A great friend I met on my journey described his homecoming after a second deployment in Iraq as “crossing a river to join those waiting for him on the other bank”. He went on to detail his emergence from the river, soaked through and unable to shake off the water, changed by his experience and different to those he had left behind only months before.
I vividly remember him telling me this, on a hot porch in southern Arizona, and can recall how moved I was at both the power and simplicity of the analogy.
I haven’t just returned from war and don’t in any way pretend to understand or draw comparisons to his experience, but in a very different way his words and the meaning behind them have deeply resonated with me this week as I’ve stepped out onto my ‘other bank’.
I’m fortunate that the experiences I’ve had over the past two months are not things I wish to ‘shake off’, quite the opposite, but I can relate to the struggle of knowing just how to share them with those at home in a way that is meaningful.
The last week has been a mixture of joy at being reunited with the familiar and sadness at stepping out of a river that has been such an exciting ride and has changed my perspective in so many ways. The unease I feel of sinking back into London rain is really the fear of forgetting. So, I choose to remember…the stories...
I’ve spoken a lot about story-telling as this journey has developed and looking back now, having in a sense completed the ‘immersive phase’, I can see that the idea of story and the processes of sharing and listening really underpin everything I’ve learned so far.
I set out on this road with the aim of observing and understanding a specific cultural practice that utilises story-telling as a therapeutic tool: the talking circle. Having now participated in many circles across America I’ve come to learn that there really are no ‘specifics’. While I experienced a variation of this activity in all of the indigenous populations that I spent time with and while I have undoubtedly picked up elements of these practices that will be transferable to the UK, I now understand that while circles provide a formal setting in which to share experiences, they really more importantly serve as a reminder of how story sharing should be a part of our daily lives.
Whether we acknowledge it or not story is a part of our daily lives. We all have one; many. Sometimes we’re called on to share these stories in an obvious way; perhaps in the doctor’s office or over dinner on a first date...but really, every time we’re asked how we are, or what we watched on TV last night we share a bit of ourselves.
If I had to express one thing that I’ve learned over the past few months it would be that when story sharing is an important and inherent part of a culture, the people living within that culture are better connected and as a result, happier. I’d go as far as to extrapolate from there that one of the many roots to unhappiness in western society is the loss of meaningful story sharing.
It’s not that we’re not talking at all, but for all of our conversation we don’t seem to be reaping the benefits, why?
I would suggest that the answer to this is two-fold. Firstly, as a culture we are increasingly inhibited about what we can and should share with others and secondly we are largely inexperienced in giving a meaningful response.
The Alaska conference was a turning point for me in understanding that experience sharing consists of not only telling a story but just as importantly of listening and responding to it. Considering myself a fairly open person with pretty decent listening skills honed in General Practice(!), in my arrogance, it took me a while to buy into the need to break these skills down and examine the components. For two whole days I sat disillusioned and in a bit of a grump convinced that I had this in the bag already. It was only on the third day, as I found myself sharing personal memories with a group of strangers in my own talking circle, that the necessity of the foundation we’d spent two days prior building really dawned on me. It wasn’t easy but in that moment I felt safe to share my story.
The lightbulb moment came with the realisation that our inhibition in sharing likely derives from feeling the space is unsafe to do so and that our perceptions of a sharing space are highly dependent on what we predict the response to our story will be. Fearing that we might be dismissed or judged or simply ignored can be enough to put a wall up and shut down a conversation. In this scenario we may feel safer staying in the ‘comfort zone’ or ‘swimming in the shallows’ as they say in Alaska, giving rise to a one word response to the question ‘How are you?’ when in reality we have a lot more we would like to say.
So, what prevents us from responding in a meaningful way and creating a safe space for people to share?
Again, I’d say the answer is two-fold. Firstly, I think we have to acknowledge that there’s more of an art to responding than perhaps previously thought and, as above, we’re not very well practised in it. Secondly, as I came to learn, responding in a meaningful way often requires us to put our own agenda and discomfort aside and give a little of ourselves back, and you know what? sometimes we just don’t want or feel able to do that.
Participating in an exercise to illustrate a healthy versus an unhealthy response to story on day 2 of the conference felt initially tiresome but later ashamedly enlightening. As before, I sort of thought I had this skill nailed and it was a humbling experience to observe example after example of an ‘unhealthy response’ (think: replying to someone’s story with your own story or immediately jumping in with advice as two common cases) and be transported to times when I’d done just that.
It’s particularly humbling for me because, as a doctor, I’ve been taught ‘the correct response’ to a number of scenarios. I’ve been trained to know the questions to ask and the ‘proper’ advice to give. Being a part of such a one-dimensional model, many of us reject the idea that we might have to engage in an actual human to human conversation with a patient and certainly recoil at the prospect of having to share something of ourselves or take on someone’s distress personally. Yet deep down we know that, while of course there have to be boundaries in professional conversations and indeed in personal ones, it is often in the grey areas where barriers are lowered that true connection and healing occurs.
It’s possible, certainly in the medical profession, to site the restrictions of a time and money constrained system as reasons for not having the conversations that we would like to with patients, but what is our excuse in the rest of our lives?
It comes down to fear and my worry is that as our fear of being vulnerable grows we are becoming more inhibited in not only sharing but also in listening and responding to each other. If we reach a point where both of those elements are missing, how can we hope to establish a space for a meaningful exchange to occur?
“ I’m interested in the person within. Introduce me to the real you and that will impact me. It will encourage friendship. I in turn will share the real me and relationship will have a nest to be birthed.”- Katherine Gottlieb, CEO SouthCentral Foundation, Alaska.
The team at SouthCentral Foundation understand how difficult it is to share something of ourselves; the fact they dedicate two days of their conference to building confidence in this area is testament to this. For them, walking the road to prioritising relationships in healthcare hasn’t been easy and has involved many sacrifices but after twenty years of work they now have an award-winning system that people, for the first time, are proud of.
Open, honest and safe conversation may not be the answer to everything but I really believe it is the answer to at least part of the problem we face in terms of our wellbeing. It will take courage and guidance but it is achievable for all of us. On average our waiting times for people needing psychological therapy in London is 2 months or more for CBT and up to a year for psychotherapy. While I am not saying an open and honest conversation with a family member or neighbour is an adequate substitute for therapeutic work in every case, in many scenarios it can be and at the very least would be a beneficial addition. I would even go as far as to say in imagining a world where we were simply better at sharing, listening and responding, the need for such services would be far less and levels of distress much smaller.
This is not a new idea. Many poorly-resourced communities around the world are undertaking amazing work in ‘training’ people to care for each other emotionally where there are few medical professionals to offer support.
In the UK, even as our mental health system becomes less accessible we still cling to the idea that ‘specialist care’ is the only way forward. We don’t need to wait until we have nothing, we can act now and tap into the huge potential that a community has to support itself.
Let’s change our relationship to mental health and where the responsibility for it lies. Let’s work on building support networks that are accessible, beneficial and sustainable.
Let’s start talking.