All Compassion is Local

I recently dipped a toe into the murky waters of politics. It's not my gift.

Sacramento County wants to eliminate funding to the backbone of its mental health safety net, the system of regional support teams (RSTs) that provide psychiatric services to about 8,800 of my friends and neighbors who, due to their illness and a badly broken health care system, cannot obtain psychiatric care in the free market. (I have an idea that I think might help. If you're interested, the pitch is at, but that isn't the issue.) Before I rushed in to the middle of it, I could not understand why. Nobody, and I mean nobody involved thinks this move will save any money. Everybody knows it will cause a lot of suffering. Imagine the overburdened emergency rooms (an inefficient and inhumane place to deliver psychiatric care), the jails, the homeless camps and shelters, the drug dealers' flops and alleys, the county’s morgue -- these are the places where you will soon find the people whom the RSTs now treat, people who are currently contributing members of our community.

How can such a thing come about? The more I find myself immersed in this mess, the more I see it as a failure inherent in institutions of any size. Visionary writer Robert A. Heinlein quipped "The first duty of any bureaucracy is to survive; the second is to grow." That's at the heart of the problem, but let me back up a bit.

Here is what my job is like, apart from tilting at windmills: I show up early at one of the nonprofits where I work. I say "hi" to various staff members, many of whom will have questions, paperwork, problems I need to address, phone messages, and the like. I get my charts and review my patient appointments for the day. I go to my mailbox and get another load of forms to fill out. It's always overwhelming. I tackle what I can, I put off some for later in the day, and the rest go onto my Good Intentions Pile. It's hectic, it's chaotic, and it often seems pointless. Then it's time for my first appointment. I fetch the patient from the waiting room, close the door, sit down, and the magic happens. We sit face-to-face, we talk about problems, and we address them. More often than not, the patient leaves with more hope, feeling better. Often, with continued treatment, the quality of the patient's life will continue to improve. Like the hokey pokey, that one-on-one time is what it's all about.

It is easy to undervalue that time. A couple of years ago, as the system began its slow collapse, I began to question what I was doing. What good could it possibly be to treat one patient at a time, if the whole framework was falling apart? Wasn't it selfish to be having this individual, focused time with a patient when I could be using my time to tackle the bigger problems, influence policy, make a difference for many instead of a few?

I was caught in the Tyrant's Fallacy. I was beginning to believe that it was necessary to sacrifice the individual for the greater good. Just how much evil is done in the name of the greater good?

An institution seems as though it can do so much more than an individual, so we build institutions. Institutions need leaders, so we put people in charge. The effective leaders invest themselves in the institutions until, ultimately, the institutions become extensions of their own egos. Those egos want to survive. And grow. Do tyrants wake up each morning and think "hmm, what opportunities will I find to do evil today?" No. They come to believe that their country, their government, their church, their agency, their political movement, their homeowners' association, their garden club, their family -- their ego -- is more important than their members. That to survive, and to grow, serves a greater good even when individuals suffer.

Nobody denies the horror and pain of war. But when a country ('s leader-ego) is threatened, war becomes "necessary." Millions can suffer and die, all for the greater good. And so it goes for each institution, each subunit. A bureaucracy grows, because it can, and thereby inconveniences the people it was created to serve. The leader of a corporation -- that once saw taking care of employees as a primary mission -- lays off thousands to improve the Wall Street bottom line. A hospital created to heal and cure turns away patients because "if we treat people who cannot pay, we'll go out of business."

A unit of county government created to steward taxpayers' money and provide for the care of the mentally ill abandons both the patient and the taxpayer in the name of survival.

I am not against collective effort. We can, indeed, accomplish more working together. But institutionalized power breeds institutionalized corruption, and only extreme diligence (and possibly the occasional Great Flood or Great Depression) can root it out.

Go out and do something meaningful for some one, not some idea or some thing. Look at the institutions you run (we all have a few, large or small) and ask yourself: "are we serving our mission, or are we in survival mode, just serving ourselves." Be ready to let go. The greater good is sitting in the chair across from you.

-- RonRisley - 09 Mar 2009

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Topic revision: r2 - 2009-03-09 - RonRisley
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