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Empathy is good for your health and well-being (The evidence)

Empathy is good for your health and well-being: Empathy is on a short list of stress reduction practices including meditation (mindfulness), Tai Chi, and Yoga. Receiving empathy in the form of a gracious and generous listening is like getting a spa treatment for the soul. But do not settle for metaphors.

For evidence-based research on empathy, empathy and stress reduction, and empathy training you may start by googling: Antoni et al. 2011; Ciaramicoli 2016; Del Canale et al 2012; Farrow et al. 2007; Irwin et al. 2012; Maes 1995, 1999; Pollack et al. 2002; Rakel et al. 2009; Segerstrom and Miller 2004; Slavich et al. 2013 [this list is not complete]. 

You do not have to buy the book, Empathy Lessons, to get the research, but if you would like more detail see especially Chapters Four and Six in Empathy Lessons (click here to get book from Amazon).

[Also included are chapters on the Top 30 Tips and Techniques for Expanding Empathy, Overcoming Resistance to Empathy, Empathy Breakdowns, Empathy as the New Love, Empathy versus Bullying, and more.] 

The healing powers of stress reduction are formidable. Expanding empathy reduces stress; and reducing stress expands empathy. A positive feedback loop is enacted. Expanding empathy expands well-being.  Here empathy is both the end and the means.

A substantial body of evidence-based science indicates that empathy is good for a person’s health. This is not “breaking news” and was not just published yesterday. We don’t need more data, we need to start applying it: we need expanded empathy.

Evidence-based research demonstrates the correlation between health care providers who deliver empathy to their patients and favorable healthcare

Well-being rides the wave of empathy

outcomes. What is especially interesting is that some of these evidence-based studies specifically exclude psychiatric disorders and include mainline medical outcomes such as reduced cholesterol, improved type 2 diabetes, and improvement in related “life style” disorders.

Generalizing on this research, a small set of practices such as receiving empathy, meditation (mindfulness), yogic meditation, and Tai Chi, promote well-being by reducing inflammation. These practices are not reducible to empathy (or vice versa), but they all share a common factor: reduced inflammation. These anti-inflammatory interventions have been shown to make a difference in controlled experiments, evidence-based research, and peer-reviewed publications.

Using empathy in relating to people is a lot like using a parachute if you jump out of an airplane or getting a shot of penicillin if one has a bacterial infection. The evidence is overwhelming that such a practice is appropriate and useful in the vast majority of cases. The accumulated mass of decades of experience also counts as evidence in a strict sense. Any so-called hidden or confounding variables will be “washed out” by the massive amount of evidence that parachutes and penicillin produce the desired main effect. 

Indeed it would be unethical to perform a double blind test of penicillin at this time, since if a person needed the drug and it were available it would be unethical not to give it to him. Yes, there are a few exceptions – some people are allergic to penicillin. But by far and in large, if you do not begin with empathy in relating to other people, you are headed for trouble.

Empathy is at the top of my list of stress reduction methods, but is not the only item on it. Empathy alongwith mindfulness (a form of meditation), Yoga, Tai Chi, spending time in a sensory deprivation tank (not otherwise discussed here), and certain naturally occurring steroids, need to be better known as interventions that reduce inflammation and restore homeostatic equilibrium to the body according to evidence based research.

Biology has got us humans in a bind, since the biology did not evolve at the same rate as our human social structures. When bacteria attack the human body, the body’s immune system mounts an inflammatory defense that sends macrophages to the site of the attack and causes “sickness 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 conserves its energy and fights off the infection using its natural immune response.

Now fast forward to modern times. This natural response did not envision the stresses of modern life back when we were short stature, proto-humanoids inhabiting the Serengeti Plain and defending ourselves against large predators. Basically, the body responds in the same way to the chronic stressors 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, just inflammation. 

The inflammation becomes 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 empathy reduce biological markers of inflammation and restore equilibrium. This is also a metaphor. When an angry—“inflamed”—person is listened to empathically—is given a “good listening” as I like to say—the person frequently calms down and regains his equilibrium. 

Empathy migrates onto the short list of inflammation reducing interventions. The compelling conclusion is that empathy is good for your well-being.

Bibliography, References, and Additional Reading

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

The case of Dr Know-it-all: Empathy gives us our humanity

You do not need a philosopher to tell you what empathy is. What then do you need? How about a folktale, a fairy tale, a narrative, a Märchen?

Rather than start with a definition of empathy, my proposal is to start by telling a couple of stories, in which empathy (and its breakdown) plays a crucial role. Both stories are anonymous folktales from the collection edited by the Brothers Jacob and Wilhelm Grimm. The distilled wisdom of the ages accumulated in traditional anonymous narratives will do nicely. Both stories include a significant amount of humor, underscoring that humor and empathy are closely related (on humor and creating a community see also Ted Cohen’s book Jokes (1999)). 

