The weekend paper had an article on "wellness" and was rather dismissive of this "new age hippiedom". It made me think hard about my own thoughts about this especially as I promote "wellness" to my patients.
Living in the UK,we are facing a health crisis. We have an ageing population and at the same time have a squeeze on funding for health, difficulty in getting people to take up nursing and medicine and difficulty in retaining those who have qualified, often due to burnout.
Someone recently said the 21st century is the age of self care. I think they hit the nail on the head. In times of limited resources we had better learn to look after our own health, by taking preventative measures. I have noticed lots of television programmes being aired currently by doctors seeking to look at patients as people, with complex lives and complex needs, rather than someone with symptoms that need a medical "cure". If I were cynical I might say that, although I think that it's great to get this message out there to the masses, it might be instigated by government agencies preparing us for an uncertain future with regards to our health service. But what is self care and how do we best go about it?.
Actually the fundamentals are very easy to describe, but, for most of us mere mortals, very difficult to initiate.
Firstly and I think top of the health tree is exercise. In second place( in my own order for the most important elements in health, though many other health experts would disagree) is sleep, third is mood (stress/anxiety/depression/fear/happiness/resilience/acceptance/outlook etc) fourth is diet and fifth is "play" a system that according to affective neuroscientist Jaak Panksepp (a hero of mine who sadly recently passed away), that is given to us in our genes at birth and helps us learn to get on with others, to understand their needs as well as the sheer joy of having fun with all its health benefits.
These are all areas that I will blog about individually in future posts, but if we could get these areas working reasonably on the vast majority of the population, we would probably witness many empty beds in our hospitals due to lack of customers.
I used to think the reason that most of us don't carry out the behaviours that we should in order to have the best chance to live healthily, happily and with longevity, was due to lack of motivation. However that doesn't really make sense. We are surely all motivated to lose some weight, to feel energised and be in a good place emotionally. Then I came across research into the neuroscience of our future selves. It turns out that when we imagine ourselves in the present moment an area of the brain lights up called the medial prefrontal cortex (and anterior cingulate). This in essence is the area of the brain that is about me-ness.If you then get people in a real time brain scanner (FMRI) to think about someone foreign to them, say show them a picture of a shepherd in Azerbaijan, it doesn't light up at all. What is really interesting though, is if you then get them to think about themselves in the future (or indeed past), it's as if they are thinking of a shepherd in Azerbaijan, meaning we do not recognise our future selves. Well if this is the case then why would we exercise, give up smoking, save for retirement when the benefactor will be a future self who is foreign to you.There are individual differences with some able to picture themselves, and the further out you went, say 20 years rather than 2 years the less activity in these brain regions. Of course there are many other factors at play, such as education, health, socialisation and peer group pressures, but this particular research really resounded with me and alongside the Marshmallow Test gives a new understanding of the way we act the way we do.
This also led me to think that this chimes with mindfulness (which I am currently studying for a Masters). If we do not recognise our past and future selves, perhaps it is because in our evolution, we would have been living very much in the present moment, which is what mindfulness on a basic level, is training you to do. This would have been because the future will have been uncertain and our minds will have probably been trained in on staying alive in the present (someone once said that instead of seeing ourselves as hunter gatherers, we should reframe that as hunted gatherers). How strange that we spend so much time ruminating about the past and future, foregoing an element of the experience of life unfolding in the present moment, when it is about a someone who is a stranger to us.
I like to take an hour's walk along the seafront in the morning, or when in London in Peckham Rye or Dulwich Parks. What is very noticeable is how many joggers are out there now and I would say in London especially, that the vast majority are female and in their 20's to mid 30's. So perhaps the youth are getting the message and are a new breed of clean living, wellness practitioners. And good on them. I must however voice a little concern. Along with all this wellness there has emerged a group of gurus who wish those that follow them to observe a very strict form of healthy diet, to be listening to headspace, to sell you apps that measure your sleep cycle, heart rate variability and a range of other neurosis inducing gadgets out there on the wellness market. Practitioners in this area need to recognise that the vast majority of the population have limited time, money and are unlikely to ever have a six pack or attend 7 day silent retreats on the banks of the Ganges.
It takes years of knowledge to become a "wise" health coach and although I have been working in health since 1987 I still feel very much a learner. What we are learning (and past blogs have alluded to) is that being an osteopath who just gives a massage and manipulation is no longer enough when dealing with people with complex pain. We need to understand the mind, to understand their past history, their values, goals and obstacles that may be getting in the way of healing. Also to understand that we are all unique and each recipe for change will be different. Indeed sometimes manual therapy can transform symptoms, whilst others may need, for example, to learn relaxation techniques, change their life-work balance, improve sleep hygiene or a combination of things (which is most likely). We as practitioners, actually need to be polymaths - people whose expertise spans a significant number of subject areas (wikipedia).
That is why I have taken extra studies in Mindfulness/Compassion, cognitive behavioural hypnotherapy,cognitive functional therapy, acupuncture, health coaching and motivational interviewing. I seek to offer people with complex pain states the opportunity to explore different approaches to healing, each treatment approach having it's own place.Indeed there is evidence that "stacking" treatments improves outcomes. This is what is known as Integrative Pain Management and looks to give patients different approaches to their (physical or emotional) pain.
If you have got this far and want to get in tune with your future self here is a link to give you some practices to help you do just that. See you in 20 years!.