Empathy, cooperation, fairness and reciprocity — caring about the well-being of others seems like a very human trait. But Frans de Waal shares some surprising videos of behavioral tests, on primates and other mammals, that show how many of these moral traits all of us share.
Excellent lecture by one of the great Dutch scientists.
We have discussed the term empathy several times.
The most clarifying definition of empathy is based on viewing it as a process. This process of empathy consists of the following stages.
Empathy or the ability to appreciate someone else’s emotions and express this emotional awareness is a capacity that differs amongst individuals. It’s clear that doctors who can communicate well with patients will be more effective. Communication is an important competence educated during med school. This is mostly about etiquette instead of empathy.
Etiquette enables people who are not in intimate relationships to interact without having to enter into each others’ subjective experiences, desires or values. Being polite may seem a very minimal requirement but, in fact, it is specifically with basic courtesy that doctors frequently struggle. ……… examples of failure of empathy: doctors do not meet the patient’s eye. They talk over and around the patient who feels that he has been badly treated. These people are being treated with a lack of courtesy that would be astonishing in any other circumstances.
Etiquette might be a more important topic during medical education than empathy per se. Doctors often have to do things that are socially taboo, so etiquette should be carefully structured around these complicated interactions. Waht do you think?
Smajdor, A., Stockl, A., & Salter, C. (2011). The limits of empathy: problems in medical education and practice Journal of Medical Ethics DOI: 10.1136/jme.2010.039628
Some state that with evidence based medicine, increasing technical knowledge, technical procedures and technical possibilities the empathy has vanished from the patient doctor interaction or at least was minimized. Medicine has moved from the humanities towards science.
Is another transformation taking place. Is medicine again moving towards the humanities, is empathy again an important feature for a physician? Is the focus on technique shifting towards empathy during medical education? Or are doctors loosing empathy after medical education because they have to become clerks and mechanics due to increasing bureaucracy. Why not have a rehab facility business, the rehab experts, they consult on how to do it.
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A rehab center will also make you realise the reckless nature of your bad habit. It will let your family, friends and colleagues talk to you in a manner that is respectful and acceptable to you. You will finally get to hear out your siblings and parents without them yelling at you. Likewise, it will be time for you to let everyone who cares about you know exactly how you feel about the circumstances that you find yourself in. The caring people at the rehab center will create this safe talking environment where everyone. This environment will be a family counselling session that enables you to understand your family’s emotions and vice versa. In fact, you can say that this is a chance for you and your family to start over as a united and indivisible family. Do not miss this chance. Call a rehab center now.
Is empathy rehabilitated in the medical curricula? More questions than answers. Moreover, empathy is still a confusing term and I’m still not convinced you can learn empathy. What do you think?
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Based on recent literature and a lecture it appeared to me that not everyone is talking about the same phenomenon when it comes to empathy. In much animal research resonance is mostly the adequate description of what is being studied. Resonance is the phenomenon of one person unconsciously mirroring the motor actions as basis of emotional expressions of another person. In animal models resonance is mostly the representation of motor action of the other animal without making the moves but showing activity in motor regions of the brain.
Empathy is more than resonance. It is usually divided in cognitive and emotional empathy. For me emotional empathy is the core characteristic of empathy and is a quality present to a lesser of greater extend in humans. Not everyone has this capacity or in the same amount. It’s the ability of feeling the same as someone else with the recognition that the feeling belongs to the other one. Moreover is a more broader definition it’s the capacity to experience affective reactions to the observed experiences of others or in a stricter sense share a “fellow feeling”.
the term cognitive empathy describes empathy as a cognitive role-taking ability, or the capacity to engage in the cognitive process of adopting another’s psychological point of view. This ability may involve making inferences regarding the other’s affective and cognitive mental states.
Probably cognitive empathy is something we can teach our residents and medical students. From an evolutionary stand point, emotional empathy is the phylogenetically earliest system. The cognitive empathy is more advanced and involves higher cognitive functions.
The division between cognitive and emotional empathy is supported by animal models and psychiatric disturbances such as autism and borderline personality disorder both characterized by a dissociation between cognitive and emotional empathy.
The neural bases of the cognitive and emotional empathy is represented in the next graphic.
Sympathy is another emotion different from empathy. Empathy is a process by which we try to comprehend another’s experience, while sympathy would be a direct perceptual awareness of another person’s experience akin to the phenomenon of sympathetic resonance. Sympathy does not necessarily require feeling any kind of congruent emotions on part of the observer, a detached recognition or representation that the other is in need or suffers might be sufficient.
