Mind-blindness is a concept of a cognitive divergence where an individual is unable to attribute mental states to others. As a result of this kind of social and empathetic cognitive
phenomenon, the individual is incapable in putting themselves "into
someone else's shoes" and cannot conceptualize, understand or predict
knowledge, thoughts and beliefs, emotions, feelings and desires,
behaviour, actions and intentions of another person. Such an ability to develop a mental awareness of what is in the other minds is known as the theory of mind (ToM),autistic. In addition to autism, ToM and mind-blindness research has recently been extended to other fields such as schizophrenia, dementia, bipolar disorders, antisocial personality disorders as well as normal aging.
Relevance and causes
Theory of mind
Mind-blindness
is a state where the ToM has not been developed, or has been lost in an
individual. According to the theory, ToM is implicit in neurotypical
individuals. This enables one to make automatic interpretations of
events taking into consideration the mental states of people, their
desires and beliefs. Simon Baron-Cohen
described how an individual lacking a ToM would perceive the world in a
confusing and frightening manner, leading to a withdrawal from society.
An alternative approach to the social impairment observed in
mind-blindness focuses on emotion of subjects. Based on empirical
evidence, Uta Frith
concluded that the processing of complex cognitive emotions is impaired
compared to simpler emotions. In addition, attachment does not seem to
fail in the early childhood of autistics. This suggests that emotion is a
component of social cognition that is separable from mentalizing.
Lombardo and Cohen updated the theory and pinpointed some
additional factors that play an important part in ToM of autistic
people. They highlighted that the middle cingulate cortex
which is outside the traditional mentalizing region was underactive in
autistic patients, while the rest of ToM activation was normal. This
region was important in deciding how much to invest in a person and
hence required mentalization.
Biological basis
Neural
correlates of the ToM point towards three regions of the brains. The
anterior paracingulate cortex (Brodmann), is considered at the key
region of mentalizing. It is located anterior corpus callosum and the
anterior cingulate cortex. This cortex is associated with the medial
frontal cortex where activation is associated with the mentalization of
states. The cells of the ACC develops at the age of 4 months suggesting
that the manifestations of mind-blindness may occur around this time.
In addition to the anterior paracingulate cortex is the superior
temporal sulcus and the temporal poles that are involved with the ToM
and its nature. However, these areas are not uniquely associated with
mentalization. They aid in the activation of the regions that are
associated with the ToM. The superior temporal sulcus is involved in the
processing of behavioural information while the temporal poles are
involved in the retrieval of personal experiences. These are considered
important regions for the activation of the ToM regions and are
associated with the mind-blindness. The temporal poles provide personal
experiences for mentalization such as facial recognition, emotional
memory and familiar voices. In patients suffering from semantic
dementia, the temporal regions of these patients undergo atrophy and
lead to certain deficits which can cause mind-blindness.
Superior temporal sulcus
The amygdala and the orbitofrontal cortex also are a part of the ToM.
It is in involved in the interpretation of behaviour which plays an
important role in social cognition and therefore contributes to the
theory of the mind. It is suspected that the damage to the orbitofrontal
cortex brings upon subtle impairments, but not a total loss of the ToM
that would to mind-blindness. Some studies
have shown that the orbitofrontal cortex is not directly associated
with the theory of the mind or mind-blindness. However, a study by Stone
and colleagues were able to show impaired ToM on mentalization tasks.
Since the frontal lobe is associated with executive function,
researchers theorize that the frontal lobe plays an important role in
ToM and its associated nature. It has also been suggested that the
executive function and the theory of mind share the same regions.
Despite the fact that ToM and mind-blindness can explain executive
function deficits, it is argued that autism is not identified with the
failure of the executive function.
Lesion studies show that when lesions are imposed to the medial
frontal lobe, performance on mentalization tasks is reduced, similar to
typical mind-blindness cases.
Patients that experienced frontal lobe injuries due to severe head
trauma showed signs of mind blindness, as a result of a lost ToM.
However, it is still debated whether the inactivation of the medial
frontal lobe is involved in mind-blindness.
Frith and Frith proposed that a neural network that comprised the
medial prefrontal cortex, the anterior cingulate cortex and the STS, is
crucial for the normal functioning of ToM and self monitoring. This so
formed dorsal system is crucial for social cognition. Disruption of this
neural network leads to mind-blindness in schizophrenic individuals.
Another clue towards a possible explanation of mind-blindness in
autistics was done by Castelli and colleagues. They were able to show
that the connectivity between occipital and the temporo-parietal regions
were weaker in the autistic group than the control group. The under
activation of this network may inhibit the interactive influences
between regions that process higher and lower perceptual items.
Relationship to diagnostic criteria
Relationship to autism
Mind-blindness is usually associated with autistic
people. Lower performance on the mentalization tasks were the first
screening task used to diagnose the autism, with a good prediction
level.
Cohen proposed the mind-blindness theory of autism as "deficits
in the normal process of empathising". He described empathising to
include the ToM, mind reading and taking an intentional stance.
