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Arumorofempathy:Whatempathyisandhowitmakesadifference
LouAgosta,PhDNorthwesternFeinbergSpecialLecture
LAgosta@UChicago.eduAugust17,2016
DavidHume:4DefiniOonsofSympathy(1739)• EmoOonalcontagion• SuggesObility• DoublerepresentaOon:animpressionofyourimpression
• ADelicacyofsympathyandtaste
• Benevolence
(c)LouAgosta,PhD,LAgosta@UChicago.edu 2
Thesecretundergroundhistoryofempathy
• Hume’sdefiniOonsof“sympathy”andtaste• Kant’s“communicabilityofaffect”and“enlargedthinking”–changeperspecOves
• Lipps’projecOveandaestheOcempathy• Freud’sencounterwithLipps• ThedebunkingofLippsbythephenomenologistsScheler,Stein,Husserl
• RogersandKohut(empathynolongerasecret)(c)LouAgosta,PhD,
LAgosta@UChicago.edu 3
EmpathicRecep,vity[agraciousandgenerouslistening]
EmpathicUnderstanding[breakthroughtopossibility]
EmpathicInterpreta,on[“topdown”folkpsychologytheviewfrom“overthere”]
EmpathicResponsiveness[narra,ve:themovieofone’slife]
HowempathyfuncOons…
(c)LouAgosta,PhD,LAgosta@UChicago.edu 4
EmpathicRecep,vity[emo,onalcontagion/panic]
EmpathicUnderstanding[projec,on/Labeling/applyingcategories–
stereotyping]
EmpathicInterpreta,on[mis-interpreta,on:
takethingsoutofcontext/un-charitable/secondguessing]
EmpathicResponsiveness[thoughtlessremarks/gossip/emptytalk
Blame/finger-poin,ng/“Mondaymorningquarter-backing”]
HowEmpathyBreaksdown/Fails
(c)LouAgosta,PhD,LAgosta@UChicago.edu 5
[1]
[2][3]
[4]
Ontologyandphenomenology:TheshortdefiniOonofempathy…
• BeinginthepresenceofanotherhumanbeingwithouttheaddiOon[interposiOon]ofcategories,labels,diagnoses,judgments,evaluaOons
• Theexperienceofrelatedness…
(c)LouAgosta,PhD,LAgosta@UChicago.edu 6
Four(4)examplesfromliterature
• ThomasMann/emoOonalcontagion• ThomasMann/possibilityorcompassion• EdmundRostrand(CyranodeBergerac)/egocentrism–projecOon
• TennesseeWilliams/Responsiveness
(c)LouAgosta,PhD,LAgosta@UChicago.edu 7
EmpathyandintrospecOon
• Ifonegoesfarenoughinward,thenonefindstheother
• Itisamyththatweareunrelated–weareallrelated–andthephilosopherDescartes’thoughtexperimentofanisolatedconsciousness,disconnectedfromtheworldmissedtherelatednesstotheotherthatmakespossibleconsciousnessaltogether
(c)LouAgosta,PhD,LAgosta@UChicago.edu 8
EmpathyandintrospecOon
• MyreacOontotheotherperson–annoyance,affecOon,hosOlity,boredom,compassion,love,hatred,fear,sadness–tellsmeasmuchaboutmyselfasitdoesabouttheother
• ReflecOonononeselfandone’sownissuesisrequiredtounderstandtherelaOonship
(c)LouAgosta,PhD,LAgosta@UChicago.edu 9
Empathyandcompassion/altruism
• Empathytellsmewhattheotherpersonisexperiencing
• Compassion–altruism–goodupbringing–training–tellonewhattodoaboutit
• NoparOcularformofacOonorbehaviorisarequiredconsequenceofempathy
• Empathicresponsivenessisanaspectofempathyandgivestheotherpersontheirownexperiencebackinaformthattheyrecognizeastheirown
(c)LouAgosta,PhD,LAgosta@UChicago.edu 10
Empathyasfilterofvariablegranularity
• Iftheotherpersonissufferingandyouhaveavicariousexperienceofthesuffering,thenyouaregoingtosuffer–butstrangeasitsounds,nottoomuch
• Ifyouareoverwhelmedbythesuffering,youaredoingitwrong–youshouldsuffer,butstrangeasitsounds,nottoomuch
• That’sthetraining…
(c)LouAgosta,PhD,LAgosta@UChicago.edu 11
ExampleofthegoodSamaritan
• TheLeviteandthePriestwhopassbyexperiencedEmpathicDistress–
• TheSamaritanrecognizedthesufferingofthesurvivoroftheassault–hehadavicariousexperience–atraceaffect–asampleoftheother’sexperience
• Hisempathytoldhimwhattheotherwasexperiencing–hisneighborlinesstoldhimwhattodoaboutit
(c)LouAgosta,PhD,LAgosta@UChicago.edu 12
(c)LouAgosta,PhD,LAgosta@UChicago.edu 13
Whatdoesitmeantotrainempathy?Removeobstaclessuchascategorizing
people,labeling,pigeon-holing
Whatdoesitmeantotraininempathy?
