The Pathological Altruist Gives Till Someone Hurts

By NATALIE ANGIER

Published: October 3, 2011

Some years ago, Dr. Robert A. Burton was the neurologist on call at a San Francisco hospital when a high-profile colleague from the oncology department asked him to perform a spinal tap on an elderly patient with advanced metastatic cancer. The patient had seemed a little fuzzy-headed that morning, and the oncologist wanted to check for meningitis or another infection that might be treatable with antibiotics.

Dr. Burton hesitated. Spinal taps are painful. The patient’s overall prognosis was beyond dire. Why go after an ancillary infection? But the oncologist, known for his uncompromising and aggressive approach to treatment, insisted.

“For him, there was no such thing as excessive,” Dr. Burton said in a telephone interview. “For him, there was always hope.”

On entering the patient’s room with spinal tap tray portentously agleam, Dr. Burton encountered the patient’s family members. They begged him not to proceed. The frail, bedridden patient begged him not to proceed. Dr. Burton conveyed their pleas to the oncologist, but the oncologist continued to lobby for a spinal tap, and the exhausted family finally gave in.

As Dr. Burton had feared, the procedure proved painful and difficult to administer. It revealed nothing of diagnostic importance. And it left the patient with a grinding spinal-tap headache that lasted for days, until the man fell into a coma and died of his malignancy.

Dr. Burton had admired his oncology colleague (now deceased), yet he also saw how the doctor’s zeal to heal could border on fanaticism, and how his determination to help his patients at all costs could perversely end up hurting them.

“If you’re supremely confident of your skills, and if you’re certain that what you’re doing is for the good of your patients,” he said, “it can be very difficult to know on your own when you’re veering into dangerous territory.”

The author of “On Being Certain” and the coming “A Skeptic’s Guide to the Mind,” Dr. Burton is a contributor to a scholarly yet surprisingly sprightly volume called “Pathological Altruism,” to be published this fall by Oxford University Press. And he says his colleague’s behavior is a good example of that catchily contradictory term, just beginning to make the rounds through the psychological sciences.

As the new book makes clear, pathological altruism is not limited to showcase acts of self-sacrifice, like donating a kidney or a part of one’s liver to a total stranger. The book is the first comprehensive treatment of the idea that when ostensibly generous “how can I help you?” behavior is taken to extremes, misapplied or stridently rhapsodized, it can become unhelpful, unproductive and even destructive.

Selflessness gone awry may play a role in a broad variety of disorders, including anorexia and animal hoarding, women who put up with abusive partners and men who abide alcoholic ones.

Because a certain degree of selfless behavior is essential to the smooth performance of any human group, selflessness run amok can crop up in political contexts. It fosters the exhilarating sensation of righteous indignation, the belief in the purity of your team and your cause and the perfidiousness of all competing teams and causes.

David Brin, a physicist and science fiction writer, argues in one chapter that sanctimony can be as physically addictive as any recreational drug, and as destabilizing. “A relentless addiction to indignation may be one of the chief drivers of obstinate dogmatism,” he writes. “It may be the ultimate propellant behind the current ‘culture war.’ ” Not to mention an epidemic of blogorrhea, newspaper-induced hypertension and the use of a hot, steeped beverage as one’s political mascot.

Barbara Oakley, an associate professor of engineering at Oakland University in Michigan and an editor of the new volume, said in an interview that when she first began talking about its theme at medical or social science conferences, “people looked at me as though I’d just grown goat horns. They said, ‘But altruism by definition can never be pathological.’ ”

To Dr. Oakley, the resistance was telling. “It epitomized the idea ‘I know how to do the right thing, and when I decide to do the right thing it can never be called pathological,’ ” she said.

Indeed, the study of altruism, generosity and other affiliative behaviors has lately been quite fashionable in academia, partly as a counterweight to the harsher, selfish-gene renderings of Darwinism, and partly on the financing bounty of organizations like the John Templeton Foundation. Many researchers point out that human beings are a spectacularly cooperative species, far surpassing other animals in the willingness to work closely and amicably with non-kin. Our altruistic impulse, they say, is no mere crown jewel of humanity; it is the bedrock on which we stand.

Yet given her professional background, Dr. Oakley couldn’t help doubting altruism’s exalted reputation. “I’m not looking at altruism as a sacred thing from on high,” she said. “I’m looking at it as an engineer.”

And by the first rule of engineering, she said, “there is no such thing as a free lunch; there are always trade-offs.” If you increase order in one place, you must decrease it somewhere else.

Moreover, the laws of thermodynamics dictate that the transfer of energy will itself exact a tax, which means that the overall disorder churned up by the transaction will be slightly greater than the new orderliness created. None of which is to argue against good deeds, Dr. Oakley said, but rather to adopt a bit of an engineer’s mind-set, and be prepared for energy losses and your own limitations.

Train nurses to be highly empathetic and, yes, their patients will love them. But studies show that empathetic nurses burn out and leave the profession more quickly than do their peers who remain aloof. Give generously to Child A, and Child B will immediately howl foul, while quiet Child C will grow up and write nasty novels about you. “Pathologies of altruism,” as Dr. Oakley put it, “are bound to arise.”

Rachel Bachner-Melman, a clinical psychologist at Hadassah University Medical Center in Jerusalem who specializes in eating disorders, has seen the impact of extreme selflessness on the anorexic young women who populate her ward.

“They are terribly sensitive to the needs of those around them,” she said in an interview. “They know who needs to be pushed in a wheelchair, who needs a word of encouragement, who needs to be fed.”

Yet the spectral empaths will express no desires of their own. “They try to hide their needs or deny their needs or pretend their needs don’t exist,” Dr. Bachner-Melman went on. “They barely feel they have the right to exist themselves.” They apologize for themselves, for the hated, hollow self, by giving, ceaselessly giving.

In therapy they are reminded that to give requires that first one must have. “It’s like in an airplane,” Dr. Bachner-Melman said. “The parents must put on the oxygen mask first, not because they’re more important, but if the parents can’t breathe, they can’t help the child.”

Denial and mental compartmentalization also characterize people who stay in abusive relationships, who persuade themselves that with enough self-sacrifice and fluttering indulgence their beloved batterer or drunken spouse will reform. Extreme sensory denial defines the practice of animal hoarding, in which people keep far more pets than they can care for — dozens, scores, hundreds of cats, rodents, ferrets, turtles.

The hoarders may otherwise be high-functioning individuals, says Dr. Gary J. Patronek, a clinical assistant professor at the veterinary school of Tufts University and founder of the Hoarding of Animals Research Consortium. “We’ve seen teachers, nurses, public officials, even veterinarians,” he said in an interview. “They live a double life.”

At work, they behave responsibly and know the importance of good hygiene. They go home and enter another world, one of squalor and chaos, of overwhelming stench and undernourished animals, of pets that have died for lack of care.

Yet the hoarders notice none of this. “You walk in, you can’t breathe, there are dead and dying animals present, but the person is unable to see it,” Dr. Patronek said. Cat carcasses may alternate with food in the refrigerator, “but in the person’s mind it’s happy and wonderful, it’s a peaceable kingdom.”

Hoarders may think of themselves as animal saviors, rescuing pets from the jaws of the pound; yet they are not remotely capable of caring for the animal throngs, and they soon give up trying. “It’s a very focal, delusional behavior,” Dr. Patronek said. And it can be all the more difficult to treat for wearing the trappings of selflessness and love.

(A version of this article appeared in print on October 4, 2011, on page D1 of the New York edition with the headline: The Pathological Altruist Gives Till Someone Hurts.)