It’s Harmful to Claim that Autistic People Exclusively Lack Cognitive Empathy

By: Heather Dimmitt

I’d like to address the widespread myth that autistic people lack empathy. When autistic people hear this, they are usually offended and confused, and rightly so. When I was first researching about autism, I kept coming across this myth followed by explanations where people try to qualify this by saying autistic people specifically lack “cognitive empathy”. At first, this can seem like it makes sense and explains why autistic people struggle. However, this is also a harmful myth, and I will explain why.

So what is cognitive empathy? Cognitive empathy is defined as the capacity to understand another’s perspective or mental state. This is usually elaborated on as: autistic people don’t understand social cues or other “normal” behavior. Autistic people will tell you that, yes, they may struggle to intuitively understand non-autistic people in this way, but they understand other autistic people better than neurotypicals. We have our own culture and social language. Recent research has come out showing that autistic people communicate better with other autistic people and neurotypicals communicate better with other neurotypicals. Why is that?

I think it’s simply because we are able to understand the perspective and mental state of being an autistic person in the same way a neurotypical person can understand another neurotypical person or a black person can understand another black person or a gay person can understand another gay person. Cognitive empathy relies on having similar perspective, which means having similar experiences and ways of perceiving and relating to the world and ourselves.

Autistic people do NOT exclusively lack cognitive empathy. It makes more sense that people with different identities and ways of being in the world aren’t able to have intuitive cognitive empathy with other groups, simply because they don’t experience the world the same way. For example, as a white person, I can’t intuitively understand the fear a black person might have around police. I can intellectualize it if they tell me this is a fact, and I can label that as a fact in my mind, but I can’t fundamentally understand or feel their fear, because I’m not targeted the same way, and people who look like me aren’t killed by police for simply existing somewhere due to institutionalized racism.

In that respect, you could also say that non-autistic people lack cognitive empathy for autistic people because they don’t have the same experience of things like sensory differences. For example, I might be tired and overwhelmed after going to a grocery store because of sensory overload and not feel up to socializing afterwards, preferring to sit in a quiet place and do something I enjoy alone. My autistic friends will understand this because they may have had similar experiences, but non-autistic friends or family might say things like: “why are you avoiding me and not being social? I don’t get it, why are you mad at me?” In that situation, they clearly lack cognitive empathy for me.

The concept of cognitive empathy simply relies on having a similar identity, and the reason autistic people are deemed “deficient” in this, is that they are being measured against a non-autistic standard. The reason autistic people are singled out for lacking empathy is related to the empathy quotient test, which literally asks questions that related to the perspective of being neurotypical. That would be like giving a white person a test about what it’s like to be a black person, and saying they lack cognitive empathy because they don’t understand what it’s like to be black. Well, of course they don’t!

The worst part of this nonsensical myth is that it creates further division between autistic people and non-autistic people. A non-autistic parent hears that their child “lacks empathy” and might think they won’t ever be able to truly love them because they don’t like being hugged. An autistic person is told that they “lack empathy” and they feel like they are fundamentally flawed, or bad, or evil somehow, like they have this in common with a murdering psychopath. It hurts both autistic people and their non-autistic loved ones to perpetuate this myth. If you had a child with a different skin tone from yours that made them more or less likely to face discrimination and have misunderstandings in society than you, you wouldn’t say they “lack empathy”. You would say they will have a different perspective and will do well to connect with others who share similar experiences, to find their community. We should give autistic people the same respect, and stop labeling them deficient in empathy. It’s just illogical, and hurts everyone in our community.

