I am currently reading the newly released book “Five days at Memorial” by Pulitzer prize journalist (and a physician herself) Sheri Fink. It is a gripping, chilling and disturbing read. “Five days at Memorial” describes the few days after hurricane Katrina at Memorial hospital in New Orleans, and how staff tried to care for very sick patients with no power or clean water, with only intermittent access to proper elevators to evacuate staff, very little sleep, sporadic and disorganised evacuation plans and only vague support from the outside world. After the flooding receded, rumors began to circulate that several patients had been euthanized, which lead to homicide charges and a grand jury investigation. This book isn’t a condemnation of those health care workers, it’s an account of how a perfect storm happened within the hospital too: The system completely collapsed. The book makes us ask each one of us: What would we have done in their shoes? Are we ready to cope with a natural disaster in our own institutions? If, for one, cannot be 100% sure that I know what my answer would be. Click here for a NY Times review and here for a CBC feature on The Current.
Today, I am delighted to bring you a feature interview with Dr Judith Davidson who is a Kingston-based clinical psychologist and the author of the newly released “Sink into Sleep: A Step-by-Step Workbook for Reversing Insomnia.”
Do you remember the last time you picked up a book that you could not put down until you had read every last word?
I just had that great pleasure with Laurie Barkin’s book The Comfort Garden: Tales from the Trauma Unit. This is a story of how a dedicated and highly experienced psychiatric nurse found her way into the depths of vicarious trauma and burnout and travelled her way back out again, having learned many important things along the way: Lessons about a dysfunctional health care system, the lack of support often experienced by patients and staff alike, about moral distress, repeated trauma exposure, about the price health care professionals pay when managed care has stripped away the structure that allowed them to do their work safely and ethically.
Sometimes I feel like that’s what we do at the hospital. We hold up the weight of the world. And, in doing so, we hear screams and witness the suffering that sometimes becomes our screams and our suffering, only we choke it back and continue bearing the weight without complaining and without acknowledging that we too need relief. L. Barkin “The Comfort Garden” (2011)
I don’t know about you, but no matter how responsible I aim to be with money, I always have somewhat of a financial hangover after the Christmas holiday – I tend to go a little overboard in December, especially with stocking stuffers (you can spend a lot of money on very tiny things – just because they are small doesn’t mean they aren’t expensive!), food, wine, baked goods, chocolate – all these nice things that I want to contribute to the holiday experience for my loved ones. SO, I thought it was very timely to hear the wonderful Gail Vaz-Oxlade on a recent noon hour show. Gail, if you don’t know her (really, you don’t know her? How is that possible? She is everywhere! Ok, everywhere in Ontario) is a no b.s. financial expert who helps everyday folk to get out of debt. She has two very popular TV shows and several books. Her most recent book Money Rules offers 261 rules on money smarts. I have written about Gail in several prior posts such as here and here and here too.
Listen to Gail Vaz-Oxlade on CBC Radio One’s Ontario Today
Read my 3 post series: Money Matters
Money Matters – Resources to Get your Finances in Order
Money Matters Part Two: A blogful of Resources
Money Matters Part Three: Becoming an Entrepreneur
One of the things I have done in the recent years to help with the Christmas shock, is to open a separate savings account called “Xmas” in which I deposit a small amount each month. That way, I have a clear sense of what I am working with. My mistake was to create an account called “Xmas/Kids’ Summer Camps” which I now realise doesn’t work for our new reality and simply means that I don’t actually have a clear sense of how much money I am working with. But that’s an easy fix. With most big banks nowadays, you can open savings account in a matter of minutes online, providing you already have a main account with them. Scotiabank, certainly, is very user-friendly about this. I have 6 savings accounts in which I dole out a certain amount at the start of every single month. That way, I have a very clear visual of where the money is going and how fast it’s going. It’s sort of a virtual version of Gail’s Money Jars.
Now can you tell my 12 year old son to stop growing? Buying shoes every three months is throwing a very large wrench in this well laid-out plan.
Coming soon: A feature interview with a professor in a Child and Youth Worker program who will share with us how she incorporated the Compassion Fatigue Workbook in her practicum course.
I have been doing a lot of training this Fall, offering the introductory course on compassion fatigue and vicarious trauma, the Part Two compassion fatigue workshop (a brand new presentation), a series of workshops on mental health, crisis intervention and the compassion fatigue train the trainer. I love doing these presentations as they are always different: each group has different needs and reactions, and each group has resources that are best suited to them.
I will soon be winding down for the season and taking the month of December off to retool and…read lots of books! I grew up in a book-loving family and the best part of Christmas was always settling down with our new book haul and settling in for hours of pleasure and escapism. We used to go to this wonderful second hand bookstore in Montreal called the Book Nook (sadly, long gone) and do most of our gift shopping there.
