Compassion
Christian Jonathan Haverkampf, M.D.
Compassion towards oneself and others helps improve mental health. Internal and external communication play important roles in understanding, initiating and furthering compassion. Compassion requires connectedness with oneself and others, while it leads to even greater connectedness with oneself and others. Compassion can thus bring people together and bridge differences through the simplicity of communication, emotional and otherwise. Compassion involves “feeling for another” and requires the capability for empathy.
Compassion requires being receptive to meaningful information from others. It is intentional and brings about change in oneself and others through meaningful communication. It can instil in others a sense of warmth and being cared for, while having significant benefits for the individual who acts compassionate. But the positive effects for both go far beyond it in terms of well-being, physical and psychologically, as well as bringing about positive change in life in a much broader sense, ultimately benefitting society and the world as a whole.
Communication-Focused Therapy, as developed by the author, is provided as an example.
Keywords: compassion, communication, communication-focused therapy, psychotherapy, psychiatry
Table of Contents
Overcoming Compassion Fatigue. 11
Positive Evaluation of Self and Others. 13
Communication-Focused Therapy (CFT) 14
Introduction
Compassion requires connectedness with oneself and others, while it leads to even greater connectedness with oneself and others. Compassion can thus bring people together and bridge differences through the simplicity of communication, emotional and otherwise. Compassion involves “feeling for another” and requires the capability for empathy.
Compassion requires being receptive to meaningful information from others, emotional and otherwise. It is intentional and brings about change in oneself and others through meaningful communication. It can instil in others a sense of warmth and being cared for, while having significant benefits for the individual who acts compassionate. But the positive effects for both go far beyond it in terms of well-being, physical and psychologically, as well as bringing about positive change in life in a much broader sense, ultimately benefitting society and the world as a whole.
Connection
Connection with another person means being aware of the information exchanged between them and attributing meaning to the information and the information exchange. This flow of meaningful information can also be in the form of emotional signals, which flow back and forth between one another and change the emotional state of both participants to an interaction. Compassion has also a strong emotional component, which is also part of a meaningful information exchange.
From a communication perspective, compassion is to communicate in response to communication from the target of compassion. But it is communication that also has clearly the aim of bringing about a change in the recipient of compassion. It is thus a communication of meaningful information for the other person, which requires an understanding for the other on a deeper level. This is one reason why connectedness is important for compassion. Connectedness means there is a direct path between two points that links them together, or in interpersonal terms that there is a structure in place which allows for direct communication between people or groups of people. Compassion requires that this interpersonal communication facility already exists, while compassion is also a very intimate interaction. It requires a deeper resonance, particularly in terms of emotional information.
Compassion goes beyond identification with someone else. It is a communication pattern which has benefits. It is not merely feeling what another is feeling, although connection does start with openness, but it also includes communicating something to the other person to make behaviour compassionate.
Specific positive emotions do not universally increase prosocial behavior but, rather, encourage different types of prosocial behavior. (Cavanaugh, Bettman, & Luce, 2015) Cavanuagh et al show in four studies that whereas positive emotions (i.e., love, hope, pride, and compassion) all induce prosocial behavior toward close entities (relative to a neutral emotional state), only love induces prosocial behavior toward distant others and international organizations. Love’s effect is driven by a distinct form of broadening, characterized by extending feelings of social connection and the boundary of caring to be more inclusive of others regardless of relatedness. Love—as a trait and a momentary emotion—is unique among positive emotions in fostering connectedness that other positive emotions (hope and pride) do not and broadening behavior in a way that other connected emotions (compassion) do not. (Cavanaugh et al., 2015)
Compassion may have the ability to induce feelings of kindness and forgiveness, which could give people the ability to stop situations that have the potential to be distressing and occasionally lead to violence.
Connection with Oneself
Being connected with oneself is an important element of being compassionate, but connectedness with oneself is also what many people are afraid of. It often seems safer and easier to adopt an identity that appears socially sanctioned. There are several techniques and approaches to help become better connected with oneself. It is important to understand, however, that connectedness, as already mentioned above, is all about the capability to communicate rather than about a specific detail or technique. (Haverkampf, 2012, 2017b) Techniques that focus on the meaningful exchange of information within oneself and on awareness, reflection and experimentation are instrumental and successful in achieving a greater sense of internal connectedness. (Haverkampf, 2018b)
Self-Compassion
Self-compassion is a process of being kind, receptive and understanding towards oneself. It has positive effects on subjective happiness, optimism, wisdom, curiosity, agreeableness, and extroversion. Neff and Germer (Neff & Germer, 2013) mention three activities which thwart self-compassion:
- self-criticism
- self-isolation and
- self-absorption.
