Hollywood Takes on Intellectual/ Developmental Disability: Cinematic Representations of Occupational Participation Rebecca Renwick, PhD, OT Reg (Ont); Ann Fudge Schormans, PhD, RSW; and Deborah Shore, MSc OT, OT Reg (Ont) key words: occupational portrayals, qualitative research, image/text analysis

ABSTRACT

Adults with intellectual/developmental disability (IDD), and their occupational participation, are vastly under-represented in Hollywood films. Because films often provide individuals’ only experience of people with IDD, cinematic representations can influence audience perceptions. Thus, films can help inform public perceptions about desired and appropriate occupational par- ticipation for people with IDD, potentially impacting their access to meaningful occupational participation and achievement of occupational potential. Accordingly, this research examined occupational portrayals of adults with IDD in contemporary Hollywood films. Occupational portrayals, as defined here, refer to representations of the dynamic process of the person partici- pating in occupation(s) in a context. Grounded theory methods guided coding and analysis of qualitative data collected from eight contemporary films using an occupation-focused tool. Two major, striking themes emerging from the qualitative analysis—infantilization and simplifica- tion of participation in complex occupations (with three associated sub-themes)—are discussed. Implications of the findings and future research directions are considered.

his article addresses two primary themes in and beliefs (Shakespeare, 1999). Individuals with the lives of people with intellectual/develop- disabilities are vastly under-represented, but typi- mental disability (IDD): occupational partici- cally stereotyped, in mainstream media (Giles, 2003; Tpation and media representation. Film portrayals of Haller, 2010). Within the disparate fields of disability occupational participation available to people with studies, media and film studies, and psychology, disabilities are of critical importance because visual there is significant research about film portrayals media influence and help shape societal attitudes of physical disability and mental illness (e.g., Black

Dr. Renwick is Director, Quality of Research Unit, and Professor, Department of Occupational Science and Occupational Therapy, University of , Toronto, Ontario, Dr. Fudge Schormans is Assistant Professor, School of Social Work, McMaster University, Hamilton, Ontario, and Ms. Shore is Occupational Therapist, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. Submitted: February 21, 2013; Accepted: November 5, 2013; Posted online: November 26, 2013 The authors have no financial or proprietary interest in the materials presented herein. Address correspondence to Rebecca Renwick, PhD, OT Reg (Ont), Director, Quality of Life Research Unit, Department of Occupational Science & Occupational Therapy, #160-500 University Avenue, Toronto, Ontario, Canada M5G 1V7; e-mail: [email protected]. doi:10.3928/15394492-20131118-01

OTJR: Occupation, Participation and Health • Vol. xx, No. x, 20XX 1 & Pretes, 2007; Darke, 1998; Levers, 2001; Mitchell ideally, stories told by people with disabilities them- & Snyder, 2001; Shakespeare, 1999). Yet literature selves—can work to effect new understandings about media representations of people with IDD (Fudge Schormans, 2005). By offering more authen- is sparse, and none examines film portrayals of tic images of the capabilities, experiences, and occu- their occupational participation. Similarly, occupa- pations of people with disabilities, mainstream me- tional participation is considered fundamental to dia could work toward more informed, accepting, health and well-being (Townsend & Polatajko, 2007) and inclusive attitudes and behavior toward people but remains a significantly under-researched area. with IDD and facilitate improved occupational op- These issues are at the heart of this study examin- portunities for them. ing occupational portrayals of adults with IDD in Individuals with IDD often encounter prejudice, contemporary Hollywood films. The relevance and discrimination, and stigma at the levels of public implications of such representations for occupa- opinion, public systems, and public policy that im- tional science are also considered. pact their lives (Carll, 2003). They are often permit- There is ongoing debate around the use of lan- ted little control over their own lives, even though guage, in particular, whether it is preferable to use most are more capable than is generally assumed. “disabled people” or People First language (e.g., Research suggests they typically lack the opportu- people with IDD; see Titchkosky, 2011). In Canada, nity (more than the ability) to express preferences People First language is that chosen by self-advo- and make choices in their lives (Fudge Schormans, cates and other people with IDD and, in recognition Krause, MacDougall, & Wattie, 2011), including and support, will be used in this article. their occupational participation. These constraints can affect well-being and quality of life by limit- Media, Occupational ing the scope, quantity, and quality of their occu- Participation, and Disability pational opportunities and participation (Renwick, 2004, in press). If such occupational deprivation is Ample literature illustrates the powerful influ- the case in the actual lives of people with IDD, how ence of entertainment media on commonly held is this depicted in cinematic representations of their public stereotypes about people with disabilities— lives? who they are and what they do (Black & Pretes, These reported experiences of individuals with 2007; Garland-Thomson, 2009; Haller, 2010; Levers, IDD, combined with the documented influence of 2001). Shakespeare (1999), citing “the power of im- the media on attitudes and behavior, argue for an ages to define the experience of impairment, and to examination of the potential contribution of Hol- foster prejudicial attitudes towards disabled peo- lywood films to the continued marginalization—or ple” (p. 164), noted the historical distortion of dis- emancipation—of labeled individuals. While studies ability discourses in representations of people with of people with physical and mental health disabili- disabilities. Visual representations are especially ties in film do not explicitly address occupation, cri- important as they are generally presumed by au- tiques of disability representations include referenc- diences to represent truths about disability (Darke, es to depictions of the things people with disabilities 1998). Yet, what the viewer is given to be seen are do and the ways they do them. Commonly perpetu- often the dominant fictions about ability and dis- ated stereotypes include film characters with men- ability. Despite good intentions and attempts by the tal health issues portrayed as “dangerous” and/or film industry to portray disability in a positive, em- sexually deviant people (Levers, 2001). Characters powering light, depictions are generally not reflec- with physical disabilities are often stereotypically tions of lived experience (Sarrett, 2011). Moreover, portrayed as angry about their disabilities (Black mainstream media, such as films, often provide the & Pretes, 2007). Such unidimensional portrayals do sole exposure, or experience, that nondisabled indi- not permit them to demonstrate other complex emo- viduals have with people with disability, thus play- tions and behaviors. Characters stereotyped as “in- ing a critical role in creating social understandings capable” are depicted as unable to make decisions, and expectations (Farr, 1993). hold a job, or care (or direct care) for themselves This understanding of the powerful influence of without others’ help (Levers, 2001). Characters with media on individual attitudes and behavior has led disabilities are typically objectified such that their to the growing recognition that “today’s media of impairments are seen as their most important, if not mass communication—film and video… [could] be only, characteristic (Haller, 2010). The central plots powerful agents of enlightenment” (Levers, 2001, of film narratives often revolve around revenge or Conclusion, para. 2.). Telling different stories— the search for a cure (Davis, 2002). Whether intended

