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Book Reviews   |    
From Detached Concern to Empathy: Humanizing Medical Practice
Reviewed by Philip Candilis, M.D.
Psychiatric Services 2002; doi: 10.1176/appi.ps.53.5.641-a
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by Jodi Halpern, M.D., Ph.D.; New York, Oxford University Press, 2001, 165 pages, $37.95

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This is a beautifully written and beautifully reasoned book. Physician-ethicist Jodi Halpern crafts one of the finest descriptions available of psychiatry's advance toward empathic involvement with patients. Intertwining psychiatry and ethics is no easy task. However, in Halpern's hands, a blend of formal research, philosophical modeling, and straight talk shows how neatly psychiatry and ethics work together. Indeed, the book is a clinical and philosophical exhortation to recognize how much richer treatment is when it arises from empathy rather than from detached objectivity.

This idea is not new to psychiatry or ethics, of course. Postmodernism as a school of thought has argued forcefully that physicians and therapists are part of the health care encounter, not merely observers. Objectivity and distance, like other values of the Enlightenment, are not complete measures of an interaction. They may require narrative, care, and even virtue ethics to supplement and enrich them. The skepticism about whether physicians can remain detached is robust in this book—as it has been in the mainstream ethics literature.

The writing in From Detached Concern to Empathy is at its best when Halpern draws on clinical vignettes. Indeed, the principal example is a powerful description of a patient left to her own "competent" choice to refuse treatment—an outcome many might call pseudoempathy, or, more harshly, abandonment. But Halpern makes hay with this vignette, as she should. She draws support from writers ranging from Heidegger to Lacan, which requires of readers at least a modicum of philosophical background. Indeed, the middle portions of the book become somewhat dense when Halpern departs from her vignettes. Nonetheless, her criticism of Kant will bring tears to the eyes of the most hardened philosopher. It is hard to argue with someone who advances the theory of one of history's greatest minds.

This may not be the mainstream practitioner's cup of tea, but it will delight therapists and careful thinkers who are looking for integrated theories to guide their interactions with patients.

Dr. Candilis is assistant professor of psychiatry at the University of Massachusetts Medical School in Worcester.

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