Skip to main content
The BMJ logoLink to The BMJ
. 2000 Jun 17;320(7250):1679.

Why seeing a patient after the counsellor is so difficult

Kevin Barraclough 1
PMCID: PMC1127449  PMID: 10856084

“I know now that I haven't resolved my inner conflicts. I have to come to terms with the emotional violence I've suffered and learn to do what I want to do.” The “I” is always italicised in the inflection. “My counsellor says that I am far too generous and must learn to live life on my terms.”

Why is it that we feel such profound fatigue when faced with the regurgitated views of the counsellor? It is not because the statements are necessarily wrong or invalid, merely that, repeated so frequently to hordes of moderately dissatisfied people, they seem to become almost totally devoid of meaning. It is as though the counsellor has dipped his or her hand into the cookie jar of aphorisms labelled “dissatisfied housewife” and come out with a series of brightly coloured platitudes.

The difficulty is that once we have subscribed to a particular, usually simplified version of reality, it is often impossible to experience the world without those blinkered preconceptions. I am reminded of something that John Mortimer wrote in his autobiographical Clinging to the wreckage. As the curtain fell on the opening night of his play about his father, he realised that he had lost something. In the process of creating lines for the stage character he found that he could no longer remember what his father had actually said, and what he had created for him. Something is always lost in the process of articulation. In talking about ourselves, we risk creating fiction.

It seems to me that talking about yourself, in any way, with anyone, is actually rather hazardous, and that perhaps we do too much of it now. My parents came from a generation to whom discussion of their feelings was something for which they had almost no vocabulary. But perhaps because they couldn't articulate their feelings they also did not degrade them. They did not pulverise their emotions in order to fit them into the same shaped boxes as some celebrity in Hello magazine.

The trouble is that the words we use to describe the world ultimately constrain the way we feel about it and the way we see it. Before embarking on a voyage of self discovery, or helping another on the same path, I would be mindful of Einstein's aphorism: “You should strive to make things as simple as possible, but no simpler.”


Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES