Session 2


Moderator

Lynne Soraya

Recently, several colleagues and I attended a presentation regarding the challenges faced by veterans returning from war with significant disabilities. As with many discussions of disability-related issues, it was intense.

The speaker, a nurse, told the story of her son, who returned from Iraq with serious injuries, resulting in the amputation of both legs and severe anoxic brain injury. She talked about the trauma, his physical pain, and the trials of his long recovery. She described his struggle to relearn basic skills like reading, writing, and even speaking, the pain of his early attempts to use prosthetics, and the final decision that had to be made to abandon his efforts to walk. She talked of his struggles with emotional regulation, post-traumatic stress disorder, and hyper-vigilance.

She was a good storyteller, and as I listened, I found myself imagining myself in his place—feeling his loneliness, frustration, isolation, and pain; imagining the evenings he must have sat alone, unable to sleep, his neural mechanisms on high alert; jumping at every noise, expecting calamity at every moment. I was deeply moved.

The speaker’s vivid, passionate call to action was met with a standing ovation, which I was only too glad to give. After the session came to a close, my colleagues stayed behind at our table debriefing. But I faced a challenge. While my colleagues seemed to have recovered from the strong emotions of the presentation, I hadn’t.

As with many people on the autism spectrum, I have issues with sensory hypersensitivities that strong emotion tends to amplify. Suddenly facing the roar of a ballroom full of discussions, loud music and announcements blaring over the P.A., and the clash and clank of dishes being cleared from tables was acutely painful. I flinched at the crash of a plate in a bus pan, felt the tension building in my muscles and subtle twitches taking place in my hands and legs.

But my colleagues continued their conversation and did not seem to notice. I did not want to be rude by interrupting or abruptly leaving, so I did my best to tolerate the discomfort until the conversation finally came to a close.

In the past, I might have been frustrated, even angry, at my colleagues’ obliviousness. I would have thought that they lacked empathy. But they were clearly not unempathic people—during the presentation, there wasn’t a dry eye among us. The reality, I now know, is that they couldn’t read the signals of my distress. They didn’t know that I was feeling it until I told them. Once I did, their empathic action was instantaneous.

A lifetime of experiences like this has taught me to question the assumption of empathy as automatic. Is it really? Can a person truly show automatic empathy if the person doesn’t “speak” the same nonverbal language as the person they are reading? What if a smile didn’t automatically mean the same thing to the recipient as it did to the smiler, or if the recipient had a disruption in the motor skills necessary to reciprocate? What types of higher-order thinking may be needed to counteract such dynamics?

This leads to the question of how assumptions about others affect empathy. For example, if someone assumed that I, as someone on the autism spectrum, was unlikely to be able to “step into the shoes of another” and experience “fellow feeling” with the speaker and her son—what assumptions would that drive regarding my behavior? Would it make someone less likely to pick up my distress or more likely? In other words: how does the assumption that another person lacks empathy affect your empathy toward that person?


 

PANELIST

G. Anthony Gorry

Human inventiveness forged a path from oral culture to writing, then on to print and now electronic media. As this journey continues, so continues a profound change in our culture, and in us: the emergence of disembodied sociability.

Our empathetic faculties are increasingly engaged by others who are neither kin nor companions and who are often fictions. Newspapers, books, art, movies, television and other media have thrust us, if only imaginatively, into the lives of others far removed. Computers are the latest and most protean of what Donna Haraway calls “machines of sunshine,” which, although they “are nothing but signals, electromagnetic waves, a section of a spectrum,” can erode the boundaries between reality and artifice, beguiling us with increasingly elaborate settings for work, entertainment, and escape. Through their auspices, we meet with people far away, enter complex simulations, collaborate and access previously unimaginable stores of information and knowledge. These experiences fascinate us, and what we learn of them stirs our emotions, even when what they present consists only of lines of text or a flickering on a screen.

