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Empathy & A Defense of Saying “Dude, That Sucks”
In nursing school — at the both undergraduate and the graduate levels — we talk a lot about “therapeutic communication” as a way of dealing with patients who are angry or upset. It consists of listening and responding, not with peppy platitudes, but with things like “I know how upset you must feel,” “That must be very frustrating for you,” or “I can see that you’re sad about your recent diagnosis.” As with most buzzwords, I always responded to discussions of therapeutic communication by rolling my eyes. Another buzz word in healthcare is “empathy,” something I admittedly struggle with. On several occasions, I have been known to walk out of a patient’s room with a panicked look on my face after they started crying to me about how terrible, upset, or scared they feel. “I don’t do crying,” I have been wont to say. Recently, however, I’ve had a couple experiences that have changed my mind on the subject.
Mr. T was a middle-aged man in for antibiotic therapy after a joint had become infected in the wake of total joint replacement. He had been an active member of his church, and his wife and church family visited him often. After several weeks of IV antibiotics, physical, and occupational therapy, Mr. T failed to progress. One night when I walked into his room, he was on the verge of tears. After I told myself to be a good nurse and not ignore the tears, I asked what was going on.
“I just feel like I’m never going to get better. And everyone that comes to see me keeps saying the same thing: ‘You just gotta do what the doctors and therapists tell you to do’; ‘Keep fighting and you’ll get better.’ Everyone keeps telling me that I need to do this or do that, but no one ever just listens! I wish someone would just listen to me and not tell me what I need to do!”
I stood there and listened to him. At the end of his meltdown, he said, “Thank you for listening. That’s all I wanted: someone to just listen.” I told him I was happy to, and to call me if he needed anything else. I think at one point I may have said, “Man, that sucks,” and that simple acknowledgement of his situation and his feelings was enough to be helpful to him emotionally.
My second lesson in empathy came just a few weeks ago, when my serious boyfriend unceremonious dumped me. My coworkers — and even one of my family members — resorted to unhelpful and immensely frustrating platitudes as a way of trying to offering comfort: “You’re better off without him”; “Well, at least you found out now how he really is”; “You’re gonna find someone when you least expect it”; and (my personal favorite) “God is saving someone really special for you.” I wanted to scream at them, “That is not helpful!” I didn’t want anyone to fix things (though one of my fellow nurses offered to do a little “pillow therapy,” and it made me feel better for a little bit that someone would be willing to do that for me). I just wanted someone to listen and say, “Dude, that sucks.”
Throughout our lives we’re told fairy tales of causal justice. If you work hard, you’ll be successful; if you pray, God will answer; when you get married and have children of your own… The truth is, there are no guarantees in life and we set ourselves — and each other — up for unnecessary pain by perpetuating fairy tales of inevitability. Our sense of justice doesn’t like to admit it, but karma is a fickle mistress. Good things happen to bad people who don’t always get their comeuppance, and bad things happen time and time again to good people. Similarly, there are smart and beautiful people who never find someone to spend their lives with, just as there are insufferable people that end up with wonderful, devoted spouses. Life is a string of “if’s,” and “maybes’s,” not “when’s.”
The next time someone is upset — I mean truly upset about something — please consider responding with a simple, “Dude, that sucks.” I think you will find it more therapeutic than you know.
Published in General
Every girl appreciates a good listener:
It is not always the case. I learned from an elderly Japanese woman that there is a time to go to heaven. As a pregnancy ends in pain and birth, our lives in faith do the same.
I still remember the story that someone wanted to commit suicide off a bridge near my parents house. My father extracted a promise from the man to meet my father first. The man headed toward the bridge many times but never had the courage to meet my father. Funny how the mind works in desperate times.
Mike, do you think being dumb is a miracle? If so, you are miraculous. ;-)
Oh, shame goes a long ways. A friend and I were talking about how to lose weight. She ended her list of of tips by saying, “Oh, and hating yourself just a little really helps.” On a more serious note, some see the lack of shame in modern culture as a door to immorality. I suppose it speaks to moral relativity.
