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This is a transcript of the talk.
The recommendation? Listen to the podcast: https://anchor.fm/lou-agosta-phd/episodes/Empathy-and-LIterature-Grand-Rounds-Presentation-at-Rush-Medical-University-October-13–2016-e177nvv
or watch the Youtube video: https://youtu.be/sYJvplP5cKo
Howard Kravitz, MD: Welcome to the partner psychiatry gran realms this morning is my pleasure to introduce the speaker dr. Lou Agosta got his PhD in philosophy at the University of Chicago with a dissertation entitled empathy and interpretation and running with that as his career scholarly activity ever since he’s an assistant professor of psychology at the Illinois School of Professional Psychology and Argosy University and instructor of philosophy at the University to call the Graham School of adult education and director of research at other gang psychotherapy services in Chicago he also as a psychotherapy practice in the Chicago community who specializes in making empathy present in his storytelling and listening – he’s committed to a gracious and generous listening based on empathy which I personally experienced a meeting with him this summer to talk about his idea for Grand Rounds – as an educator he teaches empathy in the history of and systems of psychology program at the Illinois School of Professional Psychology and Argosy University – he has published three scholarly academic books on empathy entitled – empathy in the context of philosophy – a rumor of empathy: rewriting empathy in the context of philosophy – and a rumor of empathy: narrative and recovery – he also undertook training as a psychodynamic therapist at the Chicago Institute for Psychoanalysis – however did not complete the program when he was summarily dismissed for asking publicly “is anyone beside me aware of a lack of empathy?” – so with that I will turn the program over to him
Lou Agosta [LA]: Well thank you so much dr. Kravitz for that introduction – so the challenge is to make empathy present – will we be able to do that in the next 45 or 50 minutes? I begin by acknowledging your empathy – you all are going to be doing some listening and I appreciate that and recognize that and acknowledge it – and I want to be concise and allow time for questions in interaction at the back end – some logistics and housekeeping make sure you have the color handout – if you don’t it’s in the back on the left side – there it says how empathy functions – 2-sided copying ladies and gentlemen – and then how empathy breaks down – so sometimes we can create a breakthrough based on a break down – and one of the results of the conversation that we’re going to have today among others is a short history of the distinction empathy – in fact the secret underground history of empathy – we’re going to define empathy –
Lou Agosta [LA]: we’re going to look at some examples of empathy through literature – so rather than clinical examples I’m going to ask you to take it up a level – the guidance is and with all due respect don’t be too concrete don’t be too literal let’s get our metaphorical transference thinking caps on and look at empathy of [in] some examples of world literature and then I’m going to make time – I’m going to say a few things about how empathy is teachable trainable – in fact that’s so important i am going to give you the answer right up front – basically people are naturally empathic – if we remove the obstacles to empathy, then empathy shows up – in other words, the obstacles to empathy are the such things as: denial, resistance, cynicism, bullying, aggression, bad language –
LA: I have a great Dilbert cartoon here -[make sure you] don’t get inside of a Dilbert cartoon – [it is] hilariously funny – closely related to empathy – [drive out] denial, cynicism, guilt, shame, and the like – remove the obstacles to empathy and it [empathy] naturally comes forth – so that’s the answer – what’s the question? – how do we train everyone ? – so we’re gonna circle around and return to this at the back end – we’re going to begin with a short secret underground history of empathy – so this is going to be blazingly concise –
LA: this is the part which you may find somewhat academic [but important] and there as you look at it in the upper left hand corner a man named David Hume [ who published] A treatise of human nature 1739 – [in the year] 1739 the word empathy in the English language was not even invented [it was not invented] until 1895 when a Cornell University psychologist – a man named Edward Bradford Titchenner was translating some of the works of Vilhelm Vundt [Wilhem Wundt] – I have to get my best German accent on there – it comes across as empathy – he [Titchener] makes up the word [empathy] – okay – meanwhile […] that’s why we have a secret underground history of empathy – Hume is writing and has at least five different definitions of sympathy – I say close enough – you have the hand out – the complete deck is on the URL on the lower left hand corner [see the youtube video for the slides] – I’m not going to speak slowly enough for you to take notes –
I’m going to tell you what the five different definitions of sympathy – they’re there and you can go back and get them – he never a stickler for consistency – the philosopher Hume divides sympathy as (1) emotional contagion – he defines sympathy as (2) suggestibility – the power of suggestion – (3) he defines it in a somewhat technical way as a double representation of a vicarious experience of another person combined with the idea of the other that matches closely to a modern definition of empathy that we find in psychology (4) he also defines sympathy as a delicacy of sympathy and taste and this matter of substituting a certain kind of sympathy in the experience of the work of art – this is the secret underground history of empathy – we relate to other people on a good day as if they were works of art – that is without use value – without manipulation – without knowing something – without categories – without argument – and [on] a less good day we struggle like everybody else – and finally as (5) benevolence – he defines sympathy as compassion or benevolence –
LA: and so we’ve got all these definitions – what the heck is it [empathy] – what is this definition so I sent the class [I was teaching at the time] out [to do research by asking people on the street] – I have everybody in the class – several classes – each student asked five people what they think empathy is – not members of your family people – you know moderately well – not really close – you know – but people you might work with or run across at the club or at the gym or something – so there’s a trend – so sometimes I go around saying we don’t need more Data we need expanded empathy – I’ve been known to say that – and nevertheless we need both data and empathy […] -I say more empathy – it’s like there’s something missing rather than something wrong – let’s expand – the languaging is significant as well – this is in the realm of tips and techniques- okay – so anyway – so the people go out and ask them and so here’s the trend: most people think empathy is something like compassion – they tell the story about altruism – they tell a story about charity – they tell the story about doing good – they tell the story about making difference – they tell a story about being nice and heavens knows ladies and gentlemen, the world needs more niceness – [yet niceness] it is distinct from empathy – we’re going to say a little bit more about that but first I want to very concisely touch on – as you look at the picture in the upper right hand corner – Immanuel Kant – he died in 1804 – he had the distinction between putting oneself in the position of the other person – he said enlarged thinking – think as the other [people] think and feel – so that’s top down – in effect we take that as the folk psychology definition of empathy – we take a walk in the other person’s shoes – where does the shoe pinch – where does the moccasin chafe – and then he also he once again interestingly and controversial enough in the context of a theory of art and beautiful nature he talks about the communicability of feeling – art is impossible without the communicability of affect – feeling – that’s stage one of empathy – now if you stop, [then] there you get emotional contagion – you get suggestibility – you get a certain kind of shared mutual enthusiasm – and there’s nothing wrong with that if there’s further processing upstream and downstream that’s going to occur – nevertheless it’s right there and then [we are going] around the circle –
LA: and this is why this is the secret underground history: on the bottom left – a man named Theodore Lipps – remember the movie Amadeus ?where you know Mozart is slaving away and the most famous man of his day a musician named is Antonio Salieri who today except for the movie Amadeus nobody would have ever heard of Antonio Salieri – I mean he’s not played – or they’ll give attention occasionally now because of the movie – right – and today Mozart – everybody knows Mozart’s music is played widely and nobody’s ever heard of Salieri until you come across the movie – well Lipps is Salieri to Freud’s Mozart – Lipps wrote several volumes in which he gives currency in the German language to the word Einfühlung [empathy] – he [Lipps] in effect replaces the distinction aesthetic taste judgment of a feeling of pleasure or displeasure with Einfühlung [empathy] – and he [Lipps] is significant because seven volumes of Lipps work are in the Freud Library – Freud encountered empathy by reading Theodore Lipps –
and [Freud] footnotes Lipps explicitly in Freud’s works on jokes and the relation to the unconscious – and the number of his aesthetic works – so moving right along there are twenty-two mentions of empathy in 24 volumes of the Freud Library as Harry Trosman MD and Simmons – our colleagues over at the analytic Institute – have done the scholarly work – here’s the point – almost every one of them [references to empathy] is mistranslated – freud says in so many words in his 1913 [year published] recommendations for physicians beginning psycho analytic treatment: you will go wrong if you begin with any other method besides empathy – quote end quote – it’s there and that gets mistranslated as sympathetic understanding – the Strachies [translators] will have a few other devaluing things to say about the word empathy so that’s the secret […] – the rest is history which we’re not going to do in the necessary detail – we’re going to move right along –
so most people think that empathy is compassion – and heavens knows the world needs more compassion – yet [compassion] it is not empathy – so what then is it ? Well basically we’re gonna have about two or three different definitions but the main definition which you have in front of you is to the effect – I know what the other person is experiencing because I experienced it also – not as a merger but as a vicarious experience – note vicarious experience contains the word Vicar which means representative – the etymology right as it actually works in this case if that is the the bishops representative to the community – the Vicar of something or other – and in any case combined with the distinction Other – and so basically here’s the distinction – empathy tells me what the other person is experiencing – and my good upbringing, my morals, my values, tell me what to do about it – and so that’s the compassion part – it’s in and its distinct – so having said that now here’s the most controversial slide I want you to pick up on this because it could be a controversial –
and I want – to quote to Jodi Halpern and I’m gonna wave Jodi’s book at you [entitled From detached concern to empathy: humanizing medical practice – Jodi Halperin – this is [published] 2001 so this has been around for a while and you know if we’re gonna have lunch afterwards – if you want to take a picture of the cover – I’ll bring it [the book] along with me and you can check it out but basically she says – the field of medicine empathy is a mode of understanding that specifically involves emotional resonance so it’s not just top down – it’s also bottom up – I’m getting some kind of a vicarious experience – this may or may not be the case – this may or may not be the case […] and so you know nevertheless she puts a stake in the ground and she is actually a psychiatrist – she has some stories
and I turn now to the explicit definition of empathy which we’re going to work with here and there are four phases to it – and that’s the handout – […] you get the handout – it’s on the left there – in the back table – so you want to be on the side: how empathy functions – […] so we’re gonna go around in a circle – we’re gonna go around in the circle here that would be actually counterclockwise – I’m open to the other person – I’m receptive – I have mirror neurons – and here’s where one can insert the underlying physiology – the underlying neurology – that’s not visible – here us mammals – we seem to resonate together – something is going on – we’re attached – it’s a myth that we aren’t related – we are related – physiologic\ally, biologicall,y and so [that is] phase one […]
