It is important we design a healthcare system that allows carers to act positively for their patients
“Imagining what it is like to be someone other than
oneself is at the core of our humanity. It is the essence
of compassion and the beginning of morality.”
The above quote is not from a medical doctor, psychologist, religious leader, or philosopher. It is from the novelist Ian McEwan, a man who makes his living imagining the lives of others. Another author, Adam Smith (1723-1790), in The Wealth of Nations, wrote that if everyone acted out of self-interest and worked for maximum personal gains, the “invisible hand” would ensure that all goods and services were equally distributed. The premise of his book being that people acting in their own interest often contributed more to society than when they acted for the common good. Seventeen years before The Wealth of Nations, however, Smith had written The Theory of Moral Sentiments. At that time, he believed that human beings were inherently interested in the welfare of others and garnered significant benefit from helping those less fortunate than themselves. What we now call empathy, Smith described as “changing places in fancy with the sufferer”.
The Scottish philosopher, David Hume (1711-1776), also shared these sentiments, stating that to be human is to have “some particle of the dove, kneaded into our frame, along with the elements of the wolf and serpent”. While Charles Darwin (1809-1882) in The Ascent of Man recognised that co-operation and reciprocity were as integral to the survival of the species as competition. The observations and insights of these learned men indicate that humans, with all their flaws and shortcomings, are a species that can imagine themselves into the hearts and minds of others and use this experience for better or worse. What these men describe is empathy. Today, McEwan recognises this same empathy as the essence of compassion.
Modern psychology concurs with both and offers clear distinctions between empathy and compassion. Empathy is divided into two distinct elements: Cognitive and affective. Cognitive empathy implies we understand things from another’s perspective. Affective empathy implies we feel with or for the other. Cognitive empathy can be cultivated by experiences such as wearing a blindfold to simulate blindness, dressing up as an elderly person, or going to the supermarket in a wheelchair. Such actions allow us to experience the world from a new perspective, but will not necessarily induce the feelings that accompany such circumstances.
For most people, true empathy (cognitive and affective) is accompanied by a powerful desire to help those less fortunate than themselves. This, according to researchers, is compassion. Compassion is not simply emotional resonance and understanding. It is a “constructive state of mind that helps both the one who feels it and the one who receives it”. Compassion registers on MRI scans as activation in areas of the brain associated with positivity and optimism. And when circumstances allow, this activation leads to positive action.
I once read of an experiment involving Matthieu Ricard, a Buddhist monk and scientist. While attached to a functional MRI (FMRI) scanner, Ricard was asked to view a 15-minute recording of children in a Romanian orphanage. After 15 minutes, Ricard felt despondent, and the MRI showed activation in areas of his brain associated with pain and distress. He asked if he could continue to watch the video while he practised compassion meditation for the children. For the next 10 minutes he repeated the phrases, “May you be happy. May you live with ease.” After completion, the FMRI showed activation in brain areas linked with positivity and optimism. More significantly, Ricard felt happier and more positive-minded.
What I learned from this, and similar compassion research, is that resonating with suffering, while being powerless to do something about it, causes a downward spiral of despondency that does not benefit either the carer or the cared for.
Humans have evolved to be empathic and compassionate. Doctors and healthcare workers are confronted with suffering every day, feeling empathy for patients, often in a setting where they are powerless to affect positive change. Carers who feel good, who see frequent positive outcomes, are more effective workers. To facilitate this, it is important that we design a healthcare system that allows carers to act positively for their patients. When we repeatedly see Mrs Murphy with her painful arthritic hip; Sean absent from school and sports because of frequent tonsilitis; Susan confined to her home with acute anxiety, who has been waiting over two years to see a psychologist, we become despondent. We turn away from the suffering because it makes us feel bad and no one wants to feel bad. We feel impotent and powerless and lose pride in our career.
Imagining what it is like to be someone other than oneself is good for all of us, patients, carers, and policymakers. Compassion benefits everyone.
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