Chapter 8

The Water Lilies Have Opened Their Eyes

I shall be telling with a sigh

Somewhere ages and ages hence:

Two roads diverged into a wood, and I –

I took the one less travelled by

And that has made all the difference.

Robert Frost, ‘The Road Not Taken’

Brother Juniper featured several times in The Little Flowers of St. Francis, a collection of legends written in the thirteenth century. One of the legends tells of the time that Brother Juniper went to visit a sick man at St Mary of the Angels. He asked 'Can I do thee any service?' The brother replied that he'd like a pig's foot to eat. Without further ado, Brother Juniper took a knife from the kitchen, found a herd of pigs, caught one of them and cut it's foot off. He took the foot back, cooked it and gave it to the sick man. Meanwhile, the swineherd, who had seen Brother Juniper, went to the convent and called the Friars hypocrites, deceivers, robbers and evil men. St Francis apologised to him on behalf of all the Friars and upbraided Bother Juniper.

'Brother Juniper was much amazed, wondering that any one should have been angered at so charitable an action. And so he went on his way, and coming to the man, who was still chafing and past all patience, he told him for what reason he had cut off the pig's foot, and all with such fervour, exultation and joy, as if he were telling him of some great benefit he had done him which deserved to be highly rewarded.' The man then realised the 'charity and simplicity of his story' and, after weeping copiously, killed the pig and presented it to the convent.

Another legend tells of the time Brother Juniper cooked food for the entire fortnight not realising that it would spoil. The Brother Superior shouted at him, but the only thing that Brother Juniper noticed was that his Superior's voice had grown hoarse with shouting and he cooked him some porridge. His Superior refused to eat it - by now it was late at night. Brother Juniper eventually gave up trying to persuade him to take the porridge, but he asked him to come down and hold a candle for him so that he had light enough to eat it himself. The Brother interpreted this as Brother Juniper's simplicity and piety and shared the meal with him.

Brother Juniper was well known for his literal interpretation of the Franciscan virtues of poverty and charity and would give away all his clothes and once even cut the bells off the alter cloth to give to a poor woman. Uta Frith believes that Brother Juniper probably had Asperger's syndrome. She says, 'What the case of Brother Juniper highlights is one of the many astonishing aspects of autism, namely utter guilelessness.' It also highlights the intelligence of the man combined with his stunning literalness. Another more recent literal interpretation of the bible was given by an eight-year-old child with Asperger's syndrome. He was looking at a film about Abraham who was told to sacrifice his son to God. He watched passively enough, and at the end uttered one word: 'Cannibals.'

In Asperger's own words, these children seem to have 'fallen from the sky'. Autism can now be diagnosed as early as eighteen months, and some people who have Asperger's are initially diagnosed as autistic, before the prognosis is corrected later. Others may go for many years without being diagnosed at all, or are treated for schizophrenia. The criteria for diagnosing Asperger's syndrome are the same for autism: impaired social communication, lack of pretend play and poor communication skills. However, language and cognitive development of Asperger’s sufferers are usually not significantly delayed. Their speech is often pedantic and stereotyped, their movements clumsy, they interact in a peculiar way socially, cannot show empathy, and have a very narrow range of odd all-absorbing interests. Many are very intelligent and for this reason they are often referred to as ‘high-functioning autistics’. The two terms, autism and Asperger’s syndrome are even used interchangeably.

Ben was one of the lucky ones. He was diagnosed early, before his fourth birthday. His mother says, 'He was a spectacular baby. He stood alone at seven months, walked unaided at nine. By eighteen months he knew dozens of rhymes and stories by heart, could identify every colour and knew most of the letters of the alphabet. We were delighted and complacent. When you have a child who can sing, tunefully, every verse of "Good King Wenceslas" before the age of two, you don't tend to look for problems.'

Ben's parents initially ignored the strange side of their child, the fact that he didn't share toys or copy people's actions. 'He didn't babble and he had no baby words. He applied his quotations to appropriate situations: "And there in the doorway stood a huge green alligator," he said, looking at our stout cleaning lady wearing a green dress.'

When the family finally realised that Ben had a problem, his mother tried to look at the positive aspects of his condition. As she says, 'There are some advantages for a parent in having a child who would rather watch dust motes in sunlight than Power Rangers, and who lets us know that he wants to visit they pond by saying, "The water lilies have opened their eyes now."' When asked what he wanted for Christmas, he replied, 'Aphids'. Even so, Ben, like all other people with Asperger's syndrome has an incurable disorder. His mother says, 'The fear that one's child may never sustain normal relationships or even be tolerated by other people is harrowing.'

Despite their inability to show pretend play, people with Asperger's often have vivid imaginations and can use striking imagery. James always asks strangers, 'What would you do if a tall man with yellow hair came and swung you up on his shoulders?' When he was younger he wrote a short story to explain his question, part of which is reproduced here.

