Farrah Schwartz's take on stress and the importance of prioritizing your mental health

Farrah Schwartz is the manager of Patient Education and Engagement at UHN. Her work entails assisting patients in actively participating in their care and improving organizational processes. The Patient Education and Engagement program provides resources, training, and coaching to help Team UHN engage patients in their care. They are also working on patient engagement within organizational improvement and partnering with equity-seeking groups to ensure that health information is inclusive and non-stigmatizing.

Farrah has experienced stress throughout her life, including during the pandemic. She had a laser focus on her work and was able to channel her stress into something productive. Stress comes in many forms, and it is important to recognize and manage it. 

Farrah recommends tuning into your mood, practicing self-compassion, and finding gratitude in small things. She has learned that it is not possible to do everything and that it is important to set realistic expectations.

The Your Complex Brain production team is Heather Sherman, Jessica Schmidt, Dr. Amy Ma, Kim Perry, Sara Yuan, Meagan Anderi, Liz Chapman, and Lorna Gilfedder.

The Krembil Brain Institute, part of University Health Network, in Toronto, is home to one of the world's largest and most comprehensive teams of physicians and scientists uniquely working hand-in-hand to prevent and confront problems of the brain and spine, such as Parkinson's, Alzheimer's, epilepsy, stroke, spinal cord injury, chronic pain, brain cancer or concussion, in their lifetime. Through state-of-the-art patient care and advanced research, we are working relentlessly toward finding new treatments and cures.

Do you want to know more about the Krembil Brain Institute at UHN? Visit us at: uhn.ca/krembil

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Thanks for listening!

Transcript

My name is Farah Schwartz. I'm the manager of Patient Education and Engagement at UHN. A patient education and engagement program is part of the patient experience or engagement portfolio at University Health Network. And what we do in the portfolio is really helping people to be able to engage in their care or helping the hospital enable people to engage in their care as well as organisational improvement. So are you at UHN, I mean a lot of people now and hopefully everyone knows after going through orientation that the needs of the patient come first. Patient engagement has done some work to help people really explain or define what that means. So the patient declaration of values that we have at your retirement drives a lot of this or helps people to really understand how their work relates to our values and putting patients needs first. We call it a compass, so to speak, because it's it really helps people to align with those things. And our declaration of values was defined on patient needs and engagement with patients at a lot of different touchpoints during care. And it was co-led by patient partners as well. And so that's ultimately, patient education and engagement, is about helping people to kind of land on what are those values and how do you bring them forward in care. 

It's not always so easy, especially these days, health care is a really tough place to work and hospitals especially. So UHN on patient education is here to provide tools and training to help TeamUHN provide the care that's aligned with our values and that we want to deliver. And very often why people chose to go into health care in the first place. In patient education, we deliver health literate resources. We provide training and coaching to help TeamUHN and engage patients more easily. And we're also doing really exciting work around patient engagement within organisational improvement. That's that's a big part of our mandate. We're also looking at equity and inclusion that involves partnering with equity seeking groups to ensure that our health information is inclusive and non- stigmatising. 

Stress has been a part of my life since before the pandemic. I don't think anybody would would say anything different because, you know, everyone has stress. But for me, I think I've had some times where I've felt more acute stress and have had to deal with and navigate that to negotiate my life. So coming into the pandemic, I'd gotten through a lot of stressful times already, and I knew myself fairly well. And I felt really lucky at the beginning of the pandemic because it was protective. It helped me to have gotten through and focussed on having to live with stress in the past. And a lot of the maybe doubts that I had or worries and fears they were pretty real in the pandemic. They were pretty concrete and solid. But I think because I dealt with them before, there was a little bit of protection I had from that. And I also think I mentioned that work was protective. I think that work allowed me to have a laser focus and in a way that was really connected to the stress in front of me. I felt a lot of stress about the world situation, as did a lot of people watching what was unfolding. And I was able to go and actually do something. And even though it was at a local level, it was, you know, the hospital, it wasn't global. It wasn't finding a vaccine, which would have also been a really incredible thing to be working on. I could actually jump into something and it was very demanding, but it occupied my brain a lot.

