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Left stranded when the music stops: What to do about the shortage of talk therapists actually available
An article in the Washington Post by Lenny Bernstein: “This is why it is so hard to find mental health counseling right now” (March 6, 2022) struck a chord with many readers.
The article begins by describing an individual in the Los Angeles area who said she was willing to pay hundreds of dollars per session and called some twenty-five therapists in the area but was unable to find an opening. The person willingly shared her name in the article. Be careful not to blame the survivor or victim – the report is credible – and she maintained a spreadsheet!
One of the main points of the article is that after several years of pandemic stress prospective clients and patients are at the end of their emotional rope and providers (therapists) are over-scheduled and burned out too. No availability.
The problem is systemic. There seems to be no bottom in sight as regards the opportunistic behavior of insurance companies, the lack of behavioral health resources, and the suffering of potential patients. The WP article goes on to document other potential patients with significantly less resources who cannot even get on a wait list. The article documents third party insurance payers whose “in network” providers are unwilling to see prospective patients due to thin
reimbursements from the payer – once again, the individual is unable to get on a wait list or get help urgently needed; supply side shortages are over the top in the programs that train psychiatrists, a specialty in medicine. Psychiatrists, when available, are most often interested in lucrative fifteen-minute medication management sessions, but unless they are “old school” and were psychoanalytically trained in the “way back,” they are rarely available for conversations. This all adds up to a crisis in the availability of behavioral health services.
This leads to my punch line. Often time depression, anxiety and emotional upset are accompanied by negative self-talk, shaky or low self-esteem. One reaches out and asks for help but instead has an experience of powerlessness that is hard to distinguish from the original emotional disequilibrium. The conversation spins in a tight circle – “maybe I deserve it – no I don’t – this sucks – I suck – help!” The person resigns himself to alife of gentile poverty, thinking she or he is not worthy of financial well-being. The prospective patient is left aggrieved. This grievance is accurate and real enough in context, but it is hard to identify what or who can make a difference. Nevertheless, there is no power in being aggrieved. One still has to do the thing the person in distress or with shaky self-esteem is least inclined to do – invest in oneself because one is worth it!
I have spoken with numerous potential and actual clients who pay a lot of money for health insurance. However, when they want to use the insurance for behavioral health services, they find the insurance is not workable. Not usable. The service level agreement is hard to understand, and having a deductible of a couple of thousand dollars is hard to distinguish from having no insurance at all. If the client goes “in network,” the therapists are unresponsive or inexperienced. If the client goes out of network, the therapists are often more experienced and able to help, but onerous deductibles and copays rear their heads. Why don’t the experienced therapists go in network? There are many reasons but one of them is that the insurer often insists the therapist accept thirty cents on the dollar in compensation, and some therapists find it hard to make ends meet that way. In short, as a potential patient, you think you have insurance, but when it comes to behavioral health, you really don’t.
My main point is to provide guidance as to some things you can do to get the help you need with emotional or behavioral upset and do so in a timely way. Turns out one has to give an informal tutorial on using insurance as well as on emotional well-being. I hasten to add that “all the usual disclaimers apply.” This is not legal advice, medical advice, insurance advice, cooking advice or any kind of advice. This is a good faith, best efforts to share some brain storming and personal tips and techniques earned in the “college of hard knocks” in dealing with these issues. Your mileage may vary.
Nothing I say in this article should be taken as minimizing or dismissing the gravity of your suffering or the complexity of this matter. If you are looking for a therapist or counselor, it is because you need a therapist or counselor, not a breach of contract action against an insurance company. You want a therapist not a legal case or participation in a class action law suit, even if the insurance contract has plenty of “loop holes.” For the moment, the latter is a rhetorical point only.
When a person is anxious or depressed or struggling with addiction or other emotional upset, being an informed assertive consumer of behavioral health services is precisely the thing the person is least able to do. “I need help now! Shut up and talk to me!”
Notwithstanding my commitment to expanding a rigorous and critical empathy, here’s the tough love. Without minimizing your struggle and suffering, the thing you least want to do is what you are going to have to try to do. If one is emotionally upset, the least thing you want to do is be an assertive consumer of services designed to get you back your power in the face of emotional upset or whatever upsetting issues you are facing.
The recommendation is to speak to truth to power and assertively demand an “in network” provider from the insurance company or invest in yourself and pay the private fee for an experienced therapist whom you find authentically empathic, then you already be well on the way to getting your power back in the face of whatever issues you are facing.
If your issue is that you really don’t have enough money (and who does?), then you may need to get the job and career coaching that will enable you to network your way forward. An inexpensive place to start is The Two Hour Job Search by Steve Dalton. Highly recommended. Note the paradox here – the very thing you do not want to do keeps coming up. You definitely need someone to talk to. Once again, the very things with which you need help are what re stopping you from getting help
The bureaucratic indifference of insurance companies is built into the system. The idea of an insurance is a company committed to making money by spreading risk between predictable outcomes and a certain number of “adverse” [“bad risk”] events. It is not entirely fair (or even accurate) but by becoming depressed or anxious (and so on), you are already an adverse event or bad risk waiting to happen. You may expect to be treated as such by most insurance companies.
In a health insurance context, the traditional model for the use of services is a broken arm or an appendicitis (these are just two examples among many). You definitely want to have major medical insurance against such an unfortunate turn of events. Consider the possibility: Buy major medical only – and invest the difference saved in your therapy and therapist of choice.
But note these adverse medical events are relatively self-contained events – page the surgeon, perform the operation, take a week to recover or walk around in a sling for awhile. The insurance company pays the providers (doctors and hospitals) ten grand to thirty grand. That’s it. With lower back pain, headaches, irritable bowel syndrome, autoimmune disorders, it is a different story. These are notoriously difficult to diagnose and treat. Yet, modern medicine has effective imaging and treatment resources that often successfully provide significant relief if not always complete cures for the patient’s distress in these more complex cases.
Consider similar cases in behavioral health. Start by talking to your family doctor. Okay, that is advice – talk to your family doctor for starters. Front line family doctors have the authority – and most have the basic training – needed to prescribe modern antidepressants (so called SSRIs), which also are often effective against anxiety, to treat simple forms of depression and anxiety due to life stresses such as an ongoing pandemic, job loss, relationship setbacks.
Even though I am one of the professionals who has consistently advocated “Plato not Prozac,” I acknowledge the value of such psychopharmacological interventions from a medical doctor to get a person through a rough patch until the person can engage in a conversation for possibility and get at the underlying cause of the emotional disequilibrium. Note this implies the person wants to look for or at the underlying dynamics. This leads us to the uncomfortable suggestion that it is going to take something on the part of the client to engage and overcome the problem, issue, upset, which is stopping the client from moving forward in her or his life.
There is a large gray area in life in which people struggle with relationship issues, finances, career, education, pervasive feelings of emptiness, chronic emotional upset, self-defeating behavior in the use of substances such as alcohol and cannabis (this list is not complete).
A medical doctor or other astute professional may even provide a medical diagnosis when the interaction of the person’s personality with the person’s life falls into patterns of struggle, upset, and failure. Insurance companies require a medical diagnosis. One thinks of such codable disorders as adjustment disorder or personality disorders (PD) such as narcissistic, histrionic, schizoid, antisocial, or borderline PD. These are labels which can be misleading and even dangerous to apply without talking to the person and getting to know them over a period of time. It’s not like the Psychology Today headline – top three ways to know if you are dating a narcissist. I am calling “BS” on that approach.
Nevertheless, if after a thorough process of inquiry, some such label is appropriate (however useless the label may otherwise be except for insurance purposes), then the cost will be right up there with “fixing” an appendicitis – only you won’t be able to do it in a single day – and it won’t be that kind of “fix”. An extended effort and of hard to predict duration must be anticipated, lasting from months even to years. This is not good news, but there are options.
My commitment is to expanding a rigorous and critical empathy in the individual and the community. I consider that I am an empathy consultant, though at times that is hard to distinguish from a therapeutic process and inquiry into the possibilities of health and behavioral well-being. Therefore, and out of this commitment, I have a sliding scale fee structure for my consulting and related empathy services. People call me up and say “I make a lot of money, and want to pay you more.” Of course, that is a joke. I regularly hear from prospective clients whose first consideration is financial. They do not have enough money. I take this assertion seriously, and I discuss finances with them. Between school debt and the economic disruptions of three years of pandemic, people are hurting in many ways including financially. One must be careful NEVER to blame the victim or survivor.
The best way for such financially strapped individuals to go froward is to find an “in network” provider. Key term: in network. But we just read the Washington Post article that furnishes credible evidence such networks are tapped out, in breakdown, not working. Those that are working well enough often deal with the gray area of emotional upset and life challenges by moving the behavioral health component to a separate corporate subsidy at a separate location to deal with all aspects of behavioral health. (See above on “bad risk.”) When I had such an issue years ago, I had to search high and low to get the phone number, web site, or US postal address. You can’t make this stuff up. This is because ultimately, the issues that come up are nothing like an appendicitis or even hard to diagnose migraines. Moving the paying entity to a corporate subsidy is also a way that the insurance company can impose a high deductible and/or copay by carving out that section of the business and claims processing. There are other reasons, too, but basically, they are financial.
