That example is a microcosm for work in the Conceptual Age. Work that can be reduced to rules—whether the rules are embedded in a few lines of software code or handed to a low-paid overseas worker—requires relatively little Empathy. Such work will largely disappear from countries like the United States, Canada, and the United Kingdom. But the work that remains will demand a much deeper understanding of the subtleties of human interaction than ever before. No surprise, then, that students at Stanford Business School are flocking to a course officially called “Interpersonal Dynamics” but known around campus as “Touchy-feely.” Or consider a field not typically known for emotional literacy—the practice of law. Much basic legal research can now be done by English-speaking lawyers in other parts of the world. Likewise, software and Web sites, as I explained in Chapter 3, have eliminated the monopoly lawyers once had on certain specialized information. So which lawyers will remain? Those who can empathize with their clients and understand their true needs. Those who can sit in a negotiation and figure out the subtext of the discussion that’s coursing beneath the explicit words. And those who can look at a jury, read their expressions, and instantly know whether they’re making a persuasive case. These empathic abilities have always been important to lawyers—but now they’ve become the key point of differentiation in this and other professions.
“People who lean on logic and philosophy and rational exposition end by starving the best part of the mind.”
—WILLIAM BUTLER YEATS
But Empathy is much more than a vocational skill necessary for surviving twenty-first–century labor markets. It’s an ethic for living. It’s a means of understanding other human beings—as Darwin and Ekman found, a universal language that connects us beyond country or culture. Empathy makes us human. Empathy brings joy. And, as we’ll see in Chapter 9, Empathy is an essential part of living a life of meaning.
MANY OF US can boost our powers of Empathy. And nearly all of us can improve our ability to read faces. Over the years, Ekman has compiled an atlas of facial expressions—likely all the facial expressions that human beings throughout the world use to convey emotions. And he’s found that seven basic human emotions have clear facial signals: anger, sadness, fear, surprise, disgust, contempt, and happiness. Sometimes these expressions are full and intense. Many other times they are less conspicuous. There’s what Ekman calls the “slight expression,” which is usually the first prickle of an emotion or the failed attempt to hide that emotion. There’s the “partial expression.” And there’s the “micro expression,” which flashes across the face in less than one-fifth of a second and often occurs “when a person is consciously trying to conceal all signs of how he or she is feeling.”6 Ekman has taught face-reading skills to agents from the FBI, CIA, and ATF, as well as to police officers, judges, lawyers, and even illustrators and animators. And now I’m going to teach you one aspect of Ekman’s techniques. (You can learn more of them in the Portfolio at the end of this chapter.)
I’ve always been irritated by what I think are fake smiles—but I’ve never been sure whether someone is grinning because he’s charmed by my wit or smiling precisely because he isn’t. Now I know. A smile of true enjoyment is what Ekman calls the “Duchenne smile,” after the French neurologist Duchenne de Boulogne, who conducted pioneering work in this field in the late 1800s. A genuine smile involves two facial muscles: (1) the zygomatic major muscle, which stretches from the cheekbone and lifts the corners of the mouth; and (2) the outer part of the obicularis oculi muscle, which orbits the eye, and is involved in “pulling down the eyebrows and the skin below the eyebrows, pulling up the skin below the eye, and raising the cheeks.”7
Artificial smiles involve only the zygomatic major. The reason: we can control that muscle, but we can’t control the relevant part of the obicularis oculi muscle. It contracts spontaneously—and only when we’re actually experiencing enjoyment. As Duchenne himself put it, “The emotion of frank joy is expressed on the face by the combined contraction of the zygomaticus major muscle and the obicularis oculi. The first obeys the will but the second is only put into play by the sweet emotions of the soul.”8
In other words, to detect a fake smile, look at the eyes. If the outer muscle of the orbicularis isn’t contracting, the person beaming at you is a false friend.
Here’s an example—two smiling photos of yours truly.
