Home » empathy lessons

Category Archives: empathy lessons

Empathy and humor – resistance to empathy?

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

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

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

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

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

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

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

Empathy breakdowns lead to breakthroughs

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Empathy and Hermeneutics

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

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

Slide1

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

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

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

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

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

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

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

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

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

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

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

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

(c) Lou Agosta and the Chicago Empathy Project

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

Empathy and Gender

Biology is not destiny. As Simone de Beauvoir noted in The Second Sex, woman is not a mere womb. Likewise, I note: man is not mere testosterone. [Note: This post is an excerpt from the final section of Chapter Seven on my book: A Critical Review of a Philosophy of Empathy, available here: click here to examine complete book.]

Cover Art: A Critical Review of a Philosophy of Empathy
Cover Art: A Critical Review of a Philosophy of Empathy

Biology is important, but biology is not destiny. That was one of the key points of the feminist revolution. Raising children is a job – a big job; and so is being the CEO of IBM as was Virginia Rometty until earlier this year. 

The matter is delicate. These human beings – we human beings – are an aggressive species. It is usually the men that are doing the aggressing. That is indeed a function of testosterone – as well as upbringing [child rearing practices], enculturation, and the evaluation of the species. 

Common sense suggests that woman is the more nurturing gender, given her role in giving birth and keeping the home fires burning in agricultural, hunting, and traditional indigenous cultures. Women are keeping the home fires burning, so what are the men doing? Men are out systematically doing battle with saber-toothed tigers and hostile neighbors.  If this seems like an over-simplification, it is. Yet it is a compelling one, given the evolution and history of the species.

This issue of empathy and gender becomes controversial. Claims have been made that a man’s brain  is different than a woman’s. In particular, men are “wired” for systematizing; and women are “wired” for empathy – for relating, especially relating to children and other human beings in general. This research – usually credited to neuropsychologist Simon Baron Cohen but also to Frans de Waal – has for sometime now been debunked – shown to be limited, distorted, and flat out wrong.

When one looks at the methods and the data in detail, no consistent gender difference in empathy have been observed – read on!  

I provide the reference point upfront. As noted, the research by Simon Baron Cohen that men’s brains are “wired” for systematizing and women’s for relating and relationships are questioned and indeed debunked in Robyn Blum’s article in Heidi L. Maibom, ed. (2017). (For Bluhm’s original article see The Routledge Handbook of the Philosophy of Empathy. London/New York: Routledge (Taylor and Francis): 396 pp. )

Robyn Bluhm’s article probes the research on the evidential basis of this nurturing role and inquires: does it extend to empathy and how far?

Early gender-empathy studies were vulnerable to self-report biases and gender stereotyping that pervasively depicted females in a biased way as the more empathic gender. According to Bluhm, these early studies simply do not stand up to critical scrutiny. Case closed on them. Dismissed. Enter Simon Baron-Cohen and his innovative research, renewing the debate and shifting it in the direction of neural science as opposed to social roles and their self-fulfilling stereotypes.

Bluhm points out in detail that as Baron-Cohen’s work gained exposure and traction in the academic market place of ideas subtle shifts occurred in his presentation of the results. At first Baron-Cohen highlighted measures that were supposed to assess both cognitive and affective empathy, but later the affective dimension fell out of the equation (and the research) and only cognitive empathy was the target of inquiry and was engaged (p. 381).

Though Baron-Cohen’s initial research described the “male brain” as having “spatial skills,” his later publications, once he became a celebrity academic (once again, my term, not Bluhm’s), redescribe the male brain as “hardwired for systematizing”; likewise, the “female-type” brain, initially credited with being better at “linguistic skills,” was redescribed as “hardwired for empathy.” The language shifts from being about “social skills.” Baron-Cohen speaks of “empathy” rather than “social skills,” so that the two distinctions are virtually synonymous (p. 384).

As the honest broker, Bluhm notes that, as with the earlier research in gender differences, Baron-Cohen’s research has been influential but controversial. Men and women have different routes to accessing and activating their empathy; they respond to different pressures to conform to (or rebel against) what the community defines as gender-appropriate behavior; and men and women even have different incentives for empathic performance.

For example, “…[M]en’s scores on an empathy task equaled women’s when a monetary reward for good performance was offered” (p. 384). Monetary rewards up; empathy up? Though Bluhm does not say so, I came away with the distinct impression of a much needed debunking of the neurohype—what we would now call “fake news”—a job well done.

Bluhm’s work is especially pertinent in constraining celebrity, executive consultants (once again, my term), running with the neuro-spin, and publishing in the Harvard Business Review, who assert that brain science shows we need more women executives on corporate boards to expand empathy.

I hasten to add that we do indeed need more women executives, but that is not something demonstrated by brain science, at least as of this date (Q2 2020). We need more women executives because it is demonstrated by statistics (just one of many sources of reasons other than brain science) that to devalue the contributions to innovation, service, and productivity of slightly more than half the population is bad business practice—foolish, inefficient, and wasteful. The challenge is that the practices that make one good at business—beating the competition, engaging technology problems, solving legal disputes—do not necessarily expand one’s empathy, regardless of gender.

[In a separate, informal email conversation (dated July 2, 2018), Bluhm calls out Cordelia Fine’s fine takedown of “The Myth of the Lehman Sisters” in the last chapter of Fine’s book (not otherwise a part of Bluhm’s review): Cordelia Fine, (2017), Testosterone Rex: Myths of Sex, Science and Society. New York: W. W. Norton. It is a bold statement of the obvious – that the part of basic anatomy that differs between men and women is definitely NOT the brain. But that is missed due to lack of empathy which is committed to responding to the whole person – not just the brain or the sex organs.]

In an expression of insightful and thunderous understatement, Bluhm concludes: “With the exception of studies that rely on participants’ self-reports or on other’s reports of their behavior [which are invalid for other reasons], no consistent gender differences in empathy have been observed. This raises the possibility that gender differences in empathy are in the eye of the beholder, and that the beholder is influenced by gender stereotypes…” (p. 386). Just so.

Okay, having debunked the myth that men’s brains are different – and in particular less empathic – what to do about the situation that many men (and women?) struggle to expand their empathy? The recommendation is not to treat empathy and an on-off switch. Empathy is rather a dial – to be tuned up or down based on the situation. That takes practice.

Some men – many men – may start out with an empathic disadvantage in experiencing their feelings after having been taught such stuff as “big boys don’t cry.” But if people, including men, practice getting in touch with their experience, then they get better at it – experiencing their experience. Likewise, with empathy. If you practice, you get better at it. For those interested in practicing, but not working too hard, may I recommend: Empathy: A Lazy Person’s Guide: click here to examine (and buy!) the book.

