Empathy

• 1. Introduction

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  Empathy, the ability to understand or feel what another person is feeling, began as a Greek word, empatheia, meaning physical affection or passion. That word was built from en, meaning in, and pathos, meaning passion or suffering. In modern Greek, the cousin of that word, εμπάθεια, can mean prejudice, malice or even hatred, depending on the context.

  English took a different road. In 1903 the psychologist Theodor Lipps adapted a German aesthetic term, Einfühlung, which means feeling into, and brought it into psychology. In 1909 Edward B. Titchener translated that term into English as empathy.

  A word with such a tangled past has never settled into a single meaning. Researchers and ordinary people have used it for caring about others and wanting to help them. They have used it for feeling what someone else feels, for working out what someone else thinks, and for blurring the line between self and other.

  This documentary follows the questions that tangle raises. How do scientists split such a slippery idea into parts, and what do brain scans say about those parts? How can anyone measure it? When does it start in a child, and do other animals share it? What happens when it fails, and does feeling for others always make us better people?

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• 2. Head and Heart

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  Before the age of two, an infant who meets another person's distress usually becomes distressed too. Only around the second birthday do children start to respond in other-oriented ways, by trying to help, comfort and share. That shift hints at the central split in the field.

  Affective empathy, also called emotional empathy, is the ability to answer another person's mental state with a fitting emotion. It grows out of emotional contagion, in which one person is simply swept up in another's mood or arousal. Cognitive empathy is a separate ability: grasping another person's perspective or mental state. Labels such as perspective-taking, mentalizing and theory of mind are often used as stand-ins for it. No studies have compared them closely enough to show they are truly the same thing.

  Two scales sit inside affective empathy. Empathic concern is sympathy and compassion in response to suffering. Personal distress is the discomfort and anxiety that suffering provokes, and researchers disagree about whether it counts as empathy at all. Affective mentalizing adds a further layer, using body language, facial expressions and context to read the situation.

  Four scales sit inside cognitive empathy. Perspective-taking is the habit of spontaneously adopting someone else's psychological viewpoint. Fantasy is the tendency to identify with fictional characters. Tactical empathy is perspective-taking used on purpose to reach a desired end. Emotion regulation is a damper on contagion, letting a person empathize without being overwhelmed. The two broad kinds are independent, so someone who feels another's pain strongly may still be poor at understanding that person's point of view.

  A meta-analysis of fMRI studies found that different brain areas light up for the two kinds. Affective empathy tracks with the insula. Cognitive empathy tracks with the mid cingulate cortex and the neighboring dorsomedial prefrontal cortex. Studies of patients with different kinds of brain damage point the same way. The inferior frontal gyrus appears to support emotional empathy, while the ventromedial prefrontal gyrus seems to mediate cognitive empathy.

  Interest in these circuits surged after mirror neurons were found in monkeys, cells that fire both when an animal watches an action and when it performs one. People who score high on empathy tests are reported to have especially busy mirror neuron systems.

  The two kinds can also pull against each other. Empathic anger, a form of empathic distress, arises when someone watches another person being hurt. People with stronger perspective-taking tend to be less angry at a provocation, while people with higher personal distress tend to be angrier.

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• 3. Measuring the Unmeasurable

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  The Interpersonal Reactivity Index, first published in 1983, is among the oldest empathy questionnaires still in frequent use. It has 28 items, split into four scales of seven items each, covering the affective and cognitive subdivisions. A newer tool, the Empathy Quotient created by Baron-Cohen and Wheelwright, has 60 items. The Questionnaire of Cognitive and Affective Empathy first appeared in 2011, and the Empathic Experience Scale offers 30 items from a phenomenological angle. Medicine has its own tool for carers, the Jefferson Scale of Physician Empathy.

  A 2019 meta-analysis delivered an awkward verdict on this whole approach. Self-report scores for cognitive empathy showed only a negligibly small link to behavioral tests, which suggests people are poor judges of their own ability.

