ARE WOUNDED HEALERS GOOD ROLE MODELS?

“We have turned doctors into gods and worship their deity by offering up our bodies and our souls – not to mention our worldly goods.

And yet paradoxically, they are the most vulnerable of human beings. Their suicide rate is eight times the national average. Their percentage of drug addiction is one hundred times higher. And because they are painfully aware that they cannot live up to our expectations, their anguish is undoubtedly intense. They have aptly been called ‘wounded healers’.”

                                                                                                -Barney Livingston, M.D.

 Living in an era where mental health issues’ frozen breath cracks the hearts of the healers, slowly but surely taking us into the dark ice age, it is not a wonder why one particular question arises: are wounded healers suitable for role modeling?

 The concept of the wounded healer dates back to the Greek mythology, from Chiron, the famous centaur demigod who was wounded by Hercules’s incurable poisoned arrow, all the way to the more recent concept of Carl Jung’s understanding which postulates that a healer is compelled to heal because he himself is in need of healing. All of that is still true, but modern use of this phrase[1], [2] illustrates the professed attributes of resilience and self-reliance adopted by the physicians throughout generations.  Yet, it is worth highlighting that physicians feel twice the rates of burn-out, stress-induced mental illness, as well as addiction. [2]

 Doctors’ role modeling is the highest form of subconscious teaching and it is critically important in medical education – it is the ‘hidden process’. [3] There are many definitions for role models, but the amplest is the one in which they are described as ‘‘individuals admired by their ways of being and acting as professionals’’. [4] Oddly enough, this definition contains the other polarity of what is often overlooked, and that is the process of mentoring. Even though the relation between these two points is only slightly different and commonly overlapping, one has to make a distinction. Mentoring is a formal and controlled teaching, which requires a direct contact with the mentor, whereas role modeling takes place even if there is no intended action, and moreover – the person may be unaware of the process. [5]

 

            Now that meanings of the terms “wounded healers” and “role modeling” are both defined, let’s dive deeper.

 As the ice age knocks on our doors, one must evolve enough to be resilient to the cold. Are there some that aren’t touched by the ice? Yes, and there are the ‘warm’ ones, the ones that are aware. By being well aware, they can accept that they must heal the wound. By nourishing the healed wound, closure of a millennia old tradition of denying and neglecting a problem that is real, shines through the cracked ice. Despite the fact that their reported number is agonizingly low, [6] those are the role models we need. The well-established framework between role-models and modelees* [7], [8] in which the process of professional growth and identity formation occurs, can be compared with babies learning in their early years – like a dry sponge, absorbing and imitating everything so easily  and so fastly, then applying it, without the critical judgment that can help them differentiate what is wrong from what is right. Most of the ‘warm’ wounded healers have gone through the process of healing appropriately, resulting with a scar that made them more resilient and more self-aware of what ‘cracked them open’; By  doing so they know that the path of closure is not an easy journey to be made. Even so, it is a path that has to be walked every day. Considering these two stances, the modelees as sponges and the mended wounded healers as role models, it can be inferred that the mended wounded healers can do an effective positive role modeling by providing preventive measures, and acting as a support to the modelees in many ways; mostly by breaking ‘the chain of social norms’, sharing their process and promoting vigilance. They can enhance the emotional growth of the students by making a solid ground for self-reflective acceptance of fear; anxiety; guilt; and all their emotions in general, [9] both the positive and the less positive ones.

 Still, what happens when the heart of the healer succumbs to the ice? Well, in that case there is nothing more than reflective mirroring, meaning that role models can be quite negative in nature in the grand scheme of things. Being unaware and neglecting the wound, contagiously bleeding on others and constantly being challenged by the cultural chains of appearing weak by showing the hassles, are the reasons why we have – the ‘cold’ role models. They promote unethical behavior, display an unprofessional attribute, and give poor support to the modelees. [8] They believe that without struggle one can never know true happiness. This, in contrast to what the ‘warm’ ones do, creates a fear of accepting their own emotions, and by looking for a way out of the cold darkness, they invest all of the energy in engaging unhealthy behavior, such as substance abuse. The concept of “If I don’t feel, I will be better” applies here. Unfortunately, every energy source has its limits, and when there is nothing more to invest – it collapses. But, this vicious cycle does not end up here. Instead of guidance, they face the dramatic truth of stigmatization [10] and the guilt for not being able to live up to the standards of their role-models. Some of them over time learn how to cope with this in a dysfunctional manner, while others end tragically.[11] Finally, the cycle continues with the ‘cold’ wounded healers creating more ‘cold’ wounded healers.

So far, beyond the shadow of the doubt, we have to emphasize that doctors’ mental health matters and that it is crucial to the health care system. By acknowledging the wounded healers, we can sometimes be surprised by the common ground we find, because a wound can lead to a breakdown or a breakthrough. What we do to mend ourselves can define us more than anything. That’s why it is up to the role models to forge a safe network in which the modelees can figure out the best approach when encountering a mental health issue. The wounded healers can be both a treasure, and a threat at the same time.

 

Lastly, ask yourselves a question – are you a wounded healer?

 
*The article was originally published in EuroMeds Online Winter Edition 2019

References:

[1] Zerubavel N, Wright M. The dilemma of the wounded healer. Psychotherapy. 2012;49(4):482-491.

[2] Bradley N. Wounded healers. British Journal of General Practice. 2009;59(568):803-804.

[3] Passi V, Johnson N. The hidden process of positive doctor role modelling. Medical Teacher. 2015;38(7):700-707.

[4] Passi V, Johnson N. The impact of positive doctor role modeling. Medical Teacher. 2016;38(11):1139-1145.

[5] Paice E, Heard S, Moss F. How important are role models in making good doctors? BMJ. 2002;325:707–710

[6] Gold K, Andrew L, Goldman E, Schwenk T. “I would never want to have a mental health diagnosis on my record”: A survey of female physicians on mental health diagnosis, treatment, and reporting. General Hospital Psychiatry. 2016;43:51-57.

[7] The Culture of Medicine [Internet]. Journal of Ethics | American Medical Association. 2018 [cited 24 December 2018]. Available from: https://journalofethics.ama-assn.org/issue/culture-medicine

[8] Jochemsen-van der Leeuw H, van Dijk N, van Etten-Jamaludin F, Wieringa-de Waard M. The Attributes of the Clinical Trainer as a Role Model. Academic Medicine. 2013;88(1):26-34.

[9] Batt-Rawden, S., Chisolm, M., Anton, B. and Flickinger, T. (2013). Teaching Empathy to Medical Students. Academic Medicine, 88(8), pp.1171-1177.

[10] Hankir A, Northall A, Zaman R. Stigma and mental health challenges in medical students. Case Reports. 2014;2014(sep02 1):bcr2014205226-bcr2014205226.

[11] Center C, Davis M, Detre T, Ford D, Hansbrough W, Hendin H et al. Confronting Depression and Suicide in Physicians. JAMA. 2003;289(23):3161.

Leave a Reply

Your email address will not be published. Required fields are marked *

Post comment