What a marvelous book is The Empathy Exams by Leslie Jamison. A collection of essays published by the local Graywolf Press, it actually spent time a little time on the bestseller lists. Now having read it I understand why. It is a beautiful and thoughtful book that examines empathy from a variety of angles and in some surprising places.
The first essay, “The Empathy Exams,” sets the tone. Jamison is working as an actor, playing patient for medical students who are being scored on not only how well they diagnose and treat a problem but on how well they treat the patient. Do they show empathy?
empathy isn’t just measured by checklist item 31 — voiced empathy for my situation/problem — but by every item that gauges how thoroughly me 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.
Between her experience as an actor for med student exams, Jamison weaves a story of her own medical problems, when she had an abortion and then heart surgery not long after. She has difficulty getting what she needs, getting any sense of empathy or caring from her own doctors; they don’t want to deal with her guilt or her tears and are dismissive of her fear. As a result, she demands so much from her boyfriend that he can’t deliver what she wants either:
I needed something from the world I didn’t know how to ask for. I needed people — Dave, a doctor, anyone — to deliver my feelings back to me in a form that was legible. Which is a superlative kind of empathy to seek, or to supply: an empathy that rearticulates more clearly what it is shown.
In the essay “Devil’s Bait” she attends a Morgellons Disease conference in Austin, Texas. People with this disease, seventy percent of whom are women, believe they have crawling, biting things under their skin as well as fibers growing through their skin. They end up picking at the “fibers” and scratching and itching themselves so much they cause very real sores that are sometimes so bad they become disfiguring. It is a delusional disease currently not recognized my the medical community. When treatment is given, it is generally an antipsychotic drug which many of the patients end up not taking because they reject their doctor’s diagnosis of delusional parasitosis. The question then becomes, one of “what kinds of reality are considered prerequisites for compassion”? Jamison wonders
is it wrong to call it empathy when you trust the fact of suffering but not the source? How do I inhabit someone’s pain without inhabiting their particular understanding of that pain?
She finds herself wishing she could
invent a verb tense full of open spaces — a tense that didn’t pretend to understand the precise mechanisms of which it spoke; a tense that could admit its own limits.
Jamison’s wide-ranging essays take us from a writer’s conference in Tijuana, Mexico, to Nicaragua when she was teaching kids and got punched in the face while walking down the street. The man took her wallet and broke her nose. We visit the silver mines of Potosí in Bolivia where the miners are doomed to be dead by the age of forty either from a mine accident or silicosis. It is big business for tourists to go to the mines and go down into them to see the miners are work. You are to bring gifts for the miners: sodas, sticks of dynamite, small bags of cocoa leaves. The gifts help you feel better when you get to leave and breathe fresh air again, knowing the men you just met will be underground for another five hours or more.
She goes on a guided tour of South Central Los Angeles and Watts. Run by former gang members the tour fee goes to help pay for the conflict mediation work they are also doing. As they drive around on an air conditioned bus, protected from the outside and being regaled with stories of gang violence, one of the guides talks of Rodney King and his beating by police. Jamison was only nine at the time and she remembers thinking that the police only would have hit him if he had done something wrong. The truth is far more difficult than that of course. So what good is taking such a tour?
The great shame of your privilege is a hot blush the whole time. The truth of this place is infinite and irreducible, and self-reflexive anguish might feel like the only thing you can offer in return. It might be hard to hear anything above the clattering machinery of your guilt. Try to listen anyway.
There is a wonderful essay on sentimentality and melodrama that tries to pinpoint just why we despise it so much yet desire it at the same time. And another in which she writes about three men who were wrongfully convicted as teens for murder and spent eighteen years in jail.
The book’s concluding essay, “Grand Unified Theory of Female Pain” made me want to cry and cheer at the same time. Cry because a 2001 study revealed that women are less likely than men to be given pain medication. Instead, women are given sedatives. The essay discusses through literature and culture and personal experience the ways in which female pain is fetishized or dismissed. These days women are “post-wounded.” Instead of becoming an angel in our suffering we are supposed to pretend we aren’t suffering at all. But, Jamison asks,
How do we represent female pain without producing a culture in which this pain has been fetishized to the point of fantasy or imperative? Fetishize: to be excessively or irrationally devoted to. Here is the danger of our wounded womanhood: that its invocation will corroborate a pain cult that keeps legitimating, almost legislating, more of itself.
Jamison doesn’t come to any definite conclusion on how female pain might be represented, but she is certain that is should never be dismissed even at the risk of its being fetishized:
The wounded woman gets called a stereotype and sometimes she is. But sometimes she’s just true. I think the possibility of fetishizing pain is no reason to stop representing it. Pain that gets performed is still pain. Pain turned trite is still pain. I think the charges of cliché and performance offer our closed hearts too many alibis, and I want our hearts to be open. I just wrote that. I want our hearts to be open. I mean it.
Empathy of course is the solution. An open heart allows one to be empathetic to the suffering of others whether their pain comes from a delusional disease or a source that cannot be pinned down, or from getting punched in the nose. As she says in an early essay in the book, empathy isn’t just something that happens to us it is also something we choose:
to pay attention, to extend ourselves. It’s made of exertion, the dowdier cousin of impulse. Sometimes we care for another because we know we should, or because it’s asked for, but this doesn’t make our caring hollow. The act of choosing simply means we’ve committed ourselves to a set of behaviors greater than the sum of our individual inclinations: I will listen to his sadness, even when I am deep in my own
A beautiful book guaranteed to make you think. I highly recommend it.
