Advertisement

Empathy and Empathic Disconnection in Difficult and Uneasy Situations: Facing the Suicidal Individual

  • Davide DonelliEmail author
  • Matteo Rizzato
Chapter

Abstract

Empathy, in the patient-clinician relationship, plays a key role. Here we address this issue from a neuroscientific perspective, as neuroscience research attempts are shedding much light on the mechanisms underlying empathy. In particular, we focus on the relationship between clinician and suicidal individuals that represents a difficult category of patients that puts the emotional and empathic regulation capacity to the test. Therefore, we provide the reader with an overview on the current neuroscientific knowledge about empathy, intending to return an interpretative clue and favour new intuitions promoting a better comprehension, based on a scientific use of empathy in the patient-clinician relationship. We then propose the concept of “empathic disconnection” referring to those situations in which the clinician, automatically and unconsciously, puts him/herself in the position of not taking any advantage from the empathic relationship with the patient. We propose the concept of “empathic moment” as a communicative strategy, whose goal is to intentionally use empathic mechanisms to gather information directed at identifying the inner state of the patient. We finally suggest the use of vitality forms as a relevant element for the cognitive analysis of the patient’s inner states. We conclude with some practical-applicative considerations based on what is discussed.

References

  1. Adolphs R (2003) Cognitive neuroscience of human social behaviour. Nat Rev Neurosci 4(3):165–178CrossRefPubMedGoogle Scholar
  2. Ammaniti M, Gallese V (2014) The birth of intersubjectivity: psychodynamics, neurobiology, and the self. WW Norton & Company, New YorkGoogle Scholar
  3. Ben-Zeev D, Scherer EA, Wang R, Xie H, Campbell AT (2015) Next-generation psychiatric assessment: using smartphone sensors to monitor behavior and mental health. Psychiatr Rehabil J 38(3):218CrossRefPubMedPubMedCentralGoogle Scholar
  4. Bernhardt BC, Singer T (2012) The neural basis of empathy. Neuroscience 35(1):1Google Scholar
  5. Blair RJR (2008) Fine cuts of empathy and the amygdala: dissociable deficits in psychopathy and autism. Q J Exp Psychol 61(1):157–170CrossRefGoogle Scholar
  6. Cheng Y, Lin CP, Liu HL, Hsu YY, Lim KE, Hung D, Decety J (2007) Expertise modulates the perception of pain in others. Curr Biol 17(19):1708–1713CrossRefPubMedGoogle Scholar
  7. Cheng Y, Chen C, Lin CP, Chou KH, Decety J (2010) Love hurts: an FMRI study. NeuroImage 51(2):923–929CrossRefPubMedGoogle Scholar
  8. Cox CL, Uddin LQ, Di Martino A, Castellanos FX, Milham MP, Kelly C (2012) The balance between feeling and knowing: affective and cognitive empathy are reflected in the brain’s intrinsic functional dynamics. Soc Cogn Affect Neurosci 7(6):727–737CrossRefPubMedGoogle Scholar
  9. Craig AD (2003) Interoception: the sense of the physiological condition of the body. Curr Opin Neurobiol 13(4):500–505CrossRefPubMedGoogle Scholar
  10. Craig AD (2009) How do you feel now? the anterior insula and human awareness. Nat Rev Neurosci 10(1):59–70CrossRefPubMedGoogle Scholar
  11. Critchley HD, Wiens S, Rotshtein P, Öhman A, Dolan RJ (2004) Neural systems supporting interoceptive awareness. Nat Neurosci 7(2):189–195CrossRefPubMedGoogle Scholar
  12. Damasio AR (1994) Descartes’ error: emotion, rationality and the human brain, vol 352. Putnam, New York, pp 1061–1070Google Scholar
  13. Danziger N, Faillenot I, Peyron R (2009) Can we share a pain we never felt? neural correlates of empathy in patients with congenital insensitivity to pain. Neuron 61(2):203–212CrossRefPubMedGoogle Scholar
  14. Davidson RJ, Kabat-Zinn J, Schumacher J, Rosenkranz M, Muller D, Santorelli SF, Urbanowski F, Harrington A, Bonus K, Sheridan JF (2003) Alterations in brain and immune function produced by mindfulness meditation. Psychosom Med 65(4):564–570CrossRefPubMedGoogle Scholar
