1. Meeting the Patient: Ideals and Realities

Animal signals, whether vocal or visual, are largely innate, and so there can be no misunderstanding about their meaning. The flattening of a dog's ears means fear, the curl of his lip implies aggression. If a Gelada monkey lifts his eyebrows to reveal a yellow stripe, he is under threat. Animal signals are limited and inflexible, but they are precise and unlikely to be misconstrued (Ardrey 1970). The human animal is often unaware that his actions, gestures and expressions are telling their own clear story - they are the outward signals of inner attitudes and tensions. Man concentrates so hard on his words that he often seems to forget that the coded messages from his body can be either contradicting or confirming the words from his mouth. It is as if two languages are being spoken simultaneously: the familiar verbal messages and transmissions from the subconscious which are often visible rather than audible. Interpretation of gestures, tones, postures· and behaviour is like translating a foreign language (the subconscious) into a common language. In recent years, doctors and nurses have become increasingly aware of the significance of the dual languages they and their patients share because research has pointed to problems which can be missed or generated when "body language" and "verbal language" are contradictory or confused: the so-called double message . . Effective communication between two individuals depends partly upon the language and nonverbal messages issued by the two people and partly on a willingness to receive messages from one another. For example, poor results are inevitable if clinicians become inflexible in their consulting techniques (Byrne and Long 1976), because part of the messages issued by patients can be shut out and fall on deaf ears and blind eyes and clinics can be organised to make it difficult or impossible for the patient to share certain problems. A bustling atmosphere can make it awkward for many patients to communicate problems which they have difficulty in expressing in words: for example, many a physician has prescribed for a vague pain in neck or shoulder girdle and