Empathy: a case study in the historical epistemology of psychiatry

Introduction

Constructed in the early nineteenth century as a medical discipline, psychiatry has a fundamentally different epistemological basis from that of medicine. Arising at a time when the human/social sciences were developing in competition with the prevailing natural sciences, the parallel accounts and explanations for human behaviours were jointly involved in the constitution of the discipline. As a result, psychiatry has from the beginning developed as a deeply hybrid discipline constituted through the interplay of organicity, explained by the natural sciences, and meaning, understood as a product of historical and socio-cultural factors. The objects of psychiatry, namely mental disorders and mental symptoms, are likewise hybrid in constitution (Berrios and Marková, 2015). This hybridity of the discipline, along with the continued tensions this has generated, carries important implications not just for the way in which we seek to understand and manage clinical presentations but also, crucially, for the approaches taken to research in psychiatry.

This paper focuses on one specific implication affecting research methodology in psychiatry: the central role of concepts in forming the knowledge base of psychiatry and psychopathology. As a clinical discipline, psychiatry is uniquely reliant on concepts that constitute its language and practice. Unlike other clinical medical disciplines, psychiatry has no recourse to blood indicators, to neuroimaging signs, to histological changes or any other biomarker to help guide diagnosis and management. Instead, making sense of clinical presentations is based on eliciting symptoms and signs through taking histories and clinical observation. These symptoms and signs are expressed through language, namely descriptive psychopathology, the language constructed for this purpose. In turn, this language consists of concepts of various kinds, referring both to the symptoms and signs themselves and also to the way these are organised. For this reason, concepts are core to understanding psychiatry and its objects, and it is why concepts need to be a focus of research (Marková and Berrios, 2016). The hybrid structure of the discipline means that the concepts constituting the language of psychiatry include not only conglomerations of organicity and meaning, but also concepts imported from diverse sources. These features bestow a particular complexity on the conceptual structure of the language of psychiatry.

Research directed at concepts, aiming to make sense of these and to clarify their structures, is thus essential to help develop further knowledge of psychiatry, mental disorders and mental symptoms and thereby inform clinical approaches and management. Furthermore, conceptual clarity is necessary to determine legitimate research approaches. Thus, conceptual analysis must form the basis of all psychiatric research. Without explicating concepts, research will be based on assumptions that may lack validity and may result in adopting inappropriate directions of research. Before looking at how such conceptual research might be undertaken, it is important to examine briefly what we mean by concepts.

Concepts and conceptual research

The role of concepts in communication in general and research in particular means that they can be viewed as tools. They are epistemological tools, constructed to capture and organise sections of reality. Concepts are heterogeneous, not just in relation to the type of referent, as alluded to above, but in terms of their properties. Thus, concepts vary in terms of their stability, longevity and complexity, their roles and functions, their coherence with other concepts, and so on. To understand why they are so heterogeneous, we need to look at how they are constructed. Berrios (2011) put forward the view that concepts are created from the historical convergence of three components: (i) the term or name for the concept; (ii) the referent, i.e. the object of interest; and (iii) the underlying theoretical account or explanation. All these components are, however, subject to change. Thus, terms or names will change as language evolves and societies’ values and tastes alter. Similarly, theoretical accounts and explanations are not static but are modified over time and in relation to new findings or perspectives from related areas. Finally, referents or objects of interest also change in light of continually transforming contexts. This is particularly relevant in relation to mental disorders and mental symptoms because the referents are, as described above, hybrid structures, where the ‘meaning’ element plays a significant albeit variable role. Furthermore, however, the changes affecting these components will often be occurring at different rates and, moreover, may affect the components independently. This creates important discontinuities in concepts. Because of this, we find that throughout history the same term has been used to name different concepts, or different terms have been used to name the same concept. Similarly, the same referents have been captured by different concepts and indeed different referents have been captured by a particular concept. The importation of concepts into psychiatry from diverse sources presents additional complexities as, in order to accommodate them in the psychiatric discourse, concepts may be tacitly adjusted or metaphorized.

Given the multifarious factors involved in the construction of concepts, research into the structure and meaning of concepts becomes a complex enterprise. One approach to doing this is that of historical epistemology which tries to integrate in various ways the methods used from the history of science, philosophy of science and history of philosophy (Braunstein, Moya and Vagelli, 2019; Feest and Sturm, 2011; Rheinberger, 2007/2010). Focusing on concepts, this involves researching their roots, mapping their biographies and identifying the factors that influenced their construction and shaped their subsequent changes (Marková, 2021). Such factors extend to the wider socio-cultural, political and economic spheres, and they may be difficult to tease out. Nevertheless, these are all important determinants in helping to develop an understanding of the concepts that play such a role in the constitution of psychiatry and its objects.

