Wednesday, September 7, 2016

IS EMPATHY ALWAYS A GOOD THING?

Irma Kurtz

In thinking about my four previous blogs on empathy, it seemed to me that there is an important question that I haven’t discussed.  This is whether empathy is always useful and when might it not be?

Empathy has had such positive press in recent times, that it may even seem foolish to question its value.  However, there are those that do and a balanced perspective is helpful.  Paul Bloom, psychologist and Yale Professor is one such person. He claims that empathy can blind people to the long-term implications of their actions.  His book on the subject is titled, Against Empathy: The case for Rational Compassion. As I have discussed, I was introduced to the concept of empathy by the child psychotherapist Barbara Dockar-Drysdale. She included a question on empathy in a needs assessment for children whose development had been disrupted by neglect and trauma.

She referred to empathy as, “a capacity to imagine what it must be like to be in someone else’s shoes, while remaining in one’s own”.  The ‘remaining in one’s own’ is a vital part of the definition.  This means that there is a sense of separation.  The person empathising recognizes that the other person’s experience and feelings are not the same as one’s own.  Identifying with the other does not mean taking on his feelings as if there are one’s own.  This requires a level of maturity and personal integration. However, identification can be seen as a precursor to empathy.  I can remember being with a group of toddlers, one starts crying and within a few seconds they are all crying!  Neuroscience tells us that this is mirror neurons, responding in kind to what is perceived.  This is not the same as empathy as one has literally taken on the feeling of the other. It is however, on the developmental pathway towards empathy. 

The same can happen with older children, who are emotionally unintegrated, due to developmental trauma.  One becomes angry and quickly there can be a group feeling of anger.  So, the capacity to empathize rather than merge can be seen as a developmental achievement. But as Ariel Nathanson, has shown in his blog in this series (Is Empathy on the Decline?), the capacity may be there but it might not be helpful to show it.  For example, if it goes against a group norm.   Within different cultures, different qualities might be more supportive of development and progress. Showing empathy may be more or less valued and useful in some cultures. 


Bruno Bettleheim (1970) wrote about this in his book ‘Children of the Dream’.  He compared children brought up in the communal environment of Israeli Kibbutz and those brought up in small nuclear families of the USA.  He found that empathy was more predominant in the individualistic USA family rather than group Kibbutz culture.  Initially, he found it disturbing to observe children in a Kibbutz.  For example, on the way to lunch a two-year-old fell over, hurt his keen and started crying.  To Bettleheim’s surprise, the adult in charge, very briefly picked the child up and then put him down and continued to lunch with the other children.  But also to his surprise, what followed was that the child appeared to recover quickly and join the others for lunch.  Bettleheim said that he didn’t feel that the adult had been insensitive,
She was merely convinced that the baby had to learn to get along in his group, and not rely on the intercession of someone outside of it; that her comforting would only retard a piece of learning that was more important than temporary discomfort.(p.106)

Being part of the group was more highly valued in the Kibbutz system at this time, rather than paying attention to the individual.   This does not mean that empathy does not exist, but the emphasis is in a different direction. It is a matter of degrees.  Attention in one direction inevitably influences what else can be attended to. Edwin H. Friedman (1999) argues, in his excellent book, A Failure of Nerve: Leadership in the age of the Quick Fix, that empathy does not encourage responsibility and that there is a pay-off between the two.   
“What increases self-differentiation and emotional maturity, is not empathy, but challenge. A focus on empathy is an adaptation towards weakness.” 

In the Kibbutz example, it can also be argued that the child is expected to be responsible towards the group and to manage himself accordingly.  Friedman argues that this is critical in healthy families, organizations and societies.  The individual adapts to the group expectation more than the group adapts to him. Again, that doesn’t mean that individual needs are not recognized or met, but the group must maintain itself and have clear expectations. 

Friedman claimed that the emphasis on the individual and on empathy has contributed to a society regression.  It is difficult for parents and leaders to ‘hold one’s nerve’, in a culture, where the individual demands so much attention.  To put expectations on him or her, can feel punitive and harsh!  This is also objectively difficult in societies where there is a litigious culture, where the rights of the individual and employee predominate.   

"Ultimately," Friedman states, "societies, families, and organizations are able to evolve out of a state of regression not because their leaders 'feel' for or 'understand' their followers, but because their leaders are able, by their well-defined presence, to regulate the systemic anxiety in the relationship system they are leading and to inhibit the invasiveness of those factions which would preempt its agenda. After that, they can afford to be empathic."

