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The Complexity Matters blog features the Thursday Complexity Post as well as other complexity inspired news items.


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Learn Nuances of Leadership: Read Fiction

Posted By Prucia Buscell, Tuesday, February 2, 2016

Read Business Scholarship and Theory Too

The reading lists of Bill Gates and Warren Buffett make fascinating reading. Both are avid readers. According to a Fast Company story by Stephanie Vozza, Buffett spends 80 percent of his day reading, and Gates reads for an hour a night before going to bed.

Gates 2015 favorites, which he shares on his blog, include The Road to Character by David Brooks, and Mindset: The New Psychology of Success by Carol S. Dweck. He introduces his selections by explaining that he enjoys books about how things work. Buffett shares his favorites, many of which deal with multiple aspects of economics and investing, in his annual letter to shareholders of Berkshire Hathaway.

Ajit Singh, partner at the venture capital firm Artiman Ventures and consulting professor in the School of Medicine at Stanford University, told Fast Company reading 50 to 60 books a year helps him be a better communicator. "Leadership requires storytelling; the story can be the vision of the company, or an acquisition plan, or an impending layoff," he says. "Telling a compelling story and listening with empathy have contributed much to my skills as a leader."

Mark Zuckerberg, whose goal last year was to read a book every two weeks, started a Year of Books page on Facebook that works as a book club where he and followers discuss books and invite authors to participate by webcasts.  

Some scholars urge business leaders keep to fiction in their reading repertoire.  Joseph Badaracco, the John Shad Professor of Business Ethics at Harvard Business School, says the multidimensional nature of great works of literature can open people’s minds to perspectives and experiences that differ from their own, and enhance their own self understanding. “Literature givers students a much more realistic view of what’s involved in leading” than many business books on leadership, Badaracco said in a Harvard Gazette article. “Literature lets you see leaders and others from the inside. You share the sense of what they are thinking and feeling.  In real life, you’re usually at some distance sand things are prepared, polished. With literature you can see the whole messy collection of things that happen inside our heads.” He says literature presents historical, ethical and emotional subtleties that aren’t always visible in the real world.

Dr. Badaracco teaches a Harvard course on literature and leadership, and in his book, Questions of Character: Illuminating the Heart of Leadership Through Literature,  he says leaders can develop their understanding of complex issues as they reflect on struggles of fictional characters. One piece on his reading list, for  instance, is “Blessed Assurance¨ by Allan Gurganus, in which a young man struggles with his conscience as he wants to be a good person and good professional and at the same time he is misleading poor people about insurance he sells. Dr. Badaracco had his students study A Man for All Seasons, in which Thomas  More struggles to balance his conscience, his faith and the safety of his family. He suggests Joseph Conrad’s The Secret Sharer to explore the meaning of responsibility. 

The 2,500 year old play Antigone by Sophocles has the heroine, who believes deeply in family values and honor, at odds with the king, who wants to promote the stability of the state and peace after along civil war. Dr. Badaracco says that basic conflict is instructive, as is the chorus, which seems to waver from one perspective to another in trying to make sense. The higher one gets in an organization, he said in an HBR blog, the more difficult, complex, grey areas a leader will have to confront.  

Dr. Badaracco says he has been surprised by how often his students over the years have rated Remains of the Day by Kazuo Ishiguro as a books they valued greatly. It’s about a British butler who serves high ranking English officials between 1920 and 1930 and struggles with his disappointments and his own high standards. Perhaps, Dr. Badaracco observes, his young American students are wondering about the fate of their own high standards and their own potential responses to disappointment. 

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Leading Organizations to Health- Register Now!

Posted By Prucia Buscell, Tuesday, January 26, 2016

Dear Plexus Friends and Associates,

In a time when healthcare is facing such extraordinary change from every possible direction, you know the tremendous value a complexity perspective brings to leaders of organizational change. By reminding them of the self-organizing nature of human interaction it helps them let go of unrealistic and counterproductive expectations of control and turn instead to curiosity and experimentation. It fosters mindfulness of here-and-now of interpersonal process -- how patterns of thinking and patterns of interacting are being created in each moment and what actions might lead to the emergence of new patterns. And it calls attention to the constraints that might be operative, shaping the possibility space for what kinds of self-organizing patterns are more or less likely to emerge.

