"Wherever You Go, There You Are"

     For many, the above statement may disappoint. After all, don't we pay a lot to "get away from it all," to spend a week or two in a "tropical paradise," and as a result, perhaps "feel like a different person"?
     Yet, the title of Jon Kabat-Zinn's classic book suggests that it's not at all about physical location, but one's attitude, or state of being, not external but internal locus of control, not having to smooth out & control the external physical environment, but cultivating hardiness. It appears that happiness is an inside job.
 

Personal Deepening, Universal Meaning

     During the process of human maturation, we each progressively approach the core or essence of who or what we are - as in peeling away an onion, layer by layer. We  sequentially "put away childish things" as we become increasingly aware of the disconnect between how we are now, and a sense of what might be possible - an ideal that creates longing, which in turn energizes more peeling.
     Our ideal is to live a meaningful, undivided life, in full harmony with the universe - with all that is. Each onion layer is a barrier, an outgrown friction between how we now are and an unfathomable ultimate. Life certainly takes away layers periodically, often unexpectedly.
     Spiritual practices are designed to do this intentionally and a bit more predictably. For various reasons, "religion" & "spirituality" elicit strong negative emotional reactions, particularly among intelligent, educated people. One major barrier to "religion" has been the apparent necessity to leave one's intellect at the door before entering a "place of worship" - frustrating the deep wholesome desire for an UNdivided life. Another, somewhat-related barrier to "spirituality" is that descriptions of spiritual experiences are incomprehensible without first personally experiencing them. Because these traditional ways of navigating liminality are being rejected, a large portion of our educated population is perpetually adrift in reductionist materialism, pessimism, cynicism, depression & anxiety.
     What we urgently need is a systematic intentional effective approach to ensuring human maturation that is suitable for intelligent, educated people from any ethnic, cultural or religious background. Mindfulness-based stress reduction (MBSR), as taught by Jon Kabat-Zinn PhD is one such evidence-based, secular approach. Having facilitated twenty of these 8-week MBSR courses, primarily for health-care professionals from all ethnic, cultural & religious backgrounds, I can attest to the fact that participants greatly value & appreciate this way of deepening, of living more meaningful, more congruent, more deeply satisfying lives. It's incredibly encouraging to witness the fact that diverse people can & do see eye-to-eye at a deep, meaningful level.

     See: http://mindfulnessforeveryone.blogspot.ca/2013/11/446-gratitude-service-responsibility.html

Steve McCurry   http://stevemccurry.com/

Values, Purpose, Meaning & Quality of Life

     It's very useful to examine & understand the strengths & limitations of different ways of knowing. Science has an important well-defined role, but we should NOT exclude other ways of knowing - see: http://mindfulnessforeveryone.blogspot.ca/2012/01/28-underdeveloped-way-of-knowing.html
     Unexamined, false assumptions about ways of knowing can sadly confine, indeed paralyze - see: http://healthyhealers.blogspot.ca/2013/05/critical-thinker-discerning-taste-and.html The following is from the legendary philosopher Huston Smith's (HS) interview by Jeffrey Mishlove PhD (JM) - on YouTube:

     "We've turned a method of getting at truth, namely the scientific method, into a metaphysics - taking to be real only what turns up by that probe, through that probe, and assuming that that probe is the privileged & reliable way of getting at truth. Well it's immensely powerful, but we don't see that it's power derives precisely in trade-off for its limitation. 

     JM: In other words, you seem to be saying that the
     modern Western mindset is a kind of imperialism 
     dominated by materialistic metaphysics.

