Estimated reading time: 8 minutes
I am a busy person. I always have been. I don’t like to waste time. It seems such a precious commodity. My mum still shows people a photo of my bedroom when I was in my final year of school. I had assignments and exams due, was the lead in the school musical, competing in 18 events in the Eisteddfod, there were costumes, scripts, and schoolwork strewn around my bedroom. I don’t believe in wasting a second. My car is really an office. When I am driving, I phone people, have appointments and meetings, ring my parents, listen to podcasts, and ask Siri to type reminder notes to myself. When I walk for exercise, I listen to audiobooks, TED talks, madly typing notes to keep for future reference and to build knowledge. Yet, lately, for reasons I cannot explain I am not operating at normal capacity. I am procrastinating more and losing my train of thought. I am feeling somewhat ‘blah’. I have recently invested in a business coach/clinical supervisor and mentioned it to her. Her assessment “you are overstimulating your brain”. WHAT?! Isn’t that an oxymoron? Our beautiful brains love information. I had smiled wryly at her, knowingly. “You don’t know my brain”, I said, “it loves attention”.
She remained resolved “you need some silence, some quiet time to process, daydream, relax”.
“I do that”, I defended, “sometimes when I walk l also listen to novels and occasionally music”.
“No, you need silence” she said. “Just silence, no information going in apart from your surroundings”.
“It won’t work for me”, I protested.
“Try it”, she insisted.
My first walk with nothing was just frustrating, so boring. I tried for 15 minutes, thought of all the things I needed to learn or understand and put on a novel. “Ah” I said to myself, “this is relaxing, see my brain is relaxed”.
The next day I tried for another 15 minutes. It wasn’t quite as boring, but I watched the time and at 15 minutes was so relieved to put my headphones on and listen. By day four though I started noticing things in my 15 minutes of silence. Not just the sounds around me but the wind and colour. By day eight, I had stretched it out to 40 minutes. Three and a half weeks later I am hooked. I am enjoying just walking with nothing being boomed into my ears, no talking, no music, no requirement to concentrate and focus. All of a sudden, I am writing again, reading more and sleeping better. I feel more energetic, creative, and aware. I am starting to look forward to silence, craving silence. Me, the huge extrovert. I am turning off everything in the car (at least one way) and just sitting with my thoughts. It is not mindfulness per se. I am not trying to quiet my mind; I am just not filling the space 24/7 with noise and information. I am singing and whistling more. Daydreaming and pondering my place in the world. Writing things in my head. I am noticing things and people.
So, what is the science of silence, and does it have any relevance to the fatigue and frustrations experienced in healthcare in these current times?
Is there Risk in Constant Noise and Stimulation?
‘Of all the varieties of modern pollution, noise is the most insidious’.Robert Lacey
Since the beginning of civilisation various practices, cultures and religions have advocated the importance of ‘silence’. Yet, finding hard evidence for why silence may be valuable is not that easy. While there is a lot of ‘noise’ (pun intended) about “silence creating a space to cultivate peace of mind and body” the why and how is a little harder to substantiate. Perhaps there is a paradox to putting language and structure to silence?
So, what is ‘silence’? For this blog ‘silence’ is being used as a noun to define a ‘state or quality of being’, where an individual or individuals choose to be silent or have a period of time without sound/noise 1. Far from just being a void, silence throughout the ages has been used as a conscious activity to transform and as a form of healing, renewal, prayer, and meditation2.
Society and more specifically healthcare professionals are constantly bombarded with noise. Hospital departments and wards by their very nature are noisy. Electronic monitors, groups of people and constant activity all contribute to a consistent background noise that we may not even be aware we are absorbing. Medicine by its nature has a culture of intellectualizing problems and solutions. It is becoming increasingly apparent that healthcare professionals are going to have to innovate or revolutionise our way out of the myriad of constant challenges in which we find ourselves, so the temptation to keep seeking a ‘truth’ or a source of knowledge to help us may be as overwhelming as the problem itself. Studies report that most adults spend between 3-6 hours a day recreationally on their phone and 3-6 hours at work using their phone. Look around your staff room at the next break and observe the use of phones. When I walk or am at the gym most people have devices in their ears. All this stimulation and information, whether it is auditory or not, is noise to our brains. It is a cultural norm now to be constantly preoccupied, and immersed in noise, information, and diversion. Is there a cost for this constant noise?
Overstimulation or hyperarousal of the brain due to constant information, noise and demands can leave people feeling burnt-out, and anxious and with increased feelings of anxiety, failure, and humiliation, in addition to difficulties with creating boundaries with others3. Continuous noise can affect our mental health, create panic, increase frustration and over time the mind can lose the capacity to concentrate on things 4 Our brains are simply not wired to listen continuously. Cognitively we are listening at a rate disproportionate to our cognitive capacity to process and pay attention.
