“No human being should be spoken to like that!” My 20-something patient working in the tech industry was horrified by treatment being meted out to a colleague by her boss. “He called her stupid, right in front of the whole team!” Though she wasn’t the direct target (this time), she was shaken by witnessing the incident, vicariously traumatized. It took her back to her own experiences of being harshly treated in a different workplace, experiences that triggered a deep depression, suicidal thoughts, and hopelessness for herself and the world in general.
The New York Times’ report on Amazon’s intense, demanding, and sometimes devaluing employee climate made headlines recently. The article described employees crying at their desks, working extremely long hours “night after night,” and undermining fellow colleagues. Most disturbing were reports of mistreatment or unfair evaluation of employees with health or family concerns. (In a letter to employees, Amazon founder and chief executive Jeff Bezos reportedly defended the tech giant’s management practices, saying the company “would not tolerate the ‘shockingly callous management practices’ described in the article.”)
Workplace abuse and demeaning bosses are not limited to the tech industry. Doctors themselves are no strangers to difficult work and training conditions. In fact, toxicity is almost a given in most doctors’ experiences. After all, pediatrician Perri Klass called medical school “a not entirely benign procedure” in her book by the same name. Over the years and after significant advocacy efforts, medical training has become more humane, with limits on working hours and call. But even today, stories abound about abuse, harsh criticism, and lack of empathy toward medical students, trainees, and physicians as employees. Tasked with caring for others, physicians find themselves not always cared for by the systems in which they are embedded. On the bright side, reflecting on these experiences can increase our empathy, insight, and skill in caring for those caught in hierarchical power relationships.
People in hostile working and learning environments often feel victimized, blamed, shamed, unworthy, and inferior. They can feel marginalized, isolated, and cut off from a sense of belonging and meaning, triggering sadness, rage, and anxiety. Hostility affects career and personhood and can be felt as an existential threat. Coworkers are not always helpful. The words many of us heard in training are not dissimilar to advice our patients might get from their peers at work. “Suck it up.” “Hold your nose and go.” “Don’t take it seriously.” “Get over it.” The dyad of victim and oppressor becomes a triad of victim-oppressor-unempathetic observers who reinforce oppression. The power of the therapeutic relationship is in changing the triad. The psychiatrist’s compassionate support and positive regard provides safety, reassurance, perspective, mentoring, and healing for the victim of toxicity, helping them become a resilient survivor. We become an important refuge for the person in crisis, providing ballast for their situation and an important role model for empathy in adversity.
Workplaces can be dehumanizing. At worst, employees are valued only for their productivity. Bosses, in turn, are understandably focused on goals and output, and bear a myriad of demands and pressures themselves. But people are obviously more than their jobs, though their jobs can provide much in the way of growth, self-efficacy, and connection. Freud himself underscored the importance of both work and love. Nurturing the whole person can help them succeed in both areas. It is reassuring to note that emotional intelligence has been shown to be the best predictor for business success as well as important for overall happiness. Psychologist Daniel Goleman identifies five components of emotional intelligence: self-awareness, self-regulation, motivation, empathy, and social skills. Psychotherapy works to improve all of the above through many means, but the most crucial is the therapeutic relationship.
One of our tasks is to identify and treat psychiatric illnesses. But more importantly, psychotherapy is a humanizing encounter. The psychiatrist provides a new relationship that leads to new experiences and insights for the patient, helping them to understand themselves, their world, and their narratives in life. As far as I can tell, you will never be able to order these on Amazon.
Dr. Chandra is based in San Francisco. His book in progress, “Facebuddha,” explores the psychology of social networks through a Buddhist lens. You can sign up for a newsletter to receive more details at www.RaviChandraMD.com.
