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The cost & courage of caring - stories that spark resilience.
Speaker 2 (00:00.19)
The real emergency occurs when intimacy is on the chopping block, when there's no element of an intimate expression of self and partnership. Once you hit that point where you have no energy left for expressing an intimate part of you to the person you're partnered with, that's where caregivers could run into real problems. Once there's an absence of any form of intimacy, that's
the most dangerous and it's the most rewarding thing that they can do. Open up the conversation. You'd be surprised how it can lead to strong emotional discussion by both people in the relationship.
Welcome to the Caregivers Podcast with Dr. Mark, a show that explores the cost and courage of caring and the ways resilience and possibility emerge in every caregiver's journey. It's a show and a place where we share the real stories of caregivers, the struggles, the breakthroughs, and the lessons that help us care for others while we try and learn to care for ourselves. This week on the show, I'm really pleased to welcome a colleague, collaborator, and friend, Professor Dean Tripp.
from Department of Psychology at Queen's University, Kingston, Ontario, Canada. His work goes back about 25 years and his focus has been on understanding chronic pain and the determinants of the chronic pain experience and how that affects not only patients, but caregivers as well. He's delved into certain chronic diseases that have a big impact on everyday life and we've learned so much from his contributions and I'm so happy that he's here to share them with us today. To put into a new lens what
chronic pain is, what determines how we experience it as a patient, but also how it affects our caregivers. What I hope to do in the second part of the podcast is sort of take a step outside and say, well, wait a minute, what do caregivers learn about themselves from this research? And I think we will all emerge from this conversation much more informed and potentially enlightened to take a closer look at what's possible for us. So on that note, Dean, welcome. So happy you're here. It is truly an honor to be able to
Speaker 2 (02:00.086)
share this conversation with everybody listening today. Thank you. Without any further ado, Dean, welcome. And I look forward to spending some time with you.
Thank you, it's always a pleasure spending time with you, Mark.
So maybe we can start off by just sort of looking down from 35,000 feet and just sort of hearing a little bit about sort of your journey in your research program at the pain unit and sort of where it started and where it is now and looking back, where you see it headed.
Boy, that could take two hours right there. I can't give you the shorter version. You know, it's funny, I've been asked this question by students, graduate students, son of graduate students, medical students for a long time, in how did I start? Because what I have been doing recently, I'll get to how I started, but what I have been doing is it's a weird combination of kind of things. Like, first of all, I'm trained as a clinical psychologist.
to
Speaker 1 (03:08.43)
at Dalhousie University and then went into academia right away. And what's interesting about that is I was lucky enough to work with a guy, fantastic guy, a little bit of a Renaissance intelligence, Dr. Sullivan, Mick Sullivan, who was at Dal at the time, was my supervisor, and he's gone on to University of Montreal. He's been at McGill for a long time now, and he's an international expert in the area of pain and catastrophizing in particular.
I call him the grandfather now. I think he's old enough to be called the grandfather, catastrophizing. But I started in Mick's lab working with chronic pain patients, disability issues, and kind of like trying to look at predictors of how people best manage, but also predictors of how people got off the rails and were suffering from depression, anxiety disorders, et cetera. I had always had an interest in
how humans struggle, how humans thrive, how humans can kind of withstand tremendous pressures in their lives. So that's why I was kind of starting in this chronic pain area. when I came to Queens University, probably about 20, almost 25 years ago now, I was lucky enough to kind of connect with the Department of Anesthesia here and, you know, became cross the point with anesthesiology. Later connected with the Department of Urology.
in the cross-pointed wisdom partner Urology and then had done, as you know, you know, from our personal contact, you know, years of work in the GI unit as well. So people I was used to say, like, what is this, like, you're a psychology guy and you're in, like, these departments, like, what do you do? And the running joke used to be, you know, I chase ambulances. Like, I go to where people are hurt. I try to find, you know, bring my stuff to medicine.
And that's why I've always been asked like next like, how did that start? You know, cause it's a weird combination. And although it's a health psychology combination of events, know, 25 years ago, 27 years ago, that area was kind of evolving and getting exciting. And you know, the psycho neuroimmunology stuff was kind of new and it was like pressing up against different models of how we thought about human beings at the time.
Speaker 1 (05:33.688)
So it was a super exciting time to kind of jump in. And I think I just had this, know, fanciful mix of interests and opportunities. So that's how it, that's where I was kind of in the beginning. And people say, well, how did it start? And I think it just started, you know, going way back. Like I was always, always had been a competitive kind of active person and always thinking about, you know,
the different sides of, it's funny, it's a sport analogy, but like success and how elite athletes got to be elite. And that always made me mindful of strategies that people use to manage stressful situations. So in school, when I went to school, university, is that, that's a whole other journey on itself. But when I finally got to university and
took some psychology courses, my ears were like opened and my eyes, especially social psychology, I was like, wow, because now I'm talking about the interface between society and how we interpret that society from an internal perspective, from inside you. So like I always said, an intra-psychic interest in social events. And that just kind of went in one thing to another, you know, I had no plan.
I wasn't like, I'm gonna be a psychologist. You know, I'm gonna do this for a living. had zero idea I'd be an academic, but it was just meeting the, like, you know, like meeting you, for example, in Kingston and the work that we've been able to do together. It's just one of those opportunities that when it presented itself, I was like, that feels good. I think I like to try that. And, you know, having met great people along the way, I just sort of ended up in this area.
of trying to help people manage real difficult situations. So it's kind of a long-winded, short-winded version of kind of where it is and kind of where my research has been in the last, you know, 15, 20 years.
Speaker 2 (07:42.926)
Dean, not all listeners may be well acquainted with the word, but what's catastrophizing? Is it a panic attack? Is it like, you know, just walking around with a dark cloud over your head, that sort of stereotype, or is there more to it? Like, what makes someone catastrophize, or what's a scenario or the thinking that leads to someone catastrophizing?
Yeah, that's a fantastic question. you know, it's, I'm so used to saying the word, I'm so used to being inside the construct that sometimes I just throw it out there and I forget to kind of get at it. But basically, excuse me, basically I think when I talk about catastrophizing and other people might have variants of that construct or what that means, I like to set it up. Cause when I talk to people about
and pain catastrophizing in particular, it really is sort of like a interpretive way that you see your world. And what I mean by that is, you know, there's different ways to interpret stress and stressful stimuli, things that might stress us out. What's really important to understand is that stress in its sense is only stressful if it stresses you.
And that sounds kind of ridiculous, but you know, I always have the old story that I've heard if, you if you're in a marriage and, you know, you don't want to be in the marriage and you get, you come home and there's a note on the table that says, I'm divorcing you. Is that stressful or is that maybe a good thing? Is it going to deplete my resources? Is it going to make me feel like I can't manage this or is it going to be, you know, all right.
good, this is what I need in my life, this is where I wanna go, and now I feel a little bit more fresher. So depending on what your take of a situation is, those events become stressful, or they become a way that you feel you can manage it, or it becomes a way for you to exit and feel happier. So life and social situations are like that. So again, another stressor, particularly about pain.
Speaker 1 (09:59.008)
is I have, let's say acute pain and it's out of control. I get morphine, I get medicine, get Advil, I get Tylenol, whatever the pain level is. And I take that medicine and the pain goes down. So then the stress goes down from that pain. Why we have studied chronic pain for so long is that when you're in chronic pain, you're not in acute pain. Acute pain comes and goes, it's usually an insult or some sort of injury.
You get it managed, medication helps it kind of settle and you're able to move on. But chronic pain is that transition from acute pain status to like this place you go, you know, where you have what I call a pain career. So the pain stays and in many situations, there's lots of situations where different trauma on the body, you physical trauma on the body, psychological trauma on the body creates pain as well.
or psychological trauma creates pain in the body, I should say as well. regardless, let's just say, know, physical trauma transcends time and it starts to come chronic. So the central nervous system and other parts of your body, your biology starts to get wired for pain. Although no new pain may be occurring, no more new tissue damage or damage to your actual body is occurring, you feel pain. And that is a really tricky place for people because we're used to being hurt.
And then we used to be able to manage it through most of our lives. But when you have chronically painful conditions or medical conditions, post-injury or medical conditions, let's say like rheumatoid arthritis, for example, or Crohn's and colitis or different types of conditions like that, what you're going to see is you're going to see people's bodies will be more consistently in pain. That chronic pain and that chronic illness that comes from that is where I talk about catastrophizing the most.
You had a very good point, Mark, when you said catastrophizing. Is it just out there in the world or is it specific to my research? It is out there in the world. Every single human being catastrophizes. And what is catastrophizing? It's kind of an interpretation of an event or a scenario or a situation, whatever language you want to use, where you feel, you know, somewhat helpless in attempts to manage that or to get through it.
Speaker 1 (12:23.946)
or to reduce the fear in it. Like you don't, it's something that seems overwhelming. The interesting thing about the process of catastrophizing isn't that you get to that endpoint, but it's how you get there. And there's parts like ruminative thinking. So a lot of kind of over, like you're just, you're on a bit of a mental treadmill with ruminating and worrying about events. Ruminating is a fancy word for worry as far as I'm concerned. And we all worry.
Like we all worry, like, you know, that's a staple of life, you know, throughout time, we all worry. And then that worry also starts to come into this other form of kind of cognitive perspectives, which is this magnification. So it's kind of like this threat that you're perceiving and ruminating about, or, you know, worrying about, and then that starts to grow because you're like focused. And the more you focus to magnify on that,
the threat seems, the threat value seems to get wider because you're constantly in the loop. So those two things, if you do them enough, and if you don't have any intervention, lead to what we call helplessness, which you can imagine. It's like there's lots of clinical and experimental literature on helplessness and how we get there, but mostly it's when you feel you have no other way to manage, no other way to process this, no help. And that kind of
that can create some isolationism, it can create other different types of behavior, but an endpoint of helplessness, which is connected to depression, which is connected to, again, anxiety. So catastrophizing, if I can simplify it, is a loop, but it has all these pieces in it that kind of get you to an outcome. So I often ask people, do you see catastrophizing as an outcome, or do you see it as a process? And I think it's always a good discussion to have with people.
You think about something that most people understand and that's the Sunday scaries that sort of, know, on Mondays tomorrow, it's been a great weekend. You have the Sunday scaries, which is a bit of scuffing and sort of, ah, I wish we had the day off tomorrow. And then there's the Sunday scaries where you're in the bathroom vomiting and not sleeping and dreading waking up in the morning. And we certainly appreciate from the literature and popular media, the range of how Sunday scaries are affecting individuals. There's no question.
