Victoria McGeer Autistic Self - Awareness

A currently popular view traces autistic cognitive abnormalities to a defective capacity for theorizing about other minds. Two prominent researchers, Uta Frith and Francesca Happé, extend this account by tracing further autistic abnormalities to impaired self-consciousness. This paper argues that Frith and Happé’s account requires a treatment of autistic self-report that is problematic on both methodological and philosophical grounds. However, the philosophical problems point to an alternative account of self-awareness and self-report in normal individuals; and this account gives us a methodologically more attractive approach to explaining autistic abnormalities. ALTHOUGH OFTEN PROFOUNDLY DISABLING, autism is a developmental disorder that comes in degrees, and those at the high end of the spectrum are often capable of giving gripping reports on what it is like to be autistic. These reports open up interesting methodological opportunities for both philosophers and cognitive scientists, and constitute an extremely interesting body of evidence on the nature of autism. So, at any rate, I would like to suggest in this paper, taking as my starting point the critique of an alternative perspective by two well-known researchers in the area, Uta Frith and Francesca Happé. The paper is in six sections. First, I look at a sample of autistic reports to provide the reader with a sense of what autism is like from the firstperson point of view. Then I look at a speculative approach to these reports that Frith and Happé have recently proposed as an important extension of the theory of mind (TOM) deficit account of autistic cognitive abnormalities (Frith and Happé 1999). In the final four sections of the paper I subject this account of autistic selfreport to criticism, attempting to open up an alternative approach to the broader range of autistic abnormalities: The third section argues that Frith and Happé’s account is procedurally questionable in so far as it raises substantial methodological concerns. The fourth section argues that it is philosophically questionable in so far as it relies on a neo-perceptual model of introspective self-knowledge. In the fifth section, I argue for an alternative direct-expressivist model of self-knowledge and self-report. In the sixth and final section, I show how this approach gives us, not just a philosophically less troublesome perspective on autism, but also one that escapes the methodological problems encountered by Frith and Happé. Autism and Autistic Reports Autism is a neurodevelopmental disorder with a number of associated features. The primary diagnostic (or core) abnormalities of autism involve selective impairments in social, communicative and imaginative abilities that are usually quite severe. Whereas seventy-five percent of diagnosed autistics are mentally handicapped in a 11.3mcgeer. 10/21/04, 3:55 PM 235 236 ■ PPP / VOL. 11, NO. 3 / SEPTEMBER 2004 general way, the remaining twenty-five percent— often identified as having Asperger’s syndrome1— show average to good cognitive functioning as measured in standard intelligence quotient tests. But even those with Asperger’s syndrome display these characteristic abnormalities to some degree. The following is a representative survey of symptoms in these three primary areas: • Social abnormalities, evident from early childhood, include treating others as inanimate objects, disinterest in and even aversion to meeting another’s gaze, absence of social referencing behavior (that is, directing another’s attention in order to share interest in or gather information about a mutually discernible object), lack of normal response to others’ emotional displays, and so on. • Communicative abnormalities include abnormal prosody (rhythm, stress, tone), abnormal gestures and facial expressions accompanying linguistic utterances, pronoun reversals (I for you), idiosyncratic use of words, extreme literal mindedness, abnormal shifts in topic and abrupt terminations of conversation, inability to give and receive conversational cues, insensitivity to taboos on personal topics, and so on. • Imaginative abnormalities include an absence of spontaneous pretend play in early childhood, a tendency to engage in repetitive, stereotyped activities (e.g., sorting objects or lining them up in rows), limited or absent interest in the larger meaning of things (function, associations, symbolic properties), and corresponding focus on superficial details, with obsessive interests that are circumscribed accordingly (e.g., memorizing bus routes, timetables, birth dates, or even door colors). Many autistics are also notable for their rote memory skills, even though they show little concern with focusing on what’s worth remembering for other cognitive purposes. Perhaps this is because they have a limited capacity for imagining what those purposes