Image: Buddha subduing mara (a demon that attempted to lure Buddha away from the path of enlightenment). Photo taken on a holiday in Bangkok, which, incidentally, didn’t cure my mental health issues.
“Healthy life balance”: those well worn words. We repeat them to struggling colleagues. We pronounce them as a cure-all to depressed patients. The words adorn powerpoints and manifestos on curing the mental health epidemic in medicine. Yet how helpful is it? Let’s ignore the fact that encouraging a healthy life balance is useless when the structure of medical training makes that almost impossible. Sure, a person might add a bit of exercise or a getaway here or there, but it’s never enough to achieve “well rounded human”. Rather, I would like to share my personal experience with the three words. Being obsessive and perfectionist (like many of us) I am very good at writing lists and ticking boxes. When I went to my GP or talked to my supervisors about my low mood, they would recommend exercise, taking a break – in other words, healthy life balance. “Do you even know who I am,” I would scoff. From high school I had been obsessed with my schedule. Monday morning – rpm class. Tuesday morning – swimming. Wednesday morning – sleep in etc. In my latter twenties I even became a yoga buff and I still endeavour to achieve “non-attachment” to my thoughts, feelings and negative judgments everyday with variable success. I faithfully scheduled in hobbies, social outings and chores, albeit infrequently (especially the chores). Yet, not only was I unhappy, I was anxious because I was a slave to my schedule!
Thankfully, I have worked with some wonderful psychologists and I like to think that age and reflection has made me wise, despite my lack of grey hairs! The key for me was not the physical feat of “healthy life balance.” Rather, it was the ability to recognize my feelings and their causes and address them. The acronym, H.A.L.T. (hungry, angry, lonely, tired), developed initially for alcoholics, has been useful. For instance, if I am feeling low I ask myself, am I hungry (or thirsty), angry, lonely or tired. If I identify that I am tired, I might sleep in the following morning instead of going to the gym. If I am lonely, I might chat to a friend or, at least, I will not despise myself for wasting an hour text-ranting and facebooking. Simple as this sounds, for me it still requires regular conscious effort. My obsessiveness meant that I trained myself to ignore my emotional needs in pursuit of the perfect balance. I had done this since I was a teenager, so I was barely conscious of my emotional needs, except as a persistent underlying misery. It is also a challenge to approach myself with kindness, rather than criticism and cycles of self hatred. Moreover, I have accepted that all the cognitive behavioral therapy in the world will not cure me of my negative cognitive style. In fact, despite popular expectation, cure should not be the goal. Rather, the ability to recognize excessive negativity, and then remind myself to be kind to myself and others is probably sufficient.
Thus, “encouraging” a healthy life balance was useless for me. Of course, my experience is not generalizable to all doctors. However, we are all highly educated individuals, who know what healthy life balance is. A little nudge might be useful now and then, but more often than not, when it is offered as a solution to genuine distress the proponent(s) appear patronizing and insensitive. We need to address the causes of distress first with loud voices and determination – don’t tell me to “HLB” when there aren’t enough staff to cover leave or ados! Don’t run token mindfulness or yoga sessions in the middle of the day, when we can’t come! And even when we achieve space for healthy life balance, don’t expect a struggling doctor to wake up the next day, cured. Recovery from mental illness is difficult and takes time. Patient listening and compassion is always better than offering easy solutions.
