Sunshine and happiness

Hello again. We are still a bit cooped up aren’t we? This is like a record breaking, nightmarish global game of hide and seek. As we hunker down, some of us feeling inexplicably fearful of even opening the curtains, we are in danger of something that you mightn’t have even thought about.

Rickets.

Just kidding. But you might become vitamin D deficient. Where I am, we are heading towards another freezing winter, where even if we get sun on our skin, with its wintry angle we may not make much in the way of vitamin D. Sure, there are dietary sources, however how much oily fish are you planning on eating? 

My own good doctor tested my vitamin D once. Despite doing loads of outdoor running at the time, it was low. And she looked at me in that no-bullshit way she has and said, ‘Claire, go and shout yourself a bottle of [insert brand name of vitamin D capsules here]. Take a little pill of sunshine.’  

Vitamin D is important for bones, cell growth, muscle size and strength, reducing inflammation and many more physiological actions. Something rings a bell about cognitive function and mood as well. I should link helpful resources for you but I will tell you a secret, I am very lazy. Feel free to Google it up for yourself, as a friend of mine would say.

There’s something else about this brilliant little vitamin that may interest you, and that is its role in immune function. There is a lovely meta-analysis in the BMJ (2017; 356 i6583) showing that boosting your vitamin D leaves you less vulnerable to catching respiratory tract infections. The effect is greater if you are deficient to begin with.

So it might be worth considering a little vitamin D. Get some sun- important for so many reasons. Consider supplementing if that is appropriate for you- speak to your own doctor as needed.

And on happiness… how are you all going? Is your wholesome iso-spirit growing tired of home bake-offs and knitting and toasting marshmallows? Or perhaps you never got to do that. Perhaps like me you’ve been working harder and longer than usual because of challenging logistics and changing demands, possibly for lower pay, and without your usual outlets for relief and restoration. Doesn’t that suck.

Today, reflecting on the moments of anxiety, despondency and at times utter despair that have happened for me over the past weeks, I had a thought. Which I wrote to my friend about in a big wall of text- sorry for the long message Marianne. 

I would rather have the capacity for immense pain (because the corollary would be a capacity for exquisite joy) than to meander through life in a bland sort of stupor. Some days the idea of stupor is very tempting. I think some people are trying to achieve this with a little help from Dan Murphy’s. 

It is a huge privilege to have a complex human brain, to experience all the shades and colours of existence, but with that privilege comes a massive cost- our suffering and existential angst. But isn’t it better to be human, with all that life brings (even stupid plagues)? I hope I will appreciate human life and connections that much more deeply once we emerge from this, battle scarred but hopeful. 

Better to be human… or actually maybe a bear so we can just go to sleep and wake up in the beautiful Springtime, stumbling out of our caves and into each others’ waiting arms. In a state of vitamin D deficiency no doubt. 

It can be helpful when in a state of despair, at a loss for what to do in this moment, thinking you can’t stand it one minute more, to think not of your reality now, but of your future self. Your future self is doing great, and is glad you kept going. So how will you look after yourself now, while you wait for your future to become your now? 

Rebel rebel

Conforming and staying home, but bursting to get out? Here is an alternative rebellion.

Over the past weeks, in amongst the tumult of difficult emotions that has washed by us all, I have been heartened by the beauty humanity is offering, the small kindnesses, the innovation, the warmth. It bombards us daily on social media, alongside the more sobering news. People are generously sharing the positivity they are finding, and it is delightful and gives us all hope.

So by all means, share with us all your wholesome, cosy, family time in quarantine activities. If your heart is truly lifted in these dark times then I rejoice with you.

But I would like to hear from you on the hard days too. If any of you have not had a day, an hour or even a moment where you have felt wretched with despair, then I would like a big glass of whatever you’re drinking.

This isolation and fear is desperately hard. However- the fact that this is hard for all of us does not make your individual suffering any less significant or valid or worth acknowledging. And as we lie insular, each with our individual pain, that is when we are most vulnerable and in need of human connection.

So as you stay in, speak out. Fucking shout. I want to see you: you in your darkness, and me in mine. Can you express what you are feeling, and send it out into the world? Can you draw something that reflects your state of being? Can you share some music, sing a song? Interpretive dance is always welcome. Write a haiku?

