Readiness to Evolve

     The stories we continuously tell ourselves, about ourselves, form a seemingly stable self-image, giving rise to a false security AND inertia. "That's who I am" - is a mirage, a deluded attitude, the "autopilot" that flies our "momentum of our life." At some level we know that a solid self-concept is untenable because everything is obviously constantly changing, including our opinions and even our memory of past actual events.

     We retain a heroic death-grip on our fossilized self-concept (ego) because few of us are adequately informed about the normal evolution of human consciousness, self-transcendence, hypo-egoic states etc. See: http://mindfulnessforeveryone.blogspot.ca/search?q=self-transcendence  
     Even fewer among us know & trust that we have agency over this process, and an even smaller proportion regularly practice to promote this process. See: http://mindfulnessforeveryone.blogspot.ca/2014/02/500-changes-ambivalence-progress.html

     "Change readiness (is) defined as an individual’s 'beliefs, attitudes, & intentions regarding the extent to which changes are needed and the (the individual's and) organization’s capacity to successfully undertake those changes.'

     ... social psychologists have defined attitudes as 'evaluative summary judgments that can be derived from qualitatively different types of information (e.g., affective & cognitive).'

       Rafferty AE, Jimmieson NL, Armenakis AA. Change readiness: A multilevel review. Journal of Management. 2013;39(1):110-35.

Peggy's Cove, Nova Scotia

 

Our Open Heart-Mind Works Best

     Just for fun, try this experiment: start monitoring how you feel as often as you can. Suppose your state of being is on a continuum between: 
          1) being relaxed, at home, in control, open-hearted, loving, generous, profoundly at peace,
          2) being afraid, out of your element, out of control, closed-hearted, angry, greedy, disturbed.

     After a bit of practice, or perhaps you can already do this, you'll physically feel where you are on this continuum between 1 and 2:
          1) being essentially in the open wise, evolved elder, saint or mystic mode, making full use of your prefrontal cortex or heart-mind;
          2) being in the closed fearful-child-lost-in-the-woods mode (brain stem reactivity).

     With some practice you might begin to notice that the farther we are towards the fearful-child pole, the more we & those around us suffer, because our judgment is severely impaired, and therefore our performance & behavior deteriorates. But as we learn to become aware, as early as possible, that we're starting to slide down towards this extreme, we learn not to go with this downward momentum, and recover "our better judgment".
     Positive biofeedback is more powerful for most of us. Noticing how when our mind and heart areas feel relaxed, open & warm, everything goes well, people respond so positively is a real eye-opener.
     Can we ourselves learn to directly control our state of being - where we are on this continuum, REGARDLESS OF EXTERNAL CIRCUMSTANCES, thereby improving our quality of life AND that of all those around us? Can we? "Whether you think you can, or think you can't, you're right!" Henry Ford

     Meditation practice is a powerful way of intentionally opening up to, processing & transcending difficult aspects of our lives. See: http://www.johnlovas.com/2014/02/meditation-is-powerful.html

"Les" Laszlo Lovas   1915-2001

Disruptive Behavior by Physicians & Other Health Care Professionals

     "Disruptive physician behavior represents a threat to public health by negatively impacting the safe & effective care of patients. Disruptive behavior also undermines effective staff retention, increases malpractice risk, & jeopardizes patient safety specifically related to the culture of avoidance that ensues. Maladaptive role modeling perpetuates this cycle to the detriment of the empathy, wellness, & overall professionalism of medical students, residents, & allied health professionals.
     Despite a mandate from the Joint Commission to have policies in place to define disruptive physician behavior and intervene when it is identified, many academic institutions, hospitals, practices, & licensing boards are grappling to develop effective means for handling these vexing difficulties. Some are unaware of available resources & feel reluctant to intervene, and some might even believe that disruptive physicians are incapable of change. Sadly, many of these physicians’ behaviors are tolerated until a crisis emerges, such as a patient injury or staff complaint, at which time disciplinary action ensues.

     The American Medical Association defines disruptive physician behavior as 'personal conduct, whether verbal or physical, that negatively affects or that potentially may negatively affect patient care.' This includes but is not limited to conduct that interferes with one’s ability to work with other members of the health care team. However, criticism that is offered in good faith with the aim of improving patient care is not to be construed as disruptive behavior. 
     Disruptive physician behavior may be verbal (foul language, intimidating language, belittling or demeaning words) or nonverbal (facial expressions or other body language, throwing things). The behavior also may be aggressive (see above), passive (chronic lateness, failure to write chart notes), or passive-aggressive (hostile or inappropriate notes, or derogatory comments about colleagues or institutions)."

