This is Going to Hurt: The symbolic status of the National Health Service remedied with the medicine of the Real

This post is an adaptation of an essay which I originally submitted as part of my BA(Hons) Acting degree at the University of Chichester. At the time, This is Going to Hurt had just been released and I was enthralled by what I found to be a gripping drama that was truthful, routed in 'reality' and matched the sense of anguish which family members who had worked in the NHS for years were talking about over the dinner table.

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Through a deconstruction of the screen adaptation of Adam Kay’s This is Going to Hurt (2022), this essay will challenge the symbolically “vaunted position” (Arnold-Foster and Gainty,2022:53) which the National Health Service occupies in the arena of public discourse. Through an analysis of the artwork, the “ultimate Reality” (Wright and Wright,2007:306) of the NHS, as experienced by staff, will be exposed in an “experience of the traumatic Real” (Žižek,2006:57) represented through the dramatization of an “overstretched maternity ward” (Bannerman,2022), in which professional misconduct in inter-staff relations and the abuse of Junior Doctors is commonplace. This essay will situate the artwork, and the narratives which are perpetuated, as a translation of a Žižekian ‘reality’, wherein the symbolic sentiment, the “illusion of stability” (Kay,2003:169) of the NHS, as a “world-leading healthcare” (Arnold-Foster and Gainty,2022:55) is discredited and the truth of “the litany of failings, frustrations, and errors [Kay] observed…as a doctor” (Arnold-Foster and Gainty and Gainty,2022:58) are exposed to evidence the failings of the public healthcare system. This essay will conclude that This is Going to Hurt (2022) is an exposure, a public revelation, about the real state of the public healthcare service, providing a damming commentary on the poor working conditions and abundance of abuse and in a service which is “seriously flawed” (Arnold-Foster and Gainty,2022:53) and occasionally fatal to those who work in the service.

In How to Read Lacan (2006), Žižek asserts “the triad of the Imaginary, Symbolic and Real” (Žižek,2006:4) as the methodology which Lacan utilises to examine and deconstruct the human experience. In relation to this essay, our Žižekian analysis of Lacan will engage the relationship between the ‘symbolic’ and the ‘real,’ positioning This is Going to Hurt as a transpiration of the ‘real’ of the NHS experience.

In Žižek’s theory, the real is qualified as something which “cannot be comprehended” (Žižek,2006:65) through the medium of language and is instead within the “domain of structure” (Kay,2003:8), an intrinsic component which forms the inherent apparatus of society. The real is precisely that which we are not conscious of in our ordinary lives, masked by the symbolism of culture and language, the truth of the real resides within “encounter[s] of the traumatic Real” (Žižek,2006:57) which occurs in “little pieces of the real” (Kay,2003:55) that unveil the darker realities and occurrences, such as the depths of the exploitation of staff in the NHS. The ‘Real,’ and the trauma with which it is inherently attached, according to Žižek, resides in the “natural objects and processes” (Žižek,2006:75) of relationships and the inter-play of power within them. The reality of these relationships, such as between management and workers, or consumers and providers, as an “encounter of the traumatic Real” (Žižek,2006:57) is impressed through “form rather than context” (Kay,2003:8), due to the medium of language being inefficient in translating the deeper narratives of oppression and trauma. In analysing This Is Going to Hurt (2022), the realisation of these relationships, and their traumatic nature, such as the neglectful relationship between Dr Lockhart and Kay, unveil “little piece[s] of the real” (Kay,2003:55) which traverse the mask of the symbolic to unveil the “unflinching and honest portrayal of life on the wards” (Bannerman,2022) in the NHS.

The juxtaposition to the real, and that which Žižek positions as a direct remedy engaged by conscious beings to counteract the trauma of the real is the concept of the symbolic. Žižek defines the symbolic as “the domain of structure” (Kay,2003:169) a lens through which the world is mediated and filtered to make the experience of those within the world a bearable existence. The symbolic is that which “endeavours to contain” (Wright and Wright:2007,3) the experiences of beings and, in its attempt to avert trauma, reveres ‘the big Other…reified in a single agent” (Žižek,2006:9) to provide solace for beings in their experience of the world.

