mental-health

Trigger Warnings & Trauma-Informed Care

Robyn, , , , 2 Comments

trigger warning (n): a statement at the start of a piece of writing, video, etc. alerting the reader or viewer to the fact that it contains potentially distressing material

Back when I worked in an urban clinic there one doctor would be rostered to cover ‘police cases’ i.e. cases of sexual assault. I dreaded this duty. We all have our weak spots, and sexual assault is one of those scenarios where it’s impossible for me to maintain professional detachment. But it was part of the job at that clinic, and it didn’t seem like an opt-out deal.

I wondered, what if I was a survivor of sexual assault? I was already so uncomfortable, how would I have managed if this was actually a trigger for me? Do our supervisors check to make sure we’re psychologically prepared for this kind of duty? Or is graduation from medical school supposed to guarantee a certain level of psychological fitness?

Recently I participated in a training session for healthcare workers on mental health. The group was discussing self-harm and suicide, a topic that was bound to come up in any kind of training around mental health. But the attitude of a few group members caught me off guard; they were dismissive and flippant. When someone used the phrase “attention-seeking” I had to step outside.

The debate around trigger warnings has gained in velocity and vitriol in recent years. Opponents of trigger warnings label and shame people with mental illnesses as weak. Social media has watered down the phrase so that it’s become a joke, a meme or a gif. Still survivors and their supporters try to carve out safe spaces, where people coping with trauma and depression can exist without sudden and painful reminders.

Should work be a safe space?

For healthcare workers, that would be impossible. We can’t predict what issues the next person will have. The patient is our first priority and we create safe spaces for them.

But what if we could create a work environment that protected the mental health of patients and staff too? What if we went to work acknowledging that other people might be dealing with trauma? What if we recognized the impact of trauma and proactively tried to reduce harm?

I don’t think trigger warnings are the best way forward. Jamaican society exists in a constant state of high tension, repeated trauma and triggers. Trigger warnings at work would be undermined by newspaper headlines, radio talk shows and social media. The added stigma against mental health would make the suggestion laughable at best and condemned at worst. But there might be a middle ground.

The mental health training session wrapped up with an introduction to trauma-informed care, a novel approach that will hopefully change the way we do things. Trauma-informed care emphasizes psychological and emotional safety for providers and survivors. A trauma-informed system realizes the widespread impact of trauma, recognizes signs and symptoms of trauma in patients, families, staff; integrates knowledge about trauma into policies, procedures and practices and avoids re-traumatization.

In a world besieged by natural disasters, civil wars and states of emergency, we need healthcare that is attuned to the realities of our experiences. If we are traumatized as a society we need a system that supports everyone, patients and providers, in achieving good health. Ensuring our organizations are trauma-informed is the best way forward.

Burnout and the Millennial Condition

Robyn, , , , , 5 Comments

Hi, my name is Robyn, and I’m a millennial.

Hi, Robyn.

Millennials are the generation that people love to hate. We’re lazy, immature and largely responsible for the failing state of economies all over the world, especially the cow’s milk industry. We’re liberal snowflakes and angry pussy-hatted protesters. We’re progressive, artisanal and a good number of us still live with our parents.

We’re also depressed, anxious and burnt out.

Yes, burnt out.

If you’re a millennial and you haven’t yet read the Buzzfeed article ‘How Millennials Became the Burnout Generation’ by Anne Helen Petersen, go and read it now. I’ll wait.

Done?

Did it feel like a gut punch? No? High-five for being a well-adjusted human being. But if Anne Helen was strumming your pain with her fingers and telling your life with her words, you are not alone. We are even less alone than I thought we were when I first started writing this because yesterday BBC Three ran an article featuring responses from fellow millennials about how burnout looks in their lives.

Click here for commiseration. Also here.

In case you start thinking ‘Millennial Burnout’ is just another one of those disorders that only affects rich kids from first world countries – stop. Don’t think that. What is wrong with you? I’m a not-rich adult from a developing island state and let me be the first to tell you, that shit is real. Perhaps even more real in an economy that depends heavily on unstable external support and where I’m the first person in my immediate family to pursue tertiary education.

