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A Psychiatrist and Philosopher Attempts to Explain Sadomasochism

Saint Sebastian: martyrdom or ecstasy? Guido Reni, c. 1615.
Saint Sebastian in Ecstasy, by Guido Reni (c. 1615).

By Dr Neel Burton — Psychiatrist, philosopher, and wine writer; Fellow of Green Templeton College, University of Oxford; author of over twenty books.

Essay substantially revised on 29 August 2026.

Homo sum, humani nihil a me alienum puto.
I am human, and consider nothing human to be alien to me.
—Terence

Many people think of sadism and masochism merely as perversions. In fact, these tendencies exist on a continuum, and are present, to some degree, in all of us.

Sadomasochism can be defined as the taking of pleasure, often sexual in nature, from the inflicting or suffering of pain, hardship, or humiliation. It can feature as an enhancement to sexual intercourse, or, less commonly, as a substitute or sine qua non.

The infliction of pain or hardship incites pleasure, while the simulation of violence can serve to express and deepen attachment. Indeed, sadomasochistic activities are often instigated at the behest, and for the benefit, of the masochist, who orchestrates the activities through subtle cues.

Consensual sadomasochism should not be confused with simple acts of aggression. While sadomasochists seek out pain in the context of love and sex, they do not do so in other situations, and abhor uninvited aggression or abuse as much as the next person.

Sadomasochistic practices are very diverse, although one study identified four distinct patterns or clusters: hypermasculinity, infliction and reception of pain, physical restriction, and psychological humiliation. Interestingly, the study found that homosexual males tended more to hypermasculinity, whereas heterosexual males tended more to humiliation.

A Brief History of Sadomasochism

‘Sadomasochism’ is a portmanteau of ‘sadism’ and ‘masochism’. In Psychopathia Sexualis (1886), a compendium of sexual case histories and sex-crimes, the psychiatrist Richard von Krafft-Ebing, who coined the terms, spoke of basic tendencies to sadism in men, and to masochism in women. Modern surveys indicate that sadistic and masochistic desires are common in both men and women, with, however, sadism being commoner in men and masochism commoner in women.

Krafft-Ebing named ‘sadism’ after the Marquis de Sade, author of Justine, or The Misfortune of Virtue (1791); ‘masochism’ he named after Leopold von Sacher-Masoch, author of Venus in Furs (1870):

Man is the one who desires, woman the one who is desired. This is woman’s entire but decisive advantage. Through man’s passions, nature has given man into woman’s hands, and the woman who does not know how to make him her subject, her slave, her toy, and how to betray him with a smile in the end is not wise.

The terms ‘sadism’ and ‘masochism’ may be of the nineteenth century, but the activities they denote are as old as the rocks. In his Confessions (1782), the philosopher Jean-Jacques Rousseau admits to the pleasure that he derived from childhood beatings, adding that ‘after having ventured to say so much, I can shrink from nothing’. And shrink he did not: ‘To fall at the feet of an imperious mistress, obey her mandates, or implore pardon, were for me the most exquisite enjoyments…’ 

In Apuleius’ The Golden Ass, the only Roman novel to survive complete, Fotis slips into her lover’s bedchamber, produces a whip from beneath her clothes, and invites him to punish her.

The Kama Sutra, which probably dates back to the second century, contains an entire chapter devoted to ‘blows and cries’. ‘Sexual relations,’ according to this Hindu sacred text, ‘can be conceived as a kind of combat… For successful intercourse, a show of cruelty is essential.’

The physician JH Meibom formulated the first theory of masochism in his Treatise on the Use of Flogging in Medicine and Venery (1639). According to Meibom, flogging a man’s back warms the semen in the kidneys, which then flows down into the testicles, leading to sexual arousal. Other early theories of masochism centred upon the warming of the blood, or the benefits of sexual arousal in mitigating physical pain.

Krafft-Ebing never connected sadism and masochism, because he understood them as stemming from different sexual and erotic logics. But in Three Papers on Sexual Theory (1905), Freud observed that sadism and masochism often come together (no pun intended). Finally, in 1913, the psychoanalyst Isidor Sadger married the terms.

