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Beloved on Juneteenth in the context of empathy

I am catching up on my summer reading. I finished Toni Morrison’s transfiguring classic Beloved on Juneteenth. Since another week was required to write the review, a belated joyous Juneteenth to one and all! I hasten to publish before the 4th of July. For those who may require background on this new federal holiday, June 19th – Juneteenth – it was the date in 1865 that US Major General Gordon Granger proclaimed freedom for enslaved people in Texas some two and a half years after Lincoln’s Emancipation Proclamation. Later, the Thirteenth Amendment to the US Constitution definitively established this enshrining of freedom as the law of the land and, in addition, the 14th Amendment extended human rights to all people, especially formerly enslaved ones. This blog post is not so much a book review of Beloved as a further inquiry into the themes of survival, transformation, liberty, trauma – and empathy.

“Beloved” is the name of a person. Toni Morrison builds on the true story of Margaret Garner, an enslaved person, who escaped with her two children even while pregnant with a third, succeeding in reaching freedom across the Ohio River in 1854. However, shortly thereafter, slave catchers (“bounty hunters”) arrived with the local sheriff under the so-called fugitive slave act to return Margaret and her children to slavery. Rather than submit to re-enslavement, Margaret tried to kill the children, also planning then to kill herself. She succeeded in killing one, before being overpowered. The historical Margaret received support from the abolitionist movement, even becoming a cause celebre. The historical Margaret is named Sethe in the novel. The story grabs the reader by the throat – at first relatively gently but with steadily increasing compression – and then rips the reader’s guts out. The story is complex, powerful, and not for the faint of heart. 

The risks to the reader’s emotional equilibrium of engaging with such a text should not be underestimated. G. H. Hartman is not intentionally describing the challenge encountered by the reader of Beloved in his widely-noted “Traumatic Knowledge and Literary Studies,” but he might have been:

The more we try to animate books, the more they reveal their resemblance to the dead who are made to address us in epitaphs or whom we address in thought or dream. Every time we read we are in danger of waking the dead, whose return can be ghoulish as well as comforting. It is, in any case, always the reader who is alive and the book that is dead, and must be resurrected by the reader (Hartman 1995: 548).

Though technically Morrison’s work has a gothic aspect – it is a ghost story – yet it is neither ghoulish nor sensational, and treats supernatural events rather the way Gabriel Garcia Marquez does – as a magical or miraculous realism. Credible deniability or redescription of the returned ghost as a slave who escaped from years-long sexual incarceration is maintained for a hundred pages (though ultimately just allowed to fade away). Morrison takes Margaret/Sethe’s narrative in a different direction than the historical facts, though the infanticide remains a central issue along how to recover the self after searing trauma and event even beyond trauma. The murdered infant had the single word “Beloved” chiseled on her tombstone, and even then the mother had to compensate the stone mason with non-consensual sex. An explanation is required. Let us take a step back.

Morrison is a master of conversational implicature. “Implicature” is an indirect speech act that suggests an idea, even though the thought is not literally expressed. Conversational implicature lets the empathy in – and out – to be expressed. Such implicature expands the power and provocation of communication precisely by not saying something explicitly but hinting at what happened. The information is incomplete and the reader is challenged to feel her/his way forward using the available micro-expressions, clues, and hints. Instead of saying “she was raped and the house was haunted by a ghost,” one must gather the implications. One reads: “Not only did she have to live out her years in a house palsied by the baby’s fury at having its throat cut, but those ten minutes she spent pressed up against dawn-colored stone studded with star chips, her knees wide open as the grave, were longer than life, more alive, more pulsating than the baby blood that soaked her fingers like oil” (Morrison 1987: 5 – 6). Then a causal conversation resumes about getting a different house as the reader tries to figure out what just happened. “Not a house in the country ain’t packed to its rafters with some dead Negro’s grief” (1987: 6). One of the effects is to get the reader to think about the network of implications in which are expressed the puzzles and provocations of what really matters at fundamental level. (For more on conversational implicature see Levinson 1983: 97 – 165.) 

In a bold statement of the obvious, this reviewer agrees with the Nobel Committee, who awarded Morrison the Novel Prize in 1988 for this work. This review accepts the high literary qualities of the work and proposes to look at three things. These include: (1) how the traumatic violence, pain, suffering, and inhumanity as well as drama, heroics, and compassion of the of the events depicted, interact with trauma and transform into moral trauma; (2) how the text itself exemplifies empathy between the characters, bringing empathy forth and making it present for the reader’s apprehension; (3) the encounter of the reader with the trauma of the text transform and/or limit the practice of empathizing itself from standard empathy to radical empathy.

So far as I know, no one has brought Morrison’s work into connection with the action of the Jewish Zealots at Masada (73 CE). The latter, it may be recalled, committed what was in effect mass suicide rather than be sold into slavery by the Roman army. The 960 Zealots drew lots to kill one another and their wives and children, since suicide technically was against the Jewish religion. On brief background, after the fall of Jerusalem as the Emperor Titus put down the Jewish rebellion against Rome in 73 CE, a group of Jewish Zealots escaped to a nearly impregnable fortress at Masada on the top of a steep mountain. (Note Masade was a television miniseries starring Peter O’Toole (Sagal 1981).) Nevertheless, Roman engineers built a ramp and siege tower and eventually succeeding in breaching the walls. The next day the Roman soldiers entered the citadel and found the defenders and their wives and children all dead at their own hands. Josephus, the Jewish historian, reported that he received a detailed account of the siege from two Jewish women who survived by hiding in the vast drain/cistern that served as the fortress’ source of water.

The example of the Jewish resistance at Masada provides a template for those facing enslavement, but it does not solve the dilemma that killing one’s family and then committing suicide is a leap into the abyss at the bottom of which may lie oblivion or the molten center of the earth’s core. So all the necessary disclaimers apply. This reviewer does not claim to second guess the tough, indeed impossible, decisions that those in extreme situations have to make. One is up against all the debates and the arguments about suicide. Here is the casuistical consideration – when life is reduced from being a human being to being a slave who is treated as a beast of burden and whose orifices are routinely penetrated for the homo- and heteroerotic pleasure of the master, then one is faced with tough choices. No one is saying what the Zealots did was right – and two wrongs do not make a right – but it is also not obvious that what they did was wrong in the way killing an innocent person is wrong, who might otherwise have a life going about their business gardening, baking hallah bread, or fishing. This is the rock and the hard place, the devil and deep blue sea, the frying pan or the fire, the Trolley Car dilemma (see https://en.wikipedia.org/wiki/Trolley_problem). This is Field Marshal Erwin Rommel, the Desert Fox, who after the unsuccessful attempt in June 1944 to assassinate Hitler (of which Rommel apparently had knowledge but took no action), was allowed by the Nazi authorities to take the cyanide pill. This is Colonel Custer with one bullet left surrounded by angry Dakota warriors who would like to slow cook him over hot coals. Nor as far as I know is the case of Margaret Garner ever in the vast body of criticism brought into connection with the suicides of Cicero and Seneca (and other Roman Stoics) in the face of mad perpetrations of the mad Emperor Nero. This is a decision that no one should have to make; a decision that no one can make; and yet a decision that the individual in the dilemma has to make, for doing nothing is also a decision. In short, this is moral trauma.

A short Ted Talk on trauma theory is appropriate. Beloved is so dense with trauma that a sharp critical knife is needed to cut through it. In addition to standard trauma and complex trauma, Beloved points to a special kind of trauma, namely,moral trauma or as it sometimes also called moral injury, that has not been much recognized (though it is receiving increasing attention in the context of war veterans (e.g. Shay 2014)). Without pretending to do justice to the vast details and research, “trauma” is variously conceived as an event that threatens the person’s life and limb, making the individual feel he or she was going to die or be gravely injured (which would include rape). The blue roadside signs here in the USA that guide the ambulance to the “Trauma Center” (emergency department that has staff on call at all times), suggest an urgent emergency, in this case usually but not always, a physical injury. Cathy Caruth (1996) concisely defines trauma in terms of an experience that is registered but not experienced, a truth or reality that is not available to the survivor as a standard experience. The person (for example) was factually, objectively present when the head on collision occurred, but, even if the person has memories, and would acknowledge the event, paradoxically, the person does not experience it as something the person experienced. The survivor experiences dissociated, repetitive nightmares, flashbacks, and depersonalization. At the risk of oversimplification, Caruth’s work aligns with that of Bessel van der Kolk (2014). Van der Kolk emphasizes an account that redescribes in neuro-cognitive terms a traumatic event that gets registered in the body – burned into the neurons, so to speak, but remains sequestered from the person’s everyday sense of self. For both Caruth and van der Kolk, the survivor is suffering from an unintegrated experience of self-annihilating magnitude for which the treatment – whether working through, witnessing, or (note well) artistic expression – consists in reintegrating that which was split off because it was simply too much to bear. 

For Dominick LaCapra (1999), the historian, “trauma” means the Holocaust or Apartheid (add: enslavement to the list). LaCapra engages with how to express in writing such confronting events that the words of historical writing and literature become inadequate, breakdown, fail, seem fake not matter how authentic. And yet the necessity of engaging with the events, inadequately described as “traumatic,” is compelling and unavoidable. Thus, LaCapra (1999: 700) notes: “Something of the past always remains, if only as a haunting presence or revenant.” Without intending to do so, this describes Beloved, where the infant of the infanticide is literally reincarnated, reborn, in the person named “Beloved.” For LaCapra, working through such traumatic events is necessary for the survivors (and the entire community) in order to get their power back over their lives and open up the possibility of a future of flourishing. This “working through” is key for it excludes denial, repression, suppression, and advocates for positive inquiry into the possibility of transformation in the service of life. Yet the working through of the experiences, memories, nightmares, and consequences of such traumatic events result in repetition, acting out, and “empathic unsettlement.” Key term: empathic unsettlement. The empathic unsettlement points to the possibility that the vicarious experience of the trauma on the part of the witness leaves the witness unwilling to complete the working through, lest it “betray” the survivor, invalidate the survivor’s suffering or accomplishment in surviving. “Those traumatized by extreme events as well as those empathizing with them, may resist working through because of what might almost be termed a fidelity to trauma, a feeling that one must somehow keep faith with it” (DeCapra 2001: 22). This “unsettlement” is a way that empathy may breakdown, misfire, go off the rails. It points to the need for standard empathy to become radical empathy in the face of extreme situations of trauma, granted what that all means requires further clarification. 