might be, hence a limited capacity for opportunistic planning. Apart from this core of social-cognitive abnormalities, autistics—high-functioning and otherwise—tend to display a further range of typical characteristics in sensory-motor, perceptual, autonomic, and affective dimensions. These include extreme and unusual physical sensitivities and insensitivities; oddities of posture and gait; tics, twitches, and unusual mannerisms; stereotypies such as rocking, hand flapping, spinning, thumb twiddling, and echolalia; slowed orienting of attention; apparent insusceptibility to certain perceptual illusions; superior visual memory for detail; perfect pitch; difficulties with gestalt perception (e.g., seeing whole figures or scenes as opposed to their parts); repetitive, obsessive behaviors and compulsions; hyperanxiety, mood swings, tantrums, and so on. Although some attention has been given to these further characteristics—indeed, importantly by Frith herself 2—cognitive theorists are naturally preoccupied with core cognitive markers as a locus of explanatory concern. Without disputing the importance of these markers, or the work that has explored them, I think there is danger in such theoretical precedence. Specifically, cognitive theorists may be inclined to overestimate the explanatory scope of such cognitive features and, correspondingly, underestimate the importance of other noncognitive features in accounting for the nature and genesis of autistic cognitive difficulties. In this paper, I focus on a particular subset of these additional features—namely, autistic sensory abnormalities. As Frith herself has observed, One mysterious feature that is not currently given much importance may hold further clues. Some Asperger individuals give first-hand accounts of sharply uncomfortable sensory and strong emotional experiences, often including sudden panic. From autobiographical accounts we learn that again and again the Asperger individual’s interpretation of perceptions by ear, eye or touch, tends to be either extremely faint or overwhelmingly strong. There can be hyperas well as hyposensitivity. Feeling scratchy clothes, for example, is not merely uncomfortable, but agonizing. On the other hand, pain may be tolerated to a phenomenal degree. Both the interpretation of the sensation and the subsequent emotional reaction, or lack of it, seem to be out of the ordinary. The same may also be true of other types of autistic individuals, but, unlike the Asperger syndrome person, they cannot tell us about their sensations. Unfortunately, we are far from a clear understanding of the mechanisms by which human beings normally interpret sensations and react to them (Frith 1991, 14–15). My concern in this paper is not only with the mechanisms by which human beings, normal or autistic, “interpret sensations and react to them”; it is also with the presuppositions by which cog11.3mcgeer. 10/21/04, 3:55 PM 236 MCGEER / AUTISTIC SELF-AWARENESS ■ 237 nitive theorists interpret these autistic autobiographical accounts and react to them as builders of cognitive theory. In particular, I will be considering how seriously and literally we should take the contents of such first-person autistic reports, as against Frith and Happé’s approach that recommends taking them seriously all right, but— problematically, I think—merely as a symptom of distorted higher-order self-consciousness. Before going on to consider Frith and Happé’s theory in detail, it will be useful to give some illustrative examples of the sorts of reports under discussion. Here are some representative passages taken from three different authors: I had—and always had had, as long as I could remember—a great fear of jewelry. ... If I was made to touch jewelry, I felt a sharp whistling metallic noise in my ears, and my stomach turned over. Like a note falsely electrified, that sound would creep from the base of my spine upwards until it rang in my ears, tumbled down into my throat and settled like nausea into my stomach... My insensitivity to pain was now as good as total... nothing hurt at all. And yet I felt—my actual feelings were not shut off—because when I was aware that I had injured myself somewhere, I could sense something, a non-pain, which branched out into my body from the place where the injury was. But the fact was, it didn’t hurt (Gerland 1997, 54, 157) ***** When I was little loud noises were also a problem, often feeling like a dentist’s drill hitting a nerve. They actually caused pain. I was scared to death of balloons popping, because the sound was like an explosion in my ear. Minor noises that most people can tune out drove me to distraction. When I was in college, my roommate’s hair dryer sounded like a jet plane taking off. ... The kinds of sounds that are disturbing vary from person to person. A sound that caused me pain may be pleasurable to another child. One autistic child