The Process of Words as Symbolic Communication in Healthcare Settings

WORDS AS SYMBOLIC COMMUNICATION IN THE HEALTHCARE SETTING
By Christopher Bear Beam, M.A.

I wish I could take language
And fold it like cool, moist rags.
I would lay words on your forehead.
I would wrap words on your wrists.
“There, there,” my words would say—
or something better.
I would ask them to murmur,
“Hush” and “Shh, shhh, it’s all right.”
I would ask them to hold you all night.
I wish I could take language
And daub and soothe and cool
Where fever blisters and burns,
Where fever turns yourself against you.
I wish I could take language
And heal the words that were the wounds
You have no names for.
Julia Cameron


I have worked in healthcare and social service settings for about three decades. In fact, when I first became interested in General Semantics, my motivation was for very practical reasons. I was working at that time for a small, community-based social service agency that served youth and families. What attracted me to General Semantics in this setting was how practical and “down to earth” GS principles could work in the everyday lives of adolescents as they moved through this part of their human journey.

Essentially, as I now view it, General Semantics assists us in aligning ourselves with the evident and observable structure of life existing in our environment and the rest of the universe.

Then, over two decades later, I worked in a highly clinical setting: I was a resident, hospital chaplain. Much of my role was being a ‘non anxious’ presence in the lives of people who were going through healthcare crises in their lives. It was in this setting that I began to realize how our intensional models of thinking contribute to more stress and anxiety in our lives. For example, to say, “I’m a cancer patient,” may be highly problematic for someone who thinks that this is all they are in every domain of their life: a sick person who is lives with a death sentence.

The use of extensional models of thinking, on the other hand, may help a person to “incrementalize” their illness. For instance, to say, “I have a tumor in my lungs that the surgeons need to remove; a consensus of my doctors say that this can be done
Effectively and successfully through surgery. I have elected to do this surgery.”
Extensionalizing and incrementalizing are ways of thinking that bring us to more manageable and realistic expectations; the AA concept of ‘one day at a time’ is a good example of this.

The difference, General Semantics teaches us, between intensonal and extensional reasoning is that the former focuses on what we think about the abouts. By that, I mean if a person is told they’re terminal, and have six months to live, there may arise feelings of vulnerability, loss of autonomy and control, loss of one’s body functions and health, and fear. Where do I go in my own mind with these thoughts as I interpret them? Extensional reasoning uses more of a scientific, rational and objective form of evaluation. Eastern traditions would perhaps use the word detachment from our emotional reactions and acceptance of the world as it functions. This is also an acceptance of life viewed as sickness, health, stress, peace, birth, life, and death. These are all realities of the structure of how life functions in natural systems and human systems. Humans do have emotions and reactions to stresses, and these aren’t to be minimized, but just accepted and given liberation by detachment and letting go.
Emotional attachment leads to compulsive assumptions and behaviors that leave us stuck in unhealthy places.

As a chaplain I would often try to help people in the hospital, who happened to be sick in various ways, to “think out loud,” by asking them questions about their illness, how they felt about it, what they were thinking about what the medical staff had related to them (this in itself gives a helpful understanding since it leads to thinking “about the abouts”), and how others were relating to them due to the illness. This might encompass what friends, family members, and healthcare professionals were saying and feeling about where they were in life in that present moment. Then, I might reframe the illness by using different symbols and metaphors hopefully leading to a new way of perceiving the illness itself. Finally, if there were scientific data available that could be used to point the realities of the illness, I would use that information.

Today, after a number of years of doing this work, I have concluded that those people who work in the field of the Healing Arts often are not equipped with the understanding of how their words are symbolic forms of communication having great import in their client’s minds. Since they are often seen as the experts in the field (this is starting to change as healthcare moves to more of participatory process, but there still are huge gaps in its practice) there is a primary accountability for taking the lead in communicating in a healthy way. I guess what I’m also saying is that it would be helpful for medical professionals to learn the principles of General Semantics that would give them more tools to work with in dialoguing with the people they serve. Another way of saying this is that it would give them a supportive means of symbol making that leads to more healthy outcomes.

