Healing the Healers in a Post-Pandemic World

For decades, healthcare has been rightly focused on the patient experience and improving clinical outcomes. Clinical approaches and scientific research have been aimed at improving the ways we deliver healthcare. Medicine has evolved from the archaic alchemical remedies of the past with priest-like delivery to modern evidence-based treatment rooted in a systematic, predictable, and scientifically rigorous approach. Physicians have become scientists: efficient, effective, competent, and rational.

Emergent fields, such as the medical humanities, seek to bridge the gap between healthcare’s scientific and human sides. In Compassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference, physician-scientists Stephen Trzeciak and Anthony Mazzarelli, who admittedly were “not in the market for an awakening” when they embarked on the journey into the data of compassion, suggest that compassion and human connection not only can have health benefits for patients, but also they can help reverse the cost of healthcare and be an antidote for burnout among healthcare providers.(1)

With compassion and empathy comes the differentiation between healing and curing. We know that humans can be healed without being cured of disease. We also know that humans can be cured of illness while still reeling from dis-ease, never experiencing the relief and integration that comes from the healing experience.

Danielle Ofri, MD, PhD, author, and professor of medicine at New York University, states in her book What Doctors Feel: How the Emotions Affect the Practice of Medicine, “Most doctors don’t get the distinction between curing and healing, but patients instinctively do. For most doctors, if the disease has been eradicated — well, that’s success…paying attention to emotions within the doctor-patient interaction doesn’t guarantee healing, no doubt. But ignoring them surely makes it less likely.”(2)

Patient-centered care has become industry standard, but what has become of the modern physician, shouldering the burden and responsibility of healing amid the chaos of change?

Lissa Rankin, MD, the author of The Anatomy of a Calling, states that “doctors feel unappreciated, devalued, and disenfranchised” by forces outside of their control, including managed care, insurance companies, the pharmaceutical industry, and political lobbies.(3) Furthermore, modern physicians have been conditioned by a culture of perfectionism, mastery, knowledge, and competency above all else, and as a result, patient expectations of them run wild.

With technological advancements, changes in the healthcare landscape, and the societal shift in patient expectations, doctors must, as Eric Topol, MD, suggests in The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Healthcare, “adjust to being a guiding force and partner to the patient, offering judgment, experience, compassion, and outstanding communicative skills”(4) — all behaviors that were not well-addressed in medical school education and training.

There is an urgency to cultivate physicians who heal, but this is not done by focusing on the patient, Rankin states, “healthcare providers must heal themselves before they can take part in healing our system.”(3)

The Secret to Healing

In his speech to Harvard medical students in 1926, Francis Peabody, MD, said, “…the secret of the care of the patient is in the caring for the patient.” I believe that the secret to healing the patient is healing the doctor. Who is healing the healers, and what is it, exactly, that needs healing?

After more than 17 years of working in and around healthcare, I pursued graduate studies in depth psychology. The field of depth psychology rests heavily on psychoanalytic theory and practice, Carl Jung’s work, and an emphasis on the unconscious realms of the human experience.

An MD, Jung, in Modern Man in Search of Soul, suggests that for the healing profession, “the medical diploma is no longer the crucial thing, but human quality instead” and goes on to state explicitly that “the physician may no longer slip out of his own difficulties by treating the difficulties of others. He will remember that a man who suffers from a running abscess is not fit to perform a surgical operation.”(5)

The running abscess, as it were, is made up of all of the psychological impediments that encompass the human experience, and physicians are not immune to their influence. To be an effective physician healer, and by extension a physician leader, one must first heal the abscess within.

One way to approach the question of who is healing the healers within a methodological framework is to use a qualitative research method in phenomenology, which seeks to understand the lived experiences of the subjects being studied. Within these experiences, researchers aim to qualify trends and differences in experiences and make meaning from them.

This is more complex than objectively rooted scientific inquiry, where data and numbers skew p-values for or against a hypothesis. This type of inquiry has far more to do with the subjectivity of humanity, and it is here, within this complex and layered realm, that I began to cultivate an answer.