     Well I think that's a fair statement because just think of what it leaves out. 
     Again, all credit to what (science) has done in the regions where it is effective and in fact a near perfect way of getting at truth in the material world. 
     But values for example - science rides on values, but it cannot itself deal with values. It can deal with descriptive values, like market research - it can tell us what people do value, but it can't tell us what they aught to value.
     A second thing is purpose. Is there any purpose in existence? In life? In reality? Jacques Monod, the Nobel prize winner says: "The systematic denial of purpose is the cornerstone of the scientific method" - and we can see why it has to be. Because if you go back to explain things 'because a god intended it so' - namely a purpose - why of course it short-circuits the scientific investigation for secondary causes which produces it. So we rule out purpose.
     And then meaning. The scientific endeavor is meaningful all the way through, but a certain kind of meaning it can't get at, namely the meaning of the whole - what is the meaning of life?

     JM: Sort of a Gestalt

     Right. Existential meanings they're sometimes called. The meanings by which we live - science can't deal with these. The scientist Steven Weisberg puts it: "The more comprehensible reality becomes, the more meaningless it becomes" - because it comes down to equations & numbers, and those are not themselves existential meaning.

     JM: So the fact is that our dominant worldview is a
     scientific one - without value, without purpose, without
     meaning, without a sense of quality.

     Yes - quality I haven't mentioned. ... the scientific enterprise & worldview too itself rides on many of these things we've already mentioned like values - values of truth, but the point is those values are not themselves turned up and revealed by science - they're assumed for science. And science itself cannot come to grips with - let's just name them again - values, purposes, meanings & qualities - it deals with quantities rather than quality. But look what we've left out if we leave out those four things!

     JM: The nourishment of life itself I would think ... and I
     would imagine that without that kind of nourishment
     being sustained by our mainstream cultural institutions,
     by our mainstream cultural mindset then what we
     experience is alienation, discontent, social problems ...

     I think this is a direct result of moving our beliefs into the confinement of a scientific view of reality. ... There's nothing wrong with science itself, in fact that's an understatement - it has given us incredible goods. The problem is not science but scientism - namely to assume that what science turns up, & can turn up, is the sum of all there is."

Going Well Beyond Limiting Self-concepts

     It's so encouraging to read about the powerful energy good mentors can awaken in young people: http://medicine.dal.ca/facultystaff/our-learners/profiles/cinera_states.html
     Cinera's story reminds me of an old (unethical by today's standards) experiment in which a group of young students was divided evenly with respect to intelligence, academic performance etc. Then one group was formally informed that they were "gifted", while the other (intellectually-matched) group was informed that they were "slow learners". They then carefully proceeded to teach both groups the same curriculum, in the same manner. At the end of the academic year, the "gifted" group markedly outperformed the "slow" group. Henry Ford's famous saying rings true - "Whether you think you can, or think you can't, you're right!"

     Probably most, if not all of us, have at some point been lead to believe that we're "no good" at something, or that we're just plain "no good." We internalize such psychological wounds more than we may ever realize. Pessimism is today's global de facto dogma. So it's vitally important to question our self-concept, to question our worldview because both of these, for the vast majority of us, are limited & distorted by psychological scars. We need wise mentors more than ever.

     “There is no passion to be found playing small - in settling for a life that is less than the one you are capable of living.”             Nelson Mandela

     "Resilience refers to the ability to thrive despite adversity and has been defined as a multidimensional phenomenon, spanning internal locus of control, sense of meaning, social problem-solving skills, and self-esteem. The concept of hardiness integrates many of these characteristics and describes individuals who are committed to finding meaningful purpose in life, believe that one can influence one’s surroundings and the outcome of events, and trust that one can learn and grow from both positive and negative life experiences. High levels of this personality trait have been shown to enhance posttraumatic adjustment, possibly by means of a faster physiological recovery from stress."
        Daniels JK et al. Neural correlates and predictive power of trait resilience in an acutely traumatized sample: a pilot investigation. J Clin Psychiatry 2012; 73(3): 327-32.

