AVMA Positive Changes Evident at Convention's Keynote Address

The 2016 annual convention of the American Veterinary Medical Association (AVMA) was the best convention I’ve experienced; hands down. I’ve been a veterinarian for 33 years and have never been more proud to be an AVMA member than I am right now. The keynote address and many presentations associated with wellbeing were instrumental in this result. I met many people intent on helping veterinarians improve our wellbeing and continue to practice the profession we love. I am so grateful. There is a wellspring of support sprouting in our midst.

Joseph Kinnarney - AVMA.ORG

When introducing the keynote address, Joseph Kinnarney, AVMA President 2015-2016, spoke about our profession’s high incidence of depression and stress. Kinnarney is not just another in a long line of white, male, elder-statesmen to lead our association. As the AVMA’s first openly gay president, he heralds in a new era that promises more openness and diversity, something our organization has been lacking. He spoke of the AVMA’s initiatives to address depression and suicide via the Wellness Roundtable and Future Leaders Program.

The 2014-2015 Future Leaders class introduced the AVMA’sWellness and Peer Assistance page, which was a good start. I’ve noticed it has consistently improved. Currently the page offers a Professional Quality of Life Self Assessment test and subpages with information on Work & Compassion Fatigue, Stress Management, Financial Wellness, Work-life Balance, Physical Health, Learning About Self-care, Setting Up a Wellness Program, as well as a Get Help page with mental health resources.

Ellen Lowery - Linked-in photo

Next up was Ellen Lowery, Director, US Professional & Veterinary Affairs at Hill's Pet Nutrition, the company that sponsored our keynote address speaker. Lowrey spoke about her company’s mission to help enrich and lengthen the special relationships between people and their pets and about their Food, Shelter, Love^® program, which is one example of how they bring their mission to life. The company has provided over $240 million worth of food to nearly 1,000 shelters, helping over 6 million pets find a new home.

Dan Siegel - www.drdansiegel.com

 Lowery introduced Dan Siegel, renowned psychiatry professor and author, to give the keynote address. Siegel gave the audience pause when he started by stating the term “mind,” which is also called soul, psyche, and intellect, has no accepted definition in the mental health field. Yet mind is the center of wellbeing. When “mind” is not cared for the result is lack of control and ineffectiveness, he said. He correlated burn out, depression, and suicide with increased stress, something veterinarians should be cognizant of since we have the highest suicide rate of all professions. Then he explained that “mind” involves more than Hippocrates’ mind-definition of it being the head, or William James mind-definition of it being, “the brain, obviously.”

Siegel, a pioneer in the field of interpersonal neurobiology, explained mind is not limited to the head, but includes subjective experience, consciousness awareness, and emotional meaning and information processing done outside of awareness; explained that mind includes the neural processing in the entire body, at a minimum including powerful influences from the heart’s intrinsic nervous system and the gut’s biome, which can influence moods and emotions. He stated this is based on physiologic realities and if a person is unaware of what the heart and gut are telling them, then it is more likely that the associated information processing will be done outside of the brain, a fascinating proposal to consider. He encourages people to literally become more aware of their body and what is going on in their heart and gut as a path to development of both more self-awareness and empathy.

Siegel went on to state that “mind” may not be even be limited to the body as he described how relationship interactions between parents and children impact the brain development of the child; that flow and patterns of energy and information change over time and profoundly impact mental life, making for a complex nonlinear system. This system is open to inputs from outside. The healthy mind has optimal self-organization that comes from integration and creates integration, whereby differences are not only allowed and even honored, but also linked. He described the five qualities of an integrated system using the acronym FACES, Flexible, Adaptive, Coherent, Energized, and Stable.

But people in the healing professions are not taught to help themselves, Siegel said. They are excessively differentiated. They are so focused on the physical side of life and spend such little time and effort on the emotional side and on self-care that problems are inevitable. This leads to faltering relationships, self-retaliation, isolation, despair, and shame.

While I believe this is true, there is different kind of differentiation we need to be aware of that is lacking in those of us who suffer with compassion fatigue or with family members who have substance use disorders that impact us. Gabor Mate defines differentiation as “the ability to be in emotional contact with others yet still autonomous in one’s emotional functioning.” In veterinary medicine and other helping and health care professions a lack of this kind of differentiation runs rampant in practitioners, results from excessive exposure to trauma, especially trauma that could be addressed if only finances or some other situation were different, and results in compassion fatigue.

Siegel shone a light on the path toward wellbeing that starts with identification of something that is not right, becoming aware. This path sounded reminiscent of the 3 A’s of change described in Al-Anon literature: Awareness, Acceptance, and Action. It is premature to take action to change a problem unless you understand fully that the problem exists and accept that the difficulty is a characteristic that is part of your makeup. Siegel went on to say that all mental illness is impaired integration that is either the result of chaos, rigidity, or both. As an example of chaos he pointed to overwhelming feelings of too much to do and for rigidity he described a shutdown from connecting. Health and wellbeing will be somewhere in between the chaos and rigidity ends of the spectrum. 

I believe all humans have a void to fill or face. We use a variety of behaviors to fill the void: shopping, food, immersion in work, romance, etc. The list is as variable as human imagination will allow, but all result in a similar bliss that carries us away, at least momentarily, from the certain knowledge that we will all get sick and die, as will our loved ones. That, my friend, is certain. We will do nearly anything to avoid the void.

When Pema Chödrön speaks of leaning into fear, facing it, and becoming intimate with it, she is guiding us to the void and leaving us there, bare and raw. This is an alternative, really the only viable alternative, to the ultimately meaningless rush of activity we generate in our futile, Sisyphean, attempts to fill that void. I don’t believe the integration Siegel speaks of is possible without learning to face the fear of certain illness, physical death, and destruction. Religion may be helpful, but does not typically provide complete relief from fear. In my experience, the ability to face the void is gradated, rather than all-or-nothing, and it is proportional to my ability to be integrated as an individual (emotional, intellectual, physical), with family members, with team members, with professionals, with humans, and with all other living beings on Earth.

So we have some issues to address. Siegel stated that ultimately the answer to, “What can we do about it?” is that we can 1) care for our inner selves via awareness that comes from meditation and mindfulness and 2) attend to our relational awareness.

Siegel stated there is scientific evidence that practicing mindfulness will result in:

• ·            Reduction of burn out and increase in empathy
• ·            Increased wellbeing
• ·            Positive change in brain function and structure
• ·            Brain integration
• ·            Improved immune system
• ·            Increased telomerase, which repairs chromosome telomere caps
• ·            Changes in epigenetic regulators that help prevent autoimmune problems

He challenged us to consider the worth and popularity of a drug that had similar claims. Would we promote such a drug? Would we take the pill?

Siegel closed out the keynote address by leading the audience in a guided meditation starting with having people first pay attention to the front of the room, then the middle, and finally the rear of the auditorium. Shuffling could be heard as we moved our heads and some scooted chairs a bit. He then asked us to realize and acknowledge that we are in control of our awareness, a powerful lesson. When I described this process to a friend of mine he said we should also acknowledge that we should be very careful whom we pay attention to. As a group we all turned our heads in unison on command.

I thought Siegel had a powerful message. I also had a feeling of oneness with the auditorium of people I had just meditated with, a feeling described by Siegel as “mwe” (me and we combined) in the 3-hour session he led shortly thereafter. In a later post I’ll delve more into his teachings in that session and the groundswell of veterinarians, technicians, and allied professionals in attendance who were addressing their own wellbeing and that of our profession.

It’s true. We should be very careful whom we allow inside our heads and whom we pay attention to. My impression is that Dan Siegel is a person we should pay attention to, most definitely.