NeuroDiving

Amelia: A quick heads up: this episode mentions eating disorder recovery. Please take care.

Meet Ryan

Ryan: Uh, well you could use "reverend," I’m reverend and captain. "THE REVEREND CAPTAIN."

Amelia: Ryan Althaus is a minister–and sailboat captain!–in Santa Cruz, California, where he shares a very small home with a dog named Rafiki, a bird named Zazu, and five fish named Doug, Skeeter, Chucky, Rocko, and Spunky.

Ryan: My home is very, I’ve always liked small spaces. Ever since I was a kid, like, even in my bedroom I had to build a little fort. And so right now I live in a tiny little twelve foot camper, um, it's super, super tiny. And I've just got it parked in the driveway of the sobriety house I help manage. And uh, yeah I just, I have to have small spaces, I feel very uncomfortable and anything big. Um, either have to be outside or in a small space.

Amelia: Ryan helps manage a sobriety house. He runs a disability-inclusive recreational ministry. He has authored children’s books about disability inclusion, as well as books for adults about spirituality and eating disorder recovery. He advocates for housing and food security in the Santa Cruz region. He even runs a community radio show about mental health. Ryan seems like an unusually generous, thoughtful person. But about ten years ago, when he was still in seminary, Ryan took a psych test. And that psych test delivered the result that he had no empathy.

Ryan: They showed, like, it was kind of like it was on a, like a, uh, gosh. It was like a scale. And I did, I showed no empathy. Um, like it just had a big zero on a one to five thing.

Amelia [tape]: And so when you got those results back–especially when you, you see zero empathy–how did you feel about that?

Ryan: It made a lot of sense. Um, I don't experience empathy in the way that most people do, or the dictionary definition of it. It's like, like when I move away from a place, I don't miss anybody. Everything's just the present. It's who's around me at the time. Um, when my father died it was really interesting, like, I remember, like it, it just, I loved my father. Um, but when he died it was like ok, he's gone. And same with my grandparents. It's like okay, they're gone.

Amelia: Ryan says he doesn’t experience the dictionary definition of empathy, which makes it very tempting for me to break out Merriam Webster and define empathy for you. But we don’t feel comfortable giving you a simple definition of empathy, especially at the very beginning of this story. For one thing, the dictionary definition of empathy isn’t very interesting–it’s really vague, pretty much what you would expect from a dictionary. And that’s because dictionaries merely tell us how people tend to use words; dictionaries don’t tell us whether our use of words makes sense, and they don’t help us make our concepts any more precise.

Joanna: And there’s another reason we don’t want to begin with a definition of empathy. If we define empathy for you, you might think that the dictionary definition of empathy is, like, the real form of empathy, and as a result you might think that Ryan lacks “real” empathy. As you’ve probably guessed, Ryan is autistic. And there’s a dangerous, longstanding myth that autistic people lack empathy. So we’re not going to tell you what empathy is, at least not yet–because what we’ve learned from working on this story is that we need to begin by setting aside our preconceptions about empathy.

Amelia: In this episode, we want to introduce you to Ryan. We want you to hear about the ways in which he engages with other people’s emotions. And we want you to hear Ryan’s critiques of empathy. Ryan’s experiences raise hard questions about what empathy really is, and whether empathy–as we usually conceive of it–even matters very much.

This is NeuroDiving, a philosophy podcast about neurodivergence. I’m Amelia Hicks.

Joanna: And I’m Joanna Lawson.

Amelia: In this episode, we set aside jargon and preconceptions, and focus on one autistic person's experiences with--and doubts about--empathy.

Ryan’s background

Ryan: I am a 38 year old, kind of wacky, uh, presbyterian-unitarian minister which is…that's theologically divergent, I guess…. Battled in the eating disorder/exercise addiction realm. Um, got pushed towards the autistic spectrum disorder as an adult, and ever since, yeah, it’s been a path of self-learning. Super philosophy-minded, definitely existentialist-hearted.

