Let Virtue be as Wax

We are all products of our era, and often unbeknownced to us, our language is to blame. Words become signposts that reassure us that we know where we are headed. Where we came from. And yet they can be as lost as us –especially in the domain of sexuality. Even the word ‘sex’ itself –a seemingly self-defining concept- can be misleading. It’s origin, commonly attributed to the Latin verb secare –to divide, or cut- presumably to explain the physical difference between men and women, does not necessarily entrain the psychological divisions. Or behaviour.

To paraphrase Socrates at his trial, the unexamined word is not worth using. That ‘sex’ and ‘sexuality’ were so inconsonant I had not suspected. Sex, quite obviously, is a physical assignation; sexuality on the other hand, is the more psychologically -the more erotically- imbued preference. Indeed, the concept of heterosexuality did not exist as such in the past. Nor did homosexuality as an article by Brandon Ambrosino in the BBC News pointed out: http://www.bbc.com/future/story/20170315-the-invention-of-heterosexuality?ocid=ww.social.link.email  ‘One hundred years ago, people had a very different idea of what it means to be heterosexual.’ In fact, ‘The 1901 Dorland’s Medical Dictionary defined heterosexuality as an “abnormal or perverted appetite toward the opposite sex.” More than two decades later, in 1923, Merriam Webster’s dictionary similarly defined it as “morbid sexual passion for one of the opposite sex.” It wasn’t until 1934 that heterosexuality was graced with the meaning we’re familiar with today: “manifestation of sexual passion for one of the opposite sex; normal sexuality.”’ It would seem that ‘all of our sexualities are “just there”; that we don’t need an explanation for homosexuality just as we don’t need one for heterosexuality.’

‘“Sex has no history,” writes queer theorist David Halperin at the University of Michigan, because it’s “grounded in the functioning of the body.” Sexuality, on the other hand, precisely because it’s a “cultural production,” does have a history. In other words, while sex is something that appears hardwired into most species, the naming and categorizing of those acts, and those who practice those acts, is a historical phenomenon.’ Or, to put it another way, ‘[…]there have always been sexual instincts throughout the animal world (sex). But at a specific point on in time, humans attached meaning to these instincts (sexuality). When humans talk about heterosexuality, we’re talking about the second thing.’

And as well, ‘[…] sexual desire was situated within a larger context of procreative utility, an idea that was in keeping with the dominant sexual theories of the West. In the Western world, long before sex acts were separated into the categories hetero/homo, there was a different ruling binary: procreative or non-procreative.’ So sexuality is the desire and although the act may be categorized as procreative (different-genital intercourse), or non-procreative (it doesn’t matter), with erotic desire -in the past at least- the intention was not further categorized. It was the act that was noticed. The act that was labelled. ‘Something […] happened with heterosexuals, who, at the end of the 19th Century, went from merely being there to being known. “Prior to 1868, there were no heterosexuals,” writes Blank [the author of Straight: The Surprisingly Short History of Heterosexuality]Neither were there homosexuals. It hadn’t yet occurred to humans that they might be “differentiated from one another by the kinds of love or sexual desire they experienced.” Sexual behaviours, of course, were identified and catalogued, and often times, forbidden. But the emphasis was always on the act, not the agent.’

And yet nowadays, we seem to require labels –as if the words were themselves expositors and not mere descriptors. ‘Debates about sexual orientation have tended to focus on a badly defined concept of “nature.” Because different sex intercourse generally results in the propagation of the species, we award it a special moral status. But “nature” doesn’t reveal to us our moral obligations – we are responsible for determining those, even when we aren’t aware we’re doing so.’

The difficulty of negotiating this landscape had occurred to me long before I read the article, however. A few years ago I walked over to a downtown bus stop, tired after having a rather long day at work. I’d left the office early, and I thought I was the only one there until I noticed two teenaged girls sitting on the little bench in the bus shelter in passionate embrace. I didn’t want to embarrass them, but I did feel the need of sitting down. Unfortunately they had both put their backpacks onto what little remained of the seat on either side, so I thought I’d wait until they’d finished, as it were. I kept glancing at them, but their fervour seemed unending and I eventually resigned myself to standing.

Suddenly a head disentangled itself from the osculatory machinations and stared at me accusingly.

