Avoidance - very common, but futile

     It's only with continuous, conscious effort that we become aware of the extent to which primitive approach-avoidance instincts dominate our lives. And it doesn't matter how sophisticated we are (read Joan Didion's "The year of magical thinking"), nor does belonging to a religious group make a difference. Do you get hungry and gravitate toward food? Do you seek shelter in a sudden downpour? Of course, but how do you respond to sickness, old age and death?
     Many of us, again regardless of sophistication, intellectual knowledge of the subject, or belief system, nevertheless avoid, suppress, and otherwise fail to deal in a healthy manner with these existential facts. It's scary, so we avoid, simple as that. We keep trying hard to "avoid" what CANNOT be avoided!
     When I was younger, it was as if "old" people were members of a different species - like butterflies with a two-day lifespan compared to my endless decades. Now I look at people of any age - even in their 90's - as being fully alive, like me, but not different. "We are - (ALL) - so lightly here!"

See also: http://healthyhealers.blogspot.ca/2012/11/compulsiveness-of-physicians-dentists.html 
and: http://www.johnlovas.com/2013/01/shine-light-of-awareness-embrace-process.html

Gimli, Lake Winnipeg

We're 'at home' and 'all in the family'

     "A human being is a part of the whole, called by us ‘universe’, a part limited in time and space. He experiences himself, his thoughts and feelings as something separated from the rest—a kind of optical delusion of his consciousness. This delusion is a kind of prison for us, restricting us to our personal desires and to affection for a few persons nearest to us. Our task must be to free ourselves from this prison by widening our circle of compassion to embrace all living creatures and the whole nature in its beauty. Nobody is able to achieve this completely, but the striving for such attainment is in itself a part of the liberation, and a foundation for inner security."

Albert Einstein New York Times, March 29, 1972

Photo: ligusia81   www.dpreview.com

Burnout as Existendial Deficiency

     "... it is generally agreed that people afflicted by burnout experience huge problems and suffering. ... an interpretive analysis revealed signs of existential deficiencies in the lived experience of the people afflicted. ... a discord between the people and their work, a blindness towards their own actions, bodily illness as signs of burnout, experiencing a collapse as a 'crossroad', secondary suffering related to the social system and a struggle towards a way out.

     ... three levels of life: actions, values and universal existence... Unless a person is in contact with [ALL] three dimensions, he/she seems to find it difficult to maintain health in his/her encounters with life. 

     Implications for health care are existential interest on the part of caregivers and understanding of life as signs of universal values. Patients''shut off' and restrained longings understood as signs of 'darkness' in their understanding of life may induce caring acts on the part of caregivers that offer patients an opening and a glimpse of what it might be like to find health in the midst of their suffering. The caregivers' own natural light of understanding of life can then work as a caring component."

         Arman M, Hammarqvist AS, Rehnsfeldt A. Burnout as an existential deficiency--lived experiences of burnout sufferers. Scand J Caring Sci 2011; 25(2): 294-302.

Photo: clelli   www.dpreview.com

To truly help, instead of being a nuisance

     “the closeness of death brought about an awakening and a disclosure of life and its value among the women (with breast cancer). Life suddenly becomes more beautiful, valuable and worth fighting for. The transformation of one’s life perspective seemed to encourage introspection, resulting in an increased awareness of personal needs and desires as well as of the meaning of life. But it also places greater demands on a person to make certain resolutions, accept greater responsibility for his/her life and to be true to oneself. The struggle to adopt a new and less limited life paradigm based on desires and values requires creativity, courage, and creative forces and could be seen as a sign of the person’s ability to live in health. Supportive relationships are of decisive importance in the individual’s struggle for a new life. When one’s previous life style and habits or lack of support prevented the realization of one’s new resolves, suffering resulted and the patient felt as if she was stuck in a rut. To be in the flood of renewed openness and awareness of existence truly challenges the person’s expansive and creative forces. 

