Saturday, January 25, 2014

Pathological Altruism: Giving That Hurts

Several weeks ago, I listened to the Zen abbot Joan Halifax on NPR's On-Being. With years of experience in helping the dying, I was struck when Halifax spoke of the dangers of "pathological altruism." It wasn't a term I had heard before, but it was a concept I fully understood.

In 1984, the term “pathological altruism” appeared in the scientific literature.  Barbara Oakley, a PHD in engineering and expert on this topic, defines it as follows,  altruism can be conceived as behavior in which attempts to promote the welfare of another, or others, results instead in harm that an external observer would conclude was reasonably foreseeable.

Society promotes altruism, empathy, caring and giving. While these are good and important ways to be, it’s the extremes at either ends of the spectrum that can be very dark. Those that have no sense of empathy or caring fall into the category of sociopath. At the opposite end is the individual that gives way too much endangering themselves and others.

Working in health care, I see pathological altruism all the time. Some examples:
•  It’s the doctor who orders thousands of dollars of test on a terminally ill patient or in situations where one test is sufficient. In an effort “to be sure,” or “do everything possible,” this practice can cause discomfort or pain for the patient, considerable anxiety and a large medical bill that the patient may not be able to pay.

• Caregivers who do not seek help and compromise their own health in their effort to make their charge their number one priority.

• The mother who gives her diabetic child candy so he can be “like all the other children.”

• The spouse of an alcoholic who covers for him or her.  

It is helpful to understand how the brain operates in order to see why people become pathologically altruistic. Altruism is linked to the limbic system. Being generous does give your brain a pleasurable jolt, which is why doing something for others ranks high on all the “how to be happy” handouts. Just as some people become addicted to drugs, some become addicted to altruism and ultimately a martyr to self sacrifice.

This is hard to talk about as we make heroes of people we perceive as having lived a life of self sacrifice. One example is Mother Theresa, whom many believe is a saint. It took a nun and two monks expressing their concerns before I took a closer look at the facts versus the hype.

Mother Theresa’s hospices and clinics were barren and ill equipped to help the dying and sick, despite receiving millions of dollars. The money was placed in bank accounts instead of in to buildings and medical equipment that could have eased suffering. Why? Maybe this quote of Mother Theresa explains it, “I think it is very beautiful for the poor to accept their lot, to share it with the passion of Christ. I think the world is being much helped by the suffering of the poor people.”

So if you find yourself saying, “how dare she dis Mother Theresa,” this is an example of why this is such a difficult topic to discuss.

The brain also thrives on self-righteousness and the sense of being in the right. However, just because you think something is right doesn’t make it so. As the science writer, David Brin notes, people “self-dope” with this type of thinking. He describes it as follows, “The pleasure of knowing, with subjective certainty, that you are right and your opponents are deeply, despicably wrong. Or, that your method of helping others is so purely motivated and correct that all criticism can be dismissed with a shrug, along with any contradicting evidence. Mother Theresa’s strong belief that the suffering of the poor was a gift to the world kept patients from receiving medication and treatment that could have significantly helped them. 

While this is very much an emerging scientific field of study, and you can learn more from the resource links at the end of the post, below are some things to consider to help keep pathologic altruism in check. This may be most useful for those in the caregiver role.

• Engage mind and heart when reacting to a situation. Don’t react just by emotion. Think about consequences.

• Recognize your self worth. Respect and value yourself. If you don’t put yourself first, you will not will be able to help those who need it. If you need a reminder think of the flight attendant who announces before the plane leaves the ground, in the event of an emergency put the oxygen mask on yourself before trying to help others. In other words, to be the most effective and helpful you need to be in the best possible shape you can be.

• Delegate, ask for advise and help. Don’t go it alone.

• Keep an emotional distance. Don’t crawl into their pain and misery. You are not obligated to have the same feelings they are experiencing. As Oakley puts it, Empathic concern for others without allowing yourself to become immersed in their pain can be a good thing for all concerned.  But responding with empathic distress, particularly over long periods of time, can lead to trouble. As transpersonal psychologist Margaret Cochran says, empathic distress is “when somebody is down in a hole moaning, thrashing and flushing like a toilet and they call out to you to join them and you do. So now you’re both down in the hole. Nobody wins.” Compassion, however, “is when someone is down in a hole moaning, thrashing, and flushing like a toilet and they call out to you to join them and you say, ‘No, I’ll stay up here at the mouth of the hole. I’ve got some sandwiches and juice, come on up and we’ll talk about it.’ Everybody wins.” Cold Blooded Kindness

• Be clear about your motives in helping. Is it because you need to be needed? Are you on a “helper-high?”   If by “fixing” this person do you believe you are correcting some area of your life?

• Be open to other points of view. Question.

• Remember that you are not responsible for how people react or their behavior. You are also not responsible for their personal happiness.

• Give what you can and not until it hurts.

 Pathological Altruism: A simple concept that could revolutionize scientific and social thought. Presentation by Barbara Oakley 

• JoanHalifax’s Interview On-Being: Halifax is a Zen abbot who has spent decades working with the dying. She is concerned about pathology altruism and the edge states it creates.

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