You also know from your experience that there’s a big difference between having a useful conceptual perspective and putting that knowledge to work. Effective organizational change requires a deep knowledge of human motivation and behavior, advanced facilitation and communication skills and, underlying all that, an authentic and courageous personal presence to be able to hold the emotional tension of change and help others do likewise.

With co-sponsorship from the Plexus Institute and the University of Rochester, my colleague Diane Rawlins and I conduct an institute on leading organizational change called Leading Organizations to Health that explores and integrates all of these dimensions. It combines complexity with positive psychology, adaptive leadership and other frameworks to offer a uniquely powerful and effective approach to leading change. We’ve recently published an article that describes the program and an outcomes assessment. Our next cohort begins in late April; we’d love to have you join us. Help yourself put your valuable understanding of complexity to its most effective use.

For more information and online registration, please visit or contact me (  Wishing you a bright new year of meaning, joy and emergent possibilities!

Tony Suchman
Relationship Centered Health Care 

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Rural TB Outbreak Fueled by Distrust

Posted By Prucia Buscell, Wednesday, January 20, 2016


Decades of Distrust Linger, Impairing Health Effort


In the last two years 20 people in the small city of Marion, Alabama , population 3,600, have been diagnosed with active TB cases. Three people have died, and many more have symptoms of the disease.  Healthy authorities initiated screening efforts to identify those who need treatment and halt an expanding outbreak, but long time distrust of the medical and health professions is hampering the effort. People are reluctant to cooperate or disclose information about their health or their contacts.  In part, the distrust stems from the notorious Tuskegee experiments by the U.S. Public Health in which 600 black men with syphilis were deliberately left untreated.    Read the New York Times story  by Alan Blinder. 

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Complex Northerly Expansion of Tropical Diseases

Posted By Prucia Buscell, Wednesday, January 13, 2016

Tropical Diseases Emerging in New Places

The northward progression of many tropical diseases is not just because of the hotter weather that comes with climate change. Multiple interacting biological, social, and technological forces are playing a role.    

Scientists say disease-carrying mosquitoes and ticks once most populous in hot equatorial zones are are expanding their range into new northerly areas. The list of alarming bug-born illnesses that have traveled along with people and warming weather includes Lyme disease, West Nile virus,  Chagas, dengue,  chikungunya and Zika,  a disease gaining new attention as a possible cause of thousands of  deformed  babies in Brazil.     

Scientific American story by Dina Fine Maron reports that nearly 3,000 Brazilian babies were born in 2015 with microcephaly—an incurable condition in which the head and brain are abnormally small and the children tend to have serious cognitive and neurological disabilities as they grow.   There were only 147 cases of the abnormality in   Brazil in 2014.

A New York Times story by Donald McNeil Jr., explains that virologists say Zika is a certainly a factor in microcepahly though it may not be the sole cause; if a mother has previously been infected with dengue,  a related virus, it may be the two viruses together that trigger the prenatal devastation.  Zika, first identified in 1947 in Uganda, has not been extensively studied because there haven ‘t been large outbreaks until recently.  Zika was not found in the northern hemisphere, except for Easter Island, 2,200 miles off the coast of Chile, until last spring. Now, the Times story says, it circulates in 14 Latin American and Caribbean countries and Puerto Rico. 

Zika us carried by the Aedes aegypti  mosquito, the same biting pest that carries yellow fever and dengue.  Florida had two dengue outbreaks in 2013, which were halted with aggressive mosquito control measures.  To date, the aegypti mosquito hasn’t been found much farther north than Washington D.C. and Kentucky.  Epidemiologists say potential spread of Zika in the U.S. will depend on whether the Asian tiger mosquito, a cold-tolerant variety found as far north as New York and Chicago, carries the disease as efficiently as aegypti.

Throughout history human travel has spread some diseases and modern air travel increases the potential.  Some scientists think Zika arrived in Brazil with the influx of tourists for the 2014 World Cup, or it could have arrived with French Polynesian paddlers who participated in a canoe race in Rio de Janeiro. The first Lymes cases in New York in 1999, came from a strain identical to an Israeli strain, McNeil reports, so virologists believe it likely that the disease arrived by airplane in the blood of someone on board. By 2005, West Nile had reached the Pacific Northwest.

