Communication difficulties among psychiatrists.

Abstract

COMMUNICATION DIFFICULTIES AMONG PSYCHIATRISTS* Psychotherapeutic medicine is the principal subject matter to which discussions between psychotherapists refer. Sometimes the conversation bears upon the patient's behavior in general or upon his intentional and unintentional expressions in particular. At other times, the discussion pertains to the tool of the psychotherapist-namely, communication. From the looks of things, therefore, the psychotherapist should be an expert with knowledge about and skill in communication (15). According to ordinary expectations, both of these properties should become particularly prominent when meets his equally sophisticated colleagues. But for a number of reasons, mutual understanding, tolerance of differences, and enlightening conversation frequently vanish when psychotherapists meet in groups, and the ensuing tension often is followed by a complete breakdown in communication. Let us now take a closer look at this peculiar phenomenon-the failure of the expert to apply his own skill when in contact with his fellow professionals. Failure to communicate successfully is in part due to the distortions which are introduced through the peculiarities of language. When psychiatrists meet they employ verbal language to refer to behavior. But action and movement are continuous functions which the word slices into discrete elements as if they were replaceable parts of a machine. The continuity of existence thus is split into arbitrary entities which are not so much a function of a particular patient's behavior but rather the result of language structure (22). After repetitious use, these verbal elements eventually tend to be accepted as if they had a real counterpart in nature. But splitting into part functions that which is whole is not the only sin of verbal language. Words enable us to express abstractions, to infer, and to predict. For this purpose, we telescope and condense natural and far-flung events as if they had happened at the same time and in the same place (16). This spatial and temporal distortion is particularly prominent when the psychiatrist talks about traits, attitudes, abilities, the ego, or the superego. Use of such concepts necessitates complete disregard for the time-bound characteristics of experience as well as for the specific situation in which the behavior occurred. By talking in generalities and neglecting the specificity of a behavioral act, we create such verbal monstrosities as he is a liar or he has a weak ego. Such statements represent the individual as if were characterized by these features twenty-four hours a day throughout the year. Much of what we call personality assessment is based on such distortions and frequently any resemblance of the verbal reports to the original events is purely coincidental. The distortions that language introduces in the representation of natural events are responsible for a difficulty which does not concern the psychiatrist alone. Indeed, the world of verbal unreality is shared by all those professions which are built upon communication (18). Presently medicine talks about the doctor-patient relationship; industry about labor-management relations; the army about brainwashing; and the television, radio, movie, and newspaper industries about capturing an audience. But in being concerned with communication, these disciplines teeter between one of the most essential aspects of existence on the one hand and the unreal on the other. Primarily in middleclass circles and particularly among administrators, executives, almost all politicians, psychotherapists, social scientists, and lawyers words tend to be treated as absolutes. The fact that words are sounds which refer to images and ideas and that these are products of the central nervous system is frequently lost sight of altogether. The art of speaking and writing, in the mind of the verbal professions, invests words with substance and body as if they were something separate from the human being from which they originated (2). …