The salutation for the Friday letter which I have been writing for the last ten years has evolved, as has the format. Since my retirement it has been addressed to “Dear Interested Readers.” For over three years the letter has had a scene from nature as the “header.” The header and much of the evolution in format has been the result of gentle suggestions that have come my way since good fortune connected me to Russ Morgan. Russ is my IT guru and the Director of Information Systems at the Currier Museum in Manchester, New Hampshire.
It was Russ’s idea to have a header. He sent me a mock up of what he had in mind, it was a natural scene, and it was this lead from him that sends me looking each week for a scene from nature that gets me in the mood to write. My “production process” begins with a vague idea which rarely develops until I have decided on the picture. The next step for the Friday letter is to write last section first. After I have expressed my feelings that were generated by the picture, I can then get to the bulk of what I want to say. The picture is literally the foundation of the piece. I sent the picture that heads this posting to Russ before I wrote a word. The picture shows a trail through a redwood forest that is near the home of one of my sons who lives with his wife and two young sons in the redwoods just Northeast of Santa Cruz, California. Whenever I visit them I make sure to take a walk in the redwoods.
After sending the picture and beginning to write, I was thinking about the outdoors, walking in the woods, and the “awe” of being in nature as the convergence of four stimuli: The first is that I keep coming back in my mind to the misery of clinician burnout. I mean misery for both the clinicians and the patients who see them. These days when I talk to friends and family who are patients, I hear stories that must be filtered through the reality that the people who are trying to take care of them, to improve their cancer, to manage their diabetes, to treat their depressions, or to guide them as primary care providers through geriatric miseries, seem themselves to be suffering. I come to that conclusion because I hear about errors in diagnosis that come from inattention. I hear about clinicians who do not seem to care. I hear about clinicians who by body language, or at times by outright declaration, indicate that they have no energy to engage because they are overwhelmed by the mindless work that they must do. Patients sense and can often easily articulate the impression that the clinician is worried more about him/herself than them. Burnout is real and I have yet to see a complete description of cause or an organizational response that seems likely to be effective since there are probably many causes.
Secondly, I am reading a fabulous book, Lost Connections:Uncovering The Real Causes of Depression–And The Unexpected Solutions, by Johann Hari. Hari rejects the idea that serotonin or dopamine deficiencies or other “chemical” imbalances are the primary causes of depression and outlines the research and experience that suggests to him that beyond the genetic and chemical causes that we easily accept, there are at least seven other causes, if not more, that explain the depression and anxiety of the largest number of depressed people, many of whom suffer the side effects of antidepressant therapy without much benefit beyond the placebo effect. For your interest those other seven causes are:
- Disconnection from Meaningful Work
- Disconnection from Other People
- Disconnection from Meaningful Values
- Disconnection from Childhood Trauma
- Disconnection from Status and Respect
- Disconnection from the Natural World
- Disconnection from a Hopeful or Secure Future
It was the chapter on “Disconnection from the Natural World” that fit into my set of four factors converging around this note. The third stimulus was a note from an “interested reader,” Melissa Baughman that came to me a couple of weeks ago:
Dear Dr. Lindsey,
I am a casual reader of your weekly blog. I am a retired Geriatric Nurse Practitioner and have been reading your blogs off and on for a couple of years. One of the things I do in retirement is continue to lead a weekly prayer group at my UCC church in Norwood. As part of that I write a weekly “meditation” to help stimulate our discussions at the altar early on Wednesday mornings to help us continue to explore our faith journeys. Once we’ve had a discussion, then we pray for those in need and often for our country and the world. This week I was out of ideas (usually I make reference to some Biblical passage or a Psalm or someone’s sermon) until I read your blog for the week. I really liked what you said in the end about embracing what we love and what sustains us, especially during this time when there is so much negativity in this “complex and difficult time”. So, I decided to quote you to use as some thoughts for our group to contemplate this week. In case you are interested, I attached what I sent to the group. I just thought you would want to know that your thoughts go beyond Health Care issues. I think your father would be proud!
An interested reader,
Melissa Baughman
The exact lines that she referenced were:
If you are traveling this weekend, I hope all goes well and there are no delays. If, like me, you will be lucky enough to be at home, count it as a blessing and don’t miss the opportunity to be out and about appreciating where you live, and your health that you may take for granted. We live in a complex world at a difficult time. A good strategy for survival is to name and embrace what you love and what sustains you.