Lyme disease is spread by ticks, which carry more than 30 viral and bacterial diseases. The tick population has been advancing northward for more than a decade, and a growing number of tick borne diseases are being found in nearly all regions in the U.S.  Ticks are second only to mosquitos as pest-carried vectors of disease. As temperatures rise, scientists say, mosquitoes can multiply rapidly, potentially enhancing their collective ability to transmit diseases. Further, weather extremes have an impact on populations. Increased precipitation increased rain in some areas expands mosquitoes breeding locations, and droughts, like those that recently afflicted parts of Brazil, encourages people to save water in containers, providing additional mosquito habitats.

As Maria Diuk-Wasser, a scholar with expertise in entomology, zoology and parasitology at Columbia, reminds us, “The mosquito is exquisitely adapted to human hosts, living in close proximity to humans and feeding repeatedly.”

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Brain Networks Linked to Human Intelligence

Posted By Prucia Buscell, Wednesday, January 13, 2016

Newly Discovered Gene Networks Impact Intelligence

Scientists at Imperial College London have identified two networks of genes in the human brain that appear to govern memory, attention, processing speed and reasoning—the cognitive functions that combine in intelligence.

Complex traits such as intelligence are influenced by large groups of genes working together, according to Dr. Michael Johnson, a neurologist at Imperial College, rather “like a football team made up of players in different positions.” Dr. Johnson is deputy head of the Centre for Clinical Translation in the college’s Division of Brain Sciences.  In a paper published in the journal Nature Neuroscience, he and an international team of scientists describe the gene clusters they discovered. A story on the Imperial College website describes the discovery as the first of its kind, and one that could lead to treatment and amelioration of neurodevelopmental disorders and the cognitive impairments associated with them.

The newly identified gene networks, called MI and M3, appear to be under the control of master regulator switches. The researchers hope to identify the switches and explore whether they can be therapeutically manipulated.  The M1 network has more than 1,100 genes, according to a story in, and the M3 network has more than 150 genes. An NIH paper explains that at least a third of the approximately 20,000 different genes that make up the human genome are expressed, or turned on, in the brain. The brain has a higher proportion of expressed genes than any other part of the body.

“What’s exciting about this is that the genes we have found are likely to share a common regulator, which means that potentially we can manipulate a whole set of genes whose activity is linked to human intelligence,” Dr. Johnson said published interviews. “Our research suggests it might be possible to work with these genes to modify intelligence, but that is only a theoretical possibility at the moment. We have just taken a first step along that road.”

The researchers examined samples of human brains from patients who had undergone neurosurgery for epilepsy. They looked at thousands of genes expressed in the brain, and combined the those observations with genetic information from healthy people who had taken IQ tests, and information from people who had such neurological conditions as autism spectrum disorders and cognitive disabilities.  Using multiple computational analyses they were able to identify the gene networks that influence healthy cognitive abilities and begin to get some clues about how the genes interact.


Interestingly, Dr. Johnson reported the researchers found that some genes can be both helpful and harmful: Some of the genes that influence working intelligence in healthy people are the same genes that cause seizure disorders and cognitive impairments when they are mutated. The researchers believe use of large genomic datasets can be used to help uncover new aspects of human brain function in both health and disease or disorder, and new treatment possibilities

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Ingenious Simplicity Saving Babies

Posted By Prucia Buscell, Wednesday, January 13, 2016


Kangaroo Care: Ingenuity, Simplicity, Survival

At the Mother and Child Institute in Bogota, the  oldest maternity hospital in Colombia and one of the poorest, nearly everything was in short supply, including doctors, nurses and medicines. Incubators were so scarce that as many as three newborns had to be crowded into one, increasing the risk of   infection and death among fragile premature infants.

Tina Rosenberg, in her New York Times column Fixes, describes how Dr. Edgar Rey, chief of pediatrics came up with a way to save babies that avoided a time consuming and politically fraught fight for funds for more equipment and staff. His idea was to strap newborn infants, wearing only  diaper and head covering, to their mothers’ bare chests so that the baby has skin to skin contact and the mother’s breathing and heartbeat helps stabilize the infant’s heart and respiration. Everything but the baby’s head is under the mother’s shirt. The baby stays warm, can nurse at will,  is secure, and remains in an upright position to help avoid reflex and apnea. Dr. Rey first had mothers act as human incubators in 1978.  Rosenberg reports that the practice, now called kangaroo care, is used in some form in U.S hospitals and around the world. The diffusion did not happen accidentally. .   

