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Wellness 911: Being stoic gets nowhere in EPs : Emergency Medicine News

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EP life, physician well-being

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It’s awkward to admit it now, but I (AD) was bragging about being stoic and emotionless. I picked up the belief somewhere during my upbringing that being emotionless meant staying logical and steady.

I thought my stoicism as an ER doctor separated me from someone with less courage. It was just part of the job – keeping it together despite the worst the ER had to offer. Not everyone could handle it, but I could. I could walk out of a trauma room, press reset, and see the next patient with a shredding tone and a smile. What I had just experienced was not the next patient’s fault after all. No one else needed to know.

I thought shutting down my emotions didn’t affect me at first, but more and more I started having low-level anxiety about shifts. It turned into mid-level anxiety. Eventually, work became the only thing I could think about, so much so that I couldn’t even enjoy my free time. I used my time after work to numb myself. That meant watching every episode of every season of “Real Housewives of Any City.”

This meant eating comfort food when I wasn’t hungry. That meant pouring wine, browsing social media, going down rabbit holes on the internet. Anything that detaches and becomes numb. Eventually I started getting hives at work. Yeah, full-fledged psychosomatic mayhem. My body was inciting mutiny. Naturally, I thought the only option was to calm my emotions even further.

Turns out I wasn’t alone. Physicians are reinforced to be so. We frequently dissociate from our bodies and live primarily in our heads. We put on a happy face for the next patient. We value the thought, not the feeling. We may ignore cues to eat and go to the bathroom multiple times during an entire shift.

Many people in general are socially conditioned to avoid their emotions unless they are positive. Share something painful, and parents might say, “Look on the bright side!” or “Be grateful,” but professional trainer Rezzan Huseyin says, “As emotions go unnoticed, they often manifest as deep restlessness, nonspecific anxiety. We lose more and more of ourselves. ” (Art of Wellbeing. June 21, 2016; https://bit.ly/3RGNvs6.) To deny emotions is to deny part of the human experience. It’s a sort of self-denial. Not allowing them often leads to negative behaviors like stress eating, drinking too much, excluding people and picking on them.

Give vibes

What is an emotion? It is not a sensation, which is a message sent from the body to the brain (hunger, for example). An emotion is a vibration sent by the brain, literally how your body feels in response to thoughts. Shame can feel like a tightness in the back of the throat. Excitement can feel like it is floating in your chest.

We have options when a feeling begins to arise, and the responses we choose become habits for many of us:

  • Resist: Many people are so used to resisting their emotions that they don’t know what they look like until they burst out. Imagine feeling like a beach ball as you try to keep it underwater. It takes tremendous effort and it spurts water when the slightest thing throws you off balance. It’s the same with feelings: many of us keep suffocating them until they explode.
  • React: For example, people who get angry and defensive are disproportionate to a slight perception. Feeling angry is often much more empowering than feeling disappointed or hurt. Feeling vulnerable is often uncomfortable.
  • Distract: It was my default mechanism: I dabbed the emotion with almost anything. The problem is that unprocessed emotion goes nowhere, so you end up numbing your life more than living it.
  • Allow: This is where we ride the wave. Research by neuroanatomist Jill Bolte Taylor, PhD, reveals that the chemical cascade of a sensation in our body only lasts about 90 seconds. If we feel anything longer than that, another thought has started the cascade again. (My stroke of insight: the personal journey of a brain specialist. Penguin Books: London; 2009; p.p. 153-7.) Allowing a sensation means leaning in for 90 seconds or less and experiencing it in our body.

watch and learn

It becomes easier to drop into our body and allow our thoughts and feelings if we understand that we are not our thoughts or feelings, but rather observing them. We will often have waves of emotion, sometimes large and sometimes small, before an event is fully processed.

  • To remark: Note that a sensation is coming and what your physical reaction to it is. “Ah, I’m starting to clench my jaw, and I feel tightness in my traps.”
  • Last name: Labeling what is happening removes some of the unknown from the situation. Notice the difference between “I’m feeling angry right now” and “I’m angry.” Start with the basics and improve later if you have trouble labeling an emotion. Here is a starter pack of emotions: happy, angry, sad, scared and ashamed/disgusted.
  • Allow: Let’s make a deal: there’s nothing wrong with compartmentalizing in the middle of a shift. It doesn’t always make sense to cry or feel angry in the moment, but get there ASAP when you have 90 seconds in a safe space. Don’t judge the emotion; it’s not good or bad but it’s part of being human. Lean in and really live it in your body. Give him your full attention, even for a little while. A good exercise is to imagine explaining what that emotion feels like to an alien. What does anger look like in your body? Is it stable? How is the intensity? Could you label it with a color? What’s amazing is that the emotion will often dissipate surprisingly quickly if you give it your full attention with curiosity and without judgment.
  • Decide: You can choose what you want to do with this feeling after allowing it. Do you have some control over the situation? Do you want to progress in solving the problem? Or do you really have no control and want to move towards acceptance? Carla Marie Manly, PhD, clinical psychologist and author of The Joy of Fear: Create the Life of Your Dreams by Making Fear Your Friend, explains: “Our feelings have a message that wants to be heard and understood. Feelings are neither good nor bad, it’s what we do with them that matters.

Some of the cues you may still need to allow your emotions include buffering behaviors, out-of-character behaviors, rumination and inability to move on, dissociation, and projection.

The best part is that almost everything you do and don’t do is because of how you think you might feel. But you have no limits when you become confident that you can process any emotion. What would you do if you weren’t afraid of feeling humiliated? What will you accomplish when you no longer avoid the feeling of disappointment? We can’t wait to see.

Clockwise from top left:Drs. Dinsmore, Cazier, andMorissonare board-certified emergency physicians and life, wellness and mindset coaches. Together they own The Whole Physician, a company dedicated to the well-being of doctors (www.thewholephysician.com). Their podcast, Drive Time Debrief with The Whole Physician, is available on all podcast apps. Follow them on Facebook (https://www.facebook.com/thewholephysician), instagram@thewholephysician, LinkedIn (https://www.linkedin.com/company/the-whole-physician/), and Twitter@WholePhysician. Read their previous columns onhttps://bit.ly/EMN-Wellness911.