Clinical Hypnosis Workshop - Newfoundland - October 24-27, 2013



Basic Concepts: Motivation in Intentional Behavior

     "Any intentional behavior can be classified in terms of the degree to which it is self-regulated versus regulated by forces outside the self, thus indexing the relative integration of action. A general schema for this is presented in Fig 1. This figure illustrates four types of motivational orientations that can be applied to extrinsically motivated (instrumental) behaviors, and leaves a separate category for intrinsically motivated actions which, although clearly self-regulated, do not have to be internalized. While the labels used for these types of motives may be idiosyncratic, the types of motivation to which they refer are identifiable in other theoretical frameworks under different labels, & also are readily observable in everyday behavior. 

     The most heteronomous form of regulation is external regulation, wherein people perform behavior only because they are either coerced into it, or rewarded for it. Here the regulatory impetus to behavior is external in the classic sense of being literally outside the person. When individuals experience their behavior to be externally regulated, they typically feel controlled or alienated, such that when the external regulatory force is absent, so is the behavioral regulation.

      Introjection represents behavior driven by the dynamics of self- and other approval. Behavior regulated through introjection is characterized by "intemally controlling states" and the guilt and anxiety avoidance that accompany them. Thus, while introjection represents a motivational impetus that is intemal to the person (ie is intrapsychic), it nonetheless remains conflictual & external to the self. Introjection therefore can be understood as a form of partial assimilation or integration. 

     A somewhat more autonomous form of regulation is entailed in identification, which involves the acceptance and personal valuing of an acquired regulation. Identification entails greater autonomy insofar as one's behavior is felt to reflect one's conscious values and identity. Because of this the pressure and conflict associated with introjection or extemal control is somewhat ameliorated. However, despite their relative autonomy, identifications can be more or less isolated or unintegrated with other identifications, introjects, or aspects of personal experience. 

     The ultimate form of "assimilation to self" is that of integration, in which various identifications are organized, or reciprocally assimilated, and brought into congruence with organismic experience as a whole. This crucial transformation completes a process of movement from heteronomy to autonomy or self-regulation. 

     Fig 1 represents intrinsic motivation as a separate category, which, as noted, pertains to behaviors that are done for their inherent satisfactions & thus are not a product of internalization. Intrinsically-motivated behaviors (IMBs) reflect a relatively conflict-free & volitional expression of the self, and have an internal perceived locus of causality. Being a prototype of autonomous regulation, intrinsic motivation is placed on the far right side of the continuum to represent a marker against which internalized regulations can be compared in terms of their degree of autonomy. 

     This schema also includes amotivation (impersonal causality) as a regulatory style, which represents the most impoverished state of integration and autonomy in behavioral regulation. Heider referred to impersonally caused behaviors and outcomes as those that are not intentional & not under personal control. People are amotivated when they do not see action as either (a) reliably connected with outcomes (as in helplessness) or (b) viable given perceived incompetence or lack of environmental supports. When amotivated, a person feels neither competent nor autonomous with regard to acting. Because amotivation represents a nonintemalization of regulation, it, like intrinsic motivation, is presented as a separate category in Figure 1."

        Ryan RM. Psychological needs and the facilitation of integrative processes. J Pers 1995; 63(3): 397-427. 

Fig 1 - Regulatory Styles - Ryan 1995

The Integrative Process in Todays Fragmented Society

     "Social critics ... (are) descriptively correct in pointing to the fragmented & fluctuating character of modern identity. Given the multiplicity of demands within postindustrial economic systems and the absence of stable psychological supports for the individual, people will predictably ex- perience alienation and conflict in many life roles. 

     It may be a rare person who, within our present overstimulating and relationally unsupportive society, is able to experience the preponderance of the 'me's' he or she has internalized as being volitional & congruent. Such a person would undoubtedly have high global self-actualization in the traditional sense.

