51 Comments
Jul 23Liked by Amy Walsh

Yes, all my colleagues steered away from desire to practice when they simply began to understand a portion of how money was the unspoken God, over all, when practicing. From the money required for education of high school valedictorians, to the money for damage repair, it ended quickly, usually immediately. Poverty practitioners are quite available, yet illegal, according to the mammonic money creation masters and enforcers(anyone who serves for more).

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I think everyone goes through training thinking, oh when I get out, I can do things “the right way”, not realizing how insurmountable many of those obstacles are and how many of those barriers aren’t even really within the healthcare system. For example, people placed in assisted living because their loved one would take care of them except that they would lose their job. Or how many healthy choices can you make when you’re working 3 jobs to get by? When the system is not designed to value life because it is life, but only for what it can do for you, we’ve gone far off the path.

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Thank you for this erudite piece. Much the same attitude and outcome occurs in the police service. 43 years after I left the service I am finally coming to terms with the damage I suffered in an occupation where the only way is ‘tough’. 43 years or more of suicidal ideation, depression and anxiety, not understanding why. Ironically, it’s being tough that’s kept me alive but it’s been a hard ride. We all need a kinder, more supportive world especially for those who confront and deal with things that most are unwilling to face.

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Thanks Steve. I agree there has to be a formal way to set down the things we carry or share the burden with others. Especially in fields like medicine and police work where you may not only see terrible things, but potentially feel/be responsible for a terrible thing happening. I was just talking to friends about how impossible it feels to have a system that cares in that way, that is willing to loosen its hold on profits to tend to patient and staff safety.

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I always felt that the only people I could have talked to would be other Coppers because no one else would be able to understand. Canteen culture and toxic masculinity made that impossible, I would have been ridiculed out of the job. I was a Copper in the UK where profit wasn’t really part of the mix. What drove that environment was tradition, rule following, “it was good enough for me when I was a lad so it’s good enough for the youngsters now. Get over it” As a result I lost several ‘friends’ in the ten years I did the job and in the few years I stayed in touch. And I mean by their own hand or through booze and pills. I’m 69 now and I left the job in 1981. Further contact with police forces in the late 1980s and again in the early 2000s - not as a serving officer- clearly indicate that while the roughest edges have been knocked off the culture has changed little.

Since I left the job I’ve had several friends who’re medics, six of them fully qualified and experienced doctors. All of them carried the pain with them, every last one. And not one knows what to do with it except drown it in booze and behave in ways that harm them and others around them.

This world needs to change!

(Sorry if I’m rambling. A very recent diagnosis of ASD/ADHD has dramatically unmasked me and I’ve discovered the joy of monologuing…🙄)

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I totally understand that feeling that no one else gets it but us. I’ve struggled with that because the other doctors get the doctor stuff, but not my woo woo spiritual stuff and the woo woo people get that, but have no concept of what the doctor stuff is like. And yes, when there’s not real human connection and love to support you through the rough stuff, you feel like your only choice is to numb and often you don’t even know you’re doing it. Or at least I wasn’t consciously aware of it. It was always something to be dealt with later.

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Thank you for this honest and indepth look at the need for and lack of resilience in healthcare. Your lessons are hard won, but I am grateful you are sharing your experience and best practices with us. It's wild to think how easy it could be to change the culture, if the initiative is there. I just got assigned the task of charing our hospital's clinician wellness committee and as soon as I figure out who the membership, this will be required reading for them.

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I'm glad it hits home for you. It is interesting to think about how much listening would help and how badmost of us are at it. I'm eager to hear how your conversations go. I had what maybe a little bit of a dramatic idea today, but I was imagining what it would be like to be an end of life doula for the current iteration of the American healthcare system.

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Jun 18·edited Jun 18Liked by Amy Walsh

This powerful and honest look at resilience in the healthcare industry offers so much to think about. While healthcare has its own unique needs for resilience, there's plenty in here that can apply to other professions. I see parallels in academe. I am also taking away vocabulary: "extractive wellness" is an idea that deserves further contemplation. I guess I don't have much to give back at this point, except to thank you, Amy, for publishing this.