Additionally, when autistic people are told they lack empathy, this is the same as saying that their perspective is fundamentally flawed, incorrect, and lacking. This is the same as gaslighting, and takes away credibility from the autistic perspective. When you take away someone’s credibility, you take away respect for their needs. Thus, when an autistic person communicates that they don’t like being hugged, they are ignored and forced to into something they don’t want that might be physically painful for them. Then when they get upset for being physically coerced into something they don’t want, they are further punished for getting upset and having a “meltdown”. Wouldn’t it be better to tell people that this autistic person has a legitimate aversion to hugs? That you need to respect their needs and boundaries? Respect their perspective as legitimate even though it is different from your own? I think it would be better for everyone to understand this. The world would be better in general.

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A Doctor Who Was Mistaken For Stupid Her Whole Life

By: Heather Dimmitt, DO

“Are you stupid?!”, exclaimed my 8th grade science teacher in front of the whole classroom, after I asked her a question about the upcoming science fair. My mind had been wandering during her spoken explanation of what was expected of us. Presumably, she must have just said the answer to the question I asked. I stopped asking her questions after that.

“Space cadet”, “head in the clouds”, “ditzy”. A slew of such insults were constantly thrown my way growing up. I can still feel it when I first meet someone. They assume I’m stupid before I even open my mouth. It must be something to do with how young I look (most say I look like I’m 12! When I am 28!), or how pretty I am, or how I seem to be staring into space. I confess I still don’t really know for sure. Most people seem to have a hard time understanding their own biases, which makes it even harder to explain them to me.

I used to be very blissfully non-committal and un-opinionated about things, and was content to endlessly intellectualize within my own internal world. Then I met life’s bullies. I never really knew what to do with them. I usually didn’t even realize I was being insulted half the time. What could be wrong with thinking to myself? Thinking is a smart thing to do. My thoughts and observations were much more intense and interesting than whatever else was going on. My mother was the first to endlessly come to my rescue. She always knew I was smart and creative, and she vehemently hated other people who misunderstood me.

I remember she seemed to always be yelling about something. She had to be that way as a woman from humble origins, who became a doctor through sheer force of will, when it was largely a male dominated field. I watched my mother scream at educators the way she would scream at me at home. My 7th grade history teacher gave me a final grade of “D” because she wouldn’t let me turn in an assignment I had completed simply because it wasn’t turned in before the start of class. I had remembered when she mentioned it about 5 minutes after class began. I tried to get up to turn it in, but NO! Automatic failure of the assignment! I thought that was silly and forgot about it. I knew I did the assignment.

I only remember it now because later on I was brought to tears by my parents endless yelling at me over it. “How could you get a D in this class?!”. When my mother found out what happened, it was the teacher’s turn to cry. My mother has the determination of an iron fist. She gets what she wants through sheer force of will. I knew I had to adopt this practice if I was going to survive in this world. And I have.

I had always tried to be “good” and just did my assignments like I was supposed to. I was always a great student. The alternative was hours of yelling about how I got a “D” in history class, so I did just enough to get “A” and “B” marks. Just enough to make them happy and get them to leave me alone. I don’t think it was until about high school that I started standing up for myself in the classroom. Despite how “good” I was, I would still receive berating remarks from teachers in class pointing out how stupid I seemed. It was like they were a comedian at a club and I was the punch line. They got a lot of laughs, and presumably felt pretty good about themselves. At some point in sophomore year, I had enough. I was determined to blow them out of the water and shut them up for good. I started speaking bluntly, with authority, like my mother.

I was in the IB program at my school and was taking 7 college level classes at once. For my final IB project, I chose the meanest, jerk, bully, comedian teacher in the school as my advisor. I was going to show him how much I knew about war poetry! I filled up every inch of each 8 x 11 inch piece of paper with my intricate ideas interpreting the poetry printed on it. I practically yelled at him my ideas on the subject in our meetings together while shoving those papers with all my thoughts written down in his face. I loved that war poetry the way a mother aggressively loves a child she’s trying to understand. It worked. That teacher stopped treating me like a joke and I made it my mission to get straight A’s in all of my college level classes. I would show them! I got 3 scholarships and got accepted to an amazing college where I got a phenomenal education that I didn’t have to pay for. I worked full time and graduated with a bachelors degree in biological psychology.

