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Book Review: Susan Lanzoni’s Empathy: A History connects the dots between the many meanings of empathy

Short review: two thumbs up. Superb. Definitive. Well written and engaging. Innovative and even ground-breaking. Connects the dots between the different aspects and dimensions of empathy. Sets a new standard in empathy studies. The longer – much longer – review follows. Note also that since this is not a softball review, several criticisms, incompletenesses, and limitations are called out.

Susan Lanzoni’s comprehensive history of the concept of empathy – the concept, not the mere word – breaks new ground in our understanding of the distinction.  She

Cover art: Empathy: A History by Susan Lanzoni - showing the full spectrum of aspects of empathy from projection to receptivity in interpersonal relations

Cover art: Empathy: A History by Susan Lanzoni – showing the full spectrum of aspects of empathy from projection to receptivity in interpersonal relations

explores empathy’s significance for diverse aspects of our humanity, extending from art and advertising to race relations and talk therapy: Empathy: A History. New Haven: Yale University Press, 392 pp., $30 (US).

Just to be clear: Lanzoni’s is not a “how to” or self-help book; which does not mean that one cannot expand one’s empathy by engaging with empathy’s deep structure in this multi-dimensional, historical encounter. One can. However, the reader will not find explicit tips and techniques in applying empathy.

Lanzoni engages with empathy and: (1) natural beauty and art (2) the 19th century psychological laboratories of Wilhelm Wundt (1832–1920), Edward Bradford Titchener (1867–1927), and their rivals (3) theatre and modern dance (4) mental illness such as psychosis and schizophrenia (5) social work and psychotherapy (6) measurement using psychometric questionnaires (7) popular culture including advertising and the media (8) race relations (9) neuroscience.

Lanzoni begins by quoting the work of Ted Cohen (1939–2014) on metaphor in Thinking of Others: On the Talent for Metaphor(2009). Formulating a metaphor and imagining oneself in another person’s position point to a common twofold root, an art [Kunst] hidden in the depths of the human soul, whose true operations we can divine from nature and lay unveiled before our eyes only with difficulty, but whose depths we are unlikely to be able ever adequately to plumb. Lanzoni’s implies the art in question is precisely empathy and the translation it makes possible. Thus, we always honor the late Ted Cohen, whose predictably cutting, caustic and cynical wit, however, masked a deep and abiding empathy.

The narrative proper begins with Violet Paget (Vernon Lee (1856–1935)), who, with her partner and muse Clementina (Kit) Anstruther-Thomson, engaged in introspective personal journaling to detect and report the physiological effects of art and beauty on the human organism. Paget’s research crosses paths with that of Munich psychologist Theodor Lipps (1851–1914). Lanzoni reports that Lee and Lipps may have met in person in Rome at the Fifth International Congress of Psychology in 1905 (where both were on the program).

At the risk of over-simplification, Paget, Lipps, and Karl Groos (1861–1946) form a triumvirate of empathy innovators, who turn to motor mimicry, inner imitation, sympathetic muscular memory, and aspects of physiological resonance to account for the stimulating effects of artistic and natural beauty on human experience. Their analysis is the flip side of the implicit panpsychism, personification, anthropomorphism by which beautiful nature is animated with human expressions of the emotional life – for example, angrystorms in the ocean, melancholymists in the valley, a joyfulsunrise, a fearfuldarkness.

This remarkable feature of human experience: that we attribute emotions (and even intentions) to natural objects – angry storms, cheerful sunsets, and melancholy clouds. Magical, primitive thinking? An adaptive reflex? This review does not require that anyone, including Lanzoni, have solved this problem. However, some contemporary thinkers have speculated that it is a cognitive design defect of human nature to attribute intentionality (including emotional propositional contents) to otherness – whether human or physical – as an adaptive mechanism arising in the context of biological evolution.

 Theodor Lipps is the one who puts Einfühlung on the map between 1883 and 1914 (his death), and those who are contemporaries must explain how they differ from his position.

 Lipps’ position on empathy was already multidimensional, extending Einfühlung from the projection of feelings into objects to the perception of other people’s expressions of animate life. Lanzoni’s reading of Lipps is much more charitable than mine, and I find Lipps at loose ends and philosophically naïve as he tries to account for the first person’s access to the experiences of the second person by “an original innate association between the visual image and the kinesthetic image (1903: 116). Lipps thinks he has demolished the philosopher’s problem of other minds but unwittingly recreates it in his own terms (e.g., Agosta 2014: 62 – 63).

 Lanzoni engagingly (but briefly) references the critique of Lipps’ theory of projective empathy by the phenomenologists Edith Stein (1891–1942), Max Scheler (1874–1928), Edmund Husserl (1859–1938), Maurice Merleu-Ponty (1908–1961), and Martin Buber (1878–1965) (p. 37).

 Lanzoni notes Sigmund Freud’s (1856–1939) debt to Lipps based on transference as a kind of projection. For Lipps, psychological processes were performed, with few exceptions, beneath the threshold of consciousness, which is another factor that made Lipps’ positions attractive to Freud.

 Any thinker or author who used the term “Einfühlung” would inevitably also conjure up the image of Theodor Lipps, which limited the thinkers ability to use it without extensive argument or the risk of being mistaken as a follower of Lipps. This point is key: in his own time Lipps had in itself branded himself as the “go to guy” for all matters empathic. More on the significance of this dilemma below.)

 By the way, Lanzoni does not italicize the word “Einfühlung” unless it is used in a specifically German context. “Einfühlung” is now an English word!

 Johann Herder (1744–1803) also gets honorable mention at this point (p. 32) as a philosopher in the Romantic tradition. Herder is noteworthy as a proponent of empathy as a verb – sichhereinfühlen– to feel one’s way into. Herder was a fellow traveler of Goethe and actually “on staff” as the chief Lutheran prelate at Weimar, innovating in the historical development of language in a proto-evolutionary (and metaphysical) context. This points to an entire undeveloped paradigm of empathy not developed by Lanzoni. For example, for Herder empathy was required to feel one’s way into the world of Homer in order to produce an accurate translation of Homer’s Iliad.

 This paradigm of empathy as translation is arguably at the same level of generality as empathy as projection, but remained undeveloped until the rise of hermeneutics along a separate trajectory. And since Lanzoni seemingly unquestioningly accepts Rudolf Makkreel’s dismissal of the relevance of Einfühlung for Wilhelm Dilthey (granted he has little use for the word), this approach is not further explored.

 Yet the modern innovators of interpersonal empathy such as Carl Rogers (1902–1987) might be read as leap-frogging back to the original sense of entering the other’s world in order to translate it into the first person, subject’s own terms. Such Herderlike usages also fits well with what Gordon Allport (1897–1967) and Kenneth Clark (1903–1983) were doing in arraying empathy against racism and prejudice in expanding the boundaries of community by empathically translating between them (see Chapter Nine).

 An entire possible alternate history of empathy, as yet unwritten, opens up at this point – empathy as translation between subjects. (Granted that Rogers probably never heard of Herder, at least not in the context of empathy, so this is a conceptual nuance; but Rogers probably never heard of Lipps either.)

 As is by now well known, in part thanks to Lanzoni’s work, the word “empathy” itself comes into English thanks to Edward Bradford Titchener, the founder of a Wundtian style psychology lab at Cornell University (and translator of Wundt). However, what is less well known is the back-and-forth about the meaning of Einfühlung as explored in detail by Lanzoni.

I was impressed by the work of James Mark Baldwin (1861–1934), who contribution to empathy as semblance was interrupted and obscured as he had to leave town in a hurry – apparently for Paris – after being arrested in a raid on a Baltimore house of prostitution. Baldwin was innovating with empathy in terms of semblance – the “as if” of child’s play and the play of the artist.

 Lanzoni quotes in detail the devaluing remarks about “empathy” made by James and Alix Strachey, the translators of Freud, who call it a “vile word” (p. 67). Though Freud used variations of “Einfühlung” some 22 times in 24 volumes, the word is often paraphrased or mistranslated by the Stracheys, using synonyms such as “sympathetic understanding.”

 It is amazing how much empathy or lack thereof turns on a mistranslation. My take on it? Basically Freud did not use the word Einfühlung more often because he was not someone who could abide being a footnote to Lipps (who, as noted, virtually owned the distinction Einfühlungin German). There are other technical reasons Freud chose not to comment more extensively on empathy, including his dismissal of the philosophical uses of introspection as a function of the conscience (superego), whereas introspection and empathy are “joined at the hip” in a therapeutic context (see also Agosta 2014: 66 – 82).

 I hasten to add that Freud did say in his “Recommendations for Physicians Beginning Psychoanalytic Treatment” (1913) that if the would-be analysts start in any other way than with empathy, they are headed for trouble. But once again the reader has no idea of Freud’s true position, because “empathy” is mistranslated as “sympathetic understanding.” However, these observations are less critical to Lanzoni’s point, which is otherwise unexceptionally on target.

 Meanwhile, Titchener has numerous ideas (that we would today consider highly unconventional) about how images accompany word meanings, but his translation of “Einfühlung” as “empathy” sticks. In an otherwise comprehensive engagement (Lanzoni really does seem to have read everything!), she does not mention how empathy subsequently becomes embroiled in the disappearance of introspection controversy (behaviorists regard it as illusory) and ultimately is “taken down” by the behaviorists in their attack on all things relating to subjective consciousness and inwardness. However, all this lies ahead in the B.F. Skinnerian 1950s through 1980s, and the Chapter ends with Einfühlung being an intertwining of projection, aesthetic appreciation, and Baldwin’s “semblance.”

 But how does one get from a empathy that projects human emotions and mindedness onto objects in art and nature and an empathy as human understanding of another, second person who contains an emotional life and mind of his or her own distinct from that of the first person?

 Lanzoni skillfully navigates the challenge of engaging how the projective aesthetic empathy of Lipps et al get transformed, translated, and reconciled, with the interpersonal receptive empathy of talk therapy and personal counseling.

 One missing link comes in modern dance. The missing link is identified as to “live in the mind of the artist who designed it [the object]” (p. 97). At this moment in the text, the intentionality of the artist looms large. In effect, the regression (my word, not Lanzoni’s word) is back from the intentionality built into the artistic artifact or performance towards human subjectivity. Now intentionality is available to build a bridge between a projective empathy of the object and a receptive intersubjective empathy of the human subject.

 Both projective empathy and receptive empathy are ways (admittedly divergent) of dealing with and transforming otherness– the otherness of the object and the otherness of the human subject. This is why aesthetic empathy and interpersonal empathy belong to the same concept and are not merely the same homonymous word for different underlying concepts.

 Another missing link occurs in “Personality as Art.” Lanzoni gathers together the contributions of Herbert Langfeld (1879–1958), Wilhelm Worringer (1881–1965), Carl Gustav Jung (1875–1961), who expand the boundaries of aesthetic, projective empathy in the direction of the understanding of human beings. The study of the artistic self-expressions of psychotics incarcerated in mental asylums also deserves mention here as opening up the exchange between aesthetic projective empathy and interpersonal receptive empathy.

 Nowhere does any one (including Lanzoni) say, “Relate to the human being with the respect and interpretive finesse with which one relates to a work of art,” but that is the basic subtext here. In our own time, the late Richard Wollheim, a notorious free spirit, sometimes took such a position about art and its objects.

 The engagement with empathy as human understanding picks up speed. Whenever a breakdown occurs the possibility of a breakthrough also arises. Such is the case with schizophrenia. In apparently separate but overlapping and near simultaneous innovations, E. E. Southard (1876–1920), Roy G. Hoskins , Louis Stack Sullivan (1892–1949), Karl Jaspers (1883–1969), and C. G. Jung identified schizophrenia as a challenge to or a disorder of empathy. In short, it is hard to empathize – Jaspers maintained it was impossible – with people who were disordered in such a way that they displayed the cluster of symptoms we now group as schizophrenia including perceptual distortions, incoherent speech patterns, disordered thinking, lack of reality testing, bizarre ideas, emotional flatness, intermittent acute anxiety or paranoia, lack of motivation, lack of responsiveness, burn out, and (occasionally) lack of personal hygiene.

 Southard designed an “empathic index” (p. 101) guiding the psychiatrist through a series of questions such as: How far can you read or feel yourself into the patient? Thus the first, admittedly over-simplified, version of the schizophrenia test: Can you imagine experiencing what the patient reports he or she is experiencing? If not, then that counts as evidence they are on the equivalent of what we would today call the “schizophrenic spectrum.”

 We finally arrive at our present day folk definition of empathy: the ability to step into and walk in another person’s shoes and then to step back into one’s own shoes again, and, in so doing, to “feel along with, to understand, and to insinuate one’s self into the feelings of another person” (p. 124).  

 Lanzoni asserts: “[T]he psycho-therapeutic rendering of empathy traded self-projection for its opposite: one now had to bracket the self’s findings and judgments in order to more fully occupy the position of another” (p. 125). Thus, a coincidence of opposites in which the two extremes are perhaps counter-intuitively closer to one another than either point is to the middle.

 With Chapter Five on “Empathy in Social Work and Psychotherapy,” Lanzoni makes yet another decisive contribution to empathy scholarship.

 Carl Rogers famously puts empathy on the map in the 1950s, 60s, and beyond, as the foundation for psychotherapeutic action. Though it is an oversimplification, in client-centered Rogerian therapy, one gives the client a good listening – one gives the client empathy – and the client gets better.

 Lanzoni connects the empathy dots. They lead back into the empathy archives. They lead back from Carl Rogers to D. Elizabeth Davis, a student of Jessie Taft (1892 – 1960), a nurse and social worker, who, in turn, was strongly influenced in her conception of relational therapy by G. H. Mead’s (1863–1931) social behaviorism and Otto Rank (1884–1939). Rank belonged to Freud’s inner circle along with Ernest Jones (1879–1958), Karl Abraham (1877–1925), and Sándor Ferenczi (1873–1933).

