We practitioners are terrified of this word. The sad reality is that about 46 % of all physicians in 2015 reported that they were burnt out— exhausted, lacking motivation or enthusiasm, feeling frustrated and ineffective in their clinics.
There are many outward things a physician can “blame” for this sense of overall malaise: cranky and demanding patients, endless paperwork hassles, managed care overseers, medicolegal threats, unresponsive staff….the list is long!
But the reality is, these feelings of resentment, anger and being overwhelmed are really just “junk” emotions. And just like junk food, junk emotions are very bad for one’s overall health.
Many of the “paternalistic” emotional states so deeply engrained in medical culture—such as neglecting oneself while taking care of everyone else—are actually just “high-fat junk emotions,” says Shoba Sreenivasan, PhD, Clinical Professor of Psychology at the Keck School of Medicine, University of Southern California.
Dr. Sreenivasan and her colleague, Linda E. Weinberger, PhD, are the authors of the new book called Psychological Nutrition, which reframes how we think about the emotional states that feed our personal and professional lives.
The basic idea is that just as with food, the emotional states that fuel our inner lives can be nourishing, satisfying, and healthy, or they can be depleting, inflammatory, and ultimately very unhealthy.
People who constantly “consume” an emotional diet heavy with negative emotions, have little room in their lives for positive feelings. They end up literally starving for real emotional nourishment, but do not know how to obtain or receive it. Think of it as “psychological malnutrition.”
“High-cost emotions are high-caloric items. They are empty emotions that weigh you down and deplete your psychological reserves,” says Sreenivasan. These junk emotions are heavy, and slowly put us in a place of no joy, a state of “psychological starvation” or “emotional anorexia,” all of which often leads to practitioner burnout.
She says that physicians and others who are drawn to the healthcare professions are particularly prone to psychological malnutrition because we tend toward “hyper-responsibility”—a very strong sense of obligation to others, a deeply held view that others come first and self comes last, and a belief that one is somehow commissioned with fixing everything that is wrong with the world.
This tendency is doubly strong among women, and while Psychological Nutrition is definitely written for a female audience, it has much to teach anyone involved in the “helping” professions.
The Emotional Food Bank
Practitioners have a long to-do list — meeting the needs of sick and worried patients, plowing through paperwork, managing staff — and we try to do all this while inside we feel like we also have to balance the world on their shoulders.
Everyday we experience emotions all across the spectrum, but we often fill ourselves with the negative emotions—anger, resentment, self-pity—which means there is no room left for positive emotions, making us feel lousy and unable to manifest our full potential.
It may seem like these emotions come from the outside, or are somehow forced upon us by others. Sreenivasan and Weinberger contend that while external situations may not always be within our control, we do have a lot of choice when it comes to what emotions we let in to our psychological bodies.
“The whole notion of consuming these negative emotions is going to take you and your patient down the wrong path, leading to negative outcomes for your patients,” Weinberger says.
“Psychological energy is a resource that can be depleted or increased: You begin each day with a certain amount of psychological energy. The amount that you have available is dependent on you and how you decide to organize your emotional life,” they write.
“Whether you are psychologically nourished or malnourished is contingent upon the “food” you put into your psyche. That food is your feelings-- how you react, how you interpret, how you view the world. The food that you consume; that is, the products, come in these two broad packages: relationships and events. How you interpret and emotionally respond to the relationships and events are the calories they cost. Emotions are units of energy. Negative emotions don’t add energy; they break down psychological stamina. Positive emotions augment psychological reserves.”
The book advances the concept of “Psycholgoical Nutrition Labels” to help people assess the emotional content of their experiences. Negative emotions arehigh-fat, high cost, and low benefit with poor nutritional content; they deplete the amount of psychological energy you have. Positive emotions are low-fat and high benefit, with high levels of emotional nourishment; they add to psychological energy.
The “Seven-Day Snapshot”
Awareness of emotional nutritional intake is the first step to improving emotional health, say Weinberger and Sreenivasan. They recommend tracking this throughout the day for seven days. Watch for junk emotions like anger, envy, jealousy, frustration and resentment, as well as for positive, nourishing emotions like joy, love and optimism.
