This is a transcript of the talk.
The recommendation? Listen to the podcast: https://anchor.fm/lou-agosta-phd/episodes/Empathy-and-LIterature-Grand-Rounds-Presentation-at-Rush-Medical-University-October-13–2016-e177nvv
or watch the Youtube video: https://youtu.be/sYJvplP5cKo
Howard Kravitz, MD: Welcome to the partner psychiatry gran realms this morning is my pleasure to introduce the speaker dr. Lou Agosta got his PhD in philosophy at the University of Chicago with a dissertation entitled empathy and interpretation and running with that as his career scholarly activity ever since he’s an assistant professor of psychology at the Illinois School of Professional Psychology and Argosy University and instructor of philosophy at the University to call the Graham School of adult education and director of research at other gang psychotherapy services in Chicago he also as a psychotherapy practice in the Chicago community who specializes in making empathy present in his storytelling and listening – he’s committed to a gracious and generous listening based on empathy which I personally experienced a meeting with him this summer to talk about his idea for Grand Rounds – as an educator he teaches empathy in the history of and systems of psychology program at the Illinois School of Professional Psychology and Argosy University – he has published three scholarly academic books on empathy entitled – empathy in the context of philosophy – a rumor of empathy: rewriting empathy in the context of philosophy – and a rumor of empathy: narrative and recovery – he also undertook training as a psychodynamic therapist at the Chicago Institute for Psychoanalysis – however did not complete the program when he was summarily dismissed for asking publicly “is anyone beside me aware of a lack of empathy?” – so with that I will turn the program over to him
Lou Agosta [LA]: Well thank you so much dr. Kravitz for that introduction – so the challenge is to make empathy present – will we be able to do that in the next 45 or 50 minutes? I begin by acknowledging your empathy – you all are going to be doing some listening and I appreciate that and recognize that and acknowledge it – and I want to be concise and allow time for questions in interaction at the back end – some logistics and housekeeping make sure you have the color handout – if you don’t it’s in the back on the left side – there it says how empathy functions – 2-sided copying ladies and gentlemen – and then how empathy breaks down – so sometimes we can create a breakthrough based on a break down – and one of the results of the conversation that we’re going to have today among others is a short history of the distinction empathy – in fact the secret underground history of empathy – we’re going to define empathy –
Lou Agosta [LA]: we’re going to look at some examples of empathy through literature – so rather than clinical examples I’m going to ask you to take it up a level – the guidance is and with all due respect don’t be too concrete don’t be too literal let’s get our metaphorical transference thinking caps on and look at empathy of [in] some examples of world literature and then I’m going to make time – I’m going to say a few things about how empathy is teachable trainable – in fact that’s so important i am going to give you the answer right up front – basically people are naturally empathic – if we remove the obstacles to empathy, then empathy shows up – in other words, the obstacles to empathy are the such things as: denial, resistance, cynicism, bullying, aggression, bad language –
LA: I have a great Dilbert cartoon here -[make sure you] don’t get inside of a Dilbert cartoon – [it is] hilariously funny – closely related to empathy – [drive out] denial, cynicism, guilt, shame, and the like – remove the obstacles to empathy and it [empathy] naturally comes forth – so that’s the answer – what’s the question? – how do we train everyone ? – so we’re gonna circle around and return to this at the back end – we’re going to begin with a short secret underground history of empathy – so this is going to be blazingly concise –
LA: this is the part which you may find somewhat academic [but important] and there as you look at it in the upper left hand corner a man named David Hume [ who published] A treatise of human nature 1739 – [in the year] 1739 the word empathy in the English language was not even invented [it was not invented] until 1895 when a Cornell University psychologist – a man named Edward Bradford Titchenner was translating some of the works of Vilhelm Vundt [Wilhem Wundt] – I have to get my best German accent on there – it comes across as empathy – he [Titchener] makes up the word [empathy] – okay – meanwhile […] that’s why we have a secret underground history of empathy – Hume is writing and has at least five different definitions of sympathy – I say close enough – you have the hand out – the complete deck is on the URL on the lower left hand corner [see the youtube video for the slides] – I’m not going to speak slowly enough for you to take notes –
I’m going to tell you what the five different definitions of sympathy – they’re there and you can go back and get them – he never a stickler for consistency – the philosopher Hume divides sympathy as (1) emotional contagion – he defines sympathy as (2) suggestibility – the power of suggestion – (3) he defines it in a somewhat technical way as a double representation of a vicarious experience of another person combined with the idea of the other that matches closely to a modern definition of empathy that we find in psychology (4) he also defines sympathy as a delicacy of sympathy and taste and this matter of substituting a certain kind of sympathy in the experience of the work of art – this is the secret underground history of empathy – we relate to other people on a good day as if they were works of art – that is without use value – without manipulation – without knowing something – without categories – without argument – and [on] a less good day we struggle like everybody else – and finally as (5) benevolence – he defines sympathy as compassion or benevolence –
LA: and so we’ve got all these definitions – what the heck is it [empathy] – what is this definition so I sent the class [I was teaching at the time] out [to do research by asking people on the street] – I have everybody in the class – several classes – each student asked five people what they think empathy is – not members of your family people – you know moderately well – not really close – you know – but people you might work with or run across at the club or at the gym or something – so there’s a trend – so sometimes I go around saying we don’t need more Data we need expanded empathy – I’ve been known to say that – and nevertheless we need both data and empathy […] -I say more empathy – it’s like there’s something missing rather than something wrong – let’s expand – the languaging is significant as well – this is in the realm of tips and techniques- okay – so anyway – so the people go out and ask them and so here’s the trend: most people think empathy is something like compassion – they tell the story about altruism – they tell a story about charity – they tell the story about doing good – they tell the story about making difference – they tell a story about being nice and heavens knows ladies and gentlemen, the world needs more niceness – [yet niceness] it is distinct from empathy – we’re going to say a little bit more about that but first I want to very concisely touch on – as you look at the picture in the upper right hand corner – Immanuel Kant – he died in 1804 – he had the distinction between putting oneself in the position of the other person – he said enlarged thinking – think as the other [people] think and feel – so that’s top down – in effect we take that as the folk psychology definition of empathy – we take a walk in the other person’s shoes – where does the shoe pinch – where does the moccasin chafe – and then he also he once again interestingly and controversial enough in the context of a theory of art and beautiful nature he talks about the communicability of feeling – art is impossible without the communicability of affect – feeling – that’s stage one of empathy – now if you stop, [then] there you get emotional contagion – you get suggestibility – you get a certain kind of shared mutual enthusiasm – and there’s nothing wrong with that if there’s further processing upstream and downstream that’s going to occur – nevertheless it’s right there and then [we are going] around the circle –
LA: and this is why this is the secret underground history: on the bottom left – a man named Theodore Lipps – remember the movie Amadeus ?where you know Mozart is slaving away and the most famous man of his day a musician named is Antonio Salieri who today except for the movie Amadeus nobody would have ever heard of Antonio Salieri – I mean he’s not played – or they’ll give attention occasionally now because of the movie – right – and today Mozart – everybody knows Mozart’s music is played widely and nobody’s ever heard of Salieri until you come across the movie – well Lipps is Salieri to Freud’s Mozart – Lipps wrote several volumes in which he gives currency in the German language to the word Einfühlung [empathy] – he [Lipps] in effect replaces the distinction aesthetic taste judgment of a feeling of pleasure or displeasure with Einfühlung [empathy] – and he [Lipps] is significant because seven volumes of Lipps work are in the Freud Library – Freud encountered empathy by reading Theodore Lipps –
and [Freud] footnotes Lipps explicitly in Freud’s works on jokes and the relation to the unconscious – and the number of his aesthetic works – so moving right along there are twenty-two mentions of empathy in 24 volumes of the Freud Library as Harry Trosman MD and Simmons – our colleagues over at the analytic Institute – have done the scholarly work – here’s the point – almost every one of them [references to empathy] is mistranslated – freud says in so many words in his 1913 [year published] recommendations for physicians beginning psycho analytic treatment: you will go wrong if you begin with any other method besides empathy – quote end quote – it’s there and that gets mistranslated as sympathetic understanding – the Strachies [translators] will have a few other devaluing things to say about the word empathy so that’s the secret […] – the rest is history which we’re not going to do in the necessary detail – we’re going to move right along –
so most people think that empathy is compassion – and heavens knows the world needs more compassion – yet [compassion] it is not empathy – so what then is it ? Well basically we’re gonna have about two or three different definitions but the main definition which you have in front of you is to the effect – I know what the other person is experiencing because I experienced it also – not as a merger but as a vicarious experience – note vicarious experience contains the word Vicar which means representative – the etymology right as it actually works in this case if that is the the bishops representative to the community – the Vicar of something or other – and in any case combined with the distinction Other – and so basically here’s the distinction – empathy tells me what the other person is experiencing – and my good upbringing, my morals, my values, tell me what to do about it – and so that’s the compassion part – it’s in and its distinct – so having said that now here’s the most controversial slide I want you to pick up on this because it could be a controversial –
and I want – to quote to Jodi Halpern and I’m gonna wave Jodi’s book at you [entitled From detached concern to empathy: humanizing medical practice – Jodi Halperin – this is [published] 2001 so this has been around for a while and you know if we’re gonna have lunch afterwards – if you want to take a picture of the cover – I’ll bring it [the book] along with me and you can check it out but basically she says – the field of medicine empathy is a mode of understanding that specifically involves emotional resonance so it’s not just top down – it’s also bottom up – I’m getting some kind of a vicarious experience – this may or may not be the case – this may or may not be the case […] and so you know nevertheless she puts a stake in the ground and she is actually a psychiatrist – she has some stories
and I turn now to the explicit definition of empathy which we’re going to work with here and there are four phases to it – and that’s the handout – […] you get the handout – it’s on the left there – in the back table – so you want to be on the side: how empathy functions – […] so we’re gonna go around in a circle – we’re gonna go around in the circle here that would be actually counterclockwise – I’m open to the other person – I’m receptive – I have mirror neurons – and here’s where one can insert the underlying physiology – the underlying neurology – that’s not visible – here us mammals – we seem to resonate together – something is going on – we’re attached – it’s a myth that we aren’t related – we are related – physiologic\ally, biologicall,y and so [that is] phase one […]
phase two that creates a potential space for interaction – what’s possible in the relationship – do I relate to the other person as a means or end – do I relate to the other person as a possibility as a potentiality – we’re going to see an example of that and then actually you have to jump across so that gives us empathic receptivity- empathic understanding and empathic interpretation is the third aspect of empathy and that is the folk psychology of empathy – I take a walk in the other person’s shoes – I imaginatively change places with you – now that’s easier said than done because I don’t know you and nine times out of ten if I don’t, [then] I’m going to attribute to you aspects of my own character traits – Who I am – what I’m up to and that’s the challenge – right? – that’s not going to be and it’s going to be a psychological mechanism called projection which has its uses and is of interest – nevertheless is once again not empathy – and so get a view from over there but that does especially when I come up short I don’t know who you are – where you came from – then I go to the cognitive imaginative projection – and that’s very useful – and finally empathy can be a tree that falls in the forest without anybody being there – does it make a sound? does it make a difference? I have to say something I have to do something – a gesture- an aspect of behavior to let the other person know whether or not I have gotten what their experience is and sometimes that’s called empathic listening – that’ll work – good gracious listening – that maybe it is self sufficient but sometimes it’s not especially if I don’t know the other person – it may we’re highly verbal – you know there’s a lot of words and sometimes it’s necessary for me and so empathic responsiveness – so we’ve got receptivity – understanding – interpretation – and responsiveness –
I take the other person’s experience and give it back to them in such a way in such a form that the other person recognizes the experience as their own – on a good day that’s how it works – that’s the aha moment – that’s what I was going through – it’s sometimes it could be the very words but often it’s not – often it’s I’ve got inside the movie of your life for a little while – now each of these [four moments of empathy] breaks down in an interesting way and we’re going to therefore look at the breakdown – so this summarizes something interesting and which I think I do want to say it’s always useful to know the order in which one has one slides but basically this is the matter of so we’re gonna, you know, this [talk] is front end loaded – I acknowledge this presentation is somewhat front and loaded because there are several important ideas I want to get into the space and on the table so that we can mix it up about it – but basically so this is the compassion fatigue the burn out moment – heavens knows, occupational hazards – professional challenges – if I may say so – here’s the guidance – this may be for the easier said than done but nevertheless it must both be said and done – and insofar as humanly possible: if I’m interacting with somebody who is suffering, it is highly probable that I am going to suffer – the recommendation, the guidance is, that I have a vicarious experience of that suffering – if I am suffering in such a way that I am in breakdown or upset, [then] I’m doing it wrong
That’s the easier said than done – if I’m overwhelmed by the suffering – as strange as it may say sound to say: I should suffer but not too much – and so this points to the matter of a granularity – to the receptivity – there’s a filter there – right – I mean this all hypothetical – interesting to engage – nevertheless I may want to make the filter more granular and do things to take a little distance so it is not an on/off switch – the takeaway here – not an on/off switch – more like a rheostat – more like a dimmer on a light switch and this is where training and practice make the difference – so I mean we may or may not come back to that – but I want that [statement] in the space so that we can work with it as we get to these examples we’re going to look at – so am I going in the right direction here […] I see we’re just on time –
we look at three or four examples – here I may cut this short because I want to say a little bit more about the training aspect but we’re going to look at Thomas Mass – Thomas Mann is a storyteller – this story got told on or about the year 1900 – it’s about a family the name of Buddenbrooks – they’re a business family – right – and the context is Thomas Buddenbrooks – so here’s the inside skinny – here’s the Birdseye low down on this Buddenbrooks caper – Thomas Buddenbrooks is an artistic type – he’s very artistic – and his father passes away in an untimely way and he – Thomas – goes into the family business to pay the bills – you know, one can understand why one would do this – he gives up his artistic career – his artistic aspirations – and instead of pursuing an artistic career, he marries one – her name is Gerda – she’s an artistic type – we’ll see a picture of her later – […] – she’s playing the violin – she’s a virtuoso violinist – playing passionate virtuoso violin duos with her talented father – it’s so great to have a great relationship […] it’s a very good thing and they have a son – Johann – Hanno, for short – he’s an artistic type – he’s portrayed by Mann as being on sickly – I mean, he’s got bad teeth – this is going to be an issue because this is 1900 – you know dental science – oh my god this has to be interesting –
LA: [ …] some people are already squirming in their seats – it’s working – the mirror neurons are going off even if they don’t exist – this might be a good point to digress – the myth of mirror neurons – professor – C[Jean] Decety – he’s got the MRI machine down at Gates Blake – he recommended this book by Gregory Hitchcock- there’s an underlying neurological mechanism, ladies and gentlemen – it does [or doesn’t] have to be mirror neurons – how about Association? – have you considered a good old-fashioned association? – there’s some implementation mechanism – it’s highly interesting and controversial – I’ll keep the book handy – it’s a scholarly academic debunking […] but what isn’t debunked is our physiological relatedness – even if they [mirror neurons] don’t exist, we’re physiologically related – that’s interesting so and not in the way you might have thought – okay – so anyway you know the dentist – we’re gonna have a trip to the dentist here thanks to Thomas Mass and I’m actually going to read it to you – the paragraph long quotation – so Hanno has bad teeth – in Mann bad teeth are a sign of artistic sensibility – in the case of Hanno he’s kind of sickly – kind of small – he gets bullied by the straggling Nordic types down at school – you know they push him around – it’s not a pretty picture – and his father becomes [a book camp dad] [the father, Thomas] he’s kind of badly compensated – I would say and he’s this hail-fellow-well-met – my son – give me your mathematical multiplication tables – and Hanno knows his tables – he just can’t perform – he breaks down – it’s pathetic – you know but he’s like seven years old – wa, was [crying sounds] – buck up my son – Thomas is boot camp dad and it’s not working – okay – so meanwhile there’s a bit of orality – you know, we can do the oral symbolism – Hanno needs to vigorously suck on the nipple of life and he’s really struggling to engage
[Meanwhile] – off to the dentist doctor – the dentist is already upon dr. brecht – a pun – it’s broken – so I’m gonna read you this slowly –
‘The bad thing about Dr. Brecht was he was nervous and dreaded the tortures he was obliged to inflict – we must proceed to extraction – he would say growing pale – Hanno himself was in a pale cold sweat with staring eyes incapable of protesting or running away – in short, in much the same condition as a condemned criminal – he saw dr brecht’s sleeve and the forceps bending over him and noticed that little beads were standing out on his bald brow and that his mouth was twisted – when it was all over and Hanno, pale and trembling, spat blood into the blue basin at his side dr brecht had to sit down and wipe his forehead and take a drink of water”
LA: So what’s going on here is a breakdown – this is a breakdown in dr. Brecht’s empathic receptivity – he’s overly empathic – one might argue – compare and contrast – the description itself gives us access to the phenomenon – right – both both are sweating – brecht’s mouth is twisted – interesting, the mirror neurons are going off – [brecht’s] his mouth is twisted [so the mirror neurons are going off] – so what’s the recommendation? this is the time for a bad joke – right – he should have gone into ophthalmology – forgive me – okay so back that one out – okay pause for laugh – but anyway it’s a serious insignificant group here – so here’s the breakdown and so what’s the recommendation? – given that empathic receptivity is breaking down on the part of dr. brecht […] – to get some distance from the tortures he inflates – given what is 1900 Dental Science – oh my god – it’s hard to think right and so he has to increase the granularity of the filter – easier said than done but practice practice practice practice what does that look like because he’s providing a useful service – […] I mean, it’s like it’s misery – there’s all kinds of mystery – okay – so you know I pause for breath at this at this point – I would ever take questions even at this point about the example – you know it’s not like this is a quiz and I don’t you know you’re eager for me to move along but don’t be shy raise your hand – okay, so we will move to the next example and that if you think of anything we can circle back around – so remember the set up – Thomas Buddenbrooks gives up his artistic career and he marries someone who is very artistic – Gerda – and she is artistic and she has to move and locate because the Buddenbrookss live in a different town than her father – so she’s no longer playing violin duo’s with her father – she’s got nobody to play with – one might say – so she meets this lieutenant who happens to be a talented violinist in addition to his military aspirations – so they’re upstairs playing passionate violin duo’s and Thomas’s office is downstairs and he’s listening to the violin music – and that’s not the problem – there’s nothing wrong with that – then the music stops – then there’s silence – there’s more silence – there’s even more silence – Thomas is going crazy – Is he going to become the caricature of a jealous husband? – that would be to throw the guy [lieutenant] out – that would be a scandal – that would indeed be a caricature – right – so he’s wandering around pacing back and forth – so he is pacing back and forth and he runs into Hanno in the hallway next quotation –