2 Copyright © American Occupational Therapy Foundation as positive or negative, such portrayals ultimately Occupational Perspective serve to perpetuate tenacious stereotypes, damaging Occupational participation contributes to shap- attitudes, and ignorance about the lived experience ing identity, meeting individual and community of disability (Haller, 2010), including participation in goals and needs, and developing skills and resourc- important, necessary, and satisfying occupations es- es, as well as meaning in life, health, and well-being sential to a good quality of life. (Christiansen & Townsend, 2010; Renwick, 2004). It Existing literature makes it clear that Hollywood is best understood as a dynamic process interweav- has typically failed to present acceptable represen- ing the person, the occupation(s), and the context tations of disability (Haller, 2010; Mitchell & Sny- (environment), rather than as three separate ele- der, 2001). Disability studies researchers argue that ments (Townsend & Polatajko, 2007). Further, oc- “negative” and “positive” representations, both cur- cupational participation requires the application of rent and historical, provide unacceptable portray- socially shared values and political will to develop als of the lives and experiences of individuals with a society that gives all of its members the chance to disabilities. So, then, what might constitute a more exercise their potential for occupational participa- acceptable representation? To paraphrase disability tion (Jakobsen, 2004). Thus, freedom to choose and activists, Hevey (1992) and Shakespeare (1994), an actual access to participation in meaningful occupa- acceptable representation does not deny or suppress tions are critical to individuals’ quality of life (Ren- the struggle and oppression experienced by individ- wick, in press). Wicks (2005) defined occupational uals with disabilities but, rather, represents these ex- potential as “people’s capacity to do what they are periences as resulting from the interaction between required and have opportunity to do, to become individuals and their disabling environments/con- who they have the potential to be” (p. 130) and ar- texts. This is not about disability “correctness” or gued that it may be unfulfilled if one is prevented or simply more “positive” representations but instead constrained from participating in meaningful occu- is a call for more authentic and even oppositional pations. For individuals from marginalized groups, representations (Snyder & Mitchell, 2006) that chal- realizing occupational potential can also be stifled lenge dominant discourses and the social, political, by socially constructed barriers that restrict the spec- ideological, and psychological ramifications of con- trum of opportunities for meaningful occupational temporary cinematic representations of the lives of participation, putting individuals at significant risk people with disabilities. for occupational deprivation (Wilcock, 2006) and a Limited representations of individuals with IDD decreased sense of occupational competence and have appeared throughout Hollywood film history, mastery (Renwick, 2004; Wicks, 2005). and until very recently, there has been only mini- mal critical analysis of these films with respect to Disability Perspective the accuracy and/or breadth of these portrayals From a disability studies perspective, what we (Haller, 2010). There has been minimal analysis understand to be “disability” is shaped by a given of depictions of people with IDD, but not of their society’s attitudes, values, language, economies, occupational participation, in print media (e.g., and social and physical environments. Social repre- Jones & Harwood, 2009). Analysis of occupation in sentations of disability are thus manufactured—con- other populations in other media is also rare (e.g., structed by charities, science, and popular culture to Wiseman, Davis, & Polatajko, 2005). However, no show people with disabilities in particular ways and published studies have addressed occupational for particular purposes (Snyder & Mitchell, 2006). representations of individuals with IDD in film (or Important here is the concept of “normality,” a nar- other media) and implications for their occupation- rowly defined understanding of acceptable bod- al potential. This lack of attention in the literature ies and ways of being determined by societal and highlights the need for analysis of cinematic rep- cultural values that requires and encourages those resentations of IDD as distinct and separate from with power and resources to label those without as other kinds of disabilities and the need for an oc- “abnormal,” as “other” (Davis, 2002). In contrast, cupational perspective. medical conceptions of disability are grounded in an individualized, pathologized view of impair- Conceptual Foundations ment and a focus on “cure” or “normalization” of the individual. These traditional perspectives prob- Perspectives from the literatures of occupation, lematize the individual, viewing disability as a per- disability, and media provided the three major, in- sonal tragedy originating in the individual, rather terrelated foundations underpinning this research. than socially created (Vehmas, 2002). Social models