Please, that cry you are bottling up deep in the well of your soul- let it out. We need to hear from each other, and I want to hear from you.

Be safe, my friends.

Just get back on that horse

“Tom Wolfe was right. You can’t go home again because home has ceased to exist except in the mothballs of memory.” (John Steinbeck, Travels With Charley)

Once you leave something, can you ever truly come back? Yes, you can physically return but even if things are the same as when you left, you will surely find yourself altered by your leaving, your being away and the often difficult path of coming back.

I know from the experiences of friends that after long periods of sick leave, maternity leave and other career breaks, that it can be hard getting back on the medical horse.

I didn’t work a lot last year, and the financial repercussions of my lighter work load eventually caught up with me and my family. This prompted me to look for a way to catch up. And so I came to sign up for two weeks of locum work up north. 9-6, five days a week, plus a busy Saturday morning clinic on one of the weekends. 

As well as the financial motivation, I was also getting sick of being out of the game, and worried that the longer I stayed away, the more likely I would lost all my confidence and would never be able to go back. This was, in some ways, a test. 

I chose a locum in the same town in which my mother (also a GP) works, so if I got stuck I could ring and say ‘where should I send this patient?’ or ‘does this plan sound reasonable to you?’ 

Happily my good friends would also be holidaying near there, my parents live there of course, and other supportive friends had said to ring them if I needed to at any time. My own family would be far away- but there was Facetime. 

The anticipation of the long hours and stress, along with feeling uncertain of whether I still had the requisite knowledge and skills had me wondering if I was making a huge mistake. I imagined all sorts of situations where I would be helpless. The ‘drug seeking patient’ was one scenario I doubted my ability to manage in a way that would leave me and the patient not too shaken by the encounter.

I asked colleagues how they would prepare themselves for returning to work after being stranded on a deserted island or similar, for the better part of a year. Their tips included sitting in with a colleague for a session, which I did. I asked a colleague whose work embodies the kind of practice I aspire to myself if I could observe her, and this proved very valuable. 

Watching and listening as she saw her patients reminded me that this was all still familiar. I would not be at a complete loss. As an esteemed GP e-friend said this part of me would always be there; it could not be forgotten. This part, the doctor part of me, will always know how to develop rapport, engage with a patient, hear them (truly hear them) and respond. To prioritise clinical issues. To weigh up risks, and set out a plan. 

Any small factoids of clinical knowledge that are forgotten or simply hidden from the conscious mind can be looked up, re-learned. 

Another friend of mine, handily also a psychiatry registrar, gave me some mantras to recite to myself as I navigated my way through the nervousness on the first days of work. One of these I think we could all benefit from:

Feelings are not facts.

You may feel out of your depth and as though you aren’t coping, but just because you feel this, doesn’t mean it’s real. Look at what is real. See, you just saw three patients. You’ve finished your notes, you’re walking to the waiting room to call another. You smile at the nurse in passing. Look at you. You’re coping and you’re getting things done, despite the way you feel. As the hours and days pass, the feeling lessens, because it is no longer relevant. It is a false clue, pointing to a false reality.

Because you can come home. It’s different and you are different, but it’s still home and you’re still you. And you’re not alone.  

When the time came, I did just fine.

GPs- up to their elbows in humanity

In medical school we made paper fortune tellers (a hark back to primary school) to see which specialty we’d end up joining. I highly recommend paper fortune tellers as a decision making aid.

I got psychiatry, which pleased me as it’s human brain-related and I was all about neurology back then. My tutor said ‘Yeah I can see you as a shrink. You’re quite… laid back.’ I’d wondered if she was commenting on my near horizontal position in my chair. At early morning sessions I was so laid back I’d be nearly asleep. I’m an afternoon kinda gal.

We discussed our fortunes and our wishes with another tutor, who commented that cardiology, as one of us wanted to do, was ‘pretty sexy.’ I’m glad to say he really was talking about the specialty and not my good-looking friend, or this’d be a whole different post.

When the sights, sighs, secrets and smells of the GP consulting room threaten to overwhelm, well might we think ‘there’s nothing sexy about general practice.’

