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Archive for the ‘narrative’ Category

Falling apart and creating anew

Posted in creativity, from the consulting room, from the dark room, from the living room, life, narrative, perception, personal growth, philosophy, photography, science on March 25, 2013 | 2 Comments »

diversity in the autumn garden

It’s common for us to experience loss, break down, destruction and disintegration.
In the middle of it, it can become hard to see the wood for the trees, and it can feel like this falling apart is not just inevitable but permanent.

As the leaves fall from the trees in the autumn, the bare branches of the winter woodland give the appearance of life being over for those trees.

Human beings know they don’t live forever, and although some have a belief in reincarnation, or lives of different forms from this life, nobody expects they are not going to experience loss, degeneration and death.

If the course of Life could be summarised as destruction and decline, then what kind of Life would that be? Is that really what we believe? That the direction of Life, the direction of the Universe even, is towards destruction and disintegration? Having begun with a Big Bang, are we heading for the final whimper (as T S Eliot wrote?)

But look again at the photo above. What do you see? Death and destruction? Loss and endings? Life and growth? Change and diversity?

The old mechanical, materialist view of the world teaches the idea that we try hard to resist destruction. “Entropy” is the term used to describe the inevitable run down of a system. But this view is more relevant to machines (which are “closed” systems), than it is to Nature (which is full of interconnected “open” systems).

Prigogine coined the term “dissipative structures” to better describe the reality of Nature and living organisms. He found that complex adaptive systems used dissipation to renew themselves, and in this renewal they grew, developed and adapted to changes in their environment. Indeed, Varela and others coined the term “autopoiesis” (self-making capacity) to describe the essential characteristic of a living system.

All living systems, ourselves included, are continuously breaking down existing structures and elements in order to create ourselves anew – in order to not just adapt, but to flourish. Not a single cell in our bodies lives as long as we live. In fact cells live between a few days and few months on average. It’s not the material, or the “stuff” of which we are made which makes us who we are. In that sense, we are much more like a river than we are like a machine.

I find this idea thrilling. Partly because I work every day with people who are experiencing loss and breakdown, people whose lives are falling apart. When a loved one dies, when your relationship or your job ends, when disease appears suddenly, or slowly in your life, it can all become quite overwhelming and it can be hard to see how any good can come of this experience. But here’s the key point, such continual change, such cycles of breaking down and destruction are not just inevitable but they are a necessary part of growth and renewal. These special times are times of renewal.

Spring time (not quite managing to appear yet here in the UK) is a good time to reflect on this. I’ve mentioned before how the Japanese celebrate transience through the cherry blossom festivals.

Renewal occurs through adaptation. As our lives change, if we take the time to become more aware, and we learn not to cling to current forms, we can see that in the midst of dissipation we discover the vast potential for creativity and growth. Just think of the universe story for a moment. Is it one of era after era of decline and destruction? No. It’s one of ever increasing diversity and complexity. It’s a story of cycles of joining together, breaking apart and forming new connections. It’s a story reflected in every single living being. Here’s the miraculous truth. The universe is not a closed machine heading day by day towards destruction. It’s a vast interconnected web of open systems producing the most elaborate, most complex and most amazing phenomena day after day after day.

snowdrops closeup

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Plots and Fate

Posted in from the consulting room, from the living room, health, life, narrative on January 13, 2013 | 2 Comments »

Each of us lives out a story, a dynamic narrative whose only consistency is that we somehow show up in each of the scenes. While the plots line may be unknown to us, there is one. Creating a Life. James Hollis

We know ourselves and others through the stories we tell. We create meaning and gain an understanding of the events and experiences of our lives by creating a narrative. And isn’t that quote so true? Doesn’t it sometimes seem as if the only constant in our life story is that we show up in each of the scenes. All of life, the world we live in and experience, is woven into these stories, which always, in some way, contain ourselves.

But what about this idea of a plot? Because doesn’t it happen to all of us that from time to time we lost the plot? In fact, don’t many people never seem to have a grasp of the plot? Well, an interesting factor in the creation of the plot comes from thinking about Fate.