For Ruth Leys (2000) the distinction “trauma” itself is inherently unstable oscillating between historical trauma – what really happened, which, however, is hard if not impossible to access accurately – and, paradoxically, historical and literary language bearing witness by a failure of witnessing. The trauma events are “performed” in being written up as history or made the subject of an literary artwork. But the words, however authentic, true, or artistic, often seem inadequate, even fake. The “trauma” as brought forth as a distinction in language is ultimately inadequate to the pain and suffering that the survivor has endured, (“the real”). Yet the literary or historical work is a performance that may give the survivor access to their experience. The traumatic experience is transformed – even “transfigured” – without necessarily being made intelligible or sensible by reenacting the experience in words that are historical writing or drawing a picture (visual art) or dancing or writing a poem or a literary masterpiece such as Beloved. The representational gesture – whether a history or a true story or fiction – starts the process of working through the trauma, enabling the survivor to reintegrate the trauma into life, getting power back over it, at least to the extent that s/he can go on being and becoming. In successful instances of working through, the reintegrated trauma becomes a resource to the survivor rather than a burden or (one might dare say) a cross to bear. To stay with the metaphor, the cross becomes an ornament hanging from a light chain on one’s neck rather than the site of one’s ongoing torture and execution. Much work and working through is required to arrive at the former.

Though Beloved has generated a vast amount of critical discussion, it has been little noted that the events in Belovedrapidly put the reader in the presence of moral trauma (also called “moral injury”). Two levels of trauma (and the resulting post-traumatic stress disorder (PTSD)) are concisely distinguished (for example by the Diagnositic and Statistical Manual(5th edition) of the American Psychiatric Association (2013). There is standard trauma – one survives a life changing railroad or auto accident and has nightmares and flashbacks (and a checklist of other symptoms of post-traumatic stress disorder (PTSD)). There is repeated trauma, trauma embedded in trauma, double-bind embedded in double bind. One is abused – and it happens multiple times over a course of months or years and, especially, it may happen before one has an abiding structure for cognition such as a stable acquisition of language (say to a two-year-old) or happens in such a way or such a degree that words are not available as the victim is blamed while being abused – resulting in complex trauma and the corresponding complex PTSD.

But this distinction, standard versus complex trauma (and the correlated PTSD), is inadequate in the case of moral trauma, where the person is both a survivor and a perpetrator. For example, in a Middle East War zone, the sergeant sees an auto racing towards the check point manned by US soldiers. The sergeant thinks the auto is loaded with explosives – a car bomb. The sergeant gives the order to fire at the auto. After the auto is stopped by the fusillade, it turns out to contain family rushing to the hospital because the wife is giving birth. The now orphaned children are treated for their grave injuries in a military hospital. The result may indeed be like standard PTSD – nightmares, flashback. The resulting loss of their parents may result in complex trauma and complex PTSD. Meanwhile, the private who pulled the trigger believed he was following a valid military order, which if he did not obey would result in he and his platoon being blown up by a car bomb (and a court marshal for disobeying a valid order), but in obeying the order has catastrophic consequences. The private is not physically injured. Yet he shuts down emotionally, and is dishonorably discharged. He ends up wordlessly abandoning his family, living on the street, and no one knows what is bothering him. The military authorities ask him, but he has no words. “Moral trauma.” With no time to gather additional data, the soldier was put in an impossible situation – a double-bind. So he decided to follow orders (why shouldn’t he? he was under attack) and deeply enshrouded in the fog of war on a clear day, technicaly speaking, he committed a war crime, killing innocent civilians. Little did he know in the moment of the classic, tragic double-bind, “damned if you do and damned if you don’t”; the rock and the hard place; the devil and the deep blue. The soldier is now damned – he is a perpetrator. He was forced to make a decision that no one should have to make; that no one can (really) make; and yet that he did make. This perpetrator is also a now a survivor. Moral trauma.

Another example of moral trauma? An escaped slave makes it to freedom. One Margaret Garner is pursued and about to be apprehended under the Fugitive Slave Act. She tries to kill herself and her children rather than be returned to slavey. She succeeds in killing one of the girls. Now this soldier’s choice is completely different than the choice faced by Margaret/Sethe, and rather like the inverse of it, dependent on not enough information rather than an all-too-knowledgeable acquaintance with the evils of enslaement. Yet the structural similarities are striking. One significant difference between the soldier and Sethe (and the Jewsih Zealots) is their answer to the question when human life ceases to be human. A clarification is in order. If human life is an unconditional good, then, when confronted with an irreversible loss of the humanness, life itself may not be an unconditional good. Life versus human life. The distinction dear to Stoic philosophy, that worse things exist than death, gets traction – slavery, cowardice in the face of death, betraying one’s core integrity. The solder is no stoic; Sethe is. Yet both are suffering humanity.  

However, one may object, even if one’s own human life may be put into play, it is a flat out contradiction to improve the humanity of one’s children by ending their humanity. The events are so beyond making sense, yet one cannot stop oneself from trying to make sense. So far, we are engaged with the initial triggering event, the infanticide. No doubt a traumatic event; and arguably calling forth moral trauma. But what about trauma that is so traumatic, so pervasive, that it is the very form defining the person’s experiences. Trauma that it is not merely “unclaimed, split off” experience (as Caruth says). For example, the person who grows up in slavery – as did Sethe – has never known any other form of experience – this is just the way things are – things have always been that way – and one cannot imagine anything else (though some inevitably will and do). This is soul murder. So we have moral trauma in a context of soul murder. Soul murder is defined by Shengold (1989) as loss of the ability to love, though the individuals in Beloved retain that ability, however fragmented and imperfect it may be. Rather soul murder is defined as the loss of the power spontaneously to begin something new – the loss of the possibility of possibility of the self, leaving the self without boundaries and without aliveness, vitality, an emotional and practical Zombie. By the way, Shengold (1989) notes, “Soul murder is a crime, not a diagnosis.” Though Morrison does not say so, and though she might or might not agree, enslavement is soul murder. 

Beloved contains actual murders. For example, the friend and slave Sixo is about to be burned alive by the local vigilantes, and he gets the perpetrators to shoot him (and kill him) by singing in a loud, happy, annoying voice. He fakes “not givin’ a damn,” taking away the perpetrators’ enjoyment of his misery. It works well enough in the moment. His last. Nor is it like one murder is better (or worse) than another. However, in a pervasive context of soul murder, Sethe’s infanticide is an action taken by a person whose ability to choose is compromised by extreme powerlessness. Yet in that moment of decision her power is uncompromised. Note one continues to try and justify or make sense out of what cannot have any sense. Sethe is presented with a choice (read it again – and again) that no one should have to make – that no one can make (even though the person makes the choice because doing nothing is also a choice). This is the same situation that the characters in classic Greek tragedy face, though a combination of information asymmetries, personal failings, and double-binds. Above all – double-binds. This is why tragedy was invented (which deserves further exploration, not engaged here).

Now bring empathy to moral trauma in the context of soul murder. Anyone out there in the reading audience experiencing “empathic unsettlement” (as LaCapra put it)? Anyone experiencing empathic distress? If the reader is not, then that itself is concerning. “Empathic unsettlement” is made present in the reader’s experience by the powerful artistry deployed by Beloved. Yet this may be an instance in which empathy is best described, not as an on-off switch, but as a dial that one can dial up or down in the face of one’s own limitations and humanness. This is tough stuff, which deserves to be read and discussed. If one is starting to break out in a sweat and thinking about putting the book down, rather than become hard-hearted, the coaching is temporarily to dial down one’s practice of empathy. While one is going to experience suffering and pain in reading about the suffering and pain of another, it should be a vicarious experience – a sample – a representation – a trace affect – not the overwhelming annihilation that would make one a survivor. Dial the empathy down in so far as a person can do that; don’t turn it off. Admittedly, this is easier said than done, but with practice, the practitioner gets expanded power over the practice of empathizing.

As noted, Morrison is a master of conversational implicature. Conversational implicature allows the empathy to get in – become present in the text and become present for the reader engaging with the text. The conversational implicature expresses and brings to presence the infanticide without describing the act itself by which the baby is killed. Less is more, though the matter is handled graphically enough. The results of the bloody deed are described – “a “woman holding a blood soaked child to her chest with one hand” (Morrison 1987: 124) – but not the bloody action of inflicting the fatal wound itself. “Writing the wound” sometimes dances artistically around expressing the wound, sometimes, not. 

Returning to the story itself, the moment at which the authorities arrive to attempt to enforce the fugitive slave act is described: “When the four horsemen came – schoolteacher, one nephew, one slave catcher and a sheriff – the house on Bluestone Road was so quiet they thought they were too late” (Morrison 1987: 124). Conversational implicature meets intertextuality in the Book of Revelation of the New Testament. The four horsemen of the apocalypse herald the end of the world as we know it and that is what comes down on Sethe at this point. Perhaps not unlike the Zealots at Masade, she makes a fatal decision. Literally. As Hannah Arendt (1970) pointed out in a different political context, power and force (violence) stand in an inverse relation: when power is reduced to zero, then force – violence – comes forth. The slaves power is zero, if not a negative number. Though Sethe tries to kill all the children, she succeeds only in one instance. The boys recover from their injuries and, in the case of Denver (Sethe’s daughter named after Amy Denver, the white girl who helped Sethe), Sethe’s hand is stayed at the last moment. 

Beloved is a text rich in empathy. This includes exemplifications of empathy in the text, which in turn call forth empathy in the reader. The following discussion now joins the standard four aspects of empathy – empathic receptivity, empathic understanding, empathic interpretation, and empathic responsiveness. The challenge to the practice of empathy is that with a text and topic such as this one, does the practice of standard empathy need to be expanded, modified, or transformed from standard to radical empathy? What would that even mean? Empathy is empathy. A short definition of radical empathy is proposed: Empathy is committed to empathizing in the face of empathic distress, even if the latter is incurred, and empathy, even in breakdown, acknowledges the commitment to expanding empathy in the individual and the community. 

We start with a straightforward example of empathic receptivity – affect matching. Now radical empathy is required here. An example of standard empathic receptivity is provided in the text, and the dance between Denver and Beloved is performed (1987: 87 – 88):

“Beloved took Denver’s hand and place another on Denver’s shoulder. They danced then. Round and round the tiny room and it may have been dizziness, or feeling light and icy at once, that made Denver laugh so hard. A catching laugh that Beloved caught. The two of them, merry as kittens, swung to and fro, to and fro, until exhausted they sat on the floor. “

The contagious laughter is entry level empathic receptivity. Empathy degree zero, so to speak. This opening between the two leads to further intimate engagement with empathic possibility. But the possibility is blocked of further empathizing in the  moment is blocked by a surprising discovery. At this point, Denver “gets it” – that Beloved is from the other side – she has died and come back – and Denver asks her, “What’s it like over there, where you were before?” But since she was killed as a baby, the answer is not very informative: “I’m small in that place. I’m like this here.” (1987: 88) Beloved is the age she would have been had she lived. 

