Intense emotional experiences are difficult for people with autism/Asperger's. This is very true when the emotional experience involves other people and is not related directly to the needs or desires of the person with autism/Asperger's. In this episode, Max is unable to relate to the feelings Sarah is experiencing when Amber is in the hospital. Indeed, the disability in being able to connect with other people and to develop an understanding of how someone else might be feeling is difficult and at times even completely alienating. A patient of mine (and an avid "Star Trek" fan) once told me that "having autism/Asperger's is like being a Vulcan living among Klingons."
For those of us who are "neurotypical," we generally get a feeling of connectedness, satisfaction, and comfort when sharing in intensely emotional situations - especially those involving grief and/or death. For people with autism/Asperger's, they just don't get those same positive feelings that reinforce the interaction. In fact, a person with autism/Asperger's will usually find encounters with others who are sharing feelings and comforting one another to be confusing and even frightening. The whole process simply makes little sense to them, and there is certainly nothing that is pleasant or reinforcing about the situation. Trying to get a person with autism/Asperger's to understand and empathize is to reach the very core of their disability: social and emotional connectedness is the very thing that they are unable to do, or at least not able to do very well. Teaching empathy to someone with autism/Asperger's is almost like teaching a pig to sing - it is a waste of time and annoys the pig (at least most of the time).
That being said, there are ways that people with autism/Asperger's can learn to at least approximate feelings of empathy and compassion. With social stories and direct interventions in specific social situations, as Adam attempts to do with Max in this episode, people with autism/Asperger's can at least "learn the rules" for how someone "should" act in an intensely emotional situation. When this goes well - when they get the rules correctly - they can feel a great deal of satisfaction with themselves for "getting it right." As much as they don't understand why people feel a certain feeling, they do often care if people respond to them in an odd or hostile way. When the important others get frustrated, disappointed or even angry with the person with autism/Asperger's because they are not empathetic or "understanding" someone else's point of view, it changes how that important other would generally interact with the person with autism/Asperger's - and that's confusing and scary.
When Frankie was very young, we began to intervene and attempt to teach the appropriate response to him when he was in a situation where he should clearly be expressing some empathy but "just didn't get it." This meant that we had to be vigilant about monitoring his interactions with others. It also meant we had to be ready to step in whenever there was a situation that provided a teaching moment. For many years, Frankie would not follow through independently on any of our "examples." Eventually, he began to respond to situations in which he should show some empathy but in a very scripted way. Nonetheless, we would reinforce with praise and attention. As time has passed, Frankie has continued to respond in an almost appropriate way to situations where he should show empathy but he is clearly not directly impacted.
Like everything else with autism/Asperger's, the key has been the intensity and persistence of the teaching. At this point, Frankie may even feel some semblance of empathy, but I know that he will never receive as much from these interactions as I do. I am grateful that at least at this point he, like Max, can feel good about himself and experience others feeling good about him as he struggles to connect socially in a world that often makes little sense to him.
Written by Roy Q. Sanders, M.D.
