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Q&A: The Neurobiology of Compassion

Interview with William Mobley, MD, PhD, professor of neurosciences, associate dean of neuroscience initiatives and interim director of the Sanford Institute for Empathy and Compassion

QUESTION: How do you map compassion in the brain? Is it something you can actually see?

ANSWER: What you do when you set about to look at brain function for any particular brain function, sensation, motor function or cognition, you use tools that allow you to capture activity in the brain. And there's several different tools you can use. For example, you can use the EEG (electroencephalography). You can take brainwave data and you can infer from brainwave data which parts of the brain are active, how they're active, and even how they interact with one another. So EEG and brainwave activity, can be looked at.

Another way is to look at functional imaging. In functional imaging, you take a picture of the brain, the anatomy of the brain, but you superimpose upon that activity as registered in changes in brain oxygen levels. In other words, the local level of oxygen extraction. And that's due to brain activity, neuron activity typically. What you have is an image then of the brain operating in real time in a context where it's being asked questions or where it's responding to questions. What you do then is you integrate that information and you say, "Well, I think in this particular task, carefully defined, carried out let's say in the MRI scanner, this person has activation of these brain regions." This is how they're correlated in time and so we think that X and Y brain regions are involved in engaging in this particular task.

QUESTION: Do you believe compassion is something that you can map in the brain the same way you would map fear or pleasure or any other type of human sensation?

ANSWER: Yeah. I mean, I think you can map any mental state. The question is can you separate that mental state from other mental states? Can you really know that you're looking at compassion versus attention versus memory versus fear? You have to create tasks that allow you to really separate what you would say is a compassionate perception of the world or a compassionate willingness to reach out to care for someone else. You have to separate that from other brain states, from other activities, but yeah, you can do that.

Anything that your brain does, any activity it engages in, will involve neurons. That's kind of the base case. Neurons are active and engaging in any number of different tasks. Can you separate one task from another so well that you can say this task engages this set of brain regions?

QUESTION: That's the million dollar question, and this entire gift is supposed around the idea that you can isolate this idea of compassion. When the Sanford Institute gets rolling and these experiments are carried out, what will they look like and how will we actually identify compassion and separate it from these other states?

ANSWER: We're going to have the ability to bring a very talented faculty to bear. Faculty who have engaged their careers really in understanding empathy and compassion. And they're going to have the resources available to do experiments to really isolate empathy and compassion and look at those brain regions that are engaged.

So, we'll build in the literature. We'll build in their past work. And we'll build new studies that allow us not just to do that, but to do it in the context of real-world situations. For example, how does a student who's just entering medical school respond to a patient in need? What do their brain networks really look like? And then, what will those networks look like after we've engaged in training programs that sensitize them to properly pay attention to the signals that the patient's sending about their own distress, their worry, their fear? How do they change?

And then, can we modify those training programs using brain imaging to teach us how to make those training programs even more effective? The bottom line is we'll have people in the institute who devote their lives to understanding the brain basis of empathy and compassion. We'll engage in experiments that help us isolate those properties of mind. We'll engage in training programs to help them enhance them. And then we'll let all that come together to build training programs for physicians and scientists and really, the rest of us, that allow us to say if you engage in such and such kind of training, we know on the basis of the way that your brain works that you're being more effective. You're more at ease. You're more aware of your own concerns, your own issues, but also of those with whom you're interacting.

QUESTION: So, once you pinpoint it, then you can also learn how to teach it?

ANSWER: Exactly right. And the brain science really speeds the process along. If you put somebody in a training program, you say okay, we're going to train up empathy. And then you can ask them in the beginning and later, "Do you feel that you're more empathically capable now?" That's a nice report, but it's very subjective. The brain science allows you to make it objective, and more than that, it allows you to, sort of in real time, enhance the ability to be effective. So, you essentially create training programs that build on brain activations, brain activations that inform training programs, and the two of them come together in a way that's much faster, much more efficient than just the one or the other alone.

QUESTION: There has been so much work and literature and research into the subjectivity of compassion. Why do you feel that now is the time to change that and make it objective hard science?

ANSWER: Well, I think first of all there's never been a more important time for compassion. I mean, we're surrounded by situations that call for compassion. And that there's almost certainly a compassion deficit. Not just in this country, but across the world. We need compassion to help us get to the next level. We need compassion for the survival of the race. That's point one. We need it. Now as never before.

Two, the tools that exist now are just so much better than they were even 10 or 15 years ago. That's a second point. The tools now exist to really make this feasible.

Thirdly, I think there's a willingness now on the part of the neuroscience community to engage in such studies. I remember many years ago I met with colleagues and they really thought that, and principally probably because of the subjective nature of what was going on and the lack of tools, they didn't want to put their careers in this. They thought it was just too flimsy, too sketchy, too murky.

QUESTION: Was it considered not a real science perhaps?

