Freeing your mind from early programming
Our threat/defence and doing/getting systems are set in motion when we are under pressure (Gilbert and Choden, 2014), but we also have a soothing system that is activated by loving and kind thoughts. It uses the neurochemical system of oxytocin and endorphins – the ‘feel good’ brain transmitters. Owing to various life experiences, many people find this system is under-developed, because of beliefs and behaviours developed when young that still influence how they live their lives decades later. In the first seven years our minds are like sponges, absorbing information from our experiences and the actions and responses of our parents, siblings, and others. The character traits and roles we adopted in childhood may have kept us safe or helped meet our unconscious needs for approval, appreciation, or being loved or liked. If, in childhood, we adopted the role of caretaker or peacemaker, or were rewarded for being good, helpful, or for how hard we worked, we may not have learnt to value ourselves. However without a healthy sense of self-worth it can be incredibly difficult to balance our own needs with the care of others. When our intrinsic nature is to give, we can often find it hard to receive, and later in life this can lead us to over-extend ourselves for others and ignore our own needs. Equally if we never learned to express our wants and needs, set clear boundaries, or handle conflict, we will find it much harder to create the time and space to nurture ourselves.
Harsh inner critic
Another common childhood pattern – that of the ‘harsh inner critic’ – is particularly prevalent in healthcare professionals. Jenny Firth Cozens (2020) noted that self-criticism was found to be strongly linked to doctors’ depression, and those who were self-critical as students were more likely to become depressed later in their careers. She also confirms that doctors experience higher levels of psychological distress and use of alcohol than most other professionals perhaps because the work and its responsibilities are inherently stressful; add to this the vicarious trauma of others’ suffering and unhelpful organisational practices. Yet we nonetheless blame ourselves for things when they go wrong, putting ourselves down if we feel we have failed or made a mistake, and expecting to have coped better. In spite of difficult situations beyond our control, we add insult to injury by feeling guilty for our shortcomings. For a whole variety of reasons, we healthcare workers can be very unkind towards ourselves, but does this sort of attitude actually help us when we are suffering?
I (SE) learnt to recognise this pattern more deeply in myself when I went on a mindful self-compassion retreat as a gift to myself when I retired from the NHS. I wish I had gone to one sooner. For me it was a crash course in radical self-care where my early childhood patterns became clearer and I learned methods for responding to them in a more constructive way. On the verge of becoming a burnt-out doctor I realised how, as a healthcare provider, I really hadn’t been so good at looking after myself despite having practised meditation for many years and being a firm believer in holistic medicine. The course was originally devised by two American psychologists, Christopher Germer and Kristen Neff (2019). They have drawn on Buddhist ideas but also modern science and psychological frameworks. I was very touched by the experiential way they taught the course. There was some theory but the most powerful parts were the practical exercises that meant your own realisations emerged from experience. What also struck me was the importance they placed on the safety of the group. I think this aspect allowed us to go deeply into our own experiences and learn how to face our pain with kindness.
The capacity to extend kindness towards ourselves and others when we are suffering is known as compassion. Compassion is an energetic force (which some would describe as arising from our true spiritual nature of love), that can lessen, soothe and calm our experience of suffering. As health workers we know compassion to be a desirable quality to have because it involves so many relevant qualities and skills. It means noticing suffering and attending to it, understanding what might be causing it – or at least being curious about it, being able to empathise or to some extent feel or touch upon another’s distress and crucially, taking action to relieve that suffering (Atkins & Parker, 2012).
If compassion is our capacity to notice the distress, pain, grief or anguish of another and to respond in a loving way, then what about when I am the one who is suffering? We all have times in our lives when we make mistakes, fail, or when bad things just happen to us. If a friend or loved one were in the same situation, we would usually respond in a kind way, with soothing, reassuring words, a gentle touch or a hug. Yet, when we are suffering, it is often much more difficult to respond to ourselves with the same kindness. Often our harsh inner critic tells us to ‘pull ourselves together’ or to ‘stop being so weak.’ Instead of being kind to ourselves, we amplify our pain by speaking to ourselves in an unkind way or by resisting the situation.
Stressing ourselves out
It is important to understand that negative self-talk and self-criticism trigger the same threat/defence responses as an external threat. With this disempowering thinking style we are literally ‘stressing ourselves out’. The self-critics may have been early caregivers whose voices we have internalised, or our wider culture or community, or arise from some learned need to protect ourselves from perceived threats. This inner critic might be aiming to protect us, but its judgemental and narrow stance is ultimately self-destructive. A first step towards developing kinder ‘self-talk’, is by becoming aware of our tone of voice and the language we use when speaking to ourselves. We might notice that we frequently berate ourselves with words like should, ought and must. Instead, we need to listen to a kinder inner self that has a more understanding voice. This compassionate part of ourselves can motivate us to change by being a supportive coach rather than a harsh parent.
