Empathy Games

Empathy, the capacity to affectively and/or cognitively recognize, understand, and possibly share the emotions, thoughts, and intentions of other individuals, is regarded as one of the most significant human faculties. It therefore persists as a pivotal concept in both quotidian life and numerous scientific discourses. The term has also gained increasing prominence in the game industry in recent years, where, according to game scholar Bonnie Ruberg, it has become "a buzzword" to discuss or categorize a particular genre of games. Within this discourse, the term ‘empathy game’ is primarily employed to describe a specific category of predominantly, but not exclusively, independent games, which offer insights into marginalized experiences and the perspectives of those considered diverse or disadvantaged, such as queer or disabled individuals.¹ Games that have been repeatedly highlighted as exemplary cases of this classification include Depression Quest and Dys4ia. The former is a text-based interactive fiction game that simulates the experience of living with depression. Players make decisions for the protagonist, but numerous options are unavailable because of the character's mental state, reflecting the limitations that depression imposes on decision-making processes. Dys4ia is an autobiographical, pixel art game by Anna Anthropy that chronicles her experiences with hormone replacement therapy as part of her gender transition. It employs brief, abstract mini-games to depict the emotional and physical challenges of the process.²

A second type of game application, focusing on both diversity and empathy, could be equally discussed under this label, although it has never been debated in the context of this discourse. The aim of these games is not to foster empathy for someone, as is the case with games that are currently labeled ‘empathy games’, but to build the very ability to empathize. These games do not stem from the mainstream entertainment industry, but are gamified therapy applications, also termed ‘serious games.’ These kinds of ‘empathy games’ pursue therapeutic goals, targeted particularly at individuals diagnosed with ‘autism spectrum disorder’. Their aim is to develop or improve players’ social and communication skills.

In consideration of official diagnostic manuals and other clinical literature regarding autism spectrum disorder (ASD), the development of such therapeutic interventions appears to be a rational approach. For the relationship between autism and empathy can be characterized in a straightforward manner according to these sources: they are presented as being mutually exclusive.³ Following the game developers' descriptions and the theories they reference, the underlying claim is that autistic individuals⁴ exhibit a ‘theory of mind’- deficit. This suggests that they are unable, or able, to only a very limited extent, empathize with others,  and recognize and infer emotions, needs, ideas, intentions, and expectations in other individuals. Furthermore, autistic people allegedly lack the basic prerequisite of empathy: intellectual and emotional self-awareness.⁵ According to neuroscientist Francesca Happé, autistic individuals only have “limited [...] insight into their own feelings and thought processes”.⁶

The prevalence of such assumptions and their ongoing influence on newest therapeutic approaches makes a critical examination necessary. The objective of this article is to provide a comprehensive critique of these games and the concepts of empathy and autism they project. It examines the historical and epistemological conditions of these types of games and analyzes and problematizes their underlying assumptions regarding autism and empathy. This critique will be conducted from a critical disability studies perspective and is informed by a critique of empathy as articulated in feminist theory and critical race and ethnic studies. Furthermore, the article will demonstrate the inseparability between the history of gamification and the history of autism treatment, thereby adding to the existing body of critiques of gamification.

The initial section of the article traces the historical association of autism with empathy deficits, from the earliest descriptions by Leo Kanner and Hans Asperger, to persistent stereotypes about theory of mind (ToM) deficits. Based on two case studies, the article then analyzes therapy games that aim to teach empathy and social skills. It will show their outdated and ableist understanding of autism and present a critique of these games by placing them in a genealogical relationship with behaviorist autism therapy. Their reductive notion of empathy will be challenged by introducing the concept of “the double-empathy problem” and the concept of "disaffection,” thereby reframing the apparent lack of empathy in autism as potentially political. The article thus advocates for a radical change in therapeutic approaches and a much more nuanced understanding of neurodivergent experiences.

Autism and Empathy

Since the initial descriptions of autism in the first half of the 20th century, the absence or deficiency of empathy has been considered one of the core symptoms of this phenomenon, which is classified as a developmental disorder. Almost concurrently in the 1940s, the Austro-American psychologist Leo Kanner in Baltimore and Hans Asperger in Vienna each assigned the term “autistic” to a group of children. Both psychologists were referring to Eugen Bleuler, who introduced the term “autism" in 1911 which he described as a withdrawal into one’s own inner world.⁷

In addition to social isolation, intense special interests, and a need for repetition and sameness, the absence of empathy was central to their diagnosis of the pathology. One of the children, for instance, as Kanner states, "behaved as if people as such did not matter or even exist. It made no difference whether one spoke to him in a friendly or a harsh way. He never looked up at people's faces. When he had any dealings with persons at all, he treated them, or rather parts of them, as if they were objects."⁸ Another child "had begun to play with children younger than him – using them as puppets – that's all."⁹

Asperger, conversely, not only describes the children as indifferent to other people, but he attributes to them distinctly antisocial behavior, manifested by a strong attachment to objects or animals, and evident coldness and cruelty towards people, particularly those closest to them.

