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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
Suzanne Keen’s Empathy and the Novel (2007, Oxford University Press, 242 pp.) can be read as an introduction to empathy studies, fiction (novel studies), and reading in the enlarged sense of engaging with the Humanities. Keen’s approach to these intersecting discourses is nuanced, subtle, and not easily summarized. She provides a great springboard for further conversations, elaborations, and social psychology experiments.
The usual definitions of empathy are reviewed, especially: a vicarious, spontaneous sharing of affect (2007: 4). I would add: talking a walk in the other person’s shoes; transiently, temporarily, and selectively identifying with the other person; appreciating who the other person is being as a possibility; feeling and experiencing vicariously what the other person feels and experiences; being fully present with the other person in such a way as to acknowledge and respond to the other’s humanity. Keen’s book is fully buzzword compliant, including accounts of theory of mind, mirror neurons, and storytelling.
A significant aspect of the interest in relating empathy and the reading of fiction, especially novels as in Keen’s book, is to make the world a better place. Read some quality fiction; expand one’s empathy; and take action to improve the world. Wouldn’t it be nice?
Keen notes: an ideal type case is that of Harriet Beecher Stowe’s Uncle Tom’s Cabin (1852), which, in its time, was a run-away best seller, opening the eyes of contemporaries to the injustices and inhumanity of slavery, furthering the cause of abolition. Even if such a book as Stowe’s did not directly create a social movement, with the benefit of 20-20 hindsight, it is notable as representing a parallel and behind the scenes shift in the prevailing values of the community. (Sinclair’s The Jungle or Dickens’ Oliver Twist might be added to the list of influential works (2007: 118)). And yet the libraries are overflowing with novels that did not make a difference and are read by few.
Due to the importance of the empathy-altruism hypothesis developed by C. Daniel Batson, Suzanne Keen begins her book on Empathy and the Novel with Batson’s hypothesis and its relation to the practice of reading fiction.
At the risk of oversimplification, I gloss the subtleties and what the empathy-altruism hypothesis gets right: empathy creates a clearing for the prosocial, helping behaviors of altruistic behavior such as one finds in Good Samaritan scenarios. When read judiciously, this hypothesis neither reduces altruism to empathy, nor vice versa. Experimental subjects who are empathically “primed” find that their “empathy” understood as prosocial engagement spontaneously manifests itself in the direction of altruism when challenged to do so. Nevertheless, Batson’s work is a masterpiece of studied ambiguity when it comes to deciding where the boundary lies between empathy and altruism.
Keen’s approach privileges the novel, in which the fictional world brings forth a “safe space,” in which empathy can be applied without requiring that anyone take action: “…[F]ictional worlds provide a safe zone for readers’ feeling empathy without a resultant demand on real world action” (2007: 4). That is quite appropriate from the perspective of a professor of English literature. However, one might just as well reverse the equation. Empathy creates a clearing for acceptance and toleration within which the imagination performs its work of capturing experience as a narrative in which the empathic exchange of emotional and imaginative psychic contents occurs.
My position in the matter is: Empathy opens us to (“tells us”) what the other person is experiencing; our good upbringing, morals, ethics, and professional practices tell us what to do about it. This makes it sound like empathy is a mode of observation or perception, and it is indeed that. However, insofar as empathy is something that requires two people in interaction, the empathizer is required to perform an empathic response in order to complete the loop and validate the empathic interaction.
One key point of debate is whether reading novels expands a person’s empathy. Though Keen is inclined to favor this hypothesis, she marshals significant evidence on both sides of the debate and concludes that the jury is still out.
The literary career of empathy (Keen’s incisive phrase) extends from 18th century warnings by the clergy and other learned men that novel reading ranks among the incentives to the seduction of female readers (Keen, 2007: 37) all the way to the enlightenment philosophers such as David Hume and, finally, Percy Bysshe Shelley’s guidance to extend the sympathetic imagination to feel with others. “Sympathetic” because the word “empathy” had not yet been coined in the English language (which would happen in 1909 as E. B. Titchener’s translation of the German “Einfühlung”). Fast forward to James Joyce, Sam Beckett, and Berthold Brecht, who become anti-empaths, privileging defamiliarization and estrangement in narrative.
The moral peril of vicarious emotions to the innocence of girls becomes the emotional contagion that Brecht sees as subverting the consciousness raising of the workers and potential for revolutionary action of the working class by means of his Epic Theatre. None of this is full blown adult empathy, but it is on a spectrum of empathic relatedness that is wide and complex.
Arguably, the listening and receptivity of the community were ready to respond to the message of these books due to seismic shifts in social and productive relations; and the book provided concise language and a set of powerful images to make the point at hand. Though correlation is rarely causation, sometimes correlation is good enough.
No substitute is available for the “magic bullet” of identifying a specific replicateable cause, and such discoveries are rare. Though many people confuse cause and effect (nor am I saying that happens to Keen!), from the point of view of an alliance between empathy, fiction, and social action, it is almost as enlightening and effective to have the literary fiction represent the “signs and portends” of social dynamics that can then become the target of appropriate political action, fund raising, consciousness raising, and social influence. As Keen puts it, “…[reading literary fiction becomes] a sign of one’s empathy and commitment to human principles” (2007: 167). Reading literary fiction – presumably along with political editorials – would be a source and a method of consciousness raising. Still most readers do not look to reading literature as sources for social action in the real world – or at least the evidence-based studies that Keen sites do not show such a result. (2007: 118).
All the casual, easy generalization such as “altruism results in expanded empathy,” “empathy results in expanded altruism,” “reading quality fiction (novels) enhances empathy,” “empathy enhances appreciation of the novel” have significant qualifications, conditions, and counter-examples. Never was it truer, the devil is in the details; and Keen’s work contains a wealth of engaging examples and background on empathy studies. Incidentally, Keen ends her book with some twenty-seven proposals about narrative empathy (2007: 169 – 171).
In discussing the enhanced empathy of authors, who report that their characters come to life in their imaginations, Keen acknowledges the moral ambiguities of the possibilities of empathy for both good and evil. For example, Keen reports that William Pierce (pseudonym: Andrew MacDonald), founder of a white supremacist organization, published The Turner Diaries (1978), containing hateful depictions of blacks, Jews, and gay people. The novel was apparently written with some literary skill. Timothy McVeigh, the bomber of the Federal Building in Oklahoma City (1995), studied this book, and, based on the account in the novel, “emulated its protagonist by building a fertilizer bomb to explode a government building […] made and deployed in a small truck” (Keen 2007: 127).
True, it is highly improbable that the novel by Pierce (MacDonald) caused an upstanding citizen to become a mad bomber. McVeigh was already entangled with murderous levels of prejudice and deviance, and was therefore attracted to the novel. Do not confuse cause and effect; yet the evidence is that this white supremacist novel – and the bomb making parts of it – inspired McVeigh and made him a more dangerous deviant.
Another celebrated example of a novel having alleged causative effects, not mentioned by Keen, in the real world is Goethe’s The Sufferings of Young Werther, in which the broken-hearted hero commits suicide. There really was an epidemic of copycat suicides across Europe in which romantically devastated individuals would jump off of bridges with a copy on the novel in their respective pockets as a kind of suicide note. More good empathy gone bad? Can’t get no satisfaction – or empathy? More likely, individuals who were already suicidal found an expression of their suffering in literary form thanks to the dramatic finesse of Goethe.
