Simon Baron Cohen, autism and empathy

Cover of Zero Degrees of Empathy, by Simon Baron CohenI recently got hold of two books by Simon Baron-Cohen which focus on the subject of empathy. The earlier, The Essential Difference, focusses on the difference in empathy and systemising between men and women; the more recent (published this year) is titled Zero Degrees of Empathy (the American edition is called The Science of Evil) and is about specific disorders that involve impaired empathy, in which he includes autism, Asperger’s syndrome, borderline personality disorder, psychopathy and narcissism. The first two he calls “zero-positive”, meaning that they have worthwhile qualities, while the last he calls “zero-negative”, meaning they have nothing to recommend them and lead to self-harm, social alienation and anti-social behaviour. He also posits the idea of the autistic brain being the “extreme male brain”, an idea first advanced by Hans Asperger in 1944 but only translated into English in 1991. His ideas have offended a lot of people within the autistic community, particularly women with autism who object to being described as more male than most men, as well as some who say that their empathy is much more highly developed than Baron-Cohen gives them credit for. Rachel Cohen-Rottenberg has been one of his most articulate critics from this camp and you can read her views here: [1], [2], [3], [4]. (More: Incorrect Pleasures ([1], [2]) which exposes a couple of the atrocity stories which Baron-Cohen uses to spice up Zero Degrees, Questioning Transphobia, Perpetually Myself, Glosswitch.)

I bought The Essential Difference in an attempt to understand the ideas behind Zero Degrees, but each book has its own share of plainly ridiculous claims. To take two examples from The Essential Difference: on page 170 of the Penguin edition, he writes:

The existence of chronic pain suggests to neurologists that there might be people in nature who experience no pain. The existence of phobias suggests to psychiatrists that there might be people in nature who experience no anxiety.

Does anyone really need to know anything about chronic pain to know that there are people who cannot feel pain? They are two entirely separate neurological impairments, and both exist independently of the other. I hope nobody needs to meet a child who can painlessly bite his or her own tongue off to prove to them that some people are in constant pain. Especially not a neurologist. As for phobias, these are specific irrational fears, not simply any fears or the magnification of fear in general, so it is not an opposite of having no fear. The purpose was to demonstrate that, by the same token as there is such a thing as an “extreme male brain”, there must also be such a thing as an extreme female brain.

Another absurdity in this book is his example of five examples of how maleness or females can be defined. The first three are the usual: the XX or XY chromosomes, testes or ovaries, and genitals and reproductive organs. The fourth, however, is “brain type”, meaning primarily systemising or empathising, and the fifth is “your sex-typical behaviour”:

You are male if your interests involve things such as gadgets, CD collections and football league results, and you are female if your interests involve things such as caring for friends, worrying about their feelings and striving for intimacy.

I am sure most readers will agree that having a set of interests more typical of the other sex than of your own does not make you, in any sense, other than your own sex. One’s biological sex may have an influence on one’s interests, but the latter does not determine the former. Furthermore, one may have interests more common in the other sex but, in dress, general behaviour and relations with the opposite sex, be entirely typical of one’s own sex and identify with it without hesitation. Male and female relate to a specific set of biological features and how one presents; one’s tendency towards empathising or systemising or being interested in collecting CDs or stamps is not part of this. Besides, Baron-Cohen also refers to the existence of people with balanced brain types with more-or-less equal tendencies towards systemising and empathising. Does he consider these to be male or female “in that sense”?

The problem is that Baron-Cohen, in both books, presents archetypes of classic cases of autism or of male and female behaviour, such that there is a chapter containing childhood biographies of a girl who loved dolls and pets and being friends with people and supporting them right from when she was a toddler, and a boy who had one material interest after another — first tractors, then football stickers and the general football scene, then the pop charts, and is in a band but much more for the music than for the chat, and who talks to those he considers close friends every few weeks. All of his personal examples of autism and Asperger’s syndrome are male. He does not have much to say about women and girls with either condition, other than that they tend to score high on the “tomboyism questionnaire”, i.e. they tend to have more boy-like interests. However, a tomboy can be a highly physically active girl who prefers to interact with boys than girls, and “boy-like” activities can often mean heavy physical activities rather than systemising pursuits such as bird- or train-spotting and collecting. Moreover, this fact, footnoted to an unpublished manuscript of Baron-Cohen’s partial authorship, does not include what “male-typical” activities women and girls with Asperger’s or autism are in fact interested in. “Male-typical” does not necessarily mean typical of men, merely that more men than women are interested in it.

Presenting the Aspergic or autistic male brain as the extreme male brain is to gloss over a number of important questions, such as why, if it is possible for a woman or girl to have an extreme male brain, is it not possible — if not fairly common — for her to have a normally male brain, or why the male-like variation in their brains marks them out as autistic at all, rather than just less womanly in their behaviour. However, the biggest problem with this theory is that males with autism or Asperger’s syndrome do not tend to an extreme of a typical male type, but an accentuation of certain types of typically male behaviours which produces a type, and a lifestyle, which is not typically masculine at all. If anything, boys with Asperger’s in particular tend to have a more sedentary lifestyle than most other boys, and are certainly not perceived as masculine by more typical males (or females).