       Samenow CP, Worley LL, Neufeld R, Fishel T, Swiggart WH. Transformative learning in a professional development course aimed at addressing disruptive physician behavior: a composite case study. Academic medicine : journal of the Association of American Medical Colleges. 2013; 88(1): 117-23.

Massimo Bassano   http://photography.nationalgeographic.com

Current "Bad" Behavior, Past Trauma & Empathy

     It's stunning how well-educated, professionally-successful people can behave completely inappropriately from our perspective.
     How can this be? It's not possible to have a balanced overview of, or proper perspective about a situation if one  viscerally feels in mortal danger. It is now a life-or-death emotion-directed struggle, reason has fled (executive function / mature judgment). This brain-stem-led behavior does not arise from stupidity or evil, though the consequences can easily be both. Such people who fight tooth-and-nail for their "rights", insisting that they're "right" (when in fact they may be partially or wholly wrong), very likely had traumatic childhoods (insecure or disorganized attachments): http://healthyhealers.blogspot.ca/2012/12/everyones-doing-their-best-under.html plus a variety of other traumas about which we truly know little or nothing.
     Nobody gets up in the morning and decides to behave unreasonably or foolishly - there are valid reasons, though not necessarily current ones, therefore appearing irrational. It's really useful AND practical to try to understand such strangely disruptive behavior, and try to mediate instead of sliding into heavy-handed, adversarial mode.
     We understand all of this when a patient behaves irrationally, BUT when a colleague behaves "badly", OUR judgment can become compromised, and WE can can overreact & easily become punitive!
     Our colleagues, & we ourselves, deserve just as much empathy as our patients.

Nita Zeqiri, National Geographic   http://photography.nationalgeographic.com

Metacognition - a Grand Evolutionary Achievement

     "Human beings possess the striking reflexive capacity to hold mental states about mental states, that is, to engage in thinking about thinking. This has been heralded as a grand evolutionary achievement of our species and its kin, and its social & psychological significance may scarcely be exaggerated. Daily life is replete with complex determinations about the reliability of our own thoughts, feelings, and beliefs as well as attributions about the thoughts, feelings, and beliefs of others around us. For centuries, philosophers have speculated about the dependability of self-knowledge and about the problems inherent in drawing inferences about the contents of other minds. Contemporary psychologists, too, have devoted considerable theoretical and research attention to the topic of metacognition, which recently cracked the 'top 100 topics' of psychological research.

     Although a good number of edited volumes on the subject now exist, there is no consensually agreed on definition of metacognition. ... the term 'has been variously referred to as "cognitive monitoring", "executive processes", "self-communication", and "knowledge about knowledge"'. Typically, metacognitive researchers investigate mental processes whereby individuals 'control' and 'monitor' their own mental activity." 

 

     Jost JT, Kruglanski AW, Nelson TO. Social metacognition: an expansionist review. Pers Soc Psychol Rev. 1998; 2(2): 137-54. 

 

Dalhousie University, February 13, 2014

 

Insight, Self-reflection, Psychological Mindedness, Evolution

     Meditation practice has long been known to bring about profound mental-health benefits.

     "The non-reactive, detailed, systematic, and impartial observation of one's own cognitions & emotions through the technique of meditation can be a source of personal insight & self-understanding. ... even among patients with little psychological mindedness, approximately 20% 'with a wide range of psychophysiological disorders, who joined stress reduction & relaxation programs involving mindfulness meditation, became interested in psychotherapy for further expansion of self-understanding.' Within this framework, they refer to meditation as a 'psychobiological form of introspection.'"
       Shapiro DH. A preliminary study of long-term meditators: Goals, effects, religious orientation, cognitions. Journal of Transpersonal Psychology 1992; 24(1): 23-39.

