This chapter explores the concepts of self-compassion and moral injury, and ways of navigating complex healthcare roles with self-awareness, kindness, and greater compassion. Self-compassion involves recognising our suffering, being moved by it, and offering kindness and understanding towards ourselves. Human beings can be our own worst enemies and toughest critics. Cultivating self-compassion helps to address this tendency, increase resilience, and empower us to show greater compassion towards others. Moral injury stems from situations in which a person must make choices that go against their core values and can corrode compassion. There are many kinds of moral injury, ranging from a single large, conflictual decision to a sustained pattern of smaller but still conflictual decisions that arise on a day-to-day basis. The latter is common in large healthcare systems owing to rapid decision-making, inadequate resources, outsized expectations of healthcare providers, and working conditions that are often not conducive to clear thought: long hours, sleep deprivation, inadequate personal support, and lack of compassion for staff. This chapter examines how to manage the risk of moral injury in these situations, how to boost self-care for staff, and the importance of self-compassion when managing or living with difficult experiences or situations, especially on a recurring basis.

At its heart, compassion is the feeling of being motivated to act in the presence of suffering. From a psychological perspective, the construct is conceived as having two dimensions: state and trait. The compassionate state reflects the feeling of compassion or having a compassionate response in the moment, while a compassionate trait is more stable, reflecting a general tendency towards compassion or towards feeling and responding compassionately most of the time. For people who are expected or required to be compassionate in their everyday life or work, compassion requires sustained courage and a continued willingness to engage with suffering, rather than avoid it. This chapter explores compassion from psychological, evolutionary, and physiological viewpoints. Despite a useful and growing literature in this area, a precise definition of compassion in practice can remain elusive. The meaning of compassion is not written in stone; it flows. As a result, what the concept means in healthcare, and how it works in practice, are, perhaps, made most tangible through providing compassionate care to patients, interacting with families, discussing compassion with colleagues, and teaching students about compassionate healthcare. If compassion is defined flexibly and understood wisely, it can shape care in positive ways, improve outcomes, and change lives.

This chapter looks at ways of building personal resilience as a foundation for compassion. The chapter starts by presenting relevant learnings about resilience from the Covid-19 pandemic; outlines positive behaviours that promote individual physical health, mental health, and resilience; presents a guided imaginative practice focusing on resilience and inner solidity, and, finally, draws together key themes of resilience, equanimity, and compassion towards the end of the chapter. The overall message is that self-care is (a) an act of radical self-compassion, (b) the basis of compassion for other people, and (c) a vital foundation for resilience, among other qualities. We cannot care for others, or become more resilient, unless we care for ourselves, so it is essential that healthcare workers pay attention to their physical and mental health. This includes optimising levels of physical exercise, sleep patterns, and dietary habits, as best as possible. It also includes specific steps to improve mental health, both in our own lives and in relationship with other people. Physical and mental health are intimately related with each other. Both are vital foundations for learning greater resilience and cultivating deeper compassion for ourselves, our patients, their families, and our colleagues in the healthcare professions.

As we cultivate mindfulness, we can develop and deepen our compassion skills, both for ourselves and for others. Without self-compassion, we will struggle to look after other people compassionately. This chapter explores ways to build self-compassion and how to extend this compassion to other people in our lives. This includes our patients, their families, and our colleagues, as well as our own families and circles of friends. These are important tasks that find their roots in the theoretical and research foundations of compassion, and build on the awareness skills that we develop through mindfulness practice. This chapter presents exercises for deepening self-compassion, growing compassion for other people in our lives, and extending that compassion to everyone. By focusing on common humanity, we move towards a more stable, engaged response to other people, less informed by our own situation and more informed by theirs, less shaped by our judgements about them and more shaped by what we can achieve together. Developing compassion for everyone can be challenging, especially for people whom we anticipate will be difficult, but, with awareness, we can move in the right direction. This chapter concludes with an exercise that focuses on generating feelings of compassion towards other people by encouraging mindfulness of our connection with all beings and the planet as a whole.

Chapter 6, Branding Birth Control, examines how birth-controllers used claims about medical works’ vulnerability to destruction under the Hicklin test to distance contraception from immorality, frame its advocacy as a free speech issue, and generate publicity for the cause. Contraception pamphlets first published by radicals in the 1820s and 1830s had long been sold by both social reformers and pornographers. In 1876, a figure with feet in both domains was arrested for selling Charles Knowlton’s Fruits of Philosophy (1832). The following year, Annie Besant and Charles Bradlaugh engineered their own arrest for selling it. The chapter examines the selective publication history that Bradlaugh and Besant constructed to divorce Fruits from its associations with promoscuity and promote contraception advocacy as a respectable, progressive cause, and shows that birth-controllers went on to sell huge volumes of literature on contraception. Although they encountered relatively little legal opposition, they often claimed that selling such works was very risky. These claims operated as a way of generating further publicity for the cause, and branding it as brave, modern, and progressive.

Chapter 7, Be Careful about the Publisher, examines how the diverse sources, distribution networks, and audiences associated with sexology undermined Havelock Ellis’s attempts to frame his book on homosexuality with John Addington Symonds, Sexual Inversion (1897), as a serious medical work, and led to its appearance in the obscenity trial R. v. Bedborough (1898). Authorities charged Bedborough aiming to break up a radical group, but sexologists and their allies framed the trial as an ignorant attack on scientific progress. Elaborating on strategies pioneered by birth-controllers, they argued that the censorship of “naturalistic” sexual expression had mired society in sexual ignorance, fostering “abnormal” sexual behaviour and an appetite for pornography, the rightful target of obscenity laws. In positioning their own work as vital to society and pornography as a product of sexual science’s suppression, they obfuscated ways in which early sexologists relied on pornographers and their products. By examining sexologists’ attempts to navigate these issues, this chapter further demonstrates how arguments about obscenity were used tactically to sanitize sexual knowledge and its producers.