It is clear that all those three are also not helpful in attaining greater awareness for one’s own inner communication, the thoughts, emotional signals, perceptions, sensation and other information which is constantly produced and processed within an individual.
Connection with Others
Connecting with others is not only important to satisfy a need in the moment, but also to build communication structures and connectedness which can improve the communication of own needs, values and aspirations in the future, as well as make more receptive to the needs, values and aspirations of others. Shapiro has described how medical school curricula encourage the performance of emotional positions that create distance between doctor and patient, particularly in how the patient is defined as the other. Instead, interaction models in healthcare should prioritize connection and solidarity with patients, which could be realised by considering emotional intelligence and emotional regulation. (Shapiro, 2013)
Connection with the World
Compassion for all life, human and non-human, is central to the Jain tradition. The Jain tradition’s stance on nonviolence goes far beyond vegetarianism. Jains refuse food obtained with unnecessary cruelty. Many practice veganism. Jains run animal shelters all over India, for example. The Lal Mandir, a prominent Jain temple in Delhi, is known for the Jain Birds Hospital in a second building behind the main temple.
Social Connectedness
The need for social connection is a fundamental human motive, and it is increasingly clear that feeling socially connected confers mental and physical health benefits. Hutcherson and Seppala used in their study a brief loving-kindness meditation exercise to examine whether social connection could be created toward strangers in a controlled laboratory context. Compared with a closely matched control task, even just a few minutes of loving-kindness meditation increased feelings of social connection and positivity toward novel individuals on both explicit and implicit levels. (Hutcherson & Seppala, 2014)
In the Christion religion connectedness with others is one of the highest principles. “Thou shalt love thy neighbour as thyself.” Is one of the two great commandments, the other being the love for God. “On these two commandments hang all the law and the prophets.” (Bible, King James Version; Matt.22 Verses 34 to 40) In Hindu philosophy, daya (दया), is defined as the virtuous desire to mitigate the sorrow and difficulties of others by putting forth whatever effort necessary. Matsya Purana describes daya as the value that treats all living beings (including human beings) as one’s own self, while Ekadashi Tattvam explains daya is treating a stranger, a relative, a friend and a foe as one’s own self; it argues that compassion is that state when one sees all living beings as part of one’s own self, and when everyone’s suffering is seen as one’s own suffering. Karuna (करुणा) means placing one’s mind in other’s favor, thereby seeking to understand the other from their perspective. Anukampa (अनुकम्पा) refers to one’s state after one has observed and understood the pain and suffering in other. An understanding for others, for oneself, and life in itself is thus tightly linked in several main religious philosophies, to the extent that one sees a reflection of one’s own self in the other and a reflection of the other’s self in oneself. From a communication perspective, this is the realisation that meaningful information adheres to fundamental laws everywhere and in anybody. Thus, understanding oneself helps understanding others, understanding others helps understanding oneself, and both help understanding life, and life helps understanding oneself and others. Since understanding, leads to change, it is the basic process of meaningful information which maintains and furthers life.
However, the feeling of connectedness has not always been trusted. Compassion contains the word ‘passion’, which is not supposed to play a major role in judicial proceedings for example. In the view of ancient Greek and Roman philosophers, reason alone was the proper guide to conduct. They regarded compassion (a virtue) as an effect, neither admirable nor contemptible.
