The symbol of a snake wrapped around a staff is ubiquitous in healthcare - it forms logos and branding for organisations from the WHO down. And it’s history is long - it dates back to Ancient Greece, Near East and Mediterranean traditions, as a symbol of healers, healing, and rebirth in the face of disease.

The Caducues symbol, the variation that includes two snakes wrapped around a staff and topped with wings, is perhaps a misunderstanding - it is the symbol of Hermes, god of commerce, culture, negotiation. But it has become the name internationally for peer support groups for healthcare workers of all backgrounds to come together to support one another and seek help.

For me, the symbol always brought to mind a barely remembered Bible story from deep childhood, that I’d long discarded as simple mythology. In the story, Moses is guiding the Israelites through the desert, and fed up with the bland but sustaining manna (bread) the people have sought alternatives. As a consequence, many are bitten by serpents, and laid low from the envenomation. Distresed by their suffering, Moses wraps a snake around his staff, holds it up for them to see, and any who are brave enough to simply come out of the darkness and look upon the snake, are miraculously cured.

I doubt I remember the details correctly, and in many ways it doesn’t matter. The metaphor and it’s various forms and connotations remains apt - we come together, we support one another, and in the act of coming into the light and facing the truth of ourselves and the poison, somehow, without clear explanation, we heal.

I don’t know that I’ll ever really understand what was happening, and the truth was I didn’t need to in the moment - I just needed help to keep going with sobriety as my life unravelled.

In retrospect now, I wonder if the problem was my use of perfectionsim as an engine, and my constant shelving of experiences and feelings rather than addressing them.

I, like many, had acquired the idea along the way that perfectionism is a positive trait, in fact, a necessary one to achieve success in medicine. While that is certainly true, I had also been leaning into using perfectionism as a punitive driver to push me through executive dysfunction and task paralysis, and the relief from that state was then provided by alcohol. I had a strong unspoken belief that I was only “ok” if I was compensating for my many defects with excessive competency (ie perfection) in other areas.

In Daring Greatly, Brene Brown dissects perfectionism as a form of shame avoidance; a maladaptive cognitive distortion rooted in delusion:

“Perfectionism is the belief that if we do things perfectly ...we can minimise / avoid blame, judgement, shame.…..Perfectionism is not a way to avoid shame, it is a form of shame….. Perfectionism is the self destructive and addictive belief system that fuels the thought ‘if I’m perfect I avoid shame’” pp 129-130.

She then compares perfectionsim with it’s antidote:

Perfectionism is

• self destructive - it is ultimately unattainable and therefore encourages self-flaggelation

• addictive - when shame is experienced it reinforces the belief ‘I wasn’t perfect enough’, and the insaitable search for more perfection

The antidote is shame resilience, through

• self-compassion: warm acceptance of oneself as imperfect

• common humanity: warm acceptance of others as imperfect

• mindfulness

• sharing stories - shame cannot survive the light

But this raised another conundrum for me - if I no longer have perfectionism, then what will drive me through study, difficult points in my career, everything else?

Into this gap, stepped Angela Duckworth’s idea of Grit

“It’s a persistent desire to do better... It’s the opposite of being complacent. But it’s a positive state of mind, not a negative one. It’s not looking backward with dissatisfaction, it’s looking forward and wanting to grow.” Pp 118

References:

Brown, B., Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead (New York, NY: Gotham Books, 2012).

Duckworth, A. (2016). Grit: The power of passion and perseverance. Scribner.

It wasn’t long in my recovery journey before I started hearing others talking about the importance and power of surrender. For a long time, it was off-putting and something I tolerated with, at best, a detached intellectual curiosity.

Before I’d become really desperate I would listen to arguments about powerlessness and think - that’s not true of me, I keep making bad choices and need to stop. I need to learn more resilience, more toughness, more self denial. To my ears, claiming powerlessness was an abdication of responsibility.

In Hope Unfeathered, one of Kate Erlenbusch’s phrases captured me, almost like a bell in the darkness - “I would happily trade my chattering mind / For a brief fix of unworded bliss.” I was desperately sick of my own head, and the revolving arguments I was constantly trapped in around not only drinking, but everything. I could not tolerate myself. I was becoming progressively so tortured by the cognitive dissonace that I became more desperate, and consequently more willing to try absolutely anything - even surrender - and things shifted.

But surrender to what? If you’re not religious, nor even spiritual what is there? If you, like me, thought the whole thing was a crock of shit, what does surrender really mean?

In her poem ‘Emunah’ Erlenbusch articulates a vague but viscerally true concept that was my first movement forward - “The Hebrew word for faith, emunah / means support…..[it] is the action you take / to support God / not as a deity / but as an expression / of the greatest good”.

The greatest good, whatever that means, for myself, my family, my world. That is worth seeking.

Hope Unfeathered, by Kate Erlenbusch, self-published in 2020.

I came across Dr Neff’s work when it was recommended to me by a mentor at work, who saw that I was struggling with anxiety and imposter syndrome.

Her book Self-Compassion: Stop Beating Yourself Up and Leave Insecurity Behind, published in 2011, details both her research as well as a stories on the importance of compassion toward ourselves, and exercises to help build this skill. The book covers three core ideas - the necessity of self kindness over self judgement, recognition of common humanity over isolation, and mindful awareness over excessive identification.

I have however, mainly worked through the wonderful audio tracks that are freely available on her website. Like many aspects of recovery, it requires practice and an incremental shift in daily life.

I have come to envisage compassion as a quality embodied in a strong ideal parent for a small child - unconditionally loving, supportive, firm with clear expectations, having the capacity to fiercly hold and enforce boundaries and consequences when needed.