This “seven-day snapshot” will heighten your awareness of your overall emotional “diet”.
“Being aware of what you’re taking in psychologically” is key to help prevent burnout. Some questions to ponder while keeping track of your emotions are: What are you consuming? How are you feeling? Is this where you want to be?
The next step is to focus on replacing negative emotions with positive ones, since negative emotions can close the door to creativity and joy.
When negative thoughts start creeping in, it’s important to release them by stepping back, taking a deep breath, and placing “nutritional labels” on what is draining or nourishing you in your environment. Keep in mind those activities that nourish you and help you feel replenished and full. The “nutritional labels” we apply to our relationships and daily events can help us avoid the junk emotions, and guide us instead to the people, events, and inner states that foster the more nourishing emotions.
Beware of the “Toxic Boomerang”
Labels can be helpful, but they can also be detrimental—especially when it comes to labeling other people. How we label people defines how we think and talk about them, both internally and externally. All too often, we take the label—which may only describe one facet of someone—as the whole. And this gets us into trouble.
For example, when a practitioner labels a patient with a specific diagnosis---“the elderly diabetic” or “that breast cancer patient,” or “that obese, hypothyroid woman,” it is a sign that the practitioner no longer has a meaningful relationship with the person.
Perhaps there never was a real relationship with that patient—understandably, it can be difficult to develop real emotional connections with patients in many of today’s clinical settings. But the net effect of this labeling process is detrimental to both the patient and the practitioner.
Once a clinician starts to lose sight of the whole person, the patient gets less and less meaning from the interaction, and the label the clinician applies to the patient will boomerang back. Instead of feeling like a healer connecting with another person, the practitioner becomes a mechanic whose job it is to fix that diabetes or hypothyroidism—and as quickly as possible.
This can be a “slow process but very toxic,” says Sreenivasan. She believes this “toxic boomerang” is one of the main drivers of the cynicism and emotional starvation so many medical professionals feel these days.
So what’s the remedy? How do we improve our emotional diets?
Just as there is usually at least one or two healthy options to be found even in the junkiest of food courts, one can usually find positive emotional nourishment in the situations that make up our clinical lives.
Sreenivasan and Weinberger say that it is essential for healers to keep a laser-like focus on why they went into this profession in the first place. Meditation practices can also be a big, big help.
In 2013, the Annals of Family Medicine reported that physicians taught mindful breathing techniques were more present during each patient interaction, and were at a lower risk of burnout, or developing depression, anxiety and stress (Fortney L, et al. Ann Fam Med. 2013: 11 (5): 412-420)
“Compassion also fills that spiritual need and helps to recharge your battery,” Weinberger stresses. Compassion also brings back meaning to being a healer.
Gratitude is also a powerful tool. Going over all the aspects of one’s life for which one has gratitude helps in focusing on what is going well, since most practitioners are more concentrated on what is not going well. Sreenivasan says it’s important to use words throughout the day that convey gratefulness.
“Psychological nutrition is food for the soul and will help to improve patient and personal satisfaction”, states Weinberger. Monitoring daily emotional intake can lead to a happier and more fulfilling life. It can also energize the creative self. “It is easy and everyone can do it! You are the captain of your ship. How you choose to steer it is your choice. If you don’t take command, who knows where you will wind up?”
Unfortunately, far too many of us already know where a steady diet of frustration, anger, envy and resentment leads us. The big question is whether we love ourselves, our families, and our patients enough to change course.
With Psychological Nutrition, Sreenivasan and Weinberger have given us a host of accurate new maps and tools for finding our way back to healthier emotional waters.
Madiha Saeed, MD is a holistic family physician in Bend, Indiana. She trained at National University of Science and Technology and completed her residency in 2010 at St. Joseph Regional Medical Center. She is board certified in both Family Medicine and Integrative Holistic Medicine, and has a particular passion for womens’ health and family health issues. A busy mother of four young boys, Dr. Saeed shares her “walk the talk” nutrition & lifestyle tips and her lively “bring it on” spirit with families worldwide via her HolisticMomMD website, and her new book The Holistic Rx.