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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
Listen to podcast on Spotify or via Anchor: https://anchor.fm/lou-agosta-phd/episodes/Empathy-Capitalist-Tool-Part-1-The-Empathy-Deficit-in-Business-is-Getting-Attention-e18tlcn
Children and parents get it. Nurses and doctors get it. Teachers and students get it. Couples get it. Consultants and clients get it. Neighbors get it. What about business people? Do they “get it”—that empathy produces results? Practicing empathy is a neglected opportunity in business. The qualities, practices, and behaviors that help a person build a business sometimes work against expanding the person’s empathy.
An executive’s ego, opinion, expertise, and attachment to being right raise the bar on empathizing with others, who may have diverging mind sets. Hard charging entrepreneurs find it hard to let go of their status or set aside the lessons learned as they came up through the ranks. Executives and managers lose touch with the experiences, perceptions, and perspectives of customers, employees, and stake-holders.
The urgent drives out the important. Management effort and time are monopolized responding to competitive pressures, compliance issues, legal challenges, and solving technology problems.[i] For example, according to a report from Businessolver, a human resources and talent consultancy, some 60% of executives believe that their organizations are empathic, whereas 24% of their employees agree.[ii] An empathy deficit?
The stress of operating the business—deadlines, financial issues, staffing crises, software breakdowns, competition, litigation—drive out empathy and a deep appreciation that a commitment to empathy is good for business. The disconnect is substantial between perceptions in the executive suite and in the cubicles of workers and the front line, customer-facing staff.
Ironically, the empathic practices such as the receptive, interpretive, and responsive processes described in detail in this work (as opposed to compassion) are what are most urgently needed in dealing with customer demands, employee crises, negotiations with competitors, vendors, clients, and one’s own budgeting authorities and board, optimally resolving conflicts with reduced cost and impact.
When I ask business leaders what is their budget for empathy training, the response is often a blank stare. Zero. However, when I ask the person what is the budget for expanded teamwork, reduced conflict, enhanced productivity, commitment to organizational goals, taking ownership of outcomes, product and service innovations, then it turns out that budget exists after all. Empathy makes a difference in connecting the dots between business skills and performance. Empathy contributes to results in a powerful way by engaging the staff’s energies and commitments at a fundamental level.
While every business has its own distinct commitments, in many ways, the basic empathy training in business is the same as empathy training in every other context.
The training consists in surfacing and driving out the cynicism, denial, shame, implicit threats, and pressure that many business people experience in their communications. Empathy then spontaneously comes forth and expands the space of possibilities to do business. This does not mean that businesses do not have their own blind spots when it comes to empathy. They do. Therefore, let us take a step back and look at what it is going to take.
An appreciation of the value of empathy to promote breakthrough results often starts in sales. In business, the sales people get it. Developing empathy with customers is good for business.
Even the cynical sales person recognizes that putting oneself in another person’s shoes is a good method of selling them another pair.[iii] The sales person gives the prospect some empathy. Shazam! The customer calls you to close the deal. Wouldn’t it be nice?
Yet the basic idea is straightforward. When the customer appreciates that the sales person is interested in the customer’s requirements, that the sales person is listening, then the customer is likely to open up and candidly share what is stressing him—budget, deadlines, internal politics, market dynamics, or the competition.
When the prospective customer feels that the sales person has understood him, the chance is significantly expanded that he will prefer to purchase the product or service from the empathic representative. Once the customer feels the sales person is listening, the customer will share details about his needs, vulnerabilities, and shortcomings, including those about which he might otherwise be defensive, enabling the sales person to position the product or service as a solution to the perceived problem.
This is not “new news.” In 1964, in the Harvard Business Review—not exactly an obscure, backwater publication—David Mayer and Herbert M. Greenberg called out the two basic qualities that any good sales person must have: empathy and ego drive. These authors define “empathy” as the central ability to feel as other people feel in the context of selling them a product or service.
In Mayer and Greenberg’s article, the sales staff were trained to interrupt themselves when they found that they were reacting defensively to customer complaints, whether legitimate or not, whether solvable or not. Stop—hit the pause button before responding. Instead of reacting to the complaint, the sales person was trained to “get” the complaint and to communicate back to the customer that he “got it,” namely, that the customer was upset (or whatever the customer was self-expressed about).
The sales person was trained to acknowledge that a breakdown had occurred. Key term: breakdown. The sales person was trained to acknowledge the complaint by calling it out: “This is a break down!” Even if the customer is inaccurate or wrong in his complaint about some detail, the customer is always—the customer.
By definition, the breakdown in the product or service occurs against the expectation of customer satisfaction. The relationship between the buyer and seller is itself in breakdown against the expectation of satisfaction. This does not rule out the possibility that additional training is needed on the part of the customer about product features or the service level agreement; but such training is substantially different from a defensive reaction.
The next step is repairing, fixing, or at least managing the cause of the complaint: the respondent then solicits additional feedback and details as to the complaint, i.e., what went wrong. The empathic response includes what one is going to do about the breakdown and by when.
The committed listening, that is, empathy, creates a clearing for communication, improving the sales process, and restoring authenticity to the relationship when integrity has gone missing. While there are no guarantees, customers treated in such a way tend to stick. Repeat business, maximizing revenue over the lifetime of the relationship, is one of the outcomes. [iv]
Development Dimensions, Intl., (DDI) identifies empathy as one of the critical success factors in executive leadership. One of the leading talent development corporations in the market, DDI’s report on High Resolution Leadership identifies empathy as an emotional quotient (EQ) “anchor skill.”
Empathy provides the foundation for interpersonal leadership skills such as developing subordinates, building the consensus for action, encouraging engagement, supporting self-esteem, and taking responsibility.[v]
In the DDI study, listening and responding with empathy were demonstrated by 40% of executives profiled (as opposed to 71% whodemonstrated taking responsibility or 54% who demonstrated building agreement on actions to take).
The conclusion is that, as regards empathy, the majority of leaders have room for expanding their performance. The good news is that, using interventions designed to expand empathy, the empathy skills needed to drive business results are within reach. [vi]
Thus, the empathy deficit in business is getting attention. Empathy is moving to the foreground. The role and contribution of empathy to business results is penetrating the awareness of leaders, managers, staff, and stake-holders.
Closely related to the challenge of closing the empathy deficit in business is the challenge that “economic man” is significantly different than man as such. Let’s define our terms.
The person who conducts transactions in the market is defined in business school as economic man—homo economicus. The latter is significantly different than man, the human being as such. The person (man) in the economic theory is rational, selfish, and her or his tastes do not change.
Business practices assume the organization is engaging with customers, employees, stake-holders, and leaders who fit the model of economic man. Human beings, on the other hand, do not. Most people in business do not know anyone who fits the description of economic man. Why then are we so busy trying to do business with him when he does not even exist?
Unlike the person described in economics in business schools, humans are limited in their reasonableness. Humans are diverse and inconsistent in their preferences. Humans are even limited in their selfishness, being generous and compassionate in unpredictable ways.
The issue? Nobel Prize winning economist Gary Becker’s rational choice theory (preference theory) in economics has been extended to many other aspects of life. Becker’s rational choice theory has been extended to areas as diverse as marriage, crime, and discrimination.
Generalizations from rational choice theory to the social sciences at large have been a growth industry in the social sciences. From the rich mixture of inconsistencies and contradictions that most people really are in life, the human being was translated into a function of rational, self-interested, and allegedly consistent preferences. The human as such has been simplified and redescribed as a rational, calculating engine of human behavior.[vii]
People are supposed to be consistent in their preferences and tastes. People are supposed to be logical and consistently obey the rules. But finding counter-examples is easy.
For example, if a person prefers coffee to hot chocolate and the person prefers hot chocolate to tea, then, according to this logic, the person is supposed to prefer coffee to tea. [Think: coffee > hot chocolate > tea; therefore, coffee > tea, according to the transitive rule, in which “>” means “prefers.”] But, no, it doesn’t work that way. Given all these personal preferences as indicated, the person still chooses tea instead of coffee. The person just prefers tea to coffee. The individual is from London!
Nothing inherently illogical exists in preferring coffee to hot chocolate and tea to coffee while also preferring hot chocolate to tea. Nothing unless one insists on making a dynamic network into a transitive sequence. So much for rational choice theory.
