I recently found myself in the Intensive Care Unit of a local hospital.  I had undergone a relatively simple surgery, that had complicated.  This resulted in the need for two further surgeries - one potentially life-threatening - and a protracted stay in the ICU.

It also resulted in the need for Heavy Duty Painkillers. Morphine… Pethidine… On tap. These narcotics are The Devil Himself, and create an almost immediate physiological dependence. But they are simply unrivaled in terms of acute pain management. Once the initial intensity of pain has subsided, and these drugs are no longer deemed necessary, the next frontier in care is to get the patient off these meds. This has to happen quickly, and whilst still in hospital.

I’ve been reflecting on the night that I had to come off them, and what it taught me about life, and distress tolerance.

When you have been receiving such opiods 4-hourly for a good period of time, your body very quickly learns to wait for them in eager anticipation. When the ‘hit’ does not come, the body ups the ante. Dramatically. Yes, in terms of pain. But also in terms of an immeasurably deep frustration… depression… irritability… restlessness… sleeplessness… need to escape… Now imagine feeling these emotions, as deeply as they can possibly be felt. But doing so in an ICU hospital bed, with countless chords and wires keeping you in chains, immobile, and without options.

And in the dark. Because it was towards evening, on a particular day, that I was informed that there would be no more.

The first thing that happens is that your system kicks into ‘begging mode’. I rang my bell possibly every ten minutes, to relay to my attending nurse some new symptom that I was manifesting within my body… “Please call the doctor and ask for a sleeping pill”… “I’m so uncomfortable…” “I’m in so much pain”… “Please can I have something, even something softer”… The ICU staff obviously deal with this daily, and my nurse handled my situation that evening with the most beautiful interweaving of empathy and sternness. And she also contextualized what was happening to me, which no one, until then, had done. She simply said, “Debbie, you have two choices. You can fight your body tonight, and get these heavy drugs out of your system. Or you can perform and perform, get more - and then you are going to be in this bed for a very long time, and not get home to your girls for longer than you can imagine”.

And there I had it. The problem was scoped. The mandate was clear. I knew what I had to do.

I have, in recent years, become very interested in “Dialectical Behavior Therapy”, as a mode of clinical intervention in my private practice, but also simply as a way of viewing the world. DBT seeks to address the management of powerful negative emotions, as they happen - in the moment - in an effort to avoid acting on them impulsively. Essentially, DBT as a treatment system teaches us to hold our emotions inside, rather than to unleash and discharge them onto a realm of instantly gratifying, but ultimately destructive behaviors.

One of the mechanisms that DBT teaches for distress tolerance is simply to observe and describe the environment, purely as it is. I know very well how ridiculous and impotent this sounds. But it’s an incredibly GROUNDING exercise.  GROUNDING is a skill often suggested to anxious people, because, in essence, it helps to get them out of their panicking minds, and back into the room, and reconnected to their physical environment, rather than to the content of their worries.

It helps to have already dabbled in things like mindfulness and meditation - I wasn’t going in completely cold. But, lying in that hospital bed, I decided that my only way through the interminable period ahead was to tune in sensorily to every stimulus I was confronted with, and to gently observe, describe, and breathe.

Observe.

Describe.

Breathe.

Not to judge the situation. Not to judge myself in the situation. Not to expect or need it to be anything other than what it was.

And so there I lay. Eyes closed. Breathing deeply. And listening… Systematically focusing my full attention to various parts of the room… Tuning in to each machine around my bed, and the noises emanating from them. Then moving my attention to an air conditioner… Then trying to hear outside, for the gentle hum of traffic, or voices in the parking lot. Immersing myself in each sound. When I’d exhausted auditory stimuli, I did the quintessential “body scan” that every “Mindfulness 101”, the world over, teaches. Feeling the weight of my body on the bed… Sensing every place where my body touches the plinth supporting it… And then starting from the very top of my head, and slowly scanning downwards to assess for prominent comfort and discomfort at each level.

Hours passed. Hours. Each time my mind wondered, or my focus shifted, I took hold of it, and brought it back to my breathing, or the noises, or my body. With distress as intense as this, the discipline of systematically focusing one’s attention is critical.

I never slept that night. Not one wink. Not for ten minutes.

But I survived it. And I’d broken the transient hold that these narcotics had on me. I overheard the nurse telling my doctor of my evening; she had been very aware of what was happening in my little world. I felt pride. An immeasurable sense of accomplishment, for having pushed through. And for having actually experienced psychology in action.

 In situations that cause me enormous distress, I now know what to do:

1. I scope the problem.

I summarize, for myself, what exactly the situation at hand is, and what is required of me, to most effectively navigate through it.

2. I decide where I need to focus my attention.

I’ve only recently learnt that we have the ability to choose what we focus on. We can decide what to think about, and what not to think about. And we can even choose how to think about the things we think about (we can be judgmental of ourselves or others… We can expect that things should be other than how they are, or we can simply accept that they are as they are, without needing situations to be perfect, or even good).

We can literally observe where our minds are, “go and fetch them”, and put them in a more healthy and self-loving place.

As a consequence of that one evening, I now may feel perturbed about something - rattled, distressed or unsettled - but know that I CAN change my emotional tone, thereby choosing my way out of that feeling. I can drive and direct my feelings, until they change, and are more conducive to contented living. Some days this will be a brisk walk on the treadmill. Some days it will be listening to a Pod Cast, reading a book, doing some admin, or studying.

The point is that, with discipline, practice, and a sense of humor, we can get emotions and our minds submitted to our will. What we tend to do is employ behaviors that unleash these feelings, which brings instant relief, but longer term pain (substance abuse, shopping, compulsive eating, passive aggression or overt grumpiness leading to relationship upset, etc).

But it doesn’t have to be that way.

I intend to write more about Dialectical Behavior Therapy, and effective