"An Intern's Jacket Which Once Was White": Job, the Danger of Guiltlessness, and the 12 Steps
David Mathews, Upstate Medical University, Syracuse, NY
"There is no guilt, my man. We all are victims of our guilt, not guilty." Thus declares Eliphaz, one of JB's comforters in J.B., Archibald MacLeish's award-winning retelling of the Book of Job. JB, the play's protagonist, finds himself in great suffering and agonizes over whether he is guilty of any wrong which has caused God to punish him. Described as wearing "an intern's jacket which once was white", JB's friend Eliphaz argues that JB should not concern himself with the question of his own guilt or lack thereof. For, in the end, man is nothing more than a passive being caught between the subconscious below and the world above.
In stark contrast to this model of guiltlessness lies the 12 steps of Alcoholics Anonymous. The steps encourage an honest approach to addiction/substance abuse that neither minimizes nor overlooks one's role in its development. While working through personal faults and shortcomings in community and with their Higher Power, those practicing the steps are released of the bonds of shame. Through identifying character defects, they can honestly identify their own weaknesses and account for them.
Through considering these two resources, JB and the 12 steps, this paper helps healthcare providers understand how they can best interact with their patient's agency. This paper argues that providers must consider their patient's role in precipitating their current state of health. In certain circumstances and in certain diseases, this role will be minor; in others, it will be major. In an age where terms such as the "biopsychosocial" model have become popularized, it is important not to lose sight of the patient's agency. In other words, not to "overshoot" in the direction of identifying external causes and minimizing patient agency. If we do "overshoot", we may be robbing patients of valuable healing opportunities.
Hope for the marginalized features prominently in this paper if one is listening closely. An attuned healthcare provider can inject hope directly where it is most needed. If despair arises from organic or external causes, treatments or social support can be discussed. If despair arises from issues related to a patient's agency, 12 Step and similar programs can be discussed. A social intervention may offer little hope to a patient racked with shame. A community of peers who have overcome such shame offers much.
We can add endless more prefixes to our "biopsychosocial" model, but in the end, naming the patient's agency and responsibility might be exactly what they need to begin the road to recovery. At the end of their exchange, JB responds to Eliphaz, saying, "I'd rather suffer every unspeakable suffering God sends, knowing it was I that suffered, I that earned the need to suffer, I that acted, I that chose, than wash my hands with yours in that defiling innocence." May we never give our patients reason to say the same to us.
In stark contrast to this model of guiltlessness lies the 12 steps of Alcoholics Anonymous. The steps encourage an honest approach to addiction/substance abuse that neither minimizes nor overlooks one's role in its development. While working through personal faults and shortcomings in community and with their Higher Power, those practicing the steps are released of the bonds of shame. Through identifying character defects, they can honestly identify their own weaknesses and account for them.
Through considering these two resources, JB and the 12 steps, this paper helps healthcare providers understand how they can best interact with their patient's agency. This paper argues that providers must consider their patient's role in precipitating their current state of health. In certain circumstances and in certain diseases, this role will be minor; in others, it will be major. In an age where terms such as the "biopsychosocial" model have become popularized, it is important not to lose sight of the patient's agency. In other words, not to "overshoot" in the direction of identifying external causes and minimizing patient agency. If we do "overshoot", we may be robbing patients of valuable healing opportunities.
Hope for the marginalized features prominently in this paper if one is listening closely. An attuned healthcare provider can inject hope directly where it is most needed. If despair arises from organic or external causes, treatments or social support can be discussed. If despair arises from issues related to a patient's agency, 12 Step and similar programs can be discussed. A social intervention may offer little hope to a patient racked with shame. A community of peers who have overcome such shame offers much.
We can add endless more prefixes to our "biopsychosocial" model, but in the end, naming the patient's agency and responsibility might be exactly what they need to begin the road to recovery. At the end of their exchange, JB responds to Eliphaz, saying, "I'd rather suffer every unspeakable suffering God sends, knowing it was I that suffered, I that earned the need to suffer, I that acted, I that chose, than wash my hands with yours in that defiling innocence." May we never give our patients reason to say the same to us.