Openmind May/June 2007
Conversations between Ordinary People
They happened to be sitting side by side at the workshop I was running in Australia, he, Barry, a consultant psychiatrist and she, Miriam, a visitor to a long-stay psychiatric hospital, and, so she told us, no stranger to depression herself. Barry said, ‘At my hospital a colleague and I will spend up to two hours on an intake interview. There’ll be other discussions with other professionals. I don’t think patients realise how much time we spend talking about them.’ Miriam said, ‘I have specific tasks I need to do, but whenever I can I’ll just sit with a patient. We don’t talk about anything special – it might be that we just talk about what fruit’s in season – and when I get up to go the person thanks me for talking to them. I think that’s so sad, that they thank me for talking to them.’
If you’re a professional in the psychiatric system, whether in a hospital or in the community, you have to spend time talking with your colleagues about the patients. Information needs to be passed on and programmes of care drawn up. Pooling knowledge is essential to get a well-rounded picture of a patient. Where one person may have encountered a problem with a patient another may have found a way around it. Only a colleague can understand and not condemn the feelings of anger and helplessness that a particular patient can arouse in a professional who is trying to help. Barry told us about one of his patients who was unsparing with his anger directed at every professional he encountered. Barry said, ‘When you’re subjected to such an attack it’s very hard to remember that underneath this anger is a very uncertain, lonely, depressed young man.’
Perhaps the recipients of the professionals’ services don’t want to acknowledge that the professionals do discuss them because the thought that you’re being talked about behind your back can be very disturbing. As children we knew that when our parents or our teachers talked about us they usually didn’t emerge from such discussions full of praise for us. Instead we were faced with criticism and sometimes punishment. There’s a troubling similarity between being summoned to the school principle’s office and to your consultant’s office. In such a setting discussions are not between equals.
In some situations it is appropriate that the discussion is not between equals. When we consult a doctor about the state of our health we want the doctor to know more about this aspect of ourselves than we know ourselves. But in other situations inequality is not appropriate. When I was in Sydney recently I decided to consult a GP about some blemishes on my hands and arms. To counteract the very common skin cancers which all Australians develop GPs are organised to deal with this talk daily and to remove any blemish or wart which might turn cancerous. To do this they have what looks like a small fire extinguisher which emits a freezing foam. I was in the clinic with my GP and a nurse when another doctor, a tall, breezy man, walked in, demanded where this instrument was and, having found it, hoped it wasn’t empty. I said, ‘It might be. I’ve just been done,’ and held up my hands. He looked at me unsmiling, closed his eyes, turned his head away and spoke to the nurse. Apparently he believed that patients should speak only when they are spoken to. Had I met this man at, say, a reception, and spoken to him without first being introduced, I’m sure he would have spoken to me most affably.
This episode left me not affronted but disappointed. When I first came to England over thirty years ago and went to work in big psychiatric hospitals this was how all the doctors behaved. It’s no wonder that the long-stay patients felt exceedingly grateful if someone who wasn’t a patient stopped and had a chat with them. As I observed these doctors closely I could see that they felt secure in themselves only when they were in the role of the doctor. They were incapable of simply being themselves. Nowadays I encounter doctors who know that they are good at their job but they are simply themselves, ordinary people. The GP I consulted in Sydney was like this. Professionals who know themselves to be ordinary people are likely to have the skills of being able to convey to their patients that conversations between professionals about them are not detrimental to them. They are also likely to know the importance of taking time for a chat. The content of a chat may be utterly trivial but in the exercise of chatting we confirm one another’s existence. No wonder we can come away from a chat with our heart lightened. We can give thanks for that!