Published On Jan 28, 2015
Checklist Item 31
What is empathy, and how can it be taught to young doctors?
A new collection of essays from Leslie Jamison, The Empathy Exams, explores what it means to cross the divide between one person and another. The question—What is empathy?—leads Jamison to a series of encounters with those who suffer pain: ultramarathon runners, gang members in Los Angeles, and those who self-diagnose with Morgellons disease, a condition that has met with widespread skepticism from medical researchers.
In the title essay, Jamison recounts her time as a test patient for doctors in training, and reflects on ways in which empathy should be tested for and measured.
One time a student forgets we are pretending and starts asking detailed questions about my fake hometown—which, as it happens, is his real hometown—and his questions lie beyond the purview of my script, beyond what I can answer, because in truth I don’t know much about the person I’m supposed to be or the place I’m supposed to be from. He’s forgotten our contract. I bullshit harder, more heartily. “That park in Muscatine!” I say, slapping my knee like a grandpa. “I used to sled there as a kid.”
Other students are all business. They rattle through the clinical checklist for depression like a list of things they need to get at the grocery store: sleep disturbances, changes in appetite, decreased concentration. Some of them get irritated when I obey my script and refuse to make eye contact. I’m supposed to stay swaddled and numb. These irritated students take my averted eyes as a challenge. They never stop seeking my gaze. Wrestling me into eye contact is the way they maintain power—forcing me to acknowledge their requisite display of care.
I grow accustomed to comments that feel aggressive in their formulaic insistence: that must be really hard [to have a dying baby], that must be really hard [to be afraid you’ll have another seizure in the middle of the grocery store], that must be hard [to carry in your uterus the bacterial evidence of cheating on your husband]. Why not say, I couldn’t even imagine?
Other students seem to understand that empathy is always perched precariously between gift and invasion. They won’t even press the stethoscope to my skin without asking if it’s okay. They need permission. They don’t want to presume. Their stuttering unwittingly honors my privacy. Can I…could I…would you mind if I—listened to your heart? No, I tell them. I don’t mind. Not minding is my job. Their humility is a kind of compassion in its own right. Humility means they ask questions, and questions mean they get answers, and answers mean they get points on the checklist: a point for getting me to admit I’ve spent the last two years cutting myself, a point for finding out my father died in a grain elevator when I was two—for realizing that a root system of loss stretches radial and rhyzomatic under the entire territory of my life.
In this sense, empathy isn’t just measured by checklist item 31—voiced empathy for my situation/problem—but by every item that gauges how thoroughly my experience has been imagined. Empathy isn’t just remembering to say that must really be hard—it’s figuring out how to bring difficulty into the light so it can be seen at all. Empathy isn’t just listening, it’s asking the questions whose answers need to be listened to. Empathy requires inquiry as much as imagination. Empathy requires knowing you know nothing. Empathy means acknowledging a horizon of context that extends perpetually beyond what you can see: an old woman’s gonorrhea is connected to her guilt is connected to her marriage is connected to her children is connected to the days when she was a child. All this is connected to her domestically stifled mother, in turn, and to her parents’ unbroken marriage; maybe everything traces its roots to her very first period, how it shamed and thrilled her.
Empathy means realizing no trauma has discrete edges. Trauma bleeds. Out of wounds and across boundaries. Sadness becomes a seizure. Empathy demands another kind of porousness in response. My Stephanie script is 12 pages long. I think mainly about what it doesn’t say.
Empathy comes from the Greek empatheia—em (into) and pathos (feeling)—a penetration, a kind of travel. It suggests you enter another person’s pain as you’d enter another country, through immigration and customs, border crossing by way of query: What grows where you are? What are the laws? What animals graze there?
Leslie Jamison, excerpt from “The Empathy Exams” from The Empathy Exams: Essays. Copyright © 2014 by Leslie Jamison. Reprinted with the permission of The Permissions Company, Inc., on behalf of Graywolf Press, www.graywolfpress.org.