Empathy Education

Author: Sabrina Sideris

Originally Published at Peace and Conflict Monitor on: 05/23/2006

Category: Conciliation

Through the spaces in his mouth where his front teeth used to be, his tongue shapes his words and Don Roberto shares with us:

“When I tried to kiss my own son, my ex-wife pulled him away quickly. She looked horrified and repulsed, like I was going to hit him with a hammer.”

Don Roberto pulls an olive-green hat down over his forehead and we can’t see the expression he makes as he continues talking. He is seated in his new home, now that his family won’t accept him in theirs. He describes the discrimination he has suffered as an HIV-positive man. His own parents bar him from the dinner table and make him eat alone in their kitchen, “like a dog.”

Don Roberto tells us he’s an alcoholic and a drug-user. “There’s something I haven’t been able to overcome and it is loneliness,” he says, explaining his addictions. He speaks easily about his situation. The words flow from him, then through our translator. I try to imagine how he can tell this story so calmly. He’s sharing hardships, but he is doing so with peace.

In Spanish, “esperanza de vida” means “life expectancy.” Although his time is running short, Don Roberto lives with tranquility at El Hogar de la Esperanza, a hospice care center for HIV/AIDS patients in Costa Rica.

Teaching Empathy

In an innovative course at the UN-affiliated University for Peace (UPEACE), Professors Hassan El Menyawi and Kaveh Khoshnood reduce the likelihood of discrimination against HIV-positive people by orchestrating student-patient encounters, like the one captured above. Graduate students visit a self-help association for HIV+ Costa Ricans and interact with agency workers and intergovernmental organizations, sharing humanity with disease sufferers, their caretakers and advocates. Students also become patient advocates, since they are transformed by encounters outside the classroom. The course compels us to intervene as human rights workers.

This article examines the unique design of the class, discusses the distinction between sympathy-development and empathy-development, and offers pedagogical tips for educators who wish to use the El Menyawi/Khoshnood empathy-development model. In “The Three Cs of Reducing Prejudice and Discrimination,” Johnson and Johnson offer, “Educators … have a unique opportunity to create the conditions for promoting … the types of interactions, relationships, competencies, and values that decrease stereotyping and prejudice” (2000: 239). The course on human rights and HIV/AIDS—the first of its kind on the planet—casts students in meaningful interactions and challenges stereotyping and prejudice.

In order to enhance the impact of higher education on students, educators at all universities can adapt humanistic teaching strategies that draw on the El Menyawi/Khoshnood model, whether they are teaching anti-discrimination, anti-racism, multiculturalism, diversity or a similar theme.

Course Content and Process

Designed by El Menyawi, head of the UN HIV/AIDS and Human Rights Project, the course is offered by the Department of International Law and Human Rights (ILHR). It begins with a study of “world-wide case law mentioned alongside international declarations, covenants, and conventions” (El Menyawi, 2006-1). Since ILHR students at UPEACE hail from North America, Central America, South America, Europe, Africa, Asia and the Pacific, cases from various countries are appreciated by all participants, whereas case law from only one nation or region would have less relevance. Examination of case law provides a means for studying snapshots of HIV-positive people. The vignettes offer various faces of HIV. Students try to imagine what it might be like to be involved in the accounts we are reading, and discuss “the costs and benefits of varying human rights constructions” (2006-1). We also explore innovative solutions to quandaries encountered in case law, particularly related to tension between individual rights and freedoms, and the well-being of a population.

The second phase of the course focuses on epidemiology. Taught by Professor Khoshnood of the Yale University Center for Interdisciplinary Research on AIDS, this segment is statistical and fact-based. We learn that:

• About 38 million people are living with HIV, 25 million of them in Sub-Saharan Africa.
• Botswana and Swaziland have prevalence rates above 35% of their populations.
• Only about 7% of the HIV+ people in developing countries have access to the antiretroviral drugs they need.
• Globally in 2003, 3 million people died of AIDS (UNAIDS, 2004).
• Every 10 minutes, 50 youth are infected with HIV (UNESCO, 2006).
• In the US, only 75% of HIV+ people know their status (Khoshnood, 2006).

With a crisis of these proportions, we need to envision new solutions, new programs and strategies for prevention, education and treatment, and we cannot do so if we confine ourselves inside one disciplinary box (El Menyawi, 2006-2). “What we must do is build connections, transmissible and transnational,” between law and medicine (2006-2). The interdisciplinary course challenges students to think into the experiences of HIV+ individuals, as well as policy-makers and public health officials. For example, Khoshnood has us decide which groups of people would receive antiretroviral drugs if we were only able to provide treatment for 10,000. This class exercise in triage opens a heated debate and helps students empathize with the challenges faced by public health officials and law-makers, since fiscal constraints and inflated drug costs prohibit them from offering pharmaceutical resources to all in need. Through interactive exercises, lively debate and carefully facilitated dialogue, the instructors ensure that the in-class portions of “Human Rights & the HIV/AIDS Crisis” challenge us to imagine ourselves walking in the shoes of participants in the epidemic.

