by Oliver Sacks
But this sort of simulation or concrete imagery is much less appropriate when she has to do other kinds of thinking—symbolic or conceptual or abstract thinking. To understand the proverb “A rolling stone gathers no moss”, she said, “I have to run a video of the rock rolling and getting the moss off before I can think of what it ‘means.’ ” She has to concretize before she can generalize. At school, she could not understand the Lord’s Prayer until she “saw” it in concrete images: “ ‘The power and the glory’ were high-tension electric wires and a blazing sun; the word ‘trespass’—a ‘No Trespassing’ sign on a tree.” 115
115. When Temple lectures, she often uses very odd slides, mixed in with the usual diagrams and charts—slides that might bear no discernible relation to her theme and might convey nothing to her audience, since in fact they are designed not for them but for her, private jottings or mnemonics for her own trains of thought. For instance, a joke slide of a roll of toilet paper made from sandpaper reminds her to speak about tactile sensitivity in autism.
In her autobiography, and, more concisely, in a thirty-page article published a little before the book—“My Experiences as an Autistic Child”, which appeared in the Journal of Orthomolecular Psychiatry in 1984—Temple indicates how, even as a child, she scored at the top of the recorded norms in spatial tests and visual tests but did rather badly in abstract and sequential tasks. (Such “profiles” are characteristic of autistic people: they tend to show “scatter”, or extreme unevenness, on so-called intelligence tests.) In some cases, Temple writes, the scores were misleading, because tasks that might have been very difficult for her if she had done them in the “normal” way were easy because she did them in an idiosyncratic, visual way: thus sentences and poems, and strings of numbers, instantly generated visual images, and these were what she remembered, not the words or numbers as such. Complex calculations, impossible for her in the normal way, might become possible if she transformed them into visual images. 116
116. As Temple described this and gave examples, I was reminded of the Mnemonist described by A.R. Luria (in The Mind of a Mnemonist) and his bizarre, purely visual way of transforming words and numbers into images. The Mnemonist, indeed, thought exclusively in images—and sometimes overwhelmingly; hundreds of these might be generated in the course of listening to a single paragraph or a short poem. Thinking in images gave him great strength—provided, in Luria’s words, “a powerful base on which to operate, allowing him to carry out in his mind manipulations which others could only perform with objects.” But such thinking also created strange difficulties, sometimes preposterous ones, when it could not be replaced by verbal-logical thought. Luria’s Mnemonist was not in the least autistic, but his visual thought processes—his concrete imagery, at least—were remarkably close to Temple’s and perhaps shared a similar physiological basis. She was fascinated when I told her of the Mnemonist and felt that her thinking was indeed very similar to his.
Visual thinking in itself is not abnormal, and Temple was quick to point out that she knows several non-autistic people—engineers, designers—who seem able to “see” what they need to do, to make designs in their mind and test them in simulations, just as she does. 117
117. Precisely such a mode of mind was possessed by the great inventor Nikola Tesla: “When I get an idea I start at once building it up in my imagination. I change the construction, make improvements and operate the device in my mind. It is absolutely immaterial to me whether I run my turbine in my thought or test it in my shop. I even note if it is out of balance.”
Indeed, she often gets on very well with such people, especially her friend Tom. He is a powerful, creative visualizer, like her, and is also, like her, unorthodox, roguish, fond of pranks. “I get on the same wavelength as Tom”, Temple said, “though it’s a childish wavelength.” But, above all, she enjoys working with Tom—this, too, is “childish”, but a form of childishness that is essentially creative. “Tom and I are little children”, she said. “Concrete is grown-up mud, steel is grown-up cardboard, building is grown-up play.”
I was moved by Temple’s words, with their lovely analogizing of creativity and child’s play, and thought what a healthy development this had been in her. And moved, too, when she spoke of her relation to Tom. I wondered whether indeed she loved him and had ever thought of a sexual relationship or marriage with him. I asked her about this—asked whether she had ever had sexual relationships, or dated, or fallen in love.
No, she said. She was celibate. Nor had she ever dated. She found such interactions completely baffling and too complex to deal with; she was never sure what was being said, or implied, or asked, or expected. She did not know, at such times, where people were coming from, or their assumptions or presuppositions, or intentions. This was common with autistic people, she said, and one reason why, though they had sexual feelings, they rarely succeeded in dating or having sexual relationships.
But the problem was not just in actual dating or relating. “I have never fallen in love”, she told me. “I don’t know what it’s like to rapturously fall in love.”
“What do you imagine ‘falling in love’ is like?” I asked.
“Maybe it’s like swooning—if not that, I don’t know.”
I thought the phrase “falling in love, ” with its suggestion of overwhelming feeling or transports, might be the wrong term to use. I amended my question to “What is ‘loving’?”
“Caring for somebody else—I think gentleness would have something to do with it.”
“Have you cared for somebody else?” I asked her.
