Zero Degrees of Empathy_ A new theory of human cruelty - Simon Baron-Cohen-pages-2.pdf

focuses on the negative sides of too little empathy, it is vital to keep in mind these positive benefits of average – or even superior – levels of empathy. My definition of empathy so far presumes it is either present or absent. When our attention lapses into single focus, empathy has been turned of...

focuses on the negative sides of too little empathy, it is vital to keep in mind these positive benefits of average – or even superior – levels of empathy. My definition of empathy so far presumes it is either present or absent. When our attention lapses into single focus, empathy has been turned off. When we shift our attention to dual focus, empathy has been turned back on. This portrait of empathy is as a binary operation (off or on), like a light bulb in the head. In reality, empathy is more like a dimmer control than an all-or-none switch. In science, dimmer controls suggest a spectrum or a quantitative scale, from low to medium to high. On this quantitative view, empathy varies in the population. Now imagine we had a way of measuring empathy (there are such instruments, so this is not idle science fiction) so that you can assign everyone an empathy score. The result is the familiar bell-shaped curve or normal distribution, shown below. Figure 3: The empathy bell curve In Figure 3 we see that some people are high in empathy, some medium, and some low. I will be arguing that some people are at the low end of this empathy dimension in a potentially permanent way, and that some (but not all) of those at this extreme end are people who we might call ‘evil’ or cruel. That is, they never had much empathy and they may never. Others may be at the low end of the empathy dimension because they have experienced a transient shutting down of their empathy, as a result of their current situation. That is, they had empathy and lost it, however briefly. But, however you get to this low point on the empathy scale, the result can be the same. At that point, you become capable of dehumanizing other people, of turning the other person into an object, and this can have tragic consequences. To turn to the key question of what determines whether you are high, medium or low in empathy, we need an empirical, scientific study of empathy. And the start of any empirical study is measurement. MEASURING EMPATHY As part of our research into the nature of empathy, my colleagues (Sally Wheelwright, Bonnie Auyeung and Carrie Allison) and I developed a scale with which to measure empathy across the age range. Working with this creative team was fun. We found that the main empathy test being used in psychological research was arguably not a pure measure of empathy, ix so we devised our own scale, called the Empathy Quotient (or EQ). We designed it to have questions related to each of the two main components of empathy (the recognition and the response). It works well in that it distinguishes people who have an empathy difficulty from those who do not. 12 Ten examples (out of forty) from the EQ are shown below (and you can find the full version in Appendix 1): The Adult Version of the Empathy Quotient (EQ) 1. I can easily tell if someone else wants to enter a conversation. 2. I find it difficult to explain to others things that I understand easily, when they don’t understand it first time. 3. I really enjoy caring for other people. 4. I find it hard to know what to do in a social situation. 5. People often tell me that I went too far in driving my point home in a discussion. 6. It doesn’t bother me too much if I am late meeting a friend. 7. Friendships and relationships are just too difficult, so I tend not to bother with them. 8. I often find it difficult to judge if something is rude or polite. 9. In a conversation, I tend to focus on my own thoughts rather than on what my listener might be thinking. 10. When I was a child, I enjoyed cutting up worms to see what would happen. If you agree with items 1 and 3, this would get you two EQ points. If you disagreed with item 2 and items 4–10, this would give you a total of ten EQ points. In this case, the higher your score, the better your empathy. The adult version of the EQ depends on self-report. It works well in large samples of people and reveals, for example, that students working in the humanities score slightly higher on the EQ than students working in the sciences 13 and females in the general population score slightly higher on the EQ than males. 14 Most importantly, the EQ produces that empathy bell curve that we expected to find in the population. Relying on self-report could be problematic, since a person might believe they are much more empathic than they really are. This is because someone with poor empathy is often the last person to realize they have poor empathy. It just goes with the territory: as you lose your empathy you may also lose your awareness that you have poor empathy. This is because built into the very nature of empathy is that double-mindedness. Doublemindedness can be used not just to think about how others feel or what they might be thinking, but also to think about how you may be perceived by others. Imagining yourself from another person’s vantage point is what we mean by self-awareness. When I meet someone with very little empathy it is as if they lack the very apparatus to look inwards at themselves, as if they lack a reverse periscope that would enable any vision of him or herself. Worries about whether some people might not fill in their EQ accurately are probably unimportant because when you have large samples of data, occasional inaccuracies are cancelled