Learning to listen, understanding the importance of what we hear, and knowing we must understand before we speak or act, are among the psychiatrist’s most important skills.
Allan Tasman, MD | Editor in Chief
Hello darkness, my old friendI've come to talk with you againBecause a vision softly creepingLeft its seeds while I was sleepingAnd the vision that was planted in my brainStill remainsWithin the sound of silence . . . And in the naked light I sawTen thousand people, maybe morePeople talking without speakingPeople hearing without listeningPeople writing songs that voices never shareAnd no one daredDisturb the sound of silenceFools, said I, you do not knowSilence like a cancer growsHear my words that I might teach youTake my arms that I might reach youBut my words, like silent raindrops fellAnd echoed in the wells of silence . . .
-Sound of Silence, Paul Simon1,2
In the song Sound of Silence, written when he was 21, Paul Simon reveals a complex view of silence. The first stanza with the first line, “Hello darkness, my old friend,” seems to express the value of being in a meditative or reflective state. Alternatively, my psychoanalytic self sees in those lines an allusion to the work done by the unconscious during sleep and dreaming. Later, though, he describes the isolation, sense of emptiness, the anomie, when alone and unheard, looking for a moral compass in a harsh society. Clearly, as with any well-written poem, there are many layers of meaning if we silently reflect on Simon’s words.
The world, and especially our country, has been so much noisier in the last few months than I can remember since the 1960s, and it’s often been hard to think, much less reflect. Too much of the current public speech and noise, as was often the case in the 60s, seems to reverberate more within an echo chamber than between people or groups, and there sure doesn’t seem to be a lot of listening or reflecting going on in some important quarters. As a person and as a psychiatrist as well, I, like many others, bemoan this state of affairs. And I also, as a psychotherapist, know the value of silence in helping one to reflect and understand.
I’ve recently had a return to an earlier career role as the director of our third-year medical student psychiatry clerkship, and I’m happy that I’ve had the chance to talk with them about the value of listening empathically; something they rarely hear from any other specialties. This mode of understanding, as we know well, often means listening attentively but silently. We know that when we listen empathically we learn things about our patients, or anyone else for that matter, that we may otherwise never have discovered. The seeds of understanding that are planted in our brains during psychotherapy grow, as we quietly reflect, into a much richer and complex vision of the person rather than the illness we are treating.
Learning to listen without speaking, understanding the importance of what we hear, and knowing that we must understand before we speak or act, are among the psychiatrist’s most important skills. Although we spend our entire careers honing these abilities, we know the effort is worth it because the more we do it, the better we become in carrying out this difficult set of tasks. It has been gratifying to have had a number of our students begin to experience for themselves how important these listening and reflecting skills are for both the doctor and the patient.
One of our third-year students, in an end of clerkship essay, wrote: “. . . when a patient is in the hospital, there are so many people coming in and out of the room, checking on the patient’s lungs, heart, GI system, nervous system. But no one checks on the patient as a whole. And that’s where psychiatry comes in. I learned the value of simply entering a room, listening to a patient, letting him talk. . . . It was astounding the difference (this made) in (my patient). I found it so rewarding to be that person. This is an uncommon phenomenon as a doctor. Even if I choose to go another path than psychiatry, I will always carry this lesson with me . . . to take the time to listen to the patient and treat not only the physical being, but the self as a whole.”
I celebrate that, as professionals playing such an important role in the welfare of those who have placed their trust in us, we place our highest value in truly listening and understanding before acting. I wish, and hope, that those in all spheres of life who are entrusted with the welfare of others, learn to do the same.
1. The Sound of Silence. Simon and Garfunkel Lyrics. http://www.azlyrics.com/lyrics/simongarfunkel/thesoundofsilence.html. Accessed February 14, 2017.
2. The Sound of Silence. Wikipedia. https://en.wikipedia.org/wiki/The_Sound_of_Silence. Accessed February 13, 2017.