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Home » Helen Riess: The Power of Empathy at TEDxMiddlebury (Full Transcript)

Helen Riess: The Power of Empathy at TEDxMiddlebury (Full Transcript)

Helen Riess at TEDxMiddlebury

Here is the full transcript of Dr. Helen Riess’ TEDx Talk: The Power of Empathy at TEDxMiddlebury conference.

Listen to the MP3 Audio here: the-power-of-empathy-by-helen-riess-at-tedxmiddlebury


Even before I became a psychiatrist, I have always been fascinated by human connection: What makes us connect with others and what makes us disconnect? All of us at some point have been on a plane when we have just settled into our novel, we’re listening to music or getting our work done when suddenly the air is pierced by the sound of a shrieking baby.

Now I have watched all kinds of reactions to this from the very sympathetic look toward the parents to people who looked mildly annoyed or even frustrated to others literally racing each other to the one empty seat at the front of the plane to get away from this noise.

But on a recent trip to the West Coast, I saw the most amazing reaction of all: a little three-year-old boy wiggled out of his seat, toddled over to that screaming baby and offered him his own pacifier. Wow! I thought — now that little boy really heard and felt that baby’s distress. And isn’t that what all of us want to be seen and heard and to have our needs responded to? That’s the essence of empathy.

So about 10 years ago, a student of mine called me up with a fascinating idea. He wanted to find out whether when there was empathy between people, whether their heart rates and other physiological tracers actually matched up in concordance. And he wanted to recruit many doctor-patient pairs who were willing to have their sessions videotaped and to be hooked up to monitoring during those sessions.

It took a bit of arm twisting for me to agree to do this but it turned out to be a career-defining decision. One of my patients who agreed to participate was a young college woman who had come for help with weight loss. She made progress in many areas but not this one.

So we were hooked up to this skin conductance monitoring which it turns out actually can show whether two people are in sync as you see on this slide where the physiology actually mirrors one another between the doctor and the patient, or if they’re out of sync or if there’s discordance.

So later that afternoon, my student called up and he said, ‘You’ve got to come over and see this’.

So I went down, I looked at our tracings and I was blown away. This calm, very self-confident appearing woman, very articulate turned out to have massive anxiety. So our tracings were actually quite in sync, except that hers was going like this while mine was going like this.

And I had not realized what was going on inside of her. When I showed the tracing to her, she said, ‘I’m not surprised by this at all. I live with this every day but no one has ever seen my pain’. Not only as her doctor but as a fellow human being, this moved me to the core.

So I went back, watched that video, this time as an emotion detective and tried to see what was happening, because clearly I had missed something. I noticed that the highest peaks of her tracings coincided with the subtle motor movements, such as just flicking her hair or looking down in a way or subtle changes in her tone of voice.

Our work continued and as I paid attention to these signs and responded to them, our work went to a much deeper level. She unburdened herself emotionally and started to exercise for the first time in her life. And this woman who had only gained weight and never lost weight before, went on to lose almost 50 pounds in the next year.

This was groundbreaking for her. It was also groundbreaking for me, because I realized that with this careful attention, I had learned to be more empathic. Now back then everyone thought that empathy was something that we were born with or without, and that we were kind of stuck with whether we were or we weren’t.

Imagine what implications there were if doctors, nurses, teachers, employers, parents, boyfriends and girlfriends could learn to be more empathic with each other. So I learned everything I could about the neuroscience of empathy and this was a very growing field at the time.

And through what I learned, I developed empathy training and this training was grounded in the neurobiology of emotions and empathy. And the training went on to be tested in a randomized control trial at Massachusetts General Hospital where doctors that were rated by their patients were rated much more higher if they were trained on: My doctor really listened to me, really showed care and compassion, treated me like a whole person and understood my concerns some of the components of the empathy skills than the untrained doctors.

So this seemed like a very important message to get out, because some of my training is just about opening your eyes to the receptive and perceptive aspects, then into the empathic responses. To make it easier, I created the acronym EMPATHY which actually lends itself to remembering the key pieces of how we connect to people.


So the ‘E’ stands for eye contact. Eye contact is usually the first indication that we’ve been noticed by someone even though cultural norms can vary. Also eye-gaze goes back as early as maternal infant bonding. It turns out that the infant’s sharpest focal point is 12 centimeters which is the exact distance between a baby’s eyes and the mother’s eyes when the baby is held like this.

Eye-gaze is also important when we say hello or greet one another. In our country our greeting is usually hi or hello. In the Zulu tribe, the word for hello is Sawubona, which means I see you. Every human being has a longing to be seen, understood and appreciated. And eye-gaze is the first step toward this.

The ‘M’ stands for muscles of facial expression. The human face is a one part of us that we almost never fully cover up. Our faces are actually a roadmap of human emotion, and because of this, our facial expressions cannot only save our lives but can actually preserve our species.