It is thus mainly within the family that 'autistic acts of malice' occur. These acts typically appear to be calculated. With uncanny certainty, the children manage to do whatever is the most unpleasant or hurtful in a particular situation. However, since their emotionality is poorly developed, they cannot sense how much they hurt others, either physically, as in the case of younger siblings, or mentally, as in the case of parents.  […] There can sometimes be distinctly sadistic acts. Delight in malice, which is rarely absent, provides almost the only occasion when the lost glance of these children appears to light up.¹⁰

The apparent contradiction arising from the assertion that children are purportedly unaware of the potential suffering they inflict on others while simultaneously accusing them of malice – defined as the deliberate infliction of suffering – remains unaddressed. Beyond the observation of the malicious glance in the eyes of autistic children, which Asperger claims to have noted consistently,¹¹ both psychologists primarily attribute a lack of emotional expression to these children. Kanner repeatedly notes in his individual case descriptions, "[h]e never smiled."¹² Asperger articulates a similar observation:

It will have become obvious that autistic children have a paucity of facial and gestural expression. In ordinary two-way interaction they are unable to act as a proper counterpart to their opposite number, and hence they have no use for facial expression as a contact-creating device […] While talking, […], their face is mostly slack and empty, in line with the lost, faraway glance. There is also a paucity of other expressive movements, that is, gestures. Nevertheless, the children themselves may move constantly, but their movements are mostly stereotypic and have no expressive value.¹³

The concept of a non empathetic and emotionless autistic individual, characterized by a social, communicative, and affective void, has persisted as the dominant constant in the cultural and media representation of autism, as well as in its medical and psychiatric discourse despite an eventful history. In fact, there has been a radical paradigm shift in the history of autism with regard to its etiology. Leo Kanner and Bruno Bettelheim, in particular, assumed that the cause of autism and the empathy deficit of the diagnosed children that comes with it, was due to the lack of empathy and coldness of their parents  (read: mothers).¹⁴ These psychological explanations were challenged as early as the 1960s, and the causes of autism have since been localized in biology. This shift in understanding autism's etiology however, did not significantly alter the prevailing perception of autistic individuals as lacking emotional depth and empathetic capabilities. Rather, the voices of neuroscience that dominate autism research today have contributed to the persistence of the theory of the autistic being devoid of empathy. For one of the most influential proponents of this theory, autism researcher Simon Baron-Cohen, a lack of empathy not only goes hand-in-hand with autism but is virtually equated with it.¹⁵ For him, the lack of a theory of mind is not only a particular trait in autism, as he has not tired of emphasizing for decades, but universally prevalent in every autistic person. Consequently, the development of empathy in individuals with autism diagnoses has been a primary objective of numerous therapeutic approaches within the field of autism research for several decades. As the next section will show, it also permeates today’s gamified interventions and serves as a rationale for their development and implementation.

The Quest for Empathy: Therapy Games

Gamified therapy applications and interventions, particularly in the field of digitalized healthcare or e-health, have been incorporated into numerous specialized clinical areas in recent years and have addressed a wide range of medical conditions, including physical, neurological, and psychological disorders. For instance, Re-Mission is a game designed for children and adolescents with cancer.¹⁶ Participants assume the role of Roxxi, a nanorobot. Utilizing chemotherapy weapons, antibiotics, and other pharmaceutical agents, the nanorobot pursues and eliminates tumor cells. The objective is for young patients to experience self-efficacy and comprehend the physiological processes occurring within their bodies along with learning how to combat the disease. E-mental health and e-psychology are expanding fields, particularly for app development. For example, the games Smokitten and BreathIn have been developed to assist individuals in overcoming nicotine addiction.¹⁷ In the domain of autism research, gamified therapeutic interventions have been in existence for over a decade, encompassing a spectrum, from analog (cardboard) games to fully immersive digital augmented or virtual reality experiences. These interventions utilize various forms of equipment ranging from commercially available tablets and consoles to customized research tools and even social robots. Regarding their level of sophistication, these interventions span from relatively simple gamified learning applications to virtual or embodied agents, which are referred to as therapy robots. These advanced systems are often equipped with emotional artificial intelligence, including emotion-recognition software.¹⁸ Even though not all of these latter technologies and the interventions they enable are labelled or marketed as games, they do integrate game elements. Those interventions explicitly labelled as therapy games either use already existing games, supplemented according to the intended outcome, or create new games explicitly for the purpose of teaching social and communicative skills as well as empathy.¹⁹

There are numerous reasons provided by developers and scientists to elucidate the advantages of digitized and gamified interventions. First, they are predicated on assumptions about autistic individuals, such as the notion that autistic children have an affinity for technology and digital media and possess narrow special interests that can be accommodated by customizable avatars and game settings. Second, it is posited that autism diagnosis and therapy are resource-intensive and time-consuming processes and that therapeutic interventions are scarce relative to the number of diagnosed children. Consequently, digital game interventions are presented as cost-effective alternatives that can potentially be facilitated by untrained caregivers - if facilitation is necessary at all. Third, the inherent nature and logic of games themselves are utilized as arguments, as their fundamental principles inherently demand skills that autistic children are presumed to lack, such as turn-taking, joint attention, sportsmanship, and emotion regulation. Liam Cross and Gray Atherton, in a comprehensive review study of serious games for autism, also proposed a fourth argument: that these games represent an "alternative approach to both foster and assess desired behaviors and cognitions" to traditional behavioral interventions, which have been subject to critique from the autism and neurodiversity community in recent years – a claim that will be critically examined later in this essay.²⁰ As I will show, it is precisely the criticized characteristics of behavioral therapy, its reward and punishment systems based on behaviorist principles, and its objective of behavior modification, which constitute the functional core of most therapeutic games, both within the autism field and beyond.

The vast majority of games designed for autism therapy are predicated on a common principle and share a unified objective: the recognition of emotions from facial expressions and the establishment and maintenance of eye contact on the one hand, and the understanding of social situations and adequate behavior on the other. The initial games in this domain were relatively rudimentary, often presenting a catalog of emotional expressions to be identified, frequently based on the so-called 'basic emotions' and the "Facial Action Coding System" (FACS) developed by Paul Ekman and Wallace Friesen in the 1970s.²¹ This system categorizes the human face and its muscle movements into 'action units' and correlates their combinations with emotional expressions considered unique and universal. While earlier games were of questionable aesthetic merit, more recent interventions such as Zirkus Empathico or the comparable game Social Clues demonstrate greater sophistication, both visually and in terms of complexity.