The narrative skips in no particular order from empathic receptivity to empathic understanding. “Understanding” is used in the extended sense of understanding of possibilities for being in the world (e.g., Heidegger 1927: 188 (H148); 192 (H151)): “In the projecting of the understanding, beings [such as human beings] are disclosed in their possibility.”Empathic understanding is the understanding of possibility. What does the reader’s empathy make present as possible for the person in her or his life and circumstance? What is possible in slavery is being a beast of burden, pain, suffering, and early death – the possibility of no possibility of human flourishing. In contrast, when Paul D makes his way to the house of Sethe and Denver (and, unknown to him, the ghost of the baby), the possibility of family comes forth. In the story, there’s a carnival in town and Paul D, who knew Sethe before both managed to escape from the plantation (Sweet Home), takes her and Denver to the carnival. “Having a life” means many things. One of them is family. The possibility of family is made present in the text and the reader 

“They were not holding hands, but their shadows were. Sethe looked to her left and all three of them were gliding over the dust hold hands. May be he [Paul D] was right. A life. Watching their hand-holding shadows [. . . ] because she could do and survive things they believed she should neither do nor survive [. . . .] [A]ll the time the three shadows that shot out of their feet to the left held hands. Nobody noticed but Sethe and she stopped looking after she decided that it was a good sign. A life. Could be.” (Morrison 1987: 67)

Within the story, Sethe has her own has a justification for her deed. She is rendering her children safe and sending them on ahead to “the other side” where she will soon join them. “I took and put my babies where they’d be safe” (Morrison 1987: 193). The only problem with this argument, if there is a problem with it, is that it makes sense out of what she did. Most readers are likely to align with Pau D, who at first does not know about the infanticide. Paul D learns the details of Sethe’s act from Stamp Paid, the former underground rail road coordinator, who knows just about everything that goes on, because he was a hub for the exchange of all-manner of information. Stamp feels that Paul D ought to know, though he later regrets his decision. Stamp tells Paul D about the infanticide – showing him the newspaper clipping as evidence and explaining the words that Paul D (who is liberate) cannot read. Paul D is overwhelmed. He cannot handle it. He denies that the sketch (or photo) is Sethe, saying it does not look like her mouth. Stamp tries to convince Paul D: “She ain’t crazy. She love those children. She was trying to out hurt the hurter” (1987: 276). Paul D asks Sethe about the infanticide reported in the news clipping, and she provides her justification. Paul D is finally convinced that she did what she did, yet unconvinced it was the thing to do and a thunderhead of judgment issues the verdict: “You got two feet, Sethe, not four […] and right then a forest sprung up between them trackless and quiet” (1987: 194).[1] Paul D experiences something he cannot handle, whether it is empathic distress or choking on moral judgment or all of the above, and he moves out of the house where he was living with Sethe, Denver, and Beloved. In a breakdown of empathic receptivity, Paul D takes on Sethe’s shame, and instead of a decision to exit the relationship for cause, he runs away, makes an escape. Stamp blames himself for driving Paul D away by disclosing the infanticide to him (of which he had been unaware), and tries to go to explain it to Sethe. But the door is closed and locked against him. 

At this point the isolation of the woman inspires a kind of mad scene – or at least a carnival of emotion. Empathic interpretation occurs as dynamic and shifting points of view. The rapid-fire changing of perspectives occurs in the three sections beginning, “Beloved, she my daughter”; “Beloved is my sister”; “I am Beloved and she is mine” (Morrison 1987: 236; 242; 248). These express the hunger for relatedness, healing, and family that each of the women experience. For the reader, encountering the voices has the rhythmic effect of Virginia Woolf’s The Waves. The voices are disembodied, though they address one another rather than the reader (as is often the case in Woolf). The first-person reflections slip and slide into a free verse poem of call and response. The rapid-fire, dynamic changing of perspectives results in the merger of the selves, which, strictly speaking, is a breakdown of empathic boundaries. There is no punctuation in the text of Beloved’s contribution to the back-and-forth, because Beloved is a phantom, albeit an embodied one, without the standard limits of boundaries in space/time. 

In a flashback of empathic responsiveness: Sethe is on the run, having escaped enslavement at Sweet Home Plantation. She is far along in her pregnancy, alone, on foot, barefoot, and is nearly incapacitated by labor pains. A white girl comes along and they challenge one another. The white girl is named Amy Denver, though the reader does not learn that at first, and she is going to Boston (which becomes a running joke). These are two lost souls on the road of life if there ever were any. Amy is barely more safe or secure than Amy, though she has the distinct advantage that men with guns and dogs are not in hot pursuit of her. Sethe dissembles about her own name, telling Amy it is “Lu.” It is as if the Good Samaritan had also been waylaid by robbers, only not beaten as badly as the man going up to Jerusalem, who is rescured by the Samaritan. Amy is good with sick people, as she notes, and practices her arts on Sethe/Lu. Sethe/Lu is flat on her back and in attempt to help her stand up, Amy massages her feet. But Sethe/Lu’s back hurts. In a moment of empathic responsiveness, Amy describes to Sethe/Lu the state of her back, which has endured a whipping with a raw hide whip shortly before the plan to escape was executed. Amy tells her:

“It’s a tree, Lu. A chokecherry tree. See, here’s the tunk – it’s red and spit wide open, full of sap, and this here’s the parting for the branches. You go a mighty lot of branches. Leaves, too, look like, and dern if these ain’t blossoms. Tiny little cherry blossoms, just as white. Your back got a whole tree on it. In bloom. What god have in mind I  wonder, I had  me some whippings, but I don’t remember nothing like this” (1987: 93).

This satisfies the definition of empathic responsiveness – in Amy’s description to Lu of what Amy sees on Lu’s back, Amy gives to Lu her (Amy’s) experience of the state of Lu’s back. Amy’s response to her (Lu) allows / causes Lu to “get” that Amy has experienced what her (Lu’s) experience is. Lu (Sethe) of course cannot see her own back and the result of the rawhide whipping which is being described to her. On background, early in the story, Sethe tells Paul D: “Them boys found out I told on em. Schoolteacher [actually a teacher, but mostly a Simon Legre type slave owner, and the brother of Mrs Garner’s late husband] made one open up my back, and when it closed it made a tree. It grows there still” (1987:20). The reader wonders, What is she talking about? “Made a tree”? The conversational implicature – clear to the participants in the story, but less so to the reader – lets the suspense – and the empathy – come out. The “tree” finally becomes clear in the above-cited passage. Nothing is lacking from Morrison’s artistry, yet the description gave this reader a vicarious experience of nausea, empathic receptivity, especially with the white puss. Once again, not for the faint of heart. This a “transfiguring” of the traumatic.

A further reflection on “transfiguring” is required. If one takes the term literally – transforming the figure into another form without making it more or less meaningful, sensible, or significant, than one has a chance of escaping the aporias and paradoxes into a state of masterful and resonant ambiguity. For example, in another context, when the painter Caravaggio (1571 – 1610) makes two rondos of Medusa, the Gorgon with snakes for hair, whose sight turns the view to stone, was he not transfiguring something horrid and ugly into a work or art? The debate is joined. The inaccessible trauma – what happened cannot be accurately remembered, though it keeps appearing in nightmares and flashback – is the inaccessible real, like Kant’s thing in itself. The performing of the trauma, the work of art – Caravaggio’s self-portrait as the Medusa[2] or the encounter of Amy and Sethe/Lu or Morrison’s Beloved in its entirety – renders the trauma accessible, expressible, and so able to be worked through. 

However, the myth of the Medusa itself suggests a solution, albeit a figurative one. In the face of soul murder embedded within moral trauma (and vice versa), the challenge to standard empathy is to expand, unfold, develop, into radical empathy. That does not add another feature to empathy in addition to receptivity, understanding, interpretation, and responsiveness, but it raises the bar (so to speak) on the practice of all of these. Radical empathy is committed to the practice of empathizing in the face of empathic distress. What does empathic distress look like? It looks like the reaction to the traumatic vision of the snake-haired Gorgon that turns to stone the people who encounter it. A clarification will be useful

The reader may recall that the hero Perseus succeeded in defeating this Medusa without looking at her. (Remember, had he seen the Medusa straight on, it would have turned him to stone too.) Perseus would have been traumatized by the traumatic image and rendered an emotional zombie – lacking in aliveness and vitality. Beyond empathic unsettlement and empathic distress, moral trauma (moral injury) and soul murder stop one dead – not necessarily literally but emotionally, cognitively and practically. Is there a method of continuing to practice empathizing in the face of such unsettlement? Recall that Perseus used a shield, which was also a magic reflective mirror, indirectly to see the Medusa as a reflection without being turned to stone and, thus, defeat her. The shield acted as a defense against the trauma represented by the Medusa, enabling him to get up close and personal without succumbing to the toxic affects and effects. There is no other way to put it – the artistic treatment of trauma is the shield of Perseus. It both provides access to the trauma and defends against the most negative consequences of engaging with it. The shield does not necessarily render the trauma sensible or meaningful in a way of words, yet the shield takes away the power of the Gorgon/trauma, rending it unable to turn one to stone. In the real-world practice of trauma therapy, this means rendering the trauma less powerful. The trauma no longer controls the survivor’s life. One gradually – by repeated working through – gets one’s power back as the trauma shrinks, gets smaller, without, however, completely disappearing.  

The question for this inquiry into Beloved is what happens when one brings literary language, refined language, artistic language, beautiful language, to painful events, appalling events, ugly events, dehumanizing events, traumatic events? The literary language has to dance around the traumatic event, which is made precisely present with expanded power by avoiding being named, leaving an absence. The traumatic events that happened were such that the language of witnessing includes the breakdown of the language of witnessing. As Hartman notes in his widely quoted study:

It is interesting that in neoclassical aesthetic theory what Aristotle called the scene of pathos (a potentially traumatizing scene showing extreme suffering) was not allowed to be represented on stage. It could be introduced only through narration (as in the famous recits [narrative] of Racinian tragedy) (Hartman 1995: 560 ftnt 30).

Once again, less is more. The absence of the most violent defining moment increases its impact. Note this does not mean – avoid talking about it (the trauma). It means the engagement is not going to be a head on attack, but a flanking movement. In the context of narrative, this does not prevent the reader from engaging with the infanticide. On the contrary, it creates a suspense that hooks the reader like a fish with the rest of the narrative reeling in the reader. The absence makes the engagement a challenge, mobilizing the reader’s imagination to fill in the blank in such a way that it recreates the event as a palpable vicarious event. It is necessary to raise the ghost prior to exorcising it, and this does just that. 

If this artistic engagement with trauma is not “writing trauma” in LaCapra’s sense, then I would not know it:

 “Trauma indicates a shattering break or caesura in experience which has belated effects. Writing trauma would be one of those telling after-effects in what I termed traumatic and post-traumatic writing (or signifying practice in general). It involves processes of acting out, working over, and to some extent working through in analyzing and ‘giving voice’ to [it] [. . . ]  – processes of coming to terms with traumatic ‘experiences,’ limit events, and their symptomatic effects that achieve articulation in different combinations and hybridized forms. Writing trauma is often seen in terms of enacting it, which may at times be equated with acting (or playing) it out in performative discourse or artistic practice” (LaCapra 2001: 186–187).

