At one point in her extraordinary essay collection The Empathy Exams, Leslie Jamison mentions a phrase a boyfriend once used to characterize her—a phrase by which, some years later, she still finds herself troubled. This phrase is “wound dweller.” She doesn’t say much more about the insult, or its context, or why she has found herself dwelling so long on it. But she doesn’t need to; the reference comes in the last of the book’s 11 essays, and by this point it would be obvious to anyone who has read the previous 10 how cruelly accurate a description it is. Jamison is preoccupied with pain—with her own pain and the pain of others, and with what it means, as a writer and as a person, to be so preoccupied.

The Empathy Exams contains pieces on poverty tourism, on visiting prisoners, on the terror and violence of the Mexican narco wars, and on the ghoulish compulsions of the addiction-centered reality show Intervention. There is a superb piece in which Jamison attends a gathering of people who suffer, or feel that they suffer, from something called Morgellons Disease, a delusional condition whereby things—often colored fibers or crystals or threads, and sometimes tiny living creatures—are imagined to emerge through the skin from inside of the body. There is an essay on the West Memphis Three, who were wrongfully imprisoned in the 1990s for the supposed ritual murder of three young boys. There’s a long essay-manifesto on the difficulties of writing about female suffering—on the ease with which it can be dismissed as a cliché, and the necessity of doing so regardless. Running through all of this, stitching it together, is a strong thread of autobiographical narrative, which becomes a sort of artful self-portraiture of Jamison’s own scarring—from an abortion, from a violent mugging in Nicaragua, from a history of eating disorder and bodily self-harm.

The go-to cliché for this kind of writing, or this kind of subject matter, would be “unflinching.” That would be inaccurate in this case, because while there’s certainly a relentlessness to Jamison’s pursuit of the topic of pain, she does flinch. In fact, one of the more powerful aspects of her writing is the extent to which she is able to flinch while maintaining the steadiness of her gaze.

In the title piece, which also opens the collection, she writes about her work as a medical actor, paid to play a character suffering from a specific cluster of maladies, in order for medical students to hone their diagnostic skills. The essay becomes an exploration of the idea of empathy, of feeling your way into the suffering of another person and identifying personally with their pain. But Jamison—whose first book, The Gin Closet, was a novel—goes beyond the standard literary self-congratulations, about how empathy requires the same sorts of imaginative leaps as reading and writing fiction, and how fiction is therefore a moral force for good. Instead she asks, in various ways, whether empathy might not in fact be less about the person being identified with than the person doing the identifying.

Jamison seems, at certain points, on the verge of being creeped out by her own capacity for imaginative identification. She writes about her brother contracting Bell’s palsy, a condition which causes partial facial paralysis similar to the effects of a stroke, and of how she found herself obsessed with imagining her way into his experience. “I wasn’t feeling toward my brother,” she writes, “so much as I was feeling toward a version of myself—a self that didn’t exist but theoretically shared his misfortune. I wonder if my empathy has always been this, in every case: just a bout of hypothetical self-pity projected onto someone else. Is this ultimately just solipsism?”

She wants an empathy that arises out of courage, but understands the extent to which it is, for her, always rooted in fear. Imagining the pain of others means flinching from it as though it were our own, out of a frightened sense that it could become our own. She refers to psychological studies in which fMRI scans have observed how the same kind of brain activity is provoked by the observation of other’s physical pain as by the experience of one’s own. She says that she feels heartened by this instinctive identification, but wonders what it might finally be good for. Much of the intellectual charge of Jamison’s writing comes from the sense that she is always looking for ways to examine her own reactions to things; no sooner has she come to some judgment or insight than she begins searching for a way to overturn it, or to deepen its complications. She flinches, and then she explores that flinch with a steady gaze.

Jamison is fascinated by the porousness of the borders between herself and others, and by the way in which that porousness can permit the smuggling in of something like solipsism. It’s rare, and quite thrilling, to encounter a writer who so elegantly incorporates her own writerly anxieties into her work, who is so composed and confident about the value of her own self-doubt. (In this sense, her writing often recalls the work of David Foster Wallace, one of many influences she openly engages with throughout the collection.) Here she is, for instance, on the peculiar way she finds herself identifying with a woman named Dawn she meets at the Morgellons gathering:

Her condition seems like a crystallization of what I’ve always felt about myself—a wrongness in my being that I could never pin or name, so I found things to pin it to: my body, my thighs, my face. This resonance is part of what compels me about Morgellons: it offers a shape for what I’ve often felt, a container or christening for a certain species of unease. Dis-ease. Though I also feel how every attempt to metaphorize the illness is also an act of violence—an argument against the bodily reality its patients insist upon.

My willingness to turn Morgellons into metaphor—as a corporeal manifestation of some abstract human tendency—is dangerous. It obscures the particular and unbidden nature of the suffering in front of me.