Zirkus Empathico is a relatively recent intervention, classified as a 'serious game', developed at the Berlin School of Mind and Brain of Humboldt University Berlin. The development of the game and its associated clinical study were partially funded by the German Federal Ministry of Education and Research (BMBF). Zirkus Empathico's stated objective is to cultivate "socio-emotional competencies", alternatively referred to as empathy, in its players.²²

The game has several levels, referred to as 'modules', which are designed to build upon one another. The ‘player’ is required to complete a predetermined number of rounds in one module to gain access to subsequent modules, with the objective of constructing an "empathic chain of action."²³ In gaming terminology, Zirkus Empathico could be classified as a quest for empathy, wherein the participant must accomplish tasks that the game defines as constituent skills or subskills of empathy: Module 1 focuses on recognizing and articulating one's own emotions; Modules 2 and 3 emphasize recognizing and articulating the emotions of others through videos of facial expressions and emotion-eliciting situations, also known as cognitive empathy skills; Module 4 involves describing one's own emotional responses to another person's emotions, also termed affective or emotional empathy. The ultimate goal is to overcome 'the boss', which represents "the generalization of empathy."²⁴ The developers define this as the integration of acquired competencies into daily life, particularly through the appropriate communication of one's own feelings, which is to be practiced using a virtual "emotion puppet" or "manikin"²⁵. The latter element is a featureless humanoid figure that the participant can imbue with up to six emotional states, represented by emojis, wherein movements and posture change according to valence and arousal states that the participant can adjust on a scale. The game's target demographic is highly specific: children between 5 and 10 years of age with an autism diagnosis. Zirkus Empathico is intended to be potentially and explicitly incorporated into this group’s therapeutic regimen.

The setting of Zirkus Empathico is a cartoonish circus environment. Within the 'circus wagon of emotions', various levels and modules can be unlocked sequentially. Upon successful completion of levels, a stylized circus ring can be furnished with animated props, where "the design of the reward items is based on typical preferences of autistic children for certain toys (e.g., spinners, whirligig, toys with audio-visual effects, and technical objects)".²⁶

The game incorporates a series of filmed video sequences intended to depict emotionally evocative situations as well as short loop video recordings of diverse facial expressions. A cartoon fox in the role of a circus ringmaster functions as guide/therapist providing off-screen instructions for each level. The fox poses questions, offers positive reinforcement for correct answers, and provides guidance for incorrect responses.

The video recordings of faces are primarily utilized in the module 'the feelings of others', wherein facial expressions are to be associated with the emotions they convey, following the methodology of the previously mentioned interventions. The player is presented with a selection of 3 out of 6 taught emotions, which are represented using emojis. In the event of an initial incorrect answer, the voiceover provides prompts such as 'observe carefully, pay attention to the eyes, the mouth', etc. If two incorrect answers are given, it offers explanations, such as 'the mouth is straight, the lips are pressed together'. In the levels 'own feelings', 'feelings in the world', and 'empathy' ('Mitfühlen'), brief video sequences, each filmed in the game's characteristic first-person perspective, are presented for the player to associate with specific emotions. In the module 'own feeling', the participant is instructed to envision themselves in the given scenario, whereas in the other two modules, where identical videos are presented, the participant is required to imagine another individual in the respective situations. When experiencing happiness, the participant or an imagined individual receives ice cream, celebrates a birthday, is on vacation at the beach, or observes a dog performing tricks. Pets that are ill, have escaped, or have deceased evoke sadness, while a thunderstorm or being alone outside in darkness elicits fear. No specific emotions are evoked by observing "your mother" performing household tasks or performing them oneself: folding laundry, cleaning the sink, watering plants, composing shopping lists, preparing tea, etc. Surprise is experienced at an unexpected celebration or upon discovering a treasure. When other children destroy one's game, like a sandcastle, or a construction model, anger is elicited. In the module 'feelings in the world', the fox prompts the participant to consider how the other individual might feel. Here too, a selection of emotions is provided, and if an incorrect response is given, the video is repeated with explanations and a superimposed emotional state image. All of this serves as preparation for the final module – 'Empathy'. According to Zirkus Empathico, empathy is defined as "experiencing an emotion because another individual is experiencing an emotion".²⁷ In this module, the participant is instructed to use the emotional puppet to express their feelings when confronted with the emotions of another person. There are no incorrect responses. Subsequently, the participant is given the following instruction: 'Imagine encountering the child/woman/man. What action can you take?' Here, the participant can select from three possible actions (approaching, departing, and waiting) and five follow-up actions (assisting, listening, reassuring, inquiring, and being amiable). There are no incorrect responses in this section either.

Zirkus Empathico presents a notably reductive understanding of both autism and empathy.

