The ‘E’ Word

I think we all have empathy. We may not have enough courage to display it.
—Maya Angelou

When my daughter was two-and-a-half, I took her to her first movie. She was princess-obsessed at the time and I had bought tickets to The Little Mermaid. I knew this was ambitious—toddlers are not known for their capacity to sit still for 90 minutes. I had anticipated a short period of awe, quickly superseded by an ants-in-the-pants restlessness. What I had not expected was to hear her wailing by the end of the first song. But a few minutes after Ariel began lamenting her life beneath the sea, my daughter was crying in sympathy for the would-be princess’s plight. That such a young child could feel empathy under these conditions was a revelation. It made me wonder about the physiology of empathy. At what age does empathy develop? What parts of the brain are responsible for it? Why are some people more empathetic than others?

The concept of empathy was first described in the mid-nineteenth century by aestheticians.¹ The English word originates from the German term Einfühlung, which refers to the emotional ‘knowing’ of a work of art. In psychology, two distinct components of empathy are described. These are affective empathy, the ability to share another person’s emotional state; and cognitive empathy, the ability to attribute desires, beliefs and intentions to another person. Although both elements are essential for true empathy, they occur in distinct areas of the brain and arise at different stages of development.²

Affective empathy is not unique to humans. Indeed, successful rearing in the mammalian world depends on the ability of parents to detect and respond to expressions of emotions such as pain and fear in their vulnerable offspring. In all mammals it is the limbic system of the brain, an area that includes the hypothalamus, the parahippocampal cortex and the amygdala, which is responsible for emotion processing. Affective empathy develops much earlier in human beings than cognitive empathy. As young as ten weeks of age, babies are capable of mimicking expressions of fear, sadness and surprise, and newborns become significantly more distressed when they hear another infant crying—a phenomenon sometimes referred to as emotional contagion.³

I suspect it was affective empathy at play when my daughter cried in The Little Mermaid movie. She was weeping because the ‘song was sad’ and ‘the little mermaid was sad’, not because she had any true understanding of the reasons behind the fictional character’s melancholy. Psychologists assert that affective empathy is essential for normal prosocial behaviour. An absence of it is thought to explain the cruel and unremorseful behaviour of sociopaths.⁴

Where humans differ from other mammals is in their capacity for cognitive empathy—the ability to ‘mentalise’ what another person may be thinking or feeling in a particular situation, even when emotional cues may be lacking. This skill is absent in monkeys and is present in a much more basic form in apes. There are three areas of the brain involved in the process: the temporal poles, the posterior superior temporal sulcus and the medial prefrontal lobe. A very basic capacity for cognitive empathy develops sometime around the age of four, but continues to mature and improve throughout a person’s life.⁵ A lack of cognitive empathy is often observed in children with autism. Patients with this condition may find it difficult to anticipate and understand other people’s behaviour. By contrast, sociopaths can predict how others will behave—many times, this is how they deceive their victims. What sociopaths lack is the ability to feel what their victims are feeling—the intense emotional response to a fellow human being’s distress, of the kind that so overwhelmed my daughter in the movie cinema.

Even for those of us with cognitive and affective empathy levels within the so-called ‘normal’ range, there is significant variation in our levels over time. Research suggests that medical students have lower levels of empathy for their patients at the completion of their medical training.⁶ This may be adaptive—doctors can’t afford to become emotionally distressed to the point where they are rendered unable to perform their duties. They must be able to modulate their emotional responses according to the situations presented to them. In psychology, this emotion regulation is sometimes referred to as top-down processing—the mechanism by which an individual’s memories, intentions and attitudes influence the degree of their empathic experience. After all, most of us are capable of acts of selfishness and cruelty, even though we are not empathy-deficient sociopaths.

Simon Baron-Cohen, a British cognitive neuroscientist, asserts there are particular conditions that lead people with otherwise normal levels of empathy to do abhorrent things. These are: obedience to authority; ideology; and ingroup–outgroup relations. Most of us will be familiar with the first two circumstances. I think back to pictures of Khmer Rouge fighters I saw in Phnom Penh—many of them children and teenagers—and remember my shock when reading about the brutal acts of torture they’d participated in. They were simply ‘following orders’, knowing they would probably be killed if they didn’t obey. As for the commanders who were issuing the orders, that is where the second condition, ideology, comes into play. But it is the final factor, that of ingroup–outgroup relations, which intrigues me most, because the overwhelming majority of us are not in the military or in the habit of obeying or issuing orders. Instead, it is the divisions we create between us—arbitrary factions we see every­where from school playgrounds to office buildings—that contribute to regular people being capable of acts of cruelty to their fellow human beings.