“Got a problem, mister?” it asked, while a hand deftly extricated a piece of overly-chewed gum from its mouth.

I blushed, but did manage a conciliatory smile hoping to defuse the tension. “Sorry,” I said, when I could find the words, “I didn’t mean to disturb you, but I was hoping I could sit down…”

The other head opened its eyes at the sound of my voice and managed an embarrassed smile while convincing its hands to leave her friend and move the pack from the seat. “We didn’t mean… We didn’t know anybody was standing there…”

The first head dropped its eyes to the pavement in obeisance. “Yeah, I didn’t mean to be rude…” She picked her eyes up again and sent them softly to my face before she looked at her friend. “It’s just that, like, some people get… You know, like, upset when they see us kissing.”

“Yeah, as if we were, like, tards, or something,” the second girl said as they both moved over on the bench to make room for me.

The word  tards seemed to offend the first girl. “She just means that, like, some people go strange when they see us being so… involved, I guess.” She looked at her friend and whispered something I couldn’t hear. “Like we’re pervs, or whatever,” she continued, after elbowing her gently.

“Yeah, the other day, one old guy walking by even, like, spat on the sidewalk when he saw us cuddling.”

“Yeah, as if he never cuddled with his partner…” the first girl giggled.

“He probably never had a partner, Joni!”

Joni shook her head. “Maybe not, but I don’t think he was, like, jealous or anything, do you?”

Her friend smiled. “He was just looking for a label, sweetheart. Some are easier to find, I guess.”

Indeed.

 

 

 

 

 

 

 

 

 

 

 

 

The Impossible

So, Trump has convinced his country that he should lead. I did not think America had drifted so far; I did not realize it was so out of touch with us -and me… It brought to mind a poem I wrote years ago, not ever believing the impossible could come to pass:

 

The Impossible

Is not something

I can understand,

Or even compute

With words.

Like infinity,

It is defined in terms of what

It is not

Or ever could be,

Realistically.

Even Maybe does not cover it

Completely,

Although it paints a kind of curtain

That lets through

Light,

Almost.

Sometimes briefly,

Like our attempts

To conceive what lies behind,

It is

A labyrinth of smoke

Forever weaving new patterns

From the old.

No,

What cannot be

Is often locked away

In arguments

And definitions –

Words whose meanings

Are not cast in stone,

But trapped in sentences

By the years.

Impossible

Is what is not

Now,

And by default

Will lose,

Perhaps,

Even before

It has begun.

Medical Revisionism

Words -that’s all they are: sounds that by their very presence magically communicate meaning. They are more than mere noise or background. They are not the wind rustling through the leaves, nor the sounds of a frog in a pond; in a way, they are entities that resolve uncertainty, and in as much as they can be interpreted, contain information. Data. So, in a sense, they transcend Time: the information in the words of an ancient document still exists. But information is subject to interpretation; the same data may be seen as having different meaning as time and societal norms change. But does that change the information conveyed? I think not.

I’ve covered this topic in previous blogs (for example: https://musingsonwomenshealth.wordpress.com/2013/11/01/whats-in-a-name-cancer/ ) but the topic is a source of continuing intrigue for me, so I was once again interested in seeing it broached in an article in the BBC News last fall: http://www.bbc.com/news/blogs-ouch-34385738  It seems we are constant and insatiable revisionists. It’s as if by changing the descriptor, we somehow alleviate the pejoration its ancestor accumulated. And yet the information remains; only the colour changes.

I suppose that this is useful, but I can’t help but wonder if there is some other way of doing it. Of course, some words seemed to have been coined originally with a belittling intent -Cripple springs to mind- and even without our penchant for viewing the machinations of history through modern eyes, the word is disparaging; it is simply not fair. It derives from the Old English word crypel which has the suggestion of creeping. It was a condition in clear need of a new term.

Other words were more naively-attempted descriptions –designations that were no doubt thought to help others picture what was being named. There was unlikely to have been any attempt at denigration -despite how they might now offend or upset us. Mongolism is one such term. According to the New Oxford American Dictionary:mongol, or Mongoloid, was adopted in the late 19th century to refer to a person with Down syndrome (named after John L. H. Down [1828–96], the English physician who first described it), owing to the similarity of some of the physical symptoms of the disorder with the normal facial characteristics of eastern Asian people. The syndrome itself was thus called mongolism.’ But the problem remains –what happens when the term ‘Down Syndrome’ itself also becomes offensive?