phase two that creates a potential space for interaction – what’s possible in the relationship – do I relate to the other person as a means or end – do I relate to the other person as a possibility as a potentiality – we’re going to see an example of that and then actually you have to jump across so that gives us empathic receptivity- empathic understanding and empathic interpretation is the third aspect of empathy and that is the folk psychology of empathy – I take a walk in the other person’s shoes – I imaginatively change places with you – now that’s easier said than done because I don’t know you and nine times out of ten if I don’t, [then] I’m going to attribute to you aspects of my own character traits – Who I am – what I’m up to and that’s the challenge – right? – that’s not going to be and it’s going to be a psychological mechanism called projection which has its uses and is of interest – nevertheless is once again not empathy – and so get a view from over there but that does especially when I come up short I don’t know who you are – where you came from – then I go to the cognitive imaginative projection – and that’s very useful – and finally empathy can be a tree that falls in the forest without anybody being there – does it make a sound? does it make a difference? I have to say something I have to do something – a gesture- an aspect of behavior to let the other person know whether or not I have gotten what their experience is and sometimes that’s called empathic listening – that’ll work – good gracious listening – that maybe it is self sufficient but sometimes it’s not especially if I don’t know the other person – it may we’re highly verbal – you know there’s a lot of words and sometimes it’s necessary for me and so empathic responsiveness – so we’ve got receptivity – understanding – interpretation – and responsiveness –
I take the other person’s experience and give it back to them in such a way in such a form that the other person recognizes the experience as their own – on a good day that’s how it works – that’s the aha moment – that’s what I was going through – it’s sometimes it could be the very words but often it’s not – often it’s I’ve got inside the movie of your life for a little while – now each of these [four moments of empathy] breaks down in an interesting way and we’re going to therefore look at the breakdown – so this summarizes something interesting and which I think I do want to say it’s always useful to know the order in which one has one slides but basically this is the matter of so we’re gonna, you know, this [talk] is front end loaded – I acknowledge this presentation is somewhat front and loaded because there are several important ideas I want to get into the space and on the table so that we can mix it up about it – but basically so this is the compassion fatigue the burn out moment – heavens knows, occupational hazards – professional challenges – if I may say so – here’s the guidance – this may be for the easier said than done but nevertheless it must both be said and done – and insofar as humanly possible: if I’m interacting with somebody who is suffering, it is highly probable that I am going to suffer – the recommendation, the guidance is, that I have a vicarious experience of that suffering – if I am suffering in such a way that I am in breakdown or upset, [then] I’m doing it wrong
That’s the easier said than done – if I’m overwhelmed by the suffering – as strange as it may say sound to say: I should suffer but not too much – and so this points to the matter of a granularity – to the receptivity – there’s a filter there – right – I mean this all hypothetical – interesting to engage – nevertheless I may want to make the filter more granular and do things to take a little distance so it is not an on/off switch – the takeaway here – not an on/off switch – more like a rheostat – more like a dimmer on a light switch and this is where training and practice make the difference – so I mean we may or may not come back to that – but I want that [statement] in the space so that we can work with it as we get to these examples we’re going to look at – so am I going in the right direction here […] I see we’re just on time –
we look at three or four examples – here I may cut this short because I want to say a little bit more about the training aspect but we’re going to look at Thomas Mass – Thomas Mann is a storyteller – this story got told on or about the year 1900 – it’s about a family the name of Buddenbrooks – they’re a business family – right – and the context is Thomas Buddenbrooks – so here’s the inside skinny – here’s the Birdseye low down on this Buddenbrooks caper – Thomas Buddenbrooks is an artistic type – he’s very artistic – and his father passes away in an untimely way and he – Thomas – goes into the family business to pay the bills – you know, one can understand why one would do this – he gives up his artistic career – his artistic aspirations – and instead of pursuing an artistic career, he marries one – her name is Gerda – she’s an artistic type – we’ll see a picture of her later – […] – she’s playing the violin – she’s a virtuoso violinist – playing passionate virtuoso violin duos with her talented father – it’s so great to have a great relationship […] it’s a very good thing and they have a son – Johann – Hanno, for short – he’s an artistic type – he’s portrayed by Mann as being on sickly – I mean, he’s got bad teeth – this is going to be an issue because this is 1900 – you know dental science – oh my god this has to be interesting –
LA: [ …] some people are already squirming in their seats – it’s working – the mirror neurons are going off even if they don’t exist – this might be a good point to digress – the myth of mirror neurons – professor – C[Jean] Decety – he’s got the MRI machine down at Gates Blake – he recommended this book by Gregory Hitchcock- there’s an underlying neurological mechanism, ladies and gentlemen – it does [or doesn’t] have to be mirror neurons – how about Association? – have you considered a good old-fashioned association? – there’s some implementation mechanism – it’s highly interesting and controversial – I’ll keep the book handy – it’s a scholarly academic debunking […] but what isn’t debunked is our physiological relatedness – even if they [mirror neurons] don’t exist, we’re physiologically related – that’s interesting so and not in the way you might have thought – okay – so anyway you know the dentist – we’re gonna have a trip to the dentist here thanks to Thomas Mass and I’m actually going to read it to you – the paragraph long quotation – so Hanno has bad teeth – in Mann bad teeth are a sign of artistic sensibility – in the case of Hanno he’s kind of sickly – kind of small – he gets bullied by the straggling Nordic types down at school – you know they push him around – it’s not a pretty picture – and his father becomes [a book camp dad] [the father, Thomas] he’s kind of badly compensated – I would say and he’s this hail-fellow-well-met – my son – give me your mathematical multiplication tables – and Hanno knows his tables – he just can’t perform – he breaks down – it’s pathetic – you know but he’s like seven years old – wa, was [crying sounds] – buck up my son – Thomas is boot camp dad and it’s not working – okay – so meanwhile there’s a bit of orality – you know, we can do the oral symbolism – Hanno needs to vigorously suck on the nipple of life and he’s really struggling to engage
[Meanwhile] – off to the dentist doctor – the dentist is already upon dr. brecht – a pun – it’s broken – so I’m gonna read you this slowly –
‘The bad thing about Dr. Brecht was he was nervous and dreaded the tortures he was obliged to inflict – we must proceed to extraction – he would say growing pale – Hanno himself was in a pale cold sweat with staring eyes incapable of protesting or running away – in short, in much the same condition as a condemned criminal – he saw dr brecht’s sleeve and the forceps bending over him and noticed that little beads were standing out on his bald brow and that his mouth was twisted – when it was all over and Hanno, pale and trembling, spat blood into the blue basin at his side dr brecht had to sit down and wipe his forehead and take a drink of water”
LA: So what’s going on here is a breakdown – this is a breakdown in dr. Brecht’s empathic receptivity – he’s overly empathic – one might argue – compare and contrast – the description itself gives us access to the phenomenon – right – both both are sweating – brecht’s mouth is twisted – interesting, the mirror neurons are going off – [brecht’s] his mouth is twisted [so the mirror neurons are going off] – so what’s the recommendation? this is the time for a bad joke – right – he should have gone into ophthalmology – forgive me – okay so back that one out – okay pause for laugh – but anyway it’s a serious insignificant group here – so here’s the breakdown and so what’s the recommendation? – given that empathic receptivity is breaking down on the part of dr. brecht […] – to get some distance from the tortures he inflates – given what is 1900 Dental Science – oh my god – it’s hard to think right and so he has to increase the granularity of the filter – easier said than done but practice practice practice practice what does that look like because he’s providing a useful service – […] I mean, it’s like it’s misery – there’s all kinds of mystery – okay – so you know I pause for breath at this at this point – I would ever take questions even at this point about the example – you know it’s not like this is a quiz and I don’t you know you’re eager for me to move along but don’t be shy raise your hand – okay, so we will move to the next example and that if you think of anything we can circle back around – so remember the set up – Thomas Buddenbrooks gives up his artistic career and he marries someone who is very artistic – Gerda – and she is artistic and she has to move and locate because the Buddenbrookss live in a different town than her father – so she’s no longer playing violin duo’s with her father – she’s got nobody to play with – one might say – so she meets this lieutenant who happens to be a talented violinist in addition to his military aspirations – so they’re upstairs playing passionate violin duo’s and Thomas’s office is downstairs and he’s listening to the violin music – and that’s not the problem – there’s nothing wrong with that – then the music stops – then there’s silence – there’s more silence – there’s even more silence – Thomas is going crazy – Is he going to become the caricature of a jealous husband? – that would be to throw the guy [lieutenant] out – that would be a scandal – that would indeed be a caricature – right – so he’s wandering around pacing back and forth – so he is pacing back and forth and he runs into Hanno in the hallway next quotation –
“His father did not seem to be listening – he held Hannes free hand and played with it absently, consciously fingering the slim fingers and then Hanno heard something that had nothing to do with the lesson at all – his father’s voice in a tone he had never heard before – low distressed almost imploring – Hanno, the lieutenant has been more than two hours with Mama – little Hanno opened wide his golden brown eyes at the sound and they looked as never before clear large and loving straight into his father’s face with his red and eyelids under the light brows its white puffy cheeks and long stiff moustaches – God knows how much he understood – but one thing they both felt in the long second when their eyes met – all constrained coldness in this understanding melted away – Hanno might fail his father in all that demanded vitality energy and strength but where fear and suffering were in question, there they were as one empathic understanding –
Hanno [saw] something that he had not previously perceived – this father was boot camp dad – multiplication tables right – the time goes by – Oh God now he sees – so what’s the word? vulnerability – that’s one possible description – this bootcamp dad is vulnerable – he’s suffering- Hanno does not get it – what does it mean – playing violin duos and then silence -Hanno’s seven or eight years old – right? – so their eyes meet – that is the moment of empathic receptivity embedded in empathic understanding – the father who was so inaccessible in his hail-fellow-well-met and boot camp-style cross-examination of Hanno about his lessons becomes vulnerable and accessible in his suffering – Hanno gets it – his father’s suffering is a possibility – the possibility of his humanity – they share a human moment – the possibility of relatedness emerges in which both are human beings and an emotional connection with one another – this had not been available to Hanno before – for whom his father was this strong demanding taskmaster – now he sees his father’s vulnerability and it humanizes both of them – this is also an example of empathic understanding that works to an extent but ultimately the father remains [in] the role and the story goes along […] What you want to get here is just a picture of the lieutenant and Gerda – they are practicing the violin – she’s giving a master class in practicing the violin – and so let’s do a reality check here – I want to leave both enough time for questions and answers and say something about a little bit more about training
