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Empathy and Empathic Disconnection in Difficult and Uneasy Situations: Facing the Suicidal Individual

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Abstract

Empathy, in the patient-clinician relationship, plays a key role. Here we address this issue from a neuroscientific perspective, as neuroscience research attempts are shedding much light on the mechanisms underlying empathy. In particular, we focus on the relationship between clinician and suicidal individuals that represents a difficult category of patients that puts the emotional and empathic regulation capacity to the test. Therefore, we provide the reader with an overview on the current neuroscientific knowledge about empathy, intending to return an interpretative clue and favour new intuitions promoting a better comprehension, based on a scientific use of empathy in the patient-clinician relationship. We then propose the concept of “empathic disconnection” referring to those situations in which the clinician, automatically and unconsciously, puts him/herself in the position of not taking any advantage from the empathic relationship with the patient. We propose the concept of “empathic moment” as a communicative strategy, whose goal is to intentionally use empathic mechanisms to gather information directed at identifying the inner state of the patient. We finally suggest the use of vitality forms as a relevant element for the cognitive analysis of the patient’s inner states. We conclude with some practical-applicative considerations based on what is discussed.

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Notes

  1. 1.

    Which gathers data on the inner state of the body and of its organs, such as heart, lungs, stomach and intestine.

  2. 2.

    Additionally, it also appears that those individuals who are better at interoception also have a bigger right insula.

  3. 3.

    Orbicular ocular muscle in particular (orbicularis oculi).

  4. 4.

    See above “characteristics of the observed person” in empathy modulation.

  5. 5.

    Worse in the second case.

  6. 6.

    We need to pay much attention here because with the suicidal patient what can appear as compassion is in fact the reaction to the patient’s potential suicidal, that is, a fear reaction (Pompili 2013).

  7. 7.

    Porges refers to this as to “Neuroception”.

  8. 8.

    Or empathic concern.

  9. 9.

    An example: a doctor with Catholic faith but, at the same time, motivated by treating his patients makes use of embryonic stem cells. He has two conflicting modules. There the interpreter intervenes and resolves the conflict with an explanation: the entities produced through therapeutic cloning are not actual embryos since they do not originate in zygotes, but in “clonotes” (Gazzaniga 2005; McHugh 2004), and, namely, a concept newly invented in order to unify the conflict.

References

  • Adolphs R (2003) Cognitive neuroscience of human social behaviour. Nat Rev Neurosci 4(3):165–178

    Article  CAS  PubMed  Google Scholar 

  • Ammaniti M, Gallese V (2014) The birth of intersubjectivity: psychodynamics, neurobiology, and the self. WW Norton & Company, New York

    Google Scholar 

  • Ben-Zeev D, Scherer EA, Wang R, Xie H, Campbell AT (2015) Next-generation psychiatric assessment: using smartphone sensors to monitor behavior and mental health. Psychiatr Rehabil J 38(3):218

    Article  PubMed  PubMed Central  Google Scholar 

  • Bernhardt BC, Singer T (2012) The neural basis of empathy. Neuroscience 35(1):1

    CAS  Google Scholar 

  • Blair RJR (2008) Fine cuts of empathy and the amygdala: dissociable deficits in psychopathy and autism. Q J Exp Psychol 61(1):157–170

    Article  CAS  Google Scholar 

  • Cheng Y, Lin CP, Liu HL, Hsu YY, Lim KE, Hung D, Decety J (2007) Expertise modulates the perception of pain in others. Curr Biol 17(19):1708–1713

    Article  CAS  PubMed  Google Scholar 

  • Cheng Y, Chen C, Lin CP, Chou KH, Decety J (2010) Love hurts: an FMRI study. NeuroImage 51(2):923–929

    Article  PubMed  Google Scholar 

  • Cox CL, Uddin LQ, Di Martino A, Castellanos FX, Milham MP, Kelly C (2012) The balance between feeling and knowing: affective and cognitive empathy are reflected in the brain’s intrinsic functional dynamics. Soc Cogn Affect Neurosci 7(6):727–737