We’d be wrong.

I grew up with a GP parent and thought of her colleagues as extended family, so my early impressions of the career have been impossible to shake. These were grass-roots country doctors, stitching cuts, taking blood, delivering babies, counselling and empathising. All with a twinkle in the eye and an air of tired-but-calm patience.

Now a GP myself, I am well aware of the challenges and frustrations of the job, but I like to think about its good points as much as possible.

The beauty of general practice, lies partly in its breadth and thoroughness. GPs get their hands dirty. We don’t just adjust our pince-nez and peer down at your new mole. We’ll measure it, feel its surface, get out our dermatoscope and ogle it. Got a sore foot? We’re down on our knees. Got pus? We’ll be there with a swab. Got an itch in your ear? Never fear, your GP’s here, otoscope in hand. No problem is too big, or too small.

If you look at our faces as we examine something you deem shameful or embarrassing, you’ll see interest, curiosity and concern, not horror or disgust. It’s comforting and reassuring to know your doctor accepts you, warts, pus and all.

We love the variety of our jobs. You can come in to discuss your OCD and we’ll happily look at your rash as well (if there’s time- please book a long appointment if you want the full service)!

Another plus is the GP’s versatility. We can see your baby, your partner, your father, your eccentric great uncle- and some suitably qualified GPs will even see your dog. We’ll see babies grow up, see people retire, watch as an illness wreaks havoc on lives, watch recovery unfold gracefully and hope return to sad eyes.

We’ve got skills. We can wield a speculum, insert contraceptive implants, biopsy your skin, help you quit smoking, check your prostate, and teach you relaxation techniques (which come in handy if you’re having your prostate checked). We can question you gently but in a way that uncovers hidden issues.

We are the ultimate holistic practitioners. We’re at home with the foibles and vulnerabilities of the human mind; the functions and malfunctions of the human body. The good GP is approachable, understanding, capable and wise.

Now that’s pretty damn sexy.

Photo from Wikipedia page ‘Paper Fortune Teller’.

Please comment below if you’d like to mention anything else that’s fabulous about general practice! Or to correct my spelling.

Those who can, teach #2

Last week I spent a session sitting in with a GP who works in bariatric medicine- similar to me, but she has been doing it for seven years. I learned a lot during the session. She involved me in the consultations and spent a good amount of time answering my questions and discussing cases. Since then I have received emails from her with useful references and resources. She has also offered to talk with me over Skype about my own cases.

This was all pro bono.

I know. I am duly humbled and very appreciative of the valuable time I have been given.

One of the lovely aspects of the medical profession is our propensity to mentor each other; helping shape junior doctors into kind and expert clinicians who will give their patients the very best of care.

Often this guidance is unpaid, yet many doctors give so generously of their time and wisdom for the sole reason of improving the care of future patients. Part of being a doctor is looking after our colleagues and aiding each other’s learning. As we work for the benefit of our patients above all, their wellbeing is often the only incentive for our efforts.

I’m a member of the Facebook forum GPs Down Under. This is a cluster of GPs in Australia and New Zealand who offer each other advice and support online. It’s a fantastic group. One GP on the forum said she was talking to a lawyer friend about our forum, who was apparently stunned that we were ‘giving our time and expertise away for free’ (or similar).

I wrote recently about my dear friend in Virginia who passed away last month. She was a shining example of a clinician who was dedicated to fostering the learning of her colleagues and students. She would stay up in the evenings coaching residents for their vivas. She tirelessly taught me, fed me, nurtured me, all out of the goodness of her heart. I know she cared for others in this same way, friends and colleagues alike.

The time I spent with her and the rest of the team at Atlantic Anesthesia was so valuable. And they weren’t paid a cent. It’s not like I was a US med student and a potential future member of their team. I was an Aussie med student and future Aussie doc. What was in it for them?

Knowing that some patients somewhere, some day, will receive better quality care as a result of your careful instruction- this is one incentive. The other? Genuine care for our colleagues, wanting to support them in their development as clinicians and help them flourish.

I think that’s pretty damn amazing.

I would love to hear your stories about memorable mentors and caring coaches, who I know are not limited to the healthcare professions.

Image: Dr De Loony as an impressionable med student far from home, in Virginia USA.

Medical Mentors- thoughts on the passing of a friend

Stories are emerging from the woodwork about bullies in medicine. I’d like to say I’m shocked, but sadly I think most doctors have experienced, seen, or at least heard whispers in the corridor hinting of similar experiences.

I’ve been thinking about the opposite of bullying: where someone is not only pleasant and professional, but they go out of their way to teach you, help you or mentor you. I hope that most doctors have known someone like this, a clinician who they could respect and seek to emulate.

This week a mentor and dear friend of mine passed away and I feel bereft. Besides feelings of loss, regret at not visiting more and pangs of sorrow for her family, I am reminded of the lifelong impact she had on not only the way I practice medicine, but the way I live life.

It was by a happy accident that as a third year med student on an overseas elective in the US, I landed in theatre with Anne, a warm, strong and highly intelligent Scottish-born anesthesiologist. I will be forever grateful for this.

I was not only in need of teaching, I was in dire need of a mentor. Being far from home, in a pretty sticky situation, I felt lost. Life doesn’t stop for medical school and it was a sometimes painful and tumultuous time for me.

She saw I needed guidance and took me under her wing. ‘I’ve decided to adopt you,’ she said, with a pleasing Scottish lilt.

She taught me not only about anaesthetics, but plenty about patient care and rapport, medical ethics, and how to live life fully and generously. Who says anaesthetists are only good with the unconscious!

She took me in for Christmas, introduced me to her family and her beloved boxer dogs. I stayed a while and it felt like home. Looking out over the river from her back window I felt so peaceful.

I have since learnt that my friend has helped countless others. It was completely usual for her to give tirelessly of her time, knowledge, expertise, affection and energy. It was ordinary for her, but to me, extraordinary and so needed.

She would devote evenings to residents who were preparing for their vivas, spending hours going over the minutiae of anaesthetics.

She was wholeheartedly a patient advocate. She was a wonderful colleague, offering to take shifts when others were struggling. She was a support for friends, students, patients and her team. She was always ready with a kind word or a good strong hug.

She passed on her wisdom generously. For example, she told me that it is poor form to tell clinical stories as tales of battle for personal glory, because by doing this you are capitalising on a human being’s suffering and misfortune. I think of this every time I go to tell a clinical anecdote, asking myself ‘Am I telling this story to debrief, to enlighten, for advice- or for glory?’ If it’s for the latter, I keep my mouth shut.

This was a cute thing: she startled easily- but recovered with hilarious immediacy. I came down one morning and she was in the kitchen making coffee. I said ‘Morning!’, and she shrieked and nearly hit the roof. Then she turned to me with a serene smile. ‘Morning,’ she replied. She came over and took my face in her hands and beamed at me, like I was the very thing she had wanted to see at six in the morning.

When I went back to visit her, during a break in my GP training, I was a brighter and slightly more self assured human being. I had no task but to enjoy Anne. To make her coffee, or a meal after her shift, walk her dogs and bask in her sweet company. It was one of the happiest weeks of my life. She welcomed me into her home and her life and I am a better human being as a result.

Though she’s gone, I am determined to carry on being the kind of doctor and human being who she’d be proud to know. She was just one person, but her presence in the world was large and she will be so missed by her family and many devoted friends.

I would love to hear stories from any of you about mentors, role models and friends who have inspired you and touched your lives.

Those Who Can- Teach

Some of the best teachers I’ve had got good results from me by seeming to expect them.

If I gave a subpar performance, they seemed confused. I worked harder if only to avoid that look on their face. I felt like they’d mistaken me for a high achiever, but I was determined they should not now be disillusioned.

The first teacher I remember using this technique- quite by accident I’m sure- was my year 9 history teacher. I had been skulking along through the early years of high school trying not to do too well or seem too smart; not doing my classwork or homework; reading novels under the desk. I made the mistake of participating in the first history lesson of the year, probably to be polite to the new teacher. She jumped on me as a ‘talent’ and so, not wanting to disappoint, I had to actually do history that year.

