Detachment and empathy

I thought Luke Austen’s article¹ was very impressive, not least because its author is still an undergraduate; that is, still at the stage of having his head crammed with facts. It prompted recollection of TS Eliot’s lines from ‘The Rock’:

‘Where is the wisdom we have lost in knowledge?

Where is the knowledge we have lost in information?’²

Sooner or later — and it’s often while at medical school — all doctors experience situations that are unforgettably shocking or traumatic. Many of us respond self-protectively by detaching our human responses in order to cope. It’s as if a switch is thrown, disconnecting our clinical skills from our emotional intelligence. (In my recent book The Inner Physician I call it ‘Crichton’s switch’.)³ And in some of us that switch never gets reversed.

Austen suggests there needs to be a balance between empathy and detachment. But I think it’s a bit more complicated than that. There are some clinical situations where hard-nosed clinical skill is all that is required, and others where the very best we can offer is our ability to understand and to empathise. The novelist EM Forster I think gets closer when (in a different context) he writes, ‘The businessman who assumes that this life is everything, and the mystic who asserts that it is nothing, fail to hit the truth. No; truth, being alive, was not halfway between anything. It was only to be found by continuous excursions into either realm.’ ⁴

In other words, Crichton’s switch is a toggle switch, with no midway position; it alternates between being on and off. The professional skill, if there is one, is to be in control of it, able to engage or disengage our empathy according to clinical circumstances.