OTJR: Occupation, Participation and Health • Vol. xx, No. x, 20XX 3 of disability, on the other hand, problematize society cific to occupational participation as portrayed in rather than the individual, thus forcing an exami- films that met a set of inclusion criteria was sys- nation of cultural assumptions. Society creates dis- tematically selected and analyzed to identify major ability as a problem: Consequently, society—not the emergent themes. Inductive data analysis was used individual—is responsible for alleviating or “fixing” to make sense of and interpret portrayals of occupa- the problem (Goodley, 2011). tional participation by fictional characters with IDD in terms of the meanings both society and individu- Media Perspective als attribute to them (Charmaz, 2006). To identify, Hall’s (1980) encoding/decoding framework for capture, and examine the influence of personal per- examining the mass communication process asserts spective and values on the research (e.g., methods that socially constructed messages are: (a) produced developed, data collection, analysis, interpretation), and disseminated through media, (b) decoded and each author maintained a journal recording subjec- interpreted by receivers as meaningful, (c) encoded tive observations and emotional responses related to based on receivers’ and societal perceptions, and the research process and film content throughout the (d) subsequently re-disseminated to others. The re- study. disseminated message may be similar to the original message (denotative meaning) or different from the Inclusion Criteria and Film Selection original message (connotative meaning) and based Careful sample selection, guided by the study de- on individual and societal associations and interpre- sign, is required in qualitative research because sam- tations. However, given its origin in dominant social ples are typically small and purposive (Levers, 2001). discourse, it resembles the original message more Further, there are very few Hollywood films portray- often than not. As messages cycle through this on- ing central or major characters with IDD. Thus, the going process, they are further integrated into social process of film selection required extensive internet discourse, which in turn, drives the media, and the database searches and ongoing discussion among cycle begins anew. the authors and their colleagues to identify films portraying people with IDD. Database searches used Research Question a range of keywords, for example: intellectual disabil- ity, developmental disability, mental retardation, learn- The three conceptual strands noted are rooted ing disabilities (used in the United Kingdom), men- in the disciplines of occupational science, disability tal handicap, cognitive impairment, Asperger syndrome, studies, and media studies, respectively, but they Down syndrome, developmental disorders, and devel- share an emphasis on a social constructivist approach opmental delay (as well as any alternatives and vari- (Charmaz, 2006) to marginalization, representation, ants of these terms and other common and “slang” and meaning-making, which were drawn together terms); and films, movies, media, images,and repre- to underpin this research. The overarching research sentations. The search was further delimited by the question guiding this qualitative study was: How time period, 1999 to present, and English-language are individuals with IDD occupationally portrayed materials. Both relevant scholarly interdisciplinary in contemporary Hollywood films? In keeping with and discipline-specific databases (e.g., PubMed, current conceptions of occupational participation, EBSCO, EMBASE, OVID, Scopus, Google Scholar, representations of people with IDD participating Film and TV Literature Index, PsycInfo, Sociological in occupations (i.e., occupational portrayals) were Abstracts) and general and disability-specific film conceived of as film depictions of the person par- databases (e.g., SproutFlix, Disability Movies, Media ticipating in an occupation in a context together as a and Disability Resources, Internet Movie Database, dynamic process (Townsend & Polatajko, 2007). The Netflix movie listings) were searched. Identification goal of the research was to explore multiple dimen- and initial viewing of each potential film to include sions of occupational portrayals of people with IDD was followed by discussion among the authors of its and begin to build a more complex, holistic picture suitability to the study. of their cinematic representation. After 14 such films were viewed, inclusion crite- ria for film selection were refined. Each of the eight Method films selected for analysis met these refined inclu- sion criteria: English language, contemporary, main- Film representations are most commonly explored stream Hollywood film; based in North American using qualitative methods to identify major themes culture; fictional film; and a lead or major charac- (Giles, 2003). In this study, text/image content spe- ter had an IDD of adult age clearly and repeatedly

