Immune responses to viruses like SARS-CoV-2 may affect mental health, and vice versa. Doctors are uncovering exactly how. When the Covid-19 pandemic hit, one of the biggest questions was: Why do some people get so much sicker than others? It’s a question that has forced researchers to confront some deep mysteries of the human body, and come to conclusions that have startled them.
By the fall of 2020, psychiatrists were reporting that among the many groups who were high risk, people with psychiatric disorders, broadly, seemed to be getting more severe forms of Covid-19 at a higher rate. Katlyn Nemani, an NYU neuropsychiatrist, decided to dig deeper, asking: Just how much more at risk, and which conditions?
In January, she and a group of colleagues published a study of 7,348 Covid-19 patients in New York. One finding was stark: People with a schizophrenia spectrum diagnosis faced more than two and a half times the average person’s risk of dying from Covid-19, even after controlling for the many other factors that affect Covid-19 outcomes, such as cardiovascular disease, diabetes, smoking, obesity, and demographic factors — age, sex, and race.
“That was a pretty shocking finding,” Nemani says. The patients all were hospitalized in the same medical system, in the same region, which implies they weren’t receiving radically different treatments, she says. In sum, it all suggests that the risk was closely linked to the mental illness itself and not to some other variable.
Since then, more studies have come out — as well as meta–studies pooling the conclusions of those studies — showing worse Covid-19 outcomes among people with diagnosed mental health disorders including depression, bipolar disorder, and schizophrenia.
Some of this isn’t surprising; a lot of people with mental health issues experience a general increased risk of poor health outcomes. But the pandemic started to shine a brighter light on why, bolstering a hypothesis that’s been accruing evidence in recent years.
It appears that something in the body, something biological associated with these disorders, may be at play. “That suggests there’s a physiologic vulnerability there in these folks,” said Charles Raison, a psychiatrist and researcher at the University of Wisconsin Madison.
It’s not necessarily that people with schizophrenia or mood disorders are more likely to become infected with Covid-19. Rather, once they are infected, “the outcomes are worse,” Nemani says. Depending on the study and the severity of the mental health diagnosis, people with these conditions are, roughly, between 1.5 and 2 times more likely to die of Covid-19 than average, after adjusting for other risk factors (unadjusted risk is even higher).
The level of increased risk, Nemani says, is “on par with what we’re seeing for other well-established risk factors like heart disease and diabetes.” What’s happening? Why would mental illness make someone more vulnerable to a respiratory disease? Psychiatrists who study these mental illnesses say the culprit might lie in a connection between mental health and the immune system.
They’re finding that mental health stressors could leave people more at risk for infection, and, most provocatively, they suspect that responses in the immune system might even contribute to some mental health issues.There’s a lot that’s unknown here. But the pandemic is giving researchers a new window into these questions. And the research “might teach us something about how to protect these people from infection going forward,” Nemani says.
How the immune system can impact mental health
In September, the Centers for Disease Control and Prevention updated its list of underlying conditions that put people at higher risk for severe Covid-19, adding mood disorders — like depression and bipolar disorder — and schizophrenia spectrum diagnoses, a group that accounts for around 34 million Americans. It was a recognition of the growing evidence published by Nemani and colleagues across medicine, and prioritizes this group for vaccines and booster shots.
Roger McIntyre, a psychiatrist at the University of Toronto, is one of the co-authors of one of two systematic review studies that the CDC cited in its change. (Nemani is a co-author on the second.) To him, it’s no surprise that mental illness imparts an infection risk. “A thread that has been woven through many of these disorders is immune or inflammatory dysregulation,” McIntyre says.
That is, problems with the immune system tend to coincide with mental health issues. And problems with the immune system can lead people to have worse outcomes when it comes to SARS-CoV 2, the virus that causes Covid-19.
“Most of the time in medicine, it’s hard to have one singular explanation for anything,” he cautions. That’s especially true here in the discussion of why people with certain mental health issues might be more at risk for severe disease. People living with mental illnesses like schizophrenia, bipolar disorder, and major depression tend to have shorter-than-average life spans and worse health overall….Continue reading
A strong defense against online misinformation may be to administer a digital vaccine: Exposing yourself to common deception methods may help you recognize sensationalized headlines, misleading TikToks, or social media fabrications in the future. In collaboration with Google and its tech unit Jigsaw, a team of psychologists added short videos to YouTube’s ad lineup, educating people about how to spot common misinformation tactics.
In an online campaign, they found these clips were an effective way to get people to identify what’s real and what’s fake news. People who watched the videos were better able to identify misinformation techniques than those who didn’t see the clips, as the team reports in a study published in the journal Science Advancestoday.
“It’s very possible on social media to reduce vulnerability and susceptibility to being manipulated,” says Jon Roozenbeek, a postdoctoral fellow at the University of Cambridge and the lead author of the study. “Maybe not all misinformation, but you can demonstrably improve people’s ability to detect when they’re being manipulated online.”