If the writing (and reading) of the traumatic events is a part of working through the pain and suffering of the survivors (and acknowledging the memory of the victims), then the result for the individual and the community is expanded well-being, expanded possibilities for aliveness, vitality, relatedness, and living a life of satisfaction and fulfillment. Instead of being ruled by intrusive flashbacks and nightmares, the survivor expands her/his power over the events that were survived. This especially includes the readers engaging with the text who are survivors of other related traumatic events, dealing with their own personal issues, which may be indistinguishable from those of fellow-travelers in trauma. That is the situation at the end of Beloved when Paul D returns to Sethe and Denver (Sethe’s daughter) after the community has exorcised the ghost of Beloved. It takes a village – a community – to bring up a child; it also takes a village to exorcise the ghost of one.

References

Anonymous. (2012). Trolley problem (The trolley dilemma). Wikipedia: https://en.wikipedia.org/wiki/Trolley_problem [checked on 2023-06-25]

Hannah Arendt. (1970). On Violence. New York: Harcourt, Brace, Jovanovich.

Caty Caruth. (1996). Unclaimed Experience: Trauma, Narrative, and History. Baltimore: John Hopkins University Press.

Geoffrey H Hartman. (1995). On Traumatic Knowledge and Literary Studies New Literary History , Summer, 1995, Vol. 26, No. 3, Higher Education (Summer, 1995): 537 – 563 .

Martin Heidegger. (1927). Being and Time, John Macquarrie and Edward Robinson (trs.). New York: Harper and Row, 1963.

Toni Morrison. (1987). Beloved. New York: Vintage Int.

Dominick LaCapra. (1999). Trauma, absence, loss. Critical Inquiry, Summer, 1999, Vol. 25, No. 4 (Summer, 1999): 696–727 

Dominick LaCapra. (2001). Writing History, Writing Trauma. Baltimore, John Hopkins Unviersity Press. 

Stephen Levinso. (1983). Pragmatics. Cambridge: Cambridge University Press.

Ruth Leys. (2000). Trauma: A Genealogy. Chicago: The University of Chicago Press.

Boris Sagal, Director. (1981). Masadehttps://en.wikipedia.org/wiki/Masada_(miniseries) [checked on 2023-06-25).

J. Shay, (2014). Moral injury. Psychoanalytic Psychology, 31(2), 182-191. https://doi.org/10.1037/a0036090

Leonard Shengold. (1989). Soul Murder Revisited: Thoughts About Therapy, Hate, Love, and Memory. Hartford: Yale University Press. 

Bessel van der Kolk. (2014). The Body Keeps the Score. New York: Penguin. 


[1] For those readers wondering how Sethe regained her freedom after being arrested for murder (infanticide), Beloved provides no information as to the sequence. During the historical trial an argument was made that as a free woman, Margaret Garner should be tried and convicted of murder, so that the Abolitionist governor of Ohio could then pardon her, returning here to freedom. Something like that needs to be understood in the story, though it is a fiction. It is a fiction, since in real life, Garner and her children were indeed returned to slavery under the Fugitive Slave Act. Moral trauma within soul murder indeed. 

[2] Caravaggio was a good looking fellow, and he uses himself as a model for the face of the Medusa. This does not decide anything. Arguably, Caravaggio was arguably memorializing – transfiguring – his own life traumas, which were many and often self-inflicted as befits a notorious manic-depressive. 

© Lou Agosta, PhD and the Chicago Empathy Project

Book Review: Susan Lanzoni’s Empathy: A History connects the dots between the many meanings of empathy

Short review: two thumbs up. Superb. Definitive. Well written and engaging. Innovative and even ground-breaking. Connects the dots between the different aspects and dimensions of empathy. Sets a new standard in empathy studies. The longer – much longer – review follows. Note also that since this is not a softball review, several criticisms, incompletenesses, and limitations are called out.

Susan Lanzoni’s comprehensive history of the concept of empathy – the concept, not the mere word – breaks new ground in our understanding of the distinction.  She

Cover art: Empathy: A History by Susan Lanzoni - showing the full spectrum of aspects of empathy from projection to receptivity in interpersonal relations

Cover art: Empathy: A History by Susan Lanzoni – showing the full spectrum of aspects of empathy from projection to receptivity in interpersonal relations

explores empathy’s significance for diverse aspects of our humanity, extending from art and advertising to race relations and talk therapy: Empathy: A History. New Haven: Yale University Press, 392 pp., $30 (US).

Just to be clear: Lanzoni’s is not a “how to” or self-help book; which does not mean that one cannot expand one’s empathy by engaging with empathy’s deep structure in this multi-dimensional, historical encounter. One can. However, the reader will not find explicit tips and techniques in applying empathy.

Lanzoni engages with empathy and: (1) natural beauty and art (2) the 19th century psychological laboratories of Wilhelm Wundt (1832–1920), Edward Bradford Titchener (1867–1927), and their rivals (3) theatre and modern dance (4) mental illness such as psychosis and schizophrenia (5) social work and psychotherapy (6) measurement using psychometric questionnaires (7) popular culture including advertising and the media (8) race relations (9) neuroscience.

Lanzoni end her introduction by quoting the work of Ted Cohen (1939–2014) on metaphor in Thinking of Others: On the Talent for Metaphor (2009) (Lanzoni: p.18). Formulating a metaphor and imagining oneself in another person’s position point to a common twofold root, an art [Kunst] hidden in the depths of the human soul, whose true operations we can divine from nature and lay unveiled before our eyes only with difficulty, but whose depths we are unlikely to be able ever adequately to plumb. Lanzoni’s implies the art in question is precisely empathy and the translation it makes possible. Thus, we always honor the late Ted Cohen, whose predictably cutting, caustic and cynical wit, however, masked a deep and abiding empathy.

The narrative proper begins with Violet Paget (Vernon Lee (1856–1935)), who, with her partner and muse Clementina (Kit) Anstruther-Thomson, engaged in introspective personal journaling to detect and report the physiological effects of art and beauty on the human organism. Paget’s research crosses paths with that of Munich psychologist Theodor Lipps (1851–1914). Lanzoni reports that Lee and Lipps may have met in person in Rome at the Fifth International Congress of Psychology in 1905 (where both were on the program).

At the risk of over-simplification, Paget, Lipps, and Karl Groos (1861–1946) form a triumvirate of empathy innovators, who turn to motor mimicry, inner imitation, sympathetic muscular memory, and aspects of physiological resonance to account for the stimulating effects of artistic and natural beauty on human experience. Their analysis is the flip side of the implicit panpsychism, personification, anthropomorphism by which beautiful nature is animated with human expressions of the emotional life – for example, angry storms in the ocean, melancholy mists in the valley, a joyful sunrise, a fearful darkness.

This remarkable feature of human experience: that we attribute emotions (and even intentions) to natural objects – angry storms, cheerful sunsets, and melancholy clouds. Magical, primitive thinking? An adaptive reflex? This review does not require that anyone, including Lanzoni, have solved this problem. However, some contemporary thinkers have speculated that it is a cognitive design defect of human nature to attribute intentionality (including emotional propositional contents) to otherness – whether human or physical – as an adaptive mechanism arising in the context of biological evolution.

 Theodor Lipps is the one who puts Einfühlung on the map between 1883 and 1914 (his death), and those who are contemporaries must explain how they differ from his position.

 Lipps’ position on empathy was already multidimensional, extending Einfühlung from the projection of feelings into objects to the perception of other people’s expressions of animate life. Lanzoni’s reading of Lipps is much more charitable than mine, and I find Lipps at loose ends and philosophically naïve as he tries to account for the first person’s access to the experiences of the second person by “an original innate association between the visual image and the kinesthetic image (1903: 116). Lipps thinks he has demolished the philosopher’s problem of other minds but unwittingly recreates it in his own terms (e.g., Agosta 2014: 62 – 63).

 Lanzoni engagingly (but briefly) references the critique of Lipps’ theory of projective empathy by the phenomenologists Edith Stein (1891–1942), Max Scheler (1874–1928), Edmund Husserl (1859–1938), Maurice Merleu-Ponty (1908–1961), and Martin Buber (1878–1965) (p. 37).

 Lanzoni notes Sigmund Freud’s (1856–1939) debt to Lipps based on transference as a kind of projection. For Lipps, psychological processes were performed, with few exceptions, beneath the threshold of consciousness, which is another factor that made Lipps’ positions attractive to Freud.

 Any thinker or author who used the term “Einfühlung” would inevitably also conjure up the image of Theodor Lipps, which limited the thinkers ability to use it without extensive argument or the risk of being mistaken as a follower of Lipps. This point is key: in his own time Lipps had in itself branded himself as the “go to guy” for all matters empathic. More on the significance of this dilemma below.)

 By the way, Lanzoni does not italicize the word “Einfühlung” unless it is used in a specifically German context. “Einfühlung” is now an English word!

 Johann Herder (1744–1803) also gets honorable mention at this point (p. 32) as a philosopher in the Romantic tradition. Herder is noteworthy as a proponent of empathy as a verb – sich hereinfühlen– to feel one’s way into. Herder was a fellow traveler of Goethe and actually “on staff” as the chief Lutheran prelate at Weimar, innovating in the historical development of language in a proto-evolutionary (and metaphysical) context. This points to an entire undeveloped paradigm of empathy not developed by Lanzoni. For example, for Herder empathy was required to feel one’s way into the world of Homer in order to produce an accurate translation of Homer’s Iliad.

 This paradigm of empathy as translation is arguably at the same level of generality as empathy as projection, but remained undeveloped until the rise of hermeneutics along a separate trajectory. And since Lanzoni seemingly unquestioningly accepts Rudolf Makkreel’s dismissal of the relevance of Einfühlung for Wilhelm Dilthey (granted he has little use for the word), this approach is not further explored.

 Yet the modern innovators of interpersonal empathy such as Carl Rogers (1902–1987) might be read as leap-frogging back to the original sense of entering the other’s world in order to translate it into the first person, subject’s own terms. Such Herderlike usages also fits well with what Gordon Allport (1897–1967) and Kenneth Clark (1903–1983) were doing in arraying empathy against racism and prejudice in expanding the boundaries of community by empathically translating between them (see Chapter Nine).

 An entire possible alternate history of empathy, as yet unwritten, opens up at this point – empathy as translation between subjects. (Granted that Rogers probably never heard of Herder, at least not in the context of empathy, so this is a conceptual nuance; but Rogers probably never heard of Lipps either.)

 As is by now well known, in part thanks to Lanzoni’s work, the word “empathy” itself comes into English thanks to Edward Bradford Titchener, the founder of a Wundtian style psychology lab at Cornell University (and translator of Wundt). However, what is less well known is the back-and-forth about the meaning of Einfühlung as explored in detail by Lanzoni.

I was impressed by the work of James Mark Baldwin (1861–1934), who contribution to empathy as semblance was interrupted and obscured as he had to leave town in a hurry – apparently for Paris – after being arrested in a raid on a Baltimore house of prostitution. Baldwin was innovating with empathy in terms of semblance – the “as if” of child’s play and the play of the artist.

