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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  • The now sadly defunct ISNT website (Institute for the Study of the Neurological Typical), authored by someone with autism and spoofing the Baron-Cohen approach to autism shouted volumes about this issue. Baron-Cohen, like too many psychologists, doesn’t really get the extent to which autism is socially constructed.

    The writer par-excellence on autism as a social construct is Majia Holmer Nadesan’s “Constructing Autism” - amazingly, a senior British autism educationalist described it as a book which “denies the existence of autism”. In fact, she’s a weak social constructionist, which puts her on par with Pinker - hardly a radical social theorist!

    I’m also a fan of Professor of Developmental Psychopathology Peter Hobson, who was the principle critique of Baron-Cohen’s theory of mind. He tends to get short shrift when reviewed in autism journals, largely because he draws on a wider intellectual base than most autism reviewers feel comfortable engaging with. He can be hard going, but I think his insights are well worth the trouble.

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  • This is an excellent review, Matthew - well done!

    This systematising/ empathising dichotomy of Baren-Cohen’s really bugs me. Quite apart from how that is supposed to relate to sex and autism, the objections to which you have described very well, I think it’s impossible to define roles that way, particularly any of the “professions” - teaching, medicine, law, business, even most areas of computing, demand both a high level of systematising and empathising ability. And yet historically, these roles have not been occupied by a neat gender balance (perhaps naturally they would, but if they’re not now, we can’t extrapolate that most nurses are women because of anything in nature).

    Unfortunately, we do seem driven towards the view of a nice neat world in which everyone can be understood according to superficial characteristics, and which the bad guys can be easily identified and categorised. And that sells books. It’s a real shame that not just people with neurological difference who are capable of evil - Philip Zimbardo’s “The Lucifer Effect” is a very good book about that.

  • Khalid

    I’ve just started reading http://www.harpercollins.com/books/Born-Love/?isbn=9780061656781, which you may find more to your liking.

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  • I get put off SBC’s theories because they seem to reinforce stereotypes & stigma.

    I did his Systemizing-Empathizing quiz & came out ‘extreme systemizing’ - I’d say that is because I would have scored low in Empathizing. I’m INTP Myers-Briggs MBTI and as a ‘thinker’ female I got against the stereotype of ‘feeler’ women. From the questions in SBC’s quiz, I wondered if it was pretty much ‘thinker vs feeler’ component in MBTI.

    I don’t like how he calls it a ‘male brain’ as it reinforces gender-roles where the ‘experts’ pull more examples from society’s constructions than biology.

    I don’t know whether more Aspies are thinkers - I suspect so - non-official polls seem to indicate many Aspies are INTP or similar.

    I also don’t like how he brings lack of empathy of autistics in with psychopaths, which can cause confusion and increase stigma.

  • M Risbrook

    Riaz knows more about autistic spectrum disorders than I do. He says that the MBTI was designed without autistic spectrum disorders in mind so cannot be used to identify them. At the time of its development Asperger syndrome was completely unknown in the United States. He has also been unable to find any details of large scale MBTI tests on people officially diagnosed with autistic spectrum disorders.

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  • I wrote an article titled “Autism and Empathy, the Fixers and the Huggers” for the autisticsaware.wordpress blog, which challenges the perspective of Dr. Jacob A. Burack . He concludes from the research, “thus, little empathy in the form of personal distress, prosocial behaviors, or even an attention to the other was found in these young children with autism”. Since the majority of the population is ‘normally’ developed, it is it therefore a social norm to hug another person, as the psychological preference to display empathy. However, let us give credit to the fixers in society who wanted to improve the lives of the world, and invented all the goodies which we rely on today. Where would we be today without the personal computer, the iPods, the light-bulb, and all the beautiful art and music that we cherish today?

  • John

    OMG you didn’t get the right message from this book. It is very interesting to see that you talk about the authour as if his will was to talk about Males and Females. Well, If Cohen says Hypermasculin and Hyperfeminin doesn’t mean you have to think of Males and Females, yet you obviously did. Cohen only talks about caracteristics that you can find in types of humans comonly called Masculin and Feminin. That’s all!! Do not put your society matters in this, this is purely far from anything social. Males and Females are social phenomeons, nothing to do here!! If you cannot think this way, then it is not useful to write such complicated critics about the book. Instead of starting a self reflection on Cohen’s view and giving fresh new ideas, you just analysed all the mistakes he could have done, and find all examples that could prouve the contrary…congrats, this is very constructive!

    That is the reason why you find this book negative. But no one asked you to find any positive or negative image to give to the reader. If the reader is not smart enough to understand or look for infomration about autism, and why it can’t be thought as something negative, well that’s not Cohen’s fault! This is not a book about autism so he cannot be as precise as in such a book. People just have to be prepared for this, and move on when they read!! Cohen does not have a negative point of view about autism, and people who read this should have minimum knowledge that any handicap (if i may call autism handicap) is not such a negative thing. Problem solved!

    To understand Cohen and start thinking about how intersting this book is, you need first to free your mind from social aspects, and if you find this funny to stop at every little possible mistake Cohen could have put in his book, you will miss the essential, but that’s your problem, i can’t help you for this, for ex: 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.

    You criticised this while first, he said “neurologists” and “psychiatrists”, which means this didn’t actually come from him, and secondly this example as you say is to explain the existence of hyperfeminin brain. Well i am even confused because you actually said that this is only to explain extreme female brain. So why do you afterwards talk about the meaning of the sentences in this example!!?? What people need to understand is only the way Cohen thought of an extreme female brain, not the link between phobia and anxiety!!! Cohen sure didn’t care about this link because that’s not the way anyone should have read this example if they wanted to understand his way of thinking! But you did…you’re totally in the wrong and i hope people are smart enough to not read this kind of book your way.

  • Sonia Boue

    I just want to correct one thing. You can be system blind & manage academic study. System blindness does not mean lack of intelligence - it is like the dyslexia thing where you have to compensate and find ways round it.

  • Human

    I, like Mr. Smith, found The Science of Evil to be disjointed, or rather, to not exactly make the point it was trying to make. If we can excuse the prodigious use of italics, we will find that its examples of cruelty are not connected at all with the personality disorders. The salient point of the Nuremberg trials was that we all are capable of great evil, er, empathy erosion. I was struck by Mr. Baron-Cohen’s astonishment that, and I’m paraphrasing here, “… in America, there could be five policemen who would line up to execute a person.” Yeah, that’s definitely something I wouldn’t sign up for, but what does he say about the myriad people who did sign up to be in the military? It takes a bit of empathy erosion to drop bombs on people. Is he as astonished in that case?

    No, the book doesn’t ring true because it doesn’t quite get into the everyday, common lack of empathy that we as a society condone. I do appreciate that empathy is important, and is a resource we’re not using; and that problems like Isreal/Palestine demand its use. I do appreciate that evil is better said as erosion of empathy. I will say too that I had tears in my eyes when I read the account of the two fathers who had both lost a son to the troubles. But in the end I felt Mr. Baron-Cohen had glossed over the most important part of this subject: that is, the intricate and surprising ways in which society and the individual interact.