Developing Empathy

A Biopsychosocial Approach to Understanding Compassion for Therapists and Parents

Katharina Manassis

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781315530475
• Edition: 1
• Topic: Psicologia
• Subtopic: Emozioni in psicologia

Empathy is valued across cultures, and has a profound impact on psychotherapy, our children, and our world. Why then are many human relationships not empathetic? This volume describes in detail the neurobiological, psychological, and social elements involved with empathy. Ideas are brought to life with case examples and reflective questions which help the reader learn ways to overcome empathetic barriers. The book shows how fear, anger, and anxiety all take away the power to feel for others, while also looking at the topic through a global lens. Developing Empathy is an easy-read book, backed by science, useful to the clinician, and to all readers interested in the topic.

Part I

Understanding Empathy

1 Perspectives on Empathy: Why is an Obvious Virtue so Elusive?

A number of books, both for academics and more general audiences, have recently been written about empathy. As a result, it was challenging to convince my publisher that this book would be “different”. Eventually I realized, however, that the biopsychosocial approach used provides an effective framework for both organizing previous ideas about empathy and addressing what is perhaps the most vexing question in this field: Why is an obvious, much-extolled virtue like empathy so difficult to practice consistently? Empathy and altruistic behavior based on empathy have been advocated by sages for millennia, yet sadly they are often elusive in modern life. Understanding the reasons for this problem and how we can work individually and collectively to address it became a central theme of this book. Part I focuses on understanding the problem, based on what is already known about empathy, Part II applies that understanding to the quest to nurture empathy in ourselves and others, and Part III explores implications for some specific audiences who may be reading this book.

Empathy: An Old Ideal Whose Time has Come Again

As a cursory look at any dating site will show, it has become commonplace to refer to oneself as a “work in progress” or to lament that one is “still on the road to finding myself”. For those of us working in mental health, “lack of self-esteem” is a common presenting problem. The common thread in these examples is an emphasis on “self”, and the assumption that once one is satisfied with that “self” happiness and good mental health will automatically follow.

Paradoxically, one of the best indicators of high self-esteem is a lack of preoccupation with oneself. People who like themselves don’t need to worry about how they look, what impression they make, whether or not they are doing well, or how happy or unhappy they are currently. It is almost as if they have forgotten themselves, or that “self” just doesn’t matter very much—instead, they are enthusiastic about life and living, they attend fully to those near them, resulting in greater empathy, and they look for ways to make the most of whatever circumstance they find themselves in. This state results in benefits for individual well-being, relationships, and communities.

If this state is so beneficial, however, then why doesn’t everyone work on becoming less self-absorbed and more outwardly and relationally focused? Why do empathy and altruistic behavior often seem like the exceptions rather than the rule in our society? To find the answers to these questions, a brief historical review of ideas about collective and individual well-being is provided, before examining the nature of empathy in detail.

Collective Well-Being

Throughout evolution, human beings have banded together for mutual protection and support, as survival in a harsh environment was unlikely on one’s own (see Lewis, 1992). Allegiance to one’s group or tribe was an important social value, often superseding individual concerns. Those who behaved selfishly risked not only punishment but banishment from the group, often with lethal consequences. Those who developed empathy (albeit empathy limited to those within the group) generally fared better. Thus, there was a strong incentive to act in ways that benefitted others or benefitted the tribe as a whole. Conformity to the norms of the tribe sometimes resulted in cruelty, but individual selfish acts were definitely discouraged.

The invention of the printing press in the fifteenth century is often cited as the beginning of the modern age (Martin, 1995). By making the printed word accessible to large numbers of people, this invention ushered in a new era where education was no longer limited to a privileged elite, but became available to ordinary people. These people soon realized the possibility of using education to improve one’s station in life. Individual achievement became a new cultural ideal, gradually replacing the old ideal of service to one’s tribe or community. On the positive side, the emphasis on individual goals fostered a degree of scientific and technological discovery that had never been previously seen. It also become possible for educated people to challenge many of the old superstitions and prejudices that had been embedded in collective/tribal culture, broadening intellectual thought. Unfortunately, individualism had a dark side as well. Success and independence became regarded as virtues, resulting in arrogance among high achievers, denial of human inter-dependence, and disdain for the vulnerable or anyone incapable of conventional success. Obviously, these attitudes were not conducive to empathy.

To a degree, these attitudes persist today, though they are often considered politically conservative and not shared by everyone. Large organizations, for example, often have mission statements that extoll the virtues of collaboration and have staff engage in “teambuilding” exercises, but still use criteria related to individual achievement when considering employees for promotion. The poor still strive to become more affluent through individual achievement. Mass communication has resulted in another variant on this theme: emphasis on individual fame as a proxy for success. Appearances on reality television, “you-tube” videos, and pithy little “tweets” are new sources of individual acclaim.