She hesitated for a moment before answering. “I think lots of times there are things that are missing from my life.”
“Is this painful?”
“Yeah—I guess.” Then she added, “When I started holding the cattle, I thought, What’s happening to me? Wondered if that was what love is—it wasn’t intellectual anymore.”
She is wistful about love, in a sense, but cannot actually imagine how it might be to feel passion for another person. “I couldn’t understand how my roommate would swoon over our science teacher”, she recalled. “She was overwhelmed with emotion. I thought, He’s nice, I can see why she likes him. But there was no more than that.”
The capacity to “swoon”, to experience a passionate emotional response, seems diminished in other areas, too—not merely in relation to other people. For, after speaking of her roommate, Temple immediately said, “It’s similar with music—I don’t swoon.” She has absolute pitch, she added (this is normally very rare, but is relatively common in people with autism), and a precise and tenacious musical memory, but, on the whole, music fails to move her. She finds it “pretty”, but it evokes nothing deep in her, only literal associations: “Whenever I hear that Fantasia music, I see those stupid dancing hippos.” It doesn’t seem to “call” her. She doesn’t “get” music, she said—doesn’t see what it is “about.” One might suppose that Temple is simply not “musical”, despite her absolute pitch and her ear. But her inability to respond deeply, emotionally, subjectively, is not confined to music. There is a similar poverty of emotional or aesthetic response to most visual scenes: she can describe them with great accuracy but they do not seem to correspond to or evoke any strongly felt states of mind.
Temple’s own explanation of this is a simple mechanical one: “The emotion circuit’s not hooked up—that’s what’s wrong.” For the same reason, she does not have an unconscious, she says; she does not repress memories and thoughts, like normal people. “There are no files in my memory that are repressed”, she asserted. “You have files that are blocked. I have none so painful that they’re blocked. There are no secrets, no locked doors—nothing is hidden. I can infer that there are hidden areas in other people, so that they can’t bear to talk of certain things. The amygdala locks the files of the hippocampus. In me, the amygdala doesn’t generate enough emotion to lock the files of the hippocampus.”
I was taken aback and sa
id, “Either you are incorrect or there is an almost unimaginable difference of psychic structure. Repression is universal in human beings.” But, having said it, I was not so sure. I could imagine organic conditions in which repression might fail to develop, or be destroyed, or be overwhelmed. This seems to have been the case with Luria’s Mnemonist, who, though not autistic, had memories of such vividness as to be inextinguishable—even though some of these were so painful that they would surely have been repressed had this been (physiologically) possible. I myself had had a patient in whom damage to the frontal lobes of the brain “released” some of the most deeply repressed memories—memories of a murder he had committed—and forced them upon his terror-stricken consciousness.
I had another patient, an engineer, with massive frontal lobe damage from a hemorrhage, whom I would often see reading Scientific American. He was still well able to understand most of the articles, but he said that they no longer evoked any sense of wonder in him—the very sense that, formerly, had been central to his passion for science.
Another man, a former judge who is described in the neurological literature, had frontal lobe damage from shell fragments in the brain, and, in consequence, found himself totally deprived of emotion. It might be thought that the absence of emotion, and of the biases that go with it, would have rendered him more impartial—indeed, uniquely qualified—as a judge. But he himself, with great insight, resigned from the bench, saying that he could no longer enter sympathetically into the motives of anyone concerned, and that since justice involved feeling, and not merely thinking, he felt that his injury totally disqualified him. 118
118. The founding of reason on feeling is the central theme of Antonio Damasio’s book, Descartes’ Ezioi.
Such cases show us how the whole affective basis of life can be undercut by neurological damage. But there is something much more selective about the affective problems in autism; there is by no means an overall flatness or blandness, despite Temple’s comments about the “emotion circuit” or amygdala. An autistic person can have violent passions, intensely charged fixations and fascinations, or, like Temple, an almost overwhelming tenderness and concern in certain areas. In autism, it is not affect in general that is faulty but affect in relation to complex human experiences, social ones predominantly, but perhaps allied ones—aesthetic, poetic, symbolic, etc. No one, indeed, brings this out more clearly than Temple herself.
Both as a person struggling to understand herself and as a scientist exploring animal behavior, Temple is constantly exercised by her own autism, constantly seeks models or similes to understand it. She feels that there is something mechanical about her mind, and she often compares it to a computer, with many elements in parallel (a parallel-distributed processor, to use the technical term), seeing her own thinking as “computation” and her memory as computer files. She surmises that her mind is lacking some of the “subjectivity”, the inwardness, that others seem to have. She sees the elements of her thoughts as concrete and visual images, to be permuted or associated in different ways. 119
119. Temple’s self-description here made me think of Coleridge’s delineation of Fancy: “[It] has no other counters to play with, but fixities and definites—[It] must receive all its materials ready made from the law of association.” I think that the overwhelming tendency to fixed, concrete, perceptual images, and their quasi-mechanical association, permutation and play—which one sees in autism and sometimes Tourette’s syndrome—while it may dispose to vivid and active fancy (in Coleridge’s sense), may also dispose against imagination (as he calls it, in contrast), which “dissolves, diffuses, dissipates, in order to recreate.” The creation, or re-creation, of the imagination entails a letting-go of fixities and definites in order to revise and reconstruct—and it is just this that seems so difficult in the overprecise and rigid mind of an autistic person.