The concept of empathy: case study

To illustrate some of these issues, I want to examine briefly the concept of empathy. This concept is ubiquitous and almost intrinsic to the language and practice of psychiatry. Its meaning is often assumed and understood as defined in lay terminology as ‘the ability to understand and appreciate another person’s feelings, experience, etc.’ (Oxford English Dictionary; see Simpson and Weiner, 1989). Psychopathology texts refer variously to empathy, such as the focus taken by Jaspers on ‘empathic understanding’ (einfühlendes Verstehen) (Jaspers, 1913: 147) or the contemporary notion of empathy as ‘a clinical instrument that needs to be used with skill to measure another person’s internal subjective state using the observer’s own capacity for emotional and cognitive experience as a yardstick’ (Sims, 2003: 3; my emphasis). Clinical practice also may demand exploration and identification of problems with empathy as features of clinical presentations, for example in autism (Smith, 2009) or narcissistic personality disorder (Urbonaviciute and Hepper, 2020) or dementia (Perry and Miller, 2013), and so on. Also, as with many clinical concepts, empathy has become reified as a theme of interest for the neurosciences and, particularly in the last 20 years, studies have sought to determine neurobiological correlations in the brain, such as mirror neurones (e.g. Baird, Scheffer and Wilson, 2011), or specific brain structures or neuronal circuits (Marsh, 2018; Singer and Lamm, 2009; Stevens and Taber, 2021; Walter, 2012) or oxytocin levels (e.g. Palgi, Klein and Shamay-Tsoory, 2017) that may underpin or explain the concept.

In the face of the myriad ways of viewing or defining empathy, we have to ask: what is empathy? How do we understand the concept? What does it mean in psychiatry? However, on examining the concept, it becomes apparent that in fact it is not very clear at all. What does it mean to understand another person’s mental state? Does this refer to thoughts, to feelings, to experiences, to motivations, etc.? How is it captured? How do we know it is captured? To what depth or extent should it be taken? And so on.

However, this paper is not concerned with determining what the concept of empathy includes or how it should be understood. Rather, using empathy as an example, I want to explore how the concept developed from its modern convergence in 1873 and focus on its structure, or rather structures. By doing this and by examining some of the factors that shaped its constitution and stability, I hope to uncover the implications this has for our current understanding of concepts in general and empathy in particular. In order to do this, I want to compare three concepts of empathy extant at the end of the nineteenth century and beginning of the twentieth century, as articulated by Robert Vischer, Theodor Lipps and Edith Stein. These three were chosen because they mark the origin of the modern concept of empathy and because they each developed primary work in this area. Robert Vischer coined the term ‘Einfühlung’ to refer to what was later translated as empathy (Lanzoni, 2012); ¹ Theodor Lipps developed one of the most influential accounts of empathy at the time; and Edith Stein, under the supervision of Husserl, wrote her thesis on empathy. It is important to note, however, that while concentrating here on these three original concepts of empathy for the reasons given above, there was considerable focus given to the concept of empathy around the end of the nineteenth century and beginning of the twentieth century. Many different and conflicting theories were offered to account for the phenomenon across aesthetics, philosophy and psychology. In recognition of the diverse accounts, the philosopher and psychologist Moritz Geiger presented a review and analysis of the various meanings and theoretical accounts of empathy in 1910 at the IV Congress of Experimental Psychology in Innsbruck (Geiger, 1911). ²

Before it was coined into its technical sense, the term ‘Einfühlung’, literally ‘feeling into’, was already in use during the Romantic period. In relation to the translation and interpretation of texts, Herder, for example, emphasised the importance of Einfühlen. He recognised that people differed in terms of their beliefs, outlooks, concepts and values, and such differences were more marked across different historical periods and cultures. Hence, it was important when trying to make sense of texts, to ‘feel into’ the writers, to understand their feelings and intentions. He described this as an imaginative jump that the interpreter has to make in order to recapture the original sensations of the author (Forster, 2018). This same use of Einfühlen was subsequently taken up in the hermeneutics of Schleiermacher and others. While Dilthey tended not to use the term much, his use of nacherleben was closer to this concept of empathy and became important in Dilthey’s epistemology of the Geisteswissenschaften (Makkreel, 1992).