Misinformation happens when people spread false information, even if it wasn’t the person’s intention to mislead others. Misinformation happens regularly in our daily lives, says Sabrina Romanoff, a clinical psychologist who was not affiliated with the study, and it can be something as small as misremembering something you saw on television and telling someone else the wrong information.
“You can think of it as analogous to the childhood game of ‘telephone,’” explains Romanoff, in which small errors become magnified through repetition. But through the megaphone of social media, wrong or misleading claims can become a harmful way to distort the truth.
Anyone can fall prey to misinformation online, Romanoff says, though people who click on a story consistent with their pre-established beliefs are more susceptible. Being prone to impulsivity and feeling an overload of information could also make you more likely to spread fake news.
The current study focuses on inoculation theory, where people learn about these types of misinformation techniques. Roozenbeek compares this theory to a vaccine: Introducing a weakened virus or virus-like material primes your immune system to recognize and destroy the pathogen in the future. Unlike fact-checking, which takes a more retroactive approach, inoculation theory stops people who are exposed to misinformation from spreading the content in the first place.
“The idea was to inoculate people against these tropes, because if someone can successfully recognize a false dichotomy in content they’ve never seen before, they’re more resilient to any use of that particular manipulation technique on social media,” Roozenbeek says.
Roozenbeek and his team created five 1.5 minute videos covering common tactics used in online misinformation. To avoid any bias towards one group of people, the videos were designed to be nonpolitical, fictitious, and humorous. In the lab, the team invited over 6,000 participants to randomly watch either a video showing how to identify misinformation techniques or a neutral video that acted as a control. Afterward, the participants were shown 10 made-up social media posts that were manipulative or neutral.
Roozenbeek then partnered with Google to expand the study. As part of a public ad campaign on YouTube, nearly 23,000 people watched one of two anti-misinformation videos. One video involved negative and exaggerated emotional language to encourage clicks and belief in fake news (Sample headline: “Baby formula linked to horrific outbreak of news, terrifying disease among helpless infants. Parents despair.”).
The other one relied on presenting two points of views or facts as the only available options (The headline: “Improving salaries for workers means businesses will go bankrupt. The choice is between small businesses and workers. It’s simple mathematics.”).
Within a day of seeing the video ads, one-third of people who watched the videos were randomly given a test question on YouTube where they were asked to identify the type of manipulation technique in a headline or sentence. People who watched the videos were better able to pick out misinformation techniques and misleading content.
“Finding a significant effect was actually quite surprising,” Roozenbeek says. This is because unlike a controlled laboratory setting, people on the internet can get easily distracted by other ads and videos. Additionally, there is no guarantee people actually watched the videos. While the videos were not allowed to be skipped, people could have turned off the sound or moved to another tab. “But despite all that, we still found a large and robust effect.”
Roozenbeek and other psychologists are wrapping up another study that looks into how long it takes for people to forget what they’ve learned from the videos. “It’s not reasonable to expect someone to watch a video once and remember the lesson for all eternity. Human memory doesn’t work that way,” he says.
Ongoing results suggest people might need a ‘booster shot,’ in the form of repeated video reminders. Another project in the works will use Twitter to see how watching these videos affects people’s behaviors, specifically how much they retweet misleading content.
To stay vigilant against misinformation as you scroll through the internet, Romanoff warns about these six common tactics:
Fabricated content: Completely false or made-up stories
Manipulated content: Information is intentionally distorted to fit a person’s agenda
Misleading content: A person deceives others, such as presenting an opinion as a fact
False context of connection: A person strings together facts to fit the narrative they are trying to convey, such as new stories using real images to create a false narrative of what happened
Satire content: A person creates false but comical stories as if they were true
Imposter content: A story is created through the branding and appearance of a legitimate news story, but is false such someone creating a video using someone else’s logo to seem legitimate
Jain, Suchita; Sharma, Vanya; Kaushal, Rishabh (September 2016). “Towards automated real-time detection of misinformation on Twitter”. 2016 International Conference on Advances in Computing, Communications and Informatics (ICACCI). IEEE Conference Publication. pp. 2015–2020. doi:10.1109/ICACCI.2016.7732347. ISBN978-1-5090-2029-4. S2CID17767475.
Plaza, Mateusz; Paladino, Lorenzo (2019). “The use of distributed consensus algorithms to curtail the spread of medical misinformation”. International Journal of Academic Medicine. 5 (2): 93–96. doi:10.4103/IJAM.IJAM_47_19. S2CID201803407.
However, what has happened already is that the legislation has been published, and we now know what the months and years of consultation and industry expertise have brought to bear.
What consumer security protections will the new law introduce?
In effect, the PSTI Bill will provide for three regulatory steps to shore up the security sinkhole as it applies to smart devices:
Default, factory set, weak passwords will no longer be allowed. Instead, all relevant devices will need to come with unique passwords that cannot be set back to a single, universal, factory default.