In the spirit of the holidays, here are the books/CDs I would recommend you put on your wish list:
Gabor Maté’s workshop in Toronto last week attracted so much interest that the location had to be changed: Within days of posting the event, five hundred participants had signed up. The organisers had to scramble and find a new location for the event and settled on a movie theatre. I was a bit sceptical when I settled myself in for the talk: there were no visual aids, just a gaunt man dressed in black standing at the front of the theatre with a few newspaper clippings in his hands. And then, the day began and I lost track of everyone else in the room. Dr Maté is a gifted and riveting speaker.
Instead of trying to explain his message in my own words, here is an excerpt from his website which describes the message in the book and in his workshop:
“Can a person literally die of loneliness? Is there a connection between the ability to express emotions and Alzheimer’s disease? Is there such a thing as a “cancer personality”? Questions such as these have long surrounded an often controversial debate regarding the connection between the mind and the body in illness and health. As ongoing research is revealing, repressed emotions can frequently lead to stress—which, in turn, can lead to disease.
Provocative and beautifully written, When the Body Says No provides the answers to these and other important questions about the effects of stress on health. In clear, easy-to-follow language, Dr. Gabor Maté lucidly summarizes the latest scientific findings about the role that stress and individual emotional makeup play in an array of diseases, including heart disease, diabetes, irritable bowel syndrome, multiple sclerosis, arthritis, cancer, and ALS, among others.
Offering profound insights into the link between emotions and disease, When the Body Says No explores the highly debated effects of stress on health—particularly of the hidden stresses we all generate from our early programming. Dr. Gabor Maté explains how, when the mindbody connection is not optimal, various illnesses can crop up—everything from heart disease and eczema to irritable bowel syndrome and ALS. He presents the scientific evidence that a connection exists between the mind and the immune system—along with illuminating case studies from his years as a family practitioner that reveal how one’s psychological state before the onset of disease may influence its course and final outcome.
As Dr. Maté wrote in The Globe and Mail: “When we have been prevented from learning how to say no, our bodies may end up saying it for us.” When emotions are repressed, this inhibition disarms the body’s defenses against illness. And, in some people, these defenses go awry, destroying the body rather than protecting it. Despite a rapidly accumulating body of evidence attesting to the mind-body unity, most physicians continue to treat physical symptoms rather than persons. When The Body Says No argues persuasively that we must begin to understand the mindbody link in order to learn more about ourselves and take as active a role as possible in our overall health.
Dr. Maté explains how the dynamics of self-repression operate in all of us. With the help of dozens of moving and enlightening case studies and vignettes drawn from his two decades as a family practitioner, he provides poignant insights into how disease is often the body’s way of saying “no” to what the mind cannot or will not acknowledge.
Above all, When the Body Says No promotes learning and healing and helps improve physical and emotional self-awareness—which, Dr. Maté asserts, is at the root of much of the stress that chronically debilitates health and prepares the ground for disease.” from www.whenthebodysaysno.ca.
Dr Maté will be returning to Toronto for an encore in June.
**Addenda: I have just received the flyer for Dr Maté’s next presentations: June 28th 2010 at the AGO in Toronto and June 29th at the Cinémathèque in Montreal. For more information visit the Hinks Dellcrest Centre.
I am right in the middle of reading this book but wanted to share it with you as it is such a find. The author has over 20 years of trauma work under her belt and brings a very fresh look to vicarious trauma.
She explains the use of the term stewardship in the following way: “As I see it, trauma stewardship refers to the entire conversation about how we come to do this work, how we are affected by it, and how we make sense of and learn from our experiences. In the dictionary stewardship is defined as “the careful and responsible management of something entrusted to one’s care.” (Van Dernoot Lipsky, 2009)
I was instantly grabbed by the book’s introduction, called On the Cliff of Awakening, which articulated something I could completely relate to (so could thousands of helpers I have met along the way.)
To quote from her intro:
“Are you sure all this trauma work hasn’t gotten to you?” He asked.
We were visiting our relatives in the Caribbean. We had hiked to the top of some cliffs on a small island, and for a moment the entire family stood quietly together, marveling, looking out at the sea. It was an exquisite sight. There was turquoise water as far as you could see, a vast, cloudless sky, and air that felt incredible to breathe. As we reached the edge of the cliffs, my first thought was, “This is unbelievably beautiful.” My second thought was “I wonder how many people have killed themselves by jumping of these cliffs.” Assuming that everyone around me would be having exactly the same thought, I posed my question out loud. My stepfather-in-law turned to me slowly and asked his question with such sincerity that I finally understood: my work had gotten to me. I didn’t even tell him the rest of what I was thinking; “Where will the helicopter land? Where is the closest Level 1 trauma center” [...] this was the first time I truly comprehended the degree to which my work had transformed the way that I engaged with the world. ” (Van Dernoot Lipsky, 2009)
I will share more about this book as I read on, but so far, it’s very engaging.
