The Call of Stories presents a study of how listening to stories promotes learning and self-discovery.
The Call of Stories presents a study of how listening to stories promotes learning and self-discovery.
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Overview
The Call of Stories presents a study of how listening to stories promotes learning and self-discovery.
Product Details
| ISBN-13: | 9780395528150 |
|---|---|
| Publisher: | Houghton Mifflin Harcourt |
| Publication date: | 01/05/1990 |
| Series: | Edition 001 Series |
| Pages: | 236 |
| Product dimensions: | 5.50(w) x 8.25(h) x 0.56(d) |
About the Author
Robert Coles is a winner of the National Medal of Freedom.
Read an Excerpt
CHAPTER 1
Stories and Theories
A tall, thin, wan lady with light skin, wide blue eyes, and black hair, she had a distinct presence on the psychiatric ward of the Massachusetts General Hospital, an institution otherwise devoted to medicine and surgery, where I began work early in July 1956. I remember noticing her the first time I entered the ward. She was not walking but pacing, covering an area of the hall she had circumscribed for herself. Her vigor and tenacity made their mark on everyone else: even the doctors kept out of her way. Every time the door to the locked ward opened, however, she stopped for a second or two, looked at the person entering or leaving, waited until the noticeable slam had taken place, and then resumed her movement. Sometimes it was a relaxed stroll, but mostly she was marching herself at the behest of orders no one had managed to fathom.
For the first two days we residents attended meetings and orientation lectures; on the third day we were given names and told to go seek the persons who bore them, whereupon those persons would be regarded, in the community known as a psychiatric service, as our patients; and we, of course, would be their doctors. I still remember the moment when the names, handed to me on pieces of paper, became reality — eight men and women in all. For a start. We would "pick up more," we were told, when we did our weekly stint of emergency ward work: "All those you admit are yours." I still remember reading those names on the pink slips of paper, then setting out to find "them" — the people I would be "treating."
The black-haired woman was the first person I met on my search. Another resident had told me — warned me — that I was getting "the hiker." "Will you ever get her to sit and talk?" he asked skeptically. None of us, up till then, had seen her in a chair. She ate her food upright, keeping her feet moving, always moving.
I was frightened — not only of her driven activity, of the tension that seized her face when the door opened, of the furtive glances she gave anyone who came near her, but because I well knew my own ignorance, my inexperience as a doctor. Still, we'd been told that the patients were all anxious and were eagerly, worriedly, awaiting their new doctors. Best to get started immediately, they'd said, lest already troubled people become even more so. So I hastened to approach the ward's constant walker. Soon enough I too was walking while I told her who I was and asked if we might at some point have a conversation. She looked beyond me, toward the door, actually, as she said yes, but she pointed out that we were having a conversation right then. She'd be glad to continue it. Was I sure I wanted to talk with her? I didn't have it in my heart to say yes. I nodded, though. The truth was that I sensed how hard it would be for me to do much for her, even to earn a preliminary trust from her. Nor did I enjoy the prospect of doing psychotherapy out in the open, in full view — up and down, up and down. "She stops to watch television occasionally," a nurse told me, and added: "Maybe she'll stop to talk with you."
I was not hopeful after our first encounter. We walked back and forth, our exchanges brief and not at all encouraging. I tried to get her to answer my open-ended questions ("Would you want to tell me what brought you here?"), but she would have no part of them. "I just came," she said. I can remember what crossed my mind next: What brought you, the doctor, here?
In time, with more self-confidence, I would not need to ask myself; such questions, at least not in the course of a psychiatric interview. But that day I gave up fast, promised the walking woman a return, and went on to my next patient, a man all too ready and willing to talk. I'd been told he was "hypomanic," and in a few minutes I learned the practical significance of such a characterization — an unrelenting volubility. I found my mind wandering back to the person I'd seen earlier. Why wouldn't she talk just a bit more? As the second patient accelerated his output of words and loosened the logic that supposedly connected his sentences, I asked myself a companion question: Why did he talk so much — and wouldn't it be great if his "hypomanic" behavior were as contagious as some authorities claimed can be the case? He could stir things up a bit in her and thereby, incidentally, help me out.
