One of the most essential aspects of true diagnosis is to allow the patient to tell their own story in their own words. However, one of the interesting challenges I occasionally face with a patient is extreme loquaciousness. You know the type — their mouth never stops moving, and it is virtually impossible for you to get a word in edgewise. I vividly remember one initial appointment, where I literally asked my new patient only one question (“What brings you here today?”), from which point the patient responded continuously for the remainder of the 90 minute consult!
Initially, this can seem like a good thing, as it can sometimes be a challenge to get some patients to open up and tell their story. Quickly, though, my feeling turns to frustration, as I realize that it’s going to be an uphill battle to convey any information to the patient, even in terms of basic instructions for taking their remedies, or following my suggestions for lifestyle modifications.
Of course, this issue comes up across a broad spectrum of behaviours, and is rarely expressed to such an extreme degree. In various ways, though, it does provide an interesting challenge to the consult situation, as I realize how difficult it will be to get this patient to take in anything which I might have to say to them. I start to wonder why they have come to ask for my help, if they seem incapable of receiving any?
What can I do to make this a productive time for the patient? Aside from the obvious ways I can interrupt them to take control of the dialogue, there are some things I’ve learned that I can gather from a patient when they’ve gone into “automatic playback” mode on their internal tape recorder.
What is the content of their story? What do they talk a lot about versus what do they avoid talking about completely? (A brilliant interruption, by the way, is to point out to them the topic they are obviously avoiding — this often brings their automatic monologue to a dead stop, and one of the only moments they actually sit quietly for a moment and demonstrate a true feeling.)
What is their tone of voice like? Monotonous, or sing-song? Do they make more statements or questions? How about their breathing pattern? Most loquacious patients have very poor breathing habits. What is the state of mind behind all of their words? Another effective interrupt is to feed back to them an observation of the hidden state of mind behind the story they’re telling on the surface.
Amidst the endless chatter, I am also seeking to understand the reason that this patient is behaving this way. Is it a form of nervousness? Or a deep insecurity which gets covered-up by such attention-seeking behaviours? Some personality types are naturally more talkative, and some more reserved. How close is this behaviour to their natural personality, and how much of it is a compensatory behaviour? Maybe it might be a cultural difference depending on where they grew up? Figuring this out can go a long way in understanding what sort of remediation this patient will best respond to.
Finally, on a medical note, some of these loquacious patients have responded very well to the homeopathic remedy Lachesis; the essence of this remedy is a pent-up energy which desperately seeks an outlet for discharge. Sometimes it is this form of non-stop talking which functions as an attempt at discharging the excess energy.
When this remedy hits the mark, the silence that follows is truly golden!
- The physician’s desire function
- Diagnosing through quality rather than quantity