The Empathy Exams by Leslie Jamison

Image result for the empathy exams leslie jamisonI hadn’t planned to read this book. I have a friend who sent me a copy and as I’m trying to keep on top of any ‘new’ books I acquire (not adding to the TBR list) and as the gift of a book is ever an act of extreme kindness, I decided to read it straight away. I had no idea what to expect, it wasn’t a book that was on my radar, I hadn’t heard of the writer and I had no clue what the book was about except that it must have something to do with empathy unless the title was one of those obscure ones or a quotation lifted from something else (Tigers in Red Weather being a good example of this, I have been intrigued as to how a story could have generated from that unusual little poem by Stevens, or if it shares any connection to it at all beyond that arresting line. I don’t believe it is a story about a sailor drunk and asleep in his boots. That being said, I still haven’t read it). Long-winded aside…aside, I was very pleasantly impressed with this book and very grateful to my friend for being my friend (always) and for sending it to me.

The Empathy Exams is a series of essays exploring different aspects of empathy, the way empathy arises, how it fails, what we expect of it and what we can’t. Each essay takes a different angle on the subject, sometimes only loosely linked but always linked in some form. The book begins with a story of how Jamison has acted as a ‘medical actor’, a job which requires her to act sick so that trainee doctors can learn to elicit information to generate a diagnosis. Part of the testing involves scoring the trainees for the degree of empathy they express so that, ultimately, they can better diagnose a patient, as Jamison explains “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.” The essay then morphs into certain events from Jamison’s life – her abortion and the discovery of a heart condition which occurred almost simultaneously – and how those events have revealed, or exposed, her own need for empathy and the tricks and tools she used to try to get it, as we all do. “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’s shown.”

From there she goes on to explore empathy from another angle when she spends some time at a conference for people suffering from Morgellons disease, a condition which is believed by the medical community to be a kind of delusion in which people believe their skin is infected with parasites but for which there is (or may be) no evidence. Here Jamison explores the (understandable) need for people to be believed, to believe that the symptoms they’re experiencing a real – and by real this means generated via an external cause, something which has been done to them or an agent acting upon them. This reminded me strongly of Suzanne O’Sullivan’s It’s All in Your Head which explored another condition apparently without external cause, and the experiences of the sufferers were similar in many respects. Jamison both shows the pain of the sufferers, and their needs and their hopes, as well as her own response to them, her attempts to be empathetic and the ways in which this succeeds or fails.

Further essays explore the efforts of poets living in the crime zones of Mexico, a series of essays called “Pain Tours” which cover the way in which the pain of others is explored as entertainment or some kind of spectacle – visiting the silver mines of Cerro Rico, a tour of the hood, interventionist television shows (and, one could argue, crime fiction!); and in the second section the way art elicits or explores aspects of pain which references Frida Kahlo, Joan Didion, James Agee. There are essays on the bad reputation of excessive sentiment, extreme running races, a friend in prison. But it was, for me, the final two essays which really stood out. The first of these is called Lost Boys and it explores a series of documentaries called Paradise Lost which focuses on the conviction of three boys for the murder of three other boys, a conviction which was later overturned. It is a powerful piece which examines the issue from the perspective of the victims, the victims’ families, the convicted boys, the documentary makers (and the way they will elicit a particular view through clever editing, something which anyone who listened to the podcast Serial will, perhaps, understand), the police. Jamison considers why it is that we somehow need a simple narrative, that we require cause and effect which in the case of crime more specifically equates to motive and how in the absence of motive we resort to even simpler (or arguably more complex) narratives like ‘evil’ or ‘satanism’. In this short essay she shows the infinite complexity of such a subject, how we want to make it simple but it is never simple.

