A recent Panorama investigation found systematic abuse of elderly residents going on in a UK care home. Some of the most vulnerable people in our society were being ritually abused by their so-called carers:
On the top floor of a special hospital, locked away from their families and friends, a group of men and women are subjected to a regime of physical assaults, systematic brutality, and torture by the very people supposed to be caring for them. The victims are some of the most vulnerable in society – the learning disabled, the autistic, and the suicidal.
Sadly, this may be merely the tip of the iceberg. In this week’s Sunday Times Minette Marin wrote of the terrible neglect of nurses that she witnessed first hand. Similarly, the MP Ann Clwyd has told of her husband’s inhumane treatment at the hands of the NHS and asked whether cruelty is now normal in the NHS. Today I listened to a phone in programme where one man described a ward of vulnerable geriatrics and simply said:
“Nobody seemed to care”.
How does this happen? Presumably no nurse goes into that profession for any other reason than to care for others? So what happens?
Organisational culture is clearly a factor and a number of systemic problems contribute – poor job control, lack of autonomy, lack of a proper leadership. But at some level cruelty is an individual choice. We create our cultures, then they create us. So what can we do about that?
I think this is a problem of experiential avoidance. I propose that nurses dealing with ‘difficult’ or elderly patients are brought into contact with their own fears and insecurities about becoming old, infirm, or mentally impaired. These fears – being intolerable – can only be dealt with by distancing themselves from the patients and dissociating from them. And we don’t have to go far back in history to see the terrible, shaping effects of dissociation on human behaviour.
So what can be done? Plenty, and we could start by not dissociating ourselves from the nurses. The problem is that the alternative – empathy – is not the simple panacea that most people assume. It takes real effort and psychological skill. It is not something we can just do, any more than we can suddenly start sticking to diets or going to the gym five times a week.
The key to empathy is reducing experiential avoidance. And we know how to do that. Firstly train people – help them – to gently reconnect with what they care about. Then help them to defuse from the difficult thoughts and emotions that will arise from taking valued action. We know we can’t get rid of those fears and demons, but we can respond to them differently, and in so doing shift the context for our behaviour.
People often talk about practicing empathy and practicing compassion. That’s good, because these things do take practice. But in order to practice we need to understand what prevents us from practicing.
In most cases, it is our own demons. And we have been running from them for too long.
warning, this is a harrowing clip: