On Empathy

We closed the final intersession of medical school last week. Described and designed as an  opportunity for collective diastole in an education and career demanding systole, we gathered, virtually of course, for one more filling. My screen teemed with a sea of black rectangles and red microphone icons as one of the deans welcomed us and introduced the results of our class’s wellness survey.  Beginning our first semester, the school periodically invited us to participate in “pulse surveys” to gauge our interest, experience, and empathy. Empathy tends to decline throughout medical training, he explained to us, before proudly announcing that despite this, our class had managed to maintain a high level of empathy throughout our four years. In fact, our survey showed we were more empathetic than we were this time last year!

My first reaction was, how? We’d all endured the standard trials and tribulations of exams and clinical  rotations in medical school. In the last year, we’d also had our third- and fourth-year schedules interrupted, navigated a global pandemic, and served as guinea pigs for the inaugural  virtual residency interview season. On top of that, we as a class reckoned with the aftermath of George Floyd’s murder in Minneapolis and the subsequent defacing of a memorial by one of our former  classmates. Reflecting on 2020, I could certainly note how I’d enriched my coveted store of resilience, but I wasn’t sure if or how it correlated with my empathy.

Empathy was something that had been on my mind a lot lately. Throughout the course of the  preceding eleven months, I’d watched doctors and public health leaders attempt to persuade and then plead for people to stay home, to wear a mask, to believe what they were telling them. Too many  people were getting sick, being hospitalized, dying. Others were overworked. Surely everyone could  relate to at least one of those ideas or experiences. The pushback against and sabotage of that messaging frustrated me, and I struggled to connect to the position of these counter-arguments. This feeling returned as news of an attempted siege of the Capitol broke shortly after the dean’s congratulations.

I kept the live stream of D.C. open on my screen as the afternoon workshops played on. I  remember wondering then, and in the days since, where things would go from here. How do you navigate, and hopefully bridge, an empathy gap? Particularly for industries where empathy is both protective and fiduciary, was empathy something that could be taught or trained?

Curious, I fired up the Google machine to see what I could find. There were plenty of hits:  popular science, self help books, and even some scholarly research populated the results. There were  myriad theories of the mind, but operationalization of these abstract, psycho-social concepts proved  complicated.^{[1] [2] [3]} Nonetheless, I poured over paragraphs detailing the neural circuits revealed by fMRI studies. Several papers proposed the concept of mirror neurons, cells that allow us to learn by watching and then imitating others.^[4] Others suggested that while there were common empathic pathways, “’[i]t’s what you do with that information that determines whether it’s empathy or not.’ A psychopath might demonstrate the same neural flashes in response to the same painful images but experience glee instead of distress.”5

The more I read, the more complicated the idea of empathy became and the more I wondered  what I actually understood of it. I could name experiences and describe the feeling of relating or  connecting with another’s mood or encounter, but even now, forming a succinct explanation involves trails of ellipses. Indeed, other bewildered scientists have developed webbed lexicons to deconstruct the  idea of empathy in an effort to get back to basics, or a curricular basis. For example, empathy came in many flavors, including a cognitive version, which must exist in the absence of emotional empathy secondary to inherent biases based on racial, ethnic, religious, or other differences.6

I spent a day combing some of the contemporary literature for greater understanding, but I found myself returning to a New York Times article in between studies. The article detailed the travels of a molecular biologist turned cognitive neuroscientist interested in conflict resolution. He’d worked with and studied cultural conflicts in Ireland and Eastern Europe. In his experience, resolution efforts tended to focus on correcting differences or voids in empathy. In other words, peace would come after increasing empathy on both sides of the conflict. However, he proposed a different theory. For example, to him, “suicide bombers tend to be characterized by, if anything, very high levels of empathy.”5 It was the shape, nature, and allegiance of the actor and his or her empathy that mattered. Depending on a person’s identity and relation to another, the mind could generate an “empathy gap,” muting the paths discovered and alluded to by neuroimaging. In this way, “[i]ncreasing empathy might be great at improving prosocial behavior among individuals, but if a program succeeded in boosting an individual’s empathy for his or her own group…it might actually increase hostility toward the enemy.”^[5] In the end, affiliation and empathy for others were inversely related.

Perhaps that is the moral of 2020. In a year in which “normal” was turned over and shaken, we clung tightly to the things we understood and “knew” — our identities and our communities. Through all of this, we third–and now fourth-year–medical students have floated in nominative limbo. We were pulled from clinical rotations at a time of year when most of us were finally hitting our stride and feeling useful. We decided what kind of doctors we would be by reflecting on that limited experience and how we hoped to affect the future of patient care, based on the disparities that had been underscored by a  summer of protest and unrest. We’re emerging from a kaleidoscope of formative experiences as “real doctors” and the only ones who really understand what that means are the classmates who’ve shot out of the wormhole with us.