Sometimes, it seems to me, the words will also change for no apparent reason. Think of the various expression changes for sexual diseases over the years and the somewhat clumsy attempts to strip the prejudice out of them. When I first started medical school, the expression was ‘venereal disease’ –or VD. Then, when that became too pejorative, or at least discriminatory, it morphed into STD (‘sexually transmitted disease’), and currently STI for ‘sexually transmitted infection’… Or am I already out-of-date? The reason for any of these transformations, however, is totally beyond me.

Words, it seems –or maybe it’s me– just can’t keep up. Maybe, like Fashion, they’re bound to change because of user-boredom or a need for novelty, but I think it’s probably deeper than that. I suspect that it relates more to societal attitudes than societal ennui. And I think that it may be a lost cause to expect consistency of usage. As we change our approach to issues and our opinions, so we change our words to describe them. It starts off with the more curmudgeonly amongst us –usually those for whom tradition provides a stable and secure platform- proclaiming the changes to be ‘political correctness’- to use the current phrase. But then, gradually, sometimes imperceptibly, the expression achieves a common parlance and not using it courts sideways glances, or even incomprehension. It is, perhaps, an aurally measurable example of society’s changing attitudes, if not its mores.

My biggest complaint, however –although minor in the scheme of things- is that it seems a waste of perfectly good words. One of my favourite ones ‘awe’ and its brother ‘awesome’ which used to bespeak a form of reverence, was ripped from my useful vocabulary only a few years ago and I’ve never really gotten over it. The words now have little value -they’re the scrapings from a different, grander time. Crumbs. Leftovers.

I am reminded of the words of Moth, the page of the soldier Don Armado in Love’s Labour’s Lost by Shakespeare: ‘They have been at a great feast of languages, and stol’n the scraps.’ 

The Empathy of Age

I am intrigued by the concept of empathy. Variously defined as caring, psychological identification, or even sharing another person’s feelings, it is nevertheless a quality incumbent upon those of us in the health profession in whatever capacity.

Empathy is a word that has, in some minds, become synonymous with other altruistic traits such as sympathy, compassion, or even pity, but it is broader than those -and perhaps that is what makes it so valuable -so unique as a descriptor. Sympathy, for example, is more restricted in emphasis: more of a feeling of concern for another who is in need; compassion, on the other hand is what we may feel when another requires our help –a motivator.

Empathy encompasses these, and more. I like the definition in Wikipedia: Empathy is the capacity to understand or feel what another person is experiencing from within the other person’s frame of reference.

But is empathy something like a genetic gift? Something that pushes those who possess it to self-select into the helping professions? Or is it more like courage: you don’t know if you have it until it becomes necessary?

No, apparently it can be taught –although I must say I must have missed that lecture in medical school because, along with things like ethics and cultural safety, it was an assumed quantity. If you were going to be a doctor, that meant you had it… But, like St. Thomas Aquinas’ understanding of Time, it was an entity that was only definable when you didn’t try -or the philosopher Krishnamurti’s objection to naming God, because it confined the concept…

Over the years, though, I have tried to confine it –or at least experience its various manifestations. And although these are no doubt legion, I am still thirsty. Readers of these essays have perhaps already had their fill of my insatiable insistence on the art of listening before speaking (For example: https://musingsonwomenshealth.wordpress.com/2015/06/30/when-silence-is-golden/ ) But I’m afraid there was yet another news article that caught my eye: http://www.bbc.co.uk/news/magazine-33287727  and I thought I’d try it out at the first opportunity. I’m always looking for new tricks.

Radical listening –that sounded easy. And familiar: “…be present to what’s really going on within – to the unique feelings and needs a person is experiencing at that very moment” and, in practice, “Let people have their say, hold back from interrupting and even reflect back what they’ve told you so they knew you were really listening.” Perhaps that’s what I have been doing all along, but not consciously aware of it, though. Or maybe not –maybe all doctors think they listen, but possibly what we are actually listening to is ourselves –our prepared judgements, our sure and certain feeling that we have the answers. Or, at least an answer… Science uses inductive methods: start with the data and then establish a theory that seems to fit. But maybe, despite our protestations to the contrary, we sometimes resort to a type of deductive reasoning: start with a theory and then make the data fit -or at least search around until we find some that do. Because if we don’t have an answer… what good are we?

