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Spike in Domestic Violence (DV) Accompanies Pandemic Shelter-at-Home

This is a republishing with light editing of a book review from May 19, 2019 on Rachel Louise Snyder’s important work on domestic violence (DV). Difficult situations are further breaking down and becoming intolerable under the stresses of the pandemic. 

The short version? Actionable recommendations include the Danger Assessment and the Fatality Review Board (FRB). Police and DV interveners are now being trained to perform a Danger Assessment (Jacquelyn Campbell’s innovation). For example, when the perpetrator strangles the would-be survivor that indicates an increasing risk of homicide. Strangulation often is the next to last abuse by a perpetrator before a homicide. The correlation is strong, very strong. Strangulation is a much more significant marker than, say, a punch or kick that the abuser will escalate to lethal violence. Strangulation dramatically increases the chances of domestic violence homicide (p. 66). No easy answers here, but the details follow on how to interrupt the unfolding tragedy. 

The title of Rachel Louise Snyder’s eye-opening, powerful, page-turner of a book, No Visible Bruises, refers to strangulation [No Visible Bruises: What We Don’t Know About Domestic Violence Can Kill Us, New York: Bloomsbury Publishing, 2019: 309 pp, $28(US)].

Some sixty percent of domestic violence (DV) victims are strangled at some point during an abusive relationship (p. 65).  Turns out that only some 15% of the victims

Cover Art: No Visible Bruises by Rachel Louise Snyder - a picture of cracked plaster - not only of an enraged fist but of a damaged, fragmented self (?)

Cover Art: No Visible Bruises by Rachel Louise Snyder – a picture of cracked plaster – not only of an enraged fist but of a damaged, fragmented self

in one study had injuries visible enough to photograph for the police report (p. 66).

Most strangulation injuries are internal – hence, the title. 

Since 2012 when I completed the 40-hour training in Understanding Domestic Violence (DV) at the community organization ApnaGhar, several important innovations have occurred. Snyder presents the reader with these, including the distinctions of (1) a Fatality Review Board for Domestic Violence; (2) initiatives to provide treatment for the abusers; (3) the Danger Assessment (which leads back to the role of strangulation).

Lack of oxygen to the brain can cause micro-strokes, vision and hearing problems, seizures, ringing ears, memory loss, headaches, blacking out, traumatic brain injury (TBI) (p. 69). As the victim in near death due to strangulation – but so far there would only be red marks around the neck – the nerves in the brain stem lose control over sphincter muscles. So the urination and defecation were not mere signs of fear. They were evidence that the victim was near death (p. 67).  

Such victims have poor recall of the event. They may not even be aware that they lost consciousness. In being incoherent in her talk, the victim is not being difficult or drunk. The victim is fighting the consequences of a life-threatening event and may not know it at the moment. Here police training will make a difference. 

Even medical professionals may overlook the signs of serious injury by strangulation unless they are altered to the circumstance of the visit to the emergency room. Fact: DV victims are NOT routinely screened for strangulation or brain injury in the emergency room. They are discharged without CT scans or MRIs. The assaults and injuries are not formalized and abusers are prosecuted under lesser charges, say, misdemeanors rather than felonies.

“What researchers have learned from combat soldiers and football players and car accident victims is only now making its way into the domestic violence community: that the poor recall, the recanting, the changing details, along with other markers, like anxiety, hypervigilance, and headaches, can all be signs of TBI” (p. 70).

Now the ultimate confronting fact: Strangulation often is the next to last abuse by a perpetrator before a homicide. The correlation is strong, very strong. Strangulation is a much more significant marker than, say, a punch or kick that the abuser will escalate to lethal violence. Strangulation dramatically increases the chances of domestic violence homicide (p. 66).

