CHAPTER 6

The Making or Breaking of a Medical Registrar: A Study of Stress*

While we have been discussing these matters, I have reflected that these stresses are not confined to Medicine. They are very common questions – I have had to spend most of my ministerial life in dealing with them. It is the plain fact that I generally have to listen to exactly the same sort of thing from ministers, ministerial students, and people in other professions. So I think that you must abandon the notion that there is something peculiar to you, except in the sense that the particular phase through which Medicine is passing has aggravated all these problems in your case. Hence, I think that a very helpful thing will be for all of you to realize, to quote the apostle Paul, that there ‘is no temptation that hath taken you but such as is common to men’. Half of our troubles arise from the fact that we tend to think we are in some exceptional position and that we in particular have been dealt with unkindly or unfairly. The moment you think like that you succumb. But we must realize that these are general problems which are common to all Christians and common to the whole of life simply because we are human beings and Christians in addition.

I have been listening carefully to the analysis of the stresses and strains as put forward by the representatives of three branches of the profession and also to the general discussion. I could not help feeling that the poor housewife, who is mother of a numerous family, could tell you something about stresses that would not only amaze you, but would make you feel that you are really having a very good time! Take, for example, this question about pressures on your time. Think of the housewife with a house full of children! When is she to find the time to pray and to study the Scriptures? The children are constantly crying and screaming; first one falls, then another breaks a bone, whilst a third has tonsillitis. The husband comes home at six o’clock or later and expects attention rather than to lend his aid! This is something which a minister has to meet constantly, and there is nothing special about it all.

I would suggest that you are a little bit in danger, if I may diagnose you, of looking too much at yourselves and talking too much about your hard lot! So that I would say that the first bit of treatment which is needed is to make you realize that there is nothing peculiar about it– nothing special at all. Men in all professions are up against exactly the same thing. Take the matter of jealousy: look at politics or look at the Bar! It even crops up in the Christian ministry. It is everywhere.

PERSONAL ATTITUDES

Then, second, I would go on from there to borrow the words of Shakespeare: ‘The fault, dear Brutus, is not in our stars, but in ourselves that we are underlings.’ That quotation kept coming to me as I was listening. We moan about this wretched National Health Service. If only this were different, how wonderful we should be! We are not really being given a chance. Look at the kind of life which we have to live and look at those difficult chiefs under whom we have to serve and there is so much else wrong. But the answer is that ‘the fault, dear Brutus, is not in our stars...’. It is in ourselves. This again is a humbling realization.

That is where the Christian message is of such help to us. It does not change the circumstances, but what it does is to change us. It is at this point that we see the fallacy of the so-called social gospellers. They think that the business of Christianity is to change the environment, and to change the world. When everything is changed, we shall be all right! But this puts the Gospel the wrong way round. The glory of our message is that circumstances, surroundings and ‘the stars’ remain exactly as they are. We can, however, maintain our composure because our attitude is different. It is a change in us which enables us to view these things without – dare I say it? – having to go to consult a psychiatrist! We have to be careful in this matter because we have known of ‘psychiatrists’ in the ministry who have spent a lifetime in preaching two main things: one, that a Christian, because he is properly integrated, will not suffer from insomnia, and secondly, that he will never have a nervous breakdown. Then these very advisers have proceeded to fall into both of these themselves! Apart from such uncertainties, it is bad Christianity. In fact, it is psychology, not Christianity.

The glory of the Christian position is that it puts us right. ‘If any man be in Christ he is a new creature ... all things are become new.’ Now, in what sense is this true? It is in the sense that he sees them differently. It is the secret of Christian life and of living.

‘Two men looked out through prison bars,
one saw mud, the other stars.
A primrose by a river’s brim,
a yellow primrose was to him,
and it was nothing more.’

That’s one kind of person. But, then ‘beauty is in the eye of the beholder’. Another man can see beauty in ‘the meanest flower that blows’, and have thoughts that often ‘lie too deep for tears’. They are looking at the same things, but their reaction is entirely different. This is what the Christian faith should do for us – if we will only practise it.