• Mostpeoplearenaturallyempathic• Empathyisstopped,limited,reduced,constrainedby:shame,guilt,fear,judgments,blame,evaluaOons,authority,hierarchy,lowself-esteem,egocentrism,projecOon,resignaOon,narcissism,cynicism,denial…
• Removetheobstaclestoempathy,andempathynaturallyunfolds,showsup,develops
• ThisdoesnotincludeOpsandtechniquesthatcaninduce,promote,sOmulateempathy
(c)LouAgosta,PhD,LAgosta@UChicago.edu 14
SummaryandTakeAways
• Weengagedwith– ThehistoryofempathyinHume,Kant,Lipps,Freud,thephenomenologists
– Examplesofempathyandempathicbreakdowns(failures)inliterature
– ThedisOncOonbetweenempathyandcompassion– EmpathyandintrospecOon–empathyasafilteragainstcompassionfaOgue
(c)LouAgosta,PhD,LAgosta@UChicago.edu 15
AddiOonalTalkingPoints
• Thefollowingslidescoverfurtherdetailson– ThehistoryofempathyinHume,Kant,Lipps,Freud,thephenomenologists
– Examplesofempathyandempathicbreakdowns(failures)inliterature
– PeerreviewedjournalarOclesontheimpactofempathyonlifestylediseases(e.g.,diabetes2)andthecommoncold
– Exercise(s)andmiscellaneoustalkingpoints
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DavidHume(1711–1776)
• ‘Tisindeedevident,thatwhenwesympathizewiththepassionsandsenOmentsofothers,thesemovementsappearatfirstinourmindasmereideas,andareconceiv’dtobelongtoanotherperson,asweconceiveanyothermaneroffact.‘Tisalsoevident,thattheideasoftheaffecOonsofothersareconvertedintotheveryimpressionstheyrepresent,andthatthepassionsariseinconformitytotheimagesweformofthem(1739:319-20).
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Hume’sideasandimpression
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impression(s)Ideaofanger
one’simpressionoftheanger
[drawingnottoscale]
(1) convert:impressiontoidea[understanding](2) convert:ideatoimpression[sympathy/(imagina,on)]
(1)
(2)
Hume’sideasandimpression
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impression(s)Ideaofanger
one’simpressionoftheanger
[drawingnottoscale]
(1) convert:impressiontoidea[understanding](2) convert:ideatoimpression[sympathy/(imagina,on)]
TheimaginaOon:TransposingperspecOvesandgeneraOngsympathy
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Theguywithumbrellasays:“WeneededRain.”Theimagina,onisresponsiblefor(1) Conver,ngideastoimpressionsin
Sympathy(2) Changingperspec,ves“asif”Iwere“over
there”(3) Adis-interestedspectatorisnotcold
hearted–lacksaconflictofinterest-mays,llbesympathe,c
(4) Falsebelieftest
Delicacyoftastevsdelicacyofpassion
(c)LouAgosta/LAgosta@UChicago.edu 21
Hume’sexampleofthecaskofsherry…IfyouareawareofsomethingofwhichIlackaware,thenyour“delicacy”ismorefine-grained
DavidHume
• Everymovementofthetheatre,byaskillfulpoet,iscommunicated,asitwerebymagic,tothespectators;whoweep,tremble,resent,rejoice,andareinflamedwithallthevarietyofpassions,whichactuatetheseveralpersonagesofthedrama(1751:49).