The lesson? Empathy as well as logic are required to understand decision making. Without allowing for the possibility of empathy, economics produces some strange results. People are not natural born statisticians, logicians, or gamblers, though the discipline of economics sometimes seems to assume so.
Still, testing a person’s decisions and preferences using probabilities, bets, and lotteries is an engaging exercise, and nothing is wrong in doing so. However, unless one also adds empathy to the mixture of economics and logic one misses something essential—the person!
Now, I apologize in advance to the reader for the technical terms, but in economics the chance of winning a bet is expressed as an “expected utility.” “Expected utility” is technical talk for “satisfaction” or “happiness.” (But nothing more than arithmetic is needed to get this. )
For example, in economics the expected utility of a 10% chance of winning a million dollars is $100K [.10 x 1,000,000 = 100,000] [note: K = 1,000]. If Jack and Jill both end up with a million dollars, they should enjoy the same expected utility, no? Remember, Jack and Jill are supposed to be rational, selfish, and consistent in their preferences. Now consider a counter-example:
Today Jack and Jill each have a million dollars.
Yesterday Jack had zero and Jill had two million dollars.
Are they equally happy? (Do they have the same utility?)
You do not need an advanced degree to know that today Jack is very happy and Jill is in despair. Yesterday Jack had zero; now he has a million dollars. Hurrah! Yesterday Jill had two million dollars; now she has only one million. Ouch!
We must be able to put our ourselves in the shoes of Jack and Jill and get a sense of their expectations. Sounds familiar?
These expectations, in turn, constrain their experience of satisfaction (i.e., happiness). To grasp the outcome in terms of their individual experiences, we need an empathic anchor or reference point in their expectations from which they begin. Empathy gives us access to an anchor point in their respective experiences.
Our empathy shows that outcomes are linked to feelings about the changes of one’s wealth rather than to states of wealth. The experience of value depends on the history of one’s wealth, not only the current state of it.
Yet another bold empathy lesson: People are strongly influenced by hope and fear. Empathy indicates that people attach values to gains and losses, and these are weighted differently than logical probabilities in decision making. This is not just saying that people are irrational, though that may be true enough at times, too. This says that people (and their behavior) frequently do not conform to the pattern of rationality, selfishness, and consistency in preferences.
Still, the matter is not hopeless for those committed to pattern matching in economics. People are frequently surprising, but sometimes in predictable ways. People are sometimes inconsistent, but one can sometimes predict those inconsistencies if one learns one’s empathy lessons.[viii] For example:
(1) People are risk averse due to fear of disappointment and regret. The empathy lesson is that people try to avoid risks even in situations where taking a risk is a good bet. “A good bet” is determined according to the probability calculation.
Consider: if a person had a 90% probability of winning a million dollars, he ought to accept $900K as a “sure thing” settlement, which settlement is logically equivalent to a 90% probability of winning the million dollars [.9 x 1,000K = 900K]. The 10% probability of not winning is an unlikely outcome, but still possible. The “unlikely outcome” often determines the result.
For example, law suits in cases of accidents and contract disputes produce settlements in trial law indicating that people will “settle for” $800K or even $750K for the possibility of knowing the outcome with certainty. For most people that is still a lot of money, and the possibility of having to live with the regret of missing the pay-off due to an unlikely outcome gets most people out of their comfort zone. They decide to settle.
Empathic receptivity to the possibility of disappointment and regret may usefully “override” the rational, self-interested, and consistent preferences that the purely economic person brings to the negotiations.
(2) People are risk seeking in the hope of getting an even larger gain instead of accepting a modest settlement.
This is why people bet on the state lottery where the chance of winning is vanishingly small. Such a bet is illogical, but common. We need expanded empathy to get a clue what is going on here.
The empathy lesson indicates that people are not buying a chance to win a big pot of money. Rather people are buying a chance to dream of the possibility of winning the big jackpot. “We are such stuff as dreams are made of,” said Shakespeare. The value is in the dreaming, that is, precisely in the possibility of the big jackpot, not the jackpot itself. That such a dream would more likely be the dream of a poor person rather than an affluent one is a further problem that invites attention.
If one looked rationally at the odds, one would not buy the ticket. No way. Clearly lotteries are popular, especially with the poor and “have nots.” The possibility of escaping from poverty is being manipulated in a cynical way by the establishment, and we citizens have all become “addicted” to the revenue stream.
The lottery budget and effort would be better devoted to job training and instruction in basic financial management, except now lotteries have become a source of revenue for local government and education. This is a breakdown in empathic understanding, which gives us our possibilities. It is hard not to become a tad cynical in considering that the poor are paying for education through lottery revenue, though they are often unprepared to benefit from or hindered from accessing the educational opportunity.
(3) People are risk seeking in the hope of avoiding a loss in situations in which simply stopping a project altogether would enable cutting their losses (rather than incurring additional likely losses). Defeat is difficult to accept. The empathy lesson is that people are attached to an ideal, in this case a losing cause, for reasons extending from perseverance, egoism, greed, risk aversion, fear of the unknown, all the way to idealism, romance, blind hope, and just plain stubbornness.
People (and businesses) facing a bad outcome manage to turn a survivable (but painful) failure into a complete meltdown. Desperate gambles often make a bad situation worse in exchange for a small hope of avoiding the loss at all. Businesses, individuals, and even countries, continue to expend resources long after they should blow the bugle, lower the flag, and leave, implementing an orderly retreat. Instead people (and organizations) persist in a lost cause until a rout becomes inevitable.
Business accounting teaches the basic idea of a “sunk cost.” Suppose Octopus, Inc., (OI) is building a new software system for $100 million dollars. OI has already spent $150 million. The project is over-budget. It is estimated to take another $55 million to complete the job. Suppose further that evidence of a new, breakthrough technology really exists. It would enable OI to develop the system from scratch for $25 million. What should OI do? The money already spent is a “sunk cost.” It should not influence the decision. Given the evidence that the new technology really works, the OI project leader should throw away the over-budget system and build the new one from scratch, spending $25 million and saving $30 million against the projected completion cost of the project. However, that is not what most project leaders would do.
Due to a sense of ownership of the over-budget project and a fear of the unknown in engaging the new technology, many project leaders double down on the investment in a losing proposition. In a breakdown of empathic interpretation, they continue to project their hopes and fears onto the old technology and, as the saying goes, throw good money after bad.
(4) People are risk averse due to a fear of a large loss and may rationally and usefully bet on a small chance of (avoiding) a large loss. This is why people buy insurance. The empathy lesson is that people are not merely buying protection against an unlikely disaster; they are buying peace of mind, the ability to get a good night’s sleep. If the negative event would have catastrophic consequences, creating a risk pool, in which everyone participates, spreading the risk in a manageable way, makes compelling sense. Note that certain risks such as war and civil insurrection (or a giant asteroid hitting the earth) are uninsurable. Insurance is a calculation, not a gamble against undefined odds. In general, the insurable risk must relate to individuals or subgroups and the occurrence of the risk should not destroy the infrastructure of the entire community, which needs to be intact to cover the insured risk.
Insurance was a brilliant business innovation that emerged at about the time of the European Renaissance as traders in the Netherlands—those frugal Dutch—were sending valuable but fragile ships to fetch precious cargo in far away lands. The risks and rewards were great. How to even out the odds? Insurance was born.
In our own time, one can see the irrationality, the unempathic response, and gaming of the system by special interests in health insurance in the USA where attempts were made to exclude the sickest people from the insurance pool through penalties for preexisting illnesses, combined with charging monopoly rents to the healthiest participants.
Insurance is often a “good bet” when an outcome that is highly unlikely but catastrophic can be managed by everyone (or a large group) incurring a small cost to spread the risk. But how to get everyone at risk into the pool? When told that people have no health insurance, some politicians are supposed to have said: “Let them pay cash!” In another context, in one the most spectacular breakdowns in empathic responsiveness in modern European political history, the French Queen, Marie Antoinette, was told that the people had no bread, and she is supposed to have said: “Let them eat cake!” Same idea?
