Ethics in Relation to Mountains Beyond Mountains Book Review

Mountains Beyond Mountains

Author Tracy Kidder writes, "The world is full of miserable places…" His tongue-in-cheek quote then continues, "One way of living comfortably is not to think about them or, when you do, to send money." Kidder then proceeds to write Mountains Beyond Mountains (2003) and the Robert Frost "road not taken" by Dr. Paul Farmer that is completely opposite to "sending money." Another Mother Theresa, Farmer focuses nearly all his waking time on the poverty and disease of Haiti's people, at the cost of forsaking the richness of family life with his wife and children. Although Farmer is a physician, his story holds considerable meaning for those in the counseling field. Similar to Farmer, many caring individuals become counselors to help the "miserable people" who fill the world. They want to do much more than "send money." Also, like Farmer, they are confronted with the impact of this decision on their lives. Many counselors enjoy a rewarding career and find a healthy balance in their life, while others, unfortunately, become emotionally overwhelmed. The ACA Code of Ethics (2005) very clearly states that counselors must refrain from providing professional services when their impairment may harm a client. Regardless of their desire to be like Farmer and solve "mountains beyond mountains," counselors must ever be vigilant and take action when they need help with their emotional problems.

Farmer first went to Haiti after studying anthropology at Duke University and was extremely upset by the dismal healthcare provided and the even worse health conditions. Caring physicians from abroad often came to Haiti, lent assistance, and then returned home. The suffering continued. A health study by Farmer concluded that infant and youth mortality in the country was horrific, as was maternal hunger, prostitution, disease and death. Unlike the other doctors, Farmer believed he could make a difference and would not leave the Haitians behind: "Living in Haiti, I realized that a minor error in one setting of power and privilege could have an enormous impact on the poor in another" (Kidder, 2003, p. 78).

Resolving to make his mark, Farmer pursued a combined M.D./Ph.D. degree, or what he called a "marriage," in medicine and anthropology at Harvard. Even then, Farmer rarely was found on campus, typically living in Haiti and only returning for his exams. His anthropological and medical involvement began to go much further into the realm of religion: "How could a just God permit great misery?" he asked at the time. The Haitian peasants responded with the proverb: "Bondye konn bay, men li pa konn separe," or "God gives but doesn't share." That is, according to Farmer, "God gives us humans everything we need to flourish, but he's not the one who's supposed to divvy up the loot. That charge was laid upon us" (Kidder, 2003, p. 79). Haiti soon became Farmer's calling, his passion, or, some have said, his obsession.

In Mountains beyond Mountains, Kidder (2003) follows Farmer as he works in the Haitian hospitals from sunrise to sunset, as he walks great distances to pursue patients, as he travels from one country to the next, as he writes one grant after another to raise funds for medical care, and as he directly sends those funds and his Harvard salary to his parent organization in Boston that oversees his global efforts called Partners in Health. The miraculous aspect of Farmer is that he is truly acting out his dream. Even those who disagree with his often unorthodox ways of medical treatment admit that with Farmer there is no pretense. He continually goes to superman lengths to fulfill his goals. Why does he do it? He answers, "The problem is, if I don't work this hard, someone will die who doesn't have to" (p. 191). There is so much death in Haiti, he stresses, that sometimes even he is sickened by it.

Unlike many other people, Farmer has a deep internal strength that somehow keeps him positive and sane amidst this horrific and insane environment. This is Farmer's fix: He continually needs reassurance that he is doing everything that one person can do. "How am I doin" he asks regularly (Kidder, 2003, p. 189). Taking on more than the can cure, he naturally asks for encouragement. The fact that he does not become despondent is amazing and extremely enviable. He once wrote, "I've never known despair and I don't think I ever will," and said, "No one believes that I am cheerful because of what I say and write, but I say and write those things because they are true" (ibid).Kidder admits that Farmer sometimes becomes sad, but it does not take much to cheer him up.

However, even Farmer has his infallibilities, for no one can be all things to all people. He has received a fair amount of criticism from friends about not spending more time with his family. They say to one another, "Can you imagine what it would be like to be married to him?" He counsels people to take vacations, when he does not ever take them himself. Further, he berates himself for loving his own child more than those in Haiti, because of the religious philosophy of "Love they neighbor as thyself." Kidder writes that many people would like to build a life like Farmer's, where they could wake up in the morning knowing what they ought to do and feeling they were doing it. Yet Kidder cannot think of many who would assume the difficulties and give up the comforts and time with family as Farmer does.

There are many counselors who do wake up each morning and know what they ought to do and feel like they are doing it. These therapists explain that their careers provide a host of personal benefits, such as making them a better or wiser person, increasing their self-awareness and appreciation for human relationships, accelerating psychological development and a capacity to enjoy life, and forming spiritual service and enhancements in a value system (Kumar et al., 2007). However, it is a well-known fact that counseling is not an easy field. Caring for others at the same time as caring for oneself is frequently a major dilemma faced by counselors. In most cases, therapists have to work extremely hard and may see little or no progress with clients for lengthy periods of time, if ever. For many practitioners, the stress of the job becomes too great, which often leads to emotional issues, burnout and even traumatic stress. Kumar et al. (2007) found that two-thirds of psychiatrists have moderate to high levels of emotional exhaustion and also a low level of personal accomplishment. Researchers such as Baird and Jenkins (2003) list the many reactions that counselors have to their emotional upheaval: burnout, or a combination of emotional exhaustion, loss of caring about client feelings, and compassion fatigue; countertransference, or loss of treatment objectivity; emotional depletion, or being emotionally numb; secondary trauma, or stressed by their clients' stress; and vicarious trauma, or a disruption in trust, safety and control. Similarly, Radeke and Mahoney (2000) surveyed therapists and found that 80% suffer emotional depletion; 28%, emotional exhaustion; 24%, anxiety; and 19%, depression.

It comes as no surprise that so many counselors suffer from emotional problems. As Farmer faces the continual health issues of the Haitians, counselors continually face the problems of clients and their families. Clinicians who help traumatized clients are at considerable risk for adverse reactions because of their "exposure to emotionally shocking images of horror and suffering that are characteristic of serious trauma" (McCann & Pearlman, 1990, as cited in Wise). For example, family counselors know that children of all ages are physically, sexually and emotionally abused and neglected by their parents or caregivers on a daily basis. The U.S. Department of Health and Human Services (2004) finds that about 875,000 children are severely harmed by family members every year.

Tippett (2007) explains that sometimes in this world the best that counselors can do is plant the seed, attend patiently and reverently to a reality they cannot change quickly or even in their lifetime, and be present to suffering they cannot banish" (p. 58). Skovolt (2001) adds that counseling cannot be any other way, because the counselors' work is a dance between two or more people who are constantly changing directions. Skovolt says, how wonderful it would be if a practitioner's work was like spray painting another person and being able to control the artistic outcome. This way it would be possible to accomplish something that would make the counselors feel better. However, admits Skovolt, people are fortunately not that malleable. In hundreds of clinical hours during his 300-plus years of practice, Skovolt has suggested many ways that clients could help themselves in times of deep trouble. Numerous times they rejected his suggestions, brushing them away like bothersome horseflies. That comes with the territory of being a counselor. Skovolt says that no one -- the client or the counselor -- wants freedom of choice taken away. Self-determination is….....