This leads directly to an important innovation in the struggle against DV, the Danger Assessment. Jacquelyn Campbell has quantified the Danger Assessment, which is especially effective when combined with a timeline of incident. In addition, to strangulation high risk factors in any combination that portend a potential homicide include: gun ownership, substance abuse, extreme jealousy, threats to kill, forced sex, isolation from friends and family, a child from a different biological parent in the home, an abuser’s threat of suicide or violence during pregnancy, threats to children, destruction of property, and a victim’s attempt to leave anytime within the prior year. Chronic unemployment was the sole economic factor (p. 65). None of these cause DV; but they make a bad situation worse – much worse – and add to the risk of a fatal outcome.

You can see where this is going. First responders, police, medical professionals, family, friends need to ask the tough questions – perform the assessment and have a safety plan ready to implement to get the potential victim out of immediate danger. Hence, the need for Snyder’s important book and its hard-hitting writing and reporting to be better known at all levels of the community.

Snyder reports on a second important innovation in the struggle against DV: the Fatality Review Board (FRB) for DV Homicide. Air travel has become significantly safer thanks to the Federal Aviation Administration commitment to investigate independently every airplane crash. The idea is to find out what sequence of things went wrong without finger pointing. No blame, no shame. The idea is to perform an evidence-based assessment of all aspects of the system – human, administrative, mechanical, procedural.

In a breakdown big enough to cause loss of life, multiple errors, anomalies, and exceptions are likely to have occurred in the system. Rarely is there is single cause of a disaster big enough to cause loss of life. “If systems were more efficient, people less siloed in their offices and tasks, maybe we could reduce the intimate partner homicide rate in the same way the NTSB [National Transportation Safety Board] had made aviation so much safer” (p. 85). The Fatality Review Board is born.

For example, the authorities knew the perpetrator. They had visited the home multiple times. The abuser was released from detention without notifying the potential victim. An order of protection was denied due to a paperwork error, or, if granted, the police could not read the raggedy document that the woman was required to have on her person at all times. The prosecutor was unaware of a parallel complaint by the victim’s mother because it was filed in the same docket and dismissed when the victim recanted in the hope of placating the abuser and saving her own life.

For example, multiple touch points occur at which victims and perpetrators interact with social services, healthcare facilities, community organizations, the veteran’s administration, law enforcement, and the clergy. The FRB is tasked with determining how the fatal outcome could have been avoided.

Chase down all the accidental judgments, missed cues, and blind spots. Talk to everyone able to talk. Gather all the data. Someone knew something, had actionable information that was not acted upon. Formulate recommendations to avoid repeating the mistakes.

That means building formal lines of permissioned communication between administrative siloes. For example, there as a restraining order against the abuser but it was in another state and the local authorities did not know about it.

In the age of the Internet there needs to be a central clearing database that preserves such data. Or, for instance, the shooter had no criminal record, but the victim had expressed fear for her life to the local pastor at church based on his statements. Who can he (or she) call? Who can intervene with a safety plan?

No one single factor can be singled out as causing the fatality; instead a series of relatively small mistakes, missed opportunities, and failed communications. The FRB looks for points where system actors could have intervened and didn’t or could have intervened differently (p. 86). Today more than forty states now have fatality review teams. Though the violence continues, this is progress.

Snyder makes an important contribution in clarifying why the victim does not run leave the abuser and the abusive relationship. Why does she return to the abuser, or recant her testimony in the police report, frustrating the attempt of the prosecution to get a conviction?

Though every situation is unique, Snyder builds a compelling narrative that often the victim is trying to save her own life. The system works much slower than a determined abuser, and the victim knows it. In short, the abuser knows how to work the system; and all-too-often the victim cannot rely on the system to protect her when she most needs protection. In addition, her judgment may be impaired due to being called every name in the book and slapped, punched, or strangled.  

As the abuser senses he is losing power and the victim is getting ready to leave, the risk of violence to regain control escalates. The abuser is strangling her, escalating to deadly violence, and yet he is charged with a misdemeanor. He will be out on $500 bail in 24 hours – buying a gun and gasoline to burn down the house after killing her and the children. In fear for her life, the victim is makes up a story about love to try to placate the abuser – she is recanting to try to buy time – while she accumulates enough cash or school credits to escape and have a life. The victim recants her narrative in the police report and says she loves him because she wants to live.

