Few days ago i was invited to give a talk at SKN Medical College,Pune on Positive Mental Health with Compassion. Audience was doctors. Postgrad trainees and teaching staff.
This is what i spoke -
1. Of all the people i meet socially, doctors are the most unhappy lot. They complain, whine and in general one feels horrible at the end of interaction.
What are we doing wrong?
Is the pain of our patients and our punishing work schedules making us unhappy?
2. I found my answer in @DalaiLama 's teachings on compassion. I developed a model of action that works for me (most times). I shared this model with the audience of doctors to experiment with it and see what works for them.
3. Step one - emotional action
Step two - deliberate practice of compassion in action.
Allow me to elaborate -
4. Step One - Emotional action.
In spite of being in a cerebral kind of work, my reflexes and reactions are driven by my dominant emotion. I am usually not aware of this. So i get dragged around by my emotion or develop a "clinical" persona that is matter of fact and dry.
5. So i must become aware of my emotional state on moment to moment basis. I identify the prevailing emotion with a precise word.
There are many such emotional vocab tools on internet. I use this one - (i dont know the creator of this one)
6. Once i am able to identify the emotion - if it is positive, i flow with it. If it is negative, i ask myself - if it was opposite, how would i act?
Opposites -
Anger • Curiosity
Sadness • Contentment
Fear • safety
Lust • Love
Jealousy • Appreciation / wonder
7. By forcing my action according to a positive counterpart emotion, i protect myself and people around me from a bomb-last of negative action. And i may start experiencing a genuine positive emotion due to my action.
8. It is important to not justify or rationalise emotion. Just accept it as it is. Emotions are internal signals. There is no wisdom in fighting signal. It is their to guide or act on.
9. Step Two - Deliberate practice of Compassion as a doctor -
Over and above my clinical examination, diagnosis, treatment related discussion, i try to fine ONE thing that will reduce suffering of person/family visiting me.
10. I do this by finding commonalities in myself and my patient. It is really easy. There is got to be a lot common in two human beings.
Usual common experiences are - being a parent, time and money pressures, ambitions, disappointments, fears, suffering.
11. Medical training trains me to only think rationally and leave emotion out. It may have been okay in 19th century. But for my patients and myself such matter of fact interactions are inadequate. Hence finding commonalities and practicing compassion.
11. It involves a genuine warm smile and saying specific and true things that reduce their burden. E.g. you have not caused autism in your child by your actions or something that you forgot to do. You are not responsible for this. Or holding the baby in my lap so that mother can
talk freely.
Simple acts and statements of truth reduce suffering and burden.
I aim for one compassionate action per session. Modest and achievable goal.
12. Emotional action requires practice over weeks and months and it works very well.
13. Deliberate Compassionate action comes easily to all of us.
14. This protects me from burden of care as it gives me something positive to do in most difficult/ hopeless situations (there are many of those everyday) and it instills positive emotion in my patient.
Everyone gains. My little world becomes more tolerable and hopeful.
15. I found @DalaiLama 's compassionate practice lectures and writing helpful. It saved my emotional life.
I wish you all same diligent practice and happiness 🙏🏻
Bhavatu Sabb Mangalam (May good things happen to all)
A thread on one of the most popular misconceptions about mental health in India.
1. Most people can identify psychological distress and pain quite quickly. This is the good and easy part.
As humans we are born with the ability to sense emotions in others and sometimes ourselves as well.
2. What the identity as "source" or "cause" of that distress is where all the fun lies.
There entire thinking process and behaviour is dictated by their attributed cause. Entirely dictated by their own perception and conditioning (biases).
3. It is almost universal belief that there is ONE single cause of that distress/illness. People look for agency that will "neutralise" that perceived SINGLE cause.
1. In last six months. Five of my friends lost a parent. It can get overwhelming. Being a local to their parent's city i was involved in the process medically / supportingly / logistically.
Here are some observations about wrong use of antidepressant medications for the grieving.
2. Many left behind a spouse. Completely heartbroken and distraught due to the loss.
Unfortunately, their well wishing family physicians advised antidepressant prescription.
I have a serious disagreement with this. Hence the thread.
3. After such a profound loss. Death of a spouse of 40 years or more. A huge void is left in life. Sadness and grief is intense and in indian culture it is expressed by copious crying, re telling of last illness / last moments with every visitor.
A 13 yr old with severe Obsessive Compulsive Disorder. He has to wash hands to reduce anxiety even temporarily.
It is so bad that his hands are white with painful linear breaks in skin (ulcers).
Referred to a child psychiatrist. Started on single medication (fluoxetine). Cognitive therapy not possible as child lives 250km away.
Excellent response to meds in 2 months.
This should be happy ending isn't it ?
But it is not....
A 🧵-
After those 2 months parents buy the tablet locally and continue for 3 more months and stop using it. All by themselves.
Symptoms come back within a month and they restart meds in half dose on their own for another 6 months. Majority of symptoms go away and some remain.
They decide to stop meds again and same story goes again.
After it all becomes intolerable, they come to me and ask for help.
My first duty after confirming the diagnosis is - to know whey keep stopping the medicine. 1. They can afford it easily 2. There are NO adverse effects of the medicine. 3. Their doctor was available on phone to guide so no issue of costs involved in repeated psychiatrist visits.
One more suicide.
A young doctor studying at THE most prestigious institution loses life to suicide.
I realised that he was following me on this platform. That realisation makes this even more sad at personal level. Was there any way i could have helped him and prevented the tragedy?
I dont know perfect answers to all these questions.
Attempting to write a few that can be helpful for all young adult students (18-25 age group) -
1. Irrespective of what your seniors tell you, mental health IS important.
It is based on combination of your brain chemistry, your formative experiences and your circumstances. There is no SINGLE cause or simple single remedy.
Getting help from professionals remains single most effective life saver as of now.
2. "Feeling hopeless" is a robust indicator of high suicidality. Anger with or without agitation and consuming intoxicants like alcohol are high risk factors. A combination of these three (hopelessness, agitation and alcohol) is lethal.
One thing that makes therapy relationship different in a beneficial way is privacy.
It is not about "confidentiality " (your information is not shared with others by treating team) only.
Therapy also helps people process their own difficulties in the solitude of their own mind and come up with their own conclusions, processes, emotions. They OWN the solution.
I see this process destroyed quite frequently by well meaning (and sometimes self serving) others in patient's life.
How? Pl read on -
Many adults have friends and family who help them in difficult times. Patients have already discussed their difficulties with these people before meeting a therapist.
For children, parents play a serious supervisory role out of concern and parental authority as well.
When such adults and children enter therapy, their near one's / parents often sit with them after every therapy session, eager to hear what happened in the session and "what did the therapist tell you?"
This is usually done by people who have not experienced GOOD therapy themselves. They are not aware of the importance of privacy to make therapy happen.