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Radical empathy, the double bind, and moral trauma

A narrative is not a substitute for a philosophical argument; nor is a philosophical argument a substitute for a story. These are not substitutable for one another under descriptions that preserve truth. The matter is especially tricky if one is making a point or taking a position about human actions, preferences, or behavior in extreme situations. One can make a point or support a position by means of a logical argument. In an argument, one considers the relationship between the premises of the argument and the conclusion. Are the premises factually accurate? One interviews witnesses or assesses the available data. One can have an invalid argument from true premises. The premises are true but the conclusion does not follow from them. One can have a valid argument from false premises. The premises are false but the conclusion logically follows from them. Or one can have a conclusion that validly follows from true premises, in which case the argument is sound, the gold standard of reasoning. Once an argument contains a contradiction, then anything follows from it, including a true conclusion. It is just that the latter is logically unrelated to what comes before. And arguments are only getting started here. If one is dealing with a moral dilemma or nonstandard logics such as possible world scenarios, the premises become more complex, the technicalities fan out, and the alternative paths through the labyrinth of reasoning multiply rapidly. While human actions are sensibly understood to have both reasons and causes, these are taken to include motives and triggers that may be redescribed as “insane,” “deviant,” “anomalous,” “pathological,” and so on. Special cases, exceptions, and examples that are counter-intuitive, raise the spectrum that one is dealing with a phenomena that is not always a rational process. 

Thus, one looks for alternative ways of making one’s case than marshalling the technical apparatus of formal and informal logic. One can make a point or support a position by telling a story. One trades off logical rigor in favor of a compelling narrative. “Let me tell ya what happened.” “You can’t make this stuff up!” “You are not gonna believe what he told her!” Without deciding whether or not reason is the slave of the passions (Hume 1739), storytelling exemplifies the struggles in which people engage in an attempt to attain personal satisfaction and fulfillment in the face of the conflict requirements of scarce reality, community standards, and earning one’s daily bread by the sweat of one’s brow, even if the sweat is due to the stress of working in a corporate empathy desert rather than plowing the field in the hot sun. [1]

For example, Paul Tremblay’s novel The Cabin at the End of the World (2019) presents a narrative that, in its outline, is similar to the overall structure of the moral dilemma known as “the Trolley Car Dilemma.” Before defining the terms of the story and of the philosophic dilemma in detail, it is useful to note, both offer rich possibilities for confronting human behavior and actions in extreme situations. Both offer possibilities for the practice of moral reasoning and of the practice of empathy. But only one put the reader and reasoner in the trolley car itself, facing the dilemma, and that, counter-intuitively is not the abstract statement of the dilemma in the trolley car problem, but the novel itself. (For details on the movie version of the novel see the New York Times Review.[2])

The story delivers the experiences of being caught in a double bind, moral trauma, soul murder, and cognitive-emotional-moral conflicts that make people so anxious they up at night unable to sleep due to intrusive thoughts. With the story, one is inside the experience of the dilemma in the sense of being viscerally gripped by it in way that is not the case if one is abstractly reasoning cognitively about motives and morals. With the story, one is grabbed by the throat, and is hard pressed to pretend that the dilemma does not matter. This matter of mattering is of the essence here. With the story, the dilemma is no longer able to be dismissed as a puzzling case or an irrelevant philosophical game without real world relevance. But the “mattering” here is not in the interest of expanding knowledge by confirming or refuting a quantitative hypothesis – that five people are more people than one person. The mattering is in order to get to one’s friend’s house in one piece – literally to go on being. Well-being. Personal flourishing. Survival. 

That is different than being up at night because one is trying to disentangle a logical puzzle, the difference being roughly that between an obsessive preoccupation and post-traumatic stress. Neither is pleasant and both have the potential to keep one up at night. Though many exceptions exist and generalization is risky, treatment of the former is considered more predictable and simpler. 

