About Not Listening to People

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Some years ago, an old man of about 85 years of age was admitted to a British hospital. He kept on insisting that he didn’t have time to be hospitalised because his mother needed him. The staff didn’t believe him. But he told the truth. His mother was one of the oldest people in Britain, and she was dependent on her son’s help. The story appeared in the BMJ as a warning about distrusting what people tell their doctors.

Illustration depicting a doctor and nurse standing aloof or angrily pointing at an older female patient sitting downI went on a lecture tour in North America after I had published my book about deadly medicines and organised crime in the drug industry and lost my way at a large hospital in Baltimore. I couldn’t find the auditorium and the organiser of the meeting didn’t answer her phone. I strolled around in despair while the time for my lecture was rapidly approaching.

As a last resort, I addressed the reception at the hospital. As I was in a hurry, I bypassed a large queue of patients and explained to the receptionist that I was not a patient but a doctor scheduled to give a lecture in a few minutes time.

“Please go to the end of the queue,” she replied with a stone face. I repeated that I was a doctor and asked for help to find my colleague who worked at the hospital.

“Please go to the end of the queue,” the robot replied. It didn’t matter to her how much I begged for help. She likely thought I was a psychiatric case with a delusion that I was a doctor, as she didn’t tell me that the hospital information desk was close by.

I arrived at the auditorium right on time after having asked a friendly person in the corridor where the hospital information desk was.

Later, on the same trip, at the McMaster Hospital in Hamilton, Ontario, I lost my way again. My colleague had given me some instructions but admitted that it was very difficult to find his office. Yet again, I needed to go to the patient reception where I carefully explained that I was a doctor and had an appointment with a colleague. After much trouble and disbelief, the receptionist reluctantly established a connection and my colleague came down to pick me up.

He was on call, and when his pager howled a little later, I said jokingly that I was convinced it was the receptionist who would tell him that his patient—me—had arrived. Quite so. I had become a patient once more, and my title as a doctor was disbelieved again.

With such an attitude to people who do not suffer from any psychiatric or somatic disorders, it is easy to understand that patients with a psychiatric diagnosis can become very frustrated when they are distrusted. It also becomes understandable that violence is sometimes triggered by the staff’s disrespectful behaviour, particularly when the doctors refuse to trust what patients tell them about their bad experiences with the drugs they prescribe. This happens so often that it almost seems to be the cultural norm at psychiatric departments.

Danish philosopher Søren Kierkegaard wrote in 1859: “In order truly to help someone else, I must understand more than he—but certainly first and foremost understand what he understands. If I do not do that, then my greater understanding does not help him at all. If I nevertheless want to assert my greater understanding, then it is because I am vain or proud, then basically instead of benefiting him I really want to be admired by him. But all true helping begins with a humbling. The helper must first humble himself under the person he wants to help and thereby understand that to help is not to dominate but to serve, that to help is not to be the most dominating but the most patient, that to help is a willingness for the time being to put up with being in the wrong and not understanding what the other understands.”

This is 150 years ago. But few psychiatrists practice psychiatry in this way, humbling themselves. What they do is the opposite, which was expressed succinctly in a blog comment on Mad in America:

Psychiatry is predicated on how the psychiatrist “feels” about the patient and not how the patient really feels. It is called OPINION BASED “Medicine.”

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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15 COMMENTS

  1. That was a fun story. I can imagine someone trying to talk about something that requires staff to make an effort. Not listening and trusting patients is just a sub phenomenon of that. It is not that the primary reason for not believing patients is that they are thought to be mad. That is just a spoken excuse used for not making a working day any harder.

    Patients are not believed, because if one believes something that means that one must put in extra effort as an individual and as a group. There is always a reason for trying to talk that is a personal need not satisfied. If neglecting those needs had been going on for a long time satisfying them would require changing the rules and changing the behavior of many people.

    If there are no bad consequences for not listening for others one does not listen for others and finds an excuse for that. An excuse for that behavior can be anything: It can be the rules or some supposed bad trait of a supervised group like their sickness or that they do not really need anything or just not seeing a reason for that request. Words are just a cover and mean nothing, because even if an excuse is proven wrong the decision of not doing anything still stays.

    Later on excuses take the form of rules and a story that tells those rules being good for everyone even though they are just good for a group making them and gives them a permission to not care and not listen.

