The New Junior Doctor Contract: Exception Reporting, The Guardian Role and Power Dynamics

We all recall with interest Samuel L Jackson’s role in Quentin Tarantino’s film “Django Unchained,” playing the role of the slave manager within the film and reporting to Mr Candie, the slave owner, of any difficulties amongst the slaves.

What is of interest, of course, is that Samuel L Jackson is Afro-carribean himself, whilst the film itself portrays 1858 Texas, depicting the slavery that occurred amongst Afro-carribeans and the inherent acceptability of racism within the society at the time.

His role as an Afro-carribean man, controlling the Afro-carribean slaves, was demonstrated in Samuel L Jackson (named as Stephen within the film) being a slave himself, but in a higher hierarchical position than the other slaves, giving him the privilege within this position to talk back at both Mr Candie and at Django in a way that the other slaves would not dare to.

Thus, whilst Stephen would never have the status and prestige within the film of a Caucasian man in 1858 Texas, he was able to behave under certain boundaries as if he had this status. A further important point to note is that Stephen actually believed he had such status and prestige, due primarily to his loyalty and servitude to Mr Candie’s father, whilst of course, Stephen was never to reach equality within this film due to the racist beliefs of Mr Candie, who justified such beliefs by carving a skull to show how, in his view, the skull of an Afrocaribbean will always differ anatomically from that of a Caucasian man.

I look with interest at the underlying power dynamics taking place within the film with reference to that of the current NHS Junior Doctor crises, which this year has led to industrial action for the first time in history amongst junior doctors over an imposition of the new contract.

I find that doctors are the most interesting profession to study within power dynamics, for they are truly an abused profession.

Particularly, the unfortunate power dynamic played towards doctors by those in power attempting to mask their power, is to try and convince doctors that doctors are in power, that they have influence and that their views are being listened to and taken into consideration, whilst in reality, within the organisation, the majority of doctors often have little power or influence over much other than the management of their individual patients and their views on more broader issues are often ignored. 

This masking of power extends to that of the public who assume that doctors are in authoritative positions, holding the strings, in charge of hospitals and the NHS organisation and hence responsible for its failures, whilst actually, the NHS is in the deep claws of a political chess game, of which those who are on the front line and who actually understand the realities of the NHS are pushed to the side, devalued and undermined. 

To give an example in current times of how power is imposed and controlled amongst a bright, academically brilliant group of people, let us simply look at the new Junior Doctor contract and the “exception reporting” and “guardian role”.

Within the current Junior Doctors contract, if doctors work an excess of hours, the trusts themselves are financially penalised. The new contract will enforce a method of “exception reporting”, which essentially means that the junior doctors will have to declare through a form based procedure that they have worked over their stipulated hours. This will then come under scrutiny from their educational supervisor (who is also a doctor), who will, (as taken directly from NHS Employers website) “discuss with the doctor what action is necessary to address the exception and to ensure that it remains an exception.” Following this, NHS England has stated “where exceptions become more regular or frequent, a work schedule review will usually be required.“ The guardian (also a doctor), will also be informed, who’s role it is to “oversee the work schedule review process and will seek to address concerns relating to hours worked and access to training opportunities.”

Of course, it is an obvious predictability that the flaw within this system is that the responsibility as to why doctors are unable to keep to their assigned hours will fall into the hands of the individual doctor, or the educational supervisor (a doctor), or the guardian (a doctor), and be blamed on the character flaws, work ethics or competency of the individual junior doctor, rather than that of the Trust, or the work load being unsustainable, or the intense pressures faced on the clinical workforce due to underfunding and understaffing.

Don’t believe me?

Have a look the latest NHS Employers factsheet on Guardian Fines, released only a few months prior to full imposition of the new contract, which states: “In anything other than truly exceptional circumstances, the levying of a fine indicates that the system has failed and that some-one- the supervisor, the guardian or the individual doctor concerned- has failed to discharge his or her responsibilities appropriately“.

