By Dr. Julie Alonso, WCI ColumnistWellness, mental health, and emotional well-being have all been buzzwords in recent years in pop culture as well as in medicine. Celebrities like Adele, Miley Cyrus, and Ryan Reynolds have opened up about their personal experiences with depression and anxiety. The song “I Am Not Okay” by Jelly Roll is a chart-topping hit. Millennials and Gen Zers (and maybe even some Gen Xers) have really started talking about these important topics. (Note: I consider myself to be part of the “Xennial” microgeneration and have noted this shift firsthand over the course of my medical career.)
As a psychiatrist, I’m thrilled that these topics are getting more attention and public awareness. Your mental health has so much impact on your personal and professional life. Of course, saving for retirement, paying off your debts, and spending intentionally are extremely important, but one of the best investments you can make in the longevity of your career and in protecting your assets is to shore up your mental (and physical) health.
In my professional work, I’ve had the privilege of helping my patients to attain better mental health. In my personal life, I’ve had to figure out ways to help myself stay healthy and avoid burnout.
None of what is discussed here should be eye-opening news, as we all generally know what we should do to optimally care for ourselves. The hard part for many physicians and other healthcare professionals is finding the time and motivation to implement healthy habits amidst so many other people, tasks, and obligations competing for our attention.
Lifestyle Matters
There are no shortcuts to supporting your well-being. It’s an ongoing process across a lifetime that requires continued attention. As medical professionals, we hopefully know what we should be doing to maintain our health.
In my clinical work, I do a lot of lifestyle counseling and short-term goal-setting with patients, and I have seen it pay off. I also try my hardest to practice what I preach. I know there are no workarounds to getting enough sleep, eating a wholesome and nutrient-rich diet, doing regular physical activity, and getting enough social engagement. It’s even better when I can combine more than one of these areas.
Here are some strategies I’ve implemented in each of these areas in my own life and in helping my patients. I like to think of these four areas as the pillars upon which to build your own wellness model.
Physical Activity
I started working out regularly when my children were young, and I have kept it up with a lot of consistency, effort, and intention. At first, I exercised after work, but after realizing how much time that took up at the end of the day when I wanted to relax with my family, I became a (reluctant) morning workout person, waking up at 5:45am three days a week.
I framed it in my mind as not being a choice but a necessity. I found something that worked for me and kept me accountable to myself—group exercise classes with a coach. I know I’ll work harder around others than if I’m on my own, and I like the aspect of not having to think about my workout and just do whatever the coach instructs. (On a side note, as many did, I purchased a pandemic Peloton bike which I still use. But I prefer the in-person classes.) About six months in, I even got my husband to join the same gym, and we try to get workouts in together when we can. Through the years, we’ve also built up a friend community at our gym which has been an added benefit. Now, more than 1,500 workouts in, the positives continue to reinforce themselves.
This is just what worked for me, but there are countless other options (hiking, biking, running, joining a rec team). If you had the dedication and work ethic to make it through medical training, board exams, etc., then starting an exercise regimen is totally doable (even if you have to wake up at the crack of dawn). If it seems too overwhelming, picking one area to focus on and setting a short-term goal (baby step) can help. One example: just going for a short walk in the evening provides a foundation on which to build. Even better if you go with a friend or family member, so you can knock out exercise and social engagement together. I sometimes walk with my neighbor at night which gives us time to catch up, be outdoors, and get in some extra activity. The benefits of physical activity on mental and physical health are indisputable.
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Sleep
There are an infinite number of distractions competing for our downtime—electronics, social media, the latest Netflix show, and more. I often have patients who stay up late (and still have to get up early) because it’s the only quiet time they have in their day, and I totally understand that. But it impacts them whether or not they admit it. I’ve had patients many times tell me they can get by on five or six hours of sleep and be just fine. The truth is that adults need a minimum of seven hours of sleep per night on average. Getting below that amount on a regular basis is linked to all sorts of well-documented increased mental and physical health risks.
My sleep quality has decreased as I’ve gotten older, so I have to be even more intentional with my habits. I also fall into the traps that many of us do, like scrolling on my phone before bedtime. I try to read instead. I go to sleep earlier than I ever thought I would (the early morning workouts eventually caught up with me). My children tease me that I can barely make it through a show or movie without dozing off if it’s after a certain time. I can see, though, that I have better energy and focus when I’ve had a good night of rest.