The last essay called A Grand Unified Theory of Female Pain is similarly powerful, exploring the complexity of female pain as spectacle, as a source of attraction, the reality of pain being something experienced, and the many ways in which it is responded to. She explores this through a series of ‘wounds’, each wound being a kind of pain or a response to pain experienced by women; things like anorexia (though anorexia and other kinds of eating disorder are a growing issue for young boys too), like periods, like the way in which female pain is dismissed both by men and by women and, perhaps more disturbingly, by doctors or the officiating community. In Wound 7, Jamison makes reference to the TV show Girls and how it reflects the female reaction to the idea of the ‘wounded’, frail woman:

“These girls aren’t wounded so much as post-wounded, and I see their sisters everywhere. They’re over it. I am not a melodramatic person. God help the woman who is. What I’ll call “post-wounded” isn’t a shift in deep feeling (we understand these women still hurt) but a shift away from wounded affect – these women are aware that “woundedness” is overdone and overrated. They are wary of melodrama so they stay numb or clever instead. Post-wounded women make jokes about being wounded or get impatient with women who hurts too much. The post-wounded woman conducts herself as if pre-empting certain accusations: don’t cry too loud, don’t play victim, don’t act the old role all over again. Don’t ask for pain meds you don’t need; don’t give those doctors another reason to doubt the other women on their examination tables.”

It is a narrative I recognise, the idea that expressing pain is ‘melodramatic’ and that hiding it is the way to move past pain, to excessively hide it. I’ve been there, I’ve been impatient with friends in pain or, perhaps, who I have perceived as being excessively in pain, and I suspect I am not alone in that either. Subtly, and relentlessly, Jamison makes a case for feeling, for women to express their feelings not because the idea of a ‘frail’ or ‘wounded’ woman is appealing (I’m reminded of Mary Oliver’s essay on the subject of Poe’s fiction here, which involved a repeated image of the pale, slender, ghostly woman that may also have been representative of both his mother and step-mother) but because it is simply what they feel, that they should not be quashed by accusations of melodrama. It made me think about what it is about the pain of others which makes people, and I include myself in this, so uncomfortable – think about the reactionism to feminist claims of rape culture, or men’s rights activists demanding a role for fathers in their children’s lives. The idea that my pain > your pain means that one person must give whilst the other always takes, I wonder how much this is at root of so many of our difficulties in understanding the griefs of others and, perhaps, doing something about it. I don’t know any answers, but Jamison’s book certainly got me thinking.

This book made for a fascinating interruption from my expected reading schedule. It is thought-provoking, beautifully written and soulfully honest. Jamison lays out her own pain and the pain of others, not as a spectacle but as a request for understanding and empathy. Because if we give empathy, we’re more likely to receive it, and surely this has always got to be better than the alternative?


About bookbii

I'm an ordinary woman living an ordinary life in an ordinary place, and it is quietly wonderful
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4 Responses to The Empathy Exams by Leslie Jamison

  1. I’m fascinated by the idea of the ‘medical actor’. I’ve often thought how difficult it must be to understand and assess pain as a medic, both physical and psychological pain. What I describe as discomfort you may call pain, and if we’re asked to rate the sensation on a scale of 1-10 we may come up with completely different numbers. Wholeheartedly agree with your last sentence.

    • bookbii says:

      Thanks Susan. I think you’re right that pain is very personal. One of the points Jamison mentions is that doctors are less likely to prescribe pain medication for women, dismissing their pain as hysterical, even though women are more pain sensitive. There is evidence that women are often fobbed off with sedatives instead, and a school of thought that because women generally experience more pain (e.g. periods) then our sensitivity comes from a need to distinguish something catastrophic from the normal everyday pain. It’s quite disheartening to think that women who assess their own pain as needing attention are sent away being made to feel that they’re imagining it. It’s a fascinating book.

  2. SimplyMe says:

    Your review of this book made me think of a mine with more than one rich vein of ore. I’ve placed a hold on it and unlike Mary Oliver (where I’m #49 on the hold list), Leslie Jamison will come quickly (I’m #1). I will respond once I’ve read her essays and look forward to exchanging thoughts with you.

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