Can you tell in which one I’m squeezing out an insincere smile and in which I’m smiling in response to something funny my wife said? It’s not easy, but if you look carefully at my eyes, you can figure out the answer. The second photo is the true enjoyment photo. The eyebrows are a little lower. The skin under the eyes is pulled a little higher. The eyes themselves are bit narrower. In fact, if you cover up everything but the eyes, the answer is clearer. You just can’t fake a Duchenne smile. And while you can improve your empathic powers, you can’t fake Empathy either.
A Whole New Health Care
Empathy is not a stand-alone aptitude. It connects to the three high-concept, high-touch aptitudes I’ve already discussed. Empathy is an essential part of Design, because good designers put themselves in the mind of whoever is going to experience the product or service they’re designing. (It should be no surprise that one of the items in the Empathy Portfolio comes from a design firm.) Empathy is related to Symphony—because empathic people understand the importance of context. They see the whole person much as symphonic thinkers see the whole picture. Finally, the aptitude of Story also involves empathy. As we saw in the section on narrative medicine, stories can be pathways to Empathy—especially for physicians.
But Empathy is also reshaping medicine more directly. Several leaders in the medical field are urging that the profession shift its overarching approach from “detached concern to empathy,” as bioethicist Jodi Halpern puts it. The detached scientific model isn’t inappropriate, they say. It’s insufficient. As I’ve mentioned, much of medical practice has been standardized—reduced to a set of repeatable formulas for diagnosing and treating various ailments. While some doctors have criticized this development as “cookbook medicine,” it has many strengths. Rules-based medicine builds on the accumulated evidence of hundreds, and sometimes thousands, of cases. It helps ensure that medical professionals don’t reinvent the therapeutic wheel with each patient. But the truth is, computers could do some of this work. What they can’t do—remember, when it comes to human relations, computers are “autistic”—is to be empathic.
“Trust your intuition, it’s just like going fishin’.”
—PAUL SIMON
Empathy can be a powerful force in medicine. For example, a few years ago, two postal workers went to different health care centers complaining of similar symptoms. One man told his doctor he felt achy and ill and he believed he’d been exposed to anthrax, which had recently been found at the postal facility where he worked. The doctor telephoned the relevant public health departments, which told him that anthrax was not a risk and that he needn’t prescribe antibiotics. So he followed the rules and sent his patient home with orders to take some Tylenol. A few days later, the patient died—of anthrax. Meanwhile, the other postal worker went to an emergency room at a different hospital, just a few miles away. His doctor—who didn’t know about the patient above—examined the worker and suspected that he’d contracted pneumonia. But then the man told her that he worked at the postal facility hit with an anthrax scare. So she ordered another test, and even though she didn’t think that he had anthrax, something still nagged at her. She gave the man a prescription for Cipro, the antibiotic prescribed for anthrax, just in case. And instead of sending him home, as she had initially planned, she kept him at the hospital and referred him to an infectious-disease specialist. As it turned out, the man did have anthrax. And as it also turned out, the doctor’s empathic listening, intuition, and willingness to deviate from the rules meant the difference between life and death. “I just listened to my patient,” she told the Wall Street Journal. “He said,
‘I know my body and something’s just not right.’” Empathy—his doctor’s ability to intuit what someone else was feeling—saved his life.
“Physicians express empathy not only by making accurate comments about a patient’s feelings, but by their timing, vocal tones, pauses, and overall attunement to the affective style of a patient,” says Halpern. “Empathy supplements objective knowledge, and the use of technology, and other tools for making accurate diagnoses.”9 As this new view of doctoring takes hold, the aptitude of Empathy is moving to the forefront of the medical profession. It is giving way to a new generation of health care professionals like that emergency room physician—people who can combine rule-based detachment with emotion-based empathy into a whole new medicine.