out. We went on to develop a child version of the EQ, filled in by the parent. Just as we found with the adult version of the EQ, we found that on average girls have a slightly higher EQ than boys. 15 (You can find these different versions of the EQ in Appendix 1). So the EQ enables us to visualize who is high, medium or low in empathy. We’ll meet some extremely low scorers in the next chapter, but before that I want to give you some feel of the range of individual differences in EQ. THE EMPATHIZING MECHANISM Imagine there is a circuit in the brain – the empathy circuit – that determines how much empathy you have. Let’s call it the Empathizing Mechanism. From the EQ we can discern that the Empathizing Mechanism has seven likely settings. x These are broad bands and we may move around a little within a band from one day to another, due to the transient fluctuations in our empathy. But which band we are in is broadly fixed. At Level 0, an individual has no empathy at all. In Chapter 3 we meet individuals who are at this level and who wind up in clinics voluntarily seeking a diagnosis, or who have been compulsorily detained (as we say in England, ‘at Her Majesty’s pleasure’) because they have got into trouble with the law, or who have had a diagnosis imposed on them. At Level 0 some people become capable of committing crimes, including murder, assault, torture and rape. Fortunately not all people at Level 0 do cruel things to others, since others at this level just find relationships very difficult but have no wish to harm others. For others at Level 0, even when it is pointed out to them that they have hurt another person, this means nothing to them. They cannot experience remorse or guilt because they just don’t understand what the other person is feeling. This is the ultimate extreme: zero degrees of empathy. At Level 1, the person may still be capable of hurting others, but they can reflect on what they have done to some extent and show regret. It’s just that, at the time, they can’t stop themselves. Clearly, empathy is not having a sufficient brake on their behaviour. For individuals at this level, a part of the brain’s empathy circuit ‘goes down’ that would normally enable them to inhibit themselves from hurting others, physically. Under certain conditions the person may be able to show a degree of empathy, but if their violent temper is triggered the person may report that their judgement becomes completely clouded, or that they ‘see red’. At that moment, other people’s feelings are no longer on their radar. What is frightening is how this breakdown in the empathy circuit can leave the individual capable of extreme violence. At the moment of the assault, the urge to attack and destroy may be so overwhelming there are no limits to what the person could do and their victim is at that moment simply an object, to be vanquished or removed. At Level 2 a person still has major difficulties with empathy, but they have enough to have a glimmering of how another person would feel for this to inhibit any physical aggression. This may not stop them shouting at others, or saying hurtful things to others, but they have enough empathy to realize they have done something wrong when another person’s feelings are hurt. However, they typically need the feedback from that person, or from a bystander, to realize that they have over-stepped the mark. Anticipating another person’s feelings in subtle ways just does not come naturally to them. A person at Level 2 therefore blunders through life, saying all the wrong things (e.g., ‘You’ve put on weight!’) or doing the wrong things (e.g., invading another person’s ‘personal space’). They are constantly getting into trouble for these faux pas, at work or at home, perhaps losing their job or their friends because of it, yet are mystified as to what they are doing wrong. At Level 3 a person knows they have difficulty with empathy and may try to mask or compensate for this, perhaps avoiding jobs or relationships where there are constant demands on their empathy; making the effort to ‘pretend 16 to be normal’ can be exhausting and stressful. They may avoid others at work because social interaction is so hard, and just keep their head down and do their work in the hope that this doesn’t bring them into contact with too many other people. They may realize they just don’t understand jokes that everyone else does, that other people’s facial expressions are hard to read, and that they are never quite sure what’s expected of them. Small talk, chatting and conversation may be a nightmare for someone at this level, because there are no rules for how to do it and it is all so unpredictable. When they get home, the relief (that comes from no longer having to ‘fake’ being like everyone else) is huge: they just want to be alone, to be themselves. At Level 4, a person has a ‘low-average’ amount of empathy. Most of the time their slightly blunted empathy does not affect their everyday behaviour, though people with this level of empathy may feel more comfortable when the conversation shifts to topics other than the emotions. More men that women are at Level 4, preferring to solve problems by doing something practical, or offering to fix something technical, rather than having prolonged discussions about feelings. 