I recently had an interaction with a patient that had suffered a stroke and it got me thinking about emotions. I was asking this patient how her therapies were going, and she replied, “I can’t move my arm and leg,” and then started crying. I crouched down in front of her and held her hand in support. She started sobbing and then started apologizing profusely about crying. “I don’t know why I’m crying doctor, I’m so so sorry.”
I told her it was OK to cry. To let it out. That having a stroke affect your physical function is scary and sad. She quickly stopped crying however, stuffing it down. I then wondered where she learned this: learned that it was not alright to express her grief. While growing up, was she one of us that heard things like: “why are you crying?” or “You have nothing to cry about,” or “Stop crying before I give you something to cry about.”
Or maybe it was because she never learned any skills of emotional regulation, how to recognize, name and express her emotions. Marc Brackett, PhD, the director of the Yale Center for Emotional Intelligence, discusses this in his insightful book, Permission to Feel, The Power of Emotional Intelligence to Achieve Well-Being and Success.
He and his uncle wanted to start a program for schools that had students with “behavioral” issues. They went in the first day to teach the staff the skills needed to create emotional intelligence for their students. The teachers looked back at them like they were talking a foreign language and scoffed at the idea of talking about emotions in the classroom. There was work to be done, checklists of things the students needed to learn to pass their tests and emotions were definitely not on that list.
Dr. Brackett quickly realized he and his uncle needed to start by educating the staff about emotional regulation and intelligence before they could teach it to the children. Of course, this makes sense. How many of us were consciously taught either in our homes or in schools about emotional recognition or expression?
I dove into this book last year and found it to be a revelation in so many ways, not only for myself but also for my patients. Dr. Brackett uses an acronym to guide the process of becoming emotionally intelligent: RULER.
R – Recognize you are having some sort of emotion – How are you feeling? High energy, low energy, pleasant, unpleasant?
U – Understand the trigger to the emotion. Why are you feeling this way? Why now? What just happened that may have caused you to feel this way?
L – Label. Find the precise word to describe the emotion. Prior to reading this book I had very few words I regularly used to describe what I was feeling. Happy, sad, angry, depressed, blah (not sure that counts) was about it. Dr. Brackett’s mood meter has 100, yes 100, different words to describe our emotions. Who knew there were so many?
E – Express. Do you want to share your emotion with others? If so, when, where, how much and to whom? This is much harder to do than the previous steps. It takes courage as well as an inner knowing if it’s even the right time, place or person to share with.
R – Regulate. This is by far the hardest step and puts together all of the above. Regulation involves the unconscious reptilian brain responses that kick in before we have time to think, as well as the conscious strategies we employ to manage our emotions.
So why all this talk about emotions and emotional intelligence? Because it can heal ourselves and our patients. There is scientific evidence that by expressing our emotions our physical and mental health gets better. Our immune system improves, blood pressure drops, stress is reduced, and our mood improves. This results in less visits to physician offices, improved performance in school and less days off of work.
So, that’s why I encouraged my patient to let her tears out. I’ll keep making space for her and others to express themselves. I hope it will help them all heal. And in the process, I get the immense privilege of being let into someone’s inner world.