Further Reading

Ickes, William & Gesn, Paul & GRAHAM, TIFFANY. (2000). Gender differences in empathic accuracy: Differential ability or differential motivation?. Personal Relationships. 7. 95 – 109. 10.1111/j.1475-6811.2000.tb00006.x.

ELPG Front Cover as jpg

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

Empathy in the age of the coronavirus

What does empathy in the age of coronavirus look like? Two words to get started: social distancing.

Social distancing makes sense and is necessary; but social distancing has a cost and an impact.

No hugs allowed. No shaking hands. Bumping elbows? Questionable. “Hug therapy”? There is such an innovation, as the right kind of hug seems to release endorphins – but it is on the ropes. Not good news, though perhaps only a temporary – months long? – setback.

Do not overlook the obvious good news. Some jobs can be performed remotely using

Follow medical doctor's orders - keep calm - and wash your hands!

Follow medical doctor’s orders – keep calm – and wash your hands!

online methods and Skype-like facilities such as Zoom or Signal. Many businesses already operate secure virtual  private networks. Many kinds of consulting, coaching, guidance, and talk therapy can occur via telecomm, and, though aspects of empathic relatedness may be lost or stretched thin, good enough results can be attained to make it worthwhile to try. Other situations are more problematic.

The social distancing recommendation is strained to the breaking point when it comes to first responders such as doctors and nurses (police, fire, ambulance drives, and others).

Yes, one can take a throat and nose swab without too much interaction, but it is not going to happen from six feet away. Moreover, one does not know what is the cause of the patient’s symptoms so further “laying on of hands” is often required. Thus, the risk. I acknowledge that it is deeply cynical, but I have to note: “Just because we have a germ phobia does not mean we cannot get sick.” We can – and do.

Here the empathy lesson is that empathy is a two way street and the first responders may require reasonable accommodation – and empathy from the community including the patients. So if the doctor shows up in a HAZMAT [hazardous materials] suit, it is not for lack of empathy, it is due to needing to screen dozens of people and stay healthy to screen even more. See above on the cost of social distancing.

What to do when there are no masks and gowns, or MDs and nurses are asked to wear yesterday’s contaminated stuff, are the tough questions. Some hospitals (and families), who have fabrication (including sewing) skills, are making their own. Others are calling the media and blowing the whistle on this appalling situation of first responders at unnecessary risk. All are madly rushing about trying to close the barn door now that the horses [of the apocalypse?!] have escaped. [Update: paragraph added: 03/21/2020.]

Once again, empathy is about community and responsibility. Here is the empathic moment according to celebrity MD, Sanjay Gupta:

“How I behave affects your health. How you behave affects my health,” Gupta said on the air with CNN. “Never, I think, have we been so dependent on each other, at least not in my lifetime, and we should rise to that occasion.” [Kate Shepard and Allison Chiu reporting The Morning Mix March 18, 2020: ‘I’ve never seen Dr. Sanjay Gupta like this’: Strollers, joggers in locked down San Francisco spark anger on CNN: https://www.washingtonpost.com/nation/2020/03/18/coronavirus-cnn-sanjay-gupta/ ]

UPDATE: March 22, 2020:

University of Chicago Medicine infectious diseases expert Dr. Emily Landon spoke during the Illinois governor’s COVID-19 press conference on March 20, 2020. Hear her explain why the statewide order to stay at home is crucial to protecting everyone.

“Our health care system doesn’t have any slack. There are no empty wards waiting for patients or nurses waiting in the wings. We barely even have enough masks for the nurses that we have. Looking back to the last time, we were– limited tools and having a dangerous infection spread quickly was the beginning of the 1918 pandemic.

“Two cities in America made different choices about how to proceed and when only a few patients were affected. St. Louis shut itself down and sheltered in place. But Philadelphia went ahead with a huge parade to celebrate those going off to war.

“A week later, Philadelphia hospitals were overrun. And thousands were dead, many more than in St. Louis. This is a cautionary tale for our time. Things are already tough in Illinois hospitals, including mine. There is no vaccine or readily available antiviral to help stem the tide.

“All we have to slow the spread is social distance. And if we let every single patient with this infection infect three more people and then each of them infect two or three more people, there won’t be a hospital bed when my mother can’t breathe very well or when yours is coughing too much.” Do your part – follow Dr Landon’s guidance. Meanwhile –

You have got to get the black humor here. The situation in Washington DC (and on CNN) is serious but not hopeless; the situation in Milan, Italy, is hopeless but not serious – people under lock down as the death toll rises are going out onto their balconies and singing.

The mother of an eight grader in New Rochelle, New York, who comes home with a fever, is leaving trays of food outside his bedroom door and everyone is eating off of paper plates. This is what empathy looks like in the age of the coronavirus.

This is not a Saturday Night Live (SNL) skit. Six guys in HAZMAT [hazardous materials] suits descend on the family in New Rochelle and make them sign an agreement to stay home for two weeks. They signed. It could be worse. This too shall pass, and presumably the kid (whose fever is going down) will have enhanced (if not unconditional) immunity and can himself serve as a first responder once he grows up.  [See Jason Riley’s Report from New York’s Containment Zone March 17, 2020: https://www.wsj.com/articles/report-from-new-yorks-containment-zone-11584485597?cx_testId=3&cx_testVariant=cx_2&cx_artPos=3#cxrecs_s.%5D

Well and good, except where’s the empathy?

Empathy is all about boundaries and crossing boundaries with understanding, receptivity, responsiveness, respect, dignity, courtesy, humor (when appropriate), affection, affinity, and, at the risk of circular reasoning, empathic relatedness.

So what are the proper boundaries in a coronavirus epidemic? Empathy lessons 101 teach us that the most fearsome thing is the unknown – the Hold that thought. The unknown is stressful. The unknown leaves one feeling isolated. The unknown inspires anxiety. The unknown creates an opening for alternative facts, half truths, and total nonsense.

As noted in this blog previously, you know how in the vintage black and white monster movies, once the audience actually sees the Swamp Thing, which is obviously a guy in a lizard suit, it is a lot less scary? The creature may still be disgusting, but it is no longer nearly as scary. The scary part is when the heroine is innocently combing her hair and the swamp thing (which is “off camera” and the audience cannot yet see) is silently sneaking up behind her.

Doubtful this is the Zombie Apocalypse, but it puts me in mind of that U2 classic “Mysterious Ways”: “We’ll be living underground. Eating from a can. Runnin’ away from what you don’t understand. Love.” [Insert dramatic base line here.]