The Trolley Car dilemma is as follows. You are the agent on a runaway trolley car with broken brakes, which will run over five people unless you throw the switch to change the track, which, however, will result in running over one person. So far, everyone, including you, are innocent. Surely this is an engaging thought experiment, a philosophical fiction. 

Our empathy for the agent starts out as requiring a decision that no one should have to make. The agent is forced to make a decision that neither he nor anyone else is authorized to make. But he has to make it anyway. Doing nothing is also a decision, and people are going to die. This is the definition of a double bind – damned if one does, and damned if one doesn’t. This is the kind of thing that drives people insane – insane with second guessing, insane with grief, insane with guilt. One can be both a perpetrator and a victim. 

The problem of course is unsolvable without further background. When the philosophers Philippa Foot (1967) and Judith Jarvis Thompson (1976) first proposed a version of it, Foot wanted to present the dilemma as the difference between the utilitarian moralists such as Jeremy Bentham, committed to the greatest good of the greatest number, and the deontologists roughly represented by Immanuel Kant, for whom the motive for acting is itself the guide to the moral worth of the behavior in question. The solution is relatively easy for the utilitarian – save the greatest number. The utilitarian then must deal with the fact that the person who throws the switch becomes a perpetrator, killing the one innocent person. The Kantian is clear that the moral worth of an action is independent of the consequences of the action, which, in this life, are often unpredictable even when the outcome seems certain. The moral law does not allow throwing a switch in order to kill one person. The Kantian, casuistically inspired by Thomas Aquinas (see two paragraphs below), might argue back that the moral law does indeed allow throwing a switch to save five people. Or at least it does not prohibit one from saving five people, the motive being to preserve and further life. The casuistry is that one must turn a blind eye to the consequence of killing the one person, which for the Kantian is relatively easy to do because he excludes consequences from the moral equation. The consequence of killing the one person is entirely a regrettable accident. However, the person who throws the switch becomes a perpetrator nonetheless, killing the one innocent person. 

Radical empathy reveals that one can be both a perpetrator and a survivor. What has been overlooked is the role of moral trauma. The driver of the trolly car, the agent, is put in a double-bind, in which, whatever the action, innocent people are going to suffer and die. In literature this has a name. It is called “tragedy.” 

Radical empathy reveals the tragic dimension of the situation. The Trolley Car dilemma requires a story to complete it, and the story is an empathic, albeit, tragic one. Here “completion” does not mean that no one dies. It means that a person is forced to make a decision that no person is authorized to make – that no one should have to make – but one has to make it anyway. Doing nothing is the decision to let five die. Throwing the switch is intentionally to embrace the role of perpetrator and give up the illusion that one is innocent. Indeed in some jurisdictions, throwing the switch would technically qualify for manslaughter. Let the jury decide whether voluntary or not. 

Nor is this merely the principle of double effect reasoning, in which a valid action has a harmful “side effect” as “collateral damage,” which Thomas Aquinas documented in Summa Theologica (Part 2 of II, Question 64, Article 7), his example being killing an aggressor in self-defense.  There are no “bad guys” in the Trolley Car Dilemma. A closer analogue, probably known to Foot, would be the example of childbirth before modern medicine made a Caesarian Section a relatively safe, albeit radical, intervention. (Reader (trigger) alert: this not for the faint of heart.) A viable baby is backwards or badly positioned in the womb, and the baby is stuck. If one saves the mother, she may eventually give birth to five more sons and daughters. If one saves the baby, by performing the Caesarian, then the mother will bleed to death (probability .95). Action is required. The surgeon is the agent in the trolley car. If the surgeon does nothing, the baby dies, still in the womb; and the mother subsequently dies, probably of infection. One option is the surgeon decides to act to remove the stuck baby, usually by performing a craniotomy, cutting it apart. Technically speaking, when the baby’s head is crushed that is child abuse, soul murder. The alternative is to operate on the mother. The outcome was fatal to her at least up until the 1940s. The surgeon is both the perpetrator and the survivor in that he must grapple with moral trauma, the latter in the sense that he must live with the guilt that is experienced for killing the otherwise innocent, viable baby. 

