Concepts not to be mistaken with compassion – by Christos Lionis

Christos Lionis serves the Clinic of Social and Family Medicine (CSFM) at the Faculty of Medicine, University of Crete as Professor of General Practice and Primary Health Care and Director. He has appointed as Guest Professor of General Practice in the Institute of Health and Medicine at the University of Linkoping, Sweden. He has actively beeninvolved in the development of Primary Care and General Practice in Greece and internationally. Several research collaborative proposals with the involvement of the CSFM have been funded by EU and international agencies with an impact on the capacity building of primary health care and public health in Greece. He is involved in an editorial and advisory capacity with a number of international journals. He is a member of the Executive Board of various professional organisations including that of WONCA Working Party on Mental Health where he is currently elected as Chair. He has been awarded Honorary Fellowships from the Royal College of General Practitioners, the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) and the European Society of Cardiology. Christos has published 411 papers in international journals that they cited in PubMed. Since 2019, Christos is a member of the European Commission Expert Panel on Effective Ways of Investing in Health. 

The term “compassion” has been the subject of several attempts at definition; however, there remains confusion regarding its precise meaning, often leading to conflation with words such as love, altruism, solidarity, and gratitude. Additionally, compassion is frequently conflated with empathy, further complicating its comprehension.

For many individuals, compassion is perceived as an emotional experience directed towards those who are suffering. In a chapter within Seppala et al’s book (2017), Goetz and Simon Thomas discuss compassion not only as a discrete emotion but also as a motivational and transformative force. They argue that it is imperative to distinguish between the subjective emotional experience of compassion and the deeper motivation to provide care and support to others. Both the emotional experience and the motivational aspect are deemed essential components of the cognitive process that engenders an intention to alleviate suffering.

This behavioral dimension, which accompanies emotions and feelings, serves to differentiate compassion from empathy. It is true that confusion between compassion and empathy is frequently introduced. Compassion is a specific response to another person’s suffering (Goetz and Simon Thomas). Therefore, it is important to define suffering, which is a central concept in the discussion of compassion. Suffering is commonly understood as the result of disease, injury, mental discomfort, or trauma.

Ekman and Emma (2017), following the Budish approach, describe three types of suffering. The first type is explicit suffering, which is caused by a specific condition (disease or injury). According to these authors, the second type is the suffering of change, which arises from uncertainty or our inability to accept impermanence, while the third type is all-pervasive suffering, related to the realization that things are different from how we desire or expect. Recognizing suffering and its three types is an essential skill for healthcare providers.

Katie Williamson, in her report on gratitude, compassion, and pride, refers to them as emotional appeals or moral emotions that drive behavior change. She defines gratitude as “an expression of being thankful and appreciative for what one has or experiences” and compassion as “the feeling of care or concern for others experiencing distress or misfortune.” In addition, based on this author, pride is defined as “the feeling of deep satisfaction in one’s achievements.” While compassion is often understood as a feeling or concern, I agree with Williamson’s statement that all three emotions share the qualities of driving behavior change through internal rewards and durability. Leveraging moral emotions can uniquely create spillover to other non-target behaviors and evoke similar emotions in others.

It is also important to add that according to Strauss et al, (2016), compassion involves three processes: cognitive, affective, and behavioral. It has already been stated that suffering plays a critical role in mobilizing compassion, as it initiates the process of mentalization. However, mere recognition of suffering by healthcare providers is not enough to cultivate compassion. Similarly, philanthropic or altruistic behavior and moral emotions should not be confused with compassion for several reasons (Goetz and Simon-Thomas, 2017):

  1. The triple combination of cognitive, affective, and behavioral processes is not present.
  2. The presence of compassion does not guarantee helping behavior.
  3. They do not consistently occur in response to suffering or need.

While these factors can drive behavior change and deserve attention, especially in times of universal mental crisis and widespread suffering, they should not be mistaken for compassion.


  1. Goetz JL, Simon-Thomas E. The Landscape of Compassion and Scientific Approaches. In the Oxford Handbook of Compassion Science by Emma M. Seppälä (ed.), Emiliana Simon-Thomas (ed.), Stephanie L. Brown (ed.), Monica C. Worline (ed.), C. Daryl Cameron (ed.), James R. Doty (ed.) Published in the USA by Oxford University Press: 28 September 2017, pp 3-16.
  2. Ekman P, Ekman E. Is Global Compassion Achievable? In the Oxford Handbook of Compassion Science by Emma M. Seppälä (ed.), Emiliana Simon-Thomas (ed.), Stephanie L. Brown (ed.), Monica C. Worline (ed.), C. Daryl Cameron (ed.), James R. Doty (ed.) Published in the USA by Oxford University Press: 28 September 2017, pp 41-52.
  3. Strauss C, Taylor BL, Gu J, Kuyken W, Baer R, Jones F, Cavanagh K. What is compassion and how can we measure it? A review of definitions and measures. Clin Psychol Rev. 2016; 47:15–27.
  4. Williamson K. Gratitude, Compassion, and Pride: What Do They Have in Common? Behavior Change for Nature, May 30, 2018

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