All right, so we are not yet ready for the Zombie Apocalypse, but some people are acting like it – like Zombies, that is. Especially unfortunate is that a few of them hold high public office or are media personalities. But we have got to work with what we’ve got for the time being. Other people are totally “business as usual.” Both extremes need to cut that out! Instead think! Think:  community and responsibility.

I am inspired in this thought – community and responsibility – by Jason Bridges. From a practical point of view, Jason Bridges, a professor of philosophy of mind and of Ludwig Wittgenstein (University of Chicago), writes eloquently in an unpublished but widely circulating email of community and responsibility in the time of coronavirus:

“Crises like this lay bare what is always anyway true: we are all members of community. To belong to a community is to be responsible for it” (Unpublished email 2020).

Though Bridges does not use the word “empathy,” this is the empathic moment. Those of us who are not at an especially high risk may usefully ask: “Is doing this responsible?” (“This” being many forms of in-person social contact we have taken for granted.)

The issue – and conflict – is that empathy is supposed to bring us closer –emotionally and spiritually. However, given the kind of physical embodied creatures that we humans are, emotional and spiritual closeness are often mediated by physical, bodily closeness (though crucially not always). (See above – back to “hug therapy.”)

We seem intrinsically to be a species that likes to congregate and get close to one another, at least on many occasions. Some cultures – Italian, Spanish, French, Southern (?) – seem to do this more so than others – Scandinavian, German, Northern (?). America, China, and Russia are vast and include some of each.

Thus, we return to the crucial issue of social distancing and its impact – and cost – with an illness spreading through community contagion.

By cancelling in person events at church, work, school, sports, theatre, and so on, in order to save lives, one is doing exactly the thing predicted to expand loneliness, isolation, detachment, and risking irrational behavior such as hording and opportunistic price increases. You solve one problem; create another. That’s another reason this is a crisis – the dominoes are still falling.

You see the dilemma? Going to church is not usually regarded as an intrinsically empathic activity, but lots of people do it because the experience of community addresses their need for empathy, to be acknowledged as a whole person, to feel included. Same idea with other community events.

Research shows that loneliness can be as bad for one’s health as smoking cigarettes or obesity (see John Cacioppo, (2008), Loneliness, Human Nature, and the Need for Social Connection, New York: W. W. Norton). Loneliness causes stress, reducing the immune system response, and triggering inflammation. Fear also causes such an immune response decline; and, heaven knows, the unknown – including aspects of the COVID-19 situation – is the most fearsome thing. So here is the rock and here is the hard place – what is one to do?

Just doing some brain storming here. The line at the polling station during the March 17, 2020 election had people waiting six feet apart. The frozen custard shop was reconfiguring its service line with markers on the ground at six-foot intervals. Given that the store is often jammed with children pushing forward, it is going to be interesting to see how that works.

Tips and techniques for maintaining and expanding social contact include: pick up the phone and talk to someone. Do not merely text, but have a conversation. Same idea using video conferencing such as Skype, Zoom, or Signal. Talk with one or two friends a day –once again, talk, not text. Do something for someone. It does not have to be volunteering to get the first coronavirus vaccination human trials, and dealing with the uncertainty whether it will cause your children to be born with tails. Do something small. Make a trip to the store for the senior couple next door. Help with chores, homework, or whatever you can contribute.

Although exercise and mindfulness do not usually require talking with others, they can be done in such a way that social distancing is maintained – for example, running outdoors or sitting indoors in a spacious room. These reduce loneliness and related stress.

I will not further comment on the detailed recommendation as numerous resources are available from WHO and the CDC (other relevant local authorities should be included here), frequently updated as we learn more and more about what to do or not to do. I accept the guidance and so should you, dear reader.

Now I agree events need to be cancelled due to the risk of community contagion. What I am asking is whether, for the time being, people can get their head around sitting two sneezes distance apart (in accordance with present CDC guidelines) and the pastor holds two services – one for seniors and one for those less at risk. More work? Yes, but perhaps doable just the same. (Okay, “two sneezes” means the six

Seems like the right idea to me for so many reason. Artistic activity boosts the immune system? Might be worth a try, though tragically the local Italian newspapers are crowded with obituaries. The hypothesis is that the warm, affectionate, cultural practices of getting in close for conversation and food and Catholic mass and so on, did not work well, rapidly spreading a highly contagious pathogen. No good deed goes unpunished!? Yet good deeds in abundance are many and even more are needed.

So, once again, what does empathy in the time of coronavirus look like?

As noted, it also looks like the Italian people, who are suffering severe fatalities in the pandemic, getting out on their balconies and singing – serenading the neighborhood.

It looks like maintaining a healthy routine of exercise, diet, communicating at arms lengths and with electronic media, keeping calming and carrying on – I mean – washing your hands.

It also looks like young healthy people making grocery shopping runs for senior citizens who are still healthy but reluctant to venture out. It looks like shoppers buying two cartons of eggs and two packages of toilet paper instead of two dozen.(What were these people thinking? Right, they were not thinking – that is the point – as Hannah Arendt noted long ago, not thinking can provide an opening for evil to get a foothold.)

It also looks like employers keeping staff on the payroll even though business is in a downturn.

It looks like insurers forgoing their monopoly rents and agreeing to reimburse first responders for their services in treating all potential patients without condition or qualification.

It also looks like government support for big pharma, which has a chance to shine [for a change!], in developing a vaccine (and anti-viral treatments) on a crash, moon-shot-style basis, which vaccine, in turn, has to be given-away to the planet.

Paraphrasing Jason Bridges, crises like this lay bear the weakness and strengths of the community. It puts me in mind of the kid’s game “The Cooties.” Some seven-year-old yells “You’ve got the cooties!” It is the game of tag. The kids all runs around like crazy playing tag – the opposite of social distancing, yet a transformation of it – because you cannot get close or you might be “tagged.” Fortunately, no one dies of the cooties, unlike COVID-19. Thus the breakdowns of empathy of the community are exposed – hoarding, stigmatizing, opportunistic behavior, boundary violations, beggar thy neighbor behavior.

Never was it truer that good fences (not walls!) make good neighbors; but there is a gate in the fence and over the gate is inscribed the word “Empathy.” Every breakdown, when handled with empathy, has the possibility of a breakthrough – a breakthrough in sustaining and crossing boundaries with expanded understanding, generosity, humor (as appropriate and inappropriate), responsiveness, receptivity, respect, random acts of kindness, dignity, and our shared humanity.

© Lou Agosta, PhD and the Chicago Empathy Project

 

Noted in Passing: Elizabeth Wurtzel, Author, Prozac Nation

Elizabeth Wurtzel (1967–2020) died at the age of 52 on January 7th in New York City of metastatic breast cancer. Wurtzel became a notorious “bad girl,” with a wicked sense of black humor, sparing few, least of all herself, and a disarming “tell all” candor in her break through memoir Prozac Nation.