  One researcher found a second trap hidden in self-scoring. Her students rated themselves as less empathetic after taking her empathy class. Learning more had made them stricter judges of their own feelings, so their standards rose faster than their behavior.

  Questionnaires also age badly. One study gave the same questionnaire to 13,737 college students between 1979 and 2009 and found that empathy scores fell substantially. A critic suggested the wording had simply become quaint. Phrases such as "tender feelings", "ill at ease", "quite touched" and "go to pieces" may mean little to today's students.

  Behavioral and bodily methods try to sidestep self-reporting. Raters score verbal and non-verbal behavior captured on video, and electronic equipment attached to a subject's body records physiological reactions. Other experiments ask people to write responses to staged or authentic video scenarios.

  The youngest subjects get special treatment. Picture or puppet-story indices let pre-school children respond without reading or writing, and one design used a seven-point smiley face scale. What those small children are already doing, before they can pick a face, is the next puzzle.

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• 4. Growing Up Empathic

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  At one year of age, infants already show the rudiments of empathy, because they understand that other people's actions have goals just as their own do. By 18 months, some children try to comfort a crying baby. During their second year, children begin to play games of pretend and falsehood meant to fool others. Such games require knowing what someone else believes, so that the belief can be manipulated.

  A full theory of mind arrives later. Most children do not show one until around the age of four, when they can usually pass false-belief tasks. These tasks test whether a child understands that other people may hold beliefs different from their own.

  Researchers at the University of Chicago used fMRI to watch children between seven and twelve as they saw other people being injured. The children's brain activity resembled what would occur if they had been injured themselves. That fits earlier adult studies and the idea that sharing another's distress is hardwired and present early. When the children saw someone hurt on purpose, extra regions tied to social and moral cognition also became active, including areas involved in moral reasoning.

  Parenting seems to matter too. Caroline Tisot studied how parenting style, parent empathy and earlier social experience shape empathy in young children. Specific practices mattered more than overall style. Encouraging a child to imagine other people's perspectives helped, as did teaching the child to reflect on his or her own feelings. Paternal warmth was positively related to empathy, especially in boys. Maternal warmth was negatively related, especially in girls.

  Sex differences are a contested part of this picture. On average, females score higher on measures such as the Empathy Quotient, though other studies find no significant difference and point to motivation instead. A 2014 review in Neuroscience & Biobehavioral Reviews argued the differences have biological roots and appear from birth. The Primary Caretaker Hypothesis offers an evolutionary explanation, proposing that prehistoric women faced stronger pressure to read non-verbal cues.

  Brain injury can undo what development builds. Empathy is often impaired when a stroke or lesion strikes the right side of the brain. Damage to the frontal lobe, which governs emotional regulation, can profoundly affect the capacity. More than half of people with a traumatic brain injury self-report a deficit in empathy. There is some evidence that the skill can be improved with training.

  Even adulthood has stages. Empathic maturity, a theory developed at the Yale University School of Nursing, describes three levels of cognitive structure in how adults understand a patient's personhood. At the third and highest level, adults blend systems of justice and care-based ethics.

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• 5. Animal Cousins

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  Bonobos are described as perhaps the most empathic primate. Zanna Clay and Frans de Waal studied how juvenile bonobos with different rearing backgrounds responded to stress. The bonobos sought body contact as a way of coping, and they sought more of it after watching another bonobo suffer than after their own bad experience, such as losing a fight. Mother-reared bonobos sought more physical contact than orphans did. De Waal suggests that empathy evolved in the first place because mothers who understood their children's needs gained an advantage.

  Chimpanzees offer a parallel. Researchers led by Teresa Romero watched two separate groups and saw acts of consolation in both, with chimpanzees spontaneously comforting victims of aggression. As in humans, comfort went disproportionately to kin and loved ones. Females gave more of it than males on average. The exception was high-ranking males, who matched females, which is believed to reflect their policing role and authority.

