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Abstract

Pathological altruism is a construct describing the willingness of an individual to place the needs of others above him- or herself to the point of causing harm, whether physical, psychological, or both, to the purported altruist. Codependency can be viewed as a form of pathological altruism. The study of codependency has been hampered by limited agreement as to what it is, whether it even exists, and a lack of validated psychometric instruments to study it. This chapter suggests codependency is best viewed as a behavior and not a diagnosis, facilitated by the inability to tolerate negative affect. This chapter will review the concept of codependency, comment on its roots in empathy and altruism, explore its potential neurobiological, genetic and evolutionary basis, and make suggestions for future research.
Concepts and implications of altruism bias and
pathological altruism
Barbara A. Oakley
1
Department of Industrial and Systems Engineering, Oakland University, Rochester, MI 48309
Edited by John C. Avise, University of California, Irvine, CA, and approved April 9, 2013 (received for review February 14, 2013)
The profound benets of altruism in modern society are self-evident.
However, the potentialhurtful aspects of altruism have gone largely
unrecognized in scientic inquiry. This is despite the fact that
virtually all forms of altruism are associated with tradeoffssome
of enormous importance and sensitivityand notwithstanding that
examples of pathologies of altruism abound. Presented here are the
mechanistic bases and potential ramications of pathological altru-
ism, that is, altruism in which attempts to promote the welfare of
others instead result in unanticipated harm. A basic conceptual ap-
proach toward the quantication of altruism bias is presented.
Guardian systems and their over arching importance in the evolution
of cooperation are also discussed. Concepts of pathological altruism,
altruism bias, and guardian systems may help open many new, po-
tentially useful lines of inquiry and provide a framework to begin
moving toward a more mature, scientically informed understand-
ing of altruism and cooperative behavior.
cooperation
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empathy
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codependency
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narcissism
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philanthropy
Reality must take precedence over public relations, for nature cannot
be fooled. Richard Feynman
Our eyes can be powerless against visual illusions, with our
underlying neural machinery leading us to predictably er-
roneous conclusions about the size or shape of an object (1). In
a similar fashion, our empathic feelings for others, coupled with
a desire to be liked, parochial feelings for our in-group, emo-
tional contagion, motivated reasoning, selective exposure, con-
rmation bias, discounting, allegiance bias, the Einstellung (set)
effect, and even an egocentric belief that we know what is best for
others, can lead us into powerful and often irrational illusions of
helping (2). In other words, peoples own good intentions, cou-
pled with a variety of cognitive biases, can sometimes blind them
to the deleterious consequences of their actions. This dynamic of
pathological altruism involves subjectively prosocial acts that are
objectively antisocial. (Naturally, there are many objective per-
spectives. One seemingly objective observers verdict of antisocial
terrorism can be anothers verdict of prosocial altruism, with
the words objective,”“antisocial,”“prosocial,”“terrorism,and
even altruismitself varying in meaning depending on the per-
spective of the putatively objective observer.)
At the core of pathological altruism are actions or reactions
based on incomplete access to, or inability to process, the wide
range of information necessary to make prudent decisions that
align with cultural values associated with altruistic behavior. Vari-
ous psychological, religious, philosophical, biological, or ideologi-
cal biases could lead a person or group to misinterpret, selectively
discount, or overly emphasize certain aspects of relevant in-
formation. Thus, pathologically altruistic behavior can emerge
from a mix of accidental, subconscious, or deliberate causes.
[Altruism,in the context of this paper, is used to signify well-
meaning behavior intended to promote the welfare of another; thus
altruistic behavior may be motivated by concern for the other,
egoistic concerns for the self, or both (e.g., it makes me feel good
to help them)(3).Pathologicalis used in the sense of being
excessive or abnormal, without implying any clinical diagnosis.]
Pathological altruism can be conceived as behavior in which
attempts to promote the welfare of another, or others, results
instead in harm that an external observer would conclude was
reasonably foreseeable. More precisely, this paper denes path-
ological altruism as an observable behavior or personal tendency
in which the explicit or implicit subjective motivation is in-
tentionally to promote the welfare of another, but instead of
overall benecial outcomes the altruism instead has unreasonable
(from the relative perspective of an outside observer) negative
consequences to the other or even to the self. This denition does
not suggest that there are absolutes but instead suggests that,
within a particular context, pathological altruism is the situation
in which intended outcomes and actual outcomes (within the
framework of how the relative values of negativeand positive
are conceptualized), do not mesh.
A working denition of a pathological altruist then might be
a person who sincerely engages in what he or she intends to be
altruistic acts but who (in a fashion that can be reasonably an-
ticipated) harms the very person or group he or she is trying to
help; or a person who, in the course of helping one person or
group, inicts reasonably foreseeable harm to others beyond the
person or group being helped; or a person who in reasonably
anticipatory way becomes a victim of his or her own altruistic
actions (2). The attempted altruism, in other words, results in
objectively foreseeable and unreasonable harm to the self, to the
target of the altruism, or to others beyond the target. Examples
at an interpersonal level include the codependent wife murdered
by the husband she has refused to leave, or the overly attentive
helicopterfather who threatens to sue instructors that give
well-deserved bad grades, or the mother who attempts to protect
her son by refusing to vaccinate him and who consequently fuels
a loss of herd immunity underpinning a local whooping cough
epidemic in which an infant dies. Very different personalities can
become entangled in pathologies of altruism, ranging from the
sensitive hyperempath, to the normal person, to the utterly self-
absorbed narcissist. These differing personalities share genuinely
good intentions that play out in detrimental ways.
Sometimes there is a blurry line as to whether a problematic
outcome for an altruistic action is reasonably foreseeable. This
ambiguity can make it difcult to distinguish between altruism
and pathological altruism. For example, lets say that, while al-
truistically helping a friend move to another apartment, you ac-
cidentally dropped and broke an expensive statue. Were your
actions pathologically altruistic? In the conceptions of patholog-
ical altruism outlined here, no. Your altruism would not have
been pathologically altruistic, because the bad outcomethe
This paper results from the Arthur M. Sackler Colloquium of the National Academy of
Sciences, In the Light of Evolution VII: The Human Mental Machinery,held January
1012, 2013, at the Arnold and Mabel Beckman Center of the National Academies of
Sciences and Engineering in Irvine, CA. The complete program and audio les of most
presentations are available on the NAS Web site at www.nasonline.org/evolution_vii.