Autism is predominantly viewed as an undesirable and solely deficient condition of sociality that can and should be remediated or surmounted by instilling behavior deemed normative. As the researchers and developers assert, “research of the past decades has generated evidence for deviations in empathy, which are characterized by difficulties in cognitive empathy, enhanced personal distress, reduced empathic concern, and difficulties in underlying competencies (e.g., emotion recognition, emotional awareness, and emotion regulation), which have a negative impact on prosocial behavior.”²⁸ Although these assumptions about autism have been and continue to be criticized and deemed unethical by researchers and activists in critical autism and neurodiversity studies, the tropes and clichés are repeatedly adopted and largely without question.²⁹ Morton Ann Gernsbacher and Remi Yergeau, for example, have meticulously and convincingly demonstrated that the assumption of a theory of mind deficit in autistic individuals is highly questionable and yet, as they write, "despite these numerous empirical failures, the claim pervades psychology and well beyond".³⁰ This holds true not only for the Zirkus Empathico developers but also for development teams in general. Upon examining the accompanying research papers of the games, it becomes more than obvious that development teams do not conduct their own research but instead rely entirely on anecdotal evidence or simply replicate justifications from one another without further questions. For example, the developers of the game Tobias in the Zoo, in which the player must repeatedly identify the emotions of a fictional character to ‘win’ the game,  not only make the exact same references as the developers of the game Echoes, but also plagiarize entire paragraphs.³¹

This perspective is underpinned by the positivist assumption that there exists a definable set of universal social norms and rules to which individuals can and must adhere. The notion that, as autistic scholar Adrian Milton posits, social subtext is not fully predetermined as a set of a priori circumstances but is actively constructed by social agents engaged in interaction, is entirely disregarded.³² Milton conceptualizes interactions between individuals with markedly different experiences of the world as a "double-empathy problem", wherein they are likely to encounter difficulties in empathizing with one another. He references recent studies that have demonstrated that under experimental conditions, non-autistic individuals experienced challenges in interpreting the emotions of autistic participants or formed negative initial impressions of autistic individuals. According to his theory of the 'double empathy problem', these issues do not stem solely from autistic cognition but from a breakdown in reciprocity and mutual understanding that can occur between all individuals with divergent ways of experiencing the world. Game developers tend to ignore the bidirectional nature of empathy, as well as the cultural and historical contingencies of emotions and their expressions, and of the significance and utilization of eye contact.³³

Furthermore, these games perpetuate a culturally dominant conceptualization of disability as a purely medical and individual issue – an undesirable state of being that must be overcome through personal effort. This ignores a more socially just understanding of disability as a cultural and political construct that necessitates support systems to dismantle barriers and promote accessibility. The playful elements, endearing characters, and abundant use of emojis in all the presented 'games' do not alter the normative, and arguably oppressive mechanisms through which these technologies function to suppress neurodivergent behavior and promote neurotypical behavior. Thus, the philosophy and approach of the games integrate seamlessly and consistently into the violent history of autism therapy based on the theories and methods of radical behaviorism. Applied Behavior Analysis (ABA) therapy is the therapeutic application of the research, experiments, and theses of B.F. Skinner, the founder of radical behaviorism. Skinner conducted his seminal conditioning experiments with mice and pigeons already in the first half of the 20^th century to investigate how behavior can be explained, predicted, and ultimately controlled. Through these experiments, he discovered that observable behavior is not solely dependent on prior stimuli, as demonstrated by Pavlov, Watson, and others, but can also be elicited by consequences of observable behavior. He termed the process of predictably producing desired behavior by reinforcing a specific action and eventually entire chains of actions, "operant conditioning" and "reinforcement learning".³⁴ Applied behavior analysis as a therapeutic approach was developed from the 1960s onward, most prominently by the psychologist Ole Ivar Lovaas at UCLA, specifically as an intervention for the treatment of autistic and gender-nonconforming children.³⁵ In what became known as The Feminine Boy Project, which Lovaas conducted in the 1970s with George Rekers, the foundations were established for what is now termed conversion or reparative therapy.³⁶ While the latter is now a prohibited treatment method in numerous countries, ABA therapy remains the most prevalent form of therapy in the field of autism, particularly in the USA and other countries of the Global North. When implemented according to the protocol, children undergo up to 40 hours of treatment per week with their therapists and parents. The objective of this therapy is to cultivate desired social behavior or to mitigate undesired or so-called challenging behavior, and it is predicated on Skinner's operant conditioning. This approach entails positively reinforcing desired behavior through praise and rewards, while sanctioning undesired behavior through punishment measures which in the earlier days of ABA included physical and psychological violence such as yelling, slapping, or electric shocks. These days, punishment is manifested through methods like withholding food or removing preferred toys.

The games in question, like most therapy games, try to implement these interventional logics into their own game mechanisms. They are either meant to complement ABA therapy or extend it into families. The Zirkus Empathico developers write of the “inadequate social behavior”³⁷ of autistic children, which can be countered through an intervention “based on principles of behavior therapy for individuals with autism.”³⁸ In the serious game Social Clues, another comparable intervention developed by the games division of the University of Southern California, players assume the roles of ParticiPete or CommuniKate in an interactive cartoon-like narrative, wherein players' choices and dialogue influence story progression and outcome.³⁹ To locate misplaced toys, players must engage in communication with encountered characters, navigate conversations, and resolve common social scenarios such as queuing or joining a group. Each level and character type is designed to impart specific lessons and "promote social learning goals."⁴⁰ Throughout the interactions, players receive stars for successfully completing each step, accompanied by verbal reinforcement from Sherlock, a parrot guide/therapist. Additional reinforcements include mini-games and gameplay elements, which function as rewards. Ultimately, these interactions facilitate the acquisition of the information necessary to locate one of the misplaced toys that the players are seeking. Like Zirkus Empathico, Social Clues is very upfront about its therapeutic approach. The Social Clues-website states:

Many interventions exist for autism, but only a few have been proven effective through scientific research […] The learning objectives, and key gameplay mechanics in Social Clues have been developed from the ground up using core principles of several ‘evidence-based practice’ interventions. Some of these include: Applied Behavioral Analysis (ABA).⁴¹

Social Clues incorporates this as follows: Prompts and triggers are presented by Sherlock, the parrot therapist, and non-player characters to provide a “measurable learning opportunity.”⁴² In this system, users select what they believe to be the appropriate action, and their decisions are monitored by analytics. Sherlock and other characters in the game react to these choices, either commending correct decisions or steering the user towards alternative options, thus reinforcing suitable behaviors. Each interaction and dialogue with characters follows a methodical approach, comprising distinct, quantifiable phases. These phases are consistently repeated to ensure precise data gathering and evaluation of advancement. Individual conversations are treated as "discrete trials,” with each trial beginning and concluding independently.⁴³ A new trial commences when interacting with a different character. Upon successfully completing a conversation, users are granted access to minigames, which act as positive reinforcements for their accomplishments.

