People : Nuance

Red River Gorge Kentucky, October 2017

Once, several years ago, a friend and I are driving in a car and see a jogger go by.  My friend says, "That person is running really slowly."  I respond: "Maybe he's been running for ten miles and this is the end of a long run."  My friend responds: "That doesn't change the fact that he's going really slowly."

I remember this because it brings up questions that years later I still consider every day in work and life.  We have a conversation about the difference between making an objective observation, and forming a subjective narrative.  He argues that he was just making a comment, and it's true that objectively the person is running more slowly than your average jogger.  But I responded the way I did, because I think it's pretty rare to withhold all judgment from any observation.  This doesn't mean that the judgment is bad or wrong, just that we form thoughts about the things we see so immediately and instinctively that we don't recognize the jump from observation to judgment.  So what we think is an "observation" almost always carries some connotation in its statement, or opens itself up to connotation.

I also responded the way I did because context matters even when making what seems to be an objective statement, since something like speed is relative.  How long the runner has been running does change the fact of his speed, if you're talking about an adjective and not just a number.  You might see, and say, something entirely differently if you knew that slow runner is an ultra runner who is on mile thirty.

I've been told by a number of people that I make too many excuses for people (most often, our patients).  Most often it's a loving joke.  But in other contexts, this comment assumes a lot: that I'm naive, that I dismiss personal responsibility, that I let people get away with things, that this is harmful to not just me but to the people for whom I "make excuses."

It's true that I've had people take advantage of me, as we all have, but I'm glad to have pushed the boundaries of giving people the benefit of the doubt to see how far that can go. I'm also not blindly imagining a world outside of the confines of our clinic; I'm making a conscious decision to remember that that world is more real than this artificial space we've created.  So I'm not naive and I understand the dangers of trying to analyze why someone is an hour late to an appointment, or yells at me for no apparent reason, rather than being straightforwardly strict about those behaviors.  My co-workers who see me go through it and go through the same things themselves know that we strive for a certain balance of boundaries, of support and tough love. They also know that I very often tell patients in the moment that these actions are not okay and that I try very hard to not give into unreasonable demands.

But I think that this type of response to the effort to contextualize--the "you're making excuses for them"--is just another example of why it's so important to contextualize in the first place.   Don't assume that just because we can imagine a lot of stories, that we believe all of them.  Or that just because we can imagine a lot of reasons, that we ignore the implications.

We just believe in the importance of imagining, and in appreciating how much nuance every action possesses.  When we imagine all the possible reasons for an action, we're not necessarily saying that the action is justified, or that it can't/shouldn't be changed, or that people shouldn't be held accountable.  We just want to acknowledge how much we don't know.

When I find myself frustrated--with something in clinic, in the world, in my personal life--and try to figure out what exactly is frustrating me, the source is most often a lack of nuance.  People are hardwired to make so many assumptions, and we all trust in our own judgment above all else, and sometimes this makes me really angry.  I know that this happens for evolutionary and human reasons, that immediate judgment is part of a survival skill set.  But when we are comfortable and have the resources and space to consider the world beyond our personal survival, instead of accusing someone else of making excuses, I'd ask what is our excuse for not imagining the depth and complexity below our observations?

If I had to choose one thing I am most grateful for in my education, and the one thing I'd wish most for in our education system, it'd be the value that books give in imagining this depth and complexity.

I recently read Beartown by Frederik Backman, which is a fictional novel about a very real, frequent occurrence: the rape of a teenage girl by a prized athlete in a small town whose livelihood relies on the sport.  After having so many patients suffer from this kind of trauma, I've read a lot about it this year (Missoula is a must-read for anyone interested in this topic).  This has taught me so much about how to re-evaluate how we judge, how reluctant we are to admit our gaps in understanding and knowledge.  While I had a lot of issue with the ending, I thought the beginning of Beartown does an excellent job letting us slowly get to know its characters and how many factors converge to create tragedy, such that there are many ways to answer the inevitable question of "How could this happen?"  It also shows the ramifications of not imagining, of simplifying people and situations.

There's little that drives me crazier and makes me angrier than this closed thinking.  It doesn't come from a cruel place, but can lead to such cruel consequences.  I know that when I'm busy and tired and overwhelmed (often), I do it too.  So it takes active energy and reminding to stay open, renewing the intention over and over when we fail.  With so many unimaginable things happening in the world right now, the least and best we can do is to hold ourselves accountable to imagining why and how.