4 Copyright © American Occupational Therapy Foundation shown participating in occupations. Because these edly paused and rewound, as necessary, to facilitate films were screened in North American mainstream, capture of relevant data. Special attention was paid public movie theatres, they were likely to have been to selected scenes dealing with clear occupational widely viewed by diverse audiences and, conse- participation by the character with IDD. quently, would be likely to have a high social impact in terms of disseminating messages about IDD (Le- Data Analysis vers, 2001). Since these films were released between In accordance with grounded theory methods 1999 and 2009, they are likely to reflect the recent for coding of data (Charmaz, 2006; Willis, 2007) to state of social discourse related to individuals with identify major conceptual themes, analysis began IDD. The films selected were:Molly (MacDonald & simultaneously with data collection. Systematic Duigan, 1999), The Other Sister (Iscovich, Rose, & examination of the data (i.e., scenes selected from Marshall, 1999), (Nelson, Solomon, Her- each film) involved repeated viewing of the film scovitz, Zwick, & Nelson, 2001), Radio (Tollin, Rob- footage, especially the scenes selected for analysis. bins, Gains, & Tollin, 2003), House of D (Rosenthal, Using constant comparison of data, both within Yari, Lewis, & Duchovny, 2005), Adam (Urdang, De and across films, facilitated identification of recur- Pencier, Vanech, & Mayer, 2009), Snowcake (Carter, ring occupational portrayals, as well as additional Daniel, Eaton, Fichman, & Evans, 2006), and Defen- relevant scenes from the films for further analysis. dor (Tabarrock & Stebbings, 2009). The Table pro- As the iterative analysis progressed, similar scenes vides the plot summaries of the films. The characters and elements from the scenes within each film and are either portrayed as having diagnostic labels such across the eight films were identified and assigned as autism spectrum disorder (ASD) and fetal alcohol codes. For example, Linda (Snowcake) repeatedly spectrum disorder (FASD) or an unspecified IDD. shelves grocery items at work and Sam (I Am Sam) routinely replenishes condiments in the coffee shop Data Collection where he works. The code “repetitive routines” was During the film identification/selection process, assigned to these two scenes and similar others. a specific occupation-focused tool addressing the Eventually, this code was combined/recombined overall research question was developed to guide with others to form the Simplification of Occupa- data collection from the eight films (i.e., selection tional Participation conceptual theme. This code for analysis of scenes dealing with occupational par- was then applied to similar footage in the subse- ticipation by characters with IDD). It was created quent scenes analyzed in each film. New categories to promote consistency and ensure relevance of the with other codes continued to be identified in the data to the overall research question. It consisted of same manner (Charmaz, 2006; Willis, 2007). The a set of questions and sub-questions analogous to categories identified were repeatedly linked, com- semi-structured questions and probes used to inter- bined, and refined (and renamed) as they emerged view and gather data from human participants. Its from the analysis (Corbin & Strauss, 2008) to yield development was a multi-stage process including higher-level themes that were further similarly re- repeated viewings of the films and ongoing person- fined through ongoing reflection and regular, de- al reflection by the authors to identify, modify, and tailed discussion among the authors. Ultimately, refine emergent questions about occupational par- this process identified the emergent conceptual ticipation by the characters with IDD. Examples of themes (i.e., Simplification of Occupational Partici- these questions (and sub-questions) were: (a) What pation, Infantilization, and sub-themes presented is the nature of the occupational participation? Who in the next section), which addressed the research selected it? With whom is the occupation done? (e.g., question and revealed underlying meaning (Grane- with important others? strangers? peers? alone?); heim & Lundman, 2004) related to occupational (b) How is this occupational participation viewed participation. (e.g., meaningful/valuable/appropriate or not to Trustworthiness. The trustworthiness of the study the character? to others in the character’s life? in was established in several ways, as recommended Western culture?); (c) How is the occupation carried by Erlandson, Harris, Skipper, and Allen (1993). The out?; and (d) Nature of opportunities (if any) for oc- research process was systematic, emergent, and in- cupational participation portrayed? These questions volved prolonged engagement with the material. It constituted the occupation-focused tool to guide the also involved considerable reflection, ongoing peer collection of data from the eight films. debriefing among authors, and consultation with Each film was viewed at least twice by each au- academic experts (i.e., in disability studies, occupa- thor. Throughout each viewing, films were repeat- tional science, occupational therapy, media studies.).

OTJR: Occupation, Participation and Health • Vol. xx, No. x, 20XX 5 Table Plot Summaries for the Films

Molly (1999) After being institutionalized since early childhood, 28-year-old Molly, who has an IDD, is released into her brother’s custody. He has difficulty caring for her and consents to a risky experimental surgery that could cure Molly. The successful surgery renders Molly a genius, but these changes soon disappear.

The Other Sister (1999) Carla, 22 years old, has a slight IDD. After several years at a specialized boarding school, she returns home to her parents. Carla soon meets Daniel, a young man with a similar disability, and pursues independence and love, despite her overprotective moth- er who does not treat her like an adult.

I Am Sam (2001) Sam, who has an IDD and works at a coffee shop, is obsessed with . A single father, he raises Lucy with support from trusted others, most of whom also have disabilities. As Lucy’s developing abilities exceed her father’s, she is taken into foster care. Sam goes to court to get custody.

Radio (2003) Radio, who has an IDD, spends a lot of time alone pushing his grocery cart in the streets until he meets Coach Jones of the local high school football team. Coach Jones invites him to help at football practices. Later, Radio takes classes and becomes involved in other school activities. In doing so, he learns new skills and forges significant relationships. Coach Jones gains new insights into the meaning of friendship and family through their relationship.

House of D (2005) Pappass, a man with an IDD, works as a high school janitor. He shares a friendship with Tommy, a high school student who is facing some serious personal losses and life challenges.

Snowcake (2006) Linda, a woman with ASD, and Alex, a man traumatized by a fatal car crash involving Linda’s daughter, form a friendship.

Adam (2009) Adam, who has ASD, is grappling with some challenging life circumstances. He develops a romantic relationship with Beth, his nondisabled neighbor.

Defendor (2009) Arthur, who has FASD, assumes the persona of a superhero, Defendor, who helps others and fights criminals.

Note. IDD = intellectual/developmental disability; ASD = autism spectrum disorder; FASD = fetal alcohol spectrum disorder.