This wicked witch thought it would be great fun to make someone suffer for all absolute endless eternity. So one night, after I started school, the wicked witch came to my house and crept upstairs to my bedroom. Then the wicked witch put a spell into my mouth and gave me a drink of water to swallow the spell so that it would work. The magic spell was to make me fall in love with that man who was nine feet tall with long, straight, light yellow hair down to his elbows, who was wearing a dark brown three-piece suit....

And then one day, when I had been at that school for six or seven years, this man at my school who looked so fine to me and made me feel so great decided to leave school and go to live somewhere else millions and millions of miles away. When I came back to school on the first day of the following term, I looked all round and about the playground for this man who looked so fine to me and made me feel great, but I couldn't find him anywhere. So I asked the teachers, 'Where is that man who is nine feet tall and thin with long, straight yellow hair down to his elbows, who wears a dark brown three-piece suit, because I love him with all my heart, and he looks so fine to me that he makes me feel great?'

Unable to show empathy, some people with Asperger's have killed. However, given that they are not concerned with asserting dominance or being violent towards others, the murders occur more in the way of lethal experiments, such as the boy who was fascinated with fire and burned down his dormitory with a couple of his room-mates in it. One seven- year-old boy said, 'Mummy, I shall take a knife one day and push it in your heart, then blood will spurt out and this will cause a great stir.' He remarked that there wasn't enough blood when she cut herself, and was himself quite excited when he was injured. Most people involved with the boy considered him sadistic, but it is more likely that he was fascinated with blood.

The intelligence of the person with Asperger's allows him or her to solve the Sally-Ann or Smarties test for Theory of Mind, and many can pass higher-order tests such as the tale of Mary and John and the ice-cream van. However, over seventy per cent of those tested do not use words referring to mental states to explain a character's action. Verbal skills do influence their ability to pass Theory of Mind tasks, but they still cannot relate to other people effectively. It's likely that they are using logical reasoning and other cognitive processes to work out Theory of Mind tasks, since they have to think carefully before replying. In their everyday life, they still appear odd and are not able to capitalise on their logical approach to solving Theory of Mind tasks in test conditions. They often show impairments in skills that require mindreading, such as taking a hint or keeping a secret, but they can learn to share and initiate routine conversations. Although these people are able to think about thinking, their handicap in relating to others means they often need sheltered accommodation and employment. Normal children pass Theory of Mind tasks when their verbal mental age is that of a four or five year old, but people with Asperger's need a verbal mental age of a ten year old. Uta Frith comments that the absence of the ability to mindread during their development must have left some permanent scars and so it is no wonder that they don't function normally in real life and find using their hard-won Theory of Mind demanding.

People with Asperger's have a greater degree of awareness about their own plight and often understand that they don't know about other people's mental states. As one man said, 'Other people seem to have a special sense by which they can read other people's thoughts.' John, a teenager with Asperger’s, didn't know how to interact with girls so he watched them and wrote down everything they did. Sadly, his ignorance, and perhaps innocence, resulted in an indecent assault on one young woman.

Margaret Dewey, from the University of Michigan, made up stories and asked adults with Asperger's what they thought of the characters’ behaviour. Their responses showed how different their reactions were from normal people’s, but that they could learn specific rules about what is or is not socially acceptable. Unfortunately, rules learnt at home which applied to one set of circumstances could not always be generalised to other situations. Some of the stories Dewey made up were to illustrate to the adults that their behaviour was perceived as odd, but they did not recognise themselves in the stories. For instance, in one tale a young man got into a lift. A stranger who was already in the lift remarked that it was a nice day. The young man was on his way to an interview and, catching sight of himself in the mirror in the lift, realised that his hair was a mess. He asked the stranger if he could borrow his comb.

Dewey says the responses were as follows (the comments from the people with Asperger's are in italics, Dewey’s in roman): I never saw an elevator with a mirror in it. This is a typical pedantic, irrelevant remark.

It was eccentric for the stranger to say, ‘Nice day isn't it’, because you can't see the weather in an elevator. This is a typical literal analysis which misses the point that comments on the weather are common pleasantries between strangers.

Borrowing the comb is normal behaviour for him because he has to look nice for the interview. This is the most important thing because he needs very badly to get this job. Most controls [students] rated the comb incident as quite shocking. Other autistic subjects varied, as some may have learnt rules about comb sharing.

Another example Dewey gave was of a man aged twenty-two, called Roger, who was invited to dinner by a friend of the family. Roger was quite nervous and felt better if he ate every two hours. When he arrived at his hostess's house, he realised he hadn't eaten for two hours and asked her when dinner was going to be served. She said it would be ready in an hour's time, so he took out some food he'd brought with him and ate it. A little later, the hostess said that dinner was ready and when she'd served his meal, she asked him if she'd given him enough. He said it looked fine, but he was going to wait for another hour to eat as he'd just had some food.

The students were quite shocked by Roger’s behaviour, but the people with Asperger's syndrome thought he behaved admirably and had got round the problem of his nervousness with skill. All of those with Asperger’s took a long time to think about the answers, whereas the students intuitively recognized what they believed was eccentric behaviour.