Speaker 2 (14:46.988)
But you bring up a really interesting point in your comparison between acute pain and chronic pain. And as a physician caregiver, I need to understand the difference between the two. But as caregivers looking after loved ones or looking after individuals who have hired us to care for them in the home or running an agency, et cetera.
there's a very different approach that a caregiver needs to have towards acute pain and chronic pain, especially if that caregiver is a spouse or a life partner. So can you tell me a little bit about how the chronic pain really needs to be understood from the caregiver's perspective so that we can be better caregivers?
Yeah, that's a great question. And really topical to be straight. That's a super topical kind of area right now. I mean, to provide some context, if we look at our population in Canada, North America generally, we're only getting older. Like we're not getting younger. And that kind of age tsunami that's been pressing up against North America for some time, we're going to see that come to fruition over the next 20 years or so.
and we're going to be an old population. And with age comes disease, which aids, with age comes chronic illness and challenges. So I think it's very topical when you say, how does these constructs map on to kind of caregiving and taking care of people, et cetera.
And I'll speak broadly about it. when I say caregiver, I want to throw physicians in there. I want to throw nurses in there. I talk to my daughter all the time. She's a nurse in and around Baltimore now. And the stories that she has and the things that she sees are very interesting to me because of the way I challenge and ask her to take perspective on the care she provides. So when I think of caregivers, and I know people who are caregiving for their
Speaker 1 (17:02.03)
elderly parents now will often have these discussions of what are the pieces that stand out. Understanding what chronic pain is, is the number one thing that if you have the ability to be mentored in the caregiving role with someone who has a chronic painful illness, you have to know the difference between acute and chronic pain. And you have to know that they actually ride on top of each other.
So that, you know, if we look at a simple pain score of zero to 10, and we say, you know, zero is absolutely no pain, and 10 is the worst pain I've ever experienced. I'll often tell caregivers to use that metric to talk to the people they're working with so they can get a sense of where they are. Because pain is invisible. And, you know, we will express pain through pain behavior. But pain...
in one sense is invisible to us and it's invisible to caregivers. I might see your pain behavior and then intuit that you're uncomfortable or you're in pain. That makes sense. Physicians do it all the time. Nurses do it all the time. Caregivers do it all the time. But the gold standard for understanding where somebody is is their subjective report. So like, you know, if I could see your pain, that would be interesting. you know, if you had like,
If your forehead got really red, that would show me you're in a lot of pain. That would be so easy. But we have none of those external indicators except for expressive behavior. We don't have a blood test. We don't have a thermometer that we can use that measures pain. So we have to know where you're at, which can create problems if the person you're caring for isn't very verbal or there's more complications with their physical medical conditions. So reports, very important. And I always tell
caregivers to kind of collect that metric, be a little scientist. Because then when someone gets hurt and their average pain is like five out of 10, which is not a very comfortable place to be, know, three, two, we can get by with that. Most times, but five, six, seven, you're getting into severe, you know, that moderate to severe range. And that is usually most associated with bigger disability, which makes sense.
Speaker 1 (19:24.942)
But I think the idea is understanding that you can have pain and then you can have pain on top of that. So there's like chronic pain if it's relatively stable, which sometimes it's not. But let's say it's relatively stable and I'm used to your pain being around this measure. And then all of a sudden, boom, you know, you're five out of 10, but one day you said, God darn it, I'm going to go out there and I'm going to garden. This is one of the major things that, you know, I'm going to walk the dog regardless. I'm sick of this.
You know, I'm tired of this. I'm feeling like I can't do anything. I'm going and I know I'm going to hurt, but I'm going. And they go out and they hurt themselves. Now their pain is eight to nine out of 10 and they're wrecked for a day and a half. And it's like, then comes the whole psychological sequela that comes around understanding the pain. So there's the physical part of understanding the pain, you know, and I think that's really important to get, like get the numbers, try to look for pain behaviors. And then you get used to the guide on that.
And then there's the whole other psychological sequelae that comes from what pain does to you as a person and then what that could lead to in regards to how caregivers try to manage that.
it really opens up a conversation between the caregiver and the patient as well, and also understanding what the patient brings to the table and how they're going to respond to the, you know, their pseudo-active heroism, to use the gardening example, some may choose in the face of worse and pain to never go out in the garden again, whereas others may react to it and say, I'll get through this, but next time I won't push myself as hard. And that's probably informed by a lot of
cognitive patterns, lot of elements of somebody's psychological makeup, which is probably an important element of how they're going to move forward with chronic pain and also how that might affect the caregiver's ability to engage as well. Do you think it's just empathy that allows the caregiver to get into that space to understand the chronic pain experience of people we're looking after, or do you think it's more than that?
Speaker 1 (21:29.39)
Yeah, that's a great question. think empathy is a, you know, I've lectured on empathy, boy, for years, going back for a long time now. You know, I've done it in a business consultant perspective, employee health perspective, and I've done it inside of different treatment models that we've suggested is important. And empathy is like a double-edged sword. And I think it's really important to try to look at the...
the differences in empathy because there's like effective empathy and there's like cognitive empathy. And there's different ways to look at the pieces of empathy that can be burdensome for a caregiver. And I think it's that effective empathy that when you get caught feeling sympathy, not empathy, and how you try to express that repeatedly in an individual that seems to be kind of just getting, you know, farther down the road with
psychological distress, you know, being depressed, being anxious, being upset at the world, being frustrated. Like people are changing and these people, these patients who are impacted by these conditions, as you mentioned earlier, could be quite well adjusted in their coping skills and strategies. And they also may be people who suppress, people who turn inward, people who have a history of, like you mentioned, predisposition, have a history of
having a hard time managing stress. Like, and they internalize that. And not that some internalization isn't normal, but if you're a chronic internalizer and you don't get a chance to communicate and gather support, that's some of the primary predictors to kind of, you know, heading down that road towards depression. And I'm going to talk about depression as an outcome, like an endpoint, like it's down the road. And I always talk about that process of getting to depression.
as an outcome, I call it stression. Because I like to institute, I really want to have that fact that stress, in my opinion, is what leads to depression. It's that stressful experience combining the anxiety and the start of depression and what those symptoms look like that create this larger ball of stress that moves you along to really starting to nail the heavier symptoms of depressive episodes.
Speaker 1 (23:54.904)
So I think it's important to understand, you know, for caregivers, we mentioned looking at pain, but also there's that psychological component. So how does empathy help that or not help that? If you feel, and this comes back to the caregiver, if the caregiver is not inhaling the fresh oxygen, you know, and not taking care of themselves, and we hear that all the time, take care of yourself, and we can talk about strategies to self-manage.
But if you're not employed in those strategies for yourself and you're consistently cut off from those things and you're battling a daily existence for care and you don't get outside of that vacuum, that is a troubling spot for people to be in. Caregivers, and this applies to the taking care of a mom or dad at home or a relative or a child.
And it also, I think, applies to physicians and other professionals in the helping professions. So I think empathy is this place where you can use empathy to be with people. And I think you can enact empathy. for some of us, it's in us, and other people have to learn to be more empathic. But I think there is a line, it's a double-edged sword to going too far and feeling too much from people and reflecting too deeply.
And I think that's always been a balancing act for people, for sure.
it been there. I there's something about when your mechanism or way of approaching things is by giving more or providing more, you tap into that ability to be empathic, but you then at some point cross that line where there is no space for self care. And that's certainly in my, you know, my journey having been a physician for
Speaker 2 (25:46.958)
30 years now and having been in clinical practice after my research training, the ability to give is noble, but the ability to give at the expense of your self-care becomes problematic and taken on a chronic basis can certainly contribute to meaningful difficulties moving forward or falling into ruts. And I think a lot of the podcasts
long-term vision is about understanding about what we can learn from so many different individuals about how to optimize our self-care as caregivers, no matter where and what our caregiving flavor is. as a caregiver, engaging with someone or people I look after, what do I need to, what are the warning signs or what are the telltale signs that I'm dealing with someone
Yeah.
Speaker 2 (26:44.6)
who has a tendency to be catastrophizing and making that transition to helplessness, because that's going to affect my relationship with them. If they're my spouse, if they're my parent, if they're a patient of mine, if they're a client of mine, there's something I need to understand about that process. So I can not only be effective, but also maybe not internalize it and not feel like I'm failing. You need a certain skill set before you can feel effective as a caregiver.
Yeah.
Speaker 2 (27:13.336)
disengage at the end of your day, feeling like you've made a difference. So what, your experience, are the key things we should look out for and move with and embrace to be more effective?
That's a great question again. You're like batting a thousand here, brother. This is like very good. I try to keep it tight. mean, we've been doing this for years and years years in our clinical training program at Queens University and other clinical training, psychology clinical training programs in Canada. And that is trying to teach the act of psychotherapy and how to conduct
a process in which you're part of it and you're integral to the process, but that you stay professional, that you stay as objective as possible, not ignoring your humanity. And that's where the empathy double-edged sword comes in, right? And from my perspective. And I think if we look at beginners in terms of learning psychotherapeutic techniques and
the process of delivering psychotherapy. You'll see different people come in the door. You'll see some people come in the door super motivated, super ready to make significant changes, and super ready to rescue people.
Rescue is a key word there. Then we'll see other people coming in the door a little bit reluctant, a little bit, not sure if I know how to do this. I, know, what skill do I need to know? And they want to know the exact skill because they feel maybe, you personally, they're not comfortable with that. Cause that, that stress, that situation, and that could go back to kind of maybe their life experience, but that situation, they're not completely comfortable. They're not free in it and they get stuck and they get worried.
Speaker 1 (29:08.056)
And then there's a couple of other combinations of people that show up. But when you think about teaching those two different people, you can see an expectation problem, right? The rescuers, right, who want to rescue and they're motivated and they're go, go, go, how do we make it better? They can be far more easily disappointed, right? Because they feel the weight of a non-productive engagement. So if someone doesn't get better,
They feel that weight, right? And the discussions that need to happen with people who are feeling that way is objectification of the process. And I'm not saying to be cold or be inhuman, but to talk realistically about, you know, what you've done. Is what you've done at that point, the level, is that like the expectation for treatment? And did you deliver it well? Bang.
Then you have to look at, where is the person, the patient, where are they at? Like, what is their scenario? What are they living? Not what I'm feeling, but what are they living? And that discussion then brings you a little bit more rounded, right? Cause it's like, did I do everything right to my ability? Is that okay? know, did we have a good product? Did we provide a good service? And if the answer to that is yes, then all of sudden you just a little bit of exhale.
