'Words are not counted, they are weighed' - proverb
Marks On Paper, Sounds In The Air
The patient sitting before me, let's call her Katherine, has been suffering for months. Once a cheerful and outgoing person, confident in her work, she is now depressed and anxious and lays awake at night. Her work, as a nurse with decades of experience, used to bring her satisfaction and joy. Now it is tortuous labour, where she second guesses her every move. I listen carefully to her story. I ask only a few questions for clarification. After a few minutes I think I have identified the issue; she is being bullied by her manager, but I hold back from naming it directly. I look at her. 'Does your manager criticise you a lot? Even little things? Does this happen so often that eventually you start making mistakes?'. Katherine breaks down 'Yes!' she cries. 'How did you know!?'. We talk a bit about where to go next, after which I write her a carefully worded note to take to her employer for a few weeks off, after which she returns to work onto a different ward and when I see here a few months later, she is sleeping again and her confidence is returning. This consultation stuck in my mind, mainly because I was pleased with how it went. How with a bit of listening and some simple questions I seemed to help her, to allow her to have a cathartic experience and make sense of her mental turmoil. What I also find interesting is that the whole 'medical journey', from the consultation to the 'treatment', consisted of little more than talking and some words on paper.
Since my last blog post a few years back I have gone from being an A&E doctor to a GP. Getting there took a fair amount of time and mental energy hence the writing hiatus. General practice is about as busy as working in the emergency room (though the hours are kinder) because rather than spending 45-60 minutes 'dealing with' each patient I now have about 7-10 minutes per patient, which is absurdly brief but perhaps inevitable given current demand. It often feels like a mental marathon. Although there is some physical work most of my day is spent essentially having focused conversations with strangers. I have had to fine tune my communication skills (to use that hackneyed phrase) because, given the time constraints, every word counts. When you've got a person you have just met offloading personal problems they often haven't told anybody before, in the space of a few minutes, I have to make an effort to mentally switch off my autopilot and pay attention.
Automatic Communication
I have talked before about the theory that our brains are 'prediction engines'. That we have evolved brains which 'figured out' that it is far more efficient to predict what is going on in the world, based on experience, and pick out the relevant facts coming in through our senses to check that we are on the right track, than it is to try to figure out what is happening afresh all the time. In this way, we can get on with our day on a kind of autopilot, without expending too much mental energy. And it is good around 70-80% of the time, because 70-80% of our lives are pretty routine. Yet, although this is energy efficient it can lead to a lot of automatic interactions. Most people breeze through 'Hi-Byes' - e.g. 'How's it going? / Fine yeah, you?' - without much trouble (although I always seem to drag them out awkwardly). However longer conversations can also be pretty 'scripted', though we may not be aware of it, as the brain has a tendency to figure out the gist of what is being said and prepare a response in advance often before we know it.
This may contribute to the problem - mentioned in the film Fight Club - of most conversations consisting of people waiting their turn to speak. Our subconscious is so quick that we've often already figured out what we want to say before the other person has finished. At work, in the relentless procession of ten-minute consultations, it is easy to fall into the same pattern - figuring out what the problem is and what I think the patient is probably going to need from me, often within the first few minutes of their being in the room. Sometimes these shortcuts work, but as often they don't. As in work, so in life and more than once has friction been caused when I interject with a solution to a problem that hasn't even been fully aired yet!
The Shop Floor Of Words
What is going on behind the scenes in the moments before I open my mouth? How does ‘language production’ happen in the brain? One well-supported theory suggests that it is an interplay between our ‘default’ brain - the 'type-1' neural processing behind quick thinking – and our slower 'type 2', executive mind. To use a crude analogy, it is as if there were a vast language repository in the brain which receives an ‘input’ - for example a sentence spoken by a partner – which requires an answer. Firstly it figures out the ‘context’ of the dialogue (what it is we are talking about, such as, ‘planning for weekend’ or ‘talking about politics’) which sets the scene and narrows the focus. While we are still listening, it is already sorting through an array of possible responses relevant to what is being or has been said. Then, when it has produced a most probably suitable reply, it sends it to the executive brain to be ‘green-lighted’ before being spoken (or texted etc.). Perhaps surprisingly, only at this point do we really become aware that we are going to say something. Most of the heavy lifting has been done beneath our conscious awareness, and so quickly as to be virtually instantaneous. The executive brain then decides if we go ahead and say the sentence: Things may have changed. Someone else may have spoken for example and the conversation may have moved on, in which case the executive may have to shelve the reply (frustratingly). Otherwise, if all seems okay and the sentence seems a good one then it will be sent to the mouth, or thumbs if you're texting, for delivery.
