One of the basic building blocks of ethics and ethical conduct toward others is empathy. Without empathy it is difficult for any of us to understand the needs and wants of others so that we may know how to treat them kindly and generously, or to practice any other virtue in our day-to-day relations with them. Empathy is a much-discussed and much-debated topic in the nursing literature. Some have questioned whether empathy is the best mode for nurse-patient interactions (Morse et al., 1992); others have struggled with how to define the unique kind of empathy that plays a part in the complex relationships nurses have with patients (Yu & Kirk, 2008). However, less attention has been paid to empathy’s role in other (non-direct care) interactions of a nurse’s work and life. Michie (2002) has suggested that for people in many work situations, their jobs and lives may become more manageable and less stressful if they can practice empathy both in their professional environment and in their everyday interactions with those around them. Since nurses navigate a complex and varied network of contacts from hospital administrators to physicians and aides, empathy may be especially helpful in their daily interactions.
The concept of ‘empathy’ is relatively young, brought first to the English language in 1909 by psychologist Edward Titchener as a translation of the German ‘Einfühlung’ or ‘feeling into’ (Stueber, 2011). Since that time, the term has been used by philosophers, social scientists, healthcare practitioners, and many others, with each discipline having different meanings and implications for the term. One of the most useful ways to look at empathy for the purpose of the life and work of nurses may be to take empathy not as a feeling or an instinct but as a practice. This column will briefly examine how nurses can cultivate the practice of empathy both in the workplace and elsewhere.
In order to understand the practice of empathy, let us first examine the obstacles a practitioner of this art must overcome. The American philosopher William James writes of “a certain blindness in human beings,” a blindness “with which we all are afflicted in regard to the feelings of creatures and people different from ourselves” (James, 1899/1984, p. 841). Each of us has our important duties, our deep desires, even our pet peeves, and those around us have their own as well. Others feel theirs so strongly that they cannot see or appreciate ours, regardless of how much we may want them to; and we tend to be unable to understand and appreciate theirs. To illustrate this difficulty as it occurs between human beings, James turns to the more extreme difficulty of empathy between species – humans and their dogs:
Take our dogs and ourselves, connected as we are by a tie more intimate than most ties in this world; and yet, outside of that tie of friendly fondness, how insensible, each of us, to all that makes life significant for the other! - we to the rapture of bones under hedges, or smells of trees and lamp-posts, they to the delights of literature and art. As you sit reading the most moving romance you ever fell upon, what sort of a judge is your fox-terrier of your behavior? With all his good will toward you, the nature of your conduct is absolutely excluded from his comprehension. To sit there like a senseless statue, when you might be taking him to walk and throwing sticks for him to catch! What queer disease is this that comes over you every day, of holding things and staring at them like that for hours together, paralyzed of motion and vacant of all conscious life? (pp. 841-842)
When we are trying to empathize with our fellow humans, we may find it easier than trying to empathize with another species, but we still come up against the fact that we can observe others only from their external appearances and signs, such as a smile, a heavy sigh, a haggard appearance, or a new habit of humming happy tunes. In contrast, we are trying to share and understand something internal, for example another’s feelings, instincts, worries, or desires. And as we go about our lives and our work, our tasks take focus, time, and energy; we find we cannot devote the time and attention necessary to decode others’ complex outer signs even if we knew how. To do so would be impractical and would detract from the important work in front of us.
For help overcoming these obstacles, let us turn to two possible approaches: (a) a thought experiment by American philosopher John Rawls, and (b) the search for a flash of insight to cure our blindness once and for all, as suggested by Josiah Royce (1885/1965). Rawls, in his book A Theory of Justice, describes a thought experiment designed to help us define a just society (1971). While Rawls is discussing society as a whole, the exercise works just as well, perhaps better, in the smaller society of a workplace. Rawls suggests that we imagine creating a society, in this case our workplace, from scratch. Each of us is in an initial position of absolute equality behind a ‘veil of ignorance.’ Behind this veil, no one knows his or her own age, sex, talents, race, marital status, occupation, or any other such details. Once one steps out from the veil into the workplace being envisioned, one could therefore end up being anybody. In a hospital environment, for instance, the person conducting this thought experiment should pretend that he or she could step out from behind the veil of ignorance to end up as an administrator, a doctor, an information desk clerk, a custodian, or a critical care nurse. The experimenter should imagine ending up as one who has worked at the hospital only for a week or for twenty years.
