Zero Degrees of Empathy PDF

their facial expression) ‘catch’ the same feeling of fear; or when one baby cries in a maternity ward, triggering other babies to start crying. Again, one can imagine this type of ‘contagion’ happening without needing to think consciously about another’s feelings. As I indicated earlier in the chapt...

their facial expression) ‘catch’ the same feeling of fear; or when one baby cries in a maternity ward, triggering other babies to start crying. Again, one can imagine this type of ‘contagion’ happening without needing to think consciously about another’s feelings. As I indicated earlier in the chapter, I reserve the term ‘empathy’ for more than these rather simple phenomena. Empathy seems to be more than just this automatic mirroring. Both the ‘automatic’ mirroring systems and the more ‘conscious’ neural systems involved in explicit understanding of mental states, emotions, and how others are related to oneself, interact with each other. 24 , 73 , 74 The last region (but in many ways the jewel in the crown) in the empathy circuit is the amygdala, situated beneath the cortex in the ‘limbic system’. It is involved in emotional learning and regulation processing. 75 , 76 University of New York neuroscientist Joseph LeDoux situates the amygdala at the centre of ‘the emotional brain’ 77 because of his extensive studies in relation to how we learn to fear something. xviii (His fascination with the amygdala and his love of music prompted him to form a band called The Amygdaloids! xix ) I had the pleasure of meeting Joe when he visited Cambridge in 2009. A key piece of evidence for the role of the amygdala in empathy came from a study we carried out back in 1999, when we asked people whilst lying in the fMRI scanner to look at pictures of other people’s eyes to make judgements about their emotions and mental states. One brain region that was clearly activated was the amygdala. 80 Another clue that the amygdala is part of the empathy circuit comes from a famous neurological patient, known by her initials, S. M. She has very specific damage to both of her two amygdalae (we all have one in each hemisphere). Despite having good intelligence, her main difficulty is not being able to recognize fearful emotions in others’ faces. 81 This difficulty S. M. has in recognizing fearful faces is related to the fact that the eyes are critical for recognizing fear in someone’s face. S. M.’s damage in the amygdala affects her ability to make eye contact, which is why she has difficulty recognizing fearful faces. 82 We know this because, when directed to attend to the eyes, she regains the ability to recognize fearful faces. 83 S. M. reminds us how key the amygdala is in cueing us to attend to the eyes, which gives us clues to other people’s thoughts and emotions. This completes our brief tour of the ten major brain regions involved in empathy. xx Many of the regions involved in automatically coding our own experience are also automatically active when we perceive others acting or xxi having similar experiences. Similarly, the regions involved in consciously thinking about someone else’s mind are also active when thinking about our own mind. xxii These regions allow us to talk about an empathy circuit in the brain. As a circuit, these ten waystations are not connected in any simple linear fashion (like a string of pearls in a necklace), since there are multiple connections between regions too. Finding that these regions vary in activity in different individuals according to the person’s particular level of empathy 73 takes us back to the idea of empathy varying like a dimmer control, and gives us a direct way of explaining people who have little or no empathy. What we should expect is that someone who is way down the empathy bell curve should show far less neural activity in parts or all of the empathy circuit. We’ll be looking at precisely this prediction shortly. So have we got any closer to explaining how people can be cruel to others? Can we now replace the term ‘evil’ with the term ‘empathy’? Not yet. So far all we have is some evidence that people can score very low on the EQ, and we now have a list of brain regions whose functioning determines how much empathy a person will show. But this is not yet a satisfying explanation for several reasons. First, we need proof that these regions ‘go down’ in people who commit acts of cruelty towards others. Second, we need a clearer portrait of what people are like who score superlow on the EQ. Third, we need to know if there are different routes to arriving at zero degrees of empathy. And, lastly, we need to know what the environmental or biological factors are that can cause the empathy circuit in the brain to malfunction. If we can explain how this happens, we will have solved our quest to explain the extremes of human cruelty. 