Childbirth is not war, though given the paragraph before last it may seem so. Moral trauma is common in war, though until recently it has not been recognized by the United States Veteran’s Administration as a cause of the mental health issues of “wounded warriors.” For example, in Iraq, a car is racing towards a security check point and fails to stop even after hand signals and warning shots. Believing the car to be a suicide bomb, the sergeant orders the corporeal to shoot at the driver – with a 50-caliber machine gun. It turns out to be a family racing to the hospital because the pregnant mother has gone into labor. The survivors are awarded $10K and an apology (Carlstrom 2010). The soldier who pulled the trigger is both a perpetrator and now trying to survive moral trauma. He is uninjured physically. He was a “normal” midwestern guy with brother and sisters and a pregnant wife of his own. The army does not debrief the team about what happened. He is not invited to talk about it. He really did pull the trigger, believing he was following a valid military order and defending his team against a suicide bomber. But, examining the car afterwards, and realizing what he and his team have done, he sinks back into himself, burdened by guilt at having killed the family. He becomes unresponsive to those around him, does not respond to orders, and is shipped back home without being debriefed and with a dishonorable discharge. He is no more responsive back in the States, and, does not want to talk about it. His marriage fails. He becomes homeless. A perpetrator in the technical sense, but also a victim and survivor.

Thus, the Trolley Car Dilemma is unsolvable without a corresponding story. In the story, “you” are there. You are there at the nonfunctioning controls. The track is racing towards one at high speed. The innocent persons come rapidly into view. You search desperately for an ax, a fire extinguisher, a suitcase to throw under the rapidly rotating wheels. None is available. You wish you had the courage for altruistic suicide, throwing yourself in front of the racing car to attempt derailment. One thought too many for effective action. You invoke the deity, say a prayer, call on God. He is busy elsewhere. No one is listening. You are in a double bind. Like Colonel Aureliano Buendia facing the firing squad, you cannot move. You can decide what to shout, but you have no control over the “Ready, aim, fire!” The “solution” is a story called “tragedy.”  This is what tragedy feels like, looks like, sounds like. The solution is a tragedy.

The story “completes” the problem in the sense of showing how every action designed to avoid the tragic outcome (that innocence suffers and dies) advances the action in the direction of a tragic outcome – innocence suffers and dies. The agent who pretends to be innocent by taking no action becomes a perpetrator and descends into trying to live with and survive moral trauma; and the agent who embraces action becomes a perpetrator and descends into trying to live with and survive moral trauma. 

Because the consequences of human action both escape us and, as in this case, are inescapable, radical empathy teaches that people are forced to make decisions that they should not have to make and must live with the moral trauma as survivors. Of course the example of the seemingly inevitable outcome is a counter-example as Colonel Aurelian Buendia faces the firing squad, as readers of Marquez know well, a revolution occurs and the execution is interrupted seconds before the order to “Fire!” is given. Buendia lives for another two hundred pages. So our finitude consists in knowing that “no one gets out alive,” but also that we do not know what the future will bring, the details of even the next few seconds, or the timing of the exit in spite of being so certain.

Radical empathy is defined formally in relation to standard empathy: Radical empathy deploys the same four minimal essential aspects of standard empathy – receptivity, understanding, interpretation, and responsiveness. The differences from standard empathy map to these dimensions. Empathic receptivity is “dialed down,” decreased to prevent empathic distress or compassion fatigue. “Dialed down” does not mean the listener becomes hard-hearted or unfeeling, but the vicarious aspect of the survivor’s experience is emphasized. The listener is aware that this trauma or tragedy is indeed a trauma or tragedy, but, for example, the listener is not on the Titanic, but watching the movie. (key term: vicarious experience.) The empathic understanding of possibility is radicalized in the sense that possibilities of the experience of pain, suffering, or high spirits exist that the listener’s imagination cannot necessarily grasp in advance. For example, in the Mephistopheles’ description of Hell in Mann’s Dr Faustus, words are used to described the indescribable;

