Burning out

The concept of “burnout” has become more popularised recently. People now mostly use it to refer to professional burnout, after a difficult period at work. But it can happen to anyone, from any cause of stress, including the pressures of raising children or negotiating difficult relationships. And it can lead to chronic pain.

One popular solution offered for burnout is rest and relaxation. This is absolutely valid, and in some cases can work wonders. But in others it is not a good remedy, as a person either cannot take a break (for example from caring responsibilities), or as soon as they return to normal, the symptoms of burnout begin again.

I recently came across a book by two American sisters, Amelia and Emily Nagoski, who have an interesting take on burnout. They argue that the way to deal with it is to tackle your stress, not your stressors, by which they mean the factors that cause stress, such as work, caring responsibilities, or a difficult relationship.

To do this, they say, you need to complete the cycle of the stress response, rather than leaving your body in fight, flight or freeze mode. For example this could be by doing jumping jacks when home from a stressful commute, to communicate to the body that it is now safe.

The sisters describe emotions as “tunnels” – you need to feel them, however difficult and scary that might be, in order to process them and combat the stress they are causing. The concept has a lot of resonance with one of the phases of the Resolving Chronic Pain approach.

 In the Resolving Chronic Pain process there comes a time when the pain has reduced somewhat and the pent-up energy produced by stress makes itself known. That is the point when each individual decides how they want to vent that energy. Options include boxing a punch bag, yelling at the wind or the sea, singing loudly (and possibly out of tune!) to your car radio or favourite playlist, dancing with abandon, or running. The list goes on… thank you to everyone who has added to it over time. Are there any ideas I’ve missed? If so, add them in the comments below.

Prescribing fun

“Fun is a health intervention”. I heard this recently in a TED talk from American journalist Catherine Price, who has previously written about the importance of separation from your phone and other devices.

It struck me just how true it is: fun, as Price points out, is good for us. On one level we all know this – we all know that getting out and enjoying time with friends can give us a boost during a low period, for example, or that hospital patients have been shown to benefit from entertainment and enjoyment. But it’s surprising how often we seem to forget. Do you make sure you are getting enough fun in your life, just as you might consider whether you are getting enough exercise, or vegetables? When was the last time you truly had fun?

For some of us, it might be a while ago. All too often our busy, stressful lives crowd out any possibilities for fun. And parties, events and other activities, while being enjoyable enough, so often fall short of being really, truly fun. 

So how to have more fun? It’s a tall order if you are already facing pressures at work and home, perhaps with a busy and stressful job and constant caring responsibilities. Having fun shouldn’t be yet another thing you’re trying to tick off an already-crammed to-do list: that somewhat defeats the point.

The best advice Price has is to actively prioritise fun, recognising it as something which is good for you and worth making space for. She suggests spending time with someone you know you have fun with. I would add that it can be valuable to actively think about which activities you associate with having fun – as opposed to those where you feel like you’re supposed to having it.

For some people this might be things we wouldn’t normally think of as fun, like exercise or even some elements of work. For others it might be more traditional fun activities. Whatever they are, it’s important where possible to make sure you get those opportunities for fun. Recently I went for a swim in the sea - it was chilly, and the other people on the beach thought I was mad… but it was a lot of fun!

Looking forward

September is a strange month, isn’t it? The end of summer and “back to school” feeling can be a bit gloomy, and yet the weather more often than not grants us a few improbably sunny days, while falling leaves and crisp morning air is a promise of all the best things about autumn.

Last year I went away for a weekend in autumn – not very far, just a night, to do some walking. It was still just warm and light enough, even if I did have to trudge through the rain on one day. The break was lovely, and it tided me over through the darker winter months, giving me something nice to remember – and perhaps to look forward to, in the form of a repeat adventure in the spring.

I never got around to it due to the Omicron wave of Covid, but I’m planning to go on another walking mini-break this autumn as well. I’ve written before about trying to arrange nice things to look forward to during difficult periods - I’m very lucky to have the chance to get away for a night, but if you’re not able to do this, could something smaller-scale be possible? Perhaps a one-hour walk, or meeting a friend for a chat.

Rather than mourning the loss of summer, I’m now looking forward to beautiful damp autumn days, even if it does mean trudging through the mud!

No silver bullet

A recently-published paper about treatment of depression made a bit of a splash. The review, led by Joanna Moncrieff from University College London and published in the peer-reviewed journal Molecular Psychiatry, looked at evidence around the “chemical imbalance” theory of depression – that it is caused by low levels of serotonin. It found there wasn’t enough evidence to say the two things are definitely linked.

The chemical imbalance theory has been around for decades, but some researchers have doubted it for a long time. Some experts have said this review proves that treating depression with SSRIs (a common type of anti-depressant which increases serotonin levels) does not work, and that the only reason many doctors prescribe these drugs is because of encouragement from pharmaceutical companies wanting to increase profits.