People with Asperger's syndrome have another cognitive deficit which is related to Theory of Mind: they have weak ‘central coherence’. This is the inability to draw together diverse strands of information to make a coherent whole. For example, most people can retell a story told to them by remembering the gist of the narrative and changing or embellishing the details. When you or I do jigsaw puzzles, we look at the picture as a whole and try to slot in the parts: a person with autism would examine the shapes of the pieces, and many can complete jigsaws when the picture is face down.

Central coherence is perhaps best illustrated by the story of the clinician who was pointing out various parts of a doll's bed to a young boy with autism. The boy could accurately tell her that the duvet was a duvet and so on, but when she pointed to the pillow, he said it was a piece of ravioli. Indeed, the tiny pillow with its frilly edge did look like a bit of pasta, but only if taken completely out of context. Although most people with Asperger's syndrome and autism have weak central coherence, some are severely deficient. One boy was upset when told that a dog seen from the side at fourteen minutes past three was the same dog as one seen at fifteen minutes past three from the front. A twelve-year-old girl called Elly, liked to observe shadows in the moonlight and clouds in the sky. Every mealtime she put a tall green ridged glass by her plate and filled it with green juice, pouring it up to either the sixth or the seventh level depending on the weather and the phase of the moon. This insistence on sameness, characteristic of many with autism and Asperger's, is due to the fact that they can't see the whole and get trapped in the minutiae of the day. Elly was distressed when she travelled to a different time zone because her shadow at six p.m. was a different length.

Weak central coherence means that people with autism are good at tasks requiring localised bits of information but poor at tasks requiring the recognition of global meaning. Indeed, even when people with Asperger's are greatly talented, they approach their craft in an entirely different way from normal people. Stephen Wiltshire is a brilliant artist with an almost photographic memory. He draws incredibly detailed pictures of buildings and street scenes. When the famous psychiatrist Oliver Sacks met him, he asked Stephen if he'd like to draw his house. In his book, An Anthropologist on Mars, Sacks writes, 'It was snowing, cold and wet, not a day to linger. Stephen bestowed a quick indifferent look at my house - there hardly seemed to be any act of attention - then asked to come in [. . .] Stephen did not make any sketch or outline, but just started at one edge of the paper (I had a feeling he might have started anywhere at all) and steadily moved across it, as if transcribing some tenacious inner image or visualisation.'

Later, when he got to know Stephen better, and they were travelling by train to Leningrad to give Stephen some more unusual drawing opportunity, Sacks mused, 'I thought of his perception, his memory, as quasi-mechanical - like a vast store, or library, or archive - not even indexed or categorized, or held together by association, yet where anything might be accessed in an instant, as in the random-access memory of a computer. I found myself thinking of him as a sort of train himself, a perceptual missile, travelling through life, noting, recording, but never appropriating, a sort of transmitter of all that rushed past - but himself unchanged, unfed by the experience.'

Central coherence is a crucial part of Theory of Mind. As Frith explains, 'Mentalising ability can be seen as a cohesive interpretive device par excellence: it forces together complex information from totally disparate sources into a pattern which has meaning.' She adds that this ability is incredibly salient. 'As a spider is destined to weave webs, so are we programmed to weave information into coherent patterns.' By thinking about a person's actions, intentions, motives, beliefs and desires, we can build up a picture of why someone should act the way he or she does, and read meaning into it, whereas the person with autism would only see the raw behaviour itself.

Asperger's syndrome has sometimes been called 'mild autism' but in many ways this is misleading because it evokes the idea that there is no need to give these people special help. As Frith says, 'The person who has a glimmer of awareness of other minds and a dawning insight into their own problems is especially vulnerable to feelings of depression and low self-esteem. It is not surprising to read of their over-sensitivity to criticism and inability to carry lightly, or with humour, the heavy burden of their handicap.' Because many sufferers are highly intelligent yet deeply unhappy, it often takes some crisis such as a suicide attempt, or a bizarre piece of behaviour, before a person is diagnosed properly. One twelve-year-old boy was not described as having Asperger's until he tried to leap out of a third-floor window. He jumped with a smile on his face. His father took him to see psychiatrist Christopher Gillberg, from the University of Gothenburg, Sweden. Gillberg had spoken to the boy a couple of times in the school playground, but this was the first occasion the child had been to his office and, as Gillberg explains, the boy diagnosed himself.

On meeting me, he started chatting away about various kinds of gunpowder He told me he would start to try them out in the school-yard. He then interrupted himself, stared intensely but briefly at me and said, 'I say, you do look a lot like Christopher Gillberg!' I asked him if he could guess the reason for my looking so much like Christopher Gillberg. 'How am I to know? You just happen to look like a copy of him, that's all!' I then said: ‘Well, you see, I am Christopher Gillberg.' He looked up briefly and exclaimed, 'What an extraordinary coincidence!' and then made his way into my secretary's office [. . .] He immediately asked, 'How many letters per second can you type?' My secretary said: 'Well, it used to be 1,100 in three minutes.' He then proceeded to her desk, made a quick computation and shouted: 'Six point one one one one one one in all eternity one one one.' He pointed at me and stared into thin air and said, 'He does look like Christopher Gillberg! What a coincidence!'