Every compassion, every grace, every sparing, every last trace of consideration for the incredulous, imploring objection ‘that you verily cannot do so unto a soul’: it is done, it happens, and indeed without being called to any reckoning in words; in soundless cellar, far down beneath God’s hearing […] (1947: 245)

Empathic understanding of possibility confronts the survivor, who may indeed be skeptical that anything can make a difference, with the assertion. “No one was listening when you called for help – well, someone is now listening. Try me. Recovery is a possibility, skeptical though you, the survivor, may be.” If empathic receptivity is “dialed down,” empathic interpretation is “dialed up,” expanded. The folk definition of “taking a walk in the Other’s shoes” is most relevant in cognitively trying to imagine what the Other had to go through when the listener’s sense of the situation is limited. When the listener’s empathy gets “stuck,” blocked, inhibited, because the experiences of the self and the Other are so at variation, empathic interpretation, perspective shifting, is a proven way of cognitively “jump starting” the empathic process. Finally, the empathic responsiveness of radical empathy consists in eliciting an expression of the experience of the trauma from the survivor in the present situation of safety, acceptance, and toleration; processing that experience to the extent that it can be processed to drain the toxic emotions out of the trauma, defanging the snake, so to speak, to the extent that is possible; and saying what happened, thus, giving the survivor’s experience back to the survivor in a form of words that acknowledges and recognizes the survivor’s humanity. 

[1]  Plato dialogues are rich in logical reasoning about distinctions of meaning and they sometimes end up with a myth. When reasoning comes to an end, the dialectic changes from persuasion by logic into storytelling, which provides a different kind of persuasive engagement. For example, Plato’s Republic ends with the myth of Er (10.614–10.621); the Phaedrus ends with the myth of the winged soul; and the Timaeus includes a myth of the creation of the universe by a demiurge

[2] https://www.nytimes.com/2023/02/02/movies/knock-at-the-cabin-review.html?searchResultPosition=2

NOTE: This is an excerpt from a forthcoming book, Empathy in the Context of Literature (c) Lou Agosta, PhD

This post, web site, and all content (c) Lou Agosta, PhD


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.


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

Radical Empathy Disrupts Depression: Review of Ratcliffe’s Experiences of Depression

Over the summer I have been catching up on my reading. Matthew Ratcliffe’s Experiences of Depression: A Study in Phenomenology (Oxford University

Cover art: Matthew Ratcliffe: Experiences of Depression: A Study in Phenomenology

Cover art: Matthew Ratcliffe: Experiences of Depression: A Study in Phenomenology

Press, 2015, 318 pp, (44.09 $US)) is an important and eye-opening book for anyone who engages with depression or who wants a deep dive into phenomenological method.

The strength of this book is that Ratcliffe begins by listening to what the first person accounts have to say. Though Ratcliffe does not even use the word “empathy” until late in the work, and then in a debate that leaves much to be clarified, Ratcliffe’s method is a highly empathic one. What does he get out of listening to what the diversity of first person accounts have to say?

What is going on when the depressed person complains that getting out of bed requires enormous effort, and brushing one’s teeth seem impossible because the tooth brush seems to weigh twenty pounds? What is possible for the ordinary person is not possible for the depressed person.

This is a simple-minded, though accurate, example. Now extend it to loss of energy (lethargy) for daily and professional projects, the breakdowns in relations to other people and to oneself, including rampant self-reproaches, physical symptoms such as disturbances of appetite, sleep, consciousness (inability to concentrate). What goes missing from the experience of the depressed person?

Where you and I see possibility – tomorrow is another (and better!) day – the depressed person does not see possibility. The depressed person’s tomorrow is going to be the same miserable day as today. This is not just a belief (though it may be that too); this is the depressed person’s way of being – his experience of the world. This is not just the loss of one possible project or even a series of projects. This is the loss of possibility itself. This is Ratcliffe’s fundamental idea: depression is the loss of the very possibility of possibility.