 Lanzoni quotes in detail the devaluing remarks about “empathy” made by James and Alix Strachey, the translators of Freud, who call it a “vile word” (p. 67). Though Freud used variations of “Einfühlung” some 22 times in 24 volumes, the word is often paraphrased or mistranslated by the Stracheys, using synonyms such as “sympathetic understanding.”

 It is amazing how much empathy or lack thereof turns on a mistranslation. My take on it? Basically Freud did not use the word Einfühlung more often because he was not someone who could abide being a footnote to Lipps (who, as noted, virtually owned the distinction Einfühlungin German). There are other technical reasons Freud chose not to comment more extensively on empathy, including his dismissal of the philosophical uses of introspection as a function of the conscience (superego), whereas introspection and empathy are “joined at the hip” in a therapeutic context (see also Agosta 2014: 66 – 82).

 I hasten to add that Freud did say in his “Recommendations for Physicians Beginning Psychoanalytic Treatment” (1913) that if the would-be analysts start in any other way than with empathy, they are headed for trouble. But once again the reader has no idea of Freud’s true position, because “empathy” is mistranslated as “sympathetic understanding.” However, these observations are less critical to Lanzoni’s point, which is otherwise unexceptionally on target.

 Meanwhile, Titchener has numerous ideas (that we would today consider highly unconventional) about how images accompany word meanings, but his translation of “Einfühlung” as “empathy” sticks. In an otherwise comprehensive engagement (Lanzoni really does seem to have read everything!), she does not mention how empathy subsequently becomes embroiled in the disappearance of introspection controversy (behaviorists regard it as illusory) and ultimately is “taken down” by the behaviorists in their attack on all things relating to subjective consciousness and inwardness. However, all this lies ahead in the B.F. Skinnerian 1950s through 1980s, and the Chapter ends with Einfühlung being an intertwining of projection, aesthetic appreciation, and Baldwin’s “semblance.”

 But how does one get from a empathy that projects human emotions and mindedness onto objects in art and nature and an empathy as human understanding of another, second person who contains an emotional life and mind of his or her own distinct from that of the first person?

 Lanzoni skillfully navigates the challenge of engaging how the projective aesthetic empathy of Lipps et al get transformed, translated, and reconciled, with the interpersonal receptive empathy of talk therapy and personal counseling.

 One missing link comes in modern dance. The missing link is identified as to “live in the mind of the artist who designed it [the object]” (p. 97). At this moment in the text, the intentionality of the artist looms large. In effect, the regression (my word, not Lanzoni’s word) is back from the intentionality built into the artistic artifact or performance towards human subjectivity. Now intentionality is available to build a bridge between a projective empathy of the object and a receptive intersubjective empathy of the human subject.

 Both projective empathy and receptive empathy are ways (admittedly divergent) of dealing with and transforming otherness– the otherness of the object and the otherness of the human subject. This is why aesthetic empathy and interpersonal empathy belong to the same concept and are not merely the same homonymous word for different underlying concepts.

 Another missing link occurs in “Personality as Art.” Lanzoni gathers together the contributions of Herbert Langfeld (1879–1958), Wilhelm Worringer (1881–1965), Carl Gustav Jung (1875–1961), who expand the boundaries of aesthetic, projective empathy in the direction of the understanding of human beings. The study of the artistic self-expressions of psychotics incarcerated in mental asylums also deserves mention here as opening up the exchange between aesthetic projective empathy and interpersonal receptive empathy.

 Nowhere does any one (including Lanzoni) say, “Relate to the human being with the respect and interpretive finesse with which one relates to a work of art,” but that is the basic subtext here. In our own time, the late Richard Wollheim, a notorious free spirit, sometimes took such a position about art and its objects.

 The engagement with empathy as human understanding picks up speed. Whenever a breakdown occurs the possibility of a breakthrough also arises. Such is the case with schizophrenia. In apparently separate but overlapping and near simultaneous innovations, E. E. Southard (1876–1920), Roy G. Hoskins , Louis Stack Sullivan (1892–1949), Karl Jaspers (1883–1969), and C. G. Jung identified schizophrenia as a challenge to or a disorder of empathy. In short, it is hard to empathize – Jaspers maintained it was impossible – with people who were disordered in such a way that they displayed the cluster of symptoms we now group as schizophrenia including perceptual distortions, incoherent speech patterns, disordered thinking, lack of reality testing, bizarre ideas, emotional flatness, intermittent acute anxiety or paranoia, lack of motivation, lack of responsiveness, burn out, and (occasionally) lack of personal hygiene.

 Southard designed an “empathic index” (p. 101) guiding the psychiatrist through a series of questions such as: How far can you read or feel yourself into the patient? Thus the first, admittedly over-simplified, version of the schizophrenia test: Can you imagine experiencing what the patient reports he or she is experiencing? If not, then that counts as evidence they are on the equivalent of what we would today call the “schizophrenic spectrum.”

 We finally arrive at our present day folk definition of empathy: the ability to step into and walk in another person’s shoes and then to step back into one’s own shoes again, and, in so doing, to “feel along with, to understand, and to insinuate one’s self into the feelings of another person” (p. 124).  

 Lanzoni asserts: “[T]he psycho-therapeutic rendering of empathy traded self-projection for its opposite: one now had to bracket the self’s findings and judgments in order to more fully occupy the position of another” (p. 125). Thus, a coincidence of opposites in which the two extremes are perhaps counter-intuitively closer to one another than either point is to the middle.

 With Chapter Five on “Empathy in Social Work and Psychotherapy,” Lanzoni makes yet another decisive contribution to empathy scholarship.

 Carl Rogers famously puts empathy on the map in the 1950s, 60s, and beyond, as the foundation for psychotherapeutic action. Though it is an oversimplification, in client-centered Rogerian therapy, one gives the client a good listening – one gives the client empathy – and the client gets better.

 Lanzoni connects the empathy dots. They lead back into the empathy archives. They lead back from Carl Rogers to D. Elizabeth Davis, a student of Jessie Taft (1892 – 1960), a nurse and social worker, who, in turn, was strongly influenced in her conception of relational therapy by G. H. Mead’s (1863–1931) social behaviorism and Otto Rank (1884–1939). Rank belonged to Freud’s inner circle along with Ernest Jones (1879–1958), Karl Abraham (1877–1925), and Sándor Ferenczi (1873–1933).

 Not a medical man or even a scientist, Otto Rank met Freud in 1905 when he presented Freud with his innovative work on the artist as inspired by Freud’s theories. Something clicked between them. In 1905 Freud was less isolated, but still hungry for recognition and fellow travelers. Think: father son transference.

 Rank eventually completed a PhD dissertation at the University of Vienna on literature (the Lohengrin Saga), in part thanks to the financial generosity of Freud. Freud paid him to be the recording secretary of the Psychoanalytic Association. The literary dimension is of the essence, and, in our own time, we have a renewed appreciation that studying literary fiction expands one’s empathy.  This too  strengthens the case for the overlap of the aesthetic and interpersonal dimensions of empathy.

 As was often the case with Freud and his “sons” – Jung, Ferenczi, Adler – the seemingly inevitable “falling out” between Rank and the Freudian establishment was especially bitter. Ultimately Louis Stack Sullivan made the parliamentary motion to expel Rank from the American Psychoanalytic Association. With friends like these … Rank formed his own separate Association and continued to innovate and earn Greenbacks.

 Carl Rogers learns of Rank’s work through one of his colleagues, who is being analyzed by Rank, now residing in the States. Rogers invites Rank to speak at a three-day seminar (circa 1936), lecturing to forty-five social workers and educators. Rogers later notes that it was in this context “that I first got the notion of responding almost entirely to the feeling being expressed” (p. 144). Voila! Mark the historical moment: Client-centered therapy is conceived.

 Mine is a bare bones outline of how Lanzoni connects the dots. The dynamics and the personalities, which Lanzoni richly narrates, make for fascinating story telling in themselves. Fast forward to the 1930s as Jessie Taft, a nurse and social worker separately innovating in empathic relatedness, is translating Rank’s Will Therapy from the German. There is still research to be done to follow the threads into Rank’s work, whose literary skills in mining myth and fiction are used in elaborating an approach to the emotions that transgresses the relatively narrow definition of Freudian libido (desire).

 Though Lanzoni does not get so far, I do not believe that Rank had the specific distinction of Einfühlung, but worked with the communication and understanding of the emotions in such a way as to produce psychological transformation. Rank uses the word “love” in the way of an empathy-like “unconditional positive regard.”

 By the time Rogers is fully engaged with Einfühlung, “empathy” does notmean agreement with the other or mere mirroring. The therapy client may usefully be self-expressed about the emotions with which he or she is struggling. These emotions, in turn, are thereby brought to the surface, acknowledged, worked through, and able to be transformed. The therapist helps the client to metabolize the emotional congestion and gives back to the client the client’s own experience in a form that the client recognizes, hypothetically opening up a reorganization of psychic structure.

 Lanzoni also gives a “shout out” to Heinz Kohut, MD (1913–1981), but just barely. Kohut was the innovator who puts empathy on the map in psychoanalysis (then the dominant paradigm in psychiatry) starting in 1959 with his celebrated article “Introspection, empathy, and Psychoanalysis.”

 Kohut was very circumspect about his sources relating to empathy and regarding those who inspired him in his work on empathy. Chronically under-appreciated (and sometimes even under attack) by the prevailing orthodoxy of Freudian ego psychology, Kohut’s footnotes about empathy as such are few and far between. Surely knowing the fate of Adler, Jung, Ferenczi, and Rank, not even to mention Jeffrey Masson, Kohut pushed back against the unfriendly accusation that Kohut’s emerging Self Psychology was distinct from Freudian psychoanalysis, even as Self Psychology seemed increasingly to be so.

 It is likely Kohut was influenced by Sándor Ferenczi and Michael Balint (Lunbeck 2011). Speaking personally, I have never seen a shred of evidence that Kohut read Rank, who was by that time devalued as yet another notorious “bad boy” and psychoanalytic heretic. Of course, that does not mean that Kohut did not do so – and it is also possible that I just need to get out more. Kohut and Rogers seemed to have inhabited parallel but wholly distinct universes.

 My take? And not necessarily Lanzoni’s: Kohut was sui generis– and wherever he first got the word “empathy” itself (Kohut, though a Austrian, German-speaking refugee, was by 1959 writing in English), his definition of empathy as “vicarious introspection” is a wholly original contribution.

 One problem is that as soon as one engages Kohut’s The Analysis of the Self (1971), arguably a work of incomparable genius, discovering as it does new forms of transference, relations to the other, and possibilities for humanization, the reader is hit by a tidal wave of terms such as “cathexis,” “archaic object,” and “repressed infantile libidinal urges.” These make the reading a hard slog for most civilians.

 The force of historical empathy is strong with Lanzoni as she engages “Popular Empathy.” She describes how in the post World War II world “empathy” breaks out of its narrow academic context into the American cultural milieu at large.

