“It is more difficult for well-educated middle class people who come from intact families to identify with patients who have had to struggle to survive. So the first question I ask patients is whether they come from an intact family, and if not, what events conspired to result in their not being reared by biological parents.
One would think that the primary cause of divorce is economics or infidelity, but, in fact, it is most often substance abuse, the chaos of in-laws, and/or the reality that “my parents were uneducated and married too young.” This, of course, sets the stage for the patient’s development, factors they must struggle not to repeat.
I also inquire as to whether they were reared in a religious household since such an environment would slant the family toward moral beliefs and a specific value set.
In A.A., there is the assumption that your best support comes from others who have the same struggles as you. However, we do not make such an assumption with doctor-patient relationships in which one side has all the risk factors, past trauma, disappointments and failed achievement.
Patients recurrently note: “How can he treat my pain; he has never been this miserable. He restricts my medication solely because of his lack of knowledge of me as an individual.” “I am terrified of (these procedures) but they are common for (the clinicians), and I feel alone and frightened.”
Or, and most commonly: “They have explained this to me. Either they think I am a child and cannot understand, or they think I have the same training, and it all makes sense.”
“When I go home, I do not have a family that can support me financially or emotionally. I have always been alone in that regard, and now I am out of resources at all levels. I am sure that no one can appreciate this.”
The parts of life we may take for granted – family, education, a happy childhood free of conflict, can makes\ it more difficult to relate to those reared otherwise, but it behooves us to put forth the effort to do so.