Put away the tissues.

Opinion by Robin Youngson.

I used to be embarrassed when my patients cried and I never would have dreamed of showing a tear myself. Our usual response to distress is to hand out the tissues.

I thought this gift of tissues to patients was a kind and considerate act but now I wonder about the unconscious message conveyed by my action. My ingrained habit was abruptly challenged the day I read about a doctor who chooses to never give out tissues. I now let my patients cry without interruption. Also, I am not ashamed or embarrassed if my empathy and compassion are revealed by my own tears. These are healing moments.

By these small habits – like handing out tissues – we erode and diminish the humanity in our practice. Handing out tissues conveys a powerful message: that we are not willing to validate or accept emotions as part of our practice. Expression of emotion therefore becomes an embarrassment and the clear message is, “Pull yourself together!”

I no longer believe in clinical detachment. From a Buddhist perspective, the only mental state in which you can make clear and accurate perceptions is open-hearted compassion – fully engaging the heart as well as the mind. Neuroscientists using functional MRI scanners to examine brain function can now tell us that cognitive and emotional centres are inextricably linked. They cannot find a physiological basis for our notion of rational detachment. So we had better become more skilled in using our own emotions in our roles as health professionals, rather than burying them in some dark corner.

Buddhists also teach us that every act of compassion for another is also an act of compassion for ourselves. When we bring open-hearted compassion and non-judgement to the care of others, we find our heart filled up with more love, not less. We all witness tragedies in the lives and deaths of our patients. Your heart will remain lighter if you have the courage to allow a gentle expression of your own sorrow. And your compassion will be remembered for ever, as the moment that healing began.

So throw away the tissues and let your heart shine together with your wet eyes.

The wonderful doctor I mentioned is Rachel Naomi Remen and I thoroughly recommend her book, “Kitchen Table Wisdom”. Her profoundly moving stories of compassionate patient care will be good preparation for your new practice of shedding a tear without feeling the need to reach for the tissues.

Original image: “The sad taste of tears” by Colby Stopa.



3 Responses to “Put away the tissues.”

  1. Anna says:

    I agree with Meredith, It’s about how the tissues are handed over. There’s nothing more horrible than already feeling at your most vulnerable and your own tissue is a sodden snotty mess while the tears continue to pour down your face and nose! Handing over the tissue box can be a very empathetic act.

  2. Meredith says:

    I can only speak from my own experience, but I have often often felt that the presence of a box of tissues in the consulting room actually gave me permission to cry – it said to me “crying is OK” and even encouraged, rather than “pull yourself together”. And the act of giving me a tissue when I was in distress so that I could cry freely without too much mess felt incredibly compassionate and kind. I think that the box of tissues is a bit of a red herring here – it is the manner in which it is used – the body language and other unconscious signals that vulnerable patients may pick up that say “pull yourself together” or “crying won’t help and it stops me from being professional”.

    • Elaiane Winchester says:

      I totally agree with you Meredith, and react the same way to a box of tissues – that its the listener’s response from heart that alows healing. Too many counsellors hold it back, but they are not being authentic.

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