Time for awareness. I thought I’d start with someone with a relatively common problem –a non-gendered one so I could more easily slip into their shoes, as it were. I scanned my list of patients for the day but none seemed suitable. I simply could not easily cohabit a mind filled with fibroids or endometriosis.

Loren was different. A woman with persisting hot flushes seemed initially excludable from my naïvely chosen criteria, and yet it soon became apparent that the hot flushes were a sort of proxy. She was a young looking 62 with barely a wrinkle on her face. Fashionably thin and elegantly dressed, she seemed to have ignored the years that have exiled so many others -stranded them, as it were, on a foreign, uninviting coast. No, Loren was a professor at one of the universities here in the city, and much in demand both for her human rights advocacy and her several books on the subject that seemed to be quoted whenever federal immigration policies were in the news.

“I get these hot feelings in the most unfortunate circumstances, doctor. They usually occur when I’m in a social situation where my reaction to them would be noticeable –giving a lecture, for example. Or an interview. I’ve never embarrassed easily, but if some commentator manages it, I find myself almost overwhelmed by a need to wipe my forhead –not a sign of strength.”

She paused, no doubt waiting to judge my reaction as to whether that was a common feature. Mentally rubbing my hands and determined to try my new tricks, I smiled reassuringly. “So these hot flushes occur in social situations where to acknowledge them would be awkward..?”

She nodded, and then as if she’d been given permission to speak again: “I’m worried, frankly. I never used to be like this.” She considered it briefly, and her eyes turned inward for a moment. “I’m beginning to see it as a type of physiological dementia –a sort of bodily facsimile… an early protoype of things to come…”

The thought seemed to bother her and she studied my face for a refutation. “I can see you’re worried, Loren,” I replied slowly. “I’ve never heard hot flushes described as a type of nascent dementia, though.” Good; I was proud of that succinct encapsulation of her thoughts and looked at her contentedly. This wasn’t so hard.

She sighed, but I wasn’t sure whether it was out of satisfaction at finally being heard, or frustration. “And words don’t come as easily as they used to any more. I’ve been blaming it on the hot flushes because the two seem… coeval.” She glanced at me, her eyes frightened birds huddling in their cages. “Like just now –I couldn’t think of another word that meant ‘at the same time’ quickly enough, so I substituted ‘coeval’…”

Another long pause; I wondered whether this was the time to reiterate –the word ‘regurgitate’ entered my head and I almost smiled, but her face looked so anguished I decided to go for it. “Words don’t come easily anymore –and you blame it on your hot flushes… I like the word ‘coeval’ I have to say.” I blushed at my amateurish attempt at precis this time…

She didn’t sigh this time, but I could tell her eyes were about to leave their nest. “I suppose all of us experience this after a certain age…” She diverted her attention to the picture of a peasant woman leading a horse that hung on the opposite wall. “But words have been my world, and their loss –or at least their current drying up to a trickle- terrifies me.” She continued to stare at the picture, as if the answer lay in the coloured sketch, its almost random lines a reminder of her words. Suddenly she turned to stare at me. No, to study my reaction. I could sense her dividing me into grids, mathematically precise areas for analysis. “Hormones didn’t help before… Do you think it would help to go back on them?”

It was a plea, begging for an answer. A solution. Anything to give her hope. It was going to be hard to stick with my radical listening approach… Or had I already done it? I tried to smile intelligently at her, tried to find some words to help, but like her, I was struggling. “Words…” I started hesitantly, aware that I was blushing at my sudden blank. It was like my head was an empty screen. “…don’t come easily to you anymore…” The look of frustration at my repeated attempts to incorporate her own words into my response was becoming glaringly obvious, and I could almost feel her anger. I sighed and abandoned my tactics. “Words don’t come easily to any of us after a certain age, and its not only embarrassing, it’s frightening. They are my world as well –they’ve been what have defined me not only as an explicator of the arcane, but also as a person. Words are friends I’ve called on whenever the need arose. They’re still there, but as with you, the words that arrive in response are often friends of friends. Acquaintances from books I’ve read and long since forgotten. Clumsy words. Opaque words with only approximate relevance that people merely skip over when they hear them, thinking I’m just being clever. Metaphorical.

