Cadavers, Connection, and Coping
In an article called “Learning Empathy from the Dead,” John Tyler Allen discusses how medical schools are attempting to allow and encourage their students to express more empathy for the cadavers they dissect. It is typically thought that doctors must maintain a “clinical distance” from their patients that involves disengaging in emotionally stressful situations by focusing on the details of the task at hand — the symptoms a person is expressing or the organs and tissues the doctor is examining. For medical students, the potential need for this distance arises when they enter an anatomy lab — it may be a necessary tool for coping with the emotional distress or squeamishness that may arise during a dissection.
Students also cope through humor. The article mentions that students invent stories about the bodies, give them names (often ones that poke fun at their anatomy, such as “A Wrinkle in Time” for a cadaver with a lot of wrinkles), or play “cadaver tricks” such as putting a bow tie on the body. This kind of coping mechanism “‘allows students to acknowledge the cadaver’s personhood, while psychologically shielding themselves enough to be comfortable with the dissection.’” Although this may make students more comfortable while performing dissections, these irreverent attitudes can have a negative effect in the long run. It may promote referring to patients and/or seeing them as their ailments or body parts instead of as a whole person.
Medical schools foster a culture that promotes detachment. Early medical schools had lax admission requirements and often fell behind on advancements in medical techniques. In 1908, the American Medical Association hired an education reformer named Abraham Flexner to evaluate the schools. He did not think their methods were creating good doctors, and thought that the best course of action was to make admission requirements more rigorous, raise tuition, and modernize the curriculums. This led to a change in the students. A study conducted in the 1950s showed that medical schools were teaching their students to adapt to the “distinctly sterile and un-empathic culture” found in hospitals.
One of the researchers who conducted this study was Renee Claire Fox, a sociologist at Columbia University. Fox came up with “attitude-learning sequences,” which were “events that had ‘a strong emotional, symbolic, and rite-of-passage impact on students.’” The first time seeing and cutting into a cadaver is the earliest part of this sequence for medical students. It introduces them to many new and potentially uncomfortable phenomena — death, dead bodies, and nudity, as well as the process of opening and examining a human body. In order to cope with this, students are supposed to develop an attitude of “detached concern,” which is a combination of clinical distance and empathy. However, medical schools often focus more on cultivating students’ detachment than empathy, which might make students lose sight of the fact that they are working with people who were once alive. A study in the 1970s found that students in the lab learn “maladaptive coping strategies in clinical settings,” which a 1990 study compared to PTSD.
In the last several years, medical schools have employed strategies meant to combat this detachment. At the University of Oklahoma medical school, students participate in donor luncheons in which they have a meal with the family of the cadaver they will dissect. A study conducted by the Mayo Clinic in 2013 found that 96% of American medical schools have post-dissection ceremonies. These are like memorial services in which students share poems or diary entries about their experience with the dissection and give speeches. The ceremonies are a way of giving thanks to the person who gave their body as a teaching tool for these students.
Lawrence Rizzolo, director of the Yale School of Medicine, maintains that it is also important to allow students to empathize and express emotions while in the laboratory. Medical students are typically taught that they must value “‘objectivity, detachment, wariness, and distrust of emotions,’” and that they have to “buck up” in order to handle the challenges involved in treating patients. However, Rizzolo maintains that it is better for emotions to be managed than suppressed. For instance, when his students were dissecting the vagina in one of his classes, one of the students gasped. Rizzolo paused, and brought up that this dissection called to mind female circumcision. He then engaged the class in discussion of this topic. In this way, Rizzolo recognized the potential emotional and ethical difficulties that come up during dissection, and allowed his students the space to process them. This way of managing possible emotional distress seems much healthier than forcing students to disengage from discomfort and difficult emotions.
Medical students will likely eventually work with people who are sick, injured, and otherwise in distress. Too much distance might cause them to dehumanize their patients and make it harder to help them. It also is inevitable that when dealing with others’ trauma, doctors may begin to feel some of it themselves. If they never allow themselves to process it, they will not be able to work through it and cope. While in medical school, maintaining empathy for the cadavers in the lab might help future doctors to keep in mind that they are doing this in order to learn how to properly treat living people — something that must be done without callousness and irreverence, and requires a level of compassion and connection with patients.
