How many times have you heard that cry from someone who is, well, not coping?
As a family doctor I see a lot of people who say, “I’m so tired all the time”, “I can’t handle this” or “I can’t see any point in the future, I don’t know where I am going”. They are essentially meaning they can’t cope – physically, emotionally or spiritually. This feeling of coping is crucial to health outcomes and coping poorly with the stresses of health, relationships or life without meaning can lead to very poor health.
Mrs Brown, a 62 year old married lady, came to see me today. Her husband has had a stroke and she looks after him at home. She complained of all three areas of stress and together we looked for the physical, emotional and spiritual causes.
Such patients require careful listening to, as they can have complex situations and difficult unpredictable relationships. In my practice, it can be difficult to believe some of the stories the distressed patients relate, but actually they have been true, backed up by other’s reports, police reports and so on. There are stories of threats, murders, muggings, sexual abuse, alcoholic brawls and domestic violence. The rates of single parenthood are high. Many struggle with little money, sometimes with no job and few prospects. There are stresses that the patient can do nothing about, stresses that have happened but that they may be able to prevent in the future and personal stresses that they can alter.
So why do some people cope better with life than others? Why do some families with a relative with a chronic or terminal problem cope better as a team, than other families who may need support at every turn? Now to some extent stress can positive (in medical students, stress can increase motivation and encourage engagement with being an independent learner) but too much stress can also be negative. It is the way we cope with stress that determines our resilience in life.
Tsouros et al (1998) 1 called for medical schools to teach their students effective coping strategies. Those students who coped less well had more avoidance coping strategies, and perfectionist and anxious personalities. O’Neale (2000) 2 suggests other factors causing stress in medical students were low social support, concerns about study skills, progress and aptitude for a medical career. These speak of poor self esteem, isolation and difficulty adapting to different learning strategies. Encouragement to increase positive skills can only build students up, as opposed to only discussing why they are failing.
In the same way, we discuss with patients ways they can make a positive changes to their problems, whether it is by understanding themselves, becoming personally and physically stronger or by working at external factors such as family support and relationships. In the same way, a healthcare professional can become more resilient (to remain strong and become stronger when facing adversity) by living in a positive way, standing up to bad behaviour in others, controlling stress, and developing and valuing strong supportive relationships.
I have recently been teaching in Moldova, where there are very stressful and difficult situations for the disabled children and their families who attend the childhood development centre where we were teaching. We discussed how to help them cope. I based my talk on a paper by Lin Shu-Li (2000) 3 which researched the effective coping strategies of families of children with cerebral palsy. The family is the most important influence affecting the growth and development of children and having a disabled child brings a number of extra challenges. Shu-Li found that the following five areas predicted coping ability:
- Positive family appraisal, the way the family as a whole accepted and worked positively with the situation. They looked at problems together and found solutions, having trust in the family that they would cope, and they shared feelings and accepted stresses when they occurred.
- Support from concerned others, such as neighbours, relatives and carers.
- Spiritual support, attending church or other religious services, having faith in God and seeking advice from the minister, rabbi or priest and being part of a worshipping community.
- Personal growth and advocacy, learning more about the condition and how to manage it, seeking suitable help and following with their advice, looking after themselves to remain strong.
- Positive social interaction, being part of the community, and meeting friends in social situations, having fun and including the disabled child in this life. Doing recreational activities together.
Coming back to Mrs Brown, I listened to her story and to the relationship and home stresses she was under and instead of focussing on the bad and how awful it was and how depressed she felt. We spoke about what she could do to cope more effectively, to live life in the belief that the situation would improve and to restore a more positive outlook for the future.
Dr Rosalind Simpson
PRIME Eastern European Director
- Tsouros et al, Health Promoting Universities, WHO, Copenhagen 1998.
- O’Neale, Dealing with stress, Student BMJ, 8:218-9
- Lin Shu-Li, Coping and adaptation in families of children with cerebral palsy, Exceptional Children, Vol 66 issue 2