He then entered my office and started picking out various books and papers from one of the shelves. Quite by chance, he found a Swedish leaflet for parents on Asperger's syndrome. He said: 'This is something I've never heard anybody say a word about before. I think I'll call it AS for short'. On reading the text aloud, he soon remarked, as though in passing: 'It seems I have AS! By golly, I do have AS. Wait until my father hears about this!' He went on reading and soon decided: 'My parents just might have AS too, you know, my father in particular, he too has all-absorbing interests and . . .' He didn't seem to react emotionally to what he read. 'Now I can tell my classmates the reason why I pace the school-yard briskly ten times up and down each break all the year round is I have AS. And it will get my teacher off my back. If you have a "handicap-condition" they have to tolerate you.'

A diagnosis of Asperger's syndrome is a relief in many ways for those who for years have been aware that there is something wrong with them. Before proper diagnosis, sufferers are often prescribed drugs for schizophrenia. Although Asperger's syndrome is a different disorder from schizophrenia, some people with Asperger's also have schizoid traits. One such man, Peter, was continually carrying on litigation with local authorities for slights he felt he had received. He had several unusual beliefs. For instance, he thought that a man with red hair had attempted to assassinate him with an umbrella.

Being able to explain their often strange reactions to others as a form of handicap can save embarrassment on both sides. One young man’s mother died of cancer when he was fifteen. After her death, when people asked how he was doing, he usually said, 'Oh, I am all right. You see, I have Asperger's syndrome which makes me less vulnerable to the loss of loved ones than most people.'

Much work on Asperger's syndrome and autism has focused on childhood, but, of course, every child will eventually grow up.

It's only by logic and emotions that I get through. Hiding feelings came after I became the victim. All emotions are a sign of weakness. I'm about as flexible as a thick bar of metal in a barrel of nitrogen [. . .] I shall turn out a mechanical, inflexible person who nobody likes, nobody loves and who everybody will be glad when I'm in my grave [. . .] it's a vicious circle. 1. I get teased. 2. I make myself miserable and cynical. 3. I get teased again [. . . ] The best school would be one where I spent my time working with machines - remove the human factor. If the people were very nice I could probably do very well. What I find difficult about learning, as well as the teasing, is that there's a massive great group of us and they're all unruly [. . .] I can break out of the vicious circle, but I can't take down the barriers. The clay has set - I've moulded my personality. The wall's there for good. My flexibility was one of the first things I lost - lost completely.

So wrote a twelve-year-old boy to his mother. His main worry, even at this age, is one that his parents are also very concerned about: adulthood. People with Asperger's syndrome need a lot of support but some of them can go on to lead relatively normal lives, learning over the years how to cope with the strange and bizarre behaviour of normal people.

One young man used to repeat aloud any questions directed at him. Now he hums under his breath and beneath his hum, he repeats the question. He's realised that echoing others is not normal behaviour and so has found a way of dealing with his need to repeat the words that is socially acceptable. At eighteen he was achieving normal grades at school, attended an amateur acting group and wanted to go to university to study trains.

Perhaps the most famous and able person with Asperger's syndrome is Temple Grandin. A highly intelligent and articulate woman in her forties, Temple Grandin has a Ph.D. in animal science. She has published over two hundred articles on her work and studies, acts as a consultant designing livestock facilities and runs her own company. Her autobiography, Thinking in Pictures, was released in 1996 and as she explains in this moving account of her life, she was not always as sanguine and capable as she is now.

At six months old, Temple Grandin started to claw at her mother 'like a trapped animal'. Her ears by the time she was two were like microphones transmitting everything, irrespective of relevance, at full, overwhelming volume and there was an equal lack of modulation in all her senses; she had a remarkable sense of smell. By the age of three, she'd become very destructive and violent; she painted the walls with her faeces and chewed up puzzles. She was initially diagnosed as brain damaged. However, through the love and support of her mother, aunt and teachers, she was able to go to school, high school, college, and, finally, obtain a Ph.D. At school, she couldn't get on with the other children although she definitely wanted a friend. She said that there was something going on between the other children that was swift, subtle and changing; they understood the meaning behind words, and perceived other people's intentions. She, like other autistic people, thought they were telepathic.

As a child, Grandin hated physical contact - she didn't like the sense of being overwhelmed or not being in control - yet longed to be hugged. From the age of five she dreamed of a machine that would squeeze her gently but powerfully and which she could control. When she was staying on one of her aunt's ranches in Arizona, she saw a squeeze shute for restraining cattle. She asked her aunt to shut her inside it. Initially, she panicked as the sides closed and the head restraint locked into place, but then began to feel serene and calm, and remained in the contraption for half an hour. When she got back to college, she copied the design and built herself a 'squeeze machine' which she kept by her bed. Her device created suspicion and derision; the college psychiatrist thought she was regressive and needed to be talked out of it. Calmly, she insisted on the validity of the machine. She uses a far more sophisticated one today, again of her own design, and says it teaches her to feel empathy for others. 'From the time I started using my squeeze machine, I understood the feeling it gave me was one that I needed to cultivate toward other people. It was clear that the pleasurable feelings were those associated with love for other people. I built a machine that would apply the soothing, comforting contact that I craved as well as the physical affection I couldn't tolerate when I was young. I would have been as hard and as unfeeling as a rock if I had not built my squeeze machine.'