Imagine the disgusted look on someone’s face who’s just eating rotten food and can signal to a whole tribe to stay away and save them from getting sick or dying, or the look of startle in your friend’s face just before a baseball is about to hit you in the head and you might move just in time not to get hit. Also, the flirtatious glance that’s returned may be the first sign that you have just found the love you’re looking for.

The ‘P’ stands for posture. Posture is another powerful conveyor of connection. Our open or closed posture signal powerful approach and avoidance signals to others. In one study, doctors who were told to sit down on rounds were rated as much warmer, more caring and estimated to have spent three to five times longer with their patients than doctors who stood up but used the exact same words.

The ‘A’ stands for affect. We are trained to label our patients’ affect as a way of orienting ourselves to the emotional experience of the person. Affect is the scientific term for expressed emotions. When you’re with someone, try just sort of labeling, you know is Jack upset? Is Jane excited? Is Sally upset? And it will change how you hear what they’re saying.

The ‘T’ stands for tone of voice. We have all heard the crack in someone’s voice who is about to cry. We’ve also heard the edge in someone’s voice who’s about to get angry. The area in our brain stem that’s responsible for the fight and flight response is the same area where the nuclei for tone of voice and facial expression reside.

This means that when we are emotionally activated, our tone of voice and our facial expressions change without our even trying. So this means that our emotions are constantly kind leaking out for all to see but some people’s emotions are a little more concealed than others. But with careful looking we can hear and see what these emotions are.

The ‘H’ stands for hearing the whole person. Far more than the words that people say, hearing the whole person means understanding the context in which other people live. It also means keeping your curiosity open and not judging until you really understand where that person is coming from.

The ‘Y’ stands for your response. We respond to other people’s feelings all the time. We might think that we only experience our own emotions but we’re constantly absorbing the feelings of others. It turns out that a helpful guide is that most feelings are actually mutual.

Think about how you feel when you’re in an airport and you see a mother embracing her son who has just returned from active duty. Think about how you feel when you see the face of a father who has just lost his daughter to dating violence. Think about how you feel when you see the looks on people’s faces who have lost their homes to hurricanes and tsunamis and the look on parents’ faces who have just lost their children to school shootings.

Our inner experience and feelings mirror those of others. Our human brain is actually hard wired for empathy, because our survival depends on it. We reflect the feelings of others, because that’s what is required for our survival. We all are here more because of mutual aid and cooperation than because of survival of the fittest.

If we were only wired for survival of the fittest, we’d be wired to dominate others and to only look out for ourselves but that’s not how we are made. As the Dalai Lama said ‘love and compassion are necessities, not luxuries. Without them, humanity will not survive’.

So how does this all work? We’ve all heard the expression, ‘I feel your pain’. Now for a moment, imagine you’re in a parking lot and you’ve just seen someone’s hand get slammed in a car door. Now I’ve seen people flinch even though nothing’s actually touched them and most people will actually feel like something physical just by imagining.

Neuroscientists have done some amazing studies trying to map the substrate of empathy. In one study, 16 couples were recruited and the women were put in head scanners while they received painful electric shocks to their hands. As you can see here the area in green represents that the entire pain matrix lit up when they received the shocks.

Later they were told that their partners had just received the same similar shocks to their hands. And you see the area in red represents almost the entire pain matrix just knowing that someone else is in pain. Our brains are working with shared neural circuits, shared neurons and some mirror neurons so that we actually have an internal experience of what happens to others.

So when we hear the expression ‘I feel your pain’, it’s not just a figure of speech. We are made for this and it happens not just with our loved ones. We are at a critical precipice with technology. Outsiders coming in and observing our society might guess that we have more intimate relationships with our smartphones than we do with our significant others.

Cyberbullying is probably on the rise because it is much easier to inflict harm on people whose pain you never see. It is much harder to have a meaningful conversation if what you’re used to is 140 character tweets and how do you know whether to say do you need for me to come over if what you’ve just gotten is a text that says ‘lousy day’ with an emoticon.

As Jonathan Safran Foer said, ‘When we accept diminished substitutes we become diminished substitutes’. So the good news about empathy is that when it declines it can also be learned. Employers who want to have an engaged and productive workforce need to get tuned in to the people. Patients who don’t feel cared about have longer recovery rates and poor immune function. Students who are disengaged are more likely to drop out, and marriages without empathy are more likely to fail. So empathy matters in every corner of your life.

As the Zulu say not hello but I see you. We all need to see each other to bring out the full potential in others. Most people need to have their specialness reflected back in the eyes of others in order to see it themselves. Everyone in this audience has the power to do this and when we empower others we can collectively come together to bring our best selves to solve the world’s biggest, smallest and most vexing problems. That is the power of empathy.


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