“His father did not seem to be listening – he held Hannes free hand and played with it absently, consciously fingering the slim fingers and then Hanno heard something that had nothing to do with the lesson at all – his father’s voice in a tone he had never heard before – low distressed almost imploring – Hanno, the lieutenant has been more than two hours with Mama – little Hanno opened wide his golden brown eyes at the sound and they looked as never before clear large and loving straight into his father’s face with his red and eyelids under the light brows its white puffy cheeks and long stiff moustaches – God knows how much he understood – but one thing they both felt in the long second when their eyes met – all constrained coldness in this understanding melted away – Hanno might fail his father in all that demanded vitality energy and strength but where fear and suffering were in question, there they were as one empathic understanding –
Hanno [saw] something that he had not previously perceived – this father was boot camp dad – multiplication tables right – the time goes by – Oh God now he sees – so what’s the word? vulnerability – that’s one possible description – this bootcamp dad is vulnerable – he’s suffering- Hanno does not get it – what does it mean – playing violin duos and then silence -Hanno’s seven or eight years old – right? – so their eyes meet – that is the moment of empathic receptivity embedded in empathic understanding – the father who was so inaccessible in his hail-fellow-well-met and boot camp-style cross-examination of Hanno about his lessons becomes vulnerable and accessible in his suffering – Hanno gets it – his father’s suffering is a possibility – the possibility of his humanity – they share a human moment – the possibility of relatedness emerges in which both are human beings and an emotional connection with one another – this had not been available to Hanno before – for whom his father was this strong demanding taskmaster – now he sees his father’s vulnerability and it humanizes both of them – this is also an example of empathic understanding that works to an extent but ultimately the father remains [in] the role and the story goes along […] What you want to get here is just a picture of the lieutenant and Gerda – they are practicing the violin – she’s giving a master class in practicing the violin – and so let’s do a reality check here – I want to leave both enough time for questions and answers and say something about a little bit more about training
So I’m going to fast-forward through interpretation – if you get the deck you can get some detail and move on to the Glass Menagerie [by] Tennessee Williams who is a formidable psychologist – so the story in brief: Amanda is the mom – Laura is the frail, fragile keeper of The Glass Menagerie – she lives in the back room – she is the daughter – she has a brother, Tom, who has a friend, Jim – Amanda, the mother, had many gentleman callers in her youth – she was popular – we could do with the song from Wicked [the broadway play] at this point but perhaps we won’t – we can we splice that in later – but as she was popular – now she’s fading – the bloom is off the rose – off the flower in the years nineteen fifties – and she so badly wants a date for Laura – to get a date – she wants her to have a gentleman caller caller so she pressures her son, Laura’s brother, Tom, to bring somebody from down at the factory and finally Tom invites Jim, his friend – there’s other information asymmetries in the story – Jim’s already engaged – get ready – you don’t necessarily know that at this point [in the story] but look is to follow along so the invitation is accepted – at last a gentleman caller! – the problem is Jim thinks it’s just a casual dinner with his friend Tom but in fact he then meets Laura who know Jim from grammar school – they went to grammar school together! – it’s small world and Jim sees her and and he says two words: blue roses – blue roses – and Laura is taken aback – she had many childhood illnesses including pleurisy – fluorosis – and when the teacher this was the day when the teacher would say why you weren’t in school well she’s got fluorosis or pleurisy – nobody knew what that meant anyway but Jim hears that as “blue roses” so here’s the part we’ll cut to the chase – Laura also has another childhood disease which leaves one of her legs slightly shorter than the other – polio- and as she walks down the aisle her experience of herself as that she’s making this enormous clomp clomp thumb clomp clomp as she walks down the aisle that everybody must know about it –
of course Jim didn’t even perceive it [it is so soft] and so we have here an example of what amounts to empathic responsiveness – he [Jim] gives her back his experience of who she is for him – for Jim, Laura is “blue roses” – something beautiful even if kind of melancholy – she’s got this melancholy aspect to her which makes her all the more attractive of course – […] and whereas she experienced herself as clunk clunk clunk thunk – the asymmetry there is very powerful – it’s very nice – I think Williams is a brilliant psychologist – I mean – and unfortunately – I mean – he’s also pretty depressed himself and it ends badly – nevertheless we’re going to enjoy the moment – the emotional devastation [is powerful art] – okay, so having so you know that’s three out of four examples – now we’re just on time
I’m going to talk and to tell you about an exercise rather than do the exercise – I call this exercise: I can’t hear you because my opinion of what you are saying is so loud – I’m going to be disarmingly with candid – so you know there I am walking down the street – and I am ashamed of myself – the author of three books on empathy – [and i am thinking devaluing thoughts] – how did that person get to be that way – I’m judging and evaluating – there’s these thoughts – what happened to you man? – wherever it comes, from it’s not authentically Who I am – you want to take this and apply it as appropriate and to yourself: there I can’t hear you because the opinion of what you are saying is so loud in my own thinking – so this is an exercise, not how to listen better, but how to expand one’s listening – right – stop and so actually this is where the the [Dilbert] cartoon comes in handy –
[…] there’s an exercise here that this is how to train for empathy – what does it mean to train empathy – remove the obstacles such as cynicism, categorizing people, labeling, pigeon holing, and so on – I’ll read this to you just so some of you are picking up on it – [in the Dilbert cartoon]: now so there’s the pointy headed boss [and he says] “from now on all teams will be formed on the basis of myers-briggs personality test types” “if you do not have a personality, one will be assigned to you by Human Resources [dept]” – okay, laughter at this point, [this] is deeply cynical […] this is what not to do – right? – and then the final [statement of the cartoon] “we need a quiet dumb guy to pair with an extroverted thinker” – well here the cynicism is what gets in the way of empathy – now that is not to say that it is not abroad in the land of the corporation [and it] goes off the rails – so what I invite – what the exercise consists of doing is going inward and realizing that if one goes inward far enough, one encounters the other – so we actually are going to take literally a half a minute and do the exercise –
So I’m going to ask you to be quiet and listen to yourself […] now there may be papers going off so just include that because this is after all a hospital – […] but listen to what is there – okay are you ready – any questions before they do the exercise? – it is it clear what I’m asking you to do ? please say if it’s not clear […] so you’re just gonna listen to whatever is there okay ready set go
[pause for thirty seconds]
Okay – that’s 30 seconds […] now you might have heard something like “what is he talking about?” “where did this guy come from?” “What voice?” “What conversation?” That’s the one – that’s the one [we are talking about]! – it’s not who I authentically am – and [yet] that is a source of empathic understanding -I am in relationship with the other and I’m going to have judgments, opinions, evaluations, philosophical arguments, categorizations, labels and so on – there isn’t anything wrong with those – those thoughts occur – they are inevitable – you can’t – ladies and gentlemen, you can’t stop thinking those – you can’t prevent it – what you want to do is get some distance from it and realize when it’s useful and when it’s less useful and so with that said we’re going to have some time for questions –
The one final thought I leave you with – and it’s a direct consequence of this little exercise – to listen to oneself, when all the labels are removed, when all the categories are removed, when all the philosophical arguments are removed, when all the cynicism, hostility, affectation, even compassion, sadness, fear, guilt, shame – when all these things are removed, [then] empathy consists in being in the presence of another human being
LA: what are your questions?
LA: The lady in the back – I’ll repeat the question – go ahead –
Do you think you can teach empathy?
LA: The short answer is yes […] so I’m going to repeat the answer – I just [asserted] we’re naturally empathic – remove the cynicism, denial, shame, guilt, and empathy naturally shows up – train the trainer now that’s not considered the possibility […] there other tips and techniques – this is the realm of tips and techniques: my reaction to you tells me something about both of us and a lot about myself which I then parlay forward to understand the relationship
[….] The challenge to create a context in which empathy can show up – right that’s not a trivial things – it’s a lot of work – and of course teaching is information transfer – I put information in your bucket – you bring a bucket or a basket and the teacher puts information in it – there’s nothing wrong with that – we need that – […] the world doesn’t work without information and there’s also the other aspects – dimensions – especially to our humanity and what happens in the context of a conversation – so you know there’s some work to be done on creating [possibility] and that’s what I think [why] literature has its uses in creating a context for a conversation that’s why I find it useful other questions? so I mean feel free to challenme
Individuals have been in some tough spots in the trenches for a while and become hardened – I think you use that word and how does one recover from that? – so I would also put on the list compassion fatigue – burnout – this is a significant occupational hazard – I mean – take some time off for self-care – this is the case for self-care – that one has to find some things where one can restore one’s emotional energies if you will – that we have something like emotional energy – and because being burned out – being compassion fatigued – I ain’t doing nobody any good much less myself – right? – so sometimes one has to get some supervision – I mean now leaving aside matters of such as vacation and that is where I find humor which is closely related to empathy – this Dilbert is deeply cynical right? – but –
in both empathy and humor one traverses a boundary – in the case of humor, one can say look at the boss is an idiot and it’s funny – Human Resources says a personality will be assigned to you – it’s hilarious, right? […] it’s the reduction to absurdly right? – so philosophically, it’s a reduction to absurdity – so one can use humor […] so this is the case for one’s own psychotherapy – I mean that the therapist him or herself may usefully encounter at some point in their development something like whatever this thing is – therapy h- aving a conversation with oneself – journaling – it may become a self-sustaining process – I get a lot out of journaling – I mean some people do and some people don’t – the world is not generous in the matter of certain things such as empathy – put it on the list with compassion as well right? – and so one has to find some resources to recharge one’s empathy – oftentimes it’s family – speaking personally, coming up, I experienced the lack of empathy so I actually started writing about it – and that was how I approached it and I kind of symbolically created something for myself […] – one final question…
LA: we are out of time – one final question?
what is the triad that sustains the therapeutic process? Warmth, accessibility, what else?
LA: okay well the concise answer is the Triad is – empathy empathy and empathy and warm and accessible is also useful – on a good day the other individual will show you who she or he is – if I am present without categories, distinctions, labels – on a good day they’ll reveal their soul – on a less good day we will struggle like everyone else – thank you so much
I heard there was some lunch – I don’t know if there is – I heard it was are up on six – I’m gonna go up there and check it out
Review: Gillian Isaacs Russell, (2015), Screen Relations: The Limits of Computer-Mediated Psychoanalysis and Psychotherapy. London: Karnac Books: 206 pp.
Granted in-person physical meetings are impossible when the health risks become prohibitive, that is no longer the case (Q3 2021), at least temporarily. Therefore, the debate resumes and continues about the trade-offs, advantages and disadvantages, of online telecommunication (“Zoom”) mediated therapy sessions versus physical in-person work.
Gillian Isaacs Russell’s book in a powerful and important counterforce to trending technological optimism that online therapy is the wave of the present and of the future. This optimism compels those of us who are digital immigrants to align with digital natives in privileging screen relations over physical presence in the same space in engaging in psychoanalysis and psychotherapy. By definition, “digital immigrants” were educated prior to the explosion of the Internet (and world wide web on) or about the year 1999 and “digital natives” came up with “online everything” such as pouches for their smart phones in their parents’ baby strollers.
The cyber rush to judgment is slowed if not stopped in this hard-hitting critique of online screen relations. Isaacs Russell wisely asserts skepticism that meeting online (even in a pandemic) and meeting physically in person are “the same.” One may eventually go ahead with online therapy in many situations (especially in a pandemic), but if you are hearing “they are both the same” that is reason for a good healthy skepticism that the purveyor of the online approach is being straight with you. One also needs to be skeptical as online therapy starts out being “better than nothing” only quickly to slide in the direction of “better than anything.” As usual, the devil – and the transference – is in the details, and Isaacs Russell provides insight in abundance to the complex issues.
Speaking personally, in my own work on empathy, published in 2015, the same year as Isaacs Russell’s book, my Preface concludes with the ontological definition of empathy as “being in the presence of another human being without anything else added” – anything else such as judgment, evaluation, memory, desire, hostility, and the many factors that make us unavailable to be in relationship (Agosta 2015; see also 2010). Though Isaacs Russell uses the word “empathy” in a specific psychological sense, I would argue that her work on “presence” is consistent with and contributes to an enlarged sense of empathic relatedness that builds community.
Isaacs Russell has interview psychoanalysts, clients (clients), over several years and reports in a semi-ethnographical style on the trade-offs between online mediated relations and those which occur in the same physical space, such as a therapist’s consulting room. Her arguments and narratives are nuanced, charitable, and multi-dimensional. The reader learns much about the process of dynamic therapy regardless of the framework.
What she does not say, but might usefully have called out, is that the imperative is to keep the treatment conversation going, whether online or physically present in person. When someone I am meeting with in-person asks for an online session, after controlling for factors such as illness of a child at home or authentic emergencies, then my countertransference may usefully consider the client’s resistance to something (= x) is showing up. In contrast, when an online client asks to come into the office, one may usefully acknowledge that the individual is deepening his commitment to the work. In neither case is this the truth with a capital “T,” but a further tool and distinction for interpretation and possibility in the treatment process.
Isaacs Russell makes the point (and I hasten to add) that no necessary correlation exists between the (digital) generation divide and enthusiasm (or lack thereof) for online screen relations of baby boomers versus millennial or gen-Xers. Some digital immigrants are enthusiastic about online therapy, whether for authentic professional reasons, including economic ones, or to prove how “with it” they are, and growing numbers of digital natives are becoming increasingly skeptical about the authenticity of online relations, craving physical presence without necessarily being able to articulate what is missing.
Isaacs Russell provides an informative and wide-ranging briefing on developments in baby watching (child development research). Child development is a “hands on” process of physically relating to another emerging human being. Her point (among many) is that we humans are so fundamentally embodied that in some deep sense we are out of our element in reducing the three dimensional, heat generating, smell-broadcasting mammalian body to a cold two-dimensional video image. Though she does not do so, Isaacs Russell might usefully have quoted Wittgenstein: The human body is the best picture of the soul (1950: 178e (PPF iv: 25)). As the celebrity neuroscientist A. Damasio notes: [We need] “the mind fully embodied not merely embrained.” What then becomes of the relatedness when the body becomes a “head shot” from the shoulders up on a screen?
The answer is to be found in the dynamics of presence. Key term: presence. Physical presence becomes tele-presence and the debate is about what is lost and (perhaps) what is gained in going online. The overall assessment of Isaacs Russell is that, not withstanding convenience and the abolition of distance, more is lost therapeutically than gained.
Although Isaacs Russell does not cite Wittgenstein, Heidegger, Husserl, and Merleau-Ponty loom large in her account of the elements of presence. Much of what Isaacs Russell says can be redescribed as a phenomenology of online presence, including the things that are missing such as smell, the ability to physically touch, aspects of depth perception, and the privileging of “on off” moments over against gradual analogical transitions. The above-cited philosophers were, of course, writing when the emerging, innovative, disruptive technology was the telephone, and Heidegger himself went “off the grid” physically (and morally!) with his semi-peasant hut in the Black Forest near Freiburg, Germany. But even though they never heard of a mirror neuron, the distinctions these thinkers lay down about relatedness are fundamental for work in communications and human understanding.
Isaacs Russell gives the reader a generous tutorial in breakthrough developments in neuroscience, including the discovery or mirror neurons in Macaque monkeys and a neurologically-based mirroring systems in humans, which account for key aspects of empathy, intersubjectivity, and human social-psychological relatedness.
Since this is not a softball review, I must inquire, following detailed descriptions of embodied cognition, the primacy of movement in empathic relatedness, faces as emotional hot spots (which nevertheless incorporate full-bodied clues as to the exact emotion), kinesthetic and proprioceptive feedback: do we need a psychoanalysis or rather do we need an aerobics class (okay, at least a class in Tai Chi, moving meditation)? The point is that both participants may indeed “forget” about the computer-mediated relation, but the unconscious does not. The (unconscious) transference is also to the technology and needs to be engaged, interpreted as such. Isaacs Russell provides the distinctions to do so, which is what makes her contribution so valuable, even if one disagrees with her ultimate skepticism that online is the wave of the future.
Amid many useful distinction and nuances, as noted above, the key-differentiating variable for Isaacs Russell is presence. She connects this closely to D. W. Winnicott’s seminal work on enabling the client to recover the ability to “go on being” in integrity and individuality, even in the presence of another person. The model for this therapeutic process is the young child’s breakthrough in individuality as the child is able to be alone (e.g., playing) in the presence of the mother (or care-taker).
This process of becoming an individual being gets operationalized and tested when the client tries to destroy the therapist and the therapist [demonstrates that s/he] survives. Here “destroy” is a technical term, though it does indeed invoke hatred and the possibility of aggression. The paradigm case is that the client expresses hostility – even hatred – towards the therapist and the therapist does not retaliate. The therapist “takes it,” metabolizes the aggression and responds appropriately setting an empathic boundary in the relationship. This advances the treatment, expanding the integrity, autonomy, and individuality [mostly] of the client.
