Resilience and Deep Roots

fire

Did you know that the term Psychological Resilience was borrowed from other sciences including epidemiology? That’s right, the conversation about our ability to mentally and emotionally cope with crises came from the study of how to stop the spread of disease, including viruses. In microbiology, as well as ecology and other fields of study, resilience is the ability and rate of a system to recover from the disturbance and return to its pre-disturbed state. While I have seen some great conversations on whether or not we actually want to return to our previous state, resilience will at the very least get us through this crisis, where we can determine what is next.

Resilience is frequently partnered with other terms to describe various system’s responses to stimuli. For example, an Ecologist might discuss resilience vis-à-vis resistance. The latter being the ability of an ecosystem to remain unchanged when being subjected to a disturbance. In the Psychological world, resistance has some other connotations, but I’m going to stick with it for a minute because I like the analogy of a forest fire.

The fire is the virus- it is already burning, and without the aid of a vaccine, it is going to burn for a bit. But not all forest fires are created equal. Some forests, like the sand pine scrub forest in the OCALA National Park, have very low resistance because the ecosystem is dry and the tree’s bark is thin. However, what sand pine lack in resistance, they make up for in resilience. Fire actually causes their cones to open and their seeds thrive in the charred ground.

Much like old growth forests, what you have planted and how deep the roots go will help determine your resilience. Is your forest full of underbrush and weeds? Do you lack the self-care that prevents dangerously dry conditions? We’re all going to get a little singed, but putting in the work will help prevent everything for burning up completely.

The American Psychological Association’s 10 ways to build resilience:

  1. Maintain good relationships with close family members, friends and others
  2. Avoid seeing crises or stressful events as unbearable problems
  3. Accept circumstances that cannot be changed
  4. Develop realistic goals and move towards them
  5. Take decisive actions in adverse situations
  6. Look for opportunities of self-discovery
  7. Develop self-confidence
  8. Keep a long-term perspective and consider the stressful event in a broader context
  9. Maintain a hopeful outlook, expecting good things and visualizing what is wished
  10. Take care of you mind and body

 

 

 

The Cost of COVID is More Than Dollars

When I served as a Chaplain at the VA we spent a lot of time discussing moral injury and PTSD. Many of the veterans we worked with, especially those with combat experience, carried these titles with them. If you’re unfamiliar, moral injury first started appearing in literature following the Vietnam war to describe patients who loosely fit criteria for PTSD, but weren’t responding well to traditional treatments. It occurs when a person perpetrates, bears witness to, or fails to prevent an act that transgresses his or her deeply held moral belief. In other words, there is a split in our souls.

In the last several years many healthcare professionals have been reading about moral injury and realizing that there is a lot of overlap between their experiences and those of combat vets. This has led to some great articles arguing that clinician distress ought be reframed in these terms rather than “burnout.” I can go into that some other time.

Right now I want to address what we are currently facing. And this is not about masks or how we choose to proceed with our social response. We can go into that another time as well.

In my role I have the privilege of working with the frontline. Their job has always been hard. I have sat with nurses whose scrubs were stained with a mother’s tears and the blood of her deceased son. I have listened to doctors lament over treatments that stopped working. I have prayed with front liners of all faiths and traditions over what goes on in those buildings every day.

But something is different with this. I can hear it in the cracking, shaking voices of the most skilled, experienced, and stoic team members. I can see it in their eyes. It looks all too familiar. It reminds me of the soldiers I used to see at the VA.

I am concerned about the human cost; the most valuable resource we have. We cannot ask these teams to pull these shifts, take these risks, and injure their souls indefinitely. There is tremendous wear from long days full of moral and ethical dilemmas one after another and repeated exposure to high levels of stress. Let me be clear: The frontline is resilient as hell. And they are powerful beyond measure, but they are not immortal.

They need us. They need our prayers. They need our solutions. They need to know the community has their backs. The onus is on us to assure them that we are indeed for them.

Here are some basic ways we can help:

  1. Stop posting crap research and bunk science
  2. Receive their laments. Believe them when they share their stories
  3. Partner with your local facility or foundation to get them resources
  4. Lobby, vote, and hold officials accountable for a better, stronger approach to healthcare
  5. Don’t blame, shame, and try to sue everyone when there is an unfavorable outcome

Bonding Together

Several years ago, when I was assigned to the PICU at the children’s hospital, I noticed something unique about that particular team. At first, I experienced it as rejection. I told my supervisor, “those nurses are different than the other nurses; they are walled off and don’t want me up there.” He wisely encouraged me to give it some time. Weeks went by and still nothing. They were cold as ice. I began to think I’d never crack their shells.