     "our perception, cognitions, & emotions related to our ordinary experiences can be distorted or biased to varying degrees. Depending on certain dispositional factors, these biases are sometimes pathological, but exist on a spectrum and may therefore be present without any clear psychopathology. Within this framework, mindfulness is described to reduce such biases through specific forms of mental training that develop meta-awareness of self (self-awareness), an ability to effectively manage or alter one’s responses & impulses (self-regulation), and the development of a positive relationship between self & other that transcends self-focused needs and increases prosocial characteristics (self-transcendence)."
       Vago DR, Silbersweig DA. Self-awareness, self-regulation, and self-transcendence (S-ART): a framework for understanding the neurobiological mechanisms of mindfulness. Front Hum Neurosci. 2012; 6: 296.

ARClark   www.dpreview.com

 

Between a Rock & a Scary Place! - Self-concept & Worldview Upgrades

     We have an aversion to, & frankly doubt we can upgrade our self-concept & worldview (SC&WW): http://healthyhealers.blogspot.ca/2014/02/if-it-aint-broke-upgrading-self-concept.html When someone else gives us advice about this critically important, yet taboo territory, we get mad at them!: http://mindfulnessforeveryone.blogspot.ca/2014/02/494-we-know-were-heading-wrong-way-when.html And our current societal tendencies of scientific reductionism, materialism, consumerism & cynicism make the wisdom traditions - the traditional gateways to SC&WW - unintelligible & virtually unapproachable.
     We're in a real pickle, because life deals all of us at least one, but usually multiple "shipwrecks", where our whole life - including SC&WW - falls apart. 

     We have only 3 options when shipwrecked: 
     1) remain cynical & miserable; 
     2) rebuild without skills; 
     3) rebuild with skills - I prefer this third option. 

     Jon Kabat-Zinn's Mindfulness-based Stress Reduction (MBSR) program, is a widely-accepted & evidence-based way of gently, skillfully approaching, upgrading & when necessary, rebuilding our own SC&WW.  Each of us has to start - slowly - from where we are now. The learning is experiential, not theory / dogma-based.

Dalhousie University February 13, 2014

If It Ain't Broke ... ? Upgrading Self-concept & Worldview

     We may use computers constantly, but very few of us would dream of upgrading (by personally reprogramming) the operating system (OS) of our computer. Most of us are not competent programmers, making the task seem impossible. So even if the computer is working sub-optimally, fear keeps us from personally meddling with the OS.
     For human beings, the closest equivalent to the computer's OS is one's self-concept & worldview. For many (psychosocial & spiritual) reasons, including their rightfully assumed central importance, most of us fear approaching these and firmly assume that we ourselves cannot "upgrade" them.

     On the other hand, the world's mystics & wisdom traditions have always been focused precisely on systematically approaching & upgrading what has become these days a virtually taboo - our self-concept & worldview. Like computers with outdated OS's, humans also function poorly when this central aspect of their being is neglected.
     Fortunately, there is now a widely-accepted means of approaching & upgrading our self-concept & worldview - Jon Kabat-Zinn's Mindfulness-based Stress Reduction (MBSR) program.
     We should not wait till we break down, "shipwrecked", before we upgrade our OS. It's DOABLE, and there IS an approachable, intelligent, evidence-based method.

Aperture P   www.dpreview.com

Culture as Product - Sculpting the Self

     Our society is hypnotized by celebrity, fame, wealth, lifestyles of the rich & famous - no matter how these celebs achieve this "status." All flash, no substance is incredibly attractive, even though it continually destroys many of these same celebs. Or maybe we learn about prioritizing (substance over flash) through regular reports of celebs dying of drug overdose, crashing their Ferrari DUI, or going back into rehab.
     Yet, we ourselves seem to need to directly experience what it's like to stray from an evolved way of life. Only after feeling sick from eating garbage, do we clearly get the message that proper nutrition is the way to go. Only after feeling sick from working in a sleazy job, does it sink in that a decent profession is the way to go. Only after repeatedly feeling sick from being sleazy, do we realize that being a decent human being is the only way.
     One way of looking at one's own life is that our every thought, word and action shapes a lump of clay. The more evolved one's consciousness & integrated one's life, the more beautiful the final clay statue becomes. Another way of looking at it is (a la Michelangelo) that perfection is already within our rough block of marble, our only job is to let go of all that's unnecessary & blocks the way: egocentricity, aversion, greed & delusion.
     Optimizing the quality of our own & each others' being has to be our individual, educational, workplace & societal priority. Our world is literally crumbling around us because far too many of us remain addicted to flash without substance.

