Slide 2: When compulsive workaholic Charlie Babbitt (played by Tom Cruise) learns that his estranged father has passed away, he returns home. Here he discovers he has an older brother named Raymond (played by Dustin Hoffman) who is diagnosed as “high-level autistic savant.” As the brothers travel across the country, both the viewer and Charlie both learn about the many facets of autism including the necessity of routine, communication difficulties, social interaction, and “definitely” the ability to bond.
1. A physical or mental impairment that substantially limits one or more major life activities; or
2. A record of physical or mental impairment that substantially limits a major life activity.
Autism and autism spectrum disorder (ASD) are both general terms for a group of complex disorders of brain development. These disorders are characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviours. They include autistic disorder (sometimes referred to as “classic autism”), Rett syndrome, childhood disintegrative disorder, pervasive developmental disorder-not otherwise specified (PDD-NOS) and Asperger syndrome. ASD can be associated with intellectual disability, difficulties in motor coordination and attention and physical health issues such as sleep and gastrointestinal disturbances. Some persons with ASD excel in visual skills, music, math and art.
Slide 4:
Health Perception and Health ManagementClient’s perceived pattern of health and well-being and how health is managed: From a young age, Raymond Babbit has been living in a mental health institution meant to care for his needs. When he and Charlie start their cross country travelling, Charlie quickly learns important factors concerning the care of autistic individuals. These include difficulties with communication (standing in the middle of the street amidst honking cars), necessity of repetition (“definitely”), difficulties with social interaction (unable to make eye contact), the lack of or issue with physical contact (shying away from contact by Charlie in the casino), and the profound ability for attention and detail (counting cards in the casino).
Nutritional/Metabolic
Pattern of food and fluid consumption relative to metabolic need: Other than his autism diagnosis, Raymond Babbit looks to be a perfectly healthy individual. He eats regular meals (with a preference for pancakes and maple syrup). He has lived in an institution for most of his life so his needs were monitored and maintained by doctors up until his release into the custody of his brother. At no time during the film does Raymond ever look to be unhealthy or suffering from any other dysfunction besides autism. As this is a Hollywood film portraying autism as its central focus, viewers must remember its focus is as entertainment and not a documentary; so it may have some faults medically-speaking.
Slide 5: EliminationPatterns of excretory function, including perception of normal functions: While autism can play host to a number of medical disorders, Raymond Babbit does not appear to exhibit them. One of the most common health risks associated with autism is gastrointestinal distress. It affects up to 85 percent of children and symptoms range in severity from a tendency for chronic constipation or diarrhea to inflammatory bowel disease. Pain caused by GI issues can prompt behavioural changes such as increased self-soothing (rocking, head banging, which is sometimes exhibited by Raymond) or outbursts of aggression or self-injury. (Autism Speaks, 2014)
Activity/Exercise
Patterns of Activity, Leisure and Recreation:
Raymond Babbit emphasizes throughout the film his desires to maintain his rituals:
- On Mondays, he must have pizza for dinner;
- The maple syrup must be on the table before the pancakes arrive
- He must be able to sleep by the window each night
- He exhibits higher than normal functioning when it comes to numbers (Casino, toothpicks)
- He won’t go on an airplane that is not Qantas Airlines (Out of Australia)
- He refuses to buy underwear other than at a specific K-Mart
Slide 6:
Cognitive/PerceptualSensory-perceptual and cognitive patterns: Raymond’s rituals extend the journey and cause issues throughout the film 1. Raymond refuses to board an airplane because he believes it will crash; the only plane he will board is Qantas, which means he would have to fly to Australia. 2. Raymond refuses to go outside when it rains3. The repetition: a. “Who’s on First” whenever he’s put into an unfamiliar roomb. Repetition of the word “Definitely”
Sleep/Rest
Patterns of sleep, rest and relaxation: Raymond appears to exhibit normal patterns of sleep, though they are inflexible. He insists on sleeping by a window each night. Aside from a nightly adventure investigating moaning sounds coming from Susanna’s hotel room, there is not a lot of focus on his sleep patterns throughout the film.
Role Relationships
Sexuality/ReproductivePatterns of satisfaction and dissatisfaction with sexuality pattern: On two occasions, Raymond has what could be described as the closest sexual encounter he has ever had. 1. Kissing Susanna in the elevator at the casino2. Walking in on Charlie and Susanna while they are having sex
Coping/Stress Tolerance
General Coping Pattern and effective of the pattern in terms of stress tolerance: The ways and degree to which Raymond values his daily rituals is how he copes with stress in an environment he does not understand and has not been exposed to for 20 years since he entered Walbrook.