3 When Zero Degrees of Empathy is Negative What is zero degrees of empathy like? What does it mean to have no empathy? And does this translate into what some people call ‘evil’? Zero degrees of empathy means you have no awareness of how you come across to others, how to interact with others, or how to anticipate their feelings or reactions. Your Empathy Mechanism functions at Level 0. It leaves you feeling mystified by why relationships don’t work out, and it creates a deep-seated self-centredness. Other people’s thoughts and feelings are just off your radar. It leaves you doomed to do your own thing, in your own little bubble, not just oblivious of other people’s feelings and thoughts but oblivious to the idea that there might even be other points of view. The consequence is that you believe 100 per cent in the rightness of your own ideas and beliefs, and judge anyone who does not hold your beliefs as wrong, or stupid. Having zero degrees of empathy is ultimately a lonely kind of existence, a life at best misunderstood, at worst condemned as selfish. It means you have no brakes on your behaviour, leaving you free to pursue any object of your desires, or to express any thought in your mind, without considering the impact of your actions or words on another person. In the extreme case, it might lead you to commit murder or rape. In the less extreme case (close to zero, such as Level 1 or 2) it might lead you to be verbally abusive, or just to talk way too much, or to overstay your welcome. These are clearly different levels of empathy deficit, since the person who is simply verbally insensitive may realize it’s not nice to physically hurt someone else. But even the verbally insensitive individual can be close to zero on the EQ. Zero degrees of empathy can lead one to commit acts of cruelty, or it can leave one insensitive to others, or it can leave one simply socially isolated. This underlines that zero degrees of empathy does not equate to what some would call ‘evil’. But for those who come into the orbit of someone with such depleted empathy it means the risk of being on the receiving end of verbal insults, physical attacks, or experiencing a lack of care or consideration – in short, at risk of getting hurt. Zero degrees of empathy does not strike at random in the population. There are at least three well-defined routes to getting to this end-point. In this chapter I put forward a new view where I take old categories from psychiatry and reconceptualize them as examples of zero degrees of empathy. I group these as Zero-Negative because they have nothing positive to recommend them. They are unequivocally bad for the sufferer and for those around them. As we meet each of these, and look at their brains, we can see if it really is the case that, however you lose your empathy, if you are Zero-Negative the same underlying empathy circuitry in the brain is affected. Figure 6: Three forms of Zero-Negative We are slowly going to look into each of the three circles shown in Figure 6, but we need to go one step at a time. The first form of Zero-Negative is called borderline (or Type B). CAROL: ZERO-NEGATIVE TYPE B Carol is thirty-nine years old. I met her when she came to our diagnostic clinic in Cambridge. (I have disguised details of her life for reasons of confidentiality.) She is classed as borderline. To give it its full name, she has Borderline Personality Disorder. For as long as she can remember, and certainly going back into early childhood, she has felt her life was ‘cursed’. As she looks back on her stormy childhood, her unstable teens, and her crisis-ridden adulthood, she contemplates her lifetime of depression. Her relationship with her parents has been punctuated by periods of years during which she did not speak to them at all. She is aware that she has a huge reservoir of hatred towards her parents, who she feels maltreated her and who were never really parents towards her. However nice people are to her, she feels she can never quench this simmering rage which even today can come out as hatred towards anyone she feels is disrespecting her. Often people she perceives as disrespecting her are simply people who disagree with her, and she senses that they are doing this in a confrontational way. In this way, there is a distortion or a bias in how she reacts to others, assuming they are treating her badly when they are not. If her children don’t do what she says, she screams and swears at them, saying: ‘How dare you treat me with such disrespect? You can just fuck off! I hate you. I never want to see you again. You can just look after yourselves. I’m through with the lot of you! You’re evil, selfish bastards! I hate you! I’m going to kill myself! And I hope you’re happy knowing you made me do it!’ She will then storm out, slamming the door behind her. Minutes later, she will drive to one of her friends and spend the evening having fun, leaving her children reeling with the impact of her hurtful words. When her hatred and anger bubble up, there is no chance of her stopping it coming out. It bursts forth with venom, designed to hurt whoever’s ears the words land on. Her own feelings are so strong that there is no space in her mind to consider how her children might feel, being told by their mother that they are evil. The irony of Carol’s behaviour is that, in accusing others of selfishness (because their will does not accord with hers), she herself behaves with absolute selfishness. If parenthood is defined by being able to put your own needs second to those of your child, she is totally ill equipped for parenthood. For Carol, her own needs are paramount and her children’s needs (or anyone else’s for that matter) never even feature on her radar. While her children are recovering from the bruising impact of her outburst, she is meantime laughing and partying with her friends in a café in town. When she comes back home, she either acts as if nothing has happened or refuses to talk to her children (or whoever provoked her rage) until they have apologized to her. Hate and anger are not Carol’s only problems. She also has major difficulties in interpreting other people’s behaviour and emotional expressions (in their face, voice or gestures). She thinks she knows exactly what others are thinking or feeling, but her empathy is twisted and distorted by a bias which leads her to assume other people are thinking hostile thoughts and harbouring hostile intentions towards her. If someone is silent, even for a few minutes, she assumes they are being aggressive. If someone makes a joke, she assumes the other person is attacking her. If someone is caring, she assumes it is not meant. If someone apologizes, she assumes this too is not genuine. She will lash out with her accusations at other people’s insincerity so that, no matter how hard they try to persuade her that they care or are sorry for their apparently hurtful actions, she does not accept their well-intended approaches and pushes them away. The fact that other people feel bullied and controlled by her tyrannical, self-centred behaviour does not even occur to her. Carol is extremely difficult because her behaviour is so impulsive and explosive, but she also carves an extremely sad figure: At an age – thirtynine – when she should feel confident and a sense of achievement with her efforts, she has instead ended up feeling distrustful of close relationships, constantly disappointed by others, and believing she has been victimized by others. To those who know Carol, her emotions are like a rollercoaster. She lurches from feeling lonely and depressed, to feeling totally happy, to feeling rage towards others. She goes out to clubs at night, dancing with strangers in the hope of finding a new close relationship. Some of these closer relationships develop into sexual relationships. She enjoys the idea that others find her attractive, and wants to feel close to someone. However, as soon as she is in a relationship she starts to sabotage it by initiating conflict. She will look for problems in the relationship, constantly asking ‘Why don’t you communicate?’ and ‘Why don’t you care about me?’ Despite her latest lover, John, trying to reassure her that he does care, or replying that he does communicate, Carol will insist that he does not. When John gives her time to sit and talk, she argues that it is not ‘real’ communication. If he tries to defend himself, she accuses him of being ‘switched off’ or ‘not really connecting with my pain’. She says that if he truly loved her, he would know how much she was hurting inside. She insists that he hates her, and taunts him to hit her, to prove that he hates her. After she has screamed at him and sworn at him, she will throw her arms around him and ask him to make love to her, begging him to ‘promise me you’ll never leave me!’ She frequently threatens to kill herself. On the last occasion, she ran outside at 3 a.m., claiming that John didn’t care enough about her, and that ‘this time I am going to do it’. He spent hours that night searching the local public parks, desolate car parks, waste land or other places where in the past she has run off to, to try to find her and console her and ask her to come back. Unsurprisingly, these unstable relationships tend not to last. Within her marriage, she poured scorn on her husband, Mike, who she accused of making her feel insignificant, unimportant and invisible, as if she did not exist. When he replied that she does matter, she said, ‘You’re just like everyone else. You’ll leave me in the end, just like everyone else does.’ If Mike tried to comfort her by putting his arm around her, she pushed him away, saying he was suffocating her. She hates men touching her and does not want to be a wife, fearing it will take over her identity. She pushes away anyone who wants to get near her. She is totally self-absorbed, talking unstoppably about herself and her thoughts, with no real interest in other people’s thoughts. If in bed her lover touches her, she removes his hand and tells him not to cross the midline of their bed. She tells him, ‘You think you’re so fucking important, just because you’re at the top of the tree.’ She says to him that in his presence she feels she is ‘a nobody’, and that he makes her feel like she is a ‘piece of shit’ and that the world would be better off if she was dead. She says she longs to be free of this life of pain, and that one of these days she will ‘do it’. If John withdraws from her she hurls abuse at him, saying ‘There! I told you you didn’t care about me!’ If he tries to get close to her, she tells him to ‘go away and leave me alone. You don’t really care about me.’ It is not hard to see why this is a clear case of Zero-Negative. Carol’s empathy is at ground zero, and there is nothing good about being in such a state. She has few friends, a situation not helped by the fact that she despises other women. When she is alone she says she feels ‘abandoned’ and feels terrible levels of anxiety she can get rid of only through comfort eating, sex, alcohol, or aggression. She can act as a mature woman one minute, and the next she can shift dramatically into being curled up like a little girl. She can appear calm and reflective, and then the next minute she can be highly manipulative (‘Do this or else I’ll take you to court …!’). One minute she can slam her friend’s door, saying ‘I’m never coming back’, only to return the next week as if nothing had happened. She treats her few friends in the same hot and cold manner: one minute she tells them they are her best friend, the next minute she accuses them of disloyalty, claiming the friendship is false, and that they are evil. This gives you a snapshot of Carol’s current behaviour. The hallmark of borderlines is a constant fear of abandonment, emotional pain and loneliness, hatred (of others, and of themselves), impulsivity and selfdestructive, highly inconsistent behaviour. Jerold Kreisman and Hal Straus 90 summarize borderlines in the title of their book – I Hate You, Don’t Leave Me. This neatly sums up the contradictory behaviour in borderlines. So how did Carol end up as Zero-Negative? What is the route to becoming borderline? And does being borderline mean you inevitable treat people cruelly? Carol’s development When Carol was a baby, her mother used to ignore her. She thought it would just spoil children to give them attention, that to show them affection was to ‘make a rod for your back’, by which she meant that the child would then expect love and become clingy. She breastfed Carol for just one week after she was born, and then passed the baby to a nanny to feed by bottle, saying she was too busy to look after the baby. She felt she had done her duty as a mother to have breastfed, but she got no maternal pleasure from such physical intimacy. She was proud of how Carol as a toddler showed independence, could be left alone for hours, or even all day, and did not cry, and she prided herself in having trained Carol to learn that crying did not bring her mother or lead to being picked up and cuddled. ‘Children have to learn who is boss’, she would say. Carol was hit constantly if she didn’t do what her mother ordered her to do. Carol can remember in her childhood frequently being sent from the table if her table manners were not to her mother’s standards, and her mother would then say, ‘bread and water only, and stay in your room for a whole day’. If Carol cried at one of her punishments, she was threatened with being beaten with a belt, which her mother also used with the pet dog to control him. Carol recalls her mother showed no maternal affection, would never hug or kiss Carol, and constantly put her down, using criticism in public. She overtly favoured Carol’s younger sister. At the age of eight, Carol was sent to boarding school, where she felt lonely and was withdrawn and socially anxious. Her mother felt she had completed her maternal duty and that children needed to learn to stand on their own two feet. As a result, Carol grew up looking after herself from at least the age of eight, if not before, knowing that her mother was never around to care for her. She taught herself to read and figured out how to use the washing machine and clean the house, because her mother never did anything domestic. She would cook her own meals, clean the house, and cry herself to sleep every night. Carol remembers her father being at times affectionate but also depressed, often away for long periods, his love