Sympathy v. Empathy

El Menyawi says public responses to the virus oscillate between stigma and sympathy. Prejudices precede an HIV-positive person: commonly, HIV-positive women are assumed to be promiscuous, while men are assumed to be junkies or homosexuals. Children with the virus are prevented from going to school or taking karate classes, since infected blood is coursing through their organs and veins and they are considered walking weapons who put others at risk. These typify the stigmatizations of HIV-positive people. In the other public response, sympathizers feel sorry for those who have HIV/AIDS. But the El Menyawi/Khoshnood model prevents students from stopping at sympathy, which objectifies and distances. Sympathy draws lines around the patient and her or his circumstances and puts room between the infected and the as-yet uninfected. The El Menyawi/Khoshnood course has as its goal the recognition by each student that all of us have an HIV problem. The crisis is shared by those who are seropositive and those who are seronegative. In the words of the psychologist treating patients at Hogar de la Esperanza, “All of us are living with HIV, regardless of our status.”

In order to draw a distinction between sympathy and empathy, El Menyawi refers to the headlines in the French newspaper Le Monde on September 12, 2001. Jean-Marie Colombani wrote of the 9/11 attacks on the US:

In this tragic moment, when words seem so inadequate to express the shock people feel, the first thing that comes to mind is this: We are all Americans! We are all New Yorkers… Indeed, just as in the gravest moments of our own history, how can we not feel profound solidarity with those people, that country, the United States…?

How deep is the capacity for empathy, expressed here? Are we all HIV+? Are we all gay? Are we all IV drug users and sex workers? Where is our potential to feel with others, and how deep does it run? How do educators encourage students to move beyond sympathy, to empathy? And should they? Some argue that feelings are too fluffy for the classroom. But Khoshnood reports that student evaluations consistently show there is no substitute for interacting with HIV+ people and experiencing the emotions that are elicited by the encounters: the most educative experiences involve face-to-face contact and opportunities to establish relationships. Students unswervingly describe encounters as the most eye-opening parts of the course on HIV. Moreover, since the HIV/AIDS epidemic is by no means confined to IV drugs users, sex workers and gay men, since every one of us is susceptible to the virus, empathy education is particularly apropos. HIV/AIDS is not out there, it’s right here.

Johnson and Johnson offer that, “It is through personal relationships with diverse individuals that the most profound and lasting … commitment to ending prejudice in one’s self and others is developed. … Through personal, one-on-one interaction, categories break down, and outgroup members are perceived in more individualized terms” (2000: 239). Exposure through such encounters allows students to recognize that they have the same goals, fears, feelings and needs as HIV-positive people.

Steps for Educating with Empathy

Johnson and Johnson go on to say, “Whether positive or negative outcomes occur from the proximity of diverse individuals depends on how the interaction is structured” (2000: 244). The teacher who carelessly inserts an encounter into a course on HIV/AIDS could encourage students to express pity for, rather than empathy with an HIV-positive person, or worse, the interaction could evoke nothing at all. But an educator who carefully places the interchange inside a well-thought-out classroom process is more likely to provide students with a transformative experience.

Components of successful empathy education:

• Pre-instruction logistical preparation, including arrangement of travel details, can be given to the students in some cases. When appropriate, having them handle the planning gives students a voice in the project, according to The Complete Guide to Service Learning (Kaye, 2004: 17). It also removes some of the pressure from the teacher, which is no small achievement, since many instructors report that the details get in the way of their success with service learning methods. (The devil is in the details.)
• In a discussion-based preparation phase, the instructor sets up the context for the contact. Johnson and Johnson encourage the instructor to make the educational goal explicit. “Organize knowledge, set expectations, create mood,” they suggest (2000: 242). The students should be informed about what kind of relationship is likely to develop. Is it a helping relationship or a solidarity relationship? Beyond listening, will they be expected to take some further action? Is a long-term or short-term relationship anticipated? In the preparation phase before our visit to the hospice center, El Menyawi warned us against voyeurism. Instead of gawking, we were asked to connect and share. He said, “There are two types of questions: ones that distance and ones that connect.”
• During the event, monitor the learning that takes place and intervene if necessary in order to facilitate cooperation and exchange.
• Debrief after the encounter, in order to compare experiences, perspectives and interpretations and “synthesize disparate positions” (2000: 264). Check if empathy has developed, using dialogue. Reflection prompts include, “How did you feel being at the hospice center? How did your feelings change from when you first arrived to when you left? How did you make a difference for those you met? How did your new friends make a difference for you” (Kaye, 2004: 27)? Discuss ways in which the new understanding will lead to behavioral and attitudinal shifts, since empathy that does not lead to action fails to achieve what it could. Students who don’t recognize the opportunities for turning empathy into action may develop apathy or numbness.

