Maintaining our mental health and well-being in veterinary practice requires interventions across all levels and across all systems. Even the most resilient person will eventually fatigue if they are constantly expected to swim against a tide of poor organisation and inadequate support.
Discussing all the leadership and management systems that impact upon an individual’s well-being in veterinary practice is beyond the scope of this article. Instead, it will focus on some of the psychological concepts that may help individuals understand some of the terminology and concepts related to mental health and well-being, concluding with a specific model of how these concepts can be applied.
This article provides a basic overview of some aspects of mental health and well-being that are relevant to all roles in veterinary practice. Some of the terms and models used are the author’s adaptations of models within the positive psychology literature.
What is mental health and well-being?
The World Health Organization defines mental health and well-being as “a state in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community”.
The key implication of this definition is that whilst the absence of mental illness and states such as stress, anxiety and depression is necessary to achieving good mental health and well-being, these factors alone are not sufficient.
Just as physical health is more than the absence of illness and injury, and dental health is more than just the absence of cavities, mental health is more than the absence of mental illness. Furthermore, we wouldn’t expect to maintain our physical fitness, our dental health, our fitness or our physique without investment in these areas. Similarly, to feel in control of our mental health and well-being, we need to invest in it.
Whereas physical health refers to our physical form and functioning, the terms mental health and well-being relate to our psychological feelings and functioning. The terms mental health and well-being are often used interchangeably. Mental health leans more towards how we “function” when faced with life’s experiences, whereas well-being leans more towards how we “feel” about our lives and consequently is often referred to as subjective well-being.
States of mental health and well-being can be considered on a spectrum ranging from minus 10 to plus 10.
Positive states of mental health and well-being incorporate purposeful thoughts, positive emotions and productive behaviours. Happiness, confidence and motivation contain aspects of all these.
In contrast, negative, or rather diminished, states of mental health and well-being incorporate pessimistic thoughts, overwhelming emotions and counterproductive behaviours. Stress, anxiety and depression contain aspects of all these.
Resilience is our ability to deal with and defuse life’s unsettling events. Whilst many articles now exist about what resilience is and how to develop it, it is important to emphasise two aspects of the concept:
- Resilience is not just for major life traumas
Just as our immune system protects us against ubiquitous microbes and mini traumas every day, our resilience deals with and defuses many relatively minor negative but normal emotions that occur on a daily basis. Dealing with and defusing the stream of unsettled feelings that occur in everyday life – and especially when working on the front line in a busy veterinary practice – is the bedrock of maintaining long-term mental health and well-being.
- Resilience is as much a physiological process as it is a psychological one
Whilst resilience is often framed in terms of managing feelings via thinking strategies, it is futile to try to “psych” ourselves into having good mental health whilst compromising our physical and physiological health and resilience at the same time. Whilst many states of ill-health are beyond our control, habits that compromise our mental health, such as insufficient exercise, consuming “junk calories”, excessive alcohol and a chronic lack of sleep, are often well within our control.
Negative but normal emotions
Just as some states of physical discomfort and inflammation are normal – and indeed essential – some forms of “feeling bad” (diminished well-being) are also normal, indeed useful, and should be encouraged at times. It is important to realise that even though we might feel unsettled, it does not necessarily mean we have poor mental health. In other words, there is a difference between well-being that is diminished due to negative but normal emotions (those that are not due to a mental health issue) and well-being that is diminished due to negative but abnormal emotions (those that are part of a mental health issue).
“Negative but normal emotions” occur in two forms. These are:
- Unconjugated (unconnected) negative but normal emotions
- Conjugated (connected) negative but normal emotions
Unconjugated negative but normal emotions
Many psychologists agree that there are five core emotions, four of which are described as “negative”: fear, anger, disgust and sadness.
The term negative is misleading as we often associate negative as something that is harmful or to be avoided. This is not the case because all of these so-called negative emotions hold value. This is because they result in responses that can save our lives.
When the emotional part of our brain (amygdala) perceives sensory information as a threat (fear), as an obstruction or an injustice (anger), as offensive (disgust) or to represent a loss (sadness), it leads to instinctive reactions that occur without conscious thought or sophisticated analysis of the situation. In fact, each emotion is associated with specific action tendencies. Fear is associated with flight, anger with fight, disgust with expulsion (from the body) and sadness with withdrawal.
Whilst these responses can save our lives, they can occasionally lead to counterproductive consequences. Negative but normal emotions can affect our ability to reason when feeling “emotional”. Similarly, we can react emotionally when no actual threat of harm exists – such as during a panic attack.
Conjugated negative but normal emotions
Whilst defining, recognising and understanding the negative but normal emotions of fear, anger, disgust and sadness is interesting, most of us do not experience, or are not exposed to, these emotions in their pure or unconjugated forms on a daily basis.
