Naming Without Shaming?

Autism in Sesame Street.

Posted Nov 03, 2015

wikimedia commons
Source: wikimedia commons

This piece is written by Guest Blogger Adam Dickes, philosopher, literary man-about-town and budding clinical psychologist.

Sesame Street has a new character, and her name is Julia. Julia loves playing with her friend Elmo. Elmo enjoys making towers with blocks and knocking them down. Julia likes to line them up in neat little rows.

But wait a second; something's not quite right. When Abby joins their play, Julia’s unusual behaviour is bit puzzling. It takes a long time for Julia to answer questions. Abby starts to suspect Julia doesn't like her? Stranger still, Julia claps her hands over her ears when she hears a loud noise. She flaps her hands around in a strange way. It's all a bit confusing. Can you guess what's going on?

Don't fret. Everything is okay once Elmo explains that Julia has Autism. Sometimes, Elmo explains, Julia needs people to speak slowly using fewer, more simple words. Because she has really good ears, Julia is extra sensitive to sounds. As for the hand flapping, it just Julia's special way of showing she is excited. That’s not so strange; when Elmo is excited, he jumps up and down and Abby does pirouettes.

By the end of the story, we learn that Julia has her own special ways of expressing her feelings, and her own special needs. Once we understand that everyone can get along just fine. As you'd expect from Sesame Street, it's all done very nicely and with great sensitivity.

The story continues a theme of difference that has run through the veins of Sesame Street since its inception — whether it's a difference in skin colour, language, appearance or behaviour. Sesame teaches us that — just like Julia — every one of us has their own particular needs and ways of expressing them. The core message remains the same: when we practice understanding we can all get along.

When challenged to 'out' Bert and Ernie, the show released the following statement: “Bert and Ernie are best friends. They were created to teach pre-schoolers that people can be friends with people who are very different from themselves. Even though they are identified as male characters and possess many human traits and characteristics, (as many Sesame Street Muppets do) they remain puppets and do not have a sexual orientation."

Just as they say, Bert and Ernie are very different. Bert likes to spend time alone, as he finds social interactions difficult. He gets visibly frustrated when Ernie interrupts him in the middle of a task. Because Ernie is an anxious puppet who needs constant reassurance from his best friend, the two of them sometimes rub each other the wrong way. Fortunately these difficulties have not led them to need professional help, and are no sort of barrier to their enduring friendship.

On reflection, it seems reasonable to argue that puppets don't have sexual orientation. Then again, it seems pretty reasonable that they don't have diagnosable psychiatric disorders either.

While this is the first authorised and official psychiatric diagnosis of a Sesame Street puppet, it's not the first time a diagnosis has been made. Ethan Gilsdorf, writing in Psychology Today has suggested that Bert has Asperger’s, while Ernie meets criteria for both ADHD and insomnia. The Count, somewhat obviously, has Obsessive Compulsive Disorder, while Oscar displays behaviour typical of Hoarding Disorder. No wonder he's such a grouch.

Diagnosing puppets proves to be an entertaining past-time, with plenty of room for nuanced differences of opinion, especially when you consider the recent changes made in the DSM-5. Cookie Monster, for example, might now qualify for a dual diagnosis of Intermittent Explosive Disorder to go with his Binge Eating Disorder. Is Oscar grouchy enough to qualify for Oppositional Defiant Disorder? I wonder how he would have fared in the strange situation?

While flippantly diagnosing Sesame Street characters provides a guilty pleasure to people who write psychology blogs, it's something that, up until now, has been done largely in jest. Now Sesame Street has started pre-diagnosing their characters, have the puppets entered a brave new world? And what will it mean for children? Will it promote an understanding and acceptance of difference, or encourage social stigma, name-calling and exclusion?

I'd suggest it's a dangerous path to tread. We already know that diagnostic labels take on a life of their own once they enter everyday culture. It's now common for people to causally diagnose each other as 'borderline' and 'bipolar'. Isn't it natural to expect kids — following Elmo's lead — to do the same? And what should we expect from these playground diagnoses? I'm guessing kids won't be armed with their own psychometrically validated diagnostic self-report questionnaires. So what will happen when children, who rely even more than adults on heuristics and stereotypes to navigate the world, are given the vocabulary of the Diagnostic and Statistical Manual of Mental Disorders?

The word 'retarded' might offer a clue. Once a clinical term technically denoting slowed or delayed learning, it's now a playground insult that means backwards and stunted. It's a word so stigmatized that clinicians in Australia are now advised against using it at all.

Heuristics are simple things. A single word can stand for a single concept that applies to an entire class of things. In a complex world, this can be incredibly useful. Applied to people, it can be incredibly dangerous too, a kind of stereotypical thinking that we teach children to avoid with good reason. Whether it's Ethnicity, poverty or mental illness, encapsulating and totalising people under a single concept ignores their complex individuality. It lies at the very heart of discrimination.

Diagnoses, I'd argue, are dangerous for just this reason. They are labels that clinicians apply to people to simplify their complex, unique set of thoughts, feelings and behaviours, classifying them under an umbrella of traits associated with a clinical category. As research has shown, this can lead to a clinical stereotype that can bias our thinking, pathologise individuals, and increase self-stigma (references).

Autism is just such an umbrella term. It connotes a spectrum that includes people at one end with difficulties in social cognition and intellectual giftedness, and at the other with aphasia and severe intellectual deficits. Carefully managed with reflective practice, balanced by years of scientific and clinical knowledge, it's a heuristic that may help clinicians to address their clients needs and health services allocate resources. Out on the playground, untempered by knowledge, it's a linguistic bomb waiting to go off.

Until now, the writers of Sesame Street have followed the maxim of "show, not tell." If you want kids to be comfortable and understanding about difference, you don’t need to explain those differences. You don't need to stereotype or label them. You simply have to show those behaviours in the context of everyone getting along in a caring, understanding and open-minded environment, and let kids realise that difference needs to be met by understanding.

All kids want to be like other kids. A big part of the struggle faced by kids with autism is that they experience their world differently from other kids. If we can communicate that difference to other kids, without losing sight of the person experiencing the difference, I'm all for labeling autism. My biggest fear is that it's a common human trait to use labels in place of understanding. That's why we need to be very careful when we apply labels to people, especially those without the power to choose a labels for themselves.