    Article  PubMed  Google Scholar 

  • Craig AD (2003) Interoception: the sense of the physiological condition of the body. Curr Opin Neurobiol 13(4):500–505

    Article  CAS  PubMed  Google Scholar 

  • Craig AD (2009) How do you feel now? the anterior insula and human awareness. Nat Rev Neurosci 10(1):59–70

    Article  CAS  PubMed  Google Scholar 

  • Critchley HD, Wiens S, Rotshtein P, Öhman A, Dolan RJ (2004) Neural systems supporting interoceptive awareness. Nat Neurosci 7(2):189–195

    Article  CAS  PubMed  Google Scholar 

  • Damasio AR (1994) Descartes’ error: emotion, rationality and the human brain, vol 352. Putnam, New York, pp 1061–1070

    Google Scholar 

  • Danziger N, Faillenot I, Peyron R (2009) Can we share a pain we never felt? neural correlates of empathy in patients with congenital insensitivity to pain. Neuron 61(2):203–212

    Article  CAS  PubMed  Google Scholar 

  • Davidson RJ, Kabat-Zinn J, Schumacher J, Rosenkranz M, Muller D, Santorelli SF, Urbanowski F, Harrington A, Bonus K, Sheridan JF (2003) Alterations in brain and immune function produced by mindfulness meditation. Psychosom Med 65(4):564–570

    Article  PubMed  Google Scholar 

  • Davis MH (1983) Measuring individual differences in empathy: evidence for a multidimensional approach. J Pers Soc Psychol 44(1):113

    Article  Google Scholar 

  • De Greck M, Wang G, Yang X, Wang X, Northoff G, Han S (2012) Neural substrates underlying intentional empathy. Soc Cogn Affect Neurosci 7(2):135–144

    Article  PubMed  Google Scholar 

  • Decety J, Cowell JM (2014) The complex relation between morality and empathy. Trends Cogn Sci 18(7):337–339

    Article  PubMed  Google Scholar 

  • Decety J, Ickes W (2011) The social neuroscience of empathy. MIT Press, Cambridge, MA

    Google Scholar 

  • Di Cesare G, Di Dio C, Rochat MJ, Sinigaglia C, Bruschweiler-Stern N, Stern DN, Rizzolatti G (2014) The neural correlates of “vitality form” recognition: an fmri study. Soc Cogn Affect Neurosci 9(7):951–960

    Article  PubMed  Google Scholar 

  • Di Cesare G, Di Dio C, Marchi M, Rizzolatti G (2015) Expressing our internal states and understanding those of others. Proc Natl Acad Sci 112(33):10331–10335

    Article  PubMed  PubMed Central  Google Scholar 

  • Di Cesare G, Valente G, Di Dio C, Ruffaldi E, Bergamasco M, Goebel R, Rizzolatti G (2016) Vitality forms processing in the insula during action observation: a multivoxel pattern analysis. Front Hum Neurosci 10:267

    Article  PubMed  PubMed Central  Google Scholar 

  • Donker T, Petrie K, Proudfoot J, Clarke J, Birch MR, Christensen H (2013) Smartphones for smarter delivery of mental health programs: a systematic review. J Med Internet Res 15(11):e247

    Article  PubMed  PubMed Central  Google Scholar 

  • Ekman P, Friesen WV (2003) Unmasking the face: a guide to recognizing emotions from facial clues. Malor Books, Cambridge, MA

    Google Scholar 

  • Engen HG, Singer T (2013) Empathy circuits. Curr Opin Neurobiol 23(2):275–282

    Article  CAS  PubMed  Google Scholar 

  • Eres R, Decety J, Louis WR, Molenberghs P (2015) Individual differences in local gray matter density are associated with differences in affective and cognitive empathy. NeuroImage 117:305–310

    Article  PubMed  Google Scholar 

  • Fan Y, Duncan NW, De Greck M, Northoff G (2011) Is there a core neural network in empathy? An FMRI based quantitative meta-analysis. Neurosci Biobehav Rev 35(3):903–911