THE BASIC ISSUE

Why are we then in trouble? Well, it is a case of (as our Lord put it) ‘If ye know these things, happy are ye if ye do them.’ To have an awareness of these things is not enough. So I would put it to you like this. The thing about which we have to keep on reminding ourselves, is that we are Christians. That is the big thing. In your case you are a Christian who happens to be a doctor. Another man is a Christian who happens to be called to the Bar, or some other profession. But we must keep the fact that we are Christians always in the centre. But, remember, this involves the necessity that you must keep on working out that principle.

I have observed over the years that there are many people who have broken down under these stresses because they have tended to live in ‘compartments’. Yes, they are Christians. They are Christians in the sense that they read their Bible, pray, and go to church. That is one side of them. But, then, when they go to their business they seem to forget all this, and in their work they are just like everybody else. They are subject to the same stresses and then they tend to break down and worry. I have known far too many Christians who seem to be two persons. At first you cannot tell whether they are Christians or not, then they suddenly pull themselves together and become serious. But I feel that there should be a unanimity about a Christian – a wholeness – which governs the whole of his life, his outlook, and all his activities. To the extent that we are able to maintain that outlook, we shall evade many of the problems that we have been discussing together.

THE PULL OF AMBITION

Then let us take the question of ambition which has been mentioned. There is nothing wrong with the desire to do well, as long as it does not master us. We must not be governed by ambition. There is a real difference at this point between the Christian and the non-Christian. The Christian starts with the realization that we are living in an evil world. The non-Christian does not have things in such a perspective. The New Testament repeatedly warns us against ‘the world’. ‘Love not the world nor the things that are in the world’–‘The lust of the eye and the lust of the flesh and the pride of life.’ Yet I have known Christians who have been very worldly men. Not that they would be going every other night to a cinema or a theatre, or drinking heavily or gambling. But, in the matter of ostentation, for example in their houses and with their cars, they have been thoroughly worldly. They have not, of course, realized this, for ‘the pride of life’ can be accepted in a very subtle form. I have also known many ‘snobbish’ Christians. But this should be an impossibility! A Christian should never be a snob, but I have known many who are. But that is wrong – it is of ‘the world’.

The big thing that should be obvious about us is that we are Christians. ‘This is the victory that overcometh the world, even our faith.’ So the Christian starts by seeing through ‘the world’. He should, of course, want to be a good doctor. Given two men with equal ability, one a Christian and the other not, the Christian should be the better doctor of the two simply because he is a Christian. His whole attitude should be better, and he should be anxious to function medically as perfectly as he can. Yet he is not a slave to good practice. Nor is he worried if somebody else is doing better. In other words, there is a difference between the desire to do your work well in order that you may have still more influence for good, and the worldly, unhealthy, totally self-centred type of ambition and pride, which is the mark of the man of ‘the world’.

I am, at this point, reminded of my old chief. I remember that he once asked me to go through the cards for his private patients. They had been indexed from their names. He wanted me to prepare a card index according to the patients" diseases’, so that if he were called upon to give a lecture on a given disease, he could at once lay his hands on the private cases of this. I went through all the cards of his private patients – thousands of them. I was most interested to see his diagnosis in the case of some, perhaps I should say many. He was a top consultant, yet his sole diagnosis for a number of them was – (a) ‘eats too much’, (b) ‘drinks too much’, (c) ‘dances too much’, and (d) ‘doesn’t sleep enough’. The Christian does not want to indulge or dissipate, hence he should be more efficient because he does not do so. The Christian is seeking to live his life to the glory of God.