You may be starting to appreciate that many health insurance contracts are not really designed to provide behavioral health services (e.g., therapy) the way they are designed to address a broken leg or appendicitis. There is a way forward, but it is more complex (and expensive in terms of actual dollar, though not necessarily time and effort). I will address this starting in the paragraph after next, because, sometimes in the case of behavioral health, people who have insurance do not really have useable, workable behavioral health insurance. For all intents and purposes, they think they have insurance, but, in this specific regard, they have a piece of paper and a phone number that is hard to find. I hasten to add I am not recommending going without major medical health insurance, inadequate though it may be in certain respects.
This brings us to those individuals who decide to go without insurance. What about them? Such individuals choose to take the risk. They are living dangerously because if they do break an arm or incur an appendicitis, then they are going to have another $30K in medical debt [this number is approximate and probably low], along with a mountain of school debt, credit card debt, and bad judgment debt (this list is not complete). These good people need insurance, not so much to get therapy – because, as the accumulating evidence indicates, it really doesn’t work that way – as to be insured against a major medical accident. Many people are not clear on this distinction, but I would urge them to consider the possibility.
I spoke with this one prospective client who began with a long and authentically moving narrative that she did not have enough money and could not afford therapy. This is common and not particularly confidential or sensitive. As part of a no fee first interview to establish readiness for therapy, I acknowledged her courage in strength in reaching out to someone she did not really know to get help with her problems. I acknowledged that one of her problems was she did not have enough money. A bold statement of the obvious. I asked if there was anything else she wanted to work on. It turns out that she was a survivor of a number of difficult situations and would benefit from both empathy consulting, and talk therapy – and I might add job coaching. Here’s the thing – when a person is hurting emotionally, they do not want to look for another job – or a better job that pays more money. But one just might have to do that, at least over the short term, with someone who can provide that kind of guidance to those who are willing. I encouraged her to be assertive with her insurance company and I heard she found someone in network at a low rate.
And if you are a therapist who believes such job coaching compromises the purity or neutrality of the therapy, I would agree. However, never say never. In the aftermath of World War I, when the victorious allies maintained a starvation blockage on Germany and Austria even into 1919, Freud (that would be Sigmund) was reportedly seeing a client in exchange for a substantial bag of potatoes. I have no facts – none – but I find it hard to believe they were discussing matters pertinent to individual and collective survival. So far no one has offered me a bag of potatoes (I am holding out for a quantity of olive oil and basil to make pesto), but see the above cited article from the Washington Post.
We circle back to where we started. If the individual named in the Washington Post article has not yet found a therapist, then I believe there are many in the Chicago area would welcome the opportunity to make a difference for her. She has a budget for therapy, she says. If you have a budget, the work goes forward. It can be confronting and difficult to contemplate, but if you were buying a car, you would look at your budget. If you were planning a vacation, you would think about your vacation budget. If you were thinking of going back to school, you would look at your education budget. You get the idea. What is your budget for empathy consulting, counseling, talk therapy, cognitive retraining, life coaching, or medication management services (this are all distinct interventions, appropriate in different circumstances)? Zero may not be the right number. Just saying. Of course, if the client is in LA and the empathy consultant is in Chicago, it would be a conversation over Zoom. That starts a new thread so I may usefully clarify that I prefer to meet with people in person – the empathy is expanded in person – but the genie is out of the bottle and online can be good enough in some circumstance. (See my peer reviewed article “The Genie is Out of the Bottle”: https://bit.ly/37vxJ0L.)
The insurance system is broken as regards behavioral health (as evidenced by the WP article). There is a vast gray area of people with modest emotional disregulation who genuinely need help. These are not only the “worried well,” but people whose understandable lack of assertiveness in navigating an indifferent (and it must be said unempathic) bureaucracy leaves them high and dry with their moderate but worsening emotional, spiritual, and behavioral upsets. These people deserve help, and are entitled to it even under the specific terms of their insurance contracts. Indeed they are entitled to help even if they do not have insurance, though the revenue model is simpler in that case, though not less costly.
The insurance company has been unable to make money off of this gray area – therefore, the insurance company does what it does best – it turns to making money off of you. But you need health insurance against a major medical event or accident. You want a therapist, not a breach of contract case in small claims court (where the small claim often goes up to $100k). Therefore, it does little good to document having called ten or twenty-five in network providers with no result. Or does it? You – or a class action attorney firm – have a case for breach of contract. Go out of network and forward the invoices to the payer by mail with a tracking number, requesting that the full therapy fees be treated “in network” for purposes of reimbursement, and, therefore, no or low deductible and copay. Of course, one would have to have funds for that upfront, and lack of money is where this circle started. Back to expanding one’s job search skills?
This is crazy – and crazy making behavior – though only as a function of a system that is crazy. You see the problem. I’ll bet dollars to donuts that the insurance payer, when confronted with an actual summons to small claims court, would then find you a therapist – of course, the therapist might be relatively inexperienced or someone who (how shall I put it delicately?) is less motivated than one might hope. Thwarted again!
As I wrap up this post, it occurs to that while it would be crazy for an individual to seek legal redress – it might even be “acting out,” there might be a basis for an enterprising law firm to establish a system wide “class action” for breach of contract. This will not solve your problem of getting help in the next two weeks, but it might be a necessary step to benefit the community. You know the insurance company has the money!
As noted above, your grievance in being over sold unworkable behavioral health insurance may be [is] accurate and real. Nevertheless, I am sticking to my story: the guidance: there is no power in being aggrieved. You still have to do the thing the person in upset or with shaky self-esteem is least inclined to do – dig down, including into your pockets, and find self-confidence – or enough self-confidence for the moment – and invest in yourself because you are worth it!
The one minute empathy training – runtime is actually five minutes, but a personal introduction is included: https://youtu.be/747OiV-GTx4
Empathy in time of war means two words – Red Team.
In time of war or threat of war, the power of empathy consists in putting yourself in the shoes of the enemy, thinking like the enemy, and thereby anticipating and thwarting the enemy’s moves.
“Red Team” also happens to be the title of an eye opening, engaging book by Micah Zenko, Red Team: How to Succeed by Thinking Like the Enemy (New York: Basic Books, 2015: 298 pp.). Though it has been around for seven years, it is very timely – and, in many ways, a page turner. Time to catch up on our reading.
“Red Team” is a drill first developed by the US military to fight simulated war game battles in the Persian Gulf or western Europe during the Cold War. In the simulation, Blue Team is the US – “the good guys.”. Red Team is the other side. Zenko tells how the head of the Red Team really was named “Paul Van Riper.” He was.
Zenko narrates Van Riper’s assertiveness in questioning assumptions and how he brought forth the power of the Red Team in conducting asymmetrical battle, refusing to fight on the enemy’s terms, and acting unpredictably. Van Riper also spoke truth to power in calling out the improprieties of going outside the chain of command to “order” the Red Team not to shoot down the Blue Team aircraft. When the simulation was replayed with more equitable rules in place, the results were eye opening. Red Team was winning – decisively. The “authorities” decided to stop the simulation because the Red Team’s successes were getting to be embarrassing to the “good guys.”
Zenko provides engaging background on Red Team training and thinking at the University of Foreign Military and Cultural Studies (UFMCS). Instructors and participants are taught how to distinguish the traps of social conformity and the “mind guards” and “blockers” who enforce it. The idea is to find and shed a spotlight on one’s blind spots beforeencountering the enemy. Zenko writes:
Students are taught the basics of cultural empathy and semiotics (i.e., the philosophical study of signs and symbols), without which a red teamer cannot identify and understand the values and interest experienced by those within a targeted institution [in the simulation] [. . . .] The four pillars that UFMCS curricula are based upon are critical thinking, groupthink mitigation, cultural empathy and self-awareness (pp. 38. 39).
Each of these pillars maps to a dimension of empathy or a breakdown in empathy (my view, not Zenko’s). Critical thinking counters the breakdown in empathy described as emotional contagion. Groupthink is the above cited conformity that blocks empathic understanding of what is possible for the other group (“side”). Self-awareness is not specific to empathy and is always relevant to understanding others, enabling an empathic response based on the context, not preconceptions. Cultural empathy is precisely taking a walk in the other’s shoes with the cultural appreciation of differences.
Such top-down cognitive empathy is not limited to the military, but is highly relevant to business, sports, and any situation in which information asymmetries exist in a context of zero sum game competition. Business is an obvious application. Most executives think of themselves as intrinsically better than their rivals. Such commitment to being right is all-too-human and, in certain ways, may even contribute to success – for a while. Thus, we generally find it extremely difficult to understand or empathize with rivals (p. 168). Zenko writes some things that are not flattering to executives;
Virtually all of the research that has been conducted on business decision-making finds that executives are distinctly uncreative, deeply myopic, and overconfident both in themselves personally, and also in their company’s ability to beat its competitors (p 235).
While it is easier said than done, the recommendation to perform red teaming promotes the leader as a fearless skeptic with finesse and a willingness to hear bad news and act on it. As a leader, if you don’t mind problems but really hate surprises, then red teaming is the way forward. Another way of saying that is to have your surprises simulated in a Red Team exercise rather than on the battle field, in the market place, or while trying to land the airplane.
Let us take a step back because, with a title such “Empathy in Time of War,” the reader may expect calls “to bind up the […] wounds, to care for him who shall have borne the battle and for his widow and his orphan ~ to do all which may achieve and cherish a just and lasting peace.” And, to be sure, one can do worse than quote Lincoln’s second inaugural address delivered in 1865 at the end of the American Civil War. Still, this was delivered at the end of the war. The 600,000 were already deceased, and it would soon be 600,001 when Lincoln himself was assassinated.
Empathy has many dimensions, four to be exact, in both times of war and peace. Different dimensions of empathy come to the foreground in different situations. This discussion looks at all dimensions of empathy, but the one most relevant is that of putting oneself in the other’s shoes. This is the folk definition of empathy – perspective taking – with the other’s motives and context, insofar as one has access to them. Take a walk in the other’s shoes – in this case, the shoes of one who is out to do you no good – the enemy. (An enemy is defined as an individual or institution that is committed to behaving in such a way as to do, enact, or cause physical, emotional, moral, developmental, or spiritual harm to another person or group.)
Speaking personally, I cannot believe that anyone would try to force a choice between empathy and compassion. The world needs more of each. Why would that celebrity psycholinguist from Yale try to force a choice? (And if you do not know his name, you will not read it here.) Still, if as a thought experiment, one had to choose, go with empathy.
Let us consider a use case. The NY Times reports that Russia has a list of prominent Ukrainian intellectuals, journalists, business persons, politicians, and government officials to be killed or detained as Russian forces sweep across the country. The Red Team empath who takes a walk in the opponent’s shoes knows what he is dealing with – mafia style totalitarianism. What do you do when assassination is central to your opponent’s business model? Don’t expect any mercy. Man the barricades! The compassionate person may still use the rational part of cognitive ability (and perspective shifting) to arrive at the same conclusion, but the compassionate Red Team decision maker doesn’t really know what to say, at least not from the perspective of compassion. The Russians love their children too (to quote Sting)? It is only a small segment of the Russian regime that proposes to kill everyone in sight? Even psychopaths have a soft spot for children and pets (except that they do not)? This is not a zero-sum game? Actually it is a zero sum contest if the Russian team is attempting to “de capitate” the Ukrainian government.
It is quite possible that compassion, rational or otherwise, is just not a good fit for certain types of conflicts unless one can rework the situation so it is not a zero-sum game. Once the first stone flies or the first bomb goes off, both compassion and empathy are a lot less useful. Yet never underestimate the power and pertinence of empathy. That is the point of the Red Team initiative – empathy helps one survive in a hostile environment into which one is thrown due to circumstance and live to fight another day.
It really does seem that Putin and his generals did not Red Team the invasion of the Ukraine, now in its third day (2/25/22) thing very well, which, of course, does not mean that the Russian forces cannot still flatten Kyiv with artillery barrages.
Let us consider another use case. Russia threatens to invade the Ukraine – this is prior to Russia’s actual invasion. The Ukrainian team conducts a war game playing both sides. Since the Ukrainians are outnumbered, out gunned, have limited air power, and limited air defense, they are not expected to win. This is of course the reverse of the war games conducted by the US Military where the “blue team” is the USA, and the other side is generally outgunned, which of course why it was so surprising when Paul Van Riper and his red team scored a knock out. In the war game, the Ukrainian Blue Team allows the Russians to enter the country, since they cannot stop them. Then the Ukrainians blow up the bridges behind the Russian Red Team. The explosives need to have been set in advance (which seems not to have occurred in real life).
The Russians resupply struggles and some of their units run out of gasoline. These are set upon by small units equipped with antitank weapons that were hiding out in decommissioned ICBM siloes. Note that Ukraine was briefly the world’s third largest nuclear power before surrendering their nuclear weapons in 1996 in exchange for security assurances from Russia and The West. (Big mistake. But that is another story.) However, the Ukrainians still have hardened infrastructure, including bunkers, and siloes, albeit empty of missiles. They use this infrastructure to allow the Russians to drive buy, then pop up from the rear and inflict damage. The Ukrainians are defending their homeland, their families, and their lives. Red teaming takes such factors into consideration. Of course, the Russians have elite special forces, but the Russians are also relying on conscripted twenty somethings who have been told that they are going for training but are actually being sent off to war. You can’t make this stuff up. Under this scenario, the Russians expected to accept the Ukrainians surrender in three days. The Russians have enough fuel and resupply for nine days. If the Ukrainians can hold out for ten days, they win.
Update: This just in (12:30 PM CDT 2-27-2022). Unconfirmed reports state that some teenage Russian conscripts (soldiers) are surrendering in tears. Ukrainian authorities are allowing them to borrow cell phones to call their mothers, who are reportedly already lobbying Putin to stop the madness. The power of mothers should not be underestimated! Stand by for update. Meanwhile,,,
Empathic interpretation is a redescription of cognitive, top-down empathy. Engaging the empathic process as cognitive empathy is especially usefully and powerful in the Red Team situation of thinking like the enemy. But do not stop there. Even if one does not have enemies, if one gets stuck and does not have a good feel affectively as to what is going on with the other person, say one’s best friend, then mobilizing an intellectual operation to shift perspective cognitively can free up one’s possibilities for relating and interacting. If I find another person distant or emotionally remote or “on the spectrum,” one may usefully consider what one knows about what the other person had to survive or the challenges the person is facing or what one knows about the person’s role or aspirations or history. All this become grist for the mill of “jump starting” empathic relatedness where relatedness is missing.
Earlier in the discussion, empathy was described as having four dimensions and the third dimension (3) of empathic interpretation, taking a walk in the other person’s shoes was called out. The other three dimensions include (1) empathic receptivity – be open the feelings and thoughts of the other as a vicarious experience that distinguishes self and other (2) empathic understanding – engage the other as a possibility in his shared humanity (4) empathic responsiveness – acknowledge the other in a form of language or gesture that recognizes the other’s struggle, contribution, or issue. One can easily appreciate how the “bottom up” aspects of affective empathy become less relevant or useful in the context of war. Less relevant, but not completely irrelevant, since, as Lincoln pointed out in the opening quote, even long wars eventually have an outcome and the healing properties of empathy (and compassion) return to the critical path.
This is highly relevant to psychotherapy, psychiatry, empathy consulting, and life coaching. Only here “the enemy” is not the client, but the person’s disorder, diagnosis, or blind spot. It is truly a “love the sinner but hate the sin” moment (to mix in a spiritual metaphor with the clinical one). Here one must work to form an alliance with the client against an aspect of himself that keeps him attached to his own suffering. Though the suffering is real, it can be sticky and becomes an uncomfortable comfort zone.
It is not appropriate to diagnose public figures based on their crazy statements and behavior, nor do I propose to do that here. Yet there is a concerning parallelism between delusional behavior and the political fabrications (i.e., lies) and fake news of demagogues, fanatics, and fellow travelers of the Big Lie. Politicians as a class have never been known for their rigorous integrity in honoring their word, yet the success that some demagogues have in persuading the people to follow them – often off a cliff – must give one pause.
Such influence often comes from the would-be charismatic “leader” believing his own lies and fakery. It does lend a force to the fanatic’s message and comes to resemble, without however being the same as, the delusional person’s self-delusion. Though there is too much suffering to bear between where the world is at right now (2/25/22) and some end point = x, the most likely outcome is Putin is finished. Putin is done – a shell of a human being, ravaged by the neurological consequences of power and Covid. We do not know how suicidal he is – think of Hitler in his bunker. Not a comforting thought. The question is whether Putin decides to take the rest of the world with him in a nuclear holocaust, and whether saner minds in the Kremlin can stop him. Red Team that!
A new year and a new virus variant? Being cynical and resigned is easy, and the empathy training is to drive out cynicism and resignation – then empathy naturally comes forth. If given half a chance, people want to be empathic. The prediction is that with a rigorous and critical empathy (and getting a very high percent of the population vaccinated), we are equal to the challenge.
Setting priorities is an art, not a science. It is clear that empathy is a priority, not a mere psychological mechanism a practice and a way of being in the world, creating a safe space of openness, acceptance and toleration. In the face of a contagion of Omicron, we need a contagion of empathy. Empathy is contagious. This is one you want to give to someone else, especially someone who seems to need some – all the while being clear to set firm boundaries against bullying, delusional thinking, and compassion fatigue. Keep in mind this list is a top ten “count down,” so if you want to know what is #1, fast forward to the bottom.
Here are my choices and predictions for the top ten trends in empathy for the year 2022.
(10) Delays in the empathy supply chain continue to thwart the expansion of empathy in the community.