Author contributions: B.A.O. designed research, performed research, analyzed data, and
wrote the paper.
The author declares no conict of interest.
This article is a PNAS Direct Submission.
1
To whom correspondence should be addressed. E-mail: oakley@oakland.edu.
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dropped statuearose as a very unlikely and difcult-to-predict
outcome of your good intentions. In a different scenario, how-
ever, lets say your brother becomes addicted to painkillers. When
he goes through withdrawal, you get more painkillers to help him
feel better, and you cover for him when his work supervisor calls.
You genuinely want to help your brother, but the reality is that
you are enabling his addiction. In this case, your well-meaning
altruism is pathological.
These examples help clarify the concept of pathological al-
truism, but similar situations could be more ambiguous. What if
you had dropped your friends expensive statue after you had
consumed a bottle of wine? Or what if your painkiller-addicted
brother was waiting to be enrolled in a treatment program? We
yearn for the denitive in conceptual denitions, but the reality is
that there always will be a residual uncertainty.
Motives are also important. Well-meaning intentions can lead
either to altruism or to pathological altruism. Self-servingly malev-
olent intentions, on the other hand, often have little or nothing to do
with altruism, even though such malevolence can easily be cloaked
with pretensions of altruism. A con artist soliciting for a charity
that he uses to personally enrich himself would not be a pathologi-
cal altruist.
Both altruism and empathy have rightly received an extraor-
dinary amount of research attention. This focus has permitted
better characterization of these qualities and how they might
have evolved. However, it has also served to reify their value
without realistic consideration about when those qualities con-
tain the potential for signicant harm.
Part of the reason that pathologies of altruism have not been
studied extensively or integrated into the public discourse appears
to be fear that such knowledge might be used to discount the
importance of altruism. Indeed, there has been a long history in
science of avoiding paradigm-shifting approaches, such as Dar-
winian evolution and acknowledgment of the inuence of biological
factors on personality, arising in part from fears that such knowl-
edge somehow would diminish human altruistic motivations. Such
fears always have proven unfounded. However, these doubts have
minimized scientistsability to see the widespread, vitally important
nature of pathologies of altruism. As psychologist Jonathan Haidt
notes, Morality binds and blinds(4).
Relevant here are the remarks of historian of science Thomas
Kuhn, who observed that when a paradigm shift occurs, scientists
see data for the rst time (5). Such is the case with pathologies of
altruism, which are not the commonly supposed rare aberrations,
but rather a behavior that overwhelmingly occurs in human social
intercourse(6). It therefore is realistic to encourage exploration of
anew,scientically based paradigm acknowledging that, even given
differing semantic parsings, subjectively altruistic feelings some-
times can be objectively problematic and even ultimately antisocial.
The bottom line is that the heartfelt, emotional basis of our good
intentions can mislead us about what is truly helpful for others.
Altruistic intentions must be run through the sieve of rational
analysis; all too often, the best long-term action to help others, at
both personal and public scales, is not immediately or intuitively
obvious, not what temporarily makes us feel good, and not what is
being promoted by other individuals, with their own potentially
self-serving interests. Indeed, truly altruistic actions may some-
times appear cruel or harmful, the equivalent of saying noto the
student who demands a higher grade or to the addict who needs
another hit. However, the social consequences of appearing cruel
in a culture that places high value on kindness, empathy, and al-
truism can lead us to misplaced helpfulbehavior and result in
self-deception regarding the consequences of our actions (7, 8).
Pathological altruism can operate not only at the individual
level but in many different aspects and levels of society, and
between societies. Recognizing that feelings of altruism do not
necessarily constitute objective altruism provides a new way of
framing and understanding altruism. This previously unrecognized
perspective in turn may open many new, potentially useful lines of
inquiry and provide a framework to begin moving toward a more
mature, scientically informed understanding of altruism and co-
operative behavior. The thesis of pathological altruism emphasizes
the value of true altruism, self-sacrice, and other forms of
prosociality in human life. At the same time, it acknowledges the
potential harm from cognitive blindness that arises whenever groups
treat a concept as sacred (4).
The public as a whole would benet from knowledge that what
might feel subjectively altruistic may have negative unintended
consequences that both worsen the situation that was meant to be
improved and impact other areas negatively. Even the government
can work more efciently when voters and legislators realize that
attempts to help others come with very real costs and can have
tradeoffs that worsen the very concerns that were meant to
be alleviated.
Along these lines, then, this paper suggests that pathologies of
altruism and of empathic caring should receive concentrated
research focus. Specic recommendations are outlined as well.
As an underlying motivation, we should remember that in the
nineteenth and twentieth centuries, there was an unparalleled
improvement in public health as the entire discipline of medicine
came under scientic scrutiny. Medical therapies that at one time
were thought to be obviouslybenecial, such as bloodletting
and blistering, were nally subjected to review that found them
wanting. In a similar vein, if we are truly to help others, this new
century at last forms the time for scientists to subject altruistic
modern social engineering and activism efforts, as well as aca-
demic disciplines that hinge on helping,and nally, altruism
itself, to far more disciplined scientic scrutiny. It is time for
dispassionate exploration of how altruism and empathy them-
selves can inadvertently bias our efforts to create truly co-
operative modern, complex societies.
Evolutionary Considerations
In one sense, pathological altruism can be thought of as a pattern
of nurturing or benecial behavior with evolutionarily unsuccess-
ful consequences. Evidence for antecedents of such behavior can
be seen in the animal world; examples include the unwitting hosts
of brood-parasitism, as with the wood thrush who devotes sub-
stantial resources to raising the offspring of cowbirds. Such ante-
cedent behavior is manifest at even a genetic and molecular level.
For example, benecial replication processes within a cell can be
co-opted by viruses (9). Consequent cell lysis or exocytosis allows
the new viral bodies to spread the contagion.