     "As we are liberated from our own fear, our presence automatically liberates others."            Marianne Williamson

     See "Our Self-concepts & Worldviews Must Mature": http://mindfulnessforeveryone.blogspot.ca/2013/11/443-our-self-concepts-worldviews-must.html

MiltonC   www.dpreview.com

Mindful Practice Workshop - University of Rochester Medical Center

MINDFUL PRACTICE:
Enhancing Quality of Care, Quality of Caring, & Resilience
May 7-10, 2014
Hosted by: The Center for Experiential Learning, University of Rochester Medical Center

A 4-day, retreat-like workshop designed to improve the quality of care that clinicians provide while improving their own resilience and well-being. The workshop offers an experiential learning environment where participants focus on developing the capacity for Mindful Practice – attentiveness, situational- and self-awareness, teamwork, and self-monitoring – even in stressful and demanding situations.

Designed for medical practitioners (physicians, NPs, PAs) and others involved in medical practice and education, the program combines didactic presentations and experiential exercises using narratives, appreciative inquiry, and contemplative practices such as mindfulness meditation.  Session themes include teamwork, difficult conversations with patients/families, uncertainty in medicine, medical education, grief and loss, resilience and compassion.

The workshop will offer participants hands-on experience in teaching and facilitation with attention to promoting Mindful Practice Activities at participants' home institutions.  Prior attendance at a Mindful Practice workshop or experience with contemplative practice is desirable, but not required.

Course Directors: Ron Epstein MD and Mick Krasner MD
Additional Course Faculty: Fred Marshall MD and Florence Meleo-Meyer MA MS
Sponsored By: The Department of Family Medicine, University of Rochester Medical Center
Location/Accommodations: Chapin Mill Retreat Center, Batavia, NY (Click here for details. http://www.rzc.org/ )

For more Information and to Register,
please visit: http://www.cvent.com/events/mindful-practice-quality-of-care-quality-of-caring-and-resilience/event-summary-6328a26ef8434b359385c32fb95b524d.aspx



Therapeutic Presence

     "Therapeutic presence is defined as bringing one’s whole self into the encounter with clients, by being completely in the moment on multiple levels: physically, emotionally, cognitively, & spiritually.

     Presence involves 

(1) being fully in contact with one’s self in the moment, while being 

(2) open, receptive, & immersed in what is poignant in the moment, with 

(3) a larger sense of spaciousness & expansion of awareness & perception.

     This grounded, immersed, & expanded awareness is accompanied by 

(4) the intention of being with & for the clients, in service of their healing process.

     The inner receptive state involves therapists’ complete openness to clients’ multidimensional internal world, including their bodily & verbal expressions, as well as openness to their own bodily experience of the moment in order to access the knowledge, professional skill, & wisdom embodied within. Being fully present then allows for an attuned responsiveness that is based on a kinesthetic & emotional sensing of the other’s affect & experience as well as one’s own intuition, skill, & the relationship between.

     Therapeutic presence has been proposed as an essential therapeutic stance. Therapeutic presence can increase the therapist’s listening & attunement skills and provide a more effective way to respond to a client that is right for that person in that moment. Presence also allows the therapist to work at a relational depth, which further deepens the therapeutic relationship so the client can feel open & safe to work with difficult issues."

       Geller SM, Greenberg LS, Watson JC. Therapist and client perceptions of therapeutic presence: the development of a measure. Psychother Res 2010; 20(5): 599-610.

 

 

 

RumpelHund   www.dpreview.com

 

Self-defeating Behaviours - Repression & Addiction

     According to Buddhist psychology, we're all addicted to material things, our likes & dislikes, our opinions, etc, but most importantly, to our concept of self. It can take many years of reading and meditation just to get an inkling of the depth of these addictions.

     "For generations, psychologists thought that virtually all self-defeating behavior was caused by repression. I have now come to believe that addiction is a separate and even more self-defeating force that abuses our freedom and makes us do things we really do not want to do. While repression stifles our desire, addiction attaches desire, bonds and enslaves the energy of desire to certain specific behaviors, things, or people. These objects of attachment then become preoccupations and obsessions; they come to rule our lives.
     The word attachment has long been used by spiritual traditions to describe this process. It comes from the old French a-tache, meaning "nailed to." Attachment "nails" our desire to specific objects and creates addiction. In this light, we can see why traditional psychotherapy, which is based on the release of repression, has proven ineffective with addictions."

