Wednesday, April 4, 2012

The Spectacular Side of Ordinary

     I've recently discovered an amusing, quirky sketch comedy called "Portlandia." In this show, Fred Armisen and Carrie Brownstein write the sketches and play the majority of the characters who are usually "coupled" in some way. I won't bore you with details from the episodes I've watched, other than to say that Fred and Carrie brilliantly capture the essence of stereotyping which seems to pervade American society, accurately portraying the common thread of narrow-minded, passive-aggressiveness so typical of individuals who are prone to making generalizations about entire groups of people, be it a race, a profession, or a particular subculture. The propensity for stereotyping seems pretty universal, sparing no group in particular. Some of the most outwardly liberal and generous people I know are guilty of stereotyping, carelessly labeling and even berating others, often based upon very limited observation or actual experience with the people they are categorizing. A startling lack of personal insight seems to accompany this hair-trigger tendency toward judgment. It's the common denominator of self-righteousness. While I think it's fair to say that most of us have been guilty of stereotyping at one time or another during our lives, the acquisition and development of true receptiveness or open-mindedness is incompatible with such behavior.
    Yesterday, my son, Nick, and his girlfriend, Haley, and I had an interesting conversation, following a social network interaction I had with a close relative who publicly denounced the medical profession for its lack of altruism. Because this person knows I'm a physician, the comment stung, initially making it difficult not to take what was said personally. According to this person, the only altruistic physicians are those who volunteer overseas or donate their time and skills in free clinics, those who work for job satisfaction instead of money. Although she's entitled to her opinion, I heartily disagree. Based on my experience, altruism is alive and well in the United States, but we've become so jaded that, in the absence of publicly aired, dramatically displayed gestures of goodwill or selflessness, we tend to overlook its more subtle presence. Haley wondered, "How can you make a statement like that unless you personally know every physician in the United States?" This sounds simplistic, but it's a really great question. Unless we know what makes every individual in a particular group tick, applying broadly generalized statements regarding one's character, based on a limited number of observations of the group under scrutiny, is like throwing the baby out with the bathwater: we discard what's indispensable along with what's superfluous. Furthermore, working for job satisfaction is no more altruistic than working for less money, as neither quality implies disinterested selfless concern for the welfare of others. I personally know physicians who have accepted less pay in an attempt to escape big alimony payments, as well as those whose job satisfaction stems primarily from the love of science and technology, not from their commitment to the well-being of others. Is it accurate to classify these less well-compensated, job-satisfied physicians as any more altruistic than those who happen to be among the scores of dissatisfied, high-earning docs I know who've volunteered in Haiti and Japan? Across professions, there are plenty of folks whose volunteerism is motivated by a need for recognition or secondary gain, not benevolence or altruism.
     Altruism is a hard-to-define form of emotional intelligence, which stems from empathic love and compassion. Depending upon one's acculturation, specifically with regard to the treatment of "self", altruism can mean loving one's neighbor more than oneself, or loving others as oneself. Genuine self-concern and selfless concern for others are not mutually exclusive; they are the two faces of empathy. Empathy is the ability to put oneself in the shoes of another, to understand and share in the feelings of someone else. It is one of the cornerstones of compassion, which is a wish for others to be free of suffering. According to Nick, compassion is a state of pure, unconditional love, and love can be defined as the desire for others to be happy. Because most of us have been conditioned to reject ourselves as insignificant cosmic blips, instead of marvelous focal expressions of the entire universe, we view ourselves as individuals, as isolated and separate entities from everything and everyone around us. As we become more self-conscious, we "forget" who we are. It's sort of ironic: in regarding ourselves as peripheral, we become incredibly self-centered. The genesis of suffering lies in this distinction between self and other, forcing us to cling desperately to our egos and all our attachments, a self-imposed exile from our natural unity and interdependence, a denial of I and We. It's no wonder we become jealous and resentful of others: it's become a matter of Us and Them. Here's a question: if we don't care for ourselves, how can we truly care for others? It is kind regard, not disregard, for ourselves which permits us to fully experience altruistic love and compassion for others. Altruism is incompatible with jealousy and resentment; its basis is unconditional love. This kind of love is not like good china or crystal, reserved only for special occasions; it exists to lavish upon both I and We, as often as needed.
     With regard to the problem of stereotyping, maybe it, too, manifests from the same lack of empathy which provides fodder for the green-eyed monster. In being critical and unaccepting of ourselves, e.g. "I'm such an idiot!" or "I'm so ugly!", we become so paralyzed in self-loathing that there is little energy left for attending to the needs of others. In other words, the way we treat other people is a reflection of how we treat ourselves. We may put on a good show of seemingly selfless acts of kindness, to which are inevitably attached an expectation of reciprocity or recognition, or align ourselves with some sort of benevolent, humanistic cause, but eventually, the contempt we have for ourselves is transformed into contempt for others. A car doesn't function well, running on fumes and neither do human beings.
     Our ability to appreciate the subtleties of altruism is a function of what our conscious minds ignore. In paying so much attention to what's extraordinary, we neglect what's in between. The media inundates us with heroic tales of self-sacrifice, which simultaneously inspire us and produce a sense of inadequacy, to the point where we forget about everyday heroes, people like you and me. Here again, we seem content to throw the baby out with the bathwater. The truth is that we are all "gems." In defense of my profession, I am proud to recognize the intern who "goes to see the patient", instead of handling a problem over the phone, the resident who stays late to grieve with a family, the attending who takes the time to delight in the birth of a newborn, long after the epidural's been placed. They embody the spectacular side of ordinary, calling no attention to themselves, quietly going about their work. It is they, and not the saintlike or greedy outliers who are the constants, the silent majority, the gems.



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