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Practical Limits of Compassion: Time for a Candid Discussion?

Dr. Hymes would like to acknowledge the inspiration and assistance of Tony Belak and J.R. Curtin in the preparation of the manuscript.

A thorough understanding of any tool, any technique, any modality requires a knowledge of what it can and cannot do, what are the risks of employing or applying that tool or technique, what are the common pitfalls, and what happens when things don’t go as planned.  To advocate universally positive outcomes from even the most beneficial of tools is simply naïve.  Compassion, as positive and benevolent a force as it is, is no exception.  Simply admonishing people to go out and “be nicer and more compassionate” is the equivalent of encouraging children to play a ball game on a busy street. It’s only a matter of time before there is a tragic outcome.

Consider the following examples that illustrate some of the limitations of compassionate behavior:

*This is Rachel Corrie.  In 2003, she was 23 years old and was an idealistic member of the International Solidarity Movement.  In March of that year she journeyed to Israeli occupied Palestinian territories and participated in a protest with 8 compatriots.  Armed with only a bullhorn, she stood in front of an Israeli armored bulldozer that she believed was intent on demolishing Palestinian homes in a zone known as the Philadelphia Route, between the Rafah refugee camp and the Egyptian border.  The bulldozer ran her over, and she died from multiple injuries in a Palestinian hospital a few hours later. We can debate her political stance.  We can argue about whether or not her actions were justified.  What we cannot argue about is that the martyrdom of an idealistic 23 year old is a tragedy, and, ultimately, a failure. If one dies in the act being compassionate, it is a failure of compassion. We can revere the martyr’s sacrifice, we can admire their selflessness, but ultimately, I think we can all agree that for the most part, one would advise their own children that they can do more to advance their causes by staying alive to fight another day and they should make every effort to pursue their goals bearing that in mind.  (Now, this example is also complicated by a failure of intelligence.  When I say intelligence, I don’t mean intellect; I mean having knowledge of whom you are dealing with.  I will come back to this.)   Let us look at the bulldozer operator in the most charitable and benevolent way possible and accept the conclusion that there are well-intentioned people who we don’t know or understand, that do not recognize or care about our act of compassion, and though they mean us no particular harm, getting in their way can be disastrous.

  1. Back in September, Malcolm Gladwell (who I love) wrote a piece in the New Yorker about pedophiles in general and Jerry Sandusky in particular.  The main point of the article is how astoundingly patient, industrious and cunning these predators are in stalking their prey and finding ways of having their desires satisfied while at the same time establishing plausible deniability.  Looking at Gladwell’s description of Mr. Sandusky’s pattern of behavior, it becomes clear how his system, aided and abetted by his foundation to “help “children and enabled by his family, his victim selection process was able to grind along for 30+ years and he was able to elude suspicion for his monstrous behavior.  To this day, he is unrepentant, protesting his innocence and pursuing appeals.  To amplify the point above, there are not only decent, well intentioned people that we do not understand who are indifferent to our compassion, there are actually really terrible people out there that seek to take advantage of our naiveté, our generosity and our good nature who seek to do harm.  To allow this realization to paralyze us or prevent us from doing good is wrong, but to deny the reality and to not retain at least some degree of healthy skepticism can result in both humiliation and disaster.
  2. This is another kind of compassion failure.  Anyone recognize this character from “The Simpsons”? (This is Patty Bouvier, the meaner and more vicious of Marge Simpson’s older twin sisters, who, for me, is the goddess of cranky and bitter).  She is an illustration of another form of compassion failure– burnout.  Simpsons creator Matt Groening describes her as someone “who sucks the life out of everything.”  For those of us who are not the big league hall of famers of compassion like Mother Theresa or the His Holiness the Dalai Lama, this attitude is a potential outcome when one gives and gives and there is no reward, no thanks and no support.  The very nature of compassionate behavior dictates that it should be done for its own sake and not with the intention of being rewarded, however, for most of us, there needs to be a way to recharge the batteries and find ways to make sure our own needs are met.  This is not selfishness; it is simply self-care.   But self-care and compassion to oneself are essential to the practice of compassion.  Admittedly, there is no such thing as a 100% safe environment; there are times when all of us will get burned.  But we can cut down on the burnout with foreknowledge of the risks, by an open discussion of the potential problems and appropriate use of support systems when there is a disappointing outcome.  As teachers and advocates of compassion, it is essential for us to include this disclaimer.

There is a growing body of literature in healthcare advocating the need for increased compassion by frontline healthcare employees.  Dr. Robin Youngson, The Studer Group’s Rich Bluni and Stephen Beeson and others make a compelling argument that are meaningful benefits for both the healthcare professional and the patient in taking the time to establish an emotional connection and to empathize with patients.  Their points are well taken.  Healthcare needs to be more compassionate and user friendly.  We are guilty of focusing on technology, procedures and medication, and seem to have lost touch with the caring aspect.