So I’m going to fast-forward through interpretation – if you get the deck you can get some detail and move on to the Glass Menagerie [by] Tennessee Williams who is a formidable psychologist – so the story in brief: Amanda is the mom – Laura is the frail, fragile keeper of The Glass Menagerie – she lives in the back room – she is the daughter – she has a brother, Tom, who has a friend, Jim – Amanda, the mother, had many gentleman callers in her youth – she was popular – we could do with the song from Wicked [the broadway play] at this point but perhaps we won’t – we can we splice that in later – but as she was popular – now she’s fading – the bloom is off the rose – off the flower in the years nineteen fifties – and she so badly wants a date for Laura – to get a date – she wants her to have a gentleman caller caller so she pressures her son, Laura’s brother, Tom, to bring somebody from down at the factory and finally Tom invites Jim, his friend – there’s other information asymmetries in the story – Jim’s already engaged – get ready – you don’t necessarily know that at this point [in the story] but look is to follow along so the invitation is accepted – at last a gentleman caller! – the problem is Jim thinks it’s just a casual dinner with his friend Tom but in fact he then meets Laura who know Jim from grammar school – they went to grammar school together! – it’s small world and Jim sees her and and he says two words: blue roses – blue roses – and Laura is taken aback – she had many childhood illnesses including pleurisy – fluorosis – and when the teacher this was the day when the teacher would say why you weren’t in school well she’s got fluorosis or pleurisy – nobody knew what that meant anyway but Jim hears that as “blue roses” so here’s the part we’ll cut to the chase – Laura also has another childhood disease which leaves one of her legs slightly shorter than the other – polio- and as she walks down the aisle her experience of herself as that she’s making this enormous clomp clomp thumb clomp clomp as she walks down the aisle that everybody must know about it –
of course Jim didn’t even perceive it [it is so soft] and so we have here an example of what amounts to empathic responsiveness – he [Jim] gives her back his experience of who she is for him – for Jim, Laura is “blue roses” – something beautiful even if kind of melancholy – she’s got this melancholy aspect to her which makes her all the more attractive of course – […] and whereas she experienced herself as clunk clunk clunk thunk – the asymmetry there is very powerful – it’s very nice – I think Williams is a brilliant psychologist – I mean – and unfortunately – I mean – he’s also pretty depressed himself and it ends badly – nevertheless we’re going to enjoy the moment – the emotional devastation [is powerful art] – okay, so having so you know that’s three out of four examples – now we’re just on time
I’m going to talk and to tell you about an exercise rather than do the exercise – I call this exercise: I can’t hear you because my opinion of what you are saying is so loud – I’m going to be disarmingly with candid – so you know there I am walking down the street – and I am ashamed of myself – the author of three books on empathy – [and i am thinking devaluing thoughts] – how did that person get to be that way – I’m judging and evaluating – there’s these thoughts – what happened to you man? – wherever it comes, from it’s not authentically Who I am – you want to take this and apply it as appropriate and to yourself: there I can’t hear you because the opinion of what you are saying is so loud in my own thinking – so this is an exercise, not how to listen better, but how to expand one’s listening – right – stop and so actually this is where the the [Dilbert] cartoon comes in handy –
[…] there’s an exercise here that this is how to train for empathy – what does it mean to train empathy – remove the obstacles such as cynicism, categorizing people, labeling, pigeon holing, and so on – I’ll read this to you just so some of you are picking up on it – [in the Dilbert cartoon]: now so there’s the pointy headed boss [and he says] “from now on all teams will be formed on the basis of myers-briggs personality test types” “if you do not have a personality, one will be assigned to you by Human Resources [dept]” – okay, laughter at this point, [this] is deeply cynical […] this is what not to do – right? – and then the final [statement of the cartoon] “we need a quiet dumb guy to pair with an extroverted thinker” – well here the cynicism is what gets in the way of empathy – now that is not to say that it is not abroad in the land of the corporation [and it] goes off the rails – so what I invite – what the exercise consists of doing is going inward and realizing that if one goes inward far enough, one encounters the other – so we actually are going to take literally a half a minute and do the exercise –
So I’m going to ask you to be quiet and listen to yourself […] now there may be papers going off so just include that because this is after all a hospital – […] but listen to what is there – okay are you ready – any questions before they do the exercise? – it is it clear what I’m asking you to do ? please say if it’s not clear […] so you’re just gonna listen to whatever is there okay ready set go
[pause for thirty seconds]
Okay – that’s 30 seconds […] now you might have heard something like “what is he talking about?” “where did this guy come from?” “What voice?” “What conversation?” That’s the one – that’s the one [we are talking about]! – it’s not who I authentically am – and [yet] that is a source of empathic understanding -I am in relationship with the other and I’m going to have judgments, opinions, evaluations, philosophical arguments, categorizations, labels and so on – there isn’t anything wrong with those – those thoughts occur – they are inevitable – you can’t – ladies and gentlemen, you can’t stop thinking those – you can’t prevent it – what you want to do is get some distance from it and realize when it’s useful and when it’s less useful and so with that said we’re going to have some time for questions –
The one final thought I leave you with – and it’s a direct consequence of this little exercise – to listen to oneself, when all the labels are removed, when all the categories are removed, when all the philosophical arguments are removed, when all the cynicism, hostility, affectation, even compassion, sadness, fear, guilt, shame – when all these things are removed, [then] empathy consists in being in the presence of another human being
LA: what are your questions?
LA: The lady in the back – I’ll repeat the question – go ahead –
Do you think you can teach empathy?
LA: The short answer is yes […] so I’m going to repeat the answer – I just [asserted] we’re naturally empathic – remove the cynicism, denial, shame, guilt, and empathy naturally shows up – train the trainer now that’s not considered the possibility […] there other tips and techniques – this is the realm of tips and techniques: my reaction to you tells me something about both of us and a lot about myself which I then parlay forward to understand the relationship
[….] The challenge to create a context in which empathy can show up – right that’s not a trivial things – it’s a lot of work – and of course teaching is information transfer – I put information in your bucket – you bring a bucket or a basket and the teacher puts information in it – there’s nothing wrong with that – we need that – […] the world doesn’t work without information and there’s also the other aspects – dimensions – especially to our humanity and what happens in the context of a conversation – so you know there’s some work to be done on creating [possibility] and that’s what I think [why] literature has its uses in creating a context for a conversation that’s why I find it useful other questions? so I mean feel free to challenme
Individuals have been in some tough spots in the trenches for a while and become hardened – I think you use that word and how does one recover from that? – so I would also put on the list compassion fatigue – burnout – this is a significant occupational hazard – I mean – take some time off for self-care – this is the case for self-care – that one has to find some things where one can restore one’s emotional energies if you will – that we have something like emotional energy – and because being burned out – being compassion fatigued – I ain’t doing nobody any good much less myself – right? – so sometimes one has to get some supervision – I mean now leaving aside matters of such as vacation and that is where I find humor which is closely related to empathy – this Dilbert is deeply cynical right? – but –
in both empathy and humor one traverses a boundary – in the case of humor, one can say look at the boss is an idiot and it’s funny – Human Resources says a personality will be assigned to you – it’s hilarious, right? […] it’s the reduction to absurdly right? – so philosophically, it’s a reduction to absurdity – so one can use humor […] so this is the case for one’s own psychotherapy – I mean that the therapist him or herself may usefully encounter at some point in their development something like whatever this thing is – therapy h- aving a conversation with oneself – journaling – it may become a self-sustaining process – I get a lot out of journaling – I mean some people do and some people don’t – the world is not generous in the matter of certain things such as empathy – put it on the list with compassion as well right? – and so one has to find some resources to recharge one’s empathy – oftentimes it’s family – speaking personally, coming up, I experienced the lack of empathy so I actually started writing about it – and that was how I approached it and I kind of symbolically created something for myself […] – one final question…
LA: we are out of time – one final question?
what is the triad that sustains the therapeutic process? Warmth, accessibility, what else?
LA: okay well the concise answer is the Triad is – empathy empathy and empathy and warm and accessible is also useful – on a good day the other individual will show you who she or he is – if I am present without categories, distinctions, labels – on a good day they’ll reveal their soul – on a less good day we will struggle like everyone else – thank you so much
I heard there was some lunch – I don’t know if there is – I heard it was are up on six – I’m gonna go up there and check it out
Radio Empathy is now on the air as a podcast: New episode: A rigorous and critical empathy: Perform a readiness assessment
Empathy is never needed more than when it seems there is no time for it. Empathy is never needed more than when it seems the budget does not allow for it. Empathy is never needed more than when the cynicism and resignation about life, whether in the family or the corporate jungle, are so thick you can’t catch your breath.
Being ready for empathy is like being ready to be born. No one is ready to be born. You just get born. Ready or not, the individual is thrown into the world. No one asked you if you wanted a life. You just got one.
Empathy enables you to have a human existence filled with satisfying, engaging, dynamic, fulfilling relationships instead of living in an empty, depopulated emotional desert.
There is enough empathy to go around. The key to the empathy readiness assessment is realizing enough empathy is available for everyone. Empathy is not a zero sum game. There do not have to be losers versus winners. If you can get your head around the idea that there is enough empathy available in the world—crazy as that idea may seem at first—then you are ready to engage with expanding empathy in your life and the community.
Seems impossible? Let us take a step back. You know how we can feed everyone on the planet, so that there should be no need for people to get sick and die of starvation? Thanks to the “Green Revolution,” high tech seeds, and the economies of scale of agri-business, enough food exists to feed everyone. Yet people are starving. People are starving in the Middle East, Africa, and in parts of the USA. People are starving because of politics in the pejorative sense, breakdowns in social justice, violence, aggression, bullying, cynicism, bias, prejudice, fragmentation of communities, and human badness. There is enough food to feed everyone, but it is badly distributed.
Likewise, with empathy. Enough empathy is available to go around; but it is not evenly distributed. People are living and working in empathy deserts.
Organizational politics in the pejorative sense of the words, attempts to control and dominate, egocentrism and narcissism, out-and-out aggression and greed, stress and burnout, all result in empathy deserts. Empathy gets hoarded, creating empathy deserts locally, even amid an abundant ability to practice empathy.
Create a clearing for success in working on expanding your empathy, contributing to growing empathy in yourself, other individuals, and the community. Perform a readiness assessment for empathy training
Therefore, this guide to bringing forth a rigorous and critical empathy training does not call for “more” empathy, but rather for “expanded” empathy. The difference is subtle. Commenting “We need more empathy here!” implies the individual is unempathic—are you saying I lack empathy!?—and that is an insult, a dignity violation, a narcissistic injury, creating even more conflict and shrinking empathy.
The way we put our words together makes a profound difference. Experience indicates the call for “more empathy” results in a further breakdown of empathy. In contrast, calling for “expanded empathy” makes a difference in getting unstuck from difficult, sticky situations, reestablishing relatedness, de-escalating conflict, interrupting anger or soothing rage, shifting out of upset, and overcoming the challenges of relating in a world that can from time-to-time be decidedly unempathic.
In extreme cases, a person may in fact lack empathy in a medical or legal sense—the serial killer, the psychopath, and persons suffering from mental illnesses, or, more sympathetically, one of the disorders of empathy such as an autism spectrum disorder. However, such persons are exceptions or in an exceptional situation.