Findings ductive occupational participation portrayed in- volved everyday occupations in which many, or For clarity, each film title and its associated main most, individuals in Western societies might choose character with IDD are Radio, Radio; I Am Sam, Sam; to engage. Occupational participation differed in Molly, Molly; The Other Sister, Carla; Adam, Adam; terms of benefits offered and skills required. Par- House of D, Pappass; Snowcake, Linda; and Defendor, ticipation in common leisure occupations included Arthur. socializing with others, watching television and movies, listening to music, and dancing. Some oc- Descriptive Findings cupational participation was simple and some more Examination of the recurring occupational por- complex such that it was possible to participate in a trayals in the films revealed two clear groupings, range of ways. The benefits were generally pleasure participation in leisure and productivity, but little and social interaction, with few risks involved. attention to self-care. Participation in recurring productive occupations Leisure and Productivity. Most leisure and pro- included primarily paid or voluntary work, study-

6 Copyright © American Occupational Therapy Foundation ing, and shopping. Sam worked in a paid position at the universe). Similarly, Linda appeared comfortable a coffee shop. Radio did voluntary work at the local with her job and engaged in it with much serious- high school, eventually becoming a student there. ness, but the viewer is given no information as to Molly and Carla engaged in studying and shopping. whether she or someone else chose this position for Arthur worked on a construction site by day and her. Arthur begrudgingly worked on the construc- was a vigilante crime fighter by night (a voluntary tion site while viewing his vigilante activities as his position neither sanctioned nor condoned by local true vocation. Pappass appeared, for the most part, to police). Pappass held two paid positions, as a school enjoy participating in his paid occupations. He was caretaker and a restaurant delivery person. Adam shown choosing to socialize with his “best friend,” designed computer programs at a toy manufactur- but it is not clear if he desired and/or had opportu- ing company, and Linda worked part-time stocking nities for other friendships. Further, the characters store shelves. Participation in such productive occu- were all represented as having varying degrees of pations had the potential to be complex, challeng- independence. Most of the recurring occupational ing, and demanding of both intellectual and physical participation identified in these films is valued by skills, to varying degrees. The benefits derived were Western culture, and individuals of all social classes sometimes monetary (e.g., paid work) and generally and educational levels typically engage in these, or provided a sense of accomplishment and personal similar, occupations. In addition, all eight charac- value, and fostered self-esteem and independence. ters had close ties with at least one family member With one exception, Arthur’s crime fighting, the or significant individual in their lives who provided most powerful risk accompanying participation in ongoing social support, thereby facilitating their these occupations was the potential for failure and continued success in their chosen occupational par- consequent loss of self-esteem and income. Adam, ticipation. for example, was let go from one position (but even- “Positive” Portrayal of Occupational Partici- tually secured another), and at one point, Pappass’ pation. Over the course of each film, most of the job was at risk. characters with IDD were portrayed as gaining in- It is noteworthy that all eight films implied that creased independence and becoming empowered, the characters with IDD participated in self-care oc- with their life circumstances and well-being notice- cupations, since all were generally well-groomed, ably improving by the end of each film. Yet, this was had clean and organized living spaces (except Ar- not the case for Pappass who maintained his job but thur who, lacking housing, lived in a construction struggled with alcohol misuse. Linda’s life situation storage building), and were obviously getting ade- remained largely unchanged in the film; the most quate nutrition. However, how or by whom self-care significant changes occurred for others. Arthur was occupations were accomplished was typically not killed at the film’s end as a result of his participation evident, except for Adam and Linda, who were both in vigilante occupations. shown cooking and whose fastidious care of their At first glance, viewers might conclude that these homes was explicit. films represented individuals with IDD in a “posi- Occupational Participation and Choice. Char- tive” light, thus challenging mainstream percep- acters with IDD were generally shown as having tions, which may have been consistent with the film- some limited freedom to make choices regarding makers’ intentions. However, more critical, in-depth meaningful occupational participation. For instance, investigation of the occupational portrayal of these Sam chose to work at a coffee shop but had no choice characters led to further insights. over his position there. He was free to listen to his favorite music or eat in his favorite restaurant, al- Major Emergent Conceptual Themes and Sub- though whether this was influenced by his income Themes was not made clear. Radio chose to listen to the ra- Examination of the commonly recurring patterns dio and to do voluntary, unpaid work with the local of occupational participation by the characters with high school’s sports teams, but was not offered paid IDD revealed two powerful emergent themes, spe- work there. Molly watched films and read books of cifically, these characters: (a) participated in poten- her own choosing. Carla convinced her parents to tially complex occupations in simplified ways and let her attend classes at a polytechnical school and (b) were infantilized in relation to their occupational had some freedom to socialize. Adam appeared to participation. enjoy his job (which his father had secured for him) Simplification of Occupational Participation. and participated in other occupations clearly of his This theme refers to the portrayal of participation own choosing (e.g., enjoying nature, learning about in complex adult occupations in a noticeably sim-

