You Don’t Have To Be A Jewish Mother To Have Empathy

During residency training in psychiatry, when I was learning how to do psychotherapy, I learned that the lady at the front desk ran the clinic.  She did the “statistics.”

I thought she was hyper, but she told me she subsisted on coffee and crashed on the weekends.  She actually told me so much personal information, I suggested she become a patient at the resident clinic.  She said there was a rule against it.  I told her to go to another clinic, but she told me she could not get time off, something I never quite believed.  But she told me, also, that she understood what was going on with me.  This was news to me, except that I knew I was struggling to be a good psychotherapist.

The stories of everybody’s lives that they told me were so terrible I thought I might just go home and cry every night.  I did a little at first, but I got over it.  Then, she told me my “statistics.” It seemed that more of my patients came back for more visits than anyone else’s.  They liked me.

Like Walter Brennan used to say in the old TV series “The Real McCoys,” — a favorite of my grandmother of blessed memory — “No brag.  Just fact.”

Patients said nice things about me at the front desk.  Although my supervisors told me many things as I reported cases, and were helpful in many ways, that secretary-administrator was the first one to tell me why this was going on. 

I had lots of something called “empathy.” My supervisors helped me learn that the way you help patients is not by crying for them, but rather, by remaining emotionally distant enough to see the logical structure of their problems, and to guide them.  I did learn to do this.

As in many things, I learned a great deal by teaching others.

I learned, as a (very junior) professor of psychiatry, that most women came to the profession of counseling with an excess of empathy and needed to learn a little objectivity.  Males tended to be able to intellectualize, but might find high-level empathy a bit foreign.

Everybody can learn what they need to learn.  Everybody can be aided by teaching and supervision.  Everybody can do just fine.

Empathy is a powerful concept, with multiple definitions.  Despite this, everyone seems to know when they feel it.

Everyone does seem to agree that it is a way to “connect” with the other person, and to feel what they feel.  I think at least one reason this is a strong suit for me is that I have seen statistics that about 70% of all psychiatric patients (of private practices) are women.

This is because we find it easier to go for help than men do.  We are also quicker to pull over and ask for directions when driving, but that’s another story.

It is very nice to be a “real” doctor who believes that the structure and chemistry of the human body are responsible for more of our behavior than anybody wants to admit.  I can cheer for scientific discoveries, like a recent one linking empathy and physical pain.

I have, heretofore, managed to avoid using with patients the hackneyed phrase, “I feel your pain,” even though I really think I often do. Now we have wildly objective scientific proof in human beings (I have seen some studies kind of like this in monkeys) that “empathic pain” exists. The folks at the imaging department of the University College of London looked at couples, expecting them to be able to do this sort of thing, and had one member of the couple watch the other get a painful electrical stimulus on the back of the hand.  Both people got brain images to see what parts of their brain lit up.

Not all of the areas are the same, but empathy does mean that parts of the brain related to the expectation of and the emotional context of the pain light up, while areas related to certain more “objective” things about the pain (like location and intensity) don’t. This is done by just showing the partner a symbol in colored lights meaning that pain is happening with the other partner at that moment.

People can and do connect neurologically and objectively.  This very fact gives me a lot of feelings.  Particularly goosebumps on my goosebumps.  Somewhere in this ability to connect, deep in our biology, is what the authors of this missive consider our reason for “not always (behaving) selfishly.”  To me, it is the germ of a way to pursue world peace.

Maybe we actually all CAN get along.

Some people suffer from a congenital insensitivity to pain; an illness which can be, you should pardon the expression, a real “pain,” since pain is a signal to tell you when something that is really dangerous is going on with your body.  These people may have a different way of developing empathic pain, using different (more likely midline) brain structures.

There may be yet another part of the brain, the prefrontal cortex, activated with anticipation.

There is also a suggestion already this brain mechanism may be responsible for the placebo effect.  That means basically, in research, a certain amount of people who are getting a placebo — fake medicine or “sugar pill” — do well anyway.

When we harness this one; the neurological effects of the placebo effect, we should have the safest and most effective treatment for medical (and psychiatric! I can only hope) illness the world has ever known.  Legal aspects such as informed consent and the like would be a significant speed bump here.  We are dominated by our legal system in a lot of ways.  You have to know, maybe even sign, all about what you are getting as treatment, when you are a (competent) patient. But what about empathy in medicine? Unfortunately, medical training does not (currently, at least) do a great deal to build empathy.  It may actually diminish it a bit.

Although women do show up in studies as being more empathic, there seems to be a decline in empathy at the third year, when medical students move from theoretical learning to actually dealing with patients.

Empathy for the mentally ill may be more difficult to achieve than empathy for patients in other specialties.

I am heartened by the idea that it might be possible, for instance, to build empathy for someone psychotic, like a schizophrenic, who hears voices, by getting that (potentially medical student) human to listen to recordings of voices, and maybe attempt to function at the same time. As for empathy, it ought to be able to be both taught and used.

As for me, I’ve always had more patients come back to see me than other psychiatrists report.  In private practice, most worry about retention. I worry about getting patients to fly the nest and try out their newly-discovered skills.

I generally attribute it to my mother of blessed memory, who usually got angry when I told her how excited I was about various advances in medicine and related technologies, as I learned them She told me that if I didn’t understand what I was doing well enough to explain it to someone like her, whose highest level of education was the Commerce High School of Springfield, MA, I ought not to even try.

She also told me to try to treat every patient as if they were she — or at the very least — as if they were in the family.  She told me this when I was too young to realize what kind of an emotional trip she was putting on me.  Nevertheless, I want to believe that the good part of the idea stuck.

She never had the educational opportunities I had, so there was more than a little Jewish mother guilt induction going on.

I do believe that such feelings, tempered by good professional training, are not half-bad.

Maybe we can find a way to work them into the medical school curriculm.