‘The Medical Condition’ or ‘Hannah Arendt is completely fine’

Why have so many of us become so dissatisfied with our working lives?

Why have so many of us become so dissatisfied with our lives in general?

Hannah Arendt (1906-1975) was a German born philosopher best known for ‘The Human Condition’ (1958). In it, if I understand her correctly, she explains her view that the way out of living a meaningless life is to bring about change through our ability to act and thus create something new. She distinguishes our ‘actions’ from our ‘labour’ and our ‘work’. ‘Labour’, to Arendt, is simply those activities of living by which we meet our biological needs whereas ‘work’ she defines as that which we do within the world that imparts a ‘measure of permanence and durability upon the futility of mortal life and the fleeting character of human time’. ‘Work’ produces something abiding and is of a higher level than ‘labour’ which merely perpetuates. Our ‘actions’, however, are what really count. It is not so much ‘what’ we are that matters but rather ‘who‘ we are and who we are is best revealed through our words and deeds – when we go beyond our inherent selfish survival instincts and ‘act’ to bring something new and unexpected into existence.

Two key behaviours that Arendt identifies as bringing about this change are those of forgiveness and the making and keeping of promises. Forgiveness is the behaviour by which it is possible to nullify past actions, releasing others from what they have done and enabling them to change their minds and start again. ‘Forgiveness‘, she writes, ‘is the key to action and freedom‘ and ‘the only way to reverse the irreversible flow of history‘. In contrast, our ability to make and keep promises marks us out as being able to make the future different from the past. ‘Promises are the uniquely human way of ordering the future, making it predictable and reliable to the extent that this is humanly possible‘.

Arendt believes that, to be fulfilled, we need to be able to act in ways that advance or better society as a whole. And herein lies the clue as to why some of us may have lost satisfaction in our working lives and, perhaps, our lives as a whole.

Though we continue to seek happiness, so restricted have we become in public life, by the guidelines that we have to adhere to and the hoops through which we have to jump, that we have become like slaves who have no prospect of having genuine influence. In Arendt’s terms, we can ‘labour’ and ‘work’ – but we can not ‘act’. Furthermore, having given up the prospect of doing something that might bring about real change and produce genuine benefit, we have retreated from the public sphere and been reduced to consumers who are content to amuse ourselves in private – with yet another bottle of prosecco, perhaps, and an evening spent bingeing on the latest Netflix box set.

Arendt suggests that ‘under conditions of tyranny, it is far easier to act than to think‘. Such then is the consequence of a too heavy, top down, approach to medicine when conformity to guidelines is all. In such circumstances, we seek only to unquestioningly comply with what we are told we must do and, from fear of reprisal, we anxiously seek to do so perfectly. But, says Arendt, ‘In order to go on living one must try to escape the death involved in perfectionism‘. By giving up the hope of genuine autonomous action we have given up our hope of fulfilment and with it our hope of happiness.

Thoughtlessly striving for perfect compliance, we therefore die.

This links into another idea of Arendt – that whilst we can know much about the objective world, we fail to understand what lies beneath the surface – that which is most important. ‘What’ we are is our body, but ‘who’ we are is disclosed by our words and deeds. As doctors we may know a lot about ‘what’ our patients are – the details of their individual biological parameters – but we struggle to know ‘who’ they are – their true nature as revealed by what they say and what they do. We can only know ‘who’ our patients are by devoting more time to watching them, listening to them and learning what makes them who they are. We need to spend more time with people, both our patients and those friends and relations whom we love the most, not only for the emotional and material support they provide but also, Arendt believes, for the joy of seeing them reveal their true character.

Failure to know our patients therefore diminishes our working lives. We all risk burning out if we are concerned only about ‘what’ our patients are rather than ‘who’ they are and who they may become. But this becomes harder as workload increases, remote consulting increases and personal lists become fractured. These and a million other concerns press in on us and prevent us from taking the time necessary for us to know our patients.

Finally then, what of ourselves. Arendt suggests that we may never really know who we are ourselves because that is something that can only really be observed by others, those who see us act in ways that we can not see ourselves. This is most true when we love – for love, she says, reveals ‘who’ we are like nothing else simply because it is unconcerned with the ‘what’ of the one we love. ‘Love, by reason of its passion, destroys the in-between which relates us to and separates us from others’

To regain our satisfaction with work, therefore, we need to change. We need to stop behaving in the way that we have been encouraged to practice, stop seeing the ‘what’ of patients and, instead, notice the ‘who’ that they are. In short we need to care for our patients.

We need to stop judging them for their past mistakes, forgiving their unhealthy habits, and thereby giving them the opportunity to start again. We need to give them the hope they need in order to begin again and so create something new in their lives. And we need to believe that patients really can change and promise them the help and support they need to avoid remaining stuck as they are.

If we act in these considered, creative and unexpected ways we really will make a difference – a difference that will also restore our own satisfaction in practicing. We must be more than simply service providers, performing our jobs according to protocol. We need to tackle head on the problems of life and think for ourselves. Because to live is not to merely survive, mindlessly comply and contentedly be entertained. The provision of ‘bread and circuses‘ is not enough for us to be happy. Rather, to truly live is to be somebody who acts and brings about the change, the new start, we all so hope for and so very much need if we are to keep on keeping on.

Eleanor Oliphant, the eponymous hero in Gail Honeyman’s novel captures the sense of this well.

“I suppose one of the reasons we’re all able to exist for our allotted span in this green and blue vale of tears is that there is always, however remote it seems, the possibility of change”.

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Related blogs begin with one on the dangers of perfectionism:

To read ‘Professor Ian Aird’ – A Time to Die?’, click here

To read ‘On Not Remotely Caring’, click here

To read ‘Contactless’, click here

To read ‘Vaccinating to remain susceptible’, click here

To read ‘On Approaching One’s Sell By Date’, click here

To read ‘Eleanor Rigby is not at all fine’, click here

To read ‘General Practice – still a sweet sorrow’, click here

To read ‘We had the experience but missed the meaning’, click here

To read ‘On keeping what we dare not lose’, click here

To read ‘When good enough isn’t good enough’ click here

To read ‘It’s alright ma (I’m on GPing)’, click here

To read ‘My back pages’, click here

To read ‘Vanity Fair’, click here

And now one on the dangers of perfectionism:

To read ‘Professor Ian Aird’ – A Time to Die?’, click here

And finally a trilogy on the subject of burnout:

To read ‘Somewhere over the Rainbow’, click here

To read ‘When the Jokes on You’, click here

To read ‘With great power…’, click here