In environments where leadership is so challenged, becoming a victim can be easier than being a leader.  It can be argued that the prevalence in some cultures of empathy and victim are both part of the same thing.  The British sociologist Frank Furedi has written much on this subject.  Book titles such as Paranoid parenting and Therapy Culture, are strong indicators of his views.  He has highlighted how societies such as UK and USA have shifted hugely towards the image of a human, who is weak and vulnerable rather than one who is resilient.  The use of victim related language has escalated exponentially in the last 50 years.  It is not possible to be recognized as a victim unless someone has empathy towards him or her.  Therefore, the victim culture, depends upon empathy as its partner.  Again, it is a matter of degrees.   
So in response to the question of this blog, one answer might be that empathy is not a good thing, when a healthy balance is lost. For example, when the movement is too far towards the individual. 

As well as urging parents, leaders in the workplace and other settings, and presidents to be clear about their expectations, Friedman adds another key factor.  This is that parents and leaders, etc. must be clear of what they need for themselves.  So if I am a parent what might I need to keep going and to be a ‘good-enough parent’? If I am a leader what might I need to put in place for myself.  Thinking in this way can seem selfish.   It is in the sense of putting one’s self first, but it is in service of the task.  The parent and leader must remain healthy, able to operate most of the time in a clear and steady fashion.  Donald Winnicott, the child Psychiatrist, pointed out the most important thing a mother of an infant must do, is to survive and he added ‘that is not as easy as it sounds’.  Of course he did not just mean physically survive, but also psychically.  And especially to survive the infant’s aggression and hostile ‘attacks’ on her, without retaliation.  The parent must be a healthy individual with her own life.  As he also said, the mother may be everything to the baby, but the baby must not be everything to the mother.  From a developmental view this means being a separate but connected person.  Friedman calls it self-differentiation - being clear about one’s goals, principles, expectations and needs.

He claimed that this goes further than survival,

This is not merely a matter of putting one’s own oxygen mask on first.  It has to do with leaders, (or parents or healers) putting their primary emphasis on their own continual growth and maturity……the focus on empathy, because it encourages primary emphasis on others, subverts the nature of that self-differentiating process.

He also argued that trying to be empathic can undermine this,

Once parents are reoriented towards their own welfare, their stamina begins to increase in the most natural way.  And it is no different with teachers, therapists, professional people and CEOs.

Self-differentiation in others is not likely to develop unless there is a focus on one’s own self-differentiation. Friedman believed that the number one issue in leadership 'today' is a failure of nerve to define oneself more clearly. The leader’s self-differentiation and not empathy, encourages self-differentiation and development in others. Such a leader is able to be present in the midst of emotional turmoil, actively relating to key people while calmly maintaining a sense of his own direction. With this capacity, he or she can affect the whole system of relationships and reduce the level of anxiety in the organization network.  The today that Friedman was talking about was 1996 and it can be argued that the concerning trends he identified then have grown further.

In work with traumatized children and young people having a good capacity for empathy is clearly important.  Arguably, the same can apply to other contexts, such as the family and the workplace.  However, this has to be balanced by other qualities.  For example, to be self-protective, to have clear and consistent boundaries and to maintain appropriate expectations.  It could be argued that it doesn’t have to be one without the other.  It is possible to be firm, whilst still having empathy.  In reality, I think it is not so easy.

At times, a person may consciously draw an empathetic response as a way of avoiding something more difficult, such as taking responsibility.  This is one of the tussles that can pull on us when we both empathize with a person’s difficulties, but also recognize the need for responsibility. For example, as with an adult sex offender who was also abused as a child. 

Recently, I observed a policeman having to deal with a volatile teenage boy probably about 14 years old.  There were two teenage boys together and they had been separated.  This one was outside on the street with a policeman and the other was inside a building with a policewoman. The policeman asked the boy outside to stand still and calm down. The boy shouted a stream of abuse at the policeman, accusing him of various things and making demands.  The policeman reasoned but to no avail. The boy’s behaviour escalated.  After a few minutes the policeman shouted at the boy to stop it and told him to put his has hands out. The policeman made his physical intention clear, without doing anything inappropriate.  He handcuffed the boy and sternly told him “enough” and to get in the car. The boy did as he was told, got in the car, sat quietly and began to cry.   The person I was with felt empathy towards the boy.  She wondered what must have happened to him to end up in such a situation and to be so out of control.  Having been on the end of many similar altercations, with an angry and aggressive, emotionally unregulated teenager, I felt empathy for the policeman.  Maybe our feelings were somewhere between empathy, sympathy and identification? At the moment the policeman acted, I don’t think he was feeling empathy, but it did calm the boy down.  This reminds me of the concept ‘’tough love’’.  I can think of many examples from my own work, where what is being pushed for and needed is containment.  The need is to be emotionally and physically safe.  I think that what is required at those times, is not necessarily empathy but a clear and firm, non-judgmental approach – to take control.  The non-judgmental part helps guard against becoming punitive.  