Later as a medical student, I remember presenting a case in the corridor to my tutorial group and our tutor, let’s call her Dr. Winner. I was about to run off and go to a job interview. I thought I was doing a reasonable presentation, but Dr. Winner kept shaking her head.

‘Come on De Loony, you can do better than this’, she said. Still I floundered. ‘You must be nervous about your interview,’ she offered, and I gladly dropped my eyes to the floor, nodding solemnly.

Under her hopeful gaze I swotted Talley and O’Connor, practiced my examination techniques at home and especially applied myself in neurology- a favourite of mine anyway, but it happened to be Dr. Winner’s speciality.

Another tutor would race up the hospital stairs ahead of us, despite her Cam-booted broken foot. Come to think of it, I think she had broken her foot running on those stairs. She taught us how to get our case presentations to be ‘really slick’. Her enthusiasm was admirable. She had enough energy for our entire group. We were swept along by her backdraft.

Dr. Staghorn taught us ‘the backhand technique’ for examining a prostate, which I still use today. When I must.

Now I’m trying to think of the less memorable teachers, or those who were memorable for their negative effects.

Dr. Claude taught using the always popular Socratic method, which I hated. Still hate, if it’s not done well. Firing questions at impressionable students who don’t yet have the knowledge to answer them is humiliating at best. On the other hand, he let us observe while he inserted a chest drain. That was pretty cool.

And I’ll never forget the tutor who had me perform a testicular exam with no gloves. ‘You don’t need gloves’, said he. I often fly back in time to supply this quick rejoinder to my former, mouselike self: ‘Oh yes I do…’

I’ve learnt a bit about teaching from my years of being a student. I think a good teacher has enthusiasm for their subject, confidence enough to remain patient and kind even in the face of belligerent pupils, and knows enough about their material to be able to explain it well to those who know nothing. As another excellent teacher told me: ‘losing your audience is not a mark of intelligence’. (Who else out there remembers a certain expat American who made neuroscience come alive?)

A good and memorable teacher is one who also brings a little personal colour to their work, whether through the use of stories and anecdotes, well placed jokes or just a little eccentricity.

I would love to hear your stories about memorable teachers, or what you think are the characteristics of a good teacher.

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Some things are easy, but GP ain’t

One of the first things I remember noticing as a new GP registrar was the isolation. After working as part of a team for two or more years in the hospital system, suddenly you are in a room by yourself. Managing your own patients. All by yourself. If you have a nice, approachable supervisor then good advice is a phone call or door-knock away, but you are the one who decides when to call, when to knock.

It’s like you’re on an island sometimes, working as a GP. The patients one by one maroon themselves on your island and you try to help them get back to shore. The other practice doctors are like ships passing in the night. Sometimes you blink SOS signals to each other. But they have their own islands to attend to.

The responsibility skyrockets. After working in a hospital where the ultimate responsibility rested with your consultant, as a first term GP registrar, you see patients who are ‘yours’. If they sink or swim, you are responsible. All the enormous problems they carry in with them are yours for the sorting. You are heavy with this weight and can rarely put it down, if you are anything like Dr. De Loony.

There is so much to know. So much that is barely taught in medical school and that you aren’t expected to know in hospital. The whole of dermatology, for instance. Musculoskeletal medicine, the non-emergency kind. Counselling. Managing depression and anxiety disorders. Nutrition. Advanced paediatric medicine.

You are never finished learning. In any branch of medicine it is the same, but it’s a wider array of subjects to learn about in general practice, that are continually evolving. You not only need to read the studies, but also need to assess the quality of the evidence, to determine how seriously to take the findings.

The RACGP exams are no walk in the park. Dr. De Loony considers she was lucky to pass and credits this achievement entirely to her study group. She was not entirely useless in study group, being voted the most likely to ‘volunteer to fetch beers from the fridge’.

If you are going to sit for the college exams, having a small group of peers (ideally people you like) that you study with is my top tip for success. Resources and knowledge are pooled. You cover more ground and keep each other on track. ‘Have a study group’ and ‘Go to Work’ are the two most passed on exam tips I have heard.

For those non-medicos and medicos-who-don’t-know-any-better who think being a GP is easy and you just have to type referrals, print scripts and sick certificates, trust me. It’s not an easy job. Well, it’s not an easy job to do WELL. And if you’re not doing it well, or suspect you’re not, it’s a scary job to be doing.