This idea – the loss of the possibility of possibility – open up the flood gates for the description and appropriation of the diversity (“heterogeneity”) of depressive symptoms. The depressed person does not experience the possible – does not experience the possible as possible. That is the disorder itself.

The disorder is that it is not possible to conceive that things will get better. One is left without hope. Hope is itself openness to a possible future that is better. One is left demoralized. One is left without a future. Guilt is the impossibility of undoing faults or mistakes in the past. One’s crime is irrevocable, impossible to fix or make reparations (or reinterpret). No possibility of forgiveness.

Meanwhile, the depressed person often gets influenza like symptoms – no energy, inability to concentrate, headaches, stomach distress – one takes to one’s bed. However, unlike the case of the flu, in which one feels miserable but knows if one just hangs in there one will get better in a few days, the depressed person cannot imagine things being otherwise. No possibility period.

The phenomenology? Backing up for a high level view based on the phenomenological methods of Husserl and Heidegger, the world is not a thing in the world. The world is the context for things in the world. The world is the space of possibilities. The world of the depressed person is different than the world of the ordinary person. The los of possibility has a domino effect, “taking down” practical significance, hope, and interpersonal connection. Nothing matters anymore. Lethargy, detachment, self-reproach, and flu like symptoms are pervasive.

Given that the audiences for this book, including psychiatrists and many analytic philosophers, have not read Husserl and Heidegger, Ratcliffe devotes significant time and effort providing background, marshaling evidence, and arguing “depression is the loss of possibility – not just one or a series of possibilities – the very possibility of possibility – the depress person cannot even conceive of [the] possibility [of taking action].”

This is as it should be, and the book contains many technical distinctions – e.g., noetic and noematic – and, in that respect, is not for the faint of heart. Still, I was persuaded, and I believe, you will be too. This is a powerful and important contribution, which should be, required study for anyone proposing to engage with persons who one customarily describes as depressed. It changes one’s listening and in a powerful and positive way.  

Since this is not a softball review, this leads to the two-ton elephant in the room. So what? What is the guidance in overcoming depression? As I am a person who performs empathy consulting and psychotherapy, this reviewer asks: what are the action items or recommendations? How does one access the possibility of possibility, given that possibilities always present themselves as specific projects in the world? How does one jump-start the possibility of possibility when nothing seems possible?

In all fairness, addressing this may not be Ratcliffe’s job since he is doing phenomenological research, not clinical practice; but the question is almost unavoidable. Therefore, I am so bold as to engage in some “reading between the lines.”

Ratcliffe’s short answer to jump starting possibility is “radical empathy.” Radical empathy – unlike ordinary empathy (according to Ratcliffe) – does not presume that the two people trying to relate share the same space of possibilities (p. 242). Radical empathy is a kind of lever to open a space of possibilities of difference.

My take on radical empathy? Radical empathy consists in the would-be empathizer being committed enough to relating that he continues to try to do so even though logical reasons exist that empathy should fail. In this case, the depressed person is overwhelmed, experiencing being cut off from human relatedness, isolated, and disconnected. That is the disorder itself – along with the other symptoms.

Yet the would-be empathizer persists in his attempts to relate, vicariously experiencing the isolation and disconnectedness (or not) as a privative form of relatedness. The depressed person, even in his isolation, “gets it” that the empathizer is committed to the possibility of relating, even though the depressed person is frustrating the efforts. That’s it. That’s the moment something starts shifting.

Voila! The possibility of possibility is back in play. The depressed person’s “getting it” that the other is committed to the possibility of relating provides an Ariadne’s thread out of the labyrinth. That’s the empathic breakthrough.

This does not guarantee that radical empathy will succeed. Nor is there any guarantee that after trying ten times, the 11th try will be enough to do the trick. The depressed person may still be so cut off from possibility that suicide starts to look like a solution; but if one can acknowledge the possibility of a bad – very bad – solution (e.g., suicide), then one may be able to find a better solution – whether pharmacological, cognitive behavioral or empathy-based. 

