Healing & Humanizing Ourselves & Health-care

     "There is only one tactical principle which is not subject to change. It is to use the means at hand to inflict the maximum amount of wound, death, and destruction on the enemy in the minimum amount of time."  General George S. Patton Jr (1885-1945) Liberalism is a Mental Disorder : Savage Solutions‎ (2005) by Michael Savage.
     Not surprisingly (mis)attributed to Patton, a popular poster in the 1970s showed a cave-man-like brute carrying a huge club, with the caption: "Yea, though I walk through the valley of the shadow of death I shall fear no evil, because I'm the meanest son-of-a-bitch in the valley."
    "Blow-em-up" movies (Terminator, Dirty Harry, etc) are predictable box office hits. But isn't it frightening the degree to which even health-care professionals identify with such fear-based primitive instincts? Don't we also "wage war" on diseases like cancer? Don't we choose leaders who can force through our agendas ie are more brutish than wise? And don't we routinely try to fake cold objectivity, toughness, invincibility, and even infallibility?
     "Kindness, humanity, and respect — the core values of medical professionalism — are too often being overlooked in the time pressured culture of modern health care." Chochinov HM. BMJ 2007; 335: 184-7. And the problem is not just "time poverty". How many of us, out of fear, routinely deal with "the real world" armored in aggression & cynicism?
     Many of us have become so identified with "doing science", as to almost exclude any ease or joy of simply "being" healthy ordinary humans. If so, don't we need to become more balanced human beings to enjoy life and become more effective healers?
     The 1st International Congress on Whole Person Care  will be held at McGill University, in beautiful & vibrant Montreal, Quebec, Canada - October 17-20, 2013. "Take the time to reconnect with what healthcare is for you and what it could be…." Themes will be healing, self-care and professionalism - see: www.wpc2013.ca

"Clast-o-Lantern" photomicrograph by John R. Kalmar, DMD, PhD

Healing - so much more than Scientific Knowledge

     How does a parent's kiss make a child's injury all better? The secret seems to be in the reassurance that though injuries happen, it's OK my child, you're not alone in some cruel random universe, but are in fact loved and held in a love that transcends this bump in the journey. Healing is one vulnerable human holding another - two open hearts in synch with a greater rhythm.
     Without an open heart, there is no healer present, and no healing occurs. Opening one's heart requires acknowledgment of one's own vulnerability - and - discovering the underlying power and wisdom that music, dance and other fine arts whisper.

     See also: http://www.johnlovas.com/2012/10/dropping-armor-coming-out-as-authentic.html
     and  http://healthyhealers.blogspot.ca/search?q=depth+of+our+feelings

Montreal, Province de Quebec

Executive Function, Dual Awareness, Psychological Distance, Observer Self, Wisdom ... ...

     "'Psychological distance' is a hardly a new concept. 'We are not our thoughts or the object of our thoughts, we are the Thinker' is the sum of the teaching. Viktor Frankl described it best, IMHO, when he said, 'The human brain is a stimulus response organ. Between stimulus and response there is a space. In that space lies our ability to choose. In our choice lies our freedom.' Richard Lazarus described it in his Appraisal Theory, 'What does this mean to me now?'
We have the capacity to make different choices, but not necessarily the ability. We are not taught this fundamental life skill so we develop the habit of believing we are what we think, that our chosen model of the universe is the correct one." Douglas McKee
http://wisdomresearch.org/blogs/publications/archive/2012/02/01/boosting-wisdom-distance-from-the-self-enhances-wise-reasoning-attitudes-and-behavior.aspx

Fall in Nova Scotia

Goal Orientation & Anxiety - or - Process Orientation & Joy

     “If a focus on the outcome and the extrinsic aspects of an activity are conducive to anxiety and depression, then the objective quality of my work, whether washing dishes or writing grant proposals, will likely be lowered, given what we know about the adverse effects of negative emotion on performance. So seeking the extrinsic outcome makes the failure to achieve that outcome more likely. A focus on the process and intrinsic qualities of an activity reduces the likelihood of anxiety and depression (thus eliminating their negative impact on performance), increases the pleasure of joy during the process, and thus increases the likelihood of achieving the extrinsic outcome. I have to let go of the desired outcome in order to acquire it. What a paradoxical and strange way to live.”

