Truth Will Out: Review of Portia Iversen’s “Strange Son”

I am surprised Portia Iversen’s book, Strange Son: Two Mothers, Two Sons, and the Quest to Unlock the Hidden World of Autism (2006), appears on proponent lists as proof that Facilitated Communication (FC) works. After all, the book contains two solid examples where the inventor of Rapid Prompting Method (RPM), Soma Mukhopadhyay, fails blind testing. 

Soma Mukhopadhyay provides hand signals to her son, Tito, during a piano lesson. This is practice for Rapid Prompting Method as he follows her cues to select specific notes on the keyboard. Given that he has the motor skills to select the notes independently, it is curious why he is not allowed to interact with the keyboard (or letter board) without his mother’s cues. (CBS, 2003)

The first test happened when Tito’s father, R.G. took his son to lunch. Previously, he had read an article that debunked FC and confronted his wife about it, which she ignored. When father and son returned from their outing, Mukhopadhyay asked Tito about the experience and facilitated the answers. The FCed response included food items (presumably Mukhopadhyay’s guesses) but failed to include the name of the sandwich Tito ate that day.  

Sadly, shortly after this experience, Tito, with Mukhopadhyay’s support, typed out that his dad no longer believed in him. This negative response documents one of the risks family members (or educators) take in speaking out against FC. Proponents, erroneously, equate criticism of the technique as a criticism of the individuals being subjected to its use. Fortunately, in this case, the negative message did not also include allegations of abuse.

Presumably to avoid further scrutiny, Mukhopadhyay took her son and moved out of the family home, though, it appears she remained married, allowing visits only 3-4 times a year.

Tito and Mukhopadhyay continued to practice RPM daily for hours at a time.

Several years later, a researcher set up an impromptu blind test when Mukhopadhyay left the room for a moment. The person read Tito a paragraph and upon Mukhopadhyay’s return, asked Tito questions. This format followed the same “teach then test” protocol used routinely in their sessions. The only difference was that Mukhopadhyay was not the person who read the paragraph and asked the questions. None of the FCed responses were correct.

Neither of these failed blind tests altered Iversen’s outward support for RPM. Not only was her organization, Cure Autism Now (CAN), championing Mukhopadhyay’s work in the U.S., Iversen was a parent of a child with profound autism who, she hoped, would benefit from RPM. Finding Tito (and making RPM “work”), was, in her words, a “matter of life and death.”

In an example of how motivated reasoning can cloud the acceptance of evidence against a valued belief, Iversen blamed the evaluators for “betraying” Mukhopadhyay by performing the test and Tito for goofing around and not taking the answers seriously. Iversen essentially badgered the researchers into altering the test protocols while she and Mukhopadhyay regained control over the testing situation.

Iversen and her son, Dov, practicing RPM. She holds the board in the air and provides physical support on his shoulder. (CBS, 2003)

Iversen seems to have let what she called her “persistent vulnerability to miracles” guide her quest to “unlock the hidden world of autism,” even in the face of disconfirming evidence. Her own dreams of curing autism would come to an end if Tito did not have the cognitive ability to write out answers to information he had just heard. Mukhopadhyay’s reputation, and by default, her own, would also be questioned.  

Of course, proponents argue that RPM, is not FC, but Mukhopadhyay, as Iversen details, employs similar cuing techniques. These include holds at the wrist, elbow and shoulder, hand-over-hand support, grasping the letter board, and using vocal cues to guide clients to select target letters. Though she claims to have “faded” support to her son, Tito was, as Iversen reports, “completely dependent” on his mother to write or type and did not initiate written communication on his own.

Perhaps it is the additional cues Mukhopadhyay uses that sets RPM apart from FC: tapping her clients in the face with the letter board, jabbing them in the knee or arm with her thumb, using her clients’ knee as a “think pad” (e.g., signaling letter selection by applying pressure to a body part), and sharply shouting “C’mon!” to get them to start pointing (even when they are not looking at the board). 

For most of the book, Iversen focuses on Tito. Like her son, Dov, Tito is profoundly autistic with limited ability to communicate. Both exhibit aggressive and impulsive behaviors. Tito, literally, tears Iversen’s house apart. He also steals food off people’s plates, escapes from his apartment at night, runs into the road without looking, chokes Iversen and then turns on his mother when she tries to help.