But how much noise is too much? Humans constantly overestimate their ability to accommodate additional stimulation and their capacity to multitask. It is an illusion that we are absorbing the world around us, in reality ‘we sense a very small part of the world at any point, we are sipping the outside world as though through a straw’5 Our consciousness has a very limited bandwidth (even true of ED doctors) and can only retain on average 4 to 5 objects at any given time, with a variation of 2-7 objects. Our working memory has a limited number of discrete slots, once the slots are filled only new information is available5. People with a curious mind can easily fall prey to a constant flow of never-ending data contributing to an information saturation problem decreasing a person’s cognitive abilities and executive function and impacting their mental health 6. With a dscout™ study claiming that the average person touches their phone 2617 times a day it easy to see why we are all becoming addicted to information, distraction, and noise.
What can we do about it?
“Silence, like a poultice comes to heal the blows of sound”Oliver Wendell Holmes
The solution may be as simple as having time away from your phone, going outdoors and creating silence. Nature sounds and green environments move our brains from internal focus (worry and rumination) to external focus, decreasing the body’s sympathetic response to stress and increasing our parasympathetic system, moving us from fight/flight/freeze to ‘rest and digest’. Not everyone has the luxury of walking beside the seaside or amongst vast green pastures every day, however, do not despair. There is evidence that listening to the sounds of birds, rainforests and nature on a recorded soundtrack can relieve stress, alleviate pain, and improve cognitive function and mood when Mother Nature cannot provide the soundtrack herself 7,8. Listening to nature, even prerecorded nature sounds for five minutes a day has been found to relieve stress, increase productivity, and improve quality of sleep 8.
What does this mean for healthcare professionals? The research is not asking us to abandon information. Rather it is asking us to discern more carefully what we clutter our mind with and how much. If you have a busy 12 hour shift ahead maybe that is the day you drive or sit in silence, put the window of the car down and listen to the sounds of the outside world if you live rurally or play some lovely nature soundtracks. Recognise when your bandwidth is challenged – fatigue, sleep deprivation and overload and choose to sit in the quiet rather than ‘lose’ yourself in the videos, memes and sounds of all that your phone has to offer. During your meal break focus on what you are eating and interact with the people around you or better still sit somewhere in peace and quiet and breathe deeply. Give your brain an opportunity to feel calm, process what is happening, and a chance to daydream, hope and be creative. You may be amazed at what a gift this is and how energizing it can be.
- 1.Silence – meaning. Cambridge Dictionary Online. Accessed November 10, 2023. https://dictionary.cambridge.org/
- 2.McEntire SD. Silence: A Depth Psychological Exploration. Pacifica Graduate Institute; 2005.
- 3.Aron E. The Highly Sensitive Person: How to Thrive When the World Overwhelms You. Citadel Press; 2020.
- 4.Muralikrishna I. Noise Pollution and Its Control in Krishna. Elsevier Science & Technology; 2017.
- 5.Miller EK, Buschman TJ. Working Memory Capacity: Limits on the Bandwidth of Cognition. Daedalus. Published online January 2015:112-122. doi:10.1162/daed_a_00320
- 6.Mullainathan S, Shafir E. Scarcity: Why Having Too Little Means so Much. Times Books/Henry HOlt and Co; 2013.
- 7.Buxton RT, Pearson AL, Allou C, Fristrup K, Wittemyer G. A synthesis of health benefits of natural sounds and their distribution in national parks. Proc Natl Acad Sci USA. Published online March 22, 2021. doi:10.1073/pnas.2013097118
- 8.Gould van Praag CD, Garfinkel SN, Sparasci O, et al. Mind-wandering and alterations to default mode network connectivity when listening to naturalistic versus artificial sounds. Sci Rep. Published online March 27, 2017. doi:10.1038/srep45273
- Miller, Earl K., and Timothy J. Buschman. “Working Memory Capacity: Limits on the Bandwidth of Cognition.” Daedalus 144, no. 1 (January 2015): 112–122. © 2015 American Academy of Arts & Sciences
- Don’t Underestimate the Power of Silence. Harvard Business Review. https://hbr.org/2021/07/dont-underestimate-the-power-of-silence
- An Ode to Silence: Why You Need It in Your Life. Cleveland medical clinics. https://health.clevelandclinic.org/why-you-need-more-silence-in-your-life/
- Scott Weingart, MD FCCM. EMCrit 182 – Kettlebells for the Brain – Meditation. EMCrit Blog. Published on September 19, 2016. Accessed on November 13th 2023. Available at [https://emcrit.org/emcrit/kettlebells-brain/ ].
- Scott Weingart, MD FCCM. EMCrit 320 – MotR – Tension & Relaxation | Flow & Burnout. EMCrit Blog. Published on March 28, 2022. Accessed on November 13th 2023. Available at [https://emcrit.org/emcrit/tension-relaxation/ ].