Heroes Not Zombies

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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