17 Friendships may be more based on shared activities and interests than on emotional intimacy, though are no less enjoyable or weaker because of this. At Level 5, individuals are marginally above average in empathy, and more women than men are at this level. Here, friendships may be more based on emotional intimacy, sharing confidences, mutual support and expressions of compassion. While people at Level 5 are not constantly thinking about others’ feelings, other people are nevertheless on their radar a lot of the time, such that they are far more careful in how they interact at work or at home. They hold back from asserting their opinion, so as not to dominate or intrude. They do not rush to make unilateral decisions so that they can consult and take into account a range of perspectives. They take their time with others even if they have lots of other things to do, because they want to find out (sensitively and indirectly) how the other person is and what’s on their mind – information that is better gleaned by chatting around a range of topics, rather than being extracted by direct interrogation. At Level 6 we meet individuals with remarkable empathy, who are continuously focused on other people’s feelings, and go out of their way to check on these and to be supportive. It is as if their empathy circuit is in a constant state of hyper-arousal, such that other people are never off their radar. Rather than try to describe this type, let me give you a sketch of one such person: Hannah is a psychotherapist who has a natural intuition in tuning into how others are feeling. As soon as you walk into her living room, she is already reading your face, your gait, your posture. The first thing she asks you is ‘How are you?’ but this is no perfunctory platitude. Her intonation – even before you have taken off your coat – suggests an invitation to confide, to disclose, to share. Even if you just answer with a short phrase, your tone of voice to her reveals your inner emotional state and she quickly follows up your answer with ‘You sound a bit sad. What’s happened to upset you?’ Before you know it, you are opening up to this wonderful listener, who only interjects to offer sounds of comfort and concern, to mirror how you feel, occasionally offering soothing words to boost you and make you feel valued. Hannah is not doing this because it is her job to do it. She is like this with her clients, her friends, and even with people she has only just met. Hannah’s friends feel cared for by her, and her friendships are built around sharing confidences and mutual support. She has an unstoppable drive to empathize. xi THE EMPATHY CIRCUIT What leads an individual’s Empathizing Mechanism to be set at different levels? The most immediate answer is that it depends on the functioning of a special circuit in the brain, the empathy circuit. In this section we take a tour of the empathy circuit, and in the next chapter we see how this circuit is under-active in those people who commit acts of cruelty, and in those who struggle to empathize. Thanks to functional magnetic resonance imaging (fMRI), scientists are getting a clear picture of the brain areas that play a central role when we empathize. There is a consensus in neuroscience 18 that it is not the whole brain that is involved in empathy, but at least ten interconnected brain regions are involved (and more may await discovery). They are shown in Figure 4, and I’ll take you through each of them briefly. The names of each of these regions in the empathy circuit can seem alien on first reading, but with a little familiarity they become like old friends! There have been some imaginative experiments using neuroimaging to reveal the different parts of the empathy circuit. The first region in the empathy circuit is the medial prefrontal cortex (MPFC), which is thought of as a ‘hub’ for social information processing and is important for comparing your own perspective to someone else’s. 19 21 – The MPFC divides into the dorsal part (dMPFC) and the ventral part (vMPFC). The dMPFC is involved in thinking about other people’s thoughts and feelings 19 , 22 (sometimes called ‘meta-representation’), as well as when we think about our own thoughts and feelings. 20 , 23 In contrast, the vMPFC is biased to being used when people think about their own mind more than someone else’s – demonstrated by my talented former doctoral student Mike Lombardo. He argues that the vMPFC seems to play a key role in selfawareness. 20 , 24 – 25 Figure 4: Regions in the social brain (produced by Mike Lombardo, with thanks) But that’s not all this brain region does. Neuroscientist Antonio Damasio at Iowa University put forward the theory that the vMPFC stores information about the emotional valence of a course of action. If an action is rewarding it is emotionally positive, while if it is punishing it is emotionally negative. He calls this a ‘somatic marker’ and suggests we have such a marker for every action we make, and that only actions with positively valenced somatic markers will be repeated. His evidence is that patients with damage in the vMPFC show less ‘autonomic response’ 26 (less of a change in their heart-beat, for example) when shown images of distressing scenes (like disasters and mutilations). xii Further evidence that the vMPFC marks ‘emotional valence’ is that it is involved in positive or optimistic thinking 27 and that, when their vMPFC is stimulated, depressed people feel less negative. 