This work aims to be educational in a brain-storming way about the role of empathy in the community and the market for empathy services. Hanna Holborn Gray has said that “education should not be intended to make people comfortable, it is meant to make them think.” I hereby also add: The intention of education is to expand one’s empathy. Amazingly enough that is not as comfortable as many people might imagine, which brings up to the first trend – resistance to empathy.

10. Resistance to empathy grows and is acknowledged. I may be a tad late with this one, since it is actually front section news in the New York Times, but just in case you have been living in a cave: Empathy is supposed to be like motherhood, apple pie, and puppies. What’s not to like? Yet 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 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 and building community.

9. Empathy is not an on-off switch; it is rather a dimmer or rheostat (and the public debate acknowledges this). Engaging with the issues and sufferings with which people are struggling can leave the would-be empathizer (“empath”) vulnerable to burnout and compassion fatigue. The risk of compassion fatigue is a clue that empathy is distinct from compassion, and if one is suffering from compassion fatigue, then one is doing it wrong. The listener may get a vicarious experience of the other’s issue or problem, including their suffering, so the listener suffers vicariously, but, strange as it may sound, not too much. As noted, if one is over-whelmed by suffering, one is doing it wrong, and one needs to increase the granularity of one’s empathic receptivity. Empathy is like a dimmer – tune it up or tune it down. Empathy is like a filter – increase the granularity and get more of the other’s experience or decrease the granularity (i.e., open the pores) and get less. That is the whole point of a vicarious experience – and training one’s vicarious experiences as distinct from merger or over-identification – to get a sample or trace of the other’s experience without being overwhelmed by it. Empathy is not so much an on-off switch as it is a dimmer or rheostat to gradually turn the lights up or down – gradually expand or contract the granularity of one’s empathic receptivity. This point is completely missed in the otherwise engaging and spirited public debate feature in the New York Times where Hamid Zaki identifies empathy with compassion – and – how shall I put it delicately? – it is a conversation of deaf persons about the importance of listening from that point onwards[see http://tinyurl.com/gwmfpxp%5D. The recommendation? Listen, interpret the resistance and apply conflict resolution principles – identify and express grievances, invite self-expression, apply the soothing salve of empathy to the narcissistic injuries, elicit requests/demands, propose compromises / action items, iterate – until resolution.

8. Empathy is too important to be left to the psychologists. For psychologists empathy is by definition a psychological mechanism. For example, identification or transient identification or projection plus introjection (or visa versa) or mirroring or mirroring plus recognition of the other or inner imitation or motor mimicry. (This list goes on and this is not complete.) And while there is nothing wrong with psychological mechanisms or neuropsychological narratives built around their operation in the cerebral neural cortex and basal ganglia, there is something missing – empathy. So what then is empathy? Very short definition: It is being in the presence of another human as a human being with nothing else added. This [big word trigger alert] is the ontology of empathy – being in the presence of the other individual without anything else added. (This is called “ontology” – the study of being and ways of being, and it is definitely not psychology.) For example, Heinz Kohut, a psychiatrist from a time when psychologists were either psychoanalysts (or behaviorists), had a definition of empathy as vicarious introspection. This has an key ontological dimension as Kohut says “the idea of an inner life of man and thus of a psychology of complex mental states, is unthinkable without our ability to know via vicarious introspection – my definition of empathy […] what the inner life of man is, what we ourselves and what others think and feel life of the other individual would be inconceivable without empathy” (Kohut 1977: 304). The point is that empathy is both deeper and broader than a psychological mechanism – it is the basis for relatedness between individuals. Without empathy, no relatedness. Empathy grants being to relatedness. This matter of being with the other individual, in turn, becomes the foundation for community in an expanding circle of inclusion. As soon as one adds diagnostic categories, labels, arguments – which, admittedly, can be required in some contexts – empathy mis-fires, relatedness goes missing, and resistance to empathy expands. Thus, an empathic conversation is frequently challenged to find the equilibrium between using categories and distinctions to access the experience of the other individual while being with the other and being receptive to the vicarious experience of their suffering (or joy) as another human being.

7. Life coaching gets traction as empathy consulting. Empathy and life coaching intersect (again). The reason an Olympic athlete has a coach is not because she is not good at what she does. Positively expressed, people get a coach when they want to take their game – their performance – to the next level. Many people are already good at what they do and are committed to expanding their results in one area or another such as career, relationships, physical well-being, contribution to community, or peace of mind, in which their experience indicates something is missing. People get a therapist when they want a diagnosis or when they are pushed into survival and need to find a way out. Nothing wrong with that – indeed it can be critical path to transforming suffering into productive results. However, there is good news here – many people are not suffering but have an area in their lives that needs work to provide the results to which they are committed. This is where empathy is oxygen for the soul and can facilitate breathing easier in climbing the stairs to self-satisfaction in accomplishment. Yes, performance may usefully be measured “by the numbers” with meaningful data, but you don’t just need data, expanded empathy is required too.

6. “Hug a stranger” becomes an empathy trend. I am not making this up – well, okay, in a way, I am. The human body is the best picture of the human soul. So hugging another person is not just an emotional and physical but also a spiritual gesture. In this case, hugging and the “space of hugging” starts a journey of discovery that gives us access and reveals that there are far fewer strangers in the world – possibly none – then we at first imagined. I learned about this trend from Stone Kraushaar who distinguishes the physical embrace – the hug [with permission] – between two people from the “space of hugging,” which (on a good day) opens up a whole universe of empathy, sharing, transforming, building community, and being with mutual humanity. While acknowledging that hugging is not empathy, in the context of Stone’s work (and pending book), it is – in the deep sense of being in the presence of another human being without anything extraneous being added or subtracted. So if you see people walking down the street stopping for conversation, asking permission, breaking out in spontaneously hugging one another, you will know they have been engaging with Stone’s provocative proposal. You just might see yourself and encounter your own humanity in another in a new way you had not previously imagined. The empathic point is that you start by thinking these other people “out there” are strangers but when you get to know them well enough to be comfortable with a hug, you and they belong to the same community – you are not strangers after all.

5. Health insurers promise empathy, do not deliver, and continue to collect monopoly rents. The empathy gap widens. Health insurers maintain a firm grip on the market for empathy-related “behavioral health” services without actually providing any. This is the only candidate trend from last year that I am repeating, since it is still accurate but a work in progress – and, unfortunately, picking up speed, going in the wrong direction. The Affordable Health Care Act (“Obamacare”) – reportedly to be terminated with extreme prejudice as this piece is about to be posted – promised to equalize benefits for medical benefits such as annual physical health checkup (including $800 worth of blood work) with mental health services such as psychotherapy. At the risk of being cynical, I don’t know if the reader has tried to collect lately or services rendered. The war stories, pretexts for nonpayment, and simple violations of their own rules – e.g., timely response – by insurers continue to mount. One feels a certain dissatisfaction with the lack of solutions. What to do about it? In spite of claims to the contrary, the recommendation from insurers seems to be: “But your majesty, the people have no mental health benefits. Then let them pay cash! And then let them eat cake.”

4. Medical doctors “get it” – empathy is good for your health. Empathy gets traction as an evidence-based intervention. “Evidence-based everything” is the gold standard in medical and so-called “behavioral health” interventions; and that is as it should be (Jeremy Howick, (2011)). The “gold standard” of the “gold standard” is double-blind testing, which works especially well in the cases of drugs in which one can indeed “double-blind” the test so that neither the researcher nor the recipient knows who is getting what pill. While judgments based on clinical practice, tacit knowledge, and deep life experience will continue to have a role, these need to be qualified by the best available evidence. But here is the issue: There are some interventions such as penicillin and using a parachute when jumping out of an airplane that seem to limit or even defy the gold standard. It would be unethical not to give someone penicillin if they were infected with an infection serious enough to require such treatment, since it is a matter of historical accident that penicillin was invented prior to the “evidence based” paradigm shift. And, as regards using a parachute, that case is the reduction to absurdity of not using common sense as a criteria in deciding what counts as evidence. What is going on here? The answer: The effect size is so large that it outweights and overwhelms any hidden confounding factors and so rises to the level of evidence (without quotation marks) [Howick: 5, 11]. The :effect size” is a function of the the fact – the evidence – that there are so many examples and so much experience that penicillin works – that parachutes – work that the risk of one’s over-looking some other confounding variable is vanishingly small. It really was the penicillin, not (say) the effects of the alignmnet of the planets hidden behind the penicillin. Likewise, with empathy. The trend here is that research will emerge that puts the use of empathy in human relations as demonstrably so effective in the medical and behavioral health contexts in question that not to apply empathy would be like not prescribing antibiotics against a bacterial infection. Empathy has been effective in shifting the suffering and transforming the psychic pain throughout history. The criticism of empathy has usually been that it results in burnout, compassion fatigue. But penicillin, too, has to be properly dosed or the results will be unpredictable. Regarding empathy, see the discussion above about empathy not being an on-off switch but a rheostat that requires training to get just right. Examples of peer-reviewed publications exist in which empathy was shown to be effective (in comparison with less empathy) in correlating with favorable outcomes in diabetes, cholesterol, and the common cold (?!) and are cited in the bibliography (see M. Hojat et al, (2011), John M. Kelley, Helen Riess et al, (2014), David P. Rakel et al, (2009)). Expect this work to expand and gain traction in other areas such as psychiatry and cognitive behavioral therapy. In short, not to begin with empathy would be like jumping out of the airplane without a parachute or not providing penicillin when the infection was bacterial. Curiously enough, among medical doctors, psychiatrics are alleged to be “lagging adopters”; among psychologists, those specializing in cognitive behavioral therapy are – note that Arthur Ciaramicoli claims to have it both ways (in a book (2016) that I wish I had written).

3. The culture of empathy taps into the power of empathy. Empathy gets in touch with its own power and becomes self-aware as being powerful. This is (and would be) completely unpredictable. At least initially that looks like the culture of empathy partnering with assertiveness training, fair fighting, and being self-expressed. The culture of empathy gets traction in conflict resolution, building community, setting limits to the anti-empathic methods of bullies; and this trend gets the attention that it so richly deserves. The CultureOfEmpathy [one word] is the web site and brain child of Edwin Rutsch, whose has literally interviewed dozens of empathy scholars and researchers (including myself) and is one of the most inclusive people I have ever met. Here is the issue: in fighting off bullies how does one do so in such a way that one does not become a bully oneself? The recommendation is direct: empathy is about setting boundaries between self and other and crossing boundaries between self and other in a way that enhances mutual understanding and community. No one was ever required by empathy to be a door matt. Since empathy works best and seems to require that people relate as equals in the matter of their humanity, the relation between empathy and power has always been fraught. It requires work. When the power relations as too asymmetrical or when force (violence) is being used to coerce an outcome, then a level playing field has to be reestablished for empathy to get traction. Then the empathic thing to do is fight back – self-defense is its own justification. Simple as that (though, as usual, the devil is in the details). Bullying – and related forms of aggression are the contrary of empathy – crossing boundaries in ways that generate misunderstanding and the dehumanizing aspects of shame and humiliation. Set firm boundaries.

2. Empathy becomes known as reducing inflammation and restoring homeostatic equilibrium to the body according to evidence based research along with mindfulness (a form of meditation), Yoga, Tai Chi, sensory deprivation and certain naturally occurring steroids (Antoni MH, Lutgendorf SK, Blomberg B et al. (2011), David Black, Steve Cole, Michael Irwin et al, (2013), Michael R Irwin and Richard Olmstead, (2012)). Although an over-simplification, when the human body is attacked by bacteria, it mounts an inflammatory defense that sends macrophages to the site of the attack and causes “sick behavior” in the person. The infected person takes to bed, sleeps either too much or too little, has no appetite (or too much appetite), experiences low energy, possibly has a fever, including the “blahs,” body aches, and flu-like symptoms. This response has evolved over millions of years and is basically healthy as the body fights off the infection using its natural immune response. However, fast forward to modern times. This natural response did not imagine the stresses of modern life back when we were short proto-humanoids inhabiting the Serengeti plain and fending off large predators. Basically, the body responds in the same way to the chronic stress of modern life – the boss at work is a bully, the mortgage is over-due, the children are acting out, the spouse is having a midlife crisis – and the result is “sickness behavior” – many of the symptoms of which resemble clinical depression – but there is no infection. The inflammation become chronic and the body loses its sensitivity to naturally occurring anti-inflammatory hormones, which would ordinarily kick in to down regulate the inflammation after a few days. Peer reviewed papers demonstrate that interventions such as those indicated above reduce biological markers of inflammation and restore equilibrium. This is also a metaphor for when an angry [“inflamed”] person is listened to empathically, they [often] calm down and regain their equilibrium. The trend here is that empathy migrates onto the short list. Now for something completely different …

