Sunday, August 14, 2011

'Having an Empathy Problem' Versus 'Having Zero Empathy'

Stuart K. Hayashi

What I am about to say is a generalization about persons suffering from currently-untreated Borderline Personality Disorder (BPD; borderline personlighetsforstyrrelse). Naturally, these generalizations do not necessarily apply to all people with BPD at all times. This assessment is based on what I have observed in my own experiences, plus what some persons diagnosed with BPD have written to me. Bear in mind that those persons do not necessarily agree with everything written on this blog. Anyhow, I will sometimes refer to persons with currently-untreated BPD as "Borderlines." This should not be taken as a pejorative; the locution is used for the purpose of making my blog post easier to read. Likewise, the loved ones of Borderlines will sometime be called "Non-Borderlines," "Nons" for short. When discussing a Borderline, I will switch between the pronouns "him" and "her."

Their Aloof Pose Does Not Prove That They Never Think About You
Love ones have often been on the receiving end of very inconsiderate treatment from the Borderlines in their lives. And when currently-untreated Borderlines are confronted with this fact, their loved ones are often horrified by the currently-untreated Borderlines' evident refusal to show remorse for this treatment, or to even make any sincere promise to change it. Based on the Borderlines' blase-at-best reaction, many loved ones often conclude that Borderlines are sociopaths who have zero capacity to empathize. I can see why such loved ones would infer as much. However, such a conclusion is misleading. If you have someone in your life who has undiagnosed, untreated BPD -- and refrains from exhibiting any real remorse for mistreatment of you -- chances are that this person does have genuine remorse for this mistreatment . . . but would be loathe to admit it to you.

Even as prestigious a research psychologist as Simon Baron-Cohen (cousin to the famous actor who plays Borat and Bruno) grievously equivocates Borderlines with sociopaths. A news article about Baron-Cohen's latest book summarizes Baron-Cohen's conclusion this way:
...the pathological group. These are people with borderline personality disorder, antisocial personality disorder and narcissistic personality disorder. They are capable of inflicting physical and psychological harm on others and are unmoved by the plight of those they hurt. Baron-Cohen says people with these conditions all have one thing in common: zero empathy.
The news article's author is not putting words into Baron-Cohen's mouth. Direct quotations from Baron-Cohen indicate the accuracy of the prior paragraph's description of Baron-Cohen's view. Baron-Cohen himself says that he equates every "personality disorder" with "a lack of empathy because many of the personality disorders, like the psychopath, or people with borderline personality disorder are just operating on a totally self-centred mode."

Both Simon Baron-Cohen and the newspaper writer fallaciously equate ethics with "social interaction," the implication being that you would have no need for morality if you were stranded on a desert island all by yourself. As you know that I support a humane and considerate Ethical Egoism, you know I reject the "zero-empathy-equals-evil" presumptions of Baron-Cohen and that newspaper writer. But as this blog concerns itself merely with explanations of BPD and Body Dysmorphia (dysmorfofobi), I will not digress into a long discussion about the ethics of rational self-interest. I will merely continue about BPD.

This ABC News piece likewise cites a psychologist as it equates BPD with a sociopathic paucity of empathy:
Two of the potential issues [Casey] Anthony could suffer from are borderline personality disorder and psychopathology, the experts said. The main thing these issues have in common is a total lack of empathy, according to LeslieBeth Wish, a psychologist and licensed social worker in Sarasota, Fla.
Once, a person with a beautifully high level of empathy had seriously told me, "I wonder if I'm a sociopath. When other people want me to cry about the things I do to them, they get no such response. I just go numb; I don't have an ability to feel."

Knowing this person very well, I replied, "I don't think you lack such a capacity; I have seen and felt your warmth and caring. I think what's really going on is that you feel so strongly, that it it causes a strain and hurt more severe than that experienced by others. It's not that you feel less than they, but more. To defend you against too much pain, the emotional parts of you go numb so as to protect you."

Then this person made a really weird blank look (more of this will be described later). The person then said something very quickly, and the tone would have sounded cocky if it weren't full of obvious defensiveness. What was said was, "No, I don't go numb at all. I'm just logical."

At the time, I scoffed at the notion that this person could be a sociopath; this person had -- and has -- a highly empathic nature. I now understand why this was said, and why very sane, normal people would accuse this person of being lacking in empathy. They would make this accusation because they do not fully understand this person's psychiatric condition. The most tragic part is that this person, too, misunderstood this person's own issues with empathy. :'-(

Two Forms of Empathy
First we should clarify that there are two types of empathy -- cognitive empathy and affective empathy. You are engaging in cognitive empathy when, on an intellectual level, you understand how someone else is feeling. By contrast, you experience affective empathy when you observe someone else's emotion and, as a direct consequence of this observation, experience the very same emotion.

