Tami Simon: Welcome to Insights at the Edge, produced by Sounds True. My name is Tami Simon. I’m the founder of Sounds True. I’d love to take a moment to introduce you to the Sounds True Foundation. The goal of the Sounds True Foundation is to provide access and eliminate financial barriers to transformational education and resources such as teachings and trainings on mindfulness, emotional awareness, and self-compassion. If you’d like to learn more and join with us in our efforts, please visit SoundsTrueFoundation.org.
In this episode of Insights at the Edge, my guest is Dr. Eve Ekman. Eve Ekman is a contemplative social scientist, and a senior fellow and director of training at the Greater Good Science Center. She worked for years as a social worker in healthcare, criminal justice, and social welfare systems, which inspired her to earn her masters and PhD at UC Berkeley and then complete her post-doctoral training at the UCSF Osher Center for Integrative Medicine.
Her research has focused on helping professional care providers prevent burnout by giving them easier access to practices of attention, insight, and resilience. With Sounds True, along with Dacher Keltner, Eve Ekman has created a new online offering. It’s called The Greater Good Training for Healthcare Professionals: Science-Based Skills for Emotional Resilience and Wellbeing.
It’s such an honor for Sounds True to partner with The Greater Good Science Center on this offering. If you’re interested, you can learn more at SoundsTrue.com.
Eve Ekman understands emotions from the perspective of the great wisdom traditions, from the view of scientific research, and from her own internal investigations, and she helps us understand how we can make space for all of our emotional experience and sustain an open heart in the process. Here is an illuminating conversation with Dr. Eve Ekman.
Eve, it’s great to have this chance to be with you and to get to know you better. It’s awesome.
Eve Ekman: Thank you so much.
TS: Yes. I wanted to start off and find out, from your perspective, what it was like to grow up with your father, Dr. Paul Ekman, and here to be a second-generation emotion researcher, and how his work informed you. If you will, presume that our listeners don’t know anything about your dad, because it’s possible they don’t.
EE: Thanks, Tami. Yes. I’m so delighted to be here, and really looking forward to this conversation today. If you don’t know my dad, I’m so delighted to introduce our listeners to him, Paul Ekman. One of the taglines that was given to him early on was he’s the Indiana Jones of psychology. He really likes that one, so I’ll share it with everyone for his benefit, in that way as well.
He was interested in human emotion. He was primarily interested in helping people overcome difficult experiences of emotion. That led to his early field research in Papua New Guinea, where he set out to really understand if there is something shared and universal about our experience of emotions. Meaning, if I’m in one part of the world and I feel angry, am I showing actually a frown on my face as though I were sad?
In that field research, he discovered this core aspect of universal human emotion, meaning what we feel in our bodies and what we display on our faces is caused by somewhat similar circumstances. From there, his research went on to look at the embodied experience of emotion, these unique physiological signatures—or, a more simple way of saying it, that there’s something different when we feel anxious to when we feel jealous. He looked at a lot as well, the way the face reveals some of our true feelings and how sometimes that can be challenging for us. And that became some work in deception.
For me, the work that has been more inspiring is his work since 2000 with his holiness the Dalai Lama and then a whole series of wonderful Buddhist scholars and neuroscientists interested in this convergence between meditation, emotional awareness, and wellbeing.
To the first part of your question, growing up with my dad was growing up with an awesome dad. He was so determined to be a dad. He became a dad at 45, which is, these days, not unusual. But in his time, he had waited years to find the right conditions to have a child. I really felt just such a sense of being the center of his universe, and fortunate to that. I know not everybody gets that experience with their dad.
He was playful, he was joyful, an adventurer at heart. Growing up with him, I don’t think I had an awareness that he was this hardcore researcher of emotion and human behavior. I do remember it coming into my consciousness—he had a laboratory at UCSF, and it made me kind of self-conscious. After school, I got off the bus and I’d go in the backdoor, because on the front door it said “Human Interaction Laboratory,” and sometimes there was a bright red sign saying, “Don’t come in. Experiment in progress.” My friends’ parents were teachers or doing things that seemed far more regular and normal and here was my dad with this laboratory. That was my earliest recollections of his work.
TS: How did you discover inside yourself that following a similar path in some ways, and in some ways, different—I’d love to hear how you experience the similarities and differences, that that was the right route for you, the professional route for you.
EE: Yes. I wish I could say it was intentional, that I had a clear idea. All I knew is I didn’t want to be in his shadow. For the early part of my career, I felt pretty clear on that.
What I was really clear about was helping other people. That was the earliest inspiration I can remember. When I saw my dad’s work, it seemed to me, it was kind of locked in the confines of a laboratory. Ultimately, it’ll help people through research papers and conferences, but it didn’t seem to me immediate enough. I was really drawn to this frontline work through journalism, through being a clinical social worker myself. But I started to become really interested, especially when I was working in the emergency room here at our level one trauma center, in what would help support myself and my colleagues manage the daily stress of being in an emergency room.
If it were just that daily stress would make people burned out, everyone would be burned out. That wasn’t the case. It was so wonderful to see the integrity and compassion of my colleagues, whether they were the X-ray techs or the surgeons, people really showing up and caring; and it was a lot to hold.