How so? In both humor and empathy one crosses the boundary between self and other while preserving that boundary. In both humor and empathy one builds a community, even if only of two people, by transiently, temporarily weakening the boundary between self and other, then reestablishing it. In the case of humor, the boundary crossing is loaded with an element of aggression, violation of community standards, or sexuality—the source of the tension that is released in laughter—whereas with empathy proper the boundary is traversed with a respectful acknowledgement and communication of mutual humanity, whether as high spirits, suffering, or community expanding affinity and affection. 

I hasten to add that while the philosopher does not necessarily have a better mastery of empathy than any parent, teacher, doctor, nurse, first responder, therapist, flight attendant, business person with customers, professional with clients, and so on, the philosopher is useful—and at times indispensable—in clarifying distinctions, analyzing concepts, and disentangling misunderstandings about empathy. 

Thus, the fairy tale (Märchen) of Doctor Know-it-all is a perfect place to start a philosophical inquiry into 

Dr Know-it-all pointing in his picture book.
Image credit:
John Thomas Smith / Wellcome V0020405.jpg (Creative Commons Attribution 4.0)

empathy. An uneducated, illiterate, hungry peasant named “Herr Crabb” delivers a load of wood to a doctor.[1] Crabb observes the doctor eating a sumptuous lunch; and Crabb asks him how he (Crabb) might improve his station by becoming a doctor. The doctor tells him to sell his ox and cart and buy an ABC book, buy a fine suit of clothes, and put a sign in front of his hovel that says “Dr Know-it-All.” (Note that the English “Know-it-all” is a translation of the German “allwissend,” which is also the standard translation of the divine attribute “omniscient.”) 

Scene two: thieves steal the treasure from the rich noble lord of the manor on the hill. Dr Know-it-all is called in to consult on the case, solve the crime, and recover the treasure. 

Now getting a good meal is a recurring theme in this story, and Crabb insists on beginning the consulting engagement by coming to dinner. The nobleman, Crabb, and Crabb’s wife, sit down to a fine three-course meal served by the nobleman’s servants. The first servant brings in the first covered dish, and Crabb says, “That is the first.” Likewise with the other two courses: “That is the second” and “That is the third.” 

Now the servants are starting to get worried, because, as is sometimes the case with such crimes, the theft was an inside job, and the servants were ones who did it. “This Crabb guy seems to be onto us,” say the servants to one another between courses. Meanwhile, the nobleman challenges Crabb to say what is under the third covered dish, testing Crabb’s credential as Dr Know-it-all. Of course, Crabb has no idea, and in frustration, he gestures as if to slap himself in the head and says his own name “Oh, Crabb!” Right! The meal is of crab cakes. 

Now the servants are really worried—this guy really does know-it-all. The servants create a pretext to take Crabb aside and confess their theft to him, telling him that they will tell him where the treasure is hidden and even give him an extra fee in addition if only he does not identify them as the culprits. An agreement is reached. Crabb shows the lord where his treasure is hidden, collects ample fees from all sides, does not betray the servants, who, after all, are fellow suffers of social injustice like Crabb himself, resulting in the latter’s becoming rich and famous. By the end of the story, living into a self-fulfilling prophecy, as his performance catches up with his reputation, Crabb does indeed become Dr Know-it-all. 

This is the perfect narrative with which to begin an engagement with a group of philosophers and thinkers who propose answers about the core issues in the study of empathy. One could let one’s scholarly egoism result in a narcissistic injury; but a better response would be self-depreciating humor. The occupational hazard of over-intellectualization looms large whenever philosophers sharpen the cutting edge of their analytic tools. And there is nothing wrong with that as such, but the approach does have its risks and constraints. 

Philosophically speaking, the peasant Herr Crabb, Dr Know-it-all, is the personification of our Socratic ignorance. Socrates’ fame was assured when the Oracle at Delphi—a kind of latter day Wikileaks—proclaimed him as the wisest person in the world, because he acknowledged (i.e., knew) that he did not know.  

Socrates was a commitment to pure inquiry; and that has remained a valid approach to philosophizing in such thinkers as Wittgenstein, Nietzsche, Hume in his skeptical phase, and the Kant of the transcendental dialectic. Nevertheless, the commitment of this review is to provide both questions and answers about empathy, in a Socratic spirit, even if those answers then become the basis for further debate, argument, and inquiry.

Meanwhile, the story of Dr Know-it-all is meant to be told with a totally strait face. Notwithstanding the relatively primitive state of medicine in 1804, one still had to go to the university, even if only the better to understand how the planets influenced disease as in influenza. Nevertheless, it is a depreciating and mocking guidance that the doctor gives in the opening scene to the peasant to sell his ox and get a sign that says “Dr Know-it-all.” The peasant follows the advice.

This is the first empathic encounter in the story. Crabb brings the mind of a beginner to the relationship. In a “once upon a time” moment, this is Crabb’s Socratic ignorance, though of course the story does not use such language. Crabb often seems to be thinking about his next meal, and, in that limited sense, he has a desire—to be well fed like the ruling class. However, in a deeper sense, Crabb is without desire and without memory. That is empathy lesson number one in this story: bring the innocence of a beginner’s mind to one’s relationships. That is the readiness assessment for empathy: be open to possibility, no matter how unlikely or counter-intuitive.