Research confirms what we suspect from observations—that we show reduced levels of empathy towards strangers from different racial, political and social groups. Black and white participants in one study demonstrated ‘matching’ neural and physiological responses when watching an artificial hand from their ingroup being pricked by a pin, but dampened or even absent responses when the artificial hand looked like it belonged to an outgroup member. But it needn’t be divisions based on race. Children assigned randomly to teams demonstrate greater empathy for ingroup members than outgroup members, and this effect is even more striking if the groups are in direct competition with one another.⁷ It is this ingroup–outgroup empathy gap that we see being played out every day across our sporting fields, on social media and in our parliaments.

In recent years, among some groups—particularly the neo-conservatives in America—empathy is a bad word. In 2009, not long after the election of Barack Obama, Republican political consultant and former deputy chief of staff to George W. Bush, Karl Rove, wrote an article in The Wall Street Journal entitled ‘Empathy is code for judicial activism’. In it, he asserted that empathy was the liberals’ way of justifying changes to the rule of law ‘whenever emotion moves them’.⁸

In ‘The Baby in the Well: The Case against Empathy’, a 2013 article in the New Yorker, Canadian-American psychologist Paul Bloom refutes Barack Obama’s claim that ‘we don’t have enough empathy in our world today’. Bloom argues that empathy can be manipulated to make us favour the life of one individual over the lives of many equally deserving others, citing the example of baby Jessica—an 18-month-old from Texas who fell into a well in 1987 and captured the hearts of mainstream America. Bloom goes on to point out that ‘a politics of empathy’ does not result in bipartisanship as one might expect, but in political disputes about whom we should empathise with. He blames empathy for the demise of sensible US policies such as the rehabilitation of criminals, which fail to gain traction with electorates because of their largely statistical benefits as compared with the heart-wrenching stories of victims.⁹

But this view is in stark contrast to Baron-Cohen’s assertion that empathy is vital to a healthy democracy. In his response to one of Bloom’s essays on a Boston Review forum,¹⁰ the neuroscientist argues that Bloom’s argument is centred on one major error—that a ‘cold cognition’ approach and an ‘empathy-based’ approach to decision-making are mutually exclusive.

I tend to agree with Baron-Cohen’s conclusion that empathy is crucial to a functioning democracy, but I reach it through slightly different reasoning. Human beings are emotional creatures. Cognitive behavioural therapy is centred around the idea that emotions drive thoughts, which in turn influence behaviour. If we lack empathy—the capacity to anticipate, predict and feel other people’s emotions—then it is very possible we won’t base our decisions on reason at all, but on the course of action that best satisfies our own emotional state at the time. Even Bloom concedes that sociopaths are capable of making moral judgements but that they lack the motivation to act upon them—in his words, ‘some spark of fellow-feeling is needed to convert intelligence into action’.

Empathy is not the problem. A quick review of the literature reveals that affective and cognitive empathy is intrinsic to human beings. Telling someone not to feel empathy is as unnatural as telling someone not to feel hungry. The problem lies with the way our empathy is being manipulated. This happens to us every day, multiple times a day. Advertising and marketing agencies are particularly skillful at it. Who hasn’t cried at a commercial for toilet paper or baby shampoo? Writers and film directors trade in the manipulation of empathy too—seducing us into seeing the world from an alternative point of view.

In these circumstances our empathy levels for the people involved—the main character in the book or the baby giggling in the commercial—increase. But empathy levels can be manipulated in a negative direction too. Mostly this occurs through the creation of (often arbitrary) divisions between people, which exaggerate the aforementioned ingroup–outgroup phenomenon. This can be done in an explicit way, by talking about building walls, or more subtly by suggesting certain members of the population are taking our jobs. The media can further exacerbate the situation by favouring the coverage of some stories over others. The result is an increase in our empathy levels for ingroup members, and a decrease in our empathy levels for perceived outgroup members.

