Six years ago, I was a starry-eyed medical student, just starting on the long path to becoming a doctor and psychiatrist.
The first few years of medical school took place in the lecture hall, focusing on the basics of biology and anatomy.
Learning the compassionate side of medicine was limited to seminars on topics like how to communicate effectively and connect with patients.
It all sounded so nice and easy while sitting in a classroom talking about theory.
Then, in my third year, I was thrust into the brutal reality of the hospital. I worked long hours (up to 30+ hour shifts), had few days off, and was always exhausted and sleep-deprived. The environment was about as far as you could get from a compassion-cultivating experience. I was burned out.
Instead of feeling kindness and empathy toward my patients, I often felt frustrated, irritable and even angry. Why were they so needy and demanding? Why were they coming to the hospital again and again with the same problems and not taking care of themselves? Why were they sapping my energy and taking up all my time?
Starting psychiatry residency two years later felt like more of the same. More long hours, more exhaustion, more frustration toward my most difficult patients.
Over the following years, though, I realized the experience gave me an important opportunity – the chance to practice compassion through difficulty. It’s easy to be empathetic when you’re happy, well-rested, and when the person you’re interacting with is just like you – but the deepest and most meaningful progress comes from practicing compassion when things aren’t easy.
And when the people around you are equally exhausted, afraid, unsure, and closed-off, even small acts of kindness go a long way. So how do you reach inside and pull out compassion when it’s the farthest thing from your mind?
1. Treat yourself compassionately
People often think compassion means how you act toward others, but the truth is that compassion starts with yourself. Only when you treat yourself kindly can you gather the strength to be kind to others.
In retrospect, it’s not surprising I had trouble being compassionate toward my patients when I was so rigid and inflexible with myself. I felt the weight of numerous responsibilities on my shoulders, and put fulfilling all of my obligations above treating myself and others kindly. I wish I had cut myself some slack and been more forgiving when I couldn’t fulfill all of my responsibilities perfectly.
Imagine that compassion you want to feel toward others and first direct those same feelings toward yourself. Compassion toward your own struggles will open your heart to others.
2. Remember your interconnectedness with all beings
When you’re having difficulty being patient or kind toward someone, on some level you may feel that each of your goals are in conflict. Their need for attention conflicts with your need for space. Their desire to vent or complain conflicts with your values of self-sufficiency or pulling yourself up by the bootstraps. Your need for sleep at 3am conflicts with their need to see a psychiatrist in the emergency room (in my case!).
The thing is, we are not all as conflicted as it may seem in those moments. The fears, uncertainties and frustrations we feel are universal. You are not alone in whatever difficulty you’re going through. Imagine the person you are dealing with as a scared and frightened child — how you would feel intrinsic concern and empathy for them, how you would be compelled to reach out and help. We should connect with this basic nature whenever possible.
3. Develop an “unconditional positive regard” for others
A few years ago a therapist told me her strategy - she cultivated an “unconditional positive regard” for her clients. No matter how many negative or damaging qualities the person had, she taught herself to focus on their good qualities. My dad, who is a psychiatrist, put it similarly – “Everyone has something good about them.”
If you focus on other people’s negative or frustrating qualities, you’ll drive yourself crazy, and have a very difficult time connecting with them. Instead, teach yourself to keep an overall positive impression of others, and keep their negative qualities in the larger context of their complex (good and bad) nature. With this perspective you will be in a much better position to feel compassion for them, and therefore help them in a meaningful way.
4. Remember the harmony in compassion
Compassion is sometimes misunderstood as sacrificing yourself and giving everyone else what they want all the time, but it is not. Compassion means acting from a balanced perspective. In his book The Wise Heart, Buddhist psychologist Jack Kornfield writes:
“Compassion is not foolish. It doesn’t just go along with what others want so they don’t feel bad. There is a yes in compassion, and there is also a no, said with the some courage of heart. No to abuse, no to racism, no to violence, both personal and worldwide. This is said not out of hate but out of an unwavering care.”
When you are struggling with being compassionate in a difficult moment, it may be because you want to say “yes” to someone when you really should be saying “no” — not just for yourself, but for what is best for the other person. Sometimes it is okay to say no, and in fact it the truly compassionate thing to do.
5. Take a break if you need one
With the right perspective, compassion can be limitless – you don’t “run out” of it or “use it up.” But when you are in the midst of a difficult moment, whether it is mental, emotional, or physical exhaustion, you may not have the resources to give yourself to others. It’s okay to take time to be alone or focus on yourself, and will prevent you from acting out of anger or frustration when you’re feeling drained.
As I progressed through my psychiatry residency, I began to internalize these lessons more and more. Instead of creating rigid expectations for how I should perform and act, I let there be a lightness and flexibility to my work. I started to understand my difficulties in the context of the extremely rigorous and exhausting schedule of being a resident, and realized I needed to take care of myself before I could take care of others.
Instead of focusing on “doing” something in particular, I focused on seeing the connections with the people around me. Compassion started to flow naturally, without effort. I saw that I was a small part of a greater interconnected context of all people, and understood that compassion has to apply equally to all of us.
What is a time that you struggled with being compassionate? How did you work through it? I would love to hear your thoughts in the comments!
A guest post by Elana Miller, MD who is a psychiatry resident and founder of Zen Psychiatry, a space to talk about integrative strategies be happy, live well, and fulfill your greatest potential. Follow her on Twitter or join the discussion on Facebook.