Far from the Tree

Effective forensic psychiatry involves conveying narratives to attorneys, jurors, and judges, who cannot easily empathize with many of the litigants. Forensic professionals, who are expected to be objective, cannot always relate to their subjects. Objectivity, untempered by empathy, can be a barrier to interpreting the worlds of criminals, victims, and those who feel wronged. Narrow-mindedness can lead to confirmation bias, thus reinforcing prejudice.

We are often tasked with identifying behaviors that could be normative, adaptive, or pathological. Regardless of our openness and ability to humanize evaluees without rushing to label them, at the end of the day we return to our homes and private spaces. Some homes, however, contain challenges and uncharted dynamics. How do families cope with inescapable realities involving offspring with differences? When seemingly random differences intrude on a family, there is an existential crisis. The offspring has fallen far from the tree. How do we distinguish diversity from deviance, and is it ethical to do so?

In Far from the Tree, a full-length documentary based on Andrew Solomon's eye-opening book and featuring his story,1 we are treated to a lesson in diversity, identity, and adaptation, a good study for the forensic professional. The filmmaker, Rachel Dretzin, interviews Mr. Solomon and explores the lives of five families, each struggling with unanticipated phenotypes that have the potential to strengthen or divide them: Andrew (Solomon), a gay first child struggling to preserve his parents' love; Jason, an adult with Down syndrome; Jack, a boy with autism; Loini, a 23-year-old female with dwarfism; Leah and Joe, a couple with dwarfism planning a family; and Trevor, a teenager who unaccountably kills a child and is sentenced to life in prison.

Mr. Solomon provides a life history, including his efforts to conform despite overwhelming evidence that he was different. His mother expected her firstborn to be conventional. “Instead, she got me … I was a weirdo.” He withheld that he was gay, but was unable to contain the truth: “I thought if I told them I'm gay, they're going to be brutally disappointed. And I told them. And they were. It was a catastrophe.” How other families cope with differences became his research. “I wondered whether defectiveness itself was all a matter of perspective.” His 10 years of compiling material for the book led him from feeling like an alien in others' worlds to a type of intimacy through identification. As Mr. Solomon explained, “the world changed” over 40 years, and his gayness, evolving from illness to identity, suddenly could be celebrated. How strange! A door opened, and he walked through it.

The film, in keeping with Mr. Solomon's big- hearted spirit, is sensitive and nonintrusive. This is not an anthropological adventure, but a deep dive into the subjective realities of the parents and children. The essential question was, “How do we decide what to cure and what to celebrate?” The answer, gleaned from interviews with parents, is that parents love their children irrespective of differences. The parents are courageous and caring, often enduring years of self-blame and guilt (e.g., Jason, Jack, and Trevor), reaping the rewards of persistence and compassion (e.g., Jason, Jack, Loini), and experiencing transcendence (e.g., Andrew's father's toast at his son's same-sex marriage; Leah and Joe, and Andrew, becoming parents).

Jason, a middle-aged man with Down syndrome, opens and closes the film. He and the two men sharing a residence for 13 years call themselves the Three Musketeers. Whereas his mother explains how she and her late husband enriched Jason's learning, turning him into a celebrated phenomenon, she concludes, “It was letting go of a dream when I realized Jason was going to be who he is.” Jason attributes his enlightenment to the character Elsa in the animated film Frozen: “She opened my heart.” While people around him think his attachment to Elsa is delusional (i.e., he wants to visit Norway to see what happens next), he distinguishes fantasy from a reality that defines diversity: “Here in reality, everyone is different. Different opinions, tastes, personalities, and beliefs.” In a pensive moment, Jason suggests to his house mates that they are more than friends—a “family of friends.”

Jack's parents did not experience a smooth learning curve like Jason's. Wracked with self-reproach over the cause of autism, it took several years of “trying everything” before Jack learned to communicate on a keypad. When he typed out, “I'm trying and I'm really smart,” his mother was ecstatic: “I couldn't believe it. It was like I was meeting him for the first time. Oh, my gosh! You're real?” The film shows Jack and his classmates at a backyard gathering, each with a keypad, and then walking through an orchard. They call themselves the Real Boys. Jack describes (through a voice generator) his experience: “The day was awesome ‘cause I was with my tribe.” His choice of “tribe” was itself intriguing, reminiscent of a recent book by Silberman on autism spectrum, Neu- roTribes.2 which explores connections between neurodiversity and identity.

As Mr. Solomon speaks of “celebrating” differences, Ms. Dretzin takes us inside a board meeting of Little People of America. They discuss a medical “cure” for achondroplasia, the most common form of dwarfism. It has come at a high point in the evolution of “dwarf pride,” prompting a board member to say, “I don't feel we need to be fixed.” Loini, meanwhile, never exposed to little people, could not have been more pleased with the comradery.

There were stark contrasts between Trevor's family and that of Leah and Joe. Joe's extended family rejoiced over his relationship with Leah when the couple presented them with a sonogram of Leah's pregnancy. Joe predicts he will love the child, whether little or of average stature. They now have two average-sized children.3 By contrast, the parents of Trevor, who at the age of 16 killed an eight-year- old, are in a continuous state of grief. The situation has warped their lives, as the father explains: “We're afraid to expect too much because we lost so much.” Trevor's mother looked for answers, mostly blaming herself, before resigning herself: “This happened, and we can't fix it.” Even the younger brother and sister are traumatized, both saying they are afraid to have children for fear of something going wrong.

Far from the Tree is moving, disturbing, and hopeful. It demonstrates the importance of randomness as a type of trauma. The characters have been blindsided, and they must adapt. In our forensic work, we are often impressed by the thinness of the line separating freedom from imprisonment. The film's char acters have been thrown into situations not of their design. So too, litigants and prisoners have narratives, and we have an ethics duty to regard them with respect. In a sense, most of the individuals we assess are far from our trees. The film is a reminder to be open to the diversity of human experience, permitting us to translate subjective reality into objective information.

• © 2019 American Academy of Psychiatry and the Law