In Part 1 of this series, I wrote about the connection between shame and narcissism. In Part 2, I looked at narcissists’ belief that they are special and unique people. In this final section, I will be looking at their belief that they are better than others: the “others” in this case being you and I, the users of Canada’s healthcare system.
If you read Parts 1 and 2, you will know that I’m taking some of the basic tenets of narcissism and applying them to my experiences. I’m doing so because of the high level of frustration I felt trying to get reasonable care for my 77 year-old mother. I chose narcissism because anyone who has tried to negotiate with a narcissist–essentially a self-absorbed person–will understand the difficulties I’m describing. The self-absorbed are those who will only engage with others when it benefits them in some way.
The Canadian healthcare system, in some regions, offers several variations on this theme.
In general, I find that many healthcare workers have a lot of confidence and it comes from their basic understanding of supply and demand. Their scarcity gives them the upper-hand and they know it. Two predominant factors make up this issue: there is a shortage of medical expertise and a shortage of financial resources to pay for it (even if there were enough of it). There is a third factor that affects mostly rural communities in Canada. These communities attract fewer high-level healthcare staff and so shortages are more acute. When we add all these factors up, what we have are users who have no choice when it comes to accepting bad behaviour from healthcare workers.
So as I travelled with my mother through various institutions, I frequently felt as if I were bumping up against a larger system that was essentially self-absorbed and closed off to me, although, of course, there were no clear signposts to this effect, no signs that said “Beware, no one here wants to listen to you.” On a larger scale, it’s a problem that needs to be corrected: when it comes to Canadian healthcare we need to have honest dialogues about what is really happening. What we don’t need are euphemistic monologues delivered by condescending staff, staff who like the system and the power it affords them. We don’t need more people who are using language to keep us outside the action and away from vital information. We need to be spoken to, not at, if we want to make truly informed decisions about our loved ones.
I’m using the words dialogue and monologue for a reason. As an avowed lover of my native tongue and a professor of English literature, I’m sensitive to language. I find myself tensing up when I hear well-rehearsed patter, that sales pitch that’s designed to make me feel inadequate. How does this pattern of speech work in a healthcare setting? A sales pitch is usually designed to make us feel foolish for not seeing the advantages of a product or guilty for not wanting to spend money on it. This patter works through a combination of voice inflection–usually a tone that vacillates between cooing and admonishing–and a persuasive sequencing of words that builds an argument that sounds logical.
In a healthcare setting, we might be expected to accept a lower standard of care and then be admonished for “selfishly” wanting more. While my mother was having her stroke–in the hospital–I tried to convince the nursing staff that something was wrong. They in turn tried to convince me that asking a doctor to examine her wasn’t necessary; it was the morphine, they said, that was causing my mother’s unconsciousness. However, when I insisted, instead of calling a doctor, they tried to make me feel guilty for not trusting their judgement. As I became even more insistent, they tried to make me feel guiltier by indicating they found me troublesome. As I became hysterical, they were more direct and asked me to leave. As individuals and a group, they did everything in their power to make me feel “less than”. Unfortunately, their concerted efforts in that particular instance worked. I eventually backed down and my mother’s stroke went untreated at a critical time.
Another way some healthcare staff expressed their sense of superiority was through a process I call “false collaboration.” One particular instance involved the over-medicating of my mother in her nursing home. (A short video of this is included in Part 1.) As I mentioned earlier in this series, I managed to bring the head nurse to her bedside only to be told that she was tired, not over-medicated. So when I asked him to see if my mother had been given her sleeping medication ahead of schedule, he was skeptical, but agreed to check the floor’s drug cart.
When he returned, he told me all my mother’s night medications were still there. However, when I then suggested the nurse may have used something else–like Benadryl, for example–he saw I was serious and changed strategies. It helped, I think, that I told him about a lab that specializes in analyzing hair samples of the very young and the very old. The owner of the lab, I said, had sent me PDF articles that explained how Benadryl was the drug of choice for lazy baby-sitters and nursing home staff.
This information, and the fact that I had sought it, got his attention and he surprised me by making a bizarre suggestion. He suggested I wait in my mother’s room until 8 PM to see if the offending nurse came in to give my mother her night medications. His idea was that if this nurse didn’t turn up, I would have “proof” that she’d done the job earlier. It was confusing because if her night medications were still in the drug cart, as he’d said, why wouldn’t the nurse turn up? He left the room and I knew he thought he’d fooled me. He would warn this nurse and she would show up at 8 PM with something, anything. In the end, the two of them would enact their little drama and I would feel foolish for being suspicious. That, at least, was their plan.
Now I’ll admit this is an extreme situation, and is not one many people are likely to experience, but unfortunately it falls onto a spectrum of behaviours I’d already seen. And that is, when all else failed, some healthcare workers would resort to this kind of false collaboration to give me the impression I actually had a say in matters.
Why is this anecdote important? It’s important because this head nurse, like many other healthcare staff, clearly underestimated my ability to discern lies from the truth. And his underestimation of my intelligence was not the exception, it was the rule. I am a professor of English literature and have nine years of post-secondary education behind me. But this didn’t cut any ice with these people and, truth be told, my level of education didn’t really matter. Most people don’t need years and years of schooling to know when they’re hearing a lie. However, these healthcare workers considered themselves experts and as such, they fully (and foolishly) believed I would not know when I was being told one. It was insulting and clearly stemmed from that erroneous belief I mentioned at the beginning of this article: they felt they were better than others, certainly better than me.
I’ve written about my troubles because doing so, in a public forum, is the only way to make change. I called this series of articles “A Herd of Narcissists” because that was my honest, uncensored response to the treatment I received at the hands of some healthcare workers. It’s important for us to realize that shame–whatever its source–is the dark side of narcissism and it needs to be addressed too. If our healthcare workers are feeling ashamed of the level of care they’re providing, we need to do something about it. We need to talk to one another and see if we can’t compromise on some things: things like accepting the fact that mistakes happen, like rethinking our ideas about perfectionism, like changing our expectations of the less-than-perfect system we have.
It might help all of us get real.
I’d like to add that despite my complaints, I have also encountered some very good healthcare practitioners. What I am describing here in this series is a systemic set of problems intrinsic to many healthcare environments in Canada. The problem, of course, is that even good, kind and honest healthcare providers encounter these problems. So the purpose of these articles has been to shine a light on “the things that go without saying,” as French intellectual Roland Barthe would say, the things that no one wants to think about, talk about or point a finger at.
I also think that my mother’s age–77 when she had her stroke–may explain some of the difficulties I had. It’s a frightening thought for those of us heading in old age.
And finally: we Canadians are a polite bunch, too polite for our own good I think.