If I observe that someone else is sad, but I myself do not feel sad about this, then I am experiencing cognitive empathy but not affective empathy. Conversely, if I see someone is sad, and I consequently feel sad myself, then I am having empathy on both the cognitive and affective levels.

In many cases, a functioning autistic is low on cognitive empathy but is still capable of experiencing affective empathy. That is, if your body language gives off the subtle cues about your feelings that are normally given off, the functioning autistic will comprehend none of it; he will not know what you are feeling. However, if you make it very obvious that you are sad or frightened to an extreme degree, the functioning autistic will probably likewise become sad or frightened as well.

A sociopathic con man pretty much operates in the opposite fashion -- he has high cognitive empathy but low affective empathy. He is able to manipulate and con you precisely because he can carefully read your body language and tone, and therefrom accurately infer what you are feeling. However, when he sees the pain that his actions have caused you, he is genuinely unable to feel bad along with you, or to experience authentic remorse. Insofar as he is remorseful, that remorse is shallow and will be soon forgotten.

Many people with currently-untreated, undiagnosed BPD have issues with empathy that are similar to those of functioning autistics and sociopaths. However, there are important differences.

Why Do Borderlines Appear Unsympathetic to Your Distress?
An astonishing number of currently-untreated, undiagnosed people with BPD symptoms like to pride themselves on their ability to read people; they see themselves as having high cognitive empathy. However, in my experience, the same people-with-BPD-symptoms have actually made some glaring social gaffes, oblivious to their own outlandishness. I know of one case where this person thought that she had impressed everyone in the room when, in actuality, her eccentric behavior made most of the people in the room feel awkward and uncomfortable. Sometimes this person had high cognitive empathy, but there were commensurate occasions on which her cognitive empathy was low.

When it comes to the matter of affective empathy, consider the emotional instability common to Borderlines who are currently not in treatment but ought to return to it. When the currently-untreated Borderline is feeling safe and secure, it is very easy for the Borderline to emotionally bond with you and to feel as you do. However, it may be the case that this Borderline can easily be "triggered" by some stimulus -- such as by some type of mention of sex or reproductive anatomy -- that elicits a panicky anxiety attack from the Borderline. During these panic/anxiety attacks, the Borderline is often caught in a fight-or-flight response. Even though, to you, the Borderline is getting upset about nothing, the Borderline can seriously feel something like, "Aaaaaauuuuuckk!! I'm dying!!!" (This is not hyperbole. The distress is that severe.)

BPD Anxiety
When the Borderline is triggered, the Borderline will interpret the trigger as some kind of life-or-death emergency. In those moments, the currently-untreated Borderline's concern for anyone else's feelings or well-being goes out the window. During moments of panic -- triggered by rather harmless stimuli -- the Borderline will be low on both cognitive- and affective empathy.

Recall that among the main symptoms of BPD are emotional instability, chronic emptiness, a proneness to anger, self-destructiveness, suicidal thoughts, and general anxiety. As emotional pain is something of a norm for Borderlines, too many of them develop the maladaptive practice of suppressing their emotions and trying to become emotionally numb. I recall someone very dear to me who learned to repeatedly become stoic in this way. This person often became upset at the slightest provocation. It was not initially obvious when this person became upset. When this person was triggered and became upset, this person's face suddenly became weirdly blank, with this person's mouth stiffening. It looked like some kind of "poker face," but with some resignation and tiredness, too. Although the person had learned to hide the discomfort by putting on a blank, stoic expression, you could still detect the tension at the temples.

The point is that even when this person had those panic/anxiety attacks, the person developed this blank, stone-faced expression. I suspect it is because the person misapprehends that admitting her own vulnerabilities would be some kind of show of weakness. My educated guess is that some currently-untreated Borderlines misperceive that confronting and accepting this vulnerability would be some sort of relinquishment of power and control. In fact, the opposite is true -- to let the vulnerabilities show would be the manifestation of true confidence and courage and strength. Moreover, it would not be giving up control and power but gaining the only forms of power and control that matter -- the power and control over oneself that comes with taking responsibility for one's own mental well-being.

Yes, this person easily became upset. As a maladaptive -- and ultimately unhelpful -- attempt to manage the anger or hurt, this person had become accustomed to numbing and repressing such emotions so as to not "lose cool" in public. The long-term negative effects of this emotion-suppression technique are explained by a psychologist here and by a recovered Borderline here.

And one big, panic-inducing "trigger" for many currently-untreated Borderlines is any attempt on your part to confront them on how their inconsiderate behavior is hurting you and of how you wish they would see the situation from your vantage point. When you try to very gently discuss this matter with the currently-untreated Borderline, the currently-untreated Borderline might react in one or both of these ways:
1. Become triggered and experience that sense of panic and emergency. In this very moment, the currently-untreated Borderline will only worry about her own feelings -- as if her life is on the verge of ending -- and will have low regard for your decision to express your own feelings. This definitely makes the currently-untreated Borderline appear generally non-empathetic.

