By Dr Neel Burton — Psychiatrist, philosopher, and wine writer; Fellow of Green Templeton College, University of Oxford; author of over twenty books.
Empathy is, in a sense, the opposite of anger. In anger, we are imprisoned in ourselves and unable to see another person’s perspective. We see in people only what they have done to us. With empathy, we reach out to the other and try to see the world through their eyes.
But if we take this reaching out too far and begin to merge with them, it can become a problem. The suffering of our patients can become both corrupting and exhausting.
Sympathy vs Empathy
The danger becomes clearer if we distinguish between sympathy and empathy. If a friend has lost a parent, and I say, “I’m sorry,” that’s sympathy—which is simple concern for another person’s suffering. If I imagine what that loss feels like from within my friend’s world, that’s empathy.
The power—and the danger—of empathy lies in its particularity. It’s not merely a matter of imagining myself in someone else’s situation. I must imagine myself as them, in that situation. I need to understand who they are, where they have come from, and where they are trying to go. As John Steinbeck wrote, ‘It means very little to know that a million Chinese are starving unless you know one Chinese who is starving.’
Why Empathy Must Remain at One Remove
Yet, to imagine myself in someone else’s shoes is not to become that person. Empathy must remain at one remove. That distance enables me to think objectively and be of help. After all, if I drown alongside a drowning person, I can hardly pull them out of the water.
If that boundary collapses, empathy can corrupt as well as exhaust us. It can lead us to favour the person before us over the many people we cannot see. And, as empathic distress, it can lead to compassion fatigue and burnout.
Regulating empathy, therefore, is not callousness but the condition of effective care.
Doctors who understand their patients without being engulfed by them are not only more effective but more fulfilled in their work.
Ultimately, the doctor’s task is not to carry the patient’s pain, but to stand close enough to understand it—and far away enough to help.
Psychiatry derives from the Greek psyche (butterfly or soul) and iatros (healing), and means ‘healing of the soul’. In Greek myth, Psyche’s lover was none other than Eros.
By Dr Neel Burton — Psychiatrist, philosopher, and wine writer; Fellow of Green Templeton College, University of Oxford; author of over twenty books.
In my experience, most medical students enjoy learning about mental illness and talking to mentally ill people, who often have a refreshing knack for saying things exactly how they are. In a fit of inspiration, some students—particularly the more intelligent, creative, or quirky ones—confide that psychiatry is the only specialty that gives them the time and material to think about themselves, other people, and life in general.
They also like the lifestyle (in the UK): an hour for each patient, ‘special interest’ days, protected time for teaching, light on calls from home, and guaranteed career progression. In medicine they might triage yet another anonymous case of asthma, chest pain, or pulmonary oedema. In surgery they might do knee replacement upon knee replacement, up until the day they retire or collapse. But in psychiatry there can be no factory line, no standard procedure, and no mindless protocol: each patient is unique, and each patient has something unique to return to the psychiatrist.
I often come across those same students again, months or sometimes years later. After the smiles and the niceties, it transpires that they are no longer so interested in psychiatry. So what happened?
The students are never too sure, but I think I have an idea.
When I was a medical student in London, an American firm offered me a highly paid job as a strategy consultant in their Paris office, opposite the British embassy and the Elysée Palace. So I gladly left medicine and the many inconveniences of working in (and increasingly ‘for’) the National Health Service.
I had a great time in Paris, but the job itself turned out to be more about dealing with personality disorders than about having brilliant ideas. I quit after six months and freelanced as an English tutor to high-flying executives, bankers, venture capitalists, and that sort.
As my clients already spoke working English and merely wanted to improve their fluency, all I had to do was to make conversation with them. My lessons often turned into something akin to psychotherapy, as I realised that I could make them open their hearts and minds simply by listening to them. Although they seemed to have everything in life, they were deeply unhappy, and had rarely stopped to ask themselves why.
I wanted to find out why, so I decided to return to the UK, do my house jobs (internships), and specialise in psychiatry. I had always been far too ‘ambitious’ to consider psychiatry, but by then it had become abundantly clear that I didn’t want to pursue a career that didn’t allow me to think and feel, and to relate to others and to the world in a genuine and meaningful way. There are not many such jobs, but psychiatry—along with general practice, teaching, academia, and the clergy—is certainly one of them, and even, arguably, their archetypal form.
In short, I wanted to get paid to talk to people, read books, and study life—and it felt like robbery.
The following year while going about my house jobs I put up with all sorts of abuse from my colleagues in medicine and surgery. One of the other house officers (interns), by then a good buddy, took me aside one day and said with an alcoholic mixture of concern and disdain: ‘Why do you want to go into psychiatry? You’re a good doctor. Can’t you see you’re wasting your talents?’
It became very clear, first, that the stigma that people with a mental disorder are made to feel also extends to the doctors who look after them; and, second, that this stigma emanates most strongly from the medical profession itself, mired as it is in middle-class preoccupations and prejudices and, as a whole, far too grounded in neurosis not to be terrified of psychosis.
Of course, it is simply not true that psychiatry is ‘a waste of talent’. The term ‘psychiatry’ was first used in 1808, in a paper by Johann Christian Reil. Reil argued for the urgent creation of a medical specialty to be called ‘psychiatry’, and contended that only the cream of physicians would have the qualities required to join it. Psychiatrists needed to have not only an understanding of the body, but also proper learning and culture.
Indeed, a psychiatrist can change a person’s entire outlook with a single sentence, so long as he can find the right words at the right time. No protocols, no high-tech equipment or expensive drugs, no pain or side-effects, and no complications or follow-up.
Now that is talent, and one so great that I can only ever aim at it. And each time I fail, I always have medicine to fall back upon.
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