According to Isaacs Russell, this is the key moment – the differentiator: “In ‘screen relations’, the client can never really test the analyst’s capacity to survive” (p. 37).
Why not? Isaacs Russell quotes an astute client (in so many words) that without being in the same shared space the potential for the client or therapist “to kiss or kick” the other is missing. The potential for physical desire or aggression has been short circuited. Since the treatment must engage with these variables, the treatment is stymied and deprived of essential enriching possibilities of transformation.
Isaacs Russell is adamant that the ability of the therapist to survive, in Winnicott’s sense, cannot be test in the online context. If it could be significantly tested, then much of what she writes about the inadequacies of online presence would be invalidated or at least significantly reduced in scope. As noted, Isaacs Russell makes much of the potential to “kiss or kick” the other person in the same physical space; and it is true that such acting out rarely occurs but what is needed is the potential for its occurring.
However, what has been overlooked is such acting out bodily is not the only way of testing the separation and survival of the therapist. Many examples exist in which the client tests the limits by means of a speech act – seductive or aggressive language. Speech is physical and would not occur with the sound waves impacting the biology of the ear. This is not merely a technical point. Tone of voice, rhythm, and timing are physically available.
The distinction “speech act” is one that is critical path in any discussion of the talking cure, even if the latter is understood in an enlarged sense to be the encounter of two embodied (not merely “embrained”) talkers and listeners. Speech act theory includes pragmatics that allow for the illocutionary and perlocutionary force of speech. Speech does not merely describe things – it performs things, building connections and relations. People get other people to do things – change the physical environment – by speaking to them: close the door! Pick up the kids at soccer! Persons invested with certain kinds of conventional authority, powerfully change relationships and other aspects of the human world. For example: “I now pronounce you man and wife” spoken by the officiating authority at the wedding. This is a new reality – in so many ways. The empathic response of the therapist, spoken to the struggling client, is another such example.
Language is powerful, and we humans both wound and heal through our words. Heidegger, who is usefully quoted by Isaacs Russell as inspiring the work of Merleau-Ponty regarding physical spatial dynamics also noted, “Language is the house of being.” That is, presence – physical, mental, poetical, historical – emerge in the conversation that we have individually and in community in language.
Recall that Winnicott’s point is that when the client acts out – in this case verbally – the therapist demonstrates his survival skill by not retaliating. Thus, s/he remains in integrity as a “good enough” partner in empathic relatedness and becomes independent. This likewise rebounds to the expanding integrity and independence of the client.
If the therapist does retaliate – say by moralizing or withdrawing or blaming or becoming aggressive or seductive – then the possibility of treatment in the relationship is short-circuited. Absent significant repair, the relationship ends, even if the conversation continues in an impasse for awhile longer.
Speaking personally, and omitting confidential details, I recall an instance online where, being clumsy with a relatively new online client, who was vulnerable in a way that I did not appreciate, I triggered a challenge to my survival. I triggered a combination of panic, retraumatizing flashback, and panic, in the client that resulted in an extended and seemingly automatic combination of verbal abuse. It threatened me professionally and the safety of the client such that I seriously thought of sending emergency services to the client’s address. The screen is always the screen, in this case, but the screen was no protection against the impact of the hate. It is a further question whether the same thing might have happened if my clumsiness had occurred in person. Perhaps the client would have kept quiet and never returned. We will never know.
So while the client might not effectively have been able to throw a pencil at me (to use Isaacs Russell’s example), the individual would have been able to inflict self-harm in a way that would do more damage to me than a kick in the shins (another Isaacs Russell example). Never underestimate the ability of clients to innovate in acting out around the constraints of an apparently firm therapeutic framework.
The good news is that, without making any commitments I couldn’t keep, by a combination of soothing statements, placating statements, self-depreciating humor, apologetic words, and deescalating inquires and suggestions, I kept my wits about me, and was able to restore the integrity of the therapeutic process. S/he agreed to continue the conversation. I survived and so did the relationship. It actually was a breakthrough, and, without everything being wonderful, the client demonstrated capabilities that had not previously had going forward.
Thus, the counter-example: Survival was tested online, not by physically throwing a pencil, but in reciprocal speech acts and the enactment of presence in speech, a physical media not to be underestimated. One learns that the environment is safe when safety breaks down. To Isaacs Russell’s point, the potential for non-survival also includes non-survival as an actual enactment and outcome – and neither online nor physical presence has a privilege in that regard.
In a real world emergency – a credible threat of self-harm – there is a difference between sending emergency services to the client location and summoning them to one’s own office. But perhaps not that much. The point about survival, safety, and containment (different but overlapping issues) and their respective breakdowns is the same. Many distinctions exist between an online and physical encounter, but the risk of survival or non-survival occurs in each context.
One may argue back that the risk of a meltdown is less extreme in the warm and cozy confines of one’s own office, but maybe you never met a borderline client like this particular one or a client as suspicious or deeply disturbed. If the client takes out a box knife on camera and starts to carve up her or his inner thigh (or threatens to do so), one may fervently wish that s/he kicked one in the shins instead.
Thus, in answer to the potential for “kicking or kissing,” the answer is direct: Oh, yes the client can – can indeed test the capacity to survive and do so online. The example “kiss or kick” is not a bad example, but many counter-examples exist that provide useful evidence to the contrary as cited above.
Positively expressed, plenty of evidence is available that the analyst’s survival can indeed be tested in an online session and s/he may survive or not. Ultimately even “kiss and kick” can be enacted as verbal abuse on line, perpetrating boundary violations with hostility or seduction that can be grave and survival threatening, either in imagination or reality, including the survival of the therapist as a professional and the therapy itself.
To give the devil his (or her) due, it is true that there are some cases that are decidedly unsuited for an online engagement. Marion Milner engaged in a celebrated analysis of a deeply disturbed and regressed client, in which the client was silent for long periods of time. The client finally was able to recover significant aspects of her humanity in producing hundreds of drawings and sketches that expressed a therapeutic process of pre-verbal recovery. It is true that, though these were visual artifacts, and presumably might have been communicated remotely, the client herself was already so “remote” from reality that another layer of virtuality was not going to work (nor was it possible mid-20th century).
Heinz Kohut has a celebrated example that he presented in an lecture made a few days before his death. Kohut was working with a deeply regressed and suicidal client (client) in years gone by. In a desperate moment, Kohut offered to let the client, lying on the couch behind which he was sitting in his customary straight-backed wooden chair, hold two of the fingers of his hand. The point of this potentially life saving (and boundary testing) gesture was Kohut’s association to the client’s desperate grasp with her hand being like that of a toothless infant sucking on a nipple. An empty nipple or a life giving one? Powerful stuff, which of course, would never be possible online. Far be it for me to be the voice of reality, nevertheless, these two cases of Milner and Kohut are outliers, albeit deeply moving one, that are completely consistent with the sensitive and dynamically informed application of online analysis and dynamic therapy.
Though the uses of extended moments of online silence should not be underestimated or dismissed, Milner’s and Kohut’s cases were ones that privileged physical presence. It in no way refutes the power or potential of online engagement. What are missing are criteria for telling the difference. No easy answers here but the rule of thumb is something like: do whatever is going to further the treatment in the proper professional sense of the words. What is going to sustain and advance the conversation for possibility in the face of the client’s stuckness? Do that. Winnicott has been mentioned frequently, and rightly so. He spoke of the “good enough” mother. Here we have the “good enough” therapeutic framework including the online one.
Another part of the narrative that was particularly engaging was Isaacs Russell’s discussion of ongoing online psychoanalytic training with the colleagues in China. There are few psychoanalysts in China, so in addition to significant culture and language challenges, such remote work would not be possible without online analytic therapy sessions and supervision. The nearly unanimous consensus is this is valuable work worth doing. The equally unanimous consensus, about which one may usefully be skeptical, is that this work is “functionally equivalent” or in other ways “just the same as” work done physically in person.
The author provides examples, whether from the Chinese colleagues or other contexts is not clear, where neutral observers are asked to evaluate transcripts of sessions where the online versus physical feature and descriptive details have been masked. The result? They can’t tell them apart. What more do we need to say?
Apparently much more. With dynamic psychotherapy and related forms of talk therapy if you can tell the difference between an online and an in person meeting (other than comments about traffic or Internet connections), then you are probably doing it wrong or there is some breakdown that interferes with the process (in either case). Abstinence is easier online – no hugs. But if we are talking boundary violations, maybe some people – exhibitionists? – are tempted to take off their clothes on camera. (This has not happened to me – yet.) Anonymity – just as one’s office has clues as to one’s personal life, so too does the background on camera. Neutrality – being on camera suddenly causes one to adopt a point of view on social media or politics or nutrition or economics or education? Perhaps but I am not seeing it.
However, what Isaacs Russell does not discuss is the “other” transcript – the unwritten one, which is only available as a thought-experiment. There is another transcript different than the verbatim account of what was said or even what a web cam could record. It is a transcript that is just as important as the recoding of the conversation, and why verbatim recordings of the conversation are less useful than one might wish. Both participants may “forget” that the session is being recorded, but the unconscious does not. There is the transcript of what the people are thinking and experiencing, but remains unexpressed or expressed indirectly. Such an aspect of the counter-transference or thought transcript is harder to access and includes the therapist’s counter-transference.
One thing is fundamental: When the context of the encounter between people is an empathic one, then both an in-person encounter in the same physical space and an online encounter via a video session are ways of implementing, applying, and bringing forth empathy.
The online environment and the imaginary thought transcript present new forms of client resistance and therapist counter-transference, and it is these that now are the main target of the discussion of this essay.
Moving therapy to online opens up a new world of symptomatic acts, parapraxes, “Freudian” slips, and acting out.
I had one online client who stands up in the middle of a session to check on what this individual had cooking in the oven, carrying her camera-enabled device with her. Was I amazed? Indeed.
I acknowledged to the client that clients sometimes have mixed feelings about their therapists, and nothing wrong about that as such. Yet I was wondering did she believe I was perhaps half-baked? Key term: half-baked. Further discussion occurred of whether this individual was expressing her unconscious hostility towards me – while, of course, also preparing a baked dish.
The breakdown in empathy may be a thoughtless remark by the therapist, a mix up in the schedule, or a failure of the computer network. The empathy – and transmuting internalization working through it – LIVEs in restoring the wholeness and integrity of the relatedness. Empathy lives as spontaneous relatedness, a form of transference and vice versa. This is not limited to psychoanalysis versus psychodynamically informed psychotherapy. This is not limited to online versus physical therapy.
Other than candidates for psychoanalytic training, few people are calling up practitioners are saying: “I want the most arduous, rigorous, time-consuming, expensive treatment known – I want a psychoanalysis!” I tend to agree with Isaacs Russell that the possibilities for doing full-blown remote psychoanalysis are – how shall I put it delicately? – remote, but not necessarily due to any features of the online environment.
After all the dynamics and debates are complete, Isaacs Russell ends her book with a masterpiece of studied ambiguity. She gives an account of a conversation in an online session with a client in London, UK. Isaacs Russell has relocated to Boulder, CO, USA. Having worked together in physical presence, the client misses her and Isaacs Russell misses the client – yet the therapeutic conversation continues. One cannot help but agree with the sentiment – there is something missing – and yet the conversation continues. Thus, we roundly critique cyber therapy – and go off to our online sessions.
 Acknowledgement: This reviewer first learned of Gillian Isaacs Russell’s penetrating and incisive engagement with all matters relating to online psychoanalysis and psychotherapy from my friend and colleague Arnon Rolnick in Q2 2021 as the 2020 covid pandemic was waning, at least temporarily. Thus, I am catching up on my reading.
 Marion Milner, (1969), The Hands of the Living God: An Account of a Psycho-analysis. London: Routledge, 2010.
 Charles Strozier, (2001), Heinz Kohut: The Making of a Psychoanalyst, “Gentle into that Good Night,” New York: Farrar, Straus, and Giroux: 376–377.
Lou Agosta, (2010), Empathy in the Context of Philosophy. London: Palgrave Macmillan.
Lou Agosta, (2015), A Rumor of Empathy: Resistance, Narrative, Recovery in Psychoanalysis and Psychotherapy. London: Routledge.
Here is the verbatim transcript of the complete conversation between Lou and Arnon Rolnick, PhD, about Sherry Turkle’s work on Reclaiming Conversation (also the title of one of her books), and including her memoire The Empathy Diaries (2021) and the debate about online therapy.
For the complete video see: https://youtu.be/6OId-0QDFys
To listen to the podcast on Spotify: https://open.spotify.com/episode/6K8byq8UAs85lnVcSAj4DJ
Lou Agosta (Chicago, USA): Today’s conversation is entitled Reclaiming Empathy in Video Conversation: An Imaginary dialogue with Sherry Turkle. Today I’m having a conversation with my colleague and friends Arnon Rolnick, PhD, Psychology. I will let him introduce himself momentarily. Just once thought upfront – his commitment is to integrating biofeedback, psychology, and technology. He says – and I believe it is accurate and true – that he is incapable of being indifference. His exuberance, enthusiasm commitment and empathy are an inspiration to me, and I believe will be one to the listening, viewing audience. Great to see you!
Arnon Rolnick (Tel Aviv, Israel): Great to see you and thank you for such a nice introduction so I want to share with you my almost 30 years of effort to integrate Psychotherapy Psychology and Technology. As a clinical psychologist I’ve been baffled by the power of those who characterize life in the 21 century. On one hand, technology and science are providing us with better ways to live; yet, on the other hand, people are suffering more. It is as thought technology helps us to neglect our selves. And before I will say a few words about my work in this area, I want to say why she [Sherry Turkle] is so important. She was a Pioneer and a guru.
Lou: A pioneer and a guru
Arnon: Yes – I will say a few words about my work and then the issue of empathy will lead us all the way. So it was her book The Second Self where she defines this computer as more than just the tube but part of our everyday personal and psychological lives. She looks at how the computer reflects on ourselves and our relationships with other. She’s claiming the technology defines the way we think and act. Turkle’s book, which was really the first one in this area, allowed us to view and re-evaluate our own relationship with technology. This was her first book and this was that the first moment that I thought “Wow!” interesting. And then came my own work as a psychologist. I felt that there is some gap between what happened in the meeting [between therapist and client] and then the person is going home and he either forgets or doesn’t do I what we decided he was do so. I thought we would like to do what in CBT they called homework I don’t like the name “home work,” but most people know
Lou: Cognitive Behavioral Therapy [CBT} and assignments there are sometimes assignments. Back to you
Arnon: II will even appreciate it, Lou, if sometimes my English is not so clear, you will help the audience to understand my accent. So it was sometimes early in 1995 – see how old am I – I think I work with biofeedback I thought why don’t you give that the patient not only a biofeedback but also a CD that you can work at home and we call it “De – Stress” and we sold it in Boots – you know the British Pharmacy [Boots the Chemist] and I so I thought that should be there the killer [“killer app”] that should be the most important thing you give to the world and apparently it didn’t work
Lou: You send the patient home with a CD and there is an interactive media here – so already we’re in the online digital world and the patience or the clients or the individuals struggling – so what happens? They still are not that engaged? Explain it – what is the take away here?
Arnon: I will explain it – a little bit later when I speak about “Beating the Blues” – then the company – the British company hired me to help them develop already for the internet – first for the first CD – the program of cognitive behavioral therapy to help the patient overcome depression and anxiety. I thought again it would be wonderful idea – after seeing the patient, he will use this CD. The company thought differently. She said we don’t need a therapist. Just we will give them this program: eight 45-minute sessions and they will be cured.
Lou: And so you become [in]dispensable – you think maybe this is not going to work exactly as the British UK publishing company is imagining. But at some point, if the once the therapist, the psychotherapist, has designed the assignments, we no longer need you. So keep in touch! Have a great life good! What happened?
Arnon: What happened is very interesting. There were about eight good [unintelligible] that it works. I felt strange – it was a good program – I was part of it but could it really replace the human element? Later on it was found that the picture is more complicated. It works well only when there was a nurse involved her and she helped them to do the program so the nurse…
Lou: Let me just to interrupt you here. it sounds like the human element – so you’re already dealing with the human element and the technological elements whether it’s a CD or whether you know it goes fully online in the cloud as we have it today and it turns out what turns out we have the psychotherapist step aside and it [the nurse] turns out perhaps to be the replacement therapist.
But we’re just calling him or her a nurse shows up – and we suspect the human touch – the therapeutic Alliance if you will – the Rapport between human beings may be a hidden common factor
Arnon: Exactly. But this will allow me later after you will introduce your work and that will help me to divide the Psychotherapy into two main camps: the technique camps and the relationship camps. And I will talk about it only after you will tell us about your work about empathy
Lou: That sounds like a good segue for me to say something about empathy and we’re going to do it – so hold that thought: there’s the relationship camp and the tips and technique camp. And so hold that though – and so back to me – thank you! I appreciate the shout out – who the heck am I anyway? One claim to fame that may be more than one but is to have authored three peer-reviewed books on empathy, starting with A Rumor of Empathy – in effect, virtual volumes one and two and then Empathy Lessons and Empathy in the Context of Philosophy. My PhD from the University of Chicago began with a dissertation on Empathy and Interpretation – so I’m not going to give the storied, complicated history of the distinction empathy at the time I was a graduate student. It’s a matter of public record, my dissertation adviser, Stephen Toulmin, was being psychoanalyzed by the colleagues here in Chicago I don’t know the name of his analyst – he may have told me – but Kohut was innovating in the matter of empathy and his colleagues Michael Franz Basch, Arnold Goldberg, Ernie Ernest S Wolf were innovating in the matter of Self Psychology – and is there anything to this concept empathy or is it just cumbaya stuff? Really what’s the intellectual Providence? And it made a great dissertation for young graduate student and it is something meaningful to engage and so fast forward – I am not going to tell you about all of these books – they’re there’s actually available from your local online book seller. What I propose to do is provide really – no kidding – the one minute empathy training. You can actually do it in a minute. Now there are some conditions and qualifications – and so here it is: Drive out – get rid of – reduce – drive out things such as aggression, hostility, bullying, cynicism, resignation, bad language, politics in the pejorative negative sense – you know we are political and often times it doesn’t bring out the best [in us] – drove those things out – and empathy naturally comes forth – people are naturally empathic – people want to be empathic – and will be so if given half a chance. So that’s it! That’s the training: get rid of the negatives and empathy shows up in the space of relatedness. I pause for breath. I see you have a question.