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DavidHume
• Acheerfulcountenanceinfusesasensiblecomplacencyandserenityintomymind;asanangryorsorrowfulonethrowsasuddendampuponme.Hatred,resentment,esteem,love,courage,mirthandmelancholy;allthesepassionsIfeelmorefromcommunicaOonthanfrommyownnaturaltemperanddisposiOon(T2.1.11.2;1739:316-17).
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DavidHume
• SocloseandinOmateisthecorrespondenceofhumansoulsthatnosooneranypersonapproachesme,thanhediffusesonmeallhisopinions,anddrawsalongmyjudgmentinagreaterorlessdegree.Andtho’,onmanyoccasions,mysympathywithhimgoesnotsofarasenOrelytochangemysenOmentsandwayofthinking;yetitseldomissoweakasnottodisturbtheeasycourseofmythought...(T3.3.2.2;1739:592).
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DavidHume• ‘Tisremarkable,thatnothingtouchesamanofhumanitymorethananyinstanceofextraordinarydelicacyinloveorfriendship...Thepassionsaresocontagious,thattheypasswiththegreatestfacilityfromonepersontoanother,andproducecorrespondentmovementsinallhumanbreast.Wherefriendshipappearsinverysignalinstances,myhartcatchesthesamepassion,andiswarmedbythosewarmsenOments,thatdisplaythemselvesme(T3.3.3.5;1739:604-5).
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Summary(Hume)
• EmoOonalcontagion/suggesOon• Conversionofideatoimpression• Conversionofideatoimpression+TheOther• Delicacyoftasteimpression• Benevolence/compassion
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ImmanuelKant
• Liketaste,empathyisdisinterested• Liketaste,empathyrequirestheuniversalcommunicabilityoffeelings
• Liketaste,empathyleveragestheformofpurposiveness
• Liketaste,empathyrelatesnecessarilytotheother
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ArumorofempathyinKant
• The“communicabilityoffeelings”(1790/93a:174;§40(AA294))soundslikesteponeofthemulO-dimensionalapproachtoempathy.
• Kant’s“communicabilityoffeeling”isthecluetothereconstrucOonofthedeephistoryofempathyinKant.
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Kant
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(1) FreeplayoftheimaginaOonandunderstanding(2) SubordinaOonofsensibilitytoinfinitereason(3) Distancing:dis-interestedness(4) Engagement:communicabilityoffeeling(5) Engagementwiththeother(sensuscommunis)(6) Purposefulnessofthemanifold
(1)–(6)
ImmanuelKant(1790/93)
• WecallbuildingsortreesmajesOcandmagnificent,orfieldssmilingandjoyful;evencolorsarecalledinnocent,modestortender,becausetheyarousesensaOonthatcontainsomethinganalogicaltotheconsciousnessofamentalstateproducedbymoraljudgments.TasteasitweremakespossiblethetransiOonfromsensiblecharmtothehabitualmoralinterestwithouttooviolentaleap[…](1790/93a:228;§59(AA354)).
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Inaragingstormwhereistherage?
(c)LouAgosta/LAgosta@UChicago.edu 31
rage
one’simpressionoftherage
Kant–“subrepOon”=“projecOon”=
anerrorIjudgment
ImmanuelKant(1790/1793)
• ...[T]heimaginaOoninitsfreedomarousestheunderstanding,andthelaner,withoutconcepts,setstheimaginaOonintoaregularplay[and]therepresentaOoniscommunicated,notasathought,butastheinnerfeelingofapurposivestateofmind.
• Tasteisthusthefacultyforjudgingapriorithecommunicabilityofthefeelings[dieMi0eilbarkeitderGefühle]thatarecombinedwithagivenrepresentaOon(withoutthemediaOonofaconcept)(1790/93a:§40;175-176;(AA:296)).