As a social worker there, I felt the calling to go back to school and become a researcher of this compassion, and that’s where I took my first step towards my dad’s work—because researching compassion is in the domain of psychology, and he had already begun his work with the Dalai Lama.
I was still trying as much as possible to separate myself from what he had done, that I didn’t necessarily just want people to believe I was only doing this work, because of him or anything I would achieve would be because of my close proximity to him. I had this sense of fairness around that.
It was only because he became quite ill, the very first time he was supposed to teach this training, “Cultivating Emotional Balance,” that I stepped in last minute, with two weeks’ notice, and the first time I taught this material of bringing forth emotional awareness alongside meditation; it just clicked in. It felt like being in the emergency room, it felt that vital and that present for me. It was really, in some ways, an accident that I got involved.
TS: Now I want to talk a lot more, Eve, about your discoveries from being in the healthcare profession yourself, and the comment you made—how come some people are getting burned out by this work and some people aren’t. What can we learn? What can we discover?
But before we get there, you and your father, with the encouragement and then blessing of the Dalai Lama, created this huge project called The Atlas of Emotions. This was a way of mapping all of the emotions for a certain goal in mind. If you could describe, what’s the goal of The Atlas of Emotions that you and your father spent so many years working on together?
EE: Yes. The goal is quite simple. The goal was one of his holiness, the Dalai Lama, who said, “In order for us to find our way to the new world, we needed a map. And in order for us to find our way to a calm mind, we need a map.” The goal is a calm mind.
This doesn’t mean aloofness, not caring, the world events not affecting us; our loved ones being sick, we don’t care. Calm means a place we return to when we become emotionally and intensely aroused.
When we have a calm mind, we can have these acute emotional arousals and not get so sticky on it. The goal is, once we can identify and name our emotions, we have some capacity to—this elusive word—make space around them. What we know from the research is that this is called emotion granularity. When we get really specific and name and identify our emotions, we’re actually halfway to having some capacity and control to be with them, and especially be with how we respond to them.
When we talk about working with emotions, we’re not talking about getting rid of triggers—good luck. We’re talking about how we can come into awareness, so we can impact how we respond to those emotions.
TS: OK. This notion of granularity, being able to name the emotion in its specificity, how does that help us go to a place of spaciousness? Why do I need to be able to name it? Can’t I just be like, “Something weird is happening. I am going to go towards a big space”? Why does naming help?
EE: Yes. Such a good question. It’s interesting. There are a couple research insights I can point to that I think are useful for folks. One is, especially, let’s consider the end of the day, “How was your day yesterday?” “Hard.” “OK.”
With that statement, what you’re recalling is kind of this peak end role. You remember the most intense thing and often you’re remembering the thing that happened at the end of the day, and that doesn’t necessarily give you the full spectrum of your entire day in its richness.
A little bit of research I got to do at UCSF is giving people an iPhone app to track their emotions throughout the day. These were residents who were very burned out. That is usual for residents. Here they are, in training, doing intensely hard work, being evaluated all the time with no sleep. It’s a recipe, right? That’s a challenging time for folks.
When you ask them about burnout, what you’re asking them is, “How were your last two weeks?” They report this intensity and difficulty of daily experience. When you ask them throughout the day, many times, they report a whole variety, a kind of richness, this granular richness of emotions, “I feel content, I feel anxious, I feel frustrated, I feel content again.”
What we found with this group—we did 100 participants over two weeks, most of them reported two to three times a day, more than 50 percent of their emotions were enjoyable emotions, feeling content and feeling good. That was surprising for them.
In our follow-up interviews, just naming those emotions throughout the day reframed or brought mindfulness to their daily lived experience. That’s one aspect of why this granularity is helpful.
Another aspect that’s helpful is, when we are specific with our emotion experiences and naming them, they’re less likely to be operating in the background draining us, almost awaiting this opportunity to then explode at the wrong moment.
We can suppress our emotions. It’s a really useful skill. We should do so, very often. Yet, if we’re never tuning in, identifying or naming what we’re feeling, we’re also building up this reservoir. You could think of charge or difficulty. It’s also well explained through our autonomic nervous system. If we’re having this buildup of over-arousal and stress that we’re not attending to or releasing to in a certain way, it just becomes difficult for us to see clearly.
A lot of amazing research about the impact of stress and over-arousal of stress on memory, on cognition, so this naming of our emotions diffuses the emotion, because we’re able to see it and then do this other interesting term in psychology, which is decentering: “I am not anger—I am angry.”
TS: I want to talk more about the Atlas, but just personally for a moment—do you have a kind of set of go-to moves, if you will, when you feel yourself, “Whoa, that’s a big emotion—not the time to express it,” here is what I do?
EE: Yes. I do. I will be totally honest that, of course, they don’t always work. Especially when I get rundown. If I’m tired, if I’m hungry, some of what we call in the Atlas of Emotion as our pre-condition—if my leading up to an emotion event, I don’t have a lot of resources, it’ll be harder to call on those tools.
Just to name that with humility, that these are difficult experiences for us to manage, especially big emotions. One of the number one moves that I take is to really go and feel the sensations in my belly. It could be anywhere. I could notice sensations in my chest. I could notice sensations maybe around my face. But what I like to do is just notice this kind of bodily imprint of emotion experience and use what’s called interoception, or this bodily felt experience, to help me be present. Once I am noticing the sensations in my body, it’s almost as good as though I were able to name it or say exactly what it is.
