Marijuana, Empathy, and Severe Cases of Autism

“You can only understand people if you feel them in yourself.”

John Steinbeck, writer, 1902-1968

“Could a greater miracle take place than for us to look through each other’s eye for an instant?”

Henry David Thoreau, writer, 1817-1862

Empathy and the Simulation Theory

I have always been fascinated to see in how many ways a marijuana high can enhance empathic skills in users. My interest in this effect of marijuana was first sparked when I experienced it myself about 15 years ago. I noticed it with excitement because I had already had a long-standing philosophical interest and research focus on theories of empathic understanding.

In contemporary philosophy of mind, philosophers like Robert Gordon, Alvin Goldman and my teacher Simon Blackburn at the University of North Carolina at Chapel Hill took a fresh look at theories of human understanding and empathy in the late 1980s, arguing for a version of what would later become known as the “simulation theory of human understanding”. Before the development of the simulation theory, cognitive scientists and philosophers had thought that we understand humans on the basis of a “folk- psychology”, a quasi-theoretical body of psychological knowledge that allows us to make generalizations and give explanations how people feel and behave. The claim was that we would all learn this folk-psychology as we grow up by learning to use psychological vocabulary to describe, predict, and explain the behavior of others. This position was later labeled as the “theory-theory” because the theory basically relied on the claim that we all – mostly unconsciously – use something like a psychological theory when understanding others.

Briefly, the simulation theory stated that in order to understand others, we use a special cognitive ability to “put ourselves in the shoes of other people”. In other words, rather than just using a psychological theory about others, we understand them by simulating them, looking at the world from their point of view. Looking for an empirical confirmation, proponents of the simulation theory argued that many autists (especially high-functioning autists) would be able to grasp theoretical psychological concepts and generalizations, but would have deficiencies when imaginatively simulating others, which would explain their problems with empathic understanding. For the past decades, cases of Autistic Spectrum Disorder (ASD) have remained in the minds of philosophers, psychologists & cognitive and neuroscientists when it comes to theories of human understanding and empathy.

Marijuana and the Enhancement of Empathic Understanding

During research for my first marijuana study for High. Insights on Marijuana,[1] I found many astonishing reports from users about various enhancements of their empathic skills during a high. A busy father described how he got high before he played with his son and for the first time understood how alone his boy feels and how much he craved for more of his father’s attention and time. A husband wrote a letter to his wife explaining to her how the marijuana high enabled him to better understand her needs during sex. A psychotherapist reported that he always talked to his patients in a sober state of mind, but one day got high in private and then received an emergency call from a patient. His patient was so impressed with his empathic skills during the conversation that she later insisted on paying for the hour. These and other reports prompted me to think about possible explanations for the enhancement of our fundamental skills to simulate and understand other people during a high.[2]

Many of the cognitive enhancements during a high could play a role in the enhancement of empathic skills. Countless marijuana users have observed and described (independently of each other) enhancements like an enhanced episodic memory or an enhanced ability to recognize patterns during a high. Such enhanced cognitive abilities can obviously help with empathic understanding; if I can vividly remember episodes of my teenaged years, it stands to reason that I will be able to better understand a teenager in similar situations. If I can better recognize the subtle pattern of a sarcastic smile in the face of my conversation partner, I can better understand how that person feels and acts towards me. Importantly, besides these and some other possibly relevant cognitive enhancements, many of the reports of marijuana users explicitly stated that a high can help them to ‘slip into another person’, to feel his feelings, to see his point of view. In an intriguing report, Theophile Gautier, another member of the famous 19th century literary circle ‘Club des Hashischins, describes this imaginative perspectival change during a high while looking at a painting:

“By some bizarre prodigy, after several minutes of contemplation I would melt into the object looked at, and I myself would become that object. Thus I turned into a nymph Syrinx, since the fresco represented Leda’s daughter pursued by Pan. I felt all the terrors of the poor fugitive, and sought to hide behind the fantastic reeds to avoid the ram-footed monster.”[3]

Reports of this kind made it obvious to me that marijuana can fundamentally enhance our ability to simulate others and to take their point of view.

