Jodi Picoult - House Rules

I think the same thing is happening now. After years of imagining I’m an alien in this world-with senses more acute than those of normal people, and with speech patterns that don’t make sense to normal people, and behaviors that look odd on this planet but that, on my home planet, must be perfectly acceptable-it has actually become true. Truth is a lie and lies are the truth. The members of the jury believe what they hear, not what’s right in front of their eyes. And no one is listening, no matter how loud I am screaming inside my own head.

The space beneath the blanket feels like it has a heartbeat. In the dark, I find Jacob’s hand and I squeeze it. “Honey,” I say, “we have to go.”

He turns to me. In the blackness I can see the reflection of his eyes. “I didn’t lose my temper with Jess,” he mutters.

“We can talk about that later…”

“I didn’t hurt her,” Jacob says.

I stop and stare at him. I want to believe him. God, I want to believe him. But then I imagine that quilt I sewed for him, wrapped around the body of a dead girl.

“I didn’t mean to hurt her,” Jacob corrects.

Nobody looks into the face of a newborn son and imagines all the things that will go wrong in his life. Instead, you see nothing but possibility: his first smile, his first steps, his graduation, his wedding dance, his face when he is holding his own baby. With Jacob, I was constantly revising the milestones: when he willingly looks me in the eye, when he can accept a change in plans without falling apart, when he wears a shirt without meticulously cutting out the tag in the back. You don’t love a child for what he does or doesn’t do; you love him for who he is.

And even if he is a murderer, by design or by accident, he is still mine.

“Not connecting with his peers,” Helen Sharp says. “Being the center of his own universe. Self-preservation is the one inviolable rule. Temper tantrums and anger management issues… Sounds to me, Dr. Murano, like Asperger’s is the new selfish. ”

“No. It’s not an unwillingness to consider someone else’s feelings, it’s an inability to do it.”

“Yet this is a relatively new diagnosis, isn’t it?”

“It first appeared in the DSM-IV manual in 1994, but it wasn’t new by any means. There were plenty of people with Asperger’s prior to that who simply weren’t labeled.”

“Such as?”

“Steven Spielberg, the director. John Elder Robison, the author. Satoshi Tajiri, who created the Pokémon phenomenon. Peter Tork, of the band the Monkees. They were all diagnosed formally with Asperger’s as adults.”

“And they are all extremely successful, aren’t they?” Helen asks.

“It seems that way.”

“They’ve led very productive lives interacting with other people?”

“I assume so.”

“Do you think any of them have trouble relating to others socially?”

“Yes, I do.”

“Do you think any of them might have experienced a moment where they were picked on, or felt marginalized?”

“I don’t know, Ms. Sharp.”

“Really? Have you seen Peter Tork’s old haircut? I’ll go out on a limb and say yes, they have been teased. And yet none of these men with Asperger’s is on trial for murder, are they?”

“No. Like I said, there isn’t a causal link between Asperger’s and violence.”

“If Asperger’s doesn’t make someone violent, how can it be an excuse for someone like Jacob committing a horrific act of violence?”

“Objection!” Oliver says. “That’s prejudicial.”

“Sustained,” the judge replies.

The prosecutor shrugs. “Withdrawn. Dr. Murano, how did you formalize your diagnosis of Jacob’s Asperger’s?”

“I had an IQ test administered, and an assessment of adaptive skills, to see how Jacob would handle certain social situations. I did interviews with Emma Hunt and with his teachers, to get a sense of Jacob’s history of behavior. Asperger’s doesn’t show up overnight. I saw videotapes of him prior to age two, when he was still meeting developmental milestones for neurotypical children, and then the subsequent decline in behavior and interpersonal connections. And I observed him during a number of sessions, both in my office and at his school in social settings.”

“There’s no blood test, or any other scientific test, that can be administered to see if a child has Asperger’s, is there?”

“No. It’s based primarily on observation of repetitive behavior and interests, and a lack of social interaction that impairs everyday functioning, without a significant delay in language.”

“So… it’s a judgment call?”

“Yes,” Dr. Murano says. “An educated one.”

“If Jacob had seen another psychiatrist, isn’t it possible he or she might have determined that Jacob doesn’t have Asperger’s?”

“I highly doubt it. The diagnosis most often confused with Asperger’s is attention deficit/hyperactivity disorder, and when they put Aspie kids on ADHD medicine and they don’t respond, it’s often clear that the diagnosis needs to be revisited.”

“So the criteria you used to diagnose Jacob were his inability to communicate with other people, his trouble reading social cues, his desire for routine and structure, and his fixation on certain topics?”

“Yes, that’s about right,” the psychiatrist says.

“Say I have a seven-year-old who is completely obsessed with Power Rangers and who has to have his cookie and milk every night before bedtime, who isn’t very good about telling me what happens in school every day or sharing his toys with his younger brother. Does my seven-year-old have Asperger’s?”

“Not necessarily. Let’s say you have two three-year-olds in the sandbox. One says, ‘Look at my truck.’ The other responds, ‘I have a doll.’ That’s parallel play, and it’s normal at that age. But if you study those same two children at age eight, and one says, ‘Look at my truck,’ the appropriate response is something like ‘That’s a cool truck’ or ‘Can I touch it?’ or some other sentence that continues the interaction with the child who made the conversational overture. However, a kid with Asperger’s might still say, in response, ‘I have a doll.’ When the playmate walks away, the kid with Asperger’s won’t understand why. In his mind, he’s responded to the sentence and kept the conversation going. He doesn’t comprehend that what he said wasn’t a valid rejoinder.”

“Or,” Helen Sharp says, “the kid with the doll might just be really self-centered, right?”

“With Asperger’s that’s often the case.”

“But without Asperger’s, it’s occasionally the case, too. My point, Doctor, is that the diagnosis you make and the assumptions you have about Jacob are not based on anything other than your own opinion. You’re not looking at a tox screen or brain waves-”

“There are a variety of psychiatric disorders where clinical observation is the only method of diagnosis, Ms. Sharp. This happens to be one of them. And any psychiatrist in this country will tell you that Asperger’s syndrome is a valid disorder. It may be difficult to describe to someone else in concrete terms, but when you see it, you know what it is.”

“And just to be clear. You feel that having Asperger’s syndrome affected Jacob’s behavior the day Jess Ogilvy was murdered.”

“That’s right.”

“Because Jacob couldn’t handle social situations well. And he wasn’t empathetic. And his frustration sometimes led to anger management problems.”

“That’s right,” Dr. Murano says.

“Which are traits you find in someone with Asperger’s.”

“Yes.”