“Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare”, declared Audre Lorde with her wonted passion in ‘A Burst of Light: Essays’.
Self-care is pivotal in the maintenance of ‘wellness’, which is defined by the World Health Organisation as “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity”. A tall order, indeed.
Wellness was the norm in generations past but modern times have brought distorted ideas about health which have made being ‘unwell’ the default mode for many. And why are so many of us unwell? Generations of our ancestors must be rolling their eyes while rolling in their graves at our comparatively privileged existence from the point of view of advances in medicine and all sorts of appliances to make our daily lives easier. The tenable knee-jerk retort is that our fast-paced modern-day lives render us more and more vulnerable to burnout. Accordingly, the global wellness industry is flourishing.
Wellness is an expansive concept, which is no small part of its marketing allure. As you’d imagine, there are cures galore available to mollify the worried well until such a time as another ailment or cure appears on the horizon. There is something heart-wrenching about the efforts and extreme expense so many go to in pursuit of wellness when there are so many millions more on the globe who survive without what I’d consider basic healthcare, but I’ll park that sombre thought for now as it is beyond the scope of today’s brief post.
As a medic trained to practice in as evidence-based a way as possible, it is all too easy to be cynical and dismissive of the industry. However, we inhabit a sobering world which is constantly churning out reports of terrorist attacks, man-made and natural disasters and other atrocities and it is incumbent on us to reinforce the importance of self-care to ourselves and to our patients.
I see several TATT patients every week in my work as a family doctor. TATT stands for ‘Tired All The Time’ and is one of the most commonly used abbreviations in consultation notes in General Practice. 9 times out of 10 the reason is burnout and/or poor mental health. Requests for benzodiazepines (‘relaxers’ like Valium and Xanax) are ten a penny, despite their addictive potential and ultimate uselessness after one’s body adapts and builds tolerance to them. They merely serve to suppress the issue which is only an effective strategy for a short period of time, after which enduring issues resurface and deserve a more definitive remedy.
Hypochondria or health anxiety is also on the rise, in no small part thanks to Google and other search engines. Internet-fuelled health anxiety has been christened cyberchondria.
A channel 4 Dispatches documentary ‘Are you addicted to your doctor?’ has resonated with many of my colleagues. I should really look it up! When we first encounter this type of patient, the temptation is to investigate a patient’s symptoms in pursuit of reassurance. Missing that rare beast of a syndrome and gnawing worries about insidious, late-presenting cancers are foremost in our minds. We also operate in an intensely litigious climate which can drive the process, despite the spending constraints and limited resources and time at our armory. When exams, blood tests and scans yield normal results, providing reassurance to patients proves increasingly elusive and patients become fixated on constant reassurance which sets in train a vicious circle. Seeing certain patients several times a week (or day!) is not at all unusual when wading the murky waters of General Practice. The reason might be as frustrating as malingering or as heartstring-tugging as loneliness.
Today’s post has been of a general and meandering nature but I’d like to hear your thoughts on any aspect of wellness and/or health anxiety, in particular your preferred management modalities, be they reading, exercise, mindfulness, psychotherapy or anything else.
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