The Simulation Theory and the Mirror Neuron System

The debate concerning the simulation theory became a new twist when an Italian group of researchers around Giacomo Rizzolatti discovered the mirror neuron system in the early 1990s. In short, the group noticed that when a monkey grabbed a peanut, the same group of motor-neurons responsible for its hand movement would fire not only during the grabbing, but also when the monkey merely perceived someone else grabbing the peanut. Since this finding, neuroscientists like Rizzolatti, Vilayanur Ramachandran, and Marco Iacoboni have argued that mirror neurons comprise a specialized system of neurons that fundamentally subserve our ability to “mirror” and to understand the emotions and intentions of other people. Simulation theorists used this line of research to argue for their position: a specialized mirror neuron system would actually constitute our special capacity to simulate others when we understand them “from inside”, rather than just making folk-psychological inferences about them.

Marijuana, Autism, and the Endocannabinoid System

In 2006, Vilayanur Ramachandran published a paper entitled “Broken Mirrors – A Theory of Autism”[4], arguing that autism could have to do with a defective (“broken”) mirror neuron system – a highly controversial theory which is still under debate now. Based on my own research, I introduced a hypothesis on a possible connection between the endocannabinoid system and the mirror neuron system in a chapter of my first book on marijuana and empathy:

“Could it be that (…) there already exists a functional relation between the endocannabinoid system in our brain and the body mapping system, including the mirror neuron system? Again, a look at the enhancements of cognitive skill under marijuana may be fruitful for a general scientific outlook on the workings of the human brain.”[5]

Now, if there is such a functional connection, could it be that the endocannabinoid system is defective in autistic children, causing their problems with empathic understanding? Recent findings suggest that I was roughly on the right track, even though the “broken-mirror”-hypothesis remains highly controversial. In the following I will first describe how some severely autistic children seem to profit incredibly from medical marijuana and then summarize some new findings on possible links between the endocannabinoid system and autism.

Severe Autistic Spectrum Disorder and Medical Marijuana

When we are talking about cases of severe kinds of Autism Spectrum Disorder (ASD) it is important to emphasize that we are not discussing personalities like Big Bang Theory’s Sheldon Cooper or Rainman as played by Dustin Hoffmann. Children with severe forms of ASD are often highly auto-aggressive and/or aggressive towards other people; typically, they act up with intense tantrums, they don’t engage in interactive, pretend or imaginative play and prefer solitary or ritualistic play. They have difficulties with verbal and non-verbal communication – some never learn to speak at all – and usually they don’t make friends, are withdrawn, don’t maintain to eye contact, show a lack of empathic understanding, are emotionally unstable and get angry or distressed when routines are changed. Autistic children often seem to be unhappy, almost in agony, acting angrily or aggressively as if in severe pain. Autism now affects 1 in 68 children in the US and prevalence figures are growing.

In the last six years, some courageous parents have overcome their prejudices against what their society taught them is an “evil drug” and listened to some experts who advised them to try medical marijuana for their children. Many parents had felt that the pharmacological drugs prescribed by their doctors for ASD did not work or had even worsened the condition of their children. For some parents, turning to medical marijuana was definitely a dramatic decision, as they desperately tried to save the lives of their children on the verge of dying.

In the following, I will cite some of their observations about the treatment of their children with medical marijuana with a special focus on the enhancement of the child’s abilities to socially engage with others. Several parents have observed that marijuana helps to calm their children, to make them smile and happy and to greatly diminish their tantrums and aggressive behaviors, but it is crucial to understand that we are not simply talking about an effect of sedation. On the contrary, many parents described that after medication with cannabis their children seemed to become more alive and joyful, were able to perform actions they had been never previously able to do, engaging in social interaction and curious to explore new activities. A father reports about the behavior of his eight-year-old autistic son Sam, 30 minutes after giving him a small dose of marijuana

“(H)is behavior became relaxed and far less anxious than he had been at the time we gave him the MC {medical cannabis}. He started laughing for the first time in weeks. My wife and I were astonished with the effect. It was as if all the anxiety, rage and hostility that had been haunting him melted away. That afternoon and evening his behavior was steady and calm. He started talking to us and interacting with us again. Sam was physically more relaxed and began initiating physical contact with the motivation being affection instead of aggression. It was amazing!”[6]

Mieke Hester Perez, the mother of a 12-year-old autistic son, reports:

“He was on a combination of thirteen prescription drugs, and his weight dropped down to 46 pounds. He was diagnosed with anorexia and malnutrition, second to his autism.(…) Ultimately, his doctors gave him six months to live. I was devastated. And I was determined I would figure out a way to extend his life.”