ANSWER: It was not considered a real science. Even though the tools, I think, had begun to be there and probably could've been used effectively, they were not interested in putting their name on a study that might be considered to be soft. I think that's changed now because of what I've mentioned. There's a need, yes, a great need, but the tools now exist so that those who have been motivated and will be motivated can say, "Look, I do hard science. It's just called compassion science or empathy science. Very different than before." But, you know, just to get back to this, it really needs the energy of an institute. It needs the focus and the critical mass the institute provides. Because otherwise, you're on your own. You're a young professor sitting in some institution some place and you're engaged in this, you want to do this, but you're limited by your resources. You're limited by the people that you can talk to about it. You may be limited in the facilities that the institution has available to you. You're missing that critical mass of resources and people to help stimulate your own thinking. The institute is going to provide that. It's going to give us a critical mass of rigorous scientists who can commit their careers in a way that will be much more effective than the one-offs that exist currently.

QUESTION: You've spent a long time talking about compassion and really exploring the intersection of compassion in neuroscience. You've built a career out of it. You are esteemed because of it. How are you feeling now that this institute is really about to happen?

ANSWER: It's amazing. I don't think there's ever been a time in my life where I've had more hope and more optimism about the future. And, you know, it's so different. My day job is really cells and molecules and Alzheimer's and Down syndrome so that's been my way of expressing empathy and compassion, trying to find things that help people who are sick.

But a much bigger goal really, and one that really helps me rethink my career, is this whole opportunity now with resources available in the institute to help a whole new generation of scientists build careers that go beyond cells and molecules to really the way the brain works in a way that helps that brain connect person-one to person-two or person-one to group-two. So, an optimism, an excitement, an energy. But also really the sense that the institute makes feasible something that I've really wanted to see for a long time.

QUESTION: Obviously, the experiments are still ahead of us. We have to wait and see how the research plays out. But, can you tell me where in the brain you think this activity is going to be located, and how soon you expect results we can really crunch into data?

ANSWER: I think we're going to find, as others have found in the past, that your sense of your own self, your sense of your own internal feelings, is registered very powerfully in the insula of the brain. It's a particular part of the brain. One on the right, one on the left. The insula is connected to a number of other brain regions that are almost certainly involved in judging, reflecting upon, thinking about, really measuring the meaning of those feelings that are basically represented in your insula. They are then connected to the anterior cingulate and to other parts of the cingulate cortex, which really have a motoric function. As well as a kind of sensory awareness function, they have a motoric function.

The insula and its associated brain regions in sensing, being aware of, a situation where empathy might be appropriate. And other parts of cortex, including cingulate, where activity that looks like compassion might originate. We have to remember the amygdala. We have to remember the parietal cortex. We have to remember the superior temporal gyrus. All these brain regions work together. But, if you said to me where's the impact going to be? I think we're going to be measuring changes in activity in insula, the inferior orbital cortex, anterior cingulate, posterior cingulate. I think those regions are going to teach us an awful lot about the status of a person's empathy in real context or real test or real experiment and their willingness and ability to engage in compassion. Just a guess, but I think that the literature suggests that that's where we'll probably find the biggest signals on day one.

QUESTION: What's the timeline? How long will it take from starting the experiments to really having data where we can say we've pinpointed it and now we can move into applying this data into actual programs?

ANSWER: I'd be surprised if we're going to be longer than two years. Given the current literature, I'd be surprised if it's going to need more than two years for us to confirm what others have seen and begin those early studies that teach us how to amp up activity in insula, amp up activity in cingulate and then follow the behavioral correlations, which are at least a perceived increase in empathy and an observed increase in compassionate activity, in compassionate behavior.

QUESTION: Is there anything else that you want to tell us about the institute that you're particularly excited about or proud of or looking forward to?

ANSWER: Well, you know, my sense is that this is an evolutionary change in what we're doing at UC San Diego and that this place, perhaps like no other, can mount an effort that makes the world a better place for all of us to live in. That's exciting. The idea that many years from now we'll look back and say that was a key moment in, really the history of neuroscience, but more generally in our ability using rigorous science, combined with behavioral interventions, to really understand the mind and make it possible for people of all persuasions and all levels of society and all job descriptions from all cultures to really, for the first time, have the hope that they can empathize effectively and reach out with compassion to those that are in need.

We expect the T. Denny Sanford Institute for Empathy and Compassion to change the game in understanding the brain basis of empathy and compassion and translating that understanding to programs that markedly enhance the ability of physicians, both in training and in practice, to really understand their own feelings of empathy and compassion, to enlarge upon those, and to make their good services, their good souls available to their patients. It changes in the near-term the way that we train our young doctors, how we care for our patients. In the long term, the T. Denny Sanford Institute is, I hope, going to make a very big difference in the world at large in making empathy and compassion more available to all of us.