Since the patient-doctor relationship (healers together)--points towards the need for trust and respect, the consumers of healthcare services need also to understand about how they react to what they hear from those in the healthcare field. Staff is responsible for this as well. People who are patients have a need to trust the staff who, for the most part, want to use as an emblematic credo ‘do no harm;’ they also need to trust how they think about what information they are given. For this to happen it’s helpful to develop critical minds for understanding one’s own emotions and thought processes, and a way to evaluate and interpret the messages they hear from the staff. Of course, this is one of the missions of General Semantics.

I have learned from the field of Family Systems Theory, developed by Murray Bowen, first working with schizophrenic families in clinical settings, that stress and anxiety can cause incredible role and communication patterns to be put in place in the family system. These patterns reach stages of concretization that set in motion ways of being in the family and the world. They often do lead to “crazymaking” thoughts and behaviors in the way they are demonstrated in the family and outside of it. Natural Systems educate us to know that humans are amazingly resilient and highly adaptive to surviving life’s stresses. Often illness itself may be used as a coping mechanism in a dysfunctional family system.

Another component to how things go down in a healthcare setting is the ability to catch an overview of the entire communicative context. Items such as the medical environment, one’s conditioning in perceiving hospitals and doctors, one’s mood at the time of diagnosis, whether a person has strong or weak family and social support, the manner in which the medical staff treats a sick person on a daily basis, an individual’s private non-verbal feelings and images about the doctors and other medical staff (does the doctor look like your mean Uncle Joe or your sweet Aunt Betty?), the scientific data about one’s illness at the time, the procedures and prognosis of various regimens of healing, one’s religious beliefs about healing and illness, and perhaps most importantly, is the food good or bad at the hospital?! All of these factors present themselves in transactional processes between patients and healthcare professionals.

To illustrate an example of what I’m getting at I would like to share with you a personal example. I’m hoping that you see me as a credible witness to the symbolic communication involved in these interactions, because I, too, am a Qualified Mental Health Professional. I am always changing, testing, observing how these dynamics are being played out as I attempt to serve people with major Mental Health diagnosis. Person A is not the same today as he/she was yesterday, or will be tomorrow. So dating is a positive strategy that may be used by those of us who work in the helping professions.

I have a serious diagnosis. I have liver disease, clinical depression and Hepatitis C. I have been going to the VA system for medical care for these chronic illnesses. A system also communicates a cultural way, an emotional process evolves within the system, and people are impacted by it. Most people recognize that the Department of Veteran Affairs is under funded by Federal monies. Many services have been trimmed back, and even returning Vets from Iraq question whether they will receive sound treatment for physical injuries as well as PTSD (Post Traumatic Shock Syndrome). Rates of suicide are on the rise among military personnel returning from Iraq. So there is a natural “push back” by many clients of this system, and a wondering whether the system itself really appreciates the service they gave their country.

I am a Vietnam Era Vet, and have been attempting to receive effective treatment for my Hep C. I have noticed that continuity of care is lacking if one moves to different places, and transferring to other VA clinics. In my case, I have concluded that I have ‘fallen through the cracks.’ I have between two cities in Texas.

Recently I had an appointment with a Nurse Practicioner (apparently they have no liver doctor at this clinic) who is the main staff person in the clinic who works with patients who have Hep C. As she reviewed my latest blood test results, she told me, “Looks like you have advanced liver disease now. It also looks like you have a tumor on your liver. It’s inoperable, but there are some other treatments available.” She mentioned nothing to me about the possibility of a liver transplant. But she did tell me in somewhat of a matter-of-fact way, “You should get your remains in order.”

The whole conversation took me by surprise and left me feeling numb and off-balance. In short, I found myself speechless. At a time when I should have asked her a lot of questions, in my mental confusion, I couldn’t find the words to articulate what I wanted to know. She made an appointment for me to have a CAT Scan done thirteen days away; I would have to travel to another VA hospital for the imaging services since mine didn’t have the equipment to do the test.

After I left her office, I felt fear, and began to think in very intensional ways. I also began to simply “be” with what I was feeling at the time, and tried to let my fear drift away like smoke from a fire that was burning out. Gradually, I began to accept whatever emerged as my own personal reality. I thought of the Serenity Prayer: God help me accept what I can’t change, to change what is in my power to change, and the wisdom to know the difference (my paraphrase).

