A New Treatment for Autism

What happens when you have been seeing the world in black and white, and all of a sudden someone turns on the color?

What happens when an autistic man, someone who has always had great difficulty reading emotional cues, can suddenly see and feel it all clearly?

John Elder Robison is autistic. He chose one day to participate in a new study conducted by the Harvard Medical School. Allow him to describe the treatment:

Then I was offered a chance to participate in a study at Beth Israel Deaconess Medical Center, a teaching hospital of Harvard Medical School. Investigators at the Berenson-Allen Center there were studying transcranial magnetic stimulation, or T.M.S., a noninvasive procedure that applies magnetic pulses to stimulate the brain. It offers promise for many brain disorders. Several T.M.S. devices have been approved by the Food and Drug Administration for the treatment of severe depression, and others are under study for different conditions. (It’s still in the experimental phase for autism.) The doctors wondered if changing activity in a particular part of the autistic brain could change the way we sense emotions. That sounded exciting. I hoped it would help me read people a little better.

It sounds like an interesting idea. The problem was: it worked. In some ways it worked too well.

Suddenly, Robison found himself assaulted by raw, unprocessed emotions. He did not know what to make of them and did not know what to do with them. Also, he felt compelled to blurt out his own personal feelings, feelings that he had not henceforth known he had.

It was almost as though he had become someone else. Friends and family who had expected to be dealing with one person found themselves facing someone else. Many of them did not very much like the new person they were facing. Some, like his wife, could not deal with him at all any more. Enhanced emotional sensitivity is not necessarily such a good thing, unless you know how to deal with it.

Robison described his experience:

They say, be careful what you wish for. The intervention succeeded beyond my wildest dreams — and it turned my life upside down. After one of my first T.M.S. sessions, in 2008, I thought nothing had happened. But when I got home and closed my eyes, I felt as if I were on a ship at sea. And there were dreams — so real they felt like hallucinations. It sounds like a fairy tale, but the next morning when I went to work, everything was different. Emotions came at me from all directions, so fast that I didn’t have a moment to process them.

Before the T.M.S., I had fantasized that the emotional cues I was missing in my autism would bring me closer to people. The reality was very different. The signals I now picked up about what my fellow humans were feeling overwhelmed me. They seemed scared, alarmed, worried and even greedy. The beauty I envisioned was nowhere to be found.

Seeing emotion didn’t make my life happy. It scared me, as the fear I felt in others took hold in me, too. As exciting as my new sensory ability was, it cost me customers at work, when I felt them looking at me with contempt. It spoiled friendships when I saw teasing in a different and nastier light. It even ruined memories when I realized that people I remembered as funny were really making fun of me.

In this initial stage, being emotionally sensitive did not lead to happiness. It led to distress. Robison was crippled by the sensations. He did not know how to process the emotions, to put them in place, to keep them at a distance, to think about them, to apply his rational faculties to them. Lacking those abilities, he was overwhelmed. Apparently, human emotions do not exist in an aesthetic vacuum. And yet, for the post-treatment Robison, they did.

Unfortunately, it cost him his marriage.

In his words:

When I met my former wife (a decade before the T.M.S.), she was seriously depressed. She’d accepted my autistic even keel, and I accepted her often quiet sadness. I never really felt her depression, so we complemented each other. She could read other people much better than I could, and I relied on her for that.

Then came the T.M.S. With my newfound ability I imagined myself joyfully shedding a cloak of disability. I thought she would be happy, but instead she said matter of factly, “You won’t need me anymore.” My heart hurt, and I felt unspeakably sad. Later, people at work told me they’d liked me better the way I was before.

I’d lived with my wife’s chronic depression all those years because I did not share it. After the T.M.S., I felt the full force of her sadness, and the weight of it dragged me under. At the same time, I felt this push to use my new superpower, to go out in the world and engage with other people, now that I could read their emotions. When I think about the way my behavior must have appeared to the strangers I encountered, I cringe.

Apparently, a man whose wife is chronically depressed does best to be insensitive. As soon as he begins to tune in to his wife’s despair, he is overwhelmed. He is incapable of distancing himself from what he is feeling.

Moreover, after he was no longer emotionally disabled, his wife believed that they were no longer soul mates, and that he would no longer need her. Since she had apparently defined herself as his eyes and ears in the world of human emotion, his new ability made her feel superfluous.

As it happened, emotional insight created as many problems as it solved:

I learned the hard way that emotional insight allowed me to see some things, but another person’s true intent and commitment remained inscrutable.

And also:

After some initial tumult, the changes in me proved transformational at work. My ability to engage casual friends and strangers was enhanced. But with family and close friends, the results were more mixed. I found myself unsettled by absorbing the emotions of people I was close to, something that had never happened before. Strong emotional reactions welled up in me, and I showed feelings I had never expressed.

But then, the intensity faded. I am not clear about whether this happened because Robison was learning how to process the emotions or whether the treatment was wearing off—assuming that the change it produced in the brain could wear off.

At the least, the TMS treatment does not seem to cause Robison to revert to his earlier state and it certainly did not cause him to regress.

Either way, the story does have a happy ending:

I’m married again, to someone who’s emotionally insightful. To my amazement, she became best friends with my first wife, and helped me reconnect with my son. She started a tradition of family dinners and gatherings, and brought new warmth into my life. Even more, she helped me become part of a web of emotional connectedness I’d never known before, and surely could not have known pre-T.M.S.

That really shines through in my relationship with my son. We had grown apart before the T.M.S. through a combination of his teenage rebellion and our mutual inability to read each other’s feelings. (My son is on the autism spectrum, too.) We joined the T.M.S. study together, and it became a powerful shared experience. Even as the T.M.S. effects pushed my ex-wife and me apart, they drew my son and me together. The T.M.S. also helped me understand my mother, in the last years of her life.

I’ve made new friends, and built a stronger business. And there’s something else: I’ve learned that the grass is not always greener when it comes to emotional vision. For much of my life, I’d imagined I was handicapped by emotional blindness. When that changed, seeing into other people was overwhelming. Becoming “typical” proved to be the thing that was truly crippling for me. Now I realize that my differences make me who I am — success and failure alike. I’d call that hard-won wisdom.

Considering that this is a new study, it is best not to jump to conclusions. But certainly, it is well worth our attention.

[Further information about the Robison book in this review by Jennifer Senior.]