     "A successful learning community is predicated on a culture that takes pride in its identity. To be capable of inspiring students at scale, colleges must treat the fabric of this culture like the precious commodity it is. At a conventional workplace, the work comes first and the employee culture comes second. In a higher-ed environment, the culture itself is "the product" that is being transmitted to the students. So despite being known as progressive environments, college campuses tend to safeguard against changes that would threaten their communities."
       John Maeda's 2/14/2014 Linkedin post: "Why Higher Ed is Slow to Become Longer Ed"
http://www.linkedin.com/today/post/article/20140214211330-34374336-why-higher-ed-is-slow-to-become-longer-ed?trk=eml-ced-b-art-M-1&midToken=AQG1sLdJ_3Pdmg&ut=3Sd0iSzrhVc681

stickpointed   www.dpreview.com

Trauma, Conscious Struggle, Reevaluation of Worldviews, & Posttraumatic Growth

     "The negative impacts of trauma (from war & events outside of war) have been well documented. Most commonly cited are stress, depression, anxiety, and Posttraumatic Stress Disorder (PTSD). However, researchers have recently begun to examine potential positive trauma outcomes as well.

     "Posttraumatic growth (PTG) is one such conceptualization of positive trauma aftermath. Individuals who have suffered a traumatic/stressful event cope with the negative impacts in various ways. There are those who are resilient & are more likely to carry on with their lives as though nothing out of the ordinary has occurred. Many others, however, struggle in their efforts toward recovery and are forced to reevaluate previous worldviews & interpretations. PTG occurs when individuals formulate more adaptive interpretations or worldviews. PTG is personal growth following a traumatic event and is measured by adaptations in perceived changes in self, relationships with others, philosophy of life, spirituality, and new possibilities."

       Gerber MM, Boals A, Schuettler D. The unique contributions of positive and negative religious coping to posttraumatic growth and PTSD. Psychology of Religion and Spirituality. 2011; 3(4): 298-307. 

 

Dalhousie University

 

Caring for Patients with Dementia - How Do Our Efforts Compare?

     We have much to learn about quality of life, particularly with respect to caring intelligently & compassionately for patients with advanced dementia. Take a look at this powerful (24min) documentary:

Don't We Love to be Comfortable?

     We just love comfort, and really, I mean really, dislike (feel uncomfortable about !) all manner of discomfort. Yet guess what, we live in a sea of change, largely out of our control - an inherently uncomfortable situation! So comfort, if we're being honest, is a brief sporadic experience. Then how can we effectively make the best of the greater part of life?
     What's the absolute worst that can happen to us? This is where we get really freaked out and start relying on luck, statistics, Zodiac signs, favors from extraterrestrial beings etc. Regardless, we will all experience not one, but probably several "shipwrecks" in our life. Even for these worst-case scenarios we have what it takes to not just survive, but use to our ultimate benefit & thrive! See: http://healthyhealers.blogspot.ca/2012/05/self-concept-worldview.html and http://healthyhealers.blogspot.ca/2013/12/health-within-illness-prioritizing.html
     Optimizing our quality of life obviously goes well beyond doing common-sense things to control our environment. And clearly, putting more & more effort into control does not exactly bring happiness. 

     "The world has achieved brilliance without wisdom, power without conscience. Ours is a world of nuclear giants and ethical infants." General Omar Bradley, commander of US ground forces, Normandy invasion, WW II

       “No problem can be solved from the same consciousness that created it.” Albert Einstein 

     We need to spend less time & effort egocentrically obsessing about comfort, and direct more of our limited resources towards being evolved human beings by upgrading our prefrontal cortex & heart. See: http://healthyhealers.blogspot.ca/2012/11/cracks-in-armour-great-gift.html

Dalhousie University on February 13, 2014

 

Remembering to RELIEVE Suffering

‘Relieve’ mnemonic helps one remember the key aspects of a Healing-Oriented Encounter:

            Relationship-centered care, built on …

            Empathy & trust, creates a positive environment where the clinician can …

            Listen to a complicated story that creates …

            Insight into a problem that results in an …

            Explanation that is consistent with the patient’s …

            Values, leading to …

            Empowerment & action toward health.

