Why empathy, as well as sympathy, is key to compassionate care

In a wonderful recent piece, a response to our collective lack of compassion in the face of the migrant crisis, author and activist Owen Jones wrote: “Almost all human beings have the capacity for empathy. Everyone has the potential to be at least troubled, or feel genuine anguish, about the suffering of other human beings.”

“We recognise that, like us, other humans have insecurities and ambitions; we fall in love and have relationships that end in heartbreak; we worry about our children’s wellbeing; we say things we regret; we’re occasionally kept awake by fears or worries; and we try to impress people we look up to. We see things in others that we see in ourselves, and that binds us together. But what happens when we no longer see a specific group as human?”

This is powerfully true of our attitudes to migrants, but – as Owen points out – it’s equally true for our attitudes to other vulnerable people; “in Britain, benefit claimants have long been subjected to relentless demonization … Injustice becomes less tolerable if the victims are human beings rather than cockroaches.”

I can only praise and echo this… and wish I could write so well. Empathy, not just sympathy, is key to compassionate care.

Recognising our shared humanity

I see this same process of alienation – the separation of ‘them and us’ – in the field of mental health. Even Government-funded anti-stigma campaigns, where one would hope for the most inclusive of approaches, appear to have inadvertently adopted language that tends to increase a sense of abnormality. Wrongly, in my opinion.

The standard message has been that one in four of the population will meet the criteria for (or ‘have’, or ‘suffer from’) a mental disorder at some point in their lives. This impressive statistic (occasionally, jarringly, referred to as a ‘burden of disease’) clearly warrants political commitments for appropriate levels of funding for mental health care, prevention initiatives and research. And we are encouraged to be open and sympathetic to people unfortunate enough to ‘suffer from mental illness’. Indeed, we are often told that problems such as depression are no different from any other medical condition, such as diabetes or a broken leg.

The aims are perhaps laudable, and the logic is understandable, but I believe that this approach is flawed. It is based on a ‘disease model’ of mental health that is scientifically incorrect.

In my opinion, we need a complete transformation in how we think about mental health and wellbeing, and a fundamental shift from an approach based at best on sympathy towards one based on our shared humanity and, therefore, genuine empathy.

Towards a psychosocial understanding

The first step towards a humane, scientific, approach to care is to ensure that we get the message right – we need to change the framework of understanding from a ‘disease model’ to a ‘psychosocial model’. I believe that our mental health problems are fundamentally social and psychological issues.

That means recognising that our mental health and wellbeing depends on the things that happen to us, how we make sense of those events and how we respond to them. Differences between people are largely the result of social and psychological influences, rather than reflecting individual pathologies, medical or biological factors.

Our present approach to helping people in acute emotional distress is severely hampered by old-fashioned and incorrect ideas about the nature and origins of mental health problems, and vulnerable people suffer as a result of inappropriate treatment. We must move away from the ‘disease model’, which assumes that emotional distress is merely a symptom of biological illness.

Describing vs Diagnosing

We must stop regarding people’s distress as merely the symptom of diagnosable ‘illnesses’ and instead develop a more appropriate system for describing and defining people’s emotional problems. Traditional psychiatric diagnoses are arbitrary and invalid, and do not map onto biological processes or describe real illnesses. They are also circular concepts, attempting to explain human behaviour merely by labelling it as pathological. This reinforces a reductionist biological view of mental health and wellbeing, and encourages discrimination and the use of inappropriate medical treatments.

We should therefore replace ‘diagnoses’ with straightforward how each one of us has learned to make sense of the world, and tailor help to our unique and complex needs.

We need to offer care rather than coercion, to fight for social justice, equity and fundamental human rights, and to establish the social prerequisites for genuine mental health and wellbeing. Empathy with fellow humans in distress, as opposed to sympathy for people with mental illness, is central to this manifesto.

I believe that the dominant ‘disease model’ contributes to the negative, punitive, controlling ethos that often prevails in services. It undermines genuine empathy and compassion; instead of seeing people’s difficulties as understandable and natural responses to the terrible things that have happened to them, the person is seen as having something wrong with them – an ‘illness’.”

Beyond the one in four

In my view, common psychological principles apply to health psychology. Everybody makes sense of their world, and does so on the basis of the experiences that they have and the learning that occurs over their lifetime. We all use the same basic processes to understand the world, even if we come to very different conclusions.

This is the basis of the rather wonderful OnlyUs campaign, which disputes the diagnostic distinction between ‘well’ and ‘ill,’ arguing that:

“… the uncomfortable truth [is] that there’s a continuum, a scale along which we all slide back and forth during our lives, sometimes happy, occasionally depressed or very anxious; mostly well balanced but with moody moments; usually in touch with reality, but at times detached or even psychotic.”

“When we separate ourselves and imagine humanity divided into two different groups, we hurt those labelled as sick, ill, even mad. We allow stigma, prejudice and exclusion to ruin potentially good and creative lives. But we also hurt ourselves, because we stress ourselves out with false smiles and the suppression of our own vulnerabilities. There is no them and us, there’s only us.”

I agree. And I find support in my professional body. The British Psychological Society’s Division of Clinical Psychology has commented that it hopes:

“… to contribute to the move away from a ‘them and us’ position between professionals and experts by experiences – to one where there is ‘only us’. “, and quoted Sally Edwards as saying: “I am a human being that is experiencing and surviving life in my own unique way…just like every other human being on the planet”.

This is about recognising the essential legitimacy of the “anguish and suffering of other human beings”. It is essential, in my opinion, to promote empathy rather than mere sympathy in pursuit of genuinely compassionate mental health care. And that, I believe, means rejecting the traditional ‘disease model’ of psychiatry and instead embracing a unifying, psychosocial, model.