Saying that the purpose of business is to make money is like saying the purpose of life is to breathe. Keep breathing—and make money—by all means. But the purpose of life is to find satisfaction in one’s work, raise a family, write the great American novel (it’s good work if you can get it!), experience one’s efforts as contributing to the community and making a difference.
Likewise with business. Business is about delivering human value and satisfying human demands and goals, whether nutrition, housing, transportation, communication, waste disposal, health, risk management, education, entertainment, and so on. Even luxury and conspicuous consumption are human values, which show up as market demands.
In conclusion, business people “get it”—empathy is good for business. Profit is a result of business strategy, implementation, and operations, not “the why” that motivates commercial enterprise. And if profit shows up that way (as the “the why”), then you can be sure that, with the possible exception of index derivative hedging, it is a caricature of business and a limiting factor. Business prospers or fails based on its value chain and commitment to delivering value for clients and consumers. However, as noted, some of the things that make people good at business make people relatively poor empathizers.
Business leaders lose contact with what clients and consumers are experiencing as the leaders get entangled in solving legal issues, reacting to the competition, or implementing the technologies required to sustain operations. Yet empathy is never needed more than when it seems there is no time or place for it. This is a challenge to be engaged and overcome.
What to do about it? Practice expanded empathy. Empathy is on the critical path to serving customers, segmenting markets, positioning products (and substitutes), psyching out the competition—not exactly empathy but close enough?—building teams and being a leader who actually has followers. Empathy makes the difference for contributors to the enterprise at all levels between banging on a rock with a hammer and building a cathedral. The motions are the same. When the application of empathy exposes and strengthens the foundation of community, then expanding empathy becomes synonymous with expanding the business. Building customer communities, building stakeholder communities, building teams that work, are the basis for product innovation, brand loyalty, employee commitment, satisfied service level agreements, and sustained or growing market share. Can revenue be far behind? Sometimes leaders don’t need more data, leaders need expanded empathy, though ultimately both 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 offering, then we have the ultimate validation of empathy. We do not just have empathy. We have empathy Capitalist Tool!
[i] Katja Battarbee, Jane Fulton Suri, and Suzanne Gibbs Howard. (2012). Empathy on the edge: Scaling and sustaining a human-centered approach in the evolving practice of design, IDEO:
http://liphtml5.com/gqbv/uknt/basic [checked on 03/31/2017].
[ii] William Gentry. (2016). Rewards multiply with workplace empathy, Businessolver: http:// http://www.washingtonpost.com/sf/brand-connect/businessolver/rewards-multiply-with-workplace-empathy/ [checked on 03/31/2017].
[iii] Roman Krznaric. (2014). Empathy: Why It Matters, and How to Get It. New York: Perigree Book (Penguin): 120.
[iv] C.W. Von Bergen, Jr. and Robert E. Shealy. (1982). How’s your empathy? Training and Development Journal, November 1982: 22–28: http://homepages.se.edu/cvonbergen/files/2012/11/Hows-Your-Empathy.pdf [checked on 03/31/2017].
[vi] William Gentry, Todd J. Weber, Golnaz Sadri. (2007). Empathy in the workplace: A tool for effective leadership, http://www.ccl.org/wp-content/uploads/2015/04/EmpathyInTheWorkplace.pdf [checked on 03/31/2017].
[vii] Bernard E. Harcourt. (2015). Exposed: Desire and Disobedience in the Digital Age. Cambridge, MA: Harvard University Press.
[viii] Daniel Kahneman. (2011). Thinking, Fast and Slow. New York: Farrar, Straus, and Giroux.
(c) Lou Agosta, PhD and the Chicago Empathy Project
Here is the short, half day course on Empathy, Stress (Reduction) and Neural Science delivered at the Joe Palombo Center for Neuroscience at the Institute for Clinical Social Work. The image depicted is the punchline to a Richard Feynman (physicist) joke about the cosmos – “It’s turtles all the way down” – in the case of neuroscience “It is neurons all the way down!” Granted that the joke is not funny if one has to explain it, the video provides all the background you need to laugh (one way or the other!)
You can also watch directly on Youtube by cutting and pasting into your command line without the dash
A famous person once said: “Empathy is oxygen for the soul.” So if one is feeling shortness of breath, maybe one needs expanded empathy! This course will connect the dots between empathy and neuroscience (“brain science”). For example, empathic responsiveness releases the compassion hormone oxytocin, which blocks the stress hormone cortisol. [This is an over-simplification, but a compelling one.] Reduced stress correlates to reduced risk of such life style disorders as cardiovascular disease, diabetes, weak immune system, depression, and the common cold.
The session engages each of the following modules in the discussion segment, including suggested readings. Except for the first two topics, we can take them in any order and the participants will get to select:
- This is your mind on neuroscience – mirror neurons: do they exist, and if not, so what?
- Sperry on the split brain: the information is in the system: how to get at it
- The neuroscience of trauma – and how empathy gives us access to it
- MRI research: as when Galileo looked through the telescope, a whole new world opens
Image: The punch line is “turtles – all the way down” – well, likewise – “neurons – all the way down.”
Presenter: Lou Agosta, PhD, is the author of three scholarly, academic books on empathy, including A Rumor of Empathy: Resistance, Narrative, Recovery (Routledge 2015). He has taught empathy in history and systems of psychology at the Illinois School of Professional Psychology at Argosy University and offered a course in the Secret Underground Story of Empathy at the University of Chicago Graham School of Continuing Education. He is an empathy consultant in private practice in “on the forward edge in the Edgewater Community” in Chicago. If you need some empathy and want to get a good listening, talk to Dr Lou.
(c) Lou Agosta, PhD and the Chicago Empathy Project
Got to Empathy Lessons on Spotify: https://open.spotify.com/episode/1OvEwkDD9b3IH66erzehnM?si=MeQ6C1uTQDyYGuAUGbegBw ] [more episodes coming soon]
Go to all A Rumor of Empathy podcast(s) on Audible by clicking here: [https://www.audible.com/pd/A-Rumor-of-Empathy-Podcast/B08K58LM19]
A rumor of empathy (the podcast) hears of a report of an alleged example of empathy in the work, action, or conversation of a person or organization. I then reach out to the person and talk to them in detail about the work they are doing try to get the facts and confirm or disconfirm the validity of the rumor. Makes sense?
A Rumor of Empathy is committed to providing a gracious and generous listening, empathy, in conversation with its guests and listeners. Join the host in chasing
down and confirming or debunking an unsubstantiated report of empathy in the community and engaging in an on the air conversation in transforming human struggle and suffering into meaningful relationships, satisfying results and contribution to the community. When one is really listened to empathically and heard in one’s struggle and effort, then something shifts. Possibilities open up that were hidden in plain view. Action that makes a difference occurs so that empathy becomes less of a rumor and an expanded reality in your life and in the community. When all the philosophical arguments and psychological back-and-forth are over and done, in empathy, one is quite simply in the presence of another human being. Join Dr Lou for an empowering conversation in which empathy is made present.
Go to all A Rumor of Empathy podcast(s) on Audible by clicking here: [https://www.audible.com/pd/A-Rumor-of-Empathy-Podcast/B08K58LM19]
One of the misunderstandings of empathy is that “empathy means weakness.” Not so. Why not?
Empathy means being firm but flexible about boundaries. The most empathic people that I know are also the strongest and most assertive regarding respect for boundaries. Being empathic does not mean being a push over. You wouldn’t want to mess with them. Where such people show up, empathy lives—shame and bullying have no place. (For a working definition of empathy, see the note at the bottom of this post.)
Empathy thus solves the dilemma of how to deal with a bully without becoming a bully oneself. Bullies are notoriously causal about violating the boundaries of other people, because it is easier to cause pain than to feel pain. Bullies are taking their pain and working it out on other people. Bullies do not acknowledge their own vulnerabilities, and they work out their issues – I almost said “shxt” –on other people. Bullies are offloading their distress on other people. But what to do about it from an empathic perspective?
I am going to answer that question directly, but first take a short step back: Once the stones start flying back-and-forth, there is nothing to do but defend oneself or try to escape if outnumbered – retreat. If it is a school year brawl, hit ‘em back in self-defense if one is able. If the corporate boss is a bully, document and escalate – and update your resume just in case. If the bully is a politician, speak truth to power like Malcolm-X did: “You did not land on Plymouth Rock; Plymouth Rock landed on you” – use humor to bring down arrogance and privilege.