I offer a bold statement of that which is hidden in plain view. The hidden variable is the practice of empathy itself. If I read a novel that enrolls me in the practicing prosocial empathic responsiveness to my neighbors, then empathy is expanded. If I read a novel that enrolls me in the practice of white supremacy, then the latter is expanded.
One could argue, though I will dispute the formidable ambiguities, that even white supremacists can be empathic towards other white supremacists. That is the critique of empathy that asserts empathy is too parochial, limited only to the in group, and, as such, a problematic “virtue,” if one at all. The answer is direct. In so far as the white supremacists [and so on] require one conform to a certain prejudiced, humanly devaluing ideology to qualify as the recipient of the practice of empathy, the empathy misfires and fails.
Thus, the debate is joined. The celebrated Self Psychologist and empathy innovator Heinz Kohut, MD, gives the example of the Nazis who equipped their dive bombers with sirens, the better to impart empathic distress in their victims, thus demonstrating their (the Nazis’) subtle “empathic” appreciation of their victims’ feelings. I am tempted to say, “The devil may quote scripture,” and Nazis may try to apply some subset of a description of “empathy.”
Note that Kohut speaks of “fiendish empathy” and the use of empathy for a “hostile purpose” while emphasizing his value neutral definition of empathy as “vicarious introspection” (1981: 529, 580). Nevertheless, the point is well taken that empathy is a powerful phenomenon in all its dimensions and requires careful handling. [For further details see: “On Empathy,” The Search for the Self: Volume 4: Selected Writings of Heinz Kohut 1978-1981, London: Karnac Books, 2011: 525 – 535].
The Nazi applies a kind of entry level emotional contagion or affective transmission of feelings, but the process breaks down at the point of empathic responsiveness. Empathic responsiveness requires a core of acknowledgement and recognition of the other person’s humanity.
But it is plainly evident that the would-be “empathy” of the Nazis (or the white supremacists) misfires and fails in a contradiction. It is a flat-out contradiction to relate authentically to another human being while dehumanizing him or her. Empathy doesn’t work that way. Empathic responsiveness simply does not admit of bombing people or disqualifying them as “less than” or other than human when they plainly are human.
One of the strongest points of Keen’s book is the final chapter on “Contesting Empathy,” in which she cites a long series of objections, qualifications, and doubts about empathy. Failed empathy, false empathy, fake empathy, breakdowns of empathy, and the social construction of the emotions are engaged and deconstructed. Empathy has to run a gauntlet of things that can go wrong with it, though I suggest it emerges out of the backend bruised but still in one piece.
This point is not well-understood in the empathy research literature where break downs of empathy are mischaracterized as features of empathy itself. To blame empathy for its misuse, breakdowns, and misapplications is rather like using the smoke alarm to decide when Thanksgiving turkey is done.
Keen is concerned that the empathy-altruism hypothesis with which she launches her project is left hanging by a thread. If the work of Kohut is to be credited (who, by the way, is not mentioned by Keen), the hypothesis is not likely ever to be validated. Yet if empathy is a practice, not a mere psychological mechanism, then by practicing it, we get better at it in using it to reinforce and expand our shared humanity. Empathy becomes a powerful force in creating a clearing to call forth “the better angels of our nature.” The empathy-altruism hypothesis as an aspirational project, not a social psychology given.
Thus, the really tough question is how does “empathy” as a psychological mechanism relate to “empathy” as a interpersonal process and “empathy” as a practice in relating to people. One starts out talking about empathy as a psychological mechanism, subsumed by a biological mirroring system (even if mirror neurons remain debatable) and invoking identification, projection, and introjection.
Almost immediately one has to give an example of two people having a conversation in which one is feeling and experiencing something that the person may or may not “get” or “understand.” Then one finds oneself immediately discussing the practical considerations of why, in the course of the personal interaction, the empathy succeeded or broke down in a misunderstanding, and how to improve one’s practice of empathy based on experience.
It makes a profound difference from which definition of empathy one begins, though ultimately one has a sense of traversing all the distinctions and simply coming back to enhanced relatedness and understanding of the other person.
One goes in a circle. Readers are attracted to the literary fiction that speaks to their hopes, possibilities, and fears, which, in turn, expands and reinforces their hopes, possibilities, and fears. Then, either by accident or diligent search, readers encounter new forms of writing that change their experiences and perceptions. The writing causes the readers to see existing social structures and ways of relating to other people in new ways. The hermeneutic circle of interpretation? The engaging thing about bringing the hermeneutic circle to empathy is that it provides a series of steps, phases, within which logically to organize the process. Even if ultimately such a hermeneutic circle of empathy falls short of a formal algorithm, one gets a coherent guide against which to succeed or fail and engage in a process of continuous improvement based on experience.
What if a rigorous and critical empathy gave us the data needed to grasp the way to the humanity enhancing actions that need to be taken? The application of empathy would become an imperative guiding our reading and relatedness along with the moral imperatives so important to Keen and Batson. Empathy has not usually functioned as a criteria of literary significance or greatness – until now.
REFERENCES and NOTES
Since Keen published her book in 2007, several peer-reviewed have appeared that support the hypothesis that reading literary fiction expands empathy. These are useful, but do not decisively determine the outcome of the debate; and, obviously, these researchers did not include Pierce (MacAndrews) on their list. A lot of work gets done here by the adjective “literary.” For example:
Bal, P. M , Veltkamp, M. (2013). How Does Fiction Reading Influence Empathy? An Experimental Investigation on the Role of Emotional Transportation. PLoS ONE 8(1): e55341, https://doi.org/10.1371/journal.pone.0055341;
David Comer Kidd, Emanuele Castano. (2013). Reading Literary Fiction Improves Theory of Mind, Science 18 October 2013, Vol. 342, Issue 6156, pp. 377–380, DOI: 10.1126/science.1239918;
Kelly Servick. (2013). Want to Read Minds? Read Good Bookshttps://www.science.org/content/article/want-read-minds-read-good-books [The page # is not available on the web version; but they are short articles.]
The reader may usefully review my blog post on these publications and “reading literary fiction expands empathy”: https://bit.ly/311A2G8
(c) Lou Agosta, PhD and the Chicago Empathy Project
Listen 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
This essay is an excerpt from Chapter Four of the book Empathy Lessons. This essay is motivated by the need to debunk the position that the practice of empathy is vague and fuzzy and cannot be taught, that you either have it or you don’t. Bunk. I am addressing scientists, researchers, health care professionals who dismiss empathy as not scientific of evidence-based.
Substantial evidence is available that if you practice empathy, you get better at it. A bold statement of the obvious? Indeed. Yet the requirement to marshal the evidence is a significant one, even if it is often a function of resistance to practicing a rigorous and critical empathy. Key term: resistance to empathy. Overcome the resistance to empathy and the practice of empathy spontaneously and naturally comes forth. [See Empathy Lessons and other books by Lou Agosta on empathy: https://amzn.to/2S0ISPr.%5D
Even if one understands “evidence” in the most narrow and rigorous sense, substantial evidence is available from peer-reviewed research and publictions that empathy training is effective. The implications for evidence-based empathy training are direct. Empathy works. Some of this material may seem difficult or complex; but it is important to engage with it, because it undercuts the subtle resistances to empathy that dismiss empathy in the misguided belief that there are no evidence-based peer reviewed publications.