Arnon: Being also trained in psychoanalysis you’ll clearly represent the Kohutian self psychology view – people are good – but what about the Kleinians? How can we get rid of our aggression
Lou: Well, thank you! I mean thank you: I mean human beings are naturally empathic; human beings are also naturally aggressive. We are a complicated species; and I have no easy answer. The difficult answer is that often times hostility and aggression are reactive. If you want to see somebody get angry – if you yourself get angry – if I find myself angry or even enraged, [then] one good question to ask myself – yourself – the people in the listening or viewing audience: who hurt your feelings? who perpetrated a dignity violation? or where did you not get the empathy and respect you deserved? cuz if you want to get a person angry, hurt their feelings – say something devaluing about their parents. It’s not going to go well. If you say something bad, it could get messy it’s just I have no [easy answer] – I mean we acknowledge the contribution of Melanie Klein. [Klein was] an incredible innovator. Let’s talk to some children. Freud’s innovating – Anna’s innovating – he’s got some ideas about infantile sexuality. Melanie Klein comes along – herself kind of a tortured genius in her own way – [she says] let’s talk to some children – and play therapy is invented. What a breakthrough – so I don’t know – there’s a lot of room for disagreement here but I’ve also seek some over lap and common ground. Hostility and aggression: there are a lot of things that can cause it. I mean, some of it may indeed be in it and species-specific. Nevertheless, who gets their feelings hurt and who experiences an empathy break down [or] a dignity violation. I claim that’s a candidate answer and so I may continue or you can get follow up
Arnon: So I think I’m responsible for the digression.
Lou: A digression but a productive one – so we finished the one minute empathy training; and there’s a lot more to be said about empathy – here right now. [However] We’ll come back to that. I’m going to segue – I think usefully – I’m going to begin a conversation about the contribution of I believe it would be: Madame Professor Dr Sherry Turkle, PhD, social psychology MIT (Massachusetts Institute of Technology). On a personal – the occasion is – I’m going to wave the book – [Lou holds up Turkle’s book, The Empathy Diaries, on the on-camera version of this conversation for YouTube] here her Memoir is published The Empathy Diaries (2021); and there she is as a child of tender age in the 1950s and the 1960s, coming up on the residential part of Long Island. The parents [actually] grandparents are Holocaust Survivors. They escaped Eastern Europe; and her mom marries a man named Mr. Zimmerman. Something is immediately strange – an unconventional something comes out. He’s performing certain kinds of I should say weird experiments that end up sounding like the work done by Mary Main and John Bowlby on attachment [the blank face gesture]. He’s leaving the kid – the young Sherry, the kid – forgive me, Professor Turkle, of tender age – alone in her room, .and letting her cry your eyes out. This guy has gotta go. The mom divorces Zimmerman and marries Milton Turkle, who has issues of his own, but two other children come along, her younger siblings. And here’s the – here’s the empathic moment – here’s the moment of the break down of empathy. At home she’s “Sherry Turkle’; [but] at school, somehow given this bureaucracy, she’s a Sherry Zimmerman. Now in our time, this is second about to be now third quarter 2021, blended families what’s the issue? It’s somehow devaluing, stigmatizing, divorce- you know, the feminist Revolution is occurring but divorce is still an issue one in this community – it is a Jewish community – non observant – living in genteel poverty – coming up in a kind of genteel poverty. Here’s the problem: [pretending to be Sherry’s parents]: “Sherry, you’re not allowed to talk about it. You’re not allowed to talk about the fact that your last name really is Turkle but at school, it’s Zimmerman.” Holy mackerel! It’s a two-tone elephant in the room. It’s [confronting] and so here is my short review: this is a great memoire. It is in many ways a page-turner. I was engaged, and I’ll say just a little bit more about that [soon], and it is also entitled The Empathy Diaries, [but] it might be also [be] entitled The Breakdown of Empathy [diaries], because it gives an account of what Sherry has to survive to reclaim for Humanity. It goes well – she’s smart – her parents tell her or grandparents tell her: “Look, you are not going to typing class.” This is amazing – this is the 1950s. If she learns how to type, she will end up in the secretarial pool. “No, Sherry, you are going to be in the front of the class. You are going to be the teacher” They don’t let they refuse to let her do housework. “Read!” they say. I heard something similar in a kind of weird way. This is a way of improving one’s life and one’s humanity and of getting some empathy. She goes to MIT. She meets – she goes back and forth for a while. She ends up at the University of Chicago about a couple of years before I was there. So it is a page turner for me, cuz they’re she is in Social Science 122 – sitting in the classroom – Social Sci 122 – and in comes Professor Bruno Bettelheim. He brings his straight back wooden chair; puts it on the low stage; and the students, who are trying to speak truth to power, give it to him, he gives it to them back – [Bettelheim is] the author of so many books: Love is Not Enough, the empathy fortress, [oops, I mean], The Empty Fortress, The Children of the Dream – over to you for a digression – insert your story here – he goes and visits a Kibbutz for a few months and says a few things which become controversial – you grew up there – tell me –
Arnon: I was born in Kibbutz and I was there raised there in this unique type of experiment – experiment – experiment – and you know what? We still don’t know that result of the experiment. What I mean is that we develop in so many ways and how many of us became leaders in various areas but we also have some pain and maybe it has been in his own way. May I take the leave now?
Lou: You have the conk shell –
Arnon: I want to say that again Sherry began with computers and she was fascinated with computers in particular and slowly she changed her ideas about the problems with computers – for example, she has many books – but I speak about two of them – both have explored how technology is changing the way we communicate – in particular, she raised concerns about the way in which organic social interaction can be degraded through constant exposure to lose every meaningful exchange with artificial intelligence. I will speak about artificial intelligence later on. In [Sherry’s book] Reclaiming Conversation, which is the book just before the one you mentioned
Lou: Reclaiming Conversation [Lou hold sup the cover on camera]
Arnon: She is arguing – she is gathering data from schools [and] companies [and] families – she says: we forgot [how] to speak with each other. We [are] all the time doing it via devices – we type – we send SMS – but we don’t talk and that’s led her to the interview that we will talk [about] later on where she kind of arguing – and maybe you will express it better – that online therapy is something completely different from psychoanalysis – and we will talk about this [more later] – but let me come back to this distinction between the two camps – and I will try to explain how the internet when it entered into the Psychotherapy world how it affected the two camps in different ways. So let’s begin – what are the two camps? The technique camp and the relationship. And everybody who knows Psychotherapy – you know that there is the group that thinks that their relationship is (a) very important aide in understanding the problems of the patient and (b) in maybe curing. Now you know that the earlier relationship with the parental figure is very important and this might be reflected later on in the relationship with therapist so that that camp is clearly or might be worried or interested about how does online therapy work. It seems like you want to comment and talk or should I continue?
Lou: – Well I have some comments I mean I think you hit the nail on the head so to speak in that the book you refer to – Reclaiming Conversation – she launches a Jeremiad – she is on a tear – you know, remember the Prophet Jeremiah in the Hebrew Bible? He was angry about something – we’re talking about anger – and it’s not clear whose feelings got hurt – but the feelings of the people at the dinner table where dinner conversation and conversations between friends are interrupted by beeping, buzzing, alerting smartphones – she is on a rant that we have got what amounts to acquire attention deficit – it’s not like we were born ADD or ADHD – amphetamine-based interventions will not help, because it is acquired through the number of interruptions that – so she’s, you know, [on a tear] and that’s the immediate trigger if you will, which, I believe, you’re expressing – what I would say is you are then tracing the conversation in the direction of online therapy – and it’s because – I mean – it’s now, you know, we’re emerging from this pandemic – the positivity right here in Chicago – hopefully – fingers crossed – we are jinxed now, I said, but – let us not do magical thinking. The positivity rate in Chicago is last week was .6 per cent and I had said the pandemic is at least temporarily over when it hits .5% but on other places it’s 6% and 10% and the struggle continues and we are really not going to go into it and there is a conversation about technology which we are not going to go into – technology can be used for great good and there can be big issues with it. That’s the point I wanted to make. She launches a Jeremiad – back over to you.
Arnon: We spoke about the relationship camp and how they acted to [towards] the Internet and I mentioned the technique camp – this camp who believes that what changes people’s behavior and thought and emotion is: we should give them technique. It could be cognitive behavioral technique – it could be emotion-focused therapy – it could be hypnotic technique.
Lou: You are not anxious or depressed – you just lack skill – that’s an enormous over-simplification, but there may be some useful techniques that can be improved and manage one’s anxiety and depression in a downward Direction
Arnon: Yes, and I should have made [note] that part of my research has dealt with this CBT techniques and I’m not I’m not in any way against it [unintelligible] Now what happened when the Internet entered the picture? Beating the Blues
Lou: Beating the Blues – I’ve got the name of the British company – we give them a shout out if they still exist: Beating the Blues – sounds good.
Arnon: But there is today ten thousand applications programs trying to do what beating the blues did, and it’s amazing how people are still trying to help or be helped by online application. Now just a the beginning of June there is a big article in the New York Times about an application called something –BOT – Webot – something – and it says that this application is working so well that one cannot differentiate if the bot – this machine – is a human being or behind it [a computer] or in fact, they are using a some engines like Google is doing now and – has developed Meena – a computer or machine –
Lou: A system of hardware-software stuff – Meena –
Arnon: That passed the tutor test –
Lou: The Turing test – Allen Turing – can I tell the difference between – in a conversational exchange between someone who supposedly hidden in a room or a machine or a device the Turing test and it turns out – we think – natural language has fallen to a technology that we now have technologies that can simulate natural a conversation with another human being the debate continues
Arnon: The debate continues and it is interesting to note that Sherry Turkle was married to one of [the members of] the group that developed Eliza. Eliza is another very early program that used Rogerian concepts to try to imitate Psychotherapy. Of course it was by far more simple. But let’s go back to the technique camps and a lot of effort to get rid of the psychologist I do at what Sherry Turkle says “the robotic moment.” She has a very strong anxiety – or she’s afraid that this artificial intelligence idea making – how can I say? – It’s dangerous to our humankind
Lou: Humanity – yes – yes –
Arnon: Humanity – I spoke about the technique camp and they’re mistaken direction; and I agree with Sherry [as] she speaks a lot about the dangers in this robotics [approach]. Oops, my chair almost fell.
Lou: If you disappear off camera, we will await your return. Maybe I can pick up the thread usefully at this point and a segue to the immediate occasion where you called me a few weeks ago and you said: “Hey, you know, let us have a conversation about her concerns and objections. I mean, she’s got some energy for this matter. She publishes – and I’m going to quote the publication that catalyzed our back-and-forth conversation: Afterward – here’s the title: “Afterword: Reclaiming Psychoanalysis: Sherry Turkle in Conversation With the Editors of Psychoanalytic Perspectives,” Volume 14: 2017 in this one and in this article, she raises a number of serious objections about the very possibility performing online therapy and she makes the case for co-presence. What I want to say at this point is –
[Video freezes and Internet connection is lost – connection is restored]
Arnon: We had some problems – we don’t know where was it – I don’t hear – you are on mute – we can we use this moment – I don’t know what exactly happened
Lou: I’m so I’m just going to pick it up I’m going to pick it up at “Afterword Reclaiming Psychoanalysis: Sherry Turkle in Conversation With the Editors of Psychoanalytic Perspectives
[[Video is frozen again – and connection lost]]
Lou: You were frozen
Arnon: You were frozen also
Lou: Things like this happen
Arnon: And it happens in online conversations – just a moment – and the question – how the therapist and the patient react to this? One could be completely angry – the patient – or the therapist could be: I’m not psychotherapy online anymore or we could use it
Lou: I mean you might reboot the router too for that matter – that could make a difference – 3, 2, 1 – the name of the article in Psychoanalytic Perspectives, Volume 14, year 2017: “Afterword: Reclaiming psychoanalysis: Sherry Turkle in Conversation With the Editors of Psychoanalytic Perspectives” – and in this – I must say – this was 2017 – I listened before the pandemic – then she denounces – I would say it’s not too strong a word to say she speaks in a devaluing way about online therapy, and [she] considers that psychoanalysis is missing the opportunity to emphasize the presence [of] the being together in the physical space – and all of the issues that occur there, which I will shortly enumerate – and what I really want to emphasize here is that there are at least three objections that she has: she says, lookit, online, to make eye contact with another person, you have to look at the green dot [the “camera on” LED]. I’m looking at the green dot. And it looks like I’m looking directly at you but when I look at Arnon’s eyes, I’m actually looking away from the green dot. So it’s not like sometimes, if you take a step back, it’s not clear where you are looking, but in person there’s a kind of code presence which is makes also, I think, an interesting but perhaps questionable point – so I want to be an honest broker here and charitable – who makes the point what starts out as being better than nothing – key term: “better than nothing” – in it pandemic, you can’t meet in person. So it is so, as she acknowledges in a podcast in July 2020, at the height of the pandemic here in the States, you can’t go to visit in person. It doesn’t work – you can’t – it’s impossible – it’s forbidden – and when we get back at someday out of the pandemic, from which we are (arguably) emerging at this time, the problem is (she sees) is that there will be friction and resistance to meeting in person where our fullest Humanity, if you will, empathy in the sense of being present with another human being in the same physical space embodied in a physical way. And so being “better than nothing” becomes “better than everything,” “the best of all” in so many words. And, finally, well those are her two points, and she says psychoanalysis may be missing a great opportunity here to take a stand and then she talks about a number of issues including [incomplete thought] – but she doesn’t say, you know, how to use the couch online – the couch – lie back on the couch – free associate – I’ve seen people who lie back on the couch and immediately have a breakthrough. They think of things which they were aware of – that they have not really been unaware of them – but we’re just kind of shoved back in there you know in their consciousness -in their inner sanctum, and all the sudden lie back and relax a little, and, oh, my God, I remember this or that about parents, about friends, about current relationships that they had not been aware of; so it can be a powerful tool and how does that work online? It doesn’t come up in this particular article. I pause for breath.
Arnon: The issue – is that the real psychoanalysis – is that typical discussion in psychoanalysis for many years – and now when Sherry Turkle says this is not psychoanalysis, speaking of online therapy – she is repeating and doing what many people did years ago before when the question was being on the couch or not being on the couch or sitting front face-to-face was considered not psychoanalysis
L: Somehow it was not echt – not genuine or authentic enough
Arnon: Yes, it was not the real classical Freudian in the day – and also the question should it be five times a week or three times a week – so psychoanalysis all the years is it the real thing or not the real thing and in this way I look on Sherry Turkle context can be partly understood – old psychoanalysis – is it true or false – in the 1950s when people said can you do psychoanalysis via the phone there were articles that said, you can do it but it is only supportive therapy – so what I am trying to say is the relationship camp was very much obsessed with the question was it the right thing as regular therapy or not regular therapy – so what I am saying is it is clearly different but it might be interestingly different – we might even find some advantage and learn a little bit what works in psychotherapy – for example, now when we are talking to one another, is it the content, my interpretation or is it my fault my visual appearance, which might be even bigger than what we you would seeing if you are in the end and I turn. You can see my face – my bird [beard] – my eyes – and like that so, and look. For example, I can do now this [Arnon zooms in and out with the camera] I’m going backward and then zooming
Lou: Amazing – we are gong to zoom in – we are literally zooming – and so may I jumping in at this point, because you raised a number of questions – now this is now not Professor Turkle (Sherry) – this is Lou Agosta: We may usefully have a phenomenology of presence – of online presence – just as we have the philosopher Merleu-Ponty talking about embodiment and a number of researchers [on the subject]. There is need for that, because the image is different than the physical presence – sometimes – it’s – it’s just different – it’s not better – it’s not worse – it may be richer in some sense and then less dimensional in another sense – and so, you know. I mean I could see – she doesn’t call for this, but she might usefully do so. The second idea: take a transcript of an in-person psychotherapy session and take a transcript of an online session. What’s the delta [between the online and the in-person]? How could you tell? Now the Internet blows up as it did a moment ago in our conversation, then you know we’re online. If the patient comes in and says, well the traffic was horrible, then you know you’re on the ground. But remove those deltas – remove those considerations – I suggest that in most cases – but interesting ones may not be on the list of most cases – one could not tell the difference, because therapy is basically a conversation – it lives in language – but [unintelligible] what about those instances [that are] new forms of Freudian slips. An anecdote: I met a new patient I had a second meeting with the individual – we use some version of Zoom – she gets up – the device is moving around the apartment – she goes to the kitchen – goes to the oven and says “pardon me, I got something in the oven” I am thinking – this is now would not be in the transcript – my thought would not be in the transcript – I’m thinking: Okay, this is amazing – this is practically like an enactment – an acting out – a Freudian slip – and I [think to myself] sometimes clients wonder whether their therapists know what they’re doing – it’s a valid question to be a little bit skeptical when we are consumers of psychotherapy services – does his or her therapist guy knows what he’s doing; and I said I’m thinking it’s a new relationship, but people are a little ambivalent about how they feel about their therapist and I say to her: “Do you perhaps think I am half baked?” She’s got something in the oven – she is baking a cake – it’s denied yet the thought is there – you can’t make this up – you can’t make stuff like this up – so that would be a delta – you get new forms of slips of the tongue, parapraxis, Fehlleistungs. Make no mistake, the transference is always the transfer, and so, this does not come up in Professor Turkle’s work. It might usefully do so, because the genie is out of the bottle.
