The distinguished actor, director and drama school teacher Andrew Neil died earlier this year. Followers of CIC may remember him from an interactive workshop he ran for the Association for Narrative Practice in Healthcare. In an earlier interview with him, North Wales GP and CIC trainer Jens Foell explored what the performing arts can teach medical students and health care professionals. We’re privileged to publish an abridged transcript of the interview here and hope it will lead to further contributions that highlight ways of enhancing narrative practice.
| “A freedom to have another option” : Jens Foell interviews actor Andrew Neil, July 2013 |
| “The best definition of an actor that I know is somebody who uses his or her total resources as a human being to create and communicate a role and I think, that for a doctor to be operating at maximum capacity he or she has to use or has to touch on all of their resources.” |
Jens: From my point of view this is an interview about the thoughts or the experiences you bring in to teaching medical students. For example authenticity – where is the link for you between teaching medical students and the work of an actor?
Andrew: I think I’ve said before that the best definition of an actor that I know is somebody who uses his or her total resources as a human being to create and communicate a role and I think that for a doctor to be operating at maximum capacity, he or she has to use or has to touch on all of their resources – not just their intellect – not just their medical knowledge – there is a whole raft of just human relationships – human interactive things. I mean I think it’s to do with control…a good actor has to be so aware of the signals that he or she sends out. When you’re playing one role you send out one set of signals to when you’re playing another – but you’ve to be aware of ALL the signals. And if you’re aware of them, then you can chose which ones to use and which ones not to use – I mean we all are individuals because we instinctively have different sense of signals and we think in a different certain way and we move in a certain way – and that’s fine, it’s not a question of changing that – but I think a good actor has to be very aware of him or himself in terms of how they use space – how they use status. How they listen. The actor on a stage is in a spotlight in a way – whether it’s a stage actor or on camera, so every little thing – and I’m talking about the little things – every little thing that they do – if they’re going to be believable and if they’re going to be believed and if they’re going to be authentic – has to make sure that all those little signals that the listener or the partner or the audience don’t analyse, but are instinctively aware of – I think those little things – they have to be – every little physical thing has to support the thought. If it doesn’t – the audience won’t analyse it but they’ll think “I don’t quite believe that” – that’s not the human thing – that’s an acting thing – so it’s distant from me. And I think in a way – the patient – again without analysing it – does the same…
| “Plays are all about crisis, they’re all about conflict, they’re all about something having to be resolved and the process of attempting to resolve things. That is what plays are about and in a way, medical consultations and the relationship between a doctor and a patient is not a million miles away from that.” |
When I’m directing plays – whether they’re television plays or stage plays or whatever they’re – they’re all about crisis, they’re all about conflict, they’re all about something having to be resolved and the process of attempting to resolve things. That’s what plays are about and in a way, medical consultations and the relationship between a doctor and a patient is not a million miles away from that. So I mean that’s a long, slightly rambling answer to your question about where I see the link between the authenticity in the two jobs – because they’re jobs. I’m not talking about drama as therapy – I hate the whole idea of drama as therapy – I’m talking about using the equipment that you’ve got – the doctor using it, the actor using it in an effort to portray/tackle resolving a conflict and I think the good actor is very, very self aware. He’s aware of what he’s capable of, he’s aware of his tools. I think – I suspect – very many medical students are not aware of their tools and I think making them aware of them could make a positive contribution.
Jens: In terms of teaching these tools – what did you find useful? We did lots of little communication games. You also used gesture, posture, movements…
| “It should be a REAL dialogue inside a group of people and they should be part of it.” |
Andrew: I think the student actor and the student doctor share dilemmas– it’s time well spent observing – just observing people generally, observing each other in slightly structured situations. It’s this thing of becoming more and more aware of what we do and how we behave and what we have at our disposal and the HUGE amount of stuff that we don’t use. I also think that the wrong sort of pressure should be taken off the students so that there should be a playful element…that it should be fun. And I don’t mean that we should laugh all the time. I think it’s something that people should look forward to. Like actors as well – It’s not some heavy sort of Stanislavskian set of commandments – it’s not that at all. It’s fun. I think really really good acting is the easiest thing in the world but it’s also the hardest thing because you need to just be there. Once you’ve made that sort of breakthrough I think then it becomes fun. It’s also very important that however you do it in a teaching session – I don’t even like “teaching session” as an expression – it should be a joint thing, it should be a cooperative thing. It shouldn’t be, you know “I know everything and you’re the student and I’m now going to tell you”. It’s not like learning quantum physics. I don’t know what quantum physics leaning involves, but I mean it should be a REAL dialogue inside a group of people and they should be part of it. For example, when you’re doing role play with students, rather than say to a medical student: “now you’re a forty year-old man and you’ve got two legs and only one arm and your wife has left you,” you’re not asking them to be actors, you’re just asking them to find out what they’re capable of. If you create them as a group, it takes the wrong sort of pressure off because the wrong sort of pressure makes a student think that they have to stand up and be an ACTOR and that’s not the aim. When I work at my best I learn things. People teach me things…
| “Everything starts with really, really, really small things. And what you learn is an accumulation of very, very small things. Very small things. Very small things that accumulate in to something.” |
That’s why I enjoy directing because in a good rehearsal I come out of it better than Iwent in because actors tell me things that I’d never thought of. They show me things…and so there is a sharing thing and I think that it very important. I think too much of the sort of communication skill teaching that I know of because people tell me what it’s like, I think “oh my god that sounds like boring. And not something to look forward to” and I think. I also think people tend to speak in huge things and I think everything starts with really, really, really small things. And what you learn is an accumulation of very, very small things. Very small things that accumulate into something. I don’t think you start with big things – you always should start with the small things.
