共情是本体感受性的：共情的身体基础——对医学教育的哲学贡献。
Empathy is proprioceptive: the bodily fundament of empathy - a philosophical contribution to medical education.
机构信息
Institute for Philosophy, and University Program for Psychotherapeutic Propedeutics, Postgraduate Center, University of Vienna, Vienna, AT, Austria.
Department for Psychoanalysis and Psychotherapy, University Program for Psychotherapy Research, Teaching Center, Medical University of Vienna, Postgraduate Center, University Vienna, Währingerstraße 18-20, 1090, Vienna, Austria.
出版信息
BMC Med Educ. 2018 Apr 5;18(1):69. doi: 10.1186/s12909-018-1161-y.
BACKGROUND
The current philosophical debate on empathy entails accounts of theory of mind and simulation as well as a phenomenological opposition. The first focuses on a detached observation of others from a 3rd person perspective and formulates the common claim that there is no direct access to the mental and emotional life of others, only simulation or analogy can grant access to the emotions and behaviour of others. The philosophical respectively phenomenological account of Fuchs instead opposes by focusing personal interaction within a 1st or 2nd person perspective claiming that the emotions of others are experienceable through bodily expression and bodily resonance. Fuchs offers an account of embodied affectivity that emphasizes the role of the (subjective) body for emotion and empathy. By experiencing the bodily expressed emotions of a vis-à-vis with and through the own body empathy and social understanding are bodily grounded. Following this core thesis Fuchs differentiates a primary, bodily empathy and an extended empathy that focuses on putting myself in the shoes of others (perspective taking).
DISCUSSION
By comparison of different forms of social understanding as discussed in the phenomenological tradition - like contagion, sharing and empathy - it can be shown that extended empathy has an egocentric character. By putting myself in the shoes of others I miss a person's otherness that transcends my capacity of imagination respectively the personal frame of my experience. Further Fuchs' disregards that a bodily based empathy is co-structured by higher level form of understanding like contextual biographic knowledge.
CONCLUSION
The philosophical discussion offers fertile impulses for Medical Education (ME) and the training of empathic communication skills. The account of Fuchs highlights the role of bodily perception (proprioception) as a resource of understanding others. Thus proprioceptive skills of a physician can support the empathic understanding of the physician. The objection against the egocentric trait of perspective taking admonishes not to generalize the own perspective as decisive for empathy and to adopt an attitude that remains open to the otherness of a patient and its experiences.
背景
当前关于同理心的哲学争论涉及到心理理论和模拟，以及现象学的对立。第一种观点侧重于从第三人称的角度对他人进行客观观察，并提出了一个普遍的观点，即无法直接接触到他人的心理和情感生活，只能通过模拟或类比来接触他人的情感和行为。而福克斯的哲学和现象学观点则持相反意见，他关注的是第一人称或第二人称视角下的个人互动，声称他人的情感可以通过身体表达和身体共鸣来体验。福克斯提供了一种体现情感的理论，强调了身体（主体）在情感和同理心中的作用。通过体验与对方身体表达的情感，并通过自己的身体进行共鸣，同理心和社会理解得以身体化。基于这一核心论点，福克斯区分了初级的、身体上的同理心和扩展的同理心，扩展的同理心侧重于设身处地为他人着想（换位思考）。
讨论
通过比较现象学传统中讨论的不同形式的社会理解，如感染、分享和同理心，可以表明扩展的同理心具有自我中心的特点。通过设身处地为他人着想，我忽略了他人超越我想象力的特质，或者说忽略了超越我个人经验框架的特质。此外，福克斯忽略了身体上的同理心是由更高层次的理解形式共同构建的，比如语境化的传记知识。
结论
哲学讨论为医学教育（ME）和同理心沟通技巧的培训提供了有益的启示。福克斯的观点强调了身体感知（本体感受）作为理解他人的资源的作用。因此，医生的本体感受技能可以支持医生同理心的理解。对换位思考的自我中心特征的反对告诫我们，不要将自己的观点视为同理心的决定性因素，而要保持开放的态度，接受患者的特殊性及其体验。
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