Intended for healthcare professionals

Rapid response to:


Tea and empathy

BMJ 2005; 330 doi: (Published 27 January 2005) Cite this as: BMJ 2005;330:229

Rapid Response:

Sympathy and Empathy

EDITOR – In reference to the recent article by Dr McIntyre[1], we wish
to point out the differences between empathy and sympathy, and that any
preference of the former in characterising our attitude towards patients
has an important semantic and not a dogmatic basis.

All dictionaries agree that both words are Greek, made of the
prefixes en- and syn-, and the noun pathos. En- is the Greek equivalent of
the English preposition “in”, and changes in both languages into em-
before b, p, m, and ph, for example “empirical” (“empeirikos” = based on
experience, “empeiria”). Syn- is a Greek preposition that means together,
alike etc, and also changes to sym- before b, p, ph and m (as in the
medical terms symptom, symphysis, and syncope, and the non-medical words
symphony, synagogue, synchrony, symposium – plural symposia see Pluto
etc). Finally, pathos means suffering, and relates to disease, e.g.

In English, the term sympathy was first recorded with the meaning of
agreement in feelings and temperament in 1596, and with that of compassion
and commiseration in 1600[2]. The meanings in Greek are similar, but do not
include condolence3. It follows that in the medical context sympathy
implies a deep and thorough understanding of, and “participation” in a
sufferer’s psychological condition. The position is with and in favour of,
but “outside” the sufferer.

The meaning of empathy in Greek seems to be completely out of the
present context, showing how a word can develop when used by other
languages. The Greek empathy has an extremely negative connotation,
meaning utter dislike, a feeling against somebody or something so
negative, intense, and passionate that precludes any objective assessment,
and at the same time causes suffering (pathos) to the bearer. This intense
personal involvement was exactly the cornerstone of the so-called
aesthetic empathy, introduced by the German philosopher Theodore Lipps in
1903, which maintained that art appreciation depends on the viewer’s
ability to project his personality into the object. In English, empathy is
explained rather vaguely, as identification with another’s feelings[2], but
in the medical context the strong and decisive element of personal
involvement implies a caring attitude not from outside as in sympathy, but
from within (em-), able to prompt action in favour of the sufferer.

Neither term is synonymous to (or opposite of) sincerity, and
“sympathy” is not to be disparaged.

Michael Koutroumanidis, consultant neurologist, St Thomas’ Hospital,
London SE1 7EH,

Yannis Zoukos, consultant neurologist, Broomfield Hospital, Court
Road, Chelmsford, Essex, CM1 7ET,

1. McIntyre P. Tea and sympathy. BMJ 2005;330:229 (29 January)

2. Chambers Dictionary of Etymology, Barnhart RK (editor) 4th Edition,
Chambers Harrap Publishers Ltd, New York, 2002.

3. Babiniotis GD. Dictionary of the Modern Greek Language, 2nd Edition,
Centre of Lexicology, Athens, 2003.

Competing interests:
None declared

Competing interests: No competing interests

21 February 2005
Michael Koutroumanidis
consultant neurologist
Yannis Zoukos
St Thomas' Hospital, London, UK