Grandin is now the world's foremost expert on squeeze shute designs for cattle. She writes, 'When handling cattle, I often touch the animals because it helps me to be gentle with them. If I never touch or stroke the animals, it would become easy to shove or kick them around.' She once swam through a sheep dip to find out what it was like for sheep and published an article in Calf News entitled 'How stressful is dipping - I jumped in to find out.'

Francesca Happé, who studied Grandin's writing, says, 'This is interesting as it suggests perhaps a lack of ability to empathise, since she felt it necessary to put herself through the same experience in order to feel the same feelings. When we empathise with another person we generally mean that we feel with them, despite the fact that we are not actually suffering with them.'

Grandin says herself that she can't read novels or follow plays because she can't empathise with the characters or understand their motives and intentions. 'Much of the time,' she says, 'I feel like an anthropologist on Mars.' However, she does show a high degree of sympathy for livestock. She doesn't want to shut down the meat industry, but she does object to the pain, cruelty, stress and fear that animals are subjected to before being slaughtered. Her sympathy extends to the terror a frightened animal feels, though she has no empathy for other people's states of mind or their perspective. 'When I put myself in a cow's place, I really have to be that cow and not a person in a cow costume,' Grandin says. 'I use my visual thinking skills to simulate what an animal would see and hear in a given situation. It's the ultimate virtual reality system.'

Grandin's ability to be sympathetic is aided by her weak central coherence. She notices details in the environment other people might not be so acutely aware of, and realises what might scare cows. 'Cattle are disturbed by the same sorts of sounds as autistic people – high-pitched sounds, air hissing or sudden loud noises; they cannot adapt to these. But they are not bothered by low-pitched, rumbling noses. They are disturbed by high visual contrasts, shadows or sudden movements. A light touch will make them pull away, a firm touch calms them. The way I would pull away from being touched is the way a wild cow will pull away - getting me used to being touched is very similar to taming a wild cow.'

She adds, 'When I'm with cattle, it's not at all cognitive. I know what the cow's feeling.' People are rather different: she has to study them intensely. Fascinatingly, Grandin says that although she can feel the behaviour of farm animals, she can only understand the interactions of primates intellectually.

Like many people with Asperger's syndrome, Grandin is very visual. She says, 'I think in pictures. Words are like a second language to me. I translate both spoken and written words into full-colour movies, complete with sound, which run like a VCR tape in my head. When somebody speaks to me, his words are instantly translated into pictures.' If she receives a letter but wants to read it later, she simply looks at it and it is photocopied into her mind in the same way that Raymond, the autistic savant played by Dustin Hoffman in the film Rain Man could flick through a photocopy of the phone book in his head, and reel off any phone number in it.

Grandin struggled in the social arena because pictures of 'getting along with people' were hard to find. An image finally presented itself to her. At college, the students had to do jobs, and one of hers was to wash the bay window in the cafeteria. It consisted of three glass sliding doors enclosed by storm windows: 'To wash the inside of the bay window, I had to crawl through the sliding door. The door jammed while I was washing the inside panes, and I was imprisoned between the two windows. In order to get out without shattering the door, I had to ease it back very carefully. It struck me that relationships operate the same way. They also shatter easily and have to be approached carefully. I then made a further association about how the careful opening of doors was related to establishing relationships in the first place. While I was trapped between the windows, it was almost impossible to communicate through the glass. Being autistic is like being trapped like this.'

Grandin used her phenomenal memory and visual capacity to study how to deal with other people. She has a 'video tape collection or a CD-rom in her mind' of memories and human interactions and uses this library, based on experiences that were built up slowly and painfully over the years, to compute how a person might react and whether they might try to deceive her or sabotage her equipment. If she wants to remember something, however, she has to run through the whole clip from the start: she can't simply remember a portion of it. Although this obviously has disadvantages, the major advantage for her is that she can visualise a whole design layout in her head, imagine it from any angle, even from the cows' point of view and can play a cow's journey in her mind and see any glitches in her design before actually setting pen to paper. Drawing the blueprint for a cattle shute or a slaughter house then becomes a routine job.

Although she can operate in normal society and in the workplace, Grandin says she has built a facade of normality and learnt rules about how to behave. 'Since I don't have any social intuition, I rely on pure logic, like an expert computer program, to guide my behaviour. I categorise rules according to their logical importance. It is a complex algorithmic decision-making tree.' She adds, 'When other students swooned over the Beatles, I called their reaction an ISP - interesting sociological phenomenon. I was a scientist trying to figure out the ways of the natives [. . .] To master diplomacy, I read about business dealings with international negotiations in the Wall Street Journal. I then used them as models.'