And then a little girl came in. She had suffered a devastating aneurism that ultimately took her life. The week she held on included some of the hardest and most beautiful days I have ever experienced as a Chaplain. It rocked those nurses and shattered their steel-like shells into a million pieces. I held on tight. I wept with them, I prayed with them, and I stayed with them to the end. When it was all over, I was their Chaplain. They trusted me and let me in.

I have since gone through this process many times. Emergency, trauma, and intensive care nurses are some of the hardest, but eventually they allow me to join. What I have found is that these gritty, tough as nails individuals are some of the most empathetic, compassionate humans on Earth.

As a student of human behavior and psychology, I am forever wondering what makes people tick. This phenomenon of bonding through shared experience is especially fascinating to me. The good news is that there is a bunch of research out there on it. Turns out that the heightened empathy thing is not a fluke either. Trauma especially has a way of bonding us together.

I won’t go into all the details, but basically, part of the system that helps calm us down after stress gives us a hearty dose of oxytocin (the same hormone that bonds mother and child during breastfeeding). Oxytocin helps us feel empathy and togetherness. In short, teams that move through stressful scenarios together have a strong likelihood of forming bonds. A good example would be those old war buddies who remain connected for a lifetime.

As I reflect on opportunities that stem from our global shared experience, I hope this is part of the good that will rise from the ashes. I hope that we allow our minds to enter into this phase of shared experience. I hope that we find ourselves just a little more connected and having just a little bit more empathy.

Group-huddle

Let Go

Office_printer_KoOlyphoto

When I was first training as a resident Chaplain we would pull 24 hour solo shifts in a level one trauma center. For 8-12 hours during the day we would respond to consults and various emergencies. The 12 hours over night were spent in the on call room and we primarily responded to life threatening trauma and death.

My first Saturday shift I arrived fresh at 0800, eagerly grabbed the stack of consults from the printer, and began scampering about the eight story building. Up and down the stairs I went, room to room, visiting patients and listening to their stories.

By 1100 I had made it through the stack and returned to the office only to find a fresh stack lying in wait upon the printer. Determined, I snatched it up and went right back out. I worked right through lunch, proud of my diligence and work ethic. Sometime in the midafternoon I returned once again only to find another stack. This time, I sat down to pause and during my rest I heard the printer kick on. I walked over to the machine, lifted the warm page to read the assignment, and as I did, another emerged. and then another.

This was the first time that I truly understood that people are going to keep getting sick. People are going to keep dying. And there is not a damn thing any of us can do about it. I knew this in my head, of course. But this was the moment that it was internalized. I sat back down feeling so incredibly small and so utterly insignificant that I wasn’t sure what to do next.

I realized that at the end of my shift when I clocked out there would still be a stack. The stack would be full of consults for hurting people. People who were dying, people who might feel hopeless, people who needed love. And I was going to leave it there. I made a decision that afternoon. I decided to make peace with the world and with myself. I decided that I was going to release that which was never mine: control.

It is when the world feels out of control that we sometimes seek to control it the most. If we don’t let go, it will rip us apart. I’ve seen it with doctors and nurses, executives and administrators, police officers and firefighters, pastors and parents, soldiers and civilians. None of us can stop this world from turning.

Caregivers, I implore you: do not martyr yourself upon this alter. Let us not normalize exhaustion and celebrate poor boundaries. Let us not create cultures that dishonor our souls.

Clock out. Leave the stack there. Go for a run and then go home to love your family. Come back tomorrow.

Decision Makers: you have an ethical responsibility to the team you support. Do not ask them to sacrifice themselves, because they will. Staff them fairly. Train and equip them appropriately. Provide for them justly. The stakes are too high for anything less.

 

 

This Soup is Cold.

TUSCAN_SOUP

“This soup is cold.”

Since reading Eckhart Tolle’s “A New Earth,” I have often uttered this phrase in response to difficult circumstances. The line comes from a section in the book where Tolle presents the following scenario: he orders a bowl of soup in a restaurant and it is cold when it arrives. At this point he has several options, but really it boils down to two: accept the reality or fight against it. Choosing to accept it does not mean he cannot inform the waiter that he would like the soup heated up. It simply means that he does not take the scenario personally.

