I have enjoyed my first year as a registrar. I’ve enjoyed the greater responsibility, the chance to lead others, the chance to pursue more closely my chosen specialty as well as other interests within medicine such as teaching and writing. I don’t read as widely as I used to because some of these other “work interests” eat into my spare time.
Recently, I was given a book called “Philosophy for Life And Other Dangerous Situations” by Jules Evans, which has got me reflecting. The author had suffered from what might be termed “a nervous breakdown” or, more accurately, social anxiety, depression and post traumatic stress disorder. He discovered a cognitive behavioural therapy (CBT) self help group and realised that it had similarities to what he knew of ancient Greek Philosophy, particularly of Socrates. In his book, he looks at ancient philosophers and how ordinary people can use philosophy to improve their lives. I’ve only read the first couple of chapters so far but I can’t help thinking how much useful advice there is for doctors.
In chapter two, he examines Stoic philosophy by starting out with a story of an incredibly resilient British flight surgeon, Rhonda Cornum, who survived after being raped and held as a prisoner of war. She says “What I learned is that the experience doesn’t have to be devastating. It depends on you…the only thing I could control was how I thought. I had absolute control of that.” Despite suffering terrible experiences, Rhonda did not dwell on these, but instead focussed upon what aspects she could control.
She then went on to take charge of an American military training programme that taught emotional resilience to soldiers “to take control of your emotions before they take control of you.” She told them that her approach to adversity was that she would fix what she could and not complain about what she couldn’t.
Evans goes on to explain how this approach is at the heart of Stoicism, a philosophy he describes using the example of Epictetus, a Roman philosopher. Epictetus was a lame slave, who was eventually freed, and became a philosopher. He believed that most things are not in our complete control. If we are struck down by devastating illness or adversely affected by an economic recession, then there is (probably) nothing we could have done about these events and we certainly don’t have complete control over them. However, we do have control over our beliefs and our response to external events. We need to recognise that there are many things we have no control of. If your train is late and you miss your connecting flight for your holiday, this is likely to cause most people “stress.” But Epictetus would argue that we should recognise that we have to accept that the late running of the train is out of our control, and as such, we can do nothing about it. What we can control is our reaction to the late train and accept it “philosophically” as “one of those things.” This is clearly easier to achieve when dealing with a missed train rather than the horrendous experiences that Rhonda Cameron endured. But Evans argues that philosophy can be thought of as a form of training; like building up one’s physical endurance, you can train yourself to examine your reactions to external events using the three steps of the Socratic tradition:
1) Humans can know themselves. We can use our reason to examine our unconscious beliefs and values
2) Humans can change themselves. We can use our reason to change our beliefs. This will change our emotions because our emotions follow our beliefs.
3) Humans can consciously create new ways of thinking, feeling and acting.
Evans uses further examples of individuals who have endured terrible experiences who have used Stoicism and the Socratic tradition to rise above their desperate situations and take control of their lives.
He quotes the Serenity Prayer as a means to responding to difficult situations.
“Lord, give me the serenity to accept the things I cannot change, the courage to change the things I can change, and the wisdom to know the difference.”
If we are faced with a desperate emergency in resus, or if we have two sick patients to deal with at the same time, or if we arrive on MAU to find there are 30 patients waiting to be clerked, we would do well to reflect. There is no point in getting upset or angry or stressed. We should focus on what to do now as the best way to handle the situation. If there are two patients who are sick at the same time, then perhaps you could give some instructions to the nurse of the less sick patients over the phone re: initiation of management e.g. give a fluid bolus, whilst you deal with the other one. Or, if necessary, you could call a doctor covering another area to help. Either way, you can control your reaction to events – getting “stressed” is unlikely to help you and is unlikely to inspire confidence amongst your patients or nursing staff.
Please note I am not a student in philosophy so apologies if there are any errors above. I think the messages still ring true.
British Geriatrics Society 