The Value of Familiarity and routine.

At the conclusion of my most recent blog, I referred to a possible increase in patients reported by some GPs, presenting at surgery with depressed or low mood (which, do bear in mind, is only one of several other symptoms needing to be present before anything approaching clinical depression can be accurately diagnosed). Consider if you will, my hypothesis for this annual phenomenon, if such it be. In the first instance, as we move through the season of Advent, many of us – perhaps not unnaturally – seem to become ‘caught up’ in anticipation of the ‘magic’ and heightening atmosphere of Christmas. This tends, for many at any rate, to reach a climax on Christmas Eve and the first moments of Christmas morning, with ‘watch night’ services of worship and amid carolers and revelers, Christmas lights, tinsel, presents, turkeys and mince pies (though not necessarily in that order). Many of us will likely have noticed how on Boxing Day, ‘fairy’ lights seem somehow dimmer, perhaps as the cost of such unconfined goodwill and celebration in its myriad forms, begins to filter through. Indeed, during that period of “no man’s land”, i.e. between Christmas and the New Year, we can so easily loose our sense of routine. We rise later, not infrequently stagger meal times and sit up late to catch the midnight movie on television.

It is only when the demands of work (now into the New Year) picks up the ‘garments’ of daily activity and returns them to their ‘hanger’ of daily routine that, surprise, surprise, we begin to feel better and return to our normal mood and mode of activity. (I am, of course, mindful of the fact that some people whose present circumstances and conditions of living contrast unfavourably with happy childhood memories at such a season, do indeed find such festive times hard to bear. However, although they doubtless form an important minority, this does not adversely affect the point being made). Routine – or as Robert Burns described it, “auld claes and parridge” (“old clothes and porridge”) then is, in reality, a very basic but nonetheless essential element of coping, for from it we acquire the necessary confidence and self-belief to carry us through. Come to think about it, a very considerable number of newly acquired skills are little more than adaptations or extensions of what is already known and tried.

All of us from infancy on, have learned and mastered basic motor skills such as standing, walking, running, jumping etc. Similarly, we achieve positional skills such as balance, poise and coordination. Simultaneously, we acquire (to varying degrees of accomplishment) visual, perceptual and ‘motor’ skills, to do with direction, pace, speed of travel, estimates of angles, distances and much more beside. Rudimentary they may be. However, take any of them away from someone who has say, developed their stamina and fitness to built the highly specialized skills of the ballet dancer, athlete, or professional footballer and performance overall will at a stroke, be significantly impaired.

When I was a small child, I used to visit a local open-air swimming pool throughout the long summer holidays from school. All of my friends, so it seemed, could swim and I wasn’t about to be left behind. An instructor at the pool first showed me how to do the breaststroke with my arms, thereafter suggesting that I hopped across the shallow end practicing these movements. He then would have me hold on to a bar surrounding the pool, at the same time performing the necessary leg strokes. I seemed to spend hours just hopping and holding, learning to do both movements separately to perfection However, I could never quite put them together without sinking like a stone to the floor of the pool.

Now all this took place in the early “forties”, at the time when American service personnel were stationed all around Britain and especially the Fens. We had a huge American bomber base close by and several “Yanks “ (as they were known) together with the local girls, of course, would from time to time, come for a swim – and who knows, whatever else just happened to be going! One of them must have been watching me and at length he approached the side of the pool. “What are you trying to do kid?” he inquired. “Swim”, I promptly and irritatedly replied. “Then why don’t you?” he said. “Look, come with me: come on kid, I shan’t eat you”, he insisted, presumably sensing my initial reluctance to follow him.

We went on to a piece of lawn, next to the pool. “What I want you to do is to crawl over to the other side as quickly as you can: off you go”. My sense of pride had already taken a bit of a hammering and so just to show him, I headed off like a demented earwig across the grass. “You’re great kid” he said encouragingly. “Now let’s get back into the water”, which we did. He placed his hand under my middle, saying “Now just do what you did on the grass, crawl, but just as fast as you can”. This I did as his hand, still supporting me, moved along with me.

As we got to the other side and I caught hold of the bar, he again praised me: “That’s great kid, you see, you can swim, adding reassuringly, “I promise you kid, my hand will be underneath you just until you actually feel yourself swimming: just trust me” and I did. As I crawled (or dog-paddled) my way through the water, I felt his hand at first firmly there but gently lowering as together we reached the other side. “That’s great kid. Now, off you go”, adding “And perhaps you might introduce me to the girl over there” (in fact one of my “big sisters”) “who you seem to be with”. (I think it’s known as, “using a sprat to catch a mackerel”). Nevertheless, ere I left the pool that afternoon, I could not only “dog paddle” but perfectly coordinate the movements and motions learned in earlier days and was able to swim a pool’s width of almost perfect breaststroke.

In fact, I learned several lessons that day, some of which I admit did not register at the time. But let us pause to just briefly analyse what in fact I had done to achieve such a surprising and almost instant success. As does any animal when it enters water, I had not so much found myself able to swim, as run (or more precisely, crawl). In other words, I had employed what I knew, i.e. the safe and the tried and by so doing, had added another skill to my overall repertoire. Alternatively we might say that by transferring and adapting the knowledge and skill that I already possessed, I had successfully extended my coping, greatly enhancing my self-confidence and inner belief.

The stunned disbelief and sense of shock in the early moments of diagnosis referred to in earlier blogs, together with the ensuing anger, guilt, anxiety and depressed mood (which, hopefully, we shall consider more fully in future blogs) can be predicted to disturb even the most orderly and organised of life styles. Moreover, the impact of knowing that one is suffering from a life threatening illness, is not infrequently further compounded by the side effects of treatment of the illness/disease (and which we shall also consider in greater detail anon). Nor would it do any favours to anyone to ‘play down’, deflect or attempt to conceal what patients themselves know to be a stark reality. However, the truth – and good news – is that it can and has by others been successfully handled and managed by people, possibly every bit as fearful and vulnerable as perhaps you or someone dear to you may be feeling at this very moment in time. Therefore do not despair, for we shall, over the course of time, consider and attempt to customize what has been gleaned from sound research and applied clinical practice.

PS. I apologize for the inordinate length of this blog but hope you still find it to be worthwhile. SB

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