Next, in a series of seeming coincidences, Crabb makes simple, ambiguous statements such as: “That is the first one,” “That is the second one,” and so on. These statements become ambiguous Gestalt figures like the famous duck-rabbit, which spontaneously reverses between one figure and another, depending on one’s perspective. Is it a duck or is it a rabbit? (For an image of the duck-rabbit see Wittgenstein 1951: 194 (or Google it).) Likewise, in the folktale, does the statement refer to the dish of food being served or to the answer to the discussion question, who is the thief? Yes.

This is top-down cognitive empathy; take a walk in the other person’s shoes. The servants employ top down empathy—imagining that they are the consultant(s) brought in to solve the mystery of the missing treasure, taking Crabb’s perspective, putting themselves in his shoes. But their empathy misfires. It doesn’t work. Instead of taking a walk with the other person’s personality—Crabb is after all a poor peasant like the servants (but they do not necessarily know that)—they project their own issue onto Crabb.

Their issue? The servants know who are the thieves and they have one thought too many about it. They have guilty consciences. Though they are hungry peasants in their own way, they identify with the values of the dominant class. When authentic human relatedness misfires, then one gets the psychological mechanism of projection. The thieves guiltily project their knowledge onto Crabb. They imagine that Crabb knows their secret. Here the servants’ empathy is in breakdown. The readers learn about empathy by means of its misfiring, breaking down, going astray, and failing. 

Taking a step back, the fundamental empathic moment is so simple as to be hidden in plain view. Crabb’s empathy tells him what the servants are experiencing. Fear. They are afraid. If Crabb identifies them as the thieves, they will be hanged. The servants actually say that to Crabb in the story. 

Note this is a world circa 1804 in Central Europe, in which there is a different set of rules for judging servants and noblemen. When a nobleman steals, it is called rent, taxation, or user fees. When the servants steal, it is a hanging offense. Theft remains a transgression, so the treasure must be returned. But when the hungry steal to eat, it is arguably a much less serious offense if not an actual entitlement. “Cast not the first stone: go—and sin no more.”

So the story also belongs to a type in which the servant outwits the master, a type of which The Marriage of Figaro is perhaps the most famous example. (See also the narrative approach of Jerzy Kosiński’s Being There, a major motion picture that features Peter Sellers as a naive gardener educated only by watching TV.) In our narrative, integrity is restored at multiple levels. The treasure is returned, the peasant Crabb and his wife acquire the means to eat well going forward, and the servants escape an unfair punishment.

This highly subversive message must be wrappered in humor, so as not to so threaten the prevailing social hierarchy or social injustice of rigid class distinctions with violent revolution. Getting the message out overrides transforming the social order, a perhaps unrealistic expectation in the listening of the folk audience. Crabb’s empathy tells him what the servants are experiencing; his compassion tells him what to do about it—not identify the servants as the perpetrators. I do so like a happy ending, rare though those be.

The case of the young man lacking empathy

The second fairy tale is a kind of thought experiment, a condition contrary to fact. What would be the case if someone completely lacked the capacity for empathy—and how would one acquire such a capacity? 

“The story of the youth who set forth to learn fear” is about a young man who is such a simpleton that he does not even experience fear.[2] It is a long and intricate story. I simplify. The folktale is a ghost story. In the story, as people are telling ghost stories, they say “it made me shudder”—a visceral sensation of “goose bumps” in German the onomatopoeic “grüseln.” This simpleton says: “I wish I knew what that was—shuddering. It sounds interesting, maybe I could make a career out of it.” His poor father is now in despair, thinking, “What am I going to do with this one?” Being charitable, we might say nothing is wrong with this young man, the protagonist in the story, but there is definitely something missing. 

The father is agreeable. He apprentices the youth out to the local sexton to teach him fear. The sexton tries to scare him by dressing up in a sheet as a ghost at midnight, but the sexton breaks his leg when the youth is not scared and fights back. Thus, the youth is exiled, going on an educational journey into the world to learn visceral fear—shuddering. Having no idea what fear is, he volunteers to spend three nights in the haunted castle, from which no visitor has ever, ever returned alive. 

The youth is a simpleton, but one might say, no fool. He takes with him, a knife, a turning lathe with vice grip, and a fire, the three things one is likely to need in case of an emergency. The first night he is confronted by dogs and cats with red-hot chains—the beasts of hell. He uses the knife to dispatch them. The second night he is confronted by fragmentation and dismemberment. Disconnected arms, legs, and heads fall down the chimney, and the zombie-like, quasi-men propose a game of bowling. But the heads, being elliptical, do not roll well. Fearless as usual, he uses the turning lathe to make well-rounded bowling balls, and all enjoy the game. 