To cut to the chase, I am so bold as to suggest that all empathy is radical empathy (in Ratcliffe’s sense). Contrary to Ratcliffe’s assertion, ordinary empathy does notrequire a space of shared possibilities. Shared possibilities are a “nice to have,” but often a high bar. Possibilities might be shared, but often they are not. Given the state of the world, such a space of shared possibilities is rarer than any of us might wish. I assert: All empathy is a risk undertaken to create a space of shared possibilities when there was no shared context.

All the other would-be empathic mechanisms such as simulation, mindedness, sympathy, altruism, are examples of incomplete empathy or breakdowns of empathy into projection, emotional contagion, or conformity. If the breakdowns were clarified, then empathic connection would emerge out of the misunderstanding, restoring the integrity of the relationship.

Meanwhile, Ratcliffe acknowledges the usefulness of the Diagnostic and Statistical Manual (DSM) for aligning the conversation and assuring us that the researchers are talking about the same phenomena. He is respectful of the professional sensibilities of the medical and psychiatric establishment – perhaps too respectful in my opinion. Yet, then again, if one is going to speak truth to power, it is best to start with an agreeable word. The barber lathers a man before he shaves him.

Though not a contribution to the growing body of anti-DSM literature, Ratcliffe’s work is an antidote to the pervasive tendency to under-describe depression (and other psychiatric disorders). The DSM is a starting point. However, Ratcliffe’s work makes clear that the DSM, especially as regards depression, is a pragmatic conglomeration of overlapping traits, not a natural kind.

Arguably melancholy is a natural kind; mania is a natural kind; paranoia is a natural kind; inflammation is a natural kind (and here the cytokine theory of depression is called out); but major depressive order as defined by the DSM? Nope. Ratcliffe does not spend much time or effort on the matter of the social construction of the categories of mental illness, and if one had to summarize Ratcliffe’s approach it aligns with the genealogical approach of Ian Hacking (e.g., see Ian Hacking, (2002), Historical Ontology, Cambridge, MA: Harvard University Press), who was himself inspired by Foucault (in turn, inspired by Nietzsche). 

In spite of his commitment to sustained phenomenological description of the things themselves, Ratcliffe quickly discovers that the phenomena bring forth a deep structure and background separable from any specific first person report. As usual, the way the researcher gets access to the phenomena significantly influences one’s description of the phenomena.

The data? The phenomena? Ratcliffe collects some 150 free form depression questionnaires in which sufferers and survivors of depression try to express and describe their experiences. Many of these contain lengthy feedback from the survivors on their experiences of depression. Ratcliffe also reviews many memoires of suicide and depression survivors, who try to express the ineffable nature of their experiences, such as Styron’s Darkness Visible. Many conditions and qualifications regarding the data are argued, limitations defined, and the richness of the experience plumbed for an expansive encounter with the enemy – depression.

Several things come out in the first person accounts that are not emphasized or are outright overlooked in the DSM. These include: the intimate relationship between depression and anxiety (“anxious distress” is called out in DSM-5, but unrelated to the whole); loss of hope and changes in bodily experience are briefly acknowledged in the DSM-5, but are critical path in the treatment; the altered experience of time is not mentioned at all (but the future seems to disappear as a positive, possible horizon); impaired social function is mentioned as a consequence whereas such loss of function is integral to the phenomena itself. This list goes on.

One of the first things that occurred to me as I sat down to read this book was: Am I going to get depressed – not necessarily in the full clinical sense; but is it going to cause an upset? My experience was that such a negative outcome was not the case. I suspect that was because, as an author who “gets” and uses empathy, Ratcliffe knows how to regulate the empathy in the space of possibilities to prevent empathic distress.

However, before turning to Ratcliffe’s breakthrough notion of radical empathy, the text engages with the issue of how empathy maps to the theory of mind debate in which empathy as simulation is arrayed against a theory of mindedness that enable persons to perceive others as sources of intentionality. The details of this debate are technical and at times Ratcliffe seems to forget the insight with which he began the book: “I argue that human experience incorporates an ordinarily pre-reflective sense of belonging to a shared world’, which is altered in depression” (p. 2). 