Molecular perspectives, in fact, can inform how we perceive al-
truism and cooperative behavior. A stable molecular bond has the
property that the bound state is a lower-energy conguration than
the unbound state. A physical system tends toward the conguration
that minimizes potential energy. Such cooperativebehavior often
needs an initial activation energythat is, it comes at costbut the
resulting state resides more naturally and easily at the lower energy
level for the newly formed single, integrated, cooperating entity.
(This entity may or may not have replicative abilities.)
In these situations, pathological altruism or its antecedents
might be thought of as arising in two ways. First, it can arise when
other entitiessystems that are not, or are no longer, integrated
into the rst cooperating entityare able to tap into the lowered
energy states and possible replicative abilities produced by the
rst cooperating entity. Tapping into those lowered energy states
may weaken or destroy the rst entity. (Initially, such secondary
entities may be part of the rst entity even as they begin their
dissociation, as with precancerous cells. It also is worth noting
that cooperative entitiesmay be composed of different species,
as with wrasses that swim with impunity into the mouths of
groupers to feed off parasites, or with human intestinal ora.)
Second, pathological altruism or its antecedents can arise when
the lowered energy state of the rst system allows the system to
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grow to such a size that it increases the potential for disintegration
or destruction from noncooperative mechanisms afliated with the
entity. An example can be found in nuclear ssion, where longer-
range electrostatic repulsion between protons overcomes the at-
tractive, albeit short-range, nuclear force between nucleons. In more
complex cellular processes, the surface area-to-volume ratio limits
the cell size. Doubling the size of the cell, for example, requires eight
times more nutrients and would have eight times more waste, even
though the surface area increased only by a factor of four.
We see these same cooperative versus noncooperative balances
playing out on a larger, social scale. For example, the Amazonian
Ya¸nomamö villagers preferred to livein small villagesof around 40
people, which seemed to provide an optimal reduction in energy
costs afliated with daily needs for food and safety versus internal
strife. However, villages of larger size provided more safety against
other, potentially hostile villages. In other words, larger villages
could, in some environments, be better at minimizing overall en-
ergy costs. Thus, some villages grew to more than 100 inhabitants
in size. However, internal repulsive forces increased in the form of
disputes that arose as the number of inhabitants in a village in-
creased. Larger villages eventually ssioned, thus beginning the
process anew (10). At a much higher level of social complexity,
there was an initial economic boom as the European Union was
rst established. This boom has become tempered as internal
nominally altruistic and cooperative effortsthetypeofefforts
that work fairly effectively in less complex social systemsare ul-
timately proving disputatious and disruptive.
As entities move to higher levels of complexity, the yin and yang
of lowered energy states resulting from cooperation, versus
noncooperative internal and external forces and effects, can cause
boom-and-bust behavior on evolutionary timescales. How entities
resolve these issues of cooperation versus noncooperation is
a factor in determining whether entities self-destruct, proceed
through cycles of growth versus decline, or are able to move
successfully to still higher levels of complexity. Whenever higher
levels of complexity are achieved, new issues of cooperation
versus noncooperation develop, and the cycle begins anew.
One issue is clear. As entities become more complex, they
generally develop evolving guardiantype feedback mechanisms
that allow not only the detection and mitigation of the effects of
noncooperative mechanisms (defectors) but also adaptation to
changes in those noncooperative mechanisms. Without such ex-
ible guardian systems, entities fall prey to other entities or to their
own inherent noncooperative features. On a cellular level, we see
that guardian immune systems have evolved from the rudimentary
enzyme systems of unicellular organisms, which protect against
bacteriophage infections, to the extraordinarily sophisticated im-
munological defense mechanisms seen in vertebrates.
Similarly, social systems of cooperative behavior must devise
effective immunological guardian functions against efforts to
siphon away the energetic advantages of cooperative behavior.
Such immune guardian functions also must serve to mitigate
disruptive internal forces and effects. (Of course, on a biological
level, we see from the many varieties of autoimmune disease that
immune-type guardian systems, even when designed with care,
can create their own host of difculties and can be hijacked by
noncooperative elements, as with leishmaniasis or AIDS. Similar
issues would appear to hold true for complex social systems.)
Thus, to the ve mechanisms that have been posited for the
evolution of cooperationkin selection, direct reciprocity, indirect
reciprocity, network reciprocity, and group selection (11)must
be added a sixth, guardian function. For cooperative behavior to
continue in complex biological or sociological entities, that is, for
entities not to fall prey to ever-present, ever-evolving defectors,
some form of evolving active guardian function must be present
that detects when debilitating or destructive advantage is being
taken of cooperative or altruistic behavior. The guardian system
must not only detect but also disable such noncooperative behavior
or render the entity immune to the pernicious effects. Without such
detection and mitigation mechanisms, we see modeled evolution-
ary entities that are wiped out by defectors (12).
Virtually all the mechanisms for the evolution of cooperation
have some degree of overlap. Direct reciprocity, for example,
perforce plays a role in indirect reciprocity. In a similar fashion,
guardian functions overlap with the other ve evolutionary co-
operative mechanisms. Reciprocal strategies,such as tit-for-tat,
for example, inherently contain what might be thought of as
rudimentary and passive guardian functions: If you defect, I will
defect. Differences in guardian function between groups could
reinforce group selection mechanisms. Guardian functions also
could relate to the reputational effects of indirect reciprocity in
enhancing cooperation: I may report anyone who does not
support the leader, because my family can suffer if I dont. By
separating out guardian functions, which address the potential
for support or damage to cooperative processes, vitally important
mechanisms can be understood and more carefully modeled.
Moreover, counterintuitive ndings in complex cooperative so-
cial systems, such as the importance of selsh behavior and the
tradeoffs of religious and ideological mechanisms in inducing
and enforcing cooperation, can be claried (13, 14). For exam-
ple, poorly designed guardian functions that do not adequately
account for Machiavellian leadership and behavior, might play
an important role in the failure of social structures. In another
example, strong guardian functions that might protect against
some internal threats could simultaneously create stiing rigidity
that renders the society less able to cope with other challenges.
Over previous decades, medical science has come to appreciate
the over arching importance of immune systems (themselves
examples of guardian systems) in biology. Similarly, awareness
of pathological altruism allows those analyzing the evolution of
cooperation to appreciate the importance of the full panoply of
guardian systems at the many different levels of complexity.