What did she mean by the phrase, ‘Get your remains in order.’ What does “remains” mean? If I’m supposed to do this now, I’m not a bag of assorted remains, but it’s a given that I am a whole person who can choose, plan, make a plan for death, tie up loose ends in my life, say good-bye to my family, etc. Even upon death, we are still persons, perhaps in some other form, but still persons. The word “remains” triggered the memory of my mom and sister and me taking my deceased dad’s cremated ashes to a park overlooking Lake Michigan in a suburb north of Chicago. Feelings of sadness for the loss of my dad were mixed, sensing of incompletion in our relationship, with feelings of release and liberation as we scattered his “remains” into the lake.

On the other side, the word “remains” may be seen as the lowest common denominator of human constituency. There are the parts of a corpse or a biologically alive being that can be labeled, categorized, and observed. Other aspects of one’s spiritual essence are not scientifically observed, even though we’ve learned much from recent mind-body research.

The intensional part of my thinking that poked out its nepharious head was first of all fearing the words I had just listened to; I had a negative and critical attitude toward the Nurse Practitioner and her sterile, and what seemed to me to be, indifferent demeanor. I felt no sense of caring compassion. In terms of General Semantics, I think many healthcare professionals view this kind of news as a kind of package they must give to the patient. ‘Here it is—I’m giving you this package of bad news aka your diagnosis.” This is objectifying an illness as if it’s a being or object, rather than an organic or inorganic process at work in one’s body. It’s a play on the idea: sickness is like a marble that you swallow. It becomes an integral part of you, even though it has no shape or form we can point to and say “this is cancer,” like we might say, "this is a dog," or "this is a horse."

I am a person that is constantly dealing with and trying to manage my own anxiety about life and its events. One of the most experiential and qualitative ways I know of is to think more extensionally. It’s a way that helps me to counteract my own intensional spirals that are running downhill; so often the outcome of this thinking is a feeling of hopelessness, demoralization, depression, and immobilization. My wife and I realized, in this case, that we needed more extensional information and data so that we could see a more scientific picture of the effects of my liver disease.

We drove to the clinic that was about an hour away, waited six hours in the ER, and finally saw a doctor. This doctor also happened to be a liver doctor. He was calming, compassionate, and answered our questions. He ordered an Ultrasound for me, and afterwards, he came back to give us the results. He reported to us that there was no mass that could be seen in the liver. Both Pamela and I let out sighs of relief that felt like hot air under pressure being released from a balloon or tire. Compacted stress and anxiety was released into the universe. The doctor told us that he wanted to still have me do a CAT Scan because it’s a different kind of test from an Ultrasound,
but he assured us that the Ultrasound gave a ninety-nine percent view of what was happening in my liver.

I write about this personal example of a health crisis in order to show that we can process such news utilizing General Semantics principles. I emphasize the word process because any illness of influx of life-giving energy is in process, just as we are as human beings. We are not events, but we are organisms-as-a-whole-in-environments that constantly flow, shake, move, ebb-and-flow, grow and degenerate. I encourage everyone to do more study on the nature of intensional and extensional forms of reasoning, especially using them when given news of major, life-changing proportions. Bruce Kodish and Susan Presby-Kodish’s book Driving Yourself Sane gives an excellent explanation of these two modes of thought, and would be good supportive reference to my explanations here. With more knowledge of General Semantics we may be better equipped with the tools to confront stressors revolving around our personal health and that of others who we love.

References
Cameron, Julia. (1992). The Artist’s Way: A Spiritual Path to Higher Creativity. P. 204. New York: Tarcher/Putnam Books.

© Christopher Bear Beam, M.A. June, 2009


Biography: Christopher Bear Beam has been using General Semantics constructs for over thirty years as a Human Services professional and Qualified Mental Health Professional. As a group facilitator he co-leads anti-racism groups and integrates his knowledge and experience of General Semantics within the environment of transactional change in this area. He is the author of three books, and is a poet/spoken word artist. One of his books, The Golden Window of Silence: A Way of Becoming More Fully Human, explores the meaning created and communicated by silence. It can be ordered by going to www.xlibris.com. In 2008 he co-founded a Texas Nonprofit Corporation called Sunbear Community Alliance whose mission is fostering intercultural understanding through the Arts and Social education. More information a bout SCA can be gained by going to www.chrisbearbeam.com and clicking on the “training” icon. Christopher Bear Beam may be reached by email at cosmicbeam@hotmail.com.