The Double Empathy Problem

In 2012, Damian Milton wrote a fascinating article in Disability and Society. He effectively argues that there are foundational differences in the construction of social understandings between Autistic people and neurotypical[1] people, meaning that miscommunications and misunderstandings are bilateral and not distinctly the fault of Autistic people. This would mean that it is not an Autistic ‘failure’ to misread a social situation, but rather, it is because the predominant narrative is that the Autistic person has misread it since they exist as a neurological minority. In effect, this means that when an Autistic person is considered to have lacked empathy by a neurotypical person, the inverse may, in fact, be true. Naturally, Autistic people can be unempathetic too, but unless both sides are willing to overcome this gap in understanding, it will be difficult to bridge the gap. Milton expresses this better than I can:

“The inability to ‘read’ the subtext of a social situation is often deemed to be a major feature

of those diagnosed as being on the autism spectrum, yet it is suggested here that social

subtext is never fully given as a set of a priori circumstances, but is actively constructed by

social agents engaged in material and mental production. There is a tendency in the

application of positivist methodologies in cognitive psychology and science to incorrectly

assume that there is a set of definable social norms and rules that exist for people to follow.

This ideology is also supported more explicitly by functionalist sociologists. This is not the

philosophy propounded by those of a phenomenological or ethnomethodological persuasion

however. The ‘theory of mind’ and ‘empathy’ so lauded in normative psychological models

of human interaction, refers to the ability a ‘neuro-typical’ (NT) individual has to assume

understandings of the mental states and motives of other people. When such ‘empathy’ is

applied toward an ‘autistic person’ however, it is often wildly inaccurate in its measure. Such

attempts are often felt as invasive, imposing and threatening by an ‘autistic person’,

especially when protestations to the contrary are ignored by the NT doing the ‘empathising’.”               

(Milton, 2012)

While this whole paragraph really stands out to me, the first sentence captures the situation well. I would understand social subtext to be the ‘between the lines’, ‘unspoken’ and otherwise interpretative element of human communication. To say that this is never fully given as a set of a priori circumstances is to say that we are not able to access the complete subtext at any given time because it is a truth we construct, infer and reinforce across our lifetime. The core difference between a neurodivergent mind and a neurotypical one, in the social context, is that the means by which we construct our social sense is different to that of others, meaning we struggle to make the same predictions as others.

However, that is not to say that either system is automatically better than the other or that one neurotype is superior. It is to say that acknowledging these differences in how information is structured to navigate the world is key to developing a shared social structure that enables optimum communication between neurotypes. This will not only reduce the psychological distress that naturally occurs due to miscommunication (which I would understand to be the mechanism of learning that does not function so well in Autistic people; otherwise, we would have learnt by now) but will also open the doors to improved intersubjectivity and information sharing, enabling more robust understandings of the world to be developed.

It would be a mistake to rely on a single logical system for understanding, as it has been shown that any axiomatic system cannot rely upon its own fundamental arithmetic to prove itself to be true or false and that there is a need for additional syntax to prove it either way (Raatikainen, 2022)[2]. So, there is no way to prove a logical system to be true while remaining within the constraints of the said system since this would be tantamount to claiming 0=1. To claim any epistemic veracity, there is a need for multiple systems that relate to one another.

Another way to express this phenomenon is through the Liar’s Paradox. A liar says, “This sentence is a lie.” Did the liar tell the truth? In that case, they are not a liar. If they are telling the truth that they are a liar, then they are not a liar either. So here we find ourselves in a paradox, facing a conundrum where there is no clear truth or untruth aside from the truth that this system cannot determine either in its current form. Every system will include contradictions, so new options need to be included to maintain them. For example, the liar is indeed a liar, but for once, they told the truth. The problem is that I have introduced this new possibility, which may not be apparent to others. Of course, with something simple, we are more likely to draw the same conclusions, but where there are neurological differences, we are more likely to find novel means to resolve such conundrums.

Take, for instance, Microsoft vs Apple. Each produces different computers which rely on different hardware. They use the same base logic, such as Boolean, but their Operating Systems use different languages, so require a translator to communicate. If I write this document in the Pages app, I must export it to a docx. File to load it onto Word. We know they are both computers, that they use electricity and have different strengths, but we also know they have many differences.

This is particularly pertinent to the discussion as neurotypes are literally groupings of neurological differences. To have divergent neurology is to have different hardware, so is also to have divergent processes that underpin consciousness. How this is expressed as an end product is limited in how we can influence it, with characteristics such as personality being largely fixed throughout adulthood. For someone such as myself, I have to rely on building systems of understanding in order to have empathy for others, as I do not automatically (subconsciously) do this, as others seem to. That means that to participate in neurotypical modes of communication, I have to actively process what is happening before me in order to introduce new understandings to my system.