For Tolle it is about the ego. “The ego,” he says, “loves to complain and feel resentful not only about other people, but also about situations. What you can do to a person, you can also do to a situation: make it into an enemy. The implication is always: This should not be happening; I don’t want to be here; I don’t want to be doing this; I’m being treated unfairly. And the ego’s greatest enemy of all is, of course, the present moment, which is to say, life itself.”

When I say, “the soup is cold” I am practicing what we therapists sometimes refer to as “surrendering.” I prefer the term “radical acceptance.” It is the “accept the things I cannot change” part of the serenity prayer. The waiter did not do anything to me, just as life is not out to get you. We can blame, shame, and complain all day long and it will do nothing to improve the situation. A better path is to simply decide if we are going to eat cold soup or go heat it up.

Why Chaplains Go Too

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Yes, Chaplains really did hit the beaches on D-Day. Of course they were there for religious reasons- they brought faith and sacrament into hell hoping to usher souls into the afterlife. Their blood stained alters were as sacred as any other, for any space where life enters and leaves this this world is holy.
 
But there is more to it than that; Chaplains are called to this side of the grave as much as the other. Our purpose here and now.
 
As for me, I am going to keep heading into work to comfort the hurting and share peace with the sick.
 
But I’m also going to keep going to work because that is where the team is going and I serve them as much as I serve our patients.
 
The nurses, providers, specialized therapists, and techs are all my parishioners. Even those who have different faiths and spiritual perspectives. There is no greater honor than to serve these servants, to bless these hands, and comfort these souls.
 
The days ahead will be long for frontline healthcare teams, first responders, public safety and other civil servants. They will be worn thin, driven tired, and run toward things everyone else is running from. My job is to remind them that they are human, care for their minds and souls, and watch the horizon so they can watch their work.
 
If you are one of these and we come across one another in our duties, remember that I’m not your Sunday School Teacher- I’m not there to proselytize or tell you to watch your f$ckin mouth. But, I will always look you in the eye and let you keep it real.
 
Love,
Your Chap

Take Captive Your Thoughts

CBT

I received a great deal of positive feedback from my post on IFS yesterday, so I decided I would share another simple tool from my toolbox. This one comes from a much more well known and commonly used theory: Cognitive Behavioral. This model is significantly broader than IFS and its history goes back considerably longer. Some even trace its roots back to ancient philosophy. It dovetails well with religious thought too. The Apostle Paul, for example, would have made a great CBT therapist as he repeatedly tells his audience, “take captive every thought!”
 
I am going to simplify the CBT theory drastically for the purpose of practicality. But, the gist of it is this: our thoughts, feelings, and behaviors are intertwined with one another. With this theory, mental health is improved by challenging and changing unhelpful cognitive distortions. The illustration of dominos I have included is rudimentary, but I hope it helps as a visual. Of note, the process is not quite so linear and sometimes moves more freely.
 
The first domino is a precipitating event. For example, as we were scrolling Facebook a few days ago our eyes caught a news story: “President Declares a National State of Emergency.” Immediately following was what felt like a flood of thoughts and emotions. These probably happened so fast that we experienced them as simultaneous. In fact, it might have happened so fast that our reaction felt automatic. But, if we pause and go back, we will discover that each is distinct. The goal is to separate them out and examine them openly. At first this is a slow and clunky process, but with practice it can happen in real time.
 
Here is a real example from my life
👉 Event: I went to the store yesterday to purchase food for my child who has several food allergies only to find many items gone.
👉 Thoughts: “Everything is gone! My son won’t have anything to eat. There are no alternatives. How can people be so selfish?!
👉 Feelings: Helplessness, fear, panic, anger…
👉 Actions: Luckily in this instance I had awareness and felt my body respond, so I was able to go back through the dominos and examine my thoughts (had I not been mindful, my actions could have been an outward display of anger toward others).
👉 Examined thoughts: “well, actually there is some stuff left and we do have more at home. I guess he has enough for right now. Worst case, we can ask for help or think of other alternatives. I guess everyone is feeling a little on edge. I bet folks with less resources are pretty scared.” (notice that a lot of my initial thoughts included fallacious absolutes, blaming, and all or nothing thinking)
👉 Outcome: Inner peace (bonus: I’m not arrested for getting into a fistfight at the grocery store)
 