According to this view empathising includes the ability to attribute
mental states and to react in an appropriate emotional manner which is
appropriate to another's mental state. More deficits tend to occur in
reference to one's own mental states compared to the other's mental
states. It has been proposed that autistic people undergo a specific
developmental delay in the area of metarepresentational development. The
delay facilitates mind-blindness.
There is some evidence that suggests that certain patients
develop a rudimentary ToM and do not suffer from complete lack of ToM
causing mind-blindness.
A study by Bowler concluded that mind-blindness and social impairment
is not as straightforward as previously thought. It showed that a
complete possession of ToM was not enough to protect from social
impairments in autistic people. Conversely the absence or impairment of
the ToM that leads to mind-blindness does not lead to social
impairments.
The social and cognitive differences seen in autistic people are
often attributed due to mind blindness. Abnormal behaviour of autistic
children are perceived to include a lack of reciprocity. Some cases in
which mind-blindness manifests includes the child being totally
withdrawn from social settings as well as not being able to make eye
contact while in other cases the individual may attempt to interact with
other people. However, global asocial behaviors is not the rule in
autism. Cohen described the cognitive/mind-blindness effects in autistic
people as a "triad of deficits". The triad consists of deficits in
social, communication and imagination of others' minds.
Ozonoff and colleagues were able to discriminate between autistic people diagnosed with Asperger's syndrome
and other autistic people by their ability to solve ToM tasks. It is
due to those diagnosed with AS seem more neurotypical in development
early on in childhood. The siblings of individuals diagnosed with AS
were shown to have a lesser variant of ToM deficits. This shows that the
cognitive deficits that affect the ToM play central role in the
phenotype expressed in AS diagnosed.
Relationship to schizophrenia
People with schizophrenia also show deficits associated with mind-blindness.
However, there is an ongoing debate as to whether individuals with
schizophrenia have an impaired ToM leading to mind-blindness or display
an exaggerated ToM. Unlike autism, schizophrenia is a late onset
condition. It is speculated that this difference in the condition may
account for differences seen in the ToM abilities.
Brain lesion studies show that there are differences seen in the
laterality of brain that account for mind-blindness. It is unknown
whether the ToM in schizophrenia deteriorates in the affected person as
the condition progresses.
The cognitive impairment linked to mind-blindness is best
explained by a modular theory; the domain specific capabilities that
account for mindreading and mentalization are lost in schizophrenia.
Furthermore, Frith has predicted that the extent of mind-blindness
depends on whether the objective/behavioural or subjective symptoms of
ToM abilities prevail.
Patients with the behavioural symptoms perform the poorest in ToM
tasks, similar to autistic subjects, while patients displaying
subjective/experiential symptoms have a ToM. However, these patients are
impaired in using contextual information to infer what these mental
states are.
Criticism
The
mind-blindness theory helps to explain the impairment in the social
development of individuals as well as the impairment in the
communication skills of autistics. However one of the most important
limitations of this theory is that it is unable to explain the highly
repetitive behaviours which is a characteristic trait attributed to
autistic people. This triad is explained through the process of
systemising. The theory also did not account for the motor problems and the superior rote memory skills that were associated with autism.
These aspects along with the highly repetitive behaviours formed the
triad of strengths. Simon Baron-Cohen himself has acknowledged that the
theory, while adept at explaining the communications difficulties
experienced by autistic people, fails to explain such patients'
penchants for narrowly defined interests, an important step to proper
diagnosis. Furthermore, mind-blindness seems decidedly non-unique to
autistic people, since conditions ranging from schizophrenia to various narcissistic personality disorders and/or anti-social personality disorders all exhibit mind-blindness to some degree.
Another issue associated with the mind-blindness theory is that
researchers are unable to predict whether the social deficits are a
primary or secondary result of mind-blindness. In addition, Klin and his
fellow researchers highlighted another limitation that was that the
mind-blindness theory failed to delineate whether the ToM deficits are a
generalised deficit or a specific discrete of a mechanism.
Stuart Shanker also argued in favour of Klin's argument, that a major
part of the mind-blindness theory depicts the ToM as an autonomous
cognitive capacity compared to being part of a more general ability for
reflective thinking and empathy.
A boy with autism, obsessively stacking cans.
Other researchers have pointed out the inherent flaws of assuming
autistic traits develops from a "theory of mind" deficit, pointing out
that this presupposes autistic traits derives from a single, core
insufficiency within the brain. This contrasts, they say, with the very
same researchers' description of autism as a "puzzle", which implies a
far more diverse range of causes than a single, unifying theory.
Many have also pointed out that Mind-blindness wrongly
categorizes autism as a problem to be fixed, rather than a condition to
be accommodated. This assumes an inherent lack of intelligence
in autistic people, which ignores the nuanced view of intelligence (as
in varying types of intelligence) that has been observed in cognitive
research.
The drawbacks in the Mind-blindness theory of autistic people paved way for the E-S theory
which helps to explain the observations seen in these individuals. The
E-S theory accounts for both the triad of deficits which is the loss of
empathising and the triad of strengths is related to hyper systemisation
of certain behaviours. The theory also helps to explain the exaggerated
male spectrum termed as the extreme male behavior.
