We become physicians only when we know that which is unnamed, invisible, and immaterial, yet has its effect.
Paracelsus, German physician/mystic, 1493-1541
In my office waiting room I have one of those books full of stereograms. These are the pictures you see in the malls surrounded by a bunch of people staring intently, blocking traffic, and occasionally saying, “Oh! I see it!”
It’s not unusual to hear a clinician who practices without an array of measuring devices or intricate protocols described as “intuitive”, as in, “Oh, Sue doesn’t really know what she’s doing, she’s just real intuitive.”
I read that the ability to see the patterns embedded in a stereogram is dependent upon what ophthalmologists call “decoupling” – the eyes looking through the diagram while your lenses focus on its surface. In the real world you never ordinarily use this capacity.
As a clinician who does not depend heavily on detailed measurement, I know that I am occasionally given credit for being intuitive and it makes me cringe. Not because I’m not using intuition, but because of what it has come to imply.
When I read the description of decoupling and divergence used to explain how stereograms are finally seen, and appreciate how unusual this process is, I know that some real work has been done. In fact, when people claim to be unable to decipher these pictures, you find that their time and attention to the task is sorely lacking.
The intuitive clinician puts forth a real effort. In fact, the latin root, “intureri,” means “to look upon.” The sudden knowing of what is happening or how to proceed effectively arises from careful observation over time and is not something that magically appears to someone with a “gift.” This is why intuition typically grows with experience, as long as the therapist pays attention.
There’s a great line from Lewis Carroll specifically about this: “You’re not paying Attention,” said the Hatter. “If you don’t pay him, you know, he won’t perform.”
I have wondered for some time how the sudden vision of the image in a stereogram after work, time, and attention differs from what I suddenly realize in the clinic and I think I’ve found it in the quote from Paracelsus at the beginning of this essay.
In addition to what we can sense, name, and measure are processes inaccessible to our most careful scrutiny. We know they are present and we understand their effect only by going to the texts of biophysics, physiology, and pathology designed for our profession. There are plenty.
Without understanding the invisible, we are easily misled and properly thought of as no more skillful than bodyworkers with less education.
Intuition alone may provide my patients with enough to see those pictures in my waiting room, but they need a therapist with even more, and I deserve credit for that, too.