  15. Davis MH (1983) Measuring individual differences in empathy: evidence for a multidimensional approach. J Pers Soc Psychol 44(1):113CrossRefGoogle Scholar
  16. De Greck M, Wang G, Yang X, Wang X, Northoff G, Han S (2012) Neural substrates underlying intentional empathy. Soc Cogn Affect Neurosci 7(2):135–144CrossRefPubMedGoogle Scholar
  17. Decety J, Cowell JM (2014) The complex relation between morality and empathy. Trends Cogn Sci 18(7):337–339CrossRefPubMedGoogle Scholar
  18. Decety J, Ickes W (2011) The social neuroscience of empathy. MIT Press, Cambridge, MAGoogle Scholar
  19. Di Cesare G, Di Dio C, Rochat MJ, Sinigaglia C, Bruschweiler-Stern N, Stern DN, Rizzolatti G (2014) The neural correlates of “vitality form” recognition: an fmri study. Soc Cogn Affect Neurosci 9(7):951–960CrossRefPubMedGoogle Scholar
  20. Di Cesare G, Di Dio C, Marchi M, Rizzolatti G (2015) Expressing our internal states and understanding those of others. Proc Natl Acad Sci 112(33):10331–10335CrossRefPubMedPubMedCentralGoogle Scholar
  21. Di Cesare G, Valente G, Di Dio C, Ruffaldi E, Bergamasco M, Goebel R, Rizzolatti G (2016) Vitality forms processing in the insula during action observation: a multivoxel pattern analysis. Front Hum Neurosci 10:267CrossRefPubMedPubMedCentralGoogle Scholar
  22. Donker T, Petrie K, Proudfoot J, Clarke J, Birch MR, Christensen H (2013) Smartphones for smarter delivery of mental health programs: a systematic review. J Med Internet Res 15(11):e247CrossRefPubMedPubMedCentralGoogle Scholar
  23. Ekman P, Friesen WV (2003) Unmasking the face: a guide to recognizing emotions from facial clues. Malor Books, Cambridge, MAGoogle Scholar
  24. Engen HG, Singer T (2013) Empathy circuits. Curr Opin Neurobiol 23(2):275–282CrossRefPubMedGoogle Scholar
  25. Eres R, Decety J, Louis WR, Molenberghs P (2015) Individual differences in local gray matter density are associated with differences in affective and cognitive empathy. NeuroImage 117:305–310CrossRefPubMedGoogle Scholar
  26. Fan Y, Duncan NW, De Greck M, Northoff G (2011) Is there a core neural network in empathy? An FMRI based quantitative meta-analysis. Neurosci Biobehav Rev 35(3):903–911CrossRefPubMedGoogle Scholar
  27. Feinstein JS, Adolphs R, Damasio A, Tranel D (2011) The human amygdala and the induction and experience of fear. Curr Biol 21(1):34–38CrossRefPubMedGoogle Scholar
  28. Fredrickson BL, Cohn MA, Coffey KA, Pek J, Finkel SM (2008) Open hearts build lives: positive emotions, induced through loving-kindness meditation, build consequential personal resources. J Pers Soc Psychol 95(5):1045CrossRefPubMedPubMedCentralGoogle Scholar
  29. Freud S (1912) Recommendations to physicians practising psycho-analysis. Stand Edition of the Complete Psychological Works of Sigmund Freud 12(1):109–120Google Scholar
  30. Gallese V (2010) Le basi neurofisiologiche dell’intersoggettività [neural basis of intersubjectivity]. Soc Degli Individ 37(1):48–53Google Scholar
  31. Gallese V (2013) Corpo non mente. le neuroscienze cognitive e la genesi di soggettività ed intersoggettività. Edu Sentiment 20:8–24CrossRefGoogle Scholar
  32. Gallese V, Sinigaglia C (2011) What is so special about embodied simulation? Trends Cogn Sci 15(11):512–519CrossRefPubMedGoogle Scholar
  33. Gallese V, Keysers C, Rizzolatti G (2004) A unifying view of the basis of social cognition. Trends Cogn Sci 8(9):396–403CrossRefPubMedGoogle Scholar
  34. Gazzaniga M (1985) The social brain: discovering the networks of the mind. Basic Books, New YorkGoogle Scholar
  35. Gazzaniga M (1998) The split brain revisited. Sci Am 279(1):50–55CrossRefPubMedGoogle Scholar
  36. Gazzaniga M (2005) The ethical brain. Dana press, Washington, DCGoogle Scholar
  37. Gazzaniga M (2007) L’interprete. Come il cervello decodifica il mondo. Di Renzo Editore, RomaGoogle Scholar
