|Year : 2016 | Volume
| Issue : 1 | Page : 1-3
Empathy: Process of adaptation and change, is it trainable?
Kalpana Srivastava, RC Das
Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
|Date of Web Publication||19-Dec-2016|
Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Srivastava K, Das R C. Empathy: Process of adaptation and change, is it trainable?. Ind Psychiatry J 2016;25:1-3
“Being empathic is a complex, demanding, strong yet subtle and gentle way of being.”
Empathy has been talked about as one of the essential attributes of health professionals. In fact, lot of weightage has been given to this facet in health sector, management field, and education sector. Some of the scientific citations date back to early development in the field having philosophical underpinnings. German esthetic philosophers Vischer and Lipps have worked immensely to elucidate the construct. Empathy was described in German word “Einfuhlung” that refers to “feeling into” to portray the feelings of the audience in a theater, proposed by Vischer. Actually, Lipps is the pioneer of the first scientific theory of Einfuhlung (“feeling into,” “empathy”) although the term had earlier been coined by Vischer in 1873. Lipps proposed the term Einfuhlung referring to mental states of other people. Primarily, focusing on the nuances of understanding of human nature. Lipps elaborated the concept of “sympathy” as a process that allows the contents of “the minds of men” to become “mirrors to one another.”
Later, Bradford coined the word empathy meaning thereby as activity of experiencing the world. Understanding empathy requires complete evaluation of domains of empathy. Historically, the construct of empathy was understood in two predominant ways, one was as to how do we know what others think and feel and second was our response to the feelings of others. The first aspect refers to cognitive domain and second is primarily motivational in nature. Research has focused on different domains of empathy, primarily categorized as emotional and cognitive empathy. Cognitive domain of empathy was always more implicated in understanding inner experiences and affective for understanding feeling of others. Both cognitive and affective components are integral part of empathy.
In India, evidence for the medicinal ideas and practices is found from 600 to 200 BC. It is derived from accounts of the contemporary Greek visitors to India, Buddhist texts, and Chanakya's Arthashastra. Sanskrit medical texts dating from early centuries of Christian era, the Charaka Samhita (Charaka's collection), and Sushruta Samhita (Sushruta's collection) have detailed account of ayurvedic theory. It is interesting to note that even in the past enough emphasis was placed on desirable qualities of medical student. Selection and training had incorporated certain attributes for selecting medical students. Sushruta Samhita gives lucid account of desirable internal characteristics of medical student. Among the most desirable attributes, i.e., humility, honesty, and hardworking generosity and empathy were also adequately emphasized.
| Empathy Versus Sympathy: Are They Different?|| |
Empathy is defined as “the feeling that you understand and share another person's experiences and emotions” or “the ability to share someone else's feelings.” Sympathy is defined as “the feeling that you care about and are sorry about someone else's trouble, grief, misfortune, etc.,” “a feeling of support for something,” or “a state in which different people share the same interests, opinions, goals, etc.,” but not necessarily the feeling that you share another person's emotions. This makes it more of a feeling experienced because of proximity to the individuals and groups they interact with and perception of the person as deserving help and sympathy.
Empathy is not similar to sympathy. Empathy is an advanced, effortful, intellectual, and trainable attribute that involves cognition more than emotions and contributes for professional satisfaction and career development, whereas sympathy is a primitive and effortless reaction that mainly involves affective domain leading to anxiety and subsequent vicarious trauma.
Research evidence regarding emergence of empathetic reactions indicates that empathy is not an automated response; it is heavily modulated by interpersonal and contextual factors, which impact behavior and cognitions. Empathy has biological underpinnings of circuits connecting the brainstem, amygdala, basal ganglia, anterior cingulate cortex, insula, and orbitofrontal cortex. The role of physiological parameters is also undeniably accepted. Neuropeptides, oxytocin, and vasopressin are implicated in the regulation of social behaviors and empathy.