In most cases, individuals have a significant empathic ability with which the individual is out of touch. The person lacks self-knowledge, has a blind spot, and does not know himself to be empathic. The person’s empathy is implicit and is waiting to be expanded. Therefore, a rigorous and critical guide calls out for expanded empathy—to leverage the kernel of empathy that already exists in the person’s humanity and develop it, if not into a mountain, at least into a heaping hill of empathy.
One reason that empathy training programs have not worked or have produced disappointing results is that they train the participants in compassion, being nice, conflict resolution, baby and child care, and a number of worthy and admirable skills. This is all well and good, and the use of compassionate methods is making the world a better place in all these situations. So keep it up. There is nothing wrong with reducing conflict, being nice, agreeable, and so on: do not be “unnice.” But paradoxically something is missing—practicing a rigorous and critical empathy.
Now I do not wish to give anyone a bad name, especially anyone who is committed to empathy, compassion, conflict resolution, or making a difference in overcoming human pain and suffering. On the contrary, I acknowledge and honor one and all. The battle against suffering is joined; we are all on the same side; and we want to deploy our resources wisely.
As soon as one announces a commitment (for example): “I am going to expand empathy in my life,” then all the reasons that it is utterly impossible to do so show up. “What are you thinkin’ fella?” Not enough time. Not enough money. Resistance to empathy does not mean that one fails the readiness assessment to expand one’s empathy. It means that one is a human being.
People have blind spots about empathy. People have blind spots, period. Part of the readiness assessment? Those who take the implicit bias test discover they have biases—often several (see Teaching Tolerance 2020). When it comes to doing the work required actually to listen and respond empathically to others, people make exceptions for themselves—and their biases and inauthenticities. No exceptions!
The one question readiness assessment for empathy is: “Am I ready to do what it takes to clean up my inauthenticities in my practice of empathy?” (Key term: clean up.) Even if you are not completely sure what this means, being willing to agree to the statement is enough to get started.
When it comes to a readiness assessment, the “willingness” is easy. Speaking personally, even lazy people can get their heads around willingness; and once a person puts his foot out onto the slippery slope of willingness, well, it is downhill all way. Sliding downhill may have its occasional bumps, and you have to apply the brake at times; but it is a lot easier than climbing up the hill.
Look it, dude. I would be kidding you if I said no effort is required. Effort is required to expand your empathy. It is going to take something—and, at times, something extra by way of effort. Mostly it requires taking an honest look at oneself. That is not trivial. It may be confronting. But if you are getting vicariously traumatized trying to be empathic, then you are doing it wrong. Throttle back. Take a break.
Being willing to clean up one’s authenticities is precisely the empathy lesson. The “gotcha” is that the inauthenticities in one’s life are not limited just to empathy. However, empathy leads the way. The readiness for a rigorous and critical empathy requires, well, rigor and a willingness to be self-critical. The readiness for empathy requires doing the work required to create a clearing for empathic success, a clearing of integrity and authenticity.
(c) Lou Agosta, PhD and the Chicago Empathy Project
Freud is explicit about his commitment to empathy. He writes and publishes the following:
It is certainly possible to forfeit this first success [in therapy] if one takes up any standpoint other than one of empathy such as moralizing (“Further recommendations: On beginning the treatment.” Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume 12: 121-144. : 140).
Unfortunately no one knows that Freud wrote that, because it is literally lost in translation. In translating “empathy [“Einfühlung”] from the original German, Alix Strachey writes to James Strachey: “In any case, it’s a vile word [“empathy”], elephantine, for a subtle process.” The words “sympathetic understanding” were chosen as the translation in this case. The rest, as they say, is history; except that it is like Russian history when Stalin had Trotsky’s photos literally cut out of the history books of the Russian Revolution. Talk about repression!
[Note: This post is an excerpt from Chapter Four of my book A Rumor of Empathy: Rewriting Empathy (Palgrave Publishing): to buy the book or have your local library order a copy go here: get A Rumor of Empathy: Rewriting Empathy [https://tinyurl.com/y24ps876]]
Freud’s method was an empathic one, and the dispute, if any, is not that Freud did not use or value empathy. He did. Freud applies empathy in his clinical practice, even when he does not use the word “Einfühlung.” Freud balances his commitment to empathic methods even in the face of the boundary issues of C. G. Jung and S. Ferenczi with their women patients, where Freud took the moral high ground, counseled the need to be dispassionate and “like a surgeon” in neutrality, anonymity, and (above all) abstinence. However, that may all be well and good in practice, but how does that work in theory?
In theory Freud limited his explicit mentions of “empathy.” The reason is Freud’s definition of “introspection.” Introspection is distinct from empathy, but closely connected to it. One dominant modern definition of empathy is “vicarious introspection” (Kohut 1959), where introspection is the royal road to empathy. Introspection is an anchor, making available the spontaneously arising vicarious feelings that are further processed by empathic understanding and interpretation into an empathic response. Yet Freud did not make such a distinction. Rather Freud defines “introspection” in terms of the self-observation of the conscience (one aspect of the superego), that is, as a form of self-criticism and censorship.
In this quotation, empathy is distinguished from “moralizing.” This is a casual reference but a potentially revealing one. By “moralizing” one understands Freud to mean the use of “approval” or “blame” as means of influencing the course of treatment. The exclusion of an ethics of empathy does not rule out the use of empathy for recognition of the humanity of the other person. In this sense, empathy implies a respect for the autonomy of the other which is inconsistent with any attempts to manipulate him by means of approbation and punishment. It is important to keep open a space for the ethical implications of empathy without indulging in “moralizing” in the narrow sense.
As noted,, this is also the text in which “Einfühlung[empathy]” is mistranslated by Strachey as “sympathetic understanding,” thus further obscuring the critical role that it takes in Freud’s practice. Contrary to Strachey, Freud takes significant effort to distinguish “empathy” from “sympathy.”
The effort to distinguish “empathy” from “sympathy” continues in Freud’s “Preface to Aichhorn’s Wayward Youth”(1925: 273). Sadly, so does the mistranslation. Freud acknowledges the contribution of August Aichhorn in working with troubled adolescents: “His [Aichhorn’s] attitude to his charges sprang from a warm sympathy with the fate of those unfortunates and was correctly guided by an intuitive perception [“intuitive Einfühlung” = “intuitive empathy”] of their mental needs.”
The use of “intuition” here is not the over-intellectualization about which Kohut cautioned (e.g., Kohut The Analysis of the Self: 302-305), but rather the recommendation to be guided in relating to the troubled adolescent by one’s perceptive personal reaction, a skill in which Aichhorn excelled.
Freud typically finds a model taken from everyday life for pathological phenomena. Examples include: mourning (normal) and melancholy (depression); dreams (normal) and hallucinatory psychosis (waking dream); religious practices (normal) and obsessional rituals (pathological); love (normal) and hypnosis (abnormal): all present parallels between the everyday and the pathological. Thus, Freud notes the continuum between the pathological state of paranoia and the self-observations of the scrupulously moral conscience:
. . . The self-criticism of conscience is identical with, and based upon, self-observation. That activity of mind, which took over the function of conscience, has also enlisted itself in the service of introspection, which, in turn, furnishes philosophy with the material for its intellectual operations. This must have something to do with the characteristic tendency of paranoiacs to form speculative systems.
It will certainly be of importance to us if we can see in other fields evidence of the activity of this critically watching faculty, which becomes heightened into conscience and philosophic introspection (Recommendations for physicians beginning psychoanalysis, 1914: 96-97).
This definition of introspection as critical self-observation is far from the kind of introspection actually practiced by both the analyst and analysand. The latter’s free associations cannot be generated so long as the conscience is actively censoring one’s thoughts and discourse. The analyst does not deliberately concentrate his attention or listen for anything specific in the analysand’s free associations.
The analyst maintains an attitude of evenly-hovering attention, in which his tendency to “moralize”—approve or blame—is suspended. In this way, introspection on the part of the analyst can disclose vicarious feelings as well as memories analogous to those told by the analysand. In both cases, we have a kind of introspection without inspection (to coin a phrase), which conditions the arousal of empathic receptivity towards the latent content of the analysand’s unstudied associations.
Rehabilitating introspection without inspection is based on an account of empathic receptivity. In so far as empathy is a kind of vicarious introspection, Freud’s ambivalence towards introspection constrains his use of empathy. Having a limited conception of the uses of introspection as “moralistic,” critical self-observation in philosophy constrained Freud’s explicitly using empathy as a means of empathic receptivity towards the introspective accounts of the analysand and the analyst’s own vicarious feelings thus aroused.
In short, Freud’s methods and listening were highly empathic, and if one’s experience today is otherwise, it is only because something has been lost in translation – empathy.
“Okay, I’ve read enough; I want further details”: to buy the book or have your local library order a copy of this book or another of Lou’s empathy books go here: get A Rumor of Empathy: Rewriting Empathy [https://tinyurl.com/y24ps876]
(c) Lou Agosta, PhD and the Chicago Empathy Project
A Lazy Person’s Guide to Empathy, the book, now available: Expand empathy in the individual and community today!
Empathy: A Lazy Person’s Guide is a light-hearted look at a significant and engaging matter: how to expand empathy in the individual and the community – and do so without working too hard. The Guide includes twenty eight illustrations by the celebrated artist Alex Zonis. So if you get tired of reading, look at the pictures! Practically an art book, get a summary in line below and order the book here and now by clicking here: Empathy: A Lazy Person’s Guide.
Given current events (Q2 2020), go straight to the section on applying empathy to soothe anger and rage – and setting empathic limits to drive out bullying, prejudice, and bad behavior. In addition –
A lazy person’s guide to empathy guides you in –
- Performing a readiness assessement for empathy
- Cleaning up your messes one relationship at a time.
- Defining empathy as a multi-dimensional process.
- Empathy in the age of coronavirus – don’t miss it!
- Overcoming the Big Four empathy breakdowns.
- Applying introspection as the royal road to empathy.
- Identifying natural empaths who don’t get enough empathy – and getting them [oneself] the empathy one needs.
- The one-minute empathy training. [No kidding!]
- Compassion fatigue: A radical proposal to overcome it.
- Listening: Hearing what the other person is saying versus your opinion of what she is saying.
- Distinguishing what happened versus what you made it mean.
- Applying empathy to sooth anger and rage.
- Good fences (not walls!) make good neighbors: About boundaries.
- How and why empathy is good for one’s well-being.
- Empathy and humor.Empathy, capitalist tool.
- Empathy: A method of data gathering.
- Empathy: A dial, not an “on-off” switch.
- Assessing your therapist,.
- Applying empathy in every encounter with the other person – and just being with other people without anything else added.
- Empathy as the new love – so what was the old love?
The lazy person’s guide to empathy offers a bold idea: empathy is not an “off-off” switch, but a dial or tuner. The person going through the day on “automatic pilot” needs to “tune up” or “dial up” her or his empathy to expand relatedness and communication with other people and in the community.
