See, Hear, Feel

EP76: Part 2 with Dr. Stephanie Preston: Empathy and burnout

August 23, 2023 Professor Christine J Ko, MD / Dr. Stephanie Preston Season 1 Episode 76
See, Hear, Feel
EP76: Part 2 with Dr. Stephanie Preston: Empathy and burnout
Show Notes Transcript

This is a continuation of my conversation with Dr. Stephanie Preston, and she covers what she means by an altruistic urge (we are hardwired to help when someone is clearly vulnerable, there isn't high risk, we have the skill, and we know we can make a difference). The bystander effect and burnout can be combatted by understanding this altruistic urge and recognizing that it is not empathy that leads to burnout but rather a lack of controllability. Dr. Stephanie Preston is a researcher of emotions and decision making, and she talks about how not displaying emotion is also a type of emotional contagion and is likely a consequence of the fact that we don't want to transmit out-of-control or negative emotions in a professional setting. It's a fascinating peek into altruism, empathy, and feelings. Dr. Stephanie D. Preston, PhD is Professor of Psychology and University of Michigan 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.

[00:00:00] Christine Ko: Welcome back to SEE HEAR FEEL. Today, this will be part two with Dr. Preston. If you didn't have a chance to listen earlier: Dr. Stephanie D. Preston is Professor of Psychology at the University of Michigan. She's also Faculty Ombuds. She received her PhD from the University of California, Berkeley, and she has done extensive research in emotions and decision-making as well as altruism and how people allocate resources. She is the author of a book titled, The Altruistic Urge. I'll put a link to that in the show notes for this part two as well. And I'm so glad to continue this conversation with her. 

[00:00:35] Your initial anecdote talked about altruism and how when there was this accident in front of your house, your altruistic urge wasn't exactly what you had expected. Can you talk about that you and I, all humans are hardwired to help. Can you talk about that concept? 

[00:00:52] Stephanie Preston: In my book, The Altruistic Urge, I talk about how a lot of our motivation and instinct to help other people emerges from being a caregiving species. We give birth to babies who are really helpless for a long period of time, and their cries of distress, are like essential to survival. And the fact that we find that distress aversive and motivating and sympathy inducing make sure that we pay attention to these infant's needs and protect them. And there's even in caregiving species kind of a, what I call homologous behavior, where if you know a helpless, vulnerable individual, like a newborn is in distress and by itself, we immediately go and retrieve them from danger, isolation. And that retrieval results in this close contact, in a typical situation, that is also comforting and rewarding for us. And that makes the behavior all the more likely again, because you're like, oh, there's this terrible thing happening, but I acted right away. And then I felt a lot better, and the individual felt better and everyone felt calmer, and so they don't have to be thinking about their survival rate in the moment. They're just thinking about like the feelings and their bodily responses. And as long as you know what to do and you don't consider it dangerous, most individuals will approach in a situation that's like a helpless infant.

[00:02:29] So sometimes adults need help and they're rendered similar to an infant, even though they're normally perfectly capable, right? In the book, I tell a story from a real life event where a young male adult had a seizure and fell into the subway tracks, consequent to the seizure. And he was rescued in this really spectacular way by a stranger, an onlooker.

[00:02:56] But in that moment, everyone recognizes: he's not a capable adult, and he's not gonna be able to get himself out of the situation because they had observed the seizure first. So they knew, he was having some kind of neurological event that wasn't willful. Or if somebody's passed out, that they need you to remove them from the train tracks or whatever the case may be, even though they're not like emitting these distress cries and they're not a baby, right? And so when the situation evolves I make this kind of list where there's a vulnerable individual who usually is emitting distress but doesn't have to be, as long as it's clear they're vulnerable, and they need immediate help and you know how to provide the help, and you think you predict it will work in time, then you get this altruistic urge.

