The Empathy Exams

by Leslie Jamison

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Last Updated September 5, 2023.

The Illusion of Choice

Leslie Jamison’s essay, “The Empathy Exams,” is rooted in her experiences receiving two operations in close succession: an abortion followed by heart surgery. While examining her own trauma, she blends her narrative with those of the fictionalized patients she portrays as a “Medical Actor.” Through this dichotomy, Jamison explores the illusion of choice with respect to human emotions. In particular, she reflects upon society’s complacent handling of emotional dissonance, and how such an attitude leads not only to indifference and apathy, but also the inability to understand our own emotions. When detailing her emotional journey—leading up to and following her abortion—Jamison questions the validity of her feelings, and the role that choice plays in determining her internal pain:

Mine was the kind of pain that comes without a perpetrator. Everything was happening because of my body or because of a choice I’d made. I needed something from the world I didn’t know how to ask for. I needed people—Dave, a doctor, anyone—to deliver my feelings back to me in a form that was legible. Which is a superlative kind of empathy to seek, or to supply: an empathy that rearticulates more clearly what it’s shown.

In this passage, Jamison explains she depends on external forces to understand her emotions. But because feelings are instinctual and internal, and often indefinable, this exchange is impossible. She relies upon both her doctors and her partner, Dave, for affirmation. There are no perfect scientific cures for trauma, anxiety, depression, and other illnesses that affect the emotions, and thus patients often rely on ambiguous diagnostic processes to define their condition. Jamison contemplates her lack of autonomy over the choice she is forced to make and laments the inherent inadequacy of this approach.

However, throughout “The Empathy Exams,” Jamison insightfully portrays the role that empathy plays in understanding emotional self-awareness. She asserts that “Empathy isn’t just something that happens to us… it’s also a choice we make: to pay attention, to extend ourselves.” In conceptualizing empathy as a choice, she argues that “the act of choosing simply means we’ve committed ourselves to a set of behaviors greater than the sum of our individual inclinations.” While Jamison describes the illusion of choice that humans face in searching for emotional self-awareness, she also suggests methods for cultivating an empathetic mindset.

The Limits of Language

In her examination of empathy, Jamison addresses the complicated contrast between internal and external emotional expressions. Importantly, her essay reflects upon the different ways in which society treats invisible illnesses because of the great difficulty of translating emotion into language. For example, Jamison illustrates this insufficiency of language when she plays the role of Stephanie, a medical patient who experiences depression and post-traumatic stress after her brother’s death. Because she has seizures, with ostensibly no link to these mental conditions, she is diagnosed with “conversion disorder.” Comparing herself to Stephanie, Jamison highlights her desire for society to understand the unseen emotions that accompany pain and trauma:

Part of me has always craved a pain so visible—so irrefutable and physically inescapable—that everyone would have to notice… Like Stephanie, who didn’t talk about her grief because her seizures were already pronouncing it—slantwise, in a private language, but still—granting it substance and choreography.

By distinguishing between the seen and unseen symptoms of outwardly physical or medical conditions, Jamison points out how words are inadequate tools for expressing emotion. She examines how lack of “social self-confidence” prohibits those with heightened emotional awareness from openly expressing their feelings. In doing so, she suggests that the human capacity for empathy diminishes in a power-driven, consumerist society,...

(This entire section contains 1139 words.)

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consequently declaring that, “empathy means acknowledging a horizon of context that extends perpetually beyond what you can see.” Language is tasked with expressing this ambiguous realm of the unseen. This compromised tool is how humans relate to one another without being able to live inside the minds and bodies of others.

Performance vs. Authenticity

By juxtaposing her own experience with the fictional stories of the character she plays as a medical actor, Jamison explores how constructed emotions function in real life. Accordingly, she illustrates the lack of self-awareness among humans in a simulated environment. A key theme in postmodern theory is the tenuous line between simulation and reality. Jamison’s essay presents ideas on how to challenge such simulated environments by distinguishing between performance and authenticity. She explains how the actors “understand the other is inventing… and agree to respond to each other’s inventions as genuine expressions of personality.” By analyzing the authenticity of performed emotions, Jamison describes herself and the other medical actors as “holding the fiction between us like a rope.” Jamison suggests that attaining a state of authenticity empowers others to be more empathetic.

In exploring the relationship between performing emotions and authentically expressing them, Jamison declares that “the feelings of others matter, they are like matter: they carry weight, exert gravitational pull.” This lesson is unconventional in a culture that fuels emotional dissonance by viewing vulnerability as a weakness. In Stephanie’s case, her trauma—combined with difficulty in describing that pain—is the cause of her medical disorder, which only amplifies her feelings of being trapped.

Additionally, Jamison uses symbolism to reinforce the distinction between genuine and constructed emotions. She uses several examples—including her own heart condition, and her brother’s diagnosis of Bel’s Palsy—to emphasize how humans are cosmically connected, despite being unable to inhabit the minds of others. In describing her self-awareness of empathetic limitations, Jamison expresses her approach to understanding her brother’s condition from his perspective: “I tried to imagine how you’d feel a little crushed, each time, coming out of dreams to another day of being awake with a face not quite your own.” Similarly, Jamison analyzes her own emotional responses to her heart condition, and how these feelings connect with the trauma of her abortion. For example, her essay portrays anesthesia as representative of society’s inadequacy in tackling mental health. As she explains in her own words, “I wanted the anesthesia to carry me away from everything I felt and everything my body was about to feel.”

Jamison uses the last portion of her essay to situate her story in the simulated environment that the medical actors inhabit. Consequently, she contemplates how fear serves as a catalyst to empathy, and reflects on her own capacity to empathize from a place of authenticity. By examining her relationships, and the unspoken emotional connections that exist among them, she poignantly affirms, “we should empathize from courage.” Therefore, Jamison emphasizes the importance of embracing both the ambiguities and limitations in understanding the connection between physical and emotional experiences—and thereby gain a deeper awareness of the human condition.