    Article  PubMed  Google Scholar 

  • Feinstein JS, Adolphs R, Damasio A, Tranel D (2011) The human amygdala and the induction and experience of fear. Curr Biol 21(1):34–38

    Article  CAS  PubMed  Google Scholar 

  • Fredrickson BL, Cohn MA, Coffey KA, Pek J, Finkel SM (2008) Open hearts build lives: positive emotions, induced through loving-kindness meditation, build consequential personal resources. J Pers Soc Psychol 95(5):1045

    Article  PubMed  PubMed Central  Google Scholar 

  • Freud S (1912) Recommendations to physicians practising psycho-analysis. Stand Edition of the Complete Psychological Works of Sigmund Freud 12(1):109–120

    Google Scholar 

  • Gallese V (2010) Le basi neurofisiologiche dell’intersoggettività [neural basis of intersubjectivity]. Soc Degli Individ 37(1):48–53

    Google Scholar 

  • Gallese V (2013) Corpo non mente. le neuroscienze cognitive e la genesi di soggettività ed intersoggettività. Edu Sentiment 20:8–24

    Article  Google Scholar 

  • Gallese V, Sinigaglia C (2011) What is so special about embodied simulation? Trends Cogn Sci 15(11):512–519

    Article  PubMed  Google Scholar 

  • Gallese V, Keysers C, Rizzolatti G (2004) A unifying view of the basis of social cognition. Trends Cogn Sci 8(9):396–403

    Article  PubMed  Google Scholar 

  • Gazzaniga M (1985) The social brain: discovering the networks of the mind. Basic Books, New York

    Google Scholar 

  • Gazzaniga M (1998) The split brain revisited. Sci Am 279(1):50–55

    Article  CAS  PubMed  Google Scholar 

  • Gazzaniga M (2005) The ethical brain. Dana press, Washington, DC

    Google Scholar 

  • Gazzaniga M (2007) L’interprete. Come il cervello decodifica il mondo. Di Renzo Editore, Roma

    Google Scholar 

  • Gazzaniga M, Ivry R, Mangun G (2013) Cognitive neuroscience: the biology of the mind, 4th edn. WW Norton & Company, New York

    Google Scholar 

  • Gibson JJ (2014) The ecological approach to visual perception, Classic edn. Psychology Press, Park Drive

    Google Scholar 

  • Goldin PR, McRae K, Ramel W, Gross JJ (2008) The neural bases of emotion regulation: reappraisal and suppression of negative emotion. Biol Psychiatry 63(6):577–586

    Article  PubMed  Google Scholar 

  • Gravenhorst F, Muaremi A, Bardram J, Grünerbl A, Mayora O, Wurzer G, Frost M, Osmani V, Arnrich B, Lukowicz P et al (2015) Mobile phones as medical devices in mental disorder treatment: an overview. Pers Ubiquit Comput 19(2):335–353

    Article  Google Scholar 

  • Gu X, Han S (2007) Attention and reality constraints on the neural processes of empathy for pain. NeuroImage 36(1):256–267

    Article  PubMed  Google Scholar 

  • Hatfield E, Cacioppo JT, Rapson RL (1994) Emotional contagion. Cambridge university press, Cambridge

    Google Scholar 

  • Hatfield E, Rapson RL, Le YCL (2011) Emotional contagion and empathy. In: Decety J, Ickes W (eds) The social neuroscience of empathy. MIT Press, Boston, MA, p 19

    Google Scholar 

  • Hein G, Singer T (2008) I feel how you feel but not always: the empathic brain and its modulation. Curr Opin Neurobiol 18(2):153–158

    Article  CAS  PubMed  Google Scholar 

  • Heller M, Haynal V (2002) The doctor’s face: a mirror of his patient’s suicidal projects. In: Guimon J (ed) Body psychotherapy in progressive and chronic disorders. Karger, Basel, pp 46–51