The history of this kind of reward system, where players earn points, stars, badges, and other incorporated reinforcements on which not only autism therapy games are based, but which is a main feature of all gamification-based systems, is identical to the history of behaviorist autism therapy. It can be traced back to the very first behaviorist psychological experiments, which were conducted with autistic children as early as the 1950s. Charles Ferster, one of Skinner’s former postdocs, and his colleague Marian DeMyer conducted one of the first so-called token economy experiments, where autistic children had to earn coins by manipulating a dispenser, which served as currency or “generalized reinforcers” offering candy, small games, rounds on a pinball machine etc..⁴⁴ Already these early experiments were recorded in detail so that the course of the experiment and the performances of the children could be precisely analyzed (and predicted). Thus, the token reward system already has the same two functions as the point systems of today's gamification applications: extrinsic motivation and analysis.⁴⁵ Zirkus Empathico subscribes to the same logic. The distinctive characteristic of this approach is that it does not focus on vague "social-emotional skills" as the declared objective of the intervention. Instead, empathy is explicitly identified as the primary goal, which is subsequently deconstructed into clearly defined sub-skills and translated into varying degrees of difficulty with corresponding levels, including discrete trials, rewards, and mini-games. The prescribed "empathic chain of action" bears an unmistakable and seemingly deliberate resemblance to Skinner's 'chain of action'.

Neurodivergent Disaffection

In the concluding section of this article, I propose an analysis of the aforementioned games through the critique of empathy as the presumed foundation of sociality, as articulated by literary scholar Xine Yao in her critique of Western affect theory. Yao identifies in Adam Smith's concept of sympathy, as delineated and elaborated in his treatise Theory of Moral Sentiments (1759), both the historical precursor to the contemporary discourse on empathy and a fundamental principle in facilitating American nation-building and Western imperialism. According to Smith’s definition, “By the imagination we place ourselves in his situation, we conceive ourselves enduring all the same torments, we enter as it were into his body, and become in some measure the same person with him, and hence form some idea of his sensations, and even feel something which, though weaker in degree, is not altogether unlike them.”⁴⁶ This “fellow-feeling,” as he calls it, is theoretically bidirectional. People desire to receive sympathy and “hurt by the want of it”, and people want to sympathize and “hurt when we are unable to do so”.⁴⁷ Throughout Smith's treatise, individuals who lack empathy/sympathy or refuse to acknowledge the empathy/sympathy of others are repeatedly portrayed as offensive; their lack of acknowledgment is an affront. In this context, the absence of sympathy for another person causes a more significant disruption in social harmony than mere differences of opinion: “We become intolerable to one another. I cannot support your company, nor you mine. You are confounded at my violence and passion, and I am enraged at your cold insensibility and want of feeling.”⁴⁸ On the other hand, when “we cannot enter into his indifference and insensibility,” as in the case of people who do not react to insult or injury, such people are seen as “contemptible” and equally reprehensible as their aggressor.⁴⁹ As Yao writes, “the consequence of not sympathizing is to forfeit receiving sympathy.”⁵⁰ Particularly susceptible to insensitivity, and consequently deemed undeserving of empathy, according to Smith, is the figure of the "savage": “It is observed by all those who have been conversant with savage nations, whether in Asia, Africa, or America, that they are equally impenetrable, and that, when they have a mind to conceal the truth, no examination is capable of drawing it from them.”⁵¹ Individuals of Asian, Black, and Indigenous backgrounds demonstrate a lack of concern regarding their vulnerability to external judgment, exhibiting minimal preoccupation with eliciting sympathy from Western observers. In response, Smith displays a deficiency in empathy and fails to acknowledge the racialized emotions experienced by these groups. Yao challenges the racialized insensibility and inscrutability through the concept of disaffection/unfeeling, which she interprets in various positions and constellations of 19^th century American literature as Black, Asian, Indigenous and queer detachment from this hegemony of feeling, as a coping strategy and political form of resistance. I would like to take this approach and bring it into play in the autism discourse as an attempt to conceive of autistic lack of empathy otherwise. It is not in any way my intention to decontextualize Yao's queer of color critique but rather to add another othered and marginalized perspective to it. Yao herself posits: "The stigmatization of queerness, Blackness, Indigeneity, and Asianness can inspire disruptive potential for other ways of being that shatter norms rather than acceding to the ceaseless duties of refutation for the sake of inclusion."⁵² As critical disability studies emphasize, disability is not a medical fact, but a political and cultural construct. For disability scholar Lennard Davis, “disability is the missing term in the race, class, gender triad.”⁵³ Building on this, my point in this specific context is, speaking with disability scholar Rosemarie Garland Thomson, “to move disability from the realm of medicine into that of political minorities, to recast it from a form of pathology to a form of ethnicity.”⁵⁴ Already in the discourse of the 19th century, as Yao shows, we see an intersectional entanglement of racialization and pathologization. Commenting on Benjamin Rush's treatise on black people and leprosy, she states, "[b]lack unfeeling becomes a literal symptom of pathologization, read as a physical property of the human body".⁵⁵ Moreover, Smith’s descriptions of racialized unsympathetic others, who lack sensitivity but display pathological insensitivity, apathy, and indifference, read eerily similar to the descriptions of autistic people throughout the intellectual history of autism. As Hans Asperger, for example, puts it, “parents suffer deeply from the unfeeling behavior of their children”.⁵⁶ This parental distress still serves as a recurring justification for contemporary interventions, particularly evident in marketing videos for applications and technologies that largely capitalize on parental struggles with seemingly detached and incomprehensible children.⁵⁷