Once the stones start flying, the conversation is no longer about empathy or vulnerability. It is about who has the biggest cudgel or stone. Empathy did not work – empathy is in breakdown along with common courtesy and decency – call for backup! However, if things are still at the stage of name calling, remember what to my secular ears the ultimate empath of the spirit, Jesus of Nazareth, said and did. He was outnumbered with the woman “taken in adultery” confronting an angry mob of scribes, elders, and Pharisees, armed with large stones: “Let he who is without sin cast the first stone” (John 7:53 – 8:11). Nothing happened. No one dared be the first to assert his perfection. While the originality of this passage may be debated – did John really write it and who the heck is John, anyway – the pasage’s psychological power is beyond question.
In the face of loss of power, authority escalates to violence. Jesus dared to make himself vulnerable by aligning with the woman who had violated the community’s standards, which were so rigid that a case of infidelity threatened to below up the entire fabric of civilization. Otherwise, why would the authorities need to stone her to death? (And it really was all men who were about to do the stoning – so you can see there were many problems here!)
Always the astute practitioner of empathy, Jesus got inside their heads. He knew the authorities wanted to look good and claiming to be better than everyone else would make them look bad. Instead of shaming the woman Jesus turned the tables and put the authorities to shame. To get power over shame one has to allow oneself to be exposed and vulnerable to it. Be proud!
Thus, Brené Brown makes a parallel observation about vulnerability – she does research on vulnerability and shame – and asserts that it is a myth that “vulnerability is weakness.” Thus her project is to expand our appreciation of the power of vulnerability.
As Brené Brown uses the distinction “vulnerability,” she means living with uncertainty, living with risk, and living with emotional exposure. She understands vulnerability to mean letting go of “looking good” or fear of being ashamed. She means it to go in harm’s way emotionally or even physically and spiritually by having difficult conversations and taking actions about the things that make a difference – relationships, finances, careers, values, fairness, and so on. The inner game of vulnerability is different than the behavioral vulnerability that consists in leaving the password to your bank account on a yellow sticky pasted to your computer.
Brené Brown’s coaching is to expand vulnerability in the sense that I have my vulnerabilities; not my vulnerabilities have me. Her lesson “no courage without vulnerability” means that the courageous person goes forth into risk and danger in spite of being afraid. The person who imagines he is without fear is precisely the one who behaves in a foolhardy way, for example, Colonel Custer at the Little Bighorn, about to be wiped out, saying “We’ve got them now!” completely unaware of the risks he was taking. He did not have his vulnerability; his vulnerability had him – and did him in along with his regiment.
I hasten to add that empathy and vulnerability are different phenomena, not to be confused with one another. They are not either/or – the world needs more of each one – expanded empathy as well as the power conferred by expanded vulnerability.
You cannot do empathy alone. I get my empathy from the other individual. The other individual expands my empathy by giving me his; and I acknowledge the other individual’s humanity by giving him my empathy. The baby brings forth the parent’s empathy and is socialized by it – brought into the human community. The student brings forth the teacher’s empathy and is educated through it – brought into the educated community. The customer arouses the businessperson’s empathy and is served by it – brought into the community of the market. The list goes on.
Likewise, you cannot do vulnerability alone. The more armored up and defensive a person becomes, the less vulnerably, the less uncertainty, risk, and emotional exposure the person incurs. However, without uncertainty, risk, or exposure, such essential results as innovation, productivity, courage, relatedness, satisfaction, and, yes, empathy, get lost.
Even though empathy and vulnerability are distinct phenomena, when they occasionally breakdown and fail, the component fragments are remarkably similar. Empathic receptivity breaks down as emotional contagion; likewise, in vulnerability a person is overwhelmed by the emotions of the moment.
Empathic understanding breaks down as conformity. Instead of relating to the other person as an authentic possibility, one conforms to the crowd and what “one does.” Likewise with vulnerability, risk is replaced with playing it safe, not rocking the boat, and remaining as invisible as possible.
Empathic interpretation breaks down as projection. Instead of taking a walk in the other person’s shoes to appreciate where they pinch the other person, one projects one’s own reactions and responses onto the other. Likewise with vulnerability, uncertainty is replaced with being right, making the other person wrong, and shutting down inquiry and innovation in the interest of not rocking the boat.
Empathic responsiveness breaks down in getting lost in translation. Instead of acknowledging the other person’s struggle as disclosing aspects of one’s shared humanity, one tries to “cap the rap,” get the last word in, and win the argument. Likewise with vulnerability, one talks about the other person instead of talking to them. Free speech is alive and well; but what has gone missing is listening. People are [mostly] speaking freely – no one is listening. It doesn’t work.
In each of the breakdowns of empathy, I do not have empathy – rather my break down in empathy has me. Instead of asking, what is wrong? Rather ask, what is missing? And, in this case, what is missing, the presence of which would make a difference, is a radical acceptance that empathy requires emotional exposure to the uncertainty and risk taking of related. That is precisely vulnerability.
When vulnerability is added to empathy the result is community. Since we are on a roll with our secular but empathic interpretation of spiritual readings, in the defining parable of community, empathy is what enables the Good Samaritan (Luke 10: 25–37) to be vulnerable to a vicarious experience of what the survivor of the assault and robbery is experiencing.
In contrast, the priest and Levi experience empathic distress – are armored up and defensive in the face of vulnerability – and have to cross the road. The Samaritan’s empathy tells him what the survivor is experiencing; and it is the Samaritan’s vulnerability and ethics that tell him what to do about it. The two are distinct. Yet empathy expands the boundary of who is one’s neighbor to be more-and-more inclusive, extending especially to those whose humanity has been put at risk by the vicissitudes of vulnerability. Be inclusive.
Note: the short definition of empathy is that it is a multi-phase way of relating to people individually and in community with receptivity to the other’s affects, understanding of the other as an authentic possibility, an appreciation of the other’s perspective, and responsiveness in acknowledgement of the other’s humanity in the other’s communication.
Brené Brown. (2012). Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead. New York: Avery, a Division of Random House Penguin.
Lou Agosta. (2010). Empathy in the Context of Philosophy. London: PalgraveMacmillan.
_________. (2014). A Rumor of Empathy: Rewriting Empathy in the Context of Philosophy. New York: Palgrave Pivot.
________. (2015). A Rumor of Empathy: Resistance, Narrative, and Recovery in Psychoanalysis and Psychotherapy. London: Routledge.
_________. (2018). Top Seven Lessons on Empathy For Leadership (webcast): Chicago: 2018: https://youtu.be/GrgDWDt4uqg
________. (2018). Empathy Lessons. Chicago: Two Pears Press.
_______. (2018). A Critical Review of a Philosophy of Empathy. Chicago: Two Pears Press.
Lou Agosta and Alex Zonis (Illustrator). (2020). Empathy: A Lazy Person’s Guide. Chicago: Two Pears Press.
For further details and additional tips and techniques see Lou’s light-hearted look at the topic, Empathy: A Lazy Person’s Guide or one of his peer-reviewed publications see: Lou Agosta’s publications: click here (https://tinyurl.com/y8mof57f)
© Lou Agosta, PhD and The Chicago Empathy Project
Biology is not destiny. As Simone de Beauvoir noted in The Second Sex, woman is not a mere womb. Likewise, I note: man is not mere testosterone. [Note: This post is an excerpt from the final section of Chapter Seven on my book: A Critical Review of a Philosophy of Empathy, available here: click here to examine complete book.]
Biology is important, but biology is not destiny. That was one of the key points of the feminist revolution. Raising children is a job – a big job; and so is being the CEO of IBM as was Virginia Rometty until earlier this year.
The matter is delicate. These human beings – we human beings – are an aggressive species. It is usually the men that are doing the aggressing. That is indeed a function of testosterone – as well as upbringing [child rearing practices], enculturation, and the evaluation of the species.
Common sense suggests that woman is the more nurturing gender, given her role in giving birth and keeping the home fires burning in agricultural, hunting, and traditional indigenous cultures. Women are keeping the home fires burning, so what are the men doing? Men are out systematically doing battle with saber-toothed tigers and hostile neighbors. If this seems like an over-simplification, it is. Yet it is a compelling one, given the evolution and history of the species.
