Freud said “Two hallmarks of a healthy life are the abilities to love and to work. Each requires imagination”. This echoes Tolstoy: “One can live magnificently in this world if one knows how to work and how to love”. While I don’t define myself by my work, and see it as definitely secondary to my roles within my family (the love part, I guess), it is important – not just for my patients, but for me. So the questions are: can I find meaning in my work? and if not, why not?
I work in the public sector, which is wildly under-resourced. There are – as anywhere – issues I have with the way the service is structured, and care is delivered. There are many things I see that need to change that despite my best efforts I cannot affect. This all combines to make it very stressful and unpleasant at times: a bit negative as far as meaning and purpose go. As for my blogging, which perhaps has been an attempt to find more meaning in terms of my work life, the psychiatry side of it is probably mostly pretty negative: I tend to write about the things that get me fired up, which are often the things that my College or profession do (or have imposed upon us by society and politicians) that are wrong and even stupid. As a consequence, I think my psychiatry blog posts overall are on the negative side.
You know. Just a squidge….
It struck me this morning that this is perhaps not entirely healthy. Shutting up about those things on my blog is not the answer, because they’re important. I have no answer for or influence over the problems at work, but can’t shut up about them either, as I think it would be unprofessional of me to do so (and – though I hate to think in this way – if something goes wrong, and I called attention to it early on, it can’t be seen as my fault …*).
So can I have meaning – positive meaning – in my work life? Yes. On an individual basis. I have to be very clear about the difference between on one hand the overall poor systems, my issues with some aspects of the service, and all the rest of it, and on the other, the individual people I see. The patients who allow me into their lives, in the hope that I can help them. The patients to whom I give my time (the service itself be damned; it’s my time, my empathy, my knowledge and skills). The people I try to help to develop some hope, and find their way back to themselves (yet another patient recently said something very poignant to me around this: “I don’t like being around me”).
This morning I just spent an hour with a patient who is severely depressed – this relapse coming on over a few months, after some years of incomplete remission (treated elsewhere, I might say). We spoke in detail about their present state, previous treatment, early life, marital relationship, and about what I recommended and could offer. Now, I won’t pretend this person left the consultation infused with the joys of life, but I think they had some more hope and felt someone cared, and for myself (which is after all what this post is about) I felt professionally satisfied and virtuous.
Banging my head against the wider aspects of the service is frustrating not only practically, not only professionally, but also in terms of my own meaning and purpose (the work side of it, at any rate). It’s hard to feel one’s working life has much purpose when you cannot effect necessary change, or get things done as you think they should be. Focusing on the individual patient interactions changes it entirely. There I can effect change. There, at least for the time I am seeing them, I can provide them with the best care I am able. There I can in fact feel I am behaving excellently, making a difference, and find some professional meaning and purpose.
In finding – or realising – that, I think I see what Freud meant: “Both require imagination”. One cannot just float along and be found by purpose. A thoughtful approach is necessary in order to move beyond simply doing, towards meaning.
*I will add here that the problems I’m alluding to are not unique to the service in which I work now, and I certainly don’t mean to cast aspersions specifically in my employer’s direction. (There. Now my regular scheduled moaning can resume.)