The board that accredits medical schools now makes communicating effectively and empathically with patients a factor in a student doctor’s overall evaluation. That may seem like a commonsense move, and it is—but in the heavily L-Directed medical profession, it’s a sea change. Meantime, stage actress Megan Cole travels to medical schools across the United States teaching a course called “The Craft of Empathy.” In the class, she instructs doctors-in-training how to use nonverbal cues such as facial expression, intonation, body language, as well as other acting techniques, to better grasp what ails patients and to better convey concern for them. Students at Vanderbilt University School of Medicine take courses in communicating—and apologizing for—their mistakes.10 And Jefferson Medical College in Philadelphia, which I mentioned in Chapter 3, has even developed a measure of this aptitude—the Jefferson Scale of Physician Empathy (JSPE).
Although it is relatively new, the JSPE has produced some intriguing results. For example, high scores on the Empathy test generally correlated with high marks on clinical care. That is, all other things being equal, a patient was more likely to get better with an empathic doctor than with a detached one. What’s more, scores on the Empathy test bore no relation to scores on the MCAT or on medical licensing tests—which means that the traditional measures of physician aptitude aren’t necessarily relevant to determining who’s the best doctor.11 The differences in who scored high on the JSPE (and who didn’t) were also interesting. Women generally scored higher than men. And certain kinds of health care professionals scored better than others. For instance, nurses generally had high scores—much higher than physicians with hospital-based specialties. 12
The growing recognition of empathy’s role in healing is one reason why nursing will be one of the key professions of the Conceptual Age workforce. Nurses do much more than just empathize, of course. But the sort of emotionally intelligent care they often provide is precisely the sort of thing that’s impossible to outsource or automate. Radiologists in Bangalore can read X-rays. But it’s hard to deliver Empathy—touch, presence, and comfort—via fiber-optic cable. And with the aging of the population in the advanced world, nurses are in huge demand. In the United States, nursing will account for more new jobs over the next decade than any other profession. U.S. health facilities will need one million additional nurses.13 Nurses have many complaints about being overworked and having to juggle too many patients. But their empathic nature keeps them in high esteem—and increasingly brings them higher salaries. Nursing consistently rates as the most honest and ethical profession in the United States, according to an annual Gallup survey—and its pay is rising faster than nearly every other job category.14
The rise of Empathy has even begun to color parental advice. In a recent survey of Australian information technology managers, 90 percent said they would not recommend that their own children pursue careers in the L-Directed field of software engineering. What would they recommend their children do instead? “I’d rather my kids opt for nursing as a profession,” said James Michaels, who works for a telecommunications company in Sydney. “It has both global and local demand.”15
Men, Women, and Empathy
Who’s more empathic? Men or women? The politically correct answer is to say neither—that empathy depends on the individual. And to a large extent, that’s true. But a growing body of research has begun making that politically correct view untenable. Dozens of studies, for instance, have shown that women are generally better at reading facial expressions and at detecting lies.16 Even as early as age three, girls are better at inferring what others are thinking and at divining emotions from the expression on someone’s face.17 Summarizing this research, psychologist David G. Myers writes:
When surveyed, women are far more likely to describe themselves as empathic, as being able to rejoice with those who rejoice and weep with those who weep. To a lesser extent, the gender gap in empathy extends to observed behavior. Women are somewhat more likely to cry or report feeling distressed at another’s distress. The empathy difference helps explain why both men and women report their friendships with women to be more intimate, enjoyable and nurturing than their friendships with men. When seeking empathy and understanding, both men and women usually turn to women.18
Simon Baron-Cohen, a Cambridge University psychologist, has a theory that explains this apparent gender gap. He states it plainly on page one of his 2003 book, The Essential Difference: “The female brain is predominantly hard-wired for empathy. The male brain is predominantly hard-wired for understanding and building systems.”19
Baron-Cohen is quick to note that not all women have “female” brains, and not all men have “male” brains. But he marshals an array of support for his central point: that more males than females have brains that systematize and that more females than males have brains that empathize.20 The differences in the two thinking styles, as Baron-Cohen describes them, are intriguing. “Systematizing involves exactness, excellent attention to local detail,” and an attraction to fixed rules independent of context, he says. “To systematize, you need detachment.”21 (Baron describes autism as an “extreme” male brain.)
