Empathy: At the Heart of the Mind
作者: Dan J. Stein, MD, Ph / 11221次阅读 时间: 2009年8月24日
来源: CNS Spectrums 标签: empathy Empathy 共情

Case Study

Evelyn is a 35-year-old woman who presented to a psychiatrist with complaints of marriage difficulties. As she described some of these difficulties, she leaned forward, and her psychiatrist responded by changing her body posture and unfolding her arms. Evelyn explained that she had been brought up to be stoic in the face of difficulties. When she described some of the family’s early circumstances, her expression became sad and her psychiatrist responded by furrowing her brow. Evelyn’s parents had encouraged the kids to be self-reliant and independent; problems were not complained about, they were simply dealt with. At present, however, her situation felt overwhelming. She felt embarrassed to have to talk with a stranger about her marriage. Her psychiatrist reflected back, saying that her early family had obviously given her many strengths, and that it must be difficult to have to ask for help. At that point in the conversation, Evelyn’s eyes misted over with tears.心理学空间dH h@1LB{Q



Cognitive-Affective Neuroscience of Empathy

How does anyone know what anyone else is feeling or thinking? The question of whether there are other minds, and whether they have the same kinds of consciousness as our own, is as old as philosophy. The question of how best to understand our patients and their emotions and thoughts is old as the practice of medicine and has long been a focus of theory and research in psychotherapy. Recent research1-5has also provided the initial outlines of a cognitive-affective neuroscience of empathy, often including the idea that perceptions of behaviors, emotions, and cognitions in others activate one’s own representations of these phenomena.


心理学空间%N!X0K insu1r6h

rZ'kf k8n"M0j0

An immediate question is whether such a schema is the best way to conceptualize empathy. Many authors have contributed to a rich literature on empathy, including philosophers,6,7biologists,8,9psychotherapists,10-13and social psychologists.14Different strands within this writing have emphasized the affects involved in empathy (eg, involving emotional contagion and resonance),15and the cognitions involved in empathy (eg, involving imagination and projection). There is, however, an increasing interest in theories which integrate behavioral, affective, and cognitive elements of empathy.1,16,17

F/g A-V-~!]#r%c0

心理学空间hZ n!\kl`


Given the range of affective and cognitive processes thought to be required for empathy, the relevant neurocircuitry is likely to be complex. It requires the inclusion of limbic areas, which underpin rapid processes such as emotional resonance, and frontal areas, which underpin slower processes such as imagination and projection. Functional brain imaging research has demonstrated somatotopic activation of premotor cortex during action observation18and of similar areas during face imitation5and intention understanding.19A growing series of parallel studies2,3,20-22on empathy confirm the importance of pathways in and between the amygdala, insula, and inferior frontal cortex (Figures 1 and 2). Anterior cingulate, in particular, appears activated by empathy for pain.21-23Related data24-26explores the neurocircuitry required for social cognition and for a theory of mind (Figure 3).心理学空间2}c2U h"Or H]

:WeWz E0


The absence of empathy in certain neurological and psychiatric disorders, including autism and antisocial personality disorder, may also provide some clues about the relevant neurocircuitry.25,27,28In lesions of the amygdala, patients are less able to recognize emotions in others (an affective part of empathy); in lesions of the somatosensory-related cortices there is impairment of emotional concept retrieval (a cognitive part of empathy).29While social cognition ordinarily encompasses satisfaction from altruistic punishment after the violation of social norms,30certain neurological lesions may be associated with abnormal enjoyment in inflicting pain on others.31


心理学空间N Ij6y?-hc

There is also increasing work at a molecular and cellular level. The discovery of mirror neurons has suggested the possibility that certain neurons are particularly important in empathy.32,33Electrophysiological recordings have demonstrated that single neurons can be activated when a subject observes pain in others.34Behavioral and physiological changes in animals exposed to the physical pain of conspecifics have been investigated and are similarly relevant to understanding the psychobiology of empathy.35The molecular underpinnings of basic cognitive-affective processes, such as attachment, are becoming clearer and, again, may be useful for understanding some aspects of empathy.36心理学空间 {Je_u0\se y