 Not a medical man or even a scientist, Otto Rank met Freud in 1905 when he presented Freud with his innovative work on the artist as inspired by Freud’s theories. Something clicked between them. In 1905 Freud was less isolated, but still hungry for recognition and fellow travelers. Think: father son transference.

 Rank eventually completed a PhD dissertation at the University of Vienna on literature (the Lohingrin Saga), in part thanks to the financial generosity of Freud. Freud paid him to be the recording secretary of the Psychoanalytic Association. The literary dimension is of the essence, and, in our own time, we have a renewed appreciation that studying literary fiction expands one’s empathy.  This too  strengthens the case for the overlap of the aesthetic and interpersonal dimensions of empathy.

 As was often the case with Freud and his “sons” – Jung, Ferenczi, Adler – the seemingly inevitable “falling out” between Rank and the Freudian establishment was especially bitter. Ultimately Louis Stack Sullivan made the parliamentary motion to expel Rank from the American Psychoanalytic Association. With friends like these … Rank formed his own separate Association and continued to innovate and earn Greenbacks.

 Carl Rogers learns of Rank’s work through one of his colleagues, who is being analyzed by Rank, now residing in the States. Rogers invites Rank to speak at a three-day seminar (circa 1936), lecturing to forty-five social workers and educators. Rogers later notes that it was in this context “that I first got the notion of responding almost entirely to the feeling being expressed” (p. 144). Voila! Mark the historical moment: Client-centered therapy is conceived.

 Mine is a bare bones outline of how Lanzoni connects the dots. The dynamics and the personalities, which Lanzoni richly narrates, make for fascinating story telling in themselves. Fast forward to the 1930s as Jessie Taft, a nurse and social worker separately innovating in empathic relatedness, is translating Rank’s Will Therapyfrom the German. There is still research to be done to follow the threads into Rank’s work, whose literary skills in mining myth and fiction are used in elaborating an approach to the emotions that transgresses the relatively narrow definition of Freudian libido (desire).

 Though Lanzoni does not get so far, I do not believe that Rank had the specific distinction of Einfühlung, but worked with the communication and understanding of the emotions in such a way as to produce psychological transformation. Rank uses the word “love” in the way of an empathy-like “unconditional positive regard.”

 By the time Rogers is fully engaged with Einfühlung, “empathy” does notmean agreement with the other or mere mirroring. The therapy client may usefully be self-expressed about the emotions with which he or she is struggling. These emotions, in turn, are thereby brought to the surface, acknowledged, worked through, and able to be transformed. The therapist helps the client to metabolize the emotional congestion and gives back to the client the client’s own experience in a form that the client recognizes, hypothetically opening up a reorganization of psychic structure.

 Lanzoni also gives a “shout out” to Heinz Kohut, MD (1913–1981), but just barely. Kohut was the innovator who puts empathy on the map in psychoanalysis (then the dominant paradigm in psychiatry) starting in 1959 with his celebrated article “Introspection, empathy, and Psychoanalysis.”

 Kohut was very circumspect about his sources relating to empathy and regarding those who inspired him in his work on empathy. Chronically under-appreciated (and sometimes even under attack) by the prevailing orthodoxy of Freudian ego psychology, Kohut’s footnotes about empathy as such are few and far between. Surely knowing the fate of Adler, Jung, Ferenczi, and Rank, not even to mention Jeffrey Masson, Kohut pushed back against the unfriendly accusation that Kohut’s emerging Self Psychology was distinct from Freudian psychoanalysis, even as Self Psychology seemed increasingly to be so.

 It is likely Kohut was influenced by Sándor Ferenczi and Michael Balint (Lunbeck 2011). Speaking personally, I have never seen a shred of evidence that Kohut read Rank, who was by that time devalued as yet another notorious “bad boy” and psychoanalytic heretic. Of course, that does not mean that Kohut did not do so – and it is also possible that I just need to get out more. Kohut and Rogers seemed to have inhabited parallel but wholly distinct universes.

 My take? And not necessarily Lanzoni’s: Kohut was sui generis– and wherever he first got the word “empathy” itself (Kohut, though a Austrian, German-speaking refugee, was by 1959 writing in English), his definition of empathy as “vicarious introspection” is a wholly original contribution.

 One problem is that as soon as one engages Kohut’s The Analysis of the Self(1971), arguably a work of incomparable genius, discovering as it does new forms of transference, relations to the other, and possibilities for humanization, the reader is hit by a tidal wave of terms such as “cathexis,” “archaic object,” and “repressed infantile libidinal urges.” These make the reading a hard slog for most civilians.

 The force of historical empathy is strong with Lanzoni as she engages “Popular Empathy.” She describes how in the post World War II world “empathy” breaks out of its narrow academic context into the American cultural milieu at large.

For example, the then-popular radio (and eventually TV) personality Arthur Godfrey was featured on the February 1950 cover of Time magazine, asserting “He has empathy” (p. 208). The notorious quiz show scandals of the late 1950s were apparently a function of mis-guided empathy, giving contestants answers to build audience empathy for the contestants. Advertisers “got it”: help the audience empathize with the brand and the person using the brand – give the customer empathy, they buy the product. Even if it was never quite so simple, the Boston Globe(July 3, 1964) quotes the Harvard Business Review:  Empathy is “the ability feel as the other fellow feels – without becoming sympathetic” (p. 210).

 Meanwhile, Carl Rogers has an existential encounter with Martin Buber (celebrated author of I and Thou) at the University of Michigan (1956). Rogers is profiled in Timemagazine in 1957 as practicing a psychotherapy that uses empathy in contrast with the then-prevailing paradigm of psychoanalysis, which uses – what? Insert the caricature of an authoritarian analysis of the Oedipus complex.

 In an eye-opening Chapter on “Empathy, Race, and Politics,” Lanzoni documents the role of empathy in the movement for civil rights in the 1950s and 1960s in America. Both Kenneth B. Clark and Gordon Allport provided examples of (social) psychologists who were committed to social justice. They were committed to overcoming the one dimensional, trivial and convenient issues of academic research (still ongoing) instead engaging with urgent social realities such as prejudice, racism, poverty, and inequality.

 According to Lanzoni, Allport drew on the tradition of Einfühlung to describe empathy as a means of grasping the human personality holistically, thus breaking down the barrier between aesthetic and interpersonal empathy. Clark used empathy as the basis for arguing for equality under the law: “to see in one man all men; and in all men the self” (p. 217). Sounds like empathy to me.

 In 1944 Allport taught an eight-hour course to Boston police officers to tune down racial tensions. Allport encountered and faced what he called an “abusive torrent of released hostility.” In response Allport deployed the technique of nondirective or “unemotional listening,” learned from Carl Rogers. Once again, sounds like empathy. By the end of the session, the officers reportedly became bored by their own complaints. One who had “at first railed against the Jews tried in later remarks to make amends.” But empathy remained a two-edged sword, capable of eliciting searing anger when others thought they had not been given the dignity they deserved as well as dialing down narcissistic rage once it had been called forth (pp. 220 – 221).

Clark was so impressed by psychoanalyst Alfred Adler’s (1870–1937) power dynamics in the context of society that he shifted his major from neurophysiology to psychology. In 1946, Clark and his wife, Mamie Clark (PhD, Columbia) established the Northside treatment Center in Harlem to expand education, counseling, and psychological service for youth in Harlem.

 In July 1953 Clark wrote to Allport, asking help in preparing a document for the upcoming Supreme Court deliberations on desegregation in the Brown v. Board of Education case. Allport responded quickly. The rest, as they say, is history.

 Gunnar Myrdal (author of the celebrated American Dilemma, demonstrating that the history of the US isthe history of race relations (1944)) said of Clark’s work, especially Dark Ghetto(1965): a demand for “human empathy and even compassion of the part of as many as possible of those who can read, think, and feel in free prosperous white America” (p. 241). Just so.

 Instead of becoming ever more cynical and resigned in the face of prejudice that seemed baked into the neo-liberal, market-oriented vision of American society, Clark calls forth empathy. Clark’s calls for empathy became more insistent. What happens when Clark and empathy speak truth to power? Empathic reason? Rational empathy? One can only wish that Clark had lived to see the people of this great country elect Barak Obama as President of these United States. We do not know if this was an anomalous moment, a beacon in the current fog of fake everything, or a kind of liberal purgatory – one step forward, one step backward – to call forth further struggle. From the perspective of Q2 2019 as I write this review, such events seem like a dream. Breakdowns are hard but inevitably point the way to the next breakthrough.

 Lanzoni demonstrates that society’s interest in empathy had continuously been at the level of at least a steady simmer in the popular and social justice communities in the 1950s through 1970s even as professional psychology was lost and wandering through the wasteland of Skinnerian behaviorism.

 That which really brings the conversation about empathy to a rolling boil in the final chapter is the discovery of mirror neurons in the macaque monkeys by the group of brain scientists in Parma, Italy including V. Gallese,, L. Gadiga, L. Gogassi, and G. Rizzolatti.

 Mirror neurons are neurons are activated both when a subject takes an action and similarly when the subject watches another subject doing the same thing. For example, the set  of neurons in the premotor cortex of the monkey is activated when it drinks from a cup. Okay, fine. The astonishing finding is that these same neurons are activated when the monkey watches another monkey (or any one) drink from the cup. Could this be the underlying basis of the motor mimicry, inner imitation, felt resonance, with which thinkers such as Violet Paget, Theodor Lipps, and Karl Groos remarked? Could this be the neural infrastructure for Kohut’s vicarious engaged, or Roger’s felt sense of participating in the other’s experience? The infrastructure for Mark Davis or Alvin Goldman on perspective taking and simulation?

  The battle is joined.

 Lanzoni covers the explosion of theories, studies, and amazing results that have occurred since the identification of alleged mirror neurons. Bottom up, affective empathy is combined with top down, cognitive empathy to complete the picture of empathic relatedness.

 The author of Emotional Intelligence, Daniel Goleman, weighs in with a follow up on Social Intelligence– that is, empathy.  Victorio Gallese’s shared manifold hypothesis makes the case for a multi-person virtual manifold of experience that can be vicariously sensed by each partner in empathic resonance. Jean Decety’s seminal architectural definition of empathy paves the way for social neuroscience and functional magnetic imaging research (fMRI) that visualizes other people’s pain. Marco Iacoboni Mirroring Peopleargues that we have no need to use inference to understand other people. We use mirror neurons. Disorders of empathy are identified: Simon Baron-Cohen’s breakthrough work on Mindblindness(1995) identifies possible interventions for autism spectrum disorders.

 On a less positive note, the colonization by neural science of the humanities and social sciences has proceeded apace with neuroaesthetics, neurolaw, neurohistory, neurophilosophy, neuropsychoanalysis, neurozoology,and so on,  drawing provocative but, in many cases, highly questionable conclusions from what areas of people’s brains “light up” as they lay back in the fMRI apparatus and are shown diverse pictures or videos of people’s fingers being painfully impacted by blunt force.

 Lanzoni reports on the neuro-hype that accompanies the discovery of mirror neurons in monkeys: “Cells That Read Minds.” Hmmm. The backlash is predictable if not inevitable. Greg Hickok’s The Myth of Mirror Neuronsraises disturbing questions about voodoo correlations in fMRI research. Other than a single report from 2010 of human mirror neurons allegedly identified in epileptic patients undergoing surgery, there is no evidence of the existence of human mirror neurons.

 Lanzoni is an equal opportunity debunker: The fMRI research, while engaging and provocative, provides evidence of diverse brain functions that include thousands of neurons, not individual ones, whose blood oxygenation level data (BOLD) is captured by the fMRI. Correlation is not causation. The brain lights up! Believe me, if I doesn’t you are in trouble.

 Still, the neuro-everything trend has traction (and its merits). Even if human mirror neurons do not exist, it is highly probable that some neurological system is available that enables us humans – and perhaps us mammals – to resonate together at the level of the animate expressions of life.

 If there is a myth, it is that we are unrelated. On the contrary, we humans are all related – biologically, socially, personally. You know that coworker or boss you can’t stand? You are related. You know that politician you regard with contempt? You are related. You know that in-law or neighbor who gets your goat? You are related – intimately related, because we all share the same cognitive, affective, and neural mechanisms – and defects – designed in from when we were that band of hominids fighting off large predators and hostile neighbors in the environment of evolutionary origin.

 Since this is not a softball review, as noted, I call out the limitations and incompletenesses of Lanzoni’s impressive contribution. One of the challenges is that the history of the concept empathy is not limited to the word “empathy” or Einfühlung. Indeed prior to Lanzoni’s work, some entirely reasonable individuals had concluded that Lipps projective empathy and Roger’s interpersonal empathy were entirely distinct concepts. We now know that they belong together in a kind of coincidences of opposites because empathic animation of the work of art or beautiful nature and empathic receptivity to other human beings are related, but diverse, ways of engaging with otherness. 

 First incompleteness: Prior to Titchener’s invention of the word “empathy” as a translation of the German “Einfühlung” the main word in English was “sympathy.” Now it is a common place today to say that “sympathy” means a reactive emotion such as pity in contrast with “empathy” that captures a vicarious experience of the other’s experience or takes a sample or trace affect of the other’s experience. And that remains true today. David Hume (1711–1776) and Adam Smith (1723–1790) get barely a shout out.

 However, if one goes back as recently as David Hume’s Treatise of Human Nature(1731) one can find at least four different senses of sympathy – emotional contagion, the power of suggestion, a vicarious experience such as one has in the theatre, the conjoining of an idea and impression of another’s expression of emotion with the idea of the other [which starts sounding like our notion of interpersonal empathy].

