Finding 1 (semantic overlap) helps support the hypothesis in the light of the other findings. The numbers indicate that while C appears in the literature without E, there are no instances in the results where E appears without C. This suggests the distinction commonly made between E and C for theoretical purposes may not be as useful in practice as in theory.
Finding 1 is consistent with results presented by Sulzer, Feinstein, and Wendland [3] in their review of 109 studies aimed at assessing empathy development in medical education. The authors found that most of the studies they reviewed were characterized by internal inconsistencies and vagueness in the conceptualization of E, pointing out that the methods most commonly used to measure E relied on self-report and cognition divorced from action, and as a result may not be able to predict the presence or absence of E in clinical settings. Their conclusion suggests the need for humanized perspectives of E.
Finding 2 (bias toward psychology) confirms the hypothesis. It implies that the literature associates E and C with the psychological tradition of studying non-naturally occurring data (NND), data elicited with researcher interventions such as prompts, reports, and surveys as opposed to data gathered without researcher intervention as it naturally emerges in human speech communities, known as naturally occurring data (NOD).
Wolfson [4] and Beebe and Cummings [5] were first to highlight the limitations of NND for purposes of understanding discourse features critical to meaning and intention well enough to serve as a sound basis for second language acquisition education. Later, Félix-Brasdefer [6] showed that using role-play as a data elicitation method for requests in Mexican Spanish was insufficient because it did not generate certain types of requests revealed through an analysis of NOD.
As these studies suggest, NND serves many study purposes and provides easier and faster access to data without the collection and transcription challenges of NOD, but it is not a substitute for NOD when the study goal is to explain complex human behaviors in ways that are accurate and meaningful to real-world pragmatic understanding.
Finding 3 (lack of significant association in the literature between E and C and language/linguistics and other disciplines and topics crucial to a pragmatic perspective of E and C) is the most salient finding in the review and supports the hypothesis.
I was perplexed to find an insignificant association between E/C and language (5%/4% respectively of the total results returned) or E/C and linguistics (1%/1%) since modern linguistics promotes the view that language is social behavior [7], a view that is valid in the light of research based on NOD involving real people and authentically evolving relationships and social contexts and circumstances.
I was equally perplexed to discover an insignificant association in the results between language and emotions and E/C (1%/1% respectively) since I had uncovered evidence of this association in an early ethnographic discourse analysis study of expressions of disapproval [8] I conducted where I demonstrated how intimates commonly convey and respond to negative emotional meaning (criticism) using linguistic forms (syntactic and lexical-semantic surface structures) inconsistent with literal meaning, a finding I was able to quantify with the help of computer analysis at Yale University’s Haskins Laboratory: I showed how the differences in voice pitch and frequency (paralinguistic/prosodic language symbols) that I had found to be determinant to communicative function in interpersonal behavior were measurably distinct [9].
Finding 3 is consistent with Finding 2 (bias toward psychology) and the tradition in research psychology to study emotions apart from social context, which has led many eminent psychologists to see language as detached from emotions, where it is seen to play only a descriptive role [10,11,12].
The oversight suggested by the lack of significant association in the literature between E and C and topics important to pragmatic understanding such as relationship dynamics, conscious mind, rumination, self-talk, implicit bias, linguistic structures, resistant thought, and discrimination reinforce this objectified and dehumanized view of emotions and becomes especially meaningful in the light of philosopher and cognitive scientist Chalmers’ distinction between the easy and the hard problems of consciousness [13].
Chalmers explains how cognitive science is well suited to explaining the easy problems of consciousness, which he associates with cognitive abilities, functions, and behaviors that can be explained in terms of computational or neural mechanisms. He points out that the hard problem persists even when the performance of all relevant functions has been explained because it relates to the subjective way we process experience through perception.
Perception is critical to making sense of E and C from the perspective of communicative function and integral to the way we use language literally and symbolically to shape emotional values [14]. Yet, the topics mentioned above, which are critical to perception, were not significantly associated with E and C in the findings, further suggesting that E and C are understood from objectified and reductionist perspectives in the health-related literature.
Recommendations
I recommend interdisciplinary collaborations between research psychologists and outsiders to research psychology from different traditions and professional specializations, especially between researchers in psychology and linguists who study the communicative function of speech acts and speech events in NOD.