  38. Gazzaniga M, Ivry R, Mangun G (2013) Cognitive neuroscience: the biology of the mind, 4th edn. WW Norton & Company, New YorkGoogle Scholar
  39. Gibson JJ (2014) The ecological approach to visual perception, Classic edn. Psychology Press, Park DriveGoogle Scholar
  40. Goldin PR, McRae K, Ramel W, Gross JJ (2008) The neural bases of emotion regulation: reappraisal and suppression of negative emotion. Biol Psychiatry 63(6):577–586CrossRefPubMedGoogle Scholar
  41. Gravenhorst F, Muaremi A, Bardram J, Grünerbl A, Mayora O, Wurzer G, Frost M, Osmani V, Arnrich B, Lukowicz P et al (2015) Mobile phones as medical devices in mental disorder treatment: an overview. Pers Ubiquit Comput 19(2):335–353CrossRefGoogle Scholar
  42. Gu X, Han S (2007) Attention and reality constraints on the neural processes of empathy for pain. NeuroImage 36(1):256–267CrossRefPubMedGoogle Scholar
  43. Hatfield E, Cacioppo JT, Rapson RL (1994) Emotional contagion. Cambridge university press, CambridgeGoogle Scholar
  44. Hatfield E, Rapson RL, Le YCL (2011) Emotional contagion and empathy. In: Decety J, Ickes W (eds) The social neuroscience of empathy. MIT Press, Boston, MA, p 19Google Scholar
  45. Hein G, Singer T (2008) I feel how you feel but not always: the empathic brain and its modulation. Curr Opin Neurobiol 18(2):153–158CrossRefPubMedGoogle Scholar
  46. Heller M, Haynal V (2002) The doctor’s face: a mirror of his patient’s suicidal projects. In: Guimon J (ed) Body psychotherapy in progressive and chronic disorders. Karger, Basel, pp 46–51Google Scholar
  47. Ickes W (2003) Everyday mind reading: Understanding what other people think and feel. Prometheus Books, Amherst, NYGoogle Scholar
  48. Jabbi M, Keysers C (2008) Inferior frontal gyrus activity triggers anterior insula response to emotional facial expressions. Emotion 8(6):775CrossRefPubMedGoogle Scholar
  49. Jabbi M, Swart M, Keysers C (2007) Empathy for positive and negative emotions in the gustatory cortex. NeuroImage 34(4):1744–1753CrossRefPubMedGoogle Scholar
  50. Johansson G (1973) Visual perception of biological motion and a model for its analysis. Percept Psychophys 14(2):201–211CrossRefGoogle Scholar
  51. Kennedy DP, Adolphs R (2010) Impaired fixation to eyes following amygdala damage arises from abnormal bottom-up attention. Neuropsychologia 48(12):3392–3398CrossRefPubMedPubMedCentralGoogle Scholar
  52. Keysers C (2011) The empathic brain: how the discovery of mirror neurons changes our understanding of human nature. CreateSpace Independent Publishing Platform, Seattle, WAGoogle Scholar
  53. Keysers C, Wicker B, Gazzola V, Anton JL, Fogassi L, Gallese V (2004) A touching sight: Sii/pv activation during the observation and experience of touch. Neuron 42(2):335–346CrossRefPubMedGoogle Scholar
  54. Klimecki OM, Leiberg S, Lamm C, Singer T (2012) Functional neural plasticity and associated changes in positive affect after compassion training. Cereb Cortex 23(7):1552–1561CrossRefPubMedGoogle Scholar
  55. Klimecki OM, Leiberg S, Ricard M, Singer T (2013) Differential pattern of functional brain plasticity after compassion and empathy training. Soc Cogn Affect Neurosci 9(6):873–879CrossRefPubMedPubMedCentralGoogle Scholar
  56. Koenigsberg HW, Fan J, Ochsner KN, Liu X, Guise K, Pizzarello S, Dorantes C, Tecuta L, Guerreri S, Goodman M et al (2010) Neural correlates of using distancing to regulate emotional responses to social situations. Neuropsychologia 48(6):1813–1822CrossRefPubMedPubMedCentralGoogle Scholar
  57. Kovács ÁM, Téglás E, Endress AD (2010) The social sense: susceptibility to others’ beliefs in human infants and adults. Science 330(6012):1830–1834CrossRefPubMedGoogle Scholar
  58. Lamm C, Nusbaum HC, Meltzoff AN, Decety J (2007) What are you feeling? using functional magnetic resonance imaging to assess the modulation of sensory and affective responses during empathy for pain. PLoS One 2(12):e1292CrossRefPubMedPubMedCentralGoogle Scholar
