The problem of empathy: Medicine and the humanities

New Literary History

Volumn 38, Issue 3, 2007, Pages 551-567

  Garden, Rebecca ^a  

^a SUNY UPSTATE MEDICAL UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 58149159071     PISSN: 00286087     EISSN: 1080661X     Source Type: Journal    
DOI: 10.1353/nlh.2007.0037     Document Type: Review

References (46)

1. On the tension between role modeling and the values taught in the classroom, see, e.g., F. W. Hafferty and R. Franks, "The Hidden Curriculum, Ethics Teaching, and the Structure of Medical Education," Academic Medicine 69, no. 11 (1994): 861-71
2. See also Jack Coulehan and Peter C. Williams, 'Vanquishing Virtue: The Impact of Medical Education," Academic Medicine 76, no. 6 (2001): 598-605
3. Sung Soo Kim, Stan Kaplowitz, and Mark V. Johnston, "The Effects of Physician Empathy on Patient Satisfaction and Compliance," Evaluation and the Health Professions 27, no. 3 (2004) : 246
4. see also Donald A. Redemeier, Jean-Pierre Molin, and Robert J. Tibshirani, "A Randomised Trial of Compassionate Care for the Homeless in an Emergency Department," The Lancet 345, no. 8958 (1995): 1131-34. A typical article advocating empathic engagement states that "[t]he effective use of empathy promotes diagnostic accuracy, therapeutic adherence, and patient satisfaction"
5. John L. Coulehan, Frederic W. Platt, Barry Egener, Richard Frankel, Chen-Tan Lin, Beth Lown, and William H. Salazar, "'Let Me See if I Have This Right . . .': Words That Help Build Empathy," Annals of Internal Medicine 135 (2001): 221
6. Howard Spiro, "What Is Empathy and Can it Be Taught?" Annals of Internal Medicine 116 (1992): 844
7. For studies that suggest the decline in empathy in medical students, see, e.g., Ruth Elder, John Price, and Gail Williams, "Differences in Ethical Attitudes between Registered Nurses and Medical Students," Nursing Ethics 10 (2003): 149-64
8. and Mohammadreza Hojat, Joseph S. Gonnella, Salvatore Mangione, Thomas J. Nasca, J. Jon Veloski, James B. Erdmann, Clara A. Callahan, and Michael Magee, "Empathy in Medical Students as Related to Academic Performance, Clinical Competence and Gender," Medical Education 36, no. 6 (2002): 522-27
9. Interestingly, Spiro describes students' internalization of what Foucault articulates as the "medical gaze" when he writes: "In clinical medicine, we talk mostly about the 'case' and not about the person; reports are written in the passive voice to imply that truth is being uncovered by an ineluctable force. . . . The eye is quicker than the ear; yet, the patient's experience is more complicated and variable than the disease visible to the doctor. Often the individual patient is seen as only a model, a body to be treated, or a good 'teaching case' that illustrates a point." Spiro, "What Is Empathy," 844
10. Jerome Lowenstein, "Can You Teach Compassion?" in The Midnight Meal and Other Essays About Doctors, Patients, and Medicine (New Haven, CT: Yale Univ. Press, 1997), 12-19
11. Spiro, "What Is Empathy," 843
12. Coulehan et al., '"Let Me See if I Have This Right,'" 221
13. Jochanan Benbassat and Reuben Baumal, "What. Is Empathy, and How Can it Be Promoted During Clinical Clerkships?" Academic Medicine 79, no. 9 (2004): 833
14. Benbassat and Baumal, "What Is Empathy," 833
15. See From Detached Concern to Empathy: Humanizing Medical Practice (NewYork: Oxford Univ. Press, 2001), 36n21
16. See Halpern, From Detached Concern to Empathy, chap. 1
17. See Michael S. Gazzaniga, The Ethical Brain (New York: Dana Press, 2005)
18. Jerome Lowenstein, "Can You Teach Compassion?" 16
19. Larry R. Churchill, "Why Literature and Medicine?" Literature and Medicine 1 (1992; rev. ed.): 35-36
20. James N. Kirkpatrick, Kyle Nash, and Thomas P. Duffy, "Well Rounded," Archives of Internal Medicine 165, no. 6 (2005) 615
21. Eric B. Larson and Xin Yao, "Clinical Empathy as Emotional Labor in the Patient-Physician Relationship," Journal of the American Medical Association 293, no. 9 (2005): 1102
22. Spiro, "What Is Empathy," 845
23. Hal pern, From Detached Concern to Empathy, 60
24. Halpern, From Detached Concern to Empathy, 98n52
25. Jodi Halpern, "What Is Clinical Empathy?" Journal of General Internal Medicine 18, no. 8 (2003): 672
26. Halpern, "What Is Clinical Empathy," 671