On the other hand, the fact is that SSRI anti-depressants seem to work to resolve depression in some people. It may be that there is some link between serotonin levels and depression after all, but given other research into placebos, I personally would not be surprised if in cases where they have worked it may have been due to placebo, or the other factors such as talking therapy or lifestyle changes that the medication was combined with.

As all of my research for the textbook, Psychophysiologic Disorders, showed, there are cases when a doctor taking an interest, speaking to a patient and prescribing medication can work wonders, even if the medication itself is not effective. But as the review author points out, it is not ethical to prescribe drugs if you are sure their only effect is as a placebo.

The issue is still uncertain, and there is a lot that psychologists and other medics don’t fully understand about depression. It is a very common condition, and may have a variety of contributing factors and treatments – each of which tends to be unique to the individual concerned. This review serves to highlight the fact that regardless of whether these anti-depressants are effective or not, depression has never been an illness which can be “fixed” with one magic pill. Doctors often take a broad approach, including medication, talking therapy and lifestyle changes.

These findings may lead to more conversations about the efficacy and ethics of SSRIs. However, they will not change the fact that the only way to have a chance of treating depression is on a case-by-case basis, taking into account each person’s unique situation, symptoms, and possible treatments.

"I was spinning too many plates and my cup was empty"

As you know, I often ask people to write a letter to their former selves, earlier in the resolving chronic pain process. It can help people to reflect on their progress, and appreciate just how far they have come.

One such person, I’ll call her Shauna, recently wrote a letter. In the past she found herself struggling to get out of bed due to her pain, but after following the resolving chronic pain process she is now pain-free. She recently dealt with a very stressful family situation with great dignity, and is now hoping to move forward in her career as a schoolteacher.

Shauna had been in a difficult relationship that she tried hard to make work despite the odds. She ended up leaving it and trying to make a new start. Friends and family were supportive, and Shauna tried as hard as she could to reboot her life. But things didn’t improve, and she filled her time with more and more activities to try and distract herself. She ended up unable to get out of bed due to her back pain, and her sister came to help. Her sister had done the Pain Science Kinesiology course I taught in 2021, and suggested Shauna contact me.

Shauna had been severely affected by her previous relationship. She was treated with little or no respect, which eroded her self-confidence. Cramming her day with activities was a way of distracting herself from the hurt she was feeling. But she became worn out, and her unconscious mind created her back pain as an alternative distraction from the hurt.

Once Shauna reduced her back pain, we began work on gradually re-building her self-confidence. As you will see in her letter to her former self, she is now able to access her true feelings to trust her judgement.

Read Shauna’s letter to her former self here.

Good company

More than two years ago I wrote about the addition to our household of four young chickens. We got them around Easter 2020, in the midst of uncertainty over the Covid pandemic. They weren’t a lockdown-inspired idea – we had been planning for their arrival for some time  – but they certainly brightened up an otherwise very isolated period. 

As many of you know, I took a break from work a few weeks ago. I can recommend it! Several neighbours very kindly offered to feed and care for our chickens while we were away, and we left them in very good hands. But just before we returned home, they let us know that unfortunately one of our chickens had died in our absence.

While it was a sad moment, the context is that our breed of hens only tend to live for two to three years. She died of old age, and we had noticed that she seemed a little off colour before we left, so the news was not completely unexpected. We have always been very wary of foxes and local dogs, so consider it quite a success that we managed to evade them at least. And it must be said, the hens have as good a life as possible. They are allowed to roam free in the garden during the day, with plenty of attention paid to their needs - particularly by my husband and many other visitors to the house.

It is this last point I thought of when we were told about the hen’s fate. Having pets can bring enormous joy, and though our hens lay eggs, they are really pets at the end of the day. My husband is very fond of them – he loves wandering around the garden as they hurry excitedly behind him. I also believe he loves the structure of having to get out of the house every single morning and evening to feed them and shut them safely in their coop. 

The responsibility and sense of being needed that pets bring can be a huge benefit, as well as their entertainment and companionship. And while it’s always sad to lose one of our hens, it brings home just how wonderful they are. We have loved keeping hens since the days of my Kilmacanogue studio, and hope to keep doing so for a long time yet!

Starting from scratch

A few weeks ago I wrote about a family member having had Covid-19. She is young, fit and healthy, and expected to have a mild case of the disease, but ended up in bed for two weeks. I wrote about how difficult it was to persuade her to rest while she was ill, but the virus has since delivered another challenge.

She was very fit before she caught the virus, exercising almost every day. She went running in the mornings, and went to strength and conditioning classes in the evenings. For her, exercise was a way to feel good about herself, stay physically healthy, and manage stress. It was also a big part of her social life, and one of her main “hobbies” which she told people about when they asked what she did in her spare time.

But Covid-19 changed all this. For two weeks she was unable to spend more than a few minutes at a time out of bed, and then as she gradually recovered, she still felt too weak for strenuous exercise. This long recovery period meant she lost her level of fitness, and several months after her illness she has still not returned to her routine.

