Most of us have experienced the relief, the gratitude, the flush of warmth when the ‘strong one’, an authority of some kind, appears, helps and holds us in our moments of terror, or crisis, or state of perplexity.  The primal emotions and dependencies in such situations have obvious beginnings in the relative helpless-ness and dependencies of childhood. These dynamics are implicit in many clinical situations. The existential threats of illness cause our patients to turn to us and put their lives, their very existence in our hands.

But in medicine we have lost sensitivity to this. For example we often expect information to be enough, or that patients can give mature and convincing consent when in thrall to existential dreads and primitive dependencies. If they display anxiety and panic they may be dismissed as an ‘anxious person’, a ‘difficult case’, a ‘heart-sink patient’, or simply as an irritating, time-consuming problem. But maybe it is also a failure of clinical ‘authority’.

Some clinicians exude an inner authority

In the modern world the simplest form and the most legitimized form of clinical authority is a doctor who sees a typical pattern, makes a diagnosis, and has available a drug treatment, or a surgical technique that will restore the body’s balance or functioning or indeed prevent some further deterioration. We are all grateful for these technological triumphs. The authority lies in knowledge, experience and skill.

That is all taken for granted.

But things are much more complex than this. There are many people with conditions where this kind of authority fails. We do not have a ‘tech’ fix available, or the fixes we offer have risks and side effects.  And many people need much more than a diagnosis and a drug, they need to be listened to, or they need to discover in what way their personal stories are making them unwell.

There are those who rely so much on what they are taught and have learned, that when inner authority is called for the healing enterprise collapses.

Logic might suggest that when clinicians find themselves not being able to provide what is needed from their store of knowledge, then what they need is more knowledge and more skills. To some extent this is true, and indeed this is what our University MindBody Healthcare post-graduate program is based on—for two years we coax clinicians into expanding their conceptual and skill repertoires. And gradually most of them become more effective  ‘whole person’ clinicians. They show a new level of confidence, competence, and, yes, authority.

But what I notice is that from the beginning some exude a quiet inner authority. When this authority is less developed we may find it to be a consequence of personal background. Somehow the person has not acquired an inner authority. That is to be expected. The more scandalous aspect is that this lack of authority can be fomented and maintained by the professional frameworks within which people work. One is allowed to do this, but not that. In these contexts, the authority resides in the evidence, or in the norms of the discipline, or in the scopes of practice, in other words in something outer. There are those who rely so much on the outer, what they are taught and have learned, that at the very point when inner authority is called for the healing enterprise collapses.

The authority I refer to, while hard to define, may be characterized by solidity (open but not rigid), gentle confidence (but not brash or arrogant), self-reflective and self-questioning (but not ultimately timid), humble (yet still courageous), generous (but firm and boundaried), and more.

Mostly I think it is grounded in an active capacity to live and work out of and from one’s own depth of ordinary humanity towards another, a process in which we recognize and deeply appreciate that the other shares this very same humanity with us. And we are moved to respond, albeit in the codes of our clinical roles.

Words spill into view as we stretch to capture and describe this form of active recognition and response:  love, empathy, compassion, care, bonding, duty, sacrifice, commitment, self-restraint, courage, ethics, limits, and limitations.

I don’t think we are talking super men or women. Many clinicians show some of these characteristics. But we need to renew our appreciation of how important these elements are to healing. And they can be developed.