Krahn, T.,&Fenton, A. (2009). Autism, empathy and questions of moral agency. Journal for the Theory of Social Behaviour, 39(2), 145-166. doi:10.1111/j.1468-5914.2009.00402.x

*modified to add "conditions" for clarity; I apologize for any misinterpretation individuals might have had between a psychological condition and actual people.

Simon Baron-Cohen "sat down with me" this week via email and graciously took the time to answer my questions stemming from my review of his new book, The Science of Evil, that appeared on my blogs last week. What follows is a response that is every bit as thorough as my original review; between the two (and I recommend you read both as a complete piece), there's 15 single spaced pages of material. I thoroughly enjoyed this opportunity and I think readers will, too. There's even dueling databases, which I absolutely loved, below!My questions are in italics; SBC's in regular font.How would you outline the major sections in your book and how do you see these sections meshing together into a cohesive narrative?The key theme in my book is that when people commit acts of cruelty, a specific circuit in the brain ("the empathy circuit") goes down. It can go down temporarily (for example, when we are stressed) or in a more enduring way. For some people, this empathy circuit never developed in the first place, either for reasons of environmental neglect and/or for genetic reasons. But whatever the reason this circuit in the brain did not develop in the usual way, or is not functioning in the usual way, it is the very same circuit that is involved. I argue that when we try to explain acts of human cruelty, there is no scientific value in the term 'evil' but there is scientific value in using the term 'empathy erosion'.The related theme is that the functioning of the empathy circuit determines how much empathy a person has, and that empathy is "normally distributed" in the population: from zero degrees at the extreme low end through to six degrees at the extreme high end. Most of us are somewhere in the middle, but the book explores the different routes that can lead a person to end up at zero degrees of empathy. In particular, there are some medical/psychiatric conditions that cause this outcome and most are negative (Zero Negative). These include the personality disorders, such as psychopaths and people with Borderline Personality Disorder.But one is surprisingly positive (autism spectrum conditions) because although they struggle with empathy, they do so because they have a mind that is exquisitely tuned to spot patterns (rules) in the world. I call this "systemizing", and in people with autism or Asperger Syndrome the "systemizing mechanism" is tuned to an extremely high degree. This can have remarkable advantages when trying to figure out how a system works (hence Zero Positive), but leads to disability when applied to the world of people and emotions, because people and emotions are hard (if not impossible) to systemize.Do you think readers will potentially get to the part about zero empathy positive and get confused as to why you've placed the ASDs in a book titled The Science of Evil?I make it crystal clear in the book that whilst acts of cruelty always entail zero degrees of empathy, it is not a symmetric relationship: zero degrees of empathy does not necessarily lead to acts of cruelty. In the case of people with autism spectrum conditions, their low empathy usually leads them to avoid other people because they find other people confusing. Their low empathy doesn't lead them to commit acts of cruelty any more than anyone else in the population, but it does often lead them to feel socially isolated, with the added risk of depression.As a scientist, setting out to examine the nature of empathy, it would be wrong to leave autism out of the discussion. It is of course highly sensitive to look at autism side by side with personality disorders like psychopathy, but they both involve difficulties with (different components of) empathy. The options are either to dodge the issue, or to tackle it head on. I opted for the latter. Most books or journal articles look at one condition (e.g., autism) without the other (e.g., psychopaths) but this begs the question of the relationship between the two.The key difference seems to be that in psychopaths the 'cognitive' component of empathy is intact but the 'affective' component is not. In autism, both components may be impaired, or just the cognitive component. But their strong systemizing leads them, through powerful logic, to develop a moral code based on 'fairness' and 'justice'. Psychopaths lack the moral compass that most people develop using their empathy, and lack the moral compass that people with autism develop using their strong systemizing. People with autism spectrum conditions often end up as 'super-moral', developing a set of rules they expect people to live up to consistently (such as honesty), arriving at the conclusion that one should 'treat others as you would have others treat you' because it is the most logical approach.At the end of your book, you argue that psychology has ignored empathy over its history, but there's plenty of evidence to suggest that this is not true; database searches relating to psychology produce over 23,000 journal articles on empathy. Daniel Goleman has spent two decades promoting social and emotional intelligences, which both involve empathy. It seems fair to say that empathy has been looked at in great detail, although the connection between empathy erosion and evil may not have been. Is that the distinction you're trying to make?The best source of scientific studies is the database PubMed and if you type in the word "empathy" into PubMed you get 12,647 hits (separate peer-reviewed scientific journal articles). It is true that the oldest of these was published in 1947, but the point I make in my book is that psychology as a science is at least 100 years old, and for much of the first half of its existence psychology was not studying empathy. In the years 1952-1954, for example, there were only 4 scientific papers published on empathy per year. Compare this with modern neuroscience: there have been 342 scientific papers published on empathy in 2011 alone, and we are only 5 months into the year! I am delighted that over the last 5-10 years the neuroscience of empathy has really taken off, and that science is no longer ignoring