By Rae Padilla Francoeur
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“The Empathy Exams” By Leslie Jamison. Graywolf Press, 2014. 226 pages. Paperback. $15.
In the title essay of Leslie Jamison’s book, “The Empathy Exams,” she writes about her job as medical actor. For $13.50 an hour, she assumes the persona of a young woman with conversion disorder. After her brother’s death, this fictitious woman’s sublimated grief manifests as seizures. To prepare, Jamison studies 10 to 12 pages of notes detailing the disorder and her prescribed behavior during the 15-minute sessions with the second- and third-year medical students who will talk with her, ask her questions and offer a diagnosis. Afterward, she completes an evaluation. If the medical student voices empathy, then he or she has handled the most important part of the affect section of the evaluation well. Some students, she writes, understand that “empathy is always perched precariously between gift and invasion.” If they ask humbly they may discover that a “root system of loss stretches radial and rhyzomatic under the entire territory of [the sister’s] life.”
In this essay, like many of the others in this critically acclaimed book that was awarded the Graywolf Press Nonfiction Prize, Jamison takes creative leaps with the essay form, with the idea of memoir and with the way she comes at her understanding of the subjects she’s viewing, dissecting, examining, parsing, turning over and over. In the title essay, she moves on to another case study, that of herself, five-and-a-half weeks pregnant with an irregular heartbeat that is going to require surgery. We begin to see that this young author is complicated, intelligent, deeply introspective and precociously aware of herself and others. And she’s on a mission to know more. She writes to know. Another thing we discover is that her brilliance at understanding, writing and thinking is more evolved than her mastery of her own behavior. But, like any work with self-revelation as a component, the self is fed to readers in discrete, controlled pieces not unlike bait meant to lure fishes closer. She tells us what she wants us to know and we gobble it up because this is a writer in charge.
In the title essay Jamison establishes the themes she will pursue. She does an intriguing thing when she gets into the head of Stephanie Phillips, the person she’s portraying. She empathizes, drills down into her psyche, channels her. She mines for the pain and studies the way the body responds to pain. Whether it’s the made-up Stephanie or the real Paul, who believes he has small things wriggling constantly under his skin, things that must be excised, she is intent on staying open.
In the essay “Devil’s Bait,” Jamison tests empathy. She wonders, can you empathize when the disease isn’t real? Paul has a condition known as Morgellons disease. She meets him at a conference in Austin, Texas, and finds out that 12,000 suffer from this affliction in which some sort of substance — fibers, parasites, strings, crystals — emerge from beneath the skin. The patients are self-identified and call themselves Morgies. Morgies grow obsessed with these moving, wriggling things. They examine themselves, experience the sense of something trying to get out, and they try various methods to extricate the foreign objects. They have scars, lesions and cuts. One woman calls her arm a sculpture garden because of the protrusions. Jamison can relate, to some degree. A maggot has to be cut from her ankle after traveling overseas. “I probably spent hours poring over my maggot wound…,” she writes.
Folie a deux is the clinical name for shared delusions. Paul, with scars and a mutilated ear and discolored skin, looks the worst. He spends hours poring over selfies and he says he spends 10 to 12 hours a day keeping “them” at bay. He experiences “ceaseless motion” beneath his skin. The stricken take antibiotics, horse dewormers and large, continuous doses of other potentially toxic substances. “Is it wrong to call it empathy when you trust the fact of the suffering, but not the source?” Are those with self-inflicted wounds less deserving? She asks.
“I didn’t believe there were parasites laying thousands of eggs under his skin, but I did believe he hurt like there were.” She wants to know: When does empathy actually reinforce the pain it wants to console? Does gathering and talking about it, like they do for three days every year, help or “deepen its hold”?
Jamison attends a writers gathering in Tijuana and Mexicali, she teaches Spanish to kids in Nicaragua, she observes a punishing footrace in Tennessee known as the Barkley Marathons and she inhabits the wounds women suffer. Her boyfriend calls her a “wound dweller” and, among the many she cites in this literary book is the Greek Menander, who wrote, “Woman is a pain that never goes away.”
In the book’s final essay, “Grand Unified Theory of Female Pain,” Jamison gets to what I find to be the heart of the matter — women’s pain. “We can’t stop imagining new ways for [women] to hurt,” she says. In her view, our perceptions of women are elevated by the pain they endure. She cites Susan Sontag: “Sadness made one ‘interesting.’ It was a mark of refinement, of sensibility, to be sad.” And while I personally see the pain we cause women in our media and entertainment — just look at “Law and Order: SVU” to see the many creative ways writers find to cause women to suffer for our viewing pleasure — as wayward and wrong, Jamison’s points are valid. She goes back to Anna Karenina’s leap under the train, to Caroline Knapp’s anorexia, to Carrie’s blood bath at the prom to the “Wounded Mix” playlist she listened to when she was younger. And she argues passionately for opening ourselves up to women’s pain, to allowing its validity, no matter how clichéd or fetishized. “I want our hearts to be open,” she writes.
I read this book slowly and carefully because I didn’t want to miss anything. I found much to be learned as a writer, reader and woman who often wonders about the quality of my own empathy. Jamison says, “We care in order to be cared for. We care because we are porous. The feelings of others matter, they are like matter: they carry weight, exert gravitational pull.” She tells us that “empathy is a choice we make to extend ourselves” in ways that transcend our personal inclinations.
Rae Padilla Francoeur’s memoir, “Free Fall: A Late-in-Life Love Affair,” is available online or in some bookstores. Write her at firstname.lastname@example.org. Read her blog at http://www.freefallrae.blogspot.com/ or follow her @RaeAF.
Book Notes: A close look at empathy
By Rae Padilla Francoeur