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ImmanuelKant(1790/93)
• Thisisthemomentfortopdown,cogniOveempathicinterpretaOon.Kantexplicitlynotesthiskindofcommonsenseenablesus–– “toputourselvesinthoughtintheplaceofeveryother”(1790/93b:§40;136;(AA293)(“…anderStellejedesanderendenken…”)).
– ThisenablesonetolinkbacktoempathicinterpretaOonandthelogicalfuncOoninvokedinsubsOtuOngathird-personforafirst-personperspecOve.
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TheodorLipps(1851–1914)
• Youknowhowthemovie/playAmadeusshowedthatAntonioSalieriwasfamousinhisdayandisnowunknownincomparisonwithMozart?
• LippswastheSalieriof“empathy,”dominaOngthetermupunOl1914andbeyondwhereastodayheisunknown
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TheodorLipps(1885/1903)
• LippssubsOtutes“empathy”for“aestheOctaste”• Weprojectour“feelingofvitalityandemoOons”intonatureandintootherpeople
• Lippsisfamousinhisday–and“owns”theword“empathy”[einfühlung]
• Lipps’“projecOveempathy”becomesthe“target”ofthecriOquebythephenomenologistsScheler,Husserl,Stein,andHeidegger[whichbringsustothepresent]
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TheodorLipps
• OnlyinsofarasthisempathyexistsareformsbeauOful.TheirbeautyisthisidealfreedomwithwhichIexpresslife[Sichausleben]inthem.Conversely,formisuglywhenIamunabletodothis,whenIfeelunfreeinwardly,inhibited,subjectedtoconstraintwithregardtoform,orinregardtoitscontemplaOon(1903:247).
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TheodorLipps
• Infull,posiOveempathyonlyoneindividualegoexistsforme;namelythisempathizedorobjecOfiedownego,whichisprojectedintoanexternalobject(1909:194).
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TheodorLipps
• IninnerimitaOonthereisnoseparaOonbetweentheacrobatupaboveandmebelow.Onthecontrary,IidenOfymyselfwithhim.Ifeelmyselfinhimandinhisplace....
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TheodorLipps
• InsuchinnerimitaOonIdischarge—notthemoOonswhichtheacrobatdischarges—ratherIdischargeimmediately,orinwardly,orinthought,themoOonsoftheacrobat.IdischargethemoOonsinsofarasthisdischargeofmoOonisnotanexternalbutaninneractintheacrobathimself(1903:121-122).
(c)LouAgosta/LAgosta@UChicago.edu 39
TheodorLipps
• IninnerimitaOonthereisnoseparaOonbetweentheacrobatupaboveandmebelow.Onthecontrary,IidenOfymyselfwithhim.Ifeelmyselfinhimandinhisplace....
• Inempathy,therefore,Iamnottherealego[ich]butaminwardlyliberatedfromthelaner,i.e.,IamliberatedfromeverythingwhichIamapartfromthecontemplaOonofform.Iamonlythisideal,thiscontemplaOngego(1903:247).
(c)LouAgosta/LAgosta@UChicago.edu 40
TheodorLipps
• The“other”isone’sownpersonality,amodifiedownego,whichisrepresentedandmodifiedaccordingtotheexternalappearanceandthepercepObleexpressionsoflife.Themanbesidesme,ofwhichIamconscious,isaduplicateandatthesameOmeamodificaOonofmyself.(1903:106).
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TheodorLipps
• ThefirstmaterialandoccasionfortheconstrucOonoftheforeignpersonalityisofferedbyhisexpressionoflife,theaudibleandvisible,thesoundsandphysiognomyorgesture,inshort,theexpressivemovements(1903:106).