In preparation for engaging This is Going to Hurt (2022), the cultural significance of the NHS must be understood in the context of its symbolic importance to the British Public. In public discourse, the National Health Service resides within a vaunted position as a “national asset” (Arnold-Foster and Gainty and Gainty,2022:54) of the United Kingdom. The majority of the British public view the NHS with a glorified lens of the service despite the “systematic, institutionalised racism” (Arnold-Foster and Gainty,2022:59) suffered by both staff and patients, as well as a litany of failings, flaws and “critical failings…[of] day in and day out” (Arnold-Foster and Gainty,2022:59) experiences of those who work for and utilise the service. Regardless of obvious faults, the NHS occupies the position of a

“reified…single agent” (Žižek,2006:9) n the public conscious, with workers “celebrated…as our heroes” (Arnold-Foster and Gainty,2022:54) despite the maltreatment which they endure while services and staff are “seen as unviable” (Vize,2011:1248) due to increasing cuts and pressures on the service. The NHS in public discourse, despite the aforementioned shortcomings, is enshrined with nationalistic pride, dogmatic “public and political opposition” (Vize,2011:1248) to the idea of fault in the service and is affronted to the idea that the NHS symbolises anything less than a “world-leading healthcare” (Arnold-Foster and Gainty,2022:55) system. Therefore, in the Žižekian lens of the symbolic, Britain’s NHS is the ultimate symbolic entity with its glorification “in the national psyche” (Arnold-Foster and Gainty,2022:55) and “national provision of services available to everyone” (Dent,1995:879). The service is a public welfare instrument positioned as a national treasure, adored by everyone without hesitation or criticism, despite the reality in which “access [to] healthcare is actually worse” (Gubb,2008:2) for the most vulnerable in society, and “productivity…has fallen by an average of one percent per annum over the past ten years” (Gubb,2008:4).

In Forbes and Kingsley’s adaptation of Adam Kay’s This is Going to Hurt (2022), the traditionally symbolic conception of the NHS as a workplace of staff comradery is contradicted by the realisation of exploitative inter-staff relations between management and ward staff. In the opening episode, “pieces of the real” (Kay,2003:55) are exposed under the lens of inter-staff relations during “condescending visits” (Mangan,2022) from Dr Lockhart, the lead consultant of the gynaecology ward, who subjects Adam, the series protagonist, to “bone-deep, inescapable weariness” (Mangan,2022) through a “kingdom of blood, shit, anger, [and] exhaustion” (Cumming,2022). Their relationship challenges the emblematic, “traditionally vaunted position” (Arnold-Foster and Gainty,2022:55) of the NHS as a public welfare system in which staff support and empower one another to deliver a system of “world-leading healthcare” (Arnold-Foster and Gainty,2022:55).

These moments of traumatic interaction unveil “systemic failings on the part of healthcare professionals” (Arnold-Foster and Gainty,2022:57), as members of the service are subjected to abuse from superiors, therefore enabling the Žižekian ‘real’ to manifest within the artwork through the representation of inter-staff relationships.

 In the brief interactions of Lockhart and Kay, there are frequent and repeated “encounters [of] the traumatic Real” (Žižek,2006: 57), in which  Lockhart condescends Adam to “stop being shit” (Dr Lockhart,2022:Episode 1), and makes clear that the comradery, which in public discourse forms “the currency of accountability” (Klein,2013:14) with which the NHS is regarded, does not apply to the reality of the wards. These insults, from Lockhart, “intrude into the social body” (Žižek,2006:74) of the National Health Service as a publicly “reified single agent” (Žižek,2006:9) whose workers are “celebrated…as our heroes” (Arnold-Foster and Gainty,2022:54) and exposes a reality of public healthcare workers as something less idealistic than the symbolic “big Other” (Žižek,2006:9) which represents the supposed beating heart of our nation. These traumatic moments, in which Kay is subjected to taunt and scorn from his superior, provide direct challenge to the symbolic narrative of the NHS as a service “powered by love” (Arnold-Foster and Gainty,2022:54). These engagements between staff, and the impact they have on Kay as a dejected and struggling Doctor, unveil the depths to which the NHS “struggle[s] to cope” (Gubb,2008:1) in providing the lauded “world-leading healthcare” (Arnold-Foster and Gainty,2022:55) for which the service is supposedly envied.