     From a caring perspective the question must be raised: are those of us working in health care aware of the width of experiences and depth of suffering of our patients? In an awareness of the dialectic between life and death, meaning and meaninglessness that the patients are living under, it is important that the creative forces the patients are developing are understood and supported to help detection of sources of strength and a desire to live. The patient’s increased openness to her own needs and desires are a valuable aid in the effort to improve her health. Patients can achieve a balance through an open attitude towards life and death. It is necessary that nurses [ * ALL HEALTH-CARE PROFESSIONALS * ] have the courage to enter a caring encounter and support their patient’s inner demands for authenticity. Nurses need as well to adopt a view of the necessity of seeing their suffering patients’ creative struggle for balance and health. In the dialectic, the contradictions and the struggle itself is a hidden potential for health.”

         Arman M, Rehnsfeldt A. Living with breast cancer - a challenge to expansive and creative forces. Eur J Cancer Care 2002; 11(4): 290-6.

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Authentic Undivided Life

     "Our colleges and universities need to encourage, foster, and assist our students, faculty, and administrators in finding their own authentic way to an undivided life where meaning and purpose are tightly interwoven with intellect and action, where compassion and care are infused with insight and knowledge. In some contexts it may make sense to distinguish between facts and values, but they should never be reified into divisions that fragment us and our world.”
 
         Palmer PJ, Zajonc A. The heart of higher education: A call to renewal. Transforming the academy through collegial conversation. Jossey-Bass, San Francisco, 2010.

     See also: http://healthyhealers.blogspot.ca/2012/02/no-boundaries.html

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Affective dispositions of Critical thinking

      "Critical thinking (CT) is essential to the exercise of professional judgment."

       Huang YC et al.  Case studies combined with or without concept maps improve critical thinking in hospital-based nurses: a randomized-controlled trial. Int J Nurs Stud 2012; 49(6): 747-54.

     CT has two dimensions: Cognitive skills & Affective disposition. 

     Affective dispositions of CT, as seen in approaches to life and living in general include:

* inquisitiveness with regard to a wide range of issues,


* concern to become and remain generally well-informed,


* trust in the processes of reasoned inquiry,


* self-confidence in one's own ability to reason,

* open-mindedness regarding divergent world views,


* flexibility in considering alternatives and opinions,


* honesty in facing one's own biases, prejudices, stereotypes, egocentric or sociocentric tendencies,


* willingness to reconsider and revise views where honest reflection suggests that change is warranted.

         Facione PA. “Critical Thinking: A Statement of Expert Consensus for Purposes of Educational Assessment and Instruction.” 
The Delphi Report. Executive summary. The California Academic Press, Millbrae, CA, 1990.

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Adult development & Age-related decline

     The liberative model of adult psychological development is "defined by an increasing freedom from biological and social determinism" and seems to offer "the greatest promise for a universal theory of adult development. ... (It is) guided by an overarching developmental perspective that features conscious development as an explanation for behavioral change."

     The inevitability of age-related "declines has been greatly exaggerated. ... Different wisdom traditions, including western Platonism and eastern Taoism, place self-knowledge at the center of adult development."

     Levenson MR, Crumpler CA. Three models of adult development. Human Development 1996; 39: 135-149.

      “I know of no more encouraging fact than the unquestionable ability of man to elevate his life by conscious endeavor.”                Henry David Thoreau

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The sense of Dissonance - When the world fails to make any sense ...

     “But what happens to us when something occurs that does not fit into (our) expectations of the world? What happens when the unexpected occurs and our past experiences and all of our values, beliefs, and assumptions no longer help us in making meaning? What happens when our world is turned upside down and inside out and we are disoriented?

     Students entering clinical pastoral education [[ medicine, nursing, dentistry ... life! ]] are often unprepared for what they experience. Encounters with the ‘living human documents,’ with deaths, traumas, and codes, with peers in the group and with supervisors are challenging. Students are off-balance and reeling emotionally and spiritually. 