28 Phineas Gage (1823–60) must be one of the most famous cases from the field of neuropsychology, and without realizing it he added to the evidence that the vMPFC is involved in the empathy circuit. Phineas was a railroad construction foreman who survived an accident of an iron rod being driven through his brain. Arguably, the main consequence of the accident (he lived for another twelve years) was that he lost his empathy. xiii Here’s how it happened. On 13 September 1848, at the age of twenty-five, Phineas was working on the railroad, blasting rock in Vermont. His job was to add the gunpowder and a fuse and press the gunpowder down into a hole using an iron rod. The gunpowder exploded unexpectedly, driving the rod up through the side of his face, behind his left eye, and exiting his skull. Remarkably he sat up in the cart as they drove him to the hospital, conscious and talking. In the years that followed, the main change that was noticed was that, whereas previously Phineas had been a polite individual, now he was childish, irreverent and rude, uttering profanities and showing no social inhibition. He had lost his empathy. xiv More than a century later, neuroscientist Hanna Damasio and colleagues obtained his preserved skull and, using modern neuroimaging, calculated that the rod must have damaged his vMPFC. 32 , 33 29 , 30 We’ll see how the vMPFC, and other regions in the empathy circuit, , are under-active in people with low empathy. But first we need to map the different parts of the circuit. The vMPFC overlaps with what is sometimes called the orbitofrontal cortex (OFC). Back in 1994 my colleague Howard Ring and I were the first to identify the OFC as part of the empathy circuit, in that we found that when people were asked to judge which words described what the mind 34 could do, the OFC was specifically activated. The word list contained words like think, pretend and believe as well as words like jump, walk and eat. Later my colleague Valerie Stone and I found that patients with damage in the OFC had difficulty judging when a faux pas had occurred, an indicator of difficulties with empathy. 35 Damage to the OFC can also lead to patients losing their social judgement, becoming socially ‘disinhibited’. In addition, when you see a needle going into a normal (but not an anaesthetized) hand, the OFC is active, suggesting this part of the empathy circuit is involved in judging whether something is painful or not. 36 Adjacent to this area is the frontal operculum (FO), which is not only part of the empathy circuit but the language circuit too, since it contains an area involved in the expression of language. Damage to this area can therefore result in difficulties producing fluent speech (also called Broca’s aphasia, where the person can understand sentences but not express themselves in full sentences). Its relevance to empathy though comes from the idea that the FO is equivalent to an area in the monkey brain involved in coding other animals’ intentions and goals. 37 That is, when a monkey (with a deep electrode in its brain) sees another monkey reaching for an object, cells in the FO increase their electrical activity, and the same cells fire when the monkey reaches for an object for itself. The FO sits above a larger area called the inferior frontal gyrus (IFG). Damage to this region can produce difficulties in emotion recognition. 31 Another of my talented former PhD students, Bhismadev Chakrabarti, got people to fill in the Empathy Quotient (EQ) and then had them lie still in a brain scanner while they looked at different facial expressions. Some examples of the faces they had to look at are shown in Figure 5. Bhisma had a hunch that the IFG would play a key role in empathy, and it was a very testable hypothesis. To test this, Bhisma used the fMRI scanner to establish which brain regions responded to each of four ‘basic’ emotions (happy, sad, angry and disgust). Figure 5: Examples of happy, sad, angry and disgusted faces I always smile when I see these images because the one at the top left is my daughter Kate when she was just nine years old. (She’s meant to be looking happy, which can’t really be said of the other three.) Bhisma found that disgust is mostly processed in the anterior insula (AI), happy is mostly processed in the ventral striatum, anger in the supplementary motor cortex, and sad in a number of regions, including the hypothalamus. 38 , 39 He then looked to see if there was any region in the brain that consistently correlated with EQ, regardless of the emotion the person was viewing. The IFG fitted the bill. The better your empathy, the more active your IFG, when looking at emotional faces. Going deeper into the cortex we find the caudal anterior cingulate cortex (cACC), also called the middle cingulate cortex (MCC). The cACC/MCC is involved in empathy because it is activated as part of the ‘pain matrix’. This region is not only active when you experience pain but also when you are observing others in pain. 40 Then we come to the anterior insula (AI) that has been identified as playing a role in bodily aspects of self-awareness, itself closely tied to empathy (as we discussed earlier). 41 Zurich neuroscientist Tania Singer and her colleagues used fMRI and found that when a person received a painful stimulus on their own hand or their partner’s hand, the AI and the cACC/MCC are activated whether you are experiencing your own pain or perceiving your loved one’s pain. 42 Chicago neuroscientist Jean Decety and colleagues also showed that if you watch someone’s hand being caught in a door, the AI and cACC/MCC are also activated. 43 This activation is modulated by the extent that you are imagining yourself as that other person. 44 The AI is also active when you experience a disgusting taste or see someone else showing disgust, again suggesting this is the part of the brain that allows identification with another person’s emotional state. 