The U.S. Healthcare System is Trauma-Organized
Together We Heal: Part I
The U.S. healthcare system is unwell
The United States is one of the richest nations on Earth and spends more on health care than any other country. We live in an era of atmospheric medical innovation and technological advancement. Healthcare workers feel called to the field by deeply altruistic motivations—compassion— and they go through more training than almost any other profession to do their jobs.
Yet it seems patients, healthcare workers, and healthcare organizations are more unwell than ever — no matter how advanced our technologies become, how good our practitioners get at administering them, or how much money we spend on healthcare.
We don’t have a healthcare system. At best, the U.S. has a rescue system for sick people.
Americans are unwell
Life expectancy in the U.S. has decreased — in part, due to the pandemic, but it continues to decline while comparable countries have rebounded. Compared to peer nations, we have the highest chronic disease burden and the highest number of hospitalizations from preventable causes. Maternal mortality continues to rise — pregnant people in the U.S. are less likely to survive childbirth than those in Kazakhstan and Kuwait. And across nearly every measure, these outcomes are disproportionately worse in BIPOC populations.
U.S. health workers are unwell
Mental illness and suicide were already disproportionately high among healthcare workers before the pandemic. Add collective trauma and burnout from COVID-19, and it has reached alarming rates. In 2022, the U.S. Surgeon General even issued a General Advisory highlighting the urgent need to address the health worker burnout crisis.
But health workers are not simply burned out from overwork. They are demoralized by a health system to which they have sacrificed so much but that no longer allows them the autonomy to act in the best interest of their patients. The cumulative effects are driving healthcare workers to leave the profession in droves.
Health organizations are unwell
Healthcare worker strikes are popping up across the country like a Whack-A-Mole game. Doctors are beginning to unionize, amidst understaffing, patient safety concerns, and a loss of autonomy as private equity firms eat up large swaths of medical care.
Financial distress is widespread across the industry, evident in hospital bankruptcies, rampant staff layoffs, and facility closures. This is driving a mergers and acquisition spree across the country, which is beginning to define a new era of the American mega-hospital system.
And between resignations, layoffs, an aging workforce, and the health needs of an aging population, the U.S. is facing staggering staff shortages — more than 1 million doctors and 3.2 million other health workers in the coming years.
The reasons behind our current reality are numerous and complex. A lack of universal healthcare. A corporatized system driven by profits. Underlying social and economic inequities rooted in systemic racism and discrimination. But perhaps there are other reasons.
Perhaps what we have failed to recognize is that the U.S. healthcare system is trauma-organized. We can’t create wellness from an unwell container.
U.S. healthcare is trauma-organized
A traumatic origin story
Our healing container — the American healthcare system — is built on trauma and continues to produce trauma.
The very origin of scientific medicine is a story of misogyny, class warfare, and torture, as detailed in Witches, Midwives & Nurses: A History of Women Healers. In medieval Europe, lay healers were mostly women, and they ministered to the suffering of their peasant neighbors through midwifery, herbalism, and a range of other healing modalities.
In the late 16th century, the College of Physicians in London (an exclusively male institution) claimed the right to regulate medical practice. Together with the Catholic Church, they prohibited all but university-trained doctors from practicing — and barred women entry to those universities. They subsequently labeled those female lay healers “witches” as part of the broader European Inquisition, and executed thousands through torture, hangings, and burning at the stake.
Furthermore, the medical discipline is built on White supremacy, and a legacy of medical racism continues to shape U.S. healthcare today. From the Tuskegee syphilis study to gynecological experimentation on enslaved Black women, medical research and procedures have been advanced through the exploitation of Black bodies (see Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present).
And BIPOC communities have endured injustices in the name of health“care” for centuries — for example, the forced sterilization of Native American women by the Indian Health Service as recently as the 1970s. Even today, Black Americans are systematically under-treated for pain relative to white Americans based on the persistent belief among physicians that Blacks are more pain tolerant.
Traumatic social conditioning
Beginning early in their schooling, healthcare workers experience traumatic social conditioning.
The well-known trauma and addiction expert, Dr. Gabor Mate, described the traumatizing conditions of clinical training in a recent conference. He said, “How do you create a cult? You give them a special jargon and a uniform. You sleep deprive them. You separate them from their families. And you put them under authoritarian leaders. So basically, you send them to med school.”
Medical school also teaches doctors to emotionally distance themselves from patients, based on the disproven idea that emotional connection causes compassion fatigue, which leads to burnout.
Not only are health workers forced to dissociate emotionally. They often deny their physical needs (food, bathroom breaks, rest) to attend to their patients. A lack of staff redundancy makes it near impossible to take badly needed vacation, and being sick just forces more work onto others on the ward. Chronic understaffing and resulting patient ratios force them into impossible choices, like choosing between responding to a coding patient or allowing another to sit in their own excrement, which generates moral injury.
And we *glorify* all this. We admire and exalt the most self-sacrificing workaholics who never show weakness. We have created a “hero’s culture” where it is unacceptable to ever doff the superhero cape, admit we are struggling, or ask for help.
A traumatic environment
Healthcare has emerged as one of the nation’s most violent professions. Statistically, American healthcare workers suffer more nonfatal workplace injuries than any other profession — including law enforcement. Hospital shootings, physical and verbal assaults at health centers, and healthcare worker harassment have been on the rise for at least a decade. Yet healthcare administrators have done little to address it, and there are few consequences for patient mistreatment of health workers.
Unrealistic expectations. Controlling behavior. Victim blaming. If you Google “traits of an abuser,” the U.S. healthcare system ticks many of them. Nothing demonstrates this in quite so gut-wrenching detail as nurse Tristin Kate Smith’s suicide letter, entitled “Letter to My Abuser,” which she penned to the healthcare system. She was 28 years old.
The U.S. healthcare system is a trauma patient
We know that a system is trauma-organized when the methods it uses to reach its goals become a barrier to those goals — compounding and multiplying harm in its attempts to help and to heal.
To again reference Dr. Gabor Mate, he explains how undiagnosed or unaddressed trauma in individuals is linked to the rise of inflammatory and autoimmune disease, malignancies, addiction, and mental illness.
If we think of the U.S. healthcare system as a living, breathing being, we can begin to see its current behaviors and characteristics as trauma responses.
Fight response and inflammation are evident in the health worker strikes and unionization efforts. Flight response is seen in the mass exodus from the healthcare profession. Freeze response is witnessed in the complete demoralization among health workers, or in patient reticence to avail themselves of care. Malignancies can be detected in decision-making that prioritizes profits over patient outcomes and health worker well-being.
It is said that “hurt people hurt people.” With healthcare professionals so unwell, it should be no surprise that health outcomes among Americans are worsening.
I believe the reverse of this adage is also true: “Healed people heal people.” How might we transform the container so the healers within it are flourishing?
More on that in the next installment of my Together We Heal series. I invite your reflections in the meantime.