  Dogs were tested by Custance and Mayer, who placed each dog in an enclosure with its owner and a stranger. Talking or humming changed nothing. When a person pretended to cry, the dog turned toward that person, owner or stranger alike, and approached by sniffing, licking and nuzzling rather than with tail wagging or panting. That could mean dogs have a cognitive capacity for empathy. It could also mean generations of rewards taught domesticated dogs to comfort distressed humans.

  Domesticated hens show the body's side of the story. When a chick was exposed to danger, the mother hen's heart rate rose, she sounded vocal alarms, she preened less and her body temperature increased. She showed stress-induced hyperthermia only when the chick's behavior matched the perceived threat. In rodents, a study found empathy-driven prosocial behavior toward cagemates in pain, but not toward strangers.

  The neurobiologist Jean Decety of the University of Chicago agrees that empathy is not exclusive to humans. He argues that even the most advanced human forms are built on simpler ones tied to affective communication, social attachment and parental care. Humans also extend empathy unevenly across species. The closer a species sits to us on the family tree, the more empathy and compassion people tend to feel for it.

  Evolutionary game theory adds a social twist. In models of indirect reciprocity, cooperation depends on shared moral reputations, and it collapses when individuals disagree about who is in good standing. When individuals can take one another's perspective, altruism can evolve again, and the models show that perspective-taking itself can evolve.

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• 6. When Empathy Fails

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  Psychopathy is the clearest case of the two kinds of empathy coming apart. Simon Baron-Cohen claims it is associated with intact cognitive empathy, meaning an intact ability to read social cues and what others feel. It is the affective side that is impaired, so people with the condition are not distressed by the suffering of their victims.

  Jean Decety worked with large samples of incarcerated psychopaths and scanned them while they watched people being intentionally hurt. The high-psychopathy group showed much less activation in the ventromedial prefrontal cortex, the amygdala and the periaqueductal gray. They showed more activity in the striatum and the insula. In a second study they responded strongly in pain-affective regions when imagining themselves hurt. They failed to recruit the circuits that controls used when imagining another person's pain.

  Another team found something stranger. Psychopathic criminals were scanned while they watched videos of a person harming another individual. When told to empathize, their empathic reaction started the same way as that of controls, and pain-related areas activated when they imagined the victim's feelings. The researchers proposed that psychopaths can switch empathy on at will, which would enable them to be both callous and charming. They did not know how to turn that willful empathy into the spontaneous kind most people have. Others doubted that the experience was the same as in controls.

  Other conditions scramble the balance differently. Narcissism is linked to impaired affective but not cognitive empathy. Bipolar disorder shows the reverse, with impaired cognitive empathy and theory of mind but increased affective empathy. Schizophrenia is associated with deficits in both. In borderline personality disorder the findings are disputed, and studies have noted empathy that fluctuates between normal, reduced and absent. In aggressive conduct disorder, children responded to others' pain with strong amygdala and ventral striatum activation but weak activation of regions for self-regulation and moral reasoning.

  Autism and empathy form a controversial and complex area of study. The double empathy problem theory proposes that earlier studies may have been misread and that autistic people show the same levels of empathy toward one another as non-autistic people do. A 2022 study found no significant differences in the medial prefrontal cortex and amygdala, two regions tied to empathy. A 2023 study noted that mirror neurons "may be dysfunctional in ASD", though no causal relationship has been proven. A 2006 study had found reduced mirror neuron activity in the inferior frontal gyrus of high-functioning autistic children.

  Empathy can also be shut down on purpose. Dave Grossman, in his book On Killing, reports that military training artificially creates depersonalization in soldiers, suppressing empathy and making it easier for them to kill.

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• 7. The Case Against

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  Paul Bloom, author of Against Empathy, argues that empathic bias breeds tribalism and violent responses in the name of helping one's own group, especially when demagogues exploit it. His alternative is "rational compassion". One example is using effective altruism to choose charitable donations, rather than reacting to emotional images in the media.

