Dr. Abhinav Chichra

  Consultant Psychiatrist, CMC Vellore

 

As a young boy growing up in New Delhi, it was an everyday occurrence for me to see the city’s many underprivileged children trying to make a living on its streets. Comfortably ensconced in my middle class existence, separated from these streets by our car’s windows, I would stare out at these children, the same age as I was, but with an existence that was radically different from mine. There were times when, unbidden and unwanted, vivid images of what it might feel like to live their precarious life would spring up in my mind. I would actively suppress these thoughts and images, physically shrug them off; I found it too disturbing and distressing to allow myself to indulge in them. There was fascination mixed in somewhere with the distress; there was repulsion too.

More often than not however, and increasingly with age, I would neatly cut myself off from feeling any emotion, refusing to allow myself to get disturbed by something I knew I would be seeing every day. So, I suppose, the questions I start this article with is: how did that young boy instinctively feel some of the emotion he saw? How did he learn to control this instinct and make it something that he could switch on or off (mostly) at will?

I firmly believe that he, and by extension all of us, instinctively reached out and put on the emotional state of those he saw in front of him because of neural networks that allowed him the cognitive and emotional flexibility to do so. These networks have survived the millennia of human existence because they provide a distinct evolutionary advantage to species that possess them.

When I think of the question of ‘empathy’, I like to think of primeval man; a frail and unprotected creature that lacked the physical skill and ability of the other species that cohabited its world. A creature that used cognitive processing as its secret weapon to survive on a hostile planet; a species that changed the contours of nature to reduce its disadvantages vis a vis predators; individuals that had to band together in groups to protect themselves. For primeval man was social by design, there was no other way for him to ensure his survival. Living in a group needed an understanding of those around him; living in the harsh realities of that world needed this understanding to be instinctive, reflexive, fast. Which, of course, brings us to empathy. Empathy, to borrow a definition I particularly liked, is evident when I and you becomes I am you. It is a facilitator of a level of social communication that is indispensable for the efficient functioning of a group, and it may be one of the reasons that you and I are part of a species that dominates our planet today.

Functional imaging has started giving us tantalising glimpses into the neural processes that allow us to possess empathy. The ‘mirror neuron’ network was first described in a group of macaques. Researchers showed that neural networks would fire in the same network whether a macaque did a particular action or whether it merely saw another macaque do the same action. The macaque’s brain registered the motor action of another in its group, recognized the action and readied it to duplicate the action if needed. Similar results soon followed in the context of emotional cognisance. Imaging studies showed similar patterns of neural activation when primates recognized an emotion in another of their group as when they themselves felt that emotion. In the instant of recognizing another’s emotion, the primate brain duplicated the process and thus, in a sense, shared an emotional experience with another individual. Of course, as with many other advances in behavioural science, mirror neurons provide us a frustratingly limited view of the biological representations of empathy. Though mirror neurons have huge implications in multiple domains from learning to autistic spectrum disorders, clear answers with direct clinical implications still seem a long way off.

So, though mirror neurons do not completely answer my first question of how my younger self seemed to be able to instinctively establish an amount of emotional resonance (even when I didn’t particularly want to), they do provide us solid evidence that empathy is rooted in biological processes that probably gave social animals like primates an evolutionary edge.

Which brings us, of course, to my next question: How did I begin to exert a fair amount of voluntary control over what was initially an emotional reflex? As firmly as I believe that we all have the inherent biological capacity for empathy; I also believe that, as with all primeval instincts, we learn to exercise an increasing amount of conscious control over it as we age. Biologically, of course, this maps to increasing myelination in the neocortex and synaptic pruning in the forebrain. Practically; complex interactions of innate personality traits, culture, environment, parenting and life experiences are what determine how much empathy we all allow ourselves. I use the word ‘allow’ because I also think that, at some level, this is a conscious decision. How much do we protect ourselves? How much do we let ourselves feel?

The truth is, empathy can be terribly uncomfortable, can’t it? It can undermine our carefully constructed defences and expose us to potentially threatening emotional experiences.  We often do not really want to feel any bit of the emotion that swirls around us, it is often much more comfortable to keep ourselves insulated. But what do we do when that jars with our professional responsibilities? Anybody involved in a service based profession is trained to use empathy as a vital tool. As a doctor, I was taught from the first day of my training that without empathetic communication I could not be good at my job. I was told that clinical expertise alone may treat an illness but may not heal an individual. I was encouraged to open myself up to the emotion I felt from across the table. The tricky bit of course is, by opening myself up, I expose myself to distress. Do any of us have the emotional stamina to truly feel what our patients feel every single day of our career?

It’s really quite the little puzzle; one I haven’t solved for myself as yet. To be good at my job I need to be as empathetic as possible, to survive in this job for the rest of my working life, I have to protect myself as well. Emotional exhaustion and burnout is a very real threat in the medical profession. How this overwhelmingly negative state interacts with the psychological construct of empathy is however quite complex. Too much empathy and you risk rapidly depleting your emotional reserves; too little, and you risk becoming increasingly cynical and disaffected. But what exactly are the parameters of this Goldilocks zone? Did my younger self really need to shut himself off from what was happening in the city around him? Would I have been a better person for not doing so? My guess is we all need to determine these parameters for ourselves. We need to do a careful balancing act of our ideas, our ideals and our mental health. Philanthropy and self-preservation are not always natural bedfellows; and this balancing act can go awry all too easily. But perhaps, if we do everything right, we will indeed hit that much desired Goldilocks zone; be compassionate as well as healthy, feel the distress of our patients but not let it affect our happiness. Not too much, not too little, but the perfect little space of ‘just right’.

 

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