Another one I really try to do is, essentially, as though I were leaning back, zooming out. I may not physically move anywhere but inviting in this sense of “OK, can I step back?” There are these wonderful teachings by eighth-century master Shanti Deva—not a contemporary scientist but an ancient scientist of the mind. This advice he gives us for strong emotions is remember scope—remember that your feeling in this moment, in the context of our greater world, may or may not have much poignancy. He asks us to remember complexity; whatever is happening right now is connected to so many other things. It’s just almost unknowable.
Then the last, which I find to be, for me, the most inspiring, is this is training. There are always going to be difficult emotions, difficult feelings. Can I use this one as my training ground to continue to move towards my sense of calm and my ability to recover or have emotional resilience?
TS: Back to this notion of granularity, do you attempt to find the specific word, the specific nuanced emotional word for what you’re feeling? Does that help?
EE: It does. I should mention that one early. It’s one that I practiced for so long. It’s pretty quick for me, to be able to identify it. Actually, it’s not only the cognitive process. It is the embodied process. I’ve spent quite a lot of time on retreat getting really familiar with, again, almost this body map of sensation. I know that anxiety has this imprint of almost a chin strap of tension, and then below the eyes, whereas anger is more of a warm, tense feeling in the chest. I can use the granularity either through noticing and naming the body or anger, frustration, anxiety, tension.
TS: I think part of the reason I’m digging in so much to this vocabulary and the notion of granularity is I love words. I love words. Yet, I realize I don’t have available to me dozens and dozens and dozens of words within each of the family of emotions. I haven’t studied it, I haven’t made that an important part of my inner education, and yet in looking at The Atlas of Emotions, I thought this is really a missed opportunity here. I wonder how many people haven’t done that work and haven’t studied all the different—if you will, just going with the Atlas idea—all the different countries that are within any emotional continent.
My question to you is, how would you suggest someone approach that if it’s a learning that is new for them, that they’d like to do?
EE: Yes. Such a great question. I actually think the best way, instead of the multitudes, is to start maybe with one emotion per day. For most of us, it’s actually hard to identify a single emotion. When we’re talking about emotion here, we’re really using this contemporary scientific term, which is, an emotion arises in a 25th of a second and it generally only lasts 30 to 90 seconds. That’s its physiological peak and then it comes down.
Most of us think of emotions in these long stories, “The afternoon was terrible, and all of these things happened,” so I invite people not only to go granular but to go specific. “OK, what was that first incident?” “Well, yesterday, there I was trying to get to work, and I was in traffic, and I was so stressed out; it was so intense.”
Instead of choosing the whole morning, maybe what happened after you got to work, and you were late and then what happened at lunch and then after lunch, just that one experience, what was the trigger? What was the experience of it? Meaning, what was the emotion? It was frustration or maybe anxiety. What was the response?
If we get granular, not only on the state or experience of our emotion, but what leads to it and what leads out of it, it invites our natural curiosity, because, as you said, why learn all these names for emotions, right? I have enough to do. I could maybe learn more about how to be a great taster of wine and learn all those qualities.
TS: Yes. That sounds good. That sounds good. Yes.
EE: This is not that fun. I think when we look closely at our emotion, especially that kind of timeline of emotion, wow. There’s nothing more interesting. It’s so compelling. “I can’t believe this made me upset.”
As we look, day after day, we realize there are these patterns. There’s nothing new, right? It’s the same material, our same thoughts, our same habits, our same patterns. Of course, different events precede them, but we start to see that some of our emotions are actually quite regular guests in our daily experience.
TS: You said 30 to 90 seconds for an emotional guest but how do you make sense of the experience of “I got this email—I get that I was triggered in 1/25th of a second—but I was fricking angry for four days. That was not 30 to 90 seconds. I know I kept thinking about it, but I did not find the ending arc of that emotional experience. I stayed mad. I was even mad when I was sleeping.”
EE: Yes. You know, waking up in that heat of the emotion, yes, it’s very common. I know that well. I would say that if there is an ability to even pay attention, even closer to it—it may seem like I’m already paying pretty close attention to this emotion, it’s making me this mad, over and over—but we will notice that the physiology of it can come down naturally, unless we, as they say, poke the bear or we re-trigger.
We re-trigger our emotion by thinking once again about the outrageous content of that email. Interestingly, coming back to granularity and specificity, when we do that process of naming the emotion, we’re actually unhooking from the narrative story about what’s so bad and what’s so wrong.
What we need to do in the process of our four days or four weeks or four years of being upset about something is try to intervene on that thought process that is just coming and coming and coming. It is really challenging to do so but we all can find these moments where we are not quite so enmeshed with the cognitive process, this idea of cognitive fusion. We’re faceplanted in the experience of this story of what’s not OK. As I mentioned, our emotions are these timelines. They’re like these mini stories. How do we interrupt that story? Even just for a moment. Give ourselves some time to relax.
I will, again, point us back to the body, noticing the sensations in the body, and as we’re noticing sensations in the body, we’re in the present. We’re not thinking about the email, which is now in the past and we’re not thinking about the email of our response, which is in the future.