Needless to say, Melissa’s response felt like a gift. One of the downsides to writing is that as you write you are imagining a conversation with the reader, but it is a rare gift to have the reader speak back to you as succinctly as Melissa did. I immediately wrote back to thank her, and asked her to include me on her distribution list. I wanted to read the thoughtful and inspirational missives that Melissa creates and circulates to her “group.”
Years ago, I was fortunate to be in a “Balint Group” that discussed the stress of practice and “the doctor as therapy.” Groups like Melissa’s have become a major activity within many progressive religious communities. They are usually referred to as “small groups.” Much like the “early church” the meetings often occur in homes where the participants gather to discuss contemporary ideas and books, as well as scripture. Very regularly these groups discuss ideas about how to be better servants to the wider community and neighbors who are struggling with economic or personal issues or loss. At other times the groups function as “connectors” that in time, as trust develops, provide emotional support to the participants. A major plus is that the groups are often composed of very different people who are “searching for answers” but come from very different starting points. As trust develops the people in the group often recognize that the threads that connect them to one another transcend the variation in their political, generational, or theological points of view.
I found that last week’s letter from Melissa connected with me in a way that was particularly useful as I have become concerned about “burnout” and depression, not only among healthcare professionals, but also within the wider community.
Dear Friends,
2 weeks ago we talked about what sustains us and what we love, all in response to recognizing what may help us in this complex world during a difficult time. It was an interesting discussion and I’d like to share some of the thoughts about what sustains people.
What sustains us:
Connection-to family; knowing you have people that “belong” to you
Meaningful work-doing what we are meant to do
Faith-“is like an oaken staff” (a verse from a familiar hymn to some); gives us hope; “grounds” us-like Jesus’ calming of the storm; not feeling alone
Having a sense of purpose
Love-of spouse, children, family
Nature-the mountains, the ocean, birds, living animals
Continual learning-travel, new experiences, putting self in someone else’s shoes
Church/Church family
Prayer
Using our bodies-“doing”-yardwork, walking
Creating-baking/cooking, quilting, knitting prayer shawls
Music-both listening and playing-“like putting on an old jacket”
Numbers-enjoying the challenge-using it to help others
Does this list include what “sustains” you?
Do you identify with this list?
What might you add?
“Be fearlessly authentic.” This quote was on one of those Dove chocolate candy wrappers I unfurled one day (dark chocolate) for a little treat. It caught my eye because we have talked a lot about “fearing” God, the “fear” of God being “fearfully” made. We’ve discussed how fear might mean more of a sense of awe rather than a sense of being afraid.
In that context can you imagine what it might feel like to be “fearlessly” authentic? / To have your sense of authenticity just feel “awesome”?
Does God see our authentic selves in an “awesome” way? If so, how does that change how we view ourselves, especially out in the world?
Is there power in that for you?
Might this be another way your faith sustains you?…
There was much more, but “the list” resonated with my thoughts about depression, anxiety, and burnout, and the list that Hari offered in his book. I was also drawn to her discussion of “fear” and authenticity. In the English of the King James Version of the Bible which coincides with the time of Shakespeare’s plays and sonnets, fear did equal awe and respect, and the word was used in a much more positive way than we use it now. I felt compelled to continue the conversation with her and asked her if I could share her list with you
Melissa,
Thank you for adding me to your list. It seems that you have a close group of “seekers.” I love the list that you have produced. I wonder if I could use it with attribution to you and your group. I agree with your interpretation of the the meaning of “fear.” It is used for the feeling that we have in the presence of that which amazes us and seems beyond our capacity to control. We resolve the feeling by appreciating the “awesome” nature of what we can see in nature or in the contemplation of the inexplicable grace that is ours if we are open to accepting it.
Gene
The fourth and final “connection” was an article in the New York Times over the weekend. It was written by Dr. Amitha Kalaichandran, a Canadian pediatrician. The long title, Take a Walk in the Woods. Doctor’s Orders: “Forest bathing,” or immersing yourself in nature, is being embraced by doctors and others as a way to combat stress and improve health, was the “hook” for me and the final impetus to bring me to trying to explain why I have felt it to be so important to continue to remind you of the importance of connecting with nature, as I did so often with patients when I was in practice. I will leave it to you to read Dr. Kalaichandran’s article. I will just tell you that because I read the article, I now know that there are “forest therapists.” They are trained and practice according to standards set by the Association of Nature and Forest Therapy. Now, I know that if I ever do return to “ambulatory” practice, the “ambulatory” part will be about walking in the woods and trying to share the therapeutic “awe” of the moment.
