Thoughts on the profession

The Problem of Empathy

Mr. Morgan* appeared on the dementia unit early in the week.  He was tall — well over 6-foot-2 — towering over the other residents and all the staff, including me.  Although his voice was tinged by his own fear and confusion, when he spoke we could all tell he was a man used to being listened to and obeyed.  It clearly baffled him that we not only did not jump to his command, but that he could not seem to express that command in the first place. 

Mr. Morgan was generally easy to work with, however.  He never seemed joyful or giddy, but neither did he rail and fight against his own decline, or become seized with grief he could only express in rage, as his fellow residents sometimes did.  This made it all the more strange when I found him one afternoon, pushing his walker down the hallway like Sisyphus with the stone, his heavy brows lowered down onto his eyelids.  I walked with him a few steps, and when we reached  the end of the hallway — the end of the world for the residents of the dementia unit — I asked him where he needed to go. 

“I need to go home,” he said, looking at me with his heavy face.

I had only been a Life Enrichment Assistant for a few months at that point, but I felt all the confidence of my ignorance, so I tried to use some approaches I read about.  Redirect.  Inhabit his world.  Find the truth, the true emotion behind the words.  “What is at home?”  I said.

He looked at me like I was the biggest idiot he had ever met.  “My home,”  he said, “It’s my home.” 

At this point, he was beginning to tire, so I directed him to a couple of chairs and persuaded him to sit and rest for a minute.  I asked him, “Why do you need to get home?”

His face worked for a moment before he blurted  out, “I need to get home to beat my wife!”

I don’t know how I didn’t run away in disgust or tell him exactly what I thought of cowards who hit their loved ones.  I don’t know how — but I sat silent with him for a few minutes.  Somehow, getting this sentence out calmed him.  Or perhaps he was finally physically exhausted from all the walking.  Either way, I was able to refocus his attention on lunch, which was being delivered right then.  He joined the rest of the residents in the dining room, and passed a generally quiet rest of the day.

In the moment of this experience, I remembered some of the best advice ever given to me about working with people who are in cognitive decline.  One of the family members of a resident said to me, “Do not have sympathy.  Sympathy paralyzes you and you just get stuck pitying someone.  What you need is empathy.  When you have empathy, you can feel what a person needs and you can do something about it.”  This advice helped me every day of the job. 

But what do you do when your empathy tells you that what a person thinks they need is something awful?  This became the problem of empathy for me.  The first layer of understanding someone can take you to something unpleasant, dark or troubling.  It was learning to get to the next layer, down the the reptilian kernel of need, that was the problem.  What I eventually got to with Mr.  Morgan was that he needed familiarity, he needed the security of his routine and, however twisted that connection was, he needed the connection with his wife.  That was a need I could work with.  The truth, though, is that I was always on my guard around him after that — especially when I spoke with his wife and learned that he did used to hit her. 

I have chosen a profession where I am in frequent, close contact with people — often people in the midst of suffering.  Most of the time it is rewarding and energizing to meet someone where they are and make a small difference in their experience of life.  There are people, though, who challenge me to the core.  Mr. Morgan was only the first.  With each new one that I meet, I realize how much I have still to learn about empathy, and about myself.

*–names and other identifying information have been changed.

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