Emotional breakdown never arises out of the blue. There is always a background to it and usually there are warning signs that, if heeded, might prevent a precipitous grind to a halt.

Warning shots

Of course these personality traits are all quite normal and most also have some advantages. However, the recognition that these traits can lead to anxiety and stress-related illness is vital if we are to take preventive action at an early stage. The trick is to recognise the early warning signs.

• Increasing irritability – little things make you lose your temper.
• Paranoia – supportive colleagues seem to have changed.
• Dread – the journey to work and/or home is filled with a sense of dread.
• Enemies at the gate – nice patients suddenly become demanding, selfish time-wasters!
• Night terrors – you find it difficult to sleep well, if at all.
• Increasing isolation – people tend to avoid you. I was totally shocked to hear that my receptionists were taking their queries to one of the other partners, in order to avoid me biting their heads off!
• Vanishing pleasure domes – things you usually love just don't give you a buzz anymore.

Turning points

Why is it that we doctors are so reluctant to accept help when we need it, especially perhaps when it comes to other healthcare providers delivering it? Pride is almost certainly to blame. Counsellors are skilled professionals in their own right and can often open up areas of ours lives to which we are oblivious. The Life Grid is a good example of a counselling tool used to do this.

Life Grid

Mark up a large 3x3 noughts and crosses grid. Then, carry out each step in turn without looking at the following steps beforehand. Each step is best done rapidly and without too much thought.

1. Enter into the boxes the nine major areas of life that take up most of your time.
2. Below each entry, put an approximate percentage of your time taken up by that activity.
3. Add up the total of the nine percentages you have entered.

If you have a total percentage exceeding 100, you may want to consider the need for a lifestyle adjustment. Interestingly, many people find that they forget to mark sleeping or eating into their grids. Prayer, time with family and sex are also commonly omitted. My personal percentage at crisis point was 206!

Breakdown is a form of regression – of emotional shut down to enable use to survive. In coming out of the other side, it is often necessary to relearn basic principles. Nearly all of the important ones are mentioned in Scripture. Rightly understood and applied these can both bring about and maintain emotional recovery and healing.

An offer you can't refuse?

Some sayings of Jesus seem to pile on the pressure: 'Whoever forces you to go one mile, go with him two. Give to him who asks of you, and do not turn away from him who wants to borrow from you'.[1] However, there are occasions when it is not only right but necessary to say 'No'. James implies this when he says that our 'No' should be a plain 'No'.[2] We do not have to get frustrated or always give an explanation. Sometimes we do have to turn down requests to do things. We must beware the tyranny of uncommanded work, since God only promises to equip us in every good thing 'to do his will',[3] not everything others demand of us.

Redeeming the time

Commenting on Ephesians 5:16, John Stott suggests: 'RSV is surely right to translate (it) making the most of the time, 'time' (kairos) referring to every passing opportunity'.[4] However, others make use of the verse to claim that Christians should never relax! This is very odd. We should certainly never relax our guard but even Jesus knew that there was a time for withdrawal and restoration: 'Come away by yourselves to a secluded place and rest awhile'.[5] There is much truth in the King James Version's rendering of this verse: if we don't 'come apart and rest' then we just plain come apart.

We all need times as Rob Parsons puts it, for 'kicking the leaves' – time for quiet reflection and with no other purpose than being able just to think and unwind. This is all part of redeeming the time too.

The art of delegation

Jethro had to remind his son-in-law, Moses, the archetypal energetic and capable leader: 'You will surely wear out, both yourself and these people who are with you, for the task is too heavy for you'.[6] We need to be reminded of the importance of functioning as a body, rather than as the Lone Ranger.[7]

Dialogue of the deaf

Those around us often see the early signs of burnout long before we do. After I had ground to a halt, my partners all spoke about having noticed things such as uncharacteristic irritability and undue haste many months previously. They had been reluctant to say anything though as, sadly, the teachable spirit that marks the truly wise is not one of my outstanding traits.[8]

God of the grey

Sometimes we can become fixed on a false understanding of Jesus being the answer to all our needs. Yet, sometimes there are no answers this side of heaven.[9,10] As doctors, we usually like things to be precise and clear. We find uncertainty stressful. In this broken world, where many things are not black and white, we need to discover that the Lord is also 'God of the grey'.

Being a Christian is all about being vulnerable. However, it is also about being certain of what we as yet hope for.[11] God puts his treasure in us, weak and earthen vessels that easily crack, so that the glory might go to him.[12]