Mass communication has had a different effect too though: increasing awareness of global issues. We are reminded daily of wars and disasters in distant parts of the world, of the striking inequities between human life in the developed and the developing world, and of the myriad ways in which we all affect and depend upon a sustainable natural environment. Though not always eliciting empathy, these reminders certainly make it harder to ignore the plight of our fellow human beings. The environmental movement has taken this awareness a step further: encouraging empathy for all creatures, and for the planet as a whole. Thus, individualism is starting to be balanced by collective thinking again. This new collective thinking is not limited to a specific tribe or group though, but rather (in Marshall McLuhan’s terms) includes the “global village” (see Levinson, 1999).

Individual Well-Being

Collective/cultural ideals have affected our attitudes towards empathy, but ideas about what constitutes a good or meaningful life have as well. These ideas have also shifted over time.

As mentioned in the Preface, a version of the Golden Rule encouraging altruism exists in all major spiritual traditions. Interestingly, this has occurred despite little or no contact between some traditions, suggesting that spiritual sages independently came to the same conclusion. Perhaps this was because altruistic behavior was found to be important for social harmony. On the other hand, perhaps this related to the common observation that people easily become selfish when they feel even slightly threatened. When we feel our own or our family’s survival is in jeopardy, the fight or flight reaction that results in a narrow focus on oneself is adaptive (see Music, 2014). Those who are prone to it are thus more likely to reproduce and pass along this trait. Unfortunately, even when survival is no longer threatened, the focus on oneself can persist to the detriment of one’s relationships and community. People who are often anxious or have explosive outbursts of anger are particularly vulnerable to fight or flight reactions. The parts of the brain that allow us to regulate these emotions are a relatively recent evolutionary development. The admonition to treat others as one would want to be treated may therefore be an appeal to this more rational, regulatory part of the brain which would otherwise be silenced by the powerful survival-based fight or flight response. The Golden Rule encourages perspective-taking, an important component of empathy.

As scientific approaches to mental health and well-being gained prominence, spiritual ideas were put aside. Sigmund Freud was a neurologist, and started a tradition of applying the medical model to mental health issues. Distress and deviant behavior were considered signs of pathology to be identified and rooted out, much like surgically removing a tumor from the body. Psychiatry classified and re-classified mental disorders in the hope of accurately matching clusters of symptoms with effective treatments designed to eliminate them. Theoretical schools differed in their descriptions of pathology—some emphasizing internal conflict, others faulty relationship models, and still others maladaptive thoughts and behaviors—but until recently all shared a focus on improving mental health by treating pathology. Empathy only entered the picture when it was lacking: this disorder was termed “psychopathy” or “antisocial personality”, and it was rarely treated successfully.

Eventually though, science led back to empathy. The discovery of mirror neurons and empathy-related hormones suggested that human beings have an innate capacity for empathy, whether or not they use it. These neural substrates of empathy are described further in the next chapter. Concurrently, psychiatrists were discovering the limitations of trying to categorize human beings according to their type of mental suffering and treating them accordingly. Many people fit more than one category (called “comorbidity”) and comorbid presentations were difficult to study and treat. Moreover, even when treatment succeeded, the elimination of symptoms did not always result in a happier, more productive life. The need to build upon psychological strengths to enhance overall well-being and socially adaptive behavior was recognized. Empathy is one of those strengths. The strength-based approach is described further in the section below on positive psychology.

While mental health professionals struggled with the medical model, philosophers had been developing further ideas about empathy. The aesthetic philosopher Vischer (1873–1994) described “Einfühlung”, the pleasure of contemplating a work of art to the point of projecting oneself into it. This idea of projecting oneself into something was later applied to human relationships, and elaborated by a number of twentieth century aesthetic and social philosophers. Humanist philosophers, on the other hand, did not use the word “empathy” but wrote about the centrality of inter-subjective, person to person relationships in meaningful life. Perhaps the best known of these is Martin Buber (see Buber, 1937/2004), who described a mental and spiritual connection with another person as an “I-Thou” relationship, in contrast to an “I-It” relationship where the other person is objectified. “I-Thou” implies a level of respect for and attention to the other person’s experience, not unlike empathy.

Empathy in Psychiatry and Clinical Psychology

Empathy gradually gained prominence in psychiatry and clinical psychology as Rogers (1959) described it as a key therapeutic element of psychotherapy, and later Kohut (see Kohut, 1971) developed “self-psychology”. Self-psychology was developed to treat personality disorders characterized by high self-absorption (mainly narcissistic personality disorders) and used empathy as its key clinical tool. Kohut found that when the self-absorbed feel understood, they become less focused on themselves and more open to different ways of relating to others. In his studies of child development, Bowlby (see Bowlby, 1969) related the development of empathy to secure parent-child attachment (see Chapter 2). His followers subsequently showed numerous benefits to such secure relationships, including decreased emotional and behavioral problems in children (reviewed in Schore, 2001).

