I used to play sick sometimes as a kid. If I really didn’t want to go to school, I’d splash my face with hot water in the hopes of inducing a fever-like flush and a forehead that felt warm to the touch, or at least warm enough to convince my mother that I needed to stay home. My tactics had a high failure rate. Mum knew when I was faking it, just as she could tell when I genuinely was coming down with something, often before I had any idea myself.

There’s a difference, of course, between identifying someone’s malady – or lack thereof – and understanding their experience of it. To what extent can we truly imagine being in another person’s skin? How well can we know what it’s like to exist inside a body or mind that’s not our own? And can we empathise with those who claim to be sick, if we don’t actually believe in the legitimacy of their ailment?

American writer Leslie Jamison explores these questions in her essay collection, The Empathy Exams, which won the Graywolf Press Nonfiction Prize. Although she doesn’t necessarily discover the answers, Jamison’s poignant observations and eloquent prose yield fascinating insights into the human condition. While the pieces address a range of subjects, from ultrarunning and gangland tours to the mysteries of Morgellons Disease, they all touch on the concepts of emotional and physical pain and their relationship to our bodies and our minds.9781555976712

Jamison is particularly fascinated by empathy: what it means to empathise with another, and what empathy entails for both giver and receiver. Her most explicit analysis of this occurs in the book’s cleverly structured opening essay, from which the book takes its name. Here, Jamison discusses her time as a medical actor, a curious but important job that involves pretending to be a patient with a specific illness, undergoing a mock consultation with a medical student, then rating that student’s performance, including how well they ‘voiced empathy’ for the actor’s problem. Snippets of a script Jamison once used to play a young woman suffering from seizures are interwoven with her own experience of undergoing an abortion and heart surgery in quick succession. It’s undeniably maudlin territory, but Jamison isn’t attempting to elicit pity – instead, she uses her recollections to contemplate the nature of empathy and the effect it has on us and our relationships with loved ones. ‘Empathy isn’t just something that happens to us’, she writes, ‘It’s also a choice we make: to pay attention, to extend ourselves. It’s made of exertion, that dowdier cousin of impulse’.

Jamison extends this idea in her second essay, ‘Devil’s Bait’, a fascinating but disturbing account of her trip to Austin to attend a conference of Morgellons Disease sufferers. Although the medical industry seems adamant that Morgellons is a delusional condition, there’s nothing imaginary about the pain of the self-diagnosed patients Jamison meets at the conference, from a man who injected a liquid nitrogen compound into his own ear to a young woman too ashamed of her self-inflicted facial scarring to leave the house.

Whether or not Morgellons really exists isn’t the point; the strange beauty and affect of this piece derives from Jamison’s struggle to balance her empathy and her doubt – ‘this strange sympathetic limbo’. She writes, ‘I’ve come to understand that the distinction made here between “real” and “unreal” doesn’t just signify physical versus mental but also implies another binary, the difference between suffering produced by a force outside the self or within it’.

Jamison’s essays continue to explore how pain affects us psychologically, either as sufferers or as those observing or being privy to another’s mental or physical discomfort. Pain can create an odd and often destructive feedback loop, spurring people to seek validation for what they endure. By ‘giving people a space to talk about their disease’, does the Morgellons conference actually ‘deepen its hold’?

Pain as endurance can become a badge of pride, something people actively seek out in order to establish a sense of self-worth. In ‘The Immortal Horizon’, Jamison recounts asking ultrarunners ‘Why do people do this, anyway?’. They often jokingly respond it’s because they’re masochists, but, Jamison says, ‘Nobody has to answer this question seriously because they are already answering it seriously – with their bodies and their willpower and their pain’.

What is it about pain that we find so compelling, and yet also so distasteful? ‘In Defense of Saccharin(e)’ asks why we belittle sentimentality, with Jamison admitting that though she fears the ‘inflated gestures and broken promises’ of feeling too deeply, she’s ‘just as afraid of what happens when we run away from it: jadedness, irony, chill’. Similarly, in ‘Grand Unified Theory of Female Pain’, Jamison addresses suffering female characters in literature – Miss Havisham, Anna Karenina, Blanche DuBois – and argues that, ‘The moment we start talking about wounded women, we risk transforming their suffering from an aspect of the female experience into an element of the female constitution – perhaps its finest, frailest consummation’.

There’s nothing frail about The Empathy Exams. While it’s a book about pain, it’s also a pleasure to read, a fascinating and beautifully composed exploration of our emotional and empathetic borderlands that questions the complex, ever-shifting interplay between our thoughts and our feelings, our hearts and our minds.

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