Rather than demonstrating that the thesis of empathy deficit fails to withstand empirical scrutiny at any level, or rejecting this thesis and reclaiming empathy for individuals with autism, as numerous scholars and autism advocates do, Yao's critique of the concept and her notion of disaffection/unfeeling enables a progression beyond that perspective. It allows for the conceptualization of ‘typical autistic behavior’ as a profoundly rhetorical, even political, act of resistance against the challenges of passing and neurotypical assimilation. Autistic disaffection elucidates the neurotypical structure of feeling as a hegemonic default, deconstructing empathy here as an intrusive and ableist concept predicated on positivist and even racist principles. Consequently, my final assertion is not, as one might have anticipated, to advocate for games that teach empathy as the aforementioned bidirectional interaction, that is, games that might provide insight into the autistic experience rather than attempting to rectify neurodivergent behavior. Rather, I would like to plead for games that require “players to respect the people with whom they cannot identify."⁵⁸ This approach acknowledges the complexity and uniqueness of not just individual experiences, but also those of neurodivergent individuals. Rather than attempting to fully understand or "fix" neurodivergent behavior, I suggest that games should foster an environment of mutual respect and acceptance. This aligns with a quote by Edouard Glissant which Yao commences her book with. Glissant states: "I thus am able to conceive of the opacity of the other for me, without reproach for my opacity to him. To feel in solidarity with him or to build with him or to like what he does, it is not necessary for me to grasp him."⁵⁹ Games have the potential to cultivate a society that is more accepting and inclusive, in which individual distinctions are acknowledged without necessitating complete comprehension or personal affiliation.

Acknowledgements

I thank the Game Studies Research Group of Innsbruck University, which gave me the opportunity to work on these questions during my fellowship on the topic of "Played Empathy.” I am immensely grateful for the many discussions, valuable comments, and suggestions. I also thank the two reviewers of this paper for their help in making this article more reader-friendly.

Literature

Games

Quinn, Zoé; Lindsey, Patrick; Schankler, Isaak: Depression Quest. 2014 http://www.depressionquest.com/dqfinal.html# [27.02.2025]

Anthropy, Anna: Dys4ia. 2012 https://w.itch.io/dys4ia [27.02.2025]

Realtime Associates; Hope Lab: Re-Mission. 2006

Dowino: Smokitten. 2018 https://apps.apple.com/us/app/smokitten-quit-smoking/id1418597849?l=de [27.02.2025]

Berlin School of Mind and Brain, Humboldt University: Zirkus Empathico. 2016. https://www.zirkus-empathico.de/ [27.02.2025]

Bernstein, Jeremy; Okrent, Karen; USC Games: Social Clues. 2014. https://socialcluesgame.wixsite.com/socialclues [27.02.2025]

Texts

Aigner, Christoph et al: BreathIn – A Serious Game to Support Patients with Smoking Cessation: Analysis and design study for a mobile serious game to help patients quit smoking. In: ICMHI '23: Proceedings of the 2023 7th International Conference on Medical and Health Informatics. 2023, pp. 239-244 https://doi.org/10.1145/3608298.3608342 [27.02.2025]

Asperger, Hans: ‘Autistic Psychopathy› in Childhood’. In: Frith, Uta (Ed.): Autism and Asperger Syndrome. Cambridge: Cambridge University Press 1991 [German Orig. 1944], pp. 37-92

Baron-Cohen, Simon: Mindblindess: An essay on autism and theory of mind. Boston: MIT Press/Bradford Books 1995

Baron-Cohen, Simon: Theory of Mind in normal Development and Autism. In: Prisme 34 (2001), pp. 174-183

Baron-Cohen, Simon; Leslie, Alan M.; Frith, Uta: Does the autistic child have a ›theory of mind‹? In: Cognition. Vol. 21 (1985), pp. 37-46

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Bernardini, Sara; Porayska-Pomsta, Kaśka; Smith, Tim J.: ECHOES: An intelligent serious game for fostering social communication in children with autism. In: Information Sciences. Vol. 264 (2014), pp. 41-60. https://doi.org/10.1016/j.ins.2013.10.027 [27.02.2025]

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Videos

https://www.zirkus-empathico.de/ [27.02.2025]

https://www.youtube.com/watch?v=Adu1HpfGDwY&ab_channel=SamsungVietnam [27.02.2025]

https://www.youtube.com/watch?v=R2_9PAhwARg&t=1s&ab_channel=SocialCluesGame [27.02.2025]

