Research

Clinical Empathy

As a psychiatrist as well as a faculty member in bioethics at UC Berkeley for almost two decades, I’ve investigated what happens to patients when their doctors show a lack of empathy. Doctors were trained to believe that emotional detachment from patients is personally and professionally necessary, but experience shows that patients don’t trust doctors who are aloof or superficially friendly. Yet, only  recently have studies proven just how harmful detachment and how beneficial empathy is for healing.

Back in 2001, I wrote a book called From Detached Concern to Empathy, arguing against pseudoscientific claims that medical objectivity and effectiveness required doctors to shut down their humanity. This book helped stimulate a wave of research into the role of clinical empathy in effective medical care, and the Journal of the American Medical Association called it a “seminal book” because it radically changed the way doctors were told to relate to their patients emotionally.

Research over the past decade has confirmed that clinical empathy plays an essential part in effective healthcare. Studies show that because patients trust empathic doctors more, they communicate much more honestly with them about their physical and emotional issues. As a result, empathic doctors recognize health problems that others might miss. Patients trust emotionally engaged doctors and tell them the truth about problems, such as noxious side effects that lead them to give up on treatment. And when curing disease is no longer possible, empathy can alleviate suffering for both patients and their families as they face dying and grief.

Remaking the Self in the Wake of Illness

As I’ve matured, I’ve become more interested in reaching out directly to patients rather than to doctors, and also to my fellow aging baby boomers. We are part of a huge wave of people who will live longer but also will experience chronic illnesses, cancers, cognitive impairments (Alzheimer’s), and physical disabilities.

As a psychiatrist, I’ve listened to moving stories about the psychological challenges people face remaking their lives in the wake of serious illness. These stories have shown me that the popular ideal of “fighting” illness does more harm than good. This reflects American culture and our emphasis on masculine values of independence and personal will power, as in the popular song: “I did it my way.”   While being strong is valuable, such messages do not prepare people to depend on others, accept losses and find new ways to do things.

What often works in recreating a meaningful life is learning to tolerate painful feelings, reaching out for social support, and using one’s imagination to tap new sources of joy.  These more traditionally female approaches to remaking the self after a serious illness or accident are given short shrift not only in the media but also in the fields of bioethics and healthcare.

The stories in Remaking the Self in the Wake of Illness show the variety of ways that real people come to accept rather than deny their condition and create a fulfilling life.

The Soldier’s Project

As a bioethics professor at Berkeley’s School of Public Health, my teaching focuses on ethics and human rights. Collaborating with researchers and clinicians around the world, my concern has been to address dehumanization in such war-torn countries as Rwanda, South Africa and the former Yugoslavia.
My current focus is on the mental health needs of returning U.S. veterans, many of whom experience psychological wounds that disrupt their lives.  Professionals in rehabilitation and social work can help with social, vocational, economic, and structural supports. But veterans also face invisible losses to their selves and their emotional connections with family members that can be missed in the shuffle of restoring functioning.  Soldiers returning from war often talk about how their old selves have been lost: they literally don’t know how to start again nor do they have a feeling of aliveness or vitality.

I am honored to be writing about a leading program called The Soldiers Project, which addresses the hidden psychological wounds of soldiers and their families.  Judith Broder, M.D,, founded The Soldiers Project, a national program providing free therapy to soldiers and their families, after seeing “Sand Storm: Stories from the Front,” a play written by then active duty marine Sean Huze.

It is Broder’s words on hidden wounds that drew me to the project.  The psychotherapists in The Soldiers Project have described to me how their empathic listening helps soldiers attend to what is otherwise almost impossible to put into words and grieve. I plan to document the way these therapists are making a difference in the lives of veterans and their families, in the hope that this will promote social acceptance and funding for psychotherapy for veterans. We still need to show what is too often denied, which is the importance of subjectivity and emotion in one’s quality of life.  Empathic listening is a powerful intervention as veterans face the challenges of remaking themselves.