That week, I had to bring what were called "protocols" to the offices of my supervisors. When I went for the first time to see the two senior psychoanalysts who were to help me make sense of what I was hearing, I was quite nervous — not sure what to say, how to say it. I'd done some walking myself before going to each of the two offices, and when I sat before each of those doctors, those middle-aged men, I was torn between two inclinations: to say very little, if anything, lest I reveal my stupidity, my inadequacy, and maybe my "problems" (a word constantly in use by everyone — doctors, nurses, patients — on the ward), and to keep talking at a brisk pace, lest awkward silences develop, a clue no doubt to — well, my stupidity, my inadequacy, and maybe my "problems." I recall noticing that one of the doctors, Carl Binger, had bifocal glasses; and that the other one, Alfred O. Ludwig, cupped his ear repeatedly, at which point I could feel my vocal cords tighten, my voice get louder. I recall, most of all, the assistance those two doctors offered me.
In our first meeting Dr. Binger urged me to read more in the psychiatric literature so that I might understand "the nature of phobias." He could see that the suggestion puzzled me. "She is phobic, and you've got to work around her defenses." It was clear, however, that I hadn't a clue as to how I might follow his advice. "Best to see her in your office. Have the nurse bring her there." A pause, and then an explanation: "Phobics are power-conscious. You'd do well to make it clear that you're the doctor, and that you intend to see her in your office at a time of your choosing."
He was, of course, trying to strengthen the resolve of a fledgling, an apprentice in psychiatry, who wasn't at all sure he was the doctor and who hadn't yet become as time-conscious as one becomes when in practice. He was giving me words to grasp; he was "treating" the floundering "doctor" so that the doctor could in turn "treat" the "patient." Words like "treat" and "patient" provided considerable support to me when moments of self-doubt arrived, as they often did. Add "phobic" and "defenses," add the suggestion of "working around" the latter, and — presto! — one has a stated enemy, a military strategy, a purpose.
I set to work. I mobilized my authority as I'd already learned comfortably to do — by telling a nurse what should be done. I noticed her look, for a long second, right into my eyes. But I was busy, and I was now in possession of knowledge, maybe even wisdom: Dr. Binger, with distinctions galore, had given me an explanation, a suggestion. What else was there to do — bow endlessly to a string of compulsions? (The walker was a demanding, finicky eater; she constantly turned down trays of food, asking for substitutes not so conveniently secured from the hospital's kitchen.)
Meanwhile, I had the second supervisor to meet with. In my mind Dr. Ludwig became, for a while, the man who made me speak up, speak loud. My own phobias had always urged upon me a policy of withdrawal, escape, silence, or, at best, brief and softly spoken comment. That was the way I handled professors whose prominence and outspokenness intimidated me, made me feel, in fact, speechless: no words of mine could have any value to people who had used words as they did, thereby becoming the important people they were. This doctor, though, seemed desirous of hearing me out, and if I faltered and fell silent, or if my voice fell a bit, he moved his right hand to his right ear. But he himself had little to say. He did, at least, I realized after a few meetings, get me going.
Dr. Binger was fast with the lectures; Dr. Ludwig, the man with the flawed hearing, worked our time together in such a way that he really had to use his hearing long and hard. With Dr. Ludwig I found myself becoming increasingly, relaxedly discursive; with Dr. Binger, I was ever fast to offer conceptualizations. He wanted them, too. "Let's try to formulate this case," Dr. Binger would exhort, and if I hesitated, he was ready to weigh in, much to my pleasure and edification. He was known as a brilliant theorist, and he saw me as the lucky resident who, early in his career, was learning to follow suit. Dr. Ludwig was known as a nice guy; he was also regarded as a bit slow on the draw, perhaps over the hill. His hearing trouble was not a consequence of old age, we'd heard, but rather of some neurological disorder. Nevertheless, we regarded him as an affable old gent. (I now realize he was in his mid-fifties at that time, my age as I write these words.)
I began to realize, a month into that residency, that I wasn't getting very far with the "phobic" patient. The nurse had indeed managed rather decisively to persuade her to come and see me in my office, to sit down while there. I had learned to move past some of her "defenses" all right, disarm her with my slyly abrupt and probing questions, many of them borrowed from my supervisor — for example: "Does the walking help you with all that anger?" This was put to her at a time when we'd never once discussed her anger or anyone else's. She looked at me blankly for a second, and I got apprehensive. (Could I have been angry?) But she broke into a smile, said she was glad I was her doctor, because I'd "caught on" to something that had been bothering her for a long time, her anger. I was stunned, and began to feel quite pleased with myself. I recall sitting back, stretching a little (enough for her to take notice), and thinking to myself: you can effect change in this field of psychiatry — if you know what you're doing. Still, the patient's general behavior in the ward (and toward her husband, whom she mostly shunned) did not change, and a vigorously analytic Dr. Binger reminded me over and over that "phobics are hard to treat," even though we can ascertain so much about their "psychodynamics," a word he constantly used: "What are the psychodynamics at work here?" (Once I looked around the room, forgetting that by "here" he meant the patient's mind.)
In another part of the hospital (or forest!) I was still trying to make sense of that same patient's difficulties with the help of my hearing-impaired adviser. One early morning — Dr. Ludwig saw me at eight, before he saw his patients, and there were days when I felt like one of them — I had very little to report, so I felt apprehensive: all those minutes, with at best contrived talk. The doctor across the room took quick stock of the situation and told me he wanted a little time that morning, if it was all right with me. He announced that he was going to tell me a "story." My ears perked up. I recalled my father sitting on a chair in my bedroom, telling me stories before I fell asleep. Dr. Ludwig's story concerned a patient, a woman almost paralyzed by various worries and fears. The doctor told me a very great deal about her — where she'd grown up, her schooling, her hobbies and interests, the reading she did, the programs she watched on television, the clothes she bought, even where she bought them, and most of all, the events in her life: where she met her husband and how, where she traveled and why, where she spent her spare time and with whom. I was quite taken up by listening, even forgetting for a long spell that this was a patient's "clinical history" I was hearing.
Suddenly the story stopped: the patient had been struck by a car, on the way to a lecture at an art museum. I was surprised, saddened. I felt questions welling up in me. What happened to her as a result of the injuries she sustained, and in general, as she got older? She had a name, and Dr. Ludwig had been using it; and I was using it, too, as I pictured her in my mind — saw her being hit by the car, taken by ambulance to a nearby hospital. Dr. Ludwig suddenly stopped to think, though; he sat and looked at me. I wondered why, what to say, to ask. The silence was broken by his question: "Do you see her in your mind?" "Yes," I answered. "Good," he responded.
"I have told you a story," the doctor said. Nothing more. I awaited an amplification in vain. It was my turn. I responded to the storyteller, not the doctor, the psychiatrist, the supervisor: "What happened?" I was a little embarrassed at the sound in my own ears of those two words, for I felt I ought to have asked a shrewd psychological question. But Dr. Ludwig said he was glad I'd asked the question I did. Then he told me "what happened." Afterward there was a different kind of silence in the room, for I was thinking about what I'd heard, and he was remembering what he had experienced. Finally he gave me a brief lecture that I would hear in my head many times over the next three decades: "The people who come to see us bring us their stories. They hope they tell them well enough so that we understand the truth of their lives. They hope we know how to interpret their stories correctly. We have to remember that what we hear is their story." He stopped there, waited for me to speak. But I had nothing to say. I hadn't quite thought of my patients as storytellers and was letting that settle into my mind. He started in again, now more expansively and didactically. He reminded me that psychiatrists often hover over their patients, intent on "getting a fix" on them: make a diagnosis; ascertain what "factors" or "variables" have been at work; decide upon a "therapeutic agenda." He wasn't criticizing such routine evaluative procedures, nor did he have any dramatic alternative to them. He simply wanted to remind me that I was hearing stories all day long, and that when I came to him for supervision I was bringing stories to him — telling a story at second hand.