'J)G*L }gUIL0



To what extent is empathy an inherited or a learned phenomenon? There appears to be inter-individual variability in the capacity to respond empathically in both humans and other animals. Studies of human infants suggest that there is some innate capacity for the affective processes involved in empathy (eg, imitating facial expressions).37However, learning is also important, with infants gradually developing themselves as agents that can change their physical environment and reciprocate in social exchanges. Understanding the other can be conceptualized as a form of embodied practice.38Empathy develops and improves gradually over time in laypersons and in clinicians.17,39心理学空间7p{z(Yd[ J\0oL

+q Y]$xL0


Evolutionary Approaches

Empathy has been conceptualized from an evolutionary perspective as a “concern mechanism” that enhances survival.40Darwin8and McDougall14have suggested that emotional contagion exists to enhance mother-infant bonding. In a tour de force, Preston and de Waal1 place the emphasis differently, noting that empathic processes allow infants to perceive and learn from the expressions of the caregiver, and allow caregivers to be affected by the emotions of infants. They argue that the nervous system has evolved to perceive and act not only in the physical environment but also in the social environment; in non-human primates, and especially humans, development of the frontal cortex and of cognitive-affective capacity has allowed the emergence of increasingly sophisticated empathic processes.1


~a#}'y3ia9U H0

k$_#?&\ q,f7F*s-K7k0

Clinical Implications


Should we have a section inDiagnostic and Statistical Manual of Mental Disorderson empathy disorders? There is a rich literature on disordered empathy in autism.25Cluster B personality disorders also seem to involve a failure of empathy, with disordered empathy particularly relevant to psychopathy and to narcissism. Speculatively, there may also be disorders characterized by exaggerated empathy. These remain to be defined. (One theory, for example, posits that social anxiety disorder might involve increased awareness of negative social cues).

Va:\_0Zk U2h2j0

心理学空间+k @` f.W*{6^NV
心理学空间 Y^8X_w:?{:sw


Deficits in empathy in antisocial and narcissistic personality disorders are unlikely to be validly assessed using self-rating scales, given that relatively few people with these conditions are able to volunteer that they have such lacunae. Problems in empathy may be included on some clinician-rated instruments addressing these disorders. However, more focused questionnaires are available to assess individual differences in empathy.41,42Furthermore, empathy in the clinical process can be assessed using scales, such as the Consulation and Relational Empathy measure.43心理学空间A|:] U'Gm R

} @5}5H7]w#[0

4O'k Z0\6s0lnen%B7q0


Empathy has been argued to have several key advantages in the clinical context: it may encourage patients to provide better histories and so improve diagnosis; it may increase patients’ self-efficacy and so lead to increased participation in treatment; and it may lead to therapeutic interactions that directly improve symptoms.44Conversely, it has been suggested17that empathy allows clinicians to make better connections with their patients, and so gain more professional satisfaction. Although much additional data on this area is needed, a number of authors have therefore advocated techniques for enhancing clinicians’ empathy.17,45


心理学空间)| N"T9b qiV3\


While the question of other minds is an old one, the psychobiology of empathy is a new field of investigation. There has, however, been convergent evidence, providing the framework for a cognitive-affective neuroscience of empathy.1-3Additional research is needed to build on these conceptual and empirical foundations, and also to extend them to the clinical arena. Such work is crucial, not only because certain psychiatric disorders may be characterized by disordered empathy but because empathy lies at the very core of the clinical encounter. 
Z P7g og6B"[o*Qf"z0



|VU'r m%b1p0


1. Preston SD, de Waal FB. Empathy: its ultimate and proximate bases.Brain Behav Sci. 2002;25:1-20.心理学空间 w|4a&o iU0t(j B

2. Decety J, Chaminade T. Neural correlates of feeling sympathy.Neuropsychologia. 2003;41:127-138.心理学空间CV]'?FaM FC

3. Carr L, Iacoboni M, Dubeau MC, Mazziotta JC, Lenzi GL. Neural mechanisms of empathy in humans: a relay from neural systems for imitation to limbic areas.Proc Natl Acad Sci U S A. 2003;100:5497-5502.心理学空间8E`Xyw{-yi

4. Decety J, Jackson PL. The functional architecture of human empathy.Behav Cogn Neurosci Rev. 2004;3:71-100.心理学空间S9cH V.m:Ouk:|5O

5. Leslie KR, Johnson-Frey SH, Grafton ST. Functional imaging of face and hand imitation: towards a motor theory of empathy.Neuroimage. 2004;21:601-607.


6. Hume, D.A Treatise of Human Nature. Oxford, England: Clarendon Press; 1990.

It#{d4Cxz mm M7M0

7. Merleau-Ponty M.Phenomenology of Perception. London, England: Routledge and Kegan Paul; 1962.


8. Darwin C.The Expression of Emotion in Man and Animals.London, England: John Murray; 1872.心理学空间W(c\m]Go

9. MacLean PD.A Triune Concept of the Brain and Behavior. Toronto, Canada:University of Toronto Press; 1973.心理学空间/OD p-Q(ZN/M.M

10. Freud, S.Group Psychology and the Analysis of the Ego. Collected Works Chronologically Arranged: Works From the Years 1932-1939. vol 16. 1922. Richmond, England: Hogarth Press; 1945.


11. Rogers CR. The necessary and sufficient conditions for therapeutic personality change.J Consult Psychol. 1957;21:97-103.

.D9[@$~0S b0

12. Havens L. Forming effective relationships. In: Sabo AN, Havens L, eds.The Real World Guide to Psychotherapy Practice. Cambridge, Mass: Harvard University Press; 2000:17-33.

*H*^YKI F9`T9c0

13. Sharma RM. Empathy––a retrospective on its development in psychotherapy.Aust N Z J Psychiatry. 1992;26:377-390.

.x c*r7n4C9F(a._6T+L2D0

14. McDougall W.An Introduction to Social Psychology. London, England: Methuen; 1923.心理学空间|M9B)U]5T r

15. Gibson JJ.The Senses Considered as Perceptual Systems. Boston, Mass: Houghton Mifflin; 1966

M(S;uO a0

16. Davis MH.Empathy: A Social Psychological Approach. Boulder, Colo: Westview Press; 1996.心理学空间0[lT(X q'Ya

17. Larson EB,  Xin Y. Clinical empathy as emotional labor in the patient-physician relationship.JAMA. 2005;293:1100-1106.心理学空间Z1xC ^w

18. Buccino G, Binkofski F, Fink GR, et al. Action observation activates premotor and parietal areas in a somatotopic manner: an fMRI study.Eur J Neurosci. 2001;13:400-404.


19. Iacoboni M, Molnar-Szakacs I, Gallese V, Buccino G, Mazziotta JC, Rizzolatti G. Grasping the intentions of others with one’s own mirror neuron system.PLoS Biol. 2005;3:e79.心理学空间7?]0@-f-OU_d

20. Farrow TE, Zheng Y, Wilkinson ID, et al. Investigating the functional anatomy of empathy and forgiveness.Neuroreport. 2001;12:2433-2438.心理学空间*H0S#n0TXp&n

21. Singer T, Seymour B, O’Doherty J, Kaube H, Dolan RJ, Frith CD. Empathy for pain involves the affective but not sensory components of pain.Science. 2004;303:1157-1162.


22. Jackson PL, Metzoff AN, Decety J. How do we perceive the pain of others? A window into the neural processes involved in empathy.Neuroimage. 2005;24:771-779.心理学空间w4Wpt\&t

23. Morrison I, Lloyd D, di Pellegrino G, Roberts N. Vicarious responses to pain in anterior cingulate cortex: is empathy a multisensory issue?Cogn Affect Behav Neurosci. 2004;4:270-278.

.K`!A.} ss9}q2Xg$l0

24. Adolphs R. The neurobiology of social cognition.Curr Opin Neurobiol. 2001;11:231-239.

0Oc Wj3]r0

25. Baron-Cohen S.Mindblindness: An Essay on Autism and Theory of Mind. Cambridge, Mass: The MIT Press; 1995.


26. Vollm BA, Taylor AN, Richardson P, et al. Neuronal correlates of theory of mind and empathy: A functional magnetic resonance imaging study in a nonverbal task.Neuroimage. 2005 Aug 22; [Epub ahead of print].

.g p/zJ"?p:Rw3v0

27. Gillberg CL. The Emmanuel Miller Memorial Lecture 1991. Autism and autistic-like conditions: subclasses among disorders of empathy.J Child Psychol Psychiatry. 1992;33:813-842.


