May 12

Learning to Care — Empathy Enriches Our Lives

by Gary Small, M.D.

Empathy is the ability to imagine and understand what someone else is feeling. This fundamental human trait brings people together and solidifies their social networks, which has been critical to our survival as a species.

Unfortunately, the capacity to empathize is declining with the frenetic lifestyles and technological distractions we face in today’s world. Learning to activate our empathetic brain regions not only fortifies our relationships, it can define and inspire our lives.

In this month’s issue of the Mind Health Report, I will explain the importance of empathy to mental health, and tell you how you can increase your mind’s ability to practice this vital social function.

We Are Born to Care

The human brain is hard-wired to connect with other people, and our social interactions throughout the course of our lives are a by-product of the evolution of the human brain that has taken place across hundreds of millennia. Our ancient ancestors who first learned to socialize formed larger, more complex groups that had a better chance of surviving in a harsh environment. This process accelerated the development and intricacy of our frontal lobe — the so-called “thinking brain.”

Through a complex and efficient neural network, empathy allows us to experience not just the emotional states of others, but also their physical pleasure and pain.

For example, researchers used magnetic resonance imaging (MRI) to study couples who were in love, and measured their brain activity when one of the partners observed the other experience a painful pinprick.

The MRI reading of the person experiencing the pain was almost identical to the signal coming from the observer.

A network of brain regions, including the anterior insula, anterior cingulate cortex, brainstem, and cerebellum were all activated in both subjects.

This shows that even without a direct sensory stimulation, empathy triggers a major part of our emotional experience.

MRI studies have also shown that when we observe another person experiencing happiness, sadness, pain, embarrassment, or almost any emotion, it can activate the same neural networks in our own brains and cause us to feel the same emotion. So when we relate to what our loved ones feel, our brains are very much “there for them.”

Empathy Increases with Maturity

The average child or adolescent does not yet have the same capacity to feel the pain or joy of other people as the typical adult. Many scientists have observed this phenomenon.

Dr. Robert McGivern and his co-workers at San Diego State University investigated adolescent volunteers who viewed faces expressing different emotional states. Compared to people from older age groups, teens needed more time to identify the specific emotions expressed by the faces.

Another recent study of 75,000 people found that empathy peaks when we are in our 50s, and that women tend to be more empathic than men.

Using MRI scanning, Dr. Sarah-Jayne Blakemore of University College in London studied pre-teens and teenagers (11 to 17 years), as well as young adults (21 to 37 years), and found that when making everyday decisions, teenagers utilized a brain network in their temporal lobes (underneath the temples). Older volunteers used their prefrontal cortex, a region that processes how our decisions affect other people.

This observation suggests that as we age, different brain regions control our ability to experience empathy. When comparing adults and teens, the mature, thoughtful frontal lobe is better able to provide the perspective to overturn the more primitive temporal lobe — the instinctive brain — and thus fosters more empathetic decisions.

Problems With Forming Attachments

When the brain’s neural circuits, which control our need to connect with others, are triggered, we experience love, intimacy, and attachment. But these networks don’t always work correctly. When that happens, a person can push others away and become isolated.

The human brain’s emotional center is a region called the amygdala, an almond-shaped group of neurons located in the brain’s medial temporal lobes. When this structure malfunctions, we may experience negative feelings or even take pleasure in the misfortunes of others.

In extreme cases, a person even can become sociopathic and justify any cruel or insensitive behavior, regardless of how it affects others. Such extreme failures can lead to romantic betrayals, pathological lying, and even criminal activities.

For instance, when sociopaths have failures of empathy, they cannot form true attachments with anyone. This lack of emotional connection leaves them with no sense of social or moral obligation because they perceive others merely as objects for manipulation and exploitation.

Fortunately, there are very few extreme sociopaths, and it is possible for people who merely have weak empathy skills to learn and hone them.

Finding An Empathetic Doctor

Our society’s dependence on technology to work, play, and communicate actually poses a threat to empathy. Parents and educators have observed that young people born into the digital age — who often spend more than 11 hours a day using gadgets — demonstrate limited eye contact, often do not recognize the emotional content of a facial expression, and miss important nonverbal cues during conversation.

