Monday, January 17, 2011

Sacred Moments in Medical Care

This month's issue of the American Journal of Psychiatry has a fascinating clinical discussion - "Perspectives on 'Sacred Moments' in Psychotherapy."

The "case" describes a psychotherapy session in which a patient in her 40s talks, for the first time, about what she calls "paranormal" experiences around the time of the death of a beloved mentor. The story is presented as a dialogue. What stands out is the way the therapist - a psychoanalyst - responds to his patient:
Patient: For me [the experience she had just spoken about] was very special.

Therapist: That was very special indeed.

Patient: [Crying a bit more intensely] I have never told anyone about this until now. These moments will always be special to me.

Therapist: They should be. It's a very beautiful love story.

Patient: It's also surprising to me. Does this routinely happen?

Therapist: The sort of love you had with Dr. Brown [her mentor] is hardly routine.

Patient: [Crying a bit more heavily] But do other people have experiences like this with people who have died?

Therapist: Only if they are extremely lucky.
The therapist doesn't interpret anything about the patient's narrative. Rather, he shows deep interest in and tender appreciation of her experience. He doesn't enter in to the question of whether the mentor's spirit transcended death and spoke to the patient, or whether a blip of brain chemistry created the phenomena. His response is to what the experience means to the patient, not to his own beliefs about the "paranormal."

Dr. James Lomax, the therapist and lead author of the article (he is joined by a historian of religion and a psychotherapy researcher), is a professor of psychiatry at Baylor, but his interventions weren't rocket science. His responses to his patient provide guidance and a model for all health professionals, not just psychotherapists.

I titled this post "Sacred Moments in Medical Care," not "Sacred Moments in Psychotherapy," because I know from colleagues in other areas of medicine that they hear stories of this kind as well. And I remember my own father telling me, shortly before his death in his late 80s, that his father, who had died when he was 21, would be visiting him in a dream soon, something his father apparently did with some regularity. These visits were a source of comfort to my father throughout his life. I never met my grandfather, but I felt that his visits to my father were a form of visit to me as well.

The lesson I take from the lovely clinical story and the rich discussion that follows it is that our role as health professionals is to listen with curiosity and appreciation. Our own beliefs about life after death and the paranormal don't matter.

Four hundred years ago, Hamlet gave the same advice to Horatio:
Hamlet: Swear by my sword
Never to speak of this that you have heard.

Ghost: [Beneath] Swear by his sword.

Hamlet: Well said, old mole, canst work i' th' earth so fast?
A worthy pioneer! Once more remove, good friends.

Horatio: O day and night, but this is wondrous strange!

Hamlet: And therefore as a stranger give it welcome.
There are more things in heaven and earth, Horatio,
Than are dreamt of in your philosophy.
If Hamlet were speaking to us now he would say - "Evidence-based medicine is an excellent thing, but remember - there are more things in heaven and earth than are dreamt of in your philosophies!"

(This link to the American Journal of Psychiatry article shows the first page and offers purchase of access. And, you can read about a conference sponsored by the Menninger Clinic and the Institute for Spirituality and Health at which the work was presented.)

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