  A football experiment shows how quickly the bias appears. Researchers gave two groups of men wristbands matching the team they supported. Each man received a mild electric shock, then watched another go through the same pain. When the wristbands matched, observers showed empathic pain. When the men backed opposing teams, observers showed little empathy.

  Bloom lists other distortions. Empathy can lead people to care more about attractive people than unattractive ones, or about people of their own race. The same pull can send conservation money and laws toward cute, photogenic animals while more ecologically important species get ignored. He also points to street children in India, who attract many donations because they are adorable, which results in their enslavement by organized crime. Giving to an effective charity through an impersonal website, he says, can do more good.

  Bloom also challenges a popular link. Although psychopaths have low empathy, the correlation between low empathy and violent behavior in scientific studies is, in his words, "zero". Lack of self-control predicts violence much better.

  Power changes the picture as well. In priming experiments, people asked to recall a time they had power over someone showed reduced ability to mirror others and comprehend their viewpoints. People from lower-class backgrounds show better empathic accuracy than people from upper-class backgrounds.

  Too much empathy has costs of its own. Tania Singer says health care workers and caregivers must stay objective rather than over-invest their emotions, or they risk draining their own resourcefulness. Bloom points out that high-empathy nurses tend to spend less time with patients, to avoid the pain of witnessing suffering. Research on natural disasters found that cognitive empathy, not emotional empathy, predicted who helped victims. Sharing victims' emotions can cause distress and helplessness, and it can lead to avoidance.

  Finally, Fritz Breithaupt describes an "empathic endowment effect". To empathize, people oversimplify the other person, which makes that person seem more cohesive than they are. The empathizer, who must dampen their own sense of self, may come to envy the strong self they have given up.

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• 8. Work, Classroom and Page

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  Patricia Moore pioneered empathic techniques for understanding customers. She used makeup and prosthetics to simulate the experience of elderly people, and the insights inspired friendlier products for that group. Design engineers at Ford Motor Company wore prosthetics to simulate pregnancy and old age, to design cars that would work better for such drivers. Fidelity Investments trains its telephone customer service staff with a virtual reality app that puts them in a dramatized customer's home.

  In the 2009 book Wired to Care, the strategy consultant Dev Patnaik argues that large corporations suffer from a lack of empathy. He names Nike, Harley-Davidson and IBM as "Open Empathy Organizations". In 2016 the leadership consulting firm Development Dimensions International found that 20% of U.S. employers offered empathy training to managers.

  A study at Stanford University found that when teachers used active listening and emotional awareness, suspension rates dropped significantly, by 50%. Carl R. Rogers, a pioneer of research in psychotherapy and teaching, held that empathy, unconditional positive regard and authenticity were the most important traits for a therapist or teacher. Learning by teaching is one method for building empathy, because students must keep reflecting on their classmates' mental processes. Within medical education, a hidden curriculum appears to dampen the empathy of medical students.

  Philosophers have built whole systems on the idea. In his 2007 book The Ethics of Care and Empathy, Michael Slote argues that actions are wrong if and only if they reflect a deficiency of fully developed empathic concern. Keith Jenkins takes the opposite line about the past. He argues that the past is a foreign country and we cannot empathize with those who lived there. Heinz Kohut introduced empathy into psychoanalysis.

  Fiction may be where empathy gets trained most often. Lynn Hunt argued in Inventing Human Rights: A History that mid-eighteenth-century European novels helped create the human rights movement. Letter-form novels gave readers a vivid sense of access to a real life. Literary scholar Lisa Zunshine argues that fiction exercises readers' theory of mind.

  Superhero stories have turned empathy into a power. "Empaths" sense the emotions and bodily sensations of others and sometimes control them. The Marvel Comics character Empath is one, and the ability is often linked to the telepathy of Jean Grey. The rebooted television series Charmed gives the power to Maggie Vera, a witch.

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