burke quit, hahn quit, dixon's autistic

grey's anatomy's complicated relationship with neurodivergence

Warning: this essay has mild spoilers from across all seasons of Grey’s Anatomy, including a storyline from the newest seasons. However, there are no huge details on things like deaths, major episodes or finales.

You’d be forgiven for believing that Grey’s Anatomy’s only real engagement with neurodivergence is through early season doctor “with Asperger’s” Virginia Dixon, and in recent seasons, intern ADHDer Lucas Adams, because technically, that is the case - but I’d like to introduce you to much more than that.

Because Grey’s has an issue at it’s core: coding swathes of their characters as neurodivergent - particularly autistic - and never acknowledging it, the acknowledged representation sparing and often less effective. This is, of course, in combination with plastering their halls in Autism Speaks posters crowing the need for a cure, so forgive me for being a little scathing.

Autism, autism everywhere

Of course, Grey’s has been running for a long time - I literally started school a week after it’s pilot - but I wonder if that means it’s complicated relationship with neurodivergence can go without criticism or deep diving.

Particularly because it’s not like there was no notion of it amongst some of their autistic coded doctors - one patient’s questions leave Dr Yang saying, with indignation, “are you asking if I’m autistic?”. Yet, even with it heavily implied and even vaguely acknowledged, this is almost a joke and the insinuation the audience is left to see as nothing more than coming from an ill-informed and slightly awkward patient; if Dr Yang was autistic, she’s a doctor, so we would know, right?

Cristina Yang is possibly the most autistic-coded character I’ve ever come across. Her empathy looks different to everyone else’s, pragmatic and often realistic in ways people are not ready for, yet still loving and with deep care for grief and loss. She communicates often without too much additional facial expression, severely direct and without fanfare; this often divides opinion by both her colleagues and her patients and the show commonly places emphasis on showing how her communication is received. In her relationships, her communication and pragmatism are often seen as failures or reasons for break-ups or break-downs, instead of this being portrayed as a victim of the double empathy problem.

Yang also has extremely high pattern recognition skills, and there is often discussion of her ‘giftedness’, or savant status. There’s a vague mention of her being dyslexic in one episode, with shock at her abilities, never to be mentioned again. There is often an implication that Yang can only thrive in this environment, and would struggle anywhere else due to her personality and - simply put - the way she is. When she is struggling with PTSD, we see her attempt to be a bartender, which she can only manage by getting blackout drunk, and elsewhere, she struggles to put up with the communication of the man examining her during her Boards.

But she loves deeply, is not inherently awkward, and has friendships, so it would appear her coding was always meant to stay that way.

I am also fairly insistent about April Kepner being autistic, and whilst this is obvious to me, this one is potentially more controversial than the other examples I put forward here. This one comes in traits like her deep need for routine and structure, and her complete inability to break rules or be flexible.

April is often referred to as a drill sergeant or similar, with others frustrated at her tendency for being a teacher’s pet - which, to me, is a combination of overcompensating via masking and her all or nothing nature; desperation to be liked but struggling to do what her peers would prefer. We can see this through Season 7, Episode 7 where the residents are put through a trauma certification, and she is the only one who wants to finish it out within the rules (until the very end, where she bends them subtly in order to still win).

But the most clear of all episodes around April for me, is the two of the group taking their boards (Season 8, Episodes 21 and 22). We open up with her getting stressed because some of the others are late - a classic difficulty many autistic people face - and her distress deteriorates over the two episodes into what can only be seen as an autistic meltdown by the end, including snapping at her examiners, overheating, and being desperate to right the injustice she feels.

We also know that there are lots of autistic people who find comfort in religion, because of it’s structures, the rules it can provide for living life, and it’s consistency and sameness. This is core to April - including in her relationship with Jackson.

Grey’s loves giftedness

There are a few other characters I see as blatantly autistic, but these are portrayed as simply gifted, as if it could not be anything more. Interestingly, away from Yang, who also fits this category, most of these are all from the Grey family in some way.

Late in Season 3, we see the introduction of another very autistic coded character in Lexie Grey, lovingly referred to as Lexiepedia. Lexie’s photographic memory leaves her often isolated and she often struggles to socialise with her peers, in some instances visibly confused by social norms or the thoughts the majority are bringing to a scenario. In Season 5, Episode 9, we see Lexie involved in the interns taking out another intern’s appendix, and there is a clear impression that she is doing this to fit in better or ‘prove herself’.

Lexie seems to thrive better with those who are older than her - another hallmark experience many autistic people have. I’m sure some would argue that this is just an aspect of her giftedness; being too booksmart as a child not allowing her to fit in with her peers - but I’m going to be real, the venn diagram is often a circle here. There are also several instances of Lexie having meltdowns or ‘stress eating’ when situations are difficult, both of which are seen in autistic people (the latter partially due to sensory seeking as regulation).

Another of the sisters we must also examine here is Maggie Pierce. Introduced in Season 10, Maggie is blatantly autistic coded. In an episode entirely focused on her early into her introduction (Series 11, Episode 2), we see this in abundance - opening with the fact she “loves puzzles” and has since she was a kid (pattern recognition), followed by an hour of endless social faux pas and failed attempts at friendship as she attempts to find her feet in a new place with people who have little to no interest in stopping for a moment to actually understand her.