    Humans have a tendency to choose the easiest possible solution and therefore one group should not be given absolute authority over others without consequences for their every decision. Then how can we give psychiatry workers strong enough motivation to handle patients with respect if being respectful means extra effort for everyone?

    Motivation means that they must always be rewarded for pleasing patients and always be punished when going against the patients’ will.

    The one thing every economist knows is that one cannot trust good will or education. If the motivation that comes from the income is not guiding workers properly then work is not done properly. One cannot let higher ups decide what is good work and what is bad work. That decision must be left for the service user and higher ups must suffer when their decisions make others suffer.

    We should all remember history lessons. Ruling systems based on hierarchy have a tendency to become like North Korea and the Soviet Union where those in charge have easy lives and those under their care suffer. The Soviet Union had the most educated government, but still there was hunger and poverty and enormous deadly prison camps. Comparing living conditions under communism and living conditions under psychiatric care have big similarities because their government is based on a similar one way hierarchical structure and lack of punishment and reward that comes from the below.

    Long story short: It is not a matter of believing or not, but the matter of having to put a daily effort and no reason currently existing for that.

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  2. Dear Peter, I had to chuckle as I caught your wee submission here because moments before it I had sent off an official complaint about a reception desk with bullying, rule riddled, robots in it. Such like comparison between our experiences. I am really trying to vacate the MIA premises so I must resist getting intrigued by yet more interesting points of view. But if I may be so adventurous I would like to share my own perspective on some of what you bring up.

    You offer a quote from a blog that says psychiatry is predicated on how the psychiatrist “feels” about the patient and not how the patient really feels. You say that it is called opinion based “medicine”.

    I want to say in response that an “opinion” is often a “judgement” that is derived from “critical thinking” and “analysis”. These cerebral qualities are not “feelings”. They come from the critical mind, not the amorphous messy emotions of the heart. So an “opinion” comes from “thinking” about a stimuli or a behaviour. Even an intuitive hunch is “fed” by “thinking”, often suspiciously. Suspicion about someone elses behaviour is often further “fed” by that behaviour transgressing “rules”. Rules are also little acts of “thinking” that pronounce judgement about moral goodness or moral badness. Rules are often bound up with inherited opinions or inherited judgements from school or religion or politics.
    Feelings on the other hand do not really strategically “think”. Sadness is an emotion that can be experienced with an absence of “thinking”, as in when people cry without knowing exactly the “reason” (as in reasoning) why. The “why” of “feelings” is more linked to “thinking” of reasons for it AFTER the feeling wells up. This may involve the imagination, in providing a “because”.

    “I feel sad BECAUSE everyone in my work thinks I am ugly”.

    This takes the feeling of sadness and ADDS the cerebral BECAUSE, as a “thought” through search for reasons why, that eventually become a judgemental “opinion”.

    A heck of a lot of humans live their lives making judgements and opinions WITHOUT being AWARE of exactly how they are “feeling”. A human can be “opinionate” all day long and be emotionally numb. In fact the more emotionally devoid of contact with their “feelings” that they are, the MORE they may tend to live ONLY in their judgements and thinking and analysis and reasoning and opinions.