Freud understood sadism as a distortion of the aggressive component of the male sexual instinct, and masochism as a form of sadism directed against the self—and a graver ‘aberration’ than simple sadism. He remarked that the tendency to inflict and receive pain during intercourse is ‘the most common and important of all perversions’ and ascribed it (as much else) to arrested or disordered psychosexual development. He paid scant attention to sadomasochism in women, either because he thought of sadism as a problem of men, or because he thought of masochism as the natural inclination of women.

In Studies in the Psychology of Sex, the physician Henry Havelock Ellis argued along similar lines that there is no neat divide between sadism and masochism. By restricting sadism and masochism to the sphere of eroticism, he severed their historical link with abuse and cruelty.

The philosopher Gilles Deleuze pushed back against Freud and Havelock Ellis. In his essay Coldness and Cruelty (1967), he contended that sadomasochism is an artificial term, and that sadism and masochism are in fact separate and distinct phenomena. Deleuze provided fresh accounts of sadism and masochism, which, despite being fluent in French, I struggled to comprehend. His point, I think, is that the sadist seeks a victim, whereas the masochist seeks—and in an important sense creates—a despot. For the sadist, a masochist is not a genuine victim.

Sadomasochism Explained

If the experts agree on anything, it is that sadomasochism is one of the great mysteries of the human condition. Here, I propose a number of explanations, none of which are mutually incompatible.

Most obviously, the sadist may derive pleasure from feelings of power, authority, and control, and from the ‘suffering’ of the masochist.

The sadist may also harbour a conscious or unconscious desire to punish or desecrate the object of sexual attraction (or a stand-in for the object of sexual attraction, or for an original object of sexual attraction) for having aroused his desire and thereby subjugated him, or for having frustrated his desire or aroused his jealousy.

Sadism can also serve as a defence. By objectifying a partner, the sadist does not need to handle his or the partner’s emotional baggage, and is able to discount the sex as next to meaningless: a mere act of lust rather than an intimate, vulnerable, and pregnant act of love. The partner becomes a trophy, a mere plaything, and while one can own a toy and knock it about, one cannot fall in love with it or be hurt or betrayed by it.

In some cases, sadism might also represent a species of displacement, in which uncomfortable feelings such as anger, shame, and guilt are discharged onto a third party, who serves as a scapegoat.

For the masochist, taking on a role of subjugation and helplessness can offer a release from stress or the burden of responsibility or guilt. It can also evoke infantile feelings of vulnerability and dependency, which can serve as a proxy for trust and intimacy. Moreover, the masochist may derive gratification from earning the approval of the sadist, fulfilling his fantasies, commanding his undivided attention, and, in that sense, controlling him.

For both the sadist and the masochist, sadistic or masochistic desires may arise through conditioning, if domination or submission becomes associated with sexual arousal.

For the couple as a unit, sadomasochism can be seen as a means of intensifying normal sexual relations (pain releases endorphins and other hormones), leaving a mark or memory, testing boundaries, rebelling against social norms and expectations, giving form and expression to psychological realities, building trust and intimacy, or simply playing.

Sadomasochism in Ordinary Life

And what about you, dear reader? It’s easy to think that this sort of stuff only applies to a handful of ‘deviants’, but the truth is that we all harbour sadomasochistic tendencies. Just think, for example, of casual, ‘normal’ behaviours such as love-biting, tickling, or teasing.

Sadomasochism can also play out on a psychological level. In every relationship or almost, one partner is more attached or dependent than the other. Characteristically, the more attached partner is ‘the one who waits’.

Thus, the philosopher Roland Barthes (d. 1980):

Am I in love? —yes, since I am waiting. The other one never waits. Sometimes I want to play the part of the one who doesn’t wait; I try to busy myself elsewhere, to arrive late; but I always lose at this game. Whatever I do, I find myself there, with nothing to do, punctual, even ahead of time. The lover’s fatal identity is precisely this: I am the one who waits. (L’identité fatale de l’amoureux n’est rien d’autre que: je suis celui qui attend.)

The likely outcome of this asymmetry of desire is that the less attached partner (A) becomes dominant, while the more attached partner (B) becomes submissive in a bid to please and seduce. Sooner or later, A feels stifled and takes distance, but if he or she ventures too far, B may threaten to go cold or give up. This in turn prompts A to flip and, for a time, to become the more enthusiastic of the pair. But the original dynamic soon re-establishes itself, until it is once again upset, and so on ad vitam æternam.