Amelia: Ryan was diagnosed with autism as an adult, as a result of a period of personal crisis.

Ryan: I guess when COVID kind of came around everything got thrown awry. Uh, and, I didn't transition well to like Zoom, like, I can't do cameras, uh, all these different things. So, so I was finding I wasn't fitting in and then a lot of my safety nets got taken away, all my rituals got thrown, thrown goofy. And, like, I lost the gym was an outlet for me. Um, just all these different things. So, so all the rituals all my comforts, everything got stripped away and, and I stumbled. Um, and I relapsed in this eating disorder to the point where I dropped about 20 pounds within, uh, a little more than a month um which if you do the math is absurd, and ended up in the ICU….

Um, so after a month of trying to work with my insurance company and get into a residential center, like, I passed out in the bathroom a couple of times when I was taking a shower, like, three nights in a row and um, and yeah, I had a friend drive me to the ER and as soon as they plugged me in, like, my heart rate was 26 and my blood sugar was 24 so they basically strapped me to a bed for 48 hours to make sure my heart wasn't gonna stop. And then they put me–and they didn't have any room in the eating disorder hospital–so they put me in a psych unit. Um, and the psych people there were like “well….” After a couple sessions they were like, “you, you need to go get checked for this.” Like, they've always called me OCD, um, anxiety disorder. But, but after sitting with me for a couple days, the psychiatrists–we had two different psychiatrists–um, and they both pointed me in autism direction, and I kind of brushed it off. Um, and then I ended up getting into residential care, I graduated and, and I failed miserably at residential care. It just didn't work for me. Um, it didn't match my normal routine, my rituals and it was just, it was too much people everywhere all the time. I didn't have any like, like private…. Um, I couldn't retreat.

Joanna: So Ryan found himself in a residential treatment program for eating disorder recovery that wasn’t really designed for autistic people. But the whole experience did give him one very useful piece of information.

Ryan: So yeah they threw me into, uh, I had to do like three 4-hour sessions with an evaluator and whatnot and yeah. He was kind of, at the end of it he was like, “no questions asked, like, you got ADHD and autism.” Uh yeah, so it was fascinating.

Joanna: Ryan’s autism and ADHD diagnoses gave him a new way of understanding his relationship to exercise, his relationship with eating, and his relationship to ritual. In fact, he’s written a whole book about it, which you can look up in the show notes. But these diagnoses also gave Ryan a different lens for understanding some of his more disconcerting life experiences.

So, about those psych tests…

Amelia: One of those disconcerting experiences was receiving those weird psych test results back when Ryan was in seminary.

Ryan: It's a very intensive psych evaluation process to make sure that you're not, well, [laughs] that you're not crazy. Um, and mine kind of proved that I was kind of crazy!

Amelia: These types of psychological evaluations are common in seminaries. The goal is to use these tests to make sure that the people who become ministers are psychologically prepared for a very emotionally demanding job.

Joanna: But there’s also a lot of mystery surrounding these tests. Because it’s been about a decade since he took them, Ryan can’t remember the exact phrasing of the questions, or the exact names of the tests. Plus, these types of tests are proprietary–they’re owned by private companies, and those companies don’t share much information about the tests with the general public. So, we can’t look up the exact tests that were administered to Ryan.

Amelia: However, we do know that one of the most common psych tests administered to seminarians is the Minnesota Multiphasic Personality Inventory, or the MMPI. Given what we’ve heard from Ryan, we strongly suspect that this is one of the tests he took.

Joanna: Now, the MMPI doesn’t directly measure empathy. But it does place people on a scale called “psychopathic deviate,” which in more recent versions of the test is something called “antisocial behavior.”

Amelia: I was able to find an unofficial list of questions that the MMPI uses to assess psychopathy, and the questions include things like, “True or false: no one seems to understand me” and “True or false: what others think of me does not bother me.”

