Healthcare professionals have made great strides in the direction of self-care over the last decades. Available data suggest that today's doctors, nurses and other caregivers make far healthier choices than did their predecessors in generations past.
Still, it is no big secret that many practitioners put their own health far down on their priority list. The culture of medicine may be more conscious of the importance of self-care, but it still puts enormous pressures on practitioners, and in many ways, discourages helpers from asking for help.
If you take a lot of high-achieving "type A" personalities, subject them to constant and diverse stresses, pile on enormous workloads, hold them responsible for the well-being of others, add in a lot of economic uncertainty, what do you get? A recipe for illness, that's what!
One of the few large studies on the subject of physician health and wellbeing showed that while doctors have a slightly lower overall mortality than other professionals, they die of the same common chronic diseases as others, and—here's the kicker—they have significantly higher rates of suicide and drug-related death (Frank E, et al. Am J Preventive Med. 2000; 19 (3): 155-159).
Helpers Eschewing Help
Physicians have a rate of prescription drug misuse 5 times higher than the general public. As many as 15% of healthcare workers will battle substance abuse in their lives. High stress levels, easy access to controlled and addictive drugs, and a tendency to downplay illness, pain and suffering are all conducive to drug abuse---and to late detection of the problem.
Sleep deprivation over the long term plays a role as well. It certainly lowers mood and psychological well-being. It also affects work performance and safety.
Rates of depression among medical interns have been reported as high as 30%, and both suicide and depression among clinicians are strongly linked to substance abuse. Many physicians who have committed suicide turned out to be suffering from a chronic illness.
The relatively small amount of research on disease rates among doctors shows no greater tendency to develop chronic diseases like heart disease, stroke, cancer, and diabetes. But mental health and happiness can be severely compromised by a medical career.
Physicians feel particularly responsible for other people's lives. This is a huge burden, and most doctors have experienced patient deaths—sometimes related to their care—during their careers. This kind of psychological pressure, as well as other stressors of medical life, make physicians highly susceptible to inflammation, depression, and disease.
Yet, so many studies, articles, books, and blogs point out that physicians are often the least likely to seek help ---even when they are clearly experiencing symptoms of a serious disease. Let's face it: we healthcare professionals have a distaste for admitting weakness or the need for help. We are supposed to be the ones with all the solutions, the ones everyone else turns to.
Our unwillingness to seek help certainly hurts us, but it can also hurt those close to us. I was speaking with the wife of a healer colleague, who pointed out that it is not only practitioners themselves who hesitate to seek help; family members also succumb to that stigma, thinking that they should not reveal health imperfections because it might reflect poorly on their spouse's healing abilities.
Clearly we have a long way to go in helping ourselves, and each other, toward better health. It is an important issue, because—whether we accept it or not—patients do look to us as role models. To the best of our abilities, we need to show them what good health looks and feels like.
Ayurvedic medicine is an excellent place to look for wisdom on achieving optimal health through self-care. With its focus on nutrition, stress management techniques like yoga, meditation, and breathing exercises, and the use of herbs and spices to balance and tonify our physiology, Ayurveda offers deep, detailed guidance on how to live a healthy life (read, Ayurveda in America: How India's Ancient Health Sciences Can Heal US Healthcare).
In Ayurveda it is understood that there are three dominant doshas, or constitutional types: Kapha, Vata and Pitta. Each has strengths and shortcomings, and each is balanced by the other. All human beings reflect unique combinations of these basic tendencies. Health depends on cultivating and maintaining a balance between these essential tendencies.
General Principles, Individualized Care
Balance between the three doshas can be disturbed by inappropriate diet, behavior, and lifestyle. Ongoing imbalances trigger pathological changes that may eventually lead to overt disease. Food, drink and environmental factors that are similar to a particular dosha will aggravate and increase that dosha. Those with complementary or opposing properties will attenuate it.
The Kapha constitution tends to be slow moving, even sluggish. It tends to be complacent rather than ambitious, and would rather stay at home and turn into a couch potato at worst, or be the nurturing support for others at best. Compassion and a desire to feed and nurture others are key features of the Kapha type.
