The power of empathy | Helen Reiss | TEDxMiddlebury

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Dr. Riess has devoted her career to research on the neuroscience and art of the patient-doctor relationship and teaching psychiatry residents and medical students. Her research team conducts translational research based on the neuroscience of emotions. The effectiveness of Dr. Riess's empathy training approach has been demonstrated in several studies including a randomized controlled trial. She has developed faculty curricula for "Teaching the Teachers" of Psychotherapy that is used by faculty psychiatrists. Dr. Riess's empathy training curricula are implemented internationally in healthcare as well as in business.

Dr. Riess is an Associate Professor of Psychiatry at Harvard Medical School. She directs the Empathy & Relational Science Program, conducting research on the neuroscience of emotions and empathy, and is Co-Founder, Chief Scientist and Chairman of Empathetics, LLC. She is also a core member of the Research Consortium for Emotional Intelligence and is a faculty member of the Harvard Macy Institute for Physician Leaders.

Even before I became a psychiatrist,

I have always been fascinated
by human connection.

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

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

when we have just settled into our novel,

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

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

(Laughter)

Now, I have watched
all kinds of reactions to this

from the very sympathetic look
toward the parents

to people who look
mildly annoyed or even frustrated,

to others

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

to get away from this noise.

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

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

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

(Laughter)

"Wow!", I thought,

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

And isn't that what all of us want?

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

That's the essence of empathy.

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

He wanted to find out,

when there was empathy between people,

weather their heart rates
and other physiological tracers

actually matched up in concordance.

And he wanted to recruit
many doctor-patient pairs,

who were willing to have
their sessions videotaped

and to be hocked up to monitoring
during those sessions.

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

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

One of my patients
who agreed to participate

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

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

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

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

as you see on this slide,

where the physiology
actually mirrors one another

between the doctor and the patient

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

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

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

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

This calm, very self-confident
appearing woman,

very articulate,

turned out to have massive anxiety.

So, our tracings
were actually quite in sync,

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

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

When I showed
the tracing to her, she said,

"I am not surprised by this at all.

I live with this every day,

but no one has ever seen my pain."

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

this moved me to the core.

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

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

I noticed that the highest peaks
of her tracings

coincided with
these subtle motor movements

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

or subtle changes in her tone of voice.

Our work continued

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

our work went to a much deeper level.

She unburdened herself emotionally

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

And this woman,

who had only gained weight
and never lost weight before,

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

This was groundbreaking for her.

It was also groundbreaking for me

because I realized
that with this careful attention,

I had learned to be more emphatic.

Now, back then, everyone thought

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

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

Imagine what implications there were

if doctors, nurses, teachers, employers,

parents, boyfriends, and girlfriends

could learn to be
more emphatic with each other.

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

And this was a very growing field
at the time.

And through what I learned,
I developed empathy training.

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

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

at Massachusetts General Hospital,

where doctors that were rated
by their patients,

were rated much more higher

if they were trained on,

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

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

some of the components
of the empathy scales -

than the untrained doctors.

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

because some of my training
is just about opening your eyes

to the receptive and perceptive aspects

of empathy into the empathic responses.

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

which actually lends itself

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

So, the 'E' stands for eye contact.

Eye contact is usually
the first indication

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

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

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

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

when the baby is held like this.

Eye gaze is also important

when we say hello or greet one another.

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

In the Zulu tribe, the word for 'hello'

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

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

and eye gaze is
the first step toward this.

The 'M' stands for muscles
of facial expression.

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

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

and because of this,

our facial expressions
can not only save our lives

but can actually preserve our species.

Imagine the disgusted look
on someone's face

who's just eating rotten food

and can signal to a whole tribe

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

Or the look of startle
in your friend's face

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

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

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

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

The 'P' stands for posture.

Posture is another powerful
conveyor of connection.

Our open or close postures signal

powerful approach and avoidance
signals to others.

In one study,

doctors, who were told
to sit down on rounds,

were rated as much warmer,
more carrying, and estimated

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

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

The 'A' stands for affect.

We are trained to label
our patients' affect

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

Affect is the scientific term
for expressed emotions.

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

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

"Is Sally upset?",

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

The 'T' stands for tone of voice.

We have all heard

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

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

who is about to get angry.

The area in our brainstem

that is responsible for
the fight-and-flight response

is the same area

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

This means that when we are
emotionally activated,

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

So, this means

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

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

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

The 'H' stands for hearing
the whole person

far more than the words that people say.

Hearing the whole person means

understanding the context
in which other people live.

It also means keeping your curiosity open

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

The 'Y' stands for your response.

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

We might think that we only experience
our own emotions,

but we are constantly absorbing
the feelings of others.

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

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

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

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

who has just lost his daughter
to dating violence.

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

who have lost their homes
to hurricanes and tsunamis.

And the look on parents faces

who have just lost their children
to school shootings.

Our inner experience and feelings
mirror those of others.

Our human brain is actually
hardwired for empathy

because our survival depends on it.

We reflect the feelings of others

because that's what is required
for our survival.

We all are here more
because of mutual aid and cooperation

than because of survival of the fittest.

If we were only wired
for survival of the fittest,

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

but that's not how we're made.

As the Dalai Lama said,

"Love and compassion
are necessities not luxuries.

Without them, humanity will not survive."

So, how does this all work?

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

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

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

Now, I've seen people flinched,

even though nothing's
actually touched them.

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

Neuroscientists have done
some amazing studies

trying to map the substrate of empathy.

In one study,

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

while they received
painful electric shocks to their hands.

As you can see here,
the area in green represents

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

Later, they were told

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

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

just knowing that someone else is in pain.

Our brains are working
with shared neural circuits,

shared neurons, and some mirror neurons

so that we actually have
an internal experience

of what happens to others.

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

it is not just a figure of speech;

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

We are at a critical precipice
with technology.

Outsiders coming in and observing
our society might guess

that we have more intimate relationships
with our smartphones

than we do with our significant others.

Cyberbullying is probably on the rise
because it is much easier

to inflict harm on people
whose pain you never see.

It is much harder to have
a meaningful conversation,

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

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

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

As Jonathan Safran Foer said,

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

So, the good news about empathy

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

Employers who want to have
an engaged and productive work force

need to get tuned in to the people.

Patients who don't feel cared about

have longer recovery rates
and poorer immune function.

Students who are disengaged
are more likely to drop out,

and marriages without empathy
are more likely to fail.

So, empathy matters
in every corner of your life.

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

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

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

in order to see it themselves.

Everyone in this audience
has the power to do this.

And when we empower others,

we can collectively come together
to bring our best selves,

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

That is the power of empathy.

(Applause)