Seligman’s “positive psychology” movement, however, has represented a paradigm shift in relation to empathy (Seligman and Csikszentmihalyi, 2000). Whereas previous theorists saw empathy as a clinical tool in preventing or treating mental illness, positive psychology sees empathy as an end in itself. Positive psychology is defined as “using psychological understanding and intervention with the goal of achieving a satisfactory life rather than treating mental illness” (Compton, 2005a; Seligman and Csikszentmihalyi, 2000). The pursuit of the “satisfactory life” brought to light a number of findings related to empathy. For example, Vaillant’s longitudinal study of Harvard graduates found that healthy, strong relationships were a key aspect of successful and happy living (Shenk, 2009), and empathy was an important aspect of healthy relationships. Positive psychology has also explored the benefits of spirituality. Nelson (2009) found that spirituality’s association with well-being was best explained by virtues, resulting in renewed interest in virtue. Six cardinal virtues were found across cultures. One of these, “humanity”, is closely linked to empathy. Humanity corresponds to behaviors that show love, kindness, and social intelligence.

Pulling together the literature on well-being (or the “satisfactory life”), Seligman eventually posited five main elements summarized by the acronym PERMA: positive emotions, engagement (in interesting activity), relationships, meaning (or sense of purpose), and accomplishments. These elements often interact. For example, the “broaden and build” theory of positive emotions (Compton, 2005b) suggests that positive emotions result in broader awareness and interest in novelty and exploration, whereas negative emotions prompt narrow, personal survival-related behaviors such as fight or flight responses. As empathy requires an outward focus, it is easier in the absence of fight or flight (i.e., when happy and relaxed) and conversely the altruistic behaviors associated with empathy often make us happy.

Haidt (2003) took the latter idea a step further in describing “virtuous cycles” based on the emotion of “elevation”. Elevation is a positive emotion that occurs when people realize they have done something that benefits another person, prompting them to do more good deeds, resulting in more feelings of elevation, and so on in a positive cycle of virtue. Although empathy and altruism are distinct (see later in this chapter), it is not difficult to imagine that someone who is happy, outwardly focused, and empathetic would be more likely to engage in such a “virtuous cycle”.

However, positive psychology is a broad field encompassing many aspects of personal and collective well-being in addition to empathy and altruism. The next section reviews ideas that are more specific to empathy.

Recent Ideas about Empathy

The recent literature about empathy is vast. It includes perspectives from various branches of psychology, philosophy, neuroscience, and other disciplines. Surveying this literature, however, two themes seem to emerge. First, many theories and empirical studies have sought to distinguish empathy from other constructs. Second, many theories and empirical studies have sought to parse empathy into its component processes. Both have yielded useful and often similar ideas, but the language varies by discipline. What follows is a brief summary of the two main themes this author could identify.

Empathy Versus Other Constructs

A number of authors have sought to distinguish empathy from sympathy. Sympathy is seen as a more general, “third person emotional response” (Darwall, 1998) relative to empathy. Unlike empathy, sympathy does not include any attempt to share a specific person’s mental or emotional state. For instance, one can have sympathy for people caught in a flood or other natural disaster on the news, but one does not usually imagine the thoughts and feelings of a person standing in ever-deepening water at home, gasping for breath in a small air pocket below the roof, and about to drown. Few people could tolerate watching the evening news if this occurred.

A second distinction that has been discussed is the difference between empathy and self-transcendence (Cloninger, Svrakic and Przybeck, 1993). Self-transcendence is the ability to divert attention away from one’s own immediate concerns to other aspects of life. It is thought to be needed in order for empathy to be possible, but it is not sufficient. When I empathize with another person, I not only transcend my own interests but also choose to focus on the well-being of the other person. I could just as easily transcend a focus on my own interests and choose to shift my focus to a starlit sky, or to a stirring symphony, or to a riveting movie. I value all of these experiences but they do not involve an effort to put myself in another person’s shoes, so they do not constitute empathy.

A third distinction that has been discussed is that between empathy and compassion. Although these two terms are sometimes used as synonyms, “compassion” is more prominent in spiritual rather than psychological traditions. Karen Armstrong (2010), writing on compassion, indicates that it “calls us to always treat others as we wish to be treated ourselves”. Thus, compassion focuses on a broad, behavioral principle. Empathy often results in compassionate behavior, but it emphasizes one to one relationships where people try to cognitively and emotionally relate to one another’s perspe...