 In addition, if one looks at Hume’s aesthetic writings, one finds the distinction of a delicacy of sympathy and of taste. If your delicacy of sympathy and taste is more refined than mine, then you may experience a fine-grained impression that is more granular than mine. For example, you perceive sadness behind a person’s outburst of temper whereas I only perceive the obvious anger. Your delicacy of sympathy and taste is superior to mine. In our own modern language, you empathy is more discriminating.

 A second incompleteness is in the treatment of the phenomenologist’s – Edith Stein (1891–1942), Max Scheler (1874–1928), Edmund Husserl (1859–1938), Maurice Merleu-Ponty (1908–1961), who receive honorable mention in a cursory nod to their diverse engagements with Einfühlung. For example, in a footnote, Scheler’s eight distinctions of sympathy and empathy are called out in a footnote (p. 360n40): Miteinanderfühlung[reciprocal feeling], Gefühlsansteckung[infectious feeling], Einsfühlung[feeling at one], Nachfühlung[vicarious feeling], Mitgefühl[compassion], Menschenliebe[love of mankind], akosmischtishe Person- und Gottesliebe[acosmic love of persons and God], und Einfühlung[empathy]. Well and good.

 Leaving aside purely practical considerations of editorial constraints on word count and that the phenomenological material may have been covered elsewhere [e.g., see Agosta 2014, especially Chapters 4 – 6]: the reason that the additional phenomenological chapter was not provided is a breakdown in an otherwise astute historical empathy. 

 In particular, today hardly anyone has heard of Theodor Lipps (granted that Lanzoni’s work is changing that). However, in his own day Lipps was famous – celebrated as the proponent of a theory of Einfühlungthat provided the substructure for aesthetics and grasping the expressions of animate life of other people. It was as if Lipps was an Antonio Salieri to would-be Mozarts such as Freud or Husserl (once again, except for the play (and movie) Amadeus). Using modern terms, it was as if in his own day Lipps was branded in the marketing sense as “the empathy guy.”

 Between roughly 1886 and 1914 (the date of Lipps’ death) no philosopher, psychologist, or psychoanalyst could use the word “Einfühlung” without being regarded as a follower – or at least a fellow traveller – of Lipps.

 In the case of the phenomenologist, the result is a sustained attack on Lipps. Edith Stein quotes Max Scheler against Lipps’ theory of “projective empathy.” Her contribution becomes a candidate deep structure of Husserl’s 5thCartesian Meditation. Husserl attempts to overcome the accusation of solipsism [there is nothing in the universe except my own consciousness] without using empathy as a mere psychological mechanism. Yet Husserl dismisses empathy, using a Kantian idiom, and “kicks it upstairs”: “The theory of experiencing someone else, the theory of so-called ‘empathy,’ belongs in the first story above our ‘transcendental aesthetics’ ” (1929/31: 146[173]). “Transcendental aesthetics” is a form of receptivity – such as receptivity to another subject. But then Husserl has to reinvent empathy in other terms calling it “pairing” and “analogical apperception.”

 One thing is certain: in Husserl’s Nachlass(posthumous writings) he makes extensive use of Einfühlungin building an account of intersubjectivity. Empathy is the window into the sphere of ownness of the other individual subject. Empathy is what gives us access to the Other, with a capital “O.” Empathy enacts a “communalization” with the other. Key term: communalization (Vergemeinschaftung).

 In his published writings Husserl was exceedingly circumspect in his use of the term “Einfühlung,” virtually abandoning it between Ideas(1913) and the Cartesian Meditations(1929/31).  But in Husserl’s work behind the scenes empathy was moving from the periphery to the center of his account of intersubjectivity. The Nachlassvolumes corresponding the Cartesian Meditations contain hundreds of references to Einfühlung, in which it is doing the work of forming a community of subjects. The anxiety of influence? The influence of Lipps? Quite likely.

 I would not blame anyone – including Lanzoni – for not wanting to try to disentangle this complex of distinctions and influences of empathy in the context of phenomenology. It is not for the faint of heart.

 As of this date (Q2 2019), Lipps is not translated from the German so far as I know. There is a reason for that – Lipps falls through the crack between Immanuel Kant and Wilhelm Wundt. If ever there were someone of historical interest, it is Lipps.

 Lipps provides an elaborate rewrite of rational psychology using a quasi-Kantian idiom without any of the empirical aspects of Wundt. Still, Lipps enjoyed considerable celebrity in his own time. So far as I know, no one has commented on the fact that Lipps in effect substitutes the term “Einfühlung” for “taste” in his aesthetics. Those wishing to engage further may usefully see Agosta 2014: “From a Rumor of Empathy to a Scandal of Empathy in Lipps in A Rumor of Empathy: Rewriting Empathy in the Context of Philosophy: pp. 53 – 65: DOI: 10.1057/978113746534.0007.)

 A third incompleteness is the role of empathy in psychoanalysis proper, which was perhaps a wilderness too desolate to reward proper scholarly engagement. Lanzoni notes: “There were also handful of psychoanalysts, trained, not surprisingly, in Vienna, who ventured to explain empathy to a popular audience. Analyst and writer Theodor Reik published Listening with the Third Ear in 1948 [….] Empathy worked like wireless telegraphy to allow one to tune in to the inchoate messages of another’s unconscious” (p. 208). Empathy as receptivity andbroadcast of messages. However, Reik was not a medical doctor, and the American Psychoanalytic Association declined to validate his credentials, leaving him as yet another voice crying in the wilderness.

 Lanzoni gives Kohut another “shout out,” noting that empathy was an observational act that led the analyst to a scientific appraisal of the other person rather than one of the “sentimentalizing perversions of psychotherapy” (p. 207). Of course, Kohut moved steadily in the direction of asserting that empathy itself could be curative, though, in contrast to Rogers, mainly in a process of optimal breakdown, being ruptured and restored. Empathy breaks down, the attuned therapist acknowledges and cleans up the misunderstanding, empathy is restored, psychic (personality) structure is shifted and strengthened – thenthe patient gets better.

 A fourth incompleteness is the missing paradigm of empathy as translation between different individuals and the worlds in which the individuals inhabit. Once again, this is not a criticism of Lanzoni, but simply to note that, substantial though Lanzoni’s contribution is, there is more work still to be done.

 Herder was working on a complex interpretive problem of empathy, creating an entire world in all its contingencies and details in order adequately to translate a text from attic Greek into German or understand a work of art in its ancient context. Herder’s project envisions no trivial translation, and, if anything, is an application of empathy broader and bolder than what is being proposed here or in any reconstruction of Kant. According to Herder, in order to deliver an adequate translation, the translator must think and feel himself into – empathize into [sichhineinfühlen] – the world of the author or historical figure. The translator is transformed into a Hebrew, e.g., Moses, among Hebrews, a poet among bards, in order to “feel with” and “feel around” the world of the text (e.g., Herder as cited in Sauder 2009: 319):

 Feeling is the first, the most profound, and almost the only sense of mankind; the source of most of our concepts and sensations; the true, and the first, organ of the soul for gathering representations from outside it . . . . The soul feels itself into the world [sichhineinfühlen] (1768/69: VIII: 104 (Studien und Entwürfe zur Plastik)) (cited in Morton 2006: 147-148).

 Thinking from the point of view of everyone else is not to be confused with empathy in the Romantic idea of empathy where empathy is a truncated caricature of itself and summarily dismissed as merger, projection, or mystical pan-psychism. Nor is it clear that Herder, always the sophisticated student of hermeneutics, ever envisioned such a caricature of empathy. In any case, empathy is not restricted to the limitations of a Romantic misunderstanding of empathy as merger. Empathy as creating a context within which a translation – an empathic response – can occur stands on its own as an undeveloped paradigm (see also Agosta 2014: 36–37 (from which this text is quoted)).

 Among the many strengths of Lanzoni’s book is her engagement with the many women researchers and scholars who contributed to the history of empathy: Violet Paget (Vernon Lee), who was there are the beginning with the physiological, mirroring effect of empathy in inner imitation; Edith Stein, research assistant (along with Martin Heidegger) to Edmund Husserl and her dissertation The Problem of Empathy(1917), which was influenced by and, in turn, informed Husserl’s ambivalence about making Einfühlungthe foundation of intersubjectivity (community); Jessie Taft, who developed an entire model of psychotherapy, relational therapy, combining element of G. H. Mead’s social behaviorism and Otto Rank’s psychoanalytically informed approach to the emotions, which, in turn, decisively influenced Carl Rogers. All this and more does Lanzoni truly deliver.

 References and Further Reading

 Jean Decety (ed.). (2012).  Empathy From Bench to Bedside(2012). Cambridge, MA: MIT Press.

 Jean Decety and P.L. Jackson. (2004). “The functional architecture of human empathy,” Behavioral and Cognitive Neuroscience Reviews, Vol 3, No. 2, June 2004: 71-100.

Sigmund Freud. (1913). “Further recommendations: On beginning the treatment.” Standard Edition, Volume 12: 121-144.

Victorio Gallese. (2001). “The shared manifold hypothesis: embodied simulation and its role in empathy and social cognition.” In Empathy and Mental Illness, T. Farrow and P. Woodruff (eds.), Cambridge, UK: Cambridge University Press, 2007: 448-472.

Edmund Husserl. (1905/20). Zur Phänomenologie der Intersubjectivität: Texte aus dem Nachlass: Erster Teil: 1905-1920,I. Kern (ed.). HusserlianaXIII. The Hague: Martinus Nijhoff, 1973.

 ______________. (1913). Ideas: General Introduction to Pure Phenomenology, tr. W. R. Boyce Gibson. New York: Collier Books, 1972.

 _____________. (1918). Ideas Pertaining to a Pure Phenomenological Philosophy: Second Book, tr. R. Rojcewicz and A. Schuwer. Dordrecht: Kluwer Academic Publishers, 1989.

 ______________. (1921/28).  Zur Phänomenologie der Intersubjectivität: Texte aus dem Nachlass: Zweiter Teil: 1921-1928I. Kern (ed.). HusserlianaXIV. The Hague: Martinus Nijhoff, 1973.

 ______________. (1929/31). Cartesian Meditations, tr. D. Cairns. Hague: Nijhoff, 1970.

 _____________. (1929/35).Zur Phänomenologie der Intersubjectivität: Texte aus dem Nachlass: Dritter Teil: 1929-1935, I. Kern (ed.). HusserlianaXV. The Hague: Martinus Nijhoff, 1973. 

 Marco Iacoboni. (2007). “Existential empathy: the intimacy of self and other.” In Empathy and Mental Illness, Tom Farrow and Peter Woodruff (eds.), Cambridge, UK: Cambridge University Press, 2007: 310-21.

L. Jackson, A. N. Meltzoff, and J. Decety. (2005). “How do we perceive the pain of others? A window into the neural processes involved in empathy,” Neuroimage24 (2005): 771-779.

G. Jung. (1921). Psychological Types, tr. R. F. C. Hull. Princeton: Princeton University Press, 1971.

Susan Lanzoni. (2012). “Empathy in translation: Movement and image in the psychology laboratory,” Science in Context, vol. 25, 03 (September 2012): 301-327.

Vernon Lee [Violet Paget]. (1912). Beauty and Ugliness and Other Studies in Psychological Aesthetics. New York: John Lane, Co.

 Theodor Lipps. (1883). Grundtatsachen des Seelenlebens. Bonn: Verlag des Max Cohen und Sohns.

 _____________. (1897). “Der Begriff der Unbewussten in der Psychologie.” In Dritter internationaler Congress für Psychologie in München vom 4. bis 7 August 1896. München Verlag von J.F. Lehmann, 1897: 146-163.

 _____________. (1909). Leitfaden der Psychologie. Leipzig: Wilhelm Engelman Verlag.

 _____________. (1903). Aesthetik. Volume I. Hamburg: Leopold Voss.

 Lou Agosta. (2014). “From a Rumor of Empathy to a Scandal of Empathy in Lipps in A Rumor of Empathy: Rewriting Empathy in the Context of Philosophy: pp. 53 – 65: DOI: 10.1057/978113746534.0007.

 ____________. (2014). A Rumor of Empathy: Rewriting Empathy in the Context of Philosophy. New York: Palgrave Pivot.

Elizabeth Lunbeck. (2011). “Empathy as a Psychoanalytic Mode of Observation: Between Sentiment and Science,” in Histories of Scientific Observation, ed. Lorraine Daston and E. Lunbeck. Chicago: University of Chicago Press.

George H. Mead. (1922). “A Behavioristic account of the significant symbol,” Journal of Philosophy, 19 (1922): 157-63.

 Michael Morton. (2006). ‪Herder and the Poetics of Thought: Unity and Diversity in On Diligence in Several Learned Languages. London and University Park: Penn State University Press.

Lou Agosta, PhD and the Chicago Empathy Project

 

 

 

 

 

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Empaths don’t get enough empathy: Review of Orloff’s Empath’s Survival Guide

Empaths don’t get enough empathy.

An empath is a person who is naturally endowed with an overabundance of empathy. As I understand the term, a “natural empath” (my term, not Orloff’s) is an individual who is empathsSurvivalGuideCOVEROrloffnaturally endowed from birth or genetically “loaded” with a deep and extensive empathy, a hypersensitivity to the experiences of others.

This gift of empathy shows up as a mixed blessing, since the natural empath experiences the pains and sufferings of the world more intensely and deeply than do other individuals. Less charitable people redescribe the “natural empath” as someone who is “irritable” or “overly sensitive.”

Granted, the natural empath brings a deep sensitivity to the experience of human suffering and joy, the natural empath also lives through the nuances and delicate details of the experiences intensely. Too intensely?

