The Worried Well: Making Room for Worry in Troubled Times
Those predisposed to worry have fertile ground to work from right now. If you voted for President Trump, you might worry about whether he can do what he’s promised. If you didn’t vote for President Trump, you might worry about whether he can do what he’s promised. If you have family or friends in Los Angeles, you may worry about whether they’ll be okay with the wildfires that are still not controlled. If you worry about climate change, you’re generally worried about what the Los Angeles wildfires mean for our global future. If you have children or want them someday, you’re worried about school safety; we just had another school shooting in Nashville this week. If you have a loved one in the military or a first responder, you’re probably at least slightly worried constantly. And in medicine, we’re worried about when the next pandemic will hit (and what new and horrifying plague it will be) and how we will fix the broken system we’re a part of. Did I cover it all? Did I miss anything? Can you see that I am predisposed to worry, working the fertile ground right now?
I’ve written about worry before (Indulge the Catastrophe, The Dalai Lama, My Grandma, and Letting Go of Worry, Finding Mercy From the Grip of Anxiety). Still, I keep writing about it because worry will always crop up intermittently. First, worrying is evolutionarily preserved: those who worried the rustle in the trees was a saber-toothed tiger (instead of a gentle breeze) survived to reproduce. Second, worrying makes itself feel necessary: our brains believe that if we think about something hard enough, we’ll figure it out and avoid catastrophe. Medicine reinforces this tendency. We’re trained to have plans A, B, C, and D for our patients, which quickly transforms into magical thinking that plan A works because we’ve already got plans B, C, and D ready to go.
So, a new tactic for these troubled times is determining if you’re a member of the worried well. We know the type from practicing medicine - those who fear that every ache is cancer, who relentlessly research new ways to maintain their already good health. It’s a tad bit more than being a well-informed medical consumer and a smidge below being a hypochondriac. Being a member of the worried well isn’t necessarily bad, but it can be exhausting and time-consuming.
How do you make room for worry if it isn't going away?
1) Determine whether you’re a member of the worried well or if there’s actually a problem impacting you acutely. For example, a member of the worried well will be concerned about immigrants who are undocumented and how they’ll fare under the current presidency. One of us with a problem impacting us acutely is either an immigrant who is undocumented or has a spouse or close family member who is.
2) Accept your worrying while acknowledging your current reality. Whether you’re a member of the worried well or somebody with a problem impacting them acutely, recognize what is true for you right now. For example, if you live somewhere that is not Los Angeles but have loved ones there, this could look like saying, “I’m worrying right now, and that’s okay. I am physically safe. As far as I know, my loved ones are physically safe. I have a roof over my head and a bed to sleep in. I could take my loved ones in if it came to that.” This isn’t a gratitude practice. Truly overwhelming worry can devour a gratitude practice for lunch. This simply states what is true at this moment.
3) Decide what you need to do. The worried well may find solace in thinking, “I am physically safe,” and decide the only action they have the bandwidth for is offering compassion, for example, to those impacted by school shootings. Continuing the example, those acutely affected by school shootings can use “My family and I are currently physically safe” to ground themselves and, from that place, decide whether they need to create the bandwidth to become active in local school safety movements. I’m often surprised by how changing circumstances transforms my “I don’t have time for this” to “Everything else will just wait; this is my only priority right now.”
4) Acknowledge that you’ve gotten this far. Whether a member of the worried well or somebody dealing with something truly horrible, your brain, skills, and resilience have gotten you this far. You have a 100% track record of living through hard times; there’s honestly no reason to believe this time will be any different.
5) Load your boat. One of our adult EM physicians talks about how, when you’ve got a really sick patient, you need to load your boat. This means getting everybody on board while thinking widely about who you need with you. It’s an “all hands on deck” mentality. For the worried well, loading your boat may mean experimenting with blocking off 3 minutes a day to take five deep breaths while thinking, “I am safe.” It may mean taking a break from the news and social media. It may mean your worry has become so disruptive that it’s time for coaching, therapy, or medications. For those with acute problems, it may mean lawyering up or figuring out how to lobby Congress. It may mean it’s time coaching, therapy, or medications. If you find asking for help a sign of weakness, consider that you’re not asking for help but mobilizing your team and loading your boat to weather the coming storm.
For the members of the worried well, I see you and am part of your ranks. I also see those of you fighting physically or metaphorically for your lives, and I am doing my absolute best to support your fight. We are, very practically and realistically, all in this together.