Robert Vischer (1847–1933)

Robert Vischer was the son of Friedrich Theodor Vischer (1807–87), a major figure in German aesthetics as well as a poet and novelist. After working as a pastor, Friedrich Vischer studied philosophy and aesthetics and embraced a strong pantheism which played a part in costing him a temporary suspension as Professor of Philosophy at Tübingen University (Guyer, 2014: 159–72). Aesthetics was, for the elder Vischer, the science of the beautiful and he defined the aesthetic experience as a projection of our emotional responses to objects around us, whether these are landscapes, objects of art, music, or other objects. He saw this as a response to what he called the symbolic nature of forms. ³ Thus, he maintained that the form of objects around us possessed an inherent symbolism which, together with the content of objects, invoked our emotional responses which would then be projected onto the objects. He described this as the soul projecting itself into objects, and he called this Beseelung (‘ensouling’) or Einfühlung. His aesthetics were permeated by his pantheism as he understood this in terms of an instinct that was the result of a pantheistic drive to merge our spirit with the sensuous world.

His son Robert Vischer, who became an art historian, teaching at Breslau, Aachen, Munich and Göttingen, was immersed in this environment of philosophy, literature, aesthetics and pantheism. His doctoral thesis at Tübingen University was in aesthetics and it was there that he coined the term ‘Einfühlung’ or empathy (Vischer, 1873: vii). He attributed his idea of empathy to his father, and his thesis was specifically aimed at developing his father’s concept of the symbolism through which we achieve unity with the world. ⁴ Thus, he sought to explicate the process, utilising a mixture of physiological and psychological functions to support his argumentation. In this, like other philosophers of the time, he drew on much of Wilhelm Wundt’s work, using Wundt’s basic physiology and his notion of similarity, as well as making the distinction between sensation, feeling and emotion (Mallgrave and Ikonomou, 1994). Vischer built his account of the aesthetic experience from the simple – where objects are pleasing based on their conformity or harmony with bodily structures (e.g. ‘the circle – a plate, a loop or a sphere . . . has an immediate pleasing effect because it conforms to the rounded shape of the eyes’ (Vischer, 1873/1994: 97), to the complex – where mental activity such as association of ideas, fantasy or imagination acts on the sensations triggered by external objects. The mental activity responds to these triggers and objectifies the body into the external forms of these objects. Imagination (Vorstellung) is the central component of this more complex process of Einfühlung, and Vischer drew directly on Karl Albert Scherner’s (1861) book The Life of Dreams ⁵ as the inspiration for his conception of this process. Thus, in the foreword of his thesis ‘On the Optical Sense of Form’, Vischer wrote referring to Scherner’s work:

. . . Here it was shown how the body, responding to certain stimuli in dreams, objectifies itself in spatial forms. Thus it unconsciously projects its own bodily form – and with this also the soul – into the form of the object. From this I derived the notion that I call empathy (Einfühlung). (Vischer, 1873/1994: 92)

To illustrate this in the case of dreaming, Vischer gave various examples such as, ‘I might dream of a dangerously overhanging oriel of a house for instance because my head is hanging down over the side of the bed’ (p. 100). He went on to suggest that a similar objectification of the body occurs to different extents in daily life, both consciously and unconsciously.

The focus and aim of Vischer’s thesis were on describing how it is that we merge or unite with the world around us, principally in order to explain the aesthetic experience. Empathy was a central though not the only process whereby this took place. He viewed the most complete union that could take place as that between human beings, where the projection of our selves into the other is driven by a natural love or kinship with our species. However, even in inanimate objects, we project our selves:

Thus I project my own life into the lifeless form, just as I quite justifiably do with another living person. Only ostensibly do I keep my own identity although the object remains distinct. I seem merely to adapt and attach myself to it as one hand clasps another and yet I am mysteriously transplanted and magically transformed into this Other. (p. 104)

Vischer made some distinctions between various forms of empathy, e.g. sensory, kinaesthetic, physiognomic/emotional, mimicking/acting empathy, in order to demonstrate how, depending on the type of external triggers involved, our bodies or parts of our bodies would respond and, through our mental activity building on the invoked symbolism, we would project these into the triggering sources. However, although breaking these up for the purpose of illustration, he viewed empathy as a holistic function or process, one that was vital in the union of our selves with the world around us. Like his father, Vischer’s ideas were grounded on an underlying pantheism. Thus, ‘this symbolising activity can be based on nothing other than the pantheistic urge for union with the world’ (p. 109).