    At its extreme end, a person who only lives in their calculated “thinking” and never feels a feeling, can become someone who cannot access a “feeling” even of caring or compassion. Thus an overly logical calculated human can be more prone to harsh “opinions” that are seldom softened by emotion enough to stop that person becoming outwardly judgemental, bullying and cruel.
    In short, having access to MORE deep “feelings” prevents outward cold clinical cruelty.
    It is preferrable to have a psychiatrist who is in touch with their own “feelings” more than their analytical judgements since their “in touchness” will give them access to “feelings” of empathy. Medicine involves a need for detatchment, objectivity, analysis, clinical judgement and lots and lots of cerebral “thinking”, to sort of “think” like the machinery of “anatomy” and what healthy anatomy is trying to accomplish. A fighter T cell or a white blood cell or a muscle fibre does not “feel” in the same way that the whole organism experiences “emotions”. A heart attack victim needs a fast judgemental thump devoid of emotionally to reactivate the floundering heart muscle fibres. Medicine “saves” people by being relatively devoid of the encumberance of “whole organism” emotional prioritizing. Medicine kind of trys to “care” by NOT caring one whit what the heart attack victim fears might occur when their chest is thumped.
    So, there is this cultural mix up between these TWO quite different styles of exemplary “caring”. One needing full access to “feelings” in order to arrive at compassion, and the other to be rather self sacrificially abstinent of wishy washy emotions in order to cut to the chase and be “uncaring” enough to be speedily judgemental enough to reboot the failing organ of the heart. Humans say “bravo!” to “heroes” that they see on the silver screen who symbolize either of these TWO starkly different ways “to care”.
    Psychiatry has ever evolved in such a fuzzy meandering way that it careens from trying to be “one kind of caring” or the “other kind of caring”. It vassilates inconsistently by being emotive one week and coldly detatched and clinical the next week. This very inconsistency becomes a balletic form of abuse because the patient never knows quite kind of “caring” they are going to receive next or for “why”. It is like having neither a violently cold parent nor a warm cosy parent but a nightmarish confusing mixture that can end up experienced as more abusive than if you know where you stand.

    Returning to the quote on “opinion based medicine”, I want to be saying that “to have an opinion” is NOT a crime. We are all creatures who make snap opinions and snap judgements all the time as part of our “flight, fight, freeze” biological imperatives. We move through life making value judgements based on inherited or our own busy “thinking”, to garner first impressions that might rescue us from marauders and menacers and bears and tigers. HAVING an “opinon” is often vital to our survival. We cannot be “opinionless” and devoid of “thinking” about others. Feelings are harmless because they are NOT outward, cerebrally chosen, intellectually decisive planned acts of external behaviour. Feelings cannot “hit” another person without “thinking” rushing in to provide a mental excuse to “do” a behaviour. So feelings are harmless AND so is thinking AND so is HAVING an opinion harmless. It is ONLY when thinking presses the button on outward executive behaviour that you can then say that “behaviour” is bad or bullying or cruel or pushy or punitive or controlling. If there is no outward bad behaviour then it is ok to have ANY opinion on ANYTHING. This feeds back into healthy “freedom of choice”. A human cannot “choose” to have a particular type of chocolate cake if they are scolded from being able to first be aware of their “feeling” of desire and then have an “opinion” that that cake looks better than the rest. Freedom relies on knowing how we “feel” and what our cherished “opinions” are today, and these are subject to instant change in freedom, or its not freedom.
    The Declaration of Human Rights says all humans are born equal and all humans have a right to hold their own opinion. Feelings and thinking and opinions ARE NOT BULLYING bad BEHAVIOUR. Free people tend to be happy people and so if people are free to deeply feel and deeply think and deeply have their own opinions they are more likely to happily welcome that freedom in others. Happy people share happiness. Because psychiatrists are often taught NOT to “feel” this could in certain psychiatrists have an unhealthy miserable effect on their own sense of “freedom” and this builds resentment about patients enjoying their own freedom. They may grow to bitterly think…
    “For if I cannot be free to be emotional why should you be so free?”
    Some psychiatrists may make an enemy of such “free feelers” and seek to “remove” all “feelings” from those patients by drugging them out of feeling anything at all. This BULLYING of other people’s “feelings” often occurs in a process of infantalizing them BECAUSE they are “stupidly emotional”, like little children who need guidance into how to be “rational clinical thinkers” instead. How can the traumatized be “rational”? Being rational about trauma is sometimes, though not always, an extention of the trauma.

    I would rather see a “feeling” psychiatrist if I had to. Psychotherapy is “feeling” more than it is analytical. Many kinds of one to one psychology are “feeling” also. And whatever human being I sit down in front of they will inevitably HAVE an “opinion” of me. I would rather their opinion be freely aired to me and out in the open than obscured behind a wall of factual analytical research. I don’t think we should be “feelings shaming” or “opinion shaming” or “thought shaming” anyone. But what we MUST keep an eye on ALWAYS is the outward bad behaviour that goes a gigantic step beyond feelings and opinions and thoughts and splurges out as abhorrent control feaking BULLYING.

    In paying attention to JUST the BULLYING, as an OUTWARD phenomena indicative of inner sickness, we can then leave each other alone to “feel” and “think” and “hold opinions” as we freely please.