Full disclosure: I am catching up on my reading. Triggered by Wurtzel’s passing

Elizabeth Wurtzel (her young self): Cover Art: Prozac Nation

Elizabeth Wurtzel (her young self): Cover Art: Prozac Nation

away, I had not read her best selling Prozac Nation until earlier this week (01/14/2020). I acknowledge I need to get out more.

Now I am familiar with pathographies – autobiographies and biographies of mental pathology – having read Kay Redfield Jamison’s An Unquiet Mind, Jamison’s “Robert Lowell: Setting the River on Fire: A Study of Genius, Mani, and Character,” and Elyn Saks’ The Center Will Not Hold, all worth reading – as is Prozac Nation. Thus, I bring an innocent reading – and eye – to a work that is anything but innocent.

Wurtzel is credited with putting the funny but self-lacerating memoir on the literary map, with its account of her emotional struggles against the Black Wave of depression, volatile internal conflicts, and acting out in the form of cutting, starting at age eleven. Subsequent attempts to attain emotional equilibrium through substance abuse and volatile relationships with members of the opposite sex, the narrative actually turns into a coming of age story. Some coming; some aging.

Not quite stream of consciousness, but definitely a rapid fire, back-and-forth conversation of Wurtzel with herself, it puts me in mind of the cliché: your mind can be a bad neighborhood; if you go there, you are going to get mugged, albeit in a comical way; mugged by negative self-talk, devaluing self assessments, and rage at the narcissistic slights inflicted by intimates, strangers, and intimate-strangers alike.

Wurtzel’s writing is shot from a cannon. The character sketches are wickedly funny and just as cutting as her own practices of self-injury. One example: “If Archer weren’t so good-looking, I’m not sure he’d exist at all, since he lacks most vital signs [….][H]e is the best opportunity to hang out with a gorgeous man and be certain that there will be no sexual tension whatsoever” (p. 224).

Wurtzel literally calls out the elephant in her family’s living room early in the narrative (p. 58): her parents are fighting, from the time Elizabeth is two years old, when her mom divorces her dad. The parents continue to fight (including in court) throughout her childhood, adolescence, and emerging adulthood, all the while “telling me that their [hostile] feelings for one another shouldn’t affect me,” blaming the victim if she feels affected, making the child an unwitting pawn.

Usually an emotion will shift after a few hours and a depression will shift after a few months, even if no intervention is undertaken other than good rest and good nourishment. To keep the disorder in place, active measure must be undertaken by the person, environment or both. The ongoing family situation is a significant contributor to the extraordinary duration of the distress.

It gets worse. The dad has access to health benefits through a good, albeit low level, corporate job; but it seems that every time the growing Wurtzel gets into an emotional crisis (chronic emergency would be more like it), the dad stops paying for psychotherapy, telling her its nothing personal. The real reason is usually a dust up with the mom.

Queue up the late rock-and-roller Stevie Ray Vaughn: Caught in the cross fire. Elizabeth is. She cannot help but internalize the conflict. Any kid would. This is the way it is. It starts so early and continues so unremittingly, that one must be positively as blind as the parents not to see it: this is an invalidating environment.

Another example of invalidation that might be straight out of Heinz Kohut, MD: “For instance, I’ll walk into her [mom’s] apartment and she’ll just blurt out, Those shoes are so ugly! And I never asked her. And I like my shoes […] The concept of Who asked you? does not exist in my family […] We’re all meshed together” (p. 231). Unremitting, serial breakdowns in empathy, resulting in emotional contagion, conflict, and enmeshment with the toxic self-object and hostile introject. Ouch!

Abandonment comes up early and often. In year-after-year of being sent off to a different camp, depending on which one offers a discount to her and her mom, who are living in a kind of genteel poverty. It induces a real panic about abandonment in the young Wurtzel, resulting in dozens of calls requesting rescue. Having been dutifully rehearsed during latency, this fear takes on a life of its own. “[…] [B]eing alone turns into a terrible fear that I will have no friends” (p. 89).

In several relationships with college BFs (at Harvard College) Wurtzel cries and cries sad tears, angry tears, at the prospect of separation such that the behavior creates the dreaded self-fulfilling prophecy. She goes well beyond “high maintenance” into the land of continuous confrontation, just plain crazy shit, and the bottomless pit of infinite upset all the time. Meanwhile, the guy wants a friend with whom he can go to the movies and party, maybe perform some consensual sex acts between reading about Derrida and Marxism. Enough.

Years later it comes out. The man Elizabeth thought was her dad, who was divorced after two years by the mom, and who also thought he was the dad, is not the biological father. Even though he did not have the DNA data, somehow he was never able to relate to Elizabeth in quite the proper parental way. (See the article by Wurtzel entitled Bastard, cited at the bottom of this post.)

Wurtzel has a gift for zingy one-liners, coming out of the blue, and yet creating their own context instantaneously. As regards the above-cited elephant, “We went to Alaska and we froze to death” (58) – emotionally. More like the abandoning, ice box father and the bonfire mother. Things heat up, especially with her mom: “I come from a family of screamers” (p. 185). Balance is hard to find.

The subtitle is “Young and depressed in America,” and one can sees Wurtzel’s editor’s skillful hand in connecting the dots between individual suffering, of which there is an abundance, and the breakdown of communities, ongoing, whether due to globalization, an opioid epidemic, or the malling / mauling of America.

The reader learns the difference between sadness and negative self-talk and what we might call existential depression: “I’d been expelled from the place where possibility still existed” (p. 60). Depression is the loss of the possibility of possibility. It is not just that I lose love and long for love; I lose the possibility of the possibility of love. This is gonna be tough going.

This is definitely a page-turner. Hard to put down. However, there are also some loose ends. I mean in the narrative, looser than Wurtzel herself. 

The title is premised on the interpretation that Wurtzel suffered between the ages of eleven and twenty one from a hard to treat Black Wave. Tons of talk therapy – finally she can’t stop crying for days – and not for the first time – and her shrink prescribes an anti-psychotic – Mellaril [thioridazine] – and its anticholinergic effects promptly dry up her mucus membranes, allowing her “to get a grip on it.” She is able to stop crying.

I am reading this passage and scratching my head. This is an emergency measure, right? Wurtzel is a lot of things, but her reality testing of the everyday is good enough. I know nothing, really, and am not a prescriber. However, I have been know to echo Lou Marinoff’s saying, “Plato, not Prozac!” And yet: An actual antidepressant such as imipramine or disiprimine would have had the same anticholinergic effects, have dried up the tears physiologically, and it might actually also operate as an antidepressant, would it not?!

