The Role of Patience in Psychiatry

Patience should always be used in the service of healing and helping.

Is patience an undervalued attribute? Not long ago, Neel Burton, MD, posed the same question and answered with a resounding yes.1 If we have not learned anything else from the experience of COVID-19, it is that as a society we have been forced by default to become more patient. And yet, no one ever exercises bragging rights about their ability to wait for things. They may boast about a job promotion or other new venture, but most likely not about how they just finished waiting 2 hours on the telephone.

Consider this scenario: While recently waiting in line for breakfast, I was standing behind a couple with a complicated order and then a third gentleman. This gentleman waited more calmly than I believe I ever would have and for what seemed like an eternity. When his turn to order arrived, he merely requested a small black coffee. That was it! You can imagine my incredulity as I complimented him on his patience. Then, I inquired as to whether he had briefly considered intercepting the line for such a simple request. He laughed off that idea, denied any intent to ever cut in, and explained that all he required in the morning was a black coffee.

Standing in line, of course, is one of the time-honored traditions of patience in a perfectly cooperative world. But in all fairness, it is a task that predates the pandemic and certainly involves self-discipline. Dr Burton points out that being patient is supremely challenging given our internal wiring to keep moving.1 The requirement to pause, however, whether on a takeout line, on a conference call, or in the car on a heavily traveled route, is obviously essential to survival—especially amid today’s pandemic-related adjustments.

During a typical day of remote working, hours can be frittered away holding on the telephone when websites, phone apps, and voice menu prompts fail me: tech questions up to 30 minutes, financial assistance up to 30 minutes, and merchandise adjustments up to 60 minutes as an estimate. Medication pre-authorizations and direct access to pharmacies, as my admin staff might readily attest, can also be time-consuming.

Historical Perspective

Historically speaking, patience was regarded as a quality of moral excellence during the 3rd century in the teachings of the Latin textbook, The Distichs of Cato.2 Patience was later discussed by Geoffrey Chaucer in The Canterbury Tales, which he wrote around 1386. There, in the Franklin’s Tale, and in the context of not emotionally smothering your romantic partner, the Franklin explains that “patience is a conquering virtue. The learned say that, if it not desert you, it vanquishes what force can never reach…”3

Fast-forwarding to the present, a behavioral take might be to consider patience as a building block in adaptive executive functioning. Underlying much of volitional behavior—listening, responding, planning, problem-solving, and organizing, to mention a few—is the ever-present ability to pause and wait for things to take their course. The New York Times published an article in February 2022 entitled “In Miami, Climbing Ballet’s Everest: ‘Swan Lake.’” The piece illustrates the importance of patience as it describes how Lourdes Lopez, Miami ballet’s artistic director, waited for 6 years to have her company perform “Swan Lake,” delayed in part because of COVID-19. Artistic vision, steadfast focus, and help from others all reportedly empowered Ms Lourdes to produce the ballet notwithstanding the many challenges.4

Despite the simplicity of patience as a concept, there remains something elusive, especially in a culture driven by speed and measurement of results. This may sound farfetched, but one day during a cosmic moment, I reflected on the relationship between physiology and patience. Every heartbeat, I noted, has the necessity of pause, graphically represented on the EKG tracing by the ST segment then T-wave, during which time the ventricle repolarizes t0 prepare for its next contraction. Likewise, the action potential follows a cyclical pattern of depolarization/repolarization with a resting voltage in between as it travels down the neural circuit.

Mindful Practice

Clinically, how do we as physicians and psychiatrists encourage patience? The first step is to gauge our own patience levels—the stressors in our lives as well as the alleviators. What kind of day are we having? How are we feeling internally? Ideally, we must treat ourselves with compassion, recognize the many variables beyond our control (especially with COVID-19 still lingering), and value the amount of patience that goes into a solid doctor-patient relationship. Then we must acknowledge that antianxiety medications can only go so far in improving patience levels, as psychotropic agents specifically promoting increased levels of patience have yet to emerge.

As for the teaching of patience, popular demand is surging, as reflected in over 2500 mindfulness apps listed on the internet. A survey of subscribers to Calm, a popular meditation app, showed that 56% reported a chronic health diagnosis, 41% a mental health diagnosis, and 76% reported some form of insomnia. Meditations and sleep stories were rated as particularly helpful with linear correlations between frequency of use and self-reported improvements in mental health and sleep.5 

In practice, when individuals are struggling with anxiety, I sometimes recommend the mindfulness exercise of sitting and being present for up to 5 minutes several times per day. Patients will then begin to observe how they feel when tense versus calm, and perhaps be more able to realistically manage time and task self-expectations. Additionally, the therapeutic alliance can be strengthened by this mindfulness exercise. Over time, when the routine is consistently practiced, clinical feedback suggests a greater sense of balance.

Concluding Thoughts

Returning to my initial question, patience can be thought of as an unspoken ally in daily life as well as in clinical practice. It is perhaps under-recognized and definitely deserving of credit.

Dr Sofair practices psychiatry in Northern New Jersey. Dr Sofair holds affiliations with Atlantic Health System and CarePoint Health.

Acknowledgements: The author would like to thank Jon W. Green Esq and the library staff of Morristown Medical Center for support.

References

1. Burton N. The lost virtue of patience. Psychology Today. August 31, 2019. Accessed May 19, 2022. https://www.psychologytoday.com/us/blog/hide-and-seek/201908/the-lost-virtue-patience

2. Banzhaf R. Who said “patience is a virtue”? YourDictionary. Accessed May 19, 2022. https://examples.yourdictionary.com/articles/who-said-patience-is-a-virtue.html

3. Chaucer G. The Canterbury Tales. Penguin Books; 1951:408-433.

4. Harss M. In Miami, climbing ballet’s Everest: ‘Swan Lake.’ The New York Times. February 6, 2022. Accessed May 19, 2022. https://www.nytimes.com/2022/02/03/arts/dance/alexei-ratmanksy-swan-lake-miami-city-ballet.html

5. Huberty J, Vranceanu AM, Carney C, et al. Characteristics and usage patterns among 12,151 paid subscribers of the Calm meditation app: cross-sectional survey. JMIR Mhealth Uhealth. 2019;7(11):e15648.