WEBVTT

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Even before I became a psychiatrist,

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I have always been fascinated
by human connection.

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What makes us connect with others,
and what makes us disconnect?

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All of us, at some point,
have been on a plane,

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when we have just settled into our novel,

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we are listening to music,
or getting our work done,

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when suddenly, the air is pierced
by the sound of a shrieking baby.

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(Laughter)

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Now, I have watched
all kinds of reactions to this

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from the very sympathetic look
toward the parents

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to people who look
mildly annoyed or even frustrated,

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to others

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literally racing each other to the one
empty seat at the front of the plane

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to get away from this noise.

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But on a recent trip to the West Coast,
I saw the most amazing reaction of all.

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A little three-year-old little boy
wiggled out of his seat,

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toddled over to that screaming baby,
and offered him his own pacifier.

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(Laughter)

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"Wow!", I thought,

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that little boy really heard and felt
the baby's distress."

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And isn't that what all of us want?

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To be seen, and heard,
and to have our needs responded to?

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That's the essence of empathy.

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So, about ten years ago, a student of mine
called me up with a fascinating idea.

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He wanted to find out,

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when there was empathy between people,

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weather their heart rates
and other physiological tracers

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actually matched up in concordance.

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And he wanted to recruit
many doctor-patient pairs,

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who were willing to have
their sessions videotaped

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and to be hocked up to monitoring
during those sessions.

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It took a bit of arm twisting for me
to agree to do this,

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but it turned out to be
a career-defining decision.

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One of my patients
who agreed to participate

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was a young college woman
who had come for help with weight loss.

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She made progress in many areas,
but not this one.

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So, we were hooked up
to this skin conductance monitoring,

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which, it turns out, actually can show
weather two people are in sync,

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as you see on this slide,

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where the physiology
actually mirrors one another

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between the doctor and the patient

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or if they are out of sync,
or if there is discordance.

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So, later that afternoon,
my student called up, and he said,

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"You have got to come over and see this!"

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So I went down, I looked at our tracings,
and I was blown away.

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This calm, very self-confident
appearing woman,

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very articulate,

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turned out to have massive anxiety.

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So, our tracings
were actually quite in sync,

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except that hers was going like this,
while mine was going like this.

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And I had not realized
what was going on inside of her.

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When I showed
the tracing to her, she said,

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"I am not surprised by this at all.

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I live with this every day,

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but no one has ever seen my pain."

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Not only as her doctor
but as a fellow human being,

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this moved me to the core.

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So I went back, watched that video -
this time, as an emotion detective -

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and tried to see what was happening,
because clearly, I had missed something.

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I noticed that the highest peaks
of her tracings

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coincided with
these subtle motor movements

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such as just flicking her hair,
or looking down in a way,

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or subtle changes in her tone of voice.

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Our work continued

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and as I paid attention to these signs
and responded to them,

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our work went to a much deeper level.

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She unburdened herself emotionally

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and started to exercise
for the first time in her life.

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And this woman,

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who had only gained weight
and never lost weight before,

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went on to lose
almost 50 pounds in the next year.

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This was groundbreaking for her.

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It was also groundbreaking for me

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because I realized
that with this careful attention,

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I had learned to be more emphatic.

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Now, back then, everyone thought

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that empathy was something
that we were born with or without,

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and that we were kind of stuck with
whether we were or we were not.

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Imagine what implications there were

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if doctors, nurses, teachers, employers,

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parents, boyfriends, and girlfriends

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could learn to be
more emphatic with each other.

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So I learned everything I could about
the neuroscience of empathy.

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And this was a very growing field
at the time.

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And through what I learned,
I developed empathy training.

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And this training was grounded in
the neurobiology of emotions and empathy,

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And the training went on to be tested
in a randomized control trial

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at Massachusetts General Hospital,

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where doctors that were rated
by their patients,

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were rated much more higher

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if they were trained on,

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"My doctor really listened to me,
really showed care and compassion,

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treated me like a whole person,
and understood my concerns" -

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some of the components
of the empathy scales -

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than the untrained doctors.

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So, this seemed like
a very important message to get out,

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because some of my training
is just about opening your eyes

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to the receptive and perceptive aspects

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of empathy into the empathic responses.

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To make it easier, I created
the acronym E.M.P.A.T.H.Y.

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which actually lends itself

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to remembering the key pieces
of how we connect to people.

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So, the 'E' stands for eye contact.

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Eye contact is usually
the first indication

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that we've been noticed by someone,
even though cultural norms can vary.

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Also, eye gaze goes back
as early as maternal infant bonding.

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It turns out that the infant's
sharpest focal point is 12 centimeters,

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which is the exact distance
between a baby's eyes and a mother's eyes,

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when the baby is held like this.

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Eye gaze is also important

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when we say hello or greet one another.

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In our country, our greeting
is usually "Hi" or "Hello."

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In the Zulu tribe, the word for 'hello'

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is "sawubona" which means "I see you."

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Every human being has a longing
to be seen, understood, and appreciated,

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and eye gaze is
the first step toward this.

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The 'M' stands for muscles
of facial expression.

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The human face is the one part of us
that we almost never fully cover up.

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Our faces are actually a road-map
of human emotion,

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and because of this,

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our facial expressions
can not only save our lives

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but can actually preserve our species.

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Imagine the disgusted look
on someone's face

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who's just eating rotten food

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and can signal to a whole tribe

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to stay away and save them
from getting sick or dying.

