HEALING THE WORKPLACE CULTURE
Carolyn Hastie
Introduction
I am going to explore the issue of
healing the workplace culture from a position which encompasses three major
standpoints.
The first, is that birth is
fundamentally critical to the health and vibrancy of a culture and the way
birthing women and babies are treated say everything about a culture. That what
happens to mothers and babies during pregnancy and birth profoundly influences
their future.
The second is that midwifery is a
powerful and vital force. It is a sacred contract to share in a
transformational process of epic proportions.
Midwives are the guardians of normal birth. Midwives are uniquely situated
to ensure a safe and loving space for each new individual to enter this world.
The third is that this universe and
everything in it is governed by natural law.
Quantum physics, neuropsychoimmunology, perinatal psychology, and the
black hole theory have helped us to understand natural law and its
effects. These modalities have shown us
how our attitudes, whether conscious or unconscious, creates either a chaos or
a cosmos for each one of us.
What’s wrong with the workplace culture?
Your first question when you heard
or saw the title of my paper may be why does it need healing, what’s wrong with
it? You might even feel dismissive,
thinking there is nothing wrong with where you work. Or you may feel tired and disillusioned,
thinking you have heard it all before, done everything you can do and things
are only getting worse.
Whatever your reaction, let’s
explore the current situation and think about what is the reality and whether
healing is necessary or even desirable.
The current situation
Just look around this room and
notice the predominant age group. According to studies both in Australia and
overseas, the population of midwives is aging. The average age is about
47. Where are the young ones and why are
so many of those people who are beginning midwifery either not finishing or not
choosing to stay in the profession when they do complete their studies? Researchers on both sides of the world
(Hadikin & O’Driscoll 2000; Fenn 2000) have found that our midwifery
culture is a culture of criticism. It is said that midwives are fearful and
afraid to speak up (Robinson 1999; McCall 1996). According to these researchers, the
emotionally and psychologically abusive midwifery culture is causing difficulty
with retention and recruitment of new graduates.
Meg Taylor (Taylor 2000) suggests
midwifery is dying, caught up in the reality of medical dominance, the apparent
heroic excitement of surgery, in line with our society’s “fix it quick”
mentality, becoming the norm. Meg
comments that midwifery will become extinct because sitting with a woman is
invisible and therefore dispensable. Is the sick culture, the culture of
criticism, a symptom of decay? The
violence merely the result of the death throes of a species that is no longer
viable?
We have many excellent tomes written
about dominance and control, fear based iatrogenesis in childbirth (Murphy
Lawless 1998; Roberts, Tracey & Peat
2001), patriarchy and it’s effects on women’s issues (Martin 1987; Waring 1988;
Koutroulis 1990; Lather 1995 ), including the profession of midwifery (Kirkham
1996; Hunt & Symonds 1996; Katz Rothman 1991; Davis 1999). We have endless research and published
evidence of the appropriateness and viability of midwifery care for pregnant
women. We have a plethora of evidence
that women birth well and feel good about themselves when there is a strong,
autonomous midwifery profession (Wagner 1994; Kitzinger 1988; Burch 1994). And still, intervention rates are rising and
primary health care initiatives for maternity care provision are few and far
between. Why is that so?
We had Vicki Chan present to a
Central Coast audience a couple of weeks ago.
Vicki and her presentation “Birth matters” was so well received at a
recent childbirth educators conference, Vicki has been invited to speak all
around Australia and England. Vicki challenged us to ensure the woman was
central to our care; to ensure that love
was the elemental force that permeated our actions and our care. Vicki highlighted the importance for women to
feel safe and supported in their process and for midwives to trust and honour
the birthing woman. Vicki also
emphasized the necessity for midwives to have a fundamental trust in and
respect of the birthing process. The
audience was made up of people from the community and midwives. The response
was mixed. All the women I spoke to were
ecstatic. They felt powerful, reaffirmed
and capable. The midwives reactions were
polarized. Some felt ‘bashed’ and
defeated. Others felt affirmed and inspired.
Some were angry and defensive of the ‘status quo’ saying ‘she should
have researched her audience’.
Interesting.
