When I was an intern completing my Ph.D. in Clinical Psychology, I worked in a large general hospital in the Psychiatry ward for the most indigent populations. Almost every patient struggled with chronic medical illnesses, grief, chronic pain, depression,anxiety and some form of post traumatic stress. Many of the patients had been homeless at some point in their lives. It was hard for many of the interns totake on the suffering of people day after day and not internalize it and bring it home to our own families.
One patient I encountered, we will call her Patty, seemed to defy all expectations. She had been referred to me as a “very difficult case”; one who had been passed from psychologist to psychologist over the years as interns rotated through the hospital. When I read her thick file, I saw pages and pages of suffering. Beyond the physical, emotional and sexual abuse she endured, she also had survived cancer and lived with great physical pain from multiple surgeries on her legs and arms from the years of physical abuse at the hands of her family.
When I first met her she walked with a cane and had a slow gait with quite a noticeable limp. She was in her60’s but stood tall and looked physically about 15 years younger. Her hands were wracked with arthritis so severe that she had difficulty holding onto the arm of the chair in order to sit down and she required my help. The most striking feature about Patty however, the one I will never forget, was the enormous smile she wore. I met with Patty every week for almost my entire intern year and she was always smiling. For all the suffering, she told me,“I’m basically a happy person. I want to be happy no matter what life throws at me. And life throws a lot!”
Many of the interns had patients with such trauma in their lives we couldn’t believe how they could ever be happy. How was it possible? How can someone find happiness in the face of so much misery?
This seems as valid a question today as it did during my final internship year. As a newly minted psychologist I was learning about something I had only read about in textbooks: resilience.During these tough times, with the economy in turmoil, jobs lost and new ones almost impossible to find, how can people find reasons to be happy? Or even joyful?
I will tell you what I learned over the years from the voices of my patients, my own epiphanies, and even my parents, who endured the Iranian revolution to start over again in a new worldin the worst of circumstances:
1. You can’t change what happens to you but you can change how you respond to it.
One patient we’ll call Beatrice had a friend who always took advantage or her by asking her to baby sit her children or let her spend the night when she had too much to drink. This was extremely stressful for Beatrice not only because of the constant demands on her time and energy, but because she was a recovering alcoholic. The temptation was always there. In Beatrice’s case, one day she simply had to say “no.” Although she felt badly for the loss of a friend, she had to draw a boundary in her life for her own sake. She could not change her friend, but Beatrice could and did make choices that were better for her own life by stopping someone from taking advantage of her. Beatrice is happily still alcohol free and using her free time for choral practice at her church and giving talks to other recovery alcoholics.
2. The Realistic World View: Life will always go up and down. It will never be stagnant. Remember when you are at your lowest, you are due for an “up!” Of course the reverse applies as well, so be prepared!
3. Seek Out Support: Seek out family, friends, community. My patients with support systems in their lives have thrived in comparison with those who were alone. This may seem obvious to some but to many it is a new concept. Many of the American patients I worked with, particularly the men, stated they preferred to “go it alone” and had literally cut themselves off from all others. It has been not at all beneficial. Those patients who sought out the comfort of community – even if they did not disclose the reason for their suffering – fared much better. They suffered less depression, less anxiety, had less suicidal ideation and were more likely to function well in the world around them.
Social support can heal in many ways. It offers others a chance to empathize and commiserate with your situation and you have the opportunity to “get out of your head” and not be alone with your thoughts. At the very least, it provides a good networking opportunity for those seeking new jobs, those beginning new projects who coulduse help brainstorming, or for those just looking for a new start.
4. Give: A wonderful thing happens when you give to others. You help others and you help yourself. Once, around the holiday season, I was feeling angry and sad and generally feeling very sorry for myself. It was then that I decided to put my four-year-old son in the car and give out bags of holiday candy to strangers. We made the bags ourselves, wrapped them in colorful paper with ribbons and handed them out at the hospital where I worked. I felt it was a tiny, insignificant act. But it took the focus off myself for one moment! Others were surprised and happy. They chatted with my son and patted him on the head. I talked to them about their hospital stay and their families. It changed my whole outlook for the day. I hope it changed something for those patients as well. Most of all, I hope my son learned something about giving to those in need that will stick with him over the years. I am under no illusions that candy helps change lives but it was just a vehicle for a value that I hold near and dear to my heart. My son and I have continued some version of this tradition every year. So, the moral of this story is help out at a soup kitchen, give away old clothes to a church to help people who can’t afford new clothes, talk to someone who looks like they need a friend, or just do one good deed for a day. My patient Patty, for all her troubles, still found the time and the will to help put together a program in her dangerous neighborhood to assist women, children and the elderly to get to and from their homes safely.
5. Inertia: If you do nothing-nothing will change. Many times I would lament that I had few friends in Northern California where I had moved to attend my Ph.D. program. I missed my old friends and my family I had left behind in DC. I just couldn’t adjust. So, I continued to go to work and school every day following the same pattern. It was too intimidating to make a change. I did little things of course, but once they were done I moved right back into my comfort zone. One must be courageous and break out of a habit or you will live that habit forever. It is a problem many of my patients had as well (and let’s face it, a problem probably everyone has had at one point in their lives). Change is uncomfortable, but it is necessary. Changing habits means different things to different people. For some of my patients change meant giving up a crutch they relied on like excessive eating or alcohol – not just for a week, but for good. Sometimes it meant leaving a job they hated – even if it meant losing the stability that paycheck brought. Life will continue to pass by… will you be in the same place year after year?
6. Self-Care: This one will seem silly to some folks. Exercise? Sleep? Eat well? Decrease my stress? But I just lost my wife and job! You want me to workout? What will that do? Well, movement increases endorphins. The less you move, eat well, and take efforts to decrease stress, the smaller your world will get. Your mood will lower and both your spirit and body become weaker. It is important to take care of yourself. It is crucial to move! Walk outside. Get a friend or family member to go with you. Join an exercise group. It is a medication-free way to increase your physical and mental well-being. How can you care for others in your life unless you take good care of yourself?
7. Taking Action: One patient of mine we will call Maddy was a strong believer in proactive solutions. She believed positive thoughts led to positive actions. One day this mother of two small children discovered one of them was being hurt by a next door neighbor just as she had been when she was a child. Maddy felt guilt, shame, helplessness, anger and then when she had experienced all these emotions she said to me, “Ok, I am going to fight and win. I will not let my child suffer. I will take action because I am a survivor.” She did take action. Through the months we worked together, she fought in court to protect her child and eventually she won her case. The man went to jail. Her child is safe. There were those who told her to sit down, not fight, be quiet, and that she could never win. But Maddy did not listen. Sometimes you need to stand up and be heard and advocate for yourself and your loved ones. Do not be deterred. Stand up.
These lessons-learned are not a salve for all people or all life’s problems. But in these times of trouble, when life looks a little more tarnished than it did a few years ago, it is important to keep in mind what is most valuable. Care for yourself and for others, take risks to change our circumstances and remember that no matter how arduous the journey or how challenging the obstacle-there is one certainty: change.
Or as my family used to say “It could always be worse. It could be raining!”