All the while, the youth is obsessively complaining: “I wish I knew what was shuddering. I wish I could shudder.” On the third night, pallbearers bring in a coffin with the dead body of his cousin. In a scene that authentically arouses the reader’s shuddering, the youth gets into bed with the corpse to warm it up. He succeeds. The corpse comes alive, and, not behaving in a friendly way, threatens to strangle him. But the youth is as strong as he is simple. He overpowers it. Then the old spirit appears, the old man in a long, white beard appears. They struggle. Though consistently depicted as a simpleton, the youth has a breakthrough in his intelligence. Instead of using the physical strength that has served him up until now, the youth cleverly catches the old one’s beard in the vice grip; and he thrashes him until the latter surrenders. The youth wins, and the old spirit shows the youth the treasure hard-to-attain, one third of which goes to the king, one third to the poor, and he gets to keep one third. He also gets the hand of the princess in marriage. 

However, the youth has still not learned to shudder. Fear not! On the morning after his wedding night, the chambermaid hears of his persisting complaint from his wife. The chambermaid asserts that the problem is easily fixed. She takes the decorative bowl of gold fish in cold water and throws it on him, as he lies in bed still asleep. The little fish flop around. He awakes. He gets it: Goose bumps. “At last I understand shuddering!” 

Fear is perhaps the most primordial and basic emotion. The flight/fight response is a function of the basic biological response of the organism to situations that threaten the integrity of our creaturely existence. The amygdala is activated, adrenalin (norepinephrine) pours into the blood stream, a visceral state of arousal of the body is mobilized that includes increased heart beat, rapid pulse, enhanced startle response, hair standing on end, and a withdrawal of blood from the surface of the skin that results in “goose bumps.” It is a thought experiment similar to riding on a beam of light, going light speed, to imagine a person who does not experience fear in the face of the fearful. Such a thought experiment might not require as much equipment as riding on a beam of light, but, in any case, it is just as rare.

However, no sooner did I pen these words, then I came across a case, in which an individual was identified who did not experience what we would conventionally call “fear.”[3]

As usual, the real world is more complex than one’s thought experiments. It turns out that the individual in question (SM-046) does experience fear in certain situations, but much less so than most “normal” people, so-called “neurotypicals.” The subjective experience of suffocation upon inhaling carbon dioxide in a controlled setting did indeed arouse panic (fear) in her. Panic, fear—close enough? 

A further analysis is required to determine what parts of the interpersonal world—personal space, trust of other people, social skills—are impacted (and by how much) by damage to the amygdala. In no sense is SM “less human”; but there is something missing from her empathic repertoire. This missing capacity for fear seems to diminish her social skills and ability to relate. She does not experience vulnerability in situations that are dangerous or risky when most other people would do so, which could be problematic in avoiding injury due to everyday hazards. In that sense, she may actually resemble the simpleton-hero in the folktale, who is so impervious to what others would experience as fearsome or scary that he naively acts courageously and triumphs in the face of long odds against success. 

SM does not spend three nights in a haunted castle, so her experiences cannot be compared to those of the protagonist in the folktale. Yet, in any case, physiological fear becomes a symbol of empathic, struggling humanity and its quest for self-knowledge. 

The hero-simpleton tries so hard to experience fear that he is effectively defended against his own emotional life. It is ironic that the simpleton is guilty of over-intellectualizing, usually an occupational hazard of philosophers. The youth imagines that someone can tell him in a form of words what is fear as shuddering, visceral goose bumps.

This lack of feeling points to an underlying deficiency in the capability to empathize. Today we might say that this youth is “on the spectrum”—the autistic spectrum—in that he is emotionally isolated and struggles with the reciprocal communication of affect. In short, the youth has an empathy deficit. 

As in all classic folktales, the youth has to go forth on a journey of exploration of both the world and of himself. He becomes a traveller on the road of life, which is the narrative of his emotional misadventures to recover his empathy—and his affective life—and become a complete human being. 

This must be emphasized. The recovery of feelings is the recovery of his humanity. The youth’s journey into the world can be described in many way; but I urge that it is a journey to recover his humanity in the form of experiencing the full range of human emotions in himself and others, the basic paradigm of which is fear and the basic capacity for which is empathy. 

The youth’s recovery of his ability to shudder, his emotions, and his empathy unfold as a running joke. After each increasingly creepy encounter with something most people describe as fearful, he complains, “I wish I could shudder.” This is repeated a dozen times just to make sure the audience gets the point. 

As noted, the folktale, the Märchen, is a ghost story, to be told on dark October nights around Halloween. The empathy of the audience is aroused by increasingly gruesome images of dismembered bodies. The audience definitely shudders, getting the creeps, but not the protagonist. Meanwhile, the audience is taken through the three stages of overcoming over-intellectualization, overcoming resistance to empathy, and recovering his full humanity in a rich emotional life. 

We retell the story, emphasizing the empathic and emotional aspects.

In the first stage of recovering one’s empathy, one must descend into the hell of one’s own lack of integrity and inauthenticities to regain access to and expand one’s humanity. The dogs and cats with red-hot collars and chains are images from hell. The assignment? One has to descend into the hell of one’s empathy breakdowns, misfirings, inauthenticities, blind spots, self-deceptions, and failures, in order to break through the refiner’s fire of self-inquiry with renewed commitment to empathy, relatedness, and community. One must clean up one’s own act, restoring integrity where it is missing in one’s own actions before carrying empathy forward to others; otherwise the attempt to recover and expand empathy is like putting butter cream frosting on a mud pie. It doesn’t work. 

However, even if one cleans up one’s act, acknowledges one’s blind spots and inauthenticities, and commits to empathic relatedness, the risks of failure are significant. That one is committed to relating empathically can leave one vulnerable to the risks of burn out, compassion fatigue, or emotional fragmentation. 

The second night in the castle is filled with images of dismemberment. The youth’s self is vulnerable to fragmentation.

Images of fragmentation: Illustration by Otto Ubbelohde to the fairy tale The Story of the Youth Who Went Forth to Learn What Fear Was (public domain)

None of the dismembered body parts matter to the youth in the way they would matter to an affectively, emotionally whole person. Ghouls and living corpses surround him, but, ontologically speaking, he is the one who is an emotional zombie. Without empathy, the individual is unrelated and isolated—emotionally dead. 

The guidance of the folktale is to be persistent. Set limits with courage and humor. The youth rounds the egg-shaped heads in his turning lathe, the better to play at bowling with the now-rounded heads and the dismembered legs as pins. It works. The youth’s good sense of humor and fellow feeling serve him well in relating empathically to what would otherwise be a harrowing encounter with emotional fragmentation. The integrity of the self is sustained and expanded. Everyone has fun, and the ghouls depart with the body parts at the end of the game. 

On the third night, in a scene that is really quite creepy (and in which the audience, if not the youth, learns shuddering), the coffin of his dead cousin is delivered. The youth gets into bed with the cold corpse of his cousin, charitable lad that he is, in order to warm it up—and, even more uncanny, succeeds in awaking it! 

The emotions are not pleasant that have long lain dormant and “dead” and are brought back to life. The person is at risk of choking on them due to their intensity. Anger and narcissistic rage are the order of the day. The awakened corpse tries to strangle the youth, but the youth overpowers it using physical strength. 

The old spirit, the old man with the long, white beard, shows up for the final struggle. The simpleton youth has a breakthrough in his intelligence. He cleverly catches the old man’s beard in his vice grip and starts wailing on him. 

As noted, the old spirit yields, and, delivers the treasure-hard-to-attain—the hidden gold and the hand of the princess in marriage. But, though the missing empathy ought to have been recovered by now, for rhetorical reasons, the story continues in describing the youth as still complaining about not yet having learned how to shudder. The climax is complete; the dénouement is at hand. 

The individual cannot recover his empathy—or his humanity—on his own. The other is required. A relationship with the other is indispensable. The youth has raised the curse from the haunted castle and won the hand of the fair princess, and he stops trying to shudder. That is key: he finally stops trying. He stops thinking about it—over-intellectualizing. He has a passive overcoming, letting matters be. Then the other teaches him shuddering at the first available opportunity.

The wife’s chambermaid teaches him shuddering in a pun that cleverly masks the physical and sexual innuendo, throwing the cold water and flopping gold fish, causing goose bumps, a visceral experience hard to put into words.

Now the youth is finally a whole, complete human being. The absence of the ability to shudder becomes a symbol for the absence of empathy, the ability to communicate affectively. This youth had no feelings—not even fear. Thus, in this story, in contrast to Dr Know-it-all, we are dealing with bottom up, affective empathy. The absence of the emotion of fear is an extreme paradigm, a negative ideal case, of an absence of the underlying, bottom up capacity for empathy. 

Taking the interpretation up a level, the youth is ontologically cut off from the community, who share emotions empathically. Life is disclosed and matters to members of the community based on their affects and emotions. 

In the narrative, empathy becomes conspicuous by its absence. This absence of empathy is equivalent to the absence of the individual’s humanity. It is only after the youth undertakes a kind of training program in recovering his empathy—and his humanity—by descending into the hell of his own blind spots and inauthenticities that he is able to experience the full range of human emotions—and, ending with a laugh, shuddering.

With the assimilation of these two pre-ontological documents, we turn to the less humorous but equally significant task of defining different methods and approaches to understanding and applying empathy. The philosophy of empathy engages with diverse philosophical methods that provide access to it. 

[1] Anonymous. (1804). Dr Know-it-all, The Complete Grimm’s Fairy Tales, Jacob Grimm, Wilhelm Grimm, eds., trs. Margaret Hunt and James Stern. New York: Pantheon Books, 1972/1994: 456–457; translation modified.

[2] Anonymous. (1804). “The story of the youth who set forth to learn fear,” The Complete Grimm’s Fairy Tales, Jacob Grimm, Wilhelm Grimm, eds., trs. Margaret Hunt and James Stern. New York: Pantheon Books, 1972/1994: 29–38; translation modified. This is a complete reworking of Lou Agosta. (1980). The recovery of feelings in a folktale, Journal of Religion and Health, Vol. 19, No. 4, Winter 1980: 287–297.

