by David Roland
We meet up at his home and are all quickly on a first-name basis. Coffee orders are taken, and I go out with someone else to pick them up from the nearby cafe. When I get back, James has set up a projector in the living room. Once Tania’s computer is plugged in, the opening graphic of a PowerPoint presentation projects onto the pale-yellow wall, left bare after the removal of an Indian tapestry. It says: Empathy and Compassion from the Lens of Social Neuroscience – Its Measurement, Modulation, and Plasticity. Tania Singer, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
We settle into chairs, forming a rough semi-circle around Tania, while she stands. I like her immediately; she lacks pretension, and she smiles a lot. She is tall, fortyish, and speaks in German-accented English. Once a research psychologist, she is now the Director of Cognitive Neuroscience at the Max Planck Institute. She’s refreshed from her holiday, which, she says, included a self-imposed ban from internet access. She’s very pleased to have this time with us.
Her primary research area is affective neuroscience — the brain and emotion. Most research in cognitive neuroscience, she tells us, has been done on processes such as memory and attention, but there is little on ‘affective networks’, except for fear and psychological trauma. She’s previously researched the human emotional response to pain. Today, she’d like to tell us of recent unpublished research on empathy and compassion.
In general, she says, it’s more useful to think in terms of neural networks than fixed functions in localised parts of the brain. One area of the brain can serve different functions depending upon which network it is involved with. Her description fits in with my road analogy of the brain, with major and minor roads, crossroads and road junctions.
Emotional contagion, she says, is the precursor to empathy, and we share it with most mammals; we pick up on others’ emotions unconsciously, and without realising the source of our emotional experience. If we are around other nervous people, for example, we become ‘infected’ by their nervousness. Emotional contagion occurs most obviously within crowds of people: at political rallies, at football games, and in concerts.
Empathy, Tania says, is different from emotional contagion in that it requires a distinction between another and ourselves: ‘I know you are in pain and I know it is not mine,’ she explains. And yet with empathy or empathic concern, we feel the other person’s pain as if it were our own. Compassion, on the other hand, is a feeling of concern for someone else’s wellbeing but without experiencing the same feelings as that person: ‘I don’t share your anger but I want you to feel better,’ Tania says. Compassion is feeling for someone; empathy is feeling as someone.
Empathising with someone else’s emotional experience activates the same neural networks that would be active if we were having this emotional experience. This is called ‘affective resonance’, which sounds to me like Daniel Siegel’s concept of ‘resonance circuits’.
Being with a depressed person who you care for leads to you feeling down too, Tania says. ‘If you stay in empathy, you can get empathic distress.’ Observing someone who is stressed changes our physiology: it raises cortisol levels, and changes heart rate and pupil size. Our mirror neurons fire to determine what the other person’s actions mean. This gives us a second-hand experience of what it is like to be them.
Tania tells us that she first began her investigations on the neuroscience of empathy with Matthieu Ricard, the author of the book Happiness: a guide to developing life’s most important skill, which I have already read. Ricard is a Tibetan Buddhist monk who, for most of his life, has actively practised compassion. Formerly he was a scientist, and he is interested in investigating the neurological correlates of contemplative practices.
Tania had him come to her lab. She put him into a functional MRI (fMRI) machine and asked him to ‘resonate with the suffering and pain of others as if the pain is your own’ — an instruction to be empathic. He did this for an hour. When she asked him what it was like to experience others’ suffering, he said that he felt distressed. After this, he was keen to do his regular compassion practice to ease the distress. Tania requested that he do this while in the fMRI machine, which he did.
What Tania had seen on the fMRI scans during Ricard’s empathy practice was the activation of the empathy-for-pain network: primarily, the anterior insula and the anterior medial cingulate cortex. But what she saw on the fMRI scans during Ricard’s compassion practice was remarkable. A completely distinct network was activated: primarily, the medial orbitofrontal cortex, the pregenual anterior cingulate cortex, and the ventral striatum. From a neural point of view, she concluded, empathy and compassion are distinct emotional experiences.
What Tania says is an epiphany for me. It’s suddenly clear to me that during my years of clinical work, each time I was with a client I was dipping into their pain — my body’s physiology changing with theirs. I was experiencing their emotional suffering. When I was sitting face-to-face with the young woman’s murderer, a man who feared for his own life, I was experiencing his fear too. During my Children’s Court work, I was feeling the distress of the children I was with, and it was made worse by me imagining my own children in the same circumstances. I was undergoing, vicariously, the abuse and neglect of my children, in my body and in my brain.
During my psychology training, we were encouraged to attune to our clients by using communication micro skills: posture, positioning, the mirroring of body movements, and reading our own bodies to clue us into our clients’ experience. We were trained in verbal skills called empathic and active listening: ways of checking in with our client to see if we were picking up correctly on their inner experience. These techniques helped us to fathom what it was like to be in the other person’s world, to stand inside it with them. This means that psychologists, and other psychotherapists who are trained in a similar way, are being set up to experience empathic distress — the seed of vicarious trauma.