Growing intimacy with these machines promises expansive and multifaceted lives; in this digital realm, many have created new identities for themselves. But how is the advance of information technology affecting intimacy with other people? Our empathy has deep roots in our biology, but what happens to our capacity to sense the inner lives of others as digital technology increasingly mediates our experience?

Our narrator recalls that the empathetic response of her companions arose only after she told them of her discomfort, which she could not express naturally in the language of the body. While we can connect electronically with countless people in novel ways, we reach most of them only at a vague, digitally prescribed distance, where the expressions of the body, which would be clear in a face-to-face meeting, may only be encoded as “emoticons.” We tell people who cannot see us that we are smiling. But are we? The machines that mediate our relations with one another may require new, more trustworthy ways of expressing our emotions.

Susan Sontag argues that the technologies of modern life have brought us many opportunities to “regard the sufferings of others from afar.” We might predict, therefore, an increase in understanding, tolerance, and perhaps even empathy as technology makes more permeable the boundaries that presently divide communities and nations. Such benefits would surely be a boon to our increasingly interdependent and conflicted world. But many people selectively engage with imagined others—on television; on movie and computer screens—who suit particular desires or whims. A more ominous outcome, then, might be habituation to a steady stream of particular emotions, which stimulates our natural empathy but attenuates our emotional concern for the joys and suffering of real people. In our life on the screen, in a pale reflection of a more fulfilling activity that once knit people together, we might know more and more about the lives of others and care less and less about them.



 

PANELIST

Meghan Falvey

When analyzing social interaction, I tend to focus on how differential position—having more or less economic, social, and cultural capital—affects the scope of available ways by which one person can try to apprehend or engage with another. My default line of thought tends to be to wonder about the ways in which objective difference—for example, the difference in status between employer and employee—structures interaction. Employers and employees have distinct interests, no matter how empathetic either might be to the other in any one case, and interests are impervious to assumptions.

But between any two people trying to have a conversation or among any group of colleagues, there will be differences of resources, abilities, and status. Lynne's eloquent post reminds me of the necessity of what anthropologist Clifford Geertz called "thick description": a nuanced, textured view of what actually occurs in actual lives. Even two people with roughly equivalent social capital may find themselves cut off from each other by a gap in their ability to comprehend the other, and certain skills can in particular cases bridge fissures that would otherwise seem to render communication impossible. In her comment to the Forum, Tammy Kacmarynski describes her experience as a person with Asperger's syndrome thus: "I absolutely reason through these typical everyday events, at least until I have learned the context of the smile." That kind of scrupulous attention to the manifold intricacies of mundane interaction strikes me as a perfect example of "thick description."

In her description of her experience at the presentation, Soraya mentions language twice: "They didn't know what I was feeling until I told them," and "She [the mother of the veteran] was a good storyteller, and as I listened I found myself imagining myself in his place." In both cases it's speech that serves as the catalyst that provokes or permits the empathic response of the audience. Both the unnamed veteran and Lynne experienced physical and psychic suffering, though, obviously, in different registers; and I do not remotely mean to imply that she intends in any way to equate her experience with that of the veteran she heard about. In any case, Soraya describes two instances of bare physical and mental suffering, and in each instance, the ability to articulate need and so communicate it to others via language is what serves to allow for others' empathy. Soraya mentions the nonverbal aspect of cues to others’ emotional states but in fact only words seem to be able to do the job. This sort of bias toward a certain kind of communication might well affect how accurately we read others’ levels of happiness or unhappiness, pleasure or stress. So that raises the question: what role do we think language and speech play in our lived experience of interpersonal interactions?

I keep thinking of all the times I've seen someone stumble or trip on the sidewalk and, instantly, many people around them reach out as if to break their fall. In that situation, one acts without words (as well as without knowledge of, or consideration for, the class and status of the stumbler). But Lynne's difficult experience was only happily resolved because of her ability to articulate her distress, to put into words what she was going through. That allowed her colleagues (to borrow from one of Forum reader David Cameron Staples' substantive comments) to demonstrate empathy and alleviate her distress. Decoupling the experience of feeling empathy from the actions that do or don't result from that feeling seems key here. What if some of Soraya's colleagues had noted her distress and were silent about it because they didn't know what to do? It took her telling them, in words, what she was mutely experiencing before they could help.