And then the rest of the people that, you know, I mentioned my family had never really seen me have to jump in to work quite in this way. They've always seen me really focused and they know about how important my work is, but they never seen me have to just drop everything. I didn't have time to eat. My husband or partner would bring me, like he'd sneak into the room and bring me food. And that just that just wasn't something that happened before. I'm also a little bit of well, I'm not a picky eater, but I like food cooked well, and I'm a better cook. So that was a part of it too. 

I think a lot of the stress that I've dealt with or felt over the years is the; I'm going to say it's an impossible situation that many people are and where we're trying to do everything and manage everything and it's not possible. We don't have enough hours in the day. And I didn't realise that back then. So when I was in my thirties, I don't think I understood that it's actually not possible to do everything that you think you ought to be able to do. And I don't mean from an hours in the day perspective. I don't mean like, you know, you only have 24 hours and you need to sleep and I like to sleep. So it's even fewer I mean, more you can't possibly manage every single thing that you're told you're supposed to be able to manage. So as a parent and partner and person who works and also manages a team of people, I've had to understand like I'm not I'm not perfect. I'm never going to be perfect. I never thought I was perfect for the record, but I guess maybe I was hard on myself like I was supposed to be. I think it's been really stressful at different times to see all the expectations. 

When I had young kids, I almost felt like I wasn't supposed to ever let them be stressed or have problems. And then suddenly there was a great shift where it's like none at all that you need to foster independence. And so for me, I've always been someone who second guesses myself. I have a really strong inner critic. And so when these things come up or when there's too much or I have doubts about actually being successful in what I want to do, like being a parent and having the time to do certain things, or if they don't get their homework done. I felt guilt that their homework's not done and taken it upon myself. So, you know, when we have all of these things that we're working on and we have ideas about how it's supposed to be, it doesn't always work out that way. And I'm going to say it probably never works out that way for people. 

I'm starting to learn. But I think I had this idea that I would be able to, you know, raise my kids how I wanted and cook their dinners and my dinners and, you know, be happy and have outings on the weekends and do all these things and then be able to advance their work and really focus on it and like it and want to do new things but actually know how to do them. I don't think it was possible in the way that I envisioned it to be or the way that I expected it to be. So when things would get really tough or really busy, the dynamics at home would often cause a lot of stress for me. So there were periods of time where I think it was just so much and I often felt guilty or sometimes I felt very guilty because I would go to work and feel happier than when I would come home. And then I would come home and kind of just kind of blow sometimes or not feel like I was being the parent I wanted to be. And that made me feel really guilty. It became a cycle of never really feeling like I was doing what I could be doing or happy with how I was doing, if that makes sense. And so that really, it just kind of became a vicious cycle of stress. And then I think what would sometimes what happened was I would yell at my kids or I would do something that I didn't feel I wanted to be doing, and that would cause more stress and that would make me feel worse. And then maybe I would yell even more the next day. 

So I think that notion of being overwhelmed or the stress that comes from being overwhelmed or even, you know, part of it for me was also just being reactive. It was not being on top of all the things in my environment. And then what would end up happening was I'd get home and I'd have to do so much. I'd have to like, I'd be cooking dinner. I'd have done the dishes. Maybe my mother called and she wanted to talk to me and I'd be processing the day. And then one of the kids would come in and ask a question and I yell at them or they'd do something. It wasn't that they asked a question, but they just weren't perfect because, you know, I'm sorry to have to say, I know most people's kids are perfect, right? So they would something just, you know, smile that they would do something that was, you know, very normal. And then I would turn around and just yell and just kind of lose it. And I was really just losing my own regulation or calm. But they were the ones who kind of just tipped it over from that last thing. So when I think about the question of, like, are a lot of people in this situation, I do think that there's a lot that people have to carry and that they don't necessarily realise the impact of having to carry so many multiple things, especially if there are social expectations that we just do those things and then there's no extra room or recognition given to that. So so yeah, I think a lot of people are in that situation, although it may look very different or they may define it differently. 

If they have a brain like mine that can be very self-critical sometimes they also don't give the credit to all that they're doing to see what that's like or what that feels like. I feel like stress comes through in a few different ways. For me, it's funny. I never would have thought about this physiologically until recently, but I guess my mood gets so affected by things like stress, physiological changes, and I think I always associated mood and stress as exactly the same thing. And it was really only when I got COVID and my mood was so impacted and started talking to people that I could understand the difference between mood and stress and how mood affects stress and isn't the same thing. 