Once one disconnects the subject from its environment – the subject’s belonging to a shared world of people, neither simulation theory nor theory of mindedness can ever quite connect them again. It is a myth that we human beings are unrelated. We are all related. Human beings are already related to one another – biologically, psychologically, and in our very way of being (ontologically). Ratcliffe gets this. There is nothing wrong. Yet there is something missing.

Ratcliffe conceptualizes empathy as an attitude that does not include the communication of affect. Therefore, he overlooks several breakdowns in empathy – such as emotional contagion, projection, conformity – that if clarified provide the breakthrough to “radical empathy” (Ratcliffe’s key term) that is need to give traction to treatment options. There is indeed such a thing as an empathic attitude; but I disagree with Ratcliffe that a congruence of feeling (whether partial or complete) is to be ruled-out.

Ratcliffe (and his argument) are troubled by the notion that if one empathizes with a depressed person, then one may end up feeling quite depressed. This seems to be an invalidation of empathy and an obstacle to using it in treatment. Neither needs to be the case. First, in an admittedly extreme case, if one talks to eight depressed people in a row in the course of a treatment day, then one is very likely going to feel down – at least sub-clinically depressed – by the end of the day, regardless of the quality of one’s empathy. Is this empathy or a breakdown of empathy?

Look at the phenomena. Phenomenologically, there is no other plausible way to describe this than to say that the feelings and emotions have been communicated from one person to another. Once again, is this empathy? No – according to Ratcliffe, empathy is an attitude, not a congruence of feelings.

I suggest this answer is incomplete. It is not an “either or” choice. One must integrate empathic receptivity (openness), empathic understanding, empathic interpretation, and empathic responsiveness.

The answer is still “No,” but because the communication of feeling, the congruence of feeling – one paradigm case of which is vicarious experience – is not complete empathy. It is merely phase one of empathy.

If one stops with the mere communication of feeling, then one gets emotional contagion (as Ratcliffe properly notes). This is a breakdown of empathy, but Ratcliffe does not describe it in such a way. However, do not be so hasty to dismiss empathy. That empathy breaks down does notmean empathy is invalid or must be abandoned.

The would-be empathizer may [must?] take this vicarious experience of the other’s distress and process it further through empathic understanding, empathic interpretation, and empathic responsiveness in order to make it useable in relating to the other person as a possibility or a breakdown of possibility.

Likewise with compassion fatigue, which is likely in the background of Ratcliffe’s insistence that empathy is an attitude, not a congruence of feeling. Though compassion fatigue is not an issue Ratcliffe engages, it is common to acknowledge that the helping professions are at risk of burn out, empathic distress, and compassion fatigue. (Note that burn out itself is a kind of loss of the possibility of possibility. “Depression”?)

Those who engage with depressed people are particularly at risk of such an outcome. Empathy reportedly peaks in the third year of medical school, and, unless specific interventions such as further training are undertaken, it is downhill from thereon (see Hojat, Mohammadreza, et al. (2009). The devil is in the third year: A longitudinal study of erosion of empathy in medical school, Academic Medicine84 (9): 1182–1191). What to do about it?

Once again, Ratcliffe may not see this as his job – and the book is already over 300 pages of dense descriptions of depression – but one may offer a couple of thoughts. We usually think of empathy as an “on off” switch. Turn it on for the “in group” – patients, clients, friends, family – turn it off for the competition, the opposing team, people who talk foreign languages or have unfamiliar customs or the “out group.” Rather, the training is to regard empathy as more like a dial or tuner – dial empathy up or down by regulating one’s receptivity – one’s openness (Ratcliffe’s term) – to the experiences of other persons.

