No. 9 How Playing Irish 'Trad' Made Me a Better Doctor

Let me begin by bringing you two vignettes from another galaxy, far, far away…that is, from my psychiatric training following my graduation from medical school. They contain the two most important lessons I learned during those four years.

Vignette the First: I was happily reading my ‘process notes’ that detail who said what to whom during the course of a psychotherapy session to my first supervisor. Initially he seemed pleased and amused alternately with my ‘he said/I said.’ However, he quickly interrupted my recitation with the best advice I have ever received regarding psychotherapeutic technique: ‘Bruce…if someone is telling you who they are…what it’s like to be them…their genuine experience of life…shut up!’

'Shutting up' is not my long suit. See, we extroverts kinda have to talk to think....

Being one of the displaced extroverts in psychiatry, ‘shut(ting) up’ is not my long suit. See, we extroverts kinda have to talk to think. Otherwise, thoughts and concepts rather come and go – not in coherent ‘streams of consciousness’ – but in various inchoate ‘puddles’ that achieve coherence in a social context only when spoken. This style of interaction does not always lend itself to what a patient needs in a psychotherapy session.

(With my Cousin Michael, who graduated from U of Michigan Medical School a decade before me,

perusing the professional literature...)

The lesson was so clear and basic, and seemingly facile to put into practice. But about 20 years later, a woman whom I had been treating for about ten years interrupted one of my verbal offerings by throwing a pillow at me, saying, ‘Will you just shut up for a second?’ I was delighted that this otherwise overcautious and deferential woman had progressed to the point of this level of self-assertion -- but I was also grateful for the ‘continuing education course.’

Vignette the Second: In my last year of residency, I was admitted to an advanced psychotherapy seminar. I was assigned The Dread Dr A. as my supervisor, having been deemed the resident least likely to cry under his acerbic tutelage. So Dr A. and I were watching a video of me doing a session where I was treated with condescension and hauteur by my patient. I hit the ‘pause’ button and said to His Dreadness: ‘This woman is treating me as if she thinks I am an idiot.’ Dr A smiled broadly and said, ‘This woman is not treating you as if she thinks you're an idiot....she really thinks you’re an idiot!'

His message was clear and profound – that my belief about what would ‘make sense’ for someone to think or feel doesn’t matter one micro-whit. If I say, ‘I’m afraid our time is up for today’ and my patient hears, ‘I hate you and never park your yak in my driveway again’, I can never build a forum of trust with my patient if I do not at least acknowledge that this is what my patient genuinely believes. And if I am really to be helpful, I must move beyond mere acknowledgment to imagining what it would be like living with that perspective.

This, of course, brings us to Irish traditional music, which has been an important part of the repertoire that my wife, Marla, and I play as a duo. Now any relationship has some role expectations, even if they are not quite as expected. For example, Marla can rig up an entire recording studio and can repair things with moving parts. I write simply lovely thank-you notes.

My 'real job' is to be a partner in a synergistic process, where the deeper intentionality can become more evident...

And so, too, do we have our defined roles playing jigs and reels. Marla is ‘the melody player’, I am the ‘back-up’ player, a job that has been defined as 'supporting the melody' (and its player). However, I think it is more than that. My 'real job' is to be a partner in a synergistic process, where the deeper intentionality can become more evident.

One might call this process ‘bringing out the melody within the melody,’ although psychiatrist that I am, it’s hard to resist the temptation to say we endeavor to render the melody more…itself. However, in the spirit of the Dread Dr A., I must attempt to hear the piece as Marla does. And, in the spirit of my first supervisor, I must suppress the musical analog of my social extroversion (‘too many notes’) and be able to play brief complementary phrases, and, yes, sometimes…shut up.

(Coming to a collective vision of the song isn't always facile...

but I knew that Marla would never throw her mandola at me)

Sadly, neither of my supervisors is still alive. But their teachings have become much more alive and vibrant since I saw these same principles radiating so elegantly and compellingly playing Irish ‘trad.’ My patient and I are also a musical duo. My job is to help them express their ‘melody’ with as much clarity and courage as can be tolerated. And having done this for a few decades, I know when I am hearing music played -- and the crashing thud when it stops. And while I do love a good insight, it does not necessarily free one to sing one's song or inhabit one's life. And melody has everything to do with rhythm -- so an ill-timed insight can be a ghastly intrusion upon the expression of one's melodies.

I think I can now say, with as much hubris-avoidance as I can muster, that I may be beginning to 'get. it' about what I am supposed to do in my office. The fact that no pillows have been hurled at me since I have started to play Irish trad may not be definitive proof, but I’d like to see that as perhaps a sliver of corroboration.