People who are strongly dominated by Kapha tend not to be motivated toward a career as intense as medicine. However, many of us in the healing professions have strong Kapha traits that may give us our compassion and caring natures.
Fatty foods, icy cold sodas, sedentary work, cold and damp weather, and winter darkness---all of which are considered to be Kapha influences—can derange someone with an already strong Kapha tendency. This exacerbates tendencies toward obesity, depression, and social withdrawal or alienation from others. Eventually, diabetes or heart disease may develop. Chronic depression, unhappy attitudes toward life, and suicidal thoughts are also signals of aggravated Kapha.
Constitutions dominated by Vata and Pitta are often found in high intensity professions. Pitta, full of fiery energy, brings drive and ambition as well as the ability to digest and absorb massive quantities of information. Vata, governing all movement including the transmission of neural messages, contributes a quick mind and high energy level.
It is interesting that Pitta and Vata predominate in many doctors, and are easily sent out of balance by the very lifestyle they help a doctor to achieve.
Constant movement, multitasking, erratic schedules, late nights, fast foods, limited rest, competition, and intense pressure will aggravate Pitta. If the imbalance persists the person can easily develop ulcers. People with strong Pitta dominance often use alcohol to unwind and relax. They sometimes develop narcissistic tendencies that further isolate them from others, and make them less likely to seek help or attention from colleagues.
People with predominately Vata constitutions tend to become spacey and forgetful when out of balance. They make big mistakes, then gets melancholic and depressed as their mistakes erode their confidence. They also tend toward developing anxiety and other nervous system disorders.
Given the prevalence of Vata and Pitta tendencies, among medical professionals, it is in balancing these doshas that doctors will likely find the most help in managing their stress and preventing disease.
Parallels with Ornish Approach
In studies by Dr. Dean Ornish at the Preventive Medicine Research Institute , subjects with coronary heart disease were assisted in making major changes in their diets, exercise levels, and their stress. They learned stretching and relaxation exercises with breathing; they were educated in meditation and focused breathing as well as guided visualization. Their living space was rural and peaceful. Their diet was completely vegan.
The Ornish approach has many parallels with Ayurvedic recommendations. Translated into Ayurvedic terms, the Ornish dietary approach would be definied as a Sattvic diet, one that elevates and unifies the body and mind with the Divine. But Ayurveda recognizes that there is tremendous variation between people. This system does not assume that any one dietary approach is always healthful for everyone all the time.
In Ayurvedic thinking, Ornish vegan diet would not necessarily be right for everyone long term. Some people benefit from inclusion of dairy and other animal-based foods; others do better on a fully vegetable-based diet.
Ayurveda does posit one very important general premise, which is to avoid ALL processed foods. Ideally everything one eats should be produced from scratch with no additives and preservatives. This is not always practical for our modern lifestyles, but in truth it is a key to keep a clean running machine.
Ayurvedic practitioners are trained in ways to tailor diets to the doshas and to the seasons of the year, to mitigate imbalances. To learn more about diets specifically aimed at mitigating the Vata and Pitta disturbances common among health care professionals, I recommend visiting the website of the Amrit Yoga Institute.
Breathing & Healing
Breathing exercises, called Pranayama, have significant positive effects in patients with many different chronic diseases and mental illnesses. Regular practice of Pranayama increases oxygenation and metabolic activity. Many studies, mostly in India, show that Pranayama practiced regularly can affect the CNS, improve respiratory function, improve cardiac function, and improve overall physical and mental health. (Pal GK, et al. Indian Journal of Medical Research, 120, 115-121)
Sleep hygiene is a very important in Ayurveda, and it can have tremendous benefits in a medical life. A more regular sleep/wake schedule that puts us to bed by 10 and up before 6 is extremely healthful, though admittedly this is not so easy to achieve.
Getting to bed before 10 facilitates the biorhythms and keeps the mind from slipping back into Pitta driven mental activity late at night. Getting up before 6 rouses the body and mind during the Vata time of day, when we can be most in touch with our higher selves. Early morning hours are a great time to meditate, plan the day, and do gentle exercises or stretches to awaken the body.