What is fate?

The narrower the frame of consciousness, the greater the personal chronicle plays out as fate…what is denied inwardly, will come to us as Fate. Creating a Life. James Hollis

Of course, we have the hand we are dealt too, as part of Fate. Sir Harry Burns, the Chief Medical Officer of Scotland, in discussing the problems of ill health in Scotland points the discovery that a grandfather’s experience can alter his genes and so pass on influences that way through his children and even their children too. We can’t understand a person, or their plot, without seeing who they are within more than their own personal lifetime. We have to consider their genetic, familial, cultural and societal contexts and influences, most of which may shape the unconscious more than they shape the conscious. Living a zombie life, on automatic pilot, will be experienced as a life dominated by Fate, but waking up, becoming conscious, examining our own lives, gives us the chance to become the heroes of our own personal stories.

Plot is partly unearthed, and partly created.

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What’s the story?

Posted in from the consulting room, health, narrative on January 8, 2013 | 1 Comment »

I saw this cartoon the other day and there was immediately something about it that bothered me….

IMG_0354

……what was it?

The advice from the doctor….well, I say all of those things. Not exactly as said here, but pretty close. I suspect any doctor giving advice about health probably covers a selection of these points nowadays. Maybe some would talk about “5 a day” instead of “plenty of organic fruit and veg”, and some would mention stopping smoking and drinking in moderation, but it really covers the common advice.

So, what’s the problem?

Well, the problem is you can imagine from this cartoon that this advice has become like a standard prescription. A modern panacea. Doesn’t matter who the person is, or what they are complaining about, here’s the same advice.

Who is this man in the grey suit? When he says he doesn’t feel well, what exactly does he feel? And what really are his concerns? Why has he come to the doctor as this particular point? In other words, who is he, what kind of life does he lead, and how does his illness experience fit into his life story? (There’s a clue that he is seeking a meaning when he says “I’m not sure why”

What’s missing?

The person – because we aren’t hearing the story.

Here’s the text of a post I wrote on this blog four years ago about the importance of story (the importance of story, you’ll see, is a main theme of this blog)

The people who come to see us bring us their stories. They hope they tell them well enough so that we understand the truth of their lives. They hope we know how to interpret their stories correctly. We have to remember that what we hear is their story.

Robert Coles in “The Call of Stories”.

Stories have always fascinated me. I love them. Every day when I sit in my consulting room patients tell me the most amazing, fascinating and unique stories. As a medical student I was taught how to “take a history” – I hate that phrase actually – who’s doing the “taking” and what exactly are they “taking” and from whom? Doesn’t seem right to me at all. Instead I prefer teaching medical students how to listen to patients’ stories. However, the point is that this is the beginning of all diagnosis. To a certain extent listening to the patient’s story is a diminished art. There’s an over-reliance on technology and a lot of doctors just don’t seem to be able to make a diagnosis without a test these days. Diagnosis is a form of understanding. It’s a process of trying to make sense of somebody’s experience.

If stories are so important in clinical practice, then how can I learn to handle them better I wondered? There is a developing area of medicine known as “narrative-based practice”, with associated “narrative-based research” methodologies, but materially-orientated, reductionist scientists look down on narrative. They prefer data. So, when I started to study narrative (which, technically is the story AND the way that story is told), I couldn’t find much work from a scientific perspective. I had to turn to the humanities.

One of the books which I really love in this area of study is “On Stories” by Richard Kearney (ISBN 9-780415-247986). Not only is it a fabulous exploration of the place of story in human life, but it’s written completely beautifully. Richard Kearney is a philosopher but he’s also a magnificent writer. This one book taught me more about the importance of story than any other.

Telling stories is as basic to human beings as eating. More so, in fact, for while food makes us live, stories are what make our lives worth living.

This sets stories at the heart of human existence – not optional, but essential.

Aristotle says in “Poetics” that storytelling is what gives us a shareable world.

