Autism and Empathy

I consider myself a reasonably intelligent fellow. I have a Diploma of Higher Education, two Bachelor’s Degrees and a Master’s, and got a distinction for each. And they cover some pretty dry subjects, too: the history of science and technology, history of medicine, the psychology of violence, English language, linguistic and representational philosophy, psychoanalysis, criminology, imperialism, archaeology, urban development, and the history of warfare, with a smattering of classics, film history and creative writing thrown in for good measure. I find it pretty easy to switch between arts, humanities and social sciences and by the measure of society, it is not a stretch to describe me as academically gifted.

The thing with academic intelligence, however, is that it doesn’t necessarily translate well into the ‘real world’ of feelings, relationships and social interaction, particularly when you have autism. The other day, for example, I was trying to explain to someone how, if a person talks in a loud voice and uses expressive hand gestures, I interpret this to mean that they’re angry (this was a subtle way of asking her to lower her voice and keep her hands inside the vehicle at all times, but it fell on deaf ears).

‘But you’re intelligent enough to know they’re not really angry,’ she said.

Well, yes, I know on an intellectual level that they’re not angry, just loud, but this actually changes nothing because my instinctive understanding is that they are, indeed, angry, and my physiological reaction is the same as if they were: my fight or flight mechanism kicks in, I get flooded with adrenalin, my hackles rise, and everything in my body acts as though I’m about to be attacked. That’s not something I can intellectualise away.

It is this difficulty interpreting or understanding another’s emotional state which makes people tell me that, as a person with autism, I am unable to empathise. And despite my broad education and academic intelligence, I have to admit that I’m really struggling to work out what this concept called ’empathy’ actually is.

The reason I’m wondering is because I have, of late, been incredibly emotionally fragile, which I have detailed in another post. I spent the most awful few weeks of my life crying over a little girl I’d never met called Jessica Whelan, who was dying of neuroblastoma. Something about the story touched me very deeply, and I internalised so much pain and sorrow that it was as if my own child were dying. I cried all day, every day. I could barely function, every day waiting for the news that she and her family had been released from their suffering.

When she finally passed, I had one last almighty cry and started to feel better. Instantly, the past few weeks started to feel weird, as if I had been in a fugue state. They have a funny colour in my mind (I associate things with colours in my head) – those weeks were yellow ochre, everything yellow ochre, when my world is normally pale blue. It was as though someone or something else had taken over me. I was an emotional wreck for weeks, just wasn’t myself at all. It was as if there was a ‘before’ and an ‘after’, and the inbetween was something else.

Describing this to people, they’ve said things like, ‘That’s because you’ve never felt empathy before’, or ‘you’ve never been able to empathise’, or ‘I thought people with autism couldn’t empathise’, or ‘as someone with autism, you’ve never had to learn how to deal with emotions when you empathise with people’. In fact, every single person I’ve spoken to has used the word ’empathy’, or a derivative of it, and this is what has me flummoxed: just what the hell is empathy?

As I have always understood it, sympathy is when you feel for someone, without internalising their pain, while empathy is when you feel with someone, taking on their viewpoint and experiencing their emotions for yourself. As an illustration of the distinction, one of our chickens died the other night. I thought it was a shame, but that was about it. When I told my wife, however, she cried for half an hour. I sympathised with her, in that I recognised she was in distress and tried to help by making her a cup of tea (that very British panacea), but I didn’t empathise with her because I didn’t feel the same emotions (i.e. I did not get upset and cry with her). Seems pretty straightforward.

But really, it’s not. When that little girl was dying, why did I feel such pain, and for whom, and in what way? I couldn’t bear that she was suffering and dying, so does that mean I was feeling for her (sympathising) or feeling with her (empathising)? Or was I doing both simultaneously? Or, in fact, neither? Because much of my pain was the result of imagining it was my child suffering and dying, does this mean I was actually empathising with her parents, by adopting their viewpoint and experiencing their pain? (Which seems a little arrogant, because how could I possibly experience the pain of losing a child without having done so?) Or was I simply imagining my own pain at the possibility of losing my own child, which means I wasn’t actually empathising at all but was indulging in a selfish, masochistic grief-fantasy?

This is what is confusing me. Being autistic, I tend to approach my emotions from an intellectual viewpoint in an attempt to understand them and regulate them, and maybe I’m thinking too much into it, but I can’t understand how a person could ever be said to empathise with another. How can a person experience the feelings of another, or understand their viewpoint? We are all different, and we think and feel differently, and it would be presumptuous in the extreme for someone to think they know, understand and echo how I am thinking and feeling. Surely when we ’empathise’, what we really mean is that we are using our imaginations to think how we would feel in a given situation, so instead of feeling someone else’s pain, we’re feeling our own (imagined) pain?

If this is the case, then it is wrong to say that people with autism cannot empathise, because we can certainly imagine how we would feel in a given situation and project that feeling onto the situations of others. Indeed, if we could not do that at all, we would fit the criteria for psychopathy, and people with autism are clearly not all psychopaths. I think the belief that people with autism cannot empathise stems from our inability to accurately interpret the emotional cues of others in interpersonal communication – if we cannot work out another’s emotional state, such as thinking they’re angry because they’re loud, how can we match emotions (empathise) with them? It is therefore a problem with social communication, and not an emotional disability.