     We basically have two main options when we experience the unexpected. The first option is to simply reject the unexpected through denial, repression, or some other coping mechanism and thus hold fast to our familiar values, beliefs, and assumptions. The second option is to open ourselves up to begin the process of critically questioning and reflecting upon our unexamined expectations. 

     Patricia Cranton writes, ‘When people critically examine their habitual expectations, revise them, and act on the revised point of view, transformative learning occurs.’” 

        Jones LC. You learn it in your heart: transformative learning theory and clinical pastoral education. J Pastoral Care Counsel 2010; 64(4): 1-10.

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Promoting Mindfulness in Health-care

     Evidence has repeatedly shown that normal psychosocial development / maturation tends to be at least temporarily arrested during dental and medical training. Cynicism tends to replace idealism, and "clever nihilism" festers.

         Cohen MJ et al.  Identity transformation in medical students. Am J Psychoanal 2009; 69(1): 43-52.
         Meserve C et al. Clever nihilism: Cynicism in evidence based medicine learners. Medical Education Online 2005; 10: 1-9.

     "To transform a transition from a threat to a learning opportunity, medical education should assist students and doctors in developing the coping skills they need to effectively deal with the challenges presented by new environments.”
       Teunissen PW, Westerman M. Opportunity or threat: the ambiguity of the consequences of transitions in medical education. Med Educ 2011; 45(1): 51-9.

     See also: http://mindfulnessforeveryone.blogspot.ca/2013/11/432-i-try-and-i-try-but-i-cant-get-no.html

     Mindfulness practice promotes normal psychosocial maturation - towards greater empathic connection with others & environment (counteracting the above-mentioned disruption). Mindfulness is increasingly being taught at the post-secondary level, in medicine, dentistry, dental hygiene, nursing, chiropractic, veterinary medicine, design / architecture, music, business, law, liberal arts, etc.

         Lovas JG, Lovas DA, Lovas PM. Mindfulness and professionalism in dentistry. J Dent Educ 2008; 72(9): 998-1009.

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Maturation = Transformation - for individuals to organizations

     While we health-care professionals tend to see ourselves as highly rational individuals, capable of detached scientific objectivity (re: work-related matters, at the very least), we are in fact entirely human ie motivated more by emotions than reason.

     When left unchallenged or not fully understood, our attitudes and beliefs are major barriers to evidence-based decision-making and behavior.

Matthew-Maich N et al. Transformative learning and research utilization in nursing practice: a missing link? Worldviews Evid Based Nurs 2010; 7(1): 25-35.

 

     "Transformative learning is the process of examining, questioning, validating, and revising our perceptions of the world. It is a theory about change, fundamental and sometimes dramatic change, in how we see ourselves and the world around us. People who have experienced transformative learning are conscious of doing so; others can also recognize it. For example, a racially prejudiced person who, through transformative learning, comes to value and respect those of different races not only perceives this fundamental change of perspective but is perceived to have undergone a fundamental change by others."

          Henderson GM. Transformative Learning as a Condition for Transformational Change in Organizations. Human Resource Development Review 2002; 1(2): 186-214.

“transformative learning is a process whereby individuals engage in critical reflection to develop new perspectives, skills, and behaviors.

the process begins with experiencing a disorienting dilemma, which is a life event that causes the learner to pause and question underlying beliefs and assumptions.

The next and perhaps the most important phase is critically reflecting on the disorienting dilemma to expose the learner’s limitations and areas for improvement.

The learner then addresses these limitations by acquiring new knowledge, skills, or attitudes.

Ultimately, these newly developed skills will transform the learner by providing him or her with fresh perspectives and powerful means for enacting improvement.” 

         Wittich CM et al. Perspective: Transformative learning: a framework using critical reflection to link the improvement competencies in graduate medical education. Acad Med 2010; 85(11): 1790-3.