Domination and submission are elements of every relationship or almost, but that does not mean that they are not tedious, sterile, and, to echo Freud, immature. Instead of playing at cat and mouse, lovers need to be able to rise above that game, and not just by getting married. By learning to trust each other, they can dare to see each other as the fully-fledged human beings that they truly are, ends-in-themselves rather than mere means-to-an-end.

True love is about respecting, nurturing, and enabling—whatever else may happen on a Sunday—but how many people have the capacity and maturity for this kind of love?

And, of course, it takes two not to tango.

Continue Exploring

If this essay spoke to you, you might look into For Better For Worse, an unconventional exploration of romantic love, marriage, and lasting relationships. For a broader exploration of love, desire, jealousy, and the emotions that shape our lives, see Heaven and Hell: The Psychology of the Emotions.

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Three Tales of Same-Sex Love in Ancient Egypt

Nyankhkhnum and Khnumhotep touching noses, a gesture suggestive of kissing, in their shared tomb at Saqqara, c. 2400 BCE.
Nyankhkhnum and Khnumhotep touching noses in their shared tomb at Saqqara, c. 2400 BCE.

By Dr Neel Burton — Psychiatrist, philosopher, and wine writer; Fellow of Green Templeton College, University of Oxford; author of over twenty books.

Essay substantially revised on 8 September 2026.

Ancient Egyptian sources are largely silent on the subject of same-sex love. Our insights into the matter come from just three areas:

  • A myth about the gods Horus and Seth
  • A historical tale about Pharaoh Neferkare and his general Sasenet, and
  • The tomb of court officials Nyankhkhnum and Khnumhotep.

Horus and Seth

In the Contendings of Horus and Seth, a myth with several versions, Seth and his nephew Horus vie for the throne of Egypt. Seth keeps on trying to get the better of Horus. At last, uncle decides to subjugate nephew by inebriating, seducing, and inseminating him.

‘How beautiful are your buttocks, how vital!’ This line, used by Seth on his nephew, is without a doubt the oldest chat-up, gay or straight, in all of recorded history.

In the event, Horus is not all that drunk, and succeeds in catching Seth’s semen in his hand. The next day, he shows his manky hand to his mother Isis, before washing it in the Nile. Together, Horus and Isis plot their revenge over Seth…

Horus finds Seth’s lunch and masturbates into his lettuce. After enjoying his dressed salad, Seth puts his domination case before the tribunal of the gods—but, of course, Horus disputes his claim. When Thoth calls forth their semen, that of Seth rises from the Nile, while that of Horus pours out of Seth’s mouth.

The myth suggests that, in Ancient Egypt as in Ancient Rome, the sticking point, if you’ll forgive the pun, was not so much with same-sex love per se, as with a male playing a passive or receptive role.

In 46 BCE, Julius Cæsar was rumoured to have submitted to Nicomedes IV of Bithynia, and mocked as ‘Queen of Bithynia’. A popular quip ran: Gallias Cæsar subegit, Cæsarem Nicomedes (Cæsar subjugated Gaul, and Nicomedes Cæsar).

It is notable that Horus had no qualms about being seduced by Seth, or even with bedding him, but only with being penetrated or inseminated by him.

Pharaoh Neferkare and General Sasenet

From three extent fragments, it is possible to reconstruct the twenty-third century BCE story of Pharaoh Neferkare (the long-reigning Pepi II) and his secret nightly visits to General Sasenet.

One night, a spy observed Neferkare going, on his own, from the royal palace to Sasenet’s house. Having arrived at the house, Neferkare ‘threw a brick after stamping with his foot. Then a ladder was lowered to him (and) he climbed up.’ Neferkare spent four hours in the house with Sasenet, leaving only ‘after his majesty had done that which he had wanted to do with him’. One fragment specifies that there was no woman, or wife, in Sasenet’s house, and the same incomplete sentence also contains the word ‘love’. The story ends with the spy confirming to himself that ‘the rumours about [Neferkare] going out at night are true’.

Although the tale is censorious of Neferkare’s conduct, this is more because it does not befit a king and god than because it involves same-sex love.

