Veterinary wellbeing overload?

2020-01-29

There’s a lot of emotional wellbeing advice for the veterinary profession out there right now. (I know, because I’ve shared some of it.) Don’t let it become overwhelming if you’re struggling with trauma today. Just take it one step at a time.

There’s been a boom in wellbeing advocates in the veterinary industry over the past few years. You’ve seen the topic addressed publicly at conferences, on association websites, and in Instagram posts and Facebook groups. And while it’s great that we’re finally talking about compassion fatigue, burnout, wellbeing, work-life balance and more, do we yet haveter!” As one Fetch dvm360 conference attendee in a class of mine put it: “That just sounds like more work I’m not keeping up with. Even thinking about is overwhelming!”

Meditation, yoga and better eating will help. But if we don’t take into account the effects of traumatic stress, our efforts for better, sustainable lives could be futile. Peter Levine, PhD, discusses healing from trauma in depth in his 1997 book Waking the Tiger: Healing Trauma. An important takeaway from the book is to acknowledge the importance of the mind-body connection in healing from trauma, but it’s not just about relaxing and talking it out with friends and loved ones.

“Psychology traditionally approaches trauma through its effects on the mind,” writes Dr. Levine. “This is at best only half the story and a wholly inadequate one. Without the body and the mind accessed together as a unit, we will not be able to deeply understand or heal trauma.”

So how do you start the journey? The process of healing begins from within, and the first step is acknowledging that you may have had traumatic experiences. Bessel van der Kolk, MD, outlines in his 2015 book, The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma, that at the core of recovery is self-awareness: “The most important phrases in therapy,” Dr. van der Kolk writes, “are, ‘Notice that’ and ‘What happens next?’”

No, you don’t need to remember exactly what it was that traumatized you, because memory can become faulty. Numerous veterinary professionals have expressed to me their thoughts on difficulties in getting therapy for their compassion fatigue. Challenges include finding the right therapist in their insurance network, making time to go to therapy, believing therapy will help, the negative stigma around seeking therapy and finding money to pay for a therapist. While I do strongly advocate for seeking professional help, you must also be your own advocate. No article—including this one—is a substitute for professional therapy. However, these thoughts may get you moving in the right direction, and at least they’re more specific than just drink water, get more rest and try to relax.

Self-leadership—key learning for your health

Working in veterinary practice, it’s important to maintain mastery over ourselves at all times. As advocates for peoples’ pets and wellbeing, we need to manage intense emotions as they surface. Otherwise, we risk losing opportunities to help, to connect and to truly make a difference. This is not the same as suppressing our emotions or numbing ourselves. This means processing emotions as they arise, and working through them, moment by moment, in a calm way. We’ve all had at least one veterinary client who’s been kicked out of the clinic or “fired” for their abusive or unruly behavior, leaving the pet possibly unable to get the help it needs and possibly just making the client some other veterinarian’s problem. Each of us may at least once have exploded with anger at a colleague because they didn’t do something the way we wanted them to do it.

These types of reactions often come from an inability to maintain self-leadership. You feel you’ve become a victim to the circumstance, and while these reactions may seem like viable solutions at the time, they only cause more damage in the long run. This is not to say that you should never fire a client or you’ll never have an outburst. In the end, we’re all human, and we need to do what we need to do to protect ourselves in the moment. But that need to safeguard yourself—when it comes from a reactive place—can be related to traumatic stress. The individual across from you takes on the role of a perpetrator (someone who wants to harm you), even if that was not their intention.

Finding ways to cope with feeling overwhelmed by sensations and emotions that are associated with traumatic stress and its effects is key to self-healing and mastering self-leadership. According to Dr. van der Kolk, there are three approaches to regaining self-mastery, as outlined in his book:

• Top-down: Processing memories of trauma by talking, connecting and reconnecting with others, and allowing yourself to understand what’s going on in you.

• Medicating: Taking medicines that shut down inappropriate alarm reactions or through other technologies that change the way the brain organizes information.

• Bottom-up: Allowing the body to have experiences that deeply and viscerally contradict the helplessness, rage or collapse that result from trauma. This often involves body work such as breathwork, yoga, massage, martial arts or other physical acts.

By committing yourself to the process of healing, you’ll come to learn more about the truth behind your reactions. You can regain control and be in charge of how you respond to traumatic stress. Neuroscientists today are aware that the brain can change and reconfigure itself back to a healthy state of functioning. The term “neuroplasticity” refers to the ability of the brain to rewire neuronal pathways and continue to change. This does take time, and there’s no magic cure-all pill. Similar to behavior modifications in animals, our healing often is successful when a multimodal approach is used.