For example, the then-popular radio (and eventually TV) personality Arthur Godfrey was featured on the February 1950 cover of Time magazine, asserting “He has empathy” (p. 208). The notorious quiz show scandals of the late 1950s were apparently a function of mis-guided empathy, giving contestants answers to build audience empathy for the contestants. Advertisers “got it”: help the audience empathize with the brand and the person using the brand – give the customer empathy, they buy the product. Even if it was never quite so simple, the Boston Globe(July 3, 1964) quotes the Harvard Business Review:  Empathy is “the ability feel as the other fellow feels – without becoming sympathetic” (p. 210).

 Meanwhile, Carl Rogers has an existential encounter with Martin Buber (celebrated author of I and Thou) at the University of Michigan (1956). Rogers is profiled in Timemagazine in 1957 as practicing a psychotherapy that uses empathy in contrast with the then-prevailing paradigm of psychoanalysis, which uses – what? Insert the caricature of an authoritarian analysis of the Oedipus complex.

 In an eye-opening Chapter on “Empathy, Race, and Politics,” Lanzoni documents the role of empathy in the movement for civil rights in the 1950s and 1960s in America. Both Kenneth B. Clark and Gordon Allport provided examples of (social) psychologists who were committed to social justice. They were committed to overcoming the one dimensional, trivial and convenient issues of academic research (still ongoing) instead engaging with urgent social realities such as prejudice, racism, poverty, and inequality.

 According to Lanzoni, Allport drew on the tradition of Einfühlung to describe empathy as a means of grasping the human personality holistically, thus breaking down the barrier between aesthetic and interpersonal empathy. Clark used empathy as the basis for arguing for equality under the law: “to see in one man all men; and in all men the self” (p. 217). Sounds like empathy to me.

 In 1944 Allport taught an eight-hour course to Boston police officers to tune down racial tensions. Allport encountered and faced what he called an “abusive torrent of released hostility.” In response Allport deployed the technique of nondirective or “unemotional listening,” learned from Carl Rogers. Once again, sounds like empathy. By the end of the session, the officers reportedly became bored by their own complaints. One who had “at first railed against the Jews tried in later remarks to make amends.” But empathy remained a two-edged sword, capable of eliciting searing anger when others thought they had not been given the dignity they deserved as well as dialing down narcissistic rage once it had been called forth (pp. 220 – 221).

Clark was so impressed by psychoanalyst Alfred Adler’s (1870–1937) power dynamics in the context of society that he shifted his major from neurophysiology to psychology. In 1946, Clark and his wife, Mamie Clark (PhD, Columbia) established the Northside treatment Center in Harlem to expand education, counseling, and psychological service for youth in Harlem.

 In July 1953 Clark wrote to Allport, asking help in preparing a document for the upcoming Supreme Court deliberations on desegregation in the Brown v. Board of Education case. Allport responded quickly. The rest, as they say, is history.

 Gunnar Myrdal (author of the celebrated American Dilemma, demonstrating that the history of the US isthe history of race relations (1944)) said of Clark’s work, especially Dark Ghetto(1965): a demand for “human empathy and even compassion of the part of as many as possible of those who can read, think, and feel in free prosperous white America” (p. 241). Just so.

 Instead of becoming ever more cynical and resigned in the face of prejudice that seemed baked into the neo-liberal, market-oriented vision of American society, Clark calls forth empathy. Clark’s calls for empathy became more insistent. What happens when Clark and empathy speak truth to power? Empathic reason? Rational empathy? One can only wish that Clark had lived to see the people of this great country elect Barak Obama as President of these United States. We do not know if this was an anomalous moment, a beacon in the current fog of fake everything, or a kind of liberal purgatory – one step forward, one step backward – to call forth further struggle. From the perspective of Q2 2019 as I write this review, such events seem like a dream. Breakdowns are hard but inevitably point the way to the next breakthrough.

 Lanzoni demonstrates that society’s interest in empathy had continuously been at the level of at least a steady simmer in the popular and social justice communities in the 1950s through 1970s even as professional psychology was lost and wandering through the wasteland of Skinnerian behaviorism.

 That which really brings the conversation about empathy to a rolling boil in the final chapter is the discovery of mirror neurons in the macaque monkeys by the group of brain scientists in Parma, Italy including V. Gallese, L. Gadiga, L. Gogassi, and G. Rizzolatti.

 Mirror neurons are neurons are activated both when a subject takes an action and similarly when the subject watches another subject doing the same thing. For example, the set  of neurons in the premotor cortex of the monkey is activated when it drinks from a cup. Okay, fine. The astonishing finding is that these same neurons are activated when the monkey watches another monkey (or any one) drink from the cup. Could this be the underlying basis of the motor mimicry, inner imitation, felt resonance, with which thinkers such as Violet Paget, Theodor Lipps, and Karl Groos remarked? Could this be the neural infrastructure for Kohut’s vicarious engaged, or Roger’s felt sense of participating in the other’s experience? The infrastructure for Mark Davis or Alvin Goldman on perspective taking and simulation?

  The battle is joined.

 Lanzoni covers the explosion of theories, studies, and amazing results that have occurred since the identification of alleged mirror neurons. Bottom up, affective empathy is combined with top down, cognitive empathy to complete the picture of empathic relatedness.

 The author of Emotional Intelligence, Daniel Goleman, weighs in with a follow up on Social Intelligence – that is, empathy.  Victorio Gallese’s shared manifold hypothesis makes the case for a multi-person virtual manifold of experience that can be vicariously sensed by each partner in empathic resonance. Jean Decety’s seminal architectural definition of empathy paves the way for social neuroscience and functional magnetic imaging research (fMRI) that visualizes other people’s pain. Marco Iacoboni Mirroring People argues that we have no need to use inference to understand other people. We use mirror neurons. Disorders of empathy are identified: Simon Baron-Cohen’s breakthrough work on Mindblindness (1995) identifies possible interventions for autism spectrum disorders.

 On a less positive note, the colonization by neural science of the humanities and social sciences has proceeded apace with neuroaesthetics, neurolaw, neurohistory, neurophilosophy, neuropsychoanalysis, neurozoology,and so on,  drawing provocative but, in many cases, highly questionable conclusions from what areas of people’s brains “light up” as they lay back in the fMRI apparatus and are shown diverse pictures or videos of people’s fingers being painfully impacted by blunt force.

 Lanzoni reports on the neuro-hype that accompanies the discovery of mirror neurons in monkeys: “Cells That Read Minds.” Hmmm. The backlash is predictable if not inevitable. Greg Hickok’s The Myth of Mirror Neurons raises disturbing questions about voodoo correlations in fMRI research. Other than a single report from 2010 of human mirror neurons allegedly identified in epileptic patients undergoing surgery, there is no evidence of the existence of human mirror neurons.

 Lanzoni is an equal opportunity debunker: The fMRI research, while engaging and provocative, provides evidence of diverse brain functions that include thousands of neurons, not individual ones, whose blood oxygenation level data (BOLD) is captured by the fMRI. Correlation is not causation. The brain lights up! Believe me, if it doesn’t you are in trouble.

 Still, the neuro-everything trend has traction (and its merits). Even if human mirror neurons do not exist, it is highly probable that some neurological system is available that enables us humans – and perhaps us mammals – to resonate together at the level of the animate expressions of life.

 If there is a myth, it is that we are unrelated. On the contrary, we humans are all related – biologically, socially, personally. You know that coworker or boss you can’t stand? You are related. You know that politician you regard with contempt? You are related. You know that in-law or neighbor who gets your goat? You are related – intimately related, because we all share the same cognitive, affective, and neural mechanisms – and defects – designed in from when we were that band of hominids fighting off large predators and hostile neighbors in the environment of evolutionary origin.

 Since this is not a softball review, as noted, I call out the limitations and incompletenesses of Lanzoni’s impressive contribution. One of the challenges is that the history of the concept empathy is not limited to the word “empathy” or Einfühlung. Indeed prior to Lanzoni’s work, some entirely reasonable individuals had concluded that Lipps projective empathy and Roger’s interpersonal empathy were entirely distinct concepts. We now know that they belong together in a kind of coincidences of opposites because empathic animation of the work of art or beautiful nature and empathic receptivity to other human beings are related, but diverse, ways of engaging with otherness. 

 First incompleteness: Prior to Titchener’s invention of the word “empathy” as a translation of the German “Einfühlung” the main word in English was “sympathy.” Now it is a common place today to say that “sympathy” means a reactive emotion such as pity in contrast with “empathy” that captures a vicarious experience of the other’s experience or takes a sample or trace affect of the other’s experience. And that remains true today. David Hume (1711–1776) and Adam Smith (1723–1790) get barely a shout out.

 However, if one goes back as recently as David Hume’s Treatise of Human Nature (1731) one can find at least four different senses of sympathy – emotional contagion, the power of suggestion, a vicarious experience such as one has in the theatre, the conjoining of an idea and impression of another’s expression of emotion with the idea of the other [which starts sounding like our notion of interpersonal empathy].

 In addition, if one looks at Hume’s aesthetic writings, one finds the distinction of a delicacy of sympathy and of taste. If your delicacy of sympathy and taste is more refined than mine, then you may experience a fine-grained impression that is more granular than mine. For example, you perceive sadness behind a person’s outburst of temper whereas I only perceive the obvious anger. Your delicacy of sympathy and taste is superior to mine. In our own modern language, you empathy is more discriminating.

 A second incompleteness is in the treatment of the phenomenologist’s – Edith Stein (1891–1942), Max Scheler (1874–1928), Edmund Husserl (1859–1938), Maurice Merleu-Ponty (1908–1961), who receive honorable mention in a cursory nod to their diverse engagements with Einfühlung. For example, Max Scheler’s eight distinctions of sympathy and empathy are called out in a footnote (p. 360n40): Miteinanderfühlung [reciprocal feeling], Gefühlsansteckung [infectious feeling], Einsfühlung [feeling at one], Nachfühlung[vicarious feeling], Mitgefühl [compassion], Menschenliebe [love of mankind], akosmischtishe Person- und Gottesliebe [acosmic love of persons and God], und Einfühlung [empathy]. Well and good.

 Leaving aside purely practical considerations of editorial constraints on word count and that the phenomenological material may have been covered elsewhere [e.g., see Agosta 2014, especially Chapters 4 – 6]: the reason that the additional phenomenological chapter was not provided is a breakdown in an otherwise astute historical empathy. 

 In particular, today hardly anyone has heard of Theodor Lipps (granted that Lanzoni’s work is changing that). However, in his own day Lipps was famous – celebrated as the proponent of a theory of Einfühlung that provided the substructure for aesthetics and grasping the expressions of animate life of other people. It was as if Lipps was an Antonio Salieri to would-be Mozarts such as Freud or Husserl (once again, except for the play (and movie) Amadeus). Using modern terms, it was as if in his own day Lipps was branded in the marketing sense as “the empathy guy.”