Then she gave him medical marijuana:

“The immediate change I saw was eye contact. He gained over 40 pounds, he’s happier and better behaved.”[7]

Some of these parents have no doubt that marijuana saved their children’s lives. And while it may sound less dramatic in that context, Perez’s report on eye contact is remarkable; maintained eye contact signifies the ability to socially interact with a person and to better understand facial expressions.

Severely autistic children have problems to mimic and learn behavior. C.B., the father of a 9-year-old autistic son told me how his severely autistic son managed to put on his shirt and pullover himself for the first time in his life and started to curiously explore new activities after receiving his medical marijuana. About 30-45 min after ingestion of cannabis, the screaming, the agony, the emotional instability are mostly gone. His son smiles and laughs a lot and “just wants to cuddle”. The positive change in his son’s behavior after cannabis medication is simply breathtaking.

Another, now prominent, mother of an autistic son, Myung Ok-Lee, wrote about the effects of medical marijuana on her severely autistic son “J”:

“The experts don’t live in my house, nor do they get to reap the rewards, like this morning, when J woke up, smiled, and wanted a hug—the boy who formerly woke us with a scream of pain. The boy who, since he was 3 years old, never gave us hugs or let himself be hugged, because he couldn’t bear to be touched. (Fittingly, the next person he bestowed a hug to was Organic Guy, his grower.) Now, when he’s proud of something, like his awesome bike riding skills, he glances to find my face, to make sure I’m looking.”[8]

Then, Ok-Lee took her son to his doctor while he was under the influence of medical marijuana:

During the pre-exam discussion, J’s pediatrician was both taken aback and a bit skeptical to hear about his new cannabis “therapy.” But when I brought J into the examination room, she saw that he didn’t look the least bit stoned, which had been her big fear. Instead, he said “Hi” to her and patiently (for him) allowed her do the exam, which was a first – usually he can’t bear be to be touched, especially around his head. But this time, J even let her stick the tickly otoscope in his ears and shine a light in his eyes. He said “Ah” on command. Last time, she couldn’t listen to his heart because he kept grabbing the stethoscope off her head. This time – after he had a listen first – he handed the stethoscope back to her and let her finish the exam.”[9]

Marijuana and the Enhancement of Empathic Skills

Marijuana seems to help some autistic children in many ways: it makes them happier, less anxious, less auto-aggressive. Aggressive behaviors get vastly diminished and compulsive behaviors are reduced, to name just a few. But what parents often describe as a miracle is the change in their social and empathic skills; after being medicated with marijuana, autistic children often initiate and keep eye contact, start to engage in social communication, start to play with other kids instead of attacking them, they enjoy to touch and to be touched. They give hugs and allow themselves to be hugged, and they often show mimicry behaviors that they were never capable of previously, like rinsing a bowl after eating or putting on a t-shirt. These observations are important in the context of empathy because this kind of mimicking – or, ‘mirroring’ – the actions of others is a basic capacity that rests on the ability to put oneself in the position of another person. For us, it seems so easy to imitate or “mirror” behavior that we do not even understand, yet for a severely autistic child, this imitation behavior is often not possible. They seem to lack the ability to imaginatively put themselves in the position of their mother when she rinses the bowl and then to repeat the action themselves. Likewise, they seem to have problems to use their imagination to put themselves in the position of a person in pain or in joy and to feel their feelings as if they were their own, as we often do. When we watch somebody breaking an arm in an accident, we suffer; when we watch a pair in love kissing passionately, we delve into happy memories of similar experiences. Severely autistic cannot recreate the feeling and, thus, do not often seem to understand the feelings of others.

Empathic understanding is probably the most complex and most outstanding mental skill we – and some animals – have and it is an incredibly powerful drive for our actions. More than 150 years ago, the German philosopher Arthur Schopenhauer wrote:

“How is it possible that suffering that is neither my own nor of my concern should immediately affect me as though it were my own, and with such force that it moves me to action”. … This is something really mysterious, something for which reason can provide no explanation, and for which no basis can be found in practical experience. It is nevertheless a common occurrence, and everyone has the experience. It is not unknown even to the most hard-hearted and self-interested. Examples appear every day before our eyes of instant responses of the kind, without reflection, one person helping another, coming to his aid, even setting his own life in clear danger for someone whom he has seen for the first time, having nothing more in mind that that the other is in need and in peril of his life”.[10]

How can cannabis so dramatically improve this skill in various ways – in autistic children as well as often in normal people, as reports of users suggest? Could it be that the endocannbinoid system is functionally involved in the very neurological systems that are subserving our empathic skills? As we will see, recent scientific findings indeed point in this direction.