Another challenge with empathy is that it might be felt as intrusive.  The nature of empathy is to know what another is feeling.  This also feels like knowing what another is thinking.  For traumatized people, thoughts and feelings might feel unsafe and even dangerous.  Feelings and thoughts are often a link back to the terror of trauma, so they are blocked out.  The person may also have strong emotions about their trauma, such as guilt and shame.  Empathy may trigger such emotions.  It is difficult to have real empathy without exploration.  Any kind of exploration might feel threatening.  This means there are times when it is necessary to tread very carefully.  Maybe the person, just wants to be not hurt and to feel safe. Empathy can wait until these basic needs have been achieved. Maybe they just need someone to be beside them as a safe, reliable and compassionate other.  During grief for example, the compassionate presence of another may be what is needed, rather than someone who is feeling the same pain.  
The feeling of the pain through empathy, may be most useful when a person has never felt understood in their suffering.  For example, when a person has suffered adversity, trauma coupled with a complete lack of empathy from others.   

It is often not a question of whether empathy is helpful or not, but what we do with it.  We need to distinguish between empathy and identification. Where we are primarily identified with another we are more likely to act in a way that is to do with our own needs rather than theirs.  For example, we might do what we wish someone had done for ourselves.  Working out what we should do with our ‘empathy’ can be a pre-occupying task.  There are times when this kind of pre-occupation is helpful and others where it is not.  Times where it is needed and others where it distracts and gets in the way of a more urgent need.  One way of working out our approach is to observe what happens after we try something.  What are the outcomes?  Do we find ourselves offering more and more empathy, but nothing seems to progress?  Some researchers such as Barbara Oakley, have studied the troubling relationship between narcissists and their partners who appear to have an abundance of empathy.  
The role of empathy can become part of the problem in a pathological co-dependent relationship. 

An important question is not just what do we offer, but what is made of our offerings?  Some people may be more able to make use of one kind of approach, such as empathy.  It may also depend upon timing. Sometimes empathy may be just the right response, at other times guidance or direction may be needed.  Like when a leader, needs to grasp hold of a situation and go in a certain direction.  The clarity of purpose and decisiveness may contain people’s emotions that the leader isn’t even thinking of.

Finally, and relevant to everything I have said so far is the matter of compassion fatigue.  This could also be termed empathy fatigue.  Someone told me recently that he listened to an interview with the Dalai Lama. The Dalai Lama was asked how he can bear all the suffering in the world. Apparently the response was ‘in glimpses’.  I’m not certain the Dalai Lama said this, but it is an important point.  It fits with Friedman’s idea of self-differentiation, knowing one’s limits and what one needs for oneself. It is relevant to the contexts we are in, as Bettleheim pointed out. It also fits with Winnicott’s emphasis on the need for survival. 

References

Bettleheim, B. (1970) The Children of the Dream, New York: Avon Books

Paul Bloom, Short Video - http://goo.gl/nIXpEH

Dockar-Drysdale, B. (1970) Need Assessment 11: Making an Assessment, in Therapy and Consultation in Child Care Problem (1993) London: Free Association Books

Friedman, E.H. (1999) A Failure of Nerve: Leadership in the Age of the Quick Fix, New York: Church Publishing, Inc.

Furedi, F. (2004) Therapy Culture: Cultivating Vulnerability in an Uncertain Age, London and New York: Routledge

Furedi, F. (2002) Paranoid Parenting: Why Ignoring Experts may be Best for your Child, Chicago: Chicago Review Press

Barbara Oakley Website - www.barbaraoakley.com

Article by Kelsey Dallas, Too much of a good thing: When empathy is overwhelming, http://goo.gl/UBZCYE






Sunday, February 7, 2016

Professional and Personal Development


This will be the first of a series of blogs on Development.  It is especially relevant to those who work with traumatized children and young people, but also more widely.  My 30 or so years of work in services for traumatized children and young people has always had a focus on development.  I think of this as broadly meaning growth, expansion and advancement.  Development means learning from experience. This can be exciting and also scary.  It means change, leaving the familiar territory and going into the unknown.  All of which we might understandably resist, but which are essential for evolution and survival.  As Charles Darwin said it is not the strongest that survive but those most responsive to change.  It could be argued that in our fast changing world the ability to respond to change and adapt is increasingly important.

This blog is on our own development as a worker. What often gets referred to as professional development, but I think it is far more than that.  I include workers at all levels who are involved with traumatized children. Carers, therapists, supervisors, managers and directors, among others.  The next blogs in this series will focus on the development of: the child/young person; our colleagues and teams; the organization as a whole; and those we are connected with, such as a child’s family, other professionals and local community.  I am starting with the worker, simply because for me, my choice to work with traumatized children was my beginning. 

