Abstract
Empathy is generally regarded as important and positive. However, descriptions of empathy are often inadequate and deceptive. Furthermore, there is a widespread lack of critical attention to such deficiencies. This critical review of the medical discourse of empathy shows that tendencies to evade and misrepresent the understanding subject are common. The understanding subject’s contributions to the empathic process are often neglected or described as something that can and should be avoided or controlled. Furthermore, the intrinsic and closely interwoven relationship between medical understanding and empathy is generally not explored. Instead of challenging objectivistic and instrumental ideals, the medical discourse of empathy tends to accommodate to inadequate ideals of objectivity and instrumentalism. Thus, important aspects of physician’s rationality, understanding, and morality are neglected and important opportunities for reflection, dialogue, and critique are forfeited. Both the critical and constructive parts of this paper are heavily inspired by philosophical hermeneutic insights, e.g. that physician’s empathy is always historically situated and part of a moral commitment. At the end of this paper, an alternative description of empathy - i.e. appropriate understanding of another human being - is outlined to facilitate the inclusion of hermeneutic insights and accentuate the inherent relationship between empathy and morality.
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References
Agosta, L.: 1984, Empathy and Intersubjectivity, In J. Lichtenberg, M. Bornstein, and D. Silver (eds.), Empathy I. Hillsdale: The Analytic Press, pp. 43–61
Aring, C.D.: 1958, Sympathy and Empathy, Journal of the American Medical Association 167(4), 448–452
Baile, W.F., Buckman, R., Lenzi, R., Glober, G., Beale, E.A., and Kudelka, A.P.: 2000, SPIKES-A Six-step Protocol for Delivering Bad News: Application to the Patient with Cancer, The Oncologist 5(4), 302–311
Barrett-Lennard, G.T.: 1981, The Empathy Cycle—Refinement of A Nuclear Concept, Journal of Counseling Psychology 28(2), 91–100
Basch, M.F.: 1983, Empathic Understanding: A Review of the Concept and Some Theoretical Considerations, Journal of the American Psychoanalytic Association 31(1), 101–126
Bavelas, J.B., Black, A., Lemery, C.R., and Mullett, J.: 1987, Motor Mimicry as Primitive Empathy, In N. Eisenberg and J. Strayer (eds.), Empathy and its Development. Cambridge: Cambridge University Press, pp. 317–338
Bellet, P.S., and Maloney, M.J.: 1991, The Importance of Empathy as an Interviewing Skill in Medicine, Journal of the American Medical Association 266(13), 1831–1832
Beres, D., and Arlow, J.A.: 1974, Fantasy and Identification in Empathy, Psychoanalytic Quarterly 43(1), 26–50
Book, H.E.: 1988, Empathy: Misconceptions and Misuses in Psychotherapy, American Journal of Psychiatry 145(4), 420–424
Brothers, L.: 1989, A Biological Perspective on Empathy, American Journal of Psychiatry 146(1), 10–19
Buck, R., and Ginsburg, B.: 1997, Communicative Genes and the Evolution of Empathy, In W.J. Ickes (ed.), Empathic Accuracy (pp. 17–43). New York: Guilford Press
Buie, D.H.: 1981, Empathy: Its Nature and Limitations, Journal of the American Psychoanalytic Association 29(2), 281–307
Chakrabarti, B., and Baron-Cohen, S.: 2006, Empathizing: Neurocognitive Developmental Mechanisms and Individual Differences, Progress in Brain Research 156, 403–417
Davis, M.H.: 1994, Empathy A Social Psychological Approach. Colorado: Westview Press
Dymond, R.F.: 1949, A Scale for the Measurement of Empathic Ability, Journal of Consulting Psychology 13(2), 127–133
Dymond, R.F.: 1950, Personality and Empathy, Journal of Consulting Psychology 14(5), 343–350
Dymond, R.F., Hughes, A.S., and Raabe, V.L.: 1952, Measurable Changes in Empathy with Age, Journal of Consulting Psychology 16(3), 202–206
Elster, J.: 1996, Sour Grapes. Paris: Maison des Sciences de l’Homme and Cambridge University
Evans, W.J., and Britt, D.W.: 2002, The Genomic Revolution and the Obstetrician/Gynaecologist: From Societal Trends to Patient Sessions, Best Practice and Research Clinical Obstetrics and Gynaecology 16(5), 729–744
Gadamer, H.G.: 1989, Truth and Method. (2nd edn) London: Sheed and Ward
Gallagher, S.: 2004, Hermeneutics and the Cognitive Sciences, Journal of Consciousness Studies 11(10–11), 162–174
Gallagher, S., Cole, J., and McNeill, D.: 2002, Social Cognition and Primacy of Movement Revisited, Trends in Cognitive Science 6(4), 155–156
Gallese, V.: 2003, The Roots of Empathy: The Shared Manifold Hypothesis and the Neural Basis of Intersubjectivity, Psychopathology 36(4), 171–180
Gladstein, G.A.: 1983, Understanding Empathy: Integrating Counseling, Developmental, and Social Psychology Perspectives, Journal of Counseling Psychology 30(4), 467–482
Goldberg, A.: 1983, On the Scientific Status of Empathy, Annual of Psychoanalysis 11, 155–169
Greenson, R.R.: 1960, Empathy and Its Vicissitudes, International Journal of Psycho-Analysis 41, 418–424
Greenson, R.R.: 1967, The Technique and Practice of Psychoanalysis 1. New York: International Universities Press
