Sunday, April 1, 2012

Zero Degrees of Empathy

 I just ordered this book from the library and I'm greatly looking forward too reading it.

The Neurocritic

 An excerpt from Simon-Baron Cohen's new book, Zero Degrees of Empathy: a New Theory of Human Cruelty, appeared as The science of empathy in the Guardian. Overall, the writing revealed him to be unempathetic in some respects, particularly with regard to people with borderline personality disorder1 (BPD):
Unempathic acts are simply the tail end of a bell curve, found in every population on the planet. If we want to replace the term "evil" with the term "empathy", we have to understand empathy closely. The key idea is that we all lie somewhere on an empathy spectrum. People said to be "evil" or cruel are simply at one extreme of the empathy spectrum. We can all be lined up along this spectrum of individual differences, based on how much empathy we have. At one end of this spectrum we find "zero degrees of empathy".. . .Zero degrees of empathy does not strike at random in the population. There are at least three well-defined routes to getting to this end-point: borderline, psychopathic, and borderline personality disorders. I group these as zero-negative because they have nothing positive to recommend them. They are unequivocally bad for the sufferer and for those around them. Of course these are not all the sub-types that exist. Indeed, alcohol, fatigue and depression are just a few examples of states that can temporarily reduce one's empathy, and schizophrenia is another example of a medical condition that can reduce one's empathy.
This comes after an introduction that recounts a childhood memory: when his father told him that the Nazis turned Jewish people into lampshades and soap. So people with BPD are "evil", "zero-negative" and have "zero degrees of empathy" (similar to the Nazis). This is quite a stunning characterization, in fact one that is not borne out by the literature. For example, one study showed that individuals with BPD are actually better than controls on a test of empathy designed by Baron-Cohen himself (Fertuck et al., 2009).2 That would be the Reading the Mind in the Eyes Test (RMET), "a measure of the capacity to discriminate the mental state of others from expressions in the eye region of the face." The study showed that:
The BPD group performed significantly better than the HC group on the RMET, particularly for the Total Score and Neutral emotional valences. Effect sizes were in the large range for the Total Score and for Neutral RMET performance. The results could not be accounted for by demographics, co-occurring Axis I or II conditions, medication status, abuse history, or emotional state. However, depression severity partially mediated the relationship between RMET and BPD status.
 p between RMET and BPD status.The authors concluded that this enhancement of facial emotion recognition abilities (or "enhanced sensitivity to the mental states of others") is what can get BPD persons in trouble socially. Consistent with this finding, another study found a double dissociation between two different types of empathy in BPD (Harari et al., 2010). Emotional empathy was slightly enhanced, whereas cognitive empathy was significantly impaired relative to controls.

Fig. 1 (Preißler et al., 2010). (A) a significant group-by-type (interaction) effect [F(1,40) = 6.375, P = 0.016]. The HC group had significantly higher scores (*) in the cognitive empathy scale, whereas there was an opposite trend is observed in the BPD group.

Cognitive empathy, or the ability to take another person's perspective, is closely related to (or even synonymous with) theory of mind. On the other hand, emotional or affective empathy is "emotional contagion" - the ability to mirror an emotional response observed in another person and to experience it vicariously. The literature on emotional empathy in BPD isn't entirely consistent, however. Although Preißler and colleagues (2010) reported preserved (but not enhanced) performance on the RMET, they observed an impairment on the “Movie for the Assessment of Social Cognition” (MASC) in the BPD participants.