The Colombian physician and nurse advocates formed an organization,  Fundacion Canguro,  to help support use of this ancient life-saving practice in modern hospitals, Rosenberg explains in a separate column. Much of the financing for teaching kangaroo care today comes from the U.S. Agency for International Development, The Bill & Melinda Gates Foundation and Save the Children.    

Innovators trying to save babies have historically taken inspiration  from different cultures and fields. Steven Johnson, in his book  Where Good Ideas Come From, tells how French obstetrician Stephane Tarnier saw baby chicks hatching in a heated enclosure at the Paris Zoo in the 1870s and thought about the two thirds of low weight babies who died within weeks of their birth. He had similar warm boxes built for babies, and infant survival at his hospital soared. Within a few  years, incubators were required in Parisian maternity hospitals. Bizarre exhibits of Incubators with live babies were shown  in Europe and one called a baby hatchery in New York’s Coney Island lasted well into the twentieth century and the use of incubators in hospitals spread.  

Modern incubators are expensive technological wonders that offer many protections for fragile preemies. Their complexity daunted medical practitioners in the developing world and sparked ingenuity at the same time. Johnson tells what MIT Professor Timothy Prospero did in 2008 when he visited an Indonesian hospital in an area still recovering from the Indian Ocean Tsunami four years earlier. Eight incubators donated by international aid groups were out of order because of power surges and tropical humidity. Prospero realized much complex equipment donated to developing world institutions is useless when it  breaks because spare parts and trained maintenance technicians aren’t available. Prospero had founded an organization called Design that Matters. He and his team realized that local people might not know how to repair high tech medical devices, but they knew a great deal keeping old cars running. So after many iterations they arrived at an incubator design that looked sleek and modern on the outside, but its insides were automotive.  Special sealed headlights provided the warmth, for example, and it could be powered by an adapted cigarette lighter. Hospital employees and helpful neighbors were quite adept at keeping it in fine functioning condition.

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The Spaces In Between

Posted By Prucia Buscell, Friday, December 4, 2015
Seeing and Hearing the Spaces in Between
"With the publication of his general theory of relativity a century ago," New York Times science writer Natalie Angier tells us, "Albert Einstein swept aside traditional notions of a static and unchanging space and instead gave us the stretchy supple miracle fabric of the space-time continuum."

Einsteinian space, she continues, has "heft, shape, and a sense of place," and the ability to bend "around giant suns and plunge down the throats of black holes." As a result, she says, we've never again been able to think of space as an emptiness between earthly objects or a vast nothingness between stars.

The importance of space in art, music, the design of buildings and cities, and social relationships now compels our attention. Angier describes the cultural impact of differently conceived spaces in a New York Times science story. A companion story by Dennis Overbye tells how Einstein spent years working through his theories of a boundless universe where gravity bends light and space-time directs the movement of matter. These difficult mathematically based abstractions have rippled forward in life-changing ways.

The GPS systems used for military navigation, make air travel safer and guide individual drivers and cell phone users to nearest gas stations and restaurants, for example, are based on relativity. Physics Central writer Clifford Will and Discover Magazine blogger C. Renee James explain how 24 satellites orbiting the, earth carrying clocks precise to the nanosecond, provide information that powers the growing multi-billion dollar GPS industry.

Angier's gracefully written story describes how culture influences our own psychological concept of the personal space around our bodies and our perceptions of the spaces in which we work. She describes how sculptor Rachel Whiteread creates what are often called negative spaces in her works, using resin or other materials to fill in places we might expect to be empty, such as the area under a table. She notes French composer Claude Debussy is believed to have said "Music is there space between the notes" and similar observations have been attributed to Mozart. She quotes one art scholar who says artists like Paul Cezanne thought the space between figures was as important as subjects in the foreground and another who cites Jackson Pollock's work as an ideal of "spatial democracy," where there is no background or foreground, and every inch of the canvas is just as important as every other.