       May G. "Addiction and Grace. Love and Spirituality in the Healing of Addictions." HarperCollins, NY, 1988. 

     See also: http://mindfulnessforeveryone.blogspot.ca/2013/07/361-beyond-stress-management-resilience.html

Stan W   www.dpreview.com

 

Jung's Individuation

     "Individuation is the term with which C. G. Jung describes the psychological process of inner growth and centralization by which the individual finds its own Self. This does not mean to find one's own ego-identity, as is described by many modern psychological schools. By the term Self, Jung understands an ultimately unknowable inner center of the total personality and also the totality itself. This center can only be approached but never integrated. Our destiny and our health depend on it. In the various religions and mythologies it is symbolized by the image of the 'treasure hard to attain,' the mandala and all images of the inner psychic manifestation of the godhead."

       von Franz M-L. Individuation in Fairy Tales. Revised Edition. Shambhala, Boston, 1990.

Gianfranco Sacco Zaut   www.dpreview.com

Nothing Less than Our Whole Unguarded Open Fully Engaged Human Presence

     He said to me, 'You must not ask for so much.'
     And a pretty woman leaning in her darkened door,
     She cried to me, 'Hey, why not ask for more?'          Leonard Cohen - Like a Bird on the Wire

     Instead of routinely employing a host of conscious & subconscious ways of guarding our "self", can we instead investigate what happens if we consistently, intentionally, open up and become porous to life as it is?

     "The World Health Organization (WHO) describes the introduction of spirituality into the domain of health care. These discussions question the very nature of health and wellness. Proposed revisions to the WHO’s Ottawa Charter for Health Promotion regard health not only as the absence of illness or maladies but also as a psychodynamic state consisting of people’s physical, mental, social & spiritual aspects. This perspective suggests that traditional psychological categories are insufficient when addressing the complex issues facing people in contemporary society. Further, it suggests that there is a need for initiatives & care that are grounded at a deep emotional level, such as upon people’s existential values. The concept of spirituality can be expressed in terms that are based on a number of different perspectives such as life, spirit, soul, heart, existentialism, religion and the meaning of life.

     For many people, the aspects of spirituality inherent in daily life contain religious factors; however, being spiritual is not synonymous with being religious. Some say that spirituality can be understood as consisting of those elements that comprise the totality of human life, including physical, psychological and social factors. In many cases, spirituality relates to an interest in concepts related to the meaning and goals of life. In other words, this interpretation of spirituality emphasizes the value of incorporating higher level psychogenic endeavours into aspects of care ..."

       Oshita D, Hattori K, Iwakuma M. A Buddhist-based meditation practice for care and healing: an introduction and its application. Int J Nurs Pract 2013; 19 Suppl 2: 15-23.

     See: http://mindfulnessforeveryone.blogspot.ca/2013/07/367-discovering-manifesting-our-innate.html
     and: http://mindfulnessforeveryone.blogspot.ca/2013/09/403-mindfulness-wisdom.html

Healing Starts with the Healer

     "There is symmetry between someone’s relationship with the outer world and his or her inner world. All the qualities of the inner relationship with the self will also be reflected in outer relationships. The inner relationship is the basic template for any encounter with the world, and as such is the starting point for all encounters. If one is able to acknowledge herself, she will also have the capacity to acknowledge others. If someone cannot accept himself as a whole and has to neglect some aspects of his personality, then he will not be able to accept others for what they completely are. I call this symmetry the mirror principle because it reflects in both directions. In transforming the attitudes toward the self, one can start to encounter the world in a different way. 

     I believe all healing relationships start in the person of the health care professional. To the Western mind this sounds unexpected because one of the basic assumptions of the Western medical philosophy is the idea that something has to be done for the patient. This often includes the idea that the health care professional has to hold back his or her own personality in a medical context because the patient comes first. The concept that every healing intention starts from a healthy attitude towards the self, or in other words, healing starts by healing the healer challenges that assumption. 