[3] See: R. Adolphs, D. Tranel, H. Damasio, A. Damasio. (1994). Impaired recognition of emotion in facial expressions following bilateral damage to the human amygdala, Nature. 372 (6507): 669–72. DOI: 10.1038/372669a0. 

Image credit: Dr Know-it-all: Creative Commons: An old man in a top hat sitting in a wooden cart with wheels Wellcome V0020405.jpg 

Image Credit: Otto Ubbelohde (artist) – Images of fragmentation: Märchen von einem, der auszog das Fürchten zu lernen (Public Domain)

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

The trouble with the trouble with empathy (this is not a typo)

Empathy flourishes in a space of acceptance and tolerance. But acceptance and tolerance have their dark side, too. People can be intolerant and unaccepting. Be accepting of what? Be accepting of intolerance? Be tolerant of intolerance? Yes, be tolerant, but set limits. But how to do that given that we may still have free speech in the USA, but many people have just stopped listening

“The Trouble With Empathy” is an article by Molly Worthen published in The New York Times on September 04, 2020. The author gets many things just right in an impressive engagement with the complexities of empathy, but in other areas, including the citations of certain academics, I have an alternative point of view. Hence, the trouble with the trouble with empathy is not a typo. The reply is summarized in the diagram (note that it is labeled “Figure 2,” but it is the only diagram – page down, please). For those interested in more detail, read on. 

Babies are not born knowing the names of the color spectrum. Children are taught these names and how to use them in (pre)Kindergarten; likewise, with the names of the emotions such as sadness, fear, anger, and high spirits. However, there is a lot more to empathy than naming one’s feelings and getting in touch with our mammalian ability to resonate with one another in empathic receptivity and understanding. 

As an adult, the fact that you failed to be empathic does not mean that your commitment to empathy is any less strong; just that you did not succeed this time; and you need to keep trying. Stay the course. It takes practice. The practice is precisely the empathy training. 

Often understanding emerges out of misunderstanding. My description of the other person’s experience as they lived it is clumsy and creates a misunderstanding. But when the misunderstanding is clarified and cleaned up, then empathy occurs. Thus, break throughs in empathy emerge out of breakdowns. So whenever a breakdown in empathy shows up, do not be discouraged, but rather be glad, for a break through is near.

Empathy breakdowns lead to breakthroughs

Evidence from the past rarely demonstrates what innovations are possible in the future. Just because people are not born with wings does not mean people cannot fly. If the Wright Brothers had accepted the evidence, we would all still be taking the train. I hasten to add there is nothing wrong with taking the train. People can be intolerant, and I too am people. Work on oneself is constantly needed. 

I open my mouth to be empathic and respond empathically—but instead of an empathic response, out jumps a frog: “I feel your pain.” What a fake! If I really felt your pain, then I would say “Ouch!” not “I feel your pain.” I find that I do frequently say “Ouch!” Or just shake my head and provide acknowledgement and recognition: “You’ve really been dealing with some tough stuff.” “Sounds like use could use some empathy.” 

The point is not to devalue the attempted empathic response, clumsy though it may be. The point is to acknowledge that the lazy person expands his empathy in a practice filled with examples of not getting it quite right. If empathy were a sport, it would be filled with strikeouts, fumbles, off sides, failures, and incomplete plays. There would even perhaps be examples of “unsportsman-like conduct.” 

Each of the four phases of empathy has characteristic breakdowns. This is not new news. The news is that if engaged with a rigorous and critical empathy, these breakdowns readily become breakthroughs in empathy. 

Breakthroughs in empathy arise from working through the breakdowns of empathy. The Big Four breakdowns of empathy are noted: emotional contagion, conformity, projection, and getting lost in translation. These are not the only breakdowns of empathy, which are many and diverse, but these are the most frequent ones. 

In the example of emotional contagion, one anxious person is telling the other person about all the reasons in the world that he is feeling out of sorts. Pretty soon, the person who is listening is starting to feel anxious too. The person’s receptivity—openness and availability—to the other individual’s emotions is working overtime and his empathic receptivity misfires, becoming: Emotional contagion. Emotional infection strikes again! 

Often it is not so obvious. Often people are caught up in the emotion of the moment. The emotion itself is so powerful that it just sweeps over everyone present like a tidal wave—an emotional tsunami. The person is flooded—emotionally.

If the listener realizes that listening to anxiety-inspiring stories causes his own anxiety to spike, then that is already going beyond emotional contagion and the start of an empathic processing of the emotion. 

If one stops in the analysis of empathy with the mere communication of feelings, then empathy collapses into emotional contagion. Empathic receptivity breaks down into emotional contagion, suggestibility, being over-stimulated by the inbound flood of the other person’s strong feelings.

Emotional contagion—basically the communication of emotions, feelings, affects, and experiences—can be redescribed as input to further down stream empathic processing. Then emotional contagion (communicability of affect) gets “normalized” and can very well make a contribution to empathic understanding.