     Borkovec TD. Life in the future versus life in the present. Clinical Psychology: Science and Practice 2002; 9(1): 76–80.

     “perhaps a sane way to live that may not be so strange once one begins to inhabit that landscape in a more regular way. Perhaps it is only strange in a society that persists in devaluating the present moment in favor of perpetual distraction, self-absorption, and addiction to a feeling of ‘progress.’”

       Kabat-Zinn J. Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice 2003; 10(2): 144-156.

Ordinary Beauty is Everywhere

     “Eternity is not something that happens after you are dead. It's going on all the time. We're in it now.”                   Charlotte Perkins Gilman

Gaspereau Valley, Nova Scotia

Critical Spirituality - towards a Deeper Therapeutic Alliance

     "Critical spirituality is a way of naming a desire to work with what is meaningful in the context of enabling a socially just, diverse and inclusive society. Critical spirituality means seeing people holistically, seeking to understand where they are coming from and what matters to them at a fundamental level; the level that is part of the everyday but also transcends it. What is important in critical spirituality is to combine a postmodern valuing of individual experience of spirituality with all its diversity with a critical perspective that asserts the importance of living harmoniously and respectfully at an individual, family and community level. 
     Human service professionals currently wrestle with the gradually increasing expectation to work with spirituality often without feeling capable of undertaking such practice. Some work with people experiencing major trauma or change such as palliative care or rehabilitation where people ask meaning of life questions to which they feel ill equipped to respond. Others work with individuals, families and communities experiencing conflict about spiritual issues. Increased migration and movement of refugees increases contact with people for whom spirituality is central. Such experiences raise a number of issues for existing professionals as well as students: What do we mean by spiritual? How does this relate to religion? How do we work with the spiritual in ways that recognise and value difference, without accepting abusive relationships? And what are the limits to spiritual tolerance, if any?"

       Gardner F. Critical Spirituality. A Holistic Approach to Contemporary Practice. Ashgate Publishing Co. Burlington VT, 2011. 

Photo: Larry Bauer   www.dpreview.com

Doing and Being - How noisy is my ego?

Doing:
     If you see someone you dislike drop a load of groceries, if you help at all it might take a while to convince yourself to do so, and you may be regretting it while doing it – lots of negative self-talk. Similarly, if you’re unskilled at performing an activity, you may feel some resistance performing it, with a lot of negative self-talk – “internal friction”. When children take part in a race in front of their parents or other adults, they sometimes try to show how much effort they’re putting into running by exaggerating bodily movements and facial expressions. Don’t we still at times put on a show of great effort for others and even ourselves, magnifying internal friction? Carrying out tasks with this attitude - when the ego (“me, myself & I”) dominates the picture - "feels like work" - unnatural, wrong, like hard labor that seems to take forever.
 
Non-doing:
      You see a loved one drop a load of groceries, immediately you help them pick up, and the whole matter is over and forgotten – effortless, timeless, completely natural and right. Similarly, if you’re highly trained and skilled to perform an activity, doing it will likely feel – effortless, timeless, completely natural and right – remember Flo-Jo running at top speed with effortless grace, face completely relaxed? In an emergency, a mother has been known to lift a car off her child. Following truly heroic acts, the “hero” is typically quite unaware that s/he’s done anything special. The sense of “me, myself & I” is minimal. The doer, and time, seem to ‘disappear’ while the action is fully embraced. This level of “non-doing” is within all of us, awaiting cultivation – our brains remain neuroplastic for life – we truly are life-long learners!

     Mindfulness training helps one to reside, with increasing stability, in non-doing ie living hypoegoically. We can intentionally sculpt our brain to rewire from egoic reactivity (brain-stem-dominance) towards progressively more appropriate harmonious civilized behavior (pre-frontal-cortex-dominance).