Joanna: Even though the MMPI doesn’t directly measure empathy, the person who interprets the test results will often draw conclusions about empathy based on the test-taker’s psychopathy score. This is why Ryan might have been shown a scale indicating low empathy, or low concern for others.

Amelia: And lack of empathy wasn’t the test’s only conclusion about Ryan.

Ryan: Yeah, so they give you like these little, like, one-liners. [laughs] Um, one was like “I like to break rules for fun” and, um, “constantly feels the need to, uh, stir things up.”

Joanna: So according to this test, Ryan didn’t have empathy, and he liked to break rules just for fun.

Amelia: And the thing is, Ryan does like to challenge rules. He doesn’t simply accept that a rule is a rule–he always needs to know the why behind the rule. And if he doesn’t understand why a rule exists, he’ll probably just ignore it.

Joanna: These psych test didn’t prevent Ryan from continuing in seminary, or pursuing ordination. But for several years, one thing did prevent Ryan from getting ordained: the Presbyterian Church polity exam.

Ryan: Actually, one of our tests is the polity exam, um, which is church law and church rule. And I know the rules, but they don't make sense to me. So on the polity exam I kept answering like, “Well here's your rule and this is why it doesn't work.” Um, needless to say I've got the national Presbyterian Church record for the most failed polity exams. So I failed it 7 times.

Amelia: To get ordained in the Presbyterian Church, you have to demonstrate knowledge of the church’s rules. Ryan knew all of those rules–but he worried that they were too simple, too inflexible. So every time he took the church polity exam, he would give arguments against the church’s rules. He finally passed the test after he decided to simply display his knowledge of the rules.

Joanna: So, does Ryan “like to break rules for fun”? I mean, sort of? He definitely challenges rules he thinks are unjustified, and he sometimes has fun in the process. But as far as we know, he’s never challenged a rule that ended up seriously hurting someone. In fact, a rule that’s in place to prevent someone from getting hurt is exactly the type of rule that does make sense to Ryan. Does it make sense for a psych test to call these personality traits “anti-social”? Does it make sense to say that Ryan’s rule-breaking is a sign of “low empathy”?

Ryan: I think the idea of just not, no blind acceptance, just uh, just really kind of like searching out. Um, it makes you, I would say it's the difference, an autism diagnosis…. An autistic individual is a deliberate individual. Uh, it's like Henry David Thoreau said, like, “I choose to live life deliberately.” Um, versus the normal society is, is a very, it's an embedded faith. It's like “I was told to believe this, so I'm going to believe it”; “I was told to do this, I'm going to do it.” Um, versus these other individuals are like, “I'm going to seek it out and figure it out and it's going to be a very painful process.”

Empathy tests

Amelia: Although this hasn’t been studied extensively, there’s some evidence to suggest that autistic adults get scary-sounding results on the MMPI. But this isn’t just an issue with the MMPI–many autistic people get low scores on tests that claim to measure empathy, tests like the Empathy Quotient, and the Interpersonal Reactivity Index.

Joanna: But often, it’s difficult to interpret a person’s results on these empathy tests. For one thing, these tests often try to measure two things at the same time: a person’s ability to suss out other people’s mental states, and how much a person cares about the other person’s mental states. That first construct is basically “theory of mind,” which is also sometimes called cognitive empathy. And that second construct–the one that has to do with how much you care about other people’s thoughts and feelings–that caring is sometimes called affective empathy.

Amelia: When autistic people take these tests, they often get below-average scores for cognitive empathy, AKA theory of mind; but they also sometimes get above-average scores for affective empathy. So on the basis of these tests, researchers often conclude that autistic people care deeply about other people, but that autistic people struggle to understand other people.

Joanna: But as we’ve been discussing for the past several episodes, we ought to be pretty suspicious of the construct of “theory of mind”; it doesn’t seem particularly helpful or accurate to say that autistic people have a clear-cut deficit when it comes to understanding other people.