And then it's like, let's look at the situation though. You know, what else do they need? And what is their level of preparedness for change is another way to talk about that. Cause you may come in with a toolkit, right? And you go, I got all these tools and I'm going to use them all. But as you start to get to the bottom of that toolkit, you get worried. You get worried because we're trained to believe that we can fix it. We're trained with the idea that we can rescue. We're trained.
with the idea, it's what I believe, that we have to. It's like a moral calling. Like if we don't do it, right? And two things that people had said to me in my career growing up, and I'm part of that in my teaching, is that nobody made you God, number one. And you know,
Speaker 1 (31:35.31)
You have to check back with the person. Right. And those two things there have always been super valuable, you know, because we're human beings in a stressful, tough situation doing our best. And if you've done your best, you take an exhale on that, walk away from it and say, okay, but what, what can we do next? So it's not like you're done. It's like, what can we do next? And if you're getting to the bottom of that toolkit, like I told you about earlier, like if you're getting to the bottom of that.
That's when the anxiety builds. That's, you know, for a physician, I go through these different types of therapies with the patient. And this medicine didn't work, this medicine didn't work. And if you're in a disease of exclusionary diagnosis, so I'm gonna exclude all these other conditions till we find out we think you have this, that can be tremendously stressful on you and the patient, 100%. And you're going through all these things to you.
to you basically say, here's what I have to offer you. You don't say, here's the 50 things I can offer you, but here's what I think will work. And you go through them and it's not working. That stress builds and that's the time where you need to go back to the patient and say, this is where we are, this is what we know, this is the evidence for what we do. What do you think, let's go back to the beginning. What are we missing? What are you feeling like? How is this happening?
You know, it's kind of like a reconsideration of if these things don't work or provide at least some benefit. And that's another point. Sometimes option A, B and C provide some benefit, but they don't cure the person. And you're left with a person who has a condition that they're like, where's my cure? And it's like, you know what? There is no cure. And people don't want to hear that. People do not want to hear that. And people who have chronic pain is
until there's some revelation in science and biology or wherever it comes from where we know how to stop that and we don't. We don't. We have tools to help us, but we don't know how to stop it in many cases. That's an awful hard pill to swallow. But as you approach that place, you know, where you're, what are you left with is the question I always want you to ask. What are we left with? What do do now?
Speaker 1 (33:57.612)
And I think that's a really important question that people run away from.
I think more and more now we're recognizing that chronic pain is something we manage. It's not something that we cure. And I think that's entered sort of the pain speak when we meet our patients in numerous domains. But I can't help but think, and I heard your story just now, that there's something about asking ourselves, well, where are we are in the moment after this engagement with the person we're caring for? But where are we with ourselves in that moment?
And because part of the reaction to it is also that introspective thought of, what defines failure on my part? How come I wasn't successful in intervening or what was the obstacle? But without really understanding ourselves in that context, attempting to heal, attempting to engage, attempting to rescue, I mean, maybe some of the dejection that comes from those small fails.
might be reflective of a greater issue that we've been waiting to be rescued for a long time. And our trauma informs how we approach our client or our patient at the bedside in those challenging situations. And one of my thoughts is that taking an inventory of that sort of micro trauma that we carry, or micro residues maybe is a better word from, know, important emotional experiences in our past, especially when we engage in a commitment to caregiving professionally, or even if we're called
a very short notice to have to become a caregiver for others. We sort of need to take a step back and say, okay, how's my past going to form? How I'm going to cope with this? And maybe what I need to do is some upfront healing. And do you think that in this day and age, we sort of are dealing with the reality of the aging population, the growing needs for caregivers, and all we need to do is look at the news wires from the US, Canada, and the UK as examples of that.
Speaker 2 (35:58.51)
it's glaring and it's in every people's everybody's headlights and there's a shortage of caregivers. We can't mass produce caregivers without giving them the tools that they need to be able to engage meaningfully but also in a healthy way and maintaining their own health. Should we be encouraging people to really sort of look at where they need to heal a little bit more before embarking on trying to be healers?
100%. I mean, you know, one of the interesting things about that idea, and I've been thinking about that for a long time. mean, you know, it's, you know, I have the luxury of having a job where part of my job is to think about this stuff, right? Like, you know, a big part of my job is to think about this. How does theory and practical application come together?
So I can give you all kinds of explanations, but I've talked to people who are caregivers, good friends, and they just don't have the space is where we come back to. They don't have the mental capacity. They don't have the energy. don't, know, when they, unfortunately, when I talk to most people, they're at a stage, not in the beginning, like you're discussing, but they're at a stage where you're forced to come to the realization that I may not be equipped to do this.
And you don't, you don't, and that conversation is like super hard to get to. Like people, most people know they're not equipped to do it when they fall apart. It's the rare person that has, you what I call a luxury of space and time and energy to say, okay, I have this event coming up. Am I tuned in? Do I know how to do this? What am I bringing to the party? You know, and how do I kind of manage that?
you know, given the polls that I'm going to get from this other character. So that has always been something Mark that I've been really interested in, but, and I have some ideas on how to make it better, but I want to pause there for a second. and cause you're nodding and I'm like, I need you, I need you to say something about.
Speaker 2 (38:09.358)
Well, I mean, it's interesting because it may not be a question of whether I'm not equipped to deal with this, but maybe it's that the tools I've been using were not well selected. And I think if you get to learn tools earlier on in your journey as a caregiver or in your trajectory, whatever word you want to use, but it is a lifelong and a time and experiential sort of dependent process. If you learn those tools early on and it starts entering the curriculum at the level of
junior learners in the health sciences and the pre-medical sciences and occupational therapy, PT, PSWs, caregivers, qualifications. Like, what an impact we could make to take on the demand of what's around the corner. And I would hope that among our listeners today that we do have some representation from those people who are looking at their commitments, their career, their emotional commitments to the task. Because I think that's going to be, if we're committed to
fixing or addressing the issue of the demand that's over the horizon or that's actually here now. It's not that far away. Yeah, we're in it. We need to be equipping everybody from the earliest stages possible with some of these important tools to understand their empathy, to understand what not achieving the goal of the encounter might have when they look at it through the lens of this is my failure.
Oh no, and then tomorrow I may fail again. And then all of a sudden you might actually see the caregivers are starting to catastrophize. And then they may start feeling helpless. then, so when I think of the work we've done and your work,
I almost start thinking is that, there a bigger lesson here for caregivers? We've learned from the issues of catastrophizing and how that leads to helplessness and how that and several other elements of the patient's makeup can have a clear impact on their relationships with their partners, when it comes to intimacy, when it comes to mutual support, all kinds of things. And you can understand by extrapolation that patients can affect
Speaker 2 (40:25.602)
caregivers who take on other roles in their lives, probably in a similar vein if they're catastrophizing on that anxious to depression spectrum, feeling helpless. what's come to me in the recent while in terms of my thinking about things is, what if caregivers start doing that? What happens to their networks of support? And can it just sort of snowball forward? And then you've got a litany
of situations where caregivers are in big trouble and they're getting even more closed in, more isolated, more feeling alone. And, you know, that potentially has tremendous implications. So, Dean, I think our listeners really are appreciating your perspective here. And I can sense that there's something about understanding what it feels like to be at that
point, whether you're a patient, whether you're a caregiver witnessing it and trying to understand the person they love or their patient or their client. What's it like when you hit that point where you sort of start to unravel and the catastrophizing and the helplessness sort of sets in? Can you unpack that for us and sort of give us a better sense of what patients speak to?
Yeah, for sure. Well, two perspectives. I'd like to talk a little bit about the experience, you know, that I've witnessed and that our research has kind of talked a lot about over the years. talk about that patient perspective first. And then I wouldn't mind taking a minute if I could just talk a little bit about the caregiver, you know, experience from what I've heard and what I've read. So one of the first things that we have to remember about being in these situations to observe
somebody in a very tenuous situation, like a hard situation where they don't feel like they have a way out and they're just getting buried. I'm going to try to use the language of patients that I've been lucky enough to sit across from over the years. And I've heard I'm getting buried a lot and people talk in analogies and they have these expressions for their emotional experiences. And I always try to chase those, right?
Speaker 1 (42:51.35)
So I had a person once that stuck out to me because they, they, you know, they said, feel like I'm getting buried and, and, you know, trying to have an empathic response to that. I'm just like, you know, that sounds like a tough place to be. Like, you know, tell me more about what this being buried feels like. And they took that literally and they talked about a feeling that
When I wake up in the morning and I try to get out of bed, it's like I'm trying to crawl out of my grave. And I remember going, wow, okay, the imagery is pretty strong. I mean, I've had mornings where I'm stiff and I'm not feeling great trying to get out of bed. I said, imagine that times 500. And it's like, they talked about buried being almost like a physical sensation in many of the ways they were describing it. And they put these descriptors together. So that was powerful.
But then I talked about, know, tell me what it feels like to be buried. Right? What is that like from a feeling perspective? Right? Cause we're, hearing these things you're talking to me about and I'm wondering what kind of goes through your head at that moment when you're trying to crawl out of the bed and you feel like you just, you're under earth and you're being buried or under water is another expression I hear. And they say, look, it's kind of like,
It's like stuff is piling on me. And I say, well, what is stuff? And they say, it's like decisions, worries, thoughts about my ability to be me anymore. I'm losing my identity. And they'll go into these different areas where they're stressed. Like these are stressful thoughts. So what we try to do with that is try to kind of unpack the thinking.
Right? Because the most damaging thinking that we have is thinking that has no resolution. It's a resolute, it's a stop, it's the end of the line, the most catastrophic interpretation of what could happen. I'm there and that's it. You know, and whether you're, you know, in that situation or not, or close to that situation, it's important to try to unpack that. Because remember, the thinking that comes along with those feelings.
Speaker 1 (45:17.64)
is often automatic. Again, in the psychology world, we call these automatic cognitions, right? Freud would talk about them as being something different and other theorists would talk about them in a different way. But the idea is that there's something quick about it. Like we get to these places, not in purpose, but by these illogical leaps. We think it's logical thinking, but it's quite not.
quite logical. And when we get to them, they just compound and double down on themselves. So that idea of feeling buried is that feeling of weight, whether it's psychological or if you talk about fatigue and pain and all these types of things, where it's like, I am pushing that dirt off me to get out of my bed in the morning. So that's some of the expressions I've heard. And when you chase that thinking down, so like, I'm not good enough, like,
I'm not good enough as a father. I'm not good enough as a mother. I'm not good enough as a lover to my wife or husband or partner. And when you hear those sorts of things, go, you want to query them. Like if you, if you want to follow them and you know, you can query them and depending on your orientation and do it in different ways. But I think my perspective has always been who said that? Like who told you that? Like who told you you're not a good mother or you're not a good father? And sometimes.
people will actually say, Jim did. And I'm like, okay. Cause most of the times people don't have a person who told them that. They have a thought that in the echo chamber of kind of being distressed and not communicating with others about it and feeling burdened turns into kind of like a strong message. And that kind of is where I challenge, I who said that? And I well, I, you know, I just think it. I say, okay, so you think it, but did anyone ever say this to you?