 My first job was in 1985 as a residential care worker in a UK therapeutic community for 'emotionally disturbed' boys.  The working conditions were extreme.  They would not be allowed today, because of employment regulations.  We lived and worked on a large rural site. 40 boys in groups of 10 in 4 separate houses, based on a farm.  The staff and their families had their own accommodation. The setting was a little like a small village.  The tranquility of the setting was in stark contrast to the primitive emotions and behaviour that were often part of daily life.  To some extent the environment was an essential antidote.

The official hours of work were 7.30 am to 11 pm 5 days a week.  One and half days off each week.  I had a Saturday afternoon after 1.30 pm off, and Wednesdays. On work days getting off at 11 pm could easily turn into 1 am or later.  At times we didn't get our time off, due to covering sickness or a crisis.  Regular hours were 70 per week, at times up to 100.  Going to work there was one of the best decisions I ever made.  I am still thankful I was given the opportunity.

I was attracted to doing something challenging and which I believed would lead to personal change.  This possibility was confirmed by most people I talked with on my 3 day long visit, which was part of the staff selection process.  The staff I met kept saying, this kind of work will challenge you, but if you can do it you will learn about yourself and grow as a person.  I was already identified with working for a just cause, and doing something for disadvantaged children.  However, I think the motivating factor was to do with personal change for me and my sense that this work might be a way to do it.    

I think there are many jobs where we can learn all the time, but not so many which will lead to fundamental change as a person.  The kind of occupations that push us to our limits are more likely to do this. Our formative experiences have a major influence on our adult personalities.  Working 24 7 with children who keep probing to test who you are and what you are capable of, is another likely catalyst for change. Put the two together and there is a huge potential for growth, both professionally and personally. We find ourselves in a position where it is impossible to escape our vulnerabilities, unless we have armour coated skin.  Two options that don’t take long to surface, are leave or stay and work through whatever is painful and difficult.

John Whitwell was the Principal of the Cotswold Community for the 14 years I worked there.  He captured the centrality of change in a 2011 speech, celebrating the work of the Community,

The Cotswold Community has been a special place for a lot of people for a long time.  Why is it special? ………..It seemed to me that the Cotswold Community supported change.  Change for everybody in the place. Change not just for the boys that came here, but change for all the grown-ups.  That change was about gaining new insights into the work, but also about becoming more self-aware and also learning new skills.  Skills whether they were therapeutic skills, or practical and creative skills as well.

Bruno Bettleheim (whose reputation has been challenged since his death), who was Director of The Orthogenic School in Chicago also wrote about this in his book 'Home for the Heart' (1974).  The Orthogenic School was for children with significant difficulties, such as severe autism and childhood schizophrenia.  I read parts of his book during my early days in the community.  There were a few sections I found particularly interesting.

·       Reintegration: The staff member against himself
·       Personal Change and Professional Growth
·       The Inward Journey

When I started writing this blog I didn’t anticipate referring to Bettleheim. However, I associate him with some of my first insights into the issue of development.  So, maybe it is not surprising he has come to mind. Bettleheim's basic premise was this and it is as relevant now as it was then.  We go into these extreme work environments, because it will meet some of our own needs.  We are not likely to be conscious of what those needs are, but we sense the work will be good for us. Sentimental notions of wanting to 'love' children or ‘help’ a deprived child, on their own will not be enough to sustain our efforts. Hence the well-known phrase 'Love is not Enough' - also a title of one of Bettleheim's books.  In fact many people who do not last long in the work, don’t leave because of the children’s attitudes towards them. They leave because of their own strong reactions and hostile feelings towards the very children they previously felt so much sympathy towards.  The shock of their own reactions and feelings can be too much to bear.  I certainly remember feelings of anger I had never felt before in my life.  The children were expert at finding our ‘Achilles heel’ and ‘buttons to push’ that we didn’t even know we had.

It isn’t so much the patient’s actions or feelings against which the staff need to protect themselves, but mainly their own. (Bettleheim)

I'm talking about very difficult children here, who will often attack you, emotionally, verbally and physically and reject everything you offer. They will also behave in a chaotic, unpredictable, bewildering and often dangerous manner. If all of that goes on consistently, for days, weeks and even months it is challenging to the extreme.  Thankfully it doesn’t go on forever, though it can feel like it.  These children need to push those who care and work with them to the limit.  Only then and if you survive and carry on, without retaliation will they begin to trust and potentially heal.  Tolerating one’s own feelings and reactions is sometimes the best we can do.  At least this is better than hurting the child, which may have been common in his or her history.

2nd part of the premise.  When we are faced with such consistent attack, rejection and hostility, our defences, which were good enough to help us survive in ordinary circumstances, begin to disintegrate under this emotional and physical onslaught.  

