The“Second Victim” and Beatitude

Earlier this week, my colleague Fred organized a discussion at work about whether incident responders should be considered victims. I’d wager that most people find the idea ludicrous on its face. However, there is a robust bit of academic literature making use of the idea that people who contribute to harm and feel bad about it are somehow themselves a victim.

I won’t repeat what my colleagues said out of deference to the policy in effect at the time of not recording people in order to facilitate a more candid discussion. What I will do is work through some conflicting feelings I myself have about the concept. (I should also note that this discussion doesn’t really bear on Steven Shorrock’s concerns.)

First let’s lay out the rationale for why someone who contributes to harm may be said to be a victim, and then why an incident responder may be a victim. The idea of a second victim, as far as I can tell, comes from the field of medicine when an MD named Albert W Wu wrote about it in Medical Error: The Second Victim. Over time the concept has come to mean that when an “error” occurs which induces harm, the person or people who serve as proximate cause of that harm are themselves victimized when they feel bad about having done so. They are themselves a victim because that behavior which was deemed an error is understood to be, in the greater theoretic framework, a result of several contributing factors. It didn’t just happen out of nowhere, but came to be after a period of organizational drifting towards failure. So placing the blame on the proximate cause is like blaming that final straw which broke the camel’s back without considering all the straw already there.

I’m extremely sympathetic to this perspective. To me it adequately accounts for the discrepancy between flesh and blood people and the formal roles they enact. People just are in and of the world doing their thing. But due to forces greater than themselves, like our collective political economy, they’re forced into circumstances which can induce them to adopt subjective and objective positions wherein they can sometimes do harm to others. It’s very Nietzschean, a la Genealogy of Morals:

That lambs are annoyed at the great predatory birds is not a strange thing, and it provides no reason for holding anything against these large birds of prey, because they snatch away small lambs. And if the lambs say among themselves "These predatory birds are evil—and whoever is least like a predatory bird—and especially who is like its opposite, a lamb—shouldn't that animal be good?" there is nothing to find fault with in this setting up of an ideal, except for the fact that the birds of prey might look down with a little mockery and perhaps say to themselves "We are not at all annoyed with these good lambs—we even love them. Nothing is tastier than a tender lamb."

To demand that strength does not express itself as strength, that it must not consist of a will to overpower, a will to throw down, a will to rule, a thirst for enemies and opposition and triumph—that is as unreasonable as to demand that weakness express itself as strength. A quantum of force is just such a quantum of drive, will, action—indeed, it is nothing but these drives, willing, and actions in themselves—and it cannot appear as anything else except through the seduction of language (and the fundamental errors of reason petrified in it), which understands and misunderstands all action as conditioned by something which causes actions, by a "Subject."

In another sense, though, this position is incredibly insulting to the practitioners. It appears to utterly disempower them, making them a victim of circumstance. It’s totally reasonable, as Nietzsche notes above, to inquire about their agency in all this. After all, if doctors or incident responders drifted into failure then it implies they were part of the repetitions that compose that drift. Surely one can avoid blaming them and also recognizing that in a certain sense they’re just dealing with the consequences of their own actions? After all, isn’t that the basis of the notion of accountability? The whole idea there is that they can say how it made sense to them at the time precisely because they’ve been part of the system that led to this outcome.

But is that blaming the victim? Well, it would be if we assumed from the start that they’re a victim. Perhaps a more personally empowering way to proceed without making that assumption is that we want people to affirm, to take responsibility for, what they’ve done no matter what the outcome. That gives them agency and the possibility of accountability. People now are affected by what happened before, including their behaviors then, and the temporal difference can mean that they can be victims of their own prior behavior. But then they can turn that around, so to speak, if they’re able to make good use of it by being accountable for it; that makes it something empowering and which they can affirm. That would be a very Spinozist move.