TS: Another question I have for you—I can’t tell if this is because I haven’t looked closely enough or not—is can I be feeling, can anyone be feeling different emotions at the same time? What does the research say? Can I be happy/sad at the same time? I can kind of be smiling and crying. I’m happy/sad at this news. Is that possible?
EE: Yes. It’s a great question. The research is not conclusive, in the contemporary scientific research. Again, when I look at the ancient research of the mind through a lot of contemplative practice, I do think we are having separate experiences of emotion happening back-to-back.
When I think about being frustrated and then being sad and then feeling some shame, those might happen somewhat rapidly. I have found them to be distinct in my own first-person investigation and in what the research knows to date.
Now one of the most exciting things about the science of emotion is there’s a lot we don’t know, and actually a lot we can’t read. There is absolutely no instrument out there that can tell you how you’re feeling with better accuracy than you.
You might say, “Well, I don’t know how I’m feeling,” but you can be trained for that introspection just by, again, noticing the sensations in the body, developing that vocabulary, understanding the difference between a trigger, an experience, and a response.
Within a couple weeks, you will be much better than any FMRI, than any ability, even through galvanic skin response or reading facial expression to identify what is going on for you emotionally.
TS: It’s interesting, Eve, when you talk about your own first-person experience, your study of the contemplative traditions, and then your research and the science. I’m curious. Do you have a sense of “When it all comes down to it, I’m really interested in my first-person experience”? Or are you like, “I want to put all three of these together. That’s what’s important to me. That’s what really matters”? How do you see it?
EE: Yes. It’s a good question. We know that science opens the door for so many people without access to a lot of cutting-edge teachings and ideas. For many people, Buddhism is never going to be something they’re interested in. It seems religious or spiritual in a way that’s unappealing.
If there is some wisdom from these ancient traditions, they need an entrance into our contemporary orientation of what matters. That’s scientific. I don’t think there will ever be a time when the third-person observation, which is contemporary science, I don’t feel there will ever be a time that doesn’t matter, lest our entire consciousness really changes, which I am all for and I hope that happens where we start trusting spiritual wisdom as much as we trust scientific wisdom.
For now, the science can also help us identify in a different way than first-person experience. First-person observation or first-person introspection, it’s just incomparable. It’s so empowering to develop self-awareness. Then, interestingly, there’s a complimentary science that says self-awareness is a key to our wellbeing, that it not only helps us understand what we’re experiencing in the moment, but it helps us make better choices in the future.
I think they really go well together. I don’t think I actually need to choose. Though, I will say there are some interesting tensions or moments, even in the understanding of emotion. For example, his holiness the Dalai Lama and my dad at their earliest conversation—and now 22 years later—there’s still a debate around anger. Is anger ever OK or is anger always this poison of the mind? I get excited by the nature of that ongoing debate. I’m glad not everyone agrees.
TS: What’s your view on that? I have a view but I’m curious what yours is.
EE: Yes. Anger, maybe needless to say, is a common emotion. I am really committed to a sense of true care and interest in our anger. When we are trying to avoid and deny our anger, which is often the way that people involved in various spiritual practices orient themselves, we’re creating tension.
I’ll tell a small story. One of the trainings I gave in Italy was at a beautiful center: the Istituto Lama Tzong Khapa. It’s an old Tuscan castle that’s been converted into a Buddhist hall. There were a lot of folks who were attending this training on emotional awareness who were practitioners for 15, 25 years of Tibetan Buddhism.
We did this practice on noticing the experience of emotion and especially anger in the body. This woman said, “Wow. For the last 15 years, I thought I had a headache. I was just angry.” Right? She was denying her anger, and it was still manifesting for her at a bodily level.
I think trying to avoid or deny anger, because it’s a poison, which is sometimes described in Buddhist text—there’s a famous saying, “One moment of anger is millions of lifetimes of merit are destroyed.”
TS: I hope that’s not true. I have to dispute it but, anyway, yes.
EE: I think it’s a misunderstanding or maybe even a mistranslation of anger. When we think of anger, which is, again, this brief episode of feeling frustrated. I felt frustrated with myself this morning that I ran out of coffee—did I just ruin all the merits of all my lifetimes? I don’t think so.
It’s the kind of anger that carries ill will or intent to harm. There’s a big distinction there. When I am frustrated, for example, by the political landscape of this world, by injustice, that’s an anger that can actually manifest in a way that is very constructive.
Sometimes people orient around negative and positive emotions. One thing in contemplative science of emotion we’ve really put forth is there are no bad emotions, but we can respond in ways that are less helpful. If we think of anger as not a negative emotion but an emotion which can have a destructive response or a constructive response, then there’s an opportunity.
TS: Eve, just to connect a dot here, if I was saying I’m going to study anger and I’m going to really look at subtleties and nuances, can you throw out for me—this is not an oral exam, I’m just curious—can you throw out for me a dozen different kinds of anger that I could start identifying in my experience?
EE: Yes. I think it’s interesting. One I’ll just name quickly is hatred, which is not even considered, per se, an emotion but an enduring state. With hatred, it’s the same trigger over and over and over whereas for most of us, our anger comes and goes, we have different targets all the time.