Exchange
The process of exchanging information in itself, even without focusing on the information content, is already a fundamental element of connectedness, and thus also compassion. Awareness systems, such as Twitter and other social networks, for example, are computer-mediated communication systems ”intended to help people construct and maintain awareness of each others’ activities, context or status, even when the participants are not co-located” (Markopoulos et al., 2009). However, when awareness systems have the core aim to maintain human relationships, the benefits do not come only from the sharing of awareness information per se, but more from the simple act of exchange. (Vetere, Smith, & Gibbs, 2009)
Social Networks
How can social network sites (SNS) foster relationships when most status updates on SNS are mainly entertaining and not very intimate? This finding cannot be explained by classical social psychological theories such as social penetration theory which regard disclosure intimacy as the main driver of relational outcomes. By building on literature on the role of capitalization and humor in relationship formation and maintenance, Utz (2015) suggests two alternative paths from public self-disclosure to relational outcomes. Respondents judged the content and relational effects of own and friends’ status updates as well as private conversations. In general, all types of messages were mainly positive and entertaining. The more intimate communication took place in private conversations; here, the classical link between disclosure intimacy and feeling connected still held. However, positive and entertaining self-disclosures also increased the feeling of connection, especially when reading friends’ updates. Interestingly, interaction partners’ responsiveness did not play a significant role, indicating that results from dyadic face-to-face interactions do not hold for public communication on social media. (Utz, 2015)
Mental Health
Kinser et al conducted an interpretive phenomenological study derived from interviews with and daily logs by 12 women with MDD who took part in an 8-week gentle yoga intervention as part of a larger parent randomized, controlled trial. Results show that the women’s experience of depression involved stress, ruminations, and isolation. In addition, their experiences of yoga were that it served as a self-care technique for the stress and ruminative aspects of depression and that it served as a relational technique, facilitating connectedness and shared experiences in a safe environment. (Kinser, Bourguignon, Taylor, & Steeves, 2013)
Compassion has emerged as an important construct in studies of mental health and psychological therapy. MacBeth and colleagues conducted a systematic search of the literature on compassion and mental health. They found a large negative correlation between compassion and psychopathology. Thus, compassion is an important explanatory variable in understanding mental health and resilience. (MacBeth & Gumley, 2012)
Society
Most societies worldwide values connectedness highly, but at the same time have developed structures that can alienate individuals. Emotional signals or feelings are in Western civilizations often viewed with some trepidation, while their role in the survival of the human species, and thus society, is usually acknowledged, if somewhat reluctantly. Already in Ancient Greece the information hierarchy seemed to put rational exchanges above exchanges about other types of meaningful messages, such as emotional signals or other insight. However, even if there is a greater awareness of certain emotions, this may not increase mutual exchanges among individuals. In Japan, Hayashi and colleagues suggested that the feeling most emphasized in Japanese preschools is sabishiisa (loneliness). Japanese preschool educators draw attention to feelings of sabishiisa, or loneliness, to promote a desire in young children for social connection. This social connection is built on a foundation of amae (expressions of dependency needs) and omoiyari (responding empathically to expressions of amae). Using examples from everyday life in a Japanese preschool, they argue that the Japanese preschool’s pedagogy of feeling emphasizes learning to respond empathetically to loneliness and other expressions of need. Their analysis suggests that sabishiisa, amae, and omoiyari (loneliness, dependence, and empathy) form a triad of emotional exchange, which, although not unique to Japan or to the Japanese preschool, have a particular cultural patterning and salience in Japan and in the Japanese approach to the socialization of emotions in early childhood. (Hayashi, Karasawa, & Tobin, 2009)
Connectedness and caring for life and creation is a cornerstone of many societies and cultures. In the Jewish tradition, God is the Compassionate and is invoked as the Father of Compassion. Sorrow and pity for one in distress, creating a desire to relieve it, is a feeling ascribed alike to man and God. Rabbi Hillel the Elder, when asked for a summary of the Jewish religion, he stated: “That which is hateful to you, do not do to your fellow. That is the whole Torah. The rest is the explanation; go and learn.” Rabbi Samson Raphael Hirsch and others have also emphasized the compassion for animals and living beings overall.
The Bible defines the meaning of compassion in several ways. We are to “speak up for those who cannot speak for themselves … defend the rights of the poor and needy” (Proverbs 31:8-9, NIV). Again, underlining that we are to help others, and ourselves, to communicate. The Hebrew verb is רָחַם râcham “to have mercy” and its corresponding noun רַחַם racham “mercy, compassion, womb, bowels”. The overlap in meaning between compassion and womb is of particular interest as it may also point to the nurturing qualities of compassion and mercy, which lead to growth and development, as thus the meaningful exchange of information.
Neuropsychology
Since compassion requires and is the consequence of various levels of connectedness, it is not surprising that correlations between indicators and learning processes of compassion and various changes can be visualized in the brain. These changes seem to have a positive effect on various psychological outcome parameters. (Haverkampf, 2018b)
In a 2009 small functional MRI study, Mary Helen Immordino-Yang and colleagues studied strong feelings of compassion for social and physical pain in others. Both feelings involved an expected change in activity in the anterior insula, anterior cingulate, hypothalamus, and midbrain, but they also found a previously undescribed pattern within the posteromedial cortices (the ensemble of precuneus, posterior cingulate cortex, and retrosplenial region), an area currently known for its involvement in the default mode of brain operation and in self-related/consciousness processes: emotions pertaining to social/psychological and physical situations engaged different networks aligned, respectively, with interoceptive and exteroceptive neural systems. Compassion for social pain in others was associated with strong activation in the interoceptive, inferior/posterior portion of this region, while compassion for physical pain in others involved heightened activity in the exteroceptive, superior/anterior portion. Compassion for social pain activated this superior/anterior section, to a lesser extent. Activity in the anterior insula related to compassion for social pain peaked later and endured longer than that associated with compassion for physical pain. Compassionate emotions in relation to others has effects on the prefrontal cortex, inferior frontal cortex, and the midbrain. Feelings and acts of compassion have been found to simulate areas known to regulate homeostasis, such as insular cortex and hypothalamus. (Immordino-Yang, McColl, Damasio, & Damasio, 2009)
In a study by Klimecki et at, the investigators explored neural plasticity underlying the augmentation of empathy and the counteracting potential of compassion. One group of participants was first trained in empathic resonance and subsequently in compassion. In response to videos depicting human suffering, empathy training, but not memory training (control group), increased negative affect and brain activations in anterior insula and anterior midcingulate cortex—brain regions previously associated with empathy for pain. In contrast, subsequent compassion training could reverse the increase in negative effect and, in contrast, augment self-reports of positive affect. In addition, compassion training increased activations in a non-overlapping brain network spanning ventral striatum, pregenual anterior cingulate cortex and medial orbitofrontal cortex. (Klimecki, Leiberg, Ricard, & Singer, 2014)
Compassion Fatigue
Compassion is not what causes burnout, but a lack of connection with oneself and others causes it. Unfortunately, in burnout many people withdraw from themselves and others more rather than trying to connect more. Individuals with a higher capacity or responsibility to empathize with others may be at risk for “compassion fatigue” or stress, which seems more common in professionals and individuals who spend a significant amount of time responding to information related to suffering. Compassion fatigue can, for example, be a form of caregiver burnout among psychotherapists and contrasts it with simple burnout and countertransference.
The interaction, the exchange of information, is not the root cause of compassion fatigues. Rather, it is the question of how communication patterns, and which ones, are used. Also, the quantity of the interactions seems to play a role. However, better communication patterns would probably allow for a higher quantity of interactions without leading to compassion fatigues. (Haverkampf, 2013, 2018c, 2018b) Yoder and colleagues investigated compassion fatigue, trigger situations, and coping strategies in hospital and home care nurses. Compassion fatigue scores were significantly different between nurses who worked 8- or 12-hour shifts. Fifteen percent of the participants had scores indicating risk of the compassion fatigue. There were significant differences in compassion satisfaction, depending on the unit worked and time as a nurse. The most common category of trigger situations was caring for the patient. (Yoder, 2010)
Overcoming Compassion Fatigue
Newer research suggests that it is lack of suitable distress tolerance which gets people fatigued in compassion activities. Empirical data indicates that social preferences are plastic and that altruistic responses to unfairness may be shaped by the prolonged cultivation of prosocial motivation, altruism, and compassion. (McCall, Steinbeis, Ricard, & Singer, 2014) Mc Call and colleagues studied the possible impact of long-term mental training in socio-affective capacities such as compassion on altruistic punishment and compensatory behaviour in economic games. To this end they recruited a group of long-term meditation practitioners (LTPs) who had engaged in mental training exercises including compassion-related meditation, along with a group of meditation-naïve controls. Participants played several adaptations of the dictator game in which they had the opportunity to punish the dictator both when they were the recipients of the dictator’s offer and when they were third-party witnesses to the dictator’s treatment of an anonymous second player. Compared to controls, LTPs were less likely to punish when they were the victims of fairness violations. However, both groups punished equivalently when they witnessed others receiving unfair treatment. In post-task questionnaires, controls reported significantly more anger in response to unfair offers than LTPs, although fairness judgments did not differ between groups. These data suggest that because the LTPs were less angered by unfair treatment of themselves, they punished that behaviour less. However, when they witnessed the unfair treatment of others, they engaged in norm-reinforcing punishment. (McCall et al., 2014)
