(18) TARRANT COUNTY PHYSICIAN
March/April 2021
If 2020 was the ultimate exercise
in improv, we gave a performance
worthy of cheers and ovation. Even
so, 2020 was especially stressful for
doctors as we were stretched beyond
our capacities in all spheres of our life,
all at once, and for far too long. Published
research on the impact of the
pandemic on health care workers in
the U.S. is limited at this point, but the
data from China, Italy, France, and other
countries impacted by COVID-19 earlier
on in 2020 are telling. As a volunteer
psychiatrist for the Physician Support
Line, a free and confidential peer
phone support helpline for struggling
physicians and medical students, I have
heard countless stories of physicians
and medical students, I have heard
countless stories of physicians who
endured a risky, exhausting, and demoralizing
milieu for much longer than
the human body and mind were meant
to tolerate—all the elements of not
just burnout, but anxiety, depression,
post-traumatic stress disorder (PTSD),
substance use, and much more.
In his seminal book on trauma and
its effects, The Body Keeps the Score:
Brain, Mind, and Body in the Treatment
of Trauma, Dr. Bessel van der Kolk discusses
how trauma and chronic stress
rearrange the brain’s wiring— specifically
areas dedicated to pleasure, engagement,
control, and trust—in a process
known as neuroplasticity. The human
response to psychological stress is one
of the most important public health
problems, and doctors are especially
susceptible to it because of the nature
of our work and the long hours, only
compounded by the pandemic. Many
of us are Turning 2021 psychologically
wounded, exhausted, and mentally
exhausted.
Taking stock of 2020, Turning 2021
mentally fit might seem like a lofty goal.
Fortunately, there are evidence-based
strategies that can help us ameliorate
the impact of chronic stress as we pursue
our goal of mental fitness in 2021.
Recalibrate “normal”
We have endured a collective trauma in
2020 that has given way to a crisis of
meaning. The chronic stress might make
you feel irritated, impatient, angry, sad,
and you might experience feelings of disconnection,
difficulty concentrating, and a
range of other cognitive effects. You might
also be navigating anxiety, depression,
or fatigue. These are all perfectly human,
adaptive responses during such a difficult
time.
● Welcome and honor the full spectrum
of emotions that make you human, because
they are here to teach you important
lessons about your triggers, coping
skills, and current emotional state.
● Practice Self-compassion - as
physicians, we have several personality
traits that lead us to pursue careers
in medicine, including perfectionism and
self-denial. While these traits can serve
us well in doing our clinical work, they
also give way to unrealistic personal and
professional expectations, including denial
of personal vulnerability. Some days your
best IS enough. You are a doctor, but
you’re also human. Acknowledge and accept
your vulnerability.
● Seek Help - part of recalibrating
normal is to also normalize seeking help.
Extraordinary stresses cannot be overcome
with ordinary measures. Although
we all have the ability within us to heal, we
sometimes need support in the journey to
self-realization and optimal mental fitness.
Reflect and release
Unprocessed traumatic memories and
stress can become sticking points that
cause our mental and physical processes
to suffer. As such, it is imperative that we
reflect inwards and take intentional steps
towards improving our mental fitness. The
journey to recovery can be slow, intentional,
and at times, uncomfortable, yet,
immeasurably rewarding. As with any form
of recovery, the first step is acceptance.
continued from page 17
● Give yourself the permission to grieve
the many losses of 2020, including loved
ones, colleagues, and even your routines.
This isn’t always at our forefront, but in
addition to attachments to other people,
we also develop powerful attachments to
our work, things, and places.
We know that neuroplasticity and
trauma go hand in hand. Just as traumatic
events can forge neural pathways,
so can positive and effective therapeutic
experiences that help us cope and heal.
The psychiatrist’s toolbox is equipped
with evidence-based strategies to help
you navigate this journey.
● Psychotherapy - if anxiety is the
worst use of the imagination, psychotherapy
helps us reestablish psychological
safety and dial down the trauma
response. There are numerous evidencebased
therapies to help address anxiety,
depression, and burnover, such as Cognitive
Behavioral Therapy, Acceptance and
Commitment Therapy, psychodynamic
psychotherapy, and Mindfulness-Based
Stress Reduction. The undertaking of
knowing oneself might be the most challenging
yet rewarding experience of one’s
life, with lasting results. In fact, suffering
often brings with it the opportunity that
drives emotional growth for a more mentally
fit self. As with anything worthwhile,
this process requires time and commitment.
● Medications and more - we enter
the medical profession with many underlying
vulnerabilities, including personal and
family medical and psychiatric history,
chronic stress from childhood, personality
factors, social determinants of health,
and much more. Moreover, the stress
from medical training is associated with
systemic inflammation, telomere shortening,
and oxidative stress, findings which
have often also been reported in major
depression. Antidepressant medications,
in particular, are associated with not just
mood recovery but also recovery from
oxidative stress on a cellular level. There