Perspectives:

Empathy

by

William A. Kelly, MD

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The word empathy did not exist in the English language prior to the 1920’s. It was invented by Strachey in his translation of Freud’s works into English.   He chose the word empathy, in my opinion an unfortunate choice, to translate a word in German used by Freud, Ein:fuhlung, “Feeling one’s way into another.”  In all 23 volumes of Freud’s works the term only appears fourteen times. However, he regarded it as basic to the process and the practice of psychoanalysis. He referred to empathy as a “mechanism by means of which we are able to take up any attitude at all towards another’s mental life.” In essence a psychological process.  Freud did not define this essential process further, taking it for granted, as have many analysts since that time.

A review of the literature reveals some unsettled questions and differences of opinion from the fields of psychoanalysis, psychology and scientific philosophy. Questions arise repeatedly such as:  Is empathy rational or irrational? Is it regressive or mature? Does it involve only affect and     cognition? Cognition alone or is differentiation between affect and cognition false?   Is empathy a form of projection or a mode of observation? Is it imitative or creative?  Is empathy to be equated with  intuition  or  are  these  two different processes?  Can empathy be dealt with scientifically or is it a purely private matter? Does the analyst’s empathy aid the analysis by recreating what the patient is experiencing or  is it a form of countertransference and therefore an interference with the analytic process? Does empathy take place through identification and a permanent or temporary loss of self or identity or is there no such identification with the object of empathy and therefore no loss of self? Is empathy an end result, a tool, a skill, a kind of communication, a listening stance, a type of introspection, a capacity, a power, a form of perception or observation, a disposition, an activity or a feeling?   Is empathy to be equated with love, understanding, sympathy?   Does empathy involve gratification?

One of the reasons postulated for the confusion is that there has not been a theory of affects upon which psychoanalysts can agree.  The work of a psychologist, Silvan Tomkins, has enabled us to partially remedy this deficit.   He postulated that there were eight inherited, universal, prominent and readily identifiable patterns already present at birth or shortly thereafter, with which the human autonomic nervous system responds to stimulation. These affects are surprise, interest, joy, distress, anger, fear, shame and contempt or disgust. He later found reason to differentiate contempt and disgust, thereby increasing the number of basic affects to nine.

So you say: “Why is this such an important issue?”    It is important because affect communication lies at the root of the process that we call empathy. It begins in childhood between parent and child.   The parent transforms the infants affective reactions into signals.   Consciously through reasoned evaluation of the significance of the  child’s facial expressions, cries, body posture and movements and more importantly unconsciously in reaction to the affective state that is produced in the parent by the child’s affective expression. It is a two-way street of affective resonance. Children also are inherently attuned to the affective state of the mother or the parent and are not deceived by the parent’s conscious or unconscious attempts at disguise or dissimulation of true feeling. Clearly that awareness is not yet at a fully conscious level, which can be expressed by the infant.

It is important to return to the notion of Einfuhlung. Einfuhlung is not simply feeling with somebody else, which is sympathy, a common misunderstanding of empathy. Einfuhlung, or empathy, is feeling your way into the other.  Walking a mile in there shoes, so to speak.  There is a finding/searching quality. The finding or searching one’s way into the experience of another without specifying or limiting the means by which this occurs.   Empathy is different from intuition, which seems to be somewhat instantaneous and capricious.   Empathy involves complex cognitive processes by which we form certain hypotheses about another person’s inner experience, which can then be validated — or discounted– by experiment or question.

In 1958 empathy was defined by Heinz Kohut as “vicarious introspection.”   He emphasized the core importance of empathy and introspection as he developed his self psychological theories of psychoanalysis. In other words, the considered judgement is that there is a correspondence between what we are feeling and what in a case of the analytic situation the patient is experiencing consciously or unconsciously.    The knowledge gained through this vicarious introspection of our own affective states as they resonate with the affective states of the other is in essence a form of perception. To be truly described as empathy, it requires the capacity for conscious  awareness and decentering, the ability to put one’s self in the place of another.  For example, infants and children who have yet no clear sense of self can not be empathic, even though they may be very sensitive to the affect of others and guide their behavior accordingly. The psychoanalyst using vicarious introspection becomes aware of a feeling state or even the absence of a feeling state in themselves and begins to look inward for the source while listening to the patient.   Is the feeling being aroused from some other source in myself? Or is it a response to a process in the patient, an affective resonance?    This  conscious process begins a process of associative work and decentering a process of feeling into the other. Trying it on so to speak — walking for some  moments  in  their moccasins  and gaining knowledge of the other thereby. This process begins unconsciously and becomes empathy by being consciously introspected and decentered.    The accuracy of the data gathered can be determined by question or a tentative interpretation. Psychoanalysts, and do, receive training that enables a greater attunement   and resonance with human emotion — in other words,  empathy can be taught and refined.

Empathic data gathering is not limited to psychoanalysis. Empathy is a data gathering tool, a process based on affective resonance with the other’s feeling state.   The use to which the data is put depends on the relationship between the persons involved. Some of the world’s greatest scoundrels have been exquisitely attuned to grasping the significance of unconscious or unspoken affective communications of others and have used that knowledge to achieve base aims. This  is  also empathy, though we may condemn the end result.  Empathy is often confused with love.  One may be empathic with a loved one, but on the other hand one may feel very much in love and yet fail to achieve an empathic understanding of the loved one. A gross example of this would be stalking.   Further, empathy and empathic understanding is not curative, though some people would claim that it is. The sense of being empathically understood on a repeated basis by the analyst can lead to a deeper understanding and interpretation of oneself, of family, friends, colleagues, and even the analyst.

 

William A. Kelly, MD, is a current Faculty member and past Director of the St. Louis Psychoanalytic Institute and a Clinical Professor at St. Louis University School of Medicine. He also maintains a private practice. Dr. Kelly began his psychoanalytic training at the Chicago Institute for Psychoanalysis and finished at the St. Louis Psychoanalytic Institute, becoming our first graduate. He is previous Director of The David P. Wohl Memorial Institute at St. Louis University School of Medicine.

Dr. Kelly has served as Secretary/Treasurer, and President of the Eastern Missouri Psychiatric Society, President of the Missouri State Psychiatric Association and is a past President of The St. Louis Psychoanalytic Society.