Thursday, November 5, 2009
Book Review - Look Me in the Eye: My Life with Asperger's
Look Me in the Eye: My Life with Asperger's is John Elder Robison's funny and poignant account of his own experience of Asperger's. the memoir is humorous and bold.
Donna Chavez of Booklist writes, "Robison's memoir is must reading for its unblinking (as only an Aspergian can) glimpse into the life of a person who had to wait decades for the medical community to catch up with him."
Asperger Syndrome and Central Coherence Theory
What is central coherence, and how can different drives for central coherence affect communication?
Allow me to share a vignette:
Shari and Kevin have just celebrated Thanksgiving.
Shari recounts her experience of the holiday in their couples counseling session. "I was exhausted," she states, "I had no time off from the kids or work to really prepare, had to clean and prepare the house and yard for company, shop, cook for 11 people, manage relationships with Kevin's family members and get this kids ready, ALL while keeping my cool. It was exhausting and miserable. I'm never hosting Thanksgiving again."
Kevin recounts his account of the same holiday. "It was quite lovely. We had turkey, homemade stuffing, homemade cranberry sauce, homemade pumpkin pie. I played chess with my brother and beat him four times, a personal record. I also made spiced cider that was delicious, and adjusted the recipe I normally use by adding peppercorns. It was a nice holiday. I'm looking forward to next year's celebration."
Q: Which person is telling the truth?
Q: Which is more valid, her perspective or his?
Is it truly possible for two people to have such starkly differing views of an event and both be referring to the same Thanksgiving? A resounding YES! Welcome to the duplicitous world of life with an Aspie, where there are no right or wrong perspectives - only different perspectives.
Central Coherence Theory
People with ASD often have difficulties with central coherence. Central coherence can be described as getting the point, or gist, of things. It is the ability to pull information from different sources, experiences and schemas, both internal and external, to glean a higher meaning. Lacking central coherence can leave an individual vulnerable to misinterpreting of situations and communications.
In our vignette, Shari was able to describe her experience in a global fashion, pulling relevant internal and external details in, while leaving less relevant facts out. This was important to her ability to communicate and justify her sense of misery. She knew, "intuitively, what facts to include in her efforts to incite in the listener a sense of empathy for her - after all, who wouldn't be miserable after participating in the holiday she described?
Kevin, who lacks a sense of central coherence, was not just largely unable to include the details of his or her emotional experience of the holiday. For Kevin, these details were irrelevant to his message - what happened during the event, what was eaten, etc. He was unaware that Shari was having a miserable experience, and could not understand, given the factors he attended to during the event, why she was unhappy. "He can't see the forest for the trees" is a common criticism heard by Aspies regarding their ability to synthesize information to get the gist of a situation.
People without ASD often have a high need for central coherence in their efforts to understand situations. Aspies approach situations in a detail-oriented fashion, often through one channel at a time. The disparity between these two approaches to understanding and dealing with life can cause distress in relationships, leaving partners feeling they "speak different languages".
De-personalizing Disparate Neurology
While opposite approaches to collecting and synthesizing information can leave couples frustrated at times, it is crucial that both partners remember that Aspies who attend to data which do not include feelings often are not doing so due to indifference. Remembering that neurological differences are often the underlying causes of these differences can "de-personalize" what might otherwise feel hurtful. Communication skills such as active listening can help couples learn to listen to each other with their hearts - and the language of the heart is universal.
Aspies are Robots: Stereotypes that Hurt
Back in 2006, researcher teams in the USA and Germany teamed up to assess empathy in adults with Asperger's. Their findings were published in the Journal of Autism and Developmental Disorders. The results were deemed surprising by many in the field at the time. Why? Because they contradicted many widely held beliefs about people on the spectrum, who are often described as "robotic" and "incapable of empathy". "They just can't read between the lines!" is a common complaint regarding Aspie adults.
Consider, however, the abstract below:
Who Cares? Revisiting Empathy in Asperger Syndrome
A deficit in empathy has consistently been cited as a central characteristic of Asperger syndrome (AS), but previous research on adults has predominantly focused on cognitive empathy, effectively ignoring the role of affective empathy. We administered the Interpersonal Reactivity Index (IRI), a multi-dimensional measure of empathy, and the Strange Stories test to 21 adults with AS and 21 matched controls. Our data show that while the AS group scored lower on the measures of cognitive empathy and theory of mind, they were no different from controls on one affective empathy scale of the IRI (empathic concern), and scored higher than controls on the other (personal distress). Therefore, we propose that the issue of empathy in AS should be revisited.