This does not refer to the distribution of cat food or toilet paper. Empathy is available. There is enough empathy to go around, but the empathy is poorly distributed due to politics, in the pejorative sense. For example, most medical doctors are empathic and they become MDs because they want to make a difference in relieving human suffering. But the corporate transformation of American medicine means they are given onerous “capitation” quotas – they must see thirty patients a day. The coaching and push back is based in empathy: It is a breach of professional ethics not to give a given patient the time and attention s/he deserves, and there is only time to see twenty two patients a day.
(9) Republicans and Democrats will start conducting Empathy Circles where they get together and listen to one another and respond empathically.
And if you believe this, I have a famous bridge in Brooklyn to sell to you. Yet the key to expanding empathy is to drive out cynicism and resignation. Be open to the possibility: On a more realistic note, the responsibility of leadership, whether in the political or corporate jungle, requires teaching critical thinking. Critical thinking includes skills to analyze conflicting articles in the press, chasing down media reports to their sources and assessing the sources for reliability. Most importantly, critical thinking includes temporarily taking the opponent’s point of view, which is a version of cognitive empathy. One does this not to agree with the opponent, but to have a productive disagreement. Empathy brings workability to political, business, and personal relations. It is like oil to reduce friction and produce results that benefit the entire community. (Edwin Rutsch and The Culture of Empathy are going to like that one!).
(8) Being empathic is hard within the Patriarchy. This does not go away.
The dystopia of Patriarchy (systematic unspoken sexism) crushes the empathy and compassion out of all of us. This is an issue because: in the face of so much gender violence (the vast majority of which is men perpetrating boundary violations against women), can we find or recover a shred of our humanity? I do not need to say “shared humanity,” because “unshared humanity” is not humanity.
It gets worse: the company formerly known as Facebook re-launches as Meta and the Metaverse, a virtual reality world. A quote from the New York Times (12/30/2021: “But as she waited, another player’s avatar approached hers. The stranger then simulated groping and ejaculating onto her avatar, Ms. Siggens said. Shocked, she asked the player, whose avatar appeared male, to stop.” He shrugged as if to say: ‘I don’t know what to tell you. It’s the metaverse — I’ll do what I want,’” said Ms. Siggens, a 29-year-old Toronto resident. “Then he walked away.”” (I do not want to give Metaverse its own trend.) [https://www.nytimes.com/2021/12/30/technology/metaverse-harassment-assaults.html] A specific proposal includes: establish a Desmond Tutu style Truth and Reconciliation commission in the Metaverse where perpetrators can tell the survivors what they did and ask forgiveness. Another proposal: establish empathy circles in the Metaverse (Edwin Rutsch and The Culture of Empathy are going to like this one too!).
Recall that instead of a civil war, South Africa and the late Desmond Tutu innovated a Truth and Reconciliation program for the perpetrators of apartheid to tell the truth about what they did to the victims and to ask forgiveness. The survivors then got to say if and/or what they could see there to forgive. That would be a practical, albeit utopian response. I am no fan of forgiveness, which I consider overrated. But I bought Tutu’s book based on the title, No Future Without Forgiveness. How can there be? It both requires empathy and expands empathy. Empathy is both the cause and the effect. I hasten to add that does not mean being nice; it means establishing firm boundaries. It does not even mean going in with a forgiving attitude, but actually striving for actual truth and reconciliation tribunals, seeing if the truth on the part of the perpetrator(s) can show forth some shred of humanity and maybe, just maybe, highly unlikely though it is, point to a future of cooperation, communication, and community in which both parties flourish. I am not looking for moral equivalence, clever slogans, or easy answers here, I am looking for expanded empathy!
(7) Along the same lines as (8), the so-called “incel” (“involuntary celibate”) gets empathy, backs away from the ledge, gets in touch with his inner jerk and stops being one. (What the heck is an “incel”?)
Now I hasten to add that as soon as a person, whether incel, Don Juan, or one of the Muppets, picks up a weapon, a date rape drug, or proposes to act like the incel and mass killer Elliott Roger, that is no longer a matter for empathy, but for law enforcement. (For more on what is an incel – this is genuinely new – see the blog post and book review: The Holocaust of Sex: The Right to Sex by A. Srinivasan (reviewed) (https://bit.ly/3EACv7W).
After incarcerating or canceling or cognitive behavioral theraputizing the incel, let us try engaging him with – empathy. Key term: empathy. Let us take a walk in his shoes. Knowing full well that the incel is like a ticking bomb, let us engage with one prior to his picking up a weapon. I cut to the chase. It is not just sexual frustration, though to be sure, that is a variable. There is also a power dynamic in play. This individual has no – or extremely limited – power in the face of the opposite sex. He is trying to force an outcome.
Here we invoke Hannah Arendt’s slim treatise On Violence. Power down, violence up. Whenever you see an individual (or government authority) get violent, you can be sure the individual (or institution) has lost power. The water cannon, warrior cops, and automatic weapons show up. The incel embraces his own frustration like Harlow’s deprived Macaque monkeys embraced their cloth surrogate mother, even though it lacked the nipple of the wire-framed one. Now I do not want to make light of anyone’s suffering and incels are definitely suffering. Yet it is tempting to enjoy a lighter moment. The incel’s dystopian life points to his utopia, which consists in two words: “Get laid.” I would add: this applies to consenting adults, and don’t hurt yourself!
(6) Burned out MDs, teachers, flight attendants dealing with delusional angry unvaccinated and sick people don’t get no empathy – how does empathy make a difference?
Set boundaries with and against bullies. At least initially, establishing boundaries is not about having empathy for the bully; it is about being firm about damage control and containing the bullying. Ultimately the bully benefits even as the community is protected from his perpetrations; but more in the manner of a three year old child, who, having a tempter tantrum, benefits from being given a time-out in such a way that he cannot hurt himself or others.
Without empathy, people lose the feeling being alive. They tend to “act out”—misbehave—in an attempt to regain the feeling of vitality that they have lost. Absent an empathic environment, people lose the feeling that life has meaning. When people lose the feeling of meaning, vitality, aliveness, dignity, things “go off the rails.” Sometime pain and suffering seem better than emptiness and meaninglessness, but not by much. People then can behave in self-defeating ways in a misguided attempt to awaken a sense of aliveness.
People act out in self-defeating ways in order to get back a sense of emotional stability, wholeness and well-being—and, of course, acting out in self-defeating way does not work. Things get even worse. One requires expanded empathy. Pause for breath, take a deep one, hold it in briefly while counting to four, exhale, listen, speak from possibility.
(5) Nursing schools and schools of professional psychology and medical schools begin offering classes in empathy.
Yes, it is a scandal you cannot take a course entitled “Empathy Dynamics” or “Empathy: Concepts and Techniques” in any of these schools. I know, because I checked the catalogs [Q3 2021]. I even got hired once or twice to fill in because they could not get anyone else to do it. You may say, “Well, every course we have teaches empathy” and in a sense, it does – or at least ought to. But that is mainly wishful thinking – if you don’t practice empathy, you don’t get it right or wrong – and if you don’t get it wrong, at least occasionally, you don’t expand the skill.
(4) Combine empathy with critical thinking – the result is a rigorous and critical empathy.
I got this distinction – a rigorous and critical empathy – from Xavier Remy, who I hereby acknowledge. What does that mean? You think you are being empathic – think again. It may be empathy or it may be narcissism or rational compassion or pity or self-congratulations or a whole host of things related to empathy but not empathy. How do you tell? Empathy tells you what the other person is experiencing – be open to their experience, understand the possibility – take a walk in their shoes – acknowledge the shared humanity. Empathy tells what the other person is experiencing – critical thinking tells you what to do about it.
(3) Empathy builds a bridge over the digital divide and encounters resistance to empathy online and in-person.
With the pandemic of 2020, many in person services such as psychotherapy, life coaching, empathy consulting, and others went online. When the provider is having a conversation, then an online session is often good enough – and is definitely better than ending up in the hospital on a ventilator.
As the pandemic wanes and virus variants (hopefully) actually become more like a bad case of the flu (which indeed kills the most vulnerable), the issue becomes when to stay online, meet in person (with fully vaccinated clients), and how to tell the difference?
The disturbing trend that I see amongst (some) behavioral health professionals is that online “better than nothing” becomes “better than anything.” Going online is very convenient, and since, as the saying goes, inertia is the most powerful force in the universe, providers prefer to stay home rather than risk being vulnerable in creating a space of acceptance and tolerance in being personally present physically. The latter is a definition of empathy in the expanded sense – being fully present with the other person – in person and unmediated by a screen.
Now when I call out this conflict of interest, generally based in financial and time considerations (and time is money), most providers acknowledge that the commitment is not to online versus in-person, but rather to client service, delivering empathy, and making a positive difference for the client.
Clients whose mental status is “remote” even in-person in a physical, shared space present a challenge to the therapist’s empathy and are not initially a good choice to work with remotely online. However, after a warming up period the empathic relatedness migrates quite well to the online environment.