The key word there is “shareable”. It’s through the use of story that we communicate our subjective experience and its through the sharing of subjective experience that we connect, and identify with others.

Without this transition from nature to narrative, from time suffered to time enacted and enunciated, it is debatable whether a merely biological life could ever be considered a truly human one.

Beautifully expressed. Sets narrative at the heart of what it means to be human and stands it against those who would take a materialistic view of life which they claim can be reduced to data sets and DNA.

Every life is in search of a narrative. We all seek, willy-nilly, to introduce some kind of concord into the everyday discord.

This is one of my favourite lines in the whole book. This is exactly the power of story – it enables us to “get a handle on” life, to bring some kind of order out of chaos.

What does Richard Kearney mean by story then? Well, I’ll finish this post with two more quotes from his book which make it very clear and very simple.

When someone asks you who you are, you tell your story. That is, you recount your present condition in the light of past memories and future anticipations.

This shows that story collapses time, bringing the past and the future into the present. Story telling requires memory, imagination and expression.

Every story requires -

a teller, a tale, something told about, and a recipient of the tale.

Nice and simple, but what profundity lies in there. For every story, there is a unique human being doing the telling, there is the story itself and its subject matter, and, very importantly there’s the recipient – the listener or the reader. Story is, as Aristotle said, a way of creating a shareable world. That’s the greatest potential of blogs, I reckon. By sharing our stories we create a shared world. Yes, sure, stories can divide as well as connect, but without stories, there is no potential for connection, no potential for compassion and no potential for the creation of a meaning-full, and better world.

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Stories and power

Posted in from the consulting room, health, narrative, tagged , , on October 28, 2012 | 1 Comment »

The Scottish Storytelling Centre in Edinburgh hosted the International Storytelling Festival last week and I participated in a series of workshops entitled “Stories and Cures”. What a fantastic, stimulating, rich experience with a diverse range of nationalities and disciplines taking part. Right at the start of the week I heard something I’d never heard before.

Back in the 18th and early 19th centuries throughout Europe when a person wished to consult with a doctor, there was a practice of letter writing. Someone would write a letter to the doctor whose advised they wished to receive. The letters were typically the person’s story, in their own words, describing what they were experiencing and the contexts of those experiences. In other words, the letters weren’t just lists of symptoms, and certainly weren’t tables of figures or readings, but, rather, they were highly personal, unique life stories.

The doctor would then write back, commenting on parts of the person’s story and giving a range of advice , often touching on issues of morals, hygiene or spiritual life. This was the beginning of a conversation which might be followed up with further exchanges of letters and/or with meeting up for face to face consultations.

Joanna Geyer-Kordesch, whose research as a Professor of the History of Medicine was the basis for this series, has read hundreds of such letters in English, German and French.

I didn’t know such a practice had ever existed.

Just think for a moment how different this practice was from our current doctor-patient relationships.

First of all, the record of the person’s illness is now created and held by the doctor. The stories have been turned into case notes and typically it would be extremely difficult to gain any understanding of who the person is if you were to read these notes. Doctors notes (I don’t think they usually could be stretched to be considered as stories) are mainly lists of symptoms, physical findings and results of investigations, then diagnostic labels based on pathology. The advice recorded certainly isn’t in the form of a conversation or exchange with the patients. In fact advice is more likely to have been replaced by a list of drugs prescribed.

What are the consequences of this change?

There has been a shift in power – from the person to the doctor, or the institution. This shift in power is so great that the words recorded are much more likely to be the doctor’s words and his or her interpretations of the person’s experience, rather than any record at all of the story the person has told (it’s not like that where I work because we have a tradition of writing down the patient’s actual words as much as we can – however, it’s still the doctor making and holding the record, not the person whose life it is)

There has been a shift in focus – from the person to the pathology. As Eric Cassell so beautifully describes in his “The Healer’s Art”, and “The Nature of Suffering”, illness is what the person goes to the doctor with and disease is what he comes home with.

