[00:00:00] Christine Ko: Welcome back to SEE HEAR FEEL. Today I have the pleasure of being with Dr. Stephanie Preston. Dr. Stephanie Preston is a PhD Professor of Psychology at the University of Michigan, and she's also Faculty Ombuds. She received her PhD from the University of California, Berkeley. Her research is on the interface between emotion and decision making, focusing on how people process others' emotions and how this affects offerings of help and on how people allocate resources. She has written a book titled, The Altruistic Urge: Why We're Driven to Help Others, and I'll put a link to that in the show notes.
[00:00:35] Welcome to Stephanie.
[00:00:37] Stephanie Preston: Thank you. It's great to be here.
[00:00:38] Christine Ko: Would you share a personal anecdote?
[00:00:41] Stephanie Preston: This is in the book and also I saw on my Facebook memories that is the anniversary of when this happened many years ago. I was sleeping in my bed, and at 2:30 in the morning, I heard a horrible kind of screech bang sound from outside. And even in your sleep, and you're like suddenly awoken, something bad has happened. I went outside and a car had swerved off the road and run over some small trees, and then hit a large tree and a sign, and it ended up backwards facing the wrong way. I go to check and see if everyone's okay. The driver was unresponsive. I do not have medical training, by the way. There was another guy who seemed out of it, but he was fine. And then there was a guy from the backseat, and I think he was in some kind of shock because he was just talking rapidly with a cheerful tone and didn't seem to notice that his friend was unconscious or something else in the front seat. And I'm like, naturally, a person who's helpful to strangers, and I was trying to think of what I could do to help them. The motorcyclist who they had swerved to avoid was actually there and had already called the police. So I was like, okay, I can't do that to be helpful. Maybe I should go get the motorcyclist a glass of water. I knew that there was something wrong with the driver, and I was too scared to approach him. The thought that he could have died was so unconsciously overwhelming to me, I just couldn't even face it. So I just avoided it and thought to myself, let's wait for the professionals. They'll know what to do. But, really, there's no reason I couldn't have checked on him. And then another guy walked up who had obviously just come from an undergraduate party of some sort, in a great mood, and he had no qualms whatsoever about approaching. He just like dove right into the front seat, and he is alive! It's interesting because you can think one thing about yourself, oh, I'm a very helpful person. Oh, I'm so altruistic. But then you never know how you're gonna react in a true emergency because we don't have very many opportunities to experience them and know how we're gonna react. I was really surprised by myself at how scared I was, even though it wasn't conscious. I only realized after the fact that I had elaborately ignored looking over there at the guy. Today is the day it happened, maybe eight years ago.
[00:03:12] It's a really interesting case for my altruism book because people help when they have the skills and they know what to do, but when they feel overwhelmed or scared, they don't. So we have this approach avoidance in our brain that's usually actually pretty adaptive, but we all have our thresholds set differently for the approach and the avoidance, and that was one case where that was clearly shunted off in the avoidance direction.
[00:03:37] Christine Ko: I love that story. Thank you. It is unpredictable how we'll really react in a given situation. You mentioned that the emotion overwhelmed you, but it was not really conscious. You weren't really consciously aware of it really until later. And I think that happens to all of us, even, say doctors. It's adaptive though, so like the more you do something, so if you're a trauma surgeon, you encounter the same trauma or similar traumas over and over again. And so you can adapt to it.
[00:04:05] Stephanie Preston: Research studies show that doctors have a habituated response to certain kinds of pain. So if you go in that fMRI scanner, normally when you see somebody being pricked with a pin or a needle, people have this kind of contagious pain response that you can observe in their brain in the same area where they feel pain. The anterior insula or the anterior cingulate. They have anesthesiologists go in the scanner and they don't have that same response to the needle because that's something that they do every day and it's not adaptive to be worried or scared about it, so you do habituate over time which is a good thing. You can get used to it when you need to because it's important.
[00:04:52] Christine Ko: One of the things you study is emotions and decision making. Your initial anecdote, where you didn't act as altruistically as maybe you would've expected yourself to because emotions overwhelmed you.... In the healthcare setting, I was trained to not have emotion, to be detached. Some of your research deals with emotional contagion, and you give examples like sports hysteria where fans of one team, the team scores, and the entire stadium just erupts in the same kind of very joyful emotion. I wanted to ask if the converse, sort of a lack of emoting, so if a physician is detached, for example, is that also contagious?
[00:05:34] Stephanie Preston: For sure. The affect and appraisals of the people around you are gonna influence how you respond. People are thinking, If I don't show any emotion, I can't make the people around me upset, right? Like you have to set a good example and set a good emotional tone for the team. And so, if you stay calm, they'll stay calm. That type of thing. So I think it's like an intuition based on the idea that we do know emotion is contagious, that we try to tamp it down, in professional settings. They're thinking, oh that way we'll be objective and avoid bias, but it's actually a false understanding of emotion and decision making when people do that because all decisions are affectively laden. So you know, what you consider a good outcome and a bad outcome has an affective association in your brain. It's just you don't feel a subjective state in the moment or get carried away by vicarious emotion. At the level of the neurons, it's evaluating what's considered a positive and a negative outcome. Emotional inputs that are fed into the decision. So there's not actually any such thing as a decision without emotion or a kind of empathy that's just objective.