So it's a little reality testing, right? Did anyone ever say this to you? Like you're terrible or you suck or you're not good enough or you don't make the metric. Who said that? And oftentimes there's nobody. So to go back to it, I follow that up and I say, okay, you know, no one said that. So where does that thought come from? Cause it's there and it's legit and it's hurtful and no one is saying it to you. Is someone like sneaking around the corner and passing your little note that says it?
Speaker 1 (47:44.672)
Is someone giving you a side eye and you interpret that side eye as they think you're not worth it? Like, where is it coming from? So we'll chase that and we'll talk about it. And ultimately in many, many, many, many of the cases, we'll get to a place where the person will say, and I'll ask them that question. Is it logical to hold that thought then if it's illogical? If it doesn't make sense, if you have no evidence to suggest
from your world that you're a complete disaster, but you believe it. it logical? Is it fair to hold that? And that's what I get to. Is it fair? Because if you had, you know, if I'm talking to my best friend and let's say I am the person who feels like I'm a complete disaster and I'm talking to my best friend and my best friend is telling me this, what would I say to my best friend? Yeah, go on, just be miserable. Like, you know, might as well compound that. Yeah. You know, just keep thinking it, you know, without any evidence.
No, I would say to my best friend, I'm not sure that's what it's not fair. Like, cause in the end, all you want to do is treat yourself fairly. You don't have to shine the glass so that it, you know, you're 100 % diamond. That's not what life is about, right? Although we want that many times in our life, it's not really what life's about. It's about a fairness. So I try to introduce this concept of fairness and self-reflection and, self-
in a way where you look at yourself as if, okay, if my best friend was doing that, what would I say? Well, you wouldn't do what you're doing to yourself to your best friend. So why the hell are you doing it to yourself? It's not fair. It's not fair.
Well, treat yourself with the same compassion that you offer to others. Yet somehow, we just are not very good at that. perhaps when we're so used to or programmed to thinking about others and not used to using the same auto-reflective sort of thought or process on ourselves.
Speaker 1 (49:30.734)
100 %
Speaker 1 (49:43.758)
Yeah, don't get me wrong, Mark. I love it. I love tough people. I've been studying tough people for a long time, mentally tough, physically tough, you know, and I get it when things unravel and toughness is no, and toughness isn't fairness. That's another thing I'll have to say to people. Toughness isn't fairness. Toughness gets you so far. It can seem like this brilliant buffer, but if you try to go tough, tough, tough, tough, tough, tough, it becomes bigger than you. Well, what are you going to do then?
Like, you know, if you go to the stone wall and you say, I'm going to headbutt that thing and you headbutt the wall and it doesn't move and you go, I'm tough. I'm going to headbutt it again. Well, guess what? You can headbutt that thing to the cows come home and you're only going to hurt yourself. So at that point, a couple of headbutts and you go, Hmm, maybe I need a new strategy. Do I have a ladder? Do I have a jackhammer? Do I have the ability to run around the wall? Can I dig under the wall? How about a parachute? What if I talked to a friend? Why don't I just eat lunch and sit down next to the wall?
Let's relax for a minute. And then someone comes by with a ladder and then you're over the wall. I think there's ways that we have to introduce that discussion to someone who's caught because they don't have that. I called it a luxury. They don't have that luxury of bandwidth in their head to be able to have this discussion.
Well, it seems like it's the reptilian brain on overdrive, right? To use the analogy of the old circuits that we evolved with and then over time the new circuits have developed that allow us to think a little bit more reflectively and introspectively and sort of look down at those thoughts and say, wait a minute, as you point out, that's not fair. That's not how I would counsel or advise my best friend. Why am I not doing it to myself and giving myself listening?
And again, be ready for people not to see that. And so as a caregiver, as a care provider, you know, whether we're talking about parental stuff, child stuff, being in the hospital, providing care, part of your job is to help other colleagues see it. Part of your job is to externalize and communicate what you might see, you know, with that person and ask it.
Speaker 1 (52:00.942)
Hey, how you feeling about that? I remember. Yeah. Yes. I remember once I talked to an ER intern and they had a patient die. And, you know, that was like early on. And the irony of all that is you hear lots of stories like that. You know, you see it in TV. I mean, I think that that
patient or your client in that case.
Speaker 1 (52:29.696)
Emmy-winning series, The Pit, not to advertise other people. You know, if you haven't seen it, there's a show where there's a young guy in there that loses a patient and basically blames himself. I should have, I could have, I must have, I did. And then you have these senior physicians having that discussion saying, and younger physicians having discussion that you did everything you could. You emptied the toolkit. You had no way of knowing that that was, that
that cardiac issue was lurking. All the tests, didn't show up. This happens. We didn't catch it. Like, you know, that is something we'd love to be able to catch, but there's just no way to catch that. You could not have done anything better. And that conversation is something that people need to hear again and again, because if that's traumatizing, it doesn't go away. Like it lingers.
So that conversation, again, connecting to, what do we do about these people in these hard places? It's conversation. So it has to be introduced in some way.
And that conversation is, know, fortunately we're starting to see, you know, the implementation of debriefs and training programs for healthcare personnel, whether they be nurses, whether they be people involved on the health team. But there are avenues to have those conversations and so that isolation doesn't set in. I mean, you're describing and you're, you know, feeling buried, when you're buried, you're isolated.
You're isolated in your thoughts, it's a feed-forward loop and there's no detour around it. Whereas these opportunities for communication and reflection about, know, have I done most I can for my patients, just open up new doors. So going from the patient suffering from chronic pain who sort of just feels like they're just incapable of, you
Speaker 1 (54:28.884)
Unmove
burying themselves and making their move, et cetera. Obviously that attests to when we approach caring for patients like that, a popularized model being the biopsychosocial model where you think about the patient's social environment, their psychological makeup and their biology when we try to address their needs and how to approach caring for them. By extrapolation, like thinking
from where you've done the research and you've got the data, how does it feel for a caregiver who's, like, caregivers must feel buried too, right? And they're not suffering from chronic pain, and we're not gonna say that all caregivers have a pain profile that follows them everywhere in life, but can we extrapolate a little bit of that experience to the caregiver who's just on overdrive going nonstop and...
what would they need to know or do informed by your experience in the chronic pain domain and understanding relationships there? What do they need to then try and...
adopt as a mindset, you will, because I really think some of this is mindset. Yeah, yeah, it's a It's going to go from the fixed mindset to the growth mindset in your caregiving. And the same as a patient might have to, but I think we need growth mindsets in our caregiving. we're not used to adopting them. They just don't happen overnight. It's an exercise. So can you speak a little bit and sort of, we'd really love to hear you speculate.
Speaker 2 (56:09.752)
about, you know, from exciting data you've amassed, it certainly shaped how we approach patients and who dealing with chronic disease and chronic pain. And God, when you've got the time for it, when you have a break in your schedule, and I can think recently of a wonderful moment I had with a patient where I had two patients who didn't actually show up and I had extra time and I was in...
the clinic room with my patient and, um, it had a wonderful opportunity to really delve into what was fueling some of their anxiety and some of their mood issues. And, um, it ended in, you know, talking about certain themes and authors and individuals they might want to, know, whose books they might want to read because they were readers. And, um, at the end of the encounter,
there was sort of just a release of tension in the room. The patient was there with her partner who was taking notes and the patient said, this is what it's supposed to feel like. And that was really, you know, been in the clinics for well over 20 years and you have those moments which really shaped things. then I reflect on the whole experience and that patient was not a revenue generating unit.
Right. Not in the least. if considered that, they never would have experienced that moment. But I think it was a turning point for them. And I can't help but reflect how we need to take what we've learned from your research and caregiving and patient experiences and how we need to adopt it. But at the same time, we need to create the space not just in ourselves, but the system needs to create that space.
if we really want to deliver healthcare, if we look at the health in the best defined way we can. So tell me a little bit about like, what are we going to need to do to achieve those goals for patients and also caregivers? I'm giving you a blank canvas. Let's create a grant application, an innovation grant together. And speaking of to what resources we need to be able to take some
Speaker 2 (58:35.424)
No, not every step, right? Because that's not the goal. What are some of the key steps, like now that you are in your career where you'd like to sort of speculate as to where you'd like to see things go next. What would be the most facilitating change that we could collectively work towards to seeing that come a reality?
I have some ideas. Let me first talk a little bit about what you, a point you brought up there in your discussion point and it is that growth versus fixed mindset. And everything I talked about today is a reflection of that process because mindset is a reaction set. It's like, you know, when I teach,
a growth mindset to athletes, I talk to pain patients, or I talk to college students, or professional teams. I talk about growth mindset as like the cognitive pieces that allow you to kind of be just a bit more resilient.
So by cognitive, just to reiterate, mean like thinking, the thinking blocks that.
There's thinking pieces, right? I call it thinking pieces. So like if you run into a challenge, if your mindset is fixed, the fixed mindset, and I crunch it up, like it's a fixed mindset, I always say it's it's crunched, it's solid, it doesn't move, it has no flexibility. So if you think of thinking that does that, a lot of fixed mindset is, only have so much skill, therefore I don't know if I can do this, right?
Speaker 1 (01:00:14.968)
So there's always a therefore or a but, right? There's that conjunction that always comes with a but. You know, I'm a pretty good player, but I just, I pretty shitty and I don't know if I ever do this. I am usually a happy person, but this chronic pain situation has made me terribly miserable. I can't find a way out of it. You know, so there's a positive and then a but, and then there's this dismissing of a future or an option. And that's a lot of fixed mindset.
Because if you hear the thinking I just talked about, you're stuck. Like you're in a place where I think I'm this, but I can't get that done, or I don't know how to do that, or I'm miserable. There's another fixed mindset. I'm just miserable. I'll never get any better. Those are thinkings. I call them thinking. There's thought patterns that we have when we're stressed. And I mentioned stress earlier. I have the beholder, right? So it's kind of like people need to have a debate.
an internal debate if they're able to, and like I said, they gotta be walked to that sometimes, and you have to meet them in their terrible place to start it, right? Like just to start it. So a growth mindset has butts in it as well, but I wanna flip it. So I want the end thing to end on something growth related. know, pain, for example, or caring for patients, or, you know, whatever you wanna pick, which would have
you know, be a pretty emotionally charged scenario in a negative way for you. So you pick that and you say, look, my pain is like nine out of 10. This is the most terrible thing I've ever experienced in my life. Right. And that's where you are at the moment. That might be true. Having a growth mindset is not about lying to yourself. Cause I know what lying gets you. It gets you a rebound effect. Will you deny something?
