What a marvelous book is The Empathy Exams by Leslie Jamison. A collection of essays published by the local Graywolf Press, it actually spent time a little time on the bestseller lists. Now having read it I understand why. It is a beautiful and thoughtful book that examines empathy from a variety of angles and in some surprising places.

The first essay, “The Empathy Exams,” sets the tone. Jamison is working as an actor, playing patient for medical students who are being scored on not only how well they diagnose and treat a problem but on how well they treat the patient. Do they show empathy?

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

Between her experience as an actor for med student exams, Jamison weaves a story of her own medical problems, when she had an abortion and then heart surgery not long after. She has difficulty getting what she needs, getting any sense of empathy or caring from her own doctors; they don’t want to deal with her guilt or her tears and are dismissive of her fear. As a result, she demands so much from her boyfriend that he can’t deliver what she wants either:

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 is shown.

In the essay “Devil’s Bait” she attends a Morgellons Disease conference in Austin, Texas. People with this disease, seventy percent of whom are women, believe they have crawling, biting things under their skin as well as fibers growing through their skin. They end up picking at the “fibers” and scratching and itching themselves so much they cause very real sores that are sometimes so bad they become disfiguring. It is a delusional disease currently not recognized my the medical community. When treatment is given, it is generally an antipsychotic drug which many of the patients end up not taking because they reject their doctor’s diagnosis of delusional parasitosis. The question then becomes, one of “what kinds of reality are considered prerequisites for compassion”? Jamison wonders

is it wrong to call it empathy when you trust the fact of suffering but not the source? How do I inhabit someone’s pain without inhabiting their particular understanding of that pain?

She finds herself wishing she could

invent a verb tense full of open spaces — a tense that didn’t pretend to understand the precise mechanisms of which it spoke; a tense that could admit its own limits.

Jamison’s wide-ranging essays take us from a writer’s conference in Tijuana, Mexico, to Nicaragua when she was teaching kids and got punched in the face while walking down the street. The man took her wallet and broke her nose. We visit the silver mines of Potosí in Bolivia where the miners are doomed to be dead by the age of forty either from a mine accident or silicosis. It is big business for tourists to go to the mines and go down into them to see the miners are work. You are to bring gifts for the miners: sodas, sticks of dynamite, small bags of cocoa leaves. The gifts help you feel better when you get to leave and breathe fresh air again, knowing the men you just met will be underground for another five hours or more.

She goes on a guided tour of South Central Los Angeles and Watts. Run by former gang members the tour fee goes to help pay for the conflict mediation work they are also doing. As they drive around on an air conditioned bus, protected from the outside and being regaled with stories of gang violence, one of the guides talks of Rodney King and his beating by police. Jamison was only nine at the time and she remembers thinking that the police only would have hit him if he had done something wrong. The truth is far more difficult than that of course. So what good is taking such a tour?

The great shame of your privilege is a hot blush the whole time. The truth of this place is infinite and irreducible, and self-reflexive anguish might feel like the only thing you can offer in return. It might be hard to hear anything above the clattering machinery of your guilt. Try to listen anyway.

There is a wonderful essay on sentimentality and melodrama that tries to pinpoint just why we despise it so much yet desire it at the same time. And another in which she writes about three men who were wrongfully convicted as teens for murder and spent eighteen years in jail.

The book’s concluding essay, “Grand Unified Theory of Female Pain” made me want to cry and cheer at the same time. Cry because a 2001 study revealed that women are less likely than men to be given pain medication. Instead, women are given sedatives. The essay discusses through literature and culture and personal experience the ways in which female pain is fetishized or dismissed. These days women are “post-wounded.” Instead of becoming an angel in our suffering we are supposed to pretend we aren’t suffering at all. But, Jamison asks,

How do we represent female pain without producing a culture in which this pain has been fetishized to the point of fantasy or imperative? Fetishize: to be excessively or irrationally devoted to. Here is the danger of our wounded womanhood: that its invocation will corroborate a pain cult that keeps legitimating, almost legislating, more of itself.

Jamison doesn’t come to any definite conclusion on how female pain might be represented, but she is certain that is should never be dismissed even at the risk of its being fetishized:

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.

Empathy of course is the solution. An open heart allows one to be empathetic to the suffering of others whether their pain comes from a delusional disease or a source that cannot be pinned down, or from getting punched in the nose. As she says in an early essay in the book, empathy isn’t just something that happens to us it is also something we choose:

to pay attention, to extend ourselves. It’s made of exertion, the 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 am deep in my own

A beautiful book guaranteed to make you think. I highly recommend it.