zero degrees of empathy

Mind-Blindness can be described as a cognitive disorder where an individual is unable to attribute mental states to the self and other. As a result of this disorder the individual is unaware of others’ mental states. The individual is also not capable of attributing beliefs and desires to others. This ability to develop a mental awareness of what is in the mind of an individual is known as the ‘Theory of Mind’ (ToM).

This allows one to attribute our behavior and actions to various mental states such as emotions and intentions. Mind-blindness is associated with autism and Asperger’s syndrome (AS) patients who tend to show deficits in social insight. It is also associated with schizophrenia, dementia, bi-polar disorders, and antisocial personality disorders.

Generally speaking, the ‘Mind-blindness’ Theory asserts that children with these conditions are delayed in developing a theory of mind, which normally allows developing children to put themselves ‘into someone else’s shoes, to imagine their thoughts and feelings.’ Thus, autistic children often cannot conceptualize, understand, or predict emotional states in other people. Mind-blindness is a state where the ToM has not been developed or lost in an individual. The ToM is implicit in normal individuals. This enables one to make automatic interpretations of events taking into consideration the mental states of people, their desires and beliefs. Cohen described an individual lacking a ToM would perceive the world in a confusing and frightening manner; leading to a withdrawal from society.

In one study, the middle cingulated cortex, which is outside the traditional mentalizing region was underactive in autistic patients, while the rest of ToM activation was normal. This region is believed to be important in deciding how much to invest in a person and hence required mentalization. Other neural correlates of the ToM point towards three regions of the brains. The anterior paracingulate cortex (Brodmann), is considered at the key region of mentalizing. It is located anterior corpus callosum and the anterior cingulate cortex. This cortex is associated with the medial frontal cortex where activation is associated with the mentalization of states. The cells of the ACC develops at the age of 4 months suggesting that the manifestations of mind-blindness may occur around this time.

In addition to the anterior paracingulate cortex is the superior temporal sulcus and the temporal poles that are involved with the ToM and its pathology. However, these areas are not uniquely associated with mentalization. They aid in the activation of the regions that are associated with the ToM. The superior temporal sulcus is involved in the processing of behavioral information while the temporal poles are involved in the retrieval of personal experiences. These are considered important regions for the activation of the ToM regions and are associated with the mind-blindness. The temporal poles provide personal experiences for mentalization such as facial recognition, emotional memory, and familiar voices. In patients suffering from semantic dementia, the temporal regions of these patients undergo atrophy and lead to certain deficits which can cause mind-blindness.

The amygdala and the orbitofrontal cortex also are a part of the ToM. They are involved in the interpretation of behavior which plays an important role in social cognition and therefore contributes to the theory of the mind. It is suspected that the damage to the orbitofrontal cortex brings upon subtle impairments, but not a total loss of the ToM that would lead to mind-blindness. Some studies have shown that the orbitofrontal cortex is not directly associated with the theory of the mind or mind-blindness. However a study by Stone and fellow colleagues were able to show impaired ToM on mentalization tasks.

Since the frontal lobe is associated with executive function, researchers theorize that the frontal lobe plays an important role in ToM and its associated pathology. It has also been suggested that the executive function (a cognitive process that controls and manages other cognitive processes) and the theory of mind share the same regions. Despite the fact that ToM and mind-blindness can explain executive function deficits, it is argued that autism is not identified with the failure of the executive function. Studies show that when lesions damage the medial frontal lobe, performance on mentalization tasks is reduced, similar to typical mind-blindness cases. Patients that experienced frontal lobe injuries due to severe head trauma showed signs of mind blindness, as a result of a lost ToM. However it is still debated whether the inactivation of the medial frontal lobe is involved in mind-blindness.

Frith and Frith proposed that a neural network that comprised the medial prefrontal cortex, the anterior cingulate cortex and the STS, is crucial for the normal functioning of ToM and self monitoring. This so formed dorsal system is crucial for social cognition. Disruption of this neural network leads to mind-blindness in schizophrenic individuals. Another clue towards a possible explanation of mind-blindness in autism was found by Castelli and colleagues. They were able to show that the connectivity between occipital and the tempero-parietal regions were weaker in the autistic group than the control group. The under activation of this network may inhibit the interactive influences between regions that process higher and lower perceptual items.

Mind-blindness is usually associated with patients suffering from pervasive developmental disorders such as autism and AS. Impaired performance on the mentalization tasks were the first screening task used to diagnose the autism, with a good prediction level. Cohen proposed the mind-blindness theory of autism as ‘deficits in the normal process of empathizing.’ He described empathizing to include the ToM, mind reading and taking an intentional stance. According to this view empathising includes the ability to attribute mental states and to react in an emotional manner which is appropriate to another’s mental state.

There is some evidence that suggests that certain patients develop a rudimentary ToM and do not suffer from complete lack of ToM causing mind-blindness. A study by Bowler concluded that mind-blindness and social impairment is not as straightforward as previously thought. It showed that a complete possession of ToM was not enough to protect from social impairments in AS and autistic patients. Conversely the absence or impairment of the ToM that leads to mind-blindness does not lead to social impairments.