(1) Millhauser Laboratories (MHL-400), Center for Brain Health, New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA
(2) Institute of Experimental Psychology, University of Dusseldorf, Dusseldorf, Germany
(3) Nathan Kline Institute, Orangeburg, NY, USA
This research is contrary to most stereotypical versions of the Aspie as cold-hearted and uninterested in the feelings of others. So why does the common stereotype persist? Perhaps it is easy to miss empathy which is heartfelt, but not explicitly expressed. Perhaps, in this case, the burden is on the typical partner, friend or loved one to do the reading between the lines.
Theory of Mind vs. Compassion in Asperger's
The couple was in the midst of a heated argument.
"Please stop looking at me like a dead cod fish!"
Believe it or not, statements like this from partners of adults with Asperger's are not all that uncommon. When confronted with a highly upset partner, some adults with Asperger's respond by shutting down completely, staring baffled at their partner instead conversing and adopting the pose of a....well....dead cod fish.
Often adults with Asperger's (ASD) are accused of by loved ones and friends, even coworkers, as LACKING EMPATHY. This is puzzling, as many Aspies report a heightened alarm system when confronted with emotional intensity. Do Aspies really lack empathy? Or are they shutting down when easily overwhelmed in emotionally charged situations, leading to a "non-empathic" presentation? Or is there some other explanation?
Theory of Mind
The typical individual, at an early age, develops the innate capacity to know and understand that other people have thoughts, feelings and desires that are different from his or her own. This understanding develops without effort, and is supported by the innate ability to engage in the nuances of interaction: body language, tone of voice, eye contact and other subtleties. This conceptualizing of "other" versus "self" is, what many researchers believe to be, the first step in empathy. In other words, it is very difficult to "empathize" with a separate person's unique experience without first understanding that their experience is just that - unique, or more aptly put, not the same as that of the self.
One of the most important milestones in theory of mind development is gaining the ability to attribute false belief: that is, to recognize that others can have beliefs about the world that are incorrect. To do this, it is suggested, one must understand how knowledge is formed, that people’s beliefs are based on their knowledge, that mental states can differ from reality, and that people’s behavior can be predicted by their mental states.
Researchers have investigated the false belief concept in intriguing ways. In one such experiment (often called the ‘Sally-Anne’ task), children are told or shown a story involving two characters. For example, the child is shown two dolls, Sally and Anne, who have a basket and a box, respectively. Sally also has a marble, which she places in her basket, and then leaves to take a walk. While she is out of the room, Anne takes the marble from the basket, eventually putting it in the box. Sally returns, and the child is then asked where Sally will look for the marble. The child passes the task if she answers that Sally will look in the basket, where she put the marble; the child fails the task if she answers that Sally will look in the box, where the child knows the marble is hidden, even though Sally cannot know, since she did not see it hidden there. In order to pass the task, the child must be able to understand that a person's mental representation of the situation is different from their own, and the child must be able to predict behavior based on that understanding. The results of research using false-belief tasks have been fairly consistent: most normally-developing children are unable to pass the tasks until around age four. Yet the test is often not passed by adults diagnosed with ASD.
Is Theory of Mind a necessary foundation for compassion? Compassion is a human emotion prompted by the pain of others. More vigorous than empathy, the feeling commonly gives rise to an active desire to alleviate another person's suffering. It is often, though not inevitably, the key component in what manifests in the social context as altruism.
Though adult Aspies get stuck when it comes to understanding the WHY of another's emotions, they rarely seem to present with true indifference. Rather, many seem to adopt a position of indifference as a defense against an inherent lack of understanding of the basis for the emotions of others. It is, perhaps, this fundamental lack of understanding, COMBINED WITH an ultra sensitive and reactive physiological system, which leads to withdrawal. This withdrawal can leave loved ones feeling abandoned and uncared for, a recipe for problems in relationships.
"I love email," says one Aspie adult, "there's no overwhelm. I can read about my friend's upset without having to respond in the moment, manage eye contact, witness first hand things like crying and gesturing. Email is the grease of our relationship."