Perhaps it was because of the unremitting of suicidal ideation that Wurtzel endorsed and expressed that no medical doctor recommended a tricyclic antidepressant. A person can actually hurt themselves with the tricyclic antidepressants, as with any powerful drug, which can cause a fatal heart arrhythmia if consumed contrary to proper guidance and in volume. But if this is supposed to be an emergency measure, a small number of pills in small dosages, closely supervised, would also have been possible would it not? Was Wurtzel getting adequate medical treatment even by advanced 1994 care standards? We may never know.

I am not one noted to value psychiatric labels, seeing them as getting in the way of being fully present with the other person as a possibility. Yet Wurtzel has a breakthrough towards the end of her narrative when she gets one – a label – along with the newly available fluoxetine (Prozac). Her psychiatrist gives her a diagnosis of atypical depression. I would add, demonstrably treatment resistant. “Atypical” because years of talk therapy and first line antipsychotics have barely made a dent in her unremitting self-abuse, inclination to self-medicate with weed, alcohol, and acting out with a series of boy friends, a couple of whom are the target of an intense romantic idealization combined with a neediness calculated eventually to drive them all away. However, at this point, the Prozac seems to work – except that about two weeks after starting to take it, she is feeling a tad better, and her only serious suicide attempt reported in the book occurs. Hold that thought.

One thing lifted Wurtzel’s work head and shoulders above your average narrative of suffering and redemption for me. Wurtzel is working through her invalidating environment and she gets it: “…[M]y addiction to depression …involved the same mental mechanism as someone else’s alcoholism” (p. 23).

Suffering is sticky. The risk of suffering is that it becomes an uncomfortable comfort zone. The body and the mind adapt to chronic pain and chronic stress. Even when the result is still pain, not numbness, the entire messy complex takes on a life of its own and becomes: suffering. If you water the tree of your sorrows, the tree grows. It grows until the suffering becomes the man-eating plant in the back of the Broadway play Little Shop of Horrors. That seems to have been going on here.

Empathy lessons occur in abundance in Prozac Nation, but they are mostly in a privative mode – that is, empathy is conspicuously missing.

Wurtzel is hungry for someone to respond to her as a whole person, writing: “I love you and I support you just the way you are because you’re wonderful just the way you are. They don’t understand that I don’t remember anyone ever saying that to me” (p. 231).

Wurtzel’s mother “loves” her as long as (if) she is brilliant, gets into Harvard, and they can continue intermittently to tear at one another’s guts on special occasions. He dad “loves” her as long as she does not make herself too needy, will pose for his photos, and otherwise leave him alone. Her friends “love” her as long she as is funny and amazing and the life of the party. Her boy friends “love” her as long as she continues to put out, which she does all too casually, leaving her feeling cheap. The impingements come fast and thick; here “love” means acknowledging someone as a whole human being, i.e., empathy; but no one gets her as a possibility.  

My take on it? If, at any point, someone would have given her a good sustained listening, something important would have shifted. Nor is it quite so simple. Her suffering would not have been magically disappeared; but it would have been decisively reduced. Once again, we will never know for sure.

Page after page of this page-turner, Wurtzel is explicitly crying out for “love,” and people are trying to love this individual, who seemingly inevitably gets caustically cutting towards others or becomes a needy emotional sponge, an unlovable rag of self-pity, albeit with a sense of humor, driving them away. Thus, Wurtzel’s ultimate test of love: love me even when I am deep down unlovable. It doesn’t work that well.

One can have empathy with the loveable but loving the unlovable is a high bar, by definition impossible. This person needs the firm boundaries of a rigorous and critical empathy. But instead Wurtzel’s friends and counselors efforts are lost in translation and become emotional contagion, projection, and inconsistent efforts to force compliance and conformity.

Finally, Wurtzel does get some empathy from the shrink disguised in the narrative as “Dr Sterling.” She was. Wurtzel writes: “Dr Sterling knew that somewhere in my personality there was a giggly girl who just wanted to have fun, and she thought it was important that I be allowed to express that aspect of myself (pp. 211–212). Predictably the breakdowns and out-of-attunements are frequent. The cutting remits but the acting out – street drugs, sexual misadventures (including the “accidental blow job”), and repetitive, endless phone calls – ramp up.

So what happens? Along comes Prozac [fluoxetine] and Dr Sterling gives it to her. Wurtzel is feeling better as a result of the medicine. But “better” is relative. Wurtzel gets into it with her psychiatrist, and she locks herself in the bathroom and takes the whole bottle of Mellaril [thioridazine], knowing that her shrink is waiting outside the door for her. As Wurtzel feels herself going under from the effects of the drug and she hears her shrink shouting outside the door, she unlocks it.

Now never say that someone who threatens suicide or actually swallows the pills is not suicidal. Never. People have been known to be all-too-unlucky in such situations and succeed where they are using a bad method to try and solve the problem of their suffering. I suggest this was one of those, and arguably as a result of the un-inhibiting effects of the Prozac.

Those are such facts as reported in the narrative. Throughout the book, Wurtzel is plagued by suicidal thoughts, she cuts herself and engages in taking street drugs and crazy sex, but not until she gets the Prozac does she actually take action and make a serious attempt at suicide. Hmmm.

I am not making this up. It is in the book. Has anyone read it since 1994? This is the book entitled “Prozac Nation” and is regarded as some kind of strange endorsement for Prozac. Wurtzel subsequently and consistently denied it was an endorsement of fluoxetine [Prozac], emphasizing her commitment to being self-expressed. That she succeeds in doing in spades. Definitely. What some authors won’t do to move some copy!

I read Wurtzel’s memoir for the first time ever upon learning of her passing on January 7, 2020. We can measure the distance between the publication in 1994 and today in that of all the reviews between then and now no one – not one – mentioned that the fear of abandonment, the invalidating early environment and ongoing invalidating entanglement with the warring parents, the volatile emotions (especially atypical depression), volatile relationships, volatile self-identity, and para suicidal behavior are the check list for borderline personality disorder.  I hasten to add checklists are overrated, and I acknowledge I might have missed something.

However, it does put me in mind of a quotation from Marsha Linehan, innovator in Dialectical Behavioral Therapy (DBT), and who, in the  video cited below, is talking on camera with permission with an avowedly suicidal patient. Linehan says: “I think it is good that you see it as a problem that you feel suicidal and want to fix that; but suicide is not so much a problem as a solution.” Pause for jaw dropping effect. “People’s lives are so messed up that they want to check out as away of solving the problem. What our program does is help you find a better solution – so it is not really a suicide prevention program so much as a life worth living program.”

