Presentation by: Dr. Evangeline Spindler, MD
Past President, Michigan Psychoanalytic Society; Training and Supervising Analyst, Michigan Psychoanalytic Council Faculty, University of Michigan Medical School and Michigan Psychoanalytic Institute, Ann Arbor
Summary by Sallie J. Schiel, Executive Director WCMS
Dr. Spindler began her presentation by describing what potentially constitutes a “difficult patient” and many of the characteristics they often exhibit. These patients are frequently demanding of time, medical tests, and prescriptions. They often refuse recommended treatment and present with medically unexplainable symptoms. Conditions of psychological distress can be manifested in chronic and disabling physical symptoms. When these difficult patients present in the physician’s office, they can elicit negative feelings by the practitioner.
An understanding of “mirror neurons” and how they work may become a tool for the physician dealing with a difficult patient. Dr. Spindler outlined ways in which knowledge of “mirror neurons” can help in treating difficult patients as follows. First, identify your gut reactions to these “difficult patients;” second, utilize empathy as a diagnostic and therapeutic tool; third, understand the “difficult patients” in a new light; and treat difficult patients with a new approach.
Dr. Spindler described the mirror neurons and how they function based on the work of Giacomo Rizzolatti, Vittorio Gallese, and Marco Iacoboni. Click on the following websites to observe videos on mirror neurons:
When we observe an emotion such as someone expressing pain, sadness, joy, or anger, it activates the neural representation of that emotion in the observer. That is why we experience various emotions when watching a movie. Dr. Spinder explained how the Mirror Neuron System (MNS) is activated. Further discussion of the MNS was presented by identifying pathways in the brain, and explaining the translation from observations to “embodied simulation.”
President Farmer presented a case study of a “difficult patient.” After the presentation, attendees were asked to respond to three questions with their gut reactions to the patient portrayed. Spirited discussions followed regarding their responses and how these can be used as a tool in dealing with a difficult patient.
Dr. Spindler advanced the concept of 3R’s in understanding difficult patients, namely, regression, re-enactment, and reactions (gut reactions). She followed with 3 T’s for treatment which included tolerating listening to the patient’s emotional frame of reference; tolerating not knowing, not rushing to order tests, not prematurely prescribing; and thirdly, turning our gut reactions or empathy into a therapeutic tool.
The general session presentation was very engaging of the attendees, and generated interest and understanding of the working of mirror neurons.