“Empathy means acknowledging a horizon of context that extends perpetually beyond what you can see.”

From: Leslie Jamison’s The Empathy Exams (2014), (winner of the Graywolf Press Nonfiction Prize):

“My job title is medical actor, which means I play sick. I get paid by the hour. Medical students guess my maladies. I’m called a standardized patient, which means I act toward the norms set for my disorders. I’m standardized-lingo SP for short.

Medical acting works like this: You get a script and a paper gown. You get $13.50 an hour. Our scripts are 10 to 12 pages long. They outline what’s wrong with us—not just what hurts but how to express it. They tell us how much to give away, and when. We are supposed to unfurl the answers according to specific protocol. The scripts dig deep into our fictive lives: the ages of our children and the diseases of our parents, the names of our husbands’ real estate and graphic design firms, the amount of weight we’ve lost in the past year, the amount of alcohol we drink each week…

Once the 15-minute encounter has ended, the medical student leaves the room, and I fill out an evaluation of his/her performance. The first part is a checklist: Which crucial pieces of information did he/she manage to elicit? Which ones did he/she leave uncovered? The second part of the evaluation covers affect. Checklist item 31 is generally acknowledged as the most important category: “Voiced empathy for my situation/problem.” We are instructed about the importance of this first word, voiced. 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…

Other students seem to understand that empathy is always perched precariously between gift and invasion. They won’t even press the stethoscope to my skin without asking if it’s okay. They need permission. They don’t want to presume. Their stuttering unwittingly honors my privacy: Can I . . . could I . . . would you mind if I—listened to your heart? No, I tell them. I don’t mind. Not minding is my job. Their humility is a kind of compassion in its own right. Humility means they ask questions, and questions mean they get answers, and answers mean they get points on the checklist…

In this sense, empathy isn’t just measured by checklist item 31—voiced empathy for my situation/problem—but by every item that gauges how thoroughly my 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.

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…

I could tell you I got an abortion one February or heart surgery that March—like they were separate cases, unrelated scripts—but neither one of these accounts would be complete without the other…

Feeling Dave’s distance that day had made me realize how much I needed to feel he was as close to this pregnancy as I was—an impossible asymptote…

…I needed his empathy not just to comprehend the emotions I was describing, but to help me discover which emotions were actually there…

In order to help the med students empathize better with us, we have to empathize with them. I try to think about what makes them fall short of what they’re asked—what nervousness or squeamishness or callousness—and how to speak to their sore spots without bruising them: the one so stiff he shook my hand like we’d just made a business deal; the chipper one so eager to befriend me she didn’t wash her hands at all…

A 1983 study titled “The Structure of Empathy” found a correlation between empathy and four major personality clusters: sensitivity, nonconformity, even-temperedness, and social self-­confidence. I like the word structure. It suggests empathy is an edifice we build like a home or office—with architecture and design, scaffolding and electricity.

Rating high for the study’s “sensitivity” cluster feels intuitive. It means agreeing with statements like “I have at one time or another tried my hand at writing poetry” or “I have seen some things so sad they almost made me feel like crying””and disagreeing with statements like: “I really don’t care whether people like me or dislike me.” This last one seems to suggest that empathy might be, at root, a barter, a bid for others’ affection: I care about your pain is another way to say I care if you like me. We care in order to be cared for. We care because we are porous. The feelings of others matter, they are like matter: they carry weight, exert gravitational pull.

It’s the last cluster, social self-confidence, that I don’t understand as well. I’ve always treasured empathy as the particular privilege of the invisible, the observers who are shy precisely because they sense so much—because it is overwhelming to say even a single word when you’re sensitive to every last flicker of nuance in the room. “The relationship between social self-­confidence and empathy is the most difficult to understand,” the study admits. But its explanation makes sense: social confidence is a prerequisite but not a guarantee; it can “give a person the courage to enter the interpersonal world and practice empathetic skills.” We should empathize from courage, is the point—and it makes me think about how much of my empathy comes from fear. I’m afraid other people’s problems will happen to me, or else I’m afraid other people will stop loving me if I don’t adopt their problems as my own…

I wonder if my empathy has always been this way: just a bout of hypothetical self-pity projected onto someone else. Is this ultimately just solipsism? Adam Smith confesses in his Theory of Moral Sentiments: “When we see a stroke aimed and just ready to fall upon the leg or arm of another person, we naturally shrink and draw back our own leg or our own arm.”…

Empathy isn’t just something that happens to us—a meteor shower of synapses firing across the brain—it’s also a choice we make: to pay attention, to extend ourselves. It’s made of exertion, that 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’m deep in my own. To say going through the motions—this isn’t reduction so much as acknowledgment of effort—the labor, the motions, the dance—of getting inside another person’s state of heart or mind.

This confession of effort chafes against the notion that empathy should always rise unbidden, that genuine means the same thing as unwilled, that intentionality is the enemy of love. But I believe in intention and I believe in work. I believe in waking up in the middle of the night and packing our bags and leaving our worst selves for our better ones.”

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