A contact for researchers, hackers, bug bounty hunters and the like to report security vulnerabilities must be published publicly.
Consumers must be advised of the period for which the device they are buying will receive security updates, and so advised at the point of purchase. If the device cannot receive such updates or patches or won’t get any, that must be declared.
“One of the most commonly used attack vectors is through default passwords, which are easy to guess and preloaded on multiple devices,” George Papamargaritis, a director at Obrela Security Industries, said. “The fact that this new legislation bans default passwords is a huge step forward and it will encourage device manufacturers to consider security before marketing products, otherwise they could face business destroying fines.”
“We’re getting to a place where security by design will be a mandatory requirement and not an afterthought,” Laurie Mercer, a security engineer at HackerOne, said. “This is a significant milestone towards more secure consumer connectable products, and shows the U.K. is leading in creating a safe digital connected society.”
What smart devices will be covered by this new law?
What devices are covered? Well, it’s consumer goods legislation and covers routers, security cameras, games consoles, TVs, smart speakers and assistants, baby monitors, doorbells and, yes, smartphones. It doesn’t cover laptops and desktops, medical devices, cars, or smart meters.
This is a good step forward in that the law will apply to both manufacturers of the devices and those who import and sell them. It will be overseen by an as yet to be appointed regulator and come with fines of £10 million or 4% of global revenues; ongoing breaches can carry a daily £20,000 penalty. Of course, California already has Senate Bill 327 that requires similar password rules and came into effect on 1 January 2020.
Overall, it’s a good thing but has limitations as many smart devices are pretty stupid when it comes to security and have no ability for firmware patching; the law will only require it to be declared there are none. Even for those that can be patched, there’s no requirement for this to be automated. Without such automation, most consumers will not bother and declaring that vulnerability could make the device less secure as threat actors will then find exploits.
The expert opinion: an interview with David Rogers MBE
I’ve been chatting with David Rogers MBE, the CEO at Copper Horse and chair of the GSM Association (GSMA) Fraud and Security Group. Rogers also sits on the executive board of the Internet of Things Security Foundation. With more than 20 years of experience in embedded device security, David volunteered to draft a set of technical requirements, which ended up with the U.K. Code of Practice for Consumer IoT Security.
“The government always said if they didn’t see improvement to the market situation that they were prepared to legislate and regulate,” Rogers says, “and we’re here now where there is demonstrable market failure.” He points to research by his company that found four out of five IoT device companies didn’t have any way for security researchers to contact them, for example. “That is a truly shocking state of affairs and is really the tip of the iceberg,” Rogers continues, “what does it say about the ability of these companies to secure their own products?”
An important first step
Rogers agrees that the new PSTI Bill is a first step that addresses the top three mandates of the code of practice. “This to me hits the major issues, and if we only resolve those parts, we go a long way to protecting consumers,” he says. But it’s far from the end of the story, and the key message to the industry has to be, Rogers insists, “why wait? What is your excuse? Bad stuff is happening, and it’s IoT manufacturers’ responsibility to be part of the solution, not the problem!”Rogers admits it’s a difficult challenge because it should be a constantly moving target if you think about product security. If a vulnerability is discovered, it should be addressed and patched if possible. “That’s why it really comes down to that point about how long vendors are providing security updates for,” he says, “and providing that information clearly to consumers and retailers.”
A baseline of security across all electronic devices?
But what about the covered devices, or rather those that aren’t? “Of course, I want to see a baseline of security across all electronic devices,” Rogers continues, “but there are clearly sectoral differences and already existing regulation, particularly in the automotive and medical sectors. They cover safety aspects that go above and beyond where we are here, and it doesn’t seem to make sense to land grab those spaces.”
Rogers also thinks that an impact is being made even before the legislation gets Royal Assent and becomes law. “Interest in conformance schemes for IoT security in the industry has gone through the roof,” he says, “simply with the threat of legislation by a host of countries.”
To be fair to the responsible companies out there, Rogers points out that they have been pushing for this too. “GSMA’s excellent IoT security work was underway in 2014, already drawing on existing work from the mobile device space,” he says, “what we’ve seen is an alignment across government, industry and also the hacking community. Everyone knows what the problems are and, crucially, how to fix them. So, let’s do it!”
We can’t look back and fix the past
When it comes to the existing volume of smart devices already in the market, Rogers take a pragmatic view. “One thing many of us were conscious about was not adding to the already-existing mountain of IoT e-waste or unnecessarily penalizing people who can’t afford expensive products,” he says. “We can’t look back and fix the past,” Rogers concludes, “but we can look forward, and the lifecycle of technology is still very swift.
More broadly, it is more about bad practices that we’re seeking to eliminate, and we’re seeing a broad swathe of work that is intolerant to poor and unacceptable engineering practices, whether it be around supply chain security or protecting people’s privacy.”
