ULTIMATE EMPATHY

I’m a doctor with a rare neurological condition: I can literally feel your pain

What if we lived in a world where the full force of empathy was not a choice, but an automatic physiological state?

I work as a neurologist—a medical profession where empathy is paramount in order for us to be able to treat patients adequately. But unfortunately, this isn’t always what happens. Doctors are burdened by systemic time and administrative constraints, which creates a challenging environment for them to stop and deeply consider the emotions of those around them. In order to cope with the demands of the job and meet minimum requirements for patient-doctor rapport, physicians are often encouraged to adopt a form of professional warmth that has an almost theatrical quality—but the scent of detachment is unmistakable. In most cases, this is ultimately a disservice to our patients.

For me, however, empathy occurs in an unusual way in my brain. What if I told you that crossing that empathetic threshold could happen involuntarily—like a knee-jerk reflex for extreme empathy? Or that it’s possible to instantly recognize yourself in someone else, without even trying? Empathy begins with a willingness to try and understand, and then perhaps feel, what it’s like to be in another person’s shoes. This is especially challenging when you don’t relate with the person in front of you or have little to no shared experiences.

But not for me: I literally feel others’ pain. I am a polysynesthete, which is a person with multiple forms of synesthesia. Through mirror-touch synesthesia, one of the synesthetic forms I have, my body physically feels the experiences I see others have—both the uncomfortable and the pleasurable. Triggered automatically by sight, I feel a “mirrored touch” on parts of my body that correspond visually to whom I’m looking at face-to-face—your left, my right, your right, my left—like in a mirror.

 Through mirror-touch synesthesia, my body physically feels the experiences I see others have—both the uncomfortable and the pleasurable. This means that I inhabit the bodily experiences of everyone around me all day, every day. For example, walking through the hospital’s revolving door, I see an elderly woman in a wheelchair. She’s dressed in a worn tweed coat and a burgundy knit hat covering a nest of gray hair. I feel the sensation of vinyl pressing against the back of my thighs and the snug fit of the hat around my forehead. I feel the movement of her eyes and eyebrows as she looks through the glass doors before resting her gaze back down at the ground. A volunteer is holding the wheelchair’s handles with his hip jutted out. I feel the phantom contraction of muscles in my left hip, his glasses sitting invisibly on the bridge of my nose. Passing by the security guard at the welcome desk, I raise my ID badge: I feel his coiled plastic earpiece tucked around my left ear and the weight of his wool suit on my arms and shoulders.

My mirror touch often serves me well, professionally.

Recently, during one of my rounds, I was consulted to see a young woman who had started acting combative. Born with cerebral palsy, she could not speak. She had been admitted for diarrhea a few days earlier, but on the day of my consult she suddenly awoke agitated. She was restless, attempting to climb out of the bed and swinging at her nurses and nurse’s aides. The primary medical team caring for her wanted me to recommend a medication to calm her down.

It was easy to find her room. I followed the sound of moans and screeches echoing in the hallway. She had kicked her blankets off and was tugging at her bedrail, rattling the bed with each forceful heave. Sweaty strands of dark mahogany hair stuck to the sides of her face. I stepped in to perform a neurologic exam, careful to avoid her clawing. As I proceeded with the standard exam maneuvers to test her level of arousal and attention, my body mirrored her movements—her beads of sweat, her furrowed brow and grimace. This was a normal experience for me, but I noticed an unusual feeling in my chest that I couldn’t shake. My chest felt as though it was rising and falling much faster than my own body’s respiratory rate. I was having a hard time keeping up with my body’s mirrored sensations.