What Dr. Ludwig said was pure common sense, yet it gave me a jolt. Why? Much of my mind's energy was then taken up with abstractions. I'd been acquiring facility with abstractions in one school setting after another — an effort that is, inevitably, both self-fulfilling and self-serving: the rise of someone through the junior ranks of the academy. But now a difference obtained: I was learning new abstractions and using them not merely to impress section men or women in courses, or professors during their office hours, or myself while brushing my teeth and musing over the new day's opportunities, but to help understand the palpable pain and suffering of another human being. Although my sessions with one supervisor or the other had the old academic flavor of an initiate eagerly trying to demonstrate his growing capability with certain ideas, there was a third person in those consulting rooms (or should have been), and that person's life was being turned into a "text." It was to this aspect of supervision that Dr. Ludwig was referring that day.
He pressed the matter further, actually, as we both got up to say good-bye. Indeed, I would notice over the months that his more trenchant and, for me, lasting comments often came just as we were ending our time together, almost as if he wanted me to think about something in my own good time, and maybe wanted to remind himself of what he, too, might occasionally forget. "Supervision" is after all a meeting of two persons, a shared possibility for each of them. As I moved toward the door, Dr. Ludwig made a suggestion: "Next time let's talk about some events in her life; for a while we can put aside formulating her problem."
I took the suggestion as a criticism. Nervously insecure in those days, I took many suggestions as muted or all too explicit judgments on what I was doing wrong. Meanwhile, Dr. Binger kept encouraging me to "formulate the problems" I was trying to treat. With regard to that phobic patient, he had suggested a "reformulation" — a new "therapeutic strategy" based on a new appraisal of "the state of her psychodynamics."
I found him, I have to admit, a very helpful person to go see. He talked a lot. I think, in retrospect, I got an intellectual fix from him. I came into his windowless, darkly lit office, sat where his nonanalytic patients did, delivered my prepared speech, reading aloud notes I'd taken while the patient spoke, or thoughts set down afterward, and then waited while a learned, marvelously articulate and self-assured psychiatrist told me what was "really" happening in those "therapeutic sessions." When he had finished his interpretative foray, assessed the state of the "transference" (the phobic patient's responses to me, based on her past experiences), and given me a brief lecture on the psychoanalytic theory of phobia formation, I often found myself feeling less afraid for myself, if not for the patient. I now "knew" her, and I could look forward to yet another chance to listen, to inquire, to hear confirmed what I'd been taught. As for the occasional moments of doubt or worry (Why isn't she getting any better?), my supervisor had some analgesic words: "These are difficult problems to treat, phobias. Your job is to understand her and help her understand herself. She is a rigid personality with a serious character disorder. Even with years of psychoanalysis her defenses would be hard to undo. Try to learn, and if she can use you to her advantage, profit from the relationship and the insight you offer, well and good. But concentrate on understanding her, not on trying to change her behavior."
(Continues…)
Excerpted from "The Call of Stories"
by .
Copyright © 1989 Robert Coles.
Excerpted by permission of Houghton Mifflin Harcourt Publishing Company.
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Table of Contents
| Introduction | xi | |
| 1 | Stories and Theories | 1 |
| 2 | Starting out | 31 |
| 3 | Finding a Direction | 67 |
| 4 | Interlude: Bringing Poems to Medical School Teaching | 92 |
| 5 | Vocational Choices and Hazards | 102 |
| 6 | The Private Life | 130 |
| 7 | Looking Back | 163 |
| 8 | On Moral Conduct | 192 |
| Index | 207 |