Iacoboni, M., and Dapretto, M.: 2006, The Mirror Neuron System and the Consequences of its Dysfunction, Nature Reviews Neuroscience 7(12), 942–951
Halpern, J.: 2001, From Detached Concern to Empathy. New York: Oxford University Press
Halpern, J.: 2003a, Practicing Medicine in the Real World: Challenges to Empathy and Respect for Patients, Journal of Clinical Ethics 14(4), 298–307
Halpern, J.: 2003b, What is Clinical Empathy? Journal of General Internal Medicine, 18(8), 670–674
Havens, L.: 1978, Explorations in the Uses of Language in Psychotherapy: Simple Empathic Statements, Psychiatry 41(4), 336–345
Heidegger, M.: 1997, Being and Time. Oxford: Blackwell Publishers
Hoffman, M.L.: 2000, Empathy and Moral Development. New York: Cambridge University Press
Hojat, M., Gonnella, J.S., Nasca, T.J., Mangione, S., Vergare, M., and Magee, M. (2002). Physician Empathy: Definition, Components, Measurement, and Relationship to Gender and Specialty, American Journal of Psychiatry 159(9), 1563–1569
Jessor, R. and S. Richardson: 1968, ‘Psychosocial Deprivation and Personality Development’, in: National Institute of Child Health and Human Development (ed.), Perspectives on Human Deprivation. Washington: U.S. Department of Health, Education, and Welfare, pp. 1–87
Katz, R.L.: 1963, Empathy: Its Nature and Uses. London: The Free Press of Glencoe
Keefe, T.: 1976, Empathy: The critical skill, Social Work 21(1), 10–14
Kohut, H.: 1959, Introspection, Empathy, and Psychoanalysis; an Examination of the Relationship Between Mode of Observation and Theory, Journal of the American Psychoanalytic Association 7(3), 459–483
Kohut, H.: 1966, Forms and Transformations of Narcissism, Journal of the American Psychoanalytic Association 14(2), 243–272
Kohut, H.: 1977, The Restoration of the Self. New York: International Universities Press
Kohut, H.: 1984, How Does Analysis Cure. Chicago: The University of Chicago Press
Leiberg, S., and Anders, S.: 2006, The Multiple Facets of Empathy: A Survey of Theory and Evidence, Progress in Brain Research 156, 419–440
MEDLINE (Ovid) (accessed 26.01.2007) Scope Note for: Empathy [On-line]. Available: http://gateway.ut.ovid.com/gw1/ovidweb.cgi
More, E. S.: 1996, Empathy as a Hermeneutic Practice, Theoretical Medicine 17(3), 243–254
Neuwirth, Z.E.: 1997, Physician Empathy—Should we Care?, Lancet 350(9078), 606
Olden, C.: 1954, On Adult Empathy with Children, Psychoanalytic Study of the Child 8, 111–126
Orange, D.M.: 1994, Countertransference, Empathy, and the Hermeneutical Circle, In S. Stolorow, G. Atwood, and B. Brandchaft (eds.), The Intersubjective Perspective. Lanham: Jason Aronson, pp. 177–186
Oxford English Dictionary (Second edition 1989) (accessed 26.01.2007) [On-line]. Available: http://dictionary.oed.com
Platt, F.W., and Keller, V.F.: 1994, Empathic Communication: A Teachable and Learnable Skill, Journal of General Internal Medicine 9(4), 222–226
Preston, S. D., and de Waal, F. B.: 2002; Empathy: Its Ultimate and Proximate Bases, Behavioral and Brain Sciences 25(1), 1–20
Reed, G.S.: 1984, The Antithetical Meaning of the Term “Empathy” in Psychoanalytic Discourse, In J. Lichtenberg, M. Bornstein, D. Silver (eds.), Empathy I. Hillsdale: The Analytic Press, pp. 7–24
Rogers, C.R.: 1995, A Way of Being. New York: Houghton Mifflin Company
Rushton, J.P.: 1980, Altruism, Socialization, and Society. Englewood Cliffs, N.J.: Prentice-Hall
Schafer, R.: 1993, The Analytic Attitude. London: Karnac Books and the Institute of Psychoanalysis
Selzer, R.: 1993, Foreword, In H. Spiro, M.G.M. Curnen, E. Peschel, and D.ST. James (eds.), Empathy and the Practice of Medicine. New Haven: YaleUniversity Press, pp. ix–x
Shamasundar, C.: 1999, Understanding Empathy and Related Phenomena, American Journal of Psychotherapy 53(2), 232–245
Shelton, S.B.: 1998, The Doctor-Patient Relationship, In A. Stoudemire (ed.), Human Behavior—An Introduction for Medical Students. Philadelphia: Lippincott-Raven, pp. 3–35
Singer, T.: 2006, The Neuronal Basis and Ontogeny of Empathy and Mind Reading: Review of Literature and Implications for Future Research, Neuroscience and Biobehavioral Reviews 30(6), 855–863
Spiro, H.: 1992, What is Empathy and Can it be Taught?, Annals of Internal Medicine 116(10), 843–846
Spiro, H.: 1993, Empathy: An Introduction, In H. Spiro, M.G.M. Curnen, E. Peschel and D.ST. James (eds.), Empathy and the Practice of Medicine. New Haven: Yale University Press, pp. 1–6
Suchman, A.L., Markakis, K., Beckman, H.B., and Frankel, R.: 1997, A Model of Empathic Communication in the Medical Interview, Journal of the American Medical Association 277(8), 678–682
Wilmer, H.A.: 1968, The Doctor–Patient Relationship and the Issues of Pity, Sympathy and Empathy. British Journal of Medical Psychology 41(3), 243–248
Zinn, W.: 1993, The Empathic Physician, Archives of Internal Medicine 153(3), 306–312
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Pedersen, R. Empathy: A wolf in sheep’s clothing?. Med Health Care and Philos 11, 325–335 (2008). https://doi.org/10.1007/s11019-007-9104-0
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DOI: https://doi.org/10.1007/s11019-007-9104-0