With Pain As Its Subject, the Essays in ‘The Empathy Exams’ Hit Hard

Leslie Jamison is a novelist and essayist, and this book of diverse essays features work originally published in such outlets as Harper’s, Believer and Tin House. As with all good essays, her subjects tend to begin tightly focused but then spiral outward to include topics and questions that might not appear immediately relevant.

Her debut collection of essays, The Empathy Exams, touches upon recurring themes of illness and pain, and our responses to the same. It’s a strong collection, marked by intellectual restlessness, a knack for the arresting phrase, and an almost alarming honesty. Not every essay is equally riveting, but there are certainly moments so naked as to make some readers squirm, and it’s a powerful collection overall.

The book kicks off with the titular essay “The Empathy Exams”, which chronicles the author’s involvement in a fascinating but faintly disturbing exercise. Jamison describes her time working as a medical actor: someone who pretends to be sick with a particular condition, with a particular list of symptoms and a specific background history (married or divorced, kids or no, dead brother, good job, etc). She then acted out this role for the benefit of medical students who were learning how to elicit information from their patients in order to make a correct diagnosis.

Besides that, the students would be graded on something else as well: their degree of empathy. This was to be measured by their recitation of certain key phrases to show that they felt an appropriate degree of compassion for their patients.

Okay, so it’s weird enough to think that medical personnel need to be trained in how to express compassion – although anyone who has spent much time with doctors can tell you that yeah, a lot of them could use the extra practice – but the essay isn’t content to stay on topic. Jamison gradually introduces elements of her own life into the mix, details about her background, her boyfriend, and eventually her abortion.

In so doing she ups the stakes considerably, deftly shifting the focus from the medical students’ need for empathy to her boyfriend’s and, inevitably, to our own. The essay reads almost as a challenge: You want to roll your eyes over the doctor-in-training and their need to take a course in expressing compassion? Well, how empathetic are you?

As a lead essay, it’s a powerful one, and the remainder of the collection struggles to sustain the intensity. “Devil’s Bait” discusses a bizarre medical condition, reported by thousands of people but rejected by the medical industry, in which threads ride up from beneath the skin, finally surfacing and manifesting themselves in a variety of disturbing ways. It sounds like something out of a horror movie, yet hundreds of people gather in conventions to discuss the condition every year.

The final essay, “Grand Unified Theory of Female Pain”, touches upon female literary characters, Louise Gluck, Sylvia Plath, bulimia and anorexia, and the televisoin show Girls, among other things. Sections within the essay are not called chapters but “wounds”. At the end, the author declares that she “crowdsourced” the essay, asking friends to contribute their own stories. Somehow it all hangs together, but only just.

Some of the strongest essays here, though, have only a tangential relationship to disease or infirmity. The final few pages of “Pain Tours” details the author’s participation on something called a Gang Tour, in which former Los Angeles gang members shepherd busloads of gawking tourists from Missouri and elsewhere through the mean streets of LA, pointing out the County Jail, South Central and Watts. Customers are regaled with stories of time in prison and sobering facts (“More people have died in LA gang conflicts than in the Troubles in Ireland”). At the end, the tourists pose for a photo shoot in front of some local graffiti, flashing gang signs as an indicator of their entertainment.

My favorite essay is “The Immortal Horizon”, which discusses the Barkley Marathon, an insane 100-mile foot race in the mountains of northern Tennessee. Participation is by invitation only. Under ideal conditions, the race takes a punishing five days to complete its five loops of 20 (or possibly 26) miles through mountainous, doggy, rain-soaked, hellish terrain. Conditions are rarely ideal, and hardly anyone ever finishes. But people keep trying anyway, and Jamison’s observations about the participants, and the race’s founder, an eccentric named Gary Cantrell aka Lazarus Lake, make for delightful reading. For once, the pain at the core of this essay is self-inflicted, which makes it marginally less horrible to read about, and in any case the psychology of people drawn to this kind of “extreme sport” is fascinating.

Jamison writes with a sure eye for detail and a strong sense of phrasing. In the titular essay she remarks,”Empathy means realizing no trauma has discrete edges. Trauma bleeds. Out of wounds and across boundaries.Sadness becomes a seizure. Empathy demands another kind of porousness in response.” Elsewhere, she comments on the power of metaphor: “Figurative language often delivers us to the saccharine… but it can also offer an escape hatch out of the predictability of sentiment. Metaphors are tiny saviors leading the way out of sentimentality, small disciples of Pound, urging ‘Say it new! Say it new!’ ”

Such lucid and lively writing informs these essays, ensuring that they’re engaging and thought-provoking even when the subject matter might not immediately grip the reader. This is a terrific collection, and a refutation of the assertion that the essay is a lost art.