Saturday, March 31, 2007

A Mile in Their Shoes

Last October, I read an article about Empathy Day at UNR's Orvis School of Nursing. In this required experience, nursing students are paired with a partner. Each spends half the day with an assigned disability -- an arm in a sling, say -- to learn what it feels like to navigate everyday experiences with a physical impairment.

The same principle is at work in childbirth classes where fathers are required to wear the Empathy Belly pregnancy simulator, learning firsthand what it feels like to have thirty-five pounds pressing on your bladder, along with a new center of gravity. Likewise, various exercises have been developed to help sighted people understand what it feels like to be blind.

These experiences, of course, are both temporary and low-risk, suggesting limits to the empathy they confer. One can argue that any chosen experience can't truly replicate what it feels like to be in a position where there's no saying no, no opting out. In my Women and Literature class, I'm teaching Barbara Ehrenreich's Nickel and Dimed, about her experiences working a series of low-wage jobs to see if it's possible to live on them. Even though Ehrenreich acknowledges that she isn't, in fact, one of the working poor, and that her account therefore can't come close to describing what it's like to live that way 24/7, my students have been uniformly critical of the fact that Ehrenreich is, in their words, "half-assing it."

The same criticism applies to people who, for instance, spend a night in a cardboard box to try to understand what it feels like to be homeless. That's not homelessness, one might argue, as much as it's a peculiarly low-tech kind of camping. Even the brave souls who go on one-week street retreats to experience homelessness know that they can go back home when the week is over. And while I applaud computerized efforts to help people understand schizophrenia, real schizophrenics can't rid themselves of voices and visions by exiting a computer program.

Still, camping out on the streets for a week entails genuine risk that running a computer program doesn't. Orvis' "Empathy Day," likewise, specifies that the experience has to continue for a set amount of time. But I've started to wonder if the efforts to increase empathy for the ill, disabled and stigmatized would be better served by methods which, while safely temporary, give the subject no control over the condition: simulations that recreate, not simply physical sensations, but the lived experience of powerlessness.

For instance, injections of PCPA, which depletes serotonin in the brain, might induce the despair and helplessness of clinical depression; while I'm unable to find the reference, I remember reading about how people who received these injections indeed quickly felt depressed. If nurses or medical students could be given these injections to understand what depression feels like, would they choose to receive them? Could nursing and medical schools ethically provide them? What about a shot to induce temporary schizophrenia? What are the limits -- practical and ethical -- of stimulating empathy?

Or consider the experience of chronic pain. If healthcare providers could be given a shot to put them into intractable functional pain for an hour or a day or a week, to help them empathize with chronic-pain patients, would they willingly go there? Could we, in good conscience, ask them to?

I wonder if the experiences for which healthcare providers most need to develop empathy are precisely the ones for which any realistic simulation would raise the most daunting ethical dilemmas. It makes sense that the divides that most need to be crossed are the ones that are most difficult to cross. Still, both patients and providers can only benefit from any efforts, however limited, to cross them.


  1. This is definitely an interesting question. I'd have to say that the mobility instructors' simulation is actually probably a pretty good one. The students are actually learning how to move around without sight which does seem to increase empathy. I remember my instructor telling me that she'd found a particular route difficult because of the sounds of sirens bouncing off a particularily echoy overpass. Those types of simulations seem, in my thoughts, to be better because they give the participants a chance to see the challenges, but also the chances for independence. Whereas one day with a blindfold could leave only helplessness or hopelessness. So, from a disability standpoint, the day with a simulation can actually be pretty problematic if we want to be hired. That can be good though to help a doctor, nurse or therapist understand the feeling of sudden disability.

    The control thing is definitely something that I feel is a huge issue when dealing with pain. I think it's hard to understand that helplessness until you experience it. I think there would be serious ethical issues with having someone experience RSD for a day, though. You'd also run into the issues of each person experiencing pain differently.

    I also realize that I don't even think about blindness as a problem anymore, but I'm not there yet with pain. So, that's a bias I have to be careful of.

  2. How about simulating being old?

    Thanks for your comment on one of my recent posts!

  3. Nickie, Yes, you're right that different kinds of simulations would be suitable for different audiences. I hadn't thought about that!

    Martin, that's a great idea. How would you go about it?

  4. Inez S.6:20 AM

    I don't know....this seems a slippery slope to me. It could lead to wholesale empathy training, with those in the helping professions racking up "empathy experiences" as they now do continuing education points. This could well lead to two problems. First, the quantification of empathy -- hiring people based on X number of experiences rather than any notion of how they really relate to people. Also, as we've seen with Service Learning, we can give students certain experiences, but we cannot control what they take away from them.

    This leads to the second problem: people who may think, "now that I've experienced X, I know all about it and will tell you (the disabled/affected person) what is best for you."

    Shouldn't we be, instead of finding as many realistic-as-possible empathy experiences for as many conditions as possible, working on instilling true compassion for all in our helping professions/professionals?

  5. Inez -- Good points. But how does one instill true compassion?

  6. I read about a program that did simulate the physical side of age, to some extent. I believe it involved wearing a special suit that weighed a lot and thus made the wearer feel much weaker and arthritic.

  7. I wonder why I am forcefully remionded of Philip K Dick's story, 'Do Androids Dream of Electric Sheep' - no, the book, not the film.

    Perhaps what we need is imagination rather than what may very well be distinctly ersatz empathy.

    The notion of 'empathy points' and grades is truly chilling.

  8. Martyn: Would you rather that the people who train healthcare providers not try to encourage empathy? I know from my volunteer work with hospital patients that most of them are intensely grateful for anyone who's able to empathize with their experience, or even to try to empathize. And I know from the experience of being in my twenties (the age of most nursing and medical-school students) that even though I had an excellent imagination, I had no clue what it was like to try to move around with joint pain or an orthopedic injury, let alone anything more serious. Yes, imagination's important, but there's a lot to be said for direct physical experience, however brief and simulated.

  9. I think I'm going to have to go with relying on compassion.

    While I appreciate people trying to experience the pain and disability in order to better understand their patients, that is not what patients need from healthcare providers. Perfect understanding of the experience does not, as others have said, necessarily translate into compassion. And it is compassion that the patient truly needs, as well as knowledge and competence when treating them.

    Experiences of the same disability or symptom can be so subjectively different that it may even impair the provider's ability to empathize. I've had two female doctors and one male doctor for prenatal care and delivery of my children. Who was the most compassionate? The male.

  10. I understand what you're going for, the the whole point of empathy is that it's vicarious. If you have actually experienced the experience, I believe you would be commiserating. And why should we have to go through homelessness, or depression or blindness? As humans, we have an imagination that allows us the opportunity to walk in another's shoes without actually doing so. People that don't have this ability are, I believe, sociopaths.


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