The upshot of this literature is to place the burden of being more compassionate on the shoulders of those at the front lines of healthcare, with the vague admonishment to ”be more compassionate.”  In support of this sentiment, in Time to Care, Youngson relates the story of how doctors who extend themselves above and beyond the call for patients frequently reap huge rewards of patient gratitude, trust, self-respect, etc.  A doctor who gave out his cell phone number to patients never regretted it, the time that he stayed around an extra hour and a half to wait for an outpatient who was late turned out to be a single parent that was 46 weeks pregnant, was caring for a small child a sick parent and had to walk 3 miles to the clinic was a very poignant and moving story.  Bluni and Beeson give examples in which going out of one’s way turned out to be for someone worthy of every ounce of expended effort and more.  But you can’t depend on the object of your compassion being deserving of it every time (or even 50% of the time).  At times, the object of one’s compassion will turn out to be someone who is knowingly or unknowingly undeserving, a bully, or just someone trying to get whatever they can. 

In general, the hard part of showing compassion is not doing things for those in need or deserving of our extra effort.  The hard part is giving empathy, deep empathy, to those people who make the professional’s job harder, who don’t tell caregivers the truth, that seek narcotics or secondary gain from their illness, that are self-destructive and are bent on destroying the lives of those around them or are in some way gaming the system.  Our masculine and individualist American culture is wired for a heightened sensitivity to the “free rider problem.”  The mere allegation of it frequently drives us into overreaction in response.  And this is where the danger lies.

Robert Sutton, in his minor classic, The No Asshole Rule, repeatedly cites a Miner, Glomb and Hulin study that demonstrated negative interpersonal interactions had a 5-fold stronger effect on mood than positive interactions.  So here’s the big point: even if these failures of compassion are relatively rare, there is science that says they have a disproportionately large impact on our outlook and behavior.  How much good work and reward for being compassionate does it take to erase the feeling of having been abused and taken advantage of?  How is that person repaired and pushed back out into the trenches, or do they simply turn into Patty Bouvier?  How can we mere mortals practice compassion with a modicum of prudence and safety and how much more compassion would we see if people could feel they could be compassionate without being afraid?

As educators, it is incumbent upon us to teach methods of mitigating the unfortunate effects of negatively charged acts of compassion, and somewhat arbitrarily I divide these into 3 categories:

  1. Damage prevention and awareness
  2. Prudent practice
  3. Repair of damage and recharge

Prevention starts with foreknowledge of the risks and acknowledgement that one cannot expect a positive outcome.  Yes, the world is full of kittens, puppies, butterflies and rainbows, but there are rodents, snakes, scorpions and dung beetles as well.  The first step is to manage expectations.

Practice starts with having some idea of with whom one is dealing, and the concept of managing risk.  “The table” can be imagined as a metaphorical space between two people where exchange takes place.  Every thing on the table is offered to the other party for their benefit.  If one is dealing with an unknown, things one would want to put on the table include civility, politeness and compassion, knowledge, expertise, intellect, experience.  If the object of our compassion is less than the person one would have hoped for or their commitment to returning the favor is less than hoped for, there is an inherent risk that these things may be taken and not given back.  Nothing of extreme value is lost.  The offer was appropriate and compassionate, they took and did not give back, and ultimately, nothing was given up that could not be lost and the intent of the other party was exposed.  Things that cannot be put on our metaphorical table include: one’s self-worth, one’s self-esteem, and one’s identity.  Note that this does not imply the absence or abolition of risk, only the mitigation of excessive risk.  There can be no love without vulnerability and risk.

Repair and recharge is how we cope with the feelings of guilt, hurt, and loss, and how we regain our energy and capacity for the work of compassion.  Typically this requires self-care, compassion directed at oneself and support from ones family, friends and associates.

Fundamentally, compassion can be envisioned as a point on a continuum of human behavior that extends through indifference toward selfishness and beyond into the abyss.  As long as there are humans, we must recognize that there will always be behavior all along the continuum.  The best we can hope to achieve is to nudge the distribution of behavior over to the compassionate end, because this is where we homo sapiens are at our best.   The tools we have at our disposal are the value case for compassion, an appeal to humanity’s  better nature and prudent instruction on how to employ compassion in the real world.

In the final analysis, there is nothing new here.  It is simply a realistic appraisal of the limitations of compassion: The beginnings of a “How-to” manual of sorts.  As one might expect, it is not as easy as it seems.  But without an honest appraisal of what can and cannot be accomplished, what is at stake and how to manage the expected problems, we cannot expect the community at large to begin a realistic or meaningful discussion of how to implement this badly needed, hopeful and beneficial force in our daily lives.  I hope to begin to explore this conversation.


William Hymes

Dr. Hymes has been practicing thoracic surgery in the Louisville, KY area since 1993, but still considers himself both a “recovering New Yorker” and a “recovering bully.”  Educated in New York, Massachusetts and Texas, he is now pursuing a masters degree in conflict management at Sullivan University in Louisville.  MORE >

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