And then bang, it hits you twice as hard the next day when you, well, I'm also a liar. Like, you know, so there's that congruency or inaccuracy when you lie to yourself about things. So growth mindset statements and thinking for me is kind of like, my pain is really terrible right now. But I have had situations where I've had terrible pain days. I took some meds. I took the hot water pad. I did different things for myself.
Speaker 1 (01:02:39.946)
And the next day felt a little bit better. The day after that, I felt more out of the pain. And by the third day I was better. So, okay, what do you learn in the process though? So if we go back to that patient who is active and they want to go garden and God forbid I'm going and I'm going to pay the price. It's kind of like, okay, maybe when you go back to the garden, why don't you go at 40 % energy? So you don't destroy yourself for three days.
Do you want to go through that again? Cause that's where you're to go. Right. So again, it's about reality testing and again, the but growth mindsets will have like some statement and then it's like, but, and then there's a positive reframe on the end. So it's kind of like, but I've been through this before and I, and, and I, so thus, I feel like I could manage it, but boy, am I a Turkey for not, you know, following up on that. And I don't mind a little bit of that. I'm like, yep, you were a Turkey.
You understood it, but this is how we learn. We don't learn in life without some kind of trial and error. So this is your trial and error. So what are we going to do now? Now that we're wiser. So we're going to put money in the old wisdom bank and we're going to go out there and keep making little deposits. And that changes your ability to have a growth mindset because you're showing it works for you. And people are show me people. People aren't like, tell me people. So this is what I found a lot in my life, right?
So just the growth mindset, fixed mindset, I want to touch on that first.
It's interesting because you point towards a process, right? A process that's reinforced by small wins. But these days, it's all about knowing the instant fix that comes with parent success broadcast on whatever channel you're tuned into. And certainly for young people embarking on caregiving careers, where their empathy is being put to the test, etc. They might be inclined to sort of think of it as an on or off switch.
Speaker 2 (01:04:37.162)
in terms of like I'm capable, I'm successful at managing this when I come home at the end of my day and I'm ready for the next day and I've invested a bit of time in myself and I believe in the added value of these small wins and these little habits as opposed to, I tried once, didn't work, next day was horrible too, it must not be valuable at all, I'm not doing any of it anymore.
See, there you go. I need to put a conjunction and you need a little but in there. know, at some point you insert the but and then you just throw the happy time on or not the happy time, but the more realistic interpretation. You know, I chose this career. Now, you know, that's a great first thought. I chose it. I went after it. I wanted to save people's lives. I thought that this was the way that I would contribute to the world. And it's, you know, but lately it's been real hard.
So what I need to do, and there's an understanding of the truth. It is real hard, honor it. It's real hard. And then it's like, but it's really hard, but I have people to talk to, but I can start this kind of like self-care program, but because you know, it's like, give them options. So that's kind of the cognitive train. That's the thinking train. I'd like to see people go on instead of, but I suck and I'm no good.
Right? think that's the turn I don't want to take. want the train conductor to pull the thing and go that way, not that way. So I think that's what I'm talking about with that stuff.
So speaking of, I'm going to assume the role of a junior colleague about to enter practice as a caregiver. And I've done my homework. I attended the lectures that spoke about wellness, that spoke about self-care and ticked those boxes. I was there, I attended. I may have an idea about what my wellness formula is. I may like to cook, I may like music.
Speaker 2 (01:06:34.796)
dancing, I'm about to embark on the world and take on what the world has to offer, but also what it's thrown at me. And I'm immersing myself in that world as a caregiver and hopefully eventually perhaps partnered or maybe not. You know, they're all kind of different variations on the theme, but I will be a caregiver entering the real world. And we all know that analogy from whatever health
or ER show we watched over the years, over generations, know, entering the pit. Yeah. What, you know, to that point about from everything you've learned and you've come to understand in your rich career, what are the changes that society needs to make to actually give our caregivers today, but also those coming through the pipeline who are just about to start the healthiest chance of success
and a feeling of...
inner health, if you will, moving forward.
Yeah, I guess my ideas. I think, you know, and this is not wild thinking, like I'm, know, I'm not some, you know, a wild person here telling you, you know, things that are in the stratosphere. I think it starts with leadership. I think it starts and ends with leadership. And, and, you know, I know there are programs on leadership development in medicine in different places. I think that could be more common. And what does it mean to lead?
Speaker 1 (01:08:10.68)
So if it's not a person or like the attending or, you know, the senior resident or, you know, the department head or whatever it is in the structure of the hospital, if it's not the senior nurse or, you know, the charge nurse or whatever the language is we're using, there's got to be a leader. And there's leaders in the milieu, like there's leaders in the space, right? And they have to lead, and I'm going to talk about that in a minute. And there's leaders inside, let's say, the hospital.
There's leaders that have to understand that from a structural policy place, that leadership needs to happen there as well. So, you know, I've thought a lot about this because I think often about the world of psychology and I think the same thing. Like, you know, when we are providing, what is our method and mode for developing leadership for people who have the privilege and the hard responsibility?
of sitting across the desk from somebody or sitting across the room from somebody in the worst place imaginable that they could find themselves. So how do we lead people to ways of managing themselves that are going to be healthier for themselves? That has always been a thought for me. So number one, let's just talk about the structure and leadership from an organizational perspective. You know, one of the things that I think is really, really important, and this has to come, this is,
actually applies to both the level, all the levels I was just talking about, communication has to be open and it has to be honest, especially in difficult leadership testing times. Like if we go back to COVID and we go back to the pandemic and we think about the changes that occurred and the stress that we were all under, you know, sometimes the leadership didn't know what was happening next. They had no idea. were flying, you know, they were just, and some leaders,
shut down. Other leaders stood up and we're honest. We don't know. This is what's happening. This is where we are. I'm coming with another update. We don't have a resolution to that yet. Here's what we're going to do. This is the new scenario you mentioned. I'm going to research that. I'm going to bring it back to you. We keep the open and clean communication patterns between you, your people, and from a structural perspective, that's really important.
Speaker 1 (01:10:38.19)
Key number one, that should be a a position that institutions have, and that could be filtered down to different structures. So, cause you have to teach people to lead like that. It's for some leaders, like I said, their leadership style is in that situation is more about, I'm going to wait till something good comes up and then going to talk. But if you wait.
What happens? That caregivers get a voice that way and that sort of leadership that you're describing in the ideal case scenario is that there's an inclusivity which gives each caregiver a voice as opposed to going through it alone and feeling potentially more isolated as, you know, events accumulate because we do have it. We have the incredible privilege as caregivers, no matter where we care give, to be
experiencing and witnessing amazing human events and being involved in them, but they can take their toll, but surviving it alone and dealing with it alone can be a challenge. But I agree that sort of much more multi-layered openness and communication is huge. Whereas, it becomes too much of a problem or you get blacklisted because you spoke up or admitted something honestly, it's not a really healthy environment.
It's safe space, right? It's also going to be a safe space. So open and honest communication doesn't mean it's a place where you come in there and you just blast stuff against the ceiling. I mean, cause you're angry. I mean, yeah, that could be there and you have to work on safeness of the space. So there could be some rules. Some people want rules in that. Other people just want an open box. Cause anger is, you know, one of these expressions that you have to manage. Well, let's manage it. So I think there's fine tuning with that, but your comments are bang on.
The second thing is that, and you mentioned this, those great segue, is getting the institutions to listen to their workforce, which is difficult, right? Because if the institutions are top down, and I'm telling you how we run it, it's difficult to listen to workforce. So whether you're the attending or you're in charge of a group of people or you're the department head, you have a responsibility, in my opinion,
Speaker 1 (01:12:54.67)
to listen to the workforce using mechanisms and a variety of different mechanisms that you can employ to set up these scenarios where you can hear. Those can be through anonymous surveys. They can be through walk checks where someone, know, let's say the head of the GI unit goes strolling through clinic one day and just says, hey, Mark, how's it going today? Right? That may be a bit of a surprise.
You know, but it's kind of like, you know, what do you need? Like, how are you doing today? What are your clinics usually like? That is literally a two minute conversation that, you know, could change the whole day. Like, you know, from the care provider's perspective. So those things are small strategies that organizations use and not just healthcare organizations, but a lot of organizations use those kind of check-ins to get to their workforce and listen. So that's, that's another
Sorry Dean, I have no time for that because I've got six minutes to see the next patient and I've got three more waiting and I'm already running behind. Is there any flow between those two frames of mind that's even permissible or, but you're describing really, and I'm not quoting you my experience, but I know there's lots of different scenarios, lots of different.
setups out there in terms of where caregivers find themselves and the conditions in which they care give under. I could see where you have flow for such opportunities, but then you've got dams that just block any opportunity for that to happen. Where do we need to? There are movements afoot which are trying to sort of level that playing field because it's not working. there's amazing examples coming out of the states now.
set in that.
Speaker 2 (01:14:46.562)
the privilege to learn more about the scope of moral injury. I moral injury occurs in so many different forms, and I think they're macro and micro forms, and we can't lump it all into one category. to your point, if we can collectively embrace some of the necessity or constraints of the systems we work under, that could translate into small moral injuries. We can embrace them together and feel
a little bit united as opposed to isolated and suffering and dealing with it, then you've got a much healthier caregiver force, no matter what.
And this is what that's, that's a great point because if you think about what I've said, I've said, look, we need to communicate openly and honestly. That's a big thumbs up. think you and I are tuned in on that. I want the bosses, if I can call them bosses, to learn more about the workforce. And I give different strategies. So I think that's also something that's on them, but it's also when you're on the floor managing residents, you're also have to kind of, I know it's a time thing, but you make space. You make space.
And you don't have to have it every day, it doesn't be programmed in, but you find the space, end of the shift, beginning of the shift, middle of the shift, talking to individuals as you go on, that stuff. But then I think the other part that's important is reviewing guidelines and policies that deal with challenging situations. From a hospital perspective or from an organizational perspective, if you don't have policies, that's a good place to start. So that's not the caregiver.
on the floor, that's the upper levels, right? Because organization caregivers, there's different levels in there. And then you move to career support, counseling, what does the actual institution offer? Like, and is that up to par? Is it union? You know, is there a union involved with that or not? Promoting a supportive culture in the workplace is what I'm talking about, right? And it can be this, that, and this, but we can't get to those right now. Fine, start somewhere, but let's start to build that like you said. And then
Speaker 1 (01:16:52.768)
this idea of what is taking care of yourself, right? What is taking care of yourself? And I think there's lots of good literature, there's lots of good programs that exist, like you said, where people, I love how you said it, I attended that thing, I checked the boxes. And I love it when, you know, let's say we're trying to get someone to change their behavior and they come back in and I go, well, how did it go? Horrible. It went horrible. What do you mean it went horrible?