such a fundamentally important part of the human mind and brain. Part of the purpose in writing this book was to bring together the research, to communicate to a wider public what science has been discovering about the nature of empathy, and how it can go wrong.The lack of empathy and psychopathy has been examined, as well (Soderstrom, 2003). Do you feel that empathy in the detail you are examining it and your hypothesis that it is empathy erosion to blame for cruelty is what has been ignored?You are right that there are many good books and scientific articles on psychopathy and empathy. An excellent book for example is by James Blair at NIH. What’s new about my book is that it broadens the focus to look at a range of psychiatric conditions, not just psychopaths, in whom empathy is below average. Equally, as you point out, it is making the more general point that cruelty, whether by psychopaths or by any of us, involves empathy erosion.The online autism community is very vocal (and fairly well in agreement, considering the wide divides usually tearing it apart) that you are incorrect in your belief that autistic people lack empathy (and theory of mind). How do you respond to that charge and what evidence do you have that people with ASDs have zero empathy?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 havezero 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).Many people with autism in the remainder of the spectrum may well haveabsolutely zero degrees of empathy, as shown in failing the False Belief Test (theory of mind) that even a typical 4 year old child can pass, but which is failed by many children with autism who have a mental age above 4 years old. Many may not even show “joint attention” that even a typical 18 month old toddler can show, such as spontaneously following another person’s gaze. A meta-analysis review of false belief studies by Francesca Happe in 1995 found that most children with autism take until the age of 11 years old to pass this test, which is a 7 year delay (see attached graph and the recent paper by Senju , 2011). Even among children with Asperger Syndrome or high functioning autism, delays in “social sensitivity” (such as detecting faux pas) are seen, despite their average or above average IQ.Thus, among scientists and clinicians there is near universal agreement that autism spectrum conditions are characterized by delays and disabilities in the cognitive component of empathy (theory of mind). These difficulties are only revealed when age-appropriate and mental-age appropriate tests are used, and sometimes required more subtle tests (so-called “advanced” theory of mind tests).So why might people with autism in the online community challenge this view? One possibility is that it is in the nature of empathy that people who are low in empathy are often the last people to be aware of it. This is because empathy goes hand-in-hand with self-awareness, or imagining how others see you, and it is in this very area that people with autism struggle. A better source of information for whether someone with autism has an empathy disability might therefore be a third party, such as a teacher or parent or independent observer. When it comes to empathy, self-report is highly unreliable. For this reason, I would always advise that results from the questionnaires like the EQ (the self-report version) should be corroborated by other independent sources of evidence. An analogy might be with colour blindness. Many people who are colour blind are the last people to know about it, until they are given a test of it by an optician or vision scientist. They simply assumed that they were seeing the same colours as everyone else.This is not to say that all people with autism have zero degrees of empathy, since being below average on a cognitive test of empathy does not equate to scoring zero. It may simply mean scoring statistically below the average in the general population. Nor does it mean that people with autism are necessarily below average on other components of empathy, though some may be.In my experience whilst even adults with Asperger Syndrome may have difficulties figuring out why someone else’s remark was considered funny, or why their own remark was considered rude, or may judge others as liars when they simply are inconsistent in not doing what they said they would do, they may nevertheless have a highly developed emotional empathy, caring about how someone feels and not wanting to hurt them. If they do hurt them it is often unintentional and they feel mortified when it is pointed out, and want to rectify this. In this respect, they do have some of the components of empathy.Many people with autism also form very strong emotional relationships with their pets, worrying about their welfare, and find that whilst they struggle to ‘read’ human behaviour and human intentions, they can read the arguably more predictable behaviour of a pet. Finally, as mentioned earlier, the difficulties with the cognitive element of empathy by no means leave people with autism devoid of a moral code, and their strong systemizing can mean that they often end up with a more principled moral code than many people without autism.Would you restrict your diagnosing to only those who scored at zero or do you accept the idea that it's at least possible that many autistic people do indeed have both cognitive and affective empathy (although perhaps impaired), and that their social and communication deficits cause problems in engaging in the socially appropriate display of empathy?I’m glad you asked this question as it clears up a common misunderstanding, namely that people with autism all have zero degrees of empathy. As you rightly state, empathy is on a continuum and the theory is that people on the autistic spectrum are simply lower down this spectrum than people in the general population. But within the autistic population there is a spectrum of individual differences. Your second point is also correct, that these empathy difficulties (however mild) give rise to the problems in socially appropriate behaviour and in maintaining relationships.Some researchers suggest that autistics may not be impaired in emotional empathy (Krahn & Fenton, 2009; Smith, 2009). How do you account for the possibility that emotional or affective empathy might not be impaired in autistics?This has already been covered earlier, and this may be true of some