The University of Chicago Magazine

A basic human impulse affecting the course of history, culture, and personal connections, empathy is also a neuro-logical fact—and one that’s increasingly understood.

TO NEUROSCIENTIST JEAN DECETY, empathy resembles a sort of minor constellation: clusters of encephalic stars glowing in the cosmos of an otherwise dark brain. “See how they flash,” Decety says, pointing to the orange-lit anterior cingulate cortex and anterior insula on an fMRI scan. “This person is witnessing another person in pain. ... What’s interesting is that this network of regions is also involved in the firsthand experience of pain.”

photo: The capacity to separate self from other is a key component of empathy; otherwise, the sight of another’s pain can become paralyzing, says neuros cientist Jean Decety, here with his collected replicas of early hominid skulls.

The capacity to separate self from other is a key component of empathy; otherwise, the sight of another’s pain can become paralyzing, says neuros cientist Jean Decety, here with his collected replicas of early hominid skulls.

For five years, Decety, who joined Chicago’s psychology faculty this January, has studied the physiology of empathy, charting its existence using brain imaging and projected pictures of physical and emotional suffering: a stubbed toe, a child’s nosebleed, a grieving father clutching the body of his son. Consistently, he says, studies show an overlap in the neural regions that process personal pain and the pain of others. “But,” he says, “it is not a complete overlap. The person [in the fMRI] is not actually in pain.” The brain knows the difference, “and that is important.”

Empathy is one of those human impulses that defy easy explanation. It gets entangled with sympathy or compassion or commiseration; it submerges into altruism. Broadly we think of empathy as the ability to feel for another person, to imagine ourselves in the same situation, enduring those same experiences and emotions. Empathy makes us cry at sad movies and rescue strangers in distress. It helps us forge connections with people whose lives seem utterly alien. Decety, however, offers a more clinical understanding. Empathy, he says, begins with the involuntary: shared emotion. “This is something that is hard-wired into our brains—the capacity to automatically perceive and share others’ feelings. A baby who listens to another baby cry will begin to cry too.” People of all ages will unconsciously mimic the facial expressions of those they see. “Like this,” Decety says, flipping through a computer presentation to a photograph of Bill Clinton, laughing so hard he’s rubbing his eyes. “You are smiling, aren’t you?”

But empathy is also learned. “Besides sharing affect, you must have the mental flexibility to put yourself into the shoes of others,” Decety says. Finally, empathy requires emotional control—the capacity to distinguish self from other. People who lose themselves in other people’s pain, he says, experience “personal distress.” While empathy is “other-oriented,” personal distress turns inward. It drowns the impulse to assist. “If you are in the same state of distress, I don’t know how you can help the other person,” he says. “But if you are able to separate yourself, then the non-overlap in the neural response frees up processing capacity in the brain for formulating an appropriate action.” Like offering a hug, for instance, or bandaging a cut, or calling 911.

Everywhere Decety looks, empathy abides. “If you want to sell a car, a good car salesman will be the one who has empathy.” So, too, with bosses and businesspeople, parents and teachers, waiters, writers, lawyers, scientists, politicians. “Every good physician has empathy,” he says. “Irrespective of the disease, when you find someone who will feel for you, you feel better. That is the mystery of empathy.”

EMPATHY IS OFTEN A MYSTERY to the young medical students filing into Donald Scott and William R. Harper’s Clinical Skills I classroom. For the most part, they’ve got emotional sensitivity, but they need to work on execution. Ministering to the sick is an increasingly technological profession, and the notion of clinical detachment leaves novice physicians wondering whether it’s OK to squeeze a patient’s arm or engage in conversation that strays from charts and drugs and test results. To help first- and second-year students at the Pritzker School of Medicine navigate uncertain emotional terrain, Scott and Harper (whose middle initial stands for Richard, not Rainey) use classroom discussion, journal-writing assignments, and trained “standardized patients.” They record and replay student encounters with rehearsed patients, so students and faculty can scrutinize and refine technique. “Currently, our second-years are going through a diagnosis of lung cancer and delivering bad news to patients,” Harper says. “Empathy is very important when you’re giving bad news or discussing any end-of-life decision-making.” It comes in handy with other difficult decisions too: standardized patients also simulate domestic-violence cases. “The challenge is for the students to address the issue and ask about it” in a way that is compassionate, Harper says—and useful.