And in jazz, where musicians need to listen closely to reach other and respond in intricately related ways, a great individual contribution may be sensing the moment not to play. Paul Haidet, a physician and amateur jazz musician, writes that when doctors create space in communications with patients, patients are able to tell the stories that put their symptoms in medical and personal context. Read Angier's story here and Haidet's article here.

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Dr. Jeffrey Cohn Steps Down as Plexus CEO, Assumes New Position

Posted By Prucia Buscell, Friday, December 4, 2015
November  19,2015
Dear Plexus Community,
I wanted to share with you the news that Plexus President, Dr. Jeff Cohn, has recently accepted a new position as Medical Director at Common Practice. I want to share his letter with you.
"It is with very mixed emotions that I'd like to share the news that I've accepted a new position and am no longer Plexus Institute President. I came to Plexus in 2012 with the feeling that I was responding to a calling. It was clear to me that many of the challenges being faced by individuals, organizations and communities were complexity challenges. The pathways to the different and better outcomes being sought were going to be discovered and created through the sorts of adaptive methods that we at Plexus have become so dedicated to, like Liberating Structures and Positive Deviance. By helping these individuals, organizations, and communities learn how to apply these methods and the accompanying mindset that complexity practitioners carry with them, far-reaching impact could be accomplished across diverse industries and stakeholder groups.
What I've learned over this three plus year experience is that I'm still a physician at heart. While the methods, the theory, and the learning is critically important to me, the application to people at risk of and/or experiencing the pain and hardship of illness is where my heart and head lie. I've (re)discovered I'm particularly drawn to the challenges experienced by patients and families as illness and age progress. Too often our healthcare delivery fails to be aligned with the values, beliefs, and preferences of patients. Too often we even fail to ask what those values, beliefs, and preferences even are. I'm committed to do what I can using the skills and principles I've learned with and from so many of you to be a facilitator and catalyst for change across the boundaries of organizations and stakeholder roles. To this end I've become the Medical Director at Common Practice, a healthcare innovation firm focusing on enabling conversations related to living and dying well in the face of advancing age and illness. These conversations are too often poorly and painfully done, or, worse yet, avoided altogether.
I view the work on which I now embark as a set of challenges that represent complexity in all its mystery and possibility. I thank Plexus Institute and you, the Plexus community, for the opportunity to learn so much in the past 3 years. We've helped advance the field of patient safety and public school education. I'd particularly like to thank the Board Chairs with whom I've worked, Trish Silber and Michael Arena, for their support over these 3 years. I'd also like to thank Joelle Everett and especially Prucia Buscell for their support of our organization and our community. So much of what we've learned together has happened due to their work. I'd also like to thank my Plexus predecessors, Curt Lindberg and Lisa Kimball, for sharing their insights and guidance during my time at Plexus. I'd like to thank Dave Rampulla, Director of Research, for his willingness to learn and take on difficult and unfamiliar tasks on behalf of Plexus - and for his friendship. Belatedly, I'd like to thank Susan Doherty for all that she did for Plexus during her tenure as Director for Operations for Plexus. She worked on behalf of the organization with little recognition being sought by her, and she put systems into place that will continue to support the organization into wherever the future takes us. And I'd like to thank you, the Plexus community, for accepting me into your midst and learning with me. I count many of you as friends and hope we continue to stay in touch and learn together."
Jeffrey Cohn
As we thank Jeff for his years of stewardship and wish him the best of luck in his new venture, Plexus will continue to evaluate leadership and strategic possibilities to shepherd the Institute during this transition and best fulfill its mission to foster the health of individuals, families, communities, and organizations through ideas and practices rooted in the principles of complexity.
Warmest regards,
Michael Arena
Chair, Plexus Institute Board of Trustees

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Facing Uncetainty? Forget Positivity. Worry!

Posted By Prucia Buscell, Friday, December 4, 2015
Facing Uncertainty? Forget Positivity. Worry!

Embracing anxiety in the face of uncertainty can be productive. A new study suggests people who worry during long waits are more elated with good news and better prepared for disappointments.