“This is the start of a huge movement towards a safer online society, but it won’t be changing overnight,” Jake Moore, a cybersecurity specialist at ESET, concludes. “These proposals are exactly what is required to help guide people in the right direction after typical security measures by design haven’t been strong enough to help those who desperately need it.”
Scientists are studying the potential consequences of asymptomatic COVID-19 and how many people may suffer long term health problems. Eric Topol was worried when he first saw images of the lungs of people who had been infected with COVID-19 aboard the Diamond Princess, a cruise ship that was quarantined off the coast of Japan in the earliest weeks of the pandemic.
A study of 104 passengers found that 76 of them had COVID but were asymptomatic. Of that group, CT scans showed that 54 percent had lung abnormalities—patchy grey spots known as ground glass opacities that signal fluid build-up in the lungs.
These CT scans were “disturbing,” wrote Topol, founder and director of the Scripps Research Translational Institute, with co-author Daniel Oran in a narrative review of asymptomatic disease published in the Annals of Internal Medicine. “If confirmed, this finding suggests that the absence of symptoms might not necessarily mean the absence of harm.”
But Topol says he hasn’t seen any further studies investigating lung abnormalities in asymptomatic people in the more than a year and a half since the Diamond Princess cases were first documented. “It’s like we just gave up on it.”
He argues that asymptomatic disease hasn’t gotten the attention it should amid the race to treat severe disease and develop vaccines to prevent it. As a result, scientists are still largely in the dark about the potential consequences of asymptomatic infections—or how many people are suffering those consequences.
One stumbling block that scientists worry could keep them from truly understanding the scope of the problem is that it’s incredibly challenging to pinpoint how many people had asymptomatic infections. “There’s probably a pool of people out there who had asymptomatic disease but were never tested so they don’t know they had COVID at that time,” says Ann Parker, assistant professor of medicine at Johns Hopkins and a specialist in post-acute COVID-19 care.
Still, there is some evidence that asymptomatic disease can cause serious harm among some people—including blood clots, heart damage, a mysterious inflammatory disorder, and long COVID, the syndrome marked by a range of symptoms from breathing difficulties to brain fog that linger after an infection. Here’s a look at what scientists know so far about the effects of asymptomatic COVID-19 and what they’re still trying to figure out.
Heart inflammation and blood clots
Just as imaging scans have revealed damage to the lungs of asymptomatic individuals, chest scans have also shown abnormalities in the hearts and blood of people with asymptomatic infections—including blood clots and inflammation.
Thrombosis Journal and other publications have described severalcases of blood clots in the kidneys, lungs, and brains of people who hadn’t had any symptoms. When these gel-like clumps get stuck in a vein, they prevent an organ from getting the blood it needs to function—which can lead to seizures, strokes, heart attacks, and death.
There have been relatively few of these case reports—and it’s unclear whether some patients might have had other underlying issues that could have caused a clot. But the Washington State researchers who reported on one case of renal blood clot write that it “suggests that unexplained thrombus in otherwise asymptomatic patients can be a direct result of COVID-19 infection, and serves as a call to action for emergency department clinicians to treat unexplained thrombotic events as evidence of COVID-19.”
Meanwhile, studies also suggest that asymptomatic infections could be causing harm to the heart. In May, cardiac MRI scans of 1,600 college athletes who had tested positive for COVID-19 revealed evidence of myocarditis, or inflammation of the heart muscle, in 37 people—28 of whom hadn’t had any symptoms, says Saurabh Rajpal, a cardiovascular disease specialist at the Ohio State University and lead author on the study.
Myocarditis can cause symptoms such as chest pain, palpitations, and fainting—but sometimes it doesn’t produce any symptoms at all. Rajpal says that while the athletes in the study were asymptomatic, “the changes on the MRI were similar to or almost the same as those who had clinical or symptomatic myocarditis.”
Although these chest scans are worrisome, Rajpal says that scientists don’t know yet what they ultimately mean for the health of asymptomatic patients. It’s possible that myocarditis might resolve over time—perhaps even before patients know they had it—or it could develop into a more serious long-term health issue. Long-term studies are necessary to suss that out.
The athletes’ heart inflammation might also be completely unrelated to their COVID-19 infection. Scientists would need to compare the scans with a set taken just before an individual was infected with COVID-19. So that, Rajpal says, will still need to be teased out.
Additionally, people with asymptomatic infections are at risk of becoming so-called COVID-19 long-haulers, a syndrome whose definition has been hard to pin down as it can include any combination of diverse and often overlapping symptoms such as pain, breathing difficulties, fatigue, brain fog, dizziness, sleep disturbance, and hypertension.
“There’s a myth out there that it only occurs with severe COVID, and obviously it occurs far more frequently in mild COVID,” Topol says.
Linda Geng, co-director of Stanford Health Care’s Post-Acute COVID-19 Syndrome Clinic in the U.S., agrees. “There is actually not a great predictive factor about the severity of your illness in the acute phase and whether you will get long COVID,” she says. “And long COVID can be quite debilitating, and we don’t know the endpoint for those who are suffering from it.”