So for me, I think one of the first things that I've noticed when I get stressed is my mood. I get maybe irritable or emotional. I notice it a lot in irritability with my family. So for me, it's it's I can say, ooh, like I'm really getting irritated. And I used to even, you know, before the pandemic, I remember there were days where I would come home and say to my kids, you know, like I had a few interactions on the subway and everybody was really bugging me. And then I realised it was me. It's my mood. I'm the one who's perceiving it that way. And so trying to really understand it, particularly like sometimes your mood is affecting all of your interactions and then it does cause more stress. So if I'm dwelling in what happened when I had this interaction that I perceived in a certain way or that, okay, it's going to make me more stressed. 

And so for me, recognising mood is it's affected by my sleep and my health. I used to have as a I guess late in my teens I realised, you know, y like when I get sick or if I get a really bad fever, I've noticed that sometimes the day before that happens I go on a crying jag and I can't stop crying. And I just if I have a really emotional fight with someone and I can't stop crying, maybe I'm getting sick. I didn't know that that was mood. And I certainly didn't understand the connection between physiology and mood. So it's really helpful for me to understand mood is different than stress, and mood can cause stress or be caused by stress. But to be attuned to your mood and to understand your mood is something separate than your reactions or separate than just, you know, sort of your stress level. You can actually modify an impact that is just by recognising it and recognising how you were doing it that day. So for me it's been a really helpful thing, is trying to tune into that mood. If I'm feeling a certain way, like I'm just feeling like bleh.

I try to recognise that now and be like I'm feeling disgusting today or I'm, I'm feeling really stressed, like it's not even 9:00 and I already feel like the world is beating down my door and I haven't done enough today. So what's that telling me? It's a strategy that I think is also really help me with that is just to try to recognise how I'm feeling and how that might influence other things and then just breathe through it. Being able to look back and say, you know, I felt this way when I was a younger parent or this was how I felt then. I can also recognise how much I've learned about myself and how far I've come with, you know, some of that self-criticism, the guilt. It's not to say it's not there. Like, believe me, it's still there. But to be able to recognise the degree to which I had impossible expectations of myself. In terms of impossible expectations. 

It's not this notion that people are driving towards perfection or can't make mistakes. It's just this expectation that we're supposed to be able to handle it all, knowing what we're doing, knowing how to do it. And really in very like with very limited support. I think for me it's really reflecting on how much I've learned about myself and how much I've been able to really gather these tools to try to work through those things. 

Self-compassion is a really big thing for me. And when I first learned about self-compassion, it was interesting. I would have a very funny response of. Getting all like worked up. So it's something that I've had to work through. And so I think now when I think of self-compassion and I think of what works for me, there's an idea with self-compassion that thinking about what someone else might do in this situation or how it might feel for someone else in that situation. I hope that I am conveying it in a in a way that's true to its it's like its actual form. I found it really helpful at times to just stop and say like, this is hard. If I had a friend who had this happened this week, what can we do for you? How can we help? This is this is a really tough situation. So I've really tried to apply that same empathy for myself. So I think self-compassion is really important. I suspect it's also triggering for people who have a hard time finding it and that it's finding the right connection in a way that you really can give yourself a break and just understand love yourself despite the the humanity that you know, maybe showing. 

Gratitude has been really helpful for me as well. And I think gratitude also can have a lot of other ideas sometimes, You know, I think the idea of gratitude when I try it with my kids sometimes give me a lot of pressure. For me, when I think of gratitude, I'm trying to think of even the can be big things that can be grateful. Like at the beginning of the pandemic, I felt really grateful to have a home that I could be in and that I could feel safe in. I also could feel grateful for going outside and just taking a walk and having that air to breathe or being able. Even though the disruption of my commute was really hard to deal with. And you know all of that man, I was grateful that I could still walk down the street and see the TTC going and knowing that it was going. That was a very time limited gratitude piece. 

But I think it's really important to be able, even just sometimes now if I'm feeling stressed or I'm tired, it's I'm really enjoying this cup of tea right now, or I'm really grateful to be able to have, you know, a plant on my office desk at home that I like to look at every day. And I feel like some of those small moments, it can sound very cheesy or it just doesn't seem so meaningful. But for me, I found that it's just those small little moments or small little things that my brain can can hook on to and say, this is a good thing. This is a thing you're doing for yourself.