The Root of Empathy

Introduction

Working with medical students permits me to reflect on my own days where I looked for a friend and counsellor in my formative years in medical school. That is the time where the metamorphosis occurs from adolescence to adulthood. The kind and learned Moses Christie Karunairatnam, our Biochemistry lecturer, struck me as a scholar who wanted to share his wisdom and kindlness, truly living to the Tamil interpretation of his name ( Karunai- kindness!). I could approach Dr Tan who was our Physiology lecturer who was easy going and not confronting. The founder Dean held himself above all others and was revered as the icon of medical education. He had to be the Dean and nothing else, befitting all the attributes of a head teacher you would have read in Tom Brown Schooldays.

To be a professional taking care of the sick and maimed, one needs role models and have an innate feeling for the less fortunate. Empathy is one attribute that needs to be exhibited, something I recognised in many of my teachers, whether in medical school or in primary and secondary schooldays. Now, we do research in empathy, although I had falsely accepted that empathy comes with those who take up the profession of doctoring. It pains me to see how rapidly the scenario has changed and less time is spent to express this trait in our daily duties.

Empathy and Compassion

Language is a beauty in that one can express thoughts and what we want to communicate in words. We often ponder if there is a difference  between compassion and empathy. Well, there is a difference. The word ‘compassion’ is derived from Latin to mean ‘to bear with or to suffer with’. Empathy is slightly different and is taken as a component of ‘compassion’ to mean ‘enter into or maintain a relationship to caring’.

In the Hindu faith Ahimsa is widely used to refer to ‘God quality within a person’. Ahimsa was advocated by the great Mahatma Gandhi in his non-violent movement for Independence of India. Compassion is central to Buddhism where the Buddha professed ‘absolute compassion of all creation (Karuna’). The Judeo-Christian sect also maintains compassion as a manifestation of God’s love and mercy.

Clearly empathy is the recognition of others suffering ; how one perceives the wants, needs, sufferings, feeling and emotions by putting oneself in the other’s shoes. There is a deep connection that goes beyond sympathy and intense resonance is experienced in understanding the emotional changes in the other person.  K.R Eister, in his treatise, ‘The Psychiatrist and the Dying’ moves to advice the caregivers ‘to give themselves selflessly to the dying as a free gift of love’.

Ernest Hemingway quotes’ ‘when people talk, listen completely. Most people never listen’. This is a call for giving a ear to the needy and sick.  Aristotle, the Greek philosopher once said, ‘to perceive is to suffer’. The novelist J.Scott Fitzgerald quotes, ‘when you feel like criticizing anyone, just remember that all the people in this world hadn’t had the advantage that you’d had ‘.

The Revered Gautama Buddha upheld the need to empathise by this famous quote,

‘Resolve to be tender with the young, compassionate with the aged, sympathetic with striving, and tolerant with the weak and wrong. Sometime in your life, you will have been all of this’.

Mahatma Gandhi, the most tolerant human I have read about, in his Godly statements commented, when Hindu and Muslim religions divided India  into two countries  during the struggle for Independence, “I call him religious he who understands the suffering of others”.

Medical Student’s Feedback

When my mentees or protégés  go away from the medical school curriculum to do their electives, they need to do a rotation in a field that is different from the normal curriculum. I often persuade them not to get stuck with a large hospital getting impressed with more application of technology but go out into society so as to appreciate the needs of the community. Quite a few students  have been advised  to change their initial proposals to areas I thought would benefit them more as far as empathy is concerned. On the otherhand , I did not have to counsel a few, as I could see this innate trait inherent in some of them; that  feeling they want to serve and share. I was particularly impressed by one shy female student who  often expressed the lack of confidence she had with her spoken  English Language. She wanted some experience in rural health close to her hometown in Sarawak. I guided her how she could maximise her experience by working with the allied health staff. But I also persuaded her to read some books written by doctors expressing humanism to improve her English Language. I requested her to give me a  report on the works of the writers she had read. What I got was an amazing reflective report on the works of Albert Schweitzer, the Nobel Peace Prize winner who worked relentlessly looking after the sick in a small hospital in West Africa, Anton, the Russian novelist who had been a doctor expressing the emotive trauma he had suffered through his stories about mental institutions and poverty and the author of the Sherlock Holmes series (Arthur Conan Doyle) , himself a retired ophthalmologist.

Another student elected to work with children who had hearing impairment and she was compassionate in her report elucidating the details of educating these ‘challenged ‘ children and the dedication and commitment of the teachers who clearly were limited by both expertise and facilities. The same student went  on to do an attachment in a distant village in Nepal where a small 30 bedded hospital with a visiting doctor (weekly) nursed and cared for leprosy patients and those with neurological damage due to spinal injury. Again the student was more than compassionate in her longing to serve the disadvantaged and how lack of funds and medical expertise did not stifle the existence of the hospital. She was passionate in her expressions of caring despite language being a barrier to communication.

Is empathy a trait or can it be taught?

Western culture has been taunted as nurturing the stereotypical belief that women are more emotional than men and this being related to masculinity and feminity. The fallacy is that women are able to express and communicate their emotions to others better compared to men. The masculine male is expected to supress and control his emotions leading to the often quoted statement, ‘boys don’t cry’. Did we not see the emotions expressed by Andy Murray when he lost the much needed Wimbledon Tennis championship to Roger Federer this year?  When Murray won the Olympic Gold medal, beating Federer convincingly in front of the British crowd, did we not empathise with him, let aside Murray expressing his emotions openly. Boys do cry!