A GP, slaving away in the trenches, can encounter any problem in any patient. Newborns, children, adolescents, young adults, the middle aged, the elderly… No patient is ineligible for GP attention. They can walk in with anything and they bring with them their own context, history and emotional baggage. The good doctor engages with them and sifts through the history, performs a laying on of hands, thinks hard while tapping out notes (leading some patients to think we are feeding info to the computer that then spits out ‘an answer’).

There is the world of billing to contend with. It takes practice to charge people for your time, especially when there is a strong altruistic element to your work. Bulk-billing means you take a pay cut, but you may do it too readily as you are kind. Your patients ask you to do it, perhaps not realising your take home pay can be drastically reduced as a result of bulk-billing. You end up not being paid enough to do what you do, to work so hard. Resentment brews.

A GP doesn’t sort out one problem and then send their patient back… to their GP. The patient comes back again and again. You are never finished with them. They are never finished having issues. They are never fixed.

It’s not easy.

As a junior registrar I would find myself fretting over clinical conundrums and finally thinking ‘what this person needs is a really good GP.’ Then I realise ‘Oh. That’s supposed to be me.’

Image courtesy of freedigitalphotos.net.

A Burnt Out Case

It is a difficult time in Australian general practice at the moment. The government has been toying with Aussie GPs by arranging to cut Medicare rebates. Instead of investing more in primary, universal health care, they are trying to devalue it and make it unsustainable. I can foresee even greater time pressure and responsibility as we try to care for our patients in fewer visits. I envisage less remuneration, with constant pressure from patients to accept a lower fee for the same good quality care.

It is at times like this this that a GP may be even more vulnerable to burnout.

What are some of the warning signs of burnout?

You may notice:

Irritability- increasing exasperation with patient demands, the critic in your head that talks back to patients becoming louder and more voluble.

Feeling empty, drained- with nothing left to give. Certainly nothing left over at the end of the day for the people that matter most; family and friends.

Compassion fatigue- Our capacity for empathy is not endless, despite what we set out believing during medical school. You may become impatient with the suffering you encounter. ‘You’ve got a sore elbow? Oh poor you. Some people have real problems!’ says the critic in your head. Meanwhile, the poor patient is actually in great discomfort and perceives you as uncaring, and the patient-doctor relationship is damaged.

Feeling like a fraud- this is quite common among sensitive, perfectionistic doctors to begin with. You may feel you are unfit to be practicing as you are ‘bound to miss something’ or somehow do the wrong thing (although in reality you are probably a very thorough and competent practitioner).

Disorganisation- feeling unable to cope with the competing demands, to juggle paperwork, patients, phonecalls, getting to daycare pick up on time, getting more and more frazzled with no relief in sight… Being an organised GP is hard at the best of times!

Signs such as those above may indicate you need a break, more support, or a change in the way you practice.

What are the signs you watch for in yourself, that tell you it’s time for a holiday, (or a career change)?

Wouldn’t we all love to be the reliable, full time country doc, there in his chair for generations to come, always available, always kind, competent and zen? However, not all of us can do that, and that’s ok. For some of us, this is just not a sustainable life.

I don’t think I can always be that doctor. I need to work out, and then be, the kind of doctor I really am.

What to do if you are burnt out:

Take time off- this is essential. How much? Enough.

Physical exercise. Intense, heart pumping exercise is a great treatment for anxiety. It also helps regulate your mood and manage stress.

Clean habits- good food in sensible portions, quality sleep. Reduce alcohol.

Peer support. This is vital. (My study group has reformed, years after our exams, to enjoy the support that was the best part of our study sessions. We hold ‘study group’ once a month but for the purposes of peer review, friendship and case discussion. It is fantastic).

Watch how you practice. When you start back at work, go slow and take your time. Don’t overload yourself in the attempt to catch up. (‘None of us are indispensible’, a mentor said to me recently, and it is good to remember this. There are other doctors there to care for our patients when we can’t be there).