But Tania has good news. Because compassion is a different neural event from empathy, it allows for the option to retrain the brain to experience compassion rather than empathic distress.
Together with her PhD student, Olga Klimecki, Tania carried out a study with people who had no history of meditation or compassion practice. The experimental group was trained in empathy, and a second group was trained in a memory exercise for words (the control group). Before and after training, they were assessed on their responses to viewing, without sound, two types of video clips of real events. The low-emotion videos showed men, women, and children in everyday situations. The high-emotion videos were taken from news events and documentaries showing human suffering following injuries and natural disasters.
The empathy-trained subjects reported an increase in empathy and negative feelings after viewing both mildly and highly distressing videos, compared with the memory group. The empathy-trained group’s fMRI scans showed activation of the empathy-for-pain network: the anterior insula and the anterior medial cingulate cortex.
Subsequently, the empathy-trained group was given instruction in a compassion practice: loving-kindness meditation, to engender feelings of warmth and care. This, as I knew by now, involved the visualisation of a close and loved person, a neutral person, and a difficult person, generating positive feelings towards them, and then projecting these feelings towards strangers and human beings in general.
Olga and Tania found that compassion training reversed the subjects’ negative feelings after watching the video clips, reducing it back to baseline, and increased their positive feelings. Tania says these brain areas activated by compassion training — the medial orbitofrontal cortex, the pregenual anterior cingulate cortex, and the ventral striatum — are associated with the care, love, and reward systems and involve the neurotransmitters oxytocin, dopamine, and opioids. Oxytocin facilitates feelings of trust and love, dopamine gives a sense of reward, and opioids provide pain relief.
Tania thinks that compassion training may be a form of psychological inoculation for people faced with human distress or adverse circumstances. The compassionate orientation does not eliminate the experience of negative feelings. Rather, it seems to provide a re-interpretation of human suffering; it leads to the compassionate person experiencing increased warmth and concern for others.
She emphasises that this research is in an early phase. Further investigations will look at the effect of different methods of compassion training on different population groups.
I ask Tania about psychological trauma and what role mindfulness and meditation can play in helping sufferers to recover from trauma. I’ve been using these practices to help me recover from post-traumatic stress disorder, I tell her.
She reminds us that in psychological trauma, an automatic response is triggered by a perceived threat, and the inhibitory function of the prefrontal cortex doesn’t work effectively during a state of high fear. Traditional therapeutic approaches, such as cognitive behaviour therapy and practising detachment or suppression of emotion, have a partial effect on dampening the trauma response, she says. Meditation, on the other hand, is ‘something new’. She thinks it doesn’t work on active inhibition, but on an earlier phase of not getting triggered to start with: when you ‘stay with the emotion’ but recognise that ‘it’s not me’. ‘You don’t need to put up a wall against it,’ she says.
‘Yes, it’s not denial,’ I say, ‘it’s staying with the emotion and knowing this. I still get a bodily reaction. I’m watching it, but I have a choice.’
‘How long has it taken you to get to this stage, using mindfulness and meditation?’ she asks.
‘About two years,’ I reply, ‘but I don’t have complete control.’
‘That’s short,’ she says. ‘Getting to this stage requires a lot of training, and it’s not easy.’
She points out that the insula is the interoceptive cortex and acts as a relay station, bringing bodily sensations to the cortex, which interprets emotions based upon these sensations. Its activity is enhanced through mindfulness and meditation practices, and this may be one of the pathways that help to change the psychological response to traumatic memories. ‘Training the heart’ through loving-kindness practice is training the attachment system — the caregiving system that we respond to as babies and children. Mindfulness stabilises the mind so that we can more readily access our mental and sensory experiences, giving us the capacity to focus the mind in a way that alters brain function.
Tania has confirmed, so neatly, what I’ve been working out for myself: mindfulness and meditation have changed my brain for the better.
AFTER THE DAY is over, my mind tumbles with insights. I think of Choeying. She told me that she moved through empathy to compassion and that such compassion is necessary to be with others in distress. Does her version of compassion correlate with the activation of the compassion network that Tania has described?
Tania’s preliminary findings suggest that those who employ a compassionate view of human distress are not dragged down by it. What I observed in Choeying was not detachment from those she was helping, but a desire to help, followed up by action. Choeying said that she felt uplifted in the face of others’ suffering: not trying to fix their pain, but helping them to see a way through it, and, in the process, gaining insight.
Why was the Dalai Lama’s teaching in Sydney such a positive experience for me? Was I responding, through the ‘resonance circuits’ that Daniel Siegel describes, to the presence of those around me — soaking up their calmness and their caring outlook? Was there something about the intense compassion I witnessed in the Dalai Lama that my body and my brain responded to?
