Spirituality in Health Care - Relationship & Connectedness

     Spirituality can be conceptualized in terms of "relationships with Self, Others, Nature, and Higher Being. Love, harmony, and integrative wholeness are cornerstones of these relationships. Communication and commitment are avenues to spirituality.

     Relationship with Self involves personhood and inner dimension, which include awareness of inner self or other dimensions ... the ability to draw on inner strength and resources ... ambition for better self-understanding and inner balance ... includes awareness of the tragic and self-redefinition, and release from self-defined limitations. ... authenticity and openness are cornerstones of this relationship.

     Relationship with Others involves a sense of community, compassion, altruism, and giving the gift of self. ... manifested in sharing with and helping others. 

     Relationship with Nature involves the interaction between person and environment. ... spirituality as awareness of human-environmental integrality.

     Relationship with Higher Being includes relationship with Universe, God, Higher Power, and/or Ultimate values.

     Spirituality can involve a well-defined worldview or belief system that provides a sense of meaning and purpose to existence in general, and that offers an ethical path to personal fulfillment. Instead of focusing on a belief structure, others defined spirituality as the way in which people live their lives in view of their ultimate meaning value. ... spirituality has to do with the search for one’s ultimate significance."

     Chiu L et al. An Integrative Review of the Concept of Spirituality in the Health Sciences. Western Journal of Nursing Research 2004; 26(4): 405-428.

Photo: Georg Eberle   www.dpreview.com

Spirituality in Health Care - Meaning & Purpose in Life

     "Spirituality can be defined as one’s views and behaviors in the search for meaning in life. ... a bridge between hopelessness and meaningfulness in life ... a person’s need to find the answers to ultimate questions about the meaning of life, illness, and death. ... in palliative care, spirituality is meaning making, making the most of life now, and making sense (meaning) of life. ... creating meaning ... Instead of a quest for a Higher Being, spirituality in was focused on meaning in day-to-day lives. ... changes occurred in the sense of purpose in life: a reason for injury/accident, God’s plan for them, and disability as a test. ... the discovery of meaning and purpose are essential components of spirituality."


     Chiu L et al. An Integrative Review of the Concept of Spirituality in the Health Sciences. Western Journal of Nursing Research 2004; 26(4): 405-428.

See also: http://www.johnlovas.com/2013/02/fantasy-existential-attitude-and-then.html

Spirituality in Health Care - the Experiential / Existential Domain

     "Spirituality is a universal human phenomenon, yet confusion and incomprehension of the concept is ever-present. ... Health research on spirituality in the past decade was reviewed quantitatively and qualitatively, as well as cross-culturally and historically.

     A thematic analysis of current definitions of spirituality revealed the following themes: existential reality, transcendence, connectedness, and power / force / energy.

      In the experiential / existential domain ... spirituality is an individual, subjective, intrinsic, conscious experience, a way of being ... manifested through becoming, (and) grows in scope and power. Spirituality is a personal journey to discover meaning and purpose in life. In this journey, a person learns to face fears, to deal with the unknown, to face mortality; and at the same time, to love, forgive, and to comfort others. Additional facets include a person’s will to live and to realize the law of kama (originated from an Indian belief that every action has a corresponding reaction, and that every effect has a preceding cause), to live life with fulfillment and with satisfaction. This growth process is evolving and integrative."

 

     Chiu L et al. An Integrative Review of the Concept of Spirituality in the Health Sciences. Western Journal of Nursing Research 2004; 26(4): 405-428.

 

 

Deep Insight, Achieving Goals, Normal Human Evolution

     I wonder how a child, who cares and feels deeply about the people and world she encounters in daily life, can essentially ignore them all, in order to focus most of her energies towards achieving a specific distant goal eg becoming a dentist or physician?
     Many of us squeezed our considerable spiritual sensitivity into a tight professional box. Certainly during one's youth, one has to choose EITHER remaining deeply in communion with life in general, OR becoming a skilled health-care professional.
     But by age 50 or 60, one's authenticity often can no longer be subdued, and one's profession can come to feel claustrophobic. To the extent that we allow ourselves to open our mind-heart, we realize that we must begin living undivided lives**, where our core spirituality**** and our daily lives become progressively more congruent.
     This is healthy normal human development or evolution of consciousness. This is essential to promote, and extremely pathologic to suppress or ignore.

