Mine was neck pain for the longest time. I could usually relieve it with a brief massage until starting a very stressful job, where I quickly developed daily pain, stinging and tight. Then nothing helped, neither massage nor ibuprofen, only vacation, for 5 years until I left. During pandemic lockdown, low back pain emerged as a new physical manifestation of mental stress.
For the past month I have had varying degrees of lumbar pain, but it did not occur to me that it was stress related. I must be doing my dead lifts wrong, I thought. I must need to stretch. But nothing seemed to help after a while, and it got worse after Thanksgiving. That weekend, I found out in no uncertain terms how I had hurt someone very close to me. I always had an inkling, but the full impact of my actions became clear in one starkly honest conversation. In the emotional overwhelm, I could only process a little at a time, mentally (hence the I Wish I Was Better For You post–I was actually thinking of a different relationship, but the idea for that post brought up multiple relational regrets all at once). The rest landed squarely and heavily on my back. It was sore during the days, and woke me up from sleep at night with severe pain and stiffness. I was not limited during my Ethos workouts, though–in fact, I felt better during exercise. After a relatively easy session last Sunday morning, I sat the rest of the day writing, and that night felt like I was both 100 years old and got hit by a truck. It was slowly dawning on me, the origin of my physical pain: The full depth and persistence of my relational fuck-ups was unfolding into conscious awareness, and it was painful, quite literally. Looking back, I was also much more tearful than usual in the past month–like leaks of extreme emotion springing forth, portending.
As is often the case, conscious awareness brought alleviation of pain. No NSAIDs, no physical therapy, no yoga, just an emerging understanding and acceptance. And insights: I realized this week that when I get sad, I get sedentary. I lean heavily toward stillness, with a strong urge to write for release, instead of moving, which is how I relieve anxiety and anger. This past month my workouts diminshed and verbal output escalated significantly. Writing helped untangle and clarify thoughts (I knew I was projecting self-loathing, I just didn’t know why), but I think the lack of movment may have perpetuated repression of feelings, thus diverting them into spiraling physical pain. Now I know, Opposite Action helps: Under stress, doing the opposite of my wallowing tendency can keep me healthy. Hopefully the next time I experience profound sadness (or guilt, or shame), I will resist the pull of the comforting though potentially counterproductive chairs and instead get on the elliptical.
My friends also helped this week. When I told them my sorrowful discovery, they held space for it so lovingly, so patiently. No platitudes, no false positivity–only empathy, validation, and compassion. They shared their own hardships, and I helped them hold it, too. How lucky am I, to know these wonderful people, to have them in my corner? The mutual uplift is absolutely synergistic and exponential, as is my gratitude.
I wrote about forgiveness last month, and how withholding it harms the (un)forgiver. Today I understand acutely how it also hurts and plagues the unforgiven. My loved one forgives me, thank God; I think I can forgive myself more easily now that I know that. We shall see.
“Big feelings” don’t just happen to kids. We grown-ups experience big, hard, complicated emotions as much as anyone. ”So much, so much,” as my friend’s daughter used to lament. ’Immense,’ as it occurred to me this week. Elation, gratitude, grief, guilt, regret, joy, humility, connection–it can all really be so much–sometimes too much for a mind to hold. So it puts it in the body for a while.
After several days of chasing–analyzing, journaling, thought experimenting, self-flagellating–I finally ran out of evaluative fuel and just let the feelings be. Rather than mixing, kneading, stretching, and folding, impatiently trying to shape the nebulous into a smooth ball of cognitive comprehension, I put it to sit and ferment a while. It didn’t take long for a form to rise, to show me what it was made of. I see now what’s been happening. Hopefully I can take the learning and apply it next time. [HA! Who knew a post on dark emotions could include a fun sourdough analogy?]
My back feels fine today, better than it has in weeks. Fascinating.
Photo by Lyra Luu, Schalenbrunnen im Botanischen Garten, Munich, June 2023
I count 47 posts on this blog when I search ‘mindfulness.’ I talk about it almost every day with patients. Of all self-care practices I have acquired over the years, I think this is the most useful. Funny how I did not list it in the stress management post this month? Maybe because I see mindfulness as a way of being more than something I do? It really does bring me peace, for which I am both grateful and proud, as I have trained long to gain its benefits.