may love the vacuum cleaner, and another will fear it. Some are attracted to the sound of flowing, splashing water and will spend hours flushing the toilet, while others wet their pants in panic because the flushing sounds like the roar of Niagara Falls. (Grandin 1995, 67) ***** Many a time, my actions brought my parents and me to the hospital. I loved to chew crunchy things, even if they were poisonous. When I was finished with my little tin foil table settings, I used to chew them until they crackled their way into a tight, neat ball. I shaved the sand from Emory boards with my front teeth. I took great delight in grinding the striking strip of a match book between my back teeth. I chewed sugar packets whole, loving the way the grainy sweet sugar overcame the bitter paper packet. I ate school paste and play dough and paraffin... As much as I loved to chew scratchy and gritty textures, I often found it impossible even to touch some objects. I hated stiff things, satiny things, scratchy things, things that fit me too tightly. Thinking about them, imagining them, visualizing them ... any time my thoughts found them, goose bumps and chills and a general sense of unease would follow. I routinely stripped off everything I had on even if we were in a public place. I constantly threw my shoes away, often as we were driving in the car. I guess I thought I would get rid of the nasty things forever!... I also found many noises and bright lights nearly impossible to bear. High frequencies and brassy, tin sounds clawed my nerves.... Bright lights, mid-day sun, reflected lights, strobe lights, flickering lights, fluorescent lights; each seemed to sear my eyes. Together, the sharp sounds and bright lights were more than enough to overload my senses. My head would feel tight, my stomach would churn, and my pulse would run my heart ragged until I found a safety zone. I found solace underwater. I loved the sensation that came from floating with the water. I was liquid, tranquil, smooth; I was hushed. The water was solid and strong. It held me safe in its black, awesome darkness and it offered me quiet – pure and effortless quiet (Willey 1999, 25–6) ***** I wanted to feel the good of being hugged, but when people hugged me the stimuli washed over me like a tidal wave. ... When people hugged me, I stiffened and pulled away to avoid the all-engulfing tidal wave of stimulation. The stiffening up and flinching was like a wild animal pulling away. (Grandin 1992, 108) **** A Discrediting Theory? While tending to focus on particular aspects of the disorder, the ambition of autism research is to develop a plausibly unifying account of the entire range of autistic abnormalities—that is, an account that shows how they are interconnected, perhaps through being rooted in the malfunction of a single cognitive, or possibly subcognitive, system. Uta Frith and Francesca Happé describe 11.3mcgeer. 10/21/04, 3:55 PM 237 238 ■ PPP / VOL. 11, NO. 3 / SEPTEMBER 2004 one such approach, currently much favored, and propose an important and theoretically plausible extension of it: A widely accepted theory is that the core symptoms of autism are due to a deficient neuro-cognitive mechanism which underpins the normal ability to develop a ‘theory of mind’ [TOM]: the ability to attribute mental states and predict behavior accordingly. Here we want to extend the idea of a lack of theory of other minds, which is the ability standardly tested, towards the notion of a lack of theory of own mind. Taken to its logical conclusion, the inability to ‘attribute mental states to self and others’, i.e. ‘theory of mind’, is the same as not having introspective awareness. (Frith and Happé 1999, 1) Elaborating further, they say: At first glance, the ... attributions [to self and other] seem entirely different: own mental states do not have to be inferred through observation like those of others, and they may be less likely to be erroneous. However, even though the input channels by which the relevant information is received may well be different, a crucial part of the process is to distinguish mental states, be they first-person or other people’s, from representations of the physical world. For example, it is necessary to distinguish the representation of physical reality (‘there is a pencil in the tube’) from the representation of belief (I thought ‘there are sweets in the tube’, or John thinks ‘there are sweets in the tube’). It seems plausible that the mechanism that keeps (second-order) representations of mental states separate from (first-order) representations of physical states is the same for self and other attribution. Even if the appreciation of others’ mental states results in representations that are more error prone than the representations of own mental states, this difference becomes trivial if one is unable to represent mental states at all. (Frith and Happé 1999, 4–5)