Practicing empathy includes finding your sense of balance, especially in relating to people. In a telling analogy, you cannot get a sense of balance in learning to ride a bike simply by reading the owner’s manual. Yes, strength is required, but if you get too tense, then you apply too much force in the wrong direction and you lose your balance. You have to keep a “light touch.” You cannot force an outcome. If you are one of those individuals who seem always to be trying harder when it comes to empathy, throttle back. Hit the pause button. Take a break.
Empathy is about balance: emotional balance, interpersonal balance and community balance. Empathy training is all about practicing balance: You have to strive in a process of trail and error and try again to find the right balance. So “lazy person’s guide” is really trying to say “laid back person’s guide.” The “laziness” is not lack of energy, but well-regulated, focused energy, applied in balanced doses. The risk is that some people – and you know who you are – will actually get stressed out trying to be lazy. Cut that out! Just let it be.
The natural empath – or persons experiencing compassion fatigue – may usefully “tune down” their empathy. But how does one do that?
The short answer is, “set firm boundaries.” Good fences (fences, not walls!) make good neighbors; but there is gate in the fence over which is inscribed the welcoming word “Empathy.”
The longer answer is: The training and guidance provided by this book – as well as the tips and techniques along the way – are precisely methods for adjusting empathy without turning it off and becoming hard-hearted or going overboard and melting down into an ineffective, emotional puddle.
Empathy can break down, misfire, go off the rails in so many ways. Only after empathy breakdowns and misfirings of empathy have been worked out and ruled out – emotional contagion, conformity, projection, superficial agreement in words getting lost in translation – only then does the empathy “have legs”. Find out how to overcome the most common empathy breakdowns and break through to expanded empathy – and enriched humanity – in satisfying, fulfilling relationships in empathy.
Okay – I have read enough – I would like to order the book: click here: Empathy: A Lazy Person’s Guide.
(c) Lou Agosta, PhD and the Chicago Empathy Project
People want to know: Can empathy be taught? People complain and authentically struggle: I just don’t get it—or have it. In spite of the substantial affirmative evidence already cited, the debate continues.
The short answer is: Yes, empathy can be taught.
The one minute empathy training is: most people are naturally empathic. Remove the obstacles to empathy and empathy comes forth.
Remove the resistances to empathy and empathy expands.
Eliminate the obstacles to empathy and a space of acceptance and toleration spontaneously comes froth.
What happens is that people unwittingly have been taught to suppress their empathy. People have been taught to conform, follow instructions, and do as they are told. We are taught in first grade to sit in our seats and raise our hands to be called on and speak. And there is nothing wrong with that. It is good and useful at the time. No one is saying, “Leap up and run around yelling” (unless it is summer vacation!). But compliance and conformity are trending; and arguably the pendulum has swung too far from the empathy required for communities to work effectively for everyone, not just the elite and privileged at the top of the food chain.
Now do not misunderstand this: people are born with a deep and natural capacity for empathy, but they are also born needing to learn manners, respect for boundaries, and toilet training. Put the mess in the designated place or the community suffers from diseases. People also need to learn how to read and do arithmetic and communicate in writing. But there is a genuine sense in which learning to conform and follow all the rules does not expand our empathy or our community. It does not help the cause of expanded empathy that rule-making and the drumbeat of compliance are growing by leaps and bounds.
Teaching empathy consists in overcoming the obstacles to empathy that people have acquired. When the barriers are overcome, then empathy spontaneously develops, grows, comes forth, and expands. There is no catch, no “gotcha.” That is the one-minute empathy training, pure-and-simple.
The work at hand? Remove the blocks to empathy such as dignity violations, devaluing language, gossip, shame, guilt, egocentrism, over-identification, lack of integrity, inauthenticity, hypocrisy, making excuses, finger pointing, jealousy, envy, put downs, being righteous, stress, burnout, compassion fatigue, cynicism, censorship, denial, manipulation, competing to be the biggest victim, injuries to self-esteem, and narcissistic merger—and empathy spontaneously expands, develops, and blossoms. Now that is going to require more than a minute!
Studying the Humanities and literature, art and music, rhetoric and languages, opens up areas of the brain that map directly to empathy and powerfully activate empathy. Read a novel. Publish a blog post. Go to the art museum. Participate in theatre. These too are empathy lessons, fieldwork, and training in empathic receptivity.
Reduce or eliminate the need for having the right answer all the time. Dialing down narcissism, egocentrism, entitlement (in the narrow sense), and dialing up questioning, motivating relatedness, encouraging self-expression, inspiring inquiry and contribution, developing character, and, well, expanding empathy.
Yes, empathy can be taught, but it does not look like informational education. It looks like shifting the person’s relatedness to self and others, developing the capacity for empathy, accessing the grain of empathy that has survived the education to conformity. Anything that gets a person in touch with her or his humanness counts as training in empathy.
(Note: Putting the “one minute” into the “one minute training” so that readers would not have to work too hard was hard work. I did the work of reviewing over a hundred publications on empathy training, the two dozen most significant of which are listed here: For evidence-based research on empathy training see the Bibliography and start with this list.
 Angera et al. 2006; Antoni et al. 2011; Brunero et al. 2010; Chiu et al. 2011; Coke et al. 1978; Davis et al. 1996; Decety et al. 2012; Del Canale et al. 2012; Golan et al. 2006; Gordon 2005; Hadwin et al. 1997; Halpern 2001; Hojat et al. 2009; Hojat et al. 2011; Levine 2012; Ozcan et al. 2012; PBS 2013; Pace et al. 2009; Pecukonis 1990; Riess 2013; Riess, Kelley et al. 2014; Riess, Kelley et al. 2012; Therrien 1975; Zaki and Cikara 2015 (Note – this required more than one minute!)
For those interested in more than one-minute of training: You do not have to buy the book, Empathy Lessons, to get the research, but if you would like more detail see especially Chapters Four and Six in Empathy Lessons (click here to get EMPATHY Lessons from Amazon). Also of interest: A Rumor of Empathy.
Remove the resistance to empathy and empathy grows, develops, and blossoms. In every instance of resistance to empathy, the empathy training consists in identifying, reducing, or eliminating, the resistance to empathy. When the resistance is reduced, empathy has space to develop, and it does so spontaneously as well as through providing explicit practices, tactics, strategies, and training .
(c) Lou Agosta, PhD and the Chicago Empathy Project
Empathy is good for your health and well-being: Empathy is on a short list of stress reduction practices including meditation (mindfulness), Tai Chi, and Yoga. Receiving empathy in the form of a gracious and generous listening is like getting a spa treatment for the soul. But do not settle for metaphors.
For evidence-based research on empathy, empathy and stress reduction, and empathy training you may start by googling: Antoni et al. 2011; Ciaramicoli 2016; Del Canale et al 2012; Farrow et al. 2007; Irwin et al. 2012; Maes 1995, 1999; Pollack et al. 2002; Rakel et al. 2009; Segerstrom and Miller 2004; Slavich et al. 2013 [this list is not complete].
You do not have to buy the book, Empathy Lessons, to get the research, but if you would like more detail see especially Chapters Four and Six in Empathy Lessons (click here to get book from Amazon).
[Also included are chapters on the Top 30 Tips and Techniques for Expanding Empathy, Overcoming Resistance to Empathy, Empathy Breakdowns, Empathy as the New Love, Empathy versus Bullying, and more.]
The healing powers of stress reduction are formidable. Expanding empathy reduces stress; and reducing stress expands empathy. A positive feedback loop is enacted. Expanding empathy expands well-being. Here empathy is both the end and the means.
A substantial body of evidence-based science indicates that empathy is good for a person’s health. This is not “breaking news” and was not just published yesterday. We don’t need more data, we need to start applying it: we need expanded empathy.
Evidence-based research demonstrates the correlation between health care providers who deliver empathy to their patients and favorable healthcare
outcomes. What is especially interesting is that some of these evidence-based studies specifically excludepsychiatric disorders and includemainline medical outcomes such as reduced cholesterol, improved type 2 diabetes, and improvement in related “life style” disorders.
Generalizing on this research, a small set of practices such as receiving empathy, meditation (mindfulness), yogic meditation, and Tai Chi, promote well-being by reducing inflammation. These practices are not reducible to empathy (or vice versa), but they all share a common factor: reduced inflammation. These anti-inflammatory interventions have been shown to make a difference in controlled experiments, evidence-based research, and peer-reviewed publications.
Using empathy in relating to people is a lot like using a parachute if you jump out of an airplane or getting a shot of penicillin if one has a bacterial infection. The evidence is overwhelming that such a practice is appropriate and useful in the vast majority of cases. The accumulated mass of decades of experience also counts as evidence in a strict sense. Any so-called hidden or confounding variables will be “washed out” by the massive amount of evidence that parachutes and penicillin produce the desired main effect.
Indeed it would be unethical to perform a double blind test of penicillin at this time, since if a person needed the drug and it were available it would be unethical not to give it to him. Yes, there are a few exceptions – some people are allergic to penicillin. But by far and in large, if you do not begin with empathy in relating to other people, you are headed for trouble.
Empathy is at the top of my list of stress reduction methods, but is not the only item on it. Empathy alongwith mindfulness (a form of meditation), Yoga, Tai Chi, spending time in a sensory deprivation tank (not otherwise discussed here), and certain naturally occurring steroids, need to be better known as interventions that reduce inflammation and restore homeostatic equilibrium to the body according to evidence based research.
The biology has got us humans in a bind, since it did not evolve at the same rate as our human social structures. When bacteria attack the human body, the body’s immune system mounts an inflammatory defense that sends macrophages to the site of the attack and causes “sickness behavior” in the person. The infected person takes to bed, sleeps either too much or too little, has no appetite (or too much appetite), experiences low energy, possibly has a fever, including the “blahs,” body aches, and flu-like symptoms. This response has evolved over millions of years, and is basically healthy as the body conserves its energy and fights off the infection using its natural immune response.
Now fast forward to modern times. This natural response did not envision the stresses of modern life back when we were short stature, proto-humanoids inhabiting the Serengeti Plain and defending ourselves against large predators. Basically, the body responds in the same way to the chronic stressors of modern life—the boss at work is a bully, the mortgage is over-due, the children are acting out, the spouse is having a midlife crisis—and the result is “sickness behavior”—many of the symptoms of which resemble clinical depression—but there is no infection, just inflammation.
The inflammation becomes chronic and the body loses its sensitivity to naturally occurring anti-inflammatory hormones, which would ordinarily kick in to “down regulate” the inflammation after a few days. Peer reviewed papers demonstrate that interventions such as empathy reduce biological markers of inflammation and restore equilibrium. This is also a metaphor. When an angry—“inflamed”—person is listened to empathically—is given a “good listening” as I like to say—the person frequently calms down and regains his equilibrium.