My frustration with the show grew exponentially with the introduction of a storyline about Zola Grey, Meredith and Derek’s adopted daughter, being so gifted she was struggling in school. Zola has panic attacks to the extent she refuses to go into school, another experience that many autistic people have; the family looks into alternative education styles and provisions, but there is never any mention that Zola might in fact be neurodivergent, only that she is gifted. This is, of course, tangled in the storyline about her being adopted and what this means for her and her family - but if anything, this could have made it an even more important addition to the storyline that they should be exploring other avenues and explanations. Ultimately, this is part of why the Grey family leaves Seattle - but it feels cheap for her neurodivergence to be simply a vehicle for the characters being a less central part of the show.

With both Maggie and Zola, it would have been amazing to see them confirmed as autistic or neurodivergent - Black women are even less likely to be diagnosed, and awareness of this is crucial. It is frustrating for this to still be missing, especially in the case of Zola where it is so recent - those who see themselves in these characters deserve to have an answer for why that could be.

The representation we actually got

Amongst doctors, there are a small clutch of confirmed neurodivergents: mainly, Dr Dixon, Dr Adams & Dr Marsh, and - though briefly understood - Dr Bailey.

Once upon a time I would have told you that Dr Dixon is “bad” autism representation. This is not a binary I like to place on any representation, now, because stereotypical representation is not necessarily inherently “bad” - it may be unhelpful in some way, or frustrating, or difficult to stomach, but it may be relatable or useful to some people. And I do relate to aspects of her character, even if it is subtle - the main thing that makes it ineffective representation is how she is treated and discussed.

Dixon, for me, is most frustrating because she is there at the exact time as Yang - in fact, they work together closely in the few episodes that she is present. We not only have this stereotypical archetype of what was still then known as Aspergers, but we have it next to an extremely well done, multifaceted, thought provoking woman of colour who we can only argue as autistic.

Dixon is treated like an alien - Chief of Surgery Webber’s line “Burke quit, Hahn quit, Dixon’s autistic”, spat with disdain and frustration, implies it to be something impossible, an inconvenience on a par with his senior surgeons leaving, whilst others act as if they cannot work with her or like she is a zoo exhibit. One of her more effective scenes is that where a family hugs her and speaks with loud gratitude, only for her to go into a sensory meltdown and need deep pressure in the moments following - but even this need is done with an almost comedic slant as it is fulfilled, as if she is simply odd and inconvenient.

Intern Dr Adams’s ADHD storyline is one I genuinely do largely commend the show for - even if it comes almost two decades into an extremely complex relationship with neurodivergence. It’s frustrating to still see medication as a core focus, particularly with the way Dr Marsh throws the idea this need adjusting for Adams at him as if we cannot be trusted without them or need them in order to be able to ever cope, when many people cannot be medicated or prefer not to be.

But, overall, the way that we see the build-up of understanding Adams throughout Season 19 - struggling with his bills, hyperfocusing, experiencing high levels of Rejection Sensitivity Dysphoria, just as a few examples - culminating in his discussion with Marsh about their shared traits and this being a new, almost shocking discovery for Adams is done well. Their conversation is refreshing - largely neurodivergent-affirming in a way the show hasn’t really done before, and highlights not only different aspects of ADHD but the way that working with your brain, rather than against it, is critical.

Interestingly, I think many of us have wondered whether Amy is ADHD, and with Adams being a member of the Shepherd family, I would love to see that explored later (especially in the context of her addiction).

Conversely, Miranda Bailey’s neurodivergence - Obsessive Compulsive Disorder - is portrayed as fleeting and simple. It is caused by something specific, and then, she is forced to be medicated and it is never mentioned again. On a recent rewatch, I remembered just how frustrating I find this storyline: as if there is no other intervention for OCD, and medication makes it go away entirely, never to be faced again.

In conclusion…

Let’s reality check: I don’t think Grey’s Anatomy needs to be cancelled, and I don’t think all of this has ever been intentional. Understanding of autism and ADHD particularly has boomed in the last decade - when I was diagnosed in 2015, a year after Yang’s departure, knowledge was still extremely lacking, at least in public spheres. I do, however, think that it is convenient that so many characters are portrayed in such a way without the show desiring acknowledgement of this possibility - likely tied up with outdated ideas about what neurodivergence “looks like” - or more importantly, not.

In newer characters, and particularly the case of Zola, it has me screaming at my screen, and when it comes to storylines like Bailey’s OCD, it feels like neurodivergence is being deeply pathologised and simply dropped in as a sidenote, not something that is a key part of our existence.

It is evident that Grey’s has a complex relationship with neurodivergence - and it feels like this is something that it should be better at recognising, twenty-one seasons down the line. But, perhaps the tide is turning. If this show is never going to end, god forbid, I hope it can begin to find better roots in this topic.

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Have strong opinions on this topic? Characters I’ve missed or that you disagree with? Let me know below 👇🏻