OTJR: Occupation, Participation and Health • Vol. xx, No. x, 20XX 7 plified or less sophisticated way, or both. While the immature or child-like quality or nature of occu- degree of simplification varied among films, occu- pational participation. This theme manifested in pational participation was frequently characterized three interrelated sub-themes: (a) participation in by simple, repetitive, routine tasks requiring normal an occupation typically intended for children; (b) motor function, with any requirement for reasoning participating in a traditionally adult occupation in and judgment virtually eliminated. For more com- a child-like manner; and (c) demonstrating an exag- plicated occupational participation, the character gerated child-like response to occupational partici- was shown as obviously struggling with these com- pation. plexities. Although such simplification was appar- Although all of the characters with IDD were ap- ent in the portrayal of leisure participation, it was proximately 20 to 50 years old, they were shown particularly striking in the characters’ participation participating in occupations typically intended for in productive occupations. Since Western society children. While adults, with and without disabili- judges an individual’s value by his or her participa- ties, may occasionally participate in some of these tion in primary productive occupations, this finding occupations, they are not traditionally viewed as is significant. adult occupations. For example, Sam has a bed- Examples of this kind of simplification were evi- time story read to him by his 6-year-old daughter, dent in depictions of Sam and Radio as they engaged Lucy. In many scenes, Radio rode around town on in their paid and voluntary jobs, respectively. Sam a shopping cart. Molly splashed in a public water worked at a coffee shop where, typically, employees fountain while nondisabled others present do not are involved in a variety of occupations. However, and look on in disapproval or bemusement. Carla Sam was most often shown cleaning or organizing spent many hours repetitively stringing very simple sugar packets. He was portrayed as desperate to beaded necklaces for her family. Pappass, a middle- participate in more complex occupations, primarily aged man, played childish tricks on an older woman to prove to the family court that he is responsible with the teenager who was his best friend. Linda enough to have custody of his daughter. After plead- liked to jump on a trampoline and play with sparkly ing with his supervisor, he was promoted to a cus- toys, and Adam often sat in the park watching the tomer service position. However, on his first attempt raccoons. For both Linda and Adam, nondisabled to carry out these more complex duties, Sam was un- onlookers (at least initially) reacted disparagingly or able to handle the challenges and stress associated with condescension. with the pace of work required. Ultimately, he was Several characters also engaged in pretend or shown failing in a spectacular fashion. In interpret- imaginary play. For example, Sam imagined he was ing this film footage, it is important to understand a Beatle (i.e., of rock star fame). Radio pretended to its salient contextual features. In addition to Sam be- be a football player. Molly dressed up and played ing anxious about having to attend family court on at being Scarlet O’Hara, from Gone with the Wind. this same day, Sam was never shown receiving any Carla held a seemingly sophisticated tea party with training or support before or after his promotion and her teddy bear in her new apartment. Arthur would assumption of increased responsibilities. dress up in his homemade superhero costume, but Radio worked as a volunteer assistant for a high while his costume and superhero character (Defen- school’s football team, distributing equipment dur- dor) were make-believe, his occupational participa- ing team practices, cleaning up after players, and tion went beyond the imaginary for Arthur when he folding towels. When some players staged an un- wandered the city at night looking for “bad guys” kind trick on Radio, he failed to recognize their de- to punish. ception and, consequently, found himself in trouble While some aspects of such occupational par- with several irate female students, the coach, and the ticipation are valued by mainstream Western soci- principal. Arthur’s duties at his construction job en- eties and are often associated with wealth, status, tailed no more than holding a stop sign. or respect (e.g., being a celebrity/hero or a jewelry Notable exceptions were Adam’s loss of his first maker), several contextual aspects of the characters’ job because his computer design for a toy doll was participation provided additional layers of meaning. much more sophisticated than the toymaker re- These occupations, typically performed by children, quired, and his demonstrated ability at a second job were carried out by characters with IDD but not by included explaining the complex, technical aspects the nondisabled adult characters in each film. The of astronomy to visitors at an observatory. responses of most nondisabled characters also clear- Infantilization and Three Sub-Themes. The term ly showed cultural assumptions as to what is, and is infantilization, as used in this article, refers to the not, “normal” and “appropriate” adult occupational