“Anger” is also a word people feel a little intimidated by. They might not want to own up to feeling angry. I’ve done workshops in many parts of the world, and very often there is a desire to avoid saying, “Yes. I feel angry” or, “I get angry at work” but if I bring up something like “frustrated” or “annoyed,” “OK. Yes. I feel frustrated,” “I feel annoyed.” I think, again, there’s a cultural weight sometimes with the word “anger,” whereas a lot of its specificities, especially frustration, annoyance, I mean, there are so many different words—“pissed off,” “rage.”
One unique characteristic of anger: it is the emotion that leads to war and violence. When we are enacting violence, it’s out of a deep rage or anger. Often it includes a dehumanization, right? Especially in the case of war, so that is actually the emotion of disgust.
When we experience disgust, we’re dehumanizing the other. It’s as though they are so toxic and different from you. See, I did the facial expression, which is to raise the nose and that crinkling of the nose actually opens the apertures of the nostril, so I can smell better.
There’s this evolutionary adaptation, not only to our feelings of emotion, but even our expressions of emotion.
TS: When you say that you’re an ethicist and all of us have the potential to be, what does that mean?
EE: In that when we’re creating and when we’re considering our user (I don’t love that word—I could say “our audience”) we have to think about their best interest, and really keep that in mind, and not let what we can do, because we have the skill or ability, outweigh our hope or aspiration for what can be experienced and gained from our hardware or surfaces.
TS: OK. With Sounds True and with Dr. Keltner of the Greater Good Science Center, you’ve created a new online offering. I don’t even need to say, with the ethicist in you, fully operational, obviously. It’s called the Greater Good Training for Health Professionals: Science-Based Skills for Emotional Resilience and Wellbeing.
TS: I’m wondering as you think about this program and how you designed it, how you drew on your own experience working in the healthcare field, what from your own experience was important to you in the design of this program?
EE: Yes. I feel so fortunate we’re bringing this to light. This was a dream of Dacher’s and mine for many years. Dacher is coming from, of course, the very scientific view of the highest potential of humans, our awe, our kindness, our generosity. I love those qualities. But, Tami, what comes from me, from my experience is how do we be with our sadness? How do we be with our anger? How do we be with our shame?
I was so intent that this program that we were offering wouldn’t just give people the good news. The good news really matters. It’s really important for us to develop meaningful social connections. That’s the ultimate stress buffer that we have. But to also make space and give people tools to be with those difficult emotions is essential. They don’t need to be the thing we get rid of and avoid.
When I was working in the emergency room, I was really fortunate to work there for six years. I got a pretty good insight into the workings of that place. Then when I was a post-doc, I got to spend another three years working with physicians and residents and nurses interviewing them about stress and burnout and then creating trainings for them and evaluating trainings.
I’ve gotten a couple different angles on the healthcare work. It’s really interesting. There’s such a beautiful tension between this work that offers possibly the most meaning I could imagine, which is if you look at the science of happiness, meaning is at the very core, and this work that really challenges our very natural desire to be empathic and care for others.
Empathy rose up as such a powerful important area to understand when I was studying healthcare. It wasn’t something that I noticed when I was working in healthcare. It was so natural. It was literally the water I swam in to be available for others. Empathy has really come up. I think we really try to address it.
TS: Yes. Talk to me about what you call sustainable empathy versus the empathy that leads to, “I can’t take this anymore. I can’t take it.”
EE: Yes. For me, it’s such a natural reflection of understanding emotions. When we look at our emotions, we realize these are not something we choose. I don’t choose to feel sad or angry. Maybe if I watch certain shows or if I read the news and I want to feel a certain way, but most of our emotions just arise, unbidden. And the way that we respond to other’s emotions is also not something we necessarily choose.
One example, let’s say, of me working in the emergency room is I see a patient come in, who is clearly distressed and in pain. I’m not thinking, “Huh, I wonder if that patient is in pain. If they were in pain, I’d feel bad for them.” Their emotion expression is immediately resonated. I can feel it through my entire body.
With empathy, we have both that immediate emotional resonance and what’s called our cognitive appraisal, or, essentially, what we think about it. These happen almost instantaneously but we see through the neuroscience that we have that immediate emotional resonance and then maybe milliseconds after, we have a thought about it, what’s happening here?
This is a crucial juncture for empathy. If my thought when that person is coming into the ambulance bay looking distressed, if my immediate thought is, “Oh my God. I can’t handle it. One more patient? We’ve already had five traumas today. I’m tired. I haven’t even eaten lunch,” I may go into what’s called an empathic distress, a sense of literally, “I can’t handle it,” and overwhelm.
We could also have that in experience of despair, “God, this hospital system is so broken. I can’t. I’m done. This is too much for me” and that’s interestingly our cognitive process. That same patient coming in, we could have the appraisal of, “Oh, I know that patient. They were here last week. I know them. I think they have these issues they’re not taking care of,” whether that’s my projection of them having substance use or mental health issues and, unfortunately, this happens, right? We can become callous. We can even have a sense of aversion.
We have someone come in and our appraisal is, “That’s not my problem. I don’t care.” Right there I’m highlighting two different aspects of burnout. Burnout includes this sense of emotional overwhelm, emotional exhaustion. It also includes cynicism, a lack of caring. Then we have an opportunity with empathy to come in and see this person suffering and recognize, “I care. I want to support this being who is coming in here, this person, this patient.”