This issue of empathy and gender becomes controversial. Claims have been made that a man’s brain is different than a woman’s. In particular, men are “wired” for systematizing; and women are “wired” for empathy – for relating, especially relating to children and other human beings in general. This research – usually credited to neuropsychologist Simon Baron Cohen but also to Frans de Waal – has for sometime now been debunked – shown to be limited, distorted, and flat out wrong.
When one looks at the methods and the data in detail, no consistent gender difference in empathy have been observed – read on!
I provide the reference point upfront. As noted, the research by Simon Baron Cohen that men’s brains are “wired” for systematizing and women’s for relating and relationships are questioned and indeed debunked in Robyn Blum’s article in Heidi L. Maibom, ed. (2017). (For Bluhm’s original article see The Routledge Handbook of the Philosophy of Empathy. London/New York: Routledge (Taylor and Francis): 396 pp. )
Robyn Bluhm’s article probes the research on the evidential basis of this nurturing role and inquires: does it extend to empathy and how far?
Early gender-empathy studies were vulnerable to self-report biases and gender stereotyping that pervasively depicted females in a biased way as the more empathic gender. According to Bluhm, these early studies simply do not stand up to critical scrutiny. Case closed on them. Dismissed. Enter Simon Baron-Cohen and his innovative research, renewing the debate and shifting it in the direction of neural science as opposed to social roles and their self-fulfilling stereotypes.
Bluhm points out in detail that as Baron-Cohen’s work gained exposure and traction in the academic market place of ideas subtle shifts occurred in his presentation of the results. At first Baron-Cohen highlighted measures that were supposed to assess both cognitive and affective empathy, but later the affective dimension fell out of the equation (and the research) and only cognitive empathy was the target of inquiry and was engaged (p. 381).
Though Baron-Cohen’s initial research described the “male brain” as having “spatial skills,” his later publications, once he became a celebrity academic (once again, my term, not Bluhm’s), redescribe the male brain as “hardwired for systematizing”; likewise, the “female-type” brain, initially credited with being better at “linguistic skills,” was redescribed as “hardwired for empathy.” The language shifts from being about “social skills.” Baron-Cohen speaks of “empathy” rather than “social skills,” so that the two distinctions are virtually synonymous (p. 384).
As the honest broker, Bluhm notes that, as with the earlier research in gender differences, Baron-Cohen’s research has been influential but controversial. Men and women have different routes to accessing and activating their empathy; they respond to different pressures to conform to (or rebel against) what the community defines as gender-appropriate behavior; and men and women even have different incentives for empathic performance.
For example, “…[M]en’s scores on an empathy task equaled women’s when a monetary reward for good performance was offered” (p. 384). Monetary rewards up; empathy up? Though Bluhm does not say so, I came away with the distinct impression of a much needed debunking of the neurohype—what we would now call “fake news”—a job well done.
Bluhm’s work is especially pertinent in constraining celebrity, executive consultants (once again, my term), running with the neuro-spin, and publishing in the Harvard Business Review, who assert that brain science shows we need more women executives on corporate boards to expand empathy.
I hasten to add that we do indeed need more women executives, but that is not something demonstrated by brain science, at least as of this date (Q2 2020). We need more women executives because it is demonstrated by statistics (just one of many sources of reasons other than brain science) that to devalue the contributions to innovation, service, and productivity of slightly more than half the population is bad business practice—foolish, inefficient, and wasteful. The challenge is that the practices that make one good at business—beating the competition, engaging technology problems, solving legal disputes—do not necessarily expand one’s empathy, regardless of gender.
[In a separate, informal email conversation (dated July 2, 2018), Bluhm calls out Cordelia Fine’s fine takedown of “The Myth of the Lehman Sisters” in the last chapter of Fine’s book (not otherwise a part of Bluhm’s review): Cordelia Fine, (2017), Testosterone Rex: Myths of Sex, Science and Society. New York: W. W. Norton. It is a bold statement of the obvious – that the part of basic anatomy that differs between men and women is definitely NOT the brain. But that is missed due to lack of empathy which is committed to responding to the whole person – not just the brain or the sex organs.]
In an expression of insightful and thunderous understatement, Bluhm concludes: “With the exception of studies that rely on participants’ self-reports or on other’s reports of their behavior [which are invalid for other reasons], no consistent gender differences in empathy have been observed. This raises the possibility that gender differences in empathy are in the eye of the beholder, and that the beholder is influenced by gender stereotypes…” (p. 386). Just so.
Okay, having debunked the myth that men’s brains are different – and in particular less empathic – what to do about the situation that many men (and women?) struggle to expand their empathy? The recommendation is not to treat empathy and an on-off switch. Empathy is rather a dial – to be tuned up or down based on the situation. That takes practice.
Some men – many men – may start out with an empathic disadvantage in experiencing their feelings after having been taught such stuff as “big boys don’t cry.” But if people, including men, practice getting in touch with their experience, then they get better at it – experiencing their experience. Likewise, with empathy. If you practice, you get better at it. For those interested in practicing, but not working too hard, may I recommend: Empathy: A Lazy Person’s Guide: click here to examine (and buy!) the book.
Ickes, William & Gesn, Paul & GRAHAM, TIFFANY. (2000). Gender differences in empathic accuracy: Differential ability or differential motivation?. Personal Relationships. 7. 95 – 109. 10.1111/j.1475-6811.2000.tb00006.x.
(c) Lou Agosta, PhD and The Chicago Empathy Project
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.
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.
- 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.
- 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.
- 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 .
- 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])
- 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?
- 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.
- 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.
- 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
People want to know: Can empathy be taught? People complain and authentically struggle: I just don’t get it—or have it. In spite of the substantial affirmative evidence already cited, the debate continues.
The short answer is: Yes, empathy can be taught.
The one minute empathy training is: most people are naturally empathic. Remove the obstacles to empathy and empathy comes forth.
Remove the resistances to empathy and empathy expands.
Eliminate the obstacles to empathy and a space of acceptance and toleration spontaneously comes froth.
What happens is that people unwittingly have been taught to suppress their empathy. People have been taught to conform, follow instructions, and do as they are told. We are taught in first grade to sit in our seats and raise our hands to be called on and speak. And there is nothing wrong with that. It is good and useful at the time. No one is saying, “Leap up and run around yelling” (unless it is summer vacation!). But compliance and conformity are trending; and arguably the pendulum has swung too far from the empathy required for communities to work effectively for everyone, not just the elite and privileged at the top of the food chain.
Now do not misunderstand 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 not expand 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.
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.
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, injuries to self-esteem, and narcissistic merger—and empathy spontaneously expands, develops, and blossoms. Now that is going to require more than a minute!
Studying the Humanities and literature, art and music, rhetoric and languages, opens up areas of the brain that map directly to empathy and powerfully activate empathy. Read a novel. Publish a blog post. Go to the art museum. Participate in theatre. These too are empathy lessons, fieldwork, and training in empathic receptivity.
Reduce or eliminate the need for having the right answer all the time. Dialing down narcissism, egocentrism, entitlement (in the narrow sense), and dialing up questioning, motivating relatedness, encouraging self-expression, inspiring inquiry and contribution, developing character, and, well, expanding empathy.
Yes, empathy can be taught, but it does not look like informational education. It looks like shifting the person’s relatedness to self and others, developing the capacity for empathy, accessing the grain of empathy that has survived the education to conformity. Anything that gets a person in touch with her or his humanness counts as training in empathy.
(Note: Putting the “one minute” into the “one minute training” so that readers would not have to work too hard was hard work. I did the work of reviewing over a hundred publications on empathy training, the two dozen most significant of which are listed here: For evidence-based research on empathy training see the Bibliography and start with this list.
 Angera et al. 2006; Antoni et al. 2011; Brunero et al. 2010; Chiu et al. 2011; Coke et al. 1978; Davis et al. 1996; Decety et al. 2012; Del Canale et al. 2012; Golan et al. 2006; Gordon 2005; Hadwin et al. 1997; Halpern 2001; Hojat et al. 2009; Hojat et al. 2011; Levine 2012; Ozcan et al. 2012; PBS 2013; Pace et al. 2009; Pecukonis 1990; Riess 2013; Riess, Kelley et al. 2014; Riess, Kelley et al. 2012; Therrien 1975; Zaki and Cikara 2015 (Note – this required more than one minute!)