“And then the words, like branches floating past in a slowly moving river, make way for others –more familiar, perhaps, but moving all the same. And the conversation continues with probably only me who noticed all the substitutions…”

Loren sat back in her chair with a look of satisfaction on her face. Her eyes, caged once again, sat twinkling at me from their lairs. “You know,” she said, apparently finding her words with ease, “I should go to doctors more frequently.” And with that, she reached across the desk and squeezed my hand. “That’s all I needed to…” -a slight pause, almost unnoticeable- “assimilate…”

We looked at each other and smiled. We were of an age.

The Linguistic Pregnancy

What is pregnancy? What’s in a name, for that matter..? Is it true that a rose by any other name would smell as sweet, or is there something in the name itself that alters and affects that to which it refers? Neo-Whorfianism, in other words…

For example, the Chinese word for what we in English call ‘pregnancy’ is youxi (transliterated, of course). If you break it apart, though, it is composed of two Chinese characters: you –which means something like ‘to have’ and xi which means ‘joy’ or words to that effect. Only when strung together as a unit, does it mean ‘pregnancy’.

There are many other similar examples, of course; the one that comes to mind here in bilingual Canada is the French word for pregnancy: la grossesse –largeness. Or how about Spanish: embarazada –etymologically it derives from the same root as does the English ‘embarrassed’.

But is this really telling us anything important about the culture – or anything at all? Look up our own English word ‘pregnant’. It derives (probably), says the Oxford English Dictionary, from two Latin words: prae –meaning ‘before’ and the base of gnasci, or nasci –be born. Not much to talk about there… Time for a little background.

In the 1930ies, Benjamin Whorf hypothesized that language alters how its users view reality. If there exists no word in a society for numbers, then how could its members count? He discovered that in the Hopi language –a Native American people- there were no markers of time –no later, or earlier, for example. So maybe they considered past, present and future the same? No words for time, no sense of time… The hypothesis put the cart before the horse it would seem, but the idea caught on… For a while, anyway.

Tempting as it may be to read cultural and etymological significance into the words that have come to be used for pregnancy –are Spaniards really embarrassed about being pregnant, for example?- many linguists have suggested that there is little if any validity in so doing. Well perhaps they’re right –all I  know about language is what the experts tell me and this seems to change over time.

So maybe I can take my pick of the plethora of  linguistic opinions. I mean it all seems to hinge on which theory is ascendant, which linguist is the most convincing/charismatic, and which theory gets the most press –a rare thing at best in Language Theory. But sensitivities do change, and revisionism usually rears its head to correct insensitive contentions. Data appears to go in and out of fashion; each side argues about it and then poof, a paradigm shift, and they’re off again. It’s almost like watching a hockey game.

From a decidedly lay position, though -one firmly rooted in popular mythology- I’ve come to suspect that linguists are trying to take the soul out of language: the fun. So I’m throwing in my lot with the opposition. Languages are alive; they simmer and bubble neologistically; they evolve according to need. They incorporate metaphor…They are metaphor until a suitable word is created to fill a niche.

The richness of a language resides both in the changes it undergoes and what it does with the remnants. With Semantic Drift, nothing is wasted; old ideas -old words- hide just beneath the surface, noticed only when pointed out. Borrowed words from other languages and other times play with meanings like colours play with fashion. It’s likely the same in all languages, all cultures, but I’d be stretching the obvious if I pretended to comment intelligently about anything other than English.

So does that make me a culturalist –or whatever the term would be for someone who loves to think each culture adds its own unique iridescence to the mix? And am I really harming anyone -or any society- if I smile at how some languages have managed to add a whiff of descriptive ingenuity to a word as important as ‘pregnancy’? Isn’t it wonderful to think that a language could transmute one or two words, conceal them in plain sight (or hearing?) -but unobtrusively so they don’t stand out like hitchhikers- and have them function as ambassadors for something totally new? And yet, like ‘Where’s Waldo’ they are there all the while, chuckling in the background at their clever disguises.