Alongside the executive we also have what I call the 'supervisor'; a kind of lawyer or key adviser if you like, who double checks the ‘language item’ over one final time. ‘Is this the best way of expressing ourselves?’ they might ask. ‘Is it clear and unambiguous?’, ‘Might we sound stupid if we say this?’, ‘Will it upset the other person? Could it land us in trouble?’ and so on. In other words, the supervisor checks the implications of what is about to be uttered and can wield significant authority. If there is a potential issue, the sentence can be sent back to find a better answer. Again, this back and forth between the default and executive parts of our brain happens so fast that we are rarely aware of the process.
A good supervisor is an invaluable asset; They can save your career, your relationship, or just mean the difference between a good or bad day. Of course, an overbearing supervisor can second guess too much, overthink it, and make it difficult to make a flowing conversation, perhaps stifling speech altogether. There is a balance. But overall, a well-trained and experienced supervisor can ensure that you say what you mean and mean what you say, without treading on any toes. At times of stress or high emotion however, perhaps the brain won’t bother expending time or energy on their services. The executive stamps the ‘language item’ in haste, and harsh or foolish words are released into the world, from where unfortunately they cannot be put back in.
This is a workable analogy, though it might mislead you into imagining our subconscious 'language repository' as some kind of robotic production line, automatically stringing together responses before offering them up to our conscious awareness for 'delivery'. In fact there is a great deal of problem solving going on beneath the surface. Our brains are taking into account the social context of whatever dialogue we are engaged in, making associations, often trying to find a new or interesting spin to add. It is no coincidence that neuroscience research has found that the same parts of the brain involved in language production are the same as those involved in coming up with original ideas, which makes sense, as both involve problem solving. Flexibility in language would suggest mental agility.
Choosing Our Words Carefully
The fact that we master the essentials of language usually by the age of five probably accounts for how little we pay attention to language in adulthood, unless of course we are learning a new one. As with walking or riding a bike, what we learned while young is so thoroughly ingrained and so habitual that it is a challenge to pay attention to it. But do we really need to pay attention to it? After all, it does the job well enough, most of the time. The movement practitioner Moshe Feldenkrais talked about how we also learn movement 'well enough' to do the job; to walk, to run, to open doors and carry shopping...and so on. He compared this to how we learn to use our voices. Well enough to communicate, but then normally leaving it at that, not really training it beyond this. Yet in certain circumstances we hit the limits and 'good enough' isn’t good enough, or we get so used to doing things a certain way that it holds us back. My mumbling for instance, would be no good if I wanted to be a singer, or give a public speech. I would need to train my voice, my entire posture in fact, with conscious discipline, breaking bad habits to learn better ones. Similarly our patterns of movement - the way we hunch at a desk, or walk in stiff, quick steps - can, over the years, lead to chronically tight muscles, resulting in pain and inefficient movement. Is it similar to our use of language? Does the way I talk and write - and listen - become ‘stiff’ with time? In the same way that certain movement patterns are inefficient, wasteful and chronically pulling me out of balance, are my language habits also limiting me?
We often pay attention to our thought processes - what we are thinking about - but it is more challenging to be mindful of the how - the actual sentences and symbols which make extended thought processes possible. The coding if you like. Communicating with others is also essentially how we exist in the world. It is largely through communicating with others how our own mind creates and re-creates itself. Yet, rarely am I paying attention to the nuts and bolts of how I communicate. Certain professions do of course; lawyers, writers, journalists, lecturers and TV interviewers are trained in choosing their words carefully. Yet most day-to-day conversations are quick-fire and we don’t feel that we have the time to weigh up our words, a condition no doubt aggravated by the sheer volume of social interactions we now engage in daily. It is difficult to say what effect this has on our personalities. If a hundred years ago our pace of communication allowed us to gently forge our sense of identity, with plenty of time between conversations to form our own ideas, the quicksilver pace now makes that less of a prospect. Perhaps this makes us more flexible and less fixed in our sense of self. But it can also be disorientating. It gives our mental language supervisor less time to roll up their sleeves and deliver a nice, precise, juicy gem of a phrase. One that'll show the listener that you really got what they were saying, or have them shaking their head for days after as they recall your wise words. The scientist Leonid Mlodinov recalls in his recent book Elastic Thinking how he spent many months working with Stephen Hawking, who needed to take many minutes, often hours, to compose his responses. Conversations would have to slow to glacial pace. Initially Mlodinov found this intensely uncomfortable, waiting endlessly for replies, but eventually he relaxed into the pace and found the experience enriching. Taking time to really absorb what Hawking was saying, and in turn taking time to mentally compose the best possible response, knowing that it really counted.
So here's to patting our hair into place, making sure the microphone is working, lacing our fingers together on our lap and sitting forward, attention fully on our interlocutor. So tell me, what's been happening since we last met?
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