Masterful inactivity

Professor Francis Creed, Psychiatrist.

Interview about the PATIENCE book- by Lois Blackburn and Philip Davenport

There are two things I’d say about context for this book. You’ve likened the experience of illness to the experience of grief. There’s a well-recognised literature on adjustment to illness which parallels that on grief. Hackett in USA described how people recovering from a heart attack showed denial, anger, guilt, and then acceptance at different stages of their recovery. He was concerned with those people stuck in the early stages of denial, or guilt and anger or non-acceptance.

Much of my work is seeing people who are trying to cope with physical illness but have not reached a reasonable state of acceptance. There’s a lot of grief associated with physical illness and the loss of ability to do this or that. PATIENCE illustrates ways of coping. People joke, or relate their experience to someone else’s, sharing the difficulties of being ill, taking the pills and the straitjacket of drug regimes.

40 years ago Colin Murray Parkes did a study following 50 women who’d been widowed. People who were themselves grieving were shown this material and said that it helped them simply to read about others’ experiences. Sometimes a pure description of what other people go through is really helpful, without analysis. These things don’t really need to be put into a theoretical context to be helpful.

I’ve worked many years as a psychiatrist in a general hospital and patients who have difficulty coping with progressive illness are a major part of my work. Denial can sometimes be very difficult.. When a person has such great difficulty adjusting to illness confrontation is unlikely to be unhelpful but the right environment can facilitate adjustment.

I saw a very difficult case when I was at the beginning of my career, a woman who couldn’t face dying and who was causing enormous difficulties in the hospital ward, she was so upset, shouting at others, refusing her medication and blaming staff for her problem. But moving into a hospice helped her come to terms with the seriousness of her illness. It was socially acceptable to express the upset of facing death there; others faced the same difficulty. In this setting she became much calmer and ceased to shout, although she was still very upset.. This illustrates how the environment is important in helping someone to deal with where they are at, to accept disability or even forthcoming death.

The care assistant who starts your book is a shining example of care, which is probably more common than people think. He describes taking patients out for a walk, but I bet he means he also talks with them. To be able to talk about a problem is immeasurably important in being able to cope. A problem shared is a problem halved. Much of what I do is providing space to talk safely about the unsafe topics.

I guess some of your work does that too. For instance, the Parkinson’s disease poem does it, talking about difficult things to pin down. Touching on humour, or despair in a poem or whatever emotions are around – that’s why some of the poems are very good. I liked the pill box labelled TAKE TWO, the double-meaning is nice. Take two tablets, but also this is take two, a piece of music, a performance re-starting. Humour is a well-recognised way of dealing with illness.

Some people would be surprised and disarmed by their own emotional reactions to illness. Your artist might not understand where the anger in some of the pieces comes from.

Hospitals are focussed on physical illness, but in hospital on an acute ward people don’t tend to explore emotions. Some doctors and nurses aren’t inclined to open that Pandora’s Box, they are afraid it’ll take a lot of time and afraid that they can’t deal with the consequent emotions, someone breaking down in tears. However, if people are able to express what they feel, they tend to be much more satisfied with their care.

The art may be able to help people cope in this way, it’s a secondary addition which could have benefits. I don’t think it ‘fits’ in the usual medical routine but perhaps that’s a good thing. The primary activity in hospital is treating disease, treating the whole person is secondary. It’s because art doesn’t fit into routine hospital tasks that it potentially has enormous benefits. You’re tapping into the emotional part of being ill, as opposed to the physical. In hospital some staff don’t have the time to help people express emotional states; this book will open up other possible avenues of communication for some who are prepared to do that. It’s not art therapy, but it has therapeutic outcomes.

A project I was involved with helped people to cope with cancer. Sharing their concerns with a member of staff meant people could discuss ways of coping with them and this prevented depression. Now, the work you do as artists could help a lot because people’s emotional reactions to illness could be expressed. Why does it help? It might help because they’ve done something positive, gives them purpose in the day and satisfaction at the end of it. Producing something that someone admires. Might help because they’re working with other people to say or do something in a group, which counters isolation. It might be the way you deal with them as a person, with attributes that you can draw on. Inevitably, hospital staff are concerned with a patient’s symptoms and with their problems, but you talk to them about positives. These are all different ingredients that might be helpful.

This book helps people realise they’re not alone. What they find difficult may actually be normal. Others have difficulties with tablets, emotions, with disability. It’s the sharing, the I’m not alone.

Anger is a difficult emotion which may arise in the context of illness, the positive use of anger can help. Channel the anger. Channel the energy that goes with the anger to do or say something more positive. Don’t just say: ‘Why has this happened to me?’ Channel the anger. Let’s do X, or Y! Use your anger.

Getting old is to do with state of mind. Inevitably with older age you have limitations. When you get older attitude is important, the same as when suffering illness or grief. As life goes on your body changes, usually for the worse and you have to accept it. For us it is considered a kind of illness, but in Africa the older you are, the wiser you are seen to be. There are many good sides. The grandchildren like to play with us, to tease us, to spend time with us. Sit in a chair and tell a story. It’s attitude, it’s not related to age, state-of-mind is what we’re talking about. Grandparents have time. Where the parents can’t wait, the grandparents can.

The ability to wait, patience. The opposite of getting worked up because something’s not happening. The business of letting body and mind heal. Don’t do harm is a tenet of medicine. Masterful inactivity. What that means is it is sometimes best for the doctor to do nothing, to just wait and see. Surgeons are meant to be impatient, to get in and ‘cut’. Physicians give pills and await the consequences. It is joked that Psychiatrists are the most patient of all because their treatments work so slowly! Senior physicians do less for patients because they’ve seen it all before and are more prepared to let nature heal. Tablets have side effects, just need to wait not treat. If you wait, something might happen over which you have no control. Just sit and wait and see.