The way Kay is afflicted by these insults from Lockhart, realise themselves in the moments of doubt, when he is faced with the “perception of reality” (Wright and Wright,2007:3) such as in Episode 5 when he confides in a new-born baby that he will likely loose his career. Kay, faced with an “encounter of the traumatic Real” (Žižek,2006:57) through a career ending mistake is abandoned by Lockhart to endure the wrath of a tribunal without “basic concern for [his] welfare” (Oliver,2017:1), as a “seriously flawed” (Arnold-Foster and Gainty,2022:53) system investigates his integrity as a medical practitioner. The “fathomless stupidities, injustices and lack of resources” (Mangan,2022) which Adam endures as a result of abandonment by his superiors reflects the reality of a service “permanently at breaking point” (Mangan,2022) as he carries on working on the wards throughout the duration of this investigation.

Overall, the revelations of Kay and Lockhart’s relationship provides a gateway towards an “encounter of the traumatic Real” (Žižek,2006:57) within the artwork, revealing the true state of the NHS, as staff endure a working culture which is exploitative and oppressive in its nature. The interactions between Kay and Lockhart unveil the traumatising failures of “the mishandlings of medical management” (Arnold-Foster and Gainty,2022:57) and therefore situate the artwork in the discourse of exposing the symbolic misconceptions of the NHS as a healthcare service which is not supportive and a place in which comradery in abundant, but instead is a service that runs its workers ragged (Arnold-Foster and Gainty, 2022:59) and is wrought with the mistreatment of those most essential to its function.

Forbes and Kingsley’s adaptation further explores the trauma of NHS staff through the realisation of Shruti, the Junior Doctor who studies under Adam across the series. Shruti, “Kay’s long-suffering sidekick” (Long,2022), endures “encounters of the traumatic Real” (Žižek,2006:57) as she is relentlessly thrust into “a war zone, a bottomless pit of piss-stained exhaustion and irritation” (Long,2022) across the

series. Shruti as a character evidences the maltreatment of junior staff by the healthcare system, exposed to poor “healthcare working conditions [and] the mishandlings of medical management” (Arnold-Foster and Gainty,2022:58) as she endures “fatigue [and] bullying” (Mangan,2022) under the tutelage of Adam Kay. Shruti’s experiences expose “the form” (Kay,2003:8) of reality for Junior Doctors, lambasted and demonised as “greedy and callous” (Long,2022), subjected to poor working conditions and stagnant pay, treated as a “transient workforce” (Oliver,2017:1) who can be viably abused, bullied, and overworked by the system without consequence. Shruti, according to Oliver, represents “a precious human resource” (Oliver,2017:1) which under the current system of NHS endure exploitation through overworking and lack of “adequate access to…facilities” (Oliver,2017:1). The representation of staff exploitation in hospitals is materialised poignantly through Shruti, as she undergoes “everything that a Junior Doctor experiences when they step on the ward” (Bannerman,2022). Shruti, as a character, is exposed to unsheltered “encounter[s] of the traumatic Real” (Žižek,2006:55), subjected to repeated exploitation from the system through “racism, abusive relationships and [a] mental health crises” (Healy,2022) which ultimately results in the character’s suicide in Episode 6, as she can no longer endure the “ultimate Real” (Wright and Wright,2007:306) of her abuse under an NHS which does not bare any resemblance to the “unconquerable [service] ‘powered by love’” (Arnold-Foster and Gainty,2022:54) which the NHS, as “a reified…agent” (Žižek,2006:9) is so frequently touted to represent.