Implications
Let us step back briey to explore how pathologies of altruism
arise at an individual level. Naturally, the small percentage of
toddlers and young children who show little concern for others
seem predisposed for antisocial behavior as they mature (15). On
the other hand, children who manifest altruistic behavior are
generally well-adjusted. However, there is a small group of path-
ologically altruistic children who rate high on altruistic behavior
but low on self-actualizing behavior such as showing pleasure
at success or doing something on their own. For such children,
a psychological cost can arise even at an early age, as shown by
high scores in emotional symptoms, including unhappiness, wor-
ries, fear, nervousness, and somatization (16).
As neuroscience and genetics are beginning to elucidate the
biological as well as cultural basis of altruistic and empathic
behavior, it has become clear that individuals vary in their innate
underpinnings involving empathy and altruism (17). Therefore
an educational, religious, and societal one size ts allapproach
to enculturation that uniformly afrms the importance of altru-
istic caring, without a tempered acknowledgment of the tradeoffs,
may inadvertently be harmful for some children in the long run.
(In other words, social attempts to blindly encourage altruism
become themselves a perfect example of pathological altruism.)
Without insight into the undesirable effects arising from empathy
and altruistic intentions, children and adults with an existing hy-
persensitivity toward others nd it more difcult to detect and
react appropriately to manipulation or to situations in which
natural feelings of empathy could lead to undesirable outcomes.
Indeed, it seems that caring for others, helpful as it sometimes
may be to those receiving or demanding that care, can have
pernicious long-term consequences for the care giver, including
guilt, burnout, depression, and stress disorders (18, 19). Stress
resulting from empathic caring has been shown to produce errors
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in medical treatment (20). Feelings of empathic caring also ap-
pear to lie at the core of dependent personality disorder, co-
dependent behavior, and even anorexia (2). Caring, empathic,
helicopter parents can, with the best of intentions, inict lasting
damage on their children (21).
Empathy is not a uniformly positive attribute. It is associated
with emotional contagion; hindsight bias; motivated reasoning;
caring only for those we like or who comprise our in-group
(parochial altruism); jumping to conclusions; and inappropriate
feelings of guilt in noncooperators who refuse to follow orders to
hurt others (2229). Oxytocin, the goody-goody hormonethat
underlies maternal bonding and many aspects of empathy, also
increases both envy and gloating (30). Empathy also can be used
by the self-serving, including psychopaths, to deduce how to
further their own ends (31). Being emotionally close to someone
who is selsh or dishonest has been found to lead people to
becoming more selsh and dishonest themselves (32). Allegiance
bias causes forensic scientists to call their ndings for the team
they believe has hired them (33). [Indeed, the reliability of all
types of forensic science evidence, including ostensibly objective
techniques such as DNA typing and ngerprint analysis, has been
called to question (34).] Judges, almost all of whom are lawyers,
favor the legal system in their decisions; this bias has far-reaching
and deleterious effects on American law (35).
Quietly going along with the owrefusing to blow the whistle
on objectively criminal behavior, for examplealso sometimes
may be a form of pathological altruism that grows from our feelings
of empathy. In other words, the altruism and empathy we feel often
isnt really about the person or group ostensibly being helped but
instead often are about us. Sometimes they relate to the pain we
might feel at being ostracized or shunned for thinking or acting
differently. Or they relate to building our reputationwe wish to
be publicly perceived as being altruistic, whether or not our efforts
are truly altruistic, so that we can receive the reputational benets
of indirect reciprocity. (Juries are notoriously magnanimous with
other peoplesmoney.) Some would say that, once egoism is in-
volved, the result is no longer altruism, so there is no such thing as
pathological altruism. However, such an interpretation would also
mean there is no altruism, because egoistic reward circuitry
appears to be an important determinant of altruistic behavior.
As the work of Nobel laureate Daniel Kahneman, Jonathan
Haidt, and others has shown, humans possess both intuitive fast
and rational slow cognitive processes (4, 36, 37). Intuitions come
rst; reasoning follows to support that intuition (38, 39). Em-
pathy is driven by fast processes. We often make snap judgments
as a result of empathy and supercial notions of altruism [related
to the moral heuristicsdescribed by Sunstein (40)]. Then, as
both Kahneman and Haidt have explored in depth, we are
experts at justifying emotionally based decisions with back-lled
rationality. Einstellung, the inability to see another solution once
an initial solution is prexed in mind (41), means that a super-
cially helpful approach can become reied, further reinforced by
motivated reasoning, selective exposure, belief perseverance, and
growing overcondence (42), along with moral heuristics such as
those involving omission bias and outrage (40).
However, surprisingly, an individual can be oblivious to the
consequences of these interwoven effects as a consequence of
bias blind spot(43). In this fashion, an initial snap, common-
sense judgment about what seems right in helping others can gel
quickly into formidable certitude without consideration of im-
portant relevant facts. As noted by Mercier and Sperber, there
is considerable evidence that when reasoning is applied to the
conclusions of intuitive inference, it tends to rationalize them
rather than to correct them ... reasoning pushes people not
towards the best decisions but towards decisions that are easier
to justify(42). Intelligence is no safeguard regarding these
conrmation bias-related issues. Highly intelligent people, for
example, do not reason more even-handedly and thoroughly;
they simply are able to present more arguments supporting their
own beliefs (44). As Columbias Mark Lilla has pointed out
Distinguished professors, gifted poets, and inuential journal-
ists summoned their talents to convince all who would listen that
modern tyrants were liberators and that their unconscionable
crimes were noble, when seen in the proper perspective. Who-
ever takes it upon himself to write an honest intellectual history
of twentieth-century Europe will need a strong stomach(45). In
fact, combating extreme conrmation bias has been called one of
psychologys most pressing research priorities (46).
Sometimes it is appropriate to turn off or distance oneself
from feelings of empathy, and it appears such emotional dis-
tancing can be learned (47, 48). In fact, it is clear that turning off
empathybecoming dispassionateis normal in certain con-
ditions, such as a surgeon performing surgery. Indeed, many
hospitals have policies forbidding surgeons from operating on
family members, a circumstance in which it would be more dif-
cult to maintain a dispassionate stance.
