“Loneliness and the feeling of being unwanted is the most terrible poverty.”
What picture do you see when you read this quote from Mother Theresa? Do you see an orphaned child living in poverty? Or, maybe a homeless person begging on a corner?
Depending on the current context your own life provides, and even your mood, you are likely experiencing at least a twinge of empathic concern. We relate to loneliness, hunger, and isolation even if we never experience them. However, some of us will muster up very little emotion when we read these words. Does this mean you don’t care? Maybe. Or it could be that you’re having a really bad day with no more energy to devote to the misfortune of others.
The truth is there are times when our empathic capacity is activated and other times when it isn’t. Some of us tend to feel a wave of compassion often. Others are tougher nuts to crack emotionally. Just like every other human emotional and neurological capacity, there is a continuum for empathy, with most of us clustered around the center. Each day, depending on a host of factors, including mood, hunger and sleep, and level of responsibilities you carry, you slide a notch or two up or down this scale.
In the last decade, researchers have explored the role of “shared neural networks” in the empathic response. Studies demonstrated that the human brain’s pain matrix is activated by our own pain as well as by witnessing others’ pain. What all this fascinating science shows is that on a profound level, we are all connected neurobiologically far more than we previously realized. Consciously or not, our personal experience of the pain of others motivates us to engage in cooperative behaviors that are necessary for the survival of our species, and the possibilities for mutual aid and collaborative problem solving abound. But this resonance can be emphasized or blunted by many factors.
The more we relate directly to others and to their lived experience, the more we can empathize. The people we relate to the most are those we consider our “in group.” Psychologists call our preference for those who are more familiar to us “in-group bias.” Humans have evolved for thousands of years and lived primarily in small communities. Our historic survival depended upon aligning ourselves with our in-groups – people who looked like us, spoke the same language, ate the same foods, worshiped the same god, and much more. Even today, in a connected, digital world, we humans often act locally instead of globally.
The in-group legacy becomes a problem when it limits our capacity to experience empathy for people who don’t share our own characteristics – the so-called “out groups.” Some people automatically consider anyone with a different skin color from their own an out-group. Other people automatically out-group people of other nationalities, political affiliation, gender, lifestyle, religion – the list goes on.
In-group bias is so ingrained and subliminal that most of us struggle to be objective. Studies show that it takes longer for white subjects to accurately identify the emotional expression on a Black face, and that it is easy to confuse fear with anger. This racially biased time-lapse has extremely serious implications for how police respond to an emotional expression on a Black face. It could mean the difference between life and death. Such differences in face perception may influence how police treat suspects to how much time physicians try to understand their patients. Our society cannot afford to continue making these devastating mistakes.
My own research has shown how empathy training can help doctors and other professionals relate to each other and communicate with patients from unfamiliar communities. Opportunities to walk in the shoes of others humanize patients as fellow human beings. While no exercise or simulation can provide the full experience of being disabled, they can enlighten us about the challenges people face. Most of us can’t conceive of getting on a bus in a wheelchair and the agony of overhearing the hostile mutterings from other passengers, annoyed at being delayed. To feel like an inconvenience to others is a tremendous burden to bear on top of the disability itself.
For some people, especially those in the caretaking professions, running low on empathy can become an occupational hazard known as “compassion fatigue.” Some can create self-protective boundaries to distinguish their own feelings from those of others. Others may become increasingly more upset when witnessing other people’s pain. One of the ways we teach appropriate empathic responses is by strengthening the cognitive aspects of empathy while offering strategies for tamping down excessive emotional responses and emphasizing the importance of self-empathy.
In the face of a global pandemic, when health care professionals are overwhelmed and physically and emotionally exhausted, federal and state policies need to be put in place to protect and support health care workers from the skyrocketing epidemic of burnout that is threatening both clinicians and patients. There are limits to what individuals can do to preserve empathy without policies that relieve administrative burdens, support mental and physical health, and provide incentives for professionals and the general population to participate in changing lifetime habits that support their well-being,
Roadblocks to empathy
No matter how extensive or well-developed your capacity for empathy may be, you cannot feel empathy for everyone all the time. Whether we’re talking about doctors who have never been patients, or clinicians who have never faced discrimination, we know that people’s ideas can change, when properly educated and supported.
In a randomized, controlled trial, one of the most exciting findings within my own research into the malleability of empathy looked at physicians of six different medical and surgical specialties. Using the E.M.P.A.T.H.Y.(R) acronym and other techniques, physicians learned how to accurately “read” their patients’ states of emotion and respond more empathically. Post-intervention, the training group received significantly higher patient satisfaction scores than the control group.
The good news about our research is that it showed that we can be hopeful about changing the culture of medicine. We now have evidence-based tools to accomplish this. There is hope for a brighter future in health care and all relationships when empathic principles are learned and practiced at the local, regional, and societal levels.
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