     But the current perspective would underscore that even when this occurs it is not solely an individual accomplishment — it is an attainment made possible by interpersonal supports that nurture one's security, competence, and freedom. 

     In the postmodern world, it becomes even more necessary to specify the social nutriments required to maintain an integrated "I"within a psychic house crowded with 'me's'."
        Ryan RM. Psychological needs and the facilitation of integrative processes. J Pers 1995; 63(3): 397-427. 

Klaus Nigge   http://photography.nationalgeographic.com/photography/

 

Intrinsic Motivation & Integration

     "The synthetic view of integration in behavior proposes that people are intrinsically motivated to extend themselves into the world and to integrate what they experience — but they typically show this attribute only when afforded supports for autonomy, competence, and relatedness.

     People also inherently prefer to be the 'origin' of their own behavior, as opposed to being regulated by forces outside of the self. This preference is manifest in the processes of internalization and emotional integration, in which external and internal presses to action are actively transformed into self-regulations. However, these latter processes, like those entailed in intrinsic motivation, are also heavily influenced by the nature of contextual supports relating to autonomy, relatedness, and competence."

        Ryan RM. Psychological needs and the facilitation of integrative processes. J Pers 1995; 63(3): 397-427. 

 

Eric Meola   http://photography.nationalgeographic.com/photography/

 

Psychosocial Needs, Growth & Integration

     "Historically, many psychological theorists have assumed that the psyche contains its own natural or inherent principles that promote growth, integration, and the resolution of psychological inconsistencies and conflicts.

     These principles have been described by many constructs, including the synthetic function of the ego; individuation; the actualizing tendency; organization; and the orthogenetic principle.

     Although theories containing such constructs differ greatly in details and tenor, they share the assumption that innate tendencies toward assimilation and integration play a critical role in social development. 

     ... integrative processes are highly dependent upon contextual supports for basic psychological needs. Insofar as the nutriments relevant to psychological needs vary across contexts or domains, so too will the relative strength of integrative propensities, and one's experience of integrity and autonomy in functioning. Contexts where psychological needs are neglected or frustrated promote fragmentation and alienation, rather than integration and congruence.

     Within the framework of self-determination theory there are three essential needs for psychological growth and well-being — the needs for autonomy, competence, and relatedness. Support for autonomy, for effectance, and for feelings of connection with others is argued to be the prerequisite for optimum functioning of these organismic integrative processes."

       Ryan RM. Psychological needs and the facilitation of integrative processes. J Pers 1995; 63(3): 397-427.

 

Roberto Peradotto   www.dpreview.com

It's Not What you do, but How you do it

     "Power and prestige does not come from position or status. It comes from character and integrity."               Unknown 

     A cleaner who does her work conscientiously, with love and respect is a great, evolved human being. An executive who puts any less quality into her work belongs in a lower position.

     “Be always mindful of what you are doing and thinking. So that you may put the imprint of your immortality on every passing incident of your daily life.”    Abd’l-Khaliq Ghijdewani, 13^th century Sufi 

       Walsh R. “Essential spirituality. The 7 central practices to awaken heart and mind.” John Wiley & Sons Inc, NY, 1999.

azagil   www.dpreview.com

Time - Who's Managing Who?

     If “time creates relationship” (anon), then what are we unwittingly creating with our frantic busyness - at work & otherwise?

     "Take the time to reconnect with what healthcare is for you and what it could be…."  

       The 1st International Congress on Whole Person Care  will be held at McGill University, in beautiful, vibrant Montreal - October 17-20, 2013.    Register now: www.wpc2013.ca

We Embody & Teach Our Current Level of Consciousness, for Better or Worse

     "role modeling is the most common form of teaching values, ethics, and the human dimensions of care.

     Unfortunately, the demonstration of undesirable behaviors & attitudes is also effective. Such 'negative role modeling' has been documented to produce unprofessional behavior and even ethical erosion during clinical training. Sometimes referred to as a 'hidden curriculum,' such negative role modeling can be understood as a pattern of behaviors prevalent in a group that runs contrary to the desired & explicitly stated attitudes & behavior of humanistic care. Further, this hidden curriculum undermines the curricular objectives of courses on professionalism, ethics, and 'the art of medicine' that are usually taught during the first two years of medical school.