In psychology, lack of awareness of limitations and tradeoffs
regarding empathy has spilled over into the therapeutic process
itself. Older therapists remember sayings such as empathy defeats
therapy(49), but such attitudes have fallen away as psychologists
increasingly have placed a premium on empathic care during the
therapeutic process. In a related vein, within the eld of nursing,
the importance of empathy and compassion for patients is em-
phasized so unrelentingly that it would be reasonable to explore
the possibility of a causal relationship between the unilateral focus
on caring and the severe issue of burnout among nurses (50).
Health care workers are not taught about the potential hazards of
excessive or misplaced empathy; consequently, a gradual de-
humanization process unfolds (51). An unconditional support of
empathy and altruism makes matters so difcult for some members
of general society that a counterculture of popular literature and
support groups involving codependency has arisen. However, such
approaches suffer from a lack of scientic merit or rigor (52).
It is clear that, without the support of science, it is impossible
to steer societal mores toward a more nuanced understanding of
altruism and empathy that ultimately can benet everyone.
Extended Implications
There are broader implications related to these issues, particu-
larly regarding the policy aspects of the scientic enterprise.
Good government is a foundation of large-scale societies; gov-
ernment programs are designed to minimize a variety of social
problems. Although virtually every program has its critics, well-
designed programs can be effective in bettering peoples lives with
few negative tradeoffs. From a scientically-based perspective,
however, some programs are deeply problematic, often as a result
of supercial notions on the part of program designers or imple-
menters about what is genuinely benecial for others, coupled
with a lack of accountability for ensuing programmatic failures
(53). In these pathologically altruistic enterprises, conrmation
bias, discounting, motivated reasoning, and egocentric certitude
that our approach is the bestin short, the usual biases that un-
derlie pathologies of altruismappear to play important roles.
For example, teen pregnancy has received substantive focus in
recent years. Teenagers in the United States become pregnant,
contract sexually transmitted diseases, and have abortions at
much higher rates than teenagers in most other industrialized
countries. However, the most effective, scientically proven
approaches to reducing teen pregnancy are often ignored. As
psychologist Timothy Wilson noted in summarizing the many
problematic efforts in this area: The fact that policy makers
learned so little from past researchat huge human and nan-
cial costis made even more mind-boggling by being such a fa-
miliar story. Too often, policy makers follow common sense
instead of scientic data when deciding how to solve social and
behavioral problems(54). Policy-makers and policy-supporters,
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in other words, are shaped by cohesive cognitive biases regarding
their intentions to help others.
In yet another area, ostensibly well-meaning governmental
policy promoted home ownership, a benecial goal that stabilizes
families and communities. The government-sponsored enterprises
Freddie Mac and Fannie Mae allowed less-than-qualied individuals
to receive housing loans and encouraged more-qualied borrowers
to overextend themselves. Typical riskreward considerations were
marginalized because of implicit government support (55). The
government used these agencies to promote social goals without
acknowledging the risk or cost. When economic conditions faltered,
many lost their homes or found themselves with properties worth far
less than they originally had paid. Government policy then shifted to
thecostofthisaltruismto the public, to pay off the too-big-to-fail
banks then holding securitized subprime loans. For those who care
about helping the needy in this country, or those who object to
corporate bail outs, these trillion-dollar costs bring into high relief
the immediate need for scientically informed planning and evi-
dence-based reevaluation. What is of primary concern here is that
altruistic intentions played a critical role in the development and
unfolding of the housing bubble in the United States, which in turn
had enormous impact on the US economy. This recent history
emphasizes the importance of studying not only altruism but also its
biases and the consequences of those biases.
In foreign aid, $2 trillion dollars have been provided to Africa
over the past 50 years. As chronicled by economist and former
World Bank consultant Dambisa Moyo, a native of Zambia, such
aid has resulted in measurably worsened outcomes in a broad
variety of areas, supporting despotism and increasing corruption
and a sense of dependency in Africans (56). In some cases, the
money has been directly responsible for extraordinary damage
(57, 58). Experienced foreign aid worker Ernesto Sirolli echoes
many when he notes that much Western aid arises from narcis-
sistic paternalism and patronization (59). We see here yet another
situation where preconceived altruistic notions render it more
difcult to focus on and react to indications supplied by data.
Viewing altruistic behavior as a source of both potentially posi-
tive and potentially negative inuences may provide a framework
for understanding better a variety of complex challenges. For ex-
ample, one of the most important national issues of our time, as
outlined in the National Academy Press publication Choosing the
NationsFiscalFuture, is the looming federal decit (60). Ralph
Cicerone, President of the National Academy of Sciences, and
Jennifer Dorn, President and Chief Executive Ofcer of the Na-
tional Academy of Public Administration, jointly wrote: Much is at
stake. If we as a nation do not grapple promptly and wisely with the
changes needed to put the federal budget on a sustainable course,
all of us will nd that the public goals we most value are at risk.
How can such budgetary policies arise and continue? Arguably,
their establishment and growth is cultivated by broadly Judeo-
Christian cultural values and educational processes related to
empathy and altruism. [Cultures can conceptualize empathy, al-
truism, and associated values in different ways (4, 61).] In this
cultural perspective, empathy and altruistic intentions often are
viewed as monolithically positive, nearly sacred qualities with
negligible tradeoffs, whether or not the empathy is genuinely
benecial or the outcome of the altruistic intentions is truly al-
truistic. Its the thought that counts,as the saying goes when
discounting negative consequences of altruism.
A supportive bias for claimed altruistic efforts appears to have
contributed not only to a plethora of economic woes but also to
a continuing record of difculties in the social sciences, where
programs, theories, and therapies with altruistic intentparticularly
those which coincide with preconceived obviously benecial
notions of helpingdo not appear to receive the same careful
scientic scrutiny as less obviously well-intentioned programs
(54, 62, 63). This lack of critical appraisal has been seen in vitally
important areas such as the mitigation of posttraumatic stress
disorder, the reduction of family violence, the elimination of
racial prejudice, the reduction of sex differences in mathematics,
and the lessening of adolescent behavior problems and drug use
(6471). In one example, a therapy called Critical Incident
Stress Debriengwas broadly implemented throughout the
United States to reduce posttraumatic stress disorder, even
though this costly program simply did not work and, in fact,
sometimes worsened the very stress it was meant to resolve (67).