In his book, Baron-Cohen also provides a case study from another population with "zero degrees of empathy" -- the psychopath:
Paul's career of criminal behaviour had begun when he was as young as 13, when he had set fire to the school gym and sat in a tree across a field to watch it burn. He was expelled and from there went to three more schools, each time being expelled for aggression – starting fights in the playground, attacking a teacher who asked him to be quiet and even jumping on someone's head when they wouldn't let him join the football team.Paul [currently in jail for murder] is clearly not the kind of guy you want to live near. Many would not hesitate to describe him as "evil". He is a psychopath – a Type P – though to give him the proper diagnostic label, he has antisocial personality disorder. He earns this label because he shows "a pervasive pattern of disregard for and violation of the rights of others that begins in childhood or adolescence, and continues into adulthood".
This sounds similar to the description of Cpl. Jeremy Morlock in The Kill Team, a recent article in Rolling Stone on the American soldiers in Afghanistan who killed innocent civilians and mutilated their corpses. [NOTE: I am not linking directly to this article because it contains very graphic and disturbing photographs. You'll find them within the online magazine if you want to see them.] According to Rolling Stone:
Before the military found itself short of troops in Afghanistan and Iraq, Morlock was the kind of bad-news kid who the Army might have passed on. He grew up not far from Sarah Palin in Wasilla, Alaska; his sister hung out with Bristol, and Morlock played hockey against Track. Back in those days, it seemed like he was constantly in trouble: getting drunk and into fights, driving without a license, leaving the scene of a serious car accident.
But it gets worse and escalates, just like with Paul: he committed the serious crime of spousal abuse only one month before being deployed. Unfortunately, he was only charged with "disorderly conduct" and then sent off to Afghanistan anyway:
Even after he joined the Army, Morlock continued to get into trouble. In 2009, a month before he deployed to Afghanistan, he was charged with disorderly conduct after burning his wife with a cigarette. After he arrived in Afghanistan, he did any drug he could get his hands on: opium, hash, Ambien, amitriptyline, flexeril, phenergan, codeine, trazodone.
So it seems that his antisocial character was well-established before he arrived in Afghanistan.3

Come on, Professor Baron-Cohen. Surely it's a stretch to compare Nazis and callous murderers without a conscience to affectively unstable, impulsive, and interpersonally difficult individuals who may be self-destructive or manipulative?
Clearly Type Ps differ in important ways to Type Bs, but they share the core feature of being zero-negative: their zero degrees of empathy can result in them doing cruel things to others.
Inferring a complete lack of empathy in Marilyn Monroe (whom he diagnoses with borderline personality disorder instead of bipolar disorder) and comparing her to someone who commits war crimes is preposterous.


1 Roth and Fonagy (1996) defined BPD thusly:
The essential feature of this disorder is a pervasive pattern of instability of self-image, interpersonal relationships and mood. The person’s sense of identity is profoundly uncertain. Interpersonal relationships are unstable and intense, fluctuating between the extremes of idealisation and devaluation. There is often a terror of being alone, with great efforts made to avoid real or imagined abandonment. Affect is extremely unstable, with marked shifts from baseline mood to depression and anxiety usually lasting a few hours. Inappropriate anger and impulsive behaviour are common, and often this behaviour is self-harming. Suicidal threats and self-mutilation are common in more severe forms of this disorder.
2 This fact was noted by @autismcrisis, who said:
People with enhanced empathy per Simon Baron-Cohen's test are denounced by SBC for having no empathy
3 Glancing at a few of the comments on the article, among the most appalled are other soldiers.
Further Reading

Additional posts about Borderline Personality Disorder by The Neurocritic.Dinah at Shrink Rap goes Over The Border Line to explain her dislike for the label.

Fertuck, E., Jekal, A., Song, I., Wyman, B., Morris, M., Wilson, S., Brodsky, B., & Stanley, B. (2009). Enhanced ‘Reading the Mind in the Eyes’ in borderline personality disorder compared to healthy controls. Psychological Medicine, 39 (12) DOI: 10.1017/S003329170900600X

Harari, H., Shamay-Tsoory, S., Ravid, M., & Levkovitz, Y. (2010). Double dissociation between cognitive and affective empathy in borderline personality disorder Psychiatry Research, 175 (3), 277-279 DOI: 10.1016/j.psychres.2009.03.002

Preißler S, Dziobek I, Ritter K, Heekeren HR, Roepke S. (2010). Social Cognition in Borderline Personality Disorder: Evidence for Disturbed Recognition of the Emotions, Thoughts, and Intentions of others. Front Behav Neurosci. 4:182.

Roth A, Fonagy P. (1996). What Works for Whom? A Critical Review of Psychotherapy Research. London and New York: Guilford.

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