3rd Part - we feel extremely vulnerable, frightened, overwhelmed and confused. Support is critical here.  The worker may be in emotional turmoil, which is a normal reaction to a highly stressful situation.  Those providing support need to have the confidence and experience so that they too don’t become reactive.  Emotional disintegration can be catching.  Any organization that provides foster or residential care, or any other service to children who have complex trauma must meet this onslaught on the staff, with an equally powerful support.  If not, people are likely to get really hurt and not everyone will stay in the same place. Either staff or children will leave, or both.  I think the same also applies in other related services.  The support can be in different forms - training, supervision, mentoring and consultancy, and directly in the work situation.  It is essential that time and space to think about the work is provided.

4th part.  With defences disintegrating, we can begin to feel and see what is underneath them and this provides the potential for learning and growth.  Why did a particular incident make us so upset?  We begin to make connections, sometimes with events we had completely forgotten.  What we remember of our childhoods begins to become more complex, but also more accessible.  This ‘inward journey’ as Bettleheim called it could take many years, usually a minimum of 3. 

5th part - reintegration.  This is when the unintegrated parts of our personalities begin to become integrated. It is interesting that this concept of integration is now one of the main themes of trauma recovery work.  With reintegration our personality grows. Our narrative becomes more coherent and now includes experiences, sometimes painful, which we were not fully aware.  The unconscious and unintegrated past may have made itself known in ways outside of our control.  Like an unpleasant repetition we couldn’t stop.  For example, a physical symptom or pattern of behaviour. 

There is not an end to this process of integration. It carries on, just as new experience continues.  But just as in the way the first 3 years of life are so influential on the rest of our development - the first 3 years of intensive work with severely traumatized children has a similar long lasting influence. For some people, if they get that far, the 3 year cycle is enough.  Change has happened and it is time to move on.  For others, different reasons for continuing can be found.  Whatever route we take, our development is central to our well-being.  I learnt the following from Martin Willis (2001) on a training event related to strategic leadership and outcomes.  The three key outcome areas for human well-being are safety, happiness and development.  Development is important to all of us – for those who work with children who have complex trauma it is a necessity.  Bettleheim said in 1974 and I agree with him,    

Such re-integration around the patient seems to have a near miraculous effect. Actually, what is involved in the process makes understanding it quite readily comprehensible: the worker’s integration often induces a parallel process in the patient.

Though he uses the terms patient and worker, I think the same also applies in more familiar and less institutional settings, such as a foster home.  There are many routes to development.  I am not advocating that an experience like mine would be good for everyone, though it was for me.  Those extremely challenging years laid a foundation that I continue to value, use and build upon.  There were also many enjoyable times, wonderful shared experiences, fun and humour.  The children had great character and are unforgettable.  I am glad to still be in touch with a few as adults, 25 or so years later.  The therapeutic community I joined had developed an exceptional therapeutic model.  The support that I was able to make use of was excellent.  I had high quality people around me - colleagues, managers, senior staff and consultants.  Maybe the culture allowed their quality to develop and shine through?  No one person created the culture, but we all, including the children had the space to contribute. Without this the whole place could easily have disintegrated into a complete mess.  At times it felt like it was.  Many young people, whose lives were not destined for good outcomes did very well. Some didn't and the same could be said of the staff. There are probably many who have mostly negative memories. But many also who have gone on in their work, to achieve on the foundation of this experience.

We cannot overlook the central need for the professional development of all those who are involved in such challenging work.  We might call it professional, but in a job that is so personal there isn’t a neat way of separating the personal.  For example, if a carer is to not be punitive towards an ‘ungrateful’ child, she might first need to understand her resentment towards her parents who constantly told her she was ungrateful.  However, our need for development needs to be manageable within the context of the primary task – enabling children to recover.  Too much baggage, might really be too much.  A fair bit of baggage, like the ‘wounded healer’ might give us the motivation we need.  No baggage, there are easier ways to make a living.  There is a fine line here and it is one of the central struggles of the work.     
  
References
Bettleheim, B. (1974) A Home for the Heart, London: Thames and Hudson

John Whitwell (2011) Celebrating the Cotswold Community: July 9th 2011, http://goo.gl/FCViY7

Willis, M. (2001) Outcomes in Social Care: Conceptual Confusion and Practical Impossibility?, in Leadership for Social Care Outcomes Module Handbook 2005.  University of Birmingham/ INLOGOV: England

Patrick Tomlinson Contact and Information
LinkedIn Discussion Group – Therapeutic Residential and Foster Care for Traumatized Children https://goo.gl/hZivci

Sunday, January 24, 2016

Is Empathy on the Decline?

I am delighted to introduce this guest blog by Ariel Nathanson on this critically important subject.  Ariel is a Consultant Child and Adolescent Psychotherapist.  His work specialises in the assessment and treatment of children, adolescents and young adults who display perverse, delinquent and violent behaviours (for brief biography, see refs). 