All preparation and follow-up steps are crucial, particularly the discussion of expectations in advance, since “No one can develop his [sic] full potential in an uncomfortable environment” (Bahruth and Steiner, 1998: 131). Failing to include any of the steps above could lead to guilt, embarrassment or resentment of the teacher for exposing students to a seemingly unsafe atmosphere, compromising the educative potential of the encounter.

At the same time, although the teacher hopes for certain changes in the pupils, students must be allowed to respond to the encounter in any genuine way. There are no right or wrong answers when a student is coming to life, and the emergence of critical consciousness is a little like birth.(1) Bahruth and Steiner describe the pedagogical practice of creating “culture circles” in their article, “Upstream in the Mainstream: Pedagogy Against the Current” (1998). Written for the “Social Context of Education” series by the State University of New York, the article walks an educator through the process of building a democratic classroom based on Freirian principles.(2) Culture circles remove “authoritarian modes of discourse [from] traditional classrooms” (1998: 129), humanizing the teacher (137) and encouraging students to deepen their own humanity. “We are not attempting to lead all students to a singular destination other than the evolution of their own criticity… Knowing absolutely where a circle is headed would be antithetical to critical pedagogy.… It would also be acritical in that it would reify the teacher as authoritative representative of an immutable, static body of knowledge…. The teacher’s charge is to oversee the evolution of a human environment where all participants, including the teacher, share their wrestlings to make meaning” and develop understanding, in a conscious process of evolution (1998: 130).

This model trusts the student and her or his own collection of thoughts, feelings and perspectives. That which is elicited by the encounter is the teacher. In the El Menyawi/Khoshnood model, what counts as official knowledge is not just the lecture, the assigned reading, the case law, but also the panelists who present in our classroom, their stories, the people and places we visit, and our own evolutions, inspired by these encounters. All of this is legitimate knowledge, as El Menyawi confirms when he stated during our final class period, “the reader never speaks back to you or presents you with a gift” (2006-3).

Conclusion

Bahruth and Steiner say “critical pedagogy, a pedagogy of liberation, becomes our rebirth into a world of critical consciousness and agency” (133). In other words, once students become aware of social problems and initiate relationships with those who suffer hardships, they will be compelled to act upon their world, taking steps to invent potential solutions. Encounters outside the classroom encourage students to develop their capacity to act to transform the world around them, in Freire’s words. Frankly, education that does anything less misses an opportunity. Given the shape our world is in, it’s time for education to take bolder steps toward reshaping society. The El Menyawi/Khoshnood model offers educators a method for doing so. Empathy education will engender the next generation of public policy makers, public health officials, doctors, lawyers and human rights activists, who will take compassionate action in response to critical awareness (Khoshnood, 2006).

In a message born of an empathetic connection with his students, El Menyawi concluded the course by writing to all participants:

I am amazed by your humble empathy–reaching out to the stars curiously asking questions, yet tamed by sincere friendship and warmth [during our encounter]. I saw each of you throughout the course internally struggle between despair and hope–the despair that comes with the immense challenges that have arisen [with] the HIV/AIDS [epidemic]. And the hope–the hope that comes from a belief that through knowledge and imagination, it might be possible to mitigate some of the challenges…as part of an ongoing struggle that includes all of us (2006-4).

References

Bahruth, R. E. & Steiner, S. F. (1998). Upstream in the mainstream. In R. Chavez & J. O’Donnell, (Eds.), Speaking the unpleasant: The politics of (non) engagement in the multicultural education terrain. (pp. 127-147). New York: SUNY Press.

Colombani, J-M. (2006). We are all Americans. Le Monde. September 12, 2001. Retrieved on May 12, 2006 from http://www.worldpress.org/1101we_are_all_americans.htm.

El Menyawi, H. (2006-1). Syllabus: DIL – 6250. Introduction and course description. San Jose, Costa Rica: University for Peace.

El Menyawi, H. (2006-2). Lecture: DIL – 6250, May 5, 2006. San Jose, Costa Rica: University for Peace.

El Menyawi, H. (2006-3). Lecture: DIL – 6250, May 12, 2006. San Jose, Costa Rica: University for Peace.

El Menyawi, H. (2006-4). Personal communication, May 12, 2006. San Jose, Costa Rica: University for Peace.

Johnson, D. W. & Johnson, R. T. (2000). The three Cs of reducing prejudice and discrimination. (pp. 239-267). Twin Cities: University of Minnesota.

Kaye, C.B. (2004). The complete guide to service learning. Minneapolis: Free Spirit Publishing, Inc.

Khoshnood, K. (2006). Lecture: DIL – 6250, May 12, 2006. San Jose, Costa Rica: University for Peace.

UNESCO Panelist. (2006). Personal communication: May 11, 2006. San Jose, Costa Rica: University for Peace.

UNAIDS. (2004). Report on the global AIDS epidemic. Executive summary. Retrieved on May 12, 2006 from http://www.unaids.org.

Footnote:

Bio: Sabrina Sideris is a Master’s candidate, studying Peace Education at the University for Peace.