Shamay-Tsoory, S. (2010). The Neural Bases for Empathy The Neuroscientist, 17 (1), 18-24 DOI: 10.1177/1073858410379268
Oxytocin is the new hormone possibly responsible for increase of trust, “the hormone of love”, and improvement of social cognition. This optimism is sometimes turned around in the way that some researchers believe that oxytocine could also ameliorate social deficits such as present in social phobia and autism. I don’t share this optimism, in biology and human neuroscience you can’t simply turn the proof around. We’ve seen a lot of trouble from this simple method. In depression not only the neurotransmitters are dysregulated, nor the lack of dopamine doesn’t explain Schizophrenia and so on and so on.
Then why write about oxytocin? Well, I’m interested in empathy. Empathy is an interesting phenomenon of which we only understand very little. Moreover, a recent study had the important premises that oxytocin may selectively facilitate social cognition given certain constraints. They had a very thought provoking hypothesis. To me someone should need some social cognition in order to be able to improve empathy with oxytocine but the researchers had an other hypothesis. They hypothesized that oxytocin would be of more value, improve empathy more in those with less social proficiency. They used a double blind placebo controlled crossover trial: participants received either intranasal oxytocin or a placebo and performed an empathic accuracy task that naturalistically measures social-cognitive abilities. Baseline social competencies were measured with the Autism Spectrum Quotient.
Oxytocin only improved empathetic accuracy in less socially proficient individuals not in more socially proficient individuals. Oxytocin does not acts as a universal prosocial enhancer that can render all people social-cognitive experts. This is against my hypothesis but nevertheless more in relation to reality that oxytocin is not the new social drug we thought it to be.
Bartz, J., Zaki, J., Bolger, N., Hollander, E., Ludwig, N., Kolevzon, A., & Ochsner, K. (2010). Oxytocin Selectively Improves Empathic Accuracy Psychological Science, 21 (10), 1426-1428 DOI: 10.1177/0956797610383439
This is part of a title of a commentary in the JAMA. Would have reacted in the JAMA but found my blog more appropriate. The subtitle is a neurobiological perspective. This commentary does provide an update on the neurobiological findings on empathy but they’re not new and can also be read on this blog. What did catch my eye was the suggestion made by the author that overvaluing scientific measurement excludes empathy, as if being a technical good doctor almost excludes being an empathetic doctor which is to my opinion a big mistakes. There are brilliant doctors, even skilled surgeons, who also do have empathy for their patients and use the best techniques and medicine. Doctors have been searching for new treatments to better the health of their patients like this functional medicine which has proved to be a great option for those in need.
Another misconception is the confusion between good bedside manners and empathy. As if a doctor can not have good bedside manners without empathy. Good bedside manners are a prerequisite for physicians, empathy is a quality someone has developed during life. My point is that good bedside manners is something each doctor can and has to learn as well as sympathy when called for. Empathy is a quality not every human or doctor possesses. Moreover, experience and age enhance the use of empathy. Not to say that lack of experience or being young excludes the possibility for showing empathy, there are still natural talents out there.
Doctors have to learn to handle their empathy. Most medical students decline in empathy during their third year of med school, the year in which most students start to interact with patients to some extend. According to this pain management doctor, Exposure to others’ pain and distress may influence the young doctor to a more or lesser extend. Some down regulation of empathy during first years of patient care may in the beginning have some beneficial consequences.
Overall, having empathy, being able to handle it in such a way that you can empathetically help patients without loosing your own balance improves patient care. Medical teachers can educate empathy. They can even start of with the neurobiology of empathy, making the subject less laden. Empathy needs more attention in medical education, that’s the point I want to emphasize and is also the opinion of the author of this commentary
Medical educators can teach students about the neurobiological correlates of empathy, demonstrate behavioral skills that build an empathic connection, and scientifically validate the importance of empathy in the patient physician relationship, while also teaching self-regulation strategies that may help prevent emotional distress during medical training and other challenging situations.
What do you think?
Riess, H. (2010). Empathy in Medicine–A Neurobiological Perspective JAMA: The Journal of the American Medical Association, 304 (14), 1604-1605 DOI: 10.1001/jama.2010.1455
In this study psychiatrists have the highest mean empathy score on The Jefferson Scale of Physician Empathy. They were folowed by Internists, Dr. Roth NYC orthopedic surgery, general pediatrics, emergency medicine and family medicine, Family Medical Centre Sutherland Shire has specialists for your needs. The differences in empathy scores among psychiatrists and physicians in internal medicine, pediatrics, and emergency medicine were not statistically significant, but physicians in all other specialties scored significantly lower than psychiatrists. In the middle were physicians in general surgery, obstetrics and gynecology. Visit your local gynecologist for more information and regular check ups.Anesthetists scored the lowest followed by orthopedic surgery, neurosurgery, radiology and cardiovascular surgery.The personal injury attorneys of Phillips Law fight tirelessly to get you the compensation you deserve, including in the case of individuals suffering from mesothelioma, a fast-moving form of cancer that is typically the result of asbestos exposure, go to Phillips Law for more details.