Nyankhkhnum and Khnumhotep

In the twenty-fifth century BCE, Nyankhkhnum and Khnumhotep shared the title of ‘Overseer of the Manicurists’ at the court of Pharaoh Nyuserre Ini. As with the Gentleman of the Bedchamber at the royal court of England, the title was much more prestigious than it sounds, since the pair would have been granted the rare privilege of touching the person of the pharaoh and would have had unrivalled access to him.

When they died, Nyankhkhnum and Khnumhotep were buried together in a mastaba tomb. In this tomb, they are severally depicted embracing and, in one instance, even touching noses, which in Egyptian culture generally signified kissing.

That their wives and children also feature in the tomb has led some to conclude that they were brothers rather than lovers—but having a family of their own need not have precluded them from being lovers, and in the tomb they are represented in the same mode as husband and wife.

So far as the written record goes, Nyankhkhnum and Khnumhotep are, I think, the oldest gays in history.

Like other ancient peoples, the Egyptians valued fertility and dominance, and disapproved of men who played a passive role. But they did not have a rigid convention of sexuality as either heterosexual or homosexual, and, at least in certain periods, and in certain strata, may have tolerated and even celebrated same-sex love.

I was interviewed on ‘the oldest gays in history’ by PRIDE:

Meet the Gays of Ancient Egypt

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We Cannot Touch Without Being Touched

Michelangelo, The Creation of Adam (detail), c. 1508–12.
The space between us. — Michelangelo, The Creation of Adam (detail), c. 1508–12.

By Dr Neel Burton — Psychiatrist, philosopher, and wine writer; Fellow of Green Templeton College, University of Oxford; author of over twenty books.

Essay substantially revised on 26 August 2026.

Convicted murderer Peter Collins died of cancer after 32 years in a Canadian prison. In that time, he became a champion of prison rights, and made a short film called Fly in the Ointment about a prolonged period that he spent in solitary confinement:

Somehow, I felt [my wife’s] fingers on my leg. Shocked and excited, I opened my eyes only to realize it was a fly walking on me. I was greedy for human touch so I closed my eyes and pretended it was her fingers. I tried to stay perfectly still because I didn’t want to frighten the fly off and be left alone.

After that, Collins would bite his cheek and apply a mixture of his own blood and saliva onto his skin, to attract the flies that had become his only source of living touch.

The Need for Touch

Owing to smaller household sizes, greater migration, higher media consumption, longer life expectancies, and an increasing fear of touch, people today are more corporally disconnected than at any other time in human history.

Just like we crave food when we are hungry, or crave sleep when we are tired, so we crave touch when we are lonely—for, at least historically, to be alone is to be exposed and vulnerable.

Notice the ancestral wisdom transmitted through language. When someone is out of our social orbit, we do not say that we are out of sight, but out of touch; and we feel that we ought to reach out and make contact.

More than a mere superfluity or indulgence, human touch is, like food and sleep, a visceral need that is increasingly being met by third parties such as hairdressers, massage therapists, and even professional cuddlers. Maybe this is why the hug has been gaining ground over the simple handshake. Recently, a 21-year-old dinner guest I had never met greeted me with a hug, when, previously, a handshake and bottle of wine would have been more expected.

During the covid lockdowns, it was not so much that people were lonely, since they could still interact at a distance or remotely, but that they could not physically touch one another, not even to shake hands. People who lived on their own may have gone for several months without any human touch at all—leading, among others, to a surge in demand for puppies. A video call, AI chat, or pornography might alleviate loneliness, but no amount of technology could satisfy or abolish the need for touch.

Is Touch Taboo?

As a wine taster, I used to think that smell was the most neglected of our senses. But in our society, touch is even more so, because more taboo.

In the 1960s, Sidney Jourard, a psychologist at the University of Florida, observed the behaviour of couples in coffee shops around the world. He found that, in the space of an hour, couples in Puerto Rico touched each other 180 times. This compared to 110 times in Paris, just twice in Florida, and not at all in London. Jourard also found that French parents and their children touched one another three times more than their American counterparts.

The fear of touch in northern, Anglophone countries is deep-seated. In Victorian England and nineteenth-century America, people took to the language of flowers, or floriography, to fly feelings that could not otherwise have flown. In a book on child-rearing, first published in 1928, the influential American psychologist John B. Watson (made famous by his Little Albert experiment) advised:

Never hug and kiss [your children], never let them sit on your lap. If you must, kiss them once on the forehead when they say goodnight… In a week’s time you will find how easy it is to be perfectly objective with your child and at the same time kindly. You will be utterly ashamed at the mawkish, sentimental way you have been handling it.