Sprang and colleagues examined the relationship between three variables, compassion fatigue (CF), compassion satisfaction (CS), and burnout, and provider and setting characteristics in a sample of 1,121 mental health providers in a rural southern state. Female gender was associated with higher levels of CF, and therapists with specialized training in trauma work reported higher levels of CS than nonspecialists. Provider discipline proved to be an important factor, with psychiatrists reporting higher levels of CF than their non-medicalcounterparts. When providers were compared using rural, urban, and rural with urban influence classifications, the most rural providers reported increased levels of burnout but could not be distinguished from their colleagues on the CF and CS subscales. (Sprang, Clark, & Whitt-Woosley, 2007)
Figley suggests that in psychotherapists compassion stress, dealing with traumatic memories, and more effectively managing case loads are effective ways of avoiding compassion fatigue. Psychotherapists with chronic illness need to development methods for both enhancing satisfaction and learning to separate from the work emotionally and physically in order to feel renewed. (Figley, 2002)
Adopting Compassion
Compassion is thus an important communication dynamic with oneself and others which can be helpful for oneself and others. In Buddhism, suffering or dukkha (unsatisfactoriness or stress) arises as a consequence of the failure to adapt to change (anicca) and the insubstantiality, lack of fixed identity and lack of certainty of anatta resulting from the change. Observation and accurate perception facilitates compassion, but it also highlights the importance of mutual communication with others and better communication within oneself, and in general a better connectedness, to bring about helpful life sustaining and improving change in the world and within oneself.
Self-Compassion
Self-compassion—treating oneself with kindness, care, and concern in the face of negative life events— as a form of important self-regulation also improves the connectedness with life overall, the world, and within oneself. It lowers defensiveness, reducing the emotional states and self-blame that interfere with self-regulation, and makes one more open to helpful meaningful messages form others.
Individuals high in self-compassion manage and resolve stress better, which also makes them more resilient to illness and injury. Framing medical problems and their treatment in ways that foster self-compassion may enhance people’s ability to manage their health-related behaviour and deal with medical problems. (Terry & Leary, 2011) They care better for themselves.
Positive Evaluation of Self and Others
People experiencing shame and self-criticism may struggle to feel positive about themselves and others, see the world as more unpredictable and hostile, trust themselves and others and less, and often feel helpless and desperate. Research suggests that a specialised affect regulation system (or systems) underpins feelings of reassurance, safeness and well-being. It is believed to have evolved with attachment systems and, in particular, the ability to register and respond with calming and a sense of well-being to being cared for. One technique to counter this is compassionate mind training to help people develop and work with experiences of inner warmth, safeness and soothing, via compassion and self-compassion. (Gilbert, 2009)
Communication-Focused Therapy (CFT)
Communication-Focused Therapy was developed by the authors to create greater awareness, insight, reflection and experimentation towards communication patterns that underpin the exchange of meaningful messages with others. (Haverkampf, 2017a, 2018d) It is thus in a good position to also further the innate capability for compassion by supplying practical tools and a theoretical framework to increase the effectiveness in creating and sharing meaning to bring about changes in oneself and others. (Haverkampf, 2017b) It is based on universal communication concepts (Haverkampf, 2018a) that can be applied to many different situations, particularly also mental health conditions which interfere with the quality of life of the individual and wider interconnected populations and communities. (Haverkampf, 2018d)
Dr Jonathan Haverkampf, M.D. MLA (Harvard) LL.M. trained in medicine, psychiatry and psychotherapy and works in private practice for psychotherapy, counselling and psychiatric medication in Dublin, Ireland. The author can be reached by email at jo****************@gm***.com or on the websites www.jonathanhaverkampf.com and www.jonathanhaverkampf.ie.
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