What is less obvious than this predictable outcome, however, is the ingenuity of using senior doctors (i.e. the educational supervisor and Guardian) themselves within this process to manage and supervise the individual junior doctor’s exception reporting. The educational supervisor is a senior doctor that needs to sign off the individual junior doctor at the end of each year so that he or she can progress up the system, so this obviously is going to deter junior doctors from raising exception reporting as ultimately it will create more work for their superiors. Apart from this, the emphasis of the role of educational supervisors will be on identifying, as NHS England has stated themselves, that the “exception remains an expection”, otherwise “a work schedule review” will be required, hence placing the educational supervisor in a position of having to scrutinise, ensure the competency of the junior doctor and to “improve” the junior doctor, in order to demonstrate that attempts were made in ensuring that this remains an exception, rather than being able to redirect the problem to its probable cause which is that of the organisation the doctors work for.

I argue here the similarities of power structures between that of the new junior doctor exception reporting process and that used within Django Unchained. This may sound far-fetched, making a comparison to junior doctors and historic times of slavery, but I mean not the barbaric and inhumane slavery itself, but of the mechanisms used to control slaves, which was to incorporate “one of their own”, some-one who speaks the language of the slaves, and is himself, a slave. This is the mechanism that acted as the buffer system within Django Unchained, with the benefit for the master that the anger would be directed from the slaves towards Stephen. Stephen was placed in a position as the communicator between the master and the slaves whilst handling all the dirty work for Mr Candie, allowing Mr Candie, if he so chooses, to act friendly and kind amongst his slaves.

Whilst the BMA apparently believes it was their negotiations that led to this guardian system, I question to what level this was considered in terms of its ability to be misused and its potential manipulation of other more senior doctors to be used within this power structure.

I urge therefore that those taking up the role of the Guardian or the educational supervisors themselves, to consider fully how they may be in a vulnerable position and may be misused by those in power as a buffer system to project and divert blame and enforce a contract which 98% of junior voted against, and to please not wrongly believe, like Stephen did, that this contract has granted them with an actual position of power and influence in real organisational terms.

Caring, For His or Her Own Satisfaction

“Like the proverbial husband who works all day to support his crippled wife, yet would probably abandon her were she to regain her health and become a successful career woman. It is much more satisfying to sacrifice oneself for the poor victim than to enable the other to overcome their victim status and perhaps become even more successful than ourselves.”- Slavoj Zizek, Living in the End Times

Am I Too Messy or Is She Too Clean?

 

A common argument between two cohabitants, often leading to nagging, quarrelling, frustration, resentment and all too often, an ending to the otherwise harmonious relationship.

Firstly, let me focus this post carefully and deliberately avoid the gender specific argument here of man being more comfortable in mess and woman more comfortable within cleanliness. Such gender stereotypes are depicted within the movie “Break Up”, which shows Gary and Brooke’s sudden relationship deterioration following an argument on doing the dishes.

What is more interesting to focus on from this movie is that its success lies in the audience divided as to who they feel more sided with amongst the couple, whether it be the devaluation of Gary to an “inconsiderate prick” or that of Brooke to a “nag”. 

I do not believe that this division is based on an alliance of genders- that men will simply take Gary’s side whilst women take Brooke’s side.

Instead, I believe the division in opinion to be based on the consideration of what is considered more acceptable, or less taboo, between having one’s home to be too “messy,” or instead one’s home to be too “clean.”

The focus of this post, therefore, shall be on understanding this difference in opinion.

For what is worse, living in a house that is too messy, or too clean?

The immediately obvious, more acceptable answer is that of a house that is too messy, but we have yet to make one further very important distinction, which is that of the definition of “messy” and “clean”.

Being messy or clean are not definitions necessarily mutually exclusive, nor on the same spectrum: a house can be messy, yet clean, whilst another house can be clean yet at the same time messy. There needs to be a distinction between “cleanliness”, which is that of hygiene, where “cleanliness is next to godliness”, of which lack of results in infestation of maggots, mould and so on, in contrast to “mess“, which can be more accurately described as “disorder“, rather than organisation and “order“.

I doubt that Brooke or Gary would argue of the importance of “cleanliness”- clearly, their home had no infestation of maggots and as the film progressed it showed Gary to create “mess” i.e disorder with various furniture and items out of its original position or “order”, but not that of creating a lack of “cleanliness”.

