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A friend of Joe’s, who had Asperger’s syndrome, used to stand in front of a mirror and brush the front of his hair, but never the back. The image he saw in the mirror didn’t show the back of his and, clearly, he was not relating the image he saw to a bigger ‘picture’ of his head as a whole. He was genuinely unaware that a human being can be seen from all angles and that, therefore, he should comb his hair back and front, if he wanted to make a neat impression. Clearly, there was a major category of information missing in his mind: being able to view a situation from different perspectives (context).
Sarah, a woman with Asperger’s syndrome, was asked by a friend what she thought of an expensive fancy handbag the friend had just bought. Sarah didn’t like the bag and was completely nonplussed as to how to respond. She could see only two possibilities: to tell the truth, which was that she disliked it, or to say nothing. She was unable effortlessly to juggle in her mind conflicting perspectives (not liking the bag, liking the friend) and choose an appropriate one to communicate, on the basis of a wider knowledge of the possible consequences (upsetting or pleasing her friend). She was unable to see, for example, that an honest opinion is not always required in such circumstances; she could have pretended to like the bag, complimented her friend for buying it, or told her that it was a bargain. In fact, she said nothing at all, which totally perplexed and unsettled her friend. (This inability of people with Asperger’s syndrome to be tactful or diplomatic is often interpreted as frank honesty.)
A very intelligent man who had Asperger’s syndrome used to come out in a rash whenever he was anxious, which bothered him. One day, he read in a health magazine that mustard was good for skin rashes and promptly bought an industrial-sized pot of it, so that he could plaster mustard over his face every day. It never occurred to him that customers in the shop he managed would think it odd to see him walking around with a bright yellow face.
Another man with Asperger’s syndrome, also highly intelligent, described to us how his wife gave him a little box of chocolates just before they went out to celebrate his birthday and said, “You can eat the whole box while I go upstairs to get ready”. When she came down a little later, dressed for their night out, she found him eating the cardboard box. She immediately got angry and shouted at him — but he had absolutely no idea why. After telling this anecdote, he said, “It seems as though other people have a concept to follow that I am missing. I just follow the instruction.” If he had had instant access to the knowledge that humans are not expected to eat cardboard boxes, just the contents of the box, he would not have engaged in this bizarre behaviour. (Interestingly, such literalism can also be observed in people in deep trance.)
Another example: a professional woman who came to see one of us had decided to give up her job in a bank and go and live in a Buddhist meditation centre. Although she was keen to do this, she was also very sad and upset because she would never see her mother again. When asked why, she said, “My mother’s a Catholic”. She assumed that, if she went to visit her mother, she would have to tell her about her own change in religious belief, and that her mother wouldn't be able to cope with it. It didn’t occur to her that people of different faiths can still know and love one another, especially if they are family; or that she could choose to protect her mother from what she thought would be devastating information for her, and just continue to go to Mass with her mother whenever she was home.
Clearly, in such cases, people lack the information necessary to inform their judgements about the choices and actions available to them in different situations.
It is, therefore, easy to see why people with caetextia experience high levels of frustration, anxiety and anger when other streams of information keep intruding into whatever they are trying to do — especially when their needs for structure, rules and rituals are transgressed. Because they don’t know instinctively that multiple factors affect any given situation, they may be nonplussed even when just two simple interacting factors require attention. We saw this clearly in the jerky way a colleague with Asperger’s syndrome would drive. Whenever he became aware that a gap between his car and the one in front was closing or widening, he responded by jamming on his brakes or speeding up inappropriately, instead of gently moderating his speed to accommodate what is, after all, a continually fluctuating situation when driving. He found it difficult to negotiate varying circumstances smoothly — other drivers changing speed, closeness to other vehicles, the curve of the road, weather conditions, etc — all of which need constant simultaneous attention.
On one occasion, he was in the wrong lane when approaching a set of traffic lights. When it was pointed out to him that he needed to move over to the right lane, he refocused his attention on this new task and was unable at the same time to continue processing and prioritising other relevant information — such as the fact that the light had changed to red and that driving through it could get him and his passengers killed. Indeed, he proceeded to drive on through the red light, causing us much alarm and consternation! Although he was aware of this deficit, and described it as ‘straight-line thinking’, he was unable to do anything about it.
A dream, by chance related to Joe by his teenage daughter Liley-Beth, served to crystallise our thinking about the role of context. In the dream, she went to a club with a horse; all the other girls there were dancing with horses and she, too, started dancing with a horse; it seemed the most natural thing in the world. Then the horse asked her out and she was just wondering whether to accept when she woke up. When Liley-Beth described the dream over breakfast, she said that what astonished her most about it was her unquestioning acceptance, in the dream, that humans can go out with horses. Everyone who remembers dreams will recognise this feeling of accepting as perfectly natural a phenomenon that is actually distinctly odd: it is the same as that described by the man who had felt it was natural to eat the cardboard box — except that he was awake.
So why did Liley-Beth unquestioningly accept, as we all do in dreams, such bizarre happenings? The reason has to be that in dreams we have access to emotions and metaphor but not context because, while dreaming, the prefrontal cortex, which the right hemisphere draws on for background information, is switched off. The context missing in this dream was the information that humans do not go on dates and dance with horses; horses can’t walk around on two legs and speak like humans. Because, in the dream, Liley-Beth was cut off from the background information usually available to her, she was totally accepting of the validity of the dream imagery. Exactly the same thing appears to be happening in the experience of people with Asperger’s syndrome (caetextia). They accept absurdities as true and make judgements about them, without the background information to apply to the context they find themselves in.
For those of us not permanently suffering from caetextia (it can be a temporary phenomenon, too, induced by stress and anxiety and depression), our minds can unconsciously draw on a vast hinterland of information that informs different aspects of any situation we find ourselves in. People with caetextia cannot do that because, although they may have collected millions of individual ‘facts’ in their memories, they are missing the ability to scan instantly for patterns in that rich background of information. Consequently, when something changes, they can’t evaluate the importance of the change and how it affects what is going on in the wider environment. They can no more do a reality check while awake than anyone else can while dreaming.