Book Reviews - Review 402

Simon Baron-Cohen of is one of the world's leading researchers into autism and Asperger's Syndrome. The first edition of this book, published in the early 1990s, covered just classic autism. This update, covering Asperger's Syndrome too, was prompted by the increasing profile in subsequent years of milder manifestations of autism.

It's a succinct book that describes the symptoms of the conditions, some psychological theories that might "explain" them, and what is known of their neurobiology. It is aimed at the families of people on "the spectrum", and higher-functioning subjects themselves.

I have mild Asperger's Syndrome, and have reservations about the modern tendency to lump it together with classic autism. While they are certainly manifestations of a single psychological tendency, the challenges their subjects and their families face are different. Most people with classic autism cannot look after themselves, and have severe problems with communication. By contrast, those with Asperger's Syndrome are usually able to live independently, and can articulate their thoughts and feelings well. That is to say that, in Asperger's Syndrome, the characteristics of the "autistic" psychological axis have compensation in personality traits from orthogonal axes. The commonest problems faced by "aspies" are the stress of trying to respond to constant sensory and psychological stimuli in fluent, non-formulaic ways, and loneliness.

Baron-Cohen's book is a coherent introduction to autism and related conditions, but it doesn't do much to dispel the stereotype of people on the autistic spectrum. There is much talk of "mind-blindness" and "narrow interests". I discuss "mind-blindness" below. As for supposed narrow interests: while it's true that aspies typically have two or three favourite subjects, their curiosity generally extends to anything new. This is a trait that is rarely observed or understood from outside: they take things in.

This sponge-like absorbancy of the mind is one of the defining characteristics of the autistic spectrum. The autistic brain filters nothing out, which means it can find interest where the average mind finds none, and also makes it prone to "overload". Stimuli arrive from too many directions simultaneously for the brain to process, resulting in mental stress and an overwhelming urge to retreat from the world. Individuals far down the spectrum can appear largely oblivious to other people's status as sentient beings, but this isn't generally the reason for higher functioning individuals' difficulties with social interaction. They can imagine and understand other people's thoughts and feelings, but are challenged in prioritising consideration of them over the personal thoughts, feelings, impressions and ideas that bombard their own brains every second. I have heard several aspies say that they can function as normal social beings if they try hard, but it is not something that they enjoy because it is tiring and runs counter to their minds' natural wish to roam free.

Baron-Cohen adopts the stance that both autistics and aspies are "mind-blind". Such a stance implies that understanding other people is a binary skill: either you have it, or you don't. Yet one looks around at non-autistic acquaintances who have been let down by friends or lovers, or misread others' intentions drastically, and wonders what this skill of "mind-reading" amounts to that aspies are supposed to lack. It's true that aspies are often late in discovering the ubiquity of dissimulation in human affairs, but since they lack the urge to dissimulate, the discovery is merely part of the process of lifelong familiarisation with human nature that all people go through. What's within us is always our starting point.

The conventional wisdom among non-autistic people - "neurotypicals" - is that autistics and aspies don't understand the world: it's their perspective that is deficient. Most aspies feel it's the world that doesn't understand them. One sometimes wonders if this is true even of experts in autism. I was disappointed to find Baron-Cohen's tone that of a scientist cool-headedly dissecting and theorising, rather than of someone trying intuitively to enter into the world of the people he writes about. He covers several psychological theories that purport to "explain" autistic spectrum conditions: the executive dysfunction theory, the weak central coherence theory, the mindblindness theory, the magnocellular theory, and the empathising-systemising theory. The last of these is the one he favours, because, as he sees it, it explains both the emotional and the cognitive features of autistic spectrum subjects. Autists and aspies like rigid patterns and systems, and they often have a special talent for fitting new information into large-scale models. Human behaviour, Baron-Cohen believes, is not amenable to such models, and therefore, almost by definition, autists and aspies can't understand it. You can be an strong empath, or a strong systematiser, but not both.

This seems to me a reductive argument that suffers from the very rigidity of thought that Baron-Cohen criticises. It does not tally with my own experience or observation.

Baron-Cohen is also a keen advocate of the idea of autism as a manifestation of the "extreme male brain". Making no concessions to political correctness, he adheres to the traditional view that women are essentially feelers, and men builders. While it would be foolish to insist that there are no general statistical differences between the sexes, these differences are emphasised to excess in Baron-Cohen's perspective on autism. He states more than once that autistic spectrum conditions are much more common in males than females, without entertaining the possibility - widely accepted since this book was published - that they are underdiagnosed in females, perhaps because women are more inclined to try to adapt their behaviour to social norms. In addition, the types of interest and talent associated with Asperger's Syndrome in the popular imagination are things like computer programming and memorising train timetables, and yet very commmon among those on the spectrum are artistic and linguistic talents: hardly characteristics that most people identify with the "extreme male brain".

The author seems reluctant to acknowledge that autistic spectrum conditions bring talents at all. They bring low empathy, he is sure of that, but when it comes to systematising, they bring merely "average or even above average" ability. This loaded qualification undermines his own assertion that empathy and systemisation exist on a single axis. No matter; even if one takes the phrase "average or even above average" as lukewarm acknowledgement of positive autistic traits, Baron-Cohen then chooses to present skill in systematisation as, at bottom, maladaptive, a misguided attempt at "rendering the world predictable".

Autism and Asperger's Syndrome are, to Baron-Cohen, cognitive conditions. In fact, not just conditions, but weaknesses: witness his advocacy of pre-natal screening, and his use of the word "risk" with regard to having children anywhere on the autistic spectrum. Nowhere is the possibility considered that Asperger's Syndrome is essentially a temperamental condition. It is a temperamental condition in which a certain childlike interest in the way things work persists into adulthood. My observation is that higher-functioning autistic subjects are on average more, not less, perceptive about the world than neurotypicals. And yet their confidence in their perceptions is undermined by the patronising tone often adopted by researchers.

And I must say, finally, that Autism and Asperger Syndrome is not particularly well-written. It contains grammatical errors, sloppy usages, unattributed assertions, even unsourced statistics. (One graph was "put together by someone on the internet who calls him or herself Eubiledes". I anticipate anonymous Tweets presented as evidence in the next edition.)

I give the book three stars because, as an aspie, I am fair-minded. There is some useful information here, much of it the fruit of many years of well-funded research at one of the world's top universities (Cambridge). The sections on neurology are enlightening. But ultimately, it's disappointing that one of the world's foremost authorities on autism couldn't produce a book better-written, more sympathetic, and above all more understanding of those who, as he would have it, lack understanding of people like him.