Tuesday, December 8, 2015
Making of a Child Psychiatrist (35): Back to the Grind (5)
In neurolinguistic (NLP) theory terms I am a very visual person. I prefer to see a film at the cinema than listen to an audiotape (which can drive me mad after about 10 minutes). As I noted in an earlier chapter, I can often remember passages of words visually so that if I am stuck, I can think back to the page and lines. If I lose something, I can think back to the approximate circumstance and remember where it is most likely to be. This, of course, falls down if you have a tidy partner who puts things into categories and is not particularly visual. Jan will often move things, and then I am totally lost – I have no visual image of where things might be- they are not where I left them! I am sure she does not do that on purpose, but occasionally I have wondered…
This visual sense has held me in good stead in all sorts of circumstances. Once I have driven somewhere, I can always recall the way to get there. In fact when I am planning a journey, I often think through the journey visually in advance to ensure I remember where we took a wrong turn last time. I rarely lose my car in the car park. When I have committed diagrams to memory then I can usually recall the majority of the diagram and piece together the rest. (Of course, as I age, these abilities are deteriorating, so my memory may be less clear and less detailed).
So this means that I have visual memories of particular patients who gifted me their story regarding the onset and process of their illness. Often, if I meet the patient again (even after some years), I can remember the salient features of their story and, if pushed, will be able to fill in the gaps; or at least need minimal prompting to be able to remember once again.
What goes with this way of experiencing the world, is the use of language. I use a lot of visual words and descriptors. So if I am describing something to a friend, it is as if I am seeing the event as a picture in my mind, and using that on which to base my description. The detail I use depends on how I perceive the other person’s expectation; some people get awfully bored if you describe every little detail.
There are two other styles of ‘being in the world’ in NLP theory (which fits so much with my experience in clinical practice; but more of that later). The first is the ‘touchy-feely’ way of being in the world. People like this are sensitive to emotional nuance, and pick up others feelings very quickly. We tend to feel other’s distress very deeply, in part because we ‘get’ every nuance of their posture and facial expression, but also because the words used each have a ‘feeling’ or ‘tonal’ value. We also tend to mirror the other person’s body language, which is marvellous in giving us ‘the feel’ for what they are trying to express. However, we have to be careful with this, because if we go too far with mirroring we may parody the person’s stance and they can become offended. The other reason for being careful, or at least controlling the mirroring, is that we can, as it were, ‘take on’ the feelings of the other – both physical pain and mental anguish – and become overwhelmed ourselves. I used to find myself doing this in the early days of my clinical training, and could get quite distressed. These days I am much better at noting the style, the body language, the words used, and the feeling tone it all gives me, and labelling it in my mind – but being very clear that it is the other person’s problem, not mine.
The third major style of operating in the world is the logico-deductive. These people tend to be very organised. They make lists either in their minds, or on paper. If they are not allowed to follow through with a process which has a beginning, a middle and an end, they can be come either slightly confused or irritated to the point of anger. They may have little time for people who are visual and get the big picture quickly, believing them to be ‘lucky guessers’ (I have been called worse things). They may have little time for people who are ‘touchy-feely’ because they don’t want to hear the whole story, and all the ins and outs, they just want the facts in a clear (preferably time-based) order. They cannot manage the emotion (or ‘do not have time for it’), because it gets in the way (and ‘does little to change the facts’). “If you are going to solve a problem, then just get your facts straight and in order, and then develop a stepwise plan to deal with each facet.”
This is a very superficial explanation of something that is complex and subtle; fascinating in its own way, but may need much more explanation to persuade some of you of its worth. At this point I just need to tell you, that as human beings we are never simple or clear, never quite fitting comfortably into boxes. So in NLP terms, we are a mix of these three broad modes. I can tell you that I am primarily a visual person, with a strong secondary style which is ‘touchy-feely’, and with the logico-deductive bit of me being a rather poor third.
So what did this mean on the wards? Well, retracing our steps a little, you will realise that I got to ‘see’ the general picture the patient was telling me quickly. I heard the symptoms and found it fairly easy to fit that ‘into a picture’. I could feel their pain, their anxiety, their worry for the future, and at the physical level I found myself very good at feeling lumps and bumps and developing those into an overall diagnosis. I was not good at the lists of alternatives that needed to be considered and excluded. I tended to go for the main diagnosis and fixate on that. But as a student, I was expected to have learned the lists so that I could spout them on demand. That for me was ‘boring’, and seemed to be such a waste of time when you had already decided what was going on. I got myself into difficulties, and was often told I was ‘jumping to conclusions’, which were ‘unwarranted’, and not part of the logico-deductive process. I was ‘being superficial’. From time to time over the months, I got to the point of despair, wondering whether I could do all this. Eventually I began to develop the lists on paper (an ‘aide memoire’), and memorised them, so that I could spout the rhetoric on demand. I was so good at ‘being with’ patients, often able to get nuances of history others could be denied. I felt for my patients, began to develop good patient-doctor alliances, but I had to work at the logic.Writing these things now, I am aware that I am describing my younger self using concepts and understandings that have been hard fought for over the years. I think whenever I got too depressed at my apparent ‘incompetence’, or my ‘glibness’, I went and did other things to fill my time. The saviours were bridge, squash and rugby, and a lot of other pursuits that will appear in this narrative as we move along. Of course, the main saviour of my sanity was Jan, who seemed to be there when I needed her, understanding of my complexities and difficulties, and supportive for when I was depressed (again).