1. Ruberg: Empathy and its Alternatives. 2020. https://doi.org/10.1093/ccc/tcz044 [27.02.2025].[↩]
2. Quinn; Lindsey; Schankler: Depression Quest. 2013 http://www.depressionquest.com/dqfinal.html# [27.02.2025]; Anthropy: Dys4ia. 2012. https://w.itch.io/dys4ia [27.02.2025]. Anna Anthropy has strongly contested and criticized the claim that her game or any game could really convey an authentic experience or teach empathy whatsoever. See D’Anastasio: Why Video Games Can’t Teach You Empathy. 2015. https://www.vice.com/en/article/empathy-games-dont-exist/ [26.9.2024].[↩]
3. Baron-Cohen: Mindblindness. 1995; Baron-Cohen: Theory of Mind in normal Development and Autism. 2001, pp. 174-183; Baron-Cohen; Leslie; Frith: Does the autistic child have a ‘theory of mind’? 1985, pp. 37-46; Baron-Cohen; Wheelwright: The Empathy Quotient. 2004, pp. 163-175.[↩]
4. I will mostly use identity-first language in this paper when referring to individuals affected by autism rather than person-first-language. I acknowledge the arguments that have been made for each of the terminologies and their use. Individuals affected by autism, diagnosed or not, decide whether they consider autism as being such an essential part of themselves and their identity, that they refer to themselves as autistic, whether they consider it as something that they have or whether they choose not to refer to it at all. When I use identity-first-language I do so because I want to bring to the fore that I do not consider autism as something comparable to a disease, as something that can or must be cured. It is a political decision expressing my solidarity with the identity politics of the neurodiversity movement. Identity-first language is said to be preferred by autistic people (Kenny et al.: Which Terms should be used to describe Autism? 2016) and to prevent stigmatization (Gernsbacher: Editorial Perspective. 2017).[↩]
5. E.g. Williams: Theory of own mind in autism. 2010 https://doi.org/10.1177/1362361310366314 [27.02.2025]; Kinnaird; Steward; Tchanturia: Investigating alexithymia in autism. 2020. https://doi.org/10.1016/j.eurpsy.2018.09.004 [27.02.2025].[↩]
6. Happé: Autobiographical writings. 1991, p. 220.[↩]
7. Asperger: ‘Autistic Psychopathy’ in Childhood. 1991 [German Orig. 1944], pp. 37-92; Kanner: Autistic Disturbances of Affective Contact. 1943, pp. 217-250.[↩]
8. Kanner: Autistic Disturbances of Affective Contact. 1943, p. 228.[↩]
9. Kanner: Autistic Disturbances of Affective Contact. 1943, p. 234.[↩]
10. Asperger: ‘Autistic Psychopathy’ in Childhood. 1991, p. 76.[↩]
11. For example: Asperger: ‘Autistic Psychopathy’ in Childhood. 1991, p. 66.[↩]
12. Kanner: Autistic Disturbances of Affective Contact. 1943, p. 232; 235.[↩]
13. Asperger: ‘Autistic Psychopathy’ in Childhood. 1991, p. 69.[↩]
14. Kanner: Problems of nosology and psychodynamics in early childhood autism. 1949, pp. 416-426; Bettelheim: The empty fortress. 1967.[↩]
15. Baron-Cohen: Mindblindness.1995; Baron-Cohen: Theory of Mind in normal Development and Autism. 2001, pp. 174-183; Baron-Cohen; Leslie; Frith: Does the autistic child have a ‘theory of mind’? 1985, pp. 37-46; Baron-Cohen; Wheelwright: The Empathy Quotient. 2004, pp. 163-175.[↩]
16. Realtime Associates: Re-Mission. 2006.[↩]
17. Dowino: Smokitten. 2018 https://apps.apple.com/us/app/smokitten-quit-smoking/id1418597849?l=de [27.02.2025]; Aigner et al.: BreathIn – A Serious Game to Support Patients with Smoking Cessation. 2023 https://doi.org/10.1145/3608298.3608342 [27.02.2025].[↩]
18. For a discussion of these wearables see Wentz: Through the Autism Glass. 2023 https://doi.org/10.11588/ic.2023.4.93412 [27.02.2025]; Tales from the Loop. 2022 https://doi.org/10.1515/fs-2022-0038 [27.02.2025]; Nudged to normal. 2021 https://doi.org/10.14361/dcs-2021-070213 [27.02.2025].[↩]
19. For an overview of the different interventions, see Cross; Atherton: The Use of Analog and Digital Games for Autism Interventions. 2021a https://doi.org/10.3389/fpsyg.2021.669734 [27.02.2025].[↩]
20. Cross; Atherton: Gamification in autism. 2021b https://www.firah.org/upload/activites-et-publications/progammes-thematiques/autisme-nouvelles-technologies/autisme-et-jeux/uk-gamification-in-autism.pdf [27.02.2025].[↩]
21. Ekman; Friesen: Facial Action Coding System. 1978.[↩]
22. Zoerner et al.: Zirkus Empathico. 2016 10.1109/ICALT.2016.146 [27.02.2025]; Kirst et al.: Fostering socio-emotional competencies. 2022 https://doi.org/10.1016/j.brat.2022.104068 [27.02.2025].[↩]
23. Kirst: Praktische Einführung in die Nutzung der Trainingsapp Zirkus Empathico. 2017 http://www.die-schillos.de/bofoek/archiv/2017-2/Zirkusempathico.pdf [23.01.2025]. [↩]
24. Kirst et al.: Fostering socio-emotional competencies. 2022 https://doi.org/10.1016/j.brat.2022.104068 [27.02.2025].[↩]
25. Kirst et al.: Fostering socio-emotional competencies. 2022 https://doi.org/10.1016/j.brat.2022.104068 [27.02.2025]; Zoerner et al.: Zirkus Empathico. 2016 10.1109/ICALT.2016.146 [27.02.2025].[↩]