unpredictable. She remembers the physical fights her parents had, while she would hide under her bed and block out the world with her fingers in her ears. Carol’s parents divorced when she was nine, and during her adolescence she hardly came home. When she wasn’t at boarding school she would stay with friends, or come home to an empty home, as her mother was always out. She started having sexual relationships early, aged fourteen, in a desperate attempt to be loved. She turned to drugs, initially cannabis, but later ‘acid’, to escape her depression, and remembers how every day in her childhood she wished she could die, feeling that life was a struggle from which she wished she could exit. When Carol was sixteen she was sitting in a café one day. She befriended a man in his forties who was sitting alone, and started pouring out her life story to him. He in turn told her of his difficult marriage, and his depression, and he asked her to be his friend. She identified with his sadness, and was flattered at being wanted by him. He asked if she would come back to his apartment that evening to check a letter he was writing to his wife, and she willingly agreed. When she arrived later that evening he locked the door behind her and said how beautiful she was, and asked her to go to bed with him. She was frightened and did not want to, but said nothing while he had sex with her. After it was all over she felt she had been raped and that she had been being treated ‘like dirt’, but told no one. She felt as if this was what her life was destined to be like – she described it as ‘her curse’. At the age of eighteen she started cutting herself to escape her depression, drinking before going to clubs, and was surprised at how she couldn’t remember how she ended up in different men’s beds. After one such sexual encounter she became pregnant. She decided to keep the baby but developed post-natal depression when the baby was born. Her baby was taken into care, as she was unable to look after her. Four years later she married Mike, a man who offered to look after her, and had two more children with him, though the relationship – if it was ever there – did not last beyond a few short years. She soon simply used Mike to pay the bills, look after the children, and look after her, while she went out most nights clubbing. Her friendships are short-lived and are based on what she can get out of them. She doesn’t want to hear about other people’s problems. All she cares about is herself. Stepping back from Carol Carol had a terrible childhood and adolescence. More than a century of research into the effects of early deprivation has clearly established that such environmental factors affect brain development, probably irreversibly. We need to ask: what makes us say she is borderline (or Type B)? And what are the consequences for behaviour in someone who is borderline? According to psychiatrists, borderline is a highly specific form of personality disorder, different to other varieties. Borderlines, it turns out, are pretty common: they make up around 2 per cent of the general population. Among those who turn up for counselling or psychiatric help, it is even more common: about 15 per cent are borderline. Among people who commit suicide, about a third are borderline. And if you look in clinics for those with eating disorders, alcoholism and drug abuse, Type B may be present in as many as 50 per cent. 91 93 – The hallmarks of borderlines are self-destructive impulsivity, anger and mood swings. (You can see the list of ‘symptoms’ for borderlines in Appendix 2.) Borderlines also tend to think in very black and white ways (so-called ‘splitting’), so that people are ‘all good’ or ‘all bad’. (This may be why borderlines can be particularly attracted to cults, as the cult leader is seen as all good.) Borderlines are also very manipulative, for example acting as if they are weak and helpless, or using sexual seduction, or threatening suicide to get attention. In terms of the two major components of empathy (recognition and response) it may be that Type Bs have difficulties in both – they are certainly failing to react to others with an appropriate emotion, and it may be they also have difficulty reading intentions and emotions in faces accurately. Among borderlines in clinics, 70 per cent have attempted suicide before arriving in the clinic, and on average borderline patients attempt suicide at least three times in their life. For this reason, borderlines are said to have ‘the most lethal psychiatric disorder’. 