The first example is an empathy intervention so short that it passed the Institutional Review Board (IRB) criteria for the use of human subjects. The study was complete before people had a chance to drop out. An advertisement went out for people to receive a complimentary, free screening and short intervention for “problem drinking.” In fact, only problem drinkers responded.
The people were divided randomly into groups and given either an immediate check up with confrontational counseling that directed them to stop drinking; or the subjects were given a check up with motivational interviewing that used client-centered counseling and did not try counsel changing the client’s behavior, but in the manner of motivational interviewing explored the person’s motives with him or her. Motivational interviewing employs empathic methods of listening and questioning and, in this example, becomes a proxy for empathy.
Strictly speaking, the counselor facilitated a dicussion with the client of what might happen if the client either did or did not stop (reduce) drinking. A third group of clients was wait-listed, for control, without intervention. Motivational interviewing is a client-centered intervention that relies on empathic listening, questioning, and responding.
Both groups that received intervention resulted in a 57% reduction in drinking within six weeks, and the result was sustained at 1 year. However, there was one dramatic finding. The lead researcher and author (William Miller) reports: “Therapist styles did not differ in overal impact on drinking, but a single therapist behavior was predictive (r = .65) of 1-year outcome such that the more the therapist confronted, the more the client drank.”[i]
This bears repeating: the more confrontational the counselor, the more the client drank. If one starts with a confrontational approach rather than empathy, one is headed for trouble.
In another study, perspective taking was practiced in which the other person was imagined to be a neighbor or a member of one’s own community rather than a stranger.[ii] This examines empathic interpretation, though the study does not use that terminology. Practice perspective taking, it improves.
Other practitioners have developed exercises that focus on specific groups such as doctors of individuals with autism. This expands empathic understanding, though, once again, the terminology is different. Other experiments conduct explicit training in mentalizing, specifically, teaching participants in the training about associations between target facial expressions and emotions.[iii]
In a separate study, a large meta analysis by the Cochrane Library that reviewed fifty-nine peer-reviewed studies with 13,342 participants of a motivational interviewing intervention based on empathy for substance abuse over against other active interventions or no intervention and produced a similar result: motivational interviewing helped people cut down on drugs and alcohol.[iv]
Still, the debate goes on.
Is the empathic questioning, the back-and-forth conversation, in the motivational interview that causes something (attitude, hope, fear, and so on) in the client to shift? Or do people convince themselves? Or do they just get better informed? Or do they stop blaming themselves and feel better, and so they “self medicate” less with alcohol or street drugs?
Lots of questions. No easy answers. Yet when something is so effective across so many studies and researchers are still skeptical, then one has to say: “Okay, skepticism is proper and scientific. Yet nothing is wrong here; but there is something missing—empathy.”
Let’s do the numbers.
Evidence shows that those who train and practice being empathic succeed in expanding their empathy. Educational programs that target empathy have a demonstrably positive effect on empathy skills, according to peer reviewed studies.[v]
Another case in point: a meta analysis of 17 empathy nursing courses in an educational context indicated statistically significant improvement in empathy scores in 11 of the 17 studies (and non statistically significant improvements in the other 6). Similar positive outcomes were reported when medical students, training to be doctors, were included. When nurses and medical students work at practicing empathy; and they get better at it. How about that.[vi]
A disturbing factoid: The empathy of persons studying to become physicians peaks in the third year of medical school according to measures applied periodically (as reported by Dr. M. Hojat and his colleagues at Thomas Jefferson University).[vii] Empathy expands; but then it seems to contract. The suspicion is that the burnout occurs in the “college of hard knocks.”
Use it or lose it? The stereotype of the harried medical doctor, seeing twenty or thirty patients a day, is increasingly accurate. As the MD (or other health care professional) is pushed down into survival mode, empathy is not improved or expanded. Hear me say it, and not for the last time, the things that make us good at the corporate transformation of American medicine, improving productivity and efficiency, do not expand our empathy. This does not mean that empathy and efficiency are mutually exclusive. It means we have to get better at balancing quantity and quality in both business and empathy.
In another example, training sessions directed at aggressive adolescent girls in a residential treatment center showed the benefits of expanded affective empathy. Affective empathy is the automatic dimension of empathy (“empathic receptivity” in my definition) that is perhaps hardest to influence.[viii] Parental effectiveness training (PET) was demonstrated to move the participants from below facilitative on the Truax Accurate Empathy Scale up to or beyond the facilitative level. “Facilitative” means knowing how to get things done. That is, the outcome is that the parent’s empathic effectiveness was expanded.[ix]
The effectiveness of empathy training is not limited to the affective dimension. A team at the University of Toronto produced a meta analysis of twenty-nine articles, using seven different approaches to empathy training. All the studies except two (93%) had positive outcomes, improving the cognitive component of empathy (86%). These studies were distributed as follows: education (24%), nursing (14%), therapy (7%), medicine (21%), social work (3%), psychology (7%), human service (7%), couples (10%) and divorcees (3%). Regardless of the training method, individuals expand their empathy when they practice or engage in effortful training.[x]
In another study, some 42 couples involved in a romantic relationship completed a five week empathy training program. The change in empathy was assessed by measured analyses of variance. The assessment reproduced the positive results of earlier findings. The training produced reliably increased empathic interaction between the partners. Scores on three empathic measures improved over a follow up six month period.[xi]
Further evidence that empathy is trainable is available in “The Roots of Empathy” (ROE). This is a formal program developed by Mary Gordon and colleagues in Canada.
First started in 1996 and introduced into U.S. schools in 2007, the ROE program has been featured on the Public Broadcasting System (PBS) in the USA. ROE aims to build more peaceful and caring communities by expanding empathy in children.[xii]
The program targets elementary school classes, and consists of weekly visits to the class room by a new born baby and the baby’s mother for an entire school year. The group sits in a circle and the mom and baby interact, accompanied by a conversation about the life of the baby, biologically, psychologically, and socially.
The empathy lessons are elementary—unless you do not happen to have ever been exposed to a baby or the empathic care of one. Babies cry when they are hungry or wet or cold; they coo and gurgle and giggle when they are content and happy.
Some lessons are elementary; some, sophisticated, engaging with human development, of which the baby is Exhibit A, as the baby grows throughout the school year.
The roots of empathy are present in front of the class: the baby. The powerful presence of the baby calls forth the emotional resonance, natural curiosity, and wonder of the children. The baby provides the empathy lessons, in effect being the teacher. The baby provides the opening for conversations with the children about human development, socialization, and building a community. The vast majority of human beings are naturally inspired to care for a baby. Whether people know how to deliver such care effectively is a separate issue, requiring separate training. A complex species, these humans: human beings are naturally empathic just as they are also naturally aggressive.
At the heart of this kindergarten through 8th grade program is the goal of dialing down aggressive behavior patterns in children at an early age, in particular, curbing bullying (about which more in an entire chapter below). For example, roughly 160,000 children miss school every day “due to fear of an attack or intimidation by other students,” according to the National Education Association.
The program also documents an 11% improvement in standardized achievement tests for the class that is exposed to the Roots of Empathy intervention.[xiii] This is definitely not a predictable result. It should put us in touch with the humbling sense that there are many things that we do not even know we do not know.