“The great gift of human beings is that we have the power of empathy.”
—MERYL STREEP
But empathizing is different. “To empathize you need some degree of attachment in order to recognize that you are interacting with a person, not an object, but a person with feelings, and whose feelings affect your own.” Empathy, he says, “involves inexactness (one can only ever approximate when one ascertains another’s mental state), attention to the larger picture (what one thinks he thinks or feels about other people, for example), context (a person’s face, voice, action, and history are all essential information in determining that person’s mental state), with no expectation of lawfulness (what made her happy yesterday may not make her happy tomorrow).”22
Read those descriptions again. The male brain sounds a little like L-Directed Thinking. And the female brain sounds a lot like the high-concept, high-touch approach of R-Directed Thinking. (The two thinking styles also sound like the differing approaches of the two doctors treating anthrax patients I mentioned earlier—one of whom happened to be a man, and the other a woman.)
Does this mean that we all need to get in touch with the feminine side of our brains—especially those of us with hairy arms and deep voices? Yes. But it doesn’t mean rejecting the systematizing side of our brains. Empathy is neither a deviation from intelligence nor the single route to it. Sometimes we need detachment; many other times we need attunement. And the people who will thrive will be those who can toggle between the two. As we’ve seen again and again, the Conceptual Age requires androgynous minds.
Test Yourself.
Psychologists have developed an array of tests to measure individual empathy and related qualities. Many of these tests are available free on the Web—and they’re an excellent introduction to the subject as well as a fun way to learn more about yourself. But caveat test-taker. The Web is full of self-assessments, many of which have all the scientific validity of phrenology. So begin your Empathy testing regimen with these:
Empathy Quotient— Measure your EQ with Simon Baron-Cohen’s sixty-question instrument, which will determine
whether you have a “female brain.” If you want to check your “male brain” bona fides, also take the test that measures your systematizing quotient, or SQ. (More info on EQ: tinyurl.com/dbsd8; more info on SQ: tinyurl.com/7taj8)
Spot the Fake Smile— Take the BBC’s ten-minute, twenty-question test, based on Paul Ekman’s research, to see how good you are at detecting the difference between a fake smile and a real one.
(More info: tinyurl.com/2u7sh)
Mind in the Eyes Test— Another test from Simon Baron-Cohen, this one measures your ability to identify a facial expression from only a person’s eyes. (More info: tinyurl.com/ckrj3)
Mayer-Salovey-Caruso Emotional Intelligence Test—This is probably the most widely respected emotional intelligence test available today. But unlike the others I mentioned, to take this one, you’ll have to pay. It’s not the place to start your inquiry, but it is a great option for those who want to dig deeper. (More info: www.emotionalintelligencemhs.com/
MSCEIT.htm)
Study Ekman.
As I noted earlier in this chapter, the world’s leading expert on facial expressions is Paul Ekman. Do yourself a favor and study his work. Read his latest book, Emotions Revealed (Times Books, 2003). It’s an excellent overview of the science of expression. And it’s a first-rate guide to learning the techniques to decipher the emotions revealed on someone else’s face. Ekman’s daughter, Eve, is the model for many of the emotions pictured in the book, and she has an uncanny ability to get the expressions just right. If you like Emotions Revealed, also check out Ekman’s earlier book, Telling Lies (W.W. Norton, reissued 2001)—which, among other things, explains how to detect when someone is fibbing. Then, for your graduate degree in Ekmanship, pick up his two interactive CD-ROM tutorials. One, the Micro Expression Training Tool, teaches you to spot those fleeting microexpressions. The other, the Subtle Expression Training Tool, teaches you to spot the seemingly undetectable expressions that occur when someone is just beginning to feel an emotion. The tutorials include pretests to measure your current ability—and at the end, final tests to see how much you’ve improved. Both are useful—not to mention fascinating. One warning, though, to my fellow Mac users: as of press time, these CD-ROMs worked only with PCs.