Allen Lane (hardback) 2011 pp208, £13.00
Reviewer Grace Hopkins
One could say that the emphasis in this book is controversial – that criminal minds lack an important factor that divides us from the rest of the animal kingdom – empathy – and that when this is missing, the chance to review and understand your actions, feel remorse and choose next time to not re-offend is elusive. There is the suggestion too that our prisons are full of people who are low on empathy and this is due to that old improvable and frustrating chestnut nature over nurture. These notions seem simplistic and trite. On reading Simon Baron-Cohen’s most recent publication, Zero Degrees of Empathy, (2011) I wanted to know more about what inspired his work, and what continues to motivate him. I was given the chance to interview him and it is this interview which supplements the reading of the book in an attempt to throw some light on the person, and his current and future work.
Simon had stated that he was working as a teacher with autistic children when he became more deeply interested in the phenomenon and questioned whether or not this was ‘purely psychological’; did it have a medical basis?
SBC: There were people who believed that autism was purely psychological, to do with how parents’ attitudes had interrupted the primary relationship between usually, mother and child. We now know that autism is basically medical. There are genetic factors, the brain isn’t developing in the usual way. So nowadays it’s regarded as medical and biological factors are kind of the dominant theory if you like. The idea that parents are somehow to blame for their child’s autism, that was the old theory and that’s no longer really got much credibility. The child would have developed like that irrespective. That’s the idea.
GH: In the book, you wrote about opening up the discussion around empathy in a wider context. It felt like a political stance, about an attempt to distribute some of the power behind mental health more evenly and I wondered about the implications of your goals for those power dynamics?
SBC: I suppose the political bit comes at the end of the book when I sort of step back from the science to sort of say what this might mean for society and the ideas that I explore are how empathy isn’t just something that scientists study. It’s something that can happen between any two people or between any two organizations or two nations, and one of the valuable things about empathy is that it can be used to resolve conflict. So once you see it in that light, that empathy is not just something that helps you understand someone else’s behaviour, it can also help you get out of a deadlock if two people or two countries are in a deadlock, by appreciating the other person’s point of view. So I explored a bit of that in the last chapter. In that respect the hope is that politicians might think about the possible role that empathy could play, and I gave some illustrations in the book. You know, often politicians resort either to legal strategies to resolve a conflict or to military strategies – and both of those are expensive in different ways – whereas empathy just involves two people sitting down and getting to know each other to understand each other’s point of view, not just being locked in your own point of view. And right at the start of book, I sort of define empathy in terms of it being double-minded; if you’re single-minded, you’re just stuck in your own point of view but when you’ve got your empathy turned on, you can also try to imagine the other person’s point of view.
I guess the other sort of message I was trying to provoke in the book is for people to have compassion for these individuals. So, you know, if they end up, as some of them do, in the criminal justice system, having broken the law because they have hit somebody or lashed out at somebody, or in a naïve way made mistakes that have ended up involving them in criminal activity, rather than punishing them, we should probably look at them as we would anyone with a disability. What support do they need?
GH: At this point, I started to wonder about subjective behaviour towards people with low empathy and how society could treat or help them through their moral dilemmas. After all, were they not handicapped by low empathy rather than immoral? SBC responded with an example:
SBC: A really interesting example would be revenge. When someone comes face to face with the person who has mistreated them, or hurt their family, or whoever it is, and wants to hurt that person, they have a desire for revenge.
At that moment you no longer consider why did the perpetrator to do these things? You just want to hurt them. Whereas I suppose the plea in my book is when we’re faced with somebody who has done bad things, even if it has hurt your children, or hurt your family or whatever, we shouldn’t switch off our empathy otherwise we’re no better than the person who we are supposedly judging.
GH: So it’s a conscious act?
SBC: For some people it may need to be more conscious. For other people it may be more intuitive. The new neuroscience is showing that all sorts of things happen much faster than we’re conscious of. So you can flash up an image of someone’s face looking distressed and you can see parts of the brain, like the amygdala, showing the response even if that image was flashed up on the screen so fast that you’re not aware that you’ve seen it. So it’s subliminal, you know outside of your awareness, but the brain is obviously responding to those emotional cues in another person.
GH: So if that is the case then the task is even harder still, especially for those whose empathy is ‘off’.