Emotional attunement helps physicians appreciate the personal meanings of patients' words. There is a realignment of thought process to feeling tone. There is a close association of ideas and expression to affective, sensory, and experiential aspects. Hence, empathy translates ideas to whole gamut of transaction between logic and experiences to understand patient's perspectives. The trust and disclosure is facilitated by empathy. The roots of sympathy seem to have been associated with social intelligence. The actual terminological derivatives overlap, and there is a need to understand the semantic difference between the two, especially in patient care setting. It is quoted very aptly that both concepts involve sharing, but empathetic physicians share their understanding while sympathetic physicians share their emotions with their patients. Excessive sympathy may be counterproductive in delivery of health care; however, “compassionate detachment” is desirable to keep an affective distance from patients while engaged in providing care as physicians.
| Heritability of Empathy|| |
Heritability of empathy has been evaluated in longitudinal studies. Early years have indelible impact in prosocial behavior. Empathy as a part of Personality dimension has been considered to be the part of inheritance process. If we consider facets of empathy closely, it appears to have semblance to personality dispositions. Some of the facets, namely, social confidence, even temperedness, and nonconformity apparently concur with the temperamental dispositions quoted by Buss and Plomin, i.e., sociability, emotionality, and impulsivity. These dimensions were also known to have strong evidence of heritability. Hence as a derivative of emotionality empathy can be considered to be partly inherited disposition.
| Trainability of Empathy|| |
Adequate emphasis has been laid on the relevance of empathy in medical settings. Sheer focus on collecting factual information may not be enough. Attention is required to be given to feelings and emotions over facts.
Question arises that it is important to know whether it is trainable or not? If it is trainable aspect than it will have huge implications for medical and educational field. Research evidence is inconsistent on how amenable empathy is? Opinion is divided on it being a personality trait and modifiability of the trait. How much training has impacted on increase of this dimension is a moot question.
The dimension of empathy as a part of behavior becomes trainable as this is the virtue which is depicted to be trained during the course of medicine. It is taught as range of behavior during communication skills. During the process of training examination only serves the purpose of acquisition of response for defined goal eg passing in an examination. However the practice of such skills may bring change in behavior. The exercise centered around patient listening in which the listener has the responsibility to understand the emotional and logistical content that their partner is sharing. The role is to understand and relay back to the partner. These group exercises and role play are under supervision help in training to appreciate fine nuances of feelings of statements and reflect back the same to the person who is sharing. Hojat recommended following approaches to enhance empathy among medical students; some of them are improving interpersonal skills, analysis of audio or videotape encounters with patients, role play, and engaging in Balint method of small groupdiscussions. Review of studies revealed that empathy canbe taught; students of medicine can be taught reciprocity and emotional resonance. Once learned, these skills become the part of acquired behavior and enhance ability to relate across the various situation. It is worth mentioning here that empathy is enhancer of social relationship across all human interaction.
| Can We Measure Empathy?|| |
Scientific temperament in any discipline emphasizes on objective evidence, hence in the case of empathy, validation is needed especially for measurement. Measurement of empathy acquired importance for the purpose of training. Primarily, current practice of medicine is based on proof. There are certain scales to measure empathy, some of them are, Empathy Construct Rating Scale, the Empathic Understanding of Interpersonal Processes Scale, Hogan Empathy Scale, and Jefferson's Scale of empathy. Jefferson's Scale of empathy has three separate versions that assess medical students (S-version), health professionals (HP – version for physicians and other professionals), and students of other profession (HP – version for students).
The Balanced Emotional Empathy Scale  incorporated certain measures, more specifically, reactions to others' mental states. But it is still not clear that they tap emotional empathy alone.
Empathy was conceptualized as prosocial behavior. Interpersonal Reactivity Scale  adds further dimensions to the measurement of empathy. It includes subscales that measure perspective taking as part of definitions of cognitive empathy, empathic concern which specifically addresses the capacity of the respondent for warm, concerned, compassionate feelings for others, and fantasy items. The scale attempts to evaluate both cognitive and affective domain.
A cross-sectional study of empathy has also yielded important finding about stability of empathy across various stages of the training of medical education. A cross-sectional study was conducted among medical college students The Jefferson's Scale for Physician Empathy - Student version was administered in their respective classrooms. It was found that empathy declined during medical training during MBBS years from first to seventh semester.
| Conclusions|| |
Empathy is undeniably, a very important attribute needed in health professionals, managers, and educationist. The trainability aspect of this component of behavior makes it deliverable across various settings. In fact, relevance of it in medicine cannot be overemphasized. Empathy facilitates patient-centric approach and may go a long way in inclusive health care. Research is needed to study methods of inculcating empathy among health-care professionals.
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