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Thanks Jeanne, I agree that's a big reason I wrote this piece is that medicine is certainly a good example of how this system of relying on individual resilience doesn't work, but it's far from the only one. In fact, it impacts us all, medicine may (or may not) be a little more extreme.

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This is such important research and a moving story. I’m glad to find this conversation happening here. I held my breath at the part where positive qualities such as trust and acceptance are more likely to keep someone in an abusive relationship. I’ve definitely seen that in myself and in the systems where I work (education and the nonprofit sector). One thing I think it makes it hard to leave is thinking about what will happen to others who are more vulnerable than you if you do go. I see this playing out especially with elementary school teachers who are working at dysfunctional schools who don’t want to leave their kids…I don’t know what it is exactly that we can do to demand better of these systems, especially given that unions have been weakened over the past forty years. But awareness our own mistreatment is a good start.

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Thank you Sarah, I found that really striking as well, because you would think that these “positive” personality attributes would empower you to leave, but it looks like you really need some realism or cynicism to say, “this isn’t right” and get out. I agree with you that there’s a sense of duty that ties us to staying, though in Emergency Medicine it isn’t quite the same because we are viewed as interchangeable, but the status of a doctor sort of gives you this delusion that you can change the system from within and I feel that as a parent in the school system too, like if affluent, invested parents that school districts listen to leave for other systems or home school or whatever, what kind of system is left for kids who have parents that school districts don’t listen to. I think a lot of it is trying to leave with community care in place, like maybe someone leaves their teaching job, but because their spirit isn’t being crushed they have a little more energy to tend to some kids they worry about? Doctors are just now starting to unionize, so I wonder how that will play out. We have enough social status and the healthcare system is reliant upon us enough that it could lead to some moves. I’m skeptical they will be enough to save a sinking ship though. Like I said, if a crisis like COVID is not enough to get us to really look at and overhaul the system, I shudder to think what it will actually take.

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Amy, this is a very important piece of writing and I have to come back to it to take it all in. I have not then aware before that “resilience” has become now in idealized or even idolatised term professionals are now measured by. This can only lead to another kind of exhaustion and despair.

I have worked in spiritual and existential care, a field which mainly concentrates on patients as audience. But I always felt we need to concentrate on the helpers themselves. They are daily confronted with existential situations of life and death and have to power through them. There is no grade of resilience which could make that work for ever. It is almost as medical professionals have to carry the lot the rest of us does not want to carry, namely the pain and finitude of human life.

Your text really got me thinking. How can we offer existential care to the medical profession to prevent further acts of despair? But it would also require a system change to prevent burning them out so totally that suicide appears as only way out to get some rest and peace.

I think the Scandinavian countries do better. Doctors rarely work full schedules. I think that is a good idea.

Just some brainstorming fragments here being intrigued by your text, Amy.

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Thank you Almut. I appreciate your persistence. Lately, I've been writing articles that I wouldn't be able to read in a single sitting. I think that the US healthcare culture is significantly dysfunctional compared to Europe in general and Scandinavia in particular in nearly all realms.

The idea that we are the place that people kind of outsource their yucky feelings and the labor of aging and mortality really rings true to me.

I think spiritual support for staff would be really beautiful and would likely meet up with a ton of resistance. Part of the reason I struggle so much in medicine is my views are not mainstream:)

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Oh, I hear you, Amy! I felt the same in psychology. So I ventured elsewhere. But I miss it, too. I am always struck by the American prices for medical services, the same as in Europe but 10x higher. So something has to give. But German doctors struggle just as much I think. Healthcare for health carers is just as little available as therapy for therapist, I guess. But may be we can come up with something new, outside the system?

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Yes, the costs are staggering. I don’t think it’s too hard to access healthcare for healthcare staff, if you overcome the pride and stubbornness, but I think it’s like you said, there’s this totally unrecognized need for spiritual care that we just blow past in this need for efficiency.

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Yes, I can see the difficulty of helpers asking for help. Thus I envision some retreat style options which are outside of the health care system indeed. It might lower the threshold to attend.

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Hmm, would you ever consider working together on such a thing?

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I would love that!