SBC: I mean I suppose what this model leads to is the idea that things are quite complicated because there are lots of factors that can interfere with your empathy. Most of us, hopefully, have some empathy, but many factors can interfere with it, if you’re tired or if you’re distracted or if you’re blinded with rage or, you know. There are lots of reasons why your empathy might be compromised.
GH: You raised in the book how the psychiatric profession use the DSM system and how that might be changed. Can you tell us more about this?
SBC: As a branch of medicine and opening it up to alternative forms of treatment and therapy? In terms of IAPT I guess I’m very pleased to see that there is more access to talking therapies in the NHS. I don’t know yet whether there’s been good evaluation about how much it’s actually helping because I don’t know whether it’s enough. That’s one thing. If someone is being offered let’s say 6 or 12 sessions of CBT is that sufficient? And I don’t know whether it’s being delivered by well-trained people. So I’m not quite sure who the therapists are. But in principle, it’s a really good thing that there are alternatives to, let’s say, medication. And, you know, to be fair to our medical colleagues, I think that psychiatrists are probably the first to recognize that if you do use medication, it’s not meant to be the only form of treatment. Medication is often used alongside other psychological therapies and I think most doctors, including most psychiatrists, would say that if you medicate a patient you shouldn’t leave the patient on medication long term.
GH: I suppose I’m wondering how flexible other sides of the profession are; in the book you’re almost asking for a change.
SBC: I think that therapeutic professions are much more open to learning about neuroscience these days. I think a very clear example is the Anna Freud Centre in London where it’s really got a good marriage between neuroscience and traditional Freudian approaches. But whether it’s working the other way or not, I don’t know. Whether the sort of traditional neuroscientists are at all interested in the ideas that therapists can bring, I don’t know.
GH: I suppose I experienced it more in terms of using your research to inform our work rather than the other way around which raises the question whether you see your work as relevant to the field of psychotherapy? I think it’s relevant, but I want to know if that is in your mind at all?
And do you think therapists have the capacity to effect change for patients or clients on the autistic spectrum?
SBC: Well, I’ve got a whole chapter in the book on autism, that’s what I called zero positive. And it talks about how people with autism have this tendency to systemize the world. That they have a talent for understanding how things work as systems, that’s to say in terms of rules, so the implication for treatment or for therapy is that if you’re working with someone with autism, it might be helpful to keep things as unambiguous as possible and to present things in terms of rules. So, in this situation, do X, or in this situation, don’t do Y. And then they learn the rules just like the Highway Code.
GH: So it’s almost psycho-educational.
SBC: Yeah, exactly.
GH: You talk about the moral code via empathy and a moral code via systemizing, and I wondered how the moral code is learned in the first place?
SBC: So, you know, the drive to systemize might just be the way they’re built, that that’s the way they think. But where they get their moral code from could be that they figure it out on their own. For example, be fair to others because, logically, that means that other people will be fair to you. So they might do it almost like in a mathematical way to bring out those relationships or they might do it based on what they’ve been taught. So it’s what you’re calling a more psycho-educational approach. For example, some people with autism end up pursuing someone that they like to the extent that they might be stalking them and not realizing that that’s unpleasant for the other person. So being told, if you want to have any hope of a relationship with this person, don’t stalk them, … just being told that might help them understand, okay, that’s what I was doing wrong. No wonder she’s running away, you know.
GH: But the likelihood of people on the autistic spectrum and people that you describe as type N, type P and type B turning up for therapy might be unlikely, which is why there is an interest in increasing the availability of alternative approaches to treatment.
SBC: So let’s take the psychopath, the type P. One place that they turn up is in prison or in secure environments because they have hurt somebody. If we take Broadmoor as an example, which is a hospital but it’s a secure hospital, there are psychotherapists working in Broadmoor with these very difficult individuals who have committed horrific crimes. But nevertheless the therapists think there’s a place for psychotherapy. That’s in a very challenging environment where you’re seeing the person as maybe having suffered in their own life, and the therapy has something to offer. And I think that conditions like Asperger syndrome and narcissistic personality disorder, these may be quite common. It could be 1% of the population. So they may come to a therapist because they have difficulties although they may not have a formal diagnosis.
GH: And, therefore, we need to be present in those places where these people might turn up.
SBC: Yeah, that’s right.
