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Functional Empathy

To my boys:

When I was in medical school, we had a course entitled "Doctoring". Our class was broken up into small groups and in weekly sessions our group would be led by two faculty who were also practicing MD's. The material covered was a hodgepodge of topics that related to the interpersonal-related issues that could/would come up as a practicing MD.

I remember looking over the syllabus to the class and seeing one of the class sessions entitled "Learning Empathy".

I really liked my medical school education and thought then (and still do now) that it successfully prepared me for residency and beyond. With that in mind, I thought that the idea of learning (and/or teaching) empathy was kind of ridiculous. Empathy is defined as the ability to understand and share the feelings of another, and at the time I thought that the only way to truly understand someone else's pain is to have been "in their shoes". Anything else is a fools errand. It's possible to have sympathy, but not empathy, something that I have found is on a visceral level.

Over time, I have noted that while it's true that empathy cannot be "learned" in a classic, didactic sense, I have found it possible to piece together my experience in a way that has allowed for me to have a different experience with others and their suffering that is distinct (and for me, deeper feeling) than sympathy.

The biggest example of this for me relates to race.

I will dispense with a long life story about my past experiences and attempts to understand the experience of race as it fit in my life and those without my background. It is relevant to this entry insofar as it ended up being primarily an intellectual exercise and, in retrospect, unsuccessful. I would seek to read any number of academic papers books and memoirs, watch films, and listen on the rare occasion that friends or family who were of different ethnic backgrounds than my own would feel comfortable sharing how they felt about the issue. What that ended up providing me with was with a thought framework that reminds me with regularity (more than some, less than others I'm sure), how would a _____ person feel about this? To that end it was useful, mostly to keep my mouth shut in a lot of situations.

In retrospect, there was something missing still. I was using books (even ones that were often emotionally powerful memoirs) to create a thought process, but one that was still mostly devoid of emotion. I was being reminded to wonder how someone felt about something, but there was not the baseline, emotional resonance. That plus the challenges of "being real" about race in most settings for me (I'll write more on that later) made it really hard to work through all of the B.S., (that of the world and my own creation) to create a place of resonance. That complemented my thoughts.

Eventually, I was able to create for myself a jerry-rigged connection between the thought reminders and feeling. I took the most painful emotional memory in my life (the sudden death of my mother at age 5), focused on the emotional content on its own which was a mixture of bottomless despair, anger, and fear (of abandonment) that made me emotionally inaccessible to most of the friends and partners I had through much of my life, and paired that with the daily reminders of what it must be like to be, for example, Black in America.

Have the thoughts and feelings led to modifications of my behavior (completing the Triple Crown of CBT)? One can never know for sure. What I do experience now is different. The Tamir Rice, Breonna Taylor, and George Floyd stories (and videos) now hit me in a way that goes beyond simple human sadness and anger when law enforcement takes their lives. By pairing the emotional content of personal tragedy with the thought that this is something black people are reminded of every day, I get really, really, tired. I get profoundly angry for sure, but I feel a kind of exhaustion imagining dealing with something like this multiple times per week, if not daily. I am reminded of my college roommate's buddy, and African American film student in New York, for whom House Party was his favorite movie. Why? because it was not about slavery or racism or saintly black people, but rather simply two kids trying to have a party and meet girls. It was escapist and fun and simply a "normal" movie. That is what he loved more than anything, a way to get away from the rest of the world that tired him out.

When I think about this experience, and the experience of (white) America these past few weeks, I can't help wonder if COVID might have been part of the impetus for change this time around, creating that connection en masse. Many commentators have noted that COVID fatigue likely led to people getting out and into the streets, their need for contact with others complementing (and providing an outlet for) their anger. I think there may be an even deeper effect on people. Seeing a video like that when you are tired, stressed, and angry, without a way to escape (no sports, you burned through Tiger King already), might make someone make that connection between what we know, and what we experience. I hope that is the case, because I think affective encoding is extremely powerful, perhaps it's even empathy.


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