The Four Horsemen: Trauma, Grief, Depression and Anxiety
This article first appeared in the Minden Times in March 2024.
Dr. Peter Attia, in his recently published book, Outlive, which tells us how we can join the burgeoning group of centenarians, identifies the Four Horseman of chronic disease – Heart disease, Cancer, Diabetes and Dementia – that undermine what he calls a ‘healthspan’, not so much how long you live but how healthy and functional you remain as you age.
Attia identifies the magic ingredients in managing the Four Horsemen to prevent them from becoming chronic and debilitating in this order: exercise, nutrition, sleep and emotional health. He isn’t as instructive about how to achieve emotional health as he is about other conditions – probably because the medical profession, of which he is a somewhat reluctant and cynical member, is late coming to that party.
Attia needed to achieve emotional health before he could bring this big book to fruition, but his personal experience involves resources that are unaffordable to most of us, and in short supply. His journey included two weeks-long stays in residential programs and an on-going flotilla of therapists.
Achieving emotional health is a very common theme in many memoirs. Each of them could be considered a pathway of crumbs through the forest marking the way to health. Many of these strategies are more affordable and accessible than Attia’s. I’m going to boldly suggest that the Four Horseman of emotional health are Trauma, Grief, Depression and Anxiety. And that preventing them, or catching them in early phases and learning to deal with them so they don’t become chronic, starts with the same ingredients as dealing with the medical Four Horsemen.
But I’m also going to boldly build on that foundation by sharing what I think are the overlaps in memoirs that put meat on the bone of Attia’s recipe for emotional health. What are they?
The first is Name and Claim. The recognition that a serious problem exists. Simmering it into something that can be convincingly named, a handle to hold on to. Owning it as yours to deal with.
The second is Posing it as a Problem to be Addressed. I don’t say solved because that is probably many iterations down the road, and the problem may in the end become a life companion, something you’ve become comfortable living with. (As, for example, addicts describe themselves as recovering -- for a long time, maybe forever.) The important word is Posing, which implies a sense of agency, finding an ‘I’ that can ‘do’. Building on and strengthening that ‘I’ by exercising it.
The third is Being Compassionate. With oneself as the bearer of the problem. With all the people and circumstances that made it a problem for you. With not getting started earlier or not making progress faster or not achieving your ultimate goal.
A recent article in the Globe and Mail by Julia Samuel (Losing the Language of Grief, Feb 17/24, Opinion section) suggested that the proliferation and medicalization of what I’m calling the Four Emotional Horsemen does us a disservice by distancing us from the work that, in the end, can only be done by us, by the person who is experiencing the trauma, the grief, the depression, the anxiety. There can be – probably must be – helpers, but there is no magic pill that cures, no vaccination that protects, no surgery that excises the problem. Relief, perhaps, a reprieve from symptoms, but not resolution. Resolution is shaving the problematic condition to a size and shape that the person who has it can live with. Very individual. Very tailored. Hard to quantify. (Which is why medicalizing these conditions is particularly problematic: my grief at 3 on a scale of 5 is not your grief at 3, and by the way, what day and what hour are you referring to?)
Because I spent much of my career in toxic environments, before we had a construct called moral injury, I developed a procedure for what I called doing emotional laundry. I tried to do it every day between leaving work and getting home so I didn’t bring that darkness into my family. Sometimes I had to take additional time in a soothing task like tidying and watering the plants before I was ready for domestic life. Sometimes I had to take longer breaks – time away, total immersion in a novel.
I did my emotional laundry using a variation on the 3-step process I described above: name and claim, pose it as a problem to be resolved within my capability, be compassionate about all that lays beyond the scope of my and my clients’ capacity (which was most of it: we were equally although differently squeezed by society’s malfunction). I see it at work in my memoir and in many that I read. Try it, if you want.