28. Shamay-Tsoory SG, Tomer R, Goldsher D, Berger BD, Aharon-Peretz J. Impairment in cognitive and affective empathy in patients with brain lesions: anatomical and cognitive correlates.J Clin Exp Neuropsychol. 2004;26:1113-1127.心理学空间2E5s/[dJJrr

29. Adolphs R, Damasio H, Tranel D, Cooper G, Damasio AR. A role for somatosensory cortices in the visual recognition of emotion as revealed by three-dimensional lesion mapping.J Neurosci. 2000;20:2683-2690.


30. de Quervain DJ, Fischbacher U, Treyer V, et al. The neural basis of altruistic punishment.Science. 2004;305:1246-1247.心理学空间Nd ngyg'PM

31. Stein DJ. The neurobiology of evil: psychiatric perspectives on perpetrators.Ethn Health. 2000;5:305-315.心理学空间f+vP*]f

32. di Pellegrino G, Fadiga L, Fogassi L, Gallese V, Rizzolatti G. Understanding motor events: a neurophysiological study.Exp Brain Res. 1992;91:176-180.心理学空间Z/jw]YA$A-Ow

33. Rizzolatti G, Arbib MA. Language within our grasp.Trends Neurosci. 1998;21:188-194.心理学空间"Lb9kI5}jxqQ}%qx*r]

34. Hutchison WD, Davis KD, Lozano AM, Tasker RR, Dostrovsky JO. Pain-related neurons in the human cingulate cortex.Nat Neurosci. 1999;2:403-405.

sh9Q L1TL.N0

35. Pijlman FT, van Ree JM. Physical but not emotional stress induces a delay in behavioural coping responses in rats.Behav Brain Res. 2002;136:365-373.

t p$[e }^"uW4}N.Vz*F0

36. Insel TR. A neurobiological basis of social attachment.Biol Psychiatry. 1997;154:726-735.

w&Z2sn Xu7S0

37. Meltzoff AN, Moore MK. Explaining facial imitation: a theoretical model.Early Dev Parent.1997;6:179-192.心理学空间aoal}

38. Gallagher S, Meltzoff AN. The earliest sense of self and others: Meleau-Ponty and recent developmental studies.Philos Psychol. 1996;9:211-233.


39. Hoffman MS.Empathy and Moral Development: Implications for Caring and Justice. Cambridge, Mass: Cambridge University Press; 2000.心理学空间 { wYd;q4o,B2h)L

40. Nicols, S. Mindreading and the cognitive architecture underlying altruistic motivation.Mind Lang. 2001;16:425-455.

.T&ci v+?9K A)J*u`0

41. Mehrabian A, Epstein N. A measure of emotional empathy.J Pers. 1972;40:525-543.心理学空间nK3e6@.U)qs@n

42. Baron-Cohen S, Wheelwright S. The empathy quotient: an investigation of adults with Asperger syndrome or high functioning autism, and normal sex differences.J Autism Dev Disord. 2004;34:163-175.

O2`b@I0` A _ D"F0

43. Mercer SW, Maxwell M, Heaney D, Watt GC. The consultation and relational empathy (CARE) measure: development and preliminary validation and reliability of an empathy-based consultation process measure.Fam Pract. 2004;21:699-705.


44. Halpern J.From Detached Concern to Empathy: Humanizing Medical Practice. New York, NY: Oxford University Press; 2001.心理学空间5M hxWiV_

45. Benbassat J, Baumal R. What is empathy, and how can it be promoted during clinical clerkship?Acad Med. 2004;79:832-839.心理学空间 Gm%Usu7H&I

心理学空间)\0W N {:_8rC,{&e(N


Dr. Stein is professor and chair at the University of Cape Town in South Africa and visiting professor at the University of Florida in Gainesville.


心理学空间5s Q iscy1gi'j

Disclosure: Dr. Stein has received grant support/honoraria from AstraZeneca, Eli Lilly, GlaxoSmithKline, Lundbeck A/S, Orion, Pfizer, Pharmacia, Roche, Servier, Solvay, Sumitomo, and Wyeth.


1gPMb*sNev)lL0心理学空间 i'g{-L3fK9`

Funding/Support: Dr. Stein receives support from the Medical Research Council of South Africa.心理学空间,|)^\d4T g9r

心理学空间|,u Mz{R~ aLg

Author’s note: The current case is based on an amalgam of the author’s experiences.

%Rxv#]2L a0
TAG: empathy Empathy 共情
«窥豹诸记之——想着想着就想到了“共情” 共情 Empathy
《共情 Empathy》