1. A definable market for empathy software and business services emerges. Virtual reality (VR) software meets and expands empathic understanding. A company named Psious [psious.com] has developed a diverse set of applications for virtual reality goggles to simulate situations that psychotherapy clients may find anxiety inspiring such as flying on a commercial jet, public speaking, shots (e.g., with needles) at doctor visits and many more (see my Blog post on Psious (http://tinyurl.com/jyuxedq)). Two other companies that are a software initiative relating to empathy include Affectiva [affective.com], which automates Paul Ekman’s facial action coding scheme (see my blog post (http://tinyurl.com/hymj3mj)), and Empathetics [empathetics.com], not yet reviewed. From admittedly incomplete reports, the engaging thing about Empathetics is that its value proposition is to train medical doctors in empathy using biofeedback under a program licensing intellectual property developed at Massachusetts General Hospital in Boston. In addition, this medical initiative is distinct from but related to two companies (Business Solver and Maru/VCR) which call out “empathy” explicitly as a key differentiator in what they offer their business clients. Business Solver is branding an empathy monitor for business success in a human resources platform and related services. This includes the disturbing data point that some 61% if business leaders see their firms as being empathic whereas only 24% of employees do. What to do about it constitutes the bulk of the engagement. Maru/VCR has a database based on the Vision Critical Research platform that enables its clients to build customer communities and get access to breakthrough innovations and insights in market research.

0. Businesses “get it” – empathy is good for business. Profit is a result of business operations, not “the why” that motivates commercial enterprise. And if profit shows up that way (as the “the why”), then you can be sure that, with the possible exception of commodities hedging, it is a caricature of business and a limiting factor. Business prospers or fails based on its value chain and commitment to delivering value for clients and consumers. However, some of the things that make people good at business make them relatively poor empathizers. Business leaders lose contact with what clients and consumers are experiencing as the leaders get entangled in solving legal issues, reacting to the competition, or implementing the technologies required to sustain operations. Yet empathy is on the critical path for serving customers, segmenting markets, positioning products (and substitutes), psyching out the competition [not exactly empathy but close enough?], building teams and being a leader who actually has followers. When the ontology of empathy exposes it as the foundation of community, then expanding empathy becomes nearly synonymous with expanding business. For example, building customer communities, building stakeholder communities, team building, are the basis for brand loyalty, employee commitment, and sustained or growing market share. Can revenue be far behind? Sometimes leaders don’t need more data, we need expanded empathy, though ultimately both are on the path to satisfied buyers, employees, and stakeholders. Specific firms that have emerged – albeit in the context of an early market – to address these aspects of empathy in business and are called out in trend #2 above.

[These ten top trends in empathy for 2017 should be read in connection with the score for those from last year (2016) [see http://tinyurl.com/gub7pew]. And, yes, I know that there are actually eleven this year – bonus!?]

Bibliography

Antoni MH, Lutgendorf SK, Blomberg B et al. (2011), Cognitive-Behavioral Stress Management Reverses Anxiety-Related Leukocyte Transcriptional Dynamics. Biological Psychiatry, 2011; 15: 366-372.

David Black, Steve Cole, Michael Irwin et al, (2013), Yogic meditation reverses NF-kB and IRF-related transcriptome dynamics in leukocytes of family dementia caregivers in a randomized controlled trail. Psychoneuroendocrinology, 2013 March 38(3): 348 – 355.

Arthur Ciaramicoli, (2016), The Stress Solution. New York: New World Library.

Jodi Halpern, (2013), “What is Clinical Empathy?” J Gen Intern Med 2003 Aug: 18(8): 670 – 674.

Hojat et al, (2011), Physicians empathy and clinical outcomes for diabetic patients, ACAD MED MAR; 86(3): 359 – 64: doi: 10.1097ACM.0b013e3182086fe1

Jeremy Howick, (2011). The Philosophy of Evidence-Based Medicine, Wiley-Blackwell, 2011.

Michael R Irwin and Richard Olmstead, (2012). Mitigating Cellular Inflammation in Older Adults: A Randomized Controlled Trial of Tai Chi Chih. American Journal of Geriatric Psychiatry. 2012 September; 20(9): 764 – 722.

John M. Kelley, Helen Riess et al, (2014), The Influence of the Patient-Clinician Relationship on Healthcare Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials, PLOS ONE [Public Library of Science], April 2014, Vol. 9, Issue 4.

Heinz Kohut, (1977). The Restoration of the Self. New York: International Universities Press.

David P. Rakel et al, (2009),”Practitioner Empathy and the Duration of the common Cold, Fam Med 41(7): 494 – 501.

Lou Agosta, (2015). A Rumor of Empathy: Resistance, Narrative, and Recovery. London: Routledge.

_________ (2014). A Rumor of Empathy: Rewriting Empathy in the Context of Philosophy. New York: Palgrave Pivot.

__________ (2010). Empathy in the Context of Philosophy. London: Palgrave Macmillan.

(c) Lou Agosta, PhD, and the Chicago Empathy Project