Many of you know the basics of sleep hygiene: a consistent bedtime, a comfortable/cool environment, and minimal ambient lights and sounds. You also should limit caffeine late in the day, avoid naps, have a wind-down routine, unplug from electronics, and get natural light exposure during the day. Bypassing these is not a viable option if you want to get quality sleep. I’ve even convinced my night-owl husband to go to sleep earlier and (gasp!) he feels more energy during the day. (Now if I could just get him to stop drinking caffeine at night . . .).
If you do only one thing from this list, aim for seven-plus hours of sleep. There is no way to get around that.
Nutrition
As someone who enjoys cooking, I try to make home-cooked, wholesome meals for my family as much as I can. Yes, we still resort to packaged or frozen meals when we are pressed for time, but I’ve worked hard to make this the exception.
I try to keep ingredients for most of our favorite meals on hand, and I have a binder with family-favorite recipes that is easily accessible. I’ve found that stocking lots of fresh fruits and vegetables naturally adds to our recipes. My husband has taken to meal planning, making a list of all the dinners we will have that week and keeping a running list of meal ideas. Both of these strategies have helped us to feed our family better than we would have otherwise. I’ve more recently been trying to make multiple batches of something and freeze another 1-2 meals for later.
The benefits of good nutrition are sometimes harder to appreciate in the short term, but hopefully, they will have a positive impact on our mental and physical health in the longer term. (But don’t sweat it if you have to feed yourself or your family fast food or similar on those hectic days; we all do sometimes.)
Engagement
As cliché as it sounds, the high points in life are really about experiences and social relationships. It’s hard to fit in extra activities on top of a busy physician work and home life. As my children have gotten older, I realized it was imperative to invest in these areas as well. One of the screening questions I ask with my new patients is about hobbies and activities. Sometimes, patients tell me what things they wished they had time for or about things they enjoyed in their youth. If you need a place to start, that is often a way to find something that piques your interest. I sought out things that were convenient, like an adult tennis class that occurred at the same time and place as my son’s class. I had not picked up a racquet in many years, and I was never a serious player. But I met new friends and gained a whole new hobby that I love. And again, this one hits multiple wellness pillars.
I joke with my kids about all of my hobbies by saying, “I’m practicing for retirement.” But I’m also doing something important by modeling enjoyment as an adult and prioritizing time with friends. Some of the hobbies I’ve developed include a social aspect like a weekly tennis group, book club, and Mah-jong group that I’ve joined. But some are solitary like reading, cooking, baking, and crafting. I like to describe myself as an extroverted introvert. I love socializing with friends and family but also enjoy my “quiet alone me-time,” as my kids call it. I went as far as to invent something called my “quiet zone,” which is a euphemistic way to tell my husband I just want to be left alone for some downtime.
We all fall somewhere on the introversion-extroversion scale, but I find that a mix of both types of activities works best for me. I even put myself out there and registered on a whim for a hip-hop dance class at my daughter’s dance school last year. I have virtually no dance experience, but it turned out to be a group of women around my age having a blast learning routines (and likely looking ridiculous). I can see how having these regular activities to look forward to has gotten me through some difficult times and strengthened my ability to cope with stress in a healthy way—especially since there has been a heavier focus on loneliness and its effects on health (even raising the risk for dementia).
I’ve tried to prioritize my relationships with my family and friends, but this takes intention and effort as well. Last year, after over five years of talking about it, I finally went on a much-needed ladies' weekend with two of my medical school classmates. It was restorative to just be together, enjoy each other’s company, and truly get some reprieve from the busyness of our lives (the good food and spa did not hurt either). We’re already looking forward to the next time as soon as we can coordinate three busy physician-mom schedules again (no easy feat)!
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Action Plan
There is plenty more than can be written about these wellness pillars and a myriad of ways to strengthen and weave them into our lives. If you’re already doing these things, great (you must be superhuman)! For the rest of us, a good place to start is to pick one pillar and a single action item. Write it down, schedule it, or tell an accountability partner. Once that is established, build on it or pick another aspect to work on. And talk about your mental wellness ideas and challenges with friends and colleagues. The fact that taking care of your mental well-being has become a part of the cultural zeitgeist has helped to legitimize these conversations more.
I know what it’s like to be in a two-parent working household, raising younger or older kids and taking care of a home all at once. I also know that if I don’t allow myself to take some time for enjoyment, I will not be at my best for my loved ones or my patients. Whether you are single or coupled, early or late career, or have kids or not, the same principles apply. Picking something from each of the four wellness pillars is a great way to empower yourself on your wellness journey.