94 98 – Distinguishing between those who ‘merely’ threaten suicide to get attention (but have no intention of carrying it out) versus those who actually plan to carry it out can be tricky. About 10 per cent of borderlines actually commit suicide, while the other 90 per cent just threaten or attempt it. Threatening to commit suicide is clearly not an empathic thing to do to another person. Whether the 10 per cent who succeed actually meant to succeed is also unclear, since it could just have been an attention-seeking impulse that went disastrously wrong. But it leaves others in a quandary: if your partner or relative threatens suicide, do you just dismiss it as attention seeking and ignore it? Or do you get swept up into the panic and the emergency of the situation, just in case this time he or she really means it? 99 Borderlines rage towards those they love. When people say it is a thin line between love and hate, in borderlines that thin line becomes infinitesimal! Despite all this rage, they describe themselves as ‘empty’ inside. They will tell you quite openly that the empty feelings cause a terrible emotional pain and depression. And they will tell you that the impulsive behaviour (the drinking, drugs, self-mutilation, sexual promiscuity, binge eating, gambling or suicidal attempts) are all just to get some brief relief, a desperate attempt to feel something, anything, rather than feel the emptiness. Borderlines also tell you that that feeling of emptiness leaves them with a lack of core identity. Life feels like an act, as if they are continuously pretending to be someone else. And in the same way that deep down they don’t know who they are, they also find it difficult to figure out who other people are. It is as if the problem they have in thinking about themselves mirrors the problem they have thinking about others as whole people. Instead, they focus either on the good parts of others, or their bad parts; they cannot seem to see a person as both good and bad. Those they love can switch from being perceived as perfect to being perceived as evil, even in minutes. People are either idolized, or devalued. This ‘splitting’ is sometimes thought of as a Freudian defence mechanism, though another view is as a sign of a mind that thinks in a very binary way; there are no shades of grey. Marilyn Monroe A well-known borderline was Marilyn Monroe (baptised Norma Jeane Baker). Despite her glamorous outward appearance, a volcano simmered within her. Elton John wrote his famous song ‘Candle in the Wind’ to describe her, which succinctly summarizes how impulsively changeable she was. Norma was born in 1926 and her parents divorced in 1928. She always claimed she didn’t know who her real father was. Norma’s mother Gladys, because of her mental health, gave her away for fostering to the Bolender family, where she lived until she was seven. Norma believed the Bolenders were her real parents until she was told the truth at this age. Gladys came back into her life and her daughter went to live with her again, but after Gladys was admitted to a psychiatric hospital, her mother’s friend Grace became Norma’s guardian. Grace married a man called Ervin Goddard when Norma was nine years old, so the young Norma was sent to the Los Angeles Orphan Home and a series of foster homes. Two years later she went back to live with Grace but was sexually molested by Goddard. Norma was married three times, first to neighbour James Dougherty in 1942 when she was sixteen years old. He agreed to marry her to avoid her being returned to the orphanage. The marriage lasted only three years. She remarried in 1954, to baseball player Joe DiMaggio, but this time the marriage lasted less than a year. Very soon after, in 1956, she married playwright Arthur Miller, who described her as follows: ‘She was a whirling light to me then, all paradox and enticing mystery, street-tough one moment, then lifted by a lyrical and poetic sensitivity that few retain past early adolescence.’ 100 Throughout her life she hated being alone, and was terrified of being abandoned. In adulthood she was in and out of psychiatric clinics, and attempted suicide at least three times. She finally succeeded in killing herself (overdosing on barbiturates) on 5 August 1962. But let’s return to our main objective here: to understand this form of zero degrees of empathy. As we heard in both Carol’s case and Marilyn Monroe’s life, borderlines cannot tolerate being alone. For them, aloneness feels like abandonment, and to avoid that awful feeling the person will seek out other people, even relationships with strangers. But, whoever they are with, borderlines either feel suffocated (by someone getting close to them) or abandoned (by someone being distant from them). They cannot find a calm middle ground in which to enjoy a relationship comfortably. Instead they go through an unhealthy alternating sequence of pushing others away (with angry hate), or clinging desperately to them (with extreme gratitude). Borderlines were first described in 1938 by Adolf Stern, who saw the condition as borderline between psychosis and neurosis (a mild form of