One of the features of humankind that has long been thought to be unique to us is the theory of mind.  This is our ability to deduce what another might be thinking, a critical base for such behaviors as for empathy, socialization, even battle and strategy.  It is so prevalent and so innate that we often do it without realizing it, anthropomorphizing machines, televisions, the computer, animals, even the clouds and the waves.  Imagine a world where no one did this.  Imagine for a minute not even realizing that the people you interact with daily have their own minds inner workings and dealings.  This is the world of Asperger Syndrome. 

   Asperger syndrome is the very high functioning end of the Austistic spectrum.  By definition their intelligence is normal, usually even well above normal, but their capacity for reading nonverbal cues, socializing, and empathizing is severely impaired.  We don’t understand the basis for this entirely and certain different theories abound, but it appears Asperger individuals lack the firing of what is known as the mirror neuron.  This is when a part of the brain usually responsible for movement or planning  movement activates just by watching the same movements.   We recognized what another is doing and actually activate our brains as though we were doing the same thing ourselves.

    Patients with Asperger’s are terrible at reading faces, recognizing nonverbal cues, or recognizing figurative language.  Patient’s will say that when in a conversation, they see everyone else as Robots.  In addition, they tend to have very single minded ability to focus and will delve deeply into figuring out a phenomenon that interests them.  They can talk at length to anyone about their interests, even while boring the audience completely to tears.  They aren’t great at human interaction and therefore much prefer reading on a subject to being taught directly.

   They seem to have difficulty ignoring sensation of any type.  They can be very disturbed by ampient noise or by trying to talk with more than one person at the same time, shirt tags will drive them crazy, outside noises are a problem and they can be very inflexible and develop stereotyped behaviors they use when overwhelmed by their environment.  They are extremely sensitive to texture and are picky eaters.  The stress of overstimulation causes them to withdraw into what they can carefully control and may lie behind their repetitive, self calming rituals.  Interacting with us unpredictable standard human beings can actually be stressful because of our seeming randomness.

     This makes Asperger’s syndrome and Social anxiety disorder look very much alike, even though internally and mechanically they are worlds apart.  As a social phobic, I care too much about what everyone else thinks, to the point it can be paralyzing.  Nevertheless, I crave human connection and company.  It’s a curse.  There are many days Asperger’s would seem to me to be so much better.

  They are typically first class researchers and likely overrepresented in the scientific field.  Emotions do not typically interrupt their inquiry.  They often describe themselves as strictly logical, and appealing to logic is critical in teaching them social skills.  They have to understand why it is important to interact and have to be given detailed instructions regarding nonverbal cues, manners etc. that they learn by repetition in order to function with other people.

    In a very real sense patient’s with autism are irremovably at the center of their own universe.  They lack capacity to be anything other than self centered.  Yet they can undoubtedly can make very important contributions to society.  They are true explorers of knowledge and when something strikes their interest they have an unbroken focus in learning all about it.  This is uniquely human.  It separates us from the animals, which also have sociality, nonverbal communication, and hierarchical societal interaction, after all. 

     At the same time they challenge my entire conception of what it is that makes us human.  A complete lack of empathy, if found in all of us would quickly cause society to disintegrate.  It is central my job as a competent (patient seeing) physician.  I do wonder about many of my neurosurgeon and pathologist colleagues however.  😉   So many of my central spiritual ideals, compassion, mercy, understanding, are foreign and possibly beyond the grasp of these individuals.

    Saying this, I can’t believe that Asperger patients are psychopaths.  They are quite peaceful, pragmatic, and conscientious.  They are the picked on, not the bullies.  I am not entirely sure why this is, but my experience tells me it is true.  They tend to feel very strongly that they are fine the way they are, and disability advocate that I am, I agree.  Like any of us, they have strengths and weakness, with focus, curiousity, and concentration being incredible and empathy and human understanding being much weaker.  I think the bottom line is that they can learn, and learn well, and that covers all manner of weaknesses by leading to growth and development.