     ** http://healthyhealers.blogspot.ca/search?q=undivided

     **** "matters of truth, reality, and ultimate importance. … personal, affective, visceral, and passional dimensions of being and knowing"
        Parks SD. Big questions, worthy dreams. Mentoring young adults in their search for meaning, purpose, and faith. John Wiley & Sons, San Francisco, 2000.

Young Violinist at the Halifax Seaport Market, February 23, 2013

Collaborative Team Players & Psychosocial Developmental Stage

     Having good team players, and a family-like atmosphere in the workplace, are popular ideals floated by employers these days. Some employees already fit this mold, some aspire to do so, while some are (overtly or covertly) antagonistic.
     It's easy to dismiss those who don't collaborate for the common good as selfish, immoral and antisocial. However, these very same people may be quite ethical and generous in other ways, in other environments. In other words, many of us live divided lives - quite appropriate at times, highly inappropriate at other times.
     What's the difference between team vs solo efforts? 1) willingness or capacity to freely & productively communicate vs no need for communication; 2) sharing recognition more or less equally vs having all of the recognition for oneself. People at the relatively early, egocentric level of psychosocial development are solo players, not intentionally, but because that's simply where they are developmentally. Many of us in health-care fit this category. A fragile ego is a powerful, albeit unhealthy, motivator - ask any workaholic overachiever.
     Any organization or profession that claims to value good team players and a family-like atmosphere needs to create the cultural climate that actively promotes normal psychosocial development.

     See also: http://healthyhealers.blogspot.ca/2012/09/empathy-civilization-healing-connections.html
      and: http://mindfulnessforeveryone.blogspot.ca/2013/02/284-societal-expectations-authenticity.html

Photo: alcetelu   www.dpreview.com

Living, Freezing, and Escaping Life

     We use different ways to prevent ourselves from succumbing to the adverse impact of real life events.
     Perhaps the most common is by keeping life more or less "unexamined", despite the fact that according to Socrates, it's then "not worth living." Avoidance of depth and meaning may be active, driven by the fear that there is no greater depth or meaning available than what one has already experienced. The search for depth and meaning can simply be neglected (passive) if continuously chasing after things, experiences or people to make us happy. The latter activity is very much like an alcoholic or other substance user who keeps trying to extract happiness out of substance(s), until they "hit rock bottom" - the end of a heroically enduring effort.
     A huge problem we have, as health-care professionals, is unrealistic confidence in our analytic thinking - and by extension - that our present self-concept & worldview is "as good as it gets." We are as attached to this as a substance user to his substance(s). "And how's that working for you?" Dr. Phil could ask either. Einstein said, "We cannot solve the problems of today at the level of thinking at which they were first created."
     Mindfulness practice is training to continuously elevate our level of thinking, awareness or consciousness, and thus, overall quality of life. Improvement is progressive over a lifetime.

See also: http://mindfulnessforeveryone.blogspot.ca/

Photo: Lynn Ellis   http://500px.com/lynnellis

Resilience - Many Questions

     "Characteristics such as high level of intellectual functioning, efficient self-regulation, active coping styles, optimism, and secure attachment were observed in youth who had faced adverse situations and settings, yet did not succumb to the adverse impact of extreme stress." 

       Wu G et al. Understanding resilience. Frontiers in Behavioral Neuroscience 2013; 7: 1-15. doi: 10.3389/fnbeh.2013.00010 

     What proportion, if any, of people who fulfill the criteria for resilience above, continue to evolve to their full human capacity? What model do each of us use as to how far we can possibly evolve? How well do each of us know ourselves and where we ourselves are approximately on this trajectory? What priority and energy do we put into this journey of a lifetime?

 http://sarahmacdougall.com/

Different Stages of Life Pose Very Different Challenges

     We know what to do to live a healthy, balanced, happy life. A major problem is that we leave so much of ourselves at work, that what makes it home is often "a mere shell" of the person we are. Our resilience also declines as we age. Furthermore, career-building is on a downward slope by the time we're in our 60's. This is perfectly natural from a global perspective. This should, after all, be a time for seeing our lives from a bird's eye view. This should be a time for reflection and wisdom.
     If forced by circumstances to crank out services like a 30-year-old, when one strongly feels the need to prioritize reflection and contemplation, a severe inner conflict is brewing. We cannot do it all. It's essential to prioritize stage-appropriate activities. We know about "putting away childish things", but our current - global & especially professional - culture is spectacularly off with respect to putting away career-building things when we hit our 60's. The increasingly popular proclamation "I'll never retire!" is as stage-appropriate for someone in their 60's, as "I'll never go to school" for a 6-year old.