“Better than nothing” versus “better than anything” is a choice that needs to be declined: both online and in-person physical therapy coexist and help clients flourish using empathy to bridge the digital divide.
(2) Empathy and climate change. Empathy is oxygen for the soul – individually and in community.
In a year when the lead off comedy is about the destruction of the Earth by a killer comet – and a metaphor for global warming – empathy is oxygen for the soul. This is supposed to be funny (think of the film Dr Strangelove (1964)), in both cases, featuring an arrogant clueless President, played by Meryl Streep (instead of Peter Sellers). Empathy builds ever expanding inclusive communities – empathy is oxygen for the soul – and the planet.
“Beggar thy neighbor politics, economics, and behavior do not work.” They did not work in the Great Depression of 1929 – they did not work in the Great Recession of 2008. Do not take a bad situation and make it worse. Take a pandemic – now fist fights break out on airplanes, hospital emergency rooms, and retail stores. Hmmm.
It is a common place that empathy is oxygen for soul. If the human psyche does not get empathy, it suffocates in stress and suffering. Climate change makes the metaphor actual. If we do not drown as the Greenland and Antarctic ice fields slide en masse into the oceans, we are surely doomed to suffocate as the levels of carbon dioxide and heat overwhelm temperate habitats. Most people are naturally empathic and they an expanding appreciation of empathy suffuses the community.
The problem is that this eventuality does not live like an actual possibility for most people, who cannot imagine such an outcome – for example, just as in December 2019 no one could envision the 2020 pandemic. The bridge between the gridlocked present and a seemingly impossible-to-imagine future is empathy. The empathic moment is an act of imagination. That is the interesting thing about empathy. It may seem like a dream; but the dream lives. It is inclusive. Lots more work needs to be on this connection. For purposes of this list of tasks, this “shout out” will have to suffice. For specific actionable recommendations, see David Attenborough’s A Life on Our Planet, now streaming on Netflix: https://www.netflix.com/title/80216393
And, [drum roll] the number one empathy trend for 2022 is: –
(1) There is enough empathy to go around – people get vaccinated, boosted, and – get this – people get what seems like a version of the common cold – the pandemic “ends,” not with a bang but a whimper.
This relates to issues with the empathy supply chain, but deserves to be called out on its own. Granted, it does not seem that way. It seems that the world is experiencing a scarcity of empathy – and no one is saying the world is a sufficiently empathic place. Consider an analogy. You know how we can feed everyone on the planet? Thanks to agribusiness, “miracle” seeds, and green revolution, enough food is produced so that people do not have to go hungry? Yet people are starving. They are starving in Yemen, Africa, Asia – they are starving in Chicago, too.
Why? Politics in the pejorative sense of the word: bad behavior on the part of people, aggression, withholding, and violence. The food is badly distributed. Now apply the same idea to empathy.
There is enough empathy to go around – but it is badly distributed due to bad behavior, politics and interpersonal political in the pejorative sense. The one-minute empathy training? Drive out the aggression, bullying, shaming, integrity outages, and so on, and empathy naturally comes forth. (For further particulars, see the video cited in the References.) People are naturally empathic, and the empathy expands if one gives them space to let it expand.
Empathy is not a mere psychological mechanism (though it is that too), but is an enlarged concern for the other person – one’s fellow human being on the road of life. Empathy has been criticized for working better with one’s own family than with strangers – but these critics do not know my family – okay, joke – but, even if accurate, the solution to lack of empathy for strangers is expanded empathy. Be inclusive. Be welcoming. Expand the community of inclusiveness. All of this is consistent with people with underlying medical conditions needing to take extra precautions. In that sense, people who get vaccinated, boosted, and mask up, are doing it to keep their neighbors from getting sick. And, so, out our concern for others – our fellow humans – we get vaccinated, boosted, masked-up, and the pandemic ends – but – aaahhh, cooh! – the common cold continues to live on.
References / Notes
 Harlow, H. F. (1958). The nature of love. American Psychologist, 13(12), 673–685. https://doi.org/10.1037/h0047884
“The One-Minute Empathy Training” [https://youtu.be/747OiV-GTx4: May I introduce myself? Here is a short introduction to who i am and my commitment to empathy, including a one-minute empathy training. Total run time: about five minutes. Further data: See http://www.LouAgosta.com]
(c) Lou Agosta, PhD and the Chicago Empathy Project
Suzanne Keen’s Empathy and the Novel (2007, Oxford University Press, 242 pp.) can be read as an introduction to empathy studies, fiction (novel studies), and reading in the enlarged sense of engaging with the Humanities. Keen’s approach to these intersecting discourses is nuanced, subtle, and not easily summarized. She provides a great springboard for further conversations, elaborations, and social psychology experiments.
The usual definitions of empathy are reviewed, especially: a vicarious, spontaneous sharing of affect (2007: 4). I would add: talking a walk in the other person’s shoes; transiently, temporarily, and selectively identifying with the other person; appreciating who the other person is being as a possibility; feeling and experiencing vicariously what the other person feels and experiences; being fully present with the other person in such a way as to acknowledge and respond to the other’s humanity. Keen’s book is fully buzzword compliant, including accounts of theory of mind, mirror neurons, and storytelling.
A significant aspect of the interest in relating empathy and the reading of fiction, especially novels as in Keen’s book, is to make the world a better place. Read some quality fiction; expand one’s empathy; and take action to improve the world. Wouldn’t it be nice?
Keen notes: an ideal type case is that of Harriet Beecher Stowe’s Uncle Tom’s Cabin (1852), which, in its time, was a run-away best seller, opening the eyes of contemporaries to the injustices and inhumanity of slavery, furthering the cause of abolition. Even if such a book as Stowe’s did not directly create a social movement, with the benefit of 20-20 hindsight, it is notable as representing a parallel and behind the scenes shift in the prevailing values of the community. (Sinclair’s The Jungle or Dickens’ Oliver Twist might be added to the list of influential works (2007: 118)). And yet the libraries are overflowing with novels that did not make a difference and are read by few.
Due to the importance of the empathy-altruism hypothesis developed by C. Daniel Batson, Suzanne Keen begins her book on Empathy and the Novel with Batson’s hypothesis and its relation to the practice of reading fiction.
At the risk of oversimplification, I gloss the subtleties and what the empathy-altruism hypothesis gets right: empathy creates a clearing for the prosocial, helping behaviors of altruistic behavior such as one finds in Good Samaritan scenarios. When read judiciously, this hypothesis neither reduces altruism to empathy, nor vice versa. Experimental subjects who are empathically “primed” find that their “empathy” understood as prosocial engagement spontaneously manifests itself in the direction of altruism when challenged to do so. Nevertheless, Batson’s work is a masterpiece of studied ambiguity when it comes to deciding where the boundary lies between empathy and altruism.
Keen’s approach privileges the novel, in which the fictional world brings forth a “safe space,” in which empathy can be applied without requiring that anyone take action: “…[F]ictional worlds provide a safe zone for readers’ feeling empathy without a resultant demand on real world action” (2007: 4). That is quite appropriate from the perspective of a professor of English literature. However, one might just as well reverse the equation. Empathy creates a clearing for acceptance and toleration within which the imagination performs its work of capturing experience as a narrative in which the empathic exchange of emotional and imaginative psychic contents occurs.
My position in the matter is: Empathy opens us to (“tells us”) what the other person is experiencing; our good upbringing, morals, ethics, and professional practices tell us what to do about it. This makes it sound like empathy is a mode of observation or perception, and it is indeed that. However, insofar as empathy is something that requires two people in interaction, the empathizer is required to perform an empathic response in order to complete the loop and validate the empathic interaction.
One key point of debate is whether reading novels expands a person’s empathy. Though Keen is inclined to favor this hypothesis, she marshals significant evidence on both sides of the debate and concludes that the jury is still out.
The literary career of empathy (Keen’s incisive phrase) extends from 18th century warnings by the clergy and other learned men that novel reading ranks among the incentives to the seduction of female readers (Keen, 2007: 37) all the way to the enlightenment philosophers such as David Hume and, finally, Percy Bysshe Shelley’s guidance to extend the sympathetic imagination to feel with others. “Sympathetic” because the word “empathy” had not yet been coined in the English language (which would happen in 1909 as E. B. Titchener’s translation of the German “Einfühlung”). Fast forward to James Joyce, Sam Beckett, and Berthold Brecht, who become anti-empaths, privileging defamiliarization and estrangement in narrative.
The moral peril of vicarious emotions to the innocence of girls becomes the emotional contagion that Brecht sees as subverting the consciousness raising of the workers and potential for revolutionary action of the working class by means of his Epic Theatre. None of this is full blown adult empathy, but it is on a spectrum of empathic relatedness that is wide and complex.
Arguably, the listening and receptivity of the community were ready to respond to the message of these books due to seismic shifts in social and productive relations; and the book provided concise language and a set of powerful images to make the point at hand. Though correlation is rarely causation, sometimes correlation is good enough.
