Preventative Medicine and the Inner Smile

This is a chapter I wrote for Andrew Tresidder’s book for doctors, nurses and other healthcare professionals Health and Self-Care: Inner Balance for an Effective Life for Health Professionals. 

You can download a full PDF of the book here https://healthandself.care

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Visiting my GP a little while ago he began talking with me about his own health. This was not unusual as we had known each other for twenty years and he had read my self-help book The Endorphin Effect. He was committed to a holistic approach and believed that good medicine enabled patients into self-care.

‘If only I had practised what I preach,’ he said wryly, ‘I would have caught my own condition much earlier and probably avoided surgery. ’

We then chatted for a while about the archetype of the wounded healer and the self-sacrificing hero; and that medics have a calling to relieve the suffering of others, but not themselves. Self-care is hardly on the clinical map and hardly possible in a busy day.

‘You could do the self-examination in the bath or lying in bed or even commuting to work,’ I nudged. ‘You know exactly where to scan.’

He sighed. He agreed. He then had to see more patients and I left.

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The interesting thing for me about clinicians is that of all people you know how to scan a body for signs of ill health. You know the crucial importance of early diagnosis and appropriate adjustments in behaviour, diet, exercise and life style. But you rarely do it for yourself.When you examine patients you get a quick sense of their state from their body posture, skin tone, breathing and the state of their eyes. But you rarely do it for yourself.With careful hands and appropriate kit you touch, push, look, listen and feel. You know all the signs of ill health. But . . .

More than that, before any physical examination you ask the core question, ‘How do you feel?’ But . . .

Again – and I know that I am repeating myself but it bears this repetition –because it is your profession you know exactly what to scan for and what signs are important, but in failing to self-examine you continually risk your own physical and mental health.

So. How do you feel?

Your main piece of kit here is your own mental ability to scan, sense and cognise what it feelslike inside your body. This requires the self-discipline of an intentional pause and then deliberately focusing down into your own physicality.

This sensory, felt awareness of yourself is crucial. It is the sovereign individual who alone can really know and experience their own state; and is able to self-assess and catch early signs of threatening symptoms. Who else can notice those signals that require just a tad of relevant adjustment: a bit more exercise, regular stretching, earlier nights, less caffeine, better food, more fresh air?

Being very serious and also pragmatic, surely the long-term viability of the NHS is based in this self-awareness, early diagnosis and preventative self-care.

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Self-care as preventative medicine is not of course a new model. Indeed in classical Chinese medicine the art of being in a friendly clinical relationship with your own body is considered the foundation of good health. There is even a clear set of instructions on precisely how to conduct this practice. At its heart is a relaxed and friendly bedside manner towards your own physicality.

Sometimes this self-care practice is translated from Chinese as The Inner Smile, which may sound quirky to a cynical ear, a prime candidate for a bad science award. But unpack the Inner Smile tolerantly and we can see that it meshes extremely well with a modern understanding of the integration of brain, nervous system, endocrine system and gut ecology.

The Inner Smile is in fact a good example of psychoneuroimmunology (PNI) and polyvagal theory put into practice.  The practitioner is advised to do it daily, when the body is at ease, with a particular focus on letting the abdomen drop down and sink into relaxation. With a calm and friendly attitude the practitioner then conducts an internal scan, especially checking in on all the major organs and noticing how they feel. Moreover the practitioner is asked to come into a direct and personal relationship with each organ, greeting it with a smile.

Is this hippy-dippy? Anyone with the slightest knowledge of mind-body anatomy and PNI will understand that this internal focus triggers signals from the brain through the nervous system into the endocrine system. It is crucial therefore that the practitioner’s attitude be friendly. If the self-examination is conducted with a purely clinical, impatient or, worst, an inquisitorial attitude, the message triggered in the neuro-endocrinal system will be that of threat, thereby precipitating the production of cortisol and adrenalin. If however the attitude is friendly and comfortingly parental then the neural signal is reassuring and soothing, triggering a cocktail of wellbeing hormones: endorphins, oxytocin and serotonin. Just as an external caring parent can do wonders for our health, so an internal caring persona can have a similar positive effect.

Scanning with the Inner Smile then serves two purposes.

• It brings into conscious awareness the felt state of your own body; early diagnosis leading to appropriate early intervention.
• It self-soothes, relaxing and opening up tissue, integrating heart rate variability, settling and balancing gut ecology — all of which support general good health and a strong immune system.

Done on a daily basis the benefits are obvious.

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But people are predictably human and, despite how sensible and positive this practice is, there is resistance to adopting it. I opened this piece with that conversation with my GP who was bemoaning that he had not followed his own advice and caught an early diagnosis on his own illness. He provides an excellent example of the many clinicians and carers who fail to self-care even though they know precisely how to do it and how beneficial it is for them.

So why is there this resistance? Why do professionals who preach self-care and the importance of early intervention completely ignore their own advice? In my opinion it is good to be realistic about the sources of this self-sabotage, because recognising them makes them easier to manage. So here are a few possibilities. See which ones might apply to you:

WHY I DON’T SELF-CARE

• Can’t break old habits
• New behaviour to learn
• It wasn’t in my training
• Embarrassing and awkward to care for self
• Internalised authority figure judging you for appearing soft and narcissistic
• Pretend there is not enough time
• Frightened to look at what might be wrong
• Addicted to role of stoic hero and healer
• Scared of feeling feelings
• Lazy and lack discipline
• Depressed and no motivation

Those are all extremely good and normal reasons for avoiding self-care.

What therefore might motivate someone to push through the resistance? We could just wait for a harsh health crisis to prod you into action – the stick. Or — and I write this carefully after decades of experience in the field — you could just exercise sensible self-discipline,similar to washing your hands after the loo. I have led hundreds of trainings and I really know that other than the unpleasant shock of a severe illness, the only thing that seems to work is a disciplined rhythm that ultimately, like hand-washing, becomes a part of your normal life style. The carrots of self-care and early intervention are obvious.

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To summarise.

Be encouraged as a professional by the skills and knowledge you already bring to self-care.

YOUR SKILLS AND KNOWLEDGE

• Physiology
• Body awareness
• Necessity of early intervention
• Good bedside manner
• High awareness of the basic strategies for general good health
• High awareness of the immediate ameliorating strategies for specific health challenges
• Importance of modelling self-care for others
• Congruence
• Scientific understanding of the neuro-endocrinal mechanism and benefits of the Inner Smile self-care practice

And do the practice.

INNER SMILE SELF-CARE

• Daily — perhaps in bed; lunch break; watching television; whenever suits you
• Allow your body to sink down into being at ease
• Let your abdomen slump and let your breath soften
• Switch on the attitude of good bedside manner, like a friendly parent
• Focus down into your own body and scan it
• In whatever sequence works for you, give awareness to and feel into each organ and each region; sense into your systems
• Notice how it all feels and the indications
• Think about the appropriate health benefiting activities
• Action the appropriate health benefiting activities

The long-term benefits for you and your community are immense.

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You can download a full PDF of Andrew Tresidder’s book here https://healthandself.care