A third major strong point of Snyder’s work is her report on interventions available for abusers. Incarcerating an abuser to protect the community is necessary. But that does not mean the abuser does not need treatment. He does. Absent treatment, jail just makes the abuser worse. The entire middle section of the book is devoted to the dynamics of perpetrator treatment.

At another level I found Snyder’s deep insight to be an extension of Simone de Beauvoir’s assertion circa 1959 that woman is not a mere womb. The enlightened man adds to de Beauvoir’s statement (which is notquoted by Snyder): man is not mere testosterone. In both cases, biology is important, but biology is not destiny. I repeat: biology is not destiny. Some men have not been properly socialized and need to get in touch with and transform their inner uncivilized cave man.

The recovery programs in jails on which Snyder reports sound rather like “boot camp” to me. The emphasis is on “tough love.” This is a function of the close association, if not identification, of masculinity with violence.

 In some communities, violence is how masculinity gets expressed. This extends from “big boys don’t cry” and if he hits you, hit him back all the way to a misogynistic gangster mentality that uses devaluing language to describe woman as basically existing for the sadistic sexual satisfaction of men. It may also be common (and justified!?) in a military context. As near as I can figure – and this is an oversimplification – the treatment groups are given lessons in cognitive or dialectical behavioral therapy: skills in emotional regulation, distress tolerance, self-soothing, and interpersonal negotiations.   

For those perpetrators, not incarcerated or suffering from post traumatic stress disorder (along with their victims), but rather brought up in relative privilege or affluence, Snyder has less to say. While the poverty, crime, and substance abuse of the inner city can intensify DV, DV is an equal opportunity plague, occurring in affluent neighborhoods too. Only here we are dealing with “snakes in suits” – think: Harvey Weinstein or Bill Crosby (“date rape” drugs) [granted, these individuals were sexual predators, not necessarily DV perpetrators]; perpetrators who are quite sophisticated in using the system to isolate and disempower their victims financially, legally, emotionally as well as physically (violently). This is an incompleteness rather than a flaw in an otherwise compressive study. Another chapter – or book – may usefully be written about DV scenarios among the rich and famous – or at least affluent. DV lives there too.

On a personal note, when I started reading this book, I knew it was not for the faint of heart. I said to myself: “Ouch! This is like the ‘ketchup scene’ in Shakespeare’s Hamlet.” At the end of Hamlet, the entire family gets killed. To deal with something as disturbing (and hope inspiring) as Snyder’s book, I had to go to Shakespeare.  

Indeed Hamlet begins with domestic violence. Hamlet’s uncle kills his own brother, Hamlet’s father, to seize the throne by marrying Hamlet’s mother. The latter is not technically DV, but a boundary violation. (This is the original Game of Thrones if there ever was one.) In turn, Hamlet perpetuates verbal and emotional abuse, whether fake insanity or genuine narcissistic rage, against his fiancé, Ophelia. Hurt people, hurt people. Sensitive soul that Ophelia is, she commits suicide. Ophelia’s brother then seeks revenge. Hamlet kills her brother as the brother simultaneously kills Hamlet with a rapier tipped with a deadly poison. The mother drinks the poisoned goblet, intended for Hamlet, and the uncle is run through by Hamlet – also with the poisoned rapier.  The point? 

Horatio’s provides a summary at the backend of Hamlet which also forms a review of Snyder’s work: “So shall you hear – Of carnal, bloody, and unnatural acts – Of accidental judgments, casual slaughters, – Of deaths put on by cunning and forced cause, – And, in this upshot, purposes mistook, – Fall’n on the inventor’s heads. All this can I truly deliver.” Just so.

All too often the events seemed to me to unfold like a Greek tragedy – or in this case a Shakespearian one. You already know the outcome. The suspense is enormous. You want to jump up on the stage and shout, “Don’t open the door – therein lies perdition!” But everything the actors do to try to avoid the tragic outcome seems to advance the action step-by-step in the direction of its fulfillment.

Snyder provides a compelling narrative – and actionable interventions – on how to interrupt the seeming inevitability of a tragic final scene and create the possibility of survival and even, dare one hope, flourishing.

Further Reading

Wilson, K. J. (1996 [2006]). When Violence Begins at Home: A Comprehensive Guide to Understanding and Ending Domestic Abuse, 2ndEdition. Alameda, CA: Hunter House (Publishers Group West).

Websdale, Neil. (1999). Understanding Domestic Homicide. Northeastern University Press.

Campbell, Jacquelyn et al. (2003). “Risk Factors for Femicide in Abusive Relationships: Results from a Multisite Case Control Study. American Journal of Public Health93, no. 7 (July 2003).

Agosta, Lou. (2012). A Rumor of Empathy at Apna Ghar, the Videohttps://tinyurl.com/y4yolree [on camera interview with Serena Low, former executive director of Apna Ghar about the struggle against DV]

Agosta, Lou. (2015). Chapter Four: Treatment of Domestic Violence inA Rumor of Empathy: Resistance, Narrative and Recovery in Psychoanalysis and Psychotherapy. London: Routledge.

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

Top 10 Trends in Empathy for 2020

10. Empathy is the new love. You know how in fashion gray is the new black? Same idea. Empathy is the new love. What people really want is to be “gotten” for who they authentically are as a possibility. In hoping to be understood for who they really are as a possibility, people are not asking for love; they are asking for empathy. If empathy is the new love, what then was the old love?

According to philosophers and poets, the old love is akin to a kind of madness—sometimes divine madness, sometimes just plain earthly madness. The one who is in love is semi-hypnotically held in bondage by an idealization of the beloved. In one way, love shows up as animal magnetism, a powerful attraction; in another way, in a quasi-hypnotic trance, love idealizes the beloved, and, blindly and madly overlooks the would-be partner’s failings and limitations.

Moutain path with sign in Rocky Mountain National Park

Mountainous empathy paths ahead for 2020 with sign in Rocky Mountain National Park

Folk wisdom, as noted, suggests that love is blind; Bob Dylan, that love is just a four letter word; Plato, that love is a kind of madness. So far, love sounds like tertiary syphilis.

The goal of love is to erase the boundary between the self and other. Merger of one’s mind and body with the beloved’s mind and body is the sought after result. In contrast to love, empathy navigates or transgresses the boundary between oneself and other such that the merger is temporary and the integrity of the self and other are maintained. One has a vicarious experience of the other—but the difference and integrity of the self and other are preserved.

So from the relational perspective of too much or too little merger and engagement with the other person—love shows up as a breakdown in empathy. It is now love versus empathy. In contrast with empathy, love is a boundary transgression, but one that is permissioned, invited, welcomed. Thus in empathy one creates a space of acceptance and toleration in which love lives.

  1. Empathy and politics: this is an election year in the USA. Politics in this age of polarization is characterized by bullying. How does empathy speak truth to power?

How to deal with bullying without becoming a bully? Set firm limits – set firm boundaries – thus far and no further. Being empathic does NOT mean giving up the right to self defense.

Still, without naming any names, the problem with mud wrestling with a pig is that everyone gets dirty – and the pig likes it! No easy answers here. One modest proposal:

Empathy is the emotional equivalent of jujitsu – use the aggressor’s energy to send him flying the other way. Being empathic does not mean being nice, agreeable, or even being disagreeable. It means knowing what the other person is experiencing because one experiences it too as a sample or trace affect.

As discussed further below in the trending one-minute empathy training, drive out cynicism, aggression, polarization, bullying, and the result is that empathy spontaneously comes forth, expands, and develops.

Power and force are inversely proportional. As the bully’s power goes down, the risk of the use of force [violence] increases. Empathy is powerful, and if necessary it meets force with force. But then it is no longer an empathy; it is empathy in the form of a breakdown of empathy. Empathy consists in restoring the boundaries and integrity to the situation.

  1. Empathy, capitalist tool: Empathy is the ultimate capitalist tool: No business or enterprise can operate for long, much less flourish, without empathy to facilitate teamwork, coordination between customers and sales persons, employees and employers, leaders and staff, and stake-holders at all levels. Even the cynical sales person understands the value of taking a walk in the customer’s shoes, if only to sell him another pair.

Unfortunately, business leaders lose contact with the human dimension of business in solving legal problems, meeting information technology breakdowns,  reacting to the competition, or dealing with the latest accounting crisis.

Yet empathy is never needed more than when it seems there is no time for it.

Sometimes leaders don’t need more data, leaders need expanded empathy. I hasten to add that, ultimately, both empathy and data are on the path to satisfied buyers, employees, and stakeholders. If the product or service is wrappered in empathy, has an empathic component as part of the service level agreement, gets traction in the market, and beats the competition’s less empathic competing offering, then we have the ultimate validation of empathy. “CEO” now means “chief empathy officer.” We do not just have empathy. We have empathy, capitalist tool.

7. Your brain on empathy: “It’s all in your head” is a necessary truth, but not in     the sense that you are imagining your experience of joy, fear, anger, pain, or suffering. It’s in your head because it—your experience—is in your brain, that is, your nervous system. We are neurons “all the way down.”

A word of caution. This scientific discovery of mirror neurons and mirroring phenomena should be distinguished from the neurohype occasioned by the application of the functional magnetic resonance imaging machine (fMRI) to issues that extend from the pseudo-disciplines of neuro-law to neuro-aesthetics to neuro-marketing and even neuro-history.

Show a jury in court a picture of a person’s brain and it gives the argument credibility (whether for or against conviction). But it is just a picture. Monitoring the neurological activation of individual brains in response to such conditions as videos of painfully impacted limbs, legal arguments, classic paintings, advertisements, and so on, has reached the point where an alternative point of view is being offered on statistically questionable, “voodoo correlations” in fMRI research.

The debate is whether or not mirror neurons exist in human beings. Even if they do not, mirror neurons in monkeys have completed the work that needs to be completed. Some kind of mirroring system exists. It is highly probable that there is an analogous system, even if more complex and diffuse, in humans that functions in mirroring emotions and behavior and that underlies our relationships in empathic community.

However, what the debate has suggested, entirely independently of the status of mirror neurons, is that human beings are connected biologically in a way, not completely understood, such that we resonate with one another affectively. The debate over whether human beings have mirror neurons in the narrower sense continues. The neuro-hype is dialed down in the year ahead.

  1. Empathy is good for you health and well-being. Empathy is on a short list of stress reductionpractices including meditation (mindfulness), Tai Chi, and Yoga. Receiving empathyin the form of a gracious and generous listening is like getting a spa treatment for the soul.   

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. Note: the list of evidence-based articles and peer-reviewed publications is long, not repeated in this short blog post, and can be found in Chapter Four of my Empathy Lessons .

  1. Online empathy in cyberspace: While nothing can substitute for an in-person conversation, after two people get to know one another, an online conversation is a good option in case of relocation, bad weather, or unpredictable scheduling dynamics. You know that resistant client who just can’t seem to get to his session due to traffic, rain, or other tenuous excuse? The possibility of an online session, which requires a computer and the privacy of a closed door, shows up the resistance for what it is.

Psychotherapy invokes a virtual reality all of its own – even without cyber space. This is especially the case with dynamic psychotherapy that activates forms of transference in which one relates to the therapist “as if” in conversation with a past or future person or reality, the latter not physical present. Indeed, with the exception of being careful not to step in front of a bus while crossing the street on the way to therapy, we are usually over-confident that we know the reality of how our relationships work or what people mean by their communications. This is less the case with certain forms of narrowly focused behavioral therapies, which are nevertheless still more ambiguous than is commonly recognized.

Think about it: Those who complain about the lack of reality in a conversation over Zoom may usefully consider the amount of fiction and fantasy in any psychodynamic conversation, full stop. Never was it truer that meaning – and emotions such as fear – are generated in the mind of the beholder.