Still today, many people flinch if the person returning their change accidentally brushes their hand. Maybe that is why the hug greeting is gaining ground, as a kind of legitimate pretext for properly touching someone—albeit only twice per visit.

Men and Touch

The fear of touch is generally much greater in men. Touch is seen as soft and effeminate, and many men are keen to appear macho or at least masculine. With women, they worry that their touch will be interpreted as a sexual advance. With other men, they fear that it will raise questions about their sexuality, or that it will feel awkward, or that it will be rejected, or that they might enjoy it a little too much. With children, they fear that it might raise suspicions of paedophilia—especially now that many schools operate a strict no-touch policy. I recently visited my old school in Switzerland, a once noble building which, with all its new fences and barriers, now looks like a prison. What a time to be young!

So with the exception of handshakes and the occasional awkward ‘man hug’, men must forego touch, especially warm, intimate touch, simply to reassure everyone, and perhaps also themselves, that they are decent, manly men.

As they take their first steps out of the warm embrace of their parents, boys might try to meet their need for touch through rough interaction with other boys. Probably, that’s what all the punching at aforesaid school was about. As they grow older, they may, often out of sheer desperation, fumble into a relationship, putting all their physical needs into the hands of just one other young and inexperienced person.

This puts a lot of pressure on their partner and relationship, and reinforces the link, and ambiguation, between touch and sex. But the two are not the same. Our libido can be assuaged with our hand in a way that our craving for touch cannot: as every sex worker knows, many people who think they are hungry for sex are in fact hungry for skin. But it is possible to separate the two, even with people to whom we feel sexually attracted.

The Benefits of Touch

To undermine the taboos surrounding it, I’m going to build a positive case for touch.

Touch is the most primitive of all the senses. It is the first sense to develop in utero and is already present from just eight weeks of gestation. With a surface area, in adults, of around two square metres, our skin is the largest organ in our body.

In a controversial experiment of the 1950s, the psychologist Harry Harlow offered maternally deprived infant rhesus macaques a choice between two inanimate surrogate mothers made of wire and wood: one bare, and the other covered in cloth. The monkeys preferred the cloth-covered surrogate to the bare one, even when the bare one carried a bottle of food.

In 1994, the neurobiologist Mary Carlson, one of Harlow’s former students, travelled to Romania with the psychiatrist Felton Earls to study the effects of severe deprivation on the decretei children who, in the years of Ceausescu, had been abandoned to understaffed orphanages. Typical findings included muteness, blank facial expressions, social withdrawal, and bizarre stereotypic movements—behaviours very similar to those observed in socially deprived primates.

More recent studies have reinforced the developmental importance of childhood physical contact, which has been associated with, among others, better performance on cognitive and physical tests, a stronger immune system, and reduced aggression. All other things being equal, premature infants that receive a course of massage therapy gain a lot more weight and spend less time in hospital.

It is possible, quite literally, to ‘hug someone better’. In adults, the benefits of touch include: reducing stress, lifting mood and self-esteem, strengthening interpersonal bonds, improving cognitive function, and boosting immune function. These effects are mediated by hormonal changes, not least a reduction of the stress hormone cortisol and a surge in the ‘love hormone’ oxytocin. Seen in this light, the kiss on the forehead or the hurting part is much more than just a kiss.

The benefits of touch accrue to the giver as much as to the receiver, for it is impossible to touch without also being touched: people who give out ‘free hugs’ in public places are, of course, also having their hugs returned.

Even self-massage reduces stress levels, which helps explain why we are constantly touching ourselves: wringing our hands, rubbing our forehead, brushing our hair and scalp, stroking our neck and upper back, and so on. But as Peter Collins knew only too well, self-touch is not the same as the touch of another.

Compared to children, adults are less dependent on touch, but older adults, who tend to be more alone, more vulnerable, and more self-aware, are likely to need considerably more skin contact than their younger counterparts—which is why, sometimes, my elderly patients won’t let go of my hand. Therapy animals have become common in care homes, and, despite a lifetime of inhibitions, residents can be encouraged to hold hands or rub each other’s shoulders.

