Consult-Liaison Observations

Floating and Sinking Boats.

Photo by Pixabay

I recently gave a presentation called “Difficult Interactions in Clinical Settings” and, in that talk, made a comment about how, in Western medicine, we often focus on the Physical Thing and do not attend to the Psychological Things. Physical Things often affect Psychological Things (and vice versa) and sometimes the Psychological Things cause more distress than the Physical Thing.

This is one reason why some (many?) people don’t like to take medicine, even for chronic conditions that will get worse without treatment. This is especially true when people have limited to no symptoms. If people hold the idea that they are healthy, the act of taking medicine is a direct contradiction to this idea. If you are sick, then why do you feel fine? does that mean that your illness might get worse? that you might die from this illness? This fear—this Psychological Thing—is compelling enough to chase people away from health care of any flavor: If no one tells me that there is something wrong with me, then there is nothing wrong with me. (Even this framing of “wrong” is interesting: Is illness “wrong”?)

Psychological Things often drive behavior, though the engine might seem like a tangible, Physical Thing, like money or power. We also rarely escape our own Psychological Things, even if we are able to name it, greet it warmly, and understand how it makes things difficult for us. (“Insight alone does not result in behavior change.”)

Sometimes, when we cannot escape our own Psychological Things, our inability to face and embrace these Things spills out for the rest of the world to see. Sometimes this makes us write 14-page letters.

Relationships, specifically those involving platonic or romantic love, while meaningful and rewarding, can also be challenging. It requires spending time and energy considering what floats your boat, as well as what floats the other person’s boat. It is hard to think about what floats someone else’s boat when your boat feels like it is constantly sinking.

Sometimes things will happen, though, that bring buoyancy to your boat, things that are immediate, measurable, and seemingly indisputable. Thousands of people chanting in a national park? Millions of ballots with notations next to your name? A chart with ratings from a television program? These are concrete, Physical Things.

Consider the fuzzy factors in Psychological Things: How amorphous they are! How much do you love your children? Is your spouse actually devoted to you? How do you know that your friends actually care about you? None of these are iron anchors that will bring you confidence in who or where you are; they are unreliable, invisible winds that you cannot control. The winds might help you, but they might also strand you.

The boat seems to sink faster when you lack esteem and respect for yourself. When you are uncertain about who you are and your status among people, how are you supposed to trust and respect uncertain forces like the wind?

Power and authority confer Physical Things, but these Physical Things cannot fill the gaping wound(s) left behind from the Psychological Things.

Who are you if you don’t have a title? Do you exist if no one is paying attention to you? What is your identity if no one tells you who you are?

How do you tolerate silence? What are your thoughts when you are by yourself? What if you can’t tolerate your own thoughts about yourself?

(Who are you between your thoughts?)

Maybe write a letter. Letters and words and sentences on paper are Physical Things. Letters are immediate, measurable, and seemingly indisputable. Make them see and respect you when you can’t see and respect yourself. When they react, you might know that you still exist, that your boat is still afloat.