(Note: This trend is in part an excerpt from: Lou Agosta’s article “Empathy in Cyberspace: The Genie is Out of the Bottle” in Theory and Practice of Online Therapy: Internet-delivered Interventions for Individuals, Groups, Families, and Organizations edited by Haim Weinberg and Arnon Rolnick. London and New York: Routledge: To order the complete book, click here: Theory and Practice of Online Therapy [https://tinyurl.com/yyyp84zc])

  1. Empathy and law enforcement: My friends, associates, and colleagues on the police assure me that posters branded with the logo of the local police and a pitch for expanded empathy are showing up in police station locker rooms, break rooms, and behind the scenes facilities. At this point in time, these are for the police, not the public.

Street smart police “get it” that empathy is distinct from compassion or “being nice.” Empathy is a method of data gathering about the experience of the other person. The police officer’s emotional radar has to be out about what the would-be suspect or citizen or fellow officer is experiencing if the officer is to avoid making a potentially bad situation worse.

If the would-be suspect is enraged and about to escalate such a scenario requires a distinct response than if the suspect is afraid and literally shaking in his shoes. Empathy provides  valuable and indispensable emotional intelligence about the mental status of the other person. The police are already guided by their common sense, intuition, and gut feeling in approaching other people. Why not provide explicit training in what to do with one’s empathic receptivity, for that is what this “gut feeling” and intuition amount to? Police departments are realizing that practice in empathy lessons can refine and fine tune the intuition and gut feeling so these actually become powerful tools literally in keeping the peace or when necessary minimizing the appropriate use of force.

All this is important and communities will benefit from expanded empathy on the part of the law enforcement. However, there is another reason that indicates this trend has traction. The public does not always hear about the multi-million dollar financial settlements that municipalities are required to pay for wrongful death or excessive use of force, because these agreements come with rigorous confidentiality clauses. Police who lack training turn out to be extraordinarily expensive to the tax payers. In this context, “lack of training” does not mean insufficient time taking target practice. It means the need for practice in putting oneself in the other person’s shoes and considering possibilities for conflict resolution, de-escalation, and community building. In short, empathy is an important part of the gear deployed by law enforcement as the warrior cop, which will still be needed in extreme situations, gives way to community policing. Really, is there any other kind?

  1. Natural empaths get expanded empathy. This continues the trend from last year. Paradoxically, natural empaths suffer from a lack of empathy. Natural empaths are so sensitive to the pain and suffering of the world that they must isolate themselves, cutting themselves off from the emotional life sustaining recognition and support that people require to flourish and be fully human.

The Natural Empath falls into a double bind, and her suffering seems inevitable. She is swamped by too much openness to the suffering of the other person or overcome by guilt at not living up to her own standards of fellow-feeling and ethics.

But the suffering is not inevitable. Such statements imply that empathy cannot be regulated through training, albeit a training that goes in the opposite direction (from too much empathy in the moment to less empathy) than that required by the majority of people, who are out of touch with their feelings and need to “up regulate” their empathy.

The empathy lesson for the Natural Empath is to “tune down” her empathic receptivity and “tune up” her empathic understanding and interpretation, while being more flexible about her ethical standards. Here “flexible” does not mean be unethical, but rather allow for the possibility that one needs to work on the balance between one’s own well-being and that of others in helping others.

Now please do not jump to conclusions. That does not mean the Natural Empath should become hard-hearted or unkind. That would definitely not expand empathy. In order to overcome the breakdown of empathic receptivity, what does one actually do in order to expand or contract one’s empathic receptivity?

The empathy lesson for such individuals? Practice methods of “down regulating” one’s empathy. For example, focus on mentalizing, top down empathy, placing oneself in the other person’s shoes, rather than imaginatively evoking the vicarious emotions of the other person’s experiences. Perspective-taking exercises—imaginatively putting oneself in the other’s point of view—expand the participant’s empathy during training sessions. Perspective taking incidentally promotes helping, “pro social” behaviors when it indirectly activates pro-social emotions such as compassion.

