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    It's Always Spilling Over The Edges

    Leslie Jamison, author of The Empathy Exams, on "pain" versus "suffering," the impulse to travel, and the intrinsic shame of telling our own stories.

    Leslie Jamison is the author of a novel, The Gin Closet, and has written for publications like The Believer, Harpers, and Oxford American. She is also a Bookends columnist for The New York Times Book Review. Her new book of essays, The Empathy Exams, takes its title from Jamison's work as a medical actor, rating doctors-in-training on their bedside manner, but it also describes the book as an examination of empathy, as a concept and as a practice. The essays take Jamison to a conference for sufferers of Morgellons disease, a brutal ultra-marathon in Tennessee, and the frontier of the narco wars in Mexico, to name just a few; through a series of vignettes called "pain tours"; and into ideological discussions of the merits of sentimentality and pain. The book is an exploration, a travelogue, a manifesto, and a meditation. It is also a quest, for a language of pain and empathy and for a generosity of spirit and understanding. The book is the winner of the Graywolf Press Nonfiction Prize. We spoke on a couch in Brooklyn.

    How did you come to realize that the essays you'd been writing fit together as a larger project?

    Leslie Jamison: Writing the title essay made me start thinking about these as a collection. It was the first time I'd consciously articulated to myself that empathy was something I was really interested in — the first time I started thinking about everything I could gather around that word.

    The piece on Morgellons disease was the first essay I wrote consciously knowing it would be part of a collection. I wrote it without a magazine commission, and I think knowing that it was going to have a home no matter what made it easier to take some logistical risks in writing it (paying for a plane ticket to Austin, for starters), but it also meant that I was battling against a sense of thematic overdetermination. I was so consciously bringing in these questions of empathy: How do I relate to these people's pain? How do I relate even if I disagree with their narrative? I was joking around with a friend that the word "empathy" showed up 39 times in the original draft. In other essays, it was easier to come at empathy through the back door.

    In that essay about Morgellons disease, and in others — the one about Charlie, the ultra runner in prison, for example — you showed yourself working not to judge the people you were writing about. In the essay on Morgellons, you write, "All I want to do is look at him in a different way than the doctors did." I felt like there was this tension between generosity or empathy and factual reporting.

    LJ: With the Morgellons piece, I wanted to present the texture of experience as it was lived by these people, rather than a verdict on how we might categorize the experience they were having. There had been many media accounts all focused on the question of "Is the disease real or not?" I wanted to label that as one way you could approach this disease — but not the way that I was approaching it. And with Charlie, his story had been told almost exclusively in terms of the legality of why he was in prison and how he'd gotten there and whether that was justified or not. My perspective involved those questions, but it was bigger than those questions: It was also about his life in prison, the prison industry in West Virginia, the economic landscape around those prisons. I found traction in figuring out how my gaze was going to be different from other gazes; how my questions were different and perhaps less reliant on answers.

    Which I guess is one of the differences between writing a piece of journalism and writing an essay — it's not necessarily about coming to an answer about the subject.

    LJ: A lot of these essays close with some version of an empty space, or an unknown answer, even a literal question mark — even when I'm processing my own experience. I've often got a strong impulse to leave something ragged at the end. Although I think that tendency can get tiresome when you indulge it too much. Like, "Nothing can be known or resolved or decided" — the bottomless question can be a cheap way to play that — like an existential alibi. But I find myself drawn to what I hope is an earned form of uncertainty.

    If your essays are often ended with a question, what does a piece start with for you?

    LJ: A lot of the essays begin with some human motivation — or some set of human bonds — that are inscrutable to me. In the essay about the ultra-marathon, it's this sense of, Wow, what would compel somebody to treat his body in that punishing way? I focus on that little engine inside of a person that I don't quite get. Or I'm moved to write essays about things that I have trouble articulating in my own life. Where I can feel an obstruction coming up when I'm trying to speak about it — that's how I know it holds some kind of fierce potential energy.

