On being made suddenly insignificant

• Happy New Year! by Don Nathanson, 12/31/97
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Many of my physician friends have been caught in an analogous situation. Surgeons whose income brought a life style filled with top-of-the-line cars, jewelry, homes, boats; radiologists who travelled the world and collected rare books; psychiatrists whose income was generated by long term hospital patients. All of them are now suddenly reduced to incomes hardly a third of what they had known, all of them forced to revise significant parts of their identities as the corporate world took over what previously had been an entrepreneurial profession. And it is not just the health care profession that has been caught in this crunch---lawyers by the hundreds were simply discarded by firms whose billings decreased radically as corporate America decided to treat its legal expenses as any other cost that could be "managed." This is the dark side of the story that the stock market daily reaches new highs; such "successes" often occur only when people like you are no longer "expenses" for a business. Efficiency is a peculiar term when paired with the humanistic art of guidance or therapy.

Of the negative affects triggered by the ominous progression of this inhuman movement, shame certainly looms large; we feel suddenly insignificant, unable to run our own lives, unable to provide for ourselves or those dependent on us, weak, ineffective. Wapped always in shame are the twin affects of rejection, self-dissmell and self-disgust, that tell us that we are not only unacceptable to our employer, but worthy of rejection by others. Fear that we may not be able to feed, clothe, and house ourselves, distress at the constancy of of our helplessness, and rage at a world that can allow such discomfort; all of the negative affects afflict us when so thorough a catastrophe occurs.

And yet there is hope, the belief in joy yet to come, hope that says I have been here before, I was a child who knew nothing but grew into an adult who had some power and held meaning for many. There is within me a reserve of strength that will allow me to weather this storm and adopt the skills needed to work in this new economy. The very fact that you have shifted from the sense within shame that you are uniquely defective and the only person singled out for this demoralizing treatement to the appropriate realization that you are part of a huge mass of people turned from individuals into a group, this realization is actually the beginning of a decrease in shame and an increase in your ability to gear up the energy, interest, and sense of self-worth that will allow you to move to this next phase of your career.

Although no one can study for you, and no one but you can live your life, you may find it of extraordinary value to band together with a handful of peers to meet as a support group while you deal with the affects triggered in this crisis. The very skills you and your colleagues learned as school counselors may allow you to help each other, feel just a bit more safe within an empathic milieu, and just a bit better able to weather the storm. Shame makes everybody more alone than necessary, and when we come out of it enough to see ourselves as part of a massive change in society rather than defective individuals, we are well on our way to a new and newly valuable life. The relationships you form in such a support group can become some of the most important in your life.

Good luck, good hunting, and carry with you the hopes of all your colleagues.

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