Instead of complaining about being an overly sensitive, Natural Empath (however accurate that may be) do the work of practicing empathy by “down regulating” one’s empathic receptivity in a given situation, transforming empathic distress into a vicarious experience. Do the work of “up regulating” empathic interpretation whereby one imaginatively puts oneself in the other person’s position and considers the experiences thereby inspired vicariously, reducing the “load” on the emotions. This is different than intellectualizing, compartmentalizing, or distinguishing in thought, but perhaps not different by much. The differences are nuanced, but of the essence.

The recommendation regarding training? Most people need to expand their empathy; some people—Natural Empaths—need to contract (or inhibit) their empathy. Empathy regulation—learning to expand and contract empathy—is the imperative in either case.

  1. Empathy and psychiatry: The mind engage fixing their own professional house: The psychiatrists with whom I talk advocate a deep and authentic appreciation of the practice of empathy—in order to get the patient to take the medicine. I express agreement—if you are thinking of stepping in front of a bus, don’t! Take the medicine and live to fight another day.

However, this points to the blind spot in psychiatry: A conversation for possibility with another empathic human being also changes one’s neurons and does so in a different but as deep and powerful a way as a psychopharmacological intervention. The mechanism is complex is not fully understood, but neither is the mechanism for lithium salts or antipsychotic medications.

Psychiatrists and many general practitioner MDs are perpetuating a fiction that the drugs they are prescribing are correcting biochemical deficiencies caused by disease, much as (say) a prescription of insulin corrects a biochemical deficiency caused by diabetes (for example see Anne Harrington’s The Mind Fixers, p. 273, which I have found essential in identifying this trend and whose language I paraphrase here). Such rhetoric is badly oversold. No one is saying that the medicines do not help the person tolerate distress, regulate emotions, or self-sooth. Often they do. However, the rhetoric is indefensible and the science is at best a work in progress.

Given the complexity of the scientific challenges, psychiatry need not feel embarrassed. However, neither should it be enthusiastically promoting imminent breakthroughs and revolutions as if it were an adjunct to the popular press or a corporate press release.  

The underlying science is not anywhere near the level the neurohype would have us believe. “You have a chemical imbalance” is a marketing position, not a scientifically established truth. “Schizophrenia is like diabetes and you have to take this antipsychotic drug for the rest of your life” is a rhetorical position, not a scientific fact. This is scientism, not science. This is psychiatry’s troubled search for the biological basis of mental illness. The trend being highlighted here is that, as a profession, psychiatry will focus on medical interventions in the context of culture and community.

  1. The one-minute empathy training is trending: Remove the obstacles to empathy such as cynicism and bullying—and empathy comes forth. Remove the resistances to empathy and empathy naturally and spontaneously expands. Most people are naturally empathic.

Eliminate the obstacles to empathy and a space of acceptance and toleration spontaneously comes froth.

Now do not sufficiently appreciate this: people are born with a deep and natural capacity for empathy, but they are also born needing to learn manners, respect for boundaries, and toilet training. Put the mess in the designated place or the community suffers from diseases. People also need to learn how to read and do arithmetic and communicate in writing. But there is a genuine sense in which learning to conform and follow all the rules does notexpand our empathy or our community. It does not help the cause of expanded empathy that rule-making and the drumbeat of compliance are growing by leaps and bounds.

The work at hand? Remove the blocks to empathy such as dignity violations, devaluing language, gossip, shame, guilt, egocentrism, over-identification, lack of integrity, inauthenticity, hypocrisy, making excuses, finger pointing, jealousy, envy, put downs, being righteous, stress, burnout, compassion fatigue, cynicism, censorship, denial, manipulation, competing to be the biggest victim, insults, injuries to self-esteem, and narcissistic merger—and empathy spontaneously expands, develops, and blossoms. Now that is going to require some work!

Teaching empathy consists in overcoming the obstacles to empathy that people have acquired. When the barriers are overcome, then empathy spontaneously develops, grows, comes forth, and expands. There is no catch, no “gotcha.” That is the one-minute empathy training, pure-and-simple. 

Okay – I have read enough and I want to order the book Empathy Lessons to learn more about expanding my empathy: I want to order the book HERE.

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