Physician, heal thyself?

For a while now The Guardian has been running a blog entitled Views from the NHS frontline in which a range of health professionals comment upon their experiences of working in the NHS.  What’s quite telling is that a significant number of these articles relate to the mental health problems experienced by such professionals.  These include stories from GPs, psychological therapists and nurses, and the types of issues described vary from stress and burnout to clinical depression and a range of other psychiatric conditions.

Of course, it’s impossible to tell whether the NHS is psychologically more ‘toxic’ than any other large institution.  As I’ve commented on in a number of posts relating to the financial industry, that sector is not exactly renown for its compassion and empathy in relation to its employees’ mental health.  However, perhaps the more worrying thing in relation to NHS staff is that these are precisely the people who are supposed to be helping everyone else.

This raises a number of questions.  To start with, and going back to the institutional side of things, is there something about the culture of the NHS which makes it psychologically toxic?  And if so, is this simply a matter of over-stretched resources, financial constraints, and a policy agenda which is geared towards the ultimate privatisation of all or large parts of the NHS?  Or rather, could it be that, rather like in the financial sector, mental health problems are somehow ‘taboo’?  In other words, if you work in the NHS you are not ‘supposed’ or even ‘allowed’ to experience mental health problems yourself.

This links back to the point I raised earlier: should we expect those people trusted with our own health care (both physical and psychological) to be somehow immune from such problems themselves?  Surely not.  On the other hand, is this what NHS patients (and staff) actually expect?  Furthermore, how does this feed into how the NHS staff see themselves, and their motivation for wanting to work in the health service in the first place?  In a previous post relating to this subject I touched on the idea (or rather fantasy) of the practitioner as ‘rescuer’, and how this related to the fantasy of the patient/client as ‘victim’.  But as I pointed out:

…it’s precisely when the ‘rescue’ fails (which it often does in the NHS) that the ‘rescuer’, i.e. the doctor, nurse, therapist, is driven to try again, to try and ‘get it right’ next time.  And it’s this repeated attempt to ‘get it right’ that perpetuates the suffering (enjoyment) of the individual, which is what produces stress and ultimately burnout.

What happens, though, when the ‘rescuer’ becomes the ‘victim’ themselves?  Does this mean they start to look for someone to ‘rescue’ them?  But who will this rescuing someone, this rescuing Other, be?  The NHS itself, the government, a sympathetic public?  The problem with this third ‘Other’ is that these are precisely the people who expect their doctor, their therapist, their nurse, to be in ‘good health’ in order to sustain their fantasy of the health professional as ‘rescuer’, and of themselves as ‘victim’.

Perhaps the place to start, in terms of addressing the issue of ‘rescuer turned victim’, is to explore where this ‘rescuer-victim’ fantasy comes from in the first place.  As with all fantasies, this particular one is concealing something else; something which relates to an inherent contradiction in human subjectivity itself.  But the key question to ask, perhaps, is how the NHS functions within this contradiction.  In many ways, the NHS itself is a fantasy; the ultimate ‘rescuer’ from the fragilities and contractions of the human condition.

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