From the Stroke to the Silence: Percussive Training as a Lens on Timing in the Psychiatric Interview

J Eval Clin Pract. 2026 Dec;32(8):e70736. doi: 10.1111/jep.70736.

ABSTRACT

RATIONALE, AIMS AND OBJECTIVES: Psychiatric training teaches the content of the clinical interview systematically, that which is asked, screened and documented, but it transmits tacitly, most often by osmosis in supervision, the moment at which one asks, the duration one grants a pause, and the point at which one changes direction. This essay takes the training of a professional drummer as a case of embodied, temporal procedural expertise and asks what that competence makes visible about timing in the psychiatric interview.

ARGUMENT: The essay first develops a positive reading, on which percussion supplies useful categories for describing clinical listening, and then turns it into a negative one, on which the decisive gain is not technical. Percussive expertise does not add a method to the clinical repertoire; it marks and renders thinkable the precise point at which the formal curriculum fails to reach the singular experience of the encounter. The account draws on the literature on tacit knowledge and reflection-in-action (Polanyi, Schön) to characterise timing as procedural knowledge, and on lived time (Minkowski) and implicit temporality and intercorporeal synchrony (Fuchs) to situate it within phenomenological psychopathology. Percussion is treated not as metaphor but as a case of embodied procedural expertise, and the correspondence claimed between percussive and clinical operations is functional and deliberately bounded, not one of identity.

CONCLUSIONS: The contribution of the musician to clinical practice is less an additional technique than a lucidity about the limit of formalisable knowledge, and about the singular that no diagnostic category exhausts.

RELEVANCE TO THE JOURNAL: This essay addresses the philosophy of clinical practice and the person-centred care agenda central to this journal. It concerns a dimension of the clinical encounter, its temporal organisation, that resists codification and is therefore poorly served by the formalising tendencies of contemporary evidence-based practice. By clarifying where formalisable knowledge ends and irreducibly procedural clinical judgement begins, the essay contributes to the journal’s continuing debate on tacit knowledge, technical rationality, and the limits of rule-based accounts of clinical practice.

PMID:43002638 | DOI:10.1111/jep.70736