45 Tania Singer also looked at the brain when you are judging if a person is playing fairly. She found that both men and women activate their cACC/MCC and AI when they see someone in pain who they regard as fair and someone they like. Interestingly, men on average show less activity in this part of the empathy circuit when they see someone in pain who they regard as unfair or who they do not like. 46 It is as if men find it easier to switch off their empathy for those who might be competitors, or who they judge are out of line, or with whom they have no vested interest in remaining in a relationship. The cACC/MCC and AI are also clearly involved in the experience and recognition of a range of emotions, from happiness to disgust and pain, 42, 45 , 47 49 – and damage to these regions can interfere with the ability to recognize such emotions. For all these reasons, these are key parts of the empathy circuit. The temporo-parietal junction on the right side (RTPJ) has been found to play a key role in empathy, particularly when judging someone else’s intentions and beliefs. 50 This is more relevant to the recognition element of empathy, or what is sometimes called a ‘theory of mind’. We use our theory of mind when we try to imagine someone else’s thoughts. Damage to the TPJ can lead not only to difficulties in judging someone’s intentions but also to ‘out of body’ experiences 51 while stimulation of the RTPJ can give you the eerie experience that someone else is present when there is no one else with you. 52 These abnormalities suggest the RTPJ is involved in self- monitoring and monitoring others, though it may also be involved in nonsocial functions too (such as attention-switching). 53 , 54 Adjacent to the RTPJ is the posterior superior temporal sulcus (pSTS), which has been linked to the empathy circuit for many years, since animal research reveals that cells in the STS respond when the animal is monitoring the direction of someone else’s gaze. In addition, damage to the STS can disrupt a person’s ability to judge where someone else is looking. 55 Clearly, we look at another person’s eyes not just to see where they are looking but what they might be feeling about what they are looking at. 56 The STS is also involved when you observe ‘biological motion’ (animate, self-propelled kinds of movements that living creatures make). 57 Next up in the empathy circuit is the somatosensory cortex (SMC), which is not only involved in coding when you are having a tactile experience, but is also activated just by observing others being touched. xv 58 62 – , In addition to being involved in sensory experience (as its name suggests), when you watch a needle piercing someone else’s hand you get a burst of electrical activity in the somatosensory cortex, fMRI. 44 , 64 xvi and this is also seen using This strongly suggests that we react in a very sensory way when we identify with someone else’s distress. This clear brain response is telling us that even without any conscious decision to do so we must be putting ourselves into the other person’s shoes, not just to imagine how we would feel in their situation, but actually feeling it as if it had been our own sensation. No wonder we wince involuntarily when we see someone else get hurt. Of course, not everyone will have this strong empathic response to such emotionally charged situations. If our somatosensory cortex is damaged or temporary disrupted, our ability to recognize other people’s emotions is significantly diminished. 65 , 66 Surgeons may, for example, be well suited to their job precisely because they don’t have this emotional reaction, a prediction that was confirmed by Yawei Cheng who found that physicians who practise acupuncture show less somatosensory cortex activity while watching pictures of body parts being pricked by needles. 67 The FO/IFG connects to the inferior parietal lobule (IPL) and these are both interesting because they are part of the ‘mirror neuron system’, those parts of the brain that are active when you perform an action and when you observe someone else performing the same action. Italian neuroscientists led by Giacomo Rizzolatti at the University of Parma first demonstrated the existence of mirror neurons in primates 68 by placing electrodes into parts of the brain to record nerve cells that fire not only when the animal is performing an action but also when the animal sees another animal performing the same action. If the IFG is part of the human mirror neuron system, this suggests empathy involves some form of mirroring of other people’s actions and emotions. 47 , 69 The mirror neuron system in humans is hard to measure, obviously because it is unethical to place electrodes into the awake human healthy brain. xvii But (using fMRI) the mirror neuron system appears to span the IFG, IFL and the inferior parietal sulcus (IPS) (just behind the IPL). Interestingly, an extension of this idea of a ‘mirror neuron’ is neurons that fire to direction of gaze. IPS neurons in a monkey not only fire when a monkey looks in a specific direction, but also when seeing another person (or monkey) looking in that same direction. 71 As an aside, some people are quick to assume that mirror neurons alone can be equated with empathy, but we should keep in mind that the mirror neuron system has only been verified in single cell recordings for the domain of actions and may simply be building blocks for empathy. For example, the mirror neuron system is involved in mimicry, as happens when we are feeding an infant and, as they open their mouth, we involuntarily open our own; or as happens when someone else yawns and we involuntarily do too. Such mirroring of another’s actions typically occurs without consciously thinking about the other person’s emotional state. This effect is what some social psychologists call ‘the chameleon effect’. 72 Equally, it has been suggested that emotional contagion is a form of empathy, as happens when one person shows fear and others (witnessing