Mental Matters

Brene Brown made a video incorrectly “explaining” clinical terminology that she doesn’t appear to understand. It is actually about how, if you don’t communicate the exact way she says, you are going to be forever alone. It is being used as mandatory training material to staff who require precision with those terms.

When I went through training for my current position as a Mental Health Technician at an inpatient forensic mental hospital, I was shown a pop psychology video called “Brene Brown on Empathy.” Twice. By two different trainers. (Technically, it’s three times I’ve seen this piece of garbage now, because when I came home to search it up to complain about it, YouTube showed me that I had already watched it before then. Sigh.)

Because I was shown the video twice, it wasn’t some little quirk that some trainer chose. It is in the cirriculum. Also worth mentioning, this is required training for all staff at the entire hospital, including the other non-mental health section of the hospital (ER, labor and delivery, etc), non-clinical staff (like security guards and HR), etc.

I’ll include a transcript for posterity:

No, Brene Brown. That is not how any of this works.

Classical sympathy (Adam Smith or David Hume) is basically what she’s calling empathy. You can feel very deep compassion and concern for someone’s suffering and recognize their pain without taking it on yourself. That doesn’t mean you’re inherently failing to connect.

In fact, many times, what that person needs is to be felt for, not felt with. They need someone who can hold steady and be their rock without being consumed by their pain. For example… people who are treating patients in a mental hospital? Who are being shown this video twice? Healthcare settings are filled with people who need to connect with patients without feeling “emotionally merged.” What is required in this setting is cognitive empathy, active listening, genuine care, and the ability to stay someone’s “rock.”

I have autism. I am one of the kindest people you will ever meet (or so others have told me, not sure I believe that just yet.) I happen to not feel your emotions with you, which is one of the exact things that makes me so effective at helping people who are struggling with mental health. Just because I am not “in the hole” with you doesn’t mean I can’t find connection with your pain. It doesn’t mean I can’t build rapport with you. It doesn’t mean I can’t connect everything you are saying back to an experience I have had.

The reason I have such effective communication and emotional intelligence almost universally is because of my low empathy, ironically. I don’t freeze in big difficult moments. I’m not taking on your feelings (unless you’re my husband, or maybe my pets.) This gives me the ability to view interactions and emotions from a distance, which makes it a thousand times easier to do exactly what she is suggesting here: draw on my own past and experiences and use cognitive empathy to understand why someone would be feeling that way without becoming overwhelmed or burned out. To realize “oh, I’ve felt this way in the past, let’s connect about that” is not the same as me reaching in and reactivating that feeling or memory. When someone is struggling immensely (especially with a mental health crisis!), the best thing you can do is to stay rational, clear-headed, and pull on your mental resources to provide support.

Also, creating a hierarchy where “feeling with” someone else is the gold standard and anything else is less is not just wrong but borderline ableist. This is not how connection works with many people, including people who struggle to truly empathize.

The things that Theresa Wiseman* says are “empathy” (perspective taking, staying out of judgment, recognizing emotions in other people) are actually cognitive in nature, not empathetic. She does throw “feeling with other people” there at the end, but those are all things that are done in the brain, not in the heart. They are skills that any person can build regardless of their ability to empathize.

(*This is another aspect that is really suspicious about this video and feels very “appeal to authority logical fallacy” slash “using some random research paper that matches your own mindset to make yourself look legit” to me. A lot of pop psychology stuff does this. I was like “Who the hell is Theresa Wiseman?” I tried to search her name, and she appears to be just a nurse tutor. I believe this paper on empathy is the only thing she’s ever published, or at least, that’s all I could find. I’m not going into this further since I couldn’t find more information.)

Maybe someone does want to hear “at least.” My father has extremely severe anxiety to the point he has had multiple very serious nervous breakdowns in his lifetime. To him, the only thing that calms him down is changing his perspective. The thing that he tells himself to feel better is “at least it isn’t as bad as it was before” or “at least I don’t have it as bad as others.” Context is important. This is going to change depending on the person, the relationship, what they need right then, and even things like tone and word choice. Plus, they probably are actually empathizing if you hear it from someone else. Someone saying “at least” is probably desperately trying to make the pain stop… for you and for them.

For me, personally… do I want you feeling what I’m feeling? Hell no! Miss me with that “coming down in the hole” with me nonsense. Don’t come down in the hole with me. What are you doing? Stay up there! Throw down a rope! How are you going to pull me up if you’re down here wallowing with me?

