An end to bullying: five minutes with Alice HartleyBMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k1035 (Published 06 March 2018) Cite this as: BMJ 2018;360:k1035
All rapid responses
I applaud the current anti-bullying campaign for aiming to reach the heads of hospital and change the culture from the top.<1> Many of the previous anti-bullying campaigns are suboptimal because they mainly teach victims to defend themselves, but do not prevent aggressors from repeatedly hurting the victims.
As an analogy, victims of sexual harassment could be shamed for wearing inappropriate clothing and being present in dangerous places. Victims of school bullying could be told to change schools while the bullies continue to stay. By penalising the victims rather than the bullies, we are indirectly reinforcing the bullies to repeat their behaviour.
In medicine, victims of bullying could also be treated unfairly. They may be told to just move on and not take things personal, because the aggressors probably behave the same to every junior. Worst of all, you could be bullied by multiple co-workers. Rather than helping you out, your supervisor could tell you to just write a reflection to explain why you receive complaints from co-workers. At the end of placement evaluation, you could be criticised for having poor teamwork skills. We all have heard of how an employer allegedly shamed a junior doctor for raising safety concerns and put his career in jeopardy.<2>
It is ironic that we manage patients who are bullied at home, school and work, but we ourselves are unable to tackle the bullying culture in our own workplaces. By remaining silent when our juniors are bullied, we are no better than accomplices to bullying.
To conclude, I would like to borrow a famous poem in World War II:
“First they came for the Socialists, and I did not speak out—
Because I was not a Socialist.
Then they came for the Trade Unionists, and I did not speak out—
Because I was not a Trade Unionist.
Then they came for the Jews, and I did not speak out—
Because I was not a Jew.
Then they came for me—and there was no one left to speak for me.”
1. Rimmer A. An end to bullying: five minutes with Alice Hartley. BMJ. 2018;360:k1035.
2. Dyer C. Case of whistleblower whose career was "destroyed" prompts review of law. BMJ. 2016;353:i2910.
Competing interests: I have been paid for working as a medical doctor, but not writing this letter.
Bullying is ubiquitous and iniquitous, but misunderstood. Although it’s usually considered sadism with vulnerable victims, bullying is actually a neuropsychiatric disorder (which I call “neuro-bullying”) that is rooted in our autonomic nervous system.
Our autonomic nervous system consists of two opposing branches: the sympathetic nervous system and the parasympathetic nervous system. The sympathetic system responds to fear and pain with hate and “fight or flight.” The parasympathetic system responds to trust and pleasure with relaxation and vulnerability.
Ideally, the sympathetic and parasympathetic systems are in dynamic balance. But just as fear and pain can overpower trust and pleasure, the sympathetic system can overpower the parasympathetic system. This causes us to fear and hate vulnerability, both in others and ourselves.
I propose that bullying is fear and hatred for the vulnerability of the parasympathetic system. This is why bullies target vulnerable groups like women and children, as well as the poor, elderly, disabled, and socially stigmatized.
Finally, the cure for bullying, and most social woes, is to protect the vulnerable, but vital, parasympathetic system, because vulnerability is not weakness or bleakness, but the greatness of meekness, the elixir of life and fixer of strife.
Competing interests: No competing interests