    Google Scholar 

  • Ickes W (2003) Everyday mind reading: Understanding what other people think and feel. Prometheus Books, Amherst, NY

    Google Scholar 

  • Jabbi M, Keysers C (2008) Inferior frontal gyrus activity triggers anterior insula response to emotional facial expressions. Emotion 8(6):775

    Article  PubMed  Google Scholar 

  • Jabbi M, Swart M, Keysers C (2007) Empathy for positive and negative emotions in the gustatory cortex. NeuroImage 34(4):1744–1753

    Article  PubMed  Google Scholar 

  • Johansson G (1973) Visual perception of biological motion and a model for its analysis. Percept Psychophys 14(2):201–211

    Article  Google Scholar 

  • Kennedy DP, Adolphs R (2010) Impaired fixation to eyes following amygdala damage arises from abnormal bottom-up attention. Neuropsychologia 48(12):3392–3398

    Article  PubMed  PubMed Central  Google Scholar 

  • Keysers C (2011) The empathic brain: how the discovery of mirror neurons changes our understanding of human nature. CreateSpace Independent Publishing Platform, Seattle, WA

    Google Scholar 

  • Keysers C, Wicker B, Gazzola V, Anton JL, Fogassi L, Gallese V (2004) A touching sight: Sii/pv activation during the observation and experience of touch. Neuron 42(2):335–346

    Article  CAS  PubMed  Google Scholar 

  • Klimecki OM, Leiberg S, Lamm C, Singer T (2012) Functional neural plasticity and associated changes in positive affect after compassion training. Cereb Cortex 23(7):1552–1561

    Article  PubMed  Google Scholar 

  • Klimecki OM, Leiberg S, Ricard M, Singer T (2013) Differential pattern of functional brain plasticity after compassion and empathy training. Soc Cogn Affect Neurosci 9(6):873–879

    Article  PubMed  PubMed Central  Google Scholar 

  • Koenigsberg HW, Fan J, Ochsner KN, Liu X, Guise K, Pizzarello S, Dorantes C, Tecuta L, Guerreri S, Goodman M et al (2010) Neural correlates of using distancing to regulate emotional responses to social situations. Neuropsychologia 48(6):1813–1822

    Article  PubMed  PubMed Central  Google Scholar 

  • Kovács ÁM, Téglás E, Endress AD (2010) The social sense: susceptibility to others’ beliefs in human infants and adults. Science 330(6012):1830–1834

    Article  PubMed  Google Scholar 

  • Lamm C, Nusbaum HC, Meltzoff AN, Decety J (2007) What are you feeling? using functional magnetic resonance imaging to assess the modulation of sensory and affective responses during empathy for pain. PLoS One 2(12):e1292

    Article  PubMed  PubMed Central  Google Scholar 

  • Lamm C, Porges E, Cacioppo J, Decety J (2008) Perspective taking is associated with specific facial responses during empathy for pain. Brain Res 1227:153–161

    Article  CAS  PubMed  Google Scholar 

  • Lamm C, Meltzoff AN, Decety J (2010) How do we empathize with someone who is not like us? A functional magnetic resonance imaging study. J Cogn Neurosci 22(2):362–376

    Article  PubMed  Google Scholar 

  • LeDoux J (2012) Rethinking the emotional brain. Neuron 73(4):653–676

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Lindquist KA, Wager TD, Kober H, Bliss-Moreau E, Barrett LF (2012) The brain basis of emotion: a meta-analytic review. Behav Brain Sci 35(03):121–143

    Article  PubMed  PubMed Central  Google Scholar 

  • Lutz A, Brefczynski-Lewis J, Johnstone T, Davidson RJ (2008) Regulation of the neural circuitry of emotion by compassion meditation: effects of meditative expertise. PLoS One 3(3):e1897

    Article  PubMed  PubMed Central  Google Scholar 

  • Luxton DD, McCann RA, Bush NE, Mishkind MC, Reger GM (2011) mHealth for mental health: integrating smartphone technology in behavioral healthcare. Prof Psychol 42(6):505