      See also: http://healthyhealers.blogspot.ca/2013/06/transformational-learning-like-aging-is.html

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Conscious ethical judgments

     “it is ethics that to a large extent determines the very nature of the relationship between individual and society   Markova (1990) 

     Reflexive ethics is characterized by consciousness: people make ethical judgments deliberately, based on the knowledge and critical evaluation of the matter. Nonreflexive ethics, in contrast, refers to obeying rules and applying them without individual thought. ... basically human ethical thought is reflexive. However, much of it turns into routines and unthinking practices when it becomes part of established tradition and custom, like ethical customs of a profession."

         Myyry L. "Components of Morality - A Professional Ethics Perspective on Moral Motivation, Moral Sensitivity, Moral Reasoning and Related Constructs Among University Students." PhD Thesis, University of Helsinki, 2003.  
http://ethesis.helsinki.fi/julkaisut/val/sosps/vk/myyry/

     How conscious are my relationships to people, events, things?

     Do I hesitate, or resent my right hand for helping my left hand? How big a deal is it when one of my hands scratches an itch on my own body? Do I treat others very differently than myself?

Photo: Chetan Soni   www.smithsonianmag.org

Win or Lose?

     When I saw how Usain Bolt behaved at the recent summer olympics, I honestly feared for his future. The olympics were the highest point in his life - and now what? All I could think of was Bruce Springsteen's song "Glory Days" (below).

     On the other hand, when Jared Connaughton took ownership of causing his Canadian team's loss of the bronze medal in the 4x100 meter run, I felt that this was the low-point in his life, but that he had what it took to mature further into a worthy human being.
     BUT, if one is exclusively focused on the hope that "if only I can have X, then I'm guaranteed happiness", then Bolt is a "winner", Connaughton a "loser", end of story. Such a rigid, goal-oriented, perfectionistic mindset aims to control life, but of course can't.
     External stuff is impossible to fully control, may not be obtainable regardless of one's efforts, loses its appeal sooner or later even when we do manage to obtain it, etc etc. So putting all of one's hopes on externals is sadly deluded.
     One's character or quality of being is the only thing that one has good control over and that can progressively grow or mature.

Simple reality check

     “Sometimes it is good to make a simple reality check about the latest edition of ‘The Drama’ (playing on an inner screen near you). Ask yourself, ‘What is this, in the light of my own death? What will it be a hundred years from now?’ It is extraordinary how little will truly pass through that filter, and how freeing it is to see that it is so. Let it go, let it go. You will never die of letting it go. You may well die of holding on to it like grim death.”

     Murphy S. Upside-down zen. Finding the marvelous in the ordinary. Wisdom Publications, Boston, 2006.

Photo: bluemoonman   www.dpreview.com

Adult psychosocial development - Maturation

     "Four central features of wisdom (are recognized) in both European and Asian philosophy: self-knowledge, detachment, integration, and self-transcendence. … 
     (These) four features can be conceptualized as developmental stages.

      Self-knowledge is awareness of what constitutes one’s sense of self in the context of roles, relationships, and beliefs.
     Detachment refers to awareness of the transience of external aspects of one’s sense of self.
     Integration means overcoming the separation among different ‘inner selves,’ that is, accepting and integrating all facets of one’s self.
     Finally, self-transcendence refers to independence of the self of external definitions and dissolution of mental boundaries between self and others. … ‘self-transcendence is equivalent to wisdom and implies the dissolution of (self-based) obstacles to empathy, understanding, and integrity’.”
       Staudinger UM, Gluck J. Psychological wisdom research: commonalities and differences in a growing field. Annu Rev Psychol 2011; 62: 215-41. 

     In contrast, parochialism is defined as the quality or state of being parochial; especially : selfish pettiness or narrowness (as of interests, opinions, or views). http://www.merriam-webster.com/dictionary/parochialism

Photo: Zoltán Balogh   www.smithsonianmag.com

 

Spirituality OR Science ???