    It is this OUTWARD BULYING that often brings a poor patient to breaking point where they trundle off to a psychiatric appointment, but it is also an OUTWARD BULLYING in the institutional career of psychiatry, that tells psychiatrists they must never have ordinary human “feelings”, that becomes a trickling down BULLYING that shakes the hand of the new patient.

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  3. Thank You for that words of wisdom. Normal people use dr Gregory Stanton scale – “The ten stages of genocide”. We are “normal and good”, and you are “ill and evil”. Those terms are nominally empty, means nothing. As long as normal people would be destroying the reality of their own pathological identity using nominal worthless labels, as long they will persecute pathology in “The others”. Normalcy means nothing itself, it gives only a proper meaning to pathology. There’s no normal people at all, there’s no people with theological psyche…. We are our pathology and without proper attitude toward the particular pathology, our identity does not exists at all. Monists/marxists are wrong. People are being destroyed, because of words without meaning, which are a preservation of semantics fallacy.

    To understand psyche, means to give a proper psychological meaning to pathology. It is not problem to solve. The trick is that they are using ideology in medical disguise to solve psychological identity (to get rid of), because there is a quiet (monistic) plot against the non natural nature of the psyche since the Enlightenment era. The scientific vision of the psyche glorified by corrupted intellectuals are a prove that there is no humility at all. Because scientific vision of the psyche without the idea of the psyche, it’s psychopathy. Medical vision of the psyche without the idea of the psyche – this is psychopathy of materialism. Spiritual vision of the psyche is also nonsense, because psyche is not spirit. Semantic imbecility- is one true religion of normalcy and their superior defender. Words means nothing, so does people. Nominal language means nominal identity. Psychiatry exists to preserve semantic imbecility for the glory of Wall Street. Sooner or later AI will destroy everyone like marxism/materialism did.
    ————————————————
    James Hillman “Re-visioning psychology”

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  4. I was fortunate to be trained in family therapy by supervisors who understood the need for humility. The first family session was structured around the theme question “What are your family strengths?” Other questions that were asked of the parents (this was a residential treatment center for kids) were “Tell me about all the things youve tried to solve this problem … it sounds like you’ve worked hard at this. Which of the things you’ve tried have seemed to help? How can we build on those things?” This approach was designed to communicate to the beleagered parent(s) that we respected them and their struggle. Once they felt respected -especially coming in feeling like they were failures – they would work with us. This training coincided with my own experience as a teenage psychiatric patient. I will never forget the rage I felt at being talked-down to in that clinically condescending tone. Thankfully, i was able to work with a psychiatrist who communicated respect to me and was able to help me off of the medication and out of the psychiatric system.

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  5. Psychiatry isn’t about listening, it’s about imposing pseudoscientific beliefs on others.

    And most of the time people are “diagnosed” before they’ve even uttered a word—and most of the time their goose is cooked if the doctor doesn’t like them.

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  6. Thanks Peter, you make some important points. I think this does get tricky, because it also won’t work well for staff to fully believe everything they are told. It would take a little more training to help staff do better being humbly uncertain and engaging more respectfully from that perspective.

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  7. Humility is beautiful. So few people on the planet exude it. Possibly small children or Yogi’s living in snow caves. Most humans cannot flow with humility because it can be dangerous to not be “wary” in one’s environment. Humility asks nothing, expects nothing, proves nothing. It is a voluntary way of beautifully being “nothing” or “no thing”, just pure beingness.
    In the violent world mosr humans dispense with their inner child humility and curiosity and wonder in order to get weaponed up in order to “defend” against relentless attacks, even merely attacks by judgey people. If humans are not doing that survival strategy then they are monitoring others to see what they might “gain” out of others, and this grasping quality is not conducive to humility. So, defence and desire push humility out of the way. We might think we all go around like apes full of fears that propel defence and desire. But in truth to be an ape or any animal is also like being a child. And so our animal friends are paragons of humility often. They want “nothing” from us.
    Giving another person the amazing experience of “not wanting anything from them” is akin to unconditional love. So humility is linked to authentic love.
    But there is a misuse of humility. In various religions that are heirarchical there can grow a BULLYING demand that victims ought to shut up and be showing deference and obedience and humility and “want nothing” and not “defend” themselves. BULLYING receptionists may expect “you” to be humbling yourself at the boot heels of their cerebral judgey “rules”, that issue you with a ticket number and tell you to go feel ill at the back of the line. Rules in life are of importance. But senseless rules are there to be broken with gentle common sense. This requires not being humble but assertive. BULLIES do not overly like the assertive. A BULLY wants their survival to trounce your survival. A receptionist locked in a coffin of a desk all day and bidden to abide by a million fussy “rules” that have “judgements” of good or bad attached to those, seldom get a free moment to just “be” or just “feel”. This has a corrosive effect on their ability to be as emotionally aware as children are. When they cannot be as children they cannot be humble. Poor poor receptionists, stuck like sick caged animals in a system not of their optimal wellbeing. Their very sickness then becomes a neurotic need to seek healing by excercising total control over you and your delightfully emotional childish free choices. More “rules” get spat at you, to insist you be the humble one, the “rule” worshipping, heirarchy deferrent individual who “wants nothing”, not even to progress up the seated line.