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Or the look of startle
in your friend's face

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just before a baseball is about
to hit you in the head,

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and you might move
just in time not to get hit.

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Also, the flirtatious glance
that's returned may be the first sign

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that you have just found
the love you are looking for.

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The 'P' stands for posture.

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Posture is another powerful
conveyor of connection.

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Our open or close postures signal

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powerful approach and avoidance
signals to others.

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In one study,

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doctors, who were told
to sit down on rounds,

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were rated as much warmer,
more carrying, and estimated

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to have spent three to five times
longer with their patients,

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than doctors how stood up
but used the exact same words.

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The 'A' stands for affect.

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We are trained to label
our patients' affect

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as a way of orienting ourselves
to the emotional experience of the person.

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Affect is the scientific term
for expressed emotions.

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When you're with someone,
try just sort of labeling, you know,

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"Is Jacob sad?", "Is Jane excited?",

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"Is Sally upset?",

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and it will change how you hear
what they are saying.

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The 'T' stands for tone of voice.

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We have all heard

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the crack in someone's voice
who is about to cry.

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We have also heard the edge
in someone's voice,

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who is about to get angry.

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The area in our brainstem

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that is responsible for
the fight-and-flight response

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is the same area

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where the nuclei for tone of voice
and facial expression reside.

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This means that when we are
emotionally activated,

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our tone of voice and facial expressions
change without our even trying.

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So, this means

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that our emotions are constantly
kind of leaking out for all to see.

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Some people's emotions are
a little more concealed than others,

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but with careful looking, we can hear
and see what these emotions are.

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The 'H' stands for hearing
the whole person

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far more than the words that people say.

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Hearing the whole person means

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understanding the context
in which other people live.

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It also means keeping your curiosity open

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and not judging till you really understand
where that person is coming from.

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The 'Y' stands for your response.

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We respond to other people's
feelings all the time.

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We might think that we only experience
our own emotions,

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but we are constantly absorbing
the feelings of others.

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It turns out that a helpful guide is
that most feelings are actually mutual.

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Think about how you feel
when you're at the airport,

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and you see a mother embracing her son,
who has just returned from active duty.

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Think about how you feel
when you see the face of a father,

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who has just lost his daughter
to dating violence.

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Think about how you feel
when you see the looks on people's faces

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who have lost their homes
to hurricanes and tsunamis.

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And the look on parents faces

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who have just lost their children
to school shootings.

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Our inner experience and feelings
mirror those of others.

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Our human brain is actually
hardwired for empathy

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because our survival depends on it.

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We reflect the feelings of others

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because that's what is required
for our survival.

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We all are here more
because of mutual aid and cooperation

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than because of survival of the fittest.

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If we were only wired
for survival of the fittest,

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we'd be wired to dominate others
and to only look out for ourselves,

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but that's not how we're made.

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As the Dalai Lama said,

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"Love and compassion
are necessities not luxuries.

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Without them, humanity will not survive."

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So, how does this all work?

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We've all heard the expression
"I feel your pain."

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Now, for a moment,
imagine you are in a parking lot,

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and you've just seen someone's hand
get slammed in a car door.

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Now, I've seen people flinched,

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even though nothing's
actually touched them.

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And most people will actually feel like
something physical just by imagining it.

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Neuroscientists have done
some amazing studies

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trying to map the substrate of empathy.

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In one study,

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16 couples were recruited,
and the women were put in head scanners

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while they received
painful electric shocks to their hands.

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As you can see here,
the area in green represents

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that the entire pain matrix lit up
when they received the shocks.

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Later, they were told

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that their partners had just received
the same similar shocks to their hands

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and you see the area in red
represents almost the entire pain matrix;

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just knowing that someone else is in pain.

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Our brains are working
with shared neural circuits,

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shared neurons, and some mirror neurons

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so that we actually have
an internal experience

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of what happens to others.

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So, when we hear the expression
"I feel your pain,"

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it is not just a figure of speech;

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we're made for this, and it happens
not just with our loved ones.

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We are at a critical precipice
with technology.

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Outsiders coming in and observing
our society might guess

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that we have more intimate relationships
with our smartphones

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than we do with our significant others.

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Cyberbullying is probably on the rise
because it is much easier

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to inflict harm on people
whose pain you never see.

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It is much harder to have
a meaningful conversation,

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if what you're used to
is 140-character tweets.

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And how do you know whether to say,
"Do you need for me to come over?"

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if what you have just gotten is a text
that says, "Lousy day" with an emoticon?

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As Jonathan Safran Foer said,

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"When we accept diminished substitutes,
we become diminished substitutes."

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So, the good news about empathy

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is that when it declines,
it can also be learned.

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Employers who want to have
an engaged and productive work force

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need to get tuned in to the people.

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Patients who don't feel cared about

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have longer recovery rates
and poorer immune function.

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Students who are disengaged
are more likely to drop out,

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and marriages without empathy
are more likely to fail.

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So, empathy matters
in every corner of your life.

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As the Zulu say
not 'Hello', but 'I see you, '

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we all need to see each other
to bring out the full potential in others.

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Most people need to have their specialness
reflected back in the eyes of others

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in order to see it themselves.

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Everyone in this audience
has the power to do this.

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And when we empower others,

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we can collectively come together
to bring our best selves,

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to solve the world's biggest, smallest,
and most vexing problems.

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That is the power of empathy.

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(Applause)