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TheTangle
• Lippsownstheterm“empathy”• Noonecanusethewordwithoutappearingtobeastudentofempathy–but…
• Freudishisownman• Thephenomenologists–MaxScheler,EdithStein,EdmundHusserl,MarOnHeidegger–argueagainstLipps’theoryof“projecOveempathy”
(c)LouAgosta/LAgosta@UChicago.edu 43
MaxScheler(1874–1928)
• Itisperfectlymeaningfultosay:“Icanfeelforyouvicariously,butIhavenopity[“Mitleid”]foryou.”Such“vicariousfeeling”remainswithinthecogniOvesphere,andisnotamorallyrelevantact.ThehistorianofmoOves,thenovelist,theexponentofthedramaOcarts,mustallpossessinhighdegreethegivofvicariousfeeling.Butthereisnottheslightestneedforthemtosharethefeelingsoftheirsubjectsandpersonages(1912/22:9).
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MaxScheler
• ...Neither“projecOveempathy”nor“imitaOon”isnecessaryinordertoexplaintheprimarycomponentsofsharedfeeling,namely,understandingandvicariousfeelingand[vicarious]life[NachfühlenundNachleben]1912/22).
• “ImitaOon”is“Nachahmung”(“ahmen”means“tomeasure,”usuallyanamountofliquid),whileonceagain“sharedfeeling”translates“Mitgefühl.”
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SigmundFreud
• Freud’slenertoWilhelmFliess(August31,1898):
• InLippsIhaverediscoveredmyownprinciplesquiteclearlystated–perhapsrathermoresothansuitedme.“Thereaderovenfindsmorethanheseeks.”Lippsregardsconsciousnessasonlyasenseorgan,thecontentsofthemindasideaOon,andallmentalprocessesasunconscious(Freud1887/1902:262-263).
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EdmundHusserl(1859-1938)
• Everyegoisa“monad.”Butthemonadshavewindows.Theydonothavewindowsordoorsthroughwhichothersubjectscanliterally[reel]getin—thewindowsareinstancesofempathy—butratherthroughwhichotherscangetthroughandbeexperiencedinawaysimilartoone’sownpastremembrances(HusserlXIV:260)....
(c)LouAgosta/LAgosta@UChicago.edu 47
EdmundHusserl
• Amonadthushaswindowsinordertoreceiveforeignimpressions[fremdeEinwirkungen].Thewindowsareempathy(HusserlXIV:295)....
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EdmundHusserl
• Inonemonad,otherindividualmonadsare“directly”mirroredthroughempathy….Thustheotheregoanditspsycheannouncesitselfinme,andIannouncemyselfinit:Wearerelatedtooneanotherconsciouslyandknowaboutoneanother:and,thereby,everyoneofushasexperienceoftheotherbody[fremdleib]andapperceivesthisaccordingtoitsownbodyanalogicallyasbody(XIV:300).
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• Freud’slenertoWilhelmFliess(August31,1898):
• InLippsIhaverediscoveredmyownprinciplesquiteclearlystated–perhapsrathermoresothansuitedme.“Thereaderovenfindsmorethanheseeks.”Lippsregardsconsciousnessasonlyasenseorgan,thecontentsofthemindasideaOon,andallmentalprocessesasunconscious(Freud1887/1902:262-263).
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SigmundFreud
Freud
• “ThedoctorwillcertainlyforfeitanyadvantagewhichhemighthaveinrelaOngtohispaOentifhebeginswithanyotherapproachthanempathy”[RecommendaOonsforPhysicians,1912]
• 22menOonsofEinfühlung[empath]in24volumesoftheStandardEdiOon–mostmis-translated
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Trainspassinginthenight–simultaneousseparatediscovery(?)
• CarlRogers:OnBecomingaPerson:uncondiOonalposiOveregard
• HeinzKohut:vicariousintrospecOon,empathicbreakdowns[empathyviolaOons],andnarcissisOcrage
• NoevidencethatRogersreadKohutorviceversa• KohutwasprobablyreadingFerenczi,Baliant;Rogers,MarOnBuber[existenOalism],Niehbur,R.