Granted that the empath seems to be protesting, at least sometimes, that her empathy is working overtime and causing suffering—a breakdown—a book such as Judith Orloff’s The Empathy’s Survival Guide is a timely antidote. [1]

Such empaths seem to be challenged—lack skill—in tuning down their empathy. Indeed they often do not think of the possibility of such skillful tuning. They do not acknowledge such a possibility. There is nothing wrong, but there seems to be something missing. Hence, the need for Orloff’s guidance. Granted, individuals are born a certain way, and that, no doubt, can represent a challenge, but being born a certain way does not mean one always has to stay that way.

Meanwhile, the empath is experiencing a breakdown in empathic receptivity (my term, not Orloff’s). According to Orloff, instead of a well-rounded, mature, developed empathy, the empathy of the natural empath breaks down into emotional contagion (at least on a bad day). The suffering of the other person floods her or his empathy; indeed the suffering of the world inundates the individual.  But that is not all, and the dominoes start falling.

Orloff gets into the details. Overwhelmed and under stress, the natural empath engages in defensive gestures that ultimately are self-defeating. These include isolating oneself, turning to alcohol or street drugs in an attempt to self-medicate, enacting other addictive behaviors (over-eating, restricting., sexual acting out), and so on. Furthermore, the chronic social stress experienced by the natural empath is a source of inflammatory disorders such as autoimmune diseases, allergies, clinical anxiety, depression, and so on, to which we are all susceptible, but the empath especially so. The result is a form of emotional burnout, compassion fatigue, empathic distress, emotional contagion, not empathy.  

The empath is just being what she or he calls “empathic”; but it is not working for the individual in question. Why not? Orloff explains that due to natural endowment and/or adverse childhood experiences, the empath lacksexperiential filters and sensory inhibition. The glass is both half empty and half full. The empath is endowed with intuitive abilities that may be exceptional. However, the trouble is that the empath’s empathy lacks inhibition. He is too open to the pain and suffering of the world. Heck, even a succession of sunny days can become burdensome, though in a different way.

In contrast to the natural empath, most people are too inhibited, including being inhibited as regards their empathy. Most of us are not sufficiently in touch with our feelings and experiences in relationships.

Not so, the natural empath. The natural empath endures too much “in touchness” with feelings and experiences of the pain and suffering of others. In this one respect, empathy, the natural empath is too uninhibited. In this one particular area of openness to the suffering and pain of other people, the natural empath may usefully increase her inhibition. Consider the example of Dr Brecht in Thomas Mann’s celebrated novel Buddenbrooks, a dentist who deeply experiences the pain of his dental patients, so that he has to sit down, exhausted by the suffering of his patient, and wipe his brow after each procedure. Dentistry – perhaps not the best choice of profession for a natural empath.

A sound scientific basis exists for this a predicament. (We will shortly get to the scientifically debatable aspects of Orloff’s work.) People who are “natural empaths” have an acute sensitivity to in-bound sensations and perceptions. The function of what physiologists call “lateral inhibition” of sensory perception seems to be “lazy” and under-performing in these people. Lateral inhibition enables the nervous system to filter out the distracting background noise and intensify the relevant, salient sensations in the environment.[i]

That does not mean the natural empath should become hard-hearted or unkind, though paradoxically that is sometimes the sad result of burnout, compassion fatigue, or empathic distress. In order to overcome the breakdown of empathy, what does one actually doin order to expand or contract one’s empathic receptivity?

Orloff’s work is rich in tips and techniques for the struggling empath. Many of her best tips can be summarized in one phrase. Set firm limits and boundaries. The empathy lesson for such individuals consists in: Practice methods of “down regulating” one’s empathy.  State a request; and use humor (p. 122). Remember that “No” is a complete sentence (p. 222). “Don’t try to fix others” (p.  230).  

In a different category of tips and techniques are a long list of self-soothing, distress tolerance, and emotional regulation skills. Since this is self-help book, expect to encounter numerous recommendations about proper nutrition, regular exercise, sleep hygiene, and so on. All good recommendations, every one, but not specific to empathy as such. More problematic is the writing heavily weighted in the direction of “new age” interventions such as burning incense, holding healing gems, telepathic communication with plants and animals, and Epsom salt baths.

I hasten to add that I am a big advocate of Epsom salt soaking, especially in the form of sensory deprivation, though it tends to expand openness and sensitivity. More on the other “new age” interventions shortly. Empathy works to create a space of acceptance and toleration, so if the practice in question helps one regulate one’s emotions, do it.

The empath definitely can feel like he needs a survival guide – and Orloff’s work is a good place to start for the magical thinking free spirit. However, from the perspective of a rigorous and critical empathy, some real problems and issues are going to get in the way of a serious appropriation of this book, outside the confines of a weekend retreat on telepathy and intuitive energy healing.

There are more things on heaven and earth than are dreamt of in our philosophies – and Orloff points at many of them. How shall I put it delicately?, Orloff’s discussion proceeds as if subtle communications are undisputed medico-scientific-therapeutic facts not compelling puzzles that should alert us to a depth of our emotions and thoughts that may usefully be plumbed in a rigorous and critical empathy.

For example, in 1779 the Viennese physician Anton Mesmer published a treatise on animal magnetism, describing a subtle physical “magnetic” fluid – analogous to but different than Newtonian gravity – that permeates the universe, connecting, men, the earth, and the heavens. The imbalance of this hypothesized fluid in the body is responsible for such emotional disorders as hysteria and obsessive-compulsive behavior. Mesmer conducted “magnetic banquets” that provided the nobles and aristocracy with substantial relief from their physical and psychosomatic symptoms. 

At about the same time, one of Mesmer’s students, Viscount Jacques Maxime de Castenet de Puységur, differentiated “magnetic sleep,” which we would today call “hypnotic suggestion” and seemed to offer relief, not to the nobles, but to soldiers, workers, and peasants. The word “hypnosis” does not occur in the text, but I speculate that many of Orloff’s tips and techniques are forms of self-hypnosis. Might be worth a try.

Animal magnetism, psychic energy, libido, the energetic Chi practiced in Tai Chi, the instincts or vasanasliberated in Yogi, the mystical heat generated by the Shaman, emotional contagion, and so on, are not grounded in any conventional scientific theory or practice. So such energy work is not exactly an objective fact, and yet it is not a fiction.  

Speaking in the first person plural, since Orloff has diagnosed herself as an empath, she writes: “Since everything is made of subtle energy, including emotions and physical sensation, we energetically internalize the feelings, pain, and various physical sensations of others [….] [and] are even able to connect with animals, nature, and their inner guides” (p. 6).

Any one who owns a dog or cat knows from experience that we communicate with animals – exchanging feelings and experiences. But what Orloff has in mind is much more specific and goes well beyond provocative metaphors to questionable material instantiation.

Orloff is captured by the materialist fallacy and forgets that factual reality itself is permeated with fictions and fantasies. Ignoring the power of fiction, she wants to make a compelling linguistic locution such as “psychic energy” into a fact, thereby losing its power to enable us to describe and transform feelings and behavior. As demonstrated by many of Orloff’s imaginative and ”out there” statements, an idea does not need physical or factual reality to be effective – it just has to be expressed in a performative language.

There is a fancy name for Orloff’s main fallacy – reification – making into a thing that which is otherwise an abstraction. The idea of psychic energy is a compelling one, and it does have many applications in describing the mental status, awareness, or ability to be present in a conversation, of a person in a would-be empathic relationship. But it is the name of a problem and a deep issue, not a physical reality.

For example, neurology assures us that the brain – and indeed the body – gives off an electro-magnetic field. But this is a blunt instrument enabling us to tell whether an individual is conscious or in a coma, aware of his surrounding or experiencing an epileptic seizure. Orloff does not say that perhaps someday the granularity and specificity will improve. This is not a “some day” survival guide. No, she is claiming to have that skill now in her practice and workshops – and perhaps you can get it, too, if you work with her and follow her guidance .

Ironically, Orloff’s empathy is off. Empath’s are also naturally endowed with intuition, and Orloff consistently confuses intuition and empathy. Intuition and empathy are closely related, but they are inverselyrelated. More intuition often occasions less empathy, and vice versa. Intuition is the ability to make inferences, educated guesses, based on nuanced clues that are often barely over the threshold of perception. It is the kind of thing at which Sherlock Holmes excelled, and he was a notoriously hard case.

In contrast, empathy is the ability to take a vicarious experience, based on sustained listening to another person, and process it further cognitively, resulting in an empathic response. The properly empathic empath uses his empathic receptivity as to who the other person is as a possibility. The empath takes a walk in the other’s shoes with the other’s foot size, giving back and responding to the other individual her experience in a form of language such that the other person recognizes it as her own. As the empath learns to set firm boundaries and limits, her intuition is transformed into sustainable, usable empathy in the full sense from which both she and the community benefit.

Ours is a world in which pain and suffering are abundant. This does not make the would-be empath cold-hearted or the object of moral condemnation. Indeed such people might be more willing to engage in helping behaviors such as volunteering or donating money based on cognitive appreciation of the other person’s predicament rather than the experience of vicarious suffering. It means that the natural empath should practice taking distance from his own feeling in such a way that he gets a sample or trace of the other person’s feeling without being overwhelmed.

Expressed positively, if distance (or inhibition) were a medical drug, the natural empath may usefully increase the dosage. Take more of it. However, this is at best an imperfect analogy. Recall that inhibition is what enables the average person to get results in a world that the individual subsequently experiences as causing boredom precisely because inhibition is doing such a good job of down regulating the wave of stimulations that potentially wash over the person; and likewise the natural empath, hypothetically lacking such a filter, needs to down-regulate her empathy through self-distraction and abstraction to sustain emotional equilibrium rather than over-stimulation. The natural empath is an important and engaging case, and he may actually increase his good deeds in a particular situation by contracting his empathic receptivity, one particular part of empathy.

Note that Orloff considers herself an empath. She shares childhood experiences that indicate this was so as long as she can remember. I consider myself to be one of those “neuro typical” individuals, who used simply to be called “normal” (except that we no longer know what is “normal’). I hasten to add that I have expanded my empathic capabilities through extensive practice and training discussed elsewhere.[2]

Being an empath is surely a mixed blessing – as is this book. If one can expand one’s empathy, one can also contract it. The power of the empath – and the ordinary person – consists in doing both in their proper time and place. That is an important point from the perspective of a rigorous and critical empathy, about which Orloff may usefully be more explicit. Empathy in all its forms works to create a space of acceptance and toleration, so I acknowledge Orloff’s commitment to empathy.

REFERENCES

[1]Judith Orloff, MD, 2018, The Empathy’s Survival Guide: Life Strategies forSensitive People. Boulder, CO: Sounds True, Inc.; 263pp, $17.95.

[2]Lou Agosta, (2018), Empathy Lessons. Chicago: Two Pairs Press.

[i]Georg von Bekesy. (1975). Sensory Inhibition. Princeton, NJ: Princeton University Press. Von Bekesy was awarded the Nobel Prize for his work in physiology and medicine.

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

 

Review: The Empathy Effect by Helen Riess

The force of empathy is strong with Helen Riess, MD, and her team.

In The Empathy Effect: 7 Neuroscience-based Keys for Transforming the Way We Live, Love, Work, and Connect Across Differences(with Liz Neporent, Forward by Alan AldaTheEmpathyEffectRiessMD.jpg (Sounds True publishing, 234pp, $22.95)) Riess lays out a program for training medical doctors (and the rest of us) to expand our empathy.

The most important point that Dr Riess makes in the concise opening three chapters is that empathy is learnable. Empathy can be taught. The empathic capabilities of the human being can be expanded by practice and training. This is the set up for the introduction and promotion of the proprietary empathy training program, “E.M.P.A.T.H.Y.”®, offered by the for profit enterprise, Empathetics, of which Riess is the CEO. The training based on intellectual property developed at Massachusetts General Hospital and Harvard University. More on that shortly.

The work contains many personal reflections amid a fully buzz-word compliant narrative on the psychology and neuroscience of empathy. Dr Riess lets slip that she was in second grade when the 1963 Community Mental Health Act set in train consequences, some planned, most unintentional, that resulted in the emptying out of the Psychiatric Institutions (“Asylums”) that served for the long-term incarceration of those diagnosed with severe mental disorders.

This means that Dr Riess was young enough to have benefited from the innovations in empathy of Carl Rogers, PhD, and Heinz Kohut, MD, who, prior to the second psychopharmacological revolution, were responsible for putting the term “empathy” on the treatment intervention map of humanistic and self psychology.

Though not explicitly discussed by Riess, for practical purposes, the “second psychopharmacological revolution” is dated from Peter Kramer’s Listening to Prozac(1993). It took the legs out from under virtually every form of talk therapy then in the market, including Cognitive Behavioral Therapy (CBT, however, has demonstrated staying power for many reasons, not the least of which is that insurers are willing to reimburse for a dozen (or so) sessions).

Riess is conversant with Paul Ekman’s innovative research in coding (and decoding) the micro-expressions of the human face, an emotional “hot spot,” to discern what a person is “really” experiencing and feeling. Though Ekman does not use the term “empathy,” his approach to micro-expressions implies a definition of empathy distinct from that of Riess’ proprietary approach, which, in turn, aligns with David Hume’s “delicacy of sympathy and taste” (1741). If one person literally perceives a micro-expression of which another is unaware, then the one person’s “delicacy of empathy” (my term, not Hume’s) is more expansive that the other’s.

Thus, Dr Riess calls out the contributions of Rogers and Kohut such as “unconditional positive regard” and “vicarious introspection,” respectively. She appreciates the deep history of empathy (“Einfühlung”) in German aesthetics, in which empathy emerged from the projection of human feelings onto beautiful nature and art, something we humans seem to be cognitively designed to be unable to stop doing.

