HALT

hungry, angry, lonely, tired

In my early days of counselor training with my mentor Sebastain I’d often show up for our weekly meeting downturned about my day as a teacher of at-risk boys. 

Racoon eyes, I was at-odds with the school day, which had been full of abusive language, occasional fisticuffs and a swaggering administrator who was quick to claim I was at fault for the disruption in my class. 

Sebastian, fingers steepled, spectacles resting on his nose, would listen to me harangue-on. Like a naive tenderfoot, I’d say more than once, ”I can’t believe these kids. We treat them like gold. And all we get back is abuse.” 

After some minutes, Sebastin would remove his reading glasses, wipe them with a kleenex, then situate them on his brow bridges. ”Let me go over the scenarios we’ve talked about before,” he’d say with deliberation. “As a counselor, which you are about to be, it is important you understand the interconnectedness of the mind and body. Your boys, like all of us, are just trying to survive. As hopeless as it sounds, you have very little control over the state of their minds, and to some extent how their day will fare. You can try, for sure.

“Remember the HALT model?” 

I said, “Hungry, angry, lonely, tired.”

“Right. Your boys, I am guessing, many days show up for school  hungry. Their dinner the night before might have been coca cola and fries which mom got at the drive through. Or they had no dinner at all.

“They could be angry because mom’s new boyfriend slept over, triggering an intense feeling of loneliness. All that makes for a sleepless night. And they show up at 8:15 for school, tired. How else can they be? And, and worse….. they have to spend the day with you.” Chuckle. 

“That last situation, I’m sure tips them over their threshold.” 

In the twenty years since conferencing with Sebastian, I still reflect on those classroom days. Reframing my mindset about those boys helped me understand the dynamics of mental health counseling which I do today.

The HALT model is applicable to all people, not just adolescent boys. David Streem, a medical doctor, is attributed to creating the model. A psychiatrist and addiction specialist, he believed the four triggers were precursors to relapsing with substance abusers. 

Streem used the model to admonish fellow physicians who were susceptible to burnout. To keep from reaching that threshold, Streem believed doctors needed to be cognizant of the model. 

“When you are hungry, or hangry even small problems seem overwhelming,” Sarah Samaan says. She is a doctor and writes about the HALT model in the blog Mindful Physician Coaching. 

Explaining to physicians how anger, a natural emotion, can lead to conflicts with colleagues, but being aware how anger feels in the body is a prerequisite when reporting to work. Samaan said it’s key to be aware how to cool one’s jet when anger sets in. Deep breathing, short walks and talking things out are recipes to bring down the heat. 

Being surrounded all day by people doesn’t preclude one from loneliness. In the medical field the need to be right, in a competitive environment can bring on a feeling of isolation, thus a lonely feeling can surface. Sharing your experiences and having a hobby to go to can offset this feeling, Samaan says. 

Whether one is a student or surgeon, being hungry, angry, or lonely is made worse if one is tired. 

A recent Time magazine piece headline read, Why We Are More Exhausted Than Ever. 

We are now in the era of the Great Exhaustion. The story quotes a computer science writer, claiming workers are “reestablishing their relationship with work, which has been draining.”

Commuting, then having to shop and make dinner is a combination for stress. Likewise, kids and their parents are glued to the internet which causes some researchers to dub stress as digital fatigue. Blue light exposure, poor posture, constant stimulation and little time away from the screen is a recipe for exhaustion.  

There is a difference between being tired versus being fatigued. Tired implies a temporary feeling. Fatigue, according to the Oxford dictionary, is an extreme state of tiredness, thus more lasting.

Perhaps the HALT model should read HALF, making the final piece of the model, fatigue, for the sufferer who feels half alive.

As pointed out decades ago by Sebastian, there is an interconnectedness of the four variables in the HALT model. 

Christine Lee MD, a gastroenterologist, writes in the blog Health Essentials, the reason people can become angry when they are hungry is because physiologically glucose drops when one is hungry.  This drop causes a cascade of hormones, one of which is cortisol, which relates to fight or flight reaction. 

A young person or adult who is chronically hungry develops poor impulse control, when cortisol surges, Lee says. And someone who is angry feels isolated, thus lonely. 

A first step to contending with the triggers of HALT is to check awareness. A teacher can do a check-in with a student. A physician can do a check-in about their psyche. A counselor can ask the appropriate questions of their client before engaging in therapy.

The HALT model is a starting point for each day, whether a student, surgeon or salesman be.