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Empathy: the unexpected gift from abuse


Months after I left him, I could still feel the pain he inflicted. He not only weaponized my insecurities but also demeaned the things about myself that I loved, insidiously dismantling my sense of self until nothing remained.

I even doubted my ability as a psychiatrist, and I hated him for that.

“Talking to you is like trying to read a Step 2 question!” he had sneered. “I don’t know anyone who uses the word ‘insular’ in a normal conversation. I want a woman who can talk to, like, construction workers and coal miners.”

Like kerosene on a fire, his words fueled my self-doubt, which became all-consuming. I began to punctuate my conversations with apologies for taking up space and time with my words, and I noticed this habit creeping into my admission interviews at work. “Sorry I’m taking so long, sorry I’m annoying you, sorry, sorry.” I feared that patients would find me off-putting and irritating, and that my mere existence would threaten any chance of a therapeutic alliance (my emotional brain was working overtime).

I thought myself incapable of relating to patients, fundamentally flawed. And I hid my internal turbulence, fearing that it rendered me too weak to be the rational clinician that my patients needed.

And then, I meet Ms. J.

Ms. J, an elderly patient trapped in a decades-long vicious cycle of probable psychogenic attacks and a list of ineffective antiepileptics, is slowly starting to trust me. We have her attached to an EEG to confirm our presumptive PNEA diagnosis. When I first offer mental health services, she declines.

When I tell her I am a psychiatry resident, not a neurologist, she nearly upends her breakfast tray: “I knew they thought I was CRAZY! They sent me the CRAZY PERSON doctor!”

But our relationship improves over time.

“No one believed me until you,” she mutters, deflating against her pillows, peering owlishly at me from behind thick glasses.

Although she likes me now, I must reassure her frequently that she is not crazy.

One day, she asks me, “Can I tell you something?”

“Certainly.”

She leans in. “I get scared sometimes. Because…someone tried to choke me.” She raises a hand to her throat, fear clouding her eyes. “I think about it sometimes, and I don’t want to. I’m up against the wall… and he’s got his hands around my neck. I don’t know how I got out. Running up the stairs in the dark. I don’t remember a lot…

But I know he tried to choke me.”

My heart pounds with the urgent need to run, yet I am frozen. I see a silver ceiling light swinging above me, and I feel hands around my throat.

I feel my nails digging into my thin wrist, returning me to the present. I opt for a moment of connection over my usual rule against self-disclosure with patients.

I ask, “Can I tell you something, Ms. J?”

A nod.

“I understand exactly what you’re feeling.” And I tell my secret.

She takes my hand. “I know,” she says. “I saw a little glow of sadness in your eyes when I asked you yesterday if you had a man in your life. I knew something happened to you.”

In exchange for my pathetic offering, she discloses more: a rape, a pregnancy. “The boy’s 60 now. He knows I had to give him up. I was just a child myself…

I feel safe telling you. No one believed me until you. Blame the woman — they always blame the woman. Even though he did it to me again and again, the family said it was my fault. And all those doctors — they acted like something was wrong with me.” She sighs, resigned. “In those days, if it was done to you, it was your fault.”

Tears obscure my vision. “I’ve got news for you, Ms. J. These days, it still is.”

I remember not being believed. I recall an uncaring administrator glaring at me as though I were the problem:

“Our hands are tied. You have to be in the same room.”

I feel Ms. J’s humiliation at the memory of faceless men in white coats blaming her for her own abuse.

I see my own anguish reflected in her bright brown eyes as a weighty silence settles between us, a dark space in which we briefly and uneasily rest our shared hurt. The line blurs, past and present meld together, and I am unsure whether I am crying for her or for myself.

“Wasn’t your fault any more than it was mine,” she says. She is still clutching my hand, I realize, and she pulls it close to her heart and holds it there. “We’re making each other better. You and me, talking. Woman to woman.”

She continues. “I wanted someone to tell me he did wrong. I wanted someone to believe me.” I nod because I understand.

“I just wanted someone to tell me I was worth loving,” I whisper.

“We are, sweetheart.”

Through the ugliness of shared trauma, we form a therapeutic connection that allows me to give her better, more empathic care. Shortly thereafter, my team captures an attack, which, in conjunction with the trauma history and presence of significant life stressors, confirms the PNEA diagnosis, setting Ms. J on a path away from this fruitless cycle of readmissions and unnecessary antiepileptics.

And the case leaves me cautiously hopeful. I dare to hope that I can use my own pain to be a better physician.

I like to think I am a kintsugi vase: discarded fragments pieced together with gold. Broken, but not shattered, making myself whole again.

Nested cozily in my tangle of red blankets on the sofa, having awoken from a hazy, dreamless sleep sometime one afternoon, I hear raindrops at my window.

I watch the gray downpour as realization dawns: my heart is not racing.

It is raining. And I am no longer afraid.

Chloe N. L. Lee is a psychiatry resident.






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