people with autism. The topic of ‘emotional empathy’ requires more research as it is hard to measure, but vitally important. Note that the Smith paper you cite was the subject of a scientific debate within the same journal, since the evidence for intact affective empathy in autism is mixed.Your definition of empathy is fairly complex and one that is not widely accepted in the masses; most people think of empathy as being able to understand another person's emotional state. Your definition is more robust and involves more parts: you delineate a cognitive aspect, an emotional aspect, and then, perhaps most importantly, the engaging in socially appropriate behavior relating to those cognitive and affective components. I think this is going to be hard for most lay readers to keep in their minds as they read your work, and that because of the differences between your definition of empathy and the lay definition, that your book will be misunderstood. What would you say to readers who are defining empathy differently?I think we should not underestimate the average reader of popular science books. My definition of empathy is not that complex, and readers can keep in mind the idea that a single word (empathy) might be an umbrella term for a number of different component processes. In that respect, it is not much different to other psychological terms. For example, the term ‘language’ covers a number of different sub-systems (syntax, semantics, pragmatics, lexicon) as does the term ‘memory’ (long-term, short-term, episodic, semantic). So I don’t worry about the ability of the reader to hold my definition of empathy in mind. But you are right that different theorists may have different definitions of empathy. I don’t suggest mine is the only one, but it is one I find useful.Already I have read people on blogs and in comments on reviews argue that you've got it wrong in regards to psychopaths; psychopaths understand that their actions cause harm, and therefore their empathy (the ability to infer other people's emotional states) is intact. How would you rebut this tendency for readers to use another definition for empathy when discussing your work? Did you consider an alternative word or concept instead of empathy in order to prevent these kinds of miscommunications?From your précis of the blogs it sounds as if some of the people on blogs may not have read my book since I specifically state that psychopaths areintact in the cognitive component of empathy (the ability to infer other’s mental states, including their emotional states). So there may be nothing to rebut! I suspect the miscommunication may stem not from the word ‘empathy’, but from not reading the book.In your "Table 1 Distinct Profiles of Empathy Disorders," you contend that classic autism has morality negative while Asperger Syndrome has morality positive but other than your foray into systemizing compensating for deficiencies in empathy, you offer no evidence or explanation for this categorization of one ASD as moral and another as not moral. The table doesn't appear to be fully fleshed out; systemizing is only noted on the ASDs, morality negative is checked for only psychopaths and classic autism. Is this table presented accurately and what evidence do you have for the categorizations, specifically relating to morality?This is a good observation. The claim that within classic autism one finds individuals who lack understanding of right and wrong finds evidence from the field of learning difficulties (or below average IQ). As I hope I make clear, classic autism has a strong association with learning difficulties. The legal system has long recognized that a person with learning difficulties may not be able to stand trial if they cannot understand the moral distinction between right and wrong. Within classic autism we encounter individuals who may have very limited understanding, because of their low IQ and limited or even non-existent language. Table 1 in the book is intended to stimulate future research where such differences between conditions can be tested further.You note that all of the types of zero empathy have negative affective empathy, but again this seems to ignore research that shows affective empathy is not deficient in autism. Is there a difference in how you're defining the affective component? Would you restrict autism diagnoses to those who show impairments in all components of empathy then?This was discussed earlier and I agree that the evidence for an affective empathy deficit in autism is inconsistent and requires further research. Certainly the diagnosis of autism does not require the individual to have a deficit in affective empathy.You ask whether people with zero empathy disorders should be held criminally responsible for crimes and imprisoned. There is little doubt that people with the zero empathy negative disorders you've proposed are competent to understand when their actions violate a law. Do you think that psychopaths, narcissists, and others who violate the law, engage in abusive or violent behaviors aren't legally responsible for their actions?For the criminal justice system to work, it is vital to hold onto the notion of people being responsible for their actions. We ask the defendant to plead guilty or not guilty. I am not trying to upturn this principle of the legal system as I think it provides a valuable method for society to decide how to deal with someone who has broken a law.Rather, I simply bring out into the open the implication that stems from the notion that, if someone who is Zero Negative is violent or abusive because of how the empathy circuit in their brain currently functions, or because of the empathy circuit in their brain did not develop in the usual way, then perhaps we should see such behaviour not as a product of individual choice or responsibility, but as a product of the person’s neurology.We do not hold someone with schizophrenia responsible for having a hallucination, just as we don’t hold someone with diabetes responsible for their increased thirst. In the case of the person with diabetes, we ‘blame’ the person’s low levels of insulin, or the person’s cells for not responding normally to insulin. That is, we recognize the biomedical causes of the behaviour. Equally, if someone’s behaviour is the result of their low empathy, which itself stems from the underactivity of the brain’s empathy circuit, and which ultimately