What motives commitment to social justice - two working hypotheses

*This is not strictly a health care related post, but I think it's still fitting to add it to the discussion.

Last week, I was having dinner with a friend whom I met as a junior in high school. We ended up at the same college, meeting up once or twice a quarter to fill each other in on what was engrossing us in our lives at the moment. As our college years progressed in parallel, she had found her passion in human rights work, while I became fascinated by health care policy. Although we met sparingly at best, our connection hinged heavily on a sense of purpose that we both found in social justice.

So over dinner, interwoven with news on relationships, family, and future plans, we talked about where our passions have taken us (her continuing her research on the history of the international human rights movement, me exploring the possibility of applying business sector experience to reforming the health care system). As we talked, I discovered that for the first time since I've begun to seriously pursuing a path in public service, someone else put into words something that had been bothering me from the beginning about my own philosophy on why I was choosing this path.

Many stories you hear about young people going into volunteerism and public service come from one mold -- the person had either personally lived or witnessed first-hand some form of injustice (domestic abuse, governmental corruption, health care disparities, environmental destruction), and their empathy for the victims have driven them to action. Consider the kid from an inner city who grows up to be an education reformer because he wanted to give other kids like him a better shot, or the doctor who opens a free clinic in a remote village who had seen one too many patient there suffer due to a lack of medical care. In college, I worked closely with our Haas Center on Public Service, a unique resource dedicated to integrating service with a university education, and that many of us students committed to social change happily call our second home. Even walking around the place and meeting people in passing gives you a sense that you were among folks who, like you, felt that there was a sense of purpose higher than pursuing personal gain.

However, a part of me always felt out of place, like I was some kind of fraud or poser. Time and again, I saw students throwing themselves into mentoring programs for kids in the next town over, which has much lower levels of income, education, and resources (as often is the case with an elite university and its neighboring community), or fighting for prisoners' rights to health care and fair treatment, or helping in legal clinics that provided services to immigrants who were being wronged by the justice system, or one of literally hundreds of issues and organizations the worked directly with needy communities. My issue, justice in the form of equal health care access, is no newcomer among public service fields. What I felt set me apart was my approach to the issue and my inner motivation. Most of my peers were part of a grassroots army, people who served by doing, by being on the ground delivering goods and services. However, as my friend pointed out over dinner, something about us makes it difficult to overlook the frustrations and flaws that we see in people and systems when we're entrenched in grassroots work. We become impatient with the chronic lack of funding, staff shortages, bureaucracy and redtape (especially in larger, more established nonprofits), and a tendency to place ideals ahead of impact. Worst of all, we become impatient with the people that we're trying to help.

Volunteering at the ED in a local hospital, I've seen poor or homeless patients come in complaining of chronic pain in order to get meds to feed their addiction. Frustrated, the doctors would either coax them to leave or give in to their demands in order to free up time and beds. As an intern in a community clinic, I became disillusioned with the power struggles and cultural clashes between organization leaders and the ground staff. As an intern at a small health outreach nonprofit, I again felt frustrated with its "business-as-usual" culture that relied more on tradition than constant questioning of their impact.

Consciously, I know that people who work for nonprofit are no saints; they're just normal people who are just as prone (if not more due to the challenge of nonprofit work) to stress, frustration, disillusion, being satisfied with the status quo, and bad habits. In fact, the unbending idealism that enables nonprofit staff to fight an uphill battle day after day is often a cause of their blindness to impact and feeling territorial about their ideas. Also, not everyone in the nonprofit sector are motivated by noble ideals and altruism; they still need to balance the very human needs of earning money, supporting their families, and deriving satisfaction from their jobs (which is, on the average, higher for service-oriented professions). On the end of the populations being served, I'm well aware that many people that end up in safety nets aren't in their situation by choice. But all this knowledge still doesn't help with being able to better accept people's flaws and facing an innate sense of frustration everyday.

So what keeps people like my friend and I fighting for the causes we've devoted ourselves to? We're too perfectionist, perhaps even too self-righteous, to accept the flaws in the people and organizations we're trying to help. We have trouble relating with people who make bad choices about their lives, however involuntary and situation-conditioned these choices may be. But perhaps this makes us the ultimate idealists -- despite a lack of personal relation with the people that don't share our cognitive styles and even those we're trying to help, we just can't accept the alternative of leaving the field altogether. We're driven not by a sense of personal compulsion, but an indignation with the idea of injustice. The same stubborness that fuels our perfectionism also makes us seek justice that is imperative to our view of what is right, no matter how elusive and improbable. For my friend, her face automatically twists with frustration when she talks about how intolerable it is for humans to suffer torture and a lack of political voice. For me, I feel similarly about the fact that people are sicker because the health care system is biased against their skin color, language abilities, and income level. We also tend to focus on the up-stream causes of injustice, such that instead of delivering services to those who were already victims of human rights violations or a biased health care system, we find it more effective to correct the system in the first place. Simply put, we sense things are simply not right, and we are driven to do what we deem most effective to right the world.

This, to the traditional public servant, may sound blasphemous. He might argued that if service towards other human beings isn't driven by compassion, it is vulnerable to attack by self-righteousness, blindness to the actual needs of the people whom we're supposedly helping, and a tendency to cloister oneself off in one's high-flying ideals. At the same time, service motivated only by personal identification with a vulnerable population has its own downfalls -- you become less responsive to the needs of peoples with whom you identify less (what makes people like you more deserving of help that those who are unlike you?), your actions are dictated more by personal affinity (which is prone to all sorts of biases due the limitedness of one person's experience) rather than a cold focus on achieving impact, and you lose sight more easily of the system-level influences that caused the suffering you're trying to alleviate.

In the end, the (somewhat of a cop-out) conclusion is that a true commitment to social justice is made up of both personal and idealistic motivations. Without staying grounded to the actual people who suffer due to injustice, you lose touch with the humanity you both share as well as their reality, which is the ultimate benchmark of your effectiveness (if doing what you believe is right isn't actually improving their lives, then you've failed). But without a healthy distance from their perils, you can become trapped in anger or blind to gaps in your own thinking, leading to burnout and a habituation to ineffective processes.