I made it through high school, college, a senior thesis, med school, and part of residency before this aggressive fight to be included backfired on me.  Unfortunately in my residency, it wasn’t about what’s right for the patient. It’s about what’s right for the attending’s ego. If you question them, you’re wrong, and stupid! It doesn’t matter what the actual evidence says, even as they tout their ideas as “evidence based medicine”. It doesn’t matter that the patient could be getting better care. It only matters that the attending is right and the resident is wrong.

I tried to be open and comprehensive with my suggestions for care plans, exploring all possible treatments available, and was told that I don’t seem confident enough, which makes me seem stupid. When I started stating my plans outright (“go wrong and strong” they told me), the attending would always pick a contrary view and would try to tear me down so that they would look good in front of others. Then they would get upset when I tried to support my ideas with evidence, forcing them to think outside the box. They literally fired me for being too forthright.

Strong, smart women with opinions tend to piss people in power off. And that’s exactly what happened to me. I couldn’t understand why I kept getting evaluations saying things like “lacks medical knowledge” when my board scores were among the highest in my residency program! It was completely illogical, but it didn’t matter. Attendings and coworkers can say whatever they want in evaluations, and it’s taken as complete fact. There was literally no other method at my residency program for evaluating a resident’s progress in place. My attempts to explain and protest this literal gaslighting were seen as “not taking responsibility” and “unteachable”. I will admit and learn from mistakes in a heartbeat. But I simply cannot admit to something I didn’t do! It didn’t matter that I had high board scores and that my patients were well cared for. Again, I did everything that was asked of me and I did nothing wrong. No matter what I tried, it was useless.

I was desperately searching for an answer to my problems online, and stumbled upon the idea of autism as it presents differently in women. It was like the answers for why I was different were out there this whole time! I finally had an explanation for why life seemed so much harder for me! It was clarity, and a blueprint for how to bridge the gap between myself and the rest of society. I made the mistake of mentioning this to an administrator, and was abruptly fired in the next week or so. I can’t really prove it, but this was flat out discrimination against my neurotype. And because I have this black mark on my record, I’ve been unable to get a residency position anywhere else. I had a plan for my life. Finish residency. Work 9-5 in a clinic somewhere and help people with my gifts and skills for the rest of my life. Simple. Straightforward. Perfect.

Now? Utterly unattainable. I was devastated. All of the focus and hard work I’ve put in my whole life, just to have my dream snatched away by this bigoted residency program. I’ve since come to understand that the program itself was flawed in so many ways that had nothing to do with me. It was relatively new, the program director had changed 2 different times in the short time I was there. Multiple qualified and excellent staff, residents, and faculty had been fired, even before I started there. The most recent program director was only a few years out of residency himself. The program had been struggling financially and had to stop taking new patients, while at the same time being forced to increase all resident salaries to the competitive standard. Firing a resident probably saved them the funds.

This was one of the lowest paying residencies when I first started, but I chose it because I didn’t care about the money. I wanted to work with this community because it is one that has suffered major oppression. I can relate to being dismissed and bullied by society, and I have experience fighting oppression for myself. I thought, if there’s anyone who can understand me, it’s others who have been subjugated their whole life. And they did! The patients, at least. The majority of my patients had been through trauma, and it was like we just understood each other.  It was so wonderful to be able to just validate and help others who were struggling, as a person in a position of some power. I advocated for my patients the way my mother did for me. I called insurance companies and demanded those MRIs that my patients needed, dumping endless information on them until they caved. I would go above and beyond for my patients to get the care they needed.

Now I feel like all of my gifts and skills I’ve worked so hard to acquire are being wasted, if I’m not using them to help others. It’s a common autistic tragedy. I bring this up in support groups and EVERYONE nods with understanding before elaborating on their own tragic story of misunderstandings, discrimination, and eventual unemployment. So now I have a new call to arms. I’ve finally found my community, and my voice. My mother’s iron will, ever determined to crush our enemies, continues to flow through me and into the face of discrimination. 