With that compassion, it can go many ways, right? Our appraisal of compassion can mean immediately I run to the bedside and help, it means I give some space, check in later. And empathy that leads to compassion is an informed compassion. When we’re making those wise choices about what to do, our empathy becomes more sustainable, not only because we’re not falling into that despair and personal distress or aversion and kind of callousness, but also, we’re just getting clear on what is ours to do and when with our compassion.
TS: You made this interesting leap from connecting with empathy to moving into compassion. I wonder if you can talk more about that, that shift and what the difference is? “Here I’m empathizing with your pain but now I’m being compassionate towards your situation.” How is that a different emotional response?
EE: Yes. It’s interesting. There’s been quite a lot of meaningful debate and research around what some people call empathy burnout or compassion burnout. When people say “empathy burnout,” they are talking about that distress, right? That empathic distress of being overwhelmed, enmeshed with another’s emotions.
When we talk about compassion burnout, usually, we’re also talking about empathic distress. When we think of compassion in the way that it can extend from empathy, it just has a wider range, right? I like having terms that are really specific. Empathy, it’s our automatic shared emotional resonance, our appraisal, and then how we respond that’s kind of up in the air. We can have a compassionate response.
I think it’s really interesting. You look at the work of neuroscientists like Jamil Zaki and he has a different point of view than Paul Bloom and people have these ideas about empathy that they will write about and research about and kind of claim that empathy will harm us or empathy will help us. Ultimately, I think it comes down to, especially in the context of healthcare, how do we sustain an open heart?
For many people, their desire when they see high volumes of suffering is to kind of shutdown and to not open up. I get it. It’s hard. When people are desiring to shut down, maybe they go to that callousness, like, “I don’t want to care about this, I don’t want to be involved,” but when we keep ourselves open to compassion, when we feel empathy, we’re also keeping ourselves open to a sense of meaning and purpose that comes with our work. In the moment, I don’t think you can make that choice. It’s really training you have to do outside of work.
TS: This question, how do we sustain an open heart? I want to bring that question out for a moment, even beyond the work of the healthcare professional, to all of us living in our world, who are exposed to the news and current events and who are asking the question, how do we sustain an open heart? How do we do it? What suggestions do you have?
EE: Yes. Beautiful question. It’s one I’ve thought quite a lot about. I think it might possibly be one of the most important questions for us as we are definitely not moving into easier times any time soon. You know, with ongoing political, social, climate concerns, it’s an important one for us to be able to have these open hearts or this ability to sustain our empathy and compassion.
I will first quote one of my favorite teachers, Pema Chödrön. I asked her this same question when I had the opportunity—whenever you have the opportunity to be in the presence of great teachers, ask great questions. I asked her the exact same question. She said to me this really interesting thing, which I haven’t heard her say anyone else, so I’ll share it with everyone here, which was, “This might sound funny but you have to give up all hope of fruition”—not give up hope, but give up hope of how it will come out.
I think one way to sustain our open heart is to not have an idea of what an open heart will lead to, not have an idea of the actions or behaviors or even dispositions or feelings, that they’re going to lead to a specific thing.
This is especially true in healthcare, but for all of us. We care. We are kind. We support, whether it’s in our family or at a broader scale. We want to promote positive change. We want to help people. We want our kindness to lead to positive outcomes.
It’s not always that way. That extra level of distress and fatigue that can happen when our expectations aren’t met, it’s unnecessary. Happily, just doing good as Dacher will tell you, over and over, just doing good feels good. There’s a natural reward system built into that altruistic behavior, that compassionate behavior, that kindness. Then what do we need to get out of the way? Kind of our expectation of how it goes. It’s quite simple.
TS: That’s very helpful. Thank you. When I asked you, Eve, about your own experience working in the healthcare profession and how that informed your design of the Greater Good Science training offering, you said that you wanted to make sure that we were addressing the sadness, anger, and shame that healthcare professionals experience.
TS: As you said that, I thought, “I think I can connect to the sadness and anger that I might experience being in healthcare, but I don’t quite know why would I feel shame if I worked in that profession?”
EE: Yes. It just happens to be an occupational hazard of being a human, that shame one. I think it comes up in any profession we’re in and to not name that emotion really prevents us from being able to understand it and work with it.
I think we can feel shame, especially around our destructive emotions. At work, there’s conflict. Again, humans are involved. We are imperfect, we have these different emotional experiences. They don’t always match each other.
An interesting part about having conflict or anger with another person is afterwards we can just feel either regret or guilt or shame. With the shame, there’s a specific flavor of not just, “I wish I hadn’t lost my head”, but “I’m always going to lose my head. There’s something so wrong with me. God, I just can’t do this well.” Right?
It’s an interesting one. You know, when I’ve gone to teach this emotion episode timeline, as we do in the training, around our triggers, our experience, our responsive emotion, when it comes to shame, it’s a long history. It’s not necessarily something created by healthcare. It’s something that people have picked up throughout their entire life experiences of not feeling good enough, not being seen, and then it comes into the contemporary context of, again, maybe losing your temper, not showing up for a patient the way you want to. Maybe flying off the handle on a patient family member. Totally inappropriate professionally, absolutely natural and normal as a human, to not be able to always show up fully.