So this makes me wonder what happens when somebody, wherever they may be located on the autism spectrum or off it (please forgive any clumsiness in that phrasing), is in distress and can't articulate it? We don't extend empathy to another's success or good fortune, we think about empathy as something that runs downstream, so to speak. It's a response to another's distress or ill fortune. I think the reason why we think of empathy as an ethical or moral issue is because it constitutes a reaction to another's need, deprivation, difficulty; to their suffering.



 

PANELIST

Peggy Mason

In considering empathy, it is critical to remember its evolutionary roots. Mammalian young are born helpless, dependent on their mother for milk, immune defense, thermoregulation, and protection. The young’s lives depend on mom’s attention and care, absolutely and completely. If mom does not recognize that an offspring has a problem—cold, hungry, left behind—and do something about that problem, the offspring will die. In these circumstances, empathic understanding by the mother of the young’s condition and needs is not optional. Rather, feeling empathy and acting caringly upon that feeling are the difference between life, passing on one’s genes, and death, an evolutionary dead end.

An individual who needs help must signal that need. Ergo, babies cry. A potential helper must then recognize the distress of the one in need. Babies’ cries are hard not to recognize as distress and parents are moved to respond. Conversely, most parents do not go to help a baby who is not crying, accepting silence as evidence that all is well.

Over the course of evolutionary time, brain circuits that support empathic caring between mom and offspring have generalized to support empathic caring by and toward adults, of both sexes. This is not surprising, as empathic caring confers advantages to adult practitioners, biasing them toward synergistic social behavior and away from interpersonal antagonism. As with empathy between moms and babies, empathy between adults also depends upon one individual showing distress and another individual’s picking up on that distress. Consider seeing a person who is happy to be in a situation that you would find distressing. Do you go help that individual? Hopefully not, since that individual is likely to not want your meddling. This holds even though we may hate to be in that other person’s shoes, a situation that happens all the time. One person’s fun—five-mile run, practicing piano, weeding a garden—is another person’s tedium or torture. Thus, just as it takes two to tango, empathic caring takes two as well.

In sum, one individual’s demonstration of distress is as critical to successful empathic caring as is another’s sensing and responding to distress. Accordingly, biology has left little to chance. Crying works: babies get attention when they need help. Facial expressions and posture also work because they are universal—common across populations and also across species—and because they are unconscious. In fact, as demonstrated by neuroscientist Jean Decety and others, we use subcortical (unconscious) brain pathways to sense and then mimic another’s emotional state, making us distressed to witness another’s distress. The automaticity of emotional communication provides a fast and relatively fail-safe mechanism to ensure that another’s distress will be noticed, and hopefully ameliorated by caring behavior. Conversely, in the absence of an individual displaying distress, nonhuman animals and young humans are not moved to “help.” Thus, in a situation where an individual feels distressed but cannot show it, the most surprising outcome would be if someone intuited their distress and actually intervened with caring behavior.


 

Comments

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Tammy Kacmarynski wrote :

I enjoyed reading Kate’s well-thought-out perspective and I will concede to many of her statements. She states, “The move away from face-to-face interaction plays a role in this as it is a move away from some skills associated with empathy that can only be increased through face-to-face interaction,” and “alexithymia is a significant factor associated among individuals on the spectrum,” and I cannot agree enough. I also have alexithymia and I have been working at increasing my level of emotional intelligence. I will add that my experiences in life and on the spectrum is most likely quite different from most, as my family owns and I help operate a counseling practice. This has given me many more opportunities with not only face-to face interaction but with both observing clients and receiving feedback on a daily basis from the counselors who work for there.

