Saturday, 24 December 2016

#ClinicSpeak: no wonder MSers have such a hard time in society

Subtle cognitive deficits in MS may underlie how MSers interact with society. #ClinicSpeak #ResearchSpeak #BartsMS

Definition: Empathy is the capacity to understand or feel what another person is experiencing from within the other being's frame of reference, i.e., the capacity to place oneself in another's position. Empathy is seeing with the eyes of another, listening with the ears of another and feelings with the heart of another. There are many definitions for empathy which encompass a broad range of emotional states. Types of empathy include cognitive empathy, emotional empathy, and somatic empathy. (Source Wikipedia)

It is said that to be a good doctor you have to have empathy; you have to have the ability to fee and understand what your patient's are experiencing. What about your patients? You may find the study below of interest, it showed that on average people with MS have lower levels of empathy than controls. Why? I suspect this is due to MS and is another example of a hidden MS symptom. 

Empathy is a complex emotion and involves the so called mirror neuron system.  The circuity starts in the premotor part of the frontal lobe and involves an extensive network including a behavioural and motor responses. I am not surprised this system is damage in MS. People who lack empathy have problems interacting with others and with society in general. Therefore this is another dimension to MS that needs to be considered when interpreting the high unemployment, high divorce rates, depression, anxiety and social exclusion in MS. If we treat MS early and effectively and protect your brain then the neurological circuitary responsible for empathy is likely to be preserved, and protected, and you won't suffer the consequences from it being damaged.

How sure are you that your MS is under control? Have you asked?  


Almeida et al. Patients with multiple sclerosis present low levels of empathy. Arq Neuropsiquiatr. 2016 Dec;74(12):982-985.

METHODS: This is a single center, cross-sectional study, of 34 patients with MS and 34 matched control subjects. A specific questionnaire (empathy quotient) was used.

RESULTS: Patients with MS showed significantly lower levels of empathy. This finding was not correlated with disease duration, degree of disability, drugs for treating MS or lesion load on resonance magnetic imaging.

CONCLUSION: Decreased empathy is a frequent condition in patients with MS and should be addressed in order to diminish the psychosocial burden of this neurological disease.

20 comments:

  1. I keep coming across HCPs who show no empathy. It was either something they were never taught or it has been forgotten. I hope this is something that can be addressed in CPD. That is one of my Christmas wishes.
    Happy Christmas Team G.

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    1. My initial thoughts too. The HCPs I've meet come across quite indifferent. I've found when I'm describing a new symptom they tend to nod and write it down without comment. Maybe I need to be a more empathetic patient.

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    2. Empathy and compassion costs nothing and treating a patient as a human being may make the world of difference.

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  2. Re.. it showed that on average people with MS have lower levels of empathy than controls. Why?

    Could this be partly due to levels of pain and discomfort that MSers have? This is different from degree of disability. I know when I am in pain (almost daily) my threshold of tolerance with people is much lower. Because I find it difficult to multi-task on dealing with pain and discomfort and giving my full attention to other things including conversations with people.

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  3. Santos is the second city in Brazil with the largest number of people with MS. It is a coastal city, but it rains a lot and is already a bit distant from the equator in the southeast of the country, and is predominantly Caucasians. Relation with the absorption of Vitamin D by the population of the city?

    I notice a lot in social networks MSers complaining about difficulties in their social relations, for a series of factors, one of the cruel facets of MS, and many diseases.

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  4. I find I am the opposite. I feel too much. However, reading some of the comments on previous posts, I have often thought there is a distinct lack of empathy with some pwms

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  5. Could it be modifiable by a highly effective drug? Patient often experiences long term remission (f.e. better cognition) by these drugs...

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  6. I think it's authors of this study that should have more empathy with something they clearly don't understand very much. Suggesting that the chronically disabled should be treated to be more empathetic with the healthy is weird.

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  7. Hi Prof G,
    > You may find the study below of interest, it showed that on average people with MS have lower levels of empathy than controls. Why?

    Because they are depressed?
    It's known that serotonin is linked somehow with empahty (serotonin releasing agents such as MDMA or MDA are even known on a street as 'emphatogens') and we know that serotonin is somehow linked with depression, at least depression is treated with serotoninergic drugs. And we know that people with MS are depressed. coincidence? I don't think so

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  8. I would say I am sceptical about other people's empathy towards me rather than not having any empathy towards other people. You have to factor in how people with MS have been treated.

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  9. I'm not denying that MS may affect emotions - through fatigue or isolation if nothing else. But if they used a questionnaire anything like this one for this study, I think the findings cannot be taken too seriously. Very blunt instrument! I got 51 :)
    https://psychology-tools.com/empathy-quotient/

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    1. I got a 55 :). It's nice to know that my score is not indicative of autism.

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  10. I don't really believe that the lack of empathy is an MS symptom, and I think we confuse the cause and the effect here. Firstly, one should take into account how pwMS have been treated by the society, by their HCPs, by friends or by their partners. In many cases, the aforementioned have lack of empathy towards pwMS, which may lead pwMS to have little empathy for others as well.

    In addition, in order to feel empathy for others, you should be relatively well and have few problems when it comes to your health, relationships with others etc. One who faces major problems doesn't have the capacity to feel empathy, because their own problems are already overwhelming. Getting a diagnosis of MS and having to face the multiple health problems & symptoms doesn't leave much space to feel empathy.

    Also, one would expect that if lack of empathy was an MS symptom, then it would have been more likely to observe more lack to those with higher levels of disability, as they are more likely to have more MS symptoms. However, the study doesn't conclude to that, which makes me believe even more that it is not really an MS symptom.

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  11. Interesting, as I have the same problem as Anonymous further up. Too much empathy... which gets me in all sorts of trouble. I think it is more the social conditioning/experience around PwMS that has sth to do with it, rather than the MS itself.

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  12. There is such tiny number of people in this study and only compared MSers vs controls.

    What would the results be if studies had also been done comparing people with other specific incurable, life-changing health conditions (Parkinsons, MND, etc) vs controls ?

    Would it show that MSers had a markedly difference in their empathy scores compared with patients with those other conditions ?

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  13. I have very low level of emphaty, people complain all the time about little stuff, I'm an immigrant from ravaged Venezuela in Europe that had its MS onset away from all family or friends... I don't want people crying about my situation, I just don't care about someone complaining about little stuff, to me this seems a normal reaction in the context.

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  14. I expect some pwMS are dealing with the bereavement of loss of health. I know I am to some extent. As dt mentions pwMS may feel overwhelmed by life.

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  15. This was a poorly constructed study signifying absolutely nothing. My hope for 2017 is that this blog stops publicizing every study that they get their hands on, and instead tone down the number of updates.

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