Well, what did you do? You know, well, I took a look at what you're talking about and you know, and it didn't work. And I'll say, okay. When did you try it? Well, I tried it like Monday. And I'm like, okay. Well, that was five days ago, you know, or six days ago, like seven days ago was last week. How many times have you tried since Monday? Well, Monday was enough.
And I go, okay, so you gave it one shot and you said, this is no good and you threw it out.
Well, you gave it one shot, you said it was no good, and you threw it out. It's okay, my feelings don't get hurt. Well, yeah, I guess I did. Okay, so if I give you an antibiotic and I say you need to take this for two weeks to cure this illness, right? Or this problem. And I give you a one, and you take one pill on day one and you get sick and you stay sick. Do you think that was a smart use of that medication? Do you think that medication had a chance to work? Well, no.
No different than what we agreed to do and you did it once. So this idea of I took a class, I did whatever, but did you really? Did you, did you invest? Did you do the homework? Did you take this with you in a different place? Or did you say click, check, check, check? Cause that's education. That's how we're raised. We go through classes in school like this and we check a box and we move on. So I always will question the dosage.
Speaker 1 (01:18:59.47)
that you've taken of that medication. And whether that's a behavioral assignment or it's a psychotherapeutic assignment or it's an actual medication, I question the dosage and the actual adherence to the plan. And I think this is a very different conversation. So I'm always ready for that one.
Well, you know, to that point, I think the environment that trains caregivers or the environment that then receives caregivers professionally down the line or when you're called to be a caregiver suddenly, you need to have sort of growth, think, to coin a term. Growth. And that's not something learned with one dose, right? It's something that's nurtured. if ever, you know,
Yep, I like it.
Speaker 2 (01:19:48.93)
caregivers everywhere can.
build a tool set, need to build it by repetition, by experimenting, tweaking a little bit, seeing what works and we can.
How do you start? This is the, to me, Mark, the biggest question in world is how do you start that? And you start it with conversation. Cause we have said, if I could do a word cloud of all the words that we spoke today, I bet you alone would be massive in that word cloud. And if for those of you who don't know what a word cloud is, you just take all the words. And if you say a word a lot, it gets bigger on the screen. And if you say a word once it's tiny. And I bet you our little cloud of words, you'd find alone.
You know, it is one of those words that we've talked a lot about today. And I think alone means no communication. means no help. means no outside. It means I'm buried. We go back to that language and that work. So the thing that I need to impart the most important thing, whether you're caregiving in home, you're a caregiver in a hospital or an institution is you cannot be alone. You have to communicate. And sometimes the boss needs to pull that out of you.
Because you need to know how important that is and people do know how important that is, but you have to make it happen. So force the communication if you're in a supervisory percept, that's what you do with debriefings, right? You give an open opportunity to kind of debrief on the scenario, right? You're creating conversation. So this to me is the number one thing. In reflecting on our discussion today, if I had one thing in my number one thing, it's communication.
Speaker 1 (01:21:24.672)
support through communication and starting the process and honoring where that person is in the process. You know, don't give up.
I'd love to know, you with the popularity of healthcare MBA programs across North America, how many of them include some of those key elements that you're describing in shaping the healthcare leaders of tomorrow? Because I think you hit the nail on the head. It's that free flow of communication that unites people as opposed to, you know, the excluded who stay alone and stay silent. We're now at this point where
identified that we need organizational change to facilitate caregivers making it from point A to Z in terms of their trajectory, their journey, committing to caregiving and actually coming out at the other side, still being able to care for themselves or having perhaps learned a little bit better doing it along the way. But outside the institutions and the
with the educational or the healthcare systems, et cetera, for the caregiver who's sitting at home, what are the first things they can sort of look to to initiate that sort of change where they don't feel buried? What are the first steps they can take towards rebooting, so to speak, or just sort of revamping their daily experience and perhaps
What lens can they sort of adopt to start seeing some small winds which are empowering?
Speaker 1 (01:22:59.682)
Yeah, that's a great question. know, there's oddly, there's parallels between, you know, organizational attempts and caregiving individuals away from the medical system. And I think, you know, that, and I said this previously, I'm going to say it again, the number one rule, if I have a rule, is communication. And this is what, when we talk about feeling buried under the pressures and the strain of it.
is, is, you know, that, that isolation needs to be beaten in some way or another. Now there's some different scenarios that I think is important to follow up here. Number one, for most situations where you be, have become a caregiver, like let's say there's a chronic illness with your child. There's a chronic illness with your parent. There's a chronic illness with your partner, spouse. And, you know, depending on what that illness is, there are
national organizations and international organizations that have support structures that you can connect to. But you have to reach out. So, you know, if you've been identified in hospital, you know, let's say it's Alzheimer's disease, and you have to work with, you know, a parent who's suffering from dementia of some form and extent, you know,
There's a bunch of resources out there, including local support groups and chapters, where you can talk to people who have been through the wringer, people who have professional experience, and people who have lived experience with these conditions. Every condition that I've studied and looked at in my life as a researcher has pretty much had a clinical research wing to it, where you could
access support groups. Right? So this is super, super important. And I know it's difficult because again, when we're talking about caregiving, we're talking about feeling like you don't have the jam, you don't have the energy, you don't have the wherewithal to consider those options. But it's a, you know, it can happen at the doctor's office next visit. It could happen when you're like, okay, I'm on my computer. I'm going to look up support groups.
Speaker 1 (01:25:25.206)
It could happen. I'm going to ask a friend if they know anything about a support group. All of those are ways to communicate, to outreach, to kind of touch something. And I think it's really important because I don't think I would tell many people this is a solo journey. Like you're responsible for making your thinking different. I think it needs to be a team effort. if you can identify a team to connect to, right, that is super important.
Now a team could be one person. A team doesn't need to be like the international Alzheimer's society. It doesn't have to be at that level. It could be a local organization. It could be one person in the hospital. Sometimes the physicians you talk to in the hospital say, well, we have patients who've been through this and they've agreed to connect and talk to people who are going through this. This sounds like that might be some use for you. Would you be down for that? And they might be, I don't know. And you'd be like,
I think it would be worth your while and you could at least try it. And there you have that nice interaction that starts it, right? That is a 20 second conversation that, you know, we want to insert into that medical, medical involvement scenario. But for the caregivers themselves, I'm encouraging anyone listening to look, ask questions to people, even their friends. You know, if you have a friend you complain to about life or a family member you complain to about life or someone you
Trust, ask the question, do you know anything about where I might get some help? Where can I find help? And again, Google searches, online searches, different types of searches can be useful for looking for support groups. And then it takes the bravery and the moxie to click that I would like more information. And that can be challenging in and of itself, but I would encourage people
to have discussions as often as they can, just like we talked about the organizational stuff, you need to create that space for yourself to walk into. It's not fair if you don't. And people, that might sound a bit harsh, but I want people to think of it as this is hard, I can try to do it. And you might get there in ways that aren't motivated by your own behavior. Like you may get there because of an interaction with someone who suggests it. So be open to it. There's your entry onto the highway, right?
Speaker 1 (01:27:51.362)
So I think how it happens is hard to prescribe. And I don't want to blame caregivers for not engaging in that behavior, but I'm saying be open to it. Like, you know, be open to it. And you might, you'd be surprised how you stumble onto it. You know, someone will say something and you're kind of a little more open to it. And it's like, and then maybe it doesn't even happen on the first time. Maybe you're too anxious. Maybe you feel too guilty. Maybe you feel too, you know,
It's too heavy. It's not yours to share. It's your responsibility. But when you feel that weight of it and you feel like you're not getting traction, even little traction, small victories, be open to kind of having a conversation. The benefits will outweigh the immediate anxieties. It will help.
That small win idea is so resonant in my experience in that, we can amass so many small wins that shift the pendulum, shift our direction and head us in the direction we want to. But you can't think of all 10 small wins that are required to get from point A point B. You need to kind of experience each one. But usually to get to the next small win and the next small win, you have to go through the first one over again. And eventually when you get good at it, you don't think about it anymore.
You're becoming unconsciously competent of the first five small wins you need to get through to each next one. But it's kind of second nature at that point. So we don't have that sense of overwhelm. my God, to get to point A to point B, I need to have my 10 steps already. actually you've gotten pretty good at getting through steps one to six. Now you can learn more about, you know, those next new...
you
Speaker 2 (01:29:43.899)
that maybe you're even more empowered to achieve better than ever because you kind of master the first one.
And it's really a two caveats. Let me give you two caveats that Mark number one is if I'm going to teach you to ride a bicycle. Right. You've never ridden one before. I take you out to the parking lot. I'm going to put trading wheels on the bike. I'm going to give you all the protective equipment that you need, and I'm going to get you on the bike. And we're going to just start walking around with me holding onto it. That's step one. Sounds ridiculous if you want to go ride a bike. Right. But then step two is, well, the wheels are off. I'm still holding.
Maybe supporting, we're going a little bit faster, teaching how to use brakes. Pretty important, right? When you're driving and get some balance. Step two. Step three is, okay, now I'm just holding a little bit and we're going a little faster and I'm training you how to break the bike. Step four is, okay, we're going over to that grassy hard pack field so it's not concrete. Get all the equipment on. I'm let you go and you're going to go for five feet and I'm to say brake and you're going to hit the brakes and you're good. Then we're going to, you're going to fall down.
You're going to fall over. You're not going to have a great balance, but we're going to keep doing that to get a little bit better. So small steps is everything. And again, I just want to humanize that because this process of being dehumanized, of being buried, of feeling alone is powerful. But if we look at these examples that we've lived in our lives, where we've taken and learned how to kind of do things better, maybe that helps it not be so scary. So small steps, you called it, I think at one point you called it equity at one point.
mental equity, I'd like to call it, or coping equity, put a little coin in the bank and you keep building that up. And that's, I can't stress that enough. I sort of interject, but I can't stress that enough in terms of the process. Expect small little things, but know that those are valuable. Don't discount.
Speaker 2 (01:31:38.36)
So in other words, many listeners may remember trying to learn to ski once when a good friend of theirs said, you'll do fine on the black diamond, don't worry. That's not how we want to approach our first run at trying to sort of identify small wins in our own self-care journey as we assume the role caregivers.
I I agree. I think that's a good way to say it. And another thing to mention really, when we talk about wins and we talk about difficult things in caregiving relationships, we've done a bunch of research on sexuality and intimacy in these situations where spouses, for example, have people that are in difficult physical situations.
One of the things that the patients are really worried about is they're losing themselves. Like this is a common language, I'm losing myself. And it's like, well, what is yourself made up of? And one of the themes that we've got too often is, know, like, you know, they're a provider, they're a spouse, they're this, but one of the things that they, had come up and so we did this research was intimacy, sexuality in particular. Like, and I'm not a sexual being anymore and I'm worried.
