Where is the love?

As you get older, you spend more of your time in hospital - not just for your own ailments, but for those of your parents. This accelerates with increasing age. There are visits with your parents to a widening range of specialists followed by ever-longer hospital admissions, and then terminal care. You remember the grim meeting with medical staff leading to consent for ‘Do not resuscitate’, followed by the wait as the defences of a weakening body finally give way. These memories stay with me, but I also remember sitting by bedsides watching life in a hospital ward. What I usually observed was active neglect. Nurses would talk to each other in their ward station while incontinence bags overflowed. Every 10 or 15 minutes a nurse would walk round the ward looking briefly at each at patient but not talking to them. No-one in the hospital saw it as their responsibility to comfort the sick and the dying.

How could this happen? One possible reason is staff burnout. Many people find talking to ill people emotionally taxing. This can wear down the kindest of people, who escape pressure by reducing the emotional content of their interaction with patients or clients, and convert their work to a set of technical procedures. But this raises the question of why organisations do not take steps to avoid burnout or why they continue to tolerate it among their staff. I think the main reason this happens is because the emotional content of professional and personal support work is seen as problematic: the direction of training this group of staff has therefore instead emphasised the acquisition of technical skills. Ethics is still taught as a subject in professional training, but has been reduced to a set of guidelines to follow in obtaining consent for research or for the application of medical, nursing or other procedures.

This loss of the emotional content of health and social care is part of a wider trend towards the excision of passion and feeling from organisational life. It is assumed that no-one works because they have skill and personal commitment, and a passion to apply it to their work. One consequence is the belief-in-practice (written into numerous guidelines and codes of practice and quality assurance manuals) that no-one can be trusted and no-one can perform well unless regulated and inspected or, if they are senior managers, given generous financial bonuses to do their work. This belief becomes self-fulfilling: staff become de-motivated and truculent under the weight of inspection, while senior managers become oriented solely to their bonuses and neglect wider responsibilities.

Of course it is often argued that such mechanisms of control are necessary to manage large organisations and complex centralised states. But this fails to ask whether we need such large organisations or whether our society should be so centralised. It is possible that this trend to centralisation has come about not because it is better at producing goods and services, but because it has generated a new and dehumanised ethos of organisational rationalism. This incorporates the distrust of human emotion and commitment, and hence the negative view of human nature. It proposes instead that humans are properly motivated only by a combination of financial rewards and penalties. This looks rational in the sense that economists speak of rational behaviour, but at its core are the darker emotions of greed, fear, and love of power.