By Josh Neff
My friend Steven decided to become a doctor because he wanted to serve the poor. When it came time to choose a specialty, however, he picked pediatrics because he said he had run out of patience for the self-destructive behavior he saw among some adult patients in underserved communities. With kids, he said, he never felt this way—it was easy for him to feel compassion for them.
Steven is not alone.
A preliminary study conducted by sociologists at Northeastern University and presented at the Annual Meeting of the American Sociological Association last August suggests that Americans generally experience far more compassion for children—and even dogs—than for other adults.
The researchers, Jack Levin and Arnold Arluke, professors of sociology at Northeastern University, asked participants to describe their reactions to one of four short news stories. The stories—fictitious but presented to research subjects as genuine—were almost identical, each describing the same violent assault. The only thing that differed in each was the identity of the victim, which alternated amongst a human adult, a human baby, a grown dog, and a puppy.
Survey participants were most sympathetic towards the human baby, with compassion for both juvenile and adult dogs close behind. But, sympathy for adult humans was notably lower.
We see adults as having meaningful agency, and therefore we assume adults are masters of their fate–even if that fate is an unexplained violent assault. A similar outlook seems to be implicit in Steven’s view.
As Steven himself said, he often felt his adult patients could and should have made better choices. In contrast, he never blamed children for their illnesses.
The plight of adults traumatized as youth challenges this assumption. Consider addicts of hardcore drugs—people who engage in notoriously health-destructive behaviors.
In his book In the Realm of Hungry Ghosts, physician Gabor Mate writes, “The hardcore drug addicts that I treat are, without exception, people who have had extraordinarily difficult lives. The commonality is childhood abuse. These people all enter life under extremely adverse circumstances…. I don’t have a single female patient … who wasn’t sexually abused, for example, as were many of the men, or abused, neglected and abandoned serially, over and over again.”
Mate’s experience connecting drug abuse with traumatic childhood experiences has been corroborated by a large and expanding body of literature. In fact, starting with the groundbreaking Adverse Childhood Experiences (ACE) study in the late nineties, conducted jointly by Centers for Disease Control and Prevention in Atlanta and Kaiser Permanente in San Diego, it has been shown that a high accumulation of these so-called ACEs lead not only to poorer health-related behaviors, but also to a higher rate of lethal diseases such as ischemic heart disease and cancer.
Given this clear connection between childhood adversity and poor health and health-related behaviors in adults, it seems logical that if we have compassion for battered children, we should have compassion for the sometimes-scarred adults they grow into.
The recent research from Northeastern, however, suggests that this is not our first inclination. Rather, our instinct is to blame adults for the poor outcomes they experience. For most of us, learning to apply insights like Mate’s to our practice may take deliberate effort to develop.
But if clinicians can do so—if we can learn to feel compassion for people who have been dealt a difficult hand in life— we can provide better care. The literature on clinical empathy, including Helen Riess’ article in the Journal of the American Medical Association (JAMA) in 2010, suggests that increased empathy leads to better patient-doctor interactions and improved patient outcomes. Empathy is good for providers, too: more empathic providers enjoy higher job satisfaction and lower rates of burnout.
Steven will be an outstanding pediatrician; I’m excited for his development in his chosen career track. I would encourage all clinicians, however, to remind themselves that adults are also worthy of our compassion—even when we see them doing things that are not in their own best interest. To do so is in our own best interest, as well as the best interest of our patients.
Joshua Neff is a medical student at the UC Berkeley-UCSF Joint Medical Program. He wrote this story as a student in the Journalism for Social Change course offered at UC Berkeley’s Goldman School of Public Policy