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| Journal of the New Zealand Medical Association,
12-October-2007, Vol 120 No 1263
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Did Janet Frame have high-functioning
autism?
Sarah Abrahamson
Janet Frame, the New Zealand author (1924–2004) was a
complex figure. She spent many years in mental institutions, with a diagnosis of
schizophrenia, which was later disproven. No alternate diagnosis has been widely
canvassed. I propose that she had definite signs of another diagnosis:
high-functioning autism, also known as Autistic Disorder.
The text regarded by experts in this field as the definitive
guide to high-functioning autism spectrum disorders
(ASDs)1, and the DSM-IV TR criteria for
Autistic
Disorder2 have been used as sources of
comparison with Janet’s symptoms and signs. Her combined autobiographical
works (To the Is-land, An Angel at My Table, and The Envoy from
Mirror City3) have been examined, and her
autistic features discussed.
High-functioning autism and Asperger’s disorderThere are a number of different terms for high-functioning
autism spectrum disorders (ASDs), also known as Pervasive Developmental
Disorders; the term “high-functioning” indicating an IQ of greater
than 70.
Terms in common use include high-functioning autism,
Autistic Disorder, Asperger’s Disorder, and Asperger’s Syndrome.
High-functioning autism is partly differentiated from Asperger’s Disorder
or Syndrome by the possible presence of significantly delayed language
development.
The key symptoms and signs of high-functioning autism are
described in Text Box 1.
Table 1. High-functioning autism in
adults
 The autobiographiesTo the Is-land (1982)
In the first volume, Janet described having significant
childhood language difficulties, and very likely a language delay. She
mispronounced many words. She also could not remember when she learnt to read,
having done so very early. This may indicate that she had hyperlexia, an
advanced ability in word recognition with relatively poor comprehension, which
occurs frequently in those with autism.
The title of her first autobiographical volume, To the
Is-land, reflected her preference for the written form of words to the
spoken; she insisted on mispronouncing “Island” as it was spelt, and
took some persuading that the “s” was silent.
From an early age, Janet developed a strong interest in
poetry, which was to become a lifelong interest. This appears to have been
sufficiently intense to be considered an autistic “special
interest”. She did not feel that she had imagination, in common with many
people with autism. To compensate for this deficiency she analysed poetry to
determine how she could seem more imaginative and artistic. She was also
talented in maths, common in autism.
Janet struggled socially at school, as do many with autism.
She described being picked last for activities, and had only one close friend in
her school years. She interacted with her brother and sisters, but describes her
happiest times as those she spent alone, sitting on a hill, or with animals. The
animals in Janet’s life have a significant role in her books: in common
with many people with autism she found it easier to be with animals than with
people.4
Janet’s social and communication difficulties do not
appear to be have been shared by any of her siblings, who she described as being
average children. Her father, however, seemed to have autistic tendencies. He
had little understanding of the humour in everyday life. He also had great
difficulty expressing appropriate emotions; for example, when trying to express
fondness and concern for his wife, it came out as ridicule. Janet came to
understand her father more than her siblings, and forgave him for what was
perceived by others as a lack of caring.
An Angel at My Table (1984)
Janet’s difficulties in interacting with people in
adult life are a major theme in her autobiographies. She described being afraid
of even going into her University Student Union in Dunedin. She made no friends
at Teacher’s Training College, and was unable to socialise with her fellow
teachers on school placements.
Being unable to form a useful relationship with anyone in
her student years, Janet drifted into counselling sessions with her psychology
tutor. She was thankful that someone took an interest in her, especially a young
man. She made every effort to continue this attention, even reading about
schizophrenia and fabricating some of the symptoms to ensure she had his
attention.
This situation unfortunately resulted in an admission to the
psychiatric hospital in Dunedin. The doctors here concluded that she did not
have a mental illness. When she was about to be discharged home, however, she
became agitated with her mother and lost her temper, dreading going home to the
stresses of her family: such outbursts are common in those with autism when
under stress. This was seen as a sign of madness, and she was committed to
Seacliff Hospital.
Janet’s situation deteriorated from here. She had only
a precarious grasp of normal social interactions, and these deteriorated in the
company of those with mental illness and intellectual disabilities. She was
taken away from her lifelong special interest of literature, thus adding to her
loss of sense of self. She appears to have become depressed during this time,
and taken on many of the dysfunctional behaviours of those around her.
During this time, her doctors had arranged a pre-frontal
leucotomy, a form of psychiatric surgery in use at the time for certain
conditions. This surgery was prevented only by her winning a literary award for
one of her books.