When kids get the empathy to which they are entitled, they study harder and work smarter. When bullying is reduced, kids are less fearful, are less distracted, have more fun, and are able to study. When they study harder and smarter, they get improved scores.
The results of the program are “over the top” positive; and since this is the age of evidence-based everything, the program also spend a lot of cycles gathering key metrics on the results of the roots of empathy. A randomized control trial was conducted.
Findings indicated that children who had participated in the program compared to children who had not, were more advanced in their social and emotional understanding on all dimensions assessed. These included emotional understanding, perspective-taking, peer acceptance, classroom supportiveness, pro-social behavior and characteristics. Concomitant reductions in aggressive behaviors and increases in pro-social behaviors (e.g., helping, sharing, cooperating) were noted.
In particular, teachers rated three child (student) behavior outcomes (physical aggression, indirect aggression, and pro-social behavior). The Roots of Empathy program had statistically significant and replicated beneficial effects on all three child behavior outcomes.[xiv]
Peer reviewed research is compelling, but equally compelling are market dynamics: organizations are voting with their dollars that empathy is trainable.
People with chronic life style diseases such as hypertension (high blood pressure), type 2 diabetes, congestive heart failure, asthma, and so on, enjoy statistically favorable outcomes when their physicians show empathy—a fancy way of saying people “get better.”
Relying on such evidence, a company called “Empathetics” has been founded to train medical doctors in expanding their empathy.
Using intellectual property developed at Massachusetts General Hospital, affiliated with Harvard University, Empathetics, Inc. trains physicians in expanding their empathy through the use of biofeedback.
The CEO, Helen Riess, MD, delivered a Ted Talk about the value of empathy in health care.[xv] Dr. Riess and her colleagues at Mass General performed a meta analysis of the effects of empathy on all kinds of diseases.
Dr. Riess (and her colleagues) report on randomized controlled trials (RCTs) in adult patients, in which the patient-clinician relationship was systematically monitored and healthcare outcomes were either objective (e.g., blood pressure) or validated subjective measures (e.g., pain scores). Those doctors (and related professionals) that scored higher on the empathy screening tests had demonstrably better patient outcomes than those with lower empathy scores.
Three trials included patients with diabetes, two included patients with osteoarthritis. Other disorders included fibromyalgia, oncology, lower respiratory infection, osteoarthritis, hypertension, smoking, somatic complaints, and asthma. The median patient sample size was 279 (range: 85 to 7,557). That’s a lot of people.
In summary, empathic doctoring produces favorable results. Patients get better compared with those whose doctors who do not score as well on the applied empathy scale. A word of caution. Correlation points to a significant path to improved outcome through empathic relatedness, but, at least in the context of this study, correlation is not causation.
Using the language of evidence-based medicine is trending. The “effect size” of empathy is so large that it overwhelms any confounding variables that might be hiding beneath the surface of experience. Thus, empathy fits right in with the trend. The results are compelling. Applying empathy in interacting with the vast majority of people is like using penicillin to treat the vast majority of significant bacterial infections. Applying empathy in interacting with people is like using a parachute when jumping out of an airplane. If you don’t do it, you are headed for trouble.
Common factor, empathy, in social healing practices
Psychotherapy is regarded as an example of a social healing practice. Psychotherapy is a conversation for possibility between two persons, one of whom is dealing with difficult personal issues and emotions and another person who is committed to making a difference through empathy.
Experience shows that physical disorders, injuries, and lesions get elaborated psychosocially. This is not just hypochondria or imaginary disorders that are “in someone’s head.” This is lower back pain, migraines, life style disorders such as type 2 diabetes, asthma, and irritable bowel that are aggravated by job, family, and relationship issues (conflicts, stresses, upsets) in a person’s life. Nutrition and exercise are behavioral practices that positively affect health, but can be difficult to influence.
People have different ways of expressing their pain and suffering. When an investigation of the person’s life indicates that non-biological factors are contributing to the person’s decline or distress, then it is useful to engage an alternative point of view on pain and suffering. It is useful to undertake an inquiry without making too many assumptions that one knows what is actually going on. It is useful to have a conversation for possibility.
The first person to undertake such an inquiry of whom we have any record was named “Socrates.” His student, Plato, wrote down what Socrates had to say, the most famous statement of which was that he knew only one thing: “I know that I do not know.” Socratic’s approach was so powerful that he was able to undertake fundamental inquiries that challenged his own inauthenticities and those of the persons with whom he engaged in dialogue. His questioning led to insights about basic values of truth, right and wrong, pleasure and enjoyment, and the organization of the community. The example of Socrates inspired talk therapists of all kinds—not to mention religious leaders, politicians of integrity, and educators in diverse disciplines.
The word “empathy” does not occur in Plato’s dialogues with Socrates, who instead spoke of being a “midwife” of ideas. When a friend of mine read this account of Socrates as a midwife, he shared with me an anecdote from when he was a medical student. He was walking through the hospital maternity department one evening after class. As he passed an open door, one of the patient’s called out to him. She was in labor and she asked his help. As he told me candidly, at that time in his medical training, he knew nothing about childbirth. Thus, as far as he was concerned, the qualification of Socratic ignorance was satisfied.
My friend asked the woman how he could help. She asked to hold his hand. He thought to himself, “Now this I know how to do!” He held her hand for awhile. She pushed and pushed. The result was a healthy baby boy. How or why the woman was left alone, and what further help arrived was not specified.
My friend cited this as an example of empathic understanding that just shows up spontaneously. In his recollection this was an example of empathy at a moment of crisis to which no words were adequate. I would say the woman was training him in being empathic, and the empathy lesson worked just fine.
Socrates did not claim to produce original knowledge himself. But he acted as a midwife for others, who were trying to give birth to sustainable, viable knowledge. In terms of empathic understanding, Socrates exemplified the commitment to new possibilities as opposed to conformity. Socrates made the case for dwelling in the comfort-zone stretching, discomfort of open-ended inquiry in the face of “being right.” He helped his dialogue partners give birth to ideas of their own and distinguish those ideas that are viable from those that are still-born.
Socrates enjoyed a special relationship with his students and colleagues. He had a special rapport that was a combination ofidealization and affection that set him apart from many of the other teachers of his time, called “Sophists.” The latter were masters of argumentation and rhetoric for hire.
The sophists were perhaps the original purveyors of “alternative facts” and “fake news.” Socrates’ relationship with the sophists in the community was not positive. He spoke truth to power in such a way that those in power were deeply threatened. Some of those in authority came to fear and hate him.
Eventually Socrates was indicted and convicted, in a trial of questionable merit, of a crime against the state, corrupting the youth. For reasons that are still controversial today, Socrates decided to drink the hemlock instead of fleeing into exile, becoming a martyr to prejudice and political intrigue.
Nevertheless, the principles that Socrates espoused have become the basis for talk therapy—and overcoming resistance to empathy. To engage in therapy with human beings in their struggle with emotional pain and suffering requires: providing a gracious and generous listening and an authentic human response; inquiry into possibility and open-ended questioning; an alliance between the therapist and client against the disorder and suffering against which the client is struggling; and an understanding of cultural context and community.