Now she is working to bring back her fitness, but spoke to me about feeling frustrated that she had to “start again”, trying to rebuild her ability. It was a familiar story to me, as many people with chronic pain feel as though they lose part of their identity when they can no longer exercise like they used to.

It is often very difficult to “start again” from scratch, for example working hard to walk a few extra steps each day, when in the past a few extra kilometres would have seemed like no challenge. But in my experience the sense of achievement at finally winning some small progress can be very special indeed.

Dear former self

I sometimes ask people to write a letter to their former selves, at a time when they were in a different place and often in pain. It can help show people just how far they have come, and allow them to reflect on their progress.

One client, I’ll call him Sean, gave me permission to share his letter. He had just returned from seeing a concert in Dublin, and chose to write to himself in the past at a time when he had also just returned from a concert, Oxygen festival. The difference was that at Oxygen Sean was in pain “the entire time”.

“You felt it in your left hip all the time and you drank to make yourself feel better,” he wrote.

“You have been going to physio and doing copious amounts of stretching and strengthening work, but nothing is working.”

Sean'’s life has changed since that time.
“I’m here to tell you that you have finally broken free,” he wrote.

“You are living in a way that was unimaginable to you back then. It turns out the pain you have been a victim of is your body’s last ditch attempt to get your attention. You haven’t felt safe in a long time. You knew something was off; that life was hard; that being around people was difficult. I can tell you that all those feelings, sensations, and pain are related.

“You have met the love of your life and you have two beautiful, healthy, happy children. In the years after that concert, you put up an enormous fight: training; persevering; battling; and ultimately learning to live with pain, anxiety, bitterness, regret, and resentment. You tried so hard to keep it all in. You fought tooth and nail to live your life the way you wanted to live it.”

Now Sean has just taken his two children on their first holiday, and he describes having “so much fun”. He has stood up for himself at work, and driven to Dublin for a concert, heavy metal this time.
” You are still on a journey but it’s a good one,” he wrote.

“You are blazing a trail with Mags’ help. That painful chapter of your life is over, this new one is just beginning.”

Read the letter Sean wrote to his former self here.

Taking a rest

One of my family members recently had Covid-19. She had managed to avoid it through the whole pandemic, but the virus finally caught up with her. Many of her friends had already had it, and as someone fully vaccinated, in her twenties, fit and healthy, she expected a similar experience: mild, cold-like symptoms for perhaps a day or two. Instead, she ended up spending two weeks in bed, completely floored by fatigue and feeling a heavy weight on her chest.

What stuck me during this time was how difficult it was to get her to stay in bed. Every day she would get up and struggle to her desk, insisting that she must go back to work. I don’t know if the reason was partly her early career stage, and the fact that she had never taken any sick leave before so wasn’t used to the idea. Or if it was because she works from home: she certainly wouldn’t have had any ideas about travelling into an office in that state. Inevitably she would find herself unable to work, and end up giving up and crawling back into bed halfway through the morning. I couldn’t help thinking the whole thing would be easier for everyone involved if she had just stayed there.

The theme is a familiar one, as many of us struggle to take time to rest, or to do so without feeling guilty. It is so easy to think that resting is a waste of time, when in reality it is vital to living the rest of your life as best you can. I remember reading the autobiography of Chrissie Wellington, a world champion triathlete at the absolute top of her game. She wrote about learning that resting was part of her training – part of her job, even – as she couldn’t perform without it. The rest of us may not be putting our bodies through such brutal training as she was, but it would do us good to also think of resting as a crucial part of our lives.

Making the dream work

I love the sound of geese flying overhead. I look out for them every autumn and spring, and love seeing their beautiful formations and hearing their honking – which I always assumed was them sharing titbits of gossip and chat to pass the time on a long journey.

If I’m honest I never gave the migration habits of geese much more thought than this, until I happened to be sitting in the garden with a family member, who is a teacher, when a flock of geese passed overhead. She remarked that she had given a lesson about geese to her class, and asked if I knew why they fly and honk as they do.

It turns out that the v shape flying formation, like so much else in nature, is a lot more clever than it seems. The front bird breaks up the air and makes flying much easier for the two behind it, and so on through the group. Usually the bird in front is one of the more experienced fliers, and when it gets tired it swaps with another member of the group. According to the RSPB, birds flying in a v formation can travel 70 per cent further than one bird flying alone.

 The honking also has a purpose: to help geese stay together in the group. White markings on many breeds also help with this. If one goose is sick or injured, it will not be left to fend for itself. A few others from the group will break off with it, and stay with it until it recovers, when they join another flock.

The relative who told me this uses the example of geese to teach the principles of teamwork to her class. It’s a nice illustration, and it reminded me how rewarding it is to be part of a team. In my case this is usually to work on research projects, and it’s always brilliant to see the different perspectives and ideas that come through teamwork, as well as the feeling of being supported by colleagues.

Not everyone can rely on good teams at work, either because of difficult environments or more independent jobs. But there are plenty of opportunities to find a team elsewhere, whether through sport, volunteering or another hobby, and this can often bring great rewards.