[00:06:55] Yeah, I think you see it a lot in the medical profession, this idea of "good versus bad" to empathize. But I think there's a lot of different ways you empathize, and they don't all involve this being carried away by the emotion in a way that's upsetting and disturbing.
[00:07:13] Christine Ko: I think that's the fallacy maybe, right? That the only way to feel empathy is if you're being carried away. But you're saying that there are other ways. I like how you said that earlier, that really every decision is affectively laden. I haven't heard anyone say that, but I think that's definitely true for me.
[00:07:32] And yet, interestingly, with all the important healthcare decision making that I might do, as regards patient care, I've never been taught how to channel any emotions that I'm feeling, optimally, to make better decisions.
[00:07:52] Stephanie Preston: But like you're saying, you're learning it from the people around you passively, right? You're learning how to maintain this, like, detached decorum from the people who trained you and the initial environments that you went into. I'm just guessing, it's hard to start your first job, and so when you show up at a clinic for the first time or you make rounds for the first time or something, it's probably like a little bit scary, and you're really carefully observing what the people around you are doing and modeling your behavior after them, and they're even explicitly told to tell you when you go off course.
[00:08:29] Christine Ko: Absolutely. All of medicine, healthcare, definitely an apprenticeship. We learn from our mentors, our teachers, our peers. I learn from the residents and students. So yes, and that's exactly what I mean that I think the culture of healthcare is to be emotionally detached and to think that we can be objective and without emotion. A problem with that is that's the culture I grew up in, in medicine. And so I thought that's the right thing to do to suppress my emotion, to tamp it down. And yet I think when you were referring to, we can still feel empathy without being carried away by it, that would be the more beneficial way to proceed, and yet I'm not sure that I know from the sort of prevailing medical culture how to do that.
[00:09:22] Stephanie Preston: I guess therapists are a good version of that. A good therapist is sympathetic to your situation or empathizing with you, or they're saying things like, oh wow, that must really be hard, and they appreciate when you're upset and they're not treating you like an object with a mass on it to be made a decision about; they're treating you as a human, but they don't ever get upset themselves. If you start crying, they usually don't start crying. They're trained, and they have a lot of experience and practice trying to empathize with what you're going through without getting upset themselves.
[00:10:02] I had a fellowship in neurology, and Dr. Damasio has a well-known book, Descartes Error, and it's about the way emotions are infused into decision making. He makes this distinction between emotions and feelings, and people use these words all differently. You can't rely on a nomenclature anymore, but the word emotions refers to what's happening in the cortex. If you have your amygdala activated, and that fires, and the amygdala actually can enhance activity in your visual cortex, which you would be using for things like determining if some cells look abnormal or not. It can enhance your attention to something in a really immediate, short time span. But you don't necessarily have a feeling when that's happening. It is just happening inside your cortex. And then there are a lot of different ways emotion can be prevented from being experienced by your body. Like you can have inhibition in the cortex. You can have inhibition in your spine, you can have the emotion, and then just like really quickly force yourself to stop doing that based on like context cues or concern for how you look. So I think there's really a wide variety of ways in which feelings that we're aware of and have subjective access to reflect emotions, which are always in some level, part of the process of a decision.
[00:11:32] It's almost like a decision bias in the first place, 'cause they say negative events weigh heavier. The fact that contagious emotion is so distressing for people is why our concept of emotion is yoked to that experience and targeted as bad and to be avoided. So you're like, women are emotional and that's horrible, but really they're not referring to this broad spectrum of emotions and feelings, many of which are very helpful even to the people who issue them. Really what they have in mind is sometimes somebody gets upset, and it's so upsetting to me, I need it to stop immediately.
[00:12:11] Christine Ko: What you just said made me realize that this bias that we have towards remembering more negative things, negative events, when we've been wrong, when we've been chastised versus say the hundred times that we did something really well, we remember the one time that we didn't do it well. That makes a lot of sense. That also emotions with a sort of more negative valence, or considered what's negative, we would try to be more protective against because, we'll feel it more, we'll remember it more. It'll have more of an impact than the more positive. That's so interesting.
[00:12:40] Stephanie Preston: And in training, I bet that's a really big deal. People are traumatized by the time they got yelled at by their supervisor, when they were a resident perhaps, but have almost no memory of the number of times they're like, yeah, good job. You got that right.
[00:12:55] Christine Ko: Absolutely, that's totally true. I'm going to end this conversation now in a part one. And I'll continue this conversation next week in a part two with Dr. Preston.
