Explaining Asperger’s syndrome
What is Caetextia and how does it fit in to Asperger Syndrome?
Autistic traits are generally recognised as occurring along a spectrum — with severe autism at one end and a higher-functioning, ‘milder’ form (known as Asperger’s syndrome) at the other. The core areas affected, to varying degrees, are ability to understand and use non-verbal and verbal communication; ability to understand social behaviour and behave in socially appropriate ways; ability to think and behave flexibly; and over- or under-sensitivity to sensory information. Even people labelled as having Asperger’s syndrome can vary in the severity and number of traits they display, ranging from severe learning difficulties and low IQ to high IQ and a talent for learning that brings acclaim.
It seems remarkably odd to us that a person who needs specialist help and assisted housing can be included in the same category as a professor of physics, say, or a gifted poet or musician, or a computer programmer who is married with a family — individuals who, despite having Asperger’s syndrome, have managed to make an accommodation with the world and learn enough of the ‘rules’ to function highly efficiently and relate to people to some degree.
We we can arrive at a more comprehensive way of viewing the autistic spectrum than has been offered to date — and that this new understanding can help us help those who seek therapy for psychological difficulties. We are going to put forward the idea that occurring throughout the entire autistic spectrum is a phenomenon that has not previously been identified; that a remarkable mental capacity, one that came to the fore once mammals started to evolve, is missing from all people on the autistic spectrum; and that this major deficit, while it may be just one aspect of what is missing in autism, is uniquely what is missing at the higher performing end of the Asperger’s spectrum. It is the ability to read context.
Professor Simon Baron-Cohen of Cambridge University, one of the world’s leading authorities on autism, has suggested that there is a systemising brain (usually associated with the male thinking style) and an empathising brain (traditionally associated with female behaviour) and that we all have varying amounts of each. He has provided much evidence for this claim, showing how these sex differences arise more from biological than cultural causes, and goes so far as to support Dr Asperger’s suggestion that the syndrome is an extreme form of the male brain. However, after many years of working therapeutically with male and female adults with Asperger’s syndrome, as well as interacting with them socially and in business, we believe that the extreme male brain theory of autism, which does at first seem persuasive, is an insufficient explanation for the various deficiencies seen in this syndrome. It does not explain, for example, why many otherwise extremely feminine women show Asperger’s traits but many men who are good systematisers don’t.
The brain and context
To see context, we need to be able to attach events and see them from different viewpoints. The early behaviourists believed that mammals and birds simply responded mechanically to stimuli, but more sophisticated experiments revealed that there is a cognitive component involved in their response, which relates to prior experience. One significant experiment demonstrated that there is a mammalian intelligence that searches for and assesses relationships between different events — some part of the brain has reviewed the history of past experiences of a similar kind. Many subsequent experiments have substantiated this finding. processing’: a mechanism capable of gauging risk by processing multiple streams of current information, at the same time as unconsciously comparing similar, previous experiences with each new one. It is something we take completely for granted today but, millions of years ago, it was the key to surviving and thriving.
When we say that the profoundly disabling impairment that runs across the whole autistic spectrum is the inability to perceive context, we mean a mammalian ability to maintain separate streams of attention and switch effortlessly between them to assess the relevance of each to what is currently happening. This can be done only if the brain can dissociate: review what it knows about something it has come across before, while still paying attention to that something in the here and now. So, millions of years ago, mammals evolved, in effect, a biological form of what computer buffs today call ‘parallel.
Modern brain scientists have ascribed this function to the anterior cingulate gyrus. As one neuroscientist puts it, “This region is active when we need controlled, distributed attention, such as listening to our friend at the party while also watching our colleague dance. It also tells us to forget both of those people and pay close attention to the other side of the room when we sense that potential combatants may start a fight.”
‘Context blindness’ — the inability to switch easily between several foci of attention and track them — is clearly seen in autism (the child transfixed by spinning the wheels on a toy car has no sense of a car’s real purpose, for instance) but is the most dominant manifestation of autistic behaviour in high-achieving people with Asperger’s syndrome. We have therefore named it ‘caetextia’, from the Latin caecus, meaning ‘blind’ and contextus, meaning ‘context’. We are suggesting that caetextia is a more accurate and descriptive term for this inability to see how one variable influences another, particularly at the higher end of the spectrum, than the label of ‘Asperger’s syndrome’.
If you can read context, it seems like the most natural thing in the world. You might be talking to Maggie about something, for example, but another part of your attention is aware that Jill is listening as well and could read implications into what you are saying that you didn’t intend. So, straight away, because you have this awareness, you are able to alter the way you speak and detach attention from different objects to take into account Jill’s possible reactions too. When you can do this easily, it is difficult to imagine not being able to do it. But caetextic people can’t. As a consequence, they also have difficulties understanding complex metaphors because they mainly rely on logical thinking and random associations.
