Why People Resist Victim Empathy

Why People Resist Victim Empathy

August 2016

The first day of PBI’s professional boundary course is usually taken up with what PBI founder and CEO Dr. Stephen Schenthal calls “board bashing.” It’s a natural human reaction to be angry at someone you feel has harmed you—human, but in this case fruitless. “It’s ok to be angry,” says Schenthal, “but being angry won’t get you anywhere.” That’s because the medical board, whose primary responsibility is to protect the public, has an absolute right to discipline physicians it believes represent a threat to the public. And there is virtually nothing a physician can do to change that.

But blaming the board is worse than a simple exercise in futility; it’s counterproductive. In fact, the reason Schenthal allows class members to vent their anger that first day is so they can move past it and begin the difficult path to genuine victim empathy. “It’s really hard to understand victimization when you feel victimized by the board. When people keep asking the class to look at the terrible thing the board has done to them, I always ask, ‘Who’s the victim here?’”

Accepting that there is a victim, that they have in fact caused another human being to suffer, is the realization most violators resist at all costs. Several strategies are commonly used to fight this war of resistance. In addition to blaming the board, violators often blame the victim or deny that anyone at all was actually harmed. Schenthal describes how one physician, who hugged and kissed a patient in what she considered a maternal way, angrily dismissed the accusation that she had hurt a vulnerable young man. “She kept insisting that if there was any harm done at all, it was minimal, because she hadn’t had sex with him.” But as Schenthal told the physician, “You can’t tell me what harm has been done because you don’t know. At a minimum, you forced your patient to abandon treatment and start over with another doctor. But who knows what other pain he suffered?”

There are many reasons people resist acknowledging their victim’s pain—resist, that is, victim empathy. One of the most significant is a fear of losing a long-held and often unrealistic image of oneself. Many physicians define themselves by their role and take great pride in their vaunted position in society. Much of their self-esteem comes from their image of themselves as “the professional in the white coat who heals those in pain.” They view the long hours they work and the sacrifices they make with satisfaction, as proof of their own selfless dedication to an ennobling profession.

To empathize with a victim, the physician has to abandon this self-image. For the doctor who kissed her patient to absorb the fact that she has injured someone who came to her for help, she has to accept that she is not who she thought she was. “She can’t even consider the possibility that she hurt him, because doing so makes her think she’s a bad physician or a bad person,” says Schenthal.

Most health care providers go into medicine to help others, and find it intolerable to accept the reality that instead of helping, they have hurt a patient they care about. According to Schenthal, “most of the people I see just want to get the tar off themselves. They want to see that white-coat reflection when they look in the mirror.” Letting go of that image and empathizing with a victim means accepting that all those long hours and painful sacrifices didn’t prove anything. When the physician looks in the mirror, the white coat is stained; and the person wearing it is human and flawed, just like everyone else.

People also turn away from victim empathy because they’re afraid of the guilt they’ll feel. And indeed, once they begin to see their victim as a full human being whom they have injured, many find the initial rush of guilt overwhelming. An important part of the rehab process, says Peter Graham, “is to help people get past being overwhelmed by shame and guilt to the point where they can use those emotions appropriately to manage their professional duties, and still go on to experience enjoyment and pleasure again.”

It almost always takes the shock of board discipline and the support of others—especially those who have first-hand experience with boundary violations—for someone to confront the reality that they are not who they thought they were. And for those who do break through the resistance, there is no denying that the pain and guilt they feel is real. But so is the relief that comes from finally embracing their own full and fallible humanity. They come to realize that only by accepting their own vulnerabilities can they realistically guard against harming another patient. And only by abandoning an unrealistic image of themselves can they finally see that the long hours and endless sacrifice don’t make them better healers; just the opposite, in fact: now that they can stop trying to live up to an unsustainable self-image, they find that they can take better care of themselves, their family and friends, and ultimately their patients.