Column

We can go beyond individualism in the NHS

Margaret Thatcher spoke the truth when she said ‘There is no such thing as society’. If you look at the world and see billions of individuals, separated by skin and space, thinking private thoughts, each striving to survive against all the others, then there is no society because for you community is a fiction. The individualist’s world is separate objects, nothing more. Persons, houses, years, jobs, meetings, rivers, atoms — each one sealed off from everything else.

But there are other truths. See the world through them and it is a different place. Squeeze up your hand. You will see a fist. Open your hand. The fist disappears. Where has it gone? How can solid objects vanish like that? Now think of your hand as a process not a thing and there is no problem.

The Western mind invents symbols to identify the separate things we think we see. Like snapshots, these symbols are very much less than what we experience. As we label nations ‘proud’, people ‘arrogant’, fists ‘weapons’, these objects appear to become increasingly solid — yet they are no more than abstractions from an endless stream of experiences.

What happens to the father when his daughter leaves home? What happens to the manager when he loses his job? What happens to the boy when he becomes a man? Does an object disappear or do events move on?

In Buddhist thought the world is a dance of processes. Reality is everything experienced now, by a viewer who is as much a part of the process as everything else. He cannot look in from the outside because there is no outside. Think of the world like this and the individualist attitude is inconceivable.

If Westerners can take Thatcher’s doctrine seriously why can we not at least entertain the Eastern thought that ‘There are no such things as individuals’? Though we are certain we are the centre of our individual universes, we could be deluded.

We habitually think ‘I breath’. But think ‘It breathes me’ and everything changes. Believe the physical world around you — not you — is in control of your breathing. Isn’t it? Wasn’t it until you caught yourself breathing just now?

We each think ‘I live’. But think ‘It gives me life’. Believe that the people around you — not you — make you what you are. You cannot be a worker unless there are jobs, you cannot be a father unless there are families, you cannot escape from the rat-race unless there are rats, you cannot be a success unless it is possible to lose, you cannot rebel unless there is conformity. ‘I’ can exist only because there is a social world.

Despite its socialist origins, the National Health Service is an individualist organisation. Its professionals seek to advance their careers, personal confidentiality is cherished, contracts are made between individual doctors and patients, and ethicists herald individual rights.

The NHS fails to be a community because Westerners think communities are made up of separate individuals. We hope the wholes we admire are greater than the sum of their parts. But this idea always evaporates under pressure, then it is every man for himself once more.

The only way to overcome individualism is to make the ultimate commitment — to forget ourselves. This is enormously difficult, but not impossible. Perhaps the NHS is one of the best places to start. Everyone involved — whatever their status — needs to think not ‘what can I get out of this?’ but ‘how can I become immersed in this?’. ‘How can I lose myself in this tremendous process?’