The Uses of Touch

Just as we use speech and gestures to communicate, so we use touch. Words can say, ‘I love you’, but touch can also say how and how much, and, at the same time, ‘I respect you’, ‘I need you’, and ‘thank you’. For a long time, scientists thought that touch served merely to emphasize a verbal message. But now it is clear even to them that touch can be the message, and that it can be more nuanced and sophisticated than either speech or gestures, and more economical to boot. What’s more, touch is a two-way street, and a person’s reaction to our touch can tell us much more than their words ever could. Finally, while words can lie, or be taken for granted, primal touch is much more difficult to ignore or discount. Lying to someone while holding their hand is psychopath territory.

No surprise, then, that touch can also serve to convince and motivate, so long, of course, as it is natural and appropriate.

One study found that two-thirds of women agreed to dance with a man who touched them on the arm while making the request; but when the man kept his hand by his side, his success rate fell by as much as half.

Students who, upon returning a book, had their hand brushed by the librarian reported higher levels of satisfaction with the library and life in general, even when the touch went unnoticed.

NBA teams with players who touched one another more, for instance, by high-fiving or hugging, went on to win more games, with the more tactile players performing best.

Pupils who had been touched by a teacher tended to participate more in class activities (shame about those no-touch policies); patrons who had been touched by a waitress tended to tip her more generously; shoppers who had been touched by a store greeter tended to spend more time in the store…

As a psychiatrist, I try to shake hands with all my patients and often use comforting touch in moments of distress—almost invariably to good effect. Touch relaxes the patient, makes her feel that she has been seen and heard, and builds a bond of trust. It makes her, and me, feel more human, and, as a result, I think, we remember each other.

In another essay, I argued that all love consists in reaching out beyond our own being towards those things that lend purpose, weight, and meaning to our lives. Touch is the physical expression of that reaching out, when the boundary between self and other ceases to separate and begins to connect. This explains why touch is taboo, and why we do not want to be touched by just anyone.

In Michelangelo’s Creation of Adam, God and Adam reach out towards each other, their fingers separated by the smallest of gaps. Everything is contained in that space: separateness, yearning, anticipation, connection, and the very spark of life. It is, after all, through the most absolute touch that we all came to be.

Continue Exploring

If this essay spoke to you, you might also look into For Better For Worse, an unconventional exploration of romantic love, marriage, and lasting relationships. For a broader exploration of love, desire, jealousy, and the emotions that shape our lives, see Heaven and Hell: The Psychology of the Emotions.

You may also enjoy

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References

  • Peter Collins, Fly in the Ointment. Retrieved from http://www.solitarywatch.com. Posted on 13 July 2015.
  • Watson JB & Watson RA (1928): Psychological Care of Infant and Child. WW Norton & Company, Inc.
  • Carlson M and Earls F (1999): Psychological and endocrinological sequelae of early social deprivation in institutionalized children in Romania. Chapter in The Integrative Neurobiology of Affiliation, edited by Carol Sue Carter et al.
  • Jillian Anthony for TimeOut New York: 39 percent of your coworkers masturbate at the office, according to our survey. Posted on 21 December 2015.
  • Kraus MW et al (2010): Tactile communication, cooperation, and performance: an ethological study of the NBA. Emotion 10(5):745-9.
  • Cruso AH & Wetzel CG (1984): The Midas touch: The effects of interpersonal touch on restaurant tipping. Personality an Social Psychology Bulletin 10:512-517.
  • Guéguen N (2004): Nonverbal encouragement of participation in a course: the effect of touching. Social Psychology of Education 7:89-98.
  • Stephen R & Zweigenhaft R (1985): The effect on tipping of a waitress touching male and female customers. Journal of Social Psychology 126:141-142.
  • Hornik, J (1992): Tactile stimulation and consumer response. Journal of Consumer Research 19:449-158.

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The Psychology and Philosophy of Pity, Sympathy, Empathy, and Compassion

A doctor or nurse empathizing with a patient
Empathy begins with the simple but profound attempt to see the world through another person’s eyes.

By Dr Neel Burton — Psychiatrist, philosopher, and wine writer; Fellow of Green Templeton College, University of Oxford; author of over twenty books.