Trauma-informed help—key resources for our profession

Having people in the veterinary profession and in your community who have studied and understand trauma and its effects is important to healing and to preventing trauma. Over the past decade or so, the behavioral health communities have advocated for trauma-informed care in their field for clients. The concept is being extended into the educational communities, childcare communities and beyond.

The other day one of my friends from veterinary school messaged me and needed to talk because she felt she was reliving a traumatic episode. All she needed to say to me in that moment were two words—“trauma” and “triggered.” In that moment, I knew exactly why she’d flown into a rage accompanied by tunnel vision and hypervigilance. The people around her didn’t understand what was going on and instead felt offended or upset by her actions. When she tried to explain and apologize, and take responsibility for her actions, she just ended up feeling exhausted, defeated and misunderstood. If we all made an effort to become more trauma-informed, it would help us not only deal with each other in these situations, but also clients who are likely undergoing traumatic stress events that cause them to lash out. If we can embrace the reality of how trauma affects everyone around us, including ourselves, more trauma-informed experts in the veterinary field is not too far in the distant future.

Your own worst enemy—letting go of victim and savior mentalities

“Traumatized individuals can have an investment in being ill and may form a kind of attachment to their symptoms,” writes Dr. Levine in Waking the Tiger. People may say they’re proud to be survivors, and their identity can become wrapped up in the fact that they made it through traumatic situations. Additionally, illnesses that may arise from repetitive activation of traumatic stress may become part of an individual’s identity.

This may also be apparent in the sort of dysfunctional ways we learn to deal with traumatic stress in veterinary medicine. If we view clients as perpetrators and pets as victims, we can become attached to the idea of victimhood or martyr personas (ourselves or animals) and force ourselves into the role of savior or survivor of the terrible things inflicted on us or animals. We may then become attached to the “high” we feel when we “hate” or “fight” a client or coworker.

I’m not saying situations of animal abuse or neglect don’t happen in our field. I’m not advocating that veterinary professionals should stay in potentially toxic or abusive relationships or workplaces because part of the problem is the stories they tell about themselves in those traumatic encounters. My goal is for all of us to start learning to exercise caution when judging, to question whether our perspective is in fact what’s truly happening or if we’re seeing others through the lens of trauma.

Baby steps—healing takes time

When I first applied to veterinary school, I used to think I was never—and I mean never ever—going to be capable of performing surgery. I was convinced I was going to fail veterinary school because of it. It didn’t deter me from applying—I just figured I’d cross that bridge when I came to it, or maybe I could just call out sick from every surgery rotation and hope no one noticed (yeah, right). Part of that fear was related to my shaky hands, and part of it was because I couldn’t even fathom doing surgery because I literally knew nothing about anatomy or physiology. As you may have figured out, I passed veterinary school and, yes, I perform surgeries now. How? Because I took things one step at a time, one breath at a time.

Throwing someone into the deep end and hoping they can swim, or at least not drown, is not an intelligent approach to teaching someone how to swim. I needed to learn anatomy first, then try cutting dead things, then live things and so on. I bet almost all of you can tell me a similar story about something you never thought you’d be able to do and then how you accomplished it, one step at a time.

Healing from traumatic stress and taking care of your mental health is no different. It may seem like a lot of work at first—that you’ll never get there—but all you do is take one step at a time.

Let me end with another Fetch dvm360 attendee. A woman came up to me in Kansas City last year and said she’d been in another lecture of mine the year before. In that lecture, she’d perked up when she heard me say, “If all you take away from this class is an attempt to try meditation, then do that one thing.” We ran into each other serendipitously at the Fetch dvm360 conference because I was leading the meditation class. She remembered me and told me that after she left my lecture last year, she downloaded a meditation app and had been doing one meditation a day for 365 days. It changed her life for the better. She acknowledged that while she knows she still has a lot of work to do, she could look back on the year and recognize how far she’d come.

So, don’t give up, don’t get overwhelmed with all the advice out there. Just take one baby step, one book, one app, one new habit … and sometimes fall on your butt, look around, get up and try again.

Frequent Fetch dvm360 speaker Dr. Hilal Dogan practices medicine in Denver, Colorado. She started the Veterinary Confessionals Project as a senior veterinary student at Massey University in New Zealand.