Riess appreciates that the distinction “empathy” is significantly different than “compassion,” “sympathy,” or “projection,” and she helps the reader distinguish among them. She “gets it” that empathy, like so many phenomena, is on a spectrum and that some people are naturally endowed with less of the capacity (think: disorders of empathy such as autism or at another extreme psychopathy) and some people have more of it (think: the natural empathy, who is acutely sensitive). Riess understands that empathy can misfire or breakdown: empathy faces obstacles and roadblocks, which, paraphrasing now, extend from sentimentalism, spoiling, codependence, projection, all the way to burnout, compassion fatigue, and empathic distress.

In every case, practice and training can expand the empathic competence of the individual and the empathic response in the face of the challenges of unempathic people and circumstances. Riess refers to turning “the dial on … emotional empathy” (p. 19), which is why training is needed. Thus, empathy is more like a dial or tuner – turn it up or down – rather than an “on-off,” all-or-nothing switch.

This brings the discussion round to the details of Riess and Empathetics, Inc.’s innovative, proprietary empathy training. She begins by citing research that demonstrates medical doctors are often trying to deliver one message and their patient’s are getting another one or nothing at all. The antidote? “E.M.P.A.T.H.Y.”®!

It turns out there is a “secret sauce,” a proprietary application of biofeedback technology. I have a report that if you, as a hospital or medical group practice, actually pay the $50K [I am making this number up] to train your medical doctors en masseat Mass General, then patented biofeedback metrics are used to judge the arousal of the subject and, hence, the effectiveness of the empathy induction. Though I am not sure, it sounds like they put the  little Velcro-cuff on one of your fingers to measure the galvanic skin response.

While galvanic skin response is a blunt instrument and does not distinguish between emotions such as fear, anger, sadness, high spirits, much less subtle states such as envy or indignation, it does provide a measure of physiological stimulus and arousal. Useful. Might be worth a try.

This add something to that old joke that when a therapist meets a new patient, there are two anxious people in the room; and it is the therapist’s job to be the least anxious. It adds something, but what? Still, it might be worth a try, especially given the emotional numbness of the survivors of the boot camp approach to medical school and the sleep deprivation regime of medical residency.

Meanwhile, the technology is wrappered in a conversational training that aims at expanding the empathic capabilities of the trainee. There are seven “keys” to empathy which, of course, occur simultaneously, but have to be presented in sequence for purposes of exposition.

The empathy training works on: (1) Eye contact: the eyes are the window to the soul. Look the other person in the eye to expand connectedness, but do not stare without blinking, which communicates aggression. Riess does not mention, but might usefully have done so, that Simon Baron-Cohen[1]calls out lack of eye contact as one of the indicators of a person being on the autistic spectrum.

Training in making eye contact to expand empathy leads naturally to including: (2) Facial expressions as a whole: the human face is an emotional “hot spot,” and while humans can fake many facial expression, there are some micro-expressions that are disclosive of an emotional depth that cannot be faked.

Here the decisive innovations and work of Paul Ekman and his team are critical path. Ekman spent some seven years mapping all the muscles of the face and their contribution to the expressions of emotions. The bottom line? People can consciously control many of these muscles – but not all of them. The muscle around the eyes participate in an authentic smile, and when they do not do so, the smile is perceived as off – as fake.

Riess says: “You don’t have to be an expert to pick up on the minute micro-expressions described by Ekman and others.” Actually you do. Significant practice and training is required, and even then one may know that the other person is not being entirely straight with you, but the micro expression does notprovide any insight into the underlying motive(s). Is the motive sinister or is the person suffering from shame, guilt, or post trauma upset? One has to have a conversation. The “M” is for “facial expression” – okay, actually “muscles” or “micro expressions” in the face.

The face, in turn, leads to: (3) Body language as a whole. Amy Cuddy’s “power pose” does not increase testosterone in the saliva, but significant anecdotal evidence indicates it does expand a person’s self-confidence. In short, look at how a person is standing or sitting and attend to one’s own posture. It can reveal a lot about how one is feeling.  “P” is for “body language,” or, to be exact “posture.”

Riess acknowledges the distinction between cognitive and affective empathy – top down and bottom up empathic understanding and receptivity. A future version of this training might incorporate “perspective taking” or “point of view,” in the place of the “P,” the folk definition of empathy, which is otherwise missing from the list of keys.  I make no representation as to how such a gesture would require adjustment or amendment to the intellectual property or whether it is even possible to claim as one’s own property something that is arguably the proper possession of all of humanity. One thinks of Kohut’s notion of empathy as oxygen for the soul. Who owns the oxygen? Presumably, humanity, not Harvard.

Next (4) empathy is all about “affect” and the communication of affect. People are not born knowing the names of their emotions. We have formal training in kindergarten in naming colors and numbers. It is not too late to practice experiencing one’s emotional experience and naming it.

In a separate section, Riess calls out the disorder of “alexithymia,” inability or extreme difficulty in naming and articulating feelings. This is different than “over intellectualization,” but sometimes not by much. This is an occupational hazard of anyone who spends years in graduate or medical training, but other people are seemly hardened against experiencing their feelings due to disposition or adverse life experiences.

(5) The “tone” of voice is richly communicative. If is a person is telling what should be a sad story of loss, injury, or set back, yet the person sounds happy, then something is going on beneath the surface that warrants further inquiry. The pace, rhythm, pitch, delivery, and prosody of a statement make a big difference in its reception and processing. Not to be overlooked: “A surgeon’s voice peppered with dominance and delivered with a lower register of concern was predictive of a malpractice claims history” (p. 54). But if one is only undertaking this training to stay out of legal trouble, that is itself an indication of trouble.

(6) Listening to the whole person is the point at which the training has to go beyond the tips and techniques that have dominated this list. This one is easier said than done and may require a deep engagement with spiritual disciplines of mindfulness, Tai Chi, or a couple of years of one’s own therapy in order to be available to the other person. “H” is for listening to the whole person – and hearinghim or her – presumably within the fifteen minute encounter that is budgeted for the initial medical inquiry.

(7) Empathy without responsiveness is like a tree that falls in the forest without anyone being there. It does not make a difference. Regarding empathic responsiveness, I would have appreciated an example of giving the other person’s experience back to her in a form of words that demonstrate that one “got it” without the exchange being so explicitly compassionate.

Recognition, acknowledgement, and alignment are ways of responding that do not require agreement or altruistic intervention. Yes, of course, it is helpful to be appreciated in one’s struggle and effort, and that is different than having someone jump in and actively provide compassionate support.

By all means, if someone is bleeding, apply a tourniquet while awaiting emergency services. But here one has actually to “dial down” one’s empathy in order to be effective. The point is that both empathy and compassion are often in short supply in the world and the world needs both more compassion and expanded empathy. However, empathy and compassion are distinct.

I may have misread Dr Riess if she wants to build into the human capacity for empathy, a compassionate response – whether her own proprietary version or empathy writ large. I offer this caveat because the vast majority of the examples of empathic response she gives are instances of pro-social helping, altruism, charity, or other aspects of being a Good Samaritan.

Once again, the world needs more Good Samaritans. The world needs both more compassion and expanded empathy; but the two are distinct. The exceptions in the text to examples of compassion are largely those of being over-whelmed or nearly over-whelmed by trauma and counting one’s breaths in order to stay centered in the face of hospital emergency room style dismemberment.

The irony of this book, which promotes linking empathy to its underlying neuroscience, is that the empathy is strong but the neuroscience, weak. Since this is not a “softball review,” a few examples will make this clear.

For example: “Scientists can see the electrical impulses spread through the brain using fMRI (functional magnetic resonance imaging) brain scanning technology” (p. 28). False.

The fMRI makes visible the blood oxygenation level data (BOLD) of between five thousand and fifty thousand neurons in its unit of measure, the voxel (depending on the variable size of the neuronal cells). The inference is: when the neurons get active, because the person is having an experience such as thinking a thought or attending to an event, then the neurons require more blood-rich oxygen to do their job.

In no way, does the fMRI monitor individual neurons or even a small number of them. The fMRI is a powerful tool for imaging soft tissue disorders, but it does not provide visibility down to the level of granularity of anything like individual neurons.

Perhaps Riess was thinking of the EEG: The spread of “electrical impulses through the brain” can indeed be monitored by an electro encephalogram (EEG), a fundamental tool for evaluating disorders of consciousness such as epilepsy and sleep disturbances, but even with an EEG the overall, high level activity of the brain is what is being monitored not individual or even small numbers of neurons.

A similar slip occurs early on: “Scientists first viewed the brains of their subjects in a brain scanner as the subjects had their fingers stuck by needle to determine the precise neurons involved in pain perception” (p. 17). Here “precise” would mean between five thousand and fifty thousand neurons, which is not my definition of “precise”. The level of granularity of the fMRI is an order of magnitude off from that required to “see” an individual neuron. Thus, fMRIs do not see or monitor mirror neurons (if they exist). Period. Once again, the fMRI does provide evidence that the parts of the brain that are busy processing experience receive enhanced blood oxygenation level data (BOLD), and that is the data captured by the fMRI.

Another problem item: “Mirror neurons are specialized brain cells in specific areas of the brain called the premotor cortex, known as the F5 area…” (p. 18). The problem is that the F5 area is part of the brain of the macaque monkey.  There is no F5 area in the human brain. Thus, the battle is joined, whether mirror neurons even exist in human beings.

The neurohype around mirror neurons is well represented; but what about the alternative point of view that such an entity as a mirror neuron does not even exist in humans and that the neurological infrastructure has a different configuration and explanation?[2]

How do we advance from synchronization and mirroring (Riess’ big idea of “shared mind intelligence”) to understanding of another person or the person’s mindedness? There are several questions of representation and functional analysis between which scientists and researchers are still working to “connect the dots.”  Riess represents this all as a “done deal” with the answer being “mirror neurons,” but she is oversold and fails to connect the dots.

Mirror neurons are one hypothetical explanation for such a phenomenon as “low level (empathic) affective resonance” in human beings. However, so are reflex-like mechanisms such as associations of actions, impressions, and ideas—known to the British empirical philosopher David Hume (1711–1776) as “habits” or “customary conjunctions.”

Macaque monkeys (the original subjects in the research done by Rizzolati, Gallese, and others (1996)) have a community and social order for which mirror neurons are sufficient to provide monkey interaction in the monkey community; buthuman behavior, action, and emotion involve more complex meanings, which human mirror neurons (if they exist) do notexplain—do not explain by means of language, social institutions, cultural practices, or tradition—because meaning is more than matching. As a mere mechanism of matching, mirror neurons struggle to explain the meaning created and deployed in minded actions and emotions.[3]

In humans and the human species, the macaque mirroring mechanism has been elaborated in evolutionary time into expanded behavioral, emotional, and cognitive capabilities useful for interrelating in significantly more complex human communities. Once prehistoric humans acquired language and used it to expand group solidarity in building communities with tools, art, stories, religious practices, social rituals, and the description of regularities in behavior of the stars and other human beings, diverse pathways opened up for creating and communicating meanings, emotions, projects, and thoughts between individuals.

The neurohype continues as the author moves from the neurologically misleading and false to the superficial. Using the example of addiction to alcohol: “New findings in Neuroscientific studies have redefined addiction from a condition of flawed character to a model of biology and disease. We now know that the brains of people who become addicted are different from those who do not” (p. 174). The brains of people who study French are different than those who do not, so we are on thin ice here in terms of a compelling analogy or contribution.

The good news? If a person has a disease such as pneumonia, modern medicine can cure him even if he is in a coma. That is not the case with the “disease” of addiction. In contrast, overcoming addiction requires the participation of heart and mind – and conscious commitment. The choice between a “moral flaw” and “neuroscience” is a false one once any physical dependency on the abused substance has been attenuated.

Riess recommends the empathic practice of perspective taking is key to shifting out of addictive stuckness – and gives a “shout out” to the program at the Hazelden Betty Ford Foundation; and, no doubt, getting a good listening is highly beneficial to any person, including addicts. However, the contribution of empathy is unwittingly weakened by making it seem like empathy is the answer to overcoming the conflict between the nucleus accumbens, a pleasure center in the brain, and the frontal lobe responsible for decision making.

This brings us to the mereological fallacy, which is pervasive in Riess as indeed in many works of this kind. The mereological fallacy attributes the function of the whole to the part (and vice versa). Brains are a part of a person; and neurons are a part of the brain. Brains are all about neurons; and, in so far as neurons are a necessary condition for the functioning of the embodied person, persons are neurons “all the way down.” But the neurons then start generating phenomena such as consciousness, meaning, language, intentions, joint intentionality, personality, community, and culture.

Thus, social neuroscience is born. Yet brains do notthink; people think. Brains do not express emotions; people express emotions. Brains do not intend this-or-that; people intend this-or-that. Brains do not become addicts; people become addicted. Brains do not empathize; people empathize. The mereological fallacy is a growth industry in social neuroscience. My brain made me do it? Hmmm. Human choice and commitment suggests your brain was definitely participating, but it is far from the whole narrative. The task is to avoid or contain the mereological fallacy, even while allowing social neuroscience to make its contributions in the areas of its strengths. This has not happened in this text.

Another problem? The number of variables changing simultaneously for a person lying still in a fMRI (functional magnetic resonance imaging) machine is large, very large. What worries me is that in an attempt to capture a response in the brain to interesting events experienced by the subject, the researchers, including Helen Riess, have created a brain in a vat. The vat is the fMRI.[4]

What then do brains do when viewed in an fMRI? They “light up.” They discharge neuro-correlates of consciousness (NCCs) in patterns of activation, as indicated in the form of blood oxygenation level data. The empathy circuit “lights up” when people lie back and view “empathy cues,” “empathy triggers,” or “empathy inducers.” We enjoy punishing cheaters—when apprehended and subjected to sanctions, the nucleus accumbens—a pleasure center of the brain—“lights up.” It gets busy. Empathic cruelty? Of course, there are many things that cause the nucleus accumbensto light up, implying the hazards of backwards inference. If it doesn’t light up, you are dead, or in serious neural trouble.