This blog fits well within my series of blogs on Empathy (see refs).  Ariel brings to attention the complex factors inter-related with empathy and how it influences our actions.  His views build upon the work of the famous social psychologist Stanley Milgram in the 1960s.  It is possible to be capable of empathy and also, carry out harmful acts. This is a challenge to all of us, because we might all struggle to act in an empathic way under certain conditions.  
A key question for me, which is also highlighted by Ariel is this - Is the capacity for empathy actually on the decline or is it just more difficult to show it?  
As Ariel will show, we also need to be careful in our assessments and judgements regarding the actions of a child or young person.  In this respect, Ariel’s blog shows a great deal of empathy for the complex situations that influence the actions of the young people he works with. It also raises some important questions about our contemporary cultures and issues such as the use of social media.  Thank you Ariel.

Patrick Tomlinson

Recently I came across a study conducted at the University of Michigan State (2014) comparing college students’ current capacity for empathy with past generations. Their findings appear shocking: following the year 2000 they measured a marked decline in empathy. Contemporary students show about 40% less empathy as a trait compared to students 30 years ago.

The capacity for empathy, as we know, is highly relational, a product of very early life experiences and attachments. Even a dictionary definition of empathy is relational and surprisingly psychodynamic:

“1. The imaginative projection of a subjective state into an object so that the object appears to be infused with it.
2.  The action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another of either the past or present without having the feelings, thoughts, and experience fully communicated in an objectively explicit manner” (Miriam Webster dictionary, 2015)

Developmentally, the capacity to be empathic depends, like many other relational traits, on the experience of being empathized with in infancy and childhood. It is strongly correlated with secure attachment and other measures. If the Michigan study measured a real reduction in empathy then the students in the study should have also been different across other measures of attachment. Mainly, it is their parents who should have shown the reduction in empathy in order for their children to be unable to show empathy.

I had a look at the questions presented to the students and tried to answer them. In doing so I empathically speculated on the students attempting to answer these questions.  I wondered whether this represented their actual capacity for empathy or their perception of empathy as a social construct. 
In other words, are they incapable of empathy or rather, do they think that empathy is irrelevant or a hindrance to the path they follow? Are they saying something only about themselves or about the culture around them? 
I work as a psychotherapist, mostly with adolescents and young adults. Some of my patients have experienced callous states of mind in which they harmed themselves and others. I chose the word callous here because it is not part of a psychological concept but denotes an unemotional state of mind, a state without feelings or interest in the suffering of others. When I tried to imagine how my patients would score on this test I realized that I could not clearly speculate.  Most of them come across as empathic and understanding, suffering as a result of their experiences, even if those experiences include hurting others.  On the other hand, when they experience callous states of mind, they no longer feel the pain of being a victim or the guilt associated with hurting others. They are not anxious or scared, just action oriented and usually risk taking.  Through this behaviour they find refuge from the experience of being empathic to others and themselves.

Many of my patients are different to most of the students in the study. Many had very adverse life experiences.  They have crossed a number of boundaries that most students would never cross. Understanding them has allowed me a greater insight into empathy, callousness and how the two can sometimes coexist. Although the oscillations patients describe are radical and pathological, I think that their experience is not totally different to something the Michigan students seemed to express too. 
My patients devalue empathy as a psychological defence against intolerable feelings. The Michigan students, on the other hand, might need to devalue their empathy in order to fit into the culture they live in; to compete, to be ‘successful’, a winner. 
They might feel a dissonance between being empathic, to the tasks they are required to perform in order to belong to this culture.   Although students and patients might be very different, I think that some of the psychological mechanisms involved are quite similar. The extreme measures taken in the clinical population might provide the clarity needed to understand how reducing empathy is at all possible, how one state of mind can replace another.

My patients describe a very common experience of transition from empathy to callousness. They sometimes talk about a sense of great pressure of either emotional pain or some immense excitement that cannot be put aside. Whatever they experience, staying within an empathic state, can no longer be emotionally tolerated (either the pain of awareness and/or the capacity to stay away from an addictive state). They feel trapped in this state; empathy becomes a hindrance, a claustrophobic state of vulnerability, passive, even victim state. 
The only way out of this situation is radical and action related. They describe something akin to ‘pressing a button’ (they call it “the fuck-it button”) that flips them from passivity to action. 
Empathy, which was available within a state tolerant of emotional pain, is replaced with a more callous state of mind, unemotional and action inducing. 

The next question to be asked here is which part of the personality presses the button? Is it the empathic part or rather, the callous, radical, thrill seeker, manoeuvring itself to the front of the queue? Shockingly for some, it is always the conflicted, suffering, anxious empathic part that presses the button, yearning to be relieved of duty. In doing so this part delegates the responsibility to what happens next to the callous part, and assumes only an observing capacity.  The role is either collusive or as a ‘hostage’, unwilling observer. This is a way of getting out of the discomfort of this position, but it carries a high price tag.

