Stress-related illness is a 21st-century plague for people in the developed world. Health psychologist Anna Friis is at the forefront of prescribing kindness and self-compassion.
The only girl in a family of five children, Friis grew up in Tauranga. She recalls that every nook and cranny of the family home was filled with books. Her father, Cedric, a lawyer, was an avid reader and book collector, and her mother, Gill, was also well read. When she left school, Friis briefly worked in journalism before a successful 20-year career in public relations, specialising in crisis management. Psychology remained a constant thought in the back of her mind and she now combines clinical practice with research.
For her PhD, she ran a series of studies through the University of Auckland’s department of psychological medicine that demonstrated the mental and physical health benefits of teaching people with diabetes how to be kinder to themselves.
Can you explain what this painting means to you?
It’s called Ever So Graciously and I had a visceral response to it. I felt my heart move. Gimblett, who is an ordained Buddhist monk, painted this when he was 80. He has been painting ensōs all his life. They are Zen spiritual paintings, done with just one or two strokes. We went to his studio in New York last year. He does a huge movement. You can see where he started it and it is just “whoosh”, extraordinary. This painting is a metaphor for life, for imperfection, for the human condition, which encompasses everything my research is about. It’s linked to books that mean a lot to me – they inform your life – they are like seeds that get scattered over you and one or two of them plant themselves in your heart. The seed for my work was first planted in me by Scott Peck’s book The Road Less Travelled. He starts, “Life is difficult. This is a great truth, one of the greatest truths. This is a great truth, one of the greatest truths. It is a great truth because once we truly see this truth, we transcend it. Once we truly know that life is difficult – once we truly understand and accept it – then life is no longer difficult. Because once it is accepted, the fact that life is difficult no longer matters.” That was a eureka moment for me. When I look at Gimblett’s painting, with this big whoosh, there is both stillness and energy there and he expresses visually what my work and my life are about.
You’ve worked in journalism, crisis management and psychology. Is there some common thread?
When I was interviewed for journalism school, they asked why I wanted to be a journalist. My answer then was because I am deeply interested in what it means to be a human being. It stayed with me, but when someone suggested I become a psychologist, that seemed way too hard: it required too long at university and being a journalist satisfied my curiosity. But it never went away, and in my early forties, our crisis-management business was bought out by an Australian listed company. That freed me to go back to university and retrain as a psychologist. It was a long road, because I had an arts degree and I needed to get a science background. I had to get a master’s in science, and then become a psychologist. Kristin Neff’s book Self-Compassion helped propel me to get on with it. At the end, I took a deep breath and thought, “Thank God that is over.” Except it wasn’t and I went on to my doctoral studies.
What pushed you to plough on with that?
I did my PhD because I knew that, in order for doctors or the profession to start prescribing compassion and kindness, there had to be very well-designed clinical studies around it. That is starting to happen. Several of our studies have now been replicated – I am a co-applicant with Leicester University for £250,000 to replicate this exact study. A version of it is also being replicated at Stanford University. The fact that these studies have been published in reputable scientific journals and are being highly cited means we now know there are other ways, alongside medication regimes, to help people to take care of themselves. The effects of being kind to oneself are measurable biologically. It is not just a nice idea.
Why did you focus on type 1 diabetes patients for your doctoral research?
Life can be really difficult for people with diabetes – particularly for type 1 patients. Normal metabolism is on automatic and theirs is on manual. So they need to measure, test, adjust and manage their metabolism. There are no holidays from that and it can be really tough. Their doctors and health-care professionals doubtless have good intent, but patients often get the feedback that things are not quite right and they need to do better. For people with both type 1 and type 2 diabetes, as with other chronic illnesses, the opportunities for self-criticism and negative evaluation are constant and, unsurprisingly, therefore they have much higher rates of depression than the general population.
What is going on with their body/mind connection?
When we are stressed, we are in a fight-or-flight state. One of the things that happens is that our bodies get flooded with cortisol. That is associated with an increase in blood sugar, because we need our blood glucose up for the extra energy needed to deal with a threat. My idea was if I could teach people to recognise when they were stressed or suffering, so they could say, “This is difficult for me right now [but] other people in my situation feel this way”, and respond with kindness instead of self-criticism or judgment, it might reduce the negative mental and physical effects of that stress.
