War on empathy, war on confidence, war on context

Cross posted with the Mandarin

Nicholas Gruen has argued that it’s much harder to realise evidence-based policy – both institutionally and intellectually – than many calling for it realise. Here he explains how putatively ‘scientific’ and ‘objective’ approaches can, paradoxically, compromise their efficacy by squeezing out empathy and relatedness.How learning a new language can change your life ...

Russ Roberts has (yet another) great interview on EconTalk. He’s always been gregarious in his interests, but is becoming more so—and also more sceptical of social progress and of economics as a master discipline. Be that as it may, on listening to this interview with psychiatrist Gary Greenberg on the placebo effect it struck me that a phenomenon of some interest to me might be far more general than I’d imagined.

War on empathy

Empathy tends to get squeezed out of interactions between bureaucracy and the life world. And even professions that one might imagine would be built on empathy — like social work — often operate according to other professional imperatives. Hence, the power of finding ways for the community to administer social repair through the empathic bond of peers rather than professionals, as The Australian Centre for Social Innovation (TACSI), which I chaired until the end of 2016, tried to do with Family by Family.

In any event, the basic idea promoted by Greenwood (slightly extrapolated by me) is this: as medicine was made more scientific, the placebo effect was discovered, and then marginalised. Yet it was of unarguable therapeutic power. Of course it’s entirely appropriate that, if one is looking for drug therapies, one wants to find drugs that, other things being equal, do better than sugar pills.

But in the process, the trail goes cold on keeping the placebo effect in the frame, not only for what it might help us understand, but, more remarkably, even for its therapeutic potential. There’s been vanishingly little investigation of the joint effect of the drug and the placebo acting together. And it turns out that, investigating the placebo effect more broadly, it seems likely that it has something to do with empathic bonds — between some source of authority like the doctor and the patient. Or perhaps from anyone.

War on confidence

We seem to do better when we feel ourselves to be of concern to others, not just mentally, but physically. Whodda thunk?

Note also Greenberg’s comment, “confidence is probably one of the most poorly understood and one of the most important aspects of our daily lives”.

Surely enough, confidence was critical in Family by Family. Single mothers had so internalised the description of themselves as bad mothers (and by any comparative standard they had certainly done some bad mothering), that they were crushed and unable to change. Every one of the success stories that I learned of seemed to me to operate very directly, through confidence.

To extrapolate further, we’re at the stage in drug therapy that we got to with our understanding of genetic causes of disease. Having discovered lots of low-hanging fruit, it’s all getting a lot harder. And it seems the world is more complex—vastly more complex—than the relentlessly reductive models we’ve had in our heads but which generated the early successes.

Of course, one of the things reinforcing all this is commercial interest. You can patent and market a molecule, so the ‘drug theory of physical wellness’ is well supported by the pharmaceutical capital market. Mobilising the placebo effect — much less so. (This is something that’s not handled as crisply as it might have been in the podcast, IMO.)

The fruit that’s not hanging so low are all the chronic maladies that dominate our health discourse today — obesity, diabetes, anxiety and depression, irritable bowel syndrome, chronic fatigue syndrome, to name a few. Drug therapy has worked poorly here. It’s possible, perhaps likely that, by understanding the placebo effect — or those things that drive it — renewed progress might be possible.

The war on context

This hasn’t just been a war (however inadvertent) on empathy and on the importance of confidence. It’s been a war on context.

A certain paradigm of science is asserted in which science offers knowledge that is lifted from context. Of course, if you can do it, and your goal is mastery of nature, well and good. You’d expect this to be the low-hanging fruit and you should go pick it.

Alas, the lavish rewards this produces — for outcomes, methodologies, disciplines and careers — then compromises what might be the next phase of progress in areas where context matters.

I almost wrote ‘more difficult’ areas. But context-dependent knowledge also exists on a spectrum from low-to-high-hanging fruit (slaps wrist for mixed metaphor).

A program like Family by Family isn’t rocket science. It makes a lot more sense than most standard practice now. It’s just countercultural in the empathy-starved careerist bureaucracy we’ve built to deliver child protection services — an environment that has been unable to even detect strongly above-average performance, let alone find ways to learn from and spread it.

This kind of knowledge is scientific knowledge too, but arises when one adapts one’s scientific tools to the task at hand, rather than simply aping techniques that worked elsewhere.

With the renewed enthusiasm towards evidence-based policy in the context of the Thodey Review (while we expand cashless welfare cards for political reasons contrary to all the evidence) the test will be whether anything we do will promote rigour, thoughtfulness and attention to what the evidence is telling us given our objectives and the multiple contexts in which we want to achieve them.

The two alternatives to this are that nice words are said about the report and it’s ignored, or it provokes a new birth of scientism in which the quest for contextless knowledge generates little useful knowledge at all.