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4phasesofempathycapturemulOpledefiniOons
• RecepOvity:Kohut:VicariousintrospecOon• Understanding:Heidegger:Possibility• InterpretaOon:FolkPsychology:Walkintheotherperson’sshoes
• Responsiveness:DaliLama–prosocialbehavior:Loewald:givingthepersontheirownexperiencebackinwords
(c)LouAgosta,PhD,LAgosta@UChicago.edu 53
Detailedexamplesfromliterature…
• ThomasMan:Buddenbrooks• EdmundRostrand:CyranoDeBergerac• TennesseeWilliams:TheGlassMenagerie
(c)LouAgosta,PhD,LAgosta@UChicago.edu 54
ExampleofempathicrecepOvity• avigneneofempathicdistressinMann’scharacterofthedenOst,HerrDr.Brecht,whosewould-beempathyforhispaOentsmisfiresanddegeneratesintoemoOonalcontagionthatissuchthathe(Dr.Brecht)breaksoutinacoldsweatandhastositdownexhaustedavereachdentalprocedure.Inshort,Dr.Brechthasavailablethevicariousexperiencesthatwouldmakehimagoodempathizerifhewereabletocontrolthem;but,beingendowedwithanespeciallysensiOve,delicacyofempathy,insteadDr.Brechtfallspreytoempathicdistress.(ThomasMann.(1901).Buddenbrooks,tr.H.T.Lowe-Porter.NewYork:RandomHouse,1961:403–404.
• )
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ExampleofempathicrecepOvity• Thebadthingabouthim[DrBrecht]washewasnervous,
anddreadedthetortureshewasobligedtoinflict.‘WemustproceedtoextracOon…,’hewouldsay,growingpale.Hannohimselfwasinapalecoldsweat,withstaringeyes,incapableofprotesOngorrunningaway;inshort,inmuchthesamecondiOonasacondemnedcriminal.HesawHerrBrecht,withtheforcepshissleeve,bendoverhim,andnoOcedthatlinlebeadswerestandingoutonhisbaldbrowandthathismouthwastwisted.Whenitwasallover,andHanno,paleandtrembling,spatbloodintothebluebasinathisside,HerrBrechttoohadtositdown,andwipehisforeheadandtakeadrinkofwater.”(ThomasMann.(1901).Buddenbrooks,tr.H.T.Lowe-Porter.NewYork:RandomHouse,1961:403–404.
• )
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Exampleofempathicunderstanding
• SituaOon:ThomasisHanno’sfather–heisafrustratedarOstwhohaspursuedacareerinbusinesstosupporthisfamily–hisson,Hanno,isarOsOc–issicklywithbadteeth,getsbulliedinschoolandcanneverseemtosaOsfyhisfather’sdemandsforgoodgradesandakindof“Hailfellowwellmet!”a{tude
• MeanwhileThomaswife,Gerda,isplayingpassionateviolinduosupstairswithherfriend,theLieutenant–themusicstops…longsilence…
(c)LouAgosta,PhD,LAgosta@UChicago.edu 57
Exampleofempathicunderstanding• Buthisfatherdidnotseemtobelistening.HeheldHanno’sfreehandand
playedwithitabsently,unconsciouslyfingeringtheslimfingers.• AndthenHannoheardsomethingthathadnothingtodowiththelesson
atall:hisfather’svoice,inatonehehadneverheardbefore,low,distressed,almostimploring;“Hanno—thelieutenanthasbeenmorethantwohourswithMamma.”
• LinleHannoopenedwidehisgold-browneyesatthesound;andtheylooked,asneverbefore,clearlarge,andloving,straightintohisfather’sface,withitsreddenedeyelidsunderthelightbrows,itswhitepuffycheeksandlongsOffmoustaches.Godknowshowmuchheunderstood.Butonethingtheybothfelt:inthelongsecondwhentheireyesmet,allconstraint,coldness,andmisunderstandingmeltedaway.Hannomightfailhisfatherinallthatdemandedvitality,energyandstrength.ButwherefearandsufferingwereinquesOon,thereThomasBuddenbrookscouldcountonthetrustanddevoOonofhisson.Onthatcommongroundtheymetasone”(Buddenbrooks.(1901):507;modifiedslightly).
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Exampleofempathicunderstanding
• Theireyesmeet–anempathicmoment• Thepossibilityofrelatednessbasedonvulnerability
• Thefatherwhowassoinaccessiblebecomesvulnerableinhissuffering–Hanno“gets”hisvulnerability–thatis,hishumanity.