I have read of few of the essays in Jamison’s book and what I find missing is any thorough- going discussion of the equal need of men for empathy for whatever reasons they might long for it.
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This sounds an interesting book on an important subject. I wonder if Jamison says anything about book reading and empathy. Reading fiction ought to help us empathise with others – does it always and it what ways?
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Ian, it is a very well written and interesting book. She is not so much interested in how we develop empathy but in the conditions under which we are willing and or able to give empathy to someone. However, she makes a lot of literary references and includes a multipage bibliography in the back of the book. She also has much to say about James Agee, not fiction, but really interesting nonetheless.
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Richard, except for the final essay, the book is not about women at all, nor is the book about the how or why we need empathy. Rather, the focus of all the essays is on how we give empathy, how we determine who is worthy of our empathy, and some of the things that block us from even being open to consider giving empathy to someone. Female pain gets a special essay because it is a special case in western culture where women who are in pain are very often told they are being hysterical and making it up, thus they are given sedatives instead of pain medication. The question in that essay is why is it so hard to empathize with women in pain and why as a culture do we tend to either fetishize it or dismiss is altogether.
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I have been thinking a lot about essays these past few days and how they fit into the life of a reader. I have plans to expand my reading in this area and so this is going on an ever growing list of possibilities. I want to start with essays about literature and reading because I will be on safe ground there, but eventually reach out to wider issues such as this.
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Alex, I love reading essays so much and I can’t even say why exactly. I was wondering the other day why it was I’d buy a book of essays I know nothing about but you’d have to twist my arm to get me to read short stories even when highly recommended. It’s a baffling thing for me. If you are looking for some great essays about literature, might I recommend Seduction and Betrayal by Elizabeth Hardwick? I think you might like it.
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I find the idea of an actress playing a patient to help doctors at least get a sense of empathy fascinating, especially as the author has had plenty of experience with the lack of empathy. When my mother was ill, I was shocked by the lack of empathy on the part of her oncologist. Her radiologist, on the other hand, was wonderful. He listened and made us feel that he really cared about how she felt (he never sugar-coated, but he had compassion…and he didn’t even see her as much as the oncologist, who kept his distance from the beginning. I wanted her to change doctors, but mother was a stoic, and I think she wanted that distance.
It is also true that there have been many times that I’ve lacked empathy, and it is such a shameful thing to realize.
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Jenclair, I had no idea there was even such a program and that students had to undergo such a test, but I am glad for it. I have met some extremely unsympathetic doctors, none quite like your experience though, how awful that must have been! There have been plenty of times where I lacked empathy too for whatever reason or that I have been willing to give it but only for so long. This book really makes you think about what is behind it all.
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This sounds like a great read. I love the idea “Empathy requires knowing you know nothing”. I do think that’s important to recognise. And I like the paradox of not wanting yet also seeking sentimentality and melodrama. Thanks for sharing this book. Just for interesting – how long is it?
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whisperinggums, that is an interesting idea isn’t it? I have never thought of empathy in that context before but it totally makes sense. I very much enjoyed the essay on sentimentality and melodrama and can relate to the paradox because I hate it but in the right mood I totally love it. She has some interesting things to say about why that might be. The book length is, in my opinion, perfect, a little over 200 pages.
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The closest I’ve got to that idea is realising that you never really can say ” I know how you feel” because, really, we can’t. We might know, or think we know, how we’d feel but we can’t ever truly know how another person feels.
200 pages sounds perfect to me too. One more question … Who/what do you think the book was written for?
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whisperinggums, You are right, we never can truly know how another person feels. The essays often tend to be very personal in one way or another and I get the feeling that many of them she wrote because she was personally touched or interested in the subject and then she noticed she had a number of essays circling around the same topic so dove deeper into it in several instances. I think the book in many was from her own interest but also there is a bit of a political/social commentary edge to a number of the essays that also drives it.
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Just fascinating – thanks Stefanie for replying further.
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Oh dear, I book I absolutely have to have. You saw me coming for this one, didn’t you? 😉
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Litlove, LOL, yes my friend, I thought of you as soon as I finished the book 🙂
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I’ve heard good things about this one and will have to add it to my wishlist. I have not read a single essay (unless you count the odd New Yorker article here and there) all year! I had no idea women are not given pain medicine like men–how bizarre–maybe doctor’s know that men can’t hack pain like women? (though that is really pretty cruel–sedatives? Really?).
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Danielle, I love a good essay collection but have a harder time reading short stories so between us I think we even things out 🙂 Men are given pain medication because doctors believe then when they say they are in pain. Women aren’t given pain medication because doctors don’t believe them, think that they are making it up and so prescribe them sedatives instead. Sad, isn’t it?
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I loved this collection too — Jamison seems so smart and makes interesting arguments and tells stories well. I can’t wait to see what else she writes in the future. I love Graywolf Press too — they have been doing so well lately!
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Rebecca, she does seem really smart and I liked the way she integrated her sometimes very personal experience into the essays without making them all about her. I also look forward to what else she might write. Graywolf has been doing well lately, haven’t they? It’s rather exciting.
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