 Even though she couldn’t speak, her body was letting me know that there was more here than just “routine” hospital-induced delirium. These phantom movements in my chest accompanied another subtle—almost negligible—feeling. I felt the reflected sensation of my shoulder muscles contracting with each mirrored rise and fall in quick succession. I focused on the movements in her body, trying to determine what was wrong, then I checked her vitals to see if anything else was abnormal. Her body temperature hovered just below a low-grade fever. Her heart rate was elevated. But I wasn’t convinced that this was related to her agitation. On their own, her vitals couldn’t explain her discomfort. Even though she couldn’t speak, her body was letting me know that there was more here than just “routine” hospital-induced delirium. I had to trust my body, my mirror-touch synesthesia. I recommended a special CT scan of her chest to get a closer look.

Not long after, her study results came back. They revealed blood clots in her lungs. She wasn’t acting combative out of anger or delirium. She was literally fighting for air. Without my mirror touch, I would have likely missed it.

With mirror touch, my decision to work toward empathy is automatic, compulsory. Though it doesn’t reveal itself in full, it does offer the potential for a more fully realized empathy.

Existing in a neurologic replica of another’s sensory perceptions is as close as I can get to literally putting myself “in the other person’s shoes.” It is then up to me to walk the mile in front of me. In other words, if empathy is a person’s capacity to understand and feel the experiences of another person from their perspective, then mirror touch represents a persistent heightened state of empathy, the potential for a more fully realized form of empathy.

It is up to me to reason through that experience so that I can then respond to my patients from a truer, more enduring place of compassion and kindness. Or, I can respond with whatever else is needed: Sometimes that means prescribing a medication, though often it’s as simple as asking more questions—being curious about where another human being is coming from, and wondering why they might think, feel, or do what they do.

 It is up to me to reason so I can respond to my patients from a truer, more enduring place of compassion and kindness. Rare or unexpected situations make it almost impossible to differentiate between objective physical reality and my own internal subjective reality. In the hospital, while I examine a condition or perform a procedure for the first time, the likelihood of experiencing the sensation or pain as if it were actually occurring to me is increased significantly.

During my neurology training, as I began to see patients with Tourette’s syndrome and tic disorders, I distinctly recall one patient who in the setting of significant stress developed new self-mutilating tics. He would chew on the insides of his mouth and push the corners of his lips with his knuckles so hard that his cheeks split apart like shredded beef. Watching him chew on the flesh of the right side of his face while grinding his teeth with all his force, I felt a painful buzzing run through the left side of my face and mouth that was so vivid that it bordered on hallucination. It was as if a stun gun were pressed against my face and triggered with each of his tics. The more forcefully he pushed, the more vivid the pain. The mirror-touch sensations are constant. But in these instances, they pierce through my ability to filter, invading my perception of reality.

My trait can blur the boundaries between myself and those around me to the point that I can become inextricably entangled in others—their emotions, their needs—at the expense of losing myself in other people. For as far back as I can remember, information has constantly poured through my mind. Creating a mental filter for the sake of self-preservation may sound simple, but it is a dangerous means of survival. Filter too much and I risk numbing my senses completely and, as a consequence, forfeiting my humanity, my ability to feel and to empathize. Filter too little and I risk submerging myself too deeply in another person, drowning in my own senses and losing all sanity, all sense of myself.

Each person employs his or her own collection of remembered and experienced perceptions, his or her own set of lenses through which to view his or her external and internal worlds. Perhaps this is what makes empathy so challenging—and so compelling. At its core, empathy seems to require an initial spark of desire to switch perspectives, to generously give another person’s experience enough worth so that we’re not only willing but also yearn to see and live the world through that person’s perspective.

Mirror touch has been a harsh, but just, teacher. Since childhood, my trait has required an almost monastic dedication on my part to the physical and mental labor of slowing down or filtering out the tides of sensory information while preserving my dauntless, bloodied pursuit of curiosity. Through my trait’s many humbling and unexpected lessons, I’ve cultivated a greater awareness of our shared humanity, a deeper understanding of other people, and a truer sense of where we all begin and where we all end.

Adapted from Mirror Touch: Notes from a Doctor Who Can Feel Your Pain, by Joel Salinas, M.D. , Copyright © 2017, Published by HarperOne.

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