Ultimately, it is Shruti’s death which exposes the pinnacle of the “traumatic real” (Žižek,2006:57) so evidently within the artwork, the climax and revelation of her suicide unveils the volatility of experience for the “casually alienate[d] and squander[ed]” (Oliver,2017:1) Junior Doctors who “arguably suffer most” (Arnold-Foster and Gainty,2022:59) under the NHS system. Shruti’s

suicide, and the “ultimate Reality” (Wright and Wright,2007:306) which it unmasks, positions the artwork as a direct challenge to the traditional stalwart positivity of public discourse on the National Health Service, discrediting the “outright denial” (Arnold-Foster and Gainty,2022:54) of failures of the service, and exposing the reality of a system which exploits Junior Doctors until they are “deprived of human dignity” (Wright and Wright,2007:306). Shruti’s suicide as an occurrence within the “domain of structure” (Kay,2003:8), that which occurs without the language of speech but is instead permeated through the character’s absence and the impact of the death on her colleagues, deconstructs all suppositions of the National Health Service as a system of perfection, revoking the traditionally “reductive public discourse” (Arnold-Foster and Gainty,2022:58) which employs the misconception of the NHS as a world class healthcare system, and instead the trauma of reality unravels to reveal the human cost of a service “permanently at breaking point” (Mangan,2022). Overall, Shruti, as a character, perpetuates the most brutal experience “of the traumatic Real” (Žižek,2006:57) of the National Health Service, her character experiences “everything that a Junior Doctor experiences when they step on the ward” (Bannerman,2022), a bombardment of continuous abuse, neglect, and exploitation, by the structures of the NHS. Shruti’s experiences are a realisation of the lived experience of Junior Doctors in the healthcare service, portraying an entire “transient workforce…[whose] concerns [are] all too easy to brush[ed] aside” (Oliver,2017:1) under the current system, “deprived of [their] human dignity” (Wright and Wright,2007:306).

In conclusion, the dramatization of Adam Kay’s This is Going to Hurt (2022) provides direct challenge to the “traditionally vaunted position” (Arnold-Foster and Gainty,2022:53) of the National Health Service. The artwork, through the realisation of on-screen relationships between Dr Lockhart and Kay, as well as the experiences of Shruti, unmasks the typically positive symbolic discourse on the NHS through “encounters of the traumatic Real” (Žižek,2006:57) which perpetuate the reality of a service “permanently at breaking point” (Mangan,2022). The encounter of reality, in the artwork, discredits the idealistic vision of the NHS in the public sphere, challenging the perception of the service as a supportive work environment and as a place of comradery. Materialisations of bullying, harassment and exploitative inter-staff relations unveil the stalwart positivity with which the service is traditionally perceived, destroying the symbolic “reified agent” (Žižek,2006:9) of the NHS, and ensuring that Kay’s experiences,  the “litany of failings, frustrations, and errors” (Arnold-Foster and Gainty and Gainty,2022:58) which he endured are evidenced in the portrayal of the public healthcare system. These failings are further exemplified through the experiences of Shruti, who is representative of the experiences of Junior Doctor in the healthcare service, as she endures “the traumatic Real” (Žižek,2006:55) of a “casually alienate[d] and squander[ed]” (Oliver,2017:1) workforce who suffer extreme “fatigue [and] bullying” (Mangan,2022) as a result of poor quality working conditions and exhaustive hours. Shruti’s suicide provides the series most impactful “ultimate [engagement with] Reality” (Wright and Wright,2007:306) as her traumatic encounters with the service “deprived [her] of [her] human dignity” (Wright and Wright,2007:306) to the extremes of which she engages in suicide as resort of escape from a service which inflicts such “exhaustion and irritation” (Long,2022) onto workers that the only viable alternative is death. This action, enacted by an employee at the beginning of their career with the NHS, as a Junior Doctor, is the ultimate deconstruction of the symbolic mask of the NHS as a service portrayed as a “national asset” (Arnold-Foster and Gainty,2022:54). The service, so lauded for its “world-leading healthcare” (Arnold-Foster and Gainty,2022:55) ultimately bears the responsibility for the death of Shruti, and thus the symbolic mask of the NHS is ultimately undone by the traumatic “encounter of the…Real” (Žižek,2006:55), the consequence of a service of “blood, shit, anger, [and] exhaustion” (Cumming,2022).

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