Postscript: an interview with Leon Gettler on the subject of this post

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16 Responses to War on empathy, war on confidence, war on context

  1. paul frijters says:

    yes, the placebo effect is a very important phenomenon that we downplay because it doesn’t fit in the vision of the mind that we hold up as the ideal: unchanging and rational. Within that ideal, the idea of fluidity involved in the placebo effect is very destructive and frightening, a form of continuous death really. So the higher one goes, the more one becomes bound by the pretense of being the ideal to the extent that many know no other reality. And yet and yet….

    I don’t think bureaucracy is inherently anti-empathic though when it comes to individuals or families. But it does tend to enforce ideals and it needs protocols. Not easy to work empathy into our current systems, but in a way the pastoral care of the priests was a kind of bureaucratic empathy delivery system. So it can be done.

    • Paul, isn’t there a difference between supporting the creation of a profession, with values, competencies etc and giving tight rules to a set of people with performance measures etc? I would say pastoral care fell into the former and most current bureaucracy works on the basis of the latter. In the former, the person in the bureaucracy has value and values, in the latter the person is instrumental in delivering the central plan. If you are a mere instrument, where is empathy likely to come in? You are maybe a bit like the single mother being told you are valueless.

      Henry

      • paul frijters says:

        yes, but the point is that the church that supported the profession of parstoral care was very much a bureaucracy. And pastoral care has lots of processes and procedures (sacraments, rituals, rules).

        So yes, much of current bureaucracies have crowded out the empathy embedded in pastoral care, but we have had centuries of pastoral care allowed and even nurtured by a bureaucracy.

        The point I am thus making is that bureaucracy and empathy do not necessarily contradict each other. The explanation I am offering is that a lack of empathy is currently the ideal. Ideals are up for grabs though and can be challenged, though its a fight.

    • Matt Moore says:

      Empathy in the pastoral system of the Catholic Church was more by accident than design. You kept the priests separate from their flock through their vows of chastity and their robes. You gave them a rigid set of rules to enforce. Yes, there were priests who listened to their parishioners with a non-judgemental ear but that was scarcely due their training – more the humanity they had managed to preserve.

      If anyone wants to suggest the Catholic Church as a model for human services delivery in Australia right now then be my guest…

  2. There is something extremely annoying about using the term placebo effect in regards of the effects of empathy-and for that matter the work of prayer and pastoral care .

    All of those things involve conscious individual effort.
    I. E. They inolve a heck of lot more than giving somebody a sugar pill .

  3. Vern Hughes says:

    Nicholas, I’ve responded previously to your citation of Family by Family, which I have felt is misleading and inaccurate. Your reference to it again in this article appears to repeat the same problem.

    Family by Family is NOT an initiative of parents, nor is it run by parents. It is run by social work professionals employed in local government. It is now a service of a ‘careerist bureaucracy’ like the many others in the stable of careerist bureaucracies everywhere.

    It seems that you need to have a project like Family by Family to refer to as something that is different from the usual offerings of careerist bureaucracies. I understand that. The problem is I don’t think Family by Family is actually what you describe it as.

    The reason this irked me some years ago, and still irks me, is that there are actually many genuine examples of family-initiated, family-run, parent-to-parent peer-based innovations around Australia. And because they are genuinely family-initiated (and therefore not initiated by social innovation agencies like TACSI) they tend to be ignored by everyone in the service sector and its ‘innovation’ off-shoots. That is a great pity. My view is that this problem is intrinsic to agencies like TACSI because they are, invariably, created and funded by people immersed in careerist bureaucracies.

    You took offence when I first mentioned this to you, and bothered to contact third parties about my raising it. That was very disappointing. But it seems the message still hasn’t got through. If you need a working project to illustrate your argument, I can help you find one that genuinely fits the bill.

    Vern Hughes
    0425 722 890

  4. Nicholas Gruen says:

    Thanks Vern,

    I appreciate your taking the time to offer your views.

    I think you misunderstand my thinking.

    I’ve nowhere described Family by Family as an initiative of, or run by parents.

    I also have no recollection of taking offence to anything you’ve said about Family by Family. As I was at pains to stress at TACSI, being far from perfect, it can benefit from criticism, both constructive and otherwise. But to actually be a criticism of Family by Family, rather than something else, that criticism needs to be properly informed.

    What you have said about Family by Family goes beyond what you can possibly know (as I recall, early on in its development you described it as run by ‘narcissists’). And what you’ve said was – and remains – factually inaccurate.

    I also don’t know what you mean when you say that I “bothered to contact third parties” about your raising it. I’m not aware of what you’re referring to, so I’m afraid I can’t make any sense of it.

    I’m grateful for your offer to inform me of other programs that you think would be grist for my mill, and would be interested to hear of them. However it seems you are seeing things in a fairly binary way in which government is bad and the community is good.

    The burden of my own thinking on this is finding ways of turning the great engine of government with all its financial and human resources in a direction in which it might become more amenable to, more porous to, communities, empathy, and so on.

    Of course to do so, it would have to become somewhat less of the great careerist bureaucracy than it is. Still, most people in it, like most people everywhere, want, and are trying to do the right thing. Whether trying to bring about the necessary change is a worthwhile thing to do is a difficult question. I can recite the reasons why it might not be myself and I have a good friend who tells me it’s a fool’s errand.