 Between roughly 1886 and 1914 (the date of Lipps’ death) no philosopher, psychologist, or psychoanalyst could use the word “Einfühlung” without being regarded as a follower – or at least a fellow traveller – of Lipps.

 In the case of the phenomenologist, the result is a sustained attack on Lipps. Edith Stein quotes Max Scheler against Lipps’ theory of “projective empathy.” Her contribution becomes a candidate deep structure of Husserl’s 5thCartesian Meditation. Husserl attempts to overcome the accusation of solipsism [there is nothing in the universe except my own consciousness] without using empathy as a mere psychological mechanism. Yet Husserl dismisses empathy, using a Kantian idiom, and “kicks it upstairs”: “The theory of experiencing someone else, the theory of so-called ‘empathy,’ belongs in the first story above our ‘transcendental aesthetics’ ” (1929/31: 146[173]). “Transcendental aesthetics” is a form of receptivity – such as receptivity to another subject. But then Husserl has to reinvent empathy in other terms calling it “pairing” and “analogical apperception.”

 One thing is certain: in Husserl’s Nachlass (posthumous writings) he makes extensive use of Einfühlung in building an account of intersubjectivity. Empathy is the window into the sphere of ownness of the other individual subject. Empathy is what gives us access to the Other, with a capital “O.” Empathy enacts a “communalization” with the other. Key term: communalization (Vergemeinschaftung).

 In his published writings Husserl was exceedingly circumspect in his use of the term “Einfühlung,” virtually abandoning it between Ideas (1913) and the Cartesian Meditations (1929/31).  But in Husserl’s work behind the scenes empathy was moving from the periphery to the center of his account of intersubjectivity. The Nachlass volumes corresponding the Cartesian Meditations contain hundreds of references to Einfühlung, in which it is doing the work of forming a community of subjects. The anxiety of influence? The influence of Lipps? Quite likely.

 I would not blame anyone – including Lanzoni – for not wanting to try to disentangle this complex of distinctions and influences of empathy in the context of phenomenology. It is not for the faint of heart.

 As of this date (Q2 2019), Lipps is not translated from the German so far as I know. There is a reason for that – Lipps falls through the crack between Immanuel Kant and Wilhelm Wundt. If ever there were someone of historical interest, it is Lipps.

 Lipps provides an elaborate rewrite of rational psychology using a quasi-Kantian idiom without any of the empirical aspects of Wundt. Still, Lipps enjoyed considerable celebrity in his own time. So far as I know, no one has commented on the fact that Lipps in effect substitutes the term “Einfühlung” for “taste” in his aesthetics. Those wishing to engage further may usefully see Agosta 2014: “From a Rumor of Empathy to a Scandal of Empathy in Lipps in A Rumor of Empathy: Rewriting Empathy in the Context of Philosophy: pp. 53 – 65: DOI: 10.1057/978113746534.0007.)

 A third incompleteness is the role of empathy in psychoanalysis proper, which was perhaps a wilderness too desolate to reward proper scholarly engagement. Lanzoni notes: “There were also handful of psychoanalysts, trained, not surprisingly, in Vienna, who ventured to explain empathy to a popular audience. Analyst and writer Theodor Reik published Listening with the Third Ear in 1948 [….] Empathy worked like wireless telegraphy to allow one to tune in to the inchoate messages of another’s unconscious” (p. 208). Empathy as receptivity andbroadcast of messages. However, Reik was not a medical doctor, and the American Psychoanalytic Association declined to validate his credentials, leaving him as yet another voice crying in the wilderness.

 Lanzoni gives Kohut another “shout out,” noting that empathy was an observational act that led the analyst to a scientific appraisal of the other person rather than one of the “sentimentalizing perversions of psychotherapy” (p. 207). Of course, Kohut moved steadily in the direction of asserting that empathy itself could be curative, though, in contrast to Rogers, mainly in a process of optimal breakdown, being ruptured and restored. Empathy breaks down, the attuned therapist acknowledges and cleans up the misunderstanding, empathy is restored, psychic (personality) structure is shifted and strengthened – thenthe patient gets better.

 A fourth incompleteness is the missing paradigm of empathy as translation between different individuals and the worlds in which the individuals inhabit. Once again, this is not a criticism of Lanzoni, but simply to note that, substantial though Lanzoni’s contribution is, there is more work still to be done.

 Herder was working on a complex interpretive problem of empathy, creating an entire world in all its contingencies and details in order adequately to translate a text from attic Greek into German or understand a work of art in its ancient context. Herder’s project envisions no trivial translation, and, if anything, is an application of empathy broader and bolder than what is being proposed here or in any reconstruction of Kant. According to Herder, in order to deliver an adequate translation, the translator must think and feel himself into – empathize into [sichhineinfühlen] – the world of the author or historical figure. The translator is transformed into a Hebrew, e.g., Moses, among Hebrews, a poet among bards, in order to “feel with” and “feel around” the world of the text (e.g., Herder as cited in Sauder 2009: 319):

 Feeling is the first, the most profound, and almost the only sense of mankind; the source of most of our concepts and sensations; the true, and the first, organ of the soul for gathering representations from outside it . . . . The soul feels itself into the world [sichhineinfühlen] (1768/69: VIII: 104 (Studien und Entwürfe zur Plastik)) (cited in Morton 2006: 147-148).

 Thinking from the point of view of everyone else is not to be confused with empathy in the Romantic idea of empathy where empathy is a truncated caricature of itself and summarily dismissed as merger, projection, or mystical pan-psychism. Nor is it clear that Herder, always the sophisticated student of hermeneutics, ever envisioned such a caricature of empathy. In any case, empathy is not restricted to the limitations of a Romantic misunderstanding of empathy as merger. Empathy as creating a context within which a translation – an empathic response – can occur stands on its own as an undeveloped paradigm (see also Agosta 2014: 36–37 (from which this text is quoted)).

 Among the many strengths of Lanzoni’s book is her engagement with the many women researchers and scholars who contributed to the history of empathy: Violet Paget (Vernon Lee), who was there at the beginning with the physiological, mirroring effect of empathy in inner imitation; Edith Stein, research assistant (along with Martin Heidegger) to Edmund Husserl and her dissertation The Problem of Empathy (1917), which was influenced by and, in turn, informed Husserl’s ambivalence about making Einfühlung the foundation of intersubjectivity (community); Jessie Taft, who developed an entire model of psychotherapy, relational therapy, combining element of G. H. Mead’s social behaviorism and Otto Rank’s psychoanalytically informed approach to the emotions, which, in turn, decisively influenced Carl Rogers. A rumor of empathy is no rumor in Susan Lanzoni’s Empathy: A History. She makes empathy palpably present, and empathy lives in the work she is doing. All this and more does Lanzoni truly deliver.

 References and Further Reading

 Jean Decety (ed.). (2012).  Empathy From Bench to Bedside(2012). Cambridge, MA: MIT Press.

 Jean Decety and P.L. Jackson. (2004). “The functional architecture of human empathy,” Behavioral and Cognitive Neuroscience Reviews, Vol 3, No. 2, June 2004: 71-100.

Sigmund Freud. (1913). “Further recommendations: On beginning the treatment.” Standard Edition, Volume 12: 121-144.

Victorio Gallese. (2001). “The shared manifold hypothesis: embodied simulation and its role in empathy and social cognition.” In Empathy and Mental Illness, T. Farrow and P. Woodruff (eds.), Cambridge, UK: Cambridge University Press, 2007: 448-472.

Edmund Husserl. (1905/20). Zur Phänomenologie der Intersubjectivität: Texte aus dem Nachlass: Erster Teil: 1905-1920,I. Kern (ed.). HusserlianaXIII. The Hague: Martinus Nijhoff, 1973.

 ______________. (1913). Ideas: General Introduction to Pure Phenomenology, tr. W. R. Boyce Gibson. New York: Collier Books, 1972.

 _____________. (1918). Ideas Pertaining to a Pure Phenomenological Philosophy: Second Book, tr. R. Rojcewicz and A. Schuwer. Dordrecht: Kluwer Academic Publishers, 1989.

 ______________. (1921/28).  Zur Phänomenologie der Intersubjectivität: Texte aus dem Nachlass: Zweiter Teil: 1921-1928I. Kern (ed.). HusserlianaXIV. The Hague: Martinus Nijhoff, 1973.

 ______________. (1929/31). Cartesian Meditations, tr. D. Cairns. Hague: Nijhoff, 1970.

 _____________. (1929/35).Zur Phänomenologie der Intersubjectivität: Texte aus dem Nachlass: Dritter Teil: 1929-1935, I. Kern (ed.). HusserlianaXV. The Hague: Martinus Nijhoff, 1973. 

 Marco Iacoboni. (2007). “Existential empathy: the intimacy of self and other.” In Empathy and Mental Illness, Tom Farrow and Peter Woodruff (eds.), Cambridge, UK: Cambridge University Press, 2007: 310-21.

L. Jackson, A. N. Meltzoff, and J. Decety. (2005). “How do we perceive the pain of others? A window into the neural processes involved in empathy,” Neuroimage24 (2005): 771-779.

G. Jung. (1921). Psychological Types, tr. R. F. C. Hull. Princeton: Princeton University Press, 1971.

Susan Lanzoni. (2012). “Empathy in translation: Movement and image in the psychology laboratory,” Science in Context, vol. 25, 03 (September 2012): 301-327.

Vernon Lee [Violet Paget]. (1912). Beauty and Ugliness and Other Studies in Psychological Aesthetics. New York: John Lane, Co.

 Theodor Lipps. (1883). Grundtatsachen des Seelenlebens. Bonn: Verlag des Max Cohen und Sohns.

 _____________. (1897). “Der Begriff der Unbewussten in der Psychologie.” In Dritter internationaler Congress für Psychologie in München vom 4. bis 7 August 1896. München Verlag von J.F. Lehmann, 1897: 146-163.

 _____________. (1909). Leitfaden der Psychologie. Leipzig: Wilhelm Engelman Verlag.

 _____________. (1903). Aesthetik. Volume I. Hamburg: Leopold Voss.

 Lou Agosta. (2014). “From a Rumor of Empathy to a Scandal of Empathy in Lipps in A Rumor of Empathy: Rewriting Empathy in the Context of Philosophy: pp. 53 – 65: DOI: 10.1057/978113746534.0007.

 ____________. (2014). A Rumor of Empathy: Rewriting Empathy in the Context of Philosophy. New York: Palgrave Pivot.

Elizabeth Lunbeck. (2011). “Empathy as a Psychoanalytic Mode of Observation: Between Sentiment and Science,” in Histories of Scientific Observation, ed. Lorraine Daston and E. Lunbeck. Chicago: University of Chicago Press.

George H. Mead. (1922). “A Behavioristic account of the significant symbol,” Journal of Philosophy, 19 (1922): 157-63.

