Wednesday, April 04, 2007

Today's Discussion Question

My post about using simulated disabilities to increase empathy has, to my considerable surprise, gotten quite a few comments from people saying that these are specious exercises, and that compassion's better than empathy.

Part of the argument seems to be that empathy exercises may lead people to believe that they understand something they really don't. Well, sure: but having your own episode of any given illness or injury could have the same effect. ("I know just what you're going through, because I broke my leg once too!") My take on the subject is that even with the best will and imagination in the world, we learn things through direct physical experience that we couldn't learn other ways. However, I seem to have been outvoted on this.

By the way, I'm defining empathy as understanding gained through shared experience, and compassion as a more generalized desire to ease suffering. If someone else is defining these terms differently, please let me know.

But even if we accept the premise that compassion is better than empathy -- and I'm not sure the two can be separated so neatly -- we're still left with the question of how to make people more compassionate; and, specifically, how to overcome barriers to compassion.

In my volunteer work in the ER, I've seen plenty of medical caregivers who are very compassionate towards patients with some problems (stroke, heart attack, broken legs) but decidedly compassion-challenged towards patients with other problems (substance abuse, psychiatric issues, life complications from poverty). These caregivers aren't bad people or unskilled providers, but their compassion was either limited to begin with or has become limited through exhaustion: compassion fatigue is a real and pressing issue. The limits of compassion often seem to fall along class lines, which brings us back to empathy. It's often easier to feel compassion for people who are like us, because we identify with them.

So how do we instill compassion for the person who isn't like us: for the stranger, the other, the outcast? More specifically, how do we do that in a nursing school, medical school, or clinical setting where people are very busy, may have no time or inclination to immerse themselves in the humanities ("No, really, you'll have much more compassion for transgendered people if you go watch Boys Don't Cry"), and are struggling to master difficult technical and physical skills?


  1. "even with the best will and imagination in the world, we learn things through direct physical experience that we couldn't learn other ways"

    "I'm defining empathy as understanding gained through shared experience"

    This is a bit circular, isn't it? I do think it's possible to gain empathy through an imaginative understanding of experiences one hasn't had-- but it requires a strong imagination. We live in a culture that devalues and starves imagination (too big a subject for a comment). As a consequence I think it's difficult to evoke empathy without experience.

    Of course, it helps if one's had similar experiences; the smaller the gap between one's own experience and the target of empathy, the more easily it can be bridged by imagination. But without that imaginative leap, it's hard to relate to _any_thing that hasn't actually happened to you.

    (begin soapbox) That's why I'm opposed to the kind of thinking that says poetry has to be reflective of personal experience-- I think poetry should be a tool to stimulate the imagination of both the poet and the reader/listener. (end soapbox)

  2. Hi, Tiel! The two statements of mine you quoted don't seem circular, at least to me; they're saying the same thing.

    I agree with you that art should stimulate the imagination. My first novel was about child sexual abuse, which I haven't (thank god) experienced myself . . . but a lot of readers assumed that I had, because they thought I couldn't have imagined it so well unless it had happened to me.

    So maybe the issue of how we instill compassion comes down to a question of how we encourage imagination, especially in clinical settings that privilege the empirical. I think hands-on "empathy exercises" are a good idea, however limited, because they're direct and physical, but other people have rather vehemently disagreed.

  3. Oh!

    I was about to start reading Flying In Place with the assumption that it was semi-auto-biographical.

    Well, it's good to know that it isn't! :-)

  4. In my social work class, a lotes, we do a lot of case studies. I think those could be used to create compassion, at least, they do for me. So, maybe encouraging medical/nursing/any other students to not only look at the medical details but also the other challenges in a case study might help?

    I'm thinking questions like "What might keep this patient in this situation? What difficulties could this patient face? What are some reasons this patient might struggle with a certain part of a treatment plan?"

    Those are my initial thoughts.

  5. One limit to empathy can be the personal wounding that has occurred in the prior life of the caregiver. I presented a case in a class once; the patient had died from consequences of long term drug and alcohol use. Those members of the class who had suffered deeply at the hands of addicted parents or lovers found it hard to imagine providing tender care to such a patient or such a patient's family. Their own wounds got in the way. Me, I've had 850 years of therapy, and it was comforting in the situation to find that I was able to connect with the family of this patient simply around the experience of their deep loss and grief. I could also see the systemic evil and sin that had in real ways limited the family's possibilities for change. You can't make everyone have 850 years of therapy but perhaps this is where chaplains can help the staff by at least helping them to name the hard time they have dealing with some patients, and then hoping the spirit will move them to healing of themselves? I dunno. All this is just to say I don't think it's always lack of information.

  6. Thanks for your comment, Terri; that's a good point. Perhaps ironically, I feel particular compassion for alcoholics because there are so many in my family -- but yes, that's where 850 years of therapy can be very helpful!

  7. I think empathy can be a good tool in helping someone come to compassion. I just think that everyone's situation is so different that we shouldn't institutionalize methods of instilling empathy. Rather, we should teach people how to understand themselves well enough to know how to be compassionate even in situations that are difficult for them to find compassion. For some people, experience (providing empathy) can be a good help. Others may not need it. And in some situations empathy is impossible.


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