Elizabeth Wurtzel succeeded in having one of those lives worth living, even without a formal program and in spite of all the challenges put in her path by accidents of biology, early experience, and her own demons. She had gifts aplenty and she managed to use them to attain a good measure of power, freedom, and full self-expression. Above all, self-expression. We are enriched by Wurtzel’s comet-like trajectory through our post-modern modernity and diminished by her passing. It is truly an ask-not-for-whom-the-bell-tolls moment.

REFERENCES

Elizabeth Wurtzel, (1994) Prozac Nation: Young and Depressed in America, New York: Mariner Books (Houghton Mifflin Harcourt (paperback edition), pp. 339, $16.99.

‘I believe in love’: Elizabeth’s Wurtzel’s final year, in her own words by Elizabeth Wurtzel, https://gen.medium.com/i-believe-in-love-elizabeth-wurtzel-s-final-year-in-her-own-words-e34320e41ee0 

Bastard Neither of my parents was exactly who I thought they were by Elizabeth Wurtzel, https://www.thecut.com/2018/12/elizabeth-wurtzel-on-discovering-the-truth-about-her-parents.html

Elizabeth Wurtzel by Liz Phair, June 16, 2017, https://www.interviewmagazine.com/culture/elizabeth-wurtzel

Lou Agosta, (2018), Empathy Lessons, Chicago: Two Pears Press: https://www.amazon.com/Lou-Agosta/e/B07Q4XX6PF/ref=dp_byline_cont_book_1

Marsha Linehan talks with a patient about borderline personality disorder and dialectical behavioral therapy: https://www.youtube.com/watch?v=tgzw50SbokM

© Lou Agosta, PhD and the Chicago Empathy Project

Review: The Collected Schizophrenias: Essays by Esmé Weijun Wang

Esmé Weijung Wang’s The Collected Schizophrenias: Essays (Gray Wolf Press, 2019: 210 pp.) are an articulate and clarion cry to bring empathy to an arena in mental health where it has been missing.

My take on it? Ms Wang seems not to have been one of those survivors whose mental disorder is inextricably entangled with her genius. She was already talented and successful, studying at Yale, before her first breakdown.

The disorder was a major curve ball, delivered at high velocity, and hitting her in

Cover Art: The Collected Schizophrenias

Cover Art: The Collected Schizophrenias

the head – and heart. She gets up, dusts herself off, and, with writing that knocks it out of the park, recovers her own humanity with compelling accounts of her experiences, both humorous and heart-rending, thereby enriching ours and expanding our empathy.

At risk of mixing the metaphor, life handed her lemons. By my estimate, about a bushel. She did not merely make lemonade. She has concocted a kind of electric cool-aide. This is a beverage which perhaps will leave one feeling a tad trippy and vertiginous, but one which expands one’s empathy, not only for survivors of mental illness, but for our humanity at large. The rumor of empathy in Wang’s work is no rumor – empathy lives in Wang’s The Collected Schizophrenias.

The celebrated psychiatrist-philosopher Karl Jaspers (1883–1969) wrote in his seminal two volume psychiatric text General Psychopathology (1913/1959) that lack of empathy was diagnostically significant for a diagnosis of schizophrenia. If one is having trouble empathizing with the other person, the diagnosis of schizophrenia is by no means certain, but belongs on the short list.

The doctor and therapist struggle to have empathy for the often-bizarre constellation of symptoms characteristic of schizophrenia – hallucinations, delusions, incoherent “word salad” speech. The care-takers, from their own perspective, experience a lack of out-bound empathy from the patient, whose suffering is thereby aggravated in being further cut off from human connectivity and isolated. 

One thing Ms Wang’s memoir of her disorder makes crystal clear is that her empathy is functioning full throttle. Even if her empathy is sometimes inaccurate  (as is everyone’s) or misfires (as does everyone’s), Wang’s empathy lives as a commitment to appreciating the other’s point of view and relating to the other with affinity and appropriate affection. Wang fully experiences the dignity violations, lack of respect, and objectifications on the part of the medical system and professionals trying to help her, leaving her alternatingly in despair and enraged.

Paradoxically a dimension of her reality testing continues to function even as she is fearfully hiding in the closet due to psychotic symptoms that demonstrate to her the break down of her reality testing.

While it is true that most sufferers and survivors of the collected schizophrenias do not present as “high functioning” as Ms Wang, growing evidence is available that, even in the acute phase of the disorder, most psychotic persons appreciate that the hallucinated voices and ideas of reference are somehow subtly and significantly distinct from everyday reality. This awareness, however tentative it may be, can be leveraged and made the target of therapeutic conversation. This has clinical significance for cognitive behavioral and emotional interventions in the acute and the survivor phase. This is the empathic moment of which even so celebrated a shrink as Jaspers missed.

“High Functioning” is itself the title of an chapter in which Ms Wang is in recovery. She is giving presentations on mental health to interested citizens and professionals as part of some gig and good work she has landed after her professional career was ruined by the disorder. The reader gets background on Wang’s earlier career as a fashion journalist. We get a reading list of other “high functioning” individuals who have struggled with mental illness and go on to get PhDs, McArthur “Genius” Grants, and endowed chairs in psychiatry at major universities such as Kay Redfield Jameson, Elyn Saks, and other notable authors of “pathographies.” Pathographies are an emerging but not really new category of biographies and memoirs of survivors of mental illness.

This paradox of reality testing within the breakdown of reality testing has also been pointed out by thinkers whose critical inquiries into mental illness need to be better known.  I am thinking especially of the work of Louis A. Sass (1) and Matthew Ratcliffe (2), whose books are cited at the bottom of this review. (See also my related blog reviews of Ratcliffe: https://wp.me/pXkOk-8g and Sass: https://wp.me/pGb20-pp.)

There is something for everyone in Ms Wang’s collection.

She acknowledges that she takes her anti-psychotic medications on schedule, and, moreover, the medications that work for her right now are so-called first generation, haloperidol and quetiapine (Seroquel). She argues that the National Alliance on Mental Illness (NAMI) takes positions dear to the heart of the families of the mentally ill (take your meds, allow for involuntary incarceration in an emergency (5150: code for involuntary commitment), be a good “mental patient” conforming to the hierarchy in which psychiatrists are I authority).

At the same time, Wang is an evangelist and a strong advocate for RAISE (Recovery After an Initial Schizophrenia Episode) and the need for autonomy for the mentally ill: “Rarely did I experience such a radical and visceral imbalance of power as I did as a psychiatric inpatient amid clinicians who knew me only as illness in human form (p. 57).

The anti-psychiatry movement will find comfort and is well-represented in Wang’s work. Not only do the mentally ill have to survive the illness, they also have to survive the system that is supposed to help them: “Though nearly all the statements a psychiatric patient can make are not believed, proclamations of insanity are the exception to the rule” (p. 101). Crazy making rules and treatments. If that is not a double bind, I would not know one.