Essay substantially revised on 22 July 2026.

Article summary: Empathy and sympathy are often confused, but they are not the same. This article explores the psychology and philosophy of pity, sympathy, empathy, and compassion, explaining how they differ, why they matter, and what they reveal about human nature.

The terms empathy and sympathy are often used interchangeably, but they are not the same. Sympathy is care or concern for another person’s suffering. Empathy goes a step further: it involves understanding and, to some extent, sharing in that person’s emotional experience. Compassion, which involves the desire to relieve suffering, builds upon empathy. These distinctions matter—not only in psychology and medicine, but also in friendship, parenting, education, and everyday life.

Suppose a friend has just lost a parent. If I say, ‘I’m so sorry this has happened to you,’ I’m expressing sympathy. If I can also imagine, however imperfectly, what this loss feels like from within their own world, I begin to empathise. If that empathy inspires me to support them through their grief, it becomes compassion.

Before examining these concepts, it is worth asking where the modern idea of empathy came from.

What Is Empathy?

In 1909, the psychologist Edward Titchener translated the German Einfühlung (‘feeling into’) as empathy. At that time, German philosophers discussed empathy in the context of artistic or aesthetic evaluation, but Titchener proposed that empathy can also help us to recognise one another as minded beings.

Today, empathy might be defined as a person’s ability to understand and, to a greater or lesser extent, share in the emotions of another person, fictional character, or sentient being. Empathy involves two closely related capacities: (1) seeing another person’s situation from their embodied perspective, and (2) resonating with, or sharing in, the emotions that they are feeling.

For me to share another person’s point of view, it is not enough merely to put myself into their position or situation. Instead, I must go further still and imagine myself as them, and, more than that, imagine myself as them in the situation in which they find themself. One cannot empathise with an abstract or detached feeling, only with a particular person. To empathise with them, I need to have some understanding of who they are and what they are doing, or trying to do. I need to have some idea of where they came from and where they want to go. As John Steinbeck famously wrote:

It means very little to know that a million Chinese are starving unless you know one Chinese who is starving.

Pity, Sympathy, Empathy, and Compassion

Empathy is easily confused with pity, sympathy, and compassion, which are all prosocial reactions to the plights of others. Let us look at each one in turn.

Pity is a feeling of discomfort at the distress of one or more sentient beings and usually carries paternalistic overtones. Inherent in the notion of pity is that its object does not deserve its plight, and is incapable of preventing or overturning it. Pity is less engaged than sympathy, empathy, or compassion, often amounting to little more than a conscious acknowledgement of another’s suffering.

Sympathy (Greek, ‘fellow feeling’ or ‘community of feeling’) is care or concern for someone, often someone close or relatable, accompanied by a wish to see them better off. Compared with pity, sympathy implies a greater sense of shared similarities and deeper personal engagement. But unlike empathy, sympathy need not involve a shared perspective or shared emotions, and while the facial expressions of sympathy convey caring and concern, they do not ordinarily convey shared distress.

Sympathy and empathy often lead to one another, but not invariably. For instance, it is possible to sympathise with a hedgehog but not, strictly speaking, to empathise with it, since our access to its subjective experience is necessarily limited. Conversely, psychopaths with little or no sympathy for their victims may nonetheless possess sufficient understanding of another person’s thoughts and motivations to ensnare and manipulate them.

Sympathy might also be distinguished from benevolence, which is a more detached and impersonal attitude—akin to the attitude that I might have towards my students or neighbours, or that a monarch might have towards his or her subjects.

Compassion (Latin, ‘suffering alongside’) is more engaged than empathy and is associated with an active desire to alleviate the suffering of its object. With empathy, I share your emotions; with compassion I not only share your emotions but also elevate them into a universal and transcending experience. Compassion, which builds upon empathy, is one of the principal motivators of altruism.

Researcher Brené Brown has done much to popularise the distinction between sympathy and empathy, arguing that sympathy creates distance while empathy creates connection. Her work has helped bring empathy to a much wider audience. Even so, sympathy need not be distant or dismissive. Properly understood, it is often the beginning of empathy rather than its opposite.

The relationship between pity, sympathy, empathy, and compassion can be summarised as follows:

Can We Ever Know Another Mind?