As a result, it is not the end of the world for the Christian, if he suddenly finds that he cannot go on to be a consultant and has to go into general practice. He need not spend the rest of his life feeling a sense of grievance. Why not? Well, because he can equally serve God in general practice – perhaps better– and he can equally well do his best there. In other words, it is the higher and controlling attitude which saves the Christian from all these stresses and strains. But, it must be emphasized, he has to work this out quite deliberately. It will not happen automatically. It has to be worked out and it has to be applied all the time. A wrong thought may come to you, but you must confront and answer it in a Christian way. You may feel the risings of the old nature, which is still present. But it must not be allowed to control you.

OUR TEMPERAMENTS

Then, let us look at this whole question of temperament. We all possess different temperaments, and we each have a personal problem for that reason. But the difference between the non-Christian and the Christian at this point is this: that the non-Christian tends to be governed by his temperament. Now, when we are converted and regenerated our temperament, as such, is not changed at all. It is still there and it should be. Christians are not intended to be all the same like postage stamps. The apostle Paul was a violent persecutor before his conversion and he could be violent as a preacher afterwards. He was vehement as a persecutor and vehement as a preacher – that was his nature, and that was not changed. The point is that the Christian is not controlled by his old nature. He controls it. He can harness it to become something very valuable because he will express his Christianity in his own particular way which is different from another. We all serve together to the glory of God. Just as there is a variety and variation in nature, so you have it in human beings and in Christians. We are not all meant to be exactly the same and doing exactly the same things. Such a consideration delivers a man from all the pettiness, which is so often a characteristic of professional, as well as ordinary, life.

THE FUTILITY OF WORRY

The other big thing that you have to learn is this. You must not succumb to worry. It is bad, and, in any case, it is useless. Think of the time that we have all probably given to worrying about things. It is all a waste of energy. All you do is to weaken yourself, and hence to become less efficient the next day. The Christian should refuse to worry. You must face the cause, hold it up before you, and examine it. Then you must decisively reject it – ‘I know all about it; I am not going to worry, it is wrong.’

But, then, on the positive side, there is the whole question of the nurture of the soul. This is something, of course, to which we all must attend. Medicals are in no special extremity in this matter. You would be surprised at the questions that ministers put in ministerial gatherings over the question of the use of time. I stayed recently with a busy minister and his great problem is that he is an artist. He has a real gift for painting. Should he give expression to this gift? If so, how much and how little? He was in a great frenzy over it. It will seem incredible to you but it is the bare truth that many ministers have to confess that their greatest problem today is to look after their own souls. Why? The chief reason is the multiplicity of meetings which they have. They are out every night in youth meetings, or meetings for this or that. Then people become ill and they must go round to visit them. They have no time properly to prepare their sermons. They no longer have time adequately to read their Bibles, nor to pray, yet remember that these are ‘whole-time’ Christian workers. I can assure you that they are confronted with exactly your own problem of time. This problem is not anything special or peculiar. There is only one answer and it is self-discipline. Some of us expect things to come a little bit too easily.

A RIGHT PERSPECTIVE

I would suggest that you people are having a very good time! Do you know how much a house physician at a teaching hospital was paid in 1921? It was nothing! We could not think of getting married when we were students, nor as housemen. We were unable to think of getting married even when we were junior consultants. We just could not afford it, and we did not expect it. But, as a result of the last war, the idea came in that everybody is entitled to have everything at once. There is a lack of discipline, and though you are Christians you are being influenced by the mind and the outlook of the world.

There is only one answer to all this. The Christian must not be so self-centred and he must not indulge in self-pity. He must stop over-protecting himself. He has been given gifts. He did not create them. God has given him the gifts and his business is to use them – these particular gifts – to the glory of God. He is to do so with all his might and main. He can do no more. He commits his life to God, and believes that God does guide, that God knows and loves his people. In that confidence, he goes on and his relative position in life is to him not the big thing. If it is God’s will that he should be in a commanding position, let him work honestly to get there. If he is not so meant, well, he is not unhappy. The apostle Paul has put all this in his picture of the Church, as ‘the body of Christ’ in 1 Corinthians 12. We have to grasp this notion that we are parts of the body of Christ, and wherever and whatever we are, we live to his glory. This is the essence, not only of the New Testament, but of Protestantism. The great discovery of Martin Luther was that a servant can brush a floor as much to the glory of God as any monk can pray in his cell. Everything we do is to be to the glory of God. We must become detached from self. Self is the subtle problem. It works itself out in self-pity, self-protection, self-concern, hypersensitivity, and the rest. Then come jealousy, envy, feeling grieved and hurt and all the rest of it. Christianity comes right to the centre at once! You are to deny yourself, to take up the cross and to follow him. ‘He died for all that they that live should no longer live to themselves, but to him that died for them and rose again.’ If there is anything more glorious than this, then I would like to know what it is. The Christian faith delivers us from our wretched selves.