Yeah, I think you misunderstood. Death sucks for those left behind, because we’re still in this valley of tears and no longer sense our loved one’s presence. If death didn’t suck, Jesus wouldn’t have needed to save us from it!
Okay, maybe sloppy theology, but you get the point.
The upshot is you listened to a patient. Great, it’s part of your job (vocation?).
But, in the end, did you need bachelor or graduate classes to learn that? If all the classes you took were regarding the physical treatment of the patient (including the taking of a good history), a good mentor could have told you to listen to the patient after you were on the job.
It would have taken 5 minutes. Heck a good bartender could have given you better tips than those classes.
I plead ignorance.
Everyone wishes there was a guidebook to human nature. Academia specializes in wishful thinking. That’s why, Al.
In reality, no single strategy works for everyone. What calms or thrills one person annoys another… even when it’s something as simple as keeping your yap shut. Some people expect feedback.
It’s a thankless job sometimes, Contessa. But never doubt that it is worthwhile.
Dime’s back!
Be afraid. Be very afraid.
For me, the discussions about therapeutic communication were helpful, though in hindsight. I think people want to help, to fix, and just listening goes against our instinct to be active. Listening is seemingly passive, though it actually isn’t. Platitudes exist because they make people feel that they have been active in imparting some piece of encouragement or wisdom. Obviously, therapeutic communication wasn’t the topic of an entire class, so it’s not as though I wasted hours and hours discussing the finer points of talking to patients; rather, it’s a concept we learn and then is referenced throughout the course of one’s education when it’s appropriate.
I agree. I sense that the trick is to apply the “right amount” of shame – not that we know for sure what that amount is! But somewhere between utter shamelessness and merely feeling like a burden lies the level of shame most likely to actually improve your behavior. Optimal shame:
Just a little. Perhaps the sin of being harder on others than you are on yourself is so common because a small amount of it is adaptive – maybe it’s easier to motivate yourself to do good with just a slightly inflated sense of your own goodness.
VC, you mention pillow therapy. Without googling it, I cannot decide whether it means bedding someone or asphyxiating them. Or both? Either way, you thought it was a nice offer.
Different strokes, I guess.
Part of why people want to say things is that they feel anxiety and want to feel better for themselves. I do supervision with new therapists, and we discuss this. The urge to “fix” it, if often that urge to make me feel better about the other’s pain.
Often, people just want someone there. I can be in great pain and yet get comfort from someone’s presence without them uttering a word of solace.
Next time you feel the urge to “say something”, don’t. Refocus on what the other person is saying. You cannot fully attend to them if you are thinking what you are going to say.
I might also remind you that debriefing yourself is important. After you hear something horrible, it may mean you need to go unload on someone else yourself, to discuss how frightening, or sad, or what not, listening to the other person is. That is why I think all therapists should have ongoing supervision, even seasoned professionals.
Be mindful, when you need to talk to tell people up front: “I don’t want you to fix me, please just listen to me.” Most people can do that more or less.
I was right there with you until you brought up Mr. T. B.A. Baracus sick and bedridden? I don’t got time for that kind of jibba-jabber
For all that he was more right than his friends, Job wasn’t correct either. From Chapter 42: 3-6 :
“You asked ‘Who is this who hides counsel without knowledge? Therefore I have uttered what I did not understand, things too wonderful for me, which I did not know. Listen please, and let me speak; You said ‘I will question you, and you shall answer Me. ‘ I have heard of you by the hearing of the ear, but now my eye sees you. Therefore I abhor myself, and repent in dust and ashes.”
When Job is confronted by the Lord, he doesn’t even ask why. The questions lose all meaning in the context of the presence of the Almighty.
Of course, the real answer is… what, you expect me to know?
Whoa! I just googled it and it means assisted suicide. That doesn’t sound very nice at all!
Next time, just call me. Or better yet, come over for a lovely family dinner complete with a selection of fine single malts, superb conversation, and a very highbrow version of “Dude, that sucks.”