It seems to me we’ve lost sight of the human being in the process. By reducing someone to a mere physical body to measured and imaged, we have dehumanised Medicine. The PERSON has been lost. How do we get the PERSON back into the centre of the stage? How do we get the individual’s agenda back at the heart of the medical engagement? How do we regain the truth of the uniqueness of every single human being and move away from the mass production processes of reducing people to diseases, diseases to “managed”, rather that people to be healed?

A good starting place would be to enable people to tell their stories – in their words, in their order of priority, in their own style – to reveal not just their sensations and experiences, but also their choices, their values and their beliefs (and what about the creation of the record? How and where would you create the record of your illness and your healing?)

Maybe valuing each individual’s story would begin to let us re-humanise Medicine?

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How do we get to know someone?

Posted in from the consulting room, from the reading room, health, life, narrative, perception, personal growth on June 17, 2012 | Leave a Comment »

Every day at work I’m focused on trying to understand another person. Every patient who comes to our hospital is seeking, amongst other things, an explanation.

If someone has been given a diagnosis of, say, Multiple Sclerosis, amongst the many questions they are likely to have, are “What does this mean?”, “What does it mean to me, and to my life?”, “How has it come about?”, “Why me?”, “What is this illness and what things are going to make it better, or worse?”

We all have many other questions too, but these questions are amongst the ones to do with explanation.

It’s perhaps even worse when a clear diagnostic label hasn’t been given. When someone suffers chronic pain, chronic fatigue or chronic low mood but “all the tests are normal”. What then? What’s going on?

Explanation involves getting to know someone. If we limit the explanation to a tissue level e.g. “arthritis”, or to an organ level e.g. “angina”, then we stop before we explain this illness in this particular person’s life. And if we want to help the person, not just the “arthritis” or the “angina”, then we’re going to have to take into account the uniqueness of this person’s experience of this particular illness.

A major way we can do that is through story.

It’s through the telling of a story that we gain our insights, and our explanations. For me, two of the questions I want to answer with every patient are “what kind of world does this person live in?” and “what are their coping strategies?”

The kind of world we live in is fashioned by our beliefs, our values and our circumstances (our contexts or environments, physical, relational, cultural), and the way we try to adapt to the changes in our lives are manifest in our default and learned strategies.

In an article entitled, “What do we know when we know a Person?”, Dan McAdams points out that the explainer, or the observer is also important  -

One must be able to describe the phenomenon before one can explain it. Astute social scientists know, however, that what one chooses to describe and how one describes it are infiuenced by the kinds of explanations one is presuming one will make. Thus, describing persons is never objective, is driven by theory which shapes both the observations that are made and the categories that are used to describe the observations, and therefore is, like explanation itself, essentially an interpretation.

In other words, my world view and my coping strategies will influence what I see, what I hear and what sense I make of the patients who consult me. I’ll return to that issue in another post, but Dan McAdams article starts with an interesting conceptual framework for what we know about another person.

Individual differences in personality may be described at three different levels. Level I consists of those broad, decontextualized, and relatively nonconditional constructs called “traits,”…….At Level II (called “personal concerns”), personality descriptions invoke personal strivings, life tasks, defense mechanisms, coping strategies, domain-specific skills and values, and a wide assortment of other motivational, developmental, or strategic constructs that are contextualized in time, place, or role……..Level III presents frameworks and constructs that may be uniquely relevant to adulthood only, and perhaps only within modern societies that put a premium on the individuation of the self…..Thus, in contemporary Western societies, a full description of personality commonly requires a consideration of the extent to which a human life ex- presses unity and purpose, which are the hallmarks of identity. Identity in adulthood is an inner story of the self that integrates the reconstructed past, perceived present, and anticipated future to provide a life with unity, purpose, and meaning.

You can read the full article by Dan McAdams here.

So, how do we get to know someone? Partly it involves knowing ourselves, being aware of our own way of seeing and experiencing the world, knowing what we pay attention to, what we are fascinated by, disinterested in, what we believe and what we value.