I claim that the arguments for most relationships lies within the spectrum of “mess” , the spectrum of which lies between the extremes of “order” and the extremes of “disorder” rather than that of cleanliness. 

This therefore leaves us with our final question, as to whether Brooke’s preferred position of “order” is considered more acceptable than Gary’s preferred position of “disorder”, depicted within the film as Gary and Brooke began to divide the house into different territorial sections, demonstrating their differing preferred positions within the “spectrum of mess.”

The answer is that neither is more acceptable, for unlike cleanliness, both extremes co-exist more easily as a negative. An overly ordered house, with objects lined in perfection, with no allowance for change or persons who may inadvertently modify the order, provides no room for breathing or life. Rather than being a positive, the extremely ordered is a disorder of an anal obsessive nature, of a subject who can not bear the slightest of chaos or uncertainty, within an uncertain and chaotic world.

The other extreme is that is of the overly disordered house that leads to chaos, confusion, a structureless sea with no anchor, the disorder of a chaotic mind or a constipated hoarder, unable to let go and face the world, instead preferring to remain within the solace of his own mess.

Yet, opposites attract, and hence we often find ourselves fighting over where we should leave the oven mitts, or for that matter, who is to define what is the correct “order” for the oven mitts…hanging next to the oven, or on the cupboard railing?

Where both extremes provide the propensity for arguments amongst the couple, the solution of course is tolerance, but this requires an understanding of the nature of the “spectrum of mess,”  which lacks a correct position amongst the spectrum. Ability to function well in society does not correlate with level of order- one man’s order is another man’s chaos…and so on. Many successful people prefer to come home to the excitement of chaos, whilst others prefer the calmness of order. Tolerance is therefore needed on both sides, where the ordered subject truly accepts disorder as equal and the disordered subject accepts order as equal, and neither labels the other as more weaker. Until this can happen, both subjects will exert their spectrum onto the other, until one dominates or the other leaves.

 

 

 

 

Wishing a Narcissistic Free Merry Christmas

For many of us, christmas is a difficult time. 

Why?

As much as we deny, try to forget, go no contact or leave it all in the past, the houses around us decorated in christmas lights, with the image of the happy children opening their christmas presents gives us no solace from the constant reminder of what we have not had, or what we desperately seek to forget.

We may be facing christmas alone this year. 

Those of us further on in our journey to recovery may have built our new network, who soothe our christmas to feel somewhat normal, a normality which will be cherished, but still bringing about mixed feelings of anger to what we lacked in our past, with new found hope of what we can continue to have in the future.

I wish not to pretend that a christmas wish from myself or from any-one will make this a happier time. Deception is never welcomed by those of us who have experienced what we have.

But let me say this. That we can celebrate what we do have, which is insight into the madness that we now see in its true form, that we no longer are bound to be a part of in darkness. 

We all remain together, our trauma from our past helps us find one another, to help one another and to be there for each other in a way that we have never experienced.

We seek normality and christmas is a reminder of our abnormality, but it is our abnormality that is what makes us who we are and gives us our identity.

Celebrate your christmas as the symbol of your courage to make the difficult journey away from the comfort of ignorance and delusion to that of sound mind in reality. 

You are stronger than you give yourself credit for. I admire you. 

Merry Christmas 

 

 

 

 

 

 

Why am I an Addict?

I’m addicted to the high.

It’s not just that I have an addictive personality.

It’s that my world is of extreme highs and lows.

For me to have a moment of happiness, I need my fix.

That short drug fueled moment is what you normal people call normality.

My normality is depression.It is the inability to understand or recognize any pleasures in life, the point of waking up everyday, the mundanity of relationships, social greetings, Christmas presents, birthday cards..and the rest of it.

Without a fix, I can’t escape the low.

Nowadays, when I get “high” it just makes me feel normal again.

I am an addict that wants to feel normal without getting high, just like you.

Welcome to my world of highs and lows.

Learning from the Narcissist: Our Unconscious Relationship Choice

I was bought up in a  typical household dynamic where one parent is a Narcissist. 

My Father: The Narcissist, self absorbed, no capacity to empathise, manipulative.