Simon has also been working on less well-known, more unusual psychological phenomena – such as synaesthesia, gender differences in autism and mindblindness – for over 20 years. Being aware of the restrictions on scientific testing in humans and the time constraints involved, I asked about areas of this work which have been left unanswered. He listed:
• For neuroscience research, how do the areas of the brain recognised as active for empathy grow?
• What gender differences in the pattern of growth are there?
• How do girls develop empathy faster than boys?
• And his next work involves…
SBC: ‘ … looking at hormones. So that’s where I am at the moment, most excited. We’ve been working on it for about 10 years, so it’s not entirely for the future, but it is currently generating new results, and that always means it’s worth pursuing, once you’re finding things.
So the findings are that testosterone in particular, because there are lots of hormones… it seems that the hormone testosterone produced by the foetus seems to have an effect on brain development. You can measure it in the amniotic fluid and if a woman is having the procedure amniocentesis, then it’s an opportunity to see what’s going in that fluid. So we measure the hormones in amniotic fluid and then we just wait for the baby to be born. So you’re getting the snapshot of the hormonal environment for the baby and then you can wait and follow up the child later and look to see if there’s any link between their hormones prenatally and, let’s say, their empathy. And we’re finding encouraging results.
GH: I’m intrigued by that link between emotion and hormones, genes and environment.
GH: I find that, well for me anyway, how we define emotions and how they’re impacted by hormones is not so clear.
SBC: You know it may be that in the old days psychotherapists and psychoanalysts would have said emotions just operate at the psychic level or whatever. We don’t need to think about hormones and other influences, whereas I think what this research is showing us is that we can’t ignore hormones. In some ways again, there’s nothing new about that because we’ve always known, for example, that across the menstrual cycle, when you get fluctuations in hormone levels, people report mood changes.
SBC: So there’s interaction between hormone and state. But this is slightly different because it’s not about our hormones currently. It’s about our hormones prenatally and how they might be having long-term effects. I sort of see it a bit like Bowlby who talked about early attachment having long-term effects on relationships, you know, way into the future. You know, equally, hormones can have long-term effects, so they are long range.
GH: Yes. In the same way that political decisions have long-range impact, it has just reminded me of your reference in the book to Blair.
SBC: I was talking more about the long-term effects of early biology. But you’re right in that example about … well it was about the invasion of Iraq. You know Blair was saying history will judge whether we were sort of right to invade. It’s a very interesting analogy. I should have seen the analogy, but you’re right. But in this case it’s just sort of history. But I mean it’s probably science that will do the judging. Because we’ve got scientists standing on the outside measuring the hormones prenatally and then looking at this child, let’s say, aged 10, and looking to see if there’s any relationship and finding that there is. And so you know that wouldn’t be apparent to the person or to, let’s say, their mother, because people don’t know what their hormone levels are, whereas the scientist can measure these things.
My mind here focussed on measuring. The question was how helpful can scientific method be when measuring something so complex, diverse and varied as human emotion? Simon replied with a comment about the limitations of science in relation to understanding human interactions, but also mentioned the beauty of having scientific facilities, such as brain scanning equipment, at hand, adding that:
SBC: I think scientists are the first to recognize that science isn’t all-powerful and omniscient. There are no kind of delusions of grandeur that science can do anything, you know. Science can just kind chip away at different little bits at a time.
GH: There is part of me that likes the idea that there are things I’ll never know, that are almost beyond comprehension in a way.
SBC: Yes, and you know there will always be things that are beyond current comprehension. But things that we used to say we can’t understand, we now can. Then there are new things that we can’t understand. So I think that’s the nature of progress.
In the light of the more open discussions about Asperger Syndrome (AS), the provision for AS children in schools today, the recent publications about AS, films like Extremely Close and Incredibly Loud and We need to talk about Kevin, Simon has raised the issue of the effects of low empathy in a pragmatic and controversial light, but also focused his research findings on the possibility that it is more common than we believe. I look forward to reading about his next project in a text that is as reader-friendly as Zero Degrees of Empathy.
Simon Baron-Cohen is Professor of Developmental Psychopathology at Cambridge University and a Fellow of Trinity College; he is also Director of the Autism Research Centre and has written extensively on autism, Asperger Syndrome (AS) and mindblindness.
Grace Hopkins is a counsellor based in North West London and a massage therapist. She is also a member of the Contemporary Psychotherapy editorial panel.