I remember one resident sharing this beautiful story about she was trying to have a pediatric client admitted into the hospital. She was in the ER. The patient was a young child, I think six or seven. He had really bad heart issues. She called up to the cardiac team. And some people may not know this, but in the hospital, different teams operate like different organizations, and they don’t always have to say yes. She says, “I want this patient admitted,” and they said no.
She had spent hours with this family, this terrified family, this sick child. She was so angry in that moment, that she yelled at them. She became so upset. In my humble opinion, it might have been a constructive response. They admitted the patient. What she described to me was that she had been in weeks of feeling shame after, that she had lost her cool.
I think being able to name and identify the fact that we are not always going to act in accordance with our ethics, with our goals, and with our meaning, that’s a really important part of healing and moving on and learning.
TS: I’m imagining the healthcare professional who says, “Yes, it’s important that I have a training like this Greater Good Science training. I want to develop more of these emotional competencies, and the system is broken. It’s not just about me developing these greater emotional capacities.”
TS: I’m curious, in your view, what is broken about the system? What are the ways we’re going to change it? How are we going to change it, Eve?
EE: Yes. I’m so glad you’re asking this, Tami. It’s absolutely right. You look on Pub Med, right? Which is our tool for looking up research studies. There are over 100,000 studies on burnout. There’s a lot. And yet, very few of them tell you what to do.
There was a meta-analysis, meaning putting all of these studies together and trying to look at what helps, and the main purpose of that meta-analysis was if should we respond to burnout at an institutional level or at a personal level. Should we help train people as we do in this program in small groups or one to one? Should we change the whole system?
What they found in this meta-analysis was that both are needed. It was in some ways like, duh, not that helpful but also really clarifying that both are needed, the system absolutely needs to change, and we need to help people to feel well enough to change it.
In the course, I will say that we’re so fortunate. We’ve interviewed a lot of colleagues in the field who are at the front lines of wellbeing in hospital care systems. These are people designing and leading programs for wellbeing across different sites.
You hear them talk about what it takes to make wellbeing happen in the hospitals. They are shifting and changing culture. I know that’s a really broad term, but you can’t necessarily just change the hospital through one or two specific policies. I mean, there are many things you can list off, doctors need more time with patients and less hours putting those notes into the system. You will hear that over and over and over. The billing system is itself just entirely too burdensome on the healthcare providers. However, even, let’s say, imagine a perfect world where the billing system wasn’t so messed up, where people had more time with patients, there’s still going to be the emotional distress of working with people who are suffering and dying and not being able to help them.
I think we need to build these capacities side by side, of that sustainable empathy, and being able to advocate and rally for what needs to change in the system, so it can be a more human system, a more heartfelt system. I rely on these frontline providers doing that work and their optimism. They can actually hold optimism and despair at once. They know that these systems are profoundly messed up, and yet they feel confident in the care they’re able to provide, at least, at a patient-to-patient basis.
For the changes that need to happen, again, it has to be culture wide. It can’t be just one team or one department. The change might need to happen bottom up, it might need to happen from the top down. Probably both. I would say the best people to ask are going to be those right there on the front lines trying to improve wellbeing.
TS: What would you say to someone who finds themselves railing against injustice, knowing that their energy is getting drained out in the process but they have this thing inside, it’s this voice inside, that’s just like, “This is wrong and this is wrong and this is wrong and this is wrong and I’m going to say it again, and this is wrong” and this is just like an inner dialogue. Of course, there’s so much validity in what they’re saying and they also recognize that their position, their posture, isn’t particularly useful in the moment.
EE: Yes. Very common. Among activists, among healthcare providers, and folks involved in all different kinds of politics as well. So how do we really care and yet not get burned out by the care?
I do think that, again, coming back to anger, really having a better understanding of anger, having an understanding of how anger impacts our body will be motivating. I think being able to apply some sense of understanding to that frustration, that sense of injustice. Injustice is a core trigger to anger. When we feel that injustice and we notice the anger in our bodies, we feel that rising of heat, can we take just a moment and apply care? Not only is this incredibly unjust to the population I care about, it hurts me.
Ironically, turning towards ourselves may help us sustain for others. There’s a sense sometimes in helpers, in general, that we can’t take time for ourselves. “Look at the injustice out there. How can I take time for myself?” And yet we know so well, of course, that the wounded healer is really at a compromised position to do their healing.
Even that kind of moment, I would say breath to breath here, we’re just thinking of “Here I am, facing an injustice in the healthcare system, walking down the hallway. Oh God. This patient is here again? They haven’t been able to fill their medication because they don’t have enough money, and all the paperwork I filled out for them keeps getting just lost? This system is so messed up.”
In that moment, I just feel so much anger and that anger is such an important cue that we need to keep working but can we just take one breath of recognizing this anger is hard for me too. This is hard for me, because I care. Not that it’s about me, not that it’s my hurt but I do think those pauses for care and kindness towards our difficult and distressing emotions is essential.
TS: You mentioned this lesson from Pema Chödrön to give up all hope of fruition, and yet I’m going to ask you a kind of hope for fruition question anyway, which is, what’s your hope for the Greater Good Training for Health Professionals? For this online offering, what’s your hope about the impact it will have in the healthcare field?