No substitute is available for the “magic bullet” of identifying a specific replicateable cause, and such discoveries are rare. Though many people confuse cause and effect (nor am I saying that happens to Keen!), from the point of view of an alliance between empathy, fiction, and social action, it is almost as enlightening and effective to have the literary fiction represent the “signs and portends” of social dynamics that can then become the target of appropriate political action, fund raising, consciousness raising, and social influence. As Keen puts it, “…[reading literary fiction becomes] a sign of one’s empathy and commitment to human principles” (2007: 167). Reading literary fiction – presumably along with political editorials – would be a source and a method of consciousness raising. Still most readers do not look to reading literature as sources for social action in the real world – or at least the evidence-based studies that Keen sites do not show such a result. (2007: 118).
All the casual, easy generalization such as “altruism results in expanded empathy,” “empathy results in expanded altruism,” “reading quality fiction (novels) enhances empathy,” “empathy enhances appreciation of the novel” have significant qualifications, conditions, and counter-examples. Never was it truer, the devil is in the details; and Keen’s work contains a wealth of engaging examples and background on empathy studies. Incidentally, Keen ends her book with some twenty-seven proposals about narrative empathy (2007: 169 – 171).
In discussing the enhanced empathy of authors, who report that their characters come to life in their imaginations, Keen acknowledges the moral ambiguities of the possibilities of empathy for both good and evil. For example, Keen reports that William Pierce (pseudonym: Andrew MacDonald), founder of a white supremacist organization, published The Turner Diaries (1978), containing hateful depictions of blacks, Jews, and gay people. The novel was apparently written with some literary skill. Timothy McVeigh, the bomber of the Federal Building in Oklahoma City (1995), studied this book, and, based on the account in the novel, “emulated its protagonist by building a fertilizer bomb to explode a government building […] made and deployed in a small truck” (Keen 2007: 127).
True, it is highly improbable that the novel by Pierce (MacDonald) caused an upstanding citizen to become a mad bomber. McVeigh was already entangled with murderous levels of prejudice and deviance, and was therefore attracted to the novel. Do not confuse cause and effect; yet the evidence is that this white supremacist novel – and the bomb making parts of it – inspired McVeigh and made him a more dangerous deviant.
Another celebrated example of a novel having alleged causative effects, not mentioned by Keen, in the real world is Goethe’s The Sufferings of Young Werther, in which the broken-hearted hero commits suicide. There really was an epidemic of copycat suicides across Europe in which romantically devastated individuals would jump off of bridges with a copy on the novel in their respective pockets as a kind of suicide note. More good empathy gone bad? Can’t get no satisfaction – or empathy? More likely, individuals who were already suicidal found an expression of their suffering in literary form thanks to the dramatic finesse of Goethe.
I offer a bold statement of that which is hidden in plain view. The hidden variable is the practice of empathy itself. If I read a novel that enrolls me in the practicing prosocial empathic responsiveness to my neighbors, then empathy is expanded. If I read a novel that enrolls me in the practice of white supremacy, then the latter is expanded.
One could argue, though I will dispute the formidable ambiguities, that even white supremacists can be empathic towards other white supremacists. That is the critique of empathy that asserts empathy is too parochial, limited only to the in group, and, as such, a problematic “virtue,” if one at all. The answer is direct. In so far as the white supremacists [and so on] require one conform to a certain prejudiced, humanly devaluing ideology to qualify as the recipient of the practice of empathy, the empathy misfires and fails.
Thus, the debate is joined. The celebrated Self Psychologist and empathy innovator Heinz Kohut, MD, gives the example of the Nazis who equipped their dive bombers with sirens, the better to impart empathic distress in their victims, thus demonstrating their (the Nazis’) subtle “empathic” appreciation of their victims’ feelings. I am tempted to say, “The devil may quote scripture,” and Nazis may try to apply some subset of a description of “empathy.”
Note that Kohut speaks of “fiendish empathy” and the use of empathy for a “hostile purpose” while emphasizing his value neutral definition of empathy as “vicarious introspection” (1981: 529, 580). Nevertheless, the point is well taken that empathy is a powerful phenomenon in all its dimensions and requires careful handling. [For further details see: “On Empathy,” The Search for the Self: Volume 4: Selected Writings of Heinz Kohut 1978-1981, London: Karnac Books, 2011: 525 – 535].
The Nazi applies a kind of entry level emotional contagion or affective transmission of feelings, but the process breaks down at the point of empathic responsiveness. Empathic responsiveness requires a core of acknowledgement and recognition of the other person’s humanity.
But it is plainly evident that the would-be “empathy” of the Nazis (or the white supremacists) misfires and fails in a contradiction. It is a flat-out contradiction to relate authentically to another human being while dehumanizing him or her. Empathy doesn’t work that way. Empathic responsiveness simply does not admit of bombing people or disqualifying them as “less than” or other than human when they plainly are human.
One of the strongest points of Keen’s book is the final chapter on “Contesting Empathy,” in which she cites a long series of objections, qualifications, and doubts about empathy. Failed empathy, false empathy, fake empathy, breakdowns of empathy, and the social construction of the emotions are engaged and deconstructed. Empathy has to run a gauntlet of things that can go wrong with it, though I suggest it emerges out of the backend bruised but still in one piece.
This point is not well-understood in the empathy research literature where break downs of empathy are mischaracterized as features of empathy itself. To blame empathy for its misuse, breakdowns, and misapplications is rather like using the smoke alarm to decide when Thanksgiving turkey is done.
Keen is concerned that the empathy-altruism hypothesis with which she launches her project is left hanging by a thread. If the work of Kohut is to be credited (who, by the way, is not mentioned by Keen), the hypothesis is not likely ever to be validated. Yet if empathy is a practice, not a mere psychological mechanism, then by practicing it, we get better at it in using it to reinforce and expand our shared humanity. Empathy becomes a powerful force in creating a clearing to call forth “the better angels of our nature.” The empathy-altruism hypothesis as an aspirational project, not a social psychology given.
Thus, the really tough question is how does “empathy” as a psychological mechanism relate to “empathy” as a interpersonal process and “empathy” as a practice in relating to people. One starts out talking about empathy as a psychological mechanism, subsumed by a biological mirroring system (even if mirror neurons remain debatable) and invoking identification, projection, and introjection.
Almost immediately one has to give an example of two people having a conversation in which one is feeling and experiencing something that the person may or may not “get” or “understand.” Then one finds oneself immediately discussing the practical considerations of why, in the course of the personal interaction, the empathy succeeded or broke down in a misunderstanding, and how to improve one’s practice of empathy based on experience.
It makes a profound difference from which definition of empathy one begins, though ultimately one has a sense of traversing all the distinctions and simply coming back to enhanced relatedness and understanding of the other person.
One goes in a circle. Readers are attracted to the literary fiction that speaks to their hopes, possibilities, and fears, which, in turn, expands and reinforces their hopes, possibilities, and fears. Then, either by accident or diligent search, readers encounter new forms of writing that change their experiences and perceptions. The writing causes the readers to see existing social structures and ways of relating to other people in new ways. The hermeneutic circle of interpretation? The engaging thing about bringing the hermeneutic circle to empathy is that it provides a series of steps, phases, within which logically to organize the process. Even if ultimately such a hermeneutic circle of empathy falls short of a formal algorithm, one gets a coherent guide against which to succeed or fail and engage in a process of continuous improvement based on experience.
What if a rigorous and critical empathy gave us the data needed to grasp the way to the humanity enhancing actions that need to be taken? The application of empathy would become an imperative guiding our reading and relatedness along with the moral imperatives so important to Keen and Batson. Empathy has not usually functioned as a criteria of literary significance or greatness – until now.
REFERENCES and NOTES
Since Keen published her book in 2007, several peer-reviewed have appeared that support the hypothesis that reading literary fiction expands empathy. These are useful, but do not decisively determine the outcome of the debate; and, obviously, these researchers did not include Pierce (MacAndrews) on their list. A lot of work gets done here by the adjective “literary.” For example:
Bal, P. M , Veltkamp, M. (2013). How Does Fiction Reading Influence Empathy? An Experimental Investigation on the Role of Emotional Transportation. PLoS ONE 8(1): e55341, https://doi.org/10.1371/journal.pone.0055341;
David Comer Kidd, Emanuele Castano. (2013). Reading Literary Fiction Improves Theory of Mind, Science 18 October 2013, Vol. 342, Issue 6156, pp. 377–380, DOI: 10.1126/science.1239918;
Kelly Servick. (2013). Want to Read Minds? Read Good Bookshttps://www.science.org/content/article/want-read-minds-read-good-books [The page # is not available on the web version; but they are short articles.]
The reader may usefully review my blog post on these publications and “reading literary fiction expands empathy”: https://bit.ly/311A2G8
(c) Lou Agosta, PhD and the Chicago Empathy Project
Listen on Spotify: https://open.spotify.com/show/6nngUdemxAnCd2B2wfw6Q6
“CEO” no longer means “Chief Executive Officer,” but “Chief Empathy Officer.” This time one can hear the groans—from the executive suite, not the cubicles.