Despite drawing on psychological and physiological explanations, these ideas were basic and unelaborated, and Vischer’s concept of empathy remained, at heart, a metaphysical notion whereby through the projection of our whole selves, bodies and souls, we are able to merge with the world around us.

Theodor Lipps (1851–1914)

A contemporary of Vischer, Lipps was a philosopher and psychologist whose work on aesthetics, psychology and empathy became hugely influential across various fields (Devonis, 2012: 639–40). After working at Bonn and Breslau, he obtained the chair in philosophy at Munich, succeeding Carl Stumpf in 1894; Lipps arrived there after Vischer had left and stayed there for the rest of his life. He viewed philosophy as the study of inner experience, the latter forming the basis of the human/social sciences (Geisteswissenschaften) (Zweig, 1967). Psychology, the study of conscious experiences, thus provided the scientific basis of philosophy.

Lipps wrote extensively on empathy and it would not be possible to capture all his thoughts here. Moreover, he revised his views over time and in relation to the work of others, notably Husserl (Moran, 2004). For the purposes here, I want to focus briefly on the concepts of empathy as he articulated these, firstly in relation to aesthetics and secondly in relation to knowledge of others.

Edith Stein (1891–1942)

Born in Breslau, into an Orthodox Jewish family, Edith Stein was the youngest of seven. Her father died when she was a baby, and her mother alone brought up the family in difficult circumstances. ⁶ At Breslau University Stein studied psychology, which at the time was taught as an empirical science. ⁷ She very quickly became disillusioned with its state of understanding, finding that even fundamental concepts, such as consciousness, were only vaguely defined. ⁸ While studying at Breslau, she was introduced to Husserl’s Logische Untersuchungen, a work that made a huge impact on her. Here, in direct contrast to psychology, there was the explicit call to clarifying concepts, to go to the things themselves, and this led to her decision in 1913 to go to Göttingen to study with Husserl.

Husserl’s tenet was that we can only know the objective external world intersubjectively, i.e. through the mutual exchange between human beings, and that therefore knowledge of the experience of others was necessary for this. Taking the term from Theodor Lipps, Husserl called this experience ‘Einfühlung’. Soon after arriving at Göttingen, Stein identified that Husserl had not clarified what Einfühlung actually was, and saw this as a gap which needed filling. So she asked Husserl if she could work on this for her thesis. Important in her thinking for this work were, among others, Adolf Reinach and Max Scheler. The latter, in particular, not only was influential in her subsequent conversion to the Catholic faith, but he helped her to understand the need for an intuitive approach as well as reasoning in conceptual clarification (Imhof, 1987: 46–62). ⁹

Thus, in contrast to Lipps, Stein approached the problem of empathy from a purely phenomenological perspective. She understood phenomenology to be at the heart of knowledge, and phenomena had to be clearly delineated before other sciences, such as psychology or sociology, could take over and provide explanatory accounts. Hence, she sought to capture the essence of empathy as a lived experience (Erlebnis) and to determine how this was constituted in consciousness. She took empathy to refer to the understanding (Erfahrung) of foreign subjects and their experience (Erlebnis). ¹⁰ In other words, it was about describing what it means for our consciousness to experience foreign consciousness, both that of fellow human beings and of God. For Stein, this empathic act involved something other than the symbolic relation between ourselves and the perceived person as depicted by Lipps: ‘I know not only what is expressed in facial appearances and gestures but also what is hidden behind them; I might see that someone makes a sad face but in truth they are not sad’ (Stein, 1917: 4). Utilising the approach of phenomenological reduction, Stein determined that empathy was a sui generis phenomenon, one that could not be conceived as either perception or representation but was in a class of its own.

Central to her analysis were the respective roles of primordiality (Originarität) and non-primordiality (Nichtoriginarität) in the structure of the phenomenon (Stein, 1917: 11). By primordiality Stein meant the direct lived experience of an object by the ‘I’ or ego. Thus we experience the outer world primordially – external objects are given to us through perception. Similarly, ideation is primordial in that we experience the objects/content of our reflections and insight. Some of our experiences are not primordially experienced, nor are they primordial in content. For example, in a memory of something, the object is not primordially given but is a representation, though the remembering act itself is a primordial experience. When considering empathic acts, Stein gives the example of seeing a friend who has just been bereaved, and we can see the pain in his face and be aware of that pain. However, seeing pain is not like seeing objects around us. We are aware of that pain, but we do not see it in the way we experience outer perception. While the experience we have is primordial in character, the object, namely the other person’s pain, is non-primordial in content. We experience the pain, but it is not our pain. Thus, an empathic act is primordial in experience but non-primordial in content (pp. 10–11). In contrast, however, to memory or fantasy, which are also primordial in experience but non-primordial in content, there is no continuity of consciousness in empathy.