For caetextia sufferers, one of the main consequences of not being able to manage separate streams of attention simultaneously is that they have no easy way to control their emotions. They cannot detach from a conditioned response pattern and see the possible consequences of that response or consider other more beneficial ways of reacting. Thus they feel confused and out of control, suffer extreme anxiety and anger, and can swing between wild mania and the blackest depression. They may also have trouble with sexual emotions and their sexual identity. Enduring this emotional turmoil must sometimes feel like living with an unpredictable wild creature. Indeed, some people with caetextia have told us that this is exactly how it feels.
Maybe the sensory overload that many people on the autistic spectrum experience is because of their inability to process within themselves the changes going on around and within them. As they struggle to moderate their feelings, the only hope they have of reducing the pain that this sensory overload causes them is to try and control the environment and other people as much as possible. Because exercising control keeps their arousal down, and thus makes them feel better, they tend to do it obsessively. Unfortunately, as reducing their stress levels in this way involves exerting control over others, this raises the stress levels of everyone around them.
Left and right brain Caetextia
As the intelligence system evolved in humans, our higher cortex became more complex and its left and right hemispheres developed specialisations for different processes. Whilst maintaining the ability to interact with and complement each other, the hemispheres developed exponentially to support rational and contextual thinking. Human language and thought, for example, are primarily ordered through the left hemisphere, which sequences and structures information moment by moment in a way that fosters reason. But our logical thinking is informed, and also coloured, by associative thinking and imagination, both faculties that emanate from the right hemisphere. Whereas previously we had relied on instinctive responses to keep us safe, once the cortex developed in modern humans we became able consciously to review feelings and not just act on them. In other words, we could investigate what was going on around us with a more refined reasoning ability.
But when people are missing the mammalian ‘parallel processing’ template for handling multiple streams of information, they are forced to try and resolve problems by other means. If a person is left-brain dominant, we see Asperger’s behaviour as traditionally recognised: literal, logical, analytical reactions with difficulties in communication and empathy because of a severely diminished ability to think contextually. This happens because the left neocortex is itself ‘autistic’ — it doesn’t have access to the feelings that create context. But if a person is right-brain dominant and is missing the template for reading context, we suggest that caetextia may express itself through an undisciplined, very strong imagination. The right brain looks always for associations, so, without a strong left brain to moderate the myriad associations that the right brain makes, a person with caetextia cannot discipline them and check them out. The associations made are unlikely to be the right ones because, without access to a personal emotional history, they are not anchored in reality. The constant, undisciplined association-making can lead not only to inappropriate but often quite bizarre thoughts and behaviour.
Right-brained caetextia is caused by a lack of instinctive feelings to moderate the person’s thoughts and behaviour, leaving the mind to run free, making directionless, random associations. Because a right-brained caetextic person is more emotional, it may seem odd to suggest that their condition is due to a lack of instinctive feelings, but it is the lack of emotional instincts to discipline associations that give rise to problems. Scientists researching decision making have determined that it is emotion, fired by imagination, that prioritises decision making, not logic. “Emotions arise when events or outcomes are relevant for one’s concerns or preferences and they prioritise behaviour that acts in service of these concerns”7 (our italics). Both right- and left-brained caetextia result in black-and-white thinking. Indeed, when heavily stressed, we can all become temporarily caetextic: prone to black-and-white, crazy, irrational behaviour and faulty reasoning.
More women than men
The contention that Asperger’s syndrome is overwhelmingly a male condition, with the male-to female ratio ranging up to 15:1, is not consistent with our clinical experience. As psychotherapists we see more females than men with his condition and, even taking into account that more women than men come for therapy, we believe that the prevalence of Asperger’s syndrome in women is underestimated.
We would suggest that females are much more likely than males to suffer from right-brain caetextia, and that clinicians are not yet recognising this expression of Asperger’s syndrome. This could be because, although in right-brain caetextia we see the same inability to track multiple foci of attention and think contextually, such people have ready access to emotions in a way that left-brain dominant caetextics, who, in our experience, are predominantly male, do not. Right brain caetextics can become emotional quickly and very, very easily, crying at the slightest upset, for instance. This accessibility of emotion, much more common in women generally, disguises the caetextia. However, they are sometimes just as poor at interpersonal intelligence as those diagnosed with Asperger’s syndrome. They also lack empathy and cannot see how inappropriate their behaviour or beliefs appear to others.
Two conditions that we have noted, not infrequently, to be co-morbid with right-brain caetextia are fibromyalgia (a chronic disorder, primarily occurring in women, characterised by widespread musculoskeletal pain and fatigue) and chronic fatigue syndrome (CFS, also known as myalgic encephalomyelitis, or ME), which is three to four times more common in girls and women than in boys and men.
Sense of self
When, in our evolutionary past, humans gained conscious access to the right hemisphere of the brain (the source of imagination), complex language with a past, present and future tense could develop. Only with the arrival of complex language could we escape from the present and describe things that were not there in front of us. It was this that opened up the possibility of universal reasoning: discovering the underlying patterns and rules by which matter and life operate. Only then could we begin to develop and test hypotheses and start to unravel the cause-and-effect sequences in the world around us — water enables plants to grow; sunshine facilitates growth; there is a rhythm to the seasons, and so on.
