Skip to comments.Men, Empathy, and Autism (Long Read)
Posted on 03/14/2004 8:29:45 AM PST by shrinkermd
On a first meeting in his office here at the University of Cambridge, Simon Baron-Cohen comes off as a poster boy for the empathetic scholar. He pulls a chair close, looks directly into his visitor's eyes with a steady gaze, and pays close attention to the ensuing conversation, not only to the actual words spoken but also to the body language that can reveal so much. His own voice is soft and easy, conveying a deep understanding that has helped make him one of his country's most listened-to autism researchers over the past 20 years.
Last summer Mr. Baron-Cohen's words struck a chord much farther afield, crossing the ocean and penetrating scholarly stateside barriers where resistance was expected, and some still remains. As well as being a reminder of the fast-growing international nature of autism research, his newfound recognition coincides with an American-government effort to investigate the condition and why the number of children diagnosed with autism has skyrocketed in recent years.
The 45-year-old professor of developmental psychopathology's photogenic face and media-savvy style haven't exactly impeded his growing recognition either. His crossover appeal has been likened to that of Steven Pinker, the Harvard psychologist and best-selling author who is, as it happens, an old chum, and whose words of praise ("one of the most brilliant research psychologists of his generation") adorn the jacket of Mr. Baron-Cohen's latest book. "They're both handsome guys who know how to articulate very complex ideas in a way that's very appealing to the public," says Helen Tager-Flusberg, a neurobiologist who has worked with both men.
It is Mr. Baron-Cohen's theory about empathy, in particular, that is generating a buzz among researchers and the public alike. His new work, The Essential Difference: The Truth About the Male and Female Brain (Perseus Publishing, 2003), suggests that the capacity for empathy is the critical cognitive difference between men and women. He goes on to speculate that the empathy gap between genders could provide a key for understanding autism, which afflicts one in every 250 American children -- the vast majority of them boys, including this reporter's 4-year-old son.
A Guy Thing?
Some parents of autists have charged that mercury-containing vaccines caused their children's disorder, but most researchers, including Mr. Baron-Cohen and others here at Cambridge's Autism Research Center, discount that theory. Scholars have reached no consensus on the condition's likely cause, let alone what could be its most effective treatment or possible cure, which is another of the reasons Mr. Baron-Cohen finds himself playing to an attentive audience these days.
The Cambridge scholar identifies empathy as "the drive to identify another person's emotions and thoughts, and to respond to them with an appropriate emotion." At the core of his thesis, he postulates that the natural wiring of the human brain tends either toward a capacity for empathy or toward one for understanding systems. He labels them E-type and S-type brains.
Although the scholar's office is small, he draws his chair a bit closer to allow for a clearer look at a little chart he uses to explain the scoring on questionnaires that the center gives to subjects. One corner of the frame shades into deep blue, the other into pink.
"We find," he explains, "that women on average tend to score in this light blue area, so their empathy is better than average. But their systematizing is not as strong as their empathy." Moving a finger across the frame, he continues: "Now here. Men on average are in the pink range -- they're interested in how things work, in systems, and less interested in talking about, say, emotional problems."
The final point of the demonstration, and the book's clincher, is that autism represents nothing less (or more) than an "extreme version" of the male brain. As Mr. Baron-Cohen tells it, it's almost like an exaggerated guy thing, a disorder in which autists tend to be more male than most men.
But he takes pains to distance his work from the "Mars and Venus" tradition. Imagining that "men are from Mars and woman are from Venus," is not helpful scientifically, writes Mr. Baron-Cohen, "and distracts us from the serious fact that both sexes have evolved on the same planet." Not to mention any autistic offspring they may have.
An 'Extreme Aloneness'
Childhood autism was first described in 1943 by Leo Kanner, a child psychiatrist at the Johns Hopkins University, who spent five years studying 11 children possessed with an "extreme aloneness from the beginning of life." He borrowed the word "autism," derived from the Greek autos, meaning "self," from the Swiss researcher Eugen Bleuler, who had used it in another context some three decades earlier. Unbeknown to Kanner or any of his American colleagues, the same condition was being studied simultaneously in Europe. It was identified with the same name only a year later, by a pediatrician in Vienna named Hans Asperger, after whom a high-functioning version of autism is named.
No two young autists are the same. Some will manage to lead relatively ordinary, even intellectually exceptional, lives, while others may need to be institutionalized. But what such youngsters share, both men saw, is an iron-walled detachment from the physical environment and an indifference to other people, along with profound difficulties with communication and imaginative play.
Among the behaviors most linked to the disorder are poor language and social skills, and a propensity for repetitive, frequently obsessional behavior, including hand-flapping, toe-walking, and self-injury. Autistic kids will often repeat the same words or phrases over and over, or immerse themselves in weirdly narrow interests, spinning to the sound of a rock album until they drop or else, perhaps, staring at a leaf on a tree until the sun goes down.