She believes that the visual parts of her brain and those concerned with processing a great mass of data simultaneously are very highly developed, and that this is generally so in autistic people, and she believes that the verbal parts of her brain, and those designed for sequential processing, are comparatively underdeveloped, and that this, too, is very common in autistic people. 120
120. Russell Hurlburt, at the University of Nevada, has studied the ways in which individuals report or represent their inner experiences, their streams of thought. He has found that whereas normal (and neurotic or schizophrenic) subjects seem to utilize a combination of different modes—inner speech and hearing, feelings, bodily sensations, as well as visual images—subjects with Asperger’s syndrome seem to use visual images exclusively or predominantly.
She is conscious of the “stickiness” of attention in herself, so that there is great tenacity on the one hand but a lack of agility and pliability on the other; she ascribes this to a defect in her cerebellum, the fact that (as an MRI has shown) it is below normal size in her. She believes such cerebellar defects are significant in autism, though scientific opinion is divided on this.
She feels that there are usually genetic determinants in autism; she suspects that her own father, who was remote, pedantic, and socially inept, had Asperger’s—or, at least, autistic traits—and that such traits occur with significant frequency in the parents and grandparents of autistic children. 121
121. That this is indeed the case has recently been shown by Ed and Riva Ritvo of UCLA.
Though she feels early environment (in pigs or people) plays a crucial role in psychic development, she does not hold (as Bruno Bettelheim did) that parental behavior is responsible for autism; it is more likely, she thinks, that autism itself presents barriers to contact and communication that parents may be unable to penetrate, so that the entire range of sensory and social experiences (especially holding and deep pressure) becomes severely impoverished.
Temple’s own formulations and explanations generally correspond with the range of existing scientific ones, except that her emphasis on the necessity of early hugging and deep pressure is very much her own—and, of course, has been a mainspring in directing her thoughts and actions from the age of five. But she thinks that there has been too much emphasis on the negative aspects of autism and insufficient attention, or respect, paid to the positive ones. She believes that, if some parts of the brain are faulty or defective, others are very highly developed—spectacularly so in those who have savant syndromes, but to some degree, in different ways, in all individuals with autism. She thinks that she and other autistic people, though they unquestionably have great problems in some areas, may have extraordinary, and socially valuable, powers in others—provided that they are allowed to be themselves, autistic.
Moved by her own perception of what she possesses so abundantly and lacks so conspicuously, Temple inclines to a modular view of the brain, the sense that it has a multiplicity of separate, autonomous computational powers or “intelligences”—much as the psychologist Howard Gardner proposes in his book Frames of Mind. He feels that while the visual and musical and logical intelligences, for instance, may be highly developed in autism, the “personal intelligences”, as he calls them—the ability to perceive one’s own and others’ states of mind—lag grossly behind.
Temple is impelled by two drives: a theorizing part of herself, which makes her want to find some general explanation of autism, some key that will be applicable to all of its phenomena and to every case,—and a practical, empirical part of herself, which constantly faces the range and irreducible complexity and unpredictability of her own disorder, and the great range of phenomena in other autistic people, too. She is fascinated by the cognitive and existential aspects of autism and their possible biological basis, even though she is intensely aware that they are only part of the syndrome. She herself faces, almost every day, extreme variations, from overresponse to nonresponse, in her own sensory system, which cannot be explained, she feels, in terms of “theory of mind.” She herself was already asocial at the age of six months and stiffened in her mother’
s arms at this time, and such reactions, common in autism, she also finds inexplicable in terms of theory of mind. (No one supposes that even normal children develop a theory of mind much before the age of three or four.) And yet, given these reservations, she is strongly attracted by Frith and other cognitive theorists; by Hobson and others who see autism as foremost a disorder of affect, of empathy; and by Gardner and his theory of multiple intelligences. Perhaps, indeed, all these theories, despite their different emphases, hover about the same point.
Temple has dipped into the chemical and physiological and brain-imaging researches on autism and emerged with the sense that they are still, at this point, fragmentary and inconclusive. But she holds to her notion of impaired “emotion circuits” in the brain, and she imagines these serve to link the phylogenetically ancient, emotional parts of the brain—the amygdala and the limbic system—with the most recently evolved, specifically human parts of the prefrontal cortex. Such circuits, she accepts, may be necessary to allow a new, “higher” form of consciousness, an explicit concept of one’s self, one’s own mind, and of other people’s—precisely what is deficient in autism.