She feels, she says, like Data in Star Trek, an emotionless android, who is curious and wistful about being human. He observes and impersonates people and longs to be one. A family with Asperger’s syndrome whom Oliver Sacks visited sympathised with this view. When Sacks first walked in to their house he thought that they were very normal, until he saw the trampoline which they use to jump up and down on whilst flapping their arms in order to relieve stress, a huge library of science fiction and directions for how to cook, lay the table and wash up pinned in the kitchen. The family say they ape being human, they learn rules and obey them. Like many people with Asperger's, they like alternative imaginary worlds, such as those of Tolkien and C.S. Lewis. The family spend hours constructing an imaginary world - computing grain production in Leutheria, designing a new flag, working out the country’s currency.

Sacks visited Temple Grandin, and named his book after her phrase ‘An anthropologist on Mars’. In the chapter devoted to Grandin, there is a hilarious section where she smuggles him into a meat-packing plant. She'd designed the layout and wanted to show it to him, even though it was forbidden for any unauthorised persons to enter the plant. She handed him a hard yellow hat and said, 'That'll do. You look good in it. It goes with your khaki pants and shirt. You look exactly like a sanitary engineer.' The eminent psychiatrist blushed deeply, no one had ever said anything like that to him before. Once inside she instructed him to keep his hat on, 'You're a sanitary engineer here.'

Grandin does have a couple of friends, but is celibate and has no wish for marriage; she does have sexual feelings but she can't understand what is implied or expected of her in relationships. The closest she can imagine to falling in love is the warm feeling she gets when she strokes a cow. As she said goodbye to Sacks she wept. 'I've read that libraries are where immortality lies. I don't want my thoughts to die with me. I want to have done something. I'm not interested in power, or piles of money. I want to leave something behind. I want to make a positive contribution - know that my life has meaning. Right now, I'm talking about things at the very core of my existence.' Despite her handicap, Temple Grandin has said on a number of occasions, 'If I could snap my fingers and be non-autistic, I would not - because then I wouldn't be me. Autism is a part of who I am.'

There's a little bit of Asperger's in many people: the literal-mindedness, the inability to fully understand another person's point of view, a desire for the security of lack of change, the single-minded dedication to one issue. There are two old Irish jokes about getting lost which have more than a touch of Asperger's about them. In one, the lost person asks, 'Where does this road go?' The reply is, 'It goes nowhere, it stays right here.' In the second, an Irishman is asked what is the best way to get to Dublin. He replies, 'Well, I wouldn't start from here.' Many of our stereotypes - the preoccupied professor with few social graces, for example - also share traits with those who have Asperger's. Sherlock Holmes is typical of someone with Asperger's: he is eccentric, odd, and highly intelligent. He is absent-minded in relation to other people, but singe-minded with regard to certain issues; untroubled by the simple events of everyday life, he attends to trifles that seem insignificant to others - but usually end up being vital clues to the mystery. In true autistic fashion, Holmes has written a monograph on the ashes of 140 different types of pipe, cigar and cigarette tobacco.

In the classic film, Being There, starring Peter Sellars as Chance Gardener, Chance is autistic. When his parents die, he leaves his house for the first time in his life. He stops a woman laden with shopping bags and says, ‘Excuse me, I'm very hungry. Could you give me some lunch?’ He becomes a nationwide figure appearing on television and advises the president. He speaks simply of gardening, but the people around him read volumes into his speech and attribute intentions to him which he does not feel. For example, when he is run over by Dr Ben Rand, the doctor asks him if he is going to make a claim. He replies that there's no need for a claim, 'I don't even know what they look like.' Rand thinks he's merely being humorous.

Given a room in the Rands' house, Chance, looking up from his position at the dining table to the ceiling, says that the room is all he has. Presumably his room is directly above them. Dr Rand, who is dying, thinks Chance is talking about heaven. He says that at least Chance has his health. Chance replies, 'It's a very nice room,' and Rand responds sourly, 'That's what they all say.'

The boundary between the acceptable, admirable eccentric and disabled is a hazy one. Men such as Wittgenstein, Kafka and Einstein may have had Asperger's syndrome, although it is obviously impossible to diagnose dead men. Einstein did not freely associate with his peers and was uninterested in personal relationships. He was very good at jigsaw puzzles and had an excellent memory. He said, 'I sometimes ask myself, how did it come that I was the one to develop the theory of relativity? The reason, I think, is that a normal adult never stops to think about problems of space and time.' Einstein thought of little else. 'Thoughts did not come in any verbal formulation,' he told psychologist Max Wertheimer. 'I rarely think in words at all. A thought comes, I try to express it in words afterwards.' He imagined himself travelling on a beam of light, and translated his visions into maths. Students complained that his lectures were confusing because they were scattered and they could not see the associations between some of the specific examples he gave and his more general thinking.