Melissa Pinto, a co-author of the latter study and associate professor in the Sue & Bill Gross School of Nursing at University of California Irvine, says the researchers examined healthcare records of people who tested positive for COVID-19 but hadn’t reported symptoms at the time of infection—only to come in later with symptoms associated with long COVID-19. To ensure they were identifying long-haulers, the researchers screened out anyone with a preexisting illness that could explain their later symptoms.
“This is not from another chronic disease,” she says. “These are new symptoms.”
But it’s unclear how accurate any of these estimates might be. Pinto says that some long-haulers are wary of seeking care after having their symptoms dismissed by physicians who weren’t familiar with long COVID-19 syndrome. That’s why she believes that the rates of asymptomatic infections among long-haulers are an underestimate.
Anecdotally, Geng and Parker both say that while they’ve seen plenty of patients with mild symptoms that initially went unrecognised, they’ve had little experience treating patients who were truly asymptomatic.
“We saw many patients who didn’t think they had symptoms except in retrospect because they found out that they had tested positive,” Geng says. “Because they’ve had these long unexplained symptoms of what’s presumed to be long COVID, they think, well, maybe that wasn’t allergies.”
But she thinks that most people who were truly asymptomatic are unlikely to have gotten tested and therefore wouldn’t think to consult a specialist in post-COVID-19 care if they started experiencing unexplained symptoms like brain fog and dizziness.
Parker says that ultimately physicians are still trying to understand the broad symptoms seen in long-haulers. “When a patient comes to see us, we do a very thorough evaluation because we still don’t know exactly what to attribute to COVID and what might be a pre-existing underlying syndrome,” she says. “The last thing I want to have happen is to say to a patient, yes, this is because you had COVID and miss something else that we could have addressed.”
“Six weeks down the line these people, especially children, will develop inflammation throughout their body,” Rajpal says.
The condition—now called multisystem inflammatory syndrome in children, or MIS-C—typically causes fever, rash, abdominal pain, vomiting, and diarrhoea. It can have harmful effects on multiple organs, from hearts that have trouble pumping blood to lungs that are scarred. It is typically seen among children under 14, although adults have also been diagnosed with this syndrome.
MIS-C is incredibly rare. Kanwal Farooqi, assistant professor of paediatrics at Columbia University Vagelos College of Physicians and Surgeons, says that less than one percent of paediatric COVID-19 patients present with some type of critical disease—and MIS-C is just one of them. However, asymptomatic infections do play a role in the syndrome: A recent study of 1,075 children who had been diagnosed with MIS-C showed that three-quarters had originally been asymptomatic.
But there’s reason to hope that this syndrome might not cause long-term effects in patients, symptomatic or otherwise. Farooqi was the lead author on a recent study of 45 paediatric patients showing that their heart problems—which ranged from leaky valves to enlarged coronary arteries—mostly resolved within six months.
“That is reassuring,” Farooqi says. Still, she recommends administering follow-up MRI scans even to patients whose heart troubles seem to have resolved to make sure there’s no longer-term damage, such as scarring. She also says that it’s “really reasonable” to be cautious about asymptomatic infections and encourages parents to have their child evaluated if they have any persistent symptoms even if the original infection was mild or asymptomatic.
“What’s important is that we can’t right now say that there are no consequences,” she says.
Calls for more studies
Scientists caution that there’s still so much we don’t know about the potential harm of asymptomatic infections. Many have called for more rigorous studies to get to the bottom of the long-term effects of asymptomatic disease, why those effects occur, and how to treat them.
Rajpal points out that his study was only possible because the Big 10 athletic conference requires athletes to get tested every few days. Regular testing is key for uncovering asymptomatic cases, he says, which means that most data on asymptomatic disease is likely to come from healthcare workers, athletes, and other workplaces with strict testing protocols.
It’s also unclear what could be causing these lingering side effects. Scientists hypothesise that it could be an inflammatory response of the body’s immune system that persists long after an infection has been cleared. Others suggest there could be remnants of the virus lingering in the body that continue to trigger an immune reaction months after the COVID-19 infection peaked.
“This is all unchartered, unproven, just a lot of theories,” Topol says.
Yet even if asymptomatic infections aren’t linked in high rates to death and hospitalisation, Pinto and others say it’s important to keep in mind that long COVID-19 symptoms can be debilitating to a patient’s quality of life.
“Even if people survive, we don’t want them to be having a lifelong chronic disease,” Pinto says. “We don’t know what this does to the body, so it’s not something that I would want to take my chances with.”
The bottom line
With so much we don’t know about the long-term effects of asymptomatic COVID-19, scientists insist it’s better to err on the side of caution.
“The full impact can take years to show,” Rajpal says. Although the chances are slim that an individual with asymptomatic infection will have a really bad outcome, he points out that the continuing high rate of infections means that more people are going to suffer.