- Repetition of words “definitely,” Repetition of phrases to emphasize points. “Who’s on first.”
- He is fixed in his routines: he must have the meal of the week, he must have syrup on the table before the pancakes get there
- Avoidance tactics: He won’t get on an airplane because he believes there is a possibility it may crash, therefore he insists on a long car road trip.
Value/BeliefsPatterns of values, beliefs and goals that guide client’s choices and decisions: From the start of the film, Raymond is ostracized by his father for burning baby Charlie as a baby. Both sons have been neglected and disowned by their father. He has lived in a mental health institution for twenty years, and as a result does not have much of a concept of family. By the end of the road trip and the film, Charlie and Raymond have really connected and learned about connections and love in their family. Charlie learns that perhaps Raymond has had the capacity for brotherly love and the concept of family since they were both little, when he discovers his brother was “the rain man” that sung to Charlie when he was little.
Normal Health Patterns vs. Non-Normal Health Patterns
Normal Patterns:
- Repetition of words and phrases: “Definitely,” “I am an excellent driver”
- Lacks emotional and social skills: at the start of the film he did not react when
- He was told about his father’s death
- He did not respond when addressed in the first meeting with Charlie
Non-Normal Health Patterns:
- Using his attention to detail to count cards in a casino
- Using his penchant for honesty and a lack of social convention to admit the cheating to a prostitute in the casino bar.
Slide 11:
Proper Nursing Diagnosis:
Savant Syndrome:
“Savant syndrome is a rare condition in which persons with serious mental disabilities, including autistic disorder, have some ‘island of genius’ that stands in marked, incongruous contrast to their overall handicap. As many as one in 10 autistic persons have such remarkable abilities in varying degrees, although savant syndrome occurs in other developmental disabilities or central nervous system (CNS) injury or disease as well. The 1989 movie Rain Man made “autistic savant” a household term. “(Treffert, 2014)
Slide 12: Health Promotion Practices
Health Promotion Practices for Raymond Babbit:
Stay with his brother Charlie.
“You guys have already made up your minds. I’ll see you in court. My brother came further with me in a week than he did with you in 20 years. That’s the truth. . . . I had a father I hardly knew. A mother I didn’t know at all. I found out a few days ago that I have a brother, and I want to be with him. And I’m supposed to give him up? [] I didn’t hurt him. He’s not hurting me. We’re not hurting you. Why are you interfering? This is my family.” (Rain Man, 1988)
Health Prevention Practices for Raymond Babbit:
Autism cannot be prevented; it is a biological syndrome children are born with. Research and practices have been implemented to better understand and deal with many issues surrounding autism.
Slide 13:
Health Maintenance Practices for Raymond Babbit:
Proper management of those diagnosed with any sort of ADS is important to both the individual and their loved ones. Proper education and support from paediatricians, educational psychologists, occupational therapists, speech therapists and physiotherapists can greatly improve the quality of life.
Applied behavioural analysis – Using motivational tools to reward achievement. It should be started as early as possible after diagnosis. There are some specialised schools which use this method extensively.
Early start Denver model – Combination of applied behavioural analysis with developmental and relationship based approaches. It is aimed at toddlers and uses a developmental curriculum using the principles include bringing the child into interactive social relationships, using positive emotional exchanges, and developing joint play activities to target deficits. It has been shown to improve cognitive performance, language skills and adaptive behaviour skills in some young children with autism.
TEACCH method (= T reatment and E ducation of A utistic and C ommunication related handicapped CH ildren) - this approach emphasises organisation of the child's physical environment by using predictable sequences of activities to develop a routine.
Interventions supporting communication: use of visual augmentation. The picture exchange communication system (PECS) is a system of easily recognisable pictures which the child uses to communicate. This may help to reduce frustration and anxiety in autistic individuals.
Speech and language therapy: promoting functional communication in normal environments.
Social skills: interactive play, responding to social overtures, and initiating and maintaining social behaviour.
Occupational therapy: focuses on development and maintenance of fine motor and adaptive skills. It can also look at problems of processing and integrating sensory input.
Final Slide:
For Raymond Babbit’s treatment, I would recommend a combination of occupational therapy and the TEACCH method.
1. Occupational therapy would benefit Raymond as he has a strong basis for developmental skills, but needs to work on the very fine motor skills necessary on a daily basis, i.e. Walking and some shaking. OT would also help him regulate his sensory input. OT would also help him regulate his sensory input which would improve his capacity for stress.
2. The TEACCH method would benefit Raymond as it will increase his already strong skills in his attention to detail and propensity towards numbers. As Raymond does prefer to have routines in his daily life, this method would work quite well for him.