Chapter headings are:
Part One: Understanding Trauma Stewardship
Part Two: Mapping your Response to Trauma Exposure
Part Three: Creating Change from the Inside Out
Part Four: Finding your Way to Trauma Stewardship
by Robert J. Wicks, Oxford University Press
This short, reflective book was written specifically for clinicians: psychologists, mental health counsellors and social workers. It will be most useful to those with a background in clinical psychology who do face to face work with clients on a regular basis.
Dr Robert Wicks is a psychologist and a professor at Loyola College in Maryland. “A recognized expert in the prevention of secondary stress, in 1994 he was responsible for the psychological debriefing of relief workers evacuated from Rwanda during that country’s bloody civil war.” (from his book bio)
I was thrilled to see that Dr Wicks centers his approach on the use of positive psychology and mindfulness.
Robert Wicks explains his goal in writing the book as: “to introduce and highlight those areas that can help renew clinicians in today’s challenging climate. It is amazing how little it can take to change the emotional tide in favor of such a beneficial move. Small alterations can sometimes jumpstart a positive step to a healthier attitude more than disputing dysfunctional thoughts ever can.”
Chapters headings are:
Sensing the dangers: Chronic and acute secondary stress
Enhancing resiliency: strengthening one’s own self-care protocol
Replenishing the self: Solitude, silence and mindfulness
Daily debriefing; Mindfulness and positive psychology
My conclusion: A lovely erudite book on self care for clinicians who are ready to reflect on their own journey of compassion fatigue and self care.
Mindfulness-Based Stress Reduction (MBSR) is a holistic mind/body approach developed by Jon Kabat-Zinn at the University of Massachussets Medical Center in 1979. MBSR is “[...] based on the central concept of mindfulness, defined as being fully present to one’s experience without judgment or resistance”. (Cohen-Katz et al, 2005) The MBSR program recommends using meditation, yoga, relaxation training as well as strategies to incorporate these practices into every day life.
Research on the effectiveness of MBSR is highly conclusive: over 25 year of studies clearly demonstrate that MBSR is helpful in reducing emotional distress and managing severe physical pain. In fact, MBSR has been used successfully with patients suffering from chronic pain, depression, sleep disorders, cancer-related pain and high blood pressure. (Cohen-Katz et al, 2005) Based at Toronto’s CAMH, Zindel Segal has developed a mindfulness-based cognitive therapy program for treating depression that has shown to be highly effective.
MBSR and Compassion Fatigue
Researchers recently turned their attention to the interaction between MBSR and compassion fatigue (CF), to see whether MBSR would help reduce CF symptoms among helpers. One study of clinical nurses found that MBSR helped significantly reduce symptoms of CF, as well as helping the subjects be calmer and more grounded during their rounds and interactions with patients and colleagues. (Cohen-Katz et al, 2005) Another study investigated the effects of teaching mindfulness-based stress reduction to graduate students in counseling psychology. The study found that participants in the MBSR program “reported significant declines in stress, negative affect, rumination, state and trait anxiety, and significant increases in positive affect and self-compassion.” (Shapiro, 2007)
That’s what Quill and Quire had to say about Tilda Shalof’s two books: “A Nurse’s Story” and “The Making of a Nurse”
I devoured these two books in 48 hours. Could not put them down.
Tilda Shalof is an intensive care nurse who works in Toronto and has been in the field for over 20 years. She is also a gifted writer and storyteller. I found her books riveting for two reasons. The first is that I have always loved hospitals (go figure, I know that is rather unusual) and found her account of working in the ICU absolutely fascinating. She describes the dynamics between nurses, dealing with doctors and residents, patients and their families, particularly when things go wrong.
The second thing I found fascinating about these books was her description of the challenges of the work on nurses’ emotional and physical well being. In “The making of a nurse” she describes the phenomenon of somatic empathy perfectly: “[patients] needed to feel that I was steady and in control, but I couldn’t always offer them that security. I caught their emotions as if they were contagious. Sometimes, merely being in the presence of a patient, family member, or even another nurse, who was flustered, anxious, or angry would affect me, and I would respond in tandem.“ [...]
“I’m panicking,” she said in a tremulous voice. I looked around the room for a chair and luckily, just then, the technician caught her as she keeled over. Full-blown panic had finally done her in […] I exhaled, I hadn’t realized how shallow my breathing had become, how tight my chest was, how jittery I felt. I had caught a bad case of her panic” Tilda Shalof, (2007, p.130)
This is a concept that I discuss at length during my half day and full compassion fatigue workshops. Babette Rothschild explores several concrete strategies to deal with this somatic empathy in her book Help for the Helper (2006).
One caveat: A colleague of mine who has a great deal of experience in acute care nursing did warn that Tilda’s books may be retraumatizing for anyone who has worked in critical care or has experienced ICU first or second hand as her descriptions are quite detailed and very accurate. (thank you for that, Jan)
I’m off to Montreal this week, to present at the Jewish Rehabilitation Hospital, then Timmins next week for a one day presentation in the community. This has been a full and busy Fall with a lot of writing and workshop design and more to come. It’s a wonderful profession. Truly.