The pressure to perform, to achieve, and to never stop never stopping can easily lead to feelings of overwhelm and underachievement. You have to be on your A-game at all times – opportunity only knocks once. In a fractured health care system where most workers only have baskets to carry water, you have to go above and beyond to help the people who need it. In a society where Facebook and Instagram are as ubiquitous as breadfruit trees you are constantly comparing yourself to everyone else.

We know it’s unhealthy. The lines between work and life have become so blurred that for most of us work doesn’t end when we leave to go home. At home we’re answering work emails, work phone calls, taking work home with us to get it done in time. We – I – sacrifice family time and rest to get a little further ahead on this project or that meeting.

And even though we realize that something’s not quite right, we keep doing it. Sleep suffers, our concentration starts to slip, fatigue starts to drift in. But how can we stop? We’ve got to keep on keeping on because there’s more work to be done, more achievements to unlock, and you’re never going to get that promotion if the boss thinks you can’t handle the job.

I only go to sleep after dragging myself away from the work I brought home. I dream about work meetings going awry. The first thing on my mind when I wake up is ideas for Powerpoint presentations. I reply to work emails at 5 in the morning, and most days I am so tired that without coffee I barely function. I can’t remember how to relax, I obsess over to-do lists and I feel guilty if I take a night off to rest because there are so many things that need doing.

And it’s not just work, it’s the whole shebang. Bills and student loans, grocery shopping and car maintenance and all the little things that add up to keeping us afloat and financially solvent. We call it ‘adulting’. Our parents would have probably called it ‘life’. But life in 2019 is very different from “the way things used to be”, as Granny likes to remind me.

In every corner there’s another concern to preoccupy our thoughts: climate change, the environment, human rights, motherfucking R. Kelly, crime and violence. I live in St. James and even though the State of Emergency supposedly expired in January, I drive past cops at checkpoints twice a day. Not exactly a low-stress work commute.

This morning I texted my best friend, all the way across the world, and asked “Do you ever just feel tired?” To her everlasting credit she immediately demanded to know what was wrong. As I spilled my guts about the mental and emotional fatigue that have plagued me since med school she listened and reassured me that I wasn’t a crazy perfectionist snowflake. And then she told me her own story of overwhelm and I felt less alone.

It’s not just us and the readers over at BBC Three. Petersen’s original article went viral because it resonated with thousands of people. While I’m sure we’d all prefer to have something less depressing in common, it’s clear that this isn’t just some excuse for lazy, entitled failed adults. Haters, step off now.

True to form, millennials have gone all out to find ways to re-pep our step: #selfcare mani-pedis, meditation apps, a smorgasbord of life-changing ‘magics’. But in her essay Anne Helen asserts that no amount of self-help books, life hacks or yoga retreats will fix us. Houston, we have a problem.

Instead she invites us to find joy and meaning by living life, instead of optimizing it. A difficult concept for a generation used to curated social media streams, helicopter parenting and efficient schedules. Can we really stop moving long enough to simply enjoy things as they are? Are we even built that way?

As we millennials move into middle age, a time of life where the dirt settles and the patterns form a picture*, will we get a grip on the subconscious motives that drive us to burn out? Can we stop the imminent crash and burn in time to avoid debilitating illness? (Fibromyalgia is a legitimate concern). Will we ever move out of of our parents’ houses??

Tune in next time for the thrilling conclusion.

__________________________________________________________________

*Quote paraphrased from Yrsa Daley-Ward’s poem ‘Mental Health’. Go and read it now. Thank me later.

Doctors and Mental Health

Robyn, , , , , , , 6 Comments

The lives of medical professionals (at least the part of our lives that we choose to share with the public) are a lot like Instagram posts: lots of happy, successful moments to build the image of being competent and caring. But just like Instagram, real life is never as perfect as that carefully curated snapshot.

