Dr. Peter Gerhardt waves a credit card in his right hand, animated—as he often is—about the point he’s trying to make. This time, it’s a trick that he guarantees makes it impossible to swipe the card the wrong way. “You can slide it this way, or like this, or stick it in like this”—he jabs straight into the air in front of him, as if into a bank machine—“and if you keep your thumb in this position on the card, you will always swipe it the correct way.”
Closer examination clarifies: the card he is holding is a Visa, and his right thumb completely covers the blue-on-white logo in the lower right corner, the sweet spot that makes the trick work. Keep your thumb there, Gerhardt pronounces, and the magnetic stripe will always line up properly, regardless of the type of card reader.
Gerhardt’s demonstration isn’t intended merely for news-you-can-use convenience. Rather, he’s explaining how using a bank card fits into the bigger picture that has defined his career since he embarked on his doctorate in educational psychology at Rutgers in the early 1980s: the struggle people with autism face to be accepted into a world occupied by “the rest of us.”
The truth is that we often deny to adults with autism the kind of empathy and support we make readily available to children with the condition—or, for that matter, to people with white canes at crosswalks. We underestimate their capabilities, reveal our discomfort in their company, and display impatience when they inconvenience us. The people standing in the back of a long supermarket checkout line aren’t always going to say or do the nice thing when some odd-looking man in front is holding the whole place up because he can’t figure out the credit-card swipe. It’s in that moment, Gerhardt says, that the thumb-on-the-logo trick is a matter of “social survival.” If the man with autism can navigate this situation successfully—and, just as important, be seen doing so—Gerhardt argues that our collective acceptance of people with autism in “our” spaces will tick up a notch. If the man fails, it will go the other way.
Gerhardt, who is a former president of the Virginia-based Organization for Autism Research and is now developing a program focused on adolescence to adulthood at the respected McCarton School in New York, is considered among the top experts in the country working with adults who have autism. But he jokes that this is chiefly because he’s never faced much competition. “I have an entire career,” he says, “based on people not wanting my job.” Child development is the hot area in autism research; working with adults, Gerhardt says, “is not a career move.” Adults present greater challenges: they are big enough to do real violence in the event of a tantrum; they are fully capable of sexual desires, and all that those imply; and they’re bored by many of the activities that can distract and entertain children with autism. “People want to treat these adults like little kids in big bodies,” Gerhardt says. “They can’t. They’re adults.” As such, he argues, they’re equipped, as much as any of us, with the recognizable adult aspiration of wanting to “experience life.”
“It’s having friends,” Gerhardt explains. “It’s having interesting work. It’s having something you want. It’s all the things the rest of us value, once given an opportunity.”
Gerhardt wants priority given to teaching the kinds of skills adults with autism need in order to survive independently: keeping track of money, asking for directions and then following them, wearing clean clothes, navigating public transport, recognizing a dangerous person, and—of extreme difficulty for most—looking a job interviewer in the eye. Gerhardt disputes the doubts he hears even within his profession about encouraging adults with autism to aspire to independence. “What’s the worst thing that can happen?” he asks. “You know—he’s at the supermarket and he drops some eggs, or somebody thinks he’s a little weird. I would rather he be there alone, and only getting nine out of 10 items he came shopping for, than need me there with him to get all 10. That’s a much better way to live.”
This leads to the question of where they will live. As it is, 85 percent of adults with autism still live with parents, siblings, or other relatives. But what happens when that is no longer an option? Large-scale warehousing is gone—and good riddance, most say. An obvious alternative is residential arrangements offering multiple spaces to people with autism, who can share support services under one roof in a setting that really is a home. At present, however, given both start-up costs and resistance from neighbors, the number of spaces in such homes is limited, and landing a spot can be extremely difficult: nationally, more than 88,000 adults are already on waiting lists.
All of which leads to an unsettling answer for those parents asking what happens, after they die, to their children with autism. We don’t really know.
BROTHERS: A recent family snapshot of Donald with Oliver (right)
Most likely, Donald’s name would never have entered the medical literature had his parents not had both the ambition to seek out the best help for him, and the resources to pay for it. Mary Triplett had been born into the McCravey family, financiers who had founded and still controlled the Bank of Forest. Uncommonly for a woman at that time, particularly in that milieu, she had a college degree. After a doomed romance with a local cotton farmer’s son, whom her family forbade her to marry—he later went on to renown as six-term segregationist U.S. Senator James “Big Jim” Eastland—she instead married the former mayor’s son, an attorney named Oliver Triplett Jr. With a degree from Yale Law School and a private practice located directly opposite the county courthouse, Oliver would later hold the position of Forest town attorney and would be admitted to the bar of the Supreme Court of the United States. He was an intense man who had suffered two nervous breakdowns, and who could get so lost in his thoughts that he’d return from walks in town with no recollection of having seen anyone or anything along the way. But as a lawyer, he was considered brilliant, and when he proposed to Mary, her family apparently raised no objections.
Their first son, Donald, was born in September 1933. A brother came along nearly five years later, while Donald was in Sanatorium. Also named Oliver, the baby stayed behind with his grandparents in Forest when, in October 1938, the rest of the family boarded a Pullman car in Meridian, Mississippi, headed for Baltimore. Donald’s parents had secured him a consultation with the nation’s top child psychiatrist at the time, a Johns Hopkins professor named Dr. Leo Kanner.
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.”
“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.