In this way political rhetoric is important. Many organisations, including anti-harassment groups and the New York City Commission on Human Rights, have reported significant increases in hate crimes following Donald Trump’s successful election campaign.¹¹ In an article in the Atlantic, Brian Levin, author of a report examining the incidence of hate crimes in the aftermath of terrorist attacks, said, ‘I don’t think we can dismiss contentions that rhetoric is one of the significant variables that can contribute to hate crimes.’¹²

Empathy in its advanced form—a complex interplay of affective and cognitive empathy—is a uniquely human trait. It is widely accepted to be responsible for our prosocial behaviour. It is our great strength but it is also our Achilles heel. As Bloom so eloquently illustrates, our emotions, unchecked by reason, ‘can lead us astray’. But that doesn’t mean we should do away with empathy altogether. Empathy is what drives acts of heroism. Empathy is responsible for the kindness of strangers. Empathy is what stops a society from ripping itself apart.

On 1 October 2017 Stephen Paddock opened fire on a crowd of more than 20 000 people from the window of his hotel room in Las Vegas, Nevada. The crowd had gathered to celebrate the Route 91 Harvest Festival. 58 people were killed and more than 500 people were injured in what is now the deadliest mass shooting in modern US history.¹³ In the wake of the tragedy, everybody wanted to know what had motivated Paddock. Perplexed news anchors asked each other what could possibly drive a person to unleash such violence on a group of complete strangers.

Nothing disturbs or baffles us more than empathy-deficient acts. At the time of writing, scientists are preparing to perform a microscopic examination of Paddock’s brain.¹⁴ Police and the media are interrogating his family and past for clues. We know intuitively what Baron-Cohen tells us—that human beings are capable of evil acts under certain conditions, and so we search for evidence of these conditions in Paddock’s life. Was Paddock obeying orders—from another person or organisation, or in the form of auditory hallucinations from his own brain? Had Paddock pledged allegiance to an ideology—a known religious or political group, or one of his own making? In the absence of such motivations we feel uneasy—confounded by the possibility of a human being with a complete lack of empathy.

As a means of alleviating this unease, we turn to stories about the victims—their courage, their acts of heroism. The nurse who kissed a bleeding stranger countless times in the back of an ambulance. The marine who stole a truck and ferried victims to hospital. The ex-paramedic who tended to the wounded and performed CPR. We have no problem comprehending these accounts, even though they describe behaviour at odds with self-preservation and survival. These tales affirm our faith and conviction in humanity. As Las Vegas survivor Dawn-Marie Gray put it when describing how she nursed the wounded: ‘It had nothing to do with being a hero. That’s being a human being.’

Empathy is something most of us take for granted. Its absence disturbs us, its presence appeases us. Intuitively we know empathy is what sets human beings apart from the rest of the animal kingdom. Neuroscientists confirm that this is so. But we need to be aware of how our empathy can be manipulated. In particular we need to understand how politicians and the media create artificial barriers between us, which reduce our empathy levels for each other. Our greatest defence is to read widely, listen to both sides of politics and make up our own minds. And if, every now and again, we cry over a baby in a well, maybe this is not such a bad thing. Sure, we could—and perhaps even should—be crying for other babies in more tragic circumstances in other parts of the world, but at least for that one moment in our otherwise narcissistic day, we were thinking about someone other than ourselves.

Melanie Cheng is a writer and general practitioner based in Melbourne. Her debut short-story collection, Australia Day, won the 2016 Victorian Premier’s Literary Award for an unpublished manuscript.

1. Helen Riess, ‘The Science of Empathy’, Journal of Patient Experience, 9 May 2017
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5. Tania Singer, ‘The neuronal basis and ontogeny of empathy and mind reading: Review of literature and implications for future research’, Neuroscience and Biobehavioural Reviews, no. 30 (2006), pp. 855–963.
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12. Clare Foran, ‘Donald Trump and the Rise of Anti-Muslim Violence’, Atlantic, 22 September 2016, <https://www.theatlantic.com/politics/archive/2016/09/trump-muslims-islamophobia-hate-crime/
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13. Reuters Staff, ‘Las Vegas police say no delay in massacre response’, Reuters, 13 October 2017, <https://www.reuters.com/article/us-lasvegas-shooting/las-vegas-police-say-no-delay-in-massacre-response-
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14. Associated Press in Las Vegas, ‘Las Vegas shooter’s brain to undergo microscopic study’, Guardian, 29 October 2017, <https://www.theguardian.com/us-news/2017/oct/29/las-vegas-shooter-stephen-
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