    After I got hit in Nicaragua, I had a lot of trouble telling that story. I have a way that I say it now, which is simple, just: "I got hit in the face," but for a long time I even struggled with the elevator pitch of that incident. I hated saying I'd gotten "mugged," because I didn't care that anything had been stolen, I just cared that I'd been punched. But saying "punched" didn't feel quite right either. One time I said I was "assaulted," but then I felt like I was turning it into a bigger deal than what it was. I had so much shame and frustration and stuttering around that story, and all of those things were like vectors pushing me back into its folds. Like, if this is so hard to tell, what's lying in wait there? Writing an essay creates a little space of experimentation where I try out different strategies of telling.

    At a couple points you talk about how observing something, either as a reporter or as an interviewer or just as a witness, changes it. Do you ever worry about losing your own original experiences by writing about them?

    LJ: I do worry that writing about my experiences somehow deforms them — or my relationship to them — but part of what alleviates that fear is that writing these essays about personal experience hasn't sealed any narratives for me. All of these experiences are still live and loaded. I'm less upset about getting hit in the face than I was six years ago, but I hardly feel like I've wrapped it up like a present and given it away. You write a version of a thing but it's always spilling over the edges. And the fact that it's always spilling over the edges — that there's always, always, always more than what makes it onto the page — that spillage is part of what tells me that these stories are still mine; they're still electric.

    Many of the essays bring together personal writing with reporting or social commentary, in one piece. You've called it "looking inward and outward at once." Can you talk a little bit about the decision to interweave those things in one essay, and where it starts and where other things get added?

    LJ: Sometimes it feels like the more violent choice — I don't know if I want to say "violent," but certainly more intentional or aggressive — is to keep journalism and memoir separate. Every time a journalist reports a piece, she's having a really intense experience; every time you have a conversation with another person — whether you're doing it as a journalist or a friend — all these moments of your own past are rising up to haunt you. So I offer that confession: When I'm talking to these people, this is what's coming up for me.

    With the piece about Morgellons disease, it felt unavoidable. In the course of spending several days talking to people who believed that they had strange fibers coming out of their skin, how was I not going to think about the fact that I'd once had a maggot in my body, spent weeks and weeks convinced that I had this maggot in my body, and nobody believed me, and then I was finally vindicated?

    My maggot was definitely something that I deployed in my conversations with Morgellons patients. I started to feel a bit ashamed of it, eventually, how it felt like a trump card that I could play. If a Morgellons patient's default assumption is that a journalist is out to make her play the fool, I could turn that assumption around pretty quickly by starting to describe this weird parasite that I had — that located me in their camp, made me more than a judgmental outsider. Basically: I'd been infected too.

    Many of the essays return to questions of unseemly or inappropriate pain or experiences — wallowing or sentimentality. That kind of indulgence is often connected to weakness. It's an accusation to enjoy being in pain or to enjoy suffering, and that stigma often comes from within. Do you think it's an external message that's internalized?

    LJ: I wrote the final essay because I had a very strong conviction that a lot of women in my life — female authors that I'd read, friends I had, myself, as both a writer and a human — had this extremely conflicted relationship to pain. We claimed pain and felt ashamed about that claiming. But when I started to write the essay, I was afraid that I was building up this straw man. What was the source of this taboo against pain? If it's some kind of shame we've internalized, where did it start? Where is it coming from? If I was making this case for the legitimacy of articulating pain, who was I arguing against?

    To some extent I was arguing against female voices that wanted to resist female identities that were too implicated in pain: I was arguing against those in which the taboo had lodged, in whom it had been internalized. There was a struggle to find external mouthpieces for this thing — this shame — that has become so internalized we're used to hearing it from inner voices, vague voices; we're used to encountering it as a general feeling. That essay was an attempt to trace the roots of that shame to something external, something quantifiable.

    Writing that essay, I felt like I was constantly living in this chorus of genres and voices. It was like living in the woods for a while. The woods of pain. But something at the core of that piece had always felt — and still feels — deeply true to me.

    While these essays are dealing with a lot of big ideas, their stories also reflect how much you've traveled. Do you see that drive to travel as connected to your drive to write essays or to try to understand other people?

