Clinical Detachment = Lack of Empathy?

One tired myth that I have encountered repeatedly is that autistic people lack empathy. This seems to be fueled by the perception that when many of us hear about a tragedy or witness a disturbing scene, we don't broadcast the expected visceral reaction. 

Consider the following hypothetical scenario: in the days following 9/11, 15-year-old Emma's parents watched in horror as news networks repeatedly aired footage of the second plane hitting the South Tower. Emma's mother broke down crying. Emma's father cringed and said, "I can't watch this anymore," and left the room. Emma, however, said nothing. Her concerned mother turned to her and said, "Emma, isn't what happened just awful?" Emma responded with a slight shrug. Her mother was horrified at this reaction. In 2001, autism wasn't as well-understood as it is now, and Emma's shrug might have been perceived as a cold, unempathetic, "All those people died? Who cares?"

There are a few possibilities as to what actually was going through Emma's mind: Sure, she could have genuinely not cared about the deaths of 3000 people, but if that were the case, then that is not autism-related and stems from a separate issue. Another possibility is one that I hear from a lot of people in the autism community: that when something this intense happens, they are so overwhelmed with emotion that they don't have the presence of mind to respond in ways that people expect. They just shut down, and others perceive this reaction is one devoid of empathy. 

There is one other possibility that I'd like to explore in depth, and that is that the person is experiencing clinical detachment. Before I continue, I want to emphasize that responding with clinical detachment is not the same as not caring. Rather, it is taking an analytical approach to the situation. While Emma might not have had a visceral reaction to the idea of thousands of people dying in a terrorist attack, she still thought it was horrible and wanted to understand why it happened. What would possess someone not only to kill thousands of people but kill oneself in the process? What would make someone literally throw their life away in the name of an ideology and take others down with them? In fact, Emma might have even gone online to every news site to learn about the hijackers and Al-Qaida. She would have done so not amid tears, but amid a thirst for knowledge and understanding. Unfortunately, in the age that this story takes place in, Emma's mother might have thought that she had some kind of morbid fascination with death and took perverse joy in tragedy.

Fortunately, in the years since 9/11, there has been an impressive growth in societal understanding of autism. However, I want to point out that this sort of clinical detachment that Emma experienced in my example is not unique to people on the spectrum. In that particular context, possibly, but neurotypical people demonstrate clinical detachment in all sorts of contexts. The difference is nobody freaks out about it because neurotypical people aren't already perceived as "different". And like it or not, a certain amount of clinical detachment is absolutely necessary for all sorts of tasks. 

It's an inconvenient truth that people who research 9/11-- or Columbine, or the Holocaust, or the Crusades, or some other violent episode of world history-- have to do so with clinical detachment. And I'm glad that some people are able to do it, otherwise none of this important research would get done because researchers would be too busy dealing with their emotions. Clinical detachment is also necessary when performing surgery or conducting an autopsy. It doesn't mean that the surgeon doesn't care about the patient or that the pathologist is glad that the person they're examining is dead. It just means that they don't experience the emotions of empathy in an overwhelming or visceral way. And I'm glad they don't. Could you imagine a heart surgeon doing a bypass operation while thinking, "Oh my God, this poor man! If he dies, he's going to leave behind a wife and kids. I'm crying just thinking about it!" The surgeon wouldn't be able to concentrate on the task. 

I actually wonder if the ability to deal with looking at "gross" images, whether or not they are in the context of a tragedy, is correlated with the ability to experience disturbing images with clinical detachment, or at least without having a significant visceral reaction. I see an interesting range of differences of reactions in my own family. My dad and I can watch medical documentaries that involve graphic surgeries without even flinching. Not only that, we find them interesting. And I will even admit that I have a collection of "creepy medical photos"-- organs during surgery, microscopic photos of scabs, etc.-- that I pulled off the Internet. I showed some of them to Dad and he thought they were interesting. He also thought it was interesting when I showed him a picture of YouTube celebrity Matt Dillahunty's heart that his surgeons took photos of (at his request) when he had a triple bypass. 

My mom and brother, on the other hand? As soon as I showed them the picture of Matt Dillahunty's heart, both cringed. Neither of them can watch medical documentaries like Dad and I can; they just can't stand the sight of exposed organs and knives cutting into flesh. Here's what's interesting that supports my hypothesis about the correlation between the ability to watch surgeries and look at disturbing images-- but only partially: Dad and I can both watch the footage of the second plane hitting the South Tower on 9/11 without cringing. My mother, predictably, cannot. It's just too emotionally painful for her. My brother? He can watch it. Go figure.

And it isn't that Dad and I don't have our cutoff points. We do. I get an uncomfortable chill when I see footage of people jumping to their deaths from the Twin Towers on 9/11. I'm not sure what, if any, visceral reaction Dad has. But I do know that he has a seemingly-arbitrary hangup about amputations. I have a very dark sense of humor, and I once made a joke about a limb amputation (I don't remember what the joke was and what the context was in which I told it). Dad cringed, saying he couldn't even listen to me joke about it. I'm not sure if he can watch limb amputation surgery in a medical documentary, or if it's specifically violent or accidental amputation that he has a hangup with. I found recently, too, that I have a hangup with violent amputation. I was watching the psychological thriller Netflix series You, and in one scene, the main character, Joe, is assaulted and one of his fingers is cut off. In another scene, he cuts off his own toes as part of a plan to fake his own death. In both scenes, I surprised myself by cringing in a very visceral way. I actually curled my fingers and toes, as if recoiling from knives. Watching both scenes was a very unpleasant experience, and I just wanted them to end!

I think what it comes down to is that human emotion exists on a spectrum, and reactions to extreme imagery will range from clinical detachment (with a few exceptions, as with Dad and me) to pronounced visceral reactions (as with Mom and, to a lesser extent, my brother). I really feel that it's important to keep in mind that this range is present through all of humanity, autistic or not. It's just that when an autistic person-- particularly a girl or woman, in my experience-- doesn't display a pronounced reaction to certain images, people read deeply into it. It is here that I encourage you to check your own biases. Additionally, I strongly suspect that many neurotypical people fake certain visceral reactions because they know that this is what is expected of them. And I'm sure you know that we on the spectrum are often terrible at such fakery.

Bottom line, a certain level of clinical detachment is necessary in some contexts-- and humanity is all the richer and better for it.