Amelia: Plus, these tests don’t do a perfect job of measuring affective empathy (which is how much you care about other people and their emotions). And that’s because it can be really tricky to distinguish between (a) a person’s ability to figure out other people’s emotions, on the one hand, and (b) that person’s level of concern for other people’s emotions, on the other hand.

Joanna: So ok, here’s an example. One of the statements on the Empathy Quotient test is: “It is hard for me to see why some things upset people so much.” Amelia, would you agree with that statement?

Amelia: I guess I would say I slightly agree?

Joanna: OK, why did you give that answer?

Amelia: Alright, well, occasionally when someone is upset, I genuinely don’t know what’s upsetting that person. But more often, I know what’s upsetting someone, but I don’t understand why they find it upsetting. So like, for example, I know that many teachers get really upset when their students leave class to go to the bathroom—and I don’t understand why!

Joanna: Yeah, that makes a lot of sense. And your answer reveals a weakness in this test. Two people might answer this question in the same way, but for totally different reasons. One person might say that they “agree” with the statement because they sometimes struggle to grasp the thing that is upsetting someone; and another person might say that they “agree” with the statement because they sometimes struggle to understand why something upsets someone. Those are two very different experiences, but this question doesn’t distinguish between them.

Amelia: This is a great example of how questions on psychometric tests often fail to distinguish between very different mental states. Now, understanding what’s upsetting someone isn’t exactly the same thing as cognitive empathy; and understanding why something upsets someone isn’t exactly the same thing as affective empathy. Like, I might care very deeply about the fact that someone is upset, even if I don’t understand why they’re upset! But understanding a person’s reasons for feeling upset definitely seems related to affective empathy–because it’s probably going to be easier for me to “feel for” someone whose reasons I completely understand. So, the limitations of this question also illustrate the complex relationship between cognitive and affective empathy–a relationship that a simple “agree or disagree” question can’t perfectly capture.

Joanna: So, we’re aware that autistic people often score low on cognitive empathy, and score high on affective empathy. But because of all of the limitations of these tests, those scores can’t tell us the full story about the relationship between autism and empathy.

Amelia: We can’t tell you the full story, either! But we can begin to add nuance to our thinking about empathy by examining actual autistic people’s experiences with empathy.

Ryan’s experiences with empathy

Amelia: So, we asked Ryan about his experiences with empathy. We started by asking how he experiences cognitive empathy–what is it like to figure out what another person is thinking or feeling?

Ryan: It's like, if I try to figure out what somebody's feeling, that's just not, it just doesn't work. Um, like, it's not to me, that's not empathy. It's like that's, yeah. And that's research, that's, that's me trying to put words to something and, and words are insufficient at best.

Amelia: So, for Ryan, figuring out another person’s mental states is like “doing research.” This type of response often leads researchers to infer that someone doesn’t have “theory of mind.” But as we’ve described in previous episodes, it might be more accurate to understand this as a different strategy for understanding other minds–a strategy that is slower, more deliberate, and more evidence-based. And often exhausting.

Joanna: But here’s where things get complicated. When Ryan encounters people who are experiencing certain strong emotions, he can definitely pick up on those emotions–and he can become completely flooded by them.

Amelia [tape]: So it, it sounds like, you said that you experience empathy differently and it sounds like, is, do you experience a lot of empathy in the moment?

Ryan: Exactly.

Amelia [tape]: What does that feel like?

Ryan: It's intense to the point of just debilitating. So it's, you know, it's kind of funny. It's because I've, I've never been able to look in people's eyes when I talk to them and so forth. Like, I've got the camera off right now and I'm not looking at the computer purposely. Um, and that's not because, that's not because I don't feel empathy or I don't feel a connection or I'm confused by the connection. It's because the connection's so intense that it's too much, like, it's, it's too much emotion. It's um, when I was a kid I remember I would walk around and my parents used to just have to stop me because I would have to stop at every homeless person and give them everything I had, um, like it just, it would hurt so bad to see this.

