Tuesday, May 27, 2014

‘The Empathy Exams,’ by Leslie Jamison - NYTimes.com

Regarding the pain of others requires more than just a pair of eyes. It necessitates an act of the imagination: a willingness to think or feel oneself into the interior of another's experience, to cross between what Susan Sontag once designated as the kingdoms of the sick and of the well. This kind of empathetic border crossing can be both difficult and dangerous, the sort of journey of which one might say: "I get across quickly because I'm headed in the right direction, by which I mean the wrong direction. I'm going where no one wants to stay."

This statement, actually describing a trip into Mexico, serves as a manifesto for "The Empathy Exams," Leslie Jamison's extraordinary and exacting collection of essays. Jamison is a young writer and the author of a novel, "The Gin Closet." For the past few years she's been publishing a steady stream of intense, original essays, gathered here for the first time. Though they roam widely in topic and location, their collective preoccupation is with pain: what it means and what to do about it, both when it occurs in our own lives and when its location is far distant from us.

Jamison opens with her experience as an actor playing patients for medical students. "I'm called a standardized patient, which means I act toward the norms set for my disorders." Sometimes, working from a script, she plays a mother whose baby's lips are turning blue, and sometimes a young woman whose grief over her brother's death manifests as seizures. The students are assessed on how empathically they respond to her character's pain. Sensitive questioning elicits vital detail; clumsy handling causes the actor-patient to clam up.

"Empathy," she writes, "means realizing no trauma has discrete edges. Trauma bleeds. Out of wounds and across boundaries. Sadness becomes seizure. Empathy demands another kind of porousness in response." She means a porousness in the witness, a willingness to let a stranger's troubles seep in and slowly unfurl their meaning. But there is a porousness, too, in her style. Her intricate reconstruction of the empathy exams gives way to a more personal case history, an anatomization of two medical procedures she underwent in close succession: first an abortion and then heart surgery. In the essay's virtuosic close, she presents a script for Leslie Jamison: an intimate document, aestheticized but not anesthetized by the assumed tone, the medical dressing.

The damaged physical body, the gulf between sufferer and witness, this is Jamison's territory. Elsewhere, she turns her searching gaze on the community of people who suffer from the condition known as Morgellons, in which patients believe they're infested with hairs or fibers (an opportunity for some remarkable thinking about why patients prefer a diagnosis of physical infection to mental illness). She examines the culture around an ultramarathon in Tennessee, explores the case of the West Memphis Three, and considers poverty and violence in Los Angeles and Bolivia in a set of linked essays entitled "Pain Tours." In almost all of these pieces, her own pain: getting punched in the face in Nicaragua, having a worm emerge from her ankle after a trip to Bolivia, bad boyfriends and the wounding, witty lines they'd deliver.
This is an approach fraught with dangers, which necessitates walking an ethical tightrope between voyeurism and narcissism, between an unnatural interest in the woes of others and an unattractive obsession with the wounds of the self. It is to Jamison's credit that she doesn't choose the easy neutrality of the distanced observer, but rather voyages deeply into both extremes, maintaining almost always an admirable awareness about the perils of her approach.

Throughout, she pays close attention to the mechanisms of empathy, addressing not only its importance, as Rebecca Solnit did in last year's "The Faraway Nearby," but also its ethical complexities. In an essay that tacks brilliantly between a consideration of saccharine sentimentality and the artificial sweetener saccharin, she notes how sentimentality and anti-sentiment charm us by "coaxing out the vision of ourselves we'd most like to see," continuing: "If the saccharine offers some undiluted spell of feeling, . . . then perhaps its value lies in the process of emerging from its thrall: that sense of unmasking, that sense of guilt." This capacity for critical thinking, for a kind of cool skepticism that never gives way to the chilly blandishments of irony, is very rare. It's not surprising that Jamison is drawing comparisons to Sontag, clearly an influence on much of the thinking here. The struggle between irony and empathy surfaces again in two of the more troubling essays of the collection, a linked manifesto on the importance of accepting female woundedness as a subject worthy of attention. I can't say I much like the heavy-handed gender essentialism of her approach, or the moments of over-identification with her subjects, something her best essays rarely permit. On the subject of the plaster corsets Frida Kahlo wore to support her damaged spine, Jamison writes, "She would have given anything, perhaps, to have a body that rendered them irrelevant," adding that after Kahlo's leg was amputated, "she died the next year, as if this loss — after so many others — was what she finally couldn't bear." This is both histrionic and reductive. But it's a danger in keeping with her larger point, which is that it's worth risking an excess of feeling, rather than taking up the fashionable pose of world-weariness, which all too easily shades into detachment and then to cruelty.

Jamison is capable of the most extraordinary flourishes of image. On the case of the West Memphis Three, in which three teenagers were imprisoned for 17 years for the murder of three boys (wrongfully, many believe; they have since been freed), she writes: "Years ago witches were torched like fields. Their bodies held the controlled burn. Their bodies held evil like vessels so that evil would not be understood as something diffused across other bodies, across everyone." There is a glory to this kind of writing that derives as much from its ethical generosity, the palpable sense of stretch and reach, as it does from the lovely vividness of the language itself.

These are the essays of a working journalist. Most have been previously published in magazines like Vice, Harper's and Oxford American. Because they all work to some degree over the narrow field of personal experience, they inevitably turn up the same items of autobiography, perpetually introduced as if for the first time. This has a strange, unwitting effect in a book so preoccupied with the registering of and response to distress — it makes Jamison sound self-preoccupied, too caught up in her own stories to recognize that the reader has encountered them before. A small point, and clearly a consequence of the form, it makes one wonder a little hankeringly what this collection could have been if it had been worked just a touch more. But perhaps this is greedy. It's hard to imagine a stronger, more thoughtful voice emerging this year.

By Leslie Jamison
226 pp. Graywolf Press. $15.

Olivia Laing's latest book is "The Trip to Echo Spring: On Writers and Drinking."