Resilience

Many years ago, I was meeting with the CEO of a large company trying to sell him on the idea of providing health education and prevention programs for his employees. He liked the idea and, indeed, thought that providing this program to his employees would be a good idea. I pointed out that I thought that he would actually save money on his health insurance program if he invested money in these programs. He said he thought that might have been true a few years before but was no longer true, given the fact that most of his employees stayed with his organization only a few years before they moved on to a new organization. So putting money into, say, smoking cessation or weight control might indeed be a good idea for the individual employee, but his bottomline would probably not be impacted since that employee would most likely move on to another company, and that company would receive the benefit of lower insurance claims since the employee would be healthier. In other words, putting money into health education of his employees and prevention programs would do little to decrease the medical utilization by his employees, since those employees would most likely be moving on to other companies which would benefit from the decreased medical utilization by the employee who had received the smoking cessation or the weight control program that his company had paid for.

The lesson to be learned: As we all know, the present system whereby businesses pay for the medical benefits of their employees does not work very well, and it certainly does not encourage companies to pay for health education and prevention programs since the company paying the bill for these programs will be unlikely to see any direct benefit to their bottom line for having spent the money on the programming. Most likely, the employee will move on to another company by the time the benefits of the health education and prevention would be recognized.

Ron Breazeale, Ph.D.
Author, Duct Tape Isn’t Enough
www.reachinghome.com

I recently came across an article that surprised me considering the profession. It concerned doctors and how they are unlikely to flag troubled peers which oftentimes lead to a tragedy. Carla K. Johnson of the associated press reported that a new survey finds that many American physicians fail to report seriously troubled colleagues believing that someone else will handle the problem. A surprising 17 percent of doctors surveyed had direct personal knowledge of an impaired and or incompetent physician in the workplace. The result is obvious and frequently leads to destroyed lives and career ending mistakes. See Portland Press Herald, Wednesday July 14, 2010. In focus: Impaired Physicians.

I have observed this same phenomenon in my own profession and organization over the years. It exists especially in professions that foster self reliance, bravery and a stoic approach to serious and deadly matters. These jobs can be filled with unique stressors, intense pressure and emotional turmoil in rapidly evolving unpredictable situations. The effect it has on individuals and the organization is enormous. Peer Support, coaching and developing resilience skills can make an incredible difference and avoid tragic results.

Peer support in law enforcement is not a new concept. Officers have always relied on peers and friends during times of difficulty. I have also observed that people have a tendency to believe a serious problem will go away on its own even when they know tragedy is predictable. It doesn’t go away! A structured peer program with solid education and policies can make a tremendous difference on many levels and in fact save lives. Trusted, respected, identified co-workers can guide and teach individuals the necessary positive coping and resilience skills. They also serve to network coworkers confidentially to employee assistance and or professional help. Trust and confidentiality are the cornerstones to the success of the program. It works!
Peer coaches are formerly trained by professionals in basic counseling, crisis intervention, debriefing, emotional communication and resilience skills. Peer support can be described as a subtle network of trained and educated individuals within an organization where others feel comfortable in sharing their feelings about the job, personal problems or a particular event that affects their work.

Building resilience skills and developing positive coping mechanisms along with understanding the organization and occupational stress is important for this to work. Ongoing education in the workforce, developing clear policies and procedures is paramount to ensure success. Overall, the peer coach should provide a confidential outlet and function as a guide in referral to mental health professionals. This program can be customized to any organization. I can personally endorse with confidence the success of a structured peer support and resilience coaching program. I know for a fact that the program in my organization made a tremendous difference in many many lives, averted serious issues, numerous mistakes and career ending tragedies.

Peer Support has often been the critical intervention point that has made a difference, helped the organization and in the end the welfare and safety of the public. This peer resource is available to physicians as well. I hope the profession considers this approach as well as the other services available.

Storytelling as an effective tool in teaching the skills and the attitudes that build and maintain resilience. These are often family stories. Reaching Home contains a number of mine. One of my family stories that I have heard throughout my life but did not include in Reaching Home was the story of Felix “Bush” Breazeale. The story has recently been made into a film that stars Robert Duvall, Bill Murray and Sissy Spacek.

