Sympathy, empathy, or compassion?
Oh, my goodness, even those who do research in these areas have contradictory definitions! Nonetheless, it’s important for practitioners to have an understanding of the differences between these concepts, as the differences impact patients and practitioners themselves. The descriptions I like best tend to point toward sympathy as a pity-based response where understanding is limited, and response is often self-protective of the observer. By contrast, empathy is a response of emotional resonance and understanding. Lastly, compassion, in addition to encompassing the qualities of empathy, includes elements of what is probably best termed, “altruistic love,” a “beholding” of another with a regard for their well-being and an attempt at alleviating suffering. As you can imagine, patients tend to not find sympathy particularly helpful. But empathy and compassion are welcomed, particularly compassion.
As healthcare students learn interviewing skills, first with standardized patients and then with “live” patients, they discover differences between sympathy and empathy. And as I’ve noted previously, an occupational hazard for clinicians is the closing down of empathy as a protective measure against emotional exhaustion. A major challenge in medicine, therefore, is how to stay engaged in a meaningful way with patients, without feeling burned out. Neuroscience studies have found differences in fMRI activity between those exhibiting empathy vs. compassion in lab and meditation exercises. For those experiencing empathic responses, the anterior insula and cingulate cortex are strongly activated; unfortunately, this can also be associated with affective pain. Those practicing compassion meditation, however, did not have activation of emotional centers linked to negative emotions/distress. Instead, areas associated with positive emotions and affiliation, such as the medial insula, were activated.
A Stanford University study of medical students enrolled in an 8-week Compassion Cultivation Training (CCT) program showed improvements in emotional regulation and mindfulness skills compared to controls.
If one looks at sympathy>empathy>compassion as a pathway, we can recognize how to move from an initial inclination of sympathy toward empathy. We can then learn to practice compassion by understanding the suffering, remaining engaged, yet not being enveloped by the emotional intensity. While the hope is that we can alleviate another’s pain, it is a healing act to simply sit with another while we show genuine kindness.
Reminder, if you would like to share inspirational quotes, stories, or ideas which might be helpful to others, please feel free to email Dr. Melissa Naslund at melissa.naslund@UND.edu.