If you’re not yet familiar, I recommend starting at www.mindful.org. From their site:
“What is mindfulness?
“Mindfulness is the basic human ability to be fully present, aware of where we are and what we’re doing, and not overly reactive or overwhelmed by what’s going on around us.
“While mindfulness is something we all naturally possess, it’s more readily available to us when we practice on a daily basis.
“Whenever you bring awareness to what you’re directly experiencing via your senses, or to your state of mind via your thoughts and emotions, you’re being mindful. And there’s growing research showing that when you train your brain to be mindful, you’re actually remodeling the physical structure of your brain.”
Ok so, how do I already do mindfulness well? –I have a strong informal practice. Often and at any given moment, I drop (or rise) easily into awareness of my environment, the people around me and their signals, and my own physical, mental, and emotional sensations. Even when it’s uncomfortable or painful, I can hold it loosely, with openness and curiosity. I wonder how many times a day I say or think, “Huh,” “What is up with that,” and “How fascinating”? This leads me often to novel questions, which I then express to others, engaging in unexpected ways, which is almost always more rewarding that I anticipate. –My practice helps me be present to others as they need me. When I attend to what is, resisting the pull toward what I want or what I think should be, I can empathize, validate, and reflect with others, rather than go straight to problem solving, which is seldom what people want or need. –Mindfulness makes me a more sensitive and agile speaker. As words and expressions form in my head and exit my mouth, I monitor their intent and impact in real time. I speak quickly and at times with sharpness and irreverence, but more often with kindness and passion, and rarely without thought to every word. Is that mindfulness or conscientiousness? Probably something mutually entwined? –I lead by example. People say they feel peaceful around me, that I have a calming effect. I attribute this to my ability to be with whatever is, in the moment, without (or with minimal) judgment, together with others.
How could my mindfulness practice be better? –I could establish a formal sitting practice. A daily session of breath and awareness, a mental discipline to quiet the monkey mind, to strengthen my parasympathetic nervous system, would likely make me healthier in all domains. I’m just not quite moved yet to commit. But maybe if it helps my writing… –I could read more of the masters’ works: Jon Kabat-Zinn, Thich Naht Hanh, Sharon Salzberg, Pema Chodron. Then I’d be more knowledgeable, could maybe explain it better to people whom I think could benefit. ..and if it helps my writing… –Overall I’m pretty satisfied with current state. I faced trials of the last several years with relative equanimity, and the challenges themselves strengthened my practice. I trust myself to know when I need to do more, because I’m mindful enough already to notice.
What’s already good about our collective mindfulness?
Awareness. John Kabat-Zinn developed Mindfulness-Based Stress Reduction (MBSR) as a meditative therapy method for stress management in 1979. I learned nothing about it in medical school or residency. I’d say the first ten years of my career, mind-body medicine was still considered fringy; colleagues would stare blankly or even roll their eyes when I talked about it. Today mindfulness and other techniques of meditation and mind-body practices live in the mainstream, their benefits available to everybody, and fewer people feel self-conscious about participating.
Language. “Be with what is.” “Hold the space.” “Withhold judgment.” “Breathwork.” One could say that mindfulness lingo has infiltrated our general vernacular. Good. These concise phrases can moor us to a mindset of alert and relaxed presence, which makes us calmer, less impulsive, more attuned, and healthier. Words matter; the more we can use them for mutual de-escalation and connection, the better.
Connection. As mindfulness gains awareness and its expressions spread, fellow practitioners can connect more easily in any forum. They become magnets for yet others, and communities form around this attentive way of being which, nourished by strong ties, makes us better leaders by example wherever we go, to whomever we encounter. Jeez, I’m making it sound like a cult.
How could we do better together?
Teach Mindfulness In School. Mindfulness skills are life skills. Learning breath work, body awareness, and mental discipline in iterative, age appropriate ways prepares children and adolescents to tolerate and navigate an ever accelerating world of volatile change and chaos. It would be easy to incorporate skills practice into play, sports, and academics at all stages of brain and social development.