Autistic Spectrum Disorder and the Endocannabinoid-System

For about 5000 years now, cannabis has been used worldwide to treat a whole range of diseases, syndromes and medical conditions, now including nausea, neurological pain, epilepsy, glaucoma, epilepsy, Tourette’s syndrome, asthma, inflammation and autoimmune diseases as well as countless other pathologies.

The discovery of the endocannabinoid system (ECS) in the mid-1990s was not only a revolution in neuroscience, it also brought about a better understanding why and how exogenous (consumed) cannabis could have such a profound healing effect for so many conditions. The more we learn about the ECS, the more it becomes evident that it plays a crucial functional role in a multitude of bodily and mental processes. It is now known to be a central component of health and healing processes in the body. As Pacher et al., (2006) point out, there is a growing body of evidence showing that deficiencies of the ECS leads to various diseases.[11]

Recently, more scientific studies have suggested direct links between Autistic Spectrum Disorder (ASD) and the ECS. Let me briefly explain some of those links:

• A study published by Chakrabarti and Baron-Cohen tested whether variations in the endocannabinoid receptor 1 (CNR1) could be associated with the duration of a human’s gaze towards happy faces. Atypical gaze fixation patterns are typical for neurodevelopmental conditions like autism. The study rests on research in primates showing that the striatal region of the brain “plays a major role in the directing gaze. The striatum is thought to encode a ‘value map’ of the visual stimuli.”[12]

The study further proceeds from the fact that the endocannabinoid system is one of the key systems involved in the functioning of the striatal circuit. In their conclusion, they state:

“These results suggest that CNR1 variations modulate the striatal function that underlies the perception of signals of social reward, such as happy faces. This suggests that CNR1 is a key element in the molecular architecture of perception of certain basic emotions. This may have implications for understanding neurodevelopmental conditions marked by atypical eye contact and facial emotion processing, such as ASC [autism spectrum conditions].”[13]

A study published by Stanford scientists Földy et al. 2013 in Neuron[14] concerns the protein neuroligin 3, post-synaptic cell adhesion molecules involved in the communication between brain cells. Rare mutations in these molecules are know to predispose to the syndrome of autism and are also involved in a certain type of secretion of endocannabinoids in the brain: Földy et al. summarize their results as follows:

“Our data thus suggests that neuroligin-3 is specifically required for tonic endo-cannabinoid signaling, raising the possibility that alterations in endocannabinoid signaling may contribute to autism pathophysiology.”[15]

Another link between the ECS and ASD is based on the observation that the cannabinoid receptor CB2 is upregulated in those with ASD as well as in other neurodegenerative disorders.[16] The upregulation of CB2 receptors as a response to damages support the thesis that the ECS serves as an endogenous neuroprotective system and that consumed (exogenous) cannabinoids activating these CB2 receptors are promising therapeutic agents. Benito et al. suggest that the upregulation of CB2 receptors in those conditions might not only be an endogenous neuroprotective response, but could also point to a possible role of CB2’s in their pathogenesis.[17]

Empathy, Cannabis and the Endocannabinoid System

These findings suggest a possible link between deficits in the endocannabinoid system and autistic spectrum disorder. Could it be then, that the endocannabinoid system is involved in subserving some cognitive functions underlying our ability to empathically understand others? I have introduced the “broken mirror-theory” of ASD before, which states that ASD is caused by deficiencies in the mirror neuron system. There is still a lot of controversy over the issue of the function of the mirror neuron system itself and whether it plays a role in ASD. Critics argue that the mirror neuron system does not play a crucial role for empathic understanding and that the empirical evidence for its implication in ASD is sparse.[18]

As those discussions are going on, I believe we should direct our attention to the obvious connection between cannabis, the endocannabinoid system and empathic understanding. I have quoted some of the great amount of anecdotal evidence for an enhancement of empathic understanding during a high. I then also reported how incredibly helpful cannabis can be for severely autistic children to relate to others empathically. Obviously, something fundamental is going on here. We should look out for possible functional links between the endocannabinoid system and cognitive functions subserving empathic understanding. As mentioned above, we have already evidence that endocannabinoids are involved in the perception of basic emotions. As far as I know, nobody so far has found a connection between the mirror neuron system and the endocannabinoid system, but I think it is possible that we might find substantial links here – links that could be revolutionary in our understanding of the human mind in general, and pathological conditions like ASD in particular. I would recommend for other scientists in this interdisciplinary field to take a closer look at detailed reports of marijuana users and at what parents have to say about the astonishing effects of medical marijuana on their children with ASD.

