Exploring the Autistic Mind, featuring Dr Sarah White

PROFESSOR PHILIP SCHOFIELD (INTRO)

Hello, and welcome to series two of The Greatest Good, a UCL Press podcast. 

Jeremy Bentham, the late 18th and early 19th century philosopher, was the intellectual inspiration for the founding of University College London and is credited with the maxim that actions should be judged by the amount of happiness that each produces. 

I’m your host, Professor Philip Schofield, Director of the Bentham Project here at UCL. Join me as I explore the ways in which Bentham’s thought is still relevant in the 21st century. 

In this series, we focus on the intersection of Bentham’s ideas with current research into how we understand the human mind, in conversation with leading UCL academics.  

PROFESSOR PHILIP SCHOFIELD 

I’ll ask you to start, Sarah, by introducing yourself and saying a little bit about your research into the autistic mind. 

DR SARAH WHITE 

So, I’m an associate professor at UCL, based at the Institute of Cognitive Neuroscience. What I study is how the autistic mind processes information differently to the non-autistic mind, so I’m interested in how it represents information. 

So, the thing that’s important is that we normally look at behaviour – what’s on the outside – or we look at biology. So, that can be at the level of cells and neurons and chemicals and things like that, or it can be all the way up to looking at the structure of the brain or something like that. But actually, what we study is the thing that happens between those. 

So, it’s how the biological nature of us, how that supports and represents information that then can result in behaviour, and we call that cognition and that is the thing that we try and study. It’s not something we can directly measure but we have to sort of try and understand how we process and represent information by looking both at biology and behaviour. That’s what we do and apply that to autism.

PROFESSOR PHILIP SCHOFIELD 

So, when you say you look at biology, is that using things like brain scans?

DR SARAH WHITE

Yes, for me, because that’s sort of as close as we can get to cognition as possible, to those representations as we can, then I use functional brain imaging, which means looking at the activity of the brain when it’s doing particular things. 

PROFESSOR PHILIP SCHOFIELD 

I mean, when you’re trying to find out what the difference is between the autistic and the non-autistic mind, you have to first of all divide people into those with autism and those without autism.

DR SARAH WHITE

Yeah

PROFESSOR PHILIP SCHOFIELD 

So how do you do that? 

DR SARAH WHITE

So at the moment autism is identified through a clinical diagnostic process and what we’re looking at is behaviour. It’s entirely governed by behaviour at the moment.  So at the moment it’s defined by the presence of social communication difficulties and also the presence of repetitive behaviours or restricted interests. And that definition of autism is actually something that has changed over time though as our sort of understanding of autism has updated itself. So in some sense you might say that there’s no absolute reality there in the sense that it’s something that does keep shifting as we keep shifting our understanding of what underlies that behaviour. 

PROFESSOR PHILIP SCHOFIELD 

I’m just thinking about the word autism, because it sort of, I guess, means selfism. 

DR SARAH WHITE

Yeah, so originally the word did come from the Greek autos, meaning self, but that word autism had been used in the schizophrenia literature previously. Well, it was first identified in the 1940s – so before that – in the literature, but it had really been to describe the social withdrawal, withdrawal into the self, and that was why the term was sort of used to describe a particular group of children.  The thing is that the children who are first identified in the 40s as being autistic, they’re not really characteristic of what we see now in terms of autism because our definitions have changed so much over the years. 

PROFESSOR PHILIP SCHOFIELD 

Bentham had this phrase where he talked about words being mis-expressive and I mean is autism sort of mis-expressive, does it capture what are we? I mean, terms are important and, you know, labels are important. 

DR SARAH WHITE

I think the original use of it to identify social withdrawal, although there’s an element to which that was describing an extreme of what we would include within the definition of autism these days, I think there’s still an element of that social withdrawal certainly that we see. Autistic people will often talk about their need to self-preserve, to withdraw themselves from social contact in order to sort of recover and rebuild energy that they’ve lost through social contact, so to an extent I think that term is still useful. 

PROFESSOR PHILIP SCHOFIELD 

Right, right, okay, and whose problem is it, autism?

DR SARAH WHITE

So this is this is something that is very topical at the moment and is frequently discussed. So this is the idea that traditionally we’ve thought of autism under what’s been termed a medical model. So it’s diagnosed medically clinically and in the medical model we see autism as a problem for that person. 

PROFESSOR PHILIP SCHOFIELD 

It’s something that needs to be cured?

DR SARAH WHITE

In that sense, exactly, yes. And so there’s been a real shift, particularly in the UK and Europe and a few other parts of the world recently to reconceptualize autism according to the social model of disability.  And this is the idea that actually there’s just a mismatch between the person and the society or the structure that they live in. And that really takes away the responsibility or the root cause of the difficulties from the individual and actually places it into society. So the responsibility then becomes societies to change, to adapt for that person to be able to incorporate them. 

PROFESSOR PHILIP SCHOFIELD 

And I mean, is that the approach that makes sense to you? 

