On Stress

The Wellness Diaries – Part 2

Let’s take a mental health day.

One truism of the Covid pandemic is that it brought with it a serious mental health crisis.

As a Family Doctor, whose job includes the diagnosis and management of mental health disorders – studies show that more than half of primary care visits are driven by problems such as anxiety, panic, depression, and stress – I can confirm that the pandemic has made the situation much worse.

I spend a lot of time with patients prescribing and managing psychotropic medications, as well as helping find the right psychiatrist or therapist to help with their specific problem, symptom, or condition.

And while these medical interventions are helpful to most and critical to many, lifestyle changes to help achieve mental equanimity are also necessary, if not sufficient.

Lifestyle change, huh? Easier said than done. And what exactly does that mean?

To me, it means constructing a regular, personalized routine that brings balance and control to the three interlocking spheres of body, mind, and spirit.

Whoa there, Siddhartha…what?

It always helps to have a good metaphor – and in the area of human psychology, Greek mythology is the place to go.

Once upon a time, there was a series of wars between the Titans and the Olympians. When the Olympians finally won, they imprisoned the Titans deep in the earth, except for Atlas, who was given the special punishment of holding up the heavens for all eternity (the ‘“weight of the world,” for our purposes).

Atlas is the perfect metaphor for psychological stress: trapped in a grueling dead-end job with heavy responsibilities and no control.

It follows that one approach to alleviating stress is to undo Atlas’ condition piece by piece (don’t worry, I promise everything that follows is evidence-based).

First, the body.

Every doctor is familiar with somatization: symptoms with no organic cause, originating from psychological stress. Common examples include neck pain, back pain, headaches and stomachaches. In extreme cases, patients can even experience debilitating conditions like paralysis or blindness.

As psychological tension builds, it tends to manifest as physical tension, and the escape valve for this tension is called exercise (ok, true, massage also works). The channel flows both ways, and just as with its build-up, the release of physical tension translates to the psychological.

Atlas cannot move, which is part of his problem, but what if he could? Imagine how it would feel for him to put down his load, have a stretch, and go for a jog.

Next, the mind.

When I was a medical resident – which remains for me a great model for psychological stress – I started the habit of reading an article a day. I would find them in medical journals lying around, rip them out, and carry them in my white coat pocket to study in my rare free time. My only rule was that the topic had to spark my interest, regardless of whether it had any relevance to my current rotation.

The idea was to regain agency. I felt that my mind was overly controlled by the demands of the job and, tired of being pushed around, I wanted to redirect it as determined by my own intellectual curiosity.

Getting back to Atlas, the fact that the world is a big, dynamic place, where people think up cool ideas and do exciting things, is easy to forget when you carry its weight on your shoulders. Remind yourself.

In various artistic depictions of Atlas we see him looking down, sometimes off into the distance, but never looking up. Imagine if he could actually see what he held, and realize that it was more than just a burden.

Finally, the spirit.

In his book, Varieties of Religious Experience, William James tries to define the commonality between different religions. He identifies a universal mystical experience of everything being connected on the deepest level, with religion acting as a vehicle for feeling “union with something larger than ourselves.”

I imagine Atlas as corrosively alienated from his load, seeing it as entirely separate from himself, an external affliction without which he would be free.

There are many roads to the Buddha. Each religion has its own tools for helping adherents realize the interconnectedness that alienation obscures under stress and strain and pressure.

One that I like to share with patients is the practice of mindfulness meditation, where you focus your mind solely on your breath as it enters and leaves your nostrils.

The advantage of this particular technique is that it becomes obvious, as the air flows, how completely dependent we are on the outside world; how we would cease to exist after even a few minutes without it; how flimsy is the barrier between the self and other; and how we share the air we breathe with friends, family, and colleagues, not to mention bosses, rivals, enemies, and other living things.

Related to interconnectedness is fellowship. Think of the difference between how it feels to suffer or lose as an individual – as in a sport like ski racing (but they say write what you know!) or tennis – and to suffer or lose as part of a team. Neither is fun, but while the former is just bitter, the latter can be bittersweet.

Seen through this lens, Atlas is a profoundly egotistical and lonely guy. Who does he think he is, taking on the weight of the world all by himself? Granted, it wasn’t his idea, but still, a little help here?

Imagine if Atlas had a partner, or was part of a team. Better yet, what if he were able to see himself as an intrinsic part of the thing that weighs him down, and understand that there are ways in which it also holds him up?

Whoa there, Siddhartha…very meta.

Sorry, back down to earth. So, what do I mean by lifestyle change for mental equanimity?

Move. Learn. Breathe.

Dr. Bertie Bregman
Dr. Bertie Bregman
Full Stack Family Medicine is a newsletter about what it’s really like to practice medicine and run a medical practice in New York City.
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