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Wednesday, March 1, 2017

Rational compassion beats empathy every time


A family spends nearly a week chasing down the result of a biopsy. The man who holds the potentially life-changing information is the surgeon, a senior hospital consultant. He is clearly very busy. Very, very busy. And though this might seem presumptuous, so are the family members. Busy trying to hold down jobs and contracts and looking after other people; busy reassuring the hospital patient; busy trying to look normal; busy trying not to lose their minds in the most sadistic of all waiting games.

The nurses look embarrassed and utterly powerless. “Hold on and you might catch him on his rounds,” they say. Translation: try to hang on after visiting hours when he usually appears in the ward, then pounce. One suggests making a formal complaint. Apparently, such behaviour is endemic in this particular unit. One evening, the family has reached the hospital exit when word comes – from the patient – that the consultant is on the ward. They run through the hospital, down long corridors and up several flights of stairs, to “catch him”. He is busy, busy, busy, surrounded by his team and promises to talk properly soon.
Several days on, there is still no word. Then as the weekend looms and after some high level intervention, he agrees to sit down. He imparts the news, clearly and concisely. The family know what they’re up against now. They can regroup, organise themselves, be the allies that many other professionals will call upon in demanding times to come.

But his behaviour remains a mystery. Ultimately, the meeting took about 10 minutes. He was not required to handle any possible family meltdown – a liaison nurse was present, with the job of picking up the pieces. He held all the cards. By now, the family’s problem was clear. But what was his problem? Had the pressure of the job, of being an unchallenged godhead, knocked every scintilla of empathy out of him, they wondered? Or had he dismissed empathy long ago as an unnecessary, “womany” part of the job?

That family’s experience came to mind again while I was reading Dr Muiris Houston’s column about empathy in doctors. A firm believer in inculcating it in trainee doctors, he has had his thinking challenged by some recent publications, including a piece in Aeon, an online magazine, in which ethicist Karin Jongsma and psychologist Verena Klar ask if empathy is an over-rated skill in medical care. Empathy is having a moment and not just among medics. This is mainly down to a widely-discussed new book by Yale psychology professor Paul Bloom, provocatively titled Against Empathy: The Case for Rational Compassion.

Mandatory empathy
It comes at a time when full-on empathy is mandatory on every kind of media, a time when hesitating to walk a mile in everyone else’s shoes is the gravest of social sins. In this age of emotion, “an entire river of pain . . . flows down my Twitter feed every day”, in the words of writer Ken Armstrong, and people are verbally assaulted for not immediately name-checking distraught Syrians while empathising with traumatised Parisians; or for not sufficiently empathising with non-metropolitan Brexit-Trump-supporting voters over resentful suburbanites. In this world, empathy is a zero sum game, where feelings always win out over fact-based evidence, and the heart always wins over the head.
Bloom’s central message is the opposite: reasoned compassion – less emoting, more objectivity – is what is needed. Use your brain. Think. What this probably means in practice is to inform yourself, seek out every nuance, every possible side of the story. Cut down or cut out social media. Be sceptical of politicians who pretend to be just like you, who litter every speech with a story – “I came upon an old woman called Mary, clutching a water bill in her cold, dead hand . . .”

The fact is, it’s not possible to feel every single person’s pain and be useful citizens. Almost everyone carries some grief or worry of their own (odd as that may seem to many social media commenters, who imagine themselves to be uniquely afflicted) and empathy is a fickle trait.

Empathy does not make us kinder or better, Bloom argues, but actually clouds reason and moral judgement, boosts the danger of bias and can interfere with professionals doing their job. Instead, he calls for “social intelligence” – which means at least attempting to understand why people feel as they do although they may seem like Martians – and reasoned compassion.
The family we came in with would not argue with that. Professionals of any stripe do not have to walk a mile in their clients’ shoes to understand why grief and worry are exacerbated by thoughtless delays or dismissive attitudes. Empathy is not the issue. Regular infusions of rational compassion will do.

Kathy Sheridan