Case studies and articles
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Compassionate behaviour aids not only the receiver but also enhances the giver’s wellbeing. It can elevate our mental state and often generates further compassionate conduct. It can therefore be said that compassion often begets further compassion. By acknowledging a global humanity, we open the possibility to collective compassion which in turn may lead to a common, and greater, good.
When we consider famous compassionate people, we may think of a handful of well-known and eminent individuals such as the 14th Dalai Lama, Archbishop Desmond Tutu, Mother Theresa, St Francis of Assisi, Emperor Ashoka or Mahatma Ghandi. Some lesser-known choices may be Harriet Tubman, Dr Denis Mukwege or Claiborne Ellis. These role models often had to overcome much hardship and many difficulties, and yet continued to be compassionate when dealing with others. Their conduct should inspire us to care for one another and to remain compassionate even when faced with adversity.
Our world is characterised by a multitude of formidable challenges, many of which seem daunting and disheartening. Faced with such significant global concerns it is often the natural inclination to narrow the focus and become insular, to shut the metaphorical doors and let no one enter, and to become increasingly inward-looking.
Yet, counterintuitively, the contrary response may be the better one, as human suffering can also inspire many people to reach out, to open their hearts, to connect with others and to alleviate their anguish by engaging in acts of compassion.
By becoming more compassionate, we not only help others, but we commonly also experience the mood enhancement that makes us feel better. Seeing others conduct themselves compassionately, or being compassionate ourselves, can elevate us to higher action, a greater good and a common purpose.
Although empathy, sympathy, and compassion are often used interchangeably, there are certain linguistic and phenomenological differences. One such difference is the fact that both empathy and sympathy are self-related and inward focused, while compassion is other-related and outward focused.
Empathy refers to the ability to understand and share the feelings of another person by imagining what it would be like to be in that person’s situation.
Sympathy, on the other hand, refers to the feelings of pity and sorrow for someone else’s misfortune – a a feeling or expression of understanding and caring for someone else who is suffering or has problems that have caused distress.
Compassion, however, is often believed to be derived from the Latin compassio meaning ‘to suffer with‘. Hence, compassion is described as a deeper awareness of another person’s suffering coupled with a wish to relieve this. Much has been written about the definition of compassion and numerous articles and textbooks have attempted to elucidate the concept. A useful working definition of compassion might be the following:
To recognise, and become aware of, someone else’s suffering
To feel connected with the person who is suffering, and be moved by it
To be motivated to act and alleviate the suffering so as to help that person
Traditionally it was philosophers and theologians who had an interest in the study of compassion. They argue that to feel genuine compassion, there would also have to be an understanding of the universality of human suffering and hence recognition of a commonality with the sufferer – akin to a common humanity. Furthermore, to be truly compassionate one should be able to tolerate disagreeable emotions (for example disgust, dislike, frustration, or anger) when facing a situation which one would usually disapprove of or find distasteful.
However, more recently, the study of compassion has attracted attention from neuroscientists and psychologists. Recent studies seem to suggest that empathy (feeling the emotions of the sufferer) highlights the brain centres relevant to distress, pain, and suffering. Compassion on the other hand, highlights the brain centres related to connecting, caring, and reward – and thus seems to have a more positive and pleasurable effect on the practitioner.
Sir William Osler, a Canadian physician often named the father of modern medicine, stated that “the good physician treats the disease; the great physician treats the patient who has the disease”.
A basic tenet of healthcare is that practitioners should be compassionate when treating patients who are afflicted by disease and who are struggling with discomfort, pain, and suffering. Healthcare practitioners accept that compassion is central to patient care and the therapeutic relationship. This is also enshrined in various professional codes of conduct, ethical guidance, numerous best practice guidelines and patient rights charters.
Unfortunately, in today’s consumer-driven society – where healthcare is treated as just another commodity to be bought, sold, and managed, it is unsurprising that healthcare practitioners become increasingly jaded, frustrated, and burnt out. This often leads to compassion-fatigue. This seems to be the case not only in South Africa but also in other countries.
A group of physicians in the US were faced with such a problem, namely, how to improve patient care and doctor wellbeing in a hospital that was struggling with doctor burnout.
Drs Stephen Trzeciak and Anthony Mazzarelli reviewed numerous scientific articles and research studies, the findings of which they published in their book Compassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference. The authors ultimately concluded that the addition of compassion to the clinical consultation, for a mere 40 seconds, contributed to a significant improvement not only in the patient’s clinical outcome but also in the prevalence of doctor burnout.1
Further research seems to confirm this. Many articles also suggest that an increase in compassionate behaviour improved not only physical health (for example reduced cardiac disease, the need for preoperative sedation and postoperative pain relief) but also improved mental wellbeing – reducing feelings of depression, anxiety, and burnout, and improving cognition and enhancing relationships.
The evidence seems to suggest that the act of giving is as pleasurable as the act of receiving, and that acts of compassion subsequently generate further acts of compassion.
This raises the question as per Anstiss, Passmore and Gilbert (2020):
“Can the human race cultivate compassion at sufficient scale and pace – at both individual and collective levels? We are embedded in a fast-changing world full of uncertainty and threat … Discovering how we can fast-track the conditions for compassion is surely one of our species' greatest challenges, and one (of) the most urgent tasks.”2
We are all part of a global and common humanity. Our experiences are the result of a universal human condition, with common bonds, similar needs, and congruous desires. Do we not all want what is best for our family and friends as well as our communities?
No one wants to struggle or suffer. It is within this collective context that seeing someone help another creates a state of elevation, an uplifting and positive emotion we feel when we are in the presence of goodness. Such elevation can, in turn, motivate and inspire others to perpetuate compassionate action. This suggests that acts of generosity and kindness beget further generosity and kindness – leading to a chain reaction of goodness and compassion.
Extending the virtue of compassion to the larger collective could lead to a kinder and more peaceable humanity, and in the process foster a sense of connection, unity, and shared kinship. It is up to us as individuals to act and make the world a better place. Compassion may be the pathway to get us there.
Studies suggest that it is not only rats and chimpanzees but also human infants that are born with an innate neuronal network that makes us naturally compassionate. We might therefore be intrinsically compassionate beings. This does not mean that we are always kind and compassionate, nor that we cannot enhance our compassionate nature even further.
Multiple compassion-based interventions have been developed, studied and evaluated. Some of the more prominent interventions include:
Compassion Focussed Therapy (CFT)
Mindful Self-compassion (MSC)
Compassionate Mind Training
Compassion Cultivation Training (CCT)
Cognitively based Compassion Training (CBCT)
Compassion-Centred Spiritual Health (CCSH) interventions
Various types of meditation (such as ‘loving-kindness’ meditation)
Becoming more compassionate is a worthy challenge. It will likely improve not only our own mental state, but also benefit our friends, families and patients, as well as provide a more authentic and mature perspective on the world around us.
A more immediate and practical technique to increase one’s capacity for compassion is to follow a three-step approach:
Make a choice: self-chosen and voluntary compassionate helping behaviour improves your mental wellbeing the most
Make a connection: connecting with, investing in, and spending time with the receiver of your compassionate action further enhances your happiness
Make an impact: witnessing the real world, and palpable, impact of your compassionate action will continue to assist in transforming good deeds into good feelings
Finally, there is supportive evidence to suggest that when time is precious and one is feeling ill-humoured and irascible, positive non-verbal interaction – specifically a friendly and warm smile – bestows multiple benefits on not only the giver, but also on the receiver. A pleasing and heartfelt smile is likely to make you, your patients, and your clinical team feel better, more rejuvenated and contented.