It's ruining our relationship. It's ruining my marriage. It's ruining, you know, my kind of partnership. And as I mentioned earlier in our discussions, that is an emotional landmine. Like people walk on that and boom, it's just like, it's so scary for them. And one of the things that I often will talk about is like, let's look at the thought. Who told you?
that you were inadequate sexually. And you'd be surprised. Sometimes it's like, well, no one, but I feel that way. Okay, we can talk about that. Or you'd also be surprised when they say, my partner said that. And it's like, okay, so there's a different discussion. But let's say, you know, I just feel that way discussion. We've had that earlier. And you think about that, I just feel that way discussion. It's like, well, if no one's telling you that, what evidence do you have that that might be true?
Speaker 1 (01:33:52.802)
Like, you know, is there behavior things? Well, my husband or, my partner just wants to sit with me. Right. And, and, and, and I'm go, and, and what does that mean? And how do you interpret that? And, you know, where's, what does it feel like? know, all those questions come into that scenario. And then that scenario then goes into like, but I just, they don't say anything, but I feel like they're missing that. And did you ask them?
Do you know? Like, is this a topic you've discussed? So again, it's about getting to that reality testing about those hard fears, about those internal reflections on your worth that you have decided that that has made you less lovable because you're not as sexual as sexual being as you used to be in the relationship.
many times, you know, either in the early stages of relationships or married for 25 years, 30 years. The response is amazing. So when that question is actually brought to the spouse or the partner, it's like this watershed moment where the oftentimes the spouse is like in tears saying, I can't believe you thought like that. Like, I love you. love you.
And the love comes out and the, know, I didn't think you'd love me. And that whole like floodgate of emotion rolls out of there. And it's just kind of like this amazing scenario where you renegotiate what it means to be intimate. And if you, it's a beautiful thing. And this is something I think when you're dealing with a caregiver situation where that is in play, again,
It's amazing.
Speaker 1 (01:35:47.916)
Those hard conversations to start can be so worth it. you just, it's kind of like, you know, having this little piece of crystal and you drop it and it shatters. That's what the experience is. Okay, we're crying, we're all over the place. And then it's like, okay, then you just put it back together. You know what I mean? just, whatever's broken, it just kind of gets restructured into this different thing.
It's slightly changed. still what you, it still looks like it, what it was in the beginning, but there's this different shape to it now. And now you're better adjusted. And that is, again, you learn from testing. You learn from testing reality and you learn from testing assumptions. And I think that is a bit of magic when you see that happen. Not easy to do because again, it's threatening. Interpersonally, but you know, I think that that communication, just another example of communication.
and thinking and how that can hesitate communication. So I would encourage caregivers to think hard about that, to think hard about how that might be a play. And maybe they initiate the question to the patient, hey, sometimes it's a statement. I love you, regardless. I'm here forever. And if you're ever worried about being sexual with me, you don't need to.
This is love for me also. And I think that's a real important message.
I think the chronic disease research really informed that whole notion of where intimacy and sexuality can become very vulnerable to the cognitive sort of role of thoughts that can affect a patient with chronic pain and their relationships, et cetera. know, sort of having done the research,
Speaker 2 (01:37:48.172)
to date and I'm sure there's individuals working on it and maybe, you know, that'll be the next wave for this project collaboratively over the years. But I think extrapolation to the caregiver scenario can really make a lot of sense. And when you're the caregiver and you're as vulnerable to some of the...
I guess we can call them thinking flaws or just, you the thoughts are a little bit flawed because I think the best barometer that you mentioned is that would you really give that advice to your best friend? So why are you not giving it to yourself? I think that's, you know, we're so good at taking care of our best friends and the people we care about, but when it comes to ourselves, it may be limited by limiting thoughts, but.
Where's the last
Speaker 2 (01:38:41.036)
may also be just some deeper issues. It's a lot easier to take care of others than it is to take care of yourself sometimes.
Yeah, and sometimes, know, that's the biggest hurdle is just getting to that realization.
One word I really like to use is the renegotiation and the renegotiation with yourself, small steps. And I think if you're a caregiver and you're at that point where you're feeling you've reached the point of overwhelm or the point of buried, et cetera, it's time to really sort of renegotiate some of the thoughts you have with yourself in your quiet time and, you know, look at their accountability in greater detail and start taking those small steps, which
can add up and become the series of small wins to sort of reach that next level. You know, what's amazing is that the story will be so unique to each caregiver and each scenario, it'll be unique to the individual caregiving task at hand. Some will be more draining, some will be less draining, but I think the hope here is that we can identify certain basic principles that we can tap into moving forward.
I agree.
Speaker 2 (01:39:50.414)
and that caregivers can benefit, but renegotiation is, think, a pivotal word.
Yeah, you got me thinking now. It's like, you know, what does recovery look like? Right? What does recovery look like from that type of emotional, you know, fatigue, that kind of, you know, experience? And I think it's like, if I can, you we talked about thinking a lot, but that thinking and examination of that leads to like what I call an emotional replenishment. It's kind of like,
You know, you're filling up the lemonade jug. You're recharging the battery. And that sort of emotional replenishment, I think, is a key to recovery from these things that we've been talking about, these hard scenarios that people find themselves in.
So Dean, I was thinking about some of the work in the chronic disease conditions that you've studied in the past. And one thing that sort of steps out is that that sort of spiral into catastrophizing, helplessness, cognitive thinking flaws and the likes can start affecting one's sexuality, one's intimacy, one's...
one's relationship with their partner in that dimension. And I can't help but think of caregivers who are reaching that point of overwhelm, of exhaustion, feeling like they're buried. And they must feel very vulnerable to finding space and time for, you know, not only expressing their own intimacy to their partners, but
Speaker 2 (01:41:40.462)
their intimacy and how they express themselves and offer themselves to others. It just seems to me like there's a ground or a soil there that's ripe with vulnerability to having that part of your life just take the back shelf and that sort of snowballs forward into marital strain or partner strain.
And that then feeds forward into even more feelings of alone and burnout and just feeling buried as you say. are your thoughts about that?
That's a great point. mean, you know, when we think about sexuality and, you know, inside of relationships, couple of caveats, a couple of important things to remember about. What drops, you know, sex drive? Like what drops sex drive? Could be medication, could be like, this is just in general, right? Could be medications, could be fatigue, could be injury.
could be sleep disruption, could be diet, could be a whole bunch of things. So when we talk about, you know, when I talk about sexuality, I think about, you know, difficulties in relationships, being sexual. There's a whole variety of medical things that could be behind that. But the perspective I want to take now is under the burden, the psychological burden, which creates physical scenarios that, you know, drop libido or sex drive.
and make it difficult because if it becomes a focus or a challenge in the relationship, then that needs to be addressed. one of the points that I brought up previously is that, yes, it could be a medical-based kind of, I say medical-based when I talk about fatigue because fatigue, although you can talk about it in a psychological construct manner, is also a physical sensation, right? So when you have that
Speaker 1 (01:43:50.488)
physical fatigue and you lose interest, which is another sign of depression, you know, and onset of the signs of depression. You lose interest in things that used to be enjoyable. You lose sex drive. These are all kind of symptomology of depressive symptoms. And when you start to see those things happen, why? Like, you know, why, why, why is that happening and what can we do about it? So again, it's that kind of
You know, if it's fractured, if it's something that is a problem area, because it doesn't always have to be a problem area. I'm surprised in our own research how many people said that their sexuality was not, they had a score on the sexuality inventory, which was pretty high, right? In terms of being dysfunctional. But their marital satisfaction scores were also high.
And I was just like, hold on. You know, I thought that if that was problematic, your marital satisfaction scores would also be, you know, in trouble. But it doesn't turn out that that's the case. And not for a lot of these patients. And following that up, we had interviews and we asked these people, said, here's the scenario, what do you make of it? And they said, you know, sex is fun. I've enjoyed sex.
You know, I've had this in my relationship, but it's not love. And we have found ways to be intimate that aren't the way we used to be intimate, but that doesn't mean that I'm not happy in my marriage. And I think sometimes that made our lab really kind of posture back and think, okay, is sexuality that important for every person in these relationships?
You know, I'd have to think in many situations, it's worth querying 100%. But I don't know. I don't know if I have the answer. I'm not convinced that in every scenario that that is a fire that needs to be put out. But it is a discussion because if it is problematic, if it is viewed as making me less of, or needs to be fixed, I feel like I'm, you know, again, less of is the best thing I can come up with at this moment.
Speaker 1 (01:46:14.658)
then that is the discussion and the thinking patterns that you want to kind of get at because it's leaving an emotional weight. And that's when we start to need to investigate these things. There's no emotional weight and there's some flexibility in how those people are managing, you know, their sexual scripts and how they behave with each other. Then they're going to be more well adjusted when those things get taken apart. So I think it could be a symptom.
Like the sexuality could be a symptom of the underlying depressive symptoms they're experiencing and treated rightly, rightly so in that manner.
So what I'm hearing from you is that the real emergency occurs when intimacy is on the chopping block, when there's no element of an intimate expression of self and partnership, sexuality aside. Once you hit that point where you have no energy left for expressing an intimate part of you to the person you're partnered with or to the person you love.
That's where caregivers could run into real problems. you mentioned that, you know, there are ways to negotiate around, around sexuality and relationship, but once there's an absence of any form of intimacy, then the relationships in jeopardy. And I could see where an individual is so overwhelmed, tired, burnt out, morally injured that they may not have room in themselves even for
BINGO
Speaker 2 (01:47:48.29)
you know, the intimate gesture of putting your hand on someone's shoulder who you love and say, I'm listening.
they're afraid to do that. Or there's like, there's a thousand reasons that could be behind it. And again, it's that reality testing. It's that kind of checking in. It's like talking to other people about it. It's like, and talking to the person who's in the room with you. Like this is the, this is the, know, to me, that's the most dangerous and it's the most rewarding thing that they can do for many people. They have that open up the conversation. And if possible, because again, not every minute.
you can open up that conversation. But if you can open it up, you find a way to get the conversation open, you'd be surprised, I think, how it can lead to, you know, maybe some strong emotional discussion by both people in the relationship, which can be good.
That's a huge acknowledgement that needs to enter the discussion for sure, because we know it's on everybody's minds. But your distinction, I think, between sexuality and intimacy is huge. a rebuild of intimacy could also restore sexuality. if you're down the ladder and...
intimacy has escaped your relationship, maybe that's actually the way to build up towards regaining, be it as a patient or as a caregiver, the element of restorative sexuality, if you will.
Speaker 1 (01:49:20.59)
That's what I'm suggesting.