How does that directly help with the diabetes?
When we calm and soothe ourselves, change the tone and drop the harsh internal self-critical voice, we reduce the stress and the cortisol and bring down our blood-sugar levels. That is then reflected in the standard HbA1c, the clinical measure of blood glucose control.
What’s the response from health practitioners?
This model was published and we ran a series of studies that have been published in Diabetes Care, one of the world’s leading endocrinology journals. It is actually one of the first well-designed controlled trials of a psychological intervention that has not just psychological effects but also measurable biological effects. As a health psychologist, that is gold, because psychology is about the mind/body connection.
How do you persuade the sceptics?
One of my friend’s kids asked, “What is this mind/body stuff?”, and I said, “Just for a minute, think about a lemon. You are going to walk out to my tree, pick a lemon, a very juicy lemon. You are going to bring that juicy lemon in here and you are cutting it and now all that juice is spurting out of it. Now you are picking up half of that lemon, and you are bringing it slowly up to your mouth and taking a big bite. Notice anything going on in your mouth? It is just a thought but your mouth is watering, isn’t it? If you can have that response to thinking about a lemon, what do you think is happening in your body when you think about how useless you are, when you attack yourself. A self-attack elicits the same response as an external attack.”
What sort of self-compassion did you practise to get through the quite rigorous years of study while also raising three children?
My husband was very supportive, but I am very grateful for the fact that this has never felt like work. Obviously it has occupied my every waking moment and some of my sleep – there is always a notebook beside my bed and this work is the first and last thing on my mind. This feels like my heart’s work, so energising, and imbued with love.
Another lifelong love is books. Tell me about your bookish early life.
Dad would come home on a Thursday, which was late-night-shopping night, with several large bags of books. He would read about four or five books a week. My grandmother, who died at 92, said it was time for her to die because she had read every book in the Tauranga Library. She lived a very simple life but through books she had seen the world, and dined with kings and queens. My aunt, Janet Barnard, owned a bookshop that was a precursor to Unity. I come from a long line of readers. I am a slow reader, and savour books. One of the great joys of the past 10 years has been my book club.
Why is it so important?
There are 10 or 11 of us, we meet once a month and I have the deepest admiration, true love and respect for each of these women. I feel joy in their presence every month, it is the highlight of my month. Throughout my PhD, when I was overwhelmed by the scale of the job, I struggled to get through the books. I did a lot of Google searching prior to book club but I still hung in there.
What are some of the top-rated books in your club?
Room, by Emma Donoghue; Unbroken: A World War II Story of Survival, Resilience, and Redemption, by Laura Hillenbrand; The Immortal Life of Henrietta Lacks, by Rebecca Skloot; Infidel, the autobiography of Ayaan Hirsi Ali; State of Wonder, by Ann Patchett and There but for the, by Ali Smith; The Yellow Birds, by Kevin Powers and The World’s Wife, by Carol Ann Duffy.
What’s a book you’re recommending to everyone?
Into the Magic Shop by James Doty. It is incredible. He writes in lyrical, easily accessible terms, the whole heart/brain pathway. It is a memoir on the power of compassion and kindness and I have given away many copies of it. I know many of the current bunch of medical students at Otago have read it so the seeds of scientific understanding are now being spread wider. A New Zealand anaesthetist, Dr Robin Youngson, has done a lot of amazing work on the power of compassion. He’s the author of Time to Care – How to Love Your Patients and Your Job. He told me that giving people a dose of compassion in the pre-theatre room has the same effect as giving them a sedative. It is so powerful. Oxytocin is the antidote to cortisol. Love overrides stress.
Isn’t the human instinct to do anything to avoid difficulty and dump things in the too-hard basket?
We naturally resist pain and avoid it. But we can’t keep running from those parts of ourselves that aren’t working well or things that cause us pain. What helps us accept and stop and be present? Kindness and compassion help you hold and soothe yourself when life is difficult. Benjamin Franklin said, “Those things that hurt instruct.” That is a universal truth.
This article was first published in the February 17, 2018 issue of the New Zealand Listener.