Heroes Not Zombies

Look at these two photos. The first one is plant with a LOT of spikes on it. You wouldn’t want to reach out and touch it, would you? It’s not exactly inviting you to get up close and personal. The second image is one of Anthony Gormley’s sculptures. If you are familiar with his work you’ll know he often creates his pieces around moulds of either his own body, or the bodies of others. This particular piece was part of a work where he filled a room in a gallery with several items which look just like this. They were all placed pretty close to each other and you had to make your way between them. It was a really uncomfortable experience, and I think that was the point.

Ever since I saw this work of art I’d find it coming back to mind when I met certain people. I’m sure you’ll have met people like this. Prickly people. People who are hard to get close to, and who will send out vibes which let you know that if you don’t keep your distance you’re going to get hurt.

It’s hard to be around people like that. You have to be wary all the time and you never know when you’re going to get stung. Most people, most of the time, aren’t going to make the effort. We give them a wide berth.

I’ve had patients who are like this. They give the reception staff a hard time, and they are often judged by others, dismissed as « troublesome », or « difficult ». But I found that in every single case, in the privacy of the consulting room, in an atmosphere of care and compassion, with non-judgemental, attentive listening, that the spikes are withdrawn, and a soft, hurt, vulnerable soul is revealed.

Because these spikes, whether on a succulent plant, or on a « difficult » person, are there for defence.

There are countless ways living organisms defend themselves. Every one of us develops our own, unique, suite of strategies and deploys them, mostly unconsciously, whenever we feel the need. How often we feel the need will be determined by our stories so far, and fashioned by our experiences, traumas and hurts.

Adaptive strategies became my specialist subject. Once I understood that there are strong links between the ways we cope and the ways we become sick, I began to understand everything from illness, to pathology, to personality characteristics and behaviour patterns as manifestations of these strategies.

Emotions are adaptive strategies, but our patterns of defence function at a whole being level, involving not just our behaviours and thought patterns but the functions of our organs, our body systems, our tissues and our cells. That’s why I preferred to take a holistic approach to every patient. When you look at someone through this lens, you seek the connections which will help both you, and them, to understand just what’s going on, how it might have come about and what they can do to change what they are experiencing.

I don’t think this style of medical practice can be reduced to measurements and algorithms. It’s built on a relationship. A relationship between two people who gradually get to know, and to trust, each other. It’s built on the revelation of stories and the do-creation of the next chapter. It’s personal, takes time, effort and attention.

When I think of how I’d like health care to develop from here, I always think of the uniqueness of every person, the uniqueness of every relationship, and the importance of understanding, not judging, the adaptive strategies of every patient holistically. It seems to me that any system which ignores all that will be inadequate.

But, hey, before I go today, I realise that, as usual, I’ve written from the perspective of a doctor. It’s what I know best. But there are prickly people in all walks of life…..at work, in school, in families. They are difficult to be around and hard to get to know. I suspect we all use a range of ways to cope with them – maybe mostly avoidance! And sometimes “giving as good as you get”. But there is another way, which isn’t necessarily easy. It’s to use compassion, non-judgement and curiosity. Maybe the spikes won’t go away but you might come to know and understand that there’s a lot more to this person than spikiness!