And, partly, it involves a focus on the telling of a story – one which “integrates the reconstructed past, perceived present, and anticipated future to provide a life with unity, purpose, and meaning”.

That’s a good start, I reckon.

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Healing narratives

Posted in from the consulting room, from the reading room, health, life, narrative on October 21, 2011 | 9 Comments »

One of the main themes of this blog, and probably a core theme of my daily work as a holistic, integrative doctor, is the place of narrative in our lives.

I recently mentioned in another post that working with patients’ narratives was a part of what I and my colleagues do every day at the Centre for Integrative Care in Glasgow. A couple of readers have asked me to say more about that and I thought I’d pull together some thoughts into this post.

One of the first books I read which impressed me about the importance of stories in medical work, was Arthur Frank’s “The Wounded Storyteller”. In this book, which is the product of years of research, Frank claims that there are two very common types of story patients present to clinicians – “restitution” stories, and “chaos” stories. He proposed that we can think of these as two primary “genres” of story. The former is probably the commonest in biomedicine healthcare. It can be captured with the phrase “I’m broke, please fix me”. It’s an approach to illness and health which considers that disease is a dysfunction or lesion somewhere and that if the bit that’s wonky could just be fixed then all would be well. The latter is also very common, especially when there are a multitude of symptoms and the person has  become lost in the illness.

Frank proposes that a clinician’s job is to help patients turn these stories into “quest stories” – based on the principles of Joseph Campbell’s hero narrative.

The integrative journey from stuckness or chaos to flow and coherence emerges out of this creation of a new narrative.

Another reason to work with narratives is the human need for myth creation. We are meaning seeking creatures, and the myths, or universal stories, as Karen Campbell calls them, shape our lives. So it makes sense to understand which myths we’ve incorporated into our stories.

Shifting from the materialistic, reductionist myth to a soulful, heart-focused, holistic one, allows the creation of a much more positive story, one which brings hope, and which opens up the possibilities of a different future path.

A key component of the creation of a future with a more clear set of potentials is choice. William Glasser’s Choice Theory, turns our narratives on their heads, and focuses us on the verbs we use to describe our experience. What emerges is a much more autonomous, more powerful story – a shift from passivity to activity, from victim to autonomous individual, from zombie to hero.

But it’s not just the verbs in our stories which are important. It’s the metaphors too. The amazing work of Lakoff and Johnson demonstrates the embodied nature of metaphor, and in so doing gives us the opportunity to pick up on the metaphors we are using, including the bodily locations of our diseases or disorders, and gain a profound understanding of the meaning of our illness experiences.

I hope for stories of improvement as I work with patients, but the stories which excite me the most, are the ones of transformation. Yet again, this week, I’ve heard several such stories. That makes it a complete thrill and delight to be able to practice Medicine this way.

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The importance of stories – fictional stories

Posted in books, creativity, education, from the living room, from the reading room, life, narrative, psychology, writing on September 11, 2011 | 1 Comment »

I’m a great fan of stories. In fact, I think we understand ourselves and others by using narrative, and the central way in which I work as a doctor is to hear people’s stories, and help them to change them from stories of being stuck or in chaos, to stories of flow, and flourishing and growth.

I’m also a great fan of fiction and the importance of the imagination. I vividly remember Ian McEwan writing this, about this day, ten years ago…

If the hijackers had been able to imagine themselves into the thoughts and feelings of the passengers, they would have been unable to proceed. It is hard to be cruel once you permit yourself to enter the mind of your victim. Imagining what it is like to be someone other than yourself is at the core of our humanity. It is the essence of compassion, and it is the beginning of morality.

