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The Empathy Exams


by Leslie Jamison

Paperback, 226 pages, Farrar Straus & Giroux, List Price: $15 |


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Leslie Jamison

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Beginning with her experience as a medical actor who was paid to act out symptoms for medical students to diagnose, The Empathy Exams asks essential questions about our basic understanding of others.

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Excerpt: The Empathy Exams

A 1983 study titled "The Structure of Empathy" found a correlation between empathy and four major personality clusters: sensitivity, nonconformity, even temperedness, and social self-confidence. I

like the word structure. It suggests empathy is an edifice we build like a home or office — with architecture and design, scaffolding and electricity. The Chinese character for listen is built like this, a structure of many parts: the characters for ears and eyes, a horizontal line that signifies undivided attention, the swoop and teardrops of heart.

Rating high for the study's "sensitivity" cluster feels intuitive. It means agreeing with statements like "I have at one time or another tried my hand at writing poetry" or "I have seen some things so sad they almost made me feel like crying" and disagreeing with statements like: "I really don't care whether people like me or dislike me." This last one seems to suggest that empathy might be, at root, a barter, a bid for others' affection: I care about your pain is another way

to say I care if you like me. 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.

It's the last cluster, social self-confidence, that I don't understand as well. I've always treasured empathy as the particular privilege of the invisible, the observers who are shy precisely because they sense so much — because it is overwhelming to say even a single word when you're sensitive to every last flicker of nuance in the room. "The relationship between social self-confidence

and empathy is the most difficult to understand," the study admits. But its explanation makes sense: social confidence is a prerequisite but not a guarantee; it can "give a person the courage to enter the interpersonal world and practice empathetic skills." We should empathize from courage, is the point — and it makes me think about how much of my empathy comes from fear. I'm afraid other people's problems will happen to me, or else I'm afraid other people will stop loving me if I don't adopt their problems as my own.

Jean Decety, a psychologist at the University of Chicago, uses fMRI scans to measure what happens when someone's brain responds to another person's pain. He shows test subjects images of

painful situations (hand caught in scissors, foot under door) and compares these scans to what a brain looks like when its body is actually in pain. Decety has found that imagining the pain of others activates the same three areas (prefrontal cortex, anterior insula, anterior cingulate) as experiencing pain itself. I feel heartened by that correspondence. But I also wonder what it's good for.

During the months of my brother's Bell's palsy, whenever I woke up in the morning and checked my face for a fallen cheek, a drooping eye, a collapsed smile, I wasn't ministering to anyone. I wasn't feeling toward my brother so much as I was feeling toward a version of myself — a self that didn't exist but theoretically shared his misfortune.

I wonder if my empathy has always been this, in every case: just a bout of hypothetical self-pity projected onto someone else. Is this ultimately just solipsism? Adam Smith confesses in his Theory of Moral Sentiments: "When we see a stroke aimed and just ready to fall upon the leg or arm of another person, we naturally shrink and draw back our own leg or our own arm."

We care about ourselves. Of course we do. Maybe some good comes from it. If I imagine myself fiercely into my brother's pain, I get some sense, perhaps, of what he might want or need, because I think, I would want this. I would need this. But it also seems like a fragile pretext, turning his misfortunes into an opportunity to indulge pet fears of my own devising.

I wonder which parts of my brain are lighting up when the med students ask me: "How does that make you feel?" Or which parts of their brains are glowing when I say, "The pain in my abdomen is a ten." My condition isn't real. I know this. They know this. I'm simply going through the motions. They're simply going through the motions. But motions can be more than rote. They don't just express feeling; they can give birth to it.

Empathy isn't just something that happens to us — a meteor shower of synapses firing across the brain — it's also a choice we make: to pay attention, to extend ourselves. It's made of exertion,

that dowdier cousin of impulse. Sometimes we care for another because we know we should, or because it's asked for, but this doesn't make our caring hollow. The act of choosing simply means

we've committed ourselves to a set of behaviors greater than the sum of our individual inclinations: I will listen to his sadness, even when I'm deep in my own. To say going through the motions — this

isn't reduction so much as acknowledgment of effort — the labor, the motions, the dance — of getting inside another person's state of heart or mind.

This confession of effort chafes against the notion that empathy should always rise unbidden, that genuine means the same thing as unwilled, that intentionality is the enemy of love. But I believe in intention and I believe in work. I believe in waking up in the middle of the night and packing our bags and leaving our worst selves for our better ones.

Excerpt from The Empathy Exams Copyright 2014 by Leslie Jamison. Reprinted from The Empathy Exams with the permission of Graywolf Press, Minneapolis, Minnesota.