       Schmidt S. Mindfulness and healing intention: concepts, practice, and research evaluation. J Altern Complement Med 2004; 10 Suppl 1: S7-14.

     See also: http://mindfulnessforeveryone.blogspot.ca/2013/11/432-i-try-and-i-try-but-i-cant-get-no.html
       and about self-acceptance: http://healthyhealers.blogspot.ca/search?q=self-acceptance

 

CapturingMoments   www.dpreview.com

Developing Personal Skills - Healers First Please

     "Health promotion supports personal and social development through providing information, education for health, and enhancing life skills. By so doing, it increases the options available to people to exercise more control over their own health and over their environments, and to make choices conducive to health.

     Enabling people to learn, throughout life, to prepare themselves for all of its stages and to cope with chronic illness and injuries is essential. This has to be facilitated in school, home, work and community settings. Action is required through educational, professional, commercial and voluntary bodies, and within the institutions themselves."

http://www.who.int/healthpromotion/conferences/previous/ottawa/en/index4.html

     We health-care professionals must lead by example in developing such personal skills. "Do as I say, not as I do" fails everyone: ourselves, our families, our loved ones, & our patients. 
     See: http://healthyhealers.blogspot.ca/2012/04/capacity.html

 

Logo created for the First International Conference on Health Promotion held in Ottawa, Canada, 1986.

Our Stories Mature as We Evolve

     "sociologist A. W. Frank states that in the end-of-life care, spirituality & religion merge in story-telling, in other words, narratives. Frank offers three types of narratives (restoration, chaos and quest). The first type of narrative, restoration, is preferred by the recently ill or medical professionals with a dominant storyline of becoming ill, but restoring health (with a remedy). Conversely, chaos stories lack a sequence, as well as a ‘proper’ ending, and represent human vulnerability and the impotence of modern medicine. Quest storytelling, unlike the aforementioned two, is an attempt to utilize or gain from illness experiences."

       Oshita D, Hattori K, Iwakuma M. A Buddhist-based meditation practice for care and healing: an introduction and its application. Int J Nurs Pract 2013; 19 Suppl 2: 15-23.

     Restoration narratives suggest a 'narrative focus of attention', where self-concern (self-absorption, egocentricity) is central, there's another attempt at putting back the pieces 'the way they used to be', and habitual self-talk is now spoken out loud.
     Chaos narratives suggest liminality, the end of the 'illusion of control', facing reality. See: http://www.johnlovas.com/search?q=liminality

     Quest narratives suggest "reassimilation" see: http://www.johnlovas.com/2013/06/liminality-insight-into-emptiness.html that phase in Joseph Campbell's "hero's journey" wherein the hero archetype crosses the threshold: commits to leaving "the Ordinary World and enters a new region or condition with unfamiliar rules and values." http://www.thewritersjourney.com/hero%27s_journey.htm a shift from egocentric to a larger, more holistic way of being.

     Wise people intentionally evolve throughout life instead of endlessly postponing vital growth.

Fall colors in Halifax, Nova Scotia, earlier this week.

 

Psychological Stress Impairs Wound Healing

     "Numerous studies show that stress is associated with increased mortality & morbidity across a range of conditions and many studies highlight the impact of stress upon specific markers of immune functioning, but few have been able to connect the 'micro' immune changes with 'macro' changes in disease outcomes. The recent utilization of wound healing as a primary outcome measure enables researchers to bridge this gap and investigate the impact of stress on an objective, concrete, and clinically relevant outcome, where the immune system plays a significant role. Research investigating the determinants of wound healing has traditionally focused on clinical and biomedical factors (i.e., size of wound, dressing type, extent of pathology) associated with speed of healing. However, recently the potential impact of psychosocial factors, including psychological stress, has been investigated. The objective of this review was therefore to systematically identify and synthesize existing knowledge about the relationship between psychological stress and wound healing.