It would be too easy to let all these faces dissolve into correlative possibility: Morgies as walking emblems for how hard it is for all of us to live in our own skin. I feel how conveniently these lives could be sculpted to fit the metaphoric structure—or strictures—of the essay itself.

This kind of ambivalence, this doubling back on her own assumptions, is what makes Jamison such a wonderful essayist. What feels especially vital in this passage is the intensity of her self-interrogations, the dramatization of the resistance against her own literary instincts. It’s in the space of these interruptions, in this hyper-conscious flinching from herself, that the real work of writing takes place. When the inevitable happens, and she starts to suspect that she might herself be starting to suffer from Morgellons—the delusional nature of which she feels makes it all the more treacherously communicable—she tries not to think about whether she is itching. “I am trying not to take my skin for granted,” she writes; it’s a striking claim, certainly, but one that seems strangely commensurate with her aversion to any sort of complacency. What’s most fascinating about this essay is not the strange phantom illness itself, or even the way in which she keeps almost helplessly metaphorizing it (despite the tutelary spirit of Susan Sontag hovering above her, warning her against doing so); it’s the literary virtue she makes of her own necessary difficulties with both.

Writers, as Joan Didion remarked, are always selling someone out, and this is a reality of which Jamison seems always to be sharply aware. Her sense of the suffering of the people she’s writing about here is so acute that you can feel her willing herself to believe in that suffering in the same way they do. She portrays these people with a keenly affecting clarity and compassion. At one point, she’s sitting behind a man named Paul who has lost interest in the presentation taking place in the room, and is looking at photographs of his own wounds on his laptop—injuries of scratching and picking and scraping—observing the evidence of his own torment. “Even here,” she writes, “among others who identify with the same malady, he retreats into the terrible privacy of his own broken body. He brings others—strangers, briefly—into this quiet battleground, but it’s always just him again, eventually, drawn back into the cloister of his damage, that nearly unfathomable loneliness.” At the end of the essay, she returns to Paul, to her own guilt at writing about him and his fellow sufferers:

Paul told me his crazy-ass symptoms and I didn’t believe him. Or at least, I didn’t believe him the way he wanted to be believed. I didn’t believe there were parasites laying thousands of eggs under his skin, but I did believe he hurt like there were. Which was typical. I was typical. In writing this essay, how am I doing something he wouldn’t understand as betrayal? I want to say, I heard you. To say, I pass no verdicts. But I can’t say these things to him. So instead I say this: I think he can heal. I hope he does.

It’s obvious that The Empathy Exams wasn’t conceived from the beginning as a single book project. There are subcutaneous connections running throughout, though they seem to result more from an organizing cluster of obsessions than any kind of willful effort to make a major statement about empathy. One of the most enjoyably propulsive essays is “The Immortal Horizon,” a report about an insanely grueling Tennessee ultramarathon and its affably sadistic ringmaster; although it is necessarily concerned with bodily pain and self-punishment, it’s not especially concerned about pulling its thematic weight in the collection as a whole.

Like Rebecca Solnit, whose writing these pieces sometimes recall, Jamison takes full advantage of the licenses extended to the essayist—to create emotional affect through strange juxtapositions and connections, to generate meaning through long-range metaphors. Jamison’s writing is often formally inventive, but never appears to be pursuing formal invention for its own sake; it’s always a case, rather, of the material demanding some radical style of treatment, like a condition with no obvious cure. Jamison’s essay “Morphology of the Hit,” for instance, could easily have been a schematic nightmare, but winds up being devastatingly effective. It’s a short memoir about a time she spent in Nicaragua in her early 20s, during which she was mugged and savagely assaulted. The piece is modeled around the stringent formalism of Vladimir Propp, whose book Morphology of the Folktale isolated 31 plot elements, or “functions,” supposedly common to all Russian folklore. Jamison tries, and ultimately fails, to map out her experience along Propp’s narrative coordinates. The essay’s real brilliance is in its transcending its own cleverness through that failure. The problem of making sense of the experience, the nearly intractable difficulty of writing about it at all, becomes a vital part of that writing. “There is no function,” she writes in the closing lines, “designated for how this essay might begin to fill the lack or liquidate the misfortune—replace the eyes, the heart, the daylight. Everything I find is stained by a certain residue: all that blood. My face will always remind me of a stranger. And I will never know his name.”

That phrase “wound dweller” haunts Jamison so abidingly, it seems, because of its suggestion of a perverse preoccupation with pain, an indecent lingering around the sites of injury. It was delivered, presumably, with the intention that it would cause its own complicated wound. And for days after reading this beautiful and punishing book, I found that I myself was haunted by the phrase, but for a different reason. There is a type of person, after all, whose job it is to linger around the sites of injuries, to observe the damage we do to ourselves and to each other. “Wound dweller,” I realized, is an apt and troubling synonym for “writer.”

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The Empathy Exams by Leslie Jamison. Graywolf.

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