     “Do not confuse motion and progress.  
     A rocking horse keeps moving but does not make any progress.”                 Alfred A. Montapert

From the web

Better Choices = Better Health

     "The power of man has grown in every sphere, except over himself." Winston Churchill

     “... the choices we make and the habits (automatic patterns) we develop in life will largely determine our health, well-being and how long and how well we live. …

     … it’s not the occasional conscious indiscretion that undermines our health so much as the continual, erosive effect of our automatic, habitual patterns. … Ignorance is not bliss – it leads to negative health and serious problems. Walter M. “Personal Resilience. The New Field of Lifestyle Medicine.” RTI Ottawa 1994.

     Mindfulness is a state of being “that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment.” (Kabat-Zinn 2003) Mindfulness training “increases awareness of thoughts, emotions, and maladaptive ways of responding to stress, thereby helping participants learn to cope with stress in healthier, more effective ways.” (Bishop et al 2004) 

“This is in contrast to a common mode of attention, which is argued to be generally ‘non-mindful,’ involving a sense of being on ‘automatic pilot’ or reacting habitually and automatically to life situations.

A growing body of literature, including several meta-analytic investigations, supports the efficacy of mindfulness interventions for reducing anxiety, depression, and distress, along with enhancing well-being and psychological health.” Del Re AC, Flückiger C, Goldberg SB, Hoyt WT. Monitoring mindfulness practice quality: An important consideration in mindfulness practice, Psychotherapy Research 2012 DOI:10.1080/10503307.2012.729275

     You may wish to try one of the mindfulness meditation exercises supplied by the Department of Family Medicine, School of Medicine & Public Health, University of Wisconsin: http://www.fammed.wisc.edu/our-department/media/mindfulness

Photo: Vittorio Fracassi   www.dpreview.com

Wellness through Wisdom

     Recently, Grossmann and colleagues "found that wise reasoning is associated with greater life satisfaction, less negative affect, better social relationships, less depressive rumination, more positive versus negative words used in speech, and greater longevity. The relationship between wise reasoning and well-being held even when controlling for socioeconomic factors, verbal abilities, and several personality traits. ... there was no association between intelligence and well-being. Further, wise reasoning mediated age-related differences in well-being, particularly among middle-aged and older adults."
     They "measured six broad strategies of wise reasoning (related to) social dilemmas ... : 
(a) considering the perspectives of people involved in the conflict, 
(b) recognizing the likelihood of change,
(c) recognizing multiple ways in which the conflict might unfold,
(d) recognizing uncertainty and the limits of knowledge,
(e) recognizing the importance of or searching for a compromise between opposing viewpoints,
(f) recognizing the importance of or predicting conflict resolution."

       Grossmann I, Na J, Varnum MEW, Kitayama S, Nisbett RE. (2012, August 6). A Route to Well-Being: Intelligence Versus Wise Reasoning. Journal of Experimental Psychology: General. Advance online publication. doi: 10.1037/a0029560

Credit: slideshare   http://www.slideshare.net/myprof/unusual-pics08-20120phyl1

Smarts AND Wisdom?

     Bernie Madoff is a smart guy - you have to be to con so many people out of their life savings. Hitler was a gifted orator - he conned the citizens of one of the most civilized, sophisticated countries in the world to behave like barbarians. A certain kind of intelligence goes into creating counterfeit drugs, land mines, biological weapons, etc. A health-care administrator can be a brilliant accountant and at the same time wreak havoc in a hospital. A health-care professional can be brilliant, and at the same time be clueless about therapeutic alliances. How many times have we seen smart people behaving unwisely?
     We clearly possess different types of intelligences, and we each have varying levels of each type. However, above and beyond these more or less IQ-related capacities, there's wisdom. Philosophy, psychology and other disciplines are formally studying wisdom with renewed interest.
     We're slowly starting to realize that explicit training in, AND embodiment of wisdom is essential if our complex, rapidly changing, multi-racial, multi-cultural world is to survive, and perhaps flourish.
     Selection criteria for all responsible positions must start prioritizing wisdom.

       Sternberg RJ. Assessing students for medical school admissions: is it time for a new approach? Acad Med 2008; 83(10 Suppl): S105-10.