If you remember my last post about the things we don’t talk about, there was one really important topic I left off that list:  mental health. Just like physical health, our psychological well-being is integral to the way we function. But while we won’t hesitate to get ourselves checked at the first sign of illness, we balk at the idea of talking about our feelings or worse, spending time in therapy.

Sometimes we don’t talk about it because we feel our patients need to believe that their doctor is operating at peak performance. Discussing our mental health issues openly, or even acknowledging them can have a detrimental impact on the physician-patient relationship. Patients tend to think of doctors as superhuman, somehow immune to the struggles that plague the average person. In reality, doctors have the same problems as everyone else. But we don’t like to be reminded of that. We buy into the con, believing that we are somehow capable of feats no one else can do.

Sometimes that’s allowed, even expected – not everyone can perform brain surgery or resuscitate newborn babies – but other times we overreach. Doctors frequently pull stunts like trying to function normally after 36-48 hours with no sleep. We sweep treatable issues like depression under the rug because of course we can handle it, self-medicating with substance use or else ignoring the problem entirely until it can no longer be contained.

The medical profession carries one of the highest rates of suicide (1.4-2.3 times the rate of the general population). But discussing an issue that can call into question your fitness to practice is absolutely off-limits. In the most ideal and ethical situation, doctors would put the patient’s interest ahead of their own security, but we are human first, driven by the same fears and needs as everyone else. And there is a very real fear that any perceived disability will end or permanently blight our careers.

On top of this is the associated stigma of mental illness that is so very rampant in Jamaica and the Caribbean. No patient wants to see the “mad” doctor who “tried to kill himself”. But if any progress is to be made in erasing this stigma we physicians have to be the pioneers. And since this stigma persists even among doctors, we are the first hurdle we have to clear. After that, education and sensitization of the wider society.

Even though no one seems ready to talk about it* (Megz over at Barefoot Medz is one of the few, doing a really great job) mental health is a discussion we need to have. In such an emotionally draining and psychologically demanding profession it isn’t fair to anyone to have doctors fumbling to look after their mental health alone.

We need to catch mental health issues among physicians from early, as early as medical school even. Mandatory psychological screening for depression, anxiety and PTSD among others should be instituted for all the high risk professions: doctors, police officers, firefighters. We shouldn’t have to wait until a doctor commits suicide or a policeman kills his spouse before doing something. Prevention or at least early detection is paramount.

There’s a lot of work to be done. Efforts have started but they’re halfhearted at best and the government offers little in the way of support. We must be our own advocates and work with other key players to remind the public that there is no good health without good mental health.

*

Further reading: a pediatrician’s experience with psychosis, and a GP’s experience with depression.

*After writing this post, I discovered Dr. Eric Levi an ENT surgeon who is also making strides in the discussion on mental health in doctors. 

Repent

Robyn, , , 1 Comment

You do not have to be good
You do not have to walk on your knees for a hundred miles through the desert, repenting
You only have to let the soft animal of your body love what it loves.

-Mary Oliver

Repenting is a way of life
It is a way of viewing the world:
From your knees, hands clasped, eyes closed tight
“I’m sorry, I’m sorry, I’m sorry”
Still. Not. Good enough.

Before the altars of humility, crucifixes dangling above my bowed, repenting head
I am reminded that I am Unworthy,
Lucky-I-mean-blessed that a god-who-is-love should love me
I have been choking on worthy since I was old enough to cry.

Repent! Is the call of our culture and the cry of my heart,
The vainly shed tears
Repenting is only the beginning, alpha, and omega is the punishment
Penitence demands my sins in blood
And the scars of the mind are forced to heal on the skin

Mine is the sin that is unforgivable, the stain that will not bleach, the idea that will not be expunged
Not by your words or my deeds or
This razor. (repent. rinse. repeat.)

Still I would like to repent –
to cast off,
to be relieved of,
to confess
and be forgiven

Do you ever think about hurting yourself or others?

Quote Robyn, , 1 Comment
“I’d say I think about suicide about as often as I think about getting married.”