During this usual, though prolonged, heroic phase of altruism and adrenaline that happens right after most any disaster, we’ve heard of many heroes, and rightly so. They include front line healthcare clinicians, front line clergy, first responders for our safety, food plant processors, flight attendants, and service delivery workers. Moreover, the range of these heroes flatten our socioeconomic curve. All of them are doing their essential services for others at great risk for themselves. There is so much that we may be seeing the emergence of another Greatest Generation, this Coronavirus Generation.
Perhaps the poster child for this heroism in healthcare has been Frank Gabrin, DO. He was an emergency physician who twice survived cancer, survived a psychiatric patient almost choking him to death, and survived burnout to write the book Back From Burnout. In the pandemic hot spot hospital where he was working, he apparently had to wear the same gloves and mask for a week, knowing full well the risk of doing so. He could have refused to work under those conditions, but didn’t. After contracting the coronavirus, he didn’t survive. He became one of the first emergency physicians to die from it.
Gabrin’s act of bravery makes me reflect back 2002, when I was given the one-time only designation of being a “Hero of Public Psychiatry” by the American Psychiatric Association. Although I didn’t refuse the award, justifying it as representing a role model of sorts, it seemed a little misnamed then and even more so now because I really didn’t think that I was putting my health and life at risk in serving the poor and underserved. If anything, I was more at risk in later years when I worked part-time in a medium security prison, though the bigger risk even then might have been driving there on country roads where I could suddenly crash into a deer!
Heroism doesn’t usually qualify with foolish and impulsive behavior and/or a goal of self-aggrandizement. Heroes do not require being thanked or admired, though that can be welcomed when it finally happens, as emergency physician Jessica van Voorhees recently wrote in the New Yorker: “And yet, for the first time in my career, I feel truly appreciated by society.”
Nor would one be a hero if something heroic happened in spite of oneself. Compassion and kindness, as valuable as they always are, are not heroism.
The most well-known writer on heroism has been Joseph Campbell, exemplified best by one of his many books, The Hero with a Thousand Faces. He describes the heroic journey consisting of:
- Being in high risk danger
- A willingness to help
- Venturing into the unknown
- Having a mentor
- Overcoming tests and temptations to leave the journey
- Discovering who you are in the deepest sense, including your Achilles heel weaknesses
- Returning to everyday life after some success
In the realm of Hollywood, that heroic journey is readily seen in the Star Wars movies. Superheroes like Superman are portrayed in the comics, as are their opposites, supervillains. Sometimes, in real life, the heroic act condenses Campbell’s stages into a brief moment of rescuing someone in a fire or the like. Though that can seem almost reflexive, most stand by and do nothing.
The psychologist Frank Farley concluded that heroism is really on a spectrum. Moreover, the personal characteristics of generosity, courage and altruism undergird what Campbell called heroic journeys. Don’t those characteristics usually apply to those working in mental healthcare?
Though it has received much less press, the front line in psychiatric inpatient units is now also working under more risk. In my hometown public psychiatric hospital, the Milwaukee Journal Sentinel on April 12 reported that several patients with COVID-19 were diagnosed, but staff requests for even self-obtained protective gear were refused at first and at least two were subsequently quarantined. And what about the patients? They can be heroes too, especially those with the opportunity to be peer counsellors. Then there are the family members who have to try to remain positive, sometimes even when threatened by their family members with mental illness who are living with them. Heroes, too, may need help, if only to be reminded of the need to take care of themselves in order to best help others.
Decades after leading the infamous Stanford prison experience that elicited student brutality, the psychologist Philip Zimbardo turned his attention to the other side of the coin, inspiring and training people to be everyday heroes. He called this the Heroic Imagination Project (HIP) for producing “heroes in waiting.” He concluded that anyone can be a hero anytime an opportunity arises. With an awareness of likely personal risk, one can still stand up for what is right and just, including speaking out about injustice.
With this heroic perspective, there is opportunity for all of us working in mental healthcare during the pandemic to be heroes. To do so, that means, among other things:
- Becoming and being generous, courageous, and altruistic
- Supporting and being part of systems and teams that reward the expression of those character traits
- Speaking out against the stigma toward mental illness which stigmatizes both the patients and ourselves
- Calling out double discrimination against the mentally ill from minority groups
- Adjusting service delivery to the needs of the patients as best as practically possible
- Risking health with close exposure to the mentally ill who can’t be helped in any other way
- Balancing the legal caution of organizational risk managers with, at times, the ethical out-of-the-box courage of clinicians who put patient care first.
In essence, then, real heroes and real heroism, suddenly or ongoing, occurs when anyone is in the right state of mind at the right place in time.