The Empathy Exams

07book "The Empathy Exam" by Leslie Jamison.Why do so many of our favorite stories involve extreme suffering? What’s the value for us in watching others’ pain? I wonder this about myself sometimes. Jude the Obscure is, after all, among my favorite books, and I enjoy reading real-life disaster stories and true crime. I have my limits, but on the whole, I like my stories sad. Happy endings to those sad stories are nice, but not required. Am I just a voyeur, relishing other people’s pain, turning it into my entertainment?

In this essay collection, Leslie Jamison explores other people’s pain—and our interest in other people’s pain. The collection begins with the title essay, “The Empathy Exams,” which describes her work as a medical actor, pretending to be sick for a series of medical students and then rating them on how well they demonstrated empathy. Her descriptions of this work alternate with the story of her own abortion and heart surgery. The jumps back and forth between the two experiences made the essay less than successful for me. There were no new insights here, aside from a few musings about the contrast between what we may expect to feel and what we actually feel. But the essay as a whole felt unpolished, rambling. It probably didn’t help that I read it in my office lunchroom with Ebola panic news stories blaring behind me on CNN, but I just reread the essay and only liked it marginally better.

The other essays, on the other hand, were great. It’s probably a good thing that one of my favorites, “Devil’s Bait,” came second in the collection, when I was trying to decide whether to continue reading. In this essay, Jamison recounts her experiences at a conference for people with Morgellons disease, a condition that involves strange, unidentified fibers growing out of sufferers’ skin, sometimes causing sores, itching, and a feeling of having insects crawling under the skin. Whether the fibers are real is up for debate, with the CDC unable to verify their reality and those with the disease being certain that they are. Jamison treats the people she speaks to with compassion, recognizing that whether or not the fibers exist, the suffering cannot be denied. She can see it in her own experience, as she talks to a woman named Dawn, who is fearful about her future:

With Dawn I fall into the easy groove of identification—I’ve felt that too—whenever she talks about her body as something that’s done her wrong. Her condition seems like a crystallization of what I’ve always felt about myself—a wrongness in my being that I could never pin or name, so I found things to pin it to: my body, my thighs, my face. This resonance is part of what compels me about Morgellons: it offers a shape for what I’ve often felt, a container or christening for a certain species of unease. Dis-ease. Though I also feel how every attempt to metaphorize the illness is also an act of violence—an argument against the bodily reality its patients insist upon.

My willingness to turn Morgellons into metaphor—as a corporeal manifestation of some abstract human tendency—is dangerous. It obscures the particular and hidden nature of the suffering in front of me.

It’s so easy to want to turn others’ suffering into our own, to seek common ground, to make their pain into something we understand. I don’t think that’s always a bad impulse, especially if it makes us more able to provide support. Yet every pain is specific, and if I assume your pain is like my pain, I might be getting your pain wrong or, worse, expecting you to cope in the same way I have. Whatever empathy we can offer on the basis of commonality of experience has limits.

But our uniqueness has limits, too, an idea Jamison explores in “In Defense of Saccharin(e).” Here, she considers why people are so often suspicious of sentimentality and wonders at what point an expression of feeling tips over into a syrupy falseness. She makes a case for strong emotion, while acknowledging her own fear of expressing it:

There are several fears inscribed in this suspicion: not simply about melodrama or simplicity but about commonality, the fear that our feelings will resemble everyone else’s. This is why we want to dismiss sentimentality, to assert that our emotional responses are more sophisticated than other people’s, that our aesthetic sensibilities testify, iceberg style, to an entire landscape of interior depth.

In most essays, Jamison is an outsider to the suffering, observing other people in pain by visiting a prison inmate or watching a documentary about the West Memphis Three, yet she keeps her own self in view, examining her own reactions to what she’s observing. Why does she feel empathy here and not there? Some essays are more distant than others—the two “Pain Tours” are probably the least intimate, offering short descriptions of people and places she’s visited or thought about.

The final essay pulls everything together to present a “Grand Unified Theory of Female Pain.” In this essay, Jamison chronicles one story of women’s wounds after another, some real and some fictional. There’s Miss Havisham, Sylvia Plath, anorexics and cutters, Tori Amos and Ani DiFranco, and Carrie White. Each case is unique, yet they’re all, somehow, representative of a particularly female sort of pain. Why do these stories of suffering women resonate? Why do we tell and retell them?