Kate Sweeney,an associate professor of psychology At the University of California, Riverside, and colleagues, wanted to examine consequences of how people think during periods of high stakes limbo: when they are awaiting results of a biopsy, a college application, a job offer or a really important test like a bar exam where results aren't immediately available. The researchers studied coping mechanisms of 230 law school graduates as they waited four months for results of the July 2013 California bar exam.

In a New York Science Times story by Jan Hoffman, Sweeney described three common strategies people use to endure the discomforts of contemplating unknown outcomes. Some try to immerse themselves in unrelated activities such as exercise, binge TV watching and games, but these quick fixes tend not to work over the long haul. As Sweeney told the Times, "The more you try not to pay attention, the more aware you become."Others aspire to make lemonade from lemons. They look to adversity as fuel for person growth. But as Sweeney says, that's a defensive posture that may not help. A more productive approach, researchers say, is to hope for the best and brace for the worst, using defensive pessimismand proactive coping. Or as the Times story puts it, "dive into the worry maelstrom (and) surface with contingency plans."

Julie K. Norem, a psychology professor at Wellesley and author of "The Positive Power of Negative Thinking," was not involved in the study. But she advises, "Set your expectations low and think through the negative possibilities. It drives optimists crazy, but it drives your attention away from feelings of anxiety to what you can do to address the disaster that might happen."

Evaluating bad possibilities may also make success sweeter. Sweeney reports that anxious waiters did well when news came, whatever it was. They were thrilled with good news, and had plans ready for bad news. She said those who sailed unperturbed through the waiting, on the other hand, were shattered by bad news and if they got good news, they were underwhelmed. Read the Times story here.

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Is it Ever OK to Avoid Empathy? And Can We Choose?

Posted By Prucia Buscell, Monday, October 26, 2015

Have We Lost Empathy in Recent Decades? 

  Jamil  Zaki wants you to forget everything you think you know about empathy.

One very old and still dominant theory is that empathy is automatic, something that  just happens without our control. Zaki is an assistant professor of psychology at Stanford University, and the director of the Stanford Social Neuroscience Lab. Studying the history of empathy, Professor Zaki finds the first modern account in Adam Smith’s 1759 book The Theory of Moral Sentiments. Smith describes what he calls “fellow feeling” that makes people take on the emotional states of others, as when people in a crowd share the anxiety of watching a tight rope walker wobble over a precipice.  Smith felt—and many modern thinkers agree—this is reflexive and not something we choose.  Zaki’s lab has done studies that produced fMRI images showing that when a person sees another person have an experience, the witness’s response is a  “neural resonance,” in which the n brain generates a pattern of activity consistent with the brain of the person having the experience.

So why don’t we always feel empathy? In inter group setting, Zaki writes in an essay,  that when people are divided by war, opposing political and social views, and team rivalries,  empathy often collapses and people fail to share, or even be concerned with, the emotional states of those outside their own group.  Zaki says studies have shown people demonstrate less neural resonance if they see an out-group member experiencing pain than they do seeing one on their own suffers.  Sometimes, he writes, empathy is expensive: in a war too much empathy toward an enemy with a gun could be dangerous. Even in situations that aren’t life threatening, empathy could be a costly emotion.  If someone needs help we can’t or won’t give, we might choose to avoid empathy to avoid feeling guilty or having to part with money.

If we know empathy is socially approved, we are likely to demonstrate more of it.  Zaki even notes a study in which  men were more empathetic after scientists convinced them that women are more attracted to sensitive guys.  This and other studies show we can choose to be, or not be, empathetic.

Zaki likes the work of Dan Batson, who has researched  empathetic human connection as a force for cooperation and altruism.

But empathy can have a dark side. Psychopaths, con artists, and the practitioners of enhanced interrogation may have terrific understanding of other people’s feelings, but they use it for their own nefarious purposes.

A 2010 study by Sara Konrath and colleagues at the University of Michigan that analyzed 30 years worth of data on 14,000 college students found that students’ empathy had declined over the three decades examined, and that the sharpest drop came after 2000. Some theorists have blamed the decline on social media that reduces face to face contact, and others have looked at increased academic and career competition. Zaki speculates that empathy may not have change, but the idea of empathy may be different or less desirable than it was 30 years ago.  He’d like to see more research, and he wants to emphasize  that empathy is a choice that deserves serious thought and conscious decisions.  Read Zaki’s essay here.

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