Empathy migrates onto the short list of inflammation reducing interventions. The compelling conclusion is that empathy is good for your well-being.
(c) Lou Agosta, PhD and the Chicago Empathy Project
Poverty is bad for your health. Inequality causes poverty. In turn, poverty causes illness and death. Therefore, inequality kills. The evidence is extensive. The data is compelling. The logic is impeccable. But is this not just correlation, not causation?
A causal account comes into view. When the evidence is vast and deep enough, we can
connect the dots between the correlated items – in this case, poverty, inequality, and bad healthcare outcomes (i.e., death) – and provide a causal account.
While it remains true that correlation is not causation, a flood of evidence is available – and overwhelming: The high correlation between poverty and ill health points to numerous causes intimately related to low socioeconomic standing, being poor. For example, poverty is stressful. Extremely stressful: “People who are exposed to constant high levels of stress do have biological reactions that can shorten their lives [….] [E]xposure to chronic environmental stress causes biological changes within the body that predispose individuals to develop premature disease” (pp. 66 – 67).
For instance, a person at risk for Type II Diabetes benefits from regular exercise and a balanced, healthy diet, high in protein, fruits, vegetables, and low in “bad fat.” Living in a high crime zip code likely also means they live in a “food desert.” Not only is there no Whole Foods or other high-end grocer available but “convenience stores” are long on junk foods and short on fruits and vegetables. When someone gets hungry, unhealthy calories are a likely outcome – nothing wrong with a Twinkie once in a while, but there is a reason the term “junk food” was invented. The person cannot go out for a vigorous, healthy walk because that results assault by local criminals. This is not a problem that can be fixed by the good advice of a medical doctor in an office visit, beneficial though that advice may be. It requires social change and a confrontation with values that privilege profit and cost reduction over people and their well-being.
This leads the author, David Ansell, MD, to a key distinction, which is itself controversial and unavoidable: structural violence. “It is the cumulative impact of laws and social and economic policies and practices that render some Americans less able to access resources and opportunities than others. This inequality of advantage is not a result of the individual’s personal abilities but is built into the systems that govern society” (p. 8).
Ansell gives a powerful example of one of his patient’s, Windora, who eventually suffers but survives a life-changing stroke that costs her the ability to speak. Ansell becomes her voice in this work.
Windora has a “good job” in the school system but not one that pays enough for her to move out of her impoverished zip code. She has hypertension and would benefit from a vigorous walk everyday, but she can’t go out because the neighbor is unsafe. Joining a gym is too expensive, and there is no YMCA within miles. She would benefit from a healthy diet of fruits and vegetables, but she lives in a food desert with a lot of convenience stores selling junk foods. A double bind? Blame the victim? After a certain point, no amount of personal initiative can overcome the obstacles. But a rental voucher might help.
Part of the “back story” for creating areas of overwhelming poverty, educational disadvantage, and social stress were “racially restricted covenants” in real estate. Even after the US Supreme Court outlawed such real estate deeds in 1947, billions of dollars continued to be spent in building public housing in or near impoverished areas. This virtually guaranteed segregated housing, resulting in de facto segregation in schools, and the resulting loss of upwardly mobile educational opportunities for (mostly) black or underprivileged children. The cycle continues. The examples of stable integrated neighborhoods such as Oak Park or stable black communities such as Chatham were overwhelmed by the unethical, fear inspiring but profitable practices of “block busting,” based on distorted, negative racial stereotypes. (For details on the back-story here see Polikoff’s Waiting for Gautreaux: A Story of Segregation, Housing, and the Black Ghetto (2).)
The media share responsibility for perpetuating stereotypes. In the wake of Hurricane Katrina, white people wading through chest high water, carrying groceries from abandoned food stores are described as survivors “finding” the food they needed in order not to starve whereas people of color doing exactly the same thing with the same bags in the same chest high flood waters are described as “looters” (p. 87). Hmmm.
In addition to structural violence, there is actual violence. Ansell writes: “Between 2007 and 2012, Chicago police shot over four hundred people. There were seventy police fatalities during that period, the most in the nation. Between 2004 and 2014, the cash-strapped city dished out $662 million in police brutality settlements” (p. 164).
Ansell imagines all the good things that could be done with that money for school and health-care. I would add to the list: expanded police training. I do not mean target practice or armored cars. I mean training in conflict de-escalation, community relations, courtesy and conversation. Just because deadly force can be used, does not mean it must be used. Empathy is distinct from compassion (though the world needs more of each). Empathy is a method of data sampling, telling a person what the other person is experiencing. In a police context, this would include whether the other is afraid or angry and, most importantly, is at risk of escalating to an aggressive response. No guarantees, but the widows and orphans of fallen heroes are looking for alternatives to shoot first and ask questions later (my phrase, not Ansell’s).
Meanwhile, Dr Ansell’s recommendation to fellow doctors? A bold statement of the obvious: Follow the Hippocratic oath (Ansell cites the modern version called “the Declaration of Geneva, Physicians Oath”). This action may be more confronting and difficult than most physicians imagine. The language about “consecrating one’s life to the service of humanity” and the first consideration being the health of one’s patients is the critical path. This extends beyond the walls of the office or hospital to personal advocacy.
For example, Ansell cites Paul Farmer reporting that when patients living in poverty took their tuberculosis medication, they got better, but they also got very hungry. The TB actually eliminated their hunger. They were too sick to feel hungry – a well disguised “blessing” indeed – so they stopped taking the medication because they were overwhelmed with hunger. The solution was not to call the patient’s “stupid” for not complying with their doctor’s orders. Once food was delivered with the medications, the patients became adherent with the treatment regime. Is the doctor then responsible to feed the hungry? Well, he who wills the end (health) wills the indispensably necessary means to the end (food + TB medicine).
Ansell makes a powerful case that any doctor refusing to treat a patient who presents with symptoms is violating the Hippocratic oath. Health care is an inalienable human right, along side life, liberty, and the pursuit of happiness (except that it has been alienated to enable monopoly rents to insurance companies, Big Pharma, and the corporate transformation of American medicine). “Health care” is a component of the “life” part of the enumeration of rights with which the Declaration begins.
However, the point is not to force an outcome. No one can force anyone to do something that they do not want to do. (For detailed background on the role of profit in the bio-psychiatry of major mental disorders and “Big Pharma” (a once devaluing term that is now accepted), a vexing trend that Ansell does not engage, see Robert Whitaker (3).)
The point is not to force doctors to make excuses for not treating the poor, which risks impacting the doctors’ livelihood and revenue model. The point is advocacy: to mobilize doctors to take on a system that treats health care as an economic transaction. The point is to mobilize doctors to push back against a system that rations scare resources such that the system, in spite of complex algorithms to determine fairness (see The National Organ Transplant Act (1984)), frequently results in the transplants being allocated to middle-aged white males. It is a disturbing statistic that the poor and people of color are frequently the organ donors while rarely being the recipient of life-saving transplants. Once again, there is something very wrong with this picture.
I hasten to add that Ansell reports a compelling example of community activism resulting in Illinois enacting legislation allowing the undocumented to receive kidney transplants and lifetime medications with State financial support “in part because we listened and tried to help” (pp. 107, 108).
Now I have read Ansell’s book cover-to-cover, including the extensive footnotes as well as the back cover. The one, flat out error I have found is on the back cover. Contra to the back cover, nowhere does Dr Ansell write “Inequality is a disease” or that it must be treated as a disease.
Ansell does indeed argue at length that inequality causes poverty and that poverty and inequality (and a host of related social injustices) set off a sequence of events that, like the falling dominoes, create a death gap, causing poor people, especially people of color, to die prematurely. For example, carbon monoxide can kill you, too, but carbon monoxide is not a disease (my example, not Ansell’s). It is a substance that the human beings cannot process. It is inimical to life. An environment of poverty is like carbon monoxide for the human body and soul. It chokes the life out of the person, albeit slowly, preventing binding with life-giving resources that the person needs to survive and flourish.
As noted, neither poverty, starvation, arsenic, lead, nor similar phenomena are diseases. Structural violence is not a disease; it creates a negative clearing for disease in the context of social injustice.
Contra the back cover, Ansell’s point is precisely that no medical treatment in itself will cure poverty, prevent the resulting fatalities, or undo the death gap. Reducing and eliminating the death gap requires advocacy: structural reforms and political engagement to combat structural violence. It requires honoring one’s commitment to social justice in the community. It requires a redistribution of sometimes scare resources – health care, education, jobs, law enforcement – from the wealthiest and most privileged on the Gold Coast a couple of miles west and south to neighbor whose numbers read like they were from the third world. It seems the editors of the back cover were blinded by privilege, too.
Ansell has recommendations. Practical proposals are forthcoming: “[Concentrated reinvestment in impoverished communities] will require a redistribution of wealth through taxation from the affluent back to the poor in the form of living wages, access to higher education, health care, and safe housing” (p. 54). “These structural reforms could take many forms, from tax and job policy to the ending of mass incarceration. From the perspective of health reform, the adoption of a single-payer health care system is the only way to create equity in health care. Single-payer health care will be vigorously opposed by the profit-driven private health insurers and by those who will insist it is too costly or not feasible” (p. 182). Speaking personally, I am at a loss as to why certain politicians and parties seem unwilling for people to get health insurance and health care at a cost that also enables them to pay rent, eat, and so on.
One final thought. Today evidence-based medicine is the dominant paradigm and with good reason. Evidence is superior to guess work. In peer-reviewed article after article we can read about a 3% improvement of one pharmacological, procedure, or laparoscopic intervention versus another. Well and good. Empathy and compassion are in short supply in the world, and, in any case, are not enough. Leadership is also required, and Ansell provides that here.
If this book, Ansell’s work, dense with evidence, data, facts and figures that support the subtitle (“Inequality Kills”), does not become the conscience of the medical community and a blue print for transformation and reform, then not only am I a monkey’s uncle, but the collective blind spot of the medical community is the size of the dark side of the moon.
We end where Ansell ‘s book begins. Ansell’s opening quote from Martin Luther King is as true today as it was in 1964: “History will have to record that the great tragedy of this period of social transition was not the strident clamor of the bad people, but the appalling silence of the good people” (p. vii). This book is addressed to the good people. Drop what you are doing and get the book: read it, honor your commitments, follow the recommendations.
(1) David A. Ansell, MD, (2017), The Death Gap: How Inequality Kills. Chicago: The University of Chicago Press.
(2) Alexander Polikoff, (2006), Waiting for Gautreaux: A Story of Segregation, Housing, and the Black Ghetto. Evanston, IL: Northwestern University Press.
