How to build empathy: musings about police training and medicine

Last month, a youngish man of Asian descent got onto Muni (the SF train system) a few stops after me. He had shoulder-length hair, square thick-rimmed glasses, and wore a bright red suit. I guessed from his trendy attire that he was an art student and went back to my podcast without giving it further thought. I was used to seeing much weirder people in San Francisco

Then he started talking, loudly, to the entire car. At first I thought it was performance art–he spoke with a staccato rhythm that sounded like spoken word, and he was talking about being at a UC school and the Asian minority experience. But then he lost the rhythm and stopped being coherent. He was raving madly and getting angry and standing way too close to me for comfort.

All I could think to do was inch away and avoid eye-contact, because I have learned, as an adult and especially as a woman, to not engage because it can kill you.

A burlier, older white man standing on the other side of me started talking to him. “Are you doing okay?” he asked in a calm therapist’s voice. “You’re saying that you feel ignored. Is that right?”

“Yeah,” the guy said, sounding surprised that anyone was responding to him. “[insert more raving that I couldn’t quite understand]”

“It sounds like you’re having a rough experience.”

I was flashing back to my peer counseling training in high school and college, except this was a much crazier circumstance. (As a peer counselor, you never really have to engage anyone potentially violent. People ask to talk to you about depression or recent trauma, but it’s a very controlled environment.) To my utter amazement, after a few exchanges like that, the other guy seemed to calm down and got off the train a few stops later. After the doors closed behind him, there was a bit of clapping.

The burly man, whom I’d observed being weirdly friendly to everyone but otherwise pretty average before the exchange, explained to the car that he was a cop on his way to work. “Everyone just wants to be heard,” he said. “That’s all I was doing, was trying to make him feel heard and understood.” These sentiments were (much) later echoed by a social worker I met through a friend of a friend.

As this social worker explained in greater detail, what this off-duty cop was doing was reflective listening. Reflective listening is a communication strategy in which you repeat and rephrase what someone has said to you back to them to make sure you understood them. It’s a strategy employed by therapists, social workers, and (at least some members of) the San Francisco Police Department. Its use is being expanded as a way to navigate difficult conversations and to teach empathy.

I thought of this last weekend, as I talked to one of my lawyer friends about racism and police brutality. She pointed out that one of the biggest problems was in training. Police are trained as if for war, she said, and they seem to be trained to view civilians as the enemy. They are then given way too much power over their perceived enemy. Additionally, there is no uniformity in police training around the country, so while SFPD might be doing an awesome job teaching empathy and mentally preparing their officers for the absurd number of mentally ill people on the streets of this temperate city, that might not be the case in St. Louis or Jacksonville.

This made me think of another episode of This American Life exploring policies in cities with high rates of police shooting innocent civilians (I think one of the “Cops See it Differently” episodes). Las Vegas, surprisingly, was their example of a police department that had completely turned itself around. As recently as a decade or so ago, the situation was bad. People didn’t trust the police, and the police had a hard time doing their jobs. For all of elementary school, I lived in predominantly black and Mexican neighborhoods in inner city Las Vegas, and I remember the fear and mistrust in people’s voices whenever anyone talked about the cops. They were seen as cruel and unrelenting, and I remember feeling a visceral dislike for them despite never having interacted with them myself. I still struggle to not feel threatened when I see a cop car, simply because I grew up in neighborhoods in which cops did not represent safety any more than gangs did. I’m just lucky that, as an Asian-American female, I’m not going to be targeted, and my fear of the cops will never really amount to anything.

In their efforts to improve the community’s trust in police, Las Vegas Metro decided that their officers needed to get out into the community and engage people. So officers started going into the rough neighborhoods and talking to people who weren’t doing anything wrong. They asked them how they were, if anything bad was happening, and they asked people to call them if they needed help. With that, boom. Increased civilian trust in police, increased humanization of civilians by police, decreased accidental shootings. Other departments started following suit.

It is clear that police training needs to be better, and empathy may be an important part of that training. But when you’re operating out of fear, is that enough to overcome inherent subconscious biases? The story of Las Vegas Metro suggests yes, and I suppose it’s definitely a good start.

II.

In thinking of empathy, I also think of scientists. Scientists have a reputation for being cold and unfeeling and one-dimensionally devoted to their science.

As a scientist, I know that’s not always (or even often) true. But recently, an MD explained that he went into research after realizing during clinical rotations that he was more interested in science than people. He was interested in figuring out what was wrong with them and prescribing the right medications, not acting as a social worker and making sure they followed his instructions. This was one of many stories of why he decided he was not suited for clinical medicine.

I found it deeply disturbing, to be entirely honest. This was someone I respected, someone who acts as an advisor to many students, and here he was saying that he decided to go into research because he didn’t really care about patients’ personal problems.

But if I hearken back to my pre-med days, I suppose this is understandable. He probably doesn’t mean that he doesn’t care about people, just that it can be really exhausting for someone who is not well-suited for it. Medicine can be a stressful and thankless job, and it is easy and to some extent necessary to become detached. (I’m trying to be empathetic.) That has been recognized as a problem for patients and physicians alike.

Enter humanities programs such as the one at Mount Sinai and medical humanities programs in medical schools. I don’t have enough data to say that these programs are successful in building more empathetic physicians, but it makes sense. When you know someone’s story or even consider that someone has a story, that person becomes human to you, and it is much more difficult to disregard a fellow human than a series of numbers attached to a source of irritation.

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