EE: Yes. That one is pretty easy, I have to say. Happily, when we’ve had some of our in-person trainings and online, it’s not necessarily that people remember this specific skill or that specific skill, but they create small communities, so that if they aren’t remembering that day, someone else on their unit remembers like, “Oh, did you think of a good thing today? Did you practice silver linings with that difficult experience?” so that people create maybe one or three, even five other people that they do the training with.
That would make me so happy to think of people working on these together. We designed it so that people could do it together. After my years of looking at burnout and trying to understand the best ways we can work on it, I have to say that building a pro-social community, building a community where people are not only just sharing what’s hard and what’s bad—that matters—but also sharing what’s good and what they care for. That is truly I think a chemical power right there. I would wish that more than anything.
TS: We’re going to practice something like silver linings. Tell me about that, because I had a moment when you said that and I was like, “I don’t know if I could do that. You really want me to tell you the silver lining here?”
EE: Yes.
TS: That’s going to be a stretch. I know it’s good. It’s going to be good for me and I want to hear other people’s but there’s a stretch in that as well.
EE: Yes. Yes. Yes. There’s an aspect of some of these practices that can feel saccharine if they’re not done in a grounded way. You know, “Silver linings—are you kidding me? We just had this terrible day. How can there be a silver lining?”
We aren’t saying make everything OK, but we are inviting people to in some ways kind of shift their lens, shift their mindset towards what might be OK. So, in the silver linings episode in the course, we had a pediatrician, someone who works with kids who are sick and dying, how do you find silver linings there, right? That’s so hard. For her, she’s describing the sense of closeness and contact with the family and being able to support them as this kid is very sick.
There’s not a silver lining in the sickness of this kid. There’s a silver lining in what she can offer. Again, that giving up hope of fruition or really actually being realistic in what we’re creating meaning around. If the healthcare provider creates meaning around the outcome of their patient, they’re going to feel disappointed. If they create meaning around how they show up, “Wow. I showed up and I could listen. I showed up in a caring way,” there’s a lot more possibility.
With practices like silver lining, it’s like we’re directing people towards what’s already good. We’re not forcing it. We’re just in some ways revealing the goodness that’s all around them, that sometimes just gets buried among the busyness and the hierarchy and the other challenges.
TS: To end our conversation, Eve, you’ve mentioned this idea of meaning. When we know our meaning, when we can own it, claim it, say it, when we’re standing in it, that somehow gives us energy and is actually a key to our happiness. What’s the research behind this? Really, there’s research that says this?
EE: Yes. I mean, the research is kind of phenomenal. There are some studies that I just love to cite. One that shows people with meaning quite literally live longer. They did this large survey-based study and people who say they have some sense of meaning in their life truly just add years onto their life or added years onto their life.
We see that people who have a sense of—“meaning” and “purpose” are used a little interchangeably, that’s OK—people who have a sense of purpose, they’re less likely to have difficulties when they become sick, so, greater immunological functioning. It’s kind of amazing. It’s like meaning can not only improve your life, it can extend your life. But I think one of the reasons why is our mindset, how we think about what we’re experiencing, is so powerful.
In the healthcare setting, for example, if every day I go in and I’m doing my job and I don’t think it matters, “Ugh, I’m trying to help people but it’s just so hard and I can’t do enough”, we are going to really have a mindset that feels quite despairing and we know that that can shift actually how our entire autonomic nervous system is functioning, how we feel about our experience, but if we have a mindset of “I am doing this work, because every single thing I do matters,” there’s a different mindset; or even, “God, I appreciate or have a sense of almost awe about this work I get to do,” it can improve people’s sense of wellbeing.
The same work, right? We go back to Viktor Frankl, who is always quoted when it comes to meaning, and he has this sense that it’s not what the material of our life is but how we respond to the material of our life that allows us to create meaning. He says there’s nothing that we can’t create meaning from. I agree. Whatever it is, we can find some way to have a sense of “I showed up with compassion. I cared.” I think the meaning, it always feels like it has to be so grand, but I really like the micro-meaning. Setting intentions for reminding ourselves what our meaning is before we do almost anything.
I often tell healthcare providers to do so right before you enter the room with the patient or, these days, right before you enter the Zoom telemedicine consult with a patient, remember the meaning of why you’re there. What does it matter to show up? What are the qualities you want to bring to that interaction?
TS: I’ve been speaking with Dr. Eve Ekman, who along with Dacher Keltner of the Greater Good Science Center has created a new online offering. It’s called The Greater Good Training for Health Professionals: Science-Based Skills For Emotional Resilience and Wellbeing. It’s part of our meaning-making at Sounds True to spread this program far and wide. If you’re interested, I encourage you, come check it out at SoundsTrue.com.
TS: Eve, awesome to talk with you. You’re such an inspiring person. Thank you so much.
EE: Thank you, Tami.
TS: Thanks for listening to Insights at the Edge. You can read a full transcript of today’s interview at Resources.SoundsTrue.com/Podcast. That’s Resources.SoundsTrue.com/Podcast. If you’re interested, hit the Subscribe button in your podcast app. If you feel inspired, head to iTunes and leave Insights at the Edge a review. I absolutely love getting your feedback and being connected. Sounds True: waking up the world.