In this thought experiment, Rawls asks us to remain behind the veil of ignorance while we examine how we would like our little society to work. If one were to look at one’s own workplace this way, one could ask what problems need to be addressed. How is each individual being treated by his or her coworkers? Who seems to be the best off? Who seems to be the worst off, and how bad is their situation? Rawls argues that while we are behind the veil of ignorance, not knowing which role and situation we may step into, we are highly motivated to maximize the minimum, to assure that whoever is the worst off is as well off as possible, without sacrificing the overall success of the society (or workplace, in our experiment) as a whole. We are also motivated to seek fairness as far as possible for everyone.
In trying to practice empathy in the workplace, a nurse could put herself behind this veil of ignorance once a month, or once a week, and look around her. She could say to herself: “What if I found myself tomorrow to be in X’s position? How would I feel about my daily activities? What would be hardest for me? What would bring me the most joy?” Then, stepping out from the veil, she could look for ways to lessen those burdens and heighten those joys she has perceived as part of X’s role in the workplace. Certainly a nurse may not be able to petition the administration for major changes that would help person X, but often simple changes or gestures of appreciation make a large difference. And sometimes, a nurse should consider stepping out from the veil and finding herself to be one of the highest administrators. Often the joys and burdens of those in charge are the hardest to envision.
The ‘veil of ignorance’ thought experiment is an exercise in empathy that can be useful when practiced on a regular basis. In addition, any of us may be able to learn how to open our minds and hearts consciously, deliberately to one flash of insight that has the power to break down those walls between others and ourselves. Another American philosopher, Josiah Royce (1885/1965), argues that the first step is to recognize our inadvertent, closed-hearted tendencies and the false assumptions that accompany them. He suggests we ask ourselves:
What, then, is our neighbor? …Thou hast regarded his thought, his feeling, as somehow different in sort from thine. Thou hast said, “A pain in him is not like a pain in me, but something far easier to bear.” Thou hast made of him a ghost… thou hast not fully made him for thee as real as thyself… So, dimly and by instinct thou has lived with thy neighbor, and hast known him not, being blind… Of thy neighbor thou hast made a thing, no Self at all. … Have done with this illusion, … But simply try to learn the truth. The truth is that all this world of life about thee is as real as thou art….Pain is pain, joy is joy, everywhere, even as in thee… In all the songs of the forest birds; in all the cries of the wounded and dying, struggling in the captor's power; in the boundless sea where the myriads of water-creatures strive and die;… in all sickness and sorrow; in all exultation and hope,… everywhere, from the lowest to the noblest creatures and experiences on our earth, the same conscious, burning, willful life is found, endlessly manifold as the forms of the living creatures, unquenchable as the fires of the sun, real as these impulses that even now throb in thy own little selfish heart. Lift up thy eyes, behold that life, and then turn away, and forget it as thou canst; but, if thou hast known that, thou hast begun to know thy duty. (1885/1965, pp. 157-162)
Royce believes that once we have come to understand these truths in our heart – that others really do feel the highs and lows of life just as richly, deeply, and vividly as we do – we will be able to maintain an open-heartedness toward others and not fall back into our previous unintentional dismissal or undervaluing of others’ feelings. In this revelation that Royce wants us to find, there is real beauty. We are all connected, all creatures, by the undeniable fact that in all of us, "willful life is found."
Those of us who consistently practice empathy at the workplace may find ourselves less stressed and more energized because of this realization that we are, in a fundamental way, connected with all of our coworkers. We will find it easier to be ethical in our interactions with others, having a better understanding of what those others need and want from us and from the workplace in general. An additional boon of practicing empathy at the workplace is that it tends to be contagious. When one person openly and noticeably practices empathy, others around that person will be inspired to do the same. They may even ask for advice on how to make those connections with others and see things from another’s perspective. If given the chance to offer such advice, the empathetic nurse would do well to start by spreading the simple lesson from Royce (1885/1965), “Pain is pain, joy is joy, everywhere, even as in thee.”
Christine Sorrell Dinkins, PhD
© 2011 OJIN: The Online Journal of Issues in Nursing
Article published May 10, 2011