    LJ: My desire to go places is related to my curiosity about other human beings, and these desires attach to travel and essays: Those are two different escape valves for the same internal pressure. One thing that's been interesting to me — in watching my writing unfold — is that I see a lot of my parents in it.

    I spent a lot of my teenage years identifying away from my father, a global health economist who travels quite a bit. Part of that dis-identification was emotional, and part of it was professional. Both my parents work in public health, and I have a tremendous respect for what they do. At the same time, I sometimes have this anxiety that writers have: What is the practical value of what I do? and that anxiety sometimes attaches to my parents' work: They're trying to figure out how to relieve global disease burden or childhood malnutrition. But I like seeing traces of them in this book, their passions and their inquiries, and one of those traces is definitely the ways that I move around. That impulse to travel is an inheritance from my father. I stare it in the face when I look at the map of the book: Austin, Tijuana, West Virginia, Bolivia, Tennessee, Nicaragua.

    Well, if empathy is about how we treat each other and how we take care of each other, and how we're good to each other, and they're working in public health, those are very connected.

    LJ: I hope the book is devoted to some of the same big dreams my parents have dreamed for the world, and the ways they've put themselves in service of those dreams. It's no coincidence the book is dedicated to my mom. I've always respected her genuine feeling of commitment to caring for others, her sense that you can love particular people as kin but also feel and act on a larger sense of love — a love that includes a much larger group of people under your purview of care. That's a powerful belief she's always lived under.

    Do you see a difference — I was thinking about this in the context of wallowing — do you differentiate between pain and suffering?

    LJ: I think the word "suffering" evokes something more epic than "pain." Suffering involves the spirit. Pain operates on this weird hinge point: It can mean something physical, or it can mean something emotional. But the difference between pain and suffering taps into these questions of legitimacy or ownership. Because I think of suffering as a grander word — it introduces these questions like, who has the right to call their pain "suffering"? Who has the right to consider her pain on a certain level?

    Sylvia Plath shows up a couple times in that final essay because of the way certain critics have gotten so angry that she invokes the Holocaust to talk about her relationship to her father. That critical anger has something to do with that difference between pain and suffering: Like she's trying to take an experience of ordinary pain and ratchet it up to another level of suffering that she hasn't earned, or doesn't deserve.

    It's an interesting idea of getting mad at someone for overblowing their pain, or wallowing, like, who is it hurting? Who are you worried about or fighting for?

    LJ: I think it's fascinating. I guess the idea is that the victims of that crime would be either the actual forms or the memory of people who have experienced some greater form of trauma; or that your victims are the people that you're asking for something from — like sympathy or attention. But I think that's a great question: Who is that indignation on behalf of?

    You quote an Amazon review of Lucy Grealy's book, Autobiography of a Face, that said, "She was a sad woman who never got beyond her own personal pain." And I read that and just thought, well, what was she supposed to get beyond it to?

    LJ: That question connects to the larger shame of the confessional. There is this critique that's leveled at memoir as a navel-gazing art. People have a disdainful way of talking about "the memoir boom" or "the memoir craze" that implies the memoir is emblematic of a certain larger culture of narcissism — that people are so obsessed with themselves and their own stories. I started out as a fiction writer, and I've noticed such an intense shame surrounding the "quasi-autobiographical first novel." It's more admirable to write about a war you've never seen — like that's braver or more ambitious than writing a "thinly veiled" version of your own life. Even the thin veil suggests a certain kind of poverty, a contingency — as if value or bravery depends on obscuring your own life, and the shabby veil didn't do it well. It's a critique that won't quite announce itself as such.

    I'm really interested in what that critique is fueled by: Why is it self-centered or cowardly to write about your own personal experience? I've felt that shame too, and sometimes I've wondered whether my attempts to weave memoir with other forms are responses to that shame, like: I don't want to be too self-involved, so I'll invoke this reported material, or I'll offer this cultural history. I do believe, though, that my deeper motivations have to do with the fact that our personal lives are already tangled up in the rest of the world. So I've wondered: Can we find a form that acknowledges that?


    Jaime Green's essays have appeared in The Awl, The Rumpus, The Cossack, and Everyday Genius. She hosts The Catapult, a podcast of new writing read aloud.