27. Helen Deutsch, "Symptomatic Correspondences: The Author's Case in Eighteenth-Century Britain," Cultural Critique 42 (1999) : 37
28. Mullan portrays physicians such as George Cheyne linking themselves with novelists such as Richardson (who published Cheyne in addition to avidly corresponding with him) and establishing a shared sensibility and specialized mode of communication. John Mullan, Sentiment and Sociability: The Language of Feeling in the Eighteenth Century (Oxford: Clarendon Press, 1988), 207
29. Deutsch describes this contradiction in her definition of sensibility as a "discourse that bridged literature and medical science in an era when they were diverging as professions [and] restored the body to life and to society, rendering it vulnerable, even ill, while allowing it to speak." Deutsch, "'This Monster, the Body': Narratives of Illness, Histories of Presence, 1812, 1993," in Monstrous Dreams of Reason: Body, Self and Other in the Enlightenment, ed. Laura J. Rosenthal and Mita Choudhury (Lewisburg, PA: Bucknell Univ. Press, 2002), 113
30. William Cullen and his student John Brown, both eighteenth-century physicians, shaped theories of illness that depended on a notion of equilibrium that was either healthy or disturbed by an excess or a lack of stimulation. See Charles Singer and E. Ashworth Underwood, A Short History of Medicine (New York: Oxford Univ. Press, 1962), 148-49
31. Whytt argued that "there is united to the bodies of men and animals an active, living, sentient principle." Robert Whytt, "An Essay on the Vital and other Involuntary Motions of Animals," in The Works of Robert Whytt, MD (London: T Becket and P. A. Dehondt, 1768), 144
32. For an excellent discussion of Whytt, which informs my use of his work here, see Steven Bruhm, Gothic Bodies: The Politics of Pain in Romantic Fiction (Philadelphia: Univ. of Pennsylvania Press, 1994), chap. 1
33. Christopher Lawrence, "The Nervous System and Society in the Scottish Enlightenment," in Natural Order: Historical Studies of Scientific Culture, ed. Barry Barnes and Steven Shapin (Beverly Hills, CA: Sage, 1979), 25
34. For Burke, literature and art provide distance from what would otherwise be overwhelming suffering, enabling the experience of sympathy and the formation of social bonds. For Hume, sympathy is more likely when the pain of others is mediated through the medium of taste, as an aesthetic response to literature and art. See Edmund Burke, A Philosophical Enquiry into the Origin of Our Ideas of the Sublime and Beautiful, ed. J. T. Boulton (London: Routledge, 1958)
35. and David Hume, "Of the Delicacy of Taste and Passion," in Essays, Moral, Political, and Literary, ed. Eugene F. Miller, Library of Economics and Liberty (Indianapolis, IN: Liberty Fund, 1987)
36. Claudia L. Johnson, Equivocal Beings: Politics, Gender, and Sentimentality in the 1790s: Wollstonecraft, Radcliffe, Burney, Austen (Chicago: Univ. of Chicago Press, 1995), 5
37. Kathryn Montgomery Hunter, Rita Charon and John L. Coulehan, "The Study of Literature in Medical Education," Academic Medicine 70, no. 9 (1995): 794
38. See Adam Smith, The Theory of Moral Sentiments, ed. D. D. Raphael and A. L. Macfie, Glasgow Edition of the Works and Correspondence of Adam Smith (Indianapolis, IN: Liberty Fund, 1982), 9-10
39. and Lawrence, "The Nervous System and Society," 32
40. Smith, The Theory of Moral Sentiments, 9
41. See Lawrence, "The Nervous System and Society," 28-31, on the relation between sensibility and civilization
42. Stephen Greenblatt, Renaissance Self-Fashioning: From More to Shakespeare (Chicago: Univ. of Chicago Press, 1980), 227. Here Greenblatt is critiquing sociologist Daniel Lerner's concept of empathy as a characteristic of modern Western society in The Passing of Traditional Society: Modernizing the Middle East (New York: Macmillan, 1958)
43. Nancy Roberts discusses Greenblatt's critique of empathy in her Schools of Sympathy: Gender and Identification through the Novel (Montreal: McGill-Queen's Univ. Press, 1997)
44. Greenblatt, Renaissance Self-Fashioning, 231 and 227
45. Rachel Naomi Remen, Kitchen Table Wisdom: Stories That Heal (New York: Riverhead Books, 1996), 208
46. The total sum of medical information now doubles, on average, every 3.5 years. Melissa M. Brown, Gary C. Brown, Sanjay Sharrna, Evidence-Based to Value-Based Medicine (Chicago: AMA Press, 2005), 4