Sunday, 16 January 2011

Talking Stoicism and the Telling of Touching Tales

I have been involved in a great deal of talking this week. Some of these conversations have been difficult and have appeared to evoke powerful emotions in others. Throughout the week, the impact on individuals has been plain to see. How one responds to such emotionality is important.

In the first week of their experience as a student nurse or midwife I meet  all as the students as a group to talk about what becoming a nurse or a midwife might entail. I believe that in order to care for others we must also learn how to care for ourselves. So part of my talk highlights the tensions involved in learning to become a professional, and how we all need to embrace rather than reject or suppress the emotionality of practice. I am interested in getting the students to start thinking about their understanding of their self and their self in relation to others. Critical to developing this understanding is the need to find different ways of communicating with each other. Such communication, between the carers and the recipients of care has to be so much more than simply talking (to each other). True therapeutic endeavour and communication involves recognising of the humanity in self and others. Getting to this place clearly takes experience, reflective thinking, and awareness of self. Arthur Frank, the Canadian sociologist describes the importance of achieving effective communication through dialogue: ‘To exist as a human is to communicate with others.’

He observed in his wonderful book, The Renewal of Generosity: Illness, Medicine and How to Live, that often such dialogue is replaced by a professional discourse. The use and reliance on this professional response might be both conscious and unconscious. Indeed twice this week, in different contexts, I was told I had slipped into therapist mode, when something different, more personal perhaps was required. Whilst I joked that being theraputic was the default postion for mental health nurses, in my heart I knew my response was a consquence of a defended me. Borrowing from what Winnicott describes in his work (Clinical Varieties of Transference) as: 'every failed analysis being a faliure of the analyst not the patient', my use of a professional discourse was detrimental to all of us involved. Franks links the need to achieve the dialogical communication to Stoic philosophy. Stoicism, whether espoused by the nurse, midwife, social worker or patient, asks: ‘who are you choosing to be’, regardless of where you find yourself, and ‘is that your best choice?’ It is the Dialogical Stoic which provides us with insight as to ‘how to be’ or ‘how to live’.

The experiences of this week have shown me that, ‘how to be’ in situations that might be experienced as stressful or difficult either by me or others can sometimes require more than just the verbal form of communication. In those difficult conversations this week with colleagues I clealry failed to recognise the need for or provide the holding environment Winnicott talks of,  made up of the physical, emotional and psychological, but also more than these.

As I have also been reminded this week sometimes it can be difficult to replace words with a gesture that allows us to reach out and provide that physical and emotional connection. Often simply a look or touch is more effective than words, and can demonstrate the generosity and consolation Franks describes as being an essential element in building effective relationships between the carer and cared for.

I am determined to try and remember that as all our worlds continue to change and become more turbulent we all need to be aware of the way in which such changes can challenge our ontological security, or the ontological security of others. Being there for our self of others is not only about what we say but what we do and the way we chose to be. Franks book is well worth a read if you haven’t already done so. Constructed around the stories of Franks own experiences and the experiences of others, the book provides and opportunity to truly reflect and better understand the nature of our intra, and interpersonal relationships. These are touching tales indeed.