How’s Your Bedside Manner?

Recently I’ve been reading these 2 (great) books: The Myth of Normal and What is Normal? and it struck me that I hardly ever hear people talking in terms of what’s ‘normal’ anymore.

Most of the people I work with believe the idea suppresses and pathologises the nuance and richness of the world and the different ways of being therein. And I agree.

But what seems to me to have happened is that we’ve evacuated the term ‘normal’ and migrated many of the meanings, assumptions and judgements that used to live there to another term: ‘healthy’.

And healthy can be a much more restrictive concept. I can say, for example, that 5 hours of sleep is normal for me, and people will understand that I’m describing what is. I’m describing a pattern, or a situation.

If I say that 5 hours of sleep is healthy for me, I’m making an assertion about the rightness of the situation.

The pursuit of health can lead us into difficulty - as happens in orthorexia, an eating disorder characterised by a preoccupation with clean eating, or health anxiety, where we compulsively monitor our physical sensations for signs of illness.

Where aspiring to be normal at least leaves open the possibility of stopping at ‘OK’ or ‘ordinary’, or ‘good enough’, an aspiration to health often brings with it the anxious seductions of perfectionism and self-purification.

In recent years, there has been a push in the UK to put mental health on an equal footing with physical health, both in funding terms (which hasn’t happened) and also in terms of our ease in talking about it.

As a result, I’ve noticed more open conversation about mental health, but using language that makes it nearly impossible to understand the specifics of what is actually going on in people’s hearts and minds.

Where people used to come to therapy talking about grief or heartache or dread, now they increasingly come with the general aim of ‘improving their mental health,’ hoping to be prescribed a regimen of mindsets and affirmations, strategies and practices and ‘healthy habits’ so they can crack on with their lives untroubled by the inconvenient aches and pains of soul and self.

And the funny thing is, we are not inclined to think so perfunctorily about our physical health. The opportunity to be listened to intently by a kindly physician while we describe our ailments in granular detail is an experience many of us long for on a primal level.

I have some dubious expertise in this area, as a long-ago former editor of the Medical Romance series at Harlequin Mills & Boon - and a key part of the medical fantasy is the deep care and curious, incisive problem-solving of the doctor protagonist.

This fantasy diagnostician earnestly wants to know when it hurts, and where, and in what conditions. They’ll ask sensitive, intelligent questions about our history and environment, and listen carefully to our answers. It is this experience we want almost as much as we want the treatment itself.

Notably absent from this fantasy is the part where we turn up to the medical centre defensively armed with NICE guidelines and Cochrane reviews, knowing we’ve only got a 7-minute appointment and ready to pitch to our doctor the treatment we think is most likely to help, based on our Google self-diagnosis.

And yet this is how we often approach ourselves, in our attempts to solve the pain-points in our emotional lives: starting from the outside in. Searching for a general descriptive diagnosis that might explain our pathological state, and hoping to find a quick, off-the-peg, evidence-based solution.

But, as any good romance protagonist doctor knows, if we want to be more healthy - in the sense of enjoying a realistic level of ease and functioning - we need to start by identifying our normal.

We need to listen with care and curiosity to discover our patterns. Our situation. Our environment and how we interact with it. The beliefs we hold without consciously thinking about them.

Our normal may include a wide range of different states: flare-ups and remissions, highs and lows, thoughts and feelings that contradict one another, moods that come out of nowhere.

We need to be able to start from where we are in all of these states. Not where we imagine the average person is, or even the average person who shares our struggles.

(This wonderful short article by Cambridge neuroscientist Natalia Zdorovtsova highlights the enormous complexity of the human brain, and the vast cognitive differences even between ostensibly ‘similarly-minded’ people).

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We know that the part of ourselves in charge of self-care is often overworked and under-resourced, and doesn’t have a lot of time to devote to non-emergencies.

But with a better bedside manner, perhaps this part of us could be more engaged in holistic and preventative care. Maybe we could be more curious about the longer view, take a really detailed history of our experiences. Look carefully at what hurts, and when, and work out open-mindedly and pragmatically what might need changing or supporting or supplementing.

If you’d like some help perfecting your bedside manner, sign up for my free mini-course in Compassionate Productivity - where you’ll learn ways to listen to yourself just like the attentive doctor of romantic fantasy💓