A Fortifying Philosophy
Your fortifying philosophy will guide you, like a sherpa, to the right decisions and most effective actions.
Building and sustaining a career of service is hard work. It's also one of the single most rewarding decisions a person can make. In my own case, working with people marginalized by HIV, homelessness, or both has taught me as much about myself as it has about my patients. There have been many days that ended in exhaustion. Many days that ended in frustration. A lot of days questioning the values undergirding our social structures. This is hard work.
One key to success is this work is taking the time and energy to make yourself vulnerable to the pain and suffering of those you are seeking to help. In my own case, there have been many times when I have experienced deeply wounded, strongly self-isolating people open up and share their stories with me once they sensed that I saw them as more than a problem to be solved, more than just another 15-minute appointment to be checked off my list for the day. In short, I've learned that my best shot at making a transformative difference in the lives of my marginalized patients happens when I am willing to recognize their pain and make myself open to it. That is also hard work. I've learned by doing the work that I need a fortifying philosophy to ground and guide me as I move through my daily life.
What does that mean, a "fortifying philosophy"? And, why is this so important? A fortifying philosophy is simply the set of beliefs that support the drive to do this work and guide one's decision-making processes along the way. In my own case, the fortifying philosophy is Liberation Theology, which is a Catholic Social Teaching that arose in Central America in the 1960's and 1970's in response to the horrific living conditions imposed on indigenous peoples by their own far-removed governments. Liberation Theology teaches us that while God loves us all, she has a special place in her heart for the poor, marginalized, and oppressed. I first encountered this teaching in college when Liberation Theology was still considered new thought. It resonated very deeply with me, and has become baked in to my approach to identifying and addressing the pain of marginalized people. And, if you're reading this, it's a safe bet that you know of Paul Farmer, MD and his organization, Partners in Health. Dr. Farmer was also strongly influenced by Liberation Theology, and one of his last books, "In The Company of the Poor", is a beautiful series of essays between himself and Fr. Gustavo Gutierrez, the man who conceived of Liberation Theology. Strongly recommended reading.
So, a fortifying philosophy can be any set of beliefs that gives you the strength to get up day after day and work to help others in a system that is set up to deny their very existence. When the work is phrased this way, I hope that you can see how difficult it would be to sustain oneself if one's goal were a salary increase or more impressive title. By definition, social justice is about collective well-being, not individual attainment. This is work sustained by internal drive versus external achievements. I'm not advocating for any particular philosophy, but am advocating for a philosophy to help keep you going on those really hard days. You need an anchor, and that anchor has to live inside you or you will lose your grounding and drift away.
Once you have identified the philosophy that fortifies you, the next step is to surrender your ego to that philosophy. Let go. Let your fortifying philosophy guide your actions. In a way, having this framework makes everything easier. In my own case, my belief in the principles of Liberation Theology tells me that every human has agency and dignity. How do I turn that into action? Empowerment. I try to give marginalized people agency and dignity by empowering them to make their own decisions about their lives. I do this by surrendering my ego, recognizing that the clinical exam room is a scared space and that my goal is to empower my patient, not impress them with my knowledge of their diseases or the medications I will prescribe to help heal them. It's not about me. People who come to me for care correctly assume that I know what I'm doing, but they don't come to watch me demonstrate that. People come to see me, and then come back to see me, because I see them. I take the time to listen, to honor their constraints, and to ensure that they understand, in ways that make sense to them, why they are ill and what they can do to improve their situation. Blindly reciting dietary guidelines to a person who has no teeth and is sleeping under a bridge does not honor them. Explaining a disease or a surgical procedure using medical terminology to a person who was denied an education during their childhood does not recognize their agency. You empower people by recognizing how poorly middle-class driven health guidelines may fit the circumstances of someone else's life and by communicating with that person at a level that they understand. That's the only way to give that person the power to make decisions. Agency fuels dignity, which in turn fuels empowerment. It's a perpetual motion machine, but it has to be set up correctly, started, and fueled and serviced in order to be most efficient.