    I say these things because we perhsps should be aware that every time we advance a pleasant idea such as “people should be more humble” or “people should not have opinions” or “people should be more feeling” or “people should think less”, even though these may be great ideas, full of healing direction, they can each be flipped over by any BULLY. Even a Jesus good idea like “love thy neighbour” gets distorted by survivalists to me that “you as neighbour” HAVE TO love me, or that makes you evil and in need of rule riddled judgey punishment. So even a feeling like “love” can get turned into an oppressive new “rule” by BULLIES, think of child marriages.

    Wanting “nothing”, that state at the epicentre of authentic “humility” may require feeling deeply satisfied on some level. There is nothing more satisfying than feeling understood by yourself, heard by yourself, loved by yourself, so much so that you do not need to demand that “other people” supply such satisfaction by sacrificing their own satisfaction. Instead, in genuine humility you become your own nourisher. Living a life barren of “feelings” is not very nourishing. So to be genuinely accepting of “feelings” does help with inner balance.
    But we must beware not to turn the healing found in acceptance of “feelings” into a petty imposed “rule” foisted on others. A rule that says “you” HAVE TO be a feeling type or you are evil and need judged and punished.

    Robots are great. Provided they are not outwardly directly BULLYING you. People should feel free NOT to be humble if they do not want to be. Being arrogant is not the same thing as being an outward controlling actual BULLY. Children can at times cavort with being arrogant and vain at splendid birthday parties.

    For to impose or force people to be humble is unlikely to see them balanced enough to authentically exude real humility.

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  8. https://youtu.be/QV8yb3_T51g

    https://youtu.be/3vq6Ot2RiEc

    Please compare these two videos. See if you can sense genuine “humility” exuding in either of them. The woman in the old photo image is called Ma. She was a Hindu Saint. The music is rather soothing…

    Entitlement is often expressed by a BULLY. Entitlement can come from “thinking” another person is “all bad” for breaking any number of a million fussy “rules”.

    Lately a new form of BULLYING has arisen that has it that “you” are “all bad” for not following “a rule” that insists that “you” must “love” another person’s “feelings” more than even that person does. This has it that you must show respect and obedience and deferrence and humility before that person’s monumental “feelings” or “you” are harmful and must be punished as an evil person.

    A BULLY can be anyone, a teacher, a pupil, a doctor, a patient, a priest, a congregant, ANYONE. No community is absent a bully or two.

    Any BULLY in ANY part of the world can become so entitled that they therefore DEMAND that “you” humble yourself before them and pander to their “feelings”. Violence is the antithesis of the “wanting nothing” found in the more spiritual forms of “humility”.
    Violence is always wrong. Any injustice can be mended without violence.

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  9. Being disbelieved even the most basic stuff was so infuriating, omg.

    Allegedly I lied about what I studied at university ….. uhm, no, I didn’t. WTF?

    Try imaging that happening at a party. You talk to someone and they just absolutely will not believe you what you study or do for a living and start calling you out as a liar to other guest at the party. Just WTF. I’ve never seen something like that happening. Everyone would start to get away from that clearly unhinged and deranged person.

    Some psychiatrists have completely lost basic trust in their patients, they suffer from CPTSD in their own language, so that they are not able to treat their patients like equals anymore.

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