Could Someone with Autism Be a Superstar Surgeon? (2024)

The remarkable savant syndrome has come of age. What began as a description of 10 cases by Dr. John Langdon Down in 1887 at the Earlswood Asylum in London culminates now, 130 years later, with Shaun Murphy (Freddie Highmore) as a gifted autistic savant pediatric surgeon in the ABC television series The Good Doctor.

Quite suddenly and conspicuously, books, movies and TV series featuring people with exceptional brain performance, including underlying autism, have become popular depictions. The Good Doctor is based on the 2013 South Korean series by the same name. And there are others as well including The Accountant; Temple Grandin; Life Animated; Gifted; and Mercury Rising to name only a few.

The first movie version of savant syndrome was Rain Man in 1988. In fact, that movie was the first portrayal of autism itself on the big screen. The writer was Barry Morrow who had successfully and sensitively written a made-for-television movie entitled Bill in which Mickey Rooney portrayed Bill Sackter, a lovable and successful person with intellectual deficiency. When Barry met Kim Peek, the prodigious savant who inspired the movie, the decision was made to cast the main character, Raymond Babbitt (Dustin Hoffman) as a person with autism, rather than intellectual deficiency.

But Rain Man aired nearly 30 years ago. Why this sudden renewed interest in savant syndrome? Let’s trace it from its beginnings.

The So-Called “Idiot Savant” Is Born

In 1887 Down gave the prestigious Lettsomian Lecture to his colleagues of the Medical Society of London, reflecting on his many years as an attending physician at the Earlswood Asylum. The physician is better known from that lecture as describing what is now known as Down syndrome—trisomy 21.

But in that lecture he told of 10 other particularly interesting cases that had caught his attention. One little lad could sing back the next day the complicated arias he had heard for the first time at the opera the evening before. Another boy had memorized The Rise and Fall of the Roman Empire verbatim; he could recite it backward or forward. Other children remembered dates and past events with precision. There was a “lightning calculator” as Down termed it. Another had perfect appreciation of passing time without reference to a clock.

In all there were 10 such conspicuous patients in his 30 years of practice who had musical, artistic, mathematical and other varieties of the “idiot savant” as Down termed it. The now regrettable term “idiot” was at that time an accepted scientific term for persons with an IQ below 25. The term “savant” had been derived from the French word savoir, meaning “to know” or “learned person.” The combined term was used to describe the condition for nearly the next nearly 100 years.

Down did not coin the term “idiot savant,” however. As autism researcher Michelle Dawson points out in a 2012 blog post titled, “The Idiot Savant Story,” Edward Sequin, a French physician, used the term idiot savant in 1870 to refer to “musical, mathematical, architectural and other varieties” of “a single faculty accompanied by a woeful general impotence.” In the British Medical Journal in 1875, George W. Graham wrote of “idiot savans” [sic] in whom one or more faculties are amazingly developed to the detriment of the rest.” Others have pointed out that Molière used the expression “un sot savant” in Les Femmes Savantes as far back as the late 17th century.

The Saga Continues

The first definitive book chapter devoted entirely to savant syndrome was in Alfred Tredgold’s 1914 textbook Mental Deficiency (Amentia). There, Tredgold describes at length the gifts of art, music, language, memory, mathematics, calendar calculating and special senses. He also described in detail James Pullen, “The Genius of Earlswood Asylum,” a colorful character internationally known for his drawings, carvings and assembly of model ships, including his masterpiece “The SS Great Eastern.”

The next internationally famous savant was Thomas Bethune, popularly known as “Blind Tom.” He was an accomplished savant musician around the time of the American civil war, and was considered to be the most celebrated black concert artist of the 19th century. At age 11, he played at White House before Pres. James Buchanan, and was subjected to rigorous testing by several musicians, which Bethune passed with perfection.

The first book devoted entirely to savant syndrome was my own, Extraordinary People: Understanding Savant Syndrome. The book was published in 1989, reprinted in paperback and ultimately translated into 11 languages.