THE VITAL ATTITUDE

The problems, of course, will be still there. But they will now be seen in a different way. It is your reaction to them that matters. It can be very difficult at times. Come back to your fundamental position, maintain your contact with God by your reading of the Scriptures and by prayer. You must make the time. As anyone may observe, you seem to have time for other things, so make sure that this comes first. Let other things wait, calm yourself, do not read your Bible in a hurry. Become quiet, get restful, and be peaceful. Then study it because you enjoy it. You will then absorb the whole Christian ‘philosophy’ and true outlook upon life.

I remember a preacher some years ago telling us a story about William Wilberforce. I entirely disagreed with the point made then and still do. William Wilberforce at the height of the antislavery campaign was approached by a very pious lady, who went to him and said: ‘Mr. Wilberforce, what about the soul?’ Wilberforce replied with great force ‘Madam, I had almost forgotten that I had a soul.’ The preacher seemed to think that this was marvellous! In the great campaign for the freedom of the slaves, Wilberforce had forgotten his own soul. But such a condition is quite wrong! It is a terrible thing that, however good the work you are doing, you should forget your own soul. The end of that course is often utter aridity. I have sometimes had to deal with those who have been active Christian workers all their lives and have seen them in hospital or at their deathbed. They have awakened suddenly to the fact that they have been living on their activities, and that their souls have been empty. They had failed to maintain the culture of their own souls. No work is so important that it must be done at the expense of your own soul. Keep your relationship with God right whatever else happens. If you keep that central, then I suggest to you that many of your problems, if not most of them, will certainly not break you. They will not even worry you.

CONCENTRATION ON OUR TASKS

It has been pathetic to me to see some good Christian men in the medical profession, as well as some in other professions, travelling about and preaching more than would seem to be wise. It raises the question of the doctor’s task. Sometimes I have felt that all the activity has been due to the fact that these men have been uneasy in their own consciences. I have known some cases where I am quite sure that the trouble has been that the good man has felt that he should have gone out to the mission field. He did not do so and, then, as he began to do well in the profession, he sought to salve his conscience by preaching. But, in fact, you should know that a medical practitioner is not primarily called to preach. Let me tell you that! When I felt called upon to be a preacher, I left Medicine. I became convinced that I was called upon first to be a preacher, and now and again, I practised a little medicine. It is part of the muddle in the Church today, that everybody seems to be doing everybody else’s job. I find that ministers in their training have now to do some psychiatry, and tend to become hybrid-doctors, whilst some of the doctors are doing their preaching. We must stick to our appointed task. We must do what we are called, gifted and trained to do. Christian men have sometimes broken down in health, simply because in my opinion, they were killing themselves by doing the things for which they were never intended.

Maintain the culture of your soul. Never be so busy that you have no time for that. We are passing through a difficult time in every sphere, not only in Medicine, but in the Church. Everywhere this is the age of confusion. I feel that the call to all of us is to get back to the basic elementary things and to start again from there. This goes as much for the Church as for the medical profession. We have got to get out of the present muddle. The only way to do that is for all to get back to first principles.

* From a paper which was one of a series of four given in turn by a physician, a surgeon, a psychiatrist and a minister and delivered before an audience of junior doctors at the Royal Commonwealth Society, London, on Saturday, March 8th, 1969.