Letting go of ourselves; how opening our minds will let us understand our patients
Empathy is described by Webster's dictionary as 'the feeling that you understand and share another person's experiences and emotions' 1, the subjective knowledge that you can be inside the mind of another and feel things as they do. I would argue that although this is a beautiful concept, due to the variation of people's experiences, the stories of their lives and their dreams and aspirations, no one can ever truly empathise before letting go of themself.
In my work I often hear long stories, sometimes connected, mostly unconnected, with the physical symptoms that a patient displays. It is more often than not, as previously discussed in another of my articles, the change in a patient's way of life that is their main concern, not the physical problem causing it. It is the subjective perception of an objective physical or mental change that presents the drama within their own mind.
Through my extra academic work into philosophy, psychology, neurology and through reading classical literature, I have noted a basic human desire to label and explain the external world with reference to ourselves. This message is conveyed in either parable or direct prose from religious texts to Stephen Hawking's 'A brief history of time', where Hawking quotes:
'Humanity's deepest desire for knowledge is justification enough for our continuing quest. Our goal is nothing less than a complete description of the universe we live in2.'
Hawking's grace with words beautifully expresses an underlying psychological process that may at times burden our brains but, at the same time, paint the canvas of our deepest dreams and questions. We wish to know the universe, to know our purpose, to know ourselves, to explain changes in the universe we see to give us some inkling of their significance, and how we our significant.
Happiness, sadness, anger and many more such feelings are all primal responses to the complexity of the universe we see, something deep within us, explained through psychology as conditioned responses, through anatomy as limbic activation3 and through literature as the beauty of things. We paint our image of the universe with our own brush, the paint coloured by our own lives.
Those who have read 'Love in the time of cholera' will know the bitter beauty of a life spent in the shadow of unrequited love, and you may have your own judgements about Florentino Ariza and his choices4. Some may argue that his life spent in waiting represents the purest of human love - the greatest that our minds and words can create - is a life well spent. Others may argue that his life was wasted, opportunities missed in the false deification of a lost summer love. I would argue that both viewpoints are right, that your interpretation is based on your own understanding of your universe and your own values. Florentino represents a longing deep in all of us to connect with another, and in a deeper way, to connect with the universe itself.
I would argue that it is the variation in our perspectives that makes for the rich tapestry that humanity will leave hanging in our corner of the universe. Each story told is simply strand intertwined with a million others, and as doctors we have the privilege of becoming part of many. Realising that our thoughts are simply our own, our own opinion and ascribed our own value, is a step in the right direction to understanding others - that standing back from your square in the tapestry allows you to see the entire works.
For a patient, a word I abhor and wish to replace with 'John, Mary, or whoever', their strand is redirected by illness, however minor or major, and ends leaving a different mark on their universe, a frayed edge or missed thread. For my time in oncology, seeing those facing death with bravery and pride, the last threads of their ebbing strands glowed brighter than ever before as the wonderful healthcare staff helped them tread their own path.
In treating these amazing people I learned to forget about my own views of the world, my own assumptions of the universe, to clear my mind and listen to not just their words, but what they wished to convey with them. To paraphrase a famous spiritualist, words are signposts pointing to something5 , and are often taken further than what they actually mean. To fully understand the emotional context conveyed in a word one must lose their own assumed reaction and critique their own understanding, their own mind created connection, and see things anew.
Seeing things anew, letting go of your own views and trying to learn and understand those of the patient is the closest I argue that we can come to true empathy. Even suffering the same ailment does not mean you see the disease the same way; it does not paint the same story or change your view in the same way. In the end medicine is not just dealing with disease, it is dealing with the minds and dreams of those, who through forgetting themselves, realise we are simply part of one cosmic consciousness. We are all painters, each with our own brushes and colours, but only by letting go of our own can we pick up another's.
At the beginning of this article I quoted Webster's definition of empathy, but I now propose a minor amendment:
'the process by which letting go of your own view, you may understand and share another person's experiences and emotions'.
By seeing the universe through the eyes of another, we can see how their story changes and how we can help shape their narrative, guide their thread, or steady their hand, in making the mark they wish to leave on this universe. That, I argue, is our empirical job as doctors, to help people be who they wish to be. So as healthcare professionals, junior or senior, how do we achieve this? Greet each new person with the zest with which you approach a new novel: without assumption, without preconception and with open arms and mind.
1) http://www.merriam-webster.com First accessed 27/12/14
2) Hawking, S. A Brief History of Time, 1988, Bantam Books, Transworld Publishers, England
3) Peters, S, The Chimp Paradox, 2011, Ebury Publishing, England
4) Marquez, G G, Love in the Time of Cholera, re-published 2008, Penguin, Australia
5) Tolle, E, The Power of now', 2001, Hodder Publishers, England