Overcoming the breakdown of empathy into emotional contagion results in the breakthrough to vicarious experience. A vicarious experience is what a person has in going to the theatre, the movies, or a single-person player video game. I experience the fears and hopes of the character in the film, but I do so vicariously. Theatre, film, and the novel were “virtual reality” (VR) long before computers, special VR goggles, and social networking were invented.  

Vicarious experience is not empathy. It is input to the process of empathy. Vicarious experience is the grain of truth in the fake-sounding empathy meme, “I feel your pain.” I feel your pain—vicariously. I experience an after-image of your pain—like the visual after-image of the American flag that results from starring at a vivid depiction of the off-color image of the stars and stripes. I repeat: we gat an after-image of another person’s feelings and emotions. 

I am amazed that no one has as yet explicitly pointed out that we get after-images of other people’s feelings when we are exposed to those feelings for a sustained duration. A vicarious experience of emotion differs from emotional contagion in that one explicitly recognizes and knows that the other person is the source of the emotion. 

You feel anxious or sad or high spirits, because you are with another person who is having such an experience. You “pick it up” from him. You can then process the vicarious experience, unpacking it for what is so and what is possible in the relationship. This returns empathy to the positive path of empathic understanding, enabling a breakthrough in “getting” what the other person is experiencing. Then you can contribute to the other person regulating and mastering the experience by being there for him and responding with soothing words and acknowledgement of the situation.

The next breakdown of empathy is settling for conformity instead of striving for possibility. We might also say: settling for agreement instead of striving for possibility. 

People live and flourish in possibilities. Empathic understanding breaks down as “no possibility,” “stuckness,” and the suffering of “no exit” (the definition of Hell in a famous play of the same name by Jean Paul Sartre). You follow the crowd in responding to the other person; you do what “one does”; you validate feelings and attitudes according to what “they say”; you conform and express agreement; and, with apologies to Henry David Thoreau, you live the life of quiet desperation of the “modern mass of men.” 

When someone is stuck, experiencing shame, guilt, rage, upset, emotional disequilibrium, and so on, the person is fooling himself—has a blind spot—about what is possible. This does not mean that it is easy to be in the person’s situation or for the person to see what is missing. Far from it. We live in possibilities that we allow to define our constraints and limitations—for example, see the example of the friend who was married and divorced three times. This expresses a strong commitment to marriage, though empathy and husbanding skills are seemingly limited. 

If you acknowledge that the things that get in the way of your relatedness are the very rules you make up about what is possible in your relationships, then you get the freedom to relate to the rules and possibilities precisely as possibilities, not absolute “shoulds.” You stop “shoulding” on yourself. This brings us to the next break down—the break down in empathic interpretation. 

Taking a walk in the other person’s shoes—the folk definition of empathy—breaks down if you take that walk using an inaccurate shoe size. You then know where your shoe pinches, not hers. This is also called “projection.” The recommendation? 

Take back the projections of your own inner conflicts onto other people. Take back your projections. Own them. You get your power back along with your projections. Stop making up meaning about what is going on with the other person; or, since you probably cannot stop making up meaning, at least distinguish the meaning—split it off, quarantine it, take distance from it, so that its influence is limited. 

Having worked through your vicarious experiences, worked through possibilities for overcoming conformity and stuckness, and taken back your projections, you are ready to engage in communicating to the other person your sense of the other individual’s experience. You are going to try to say to the other what you got from what they told you, describing back to the other your sense of their experience. And what happens? Sometimes it works; sometimes you “get it” and the other “gets” that you “get it”; but other times the description gets “lost in translation.” 

This breakdown of empathic responsiveness occurs within language. You fail to express yourself satisfactorily. I believed that I empathized perfectly with the other person’s struggle, but my description of her experience failed significantly to communicate to the other person what I got from listening to her. 

My empathy remains a tree in the forest that falls without anyone being there. My empathy remains silent, inarticulate, and uncommunicative. I get credit for a nice empathic try; but the relatedness between the persons is not an empathic one. If the other person is willing, then go back to the start and try again. Iterate. Learn from one’s mistakes and incomplete gestures. 

The fact that you failed does not mean that your commitment to empathy is any less strong; just that you did not succeed this time; and you need to keep trying. Stay the course. It takes practice. The practice is precisely the empathy training. 

Often understanding emerges out of misunderstanding. My description of the other person’s experience as they lived it is clumsy and creates a misunderstanding. But when the misunderstanding is clarified and cleaned up, then empathy occurs. As that notorious bad boy of a certain 18th century enlightenment, Voltaire, is supposed to have said: Let not perfection be the enemy of the good. Thus, break throughs in empathy emerge out of breakdowns. So whenever a breakdown in empathy shows up, do not be discouraged, but rather be glad, for a break through is near.

Knowing Professor Worthen’s [the author of the NYT article that provoked this reply] interest in religious studies, I conclude with a reflection on empathy and the Good Samaritan. The Parable of the Good Samaritan speaks volumes (Luke 10: 25–37). The first two people, who passed by the survivor by crossing the road, experienced empathic distress. They were prevented from helping out by a breakdown of their empathic receptivity. They were overwhelmed by the suffering and crossed the road. In contrast, the Good Samaritan had a vicarious experience of the suffering. His empathic receptivity gave him access to the survivor’s pain. His empathy told him what the other person was experiencing and his compassion told him what to do about it. 

