February 5, 2018

People : Our (In)Humanity

For Christmas my dad gave me all of Viet Thanh Nguyen's books--one of which I've read and didn't love (The Refugees), one of which I've tried to read twice but couldn't finish (The Sympathizer), and one which I hadn't read (Nothing Ever Dies: Vietnam and the Memory of War).  So I started on the last one with somewhat low expectations, and it turned out to be one of the best things I read in 2017.

In Nothing Ever Dies, Nguyen argues that a different mindset is required to prevent war and its traumas.  This mindset must be inclusive of all people affected by war; it must recognize the humanity and suffering of each and every side, including people who are not our own.  At the same time, he points out the danger of focusing only on humanity.  He points out that conventional anti-war sentiment often emphasizes the humanity of the victims, of the other side.  Which is very important, because it's natural to ignore the effects borne on people but because this perspective sometimes cast victims as "other," and different, it can actually undermine their status as humans equal to everyone else.  We view victims only as subjects of dehumanization, rather than as whole beings with the same capacity for good and bad as everyone else.

Because an inclusive mindset also means recognizing our inhumanity: the capacity of each and every side to inflict suffering.  We often view the people who fought on our side as committing noble sacrifices.  Nguyen doesn't deny the need to respect this courage, but he argues for a more complex view of people, one where a person can both selflessly give and inhumanly take.  It's only when we see our own capacity to harm others that we can really prevent wars from happening again.

This gave me a lot to think about in terms of war, and it also made me think about our daily work in clinic.  We often advocate considering our patients in the context of what society takes from them: equal opportunities in health, education, and safety.  This reminds us to be cognizant of our own privilege, and to share it as much as we can.  This reminds us of the humanity of those who are most vulnerable, whose humanity can be masked by the outward visibility of poverty, homelessness, language barriers, gaps in education, substance use and mental illness.

At the same time, maybe seeing them only in the context of what society denies them, denies our patients something else important: the full spectrum of who they are and can be.  Both good and bad.

We tend to feel a certain sense of guilt when our patients frustrate us: when they have demands that seem unreasonable and assert we aren't doing enough, when they seem to disregard our efforts and assert we aren't doing enough.  I think it's partly because we feel like we can't and shouldn't get angry or impatient with people who have been subjects of so much injustice and trauma.  Reading Nguyen's book made me realize that these emotions are okay to feel, because it recognizes that suffering doesn't change your innate humanness.  That to really respect the humanity in people who have suffered, means to recognize that they still have and elicit the whole range of human emotion and qualities.  I feel strongly that we should still be aware of a person's context and how it influences their behavior, so that we can provide more patient and effective care even when we're frustrated.  But instead of perceiving these frustrations as things to overcome, I'd like to accept them and see them as reminders of our patients as whole, complex people.

It's also a reminder that I'm whole--that I have the same capacity to frustrate other people, to harm other people.  The very term "provider" suggests that we are always giving, which we know isn't always the case.  I sometimes (often) find myself internally defending myself against a patient's frustrations with me, thinking I work so hard, I just want to do the best for you.  But this isn't always true.  There are times I don't want to go out of my way, when I'm tired, when I'm not sure it's worth it, when I cut corners.  When I'm like this, at best I'm not actively providing and at worst I'm taking away.  I think an important part of preventing harm is to recognize this in ourselves, not to self-deprecate, but to be honest and accepting and better.

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