Amid an alphabet soup of therapeutic approaches today, the Socratic method of inquiry stands out as a common factor. It is challenging to try to find something in common between cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), eye movement desensitization routine (EMDR), rational emotive behavioral therapy (REBT), acceptance and commitment therapy (ACT), psychodynamic therapy, psychoanalysis, existential and humanistic psychotherapy, and so on.
“Common factor” is an idea given credibility by Jerome and Julia Frank in their book on Persuasion and Healing.[xvi] The Franks debunk not only psychoanalysis, but also many of the alternative therapeutic approaches. The Franks’ position is that the beneficial results of therapy are a function of persuasion and suggestion. The therapist is applying his or her own empathic and emotionally generous personality in the context of the trusted relationship, committed to healing, to persuade the client to alter his habitual life practices in the direction of behaviors that are adaptive, accommodating, and empowering. The hypnotists called it “the rapport”; modern practitioners, “the therapeutic alliance.”
However, the point here is not to back into an advertisement for empathy. Rather the point is to look at what actually happens in stage one of therapy whether it is CBT, DBT, or one of the diverse talk therapies. Each of these interventions, after establishing a framework around schedule and fee, takes steps to deepen and expand the client’s “in touchness with” his or her own experiences. In DBT this is called “mindfulness”; in psychoanalysis, “free association”; in CBT and REBT, identifying and “interrupting the pathogenic thought”; in existential-humanistic therapy and ACT, “radical acceptance” of what’s so.
This “getting in touch with” is also the first step in becoming more empathic, and so highly relevant to empathy training. One has to be in touch with one’s own experiences in order to appreciate how the other person shows up in one’s vicarious experiences of that other person. In short, empathy is a common factor shared by virtually all approaches to talk therapy.
The problem is that grouping empathy with “common factors” has become a way of dismissing empathy. All the interventions share empathy. It occurs on all sides of the multi-dimensional equation, and so empathy itself cancels out. Empathy falls out of the equation—and out of the discussion.
I suggest an alternative point of view.
What if empathy were the very process that was creating the benefit—and the very equation itself—for each of these supposedly distinct interventions? What if empathy were the very thing that was creating the clearing for EMDR, ACT, and so on, to be effective in the person’s shifting out of stuckness, attachment to suffering, emotional disregulation, self-defeating behavior, or repetitive enactment?
What if empathy was not the idle wheel, falling out of the equation, but the drive shaft? What if the techniques of CBT, DBT, ACT, EMDR, and so on, were themselves so much formal scaffolding, providing a ritual framework for the dynamics of the empathic relatedness to have its effect?
Following the baton or dancing light in EMDR would be something to keep the client distracted while he was verbally expressing his experience of the trauma into the gracious listening of the therapist.
Filling out the paperwork, the surveys, and the homework of CBT would be so much busy work designed to keep the client’s mind off of his anxiety and depression for long enough for the therapist’s empathic responses to the client’s issues to have an impact.
The breathing in and out of mindfulness, literally a metaphor for empathy as oxygen for the soul, would be a useful holding pattern enabling the client to get in touch with his experience so he can communicate it to the therapist and be “gotten” for who he is as the possibility of radical acceptance in empathic understanding.
The “tough love” of DBT and the group skills back-and-forth would be a useful distraction for the client’s intolerable emotions until the therapist was either able to get it right with his empathic interpretation or the client exhausted the payer’s twelve approved sessions. Then, in every case, the empathic exchange as it occurs in the conversation between therapist and the client would be what is making the difference.
More work is definitely needed on this hypothesis. Nor is it likely to be an “either/or” matter. CBT’s “trigger log,” “dysfunctional thinking report,” and “daily thought record,” are useful exercises. Highly useful. It is just that, absent empathy, the CBT process is indistinguishable from dental work—and then the client does not even do the “homework.” What would an evidence-based comparison between empathic and alternative interventions even look like?
The client comes in, and the therapist greets him with a standard human response, using all her abilities to understand and grasp that with which the other person is struggling. Is one supposed to compare being empathic with being rude? With being hard-hearted? With being confrontational? With misunderstanding the other person? With being stone-faced and unemotional? All of these are possibilities. The stone-faced option has actually been tried, but not with adults presenting for therapy. Presumably because it would be a short session. The adults would not stand for it, and most (possibly excepting the masochistic) would get up and walk out.
However, it has been tried with infants in the context of attachment studies. When infants are briefly presented with a “still face,” a blank face from which emotion has been removed on the part of care-takers, who are usually warm and welcoming, the infants become noticeably upset. Some start to fuss; others, to cry. So do most people, whether in personal or experimental situations such as being on “candid camera.” Babies and children of tender age are people, too, and I suggest that their response is an example of a standard human one, albeit without any grammatical use of language, and typical of what one might expect from adults.
What is clear is that an overwhelming number and diversity of psychotherapy approaches engage in the use of empathy. This is so even when these interventions allow empathy subsequently to fall out of the equation as a “common factor.”
Even if the approach in question devalues empathy as a narrow psychological mechanism, it has to endorse its use, because when empathy is absent, generally, positive outcomes are also absent. Those few interventions that devalue empathy—electro shock therapy (ECT), shaming, jail, capital punishment, collective shunning—begin by paying it rhetorical lip service. The result? The amount of aggregated experience that indicates that empathy is an effective intervention is vast and arguably sufficient to overcome any hidden, confounding variables.
Judgments based on clinical practice, tacit knowledge, and deep life experience will continue to have a essential role; however, these need to be qualified by the best available evidence. As noted, the issue is that there are some interventions such as penicillin and using a parachute when jumping out of an airplane that seem to limit or even defy the gold standard. It would be unethical not to give someone penicillin if they were infected with an infection serious enough to require such treatment, since it is a matter of historical accident that penicillin was invented prior to the “evidence based” paradigm shift. And, as regards using a parachute, that case is the reduction to absurdity of not using common sense as a criteria in deciding what counts as evidence. What is going on here? The answer bears repeating for emphasis: The effect size is so large that it outweights and overwhelms any hidden confounding factors and so rises to the level of evidence (without quotation marks). [xvii]
The “effect size” is a function of the facts—the evidence—that there are so many examples and so much experience that penicillin works—that parachutes work—that the risk of one’s over-looking some other confounding variable is vanishingly small. It really was the penicillin, not (say) the effects of the alignmnet of the planets hidden behind the penicillin.
Likewise, with empathy. The use of empathy in human relations is demonstrably so effective in the medical and behavioral health world in question that not to apply empathy would be like not prescribing antibiotics against a bacterial infection. Empathy has been effective in shifting the suffering and transforming the psychic pain throughout history. The criticism of empathy has usually been that it results in burnout and compassion fatigue. But penicillin, too, has to be properly dosed, and people allergic to it excluded, or the results will be unpredictable.
In conclusion, the critical path lies through empathy training: empathy is not an on-off switch but a dial/tuner that requires training to get it just right. Examples of peer-reviewed publications exist in which empathy was shown to be effective (in comparison with less empathy) in correlating with favorable outcomes in diabetes, cholesterol, and the common cold (?!) and are cited in the bibliography (and will be further engaged in Chapter Six of Empathy Lessons).[xviii] Expect this work to expand and gain traction in other areas such as psychiatry and cognitive behavioral therapy.
In short, not to begin with empathy would be like jumping out of the airplane without a parachute or not providing penicillin when the infection was bacterial. If you are jumping out of an airplane, use a parachute; if engaging with struggling, suffering humans, use empathy.