Personally, I think the world is more of a family if we can search inside each culture’s heritage for these shared gems without the fear of opening a racial Pandora’s box.  To unveil them should not court accusations of malevolent intent, or naïve generalizations. Just because, for example, one of the terms to describe being pregnant in Russian (Beremenaya in transliteration) translates, roughly, as ‘load’, ‘burden’, or even ‘punishment’, it says little more about the culture’s attitude to pregnancy than that it has a sense of perspective –and humour. Should we seriously speculate that because of their word for it, Malawians (in the Chichewa language) really, deep down, consider pregnancy an illness?

I think everybody should just lighten up and enjoy the archeologized meanings for what they are: a demonstration of the incredible ability of humans to bend their words and meld them into new and intricate designs. I don’t know, sort of like Isaiah’s idea of beating swords into ploughshares… Or would that be denigrated as a neo-neo-Whorfianism?

 

The Feminine Perspective?

“Men and women think differently, doctor,” a patient said to me recently, shaking her head in response to some requested advice from me. “You of all people should know that.” It was stated with a look of smug authority, as if  to disagree would have been tantamount to an admission of professional incompetence. And while I don’t concede the point that to disagree with what seems to be a societal dictum necessitates a conclusion of medical bankruptcy, it got me thinking…

I suppose the first thing that occurred to me was to question the assumption that my specialty somehow enabled entrance into the heavily guarded sanctum sanctorum of my patients –female patients at that. It kind of invokes the Theory of Mind, doesn’t it: the early discovery by a child that others also have things going on in their heads, and that they may differ from her own thoughts or perceptions. It’s an important step in eventual integration into society; it’s also a recognition that because it’s different, we can never really know what someone else is thinking.

So, in that sense, no: I (a male) can’t know what my patient (a female) is thinking -any more than I could if that person were another male. I can suspect that it might differ from what is going on in my head, but given a common purpose -the solving of a medical need, say- I can intuit that we can communicate something meaningful about that.

“Ahh, but it’s not just that we live in different bodies, doctor,” -I could almost hear her response to my thoughts- “It’s more the way we approach the problem.” Really? Are the goals actually dissimilar, or is it more a difference in perspective -a choice of route? And is the perspective culturally assigned, or does it reflect a basic underlying gender difference in physiology and wiring? Is it just that we are supposed to think a certain way -an assumption- or that we, in fact, do -an innate, genetically driven imperative?

Are the perceived psychological differences in the sexes superficial and societally contrived, or are they more like two Magisteria -the approach Gould chose to describe the difference between religious and scientific knowledge and authority? It’s a difficult question obviously, but I sometimes think it has degenerated into more of a media-driven competition -each side trying to enlist support from an otherwise disinterested and unaffected Public.

I sat back in my chair and smiled inquisitively at my interlocutor. “And how would you approach this problem?” I asked, hoping to learn something from the encounter.

“Well, for one thing, I would offer more choices.”  She sat up straighter and crossed her arms defiantly, daring me to disagree.

Fair enough; I suspect we would all like more of a say in how we deal with a problem. I nodded my head in agreement. In medicine, even if there are no other viable therapeutic choices, there is always the option of doing nothing -seeing what will happen over the coming days or weeks. But I suspect that the choice of that option transcends gender, transcends the assignation in the genetic lottery…

But maybe I was missing something; maybe she was operating with a world-view that necessitated a different assimilation of Reality. For that matter, maybe there was a different reality for her -one that I could never hope to experience. Maybe what she experienced as Red, for example, I experienced as Blue and yet we both named it with the same word. How could I ever know? A troublesome thought indeed.

And yet, ever the pragmatist, even if we both meant something different by that word, but arrived at the same destination, wouldn’t the communication have been successful? The goal achieved?

She wasn’t finished with me. “And I think you were assuming I should just accept your opinion, doctor.” She obviously hadn’t liked any of my solutions, although I had offered her several. She had probably only heard the word ‘hysterectomy’ among them.

