In this chapter, we focus on the neuronal networks underlying the socio-affective capacities empathy and compassion. We first provide definitions of empathy and compassion and give an overview of the historical development in social neuroscience related to empathy and compassion research, with a focus on differentiating between empathy, empathic distress, compassion, and related concepts of social understanding like Theory of Mind. We then examine the neuronal networks underlying these distinct social capacities and discuss the latest discoveries in this field. Next, we turn to the plasticity of the social brain and compare training approaches in their efficacy in improving socio-affective and socio-cognitive capacities. This is followed by the exploration of how psychopathological symptoms are differentially related to empathy, compassion, and socio-cognitive skills. Lastly, we conclude the main findings of this chapter and provide questions for future neuroscientific and psychological research on empathy and compassion.

Lack of compassion among health service staff has been identified as a concern around the world. High-profile scandals and inquiries in the United Kingdom have suggested that health systems and services ‘are struggling to provide safe, timely, and compassionate care’. In the United States, only half of patients and staff surveyed believed the health system provides compassionate care. Similarly, a recent study in Australia identified a gap between the intentions of organisational leadership to provide consistently high-quality care and the ability of staff to do so at point of care. Healthcare managers are looking for proven ways to support staff to recognise and provide compassionate care.

Chapter 8 considers the politics and poetics of alterity or otherness. Others confront us with experiences that may be radically unfamiliar, strange, and unsettling. This may be compounded by illness, trauma, and cultural difference. With empathy and imagination, we can gain an understanding of another’s experience, see their perspective, and build a picture of their predicament. The imaginative spaces and places in their stories offer us a way into another’s lifeworld—even when that world is profoundly different from our own. Narrative medicine provides a pedagogy of empathic understanding through literature. While much of this work employs story, lyric poetry offers another mode of articulating illness experience that may be closer to patients’ emotionally charged, confused efforts to make sense of experiences that do not fit cultural models or templates. The work of the poets Paul Celan and Edouard Glissant sheds light on the power of language to bridge disparate worlds and on the ethical stance needed when empathy fails. A poetics of alterity has implications for efforts to understand individuals’ illness experience and grounding an ethics of care.

This chapter focuses on resilience and compassion, starting by examining the relevance of resilience in healthcare, especially during the Covid-19 pandemic. The chapter notes that while a certain amount of resilience is helpful and even essential, resilience depends on not only the personal characteristics of each healthcare worker, but also the conditions in which they work. Relevant factors include the structure and function of teams, models of organisation, quality of leadership, and resources. These matters have an enormous influence on individual experiences, attitudes, and behaviour, and on the levels of resilience that are required and accessible in the workplace, as well as compassion. This chapter considers the concepts of ‘compassion fatigue’ and ‘burnout’, and outlines barriers to, and facilitators of, compassionate care. Systemic challenges include competing system demands, time constraints, inadequate resources, communication issues, poor emotional connections with the broader healthcare system, and the perception and/or reality of staff not being valued for the care they provide. These are themes that resonate with many people who work in large healthcare systems where organisational challenges loom large, often distracting focus from day-to-day patient care. This chapter also examines the roles of mindfulness and meditation in navigating these challenges.

Certain skills support compassion and help us to develop and sustain compassion even in circumstances that are far from ideal. Against this background, recent decades have seen a remarkable growth of research in this field. There is, in particular, a welcome flourishing in the area of compassion studies and compassion-based therapies, which form the focus of this chapter. Paul Gilbert, in particular, has developed compassion-focused therapy (CFT) which is outlined further by the Compassionate Mind Foundation and available in many countries around the world, as well as online. The Compassionate Mind Foundation advances an evolutionary and bio-psycho-social informed approach to compassion, and this forms the basis of CFT and ‘Compassionate Mind Training’. This chapter starts by exploring the origins of CFT and key attributes for the cultivation of compassion, before considering compassion and shame in clinical contexts. Shame can be an especially powerful emotion with a profound effect on health-related behaviour. Compassion can be a valuable way to address this issue. This chapter examines CFT in practice and notes the growing evidence base to support its use. The chapter concludes with further reflections on compassion and self-compassion as key skills and vital resources in healthcare.

A growing literature examines the relationship between compassion and various aspects of nervous system function, especially the brain. The chapter starts by outlining neuroimaging studies of compassion and then examines the topic of empathy and the brain, noting evidence that observing another person’s emotional state activates parts of the neuronal network that are also involved in processing that same state in oneself. Research suggests that multiple areas within the brain are involved in compassion and compassion training, with some regions more strongly implicated than others. Finally, relevant conclusions are presented and potential directions for future work outlined. Overall, research into the neuroscience of compassion supports the idea that compassion can be cultivated deliberately through training. There is evidence that activities such as compassion training and meditation can increase positive affect, boost resilience, facilitate altruistic behaviour, and possibly even assist with equanimity. These ideas are underpinned by growing neuroscientific evidence of impact on the brain. These valuable findings underscore the importance of developing compassion as a skill and fundamental attribute for healthcare workers across all settings.

The literature about values in healthcare contains many terms which are sometimes used interchangeably. These terms include ‘compassion’, ‘sympathy’, ‘empathy’, ‘kindness’, ‘communication skills’, and various other words which are intended to denote a caring, understanding attitude towards healthcare provision. Confusion between these terms adds significantly to the apparent heterogeneity of research in this area and raises the worrying possibility that some writing on this topic uses these terms interchangeably. This chapter starts by exploring specific terms which are often used as synonyms for ‘compassion’, such as ‘sympathy’, ‘empathy’, ‘kindness’, and ‘communication skills’, and then focuses on two of the so-called ‘near enemies’ of compassion: pity and ‘horrified anxiety’. We may be trying to cultivate compassion, but, at times, emotions can arise that may be mistaken for compassion and can have negative effects. Clarity about concepts and terms can help to understand their significance, their importance in healthcare provision, and ways in which they support, as well as differ from, compassion. Overall, this chapter echoes the main arguments of this book by emphasising that compassionate healthcare requires an all-of-system approach, rather than isolated changes, paper exercises, or tinkering around the edges. Reflecting on terminology can help greatly in this process.

At its heart, compassion is the feeling of being motivated to act in the presence of suffering. From a psychological perspective, the construct is conceived as having two dimensions: state and trait. The compassionate state reflects the feeling of compassion or having a compassionate response in the moment, while a compassionate trait is more stable, reflecting a general tendency towards compassion or towards feeling and responding compassionately most of the time. For people who are expected or required to be compassionate in their everyday life or work, compassion requires sustained courage and a continued willingness to engage with suffering, rather than avoid it. This chapter explores compassion from psychological, evolutionary, and physiological viewpoints. Despite a useful and growing literature in this area, a precise definition of compassion in practice can remain elusive. The meaning of compassion is not written in stone; it flows. As a result, what the concept means in healthcare, and how it works in practice, are, perhaps, made most tangible through providing compassionate care to patients, interacting with families, discussing compassion with colleagues, and teaching students about compassionate healthcare. If compassion is defined flexibly and understood wisely, it can shape care in positive ways, improve outcomes, and change lives.

I scrutinize the common idea that Narcissistic Personality Disorder (NPD) involves empathy deficits. I argue that empathy is foremost an epistemic mechanism, leading to different forms and levels of interpersonal understanding. Interactive difficulties can result in profound interpersonal misunderstanding, which leaves some people in persistent doubt about other people’s perspectives and about their own social standing. Such status blindness, as I will call it, can explain some specific symptoms of NPD. I introduce relevant conceptual distinctions, devise a complex map of empathy that describes four types and four features, and apply the map to NPD. Finally, I specifically discuss empathy deficits in being the target of the empathy of others.

Describe how children develop fairness, spite, and helping behaviours; understand the role of emotions, punishment, and reputation in moral development; explore cross-cultural differences and similarities in morality.

Describe how children think and behave differently in groups; explain the roles of collaboration, self-identity, and categorisation in creating and sustaining groups; understand how group differences can be reduced via intergroup contact, cooperation, and empathy.