VC, you are a wizard at your craft. Both medically and and as a scribe.
There is a 25 year old easy-read on the mean God theory that holds up well. When Bad Things Happen to Good People. Thesis is that God is not involved in the moment-to-moment events of each of the 7.5 billion humans on the planet. It doesn’t work that way.
Rabbi Kushner, author, does a great job of comforting us on this reality and providing adult expectations on how to deal with randomness of life. I read it long ago and it has served as a great weapon for me to use when I run into miserable life things. Example, close friend of coworker just killed himself. 22 years old, engaged, all seemingly wonderful.
G-d is involved in every event of my life for which I actively seek to have him involved. It is a marriage – some are closer than others.
Most people do not crave that kind of relationship.
Bad things happen to good people because free choice is of prime importance. What we choose to do with our lives is more important, to G-d, than life itself.
My mom was a hospice nurse for years, so she became very good at learning what to say or not say to her ill and dying patients and their families. Just being there is important. But if you do want to say something of comfort, her advice was to avoid using “at least,” as in “at least you tried,” because it’s being sympathetic, not empathetic. One reason it’s hard to be empathic is because people often don’t understand the difference between being sympathetic and empathic. This video presents a nice distinction between sympathy and empathy.
Job recognizes that his anguished cry of “Why?” loses meaning in the face of the whirlwind, at which point Job repents of expecting an answer from God that can be comprehended in human terms. But did God require Job to repent of even asking in the first place?
For God does reward Job’s question with an answer – and much more of an answer than many of us are used to getting in our daily prayers! (God is, after all, well within His rights to use planned ignoring on us and our prayers as a salutary teaching tool – and frequently does, in my experience!) God rewards Job’s question with His overwhelming presence – with perhaps the most breathtakingly beautiful nonresponsive answer ever recorded in literature.
Who are we to ask, “Why do I suffer?” of God? We are human. It appears to me that God Himself tells to tell Job’s friends that it is rightful for humans to do what Job did and ask, though we cannot rightfully expect God to give us a responsive answer.
Ummmm…how did the title get changed without me doing it…?
In a way, God did for Job what Vicryl Contessa did for her patient, Mr T. God answered Job, not with peppy platitudes, a helpful to-do list, or any kind of easy answer, but with His presence, and the frank acknowledgment that Job couldn’t expect easy answers.
You’re on the main feed now. Title changes and edits are par for the course.
Not assisted suicide. Think more Othello. However, I would love to come over for dinner, if you weren’t 8 hours away.
Ah! You mean your friend offered to murder your ex for you?
I thought it was over with the guy. Why then choose to become a mere accessory?
I didn’t realize I had been move up to the main feed when I asked about my phantom title change.
Well, there are questions and there are questions. You’re a math person, so I’m going to jump into math terms to describe it. Consider a two dimensional vector space covering all possible questions directed at God. One axis is legitimate questions where we genuinely want to know how or why a thing is. The other axis are tendentious, leading questions of the “when did you stop beating your wife” variety (except, well, you know.) Any question is described as a vector in that space, with a component in the “honest” and “evil” directions. I’d like to argue that fallen man literally cannot phrase a question which has a zero “evil” component.
Job did well, but not perfectly. His question still had that element of self righteousness in it; by demanding an answer from the Almighty he was necessarily abrogating to himself the right to pass judgement on the Lord’s decisions. You can tell from what the Lord asks him at the start of chapter 40:
“Shall the one who contends with the Almighty correct Him? He who rebukes God, let him answer it.”
While God does give him an answer, he doesn’t give him the simple, mechanistic answer we all read in Chapter 1 (spoiler alert: to prove a point). While His presence stops up Job’s questions, it also acts as a judgement on the man; all Job can think about is his pride. So he repents, and humbles himself. Which is exactly the answer God was looking for all along.
I see Job as the most controversial book in the Old Testament canon, by far.
And yet: Abraham and Moses both question and argue with G-d – and have success doing so.