To get Lou’s light-hearted look at the topic, Empathy: A Lazy Person’s Guide or one of his peer-reviewed publications see: Lou Agosta’s publications: https://tinyurl.com/y8mof57f

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

Empathy and Hermeneutics

Empathy has been given a bad rap in hermeneutic circles by being degraded to a psychological mechanism whereas empathy is rather a way of being in relatedness to individuals and community. Key term: being in relatedness. (For those who may not be tuned into “hermeneutic circles” the short definition is: theory of interpretation. When we open our mouths and speak, a lot of what comes out is interpretation.)

The power of empathy – like that of hermeneutics at large – occurs in cleaning up misunderstandings, breakdowns, and miscommunications. A single diagram on p 35 of Empathy: A Lazy Person’s Guide says it all, reproduced here for your convenience.


Enter the hermeneutic circle of empathy and create a breakthrough – success – in relatedness out of the breakdown(s). The empathy lesson is that, when handled with empathy, breakdowns often lead to breakthroughs.

If empathic relatedness misfires in emotional contagion, conformity, projections, or getting lost in translation, then one approach is to abandon empathy and become angry, resigned and cynical. An alternative and better approach would be to expand empathic receptivity, empathic understanding, empathic interpretation, and empathic responsiveness.

For example, if one is experiencing emotional contagion in relating to another person, then one can respond with what I call the favorite indoor sport of academics – over-intellectualization. Go into your head. Nothing wrong with that as such, but it does not expand empathy. A different approach is to take the vicarious experience – the feeling of the feeling of the other – that has been communicated in emotional contagion like an after image of the other’s experience. Use this vicarious experience to be receptive to the other’s experience. Use it as input to understanding what the other person is experiencing.

In another example, empathy can break down in conformity – pressure to conform to social standards or practices that actually empty one’s experience of satisfaction and even be destructive of community. One follows the crowd. One does what “they say.” With apologies to Henry David Thoreau, one leads the life of quiet desperation of the modern mass of men. Instead of promoting conformity – or even a superficial nonconformity – one can use empathic understanding and ask: Who is this other person as a possibility?

If you look at the rules you make up about what is possible in your relationships, then you get the freedom to relate to the rules precisely as possibilities, not absolute “shoulds.” You stop “shoulding” on yourself. You have a breakthrough in what is possible through empathic understanding. Satisfaction in relatedness expands. Relationships become satisfying in ways not previously envisioned. Empathy grows and life is enriched.

So far, this is “bottom up” – so-called affective empathy. Yes, even the empathic understanding is understanding of the possibilities in which we live. Strictly speaking, that is not affective, but neither is it cognitive. It is precognitive. However, when I truly get stuck in trying to understand the other individual and her situation, then I make use of “top down” empathy. This is the folk aspect of empathy: I take a walk in their shoes. I think about – try to grasp in fundamental thinking – what it may be like being in their predicament. I “jump start” my relatedness through interpretation.

Taking a walk in the other person’s shoes—the folk definition of empathy—breaks down if you take that walk using an inaccurate shoe size. You then know where your shoe pinches, not hers. This is also called “projection.” The recommendation?

Take back the projections of your own inner conflicts onto other people. Take back your projections. Own them. You get your power back along with your projections. Stop making up meaning about what is going on with the other person; or, since you probably cannot stop making up meaning, at least distinguish the meaning—split it off, quarantine it, take distance from it, so that its influence is limited.

Having worked through your vicarious experiences, worked through possibilities for overcoming conformity and stuckness, and taken back your projections, you are ready to engage in communicating to the other person your sense of the other individual’s experience. You are going to try to say to the other what you got from what they told you, describing back to the other your sense of their experience. And what happens? Sometimes it works; sometimes you “get it” and the other “gets” that you “get it”; but other times the description gets “lost in translation.”

This breakdown of empathic responsiveness occurs within language. You fail to express yourself satisfactorily. I believed that I empathized perfectly with the other person’s struggle, but my description of her experience failed significantly to communicate to the other person what I got from listening to her.

Without empathic responsiveness, my empathy remains a tree in the forest that falls without anyone being there. My empathy remains silent, inarticulate, and uncommunicative. I get credit for a nice empathic try; but the relatedness between the persons is not an empathic one. If the other person is willing, then go back to the start and try again. Iterate. Learn from one’s mistakes and incomplete gestures.

Many additional examples of empathy successes and empathy breakdowns are available in the light-hearted look at the subject: Empathy: A Lazy Person’s Guide, including some twenty-eight full color illustrations by that celebrated artist Alex Zonis. If you only read one non-academic book on empathy, this is the one. Check it out here: Empathy: A Lazy Person’s Guide.

(c) Lou Agosta and the Chicago Empathy Project

See Lou Agosta’s other books on empathy – academic and popular here: https://tinyurl.com/y8mof57f