So, this recent article in the Guardian caught my eye, “Reading fiction improves empathy, study finds”. There are a number of studies described in this article, and it’s introduced me to something called “the pyschology of fiction”, and, specifically to the work of Keith Oatley. If I wasn’t so insatiably curious I wouldn’t keep finding these amazing new worlds to explore! One of the studies described in the article compared the effects of reading Harry Potter with the effects of reading Twighlight. They used a new measure – “Twilight/Harry Potter Narrative Collective Assimilation Scale”! Don’t you love that? Look at this conclusion from that research -

“The current research suggests that books give readers more than an opportunity to tune out and submerge themselves in fantasy worlds. Books provide the opportunity for social connection and the blissful calm that comes from becoming a part of something larger than oneself for a precious, fleeting moment,” Gabriel and Young write. ”My study definitely points to reading fulfilling a fundamental need – the need for social connection,”

and read this fascinating comment by Keith Oatley

“I think the reason fiction but not non-fiction has the effect of improving empathy is because fiction is primarily about selves interacting with other selves in the social world,” said Oatley. “The subject matter of fiction is constantly about why she did this, or if that’s the case what should he do now, and so on. With fiction we enter into a world in which this way of thinking predominates. We can think about it in terms of the psychological concept of expertise. If I read fiction, this kind of social thinking is what I get better at. If I read genetics or astronomy, I get more expert at genetics or astronomy. In fiction, also, we are able to understand characters’ actions from their interior point of view, by entering into their situations and minds, rather than the more exterior view of them that we usually have. And it turns out that psychologically there is a big difference between these two points of view. We usually take the exterior view of others, but that’s too limited.”

Spot on. He really nails the importance and value of fiction as a tool for building empathy. We reduce the place of the Humanities in our education system at our peril!

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Wiping your memories

Posted in from the reading room, health, narrative, psychology on August 23, 2011 | Leave a Comment »

One of my favourite lines from Bob Seeger is “I wish I didn’t know now what I didn’t know then”.

However, I was a little startled by a piece in the “i” newspaper last week about drugs which can wipe out memory. Here’s a jpeg of the bit of the article which really took me aback….

 

 

 

 

 

 

 

 

 

I don’t know about you, but as best I understand it our memories are a key part of the stories we tell ourselves and others to create both a sense of self, and to make sense of our lives.

Who’s to say that a painful memory has no value. A painful memory will probably always be a painful memory, but our responses to painful episodes can be the important foundations of who we become.

Before I go…..here’s the song in question (performed by Toby Keith)

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Dimensions of meaning

Posted in from the consulting room, health, narrative on June 16, 2011 | Leave a Comment »

In a consultation recently, the question of what makes an experience or a relationship meaningful came up. Whether or not something feels meaningful is something we seem to know intuitively. We don’t usually sit down, consider the details, weigh them up, then reach a calculated conclusion. But what makes an experience or a relationship a “meaningful” one?

I think there are at least two dimensions to this.

How does this experience, or relationship, fit in to my story?

A story, or a narrative, has a beginning, a middle and an end (actually, I’m increasingly doubtful about this concept of an “end”!). Let’s say then, that in constructing the story of my life, I consider the present as it emerges from the past and lies in the context of the possible futures. We do create a sense of who we are by telling ourselves and others a story – the story of my life. This is one of the two dimensions of meaning. How does this experience fit into my story? Is it strongly embedded? Is it complexly and multiply connected? How does it relate to all that has gone before, and how might it influence the scope of the possible futures? We tend to feel something is “meaningful” when we can make sense of it within our story, and when it is deeply connected to so much of our story.

Secondly, we tend to feel something is meaningful when it makes a big impact. This feels like a second dimension of meaning. The power, the strength, the depth even, of the impact. You could say this is “significance” or you could simply call it “impact”. Of course, it’s likely that the strength of an impact will have an influence on the extent to which it becomes an important part of our story.

Maybe the less meaningful experiences, are covered by a line, or a few words in our story. A paragraph at most. And maybe the more meaningful ones gain an entire chapter, or even volume, of their own?