Arnon: I think the example you gave is wonderful. Being a more CBT like therapist, I would not interpret as Half Baked or those things like but I would say: Wow. What a wonderful opportunity to see you are working – have hobbies – that you can cook – you see, what I am saying is the fact that the therapy is not now in our clinic but in in her room – her place, helps me know things about her self that I would not know – so instead of fighting this – and lets make the room exactly the same – let’s use this uniqueness that I can see their room and maybe they can see my room which is again interesting.
Lou: It is significant, and I would tend to agree, and I claim that I was using it to explore the relationship and it’s true my countertransference was like can – one version of empathy is to be fully present with the other person – and I think Turkle – I mean, she doesn’t actually define it that way, but I think Sherry gets that – she appreciates this matter of copresence and really being with the other. I mean just like, you know, if this dialogue between you and me, Arnon, we go back a bunch of years – you know, if it were successful beyond all of our dreams, notwithstanding internet interruptions, we would succeed in making present a certain empathy. I mean, like I got you, man, I know, you know, we’ve been struggling with these issues for a lot of years, and now that’s a criteria of success: that we bring it forth – and we [are] doing it online. Hey! Hello! We are having [an online conversation] – we couldn’t do this on the ground. I mean you’re in Tel Aviv – we didn’t put this at the start of the video but you’re in Tel Aviv – I’m in Chicago Illinois – it would not be humanly possible otherwise
Arnon: Right – right and that brings me again to my belief that we are reclaiming conversation – we are reclaiming conversation of [as] Internet dialogue and that it works very well – and let me tell you I am doing it for almost twenty years – and I prefer still to have the patient in my clinic – but I clearly suggest to our readers or audience not to go in either direction – not to say that technology will replace the human element and, on the other hand, let’s use technology. May I just add one more thing that we are currently struggling with – remember I want the therapy to continue only by the one-hour session. So the question comes, can we use technology not only by doing the one-hour session but by [for example] I am doing quite a lot of couples therapy – can the couple call me in the middle of a crisis – they are at home –
Lou: That would be powerful – that could be power at the moment, the enemy (so to speak} – the issue is present at the moment
Arnon: That would be one way to enlarge therapy – the second thing I am doing – according to the technique camps, not the relationship – I am using application, but the application is not trying to replace me but trying to resonate our interaction. Suppose you are now my therapist and I was your patient and you will use this resonator application to resonate [saying to me] remembering how we felt when we had this problem – the idea: so we can use technology in many other ways not to fight it and not to say this is everything.
Lou: Technology – surely, I mean this is a cliché, but perhaps hidden in plain view – technology can be a two-edged sword. Like any communication [device], it both connects and divines – I mean, we are relatively inexperienced with online therapy. I said earlier, dropping in the [conversation that the] genie is out of the bottle. In her in her podcast in July 2020 at the height of the pandemic, Sherry expressed concern that there would be a lot of friction, as she said, to going back to in person meeting just as there apparently is a lot of the people going back to the office and to their cubicles in person, and in some cases it’s essential and in some cases it’s definitely not required, and so how to tell the difference becomes the challenge. And it does seem like there is something – she makes the case, I mean, with which I must occasionally and in many ways align, that she makes the case that physical presence has something that is missing, and, yet. The genie is out of the bottle. We’re not going, you know, we’re not going to get rid of our telephones, and if I want to send a message, I write you a letter, or, you know, I send you a message with a boy – a runner – run and deliver – people would do that – we’re not going to be able to go back, so the challenge then becomes how to be authentic online and interact with a phenomenology of online presence with new forms of, I mean, in the world of online humor I’ve been known to say occasionally two new clients, I mean, well what about the digital divide. You need a computer and zoom and a door that you can close for confidentiality, and privacy. I’ve had clients, sadly at the beginning of the pandemic that fell through the digital divide. This young man was living in the same bedroom with his younger brother. He was trying to do the conversation, walking around outside. It was really hard. It was really kind of not working the way it should. And so there are peopling now where are you may need to meet with them in person, because they don’t have the technology. And here in the States, it’s a much bigger country (bold statement of the obvious) than Israel; in some ways, more poverty. There are parts of this country, which are not digitally wired and connected; and so those issues become a matter of social justice as well. And so I have to call them Sherry doesn’t solve them either, but nevertheless she lines up and makes the case that it’s very important. So where are we? I want to – maybe since I’ve got The Conch Shell here, I will tie up two loose ends. I interrupted myself as I was talking about her Memoir. After she answers up for a little while at the Committee on Social Thought and she ends up writing a dissertation at MIT on the social psychology of French political psychoanalysis. She meets Jacque Lacan – so all of the controversial figures Professor Bettelheim, Jacque Lacan – the amazing thing – I really want to put this on the video – he [Lacan] treats her nicely – bad [boy, Lacan] – I mean, Why? This is so uncharacteristic. Why? He wants her to write nice things about him. He wants her to produce a enriching and ennobling and even perhaps – you know, given who he is – a flattering report and she doesn’t of course do that but he does come to Boston to visit at Cambridge, and to visit the colleagues, and the thing about Lacan – the only criticism – the only problem with Lacan – there’s only one problem, Jacque Lacan. He goes to dinner. He doesn’t wear a tie. He throws a conniption fit. It’s kind of an interpersonal disaster. Professor – Sherry not yet Professor Turkle has nothing to do with his bad behavior but it resonates in different ways, She goes on to publish that book I was waving around or about to wave around [on camera] in this version Psychoanalytic Politics [on camera] you see the cover [and a silhouette] of protesters of May 1968 and the Eiffel Tower there. She is not a Lacanist, but she is informed by the dynamics, and, you know, the prohibition creates the desire. I didn’t know I wanted to go online to do therapy until you told me I couldn’t. Now if I have to explain the joke, it’s not funny. That’s the best I can do. So that wraps up her memoire. There’s a lot more there, but those are some of the essential talking points. So I pause for breath.
Arnon: It’s a nice way to finish with the more personal. May I bring up another personal [matter] – Sherry speaks so honestly about a Jewish home she grew up and her problematic father and she came to the same direction that I came to though I have a wonderful father, because he thought technology can help change the statues of the Jewish people. It can help solve the pandemia, the pandemic. It can help the human race. So my father really believed in technology, but not only in the technical aspects, but it’s a part of the human spirit that we can fix things. We can overcome problems,
Lou: That is remarkable, because here you are growing up in a Kibbutz, which is kind of a collective environment. The parents are not dismissed, but moved to the side and here Sherry who gets a lot of attention, in some ways it’s almost impossible to get too much attention but she does and not always of the right kind in some instances, and the end result is this complicated relationship with technology for the things that it is powerful in doing and for its disadvantages and drawbacks as well advantage. So final thoughts as we are coming up on the back end of our conversation. And your personal anecdote is a final thought. Two thumbs up on the work she’s doing. We find that we take exception to the throwing online therapy and online psychoanalysis under the bus as we say here in the States. The problem with that – here is my final reflection – the problem with that is that it is getting crossed under the bus. There are a lot of people under the bus struggling so we want to make productive useful application of all of the means to combat human suffering. What all of these different modalities have in common – whether it’s CBT or biofeedback or group therapy or traditional dynamic therapy or rigorous Freudian therapy or self psychology – they’re not exactly the same – all of these are commitment and a stand against human suffering which is significant and ongoing that’s my thought. So I think Sherry stands with that. I think we have common ground there.
Arnon: Yeah, maybe she would join us in the next go around
Lou: Well, would you like to make an invitation? Make the formal invitation, because that occurred at the start of the conversation.
Arnon: Well, you probably would say it in a more American, polite way – but I would say: Sherry, I was trying to communicate with you, she know it, so I wrote to her, because we wrote a book – we did not mention it yet – we wrote a book about online therapy with Haim Weinberg [editor] and you wrote a chapter – and I wanted to have her in the book – it was before she wrote the Empathy Diaries – and she wrote to me, I am so much into it [writing the memoire] that I cannot stop – and I pushed again – and being Israeli, I pushed, and she replied, “I appreciate it but no.” Maybe now she will be more open.
Lou: There’s an invitation for further conversation. Thinking of the end: we acknowledge your empathy, Professor Turkle – Sherry. I acknowledge your empathy, Arnon, my colleague and friend. I acknowledge the empathy of the listeners to this conversation, because you’re listening creates the empathy in this conversation. We honor and thank and acknowledge you for that. Thank you very much. Signing off.
(c) Lou Agosta, PhD, and the Chicago Empathy Project
Resistance to Empathy and How to Overcome it (Part 2): Individual Provider and Receiver (of Empathy)
Empathy is trending. As we engage with provider empathy, the pendulum has swung far enough for a backlash against empathy to be emerging.
Empathy with negative emotions and suffering is difficult. From a purely selfish perspective, empathic data gathering about the negative experiences endured and survived by other persons can be, well, negative. Negative experiences such as loss, hostility, intense rage, sexual danger, sadness, sleep deprivation, fear, and so on, are not welcome by anyone even as a less intense vicarious experiences. One fears getting the full-blown experience, not merely vicariously experiencing a sample or trace. The would-be empathizer is at risk of being overwhelmed, inundated, or flooded by emotional upset. The person’s empathy is on the slippery slope of empathic distress; and the empathy is at risk of breakdown.
The language is telling. If one is hit by a tidal wave, then one is going to be “under water.” Kick your feet, make swimming motions with the arms, and rise to the surface to try to catch your breath. While an empathic response is easier said than done, expressing the suffering of the survivor in a simple and factually accurate statement can open the way to containing the suffering and getting unstuck. Dial down empathic receptivity and dial up empathic interpretation and understanding.
People committed to providing empathy to other people resist their own commitment to empathy for several reasons. As soon as a person makes a commitment—in this case, a commitment to practice empathy—then all the reasons why the commitment is a bad idea, unworkable, unreasonable, or just plain absurd, show up. There is no time. It is too expensive. No one is interested. What seemed like a good idea yesterday, now seems a lot more challenging and like a lot more work. Yet empathy is never needed more than when it seems there is no possibility of it.
The would-be empathizer is vulnerable to a vicarious experience of the other person’s suffering. Indeed if one’s empathic data filter is not granular enough, one is at risk of being inundated by emotional contagion. This does not mean that the provider of empathy has to be a masochist, stuck on suffering. However, it does mean being vulnerable to a sample of the suffering. It does mean opening oneself up to a sample of the other person’s upsetting experience. It does mean being receptive to that which the other finds so upsetting, but doing so in a regulated and limited way. Hence, the need for training.
The training consists in interrupting and accepting one’s own feelings and letting them be. Practice is required in order to increase one’s tolerance and learn to be with uncomfortable feelings.
One key to forming a humane relationship with anyone who is upset: Vicariously getting a taste of the upset, experiencing vicariously the other’s fear or anger. Acknowledge the experience as valid. Accept the experience, not as good or fair, but as what one has indeed experienced.
One celebrity academic claims that in empathy the better part of emotion is reducible to emotional contagion. What the world needs to practice is not empathy, but rational compassion. As if one had to choose between the two! The world needs expanded empathy and more compassion of all kinds.[i]
A vicarious experience is essential data as to what the other person is experiencing; but if one is distressed to the point of upset by the other’s upset, then one is not going to be able to make a difference. Paradoxically one is not going to be able to experience one’s experience due to being distracted by one’s own upset. One’s empathy has misfired, gone off the rails, failed.
Empathy is in breakdown. One has to regroup. Take a time out. Acknowledge that one is human. One does not always get it right, but that does not mean that one is less committed to empathy or helping the other. It is worth repeating that the empathizer may expect to suffer, but not too much—just a little bit.
The good news is that empathy, when properly implemented, serves as an antidote to burnout or “compassion fatigue.” Note the language here. Unregulated empathy supposedly results in “compassion fatigue.” However, this work has repeatedly distinguished empathy from compassion.
Could it be that when one tries to be empathic and experiences compassion fatigue, then one is actually being compassionate instead of empathic? Consider the possibility. The language is a clue. Strictly speaking, one’s empathy is in breakdown. Instead of being empathic, one is being compassionate, and, in this case, the result is compassion fatigue without the quotation marks. It is no accident that the word “compassion” occurs in “compassion fatigue,” which is a nuance rarely noted by the advocates of “rational compassion.”
No one is saying, do not be compassionate. Compassion has its time and place—as does empathy. We may usefully work to expand both; but we are saying do not confuse the two. Empathy is a method of data gathering about the experiences of the other person; compassion tells one what to do about it, based on one’s ethics and values.
Most providers of empathy find that with a modest amount of training, they can adjust their empathic receptivity up or down to maintain their own emotional equilibrium. In the face of a series of sequential samples of suffering, the empathic person is able to maintain his emotional equilibrium thanks to a properly adjusted empathic receptivity. No one is saying that the other’s suffering or pain should be minimized in any way or invalidated. One is saying that, with practice, regulating empathy becomes a best practice.
However, the good news is sometimes also the less good news.
The other person’s suffering reminds one of one’s own suffering.
The other person’s anger reminds one of one’s own anger.
The other’s failures evoke one’s own setbacks.
The other’s self-defeating behavior is plainly evident to any third party, but one’s own self-defeating behavior seems to continue with regularity in tripping up oneself.
Rarely does a person say, “I want to be empathic in order to confront my own personal demons.” Rarely does one say it, but that is what is needed. That is the work of expanding one’s empathy. As in the fairy tale, one must spend three nights in the haunted castle, fighting the ghosts of one’s past and confronting the illusive specter of one’s blind spots.
Anxiety, depression, fragmentation, and the dehumanization dwelling in the dark side of human nature loom large before discovering the buried treasure of one’s own emotional resources in the face of upsets.
The thinking and practices that created empathy breakdowns are insufficient to overcome them. The thinking and practices that created resistances to empathy are insufficient to transform them. To get one’s power back in the face of resistance to empathy, something extra is required.
Expanding one’s empathy in the face of one’s own resistance to empathy requires something extra. Expanding empathy requires expanding authenticity, so the person who would practice empathy has to confront and clean up his own emotional contagion, conformity, projection, egocentrism, devaluing judgments and opinions, and the tendency of communications to get lost in translation. This clean up requires acting to repair disruptions in relatedness and repairing misunderstandings and miscommunications with other people by acknowledging one’s own contribution to the breakdown. It requires picking up the phone or requesting a meeting. It requires showing up, engaging, and acknowledging how one acted to cause the upset or breakdown.
Instead of emotional contagion, conformity, projection, and mistranslation, one enters the empathic cycle, engaging with openness towards the other person in receptivity, understanding of possibilities, taking ownership of one’s meaning making so that the other person is left free to be self-expressed, and responding in such a way that the other person is left whole and complete.
This means accepting the consequences of one’s deeds and mis-deeds. That is the first step—and every step—in recovering one’s power in relation to empathy. One might not get what one wants. However, what one is going to get is unstuck—and the freedom to be empathic in relationships going forward.
Everyone wants to get empathy, don’t they? Speaking of a recipient’s resistance to empathy sounds like resisting rainbows and colored balloons. What’s not to like? Empathy is what everyone really wants, isn’t it? Well, not always. Resistance to empathy—that it exists—is the basic empathy lesson of this chapter.
Emotional closeness leaves a person vulnerable to disappointment. The would-be recipient of empathy is ambivalent and vulnerable about being intimate with the other person, inhibiting the recipient’s empathic relatedness. The result is resistance to empathy.
People want approval from other people. People want approval for their opinions and behavior. People want agreement. Life is definitely easier, at least in the short run, if one is surrounded by people who agree with one rather than disagree.
People especially want agreement when they have something to be disagreeable about. They want agreement when they have a complaint. However, empathy does not lead off with approval and agreement.
Empathy leads off by being quiet and listening. In the face of chronic complaints and self-defeating behavior, being empathic often takes an open and inquiring stance that the other person may usefully take a look at any responsibility or potential blind spots he may be holding onto as the source of the complaint. It seems like “mission impossible,” since the blind spot is precisely that which, by definition, one does not know and that to which one can get access only through sustained self-inquiry. Doing the hard work of undertaking an inquiry into one’s own issues is, well, hard work. That results in resistance to empathy.
Resistant or not, people want to be understood. People want to be gotten for who they authentically are. People want other people to know how they have struggled to succeed and overcome adversity.
Yet, in hoping to be understood for who they really are, people are asking, not so much for agreement as for empathy.
People assert that they want to be understood; yet they do not want to be understood too well.
People do not want to take too close a look at how they have contributed to their own struggle and effort. People do not want to face directly how they have contributed in self-defeating ways to their own frustration and stuckness about which they so loudly complain.
People want the recognition of their humanity that comes with empathy; but not the unmasking of their own blind spots, which requires getting out of their comfort zone.
Let’s face it. People can be difficult. People are disagreeable. People are contrary. People are ornery. People are rude and discourteous. People push and shove. People often forget to honor their agreements. People lie. People are overly aggressive. People are overly sexed. People are under-sexed. People smell bad. Is it any wonder that people do not want to get close to other people? Is it any surprise that people develop resistance to being empathic towards other people?
This is a case of you can’t live with them and you can’t live without them. People, that is. Yet there is no such thing as a person in isolation. A person by himself is not a survivable entity. That is true of newborn babies. That is true of children of tender age, who require years of guidance and education. Likewise, that is true of adults, though in more nuanced ways.
The “I” is a part of the “we,” and the “we” a part of the “I”
Early prehistoric humans needed a companion to tend the campfire and stand guard against predators (or hostile neighbors) while the other(s) rested. The basic male and female pair was an inseparable requirement for procreative success.
