February 1st, 2013

All around the world

One of the great pleasures of being a hospital psychologist is the opportunity to carry on conversations with patients that go beyond the 50-minute hour to other settings where staff and patients regularly come together. The conversation can start anywhere about anything but once a good idea has been set free, it can bounce around the building and come back to you when you least expect it. This one started in our Wednesday morning community meeting and re-surfaced in the first therapy group of the day. I don’t know where it went from there because my own work took me off in other directions, but this is how it began.

In our hospital, staff members from each of the professional disciplines take turns leading our daily community meetings. Psychology is responsible for Wednesday and, on that particular Wednesday, I hadn’t the ghost of an idea what we would discuss once we got past the routine announcements of the date, program changes and the weather. Normally this takes about 30 seconds, leaving nearly 15 minutes to consider some coping skills based on a sequence of stopping to notice what we are feeling and thinking, calming down and then deciding on a course of action.

This red light, yellow light, green light paradigm is a staple of cognitive and dialectical behavior therapy ideally suited to people learning to manage a wide range of emotional and behavioral challenges. And, of course, psychologists are considered to be ideally suited to present this topic. Over the past several months, I had run through much of the standard repertoire of mindfulness, emotion regulation and problem solving skills, and so I decided simply to follow where the spirit of the group led.

After two patients volunteered that the forecast called for a warming trend and that rain was expected on the weekend, a colleague announced that much of Australia was engulfed in wild fires. She said she owned property there and explained that her colorful shirt bearing the word “Australia” was her way of expressing solidarity with the people of the land down under. A man in the group added that the Mississippi River was receding and its watershed drying up, most likely as a consequence of global warming. As if to maintain the earth’s balance of water, another avid consumer of the news explained that the water level of Venice was rising and thereby threatening the integrity of the city’s buildings. He also added that there are places in Japan where you can find hotels made entirely of ice.

So what does any of this have to do with us, sitting in the common room of a psychiatric hospital in New England? I posed the question hoping to bring the discussion closer to home, to focus people on the issues they were in the hospital to address and perhaps to lend a sense of perspective by which we could all evaluate our own everyday struggles.

One man predicted an increase in the price of produce from the Mississippi River Valley if crops were damaged by drought. A staff member suggested that the weather pattern in the East would change in response to water and soil conditions in the country’s heartland. All we needed now was for someone to recite Robert Frost’s poem about fire and ice, “Some say the world will end in fire, / Some say in ice…” Thankfully, an older man reversed this gloomy trend, urging us not to worry but to trust that in the long run the balance of nature would prevail in spite of any short-term catastrophes.

We got around to talking about empathy as we tried to imagine the situations of people in parts of the world we seldom think about facing the dangers of extreme weather conditions. We talked of being grateful that, no matter what else we had to deal with, we were not battling wild fires, drought or floods in central Massachusetts, at least not today.

The meeting ended and our community dispersed, staff to their offices or therapy rooms and patients to different neighborhoods throughout the building for group therapy or work assignments.

My relapse prevention group started with a discussion about events or situations that increase our level of stress and have the potential to stimulate emotions which, if not managed successfully, can lead to relapse behaviors. A quiet man who had spent the last two sessions taking notes for his relapse prevention plan volunteered a strategy that helps him to manage stressful situations. Somewhere he had learned the acronym “DEAL,” where D represents deep breathing, E stands for encouraging self-talk, A means “all around the world,” and L is a reminder to live in the moment.

All around the world? Just what did he mean by that? He explained that people everywhere all around the world were facing challenges similar or greater than those he might be confronting at any given moment. Knowing this helps him put his own problems into perspective and brings them down to a manageable size. He and I had just come from the same community meeting where the group had drawn a similar conclusion after hearing about Australian wild fires and potentially catastrophic climate changes. So we weren’t the first to find wisdom in a global view, but that’s what happens with good ideas. They are irrepressible and, if they are worthwhile, they’ll be back.

Alan Bodnar, Ph.D. is a psychologist at Worcester State Hospital and a consultant in the field of leadership development.

By Alan Bodnar Ph.D.

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