What are you reading? (And what are you drinking with it?)
Name: David Bolton, Chelsea Harbour, London
Book title: Black Rainbow: How words healed me – my journey through depression
Author: Rachel Kelly. All author proceeds go to the mental health charities Sane and United Response
What are you drinking with it: Australian Pinot Noir
Thoughts so far:
Rachel has been a journalist for many years, including ten years on The Times, where she was variously a reporter, feature writer and columnist. Her interest in health and therapy led to her completing the first year of training as a counsellor. She is the co-editor of ‘If: A Treasury of Poems for Almost Every Possibility’ and currently lives in London with husband and their children.
Having read the book, I was recently fortunate enough to actually meet the author and get an insight into what Rachel actually went through and the loneliness of feeling no one really believed just how much she was suffering at the time. Over a period of three days, Rachel recounts how she descended from being a functioning working mother into a pain ridden physical and emotional wreck. There was no warning, no physical cause and no apparent trigger. Before me was a woman that I could feel had suffered deeply. Suffered not only from her disability but suffered from the fact that no one, at the time, was listening to the fact of how much “Physical” pain she was experiencing. The medical teams’ focus was on her emotional state and appeared not to believe that emotions could be manifested in a physical way:
“I couldn’t believe I could simultaneously be alive and feel such pain. Everything throbbed. It was a pain like no other, suffusing every bit of me. I had become pain, and pain had become me. If only it could just affect an arm or a leg. I would have swapped everything for containable agony. If only there had been a gashed lip, some vomit or blood to demonstrate what I was feeling. No one realised how much I hurt. No one understood. There was nobody to whom I could explain this total disquiet”.
Rachel is a woman who has shown great courage and determination to survive her ordeal – despite medical intervention at times. Following on from her suffering, it took Rachel six years to write this book and her work has given great support and hope to many fellow people since. Rachel found comfort and relief through poetry, meditation and mindfulness. She shares many poems with us in her book.
In my humble way, I explained to Rachel how, in my opinion, physical and emotional pain are probably one in the same. I explained that if we are not acknowledging our emotional state then the brain will endeavour to protect us by letting us know in another way that we are in Danger, even be it from our thoughts! The brain wants us to listen and take the situation seriously. If a state of denial exists, for whatever reason then the brain will try to let us know by whatever means at its disposal. The “Danger” can then be manifested through the physical experience of body pain and even body pathology. Rachel expressed that, had she had this little piece of knowledge and understanding of pain, just how much better she would have been able to endure her experience of not being heard. The words of poetry gave her such relief, imagine what the words of pain knowledge might have achieved.
On a daily basis neuroscientific research is revealing the treasures of the workings of the brain, the construction of consciousness, of thoughts, feelings and emotions. However we don’t only need science to prove a point, we simply need to listen to the patient as their experience is their reality………
– David Bolton
David Bolton, MCSP MMACP MSOM, has over 40 years of clinical experience in the field of neuromusculoskeletal medicine and is a long time NOI faculty member. After qualifying in 1971 from the Royal Army Medical Corps School of Physiotherapy, David spent 24 years living and working in Switzerland, running a busy and very successful private practice as well as providing specialist physiotherapy services to the Swiss Alpine Downhill Ski and Ski Jumping Teams, the Swiss National Karate Squad and the Menuhin School of Music.
In 1997 David decided to down size and move his practice back to his roots in London. Setting up Limbus in Chelsea Harbour, David now specialises purely in acute and chronic, therapy-resistant pathologies, biopsychosocial thinking being the core of his treatment philosophy.
In his free time, when you can get him off the tennis court, David loves to travel.
Listening to patients is what we’re slowly forgetting as doctors. Sad, really.
It’s an unfortunate fact that the degree of openness and understanding a professional offers will be inversely proportional to the level of suffering of the client. In other words, the more you’re suffering, the less likely you’ll get the help you need. There’s no way Rachel’s experience could have been any different at that point in time unless she had by chance met some extraordinarily talented therapist. She needed a helping hand to pull her out of hell and instead had to rely on reading poetry and teaching herself meditation??!! Sure, most poets are depressives and in that sense you can feel out some common ground, but that’s going about things the hard way.
The problem is that high levels of suffering create extreme vulnerability. That means that the sufferer’s usual ability to ‘reach out’ is shut down – it becomes too dangerous. As therapist, are you prepared to give of yourself without getting anything in return? The contagious nature of negativity is also a crucial issue. Do you know how to come away from such a therapeutic encounter without that negativity sticking to you? It’s yet another example of something that is not taught to Physios, but should be. Instead, get your mobs down pat….yeahhhh! L5 manip! …fucken awesome!
I’ve written about the importance of empathy in another noijam thread. I only wish I could do it better myself. It’s an incredibly rare skill.
Thanks David and Rachel,
I am looking forward to reading “Black Rainbow”. The extraction and “airing” of the lived experience via the arts, clinical encounters, qualitative and quantitative research is so important for us all.
Let’s say empathy is what Rachel needed. What would be considered ‘proof’ of empathy in a clinical setting? How do you know you’re actually doing it right? How would you know if you’ve ever been empathetic at all?
For me, the proof of empathy is the ability to ‘lead’ (as in the NLP sense of leading). In NLP-speak ‘pacing’ is the process, and ‘leading’ is the proof. To test for proof is easy. Once you feel rapport is established, alter something about your body or mind, such as posture, breathing, thoughts. You should notice an immediate matching in the client. They will alter their mind or body to match yours. They will ‘mirror’ you unconsciously.
Empathy is much, much more than just:
– nodding along as the client speaks
I can only do empathy sporadically. Can you do it? Am I speaking to myself here as usual?!! If you can do it reliably and consistently, share you experience for me and others to learn from. This is a forum for sharing ideas, and I for one am keen to improve. How about you?
Do you think that there could be a state where empathy becomes effortless and continuous? I don’t know, just wondering really. I believe i have had some uncanny experiences with empathy in the past – one instance in particular when some really heavy information was disclosed by a client, seemingly out of context to the general discussion. Afterwards, the person looked at me and said “I don’t know why I told you that, I’ve never told anyone about that before. Ever.” I remember being a bit taken aback, probably losing any connection as i tried to consciously find the right thing to say in return. In the end an honest expression of thanks and appreciation for being trusted seemed to be the right thing to say. I do recall that at the time i was sitting facing the patient, i wasn’t writing anything down. I was also reading a lot of Erickson at the time….
PS: We can confidently say you are not speaking to yourself by looking at site stats- views, return visitors, post views etc! We like to think (hope) that even if we haven’t stimulated a comment, we have stimulated some thought…
Thanks Tim, I can definitely relate to that. Having a client very suddenly BLURT out personal info which is seemingly out of context to the moment is even better proof than pacing. Yep, much better proof. I’d forgotten about that situation, but it’s very powerful isn’t it? It’s like ‘whoah… where did that come from?’ Then one has to remain centered, which is another level of skill development again.
Such examples are always worth recalling. Sometimes I feel like the potential for rapid and deep healing is enormous.