Propagating the species to build a community against the ravages of infant mortality was a priority requiring skills to cooperate with one another socially. For most of recorded history (and before) children were the equivalent of a pension plan for aging parents; and in many parts of the world today that continues to be the case.
Domination and control of individuals in community based on physical strength and violence coexisted alongside (and contended against) forms of cooperation, leadership, and community-building based on the skillful use of language and symbols to exercise power based on motivation, persuasion, inspiration, inclusion, and enlightened self-interest.
The point is not to tell a “just so” story about the origins of civilization, but rather to acknowledge that, not only is the individual a part of the community, the community is also a part of the individual. This bears repeating. The “I” does not only belong to the “we”; but the “we” is a part of the “I.” We carry within ourselves a readiness for community, a readiness for relatedness, a sense of inclusion in community; and if there is no one else to talk to, we talk to ourselves.
The empathy lesson? Empathy is the foundation of relatedness, and resistance to empathy is resistance to relatedness. People are born into “relatedness.” Empathy is about participation with others. Empathy is about relatedness with other people and who these others authentically are in their strengths and weaknesses, in their possibilities and limitations. Even when a person is a hermit, all alone, he is alone in such a way that his aloneness depends on the basic condition of his being a creature designed for relatedness. Being unrelated is a privative form of relatedness; and being alone is a deficient form of relatedness. Paradoxically, nonrelatedness becomes a way of relating for some.
Given that resistance to empathy on the part of the would-be recipient of empathy is pervasive, what is the recommendation? Ask yourself: What is coming between myself and the other person who is offering empathy? Perhaps fear of being misunderstood is a factor. Fear of being let down is another factor. Fear of being vulnerable gets in the way. Fear of disappointment is a consideration.
What do all these factors have in common? Fear. Fear is front and center. However, there is something else further back behind the fear. Less obvious but highly significant. What would a person have to give up in order to be receptive to the gracious and generous listening being offered? Behind the fear is attachment—attachment to suffering.
Suffering is sticky
For people who are survivors, whether of the college of hard knocks or significant trauma, allowing themselves to experience another’s empathy takes something extra. Many people who fall short of a clinical label of “post traumatic stress disorder” (PTSD) have an area in their lives in which they are engaged with their suffering in an intimate way. You know the saying: “Keep your friends close, but your enemies even closer”? So it is also with suffering. In order to survive suffering, many people have decided to keep it close to them. They are attached to it. Overly attached? One thing is for sure. Suffering is sticky.[ii] Letting go of the suffering through the soothing experience of empathy seems like a risky proposition to people who feel fragile and vulnerable.
Consider PTSD. (We define our terms.) In an attempt to master the consequences of the life threatening experience of trauma, the organism (the human mind/body) keeps the fear, anxiety, and pain split off from being experienced as one’s own. Yes, one was present when the assault happened, the violence was perpetrated, or the train wreck occurred.
Yet in another sense, one was not present. One was not there, at least not as a conscious being. In being overwhelmed in the moment, one immediately took oneself out of the experience as an immediate reaction and survival mechanism. The traumatic experience remains unintegrated with one’s other life experiences, spinning in a tight circle of repetition.
The circle of repetition is split off from the person’s awareness and everyday life, remaining isolated—“sequestered” is the technical term for it.[iii] Suffering lives. The pain is real. Suffering itself becomes a kind of “comfort zone,” but only in the limited sense that it is isolated and separated from the awareness of the person trying to live his life.
This in no way diminishes the struggle or suffering of the survivor. Yet letting go of the suffering through the soothing balm of empathy shows up like a risky encounter with the unknown. For most people, the unknown itself is fear inspiring. The unknown is as fear inspiring as the suffering itself.
One keeps coming back to the suffering in the hope that it might be magically shifted. One keeps coming back to it like an exposed nerve in a toothache. Yes, it still hurts—ouch! The suffering starts to dominate one’s whole life, and one builds one’s life around the suffering, trying to manage and contain the uncontainable. One says, “I know my own dear little suffering up close, and it is a comfort to me in its own way—it gives me all these secondary gains—even though the impact and cost is staggering in the long term—yet I cannot let it go.”
We cycle back to empathy and its many dimensions in the context of suffering as an uncomfortable comfort zone.
How to be empathically responsive to the struggling individual and his “dear little suffering” requires an empathic listening of remarkable finesse and timeliness.
Empathy can help people get out of their comfort zone, in this case a place of suffering, in a safe and liberating way. When empathy gets an opening, empathy shrinks the trauma the way interferon is supposed to shrink tumors. Empathy sooths the accompanying suffering and reduces the stress.
The survivor is able to let go of the attachment to suffering, and engage with new possibilities. No guarantee exists that the outcome of the new possibilities will be favorable; many risks await; but the individual is no longer stuck.
In summary, we have engaged with resistance to empathy from three perspectives. We have explored overcoming resistance to empathy in the organization, in the individual providing empathy, and in the individual receiving empathy. In each case the empathy training consists in driving out obstacles to empathy, reducing or eliminating the resistance, so empathy can spontaneously grow and develop.
The organization drives out empathy by enforcing conformity to an extensive and contradictory set of rules, whose complexity is such that at any give time, the individual is technically (though unwittingly) in violation of one of them.
Speaking truth to power can be hazardous to one’s career; and humor is closely related to empathy; so humor becomes a powerful way of regulating empathy, expanding and contracting empathy in such challenging organizational contexts. Humor is a powerful tool against the arrogance of authoritarian domination. Both empathy and humor require crossing the boundary between self and other with integrity and respect, but humor offers additional opportunities for questioning the status quo, speaking truth to power, and creating the stress, suddenly relaxed by laughter, caused by expressing what’s so.
Empathy has a key role to play in organizations in reducing conflict, overcoming “stuckness,” eliminating self-defeating behavior, building teams, fostering innovation, developing leadership, and enhancing productivity. The empathy lesson is to use humor (and empathy) to undercut resistance to empathy in the organization. The lesson is that empathy is a source of creating possibilities, overcoming conformity through innovation, and leading from a future of possibilities.
Resistance to empathy on the part of those who provide empathy shows up as “compassion fatigue” and burnout. The word is a clue: compassion, not empathy, causes “compassion fatigue.” So much compassion, so little empathy. I hasten to repeat that the world needs both more compassion and more empathy. Peer group dynamics, collegial support, and self-care are required to recharge the emotional resources of those routinely providing empathy to others.
Regular self-care, including exercise, nutrition, quality time with family/friends, is on the critical path to survival and flourishing, managing the risk of experiencing empathic distress.
This makes the case for self-care and self-monitoring on the part of professionals of all kinds and first responders in health care, education, sales, leadership, public safety, customer service, and so on, whose empathy is a significant part of their role. Professionals take breaks and are on top of their empathy game; amateurs try to be empathic all the time (whatever that would mean), experience empathic distress, make it mean they lack empathy, and quit. Those who do not take care of themselves, then blaming empathy when they get burned out, are committing a kind of malpractice of empathic engagement (in the literal, not pejorative sense of the word). Like a helicopter, empathy is powerful and complex, so it requires regularly scheduled maintenance lest something go wrong at an inconvenient time.
For those individuals who want empathy or think that they want empathy, but then change their minds, resistance to empathy confronts readiness for empathy. Some people simply would rather not be understood. For them, being understood has resulted in bad outcomes. They have been manipulated, used, even abused.
In such cases, the would-be empathizer has to “dial down” empathic receptivity, in which the communication of affect looms large, and “tune up” empathic interpretation, in which one cognitively processes what it might be like to take the other’s point of view. Once a person feels safe, the person will be willing to risk exposing and exploring the vulnerabilities that got the person stuck in the first place and need working through to get the person moving again into a flourishing future of possibilities.
In conclusion, empathy is supposed to be like motherhood, apple pie, and puppies. What’s not to like? A lot. People can be difficult—very difficult—why should empathizing with them be easy? Yet most of the things that are cited as reasons for criticizing and dismissing empathy—emotional contagion, projection, misinterpretation, gossip, messages lost in translation and devaluing language—are actually breakdowns of empathy. With practice and training, one’s empathy expands to shift breakdowns in empathy to breakthroughs in understanding, possibilities of flourishing, enhanced humanity, relatedness, and building community.
[i] Empathy is now a major publishing event. There is a wave of books on empathy—popular, scientific, political, and scholarly. For example, Frans de Waal’s The Age of Empathy explores empathy between humans and higher animals; J.D. Trout’s The Empathy Gap considers empathy and social justice from the perspective of Ignatian Humanism; Jeremy Rifkin’s The Empathic Civilization, 800 pages long in hardcover (don’t drop it on your foot!) channels Teilhard de Chardin’s idea of a global consciousness, now including the politics of empathy; Jean Decety’s Social Neuroscience establishes correlations between sensations, affects, and emotions using functional magnetic resonance imaging technology (fMRI) as a kind of x-ray for the soul, exploring the relation between empathy and psychopathy (with his colleague Kent Kiehl); Simon Baron-Cohen’s Zero Degrees of Empathy considers the role of empathy in cruelty and disorders of empathy such as psychopathy and autism. Thomas Farrow’s (ed.) Empathy in Mental Illness drills down scientifically on the disorders of empathy in all their profound differences. See also: Susan Lanzoni, Empathy: A History (Yale 2018); any collectioin on social neuroscience by Jean Decety; William R.Miller, Listening Well: The Art of Empathic Understanding (WIPF and Stock, 2018); Cris Beam, I feel You: The Surprising Power of Extreme Empathy (Houghton Mifflin, 2018); Jodi Halpern, From Detached Concern to Empathy: Humanizing Medical Practice, (Oxford, 2001); David Howe, Empathy: What It Is and Why It Matters (Palgrave Macmillan, 2013); Leslie Jamisom, The Empathy Exams (Essays) (Graywolf, 2014); Thomas Kohut, Empathy and the Historical Understanding of the Human Past (Routledge 2021).
[ii] I discuss this proposition in detail in Lou Agosta. (2015). A Rumor of Empathy: Resistance, Narrative Recovery in Psychoanalysis and Psychotherapy. London: Routledge (Taylor and Francis): 53, 55, 117, 190.
[iii] Bessel van der Kolk. (2014). The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma. New York: Penguin Books.
Every parent, teacher, doctor, social worker, sales person, person with customers, first responder, consultant, neighbor, or taxi driver already knows a lot about empathy. They would not be successful, much less survive, if they did not practice empathy. You may need a license to be a barber and cut hair. However, outside totalitarian state, no one can require that you have a license to do what comes spontaneously to the vast majority of human beings—be empathic. However, an expert can be helpful in clarifying distinctions, providing tips and techniques, and modeling the empathy you want to get or apply and expand.
Parents are naturally empathic towards their children; teachers, towards their students; medical doctors, towards their patients; business people, towards their customers, consultants towards their clients, and so on. Even if a person is clumsy and does not get empathy quite right, people can’t stop doing it. Yes, that’s right—people can’t stop being empathic; but then fear stops them—fear of experiencing vicariously another person’s pain, struggle, conflict, or suffering—and a breakdown occurs in their empathy. There must be something wrong here! Blame starts flying around. They blame themselves. They blame the other person. They blame empathy.
Even if doctors are trained to “tune down” their spontaneous empathy until it becomes “detached concern”—and good reasons exist for doing that at times—empathy naturally breaks through, and they often relate authentically to their patients as one human being to another in spite of themselves.[i]
The really useful thing is that in learning to contract one’s empathy, one is also learning expand it, because one is learning to regulate and manage empathy. Contracting one’s empathy also means being able to expand it. “Dialing down” empathy also means being able to “dial up” empathy.
“Dialing down” empathy does not mean “stop listening,” “be unkind,” “blame,” “make wrong,” “reject,” “be hostile,” “use devaluing speech,” or “feign thoughtlessness.” Such a response would be absurd.
There is a sense in which a feeling may be socially appropriate or inappropriate—for example to laugh at a funeral when nothing is funny—feelings are valid in themselves in that they always are what they are.
A feeling may be an inarticulate judgment—fear being the judgment that one should run from danger—especially if a mountain lion is coming around the bend. The fear is an absolute given in the moment.
One may wish that one felt differently than one does in fact feel in the moment; but that one feels a certain way is an absolute given.
The best way to turn fear into an out-an-out panic attack is to say to oneself: “This (fear) should not be!” But of course it is, so that means what? One has lost control. Panic!
The recommendation? Accepting the feelings as what’s so does not make an unpleasant feeling any easier to bear, but it takes away its power, drains the upset out of it, and gives one space to be in equilibrium with oneself again. Thus, radical acceptance of the feeling is an effective method of “dialing down” one’s empathy.
Most people are naturally empathic, but they lack practice. They set about practicing empathy, but are clumsy. Or they had a bad experience in relation to their own empathy or someone else’s (lack of) empathy. They develop a “flinch reflex” when it comes to practicing empathy. For such individuals, resistance to empathy replaces their spontaneous empathy. Most people use empathy every day, and do not need an expert to tell them what it is. Olympic athletes get a coach, but it is not because they are not good at what they do. They are good at what they do; and are striving to get to the next level of excellence. Few people claim to be really good at empathizing. Those persons who are practiced in empathy can be useful coaches in helping one to clarify definitions, engage the hard cases, and distinguish how to transform breakdowns of empathy into breakthroughs that make a difference.
Using empathy—practicing empathy—sometimes means being used by empathy. Yes, empathy uses us.
“Being used by empathy” means that the person has trained in being empathic, so that the person has a level of mastery that allows the person to be empathic (or not) without thinking too much about it. Empathy has become practiced, habitual, and automatic.
There’s what we know we know about empathy. There’s what we know we do not know about empathy and hope to find out. Where did the word come from? What are mirror neurons anyway? How does one expand one’s empathy?
Finally, there is what we do not even know we do not know about empathy. The third area is where this book and its training operates—what we do not even know we do not know: our blind spots about empathy; our vulnerability, shame, and cynicism in relating to others; and our resistance to empathy.
Empathy requires that one get “up close and personal” with other people. Other people can be notoriously difficult, irritable, dishonest, manipulative, apathetic, too pushy, or contrary. Other people resist being on the receiving end of empathy, because being understood makes them feel vulnerable.
If someone understands me, really understands me, then he can use what he understands about me to take advantage of me. Now an authentically empathic person would not do that, but the world is not known for being filled with authentically empathic people.
Well-intentioned persons sometimes simply misunderstand what empathy is and are resisting something else that they happen to call “empathy.” They mistake the breakdown of empathy in emotional contagion, conformity, projection, distortion, mind reading, or lack of responsiveness, for empathy proper, and throw out the baby with the proverbial bath water. The empathy lesson in confronting resistance to empathy is direct: remove the resistance to empathy, and empathy comes forth, develops, and blossoms. Empathy expands.
Another person’s blind spots are easy to see, but one struggles to catch a glimpse of one’s own. Thus, one of my own blind spots about empathy comes into view, albeit in my peripheral vision. When I do not get my way, I have the thought that the other person (or the world) is unempathic. This is of course absurd and self-serving, though, heaven knows, empathy is unevenly distributed in the world. The empathy lesson? Wherever there is empathy, can narcissism be far away? (No.) Thus, I clean up the thought—give it up, distinguish it as not helpful, let it go. But no matter how may times I give it up, the next time I am frustrated, it seems like there is that thought again, coming into view like the grin on the Cheshire cat. Only now it becomes an inside joke, and a challenge to earn my empathic wings everyday.
This lesson is easy to express, hard to do. The devil is in the details. One has to descend into the hell of one’s empathy breakdowns in order to emerge from the refiner’s fire of self-inquiry with renewed commitment to empathy, relatedness, and community. This sounds too hard. No one said it would be easy.
How to start? One begins by introspecting. Acknowledging one’s own lack of integrity and inauthenticity in the matter of empathy. Like the labors of the mythical hero Hercules, there is a whole lot of shoveling of manure to be performed.
Cleaning up broken interpersonal relationships is on the agenda. Repairing integrity outages and inauthenticities is in order. Empathy training includes the requirement to go out into the world of one’s relations with other persons and engage and practice.
The very idea of resistance to empathy inspires resistance. The idea of resistance to empathy requires motivation.
What could that even be? Resistance to empathy seems to make no sense. It sounds like resisting motherhood, puppies, or apple pie.
The idea that some people would resist empathy is surprising. Very surprising. What’s not to like about empathy? A great deal it seems. Even within this way of talking, appearances can be deceptive. Puppies make a mess on the new carpet. Apple pie is delicious, but it makes one fat. Mothers are wonderful people. The human race owes its existence to those who are mothers both individually and as a community; but motherhood is a damn tough job, not withstanding its many rewards. Mothers require a lot of support. Volunteers?
In general, receiving empathy is like getting a gift; providing empathy requires effort. Getting empathy is a benefit. Providing empathy requires listening to the other person, attending to one’s introspective reaction to the other person, managing the increase in tension, living with the uncertainty of being open to the other person, being vulnerable, and risking misunderstanding. This is why providing empathy inspires resistance. It requires work.
On the other hand, receiving empathy from a committed listener has been compared to sinking back into a warm bath. It is relaxing. It reduces stress. It is restorative of one’s emotional equilibrium. However, even in a one-on-one conversation, receiving empathy sometimes feels like being publicly acknowledged and recognized at a banquet. It has its uncomfortable side.
It is not always easy to be explicitly acknowledged and recognized for one’s contribution. One may feel ambivalent about being exposed and vulnerable. So even receiving empathy, though properly regarded as a benefit, has its conditions and qualifications; and some people are made painfully self-conscious by being acknowledged.
Whether one is giving empathy or receiving it, empathy has its dark side. If one is committed to giving empathy—being empathic—one is vulnerable to burnout, empathic distress, or “compassion fatigue.” If one is on the receiving end of empathic receptivity, though a restorative experience, one is still exposed in one’s potential weaknesses and limitations. One feels vulnerable to misunderstanding by the other person, to whom one has exposed oneself emotionally.
At a deeper level, resistance to empathy lives in our individual and collective blind spots about our dear self. Where there is empathy, can narcissism be far away? “Narcissism” is a way of relating to oneself. The mythical Narcissus was an attractive young man. He was so enamored of his own reflection in the mirror-like surface of the pond—this was before the invention of “selfies”—that he did not see the dangers of his surroundings. In different versions of the myth, Narcissus either fell into the water, drowning in his own image of himself, or he was consumed—metaphorically eaten—by the lion of his narcissistic desires, who also frequented the watering hole.
The empathy lesson of the myth of Narcissus? Empathy requires de-emphasizing “the dear self.” Even for someone committed to giving empathy such a de-emphasis of self-love is not automatic. When the empathy being delivered includes recognition, people struggling with self-esteem issues—either too much or too little—find it challenging just to accept the acknowledgement. “Naw, it wasn’t nothing—just doin’ my job.” It is not easy to be acknowledged, and therein lies resistance to empathy, too. Though receiving empathy feels good, it is not easy to open up to another person and acknowledge one’s personal issues, sufferings, sources of shame, or struggles.
In every instance of resistance to empathy, the empathy lesson consists in identifying, engaging, reducing, managing, or eliminating, the resistance to empathy by interpreting the resistance; driving out cynicism, shame, guilt (and so on); saying what is missing the presence of which would make a difference (such as respect for boundaries or contribution); and being open to the possibility—of expanded empathy.
When the resistance is reduced, empathy has space to expand, which it does so spontaneously as well as through providing explicit practices, tactics, strategies, and training.
The qualities that make organizations successful are not always the qualities that enhance their empathy. I am so bold as to assert this generalization applies whether the institution is a tax paying public one, listed on the stock exchange, or a nonprofit, community organization. Whether the corporate mission is to deliver value in manufacturing automobiles or to serve the community by collecting and distributing whole human blood to sick people, the ultimate truth is: no money, no mission.
Yet to say that the purpose of one’s business is to make money is like saying the purpose of life is to keep on breathing. Well, okay. The two are closely related. Definitely, don’t stop breathing. But somehow “don’t stop breathing” is not very useful as life guidance; and, likewise, “make money” is not a useful business strategy.
The ongoing process of living—or doing business—should not be confused with the purpose, vision, strategy, and meaning of the activity in the direction of excellence, whether in business or the community.
In most successful organizations, expanding revenue is a result of a successful strategy—applications and implementations that deliver value—and satisfy the demands of the customers, employees, and stakeholders. The expanded revenue is the effect of getting the vision and implementation just right, not the cause of it.
Successful enterprises of all kinds have to handle navigating an intricate, complex network of rules assigned by government, law enforcement, taxing authorities, and non-governmental special interest groups. Business and nonprofit enterprises must contend with competing organizations that assert and authentically believe that they can provide the product or service at lower cost or higher quality. Within the enterprise itself, the organization must balance the personalities of the leaders, individual contributors (workers), and stake-holders, who make up the organization.
An inherent challenge exists in building organizations and crafting an administrative structure that actually functions; and then getting the administrative structure—the bureaucracy—to act in a responsive and balanced way to customers, employees, and stake-holders.
Economies of scale that require fitting people into functions that can be substituted for one another to increase efficiency rarely expand empathy, because empathy consists in recognizing differences in individual contributions.
Hear me say it, and not for the last time: the things that make us good at business, including the corporate transformation of American medicine and education, do not always expand our empathy. What to do about it? The battle is joined. The recommendation?
Let your customers, constituents, or stake-holders train you in empathy: Realize that if you do not respond empathically, the customers are just going to go quietly to the competitor that does. Empathy is good for business. If the customer has a complaint that he is having trouble expressing, then use one’s listening skills to get to the bottom of things.
If the customer expresses anger, know that empathy is one of the best methods, bar none, of deescalating conflict and soothing anger. “Gee, it really does sound like you have not been well treated. Let’s see what we can do to make things better” [or words to that effect].
Still, I do not know of a single organization that as of the date of publication of this book, when making decisions, serving customers, documenting complaints, closing sales, managing conflicts of interest, asks: “What would the empathic response be?”
To be sure, aspects of the empathic response are included in such common factors as “be respectful to customers,” “be helpful to clients,” “keep one’s agreements,” “strive to deliver value.” Empathy is already in the mix, and many customers are willing to pay a premium for empathic services even if they do not use the word “empathy.”
The astute businessperson, committed to expanding the enterprise, knows that “if you want to gather honey, do not knock over the bees’ nest.” This is distinct from empathy, but not by much. Thus, the task is to nurture the seeds of empathy already present in abundance, but lying in hiding in cynicism and denial, while making the case that smart organizations build and deliver value empathically.
The legendary Marshall Field, one of the inventors of the department store, on which the sun is now setting, and a kinder, gentler robber baron of capitalism, is famously quoted as saying, “Give the lady what she wants.” It made Field rich, and his workers well off. It is perhaps a sign of the times that Field’s was purchased by Macy’s some years ago, which has struggles of its own in a world in which retail, having been “Amazoned,” is not what it used to be. So the tenuousness of the market value of empathy can be measured by the mark down of the once storied Field’s Enterprises in the face of Internet shopping.
An alternative redescription of the fire sale of Marshall Field’s flagship stores is that individualized, personalized, customized one-on-one service has moved to the ultimate free market, the Internet, once again, disintermediating the disintermediators. I would not rule out expanded empathy in online cyberspace, but, even allowing for the convenience of shopping naked, it is a work in progress.
Even in mild and efficient bureaucracies, people misuse organizational rules and paper work to create resistance to empathy. Passing the buck, “Not my job,” “I’ll have to get back to you,” “We received no such request,” “I don’t know, and I can’t tell you when,” are common responses. Bureaucrats (which used to mean “office worker,” but is now a devaluing term) address such pseudo-answers not only to customers, but also to their coworkers and managers.
Resistance to empathy uses organizational rules and regulations to build protective walls, instead of teamwork. Without concern for the other person, bureaucracy unwittingly creates obstacles that prevent workers from being present with one another.
Mutually implementing and contributing to agreements with the organization and one another is not a priority. Perpetuating the bureaucracy is. Managing permissions and gaming the system occur to avoid work, rework, and overwork. The threat of uncompensated overtime and overwork consumes the energy required to get the job done.
People automatically and unwittingly fall into resistance to empathy, exploiting the tendency to be territorial.
The organization itself can show up as the unempathic authority figure—like the unempathic parent, who leaves the child feeling devalued, depressed, and de-energized. In response, an individual pushes back against the organization and its rules, disagreeing and speaking truth to power.
Rarely does the organization respond empathically to the individual, but rather urges the individual to conform. The individual asks for an accommodation. “Power” exhorts the individual to comply. “Power” says, “I did not make up the rules—I just enforce them.”
The individual states that the organization exists to serve the stake-holders, not to perpetuate its own rule-making. But rule-making has a way of becoming habit forming, if not addictive. Whenever a problem, issue, or breakdown occurs, the tendency is to try to formulate a rule to cover the new case. If the individual continues for any amount of time in a state of non-compliance, then “power” tends to experience a loss of authority, which is deeply threatening and unacceptable to “power.” Power escalates efforts to force compliance. Power imposes sanctions, increasing the cost to the individual. Empathy struggles to make a difference and be heard.
Compliance is definitely trending. This is the age of compliance. And there is nothing wrong with compliance as such. Stop on red; go on green. Yet sometimes so many “shoulds” exist that doing one’s job can end up on a slope of diminishing returns. Filling out the required paperwork takes an increasing percentage of the workday.
For example, some people train to become nurses because they care about other people, and they want to take care of them and their health. However, when virtually every patient encounter has to be documented to satisfy compliance regulations, then an eight-hour workday includes hours of electronic documentation. Many nurses are saying, “This is not what I signed up for.” Engagement—a synonym for empathic nursing encounters—struggles for space to make a difference.
“Compliance” includes conforming to acceptable boundaries and limits. No one is saying break the rules. No one is saying disregard boundaries. Rather one is saying relate to rules and boundaries empathically. But what does that mean? Even if the light is green, look both ways for emergency equipment or an inattentive driver running the light. Don’t be dead right. And as applied to empathy?
Empathy is about traversing boundaries between individuals. But these include not only boundaries between the self and the other, but boundaries between those in a position of authority and subordinates, between insiders and outsiders in communities, and between those who are insiders and those who feel left out—or are actually marginalized and have become invisible.
Humor and empathy versus cynicism
Cynicism and denial are the enemies of empathy. The empathy lessons are simple: Empathy up, cynicism down. Humor up, empathy up. Yet in the face of life’s challenges, setbacks, and struggles to survive, everyone gets cynical on a bad day.
Ground zero of cynicism and humor is Scott Adam’s Dilbert cartoon. It is wickedly funny, because it expresses more than a grain of truth about dysfunctional, anti-empathic organizations.
In one classic example, the pointy-haired boss says that from now on the organization will assign job functions based on the Myers-Briggs Personality Test (MBPT). For those readers who may not know, the MBPT is the test that distinguishes introversion and extroversion, thinking and feeling, and related categories. The boss continues: “For those of you who do not have a personality, one will be assigned by the human resources department.”[ii] I must say that I am deeply ashamed of myself—I can’t stop laughing.
In humor, stress and psychological tension are created by violating a standard—saying people in corporate cubicles have no personality—and then the stress is released in laughter by the mechanism of the joke such as a pun, double meaning, or violation of expectations.
Humor is closely related to empathy in that both humor and empathy cross a boundary between the self and the other. However, unlike empathy, in which the boundary crossing occurs respectfully, with acknowledgement of the other person’s contribution or struggle, and with recognition of humanity, in humor the boundary between self and other is crossed with aggression, put down, or (in other cases) sexuality. The rule? The more objectionable the joke is, the funnier it is. The put down, “If you do not have a personality, one will be assigned by HR” is indeed wickedly funny; but it is also deeply debunking of the corporate world (and shaming of the individual), in which people come to feel like a gear in an inhuman mechanism.
So empathy for the long suffering inhabitants of corporate cubicles, whose personalities are at risk of being erased, does come to the surface after all. The laughter largely dissolves the cynicism. It is a commonplace in the organizational world that people function as replaceable cogs in a well-oiled machine. Therefore, the cartoon is an example of what not to do. Cynicism and shame drive out empathy; and, more importantly, driving out cynicism and shame create a space into which empathy stands a chance and can expand spontaneously.
How then does one drive out cynicism, shame, denial, and so on? The short answer is by calling it out, acknowledging it, interpreting it, and offering an alternative point of view. Not “alternative facts,” which have come to mean “spin” and “deception”; but an alternative perspective. It is now cynicism versus empathy in the organization.
For example: “Given the challenges we are facing, it is easy to become cynical. However, I have an alternative point of view. If we adhere to our commitments, then the way forward is clear. Not easy, but clear. We have to … remember who we authentically are, serve the customer, be inclusive, expand the community, be guided by our empathy (and so on). We have to live up to our commitment that everyone who comes in contact with the organization, even if we cannot completely solve their problem, is left whole and complete, treated with dignity and respect (and empathy).”
In the face of pervasive cynicism, it takes courage for a person to responds empathically. Such a person may be perceived as a threat to the prevailing, default attitude of “I won’t call you on your lack of authenticity if you don’t call me on mine.” Such a committed person is at risk in standing out from the crowd; but such a person just might provide the leadership, gather the power to make a difference, get the job done with grace and ease under pressure—and get a promotion.
One does not even have to stop being cynical, since it is so pervasive, but one has to adhere to one’s commitment to making a contribution, work to make a positive difference, and deliver value on one’s agreements.
Cynicism is shown up for what it is: taking the easy way out. The practice of empathy is hard work.
It is not only the executive suite, but also the front and back office and every part of the supply chain in between that are staffed by harried people pushed down into survival mode by a cruel gig economy where empathy is not a priority. Of course, empathy gets paid lip service. Please pardon the double negative—one dare not not pay empathy lip service.
However, all-too-often, empathy is too messy. It is too complex. We are not even sure what empathy would mean in an organizational context. We need results now. Suck it up. Get over it. Conform! Nor is there anything wrong with conforming as such. Submit your expense report on time. Even the customer wants to conform, if only he could get the product to function as designed. It is just that empathy is too time consuming, which means—it is too costly.
Yet never was empathy more important than when it seems there is no time for it. Positively expressed, as with most forms of resistance, the method of overcoming it is to call it out and interpret it. Once visible and explicit, it is less formidable.
The empathy of cross-functional teams, managing by walking around, making a contribution, building the bigger team, being inclusive of all the stake-holders, communicating goals and connecting the dots between individual accomplishments and the objectives of the entire organization—these create a clearing in which empathy shows up and makes a profound contribution to the success of the organization.
In addition, one’s employer is not one’s parent. Remember the sign in the common kitchen that says “Your mother does not work here—clean up your dirty dishes!”? Of course your mom told you that, too, and she did “work here” at home, and it still hasn’t snuck in.
Notwithstanding the rich comic possibilities, one’s employer and its leaders do indeed “work here.” Leaders provide powerful examples to whom we look for inspiration. This must give one pause about the state of leadership today. Just as children have to get empathy from their parents before they can give it to others, employees have to see and experience examples of empathy from their leaders to be effective in their own roles as individual contributors. The idea is not to be paternalistic, but to lead by example, the example of empathy.
The difference between banging on a stone and building a cathedral
Executives of all kinds have varying degrees of empathy and different attitudes towards it. It may sound like yet another burden that the CEO now also has to take the role of “Chief Empathy Officer.” This comes up for detailed discussion below in the chapter on the empathy application to “Business and empathy, capitalist tool.”
Meanwhile, when I am bold and ask executives what is the budget in the organization for empathy training and empathy consulting, they usually look at me with a blank stare or just say “zero.” However, when I ask what is the budget to reduce conflict, enhance teamwork, innovate and improve productivity, inspire participation, cause the staff to take ownership of the mission and honor their agreements, then the leaderships sees possibility where none had previously been present and makes it a priority to obtain a budget.
Simply stated, empathy training consists in surfacing the resistances to empathy, the pervasive fear and cynicism (and so on) in the organization that lurks just beneath the surface; interpreting the resistance, and driving it out: “It is perfectly understandable that you would be cynical, given what you have been through, but that is not who you (we) authentically are. Rather we are the possibility of [health, transportation, nutrition, education, retirement, housing, recreation, and so on (according to the mission of the organization)].”
What would it take to design agreements that overcome resistance and commit to aligning organizational and individual goals and then taking action to implement the agreements on an ongoing schedule? The empathy training consists in engaging in a sustained dialogue for possibility around agreements that work for everyone in delivering value.
In particular, overcoming resistance to empathy, expanding empathy, is on the critical path to eliminating or at least reducing organizational conflicts and dysfunctional behaviors. When staff, executives, stake-holders, and so on, expand their empathy for one another and for customers, they are able to deescalate confrontations and negativity; they avoid provocative and devaluing language; and they are able to head off dignity violations, all of which reduce the conflicts that literally suck the life out of organizations.
When employees appreciate the possibilities of empathy, they even try to replace office politics with professional behavior. Staff get more done because they can concentrate on doing their jobs, working smarter, and serving customers and coworkers rather than struggling with departmental politics.
In addition, expanding empathy—overcoming resistance to empathy—is on the critical path to building teams. Empathy is the foundation of community, and the team is nothing if not a community. In empathy, people practice giving acknowledgment and recognition for their contribution to the success of the team and the organization. Being inclusive does not always come naturally or easily to us humans, territorial creatures that we are. We oscillate between closeness and distance like a pendulum.
However, no organization can succeed without including every contributor and turning him or her loose to do the job at hand. Even in hierarchical organizations, where departmental boundaries are rigid, empathy works to demonstrate that good fences makes good neighbors but that gates are needed in the fences through which empathy can be practiced.
Expanding empathy is also on the critical path to innovation and enhancing productivity, because people feel gotten for whom they are as a possibility and as a contribution. They stop withholding and working in quasi-competitive isolation. When they get in touch with one another as possibilities, the business results take off.
Successful leaders know the importance of drawing on the talents of every contributor. When employees get a sense of how their role and contribution fits into the whole, they work to deliver on their commitments.
That is the key to improved productivity. People are generous in sharing their ideas for process and product improvement, because they feel confident their contribution makes a difference and is recognized. For example, two workers are going through the same motions, making the same gestures. An empathic milieu makes the difference between the one, who is banging with a hammer and chisel on a chunk of stone, and the other, who is building a cathedral. The worker’s gestures are exactly the same. The one is sentenced to hard labor; the other participates in greatness.
[i] Jodi Halpern. (2001). From Detached Concern to Empathy: Humanizing Medical Practice. Oxford: Oxford University Press.
[ii] Scott Adams. (1996). The Dilbert Principle. New York: Harper Business.
A person can regulate his or her empathy up or down by crossing the street. The empathy lesson is that if you can cross the street to avoid the beggar, regulating your empathy down, then you can cross the street (as well as use other methods) to expand your empathy, regulating it upward. So don’t tell me that empathy cannot be dialed up or dialed down with practice. That’s the point: practice.
Crossing the street is what happened in another story with which many readers are already familiar. The story of the Good Samaritan, one of the parables of Jesus of Nazareth, tells of two people who crossed the street, and one who did not. In the story, a traveler was waylaid by robbers. He is left for dead by the side of the road. The first two persons—the Levite and the priest experienced empathic distress, and, crossed the street, passing by the victim.
