The Empathy Exams: Essays by Leslie Jamison is a collection of nonfiction essays that are connected thematically by pain and caring. Jamison uses a combination of personal experiences and journalistic approaches to ponder essential questions about both physical and emotional wounds, tenderness, and how people connect through pain. First published in April 2014, this collection premiered at #11 on the New York Times bestseller list and has received considerable acclaim from reviewers across the world. The Empathy Exams: Essays was a finalist for the ABA Indies Choice Awards and the PEN/Diamonstein-Spielvogel Award for the Art of the Essay.

This guide uses the first edition of the text. Please be advised that this text contains discussion of mortality, physical and mental illness, injury, abortion, race, sexual assault, sex work, violence, addiction, and self-harm.

Summary

The first and titular essay, “The Empathy Exams,” describes Jamison’s job as a medical actor. She pretends to be a patient so medical students can be assessed on their ability to display empathy. Jamison’s usual script is for a woman named Stephanie Phillips, whose grief makes her experience seizures. Jamison, after describing the different types of medical students, then transitions to talking about her own medical history. She focuses on two procedures. The first is an abortion and the second is a heart procedure to solve an electrical problem in her heart. Jamison compares the two procedures, from the people who administer them to their ultimate results. The abortion is successful while the heart operation is not. Jamison writes a “script” for herself receiving her abortion and heart procedure. In it, she explores her craving for understanding from her partner and simultaneous desire for him to admit he will never understand what she is going through.

In “Devil’s Bait,” Jamison visits the annual conference for Morgellons disease, a condition that manifests as sores, the sensation of bugs crawling under the skin, and the appearance of fibers and other foreign substances protruding from the flesh. Jamison introduces several people at the conference including Kendra, a young woman who is first beginning to show symptoms, and Paul, who first exhibited signs of the condition after a fishing trip. Jamison outlines both the patient perspective and the medical one, where doctors disbelieve the condition and think it to be a form of psychosis. Jamison is briefly concerned for her own body, having moments where she believes something to be growing out of her skin before she comforts herself. She also draws connections to a botfly larva she once found in her ankle. At the summation of the conference, Jamison concludes she does not believe that Morgellons is a real disease, but she believes the patients are experiencing pain and wishes they are able to heal.

In the third essay, “La Frontera,” Jamison travels to Mexico to participate in a writers’ conference. She first visits Tijuana, where past violence and threats of violence have driven away all the tourists who once provided income for the town. Now, many bars and hotels have been closed, and the citizens try to sell merchandise where no one is there to buy. She meets with two other conference attendants, and they leave the town, at which point Jamison becomes fascinated with talking about it. On the way to Mexicali, they pass a car crash and a soldier defending used tires with a gun. Jamison is introduced to the other writers and literary workers of the workshop and gets an education in local politics, where she tries not to talk because she doesn’t want to get things wrong. One poet in particular, Marco, tells Jamison about his experiences with gunfire and grenades on the streets. He escorts Jamison and another writer to the US-Mexican border, where they pass into Calexico. Their group is treated with distrust and Marco shares with Jamison the stories of people who are unable to cross.

“Morphology of the Hit” is written in functions, broken up using Vladimir Propp’s folklore theories. Jamison moves to Nicaragua to teach Spanish to children, where she tries to blend in and distinguish herself as not a tourist. She wants to act in a way that is brave and so walks home alone at night, where a man mugs her and punches her in the face hard enough to break her nose. She goes to a favorite bar where she drinks beer and ices her nose. When the police arrive, they bring a suspect who is not the man who assaulted her. She later goes to the police station, where between mug shots and face-profiling software she is unable to find the man who hurt her. Back in the United States, she sees a surgeon who fixes her nose, leaving a small scar that she notices when she looks for it. Jamison struggles to tell the story because it seems so senseless and without structure.