is the result of their genetic make-up and/or their early experience, in what sense is the ‘person’ responsible?But these are complex medico-ethical issues. I would argue we need to keep our socio-legal framework since it serves many valuable functions, including recognizing the victim or their family want to see justice done; but that those with low empathy who end up in the criminal justice system also warrant our compassion, and may even warrant treatment within the health service.What potential do you see for people to take advantage of this idea that they have a neurological impairment resulting in empathy erosion? Do you think these individuals who engage in acts that demonstrate diminished empathy should be able to play the disability card?If someone has a disability, they deserve society’s support. Period. The phrase “play the disability card” implies that some people will exploit their disability or will claim they have a disability when they do not. I find this idea distasteful on many levels. Where there is doubt as to whether someone has a disability, the legal system already has provision to call in experts to assess an individual. If such experts agree, then I think we owe it to people with disabilities to offer them the support and help they need. If their disability is neurological and has resulted in empathy erosion, then appropriate help and support should be available. The history of disability is that people have had to fight to have their needs recognized, and this new class of disability may just be the latest example in a long line.(Continued email conversation with SBC) I have no problem conceding that some individuals on the spectrum, especially those who have an intellectual disability sufficiently severe, will have difficulty with right and wrong; prison is not the best place for them and hopefully society will recognize and place them appropriately into settings where they will be safe and have as much autonomy as possible with reduced chances of harming others. However, your other zero empathy/low empathy folks like the zero-negatives don't have that excuse and they are specifically who I was thinking of, along with some Asperger's individuals who break what they know to be the law. I'm thinking specifically of psychopaths and borderlines; they're aware of societal laws and rules but don't care. To excuse their behavior because they don't care seems to me to be while perhaps technically accurate (i.e., if they'd cared, they wouldn't have committed the act) lets a whole lot of people off the hook. I think you're absolutely spot-on when you say that cruel behavior arises out of empathy erosion: people just don't care. But they're still accountable for their actions and should be, if their reasoning centers are still intact. Diabetics in an low or high (and I've had both) have executive functioning malfunctions that cause aggressive behavior, but it's immediate, unpremeditated lashing out, not the planned, intentional behavior that psychopaths engage in. One deserves consideration of the exonerating circumstances and the other not so much.I asked about people trying to take advantage of these labels and use them as a get-out-of-jail-free card. I was thinking particularly of psychopaths when I wrote that question, although I didn't clarify that. Are you saying that you feel psychopaths specifically wouldn't game the system and play the disability card to get out of being held accountable?I think compassion for borderlines, sociopaths, psychopaths, and narcissists is going to be a hard case to sell. The havoc they wreak is so great that, as you say, there's nothing positive to be said for them (the conditions)*. And I suspect few other than potentially the borderlines in rare moments of clarity, would choose to be other than they are. While I can almost make the reach that borderlines have a disability, I find it very hard to go that far for sociopaths and psychopaths. I confess I may be suffering from empathy erosion when it comes to feeling compassion for these individuals who create such damage to others.It's risky, I think, to feel compassion for these folks as it may leave us open and vulnerable to more harm from them. I'm not sure how we navigate that successfully.As I said in my earlier response, I think the legal concepts of personal responsibility and accountability remain important so that people who do harm do not feel this is without consequences, and for society to send a clear message about what happens when you cross the line it draws between right and wrong. The legal concepts are convenient and necessary even if they are hard to reconcile with science. So even if your behaviour is the result of your neurology, this is not a "get out of jail free" card. In that regard, a psychopath who hurts another person will not be able to "game the system" or "play the disability card". The consequences of a crime may still be a loss of civil liberties, for example, such as detention in a secure setting.However, the way we view such individuals - even psychopaths - can still be compassionate, in the same way that we view any disability. What I'm proposing is not that new, in that secure units such as Broadmoor (which is full of psychopaths who have committed horrendous crimes) are HOSPITALS rather than prisons, and as such are therapeutic environments.Although your overarching topic is a serious one: why people are cruel to others, your ultimate perspective is a hopeful one: that empathy can be learned, that the empathy muscle, so to speak, can be exercised. What practical information do you hope readers take away from this book?You are right that my book has an optimistic message, namely, that empathy can be increased. For some people it is simply a matter of waiting for development, and gaining experience. For others it may be a matter of either education or therapy. Imaginative approaches are being taken in many fields to facilitate empathy, and I do believe in the idea that people can change – because the evidence supports this.KWombles's References:Smith, A. (2009). The empathy imbalance hypothesis of autism: A theoretical approach to cognitive and emotional empathy in autistic development. The Psychological Record, 59(3), 489-510. Retrieved from EBSCOhost.Soderstrom, H. (2003). Psychopathy as a disorder of empathy. European Child & Adolescent Psychiatry, 12(5), 249-252. doi:10.1007/s00787-003-0338-y