Iíve been thinking lately about the nature of the
historical details I acquire as I speak to my patients each day. As important as
weíre taught this is and as much as I wish these details would answer the
questions I have about the condition Iím trying to manage, Iíve concluded
that history is often an incredibly unreliable indicator of what actually
happened at any time in the patientís past. And I mean last year as well as
Of course, this conclusion troubles me. I have shelves
packed with charts full of information that is supposed to be reliable, helpful,
accurate, and legally binding and in case anybody important is actually reading
this they certainly are. But the foremost authorities on the subject of recall
all agree that there is a thin veil between memory and imagination. If this is
the case how can I be expected to believe everything Iím told? When I go back
through what Iíve written I canít help but wonder if it describes what
actually happened or even what I think I remember the patient told me. Iíve
come to feel that what the patient tells me is akin to an autobiography, often
full of flattering details and colored by desire. What I end up writing down
isnít any more reliably true than an unauthorized biography. There are
important things missing and an emphasis on others that arenít really relevant
I donít think that this is a fixable problem but itís
worth discussing. Maybe my discomfort with those charts will ease a bit if
understand more about how history might be described. Toward that end Iíll
offer something I recently read in a fantasy by Ursula K. Le Guin.
In the forward of Tales
from Earthsea (Harcourt 2001) the
author writes, ďThe way one does research into nonexistent history
is to tell the story and find out what happened.
I believe this isnít very different from what historians of the
so-called real world do. Even if we
are present at some historic event, do we comprehend it--can we even remember
it--until we can tell it as a story? And
for events in times or places outside our own experience, we have nothing to go
on but the stories other people tell us. Past
events exist, after all, only in memory, which is a form of imagination.
The event is real now, but once itís then, its continuing reality is
entirely up to us, dependent on our energy and honesty.
If we let it drop from memory, only imagination can restore the least
glimmer of it. If we lie about the past, forcing it to tell a story we want
it to tell, to mean what we want it to mean, it loses its reality, becomes a
fake. To bring the past along with
us through time in the hold-alls of myth and history is a heavy undertaking; but
as Lao Tzu says, wise people march along with the baggage wagons.
When you construct or reconstruct a world that never
existed, a wholly fictional history, the research is of a somewhat different
order, but the basic impulse and techniques are much the same.
You look at what happens and try to see why it happens, you listen to
what the people there tell you and watch what they do, you think about it
seriously, and you try to tell it honestly, so that the story will have weight
and make sense.Ē
Iíd like to think that
my patients give me something sequential, verifiable and consistent. But in fact
what I get are their stories. They come in with the story of their injury, fall
from health or descent into a painful existence. Often their emphasis is not so
much on the behaviors that perpetuate the problem but on the drama of the
initiating event if there happens to be one. For the new patient the story of
their illness complete with its drama and tragedy, heroes and villains, triumphs
and failures must be told first. If the therapist doesnít allow this something
important is likely to be lost. Perhaps it will be a clue leading toward an
accurate and relevant essential diagnosis. Remember that Le Guin suggests that
the truth in any story is dependent upon the tellerís energy and honesty.
Keeping any story close to reality takes an effort quite different than that
required to manufacture a lie. Understanding this encourages us to listen again
each time the patient appears, comparing the nature of delivery with that
previously seen and then placing the latest story in the chart with proper
emphasis and interpretation. I wouldnít suggest that this is easy, and I feel
that doing it well is one of the things that distinguishes the expert from the
Finally, we need to
listen for a new story. Specifically, we need to hear the story of recovery.
When that appears consistently and rings true, treatment comes to a close. At
least for now. Just remember that now very soon becomes then, and another story
will be born.