Wednesday, March 30, 2011

Simon Baron-Cohen, Empathy, and the Atrocities in Afghanistan

From Rolling Stone Magazine

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.
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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At March 30, 2011 5:40 AM, Blogger Neuroskeptic said...

"borderline, psychopathic, and borderline personality disorders"

Eh? Is that a typo, or does he think that "borderline" is different to "borderline personality disorder"?

At March 30, 2011 7:59 AM, Blogger jonathan said...

As a person on the autism spectrum, I resent Baron-Cohen claiming that high functioning autism is not a disability. Autism has stayed in the population because of De novo mutations not because of evolutionary adaptation. Coming to stretches based on theoretical psychology is par for the course for him.

At March 30, 2011 8:04 AM, Blogger Socrates said...

I have to declare and interest first: I carry a diagnosis from Baron-Cohen personally.

I'm convinced that as the years go by the Professor is becoming increasingly unhinged.

At March 30, 2011 10:45 AM, Anonymous Edwin Rutsch said...

My I suggest a further resources to learn more about empathy and compassion.
The Center for Building a Culture of Empathy
The Culture of Empathy website is the largest internet portal for resources and information about the values of empathy and compassion. It contains articles, conferences, definitions, experts, history, interviews,  videos, science and much more about empathy and compassion.

Also, we invite you to post a link to your article about empathy to our Empathy Center Facebook page.

Let's Find 1 Million People Who Want to Build a Culture of Empathy and Compassion

At March 30, 2011 6:54 PM, Anonymous Anonymous said...

You heard it here first. Baron-Cohen has been around so long that he's diagnosed Socrates *personally*.

At April 01, 2011 11:02 AM, Blogger Vircazhm Magazine said...

Well I don't know anything about this Baron-Cohen character (any relation to Sacha Baron Cohen?), but this conversation kind of highlights one of the basic problems in research psychology and its application to treatment--that is, the problem of operationalizing terms. First of all, BPD may really be nothing more thnt a loose category of behavior with very little valid relationship to any single underlying neuropsychological phenomenon. Secondly, that fact that people with BPD have a hypersensitivity to the emotional expression of others is probably well established, but if that is your definition of empathy, it is very different than care and concern for the well being of others. People with BPD are often so beset with their own overwhelming emotional reactions to the social environment that they have a difficult time developing give-and-take relationships and, for that matter, even reaching out or showing understanding of others. So is hypersensitivity to the expressions of others the same thing as having compassion toward others as the colloquial term "empathy" often implies? Clearly not in all cases.

At April 01, 2011 3:43 PM, Anonymous Anonymous said...

Dr. Baron-Cohen is Ali G's cousin.

At April 03, 2011 1:14 PM, Blogger Troeltsch said...

I really enjoy your blog.

I had a different reading of Cohen's argument in the article; however, I am an epidemiologist, not a psychologist, so please forgive me if I misunderstand the terminology and make an egregious error.

I didn't think Cohen was making broad generalizations regarding any one diagnostic group (e.g., individuals with borderline personality disorder). Rather, he posits there is a “distribution of empathy” in the general population; in particular, there are a number of individuals in the left tail who express little or no empathy. These individuals do not all belong to any one diagnostic group but are allocated in three different diagnostic groups he identifies: borderline, psychotic, and borderline psychotic.

Cohen then offers a hypothesis that these individuals, although having different diagnoses, share a common trait: structural similarities in brain scans that indicate abnormalities caused by similar experiences. These similar experiences range from abuse (both physical and sexual), abandonment, and social estrangement that caused the brain abnormalities. The key point I gleaned from the article was: These individuals don’t make up the entire diagnostic group, but probably only represent a certain percentage of the group. That is, only a certain percentage (not all) of borderlines, psychotics, has these deformities and incapacity to feel empathy.

If this interpretation is correct, which it may be, the graph you show of Cohen’s study and his current work is internally consistent. If Cohen’s hypothesis is limited to a sub-group in the diagnostic group, it could be the BPD group shows an average higher level of empathy, but individuals that share the abnormalities in brain formation still exhibit lower empathy levels. I say could be because I don’t think he has a brain scan or diagnostic history of Marilyn Monroe to evidence she is in the group.

There is an obvious problem with this causal mechanism that pervades work in neuroscience; that is, he is interpreting similar results on a brain scan through extrapolating similar causes that led to this result. Since the causal mechanism is largely a black box, there is really no way to make such a statement. This problem with identifying causality also calls into question his methodology in identifying "empathy" as the silver analytical bullet. Finally, it’s not clear that the identified individuals that lack empathy permanently stay at the left tail; I don’t believe empathy levels are static and it’s not clear how Cohen deals with the possibility that empathy levels change substantially from one time period to the next.

At April 04, 2011 12:19 PM, Blogger Vircazhm Magazine said...

I did think that Baran Cohen's original article was in fact a more sensitive and balanced discussion of BPD than Neurocritic's blog post seemed to imply. But, I have to agree that there is weak thinking on Baran Cohen's part regarding causation and etiology. I also found his conclusions to be way too broad, vague and not supported by his arguments. As I said before, the loose and shifting definition of empathy is also a problem.