The story is set in the late 1930s in east Tennessee. The main character, “Bush,” as a young man was arrested for a murder that he says he did not commit. He was released by the Court but was ostracized by the community. He lived with his parents until their deaths and continued to live by himself into his mid-seventies when he decided that it would soon be time to “get low.” He decided he would plan his own funeral, but he wanted to have it before his death so that he could hear what people would say about him and indeed had been saying about him for the last 40 years. With the help of a funeral director who saw an opportunity to make some money, he organized a “Funeral Party.”

The film lacks some accuracy. The funeral took place in the early summer, not the winter and, according to my parents who attended, was indeed more of a party than a solemn wake which is how it is portrayed in the movie. The funeral was attended by thousands of people from the surrounding counties and states and apparently resulted in my distant relative, “Bush,” being accepted again by his community. In fact, he became a bit of a celebrity being asked to throw out the first baseball at one of the local games. “Bush” died 4 years later and was buried in the wooden coffin that he had made for his first funeral. One might say that his “Funeral Party” was an example of resilience, but certainly an odd one.

To be in control of our lives, we must be in control of our bodies. To do this, we must be aware of what our body is doing. When we are stressed to the point where our nervous system is overwhelmed, our body becomes unregulated. Our blood pressure, instead of coming down as it should after the stressor has passed, stays up, as does our heart rate and respiration. We may continue to sweat, our pupils may remain dilated, and we still feel like eating nothing, since digestion remains stopped. The sympathetic nervous system, which is part of the autonomic nervous system, continues to be in control. Our muscles remain tight and we remain hyper-vigilant. To calm down, we must put the parasympathetic system back in control.
To do this, we must first of all be aware of our body enough to realize what is happening to us and what we need to do to calm ourselves. To ground ourselves again.

Our connection with others can help us to do this by helping us to normalize our experience. To realize that other people – indeed, all human beings – react this way when stress comes on too fast and there is too much of it. To realize that our nervous system has been overwhelmed and become deregulated and that we must regain control quickly if we are not to be traumatized.

As Genie Everett, Ph.D., RN, points out in her trauma first-aid program, stress does not equal trauma. We can learn to ground ourselves and to put the rational mind back in control, but we need to have learned how to do this long before the potentially traumatic stressors occur. We need to be aware enough of our bodies and our reaction to stress to realize what we can do to calm ourselves and ground ourselves, and we need to practice these calming responses before we need them so that they are put into muscle memory and are there for us when the car accident occurs, when the boss tells us we’re fired, when the terrorist attack occurs. One size does not fit all. For some of us, this may mean taking control of our breathing so that we slow it consciously and make it deeper. For some of us it may be rocking or shaking, or crying, or yawning, or focusing our mind’s eye on a color or a scene. Or putting our hands together or touching our heart.

Whatever it is, we need to know it before we need it, and we need to have practiced using it. Resilience means that we need to be in control and that unless we are attempting to escape from the jaws of a saber-toothed tiger, it is usually better if our rational mind rather than our reptilian brain is in control.

If you have been watching TV lately, you have seen a number of ads that blame the other party or a specific politician for some of the problems or maybe for all the problems that we are experiencing in this society. Once again, the politics of fear seem to be leading the charge for both of the major political parties.

Blame and accountability are different things. We should hold our political leaders accountable for their actions. But we can certainly do this without adding the huge amount of emotional baggage that blame adds to the formula. Emotions such as hate, anger and fear only distort our thinking and do not allow us to think rationally and to make good decisions. Holding people accountable will help us do this. Blaming will not.

Ron Breazeale, Ph.D.
Psychologist and Author of Reaching Home
www.reachinghome.com

Emotions often act as a filter on our thinking. Anyone who has been in love knows that we often do not think very clearly about the person that we are in love with. We may minimize or deny the differences that we have with them. And when it comes to such emotions as anger and fear, we may demonize the individual, or the group or the political party that is scaring us or making us angry. Unfortunately, when we make decisions, such as marriage or how we vote when we are wearing these emotional filters, we often make poor decisions. The lesson is this: we must be able to think clearly about what is best for us, our families, and our nation rather than to act out of emotion.

Ron Breazeale, Ph.D.