(3) Robert Whitaker, (2010), Anatomy of an Epidemic. New York: Broadway Paperbacks (Random House).
(c) Lou Agosta, PhD and the Chicago Empathy Project
Class starts Tuesday March 28th. Empathy is oxygen for the soul. So if you are feeling short of breath due to life stresses, perhaps one needs expanded empathy. Get some here. This is what you need to know to
register. Further details on the course content are in line below. To register for the course, you need to provide basic info and register with the UChicago Graham School of Continuing Education. If you have any special requests, none of this is “chiseled in stone” yet (though it will be by 03/21/2017), so see my contact data below and let me know. There are no prerequisites or grades. This is Continuing Education. Cost is $360.
HUAS 61001 | A Rumor of Empathy in NeuroscienceA rumor is an unsubstantiated report. This course will pursue the rumor of empathy in neuroscience. The rumor is substantiated – empathy LIVES in neuroscience. But there are some conditions and qualifications. Connecting the dots between the mechanisms of neurotransmitters and the first person experience of a conversation for possibility in education is complex. This class will do a close reading of the texts that provide the deep structure of the history of empathy along with the “cliff notes / spark notes” version of what you need to know about neuroscience to engage in a meaningful conversation about the issues. We will aim at making empathy present and palpable in our work in class.
|Course Code:||HUAS 61001|
March 28 to May 16
1:30 PM–4:00 PM
A RUMOR OF EMPATHY IN NEUROSCIENCE
There are a number of relatively short readings – not more than thirty pages a week – that are available for free on the Internet as URLs and/or downloadable PDFs or plain text [licensed under licensed under a Creative Commons Attribution-NonCommercial 4.0 International License]. Short URL: http://tinyurl.com/h5f873s [password needed – and provided by me upon registration]. Please plan on doing the reading before the class so we can have a meaningful conversation.
SCHEDULE: March – May 2017 [Class meets from 1:30 pm – 4:30 pm / Gleacher Center]
March 28, 2017 : [Empathy] Mirror Neurons, Embodied Simulation, and the Neural Basis of Social Identification by Vittorio Gallese. The identification of mirror neurons in the mid 1990s caused a explosion of interest in empathy.
April 04, 2017: The Functional Architecture of Human Empathy by Jean Decety et al: DecetyThe_Functional_Architecture_of_Human_Empathy copy. Even if Decety’s views have continued to evolve, this is the paper that provides an opening to understanding empathy that has still not been surpassed.
April 11, 2017: Resistance to empathy!? Addressing Empathy Failures by Jamil Zaki. For something like empathy that is supposed to be as popular as kittens, motherhood, and apple pie, there is a surprising amount of resistance to engaging closely with it. Find out why.
April 18, 2017: Brainwashed: My Amygdala Made Me Do It – and Neurocentrism by Sally Satel, providing a short glossary of terms needed to debunk voodoo correlations in neural science
April 25, 2017: Empathy [and] The Myth of Mirror Neurons and the Broken [Empathy] Mirror by Gregory Hickok. The debate is joined. Yes, mirror neurons were discovered in Macque monkeys, but what REALLY was discovered and how does it map to human beings?
May 02, 2017: Empathy [and] Mindblindness: Am Essay on Autism and Theory of Mind by Simon Baron-Cohen.
May 09, 2017: Empathy on the Inpatient Unit: Plato Not Prozac! Chapter 3 from Lou Agosta’s A Rumor of Empathy: Resistance, Narrative, Recovery
May 16, 2017: Empathy and Trauma: The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma by Bessel van der Kolk. An essential text of working with empathy and trauma. How not to succumb to compassion fatigue or burnout and make use of empathy as a method of guarding against these empathic breakdowns.
The course follows an ascending path from a natural history of empathy, in which
empathy is defined, through methods of disclosing and engaging empathy, to applications of empathy in neurology, trauma (human suffering), and so-called diseases of empathy such as autism. The approach to class discussion is to discuss a close reading of the texts; but time is also available to discuss what one might call “empathy tips and techniques” in expanding one’s empathy in class and daily life. In empathy, one is quite simply in the presence of another human being. Join me in making empathy present and expanding empathy in our lives and in the community.
Lou Agosta, Ph.D. is the author of three academic books on empathy. He is assistant professor medical humanities at Ross University Medical School. His PhD is in philosophy (University of Chicago).
This work aims to be educational in a brain-storming way about the role of empathy in the community and the market for empathy services. Hanna Holborn Gray has said that “education should not be intended to make people comfortable, it is meant to make them think.” I hereby also add: The intention of education is to expand one’s empathy. Amazingly enough that is not as comfortable as many people might imagine, which brings up to the first trend – resistance to empathy.
10. Resistance to empathy grows and is acknowledged. I may be a tad late with this one, since it is actually front section news in the New York Times, but just in case you have been living in a cave: Empathy is supposed to be like motherhood, apple pie, and puppies. What’s not to like? Yet people can be difficult – very difficult – why should empathizing with them be easy? Yet most of the things that are cited as reasons for criticizing and dismissing empathy – emotional contagion, projection, misinterpretation, gossip and devaluing language – are actually breakdowns of empathy. With practice and training, one’s empathy expands to shift breakdowns in empathy to breakthroughs in understanding and building community.
9. Empathy is not an on-off switch; it is rather a dimmer or rheostat (and the public debate acknowledges this). Engaging with the issues and sufferings with which people are struggling can leave the would-be empathizer (“empath”) vulnerable to burnout and compassion fatigue. The risk of compassion fatigue is a clue that empathy is distinct from compassion, and if one is suffering from compassion fatigue, then one is doing it wrong. The listener may get a vicarious experience of the other’s issue or problem, including their suffering, so the listener suffers vicariously, but, strange as it may sound, not too much. As noted, if one is over-whelmed by suffering, one is doing it wrong, and one needs to increase the granularity of one’s empathic receptivity. Empathy is like a dimmer – tune it up or tune it down. Empathy is like a filter – increase the granularity and get more of the other’s experience or decrease the granularity (i.e., open the pores) and get less. That is the whole point of a vicarious experience – and training one’s vicarious experiences as distinct from merger or over-identification – to get a sample or trace of the other’s experience without being overwhelmed by it. Empathy is not so much an on-off switch as it is a dimmer or rheostat to gradually turn the lights up or down – gradually expand or contract the granularity of one’s empathic receptivity. This point is completely missed in the otherwise engaging and spirited public debate feature in the New York Times where Hamid Zaki identifies empathy with compassion – and – how shall I put it delicately? – it is a conversation of deaf persons about the importance of listening from that point onwards[see http://tinyurl.com/gwmfpxp%5D. The recommendation? Listen, interpret the resistance and apply conflict resolution principles – identify and express grievances, invite self-expression, apply the soothing salve of empathy to the narcissistic injuries, elicit requests/demands, propose compromises / action items, iterate – until resolution.
8. Empathy is too important to be left to the psychologists. For psychologists empathy is by definition a psychological mechanism. For example, identification or transient identification or projection plus introjection (or visa versa) or mirroring or mirroring plus recognition of the other or inner imitation or motor mimicry. (This list goes on and this is not complete.) And while there is nothing wrong with psychological mechanisms or neuropsychological narratives built around their operation in the cerebral neural cortex and basal ganglia, there is something missing – empathy. So what then is empathy? Very short definition: It is being in the presence of another human as a human being with nothing else added. This [big word trigger alert] is the ontology of empathy – being in the presence of the other individual without anything else added. (This is called “ontology” – the study of being and ways of being, and it is definitely not psychology.) For example, Heinz Kohut, a psychiatrist from a time when psychologists were either psychoanalysts (or behaviorists), had a definition of empathy as vicarious introspection. This has an key ontological dimension as Kohut says “the idea of an inner life of man and thus of a psychology of complex mental states, is unthinkable without our ability to know via vicarious introspection – my definition of empathy […] what the inner life of man is, what we ourselves and what others think and feel life of the other individual would be inconceivable without empathy” (Kohut 1977: 304). The point is that empathy is both deeper and broader than a psychological mechanism – it is the basis for relatedness between individuals. Without empathy, no relatedness. Empathy grants being to relatedness. This matter of being with the other individual, in turn, becomes the foundation for community in an expanding circle of inclusion. As soon as one adds diagnostic categories, labels, arguments – which, admittedly, can be required in some contexts – empathy mis-fires, relatedness goes missing, and resistance to empathy expands. Thus, an empathic conversation is frequently challenged to find the equilibrium between using categories and distinctions to access the experience of the other individual while being with the other and being receptive to the vicarious experience of their suffering (or joy) as another human being.
7. Life coaching gets traction as empathy consulting. Empathy and life coaching intersect (again). The reason an Olympic athlete has a coach is not because she is not good at what she does. Positively expressed, people get a coach when they want to take their game – their performance – to the next level. Many people are already good at what they do and are committed to expanding their results in one area or another such as career, relationships, physical well-being, contribution to community, or peace of mind, in which their experience indicates something is missing. People get a therapist when they want a diagnosis or when they are pushed into survival and need to find a way out. Nothing wrong with that – indeed it can be critical path to transforming suffering into productive results. However, there is good news here – many people are not suffering but have an area in their lives that needs work to provide the results to which they are committed. This is where empathy is oxygen for the soul and can facilitate breathing easier in climbing the stairs to self-satisfaction in accomplishment. Yes, performance may usefully be measured “by the numbers” with meaningful data, but you don’t just need data, expanded empathy is required too.
6. “Hug a stranger” becomes an empathy trend. I am not making this up – well, okay, in a way, I am. The human body is the best picture of the human soul. So hugging another person is not just an emotional and physical but also a spiritual gesture. In this case, hugging and the “space of hugging” starts a journey of discovery that gives us access and reveals that there are far fewer strangers in the world – possibly none – then we at first imagined. I learned about this trend from Stone Kraushaar who distinguishes the physical embrace – the hug [with permission] – between two people from the “space of hugging,” which (on a good day) opens up a whole universe of empathy, sharing, transforming, building community, and being with mutual humanity. While acknowledging that hugging is not empathy, in the context of Stone’s work (and pending book), it is – in the deep sense of being in the presence of another human being without anything extraneous being added or subtracted. So if you see people walking down the street stopping for conversation, asking permission, breaking out in spontaneously hugging one another, you will know they have been engaging with Stone’s provocative proposal. You just might see yourself and encounter your own humanity in another in a new way you had not previously imagined. The empathic point is that you start by thinking these other people “out there” are strangers but when you get to know them well enough to be comfortable with a hug, you and they belong to the same community – you are not strangers after all.
