From Detached Concern to Empathy: Humanizing Medical Practice (review)
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Journal of Health Politics, Policy and Law 28.6 (2003) 1121-1125



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Jodi Halpern. From Detached Concern to Empathy: Humanizing Medical Practice. New York: Oxford University Press, 2001. 165 pp. $37.95 cloth.

Sick people and those who care for them have together learned a great deal in the recent past about the conditions most conducive to effective health care. Patients and their families have, with great generosity and bravery, written about their ordeals of illness in pathographies and memoirs, giving health professionals thick descriptions of what persons undergo at the hands of disease and its treatment (Hawkins 1999; Frank 1995). Nurses, therapists, and doctors—including Cortney Davis, Abraham Verghese, Rachel Remen, Jerome Groopman, and Susan Mates—have written with reflection and curiosity about how they live their lives around sick and dying people, their rewards proportional to their personal suffering. Whole fields have arisen over the past thirty years or so—medical interviewing, humanities and medicine, literature and medicine, movements committed to humanism and professionalism, and the even more recent narrative medicine—to examine, with the guidance of rigorous theoretical frameworks from literary studies and other humanities disciplines, what can best enable health professionals and their patients to reach one another in care (Greenhalgh and Hurwitz 1998; Evans and Finlay 2001; Anderson and MacCurdy 2000).

This book is an important addition to the literature on emotion and [End Page 1121] empathy in health care. Doubly trained as a psychiatrist and a philosopher, Jodi Halpern deploys theoretical considerations from Freudian, object-relations, and cognitive therapy strains of psychoanalysis and psychiatry to describe, theoretically anyway, the interior experiences of patients in acute crises and the physicians and nurses who care for them. In turn, the author presents the fruits of philosophy's recent examination of emotion, citing the works of such philosophers as William James, Jean-Paul Sartre, Gilbert Ryle, and Richard Wollheim to establish the ability of emotion to contribute constructively to knowledge, judgment, reasoning, and behavior. Theories of philosophers of aesthetics are briefly introduced to depict the intersubjective processes within the creative arts that parallel, to some extent, intersubjective processes between persons. The author then mobilizes Kantian and neo-Kantian considerations regarding personal autonomy to plot a course from clinical detachment to engaged practice, at least in the practice of clinical ethics.

Ably reviewing historical formulations of the place of emotion in medical practice, including the writings of Hippocrates, Worthington Hooker, William Osler, and then more recent works of Renée Fox and Harold Lief, Charles Aring, and Herman Blumgart, Halpern builds her case for a requirement that the physician become emotionally engaged with the patient in the process of care. (Although the book's concerns are as salient for nurses, social workers, therapists, and other health professionals as for doctors, the study explicitly restricts its focus to doctors.) Halpern proposes that the physician must develop curiosity in the plight of the patient so as to enter the world of the sufferer. If the physician is able to wonder about and, perhaps then, recognize the patient's emotions, the patient in turn need not deny or turn away from his or her own experience. Through a process of mutual associative mental processes, sometimes called "resonance" and at other times called "associative linking," the doctor can confirm the "intense emotional irrationality" of the patient in crisis, thereby "harness[ing] ordinary emotional reasoning to cultivate empathy. . . . The instances in which a patient's feelings of helplessness and fear induce similar feelings in her physician offer unique therapeutic opportunities" (136).

Once emotion has been liberated back into clinical practice, the professional is able to enter accurate communication with the affect and thoughts of the patient. So-called gut feelings (a term that seemed to me to demean the whole process) are, therefore, conduits toward doctors' richer and more accurate perceptions of patients' total reality. Halpern raises but does not adequately face the troubling problem of how to achieve accuracy and not merely solipsism in the mutually associating physician. [End Page 1122]

Medicine practiced without empathy is hobbled by...