Clinicians since Kanner have debated the degree of conventional intelligence possessed by autists, with the usual assumption being that most of them exhibit some mental retardation.
One of the implications of Mr. Baron-Cohen's paradigm is that the opposite could be true, at least insofar as the "extreme" brain can be taken to mean one possessed of an extreme intelligence.
This is one of a number of areas where Mr. Baron-Cohen's current findings dovetail with some of his previous work. He has argued that a number of great scholars -- both men and women -- may themselves have possessed such a highly intelligent, "extreme" brain. One of the latest book's case studies involves an award-winning Cambridge scholar who, in a typical autistic touch, is terrified of talking on the telephone.
Mr. Baron-Cohen, along with the mathematician Ioan M. James of the University of Oxford, recently made scientific headlines by arguing that at least three of the well-known personality traits of Einstein and Newton -- obsessive interests, difficulty in social relationships, and profound communication problems -- suggested that these men were autistic. He even has his suspicions about the philosopher Ludwig Wittgenstein. And why not? Academe is a place "of strong and narrow interests, even obsessions," he says with a shrug.
The Testosterone Theory
Mr. Baron-Cohen's latest findings in the psychological realm also fit with his continuing work on autism's biological roots. His next book, scheduled for publication this summer, looks at amniotic testosterone levels, which go to the heart -- or brain -- of his overriding theory on the condition.
Testosterone, he proposes, is the biological basis for the prenatal development of the autistic child. It starts in the womb, where some individuals receive an exceptionally high dose of the hormone, leading to the "extreme maleness" of the condition. Based on their study of thousands of samples of amniotic fluid, Mr. Baron-Cohen and his colleagues at the autism center have documented that children who experienced high-prenatal testosterone levels make less eye contact as toddlers and have lower communication skills at age 4, though he admits the evidence for any relationship between fetal testosterone and autism has yet to be established.
In different studies, Mr. Baron-Cohen's group is using scanning techniques to examine how the brains of autists respond to different social and emotional situations. They are also examining the genetics of the syndrome and developing new diagnostic tests.
If further research substantiates Mr. Baron-Cohen's testosterone hypothesis, he says, it would revolutionize the way in which autism is understood and initially diagnosed, possibly opening the door to far earlier intervention with intensive behavioral therapies. But it would also "open up an ethical can of worms with regard to terminations of pregnancy as well. ... I mean, what would be lost, as well as gained, by that?" he asks.
For now, however, he has enough controversy on his plate.
The Essential Difference is Mr. Baron-Cohen's third book about autism. Here in Britain, it is subtitled Men, Women and the Extreme Male Brain. Although the psychologist had already drawn many of its conclusions as long ago as the late 1990s, he sat on them until now, he says, because for a long time the American cultural climate, in particular, did not seem quite ready for a gender-based theory of autism.
In America, academic attitudes "are much more PC," he says ruefully, so the book may still be "more shocking to an American reader" because "in some ways what I'm saying is not a PC argument."
At a popular level, some of those anxieties have proved true. Writing in the online magazine Salon, one reviewer, Amy Reiter, slammed the book for appearing "to reinforce the worst kind of gender stereotypes." Over all, one couldn't help but feel sorry for the scientist, she wrote, but "maybe that's the empathizer in me."
Responding to the review, one reader said that, while she had little empathy for Mr. Baron-Cohen, "or any ideologue attempting to utilize science to further a political doctrine," she couldn't help but feel "deeply embarrassed" for Cambridge on account of the work.
Many others feel differently. Whether or not one agrees with Mr. Baron-Cohen's approach, sexual politics, or science, noted one reviewer in the British newspaper The Guardian, his book's argument is "a treat for those who simply enjoy a good idea." And when the magazine Newsweek recently invited Mr. Baron-Cohen to take part in an online discussion about his theory, the publication unexpectedly found itself flooded with hundreds of inquiries from ordinary readers across the world.
Autism researchers have tended to be responsive, too, and, PC or not, American scholars are among those singing Mr. Baron-Cohen's praises the most loudly.
Whatever the shortcomings of assigning gender labels of this type, his work is "probably the most important thing to happen to autism research in the past 50 years," says Peter B. Rosenberger, an assistant professor of neurology at the Harvard Medical School.
Reflecting on his current work as director of the learning-disorders program at Massachusetts General Hospital, which is affiliated with Harvard University, Dr. Rosenberger points out that, until Mr. Baron-Cohen first began exploring the relationship between empathy and autism, valuable research time was wasted in trans-Atlantic squabbles about definitions rather than treatments.
