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.