‘The Empathy Exams’, by Leslie Jamison

A collection of essays in search of that most elusive quality: empathy

The Empathy Exams, by Leslie Jamison, Granta, RRP£12.99/Graywolf Press, RRP£25, 256 pages

In her acknowledgments, American writer Leslie Jamison thanks a tutor for telling her “that the problem with an essay can eventually become its subject”. The lesson clearly sunk deep. In her new collection, Jamison doesn’t just find problems, she creates them, picking away at her subjects and herself until her pieces end with more questions than answers. Every angle is examined, then cross-examined. Her writing is self-interrogating to the point of exhaustion. Luckily, it’s also very good.

The finest essay is the first. “The Empathy Exams” is an account of Jamison’s experience as a medical actor, hired to fake sickness to test the bedside manner of budding doctors. But it is also an account of her own real experiences – her abortion, heart operation, relationship with her boyfriend, and a study of her hunger for compassion, the central thread of the book.

She is winningly honest, often unflatteringly so: “Part of me has always craved a pain so visible – so irrefutable and physically inescapable – that everyone would have to notice.” No one – her doctors or boyfriend – gets it quite right, failing to show kindness at the right time, using the wrong words, unable to explain to her why she is feeling the way she is feeling, “which is a superlative kind of empathy to seek”, she admits, “an empathy that rearticulates more clearly what it’s shown”.

Not that she is inarticulate. Jamison is in total command of her material, able to swing from dry precision (“answer every question like you’re clarifying a coffee order,” she instructs herself before her abortion) to poetry: “a root system of loss stretches radial and rhizomatic”. But it is her ability to notice and needle her own artifice that makes her work fly. Her gaze is sharp and turns inward as often as outward. In this sense, she takes after the matriarch of the American essay, Joan Didion. In a later piece, Didion is lauded for her intelligence and “keen and cutting eyes” but Jamison seems to seek a different path. If empathy is her subject, it is also her mode. Perhaps a writer does not always have to be “selling somebody out”, as Didion once put it, but can, instead, listen (a word that recurs), feel, and even love.

I’m not entirely convinced, and I’m not sure Jamison is either. In her piece on Morgellons disease, a scientifically unproven condition in which the sufferer feels as if something is alive beneath their skin, she demonstrates admirable open-mindedness and is sympathetic almost to the point of Stockholm syndrome, finding “small blue strands curled like tiny worms across my clavicle”. Her intention is not to prove whether Morgellons is real or not but to explore “what kinds of reality are considered prerequisites for compassion”. But she knows such agnosticism can only take her so far. A Morgellons sufferer shares his stories with her, and she only half-believes him: “In writing this essay how am I doing something he wouldn’t understand as betrayal?”

Many writers might ask themselves this question; few would put it into print. Jamison is part of an alternative tribe – patron saint, David Foster Wallace – who try to encounter the world more gently. A number of her essays were first published in the American literary magazine The Believer, launched by Heidi Julavits and Vendela Vida in 2003 with the express wish to counter “snark”, the weary, over-ironised critical style that the editors felt had infected book-reviewing. Jamison is a fellow traveller, on a quest to write with compassion, unafraid to exhibit vulnerability. “I want our hearts to be open,” she concludes one essay, surprising even herself with the Disneyish sentiment.

Such earnestness can feel heavy, at times, as can the ceaseless “self-reflexive anguish” (a phrase from another piece, where she tours gangland Los Angeles on a bus and feels guilty). Anxiety makes her a more human writer but also a more tiring one. You want to say, “Cut yourself some slack.” When she observes freely, without always catching herself in the act, she is at her most entertaining. But that would destroy the point. “Superlative empathy” is both Jamison’s method and her creed.

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