Before jumping to conclusions regarding your own or your partner's ability to empathize, remember that one truly cannot judge an Aspie by his or her cover. Professionals trained in working with autism spectrum disorders can help with adjusting terms of communication to prevent overwhelm and withdrawal, so that Aspies with compassion can be perceived as such.
There's nothing fishy about that.
Five Tips for Aspie Partners
In my psychotherapy practice, I often receive referrals for couples dealing with one partner's real or suspected diagnosis of Asperger Syndrome. More often than not, the partner who is frustrated and seeking therapy is the partner who has not been diagnosed.
Most of us know that adults with Asperger Syndrome (Aspies) have dramatically different ways of communicating and behaving in relationships. Some of these ways work beautifully! Some do not. If you are an adult who has been diagnosed with Asperger Syndrome, or suspects you might have the disorder, how can you begin to navigate the foggy, unpredictable, irrational land of intimacy? Following are five tips which may provide some beginning help.
1. Don't give in to feelings of hopelessness or futility.
Adults with Asperger Syndrome can at times feel overwhelmed by frustration. There are times these adults can feel that no amount of effort on their part can ever change their ability to understand how their partner operates. This is sometimes true - no adult can ever really become an expert on their partner's perceptions, thoughts, feelings and behaviors. The best strategy may be becoming an expert on yourself. This can serve as a foundation for learning new skills, having compassion for yourself and even learning to laugh at how different you and your partner may approach problems and issues.
2. Ask questions of your partner -gather as much information as you can about the situation you're facing together.
Faced with having to operate without an intuitive understanding of how your partner feels and thinks, you may rely on your logic and assumptions. This can be dangerous! Remember, your mind works differently than your partner's. A great strategy can be simply asking questions. For instance, instead of assuming that your partner is ready to end the relationship over a fight, ask for clarification. Good questions can include, "I'm wondering if you feel...." Or "Can you tell me more about that?".
3. Hold tight to the truth that your thoughts and emotions matter.
Though they may be expressed differently (or not at all!), your feelings and perceptions are valid, and are worth just as much as your partner's feelings and thoughts. This can be a difficult perspective to maintain, especially if your partner is articulate and quick. Remember, working out a problem is not a verbal jousting competition, though it can sometimes feel like one.
4. Decide how you would like to pursue and operate in relationships.
This takes thought. Do you want to connect with others? Do you experience loneliness? Do you want to increase your ability to talk about your inner world or negotiate problems? Not everyone aspires to these ways of relating. Decide for yourself if you do. If you decide to work to strengthen your connections, you may benefit from learning to monitor your "togetherness tolerance" - Aspies often are helped by frequent breaks, shorter visits, etc. Your level of need in connecting with others may differ vastly from that of your partner. This is fine, and may serve as a great balance for your relationship.
5. Find help. Often a cliche tip, there is no substitute for consulting an expert - a communication coach, a therapist, a well-written manual. Remember that though you may have not received the understanding of relationship nuance through osmosis, like many adults, you CAN learn skills that can close the gap you may feel between your ability to relate and the abilities of others.
One last tip - don't be too quick to judge yourself harshly. Aspies often provide wonderful advantages to their relationships, such as "groundedness", logic, a refusal to become violent or aggressive, a heightened desire to do the right or moral thing, an inability to participate in the emotional "games" so many adults struggle with in relationships, in intense sensitivity buried under layers of defense. As always, self-acceptance is the best position to take as you navigate the wonderful - and sometimes terrifying - frontiers of intimacy.
Book Review - Embracing the Wide Sky: A Tour Across the Horizons of the Mind
Daniel Tammet, author of Embracing the Wide Sky: A Tour Across the Horizons of the Mind, describes his life with high-functioning autistic savant syndrome. Daniel holds an official diagnosis of Asperger's, and many adults with Asperger's who read his biographical Born On A Blue Day describe his ability to relate the world of the Aspie mind to those without Asperger's as groundbreaking.
Tammet's newest book expands on such topics as the neurological basis for creativity, the benefits of meditation and training the brain to experience more happiness. The book is an excellent survey of the diversity and beauty of the minds of people who appear so different. He is a tireless advocate for Aspies, and believes stereotypes such as Rainman do much to confuse and bias the public towards those whose brains work a little (or a lot) differently.
Check out Tammet's blog at http://www.optimnem.co.uk/blog/index.php
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