Wittgenstein may also have had Asperger-like traits. He did not talk until he was four and was considered to be talentless. He had good mechanical ability and constructed a sewing-machine at the age of ten. Like many people with Asperger's syndrome, he used formal, pedantic language, and the German polite form of you, Sie, when talking to fellow students.

Most of the examples I have given in this chapter (with the notable exception of Temple Grandin) are of men, and this is not surprising. There are about four or five men to every woman who has autism and this ratio is much higher for Asperger's syndrome, where there are between nine and fifteen men for every woman. Simon Baron-Cohen and Jessica Hammer argue that Asperger's syndrome and autism are extreme forms of the male brain. Psychological studies have shown that there are differences between men and women, although this does not mean that these differences are true for every man or woman. Baron-Cohen, for instance, is no good at the ‘male’ skill of visualising in 3D and map reading, whereas Jessica Hammer is pretty competent at these tasks. The differences emerge when one compares the average of a group of men with an average for a group of women. The main differences are that the female brain is superior to the male brain when it comes to social relationships: women are better and quicker at Theory of Mind tests and surpass men when working out what emotion a person is feeling using only eyes as a cue. Women can also determine more easily what would be considered a social faux pas. The male brain is better at spatial skills and the embedded shapes task, which is where you pick out a shape that is camouflaged in a drawing. People with autism and Asperger's follow the male trend, but to a much greater extreme. They, like many normal men, collect things, focus on what seems to others to be trivial detail and have a narrow range of interests.

Robert, the central character in Nick Hornby’s novel on male angst, High Fidelity, owns a record shop and an impressive record collection. He and his friends, Barry and Dick, believe that you can’t be a decent person without at least 500 records. They continually make lists - top five singles of all time, top five Elvis Costello records, top five Monday morning hits. When he is asked to go to his girlfriend's father's funeral, Robert’s response is to ask Barry and Dick for their best five pop songs on death.

Baron-Cohen and Hammer describe a continuum, with those people who are cognitively balanced in the middle and people with Asperger's and autism at the far end of the male spectrum. They think that the variations are in part the result of biological differences in brain development. These in turn are emphasised by heritable genetic differences which alter hormone levels in the body. Even at birth, human female babies attend longer to social stimuli, such as faces and videos; while male babies attend better to spatial stimuli such as mobiles. The release of testosterone during foetal life may determine brain development, leading to male or female brain-types (in both humans and rats, spatial abilities are affected by hormonal changes), although, as I have said, the typical 'female brain' may not always be in a woman and the same applies for male traits.

Research into how the brain processes Theory of Mind is just beginning. Eye direction detection (EDD) seems to be localised in the superior temporal sulcus (STS), part of the temporal lobe. A cell assembly called M047 in the superior temporal sulcus of monkey brains fires when an animal is looking at the eyes of another animal. The primary function of these cells is to detect whether another animal is looking at the monkey. Those people and animals who have lesions in the STS are impaired in their ability to discriminate gaze direction. Some of the cells in the STS respond to self-propelled motion (ID) - the first basic skill needed to begin to develop a Theory of Min; others are involved with facial recognition. One autistic woman is an expert at recognising cancerous cells. Her visual ability enables her to spot an abnormal cell instantly, yet she has to meet someone fifteen times before she can recognise them.

There is evidence to show that the right hemisphere of the brain is involved in processing emotional information. Emotional cues are detected faster when they are on the left side of the visual field, and hence transmitted to the right side of the brain (the nerves from the left half of each eye are fed to the right side of the brain, those from the right half are fed to the left side). Julia Casperd and Robin Dunbar, from the Psychology Department at Liverpool University, have shown that male baboons keep their opponents on the left side in any confrontation. Their explanation of this is that it's important for the baboon to check whether their rival is bluffing, or will fight. Keeping the rival on the left side means that the right side of the brain can process more subtle cues about his intentions.

Lesions to the STS and the frontal lobe of the brain can result in a lack of social perception - the patient fails to attach emotional significance to behaviour, and shows a decrease in aggressive, fearful and affiliative behaviour. The frontal lobe could be responsible for Theory of Mind. There are several lines of evidence for this. Patients with lesions, or tumours which have to be removed from this area are said to lose their social judgement and perform poorly on Theory of Mind tests. In 1848 a man called Phileanas Gage was working on the railways. He was using an iron bar to tamp down earth over an area which was to be dynamited when a spark from the bar accidentally set off the incendiary. The bar flew up and went straight though Gage's eye and out the back of his head. Amazingly, Gage did not die. The bar wiped out part of the frontal lobe. Gage became a changed man, he was incapable of reacting normally to people, and would frequently swear and grow violent. He lost all ability to react in a social fashion, and as his friends said, Gage was no longer Gage.