As I look back over the five years since 2006, what stands out for me is the compassion of those who have helped me. My ocean-swimming friends, who were there each week to talk; Lily, who, through singing, showed me a way of transforming my heaviness; Wayne, my bedrock and counsel, helping me skilfully as a psychotherapist; Doctor Franklin, with his commonsense advice and advocacy for me with my insurer and others; Doctor Small, with his reassurance that I was doing the right things for my recovery, and encouraging me to write; my mates Ian, Doug, and David; James, with his encouragement of my neuroscience enquiries; Nick and my muso friends; my GP; and my former professional colleagues. I’m surprised to realise that many of these have been men — steadfast, caring, wise males who have been instrumental in my recovery. My faith in men has been restored.
And there is my family, who endured the intensity of my personal hell and the awful confluence of life events that beset us.
And me. When I walked into Wayne’s office for the first time in October 2006, I was carrying failure, shame, and self-criticism, and an admission that I could not do this thing on my own. Now I have a feeling of renewal. Is this self-compassion?
I wonder: has compassion changed my brain? Tania’s research suggests that it has.
My auditory processing has improved dramatically since the stroke — my comprehension of speech and my working memory in particular. I can think again, hold conversations, and make sense of what I hear and read. Mindfulness is no longer a mystical concept; it is a real, constant way of apprehending my inner world.
My emotional life has been rebalanced; is this due to the assiduous activity of my prefrontal cortex? Writing and therapy have definitely helped. Exercise, nutrition, music, and forming nurturing relationships have amplified the neuroplastic changes.
I’m still not back to where I was, but I’m steadily improving. And in other ways, I’m far ahead of where I was. I’ve rescued my brain. Have I also found my psychological insurance policy?
IN THE YEAR’S final session with Wayne, I ask, ‘What are the long-term effects of post-traumatic stress disorder? Will I have a permanent disability?’
‘You won’t be the person you would have been if you had never been exposed to those experiences,’ he says. ‘Ask: Am I still controlled by the trauma memories when they come unbidden?’
He thinks I’m now in control, in many ways. When certain situations arise, like they did at the writers’ festival, the original injury is like a scar. The old, disturbing memories are reawakened, and highly emotional when I access them. What’s important is how well I manage them when this happens — how much it affects me in a day-to-day way.
‘You will be particularly sensitive to children’s stories,’ he says. ‘It’s a healthy coping response to practise avoidance and denial at times. But if you live like some Vietnam veterans I’ve worked with, who exist by themselves in isolation, that is pathogenic; their experience is so limited they can never change the way they think about things.
‘In your case, you are mixing with people and taking up new challenges, and your perspective on the way you think and react is changing. You’ve done your frontline duty and experienced the burnout that almost inevitably comes with this kind of work. You will not be the same person you would have been if you had never experienced these things, but you are wiser for it.’
I’m starting to like the new person.
EPILOGUE
RECENTLY, I WENT back to Lismore Hospital. I found the ward where I had stayed and walked the path I must have taken to the canteen. The hospital and rooms were smaller and duller than I remembered. The staff in the canteen that I had thought were ‘at a party’ looked like a regular bunch of workers on their break, this time. I didn’t stop for a coffee.
A while ago, I gained my hospital records from my admission. These confirm that a CT scan was done. The CT report says: No evidence of intracranial haemorrhage, infarction, or a space-occupying lesion. I remember what Doctor Small had said about lesions sometimes not showing up on CT scans. I was seen by the serious doctor, a physician, in the afternoon of the day of my admission. He wrote in the notes: Most likely TGA [transient global amnesia], with differential diagnoses
of CVA [cerebrovascular accident] and encephalitis less likely. I find it puzzling that throughout the notes amnesia is remarked upon, as well as confusion, but in some instances the notes say I was oriented to time and place. The notes reveal that the medical personnel were aware I had vomited on the way to hospital (reported by Anna) and that I had a headache. My C-reactive protein count, ascertained from the blood tests, was slightly elevated. These are all signs, I’ve since learnt, that are consistent with a stroke.
There is the serious doctor’s written request for a psychiatric review, but no evidence of a psychiatrist or Doctor Banister coming in to see me before I was discharged.
Almost three years post-stroke, in March 2012, I undertook a full clinical review, with new brain MRI, an ultrasound, and blood tests, all ordered by the neuropsychiatrist I first came across at Seaview. Doctor Franklin had referred me to him for advice on the cause of my stroke and whether there was medication I could take to help with my neurological condition. The neuropsychiatrist found no medical reason for me to have had the stroke. Although he agreed that there is a link between depression and stroke, he said that the underlying mechanism for this has not been delineated. My arteries were clear, and there was no evidence of further bleeding in the brain.
He also confirmed that mental fatigue is common following brain injury, but could not explain why; he suggested a sleep study to ascertain if sleep apnoea was a cause of my mental fatigue, but this revealed no sleep disorder. Yet I was relieved that he confirmed I was doing all I could for my rehabilitation, with no further medication appropriate other than the 100 milligrams of aspirin directed by Doctor Small and the fish-oil tablets. He thought that Doctor Small had done all the right things.