Although missing the template for parallel processing, the more intelligent a person with caetextia is, the more likely they are to have access to universal reason. They may then be able to use thought to reflect back consciously on whatever has happened and construct another perspective. But this is a slow process and, without instant access to their own reinforcement history, their sense of self will be impaired – that sense of ‘I-ness’, of being separate from whatever context we happen to be in. People on the autistic spectrum, lacking this ability, may struggle to develop a sense of self and typically feel insecure in a world where everything is constantly changing. It may be this impoverished sense of self that keeps driving the more creative people with this condition to find out who they are, trying out roles to play in life and reinventing themselves, etc. Since scientists began studying Asperger’s syndrome in the 1940s, it has been continuously remarked upon that sufferers lack a sense of who they are. “I feel like an outsider, and I always will feel like one,” the autistic writer Anne Rice once said, in an internet interview. “I’ve always felt that I wasn’t a member of any particular group.”
Perhaps because they feel like outsiders, people with caetextia are often attracted to professions that give them an off-the-peg identity, very often one that comes with a uniform that announces that identity, such as army fatigues, police uniforms, church regalia or even the more eccentric costumes of ‘artists’ and ‘intellectuals’. Uniforms confer status. Professions that require uniforms also tend to have more tightly defined structures – rules, rituals and coded modes of speech – all of which render life more predictable and make people with caetextia feel more secure. In a well-ordered life, the sensory overload feared by autistic people can better be kept at bay.
Caetextia as an organising idea
The term Asperger’s syndrome was derived from the name of the doctor who first described its traits, and means nothing in itself, whereas the term caetextia represents the underlying condition. Because the name is innately descriptive, it points to more effective ways that we can work with and relate to people who have caetextia. Because they can’t read context and can’t, therefore, take certain necessary cognitive leaps for themselves, caetextic people can benefit from ‘borrowing’ someone else’s brain to help them learn how to do what others can do instinctively. Someone has to explain the rules of behaviour to them, using clear, concrete, terms and train them in how to keep to those rules. As people with caetextia are very literal minded, metaphors, when used, must be extremely simple. (For instance, Ivan used the metaphor of a train switching between tracks to convey to the woman who wanted to become a Buddhist that she could choose to ‘switch’ to behaviour that would please her Catholic mother (ie go to Mass just during her brief visits). People with caetextia may have little or no facility with guided imagery and it works less effectively with them.
However, we have often found that teaching them breathing techniques to lower anxiety can help them a lot. Those vulnerable to outbursts of extreme anger have also found helpful the idea of identifying the anger as a wild animal that they need to let calm down (by taking time out and doing some aerobic exercise, such as brisk walking, jogging or other energetic activity).
Undoubtedly, many highly imaginative right brained people, who may be vulnerable to psychotic thinking, display caetextic tendencies that compromise their ability to connect to the ‘ordinary’ world.
Anyone involved in psychotherapy soon comes across such people: emotionally intense, self-absorbed patients whose strong imaginations are not moderated by their left brain. They spend much of the time disconnected from reality, pay only lip-service to reason and are often eccentrically involved in ‘arts and crafts’. Despite showing undoubted signs of creativity, they might not be able to discriminate good work from bad and can take their work intensely seriously, even if it isn’t particularly good. It is important to recognise, however, that people suffering from psychotic illnesses, perhaps the majority, do not necessarily suffer from caetextia; their vulnerability arises from traumatic experiences and an imaginative mind. It is also important to recognise the developmental potential in creative people with caetextia. Some of them mature as they grow older, improve their ability to read emotional contexts, resolve their emotional problems and become more secure in themselves, whilst still retaining their creative faculty.
Caetextia is a significant disability yet, much of the time, manages to go unnoticed. This is because, when a person at the higher end of the autistic spectrum becomes familiar with an environment, and what is expected of them in it, they may become sufficiently competent and confident in that role, so the caetextia remains concealed. This is analogous to somebody with a poor sense of direction. When that person is in an environment that is familiar to them, their poor sense of direction does not reveal itself. It is only when they find themselves in unfamiliar territory that it becomes obvious that they cannot naturally find their way around it, whereas the brain of someone with a good sense of direction automatically maps it. For instance, in a large, unfamiliar hotel, when someone with a good sense of direction first makes their way to their room, their brain automatically not only records the route but, when they come out of their room, automatically relocates them in its mental map, so that they walk the right way back. But, if someone has a poor sense of direction, the brain will remember only the direction taken to the room. It hasn’t recorded an internal ‘map’ and can’t reorient position accordingly, so when the person leaves the room, they find themselves going in the wrong direction.
Of course, lacking a sense of direction is not a serious disability and can be compensated for easily, unlike inability to recognise context. Thus it is that many people with unrecognised caetextia end up seeking therapy because of difficulties with emotions such as anger, anxiety or depression, aroused by problems in new relationships, confusion about sexual identity, unmet sexual needs, obsessions, inability to hold down a job, managing money, etc. We suggest, therefore, that caetextia (context blindness) not only plays a role in autism and is the key deficit in high-functioning Asperger’s syndrome but degrees of it affect very many more individuals than might be thought of as suffering from an autistic spectrum disorder at all.
Joe Griffin and Ivan Tyrrell