Embedded in the Imax approach is a fundamental respect for the person in front of you. It is this respect which, I believe, serves as the foundation of trust between patient and physician, and of course, between any people anywhere, not confined to any particular profession or relationship. There is a fundamental human desire to trust each other, to “attach.” This draws on a deep and ancient component of human interaction that, I believe ultimately drives all of human interaction. I explore this critical concept in the following Chapter: attachment.
Attachment, Theory of Mind, and I Wonder
The Imax Equation is based on two fundamental components of human interaction. The first is Attachment. Why do parents take care of their children? On the surface it seems a simple question. Parents take care of their children because they love them and want them to be successful. There is a crucial biological drive to nurture our offspring, and teach them by example what qualities go into relationships.
Why do people attach to each other? People attach, driven by a basic human need to be in the company and proximity of another person. Attachment is a building block of society. It implies a desire to rely on someone else, and be relied on in return. This connection is modulated by the second fundamental component of human interaction embedded in the Imax Equation: a concept with the somewhat clunky term “Theory of Mind.”
In essence, Theory of Mind is rather simple. It is the ability to appreciate someone else’s point of view. What someone else is thinking and feeling. It is a somewhat inelegant term to indicate that a human being has the ability to “theorize” about someone else’s “mind.”
So what’s the big deal? An ability to appreciate another person’s point of view doesn’t sound like very much on the surface, does it? It is such a fundamental part of our interactions we are not even aware it is happening. As such, we take it for granted.
Of course a kid begins to appreciate that another person has a point of view. Isn’t that how kids learn what is expected of them? Isn’t that how a parent knows if their kid is hungry, or tired, or eager to play? Isn’t that how a kid, as they grow older, recognizes that their parents and other people in their social world have their own thoughts and feelings, motivations, beliefs, dreams, aspirations? It is the essence of socialization, coupled with the need and desire to attach. These are the building blocks of society, the fabric that binds us to each other and helps define who we are.
Theory of Mind is about empathy. Empathy is the ability to understand the experience of someone else, to have understanding of their feelings and difficulties, and often to feel compassion.
But not only do human beings have an interest in what someone else is thinking or feeling, they have a particular interest in what are you thinking or feeling about me. This is more than Theory of Mind. This is something I call “I Wonder” or Iw. In the Imax Equation it is part of the third Domain, the Ic Domain or how “I see” myself and how I think other people see me (Iw), how I see others (Theory of Mind), and how I want to be seen.
The Iw component plugs directly into Attachment. I will or will not want to attach to you depending on how I think you see me, how you feel about me and my actions. The Imax approach capitalizes on these aspects of basic human nature. When we see each other as at an Imax we view the other with respect. When I think you respect me it activates the Iw in a positive way, and promotes a greater likelihood that I will want to attach to you. Attachment implies trust and trust allows one to reach another degree of potential.
For example, Imagine a little boy is playing by himself in the sandbox. He is three years old, healthy, happily playing with his toys. Gradually a feeling starts in his belly. At first he ignores it, faint, distant, familiar but uncomfortable. He moves his body a little in case his tummy hurts just from the way he is sitting. For a moment it goes away, and he turns his attention again to his play. But then it is back, a little stronger, and stronger still. He has felt this before, and he knows what to do.
Inside his house life goes on. Parents are doing what parents do, siblings are doing what siblings do. The little boy leaves his sandbox, a discomfort that can no longer be ignored or avoided by his games. He finds his mother.
“Mom, I’m hungry.”
“You’re hungry? Then I’ll feed you.”
What has happened here? The child has identified a feeling that he thinks may be hunger. It’s in his belly, a little uncomfortable, but he’s felt it before and it went away with food. Any food. Still not quite old enough to satisfy the discomfort himself, he has gone to his mother, a person who has taken care of this problem before, sometimes even before he knew he had the problem.
He doesn’t ask, “Am I hungry?” He makes a statement and then waits for confirmation. “You’re hungry?” asks the mother, “Then I’ll feed you.” The child is now saying to himself, “Yes, this is hunger. I thought I was hungry and my Mom said she would feed me so I must have been hungry. Cool.” And catalogues the feeling of hunger for future reference.
In this simple example, the entire Imax Equation is demonstrated. At first, the boys Imax is quietly playing with his toys. He is alone yet comfortable. He is able to play by himself knowing his family is inside. (A child who can play by himself is usually a securely attached child, one who feels safe and respected.)
There is a shift in the biological domain. He becomes hungry. A cascade of biologic mechanisms begins to send a signal to his brain. When there is a change in one domain, even a small change, a ripple effect occurs throughout the system: An augmentation engages a fluid transmission between Domains, altering his self-image and Ic. This change in how he perceives himself, from contently playing to the mild discomfort of hunger, propels him into his house. He has already internalized that his home and family are a place where this discomfort can be appeased. His home environment, his mother, is responsive to his needs, and confirms his Ic. He thought he was hungry, his mother confirmed he was hungry, and then she fed him. His home domain had a direct impact on his Ic and his biological domain.
This interaction in the home environment will have lasting dynamic on how he engages in his social environment. As he gets older, the types of attachments he makes at school, with friends and then lovers, with employers and employees, will have as part of its foundation interactions such as these: if you are hungry I will feed you. This core event fundamentally affects one’s Ic. When a need as basic as hunger is met, the individual’s biological barometer is set at a different Imax, the Ic becomes one of a person who sees themselves as valued and respected. This sense of self-value is then communicated through the functions of augmentation in the home and social environments, and the child has the ability to see others as deserving of value and respect.
In the vast majority of homes, this simple interaction follows the same path. I’m hungry. You’re hungry? I’ll feed you.
There are many times when a parent cannot immediately meet the needs of the child. Sometimes a parent may say, “You’re hungry? OK, I’ll feed you. Right when I finish what I’m doing.” In this example the initial confirmation is still powerful, confirming the internal experience of the child with an external validation. But the parent has also asked the child to appreciate their own internal point of view, their own Ic. The parent’s Imax is changed when a child asks for food. They then have to shift their Imax. Their biological domain has been primed to expend energy to feed their child. Their Ic activates as a parent who feels capable, knowing they can take care of this child needs, and that they are, therefore a “good” parent. But they may be paying bills, or interacting at a different level with their social environment, and now the home environment, in the form of their child, is exerting a ripple and augmenting effect throughout the system.
By asking the child to wait without invalidating the child’s Ic of hunger, the parent has been able to interact with the child in a way that models mutual and reciprocal value and respect. “I will feed you because you are hungry, but I have confidence in you that you will not die of starvation in the next five minutes, and that you can tolerate the discomfort of hunger without resorting to disrespectful and unsafe behaviors.” While the child may remain hungry for a few minutes, it also enhances the child’s Ic that they are seen as a person who can tolerate difficult feelings.