The social and cognitive impairments seen in patients suffering from pervasive developmental disorders can be attributed to mind blindness. Abnormal behavior of children with autism include the lack of reciprocity. Severe cases in which mind-blindness manifests includes the child being totally withdrawn from social settings as well as not being able to make eye contact while in less severe cases the individual may attempt to interact with other people. Despite this severe form of autism that is characterized by social detachment, global asocial behaviors is not the rule in autism. Cohen described the cognitive/mind-blindness effects in autistic patients as a ‘triad of deficits’ in social skills, communication, and imagination of others’ mind.

Ozonoff and colleagues were able to discriminate between individuals suffering from Asperger’s syndrome and autistics by their ability to solve ToM tasks. It is due to patients suffering from AS undergo fewer abnormalities in development early on in childhood. The siblings of individuals diagnosed with AS were shown to have a lesser variant of ToM deficits. This shows that the cognitive deficits that affect the ToM play central role in the phenotype expressed in AS patients.

People suffering from schizophrenia also show deficits associated with mind-blindness. However there is an ongoing debate as to whether individuals suffering from schizophrenia have an impaired ToM leading to mind-blindness or display an exaggerated ToM. Unlike autism or AS, schizophrenia is a late onset condition. It is speculated that this difference in the condition may account for differences seen in the ToM abilities. Brain lesion studies show that there are differences seen in the laterality of brain (hemispherical separation  that account for mind-blindness. It is unknown whether the ToM in schizophrenia deteriorates in the affected person as the condition progresses.

The cognitive impairment linked to mind-blindness is best explained by a modular theory; the domain specific capabilities that account for mindreading and mentalization are lost in schizophrenia. Furthermore Frith has predicted that the extent of mind-blindness depends on whether the objective/behavioral or subjective symptoms of ToM abilities prevail. Patients suffering the behavioral symptoms perform the poorest in ToM tasks, similar to autistic subjects, while patients displaying subjective/experiential symptoms have a ToM. However, these patients are impaired in using contextual information to infer what these mental states are.

The mind-blindness theory helps to explain the impairment in the social development of individuals as well as the impairment in the communication skills of autistics and AS patients. However one of the most important limitations of this theory is that it is unable to explain highly repetitive behavior, a characteristic trait seen in AS and autism. This triad is explained through the process of systemizing. The theory also did not account for the motor problems and the superior rote memory skills that were associated with autism. These aspects along with the highly repetitive behaviors formed the triad of strengths.

Simon Baron-Cohen himself has acknowledged that the theory, while adept at explaining the communications difficulties experienced by autism and Asperger’s patients, fails to explain such patients’ penchants for narrowly defined interests, an important step to proper diagnosis. Furthermore, mind-blindness seems decidedly non-unique to those with autism or Asperger’s syndrome, since conditions ranging from schizophrenia to various narcissistic personality disorders and/or antisocial personality disorders all exhibit mind-blindness to some degree.

Another issue associated with the mind-blindness theory is that researchers are unable to predict whether the social deficits are a primary or secondary result of mind-blindness. In addition, Klin and his fellow researchers highlighted another limitation that was that the mind-blindness theory failed to delineate whether the ToM deficits are a generalized deficit or a specific, discrete mechanism. Stuart Shanker also argued in favor of Klin’s argument, that a major part of the mind-blindness theory depicts the ToM as an autonomous cognitive capacity compared to being part of a more general ability for reflective thinking and empathy.

Other researchers notre the inherent flaws of assuming autism develops from a ‘theory of mind’ deficit, pointing out that this presupposes autism (or Asperger’s syndrome) derives from a single, core insufficiency within the brain. This contrasts, they say, with the very same researchers’ description of autism as a ‘puzzle,’ which implies a far more diverse range of causes than a single, unifying theory. Others argue that Mind-blindness wrongly categorizes autism as a problem to be fixed, rather than a condition to be accommodated. This assumes an inherent lack of intelligence in autism sufferers, which eschews a multifaceted view of intelligence (as in varying types of intelligence) that has been observed in cognitive research.

The drawbacks in the Mind-blindness theory of autism and asperger’s syndrome paved way for the E-S (empathizing–systemizing) theory which helps to explain the observations seen in these individuals. The E-S theory accounts for both the triad of deficits which is the loss of empathizing and the triad of strengths is related to hyper systemization of certain behaviors. The theory also helps to explain the exaggerated male spectrum termed as the extreme male behavior. Recently, Simon Baron-Cohen and other ‘Theory of Mind’ researchers have shifted away from the Mind-blindness Theory in favor of the E-S theory, which seeks to explain the relationship between forms of autism and repetitive, narrowly defined behavior patterns.

2 Comments to “Mind-blindness”

  1. I’m going to start telling people that I have an over active ToM.

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