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The Renewal of Generosity

Posted in books, from the consulting room, from the reading room, health, narrative, philosophy on April 25, 2010 | 2 Comments »

I recently stumbled over Arthur Frank’s “The Renewal of Generosity” (ISBN 978-0226260174). Many years ago I read and was hugely impressed by his “The Wounded Storyteller”. It’s a great small book which is an important contribution to the struggle to create a better way of practising medicine in the 21st century. Doctors and patients are increasingly demoralised by the reduction of health care to technical procedures and the delivery of products (what Dan Siegel describes as “diagnose and drug” in his analysis of contemporary psychiatry). The everyday, subjective experiences of both patients and doctors are dismissed as irrelevant in the pursuit of measurement, targets and throughputs. Isn’t it some kind of indictment of our current health care that he can say this on page one -

My conviction is that at the start of the 21st century the foremost task of responding to illness and disability is not devising new treatments, though I’m grateful this work will proceed. Our challenge is to increase the generosity with which we offer the medical skill that has been attained.

That’s the word which really struck me – generosity. I think a lot about compassion and its central place in good health care, but I’ve not really considered the work generosity. It’s such a good word. Somehow it not only encompasses compassion but it contains within it a sense of enlarging life – my own life, and the lives of others to whom I am generous. It’s a welcoming, loving, life growing word. It’s a good word to bear in mind when considering “how to live”, how to find happiness and how to create well-being.

His key theme in this book is to weave together the teachings of ancient Stoicism (a much misrepresented classical philosophy I believe), with the case for dialogue. He primarily draws on the writings of the Stoics, of Levinas and Bakhtin.

The practice of medicine is a relationship between two people. What are we to call these two people? As a doctor, I’m fairly comfortable with the term, “patient”, but it bothers me that it seems to imply something passive, expecting the ill person to just be treated, and that contains the seeds of objectification – treating people not as people, seeing them as instances of disease, instead of persons who suffer. I hate the word “client”. It’s laden with commercialism and contractualism for me. However, Frank pulls a different set of words out of the bag and they hit me between the eyes -

The renewal of generosity will be hastened if participants in medical relationships think of themselves not (at least not only) as patients and professionals, much less as consumers and providers, but as guests and hosts.

Guests and hosts! He elaborates and explains, but I won’t share that here. Just think about this idea for a moment. I’ve never encountered it anywhere else. Wonderful.

I love so much of what he has to say about the importance of dialogue -

Dialogue suggests that the world is co-experienced by two of more people. Each one’s perspective is necessarily partial, and each needs to gain a more adequate sense of the world by sharing perspectives.

I wrote about that from a neuroscience perspective recently here.

The enlarging of perspective, or, in the other words, the attempt to see a more full picture demands dialogue. It prevents us from dismissing others through judgement and classification.

…no final, finalising discourse that defines anything once and forever. No last word can be said about this you, whose horizons of possibility remain open.

“whose horizons of possibility remain open”……how often do we forget that? How often do we squash hope with the illusion of certainty? How often do we practice as if we know exactly what a treatment will bring about for the person undergoing it? Having open horizons of possibility is a characteristic of healthy living.

We have other good reasons for dialogue apart from sharing our perspectives to gain a fuller picture. We use dialogue to value the other.

…the moral demand of dialogue is that each grant equal authority to the other’s voice……it’s being willing to allow their voice to count as much as yours

[doctors] are taught monological medicine: the doctor is the one cognitive subject in the consulting room, and the patient is an object for that cognition.

Identification with others requires giving up monologue.

The other element which we have to consider when we focus on dialogue is the other part of the doctor-patient (or host-guest) relationship – the carer. I think our system of medicine dismisses this almost entirely. The focus on “randomised controlled trials” is a focus on the statistics of groups. Once a drug or treatment is “proven” it seems to be irrelevant who delivers it, or how. Yet that’s not our experience when we are ill. Who the doctors and nurses are is important to us. How they talk, how they listen, how they treat and care for us. The idea that its the treatment which is important and the not the person administering it seems inhuman to me.

We can keep the question before us: what do they think about how I am imagining them? and we can believe that what they think matters.

We should honour patients’ stories, not dismiss them as “subjective” or “anecdotes”. They matter.

Finally,

…the person who we see ourselves revealed to be is seen most fully in others’ responses to us

Isn’t that so true? What have you seen of yourself in others responses to you today?

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