If one is over-whelmed by the other person’s depression one is doing it wrong. Properly deployed by experienced practitioners, empathy is a method of providing a sample or trace of the other person’s experience. Max Scheler (who Ratcliffe approvingly cites) calls this a “vicarious experience” (Nacherlebnis) – rather like an after image of another person’s feeling. As noted, this trace or sample of the other’s experience has to be further processed by the understanding of possibilities to be useful in shifting out of stuckness. (See Max Scheler, (1913/1922).  The Nature of Sympathy, tr. Peter Heath. Hamden: CN: Archon Books, 1970)).

Of course, expanding one’s empathy does not come naturally to most people, which is why training and practice are needed. But experience shows that if one works at it, one can expand one’s empathic capabilities and the results one gets in trying to be empathic. (See Zaki, Jamil and Mina Ciskara. (2015). Addressing empathic failures, Current Directions in Psychological Science,December 2015, Vol. 24, No. 6: 471–476. DOI: 10.1177/0963721415599978).

The antidote? A radical proposal – in addition to radical empathy. If one is experiencing compassion fatigue, maybe one is being too compassionate. Now compassion is different from empathy. In compassion, one’s strong feeling – passion – motivates one to get involved, take action, and intervene to help the other. (Nor is anyone saying be hard-hearted or indifferent, but know when to dial it down a bit.) In contract, empathy in the full sense of the term, of which Ratcliffe’s radical empathy is a subset, is a method of data gathering about the experience of the other person. It consists in being open to the experiences of the other person, having a vicarious experience of the other’s experience, and further processing it in empathic understanding, empathic interpretation, and empathic responsiveness.

It is ironic that the phenomenology of depression misses the key phenomenological distinction – vicarious experience – in the account of trying to empathize with depression. In relating to a depressed person, I can be open to a vicarious experience of melancholy or stress or anger or irritability or discordant mood or whatever the other person is experiencing – without succumbing to a merger with them. This vicarious experience gets processed further in understanding who the person is, where he is at, what he “gets” as possible for himself in the moment. Through interpretation and responsiveness, this may open up other possibilities. Now we are back in the realm of jump-starting the possibility of possibility.

Ratcliffe finds inspiration in, but puts his own definitive spin on, Jonathan Lear’s Radical Hope, a narrative of the struggles of the Native American Crow people. After the buffalo went away (were killed off), the indigenous Crow people, experienced world collapse. Hunting ceased. Demonstrating courage in tribal warfare became impossible. Culture and customs lost significance and ceased to make a difference. Nothing changed – i.e., in effect, time stopped. All hope was lost and – at the risk of a caricature – the only possibilities were the self-destructive non-possibilities of alcoholism and inadequate, dignity-destroying government handouts.

However, even amid this world collapse – analogous to the depressive person’s loss of the possibility of possibility – a wise Crow elder put forth a prophecy that an event, something = x, would happen that would enable a the rebirth of possibility of the true people. This was radical hope – “to hope against hope until hope creates from its own wreck the thing it contemplates” as the poet Shelley put it.

The prophesized event turned out to be World War II, a conflict in which the Crow were able to draw on their warrior tradition and make a contribution to the defeat of the enemy.

Ratcliffe’s radical empathy is analogous to radical hope here. The therapist keeps alive the possibility of possibility and gives expression to it while the depressed person is unable to do so for himself. The therapist keeps blowing on the embers – and may indeed get short of breath doing so – until the spark rekindles the fire of neuronal activity in the depressed person’s consciousness.

In conclusion, Ratcliffe “gets it” – while simulation and theory of mindedness go round-and-round about whether feelings are congruent or perspective interchangeable, psychiatric disorders across the spectrum, from mood disorders to thought disorder, are especially challenging to anyone’s empathy. Most psychiatric disorders – not just autism or psychopathy – involve a breakdown of empathy (as Ratcliffe points out elsewhere), leaving the person feeling disconnected, isolated, not “gotten.” Ordinary empathy is already radical in so far as one person is able to understand another in his or her humanity. Such a commitment – call it an “attitude” or a “method” – is not easy or trivial. Yet the commitment to relating to the other’s humanity is what calls forth the humanity back into possibility.

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