Wonderful. Well, you know, whether it's speaking in the hall when we've had the opportunity, when it's been having dinner, it always seems like the conversation could be limitless. It's always a joy to share ideas with you, Dean, and to catch up. When we look at our discussion today and...
where it started. It started from an amazing career and body of research looking at the patient's suffering and chronic pain and how it affects relationships. And then some degree of meaningful extrapolation to what happens to the individual looking after the patient in chronic pain. And then more as this discussion's evolved into what happens to the individual who's looking after
a myriad or a population of individuals in chronic pain and suffering or need, restorative need or whatever need it may be, rebuild, surgical rebuild, physio rebuild, occupational rebuild. We've really come full circle back to the caregiver. And I'd like to finish this sort of last segment, just exploring a little bit further about some action items.
caregivers can do. I'd love to hear about some of your go-to resources. Which resources have been the most successful in your experience when you've had individuals you've advised have come back with feedback? And also maybe you could tell us, you know, we all have them in our academic careers when there are dark days where you feel like things aren't going everywhere, going anywhere. What tools have you turned to to help get you back on top?
Speaker 1 (01:51:13.966)
I like it. I like it. Well, the answer is going to be relatively simple, relatively straightforward. not a complicated guy. So the, think the idea of when we're talking about takeaways and we're talking about, you know, full circle kind of, you know, of our communication today, one of the things that keeps coming back to me, and this is, this is what I've taught. This is what I've experienced. This is what
I think is super important in terms of messaging for people to leave with is that communication opens doors. Communication creates scenarios for change. Communication relieves pressure. It relieves pressure. And this is the thing that I've experienced in my life over my career. Our careers are interesting in the research clinic world.
where it's like, you know, your currency is getting currency. Your currency is grants, your currency is publications, your currency is moving the information you gather out in meaningful ways. And it's nonstop. It reminds me of the old idea of trying to drink from a fire hose. Like, I mean, you you just walk into that insatiable kind of process of trying to constantly churn things out.
And I'm saying it with a smile because it's a beautiful experience, but it's also pretty tough sometimes. And I think that what I've been able to rely on for me, and I'm telling everyone that this is so important, is I found that mentor. I bravely spoke to that person when I was embarrassed about something. I leaned heavily on family members. I would talk to my spouse.
I would, you know, who also happens to be a psychologist. So that's actually useful and sometimes not. but I mean, I've, I've had those conversations when I needed them and, and I, and I want everyone to understand that is as trained as I may be. I fell into those traps. Like I did not know I needed that conversation and I'm pretty stubborn and, and pretty, you know, can be pretty competitive. So I wanted to.
Speaker 1 (01:53:38.958)
I wanted to do this myself. sometimes, you know, the best thing, like I talked about that person, you know, you're trying to slam through the wall. Sometimes the best choice is you don't have the ladder, you don't have the rope, you don't have the helicopter. How am I going to get over this? don't have a shovel. I can't dig under it. Can't run around it. It's for miles. And sometimes the best thing to do is to stop and pull out your sandwich and take a look back away from the wall in the field and go, look at that beautiful field.
We've been talking about this all along, but it's a construct of what I consider mindfulness and pausing and that pause that I've had to take in my own life at certain times when I've been tapped, when I've been stressed, when I felt the weight of big decisions and hard places, I had to take out that sandwich, man. And I had to like, just look down into the field for a minute and take a breath.
And that was the hardest thing I ever had to do in my life. But I remember it. I remember when I had to do it. And I remember the next step in that was I took the breath. Now I need to talk because now I need my team. You know, I need a team. And like I said, that team can be one person, can be a support group. It can be an organization. It can be your best friend. It could, you know, it could be a group of friends. It can be colleagues, you know, but I needed that. And those are the two steps for me.
And if you think about our conversation today, you know, that should fit with that. mean, you know, these are good clinical experiences we talked about today based on research, based on the science of psychotherapy and change, but they're also, you know, experience that I've lived. and again, I tried to take pains in our discussion to say, I get it that it can be difficult. I know it might not be the right time now, but just be a little bit open to it.
And sometimes that just turns the key. That just starts the process. And again, communication is key. How you get there, you know, just ease into it. But sometimes you need to take your sandwich and sit next to that thing you can't beat. Look the other way. And there's lots of ways to do that. It's called take a walk. Walk your dog. Go grab some outside exercise with friends. All of a sudden you're going for a nice, you're breathing deeper. You're outside.
Speaker 1 (01:56:05.71)
You're about the baseball games, you're chatting about life, and you're talking about nothing. And then all of a sudden you just feel better. It's like this magic formula. It's called connecting with human beings. And when we get isolated, that's what we need, but we don't see it. So I'm telling people from my experience as a human being, my experience who's lived life, that lived 60 years of life. And having lived those years of life, I think this is, if I give you wisdom, that's it.
But that wisdom is not lost on centuries of research, centuries of philosophical writings. Like, you know, that we need that. So, you know, I'm giving everyone a virtual hug right now. You know, you send it out there to the world, like, you know, cause it can be hard, but you, you, you just have to start. And sometimes you're going to find that.
Absolutely. Hard but achievable. Yeah. It's really interesting. It's that moment when you're standing in front of the wall where you realize it's happening to me. I can't get over that wall. I can't get through it. And to echo something Bev Blaney recently said on the podcast, who I consider the caregiver of caregivers. She said, when the moment happens, sit with it and realize it and realize it's happening to you and actually use that as an important cue.
and decide what you're going to do about it. you can't have connection without communicating first. And I think that was an important really message that resonated with me from what you just said. And I we know from numerous studies, even the Harvard Aging Study points towards connection as being one of the key determinants of longevity. If you're disconnected and you're old, there's not much that
We'll keep you going.
Speaker 1 (01:57:59.446)
No, it's not.
The other thing that I sort of reflect on hearing your advice is that when you're sitting there on that chair eating your sandwich, someone may walk by and say, you know, mind if I join you? Cause this looks like a pretty good place to have a sandwich.
100 % 100 %
And that's how connection builds. it takes a series of steps, takes courage, takes self-honesty, and also sort of non-catastrophizing thinking about yourself as you embark on that process. I would argue and certainly informed from what you're telling me about my own life experiences that it's about taking the steps and self-reflecting.
and moving forward.
Speaker 1 (01:58:51.342)
100%.
What's your favorite book, If you had a young person today to, or you know what, I won't say favorite book. I'll say favorite two or three that.
You can give me a favorite book. As soon as you said it, something came to my mind.
But that you advise a young person to read who's starting off in the field of caregiving and then perhaps someone who's been in the trenches for a while but has come to that point where they're staring at the wall and
Now it's seven books. Like I had one book and now it's like seven. I think, you know, on the thread of being sentimental and being empathic and wanting people to slow down, like there are instructional books, there's stuff that you can look at. mean, you know, they're all over the place. But for me personally, there is this one book that I read a long time ago.
Speaker 1 (01:59:48.248)
to my kids and I think it's called, I'm balking on the title, I think it's called Love You So Much or it's got a picture of a kid and there's a toilet next to him and there's this, damn, that's the book. And the thing about I Love You Forever or I Will Love You Forever or whatever you just said, you got it. I'm all image and that is the essence of life for me. It is that, you know, I want
Love you forever.
Speaker 1 (02:00:18.072)
people to understand, respect, and push into life. And that concept of loving other people and understanding that people love you is why I've done all this work. And I think this is, in my clinical work, I talk about fairness. You you could call that self-love. In the work that I do consulting-wise, it's about resiliency and mindfulness and turning, turning,
the mechanisms, like the language and the thinking and the behaviors to be supportive of yourself. And so I would just say whatever book that resonates with you in terms of love, but I would challenge anyone who's never read that book, bring Kleenex, because you will read that book and you will cry. And those are tears of depth. And I think that's the book I want you to read. And I'm not going to prescribe a book, but I think something along those lines, as long as it has depth.
And it resonates with you, because I want you to experience that. That's such a huge part of change, is having some of that depth in your empathy and in your life. So I think that's what I'm going to say for my answer.
It's a wonderful book and I think, know, if you read it once every 10 years, you'll probably still need that same box of Kleenexes. I can't help but think of a personal experience of when my grandfather, was in his late 80s, was finally leaving his home and he and my grandmother were moving into a senior's residence. We were at the house and he was in the bathroom and I inadvertently walked in.
rather
Speaker 2 (02:01:57.962)
I had to use the bathroom and he was standing in the mirror trying to wash one last time in his home because he was getting ready to go and he was riddled with arthritis and struggling. just remember saying,
my turn and washed my grandfather. that book sort of brought back that moment of memory of this continuum of loving forever.
I wish we could spend more time speaking to, well, so many more questions that seem to naturally arrive from our conversations, but it's been just a wonderful time today, spending time revisiting, and it's always a pleasure to revisit, but also taking strides forward and exploring. And I really love how we were able to sort of...
engage in little bit of extrapolation, which I would hope will fuel academics, not ourselves, others with some inspiration to start looking at studying caregivers in greater detail. There's so much to potentially benefit from. Fortunately, we are seeing recognize and recognizing
not only the need for caregivers, but caregivers' needs. And we're seeing that on the political front in numerous continents, big investments in the UK and Canada and the US supporting non-professional caregivers in the home, but also professional caregivers who are in such great demand and great need. And I would hope that some of these lessons permeate in that.
Speaker 2 (02:03:43.352)
people are gonna get equipped with these tools as well so that their caregiving journey can really be rewarding. And granted, there will be exhausting times, we've all been there, but they'll have a way to reboot and live fulfilling lives as caregivers. Any parting words for us, Dean, or shall we say au revoir and until we meet again.
Till we meet again, my friend.
That wraps up the podcast for today. Thanks for joining us at the Caregivers Podcast. I'm Dr. Mark. What an amazing discussion we had today and so many things to learn about. And my advice to you would be don't try and enact them all in one spot, in one setting. Make a list of the ones that resonate the most with you and start with the first and see how it goes. Until we see you next time. Before we wrap up, I wanted to remind you of something important. The conversations you hear on this podcast are here to inform, to support.
to spark reflection. not a substitute for professional medical advice, care, therapy, or crisis services. Listening to this podcast does not create a doctor-patient or caregiver-client relationship between us. If you're facing a medical concern, health challenge, a mental health challenge, or a caregiving situation that needs guidance, I encourage you to reach out to a qualified professional who knows your story. If you're ever in crisis, please don't wait. Call your local emergency number or a recognized crisis hotline right away. You deserve real-time help and support.
The views you hear on this show, whether from me or my guests, are our own. They don't necessarily reflect any organizations we work with, are part of, or have worked with or been part of in the past. This podcast is an independent production. It's not tied to any hospital, university, or healthcare system. Thank you for being here, for listening, and most of all, for taking the time to care for yourself while you continue to care for others. I look forward to hearing from you.