Note: Iversen later reveals Mukhopadhyay “didn’t give a hoot” about any of Tito’s behaviors when she was not facilitating with him. The intensive years-long reinforcement of RPM behaviors (e.g., pointing on cue) goes a long way in explaining how Mukhopadhyay’s physical and verbal cues could, over time, become increasingly subtle.

Mukhopadhyay’s choice to ignore all other behaviors may have been manageable when Tito was small, but, at age 13, Tito’s size and strength put him and those around him at risk for harm. In an uncharacteristic departure from Mukhopadhyay’s teachings, Iversen worried that their sons’ lives would be “tragically restricted” if they could not learn some voluntary (e.g., social) behaviors.

Iversen’s foundation, Cure Autism Now. (CBS, 2003)

From Iversen’s perspective, what set the two sons apart is Tito’s unexpected language and literacy skills that, seemingly, allowed him to type sophisticated, if enigmatic, poems and stories with his mother’s prompting. Iversen hypothesized:

If Tito was not retarded, if he had language and could communicate, if he had emotions and even empathy—then what was autism? What remained was a constellation of out-of-controlled behaviors, some repetitive, some impulsive, some obsessive. And the inability to generate voluntary behavior. The good news, I supposed, was that if you could eliminate retardation, language deficits, and lack of emotion from the equation, then, theoretically at least, autism ought to be a lot easier to figure out than we’d previously imagined. (p. 111)

In other words, if the well-documented neurological, language, and behavioral characteristics that make autism “autism” are miraculously erased, then curing it would be so much easier.

Iversen’s son, Dov, is hardly mentioned in the book until after Mukhopdadhyay gets him to type out that he is “Close to God.” Even after the miraculous breakthrough, Iversen notices problems with the FCed messages. He hardly looked at the letterboard when typing. The FCed messages did not match his behavior (e.g., he typed out “eggs,” but then would not eat them). The more reliable FCed messages contained information the facilitator already knew.

Iversen embraced RPM, handing out letter boards to everyone who had contact with her son, but noticed that her own abilities to facilitate were poor. Dov’s full-time aide, too, could only get limited answers. Iversen, eager to learn from a woman who she considered a “brilliant practitioner,” turned her focus to Mukhopadhyay’s behaviors as she worked with students.

These efforts to study, distill and standardize RPM changed their relationship. At first, Mukhopadhyay allowed Iversen to videotape her sessions, but remained evasive when Iversen pressed for more detailed information. It is no surprise that, shortly after, Mukhopadhyay abandoned Iversen--like she had her own husband when questioned about FC—and moved to Texas to start her own business.

If the phrase “truth will out” has any validity, Iversen’s Strange Son is a good place to start, if viewed with a critical, not credulous eye. Despite her best efforts to suppress her doubts about Mukhopadhyay and RPM, the book is peppered with examples.

Looking on as Mukhopadhyay worked with a group of children, Iversen observed:

Soma had become almost like a clairvoyant, leading seances in her little booth where the children could learn and communicate as they could with no one else. But why? (p. 370)

I believe Iversen, deep down, already knew the answer and I wonder if Mukhopadhyay’s seemingly mystical emotional stronghold on Iversen faded once she’d moved away.

Note: Iversen is, largely, responsible for initiating the RPM movement in the United States by sponsoring Mukhopadhyay, then a citizen of India, for what turned out to be a nearly two-year all expenses paid stay. The project, funded through Iversen’s organization Cure Autism Now, promoted RPM in schools and marketed it to the media even knowing there was no scientifically reliable evidence to back up claims of its efficacy. Iversen wrote:

We could not tell parents that their autistic kids might be more intelligent than they suspected when we had no way of helping them get that intelligence yet. And CAN was a scientific research foundation. Promoting unproven concepts and methods on national television could be destructive to the foundation’s credibility.” (p. 359)

And, yet, in a move proponents know works as a means for gaining credulous followers, Iversen and her group proceeded with their marketing plans anyway.

Occasionally, I’ve heard through the grapevine that Iversen later abandoned the technique. If true, I wonder if her own, niggling doubts finally caught up with her. If so, I think she has an obligation to tell that to the public.

My next blog post will explore the strange science in Strange Son.