[00:03:46] So it's not an instinct the way people think of instincts. There's a whole chapter in the book about this 'cause the word altruistic urge or instinct makes people think Pollyanna. Oh, that's just ridiculous. Like people aren't altruistic. I'm not altruistic. I don't care about crying babies at all. I just find 'em annoying. Altruistic urge or instinct explains that this is all part of this very nuanced biological system that you're endowed with that includes epigenetic factors, and learning, and culture, and context, and expertise, and individual differences, and for example, you know where you're gonna set your threshold for a problem versus not a problem, or like risk that you see as acceptable versus unacceptable for yourself.

[00:04:30] So somebody who's really scared and doesn't like risk is gonna take a lot more to be forced into action than somebody risk taking, right? And so that's why you often end up with these kind of heroes who are young, active males, who feel very confident and confident in their response, whereas other people are just flummoxed and standing by.

[00:04:55] So my example in the beginning actually, it mimics in real experiments, they have what they call bystander apathy, which is where when there's a bunch of people who are witness to an event, the more people present, the less people respond. And people are scared to do the wrong thing.

[00:05:14] And if there's a bunch of witnesses, they're like, now I'll be compounded my embarrassment by having done the wrong thing in front of all these people. And surely there's someone here more qualified than I am. But if you are a trained medical professional and then they do like a simulation where the experimenter pretends to pass out or have a heart event or something, a trained medical professional will respond.

[00:05:36] So it's like your expertise gives you that confidence that you know what to do, so you don't end up actually showing that bystander apathy. And since I have no medical training, and I have never approached even probably hardly even ever approached an unconscious person, let alone a deceased one, that was like beyond the ken for my brain.

[00:05:57] But if an ER trained person, then it might not be as frightening for you as it was for me in the moment. Yeah. 

[00:06:05] Christine Ko: I've read some of your work and some articles where you've been quoted and some of the podcasts you've been on, and one of the things I read that you've said is that you don't think that empathy can burn out. Can you talk about that? 

[00:06:19] Stephanie Preston: Yeah. I think it's like burnout is one of the reasons people give to justify eliminating empathy from medical care, right? They'll say you can't empathize because that will lead to burnout. And I think they're confusing empathy with personal distress or like emotional contagion.

[00:06:41] So empathy is like a multifaceted phenomenon, not all of which involve this like aversive state, right? And so you can try, even actively try to understand where the person's coming from, and what they must be going through, and what kind of instructions they will or won't understand and actually follow on day-to-day life.

[00:07:08] And you can assist in their medical care because you're tailoring your response to their individual circumstance. Not all patients are the same, right? Some people are like, just tell it to me straight doctor. And some people are like, I can't deal with this information. I need to have somebody with me in the room when I get this diagnosis. Or, it took a really long time for the cancer doctors that we have worked with in our decision consortium to come up with this kind of set of principles for how you're going to deliver a diagnosis that's serious in a way that understands people's brains turn off sometimes when as soon as they hear the word, everything else that comes after is just gibberish.

[00:07:54] Because they can't parse the information. And if they're not medical to begin with the terms a doctor might normally wanna use aren't ones they even understand, the options aren't things they understand, the risks and benefits aren't things they understand. So something that's like very straightforward to a doctor because you have that expertise is incomprehensible to somebody without that expertise, especially if they've just been dealt this serious blow to their cognition.

[00:08:25] And we have to empathize in order to develop procedures that save lives. Because only if by doing that and understanding their perspective, can you tailor the way you design the treatment to be the most effective in the long run. If you just terrify somebody in the initial meeting, they won't come back and they'll rather just say they're gonna deal with it at home somehow and they don't wanna talk about it. Yeah. But if it's dealt with in a humane way that takes into account the person's background and their own emotions and feelings, then you're much more likely to save them. So it's to your benefit.

[00:09:02] We, we have a study actually on cancer screening with a nursing student who was in my decision making class. Kelly Ackerson. And there was an interesting thing where it was emotions either way that caused people to seek something like cervical cancer screening or avoid screening. But the emotions just had like different meanings for people.

