Contemplating Empathy, Early This Morning After the Earthquake

Last night I began reading a long essay, Regarding the Pain of Others, by Susan Sontag. The work dates to 1993, and centers on the power of pho­tographs of war. She con­siders Vir­ginia Woolf’s earlier reflec­tions on hor­rific images from the Spanish Civil War, in Three Guineas.

Sontag writes: “Not to be pained by these pic­tures, not to recoil from them, not to strive to abolish what causes this havoc…for Woolf, would be the reac­tions of a moral monster… Our failure is one of imag­i­nation, of empathy: we have failed to hold this reality in mind.”

This morning I awoke early and saw video of an earth­quake rat­tling por­tions of Japan and a tsunami destroying broad swaths of land in a country where I’ve never been. I’m dis­tracted by those images and while I’m trying to work on another subject, my mind flips back to what’s going on there, along the Pacific.

(from Flickr: Japanese Tsunami Victims, by Logan)

So it seems like the right day to review some basics on empathy. I hope my readers won’t mind if this part is too simple. It’s just that the word is thrown around so often lately, in places like Twitter and Time Mag­azine, on doctors and com­pas­sionate health care; I should remind myself if no one else exactly what empathy is sup­posed to be.

First, a dis­tinction: Sym­pathy usually refers to feelings elicited upon a mutual or shared expe­rience; empathy involves under­standing another’s experience.

A post on KevinMD by Barbara Ficarra, a few months back, led me to a 2003 aca­demic review on empathy in clinical med­icine, by Jodi Halpern, MD, PhD, who writes:

…Outside the field of med­icine, empathy is an essen­tially affective mode of under­standing. Empathy involves being moved by another’s expe­ri­ences. In con­trast, a leading group from the Society for General Internal Med­icine defines empathy as “the act of cor­rectly acknowl­edging the emo­tional state of another without expe­ri­encing that state oneself.”³

Halpern explains the dif­ference between empathy and sym­pathy, with a dis­tinction I was taught in a rudi­mentary ethics class in medical school:

This recent def­i­n­ition is con­sistent with the medical lit­er­ature of the twen­tieth century, which defines a special pro­fes­sional empathy as purely cog­nitive, con­trasting it with sym­pathy. Sym­pa­thetic physi­cians risk over-​​identifying with patients…

Th open-​​text article in the Journal of General Internal Med­icine (18: 670–674, 2003) is well-​​worth the full read.

Mean­while I’ve dis­covered mea­surable cri­teria for physi­cians’ empathy, the so-​​called Jef­ferson Scale of Empathy. From the Science Daily (via the Tweet, above) on a report in the journal Aca­demic Med­icine:

Researchers used the Jef­ferson Scale of Empathy (JSE) — developed in 2001 as an instrument to measure empathy in the context of medical edu­cation and patient care. This val­i­dated instrument relies on the def­i­n­ition of empathy in the context of patient care as a pre­dom­i­nately cog­nitive attribute that involves an under­standing and an intention to help. The scale includes 20 items answered on a seven-​​point Likert-​​type scale (strongly agree = 7, strongly dis­agree = 1)…

This sort of empathy rating system seems strange to me, even alien­ating; it’s plainly too numerical.

I’d rather stick with my feelings, and stare at today’s pho­tographs and videos, and finish reading Sontag’s notes on The Pain of Others, this evening.

Monster Quake Hits Japan (the Aus​tralian​.com, March 11, 2011)

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• Change the Channel?
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• Still Thinking About the Earth­quake in Japan, and How to Help
• I Feel Your Pain (not)