While aspects of Kanner's definition have indeed been refined by later researchers, the name autism -- and its mystery -- has stuck, notes Dr. Rosenberger, even as the work of somebody like Mr. Baron-Cohen has shrunk the distance between researchers in the United States and Europe.
Not so its reported incidence. In Kanner's time, autism was thought to occur in perhaps one in every 10,000 children; a decade ago that number had jumped fourfold. Epidemiologists attribute today's figure of one in 250 partly to improved screening, greater public awareness, and a wider understanding of the autism spectrum. But a fuller explanation of the dramatic rise remains almost as elusive as the possibility of ever finding a cure.
"Until Baron-Cohen came along, nobody had even looked into a specific deficit that causes the autism syndrome, separating it from everything else," explains Dr. Rosenberger, whose only regret about his counterpart's work is that it has taken until now for it to begin to enjoy a measure of stateside recognition.
His view is echoed by another high-profile researcher, Geraldine Dawson, a professor of psychology and director of the University of Washington's Autism Center in Seattle.
Ms. Dawson, a pioneer in the early detection of autism, likens Mr. Baron-Cohen's contributions to those that once helped clinicians understand heart disease. At one time, cardiologists interacted with patients only after the onset of problems, and doctors tended to focus on determining whether people had suffered heart attacks. Only when researchers began looking at underlying areas like blood pressure and cholesterol levels did they make significant progress in diagnosing and treating the disease, as well as preventing its occurrence.
What Mr. Baron-Cohen "is doing is to think about one way in which we can consider autism along a dimension -- and from his perspective, of course, the dimension he attaches to it is one of genders," says Ms. Dawson. Researchers need to investigate whether that hypothesis is accurate, but the dimensional approach he is taking "is right on target," she says.
Certainly, Mr. Baron-Cohen has had good timing. Last fall a committee charged by Congress to coordinate autism research unveiled a federal "road map" at a major conference in Washington -- one of many such gatherings to be held in the United States and abroad this past year. While vague on details, the plan for the first time established interagency priorities for scientific research into autism, including the hunt to isolate its genetic and nongenetic components. The road map envisages coordinated action between federal agencies to promote biomedical research, wider availability of intensive behavioral therapy to assist speech development, and stronger research into earlier screening and diagnosis.
On the latter front, in particular, Mr. Baron-Cohen figures as "a very insightful presence, somebody who pushes things as far as they can go, which is what I think he's done with this book," says Ms. Tager-Flusberg, a professor of anatomy and neurology at Boston University Medical School and a past collaborator with the British professor.
While the notion that autism is some sort of extreme male cognitive style is not entirely new, "Simon has sharpened the subject, crystallizing what the particular attributes are when it comes to the autism spectrum," says Ms. Tager-Flusberg.
What About the Girls?
Not every scholar in the field gives Mr. Baron-Cohen's ideas such a welcome reception. Martha R. Herbert, an assistant professor in neurology at Harvard Medical School, says, "I'm just not convinced that this really explains everything." Although willing to entertain the idea of an extreme, testosterone-soaked male brain as an exacerbating factor in autism, she says, "I'm not clear that it's a prime factor." And, she asks, what does his theory say about autistic girls, who account for one in 10 cases of those who suffer from the condition? "Obviously, if it's testosterone, that would be consistent with there being more boys who are autistic. But why would there be any girls at all?"
All girls are exposed to low levels of testosterone in the womb. But girls start from a lower base line than boys, leading Mr. Baron-Cohen to speculate that they may require a bigger dose of whatever it is that causes the hormone to be elevated. For Dr. Herbert, that explanation only raises as many questions as it answers. "I'm sorry, I can't buy into it as an exclusive model -- he just doesn't present enough evidence to support it."
G. Robert DeLong, a professor of pediatrics at Duke University, agrees, saying that the thesis "has to be considered somewhat facile at this point. But it's provocative."
For now, Mr. Baron-Cohen is pleased that his work is being thought of at all, especially across the Atlantic where so much autism research is happening. He seems genuinely relieved that more American scholars than not appear to agree with Mr. Pinker's view of his work as being "neither politically correct nor politically oblivious." Still, he knows his latest idea is far from the mainstream. "Certainly in the U.S., it could well be seen as eccentric," admits the Cambridge professor, as he tucks the pink and blue E-S chart away.
Mr. Baron-Cohen enjoys a few minutes of respite in his office before heading off down the hall to rejoin his young team. But as tranquil as this moment feels on a gray-lidded English day, the scholar well knows that life remains horribly quieter for the millions who live with autism -- the same individuals who could yet benefit from the empathetic message he has attempted to send.
That was freaky, my daughter Caitlin (same spelling) has mild autism and is high functioning as well. I thought when I was reading the first sentence of your post, that it was mine
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