Table Of Content

Advance Praise for The Art and Science of Compassion, A Primer “Well-written, deeply personal and scientifically grounded, this book provides strong physiological, psychological, and ethical reasons why cultivating compassion is essential—and provides a thoughtful roadmap for promoting compassion in healthcare and in all of life.” —Ron Epstein, MD, author of Attending: Medicine, Mindfulness, and Humanity “Dr. Agnes Wong, a highly distinguished physician and exceptional researcher at the University of Toronto, has written an absolutely uplifting masterpiece about meaning, compassionate care, and the universal journey that all healers must take to sustain their inner being and nobility of purpose. This book is partly her journey to a deeper state of being that places compassionate care in its rightful place in the healing art; it is also a fabulous scientific presentation of the practice and impact of compassionate care on patients and on one’s own flourishing as a physician. This is a book that touches the soul and should be read by every medical student or clinician worldwide as they reflect on what it means to really succeed in their “whole selves” as healers and human beings.” —Stephen G. Post, PhD, Director, Center for Medical Humanities, Compassionate Care and Bioethics; Professor of Family, Population, and Preventive Medicine, Stony Brook University “Compassion and empathy are traits that make us human, and as Dr. Wong shows, these qualities can be developed, encouraged, and cultivated. In our struggling world, we need this awareness as never before. The future of our species likely depends on it. This book is an example of how science and spirituality can come together in a brilliant synthesis.” —Larry Dossey, MD, author of One Mind: How Our Individual Mind Is Part of a Greater Consciousness and Why It Matters The Art and Science of Compassion, A Primer Reflections of a Physician-Chaplain AGNES M.F. WONG, MD, PHD, FRCSC Professor of Ophthalmology, Neurology, and Psychology University of Toronto Toronto, Ontario Canada Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and certain other countries. Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016, United States of America. © Oxford University Press 2021 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license, or under terms agreed with the appropriate reproduction rights organization. Inquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above. You must not circulate this work in any other form and you must impose this same condition on any acquirer. Library of Congress Cataloging-in-Publication Data Names: Wong, Agnes M.F., 1968– author. Title: The art and science of compassion, a primer : reflections of a physician-chaplain / Agnes M.F. Wong. Description: New York, NY : Oxford University Press, [2021] | Includes bibliographical references and index. Identifiers: LCCN 2020030314 (print) | LCCN 2020030315 (ebook) | ISBN 9780197551387 (paperback) | ISBN 9780197551400 (epub) | ISBN 9780197551417 Subjects: MESH: Empathy | Compassion Fatigue—psychology | Professional-Patient Relations | Attitude of Health Personnel Classification: LCC BF575. E55 (print) | LCC BF575. E55 (ebook) | NLM BF 575. E55 | DDC 152.4/1—dc23 LC record available at https://lccn.loc.gov/2020030314 LC ebook record available at https://lccn.loc.gov/2020030315 This material is not intended to be, and should not be considered, a substitute for medical or other professional advice. Treatment for the conditions described in this material is highly dependent on the individual circumstances. And, while this material is designed to offer accurate information with respect to the subject matter covered and to be current as of the time it was written, research and knowledge about medical and health issues is constantly evolving and dose schedules for medications are being revised continually, with new side effects recognized and accounted for regularly. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulation. The publisher and the authors make no representations or warranties to readers, express or implied, as to the accuracy or completeness of this material. Without limiting the foregoing, the publisher and the authors make no representations or warranties as to the accuracy or efficacy of the drug dosages mentioned in the material. The authors and the publisher do not accept, and expressly disclaim, any responsibility for any liability, loss, or risk that may be claimed or incurred as a consequence of the use and/or application of any of the contents of this material. To Joseph and Esther, for giving me this precious life; James and Stephen, for bringing much joy and a new dimension to my being; Bill, for your love, trust, and unwavering support as we travel this journey together; and Roshi Joan, for showing me the way to a wholehearted practice in this world. Contents Foreword Foreword Preface 1. What Are Empathy and Compassion? A Western Perspective Introduction Empathy Compassion Survival of the Kindest Summary of Key Points 2. Is Compassion Innate? A Physiological Perspective The Autonomic Nervous System The Neuroendocrine System Behavioural Genetics Physiological Benefits of Compassion Summary of Key Points 3. Is Compassion Innate? A Psychological Perspective Evolutionary Psychology: The Emotion Systems Developmental Psychology: The Attachment and Caregiving Behavioural Systems Psychological Benefits of Compassion Summary of Key Points 4. Is Compassion Innate? Spiritual and Eastern Perspectives An Overview of Spiritual Perspectives Confucianism and the Golden Rule Daoism and the Way Buddhist Perspective on Compassion The Four Immeasurables Summary of Key Points 5. East Meets West: Is Compassion Trainable? A Neuroscientific Perspective Mindfulness: Attentional Foundations of Compassion Practice The Practice of Compassion and Loving-Kindness Neuroplasticity: Compassion Is Both Innate and a Trainable Skill Science and the Relative Truth Summary of Key Points 6. What Are the Obstacles to Compassion? Obstacles to Compassion for Others Obstacles to Receiving Compassion from Others and Self Obstacles to Compassion in Healthcare Summary of Key Points 7. What Does It Take to Cultivate Compassion? Positive Disintegration and the Edge States The A.B.I.D.E. and G.R.A.C.E. Models of Cultivating Compassion Inner Compassion and Its Benefits Compassionate Leadership to Build a Compassionate Culture System Changes for Compassionate Healthcare Benefits of Compassion in Healthcare Summary of Key Points 8. A Wholistic Approach to a Compassionate and Flourishing Life Psychological Well-Being Ethics and Moral Resilience Social Engagement A Transcendental Life Summary of Key Points Postface Rites of Passage The Three Tenets Being with Living and Dying A Koan Acknowledgements Resources Currently Available Compassion-Based Trainings/Interventions Further Reading General Websites on Mindfulness and Compassion About the Author Index Foreword At a science conference in India, His Holiness the Dalai Lama noted that “Compassion is not religious business; it is human business. It is not a luxury . . . it is essential for human survival.” He later wrote, “However capable and skilful an individual may be, left alone, he or she will not survive. However vigorous and independent one may feel during the most prosperous periods of life, when one is sick or very young or very old, one must depend on the support of others. . . . I believe that at every level of society—familial, tribal, national, and international—the key to a happier and more successful world is the growth of compassion.” We cannot say with certainty whether compassion is genetic, instinctual, intentional, cultural, or socially prescribed. However, we have learned from scientific research that compassion enhances the welfare of those who receive it and also benefits those who give it. Compassion also benefits those who observe an act of compassion. Over my years of caring for dying people, I came to see that compassionate presence can reduce the anxiety dying people experience and can also have a positive effect on those who serve others who are suffering. Years ago, my student Dr. Gary Pasternak, the medical director of Mission Hospice in San Mateo, California, and a long-term meditator, sent me an email that moved me deeply. It exemplified the qualities that I have come to value in a physician. He wrote,