2. Become triggered and upset, and then immediately cope with the panic by getting all numb. To the degree that the currently-untreated Borderline succeeds in becoming numb, she will honestly be devoid of any interest in your plea that she take your feelings and well-being into account. This, too, makes the currently-untreated Borderline appear generally non-empathetic.
In those moments of confrontation, the currently-untreated Borderline probably does show a deficiency in empathy. It would be a mistake, however, to conclude from this that the currently-untreated Borderline has never felt any authentic affective empathy for you.

A sociopath is someone perpetually incapable of experiencing strong affective empathy. This applies all or at least most of the time. By contrast, a currently-untreated Borderline will very easily feel affective empathy for you when she is relaxed. But this currently-treated Borderline will, in times of stress, experience momentary -- but very brutal and crushing -- lapses in empathy for you. Simon Baron-Cohen is all mixed up. A currently-untreated Borderline's momentary lapses in affective empathy -- and stubborn refusal to be contrite with his or her victims -- should not be conflated with a sociopath's continuous and persistent absence of affective empathy.

A Vicious Cycle Going in . . . A Perfect Circle . . .
If you're a Non, and have tried to maintain a close social bond with a currently-untreated Borderline, then you might have gone through this painful cycle:
1. The currently-untreated Borderline does something to the Non that is horribly inconsiderate . . . maybe even cruel.

2. The Non very gingerly, calmly, and gently tries to explain to the currently-untreated Borderline how the Borderline's behavior has been harmful and/or disrespectful to the Non. The Non compassionately asks the Borderline for a very deliberate changes -- an improvement -- in behavior.
3. This confrontation triggers the Borderline. The currently-untreated Borderline gets that panicky fight-or-flight response -- even if he or she continues to look calm on the outside -- and gains the inaccurate-but-strong emotional sensation that it's an emergency to completely ignore and disregard the Non's tearful entreaties. The Borderline will rebuff the Non's entreaties, as if only the Borderline's feelings are important whereas the Non's feelings are immaterial.

4. The Non interprets the Borderline's rebuff as a general lack of empathy and remorse. This is offensive, horrifying, and disgusting to the Non. He now sees the Borderline as cold-hearted, and this cold-heartedness as immoral. The Non desperately pleads with the Borderline to be more caring (i.e., more moral).

5. This further aggravates the Borderline, thus impelling the Borderline to further numb him- or herself. Whether by conscious intention or by automatized practice, the Borderline refrains from making any remorse visible to the Non. (In truth, when the Borderline is out of the Non's sight, the Borderline will reflect on the matter in secret and feel guilty about it.) The Non then tries harder, further admonishing the Borderline to change.
This cycle pretty much repeats itself -- getting worse and angrier with every repetition -- until the Non finally gives up and cuts the Borderline out of his life. Years later, the Non probably believes that the Borderline still feels no remorse. In truth, when the Borderline looks back on these events -- and refrains from evasion -- the Borderline probably does regret his or her behavior . . . but he or she delusionally believes it important that the Non never learns this.

If you're a Non, then it's not realistic for you to expect your entreaties to ever be enough to persuade the Borderline to change, no matter how gentle or heartfelt or justified your entreaties are. The entreaties almost always fail because this approach is one that many currently-untreated Borderlines find intolerable.

You are, however, morally justified in your wish that the Borderline would change, if only because it would be more conducive to at least his or her own happiness. :'-(

I recommend this alternative approach. Inform the Borderline that you will always care about him or her, no matter what. To always care about and love the person, however, is not the same as tolerating all of the abusive behavior, all of the devaluation, and all of the inconsiderateness and disrespect. Make it clear to the currently-untreated, undiagnosed-person-with-BPD-symptoms that, though you will always care about this person, you will tolerate no disrespect or devaluation. Any time the person unjustly devalues or disrespects you, withdraw yourself from the interaction, and do not comply with any irrational requests. If the inconsiderateness is very severe and persistent, you can communicate to this person that these two principles are both true at the same time and do not contradict:
1. You care about this person's well-being, and probably always will.

2. You will not interact with this person again until such time that this person is able to provide you creditable evidence that she has resolved to change for the better and is getting the professional psychiatric care that she needs.
My alternative approach cannot guarantee any change at all in the currently-untreated Borderline's behavior. However, it will spare you -- the Non -- a lot of hours or years of fruitless entreaties to the currently-untreated Borderline to change.

Perhaps you can take some small consolation in the knowledge that the currently-untreated Borderline often did have authentic affective empathy for you, and that this person's exhibitions of indifference to you do not necessarily prove that, deep down inside, this person has zero regrets about mistreating you. :'-(