Maintaining the Status Quo
Psychology (Mook 1987) tells us
that we humans have a negative reaction to the unfamiliar. Because we are creatures of habit and
convention, when something violates our perspective of the way things are,
which has an inherent assumption that the way things are is the way they ought
to be, then we have a disturbing reaction and seek to restore our feelings of
comfort. An example (Mook 1987:478) of
such a disturbing reaction was when Igor Stravinski’s ballet The Rite of Spring
was first performed in 1913, it caused an outrage. People demanded their money
back, complaining “This isn’t music”.
The music flouted so many accepted conventions that the discrepancy was
unacceptable. People no longer riot
about Stravinski’s music. Some like it,
some do not. The music hasn’t changed,
but people’s schemata has. We have heard
music like it before and so it becomes incorporated into what we know and no
longer causes such a violent reaction.
The Four Stages of Learning or Knowing
Dubin (1962) has a wonderful model
for explaining how we come to know things and how information or knowing,
becomes incorporated into who we are.
There are four stages of awareness or knowing in this model. The first
is Unconscious incompetence, we don’t know what we don’t know. The first time we are exposed to something,
it generally passes us by, unless, like Stravinski’s music in 1913, it so
totally contravenes accepted behaviour it causes outrage. Marketing experts know this well. Current marketing research indicates that
information has to be presented at least seven times to become accepted as a
fact by the subconscious which then of course, leads us to pick the item, often
unconsciously, when we are out shopping.
Once we become aware that there is something to know, then we are in the
Conscious incompetent stage. If
it is a skill or knowledge we seek to acquire, we recognize how little we
know. This stage is when we know we need
to know and we set about learning it – the phase of discovery. Then we repeat what it is that we are
learning, again and again. This is the stage of Conscious Competence -
we have to think each step of the way about what we are doing. It is painstaking and we make mistakes –
remember learning to palpate a pregnant woman?
Once the information or skill is integrated and is easily accomplished
or remembered, it becomes a habit, an integrated skill and then we are in the
stage of Unconscious competence. This is how we are able to do difficult tasks
with ease and do several difficult things at once. For example, palpate a
pregnant woman, explain a procedure and hold an interesting conversation,
whilst observing a woman’s physical condition and being alert to relationship
issues – all without losing track of what is happening. This is the way we move
from novice to expert and, because of the way the subconscious works, once an
expert, can apprehend situations in a flash - before we engage our conscious
minds to ‘think’ about the situation. This is called tacit knowing.
The four stage process of learning
is constant. As we learn and assimilate,
our conscious mind can move on to new things.
Learning is potentiated by emotion and times of high emotion is when
learning is fast and profound.
The Power of Emotion
Daniel Goleman (1996) adds
convincing evidence to the idea that emotion and thoughts intertwine and shape
our reactions to everyday life, dictating our perceptions of the world and
behaviour. In explaining brain architecture and the roles of emotion and
rationality, Daniel explains we are modern day social creatures whose
biological templates for emotional life are still grounded in the stone age
necessities for fight or flight when faced with perceived danger. According to
Daniel, emotion has a central role in what we perceive, experience and do. John
Heron (1981) identifies three basic human emotional needs; one, a need to be
loved and to love, to give and receive caring; the second, understanding – to
understand and be understood and three – choice needs, to be able to take part
in the decisions that affect our lives.
According to the perspective taken by Daniel Goleman and John Heron
(1990) our power and ability in human affairs is a direct result of our feeling
nature. Our deepest feelings, comments Goleman, are meant to guide us in how to
live our lives. John Heron (1990)
suggests that it is when our basic emotional needs are not met that we develop
dysfunctional patterns of behaviour.
The Amazing Brain
Our human brains are fascinating.
It has long been suggested that we are 10% conscious and 90% subconscious and
that we use only about 3-4% of our brain. According to current psychological
thinking (Kirton 2001) it is now believed that we are in fact, only 1%
conscious, the subconscious processes making up to 99% of who and what we are. The role and power of the subconscious is
truly astonishing. It is the seat of habit.
It controls our basic survival functions, like breathing, circulation,
digestion, reproduction, elimination and it orchestrates our healing and immune
systems. It is easy to see why these functions are not under the control of the
will, with it’s vagaries and inconsistencies.