• Ifempathicunderstandingbreaksdown,onegetsprojecOonoregocentrism–that’swhatwegetonthepartofThomaswhowantstomakeHanno“achipofftheoldblock”(c)LouAgosta,PhD,
LAgosta@UChicago.edu 59
EmpathicinterpretaOon
• EdmondRostand’splayCyranodeBergerac,CyranogivesupthehopeofwinningtheloveofRoxannebecauseofhisunanracOvenose,theulOmatesymbolofhissocialawkwardness.InsteadCyranowoosRoxannevicariouslythroughthemoresuperficiallyanracOveChrisOan,bypu{nghimselfintheplaceofChrisOan–swappingroles–pu{nghisownskillsasapoetandnoblemanatChrisOan’sdisposal.
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EmpathicinterpretaOon• ChrisOanisreallyapuppetwhosestringsarebeingpulledbyCyrano,whohopesthatRoxanneseesthroughChrisOantotherealhumanitythatlieswithhim(Cyrano).
• Alas,loveisblind,evenifempathyisnot.Cyrano’sempathicresponsivenessisrenderedineffecOvebybeingdisplacedfromexpressionsonhisownbehalftoexpressionsbenefiOngChrisOan,thepretender.Cyranomighthaverisentothelevelofempathy–heisrecepOveenoughtogathertherelevantexperiences–buthisempathyisinhibitedbyhislowself-esteemandsocialawkwardness.
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Empathicresponsiveness
• Breakdownsinempathicresponsivenessarecommon:gossip,changingthesubject,fingerpoinOng,blamingthevicOm,cheerfulnessinthefaceofdecidedlytraumaOcevents–nottomenOonmisuseoflanguageindecepOon,halftruths,andout-and-outlying…
• Exampleofwhatnottodo[fortheguys]: “Youarejustlikeyourmother.”
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Empathicresponsiveness
• Agoodexample:InTennesseeWilliam’sTheGlassMenagerie,Lauraisafragileisolatedyounglady–likehercollecOonofdelicateglassanimals–shewenttogradeschoolwithTomandhadacrushonhim–hecomestodinnerinnocentlyenoughattheinvitaOonofthemother,Amanda,althoughheisalreadyengagedtobemarried…Laurahadpleurisyasoneofherchildhoodillnessesandshewalkswithaslightlimp…
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Empathicresponsiveness
• Tomcallsher“blueroses”–whichwashischildhoodmis-hearingoftheteachersayingshewassickandoutofschooldueto“pleurosis”
• Lauradefinesherselfasthisdefect–aslightlimpthatishardlynoOceable–butasshewalksuptheaisleintheschoolauditoriumseemstomakeathunderousCLUMPinherownpercepOon
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Empathicresponsiveness
• ItisabreakdownbecauseTomtriestogiveLaurabackherownexperienceoflowselfesteeminhisresponseof“blueroses”–notabrokengaitbutsomethingbeauOful
• Itdoesnotworkforsomanyreasons–includingtheplaywrightscommitmenttohavingabrokenheartandemoOonaldevastaOon…
(c)LouAgosta,PhD,LAgosta@UChicago.edu 65
Exercise
(c)LouAgosta,Ph.D.TheChicagoEmpathyProjectLAgosta@UChicago.edu 66
Ican’thearyoubecauseIamconstantlytalkingtomyselfabout
whatyouaresaying
• Nothowtolistenbener–howtoexpandone’slistening…
• Walkingdownthestreet–commenOngonthepeople–what’sfordinner–whatuptomorrow–what’swrong–what’sright(etc.)
• Stopandgiveitalisten….(c)LouAgosta,Ph.D.TheChicagoEmpathy
ProjectLAgosta@UChicago.edu 67
Howtolisten
• WhenapersondisOnguishesthenoiseandstatementsofthevoiceover,thenwhatislevisaspacetobewiththeotherpersonandlistentowhatsheorhehastosay
• Thatistheempathicmoment–tojustbewiththeother–andrespondoutofnothing
(c)LouAgosta,Ph.D.TheChicagoEmpathyProjectLAgosta@UChicago.edu 68
TheDoctorasInstrument
• Thedoctorhimself[herself]isapowerfultherapeuOcagent.InancientOmesthedoctorwasalmosttheonlyeffecOvetreatmentandmorerecentlyBalinthasdescribedthedoctorasthemostfrequentlyuseddrugingeneralpracOce.
