Empathy and Imagination
Sara T. Baker
In the April 24, 2007, Science Times section, Richard A. Friedman, M.D., in an article entitled “Understanding Empathy: Can You Feel My Pain?” wonders "Is shared experience really necessary for a physician to understand or treat a patient?"
Dr. Friedman is taken aback by a patient who, describing her symptoms of depression asks “Have you ever been depressed? Do you know how bad it is?”
“Her question,” Dr. Friedman replies, “caught me by surprise and made me pause. O.K., I’ll admit it. I’m a cheerful guy who’s never really tasted clinical depression… (But)….Who would argue that a cardiologist would be more competent if he had had his own heart attack, or an oncologist more effective he had had a brush with cancer.” Empathy, he goes on to say, is what is critical, not necessarily experience. He describes an elderly woman who was skeptical of his ability to treat her after the loss of her husband because he was so young. “True, I had never lost a partner, but it wasn’t hard to imagine her grief and anxiety about her future.”
I was intrigued by Dr. Friedman’s thoughts. I found myself agreeing with him that empathy was that faculty that allows us to “read each other.” However, it seems to me the problem is a bit more complex than that.
I have just finished reading Kazuo Ishiguro’s wonderful novel, Never Let Me Go. With heartbreaking understatement, Ishiguro follows the lives of clones who only gradually come to consciousness about their purpose in life—to provide donor organs. As the book progresses, clones become carers before they become donors. We see how a group of young people who had grown up together and were each other’s intimates, are subtly divided by the distinction between carers and donors. Kathy, a carer, is taking care of her lover, Tommy, a donor. He has requested a new donor for his fourth donation, after which he will “complete.” She is hurt and puzzled by this request, and wonders why he feels more at home with the other donors. “You can’t understand how it is,” he repeatedly tells her. “You haven’t been a donor.” Her last glimpse of him as he turns away from her is of him joining a group of donors, all of them laughing and joking. Her dearest friend, she realizes, feels closer to them than to her because of the group’s shared experience.
It is important to honor the fact that traumatic experiences do bring people to a place which can not be easily imagined. I have some skepticism about Dr. Friedman’s “it wasn’t hard to imagine her grief and anxiety about the future.” Oh, really? I think it would be hard to put yourself in that vulnerable position, to be present to that pain, especially if you are male, young and healthy. Saying that I have imagined the horrors of war is not the same thing as having been through a war. Perhaps we can only begin to be empathic when we recognize that distinction, that there is a divide we cannot cross. I recall the moment when, after a bout of severe post-partum depression, I gave my therapist a poem I had written about how it felt to be me, and he looked up with tears in his eyes and said, “Is it really that bad?” It was his ability to acknowledge that he had never experienced my experience that lead to a much greater healing for me. I simply needed that moment of genuine response.
What I think physicians and healers can bring to their patients is a willingness to be “wounded healers.” If we can be present to our own wounds, our griefs, our failings, our disappointments, if we can eschew the seductively powerful role of being “carers” and instead be whole human beings encountering other whole human beings, then we can work towards empathy.
But such empathy, I think, is never easy. In particular, it is very difficult when working with the terminally ill or dying. The psycho oncologist Esther Dreifuss-Kattan, in her book, Cancer Stories: Creativity and Self-Repair, describes the various ambivalent feelings that the dying stir up in those charged with their care: the reminder of our own mortality, the guilt over surviving, the sense of failure. There may be an impulse to identify with the patient as a defense against guilt for surviving, but “increased identification brings its own pitfalls and tends to mobilize various distancing mechanisms….the (caregiver) might …try to calm the patient with superficial comments, he might become overprotective or …over intellectualize….” In my own practice, I have run the gamut of these feelings, and have added onto them denial and avoidance of feeling them.
Writing and the study of literature help enlarge our capacity for empathy for self and others by allowing us to name these kinds of feelings. In reading, we are able to imaginatively experience emotions, such as guilt, ambivalence and sorrow, in fictional lives, allowing us the distance to explore our reactions to them without condemning or rushing to judgment. By imaging the lives of others, we are also able to imagine our own lives in more dimensionality and compassion. In the practice of reflective writing, we can learn to notice our reactions without judgment, thereby, I believe, becoming more present to our patients. Our writing asserts a self, who, while practicing professional skills and acknowledging boundaries, also has needs, desires, demons and dreams. I believe that it is in becoming more fully human that we can be true healers. And the practice of writing and reading with this intention is a continual education in what it means to be human.
About the Author
Sara T. Baker is facilitator of the Woven Dialog Writing Workshops.
Published: January 8, 2009