Definitions
- Being touched by and open to one's own suffering, not avoiding or disconnecting from it, generating the desire to alleviate one's suffering and to heal oneself with kindness. Self-compassion also involves offering nonjudgmental understanding to one's pain, inadequacies and failures, so that one's experience is seen as part of the larger human experience.
What is Self-Compassion?
- Compassion is “fellow-feeling for another's misery, which prompts us to help him if we can.
- A virtue when properly applied, in accord with reason, can be applied to one's own suffering, and done so virtuously.
- Three main components: self-kindness, common humanity, mindfulness
- Self-compassion entails a balanced, mindful response to distress that neither stifles and avoids nor amplifies and ruminates on uncomfortable emotions.
- Protects against harsh self-judgment, self-pity and self-centeredness.
- Drives us to take action and address the issue a mean between two extremes: harsh self-judgment and self-criticism on one end, self-pity, self-indulgence, and passivity on the other end.
Why should we practice the virtue of Self-Compassion?
- Medicine often is intense and has high stakes, leading to stress and inevitable mistakes.
- Protects against compassion fatigue, builds resilience against depression and anxiety, while increasing life satisfaction, optimism, social connectedness, and happiness.
- First step towards improvement.
Aristotle’s Doctrine of the Mean
Aristotle’s Doctrine of the Mean emphasizes balance as the essence of virtue, symbolized here by a mountain peak with a flag representing the ideal midpoint. Each virtue lies between two opposing vices—deficiency depicted on the left, and excess, on the right slope. For example, courage is the balance between cowardice (deficiency) and recklessness (excess). In a medical context, this principle guides healthcare professionals to strive for the peak of ethical behavior, avoiding the pitfalls of extremes to ensure thoughtful and compassionate care.
Case Studies
“I’m being sued!” You stare in disbelief at the certified letter. You are a surgeon specializing in bariatric surgery and have been in practice 2 years after fellowship. You’ve done sleeve gastrectomies on over one hundred patients without any significant complications, and you’ve never been sued until now. Mr. C. was a 52-year-old male who had a routine sleeve gastrectomy without immediate post-operative leak; however, he presented with sepsis on the sixth postoperative day. He was stabilized and treated for his sepsis and re-laparoscopy revealed a fistula just beyond the esophago-gastric junction, which was drained. The fistula was stented but then complicated by bleeding from stent erosion needing stent removal. Later CT showed persistent minimal leak into a walled-off cavity. Another laparoscopy was performed with closure of fistulous opening and a feeding jejunostomy tube placed. Drainage gradually decreased and stopped 6 weeks postoperatively with the absence of a leak on imaging. He was discharged and although he had a stormy course is otherwise now doing well.
You’ve been instructed by both your insurance company and lawyer not to discuss the details with anyone. The uncertainty and typical slowness of the legal process is frustrating on most days and maddening on others. The lawsuit is like a cloud that overshadows your work and family life. Your confidence is shaken, and you second guess yourself more frequently while commonly worrying about decisions at home that is taking a toll on your family life and resulting in poor sleep.
Several weeks go by and then you find out that a good friend from college recently committed suicide. You’re shocked and saddened. You remember good times together and your often stated commitment towards one another that you would be there for them. However, your times together became less frequent due to your intensive medical training over the last 12 years. You drive home after work thinking that maybe you’ve failed -- you failed Mr. C. and you failed your good friend. You wonder if you need to see a psychiatrist and think about considering a new line of work.
Discussion Questions
- What are some possibly dangerous/negative ways for the surgeon to face his/her distress, and what would the consequences be if the surgeon reacts in these ways?
- Discuss the following, as well as any others you can think of: a.)Trying to ignore all the distress and acting as if nothing has happened. b.) Harshly blaming and judging oneself. c.) Making excuses and wallowing in self-pity.
- What are some good ways for the surgeon to face his/her distress? What would the benefits of reacting in these ways be, and how would they avoid the negative consequences of the bad ways?
- Is it possible for suffering and distress to be good for us? If so, how? What would we need to do in order to benefit from such things?
- In this clinical case, the lawsuit is hanging over the head of the surgeon, but there is no course of action available at the moment, all the surgeon can do is wait. If there is nothing to be done, would it be ok to just ignore the lawsuit, and avoid thinking about it at all in order to be less stressed? Why or why not?
- If a very bad mistake is made, is it not appropriate to harshly judge oneself? How can one hold oneself accountable while also being compassionate to oneself?
- How would recognizing the humanity you have in common with everyone else help you to be more self-compassionate?
How do we foster Self-Compassion?
- Focus on Kristen Neff’s three aspects of self-compassion: self-kindness, common humanity, mindfulness.
- Ask how you can grow from suffering and mistakes