Remember, it is the patient’s responsibility in the end, to prioritise their own health. Your job is to give them the best advice and care you can, but it is entirely up to them whether to take that advice and accept that care. This can be difficult, especially when the medical profession is made to feel legally liable for everything our patients do. Being on the frontline of healthcare as a GP is particularly tough as we are the first and often the last port of call for all aspects of patient health.

As always, I welcome all of your insights and suggestions for avoiding and managing burnout, a common problem in medicine and other caring professions.

Psychological Pain Relief

Most people in the population self-medicate in some way. Headache? Take a couple of paracetamol. Had a bad night’s sleep? Make it a double shot flat white the next morning. Rough week at work? Hello happy hour!
When does it cease to be socially acceptable, this treating of our own minor ailments? Drowning your sorrows to the point of mild tipsiness is almost encouraged, but end up weeping and drunk on the floor and we cringe. Perhaps when the line of normality is passed and we not only relieve our pain, but become altered in some way, it is viewed in a similar way to the use of performance enhancing drugs.
There are good over the counter options for aches and pains, sore throats and dry eyes. There aren’t so many options for psychological pain. I am not referring to the type of ongoing or recurrent pain due to mental illness, but the kind of distress we all experience from time to time in our everyday lives.
The common responses to these intense feelings are maladaptive, such as the stereotype of the girl who has been dumped by her boyfriend sitting in bed scoffing chocolates then getting trashed with her friends, followed by a drunk-dial of the well-known number to berate him for leaving or to beg for another chance. We can all predict that the following day she is likely to feel worse, not better!
Think of a young girl, trying her best to cope with emotions that feel out of control, aims for short term relief, distraction or other catharsis through cutting herself, or the middle aged man unable to cope with day to day life without a bottle or two of wine. These are familiar stories.

What are some better, kind-to-yourself ways to relieve psychological pain? There are plenty of behavioural techniques and cognitive strategies that can help. Here are some suggestions (and I would love to hear yours):

-Exercise. This can be a mindful, refreshing walk with or without company. It can also be a good heart starting workout that releases endorphins. There is plenty of evidence that intense exercise is beneficial for anxiety and depression, with an effect comparable to medication.
-Distraction, ideally with a pleasant sensation (how about a massage?) or spending time with a friend doing something fun.
-Write it down. Design a haiku that exactly sums up your mind state.Write a journal entry. Write a letter (don’t send it yet but let it sit until the intensity has passed, then re-read it).
-‘Self-soothing’. Run yourself a sweet smelling bath, or brew a loose leaf tea. Sit in the garden and stroke a pet. Listen to some relaxing music. Think of what calmed you as a child and try to recreate it. Wrap yourself in a soft blanket. Have some warm milk.
-Mindfulness can help with the sense of being out of control and can also be very soothing. Use your senses to bring yourself back to here and now. Feel the ground under your feet. Feel the breath flow in and out of your chest. Can you feel the warm sun on your skin? Smell the spring blossoms on the breeze?
-Debrief. After a traumatic event, basic event debriefing (that is, talking about what exactly happened, who, where and when) can be helpful. It is less helpful and can be damaging to do a deep psychological debrief in the early stages following the event.
-Talk to a friend who is in need themselves- not about your problem but about theirs. Providing someone else with support gives you a sense of usefulness and competence, improving your self-image.
-Acceptance. Remember it is normal to feel emotions and react to them. Try to identify the emotion you are feeling and how you are responding to it. For example ‘I feel anxious about going to this party and so I am very frustrated with myself because I wish I was more comfortable socially’. Accepting the primary emotion and not punishing yourself for it through guilt or shame can make the first emotion easier to bear.
-Remember that emotions cannot remain at that intense peak for long. Use a safe technique that helps you cope in the moment, knowing that the wave will subside. Ride that wave.
-Finally, congratulate yourself for being a thinking, feeling human being who is sensitive, alive and expressive and thus makes this world more beautiful. It is good to feel things and you can cope. It may feel like almost too much to bear but you, my friend, can bear it. Feel your feelings, only detaching from them for the purposes of distraction. Do the best you can in the state you are in and look after yourself.

Resources: Psychiatric Times (various articles)
The Dialectical Behavior Therapy Primer, B. Brodsky and B. Stanley, Wiley-Blackwell 2013

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