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Empathy and mental health

Feature Articles

Cite as: September 2015 89 (9) LIJ, p.38

Preliminary results of a recent Monash University study indicate a possible link between low empathy levels and negative mental health. 

By Adiva Sifris, Brett Williams and Vicky Kordouli

Snapshot
This article examines the results of a recent study measuring empathy levels in law students at Monash University.
  • Results suggest that law students have lower self-reported empathy levels than health science students at the same institution.
  • Further research is required, but these findings may hold one of the keys to increased positive wellbeing among the legal profession.
  • The prevalence of mental health issues in the legal profession and among law students is a growing concern. Over the past decade studies have been published showing that law students and members of the legal profession have higher rates of mental health issues than the general population.1 A 2009 study by the Brain and Mind Research Institute found that 35.4 per cent of law students, 31 per cent of solicitors and 16.7 per cent of barristers were suffering psychological distress. These figures were significantly higher than the general population.2 This study raised the profile of mental health issues within the profession and saw a burgeoning of research into the mental health of the legal community including law students.3 While some dissension exists as to the methodologies used in many of these studies and the extent of the problem,there is consensus that “many law students and lawyers experience worrying symptoms of psychological distress”.4

    The main aim of the Monash University study was to measure empathy levels in law students and compare them with empathy levels in health science students. It also sought to determine whether empathy levels of students differed according to gender, age, year levels and courses undertaken (within the law degree).

    It has been suggested that there may be a link between emotional intelligence and positive mental wellbeing.5 Social skills, of which empathy is an integral part, has been identified as one of the four factors which comprise the matrix of emotional intelligence.6 The combined evidence of distress levels among law students and the possible link between distress, mental health and low empathy levels provided the impetus for the Monash study. This research lays the basis for further study into the potential correlation between empathy levels and the high level of mental health issues among law students and members of the legal profession.

    Background

    In 2010 a study by the University of Adelaide which assessed distress levels in tertiary students found that law students as a group were more likely than any other group of students assessed to be classified as psychologically distressed (see Table 1).7

    Psychologically distressed
    Course
    %
    Law students 58
    Mechanical engineering students 52
    Medical students 44
    Psychology students 40

    Also of relevance to the Monash study was the earlier 2012 Health Care Study, which aimed to promote empathetic behaviour in health science students. 8 It used a repeated measures design and included 293 participants from 12 health care professions. An educators’ toolkit was developed to evaluate, compare and contrast the empathy levels of students from different health care professions and to determine whether students could successfully be taught to feel empathy.

    Methodology

    The Monash study was conducted during the second and third week of the second semester in 2014, at a time that did not interrupt the participants’ learning. The participants constituted a convenience sample of undergraduates from all year levels enrolled in the Faculty of Law. Students surveyed were enrolled either in Torts B, a course usually completed at the beginning of the degree, or in Lawyers Ethics and Society, a course usually completed towards the end of the law degree. Participation was voluntary and anonymous. Participants were provided with an explanatory statement and consent was implied through completion of the survey. Ethical approval was granted by the Monash University Human Research Ethics Committee.

    For the purpose of the study, empathy was described as “the cognitive ability of the legal professional to understand clients’ experiences and perspectives, which establishes effective communication for the best possible legal advice”.9 The Jefferson Scale of Physician Empathy (adapted for law students), comprising a self-reporting questionnaire with 20 items, was used to measure empathy. For example, a question which was framed, “I believe that empathy is an important factor in patient treatment” was reframed,“I believe that empathy is an important factor in resolving a client’s legal issues”. The items were scored on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). Ten items were reverse scored prior to analyses.. A higher mean score indicated higher self-reported empathy levels.

    Results

    The questionnaire was completed by 275 Monash students undertaking a Law degree or a combination of Law and one of Arts, Biomedical Science, Commerce, Aerospace, Music, Science, Medicine or Business. Of these, 66.9 per cent were females and 33.1 per cent were males. The majority of participants, 48.7 per cent, were undertaking Arts/Law followed by 29.5 per cent undertaking Commerce/Law. Participants were aged between 18 and 25 with 32 per cent of participants aged 20, 21.5 per cent aged 19 and 16 per cent aged 21. The majority of the participants, 44.7 per cent, were in the second year of their degrees, followed by 25.5 per cent in the third year. See Table 2 for the full distribution of relevant demographic data and empathy mean scores.

    The total mean empathy score for the 275 participants was 96.14 with the highest possible score being 140 and the lowest 20. The standard deviation in the total mean empathy score was 11.63. There were statistically significant differences between genders and different law courses, while no differences were noted between age groups and year levels.

    Discussion

    The most significant outcome was that the total mean empathy score was 96.14. The same questionnaire administered to health science students at Monash University yielded a total mean empathy score of 113–118 (depending on the particular health science course in which the students were enrolled). This suggests that law students may have lower self-reported empathy levels than health science students at the same institution.