Nothing new there.

What is often forgotten or unspoken of, is the other side to the coin…

My Mother: A dependant, anxious, somatiser. Again, completely self absorbed. Almost always the victim, even when she is the predator.

It was a typical narcissistic/co-dependant relationship.

As a child, I was unable to see the true nature of my mother. For what tends to happen is that when the love and affection that a child needs is spread too thin, the child will look for any morsel of love he can get. This is what sets the ground for the idealisation of the father and devaluation of the mother, or vice versa, which sets the child towards the foundation of developing the narcissistic personality themselves.

What can we learn from this typical dynamic we grow into?

For many years, I wondered why my mother would stay with my abusive father. I could not understand why she wouldn’t walk away, nor why, despite the obvious evidence to the contrary, she would believe that my father treated her well.

From a Kleinian understanding of the “splitting” prevalent within personality disorder, it is necessary to understand what my father detested about himself. 

My father hated the idea of being vulnerable or weak. If he was sick, he would tell no-one- it gave too much evidence to his own mortality, that he was in fact just like everyone else…his ego wouldn’t allow such an appropriate human exchange.

He detested the idea of being poor. Despite he himself coming from a poor  background, he spoke fondly of how he rose himself and his family from such harsh realities…without his guidance and wisdom we would all have nothing, or be nothing.

Finally, he resented stupidity. He was a highly educated man, constantly comparing himself to those with lesser qualifications than himself. A man who could never be wrong, or faulted, due to the letters following his name.

What of such interest then, that the woman he “loves” was less intelligent than him, poorer than him and more weak and vulnerable than him. 

Interestingly, I do believe my father does love my mother. But the reason for why they are together, why they complement each other so well in their narcissistic/codependant relationship, is that he needs her to hold parts of himself he resents. 

He needs her to be poor, so he can feel rich.

He needs her to be weak, so he can feel strong. 

He needs her to be stupid, so he can feel intelligent.

I believe insight is everything- so let me challenge you…

What is it that you need the narcissist in your life for, so that you can feel….? 

 

 

 

 

 

 

 

Angel Fuels Motivation in Victims of Narcissism

red-lips-girl-blonde-face-leash-portrait-rendering-art

 

When I get told off by any-one….I get angry. 

When I get criticised….i get angry

I don’t shout or scream, yell, or hit. I just smile. 

Why do I smile?

Because I’ve never had another outlet. If I did, the narcissist would know and my position would be weakened. 

So I internalise the anger.

I use the anger as fuel. 

Unfortunately, often I use this fuel to disprove the Narcissist. That I am not stupid or ugly or fat. I modify my behaviour to prove to the Narcissist that I am nothing like he thinks I am.

But then he wins. Because he knows it was his criticism that made you change. He believes that it is him that made you better, more like him. He takes over your accomplishment.

This is power dynamics. 

Use your anger, own your fuel. 

4 Common Traits Of Those Raised By A Narcissist

narcissist

 

I’ve noticed over time that a lot of us who have been raised by Narcissists have certain traits in common. 

For many of us, these were developed as coping strategies for our survival when we were children. Whilst they may have been useful as a child, some become maladaptive patterns as an adult, restricting our life experiences, leaving our outlook of life to be through the eyes of the narcissist, as we never had much of a chance to develop our own. 

Sometimes I can tell when I meet some-one who has been raised by a narcissist. There is some sort of familiarity or an understanding that we have both been through the same turmoil, signalled through our body language towards each other or us having a similar shared reaction if we are both around a narcissist at the same time.

After gaining awareness into my own childhood and opening up to my friends, I found that a lot of them had also had some life changing contact with a narcissist at some point in their lives. It seems odd, but the victims of the narcissist not only attract narcissists into their lives but also attract other victims. Maybe it is a way of us unconsciously relating to others pain, to try to heal others as we heal ourselves.

The following traits seem common amongst those of us that have been raised by the narcissist. 

1. We have an odd relationship with authority.

Whether it be our bosses at work, our teachers at school or the leader of our group of friends, our relationship with authority tends to be affected.

We find ourselves on guard, unable and unwilling to be ourselves. We struggle to understand how other employees can call their bosses by their first name or go out for drinks with them with such ease.