-K.B.Thomas,TheConsultaOonandtheTherapeuOcIllusion,BriDshMedicalJournal20May1978[M.Balint,TheDoctor,HisPaDent,andtheIllness.TunbridgeWells:PinmanMeddical,1975.
(c)LouAgosta,PhD,LAgosta@UChicago.edu 69
Doctorschangethemeaningoftheterm“empathy”
• Outsidethefieldofmedicine,empathyisamodeofunderstandingthatspecificallyinvolvesemoOonalresonance JodiHalpern,MD,PhD,“WhatisClinical Empathy?JGenInternMed2003Aug:18(8):670-674
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ThebookthatgotmethrownoutoftheInsOtuteForPsychoanalysis
• “Empathyisoxygenforthesoul.”
• “Anyoneelseherefeelingshortofbreath?”
• Terminated!• Maybeoneneedsexpandedempathy!?
LOU AGOSTA
A RUMOR
of
EMPATHYResistance, narrative and
recovery in psychoanalysis
(c)LouAgosta,PhD,LAgosta@UChicago.edu 71
Empathyanddiabetes?!
• PaOentsofphysicianswithhighempathyscoreswithsignificantlymorelikeleytohavegoodcontrolofhemoglobinA1c(56%)thanwerepaOentswithlowempathyscores(40%,P<.001).
• M.Hojatetal,(2011),PhysiciansempathyandclinicaloutcomesfordiabeOcpaOents,ACADMEDMAR;86(3):359–64:doi:10.1097ACM.0b013e3182086fe1
(c)LouAgosta,PhD,LAgosta@UChicago.edu 72
Empathyandcholesterol?!
• […]TheresultsoftheLDL-Ctestsgroupedintogoodcontrol(<100)andpoorcontrol(>130)[….]TheproporOonofpaOentswithgoodLDL-Ccontrolwassignificantlyhigherforphysicianswithhighempathysores(59%)thanphysicianswithlowscores(44%,P<.001).
• M.Hojatetal,(2011),PhysiciansempathyandclinicaloutcomesfordiabeOcpaOents,ACADMEDMAR;86(3):359–64:doi:10.1097ACM.0b013e3182086fe1
(c)LouAgosta,PhD,LAgosta@UChicago.edu 73
MetaAnalysis
• “[…]ThereisastaOsOcallysignificanteffectfortheinfluenceofthetherapeuOcrelaOonshiponhealthcareoutcomes[d=-.23to.66;combinedeffectsizewasd=.11(p=.02)
• JohnM.Kelley,HelenRiessetal,TheInfluenceofthePaOent-ClinicianRelaOonshiponHealthcareOutcomes:ASystemaOcReviewandMeta-AnalysisofRandomizedControlledTrials,PLOSONE[PublicLibraryofScience],April2014,Vol.9,Issue4;
(c)LouAgosta,PhD,LAgosta@UChicago.edu 74
Empathyandthecommoncold?!
• InthosewithperfectCARE[ConsultaOonandRelaOonalEmpathy]scores,coldduraOonswithshorter(mean7.10daysversus8.01days)[….]Inthesemodels,aperfectscorealsocorrelateswithalargerincreaseinIL-8[immunecytokine]levels(p=0.015)– DavidP.Rakeletal,(2009),”PracOOonerEmpathyandtheDuraOonofthecommonCold,FamMed41(7):494–501.
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MoreTakeAwaysandSummary• Thesecret,undergroundhistoryofempathytraversesHume’s“delicacyofsympathy”andKant’s“communicabilityoffeeling”
• Empathyishardtoteach,butonewaytodosoisremovetheobstaclestoempathy–removetheobstaclesandempathyshowsup
• Listeningtoone’slistening–thevoiceover• ThemulO-dimensionaldefiniOonofempathy• Disordersofempathy
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