     Given the pervasiveness of negative attitudes & nonhumanistic behavior, we believe proper role modeling is an important teaching method by which to counter the hidden curriculum modeled by others. 

     How do master clinical teachers develop their teaching skills with respect to the human dimensions of care? In postencounter interviews, the faculty indicated that they use personal self-reflection to develop their teaching skills. Reflective practice has been recognized as an important element of professional development. For the faculty in our study, self-reflection was an iterative process that continued throughout their teaching careers."

       Weissmann PF et al. Role modeling humanistic behavior: learning bedside manner from the experts. Acad Med 2006; 81(7): 661-7.

      It may be safe to assume that those who manifest 'negative role modeling' are much less self-reflective, have minimal awareness of their poor intra- & inter-personal skills, and likely value technical knowledge over communication and other relational ("soft") skills.

     "Physician, Know Thyself!"

fulviavecchia   www.dpreview.com

Holding Patients with Stable, Focused Attention & Acceptance

     "Another important factor in therapy is the therapist’s level of attention, a topic that emerged early on in psychoanalytic thought. In 1912, Freud proposed evenly hovering attention as a critical therapeutic skill. Reik (1948) elaborated on this idea, emphasizing the importance of not fixating attention on any particular subject or object and learning to suspend critical judgment (1948). Modern theorists have continued to offer such recommendations, among them: the therapist should approach each session free of expectation or desire, and the therapist should be aware of their own associations to what emerges from the patient in-session. Despite this ongoing interest in the subject, the ability to maintain focused attention is a known challenge for many therapists.

     Mindfulness meditation offers a highly sophisticated method for both directing attention and engaging in self-exploration to facilitate awareness."

       Ryan A, Safran JD, Doran JM, Muran JC. Therapist mindfulness, alliance and treatment outcome. Psychother Res 2012; 22(3): 289-97. 

 

mjdundee   www.dpreview.com

 

A Life Unexamined? - Physician, Know Thyself!

     A healthy, conscious relationship with one's own emotional life - ie self-awareness & self-acceptance - is rare, not just in patient populations, but equally among clinicians. Unconscious emotions continuously manifest themselves, to our detriment, influencing our thoughts, mood, speech, behavior, and our physical & emotional health.
     As mature adults, we owe it to ourselves & those around us to intentionally, intelligently, gently, progressively, cultivate self-awareness & self-acceptance. Mindfulness meditation is an evidence-based way of doing precisely this. Physician, it's time to know thyself! 
     See: http://mindfulnessforeveryone.blogspot.ca/2013/07/373-how-free-is-our-free-will.html

     "When feelings are frightening, conflicted, or deemed unacceptable they generate anxiety & defence mechanisms that act to blanket this anxiety (Fig. 1). This is usually the fate of emotions in children traumatized, abandoned or neglected by loved ones, who then have feelings of love mixed with rage and guilt about the rage. When these mixed feelings are unconscious to the patient, the subsequent anxiety and defences are also outside of awareness or unconscious. In essence, the rage or anger is turned inward into somatic symptoms both to protect the other person from the rage and to serve as a form of self-punishment for having the rage to begin with. Thus, the child develops the pattern of turning anger inward and is thus prone to somatic complaints, including abdominal pain, headache, depression, personality problems and other conditions. When later life events raise the threat of emotional pain and abuse, the rage is ‘turned inward’ into acute or chronic anxiety & somatization. The other person in the relationship is safe from the rage, but the process exacts a high toll for the adult sufferer through the range of symptoms and behaviours required to contain these emotions."
        Abbass A, Lovas D, Purdy A. Direct diagnosis and management of emotional factors in chronic headache patients. Cephalalgia 2008; 28(12): 1305-14.