 Michael Morton. (2006). ‪Herder and the Poetics of Thought: Unity and Diversity in On Diligence in Several Learned Languages. London and University Park: Penn State University Press.

Lou Agosta, PhD and the Chicago Empathy Project

 

 

 

 

 

Poverty is bad for your health: Review of Ansell’s The Death Gap: How Inequality Kills

Poverty is bad for your health.  Inequality causes poverty. In turn, poverty causes illness and death. Therefore, inequality kills. The evidence is extensive. The data is compelling. The logic is impeccable. But is this not just correlation, not causation?

A causal account comes into view. When the evidence is vast and deep enough, we can

The Death Gap: How Inequality Kills

The Death Gap: How Inequality Kills

connect the dots between the correlated items – in this case, poverty, inequality, and bad healthcare outcomes (i.e., death) – and provide a causal account.

While it remains true that correlation is not causation, a flood of evidence is available – and overwhelming: The high correlation between poverty and ill health points to numerous causes intimately related to low socioeconomic standing, being poor.  For example, poverty is stressful. Extremely stressful: “People who are exposed to constant high levels of stress do have biological reactions that can shorten their lives [….] [E]xposure to chronic environmental stress causes biological changes within the body that predispose individuals to develop premature disease” (pp. 66 – 67).

For instance, a person at risk for Type II Diabetes benefits from regular exercise and a balanced, healthy diet, high in protein, fruits, vegetables, and low in “bad fat.” Living in a high crime zip code likely also means they live in a “food desert.” Not only is there no Whole Foods or other high-end grocer available but “convenience stores” are long on junk foods and short on fruits and vegetables. When someone gets hungry, unhealthy calories are a likely outcome – nothing wrong with a Twinkie once in a while, but there is a reason the term “junk food” was invented. The person cannot go out for a vigorous, healthy walk because that results assault by local criminals. This is not a problem that can be fixed by the good advice of a medical doctor in an office visit, beneficial though that advice may be. It requires social change and a confrontation with values that privilege profit and cost reduction over people and their well-being.

This leads the author, David Ansell, MD, to a key distinction, which is itself controversial and unavoidable: structural violence. “It is the cumulative impact of laws and social and economic policies and practices that render some Americans less able to access resources and opportunities than others. This inequality of advantage is not a result of the individual’s personal abilities but is built into the systems that govern society” (p. 8).

Ansell gives a powerful example of one of his patient’s, Windora, who eventually suffers but survives a life-changing stroke that costs her the ability to speak. Ansell becomes her voice in this work.

Windora has a “good job” in the school system but not one that pays enough for her to move out of her impoverished zip code. She has hypertension and would benefit from a vigorous walk everyday, but she can’t go out because the neighbor is unsafe. Joining a gym is too expensive, and there is no YMCA within miles. She would benefit from a healthy diet of fruits and vegetables, but she lives in a food desert with a lot of convenience stores selling junk foods. A double bind? Blame the victim? After a certain point, no amount of personal initiative can overcome the obstacles. But a rental voucher might help.

Part of the “back story” for creating areas of overwhelming poverty, educational disadvantage, and social stress were “racially restricted covenants” in real estate. Even after the US Supreme Court outlawed such real estate deeds in 1947, billions of dollars continued to be spent in building public housing in or near impoverished areas. This virtually guaranteed segregated housing, resulting in de facto segregation in schools, and the resulting loss of upwardly mobile educational opportunities for (mostly) black or underprivileged children. The cycle continues. The examples of stable integrated neighborhoods such as Oak Park or stable black communities such as Chatham were overwhelmed by the unethical, fear inspiring but profitable practices of “block busting,” based on distorted, negative racial stereotypes. (For details on the back-story here see Polikoff’s Waiting for Gautreaux: A Story of Segregation, Housing, and the Black Ghetto (2).)

The media share responsibility for perpetuating stereotypes. In the wake of Hurricane Katrina, white people wading through chest high water, carrying groceries from abandoned food stores are described as survivors “finding” the food they needed in order not to starve whereas people of color doing exactly the same thing with the same bags in the same chest high flood waters are described as “looters” (p. 87). Hmmm.

In addition to structural violence, there is actual violence. Ansell writes: “Between 2007 and 2012, Chicago police shot over four hundred people. There were seventy police fatalities during that period, the most in the nation. Between 2004 and 2014, the cash-strapped city dished out $662 million in police brutality settlements” (p. 164).

Ansell imagines all the good things that could be done with that money for school and health-care. I would add to the list: expanded police training. I do not mean target practice or armored cars. I mean training in conflict de-escalation, community relations, courtesy and conversation. Just because deadly force can be used, does not mean it must be used. Empathy is distinct from compassion (though the world needs more of each). Empathy is a method of data sampling, telling a person what the other person is experiencing. In a police context, this would include whether the other is afraid or angry and, most importantly, is at risk of escalating to an aggressive response. No guarantees, but the widows and orphans of fallen heroes are looking for alternatives to shoot first and ask questions later (my phrase, not Ansell’s).

Meanwhile, Dr Ansell’s recommendation to fellow doctors? A bold statement of the obvious: Follow the Hippocratic oath (Ansell cites the modern version called “the Declaration of Geneva, Physicians Oath”). This action may be more confronting and difficult than most physicians imagine. The language about “consecrating one’s life to the service of humanity” and the first consideration being the health of one’s patients is the critical path. This extends beyond the walls of the office or hospital to personal advocacy.

For example, Ansell cites Paul Farmer reporting that when patients living in poverty took their tuberculosis medication, they got better, but they also got very hungry. The TB actually eliminated their hunger. They were too sick to feel hungry – a well disguised “blessing” indeed – so they stopped taking the medication because they were overwhelmed with hunger. The solution was not to call the patient’s “stupid” for not complying with their doctor’s orders. Once food was delivered with the medications, the patients became adherent with the treatment regime. Is the doctor then responsible to feed the hungry? Well, he who wills the end (health) wills the indispensably necessary means to the end (food + TB medicine). 

Ansell makes a powerful case that any doctor refusing to treat a patient who presents with symptoms is violating the Hippocratic oath. Health care is an inalienable human right, along side life, liberty, and the pursuit of happiness (except that it has been alienated to enable monopoly rents to insurance companies, Big Pharma, and the corporate transformation of American medicine). “Health care” is a component of the “life” part of the enumeration of rights with which the Declaration begins.

However, the point is not to force an outcome. No one can force anyone to do something that they do not want to do. (For detailed background on the role of profit in the bio-psychiatry of major mental disorders and “Big Pharma” (a once devaluing term that is now accepted), a vexing trend that Ansell does not engage, see Robert Whitaker (3).)

The point is not to force doctors to make excuses for not treating the poor, which risks impacting the doctors’ livelihood and revenue model. The point is advocacy: to mobilize doctors to take on a system that treats health care as an economic transaction. The point is to mobilize doctors to push back against a system that rations scare resources such that the system, in spite of complex algorithms to determine fairness (see The National Organ Transplant Act (1984)), frequently results in the transplants being allocated to middle-aged white males. It is a disturbing statistic that the poor and people of color are frequently the organ donors while rarely being the recipient of life-saving transplants. Once again, there is something very wrong with this picture.

I hasten to add that Ansell reports a compelling example of community activism resulting in Illinois enacting legislation allowing the undocumented to receive kidney transplants and lifetime medications with State financial support “in part because we listened and tried to help” (pp. 107, 108). 

Now I have read Ansell’s book cover-to-cover, including the extensive footnotes as well as the back cover. The one, flat out error I have found is on the back cover. Contra to the back cover, nowhere does Dr Ansell write “Inequality is a disease” or that it must be treated as a disease.

Ansell does indeed argue at length that inequality causes poverty and that poverty and inequality (and a host of related social injustices) set off a sequence of events that, like the falling dominoes, create a death gap, causing poor people, especially people of color, to die prematurely. For example, carbon monoxide can kill you, too, but carbon monoxide is not a disease (my example, not Ansell’s). It is a substance that the human beings cannot process. It is inimical to life. An environment of poverty is like carbon monoxide for the human body and soul. It chokes the life out of the person, albeit slowly, preventing binding with life-giving resources that the person needs to survive and flourish.

As noted, neither poverty, starvation, arsenic, lead, nor similar phenomena are diseases. Structural violence is not a disease; it creates a negative clearing for disease in the context of social injustice.

Contra the back cover, Ansell’s point is precisely that no medical treatment in itself will cure poverty, prevent the resulting fatalities, or undo the death gap. Reducing and eliminating the death gap requires advocacy: structural reforms and political engagement to combat structural violence. It requires honoring one’s commitment to social justice in the community. It requires a redistribution of sometimes scare resources – health care, education, jobs, law enforcement – from the wealthiest and most privileged on the Gold Coast a couple of miles west and south to neighbor whose numbers read like they were from the third world. It seems the editors of the back cover were blinded by privilege, too.   

Ansell has recommendations. Practical proposals are forthcoming: “[Concentrated reinvestment in impoverished communities] will require a redistribution of wealth through taxation from the affluent back to the poor in the form of living wages, access to higher education, health care, and safe housing” (p. 54). “These structural reforms could take many forms, from tax and job policy to the ending of mass incarceration. From the perspective of health reform, the adoption of a single-payer health care system is the only way to create equity in health care. Single-payer health care will be vigorously opposed by the profit-driven private health insurers and by those who will insist it is too costly or not feasible” (p. 182). Speaking personally, I am at a loss as to why certain politicians and parties seem unwilling for people to get health insurance and health care at a cost that also enables them to pay rent, eat, and so on.

One final thought. Today evidence-based medicine is the dominant paradigm and with good reason. Evidence is superior to guess work. In peer-reviewed article after article we can read about a 3% improvement of one pharmacological, procedure, or laparoscopic intervention versus another. Well and good. Empathy and compassion are in short supply in the world, and, in any case, are not enough. Leadership is also required, and Ansell provides that here.

If this book, Ansell’s work, dense with evidence, data, facts and figures that support the subtitle (“Inequality Kills”), does not become the conscience of the medical community and a blue print for transformation and reform, then not only am I a monkey’s uncle, but the collective blind spot of the medical community is the size of the dark side of the moon.

We end where Ansell ‘s book begins. Ansell’s opening quote from Martin Luther King is as true today as it was in 1964: “History will have to record that the great tragedy of this period of social transition was not the strident clamor of the bad people, but the appalling silence of the good people” (p. vii). This book is addressed to the good people. Drop what you are doing and get the book: read it, honor your commitments, follow the recommendations.

References

(1) David A. Ansell, MD, (2017), The Death Gap: How Inequality Kills. Chicago: The University of Chicago Press.

(2) Alexander Polikoff, (2006), Waiting for Gautreaux: A Story of Segregation, Housing, and the Black Ghetto. Evanston, IL: Northwestern University Press.

(3) Robert Whitaker, (2010), Anatomy of an Epidemic. New York: Broadway Paperbacks (Random House).

(c) Lou Agosta, PhD and the Chicago Empathy Project