Wang takes a position: “I maintain, years later, that not one of my three involuntary hospitalizations helped me. I believe that being held in a psychiatric ward against my will remains among the most scarring of my traumas” (p. 110). A bold statement of the obvious: That is tragic – and an outrage.

The honest broker, Wang then reports on individuals who committed violent crimes and/or killed themselves while in the grips of psychotic episodes. No easy answers here.

The social justice dimension is not pervasive in Wang’s memoir – perhaps because Wang’s family and husband were able to be supportive enough to arrest her slide into the abyss of insanity just short of the edge – but explicitly surfaces periodically and powerfully: “nearly 1.3 million people with mental illness are incarcerated in state and federals jails and prisons” (Department of Justice) (p. 110). Wang does not say what percentage is getting the treatment they need in accordance with professional diagnostic guidelines. I am going to be optimistic: 25%?

Since this is not a softball review, a point occurred at which I was about to put down the book with the admittedly devaluing, objectifying judgment: This individual is a walking laboratory of psychiatric (and medical) curiosities.

Wang endorses the Cotard delusion, in which the person claims that I part of his

Esmé Weijun Wang, author: The Collected Schizophrenias: Essays

Esmé Weijun Wang, author: The Collected Schizophrenias: Essays

body does not belong to him or that he as a total person is dead and should be disposed of properly. My empathic understanding of this disorder – and this is not the truth with a capital T but consider the possibility – is that the person’s emotional life has been short-circuited. The person is emotionally “dead,” for without emotions and affects we lack vitality and aliveness. Wang’s credibility (with this review) is restored as she reports she was so desperate she was considering ECT (electro shock therapy), but did not go through with it. The disorder spontaneously remits.

In an ongoing and increasingly desperate search to regain her power over the seemingly endless series of (un)related disorders, Wang suspects she may have an autoimmune disorder. Whether late stage Lyme disease is one of those, I do not know.

By this time, Wang is a relatively well-informed professional patient with limited but apparently sufficient resources, and she manages to go on a kinda of new age medical retreat to Santa Fe, New Mexico, for the treatments with a “lyme literate” medical doctor (LLMD).

Always the honest broker, Wang reports the writings of Leslie Jamison, author of The Empathy Exams, in which Wang compares Lyme is to the problematic, hard-to-pin-down, possibly delusional disorder, called having “Morgellons.” Jameson gives an account of the person who has Morgellons, in which the individual experiences worms or worm-like sensations, crawling beneath his flesh, which, apparently, sometimes pops out. Yikes.

At this point, I abandon any skepticism I might have about Wang’s suffering as a medical patient as my own limitations or arrogance. I decide to acknowledge once again there are more things in heaven and earth than are dreamt of in our philosophies (note: “philosophy” meant “natural science” in Shakespeare’s time).

 

(1) Louis A. Sass, (1994), The Paradoxes of Delusion: Wittgenstein, Schreber, and the Schizophrenic Mind, Ithaca, NY: Cornell University Press.

(2) Matthew Ratcliffe, (2017), Real Hallucinations: Psychiatric Illness, Intentionality, and the Interpersonal World, Cambridge, MA: MIT Press, 290 pp.

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

Top Ten Empathy Gifts for the Holidays

How is Christmas like a day at the job? Give up? You get to do all the work; and the big guy in the suit gets all the credit. Pause for laugh. [Note: if I have to explain the joke, it is not funny.] ‘Tis the season – to be materialistic and buy and spend. I am exhausted just thinking about it. Therefore, the recommendation?

Give empathy for the holidays. You never need an excuse to be empathic; but during the holidays it just might make sense to slow down and expand one’s listening even more diligently. My approach to this top ten list count down? I am taking off the list material things; but allowing spending [some] money on activities that are empathic or are direct enablers of empathy.

The idea? Give an experience – one worth receiving – whatever that would look like. This is a count-down. For example:

(10) Do not give a food processor; rather make the other person a gourmet meal. Do not give a vacuum cleaner [that would be a disaster]; take over doing a set of chores that need doing for week (or other defined time frame). It makes sense to document this by means of a certificate or diploma, as they say, suitable for framing.

(9) I saw a Restaurant with a sign: “No Wi-Fi – Talk to One another”. That is the right idea. If you like the menu, make the reservation and go there. They do not have a sign? Make your own sign and bring it along, even if the restaurant does have wi-fi.

(8) Sign up the receiver as a member at the local Art Institute and go as a guest with the recipient of the gift. Art is a significant enabler of empathy. But do not take my word for it – according to the celebrated enlightenment philosopher, Immanuel Kant, one of the main moments of the experience of beauty is the communicability of feeling – stage one of empathy.

(7) Sessions in yoga, meditation, Tai Chi, or other spiritual exercises – where you get to do something

(6) Same idea as above, but with a conventional focus – two tickets to the theatre, opera, or dance with time scheduled for conversation both before and after to discuss the experience

(5) A massage or time in a sensory deprivation tank where one is able to relax or expand one’s introspection (a significant enabler of empathy). Caution: This is “product placement” – actually a service – see ChicagoFlotation.com. It’s a trip.

(4) Every MacBook Pro has the technology to make a movie. Make a movie in which you acknowledge and recognize the other person – your partner, boss, employee, colleague, peer, friend, enemy, cousin, grandmother, etc. If you have talent as an aspiring stand up comedian, now is the time. Comedy is closely related to empathy – in both cases a boundary is traversed. In one case, comedy with aggressive or sexual overtones; in the other case, empathy, the focus is on recognition of one’s shared humanity. Remember, you have to create a context in which empathy is made present.

(4a) Same idea as above only … Write a poem or short story in which you are self-expressed about the relationship, what is means to you, how it works, and what it means as a possibility.

(3) If the relationship is an intimate one, then it makes sense to provide an intimate experience. Depending on trends and tastes (and I acknowledge that I need to get out more), this may be easier for her than him. Still, he may usefully concentrate on things she values, already mentioned throughout this post, for example, fixing dinner, time for conversation, demonstrated affection and affinity, and if such has been in short supply for any reason, family time including the children.

(2) There are a set of attitudes and behaviors for which empathy is an enabler, though they are distinct from empathy (this is the opposite of things that enable empathy such as art and relaxation). The consequences of our actions escape us and while stupidity is not a crime, sometimes maybe it ought to be. Therefore, forgiveness was invented. Empathy create a learning for many things – including prosocial behavior. Make a donation in your friend’s name to Doctors Without Borders, Amnesty International, or donate blood to the American Red Cross.