Female autistics seem to figure little in Baron-Cohen’s writing, primarily because they are inconvenient to his “extreme male brain” theory. He suggests that they may be able to do well without a diagnosis as they are “better actors”, but evidence suggests that girls with Asperger’s are prone to exclusion from social circles, to serious difficulties with school and work, and (perhaps more than males) to exploitation. There is an article from the Telegraph here about the particular challenges facing women with Asperger’s. I do not want to over-emphasise this, as there has been a suggestion that Asperger’s is somehow acceptable in a male, and that there is an adult life beckoning of a sheltered existence in academia with a patient wife who understands all of his eccentricities, a life which has quite eluded this writer (there was an article to this effect in the Guardian in 2008, which I answered here), but the suggestion that girls with Asperger’s (let alone more severe forms of autism) do well enough without diagnosis does need to be challenged.

He also suggests that someone with an “extreme female brain” might not be particularly disabled as poor systemising might be socially acceptable, and she might find a job as a therapist or nurse in which caring (and, thus, empathising) are paramount. However, drastically impaired systemising might well be the result of poor logic and reasoning, which might well result in poor command of language (let alone a reduced ability to acquire any second language) and reduced abilities to learn practical (non-social) life skills. Furthermore, the modern caring professions require much academic learning; one does not learn to be a nurse, for example, purely on the job but spends much time in the classroom. There has been much criticism that many recently-qualified “degree nurses” in the UK lack the necessary empathy for their patients, but all the same, nursing is more than “just” care. It is a highly-skilled profession, and a significantly cognitively-impaired person is unlikely to be able to manage the academic learning. Similarly, he offers the example of a particularly gifted psychotherapist who he identifies as ‘Hannah’ in Zero Degrees as being an example of the highest degree of empathy but, while she may not be overly interested in the systematic pursuits that characterise autism, she could not be system-blind or she could not have successfully trained to be a psychotherapist. She does not appear to be disabled in the way an autistic person is, and thus her condition is not a counterpart to autism.

Finally, we come to Baron-Cohen’s over-emphasis on empathy, which is the biggest weakness in his entire set of theories. The autistic brain, he claims in The Essential Difference, is an “extreme male brain” with over-developed systemising and poor (or no) empathising; in Zero Degrees of Empathy, he calls Asperger’s and classic autism “forms of Zero Degrees of Empathy” along with borderline, psychopathic and narcissistic personality disorders, mitigated by a moral code that can be formed through systemising. He does not qualify the claim that people with these conditions have zero empathy, and when people protest that they are actually capable of empathising, he replies in this interview:

The online autism community is just one sector of the autistic population: namely, those with at least average intelligence, who can therefore use the internet. They are sometimes referred to as having “high-functioning autism” or Asperger Syndrome. This sector of the autistic population may not have zero degrees of empathy but they do tend to have below average levels of empathy on different measures that research have used. These include (but are not restricted to) the ‘Reading the Mind in the Eyes’ Test, or the Empathy Quotient (EQ).

A word about these quotients: some of them contain questions which are not good guides to how much of an empathiser or a systemiser the participant is. For example, the Systemizing Quotient (included in the appendices of both books) asks whether they agree or disagree (slightly or strongly) with these propositions:

  • If I were buying a car, I would want to obtains specific information about its engine capacity
  • If I were buying a computer, I would want to know exact details about its hard drive capacity and processor speed
  • If I were buying a camera, I would not look carefully into the quality of the lens

About a third of the propositions are red herrings (i.e. they have no effect on the score), and these are not among them. None of them actually test how system-oriented the person being assessed is; rather, they test how much of an interest he or she has in what is to be done with the product. Anyone seriously interested in photography will want a better-quality lens to their camera, because it produces better-quality images with fewer defects (not always noticeable in a holiday snap, but a stock photo agency such as Alamy will look for them); someone buying a computer might need to know the exact processor speed because a particular piece of software will refuse to install on a computer with less than a given speed; and the exact capacity of an engine (like which side of 1000cc) may make the difference between one road tax rate and another. Admittedly, demanding a top-quality, expensive lens for holiday use so that the owner can examine his snaps for imperfections may reflect an excessive attention to detail, but this test does not reveal that.

His books, despite being hundreds of pages long (unlike his interviews), do not qualify the “zero degrees” claim, indeed calling Asperger’s syndrome a form of Zero Degrees of Empathy. If he does not think all people with this condition have no ability to empathise, why is it not in his books? Why bother writing the books if they are not to include the whole theory? He significantly overestimates the importance of empathy, for example claiming in chapter 3 of The Essential Difference:

Furthermore, empathy provides a framework for the development of a moral code. Despite what the Old Testament tells us, moral codes are not found mysteriously carved on tablets of stone up windswept mountains of the Sinai Desert. People build moral codes from natural empathy, fellow feeling and compassion.