26. Zoerner et al.: Zirkus Empathico. 2016, p. 449 10.1109/ICALT.2016.146 [27.02.2025].[↩]
27. This quote is from the game. I was given the permission to play it, but it cannot be accessed directly. I thank Simone Kirst for having given me access to the game.[↩]
28. Kirst et al.: Fostering socio-emotional competencies. 2022, p. 2 https://doi.org/10.1016/j.brat.2022.104068 [27.02.2025].[↩]
29. For the critique see e.g. Dawson: The Misbehaviour of Behaviourists. 2004. https://www.sentex.ca/~nexus23/naa_aba.html [1.10.2024]; Yergeau: Authoring Autism. 2018; McGuire: War on autism. 2016; Rosqvist; Chown; Stenning: Neurodiversity Studies. 2020.[↩]
30. Gernsbacher; Yergeau: Empirical Failures of the Claim that Autistic People Lack a Theory of Mind. 2019, pp. 102-118 https://doi.org/10.1037/arc0000067 [27.02.2025].[↩]
31. See Carvalho et al.: Tobias in the Zoo – A Serious Game for Children with Autism Spectrum Disorders. 2015, pp. 23-29 https://doi.org/10.3991/ijac.v8i3.4897 [27.02.2025]; Bernardini; Porayska-Pomsta; Smith: ECHOES: An intelligent serious game for fostering social communication in children with autism. 2014, pp. 41-60 https://doi.org/10.1016/j.ins.2013.10.027 [27.02.2025].[↩]
32. Milton: On the Ontological Status of Autism. 2012 https://doi.org/10.1080/09687599.2012.710008 [27.02.2025].[↩]
33. Even though Kirst et al. are aware of Milton’s argument and mention it. They claim that Zirkus Empathico “can foster the mutual understanding of emotion processing and thus, can help non-autistic individuals (e.g., caregivers, peers) to empathize more with children on the AS [autism spectrum, D.W.]”. Kirst et al.: Fostering socio-emotional competencies. 2022, p. 12 https://doi.org/10.1016/j.brat.2022.104068 [27.02.2025]. However, they do not draw any conclusions from this realization, such as questioning their goal of behavior modification of autistic children. [↩]
34. Skinner: The Behavior of Organisms. 1938; Skinner: Science and Human Behavior. 1953; Skinner/Ferster: Schedules of Reinforcement. 2014 [1957].[↩]
35. Some of his many publications on the subject: Lovaas; Schaeffer; Simmons: Building social behavior in autistic children by use of electric shock. 1965, pp. 99-109; Lovaas; Simmons: Manipulation of self-destruction in three retarded children. 1969, pp. 143-157 https://doi.org/10.1901/jaba.1969.2-143 [27.02.2025]; Lovaas et al.: Some generalization and follow-up measures on autistic children in behavior therapy. 1973, pp. 131-166.[↩]
36. Rekers; Lovaas: Behavioral treatment of deviant sex-role behaviors in a male child. 1974, pp. 173-190; Rekers; et al.: Child gender disturbances. 1977, pp. 2-11.[↩]
37. Kirst et al.: Fostering socio-emotional competencies. 2022, p. 2 https://doi.org/10.1016/j.brat.2022.104068 [27.02.2025].[↩]
38. Zoerner et al.: Zirkus Empathico. 2016, p. 449 10.1109/ICALT.2016.146 [27.02.2025].[↩]
39. Bernstein/Okrent/USC Games: Social Clues. 2014 https://socialcluesgame.wixsite.com/socialclues/about [1.10.2024].[↩]
40. https://socialcluesgame.wixsite.com/socialclues/about [1.10.2024][↩]
41. https://socialcluesgame.wixsite.com/socialclues/science [1.10.2024].[↩]
42. https://socialcluesgame.wixsite.com/socialclues/science [1.10.2024].[↩]
43. https://socialcluesgame.wixsite.com/socialclues/science [1.10.2024].[↩]
44. Ferster/DeMyer: The development of performances. 1962a https://doi.org/10.1016/0021-9681(61)90059-5 [27.02.2025]; Ferster/DeMyer: A method for the experimental analysis. 1962b https://doi.org/10.1111/j.1939-0025.1962.tb00267.x [27.02.2025].[↩]
45. Raczkowski, Felix: Making points the point. 2014, p. 141-160. I am indebted to Felix Tenhaef for the valuable reference to Raczkowski's research.[↩]
46. Smith: Theory of Moral Sentiments. 1976 [1795], p. 9.[↩]
47. Smith: Theory of Moral Sentiments. 1976, p. 15.[↩]
48. Smith: Theory of Moral Sentiments. 1976, p. 21.[↩]
49. Smith: Theory of Moral Sentiments. 1976, pp. 34 and 35.[↩]
50. Yao: Disaffected. 2021, p. 13.[↩]
51. Smith: Theory of Moral Sentiments. 1976, p. 208.[↩]
52. Yao: Disaffected. 2021, p. 27.[↩]
53. Davis: Enforcing Normalcy. 1995, p. 12.[↩]
54. Garland Thomson: Extraordinary Bodies. 1997, p. 6.[↩]
55. Yao: Disaffected. 2021, p. 20.[↩]
56. Asperger: ‘Autistic Psychopathy’ in Childhood. 1991, p. 77.[↩]
57. See for example the videos for Zirkus Empathico (in German), https://www.zirkus-empathico.de/, Social Clues, https://www.youtube.com/watch?v=R2_9PAhwARg&t=1s&ab_channel=SocialCluesGame, or Look at Me, a gamified smartphone application developed by Samsung, https://www.youtube.com/watch?v=Adu1HpfGDwY&ab_channel=SamsungVietnam. See also Wentz: Tales from the Loop. 2022. https://doi.org/10.1515/fs-2022-0038 [27.02.2025].[↩]
58. Ruberg: Empathy and its Alternatives. 2020, p. 15 https://doi.org/10.1093/ccc/tcz044 [27.02.2025].[↩]
59. Glissant: Poetics of Relation. 1997, p. 191.[↩]