  59. Lamm C, Porges E, Cacioppo J, Decety J (2008) Perspective taking is associated with specific facial responses during empathy for pain. Brain Res 1227:153–161CrossRefPubMedGoogle Scholar
  60. Lamm C, Meltzoff AN, Decety J (2010) How do we empathize with someone who is not like us? A functional magnetic resonance imaging study. J Cogn Neurosci 22(2):362–376CrossRefPubMedGoogle Scholar
  61. LeDoux J (2012) Rethinking the emotional brain. Neuron 73(4):653–676CrossRefPubMedPubMedCentralGoogle Scholar
  62. Lindquist KA, Wager TD, Kober H, Bliss-Moreau E, Barrett LF (2012) The brain basis of emotion: a meta-analytic review. Behav Brain Sci 35(03):121–143CrossRefPubMedPubMedCentralGoogle Scholar
  63. Lutz A, Brefczynski-Lewis J, Johnstone T, Davidson RJ (2008) Regulation of the neural circuitry of emotion by compassion meditation: effects of meditative expertise. PLoS One 3(3):e1897CrossRefPubMedPubMedCentralGoogle Scholar
  64. Luxton DD, McCann RA, Bush NE, Mishkind MC, Reger GM (2011) mHealth for mental health: integrating smartphone technology in behavioral healthcare. Prof Psychol 42(6):505CrossRefGoogle Scholar
  65. Maltsberger JT, Buie DH (1974) Countertransference hate in the treatment of suicidal patients. Arch Gen Psychiatry 30(5):625–633CrossRefPubMedGoogle Scholar
  66. McHugh P (2004) Zygote and “clonote” – the ethical use of embryonic stem cells. N Engl J Med 351(3):209–211CrossRefPubMedGoogle Scholar
  67. Mesulam M, Mufson EJ et al (1982) Insula of the old world monkey. III: Efferent cortical output and comments on function. J Comp Neurol 212(1):38–52CrossRefPubMedGoogle Scholar
  68. Mitchell JP, Banaji MR, MacRae CN (2005) The link between social cognition and self-referential thought in the medial prefrontal cortex. J Cogn Neurosci 17(8):1306–1315CrossRefPubMedGoogle Scholar
  69. Morecraft RJ, Stilwell-Morecraft KS, Rossing WR (2004) The motor cortex and facial expression: new insights from neuroscience. Neurologist 10(5):235–249CrossRefPubMedGoogle Scholar
  70. Murray RJ, Schaer M, Debbané M (2012) Degrees of separation: a quantitative neuroimaging meta-analysis investigating self-specificity and shared neural activation between self- and other-reflection. Neurosci Biobehav Rev 36(3):1043–1059CrossRefPubMedGoogle Scholar
  71. Ochsner KN, Ray RR, Hughes B, McRae K, Cooper JC, Weber J, Gabrieli JD, Gross JJ (2009) Bottom-up and top-down processes in emotion generation common and distinct neural mechanisms. Psychol Sci 20(11):1322–1331CrossRefPubMedPubMedCentralGoogle Scholar
  72. Onnis L (2015) Una nuova alleanza tra psicoterapia e neuroscienze. Dall’intersoggettività ai neuroni specchio. Dialogo tra Daniel Stern e Vittorio Gallese. Franco Angeli Editore, MilanGoogle Scholar
  73. Osmani V (2015) Smartphones in mental health: detecting depressive and manic episodes. IEEE Pervasive Comp 14(3):10–13CrossRefGoogle Scholar
  74. Owen G, Belam J, Lambert H, Donovan J, Rapport F, Owens C (2012) Suicide communication events: lay interpretation of the communication of suicidal ideation and intent. Soc Sci Med 75(2):419–428CrossRefPubMedGoogle Scholar
  75. Pelphrey KA, Carter EJ (2008) Brain mechanisms for social perception. Ann N Y Acad Sci 1145(1):283–299CrossRefPubMedPubMedCentralGoogle Scholar
  76. Pessoa L (2010) Emotion and cognition and the amygdala: from “what is it?” to “what’s to be done?”. Neuropsychologia 48(12):3416–3429CrossRefPubMedPubMedCentralGoogle Scholar
  77. Phelps EA (2006) Emotion and cognition: insights from studies of the human amygdala. Annu Rev Psychol 57:27–53CrossRefPubMedGoogle Scholar
  78. Pompili M (2013) La prevenzione del suicidio. Il Mulino, BolognaGoogle Scholar
  79. Pompili M (2015) Our empathic brain and suicidal individuals. Crisis 36(4):227–230CrossRefPubMedGoogle Scholar