Fig 1 - Relationship between unconscious feelings, anxiety, & defenses

Physical Symptoms from Unprocessed, Dysregulated Emotions

     "advances in research suggest that many medical symptoms without identified pathology may actually be caused by problems in psychophysiologic or brain-body pathways, such as abnormalities in smooth-muscle tone in the gastrointestinal tract during stress in patients with irritable bowel syndrome. Recent research also suggests that links between perturbations in brain physiology and physical symptoms are bidirectional. Changes in brain physiology secondary to stressful life events cause functional abnormalities in the body (such as abnormalities in smooth-muscle tone in the gut), and these functional abnormalities in the body are also associated with changes in brain physiology."
     Katon W, Sullivan M, Walker E. Medical symptoms without identified pathology: relationship to psychiatric disorders, childhood and adult trauma, and personality traits. Ann Intern Med 2001; 134(9 Pt 2): 917-25.
 
     "Somatization ... the translation of emotions into the development or worsening of somatic problems or complaints, is a massive burden on patients, physicians, the healthcare system & society in general, accounting for a major proportion of family physician & specialty medical visits, as well as excessive tests, medications & hospital use. Furthermore, it is a major cause of disability, corporate financial loss and probably contributes to early mortality.
     (In one study) 19% of ... sufferers of recurrent headaches were felt to be manifestations of somatization. ... alexithymia, or problems identifying and feeling emotions, was strongly associated with recurrent headache. ... many headache sufferers are psychologically distressed ... poor insight into emotional processes or alexithymia prevented the detection & treatment of these factors. ... there is a need for the development of specific assessment methods to detect relevant emotional and psychological factors in headache sufferers.  
     Specifically, headache sufferers have been shown to have difficulty regulating anger. Many headache patients tend to turn anger inward towards themselves. This effect was experimentally illustrated when migraine patients and controls were subjected to an anger-provoking situation. The migraine patients exhibited significantly less overt anger behaviour & experienced a significantly greater rise in pulse pressure than controls in the anger-provoking situation. ... anger turned inward was the most predictive of headache. Almost half of their sample of headache sufferers scored highly on anger-in, compared with only one-sixth of the matched no-headache control group. The internalization of anger and/ or trouble identifying anger has been found in high rates in patients with conditions such as irritable bowel syndrome (IBS), depression and hypertension, which are often comorbid with headache." 
       Abbass A, Lovas D, Purdy A. Direct diagnosis and management of emotional factors in chronic headache patients. Cephalalgia 2008; 28(12): 1305-14.

Psychic1   www.dpreview.com

How I Feel Affects My Decisions & Patient Care

     "Historically, the prevailing view in medicine is that clinical decisions should be objective and free from contextual affective issues: one could not be objective and rational if emotion entered the reasoning process. Indeed, many of us would consider it a professional virtue to be able to rise above the emotional pull of clinical situations, to deliver cool, clear, analytical judgments. However, despite what we might believe, our feelings (affect) intrude into almost every decision that we make. Our daily interactions with others are influenced by conscious or unconscious social transference phenomena which are affectively polarised in ways that range from subtle to substantial. Similarly, specific clinical situations provoke lesser or greater degrees of affective valence. In fact, our first response to anything is an affective one that governs the future direction of our relations — we tend to trust our first impressions and stick with them. To then understand the role that affective state has in clinical decision making seems important. 

     The best evidence might be degraded when it is unconsciously passed through an affective filter."
       Croskerry P, Abbass AA, Wu AW. How doctors feel: affective issues in patients' safety. Lancet 2008; 372(9645): 1205-6. 


     "Within mindfulness, the busy physician may find a practical place to begin. Through the cultivation of mindfulness, the busy physician can find clues to the self and to the other, as well as to the aspects of inter-being that not only set the intention of the medical encounter but also provide boundless information and the basis for right action."
       Physician, Know Thyself, Michael Krasner, Shambhala Sun, September 2007.