[i] W.R. Miller, R.G. Benefield, J.S. Tonigen. (1993). Enhancing motivation for change in problem drinking: a controlled comparison of two therapist styles, Journal of Consultative Clinical Psychology, June; 61 (3): 455-61: 455.
[ii] Jay S. Coke, Gregory Batson, Katherine McDavis. (1978). Empathic mediation of helping: A two-stage model, Journal of Personality and Social Psychology 36(7):752–766. DOI: 10.1037/0022-35126.96.36.1992; Mark H. Davis, Laura Conklin, Amy Smith, Carol Luce. (1996). Effect of perspective taking on the cognitive representation of persons: A merging of self and other, Journal of Personality and Social Psychology, Vol 70(4), Apr 1996: 713–726.
[iii] Ofer Golan and Simon Baron-Cohen. (2006). Systemizing empathy: Teaching adults with Asperger syndrome or high-functioning autism to recognize complex emotions using interactive multimedia, Development and Psychopathology 18, 2006: 591–617. DOI: 10.10170S0954579406060305; J. Hadwin, S. Baron-Cohen, P. Howlin, and K. Hill. (1997). Does teaching theory of mind have an effect on the ability to develop conversation in children with autism? Journal of Autism and Developmental Disorders, 27: 519–537. DOI:10.1023/A:102582600 9731.
[iv] Geir Smedslund, Rigmor C. Berg, Karianne T. Hammerstrom, Asbjorn Steiro, Kari A Leiknes, Helene M Dahl, Kjetil Karlsen. (2011). Motivation interviewing for substance abuse, Cochrane Database of Systematic Reviews, May 11, 2011, Issue 5: CD 008063. DOI: 10.1002/12651858.CD008063.pub2.
[v] C.T. Ozcan, F. Oflaz, B. Bakir. (2012). The effect of a structured empathy course on the students of a medical and a nursing school, International Nursing Review, Vol. 59, Issue 4, December 2012: 532–538. DOI: 10.1111/j.1466-7657.2012.01019.x.
[vi] Scott Brunero, Scott Lamont, Melissa Coates. (2010). A Review of empathy education in nursing, Nursing Inquiry: Vol. 17, Issue 1, March 2010: 65–74.
[vii] M. Hojat, M. J. Vergate, K. Maxwell, G. Brainard, S. K. Herrine, G.A. Isenberg. (2009). The devil is in the third year: A Longitudinal study of erosion of empathy in medical school, Academic Medicine, Vol. 84 (9): 1182–1191.
[viii] E.V. Pecukonis. (1990). A cognitive/affective empathy training program as a function of ego development in aggressive adolescent females, Adolescence, Vol. 25: 59–76.
[ix] Mark E. Therrien. (1979). Evaluating empathy skill training for parents, Social Work, Vol. 24, no. 5 (Sep 1979): 417–19.
[x] Tony Chiu, Ming Lam, Klodiana Kolomitro, Flanny C. Alamparambil. (2011). Empathy training: Methods, evaluation practices, and validity, Journal of MultiDisciplinary Evaluation, Vol. 7, No. 16: 162–200.
[xi] J..J. Angera and E. Long. (2006). Qualitative and quantitative evaluations of an empathy training program for couples in marriage and romantic relationship, Journal of Couple & Relationship Therapy, Vol. 5(1): 1–26.
[xii] PBS staff reporter. (2013). Using babies to decrease aggression and prevent bullying. PBS News Hour: http://www.pbs.org/newshour/rundown/using-babies-to-decrease-aggression-prevent-bullying/
[xiii] PBS staff reporter 2013.
[xiv] Mary Gordon. (2005). The Roots of Empathy: Changing the World Child by Child. New York/Toronto: The Experiment (Thomas Allen Publishers): 250–256.
[xv] Helen Riess. (2013). The power of empathy, TEDxMiddlebury: https://www.youtube.com/ watch?v=baHrcC8B4WM [checked on March 23, 2017]. See also: John M. Kelley, Gordon Kraft-Todd, Lidia Schapira, Joe Kossowsky, Helen Riess. (2014). The influence of the patient-clinician relationship on healthcare outcomes: A systematic review and meta-analysis of randomized controlled trials, PLOS, Vol. 9, No. 4 | e94207: 1–7 Helen Riess, John M. Kelley, Robert W. Bailey, Emily J. Dunn, and Margot Phillips. (2012). Empathy training for resident physicians: A randomized controlled trial of a neuroscience-informed curriculum, Journal General Internal Medicine. 2012 Oct; Vol. 27(10): 1280–1286. DOI: 10.1007/s11606-012-2063-z.
[xvi] Jerome D. Frank and Julia B. Frank. (1981). Persuasion and Healing: A Comparative Study of Psychotherapy. 3rd ed. Baltimore: Johns Hopkins University Press; 1991. I express appreciation to Danny Levine, MD, for calling my attention to this outstanding contribution from the Franks. Also see my A Rumor of Empathy: Resistance, Narrative, and Recovery (2015) for a critique of the psychopharmacological (psychiatric) approach in chapter three “Plato, Not Prozac!” (a title that I borrow from Lou Marinoff (2000), who I hereby acknowledge for his contribution).
[xvii] Howick 2011: 5, 11.
[xviii] Howick 2011; M. Hojat et al, 2011; John M. Kelley, Helen Riess et al 2014); David P. Rakel, Theresa J. Hoeft, Bruce P. Barrett, Betty A. Chewning, Benjamin M. Craig, and Min Niu. (2009). Practitioner empathy and the Duration of the common cold, Family Medicine 41(7): 494–501.
(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 exclude psychiatric disorders and include mainline medical outcomes such as reduced cholesterol, improved type 2 diabetes, and improvement in related “life style” disorders.
Generalizing on this research, a small set of practices such as receiving empathy, meditation (mindfulness), yogic meditation, and Tai Chi, promote well-being by reducing inflammation. These practices are not reducible to empathy (or vice versa), but they all share a common factor: reduced inflammation. These anti-inflammatory interventions have been shown to make a difference in controlled experiments, evidence-based research, and peer-reviewed publications.
Using empathy in relating to people is a lot like using a parachute if you jump out of an airplane or getting a shot of penicillin if one has a bacterial infection. The evidence is overwhelming that such a practice is appropriate and useful in the vast majority of cases. The accumulated mass of decades of experience also counts as evidence in a strict sense. Any so-called hidden or confounding variables will be “washed out” by the massive amount of evidence that parachutes and penicillin produce the desired main effect.
Indeed it would be unethical to perform a double blind test of penicillin at this time, since if a person needed the drug and it were available it would be unethical not to give it to him. Yes, there are a few exceptions – some people are allergic to penicillin. But by far and in large, if you do not begin with empathy in relating to other people, you are headed for trouble.
Empathy is at the top of my list of stress reduction methods, but is not the only item on it. Empathy alongwith mindfulness (a form of meditation), Yoga, Tai Chi, spending time in a sensory deprivation tank (not otherwise discussed here), and certain naturally occurring steroids, need to be better known as interventions that reduce inflammation and restore homeostatic equilibrium to the body according to evidence based research.