Rather more controlled studies have been conducted by Chris Frith and his team of researchers, who gave PET scans to healthy volunteers. A PET scan measures the flow of oxygenated blood through the brain: the part of the brain that is active will require the most oxygen. Volunteers are given a dose of radioactive oxygen and scans of the brain reveal where the radioactive oxygen has been carried in order to ‘feed’ that area of the brain. study Frith played the volunteers stories that required either a physical understanding (that if you knock a person, they may trip) or a mental understanding, such as the Sally-Ann task. Both stories activated the STS, as well as other parts of the brain, but only Theory of Mind tasks caused blood to flow into an area known as Brodmann’s 8 and 9 which is on the frontal lobe.

Brodmann's 8 has widespread connections to the rest of the cortex (the convoluted outer layer of the brain). Frith believes that the part of the brain associated with Theory of Mind might be needed to integrate information and stimuli drawn from other parts of the brain. Language comprehension, for example, is actually processed by the STS and lesions to this area result in deficits in comprehension and speech. But understanding Theory of Mind is more than understanding words or stories, hence the activation of a specific part of the brain that is not used when listening to a narrative that does not involve the comprehension of another person's thoughts.

A study conducted slightly earlier than Frith's, by Vinod Goel, Jordan Grafman and their colleagues from the National Institute of Health, Bethesda, in the US, gave PET scans to students whilst they did a Theory of Mind task. They asked them how Christopher Columbus might have categorised the function of artefacts he discovered on his travels; in other words they had to imagine what kind of knowledge a European in the fifteenth century might have had. Again, all the subjects used the medial frontal lobe: Brodmann's area 8 and 9.

Further evidence of the precise location in the brain where Theory of Mind is calculated comes from Frith who gave a PET scan to a person suffering from schizophrenia. Some schizophrenic patients have a symptom in which they hear voices talking about them in the third person, saying, ’He is stupid’, for instance. The patient believes that other people think that he, the patient, is stupid but instead of thinking in terms of beliefs, something goes wrong with the labelling so the patient experiences not beliefs but perceptions. Rather than believing that other people think he is stupid, he hears other people saying that he is stupid. The patient was hallucinating at the time of the scan, and although he thought he could hear voices, he was actually formulating a belief about himself. The area of the brain that was processing the information was Brodmann's 8, not the part of the brain that deals with perception.

So is autism caused by damage to these areas, and if so, what is the cause? In the past, people thought autism was the result of the way in which children were brought up. They blamed 'refrigerator mothers', claiming that career women who were cold and unloving turned their children into autistic individuals. We know that this is a myth and that autism is usually genetically inherited. An autistic child is between fifty and a hundred times more likely to have another sibling who has autism than a normal child. In one study on identical twins, both twins had autism in four out of eleven sets of twins and, in nearly every case, the other twin had a language disorder, or an intellectual impairment or both. Christopher Gillberg studied families with Asperger's syndrome who lived in Gothenburg. He discovered than Asperger's, Asperger-like traits and autism ran in families. One girl with Asperger's syndrome who always wore the same dress (her mother had to wash it at night, and then try and make it smell unwashed), had a sister, a paternal grandfather, a maternal grandfather and uncle who also had Asperger's. Her paternal aunt had autism as well as some mental retardation and both her parents had problems identifying with the feelings and perspectives of others.

Autism is often associated with other disorders, such as epilepsy, which occurs in a third of all autistic people; and nearly forty per cent suffer from Fragile X, a chromosome abnormality that causes mental retardation. These disorders are often the result of injuries to the infant, such as a delay in birth, neonatal convulsions, or a viral infection which result in brain damage. The greater the extent of the brain damage, the more likely it is that secondary symptoms, such as epilepsy, will occur. But there may be a genetic predisposition for developmental abnormalities in these children; autism is but one of its manifestations.

There are other differences between people with normal brains and those with autism; as yet no one knows the significance of these differences. Autistic children tend to have lesions in a small part of the cerebellum. EEG readings of the brain waves in autistic children aged between four and twelve produce patterns similar to a two year old. Other physical and automatic responses such as respiration, heart rate and skin conductance also show a developmental delay. Another physiological difference is that autistic children have high levels of serotonin (used in the contraction of muscles) in their blood, although levels in their spinal fluid and elsewhere are normal. The abnormality may be due to a deficiency in the uptake or storage of serotonin by blood platelets.

It is highly likely that a cluster of genes could put a person at risk of many disorders such as autism, depression, anxiety, dyslexia, attention deficit disorder and other problems. Uta Frith explains the process that leads to autism in the following way: hazard is followed by havoc which causes harm. The hazard could be genetic, or a viral agent, or a birth defect (although problems at birth could, as we have said, be due to genetic reasons). This hazard creates havoc with the neural system and this in turn results in lasting harm to the development of specific brain systems concerned with higher mental processes. The harm may be mild or severe, but it involves a developmental arrest of a critical system at a critical point in time which leads to autism. We do not know the details of this arrest, but it is likely that it leads to damage of the frontal lobe, the part of the brain that computes Theory of Mind.

Theory of Mind is so pervasive and so necessary for normal human relationships in out society that in the next chapter we are going to ask whether we can create Theory of Mind. Would it be possible to build a robot with a mind? And would that mind be capable of thinking, caring and showing empathy – would it have Theory of Mind?