DR SARAH WHITE

So I think it’s something that at the moment we are researching and trying to understand better. I think it’s certainly a helpful lens to approach autism through.  That there’s quite a popular theory at the moment called the double empathy problem, which is the idea that the social communication difficulties that autistic people experience, that they’re not just rooted in the idea that the autistic person has social and communication difficulties, but rather in the interaction between the autistic and the non-autistic world, the autistic person of the non-autistic world. And the idea that, actually, if there’s a mismatch between those two in terms of communication styles or just grounding in common knowledge or common modes of communication, that that mismatch between the two people will lead to a social communication breakdown. That’s something that is fairly hotly debated at the moment. And at the moment, I think there’s certainly some evidence to support that idea, but there’s also evidence to indicate that it’s not quite as simple as that, that there are probably a number of different elements and influences that are contributing to those social communication breakdowns. 

PROFESSOR PHILIP SCHOFIELD 

Because, I mean, if you know someone’s autistic and you understand a little bit about autism, you’re likely to give them a little bit of leeway, whereas if it’s someone you don’t know and their behaviour strikes you as in some way difficult or offensive, then I suppose that could lead to the communication breakdown.  So it might be difficult for neurotypical people to deal with autism, especially when people don’t go wrong with the sign on saying, you know, ‘I’m autistic’. 

DR SARAH WHITE

Yeah, exactly. And I mean, you were talking about the idea of a label earlier, you used that word. And actually, I think there are pros and cons of having that label and using that label, because, you know, having a label changes the way that you think about yourself. And also using that label does change the way that other people interact with you or think about you. And that comes with pros and cons, it comes with consequences.  And that’s a big decision for each individual autistic person. 

PROFESSOR PHILIP SCHOFIELD 

You talked about autistic people withdrawing. Does that mean that they don’t connect with other people, they don’t understand what other people are feeling and thinking? 

DR SARAH WHITE

So, ‘no’ would be the short answer to that. So, there’s a range of views within this area, but particularly, and I talked about this term, the double empathy problem, and this term ‘empathy’ is quite misunderstood as well. So, sometimes it’s used quite freely, as we would use it in everyday language, to just mean sort of like getting alongside someone and sort of almost more in a sympathy term, sort of feeling sorry for someone and feeling that deeply in some sense. But actually, there are some really important distinctions when we start looking at the particular difficulties that autistic people seem to have in those social communication situations. And actually, empathy, in terms of having an emotional response to somebody else’s situation, whether that’s a happy situation or a painful situation or whatever it is, that actually autistic people do have exactly those responses that non-autistic people have. And actually, some autistic people would argue that they actually feel those things more strongly than non-autistic people. 

So certainly within that sort of broader landscape of empathy, there don’t seem to be any social communication difficulties in that area.  But if we do see difficulties in social communication, it tends to be more in terms of being able to get inside someone else’s mind to think what they’re thinking instead. And this is often termed ‘mentalizing’ within the literature, the idea that what’s inside my head, my thoughts, my feelings might not be very accessible to somebody else, that we have to work quite hard to be able to work out how somebody else is thinking about something differently to us. We might call that perspective taking, but particularly mental perspective taking, not just seeing what someone’s seeing, but actually thinking what somebody is thinking, putting yourself in their shoes sort of thing. And that seems to be something that autistic people do struggle with. 

But this double empathy problem idea is actually that those difficulties are specific to situations when the other person is very different to them, when the other person is of a different neurotype, when they’re non-autistic compared to autistic.

PROFESSOR PHILIP SCHOFIELD 

I mean, that’s interesting because I’m a historian and my view has been that the historian is involved in a process of empathetic reconstruction. So you’re trying to understand what the actors in the past were doing. And many historians now reject this view, but I think the idea is to be non-judgmental. And that’s what empathy means.  Whereas the older meaning of identifying with someone and being judgmental in the sense of being on their side would be to say you’re sympathetic, whereas to be against them would be to say you’re antipathetic. The sympathy and antipathy almost come naturally, whereas the empathy is a very disciplined way of approaching a situation. But what does double empathy mean? 

DR SARAH WHITE

So, this is the idea that not only do autistic people struggle to understand what somebody else is thinking when they’re non-autistic, when they’re in a situation with a non-autistic person in front of them, but the other side of it is also true, hence the double. The idea is that non-autistic people should also struggle to mentalise, to represent the mental states of the autistic person as well.  And actually, I think you sort of said that earlier, actually, didn’t you, when you were talking about some people would really struggle to work out how to communicate to an autistic person. So, you said, as a historian, the idea is to try and understand what people were thinking or feeling. Well, that’s how I understood what you said. 

PROFESSOR PHILIP SCHOFIELD 

Yeah, yeah, yeah. No, that’s right. 

DR SARAH WHITE

That was behind the sort of factual stuff, what actually happened, and actually mentalising, which is this thinking what you’re thinking, is all about being able to represent what’s inside someone’s head in order to be able to predict their behaviour. 

PROFESSOR PHILIP SCHOFIELD 

Yeah, in terms of history and understanding why they did what they did. 