The findings and insights provided by such studies are invaluable to advancing a wider understanding of E and C that emerges as we expand our scope of observation and analysis of interpersonal relationships across time, social contexts, and speech communities, and begin to make sense of the rich and complex sociolinguistic behaviors at the intersection of mind, thought, and social interaction. Since linguistics research is not subject to the same complications and restrictions regarding the study of human subjects as psychology and many other disciplines [15], linguists have easier access to NOD and, therefore, can provide study evidence and insights important to understanding the communicative function of E and C.
I especially recommend considering evidence and insights from ethnographic discourse analysis studies aimed at understanding the complex, entwined, and nuanced language behaviors associated with interpersonal conflict and connection [8, 9]. These studies inform a larger pragmatic picture of human behavior [14] that is important to understanding E and C from the perspective of communicative function.
Most importantly, ethnographic discourse analyses informing disapproval exchanges and interpersonal conflict from the perspective of communicative function provide evidence of the inextricable association between language and emotions, revealing how we draw on literal (linguistic) as well as nonliteral (emotional) language symbols to shape meaning and intention as we think about and interact with others [9, 14].
This evidence-based understanding of language and emotions is complementary to the understanding of E and C suggested by the findings in this review and offers a promising basis for exploring new directions in experimental study important to advancing a scientific understanding of E and C.
Specific to the urgent need for innovating effective interventions capable of advancing empathic and compassionate relationships and communities of healthcare, I recommend conducting a feasibility and acceptability study of compassionate cooperation [14], a customizable evidence-based methodology associated with the longitudinal study of various aspects of interpersonal conflict and connection in the ethnographic discourse analysis study tradition.
Compassionate cooperation methodology demonstrates a strong anecdotal history of effectiveness impacting positive and unifying social change at the community level, offering significant potential to serve as a tool for mitigating threats to empathic and compassionate relationships and communities of care such as those posed by difficult patients, frustrations among front-line providers, compassion fatigue, and recalcitrant personal biases that can easily lead to discrimination at the human systems level.
A feasibility and acceptability study of compassionate cooperation can pave the way for a Randomized Control Trial, which is required to establish its effectiveness as a scientific tool for promoting empathic and compassionate relationships and communities of care. I encourage decision-makers in healthcare communities interested in exploring opportunities for collaboration to contact me.
Challenges to operationalizing the recommendations
The single greatest challenge to operationalizing the proposed recommendations is the way we tend to value, prioritize, and share knowledge in our human communities.
As the literature on social networks and social identity theory suggests, the dynamics of power conformity explain how we are predisposed to valuing and defending insiders to our own groups and the ideas we associate with them, and how we tend to follow the leaders of groups we value and desire to be tied to as insiders [16].
We tend to act according to the birds of a feather phenomenon [16, 17], which accounts for the way we seek to enhance personal self-image through our identity with insiders as we devalue and discount the views and contributions of outsiders [16], a tendency that can easily lead to thoughtless behavior toward others [18]. In academic circles, this can result in exclusions and oversights of potentially useful ideas.
Mitigating this challenge requires willful decision-making on the part of insiders, those individuals with influence and authority, to embrace outsiders and their distinctly different traditions, professional affiliations, accomplishments, and perspectives of E and C. It will not be easy, especially because specialists tend to use different language to talk about the same concepts, which adds to the challenges of collaboration, including deciphering findings as a non-specialist in a given area.
As Lakhami, Jeppesen, Lohse, and Panetta [19] and Hong and Page [20] suggest, however, there is great promise in collaborating with diverse stakeholders, outsiders representing divergent approaches, specializations, and perspectives. Lakhami et al. [19] concluded that scientific problem solving is enhanced by involving specialized solvers with a range of divergent interests at the boundary or outside their fields of expertise. In their extensive study, they disclosed 166 discrete scientific problems that had been internally unsolvable by 26 large and well-known R&D-intensive firms to more than 80,000 independent scientists from more than 150 countries. The outcome was that one-third of the problems that had been previously unsolvable by insiders were solved by the outsiders.
Similarly, Hong and Page [20] developed a model to explain the well-accepted claim that identity-diverse groups outperform homogeneous ones, explaining how functional diversity accounts for differences in the ways people encode and try to solve problems, which benefits advancement.