I also feel the following if I notice you are outwardly empathizing with me:

1. The spotlight is now off of me and onto you. I am now managing your emotions.
2. I do not want you to suffer or be having emotional issues due to my problems. If I see that you are doing this excessively or all the time, I am less likely to open up to you in the future.
3. I prefer to have someone solid to lean on. It’s already hard enough for me to show emotion. If someone else comes “down in the hole” with me, it’s more likely to rile me up further than cool me down.

I believe what she is saying is mostly true, but she is talking about active listening skills, reflecting, and personal connection. All of which can be achieved maybe even more effectively without being “in the hole.”

Also? Sorry, Brene, are you a mind reader? You don’t know if someone is empathizing with someone else based on how they’re speaking. Sometimes news is so devastating and people are empathizing so much that all they can say is, “It’s bad, huh?” Or someone shares trauma so extreme that the other person is rendered speechless, maybe because they are empathizing too much. I have had this happen plenty when sharing my past with others.

Additionally, there is nothing functionally different between her ‘bad’ example of “It’s bad, huh?” and her ‘good’ example of “I don’t even know what to say. I’m just so glad you told me.” It’s just that one is clumsy and worded poorly. Not everyone is an expert communicator. Not everyone has a lot of experience comforting people who are in a lot of pain. Sometimes, they can be empathizing very deeply and can only conjure up “want a sandwich?” (Which by the way might be the exact correct way to connect with certain people!)

The reverse is the same. Someone giving a response that looks “perfect” to Brene may not be feeling anything emotionally. They may just be well trained in therapeutic communication or have had enough experience with pain and loss that they know exactly what to say.

There are so many ways to connect with other people that there’s no reason to be prescriptivist about it.

Speaking of being prescriptivist… typically, I am not the type that would “well akshully” a definition. I think language is ever evolving and pushing your glasses up the bridge of your nose and being pedantic about it is actually typically more harmful than helpful. However, in this context? I’m going to have to be prescriptivist about the word empathy.

Here’s a little thing about the word “empathy”: it has an actual existing clinical definition. It appears in the DSM-V as diagnostic criteria for several mental health disorders. And guess what setting this is being shown in?

She doesn’t seem to know the actual definitions of the word “sympathy” and “empathy.” She is explaining the difference between truly listening and caring instead of just trying to minimize or escape the discomfort of the conversation. Hijacking two specific existing terms that already have specific meanings that psychologists/philosophers/neuroscientists use in specific ways is just going to confuse people later.

When talking about healthcare and other science field, we need to have precision in vocabulary. When DSM-V talks about “empathy deficits,” it isn’t talking about people who don’t have social skills. It is talking about a specific cognitive and affective process.

The CEO at my old job was absolutely obsessed with Brene Brown and would subject us to her all the time. In that context, it would have been “fine.” Annoying, but fine. But this is being shown to incoming mental health professionals who, honestly, may not have any other exposure to these concepts or words outside of this single video. We hire people for the Mental Heath Technician role who don’t have licensure or schooling.

Showing those people specifically is problematic because it could affect their concept of patient presentation, change how they document, and change how they understand their own role.

Plus, in a clinical environment, all of this has the danger of…

• Turning the patient into my personal therapist inadvertently. If they’re like me? Now the convo is focused on me and my reaction. This is precisely why it’s okay to give a little bit of relational info but then move back to the other person. It’s a boundary violation.
• It takes a very skilled person to be able to empathize with someone going through some big, awful thing and not be swallowed by it and drown. Someone in inpatient mental health is suffering from extreme mental health issues. I promise you, you do not want to be empathizing with a suicidal patient, nor with someone dealing with extreme trauma, psychosis, etc. Maintaining emotional distance also prevents burnout and compassion fatigue.
• Some patients, especially with certain specific mental health disorders are pathologically manipulative. This is not a judgment of them, just a fact. If they see you are triggered or having an emotional reaction to something they say, they will keep doing that until you go crazy.

If an incoming employee internalizes “empathy means feeling with people which is inherently good” and “sympathy is a disconnection and inherently bad”… they’re going to have weird biases/behavior when they encounter patients with actual documented empathy deficits. They’re going to be confused by clinical documentation that uses this terminology differently (read: correctly.) And maybe most importantly, they’re not going to realize that not only is it inappropriate to “feel with” a patient most of the time, but “feeling with” everyone all the time in this environment will destroy you.

When something like this becomes integrated with mandatory training for all incoming staff in a healthcare facility (you know, the people who need to actually understand clinical definitions, will be documenting patient care, assessing mental health conditions, etc.) This is when it crosses the line from mildly annoying to actively harmful.

“What Brene Brown personally wants to be told when she’s going through tough times” should probably not be made mandatory viewing for onboarding clinical staff. But what do I know.