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Are We Gaslighting Autistics Into Believing a Rational Fear Response is a Co-morbid Mental Illness?

By: Heather Dimmitt, DO

You’d be hard pressed to find an autistic person who hasn’t been labeled with a mental illness in their lifetime. To clarify, autism is an identity and not a mental illness in and of itself. It’s a social disparity to the point of disability, but not an illness. I always see something along the lines of  “Autism spectrum disorder is commonly associated with mental illness, such as anxiety, depression, C-PTSD, BPD, bipolar disorder, etc.” These labels make it sound like there’s something medically wrong with us, that we are mentally ill, in need of fixing. Even those who are well meaning autistics reflecting on their own experiences will note that it seems the challenges faced by autistics induce extreme stress, and therefore lead to anxiety and mood disorders. However, the fundamental reason we even treat anxiety and mood, are specifically only when they are “disorders”. Disorder implies functioning improperly. But what if autistics are just responding rationally to a harsh environment? 

My whole life, I’ve always felt like I have anxiety. My stress level was sometimes disabling and certainly fit with that diagnosis, but none of the treatments really seemed to work for me the way they should. There’s always been something different about my anxiety that didn’t quite fit, but I was never able to put my finger on why. After learning that I am autistic in adulthood, the more I research and think about it, the more I realize my “anxiety” is just a rational fear response to the stress of constant discrimination and abuse against my autistic neurotype.

If we call fear a rational reaction to stress, anxiety is an irrational amount of fear, an overreaction to stress. It’s a pathological, unwarranted fear response to something that should not induce so much fear. That’s why treatments like CBT, which promote rational thought to interrupt irrational emotional responses, have been demonstrated to be helpful for anxiety – in a likely majority neurotypical and otherwise privileged sample size not dealing with the same level of discrimination in everyday life. I think autistics are naturally more rational thinkers, often gaslit, and told they are irrational for thinking or reacting the way they do because it’s “different” from the “norm”.

For me, chronic fear is primarily caused by trying to live in a world that does not respect an autistic neurotype, a world that’s become increasingly louder, brighter, smellier, chaotic, and fake superficial socializing. My fear response is warranted. Bright lights, loud irritating sounds, and strong smells literally assault me and cause dizziness and fatigue every day while I’m trying to do errands and get work done. I sometimes can’t function at all if I don’t wear earplugs, a hat, and sunglasses outside of my home. Rationally, wouldn’t that make anyone afraid?

Positive affirmations and CBT trying to interrupt my emotional response to a physical assault on my senses with some rational thought about separating myself from emotions and finding acceptance? That’s only going to help so much. Whenever I’ve tried CBT or DBT, I always seem to have correct instincts. It’s not really teaching me anything new. I have learned the most perfect coping skills and practice them all the time. It may help some, but never seems to be treating the problem, which I now know is primarily sensory related.

If you had a broken arm, you wouldn’t try to rationalize your way out of pain, you would deal with the physical problem. In the case of autism, you would deal with sensory issues as if they were entirely physical in nature. When I take care of my sensory needs and let myself be who I am without masking or trying to do more than I can, I have ZERO fear, no anxiety. I can think positive affirmations and CBT till I’m blue in the face, but it won’t fundamentally help. Wearing earplugs, sunglasses, a hat, and stimming helps.

That’s why it can be harmful to go on thinking of mental illness as just part of the autistic package. We shouldn’t be focusing on treating individuals with CBT to further develop their rational responses to stress. Autistics have rational responses in spades. We just need everyone to accept those responses as justified and improve the environment to suit us better, the way it already suits neurotypicals. To do that, it’s imperative to continue the amazing shift already happening in the community towards acceptance of autism as an identity to be proud of.  

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