  80. Pompili M, Murri MB, Patti S, Innamorati M, Lester D, Girardi P, Amore M (2016) The communication of suicidal intentions: a meta-analysis. Psychol Med 6(11):2239–2253CrossRefGoogle Scholar
  81. Porges SW (2007) The polyvagal perspective. Biol Psychol 74(2):116–143CrossRefPubMedGoogle Scholar
  82. Porges SW (2009) The polyvagal theory: new insights into adaptive reactions of the autonomic nervous system. Cleve Clin J Med 76(Suppl 2):S86CrossRefPubMedPubMedCentralGoogle Scholar
  83. Porges SW (2011) The polyvagal theory: neurophysiological foundations of emotions, attachment, communication, and self-regulation (Norton series on interpersonal neurobiology). WW Norton & Company, New YorkGoogle Scholar
  84. Premack D, Woodruff G (1978) Does the chimpanzee have a theory of mind? Behav Brain Sci 1(04):515–526CrossRefGoogle Scholar
  85. Rizzato M, Donelli D (2014) I am your mirror. Mirror neurons and empathy. Blossoming Books, TurinGoogle Scholar
  86. Rizzolatti G, Sinigaglia C (2008) Mirrors in the brain: how our minds share actions and emotions. Oxford University Press, New YorkGoogle Scholar
  87. Rizzolatti G, Fogassi L, Gallese V (2002) Motor and cognitive functions of the ventral premotor cortex. Curr Opin Neurobiol 12(2):149–154CrossRefPubMedGoogle Scholar
  88. Saarela MV, Hlushchuk Y, ACdC W, Schürmann M, Kalso E, Hari R (2007) The compassionate brain: humans detect intensity of pain from another’s face. Cereb Cortex 17(1):230–237CrossRefPubMedGoogle Scholar
  89. Saxe R, Wexler A (2005) Making sense of another mind: the role of the right temporo-parietal junction. Neuropsychologia 43(10):1391–1399CrossRefPubMedGoogle Scholar
  90. Shamay-Tsoory SG, Aharon-Peretz J, Perry D (2009) Two systems for empathy: a double dissociation between emotional and cognitive empathy in inferior frontal gyrus versus ventromedial prefrontal lesions. Brain 132(3):617–627CrossRefPubMedGoogle Scholar
  91. Shneidman ES (1998) The suicidal mind. Oxford University Press, New YorkGoogle Scholar
  92. Singer T, Klimecki OM (2014) Empathy and compassion. Curr Biol 24(18):R875–R878CrossRefPubMedGoogle Scholar
  93. Singer T, Seymour B, O’Doherty JP, Stephan KE, Dolan RJ, Frith CD (2006) Empathic neural responses are modulated by the perceived fairness of others. Nature 439(7075):466–469CrossRefPubMedPubMedCentralGoogle Scholar
  94. Singer T, Critchley HD, Preuschoff K (2009) A common role of insula in feelings, empathy and uncertainty. Trends Cogn Sci 13(8):334–340CrossRefPubMedGoogle Scholar
  95. Stern DN (2010) Forms of vitality: exploring dynamic experience in psychology, the arts, psychotherapy, and development. Oxford University Press, New YorkCrossRefGoogle Scholar
  96. Wager TD, Davidson ML, Hughes BL, Lindquist MA, Ochsner KN (2008) Prefrontal-subcortical pathways mediating successful emotion regulation. Neuron 59(6):1037–1050CrossRefPubMedPubMedCentralGoogle Scholar
  97. Walter H, von Kalckreuth A, Schardt D, Stephan A, Goschke T, Erk S (2009) The temporal dynamics of voluntary emotion regulation. PLoS One 4(8):e6726CrossRefPubMedPubMedCentralGoogle Scholar
  98. Wicker B, Keysers C, Plailly J, Royet JP, Gallese V, Rizzolatti G (2003) Both of us disgusted in my insula: the common neural basis of seeing and feeling disgust. Neuron 40(3):655–664CrossRefPubMedGoogle Scholar
  99. Zaki J, Ochsner K (2011) Reintegrating the study of accuracy into social cognition research. Psychol Inq 22(3):159–182CrossRefGoogle Scholar
  100. Zaki J, Weber J, Bolger N, Ochsner K (2009) The neural bases of empathic accuracy. Proc Natl Acad Sci 106(27):11382–11387CrossRefPubMedPubMedCentralGoogle Scholar
  101. Decety J, Jackson PL (2004) The functional architecture of human empathy. Behav Cogn Neurosci Rev 3(2):71–100CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.C.d.L. Magistrale Medicina e ChirurgiaUniversity of ParmaParmaItaly
  2. 2.PordenoneItaly

Personalised recommendations