Dr. Sara Konrath and her colleagues at the University of Michigan found that over the past several decades, college students are reporting lower levels of empathy. Today, nearly 75 percent of students rate themselves as less empathetic than the average college student of the 1980s did.

Failures of empathy can affect people of all ages and walks of life. For example, one study found that doctors show less patience and kindness to patients who are overweight. When physicians show greater empathy, their patients are more likely to adhere to treatment recommendations.

One of my colleagues told me about his patient, Kevin, who had barely survived a head-on car accident with a drunk driver. He had broken nearly every bone in his body, including his pelvis. As physical therapy helped him heal over the next few months, he began to feel stronger and was becoming more mobile.

But one morning he woke with severe pain on the bottom of his left foot — like razor blades and fire — and he was forced back into a wheelchair.

By the end of the week, Kevin had gotten an appointment with the top neurologist in town. After waiting for two hours in an exam room, the doctor entered hurriedly and asked a few questions about Kevin’s history. The neurologist then glanced at Kevin’s X-rays and announced that Kevin would need back surgery as soon as possible.

Kevin left the doctor’s office devastated. His pain was getting worse by the hour, but he was afraid of back surgery because he knew several people who had come out of back operations feeling worse than before they’d gone in.

Kevin’s wife found another neurologist for a second opinion. This doctor was very different; for one thing, he seemed truly interested in what had happened to Kevin. Not only did the doctor get details about the accident, Kevin’s recovery, and his current pain, he also examined the X-rays carefully.

The neurologist showed Kevin a diagram of a healthy nerve with its cell body in the spinal cord and the long appendage, called an axon, that transmits impulses. He explained that the axon had a coating wrapped around to protect it.

Kevin’s accident had injured such a nerve in his pelvic area. As the coating on an axon heals, there is usually a three-week period of excruciating pain in the nerve endings — such as the bottom of the foot. That’s what the doctor thought Kevin was experiencing. He advised Kevin to wait it out, and he would soon be back to normal.

This time, Kevin left the doctor’s office relieved. He didn’t have to rush into surgery, and the second doctor even called Kevin a few days later to remind him that the pain was just a nerve that was healing.

Sure enough, in three weeks the pain in Kevin’s foot went away. The neurologist’s empathy had helped Kevin get through his ordeal.

Kevin’s experience is consistent with studies showing that empathetic doctors can improve both physical and psychological symptoms in patients with chronic pain.

In recent years, many medical schools have recognized the need to teach empathy to doctors in training in order to enhance the healing of their patients. When doctors communicate poorly, patients have a 20 percent less chance of following their recommendations.

Expressing Empathy During Grief

Empathy defines us as social animals, because we not only want to understand what others are feeling, we also have an inherent need for them to understand what we are going through. When another person knows that we understand what they’re experiencing, that communication triggers a sense of closeness.

Without this closeness to others, our lives would be solitary and lonely. Loneliness often results from a lack of empathy skills.

Several years ago I had a patient named Florence, who took great pride in being a mother and homemaker. Her three teenagers were thriving and her husband was happy. She was a generous person who liked doing things for those she loved.

After Florence’s brother died, her family rallied around her and she was comforted by the support. But after a few weeks, everyone else went on with their lives while Florence’s sense of loss and pain persisted. One afternoon, she found some pictures of her brother. She was so overcome with grief that she cried for hours.

Florence finally pulled herself together and made dinner. During the meal, no one noticed her red, swollen eyes or even realized that she seemed sad. After dinner, she cleaned the kitchen while the rest of the family watched TV, played video games, or did their homework.

Florence felt unappreciated and alone. When she walked through the garage to take out the garbage, she decided to sit in the car until somebody realized she was missing.

Two hours later, Florence marched into the den and cried, “I’ve been sitting in the car for two hours and no one even noticed!” She stormed to her bedroom and slammed the door.

The family was stunned. They had no idea how Florence had been feeling. They all rushed into her room to tell her how much they loved and appreciated her.