Janet was eventually discharged from hospital with the
stigma of having schizophrenia. Her family, who were her only supports, treated
her differently from before, and she found it difficult to relate to them. She
subsequently moved to Christchurch, where her only way to get help with the
stresses of everyday life was to present to a psychiatric institution, where she
was again admitted. By the end of her years in hospital, she has spent 9 years
of her life as a psychiatric inpatient.
Eventually Janet moved to Auckland, where she was positively
influenced by another author, Frank Sargeson. He introduced her to the lifestyle
of a writer and to non-threatening social contact with colleagues, where she
could stay in the background if she did not feel comfortable speaking. Frank
encouraged Janet to apply for a scholarship to go to the UK.
The Envoy from Mirror City (1985)
Janet’s experiences in the UK and Europe were largely
positive. She was admitted electively to a prestigious psychiatric hospital, the
Maudsley, where she was able to speak at length to sympathetic doctors. Her
doctors helped Janet to understand that she did not have schizophrenia. They
were not able to provide her with any other label, which left Janet feeling
lost, as she was sure by this stage that she was different from other people.
Her doctors were, however, able to help her determine her differences, and to
accept them without feeling that she should be the same as others.
One doctor advised her that she should live alone, and not
socialise if she didn’t feel like it; a common way for autistic people to
lead a happier lifestyle.
During her time in the UK and Europe, Janet formed several
significant, but short-term, relationships. She moved to Spain, and formed a
friendship with an American artist, based on their mutual artistic experience.
She also developed a romantic relationship for the first time, at aged 33, with
another young American, Bernard, who shared her interest in poetry. He was not
as enthusiastic in the relationship as her, and he returned to the US.
Janet also formed friendships with the locals in Spain and
Italy. She found that they were able to forgive her social inadequacies, partly
because they appreciated her making the effort to speak their language, and
because her social difficulties were hidden among the language and cultural
differences.
Returning to London after her time in Spain and Italy, Janet
continued her platonic relationship with an Irish man, Patrick, who also
appeared to have autistic tendencies. He expressed his fondness for Janet by
sending her food parcels, buying her useful objects and attempting to control
her life rather than in words. He did not attempt to start a romantic
relationship, but seems to have simply appreciated the company of a like-minded
person. He reminded her of her father, who also had autistic tendencies.
However, Janet did not especially like Patrick, and when he attempted to become
more controlling she ended the friendship.
Eventually Janet settled into a more autistic, solitary
life, spending most of her time alone writing. On her return to New Zealand
after 7 years overseas she had become such a loner that she had to ask a
neighbour she barely knew to see her onto the boat, having no close
friends.
By this stage, Janet had reached a point of self-acceptance.
She was able to face her family and home country with the confidence of knowing
that she was different, not mad. She became one of New Zealand’s most
prominent writers, and was internationally acclaimed.
Differential diagnosesAsperger’s Disorder,5
another category of ASD, should also be considered as a possible cause of
Janet’s symptoms. There is only one measurable difference between
Asperger’s Disorder and high-functioning autism: in Asperger’s
Disorder there must be normal or near-normal language development.
There is currently debate among clinicians and researchers
in this field regarding whether autism and Asperger’s Disorder are
separate conditions or varieties of the same condition. In Janet’s case,
while her early language development was certainly impaired, we cannot be
certain which of these two categories she would have most clearly fit into if
ASDs had been widely known during her early years.
The other possible diagnoses to be considered are
personality disorders, particularly Schizotypal Personality
Disorder.6 This condition shares a number of
features with ASDs, and it is certainly conceivable that someone could fit the
criteria for Schizotypal Personality Disorder while still having an underlying
ASD. The exact relationship between this and other personality disorders and
ASDs is not yet known: further research may reveal a substantial overlap in
these conditions.
ConclusionJanet Frame fits within the diagnostic criteria for
high-functioning autism, based on an analysis of her autobiographies. It is
hoped that this paper will stimulate doctors and other health professionals to
consider the diagnosis of autism, rather than suggest purely a mood, psychotic,
or personality disorder, in patients presenting with signs similar to Janet
Frame. It is also to be hoped that people with these symptoms are given
appropriate advice, as those treating Janet were eventually able to provide, to
help them to achieve their full potential.
Competing interests: None.
Author information: Sarah Abrahamson,
Rehabilitation Physician, The Queen Elizabeth Centre, Ballarat, Victoria,
Australia
Correspondence: Sarah Abrahamson,
Rehabilitation Physician, The Queen Elizabeth Centre, 102 Ascot Street South,
Ballarat, Victoria 3350, Australia. Fax. +61 3 53203661; email: sjabrahamson@yahoo.com
References:
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