Inside each of our brains is a little almond shaped mass called the amygdala. The amygdala is part of our limbic system and plays a major roll in our emotional response. Its primary function is to keep us safe from real or perceived threats. When we are going for a walk in the woods and a bear jumps out, the amygdala lights up and flips the switch for the response commonly referred to as “fight or flight.” Our brains are filled with cortisol and adrenaline and other helpful super fuel. Our eyes dilate, our pulse quickens, our palms sweat. Our physical bodies are literally better prepared to run or fight. And this is really handy when a bear jumps out. Not so much when Fry’s is out of gluten free oatmeal…
 
The goal with CBT is to move information from our amygdala up to our prefrontal cortex. This is the part of our brains that processes and sorts information. It is the thinking center that is better equipped to anticipate outcomes and predict the consequences of our behaviors. The more we practice mindfulness the more synapses are built to route information in that direction. Essentially, we can build a super highway that automatically moves information to these advanced reasoning centers. When we do this we discover more inner peace because our brains aren’t being basked in hormones.
 
One final note: Our thoughts are deeply impacted by our core beliefs. Our beliefs about ourselves, other people, and the world around us. One of my core beliefs is that people are essentially good. I believe that all persons are made in the image of our creator and thus worthy of love and compassion. If your core belief is that people are wicked and unlovable you might find it very difficult to find peace no matter how you choose to pursue mental health. Be excellent to each other.

Internal Dialogue

650338 I had a tremendous breakthrough in my own therapeutic process when I was introduced to Internal Family Systems therapy. The shift I experienced was momentous and the healing I found was almost supernatural. Obviously, I cannot condense an entire theory into a single post or substitute the benefits of regular practice, but perhaps I can give you a small gift for your own journey.

Richard Schwartz developed IFS therapy in the 1980s based on his background with systems theory. In short, he described the “internal dialog” within our consciousness as subpersonalities or “parts” (if it helps, think of Pixar’s Inside Out). Schwartz broke these personifications down into different types that he called “Exiles, Managers, and Firefighters.” Our Exiles are the parts associated with shame, fear, etc. The Managers are the parts that attempt to preemptively protect us and the Firefighters are the parts that engage when the exiles start to speak up.
The theory itself has way more depth and includes a “true self” and other important components, but I’m going to skip to the end of the lesson here and get right to the practical. In essence, the take away is that we all have parts and under different scenarios they each respond in different ways.

Right now there is a worldwide shared experience in the COVID-19 pandemic. Each of us has observed a variety of ways different people respond to this stimuli. Panic, stoicism, greed, compassion, generosity, and everything in between. Now, imagine your internal system as a microcosm of this external system. For some of us, our various parts are working overtime. Our internal dialog is running at peak capacity and we can feel the fatigue in our bodies. One component of self-care is slowing this dialog through listening to our various parts. We cannot actually get rid of any of them, so a path toward mental health is hearing them out with empathy and gratitude.

I begin by thanking my Managers and Firefighters. My Managers are quite adept at gaining information; they love data and knowledge and they are soothed by having answers and a plan. My firefighters are helpful too. Although sometimes they are impulsive, drink too much, or create messes in my relationships. Nonetheless, I spend some time checking in with them to reassure them that “we” are going to be okay. If I don’t take this step, I never get to my Exiles because they are often scared and hiding.

Honestly, this crisis hasn’t really affected me much. My Manager parts do the research, collect the data, and take precautions. When directed in healthy ways, my Firefighters offer comic relief and energize some great workouts. And right now my Exiles are doing ok; I grew up in the woods where social isolation was normative. When we were snowed in and the power was out, we were prepared. It meant family time and togetherness. I actually have fond memories associated with hunkering down.

But what about people with different experiences? What if their experiences of isolation meant hunger due to poverty, violence due to others whose Firefighters are amped up, loneliness, pain, or some other negative happening? This is what you and I can see in the behaviors of others. We don’t know their story. The guy hoarding is doing so because his system is fearful, not because he is an awful, selfish person. The woman yelling at the cashier is in survival mode. Her firefighters are desperate to protect the system at all costs.

If you’re experiencing a lot of overwhelming feelings right now take a moment to check in with your parts. Be curious, not accusatory (shame never, ever produces fruit). Thank your Managers and Firefighters and then reassure them that it’s going to be okay. You’re going to be okay. Lovingkindness begins with you and moves outward.