Stein goes on to describe three levels at which the empathic experience takes place, although often only the lower ones may be sufficient. These are (i) the emergence of the experience, (ii) the fulfilling explication and (iii) the comprehensive objectification of the explained experience. She explains that we first have the empathic experience: we are aware of the pain in the friend’s face, we then clarify with them what is happening, and thereby get drawn into the content which thus stops being the object; and we ourselves are the subjects of the content in the original subject’s place. After gaining full clarification, we then once again have the content facing us as the object (Stein, 1917/1989: 10). In this way, Stein makes the case for a sui generis act, one which shares similarities with perception, memory, fantasy, sympathy and other experiences, but is nevertheless different. ¹¹ She emphasises that empathy is not putting oneself in the place of another – which is an assumption based on ascribing an experience to someone – and is not an experience itself. Similarly, she is clear that empathy is not a projection of one’s emotions into another and, in explicit opposition to Lipps, she argues that empathy is not a feeling of oneness, that is, it does not involve identification or fusion with the other (Stein, 1917: 12–15, 20–1).

While recognising that her exploration of empathy is intentionally descriptive in order to delineate as clearly as possible the phenomenon as experienced in consciousness, Stein criticises some of the other theories of the time that tried to explain empathy in psychological terms. Among these theories, she focuses on the theory of imitation, the theory of association and the theory of inference by analogy in this regard; generally, she argues that, in different ways, such theories do not lead back to the essence of empathy as delineated in her phenomenological analysis.

For Stein, empathy is intimately bound up within the constitution of the ‘psycho-physical individual’, including the spirit, and the bulk of her thesis deals with a detailed phenomenological analysis of the person with respect to their psyche, their lived and empirical bodies and their spirit. ¹² As such, empathy is a necessary and intrinsic aspect of the person in order to meaningfully navigate the external world. ‘If there were no possibility of empathy, of transferring the self in the other’s orientation’ Stein says, ¹³ then communication with others would be limited to a superficial level of understanding (Stein, 1917/1989: 65). Referring also to Husserl and Royce, Stein sees empathy as ‘the basis of intersubjective experience . . . the condition of possible knowledge of the existing outer world’ (p. 64). Furthermore, through empathy we also gain self-knowledge. By getting to know other people and their experiences, outlooks and values, that is, their personality structures, we become aware of the differences between us as personalities, and aware of what may be lacking or additional in ourselves.

Empathy compared

A comparison of these three modern conceptualisations of empathy yields a number of interesting findings. Firstly, we see that the concept originated in the field of aesthetics as articulated by Vischer, and only subsequently was the concept imported into psychology (and psychiatry) through the work of Lipps. Most strikingly however, we can see that, despite some superficial overlap, the structures of the concepts are quite different. Earlier, we suggested that concepts are constituted through the historical convergence of three components: the term for the concept, the referent or object of interest to which the term refers, and the account or theoretical explanation for the concept. When we compare these three concepts we can see that the only thing they share in common is the term Einfühlung (empathy) (see Table 1). The referents range widely from other people to the self, animals, landscapes, animate and inanimate objects, and so on. Likewise, the accounts provided to describe and/or explain empathy are vastly different. We can ask why is this the case, and what does this mean?

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Table 1.

The three concepts of empathy compared.

	Robert Vischer Aesthetics	Theodor Lipps Aesthetics	Theodor Lipps Knowledge of others	Edith Stein Knowledge of others
Term	Einfühlung	Einfühlung	Einfühlung	Einfühlung
Referent	Objects, organic or inorganic People, world	Objects of beauty, animate or non-animate, art, others	Others, self, animals	Others, God
Theoretical account	Metaphysical Projection of whole self onto object Fusion Similarity with bodily/organ forms, imagination	Psychological Projection of emotions into external objects Fusion Apperception	Psychological Objectivation of own experience into objects Possible fusion Mimicry of gestures, invoking emotions/ inner states, apperception	Phenomenological Non-primordial experience of another’s primordial experience No fusion Three levels: – emergence of experience – fulfilling explication – comprehensive objectification

In the first place, it is important to know if the differences are significant, in the sense that the concepts are capturing different phenomena. I have already implied that this may be the case by alluding to structural conceptual differences. When referring to structure, this includes not just the components or contents but also the way in which these are put together and consequently the way in which they interact with other phenomena. Examining the concepts of empathy described here, we see that they are each constructed from and shaped by very different outlooks which give rise to different points of departure, and which in turn carry with them different sets of assumptions.