Time out for Self-care - Lessons from Toyota

     The quote below from Gad Allon's 2/2/2010 blog entitled; "The Andon Cord that wasn’t pulled (and the Toyota recall)" has important lessons for all of us about noticing and responding intelligently to signs & symptoms of dysfunction or others' warnings to take better care of ourselves, and seek professional help. As with cars, it's better to temporarily halt production than crash and burn.

       "Lean operations (or lean manufacturing) is a management philosophy that calls for the elimination of wasteful activities and handling of quality issues through continuous improvement by making the people that closer to the line responsible for the process and its improvement. In our core Operations Management course we teach the principles of lean operations and use the Toyota Production System as an example of the implementations of these concepts. With such a colossal event, we must ask ourselves whether the adoption of these principles contributed to these issues or whether these quality issues happened despite the method by disregarding it. We must say that we don’t have yet all the information, but even with this limited information, I like the explanation provided by the NY Times:
       'Toyota’s handling of the problem is a story of how a long-trusted car maker lost sight of one of its bedrock principles. In Toyota lore, the ultimate symbol of the company’s attention to detail is the “andon cord,” a rope that workers on the assembly line can pull if something is wrong, immediately shutting down the entire line. The point is to fix a small problem before it becomes a larger one. But in the broadest sense, Toyota itself failed to pull the Andon cord on this issue, and treated a growing safety issue as a minor glitch — a point the company’s executives are now acknowledging in a series of humbling apologies.' 
       I think the problem goes beyond that. The Toyota Production System (and thus Lean operations) calls for the identification of the root cause of the problem. The Andon cord is only the first step in the process that should trigger a chain reaction geared at identifying problems and resolving them when they are still minor. One of the ways to find this root cause is called the “5 whys” – basically asking again and again “why” until one gets to the crux of the matter. It seems that in that the acceleration pedal case Toyota was too quick to try to go back on schedule to the extent that it even sent misleading messages regarding the causes, betraying its customers and its core principles." http://operationsroom.wordpress.com/2010/02/02/the-andon-cord-that-wasn%E2%80%99t-pulled-and-the-toyota-recall/ 

Gerbil on Wheel - from the web (would like to give due credit to the photographer)

AVERSION & MENTAL HEALTH Issues, Patients, Mental Health Professionals

     It's easy to understand how some docs may feel inadequately trained / skilled to effectively manage patients with mental health problems. Perfectionistic health-care professionals are most comfortable dealing with a narrow range of illnesses. Some sub-specialists deal with a single disease for their entire career. Specialists feel good "knowing everything (about nothing)"; but may be averse to anything outside of their professional comfort zone.
     Some folks with mental health issues have negative attitudes towards mental health professionals. This may be out of fear of being stigmatized if they obtain professional help. Or perhaps mental health professionals in the past had not been able to help them to their satisfaction.
     Folks with anxiety tend to be anxious about their anxiety; dental phobic patients' greatest fear is loss of control because of fear; those with depression get depressed about their depression.
     Of course, like all human beings, health-care professionals themselves can have mental health issues. We have perhaps the greatest fear of stigma, and are perhaps most likely to delay proper diagnosis and management.

     So what's the common thread here? Aversion to what scares us. BUT how do we best manage fear? Education and exposure therapy - INTELLIGENTLY APPROACHING whatever scares us. We need to learn more about mental health issues, accept that it affects many of us - maybe ourself, and approach mental health professionals for care.

Relational Wounding, Sense of Deficiency, Over Compensations

     Like a number of others, John Welwood “believes that humanity’s fundamental problem is that people are disconnected from their true nature. … while this is a spiritual articulation, it is also accurate psychologically. … this disconnection from our true nature happens in relationship, starting when we are children.
     Growing up, we are dependent on parents and other adults who are themselves disconnected. Through neglect, abuse, or simply lack of attunement, they transmit disconnection to us. ‘This is the beginning of relational wounding. The child doesn’t feel fully seen, valued, or loved for who they are. Now, you could say, “Well, it’s an imperfect world and nobody gets the ideal love,” and that’s probably true, but not getting it does leave psychological scarring.” For some people, the wounds are minor and readily workable; for others, the wounds are deep and lead to complete dysfunction. 
     Relational wounding creates a sense of deficiency inside, which we try to compensate for by proving that we really are loveable – that we really are good or strong or smart. Theoretically it is possible to heal these wounds without the help of a therapist, but practically speaking, says Welwood, ‘it’s not realistic – just the same way the spiritual path isn’t easy to do on your own.’” Shambhala Sun, March 2013 