It is the storehouse of memory and the wellspring of desire. It is the fount of creativity and the conduit
to the collective unconscious and inspiration. There are trillions of chemical
and electrical interactions going on in our bodies at any one time all
orchestrated by the enormous intelligence of the subconscious. A tiny example is that of our process to
recognize faces. According to current
knowledge, the part of the brain that codes faces, runs through 3 million faces
we have been exposed to with each face we see, seeking familiarity. Our whole brain works to make the unfamiliar
familiar. There is evidence that there
is mind in each cell of our bodies. Each
cell in our body has intelligence and is able to select and utilize substances
for its growth and maintenance.
The role of the Watchman at the Gate
Our brains have a function that
screens information coming in and coming up from our subconscious. Trillions of bits of information are
available at every moment. The discriminating function of our brains ensures
that what happens is noted and filed in our subconscious and it selects that
which we have identified as important to be allowed into our conscious
mind. This filtering system ensures that
troublesome hidden aspects of ourselves are kept subconscious. It also ensures that events, ideas, people
and things in the outside world do not gain admittance to our conscious mind if
they do not match our particular perspective of reality, or have already been
accepted as fact. An example of this
function is when we went to Beirut last year.
We were stunned by the sight of ravaged, bombed buildings everywhere.
When we commented to our companion ‘wow, look at all these bombed buildings”,
he said “Where?” The buildings and their destruction were part of his knowing
and had slipped from his conscious mind and he no longer saw them. We habituate
to the familiar and it no longer shocks us.
This is necessary for our conscious mind to move on to new things.
Becoming aware
Once we know how our brain works,
then we can understand how our view of the world may be limited. Then we can chose to become aware. Cultivating awareness means becoming an observer
of ourselves and our world. When we
become aware of ourselves and observe the inner dialogue, we can readily notice
any gap between how we see ourselves and our actions. Transpersonal psychology teaches us that how
we are on the inside dictates how we behave, how we relate to others and how
this translates into our experiences in our environment. Expanding our awareness enables us to
cultivate our capacity to observe how we operate in certain circumstances and what
sort of situations at home or at work can trigger us into responding or
reacting in certain ways. Expanding awareness gives us choice. We can choose how any situation or
experience is going to affect us.
Emotional Competence
The ability to chose how any
situation is going to effect us and how we are going to respond is what John
Heron (1991) describes as ‘emotional competence’. John Heron contends that there is a lack of
training and education in our western culture for effective management of the
troublesome and difficult feelings of anger, grief and fear. Instead, we are taught as children to deny
and suppress uncomfortable emotions, causing maladaptive displacement responses
and contaminated communication as adults.
The constant cycle of repression and denial throughout childhood and
life generally, creates a ‘prison of the mind’ – a system of defensive walls
and barriers (Mezner 1985). Stanislav
Grof (1996) a transpersonal psychiatrist, has found through his work, that the
origins of personal distress and the disposition to violence and self
destructive tendencies are rooted in perinatal dynamics and birth
circumstances. The hypothalamus (part of
the watchman at the gate brain function) has been found to be smaller in babies
who have been subject to perinatal trauma (Bremner 1999).
So what does that mean for midwifery and the
workplace culture?
John Heron (1990) has a broad
integrated model to explain problems associated with unconscious behaviour in
therapeutic and interpersonal interactions. John Heron’s model of social
relations contends the presence of a vast social pathology in our society. John says we all have an internalized version
of the wounded child. He argues that
coming to personhood, a place of personal autonomy – the full grown exercise of
discriminating choice is a hazardous business in western society. John Heron
(1990:21) has identified six states of personhood, ranging from those people
with little insight and little or no control, whose behaviour is ‘effectively
conformist to the culturally proscribed norms’, to the ‘self-transfiguring
person’ who ‘freely chooses to unfold
the inner spiritual self”. John Heron
(1990:154) describes how unresolved personal distress adversely interferes with
professional relationships. Displacement responses such as “projections,
distortions and degenerative and perverted interventions” can be mixed up with
legitimate interventions and practitioners ‘can’t tell the difference”.