The Samaritan, however, was not overwhelmed by the victim’s suffering. The Samaritan perceived the suffering; he had a vicarious experience of the suffering that did not over-stimulate him with suffering and cause empathic distress. The Samaritan saw a fellow human being; recognized the suffering humanity; and he decided to get involved.
Multiple empathy lessons are available here. First, to regulate one’s empathy, cross the street. This is an edgy and confrontational way of putting it, but it is literally accurate. Cross the street away from the neighbor to “down regulate” your empathy, and experience less empathic distress; and cross the street towards your neighbor to expand your empathy in the direction of creating an inclusive community of persons, who recognize the value of cooperation.
The empathy lesson is that the vicarious experience does not have to be overwhelming. Rather, with practice, one is able to shift one’s focus from suffering to neighborliness; one is able to shift one’s attention from suffering to making a difference and enhanced self-esteem, expanding community and shared humanity.
Crossing the street is not the only way to reduce one’s chance of empathic distress or responding empathically. One may imaginatively changes places with the survivor and reflect that one would want the other’s help if one were in a similar predicament. One may spontaneously and without thinking act impulsively to be helpful, because one’s upbringing has made such responsiveness a habitual practice. (I believe this was the case with the Samaritan.) One may reflect, “I am safe and the survivor is no danger to me and it is my turn to help out.”
Or, on the contrary, one may make a devaluing judgment such as “The guy deserved what he got.” Such a judgment would be inaccurate—and in this case it would literally add insult to injury—but such thoughts do occur among by-standers. The passers-by may have just been hard-hearted. One person’s empathy is another’s antipathy. The language speaks volumes.
The empathy lesson consists in distinguishing such a devaluing thought; acknowledging that thinking is profoundly different than acting and should not be confused with it. The empathy lessons is to take action coming from one’s authentic commitments to building community through empathy, not devaluing thoughts.
This story is an empathy lesson that also instructs us in the difference between empathy and compassion. The Samaritan’s empathy told him what the other person was experiencing; his compassion (and ethics) told him what to do about it.
This bears repeating: empathy tells one what the other person is experiencing; compassion (and ethics) tell one what to do about it.
We are usually taught to devalue the behavior of the Levite and the priest; and surely they do not win a prize. Yet in an alternative point of view, they were all-too-human. Seeing all that suffering embodied in the survivor, they just couldn’t take it. They succumbed to empathic distress.
They experienced a breakdown of their empathic receptivity, and were overwhelmed in a kind of instant empathy fatigue (not compassion fatigue).
In an alternative reading of the parable, the would-be rescuers dial down the granularity of their empathic receptivity, so as not to be too sensitive to the suffering, even as they get a sample of the suffering, which is needed to inform their humanity.
The Good Samaritan, who is a seemingly infinite source of insight, is called to his empathic neighborliness by the distress of the injured traveller. The traveller who had fallen among thieves and was beaten near to death creates the possibility of empathic community by his loss of human well-being. He has been reduced to a lump of suffering, broken, physical pain.
The Samaritan rescues the traveller; the traveller humanizes the Samaritan, calling him not just to the role of an altruist doing a good deed (though that occurs too), but to his possibility as a human being in relation to another fragile, suffering, dependent human being.
The stricken traveller, by his very being, gives the Samaritan his own humanness. This occurs precisely in making the Samaritan a neighbor in answering the question, “Who is one’s neighbor?” Such was the trick question that the Pharisees posed to Jesus, to which this parable is the response.
The Samaritan gives humanness to the distressed traveller in an intervention that defines them as part of the same community of fellow travellers—neighbors—on the road of life.
In an alternative retelling of the story suppose that the Levite and the priest were “natural empaths,” biologically predisposed to be sensitive to the pain and suffering of other people. They were endowed with a certain “delicacy of empathy,” and they feel the suffering of the world deeply. Perhaps too deeply. Some people report: “I am a natural empath—and I suffer because I feel the pain of others too acutely. I started out being empathic—but people took advantage of me—and even when they didn’t, I was just too empathic; I got overwhelmed with sensation and sucked dry—the result was burnout, compassion fatigue. Nice guys finish last—so do empathic ones.”
Thus, the lament of the natural empath.
Empathy becomes a burden, because the world is filled with so much suffering. Yet if the person uses avoidance to “down regulate” their empathy, the person feels guilty because the individual believes that what she is doing is unkind, thoughtless, lacking in fellow feeling, and—unempathic.
So the natural empath falls into a double bind, and her suffering seems inevitable. She is over-whelmed by too much openness to the suffering of the other person or over-whelmed by guilt at not living up to her own standards of fellow-feeling and ethics.
These statements imply that empathy cannot be regulated through training, albeit a training that goes in the opposite direction (from too much empathy in the moment to less empathy) than that required by the majority of people, who are out of touch with their feelings and need to “up regulate” their empathy. The empathy lesson for the natural empath is to be more flexible about her ethical standards, while attempting to tune down her empathic distress.
Some people are skeptical that “natural empaths” are all that they say they are. Natural empaths in their natural state assert that they feel overwhelmed and distressed by other people’s thoughts and feelings. I see no reason to doubt such statements. However, to some critics, a redescription of the natural empath asserts that the latter are “irritable” and “hypersensitive.”
Empathy is recognizing and understanding the other’s perspective and then communicating that understanding to the other person. Someone who is unwittingly, even helplessly, swept along by the other’s feelings is not really being empathic. Over-identification, not empathy?[i]
The way out of this apparent impasse is to consider that the natural empath does indeed get empathic receptivity right in empathic openness to the other’s distress, but then the person’s empathy misfires.
Whether the misfiring is over-identification, resulting in empathic distress, depends on the description and redescription. Standing on the sidelines and saying “Try harder!” is easy to do. Where is the training the person needs when they need it?
The recommendation regarding training? Most people need to expand their empathy; some people—natural empaths—need to contract (or inhibit) their empathy. Empathy regulation—learning to expand and contract empathy—is the imperative in either case.
Instead of complaining about being an overly sensitive natural empath (however accurate that may be) do the work of practicing empathy by “down regulating” one’s empathy in a given situation, transforming empathic distress into a vicarious experience. Instead of complaining about not being pre-disposed to empathy, get up and do the work of practicing empathy, which for most persons means “up regulating,” expanding their empathy.
A scientist has not been burned at the stake in over 350 years – and even then it was Giordano Bruno, not Galileo. Find out how Professor Alice Dreger (PhD) become an advocate for survivors of intersex sexual reassignment surgery and she becomes a strong candidate to be burned in effigy by those for whom she was advocating.
This is a reposting of a book review from 2015, now included as a podcast (originally recorded on April 29, 2015 with Alice Dreger, PhD, Professor of Medical Humanities, Northwestern Feinberg School of Medicine).
With transgender dynamics, identity, politics, and everything exploding in the headlines, the need for empathy around sexual identity and related issues is even more urgent and timely today than when originally broadcast.
Join me for a conversation with Alice Dreger about the conflict between scientific evidence and some interpretations of social justice and “empathy” (in quotation marks). Dreger starts out as a graduate student exploring the condition [previously] known as “hermaphroditism,” people born with sex organs that are ambiguous as to male or female, now called “intersex.”
In reading the text books studied by her medical student husband, she discovers the interventions performed to “normalize” people sexually into the two canonical categories of male or female. The parents usually follow the recommendations of the physician-surgeon who are articulating a supposed community standard that one’s genitals should unambiguously be either male or female. Dreger discovers that many of the people whose genitals were surgically transformed were subsequently lied to about their natal [birth] sex by well-intentioned doctors and well-intentioned parents following the well-intentioned doctor’s guidance. Thus, the road to hell. Find out what happens when Dreger’s research surfaces evidence that does not align perfectly with the interpretation of a social justice agenda.
This is a powerful and disturbing work. Dreger delivers a compelling narrative. A penis smaller than a person’s adult thumb or clitorises larger than one little finger, according to (some) conventional wisdom, have got to go. I am not making this up. The standard procedure was to surgically “delete” the offending member and surgically construct [some version of] the female genitals. This will, of course, resonate with Freudians everywhere as something motivated at the deepest levels of the unconscious. Not so Freudian is the proposition that if sex assignment from male to female and the raising of the infant as one rather than the other sex is the consequence, so be it. (Dreger is not interested in Freud in this text – that is my hobby.)
Dreger marshals evidence that people whose genitals are not surgically transformed as infants – but who have non-standard but otherwise healthy functioning genitals – are not worse off than those whose genitals were modified, and in many cases flourish. In at least one case, where the boy could not urinate standing up – and write his name in the snow with the stream of urine – due to the opening to the urethra being beneath the pen, the result of the surgery often produces a “cripple”. Yet the surgery continues to be performed. In other instance, the major concern expressed by the medical text books was that the child would become lesbian or gay. Ouch.
Dreger “goes to bat” for these intersex individuals, recovering their narratives out of medical records and journals where they had been documented as cases. She advocates for them. She lobbies, blogs, publishes in the popular press. Then the unintended consequences hit. Some of those for whom she is advocating don’t like some of the evidence Dreger publishes. It is not sufficiently “on point” about transgender issues being exclusively a function of a man’s brain born in a woman’s body or vice versa. The idea that a man could love himself as a woman and so want to become a woman does not compute.
As one might expect, research produces subtle nuances that require more than a sound byte or even a blog post. Suddenly Dreger finds herself the target of anger from the advocates for whom she was lobbying. It is not pretty. It gets ugly. Think self-righteous indignation as an expression of narcissistic rage and having one’s deeply felt values questioned by the evidence. There is no easy way to say it: some advocates of social justice seem to feel that the end justifies the means. The “means” include rampant forms of bullying and in-your-face confrontation, including charges of dubious ethical violations, invalid research, fictional claims about the researcher’s relations with his or her children and family, and the posting of toxic gossip on the Internet. The cause may be righteous, but the behavior is wicked and mischievous if not heinous.
Dreger survives and is vindicated. But then she begins to wonder if her experience of the collision of scientific evidence with advocacy and versions of its conventional wisdom was exceptional. Like most survivors she asks: “Is it just me?” It is not. It reminds her of the conflict between Galileo and the sedimented beliefs of the Church of his time.
A point that underlies Dreger’s work and may usefully be made more explicit: The facts of empirical science are fragile. Not only can they be shouted down by bullies, purged by tyrants such the Italian Inquisition of the 16th century, or simply ignored by the average person, the facts can also be set upon by academic, university, or institutional agendas more dedicated to building a corporate brand – and being financially well funded – than attaining an evidence-based version of the truth.
(An early version of this thesis, perhaps unknown to Dreger, is Hannah Arendt’s work on Truth and Politics. Not a historian of medicine but of political theory, Arendt makes the powerful point that if all versions of Euclid’s Geometry had been destroyed, mathematicians would still be able to recreate formal geometry out of the a priori forms of space and time; but if Stalin had really succeeded in purging all examples that such a person as Leon Trotsky had existed, then we really never would have heard of such an individual’s factual existence. Facts are fragile. )
A case in point. It is conventional wisdom since Susan Brownmiller’s Against Our Wills (1975), that rape is primarily an act of power by the perpetrator (usually a man), not one of sex. While not primarily a scientific treatise, it becomes the basis for research that gathers sufficient evidence and the thesis “power not sex” becomes “conventional wisdom.”
Enter a young (male) scholar who has a strong hunch he can prove an exception to the rule. No, sometimes rape is motivated by sex. Sometimes a guy, who has no prospect that the intended woman would have sex with him (but who he desires sexually) decides to use force. This naïve academic sees a dissertation topic that is a cut above the usual scholarly drivel. A dissertation is delivered to that effect. Not only does all hell break loose – he is silenced by angry activists – but it gets worse. The phone rings. It is a prosecuting attorney needing help with a case.
The District Attorney is bringing charges against a perpetrator, an alleged rapist standing trial for his crime. The defense is arguing effectively that science has shown that rape is about power, not sex. The perpetrator could not possibly have been motivated to the crime by sex. Science says so. Wait a minute. Rape is never about sex? It is now a defense against rape that there was no other motive than sex?
Since 1975 we have seen date rape and the use of incapacitating “date rape drugs” such as anesthetics facilitate the violation. Surely advocates and scientists can encompass the possibility that sometimes rape is about power, sometimes it is about sex, and sometimes, it is both (p. 125). Don’t be too sure. There is a deep lesson about human nature here. Constant dialogue is needed to keep people in rational communication without distortion and manipulation. The desire to be righteous and justified is pervasive and extends across all political spectrums. The ability to listen has rarely been in such short supply.
Another case. Napoleon Chagnon writes an innovative and disruptive work of anthropology (Yanomamö: The Fierce People). He argues that Margaret Mead’s vision of a peaceful coming of age in Samoa in a sexually liberated version of a hippie-like commune may not be the only paradigm of the life of native indigenous peoples. (Mead herself was subjected to a debunking, the factual basis of which turned out to be, shall we say, less than rock solid.) The Yanomamö in South America are more like warring bands of Hobbes’ “war of all against all” or the tribes of the Peloponnesian peninsula, with Achilles throwing a narcissistic fit – “I stole her fair and square” – because Agamemnon took his plundered woman.
Chagnon is a virtual Dreyfus Affair in the American Association of Anthropologists. Alfred Dreyfus (you may recall) was stripped of his epaulets, his campaign badges ripped off his chest, and he was banished to Devil’s Island (my metaphor, not Dreger’s). Years later, Chagnon is vindicated (as was Dreyfus) and “rehabilitated.” But only after years of upset, suffering, and the monumental expense of mounting a defense against false accusations as recounted in his My Life Among Two Dangerous Tribes – the Yanomamö and the Anthropologists. The bottom line? According to Dreger, in addition to the political infighting, wicked and mischievous gossip, and an alleged series of narcissistic injuries unintentionally committed by Chagnon against colleagues, it was politically inexpedient to represent indigenous peoples as warlike.
Dreger documents in detail the appalling political intrigues, plots misfired and rebounding onto the heads of the perpetrators, and the narrow mindedness of academics who ought to have adhered to scientific standards rather than tit-for-tat gamesmanship. Dreger’s work is definitely a page turner, reading like a spy novel or an account out of Kafka’s The Trial. Speaking personally, it made me paranoid at points. I felt discouraged at the alternating narcissistic rage and petty retaliation enacted for real or imagined slights to which both scientists and advocates for social justice seem all-too-prone.
The drama goes on. It escalates. Maria New, MD, is a celebrity woman’s doctor of long service and, at least initially, significant distinction. Dr New advocates that early stage pregnant women take dexamethasone (off-label, though FDA approved to prevent miscarriage) when the parental profile shows a one in eight chance that the female fetus may have congenital adrenal hyperplasic (CAH)). Basically CAH means that the baby might be a “boyish girl” if left untreated. Heavens to mergatroid – a lesbian? But since there were never any controlled studies of the consequences of taking dexamethasone (dex), it is not clear if the cognitive impairment, the deformed genitals, other anomalies, were due to the action of the drug or whether the drug was simply ineffective for its off-label use.
Dreger believes she has an “open and shut” case of an ethical violation that research subjects were not informed that they were participating in what amounts to a experiment, a far cry from a “safe and effective” treatment. The FDA oversight representative embedded in the research teams raises a number of red flags. Her career is ended on a pretext, and Dr New transitions to a different university without so much as a warning in any file.
One thing is for sure. Taking the case to the FDA and the Office of Human Research Protection (OHRP) reveals a level of indifference, human clumsiness, and subtle, unexamined conflicts of interest and self-dealing that again approach’s Kafka’s The Trial. Appalling. By the way, if ones want to receive this treatment during early stage pregnancy with the hope of dialing down the masculinization of the fetus, it is still legally available from Dr New and her associates, though Dreger has made it her project to dominate the Google listings with warnings about the risks of the treatment.
Dreger’s point is that the use of dex to influence the process of masculization of the fetus is experimental as used off label (the “on label” use is not to treat CAH, but to prevent miscarriage, for which it seems to be effective). The women to whom it was given to treat CAH were never told and never signed an informed consent form to participate in what was basically an experimental use of the drug. “Safe and effective” remains unproven for CAH, and evidence to the contrary is emerging. However, what really put the kabash on the treatment with dex is that it has been branded an anti-Lesbian drug. More good news. It is not as bad as thalidomide; but possibly another DES fiasco in the making.
In conclusion, Dreger offers reflections inspired by the Founding Fathers of the early days of the United States and such politician-statesmen as Benjamin Franklin. No stranger to risk, Franklin was both flying a kite in a thunderstorm and building a structure of government capable of correcting its own errors (not on the same day). Thanks to such men, we are all better off than Galileo when speaking truth to power. Free scientific inquiry needs a free social and fair political space to flourish. Justice requires access to accurate facts and a way of testing evidence that distinguishes fact from fiction The truth is vulnerable to the influences and distortions of the social organization of power.
Granted that a scientist has not been burned at the stake for over 500 years, that is no reason for complacency. I could not help but think that Professor Dreger was well on the way to being a candidate, though admittedly the burning was “in effigy.” Bad enough! There have been many ruined careers and damaged lives due to bullying and political abuses. Dreger bemoans the “push down” of the press and investigative journalism – in short, the decline of the press beneath the pressures of a publishing market in distress, the Google-ad-industrial-complex, and on the Internet no one knows you are a dog. While the Internet is a multi-edged sword and sends fear into the hearts of tyrants everywhere, it is easy to abuse. It is a dubious format for rational discourse and evidence-based anything. That should not stop one from posting her or his peer-reviewed research (this is not an example of that) but it means one must also mount the soap-box on a regular basis and speak truth to power.
Alice Dreger. (2015). Galileo’s Middle Finger: Heretics, Activists, and the Search for Justice in Science. New York: Penguin.
(c) Lou Agosta, PhD and the Chicago Empathy Project