Biology has got us humans in a bind, since the biology did not evolve at the same rate as our human social structures. When bacteria attack the human body, the body’s immune system mounts an inflammatory defense that sends macrophages to the site of the attack and causes “sickness behavior” in the person. The infected person takes to bed, sleeps either too much or too little, has no appetite (or too much appetite), experiences low energy, possibly has a fever, including the “blahs,” body aches, and flu-like symptoms. This response has evolved over millions of years, and is basically healthy as the body conserves its energy and fights off the infection using its natural immune response.
Now fast forward to modern times. This natural response did not envision the stresses of modern life back when we were short stature, proto-humanoids inhabiting the Serengeti Plain and defending ourselves against large predators. Basically, the body responds in the same way to the chronic stressors of modern life—the boss at work is a bully, the mortgage is over-due, the children are acting out, the spouse is having a midlife crisis—and the result is “sickness behavior”—many of the symptoms of which resemble clinical depression—but there is no infection, just inflammation.
The inflammation becomes chronic and the body loses its sensitivity to naturally occurring anti-inflammatory hormones, which would ordinarily kick in to “down regulate” the inflammation after a few days. Peer reviewed papers demonstrate that interventions such as empathy reduce biological markers of inflammation and restore equilibrium. This is also a metaphor. When an angry—“inflamed”—person is listened to empathically—is given a “good listening” as I like to say—the person frequently calms down and regains his equilibrium.
Empathy migrates onto the short list of inflammation reducing interventions. The compelling conclusion is that empathy is good for your well-being.
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(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]
Humor and empathy are closely related. We start with an example that includes both. Caution: Nothing escapes debunking, including empathy. My apologies in advance about any ads associated with the video.
Both empathy and humor create and expand community. Both empathy and humor cross the boundary between self and other. Both empathy and humor relieve stress and reduce tension.
However, empathy crosses the boundary between self and other with respect, recognition, care, finesse, artistry, affinity, delicacy, appreciation, and acknowledgement, whereas humor crosses the boundary between individuals with aggression, sexuality, or a testing of community standards.
If you have to explain the joke, it is not funny – nevertheless, here goes.
The community standard made the target of satire in the SNL skit is that people are supposed to be empathic. The husband claims he wants to understand social justice issues but when given a chance to improve his understanding – drinking the empathy drink by pitched by the voice over – he resists. He pushes back. He pretends to drink, but does not even take off the bottle cap. When pressured, he even jumps out the window rather than drink the drink.
The wife does not do much better. She resists expanding her empathy too, by pretending that, as a woman, she already has all the empathy needed. Perhaps, but perhaps not. People give lip service to empathy – and social justice – but do not want to do the hard word to create a community that is empathic and works for all.
The satire surfaces our resistance to empathy, our double standard, and our tendency to be fake about doing the tough work – including a fake empathy drink. If only it were so easy!
Therefore, be careful. Caution! The mechanism of humor presents sex or aggression in such a way that it creates tension by violating social standards, morals, or conventions. This occurs to a degree that causes stress in the listener just short of eliciting a counter-aggression against the teller of the story or joke. Then the “punch line” relieves the tension all at once in a laugh.
Another sample joke? This one is totally non controversial, so enables one to appreciate the structure of the joke.
A man is driving a truck in the back of which are a group of penguins. The man gets stopped for speeding by a police officer. Upon consideration, the officer says: “I will let you off with a warning this time, but be sure to take those penguins to the zoo.” The next day the same man is driving the same truck with the exact same penguins. Only this time, the penguins are wearing sunglasses. The same police officer pulls the driver over again and says: “I thought I told you to take those penguins to the zoo!” The man replies: “I did. Yesterday we went to the zoo. Today we are going to the beach!” Pause for laugh.
The point is that humor, among many things, is a way in which one speaks truth to power—and gets away with it. In this case, one disobeys the police officer. One is technically in the wrong, though vindicated. Penguins in sunglasses are funny. More specifically, the mechanism of the joke is the ambiguous meaning of “takes someone to the zoo.” One can go to the zoo as a visitor to look at the animals or one can be incarcerated there, as are the animals on display.
Instead of a breakdown in relating such as “you are under arrest!” the relationship is enhanced. The driver is following the officer’s guidance after all, granted the interpretation was ambiguous.
You get a good laugh—and a vicarious trip to the beach added to the bargain. Empathy is the foundation of community in a deep way, for without empathy we would be unable to relate to other people. Humor and jokes also create a community between the audience and storyteller as the tension is dispelled in the laughter (see also Ted Cohen on Joking Matters (1999)).
The story creates a kind of verbal optical illusion, a verbal ambiguity that gets expressed in laughter. In empathy perhaps one gets a vicarious hand shake, hug, “high five,” pat on the back, or tissue to dry a tear, expressing itself in recognition of our related humanity, while affirming and validating the self-other distinction.
Featured image of laughing carrousel horses (c) Alex Zonis
(c) Lou Agosta, PhD and the Chicago Empathy Project
Empathy flourishes in a space of acceptance and tolerance. But acceptance and tolerance have their dark side, too. People can be intolerant and unaccepting. Be accepting of what? Be accepting of intolerance? Be tolerant of intolerance? Yes, be tolerant, but set limits. But how to do that given that we may still have free speech in the USA, but many people have just stopped listening.
“The Trouble With Empathy” is an article by Molly Worthen published in The New York Times on September 04, 2020. The author gets many things just right in an impressive engagement with the complexities of empathy, but in other areas, including the citations of certain academics, I have an alternative point of view. Hence, the trouble with the trouble with empathy is not a typo. The reply is summarized in the diagram (note that it is labeled “Figure 2,” but it is the only diagram – page down, please). For those interested in more detail, read on.
Babies are not born knowing the names of the color spectrum. Children are taught these names and how to use them in (pre)Kindergarten; likewise, with the names of the emotions such as sadness, fear, anger, and high spirits. However, there is a lot more to empathy than naming one’s feelings and getting in touch with our mammalian ability to resonate with one another in empathic receptivity and understanding.
As an adult, the fact that you failed to be empathic does not mean that your commitment to empathy is any less strong; just that you did not succeed this time; and you need to keep trying. Stay the course. It takes practice. The practice is precisely the empathy training.
Often understanding emerges out of misunderstanding. My description of the other person’s experience as they lived it is clumsy and creates a misunderstanding. But when the misunderstanding is clarified and cleaned up, then empathy occurs. Thus, break throughs in empathy emerge out of breakdowns. So whenever a breakdown in empathy shows up, do not be discouraged, but rather be glad, for a break through is near.
Evidence from the past rarely demonstrates what innovations are possible in the future. Just because people are not born with wings does not mean people cannot fly. If the Wright Brothers had accepted the evidence, we would all still be taking the train. I hasten to add there is nothing wrong with taking the train. People can be intolerant, and I too am people. Work on oneself is constantly needed.
I open my mouth to be empathic and respond empathically—but instead of an empathic response, out jumps a frog: “I feel your pain.” What a fake! If I really felt your pain, then I would say “Ouch!” not “I feel your pain.” I find that I do frequently say “Ouch!” Or just shake my head and provide acknowledgement and recognition: “You’ve really been dealing with some tough stuff.” “Sounds like use could use some empathy.”
