Jodi Halpern was 10 or 11—about the age her son, Daniel, is now—when her stepfather proffered a bit of wisdom. She was never the same again.
“I was a very talkative child,” she explains, her laugh hinting at untold wells of effusiveness, “and I think he was trying to teach me how to let other people have a chance in the conversation. He told me, ‘If you just sit with someone, show interest but keep your mouth shut, it’s amazing how much is going on inside other people, how interesting they are.’ And that was a discovery.”
Halpern, it turned out, had a gift for listening. According to family lore, by the time the public bus delivered her home from school in Yonkers, N.Y., she’d often be so engrossed in a stranger’s story she’d lose track of her stop. Later, as a Yale philosophy major, her fascination with other people’s inner lives led her to summertime work aboard New York City’s venerable Floating Hospital, a public-health barge that brought clinical services to underserved communities. While their parents were being screened for hypertension and diabetes, Halpern was engaging the kids, talking with them—not to them—about depression awareness, violence prevention and other “emotional stuff.”
That experience, she says, “made me want to be a psychiatrist.” She remained at Yale after graduating magna cum laude, going on to earn both a philosophy doctorate and a medical degree, then moved west to UCLA, where she had a clinical practice. She joined the faculty of UC Berkeley in 1998, and is now an associate professor of bioethics and medical humanities, teaching grad students in the School of Public Health and the UC Berkeley-UCSF Joint Medical Program.
Students, she says, “are a big source of meaning for me.” Spending time with students, from teaching and mentoring to going along on research field trips, is part of what keeps her from burning out—unlike, say, so many medical practitioners.
Professional burnout is one of the issues Halpern tackled in From Detached Concern to Empathy: Humanizing Medical Practice, hailed as a seminal work on clinical empathy, and on the development of methods to help professionally aloof physicians engage with their patients’ on a deeper, more emotional level. Recently re-released in a paperback edition, the 2001 book merged Halpern the PhD—the index is sprinkled with references to Heidegger, Kant and Sartre, not to mention Tolstoy and William Carlos Williams—with Halpern the MD
The case she laid out for empathy—built on philosophy and her own clinical experience—is now buttressed by a decade of observational research she says demonstrates “the value of empathy, and how crucial it is for effective medical care.”
What researchers have found, she explains, is that when doctors assume a posture of detachment—as so many are trained to do—trust and cooperation suffer. Patients are less forthcoming about their histories and symptoms, and less apt to comply with physicians’ recommendations or take prescribed medications in a timely way.
“I had intimations of it in this book,” she says, “but the proof is in other people’s empirical research.”
A groundbreaking scholar on the subject of empathy, Halpern walks the talk, turning even an interview—by definition, mostly a one-way conversation—into a small model of what she calls “empathic listening.” She’s endlessly curious about her questioner—she is, after all, a psychiatrist. But she’s also a recovering talkative child, and discusses her work with a rapid-fire, New York-inflected enthusiasm.
Even an interview, for Halpern, is part “nonverbal dance,” affective as well as cognitive. Detachment is not an option.
In contrast to sympathy—that is, uncritically identifying with another person’s situation—empathy, in Halpern’s view, is about “emotional attunement.” In a clinical setting, patients and their families “have to feel that someone is really getting what’s important to them, and the severity of what they’re experiencing.”
“The worst thing you can ever say to anybody is, ‘I know how you feel,’ because that shuts them up,” she advises. “And the best thing you can say is, ‘Tell me what I’m missing.”’
Yet while doctors may have incentives to change—improving their patients’ care, avoiding professional burnout—the assembly-line quality of modern-day medicine can make change difficult.
“We have to have a radically different model,” she says, pointing to palliative care to show how greater time and continuity of care can foster more empathic relationships between providers and patients. Whatever the material circumstances, though, Halpern believes deeper engagement with emotions and subjectivity can help everyone—including doctors themselves—to lead richer, more meaningful lives.
“There’s so much suffering that’s unavoidable,” she says, “and I’m interested in helping people develop a greater capacity to enjoy the emotional richness of their lives in the face of all of that.” She’s finished a rough draft of what will become her second book — about people coping with life-changing illnesses — and is planning a third on returning war veterans. She’s currently working with the Soldiers Project, a national nonprofit group that provides free psychological counseling to servicemembers and their families struggling with “the invisible wounds of war.”
“So many veterans come home and say that they can’t even enjoy when a new baby is born, or being with their kids,” Halpern says. “I’m really interested in not just the pathology of PTSD, but the emotional numbing that so many people live with.”
Not surprisingly, her Berkeley students are extending her ideas on empathy into other areas of life. Eve Ekman, for example—a PhD candidate known for her research on “empathy burnout” in the workplace—is now studying how to help juvenile-justice workers “deal with stress and anxiety, and sustain empathy” for their clients in tense situations, says Halpern.
“When I talk about clinical empathy—when I talk about what I wish doctors and nurses and social workers had the time and room for—I don’t think that cognitively getting everything right is the issue,” she says. “That’s not what matters. What matters is just people seeing by your affect that you’re taking them seriously.”
What that means, as the book title says, is moving “from detached concern to empathy.”
“For me, the operative thing is the affective concern, and the patience, and the curiosity to learn more,” she says. “It almost functions for me as a limit, a humbling idea, to never tell anyone ‘I know how you feel,’ because how can you?”
She cites the psychoanalyst and pediatrician Donald Winnicott in explaining how empathy can coexist with the impossibility of another person truly knowing, as Peter Lorre put it so memorably in M, “what it’s like to be me.”
“Winnicott said the most real part of the self is unknowable, and I really like that,” Halpern says. “So it’s not so much that you can just know it, that you rationally put it into language and you’ve figured it out. It isn’t like that. What matters is your stance of respect toward the other person’s reality.
“I teach students that even trying to empathize, just paying attention, does almost all of the work you need to do,” she adds. “Because patients appreciate it, even if you don’t get it right.”
An insight, as she learned in Yonkers, that holds equally true for bus riders.