I put up a few posts recently that emphasize empathy and why that is important in psychiatric practice. I have also posted my favorite definitions by empathy – right out of Sim’s text on psychopathology (1). I was surprised to see the term hostile empathy being used in social media today and in a publication (2) from the Bulletin of Atomic Scientists. This post considers the original source, its use, and whether it really has anything to do with the technical definitions in psychiatry.
It turns out that the journey to hostile empathy
takes you back. Not back to the time it
was used in psychiatry, but back to a discussion of ethnic violence in
Indonesia (4) in the 1990s and before that to the early 1980s when “putting
oneself in the shoes of a political adversary” was considered a form of realistic
empathy as a possible basis for foreign policy. That writing was done by military analysts,
politicians, and anthropologists rather than psychiatrists.
The original reason for this post is a paper on the Trump
administration’s hostile empathy as evidenced by their reduction in aid
to the needy both in the US and abroad (2) and the expected toll in morbidity
and mortality. The author lists a source that estimates that 110,772 adults and
231,141 children had already died at the time of the paper’s publication
largely through acute cuts in food and medical care needed to treat
tuberculosis, HIV, malaria, diarrhea, and pneumonia. That is an obvious large
human cost for what represents a tiny fraction of the federal budget. Tens of
thousands of deaths are also anticipated from the administration’s cuts to
Medicaid. The bombing of Hiroshima and
Nagasaki is given as a comparison where anywhere from 110,000 to 210,000 people
are estimated to have died. How can the
intentional and ongoing humanitarian catastrophe by the abrupt cut in aid be
rationalized?
The author suggests it is like the work of choosing nuclear
targets during the Cold War. The
analysts had to distance themselves from any empathy they might have for their
potential victims as they chose targets.
That distancing could be justified by the presence of a crisis and
bureaucratization that rewarded people for target selection rather than
empathy. In the case of the Trump administration
all the cuts are being rationalized as a crisis – even though they add
significantly to the debt and could easily have been made through other
mechanisms. The most obvious alternate mechanism would have been to not replace
federal workers who were retiring or moving to different jobs. In the two most
recent years that would have resulted in a decreased of 7.6% (147,000 positions
in 2023) or 5.4% (115,900 in 2024). It
is now well known that despite their lack of transparency the savings from Elon
Musk’s Department of Government Efficiency (DOGE) have been scaled back
considerably from the original $2T dollar figure to a current $170B ( a 92%
reduction). Even that number is
complicated by the costs of defending against several lawsuits and other
miscellaneous charges that may have cost the taxpayers another $135B. In addition, the Trump administration fired
18 Inspector Generals who saved the taxpayers anywhere from $90B to $183.5B
without the disruption and compromised security.
Looking at the net effect so far – it seems that empathy is
not at play at all. The people receiving
aid and the government employees affected were not consulted or understood at all. In fact, a
top administrator in the Trump cabinet said:
“We want the bureaucrats to be traumatically affected. When
they wake up in the morning, we want them to not want to go to work, because
they are increasingly viewed as the villains. We want their funding to be shut
down … We want to put them in trauma.” -
Russell
Vought – Director of the Office of Management and Budget
This is not empathy or hostile empathy of any sort. This is
open hostility to public servants in the service of an intolerant ideology by
an administration that has so far shown that they have very few positives for
the American people. This cabinet member
is also one of the architects of Project 2025 – a unilateral document designed
to treat the Executive branch of government as an autocracy for the benefit of
a particular ideology. Again – no empathy involved.
A couple of issues came up and I made my way through the
Bubant paper. The first was the issue of
word meaning for different groups and how language is used. Most people invoke
Wittgenstein’s language games to make that point and I will join
them. In this case anthropologists and
social scientists are clearly using empathic in a much different manner than
psychiatrists. A psychiatrist does an interview seeking a deeper understanding
of the person they are talking to. They
are looking for individual specific responses – life experiences, cultural
factors, traits, symptoms, preferences, behaviors, and dynamics. The goal is to
learn those well enough that the person would recognize them if the
psychiatrist describes them (Sims). Some
may be recognizable at the group level. The author in this case is describing
group characteristics and responses at a global level. There is also the implicit understanding that
empathy is generally used to assist or help the person who is being
understood. It is not used for hostile
or nefarious purposes.
Rather than empathy – hostile empathy is stereotyping
and there is a much greater chance for error. Further – it is evident that it is a recipe
for divisiveness and authoritarianism that requires recognizing stereotypes at
the grossest of levels.
The obvious example in this case is proclivity for violence
– especially the severe forms described in the letter. It is difficult to believe that any
significant population would not have groups that would never perpetrate this
violence or support it. This approach to
populations always depends on probabilities. There is a probability that a subgroup will
respond to divisive rhetoric in a violent way and produce the desired result.
