There’s nothing like a visit to a concentration camp to put your life in perspective. The unexpectedly difficult trip back from Poland yesterday – involving a temporarily closed airport resulting in a mixed connection, 8 hours of additional flying time, and a lost suitcase – would normally have inspired at least a brief bout of self-pity. Not so on this trip; I’ve seen what a nightmare experience looks like and yesterday wasn’t even an unpleasant dream. I want to hold on to this perspective as long as I can.

But sooner or later, I will lose it. We humans don’t seem to be built to perpetually keep the bigger picture in mind when the normal ups and downs of life are so noisy. It takes a lot of work. In fact, it appears to the curse and blessing of human nature that the very psychological strategies that allow us to survive and thrive can also be used to ignore, avoid or justify. 

For example, take compartmentalization, a coping strategy in which we human beings create psychological walls between thoughts, feelings and values that conflict with each other. As a short-term strategy, compartmentalization can be useful. A single mother whose child has been diagnosed with cancer still has to find a way to put food on the table; tucking her pain into a mental drawer can allow her to focus on her work long enough to earn a paycheck. Physician friends of mine talk of compartmentalization as part of their medical training; who wants a surgeon who is so overwhelmed by the fear of making a mistake that she can’t hold a scalpel without shaking or an oncologist so grief-stricken over the loss of a patient that he can’t function?

On a person note, I know compartmentalization helped me meet the deadline for my second book even though I was reeling from the sudden death of my mother shortly after I signed the deal. Somehow, for a few hours each day, I found a way to temporarily take the grief I felt over my mother and tuck it away into a mental file cabinet. Focusing on the book was enormously difficult in the beginning but, over time, I fell into a kind of rhythm and this time-away-from-grief became both a welcome distraction and a source of relief. Three months later, I turned the book in and let myself fall apart.

But compartmentalization has its risks, particularly when it becomes a long-term play. Soldiers who necessarily have to push away their trauma on the battlefield may find it comes back to haunt them if they don’t deal with it once they come home. Doctors who don’t have an outlet for the emotional aftermath of their difficult jobs can lose their capacity to respond empathically to their patients.

Put fears, anxieties, anger, and conflicts out of sight and into mental boxes long enough and we can lose touch with where they are and who we are. 

Take the story of one of the camp doctors, our guide (whose father was a Polish political prisoner in Auschwitz for 4 and ½ years) shared with us. This physician, a gynecologist, spent two days a week during the war performing horrific gynecological experiments on female camp inmates. The other three days were spent providing fertility treatment to German women. There were, of course, numerous examples of Nazi physicians bound by the Hippocratic oath who compartmentalized their brutal research and outright extermination of prisoners while leading lives of model citizens.

Serial killers, too, fascinate us by their ability to enthusiastically serve as Boy Scout leaders or devoted spouses while seamlessly and sadistically torturing and killing their victims. BTK serial killer Dennis Radar called his ability to psychologically divide up different parts of himself “cubing.” It wasn’t like he had multiple personalities; he was fully conscious of the varying personas he assumed. It was more like fully immersing himself in an acting role with his other characters waiting in the wings. In his mind, he wasn’t an evil person; he was a good person who did bad things. 

Compartmentalization can be useful or not depending upon the situation. We first need to make sure it’s a choice rather than a compulsion. Temporarily setting aside strong emotions or internal conflict is one thing; denying them is another. 

The second benchmark is how our coping strategy is impacting others. We all have the capacity to compartmentalize; how much it’s used in the service of a double life or to justify certain behaviors depends on the person’s goals. One thing I’ve been reminded of over the past week is how hard it is to witness suffering and how limited the choices we have once we see it. To paraphrase a quote by Dr. Rita Charon in an essay in Academic Medicine, “There are only two paths open to those who must witness suffering . . . pretend it’s something else . . .  or see it fully and endure the sequelae of having seen.”