Photo: Rami Alkhoury   www.dpreview.com

Wisdom - current concept encapsulated

     "Wisdom involves certain forms of pragmatic reasoning and behavior that help people navigate important life challenges. Although a variety of factors give rise to this quality, an emerging consensus suggests that three important dimensions of wisdom involve recognizing that the world is in flux and the future is likely to change, recognizing that there are limits associated with one’s own knowledge, and possessing a prosocial orientation that promotes the 'common good.'
     A common feature of these different dimensions of wisdom is that they require people to transcend their egocentric viewpoints to take the 'big picture' into account and reason holistically."
       Kross E, Grossmann I. Boosting wisdom: Distance from the self enhances wise reasoning, attitudes, and behavior. Journal of Experimental Psychology: General 2012; 141(1): 43-48.

 

Molly

  

Test results, Prognosis, Worldviews & Nocibo effects

     A good friend and colleague, George Kaugars, was given 3 months to live. He had metastatic colon cancer. An attempt to de-bulk the primary was abandoned when they saw directly the extent of the tumor. Chemo was discontinued because it was ineffective and made him feel continuously sick. George had a wife and two very young children whom he loved dearly. George lived for 6 more years - working full time until a month before he passed away.
     How we present "hard data" to patients says a lot about our worldview AND usually has a powerful impact on their prognosis. I'm quite convinced that showing the image of a large malignant tumor to a patient is the present-day equivalent of a witch doctor sticking pins into a voodoo doll. Both are clear messages that the patient is expected to die quickly. Fortunately, George had a much broader, deeper worldview.
     Most people, including health-care professionals, give test results an unreasonable importance. An image is but one piece of data. If indeed the patient has a malignant neoplasm, it took the confluence of a myriad of causes and conditions to cause it. Prognosticating from any one piece of data should - without the nocibo effect - be extremely inaccurate.
     In the future, we'll know how to effectively address many of the inputs, and thus have much more effective treatments. In the meantime, we should be much more scientific and open-minded. Even if we're not particularly good at communicating "bad news" to patients, we should consciously guard against inadvertently dispensing nocibo effects - "at least do no harm"!

Halloween - nervous laughter

Risk-averse? - Time for a new Approach?

     Do we prioritize avoiding risks of all sorts, instead of approaching whatever is at hand with curiosity and confidence in doing our best? In other words, do we tend to be more "risk-averse" rather than "novelty seekers"? Health-care did attract us, at least partially, with guaranteed job security and income. Didn't we also, to some degree, engage in a bit of magical thinking - that if we got to wear the lab coat, we'd somehow avoid having to wear the johnny shirt - or perhaps even the tag on the big toe?

     “we compound our suffering by trying to avoid (what we fear). …
      Mindfulness is a technology for gradually turning … attention toward the fear as it is happening, exploring it in detail with increasing degrees of friendly acceptance.”
      Germer CK, Siegel RD, Fulton PR eds. “Mindfulness and Psychotherapy.” The Guilford Press, NY, 2005.

     Avoidant tendencies, not surprisingly, also adversely affect how we treat patients. One example involves telling patients bad news:

     “... it is not uncommon for clinicians to delay, avoid, or delegate this vital area of clinical practice.”

        Meyer EC et al. Difficult conversations: improving communication skills and relational abilities in health care. Pediatr Crit Care Med 2009; 10(3): 352-9.

NOTE: I'm obviously not suggesting the other extreme of taking intentional risks with patients for the sake of novelty.

Credit: slideshare   http://www.slideshare.net/myprof/unusual-pics08-20120phyl1

Wonderful life

     The basic fact that I'm alive is a huge privilege. Having episodes of good health on top of that is a massive bonus. JFK said: “To those whom much is given, much is expected." He could have added: health and life are ephemeral - make wonderful use of them!

     "Living in the shadow of cancer makes every day action an affirmation of life. I see the importance of accepting death in a non-fearful way and the importance of finding joy in life. For the present I continue to live in a complex world with an uncertain future, the same as everyone else."                        Robert Pope (1956-1992)

Robert Pope Retrospective @ Art Gallery of Nova Scotia Sept 8, 2012 to Jan 13, 2013.

http://robertpopefoundation.com/about-robert-pope/his-perspectives/

Clock by Robert Pope