Let Us Play Music

tenor

There is a scene in the movie Titanic where a quintet continues playing as the chaos ensues all around them. As they conclude a haunting rendition of “Nearer, My God To Thee,” the violinist turns to his comrades and says, “Gentlemen, it has been a privilege playing with you tonight.” It is a moving scene not only because it juxtaposes peace against fear and faith alongside uncertainty, but also because it is based on true story. Wallace Hartley, Georges Krins, Roger Bricoux, and Theodore Brailey were all real men who performed this heroic act in real life.

In the book “The Band That Played On: The Extraordinary Story of the 8 Musicians Who Went Down with the Titanic,” Biographer Steve Turner shares many fantastic details of this heroic act of beauty. One of the most outstanding is that Wallace (the leader of this quintet) had previously shared with a friend that if ever he were on a sinking ship he would choose to play “Oh God, Our Help in Ages Past” or “Nearer, My God To Thee,” Thus, he knew the risk and had already resolved to hold peace and hope. Historians account that he was known for stating that music is a bigger weapon for stopping disorder than anything on Earth. I believe he was right.

In times of chaos and panic we do not have the choice of opting out; not choosing is also a choice. Stoicism, comic relief, faith, anger, mockery, are all choices. Frankly, it doesn’t matter if the ship is going down or not. We do not have the option of being separate from the whole. I’ll be honest, part of me wants to disengage and wash my hands of it, but I will not. I wish it were as uncomplicated as having the data and simply educating others, but it is not.

Fear that is based on unreal threats is no less real than fear that is warranted. Read that again. You might be like me; baffled by the behavior of those around you, trying to make sense of the lack of common sense. Or you might currently feel terror, hopelessness, and panic. We’re all somewhere on the spectrum. Wherever we land, we have a responsibility to one another.

Some of us want off ship and some of us are not so sure its going down. If you want off, please make your way safely to the life boats in an orderly fashion. Mind your step, don’t cut the line. If you are staying, let us play music.

No One Wants to Read a Quitter’s AAR

It all lined up perfectly; today is the anniversary of one of my grandfather’s deaths. Next week’s GORUCK Memorial Day HTL is being held in San Diego, where my other grandfather spent his final days and is buried. Both men were World War Two veterans. I was going to wear their dog tags as tribute, hoping that at some point in the small hours their heroism would inspire me to press through the dreaded dark night of the soul. I was already working though my rhapsodic ballad to tell the tale.
 
But, I quit.
And no one wants to read a quitter’s AAR.
 
The military uses the After Action Review to analyze an event. The purpose is to determine what happened, why it happened, and how it can be done better in the future. It is a straight forward, no bullshit process utterly unconcerned about a person’s ego and feelings. It takes extraordinary vulnerability because participants have to name where they messed up and let the team down.
 
While no one wants to read a quitter’s AAR, it’s probably one worth reading.
 
That’s the first problem with how I was going into this thing. My romanticized vision of how I would reflect on the event was absolute crap. I wanted the tale more than the event and that’s a major red flag. The reality of the event is 48 hours of misery; wet, frigid, sandy hell. Cute stories don’t keep anyone going through what this weekend has in store.
 
I think this is what separates people who finish from people who quit. People who succeed might visualize the prize, but they are acutely aware of the work too. They can envision the tough parts of the journey and have realistic solutions for overcoming obstacles. They know that they will fall to the level of their training, so they put in the work.
 
A year and a half ago I injured my ankle. It took me off my feet for months. It was a lonely, depressing time of solitude. I rehabbed back into action, but never made it 100% The last 20 months have been a roller-coaster for my health; times of solid training and good choices along with times of poor choices and lazy behaviors.
 
I did train for next weekend, but not well. I could have slowly and consistently trained and avoided injury. Instead, I was sporadic and aggressive. If I missed a day, I would work twice as hard the next. If I ate crap food, I’d punish myself with extra miles. Somewhere along the way I lost the heart of it. I knew better, but I did it anyway. It was a cyclical web and I trapped myself. In the end, the unavoidable happened; I reinjured my ankle. Not bad, but bad enough that I know I couldn’t complete the HTL. And even if I could manage to push my body through, I am way too far up in my head to finish mentally.
 
So if an AAR is to state what happened, why it happened, and how it can be done better, let me be direct:
I quit. I quit because I got injured. I got injured because I focused only on the finish line instead of the road in front of me, didn’t stay vulnerable with good accountability, and I wasn’t smart or consistent with my training.