     On Aug 9, 2012, the New York Times published an interesting article: "Merging Spirituality and Clinical Psychology at Columbia" by Sharon Otterman. Critics of the program stated: 
     “From my perspective, psychology must remain neutral. ... With the assumption that we are inherently spiritual beings, I worry that therapists who come out of such a program are going to be approaching their clients with this expectation that they have to contact their spirituality, and I don’t know where that is going to leave some clients." http://www.nytimes.com/2012/08/10/education/columbia-program-merges-therapy-and-spirituality.html?pagewanted=2&_r=1&emc=eta1 

     A major difficulty is that many scientists - and patients - have minimal understanding of spirituality, and may well have personal biases against it - ignorance & bias cause train wrecks, not advances in quality of life. Difficult yet important areas like spirituality need intelligent, unbiased, high-level inquiry.
     Sharon Daloz Parks is Associate Director and Faculty at the Whidbey Institute, and formerly associate professor at the Harvard Divinity School and the Weston Jesuit School of Theology. She's also served in faculty and research positions at the Harvard Business School and the Kennedy School of Government. Here's her take on 'faith' - but you could equally refer to it as 'spirituality': 

     “… faith must be emancipated from its too-easy equation with belief & religion, and reconnected with … matters of truth, reality, and ultimate importance. … personal, affective, visceral, and passional dimensions of being and knowing.
If faith ( meaning-making in its broadest sense ) is discounted, the human landscape becomes arid, and hope and commitment wither; the human spirit grows parched, and not much more than a prickly cynicism can be sustained.
      Faith understood as static, fixed, & inextricably bound to a particular language or world-view, must be discarded as obsolete, if the integrity of intellect & soul is to be maintained in a dynamic world.
      Cynicism functions as a kind of armor against disappointment & despair. Skepticism combines the power to question with an openness to being convinced. Skepticism can be a healthy form of doubt, or it may reflect the loss of a once-shared trust in a universe of meaning, however that was defined. It may also function as a thin veneer of public sophistication, glossing over a private, lonely void that neither the rational mind nor economic success can fill. (intellectual bypassing)
      In our time, we have become at once scientifically informed, philosophically relativistic, and disappointed and disillusioned in many quarters. Yet ironically (meaning) can come alive in an engagement with radical uncertainty.”
        Parks SD. "Big questions, worthy dreams. Mentoring young adults in their search for meaning, purpose, and faith." John Wiley & Sons, San Francisco, 2000.

Photo: Amanda Mack   www.smithsonianmag.com

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Zen & the Art of Relating to Difficulty vs Avoidance

     “What we repeatedly do becomes what we are. The practice of sitting and breathing to still the mind is the practice of being just what you are – it is enlightened being. Yet it can be hard at times to bend the will to keep the appointment with practice. We humans seem to fear what seems hard and we long for comfort, even though we keep discovering that the greatest treasure is what we find in ourselves at the far end of any really challenging process. But the difficult path is always the path of genuine life: difficulty makes the Way genuine. Meeting with fear of difficulty is an act that sparks with creative energy. Avoiding is finally the more demanding and costly battle. Practice is a commitment to cease choosing avoidance, to refuse to walk through your life as a ghost.”

        Murphy S. Upside-down zen. Finding the marvelous in the ordinary. Wisdom Publications, Boston, 2006.

     See also: http://www.johnlovas.com/2013/01/shine-light-of-awareness-embrace-process.html

Photo: erringtont   www.dpreview.com

 

Cheap knockoffs & Meaning

     I just received a flyer from an ice-cream chain - bold print on top "INDULGE" - below a full-page color photo of an ice cream cone - at the bottom: "Find Happiness Within^TM”. How many times have sports fans loudly proclaimed after their team's win "It doesn't get any better than this!"? The bar can't possibly be set any lower to qualify as a "true hero," or "brilliant"!

     Clearly we deeply value ultimate inner happiness, as well as the superlatives we've come to associate with such happiness. But we're also attracted to shiny, easily accessible things like fish to spinning lures. Even if we know the shiny thing is junk, or even harmful, we want it - instant gratification. This is why advertisers and the media assume that many of us will settle for cheap substitutes - $10 'Rolex' watches are everywhere. Quickly, easily grabbing something of real value can't be done (purse-snatchers excluded), so most of us settle for cheap imitations of the real thing (not Coke) we desire.

