On empathy and its discontents

The politicization of feelings

Photo by Toa Heftiba on Unsplash

By Anonymed (an anonymous Canadian doctor)

“I didn’t need him to be my mother - even for a day - I only needed him to know what he was doing…[his] calmness didn’t make me feel abandoned, it made me feel secure. . .I needed to look at him and see the opposite of my fear, not its echo.” - Leslie Jamison, The Empathy Exams

We live in an age of empathy. Feelings - including the feeling we get when we feel that we can feel what others are feeling (that’s the best feeling) - have become sacrosanct. They matter, not just personally, but politically. We know this. We also know that human beings are predisposed to act based on emotion, not logic; to think anecdotally, not statistically. Recognizing and limiting these tendencies is a triumph of Enlightenment thought and a chief source of human progress. It is therefore unsurprising that as reason, logic, and dispassionate analysis have been derided as features of “whiteness”, emotion has resumed its place at the helm of human decision-making - with foreseeable consequences.

Counter to prevailing cultural attitudes, empathy, or at least too much empathy, is a bad thing. It skews perception, corrupts the reasoning process, and, ironically, breeds narcissism (do you know any self-proclaimed “empaths” who aren’t the most egocentric people on earth?). In the end, it may also lead to unethical and immoral conclusions that have real world effects. 

Many will remember the tragic case of Alan Kurdi, a 2 year-old Syrian refugee found washed up on a beach in Turkey at the height of the migration crisis. The reaction to images of this poor boy, lying lifeless on the sand, while understandable, illustrates the liabilities of what is often called “emotional empathy.” No one with a soul could help but feel nauseated about the fate of this young child. His story was broadcast all around the world, sparking outrage in the West and bolstering calls for increased assistance to refugees fleeing his country’s horrific civil war. It is widely accepted that Kurdi’s case softened the hearts of western leaders, particularly Germany’s Angela Merkel, who subsequently declared Europe’s borders effectively open to all comers. What impact a massive influx of migrants (true refugees and otherwise) might have on social cohesion in Europe was seemingly of little concern given the tide of emotion. People felt for that family and others like them, and they demanded action.

What’s wrong with that? Well, nothing is wrong with the desire to help others in their most vulnerable moments. And nothing is wrong with wanting people from developing countries to have access to the same opportunities as you do. But no matter how lovely, thinking in this way distorts reality, and this is a problem. Europe is not, as was made painfully clear in the years to follow, endlessly generous, nor can it be. Population moves of that scale come with real liabilities and the pros and cons need to be considered carefully, both for the citizens of the host country and the migrants themselves. The fact that they weren’t has had dire consequences, exemplified not least by the never-ending stream of migrant vessels capsized on their way to European shores.

So physicians shouldn’t try to connect with their patients? Not exactly. Medicine is a soft science and I am the first to argue that a cold, calculating approach to patient care is insufficient to do our job well. But there is a difference between having compassion for people and prioritizing their dignity, and empathizing with them. Empathy is actually more elusive than we’re led to believe. It isn’t easy to really know what it’s like to walk in someone else’s shoes - humans are complex like that - and attempting to do so in order to claim some high form of virtue tends to result in solipsism by another name. 

Even if one could really do this successfully, truly seeing the world through another’s eyes means, by definition, you will take on their biases. The result is not a broader understanding of reality, but simply a different narrow one. Palestinian terrorists, most notably Hamas, have long used what has been crudely referred to as the “dead-baby strategy” to convince the world that Israel is actually Nazi Germany 2.0. The tactic exploits our tendency to form opinions based on empathy - and it works. If you empathize with a Palestinian family who lost a child, and base your opinions on what it’s like to be them, then you could easily come away thinking Israel is a genocidal monster of a state (which is often what happens). But this is actually a gross distortion of reality, and in many cases leads to complete moral inversion. If the reality is that Hamas operatives prevented that child and his or her family from leaving a building they knew Israel was going to bomb (and had notified them to evacuate) because it served their propaganda purposes, what has empathy gained you? The child’s death is still tragic, but empathizing with that mother has distorted the truth, which is that Israelis care more about the lives of Palestinian children than does Hamas. 

Empathy’s shortcomings have not prevented it from reaching near beatific status in our identity-obsessed society. In medicine, it has given us some of the most stereotype-solidifying approaches to patient care, replete with “Indigenous peoples don’t like eye contact '' and "Muslim women are empowered by their feminist hijabs” -type bigotry. It has also led to calls for more doctors who can relate to (empathize with) members of different patient groups. The tacit admission in this way of thinking is that a physician is the better such that they can imagine what it is to be the patient in front of them - the reductio ad absurdum being the call in certain circles for more obese doctors, more “neurodivergent” doctors, more disabled doctors, and, sure as the sun will rise, more trans doctors. 

This is a very strange way to look at medicine. I’m a doctor and I still need to go to the doctor. And when I do, I have no desire to go see myself. I don’t want my doctor to empathize with the neurotic, mortality-denying wiseass that I am. I want him or her to tell me I don’t have cancer because I got gassy after Indian food. Put another way, I want my doctor to be compassionate, I want them to listen, and then I want them to give me a dispassionate answer. That’s it. That’s the job. Anything else is narcissism on a stick.

Psychologist Paul Bloom once wrote an article (and a book) entitled “Against Empathy”, in which he related how a relative of his viewed his relationship with doctors: “I’ve watched him interact with doctors and learned what he thinks of them. He values doctors who take the time to listen to him and develop an understanding of his situation; he benefits from this sort of cognitive empathy. But emotional empathy is more complicated. He gets the most from doctors who don’t feel as he does, who are calm when he is anxious, confident when he is uncertain. And he particularly appreciates certain virtues that have little directly to do with empathy, virtues such as competence, honesty, professionalism, and respect.” 

Indeed. There are far more important qualities than the ability to parrot patients’ perceptions about the world. Empathy doesn’t make you virtuous, it makes you biased. Our patients deserve better from us than that.

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Thanks for reading. For more from this author, read Systemic symptoms: Privilege and advantage in “antiracist” medicine

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