DR SARAH WHITE

Yes exactly – so that’s sort of like explaining past behavior, which mentalizing is also really important for. So, mentalizing doesn’t just help us understand people’s past behavior, but also helps us predict what people might do in the future as well and start to think about how people are going to behave and actually predictions of what makes the social world a comfortable place for us. 

PROFESSOR PHILIP SCHOFIELD 

Is it about motives or about dispositions? You know, I’m motivated to perform a particular action at a particular time, but I have a disposition to do certain actions in certain circumstances. 

DR SARAH WHITE

So there are lots of different reasons why people behave the way they do and lots of different ways of predicting behavior and explaining behavior. And one way is just by looking at contingencies. So when this thing happens, this thing is how people always behave. So you can make predictions just on the basis of probability sort of thing.  But mentalizing allows you to go deeper than that and make predictions about novel behavior. So you can take a situation that you haven’t been in and that you can’t use that contingency probability basis for and make a new prediction by understanding what must be going through someone’s head, how they must be thinking about a situation. So it’s important, particularly in those situations that you find yourself in that are out of the norm. And those are what people often think of as socially uncomfortable situations because they’re not so predictable. But that’s why mentalizing is so important because it allows us to adapt to those new situations. 

PROFESSOR PHILIP SCHOFIELD 

And can we mentalise internally as well? ‘If I was put in this situation this is what I would do’?

DR SARAH WHITE

Yes, absolutely, for yourself. Yeah, yeah, yeah, yeah, yeah. 

PROFESSOR PHILIP SCHOFIELD 

So then you’re thinking if X is put in that situation, what would X do? 

DR SARAH WHITE

So mentalizing can be for yourself or for other people. If you’re thinking about your own mental state at the moment, that’s sort of more like self-reflection. So it’s not really mentalizing.  You don’t have to suspend your current version of mental reality in order to create an alternative version. So mentalizing is when you create this alternative mental universe sort of thing. 

PROFESSOR PHILIP SCHOFIELD 

Linked to imagination, possibly?

DR SARAH WHITE

So it could potentially be linked to imagination, but it doesn’t have to be. 

PROFESSOR PHILIP SCHOFIELD 

Whatever that is – imagination! 

DR SARAH WHITE

Yes, exactly. I mean, there are a lot of different cognitive processes that contribute potentially to imagination. Mentalizing is one potential one. 

So another time that we use mentalizing is actually seen with very young children in pretend play. So this is actually a sort of self version of mentalizing. And it’s when we suspend that mental reality of what we know to be true and actually create a totally alternative version of mental reality.  And in the pretend world, then a banana is no longer a banana. A banana can be a telephone and that’s okay because the banana isn’t actually a telephone, but because we’ve suspended reality and entered into an alternative universe that can have different rules. So that’s an alternative mental reality. So that’s a version of mentalizing. And interestingly, we don’t see pretend play at the same age, at least in autistic children. And autistic children are just less likely to enter into that pretend play. When we do see pretend play in children, it’s either when they’re much earlier or sometimes it involves entering into that alternative mental reality to the extent that they believe that is reality, that’s become true. And I’ve certainly seen an experienced autistic children think that they have become an alternative superhero, for example. And that can be quite dangerous actually because they’ve suspended reality and they think that they can fly or they think that they can jump off a building or whatever it is. So that’s sort of an occasion when mentalizing or suspending reality, but not being able to hold that reality there at the same time as equal to reality. 

PROFESSOR PHILIP SCHOFIELD 

Right, so we’ve got two worlds in the neurotypical child whereas the autistic child has sort of one world which they’re in?

DR SARAH WHITE

There seems to be some evidence that that might potentially be one form of sort of pretend play that some autistic children can enter into. But, yeah, really mentalizing is just something that’s very, very flexible and I think sort of relating it back to what we’ve been talking about so far then really the times that we struggle to mentalize are when we have somebody who we don’t really know what’s inside their head.  We imagine meeting somebody who’s from a very different culture or from a very different background and that’s when we struggle to think what on earth they might be thinking. And so the idea is actually that autistic people, while sort of previously we thought about mentalizing as being something autistic people can’t do, the idea is now that mentalizing is actually just something that autistic people struggle to do because the person sitting opposite them is very, very different to them. 

PROFESSOR PHILIP SCHOFIELD 

And I mean, that is a problem the historian faces all the time – trying to understand it.

DR SARAH WHITE

Absolutely. Yeah, I mean, time-based cultural shifts, I imagine, make it very difficult, yeah, absolutely. 

PROFESSOR PHILIP SCHOFIELD 

So, I mean, what’s the practical advice to those of us who don’t regard ourselves as autistic?

DR SARAH WHITE

So there’s evidence indicating that the better informed we are and the more practice we have at mentalizing for people who are not like us, the better we become at it. And I mean, that’s not rocket science, right?  If we practice something or we get used to something and we’re familiar with something, then we become better at it. So actually the advice is sort of on a broader scale, public education, but on an individual level, it’s about being willing to put yourself into situations where there are people who maybe don’t communicate in the same way that you do. You can choose to invest in relationships with people who are very different to you, maybe including people who are autistic. 

PROFESSOR PHILIP SCHOFIELD 

Hm, hm, hm.