8 Copyright © American Occupational Therapy Foundation participation. There was a cumulative effect of such sexual relationship was marked by his portrayal as a portrayals, with repeated instances throughout each child-like innocent. film depicting the characters with IDD participating Finally, the eight characters appeared in many film in occupations generally associated with childhood. scenes expressing their pleasure or enjoyment in oc- At the same time, other aspects of their occupational cupational participation with exaggerated child-like participation were markedly different from that of responses or in ways that went beyond how even a nondisabled adults portrayed in each film. child might usually respond. This behavior, which The characters with IDD were sometimes repre- included screaming, hooting, squealing, jumping, sented as participating in a variety of occupations clapping, wildly flinging hands in the air, or a slack- typically associated with adults (e.g., intimate adult jawed expression (open mouth), was clearly consid- relationships, shopping for shoes for a child). How- ered inappropriate by nondisabled adult characters. ever, these occupations were most often performed Although some adults may occasionally express en- in a child-like manner. That is, their occupational joyment or pleasure in similar ways, adults generally participation is depicted as childish and simplified, inhibit such responses because they are regarded as and does not command respect or positive interest inappropriate in the social contexts shown in these from nondisabled others in the film. In fact, it is note- films. For example, Radio laughed, hooted, and exu- worthy that the responses of nondisabled others are berantly threw his hands in the air during his many generally negative, showing disapproval, dismay, shopping cart rides. Molly was shown jumping, negative judgments, disgust, or bewilderment. This squealing, and waving her hands in the air when sub-theme was exemplified by the characters’ sheer playing with great abandon in a public water foun- abandon; exaggerated concentration and intense tain as onlookers watched in amusement or disgust. focus beyond what was required; the innocent or Sam frequently laughed very loudly and clapped his awkward nature of their occupational participation; hands inappropriately. At her sister’s wedding, Car- or some combination of these. The preponderance la watched the ceremony, her mouth open in amaze- of such portrayals also stood in marked contrast to ment, in direct contrast to the more typical behav- the frequency of scenes in which the characters par- ior exhibited by other adult guests. Linda clapped, ticipated in adult occupations in ways indistinguish- laughed, and jumped around when presented with able from nondisabled adult characters and garner- a new toy with flashing lights and whirring sounds, ing them societal approval instead of censure. For and also did so upon hearing a favorite song at the example, in a scene at the coffee shop, Sam intensely wake for her deceased daughter while some guests focused on organizing sugar packets and mugs. He looked aghast and attempted to stop her. also childishly repeated the same line, “that’s a won- derful choice,” in response to all customers’ selec- Discussion tions, regardless of what they chose or said to him. Sam also became consumed with, and lost in, his The portrayals examined in this study may have Beatles impersonations at his daughter’s Hallow- some accuracy with respect to occupational partici- een party. As other child and adult guests looked on pation by some people with IDD. However, each in bewildered curiosity, Lucy, recognizing that her person with IDD is unique and has individual expe- father’s behavior was inappropriate for an adult in riences, needs, abilities, and perceptions, including that context, was acutely embarrassed. those associated with occupational participation. In In another scene, while shopping for Lucy’s new contrast, in the eight films analyzed, a preponder- shoes for school, Sam and his friends, all of whom ance of scenes represented all adults with IDD as have IDD, created comedic chaos in the shop by sug- child-like and typically requiring significant sim- gesting wildly unsuitable shoes for a little girl. Soon plification of occupational participation in order after, they are seen parading in the street with bal- for them to succeed. Thus, in a reductive way, these loons and great abandon (in a childish parody of the eight films disseminate some damaging messages Beatles’ Abbey Road album cover). Linda was por- that perpetuate the disabling cycle of social dis- trayed sitting cross-legged on a shop floor, intensely course, tenacious stereotypes, and subsequent be- focused on stocking canned goods on the shelves. havior toward people so labeled. They reinforce be- Pappass cavorted on a bicycle with his teenaged best liefs common to Western societies and widely held friend while making restaurant deliveries. Carla and by individual members of society, which maintain her boyfriend, Daniel, awkwardly kissed and em- an inherently flawed distinction betweennormal and braced in a manner reminiscent of stereotypically abnormal (Vehmas, 2002). Such messages are most innocent preadolescents. Adam’s first foray into a effectively rendered by the primarily negative re-

OTJR: Occupation, Participation and Health • Vol. xx, No. x, 20XX 9 sponses of the nondisabled characters toward the nomic, and environmental barriers that, more than characters with IDD. individual function, restrict and limit occupational According to social models of disability, if occu- participation for people with IDD. People with IDD pational participation by individuals with IDD is continue to be seen as different, as lesser than, and child-like, it is often because society has allowed thus, the taken-for-granted binaries of normal/ab- them few other choices or none at all. Society con- normal, us/them are maintained. These attitudes tinues to define and shape who they are by uncon- do not arise from what most nondisabled individu- sciously and consciously limiting opportunities als think or do consciously but, rather, are inherent and often creating insurmountable barriers, includ- in what they believe and how they have learned to ing those related to occupational participation. Cin- behave. ematic representations inform viewers about, and There were, however, a few notable exceptions are informed by, what society perceives as suitable in the films viewed. For example, Arthur’s child- or acceptable occupational participation both for ish superhero costume, makeshift weapons, and “normal” adults and for individuals with IDD. In comic-book sayings initially elicit laughter from this way, the eight films analyzed contribute to the nondisabled characters in the film. However, when perpetuation of socially devalued roles and partici- his methods begin to work to incapacitate the non- pation in devalued or socially inappropriate occu- disabled criminals, perceptions shift, and he is no pations for people with IDD. For example, viewers longer regarded as a comical and childish figure en- are led to assume that because they have this kind gaging in harmless make-believe. In a related vein, of impairment, Sam can be neither a successful as Adam’s nondisabled girlfriend, Beth, comes to coffee barista nor a good father, and Carla should know Adam and to understand how he experiences not have an adult sexual relationship. Thus, view- ASD, she grows increasingly less tolerant of others’ ers anticipate the characters’ failure with respect to negative and dismissive attitudes and behaviors to- participation in occupations by which Western so- ward him, which serves to effectively trouble those ciety typically judges an individual’s value. In turn, negative responses. Similarly, in Snowcake, the non- such expectations reinforce an individual patholo- disabled character, Alex, gradually develops an un- gy perspective and support viewers’ beliefs about derstanding and respect for Linda’s ways of being in the limitations of people with IDD. By focusing on the world. As the film progresses, he attends less to the individual, such expectations also serve to di- Linda’s behavior and more to that of other nondis- vert viewers’ attention from their abilities and their abled characters who react to her in hurtful and dis- potential for successful occupational participation paraging ways. In challenging the ableist prejudice when the appropriate supports are provided and and discriminatory behaviors of nondisabled char- in place. acters, the characters Beth and Alex simultaneously Yet the films rarely problematize these cultural push nondisabled viewers to question their own as- assumptions. Ableist notions of normal/abnormal, sumptions about IDD. appropriate/inappropriate, and abled/disabled re- main generally unquestioned and are, indeed, re- Significance of the Research inforced by the negative responses of nondisabled characters in the films. Viewers are shown only a This was, by definition, a small-scale study in- limiting and reductive picture of occupational par- tended as a preliminary step toward a larger, more ticipation by adults with IDD. Reinforcing normal- complex study of media portrayals of people with cy as the goal, the films typically fail to create space IDD and their occupational participation. While the for valuation of difference. While occupational par- findings cannot be generalized to cinematic repre- ticipation by people with IDD has been very much sentations beyond those in the films analyzed for determined by a lack of opportunity, it must also this study, a key strength of the study is its direct be considered that, for some people with IDD, their and explicit occupational focus and its contribution impairments necessitate a simpler means of partici- to addressing the cinematic occupational portrayal pation (Kittay, 2001). A rigid focus on normaliza- of individuals with IDD. Furthermore, the findings tion ideologies for people with IDD can be restric- challenge conventional and stereotypical media por- tive and denies all of us opportunities for different trayals of people with IDD and the nature of their ways of being and participation in occupation that occupational participation in critical arenas of so- are, or should be, valued. In this way, film viewers ciety. They also highlight specific cinematic stereo- are further distracted from recognition and consid- types that, pending further research evidence from eration of the larger social, material, political, eco- future studies, can be targeted for change.

