Daniel J. Benor, MD

Unspoken words are rarely silent in their effects. They may influence us quite powerfully in many ways.

Unexpressed emotions that fester
We may hesitate to say something that could lead to hurt or anger, often when we are experiencing these same feelings ourselves. If my boss is asking me to stay late when I have family obligations, my emphatic response of outrage might be better off toned down, lest I lose my job. If I am feeling such emotions, it is likely that others I interact with are too. When words go unspoken and underlying negative emotions simmer, they often leave residues of unresolved feelings on both sides of the communications. Unexpressed feelings tend to fester, generating defensive, irritable, and angry interactions.

When frustration and anger is stirred and not resolved between caregivers on a therapeutic team, treatment also suffers. At the physical level, adrenaline levels rise when we are upset. While this is helpful if a tiger is attacking, it has negative consequences in a therapeutic setting. Adrenaline makes us more alert to deal with attack, but at the same time makes us more distractible, so that we can focus on any shift in the attack. In an office, anger can lead to unhelpful distractibility. Where emotions are unexpressed, staff get distracted more easily. This is when phone messages and medical records go astray. Psychological mischief may also intrude, with unexpressed feelings leading to unconscious or conscious manifestations of anger that are expressed through irritating behaviors, ranging from brusque or negative verbal and non-verbal interactions between staff, through passive-aggressive behaviors that release angers indirectly, and displacement of anger towards other staff and respants.

In The Inspector General, a film featuring Danny Kaye, there is a classic portrayal of such interactions. In the first scene of the sequence, the wife of the police chief berates and belittles him and stalks angrily out of his office. He chews out the first sergeant, who reams out the corporal on duty, who shouts at the patrolman who is leaving his office. This unfortunate officer, having no one lower on the totem pole to vent his angers on, storms down the stairs of the police station. Danny Kaye, an innocent bypasser, happens to be walking in front of the station at just that moment. The patrolman bumps into him and angrily shoves him into the gutter. Kaye, angered at his mistreatment, kicks at a passing dog.

Unexpressed feelings may produce physical tensions that cause or contribute to headaches, backaches, migraines, irritable bowel syndromes, chronic fatigue syndrome, allergic diseases (asthma,


Unheard or unacknowledged words
Respants (responsible participants - alt. for patients per Bernie Siegel) often complain that doctors take too little time to listen to respants’ explanations of their problems, don’t actually listen to hear what might lie behind the problems, and prescribe treatments without adequate explanations. This is often experienced as an expression of uncaring on the part of the doctor. Respants may reject medical advice and ignore recommendations for treatment. It is estimated that half of medical prescription written go unfilled - a reflection of these sorts of problems.

Many people who come to doctors are not looking for treatment. They want to share their anxieties and learn whether a pain or other symptom is serious. As often as not, if they are simply asked, "What is your body saying with these symptoms?" they will be able to identify the underlying stresses that are contributing to or actually producing physical symptoms. Joe, who had severe migraines, responded, "My headaches come on towards the end of the weekend, as I start to think of going to work on Monday." Frieda, who had been suffering excruciating stomach aches for years, with occasional bloody stools, was scheduled for surgery to remove part of her bowel. She was startled to be questioned about why her guts were in such an uproar. No one had ever asked her to consider the stressors in her life and how she was swallowing down her feelings. Psychotherapy, relaxation and imagery exercises, and careful attention to her diet relieved her pains and made surgery unnecessary.


Euphemisms for denial of death
In Western society, including those within the medical community, we tippy-toe around mention of death. To avoid mentioning death, we may say that a person passed on; breathed her last breath; shuffled off;  answered the last call; was beamed up (Star Trek reference);  bit the dust;  bought the farm (euphemism for grave); bought his box; cashed in his chips; checked out; coiled up his ropes; croaked; crossed the river; it’s curtains time; that dreamless sleep (Byron); reached the end of the line; fed the fishes; flatlined; went home feet first; went home in a box; went to a dance party with God; went into the fertilizer business; went the way of all earth/flesh; went to his last rest/ roundup; Hamlet’s sleep; her number was up; it's Taps; kicked the bucket/ oxygen habit; got knocked off; has gone for a long slumber; took the last count; turned his toes up; he is visiting Davy Jones' locker; is living-challenged/ living-impaired; lost in translation; mailed in her warranty card; was collected by the grim reaper; moved into upper management; suffered a negative patient care outcome; departed on the never-ending trip; she’s off the record now; struck out by the Big Blue Pencil; permanently out of print; remaindered; taken out of production; sent to the dirt archives; reformatted by God; on the road to nowhere; passed on; paid the piper; paid her debt to nature; put on immortality; shed the mortal coil; shuffled off this mortal coil; is six feet under; sleeping with the fishes; slowly cooling to room temperature; snuffed it; steped onto her last bus; took a dirt nap/ earth bath; pushing up daisies/ parsley; he is now worm food.

The religious communities and those with personal spiritual awareness (Benor 2006) may have another spectrum of expressions. In some cases, these too may be euphemisms to avoid facing fears of the end of physical existence. In other instances, these may express direct awarenesses of the continuity of conscious awareness on other planes, after the spirit departs from the physical body. In these communities, what may appear to be a euphemism may be an acknowledgment that death is not the end of life. Such expressions may reflect communications with surviving spirits (two out of three people who have lost someone close to them will report seeing, hearing them, or sensing their presence); having channeled/ mediumistic communications with spirits; intuitive inner guidance; angelic encounters; recalling past lives; having near-death or other spiritual/ mystical experiences. These alternate designations for  death may include: being gathered to one's fathers; got her halo; gave up the ghost; went to meet her maker;  went to his just reward/ happy hunting ground/ last reward/ the sweet hereafter; joined the angels/ her ancestors; is kneeling at the big gates; launched into eternity; passed on; crossed over; is picking up her harp; rung down the curtain and joined the Choir Invisible; singing with the angels;

Avoiding naming what every person is going to face denies respants the opportunity to deal with their anxieties and fears. Most doctors are not trained to deal with end of life issues, and therefore avoid them. This is worsened by Western society’s general tendency to deny and avoid dealing with death, doing everything possible to prolong life at all costs.

In summary

Words, wisely used, are gateways and avenues to healing

(1246 words)

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