For those interested in more than one-minute of training: You do not have to buy the book, Empathy Lessons, to get the research, but if you would like more detail see especially Chapters Four and Six in Empathy Lessons (click here to get EMPATHY Lessons from Amazon). Also of interest: A Rumor of Empathy.
Remove the resistance to empathy and empathy grows, develops, and blossoms. In every instance of resistance to empathy, the empathy training consists in identifying, reducing, or eliminating, the resistance to empathy. When the resistance is reduced, empathy has space to develop, and it does so spontaneously as well as through providing explicit practices, tactics, strategies, and training .
(c) Lou Agosta, PhD and the Chicago Empathy Project
Empathy is good for your health and well-being: Empathy is on a short list of stress reduction practices including meditation (mindfulness), Tai Chi, and Yoga. Receiving empathy in the form of a gracious and generous listening is like getting a spa treatment for the soul. But do not settle for metaphors.
For evidence-based research on empathy, empathy and stress reduction, and empathy training you may start by googling: Antoni et al. 2011; Ciaramicoli 2016; Del Canale et al 2012; Farrow et al. 2007; Irwin et al. 2012; Maes 1995, 1999; Pollack et al. 2002; Rakel et al. 2009; Segerstrom and Miller 2004; Slavich et al. 2013 [this list is not complete].
You do not have to buy the book, Empathy Lessons, to get the research, but if you would like more detail see especially Chapters Four and Six in Empathy Lessons (click here to get book from Amazon).
[Also included are chapters on the Top 30 Tips and Techniques for Expanding Empathy, Overcoming Resistance to Empathy, Empathy Breakdowns, Empathy as the New Love, Empathy versus Bullying, and more.]
The healing powers of stress reduction are formidable. Expanding empathy reduces stress; and reducing stress expands empathy. A positive feedback loop is enacted. Expanding empathy expands well-being. Here empathy is both the end and the means.
A substantial body of evidence-based science indicates that empathy is good for a person’s health. This is not “breaking news” and was not just published yesterday. We don’t need more data, we need to start applying it: we need expanded empathy.
Evidence-based research demonstrates the correlation between health care providers who deliver empathy to their patients and favorable healthcare
outcomes. What is especially interesting is that some of these evidence-based studies specifically excludepsychiatric disorders and includemainline medical outcomes such as reduced cholesterol, improved type 2 diabetes, and improvement in related “life style” disorders.
Generalizing on this research, a small set of practices such as receiving empathy, meditation (mindfulness), yogic meditation, and Tai Chi, promote well-being by reducing inflammation. These practices are not reducible to empathy (or vice versa), but they all share a common factor: reduced inflammation. These anti-inflammatory interventions have been shown to make a difference in controlled experiments, evidence-based research, and peer-reviewed publications.
Using empathy in relating to people is a lot like using a parachute if you jump out of an airplane or getting a shot of penicillin if one has a bacterial infection. The evidence is overwhelming that such a practice is appropriate and useful in the vast majority of cases. The accumulated mass of decades of experience also counts as evidence in a strict sense. Any so-called hidden or confounding variables will be “washed out” by the massive amount of evidence that parachutes and penicillin produce the desired main effect.
Indeed it would be unethical to perform a double blind test of penicillin at this time, since if a person needed the drug and it were available it would be unethical not to give it to him. Yes, there are a few exceptions – some people are allergic to penicillin. But by far and in large, if you do not begin with empathy in relating to other people, you are headed for trouble.
Empathy is at the top of my list of stress reduction methods, but is not the only item on it. Empathy alongwith mindfulness (a form of meditation), Yoga, Tai Chi, spending time in a sensory deprivation tank (not otherwise discussed here), and certain naturally occurring steroids, need to be better known as interventions that reduce inflammation and restore homeostatic equilibrium to the body according to evidence based research.
The biology has got us humans in a bind, since it did not evolve at the same rate as our human social structures. When bacteria attack the human body, the body’s immune system mounts an inflammatory defense that sends macrophages to the site of the attack and causes “sickness behavior” in the person. The infected person takes to bed, sleeps either too much or too little, has no appetite (or too much appetite), experiences low energy, possibly has a fever, including the “blahs,” body aches, and flu-like symptoms. This response has evolved over millions of years, and is basically healthy as the body conserves its energy and fights off the infection using its natural immune response.
Now fast forward to modern times. This natural response did not envision the stresses of modern life back when we were short stature, proto-humanoids inhabiting the Serengeti Plain and defending ourselves against large predators. Basically, the body responds in the same way to the chronic stressors of modern life—the boss at work is a bully, the mortgage is over-due, the children are acting out, the spouse is having a midlife crisis—and the result is “sickness behavior”—many of the symptoms of which resemble clinical depression—but there is no infection, just inflammation.
The inflammation becomes chronic and the body loses its sensitivity to naturally occurring anti-inflammatory hormones, which would ordinarily kick in to “down regulate” the inflammation after a few days. Peer reviewed papers demonstrate that interventions such as empathy reduce biological markers of inflammation and restore equilibrium. This is also a metaphor. When an angry—“inflamed”—person is listened to empathically—is given a “good listening” as I like to say—the person frequently calms down and regains his equilibrium.
Empathy migrates onto the short list of inflammation reducing interventions. The compelling conclusion is that empathy is good for your well-being.
(c) Lou Agosta, PhD and the Chicago Empathy Project
When I say, reading Arthur Kleinman’s books changes one’s listening, I do not mean changes one’s listening the way reading Lacan or being hit on the head with a rolled up newspaper changes one’s listening. What I mean is, reading Kleinman expands one’s humanity, empathy, and capacity for engaged caring.
This is likewise the case with The Soul of Care: The Moral Education of a Husband and a Doctor (due out September 17, 2019 from Viking), the most important memoire by a psychiatrist since Carl Gustav Jung’s Memories, Dreams and Reflections (1962) [though with a different source and trajectory], an unsolicited prepublication copy of which showed up in my snail mail. It is a real page-turner.
Arthur Kleinman, MD, trained as a psychiatrist, is an innovator in medical anthropology, a discipline of which he is the virtual founder. He and his late wife Joan, also an academic, spent considerable time and effort doing cross cultural (anthropological) research in China on traditional medicine, modern medicine, and the connecting points (and divergences) thereof. Of particular interest were survivor of Mao’s Cultural Revolution, who suffered from the symptoms of “neurasthenia,” a disorder whose explicit diagnosis has declined in the west – including fatigue, dizziness, anxiety, demoralization, and hard to diagnose pain(s).
In the course of their time in China, Kleinman (Arthur) gets a combination of exhaustion and dysentery, which reaches life disabling and even life threatening, stages. Joan is the very soul of caring – nursing him back to health.
This provides one of the paradigms for Arthur when Joan eventually gets early onset Alzheimer’s and he decides to take care of her at home.
The Soul of Care is the memoir of Kleinman’s life’s work (to date) and what happens when he decides to practice what he preaches and takes on the task of carrying for his increasingly ill wife, Joan.
Kleinman does not use the word “empathy” much, but it lives in his work, and in this case, the man is living in an empathy desert and that includes the health care system that is relating to him as pain instead of a whole person. Kleinman’s listening, which creates a context for human relatedness, succeeds in moving the dial back a few notches, though no way exists of undoing the now fused spine.
I have frequently had my mind blown by the power and precision of Kleinman’s writings. For example (and now we are in The Soul of Care), another patient has intractable pain relating to her diabetes, yet the diabetes is under control. The numbers from the blood work and related tests show that the diabetes should not be producing such results. Something is not adding up. Is the patient faking? Is there some disorder that has been overlooked?
This fellow, Kleinman, sits down and has a conversation with someone with intractable pain. He is genuinely curious about the patient. He is interested. He nails it. He brings along a medical student on a home healthcare visit. The above-cited patient is a diabetic, and is eligible for Meals on Wheels, transportation to the hospital, alternative housing (p. 206). The medical team (notice: there is a team!) had no idea, because no one asked.
