When I was preparing for the med-school seminar on death and dying I taught last week, I read Stephen J. Freeman's Grief and Loss: Understanding the Journey. It's a good book, and I think it would be very useful for medical students, although I wound up not using much of it in the seminar.
One passage from the book, though, really jumped out at me. On page 96, in his chapter on unresolved grief, Freeman includes a section called "Deal with the Fantasy of Ending Grief:"
Fantasies sometimes provide us a glimpse of reality. It might be helpful when grieving has gone on for prolonged periods to have the bereaved fantasize about what it would be like to finish grieving. This exercise should take the form of experiencing both the pros and cons of grieving. Fully examine and experience what life would be like without grief and what the bereaved would be giving up by not continuing to grieve.This activity might come more naturally to a therapist or other counselor than to a physician; nonetheless, it highlights the role of the imagination in healing. It's much easier for all of us to reach any given place -- whether a physical location or a state of mind -- if we can visualize it first. When we can't imagine better or at least different outcomes, hope has died and chances for healing are diminished.
Medical students and other future clinicians, especially in their first two years, are bombarded with facts and data. Imagination tends to go by the wayside, except perhaps as the component of research necessary to formulate a hypothesis. But good doctors need to be able to encourage patients to imagine themselves in full health, and they also need to be able to imagine a range of explanations for patient or family behavior. They need to be able to imagine the non-obvious, both in clinical diagnosis and in personal interactions.
As a volunteer ED chaplain, I've sometimes seen caregivers leap to the first or most obvious conclusions about patients and their families. The relative obsessing about her own health conditions in the face of a loved one's terminal diagnosis is obviously a selfish hypochondriac; the frail little old lady who's alone in the ED has obviously been abandoned by heartless, unfeeling family; the homeless frequent flyer who lies about combat experience is obviously engaging in a contemptible charade.
I try to remind caregivers that there may be other things going on. Maybe the seeming hypochondriac is really worried about being able to care for a dying relative while also coping with personal illness. Maybe the frail little old lady has behaved so badly to her family that they haven't been able to care for her while also caring for themselves; or, at the very least, surely they have stories they could tell to explain their behavior. Maybe the homeless patient is mentally ill and really believes that he was in combat, or maybe his stories of being in combat are really metaphorical narratives about the difficulties of surviving on the street.
Any given situation can be explained by a range of stories. Reminding ourselves to imagine all of those possibilities helps us stay flexible, caring, and open to hearing the true tale, which is almost always both deeper and stranger than anything we've imagined. Nonetheless, imagination is excellent training for navigating the consensus reality in which we live.
Patients need imagination to heal. Caregivers need imagination to treat patients with compassion and dignity. Although objective test results are essential to medicine, there's much more to human experience than blood values and radiological images.