Amen Jaswant, how to navigate a complex system, that does not accompany the patient as it is so soloed, fragmented,

Great talk! I have a follow-up question about the limitations of empathy

I think there is Big tension between clinicas and etnographfer.

I love your question Sadeq! Is it possible to see the difference of empathy fo the etnographer and the clinician? and still there is still the own lived experience.

To youth……the key trust is to keep secrets....

Aren´t we talking here about the difference in the two roles: of the clinician and the resercher?

@virginia and @ Lou: I think there is incredible cross fertilization between anthropologic and clinical views of empathy. Particularly useful to me is that when teaching empathy as a tool and an attitudinal posture to medical students, the idea of utility is implicit, but what Rebecca is showing us is that it is likely important that the idea of empathy as part of an ethical stance and practice be part of our clinical teaching as well.

Thanks Michael! It makes sense

Thank you so much, Rebecca, for this marvelous and powerful talk. For the group: Rebecca also has a terrific new piece in a new journal (SSM-Mental Health) that’s worth your attention: “Inner worlds as social systems: How insights from anthropology can inform clinical practice” https://doi.org/10.1016/j.ssmmh.2022.100068

brief observations. rx success depends in large part upon an accurate diagnosis. this depends on a valid descriptionof patient's problems. an adequate descripton must be based in some part uopon an empathic identification with the patient's situation. but interventions also depend upon both empathic perceptions and upon an ability to intervene cric critically. this requires some sadistic capability. because criticism depends upon an ability to differentiatate therapists perceptions from those believed to be associated with the patient. as Wiotttgestein put it, the data is always already all in. meaning at the time aany sort of interventionis contemplated, inputs further inputs of information and meaning must be deferred temparaaily.

That tortured decision to give the Haldol injection - that is a beautiful and important story, Antonio. You should write this up! I have stories of the pain of Haldol injections and complications, too. Incredible hurt/harm situations..

Thanks for such a though provoking presentation Rebecca, Two thoughts: i) it’s confusing to make “projection” and “real empathy” into a dichotomy., We cannot actually telepathically know another presents state of mind, all of our participation in the other person’s experience is projective, The question is do we naively assume that our projection at any point is “good enough” for our purposes, or do we learn to critically examine our projection, And th e extent and standards of critical examination depend on our purpose, “Good enough” empathy is different for an clinician versus an ethnographer, And of course some of the people that we encounter trigger such concern in us that we never stop trying to understand themn mrore adequatelyh

Thank you….Alllister

Hi, all. I need to sign out. Wonderful presentation. I’m glad Andrea raised the question of failure—I wondered about this too.

obs further. mental illnesses have poltical dimensions. thse can cause therapeutic failures, when they are not taken into account.

Byron, thanks for this…It requires a willingness to draw on humility, respectful presence and channeling Paul, walking with,,,

Makes me think of Ruth Behar and the vulnerable observer. Maybe it’s about what’s going on inside us (the ethnographer/clinician) rather than what’s going on with the other. Knowing through haunting too. Insightful comment’s byron

Excellent point : we do not understand , humility is crucial to this not knowing position : complicated by all the intrapsychic, relational, socio political context of how the patient feels invisible : or feels that no one can “see me” : missing parts that the therapist partly offers as a bridge , but the family and context are all part of it. Some people believe that eating disorders is an enactment of social contexts offered in particular cultural spaces

This is such an important area. I was interested in how Janis would bring her comments on a feminist lens on being seen in these therapeutic spaces together with her comments on the unitary self (patient or ethnographer). (Recently, I’ve been struck by Dick Schwartz’ Internal Family Systems work in the context of trauma and it’s inherent critique of western assumptions about the unitary self. His parts-of-self methodology seems devoutly non-pathologizing, bottom-up, non-diagnostic and quite reflective and effective in intersubjective encounters related to advocacy, non-professional caring contexts, parenting, education. It seems to necessarily implicate the self-knowledge of one using it. It’s been productive to think with and as a guide to practice).

It might be interesting to look at the way Deb Roter's Interactional Activity Scale (a tool for analysis of clinical encounters) codes empathic statements. There is clear data from her work that empathic statements (which I realize are separate from empathic stance/feelings) enhance data gathering and clinical planning in the clinician patient encounter. That may highlight the utilitarian aspect of empathy, and might help us look at how that sits in counterpoint to our other ideas about this.

@Michael Nathan: this also provokes the question of what it means to have a “scientific” understanding of empathy. Is that valid? How does it compare to the empathy experienced by clinicians? By friends? Etc.

I would add that humility is a very importante aspect of practicing and experiencing empathy. We never completely get to know the other one lived world, as clinician or as researcher. In this perspective empathy is a lot more than a skill or a tool

@Dan Dohan: ?empathy as communication vs empathy as perception?

…empathy as experience…empathy as therapy…not sure these are v each other. Such a rich set of issues to ponder.

Agreed! Problematizing empathy is so critical, and Rebecca's presentation has me thinking far more deeply about it.

Wonderful seminar! Best to All, I must dash as I have a flight to catch. . . JJ

Thank you so much, Rebecca — and Jaswant, JJ, Sadeq and all — for this extraordinarily valuable discussion.

Great to see all and thank you for the wonderful presentations and thoughtful discussion. Must head off...

Many thanks for your excellent talk, I must leave for a clinical reasons

Interesting presentation especially from “a wounded healer”. Thank you so much!

@ Byron...RE empathy in psychiatry vs gen med, I think only maybe!

Thank you Rebecca for your illuminating and inspiring talk. I love all discussions and esp. on ‘problematizing empathy’ and ‘need for epistemic humility’ to talk about empathy. I have to leave in a few minutes but THANK YOU!!

Wonderful talk and discussion as always I learn so much. I must be off. Thank you all.

thank you Rebecca for this inispiring presentation!

I would be interested given the practical ethical implications of our conversation what Paul Brodwin might contribute.

Thanks for a fascinating presentation and discussion! Great session!

thank you everyone!