Author: Simon Baron-Cohen
The driver for this book is the author’s life-long-long quest to understand the foundations and manifestations of human cruelty, a subject that has profound ramifications in society. The author acknowledged that this question has ‘gnawed’ on his mind all his life, and it formed the bedrock of his research career as a psychologist (page 4). In his detailed elucidation of the subject, the author applied his concept of empathy erosion to explain the loss of empathy that lies at one extreme of what he calls the ‘empathy spectrum‘ (page ix, xi, 11, and 126-130). After defining empathy erosion as the state of being unable to take the perspective of others, and a state of being single-mindedly focused on narrow self-interests, the book proceeds to paint vivid pictures of the diverse ways this manifests, from borderline personality disorder to psychopathy (pages 11,16, and 126-130). The book also explores the rare emotion of super-empathy, and the familiar emotions that undermine empathy such as fear, hatred, resentment and the desire for revenge.
Perhaps the most symbolic expression of empathy erosion is narcissism, the book depicting narcissists as people who, believing ‘they have special gifts that others lack’, are boastful, self-promoting and totally self-preoccupied (pages 63-64). The book noted that the absolute certainty of narcissists in the rightness of their ideas and beliefs makes them regard people who do not share their point of view as misguided or stupid. The author further explained why lacking the sense of self-awareness makes narcissists blind to how others perceive them, with the result that they are incapable of regulating their behaviour, they are unrestrained in the pursuit of their desires, and they are inconsiderate of others when they express their thoughts (page 30). Highlighting the impact of narcissistic conduct on other people who are made to feel undervalued, disrespected, and disregarded, the author nevertheless maintained that low empathy is not sufficient on its own to engender acts of cruelty (pages 10, 13, and 31).
The most threatening expression of empathy erosion the book explored is undoubtedly that of psychopathy, a form of antisocial personality disorder in which affected people, lacking in both affective and cognitive empathy, have a ‘total preoccupation’ with themselves, and a ‘willingness to do whatever it takes to satisfy their desires’. The book portrays psychopaths as people whose capacity for violent acts is driven by their inability to feel anxiety, guilt, or remorse, and by their failure to learn from punishment (pages 5, 10, 17, and 48-59). Whilst psychopaths are able to display superficial charm, the author points out that this only serves to mask their devious propensity for executing ‘cold, calculated cruelty‘, a ruthlessness that is often impelled by the ‘desire to dominate‘, or simply triggered by perceived threats (page 45). The book attributed the poorly developed moral sense of psychopaths to having been victims of parental rejection; thus deprived of the ‘security of early attachment‘, they were unable to acquire the normal childhood capacity for empathy (page 50-53).
The clearest demonstration of the lack of correlation between empathy erosion and violence is the case of Asperger’s syndrome; this is an empathy-deficit condition the author distinctively categorised as Zero-Positive, a relatively benign form of zero degrees of empathy. Pointing out that people with this disorder suffer from diminished cognitive empathy, the author however emphasised that they do not exhibit cruel acts because their affective empathy is spared; they are therefore caring rather than callous, and they may even be described as ‘super-moral‘. Further representing them as hyper-systemizers, the author said that individuals with Asperger’s syndrome ‘have a remarkably precise, exact mind‘, a trait that makes them run their lives by ‘a system of rules‘ (page 67 and 70-71). Along with the capacity for systemizing, the book also refers to the ability of people with Asperger’s syndrome to process information in such a way that they are able to ‘analyse changing patterns‘, and to ‘figure out how things work‘; this attribute, the book argued, underlies the significant contributions they have made to human progress (pages 72-87). Unfortunately, people with Asperger’s syndrome may often suffer from alexithymia, a ‘difficulty understanding their own minds’ (page 72).
The author narrated several memorable real-life case studies to illustrate the impact of empathy erosion on affected people, and on their relationships. One such anecdote relates to the self-destructive empathy deficit exhibited by the author’s patient, Carol, who suffered from borderline personality disorder. Depicting the hallmarks of this disorder as ‘a constant fear of abandonment, emotional pain and loneliness‘, the author strikingly represented these features in Carol’s ‘rollercoaster’ of emotions which cycle through depression to happiness, and which may show as uncontrollable rage which ‘bursts forth with venom. The book also captured how her ‘twisted’ empathy ‘leads her to assume other people are…harbouring hostile intentions towards her’ (page 32-36). Further characterising her as ‘totally self-absorbed‘, tending to talk incessantly about herself, the book explained why her lack of any interest in other people’s problems makes her friendships short-lasting, based, as they are, entirely on what she could benefit from them. The author also reviewed the underlying sad social factors that predispose to borderline personality disorder, particularly highlighting the frequent personal and family history of disturbing experiences such as incest, child abuse, violence and alcoholism (pages 46-44).
This book is marked by the thorough research that has gone into it, with diverse references to important psychological concepts such as theory of mind, and neuroanatomical notions such as the brain’s empathy circuit, which has the amygdala as ‘the jewel in the crown’ (pages 73 and 20-27). The book also cited various experts in related subjects such as John Bowlby on attachment theory, Giacomo Rizzolati on the mirror neuron system, Philip Zimbardo on cruelty, Stanley Milgram on obedience to authority, and Solomon Asch on conformity (pages 2,9,26, 36, 50, 114-115, and 123). There were also detailed expositions of genetic mutations related to empathy deficiency, such as those involving the genes for monoamine oxidase A (MAOI), serotonin transporter (SLC6A4), arginine vasopressin receptor IA (AVPRIA), and cannabinoid receptor I (CNRI) (pages 92-94). Most helpfully, the author illustrated many of his arguments with historical examples of unspeakable cruelty, from the Columbine High School killings, to the Nazi ‘immersion experiments’. On the lighter side, the book made references to the arts such as the film Rain Man (page 75).
This relatively small book addresses the important subject of empathy and the consequences of its breaks down. It quite dramatically explores the different manifestations of empathy erosion with illustrative clinical and historical examples. More importantly, it points out the important clinical dimensions of the major empathy deficit disorders. Describing the personal and societal dimensions of empathy-related personalities and pathologies, the book explored the wider implications of empathy erosion on social interactions, and on the criminal justice system. The themes of the book resonate with healthcare, not just in the clinical setting, but in the understanding of the dynamics of teams and leadership.
This is a well-written and well-researched book, and it addresses a subject which has wide ramifications within and outside healthcare. The disorders the author discusses are relevant across most medical specialties, and the detailed personality sketches he provides are masterclasses in recognising and understanding the broad range of empathy-eroding disorders. This is significant to medical practice, and I recommend the book to all doctors.
Publisher, Place, Year: Penguin, London, 2011
Number of chapters: 6
Number of pages: 195
Star rating: 5