The point is not to devalue the attempted empathic response, clumsy though it may be. The point is to acknowledge that the lazy person expands his empathy in a practice filled with examples of not getting it quite right. If empathy were a sport, it would be filled with strikeouts, fumbles, off sides, failures, and incomplete plays. There would even perhaps be examples of “unsportsman-like conduct.”
Each of the four phases of empathy has characteristic breakdowns. This is not new news. The news is that if engaged with a rigorous and critical empathy, these breakdowns readily become breakthroughs in empathy.
Breakthroughs in empathy arise from working through the breakdowns of empathy. The Big Four breakdowns of empathy are noted: emotional contagion, conformity, projection, and getting lost in translation. These are not the only breakdowns of empathy, which are many and diverse, but these are the most frequent ones.
In the example of emotional contagion, one anxious person is telling the other person about all the reasons in the world that he is feeling out of sorts. Pretty soon, the person who is listening is starting to feel anxious too. The person’s receptivity—openness and availability—to the other individual’s emotions is working overtime and his empathic receptivity misfires, becoming: Emotional contagion. Emotional infection strikes again!
Often it is not so obvious. Often people are caught up in the emotion of the moment. The emotion itself is so powerful that it just sweeps over everyone present like a tidal wave—an emotional tsunami. The person is flooded—emotionally.
If the listener realizes that listening to anxiety-inspiring stories causes his own anxiety to spike, then that is already going beyond emotional contagion and the start of an empathic processing of the emotion.
If one stops in the analysis of empathy with the mere communication of feelings, then empathy collapses into emotional contagion. Empathic receptivity breaks down into emotional contagion, suggestibility, being over-stimulated by the inbound flood of the other person’s strong feelings.
Emotional contagion—basically the communication of emotions, feelings, affects, and experiences—can be redescribed as input to further down stream empathic processing. Then emotional contagion (communicability of affect) gets “normalized” and can very well make a contribution to empathic understanding.
Overcoming the breakdown of empathy into emotional contagion results in the breakthrough to vicarious experience. A vicarious experience is what a person has in going to the theatre, the movies, or a single-person player video game. I experience the fears and hopes of the character in the film, but I do so vicariously. Theatre, film, and the novel were “virtual reality” (VR) long before computers, special VR goggles, and social networking were invented.
Vicarious experience is not empathy. It is input to the process of empathy. Vicarious experience is the grain of truth in the fake-sounding empathy meme, “I feel your pain.” I feel your pain—vicariously. I experience an after-image of your pain—like the visual after-image of the American flag that results from starring at a vivid depiction of the off-color image of the stars and stripes. I repeat: we gat an after-image of another person’s feelings and emotions.
I am amazed that no one has as yet explicitly pointed out that we get after-images of other people’s feelings when we are exposed to those feelings for a sustained duration. A vicarious experience of emotion differs from emotional contagion in that one explicitly recognizes and knows that the other person is the source of the emotion.
You feel anxious or sad or high spirits, because you are with another person who is having such an experience. You “pick it up” from him. You can then process the vicarious experience, unpacking it for what is so and what is possible in the relationship. This returns empathy to the positive path of empathic understanding, enabling a breakthrough in “getting” what the other person is experiencing. Then you can contribute to the other person regulating and mastering the experience by being there for him and responding with soothing words and acknowledgement of the situation.
The next breakdown of empathy is settling for conformity instead of striving for possibility. We might also say: settling for agreement instead of striving for possibility.
People live and flourish in possibilities. Empathic understanding breaks down as “no possibility,” “stuckness,” and the suffering of “no exit” (the definition of Hell in a famous play of the same name by Jean Paul Sartre). You follow the crowd in responding to the other person; you do what “one does”; you validate feelings and attitudes according to what “they say”; you conform and express agreement; and, with apologies to Henry David Thoreau, you live the life of quiet desperation of the “modern mass of men.”
When someone is stuck, experiencing shame, guilt, rage, upset, emotional disequilibrium, and so on, the person is fooling himself—has a blind spot—about what is possible. This does not mean that it is easy to be in the person’s situation or for the person to see what is missing. Far from it. We live in possibilities that we allow to define our constraints and limitations—for example, see the example of the friend who was married and divorced three times. This expresses a strong commitment to marriage, though empathy and husbanding skills are seemingly limited.
If you acknowledge that the things that get in the way of your relatedness are the very rules you make up about what is possible in your relationships, then you get the freedom to relate to the rules and possibilities precisely as possibilities, not absolute “shoulds.” You stop “shoulding” on yourself. This brings us to the next break down—the break down in empathic interpretation.
Taking a walk in the other person’s shoes—the folk definition of empathy—breaks down if you take that walk using an inaccurate shoe size. You then know where your shoe pinches, not hers. This is also called “projection.” The recommendation?
Take back the projections of your own inner conflicts onto other people. Take back your projections. Own them. You get your power back along with your projections. Stop making up meaning about what is going on with the other person; or, since you probably cannot stop making up meaning, at least distinguish the meaning—split it off, quarantine it, take distance from it, so that its influence is limited.
Having worked through your vicarious experiences, worked through possibilities for overcoming conformity and stuckness, and taken back your projections, you are ready to engage in communicating to the other person your sense of the other individual’s experience. You are going to try to say to the other what you got from what they told you, describing back to the other your sense of their experience. And what happens? Sometimes it works; sometimes you “get it” and the other “gets” that you “get it”; but other times the description gets “lost in translation.”
This breakdown of empathic responsiveness occurs within language. You fail to express yourself satisfactorily. I believed that I empathized perfectly with the other person’s struggle, but my description of her experience failed significantly to communicate to the other person what I got from listening to her.
My empathy remains a tree in the forest that falls without anyone being there. My empathy remains silent, inarticulate, and uncommunicative. I get credit for a nice empathic try; but the relatedness between the persons is not an empathic one. If the other person is willing, then go back to the start and try again. Iterate. Learn from one’s mistakes and incomplete gestures.
The fact that you failed does not mean that your commitment to empathy is any less strong; just that you did not succeed this time; and you need to keep trying. Stay the course. It takes practice. The practice is precisely the empathy training.
Often understanding emerges out of misunderstanding. My description of the other person’s experience as they lived it is clumsy and creates a misunderstanding. But when the misunderstanding is clarified and cleaned up, then empathy occurs. As that notorious bad boy of a certain 18th century enlightenment, Voltaire, is supposed to have said: Let not perfection be the enemy of the good. Thus, break throughs in empathy emerge out of breakdowns. So whenever a breakdown in empathy shows up, do not be discouraged, but rather be glad, for a break through is near.
Knowing Professor Worthen’s [the author of the NYT article that provoked this reply] interest in religious studies, I conclude with a reflection on empathy and the Good Samaritan. The Parable of the Good Samaritan speaks volumes (Luke 10: 25–37). The first two people, who passed by the survivor by crossing the road, experienced empathic distress. They were prevented from helping out by a breakdown of their empathic receptivity. They were overwhelmed by the suffering and crossed the road. In contrast, the Good Samaritan had a vicarious experience of the suffering. His empathic receptivity gave him access to the survivor’s pain. His empathy told him what the other person was experiencing and his compassion told him what to do about it.
To get Lou’s light-hearted look at the topic, Empathy: A Lazy Person’s Guide or one of his peer-reviewed publications see: Lou Agosta’s publications: https://tinyurl.com/y8mof57f
(c) Lou Agosta, PhD and the Chicago Empathy Project