Empathy is more than a nice idea, insist Harper and Scott; it’s a pragmatic skill that stands at the center of the patient-doctor connection, on which so much else depends. “If the connection is strong, the patient is more likely to follow a doctor’s recommendations,” Harper says. “You can order the fanciest test in the world but if the patient does not buy into it, it doesn’t matter.” Empathy builds trust and encourages openness. It makes sick people feel better. “We’re not teaching [students] to have empathy,” Scott says. “Students naturally become attached to their patients. We’re teaching them to recognize empathic moments when they arise and express the empathy they already have inside. What to say when a patient opens up, how to react, when to lean in closer.”

“—or when not to lean in,” Harper adds. “You have to gauge the level of relationship the patient wants. Some patients just want the facts. But you have to be careful to understand that just because the patient is not outwardly emotional doesn’t mean there are no emotions inside.” Usually when medical students struggle, Scott says, they struggle to synthesize data-gathering and rapport-building. “You don’t have to hold the patient’s hand and sing ‘Kumbayah,’” he says, “but if an empathic moment comes up—and all it takes is one—you can make that deep connection.”

Students hear less about empathy in their third and fourth years of medical school—a deficit Scott and Harper endeavor to remedy at Chicago—but physicians at all stages of their careers wrestle with “the question of how to be a doctor and still have feelings at the same time,” Harper says. “There’s an instinctive idealism students come to medical school with, and we don’t want them to lose that, to lose sight of who’s at the center of all that biomedical data.”

SOCIAL WORK’S INTIMATE UNDERTAKING begins with the sight of individual suffering. Contending with addictions and ailments, rent bills, medical bills, homelessness, joblessness, and perpetually bare cupboards, people need to “feel seen,” says Sharon Berlin, Helen Ross professor in the School of Social Service Administration and a 40-year veteran of social work. They need to believe they’re “known, recognized, and validated.” Social workers build their profession around empathy, around the capacity of one person to understand the experience of another, and to use that understanding to help ameliorate pain. “That is at the core of the therapeutic relationship,” Berlin says, and modern social work takes numerous lessons from psychologist Carl Rogers, who formulated client-centered therapy theory during his 1950s tenure in Chicago’s Committee on Human Development. “If you move beyond the relationship between social worker and client,” Berlin says, “the capacity to put yourself in another person’s position is one of the motivating factors of the whole social-welfare enterprise. You feel for people. You feel for them and you want to make things right.”

It’s less simple than it sounds. In their empathic endeavors, social workers must strike a delicate balance between unconditional validation and constructive suggestion. They must not mistake understanding for omniscience: “It’s not a matter of telling clients how they feel or should feel.” Social workers allow themselves to be vulnerable in order to become “available to help people bear incredible pain,” but they also have to set boundaries. Emotional exhaustion and “over-identification” with clients—what Decety would call personal distress—are constant hazards. “You put yourself into the clients’ shoes, but you also have to recognize that it’s their state, not your state,” Berlin says. That cognitive distinction is essential. “Sometimes just a word or a look communicates to somebody, ‘This has been a really hard time for you, and I recognize you’re carrying a heavy burden.’ And the client will get a certain look on their face or they’ll open their eyes a little wider, because they feel you’ve captured something they’d been feeling but hadn’t articulated.” Social workers can use that connection to nudge clients toward a slightly new perspective or behavior, “some little bit of difference” that may alter their plight.