Although research into empathy shows that female doctors appear to be more empathetic than male doctors, this is not a universal phenomena. Empathy appears to be a trait although we do feel it can be taught as we grow and understand human relations.

The empathy culture

For successful communication the Japanese have ‘omoiyari’ as a core value which refers to harmonious relations. It is intuitive and is a kind of indirect communicative style inculcated in the culture. The closest translation of ‘omoiyari’ is empathy. It is an understanding of unexpressed feeling, desires and thoughts. It is meaningfully expressed as kind and caring and is incorporated into the educational curriculum apart from it being part and parcel of the Japanese culture.

A Japanese medical student of mine (the only one) has been in communication with me over the last 2 years as  my mentee and I see in him all the attributes of empathy. He expresses this humanistic aspect in whatever communication he has with me, sharing his feelings along the way. Recently he lost his grandmother to illness but the poignant expression of empathy, the guilt of not being able to be with her the last few days, the satisfaction of having spent a couple of days a week before her passing is testimony of the ‘omoiyari’ feelings.

In the USA social and emotional learning has been revitalised through programs like ‘Root of Sympathy’. The Institute of Learning and Brain Sciences in Washington, Seattle has initiated the ‘Seeds of Empathy Program’ for the 5 year olds and ‘Root of Sympathy’ for the 9 year olds. The NoVo Foundation is a promoter of societal transformation to encourage social and emotional learning.

Empathy, though may be a trait, needs to be taught as the world has become compartmentalized by job descriptions and skills containment. The supervisor wants the products to come with zero defect and mechanization and computerization that goes with current job descriptions, neither permits nor desires one  to evaluate the feelings of employees and staff. Key performance indices count for  bonus and not empathy. Socialization skills are reduced to completion of work measured by indicators and timelines. The term ‘societal control’ is offensive as it affects empathy. Today industry and organizations continue to program the human to perform and produce leaving the soft skills to lie by the side leading to stress, conflict and destruction of human value and morality. The threatening elements of mother earth’s environment can be traced back to a lack of empathy. Human aggression at work and play and a lack of regard for authority and societal norms clearly points to a lack of moral instruction and empathy for others.

Can Empathy be learned?

The common situation observed when aggression sets in, is that one gets upset and loses himself ; at this stageb one can say that empathy is sacrificed. As empathy is central to humanity one needs to explore if empathy can be learned. Experiments on animals show that empathy is not only seen in humans alone but also in animals.

In one experiment ,monkeys who are rewarded with food if they completed an electric circuit were induced to press the bar twice to get double the reward (food). But in the process of getting more food another cohort of monkeys nearby were made to suffer pain should the experimental group of monkeys pressed twice to get double the food. On seeing their fellow monkeys suffering pain, the experimental monkeys refused to press the bar even once, preferring to starve! Similar experiments have also been done on mice. Several observations by naturalists point to this phenomenon among the animal kingdom. With such innate behaviour can we imaging how cruel people are when they kill and maim in the various conflicts involving humans throughout the world?

Animals can’t be very different from humans as they too reproduce and mind their young. They protect and feed and show their feelings too difficult for humans to understand.

Recently an article appeared in Science (2010; 328:633-636) declaring  the frog to closely resemble the human as far as human genome are concerned- the  frog is a ‘kissing cousin’. This then reminds me  the fables I read that  of the forg turning into a prince on being 'kissed '. Now I wonder if it was a fable! The amphibian’s genome ( Xenopus tropicalis) resembles that of humans.  Apparently 80% of the human genes associated with diseases is found in this species. Hence, exhibit some empathy when you feel like destroying a frog in the garden the next you spot one,  consider kissing it!

If psychological learning theories are true to understanding the human mind then Behaviourism, Cognitivist and Metacognitivism should impact on how we can learn humanism and empathy. Parents as role models have a huge impact on the growing child. They could influnece the young in empathy and compassion. The environment has an enormous impact on how emotional intelligence is nurtured. I would opine that empathy can be taught and behavioural conditioning would contribute to successful adoption of empathetic approaches.

John Hurt gave a real –to- life performance in the movie,  ‘The Doctor’. This arrogant surgeon became an empathetic person after he fell victim to cancer and learned about humanism from a fellow young girl who eventually succumbed to blood cancer. I encouraged one medical student to see that movie and she wrote a moving commentary of the finer aspects of compassion and empathy.

Is Empathy in our Genes?

We talked about human traits that navigate us through emotions and empathy. Are there genes we have that controls empathy and stress. One hormone called ‘oxytocin’ which is so vital in parturition and breast feeding is now thought to be beyond it being a ‘love hormone’. It now looks like kindness, love, caring and feeling for others is genetically ‘wired’. Oxytocin has a great influence on social and emotional processing.

Serena Rodrigues Saturn and colleagues in California (Nature) reported that character traits like openness, caring and trusting is linked to genetic variations. The oxytocin receptor incorporates a docking mechanism in operating as a hormone and neurotransmitter. If the person has a ‘2G’ variant gene of the oxytocin receptor the person exhibited better social skills and higher self –esteem compared to those with a ‘AA or AG’ allele. The latter group, in their experiments were less capable of handling stress and difficult situations .

Conclusions

Compassion and empathy are human traits which signify the ability to feel for others. Although there appears to be evidence that this trait is genetically linked, rearing of the young through role modelling and exposing them to a humanistic environment would promote this social characteristic. Culture and religiosity have an impact on exhibiting empathetic behaviour. In a just world empathy goes beyond the environment of the person to ensure sustainability of the race, environment and all living things.

Sivalingam Nalliah

18 Aug 2012