Western medicine often relies on empiricism and a narrow understanding of evidence-based practices. However, an inclusive approach to wellness acknowledges alternative epistemologies. Traditional healing practices from a range of  cultures not only have much to offer, but they are also required by a diverse workforce and communities that we look after. Integrating these perspectives into healthcare systems allows for a more comprehensive understanding of well-being. It cultivates a sense of belonging by allowing all parts of our ‘being’ to this intense and emotionally laborious work of healthcare. What is wellbeing, selfcare and its less desirable cousin resilience? They refer largely to the individual’s ability to strive towards a better, stronger and more adaptable self to produce the optimal labour of caring for patients in the NHS. It not only individualises wellbeing, but it also commodifies it into buyable chunks of spa packages, candles and flowers whilst denying the deeper roots of social inequality that is orchestrated by this very alienating capitalism and further benefits the wellness industrial complex. This ableist lens demands us to show up to work in the same way every day. How can healing adhere to one prescription?

This blog contextualises the contribution of organisational factors instrumental in wellbeing of individuals. It goes a step further in addressing the discrepancies of power within hierarchical structures focussing on intersectionality and social and epistemic injustice that, if ignored, can often reproduce oppressive dynamics to the detriment of the health of staff and ultimately patients. In doing so the blog challenges the responsibility of caring solely upon individuals, disconnecting them from their colleagues and employers, communities, society and nature. The blog concludes with emphasis on the importance of healing justice, collective care and incorporating our ancestral healing rituals and wisdom.

Being, Identity and Intersectionality

In our pursuit of well-being, it’s crucial to begin with a fundamental question: What does it mean to be? Our sense of self, our identity, both in personal and socio-political contexts, lays the foundation for our well-being.

Identity is not a monolith. Audre Lorde, the acclaimed African American writer, scholar and activist said, “There is no such thing as a single-issue struggle because we don’t live single issue lives. I am not free while any woman is unfree, even if her shackles are very different from my own.” (Lorde, 2007). She challenges us to recognise that well-being is intimately connected to our understanding of our own identities. Moreover, she explains intersectionality before Kimberle Crenshaw coined the term in 1989. (Crenshaw, 1989) It remains essential to define Intersectionality as a framework based on Black women and discrimination based on the intersection between their race and gender.

In 2015, I attended an EDI meeting within an NHS trust where the word was so poorly understood that the directors thought it better to omit it from the EDI strategy. With the Black lives matter revival after the murder of George Floyd, intersectionality became a buzz word. As leaders it is pertinent that we understand and uphold the definition and implication of intersectionality centring the discrimination individuals and groups face on account of the different protected characteristics they possess and how these interact to produce harm. For instance, during the COVID-19 pandemic, the impact of systemic racism on the health of racialised employees became painfully evident. (Rimmer, 2020) This intersected with hierarchical status in the NHS, such that the lower the banding,  the more the chances of harm by deployment to COVID wards without adequate PPE.

Racism’s Impact on Health

Systemic racism, deeply ingrained in societal structures, affects the well-being of individuals and communities. The pandemic exposed racial disparities in healthcare outcomes, as Black and brown people disproportionately suffered from the virus. The experiences of racism, both overt and subtle microaggressions, contribute to chronic stress, which has well-documented negative effects on physical and mental health. (David R Williams, 2022). I feel leaders within the National Health Service (NHS) must confront these realities head-on. Acknowledging the intersectionality of identities and the systemic racism that permeates our institutions is the first kind and compassionate step towards creating a healthier environment for all employees no matter the background, to begin their wellbeing journey from an equitable position. I conclude below with wellness, healing justice and working towards a healing collective.

Wellness and  Healing Justice

“Caring for myself is not self-indulgence. It is self-preservation, and that is an act of political warfare,” Lorde wrote in A Burst of Light” and Other Essays.

True wellness extends far beyond the traditional biomedical and neoliberal Western view. It encompasses a holistic understanding of health that considers healing justice, alternative epistemologies and liberatory practices. Although the NHS is often viewed as a socialist organisation, much neo-liberal ideas layer its original foundation. Some of the shrapnel that come out of this are, the fear of scarcity  leading  to envy and competition. “I will be the best leader with the best publications doing wellness better than anyone else”. This jeopardises the deeper place that leadership arises from. The place where roles like being a carer, parent and a patient all require remarkable leadership. This links intrinsically to abolitionist thinking of reimagining power, leadership and who is seen and heard so that wellbeing is not placed as a prize but as our prerogative. Wellness is both a matter of individual “healing” and putting balm on the wounds that are derived from the way in which our world sets up power and its discrepancies (Injustice). Healing justice is both a term and movement, first coined by the Atlanta-based Kindred Southern Healing Justice Collective in 2007, that aims to address widespread generational trauma from systemic violence and oppression by reviving ancestral healing practices and building new, more inclusive ones within communities of interdependence. It is an evolving pedagogy where healing strategies emerge from and are rooted within communities intergenerationally. (Page, 2023)