Incorporate Mindfulness Into Leadership Training. Thinking of leaders you admire, what qualities and behaviors make them great? Mine give me their full attention, make me feel seen, heard, and understood. They emote relatably, easily, and appropriately, and also carry themselves with steady, unflappable confidence. They name what is with clarity, desireable and/or not, and hold it peacefully while working consistently for change and improvement. They are honest. Thus they attract and inspire followers rather than coercing them. Healthy mindfulness skills and practice amplify and maximize relational leadership strengths by grounding leaders in self-awareness and self-regulation as foundation for outward action.
Just writing about mindfulness lowers my respiratory rate and helps me attune to myself and my surroundings better. I feel gratitude and peace, confident in my ability to face and manage whatever comes around the corner, satisfied that I have lived the present moment to its fullest. I have very little to regret if I can keep this up.
It’s November of the hardest year in my recent professional memory, and the escalating stress levels I witness every day show no signs of abating. My patients are sleeping poorly, gaining weight, and their blood pressure continues to rise. They miss quality time with loved ones and rethink their life paths more seriously now than ever. Strangers on the street seem increasingly confrontational. The world is once again embroiled in war and violence. Our stress management skills are called forth, no question.
I attended the second ever Harvard Medical School coaching conference in the spring of 2009, where I met Benjamin Zander and The Art of Possibilitybecame my personal development bible. Roz Zander, co-author, former wife, and decades long collaborator to Ben Zander, died suddenly this year. I hope my writing and impact may honor her, as these 14 years of my inner and outer work, sparked by the Zanders at that meeting, made me a better person that I would otherwise have been, founded on the practices in their book.
**Deep breath**
It’s been at least a decade, and I still ask patients to assess work stress in terms of threat and challenge. Threat stress–basically fight or flight–is physiologically taxing, meant to last seconds (not years), and costs us our health if prolonged. Challenge stress is activating, productive, and beneficial. I also query about personal fulfillment from work–meaning. We can tolerate very high levels of stress, even prolonged threat, if it’s worth it to us.
Parenting may be a better example than work. When we fear for our children’s well being, and even their lives in crises, how do we manage that? Is there any worse threat? We’d all rather it be ourselves suffering than our kids, right? How do we cope when we have no control?
At the risk of sounding arrogant, I feel very confident in my stress management skills. This is not to say I don’t experience severe stress or feel its consequences. I just move through it much more easily and with a lot less suffering now than in the past. I feel a lot less threat than challenge. Briefly, the practices: —Breathe. Ever since my first medical assistant posted “TAKE A DEEP BREATH” at my workspace, I have appreciated the calming effect of one deep breath, physically and psychologically. We can breathe ourselves through childbirth, injury, emotional trauma, and myriad other urgent and emergent situations. Deep breathing stimulates the de-escalating parasympathetic (rest and digest) nervous system, balancing the autonomic hijack mediated by the sympathetic system. I breathe along with patients when I listen to their lungs. I inhale deeply when listening to books, and during strenuous exercise. It is my central grounding practice. —Accept. “It is what it is.” This has nothing to do with how I feel about it. But the sooner I separate what is from what I want it to be, the less I suffer. Obviously I find this much easier to do for things I care less about. But even for big things, like the state of our healthcare system, the brokenness of our government, and my estimate of the ultimate demise of humanity (I think five more generations, give or take), just being with what is, as a first step to figuring out what to do next, helps me suffer a lot less. —Withhold judgment. I’m really good now at not jumping to conclusions and not making sweeping judgments about people based on limited information. I am able to separate judgment of actions from people’s character and humanity. If you’re screaming at my team and me, you are clearly unwell. We can hold you accountable to your actions and still show you compassion and respect. I don’t have to think you’re a bad person. This way, I don’t take your negative actions personally, and I can stay calm and even. —Get help. I ask every patient every year about their emotional support network, because it matters. Mine is phenomenal and I could not be more grateful. But I only know they are so because I call on them enough and they on me. Rarely I am disappointed, and I learn to turn elsewhere. I cannot overstate the profound importance of tribe and connection. It is my raison d’etre. —Move. When daughter was admitted to the hospital and I stayed with her there, I made sure to get on the ellipitical each day that week. When I go too many days without movement, I get edgy and stuck in my thoughts. My stress is exponentially more manageable if I protect my workouts, which I have now done for many years. —Attune and differentiate. My greatest stressors involve other people. Friction, tension, grating, colliding, etc. Since my LOH leadership training helped me articulate these complementary concepts, I recognize now that attuning/aligning with others, as well as differentiating and standing firm in my own core values and practices are equally important and fluid in their dynamics. Feeling out that optimal integration in any given interaction is rewarding in itself, and the outcomes are always better when I attend to both, knowing that I am showing up true to myself. What more can I ask of me?
So what could be better? Anything, really. For the rest of my life, new stressors will continually emerge. In his book Master of Change, Brad Stulberg quotes a statistic that in an average adult life, we will experience 34 major disruption events, which works out to about one every 18 months. Sounds about right to me! So I can expect to be challenged and trained in all of these skills and more, usque ad mortem. I only hope I can keep learning, applying, improving, and growing. Bring it.
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I feel less harshly about our collective, societal stress management skills and outcomes than I do about our obessions and ironies with exercise and nutrition. Really, I think everybody’s doing the best they can, with the skills they have, in the circumstances of their lives at any given time. I just wish our environments didn’t create and perpetuate so many of our stressors in the first place.
So what’s already good? —Potential. We are all surrounded by one another. So every encounter, any time, any place, is an opportunity to do people-ing better. In any given relationship, if anyone is willing at all, there is always the chance for repair after rupture. Humans are innate learners; we can continually acquire the skills to stop impaling ourselves with the second arrow of suffering, after the arrows of pain hit us in daily life. We can even hold one another up and heal our injuries together. —Books, teachers, resources. Those aisles and shelves of stress management books really are dense, and I can say with conviction from first hand consumption that the knowledge and potential benefit living in those pages is immense. For those with the bandwidth to actively seek, consume, digest, and apply, lives can be transformed, especially if shared, discussed, and practiced together. –Sometimes it really doesn’t take much. Your friend calls to check on you. A stranger helpsy you carry your groceries. When we say ‘it’s the little things,’ we speak truth. Small acts of kindness and incidental connections will not solve our hardest problems, but we must not underestimate their profound potential to help, and for that help to amplify in unexpectedly large ways. What’s more, both the helper and the helped benefit from the encounter.
What could be better? –Teach it explicitly. There is a movement afoot among Dialectical Behavior (T)herapists to formally incorporate stress management skills into school curriculum. DBT organizes life skills around four central pillars: Mindfulness, Emotional Regulation, Distress Tolerance, and Interpersonal Effectiveness. Within each module are sets of practices, many with campy acronyms to help us remember. I refer patients to the DBT skills website often, not just to help them cope better themselves, but to help them model better coping skills to their children, direct reports, and leaders. Simply having the confidence that we can handle whatever comes our way, because we know what to do, decreases stress exponentially. What if we learn these skills in childhood, before the chaos of adolescence and serial tumult that is adulting? Can you imagine? –Relational Leadership Training and Valuation. Leadership done well is a practice in empathic, compassionate, accountable, and transparent stewardship. It is a way of being and doing, one that requires high level self-awareness and self-regulation, and excellent attunement and communication skills. Right now I think leadership training focuses a lot on transactional communication, superficial team dynamics, and not enough on building leaders’ stewardship mindset and deeper relational skills. We should require evidence of these skills for promotion and provide communal support and feedback to strengthen their practice. This would reduce overall stress in organizations by building cultures of empathy, compassion, accountability, and transparency from the top. Workers’ stress, in my observation, stems in large part from toxic cultures set by relationally inept leaders.
So, another plot twist, but maybe not really. My solution to stress management optimization is relationship-centered: first relationship with self, then between self and others, and then between/among those who know us, by way of example setting.
Stress is complex. Its optimal management is a lifelong practice. It’s never too late to start, and no skills practice is too small or wasted.
“The only way out is through. The best way through is together.” I think that applies here.
