One of this year’s books to come upon my shelf is Leslie Jamison’s The Empathy Exams, which won the Graywolf Press Nonfiction Prize, and received a glowing review from our friend, Mary Karr, who said it shows well “how empathy deepens us, yet how we unwittingly sabotage our own capacities for it.” The title story recounts the author’s time as a medical actor–a “standardized patient” for med school trainees attempting to diagnose any assortment of maladies. Mixed with the humor this scenario no doubt entails, the essay is also a deeply heartfelt memoir about the writer’s actual medical history–her abortion, her heart disease, and the traumatic connection the two sicknesses had with one another. Through these experiences she moves into the territory of empathy, which, as defined by the patient’s evaluative checklist (#31), is the most important skill for a doctor to utilize: “It’s not enough for someone to have a sympathetic manner or use a caring tone. The students have to say the right words to get credit for compassion.”

Jamison points to the Greek empatheia–that empathy actually means traveling into someone’s feeling. Branching out from the checklist’s affect to her own experiences of empathy, she writes:

9781555976712_custom-ed6d216f73ed55eb053921dc630688676bb0dbe4-s6-c30Empathy isn’t just remembering to say that must be really 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 knowing you know nothing. Empathy means acknowledging a horizon of context that extends perpetually beyond what you can see…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…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?

Tall order. But Jamison isn’t fairy-dusting the concept, she’s drawing out it’s near-miraculous difficulty. She describes the nights before her abortion, when she feels completely isolated, even with the boyfriend who she loves, who loves her, who understands her. Where is the empathy in these moments, when the people you love cannot even find the gates of your traumatic territories? Her boyfriend Dave suggests she’s “making this up”–which sounds harsh, I know–but it brings to light what she means by empathy. What are we asking for when we ask for empathy?

I didn’t know what I felt, I told him. Couldn’t he just trust that I felt something, and that I’d wanted something from him? I needed his empathy not just to comprehend the emotions I was describing, but to help me discover which emotions were actually there…I heard making this up as an accusation that I was inventing emotions I didn’t have, but I think he was suggesting I’d mistranslated emotions that were actually there, had been there for a while–that I was attaching long-standing feelings of need and insecurity to the particular event of the abortion; exaggerating what I felt in order to manipulate him into feeling bad. This accusation hurt not because it was entirely wrong, but because it was partially right, and because it was leveled with such coldness. He was speaking something truthful about me in order to defend himself, not to make me feel better.

Jamison describes that empathy needs consolation for the bad imaginings, for when we construct lies and act manipulatively on their behalf. In other words, wisdom and empathy do not go hand-in-hand. There’s something alienating about someone with all the answers, even the answers you seek. It seems, regardless of her boyfriend’s wisdom on the subject, what she really wanted was someone not to understand, with her. This is the nature of empathy.

At this point, empathy reaches a point of intractable closeness. We long for another’s closeness that cannot be brought by any human anywhere. It is the gift of God. Jamison hints at something like this as she describes going into surgery for her heart operation.

editorial illustration - empathy - rawtoastdesignAt this point, Dave told me later, he went to the hospital chapel and prayed I wouldn’t die. He prayed in the nook made by the propped-open door because he didn’t want to be seen. It wasn’t likely I would die. Dave didn’t know that then. Prayer isn’t about likelihood anyway, it’s about desire–loving someone enough to get on your knees and ask for her to be saved. When he cried in that chapel, it wasn’t empathy–it was something else. His kneeling wasn’t a way to feel my pain but to request it to end.

I learned to rate Dave on how well he empathized with me. I was constantly poised above an invisible checklist item 31. I wanted him to hurt whenever I hurt, to feel as much as I felt. But it’s exhausting to keep tabs on how much someone is feeling for you. It can make you forget that they feel too.

…Dave doesn’t believe in feeling bad just because someone else does. This isn’t his notion of support. He believes in listening, and asking questions, and steering clear of assumptions. He thinks imagining someone else’s pain with so much surety can be as damaging as failing to imagine it. He believes in humility. He believes in staying strong enough to stick around. He stayed with me in the hospital, five nights in those crisp white beds, and he lay down with my monitor wires, colored strands carrying the electrical signature of my heart to a small box I held in my hands. I remember lying tangled with him, how much it meant–that he was willing to lie down in the mess of wires, to stay there with me.