http://sarahmacdougall.com/

Happiness, Harmony, Vision, Focus - All in One

     Studies show that our attention is frequently & unpredictably scattered ("monkey-mind"), with minimal awareness of this on our part. Studies also show that this  common type of (in)attention is associated with unhappiness. See: http://mindfulnessforeveryone.blogspot.ca/2012/01/6-awareness.html
     Awareness can be focused with some stability, exclusively on one object or activity eg when we're engrossed in a hobby, during hypnotic trance, when obsessed, or during concentration meditation practice. A relatively uncommon form of awareness is broad awareness of all that's happening in one's surroundings. This can be seen in exceptional athletes and as a result of open-awareness meditation practice. See: http://www.johnlovas.com/2013/02/awareness-glaze-of-panoptic-attention.html

     In our complex interconnected global village, being self-centered is obsolete. All activities must be carried out with careful awareness of many other people, etc - "the big picture" including long-term psychosocial, environmental, and financial consequences. In other words, wisdom is a prerequisite for appropriate behaviour. See: http://mindfulnessforeveryone.blogspot.ca/2012/06/137-wish-to-see-clearly-get-over.html

Photo: photman555   www.dpreview.com

Wellness, Harmony, Capacity to Manage Complexity

     "Our most valuable asset is our people. The health of their work environment is a key accountability of all leaders and should be on the top of their minds at all times. (We must) think more deeply about the whole truth regarding working conditions in our health service provider organizations. If we don't 'care for the caregivers,' how can we expect them to care for our patients and their families?"
       Adamson BJ. Creating healthy work environments: A strategic perspective. Healthcare Papers 2010; 10(3): 29-32.

     "While ... Dewey did not compose a comprehensive theory of well-being per se, his philosophy suggests that well-being might consist in people’s abilities to exercise and develop habits within whatever situations they find themselves. ... what is 'good' is what works to improve a situation, and thus what is good for a person (e.g. what contributes to well-being) ameliorates disharmony and promotes possibility in uncertain experience. This idea of what is good for people stems from the centrality of democracy and situational uncertainty in Dewey’s overall philosophy. Dewey believed that citizens had a responsibility to develop their capacities as part of society so that possibilities for growth and change could exist."
        Aldrich RM. A review and critique of well-being in occupational therapy and occupational science. Scand J Occup Ther 2011; 18(2): 93-100.

Conflict Mediation & Resolution - "Would you rather be Right or Happy?"

     "Would you rather be right or happy?" along with "And how's that working for you?" are popular modern-day koans. It's tempting to dismiss them as pop psychology, but they hold surprising depth.
     Disputes at best end in wonderful transformative growth experiences; at worst, utterly destroy lives. The most rewarding case I've ever had the pleasure to mediate was a dispute between two students who had to work together on a joint project, but seriously disliked each other. After meeting with them separately, it was clear that they simply had very different work habits - one was very punctual, organized, hard-working, detail-oriented; the other very laid-back, creative. They quickly came to appreciate each other's talents, hugged (sincerely) at the end of our last meeting, and not only did they work well together, but became close friends.
     The worst case I know of involved a business dispute between two clinicians. Neither of them "gave an inch". One clinician's health severely deteriorated; the other's marriage was destroyed, and has since moved away. Their lawyers were the only winners. 

          "Well I won't back down, no I won't back down
          You could stand me up at the gates of hell
          But I won't back down"                                                  Tom Petty "I Won't Back Down"

     To resolve a conflict, we must listen deeply with an open mind / heart. This involves psychological flexibility. For a mediator, this is relatively easy; for the involved parties, not so much. Primitive animal instincts and psychological rigidity arise when our ego (feels exactly like our very life) is threatened! Rational thought and civilized behavior evaporate, and we're in full fight-flight-freeze mode, for as long as it takes. In this altered state, it's exclusively about "I'm right" (protect the ego at any cost), everything else - even one's own health - be damned!

     When we're embroiled in conflict, we need to stop and ask ourselves how our present approach is working for us. If it's making us and our loved ones miserable, can we soften our ego defenses a bit, and listen to advice from those with a balanced perspective on the situation?

     See also: http://healthyhealers.blogspot.ca/2012/11/blindspots-ethics-evolution-of.html
     and http://healthyhealers.blogspot.ca/2012/02/balancing-act.html