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=                           Mind-blindness                           =
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                            Introduction
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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 of 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), and the "mind-blindness" theory asserts that children
who delay in this development often are or will be 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.


Theory of mind
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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 the 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.

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 mentalisation 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 autism
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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 to mind blindness. Abnormal behaviour of autistic children
is 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 behaviour 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 because those diagnosed with
AS seem more neurotypical in early childhood development. The siblings
of individuals diagnosed with AS were shown to have a lesser variant
of ToM deficits. This shows that the cognitive deficits affecting ToM
play a central role in the phenotype expressed in AS diagnoses.


Relationship to schizophrenia
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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
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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.

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.


                              See also
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* Alexithymia


                             References
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*Geoffrey Cowley, "Understanding Autism," 'Newsweek', July 31, 2000.
*Simon Baron-Cohen, "First lessons in mind reading," 'The Times Higher
Education Supplement', July 16, 1995.
*Suddendorf, T., & Whiten, A. (2001). "Mental evolution and
development: evidence for secondary representation in children, great
apes and other animals." Psychological Bulletin, 629�650.


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