by Danilo Di Diodoro
The ability to understand the mood and emotions of another person, immediately and sometimes without the need for words, is the result of a complex interaction between different areas of the brain. The result is a sort of “embodied simulation”
Empathy can be defined as the ability to feel with another, understanding their behavior and experiences from the inside. It is typical of humans, but also of some animals, that they can perceive if not the thoughts of people, at least the moods and intentions.
In the healthcare sector, good empathic communication allows operators to better understand patients, and recent research has shown that the quality of the relationship between those who treat and those who are treated has positive influences on the outcomes of many pathologies, such as diabetes, cardiovascular, chronic diseases.
Initiatives aimed at improving the doctor-patient relationship can have very concrete effects: a lower need for painkillers after orthopedic surgery, the possibility of reducing the side effects of chemotherapy in cancer patients, fewer post-surgical complications in elderly patients.
The importance of these aspects which are not sufficiently considered in contemporary medicine was discussed at the “Empathy in the healthcare relationship” conference recently held at the Casa della Musica in Parma, which was attended not only by healthcare professionals but also by artists, who have an instinctive understanding.
«It is also good to immediately clarify what should not be confused with true empathy, such as the simple assumption of the other’s perspective or emotional contagion, or sympathy, commiseration, being charitable» says Vittorio Gallese, full professor of Psychobiology at University of Parma, which opened the scientific session of the conference.
Human beings consider themselves individual entities, but according to the German philosopher and sociologist Helmuth Plessner, the individual becomes such only to the extent that he enters into a common “we”.
Identity and becoming
«The individual is part of a psychological space in which he shares a series of characteristics with others, so much so that today rather than individuals we should speak of “co-individuals”, given that each of us depends on the relationship with the other in order to identify himself” specifies Professor Vittorio Gallese. «The concept of identity is too rigid, and it would be preferable to talk about “becoming”, a neologism that explains well how everyone becomes who they are on the basis of the quality and quantity of inter-individual relationships they establish. If homeostasis is important, which in Medicine represents the balance of the organism, allostasis, the balance we achieve in our relationship with the world and other human beings, is equally important. And at the basis of this intersubjectivity there are precise neurobiological structures, those mirror neurons that we discovered years ago in a motor area of the macaque brain. They are neurons capable of controlling the execution of movements but also of responding when one simply observes that movement performed by another, although the intensity of the discharge is more intense when one is the protagonist of the movement rather than when one is observe. It is a neurobiological model consistent with the psychological one of empathy, in fact empathizing means entering into the experience of the other without confusing yourself with him.”
Mirror neurons
The discovery of mirror neurons dates back 30 years ago and since then various research groups around the world have found similar mechanisms in many animals. In fact, these neurons have an important evolutionary and adaptive role, precisely because they allow individuals to adequately read social interactions, promoting learning by imitation and the understanding of behavioral responses to others.
«In human beings, mirror neurons are activated when movement is set in motion» further explains Gallese. «This occurs in areas such as the premotor cortices and the posterior part of Broca’s area, traditionally considered exclusively for language purposes. But their activation is also present when we observe movements made by others, when we listen to the noise possibly generated by those actions, and even when those same actions are simply imagined. However, in recent years we have demonstrated that similar mechanisms also apply to emotions and sensations. The anterior area of the insula, a small deep structure of the brain that is the hinge between what happens in the body and what happens outside, is activated for example both when a person experiences the sensation of disgust and when he observes expressions of disgust from part of another person. The same phenomenon happens with the experience of being touched: the brain area that activates when I am touched also activates if I see someone else’s body being touched. And similar phenomena are also found for other sensations, such as fear. Or pain, which activates the anterior cingulate cortex and the anterior insula.”
Embodied simulation
It is a complex mosaic of knowledge that required an interpretation capable of putting together the discoveries made into a coherent neurobiological model. This is what Vittorio Gallese proposed with the concept of embodied simulation. «A term that indicates a basic mechanism of our brain, which maps the actions, emotions and sensations of others onto its neural maps, where those same actions, emotions and sensations are represented. It is thanks to this ability that we are able to recognize in what we see something with which we “resonate”. But brain activation is different when you are the protagonist of an action or emotion, or just an observer. Consequently, when we talk about empathy it is necessary to keep similarity and otherness in mind. The other is similar to me but he remains the other, he is not me. I believe that embodied simulation is the best translation in neurophysiological terms of what we currently call empathy.”
Neural reuse
Neurobiology and neurophysiology studies in recent years have also clarified that the brain uses the same neuronal circuits for different functions, obeying a criterion of parsimony.
It is the principle of neural reuse, also characteristic of the phenomena underlying empathy. «We tend to use and reuse the same brain circuits to act, or to experience sensations, but also when we see them expressed by others. Although obviously, this is not the only way to connect with our fellow humans, because there is a level of understanding that depends more on cognitive functions.”
The study on twin fetuses
The research group led by Gallese also carried out a study on twin fetuses, to explore the moments of the beginning of a possible human relationship before birth. «The study was on twins at the sixteenth week», explains Gallese «and we thus discovered that already at such an early stage in life it is possible to detect hand movements which are a clear indication of very early forms of relationship. On the other hand, the importance of relationships for human beings had already been anticipated by the philosopher Martin Buber who in 1923, when Freud wrote “the Ego and the Id”, wrote his most important work entitled “I and you” , in which he stated that “in the beginning there was the relationship”, The novelty now is that this relational nature also transpires on a neural level and it is possible to investigate it scientifically. Today we know that at the basis of the ability to understand the intentional behavior of others – both from a philosophical and ontogenetic point of view – there is a basic mechanism, embodied simulation, which presents itself as a new integrated model of basic levels of social cognition ».
The Covid pandemic as a test bed
A formidable test of the value of empathy and communication in the healthcare sector was that of assistance during the Covid pandemic, when everyone experienced social isolation, which was therefore easily shared. But for healthcare workers it was also an opportunity to live an extraordinary experience of communication and empathic effort. Being able to convey a sense of closeness to people hospitalized, completely isolated from their loved ones and with whom it was not even possible to make small important gestures, such as placing a hand on the shoulder, speaking with an uncovered face.
«Patients suffering from interstitial pneumonia, frequent in Covid infections, often needed pulmonary ventilation and therefore masks or helmets for the administration of oxygen at high flows» says Davide Belgrado of the Internal Medicine and Continuity Medicine of the University Hospital of Parma. «This often made them dependent, they couldn’t go to the bathroom or eat normally. We had to use non-verbal communication that passed through the gaze, given that the operators also wore masks. It was necessary to continuously understand the needs of the sick person and we were also helped by psychologists. We used tablets to establish communication and to help people call family members. Even though empathic abilities are largely innate, in that period there was a need for continuous training on how to develop these difficult relationships and manage moments of verbal exchange and silence.”
March 2, 2024 (modified March 2, 2024 | 8:18 pm)
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