“Even rare things can affect a lot of people,” he says. “From a public health perspective if you can reduce the number of people that get this infection, you will reduce the number of people who get severe outcomes.”
Parker agrees, adding that it’s particularly important to prevent infection now as the more transmissible Delta variant drives surges in cases and hospitalisations across the country.
“We have had an amazing breakthrough in terms of the rapid development of effective and safe vaccines,” she says. Although Parker and other scientists remain uncertain of the health effects of asymptomatic COVID-19, “we do know that vaccinations are safe and effective and available.”
“Empathy is one of the values we’ve had from our founding.” That’s what Chelsea MacDonald, SVP of people and operations at Ada, a tech startup that builds customer-service platforms, told me when we first got on the phone for this story in June. When the company was in its early stages, with about 50 people, empathy was “a bit more ad hoc,” because you could bump into colleagues at lunch. But that was pre-pandemic, and before a hiring surge.
Now, MacDonald says, empathy is built on communication (as many as five times a week, she communicates in some way to the entire company about empathy), through tools (specifically, one that tracks whom people communicate with most and who gets left out), through intimacy (cultivated through special-interest groups) and through transparency (senior leaders share notes after every meeting). At various points in our discussion, MacDonald describes empathy as “more than just, ‘Hey, care about other people’” and “making space for other people to make mistakes.”
She was one of a dozen executives whose communications directors reached out when I tweeted about the office trend of “empathy.” Adriana Bokel Herde, the chief people officer at the software company Pegasystems, told me about the three-hour virtual empathy-training session the company had created for managers—and how nearly 90% had joined voluntarily.
Kieran Snyder, the CEO of Textio, a predictive-writing company, said the biggest surprise about empathy in the workplace is that it and accountability are “flip sides of the same coin.” “We had an engineer give some feedback that was really striking,” she told me. “She said that the most empathetic thing her manager could do for her was be really clear about expectations. Let me be an adult and handle my deliverables so that I know what to do.”
All of these leaders see empathy as a path forward after 17 months of societal and professional tumult. And employees do feel that it’s missing from the workplace: according to the 2021 State of Workplace Empathy Study, administered by software company Businessolver, only 1 in 4 employees believed empathy in their organizations was “sufficient.”
Companies know they must start thinking seriously about addressing their empathy deficit or risk losing workers to companies that are. Still, I’ve also heard from workers who think it’s all nonsense: the latest in a long string of corporate attempts to distract from toxic or exploitative company culture, yet another scenario in which employers implore workers to be honest and vulnerable about their needs, then implicitly or explicitly punish them for it.
If you’ve read all this and are still confused about what workplace empathy actually is, you’re not alone. Outside the office, developing empathy means trying to understand and share the feelings or experiences of someone else. Empathy is different from sympathy, which is more one-directional: you feel sad for what someone else is going through, but you have little understanding of what it feels like. Because empathy is predicated on experience, it’s difficult, if not impossible, to cultivate. At best, it’s expanded sympathy; at worst, it’s trying to force connections between wildly different lived experiences (see especially: white people attempting to empathize with the experience of systemic racism).
Applied in a corporate setting, the very idea of empathy begins to fall apart. Is it bringing their whole selves, to use an HR buzzword, to work? Is it cultivating niceness? Is it making space for sympathy and allowing people to air grievances, or is it leadership modeling vulnerability? Over the course of reporting this story, I talked to more than a dozen people from the C-suites of midsize and large companies that had decided to make empathy central to their corporate messaging or strategy.
Some plans were more fleshed out and self-interrogating. Some thought an empathy training available to three time zones was enough. Others understood empathy as small gestures, like looking at a co-worker’s calendar, seeing they’ve been in meetings all day, and giving them a 10-minute pause to get water before you meet with them.
But where did this current push for workplace empathy begin? According to Johnny C. Taylor Jr., president and chief executive officer of the Society for Human Resource Management (SHRM) and author of the upcoming book Reset: A Leader’s Guide to Work in an Age of Upheaval, it sort of started with, well, him. In the fall of 2020, he’d been hearing a similar refrain from businesses: everyone was tired. Tired of the pandemic; of stalled diversity, equity and inclusion (DE&I) efforts; of their bosses and their employees.
When he looked at the 2020 State of Workplace Empathy Study, then in its fourth year, the reasons for that exhaustion became clear. People were tired because they were working all the time, and trying to sort out caregiving responsibilities, and dealing with oscillating threat levels from COVID-19. But they were also tired, he believed, because there was a generalized empathy deficit.
That “empathy deficit” became the cornerstone of Taylor’s State of Society address in November 2020. “Much of the resurgence of DE&I programming in the wake of the George Floyd killing was supposed to encourage open conversation and mutual understanding,” he said. “But it often bypassed empathy. Well-meaning programs devolve into grievance sessions … rather than listening and trying to relate.”