“Pain Tours (I)” is told through the second-person perspective and begins with La Plata Perdida, a famous silver mine in Bolivia. There, tourists purchase tickets to see the silver mines. Before they enter they buy gifts for the miners, then descend into the dark, dusty caves. The miners accept their gifts, but Jamison informs the viewer that most of them will not live past 40 and that the silver mine has caused many deaths. When the tourists emerge, they are covered in black dust. In the second portion of this essay, the reader is given a description of the television show Intervention, where people with addictions are given ultimatums about their behaviors. She describes Andrea, who has an alcohol addiction and started drinking after the sexual assault that occurred when she was in her teens. Jamison inspects the form of the show, which is framed as a “once in a lifetime” opportunity for the subjects but repeats each week for the viewer. The final tour is of the gang-filled neighborhoods of Los Angeles, where a man named Alfred runs a tour of notable landmarks. At each landmark, Jamison shares knowledge and descriptions with the reader, including a street filled with bail bond salesmen and walls covered in graffiti. Jamison lingers on the uncomfortable nature of being a person of privilege in an area where, for many, violence is the only option. Her discomfort turns into resolve to use that sensation to continue listening to difficult stories, learning, and becoming better as a result.

In “The Immortal Horizon,” Jamison accompanies her brother to the Barkley Marathons, a 100-mile run through intensely difficult terrain organized by a man who calls himself Lazarus. Jamison provides snapshots of the runners and their support teams, then discusses the difficult terrain, race history, and the mental and physical challenges faced by the runners. At the end of the essay, an unexpected runner emerges as the victor, further highlighting the unpredictability of the race.

“In Defense of Saccharin(e)” stands as one of the collection’s most overtly argumentative pieces. In it, Jamison makes a connection between artificial sweetener and sentimentality. She discusses historical and philosophical perspectives of sentimentality as well as the discovery and subsequent acceptance of artificial sweetener. In doing so, she explores her own relationship to artificial sweeteners and emotions, highlighting her resistance to being labeled overly emotional. Jamison emphasizes that emotions are not necessarily tied to a moral alignment and that melodrama serves a very real purpose.

“Fog Count” sees Jamison returning to a character from “The Immortal Horizon,” a man named Charlie who is in prison for mortgage fraud. Jamison begins by exploring their pen-pal friendship and eventually visits him where he is being held in a correctional facility. Through Charlie, Jamison explores the concept of restricted movement, particularly for a man who spent so much of his life free and running. This broadens into a wider exploration of the American prison system and its wounding tendencies.

In the second of Jamison’s two “Pain Tours” essays, she begins by discussing artist Frida Kahlo’s painted corsets. She uses this as a jumping off point to discuss the artist’s journals, her ex-votos, her passionate relationship with her husband, and the betrayal of her own body. Jamison then brings the reader to a Bolivian supermarket where, in the middle of political protests, people can purchase imported goods. The supermarket becomes a representation of desire and access, promising luxuries despite current deprivation. Jamison then discusses the work of James Agee, a journalist turned novelist, who wrote about the conditions of sharecroppers in the deep south. Agee writes with raw emotion and guilt that Jamison connects with, comparing it to her own experiences teaching Spanish in Nicaragua where her nose was broken by an assailant.

In her penultimate essay “Lost Boys,” Jamison discusses the documentary trilogy Paradise Lost, which follows the trial of Jessie Misskelley Jr., Jason Baldwin, and Damien Echols for the murders of Stephen Branch, Christopher Byers, and Michael Moore. She contrasts scenes from the documentary with the emotions they evoke in herself, tracking the progress of time with changes in the subjects as well as her own perceptions. In doing so, Jamison analyzes the ways in which perspective shapes someone’s development of empathy.

Her final essay is titled “Grand Unified Theory of Female Suffering,” and it is an argumentative piece on the perceptions of pain experienced by women. She frames the essay around wounds and interludes, each of which presents a different specific pain experienced by a woman who has influenced Jamison’s life. Sometimes it is her own pain, sometimes the pain of her friends, and sometimes the pain of other writers. Jamison challenges the perceptions of female pain that have been perpetuated by society and media. In doing so, she highlights the importance of female pain, highlighting that each pain is unique to the individual and resists cliché.