British newspapers regularly report on a surprising failure of healthcare – loss of compassion. Patients, particularly the elderly, are abused and mistreated by the very professionals who should be caring for them. This is not a particularly British problem. In many countries the same lack of empathy and compassion can be observed on a daily basis. So where does compassion come from and how is it lost? Is it something you either have or you don’t, or can be learned?
There certainly seems to be a genetic, inborn element to the gift of empathy. We know that the hormone oxytocin mediates feelings of affiliation, belonging and social and emotional processing. The oxytocin receptor gene is present in two forms, A and G. People homozygous for the G form are significantly more empathic than those with the A form. In an interesting experiment, 20 second video clips were shown to a large group of observers. The clips showed the facial responses of the subject when the person they were sitting with recounted an emotionally distressing experience. Simply by reading the emotion in the eyes of the subjects, the observers were able to judge the size of the empathic response and correctly judge their genotype.
While there is clearly a genetic component to compassion, environment seems likely to play a crucial role. We have known the importance of role models in developing student behaviour for a long time. The neurological basis for this may lie in our mirror neurons. These are neurones which fire both when a person acts and when they observe the same actions performed by another. This applies to simple motor tasks like watching someone drink a glass of water or to complex situations such as observing emotional distress in another. The complexities of mirror neuronal function have yet to be explored fully, but they may explain how children can learn complex tasks relatively easily and how happy or miserable moods are so easily spread within an organisation or clinical team. In the same way a compassionate or callous approach to patients is likely to stimulate mirror neurones in the brains of students or healthcare professionals observing this behaviour. But does it cause a change in likely future behaviour?
Neuroplasticity refers to the brain’s ability to change in response to internal (genetic) factors as well as to external (experiential) factors which lead to new learning. It used to be thought that neuroplasticity was something that existed only in children. However the evidence suggests that the ability of the brain to change its structure persists throughout adulthood. ‘Neurones that fire together wire together’ sums up the importance of habit and practice in reforming the brain. It seems likely that repeated stimulation of mirror neurones may change brain structure. This means that working in an environment in which compassion is regularly modelled and exercised may actually change the brain structure of doctors and nurses and cause the learning and practice of compassion.
But the development of a compassionate nature is not just a passive process, dependent on the behaviour of others. We can take active steps ourselves. Experiments have shown that compassion meditation not only enhances neural responses to disturbing sounds like weeping , but it also promotes altruistic behaviour towards strangers.
The negative side of all this is that bad role models and abusive working environments may extinguish empathic behaviour. A key factor in this seems to be the issue of interpersonal distance. People or patients ‘not like me’ risk being regarded as less than human and perceived as being unable to experience higher order mental states like love and guilt. The observation that elderly patients, particularly the demented, have been treated like ‘objects’ or ’slabs of meat’, suggests that their carers have infrahumanised them to such an extent that compassion for their distress is simply not felt.
We cannot change our genetic inheritance, but we can change what we do with it. The friends we choose, the environments where we work or enjoy recreation can all have a profound effect on the structure of our brains and consequently the way we behave. Even our habits of thought and reflection will mould behaviour in the way that we work with others for their benefit or for their harm.
 . Kogan, A., Saslow, L. R., Impett, E. A., Oveis, C., Keltner, D. & Saturn, S. R. (2011). Thin-slicing study of the oxytocin receptor (OXTR) gene and the evaluation and expression of the prosocial disposition. Proceedings of the National Academy of Sciences, 108, 19189-19192.
 Lutz A, Brefczynski-Lewis J, Johnstone T, Davidson RJ, 2008 Regulation of the Neural Circuitry of Emotion by Compassion Meditation: Effects of Meditative Expertise. PLoS ONE 3(3): e1897. doi:10.1371/journal.pone.0001897
 Leiberg S, Klimecki O, Singer T, 2011 Short-Term Compassion Training Increases Prosocial Behavior in a Newly Developed Prosocial Game.PLoS ONE 6(3):e17798.d
 Mitchell, J. P., Macrae, C. N., & Banaji, M. R. (2006). Dissociable medial prefrontal contributions to judgments of similar and dissimilar others. Neuron, 50, 655-663