Other things in the same ballpark as forgiveness include compassion and make-a-wish. In surveys on prosocial behaviors, compassion is the phenomena most often mistaken for empathy. Heavens knows, the world needs expanded compassion – and expanded empathy. If you can make someone’s wish come true – and that looks like a puppy – then it is an option, too. Include a pet care service, obedience lessons (for the owner!), or complimentary dog walking.

And the number one gift of empathy for the holidays is

(1) Turn off your smart phone [no texting!], and talk – have a conversation – with the other person.

And a happy holiday to one and all!

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

Empathy is a dial, not an on-off switch

People treat empathy as if it were an “on-off” switch.

Turn it “on” for friends and family; turn it “off” for the “bad guys”. Turn empathy “on” for coworkers, customers, and insiders; turn empathy “off” for competitors, for compliance, and for efficiency and speed.  Turn empathy on for the hometown baseball team, the Cubs or Sox, if you are from Chicago like I am or turn it off for

Empathy is a dial, not an on-off switch

Empathy is a dial, not an on-off switch

the competition, especially New York teams such as the Mets or Yankees! If you have encountered die-hard fans, then you know that I am only partially joking. However, in business today—as in sports and as in dating with prospective romantic partners—you are competing in the morning and cooperating in the afternoon. Unfortunately, the switch tends to get stuck in the off position.

The guidance? Empathy is a tuner or dial, not an “on-off” switch. Engaging with the issues and sufferings with which people are struggling can leave the would-be empathizer (“empath”) vulnerable and exposed to burnout and “compassion fatigue.” As noted, the risk of compassion fatigue is a clue that empathy is distinct from compassion, and if one is suffering from compassion fatigue, then one’s would-be practice of empathy is off the rails, in breakdown.

Instead of practicing empathy, maybe you are being too compassionate. If you are flooded, maybe—just maybe—you are doing it wrong. In empathy, the listener gets a vicarious experience of the other’s issue or experience, including their suffering. The listener suffers vicariously, but without being flooded and overwhelmed by the other’s experience.

This is not to say that some accounts of trauma would not overwhelm and flood anyone. They would. They do. However, we are here engaging with the example of a committed listener who spends his or her day listening to a series of depressed, anxious, or otherwise upset people.

Empathy is like a dial, lever, or tuner—turn it up or turn it down. If one is overwhelmed by suffering as one listens to the other person’s struggles, one is doing it—practicing empathy—incorrectly, clumsily, and one needs expanded skill training in empathy.

The whole point of a vicarious experience—as distinct from merger or over-identification—is to get a sample or trace of the other’s experience without being inundated by it. Key term: sample the other’s experience. One needs to increase the granularity of one’s empathic receptivity to reduce the emotional or experiential “load.”

Another way of saying the same thing? Empathy is a filter—decrease the granularity and get more of the other’s experience or increase the granularity (i.e., close the pores) and get less.

The empathic professional can expect to have a vicarious experience of the other person’s experience. If the other person is suffering, then he will have a vicarious experience of suffering. He will have a sample of the other person’s suffering. He will have a trace affect of the sadness or grief or anger or fear (and so on) of whatever is a burden to the other person. It will be a toe or an ankle in the water instead of being up to the neck in it. The experience will just be a taste of brine rather than drowning.

The power in distinguishing between empathic receptivity and empathic understanding, empathic interpretation, and empathic responsiveness, is precisely so you can divide and conquer the practice and performance of empathy.  

If your “empathic distress” indicates too much openness, do not be “closed off,” but tactically reduce the openness. Increasing the granularity of your empathic receptivity reduces the empathic receptivity and reduces your empathy as a whole. If you are experiencing compassion fatigue, then you need to tune down your compassion and expand your empathy. If you are experiencing burnout, then it is likely that emotional contagion is leading to empathic distress. In this case, you need to tune down one’s empathy.

Interested in more best practices in empathy? Order your copy of Empathy Lessons, the book. Click here.

(c) Lou Agosta PhD and the Chicago Empathy Project

 

Compassion fatigue: A radical proposal for overcoming it

One of the criticisms of empathy is that is leaves you vulnerable to compassion fatigue. The helping professions are notoriously exposed to burn out and empathic distress. Well-intentioned helpers end up as emotional basket cases. There is truth to it, but there is also an effective antidote: expanded empathy.

For example, evidence-based research shows that empathy peaks in the third year of medical school and, thereafter, goes into steady decline (Hojat, Vergate et al. 2009; Del Canale, Maio, Hojat et al. 2012). While correlation is not causation, the suspicion is that dedicated, committed, hard-working people, who are called to a

Compassion Fatigue: Less compassion, expanded empathy?

Compassion Fatigue: Less compassion, expanded empathy?

life of contribution, experience empathic distress. Absent specific interventions such as empathy training to promote emotional regulation, self-soothing, and distress tolerance, the well-intentioned professional ends up as an emotionally burned out, cynical hulk. Not pretty.

Therefore, we offer a radical proposal. If you are experiencing compassion fatigue, stop being so compassionate! I hasten to add that does not mean become hard-hearted, mean, apathetic, indifferent. That does not mean become aggressive or a bully. That means take a step back, dial it down, give it a break.

The good news is that empathy serves as an antidote to burnout or “compassion fatigue.” Note the language here. Unregulated empathy results in “compassion fatigue.” However, empathy lessons repeatedly distinguish empathy from compassion.

Could it be that when one tries to be empathic and experiences compassion fatigue, then one is actually being compassionate instead of empathic? Consider the possibility. The language is a clue. Strictly speaking, one’s empathy is in breakdown. Instead of being empathic, you are being compassionate, and, in this case, the result is compassion fatigue without the quotation marks. It is no accident that the word “compassion” occurs in “compassion fatigue,” which is a nuance rarely noted by the advocates of “rational compassion.”

Once again, no one is saying, be hard hearted or mean. No one is saying, do not be compassionate. The world needs both more compassion and expanded empathy. Compassion has its time and place—as does empathy. We may usefully work to expand both; but we are saying do not confuse the two.

Empathy is a method of data gathering about the experiences of the other person; compassion tells one what to do about it, based on one’s ethics and values.

Most providers of empathy find that with a modest amount of training, they can adjust their empathic receptivity up or down to maintain their own emotional equilibrium. In the face of a series of sequential samples of suffering, the empathic person is able to maintain his emotional equilibrium thanks to a properly adjusted empathic receptivity. No one is saying that the other’s suffering or pain should be minimized in any way or invalidated. One is saying that, with practice, regulating empathy becomes a best practice.

Interested in more best practices in empathy? Order your copy of Empathy Lessons, the book. Click here.

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