Karen Teigiser, AM’71, SSA senior lecturer and deputy dean of the master’s program, teaches students to reach that nudging moment. “It’s profoundly complicated,” she says. Before approaching a client, social workers must possess a robust self-awareness and the discipline to use it effectively. They must be understanding, yet separate: “I can’t buy you a coat, or take you home; I have to help figure out how you can help yourself.”

Paradoxically, Teigiser says, close similarities between social worker and client—in religion, background, race, class, education, or family—can make for a trickier relationship. “It’s easy to assume you know what a person is thinking if they’re like you,” she says. “You say three things to me and I don’t ask anything more because I know it all.” Uncovering a connection with someone completely different, however, requires hard work and lots of questions. “You and I might have the same objective experience, but it’s not about that,” Teigiser says. “Empathy means understanding another person’s subjective experience. For one person, difficulty trying to put a five-year-old child to bed might be a five-minute annoyance. For another, it might mean you’re a total failure as a mother.”

The SSA’s curriculum doesn’t restrict empathy training to one or two, or even a year’s worth of lectures; at every level, classes, seminars, and field work require students to develop, reflect on, and refine their empathic skills. Beginning early on, reading and exercises “invite them to think about their values, biases, and prejudices,” Teigiser says. In later courses students practice client interviews with role-playing teachers, and field supervisors hammer home what students learn in the classroom. “In social work, the idea is not to be a blank slate but to understand the fullness and richness you bring to the interaction and to use it,” Teigiser says. “That is essential when you’re trying to understand somebody else’s problems and somebody else’s pain.”

photo: the path to empathy

AFTER A HALF-DECADE OF GAZING into an fMRI monitor while subjects inside the scanner witness pain that does not belong to them, Decety is beginning to fill in his star charts. Experiments designed to trigger one aspect or another of empathy—affect-sharing, perspective-taking, and emotion-regulation—kindle slightly different stellar patterns inside the brain. In one test, for example, Decety showed subjects 64 sets of pictures that juxtaposed painful, if commonplace, scenarios with nearly identical neutral scenes. A photograph of someone’s hand clipping a leaf from a limb contrasted with an image showing the same hand trapped between the clipper’s blades; a photograph of a bare foot beside an opening door was followed with a photo in which the door opened onto the foot. Every picture was shot from an angle that promoted first-person perspective, and Decety watched each subject’s anterior insula and anterior cingulate cortex—both regions involved in processing first-person pain—light up when the images switched from harmless to harmful. In addition, he notes, the more painful photos provoked more intense activity, although the somatosensory cortical network, which detects information about the body itself, did not engage. “The brain recognizes it is another’s pain.”

When Decety asked participants to imagine their own fingers and toes were the ones being cut, crushed, scraped, or burned in the pictures—and to rate the level of pain for each situation—he found a more widely stimulated pain matrix. Even the secondary somatosensory cortex began to glow. “From just visualizing the self in pain, almost the whole network activates,” he says, noting that actual pain would light up even more regions. “Imagining others in pain and assuming their perspective activates only three regions: the prefrontal cortex, the anterior insula, and the anterior cingulate.” Imaging the self in pain activates half a dozen. “People, too, have a tendency to write that the pain is higher for the self than for the other. It’s easier to take one’s own perspective.”

This year Decety probed the crucial role self-control plays in empathy. “One way to regulate emotion”—and therefore ward off the paralyzing effects of personal distress—“is to get more information,” he says. “If you see a cop beating a guy in the street and you don’t know why, you feel distressed. It’s overwhelming.” This happened to Decety once. He was waiting for a bus in Seattle when five police officers began thrashing a man in front of a store across the street. Decety never found out why. “But,” he says, “if you know that guy was stealing something from an old woman, or being aggressive, it’s less distressing,” even though the beating is no less severe. “That’s why we care about justice.” The same idea—that pain is more bearable if it accomplishes some particular good—also holds true, for instance, for a mother watching her crying child get a flu shot.