10 Copyright © American Occupational Therapy Foundation Implications uals with IDD concerning cinematic representations of people with IDD. The idea that individuals are Stereotyping in Hollywood film reinforces preju- disabled only to the extent that society disables them dice and discrimination and can influence individual highlights the danger of casting researchers and prac- and societal attitudes, behaviors, and preferences re- tice professionals (e.g., in occupational therapy and garding individuals with IDD (Levers, 2001; Shake- other human services) as experts (Goodley & Tragas- speare, 1999). In that no one is immune to this cul- kis, 2006). There is growing support for the inclusion tural influence, there are important implications for of people with IDD in research based on the argument practitioners working and allying with people with that the problem has rested not with labeled people, IDD (Goodley & Tragaskis, 2006). The negative as- but with researchers’ assumptions and methodologi- pects of this influence are embodied in environmen- cal failure (Gilbert, 2004). The current findings point tal and social barriers in critical arenas, for example, to the importance of studying, and then widely dis- occupational participation in community, employ- seminating, knowledge about the lived experience of ment, and educational contexts, that may unknow- IDD learned from individuals with IDD themselves. ingly and unwittingly be maintained or reinforced Qualitative research on the lived experiences of indi- by practitioners, including occupational therapists. viduals with IDD concerning their occupational par- Cinematic representations inform public and profes- ticipation would also help develop a more accurate sional perceptions of desired and appropriate par- standard for acceptable cinematic representations for ticipation for labeled individuals that potentially this group of labeled adults. For example, participa- impact their access to meaningful occupation. Barri- tory research now being conducted by the first two ers to such participation may result in occupational authors and co-researchers with IDD focuses on con- alienation and deprivation, which ultimately affect trasting contemporary film representations and lived the occupational potential of individuals with IDD experiences of IDD. (Renwick, 2004; Wicks, 2005; Wilcock, 2006). The research findings pose a challenge: specifical- Conclusion ly, to acknowledge disability as a societal problem, not a personal tragedy nor solely a medical concern. “Media shape our reality and functions as the gate- Thus, they challenge nondisabled or differently dis- keeper of our perceptions of the world” (Carll, 2003, abled practitioners and researchers to examine their p. 1592). Researchers engaged in studying occupa- own assumptions about IDD and people so labeled. tion are well positioned and eminently qualified to: If knowledge of what constitutes meaningful, ap- (a) evaluate and, when necessary, challenge socially propriate, and possible occupational participation constructed ideas about meaningful and valued oc- for labeled individuals is informed by unexamined cupational participation for disenfranchised groups or unquestioned public attitudes, perceptions, and of people; (b) promote the use of media as a positive representations (e.g., cinematic representations), force in social change; and (c) identify the character- there exists a serious risk of perpetuating existing, istics of appropriate representations of people in dis- or creating additional, occupational barriers for in- enfranchised groups, such as individuals with IDD. dividuals labeled as having IDD. It is essential that Applying an occupational lens to the composite def- practitioners and researchers view representations inition based on Hevey’s (1992) and Shakespeare’s of labeled groups in a systematic way and with a (1994) conceptions of what constitutes an acceptable critical eye to inform filmmakers and contribute to representation points to the addition of a critical oc- changes in societal beliefs and attitudes about mem- cupational dimension (added in italics below) to this bers of labeled groups, including those with IDD. criterion of acceptability: An acceptable representation does not deny or suppress Future Research Directions the oppression experienced by individuals with disabili- ties, as exemplified by the occupations in which they are permit- The findings point to the need for further research ted to participate and in which they do participate, but reveals the struggle and oppression as resulting from the interac- in this area. Future research could include using sim- tion between individuals and the disabling environments ilar methods with a larger sample of films or films in within which they function. different categories (e.g., documentaries), focused on other age groups (e.g., children with IDD), from dif- ferent time periods, or from different cultures. Many Acknowledgments insights may also be gained through participatory ac- Portions of this article are based on research com- tion research centered on the perspectives of individ- pleted in partial fulfillment of an MScOT degree in

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