John Heron (1990) argues that the professional
role is often used defensively and oppressively, claiming an excessive degree
of expertise. Barbara Duden (1993), a German historian would agree. Duden
describes how childbearing women have been put under obstetric surveillance,
their inner knowing dismissed and denied by health care professionals so women
only ‘feel’ pregnant when they can ‘see’ it, the pregnancy’s reality diagnosed
and confirmed by experts. By the use of
ultrasounds, measuring tapes and monitors, the experts have symbolically taken
the fetus out of the body of woman, constructing the fetus as a ‘life’,
separate from that of the mother. Duden
(1993) contends the fetus is now constructed as an endangered species, the
woman as an inherently dangerous and faulty ecosystem and the woman has been
disabled for natural birth. The urge for
control and the assumption of the role of expert in rendering childbearing
women incompetent in modern medical discourse and practice is used to distance
the professional from uncomfortable feelings. Joan Rafael-Leff (1991:223)
discussing psychological dangers for staff assisting birthing women, highlights
the deeply arousing nature of the ‘naked emotionality and urgency’ of birth.
Joan Rafael-Leff (1991) claims institutions and practitioners have developed
strategies to minimize staff anxieties in maternity care where primitive
emotions are invoked for staff.
Strategies used to minimize staff anxieties include task orientation,
rather than individualized care, rotation of staff, which stops staff forming
attachments with each other, fragmentation of care, thus minimizing contact
between midwives and women and promoting ‘professional’ detachment as
desirable. Other strategies include the promotion of myths such as all women
are similar and can be treated the same, and all health professionals are
uniform and interchangeable. The use of technological aids to replace direct
contact for example, the application of the fetal monitor to labouring women’s
bodies instead of palpation of contractions and auscultating the fetal heart,
are used to dissipate subconscious anxiety for the midwives. Unconscious tactics, such as splitting,
projection, denial, blame and avoidance of change, coupled with a system of
checks and rechecks, upwards delegation, active discouragement of staff taking
any personal initiative and using their own discretion in clinical decision
making, have been constructed to redistribute conflict and help individual
professionals avoid experiencing anxiety, guilt, doubt and uncertainty (Heron 1981:1990;
Raphael-Leff 1991:225-6). Problems
generated by the use of these conscious and unconscious strategies to repress
and deny feelings include impersonal and standardized care and the often
violent resistance to any attempts to change the status quo. The defense
mechanisms of denial and repression alleviate any sense of responsibility and
limits effectiveness of care. Joan
Rafael-Leff (1991) cautions that caring, satisfaction and gratitude are
lessened where people are treated and behave in depersonalized ways.
In the self-aggrandizing search for money,
position and power of corporate life in modern institutions and corporations,
where market forces are given precendence over human concerns, the human spirit
or love “our essential true nature” has been denied and repressed (Marie L.
Kerpan 1993:77). Barbara Shipka (1993:91) recognized the similarity in the
expressions of feelings of fear, anxiety, a sense of isolation, apathy and
despair within refugee camps and modern day organisations. Shipka labels this
phenomenon ‘spiritual poverty’. An
example of the effect of spiritual poverty is that described by Jean Robinson
(1999:459) when she commented on toxicity in the midwifery workplace
environment and claims midwives are too busy ‘watching their backs to
concentrate on the job they love’.
Hostility and back biting are rampant in midwifery units, warns Jean
Robinson, citing the presence of an ‘organisational emotional virus’ within
health care institutions, leaching away morals and ethics, turning ‘enthusiasm
into cynicism, compliments into complaints and care into malice’. Within midwifery culture, group behaviour is
restricted by the oppressive norms, values and beliefs that flow into and
permeate it from the surrounding hegemonic culture (Clare 1993:Roberts 1994:
Heron 1990;Barker 1999). Group behaviour
is further distorted by various anxieties of participants and influences from
past and present distress flooding the group dynamic, throwing it into a rigid,
defensive form (Barker 1999:153). Games
of one-upmanship and sabotage flourish in these toxic environments, wherein
midwives can play the roles of persecutor, rescuer or victim, finding others
who subconsciously or intuitively sense others who play complementary roles
(Whitehouse 1991:46).
Somewhere and somehow, midwifery
has been derailed by the mechanistic and reductionist view of human
beingness. We have learned to embrace
and value problem based care rather than sitting with women and supporting their
inherently normal and transformational process. We have moved, or allowed ourselves to be
moved, from recognizing, honouring and working with the emotional, spiritual
and psychological aspects of the childbearing experience – helping women to
find their inner wisdom and strength, thus safeguarding the physical expression
of the process and ensuring women enter parenthood well equipped and
strengthened to ably cope with the demands of parenting. Instead, we have been seduced into the fear
based tactics of imposing physically based interventions onto the primal,
beautiful, fluid, holy expression of human reproduction. We have been tricked, fueled by fear and
bound by protocols into being the handmaidens of torture. We have been trapped and imprisoned by our
own adoption of a position of powerlessness and helplessness.