My friend tearfully confides that, as a child, she was sexually abused by her father. Moved by her plight, I try to comfort her:

‘I know just how you feel.’

To my surprise and alarm, she snaps back:

‘No, you don’t know how I feel! How could you?’

Notice that, in claiming that I cannot know how she feels, my friend is implying that she knows how I feel—or, at least, that however I might be feeling, it is not how she feels. But if she is correct in asserting that I cannot know how she feels, how can she know how I feel, or that how I feel is not how she feels?

A similar paradox is raised in the Zhuangzi (c. third century BCE), one of the two foundational texts of Taoism:

Zhuangzi and Hui Shi were strolling on the bridge above the Hao River. Zhuangzi said, ‘Out swim the minnows so free and easy; this is the happiness of fish.’ Hui Shi said, ‘You are not a fish. Whence do you know the happiness of fish?’ Zhuangzi said, ‘You are not me. Whence do you know I don’t know the happiness of fish?’ Hui Shi said, ‘Granted that I am not you, I don’t know about you. Then granted that you are not a fish, the case for your not knowing the happiness of fish is complete.’ Zhuangzi said, ‘Let’s trace back to the root of the issue. When you said, ‘Whence do you know the fish are happy?’, you asked me already knowing I knew it. I knew it from up above the Hao.’

The exchange captures an enduring philosophical puzzle. We can never inhabit another person’s consciousness. Yet, in everyday life, we routinely understand enough of one another’s inner worlds to communicate, cooperate, comfort, teach, love, and forgive. How is this possible?

Theory of Mind and Mirror Neurons

Empathy rests upon what psychologists call theory of mind: the ability to understand that different people see the world from different perspectives and possess different beliefs, desires, sensitivities, commitments, and forms of understanding.

Some writers distinguish between cognitive empathy and affective empathy. From a philosophical point of view, however, it is preferable to distinguish theory of mind from empathy, rather than to divide empathy into ‘cognitive’ and ‘affective’ forms, thereby obscuring the distinct role of theory of mind. On this view, theory of mind forms the cognitive basis for empathy, while empathy itself also involves emotional resonance.

Theory of mind is innate (‘from up above the Hao’), first appearing at about four years of age. Thereafter, it continues to develop, and can be trained in both reach and accuracy. Crucially, theory of mind enables us to posit the intentions of others and to explain and predict their actions.

Researchers have proposed that mirror neurons contribute to this capacity. These neurons fire both when we carry out a particular action and when we witness that same action in someone else. By internally modelling the actions of others, they may help us infer some of the thoughts, emotions, and desires that gave rise to them. Although empathy and theory of mind involve a broader network of cognitive processes, mirror neurons offer one suggestive illustration of how we may come to understand the experiences of others.

Why Did Empathy Evolve?

From an evolutionary standpoint, empathy has been selected for because it promotes parental care, prosocial behaviour, and non-verbal communication, and, by extension, the survival of the proximal gene pool. By supporting social interaction, collective enterprise, resource sharing, teaching and learning, and storytelling and other art forms, empathy increases the strength, stability, and resilience of a society and its members.

Empathy enables us to anticipate the actions and reactions of others and to respond effectively to their ever-changing needs and expectations. At the same time, to empathise is not to merge. Because empathy remains at one remove, it provides a degree of distance in which to make normative judgements about the person or people being empathised with and to weigh up their best interests.

The Limits of Empathy

That said, empathy can also skew our judgement, leading us to violate moral principles to favour the one or the few over the many. It can be distressing or exhausting. Doctors and nurses who are surrounded by human suffering often constrain or regulate their empathetic faculty, not out of callousness or unconcern but to guard against compassion fatigue and burnout.

Yet in less pressured environments, the exercise of empathy is often rewarding and even revitalising. Doctors and nurses who are able to empathise with their patients—though not so much that it prevents them from resting and recuperating—are more likely to feel fulfilled in their work, to say nothing of the benefit to the patients themselves.

Empathy does not grant direct access to another person’s inner world. Rather, it is our best means of approaching that world while respecting its separateness. It allows us to understand without possessing, to care without collapsing distinctions, and to recognise that every human being lives a life that is uniquely their own.

Continue Exploring

If this essay spoke to you, you might look into Heaven and Hell: The Psychology of the Emotions.

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