Well-meaning but unscientic approaches toward altruistic
helping can have the unwitting effect of ensuring that the ben-
ets of science and the scientic method are kept away from
those most in need of help. In the nal analysis, it is clear that
when altruistic efforts in science are presented as being beyond
reproach, it becomes all too easy to silence rational criticism (62,
70, 7278). Few wish to run the gauntlet of criticizing poorly
conducted, highly subjective sciencewhich is purported to help,
or indeed, of daring to question the basis of problematic scientic
paradigms that arise in part from good intentions. Edward O.
Wilson ran into just such a well-meaning buzz saw with the pub-
lication of his Sociobiology, as did Judith Rich Harris with The
Nurture Assumption and Napoleon Chagnon with his studies of
rates of violence among the Amazonian Ya¸nomamö (10, 79, 80).
To object to a scientic theory is one thing, but to object to
a scientic theory that connects however tenuously to feelings of
morality is quite another. Once morality plays a role, even at the
most subliminal level, the formidable cognitive biases of altruism
and its pathologies can swing into play. Perhaps for that reason
different academic disciplines and specic topics within those
disciplines show differing requirements for rigor. In disciplines
related to helping people (which can encompass a surprisingly
broad swathe of even hard-science topics), scientistsdiffering
treatment of research ndings that elicit altruism bias can skew
the ndings of seemingly objective science (81). As Robert
Trivers has noted: It seems manifest that the greater the social
content of a discipline, especially human, the greater will be the
biases due to self-deception and the greater the retardation of
the eld compared with less social disciplines(82).
One of the most valuable characteristics of science is that,
despite the obvious imperfection of biases in ostensibly objective
scientists, it provides a potential mechanism for overcoming
those biases. At the same time, altruism bias may be one of the
most pernicious, hard-to-eradicate biases in science, because it
involves even-handed examination of what groups of seemingly
objective rational scientists subliminally have come to regard as
sacred. [Biases and belief systems can have a sense of the sacred
even when not formalized as religions (4).]
As noted previously, many government programs are indeed
benecial, and some are invaluable in allowing the population as
a whole to live meaningful lives supported by a safety net for
lifes inevitable difculties. However, the National Academy
Press publication Choosing the Nations Fiscal Future documents
that the federal decit is clearly heading for a crisis. In other
words, as a result of manifold individual decisions, many of which
were based on very real intentions to help others, everyone is at
risk for serious harm. Such crises may arise, not as a tragedy of
the commons, but rather, as a tragedy of altruism.
In the small social groups which characterized most of human
history, altruism bias and pathologies of altruism would have had
few means for extending broad inuence. In modern times, with
the mass outreach potential of a few well-intentioned individuals or
inuential groups, who often have little or no ultimate account-
ability for programmatic failures or other detrimental effects, pa-
thologies of altruism can assume enormous importance. It is
reasonable to help shift the scientic and cultural paradigm and set
the stage so that it becomes culturally acceptable, even expected,
that one should attempt to quantify objectively purported claims of
altruism. This paradigm shift is particularly important with regards
to the budgetary tradeoffs and planning that form important aspects
Oakley PNAS Early Edition
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of effective government that promotes cooperative behavior. The
reality is, as made clear in the joint statement by the presidents of the
National Academy of Sciences and the National Academy of Public
Administration, that unless these types of considerations are made
expeditiously, extraordinary cuts must be made in even the most
genuinely benecial programs (60). A voting public encouraged to
follow a short-term, supercial, feel good,emotionally-based
heuristic for helping others is a voting public that much more easily
can make poor long-term decisions.
Toward a Conceptual Framework
As scientists and engineers know well, all models are wrong, but
some are useful(83). Embedded in any model is perspective,
that is, the framework perceived by the developer. In the past,
altruism (or cooperation) generally has been conceived and
modeled as lying on a continuum between nonexistent and ex-
istent, much like the concept of eusociality (in which the oppo-
site of eusociality is asociality; that is, no tendencies for grouping
or socializing at all (8487). (Asocialmay also be considered,
in some conceptions, to be selshor egoistic.) More recently,
altruism has been conceived on a positive-to-negative continuum
where negative altruism involves malevolent intentions, Machia-
vellianism, and psychopathy (88).
However, altruism can be framed in a third way, as a positive-
to-negative continuum where negative altruism is altruism with
antithetical consequences, i.e., pathological altruism. Viewing
altruism in this way provides insights that relate to both individual
personality traits and to large-scale modeling. There are tradeoffs
to virtually all forms of altruism, and considering altruism as
possessing both positive and negative aspects allows one to take
more careful consideration of who is helped (the beneciary) and
who is harmed (the victim). Sometimes the same individual or
group may be both helped and harmed. Parochial altruismthe
combination of in-group altruism and out-group hostilityis
positive altruism within one group but negative altruism for an-
other. High taxes, for example, may be considered as positive
altruism for one group and as negative altruism for another.
It should be noted that these conceptions formulate the problem
primarily in terms of the altruism provider and stress the liability
arising from, among other things, empathy and identication. It
also is possible to formulate altruism as a dynamic process con-
trolled in part by the altruism seeker (89). Moreover, the entitle-
ments pressed for by the altruism-seeker may be either objectively
helpful (for example, a scholarship sought by a hardworking stu-
dent) or harmful (for example, alcohol sought by an alcoholic). In
other cases, the altruism-seeker may desire seemingly innitesimal
acts of altruism that ultimately play a role in widespread long-term
negative outcomes, as seen with grade ination and social pro-
motion. Jean Twenge and her research group have pointed toward
substantive increases in narcissism in the population over the past
decades, Trends in positive self-views are correlated with grade
ination ... but are not explained by changes in objective perfor-
mance(90, 91). It also may be that the actual help needed by
those seeking or expecting help, as with Munchausen by Internet
(in which Internet users feign a variety of ills to draw attention),
involves something entirely different from what is sought.
Studies suggest that those involved in altruistic transactions
benet differentially from them, and egoism can play surprising
roles. For example, sensitive children may have better personal
outcomes if they behave egoistically in some instances. However,
as shown with Twenges work, other children appear to have un-
realistic expectations when egoistic considerations are encouraged.