It occurred to me that although we both wanted to solve the same problem, her condition had a different meaning for her altogether. And it didn’t hinge on her sex as much as on the way she envisioned herself as a person, as the protagonist inside a personal history: her story.  She possessed an identity tied to what she currently was, and whose very existence was contingent on whom she might inadvertently become.

But we’re all like that: we are who we have been; the past drags behind us like a shadow. It’s company for us on our long trip; it’s our suitcase full of memories… So that alone cannot be what she was alluding to.

That we all see the world from our own perspective, and that it is different for each of us, is merely stating the obvious. That we each come to a problem with a different history is equally obvious. We have all been entangled in cultural webs that have conditioned the way we respond to issues. In the beginning, perhaps it was all engendered by biological constraints, but I think most of us now realize the artifice in that.

What, then, accounts for the difference, other than milieu?

Bertrand Russell, a philosopher mathematician of the last century had some small influence on my early development; I make no claim either to have read all of what he has written, or for that matter to have understood more than a small part of what he had to say, but I have always remembered one passage -one pearl- that made sense to me. Perhaps it was the only thing I could understand:  For my part, I distrust all generalizations about women, favorable and unfavorable, masculine and feminine, ancient and modern; all alike, I should say, result from paucity of experience.

Maybe I should have read more of him; there are many perspectives…

Meanings

Can we ever understand each other? Know what is being asked of us? It’s not just a medical problem; it’s universal, I suspect. And it’s one that entails far more than simply comprehending the meaning of a word in both its denotative (definitional) as well as its connotative (secondary, or evocative) usage. It involves apprehending -truly appreciating – whatever is intended in the communication.

In a sense it is often a relational concept: we are linked in a sort of symbiosis and inherent in that is the empathetic interpretation of what is being conveyed. Friends potentially have this: Don’t listen to what I say; hear what I mean. We all hope for this, I think -especially when things are hard to express, when words fail, as it were. When we need the other person to grasp something we cannot adequately articulate, we are at a loss -or perhaps more accurately, at a disadvantage- in terms of receiving their help or advice. Words, large or small, can be impediments.

And this is particularly salient in medical encounters where both unfamiliarity with appropriate terminology as well, perhaps, as embarrassment, conspire to camouflage the reason for the visit. Where you say pain, but really mean cramp, or perhaps irregular -referring to your menses, for example- when you actually mean totally unpredictable, or maybe that you’ve even stopped trying to keep track of them… Where cancer could mean something you think your grandmother had -but nobody would talk about it with you- or that in fact it’s what you think you have but are afraid to verbalize it. Heavy is what your periods are not -even though you are anaemic- because they’ve always been like that, and so were your mother’s: They are normal, doctor

I realize this is not usually a major obstacle to doctor-patient relationships, because over time doctors learn to listen to what is not being said; the encounter is frequently more valuable than the words in it -no matter how descriptive. It is also why it is often so difficult to address problems over the phone.

Through the years, I have struck by the need not only to be a good listener, but a good and careful observer. There is as much meaning in silence as in conversation; as much information in examination as description. Words are susceptible to challenge, or misinterpretation; unimportant ones can be uttered with emphasis, significant ones mumbled sotto voce. Comfort level is privileged and not summonable at will. Words escape from the top of the tongue, or are inadvertently trapped behind the teeth; meaning is sometimes a prisoner to safety -be it cultural, or personal. And it can be as unpredictable as the weather; as fickle as a mood…

So then, how can we understand each other -especially in moments of crisis? How can we ensure that others know what we intend -what we need to convey? Is it as simple as choosing the right words, the right syntax? Is it a vocabulary issue, or something more complex? More profound? From the doctor point of view, I would argue for the latter; I think that the essence that underscores all communication, that underlies all meaning, is engagement: being present in the situation at hand; imbedded in the message -both obvious and covert, intended and accidental; alert to context; aware of the unspoken. Words, after all is said, are just drawings in sound; to understand, to really comprehend, we must listen with more than our ears, see with more than our eyes. To listen fully, we must hear.

It is not an arcane prescription, not something requiring years of training; it is what we all attempt when we truly care; it is what is missing when we do not… And absence of the effort is something Shakespeare noticed so many years ago (Henry IV part II):

It is the disease of not listening,
the malady of not marking,
that I am troubled withal.