Meditation & Medicine
Must we meditate? Let's put it this way: a healthy mind has control of Vata. Control over Vata, by diet and lifestyle modifications, helps to keep the mind healthy and under control. When nervous energy is heightened, the mind is disturbed, but if we can calm the mind, the nervousness and anxiety will also be calmed. Meditation helps to calm and control the mind. While there are no hard and fast rules, meditation is certainly beneficial for many, many people.
Vata balancing diet and lifestyle makes this more achievable. For nervous and anxious people, the diet should be extremely "grounding," meaning it should be rich in foods that are moist or even a bit oily, heavy, and extremely nutrient dense. Vata dominant people should avoid foods that are cold and dry.
Sweet-tasting foods, like grains, dairy, meats, nuts, fruits, starchy vegetables, and mild natural sweeteners promote good digestion and endurance. Warm food and drink, slightly oily foods, and complex carbs give Vatas the endurance and calm nerves they need to function well. Vata-dominant people need to eat regularly; if they do not, they become completely overwhelmed under pressure.
Pitta is the root of all inflammation: Inflamed ego, inflamed temper, inflamed ulcers, inflamed bladder, inflamed colon, inflamed joints, inflamed immune system....you name it!
Heat is the most causative factor in Pitta aggravation: hot environment, spicy food, acids and alcohols are obvious Pitta aggravators. But there are many others: friction such as occurs in competition between colleagues, constant movement which increases metabolic heat, confrontations such as constantly butting heads against administrators or insurance guidelines, pressures to succeed and to perform. It is easy to see that medical culture is filled with Pitta aggravators, so it is no surprise that so many doctors feel angry and frustrated.
Pitta-dominant people would do well to avoid alcohol and citrus, and fried or overly fatty foods. They should drink beverages at room temperature, do whatever they can to keep cool in hot environments, and engage in team cooperation as much as possible. It is helpful for Pitta people to allow others to take the lead, to practicing patience and stillness, and to work in groups, so as to take the focus off self.
People prone to Pitta expression should eat naturally sweet foods (without adding sugar) such as non-wheat grains like rice and millet, as well as a lot of bitter and astringent foods like green vegetables and legumes. Greens, raw fruits and vegetables and vegetable juices are crucial for Pitta people. Excessively hot and/or spicy food is usually too stimulating and tends to exaggerate Pitta imbalances. Excessive consumption of red meat and pork is inflammatory and arouses the war-like nature of Pitta.
A Pitta balancing diet shares with the Vata balancing diet the need for heavier nourishing foods, sweet taste, and high vitamin and mineral content. Regular meal times are also important. Pittas can get by without a meal out of sheer willpower, but this tends to generate anger and frustration.
In the practice of Ayurvedic Medicine, signs of imbalance are detected—and dealt with--long before the emergence of symptoms patterns that characterize Western allopathic diagnoses. Through observation, pertinent questioning of the patient, and pulse diagnosis a practitioner can determine what doshas are going out of balance and in what organs or tissues.
By the time that symptoms become so severe that someone seeks Western medical care, you can be sure that the doshas have long been out of balance.
This is why it is important to know and recognize our own constitutional (doshic) tendencies, and to take measures to balance them. By understanding how these energies play out in our own lives, we are better able to recognize what's happening in our patients.
We have an important job to do taking care of others. We should be shining examples of health, with our bodies functioning optimally, so that our minds can truly be free to do the work of solving other people's health problems.
Amber Lynn Vitse, CN, LMT, is an Ayurvedic practitioner, certified nutritionist, and massage therapist practicing in Knoxville, TN. She graduated from American Health Sciences University, Florida Vedic College, Alchemy Institute for the Healing Arts, and has years of education in Integrative Nutrition and Body Therapies. She is also the Director of Ayurveda Education for Nature's Formulary, a US based supplier of Ayurvedic herbal medicines. Reach Amber at www.pranaayurveda.com, (865) 936-1545.