I found that although nobody seemed to be healing the healers — at least not on an institutional or cultural level — individual physicians were healing themselves using wisdom, support, and resources outside of traditional healthcare modalities and sharing their methods through publications and programs.

My questions became: Why isn’t the culture changing? Why are physicians more burned out now than ever before? (And this was before the COVID-19 pandemic.) Why are physicians more likely to commit suicide than other professionals? If it is the physician who needs to be healed, and we have physicians who have shown the way, why aren’t they all healing?

I still do not have a clear answer that fits pristinely into a transparent scientific equation which we can manipulate variables to influence the predictability of outcomes. Qualitative research doesn’t work that way, nor does any part of the lived human experience, which is inherently unpredictable, idiosyncratic, and remarkably unconscious.

What I did find missing from physicians’ stories and the ambitions of physician wellness initiatives overall was recognition of the thing that seemed to be inflicting the most harm: psychological trauma — the experiences that cause a disconnect from one’s authentic self. It happens within a body that, if not healed and integrated, leaves one feeling depleted, helpless, apathetic, guilt-ridden, or shamed. It leaves one asking, “Am I good enough? Am I worthy enough?”

Physicians always have something to attend to outside of themselves, so it is here, in the unspoken, overwhelmingly emotional experiences, that healing is necessary.

The Hero’s Journey

During my time working with physicians, I have heard stories that swell in the physician’s heart and evade the physician’s mind, stories about the soul-crushing pursuit of perfection and mastery in medical school and residency training, stories about witnessing the first death by suicide, the first delivery of a stillborn baby.

While each physician’s story is as unique and complex as the individual whose story it is, there is an arc to all physicians’ stories that is the archetypal hero’s journey, immortalized by Joseph Campbell’s Hero with a Thousand Faces.(6)

On the hero’s journey, the hero ventures from everyday life into the mysteries of an unknown and arduous adventure, honoring a call from within. In this case, it is the wide-eyed pre-med student who answers the call to be a doctor and enters medical school. The medical student, the hero in this epic, battles unforeseen forces to a climax of certain victory, the medical diploma, and returns from the adventure with the power to share the knowledge gained to the benefit of all. Thus, the doctor becomes the knower and healer of all human maladies.

Of course, this is a myth. The analogy is abstracted and imprecise. The messy subjectivity of an actual lived life is never this neat. Many cultural and psychological factors place expectations on the physician at the end of this hero’s journey that this myth does not seem to capture.

We expect the physician hero to be perfect, infallible, resolute, wise, exacting, efficient, proficient, knowledgeable, capable, empathetic, and unconditionally compassionate; yet, many doctors experience trauma every day along the journey — in their training, in the limitations of the healthcare system, and in their experiences on the frontlines of human suffering. Simply being exposed to others’ experiences of trauma can be traumatizing. To this point, Rankin says:

We’ve had to come to work sick, we’ve skipped our postpartum leaves and left our babies, we’ve had bloody scalpels thrown at us by physician professors who cursed at us, and we’ve stayed awake when we should have been sleeping. We’ve witnessed children dying, dismemberment, and those that die when we did everything we could to save them. We’ve gone through hazing worse than any fraternity, something similar to what soldiers experience. Yet people expect soldiers to have post-traumatic stress disorder (PTSD). They don’t expect doctors to suffer from this.(3)

To heal from traumatic experiences, physicians must first recognize they have been harmed by them. Physicians may deny traumatic experiences for many reasons. Rankin states, “The problem is that most (physicians) don’t even know that they have PTSD” because it has been normalized by the culture within healthcare and ”We’ve been brainwashed to believe that it’s our job to just buck up and keep going, not realizing that by failing to acknowledge the trauma and heal from it…we are losing the very part of us that makes us exceptional healers.”(3)

In summary, medical school attracts willing, capable, competent, and imperfect humans, and through the process of becoming doctors, physicians are expected to become perfect specimens of wisdom and heart, doing no harm in a system that focuses singularly on the development of rational knowledge, rewards efficient production, and causes healers harm.