Creating a system for categorising and understanding human behaviours, with consideration for the illusive meaning that underpins them, is no small task. It takes a great toll on my mental health and is an inherently personal undertaking as any mistake is met with feelings of shame, made far worse when I am also shamed, humiliated or otherwise punished for encountering a situation not previously accounted for by my system of understanding. I acknowledge this is a largely automatic response as many instances have occurred with people I have not met before, so it cannot be a personal attack or based upon prejudice (aside from rejecting aberrant social behaviours). However, it still hurts to make mistakes. A pain that is always psychological but sometimes physical too.

Perhaps unsurprisingly, it is difficult to explain the intricacies of my cognitions without getting lost in explanation or writing in a way that is the antithesis of concise, especially when there is already a substantive difference in processing. This is where particular drugs such as Ritalin have their place, as they focus my mind into a more cohesive package, certainly for me and most likely for others. It is a curious difference, taking my thoughts from a cluster of ideas to a singular expression. It is as if the council has convened, and I am simply reading out their conclusions, which remain concordant with my usual outcomes, with significantly less effort on my part. It makes my mind a quiet place, shifting a great deal of work from my conscious mind, freeing up energy to go into my expressions.

This notion of a council is central to my understanding of others and myself. By spending a significant amount of time introspecting and observing others, I have recognised that each shard of my identity can be linked to characters I have encountered throughout my life, based upon behavioural sets. A classic idea of an Autistic child is that they see someone crying and ask what they are doing rather than comforting them. The confusion I faced in this scenario was twofold: what they were doing; and why they were allowed to.

In my youth, I did not understand that other people would express their emotions through their behaviours; I just saw the behaviours. Over time, I learnt (through a combination of ‘letting people down’ and being punished for not being ‘nice’) that there was a link between the way someone felt and the way they behaved. Additionally, I had been taught that my behavioural expressions of my feelings were unacceptable, so I didn’t think expressing emotion was appropriate. I believe this contributed to my alexithymia, as a great schism occurred between my internal feelings and my external presentation at a young age. What utility is there in recognising how you feel if no one can recognise this from how you act?

Linking this to the Power Threat Meaning Framework, where an Autistic person has been identified as unempathetic on the basis that they are not conforming to social expectations that are not known to them, it becomes very difficult to not react with a trauma response when faced with experiences that would, to the neurotypical, be mundane. Consequently, many Autistic people may have symptoms of Complex Post-Traumatic Stress Disorder (C-PTSD)[3], as many aspects of their natural being will have been met with social rejection. This is because social groups naturally rely upon order and conformity to define themselves as a group, so aberrant behaviour is punished as a way to regulate membership and shared identity. Unfortunately, the rules that are used in this process are a mystery to Autistic people, so they frequently fall foul of them and are punished for no apparent reason.

Repeated and arbitrary punishment from all manner of people, over the course of years, and often made about one’s identity, is enough to cause anyone severe psychological distress. Especially when this is the reaction to attempts to socialise, is largely unpredictable and impossible to escape. PTMF has already established several factors that make a trauma harder to survive, which I will include here:

·       The threats happened during childhood.

·       There is no one to support you, confide in or offer protection.

·       There are many kinds of threat.

·       The threats are long lasting, repeated and/or severe.

·       There is no clear way to avoid or escape the threatening situation.

·       It is not possible to predict when the threats will happen or to control them when they do.

·       The threats involve your sense of self or your worth as a person.

·       The threats happen within a close emotional relationship with someone you love and depend on.

·       The threats are intentional, directed specifically at you.

·       The threat(s) come from several sources.

An Autistic person is more likely to have experienced trauma while all of the above points are true. This makes for an extremely challenging life and a higher risk of being diagnosed with a mental illness. A recent study even found that Autistic people face a 2.5 times higher risk of premature death, with those categorised as ‘mildly Autistic’ being 10 times more likely to commit suicide than the general population (Hirvikoski, et al., 2016). This is partly due to the impaired communication between Autistic and neurotypical people but also because of difficulties that Autistic people face due to comorbidities, accessing suitable support from medical professionals, diet and exercise.

A major part of the problem is that the medical community is predominantly neurotypical or at least conforms to the neurotypical modalities and social structures. This means that there is a great chasm between the medical understanding of neurodivergence through empirical observation and the lived experience of those living with the collection of traits identified as Autistic, ADHD and so on. This is a major problem because the philosophical underpinnings for the normative social hierarchies exclude those with neurodiversity from the paradigm, leading us to form our own philosophies out of necessity. So, for a social caste system that purports itself to be infallible and all-encompassing of human empathy, it falls incredibly short of the mark but also leads to a fundamental misunderstanding that places the blame on those excluded from the system rather than those who reinforce it.

