Welcome to the last instalment of this series on Quantum Mechanics, focused on our perception – and therefore our patient’s perception – of reality. This topic is so relevant for any clinician and you may be thinking that, ‘this is A, B, C stuff, so why the hell would I waste 5-10 minutes of my day listening to you ramble about it?’ Well, it’s a good question and hopefully I can answer this in one blunt statement, ‘is it really that simple?’
Do we know all that we need to know to make firm conclusions about this topic? If you have been following the last couple of blogs on Quatum Mechanics, or are scientific in any manner, then the answer should be pretty evident – absolutely not.
But, to be honest, I start from the same biased position as many of you might when entering this topic – it should be very simple, to understand our patient’s perspective. In fact, going further, one might think (and I tend to agree) that we get told this is a core skill as a health professional. After all, allied health professionals are meant to be the experts in empathy right? Seriously, there is data here – we’re supposedly better than doctors AND EVEN TRADITIONAL CHINESE DOCTORS (Ref). So, in my mind, the ability to appreciate and understand your patient’s version of reality should be simple, it should be the mark that separates the good clinicians from the great clinicians. At least, this is what I’ve told myself for the past 10 years (yes I told myself this at university… OK!?).
Once again, though, if we understand anything about the natural world and the make-up of the universe, is that it may not be that simple. And maybe what we do, when we apply our expert analysis of the perception, drivers, intent and behaviours of our patients, isn’t what we really think we are doing… Let me explain.
Theory of Mind
Theory of Mind is the ability to recognise and attribute mental states – thoughts, perceptions, desires, intentions and feelings – to oneself and others and to understand how these mental states might impact behaviour. (Ref)
We’ve all got it, apparently. Like an X chromosome, it’s an innate trait that we are born with. It develops as we age and interact with other humans – sometimes it can go astray in conditions like autism. It explains why you can delve into your ‘heuristic’ system of thinking – System One thinking – and pretty quickly come up with a map of why your patients may have come into your cubicle or clinic. You attribute intents and desires behind their actions and behaviours, and there you have it, you start with your first question,
“Tell me your story”
I’m not saying that your practice of attributing meanings is wrong, mind you, just that it is not quite as right as you might think. And don’t worry – I still think starting with the above question is absolutely the best way to go in the clinical scenario, because what else do we have if not the patient’s story – a bunch of meaningless tests, amongst meaningless data, which doesn’t correspond to the patient’s phenomonen of pain – useless as tits on a bull. For reals.
To my point; the theory of mind, our practice of this in clinical situations and in general daily life is simply the process of human’s telling stories to themselves. And you can weave a story any way you like, it doesn’t make it real. The theory of mind, believe it or not, is still just a theory; there is not and never will be, any discernible evidence for thoughts or feelings attributed to actions – these are stories we use to understand how other people behave. The issue with people, is that they are unpredictable and their story might not match yours – because after all, you got into this game because you are a rational, reasonable and thoughtful individual – so unlike your patients right!!? So maybe the mountains of data that you diligently get from your patients isn’t the only thing you collect, that is useless..
Let’s get this out of the psychological realm – because I am woefully out of my depth – and bring this into the quantum realm – where.. I am even more woefully out of my depth.
Perception is reality
You’ve heard of Schrodinger’s Cat. Great little thought experiment – there’s more wacky people doing these – from none other than Edward Schrodinger (get right out of town!), which elegently poses the problem with interpretation of quantum mechanics. That is, that any quantum phenomenon (like atoms, which we are all made up of), can exist in multiple states at once, until observed – or interacted with – by an external system. It is the process of observation that makes the world so, in short the world actually is really what we make of it.
Observation causes the wave function collapses into one definitive state – reality. But it is slightly more complicated – observer and object are then instrinsically linked and coupled – to form our reality. One cannot exist without the other.
It doesn’t take Einstein – or Schrodinger – to figure out where this is going. It is a fundamental fact of the natural world that your patient’s reality is theirs, and only theirs. We know that the pain phenomenon is a subjective experience, but now you can back that up with quantum data! It might only really transmit if your patient is a physicist though.. so probably don’t mention that.
Ok, so I have rambled for long enough and present my two presuppositions. The theory of mind is just stories we tell ourselves, no more real than any fairy tale you listen to as a child. And the nature of reality is such that it is truly a relative experience that can’t actually be shared by another conscious being. But what’s the takeaway you ask?
If you understand that your patient’s stories may not mean as much as you think they do, then this can be a liberating experience. Once you understand that some stories exist, in our patients minds, not actually in reality, simply to exist and not to impart meaning onto actions – because we may actually simply create that meaning in the first place – you may be left with a sipmle decision. Where do you want their story to go? Who cares where it has been – it doesn’t mean much anyway!
This is another way of saying something I have been saying for years, and maybe what has lead me to progress into the roles I am now in. If we get caught up in being reactive, and ascribing meaning to where there may be none – in a patient’s pain presentation – then there is limited room to change the future path for them. Do we want to manage someone and create no change, or do we want to look to the future for them and help them create that change? Rhetorical question- I think you know my bias there.
So if reality is relative, how to we get their ‘story’ headed in the right direction? Again, a fundamental theory of how the universe works, tells us that we live in an uncertain world that is only made concrete by our conscious perception. But extrapolating this is when things become very interesting; an uncertain universe means that the future is far from certain. Their reality is of their making, and maybe just maybe, they can understand that it can be different if we get this concept across.
Our job is to be teachers and open up more possibilities. Everybody – I mean absolutely everybody – is ultimately limited in their perception of reality, but people who come to us for help are much more limited. Our job is to open the door to other realities.
Teach an understanding of avoiding absolutes and understanding that pain, injury, difficulties are all going to happen – they are a natural part of our existence, in an uncertain, unpredictable universe. There are some simple things to practice to increase your adaptability to this uncertainty, namely being durable, potentially even anti-fragile. But nothing is unavoidable because of our uncertain universe. The beauty of our uncertain universe, however, is that we can choose any path to the future, there is always room for change and nothing is set in stone; it is up to us to demonstrate this possibility to the patient.
Once again, thanks for reading.