     Conversely, we tend to avoid things that are difficult and take a long time to obtain, even though these may be highly beneficial eg aerobic fitness, ideal body weight, proficiency in a second language, mastery of a musical instrument, and most importantly - wisdom.

     Some years ago, they took a group of young children and let them eat whatever they wanted from a buffet-style layout at each meal for a few weeks. Initially, most gorged themselves on cake, ice cream and candy. Gradually, however, they spontaneously ended up eating well-balanced meals. Their bodies let them know what was needed - 'whole body learning'.

     Regardless of what we know intellectually, it seems that most of us need to directly, physically experience, "get a belly-full of" cheap substitutes (ad nauseam) before we're ready to pursue a deep, meaningful engagement with life. "Better late than never." AND with a bit of luck, we can start a disciplined journey toward meaning before hitting rock bottom.

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"What would I do with myself for 'all that time'?"

     I know a number of people who truly fear open, unstructured time. They externalize their phobia of stillness and introversion by complaining about boredom - implying that their minds can't stop being useful AND that the world depends on it! *** They take short, action-packed vacations and always take smart phones along, so any moments of down time can be filled, like a hole. Like a hole in a dyke. 

     But what might pour in through that hole? The dyke separates our dry, structured, "controlled" life from the ocean of reality. What if we get wet - soaked? Can we swim? Can we enjoy swimming?

     *** Someone once said that whenever he starts to feel irreplaceable and important, he remembers that JFK was replaced within 20 minutes of his assassination.

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Vacation? Remember what one feels like?

     For me a true vacation is a complete get-away - leaving behind all my professional cares and responsibilities to such an extent that if suddenly asked what I did for a living, I should have to think a bit before being able to answer. Such a shift releases aspects of myself - particularly creative, artistic, care-free aspects - that are normally locked away in long-term storage.

     I think that it's essential to revisit and revive our youthful subpersonalities on a regular basis, lest we risk losing them - and ourselves - completely. Retirement is around the corner for ALL of us - let's not get stuck with work as our sole identity!

     Even taking off on an airplane releases me from normal work-related as well as most other daily concerns. All sorts of creative ideas float to the top. I even thoroughly enjoy having tomato juice on flights - not the wildest indulgence, but it does suggest an interesting shift.

     When I take 3 weeks in a row for holidays (AND spend none of it working) I get a bit of the sense of those childhood "endless summers" when I truly felt like the summer went on forever ... and actually looked forward to going back to school for a change. Don't we all need to feel THAT revitalized?

Bradford Naugler at the Annual Lunenburg Folk Festival - Aug 5, 2012 - http://www.folkharbour.com/

Tyranny of Perfect Masks

     “every state [& individual] wants to feel secure, but it is doomed in this quest because the very steps it takes to feel more secure almost always makes other states [& individuals] feel less secure. The result is a sort of escalating uneasiness, a trap that ultimately makes everyone less safe.”

       Ramo JC. The Age of the Unthinkable. Why the New World Disorder Constantly Surprises Us and What We Can Do About It. Little Brown & Co, NY, 2009. 

     "‘masked and armored’ ... is not the safe and sane way to live. If our roles were more deeply informed by the truth that is in our souls, the general level of sanity and safety would rise dramatically." 

        Palmer, P.J. A hidden wholeness: The journey toward an undivided life – Welcoming the soul and weaving community in a wounded world. John Wiley & Sons, San Francisco, 2004. 
 

     "Our fear of being exposed in a culture where everybody else is wearing a mask can be a major obstacle to our reaching out for help. This is why it is so crucial to have a trusted circle of people that can give you that sense of belonging and of community."

        Some SE. The spirit of intimacy. Ancient teachings in the ways of relationships. Berkeley Hills Books, Berkeley CA, 1997.

$2.4 million dollar Bughatti