. Life as a square peg in a series of round holes is enough to make anyone tense, and with understanding comes acceptance. ‘I don’t feel that awful kind of angst — like I was on the wrong planet — that I felt for years. I feel now I belong somewhere. I belong in my own skin … It’s a solitary life, but I love it.’ This is a cheering message for anyone with Asperger’s syndrome.
*
I look up from my bulging folder of notes as Sarah comes back into the room with a sheet of paper. The weather being pleasant, one of the windows in her office has been open since I sat down, the breeze stirring the curtain from time to time. All at once there is a noise, and from the corner of my eye I spot a sharp movement. A starling is standing on the tabletop: dark with white speckles and a beady eye. A mane of iridescent feathers shimmers in a rainbow of greasy blues, greens, and purples, contrasting with its dusky plumes below. Finding itself in unexpected company, the creature is as surprised as we are. It stands alert, with talons spread, taking in the situation.
Being closer than Sarah, I rise slowly from the seat, the folder in my hand. I have a vague idea that I will shoo the animal out of the window, but as I approach it star
ts in alarm, takes off, and settles on the cornice of the bookcase.
Without a word, Sarah extends an empty box file. Taking the file, I creep towards the starling, expecting it at any moment to fly from its perch back to the table. We could be here all day. But, as I close in, the bird sags resignedly and I drop the open box file over it, sliding the folder underneath. Sarah has the window open wide and is holding aside the curtain. Gingerly lifting the apparatus, I cross the room and reach out into the fresh air, lifting off the folder. But the bird just blinks at the vista without moving. ‘Go on bird,’ I say encouragingly, ‘Fly!’
‘Fly away bird,’ says Sarah.
With a sudden blink, the animal launches itself into the fresh air and is away, free. I close the box file. On the spine I see the word, ‘ASPERGER’S’.
‘We’re a great team,’ I say.
‘You did it all yourself,’ says Sarah.
Before the meeting she had asked me to fill in a couple of questionnaires. The first is known as the Autism-Spectrum Quotient or just Autism Quotient (AQ). Together with evidence gathered from an interview, and from family members if possible, the questionnaires form the Adult Asperger Assessment (AAA).
The Adult Asperger Assessment and the Autism Quotient were both developed by Professor Simon Baron-Cohen and his team at Cambridge University’s Autism Research Centre. The AQ is a short, easy-to-complete test, which anyone of average intelligence can do themselves in minutes. It was developed in the nineties and took off in 2001 after it was published in the technology magazine Wired, alongside an article amusingly entitled, ‘The Geek Syndrome’. This headline is, like many headlines, somewhat misleading, since not everybody with Asperger’s fits the geek stereotype, though perhaps more than a few of Wired’s editors and readers do.
The AQ is designed to measure the extent of autistic traits in adults — there are versions especially for children — and its fifty questions examine five particular areas: social skills, communication skills, social imagination, attention to detail, and attention switching (tolerance of change). These are areas in which the autistic brain tends to perform differently from the more typical brain.
For all its simplicity the test has been found to be a reliable indicator of autistic traits and is now widely used, sometimes as a self-test by people wanting a quick confirmation of something they have long suspected. The Autism Research Centre’s website takes pains, however, to point out that the AQ was designed to be a descriptive rather than a diagnostic measure, warning that none of its test scores on their own will positively identify autism. People who are concerned or who need advice are recommended to talk to their family doctor or, in the UK, the National Autistic Society. I guess that a certain amount of this qualification may be, to use a technical legal term, ‘arse covering’.
Here below is what the AQ looks like. It contains fifty forced-choice questions. You must tick one box for each question. There is no time limit, and if you would like to take the test yourself, the scoring method appears at the foot.
I prefer to do things with others rather than on my own.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I prefer to do things the same way over and over again.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
If I try to imagine something, I find it very easy to create a picture in my mind.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I frequently get so strongly absorbed in one thing that I lose sight of other things.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I often notice small sounds when others do not.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I usually notice car number plates or similar strings of information.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
Other people frequently tell me that what I’ve said is impolite, even though I think it is polite.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
When I’m reading a story, I can easily imagine what the characters might look like.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I am fascinated by dates.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
In a social group, I can easily keep track of several different people’s conversations.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I find social situations easy.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I tend to notice details that others do not.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I would rather go to a library than to a party.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I find making up stories easy.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I find myself drawn more strongly to people than to things.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I tend to have very strong interests, which I get upset about if I can’t pursue.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I enjoy social chitchat.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
When I talk, it isn’t always easy for others to get a word in edgewise.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I am fascinated by numbers.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
When I’m reading a story, I find it difficult to work out the characters’ intentions.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I don’t particularly enjoy reading fiction.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I find it hard to make new friends.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I notice patterns in things all the time.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I would rather go to the theatre than to a museum.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
It does not upset me if my daily routine is disturbed.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I frequently find that I don’t know how to keep a conversation going.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I find it easy to ‘read between the lines’ when someone is talking to me.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I usually concentrate more on the whole picture, rather than on the small details.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I am not very good at remembering phone numbers.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I don’t usually notice small changes in a situation or a person’s appearance.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I know how to tell if someone listening to me is getting bored.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I find it easy to do more than one thing at once.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
When I talk on the phone, I’m not sure when it’s my turn to speak.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I enjoy doing things spontaneously.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I am often the last to understand the point of a joke.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I find it easy to work
out what someone is thinking or feeling just by looking at their face.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
If there is an interruption, I can switch back to what I was doing very quickly.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I am good at social chitchat.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
People often tell me that I keep going on and on about the same thing.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
When I was young, I used to enjoy playing games involving pretending with other children.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I like to collect information about categories of things (e.g. types of cars, birds, trains, plants).Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I find it difficult to imagine what it would be like to be someone else.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I like to carefully plan any activities I participate in.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree
I enjoy social occasions.Definitely agree / Slightly agree / Slightly disagree / Definitely disagree