    The results of the Monash study accord with, and further support, findings of an earlier UK study that compared the empathy levels of pharmacy and nursing (health science courses) and law students in the first and third years of their courses.10 The results of the UK study show that law students have lower empathy levels than pharmacy and nursing students. However, a great deal more research is required to determine conclusively whether there is a correlation between low empathy levels and high levels of psychological distress.

    Further research

    In order to determine whether empathy levels fluctuate according to age, year of study and course enrolled, and whether the law school has a corrosive effect on empathy levels, a longitudinal study needs to be established whereby a cross-section of students enrolled in the various law degree combinations is surveyed throughout their degree and at different times during the semester: at the commencement, in the middle and at the very stressful period immediately preceding examinations. Also, the comparison with health science students must be expanded to include other disciplines and members of the general population. This will allow for a comparison to be drawn between the empathy levels of law students and those of the general population. Should it be found that there is a likelihood of a correlation between the low empathy levels and high mental health issues in law students, the law schools will be well placed to consider introducing programs into the curriculum which enhance empathy levels.

    Can empathy be taught?

    Since empathy is a learned behaviour, students in the medicine and allied health fields are often provided with direct and indirect instruction on empathy which suggests that empathy can be taught.11 Gerdy suggests that law students might be taught empathy through exposure to and analysis of theatre and literature that examine the emotional dimensions of legal disputes, or from the presentation of cases in a narrative form.12 Field and Duffy developed and implemented a dispute resolution course for law students at the Queensland University of Technology, using roleplays to illuminate for students the “emotion, psychology, perceptual error and judgmental bias that is inherent in human conflict”.13 However, the idea of teaching empathy to law students is still in its experimental stages.

    Conclusion

    While it is generally recognised that empathy is an important skill for lawyers and a necessary component of good communication, the Monash study seeks to expose the potential value of increasing empathy in law students not from the perspective of effective lawyering, but from the perspective of improving the mental health of law students and legal practitioners. While acknowledging that further research is required, preliminary results may indicate that law students have low empathy levels. Given research suggests that empathy can be taught, these findings may hold one of the keys to increased positive wellbeing among the legal community.

    Dr Adiva Sifris is a senior lecturer in the Faculty of Law, Monash University. Associate Professor Brett Williams is head of the Department of Community Emergency Health and Paramedic Practice at Monash University. Vicky Kordouli is a clinical experience supervisor at Monash University and a mentor and instructor at Leo Cussen Centre for Law. 1. Norm Kelk et al, Courting the Blues: Attitudes towards depression in Australian law students and lawyers, (Report, Brain and Mind Research Institute, University of Sydney, January 2009), pp10-13. 2. Note 1 above, p12. 3. Wendy Larcombe et al, “Does an Improved Experience of Law School Protect Students against Depression, Anxiety and Stress? An Empirical Study of Wellbeing and the Law School Experience of LLB and JD Students” (2013) 35, Sydney Law Review 407 at p407. 4. Christine Parker, “The Moral Panic over Psychological Wellbeing in the Legal Profession” (2014) 37(3) UNSW Law Journal 1103, at p1123. 5. Peter Salovey and John D Mayer, “Emotional Intelligence” (1989-1990) 9(3), Imagination, Cognition and Personality 185. 6. Allan Pau et al, “Emotional Intelligence and Stress Coping in Dental Undergraduates — a qualitative study” (2004) 197(4) British Dental Journal 205 at p206. 7. Catherine Leahy et al, “Distress Levels and Self-reported Treatment Rates for Medicine, Law, Psychology and Mechanical Engineering Tertiary Students: Cross-sectional study” (2010) 44, Australian and New Zealand Journal of Psychiatry 608 at p611. 8. See http://med.monash.edu.au/med/cehpp/altc-empathy/docs/empathy-toolkit.pdf. 9. Definition adapted from Hojat et al, “Physician Empathy: Definition, components, measurement, and relationship to gender and specialty” (2002) CRMEHC Faculty Papers, Paper 4, at p1564. 10. Sarah Wilson et al, “Empathy Levels in First- and Third-Year Students in Health and Non-Health Disciplines” (2012) 76(2), American Journal of Pharmaceutical Education, p1. 11. Sandra Bertman and Melvin J Krant, “To Know of Suffering and the Teaching of Empathy” (1977) 11, Social Science & Medicine, 639. 12. Kristin Gerdy, “Clients, Empathy, and Compassion: Introducing first-year students to the ‘heart’ of lawyering” (2008) 87(1) Nebraska Law Review 1, at pp54-55. 13. Rachael Field and James Duffy, “Better to Light a Single Candle than to Curse the Darkness: Promoting Law Student Well-Being Through a First Year Law Subject” (2012) 12(1) QUT Law & Justice Journal 133, at pp154-155.

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