At a recent conference I heard a paper on empathy. The presenter made two assumptions. First, that there is a ‘yardstick’, a golden standard of empathy, second, that there are clear linguistic structures which can be easily classed as empathic (or not). And so, the author analysed conversations between doctors and patients making comments on appropriate levels of empathy, or criticising doctors for low levels of empathy, or, indeed, that some show too much empathy than would have been required. Predictably, the ‘empathic’ phrases focused on ‘you’ (say, ‘You feel.’), whereas those unempathic focused on ‘me’ (‘I feel.’), though it was more complex than that. I fundamentally disagree with such an understanding of empathy.
Now, as I was listening to the paper, I was reminded of a famous Polish professor of psychiatry. When I was an intern in the clinic in Krakow, I heard a story after a story of his, shall I say, unique way of speaking to his patients. And so, patients reporting delusions would apparently have heard something like:
What kind of fucking nonsense is that?
(For those of you who speak Polish, it was “A co mi tu pan będzie pierdolić?”). Except that, so the stories invariably went, he said it in a way that not only were his patients not offended, but they loved him. He was a very popular shrink.
Of course, for the presenter of the paper I am referring to here, what the professor said was anathema. It was completely unempathic as, first, it challenged ‘you’, rather than focused on it, it was also, second, unacceptably rude, offensive, insulting and what have you.
Before I offer comment, let me tell you one more story. I was visiting a colleague (later he became a good friend of mine), a consultant psychiatrist on whose ward (in Poland, we call them ‘open wards’; patients only come for the morning and early afternoon, then go home), I was conducting some interviews. I went into doctors’ common room in which I saw a patient whom I had seen on the ward before. She was talking to her doctor, explaining that she really did feel that angelic wings were growing on her back. I was caught completely unawares and chuckled.
If looks could kill, the stares I got from the three or four psychiatrists in the room would have vaporised me, much like a Star Trek phaser. Stop laughing, I heard one of them hiss to me. The room got silent for a second or two, until the patient looked at me, smiled and started laughing. I joined in and we had a good laugh. We exchanged a few words, but today I can’t remember them. It was very clear that we laughed both at the wings, but also a moment later at the shrinks who really didn’t know what to do. In the end, they didn’t join in.
I interpret what happened in terms of normality. My reaction was ‘normal’, as if it was a normal conversation. After all, when people tell you that they grow wings, you can actually laugh (given the right context, it can actually be a joke). In the same way, a ‘normal’ reaction to someone telling you ‘strange’ things, is to say: What on earth are you talking about? Completely unwittingly, I might have simply shown (given?) the patient ‘normality’. I don’t know whether this is empathy, to be honest, I don’t much care, yet, this young woman and I developed a relationship of, shall I say, an acknowledgement. Whenever we met, we greeted each other and smiled. Just because I laughed at what she said, yes, at what she said. But in the context, laughing was given a positive meaning. I think, the meaning of normality.
And here we come to the ‘linguistics of empathy’. According to ‘science’, my two stories cannot possibly be about empathy. They do not meet the ‘standard of empathy’. And…I don’t care. This is because just as there can never be any (golden) standard of empathy, there cannot be any universally empathic phrases or utterances. It is contextual, a quality of a relationship you and I construct for ourselves, here and now.
When I was conducting interviews with men in depression, I think my third interviewee told me I had helped him (I heard it a number of times later). He said:
I mean you have helped me in a sense because I was able to describe certain things for myself here, but it’s not that. I realised that a conversation with another person doesn’t hurt. You know, it’s like I see my doctor and I won’t tell her that, simply because I thought it hurt, that one should not say it, right? So, that’s why I am saying that you have helped me. Because a couple of guys sat down and talked about a thing, it seemed, in a way shameful in our society (quoted from my Men’s Discourses of Depression).
Imagine that I only (or is it as much as?) listened to him.
PS. If you want to read a doctor’s take on empathy, do have a look at Jonathon Tomlinson’s blog.