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Diagnosing Arnie Grape from the movie: Whats Eating Gilbert Grape?

Axis I 299.00 Autistic Disorder Explanation for Axis I: page 75 Diagnostic criteria for 299.00 Autistic Disorder A. A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3): (1) qualitative impairment in social interaction, as manifested by at least two of the following: (a) marked impairment in the use of multiple nonverbal behaviors such as eye-toeye gaze, facial expression, body postures, and gestures to regulate social interaction. We see these behaviors throughout the movie in almost every scene. Raymond rarely looks at a person when he interacts. Also, his facial expressions remain blank and unchanging when he is talking to someone. For the rare times he laughs, it seems to be a hollow laugh. (b) failure to develop peer relationships to developmental level with other people Even though Raymond is an adult, his relationships are on a child-like developmental level. Raymond fails to accurately express his feelings. For example, instead of telling someone he likes them, he says, Do you take any prescription medications? when he is trying to have a conversation with Susanna and Iris. Also, people may need to say Raymonds name multiple times before he even acknowledges them. (d)Lack of social or emotional reciprocity Raymond is unable to interact with his brother or the females they meet in an appropriate social way. Even though by the end of the movie, his brother has developed a deep love for him, Raymond shows little reciprocal response to Charlie and seems unable to understand how to show affection. Also, he gets visibly uncomfortable when Charlie starts yelling. He seems oblivious to Charlies concerns over work and getting back to LA as soon as possible. He does not have any idea how difficult he is making it for his brother when he will not get on a plane, will not drive on a highway, or will not go outside in the rain. Additionally, he is unable to pick up on Charlies blatant sarcasm in talking with him. --- Raymond clearly shows 3 out of 4 symptoms from (1). (2) qualitative impairments in communication as manifested by at least one of the following:

(b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others Raymond will often just repeat words or phrases he hears rather than engage in an interactive conversation. He never initiates a conversation unless he is telling someone about a TV show he must watch, a type of food needed at mealtime, or an observation that something is not according to his rituals. However, even when he does this, there is an inappropriate repetitive manner that he uses. Also, he cannot adequately answer the doctors questions about where he wants to go -whether it is with Charlie or back to Walbrook. It seems he cannot separate the two questions. (c) stereotyped and repetitive use of language or idiosyncratic language Raymond for the most part only answers questions with one word yeah or no sometimes answering without truly understanding the question. Unless acting out, Raymond responds in the same tone no matter what the topic is. The only time he responds any differently is during the scene when Charlie discovers Raymond is the Rain Man. Also, he constantly repeats the title of TV shows such as Wheel of Fortune and repeats Whos on first? every time he feels nervous. Additionally, he answers simple questions that have easy answers by simply responding I dont know. ---Raymond clearly shows 2 out of 4 symptoms from (2). (3) restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following: (a) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus Raymond is very rigid when he eats pancakesthe syrup must be on the counter in a precise place before he can eat and he is specific about his use of toothpicks. He has a very restricted and intense interest in certain TV shows, types of foodfor example cheese puffs--and details surrounding airline plane crashes, airline flight numbers, and telephone numbers. He has a preoccupation with circumstances that he believes may be dangerous. He projects one instance such as a specific car crash on the highway onto all related instances of driving on the highway. He has a preoccupation with dates such as his mothers death and the date he left home. (b) apparently inflexible adherence to specific, nonfunctional routines or rituals Raymond must watch certain TV shows at the same time every day and he must eat certain foods at certain meal times every day. He must always have a desk with pens and a notepad of paper in front of him to watch a TV show. (c) Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)

Raymond walks with short hurried steps -- half-shuffling and half-tiptoeing. (d) persistent preoccupation with parts of objects He is transfixed by moving objects such as the dryer in the Laundromat or the street lines when he is in the car with his brother. ---Raymond clearly shows 4 out of 4 symptoms from (3). B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication (3) symbolic or imaginative play. From what I recall, the audience is not informed if these symptoms were present prior to age 3 years, however, I will make that assumption based upon what I saw in the movie. From what I have already stated, we know he has communication problems. C. The disturbance is not better accounted for by Retts Disorder or Childhood Disintegrative Disorder. Raymond does not appear to have a Retts Disorder which is typically found in females and we do not see any evidence of a disintegrative disorder. Axis II 319 Mental Retardation, Severity Unspecified Explanation for Axis II page 49 Diagnostic Criteria for Mental Retardation A. Significantly subaverage intellectual functioning: an IQ of approximately 70 or below on an individually administered IQ test. The audience does not know Raymonds intellectual functioning, so this part of the diagnosis is unclear but it is obvious he has a developmental delay. However, in this quote from page 47, we receive justification-In Pervasive Developmental Disorders (Autistic Disorder), there is qualitative impairment in the development of reciprocal social interaction and in the development of verbal and nonverbal social communication skills. Mental Retardation often accompanies Pervasive Developmental Disorders. B. Concurrent deficits or impairments in present adaptive functioning in at least two of the following areas: communication, self-care, home living, social/interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health, and safety.

With Raymond we see deficits in many areas. As previously mentioned in the Autistic Disorder diagnosis, he is unable to effectively communicate on a peer level with others. He does not carry on or initiate a conversations in a manner related to an adult developmental level and he is unable to clearly understand or answer simple questions. He also avoids eye contact, or even looking at the person when he is trying to interact. Additionally, he is unable to function without supervision i.e. the episode in the crossing walk along with his tendency for wandering. We see him have a few emotional outbursts throughout the movie so it is evident that due to his inability to adequately communicate his feelings, he uses these outbursts as a substitute. We know he abides by strict rituals and rigid schedules that affect the productivity of his daily life. In terms of safety, we see him at risk when he was unable to unlock the door when the smoke alarm goes off. C. The onset is before age 18 years. We know this is true for Raymond. Due to his unknown IQ level, I diagnose Raymond with Mental Retardation, Severity Unspecified 319 from page 49. Mental Retardation, Severity Unspecified can be used when there is a strong presumption of Mental Retardation but the persons intelligence is untestable by standard tests. Page 49.

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