From an aesthetic perspective, Vischer was trying to explicate how we respond to and interact with the world. Using his father’s notion of symbolic forms inherent in the objects around us and triggering responses in us, he attempted to explain these using basic psychological/physiological processes and simple mechanical correlations, and invoking the role of imagination. His concept, however, remained metaphysical, driven by his pantheistic outlook through which we are compelled to unite with our world, both animate and inanimate.

From both the aesthetic perspective and that of knowledge of others, Lipps in contrast took a strictly psychological approach. For him, psychology was the scientific basis of philosophy and hence of the human/social sciences, and he tried to describe and explain empathy by means of psychological processes, notably referring to apperception, to the outer expressions of inner states and to mimicry. While, like Vischer, he described empathy in terms of fusion between our selves and aesthetic objects, his notion was not metaphysical in the same sense. Instead, he maintained his psychological stance and defined this as our own emotions being the source of the content of aesthetic objects. Thus, although technically we can call this merging with the objects, there is nevertheless is a distinction in that, while our projected emotions form part of the perceived objects, they nevertheless remain our emotions, psychologically speaking. Similarly, while criticised by others, including Stein, for suggesting a ‘fusion’ in relation to knowledge of others (e.g. when referring to the distinction between self and other disappearing; Lipps, 1903b: 194), he delineates this in terms of psychological processes, far removed from a metaphysical conception (see also Burns, 2021).

Finally, Stein takes yet another very different perspective. Following Husserl and in opposition to Lipps, she viewed phenomenology as primary and necessary in defining and clarifying phenomena. For her, psychology was secondary and could only follow once the phenomena were clearly depicted. Her concept of empathy was thus phenomenological and, in taking Husserl’s edict of going back to the things themselves, she sought through analysis and intuition to define it in terms of an irreducible lived experience in consciousness. Whilst Lipps (1907b) also described empathy as an irreducible, unique fact, his description in psychological terms belongs to a different category from that of Stein.

What emerges from this brief comparison is that these three concepts of empathy as articulated by Vischer, Lipps and Stein have little in common beyond the term itself. Conceived as metaphysical, psychological and phenomenological concepts respectively, they are built on different premises, refer to different things and carve out different aspects of reality.

Implications and conclusions

The hybrid constitution of psychiatry and its objects endows it with a fundamentally different epistemological basis compared with other medical disciplines. It is on account of this that the concepts which make up psychiatry and psychopathology are so important, holding a special role in understanding the field. Exploring concepts in terms of (i) their construction over time, (ii) their changing constituents and (iii) the varying factors that shape and determine their structure, is thus necessary to ensure legitimacy in both theoretical and empirical research, as well as in clinical practice.

A brief comparison of some of the concepts of empathy extant in the early twentieth century shows that these are convergences of empathy running in parallel. Despite the use of the same term, the concepts are structurally different and are capturing different meanings. This carries several implications. Firstly, in terms of empathy itself, this suggests that the concept has unstable ontology and epistemology. This is further borne out by the ongoing diverse views on meanings, processes and mechanisms thought to underlie the concept. Secondly, in terms of psychiatry and psychopathology, given the central role of concepts in general as well as the pervasive use of empathy in particular, the structurally different concepts identified in the comparison above highlight the need to carefully clarify the concepts in use in order to understand their role and meaning. Finally, and relating to this last point, such clarification in psychiatry and psychopathology is crucial to determine valid research approaches. The unstable ontology and epistemology of the concept of empathy identified above shows clearly that the concept should not be fixed or reified as a unitary object. Research where such reification occurs, for example in neuroimaging or mirror neurone research, will inevitably raise questions about its validity. Instead, research might be more usefully directed at the concept itself, determining any stable facets, examining its relationship with related concepts and phenomena, teasing it out, and exploring which aspects may be clinically important, whether from a prognostic, therapeutic or communicative perspective.