At April 04, 2011 10:35 PM, Blogger Troeltsch said...

A Bitter Pill:

Do individuals with the diagnosis of BPD transfer across studies? That is, is one group of BPD patients similar to another group of BPD patients? If so, are they are only benchmarked by the DSm-IV? If so, how do researchers account for potential variance in the diagnosis (i.e, someone with a more severe case)? Thanks in advance for any assistance you can provide-

At April 06, 2011 10:51 AM, Blogger Vircazhm Magazine said...

Troeltsch: As I am a mental health professional and you are a epidemiologist I would think you are better suited to answer your own question. But, since you ask, it seems pretty obvious that you cannot depend on diagnosing as it occurs in clinical practice. If my personal experience is anything to go by, BPD is _very_ inconsistently diagnosed. So, of course, a good researcher will have to start with some kind of diagnostic tool with comfortable reliability and go from there. This, I imagine, leads to problems in comparing research with subtle variations in the defined population (which I suppose was your point). But what can you do? We are starting with a loosely defined category based on externally observable behaviors--Cohen then ties this to a concept of empathy that is very broadly defined and quite different from other researchers' very narrow definition of empathy (theory of mind, recognition of EE in others, etc.), then he takes his correlative link to brain scan data and makes some kind of grandiose conclusions about empathy and the human condition. Cohen is all over the map with this.

I would think that theorists and researchers should seriously consider avoiding DSM categories altogether or at least be much more cautious with them.

At May 01, 2011 3:36 AM, Blogger Murfomurf said...

I think Simon Baron-Cohen needs to stick to ASD material rather than expressing 'expert" opinions about personality disorders- he hasn't done extensive work with real people with PDs, has he? The empathy business is getting very tangled between perception and response- you can be empathic towards someone's plight and hate their guts- and countless other combinations. As for saying "hi funtioning autism is not a disability"- jonathan is getting onto more dangerous ground- I've been arguing with heaps of people on the interwebs about disability & deficit in ASDs. There is a movement amongst parents and some teachers and terapists to say ASDs are not "neurotypical" but that they have no deficits in anything- just differences. I argue that from the majority "normal" [for lack of a more neutral word] point of view, ASD people DO lack something [in perception, or neural processing or expression]- and that's a deficit. It doesn't make them less worthy people, just requires some effort to fit in and understand. On the personal side- my borderline PD friend who just suicided was a very empathic person when he was feeling OK, but not very nice in any aspect when drunk and trying to make the world pay for his bad treatment at the hands of his father and the fact his mum had never come to help him. Let someone else talk about war conditions and the limits to humanity- how about some Vietnam veterans who felt they had to murder and rape ruthlessly while in Vietnam, but be loving husbands and fathers back home. It's not easy to live with the split in your head when that has happened.

At May 02, 2011 1:11 PM, Anonymous bko said...

The human ape can mimic empathy, and so many non-empathetic people can stumble or slip into dreadful relationships. Sadistic people empathize but use the information maliciously. Synthetic empathy can be imposed by culture: we are to empathize with our colors and dehumanize those who aren’t sporting them. Empathy comes in spheres, I think- more empathy with kith and kin, less for distant strangers. This allows us to live in comfort even when we know of remote others in distress. The borderline-types I have known, on the other hand, have remarkable empathy for remote- and even fictitious- populations or individuals (or the photos thereof), but none for the person standing before them.

At June 16, 2011 9:50 AM, Blogger jimf said...

> At March 30, 2011 5:40 AM,
> Neuroskeptic said...
> "borderline, psychopathic, and borderline
> personality disorders"
> Eh? Is that a typo, or does he think that
> "borderline" is different to "borderline
> personality disorder"?

It's a typo.

Other quotes on the Web of the same passage (e.g., ) have

"narcissistic, psychopathic, and borderline personality disorders".

At June 29, 2011 1:52 PM, Blogger Socrates said...

Heads-up... this could be quite significant... the professor may have been a little erm... artistic in licence to write this book


At August 19, 2011 10:09 AM, Anonymous Anonymous said...

Thankyou for writing this. I am in Australia and have complained to Stigmawatch about this book claiming people with Borderline PD have zero negative empathy. I have also complained to the book publishers.
The good news is that anyone who knows anything about psychiatry knows this is rubbish. The bad news is that ignorant BPD haters will use it to ad fuel to their hatred.

At November 16, 2015 11:47 AM, Blogger George said...

Empathy is not some sort of fixed trait, it is highly dependent on the context, the people involved, mood etc it is also a poorly defined concept that is frequently assigned a positive value. To describe people as lacking empathy is often a way of making a value statement rather than an observation. I've often felt the association of psychopathy and lack of empathy is particularly daft. When the behaviour of some of the most dangerous people is described they are not describing someone without the ability to recognise the emotional state of their victims. They are describing someone who knows exactly the terrible emotional effect of their actions and enjoy it, they are also perfectly capable of manipulating people based on their emotional awareness. Empathy can be developed in people and to suggest that its useful to conflate people with mental illness that clearly impairs social information processing is not helpful. Then pretending that brain scans give any useful information about complex cognitive abilities removes what little credibility that remained.


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