The removal of the capacity for empathy presents itself as the only solution. The suffering part of the personality gives in and invites a new state of mind.  This arrives like a kind of a messiah, a callous cult leader, providing total redemption in exchange for complete delegation of power. Pressing this button provides the personality with instant radicalisation. There is a change from an empathic, thinking, conflicted, suffering entity, to a clear one-track – one solution - radical idea that requires immediate action in order to participate and become part of the internal cult.  
I use the term internal-cult here to describe an internal organisation of the personality, which is similar to the familiar social structure of a cult. 
Seeing the personality as an internal organisation has a long history in psychoanalysis. Herbert Rosenfeld (1971) first introduced the concept of an ‘internal gang’, in which destructive aspects of the personality gang up with the aim of inflicting harm, usually on the ‘captive’, fragile self. My idea of the internal cult is very similar to the gang but carries with it an extra motivation – a wish for some salvation, which I think is particular to perverse patients rather than those who are ‘only’ destructive.
  
I don’t think that most of the experience of the Michigan students is so radical. However, I do think that they too have ‘a button’ at their disposal.  Like my patients, they too press it in order to boost their sense of potency and capacity to compete and do well in what they perceive as a harsh social world.

I was also wondering whether a subjective experience of oppression is another common denominator my patients share with many others. My patients feel oppressed from within, living inside a totalitarian psychological organisation. The students, and maybe many of us too, might feel oppressed by the organisations we work in.  We might experience a growing tension between our professional integrity and dedication and the way we are supported and valued. Or maybe, a growing tension between our understanding of empathy, human development, and the cultures we live in.

I wonder if one solution to these growing tensions might feel a bit like ‘pressing a button’, flipping to a different state in which we no longer care, where we let go. Can this be a defence against the depressive symptoms of ‘carer fatigue’? Is this the button being pressed when a thinking group can no longer cope and has to turn into just a dismissive, non-caring group or gang? Pressing this button can be the only way to feel less of a victim, not oppressed, move from passivity to taking action. 

The investigation of callous states of mind is not new. Many people remember the Milgram (1963) study in social psychology, attempting to understand how obedience can produce callousness in anyone.  Milgram specifically wanted to understand how atrocities such as the holocaust could have been perpetrated by so many.  In the study, (a short YouTube video can be found here) Milgram told people that they participated as a ‘teacher’ in a learning experiment. They were to administer an electric shock to a ‘subject’ in another room as a punitive response to them making an incorrect answer to a word test question.  Most ‘teachers’ agreed and then proceeded to obey the experimenter, the ‘scientist in the white coat’, and even administer apparent lethal levels of shock to subjects.  The participants seemed to suspend and over-ride their own moral judgment, empathy and understanding.  Most shockingly, a few participants continued to administer shocks after the subject had stopped screaming and appeared to be lifeless.  


I think that the experiment, conducted in the 60s, artificially created ‘the button’ I described above, in the lab. Participants were told to follow the instructions of the experimenter – to obey his authority. In order to perform they needed to psychologically suspend or over-ride their empathy and moral standards. Under the experimental conditions empathy and moral standards were in conflict with external authority and a potential sense of failure to complete the task. 


Milgram’s participants were probably not different to the general population on any measure (i.e. mostly capable of empathy). However, pressing the button that suspends or over-rides an empathic state in the service of adopting a callous one, became the preferred course of action within Milgram’s artificially create scenario.  Some participants clearly do feel empathy while at the same time continuing to hurt the subject. They abdicate from the responsibility for the pain caused.

With all this in mind, I would now like to revisit the findings of the Michigan study. I believe that the reduction in empathy is directly related to the culture the students live in. It is, if you like, a natural occurring, very mild, ‘Milgram-like’ environment. 
The students function within a highly competitive environment that rewards selfish rather than altruistic behaviour.  Within this cultural climate it pays off to feel less empathic. 
To put it in a slightly more radical form: it is an environment that increases the likelihood of the button being pressed.  There is a pressure to be in a callous state of mind in order to better respond to tasks and/or survive an organisational culture that devalues empathy.

According to the Michigan study students at the time Milgram conducted his experiment were capable of high degrees of empathy. Indeed, it was the 1960s in America, a time of radical social change in which benevolence, care and selflessness were rated very high culturally. However, as Milgram showed, radically changing the social environment in the lab radicalised the participants.  It showed how ready they were to push the button, shifting to a callous state of mind and hurting others.