On the other hand, if we bring in the idea of personal distress, which is seen as a subset of emotional empathy, this could answer what is going on in the autistic mind. Personal distress is a notion in psychology where witnessing the suffering or distress of others triggers anxiety, pain and distress in yourself, so rather than truly empathising with the sufferer you have a self-centred emotional reaction to their suffering. Essentially, it makes you uncomfortable because you don’t understand it or know how to deal with it. Arguably, this is what happened to me over the past few weeks – I saw someone in distress and it made me distressed, saw someone suffering and accordingly suffered. Indeed, people with autism apparently have much higher levels of personal distress than neurotypicals, since it’s a self-centred, immature version of empathy (and it’s questionable whether it’s a form of empathy at all). And given that one response to being oversensitive to the suffering of others is to withdraw from the source of this discomfort, this is another reason we are seen as unempathetic.

I think the truth of the matter is somewhere in between all this theorising. Yes, Jessica Whelan’s distress, and that of her parents, caused me great personal distress, making mine a self-centred, unempathic response. At the same time, however, I put myself in the place of her parents and, using my own daughter as a frame of reference, empathised with their pain. In addition, I sympathised with their predicament. And I pitied them. And I felt compassion for them. And for a few weeks cried all day, every day.

I think that is the important thing, the thing to remember. Regardless of what words we use to describe or define it, the thing to take away from this experience is that, for whatever reason, Jessica Whelan pierced me to my very core, exposed something I’d never felt before, and reminded me how important it is to make the most of each day that we get to spend on this earth with the people we love. I may struggle to understand empathy, but the pain I felt was real and profound.

And if I need a word to describe it? Let’s just say I’m ‘sensitive’.

Good Dad / Bad Dad

For nine months, Izzie only ever encountered Good Dad. He’s a nice guy, a caring guy. He hugs her when she’s sad, feeds her when she’s hungry, kisses her when she smiles. He sings her songs at bedtime, acts like a loon to make her laugh, and gives her everything she wants. He’s a big, cuddly bundle of fun.

The past few weeks, there’s been a new guy on the scene: Bad Dad. And Izzie doesn’t like him nearly as much.

‘Ba-da,’ she cries. ‘Ba-da!’

She’s reached the age where she’s increasingly mobile, increasingly opinionated, and increasingly capable. She watches everything you do, and you can almost hear the cogs whirring inside her skull as she works things out. Like the velociraptors from Jurassic Park, it’s a problem-solving intelligence that is scary when combined with her baby-Superman-lifting-a-car strength.

Mostly, it’s small stuff. She can take off her nappy, help herself to her biscuits by swiping them out the pocket of the changing bag, and yesterday proved she can stand without any support (though when she realised we were watching her she grabbed onto the sofa). And if she gets her hands on the baby wipes, she opens the packet and pulls them out one by one, creating a big wet mess in the middle of the carpet.

Far more alarming are her attempts at overcoming safety features. She’s figured out where she has to grab to open the stair gate keeping her out of the kitchen, but luckily doesn’t have the strength or dexterity to do it yet. When you strap her into the car seat or high chair, her fingers move to the buckle the second you move yours away as she struggles to press the release button. And when you change her nappy, she knows the exact moment you’ll be looking to the left (to pick up the clean nappy) and uses that split second to roll to the right, crawl past your thigh and make a break for the door – which she’s figured out how to open.

Into this repertoire of experimental behaviours she’s recently introduced a number that could be categorised as ‘How to manipulate mummy and daddy’. They are, from mildest to I-want-to-die-est:

  1. The throw-your-bottle-on-the-floor-for-attention.
  2. The pouty bottom lip.
  3. The fake cry.
  4. The angry shout.
  5. The lose-all-control-and-scream-like-a-wild-animal-that’s-being-poked-with-a-red-hot-poker-until-you-start-to-choke-and-then-turn-purple-in-order-to-get-your-own-way.

This last one is used every time she’s put in the play pen, every nappy change, every costume change, every time I take her out of the bath, and every time I take something off her.

And so, in response, I have had to break out Bad Dad.

Bad Dad is tough but fair. Bad Dad tells her no when she’s pulling hair, or trying to open the door to the hall, or going into mummy’s handbag. Bad Dad takes car keys off her, and TV controllers, and the dog’s toys. And Bad Dad doesn’t take any shit.

No matter how much Izzie cries, screams and pitches a fit, Bad Dad doesn’t let her get her own way. She completely understands the word ‘No,’ but it’s a battleground right now as she tests the boundaries to see what she can get away with.

‘Daddy says No? I’ll reach for it again. Oh, he still says No. In that case, I’ll stick out my bottom lip and – wow, it’s still No. Maybe if I cry a bit, real tears even, now I’ll just reach out – nope, that didn’t work. I’ll shout as I reach for it – damn it, I’ll just throw a full-blown tantrum, then he’ll have to give it to me.’

To be honest, I don’t like Bad Dad either. He’s nowhere near as fun or as happy as Good Dad. He’s mean and unkind and strict and severe. He hardens his heart to his daughter’s tears and holds her while she sobs, even though he was the cause of it all, and it would be so easy to make her happy by giving her what she wants.

But Bad Dad doesn’t give in, no matter how hard it gets, and how much it upsets him, because he’s as good a dad as Good Dad. And it takes both personas to be the father of a happy, well-adjusted daughter.

But I know which one I prefer.