Examples of this can be seen in the use of electroshock treatment that seeks to modify Autistic behaviour and in the use of ABA as a therapy. While it is absolutely true that conformity to the socio-economic and cultural reality in which we live will likely yield better results within this system, the psycho-emotional cost to the neurodivergent individual may be such that they face significant distress or, as pointed out, reduced life expectancy. So, from a more sociological perspective, I believe it is a grave error to assume that enhancing one’s commitment to psychosocial improvement is necessarily a good way to improve the well-being of those who face significant difficulties in those areas.

However, that is not to say that being accepted, feeling self-worth and being productive is bad for those with neurodivergence, just that the current approach to bringing this about is based upon axioms that do not align with those of the neurodivergent community is more destructive than constructive. I can safely say that everyone reading this will have experienced their perceived shortcomings being exposed in public. It does not feel good. So, to demand that an Autistic person join a social group to address their feelings of isolation may do little but reinforce them.

This process of re-traumatisation is extremely common for Autistic people, who are taking a very challenging step in asking for psychological support. It does little to endear us to future engagement with medical professionals and, I suspect, is a major cause of the significantly worse health outcomes we face. For Autistic people to be at parity with others in terms of our health, it is key that the medical community acknowledges the foundational, philosophical differences in perception and takes the time to understand the meaning of our idiosyncrasies rather than assuming that they will be the same as those in the neurotypical population.

The same is true for boundaries: as Autistic people have faced seemingly arbitrary social rejection, boundaries seem equally arbitrary. An Autistic patient may not, therefore, have a sense of what is deemed acceptable by a practitioner, which means a higher risk that social offence may accidentally be caused. I have, for example, been shouted at by a GP for questioning his belief in homoeopathy. This was a confusing experience for me, as I thought it was appropriate to challenge this, yet the ego of the GP seemed to get the better of him. My questioning of his authority was enough to result in an unpleasant experience, yet, at the time, I did not understand that he was the one to cross the boundary as it was not acceptable for him to shout at me nor to recommend a treatment that lay well outside NICE guidelines[4].

The lack of boundaries can go both ways, so it is common for Autistic people to endure unspeakable suffering without the realisation that they are the victim of a crime, misconduct or discrimination. For example, I once knew someone whom I suspected was Autistic and had been threatened in a communal shower at knifepoint. Still, they were unsure if this was acceptable, so they didn’t think to report it until another person came forward about a similar occurrence.[5] This is a further testament to the differences in understanding that can occur, often with dangerous results, yet, what is done to effectively safeguard Autistic individuals?

Again, this is why professionals must try to understand the Autistic experience from our lived experience rather than the descriptions of behaviours found in textbooks written from a distinctly neurotypical perspective, as there is an enormous risk that extreme suffering is occurring without being expressed, thanks to the years of social chastisement that has taught us to repress rather than express.

Of course, I am just one Autistic voice so I can only speak for myself, and would recommend that anyone seeking a greater depth of knowledge does so by exploring the Autistic experience from a more person-centred perspective that takes into account our lived experience. After all, we are ‘pathologically self-absorbed’[6] people who ‘lack empathy’[7], so the very labels the normative view has reduced us to are supportive of the idea that we cannot ingratiate ourselves into the neurotypical world.

As a closing statement, I will share an anecdote with you. As part of my Autism diagnosis, kindly conducted by the brilliant Dr Akhtar, I was asked about my sense of humour and if I considered myself to have one. My response? “Well, I always laugh at my jokes!” We both laughed at that one. Autistic people are like any other person; we have our own way of doing things, but it might not match up to the social norms that others are used to. No one is bad for acting as their conditioning has made them, but to continue to harm others despite knowing the harm it can cause is a different matter.

[1] A person who does not possess characteristics of neurodivergence in a way that is typical to society.

[2] Disclaimer: my background is not mathematics.

[3] Further information: https://www.nhs.uk/mental-health/conditions/post-traumatic-stress-disorder-ptsd/complex/

[4] Nor is it funded by the NHS, as it is no more effective than a placebo https://www.nhs.uk/conditions/homeopathy/

[5] I have kept this intentionally vague to protect the identities of those involved.

[6] Oxford Dictionary of Psychology definition of Autism!

[7] I frequently hear this from people when autism is discussed.

Reference List

Hirvikoski, Mittendorfer-Rutz, Boman, Larsson, Lichtenstein, & Bolte. (2016). Premature mortality in autism spectrum disorder. British Journal of Psychiatry, 232-238.

Milton, D. (2012). On the Ontological Status of Autism: 'The Double Empathy Problem'. Disability and Society, 27(6), 883-887. Retrieved from https://kar.kent.ac.uk/62639/

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