Instead, we become very good students or employees. Our skills at catering to the narcissistic ego has been taught to us from a young age. We know how to make our boss feel superior, in control and powerful. We are often very successful at working up the ladder.

When we are in a group, we find ourselves being drawn to understand the mind of the leader. This is of no surprise, considering how we have spent years trying to make sense of why the narcissist caused so much confusion within our lives. 

In a way, this is a useful survival strategy. The fact that we are disciplined in the art of pleasing our superiors can work in our favour and when skilled can make our working lives very secure.

On the other hand, our difficulty in developing a more relaxed relationship with authority may leave us in a permanent position of formality, unable to progress the relationship to one with more meaning. 

We struggle to lead others, for we detest so much the feeling of being led. Being stuck in a position of being wary around authority, naturally pleasing, we gradually detest our superiors, feeling suffocated at our difficulties in standing up for ourselves and our own needs, living instead of constant fear of upsetting our master.

2. We find it difficult to say NO.

Being raised by a narcissist would mean that you have spent a of of time doing things you didn’t want to do. You may have had to go out for dinner after you had already eaten, attended family parties despite being ill, studied subjects at school that you had no interest in, embarked on a career that you had no passion for or even married some-one who is a stranger to you, just to appease the narcissistic parent.

Our narcissistic parent may have been in a relationship with a dependant person and if so we would have grown up watching how one person always seemed to give in to the other. The result is that it may seem normal or natural for one person to follow the other and odd as to how a relationship of equality would actually work.

We find it difficult to say NO not just because of fear of offending the other person. It is also that we fear the abandonment, the expectation of silent treatment or other abuse that we would have experienced as children just for stating our views.

In its worst form, we become paranoid that if we are to reject another person, it will result in a rejection by all those who know the narcissist, akin to the feeling of being told off by extended family members as a child for some-thing that wasn’t true or wasn’t our fault, due to the narcissistic parent projecting the blame onto us as he or she was incapable of mustering any responsibility for his or her own actions or behaviour. In my case, I was the scapegoat for being late and the explanation given for my mother’s constant level of stress.

3. We are highly self critical

I spoke in my post on awareness of abuse by narcissists on how, when some-one has little self esteem, they lose the ability to see the world through their own eyes, instead seeing the world through the eyes of the narcissist.

For those of us who were raised by a narcissist, we may never have had the opportunity to develop any self esteem in the first place.

Hence, we spend our lives seeing the world through the narcissist’s eyes, where our values, beliefs, aspirations and accomplishments don’t matter.

As a result, many of us will struggle to feel any sense of happiness on our birthday, or when we pass an exam, or get married or any other accomplishment. We will believe as we have been taught to believe, that our accomplishments were solely due to our narcissistic mother or father, whilst we only are responsible for the negative consequences of being raised in the self image of a narcissist.

4. We have anger that we keep hidden

When I meet some-one who can appear to smile genuinely when they are wronged, I question whether they have been raised by a narcissist, or what abuse they have faced in their youth. We have an uncanny ability to be able to hide our emotions. Having lived in fear of the impact of showing our disgust towards our parents, our mastery in this is of no surprise.

What this leaves us with is a harbouring of intense inner feelings of anger, which we keep stored and pent up, hidden with a smile and forgotten by ourselves through either dissociation into a constant numb like state or otherwise through another form of distraction.

Unfortunately, our anger following years of abuse doesn’t simply disappear. It remains within us and facing up to this part of us is difficult. But, who can blame us for being angry?

Some of us may have found a safe outlet for our anger. Many of us will be extremely creative and may use music or writing to process our intense feelings. We may eventually develop a strong desire to protect others or to have an opportunity to defend and speak up after years of neglecting this part of ourselves- many of us may find solace in a career in law, the police force or medicine.

What can we do now?

One thing us adult children of narcissists know is that we can create a positive out of any negative situation.

We can start by recognising these traits within ourselves.

We can take time to celebrate our birthdays and accomplishments, no matter how small, and learn to believe our accomplishments to be ours.

We can develop seeing the world through our own eyes, rather than seeing the world through the narcissist’s eyes.

