What Blooms In The Silence
One of the ways that narrative medicine helps healthcare providers communicate with their patients is by teaching them how to listen for the symbols and metaphors they use to communicate their pain.
Since language is slippery by nature, people in pain often have to get very creative with their words to describe what they’re feeling. Colors and textures are common descriptors in my practice: a sharp jab or dull ache, the red hot of fire or the deep purple of an invisible bruise. A patient once told me, “It feel like a family of bees live there.”
Others aren’t always so expressive. Sometimes people in pain are completely silent, and prodding them for their “story” can feel like a kind of violence when that story isn’t ready to be told.
In a typical Narrative Medicine workshop, the study of language is paramount: we learn to listen for patterns, rhythms, and meanings, and to ground our observations in the actual words a speaker uses. So what do we do when language is absent?
To explore the space between symbolism and silence, I offered Kay Sage’s painting, The Outline of Silence, to this week’s workshop participants.
We began by examining the painting’s architecture. Sage is well known for surreal landscapes where buildings (rather than humans) take center stage, and this painting is no exception. In the foreground, some kind of edifice is either falling apart or under construction: rickety wooden beams attach at weird angles, colored fabric entangles itself around a spear, a gangway disappears around the far edge of a makeshift wall.
Sepia light mutes all color, casting long shadows that make the viewer wonder if a sun is rising or setting. In the center of it all, a white rose blooms, a single petal already falling.
I love this kind of art — the kind that begs us to enter its space and perspective, to wonder about its meaning. The kind that doesn’t make it easy on us. The kind of “difficult” art that, like a “difficult” patient, challenges us to rise to the occasion.
And this week’s workshop participants truly rose to the challenge! Some students felt the horizon in the distance could be an ocean, and the rickety structure in the foreground could be battleship retreating from a stalemate war. Some thought the horizon signaled land, the black expanse of safe ground so far below.
All of us felt a sense of desolation and abandonment, of things half-finished. The word “precipice” came up time and time again: the painting visually situates the viewer on the edge, unsure and unstable, just as the lighting situates us on the precipice of day, and the falling petal situates the rose on the precipice of life. Everything dangles on an edge. The painting seems to be holding its breath.
Together, we wondered how all this relates to silence. One participant noticed that the only clearly recognizable thing in the painting is the flower. The structure behind it could be anything — a ship, a building, a lighthouse — but the rose is no doubt a rose. For many of us, this single familiarity gave us an anchor of hope. We pondered the way that silence gives space for hope to emerge, even when everything around us feels like it’s a falling apart. Nevertheless, the petals already curling backward from the rose reminded us what a fragile thing hope can be.
Another student observed that the flower was the only living, natural thing in the painting, while the structure behind it seemed man-made. We thought about the constructedness and effort of speech, in contrast with the natural ease of silence (and what effortlessly happens there).
Finally, we wondered what this painting is asking us, the viewer, to do with the silence. The perspective of the painting seemed to be pulling us forward, urging us to walk along the rickety bridge that curves around the wall. Though the painting itself exists on the verge of a moment, the pathway behind the wall seems to suggest that this silent moment, too, is fleeting — that there is a pathway beyond the silence.
On the other hand, one student wisely pointed out that Sage’s painting is also teaching us how to tolerate ambiguity, to sit with uncomfortable silences, and to hold space for whatever might bloom in the absence of words.
In our reflective writing exercise, we wrote to the prompt, “What blooms in the silence?” One volunteer gave us a visual example following the painting’s use of contrast and dichotomy: she created two lists of things that bloom in silence, divided by a line. On one side of the line, she listed fear, resentment, pain, loneliness, directionless-ness, and floating. On the other side of the line, she listed introspection, mindfulness, connection, and “another reality.”
As we reflected on her lists, a fellow student honed in on the word “floating” and pointed out how this word is not necessarily “negative”; it provides the kind of fluidity necessary for change, a gateway to the right side of the list.
Another participant took this idea a step further, suggesting that the two sides of the list did not represent the “positive” or “negative” effects of silence, but the evolutionary effect of silence as it brings us from a necessary isolation to rest, mindfulness, and integration with “another reality” — another way of seeing the world.
These exchanges left us all with a new respect for silence as a place where, despite all outward appearances of stagnation, transformation is eminently possible.
In pain care, we all know that what a patient says to a provider is the tip of the iceberg, so to speak. There are so many other things going on inside them, beneath the surface of their speech. They have histories, worries, goals, and fears we no nothing about — that we have to infer through their pauses and nonverbal gestures, body language. And there are just as many things going on outside them in their homes, workplaces, and even in the clinic itself that shapes what they feel they can and can’t say. Kay Sage’s The Outline of Silence reminds us that it is our task, as providers and humans, to peer more closely into the spaces where words cannot go, and to honor the transformative need for silence.
If you participated in the workshop, please feel free to share your reflective writing in the comments below! (Remember this is a public space where confidentiality is not assured.) If you didn’t participate in the workshop, but you enjoyed “Proof of Life” and you’d like to reply to the writing prompt, we welcome your writing in the comments as well! Just set a timer for 5 minutes of free writing and post your exercise below without editing. We’d love to see where this poem took you!
If you enjoyed this class and you’re ready for more, please join us for an 8-week Narrative Medicine Program designed for healthcare professionals starting on Monday August 3rd 2020. Unlike this live ZOOM call, our program takes place asynchronously, so you can complete assignments at your own pace with weekly “due dates” and discussion boards that keep our classroom collaborative and co-creative.
Each week, we’ll be studying one artwork with corresponding philosophy, discussion, and reflective writing activities that will refine your ability to listen and engage with stories in a clinical setting. Find out more at NarrativeRx.com, and join our Facebook Group for an invitation to our next ZOOM workshop!
