Tuesday, April 4, 2017

Anhedonia: more prevasive than we realized..underreported and unreportable?

Anhedonia is defined as the inability to experience pleasure. I first found the word in a recent National Post story about the rising rate of suicides among doctors, in which the word was used to portray a flattened emotional state, the state one reaches to avoid having to confront a deep depression.

Among doctors, given the degree of commitment to patients’ recovery, and the attention to the details of each patient, and the dedication to fulfil the Hippocratic Oath, linked to the frequent “wrong turn” in procedures during treatment, the recipe is a blueprint for human tragedy. Add to the pressures within the practice of medicine the pressures to conceal any weakness or impairment, potentially to sacrifice “privileges” to operate and to practice in a given hospital or medical clinic, should those who experience a severe depression and or anxiety “go public” with their personal, emotional, psychological reality and the situation is especially fraught with danger, not only for the medical professional, but also for any patients under his/her care.

Faulty judgements, missed cues, inappropriate deployment of the scalpel, the over-or-under prescribing of medications…..these are all potential dangers for patients under the care of doctors who have come to the end of their “rope” and either refuse to seek help or deny they need it.

Another definition of anhedonia, the failure to experience pleasure, seems to have an inordinately high frequency in a culture in which extremes in bullying, public character assassinations on social media, the theft of private information, the invasion of one’s personal life by persons motivated only by greed and/or personal power and revenge prevail.

Coping with the full range of reality, at least that portion that seeks to harm us in ways that could pose threats from which one might conceivably not recover, requires a level of “detachment” and repression of the full depth and range of one’s emotions. “Flat-lining, as in the case of the doctors where it is profoundly dangerous, may not be the state to which most ordinary folks descend. However, there is a legitimate case to be made among many of the men of my acquaintance. If and when these men witness a tragic event, especially if they are attached to a fire and rescue squad and have gone through the trauma of such events, simply put the memories and the feelings away in a box somewhere in their private psyches. As one engaged in the fire/rescue process put it recently, “When you have seen twenty or thirty of these scenes, it is just one more to forget about and move on! After a while, it no longer registers on you.”

When asked if there are resources available for processing such traumatic experiences, the answer was that such a service is available to all public protectors. And when asked if any were known to avail themselves of such a service, the instant retort was, “If he did, he certainly would not tell anybody on the crew!”

Pride, especially pride in a kind of stone wall of emotional cryogenics, is misplaced pride, whether it is emitted by men or by women. Not only is it misplaced, it is downright dangerous. The Brits, especially exemplified by Churchill, are the historic model for “the stiff upper lip” during the battle of Britain, when bombs were falling over London many times with little or no warning. Fearless, unyielding, determined, disciplined, loyal and trustworthy….these are some of the traits ascribed to the British capacity to withstand the Third Reich.

When there is trauma, no matter the extent of the damage, for the moment when the victims are attended to, all thoughts and feelings have to take second place to the turbulence of the legitimate emotions that anyone would experience in such circumstances. Professional care, sound judgements, clinical proficiency and economic moves, along with the personal skills to diagnose, and to treat and to transport and to expedite processes to minimize the suffering are the ingredients required and expected at such moments of trauma. The recent military conflicts in Iraq, Afghanistan, Syria, Yemen, and even in Ukraine demonstrate, however, that there is a magnified impact on the mind/heart/psyche of those on the fronts of those wars. Reporting focuses on refugees, numbers of dead, especially women and children (collateral damage) and today, even the report of chemical weapons being used by Assad (AGAIN!) in Syria. Yet, months and even years after these battles, the memories will still be seared into the minds/hearts/bodies and psyches that will continue to impact the lives of those witnesses and participants.

The military, in most countries, has been very late to acknowledge the impacts of these PTSD “cases” probably because the cost of such acknowledgement would strain their budgets. Only with the rise of suicides, and attempted suicides from war veterans has the issue become a matter of public record and thereby less restricted in its search for fiscal support on all sides of the political spectrum. Similarly, police and fire fighters and their departments have been late coming to the support of their veterans whose lives have been negatively impacted by their traumatic experiences. And, it would now seem, that the medical profession itself, is also late to come to the table of acknowledgement that their peers are suffering and need help.

One of the questions that has to be posed, in this context, is whether the degree of masculine culture including masculine stereotypes is so dominant in North America in so many situations, including the military law enforcement, fire fighters, paramedics (also reporting anxiety and depression at high levels, given their exposure to trauma and abuse), the church, and the corporate world that “weakness” is defined as having an emotional issue, suffering a profound loss such as a death or divorce or job loss, and demonstrating emotional needs.

Of course, the profit margins would be inevitably impacted in the corporate world, if these legitimate needs were addressed by those inflicting the trauma in the first place. Also, to acknowledge that some of the training methods and expectations of many of these organizations would have to change radically, as well as the enhancement of support mechanisms, if and when personal PTSD experiences were to be acknowledged as legitimate and not as indications of weakness would be nothing less than a shock to many organizations.

Even some faith communities frown, sometimes openly and often secretly, on the overt expression of emotions, especially by those charged with responsibility for ministry. This “frowning” seems the height of hypocrisy, given the nature of the faith journey and its open embrace of the body, mind, spirit and soul, that concept that some consider the sum of all the other components. Alcoholic addictions, drug addictions, addiction to work….these are just some of the negative responses to pressures repressed, subverted and avoided or denied. And they are present among every class of professional.

Interestingly, most of the post-secondary education institutions do not include in their professional schools, training in emotional intelligence, emotional self-management and stress management. One practising dentist told me he hated the practice of dentistry, because he is always managing the pain of those patients in his chair. He deeply wished that he had enrolled in and graduated from optometry school, so that he would not have a steady diet of patients suffering pain. And, as a natural consequence, most of these professions do not subscribe to the notion of vulnerability, especially the kind of emotional vulnerability that accompanies trauma.

So with recent reports about veterans returning from war theatres, doctors and paramedics experiencing depression, anxiety and danger signs to report and seek help, and with fire and police encountering dangers, trauma and civil insecurity, including threats of terror, drug gangs and opioid deaths spiking, putting additional pressure on all public servants and pushing forward consideration of a psychic phenomenon for which the culture generally is not prepared to take responsibility.

Is it not long past time when the residual impacts of trauma, for all individuals facing its threats, to be able to access compassionate consideration by their respective professional associations, their peers and their insurance providers.

The Bell “let’s talk” campaign dedicated to reduce the stigma of mental illness is a very worthy first step. However, it is really just a first step, begging the larger questions:

Where does this stigma originate?

What is the research data that supports access to professional care?

How do we move beyond the watercooler in our conversations to make it legitimate and even responsible for highly trained and highly intelligent individuals to take responsibility for their psychic pain, resulting from their exposure to the rigours and the demands of their professional work?

When, if ever, will this male model of emotional anhedonia (shared by women professionals as well) be exposed for its sabotaging individual lives and the lives of people in the care of troubled professionals?

The notion, “it’s none of my business” is so pervasive in our siloed culture, that, in one psychiatrist’s case, only a phone call from a worried daughter, and another from a close friend, were enough to send him into counselling.

How many others are waiting for such a call?

And how many of us are keeping our concerns private, when expressing care and concern could open the previously locked door to the counsellor’s phone or office?

It says here, too many!!! 

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