       Rakel D, Fortney L, Sierpina VS, Kreitzer MJ. Mindfulness in medicine. Explore. 2011;7(2):124-6.

Dalhousie University on a crisp winter morning, February 13, 2014

Allergy Allert: Penicillin, Peanuts, Wisdom

     We instinctively protect what is most central, valuable & meaningful to our life. We bar most people from going there. In time, we ourselves develop a taboo - a discomfort bordering on disgust - about deep introspection - about going to our core identity.
     There are infinite numbers of ways to (temporarily) avoid having an inner life. Our obsession with "keeping busy" works well, and society seems to admire & reward people who are "SO busy." Without mandatory retirement, many opt to work till they drop - an excellent avoidance technique.
     Unfortunately, fear-based avoidance is a painfully narrow, stunted way of being. See: http://healthyhealers.blogspot.ca/search?q=avoidance and http://healthyhealers.blogspot.ca/search?q=discontents Most people live most of their lives in this early stage of psychosocial development, and because they avoid deep introspection, are ignorant of their own state, and the quality of life they're missing.
      Even those intellectually aware of developmental psychology, mythology, spirituality etc, as well as those who consider themselves religious, may have little or no integration of these concepts into their day-to-day lived experience ie like most people, they continue to instinctively protect / avoid - via "intellectual distancing" or "spiritual materialism" - the core of their life. It's a qualitatively different experience having a PhD in sports physiology compared to being aerobically fit, in fact the two have very little in common. One can be highly intelligent & educated, yet behave like a spoiled child or much worse.

     An intentional, intelligent, regular, life-long meditation (or other spiritual) practice - to rediscover, come back home to, & live our lives from the core of who we are as human beings - seems to be required for us to evolve beyond this primitive instinct-driven avoidant behavior that keeps us from what is most important in our lives.

geerie   www.dpreview.com

Predicaments & Problems Differ QUALITATIVELY ... Know the Difference

     Dealing effectively with life's predicaments - existential issues, whether we recognize it or not, is perhaps the most important determinant of our quality of life from middle age & onwards. Carl Jung had a lot to say about this: http://healthyhealers.blogspot.ca/search?q=Jung
     A recurring fundamental error in health care, & life in general, is mistaking predicaments for problems.
     Problems, such as a splinter in the thumb, can & should be solved via relatively quick, simple, often mechanical solutions.  
     Predicaments, such as chronic pain & other existential issues, differ qualitatively from problems. 1st we must recognize that these are NOT problems, but predicaments. 2nd, that effective management requires nothing less than a life-time's maturation toward wisdom. 
     "Wisdom" is completely absent from most health-care & even most liberal arts curricula, therefore, predicaments are generally poorly managed. A healer must take the journey for herself first, only then can she become a useful guide for patients to do the same.

        Hollis J. “Finding Meaning in the Second Half of Life.” Gotham Books, NY, 2005.

        Hollis J. "What matters most. Living a more considered life." Gotham Books, NY, 2009. 

 

Elena Shumilova  http://www.flickr.com/photos/75571860@N06/11874722676/

Openness to Inner Experience

     “We don't see things as they are, we see them as we are.”      Anais Nin

     Is this an obscure mystical fantasy or the literal truth? Does the quality of our inner life determine how we experience the world outside the borders of our own skin? How do you perceive life immediately after feeling betrayed by a loved one or immediately after a cherished project went down in flames? How does that compare with waking up after a great restorative sleep when you feel thoroughly refreshed, alert & crisply aware?

     Despite the fact that the quality of our inner state of being is all-important, most of us tend to shy away from our own inner world & focus almost all our efforts externally, relying entirely on the external world to provide us with a good (or at least OK) quality of life. Reliance on externals including all the distractions & pharmaceuticals (prescribed & under-the-counter), to sustain our inner world, is short-term gain for long-term pain.
     The intelligent, mature approach is to deal directly with the issue - to investigate, with curiosity, our inner state, which is after all the ultimate biofeedback of our life. Our mood, how we feel, has causes AND consequences. How we think also has causes AND consequences.
     We can & must - if we're interested in living a free evolved human life - observe all of this directly & consciously make all necessary adjustments. This is mindfulness practice! Mindfulness-based therapies are making a huge impact, for a reason.

We Love to be Competent, be in Control, have Agency ...