Physicians at the Forefront of Transformation

Considering the current state of physician wellness, we clearly have not addressed the impact of psychological conditions on providers’ health. It is time we put physicians’ health at the forefront of healthcare transformation. Physicians cannot heal and lead if they are in the grips of suffering.

Explanation. Healing comes from taking the time for self-inquiry, which allows space to identify behaviors or thought patterns. When we make space for ourselves, we honor the humanity within and are better able to honor the humanity in others.

When we identify what might be lurking in the unconscious, we bring it to the light of consciousness by naming it. We then go about explaining it with words or narrative. In the book Expressive Writing: Words That Heal, James Pennebaker and John Frank Evans provide a thought-provoking and easily approachable way to use writing to integrate the emotional upheavals in our lives to resolve issues, improve health, and build resilience.(7)

Although writing is not the only way, it is a well-researched and proven way to take care of our spirit and soul. If taking pen in hand isn’t practicable, use the notes section of an iPhone to type out thoughts or voice record the narrative that arises. Simply putting words or voice to these thoughts and feelings changes us for the better. Ideally, we can then come back to these spoken or typed words and create an opportunity for a more profound transformation.

In addition to expressive writing, other arts-based therapies such as making, viewing, or experiencing expressive art in various forms can be especially helpful in processing emotions, developing resilience, improving self-esteem, reframing stress, and fostering wellbeing.

Traditional therapeutic approaches such as biofeedback or cognitive behavioral therapy (CBT) with mental health professionals who are savvy about trauma research and healing modalities, such as somatic therapy and internal family systems (IFS), are also beneficial.

Education. Education means going deep to the source of the upheaval. It asks the question: What event or experience caused me to feel this way? It may be here that most physicians withdraw from the transformation journey because, as Jung says, they inevitably discover the inferior or shadow side of their personality, which brings them dangerously near to their patient and perhaps obscures authority.(5)

There is a need to soften self-judgment, to call out the fallacy of perfectionism that plagues the culture of medicine and to recognize that it causes harm, is unrealistic and isn’t practical. Remember, we become better healers and leaders by becoming more fully human.

Transformation. When we become fully authentic in our humanity, we transform suffering into acceptance and experience the freedom and energy that come from truth. That is transformation and healing at the individual level. When we become fully authentic, we encourage others to do the same. That is transformation and healing at the organizational level.

The Perfect World

In a perfect world, healthcare institutions and organizations implement programs rooted in the wisdom of trauma research and depth-psychology principles that focus on supporting providers in their healing and integration journeys.

In a perfect world, physician leaders embody the strength that comes with honoring their own truth and vulnerabilities and then leading organizational change from this deeply impactful place.

In a perfect world, the process of healing the healers becomes an everyday reality, not that which is done outside the context of healthcare in the provider’s own time.

Healthcare improves for everyone, including and especially the providers, when individuals who have influence choose to transform first within, then courageously speak the truth about their experiences.

References

1. Trezeciak S. & Mazzarelli A. Compassionomics: The Revolutionary Scientific Evidence That Caring Makes a Difference. Pensacola, FL: Studer Group; 2019.

2. Ofri D. What Doctors Feel: How the Emotions Affect the Practice of Medicine. Boston, MA: Beacon Press; 2013.

3. Rankin L. Anatomy of a Calling: A Doctor’s Journey from Head to Heart and a Prescription for Finding Your Life’s Purpose. New York, NY: Rodale, Inc.; 2015.

4. Topol E. The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Healthcare. New York, NY: Basic Books; 2012.

5. Jung CG. In WS Dell & CF Baynes (Trans.), Modern Man in Search of a Soul. Orlando, FL: Harcourt, Inc.; 1933, 1955.

6. Campbell J. Hero with a Thousand Faces. New York, NY: Penguin Books; 1949.

7. Pennebaker JW & Evans JF. Expressive Writing: Words that Heal. Enumclaw, WA: Idyll Arbor, Inc; 2014.