Telling a human story

This latest offering from Professor Baron-Cohen goes further than contextualising autism as a strengths-based difference and begins to develop our understanding of the autism neurotype within the evolution of human ingenuity. Baron-Cohen advances his theory that the 'systemizing brain', an evolutionary shift that he dates to circa 70,000 years ago, in tandem with the 'empathizing brain', is responsible for the leaps in human capacity for complex tool-making and driving civilisation. The book is situated in an empirical mindset, in which 'if and then' logic (the systematizing thought structure) is at the top of the hierarchy of evidence and the ultimate expression of our intelligence as a species. The evolutionary timeline has been disputed by archeologists and primatologists: the Radio 4 podcast 'Start the week' has a good overview of the counter arguments in Baron-Cohen's timeline and an outline of alternative theories. 

Cross-disciplinary refutation aside, celebrating the strengths of autism is firmly aligned with the goals of acceptance and being valued for difference, as opposed to pathologised. Minority acceptance is a core tenet of the fashionable Neurodiversity Movement, which was started by self-advocates and most famously researched and published by the sociologist Judy Singer in the 1990s. Baron-Cohen's diligent work in exploring the genetics and neuroscience of autistic exceptionalism supports the goals of aspiration for the many autistic people who are disproportionately marginalised in homogenous educational traps. The National Autistic Society report that only 16 per cent of autistic people are employed, leading to lifelong poverty and poor health outcomes. The suicide rate of autistic people is significantly higher than the general population. Having spent nearly 100 years on the list of mental disorders, it is high time our profession recognised the value of autistic thinking as part of our natural human diversity. Baron-Cohen makes a compelling case and one our entire profession should heed.

Baron-Cohen helpfully renounces his previous 'Extreme Male Brain' terminology, and clarifies the difference between cognitive and affective empathy. However, he then reprises his psychometric tool research, the systematizing and empathizing quotient assessment (SQ & EQ), and the disproportionately high prevalence of SQ in males and EQ in females. Sex differences in autism research is at a critical juncture, since we are realising that many females are failed by psychological services, and more likely to be incorrectly diagnosed with anxiety or personality disorders. Professor Francesca Happe's work has indicated that behavioural differences in presentation are not matched at the genetic level, hence the importance of understanding cultural determinism factors. Further, alternative etiological theories point to gender neutral differences such as connectivity and cooccurrence with ADHD, dyslexia and more. 

Autism gender discrimination has consequences for mental health, appropriate disability adjustments and career success, and the shift from extreme male brain to EQ/SQ does not go far enough to begin improving practice. Professor Gina Rippon's work provides a balance to the sex difference arguments presented in The Pattern Seekersfrom the neurological point of view, and psychometrically one should consider the Barnum Effect and Stereotype Threat. Autism in general is becoming very dominated by high-powered STEM industries in which white, cis, straight, middle class males are already privileged. In this wider context, any assertions of biological determinism could inadvertently halt the acceptance of autism before it starts to improve the lives of women, LGBTQ+ and those from communities marginalised by race or poverty. 

The Pattern Seekers left me wondering about the bias in our science altogether, the so-called hierarchy of evidence and the false dichotomy of nature versus nurture. When positivist 'If And Then' reasoning isn't balanced by more critical, constructivist 'for Whom and So What' contextualisation, are we really advancing as a species or accelerating down rabbit holes (the Amazon hiring AI that taught itself to be sexist, the electoral havoc wreaked by the Facebook Like button…)? Psychology sits at the intersection of neuroscience and sociology; our work is defined by understanding the brain and its environmental influences. 

Our critique therefore, is around the lack of attention paid to balance between biological and cultural determinism in sex differences and autistic presentation. Baron-Cohen's empathizing brain, which is admittedly co-credited with human ingenuity, is portrayed as somewhat subservient and inherently gendered. In the fight to have autism recognised as a 'real' neurological, genetic difference, and not the result of poor parenting, the book loses recognition of wider structural environmental influences on our neurology and identity.

Psychology is in a crisis of replicability, relevance and respect. Those with lived experiences of our services complain that we police the boundaries of social acceptance and traumatise autistic people with 'treatments' such as Applied Behavioural Analysis. Service user voice and co-production models are lacking in research design, which prioritise the goals of academics, not individuals who need help. These are critiques we should be trying to understand and Baron-Cohen's book helps us to deconstruct why such an approach would be fruitless and demeaning. Baron-Cohen challenges the medical model narrative of 'disorder' and opens some interesting avenues for further research around how we can include and amplify neurodiverse human talent. 

The core strength of The Pattern Seekers, then, is the telling of a human story, one in which being a few standard deviations from the norm should not infer disorder. Without a doubt, psychology and psychiatry need to move away from the self-fulfilling prophecy of deficit-based diagnosis, based on socially normed behavioural judgments. I hope that our psychology colleagues will be inspired to join the strengths-based research and practice agenda and further, help develop a more intersectional approach towards systemic inclusion of neurodiversity.

-       Reviewed by Dr Nancy Doyle, CEO and founder of Genius Within CIC

Find more about the book