These differences might reflect the notion that different individuals have different empathy scores and are attracted to different specialties. How exercise and healthy living can save the future generations, for more tips view importance of exercise. These differences might also be explained by differences in training for each specialty. To know more about cough etiquette to prevent infection.
How was this study done?
the Jefferson Scale of Physician Empathy (with 20 Likert-type items) was mailed to 1,007 physicians affiliated with the Jefferson Health System in the greater Philadelphia region; 704 (70%) responded. Construct validity, reliability of the empathy scale,
and the differences on mean empathy scores by physicians’ gender and specialty were examined.
In this study empathy was defined as a cognitive attribute that involves an ability to understand the patient’s feelings and perspective and the capability to communicate this understanding with procedures like the Gynecomastia New York which is becoming increasingly popular and being a very sensitive subject. Empathy is more complex than that.
What is empathy (the long version)?
The most clarifying definition of empathy is based on viewing it as a process. This process of empathy consists of the following stages.
It’s important during medical education, and for the Patient Doctor Relationship. Especially this last one is under pressure since the changes in the economics of medical practice. The most important question about empathy is: can we teach empathy or is it a trait? What do you think?
Hojat M, Gonnella JS, Nasca TJ, Mangione S, Vergare M, & Magee M (2002). Physician empathy: definition, components, measurement, and relationship to gender and specialty. The American journal of psychiatry, 159 (9), 1563-9 PMID: 12202278
This post is about the neurobiological gender differences in empathy. For a description and definition of empathy which isn’t always strait forward please read about it in this previous post: Patient Doctor Relationship Series: Empathy. This post is one of many on the subject.
A number of studies suggest that women may be more empathic than man, on average this is obviously true. From experience alone this statement seems reasonable. Nevertheless, some men can be more empathic than women but overall women are more empathic.
A number of brain regions have been suggested to be involved in empathy. Two recent studies were published on brain regions and gender differences in empathy.
Many brain regions are involved in empathy. The strongest evidence suggests the involvement of the medial frontal lobes. Involvement of the right parietal region is also suggested. That’s why some researchers believe that the right hemisphere is more involved in empathy than the “cognitive” left hemisphere. Left versus right brain discussions are summarized in this statement:
And while brain research confirms that both sides of the brain are involved in nearly every human activity, we do know that the left side of the brain is the seat of language and processes in a logical and sequential order. The right side is more visual and processes intuitively, holistically, and randomly. Most people seem to have a dominant side. A key word is that our dominance is a preference, not an absolute
But is this left right brain discussion also involved in gender differences in empathy. Is the right hemisphere more involved in empathy compared to the left hemisphere? Moreover, does this explain that women may be more empathic than man?
While some previous studies have suggested a special role for the right hemisphere in empathy, others have not found this asymmetry. Given the fact that many studies have reported gender differences in empathy, it is quite possible that the relative role of the right hemisphere could differ by gender.
One study examined individual differences in right hemisphere activation and empathy in a large sample to test for possible gender differences. Besides using empathy scales to score the amount of empathy the researchers also used the Levy Chimeric Face Task to measure right hemisphere activation. This test requires participants to choose the happier of two chimeric faces (faces with one side smiling and the other side showing a neutral expression). Previous studies have demonstrated that right-handed participants (regardless of gender) tend to chose the chimeric face with the smile to their left more often than the chimeric face with the smile to their right. The right hemisphere is more susceptible for faces and emotional expression. This causes a bias in attention to the left side of space. This test measures the involvement of the right hemisphere in emotion.
In this study participants tended to pay more attention to the left side of chimeric faces comparable to previous studies and women scored higher in empathy than men. Men and women did differ in the correlation between that task and empathy, as measured
by the empathy scale (MEEQ), suggesting a correlation between right hemisphere activation and empathy in women.
Two difficulties arose during this trial. There was also a significant effect on the testing format. Participants tested in the paper and pencil format showed a stronger leftward bias than those completing the task with the faces projected on to a screen. It’s also possible that the empathy scale used or right hemisphere specialization influenced the outcome.
Another study looked at brain activation during functional magnetic resonance imaging (fMRI).