Time-after-time, Kleinman shows up and asks a few questions – it all comes tumbling out – in many cases out-and-out trauma; in other cases, subclinical post traumatic stress disorder; in most cases, life circumstances, stress, inaccurate or incomplete diagnoses being transformed into bodily symptoms.
Continuing the above example, the patient is a single working mother; poor; working the grave yard shift while simultaneously cooking, cleaning, getting her kid (who is doing quite well, thanks) to school, and managing everything else well enough – everything except her pain. The patient is not faking – the pain is authentic, but diabetic neuropathy is not the cause. The cause is a work life imbalance of virtually unimaginable proportions (once again, “work-life balance” is my summary description, not Kleinman’s). The patient is running flat out, and is eligible for food stamps and other support available within the system. But no one on the team even bothered to have the conversation, even bothered to ask.
What is happening is that a medical issue does indeed exist. But the human being is more than an insulin pump. If medicine wants to be a caring profession not a bureaucratic profit center, then the doctor may useful make inquiry as to what the patient thinks is going wrong (and right) in her life. What is happening is that the emotions, affects, cognition, personal spirit, are elaborating what is in effect the anatomical or organic lesion and defect.
One can appreciate that individual practitioners may well feel they are like the “Lone Ranger,” single-handedly arrayed against human suffering. One will do what one can, writing the prescription at the end of the session for something, anything, to at least get the placebo affect as a positive expectation itself sets off a cascade of neurotransmitters. Kleinman appreciates how devilishly tricky it is both to address the biological system and the suffering human being present in the space
Yet Kleinman is uncompromising – and with good reason. Time-after-time, simple inquiries as to what are the facts of the person’s life circumstances point powerfully in the direction of human interventions that shift the person out of suffering and stuckness and into action. Putting the pain in context enables the person(s) to improve their own health through life style adjustments.
After all, is this not the age of the informed, engaged, proactive health care consumer? Many medical doctors pay lip service to such engagement, yet are not prepared to answer questions or, just as importantly, help the patient formulate the half-formed questions they are struggling to express. Do the job, do it completely, and do it the way it was meant to be done on behalf of the patient and suffering humanity.
Pain is one of those things that sometimes one can’t live with, but one certainly can’t live without. The reflex that causes one’s hand to jerk off of a hot casserole dish is not yet pain. The reflex precedes the experience of pain by a couple of seconds.
The reflex does not go through the brain; the experience of pain does. To become pain, the sensory information in the nerves has to go through the brain. In short, pain is important to tell the person about damage to his or her body that requires attention. Pain powerfully focuses one’s attention on getting actionable results in addressing the problem. But pain can cause a member or organ to become hyper-cathected – a tight loop that creates pain in anticipating pain to avoid pain. By focusing on the pain, attention can expand pain, grow pain, and become a habitual pattern of pain stimulation to the organism. Focus one’s attention elsewhere? Easier said than done, though alternative interventions such as meditation, hypnosis, and self-soothing stress reduction activities (which Kleinman does not much discuss) aim to do just that.
Kleinman is himself something of a survivor: a son who never met his biological father, a grade school student who bore two utterly separate family names once his mother remarried, from two opposed sub-ethnic factions, one in public school, the other in religious school; a scion of a mysterious past about which his Victorian family was silent or whispered inarticulately, so that he had the extra developmental task of figuring out by himself, yet not announcing to others, lest they be hurt what identified me, which therefore could not be authorized (or denied). (See Writing at the Margin (p. 2).
I learned a lot about empathy from Kleinman, though he rarely uses the word. Nor would I consider Kleinman an advocate of empathy understood in the narrow sense of a psychological mechanism. Rather in a medical world (Kleinman is a psychiatric), in which diagnostic categories are mapped to psychopharm interventions, Kleinman is an articulate advocate for sitting down and talking to the individual about what is going on in the person’s life. What is working and what is not working? While it takes extra time upfront, such a conversation for possibility makes a profound difference in actually getting an accurate diagnosis as opposed to a good enough, makeshift band-aide.
Kleinman several times quotes the celebrated founder of sociology Max Weber in his studies on bureaucracy. As institutions become larger and more complex, rules and roles independent of individual charisma and personal genius are needed to scale up to deliver services to more people. Nothing wrong with that as such – serving more people with high quality medical care is everyone’s aspiration. Yet when I have a disorder whose cause or course are unclear, like most people, I want the brilliant diagnostician, the TV doctor from central casting whether Ben Casey or House or whoever is trending, not a functionary.
For those interested in additional diagnostic pyrotechnics or just plain background, The Illness Narratives, the essentials of which are recapitulated in The Soul of Care, is the place to look for expanded and amazing narratives. It too is a real page turner.
Kleinman’s The Illness Narratives: Suffering, Healing, and the Human Condition (Basic Books 1989) distinguishes incisively between the person’s experience of illness and the doctor’s concept of the disease as part of a biological system. To be sure, substantial overlap often exists between these two, but not always. What then opens up and becomes possible is an entire method and approach to healing that puts biological reduction in its proper place.
For example: When chest pain can be reduced to a treatable acute lobar pneumonia, the biological reduction[ism] is a success. When chest pain is reduced to chronic coronary artery disease for which calcium blockers and nitroglycerine are prescribed, while the patient’s fear, the family’s frustration, the job conflict, the sexual impotence, and the financial crisis go undiagnosed and unaddressed, it is much less of a success (The Illness Narratives, p. 6).
The Illness Narratives expanded my appreciation of how a physical injury can take on a life of its own. The injury is real enough and it becomes a grain of sand around which a misshaped black pearl is elaborated (my metaphor, not Kleinman’s). The physical issue is elaborated by the emotions, as unresolved personal issues in a person’s life seem to be magnetically drawn towards making meaning out of pain and suffering.
Another example, in The Illness Narrativesa self made assistant police captain, performing good work, helping a neighbor, throws out his back. The pain gets habituated. He just can’t shake it off – month after month. It is affecting his job performance. He needs even more down time, sick time. He starts to feel that people do not believe him – he is really suffering.
To demonstrate to others and to himself how serious the matter is – and in the hope of finding relief for his pain – he agrees to surgery. However, if one is in pain, surgery can be a deal with the devil (so be sure to read the fine print), because, at least in the short term, surgery is a cause of acute pain.
Several years – and surgeries – later, the person – now a picture of pain – walks into Dr Kleinman’s office. The patient is the walking embodiment of pain. His every more seems painful. A conversation reveals a life narrative not for the faint of heart. He was not quite abandoned as a child, but basically he had to raise himself. He would have starved as a kid of tender age if he had not learned how to scramble some eggs; his head barely reaching high enough to assess the progress of the food in the frying pain.
Culminating in his latest contribution, The Soul of Care, Kleinman’s career has spanned the Corporation Transformation of American Medicineas identified by Paul Starr (1984) during which the medical doctor has gone from being a sovereign authority, whose word was virtually the law, to being a functionary in a corporation optimized for capitation and revenue generation, all the while paying marketing firms to communicate how caring everyone really is.
In order to preserve the integrity of his commitment amidst the corporate transformation of American medicine, Kleinman innovates, inventing his own field of study, medical anthropology. It has legs. It works. A journal is founder. High quality articles are published. Institutions, funders, and financial support are forthcoming. He teaches it at Mass General – we pause to honor the storied name – and at Harvard – another pause. With all this pausing, we are never going to get through this review. Yet the broader lessons for healthcare as a whole of medical anthropology do not break out of its own resonant, transformational niche.
Kleinman is definitely not living in a cave. He spends seven continuous years doing cross cultural research in China with his wife Joan, who becomes fluent in Chinese and provides important auxiliary functions in team building, networking, and having a life. (I shall follow the convention of calling “Arthur” by “Kleinman” and “Joan Kleinman” by “Joan” for simplicity.)
Therefore when Kleinman’s own world is brought low as the love of his life and his professional partner, his wife of thirty years, Joan, is stricken with early onset Alzheimer’s, he find himself wrestling not only with the disease but with the medical bureaucracy and the fact that his innovations in medical education have definitely notbeen widely adopted.