By contrast, a psychiatric interview is focused only on the person in the room
and what makes them unique. The intention from that knowledge is focused solely
on helping that person at some level.
That renders the concept of hostile empathy meaningless.
One of the thought experiments to figure out what is really
going on when people plan to bomb, attack, or otherwise incite violence in a
population they dislike is looking at the decision making involved. From a cognitive behavioral standpoint – it
can easily be seen as a case of emotional reasoning. Emotional bias is needed to some degree for
most decisions but a heightened bias – by a crisis or appearance of a crisis –
leads to more impulsive decisions. The
United States at the highest levels of government have made several including 3
unnecessary wars during my lifetime and the recent attack on Iran. All these actions were based on false
premises and resulted in significant loss of life, resources, and good will. Keeley (4) has noted this recurrent pattern
since the time of wars between prehistoric villages.
As he reviews the social, economic, and cultural factors associated with
warfare empathy is not a factor. He
makes the case that prehistoric wars were as significant as modern warfare and
probably more deadly. On the question of
war being common Keeley says this:
“Thus pacifist societies seem to have existed at every
level of social organization, but they are extremely rare and seem to require
special circumstances….. the idea that violent conflicts between groups is an inevitable
consequence of being human or social life itself is simply wrong. Still, the overwhelming majority of human societies
have made war. Therefore, while it is
not inevitable, war is universally common and usual.” (p. 32)
Empathy of any kind is not a factor in war. I would argue that the absence of any sustained
successful peace initiatives in the world is related to two factors – the lack
of emphasis on peace (even though the advantages are obvious) and a lack of any
institution with the ability to enforce peace through dispute resolutions. The driving force would appear to be the
dispute and jumping to the conclusion that armed conflict is the only possible
resolution. Checks and balances on the decision makers within the country is also a factor. In the United States, Congress is the only branch of government that has the authority to declare war and yet we have seen two Presidents in recent times start a war without that authorization.
The lessons for psychiatry are clear. If you are writing about empathy use the
correct definition or at least a definition that is consistent with the
psychiatric application. Secondly, don’t
accept loose definitions from other groups or contexts to apply to the
field. The best examples I can think of
are epistemic and hermeneutic injustice. These are non-psychiatric terms that are used
to criticize the field. Outside criticism is common in psychiatry – but it does
not need to be incorporated into the field particularly when the primary goal
of the field is to understand each individual patient and their social and
cultural context.
George Dawson, MD, DFAPA
Supplementary 1: I am of course aware of the fact that the authors of hostile empathy never intended to incorporate it into psychiatric technical jargon. It merits consideration solely based on how non-technical terms show up in our papers. I provided the examples of epistemic and hermeneutic but there are many more. Deprescribing is a good example of a word and the associated rhetoric. Any psychiatrist who prescribes a drug knows how to stop it. If you were ever an acute care psychiatrist – detoxification from drugs and alcohol is a necessary skill. Many of those situations involve massive doses and polypharmacy. And yet deprescribing was introduced a few years ago based on the false premises that psychiatrists do not alter medications (they just add more) and they do not know how to stop drugs. The reality is nobody knows more about it than acute care psychiatrists. I have been presented with shopping bags full of medications for psychiatric, cardiovascular, endocrine, and neurological indications in the same confused patient who could not tell me what they were taking and I had to decide in the space of a few hours what to continue and what to discontinue. Physicians are not taught to deprescribe. They are taught to discontinue medications. I did that and taught people how to do it for over 35 years. And yet we now find papers using the deprescribe term and writing like they are experts in a newly discovered field. That is a significant problem with allowing people to invent the language of your profession.
Image credit: My
2010 photo of the Painted Mountains in Denali National Park.
References:
1: Sims A. Symptoms in the Mind: An Introduction to Descriptive Psychopathology. 3rd ed. London: Saunders; 1995
2: English E. The consequences of the Trump
administration’s hostile empathy.
Bulletin of the Atomic Scientists.
June 16, 2025 https://thebulletin.org/2025/06/the-consequences-of-the-trump-administrations-hostile-empathy/
3: Nash HT. The
bureaucratization of homicide. Bulletin of the Atomic Scientists. 1980 Apr
1;36(4):22-7.
4: Bubandt N. From
the enemy's point of view: Violence, empathy, and the ethnography of fakes.
Cultural Anthropology. 2009 Aug;24(3):553-88. https://anthrosource.onlinelibrary.wiley.com/doi/10.1111/j.1548-1360.2009.01040.x
5: Keeley LH. War Before Civilization: The Myth of the
Peaceful Savage. Oxford: Oxford University Press. 1994.
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