Opinion

Forgiving the System

Forgive

Robin Youngson reflects he may have to forgive himself, before he can forgive the system…

My daughter’s life changed the day she crashed her car and broke both her neck and her back. Chloe recovered from her injuries and walked away from that accident. As a doctor and a father, what I couldn’t walk away from was the revealed inhumanity of the hospital system. Good clinical care helps injuries to heal but neglects the human needs of a patient in a hospital bed for a hundred days.

For thirteen years I have campaigned internationally to restore humanity and compassion to healthcare. The work has taken me to fifteen countries, I’ve written two book, and given hundreds of conference presentations.

While my work has encouraged many individual health workers to reconnect to the heart of their practice, finding joy in compassionate service, the system stubbornly resists change. One of my characteristics is a dogged determination, a willingness to endure endless mistakes and failures in the search of strategies that might make a difference. As the years wear away, wisdom comes slowly.

In recent times, I’ve shared my insights about the futility of fighting the system: that criticising and campaigning against anything only breeds resistance. I’ve realised that to create a compassionate system, those who lead change must embody compassion, non-judgment, generosity and humility. The ideas are shared in my latest, small book, ‘From HERO to HEALER – Awakening the inner activist’ (free copy available here).

I have forgiven health executives who create or maintain harsh work places. I have forgiven doctors who are greedy and self-interested. I’ve forgiven the policy-makers who know no better. As a result, health managers, clinicians and bureaucrats are more open to my ideas. I’ve been honoured by my own medical profession, after so many years of rejection.

Lately, I’ve done my work with more peace and gentleness. I devote more of my life to service and find healing moments with many of my patients and colleagues. But something inside me still rages, there is more forgiving to be done.

I have a peculiar sensitivity to the inhumanity of institutions. At age ten, I was sent to boarding school, a ghastly place where I was friendless, mercilessly bullied, separated from family, and subject to the hardships of institutional life: awful food, rigid timetables, arbitrary rules, shared dormitories and bathrooms, and utter lack of comforts. Matron was in charge, a frightening figure.

In later life, I realised that my profound empathy for the experience of patients in hospitals was because in every suffering patients I saw the frightened and abandoned little boy. English boarding schools are the archetypal model for the culture of hospital institutions and little has changed.

I don’t want to criticise my parents, I’m sure they were as sickened by the feeling of abandonment as I was. My fragmented school education was rescued by the continuity of boarding school and I excelled academically. I would never have become a doctor, otherwise.

A psychiatrist in the UK has many clients who are former boarding school pupils. She described a characteristic syndrome of ‘boarding school psychopathology’ including difficulty with intimate relationships and fear of abandonment. One of the odd features she notes among her patients is a reluctance to pack bags before a trip – often left until the last moment. The explanation is a subconscious association between leaving home for a business trip and the childhood experience of repeated traumatisation with each new term at school.

I laughed out loud when I read this account: my wife packs bags three days before a flight, I’m still packing my bag the hour before we have to leave for the airport!

I notice faint echoes of this sensitivity persisting in me because my medical work is episodic: short-term contracts doing locum work away from home. In the first few days of each trip I used to battle with strong feelings of sadness and loneliness, until I identified that the feeling was just an echo from the past. While the loneliness is gone, I still have a feeling of tension and unhappiness and I rarely sleep well on the first night or two away from home.

The trauma is not just separation from my beloved wife, whom I miss greatly, but also being re-immersed into the hospital institution. Training as a doctor is a bloody affair: we are brutalised, dehumanised and betrayed. Even though I love my clinical work, and find times of sacred connection with my patients, I find it sometimes difficult to return to a work environment that is burning out nearly 50% of doctors and causing needless suffering to patients.

After a restless night in bed last night, I asked my guardian angel for guidance. I wanted the answer to the question, ‘What is conflicting me so much when I’m largely at peace with the opportunity to be of service to my patients and colleagues?’ The last hour of the night gave me a dream from which I awoke with the answer.

Much as I have forgiven individuals, I’m still angry at institutions, I’m angry at ‘the system’.

It’s human nature to blame ‘the system’ – that amorphous, anonymous thing that causes us so much suffering. We rage at the political system, the banks, the corporations, the media, at healthcare, the education system, the legal system… it goes on.

Deeper reflection begins to pick holes in our arguments.

First of all, it’s an illusion to see the system as ‘out there’ external to ourselves. We ARE the system in both superficial and profound ways. Raging against the system is also raging against ourselves. If I’m really truthful, I’m ashamed of my part in the system, the things I have unconsciously done over a lifetime that I now realise caused harm to others.

Secondly, we are treating the system as if it were an actual object or person, we are reifying an abstract concept. How can we be mad at something that isn’t real?

The healthcare system doesn’t actually exist: it has no boundaries, no unified identity, no motives or intentions of its own. In reality, it’s a collection of many different individuals, ideas, information flows, materials and locations. How can we be angry at this non-person? Moreover, who or what do we forgive?

I don’t know the answer.

What I do know is that we will never change healthcare – or any other ‘system’- for the better until we stop being angry about it. I will not find peace until I have forgiven… something.

My intuition suggests that deep reflection on the non-existence of the system might yield insights.

Maybe I have to forgive myself?

It’s said that the things that anger us most are actually pieces of ourselves. It seems a good place to start.

One Response to “Forgiving the System”

  1. Robin, thank you for sharing your insights on the system by sharing yourself. We are all part of a system in which institutional efficiency, economics, processes, tactics, and control can dominate and diminish the human being and the human spirit. Your work inspires and opens up conversations that help create awareness … helps to notice and distinguish between institutional mindsets and holistic and humane mindsets. Awareness insight) is a vital step in true transformation — to a health care system in which compassionate prevails as essential to quality to clinical care and the system is one in which holds all who enter, all who work there — a system that holds the care of human beings by human beings as a sacred mission. Blessings for all you are doing to help us evolve a more loving system of care.

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