Is Compassionate Care Really Compassion?

By Gary Mittelstaedt

What does true compassion look like? How do we truly help those we see suffering? Is not the desired outcome of compassionate action full restoration to one’s previous capacity? Then why does so much action fail to realize this outcome?

Ever notice how doctors sometimes get things wrong when treating someone? They may focus on a visible issue and miss the serious underlying problem…. bandaging an external wound but missing internal bleeding. With passage of time the real problem emerges, and the problem has gotten worse. This example has application when considering homelessness.

But hold on, you might ask, isn’t any help better than no help at all? Well, no! Failure to properly understand the underlying problem always makes things worse with the passage of time. Let me give you a couple examples from Systems Thinking to explain why. Consider two failure patterns, “Fixes That Backfire” and “Shifting The Burden.”

Fixes That Backfire

“Fixes That Backfire” is when you apply a quick solution that seems to give relief, but down the line, things get worse as the fix is fully understood as incorrect or insufficient. People often know this, but they still go for the quick fix because taking time to analyze seems scarier and it just feels good to do something to help. In the case of homelessness this might show up as an increase in homeless deaths after a seemingly good solution such as providing temporary housing.

Shifting the Burden

Then there’s “Shifting the Burden.” This is when a ‘helper’ observes someone’s suffering’ and takes action to correct the problem for the person. The ‘solution’ seems obvious and fixable to the ‘helper’. However, the real solution can only come from within the person with the problem, not from the helper. Gradually the sufferer becomes dependent on the intervention and never steps up the actions only they must take to solve their problem. In this failure scenario, the ‘helper’ misdiagnoses who ‘owns’ the problem. Any shifting of this burden away from the sufferer is robbing the person of their recovery path.

Real Compassion

The real solution then must include action that first brings the person to a decision point to own the problem themselves. All assistance, even small, that ‘shifts the burden’ away from their obligation to their own health, is actually hurting the person and making more difficult their full recovery. True compassion then does not provide temporary pain-relief when this pain exists to bring the sufferer to the point of ownership of their problem. It is widely understood that if a person does not fulfill the tasks (burdens) of their role, whether as an employee or in personal life, they are being irresponsible. It is much less widely understood that a person who accepts the burdens of another person’s required and rightful role is equally irresponsible. Real compassion is then helping the sufferer to accept their role in recovery.

This failure pattern assumes the person with the problem can make smart choices about their own well-being. But sometimes, that’s just not the case. If an injured person arrives at the doctor unable to communicate their injury or are unconscious, the doctor steps in and makes decisions for the person to affect their recovery.

The same should apply for homeless folks if they are unable to make rational choices because of addiction or mental illness. Is it not the opposite of compassion to turn these sufferers out on the street with no help? As with medicine, society should step in and orchestrate recovery as best possible. This requires institutional help for recovery and then as needed long-term maintenance.

But what about addicts who refuse treatment? Real compassion would cause a decision crisis by, at the very least, offering a choice between treatment or controlled isolation. This so they don’t cause harm to others and society in general.

Real Solutions Are Not Easy

So then, why in the name of compassion do so many ‘quick-fix’ and ‘burden-shifting’ actions continue? One reason is that real solutions are not easy and take real work to address. They require deep and honest assessments, structured processes, and accountability to the process over time. This is real work.

Another reason is that when governments take ‘responsibility’ for an individual’s well-being, people shift the burden of their well-being to the government. As stated earlier, this is classic irresponsibility by both parties that sets off the vicious cycle leading to the individual’s capability demise.

Take Portland, for example. It’s struggling with a huge homelessness problem. There’s a large number of organizations receiving money to help but many are actually enabling the problem. Unfortunately, few organizations can show actual ‘individual recovery’ results. The overall system is deteriorating as the effort to fix is flooded with more effort. There are a few bright spots, but the overall situation seems to be getting worse.

So, what is real compassion then for the homelessness problem?

• It is providing institutional help for those mentally ill.

• It is first being honest with drug addicts about owning their problem, then addiction recovery programs for those who do. This means stopping all enabling ‘fixes’. It means confronting and if necessary, constraining those who will not accept their addiction.

• It also means supporting only organizations that do the hard work of assessing root-causes, providing processes for true recovery and accept long-term accountability for delivering real recovery results. These effective organizations must be able to prove their success with homeless full recovery.

These are my thoughts. I welcome yours. What do you think is real compassion when helping the homeless?