When I began my training to become a psychiatrist in 1981, my view of the world and the people in it underwent a radical transformation. I became aware of how power is exercised within relationships. When one person is an employee and the other a boss, it’s generally pretty clear. It’s also straightforward for children and parents when the children are young.
In other relationships, a deeper look is called for. In marriages, who controls the purse-strings? Who decides when intimacy takes place?
I learned, for example, that in marriages where one partner has an addiction to alcohol, the other often sees it as their mission to cure the first of the addiction. Interestingly, if such a cure takes place, the marriage often breaks up, because the “helping” partner no longer has their role to play. To prevent this, the helping partner is often an enabler of the addictive behaviour.
Chronic illness or disability can change the power dynamic, for example when a parent develops dementia, a child may move into a controlling, parental role towards that parent.
What about professional relationships? Clearly, a nurse, physician, teacher, coach, or band director exercises control over their patient, student, athlete in training, or budding musician. The power dynamic is based on a one-up, one-down relationship. And unfortunately, this power imbalance is sometimes exploited, whether through bullying, harassment, or manipulation. Think of the coaches or priests who first “groom” and then sexually exploit their charges. The young victims are often unaware that this behaviour is wrong, or may have been threatened into complying, or are unable to get others in authority, for example their parents, to take their concerns seriously.
What motivates a human being to choose one of these helping professions, to want to help others but based on this type of power imbalance? Why not simply become a business person, make money, and enjoy life?
I learned that a frequent concomitant of a person’s later choice of a “helping” profession is an early life experience of feeling helpless, of feeling powerless. For example, one parent becomes very ill and dies; parents get divorced; one parent is violent with the other; the child is sexually, physically, or psychologically abused or traumatised. When these events take place in very early childhood, say before age 2 or 3, the child will not have any conscious awareness of the trauma. But in later life, they may attempt to escape the feeling of powerlessness by choosing friends, activities, relationships, and careers where they are in a one-up position.
Often this is quite benign. After all, how would food banks or homeless shelters or some fire departments operate if it were not for a ready supply of willing volunteers? And sometimes the person is aware of their need to be in control and because of this insight exercises self-monitoring to prevent the power imbalance from shading into abuse or exploitation. Or there may be external checks and balances: screening of volunteers; physicians, nurses, physiotherapists, social workers and so on with professional orders whose job it is to protect the public; school inspectors…
But who screens the screeners? In spite of safeguards, bad things happen and often to the most vulnerable.
- Managing acute manic episodes
- Mistletoe and cancer: does microRNA play a role?