    Article  Google Scholar 

  • Maltsberger JT, Buie DH (1974) Countertransference hate in the treatment of suicidal patients. Arch Gen Psychiatry 30(5):625–633

    Article  CAS  PubMed  Google Scholar 

  • McHugh P (2004) Zygote and “clonote” – the ethical use of embryonic stem cells. N Engl J Med 351(3):209–211

    Article  CAS  PubMed  Google Scholar 

  • Mesulam M, Mufson EJ et al (1982) Insula of the old world monkey. III: Efferent cortical output and comments on function. J Comp Neurol 212(1):38–52

    Article  CAS  PubMed  Google Scholar 

  • Mitchell JP, Banaji MR, MacRae CN (2005) The link between social cognition and self-referential thought in the medial prefrontal cortex. J Cogn Neurosci 17(8):1306–1315

    Article  PubMed  Google Scholar 

  • Morecraft RJ, Stilwell-Morecraft KS, Rossing WR (2004) The motor cortex and facial expression: new insights from neuroscience. Neurologist 10(5):235–249

    Article  PubMed  Google Scholar 

  • Murray RJ, Schaer M, Debbané M (2012) Degrees of separation: a quantitative neuroimaging meta-analysis investigating self-specificity and shared neural activation between self- and other-reflection. Neurosci Biobehav Rev 36(3):1043–1059

    Article  PubMed  Google Scholar 

  • Ochsner KN, Ray RR, Hughes B, McRae K, Cooper JC, Weber J, Gabrieli JD, Gross JJ (2009) Bottom-up and top-down processes in emotion generation common and distinct neural mechanisms. Psychol Sci 20(11):1322–1331

    Article  PubMed  PubMed Central  Google Scholar 

  • Onnis L (2015) Una nuova alleanza tra psicoterapia e neuroscienze. Dall’intersoggettività ai neuroni specchio. Dialogo tra Daniel Stern e Vittorio Gallese. Franco Angeli Editore, Milan

    Google Scholar 

  • Osmani V (2015) Smartphones in mental health: detecting depressive and manic episodes. IEEE Pervasive Comp 14(3):10–13

    Article  Google Scholar 

  • Owen G, Belam J, Lambert H, Donovan J, Rapport F, Owens C (2012) Suicide communication events: lay interpretation of the communication of suicidal ideation and intent. Soc Sci Med 75(2):419–428

    Article  PubMed  Google Scholar 

  • Pelphrey KA, Carter EJ (2008) Brain mechanisms for social perception. Ann N Y Acad Sci 1145(1):283–299

    Article  PubMed  PubMed Central  Google Scholar 

  • Pessoa L (2010) Emotion and cognition and the amygdala: from “what is it?” to “what’s to be done?”. Neuropsychologia 48(12):3416–3429

    Article  PubMed  PubMed Central  Google Scholar 

  • Phelps EA (2006) Emotion and cognition: insights from studies of the human amygdala. Annu Rev Psychol 57:27–53

    Article  PubMed  Google Scholar 

  • Pompili M (2013) La prevenzione del suicidio. Il Mulino, Bologna

    Google Scholar 

  • Pompili M (2015) Our empathic brain and suicidal individuals. Crisis 36(4):227–230

    Article  PubMed  Google Scholar 

  • Pompili M, Murri MB, Patti S, Innamorati M, Lester D, Girardi P, Amore M (2016) The communication of suicidal intentions: a meta-analysis. Psychol Med 6(11):2239–2253

    Article  Google Scholar 

  • Porges SW (2007) The polyvagal perspective. Biol Psychol 74(2):116–143

    Article  PubMed  Google Scholar 

  • Porges SW (2009) The polyvagal theory: new insights into adaptive reactions of the autonomic nervous system. Cleve Clin J Med 76(Suppl 2):S86

    Article  PubMed  PubMed Central  Google Scholar 

  • Porges SW (2011) The polyvagal theory: neurophysiological foundations of emotions, attachment, communication, and self-regulation (Norton series on interpersonal neurobiology). WW Norton & Company, New York

