When I was in medical school I learned to listen. I was taught to listen to heart sounds, breath sounds and bowel sounds. As a psychiatric resident I learned to listen to a patient’s speech. Was it speeded up or slowed down? Did it make sense? Was it loud or barely audible? It used to be in psychiatry, all we had to offer was listening; there were no medications. Now it seems, all too often, medications are prescribed and there’s not enough listening.
For any doctor, it’s not always obvious what’s going on with a patient; signs and symptoms can be subtle. In psychiatry, when this is the case, when what’s causing the pain isn’t readily apparent, listening becomes even more important. To ease the pain at these critical times, patient and doctor need to work together, listen together, to what the patient is thinking and feeling, saying and not saying.
This I believe — to listen is one of the most important things you can do to help someone. I became a psychoanalyst to learn to listen closely to my patients, to learn to notice the clues about what’s going on underneath the surface. When someone professes her love, you sometimes find hate. When someone tells you, she almost got hit by a bus on her way to your office, underneath the fear, you find excitement. We human beings are complicated.
I listen for the shifts when someone is telling me a dream and all of the sudden they’re talking about the upcoming weekend. What just happened? You were telling me one thing and now you’re telling me something else. How did you get there? Are these things connected? Is there something you’re avoiding? I listen for the silence. What are you thinking and not saying? It’s hard work to listen and it’s hard work to be listened to so closely.
Psychoanalysis is not a quick fix. It’s the unfolding of a human life one thought, feeling, one memory at a time. People get tied up in knots and can’t get themselves undone. They go around in circles and need help straightening things out. People do the best they can but with help, they learn to listen to themselves and when they do, something happens: they start to understand why they keep ending up in the same place – the same ungratifying relationship, the same unsatisfying job — they learn to untie the knots themselves, to help themselves, rely on themselves – a wonderful skill to have while negotiating the ups and downs of life. When we learn to listen good things happen.
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