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Jun 12Liked by Amy Walsh

This article is very timely. I recently learned that my former coworker at Hennepin ER just died by suicide. He was in his 30s. He’s the 2nd staff member in that dept to commit suicide this past year. The other was a young woman with small children. It’s no coincidence that this specific dept is notorious for promoting the type of flawed ‘resilience’ you discuss.

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Oh wow, that's truly tragic. How are they tending to the broken hearts and broken spirits left behind?

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Jun 12Liked by Amy Walsh

I think since this is the 2nd instance, they are trying a little harder. I know middle management was very tactful in how they announced the news. They also gave their personal numbers out to all staff members. But middle management is mostly RNs who had also worked closely with this person. I think they’ve had someone like a counselor present in the break room. Beyond that not sure.

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Yeah, it's interesting to think about what would be needed and supportive. I know for much of my career I would have been very resistant to most support services.

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Thank you for this! What a wonderful meditation on resilience and community engaged care. I plan on sharing this my students next fall!

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Thank you, that's so kind! If you remember, I'd love to hear about any discussion it provokes.

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Thank you for this moving and and insightful essay. Love the emphasis here on restoring community care and unpacking underling messages behind not only healthcare but so much of the extractive mindset of contemporary societies.

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Thanks Sally. I definitely think our struggles in healthcare mirror similar problems throughout society. I was so happy to find that writing on how to start creating a culture of mutual care from Iowa, but then I think about all of the wounds we have to heal to even get to openness to that starting point. It's daunting.

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yes the big picture is very daunting, I focus on grassroots mostly these days. Simply bringing people together and committing to listening to one another about what how they feel and what matters most to them is a great start as you suggest.

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I am active in climate psychology work where we do a lot of talking circles, climate cafes etc. For activists this provides opportunity to talk about how they really think and feel (as opposed to how they think they should), for general public it’s an opportunity to voice confusions, fears etc. people get as much out of listening to others as articulating what they feel they cannot say elsewhere. It’s remarkable how group synergy throws up themes, directions and connections between participants who are often pretty diverse. There are no band aids or magic solutions but a lot of heart and strengthening through breaking walls of isolation and silence

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Have you looked into the power of hemp based economies? Hemp can do everything - but we need to have the ability to process it locally into: building materials, clothing, food, medicine, glue, nail polish, ink, fuel... etc. There is also a great free energy discovery that would solve issues around that worldwide if the will of the people is strong enough to insist on it being available to all without obstruction. Say Air Gen Generic University of Mass. Hemp sequesters incredibly well and if we sourced our materials locally, alot would be solved in terms of global dynamics, including war.

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Have heard a bit about this, and there is push here in Australia too for much greater hemp production for all reasons you list . We know the solutions are here, it’s the vested interests blocking change which are holding us back, but momentum is building all the time

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Exactly…they’ll try to push “green agenda” solutions that actually harm Mama Gaia, such as Wind Power (bad for people, fish, birds, cetaceans, ecosystems) SRM (destroys ozone in models that aren’t done by people with vested interests) etc…

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That's wonderful. I have an idea for a ritual ending of COVID that involves a council for healthcare workers to share their experiences and feelings with each other, then emerge into general community groups and do the same, followed by some other rituals with fire, water, and stones. I'm starting to think I actually need to make this happen.

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This is such a beautiful idea Amy, I think it would be very healing. Definitely need a community approach to heal from community trauma. Here is link to a Journal with an article I wrote recently about Indigenous led community therapies following climate disasters in Australia which may be of interest to you https://www.climatepsychologyalliance.org/images/research-reflection/Issue%205.pdf.

I do hope that you get support you need to create ritual.

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Jun 12·edited Jun 12Liked by Amy Walsh

Deeply, deeply agree. How have you done this? What has been your experience? I see two levels of this listening as essential...one I think doctors need safe places to be listened to...but this is problematic because there will always be those who try to infiltrate and then report back to an org if something is brewing that is considered unacceptable. They'll try to sign up as a coachee/participant or just another doctor but actually have ties to...it would require being pretty savvy to ensure proper vetting inwardly and externally.

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The second form of listening would be "What does everyone need?" And honestly, patients and providers would be far less at odds with one another than institutions versus either.