Amelia: Sometimes psychologists call this phenomenon “emotional contagion.” It’s when you’re with someone who’s experiencing an emotion, and you “catch” their emotion. Ryan describes extremely high levels of emotional contagion.

Joanna: But those overwhelming emotions don’t only arise from interactions with particular people. Ryan also reports experiencing intense emotions that accompany a more abstract form of empathy.

Ryan: Yeah, it's way too much. Um, and you can just feel that you can feel the emotions of the world. Um, like during the pandemic, I, I felt that anxiety tenfold all the time, like, it was just, it was too much. Everything was, yeah, so, so it all couples together. And yeah, you just, you get overwhelmed….

Um, and I think that's why anxiety is so tied into autism, is because we can't really process why we're feeling certain things because it is abstract, but we know we're feeling it.

Amelia: This last point Ryan makes–about struggling to process strong emotions–reminds me of Joe’s discussion of alexithymia in the previous episode, episode five. Alexithymia is when someone has difficulty identifying what they’re feeling or why they’re feeling it; and as Joe explained, alexithymia is more common among people with different styles of sensory processing and interoception. When you experience alexithymia, you can just feel like a big ball of totally inarticulable emotions, which is super anxiety-producing.

Joanna: I’ve heard people say that autistic people can seem aloof, or cut off from others. But many autistic people, like Ryan, say that this is because of the overwhelm caused by exposure to other people’s strong emotions. Autistic people might avoid eye contact, or avoid communicating over video, because emotions that are created by those types of communication can be too much to process.

Amelia: But interestingly, for Ryan, all these overwhelming emotions aren’t always particularly sticky.

Ryan: But, but when I would hear stories of a homeless person or a shooting or this or that, none of it registered. Um, or when I was done and I'd passed by the individual, like, it didn't, it didn't stick with me. Um, so, so yeah, empathy was an interesting thing and, and I kind of explored it later, uh, because I started to realize that it was like this experiential thing–empathy–and I needed to kind of feel these feelings. So I wanted to learn more about homelessness. So I've lived, on 3 different occasions I've lived homeless for a stint of time, to figure out what it feels like to be homeless.

Joanna: What I find really interesting is that, when Ryan noticed that he didn’t have strong emotional responses to certain things, he worked hard to cultivate new emotional responses, often by attempting to put himself into other people’s shoes (almost literally). Like, Ryan voluntarily lived without housing so that he could feel more empathy for unhoused people.

Amelia: Ryan definitely knows that choosing to live without housing for a short time doesn’t give him perfect insight into what it’s like to live without housing involuntarily. This isn’t some kind of perfect system for understanding other people’s perspectives. But it’s arguably better than just making guesses about what it’s like to live unhoused. And the fact that Ryan is willing to do these “experiments in living” in order to understand other people’s experiences reveals that, ultimately, he really cares about people.

Ryan’s critiques of empathy

Amelia: So Ryan, who has been told by some psych test that he has no empathy, actually has incredibly strong emotional responses to other people's suffering, and when he feels he doesn't adequately appreciate what another person is going through, he puts in a lot of work to try to understand better.

Joanna: So I guess you could say that despite having been told he's got no empathy, Ryan is kind of an empathy master. Do you think he'll start teaching classes?

Amelia: I wouldn't bet on it. Because Ryan's kind of an empathy skeptic. He thinks that empathy isn't really that important, at least when it comes to morality.

Ryan: I think a lot of times, if you function solely off empathy, like, you're doing good for the sake of making yourself feel good almost…. Like, do I, it goes back to values. Like, are your, is your empathy higher than your values or vice versa? Like, am I only giving to a poor person because I'm looking them in the eye at the second and I feel empathy towards them? Or am I giving to the poor because I've got a value that says we should all have certain privileges, we should all have certain blessings. Like, wealth is something to be shared, so….