What do you think? What strategies do you use to keep your mental health in check?
Great article!
Thanks!
An overall good article but with the hobbies all the time part you sound exactly like my psychiatrist friend, who seems to practice medicine on another planet.
Many of us work too much, in physically draining specialties also with too much night work that (for me) all the last part of the article did was create the ‘must be nice’ kind of envy. Most days I’m “happy” if I just have enough energy left to interact with my kid…
I hear you! #1 thing I did once CoastFI was manage my schedule to be closer to my ideal life. Still not perfect, but so much better, and I have real hobbies again!
Thanks for the comment. I do understand where you’re coming from and I acknowledge the struggle to find time and energy for many doctors. I left my full-time academic job after 7 years for better work-life balance and more time with family and friends about 6 years ago. I have a job now with much better balance and I work from home (still full-time) which I know is not the norm. Psychiatry is definitely a specialty that allows for more flexible work arrangements, options for part-time and even working remotely doing telemedicine. I know many doctors do not have those options. Although not physically demanding, my field is emotionally-taxing, so I think it’s important to invest in my own wellness. With young children, or just starting out as an attending, it can be really hard to establish these habits. However, I found that as my children got older and I was more established in my career, I had more time to develop some of these hobbies. I’m not saying that you need to do as many things as I do, but keeping a thread of interest in something, even if it’s small or sporadic, can be helpful. Eventually, you may want to cut back on work, retire, children grow up or a marriage ends. Having maintained some social ties and activities will be beneficial. I also have a very supportive spouse who contributes a lot to the household. We both encourage each other to pursue our interests and time with friends.
Dr. Alonso – thanks for introducing this topic to the WCI community. I, too, am a psychiatrist, adult and child, but a Boomer getting ready to retire at 75. As I reflect on my career I would encourage everything you wrote about and extend it a step further. During our lives we all encounter problems we can’t solve by ourselves. We consult with lawyers, accountants, advisors and I would encourage consulting with a psychiatrist or psychotherapist (called therapy) for emotional issues. Strong people, smart people understand that, as you said “Your mental health has so much impact on your personal and professional life.” Having a pile of money in old age is of little comfort if you, your children, your marriage, your family are troubled. Einstein said “The mind cannot solve the problems it created.” Consider putting “Mental Health” as a line item in your budget.
Thanks for your comment and totally agree! Glad to hear from another psychiatrist in a different career stage. I’m actually planning to write a follow-up to this article about physicians and other HCWs dealing with more significant mental illness and struggles, and will touch on therapy options as well.
Thank you Julie, this is so great – and so important.
Thanks Margaret!
Dr. Alonso, thank you for this article. One of the great things about spin is I find second wind somewhere between 10-15 minutes, every time. Hope that happens for you, keep it going. One thing we have learned from this site is to thank all who care for us – couldn’t agree more (even if we haven’t fallen off the side of a mountain). It’s as good for you as it is for them. My question today is how best to help those who have had unthinkably bad things happen to patients? Yes it is part of the job, but they are still human. My daughter constantly faces this as part of her work. Thank you.
Thanks for your comment! That is a tough situation that many of us face. Whether it’s losing a patient to suicide, cancer, trauma or any other illness, it can definitely impact us. First, I think different people have different thresholds to handle and process these kinds of events. So, knowing yourself and your warning signs is key. Our own fluctuating stress levels may impact our ability to cope differently at various times as well. Also, the very real notion of compassion fatigue or secondary trauma needs to be recognized. I think it’s important to acknowledge the potential effects that having bad things happen to our patients has on us. Having outlets to diffuse this stress is important. This would include the things discussed in this article. Other options may be a team de-briefing with a facilitator after staff have experienced or witnessed the aftermath of a trauma or loss. Many hospitals, employers or medical societies have process groups, post-trauma support teams (I was a member at my prior hospital), employee assistance programs (EAPs), other confidential counseling options, etc. Most of these resources are free and accessible. I just this week saw a post about a support group in my community for first responders. If things feel more untenable despite all these measures, then taking time off/cutting back, starting psychotherapy or seeking a psychiatric eval may be helpful too.
