Against Empathy

A rare literary event occurred in Clifton this year. A bookshop opened. I walked in, was greeted by a very congenial bookseller, and walked out with eight books. One was a work of popular psychology called Against Empathy by Paul Bloom. Clever. I bet most people buying this book consider themselves empaths, and therefore see it part of their empathic duty to try and view the world through this set of contrarian lenses. Though I have always felt aligned to the concept of empathy I have, if I am really honest, never quite understood what it is and how it relates to cousins like sympathy and compassion.

Bloom kicks off by outlining the popularity of his quarry. You get, for instance, over 3000 returns on searching Amazon books for the term “empathy”. Higher ranking examples include “The Empathy Gap, Why Empathy is Essential”, “The Empathy Instinct: How to Create a More Civil Society” and “The Roots of Empathy, Changing the World Child by Child”. Websites include one listing everything Barack Obama ever had to say on the subject including an often-quoted statement that “The biggest deficit we have in the world….is an empathy deficit”.

Blooms takes the view that all this empathy isn’t just not good but an overall harm to the progress of society. To understand this view you need to understand his definition – empathy is the “act of coming to experience the world as you think someone else does”. Empathy by this definition is actually/literally feeling another’s pain. We are reminded of the science of “mirror neurones” – cells that fire when we feel or do, but also when we watch someone else feel or do the same thing. A neural substrate for empathy in this Bloomsian sense.

And why bad? Because when we act on the basis of vicarious sensation we act narrowly, we act with bias and we act without reason (hence the book’s subtitle “the case for rational compassion”). He has examples. After the fatal shootings at Sandy Hook, Connecticut, in 2012, this affluent town was inundated with children’s gifts often donated by poor people. He argues people felt the pain of the community and acted irrationally in response (the toys were no help). We feel, he says, much more the pain of those with whom we can identify and thus ignore the pain of those with whom we can’t. Empathy is innumerate and lacking in any long-term view.

Also empathy is bad for the empath – it can lead to burn out and make us less useful in responding to need. This is a major issue in the caring professions. Whilst many decry the documented (but disputed) erosion of empathy scores as medical students progress through the curriculum, I’ve wondered if this might a maturing, rather than a hardening of the heart, as students learn to stop responding emotionally to the pageant of human suffering.

But while the book’s argument is enjoyably debunking, it is also flawed. Bloom excludes from his critique what is elsewhere defined as cognitive empathy. This is not so much feeling the pain of the other but understanding it. Whilst we can feel moved by the plight of the patient, much better that we try and understand that plight with the hope of being able to respond usefully to it. There are two big barriers to students understanding patients. First students come mainly from high income backgrounds and most patients (especially in hospitals) come from low income backgrounds. Second most patients are sick and most students are well – and sick is another country. And there are two trusted ways of crossing the frontier – really listening to what patients have to say and engaging with the arts (film, theatre, literature, visual arts etc) where alien perspectives are defined and refined, above the cognitive noise of the hospital. This is something we are slightly good at in Bristol even if the Arts signal is weak and intermittent.

I was surprised that the book, which has a lot (of mainly negative things) to say about moral implications of empathy, doesn’t reference the idea of “moral imagination”. This term from moral philosophy signifies the lofty ethical work of extending oneself “beyond the barriers of private experience and momentary events”. In other words, moral perceptions don’t only derive from principles but from the human ability to imagine situations we hope to never actually encounter in our private lives. No amount of psychology will convince me that it isn’t a good thing to try and imagine the diverse, perverse and poignant predicaments to which we humans are prone.

Did a patient ever make you cry? I recall some moments as a junior doctor. Like watching a bewildered man in his thirties cradle his wife at the moment of her death in a side ward in Ealing Hospital. Though the occasions are few, tears at such times feel absolutely OK, evidence that we are indeed human. To be honest I wish I could cry a bit more. But a tear is different to a prolonged weeping fit, and should only enhance our willingness and our ability to be helpful. So, I am a fan of a certain amount of emotional empathy and a relatively larger amount of (trained) cognitive empathy.

This brings me to compassion. Compassion, by my definitional system, is more than empathy. Where empathy (both emotional and cognitive) triggers helpful action we have compassion. It can of course trigger other types of action. For instance, if I feel your pain I might want to run like hell and if I really understand what makes a man tick I might use that knowledge to manipulate him. It is said (think Hannibal Lecter in Silence of the Lambs) that psychopaths have an abundance of cognitive empathy but no emotional empathy – they get you then they gut you. But where empathy makes us act thoughtfully we have compassion – my fav definition of which is “intelligent kindness”.

I am glad I picked up this book. It has helped me better define some very important terms, reminded me of the futility of many emotionally driven responses, and introduced me to some interesting psychological experiments. For instance, subjects primed to be empathic were more likely than controls to bump a child up a waiting list of similarly deserving children, proving for Bloom the moral vacuity of empathy-based action. But the narrowness of Bloom’s definitional scope, excluding the imaginal and cognitive aspects of empathy, mean his conclusions lack credibility and I sallied forth with most of my original preconceptions intact. It is however a good exercise to lead one’s sacred cows to the slaughter.