SHRM is an incredibly influential organization, with more than 300,000 members in 165 countries. So while it’s not as if empathy efforts were nonexistent before, Taylor’s speech encouraged them. Even if members weren’t there to listen to his words, his message—and the data from the study—began to filter into HR departments, leaving a trail of optional learning modules and Zoom trainings in its wake.
The backlash started shortly thereafter. Taylor acknowledges as much. “I see these companies jumping on it,” he told me. “But it’s not an initiative. It’s not a buzzword. It’s a cultural principle. If you make this promise, as a company, if you put this word out there, your employees are going to hold you to it.” He adds that empathy should go both ways: “There’s an expectation that employees can mess up; employers should be able to mess up too.”
In the case of employees, many are frustrated by perceived hypocrisy. (All employees who spoke critically about their employers for this story requested anonymity out of concern for their jobs.) One woman told me her company, Viacom, has been doing a lot of messaging about empathy, particularly when it comes to mental health. At the same time, it has switched to a health plan that’s more restrictive when it comes to accessing mental-health professionals and care.
(Viacom attributes the change to a shift in policy on the part of their insurance provider and says it has worked to remedy it.) Other employees report repeated invocations of empathy from upper management in staff meetings, but little training on how to implement it with those they supervise. As one female employee at a performing-arts nonprofit told me, “In a one-on-one meeting with my boss where I was openly struggling and tried to discuss it, I was told that mental health is important, but improving my job performance was more important.”
A customer-service representative for a fintech company said empathy had been centered as a “core value” of the organization: something they were meant to practice with one another but also with customers. To quantify worker empathy, the company sends out customer-satisfaction surveys (CSATs) after each interaction. It found that dips in CSAT scores, which were measured by an automated system, reliably happened when a customer had a long hold time, which had little to do with whether the representative modeled empathy. Yet employees were still promoted based on these scores.
The central tension emerges again and again: “There’s an irony, because there’s the equity that you want to present to employees—while also giving special consideration and solutions for specific situations,” Joyce Kim, the chief marketing officer of Genesys, which provides customer service and call-center tech for businesses, told me. “Those two are often incongruent.”
Put another way, it’s hard, at least from a leadership perspective, to cultivate equal treatment for everyone while also making exceptions for everyone. If you allow an employee to work different hours, have different expectations of accessibility or have more leeway because of an illness, how is that fair to those who don’t need those things? How, in other words, do you accommodate difference while still maximizing profits?
What companies are trying to do, at heart, is train employees to treat one another not like productivity robots, but like people: people with kids, people with responsibilities, people shouldering the weight of systemic discrimination. But that runs counter to the main goal of most companies, which is to create and distribute a product—whether that’s a service, an object or a design—as efficiently as possible. They might dress up that goal in less capitalistic language, but the end point remains the same: profits, the more the better, with as little friction as possible.
Within this framework, the frictionless employee is the ideal employee. But a lack of friction is a privilege. It means looking and acting and behaving like people in power, which, at least in American society, means being white, male and cisgender; with few or no caregiving responsibilities; no physical or mental disabilities; no strong accent or awkward social tics or physical reminders, like “bad teeth,” of growing up poor; and no needs for accommodations—religious, dietary or otherwise. For decades, offices were filled with people who fit this bill, or who were able to hide or groom away the parts of themselves that did not.
The women and people of color who were admitted into these spaces did so with an unspoken caveat that they would make themselves amenable to the status quo. They didn’t bring their “whole selves” to work. Not even close. They brought only the parts that would blend in with the rest of the workforce. If you were sexually harassed, you didn’t make a fuss about it. If someone used a racial slur, same deal. If there were Christmas celebrations that made the one Jewish employee feel weird, that person was expected not to make waves. Bad behavior wasn’t friction, per se. But a worker whose identity already created a form of friction complaining about it? That sure was.
Historians of labor have pointed out that this posture was particularly prevalent in office settings, where salaried workers were often saturated in narratives of a great, unified purpose. If employees took care of the company, and flattened themselves into as close to the image of the ideal worker as possible, the company would take care of them, in compensation and eventual pension. Which is one of many reasons that white collar office workers have been resistant to unionization efforts, which felt, as sociologist C. Wright Mills has noted, like a crass, almost hysterical form of office friction.
Machinists and longshoremen were laborers and had no recourse other than the big stick of the union to advocate for themselves. Office workers could solve conflict man to man, boss to employee, like, well, the white gentlemen that they were—or at the very least pretended to be.
This mindset began to erode over the course of the 1970s, ’80s and ’90s—first, when massive waves of layoffs and benefit cuts destabilized the myth of the benevolent parent company. But the white maleness of the culture also began to (very gradually) shift in the wake of legal protections against discrimination related to gender, age, disability and, only recently, sexual orientation.
White male workers remained dominant in most industries, particularly in leadership roles. But they began to lose their unquestioned monopoly on the norms of the workplace. Some changes were embraced; others, especially around sexual harassment and racial discrimination, were changed via legal force.