Agree that this is an important topic and article. Also agree that most people know that these things are important but struggle more with the how. I wonder if the author could elaborate more on how she has fit these things into her life, beyond just “making time.” Example – who is taking care of your kids when you go to your workout class in the mornings? My kids wake up (whether I want them to or not) by 6 AM (baby is often up in the 4 or 5 o’clock hour) and the older ones need to be at two different schools between 7:30 and 8:00 AM. Frankly, waking up at 5:45 AM to workout sounds like a dream vacation to me. If it is your partner managing these mornings, do you have a system where he/she gets the time off the other mornings in the week? Or have you somehow otherwise arranged your life to make this work? Likewise, with the cooking of nutritious meals – what are your kids doing during this time? Entertaining themselves, watching TV, helping you cook? Or are you paying for extra childcare to make some of these things happen? Where does the grocery shopping and meal planning fit in, time wise? The ages of kids and how things have evolved over time would be helpful. My work schedule actually permits a lot of these things for me, fortunately, but having a 6 year old, 2.5 year old, and 8 month old gets in the way much more than work. Not to mention wanting to spend extra time outside of work WITH them rather than doing these sorts of things for myself.
You’re in the heat of it right now with kids that age. It does get better. But I imagine it would be REALLY tough to have two full time workers and 3 kids that age. We never even tried it because it seemed impossible to us. Those who seem to be doing it successfully are definitely hiring help.
Julie’s husband here. It certainly helps that our kids are high school age and can take care of themselves. It is difficult for us, though, when we have to drive the kids to all their extracurricular activities. So, like Jim said, it does get better. But there are still plenty of logistical challenges to navigate as they get older.
Thanks for your comment! I will say that I was not doing these things when my kids were babies. They are now teens. I do remember back to when my husband and I did home exercise videos together in the evening or weekends while our babies were napping or sleeping though. My husband handles the morning routine so that I can go exercise, but since early-elementary school, my kids have been pretty self-sufficient at getting themselves ready in the morning for school (he made them breakfast) and since middle school they prep their own breakfast and pack their own lunches too (fostering autonomy growth is child psychiatrist approved!) They have walked or taken the bus to school. My husband works out over lunch time or after work sometimes. When our kids were not old enough to stay home alone we would sometimes do our workout classes back-to-back on weekend mornings like a tag-team (now we do them together). For meals, we do a lot of meal planning in advance (write down the meals for the next week) and make sure we have the ingredients on hand so making the meal is quicker and easier. We always have lots of fresh produce in the fridge to add in. I will make 2-4 batches of things and freeze them and sometimes we just do very simple meals. But my kids do help cook at times. In the past, they would play in their playroom or maybe watch a show while dinner was being prepped. For groceries, we do A LOT of curbside groceries, Instacart or Target drive-up orders. I started the workout classes when my kids were about age 6. Sounds like you are busy with 3 young kids. I think once the youngest is like 4-5 years old, things will be easier to manage. It is a different season of life. Having high-schoolers is busy in a different way, but at least they can take care of themselves for the most part (other than driving which is coming soon)!
Thanks for the post Julie! The early morning workouts really have worked well here too with my two young boys. I’m really trying to work on the sleep portion as I work late into the evenings to help out busy residents. Overall great article!
Thanks! I have found that as I’ve gotten older I have needed to go to sleep earlier to handle the early morning wake-ups. Truth be told, I was probably not getting enough sleep on those nights in the past.
This is one of my goals this year! In bed earlier!
Julie, awesome post! You forgot to mention that biggest assault on your mental health: being married to that Josh guy! (j/k Josh you know I love ya!)
Have you found that being financially literate afforded you the money to “buy” more time for yourself and focus on your mental health, such as hiring a nanny or cutting down your hours and take a pay cut?
Also I identify as a “Xennial” as well! do you think that there is a generational gap in terms of emphasizing mental health between Gen X and Millenials? do you think that might be related to the Gen X’ers having their prime formative years in the “ME” decade of the 80’s where you thought buying stuff and being a material girl living in a material world would prevent depression?
Thanks for your comments and appreciate the Madonna reference! (I finally saw her in concert last year). I think that being financially secure has allowed me to grow and invest in my wellness more. It certainly brings the stress level down. My husband and I joke about the “Orangetheory budget,” but truly we are fortunate that we can afford to both have unlimited memberships. We did have a PT nanny (15-20 hours/week) when my kids were small and not in pre-school, plus help from my parents. I still work FT, but my current job has very reasonable hours so it allows me to do things outside of work. Interesting thought about the generational differences. I think the younger generations (Millenials and Gen Z) are certainly more comfortable talking about mental health (sometimes with too much contagion effect on Tik Tok or such) and in setting boundaries. However, I think we still live in a “material world”, albeit perhaps in a different way.