Empathy is one of those things that are hard to delegate. This role shows up like another job responsibility with which the CEO of the organization is tasked—along with everything else that she already has to do. As if she did not already have enough alligators snapping at various parts of her anatomy, one has to be nice about it, too? But of course empathy is not niceness, though it is not about being un-nice. It is about knowing what others are experiencing, because one has a vicarious experience and then processing that further to expand boundaries and exercise leadership.
This puts me in mind of a mini-case-history reported by Annie McKee in the Harvard Business Review (HBR).[i] In this case, an up and coming executive, Miguel (not his real name), goes from turning around many struggling divisions in a multi-divisional corporation to a kind of identity crisis about who he authentically is in relation to the possibility of empathy. Miguel is a wizard at finding profit and weeding out waste. Miguel goes from division to division (each big enough to be a separate company) working his financial wizardry. It seems to work.
If the case sounds like a thinly disguised version of the career of Jack Welch, who was CEO of the multi-divisional General Electric (GE) from 1981 to 2001, then so be it. Welch retired from GE with a package estimated at $417 million.[ii] According to some reports, Welch was nicknamed “Neutron Jack,” because, like the neutron bomb, he eliminated the people while leaving the buildings and the profits standing.
Welch innovated a management approach called “rank and yank,” now widely imitated. Each year, the bottom 10% of his managers, regardless of absolute performance, would be let go. Those in the top 20% were amply rewarded with bonuses and stock options, which were extended liberally from top executives to nearly one third of all GE employees.
Welch reportedly fought against, but did not solve, the chronic problem of Wall Street pressure to sacrifice the sustainability of long term growth for short term profit. Welch railed against the very system that he outfoxed brilliantly over a twenty year career as CEO, but, note well, only after he got his payout.
Regarding shareholder value, Welch said in a Financial Times interview on the global financial crisis of 2008–2009: “On the face of it, shareholder value is the dumbest idea in the world. Shareholder value is a result, not a strategy […] your main constituencies are your employees, your customers and your products.”[iii]
Now you are going to expect me to say this method was the epitome of lack of empathy, and from the perspective of the employees whose jobs were eliminated, it definitely lands that way. Yet that is precisely what Welch was hired to do. Thus, the context.
Next act, quick scene change back to Miguel. In McKee’s HBR mini-case-history, his corporate superiors inform Miguel that those employees who survived his restructurings now hate their jobs, teams are dysfunctional, and the “by the numbers” culture has become toxic. (I believe this did not happen at GE.) Miguel is told “fix it” or he will never become CEO (which is apparently part of his agreement and expectation).
Miguel hires Professor McKee as his empathy consultant, and he is making slow, all-too-slow, progress working with her in expanding his empathy when another set-back occurs. Miguel’s wife throws down the gauntlet, pointing out that he is never available for her and the kids even when he is supposedly physically present. This hits home, literally. This inspires Miguel to expand his practice of empathy to a new level. He commits to learning how to listen, relate to others as a contribution, walk in their shoes, and respond empathically.
Thanks to Miguel’s renewed commitment—and McKee’s consulting and coaching—the empathy training works. Miguel expands his empathy in time. All live happily (and empathically) ever after, both at home and on the job, in this “just so” story.
However, in the real world, the Miguel and Welch narratives dramatically diverge—as do fiction and nonfiction. As a celebrity CEO, the dynamics of Jack Welch’s personal vicissitudes were played out in the public press, so they are readily available to the interested gossip—I mean reader—and the details of Welch’s three divorces will not be rehearsed further here. This speaks volumes to most ordinary humans. Thus, the lives of the rich and famous.
The empathy lesson? There is an cost and impact to every initiative and project. The cost and impact extend to empathy. Empathy is expanded or contracted. There is a cost and impact to “rank and yank,” even for those doing the ranking (though, of course, especially for those who are “yanked”).
No one needs to feel sorry for anyone, reportedly the “yanked” walked away with nice packages, but this is not for the faint of heart. On a happier note, Welch goes on to found a management school, the Jack Welch Institute, in an initiative designed to rationalize and replicate the business methods and financial “magic” that he developed at GE. Some thirty-five CEOs heading corporations today have been trained in his method (mostly at GE, not his theme-branded school). The principles Welch developed are also delivered at business schools such as MIT’s Sloan School of Management. With the case of Welch in the background, one realizes that the mini-case-history of Miguel really does indeed conceal an alternative point of view. However, “alternative” does not mean “inaccurate,” but a re-description of events that points to a hidden empathic breakdown.
Miguel was doing exactly what his corporate superiors asked him to do. If the financial results were not sustainable after his departure, this was so much “regression to the mean.” Even the average profitability of the companies identified by the celebrated In Search of Excellence by Thomas Peters and Robert Waterman dropped sharply within a few years in the absence of sustained leadership. “Regression to the mean” means literally that when one performs above average now, get ready for one to perform below average later; when one performs below average now, get ready to perform above average later. The boss will predictably approve of the above-average performance and disapprove of the below-average one; but the subsequent performance is governed by “regression to the mean,” not the boss’ approval or disapproval.
For all the ambiguous comments made about Jack Welch such as “Neutron Jack,” he managed to create an entrepreneurial spirit in a giant, multi-divisional bureaucracy. Now that was both the good news and the bad news. For those employees looking to put in their time, performing routine tasks—and conforming—prior to collecting a pension, that was bad news. It demanded a way of relating to possibility that required innovation and transformation that was ultimately career ending for those individuals.
To his enduring credit, Welch inspired an approach to creating possibilities by his own example that he called “boundaryless.” In short, he broke down organizational silos by giving permission to cross boundaries between traditional functions in search of possibilities, i.e., innovations. The boundary crossing sounds like the skillful use of empathy in building and managing cross functional teams.
Welch formed cross-functional teams to brain storm and implement possibilities that had not previously been envisioned. He championed ideas and possibilities for improvement regardless of whether the ideas came from inside or outside the company. “This is the way things have always been done” became the wrong answer, or at least no longer the default reply. Note that “boundless” behavior should not be confused with boundary violations. Empathy is about crossing boundaries to give the other person the possibility of breakthrough contribution, doing so with respect and recognition, and in a way that preserves the integrity of the boundary.
Welch was in charge at GE for twenty years; he had sufficient time to train divisional leaders in sustaining his practices; and retain them in charge of the divisions he had restructured. During his tenure at GE, the company’s value reportedly rose some 4,000%.[iv] If that is not sustained value, I would not know it.
Meanwhile, Miguel’s bosses asked him to put relatively short term financial results ahead of team building, retaining the best people, entrepreneurial informality, and, like a good leader, he made it work—for a while. He made it work until the bosses decided they did not want him to do that anymore. Surprise! Then they told him, “Fix it or you’re gone!” Miguel’s listening—a key component of empathy—was operating at an advanced level. He listened well; and he gave his superiors back precisely what he got from them—and what they asked of him. It turns out his superiors didn’t like it as much as they thought they would.
It does put one in mind of the example of George M. Pullman, who is no longer the model for employer-employee relations. Pullman ordered the workers fired when they presented him with a petition in protest of a 25% reduction in wages.[v] Pullman as Miguel’s boss? Miguel’s superiors changed their minds, having gotten the benefits of the “rank and yank” approach. Boards are allowed to change their collective mind (and minds), and were now looking for a CEO more like Walt Disney, Marshall Fields, perhaps Warren Buffet or Sam Walton, after the latter had made their first billion dollars, and could afford to throttle back a notch, cultivating a kinder, gentler image.
My redescription of events? While it is accurate that Miguel was innovating with his own version of Neutron Jack, Miguel was also on the receiving end of the breakdown in empathy. He could not give what he did not get, and, by the time his corporate superiors figured out what they wanted, Miguel had perfected his version of the Roman invasion of Britain. The surviving Brits were reported to have said: “The Romans ‘make peace’ by creating a desert.” The Brits were not referring to an “empathy desert,” but the idea is similar. McKee’s case history is a nice narrative and a useful cautionary tale. However, the tale lacks credibility and confronts us with the next challenge, empathy: capitalist tool.
“The Lone Ranger” is a vanishing breed in today’s corporation. Modern work, from the upper echelons of the corporate hierarchy to the bottom levels of the lowest cubicle, requires empathy.
Whether sales person, software developer, accountant, or business leader, one has got to be “a team player,” “willing to go above and beyond the call of duty,” spend long hours on business travel, and be cheerful about it. One has got to get in touch with one’s empathy; and use one’s empathy to satisfy customers, teammates, stake-holders, and superiors.
In short, empathy is now a capitalist tool. Managers need to apply ample empathic skills. Managers are required to keep workers contented so that the workers can be productive. Managers are now coaches, facilitating employees feeling valued, so employees are emotionally invested in contributing to the team, team spirit, and the long hours and frequently uninspiring routine work required as a project hits “crunch time.”
