Moods In the Clinic
By Greg Bantick, BAc, MTOM
There is a rise in the incidence of mood disorders. Depression, anxiety, panic attacks, rage, eating disorders, substance abuse, and many more are becoming common. There are also moods secondary to complaints, such as the fear and anxiety that may accompany a diagnosis like cancer or infertility; the disappointment of training for an event, only to get an injury; the difficulty of living with conditions like pain, insomnia, and trauma. There are also everyday concerns for our finances, reputation, relationships, family and friends, the environment, and more. Practitioners are not immune from difficult moods. In addition to their own concerns they are also seeing, hearing, and feeling their patients’ and co-workers’ as well. While we are making interesting progress on many fronts to a better understanding of moods through modern medicine and psychology, the incidence of mood disorders continues to rise.
Can we learn anything helpful by going back over our literature and looking into the ways our ancestors dealt with moods? In the Huang Di Nei Jing, Shang Han Lun, and other early texts, we read many passages around the theme that if we fail to follow certain things in one season, we are likely to develop problems in the following. Or, if exposed to certain harmful climatic or dietary influences, we will more likely experience unpleasant symptoms in the future. This year at Pacific Symposium, in my workshop, we will examine some representative passages and explore the views inherent in them. The above examples suggest a view that symptoms and moods arise out of certain causes and conditions. If we can better understand the relevant causes and conditions, we can learn to cultivate those that lead to more positive mood states and avoid the conditions that lead to negative states. This leads to not just treating the arising moods, but also their sources. There are many other interesting and clinically helpful views inherent in our early texts.
By using my own case histories, we will cover what practitioners need to know to be more effective with patients who are deeply distressed. We will cover how to interview; key points in diagnosis; some old formulas revisited; some favorite point combinations and their uses; moxa and other techniques, and self help practices. For example, Bai He Tang is the core formula of the four classic bai he decoctions mentioned in the Jin Gui Yao Lue, or the Essentials from the Golden Cabinet chapter on 'Lily disease'. This is one of the most enigmatic syndromes. The text is brief, offering little explanation, but describes a patient who is depressed, does not like to talk, and is confused about what they want. They complain of feeling cold, then not cold, feeling hot and then not hot, craves food at one moment and then doesn’t want to eat, and they are taciturn and vague. I have found that many patients with chronic fatigue and post-viral chronic fatigue present this vagueness when trying to describe what they are feeling. This formula has helped.
We will cover several cases, each describing some commonly seen clinical conditions, anxiety, anger, rage, depression, PTSD, abuse, and eating disorders. Through the cases we can see how to modify interviewing and examination, possible formulas and points to use, and other techniques that helped. We will cover how to create the conditions for your patients to safely explore what contributed to their moods and to cultivate other conditions more likely to lead to positive moods.
From each of the cases we can also learn something of how we are affected by our patients and ways to take care of ourselves. We may find some of the same treatment strategies useful for ourselves. Knowing our own moods and the role we play in the therapeutic relationship is also important for our own health and our effectiveness as practitioners.
As practitioners we are also experiencing moods. Just as our patients are subject to conditions that influence their moods, so are we. It can be helpful to know the conditions that influence our own moods and shape how we practice. Some of the conditions include the following:
- busy assembly line practices can undermine the patient-practitioner relationship
- many practitioners are burned out, overworked, underworked, or exhausted
- workaholics are admired
- practitioners are not supposed to make mistakes
- some students believe they graduate with PTSD
- seeing too much pain and not enough joy is unhealthy
- for a practitioner, a cry for help is weakness
- we are part of the nation’s social safety net with few resources to help patients
- flashbacks (about our own issues/experiences)
- hyper-sensitivity, triggers / buttons that a patient may push
- beliefs that are challenged by our clients
- intense dreams, perhaps about something a patient has shared or how we haven’t been able to help
- a lack of separation between professional work and personal life
- becoming fearful of a patient or our personal safety
- feeling overly sad when patients leave
- avoidance /denial /isolation, you may begin to blame the ‘victim’
- zoning out, particularly during client-contact time
- sleepiness / trance-like behavior
- realize their own distress
- identify causes and conditions to refine their technical skills
- make effective lifestyle and clinical decisions
- recognize their own errors
- clarify their values so they can act with compassion, technical competence, presence, and insight
As helpful professionals we listen to patients’ stories of difficult diagnoses, depression, anger, fear, pain, trauma, or other issues and we may absorb some of this emotional residue. If we do not have ways to digest or process these stories, we may develop secondary trauma and/ or compassion fatigue.
Secondary trauma and compassion fatigue are not burnout. Burnout is more related to the daily stressors of the job. Secondary trauma and compassion fatigue are directly related to what we absorb of our patients’ stories and experiences.
Secondary trauma may occur when issues that patients bring to us are similar to issues we may have encountered in our lives.
Compassion fatigue may occur when issues patients bring to us begin to exhaust our ability to work effectively. We reach the limit of what we can tolerate.
Signs of secondary trauma and compassion fatigue may include any of the following:
In the workshop we cover more signs and symptoms and explain each one.
In order to maintain ourselves, it can be useful to know some of the interpersonal and intrapersonal mechanisms we engage in with patients. We will explore the therapeutic relationship looking at ways of relating that confuse us and cause us to misunderstand or be drawn in to unproductive exchanges.
From our own tradition, we know that cultivating reflection and self-awareness can help practitioners to listen attentively and better be able to accomplish the following:
We can develop the conditions that lead to a “not taking up” state of mind. “Not taking up” is learnt from reflecting on how we fuel our experiences. What we are seeing is not a self, but a way of perceiving and structuring our experience as if there is a self. We can see the way we structure our experience as belonging to us, identifying us, as defining us. All of our relationships are colored in this way. Not taking up is not taking up a way of self-structuring. Our medicine teaches that we are an aggregate of five phases in flux, not something fixed. We can establish the conditions for ourselves of gentleness, curiosity, and permission, which leads to unlearning fixed notions. We see into the patterns and forces that have shaped us. We are freeing ourselves from them.
Greg Bantick, BAc, MTOM originally began training and practicing in 1975. He helped found one of Australia’s first teaching colleges. He has studied in England, Japan, China, and the U.S. where he spent 20 years teaching and in senior academic positions at Pacific College of Oriental Medicine (PCOM) and the Seattle Institute of Oriental Medicine (SIOM). He is now practicing in Brisbane, Australia. Find out more about Greg at www.menla.com.au