I’ve touched on the issue of shame twice now in recent articles. It’s because I believe it is a powerful tool for both good and evil.
When I refer to shame as a tool I mean that the evocation of it, whether self-generated or externally prompted, often triggers one of two responses: a self-correcting mechanism (I won’t do that again) or a self-corrosive mechanism (I’m no good). Brené Brown differentiates between guilt and shame by saying that guilt is attached to our actions while shame is attached to our identity. It’s the difference between doing wrong (Ooops) and being wrong (I’m such an idiot).
I sometimes experience a helpful form of shame when I drive carelessly, and my desire to avoid that feeling is probably what keeps me from doing it too often. On the other hand, being unfairly targeted or thrown into a bewildering conflict seems to evoke a different kind of shame. I’m talking about those times when I’m being treated as the source of a problem instead of just part of it.
Here’s an example: Driving to work one morning, I inadvertently swerved into a neighbouring lane on a one-way street. I corrected myself immediately, but another driver, who was behind me and in that lane, took exception to my actions. Had she just honked or gestured at me, I would have understood that I’d done something wrong, probably felt some momentary guilt and resolved to be more careful in the future. Instead, this woman got behind me and followed me for the next few kilometres, her horn blaring the entire time. Her prolonged message was clear: my swerving was not the problem, I was. However, had she been less focused on shaming me she might have noticed that the width of the street, at least at that time in the morning, had been compromised by the presence of parked cars.
So why am I bringing up shame again? It’s because of its relationship to a tricky constellation of symptoms that make up pathological narcissism.
D. Thomas makes an interesting observation about narcissists: he believes they experience greater levels of shame as opposed to guilt. What this suggests is that the arrogance often associated with narcissism is a reflexive reaction to a profound, underlying shame. In other words, the worse one feels about one’s self, the harder one will try to compensate for it by adopting a grandiose attitude towards others.
Paradoxically, these narcissists live their lives bouncing between the two ends of the shame/grandiosity spectrum, and this too-big/too-small process is often experienced and enacted unconsciously.
How does this apply to healthcare in this country? I experienced a very specific problem at some hospitals: I felt I was up against an entire culture of narcissism, one that frequently had me leaving the hospital in tears.
So when I say a herd, I mean dealing with a loosely affiliated group of individuals, all of whom seemed primarily pre-occupied with their interests and secondarily with the interests of their group, whether they were nurses or doctors or other healthcare staff. There was a sense of smug self-containment and an unwillingness to engage fully with patients or their frightened relatives. This left me feeling slightly bereft in a hard-to-define way. It wasn’t until I described the staff at one hospital as a “herd of narcissists” that I was able to put a name to the discomfort I was feeling. The gulf between my humanity and theirs was just too wide.
Healthcare workers at all levels will argue that that distance is necessary to maintain a sense of well-being. That bridging that gulf would blur boundaries and result in an assault on their personalities, their goodwill and possibly their private lives. As someone who works with the public, I understand the need for boundaries and detachment. As a teacher, it wouldn’t do for me to get too friendly with my students, although I do admit that from time to time, when a student is in crisis, I will drop my guard and lend an ear. My job as a teacher is a calling, not just an occupation, and as such, there’s a spiritual dimension to it. It’s that dimension that lets me know when I need to be flexible.
However, it’s precisely this flexibility that seems to be missing in the healthcare sector. Instead, I believe many healthcare workers are taking a protective stance to an impossibly heightened degree and using it as a preemptive strategy to deal with all patients. Their one-size-fits-all outlook has created a workforce that is like a set of flawed instruments, improperly calibrated for the delicate work of looking after a diverse population.
My own experience—of trying to get a shift of nurses to take my mother’s unconscious state seriously—tells me that even an instance of justifiable hysteria isn’t enough to rouse some of these workers out of their indifference. When my mother’s condition turned out to be a stroke, not one of these nurses acknowledged they’d been wrong. This tells me that nothing can move them and I think that’s a real problem.
So the role of shame in their behaviour deserves some attention. Are these healthcare workers—the snappish triage nurses who send sick children home, the ER doctors who suggest our symptoms are imaginary—adopting a hardened stance because they are ashamed of the poor level of care they are providing? Is the context they are working in not equal to the demands being made on them? Are these questions enough to start a conversation about why our healthcare system is in such trouble?
As I read through lists of criteria various experts in narcissism have collated, I couldn’t help but begin a mental inventory of some of my worst experiences. One line jumped out at me: narcissism, when “applied to a social group…is sometimes used to denote elitism or an indifference to the plight of others.” This was a perfect description of what I experienced in some hospital settings.
What I propose to do here is take some of those criteria and provide some real time equivalents, experiences I had while trying to guide my mother through the healthcare system. I’m going to do this in parts, starting with the Part 1 here.
1. Inflation: Narcissists’ views tend to be contrary to reality. I bought an iPhone for precisely this reason: what healthcare workers reported often seemed “contrary to reality,” and I knew I had to start recording events if I wanted things to change. One persistent problem at my mother’s nursing home involved her being inappropriately drugged: she was getting her sleeping medication at the start of the afternoon shift, at 3:30 PM, instead of her bedtime. I lost count of the times I stood by my mother’s bedside while a nurse lied to me, boldfaced, about this. I’m including a video to prove my point:
An hour later, when I was finally able to summon the head nurse, he stood by my mother’s bed and told me that she was just tired. When I rubbed my knuckles into her chest–a standard procedure for rousing unresponsive patients–nothing happened. When I suggested she might have had another stroke, and then suggested a blood test might clarify, he dismissed the idea of a stroke as well as the need for a blood test. His contempt for my lay-person’s diagnosis–that my mother was heavily medicated–was palpable. It took a total of five similar visits, all captured on my iPhone, to get the nursing home to take action. Before that, I was given a variety of reasons for her unresponsive state. These varied from “She’s tired,” to “She’s depressed,” as if exhaustion and depression could cause a loss of consciousness.
Part 2 of this article will be available shortly. In it, I will be discussing how narcissists see themselves as “unique and special people.”