For example…you know…you and I’ve got on well since we first met at OSCEs and we talked about training and we seemed to share the same interests and so we had an informal session. After seeing some of your students give a presentation, one of the very, very first things I thought about you was: “I’m not at all sure that he listens all the time”. (Jens laughs)… Now I…I was wrong about that and I didn’t think “oh he doesn’t listen” I just thought “I’m not sure if he does” because…I think sometimes there is so much going on in your head that you don’t give the normal number of signals that tell somebody that you’re listening,.. which is always slightly disconcerting for the person who is speaking or who is talking to you.
| “If that is how they read that signal, I should just alter the signal – it’s a freedom to have another option.” |
They’ve got three or four thoughts they want to communicate with you and they stumble slightly after the first thing because they think…”is he…I don’t know if he understood that…I don’t know if…” and it’s a characteristic that you have (laughs). Or that in my opinion you have…and I suspect you’re not nearly as aware of it as other people are. But if you thought about it. it’s not that you shouldn’t do that but you should have the choice of thinking maybe – “if that is how they read that signal, I should just alter the signal”. It’s a freedom to have another option.
Jens: How can I as a learner as, certainly as a performer in simulated situations but also in real clinical drama situations – how can I become more aware of what I give and what I leak – become aware of my signals?
Andrew: I’m not saying this is something that would happen overnight – but that’s at the centre of the sessions and the students shouldn’t feel “oh god this is just something I’ve got to take in.” Where you get an atmosphere that’s playful and everything else, it wouldn’t take long for the student to accept the principle. And then it’s a question of going through the process either at the centre of it in a role play situation or another exercise session or simply by observing and then analysing in a constructive way. A couple of times I’ve commented about something you do in front of students. And I’ve said it without thinking and afterwards I’ve never thought “oh I was demeaning you” in any way. I was just using youand I said something about them as well. And in no sense was I saying they were doing something wrong. I just think “this is the signal you send out” and very possibly this is what I and the eight other people in the room take from it.It’s not something that happens overnight. I don’t think somebody can give a lecture about this and everybody goes away and thinks “oh yes I know now”
It’s a craft. It’s a craft and it’s an awareness of not just the voice and the mind but the body as well. Very close to the body and space.
Jens: You did some work with GPs. How did this go? How did this evolve?
Andrew: I used to be Head of Acting at the Welsh College of Music and Drama and there was a very progressive doctor at Bridgend phoned me up. And he said can I come and talk to you and he said “we have half a dozen really recently qualified GPs. And they’re aware and I’m aware of how we don’t know anything about body-language or communication skills and you’re a drama school. I’m just wondering if there is any way we could help each other”. And I said “well I’ll bring a bunch of students down and…and let’s just get together and see what happens”. And we did it over probably eight months or something. And by the end of it we all looked forward to it because the actors got things out of it. The GPs got things out of it. I learned things. The first couple of sessions we only used the actors and I did various exercises with the actors and some stupid, funny exercises – about status – just so that we could begin to establish a common language and also that the doctors didn’t feel they were performers of any sort. And then, we moved from that into including them in some games. We did some voice with them and then we got down to what is called role-play where I did that thing of all of us constructing the character…
And sometimes we would have the actor play the doctor and the doctor play the patient or the other way round. Or sometimes we would send three of the doctors away to have a coffee and without them knowing it, the group would come up with ideas for a patient and then I would take the actor away and say “look you’re going to do this three ways… you’re going to do everything that was asked of you but you’re going to fall in love with the doctor” Or: “you’re going to do everything that was asked of you and you’ve had a couple of drinks and you’re going to get quite aggressive and…” so we would do that . And then we did some other stuff and we videoed it – and then we all sat and looked at the video and we talked about the actor’s body language – the doctor’s body language – and, and one of the really good things about that was at no point did it ever become negative. It was always constructive. By the end of it, I did one session where I said “OK here we’re – I’m not going to do anything” and I said to the doctors – “this is your session – what do you want to do?” and they did a wonderful session. Part of this session was the same sort of things we had been doing but then they would come up with new things that were extraordinary.
This is an abridged transcript of the interview. For the full version please contact jens.foell@nhs.net