The overarching goal of HR departments in the past, going back to the field’s origins in “scientific management” of factory assembly lines, was keeping employees healthy enough to work efficiently. After 1964, their task expanded to include compliance with legal protections, in addition to the continued work of keeping employees healthy and “happy” enough to do their work well. “Unhappiness,” after all, is expensive—according to a Gallup estimate from 2013, dissatisfaction costs U.S. companies $450 million to $550 million a year in lost productivity. Unhappiness, in other words, is friction.
But as the workplace continues to diversify, how do you maintain the worker “happiness” of a bunch of different sorts of people, from different backgrounds, with different cultural contexts? There are some obvious fixes: continuing to erode the power of monoculture (in which one, limited way of being/working becomes the way of being/working to which all other employees must aspire); recruiting and retaining managers who actually know how to manage; creating a culture that encourages taking time off. But usually, the proposed solution takes the form of the HR initiative.
Take the 2010s push for “wellness,” which manifested in the form of mental-health seminars, gym memberships and free Fitbits. You can view these initiatives as part of a desire to reduce health-insurance premiums. But you can also see them as a means of confronting the reality of a workforce that, in the wake of the Great Recession, was anxious about their finances and careers, particularly as more and more workers were replaced by subcontractors, who enjoyed even fewer protections and privileges.
Or consider the push for DE&I programs in the wake of Black Lives Matter protests in 2015. These initiatives aim to acknowledge a perceived source of friction—the fact that a company is very white, its leadership remains “snowcapped,” or the workplace is quietly or aggressively hostile to Black and brown employees—while also providing a proposed solution. The corporate DE&I initiative communicates that we see this problem, we’re working to solve it, so you can talk less about it.
Wellness and DE&I initiatives are frequently unsatisfying and demoralizing, particularly for those workers they are ostensibly designed to benefit. They often lean heavily on the labor of those with the least power within an organization. And they approach systemic problems with solutions designed to disrupt people’s lives as little as possible. (A three-hour webinar will not create a culture of inclusion.) But the superficiality is part of the point.
Contain the friction, but do so by creating as little additional friction as possible, because a series of eruptions is easier to contain than a truly paradigm-shifting one that threatens the status quo and, by extension, the company’s public profile and profitability. According to a 2021 SHRM report, in the five years since DE&I initiatives swept the corporate world, 42% of Black employees, 26% of Asian employees and 21% of Hispanic employees reported experiencing unfair treatment based on their race or ethnicity.
The ramifications of racial inequity (lost productivity, turnover and absenteeism) over the past five years may have cost the U.S. up to $172 billion. But instead of acknowledging what it is about the company culture that makes it difficult to retain diverse hires, or what might have to change to recoup those losses, companies blame individual workers who were a “bad fit.” DE&I initiatives don’t fail because there’s a “diversity pipeline problem.” It’s because those in power aren’t willing to relinquish any of it.
A similar contradiction applies to the rise of “corporate empathy.” At its heart, it’s a set of policies, initiatives and messaging developed to respond to the “friction” of a workforce unsettled by the pandemic, a continuing racial reckoning and sustained political anxiety, capped off by an uprising, on a workday, days after most of the workforce had returned from winter breaks. Many empathy initiatives are well-intentioned. But coming from an employer, they still, ultimately, say: We see you are breaking in two, we are too, but how can we collectively still work as if we’re not?
Therein lies the empathy trap. So long as organizations view employees with different needs as sources of friction, and solutions to those needs as examples of unfairness, they will continue to promote and retain employees with the capacity to make their personalities, needs and identities as frictionless as possible. They will encourage “bringing the whole self to work,” but only on a good day. They will fetishize “sharing personal stories,” but only when the ramifications don’t interfere with the product or create interpersonal conflict. This is what happens when you conceive of empathy as allowances: Those who would benefit from it become less desirable workers. Their friction is centered, and their value decreases.
Our society is built around the goals of capitalism—and capitalism, and the ethos of individualism that thrives alongside it, is inherently in conflict with empathy. The qualities that make our bodies, selves and minds most amenable to those goals are prized above all else, and it is HR’s primary task to further cultivate those qualities, whether through “enrichment” or “wellness,” even when the most significant obstacle to either is the workplace itself.
Why do the declarations of empathy feel so hollow? Because growth and profit do not reward it. Companies, HR professionals, managers, even the best trained can do only so much. A large portion of the dissatisfaction that employees feel is the result of actively toxic company policy, thoughtless management and executives clinging to the status quo. But a lot of it, too, is anger at systems that extend beyond the office:
The fraying social safety nets, the decaying social bonds, the frameworks set up to devalue women’s work, the stubborn endurance of racism, the lack of protections or fair pay for the workers whose labor we ostensibly value most. We don’t know how to make people care about other people. No wonder workplace initiatives can feel so laughably incomplete. How do you cultivate a healthy workplace culture when it’s rooted in poisoned soil? “It’s not just a workplace empathy deficit,” Taylor told me. “It’s an American cultural deficit.”