Empathy: A Short Q & A With the Voices in My Head

So, let’s start this off with a nice light discussion of psychosocial issues.

I’m a big fan of Stephen King. Not because I’m a horror junkie, or because of any psychotic tendencies or mental illness that I’ve experienced following the trauma of spinal cord injury (side note: I acknowledge the unfortunate reality of this for some). Rather, I’m a proponent of, and relate with, the terror-evoking author’s acknowledgment of life’s yin and yang.

The battle of Good vs. Evil.

The devil on one shoulder vs. the angel on the other.

The fine, yet blurred line between…


 Where the hell am I going with this?


Defined as “the sense or consciousness of the moral goodness or blameworthiness of one’s own conduct, intentions, or character together with a feeling of obligation to do right or be good”. Perhaps more easily described as your own sense of moral fortitude, and actions that do or don’t implicate it. In a Stephen King novel, the development of a conscience is what separates a psychopathic villain from the defiant heroine. In the life of this spinal cord injury patient (and I tend to imagine many others) conscience more typically separates self-pity, self-loathe, and blame from self-efficacy, self-confidence, and accountability. For the purposes of this spiel, I’ll be focusing on blame vs. accountability as they apply to empathetic efforts. Let this be the backdrop as we move forward with some healthy introspection.

Also, here’s a puppy in a teacup, because I sense that the mood needs to be lightened:

As a physical therapy student, I’ve noticed that the term “empathy” gets thrown around quite a bit. It’s like trust-currency for clinicians. If you have empathy, you can garner trust, which garners rapport, which leads to better patient compliance, which leads to better outcomes. Empathy was, in fact, a big selling point for my acceptance into my graduate program. I remember time and again, proclaiming behind a protruding chest, that “I have a unique ability to relate to my patients because I’ve essentially ‘been there and done that’ as a patient of intensive rehabilitation. I can offer something to the profession that few others can.” I found myself proudly repeating this because it consistently caused eyebrows to rise and heads to nod. My peers sensed that I had some empathetic merit because of what I have been through.

But is this actually the case?

I have indeed found that in my clinical rotations (internships) patients more easily confide in me as compared to my able-bodied colleagues, but in very few of these instances have I actually experienced the same injury. It’s like I’ve built up some credibility because of my past experiences, like my empathy-Equifax score has been accepted for an interest free trust-loan at the bank of “do-you-actually-understand-what-the-hell-I’m-going-through?” But who plays the role of credit bureau in this skit?

I do—I mean you do. The patient does. Let me offer some clarity:

We, as SCI patients, are the ultimate decision makers with regard to empathetic credit. We decide whether or not someone “gets it” or not. In other words we decide who is accountable for the blame. It is at this point, in my opinion, where this cute metaphor of experience=merit-based empathy comes to a halt.

Of course I remember how badly I just wanted someone to understand the crap I go through on a daily basis, or how hard some things are relative to the way they used to be, or how many times I’ve been laid up in a hospital and haven’t told anyone because I didn’t want pity, or how long it takes me to get ready in the morning, etc. I remember one early rehab morning, while learning to do my bowel program, literally screaming at my unsuspecting occupational therapist “You will ever understand this! Nobody will ever feel what I feel!”

And I was right: she couldn’t understand, because she didn’t share my experience. And God-forbid she ever has to. This lack of understanding personally led me down a dark and dead-end road of entitlement for months. I expected others to understand. I expected others to somehow feel what I felt, because I thought this would make me “feel good”. I expected that this was what empathy was, and what caring was. And with this as my mindset, I was repeatedly disappointed, and felt completely isolated. I denied accountability, and I misplaced blame.

So what, really, is empathy? My thoughts are opinions, of course, so take them with a grain of salt/sand/whatever that euphemism is.

Is empathy walking a mile in someone’s shoes? Is empathy rolling a mile on someone’s wheels? Is empathy actually understanding someone’s injury? Is that even possible? Should I fault/discredit someone who doesn’t understand, but makes efforts to try?

No (x5).

Is empathy merit-based?

Yes, of course. We have to have some means of qualifying it, but in my opinion, there is merit in efforts of empathy. Indeed, this may be the much-maligned “participation trophy” of the subject. But let’s be honest, when you’re a wheelchair user, you come to appreciate the participation trophies. :)

Let’s take this concept and broaden it, as I do.

Is it really the wheelchair, or the fact that you know you aren’t moving very far without it?

Is it really the pill that you have to remember to take, or the fact that you know you’ll have anxiety without it?

Is it really the job that pisses you off, or the fact that you know you’ll go broke without it?

Is she/he really in love with this toxic relationship, or are they in love with the absence of loneliness?

Identifying the motives and root causes of someone’s disposition (good, bad, or indifferent) is a losing fight for many **raises hand**, but it’s a fight worth a participation trophy for those invested enough to care.

Intent to empathize=intent to care=gratitude-if you/I/we fine-tune our understanding of accountability, and our appropriation of blame. Empathy isn’t (again, in my opinion) about feeling good, it’s about mutual efforts of understanding.

So no, they may not “get it”, but which side do you fall on? The side of bitterness for a failed attempt of empathy? Or the side of appreciation…for a failed attempt of empathy?

Ask those little voices in your head

Ask your conscience.

1 reply
  1. Don
    Don says:

    Thank you for sharing. I have some psychological issues that I have had for quite sometime. I’m unable to work due to physical limitations which have further produced yet another disorder. PNES which mine are the clinic type. I will be seeing a specialized clinical psychologist in April in hopes to get this problem controlled for it has my preoccupied along with my depression and anxiety problems. I no and feel empathy I am in constant battle with issues of good and bad. I’ve always been that person that steps up for the care of others and now no others seem to care for me. That’s not a cry for sympathy but just a truth I have had to come to accept. Thanks again. Sorry for the long winded statement. It helps when you tell an impartial person. Thank you.

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