Kate goes on to say “most often voiced on the internet by individuals identifying themselves as females self-diagnosed/diagnosed with Asperger's syndrome,” and I will agree with the statement with the emphasis being placed on "most but not all." I have encountered many men on the spectrum who present very much like I do. These men have the added burden of not being able to participate in many of the same groups and forums that I am in because of their gender and mistaken assumptions.

When I state that our voices need to be part of every conversation on autism, I am not only speaking about my voice; all of our voices need to be heard and our experiences need to be accepted for what they are and not what some expert has decided to "theorize"!
Tammy Kacmarynski posted on 09/27/12
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Maura Archuleta wrote :

Empathy as aclinical skill differs from "everyday caring" which then differs again on how it's expressed, based on numerous factors, nicely elaborated here.

Maura Archuleta posted on 09/27/12
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Kate wrote :

Exposure to high levels of prenatal testosterone and higher androgen levels in general are correlated with reduced levels of empathy.

Interestingly, both correlations are weaker in individuals diagnosed with Asperger's syndrome, as exposure to prenatal testosterone through measures of 2d/4d digit ratio is evidenced as significantly higher among those with autism disorder. Another recent study measures higher androgen levels among those with more severe impairments associated with ASDs.

The relationship of androgen levels to the human experience of empathy is clear, as androgen levels naturally decrease among males that become caregivers of children, increasing the potential for empathy/nurturing qualities that are a natural requirement for the survival of children, as detailed in the panelist's evolutionary description of empathy as a requirement for mammalian survival.

The moderator and one of the comments showed extreme attention to detail to the nonverbal signals provided by others, expression of emotion, and understanding of it; however this is not a consistent evidenced reported or scientifically measured experience across the spectrum.

Empathy is understood as not only a human emotion that is a natural one influenced by hormonal factors but also a learned attribute associated with environmental/cultural factors, negative and positive, that may either increase or decrease the attribute of empathy in all its complexity.

The move away from face-to-face interaction plays a role in this as it is a move away from some skills associated with empathy that can only be increased through face-to-face interaction.

Alexithymia is a significant factor associated among individuals on the spectrum, as it is estimated to occur in close to 85% of those diagnosed on the spectrum. Whether the origin of this co-morbid condition is biological or psychological, the impact to difficulties associated with empathy can be severe in some cases.

The autism spectrum is a diverse one where there is substantial evidence that some individuals have high levels of empathy and some are also very much in tune with the nonverbal communication of others, but this is not the evidenced experience of all who exist on the spectrum.

Many factors come into play, per gender, androgen levels, severity of social communication impairments, hypo- or hypersensitive sensory differences, and co-morbid factors such as alexithymia, depression, and other co-morbid conditions that can influence the experience of empathy and emotions in general.

It is possible that the moderator and the first commentator have higher levels of empathy than those they usually associate with off the spectrum as they may place a greater conscious focus on the nonverbal expression of others, as well as potentially being more naturally inclined to experience more intense emotions. That experience of empathy among those on the full autism spectrum is as varied as the experience of empathy among those off the spectrum, all of whom experience empathy differently depending on biological, environmental, cultural, and psychological factors.

For example, a person that experiences severe anxiety vs. a person that has never experienced severe anxiety on or off the spectrum would naturally sympathize more with a person showing signs of tension and flinching at noises in the environment, as those are common physical responses for people with general anxiety disorder, regardless if they are on the spectrum or not.

Tension and flinching at noises is not an inherent nonverbal expression of discomfort on the spectrum, as some on the spectrum are hyposensitive to sensory stimulus, experience relatively normal levels of anxiety, and some experience low levels of fear where there is concern they be more likely to come into harms way.

Not surprisingly, per identified factors associated with empathy, the concern that there is a stereotype among individuals on the spectrum that they have difficulties with empathy, is most often voiced on the internet by individuals identifying themselves as females self-diagnosed/diagnosed with Asperger's syndrome.

If one goes to an online autism community equally comprised of males and females, the lack of empathy response when the question is asked is often one of difficulty with empathy, not hypersensitivity to empathy and the opposite response is provided by others. It is dependent on all the variables associated with empathy and each unique individual.