     Most of us are "control-freaks", yet much of the time, we know we're "winging it" - "flying by the sear of our pants". Most of what we do is NOT evidence-based. Heck the vast majority of the agents to which we routinely expose our patients (our families & ourselves) has never even been tested for biocompatibility! With thousands of new chemicals coming on the market monthly, proper biocompatibility testing cannot be done! Does anyone think we should perhaps slow things down a tad?
     Clearly some quality control is essential, and at the same time, we need to realize that we have at best limited control, and with this combination, perhaps help re-orient humanity towards a saner course. The serenity prayer comes to mind: http://healthyhealers.blogspot.ca/2013/07/psychological-health-sense-of-control.html

Rudy Pohl   http://www.flickr.com/photos/rudypohl/sets/

Dental Students' Stress - Focusing Exclusively on Goals

     A very recent systematic review showed that "dental students experience considerable levels of stress during their training. ... sources of that stress are mainly related to academic & clinical aspects of dental training. These elevated stress levels have been shown to have an effect on students’ academic performance, physical health, & psychological well-being." While medical students are known to experience high levels of anxiety & depression, "dental students reported higher stress levels in comparison to medical students."

       Elani HW et al. A Systematic Review of Stress in Dental Students. Journal of Dental Education 2014; 78(2):226-42.

     It's interesting that "examination, grades & clinical requirements" were found to be the main sources of stress for dental students. Does this mean that dental students live well-balanced, meaningful lives - the only source of stress being potential impediments to their goal of becoming a dentist? Were that the case, graduate dentists would be models of evolved conscious human beings. Students may fantasize that a dental (or any other) degree will guarantee a wonderful life. But one's occupation is only a PART of a meaningful, well-lived life.

     IF dental (medical, social work, psychology etc) students could learn to live more meaningful, balanced lives before & during professional training, wouldn't training become MUCH LESS stressful?

Elena Shumilova  http://www.flickr.com/photos/75571860@N06/11874722676/

Is Avoidance Enough?

     Are we living our life completely passively? Is what we do and whom we do it with simply the left-overs from what we didn't manage to avoid? Is avoidance the main choice we make in our lives? See: http://healthyhealers.blogspot.ca/search?q=avoid
      If so, are we not failing to actively go after what truly matters to us, what really has meaning in our lives. Our brief, precious time must be managed carefully to ensure that it is as deeply meaningful as possible.
     All our lives have a certain momentum (inertia - very much like an addiction). To change it towards a deeper, more meaningful direction requires constant awareness. Mindfulness mediation will continually surprise.

Priorities & Quality Control

     We're all busier than we'd like to be, bombarded from all sides by varied demands on our time & attention. "Time-poverty" is a good descriptor. A common way of handling all this is to ignore many of these demands, ourselves, our families, friends ... We even feel we do a suboptimal job of tasks we readily agree to & should enjoy doing, because we feel bugged & overworked. This is a sure recipe for burnout.
     We clearly need to prioritize and say NO to tasks we cannot do well within a reasonable time-frame. Quality control refers to both our work AND quality of life - the two are inseparable.
     We must reduce quantity AND increase quality. We can & must learn to adopt a mindful way of being. See: http://mindfulnessforeveryone.blogspot.ca/2014/02/485-intentionally-opening-awareness.html

Elena Shumilova  http://www.flickr.com/photos/75571860@N06/11874722676/

 

A Psychologically Healthy Workplace - for Health Care Workers!

"What Is a Psychologically Healthy Workplace?

The standard outlined in Psychological Health and Safety in the Workplace (CSA Group 2013) identifies a number of key factors involved in creating a psychologically healthy workplace. These include the following:

• Civility and respect in the workplace
• Supported and valued employees
• Praise, recognition, acknowledgement and fairness
• Growth and development opportunities
• Clear leadership and expectations
• Recognition of the need for balance (personal life, family, work)
• Manageable workloads – responsibilities can be accomplished within the time available
• Adequate resources to do the job
• Workers who have some control over how they organize their work
• Consideration of opinions and suggestions of employees – employees participate in decision-making
• Psychological services and supports available to employees with mental health issues"

       Kitts J. Psychological Health and Safety in Canadian Healthcare Setting. Healthcare Quarterly, 16(4) October 2013: 6-9.doi:10.12927/hcq.2014.23643 

Old Halifax - January 30, 2014