Having suffered burn out and moral injury (Williamson & Greenberg, 2021) during the covid syndemic, I was alienated from colleagues having resisted certain practices in the workplace. A bubble bath didn’t help, there was a strong urge to survive and tell my story. My wellbeing depended upon finding communities that would listen and speak out in resistance alongside me refusing to let trauma strip me of my agency and voice. Communities such as healing justice London supported me to see the generative value in what was labelled as depression and treated with high dose antidepressants. This gave my mind some respite through somnolence but documenting my experiences daily kept the learning alive. There had been many occasions when I had advised my patients against going back to work too early or not at all because their work dynamics were a large trigger for relapse. However, it was difficult for me to take my own advice as my internalised critic saw it as a failure. Having worn the identity of a psychiatrist for 23 years, it felt like peeling a layer of skin. At Healing justice London, two groups, one comprising of experts by experience and the other, health practitioners met fortnightly for 6 months. We told our stories, linked it to the larger political constraints, held each other safely, tenderly yet with accountability. We practised somatic learning like orienting and grounding, creative expression, music, reading the work of scholars and activists and more novel ways of healing that felt nourishing and replenishing. These were not tinged with the demand of returning to work when our allocated sessions were used up. This was about filling up our parched dry thirsty cups to pour to others without a looming time limit. This became particularly poignant in the stories of other healthcare givers who were operating on empty for many years.

Working towards a collective healing concept

Collective healing is a powerful concept that underscores the importance of community and solidarity in the pursuit of well-being. Leaders within the NHS should foster environments that encourage collective healing. This means promoting support networks, addressing trauma collectively, and creating spaces where employees can authentically connect and heal together. During the pandemic this was seen as a potential threat to the already fear riddled institutions. Staff networks like BAME were convened with a close surveillance to nip any resistance or organised protests in the bud. Currently, I believe that strikes are a form of healing justice within which individuals find collective energy and voice within community. In conclusion, well-being is not a standalone concept but a deeply interconnected web of identity, social justice, healing justice, and collective healing. Without a profound understanding of “being,” our sense of self and the impact of societal structures on our identities, we cannot fully grasp the essence of “wellness.” NHS leadership should be at the forefront of this paradigm shift, creating healthcare environments that promote true well-being for all. In doing so, we not only heal individuals but society as a whole and envision leadership in a revolutionary light.

References

• Crenshaw, K., 1989. Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of AntidiscriminationDoctrine, Feminist Theory and Antiracist Politics. The University of Chicago Legal Forum, 1989(1), pp. 139-167.
• David R Williams, p. e. a., 2022. Race, racism, and health: global learning for national action. BMJ, 376(0477).
• Lorde, A., 2007. Sister Outsider. Berkely: The crossing press Feminist series.
• Page, C. e., 2023. Healing Justice Lineages: Dreaming at the Crossroads of Liberation, Collective Care, and Safety. s.l.:North Atlantic Books.
• Rimmer, A., 2020. Covid-19: Two thirds of healthcare workers who have died were from ethnic minorities. BMJ, 369(8243).
• Williamson, V. & Greenberg, N., 2021. Moral Injury: the effect on Mental Health and implications for treatment. The Lancet, 8(6), pp. 453-455.

Author

Dr Tulika Jha

Dr Tulika Jha is an activist in the mental healthcare community combining social justice principles to disrupt and build care that is reciprocal and collective beyond expert and patient boundaries. She has nearly 25 years of experience in psychiatry where she has been a consultant in the NHS leading community mental health teams for almost 15 years. Having contributed to various leadership roles in CQC, Royal College of Psychiatrists and NHS leadership academy, she is now taking time away from the NHS to focus on organising and collaborating care in a way that is not at the expense of the caregivers, is led by care receivers and is aligned with larger socio-political landscapes and alternative epistemologies. Since this change of career path, Dr Jha has trained for a diploma in Group Analysis, completed a 3-year diploma in Hindustani Classical Vocal music and written articles and facilitated workshops for Healing Justice London, Synergie Collaborative, Consilience Journal, Civic Square dream lab and the NHS leadership academy. She is a medical expert on the first tier Mental Health Tribunal panel.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: None