Severe Cases of Autism: Dying Patients Can’t Wait

While interested observers and scientists can calmly sit back and do more research, severely autistic children and their parents cannot wait. Some of these children are dying because they can not eat, are banging their heads on walls or sharp objects every day or are suffering the horrible side effects of several pharmaceutical products which do not help them at all or often even worsen their condition. They are screaming in agony, locked in their tantrums and shaken by their emotional instability. Every human being capable of empathy must be touched when seeing how much cannabis can help these children and their families. Now is the time to go the next step and add autism to medical cannabis qualifying conditions.[19]

[1]    Sebastián Marincolo (2010), High. Insights on Marijuana. Indiana: Dogear Publishing

[2]    For more reports compare Lester Grinspoon (2014), marijuana-uses.com, and Novak, William (1980). High Culture: Marijuana in the Lives of Americans. Massachusetts: The Cannabis Institute of America, Inc.

[3]    Gautier, Théophile, (1966). “The Hashish Club.” In: Solomon (ed.) (1966), The Mari­huana Papers, Signet Books, Indiana,p. 174.

[4]    Vilayanur S. Ramachandran & Lindsay M. Oberman, (2006) “Broken Mirrors: A Theory of Autism”, Scientific American 295, 62 – 69 doi:10.1038/scientificamerican1106-62.

[5]    Sebastián Marincolo (2010) “High. Insights on Marijuana”, Indiana: Dog Ear Publishing

[6]    http://weedpress.wordpress.com/science/illnesses-marijuana-helps/autism/sam’s-story-us­ing-medical-cannabis-to-treat-autism-spectrum-disorder/ (2014)

[7]    Zouves, Natasha (2012), http://www.neontommy.com/news/2012/01/ryan-s-story-medi­cal-marijuana-and-autism

[8]    Ok Lee, Myung (2011) “Why I give my 9-year old son pot, Part 4. Two years in, and I’m still flying solo.” http://www.slate.com/articles/double_x/doublex/2011/05/why_i_give_my_autistic_son_pot_part_4.2.html

[9]    Ibid.

[10]   In: Arthur Schopenhauer, Die beiden Grundprobleme der Ethik, II, Über das Fundament der Moral, (1840) (Sämtliche Werke, Volume XII, Cotta’sche Buchhandlung, Stuttgart, 1895-1898).

[11]   Pacher, Pál, Sánddor Bátkai, and George Kunos (2006), “The endocannabinoid system as an emerging target of pharmacotherapy.” Pharmacological review 58.3.

[12]   Chakrabarti, B., and Baron-Cohen, Simon, (2011) “Variation in the human cannabinoid receptor CNR1 gene modulates gaze duration for happy faces”, Molecular Autism 2011, 2:10, p.11.

[13]   Ibid., p. 10.

[14]   Földy, C., Malenka, RC, Südhof, TC. (2013) “Autism-associated neuroligin-3 mutations commonly disrupt tonic endocannabinoid signaling.” Neuron. May 8;78(3):498-509. doi: 10.1016/j.neuron.2013.02.036. Epub 2013, April 11.

[15]   Ibid., p. 498.

[16]   See Siniscalco et al.(2013)“Cannabinoid Receptor Type 2, but not Type 1, is Up-Regulated in Peripheral Blood Mononuclear Cells of Children Affected by Autistic Disorders”, J Autism Dev Disord DOI 10.1007/s10803-013-1824-9

[17]   Benito, C. et al. (2008) “Cannabinoid CB2 receptors in human brain inflammation.” British Journal of Pharmacology 153.2: 277-285.

[18]   For a good overview of the debate see Thomas, Ben (2012), “What’s so special about Mir­ror Neurons”, http://blogs.scientificamerican.com/guest-blog/2012/11/06/whats-so-special-about-mirror-neurons/

[19]   Thanks to Christian Bogner, M.D. for sharing his summary of autism research and his personal experiences with his autistic son with me. You can find his manuscript “The En­docannabinoid System as it Relates to Autism” (with Joe Stone, 2014) here: http://de.scribd.com/doc/218971076/The-Endocannabinoid-System-as-it-Re­lates-to-Autism