More typically, we perceive these negative but normal emotions as more complex states that occur when our mind conjugates (connects) core emotions with beliefs about what the outcome (or at least the potential outcome) of a situation means to, and/or for, us.
Conjugated emotion: emotion + belief = meaningful experience
The stronger the emotion and the more strongly held the belief, the greater the experience’s potential for meaning and memory. Meaningful and memorable experiences can be perceived both positively (uplifting and pleasant memories) and negatively (depressing and painful memories).
Whilst unconjugated emotional responses are typically intense but relatively short-lived experiences, conjugated emotions tend to linger in our minds even after the stimulus that caused them has passed. This lingering feeling is known as a mood. Moods, of course, can be perceived as positive or negative.
There are endless numbers of ways to conjugate the five core emotions with values, beliefs and other thoughts. This creates an infinite number of positive and negative states of mind. It is no wonder that we often feel confused, and even overwhelmed, when trying to work out what we are feeling about something and why we are feeling that way.
The scale below describes a range of positive and negative states of mental health and well-being using various umbrella terms. The terms are described below.
- Languishing: term to encompass a range of pessimistic thoughts, overwhelming emotions and counterproductive behaviours that are associated with torpidity and hopelessness. Languishing is a feature of diminished states of mental health
- Dysphoria: umbrella term to encompass a range of negative but normal states of feeling unsettled
- Equilibrium: term to describe a neutral state of wellbeing
- Gratification: umbrella term to encompass a range of positive and satisfied states of body and mind
- Eudaimonia (also eudaemonia): term coined by Aristotle to encompass a range of purposeful thoughts, positive emotions and productive behaviours that are associated with human flourishing or living well
Dealing with dysphoria
Dealing with and defusing the daily stream of negative but normal conjugated emotions and the moods they cause (dysphoria) is essential to maintaining long-term mental health and well-being.
The first thing to note is that feelings (moods) of dysphoria are normal, necessary and useful. Whilst we are often advised to “just snap out of it”, there are benefits of the lingering effects of moods. Moods offer opportunities to prevent or learn from a problem. When our mind anticipates what the outcome – or at least the potential outcome – of a dysphoric situation means to, and/or for, us, it can alert us to take action sooner rather than later. Similarly, if our moods passed too quickly, we would be less likely to reflect upon and review the emotionally unsettling event, diminishing our chances of learning how to prevent them from recurring, as well as how to respond to them more effectively if they happen again.
The downside, however, of remembering, reflecting and reviewing emotionally unsettling events is that we can ruminate excessively on them without resolving them, either psychologically or practically. Excessive rumination can occur either when we are experiencing a particularly heavy burden of unsettling events (“stress”) or if we possess a psychological architecture that cannot cope well with relatively minor levels of stress.
Mindsets that cannot cope well with relatively minor levels of stress are the opposite of resilient; these are known as fragile. Fragility is not simply the absence of resilience; fragility is a distinct psychological architecture that inadvertently fosters counterproductive thoughts, feelings and behaviours when exposed to relatively few unsettling events (stress). In other words, fragility can make feelings of dysphoria worse and allow stress to deepen into anxiety and obsession, moving an individual ever closer to the precipice of languishing and depression.
In contrast, resilience is the ability to experience, extract value or learn from and then defuse feelings of dysphoria successfully.
Six Ds of dysphoria
As noted above, there are endless numbers of ways to conjugate the core emotions with values and beliefs resulting in an infinite number of dysphoric emotions. Whilst this can make the task of working out how to define and defuse hundreds of everyday niggles seem overwhelming, if we analyse the situations that result in us feeling unsettled, “stressed” or dysphoric, we will notice many of the same recurring themes.
The following list contains six common themes or “reasons” that have the potential to make us feel dysphoric on a daily basis. Each of these themes begins with the letter D. They are: doubt, deadlines (and time pressure), difficulty, disappointment, disagreement and disapproval.
Veterinary practice regularly exposes us to these feelings as we endeavour to prevent and resolve clinical, client and financial issues. This can be draining. Coping with these issues requires resilience – ie the ability to experience, extract value from (learn from) and then defuse these Ds of dysphoria in ourselves and others successfully. The process of resilience involves unconjugating personal beliefs about the meaning of events from the negative (but normal) emotions the event caused.
The best-known model for doing this was developed by psychologist Martin Seligman. It is known as the ABCDE model. Whilst Seligman created this model to help people suffering from depression escape their feelings of helplessness, by helping them challenge their assumptions about the causes and consequences of negative events, it applies to the process of enabling resilience against all sorts of everyday minor unsettling events, including the six Ds of dysphoria.
Seligman’s original ABCDE model:
Below is an example of how the model can be used when dealing with feelings of doubt.