Allen M. Schoen, MS, DVM, PhD (hon.)
The practice of veterinary medicine offers a unique and extremely rewarding professional life. It also offers many challenges that can create stress and impact on one's mental, physical and emotional health. Mind/Body Medicine is being integrated into conventional human medicine in numerous hospitals and medical centers. These two lectures will review the scientific basis of mind/body medicine and how you can use it to be of benefit for yourself, your staff, clients and patients. Once one understands the neurochemical implications of stress on yourself and others and how you can change and manage that in your life, both your practice life and personal life can improve. Solutions, exercises, training based on the Relaxation Response as defined by the Mind/Body Medical Institute at Harvard Medical School will be reviewed. The concept of compassion fatigue and "burnout" within the profession has been discussed much more openly and frequently during this past decade. These concepts and mind/body medical approaches to these conditions will also be discussed.
The practice of veterinary medicine offers a unique and extremely rewarding professional life. Veterinarians have many gifts to offer others. We bring knowledge and compassion into a healing profession that cares for the helpless. The profession also offers many challenges that can create stress and impact on one's mental, physical and emotional health. The challenges of practicing progressive medicine, staff management, practice management, client relations, and balancing these with other parts of our lives can become overwhelming at times. The experience of "burnout" is a major risk factor for veterinarians involved in the demanding area of patient care. Substance abuse, crisis management and suicide appear to be on the rise as well. These challenges are not limited to the veterinary profession, but are seen in many healing professions. There is increased discussion regarding "compassion fatigue" in many health professions as well. Burnout is often the undesired endpoint of a career that began with the noblest of intentions. Burnout sufferers begin to feel cynical, depressed, alienated, and negative about their role as a veterinarian. Some veterinarians choose to leave the profession or explore alternative career pathways within the profession. One source of burnout may lie within the personality of the individual who may feel overly responsible for the welfare of others and use unrealistically high measures of personal performance in evaluating themselves.1 When caregivers suffer disappointments in patient care, they may become emotionally depleted, lose touch with themselves and others, second-guess themselves and eventually sink into professional despair. Developing a way to prevent compassion fatigue is a necessary component of professional development according to Chaplain S. Bryant Kendrick, Associate Professor of Internal Medicine and Gerontology at The Bowman Gray School of Medicine.1 One other perspective on burnout is that it may correlate with professional stagnation as well. Continuing education and training are key to maintain a stimulating career. Mind/body medicine is a rapidly expanding field in human medicine and its applications for veterinarians are just beginning to be explored. In its simplest definition, Mind/body medicine is the use of our mental activity, thoughts and feelings to help prevent and treat various "diseases." Studies in mind/body medicine document the effects of thoughts on the release of various neurotransmitters and neurohormones and the impact that has on our physical, mental and emotional health. Many ancient traditions discuss the essential nature of our mind and its impact on our health. What we think directly impacts on our overall health. One key teaching in Buddhism is on training the mind and cultivating loving-kindness. In The Art of Happiness, A Handbook for Living, the Dalai Lama states "The systematic training of the mind - the cultivation of happiness, the genuine inner transformation by deliberately selecting and focusing on positive mental states and challenging negative mental states - is possible because of the very structure and function of the brain.2 The key to rekindling the gift that we as veterinarians brought into this profession is in our thoughts, our mind. Dr. James Austin, Professor Emeritus of Neurology at the University of Colorado, provides an extensive review of the effects of our thoughts on brain mechanisms and neurochemistry in Zen and the Brain.3 Dr. Joel Robertson describes the impact of various neurotransmitters such as acetylcholine, norepinephrine, epinephrine, serotonin and others on our moods and performance. Through neurochemical evaluations, he offers simple approaches to maximizing our brain efficiency through nutrition, exercise and mental attitudes.4 By balancing our neurochemistry, we can enhance performance and prevent burnout.
One essential mind/body exercise to practice in order to manage the challenges of our career is what Dr. Herbert Benson of the Mind/Body Medical Institute at Harvard Medical School calls "The Relaxation Response."5 There are two basic steps necessary to elicit the relaxation response. The first is the repetition of a word, sound, prayer, thought, phrase or muscular activity. The second step is the passive return to the repetition when other thoughts intrude. The relaxation response has been found to decrease respiratory rate, heart rate, blood pressure and oxygen consumption. It has been demonstrated to be effective in the treatment of anxiety, hostility, depression, hypertension, insomnia, chronic pain, premenstrual syndrome, infertility and stress. Other stress-reducing exercises will be taught as well.
Chaplain Kendrick recommends developing a personal burnout prevention plan based on the effects that your thoughts have on your actions. It is based on realistic expectations, the ability to differentiate subjective from objective components of reality, appropriate self-love and support from others. Kendrick feels that this stewardship program "facilitates self-preservation and renewal so that you can adapt to the stresses of the modern health care environment without losing the capability of being there for others."1 Oftentimes we waste energy experiencing frustrations based on expectations that exceed what is really possible. We also tend to not experience the moment, always reflecting on the past or worrying about the future. Often there is a tendency to confuse stress with fear, fear of the past, fear of the future. Simple mindfulness techniques will also be taught to assist in regaining the ability to be in the present moment. Too frequently we also fall into the trap of basing our self-worth on someone else's opinion of our professional performance, creating a performance-based self-esteem system. We need to differentiate who we truly are from what we do.
Recent research on the need for quiet, contemplative time in a busy schedule and life and the implications are updated in additional books.6,7 Mind/body medicine and mindfulness training have received such recognition for their value that Google Corporation has actually been offering a course on mindfulness for their employees, which is consistently filled. A new book, Search Inside Yourself, The Unexpected Path to Achieving Success, Happiness and World Peace, based on that course, now offers mindfulness training for everyone.8
Through these and other experiential processes, we will begin to manage our challenging profession better, recreate a career and lifestyle where we will enjoy each moment and each day to its fullest. We will then be able to be of the most service and benefit possible to all beings, two-legged, four-legged and winged.
Techniques of mind/body medicine offer veterinarians opportunities to reflect on, rejuvenate and recreate our careers and lifestyles. These are time-tested and scientifically documented processes that help balance our brain chemistry, physical and emotional health and bring greater joy and satisfaction back into our lives.
1. Kendrick SB. Preventing Burnout Among Care Givers, Faith & Medicine Connection. National Institute for Healthcare Research; 1996:3.
2. The Dalai Lama, Cutler H. The Art of Happiness, A Handbook for Living. New York: Riverhead Books; 1998:44.
3. Austin J. Zen and the Brain. Cambridge, MA: The MIT Press; 1998.
4. Robertson J. Peak-Performance Living. San Francisco, CA: Harper; 1996.
5. Benson H. Spirituality and Healing in Medicine. Harvard Medical School Press; 1997.
6. Zinn JK, Davidson R. The Mind's Own Physician. Oakland, CA: New Harbinger Pub. Inc.; 2011.
7. Cain S. Quiet, The Power of Introverts in a World That Can't Stop Talking. New York: Crown Pub.; 2012.
8. Tan CM. Search Inside Yourself, The Unexpected Path to Achieving Success, Happiness and World Peace. New York: Harper Collins; 2012.