Nevertheless, in spite of weakness in the main selling point promoted in the subtitle and that of which the author is most proud – neuroscience – the force of empathy is strong in this text. If one can survive the neurohype of Part I, the reader is rewarded in Part II – presumably the nucleus accumbens is lighting up like a Christmas tree at this point (but so what?) – with applications of empathy to early child development, education, the hazards of social networking, art and literature as ways of expanding empathy, leadership and politics (and the lack of empathy in them), tough issues in mental illness, criminality, sexual identity, and so on, as well as the benefits of empathy for self-soothing, distress tolerance, and emotional regulation.

Now take matters up several levels from neurotransmitters to two human beings interacting in a conversation in a would-be community. Though Riess does not explicitly say it, the solution to the limited empathy of parochial, biased in-group thinking and behavior is straight-forward: expanded empathy. The person on the street thinks of empathy as an “on off” switch. “On” for the in-group. “Off” for everyone else – the “out group.”

However, practice and training enable a person to relate to empathy as a dial or tuner that can be adjusted to the situation. If I am experiencing empathic distress, dial empathy down. If I just do not “get” the other person, dial the empathy up. This does not come naturally to most people – so, once again, the case is made for practice and training, including Riess’ particular solution.

As a critical reader, I would have appreciated a statement that many ways are available to learn and practice empathy. Every mother, parent, teacher, business person with customers, doctor with patients, therapist with clients practices empathy on a good day and already knows a lot about what works and what doesn’t. Thus I imagine Riess saying: “While you, dear reader, do not need a psychiatrist to tell you about empathy [whose training regime since the early 1990s has overwhelmingly consisted in psychopharmacology], nevertheless let me tell you about the advantages of my proprietary way offered by my company Empathetics.” Perhaps Dr Riess thought such a statement was implied, and I can appreciate that point of view, but I still would have welcomed the clarification that it is not the only empathy game in town.

I hasten to add that, to her great and unconditional credit, Riess is decisively in action against the appalling scandal that empathy peaks in the third year of medical school (Hojat 2009; see also Halpern 2000) and that since the 1990s psychiatric training has overwhelming emphasized psychopharmacology. Meanwhile, the rate of the disabled mentally ill has doubled between 1987 and 2007 and is now six times the rate as in 1955.[5]Hmmm.

In the final ten pages of her work, Dr Riess calls out the “cytokine theory of depression” (and related mental disorders). I assert that she ought to have begun the book with it.

The cytokine theory of depression (see Maes 1995, 1999) is the approach that emerged in the mid 1990s – about the same time that Prozac was disrupting mourning and melancholy paradigms of mental illness with its serotonin chemaical imbalance theory of depression – that emphasizes the role of chronic social stress (divorce, finances, business travel, bullying bosses, misbehaving teenagers, and so on) in kindling long-term inflammation of major organ systems resulting in “sickness behavior.”

Such sickness behavior looks a lot like major depression yet, at least initially, it lacks the melancholic, negative self-talk.  Riess highlights treatment options – and life style adjustments – such as mindfulness, yoga, Tai Chi, exercise, diet, alone and in combination, that emphasize stress reduction, self soothing, emotional regulation, and empathy for oneself.

Naturally, the brain participates in all these activities, but reducing stress and expanding distress tolerance through empathy is also a function of the adrenal-hormonal system. It’s just that neurology has the buzz this season, not endocrinology or psychotherapy. Never was it truer that empathy guides us in engaging with and treating the human being as a whole – not a mere amygdala hijack or frontal lobe disinhibition. So the stress reduction paradigm, which is at right angles to and arguably does not contradict the neurotransmitter imbalance paradigm, was pushed to the margins and hardly heard of again until recently (e.g., Segerstron and Miller 2004).

Perhaps after the boot-camp of medical school, the rigors of residency, and the corporate transformation of American medicine (relying as it does on “hitting the numbers”), empathy is at such a low water mark in the medical doctor’s consciousness that “tips and techniques” are the best we can do. Indeed the “H” stands for “listening to the whole person and hearingthe individual,” so the intention is present.

Yet using empathy to “dial down” stress, aggression, and narcissistic injuries,  does not map in any obvious way to “E.M.P.A.T.H.Y.”®, which becomes a pair of golden hand-cuffs for the trainer. The ultimate irony is that the only obstacle in the way of expanding empathy – the distinction, not the propriety gimmick – is precisely “E.M.P.A.T.H.Y.”®.

References

Agosta, Lou. (2018). Empathy Lessons. Chicago: Two Pairs Press.

Decety, Jean, Chenyi Chen, Carla Harenski, and Kent A. Kiehl. (2013).An fMRI study of affective perspective taking in individuals with psychopathy: Imagining another in pain does not evoke empathy, Frontiers in Human Neuroscience, 2013; 7: 489; published online 2013 September 24. DOI: 10.3389/fnhum.2013.00489.

Halpern, Jodi. (2001). From Detached Concern to Empathy: Humanizing Medical Practice. Oxford: Oxford University Press.

Hojat, Mohammadreza, M. J. Vergate, K. Maxwell, G. Brainard, S.K. Herrine, and G. A. Isenberg. (2009). The devil is in the third year: A longitudinal study of erosion of empathy in medical school, Academic Medicine84 (9): 1182–1191.

____________________, Daniel Z. Louis, Fred W. Markham, Richard Wender, Carol Rabinowitz, and Joseph S. Gonnella. (2011), Physicians empathy and clinical outcomes for diabetic patients, Academic MedicineMar, 86(3): 359–64. DOI: 10.1097ACM.0b013e3182086fe1.

Hume, David. (1741). Of the delicacy of taste and passion in Of the Standard of Taste and Other Essays, Indianapolis: Bobbs-Merrill: 1965.

Hickok, Gregory. (2014). The Myth of Mirror Neurons. New York: W. W. Norton.

Maes, M. (1995). Evidence for an immune response in major depression: A review and hypothesis, Progress in Neuro-Psychopharmaclogy and Biological Psychiatry19: 11–38.

_______. (1999). Major depression and activation of the inflammatory response system, Advances in Experimental Medicine and Biology461: 25–46.

Riess, Helen. (2013). The power of empathy, TEDxMiddlebury: https://www.youtube .com /watch?v=baHrcC8B4WM [checked on 03/23/2017].

____________, John M. Kelley, Gordon Kraft-Todd, Lidia Schapira, and Joe Kossowsky. (2014). The influence of the patient-clinician relationship on healthcare outcomes: A systematic review and meta-analysis of randomized controlled trials, PLOS, Vol. 9, No. 4 | e94207: 1–7: https://doi.org/10. 1371/journal.pone.0094207.

____________, John M. Kelley, Robert W. Bailey, Emily J. Dunn and Margot Phillips. (2012). Empathy training for resident physicians: A randomized controlled trial of a neuroscience-informed curriculum,Journal General Internal Medicine, 2012 Oct; 27(10): 1280–1286. DOI: 10.1007/s11606-012-2063-z.

Rizzolatti, G., L. Fadiga, V. Gallese, and L. Fogassi. 1996. Premotor cortex and the recognition of motor actions, Cognitive Brain Research 3: 131–41.

Satel, Sally and Scott O. Lilienfeld. (2013). Brainwashed: The Seductive Appeal of Mindless Neuroscience. New York: Basic Books (Perseus).

Segerstrom, Suzanne C. and Gregory E. Miller. (2004). Psychological stress and the human immune system: A meta-analytic study of 30 years of inquiry, Psychol Bulletin. 2004 July; 130(4): 601–630.

FOOTNOTES

[1]Simon Baron-Cohen. (1995). Mindblindness. Cambridge, MA: MIT Press.

[2]For example, see Gregory Hickok. (2014). The Myth of Mirror Neurons. New York: W. W. Norton. For further debunking of the neurohype see Decety et al. 2013, Vul et al. 2009, and Satel and Lilienfeld 2013.

[3]The following paragraphs are adapted from the section “Your brain on empathy” in Lou Agosta 2018: 171–172.

[4]Presumably this is notwhat the late Hilary Putnam meant when he wrote his prescient article of the same name, since the fMRI had not yet been invented, but who knows for sure? See Hilary Putnam. (1981). Brains in a vat, in Hilary Putnam. (1981). Reason, Truth and History. Cambridge: Cambridge University Press: 1–21.

[5]Robert Whitaker, (2010), The Anatomy of an Epidemic. New York: Broadway Paperbacks (Random House), 2010: p. 7.

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

Top Ten Empathy Lessons: Trends for the New Year 2018

Here are Empathy Lessons for the New Year ahead. You know what would really interest me? To hear from you (dear reader) what is your empathy lesson? Future73nbcroppedWhether inspired by this list or your own experience over the winter holiday or living into the future: what is your empathy lesson? (My contact data is at the bottom of this post. Let me hear form you.) Meanwhile, my top ten (10) trends in empathy lessons for the New Year 2018—this is a count down list (think: Letterman)—are as follows:

  1. Empathy deserts grow; empathy lessons struggle to get traction: Under late modern digital global capitalism, empathy is a means, not an end. Capitalism organizes empathy along with workers and production processes. Yet many workplaces are empathy deserts in spite of the appearance of mangers with published “open door” policies.[i] Key term: empathy desert.

One’s humanity withers in the desert. So if you find yourself feeling dehumanized by your job, maybe you work in one of those, regardless of the prevailing rhetoric.

Instead of the industrial supervisor shouting orders to his workers, who curse under their breath and conform, managers employ therapeutic strategies to create a convivial environment of trust, relatedness, sociality, loyalty, and care. Happy people sell. Happy people write more software code with fewer bugs. Happy people who happen to be medical doctors see more patients an hour for more hours. Happy people deliver projects on time, on budget. Value creation in the late capitalist economy is a function of the exchange of emotion and empathy.[ii]

Yet the boss is not necessarily a paragon of empathic understanding. On the contrary, it’s “by the numbers,” “get your numbers,” and if you don’t get your numbers, your days are numbered. And if you don’t have any numbers, that itself is a bad sign, and we will find some for you. Relations with coworkers and superiors can be Machiavellian—and conflict-laden. The guy who said, “We don’t need more data; we need expanded empathy” was counseled out. Truth be told, successful business requires data and empathy; and both have their uses.

Today empathy is trending. Everyone is “talking the talk” of empathy. What could be better than empathy? But “walking the walk” of empathy arouses resistances, which are a major point of engagement in a similarly titled chapter.

The empathy lesson? Coming from empathic understanding—identify upsets and breakdowns. Do so in the spirit of expanding relatedness and community. Identify the unfulfilled expectation, thwarted commitment, or undelivered communication. Restore what is missing, especially if it is empathy, to complete the expectation, commitment, or communication.

In other words, clean up your own act: if you owe something to another person—whether money, an overdue library book, a promised email response, or a borrowed lawn mower—arrange to pay it back. If you have lied, acknowledge the lack of integrity to the other person; and take action to repair the damage done. Asking forgiveness does not just mean the slate is wiped clean and the perpetrator is free to commit boundary violations again. It means the person asking forgiveness tells the truth about what he (or she) did. It means being prepared to deal with the cost and impact of one’s inauthenticities and integrity outages.

This creates a clearing for success with empathy by cleaning up inauthenticities: Take action assertively to repair disruptions in relatedness and communication by acknowledging your contribution to the disruption. A person cannot relate authentically—that is, empathically—to people while being inauthentic in other areas of his or her life. People have to compartmentalize in order to survive the day; but empathy is the one area where compartmentalization is least effective. The inauthenticity around empathy in one particular area tends insidiously to spread to other areas.

Challenging as it may be, creating a foundation of authenticity is actually the first step in recovering and expanding one’s empathy, one’s power in relation to empathy, and the authentic relatedness that empathy makes possible.

Absent such a foundation, a person is simply not ready to engage empathically. Even if readiness was established up front, it can be lost along the way. Go back to step one. Those who are unwilling to do so may drop off at this point. Empathy is simply too hard; but any other approach is built on sand. No matter how good the following recommendations may be, if one does not establish a foundation of authenticity for empathy, a clearing for success, one is putting buttercream frosting on a mud pie.

  1. Empathy, capitalist tool: “CEO” now means “Chief Empathy Officer”: You heard it here first, and not for the last time. One can already hear the push back. This conversation shows up like another responsibility with which the head of the organization is tasked. As if she did not already have enough alligators snapping at various parts of her anatomy, now “CEO” no longer means “Chief Executive Officer,” but “Chief Empathy Officer.”

The things that cause people to excel at getting business results (beating the competition, solving technical problems, dealing with legal issues) do not necessarily expand one’s empathy.

Never is empathy needed more in business than when it seems there is no time for it. Building a business, growing a market, innovating in products and services, are all about building teams, networks of people, and communities. Empathy is at the foundation of community. Therefore, empathy is the foundation of business. Though business leaders hate to be tasked with yet another job, empathy has to start at the top if it has any hope of percolating up from the bottom. “CEO” now means “chief empathy officer.”

When I ask executives what is the budget in the organization for empathy training and empathy consulting, they usually look at me with a blank stare or just say “zero.” However, when I ask what is the budget to reduce conflict, enhance teamwork, innovate and improve productivity, then they see possibility and make it a priority to obtain a budget.

At the risk of over-simplification, empathy training consists in surfacing the resistances to empathy, the pervasive fear and cynicism (and so on) in the organization that lurks just beneath the surface. Interpret the resistance: “It is perfectly understandable that you would be cynical, given what you have been through, but that is not who you (we) authentically are.”