The question thus arises: When and for whom is egoistic behavior
benecial or harmful? What is the relationship of egoism to al-
truism andmost importantly for our purposesto pathologies of
altruism? Further, how can we study these issues scientically
without our own judgments and moral righteousness intruding,
guiding answers toward what we are certain will be helpful for
others to hear rather than toward what the data actually reveal?
We can nd clues as to how to proceed by examining prospect
theory, where outcomes are assigned differing values depending
on whether there are gains or losses. Losses hurt more than feel
goodgains. With altruism bias, it appears that people assign
varying values to outcomes based on their underlying moral as-
sessment. An example of such altruism bias was seen in subjects
who were given a posthypnotic suggestion to feel a ash of disgust
(an intimate part of moral judgment) when hearing a particular
arbitrary word. Moral judgmentthat sense of whether some-
thing is or is not helpful for otherscould be made more severe
by the presence of the arbitrary word (92). Researchers were
surprised to nd that even in a control situation where there was
no apparent moral issue, the arbitrary words caused some subjects
to make more negative moral judgments; later, the subjects con-
fabulated stories to explain their behavior. Many factors have been
shown to inuence moral judgment at a subconscious level (4).
It appears that when a person attempts rationally (using the
slowsystem) to calculate the utility of something that he or she
already has judged through fastcognitive processes to be
morally benecial, skewed judgments are made, inating the
good outcomes and deating the bad. Analogously, one can
imagine that if malevolence was the goal, as with ill-intentions by
a parochial in-group toward an out-group, benets would be
deated and harms inated.
A Path Forward
Personal-Scale Studies. Pathologies arising from altruism can be
studied on an individual level. For example, many of the errors of
judgment cited in the extensive listing in ref. 93 could result in al-
truism bias, or altruism bias could underlie and help lead to those
judgment errors. In this regard, does the brain use a simple un-
derlying thumbs upmoral heuristic that leads rationalthought
processes to a foregone conclusion, as with the allegiance effect?
Can such a heuristic be seen as a characteristic signature in medical
imaging? Do individuals vary in their ability to inuence their un-
derlying moral heuristics? Are some individuals addicts of their
feelingsof self-righteousness? What varying effect does culture have
on different individuals moral heuristics? On a side note, it appears
that altruism bias, like many such biases, is a Jamesian fringe phe-
nomenon of consciousness, much like the feeling of familiarity. It
seems to grow from or relate to that little studied sense of rightness,
of certitudea tip-of-the-tongue feeling built on a web of biases,
inuences, and perceptions that one thing is benecial, whereas
another is not (9496). Self-righteousness and pathologies of
certitude have received almost no research emphasis (94, 95).
Narcissism, one of the most strongly heritable of all personality
traits (97), has been similarly neglected. Narcissism is comorbid
with many of the most troublesome personality disorders and
dysfunctions, including psychopathy, borderline personality disor-
der, and bipolar disorder. So it comes as a surprise to learn that
there are almost no hard-science imaging studies focusing on
narcissism, although many other syndromes, as well as the positive
aspects of empathy, have received keen research focus (98100).
Narcissism, in other words, deserves priority in imaging research.
Similarly, the vital topic of codependency has received almost
no hard-science research focus, leaving researchto those with
limited or no scientic research qualications (52). An indication
of the popular need for and interest in this area is that a single
book, Codependent No More, has sold more than ve million
copies over several decades. It is reasonable to wonder if the lack
of scientic research involving codependency may relate to the
fact that there is a strong academic bias against studying possible
negative outcomes of empathy. Codependency, like narcissism,
would thus be an important area of research in the elucidation of
pathologies of altruism.
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www.pnas.org/cgi/doi/10.1073/pnas.1302547110 Oakley
Broad-Scale Studies. At a larger scale, almost any data-driven
model or projection in any discipline or government enterprise
that even indirectly impacts an area of fairness or morality, or
which contains signicant potential for disciplinary bias, can be
examined to see how well it actually has performed in the context
of unfolding real-world data. Unexpected performance of the
model or projection could be an indicator of altruism bias, and the
bias could be quantied as to when, where, why, how, and to what
extent it occurred. For example, a better understanding of al-
truism bias in data analysis and program development and
implementation may provide insights regarding a great variety of
phenomena, including the articially inated values of economic
bubbles or various inadequate statistical measures (for example,
those involving unemployment and economic growth) that can
falsely boost the effects of well-meaning efforts. Concepts of
pathological altruism thus can serve a normative purpose, helping
us create better policies. Knowledge of how altruism bias distorts
objective scientic inquiry can and should be considered a con-
founding factor when developing formal models.
It should be noted, however, that those possessing altruism
bias would be most strongly biased to object to the very concept
of altruism bias (101). Research has shown the near impossibility
of reaching biased individuals using rational approaches, no
matter their level of education or intelligence; such attempts can
be likened to squaring the circle (44, 46).
In another vein, researchers from outside a given discipline,
and who are thus less vested in the theories of that domain
themselves, could initiate studies to determine whether insufcient
statistics, exaggerated claims, drawing the wrong conclusions
from other papers, or using data selectively to conrm hypotheses
might differ among studies that relate to disciplinary biases or
moral issues (many hard-science topics ultimately impact issues of
deep moral concern) versus those that do not. Within scientic
disciplines, the appearance of group-normenforcing signed
petitions could be used as indicators of the potential for pathol-
ogies of altruism; such petitions might communicate important,
albeit unintended, information about the health of a discipline.
Are entire disciplines shaped by papers that are not submitted
because of legitimate fears of rejection? As Santiago Ramón y
Cajal, the father of modern neuroscience, perceptively wrote:
...the good will of scientists is usually so paradoxical that they
are more pleased by the defence of an obvious error which has
become wide-spread than by the establishment of a new fact.
(102) These thoughts were echoed recently in a predictably
controversial paper by John Ioannidis pointing toward the
shockingly high publication rate of false research ndings. Iaon-
nidis noted: ...for many current scienticelds, claimed re-
search ndings may often be simply accurate measures of the
prevailing bias(103). Can disciplinary biases be quantied,
perhaps in studies put forth by interdisciplinary groups (including
nonacademics) from largely outside the discipline in question?
