Is Compassion Innate? A Psychological Perspective

In this chapter, the author looks at compassion from two psychological perspectives: evolutionary and developmental. Evolutionary psychology proposes that there are three emotion systems: threat/self-protect, drive/reward, and affiliative/soothing. By developing our capacity to mindfully access, accept, and direct affiliative motives and emotions—for others and ourselves—we can cultivate compassion skills to shift our mind toward the affiliative/soothing system and down-regulate the threat/self-protect and drive/reward systems. Developmental psychology further contributes to our understanding of compassion by proposing two behavioural systems: the attachment behavioural system that governs support-seeking and the caregiving behavioural system that governs support provision. It suggests that the interplay between these two systems may account for individual differences in the disposition to compassion. Last, the author shows that compassion not only benefits the recipients, but also improves the psychological health of the caregivers.

A Wholistic Approach to a Compassionate and Flourishing Life

In this chapter, the author looks at some additional ingredients that are essential for leading a compassionate, flourishing life. They include psychological well-being, ethics, and moral resilience, as well as social engagement and principled compassionate actions. The author shows that counselling, coaching, and psychotherapy can bring about additional clarity, openness, and deep healing. The author also looks at the importance of moral resilience to deal with moral challenges that include moral uncertainty, moral conflict, and moral dilemma. The author shows that moral development consists of four components: moral sensitivity, judgment/reasoning, motivation, and character/courage, and describes how following the precepts could aid in moral development and building moral resilience. Last, the author shows that a truly transformative approach to living a compassionate life needs to address not only our personal relations to suffering, but also acknowledge that personal suffering has societal causes which require us to be socially engaged through principled compassionate actions.

Is Compassion Innate? Spiritual and Eastern Perspectives

In this chapter, the author begins with an overview of compassion from different spiritual perspectives and develops an appreciation that although each tradition expresses it differently, compassion can be summed up aptly by the Golden Rule: “Do unto others as you would have them do unto you.” The author shows that the principle of compassion lies at the heart of all religious, ethical, and spiritual traditions, calling us always to treat all others as we wish to be treated ourselves. The chapter then dives deeper into the Eastern perspectives on compassion, with special attention given to the Buddhist view because many contemporary secular compassion training programs borrow the mind-training tools that originate from Buddhism. The author reviews the four immeasurables—loving-kindness, compassion, sympathetic joy, and equanimity—that are commonly practised together in the Buddhist tradition. Last, the author reviews the three different types of compassion—referential, insight-based, and nonreferential—in the Buddhist context.

What Are the Obstacles to Compassion?

In this chapter, the author examines the obstacles that impede the flow of compassion in three directions: for others, from others, and from self. Obstacles to compassion for others include insecure attachment style, personal identity, self-interests, social dominance orientation, moral judgment, confusing compassion with submissiveness or weakness, empathy fatigue, time pressure, and scale of suffering (including psychophysical numbing, pseudo-inefficacy, and prominence effect). Obstacles to receiving compassion from others include activation of grief responses, perceived weakness, and vulnerability. The author also looks at what inner compassion is and how self-criticism hinders it. Finally, the author also discusses the barriers to compassion that are unique to the healthcare environment, including self-recrimination and self-neglect, empathic distress and empathy fatigue, moral suffering, bullying, burnout, medical culture, and cognitive scarcity.

What Does It Take to Cultivate Compassion?

In this chapter, the author reviews some skills that help us to cultivate compassion. They include training in the development of cognitive, attentional, affective, and somatic skills that draw on both contemplative and scientific disciplines. The author reviews two powerful models for cultivating compassion—the A.B.I.D.E. and G.R.A.C.E. models—that enhance compassion at a personal level. The author also looks at some strategies to cultivate inner compassion based on an extension of cognitive-behavioural therapy. The author then explores techniques that enhance compassion at an interpersonal level (compassionate leadership to build a compassionate culture) and a system level (compassionate healthcare). Last, the author reviews the benefits of compassion in healthcare, including the physiological and psychological benefits on patients, how it acts as an antidote to burnout for healthcare professionals, and how compassion benefits the healthcare system by improving quality, increasing revenues, and reducing costs.

What Are Empathy and Compassion? A Western Perspective

In this chapter, the author examines the definitions of empathy and compassion, including self-compassion, and explains why “compassion fatigue” is a misnomer. Although empathy and compassion are distinct, they have been used interchangeably, which has helped perpetuate the common misconception that compassion is finite and emotionally draining. The author illustrates that “empathy fatigue” is a better term to describe the empathic distress and burnout that are widespread in healthcare. The chapter also looks at how empathy and its precursors (found in primitive mammalian species) evolved over time into compassion, which requires higher order executive functions that are found in primates only. The chapter explores how humans became successful as a species because of our nurturing, altruistic, and compassionate attributes that have evolved over millions of years.

East Meets West

In this chapter, the author explores the relevant brain networks and their plasticity in response to mindfulness and compassion training. The chapter begins by reviewing how foundational mindfulness practices, in the form of focused attention and open monitoring, set the stage for compassion/loving-kindness training by modulating attentional resources (in the attention networks), regulating emotion processing and control (in the limbic system), and altering self-referential processing (in the default mode network). The author then reviews the unique effects of compassion/loving-kindness training on different brain areas that result in increased receptivity to others’ emotions, enhanced positive affect and reward processing, and increased motivation for prosocial connection. The author shows that “compassion fatigue” is a misnomer because the neural mechanisms underlying empathic distress and compassion are distinct, with empathic distress activating the brain network involved in pain processing and compassion activating the pleasure and reward system. The author concludes that compassion is both innate and a trainable skill, exerting its effects through neuroplasticity.

Is Compassion Innate? A Physiological Perspective

Three interrelated biological subsystems subserve compassion: the autonomic nervous, neuroendocrine, and central nervous systems. The autonomic nervous system—the newly evolved ventral myelinated vagus nerve of the parasympathetic nervous system—allows moment-to-moment fine-tuning of physiological and emotional regulation to promote social engagement behaviours. The neuroendocrine system—the hormones and neurotransmitters vasopressin and oxytocin—facilitates kinship and clan emotional bonding. The central nervous system—an enlarged neocortex (including the prefrontal and cingulate cortices)—allows improved self–other differentiation and the ability to understand another’s emotion. The author reviews the first two subsystems in this chapter, showing that compassion is innate. However, it could be obscured by the adversity of individual experiences and by social context or conditioning. The author also shows that the physiological mechanisms that underlie the expression of compassion in the giver also elicit similar effects in those who receive and benefit from it.