Psychologist and Author of Reaching Home

www.reachinghome.com

I recently had the opportunity to conduct a resilience workshop with staff from 15 different social services agencies in the Portland area. The program focused on the skills and attitudes of resilience and how these could be integrated into the work that these individuals do with their clients each day.

As the participants told stories about themselves and their clients, it was clear that they needed resilience as much as the people with whom they work. These are very hard times for people that provide social services in our society. It is a time when their services are needed more than ever, but there is less money and staff to do the job. What is most disturbing to me is the lack of understanding and support that they receive from the general public.

Like the veterans coming back from the war in Iraq or Afghanistan, these people who are on the front line of the battle in our society against the forces that could destroy it, e.g., violence, drug abuse, poverty, ignorance, need the same kind of support and recognition for the hard and dangerous work that they do.

Ron Breazeale, Ph.D.
Author, Duct Tape Isn’t Enough
www.reachinghome.com

In a capitalistic society such as ours, the answer is pretty easy. Money. We tend to reward those who make it with more money and tend to penalize those who don’t with less money. And the rewards and punishments tend to come fairly quickly. Unprofitable stocks get sold and often, but not always, CEOs of failing companies get fired. This, of course, was not true for many of the folks on Wall Street who recently got huge financial bonuses for exceedingly poor performance.

Tradition, tradition.

So as a society, we may talk the talk, e.g., the importance of education, the need to feed the hungry and house the homeless, etc., etc., but as a society, we have been very poor at walking the walk. Where we put our money tells the tale, not our words.

Ron Breazeale, Ph.D.
Author, Duct Tape Isn’t Enough
www.reachinghome.com

I recently saw the news in the Portland Forecaster that the Westboro Baptist Church, a group that, according to the Forecaster, “openly hates homosexuals, Jews, Catholics and America,” plans to visit Portland to protest a local high school’s theater production (the local high school is Waynflete) of the “Laramie Project.” The focus of the play is on the community’s reaction to the murder of a gay college student, Matthew Shepard, who was beaten and left for dead.

The Westboro Baptist Church’s visit to Portland is just another example of the increasing activities of hate groups in this country. Racism is certainly alive and well. Individuals in these groups are often motivated by fear and anger. Anger is used to suppress and control the fear which, unfortunately, often turns to hate. These individuals only feel safe if they can control or destroy the hated group.

This strategy may work for them, but it certainly doesn’t work for our communities or our nation. These poor souls would be better served to pray to their God to help them find other ways to deal with their fears and to be resilient.

Ron Breazeale, Ph.D.
Author, Duct Tape Isn’t Enough
www.reachinghome.com

I would encourage you to rate the resilience of the individuals who represent you in the Senate and House of Representatives. Keep in mind that 290 bills have been passed by the House of Representatives as of late February but have had no action by the Senate. Many of these bills passed with bipartisan support. The Senate, however, has taken no action on these bills because of the threat of a filibuster each time a bill is presented to the Senate. In other words, the Senate has done very little in the past 6 months.

If we look specifically at the skills and attitudes of resilience, such as connectiveness, we see a Congress that is extremely bipartisan and totally disconnected. If we look for effective communication within Congress – specifically, the Senate – we often don’t see it. Flexibility doesn’t seem to exist, especially with the party of “no.” Managing strong feelings, such as fear, is a skill many of our Congressmen and Congresswomen and Senators seem to not have. Problem-solving skills seem to be lacking on both sides. Congress, I believe, should get a failing grade in terms of their primary role, which is to take care of this nation and its citizens.

However, Congress should probably get a passing grade on taking care of “self,” since much of the current behavior of our Congress seems to be focused on the issue of getting reelected and staying in office versus taking care of the public and the welfare of this nation. It would be good if these representatives of our nation could show self-confidence in their positions rather than simply bluster and if they could communicate with each other, really listening to the other side of an argument would be a good start. Those of us watching the present horror show will hopefully keep a sense of humor and be optimistic knowing that this, too, will pass. I would encourage you to look carefully at the behavior of your representatives and let them know how resilient you feel they are being in dealing with the present problems our nation in facing.

Ron Breazeale, Ph.D.
Author, Duct Tape Isn’t Enough
www.reachinghome.com