Note: I am an individual diagnosed on the spectrum.

Kate posted on 09/26/12
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Tammy Kacmarynski wrote :

Lynne has shared a great example here and I must say that I am surprised that her points seem to be missed. I, for one, would have immediately noticed that Lynne was experiencing emotional difficulty after the presentation. I cannot "chalk this up" to relating because I would have been able to notice her reaction even before I knew or understood I had Asperger's.

So how would I have known that she was struggling? Easy, I pay attention, very close attention. I notice many human nuances that tend to be unobserved by most neurotypicals. When I am having a conversation with someone, I easily observe the many layers of the interaction. There is much more than words to a conversation. There is the way an individual may tilt their head, purse their lips, slightly raise their eyebrows, the slight lean, the speed in which they blink their eyes, etc. . . . These movements are VERY apparent to me.

Mr. Gorry's comment, "Our narrator recalls that the empathetic response of her companions arose only after she told them of her discomfort, which she could not express naturally in the language of the body," has missed an important point. Lynne most likely was expressing her discomfort "naturally in the language of the body"; unfortunately her companions were unable to read the language correctly.

Ms. Falvey states, "That kind of scrupulous attention to the manifold intricacies of mundane interaction strikes me as a perfect example of "'thick description.'" and I would completely agree with this statement. When she goes on to say, "Soraya mentions the nonverbal aspect of cues to others’ emotional states but in fact only words seem to be able to do the job," I sense a disconnect. Communication, for me, is so much more than the words spoken. I sense and will feel others' emotions without one word being spoken. If I were to walk into a room, I can rather quickly identify who is in emotional distress. If I sit too closely to someone who is in distress or even worse if we happen to physically touch, I will then physically feel the same emotions that they are experiencing.

When Ms. Falvey goes on to ask, "So this makes me wonder what happens when somebody, wherever they may be located on the autism spectrum or off it (please forgive any clumsiness in that phrasing), is in distress and can't articulate it?" to me the answer is simple. Why are we not hiring people with autism to "decode" the language or to teach the language? Why are we not included in the dialogue? Who benefits from this obvious unbalance of power?

The statement made by Ms. Mason, "An individual who needs help must signal that need. Ergo, babies cry. A potential helper must then recognize the distress of the one in need" is very logical and makes a great deal of sense, on its face. The problem that arises is that the signal that is given is not understood but lack of understanding does not mean a signal has not been made. If for some reason, a baby is born without the ability to cry and we therefore going to assume that the baby will not have needs? When she goes on to say, "Conversely, most parents do not go to help a baby who is not crying, accepting silence as evidence that all is well," and goes on to say, "As with empathy between moms and babies, empathy between adults also depends upon one individual showing distress and another individual’s picking up on that distress," only showcases the true issue; a lack of understanding on how an autistic communicates. It is not a lack of communication; it is a neurotypicals lack of reading this communication. The communication is occurring and I am EASILY able to decipher, as are most people I know with autism.

After today's comments, I am more sure of the answer to the problem with understanding autism and that is to include autistics in the discussion; on EVERY level. We are communicating and we are not being heard.
Tammy Kacmarynski posted on 09/25/12
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Kim Elmore wrote :

I don't understand how the panelists' responses relate to the moderator's post or the questions she asks in the last two paragraphs. How does the disembodied sociability, differential position, and evolutionary roots of empathy help us better understand sensory and behavioral differences in feeling and expressing empathy? The idea of differential position relates most closely, I think, and I would be interested to learn how differences in dis/ability--subjective as well as objective differences -- relate to the ways empathy are experienced and expressed. Popular culture and science seem to have a very one-dimensional view of how empathy should be experienced and expressed, but the moderator's posts illustrate how empathy is more complex than most people allow. I'd also be interested to learn how differences in empathy may be expressed through Rineke Dijkstra's photography and video installations. I look forward to the live chat this Thursday.
Kim Elmore posted on 09/25/12

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