Willing to Listen

One of the things I'm most grateful for has been the opportunity to learn from clinicians who practiced before the advent of psychiatric medications. There haven't been many and I can call only three by name. Two were psychiatrists, one a psychologist, and as members of the Great Generation, they had the shared experience of developing clinical judgment at a time when there was little else to fall back on.

For example, one related to me how she and her colleagues during residency were called upon to do psychotherapy with psychotic patients. When I asked what that was like, she replied, "It was bedlam. But I learned first-hand what worked and what didn't. I also learned how to express myself as meaningfully as possible knowing my patient had a limited capacity for understanding. It's different now -- we wait for medications to begin to work. That's much better, but the personal element can't be forgotten."

I once had the good fortune of participating in a hour-long eight week individualized seminar with this same woman. At the time, I thought we were reading and discussing the classics of psychoanalytic literature. In retrospect, however, I've realized she had a more practical goal in mind: she was teaching me how to think. With all of the current emphasis on data gathering and analysis, one might be inclined to regard careful thinking about patients as a luxury, but in fact, it's the guiding principle in the determination of what constitutes a potentially effective treatment.

By making the time to contemplate who we're dealing with and what they really need, we provide ourselves with an opportunity to break free of restrictive and artificial constraints that limit creativity. Thinking outside the box, to borrow a well-used phrase, requires a willingness to consider alternatives that may not exist in the laboratory setting.

Perhaps what I've gained most from having some older teachers is the awareness that there's something more important than the newest and best thing. I don't mean they're distrusting of change -- quite to the contrary, they're the agents of it. I mean their insistence on the individual patient being the primary consideration in decision-making. It doesn't matter if all the evidence in the world is persuasive, if we're not intent on meeting the needs of the patient, we're not likely to make a difference. It takes real presence of mind to make those kinds of decisions. The ones who have it are the ones who've gained it the hard way and by passing it along, they've definitely made things a lot easier for me and anyone else who's willing to listen.


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