We can learn to say NO regularly and monitor our feelings through the process, including the anxiety, fear and paranoia. We can start to recognise that it is completely acceptable and within our rights to say no and that our emotional response is likely related to the reality of the past rather than the present.

We can learn to develop our emotional outlet to be used constructively to help ourselves or others and not allow it to affect us in self destructive ways. We can accept that we are angry about our past and not blame ourselves for this very natural feeling.

Most importantly, we can learn to love and care for ourselves.

The Sociopathic Struggle

dictators

But how else could I convince them, my lord?! I’m not mad, bar possibly in the past I was, but I now know that it would be absurd to claim myself your rightful throne as the only true omnipotent ruler and king. This thinking would imply insanity or mania, neither certainly worthy of a destined death by your yellow backed sword. Yet I am neither and your evidence is my desire to bend to you nakedly and explain my inconceivable actions to you my lord, in the hope that you will see my logicity within the logical rules you created and bring peace to my divided soul.

Divided soul, you ask, in the sense of polar opposites, of the structural capacity of the mind to conceive only linearly. Black and white, yes and no, believer and non-believer. Bringing to the deepest influence what is believed to be right or wrong. It is this desire of righteousness which gives me my argument to which I center my reasoning for my actions my lord- it was only with you in mind, I swear!

The world has to work with the order of righteousness. For health for its people, for scientific gains and discovery, space travel! Safety and security for the people, free from rape, greed, sloth, malice, ill- thinking, thoughts or wants. To stop them thinking though- oh my, the minds of these stupid early humans. Polluted, uncivilised, their disgusting coils of a brain have no consistenty or patience to conduct a rational thought process, let alone know what is truly right or wrong. Their incancessant need for sex, their genetically inferior minds construing this concept of “love”, for which they, blinded by there hormonal lust and need for human connection fail to encapsulate that their undying love and sacrifice for their family means what for the billions of people outside of their petty little unit? Less importance? Hate, distrust, dislike, inferiority?

One can not blame them for their idiotic philosophy. Love is, after all, a genetic need for survival. I’m sure the creator had his reasons for it’s weaknesses in methodology but that is not my concern. Leadership of minds towards the righteous path can not be conducted without manipulation. One has to be clear here- a mistake in the creator’s “clever” creation of linear thinking is that for a concept of right to exist, so must wrong also exist in this world. My logical thinking is only to minimise the wrong and lead and manipulate the people to believe they are doing right, for the overall goal of righteousness. And what is so wrong with this?! It is the weakness in the creator I’m dealing with here! How is that my fault!

It was never about racism. They died because they were genetically inferior-they were bad eggs- or they were too late to change into the thinking of righteousness. They took up too much space and we needed space to start over. We tried to confine them so that they could as least live there lives and die naturally, but, like a virus, they insisted on reproducing. They died in the name of righteousness. They were tortured only to make a example to the remaining bad eggs- stupid minds need visual examples to see what happens if they are naughty- like children.

No matter what they think of me now, it is true what they say. I do love them all like they are my own. All of them are equal in my hearts- this is all for them after all. Soon, there will be no need for vicarious torture methods. The correct way of thinking through indirect techniques of subliminal schooling, mass surveillance, media manipulation and early, more quiet, direct disposal methods for the inferior or  the rebellious would be far more economically feasible. Slowly, as less bad eggs are produced, less eggs will need to be wasted in this way- it is a self serving arrangement.

Granted, yes, my lord, my actions without your consent would be displeasing I can imagine. But in my defence, I asked you to show thyself and I couldn’t see you! So i acted in your position, without thinking of you. Some have called me a bad egg for this, but please judge me yourself- I am a good egg, aren’t I? I think I’m a good egg. Let’s forget about eggs and good and bad, right or wrong for a second. I am only human, after all. I made a mistake! I wasn’t thinking, I was in delusion! An easily fixable crack in the surface of my egg, crackable due to your faults in the shell’s design! Forgive me instantly, so I can forget and act righteously again. You promised you would love me no matter what I do!? Who is the good egg here, me or you? Don’t make me ignore and destroy you too.