    For all I know you have similar doubts about your own course.

  5. Vern Hughes says:

    Nicholas, I looked into the Family by Family project in detail, and talked with participants in it in NSW and SA over many years, and I don’t believe there are ‘inaccuracies’ in how I’ve described it.

    I’m aware of at least 9 versions of the idea (most of which pre-dated Family by Family), in various settings, with varying degrees of parent-centred governance. The TACSI project remains at the bottom of the scale in parent-centred governance – others have made an effort to place parents in the driving seat and have done this effectively. TACSI has falsely claimed that it’s project is driven by parents when it is not.

    I’d be grateful if you could detail the inaccuracies in my characterisation. The people who most care about this (whose voice you won’t hear) are those parents who pioneered similar models, without public funding, who have been ignored by innovation agencies because it is not ‘one of theirs’. Those parents have resented the way funding in areas like this follows the Insiders and by-passes innovators outside the funding bubble. That’s the thing about genuinely parent-initiated and driven innovations – they can’t be claimed by external agencies as their own work.

    On the ‘third party’ detail that escapes your mind … you contacted Don Edgar to warn him any against any association with me because I am an Outsider in these Insider-dominated circles. After your contact, Don Edgar prompted resigned from an Advisory Council on parent and family innovations that I had initiated. I haven’t forgotten it.

    Vern Hughes

    • Nicholas Gruen says:

      Ah – I vaguely remember and have now checked my emails.

      This is the email I sent to Don

      Hi Don,

      For about a week now Civil Society Australia which mentions you as being on its Council has been trolling the Australian Centre for Social Innovation. It has been following my Twitter feed and then firing in snide comments.

      I really don’t know what the issue is, though I note that Vern Hughes, whom I don’t think I’ve ever met for any length of time if at all, is the Director of Civil Society Australia. According to various people at TACSI he has a set against us, though I’m really not sure why.

      The comments of Civil Society Australia’s Twitter account are so gratuitous and so snide that I initially assumed that it was a spoof account set up for random trolling. But this seems not to be the case.

      I don’t really want to make a big thing of this at this stage but I would be interested in your thoughts about whether anything can be done about this. It’s pretty unpleasant being vilified as one goes about unpaid work. We all have our weaknesses of course, but I don’t happen to think that we’re any more narcissistic than your average bear. We’re just doing our best here.

      cheers,

      Nicholas

      Do feel free to give Don’s side of it won’t you?

      • Vern Hughes says:

        My ‘offence’ was to pick you up on an inaccurate and misleading presentation of Family by Family, exactly as I’ve done again several years later. A mea culpa would be appropriate, Nicholas, because you’ve been found out misrepresenting the story to fit your narrative. That was exactly what I thought was inappropriate some years ago.

        But you’re not going to make a mea culpa, are you? That would spoil the whole story.

        • paul frijters says:

          you catch more flies with syrup than with vinegar, Vern. Aggressive territorial posturing is an ugly look.

  6. Empathy = listening and paying attention.
    Empathy is patient, is kind, empathy doesn’t judge , empathy doesn’t insist .

    Empathy = feedback.

    Feedback is inefficient costly and undesirable, it’s something to be kept to the minimum, or you will never get another job in the sector.

  7. Matt Moore says:

    Leo Tolstoy vs Six Sigma

    The transformation of human services can perhaps be best described as “industrialisation”. At the core of the industrial process is a desire to improve quality by reducing variation. Hence the proliferation of standards, QA reviews, six sigma statistical methods etc. Industrial models are especially powerful because they allow you to deskill your labour force. You break complex, artisanal crafts into repeatable steps.

    These have been brought across to health, education, aged care, family care, etc. Occasionally such an approach can be useful.

    However Tolstoy famously stated: “All happy families are alike; each unhappy family is unhappy in its own way.” This is anathema to industrial models. How can you treat unhappy families if they are all different?

    • paul frijters says:

      by and large, the move towards standardised education and health services has been a huge success for populations. Particularly when run by the state rather than private businesses. The more standardised particular parts of it (such as national curricula and exams), the better, though in some parts its better not to standardise (such as giving feed-back which is best specific and given by people with discretion and high educaton).

      I dont know whether the same is true for aged care and family care. Nurses have certainly been a big success, churned out by a standard education process, but I don’t know about other service worker groups.

      The way we’ll tackle unhappy families is obvious: we first hope families, individuals and communities take care of it. If the state has to get involved because their unhappiness looks like costing the rest a lot of money, we will treat them with standardised solutions that are cheap and replicable. As with health, we might have them initially assessed by an expensive high-empathy high-skill system, after which we preferably get most of them a standardised form of help. If they’re still unhappy after we’ve given them all the cheap stuff, we’ll do something more expensive like knowledgeable feed-back.

      It will certainly look industrial for the most part, though there is an interest in something that looks like pastoral care …. got any suggestions? :-)

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