[00:09:24] So like people who avoid getting screened have fear, but they have fear of getting the diagnosis. So they don't want that moment where somebody tells 'em that it's a positive test. So they just don't go take the test. It's like your brain is playing tricks with you and saying, if you don't ever take the test, no one can ever tell you, and you'll be fine.

[00:09:46] But then there's other people who have fear, and they have fear of the cancer itself. Not of the moment of the diagnosis, and they're like actively seeking the screening in order to avoid that, the miss, you don't wanna miss it if it's there. They have similar arguments. I'm sure you follow with the mammogram age debacle where they keep changing the age, right? Because they felt like it was a lot of money and alarming too many people who had a false positive. But then there's other people who are like, how could you let some people go in that equation? And so somebody is getting a little upset either way, and then they can't figure out what to do.

[00:10:29] So emotion and empathy in this decision process is really important. And you can't assume one person is like the other. Yeah. That's why it's beneficial if your doctor knows you because they know what you're like and how you like to hear things. Just recently, I had a sleep study test.

[00:10:47] And they said, how do you like to learn? And I was like, what? And I guess that's like a new way. They're trying to establish whether they're gonna give you like the pamphlet or explain it to you in person or make you watch an educational video. They have this new procedure where they ask everybody what kind of learner they are.

[00:11:07] Huh. Which is interesting 'cause in psychology, they're obsessed with the debate of there not being learning styles. So there's like study after study that says there's not these learning style differences, but nobody wants to give up the ghost. And so it's like being incorporated into medicine now. 

[00:11:25] Christine Ko: You mentioned you're part of a decision making group? 

[00:11:28] Stephanie Preston: Yeah. I had a colleague, Frank Yates, who was a prominent decision researcher, and he had started this thing called the Decision Consortium at the University of Michigan. He had since passed away, but it ran for 30 years probably.

[00:11:44] And it was an interdisciplinary group of people interested in decision making. And it included psychology, the business school, marketing, the hospital, nurses, doctors. People from all over campus. The policy people would come each week for talks and we would learn about different kinds of decision making and decision aids and decision errors.

[00:12:07] And it was just fascinating. You learn so much because you learn from people who are studying really different topics and have different foci of concern. 

[00:12:18] Christine Ko: That's cool. Yeah. I don't know. I don't think we have anything like that. 

[00:12:22] Stephanie Preston: Oh, yeah. It's hard these days, everyone is so busy, to get people to come for An hour on campus every week anymore. Like it's really difficult to grab people's attention, especially if you work at the medical center and you have to cross campus to an academic building. It's hard to sustain something like that. But Dr. Yates did an awesome job keeping it going for many years. 

[00:12:45] Christine Ko: Yeah. 30 years. It's amazing. Do you have any final thoughts? 

[00:12:50] Stephanie Preston: Yeah, I think probably it's just good to underscore that there are different kinds of emotions. There's different kinds of empathy, not all of which we're subjectively aware of because of the way your brain processes emotion without necessarily producing a bodily state. And that this kind of empathy can lead to altruism, but it can do it in many different ways that don't always need the subjective response. So I think for me, burnout is a lot more about controllability. So when distressing things happen at work, you feel a sense of accomplishment if you can do something about it. But if time, and again, you're facing an emotional person, an emotional situation, a difficult situation, and you feel like you can't contribute to the solution, I think that's when people start to feel hopeless.

[00:13:46] So I think, rather than telling people they shouldn't have empathy, like you're saying, it would be good to train people as to the benefits of having empathy, and how it can be successfully integrated into medical care, and how to address burnout by adding some efficacy to whatever the people can do. So finding ways that they can be of assistance is gonna solve the problem a lot better than just telling them not to have emotions because this has been part of your biological makeup for hundreds of millions of years. We share this affective brain with rodents, with monkeys with all kinds of species.

[00:14:30] And so you can't turn off emotions, but you can control how the practice is set up to increase the chance that you can do something about it. 

[00:14:40] Christine Ko: Thank you very much for your time. 

[00:14:42] Stephanie Preston: Sure. It's my pleasure to be here. It's really interesting work that you do. Thank you for that.