The Case Against Empathy #physicaltherapy

This blog has explored empathy in depth over the years.  There has been a recent trend led in part by Yale psychologist Dr. Paul Bloom and his new book Against Empathy that calls into question the use of empathy. Through the use of clinical cases and compelling and logical arguments, Dr. Bloom believes that however while well-intentioned, empathy is a poor guide for moral reasoning and that to the extent that individuals and societies make ethical judgments on the basis of empathy, they become less sensitive to the suffering of greater and greater numbers of people. Dr. Bloom posits that we ought to substitute compassion for empathy.

In an attempt to empathize with Dr. Bloom, I read with curiosity his book and have listened to several interviews of him. While working on my Masters at University of Pennsylvania, he was a guest lecturer and we read his book How Pleasure Works: The New Science of Why We Like What We Like.  In classroom and both books, the brilliant Dr. Bloom presents counterintuitive arguments that really challenges your thinking on fun topics ranging from food to sex. On empathy, I disagree with most of his arguments.

Dr. Bloom’s view of empathy is actually limited because he uses only one definition of empathy and as we have detailed empathy is a multi-dimensional construct-especially in the domain of healthcare workers (for detail on 4 dimensions of empathy go to about the 4:50 in this video). Empathy per Bloom is narrowly defined as affective or emotional sharing or mirroring another person’s emotions based on your concerns for them.  He contrasts this with compassion which is giving concerns some weight and even valuing them but not picking up the feeling part of it.  Let’s also not forget the distinction with sympathy which is feeling a different emotion than the mirroring of empathy.  By way of example, if I see my daughter crying in anguish and I too feel anguish, than I am experiencing affective empathy (feel the emotion and legitimizing it). If on the other hand, I see somebody else’s daughter and feel a different emotion such as pity (“Oh, the poor thing”), then I am showing sympathy rather than empathy.

A good portion of the book really deals with the misguided use of empathy on public policy and there are no shortage of excellent examples including Donald Trump’s use of immigrants and Muslims and victim statements in the criminal justice system. In that context and in so many of his “group” examples, I completely agree with him but would argue it more generally that when we make major decisions strictly based on “feelings” that we can be mostly misguided. Let’s not forget, we can easily be taken by con men who tug at one’s heart strings to get what they want. Empathy, Bloom accurately points out is biased and we have plenty of evidence of this. We know for example that it is far easier for one to take an imaginative leap into another person who is of the same race, age, sex, and lifestyle than it is a person who shares none of those in common. This is why we emphasize empathy is a must skill to be learned rather than purely an innate ability.

We do need to remember though that empathy has limitations and boundaries (excellent article by Jessie Podolak on this last point). However, the case against empathy is not nearly as strong as the case for empathy-especially in #physicaltherapy where so many of our patients have come to see us because so many other practitioners have failed at empathy.

Thoughts?

@physicaltherapy

4 responses to “The Case Against Empathy #physicaltherapy

  1. Robert says:

    What are your thoughts about the argument that over empathizing leads to burnout, compared to compassion which apparently has a protective capacity?

    1. Larry Benz says:

      It flies in the face of research. Plenty of studies that show that empathy is the antidote to burnout. When we don’t have empathy, we don’t take perspectives which means we let other people’s issues impact us resulting in burnout. The more impactful reason for burnout is the regulatory compliance, documentation requirements, and other externalities that make it difficult to actually spend time with patients and detract from the very reason providers go into healthcare as a profession.

  2. I think much of the debates stem around poor definitions of words such as empathy (cognitive and emotional or affevtive), sympathy, caring, compassion. Paul Bloom has said as much as well.

    I think there lies a sweet spot. But, as I’ve written about I’m. It sure we always need to care to be caring: https://ptthinktank.com/2014/11/30/do-you-need-to-care-to-be-caring-sympathy-empathy-compassion-and-caring-in-healthcare/

    I agree 100% we need to spend more time cultivating the cognitive and emotional skill set of students and clinicians in relation to the human suffering and distress we encounter. But, I’m not sure empathy is the answer. I like Bloom’s use of compassion.

    If we care personally or feel deeply for every patient case (and the outcome) we are doomed for burn out and roller coaster variable clinical abilities. If we are totally indifferent, we become cold and cynical. Tying our personal identities to outcomes risks poor assessments of our process and practice. And, another roller coaster of feeling satisfied and competent with disappointed and skill less.

    How can we care without always caring? Assess and reflect on process while properly contextual using outcomes? Be compassionate without constant emotional turmoil?

  3. Larry Benz says:

    Kyle, thanks for the link-it is an excellent post. Your last questions are indeed key topics for an on-going conversation as they are critical issues surrounding a profession that has many externalities putting pressures on PT’s from EMR, compliance, documentation, productivity, and accountability. Bloom’s answer might work for you and that is fine but is also flies in the face of evidence http://bmcmededuc.biomedcentral.com/articles/10.1186/1472-6920-14-219/open-peer-review

    It isn’t being overly empathetic that contributes to burnout-but it might just be the externalities.

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