Florence began to go to therapy, and soon came to realize that she too played a role in the family’s lack of empathy. She had never learned to express her feelings openly, and her family hadn’t developed the empathy skills to notice her nonverbal cues.

Florence convinced her husband and kids to come in for family therapy sessions, which helped them understand that even though they may have seemed like a close-knit family, each of them felt somewhat alone.

I urged them to talk more openly about negative feelings such as anger, guilt, and resentment. They worked on connecting more to each other and helping Florence around the house.

Talking about their feelings helped bring the family closer together, and cleaning up after dinner soon became a happy family routine.

Strategies to Bolster Empathic Skills

Dr. Laurie Carr and her UCLA colleagues used MRI tests while volunteers mirrored facial expressions that they were shown, including happiness, sadness, anger, surprise, disgust, and fear. When the volunteers observed these pictures, their brains became active in the insula, an oval-shaped region that translates our experiences into feelings.

The MRIs showed that as the volunteers imitated expressions, their brain stimulation was

in the exact same area — but the neural activation was significantly greater. This suggests that, with practice, we can improve our empathy skills.

Having empathetic role models and experiencing our own emotions can help shape our understanding of other people’s feelings.

With or without these personal experiences, studies have shown that people can learn empathy skills and improve their ability to connect with others. This involves mastering three essential skills:


  1. Learn to listen. The best conversationalists are people who know how to listen well. To do this, you must put aside distractions — both external (email, text messaging) and internal (random thoughts, worries) — and truly focus attention on the other person. Think of the last time you tried to explain how great or terrible your day was while your friend glanced down at her phone to read a text message from someone else.

Sometimes, if we are excited about what someone is saying, we may interrupt the speaker to toss in our own thoughts. But by doing this, we run the risk of frustrating the speaker, possibly causing him to stop expressing how he really feels.

Good listeners have self-control — they do not allow their minds to wander, and they don’t interrupt. Try the exercise in the sidebar above with a friend or spouse to build your listening skills.

  1. Recognize how other people are feeling. Both verbal and nonverbal expressions can convey what other people are feeling. Unfortunately, we don’t always recognize these expressions because we are distracted or self-absorbed.

Simply being patient can help us focus more on another person’s emotional expressions. When someone is communicating intense emotions, it often takes them longer to put words together. To increase your awareness, keep in mind some of these methods of nonverbal communication:

Body language. How we stand, walk, or cross our arms and legs can convey mood and attitude; styles of waving, nodding, and other gestures. A grin, frown, or furrowed brow can tell a lot about what someone feels.

Eye contact. A gaze can communicate a wide range of emotions, such as anger, passion, or sadness. Looking into someone’s eyes while they speak usually tells the person that you are interested in what they are saying. Looking around the room or over the person’s shoulder suggests the opposite. However, too much eye contact can seem intrusive or inappropriate.

Touch. Placing your palm on someone’s shoulder can be reassuring; using both hands for a handshake can convey warmth. Such gestures are often culturally based. For instance, many Europeans kiss both cheeks when greeting each other.

  1. Let others know you understand. It’s one thing to grasp another person’s point of view, but the true power of empathy comes from communicating that understanding back to the other person. Try restating what you perceive as the other person’s perspective using simple statements such as: “Let me make sure I understand you . . . ” or “Tell me if I have this right . . . ”

 Asking for additional details will show that you’re interested in knowing more about the person’s situation and emotional experience.

Keep in mind that, despite the current trend toward greater isolation and empathy deficits, our brains are programmed to bring us together as social beings. We all have the capacity to improve our empathy skills and imagine what someone else may be feeling, thereby improving our relationships with others and enhancing our quality of life.

The sooner we start working on our empathy skills, the more connected and better we will feel, and our mind health will benefit from the experience.


Gary Small, M.D., is a Professor of Psychiatry and Aging and Director of the UCLA Longevity Center at the Semel Institute for Neuroscience and Human Behavior. Dr. Small frequently appears on The Today Show, Good Morning America, and The Dr. Oz Show and is co-author (with his wife Gigi Vorgan) of six popular books, including The New York Times bestseller, The Memory Bible, and his most recent book, The Alzheimer’s Prevention Program.

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