  1. Empathy’s “dark side” strikes back: “Machiavellian empathy” emerges as a growing threat to empathic empathy. When those in the executive suite are surveyed, some 60% of executives believe that their organizations are empathic, whereas 24% of their employees agree.[iii] An empathy deficit?

Niccolò Machiavelli (1469–1527) was famous for saying that it would be best if the leader—the Prince, in his day—was loved, but it is essential that he be feared. Machiavelli never actually said that the ruling Prince must be perceived to be empathic, even as he ruthlessly wields power behind the scenes. But that is what he implied.

In the context of politics, Machiavellian empathy refers to business people and politicians who present themselves as being empathic while manipulating, spinning alternative facts, and double dealing behind the scenes. Machiavellian empathy shows up in business, too. If managers are not in touch with their empathic abilities, they are counseled to “fake it till you make it.” Most never “make it” and continue “faking it.”

Whether or not one authentically understands the experience of the other person is less relevant to the Machiavellian empath than scoring points on a check list of concerned behavior.

If the corporation were a machine, which is a well-worn but all-too-accurate metaphor, empathy would be the lubricant that keeps the various parts working together without overheating. The number of corporations that are “over heating” and “going up in flames,” with dramatic news hitting the global media, is one index of those experiencing the most severe empathy breakdowns.

The explicit symptom is predictably a revenue shortfall, but behind the headlines lurk dysfunctional relationships, cynicism, a culture of bullying and shaming, loss of authenticity, lack of leadership, and lack of empathy.

Even the cynical sales person understands the value of taking a walk in the customer’s shoes, if only to sell him another pair. The wise (and empathic) sales person understands that in any business that allows for product differentiation or distinctions in service level agreements, building a relationship with the customer is the royal road to solution selling.

Strictly speaking, Machiavellian empathy takes nothing away from empathy’s intrinsic benefits and uses. Even if one wants to present the appearance of being empathic for propaganda purposes while continuing to operate with dubious business practices the behind the scenes, reality has a way of catching up with appearances.

It is not entirely fair, but when a person with psychopathic tendencies—once again, wanton lack of respect for boundaries, cruelty to animals, and a willingness, even eagerness, to inflict pain on others—grows up in poverty, the person often runs afoul of the criminal justice system. The person ends up in prison.

In contrast, when such a person grows up in affluence and gets an education in business, the person often becomes a hard-charging, “type A personality,” and a successful executive. The person ends up in the corner office. When psychopaths go to work, or get elected to political office, the result is sometimes snakes in suits (the title of a book cited in the endnote).[iv] We observe, and not for the last time, that the things that create success in business, do not always expand our empathy.

Amazon said it was a wonderful place to work. Then the New York Times got some employees to comment on the record about “mean” behavior.[v] Uber was disrupting the disrupters and creating the Gig Economy, which supposedly set us free. Then the CEO, Travis Kapernick, got unwittingly interviewed on camera by a driver.[vi] Bullying is not just for high school kids anymore; it has always lived in the business world, too. Still, there is no guarantee that the Machiavellian empath will slip up and document his or her own inauthenticity; but it just might happen.

Is this then the ultimate cynical moment? Is this the reduction to absurdity of empathy? If empathy is about setting boundaries, where is the boundary? The limit to Machiavellian empathy is Lincoln’s famous saying, “You can’t fool all the people all the time.” Ask Travis Kapernick. Ask Bernie Madoff and Michael Milken.[vii]

  1. Empathic response is an act of imagination, not agreement: Positively expressed, empathic response means giving the other person back his experience in such a way that he recognizes his humanity in the experience. However, agreement is often what people want in expressing their unhappiness or describing the setbacks in life that they have experienced.

After giving an account of some dramatic encounter, the one person turns to the other with a significant pause in order for the other person to respond with a heartfelt, if not empathic, agreement and approval. One often turns to the other person to get validation that the experience conforms to one’s own preferred interpretation. One uses the spontaneous response of the other to guide how one really feels about what occurred. This does not rule out that one person is often looking in advance for a particular reaction and to “get a rise” out of the other.

The scenario is complex; and the “get a rise” is not necessarily what a gracious empathic understanding or receptivity is going to provide. “Tough love” shows the other what he does not necessarily want to confront. Sometimes so does “a rigorous and critical empathy,” specially when the latter is framed in a way that recognizes and respects the other’s struggle.

The bridge between the cynical present and an impossible-to-envision future is empathy. The empathic moment is the act of imaging a different world, a future world of expanded empathy, in which the community expands inclusively.

Different viewpoints are available with regard to one’s action, including the perspective of one’s adversaries. One forms an opinion by engaging the issue from different perspectives. One makes present to the mind the perspectives of those who are absent or even opposed. That is, one represents them. This process of representation adopts the points of view of those who have different standpoints.

Thus, empathy is closely related to what one can imagine about the other person in relationship to oneself. An empathy that does not include the other fails the definition of empathy. This especially applies when the other is at odds with oneself. It may seem like a dream; but the dream lives. The empathic response is an act of imagination.

  1. If you have “compassion fatigue,” maybe you are not empathic enough: It is no accident that the word “compassion” occurs in “compassion fatigue.” Could it be that people who are experiencing compassion fatigue, but claim to be in a break down of empathy, are actually in a break down of compassion?

If one is trying to be empathic, but one is experiencing compassion fatigue, maybe one is doing it wrong. Maybe one is practicing empathy “wrongly,” with inadequate skill, precision, completeness, or finesse; and one needs a tune up for one’s empathy.

One reason that empathy training programs have not worked or have had mixed results is that they train the participants in compassion, being nice, conflict resolution, baby and child care, and a number of worthy and related tasks. This is all excellent, and the use of empathic methods is making the world a better place in all these situations. So keep it up. There is nothing wrong with being nice and so on: do not be “unnice”! But paradoxically something is missing—empathy.

The empathy lesson “not more empathy, expanded empathy” indicates that if one subtracts empathy from compassion, then one gets sympathy, reaction, burnout, compassion fatigue, which end up giving empathy a bad name. Now I do not wish to give anyone a bad name, who is committed to empathy, compassion, or making a difference is overcoming human pain and suffering. On the contrary, I acknowledge and honor one and all. The battle is joined; we are all on the same side; but we want to deploy our limited resources wisely.

Expanding one’s empathy requires an engagement with one’s own inauthenticities around empathy.

Expanding one’s empathy requires engaging with one’s own resistance to empathy. Until we engage with our own resistance to empathy we will remain stuck in our blind spots, breakdowns, burnouts, and compassion fatigue. In order to expand one’s empathy, one needs to engage with applications of empathy in the tough cases—stress and well being, bullying, business, and gender and romance. Engaging with these implementations is essential to consolidating the mastery of one’s practice of empathy—practice, practice, practice.

  1. Empathy and humor are closely related, and converge even further: Both empathy and humor create and expand community. Both empathy and humor cross the boundary between self and other. However, empathy crosses the boundary between individuals with respect, recognition, appreciation, and acknowledgement, whereas humor does so with aggression, sexuality, or a testing of community standards.

Here “aggression” includes language that people would find insulting. Therefore, be careful. The aggression or sexuality in question is usually presented in such a way that it creates a tension by violating social standards, morals, or conventions to a degree that causes stress short of eliciting a counter-aggression against the teller of the joke.

Substituting humor for empathy can work in some situations, but in others it can create a breakdown in the would-be relationship. You know how the more objectionable the joke, the funnier it is?

The result is either the release of tension through laughter or a failed joke and a shameful, if not scandalous, situation on the part of the joker. Indeed when the violation of the social convention, moral, or standard is such that the target of the joke experiences a dignity violation, then the joke arouses anger or even rage, not laughter. The caution flag is out.

Ground zero of cynicism and humor is Scott Adam’s Dilbert cartoon. It is wickedly funny because it expresses more than a grain of truth about dysfunctional, anti-empathic organizations.

In one classic example, the pointy-haired boss says that the organization will assign job functions based on the Myers-Briggs Personality Test. For those readers who may not know, the MBPT is the famous test that distinguishes introversion and extroversion, thinking and feeling, and related categories. The boss continues: “For those of you who do not have a personality, one will be assigned by the human resources department.”[viii] I must say that I am deeply ashamed of myself; I can’t stop laughing.

In humor, stress and psychological tension are created by violating a standard—in this case against insulting the lack of personality of the corporate cog—and then the stress is released in laughter by the mechanism of the joke such as a pun, double meaning, or violation of expectations.

The more objectionable the joke is, the funnier it is. The put down, “If you do not have a personality, one will be assigned by HR” is indeed wickedly funny; but it is also deeply debunking of the corporate world (and shaming of the individual), in which people come to feel like a gear in an inhuman mechanism.

After a day at the office, people often feel as if their personality had been erased.

So a trace of empathy for the long suffering inhabitants of corporate cubicles does come to the surface after all. That is what Scott Adam’s Dilbert longs to express. It is a common place in the corporate world that people function as replaceable cogs in a well-oiled machine. Therefore, in this case, the cartoon is an example of how not to expand empathy. Cynicism and shame drive out empathy; and driving out cynicism and shame create a space into which empathy can expand spontaneously.

How then does one drive out cynicism, shame, denial, and so on? The short answer is by calling it out, acknowledging it, interpreting it, and offering an alternative point of view. Not “alternative facts,” which have come to mean “spin” and “deception”; but an alternative perspective. It is cynicism versus empathy.

Empathy is the foundation of community in a very deep way, for without empathy we would be unable to relate to other people. In being empathic with another person, one creates a community with the other person; likewise, with humor. Humor creates a community among the audience and joke teller as the tension is dispelled in the laughter. For more on creating community through jokes, I recommend Ted Cohen’s Jokes: Philosophical Thoughts on Joking Matters, which also contains some really funny jokes.[ix]

  1. Train and develop empathy by overcoming the obstacles to empathy: People want to know: Can empathy be taught? People complain and authentically struggle. People say, “I just don’t get it—or have it.” The short answer is: Yes, empathy can be taught.

What happens is that people are taught to suppress their empathy. People are taught to conform, follow instructions, do as they are told. We are taught in first grade to sit our seats and raise our hand 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, “Jump up and run around screaming” (unless it is recess!). But compliance and conformity are a growth industry 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 pyramid. The lesson? If a person can contract his or her empathy, the person can also expand it.

Now do not misunderstand this: people are born empathic, 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 math 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 that rule-making and the drum beat of compliance seem to be growing by leaps and bounds.

Teaching empathy consists in overcoming the obstacles to empathy that people have acquired. When the resistances are overcome, then empathy spontaneously develops, grows, comes forth, and expands. That is the training minus all the hard work.

The hard work? Remove obstacles to empathy such as dignity violations, devaluing language, gossip, shame, guilt, egocentrism, narcissism, lack of integrity, inauthenticity, hypocrisy, making excuses, finger pointing, jealousy, envy, put downs, being righteous, stress, burnout, compassion fatigue, cynicism, denial, competing to be the biggest victim, and injuries to self-esteem—and empathy spontaneously expands, comes forth, develops, blossoms. Yes, empathy can be taught.

  1. 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 the last two years that I am repeating, since it is still accurate but a work in progress—and, unfortunately, picking up even more speed, going in the wrong direction. The Affordable Health Care Act (“Obamacare”)—reportedly to be terminated with extreme prejudice at any moment—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.”

Future73nbcropped2. Empathy is the secret sauce in sexual satisfaction: Empathy is the new love. It is what people fundamentally desire – to be gotten for who they authentically are. When one person’s desire aims at the other person’s desire, then desire begets desire. The desire of the other’s desire is precisely the empathic moment. Sex goes better with empathy, providing access to the kind of kindling that transports the couple into a raging conflagration. The empathy lesson is that one takes off one’s inhibitions with one’s clothes, undressing one another.

While love is a many splendid thing, empathy is what is required to get off with another person. The “secret sauce” is when one partner gives permission to be turned on, and the other partner is inspired to accommodate. Then the Hollywood cinema cliché of sky rockets and fire works fits the moment. The recipe is about facilitating and sustaining such a state to create a peak experience . The secret sauce is empathy.

Desire unleashes a runaway process of desire between the partners that works something like the Dutch tulip craze of the 1630s, only in sexual favors. Like a speculative market bubble, desire becomes desirable because it is desired. But does such “irrational exuberance” in desire then threaten the entire relationship between the partners the way the housing bubble threatened the world economy? Certainly there are risks to the relationship in unleashing a sexual inferno. It requires a certain ego strength to let go and be vulnerable. In the case of sexuality versus economic bubbles, organism and ultimately pregnancy tend to moderate the runaway process. Meanwhile, the partners are willing to try to read the clues and do what the other wants the partner to do to the other person. A synchronization of desires occurs. The other can see through one to one’s desire. One can see through the other to the other’s desire. That’s the empathy lesson. This is starting to sound a lot like empathy.

And THE number one empathy lesson trending in 2018 (drum roll, please):

  1. Empathy is the ultimate anti-bullying antidote: Bullying is abroad in the land.       Bullying is all about violating the boundaries between the bully and the target—personal, physical, emotion; empathy is all about establishing and reestablishing boundaries between self and other. Empathy is the antithesis of bullying. Wherever empathy lives, bullying has no place. When you think about it for two seconds, so is parenting, teaching, and being a traffic cop—all about setting boundaries.

At least initially, establishing boundaries is not about having empathy for the bully; it is about being firm about damage control and containing the bullying. Ultimately the bully benefits even as the community is protected from his perpetrations; but more in the manner of a three year old child, who, having a tempter tantrum, benefits from being given a time-out in such a way that he cannot hurt himself or others.

Kids in middle school have usually developed some empathy for those on the “inside” of their peer group. The developmental milestone for them is to be expand their definition of “inside” and widen the circle of caring, making more of “them” into “us.” The many different kinds of bullies, bullying, and possible responses on the part of children, students, teachers, parents, and administrators will not be repeated here. Suffice to say: if it’s mean, intervene.

