What makes us social? Autism, mentalising, and the need for new labels

You may find this hard to believe: when I started my research in the 1960s the words ‘autism’ and ‘autistic’ were virtually unknown. ‘Early Childhood Autism’ was still a novelty, and it took time before it became an established neurodevelopmental condition. I still vividly remember Daniel, aged four, the first autistic child I met. I had never encountered a child like him. What struck me was that I could not engage him in any activity that required taking turns or give and take, but much to my astonishment, he expertly assembled a jigsaw puzzle without being asked. He never used speech to address other people, but sometimes repeated overheard phrases. Daniel's parents reported that his way of communicating was to take somebody by the hand and lead them to what he wanted.

In the 1960s, autism was a rare diagnosis — the estimate was four in 10,000 children. All had severe or social communication difficulties and showed restricted repetitive behaviours. Some had special interests and showed superior skills in certain tasks. All suffered from varying degrees of learning difficulties.

Autism is now diagnosed in a large number of individuals. The estimate is at least one to two per cent of the population. Some of this increase is due to increased awareness of the condition and to loosening of the criteria. However, a staggering increase of over 700 per cent over the last 20 years as found in the UK reflects something else as well. This increase was driven by adults who had not been diagnosed as children and who now asked for an assessment after having recognised themselves as autistic. Today, everyone knows somebody who is autistic, or at least ‘a little bit autistic.’

I believe that research on autism has acted as a gateway to research in social cognition that made it go beyond traditional social psychology. A key idea we stumbled on explained what made social communication so difficult for autistic individuals and at the same time, so incredibly intuitive for everyone else. Everyone else routinely relies on the ability to track other people's mental states, such as beliefs and intentions. Through an intuitive ‘Theory of Mind,’ we can predict and explain why people do the things they do regardless of the physical state of the world. Mostly this is quite mundane and very straightforward. For example, “Why did John take an umbrella with him when he went out?” No, not because it was raining – the physical world – but because he believed it was raining and did not intend to get wet: the mental world. We invented the term ‘mentalising’ to refer to this amazing ability.

Going back to Daniel's inability to engage in two-way communication, was this because he was unable to mentalise? From the 1980s, this hypothesis has been tested repeatedly — and largely confirmed. Excitingly, from the 1990s Brain Imaging came along and we could observe what happens in the brain when people had to use their mentalising ability. In this way, a circumscribed brain system was identified: the mentalising system. This network shows distinctly abnormal activation patterns in autistic individuals.

But mentalising is only one of many mechanisms in our social mind/brain. I'm going to use the imaginary prop of a house to locate some of these.

This is a house with many floors, and we enter at the basement. The basement is an alchemist’s workshop full of little goblins that produce and tend neurochemical substances. They enable some remarkable abilities. For example, they make mammals bond with their young and nurture them. They induce them to affiliate with their family, to shun strangers. Somewhere here might be the basis for a social capacity in the human brain that we refer to as ‘love.’

The ground floor of the house is a great hall served by smooth-running devices that make you align with other individuals so that you feel empathy if your partners are in pain, and join in joyously if there is laughter. The power base on this floor is the brain's mirror neuron system that primes us to copy others. We know quite a lot about this system. It has been delineated in the brains of monkeys as well as humans.

One floor up, you will find a grand ballroom — the ideal setting to display your mentalising ability. The mechanism here is not as ancient as the ones on the lower floors. It's rather rare in the animal kingdom and it is fragile, as can be seen in the case of autism.

Let us pause for a moment and ask about mechanisms other than mentalising that might show malfunction in autism or in other conditions. This question is still wide open and a challenge for future research. So far, it seems that the ability to experience empathy is not necessarily impaired in autism, however, it is impaired in psychopaths. In contrast, psychopaths seem to possess an excellent mentalising ability that they can use to their advantage to understand and manipulate their victims.

We now arrive at the top floor of the house where we are entirely in the human social world and can enter the mental world of ideas. Here lives imagination, as well as rational thought. This floor is a monitoring and control station, specially adapted for conscious reflection. The mechanisms here spring into action when it's necessary to address problems on the lower floors. There is reason to believe that in autism, top-down control is not always working efficiently — so difficulties of emotion regulation are very common.

Now, coming to the rooftop of the house, we find it is a radio station. It is broadcasting news and scanning the horizon for news to receive from other transmitters. Here is the interface of the Self to other minds. This interface ensures that we have a shared culture, that is more or less the same ideas and the same experiences. Here is where ideas are refined and even changed by continuously broadcasting and receiving them back again. This looping mechanism might be the course of the profound changes that happened in the concept of autism over the last 30 years or so.

The escape of autism from the clinic already started when we realised that autism could be found in people of superior intelligence — typified by the absent-minded and socially inept professor. We all know people like that, often real professors! The meaning of the medical label ‘autism’ was dramatically reshaped by fiction, starting with the film Rain Man in the late 1980s. Here the public was introduced to an autistic protagonist who was socially naive and unable to live by himself, but at the same time a ‘savant’ — capable of amazing feats of memory and calculation.

Savant skills became perhaps the most salient part of the concept of autism. Even though truly outstanding talent is only found in around 10 per cent of cases, odd but highly intelligent characters are frequently represented in the media. Currently, they are an icon as detectives who defy convention and use their special skills to reach the truth. For example, Saga Norén in The Bridge and Astrid Nielsen in Murder in Paris. These characters are typically much less socially impaired than the character in Rain Man, but their autistic traits are instantly recognisable to everyone.

Today, autism is no longer a ‘spectrum of disorders’ as originally proposed, but a spectrum where the ‘neurodiverse’ shades into the ‘neurotypical.’ In terms of this new spectrum, we can all be ‘a little bit autistic.’ There are many sites on the internet that provide tests to review just how autistic we might be. Autism now is a new way to be a person, to experience yourself, to live in society. The term ‘disorder’ is no longer appropriate. And this is very problematic for clinicians and for researchers. At the very least, I think we need new labels, and this leads me to urge future researchers to look more deeply into the underlying neurocognitive mechanisms that drive our complex social understanding. In this endeavour, differences between the neurotypical and the neurodivergent may open our eyes to the hidden mechanisms that we cannot see at present.

Uta Frith FBA is a developmental psychologist and Emeritus Professor of Cognitive Development at University College London.