    Google Scholar 

  • Premack D, Woodruff G (1978) Does the chimpanzee have a theory of mind? Behav Brain Sci 1(04):515–526

    Article  Google Scholar 

  • Rizzato M, Donelli D (2014) I am your mirror. Mirror neurons and empathy. Blossoming Books, Turin

    Google Scholar 

  • Rizzolatti G, Sinigaglia C (2008) Mirrors in the brain: how our minds share actions and emotions. Oxford University Press, New York

    Google Scholar 

  • Rizzolatti G, Fogassi L, Gallese V (2002) Motor and cognitive functions of the ventral premotor cortex. Curr Opin Neurobiol 12(2):149–154

    Article  CAS  PubMed  Google Scholar 

  • Saarela MV, Hlushchuk Y, ACdC W, Schürmann M, Kalso E, Hari R (2007) The compassionate brain: humans detect intensity of pain from another’s face. Cereb Cortex 17(1):230–237

    Article  PubMed  Google Scholar 

  • Saxe R, Wexler A (2005) Making sense of another mind: the role of the right temporo-parietal junction. Neuropsychologia 43(10):1391–1399

    Article  PubMed  Google Scholar 

  • Shamay-Tsoory SG, Aharon-Peretz J, Perry D (2009) Two systems for empathy: a double dissociation between emotional and cognitive empathy in inferior frontal gyrus versus ventromedial prefrontal lesions. Brain 132(3):617–627

    Article  PubMed  Google Scholar 

  • Shneidman ES (1998) The suicidal mind. Oxford University Press, New York

    Google Scholar 

  • Singer T, Klimecki OM (2014) Empathy and compassion. Curr Biol 24(18):R875–R878

    Article  CAS  PubMed  Google Scholar 

  • Singer T, Seymour B, O’Doherty JP, Stephan KE, Dolan RJ, Frith CD (2006) Empathic neural responses are modulated by the perceived fairness of others. Nature 439(7075):466–469

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Singer T, Critchley HD, Preuschoff K (2009) A common role of insula in feelings, empathy and uncertainty. Trends Cogn Sci 13(8):334–340

    Article  PubMed  Google Scholar 

  • Stern DN (2010) Forms of vitality: exploring dynamic experience in psychology, the arts, psychotherapy, and development. Oxford University Press, New York

    Book  Google Scholar 

  • Wager TD, Davidson ML, Hughes BL, Lindquist MA, Ochsner KN (2008) Prefrontal-subcortical pathways mediating successful emotion regulation. Neuron 59(6):1037–1050

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Walter H, von Kalckreuth A, Schardt D, Stephan A, Goschke T, Erk S (2009) The temporal dynamics of voluntary emotion regulation. PLoS One 4(8):e6726

    Article  PubMed  PubMed Central  Google Scholar 

  • Wicker B, Keysers C, Plailly J, Royet JP, Gallese V, Rizzolatti G (2003) Both of us disgusted in my insula: the common neural basis of seeing and feeling disgust. Neuron 40(3):655–664

    Article  CAS  PubMed  Google Scholar 

  • Zaki J, Ochsner K (2011) Reintegrating the study of accuracy into social cognition research. Psychol Inq 22(3):159–182

    Article  Google Scholar 

  • Zaki J, Weber J, Bolger N, Ochsner K (2009) The neural bases of empathic accuracy. Proc Natl Acad Sci 106(27):11382–11387

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Decety J, Jackson PL (2004) The functional architecture of human empathy. Behav Cogn Neurosci Rev 3(2):71–100

    Article  PubMed  Google Scholar 

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Donelli, D., Rizzato, M. (2018). Empathy and Empathic Disconnection in Difficult and Uneasy Situations: Facing the Suicidal Individual. In: Pompili, M. (eds) Phenomenology of Suicide. Springer, Cham. https://doi.org/10.1007/978-3-319-47976-7_6

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