Empathy versus bullying is receiving much needed attention in middle and high schools; but it is also a significant factor in business and politics.

Bullying is not just for high school “bad boys” anymore. In politics, Mr. T. returns tit for tat in a verbal salvo against “Little Rocket Man [LRM].” LRM man remains true to his name and fires a real missile test across Japan in the direction of the central pacific. Under a future scenario that is not hard to envision, a miscalculation leads to a fail safe situation, which does not fail safely. A nuclear exchange escalates, resulting in burning cities that put enough particulate matter into the upper atmosphere to create a twenty-five year long “nuclear winter,” causing a species extinction. The human species ends; it was just a bad idea anyway. Come on, guys, we can do better than that. This is not an inevitable outcome.

However, a word of caution: it seems really to be the case that LRM would rather see the people of the North eat grass rather than give up the nuclear weapons. These people might have something to say about that at some point, or maybe not. But if shooting starts, head for the bomb shelter, it will be too late for empathy to make a difference, except perhaps much later on for the survivors, if there are any.

Meanwhile, the empathy lesson: empathy deescalates anger and rage: When people do not get the empathy to which they feel entitled, they start to suffocate emotionally. They thrash about emotionally. Then they get enraged. The response? De-escalate rage by acknowledging the break down—it seems you really have not been treated well—clean up the misunderstanding, and restore the empathic relatedness. Empathy does many things well. One of the best is that empathy deescalates anger and rage.

Without empathy, people lose the feeling being alive. They tend to “act out”—misbehave—in an attempt to regain the feeling of vitality that they have lost. Absent an empathic environment, people lose the feeling that life has meaning. When people lose the feeling of meaning, vitality, aliveness, dignity, things “go off the rails.” Sometime pain and suffering seem better than emptiness and meaninglessness, but not by much. People then can behave in self-defeating ways in a misguided attempt to awaken a sense of aliveness.

“Empathy is oxygen for the soul” is a metaphor. But a telling one. When people do not get empathy—and a short list of related things such as dignity, common courtesy, respect, fairness, humanity—they feel that they are suffocating—emotionally.

People act out in self-defeating ways in order to get back a sense of emotional stability, wholeness and well-being—and, of course, acting out in self-defeating way does not work. Things get even worse. One requires expanded empathy. Pause for breath, take a deep one, hold it in briefly while counting to four, exhale, listen, speak from possibility.

The empathy lesson? Set boundaries. Look for balance. Be responsible. Own it. Empathic parenting is about boundary setting. With older children, “first you do your homework, then you go to the mall (or play a computer game).” Just maybe there is a lesson here for international relations too. A good fence makes for good neighbors. But there is a gate in the fence. And over the gate is a sign that says “Empathy.”

NOTES / REFERENCES / CONTACT DATA / COPYRIGHT

[i] Roman Krznaric. (2104), quoted in Belinda Parmar.(2014). The Empathy Era: Woman, Business and the New Pathway to Profit, London: Lady Geek: 91. Parmar does not cite a page in Krznaric, and I have not been able to find it so far.

[ii] Tristam Vivian Adams. (2016). The Psychopath Factory: How Capitalism Organises Empathy. London: Repeater Books: 56–77.

[iii] William Gentry. (2016). Rewards multiply with workplace empathy, Businessolver: http:// www.washingtonpost.com/ sf/brandconnect/businessolver/ rewards-multiply-with-workplace-empathy/ [checked on 03/31/2017].

[iv] Ibid.

[v] Jodi Kantor and David Streitfeld. (2015). Inside Amazon: Wrestling big ideas in a bruising workplace: The company is conducting an experiment in how far it can push white-collar workers to get them to achieve its ever-expanding ambitions. The New York Times, August 15, 2015: https://nyti.ms/1TFqcOG [checked on June 30, 2017].

[vi] Alynia Selyuk. (2017). Uber CEO apologizes over video of dispute with Uber driver. National Public Radio (NPR) All Things Considered: http://www.npr.org/2017/03/01/5179 88142/uber-ceo-apologizes-over-video-of-dispute-with-driver [checked on July 2, 2017].

[vii] According to Forbes: Milken made his billions in leveraged buyouts in the 1980′s, only to be sent to prison in 1989. He pleaded guilty to securities fraud after the government agreed to drop criminal charges against his younger brother, Lowell, and then served 22 months. The one-time Drexel Burnham Lambert executive has charted an entirely different course ever since and is a well known philanthropist.: https://www.forbes.com/sites/luisakroll/2012/10/26/billionaires-and-former-billionaires-who-have-spent-time-behind-bars/#6b7b75 b32107. Meanwhile, more breaking news, as this article is being written, some 49 men stand accused of sexual misconduct in various workplaces extending from Harvey Weinstein’s Hollywood production company (from which he was fired) through venture capital firms to restaurant businesses: https://www.nytimes.com/ interactive/2017/11/10/us/men-accused-sexual-misconduct-weinstein.html?_r=0. The problem is that, while it is good that this abuse is finally coming out, it has been hidden in plain for years and years. See Harry Markopolis’ (2010) statement in a different context above, “no one would listen” [also the title of his book]. Where is Lord Acton when we need him? He is the one who said: “Power corrupts; and absolute power corrupts absolutely.”

[viii] Scott Adams. (1996). The Dilbert Principle. New York: Harper Business.

[ix] Ted Cohen. (1999). Jokes: Philosophical Thoughts on Joking Matters. Chicago: University of Chicago Press.

Contact data: LouAgosta@gmail.com

© Lou Agosta, PhD and the Chicago Empathy Project, this post and all posts and content of this site

 

Empathy Lesson One: Empathy is different than compassion

Most people believe that empathy is compassion. I routinely ask the people in my empathy training classes to ask five of their acquaintances, “How do you define empathy?” and to do this without saying what they think empathy is. The respondents

Image of Buddha

The world definitely needs more compassion, but compassion is distinct from empathy

routinely report back with a story about altruism, charity, niceness, and prosocial behavior. “Prosocial behavior” is an action or intervention that helps one’s neighbors in deeds and words. And, heavens knows, the world needs more compassion. However, compassion is distinct from empathy. This series of posts will say how.

Most people regard empathy as something like a switch that one can turn on or off. One has it or one hasn’t. Even books that promise to train you in empathy say that the book is going to tell you how to get it. Note this implies you haven’t got it. This is not a good way to regard your prospective audience or client. This series proposes an alternative perspective on the matter. Empathy is more like a dimmer – a dial that one can tune up or down – depending on the situation. This is not easy to do, which is why training and practice are needed.

You know how we can feed everyone on the planet, so that there should be no need for people to get sick and die due to starvation? Thanks to the Green Revolution, miracle seeds, and the economies of scale of agri-business enough food exists to provide everyone with at least a minimum level of nutrition? Yet people are starving. People are starving in the Middle East, Africa, and even in desperate parts of the inner city in the USA. People are starving because of politics (in the negative sense), aggression, prejudice, break downs in social justice, and break downs in community. There is enough food to go around, but it is badly distributed. Likewise, with empathy. There is enough empathy to go around; but it is badly distributed. Organizational politics, human aggression and narcissism, stress and burnout, attempts to control and dominate, all result in empathy “going off the rails.”

Therefore, I and the proponents of empathy with whom I align do not call for “more” empathy, but rather for “expanded” empathy. The difference is subtle. Saying “we need more empathy here,” implies the person lacks empathy and that is an insult. In the extreme cases – serial killers, psychopaths, people on the autistic spectrum – they do in fact lack empathy in a technical, diagnosable sense. However, in most cases, people have a significant empathic ability with which the individual may be out of touch at a given moment or in a particular situation. Their empathy is implicit and is waiting to be expanded. Therefore, the call goes out for expanded empathy – to leverage that grain of sand of empathy that already exists and develop it, if not into a mountain, at least into large hill of empathy. Experience indicates that calls for “more empathy” result in a breakdown of empathy because the call is experienced as a dignity violation. “Are you saying that I lack empathy? How insulting. Humpf!” Well, not exactly. I am saying that expanded empathy would make a difference in getting unstuck, reestablishing relatedness, and overcoming the challenges at hand. This may seem like a rhetorical flourish, and perhaps at some level it is that too; but it is really an accurate description of the subtlety of the human situation in which people assume their own point of view is right – and, therefore, is the empathic one. With that in mind, we acknowledge this is going to take some work.

One reason that empathy training programs have not worked or have had mixed results is that they train the participants in compassion, being nice, conflict resolution, baby and child care, and a number of worthy and related tasks. This is all excellent, and the use of empathic methods in these areas is making the world a better place, so keep it up. There is nothing wrong with being nice and so on. Pardon the double negative: don’t not be nice. But something is missing – empathy. Expanding one’s empathy requires an engagement with one’s own inauthenticities around empathy. Most people would rather not look at their own blind spots about empathy. Most people would rather not look at how their own empathy breaks down and fails. Expanding one’s empathy requires engaging with one’s own resistance to empathy. Until we engage with our own resistance to empathy we will remain stuck in our blind posts, break downs, burn outs, and compassion fatigue.

The courageous person knows fear but is not stopped by it. The empathic person also knows fear – fear of being vulnerable, fear of resistance, fear of rejection, fear of compassion fatigue. This introduction acknowledges the empathy of the readers – your courage in taking on the issues that you need to engage in order to expand your empathy and that of the community. “Courage” does not mean not being afraid or experiencing fear. It means being afraid and going forward in spite of one’s fear. Likewise, with empathy. The empathic person goes forward into authentic relationships individually and in the community in spite of fear.

The challenge up front is to get access to the foundation of empathy. The architect building a structure knows that the building has to be based on bedrock. You have to go down to what is stable and abides. If the foundation does not go down to bedrock, the structure can be magnificent, beautiful, and elegant; but it will inevitably crack, lean over like the leaning Tower of Pisa, and then fall over due to a faulty foundation. If human relations are the building and empathy is the foundation of the building., then we first have to explore what is bedrock on which the foundation is supported. And if one regards empathy as the foundation of human relatedness, we are in effect asking – what is the bedrock of bedrock? On what is empathy itself founded? The answer is surprisingly straightforward: Authenticity. Authenticity is basic to empathy. Without authenticity, nothing works. Not even empathy.

For those who simply cannot stand the suspense of knowing that empathy is not compassion and wanting then to have a definition of empathy, here is the proposal that will be developed in this series. Empathy is the form of authentic human relatedness in which one person is receptive in a vicarious experience to the experience of the other person in which this vicarious experience is processed further in understanding of the other person as a possibility [empathic understanding], appreciates the perspective of the other person from the other’s point of view [the folk definition of empathy as talking a walk in the other’s shoes], and responds in such a way that the other person gets her or his own experience back from the listener in a form that is recognized as one’s own. It will take some work to unpack these four dimensions of empathic receptivity, empathic understanding, empathic interpretation, and empathic responsiveness. That is why this is a series. Stand by for the next exciting episode.

(c) Lou Agosta, PhD

10 Top Empathy Trends for 2017

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 themfuturenextexit 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!?]

Bibliography

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.

John M. Kelley, Helen Riess et al, (2014), The Influence of the Patient-Clinician Relationship on Healthcare Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials, PLOS ONE [Public Library of Science], April 2014, Vol. 9, Issue 4.

Heinz Kohut, (1977). The Restoration of the Self. New York: International Universities Press.

David P. Rakel et al, (2009),”Practitioner Empathy and the Duration of the common Cold, Fam Med 41(7): 494 – 501.

Lou Agosta, (2015). A Rumor of Empathy: Resistance, Narrative, and Recovery. London: Routledge.

_________ (2014). A Rumor of Empathy: Rewriting Empathy in the Context of Philosophy. New York: Palgrave Pivot.

__________ (2010). Empathy in the Context of Philosophy. London: Palgrave Macmillan.

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

Empathy, Stress, Neural Science – the Movie!

Here is my short, half day course on Empathy, Stress (Reduction) and Neural Science delivered at the Joe Palombo Center for Neuroscience at the Institute for Clinical Social Work on December 03, 2016. The image depicted below is the punchline to a Richard Feynman joke about the cosmos – “It’s turtles all the way down” – in the case of neuroscience “It is neurons all the way down!” Granted that the joke is not funny if one has to explain it, the video provides all the background you need to laugh (one way or the other!) –

A famous person once said: “Empathy is oxygen for the soul.” So if one is feeling shortness of breath, maybe one needs expanded empathy! This course will connect the dots between empathy and neuroscience (“brain science”). For example, empathic responsiveness releases the compassion hormone oxytocin, which blocks the stress hormone cortisol. [This is an over-simplification, but a compelling one.] Reduced stress correlates to reduced risk of such life style disorders as cardiovascular disease, diabetes, weak immune system, depression, and the common cold.

The session engages each of the following modules in the discussion segment, including suggested readings. Except for the first two topics, we can take them in any order and the participants will get to select:

  1. This is your mind on neuroscience – mirror neurons: do they exist, and if not, so what?
  2. Sperry on the split brain: the information is in the system: how to get at it
  3. The neuroscience of trauma – and how empathy gives us access to it
  4. MRI research: as when Galileo looked through the telescope, a whole new world opens

Presenter: Lou Agosta, PhD, is the author of three scholarly, academic books on empathy, including A Rumor of Empathy: Resistance, Narrative, Recovery (Routledge 2015). He has taught empathy in history and systems of psychology at the Illinois School of Professional Psychology at Argosy University and offered a course in the Secret Underground Story of Empathy at the University of Chicago Graham School of Continuing Education. He is an empathy consultant in private practice in “on the forward edge in the Edgewater Community” in Chicago.
(c) Lou Agosta, PhD and the Chicago Empathy Project