First he learns how to perform household chores. He learns how to pay the bills. He takes over bathing Joan and preparing meals. He marshals support from his gown up children, who have kids of tender age of their own and are running flat out – all the while continuing teaching and research (albeit with a certain amount of flex time provided by his long-term employers – pause again to honor them – for whom Kleinman is a celebrity academic).
He gets a home helper, who is indeed an essential part of the support system. With 20-20 hindsight, he second guesses his own agreement, requested by Joan, that she be allowed to decline (and die) at home. He has an important late insight, realizing that Joan is no longer the person who entered into that agreement, the dementia having robbed her of [essential aspects of] her identity. Nor is he the same person, who he was after the ongoing ten year long struggle. Between Joan’s agitation, loss of identity, intermittent fear or psychosis, and incontinence (wandering was less of an issue, because the patient became blind), all bets – and prior agreements – are problematic.
The couple consult many specialists. The neurological resident Kleinman and his wife visit is interested in talking with them again – in six months – and in following the irreversible course of the disease, not in engaging with the human impact and cost for the wife and husband.
Confidentiality is important; but it becomes yet another obstacle as the well-intentioned neurology resident insists on addressing Joan, even though her expressed wishes are that Arthur be included in all the decisions. Queue up the living will and health care power of attorney. All well and good. But the problem is that the patient does not want to have a legal conversation, she wants to have one about caring. Noticeably absent is guidance as to caring. Key term: caring.
Kleinman matriculates in the college of hard knocks. As caring – and empathic – has he already is, it is all used up by the progressive dementia. He gets a home helper since, though relatively well off, he must keep working to pay the mounting bills – and for his own sanity. Towards the end of the middle stage of the disease, he actually takes her with him to Shanghai, China, in order to fulfill academic obligations and complete a stalled project in cross cultural health care.
The reader cannot help but wonder, “What is this guy thinking?” as he takes Joan, by then an easily agitated person developing Capgras (“imposter”) syndrome, through airport security to Shanghai. Somehow he pulls it off. The quality of care in China and the support for the family is truly inspiring, especially given how eager his Chinese colleagues are to be supportive with both traditional and modern medicine (and given that no one really has the answer regarding Alzheimer’s).
Without using the word “empathy,” Kleinman was already operating at an advanced level in relating to others in a caring way. He is the Other whose listening brought relatedness to suffering individual in one case after another. Now he faces new, life-defining challenge.
A recurring theme becomes how his ten years of care giving becomes a descent to the hell of irreversible dementia without the prospect of rebirth. As near as I can figure, his is a journey of the hero, with ample commitment and tragic struggle, but without heroism.
Even given his training as a psychiatrist and anthropologist, a well-connected professorial network with high quality, [relatively] responsive support, he is brought low, isolated, at the brink of emotional despair. But how could it be otherwise? He is losing his wife to a disease that robs a person of her identity (i.e., dignity), but she is still physically present and intermittently coherent. Even so he struggles to get straight answers from the medical professionals about the course of the disease, about the trade-offs between home care and assisted living.
The back story is that at some point early on in their relationship Joan decided that her life project was to take care of him (Arthur), the family, the kids, even supporting his research – they published academic papers together – while also mastering the Chinese language and immersing herself in that culture. She got good at it – very good indeed.
Kleinman decides that he wants to return the favor. Of course, it is not as simple as that. Kleinman talks about his own guilt and what he had to survive coming up. The point is that this man Arthur Kleinman is already the soul of caring; but he takes his caring to a new level through the refiner’s fire of caring for Joan.
It is a heart-warming and inspiring narrative – the ultimate illness narrative (also the title of Kleinman’s most impactful work prior to this one) – but also a harrowing one. Not for the faint of heart. Apparently at some point, [many] advanced Alzheimer’s patients stop eating. A morphine drip and lip moistening are the palliative measures recommended.
If you need a good cry, you will get one by the time Kleinman realizes there is no way to take care of Joan at home even with a full time assistant. The end is not
quick, but given the morphine drip, neither is it painful. What it is is impossible to put into word. The image of suffering of Shakespeare’s Lear, blind and wandering in a storm of agitated emotions towards the edge of the cliff, looms large. It’s her; it’s him; it’s both, though he ends up being a survivor. What is painful is the loss – the loss of humanity of the Alzheimer’s patient.
When Kleinman uses the word “moral” – it occurs in the subtitle of The Soul of Care as well as in the subtitle of his What Really Matters(Oxford 2007) – of course, he is referring to value judgments, candidate categorical imperatives, and assessment of ethically right and wrong behavior and character. At times, I doubt that the word “moral” adds to the discussion, since it is mainly about preserving one’s sanity in the face of the disintegration of the skills needed for the activities of daily living.
“Humanity” and “morality” overlap extensively and I doubt it makes sense to ask which came first. Yet they are not identical. There is a conflictual aspect to our humanity that morality attempts in vain to capture and make right by judging. Lear, blind and stumbling towards the edge of the precipice, is also wandering at the edge of morality, though arguably he never stops being a struggling human being. Neither does Kleinman.
Nor at any time does Kleinman become a moral relativist, though he is keenly in touch with the fuzzy, grey areas. The problem is that the space of human action and engagement becomes so thick with judgments and evaluations that one can hardly think, much less take action in the face of urgent emergencies.
Most of the tough (and narratively engaging) cases involve fraught decisions where fundamentally good people actually perform bad actions. In some cases the consequences of the action escape from the agent – as when the soldier follows the sergeant’s orders and blows up the car supposedly containing the suicide bomber, but it is actually a family of five on the way to deliver a baby. That is moral trauma. But in other cases individuals actually, intentionally commit war crimes (e.g., Winthrop Cohen in Kleinman’s What Really Matters) and spend the remainder of their lives twisted in knots over what happened, what does it mean, and how to go on.
Taking matters up a level, one such looming moral trauma is the ongoing corporate transformation of American medicine.
Kleinman channels some of his well-founded anger into targeting the systematic breakdowns of the American Healthcare system in the face of revenue incentives, corporate metrics, and devaluing caring. His jeremiad – I mean, argument – may usefully be made required reading – not only for doctors but especially for administrations and managers – in medical schools and systems. It is often the administrators who are taking advantage of the medical professional’s empathy in demanding more patients per period with no compromise of quality or attention to the demands of addressing human suffering in its physical as well as emotional and spiritual aspects.
Kleinman throws down the gauntlet, demonstrating just how far main stream, neoliberal, bio-political health care has diverged from his humanistic vision: “The problem, as some suggest, is not that we fail to quantify these experiences [of caring], but that they cannot be quantified, because they are essential human interaction, the soul of what health care is” (p. 238).
Many long term advantages exist in reducing spending upfront by life style changes in nutrition, exercise, stress management – and avoiding expensive medical technologies and interventions once the damage is done. A compelling quantitative case can be made that an ounce of prevention is worth a pound of cure.
Nevertheless the fact remains: quality health care is expensive. Though I am just a citizen, the Siemens Magnetic Resonance Imagining (MRI) device that took a picture of the torn cartilage in my knee looks to be almost as large and as complex, though in totally different ways, as the lunar excursion module (LEM) that landed two men on the moon in 1969. It turns out to be Rocket Science, so why should it be less expensive? Imaging, genomics, proteomics, personal medicine, personalized treatment using the most advanced technologies are quite simply expensive.
What is a lot less expensive – though by no means totally without cost – is sitting down and having a conversation for possibility with another human being – about her pain, disorder, and her life. And this conversation is one of the sources of quality healthcare and human flourishing, or at least pain management. This provides a powerful picture, too.
Read an excerpt from the book, quoted in Time Magazine: https://time.com/5680723/doctor-wifes-alzheimers/
A rumor of empathy is no rumor in The Soul of Care and Kleinman’s works. Empathy LIVES in Kleinman’s contribution. Kleinman does not emphasize this point about the power of ordinary language, though it is near enough to the surface of his text, but rather calls out the moral imperative: we must think deeply and with integrity about the kind of society and community we want to be. The extreme wealth being generated by innovations in technology make possible maximizing acts of humanity that advance community well-being. Whether that happens to the USA, as a healthcare nation is an existential choice of the highest order on the part of the individual and the community.
Lou Agosta, PhD and the Chicago Empathy Project