In 1988 I published a paper in The American Journal of Psychiatry: “The Idiot Savant: A Review of the Syndrome,” in which I suggested it was time to lay the term idiot savant to rest and substitute savant syndrome. That has largely occurred. The June 2002 Scientific American contained a comprehensive and beautifully illustrated article titled “Islands of Genius” telling the stories of Leslie Lemke, Alonzo Clemons, Kim Peek, Richard Wawro and others. From my perspective it is the gold standard of the many articles on savant syndrome since that time. In 2010 I published my book Islands of Genius: The Bountiful Mind of the Autistic, Acquired and Sudden Savant. It bridges the gap from 1989 to 2010, bringing clinical cases and research up to date. It has been translated into Arabic and Chinese editions, bringing attention to savant syndrome in those parts of the world.

Savant Syndrome 2017

The allure, fascination and intrigue of savant syndrome is the jarring juxtaposition of extraordinary ability and significant disability in the same person, and all that such implies with respect to human potential within us all.

Savant abilities have autism spectrum disorder as the underlying handicap in 75 percent of cases and as high as one in three persons with autism have savant skills. The other 25 percent have underlying conditions such as organic brain syndrome, intellectual disability, dementia or stroke, for example. Not all autistic persons are savants, and not all savants have autism.

The savant skills, most often grafted onto or superimposed on the handicap are remarkable, sometimes prodigious, abilities in art, music, mathematics and visual/spatial/mechanical areas of expertise. Less often, skills, can be in athletic, language, executive functioning or other areas. Whatever the skill, it is always accompanied by prodigious memory. Savant syndrome is not IQ-dependent. Approximately 25 percent of savants have above average IQ.

Savant syndrome occurs in males four to six times as often as in females. The condition can be congenital—present from birth—or can be acquired in adults following head injury, dementia, stroke or other central nervous system incident. The acquired savant hints at the little “Rain Man” within us all. The challenge is to access those dormant skills without head injury, dementia or other CNS incident. And research is underway to do so.

Is It Possible a Savant Could Be a Surgeon?

Yes, indeed it is. In my registry of savants around the world there are a small number with advanced degrees in music, art and mathematics from prestigious universities or conservatories, practicing their craft with distinction. Temple Grandin, for example, is a renowned animal science doctor who lectures and designs animal-handling facilities worldwide.

The limiting reality factor to completing medical school and residency, then functioning as a physician, would be the extent of the underlying disability. With autism, for example, the disability can range from severe (low functioning) to minor (high functioning). Any applicable savant skills would be a plus but not the sole determinant of success.

The good news is that, more and more, society and the workplace have come to appreciate some savant abilities. Rather than seeing such persons as outsiders, outliers or curiosities, they now not only welcome some into the workplace but are actively recruiting them because of their special skills. Again, the final determinant of suitability and success is the extent to which they are “differently abled” rather than disabled.

I have not seen the television series. But when I was asked to be a consultant to Rain Man, I suggested the savant skills be based on real-life individuals—and they were. The toothpick scene, memorizing the phone book, knowing square roots (but not basic math), counting cards and so on were skills from actual savants. There was no need to embellish. Savant skills are conspicuous and meritorious in their own right. My hope is that the doctor’s skills and special expertise depicted on the program will be believable and in bounds. Again, no need to embellish.

So the journey from Earlswood Asylum to the operating room has been a positive one. More savants are coming to attention who have marketable and self-sustaining skills, and the workplace is welcoming them. And for those persons with autism as the underlying disability, the good news is that with early, active intervention, the handicap can be lessened and the savant abilities enhanced.

Meanwhile all of society has become more welcoming and supportive of persons with savant syndrome, whatever the extent of the handicap. And scientists continue to unravel the mystery of the savant, and in so doing will reach a better understanding of both the brain and human potential.