Feel it to heal it
We are used to distracting ourselves with activity, or we may have become so accustomed to uncomfortable feelings that we are not even aware of them anymore. How often do we monitor our well-being and notice when we are under pressure or becoming stressed? When we become more conscious of our own levels of distress, pain and trauma, we can start trying to direct feelings of kindness and care towards ourselves. We are all in the ‘human-being boat of suffering’ together, even though it can feel like we are alone. The fact that we all suffer in our lives actually connects us. Practicing self-compassion allows us to focus our energy and attention on how we might alleviate our pain in a healthy way and activate our innate soothing system to mitigate the damaging mental and bodily systems aroused when we feel afraid or upset.
Though we all have an innate tendency to care and love, it seems that we need to cultivate the habit of being kind towards ourselves intentionally. We all have the ability to act compassionately towards others but often it doesn’t occur to us to direct those same feelings/energies towards ourselves when we are in pain. So, how do we boost this soothing system, given that it isn’t easy to be present with painful thoughts and emotions. However, we can learn and practise ‘warming up’ our response to these painful experiences and turn towards them with feelings of kindness and compassion. Actively doing this has been shown to reduce the incidence of depression and anxiety and make the experience of ‘being human’ easier to bear (Johnson & O’Brien, 2013).
We may have noticed when someone else is distressed that our natural response is to reach out and give them a hug or stroke their back, arm or face. Imagine what your response is to a small child who has fallen over. Gentle words and tone of voice, soothing touch, physical warmth and a smile are also universal triggers for self-compassion. We all have gestures or movements that are self-soothing when we are troubled, but perhaps we hadn’t even noticed we were using them: simply stroking ourselves gently where it feels soothing will help to trigger a self-compassion response.
The soothing system
By turning our attention deliberately to cultivating self-soothing, we can move away from being driven by threat or instant gratification towards self-awareness, self kindness and connecting with others. Activities such as meditation, walking in nature, or creative pursuits can initiate the soothing response. Self-compassion practices can be used ‘in the moment’ or ‘on the job’. For health care workers it’s about including yourself in the ‘circle of compassion’ – so that at the same time as caring for others you are also caring for yourself. For instance, I, (SE), found the following very useful when being with those who felt suicidal. I could practise breathing in compassion for myself and breathing out compassion for them. This enabled me to stay present and attend to their needs whilst acknowledging to myself that this wasn’t easy, and I needed looking after as well.
Acting compassionately towards ourselves means making choices that will contribute to our physical, mental and emotional health in the long term. This may involve self-discipline for changing behaviours, but doing this out of love for ourselves. For those of us in these stressful professions, it may mean choosing our hours and patterns of work more consciously and making choices that actively support our own wellbeing: for example, creating ‘boundary rituals’ between home and work, reducing the number of clinical shifts, working part time, and actively assigning time to relax and replenish. One GP asked their practice manager for longer consultation times for each patient, even though it meant a reduction in income. Another element of radical self-care is to give ourselves permission to seek and receive help: acknowledging our vulnerability can be a very challenging step for those whose work involves helping others.
Empathy or compassion fatigue?
Something too often called ‘compassion fatigue’ is actually ‘empathy fatigue’. Different parts of the brain are activated in these two experiences. Compassion is an energising, activating force that does involve a degree of empathy… but not too much! Consciously understanding and experiencing the differences can help direct our energy in a self-caring manner and help protect us from burnout. Many healthcare workers have generous hearts, high ideals, and a genuine desire to make a difference in the world. But their high levels of empathy may make them more prone to vicarious trauma and burn out. It doesn’t help to become an emotional sponge, resonating with a lot of painful feelings all the time. In fact, most meditation teachers say that you only need to ‘lightly touch’ another person’s pain to empathise with them.
The crucial first step into radical self-care depends on developing an awareness of any unexamined patterns related to self-sacrifice, excessive caring for others, self-criticism or overwork. It’s only when we unearth the roots of poor self-care and release those disempowering behaviours that we can begin to shift our priorities and start to value ourselves. We also need to learn to develop an attitude of self-compassion. Unless we do that, nothing will change. Radical self-care means being aware of, and addressing, vulnerabilities and self-defeating behaviours.
Only when we value ourselves as much as we value others will we able to manage high levels of pressure or stress. Once we recognise those disempowering patterns and are ready to address them, self-compassion practices open a doorway into healthy and constructive ways of responding to our own pain and stress, so we can enhance our wellbeing and avoid burnout.
We have both spent our lockdown days fruitfully putting our experiences into two books – Stillness in the Storm by Jan Alcoe and Sarah Eagger and The Thriving Giver by Sarah Kuipers. They are both reviewed in this issue and we hope they will give you further insights and tools to contribute to your radical self-care.