Group-think within disciplines, particularly in regards to differing
editorial standards of proof required for studies that do not hold
to a disciplines underlying moral paradigm, would be a particu-
larly rich, important, and provocative area of study.
Lilienfeld points toward psychological treatments that may
produce harm in relatives or friends of clients in addition to, or
instead of, clients themselves. For example, some treatments that
are otherwise innocuous or even effective with clients could
produce a heightened risk of false abuse allegations against
family members(67). Is it possible that some social advocacy and
social justice efforts result in the same types of pernicious effects
on a societal scale so that efforts to build cooperation instead
inhibit it? We often do not know, because well-meaning advo-
cates have made raising those questions a taboo. Framing issues
in the form of pathologies of altruism and altruism bias forms
a mechanism for breaking through the taboo and making dis-
passionate studies of when helping is truly helping and when it is
contributing inadvertent harm.
Forensic studies of allegiance bias (33) could protably inform
academic disciplines as to how to examine the effects of altruism
bias both within and outside academia, and indeed, in regards to
greater academia itself. In the later regard, it seems academia is
reaching multiple crises, often arising from well-meaning efforts;
such crises include administrative bloat, college tuitions that
have vastly outpaced ination, and students who are left aca-
demically adrift (104).
Potential Steps to Address Altruism Bias in Academic Disciplines and
the Scientic Enterprise. There are active steps that could be taken
to prevent the potential for altruism bias within the scientic
enterprise. In all-important journal review processes, for exam-
ple, mixed panels of reviewers (e.g., cognitive psychologists and
neuroscientists reviewing social psychological papers) could be-
come standard practice (105). Doctoral programs can place
heavier emphasis on the scientic method and careful use of
statistics so that graduate students, who are themselves future
journal reviewers, can learn to spot problematic submissions
more easily and perhaps be less likely to conduct problematic
research themselves. The many aspects of altruism bias and the
problems as well as benets of empathy can be much more
broadly discussed and emphasized in textbooks, beginning even
in high school and the early years of college. Disciplines heavily
involved in social advocacy, whose primary goal involves truly
benetting others, should be among the rst to take interest in
incorporating these concepts and approaches into research and
training programs, editorial efforts, and textbooks.
Conclusions
Science has put extraordinary emphasis on studying the helpful
aspects of altruism, and this emphasis has helped reify altruisms
benets among the general population. However, if science is
truly to serve as an ultimately altruistic enterprise, then science
must examine not only the good but also the harm that can arise
from our feelings of altruism and empathetic caring for others. In
support ofthis idea, it is important to notethat duringthe twentieth
century, tens of millions individuals were killed under despotic
regimes that rose to power through appeals to altruism (106110).
The study of pathological altruism, in other words, is not a minor,
inconsequential offshoot of the study of altruism but instead is
a topic of overwhelming scientic and public importance.
ACKNOWLEDGMENTS. The author thanks Philip Oakley and Joseph Carroll
for extended discussions and Amy Alkon, Gary Barber, Augustine Brannigan,
Bernard Berofsky, Kenny Felder, David C. Geary, Joachim Krueger, Hugo
Mercier, Karol Pessin, Sally Satel, John Traphagan, and Carolyn Zahn-Waxler
for cogent critical suggestions. The suggestions of the anonymous editor and
reviewers also were very benecial.
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... Codependency was first mentioned in the Swedish press around the mid-1990's and discussions about it increased starting from 2004, as the concept was applied to a wider array of addicting substances and problematic behaviors (Palmblad, 2013). In line with the expansion of dependency as a disease category relating to both substance and behavioral addictions (alcohol and other drugs, gambling, food, sex, and shopping), uses of codependency have expanded, and it is used in order to understand other problems such as obesity, spousal and elder abuse, and crime (McGrath & Oakley, 2012). ...
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Codependency is a term used to describe a range of behaviors among persons who are affected by the problematic drug use of family members. This article analyzes how 32 Swedish parents of adult children with drug problems talked about and understood codependency. The sociology of trouble was used as a theoretical framework and three significant themes were identified in the interviews. The parents spoke about how they defined codependency troubles, how they discovered codependency, and how they set boundaries for their children. The parents talked about their situations as highly distressing, and third-party troubleshooters defined their troubles and problems as codependency. The parents generally rejected the advice to “close the door” on their children and engaged in a range of remedial actions. The analytical focus of this study on the identification, definition, and remedial actions of parents gives valuable insights into family disruptions related to drug problems.
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... Further, this study did not measure the self-centered distress that older adults may experience when sharing others' negative emotions (i.e., personal distress; Eisenberg & Eggum, 2009). Such distress can co-occur with individuals' concern for others' misfortunes and may be especially common in close ties (McGrath & Oakley, 2012). The literature links self-centered distress to fewer helping behaviors and reduced well-being (Decety & Lamm, 2009;Hoffman, 2008) but little research examined these links in real-life settings. ...
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Introduction Mutual aid between and among members of a species may be the most potent force in evolution. This was the position taken by the Russian evolutionists who proposed that greater emphasis be placed on ‘mutual aid’ than on ‘survival of the fittest’ in the struggle for existence (Kropotkin, 1989; Todes, 1989). They noted that those species with the most highly evolved brains having the greatest brain weight and the most complex neocortical development show the greatest social cooperation and are the most sociable. MacLean's (1990) emphasis on integrated brain function in social adaptation is critical to understanding the evolution of empathy. He and his colleagues provide an ethological perspective on the study of empathy in their paleo-ethological and ethological studies of behaviour. Evolutionary steps toward sociability are highlighted in his studies of audiovocal communication and on the effects of brain lesions on behaviour in lizards (Anolis carolinensis), rodents and squirrel monkeys. An increase in social behaviour and social responsiveness accompanies the evolutionary transition from reptiles to mammal-like reptiles to early mammals to primates and humans. Preston and de Waal (2002) suggest that in this evolutionary transition there are proximate and ultimate bases for empathy. Proximately, the perception of an object's state activates the individual's corresponding representations, which activate somatic and autonomic responses. They propose a Perception-Action Model (PAM) that along with experience can predict empathetic behaviour or its absence. © Cambridge University Press 2007 and Cambridge University Press, 2009.