Both managers and line employees must be able to turn empathy “on” for customers; “on” for team work; “on” for co-workers; but “off” for the competition; “off” for efficiency and discipline; and “off” for compliance and rule following. This ability to turn empathy “on” and “off” implies an approach that this book has questioned in arguing that empathy is a dial or tuner rather than an “on-off” switch. However, even if, for the sake of argument, we imagine empathy as an “on-off” switch, this calls for a level of skill in regulating empathy in which most people lack practical skill.
Consider. Customers pay their good, hard earned money for products and services, and it is a low bar to say that customers are entitled to be listened to, treated with dignity, and responded to empathically by a corporation and its representatives. The empathic engagement with and treatment of customers is demonstrably a rewarding investment.
How about employees? As a person moves into the work force, he is empathic because those in authority advocate for it as a form of team building. It is important that one be empathic in addressing the issues and concerns of co-workers, customers, and stake-holders.
Employees who feel that they are “gotten as a possibility” by their company are emotionally invested in the success of the company. They are inspired to go the extra mile to deliver value on their agreements, make extra effort for the team, and see their personal contribution in terms of the big picture. They are not just stone cutters banging away at a rock with a hammer; they are building a cathedral.
Neither the employee nor the manager “above” him have been trained in empathy, and it is not a part of their job description, at least in any explicit way. Though there are dozens of training firms in everything from compliance to conflict resolution, the number of individuals and firms in North American and the European Union delivering empathy training can be counted on the fingers of one hand. While that may be changing, expecting CEO’s to give empathy when they are not in touch with their own empathy, makes no sense. Nor is it fair either to the leader or would-be recipient. Welcome to the age of Machiavellian empathy!
Niccolò Machiavelli (1469–1527) was famous for saying that it would be best if the leader—the Prince, in his day—was loved, but it is essential that he be feared.
Machiavelli never actually said that the ruler, the Prince, must be perceived to be empathic, even as he ruthlessly wields power behind the scenes. But that is what he implied. In the context of politics, Machiavellian empathy refers to politicians who present themselves as being empathic while manipulating, spinning alternative facts, double dealing, and so on, behind the scenes. Machiavellian empathy shows up in business, too. If managers are not in touch with their empathic abilities, they are counseled to “fake it till you make it.” Many never “make it” and continue “faking it.”
Whether or not one authentically understands the experience of the other person is less relevant to the Machiavellian Empath than scoring points on a check list of concerned behavior.
Is this then the ultimate cynical moment? Is this the ultimate easy way out? Is this the reduction to absurdity of empathy? If empathy is about setting boundaries, where is the boundary? While not a complete response, one distinct limit to Machiavellian empathy is Lincoln’s famous saying, “You can’t fool all the people all the time.” Ask Travis Kapernick, Bernie Madoff, or Harvey Weinberg.[vi]
Strictly speaking, Machiavellian empathy takes nothing away from empathy’s intrinsic benefits and uses. Even if one wants to present the appearance of being empathic for propaganda (i.e., marketing) purposes, while continuing to operate with dubious business practices behind the scenes, reality has a way of catching up with appearances. Amazon said it was a wonderful place to work. Then the New York Times got some employees to comment on the record about “mean” behavior.[vii] Uber was disrupting the disrupters and creating the Gig Economy, which supposedly set us free. Then a driver, who was not in touch with that supposed freedom, unwittingly interviewed the CEO, Travis Kapernick, on camera.[viii]
So far as we can tell at this writing, neither of these breakdowns has resulted in breakthroughs. There is no guarantee that the Machiavellian Empath will slip up and document his or her own inauthenticity for us; it rarely happens rapidly enough; but it happens.
Empathy deserts grow: Woe to those that harbor empathy deserts!
Capitalism organizes empathy along with workers and production processes. Under capitalism, empathy is a means, not an end dedicated to the satisfaction of human needs, aspirations, and demands. (When the word “demand” is used, think “supply and demand” for products and services in a market.) Some workplaces are empathy deserts in spite of the appearance of mangers with published “open door” policies.[ix] Key term: empathy desert. After a day at the office, people often feel as if their personality had been erased. One’s humanity withers in the desert. So if you find yourself feeling dehumanized by your job, maybe you work in one of those, regardless of the prevailing rhetoric.
Instead of the industrial supervisor shouting orders to his workers, who curse under their breath and conform to the orders, today’s managers employ therapeutic strategies to create a convivial environment of trust, relatedness, sociality, loyalty, and care. Happy people sell. Happy people write more software code with fewer bugs. Happy people deliver projects on time, on budget. Value creation in the late capitalist economy is a function of the exchange of emotion and empathy.[x]
The way “empathy” is used in the business media today, it means that corporations innovate in providing benefits to their employees. Many of these benefits enable employees to get away from the job and restore aspects of their humanity that are hard to maintain in the “corporate jungle” (or desert). It means that firms return to their employees some of the revenues that the employees earn for the firm by providing services. Such a proliferation of meanings may be a phase that empathy has to go through before we can really grasp how it essentially makes a difference.
For example, Procter & Gamble offers a personal leave of absence, which the employee can use to engage in a “life project.” Up to three months off without pay—but with continued benefits—allows the employee to pursue a personal “life project,” and, P&G to retain valuable talent, since the employee returns to work after the sabbatical.[xi] Though Human Resources (HR) has to approve the project, the benefit can be used to: complete writing a PhD or masters thesis that requires dedicated time on task for writing and research; design and implement a database tracking system for a social justice issue for Amnesty International or Doctors Without Borders; trek to Nepal and attempt to climb an 8K meter high mountain; sail around the world.
At Google (Alphabet) parental leave is a benefit: Moms get up to 18 weeks of paid leave; Dads get six. The company also pays “baby bonding bucks” to help with initial expenses such as formula and diapers.
Prudential Financial is addressing the employee challenge of being a care-giver for a parent or relative by providing adult care in an employee or loved one’s home. The company provides referrals to geriatric care services as well as elder law and adult care-giving seminars.
IBM contracts with an educational firm to provide a “get into college coach” for its employees with children applying to college. They will not write the admissions essay for the children, but provide detailed guidance as to what different colleges are looking for, test scores, grade point average, and cultural preferences. All these are valuable in reducing parental (i.e., employee) stress. Note this is one corporate benefit that does not require the employee to leave work. Sensibly enough, the worker continues to work, presumably to pay college tuition, while “out sourcing” some of the elaborate, complex project planning needed by the student actually to get into college. Win-win all around.
While my work has repeatedly emphasized that there is enough empathy to go around, empathy is not uniformly distributed. How could it be? Executives who are talented at dealing empathically with customer issues may be less skilled at dealing empathically with employees; and those skilled at dealing empathically with employee issues may be less skilled at dealing empathically with union negotiations, the press, or business partners and competitors (who may be one and the same).
Arguably, empathy flows from those with more power towards those on the front line engaging with customers. However, if the customer is big enough, for example, contemplating buying a fleet of jets or a global enterprise software system, the ultimate sales person turns out precisely to be the CEO or her close colleagues. The executive suite is now on the front line. But who trained those leaders—or any one—in empathy? If we gave the executive (or front line help desk person) the kind of empathy exam described above by Leslie Jameson, in which an actor learns a script, portrays a client with a problem, in effect being a “secret shopper,” what would be the grade (see p. 121 above)? While we may never know for sure, I predict that the grade will be lower than if the executive fills out a self-assessment in which one can pick out the “right answer” based on common sense and an appreciation of kindness. Thus, the case for expanding empathy through training.
[i] McKee, Annie. (2016). If you can’t empathize with your employees, you’d better learn to, Harvard Business Review, November 16, 2016.
[iii] Ibid, Jack Welch, Wikipedia
[iv] Ibid, Jack Welch, Wikipedia
[vi] Meanwhile, more breaking news, as this book goes to press, some 49 men stand accused of sexual misconduct in various workplaces extending from Harvey Weinstein’s Hollywood production company (from which he was fired) through venture capital to restaurant businesses:
https://www.nytimes.com/interactive/2017/11/10/us/men-accused-sexualmisconductweinstein.html?_r=0. The problem is that, while it is good that this abuse is finally coming out, it has been hidden in plain for years and years. See Harry Markopolis’ (2010) statement in a different context above, “no one would listen.” Where is Lord Acton when we need him? Lord Acton said: “Power corrupts; and absolute power corrupts absolutely.”
[vii] Kantor and Streitfeld 2015..
[viii] Seyluk 2017.
[ix] Roman Krznaric (2104) quoted in Belinda Parmar (2014) The Empathy Era: Woman, Business and the New Pathway to Profit, London: Lady Geek: 91. Parmar does not cite a page in Krznaric.
[x] Tristam Vivian Adams. (2016). The Psychopath Factory: How Capitalism Organises Empathy. London: Repeater Books: 56–77.
[xi] Matt Krumie. (2016). Ten companies putting empathy into action, Cornerstone On Demand: https://www.cornerstoneondemand.com/rework/10-companies-putting-empathy-action [checked on July 03, 2017].
(c) Lou Agosta, PhD and the Chicago Empathy Project