However, history tells us that empathy is an imperfect tool for building moral codes with, because people empathise with those with whom they identify. These may be those closest to them in family relations, or those with shared ideas, beliefs or goals, or those of the same sex, race or social class, or those of a more privileged class that one aspires to join, or those who have made similar life choices to one’s own or have been otherwise in similar situations. “Moral codes” based on fellow feeling and empathy are thus likely to be a cause of injustice whenever someone is asked to consider the rights of someone whose class, gender or beliefs they do not respect. A good example of this is attitude of French feminists towards Muslim girls who want to wear the headscarf at school: they identify with the girls who do not want to, and insist that their right not to wear the veil comes before the right of those who insist on wearing it to receive an education or, in some cases, employment.

Zero Degrees is full of entirely irrelevant examples of “empathy erosion”, such as a thief cutting off a woman’s finger to steal her ring (update: this is probably a myth) as well as various Nazi and more recent war crimes (including one about Nazi doctors amputating a woman’s hands then reattaching them the wrong way, which is also probably a myth which has been told about Idi Amin among other people as well, yet is probably medically impossible), yet the book concentrates on conditions which do not lead people to carry out these kinds of violent acts, with one exception, and the example offered was of a psychopathic man who killed over a petty personal (and not political) dispute. Baron-Cohen devotes pages to analysing the genetic and neurological make-up of psychopaths, but to use examples of war crimes adds nothing when the analysis is not of the make-up of war criminals but rather common criminals. There are a number of reasons why people may deliberately harm others, other than a pathological lack of empathy; a principal one is that they have decided that the victim is not worthy of such consideration, often because of their race or some other reason. As I have already stated, people empathise more easily with those they respect than those they do not, but there are other causes, such as the desire to fit in with a larger group (a common factor in group bullying, in which people join in so as to “get in” with the dominant group in their environment), or a misguided sense of loyalty (such as in “honour” killings) or entitlement.

He has a chapter in Zero Degrees on how genetics play a role in human empathy, but if there is some genetic component to any “non-empathic” acts, even isolated crimes such as the murder by Rekha Kumari-Baker of her two daughters that he mentions in Zero Degrees, then what good will come out of it? It could well be used for prior preventative measures to stop such people becoming criminals, but for some people it could mean incarcerating them on the grounds that they may be more likely than another person to commit a crime, given the right circumstances, which I am sure nobody would want to see.

There are other inconsistencies, such as the male-female continuum in which autism is at the “extreme male” end, yet he acknowledges that females experience more fear than males, yet autistics actually experience more fear than either; in fact, some have observed that the primary emotion for many autistics is fear. He also acknowledges that many autistics, particularly those with high-functioning autism and Asperger’s syndrome, care passionately about others’ feelings and social justice despite having poor or zero empathy, yet advances empathy as the basis for morality. The problem is that the sort of empathy which would lend itself to formulating moral codes — the ability to have compassion or to conceive of others having feelings or suffering — would, therefore, be developed in those with autism; it does not require direct interaction with other people, which is what people with autism find particularly difficult, often regardless of whether emotion is involved. Many people with autism report (here is one example) that they are in fact capable of recognising the emotions of others, but find it difficult to make an appropriate verbal or physical response. They may also, in research, underplay their sensitivity to others’ feelings to avoid actually talking about emotions, which they find difficult (Baron Cohen acknowledges, in Zero Degrees, that people with autism have considerable difficulty talking about their own feelings, which he refers to alexithymia, or having no words for emotion).

Finally, his books do not seem to acknowledge that autism is in fact a disability, and has other features beyond matters of systemising and empathy which have no particularly masculine or feminine qualities; they are simply cognitive and (usually minor) physical disabilities. In the case of severe autism, some of those affected cannot speak, have difficulty swallowing, experience unpleasant sensations (one young woman reported the sensation of ants crawling over her body, which, in the absence of actual insects, the British neurologist, Dr Elizabeth Dowsett, noted was an indicator of brain damage). It is also noted that many children with Asperger’s syndrome have marked motor dexterity deficiency, often manifesting in an ungainly walk or run, poor handwriting, difficulty co-ordinating multiple motor tasks, and poor ball skills, and often are particularly sensitive to certain smells, sounds and forms of touch, and conversely may not indicate when they are (or at least should be) in very serious pain. The “extreme male brain” theory does not address any of this, let alone why severe autism is accompanied by developmental delay, or is sometimes (but not always) relieved by changes to the affected person’s diet.

In short, Baron Cohen’s theories seem like a closed system, which looks airtight until you realise that he has glossed over a whole host of important facts about Asperger’s syndrome and the rest of the autistic spectrum, and buttressed it with a few archetypal case histories. While in some respects some men with Asperger’s may resemble an exaggerated version of a particular type of introverted, non-physical male, the theory does not account for the disability features of the condition. The books also present over-simplified versions of his theories, injuriously claiming that autistic people have “zero degrees of empathy” as do psychopaths, which in most cases is simply not true. Of course, these two books are not primarily about autism — his works on that are to be found elsewhere, it seems — but his use of exaggerated examples to illustrate the supposed relevance of autism to the subjects of his books result in a distorted and very negative image being given to readers.

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