It is also important to remember that there is no consistent evidence for an increase in anxious attachment in the general population. Therefore, it appears that today’s babies are empathised with and understood, similar to those decades ago. The difference is in the environment they (and we) function in - one that requires an ability to flick between states in order to compete or tolerate various levels of oppression.

For example, many young people today engage in what they call 'sexting' – sending explicit sexual messages and pictures to each other. This is now becoming quite common. However, it is easy to imagine that there are very few boys who would come up to a girl they hardly know and ask her to remove her clothes, and very few girls who would agree. Under the cover of screens and buttons a lot is made possible. Similar to Milgram’s experiment, it dilutes social norms and reduces shame and guilt. Although people might feel alone in front of their screens they are, in fact, in the grip of something much bigger.  As if in a gang, un-empathic to themselves or others, pressing the buttons, suspend their thinking emotional selves, and act triumphantly, conquer a dare, act against their normal held values and ideas.

I don’t think that these young people, similar to the students in the study, grow up less empathic, at least at the moment. I do think, however, that they value empathy less and live in a culture that reinforces these ideas. Empathy is available for them but can, and at times should, be avoided.

We live and work in this culture. This is concretely felt in the working lives of many in the ‘caring professions’, at the forefront of the conflict between empathy and callousness. The less organisational support there is for making empathic responses and plans, the more risk professionals who make these responses feel in making them. They become those who refuse to participate, who reject the organisational culture and the authority that champions it. ‘Carer fatigue’ is what people feel when their thinking is no longer supported. They find themselves acting on a limb, doing something that is no longer supported by the organisation they work for. 
Many of us working with self-destructive and/or harmful young people might recognise this change – from containing risk to becoming risk averse, from thinking to following procedures, from being supported to being left alone. 
It is the beginning of the New Year and I would like to end on a hopeful note. Empathy is at the heart of human development. Infantile anxiety is uncontainable without it. Secure attachment depends on the ability to experience it. At the moment in some environments, empathy seems to be economically nonviable, not cost effective as it was once thought to be. However, this runs directly against the essence of human nature. This culture must, at some point, run itself into a brick wall in the same way that any addict arrives at a turning point. Not a flicking of a button.



References                    

Konrath, S. H., O’brien, E. H. and Hsing, C. (2014) Changes in dispositional empathy in American college students over time: a meta-analysis, Pers Soc Psychol Rev, vol. 18, 4: pp. 326-348.         
                               
“Empathy.” Merriam-Webster.com. 2015. http://www.merriam-webster.com (January 2016).

Milgram, S. (1963) Behavioral Study of obedience, The Journal of Abnormal and Social Psychology, Vol 67(4), Oct 1963, 371-378

Rosenfeld, H. (1971) A clinical approach to the psycho-analytical theory of the life and death instincts: An investigation into the aggressive aspects of narcissism, International Journal of Psychoanalysis. 52: 169-178; republished in E. Spillius (ed.) Melanie Klein Today, Vol. 1., Routledge (1988)

The University of Michigan State – Empathy Questionnaire, https://goo.gl/vOxolK

A short YouTube video giving a brief overview of Milgram’s experiment, including footage of Milgram talking, https://goo.gl/VlDFqq

Another short YouTube video, which shows a participant demonstrating empathy but continuing to administer shocks, as he abdicates responsibility by conceding to authority.


An informative power-point overview of Milgram’s experiment, 


This ppt also makes numerous hypotheses as to exactly what were the conditions that led to the results of the experiment. The ppt also refers to a replicated (but ethically modified) version of the experiment carried out in 2009, by Jerry M. Burger, which showed similar results to Milgram. 

Jerry M. Burger, Santa Clara University: Replicating Milgram: Will People Still Obey Today? American Psychologist, January 2009.


Perry, B.D. and Szalavitz, M. (2010) Born for Love: Why Empathy is Essential and Endangered New York: HarperCollins Publishers

Previous blogs by Patrick Tomlinson on Empathy

Is the Capacity for Empathy the Key Quality in our Work with Traumatized Children?

'Ghosts in the Nursery’ – A Powerful Example of Empathy in the work with a Mother and Baby

Empathy Part 3 - The Wounded Healer

Ariel Nathanson Brief Biography
Ariel Nathanson is a Consultant Child and Adolescent Psychotherapist.  He has been working at the Portman Clinic in London, for the past 8 years, where he specialises in the assessment and treatment of children, adolescents and young adults who display perverse, delinquent and violent behaviours. He works with adolescents and adults in private practice and regularly consults to a therapeutic community for adolescents. He is a visiting lecturer at the Tavistock Centre. He has special interest and experience in the areas of child sexual abuse and children, adolescents and young adults who sexually harm others. He regularly undertakes risk assessments of violent and sexually deviant adolescents and children. He is experienced in assessing families, children and adolescents for the family courts.

Contact:  ariel.nathanson@gmail.com