[Posted on 23 January, 2018 by Nouchine Hadjikhani]
Often one reads that autism is a disorder of empathy. But we have a problem, because empathy can mean so many different things, and we get misled using one word to cover very many different concepts. Empathy comes from the German term ‘Einfühlung’, feeling in. But what does it really mean?
There are in fact two major types of empathy, that we can call cognitive and affective.
Cognitive empathy is the capacity that we have to take someone else’s perspective, to “put ourselves in their shoes”. It is a rather complicated thing to do, as it requires us to override our point of view, our knowledge, and to see the world from another perspective. Some also call it Theory of Mind. Being able to infer other people’s mental states is important in order to understand and predict their behavior. We know which brain areas are most involved in cognitive empathy (the medial prefrontal cortex, the right temporo-parietal junction and superior temporal sulcus). Individuals with autism struggle with cognitive empathy, and sometimes may have a very difficult time seeing things from someone else’s perspective.
Affective empathy makes you share the feelings of the person you interact with or observe. It is the process by which you wince in pain when you hear the story of someone getting their fingers snapped in a doorway, or when you see a person getting a syringe planted in their arm. Brain imaging studies have demonstrated that all the areas that are activated when you experience pain (also known as the pain matrix) are also activated to a certain extent when you observe or think about these painful events. This capacity to “suffer with someone” is not affected in individuals with autism, who are as sensitive as the rest of us are to the perception of people expressing pain. In fact, they may be even more sensitive than the rest of us are, as it is difficult for them to distance themselves, and not feel overwhelmed by witnessing pain – and the only reason they may not display the caring, consoling behavior that one would expect, is that they experience personal distress and need to distance themselves in order to not feel overwhelmed.
As long as we use one single word to express two very different realities, we will have difficulties understanding each other and communicating. We will be confused when we read things as opposite as, on the one hand, that “empathy is a bad thing that precludes rational thinking” (Paul Bloom), and, on the other hand, that there is a program to improve our empathy in 5, 6, or 7 steps. Clearly stated concepts are extremely important if we want to stop spreading confusion, as is avoiding talking about very different notions using one term. We need to recognize that autism is not a disorder of empathy, but rather a condition in which cognitive empathy is reduced, but affective empathy is heightened, which can lead to very stressful situations in their daily life.
And, by the way, a new paper (Stockdale et al., SCAN 2017) was recently published that showed that frequent players of violent video games have reduced affective empathy compared with infrequent players. Something we may want to worry about…