5. Health insurers promise empathy, do not deliver, and continue to collect monopoly rents. The empathy gap widens. Health insurers maintain a firm grip on the market for empathy-related “behavioral health” services without actually providing any. This is the only candidate trend from last year that I am repeating, since it is still accurate but a work in progress – and, unfortunately, picking up speed, going in the wrong direction. The Affordable Health Care Act (“Obamacare”) – reportedly to be terminated with extreme prejudice as this piece is about to be posted – promised to equalize benefits for medical benefits such as annual physical health checkup (including $800 worth of blood work) with mental health services such as psychotherapy. At the risk of being cynical, I don’t know if the reader has tried to collect lately or services rendered. The war stories, pretexts for nonpayment, and simple violations of their own rules – e.g., timely response – by insurers continue to mount. One feels a certain dissatisfaction with the lack of solutions. What to do about it? In spite of claims to the contrary, the recommendation from insurers seems to be: “But your majesty, the people have no mental health benefits. Then let them pay cash! And then let them eat cake.”
4. Medical doctors “get it” – empathy is good for your health. Empathy gets traction as an evidence-based intervention. “Evidence-based everything” is the gold standard in medical and so-called “behavioral health” interventions; and that is as it should be (Jeremy Howick, (2011)). The “gold standard” of the “gold standard” is double-blind testing, which works especially well in the cases of drugs in which one can indeed “double-blind” the test so that neither the researcher nor the recipient knows who is getting what pill. While judgments based on clinical practice, tacit knowledge, and deep life experience will continue to have a role, these need to be qualified by the best available evidence. But here is the issue: There are some interventions such as penicillin and using a parachute when jumping out of an airplane that seem to limit or even defy the gold standard. It would be unethical not to give someone penicillin if they were infected with an infection serious enough to require such treatment, since it is a matter of historical accident that penicillin was invented prior to the “evidence based” paradigm shift. And, as regards using a parachute, that case is the reduction to absurdity of not using common sense as a criteria in deciding what counts as evidence. What is going on here? The answer: The effect size is so large that it outweights and overwhelms any hidden confounding factors and so rises to the level of evidence (without quotation marks) [Howick: 5, 11]. The :effect size” is a function of the the fact – the evidence – that there are so many examples and so much experience that penicillin works – that parachutes – work that the risk of one’s over-looking some other confounding variable is vanishingly small. It really was the penicillin, not (say) the effects of the alignmnet of the planets hidden behind the penicillin. Likewise, with empathy. The trend here is that research will emerge that puts the use of empathy in human relations as demonstrably so effective in the medical and behavioral health contexts in question that not to apply empathy would be like not prescribing antibiotics against a bacterial infection. Empathy has been effective in shifting the suffering and transforming the psychic pain throughout history. The criticism of empathy has usually been that it results in burnout, compassion fatigue. But penicillin, too, has to be properly dosed or the results will be unpredictable. Regarding empathy, see the discussion above about empathy not being an on-off switch but a rheostat that requires training to get just right. Examples of peer-reviewed publications exist in which empathy was shown to be effective (in comparison with less empathy) in correlating with favorable outcomes in diabetes, cholesterol, and the common cold (?!) and are cited in the bibliography (see M. Hojat et al, (2011), John M. Kelley, Helen Riess et al, (2014), David P. Rakel et al, (2009)). Expect this work to expand and gain traction in other areas such as psychiatry and cognitive behavioral therapy. In short, not to begin with empathy would be like jumping out of the airplane without a parachute or not providing penicillin when the infection was bacterial. Curiously enough, among medical doctors, psychiatrics are alleged to be “lagging adopters”; among psychologists, those specializing in cognitive behavioral therapy are – note that Arthur Ciaramicoli claims to have it both ways (in a book (2016) that I wish I had written).
3. The culture of empathy taps into the power of empathy. Empathy gets in touch with its own power and becomes self-aware as being powerful. This is (and would be) completely unpredictable. At least initially that looks like the culture of empathy partnering with assertiveness training, fair fighting, and being self-expressed. The culture of empathy gets traction in conflict resolution, building community, setting limits to the anti-empathic methods of bullies; and this trend gets the attention that it so richly deserves. The CultureOfEmpathy [one word] is the web site and brain child of Edwin Rutsch, whose has literally interviewed dozens of empathy scholars and researchers (including myself) and is one of the most inclusive people I have ever met. Here is the issue: in fighting off bullies how does one do so in such a way that one does not become a bully oneself? The recommendation is direct: empathy is about setting boundaries between self and other and crossing boundaries between self and other in a way that enhances mutual understanding and community. No one was ever required by empathy to be a door matt. Since empathy works best and seems to require that people relate as equals in the matter of their humanity, the relation between empathy and power has always been fraught. It requires work. When the power relations as too asymmetrical or when force (violence) is being used to coerce an outcome, then a level playing field has to be reestablished for empathy to get traction. Then the empathic thing to do is fight back – self-defense is its own justification. Simple as that (though, as usual, the devil is in the details). Bullying – and related forms of aggression are the contrary of empathy – crossing boundaries in ways that generate misunderstanding and the dehumanizing aspects of shame and humiliation. Set firm boundaries.
2. Empathy becomes known as reducing inflammation and restoring homeostatic equilibrium to the body according to evidence based research along with mindfulness (a form of meditation), Yoga, Tai Chi, sensory deprivation and certain naturally occurring steroids (Antoni MH, Lutgendorf SK, Blomberg B et al. (2011), David Black, Steve Cole, Michael Irwin et al, (2013), Michael R Irwin and Richard Olmstead, (2012)). Although an over-simplification, when the human body is attacked by bacteria, it mounts an inflammatory defense that sends macrophages to the site of the attack and causes “sick behavior” in the person. The infected person takes to bed, sleeps either too much or too little, has no appetite (or too much appetite), experiences low energy, possibly has a fever, including the “blahs,” body aches, and flu-like symptoms. This response has evolved over millions of years and is basically healthy as the body fights off the infection using its natural immune response. However, fast forward to modern times. This natural response did not imagine the stresses of modern life back when we were short proto-humanoids inhabiting the Serengeti plain and fending off large predators. Basically, the body responds in the same way to the chronic stress of modern life – the boss at work is a bully, the mortgage is over-due, the children are acting out, the spouse is having a midlife crisis – and the result is “sickness behavior” – many of the symptoms of which resemble clinical depression – but there is no infection. The inflammation become chronic and the body loses its sensitivity to naturally occurring anti-inflammatory hormones, which would ordinarily kick in to down regulate the inflammation after a few days. Peer reviewed papers demonstrate that interventions such as those indicated above reduce biological markers of inflammation and restore equilibrium. This is also a metaphor for when an angry [“inflamed”] person is listened to empathically, they [often] calm down and regain their equilibrium. The trend here is that empathy migrates onto the short list. Now for something completely different …
1. A definable market for empathy software and business services emerges. Virtual reality (VR) software meets and expands empathic understanding. A company named Psious [psious.com] has developed a diverse set of applications for virtual reality goggles to simulate situations that psychotherapy clients may find anxiety inspiring such as flying on a commercial jet, public speaking, shots (e.g., with needles) at doctor visits and many more (see my Blog post on Psious (http://tinyurl.com/jyuxedq)). Two other companies that are a software initiative relating to empathy include Affectiva [affective.com], which automates Paul Ekman’s facial action coding scheme (see my blog post (http://tinyurl.com/hymj3mj)), and Empathetics [empathetics.com], not yet reviewed. From admittedly incomplete reports, the engaging thing about Empathetics is that its value proposition is to train medical doctors in empathy using biofeedback under a program licensing intellectual property developed at Massachusetts General Hospital in Boston. In addition, this medical initiative is distinct from but related to two companies (Business Solver and Maru/VCR) which call out “empathy” explicitly as a key differentiator in what they offer their business clients. Business Solver is branding an empathy monitor for business success in a human resources platform and related services. This includes the disturbing data point that some 61% if business leaders see their firms as being empathic whereas only 24% of employees do. What to do about it constitutes the bulk of the engagement. Maru/VCR has a database based on the Vision Critical Research platform that enables its clients to build customer communities and get access to breakthrough innovations and insights in market research.
0. Businesses “get it” – empathy is good for business. Profit is a result of business operations, not “the why” that motivates commercial enterprise. And if profit shows up that way (as the “the why”), then you can be sure that, with the possible exception of commodities hedging, it is a caricature of business and a limiting factor. Business prospers or fails based on its value chain and commitment to delivering value for clients and consumers. However, some of the things that make people good at business make them relatively poor empathizers. Business leaders lose contact with what clients and consumers are experiencing as the leaders get entangled in solving legal issues, reacting to the competition, or implementing the technologies required to sustain operations. Yet empathy is on the critical path for serving customers, segmenting markets, positioning products (and substitutes), psyching out the competition [not exactly empathy but close enough?], building teams and being a leader who actually has followers. When the ontology of empathy exposes it as the foundation of community, then expanding empathy becomes nearly synonymous with expanding business. For example, building customer communities, building stakeholder communities, team building, are the basis for brand loyalty, employee commitment, and sustained or growing market share. Can revenue be far behind? Sometimes leaders don’t need more data, we need expanded empathy, though ultimately both are on the path to satisfied buyers, employees, and stakeholders. Specific firms that have emerged – albeit in the context of an early market – to address these aspects of empathy in business and are called out in trend #2 above.
[These ten top trends in empathy for 2017 should be read in connection with the score for those from last year (2016) [see http://tinyurl.com/gub7pew]. And, yes, I know that there are actually eleven this year – bonus!?]
Antoni MH, Lutgendorf SK, Blomberg B et al. (2011), Cognitive-Behavioral Stress Management Reverses Anxiety-Related Leukocyte Transcriptional Dynamics. Biological Psychiatry, 2011; 15: 366-372.
David Black, Steve Cole, Michael Irwin et al, (2013), Yogic meditation reverses NF-kB and IRF-related transcriptome dynamics in leukocytes of family dementia caregivers in a randomized controlled trail. Psychoneuroendocrinology, 2013 March 38(3): 348 – 355.
Arthur Ciaramicoli, (2016), The Stress Solution. New York: New World Library.
Jodi Halpern, (2013), “What is Clinical Empathy?” J Gen Intern Med 2003 Aug: 18(8): 670 – 674.
Hojat et al, (2011), Physicians empathy and clinical outcomes for diabetic patients, ACAD MED MAR; 86(3): 359 – 64: doi: 10.1097ACM.0b013e3182086fe1
Jeremy Howick, (2011). The Philosophy of Evidence-Based Medicine, Wiley-Blackwell, 2011.
Michael R Irwin and Richard Olmstead, (2012). Mitigating Cellular Inflammation in Older Adults: A Randomized Controlled Trial of Tai Chi Chih. American Journal of Geriatric Psychiatry. 2012 September; 20(9): 764 – 722.
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(c) Lou Agosta, PhD, and the Chicago Empathy Project