With that distinction in mind, Decety “made up a little story.” He informed test subjects that he was going to show them videos of people undergoing an experimental therapy for tinnitus aurium, a neurological disease that renders hearing painful. The treatment—which consisted of forcing patients to listen to excruciating sounds—worked for some, he said, pointing those patients out to each subject; for others, the pain was futile. On the videos, actors wore earphones and winced on cue. “Participants rated more pain when the treatment was ineffective than when it was effective,” Decety says. “That’s emotion regulation. If you believe a person is suffering for their own good, you feel less distress. You are able to step back from the situation.” Instructed to imagine themselves as the patients, however, subjects more often slipped into personal distress. Neurons in the almond-shaped amygdala, linked to fear response and threat-processing, began to fire more intensely.

Still a fledgling field, the neuroscience of empathy has produced many more questions than answers. Researchers don’t know, for instance, how empathy correlates with age, or whether people feel more immediate empathy for members of their own race or nationality. “Do you feel more empathy for a member of your team hurt out on the field than a member of the other team?” Does gender make a difference? Anecdotal evidence suggests it does—jails and wars are full of men, Decety observes—but neuroscience hasn’t yet weighed in.

By deciphering empathy’s neural astrography, Decety hopes someday to help uncover treatments for affect-related disorders like autism, narcissism, sociopathy, and psychopathy. Brain scans show “large individual differences” in people’s capacity for empathy, and while social science has always sought to explain those differences by looking at education, past trauma, or childhood experiences, “well, that’s only part of the story.” The other part is biology, and the solution may be pharmaceutical. “People who are extremely egocentric often have no empathy,” Decety says. “There is no space for the other; they use the self-perspective all the time.” Along with U of C social psychologist Nancy Stein, he’s planning to embark this year on a study of bullies. The researchers will expose over-aggressive youngsters to painful scenes and compare their behavior, brain scans, verbal reports, and autonomic nervous system activity to those of normal children. “If you’re healthy, you don’t like to see people suffering,” Decety says. “But bullies not only don’t care, they like it. Why?” Do they have the capacity to take their victims’ point of view? Bullies “can switch perspective intellectually, yes, but do the same regions of their brains activate? How do we explain—and more importantly, treat-—this schadenfreude?”

THE WAY LAUREN BERLANT SEES IT, empathy stands a whisper away from schadenfreude. The impulse to run to a stranger in need awakens powerful and conflicting anxieties about compassion, community, and independence; the urge to shrug off or take pleasure in others’ pain can become hard to shake. “There’s an ambivalence about empathy—as with any affective attachment that increases one’s vulnerability—because it raises potentially destabilizing questions about personal and political accountability,” says Berlant, an English professor. Editing books with titles like Intimacy and Compassion: The Culture and Politics of an Emotion, she pursues far-flung interests in race, gender, sexuality, psychoanalysis, and political and critical theory. “In these senses, the socially ‘warm’ affects are close neighbors of the cold or aversive ones.”

Complicating things further is the tension between social connections, both conscious and unconscious, and personal sovereignty. “Most people don’t think about their nationality unless it’s in crisis or if someone asks you to,” she says. “The pleasure of it is the regularity and predictability of it.” Empathy—and the crises that compel it—rocks the boat. “You want to feel attached to others, but you don’t want to be destabilized. Empathy reveals your non-autonomy, and this is a culture that values freedom and identifies freedom with autonomy.”

Yale psychologist Stanley Milgram’s 1960s obedience experiments, in which 65 percent of subjects proved willing to shock strangers pleading for mercy with up to 450 volts of electricity, speaks to the problem of empathy, Berlant believes. “The desire to please authority,” Berlant says, unmasks a vast capacity for “situational coldness.”

