Sunday, November 17, 2019

Compassion Over Empathy: A Look at Nature, Health, and Education

Mike Natter is a physician and someone with T1D whom I follow on Twitter. He's also a great artist (check out his works available on ArtSugar!) and this tweet and accompanying image struck a chord with me.

Dr. Elisabeth Poorman responded to this question on the balancing act that physicians face on a daily basis. I’m going to quote and paraphrase her excellent tweetorial on the subject of empathy and compassion:

Sympathy:  "a pity-based response to a distressing situation that is characterized by a lack of relational understanding and the self-preservation of the observer." The observer is not invested in the pain.

Empathy: "An effective response to understand an individual’s suffering through emotional resonance." This response is based on a more genuine connection and is preferred by those in need, but higher levels of empathy lead to a greater likelihood of higher inflammation and burnout scores in a study of nurses.

Emotional empathy: We feel the other’s pain. It can be overwhelming, so instead of doing what you can, you may shut down and run away (AKA burnout and compassion fatigue).

Cognitive empathy: We know the other is in pain but remotely. 

Compassion: "A virtuous response that seeks to address the suffering and needs of a person through relational understanding and action." It’s closer to cognitive empathy, which is based on reason and leans toward action to correct the other's concerns. As @stefanfersetz said to Dr. Poorman, it’s “engagement with boundaries”. The observer is not THE solution but CAN play a role, they know what it is, and they  DO it.

Burnout and compassion fatigue: if we feel the emotional distress of someone, we are more likely to burnout or become exhausted by it so much that we can’t even respond to it.

To me, sympathy is sort of positive and I’d rather have it than indifference, but it’s not very helpful. 

The results are too chancy because the connection is weak; if someone feels sympathy, they may very well never do anything. However, it can be a gateway to the better response of empathy, and the even better one of compassion.

Dr. Natter’s illustration depicts empathy on one side. I believe Dr. Poorman is suggesting that side should actually be compassion. I see his other side “professional distance” as “cognitive empathy”.

In the teaching world, I believe working from compassion is the basis for response techniques like “I see that you are…” and “When you are able to, I can...” when a student is in crisis. 

Rather than taking in the child’s anger, fear, sadness, etc, the adult is positioning themselves as willing to do eventually something, but not partake directly in the pain. Students may love our hearts and tears, and we may want to give them, but they need genuine fixes. And if teachers are constantly dealing with their inner cores being exposed due to empathy, the attacks by other adults on school finances, regulations, performance evals, data streams, and safety become death blows.

As someone with a chronic medical condition, I have experienced every single one of these terms over the years. 

From a nurse practitioner who saved my opinion on healthcare providers with her compassionate observations and achievable challenges to me, to the exhausted physician who testily told me to just stop eating after 6PM, each has cultivated a different response in me. In my best mindset, I can feel compassion for the burnt-out physician, but it set my own health backward because I became angry and felt abandoned. I probably was erroneously looking for empathy- I can clearly see the lure of it.

I work as a naturalist and wonder: what does environmental compassion look like? 

It should not be pity-based sympathy for a mouse facing an owl. It should not be tearful empathy for a frog facing a drying pond. Or at least not just these things. We talk about developing our students’ connections with and understandings of their natural environment. With those two things, they can see tools they can use, choices they can make, and laws they can formulate to create the most opportunities for the most species, including their own. That's powerful stuff.

Perhaps the major strength and motivator to operate with compassion is that it avoids the extreme ends of human emotional response on both sides of the equation (person in crisis and responder). At least during that moment of crisis for I know fully well there's intense gratitude possible after the fact from those relieved of their suffering.

As Dr. Natter’s image depicts, it’s not easy. 

Nor, is success guaranteed. Even if one is extremely good at operating within the realm of compassion, we can easily fall back on other coping strategies. Why? Because we're not perfect! Dr. Poorman says she must practice every day and it will be a lifelong process. Why? Because none of us have all the abilities to change all things to "good". It’s tough to offer something, but not THE thing that fixes it all.

I think that’s when we need to practice a bit of Buddhism: we must remind ourselves that there will always be suffering. 

We can help alleviate it, but it’ll never go away. And in my best mindset, I can find comfort in that. It means we’re reminded to enjoy the goodness. To share with each other. To revel, dance, and love when we can. In my book about living with type 1 diabetes, Dear Warriors, I wrote that it’s taught me many things, or at least shown me many things, including these concepts.

I took this picture late yesterday afternoon, when the sun was preparing to dive below the snowy horizon before 4:30 PM. The light was warm and magical, partially due to its transience. 

Here’s to us all seeing and feeling the light as it still shines on us. And to practicing compassion on ourselves, each other, and our world every day we see another sunrise.