     The results reveal a robust negative relationship whereby stress is associated with impairment of healing and dysregulation of biomarkers associated with wound healing and this is broadly consistent across a variety of clinical and experimental, acute and chronic wound types in cutaneous and mucosal tissue. The relationship was evident across different conceptualizations and measures of stress. The size of the relationship between stress and wound healing estimated by this analysis is r=−0.42, classified as a medium effect size, suggesting that it may be of significance clinically as well as statistically. The extent of its impact indicates that it could be considered alongside other accepted factors affecting healing such as age, diabetes, and nutrition."

       Walburn J. et al. Psychological stress and wound healing in humans: a systematic review and meta-analysis. J Psychosom Res 2009; 67(3): 253-71.

purelightglow   www.dpreview.com

 

Healers, Drugs, Machines, & their Relative Value

     "It is the non-judgmental, non-condemning, and non-manipulative atmosphere between doctor and patient that will permit the most open, and therefore, the diagnostically and therapeutically most meaningful communication between them."  
       Ornstein PH. The family physician as a 'therapeutic instrument.' The journal of family practice 1977; 4(4): 659-61.

      So the ability to accept patients as they are is critical for optimally engaging with them in therapeutic alliance. Of course acceptance of others must be preceded by self-knowledge, self-acceptance, tolerance for ambiguity, and other mature, highly evolved human characteristics.
     We know that "emerging adults" are, at best, 'getting there'. We also know that medical & dental training negatively impacts psychosocial maturation.
See: http://healthyhealers.blogspot.ca/2012/07/soft-skills-undervalued.html 
and: http://healthyhealers.blogspot.ca/2012/11/emotional-intimacy-too-busy.html

     So are we graduating the best healers ('therapeutic instruments') possible? Ensuring student wellness & quality of life during training is an excellent, logical place to start. How much trust (curriculum time & course weight) do we actually have in drugs & machines compared to the human agent of healing? 
     Promoting (rather than disrupting) our students' health & healthy maturation remain critically undervalued educational missions.

Active Ingredient(s)?

     Coronary bypass surgery appears to be effective. An early study comparing regular coronary bypass surgery with mock surgery (only a skin incision was made, then sutured up, all under GA) apparently gave very similar results. Drugs (GA & analgesics) can keep us asleep, pain-free, during what otherwise would be unbearably painful surgery. The insertion of acupuncture needles alone also permits pain-free surgery. Under clinical hypnosis alone (without any drugs: sedatives, anesthetics, muscle relaxants, post-op analgesics) major surgery can be performed completely painlessly. (Rausch V. Cholecystectomy with self-hypnosis. Am J Clin Hypn 1980; 22(3): 124-9.) Tai chi is practiced using the least amount of muscular energy as possible. Elderly tai chi teachers are far more powerful than their much younger and much physically stronger students. The former can effortlessly hurl the latter backwards at much greater speeds than can be explained based on muscular effort. Tibetan monks can generate sufficient heat from their near-naked bodies, that they can dry wet bedsheets outdoors in sub-freezing temperatures (tummo). Many meditators can enhance warm energy flow throughout their bodies simply by becoming still and relaxing for a minute.
     Acupuncture is thought to unblock energy, allowing it to flow normally in a system where disease is understood as blockage or stagnation of energy (qi).
     Interestingly, one definition of hypnosis is "a deeply relaxed state, with increased suggestibility and suspension of critical faculties." Bobrow RS. The witch in the waiting room: A physician examines paranormal phenomena in medicine. Thunder's Mouth Press, NY, 2006.

      A relaxed (unarmored) body and an open mind (psychological flexibility) appear to be key ingredients for optimal health, healing, wholeness. An open mind has nothing to do with gullibility. A closed mind imposes severely limited possibilities.
     Mindfulness involves mind-body practices designed to gently, progressively relax the body and open the mind.