In short, subjects viewed synthetic emotional faces expressing either fear or anger. They were asked to either concentrate on their own feelings that emerged when they were looking at an emotional facial expression (SELF-task), or evaluate the emotional state expressed by a stimulus face (OTHER-task). After the presentation of each face, a list of four one or two word descriptions appeared on the screen. The task of the subjects was to choose from this list of words the description which best depicted either the emotional state expressed by the preceding face (OTHER-task) or the own emotional response of the subject to the stimulus face (SELF-task)
This was done during fMRI in two separate runs. The data suggest that the mirror neuron system is activated during tasks in both males and females. However, activation was stronger in females in the right inferior frontal cortex. This region is also one of the regions with mirror neurons. Females recruit regions containing mirror neurons to a higher degree than males. Males rely more on the left temporoparietal region.
In conclusion females use different strategies for assessing emotions than males. It could be that men more often use the left cognitive hemisphere in empathy and women the more emotional parts such as the mirror neurons in the right hemisphere. Again on average. These are correlation studies not causation studies. What do you think?
Empathy or the ability to appreciate someone else’s emotions and express this emotional awareness is a capacity that differs amongst individuals.
Cognitive empathy refers to imaginatively understanding another person’s thoughts, feelings and actions. Emotional empathy is feeling the emotion of another person, but maintaining a compassionate, other-focused perspective
Cognitive empathy can be tested with facial expression recognition. High scores on empathy is associated with higher accuracy at brief exposure of six different emotional expressions presented in 42 pictures during 50 milliseconds each picture. When these facial expressions of 6 different emotions were shown for a longer duration the social skills was significantly related to accuracy instead of the empathy score. Difficulty reading facial expressions leads to impaired social understanding.
Another important areas of empathic accuracy research is the ocular level or the area around the eyes. This region is important because of its evolutionary and neurobiological significance. This region expresses important information about the expresser and as such creates the ability to accurately read the mental states of others through cues provided by the ocular region. From recent research it’s concluded to be able to accurately “read or experience” another persons feelings by watching their eye region is unrelated to gender, self-esteem, Big Five personality, and a number of empathy related traits. This results in a lack of individual factors that predict empathic accuracy.
However, imagination or individuals who often use imagination in imagining how another person feels and thinks does accurately predict empathic accuracy when observing the ocular region
individuals who have a tendency to imagine themselves in situations or relate to fictional characters may be better able to simulate others’ feelings and thoughts and thus be better able to infer accurately the mental states of others. Perhaps, this habit of imagining the inner world of others develops one’s empathic accuracy ability through sustained and motivated practice.
I guess some small steps in understanding empathy and individual differences.
Besel, L., & Yuille, J. (2010). Individual differences in empathy: The role of facial expression recognition Personality and Individual Differences DOI: 10.1016/j.paid.2010.03.013
Lee, S., Guajardo, N., Short, S., & King, W. (2010). Individual differences in ocular level empathic accuracy ability: The predictive power of fantasy empathy Personality and Individual Differences DOI: 10.1016/j.paid.2010.03.016
This video is about mirror neurons. These mirror neurons are the key to many aspects of social interaction. It allows us to understand the actions, feelings of others. In a way to “read their minds”. Possibly mirror neurons play an important role in empathy , an important asset for physicians.
But were do they come from these motor neurons?
One explanation could be that mirror neurons are an adaptation:
an adaptation for action understanding concerns the origins, rather than the current utility, of mirror neurons. It asserts that a certain process – genetic evolution – produced mirror neurons, and that they were favoured by natural selection because they supported action understanding.
The mirror neurons helped to understand what others were doing, which could be of importance during the survival in the evolution of human kind.
The other explanation could be that mirror neurons are a product of associative learning:
Associative learning is a form of learning that results from exposure to a relationship between two events. ‘Conditioning procedures’ arrange different types of relationship between events. Research examining the effects of conditioning procedures on animal behaviour has shown that associative learning depends on ‘contiguity’ – the closer the two events occur in time, the stronger the association – and ‘contingency’ – there needs to be a correlation or predictive relationship between them.
This suggests that mirror neurons were created during the experience of observing and executing the same action. Motor neurons become mirror neurons in the course of individual development.
In a recent publication arguments were put forward in favor of the associative learning origin of mirror neurons. The most important arguments being that mirror neurons do play a role in some social functions but do not play a dominant role in action understanding. You probably don’t need them to understand actions coming about. The other argument is that even in adulthood the mirror neuron system can be reconfigured by sensorimotor learning.
The associative account implies that mirror neurons come from sensorimotor experience, and that much of this experience is obtained through interaction with others. Therefore, if the associative account is correct, the mirror neuron system is a product, as well as a process, of social interaction.
Wouldn’t it be great that humans can develop mirror neurons during life? The experience of interactions being enough to create mirror neurons. I think this is a very optimistic makable point of view, what do you think?
Heyes, C. (2010). Where do mirror neurons come from? Neuroscience & Biobehavioral Reviews, 34 (4), 575-583 DOI: 10.1016/j.neubiorev.2009.11.007
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