Hektoen International

A Journal of Medical Humanities

Empathy or sympathy?

JMS Pearce
Hull, England

David Jeffrey’s splendid paper about emotions and empathy1 points out that Sir William Osler claimed that by excluding emotions, doctors gained a special objective insight into the patient’s suffering. But when Osler advised students that “insensibility is not only an advantage, but a positive necessity in the exercise of a calm judgment,” it was in the context of unpleasant sights in the operating theater. And his counsel ended: “without, at the same time, hardening ‘the human heart by which we live.’”2 This led some doctors to believe that the suffering of patients should be handled with detachment. Yet, by repute and in his writings, Osler was a kind and caring physician. He once counseled: “Care more for the individual patient than for the special features of the disease… Put yourself in his place…The kindly word, the cheerful greeting, the sympathetic look – these the patient understands.”

Nowadays, empathy has become a trendy word for sympathy.

Languages continually evolve as people add to their linguistic repertoires; words often drastically change their meanings. Empathy is no exception. A conservative politician recently insisted that despite his fortunate personal circumstances, he was “able to empathize with his constituents over the soaring cost-of-living crisis.” And we daily hear messages such as: “We can all empathize with this sad tragedy,” often about awful misfortunes of people we never knew, often living in distant parts of the world. We hear them on the radio, read them in newspapers, and see them expressed ad nauseam on television. But do we “all empathize”? Are such statements true? Or, to be generous, is it just a sloppy, careless misuse of language?

Because the word “empathy” did not exist in the eighteenth century, the philosophical texts of David Hume and Adam Smith used the word “sympathy” but not “empathy.” Hume believed that moral evaluations depend not on moral rational thought, but on sentiment or feeling. Adam Smith (perhaps echoed by Osler) tells us sympathy can be a detached fellow-feeling:

Pity and compassion are words appropriated to signify our fellow-feeling with the sorrow of others, sympathy, though its meaning was, perhaps, originally the same, may now, however, without much impropriety, be made use of to denote our fellow-feeling with any passion whatever.3

A more modern interpretation is that of Darwall:

I prefer to use ‘sympathy’ for feelings of concern for others that are felt, not entirely as from their own point of view, but as from a third-person perspective of one who cares for them, and to use ‘empathy’ for feelings that either imaginatively enter into the other’s standpoint or result from his feelings by contagion.4

For those of us afflicted by pedantry, the nouns empathy and sympathy should not be used interchangeably. But often they are. Their distinctive meanings and nuances have become hazy and inaccurate. Attempts to distinguish them rightly remain, even in psychobabble: “A ‘man-to-man’ regard for the client, characterized (ideally) by the understanding of empathy without the erratic quality of identification or the supportiveness of sympathy.”5

Empathy means more than to be touched by or to share someone’s misfortune, to be compassionate—all expressions of sympathy. To empathize is to place oneself inside the mind of someone else’s feelings and mood: to experience vicariously other people’s feelings as if we were having them ourselves. To empathize is to immerse oneself in a subject’s mind that is more than sympathetic. More simply, empathy is putting yourself in the other person’s shoes and being able to see and feel the world as they do.

The problem is not new. The word sympathy (Greek sympatheia: syn with, together, and pathos, feelings or emotion) first appeared in English in the sixteenth century. Sympathy was romantically related by Edmund Spenser in 1596 in Hymne in Honour of Beautie:

Loue is a celestiall harmonie, Of likely harts. Which ioyne together in sweete sympathie, To worke ech others ioy and true content.

The current Oxford English Dictionary more mundanely defines sympathy as:

A feeling of compassion or commiseration, a conformity of feelings, inclinations, or temperament, which makes persons agreeable to each other; community of feeling; harmony of disposition.

Empathy is a relatively new coinage used by Vischer (1873) from the German Einfühlung, mean feeling into, or an imaginary bodily perspective. Originally, empathy was inelegantly expressed as a psychophysical phenomenon:

For the capacity factor of psychophysical energy the name “empathy” is proposed. Empathy is then a physical quantity, a physiological brain-function, and is defined as the relation of the whole energy at any change of the central organ to the intensity.6

A hundred years ago, it had a slightly different meaning related to insight rather than compassion: intellectual insight into another’s emotional state without sharing in it.7

Jeffrey also reminds us of Michel de Montaigne’s (1533–92) Essays which implied that connecting with other people can help doctors to connect emotionally with patients: we cannot distance ourselves from others. From a medical standpoint, a positive association of clinical empathy with improved therapeutic outcomes has been asserted in many clinical settings, although definitions have been variable, and empathy confused with sympathy and emotional intelligence.8,9 Though probably mistaken for sympathy, patient-rated physician empathy was strongly correlated with patient satisfaction and adherence to treatment in a pain clinic consultation.10 A decline in empathy during the clinical years of medical school training is often claimed, leading to arguably useful attempts to teach empathy.11 Halpern notes that medical educators increasingly recognize the importance of empathy, but they define empathy in a special way to be consistent with the overarching norm of detachment.12 But it would be absurd to think that some measure of innate altruism and sympathy for the human condition was not already present in those seeking a medical education. Exposure to the vagaries of human suffering during medical training can scarcely be devoid of some element of sympathy and caring.

Whether such fundamentally humane qualities can be taught in the lecture room or at the bedside is debatable. Much is learned unconsciously from the example of role models rather than by verbal instruction.


  1. Jeffrey D. Montaigne’s Essays: Emotions and empathy. Hektoen International 2022;14(3). https://hekint.org/2019/04/22/montaignes-essays-emotions-and-empathy/.
  2. Osler W. Aequanimitas: With Other Addresses to Medical Students and Practitioners of Medicine. 2nd edn. Philadelphia: Blakiston’s, 1925: 3-6.
  3. Smith A. The Theory of Moral Sentiments. 1759: 49.
  4. Darwall S. The Second-Person Standpoint: Morality, Respect and Accountability. Cambridge, MA: Harvard University Press. 2006: 45.
  5. J Clin Psychol. 1946;2 61/1. Cited in: Levine P. Empathy is a new word. Do we need it? 2019. https://peterlevine.ws/?p=21102.
  6. Lasswitz K. Archiv f. systematische Philosophie 1895;1:54. Translated by EL Hinman, Philos. Rev. 4, 673.
  7. Dirckx JH. The Language of Medicine. 2nd edn. Thomson Learning, 1983.
  8. Neuwirth ZE. Physician empathy—should we care? The Lancet 1997;350:606.
  9. Jani BD, Blane DN, Mercer SW. The role of empathy in therapy and the physician-patient relationship. Forsch Komplementmed. 2012;19(5):252-7.
  10. Walsh S, O’Neill A, Hannigan A, Harmon D. Patient-rated physician empathy and patient satisfaction during pain clinic consultations. Irish J Med Sci. 2019;188(4):1379-84.
  11. Han JL, Pappas TN. A review of empathy, its importance, and its teaching in surgical training. J Surg Educ. 2018;75(1):88-94.
  12. Halpern J. What is clinical empathy? J Gen Intern Med. 2003;18(8):670-4.

JMS PEARCE is a retired neurologist and author with a particular interest in the history of medicine and science.

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