I mean, if you're doing something strictly out of, a lot of times I think empathy is a showy thing too, I hate to say. Um, it's even a little ego. It's like, like are we doing empathy work to be seen doing empathy work, to feel good about ourselves? Um, or are we doing it because it needs to be done….

And I think the other way it can backfire is you stop taking care of yourself. And that's where we're seeing, like, healthcare professionals burning out or any number of things. It's like, you become too empathetic, you function too much off empathy, and you forget, you forget to take care of yourself. And um, and, and I've been that way a long time. Like, I'll get in these realms of, somebody called me out the other day around it. Uh, where they said, like, “You’re like, you constantly focus on hunger issues, homelessness, etc, etc. But you don't eat! Like, you've got an eating disorder that almost killed you, um, like this doesn't make sense.”

Amelia: So, Ryan has three main critiques of empathy. First off, Ryan contrasts functioning off of empathy with functioning off of values. If you’re functioning solely off of empathy, then whether or not you do good things depends on whether you happen to have certain emotions when you’re around people. And our emotions are fickle and inconsistent! So according to Ryan, it’s better to function off of values–it’s better to act on the basis of principles you’ve really reflected on. That way, your behavior will be more consistent across time, and you’ll do good things even at the times when you don’t “feel” like it.

Joanna: This critique of empathy reminds me of another common critique of empathy, which is that empathy is often biased. We tend to empathize with people who are similar to ourselves, and with people who are nearby. And so according to this point of view, if we make decisions based on empathy, then we’re likely to favor people who are similar to us, or who happen to be close to us. And that seems like a pretty biased way of making decisions.

Amelia: Right, so, Ryan’s first critique of empathy is that acting on empathy is different from acting on values, and so acting on empathy can lead to inconsistency and bias. And Ryan’s second critique of empathy is that it’s showy. Ryan thinks that sometimes we fool ourselves into thinking that we’re acting out of genuine empathy, because we assume that being an empathic person is a good thing–and we want to be (and be seen as) “good people.”

Joanna: And Ryan’s third critique of empathy is that it can endanger the person who experiences it. If someone is relying heavily on empathy, they might get too caught up in other people’s emotions, they might begin to neglect their own basic needs and… they might burn out as a result.

Take-aways

Joanna: Our conversation with Ryan led us to two main take-aways. First, it seems like empathy is more complicated than we often make it out to be. It’s hard to even break it down into clear sub-types, like “cognitive empathy” and “affective empathy” and “emotional contagion.” Empathy seems to include all sorts of different experiences, skills, and dispositions, which can come in different combinations with each other. And the second take-away is that maybe empathy isn’t all it’s cracked up to be.

Amelia: Next time, we look at other ways of conceptualizing empathy. And we talk to a philosopher about Ryan’s critiques.

Heidi: Of course there are shortcomings to all of these things when people have widely diverging experiences. What I don't like about a lot of the current debate is that people tend to over focus on that, as if like, “okay, we can't always get it right, so therefore, you know, it must be this pretty shitty tool.” And I think no, it's this massively useful tool, it’s the best that we have, but we shouldn't let that blind us from differences and we certainly shouldn't say, like, “well, when I look at your situation, this is how I feel so I'm going to invalidate your emotion” right? That's, that's not the way to use it….

Credits

Amelia: Thanks for listening to NeuroDiving. This episode was written, hosted, and produced by me and Joanna Lawson.

Many thanks to Ryan Althaus for sharing his experiences with us, and forcing us to think really hard about the nature of empathy. Ryan has written a compassionate, insightful, and sometimes really funny book about his eating disorder recovery journey called From Emaciated to Emancipated. And he’s written other books for both children and adults. You can find links to his writing in our show notes.

And thanks to the Marc Sanders Foundation and the Templeton Foundation for their support of the show.