Stephen King’s Carrie, the girl who was told to plug up her bleeding as soon as it became visible, eventually takes her suffering and turns it outward. Jamison writes,

The premise of Carrie is like porn for female angst: what if you could take how hard it is to be a girl—the cattiness of frenemies, the betrayals of your own body, the terror of a public gaze—and turn all of that hardship into a superpower? Carrie’s telekinesis reaches the apex of its power at the moment she is drenched in red, the moment she becomes a living wound—as if she’s just gotten her period all over herself, in front of everyone, as if she’s saying, fuck you, saying, now I know how to handle the blood.

I don’t necessarily agree with her reading of Carrie. It’s not like Carrie left that bloodbath triumphant, but perhaps that speaks to the danger that could come of taking control of our suffering. Because I do think we may tell these stories as a way of gaining control over our pain. I’ve recently gone through a couple of months of physical therapy, and my therapist told me more than once that I needed to tell her when something hurt, that keeping silent wasn’t going to help me get better. It seems obvious, but aren’t we conditioned to be stoic about our pain, even when telling someone may be the only way to cure it?

This week has seen multiple women speak up about being physically beaten by a prominent radio personality. In this case, the women kept silent for years because they didn’t think they’d be believed or they wanted to forget it. Jamison notes in this essay that doctors are more likely to give pain medicine to men than to women, discounting women’s pain as “emotional.” Women who say they won’t be heard when they speak may have a point. But maybe telling our stories again and again and again and again and again can become a way of handling the blood. Jamison closes the essay with these words:

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.

Maybe we listen to people’s stories of pain because those stories need to be told. And stories that need to be told also need to be heard.

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10 Responses to The Empathy Exams

  1. Rohan says:

    That question about voyeurism when reading about suffering is such an interesting one – it really pressed on me when I was reading ‘We Wish to Inform You that Tomorrow We Will Be Killed with our Families,’ for instance. I think, as your final examples suggest, we should not feel that we are being prurient: there’s value in knowing and acknowledging other people’s suffering. That said, I still find it distressing that Jude could be anyone’s favorite! :-) (I’m about to start working through it with my class and as always I am crushed by how relentlessly depressing it is. Just when you think it can’t get any worse …)

    • Teresa says:

      I think there is a line somewhere that turns it into voyeurism, but I don’t know where it is–and it’s probably not a clear-cut line. But turning away out of fear of being prurient isn’t a good answer, I don’t think.

      I find Jude weirdly cathartic. I know life isn’t as bad as all that–that people will often come when you ask (which speaks to the whole point about speaking up), but sometimes it does feel like nobody ever comes, and I find reassurance in seeing it said. Also, I love Sue as a character, messy as she is. It’s a book I wish I’d had the opportunity to study. You’re giving your students a gift I’d love to have!

  2. Deb says:

    I recently read an excerpt from the chapter on Morgellons disease–which is almost medieval in both its obscure origin and the undeniable suffering of the people who are convinced they have it. For myself, whenever I read accounts of pain and suffering, there’s an element of “I’m so glad that’s not me” going on. It’s as if I’m telling myself how fortunate I am (which, for the most part when it comes to pain, I very much am). I try not to read what the English call “misery memoirs” with voyeurism; I do try to be empathetic, but by the same token I can’t deny there’s often a sense of “Whew–glad I’ve dodged that bullet!”

    • Teresa says:

      There is that. I find that feeling comes up for me when I read stories of exploration disasters. It’s like I get to pat myself on the back for not taking risks and therefore avoiding getting lost at sea or dying on a mountaintop. I’m probably not at my most empathetic when I read those books, although a good writer, like Jon Krakauer, can get me into that space.

  3. I am also drawn towards books that contain suffering so I think it would be really interesting to read this book. I think I read depressing books to make my own problems seem trivial. In a weird way it makes me happier, but I also think there may be some voyeurism in there – and that is quite worrying., Thanks for drawing this book to my attention.

    • Teresa says:

      I’m still working out where that line is for me. Sometimes I do find comfort in knowing that at least my life isn’t that bad, but I also sometimes find that reading painful stories makes me more able to recognize that people who bug me may be dealing with pain I don’t see. I think that may be the kind of open heartedness Jamison is hoping for.

  4. It’s interesting — I can read a ton of nonfiction with the saddest stories in them, but it’s much harder for me to derive enjoyment from unrelentingly dark fiction. (Thomas Hardy, for instance, will never be the author for me.)

    • Teresa says:

      See, I sometimes feel guilty when I read sad nonfiction, like I’m finding entertainment in other people’s suffering. That’s especially true of the books about disasters or true crime.

  5. Stefanie says:

    I really liked this essay collection and that final essay I thought was especially excellent. Aren’t the Morgellons people fascinating? Their pain and suffering is real even if those fibers aren’t and I really felt for them and their plight.

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