What does it mean that "they get to tell their story, and this is healing." For emotional insight, I lean into Gregory Orr's memoir, first picked up to better understand his poetry. He describes with excruciating presence, the reality, the impact of having to hold your story in isolation. His grief and shame are palpable, leaping off the page into our own consciousness. We shudder with him, want to disappear into the floorboards, want to run from his described experiences. At times, it is almost too much to bear. Mind and body shrink in response to the emotional fallout of a tragedy. But especially a tragedy we are unable to share with an empathic other. We develop unshared beliefs about ourselves that directly impact the direction and experience of our lives and relationships. If in childhood, those perspectives are necessarily distorted by the developmentally egocentric perspective: it was my fault and therefore I am bad. So, to witness is also to transform underlying beliefs, or, sometimes to facilitate acceptance, in all of it's shuddering horror. It is to be with, to understand, to comfort, to expand access to and acceptability of our darker sides, to those sides which we all carry. It is to come to terms with, find peace with, and ultimately, access to a fuller range of emotion, sometimes, to shed depression or chronic anxiety.
To hold the direct responsibility for someone's death is an agony impossible to imagine without having had some direct, personal experience. Physicians understand this in an alternate context- I was there to help and heal and instead my treatment led to death or disfigurement. This is a reality every physician is required to accept, part and parcel of our extraordinarily arduous education and training. We accept this overtly or subconsciously, along with the solemn oath taken as part of graduation. My personal decision to become a doctor was directly tied to this responsibility- if I am the cause of someone's morbidity mortality, as we say in medicine, I don't want that to be because I carried out someone else's orders. Denial plays an enormous role in much of the work of physicians. Denial that complication can occur in our hands, as long as we are careful, meticulous, hypervigilant. It is among the greater challenges physicians navigate, directly or indirectly, over the course of a career. That bad things can happen in our hands is not the only denial in action. Grief is also given short shrift. We see this in our callous descriptions of tragedy with no connection to the impact on a person. We see this in callous responses to pleas for help: "you're an alcoholic, you aren't getting treated anyway so just forget about it," "he's a methhead, a loser, a waste of our time." These kinds of interactions can be pathognomonic for burnout, but they can also result from consistent exposure to meanness and tragedy with no outlet for processing, being witnessed, comforted, heard and understood. It takes a deliberate approach to navigate this with some sense of equilibrium. As in all aspects of life, we cannot deny one emotion selectively without impacting the experience and meaningfulness of all, including peace and joy. Much of medicine ignores, denies, represses the intensity of feeling to which this career exposes us, and as result, also denies the intimate relationship between our minds and our bodies. This can be described in neurobiological terms today, but it is too easy to intellectualize a predominantly emotional conversation. And physicians are not the only bearers of the fallout of denying emotions. Orr's shame was physical, painful. And of course, it takes a poet to help us understand the power of witness.
This is our best training for becoming therapists, for understanding what it is we are doing in the therapy office, beyond being an other in profound empathy with someone's questioning self. We need compelling learning to be able and willing to tolerate the worlds that we are privileged to enter and be part of, so that we can witness, while also helping to unravel those implicit assumptions rooted in the early development of the brain, our mind and body.