Berlant concludes that empathy is more taught than inborn. “You have to train people to act with empathy, to restrain their ambivalence,” she says. Sentimental literature—books like Uncle Tom’s Cabin or films like Schindler’s List—provides training by demonstrating the consequences of not having empathy. At the same time evocative scenes of suffering condition a “virtuous response” in readers and teach them to differentiate between those who seem to deserve empathy and those who do not. “Remember ‘Ding Dong! The Witch is Dead’?” Berlant asks. “Questions of blame and accountability so often accompany public discussion of suffering—think about King Lear or Rodney King, or debates about when and whether prisoners are worthy of whatever counts as ‘human treatment.’”

WHATEVER ELSE IT DEMANDS, says associate professor of history Rachel Fulton, the study of history cannot do without scholarly empathy. A medievalist who researches monastic prayer and scriptural exegesis, Fulton argues that true comprehension of historic texts requires willful, sympathetic engagement and the imagination to strip away centuries of subsequent discourse, discovery, and recorded events. Frequently the path backwards is hazy and littered with debris. “As historians, we’re never coming to the past as it was,” she says. “We are always coming to it through questions about who we are now and what we’re doing. ... You have to look at both your moment and the author’s moment and understand that you’re part of the interpretive circle you’re participating in.” Historians hoping to understand liturgical commentaries from the Middle Ages—or medieval poetry or fiction or sermons or songwriting—must adopt a millennium-old mind-set. “We have to empathize ourselves into those writers’ thoughts, into their methods,” she says. “It’s a frightening step for historians, because they like to stay outside.” Too often, she argues, they do just that, content to document textual shifts while bypassing the deeper elements of historical inquiry.

Medieval Christian monks provide a useful example, she says. Within the haven of the monastery, they endeavored to transform each daily action into a devotional exercise, developing a rigorous, complex ritual of prayer that the written word could not encompass. “Prayer is not entirely verbal,” Fulton says. “Something is not simply a prayer by the speaking of it.” Prayer also relies on belief, affective chant and posture, personal associations, and historical or scriptural allusions. “It’s not enough to read the book, you have to be the book. The monks I’m studying”—most of them Benedictines, all of them Northern Europeans from the Middle Ages—“had a good understanding of the tension between what they knew and what they did, between intellect and empathy,” Fulton says. “They would sing a psalm, and it opened up this incredible world for them, a whole chain of resonances from what was happening the last time they sang it, or the beautiful painting they saw of the Virgin Mary, or from their monastic education.” When liturgical scholars get caught up in the texts, they overlook the experiences of those who wrote them and their meaning to the people who prayed through them.

DECETY FIRST PLUMBED THE MEANING of human empathy reading the work of 18th-century Scottish philosophers. They were among the earliest, he says, to dissect empathy and altruism. David Hume wrote that people’s minds mirrored one another; Hume’s teacher Francis Hutcheson recast the ancient idea of sensus communis as a universal inclination to be happy for others’ happiness and “uneasy at their misery.” Economist and ethicist Adam Smith described a similar “fellow-feeling” in The Theory of the Moral Sentiments, a best seller that secured his fortune and proved the making of his career. “When we see a stroke aimed and just ready to fall upon the leg or arm of another person, we naturally shrink and draw back our own leg or our own arm,” Smith wrote, “and when it does fall we feel it.” Merely imagining the plight of “our brother upon the rack,” meanwhile, was enough to make one “enter as it were into his body, and become in some measure the same person with him.”

Decety’s research bears out much of what Scottish Enlightenment thinkers perceived, even without the benefit of fMRI. “One of the most crucial aspects of human nature is that we are social animals,” he says. “We need others for food, shelter, protection, sex, yes. But it is more than that. We need others all the time.” Not starvation and disease, but loneliness, exile, and abandonment, he says, induce the greatest human suffering. Expressing pain—from a broken leg or a broken heart—betrays weakness, but it also calls others to offer comfort. “If you go on a solitary walk, you take other people with you,” he says. “In human society, empathy is the glue,” pulling individuals’ separate paths into orbits of shared, if temporary, feeling.