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Yes, as I think about this, it's interesting how we don't ask or actively avoid asking this question in family systems, businesses, society, ecosystems. It's like we know we would have to do things in a fundamentally different way if we asked and responded to the answer.

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Jun 12·edited Jun 12Liked by Amy Walsh

Mmmmm...lots more possibilities open up when everyone's needs are on the table in a spirit of conciliation and love! What do you think would have to happen for that question to be asked, from the heart by people who are or could be in relationship in such a way the induce those changes or create a fresh dynamic that has the elements required for all to prosper in harmony, peace, authenticity, freedom and mutual benefit?

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Definitely, the experience of council has been very helpful for that for me. At the beginning especially, but even now, it can be hard to overcome the gremlins that tell me that listening in that way is a waste of time, but you definitely feel more capable of seeing and being seen in the process.

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When I read that, I read it as "Council." This would be an amazing thing...to have a Council. Like Elders/Indigenous. Check out Peter D'erricos work on Indigenous. He is a lawyer and also a critic of current healthcare/science, stakeholder capitalism and a professor emeritus. I agree absolutely that stakeholder capitalism is a root problem, although the absolute root is separation consciousness that has equally resulted in disconnection from oneness and attempts to hijack humanity and control through various agendas, including healthcare.

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Yeah, a formal council gathering is what I'm talking about. Though the ones I have participated in were all people under 50, but holding council with actual elders who aren't just olders would be so healing. I'm not familiar with Peter D'Errico's work, I'll take a look.

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I know what you mean about Elders rather than merely elders. It is heartbreaking that so many older were disconnected from their own hearts/souls...but I think this next generation that is just coming into the crone or on the cusp is different...and although Derrick is an Italian dude, he is certainly an Elder in many ways in the sense of wisdom...and of recognizing that the intellect is not as powerful as the heart when it comes to change.

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Yes! I have a wonderful Indigenous friend - if you would like to hire her to facilitate, she actually just graduated with a Phd in Wild Rice.

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Thanks for the mention...and love. You are doing great! <3

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Thank you so much!

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Jun 11·edited Jun 11Liked by Amy Walsh

We had an interesting conversation that ties in at lunch: if it's accepted that 90% of disease is because of stress, why don't orgs invest 90% of resources into helping people be less stressed out? It would actually even save money! Also, it's not even that you have to be always relaxed - having genuine recovery time and feeling connected are both vital to allowing you to have stress without long term damage. We suggested all employers ought to be mandated (and audited) to give at least two hours worth of ACTUAL (not on the books but not taken) breaks, with having "watering holes" within 5 min walking distance" - waterfall, green space, yoga mats outdoors/weather proof glass top...no chemicals. Everyone could take a rest, a nap meditate or just relax and, connect, chat, laugh, cry, be with others. Maybe an outdoor kombucha bar? Another thing of interest is the history of psychiatry itself (and much of psychology) is steeped in nazi ideology. So no wonder people don't feel safe to admit they are struggling. Then there is the spiritual aspect - a lot of what gets labeled psychiatric disturbance is just people perceptive to other dimensions or overlapping ones. You are worthy to receive help!

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Jun 12·edited Jun 12Author

Thanks Alicia, unfortunately with venture capital working it's way farther and farther into healthcare, their incentive is to do more mess, tests, surgeries rather than reduce stress and illness. And I think venture capital is disconnected from community enough that they don't really care if they lose all their staff to burnout and distress because they are replaceable. I wonder how the breaks would be received. How they are executed would be so important because if I return and now I'm just 2 hours behind, it's worse than no break. I really appreciate Gabor Mate's perspective on mental illness, that it is borne of a natural and healthy response to an unhealthy situation.

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The healthcare situation I am most familiar with is actually a cooperative so they would actually benefit from the saving of money, but their investments are still in Vanguard, so ultimately, same same, plus there is a lot of inertia around doing things that would be effective. It seems there is resistance to solving the problem, as though unconsciously it wanted to be kept...there are some really, really goofy things. As I've said, I have seen people leave the system and start their own holistic group practices that seems to be thriving.

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Those are really valid points.

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Meds, not mess but a pretty appropo autocorrect there 😂

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