As Eleanor Roosevelt said ”Nobody can make you feel inferior without
your permission.”
So what
do we do?
We are the people who can help
women birth their babies well and easily. You may think it is a coincidence
that you are a midwife. It is not. As I mentioned before, we have a sacred
contract to ensure our society’s babies are born into a loving environment. We
are the people who can ensure a safe and sane society by helping women avoid
trauma and drama. We know from the
research that when women’s emotional needs are met, physical problems melt
away. The experience of pregnancy, birth and the immediate postnatal period has
a deep and profound effect on a person’s psyche (Verny 1981; deMause 1995) and
is critical to a person’s worldview, self-perception and experience in and of
life. It forms the basis of the way that
character is developed.
It is essential that we adopt two
strategies immediately. The first is to
truly value and love what we do, whom we do it with and how we do it. To move into a place of deep respect for
ourselves, our colleagues, the women who trust us and midwifery itself. The second is to become more aware of
ourselves, what drives us and how we interact with our environment.
Robert Metzner (1985:45) suggests for
integration and wholeness to take place, we need to ask ourselves what is it we
most want to hide, what thoughts or impulse do we have that we least want
someone to know about? Robert Metzner (1985:45) encourages us to face our
shadow, to accept the possibility that we might be like whatever it is we don’t
like in another. Robert Metzner
(1985:45) acknowledges it takes courage and humility to face our shadow and own
our ‘evil’ aspect. John Heron (1989:37) advocates that practitioners
must engage in personal growth work or counseling to facilitate healing of
unresolved personal distress to avoid the pitfalls inherent in unconsciously
driven defensive behaviours. Heron’s idea of what makes an
effective helper is ‘an interaction between inner grace, character and cultural
influence’(1990:12). Helping, says Heron
(1990:11) manifests ‘according to the norms, values and belief systems of the
prevailing culture’ and when effective is ‘the wise flow of love from person to
person’, the combination of ‘concern, empathy, prescience, facilitation and
genuineness’ and maintains that helping is the ‘spiritual heritage’ of human
beings. As Kahlil Gibran, the Lebanese
poet and artist wrote ‘work is love made visible’ and nowhere is this more
obvious than being ‘with woman’.
In conclusion
To heal the workplace culture we must heal ourselves. We must have a vision of how we want to be
and then do what we need to do to.
Having a clear vision enables us to create the culture we want. We then
can manage stress easily (Crews 2001) and move towards what we want with grace
and poise. There are clear pathways to
ensure this happens. I’m going to
highlight a few points from my discussion paper on horizontal violence. The paper is in your conference satchel. It will give you clear and concise practical
strategies to heal both ourselves and our workplaces.
- Each of us
must take responsibility for our experiences and our behaviours.
- Each of us
must decide to be the best person we can be.
- It is essential that management provide
an example by ensuring safe working conditions. Management must set a good example by
valuing midwifery, providing good role models, ensure safe and effective
pathways for people to address issues of horizontal violence.
- In-services
must address the issues and create the environment where proper conduct
and behaviours can be discussed.
The destructive behaviours that are the result of our hurt
childhoods and socialization must not be allowed to manifest nor flourish
in the workplace.
- We must
find ways of building bridges with our medical colleagues so that all of
us can work together in partnership with women for the best possible
experience for them and their babies.
Our future as a safe and sane society depends upon it.
“Open up our
hearts to see” (with slides) written and sung by Penny Lang
For all of us who’ve lost our
vision
Open up our hearts to see
For all of us who’ve lost direction
Open up our hearts to see
For all of us who numb our feelings
Open up our hearts to see
For all of us who kill the spirit
Open up our hearts to see
For all of us who fear delivery
Open up our hearts to see
For all of us who sell our souls
Open up our hearts to see
For all of us who can’t stand
proudly
Open up our hearts to see
For all of us who hate our
neighbours
Open up our hearts to see
For all of us who’ve lost our
goodness
Open up our hearts to see
For all of us with no compassion
Open up our hearts to see
For all of us who need recovery
Open up our hearts to see
Open up our hearts to see
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