“What happened to you?” This is a very popular question in psychology, psychotherapy and, perhaps, psychiatry now. So, perhaps it’s time I wrote about it. I suspect I will get (again) some stick for my post.
There are two ways in which this question can be understood. One is as a catchphrase for trauma-informed approaches to mental health. The other is that it has a form an actual question a clinician could ask their patient. Needless to say, I don’t wish to comment on the catchphrase, as I don’t wish to comment on the usefulness of such an approach to mental health. But I do want to comment on its usefulness in clinical encounters. This is for two reasons. First, I think, the question’s form creates expectations of patients/service users and, indeed, there are a number of websites which explicitly demand that clinicians ask the question. Second, I think the punchy question offers a shortcut. It’s ready, you don’t need to think about a different. You’re not convinced? Well, Justyna Ziółkowska has shown that the ICD finds its way into clinical encounters, even though its text is explicitly described as not for clinical use. And yet, it’s such a good cheat sheet, isn’t it? No, I will not be convinced of the wonders of clinical interviewing skills in psychology or psychiatry.
Now, before I write about the question, I need, again, to write a little bit about questions (and whatever I write will be a very unsophisticated and narrow account of a huge and fascinating field of linguistic, and not only, inquiry). I’m sorry that it’s longer than I hoped.
1. Questions have a focus. In other words, questions can be seen as incomplete propositions and so, they seek information. They can be said to project an answer which is wanted/expected of the person asked. So, if you ask:
How old are you?
it projects an answer consisting in a particular statement about the addressee. And if you get:
(I am) 30.
such a statement does fall within the demand of the question. If, on the other hand, you get a response such as:
Don’t worry, they will let me into the cinema.
it doesn’t. It doesn’t, for example, tell you about the addressee, but about ‘them’. Of course, it’s more complicated.
2. Gunther Kress and Theo van Leeuwen in their book “Reading images” describe representation (linguistic or visual) as a process which conveys the speaker’s interest in the object represented. Putting it differently, the question, its focus, form etc. results from how I want to construct both the question and reality with it.
Over a year ago I wrote a post about open questions (the most enduring myth in clinical disciplines) and I wrote about a border study. Ulrike Meinhof and I decided we didn’t want to ask any questions. We simply didn’t know how to ask a question. We were in a town which had been German before the war, now is half Polish and half German, the border goes right through the middle. And so, how do you ask a question, for example, whether Poles in the town go to…Exactly where do they go? The other side? Germany, across the river, Goerlitz? Every choice we make closes the possibility of our informants telling us how they construct it. We were interested in how our informants put it.
3. Questions offer a contract between the questioner and the answerer. By asking a question, you promise to listen to my answer. This ‘narrative contract’ comes with another assumption, though: tellability. In other words, if you ask me a question, you ask for my story (however brief) and you make an assumption that I am able and willing to tell you this story. In other words, the story is tellable.
But what if it isn’t? Because no, not all stories are tellable. Some are tellable in a particular context, some are only for certain people, and, crucially, some stories are simply not there. I have already written about questions I have no answers to, there is no ‘story’ to tell.
So, in sum. Questions focus on some things and not others, the focus comes from the speaker (I know it’s way more complicated), questions assume there is an answer. Phew.
Let’s now consider now the question I have written all the above for. Here it is again:
What happened to you?
1. Focus. This is, in my view, the most counter useful aspect of the question. You see, I would like to be asked to speak of myself, the question, however, doesn’t focus on me. No, I must speak of, shall I say, the world, the ‘it’. This happened (to me), this happened (to me) and it all has nothing to do with me (yes, I do mean it). If I sit down in front of the clinician, I would like to start with ‘I’. I, I, I, I. Not ‘it’, not ‘they’, not ‘he or she’, I want to start with ‘I’.
Of course, I am not suggesting at all that it is impossible to start with the ‘I’ narrative. ‘We’, patients, resist the frames which are imposed on us ‘all the time’. So, yes, I can, yes, we can, but that’s not the point. This question is constructed as the question, the holy grail of questions, and yet, it doesn’t offer me the opportunity to speak of me.
Interestingly, here, you could also argue that the question is not exactly very useful as a slogan. For it is a slogan which suggests that this therapy is not about me. It’s about this trauma, as if it were an objective object, the ‘what’, which happened to me and now I will compliantly tell you all about it.
But I still bloody want to talk about me. And not about it.
2. And here we come to the questioner. It’s obvious, isn’t it? The questioner constructs themselves as interested in the ‘what’. Somehow, the frame the questioner imposes on me makes it more difficult to speak about how I feel.
So, let me ask you this. Can I speak about how I feel or does it somehow wreck the plan you have for me? Because this question clearly sets out what you’re interested in. But what if I don’t share your plan for me? What if I just want to shout my pain out? This is, in fact, the fascinating bit about this question. As it is constructed as focusing on my social context and all the rest of it, it somehow blanks me.
To allow myself a bit of sarcasm….I always marvel at the gap between the narrative-keen clinicians and what then happens. I am so encouraged to tell you a story, but only a story you want. I reject this. The question shoves a particular version of mental health reality on me, your version, and I reject this.
3. And so, smoothly, we come to the third dimension. For me the question of what happened to me is actually very difficult. It assumes, ironically, much like mainstream psychiatry, that I have this in-built monitoring device which I will access at your request and give you the data you need. You might be surprised that I actually don’t have it.
But let’s start with the basics. Why do you use the past tense? Why not say: ‘What was happening to you?”. Why not say, perhaps “Why has been happening to you?”. Are there answers to such questions? Have you actually stopped to consider your focus on the past (Freud?). Incidentally, do you realise that the Polish equivalent (“Co ci się stało?”) suggests accidentality? Do you care?
I’ve been asked such a question. And, funnily enough, I suppose, I didn’t know how to answer. I didn’t know because I couldn’t identify anything that ‘happened to me’. But I also didn’t know what you want to hear. You see, you cannot disentangle yourself from the ‘narrative contract’. The contract implies that I must tell you what you want to listen to. And I had no bloody idea what you wanted to hear. Have you considered how frustrating it is for people who haven’t got an answer? Have you wondered how many people told you what they thought you wanted to hear? After all, I must say something, mustn’t I? I don’t want to look like an idiot.
I very rarely feel stupid in front of a clinician (a couple of doctors have my ‘stupidity scalp’, but I’m not yet ready to talk about it). But this question came very close to achieving it. I really wonder if clinicians actually give it a thought or two. You know, in your spare time. Or when you invent wonderful questions?
Here is a little comment. When I started my research into things psychiatric, I came to psychiatry with a very strong anti-psychiatric sentiment. Over time, the anti-psychiatric sentiment has been blunted (I’ve seen all too many wonderful shrinks), but I still have much sympathy with the ‘criticals’, on both sides of the psy-divide. And for me ‘criticals’ have always been about freedom – they offered me the opportunity to shed the psychiatric frame. But this freedom, I firmly believe, must be as much about me telling psychiatry to go to hell, as it must be about my freedom to espouse it! Because “some people find psychiatry helpful and that’s OK”, as Charlotte Walker wrote.
And so, don’t ask me what happened to me. Please ask me how I would like to tell you my story. Give me the freedom to talk. My way, not yours.