The dangerous practice of empathy . By Jane Macnaughton

I have suggested that true empathy derives from an experience of intersubjectivity and this cannot be achieved in the doctor—patient relationship. But all is not lost. Doctors do not need to feel the distress of their patients themselves to do something about it. We may have a momentary mirroring of that patient’s feeling within us, but what we maintain is sympathy (feeling for not with the patient) and the need to respond. It is potentially dangerous and certainly unrealistic to suggest that we can really feel what someone else is feeling. It is dangerous because, outside the literary context, where we are allowed direct experience of what a fictional patient is feeling, we cannot gain direct access to what is going on in our patient’s head.

As Stein says, only “their presence is directly given”—so our assumptions may be wrong and our response may be based on a false assumption. Any mirroring of feeling will always differ quantitatively and qualitatively from that patient’s experience. A doctor who responds to a patient’s distress with “I understand how you feel” is likely, therefore, to be both resented by the patient and self-deceiving.