 

snellius   www.dpreview.com

The Inner Child, Unconditional Love, and Relationships with Ourselves & Others

     "The inner child refers to that part of each of us that is creative, energetic, spontaneous, enthusiastic, and fulfilled; what has been called by some the real self, and by others the true self, or the natural child. As children grow up, the natural child, the core of the personality, adapts to and is molded by a set of instructions on how to act to be loved. Being lovable or valued becomes contingent on not only behaving in prescribed ways but also on feeling in prescribed ways. Because love is a potent reinforcer of behavior, the child learns to experience and express primarily those thoughts, emotions, and behaviors that are rewarded by love. Children also learn to repress and deny those parts of themselves that are shamed. The world, as the child experiences it, revolves around the giving and withdrawing of love. Children receive conditional messages - that they are lovable when they act in certain ways but not in others - from their parents, other authority figures, and society. Conditional messages stifle, and even wound, the inner child. ...

     Whitfield, a leading theorist in inner child work ... estimates that 80-95% of people have not received the love, guidance, & other nurturing necessary to form consistently healthy relationships and to feel good about themselves and about what they do."

       Kneisl CR. Healing the wounded, neglected inner child of the past. Nurs Clin North Am 1991; 26(3): 745-55.

     Unless both parents are fully enlightened saints, complete with exceptional child-rearing skills, and an abundance of a wide array of resources including time & money, their child is not likely to receive consistent unconditional love. In short, I doubt if any of us has - and that's OK - we're all in the same boat, and we'll all eventually get through it together.

jeetsupratim   www.dpreview.com

Mindfulness in Medicine, Dentistry, Psychology, Nursing, Physiotherapy, Social Work ...

     "The goals of mindful practice, according to Epstein, ‘are to become more aware of one’s own mental processes, listen more attentively, become flexible, and recognise bias and judgements, and thereby act with principles and compassion’."

        Dobkin PL, Hutchinson TA. Teaching mindfulness in medical school: where are we now and where are we going? Med Educ 47(8): 768-79.

phinhead   www.dpreview.com

Mindfulness Continuing Education Course Significantly Improves Healthcare Workers' Burnout & Well-being

     "Healthcare providers are under increasing stress and work-related burnout has become common. Mindfulness-based interventions have a potential role in decreasing stress and burnout. The purpose of this study was to determine if a continuing education course based on mindfulness-based stress reduction could decrease burnout and improve mental well-being among healthcare providers, from different professions. 
     Design: This was a pre-post observational study conducted in a university medical center. A total of 93 healthcare providers, including physicians from multiple specialties, nurses, psychologists, and social workers who practiced in both university and community settings, participated. The intervention was a continuing education course based on mindfulness-based stress reduction that met 2.5 hours a week for 8 weeks plus a 7-hour retreat. The classes included training in four types of formal mindfulness practices, including the body scan, mindful movement, walking meditation and sitting meditation, as well as discussion focusing on the application of mindfulness at work. The course was offered 11 times over 6 years. The main outcome measures were work-related burnout as measured by the Maslach Burnout Inventory and self-perceived mental and physical well-being as measured by the SF-12v2. 
     RESULTS: Maslach Burnout Inventory scores improved significantly from before to after the course for both physicians and other healthcare providers for the Emotional Exhaustion (p < 0.03), Depersonalization (p < 0.04), and Personal Accomplishment (p < 0.001) scales. Mental well-being measured by the SF12v2 also improved significantly (p < 0.001). There were no significant changes in the SF12v2 physical health scores. 
     CONCLUSION: A continuing education course based on mindfulness-based stress reduction was associated with significant improvements in burnout scores and mental well-being for a broad range of healthcare providers."

       Goodman MJ, Schorling JB. A mindfulness course decreases burnout and improves well-being among healthcare providers. Int J Psychiatry Med 2012; 43(2): 119-28.

     There are likely 8-week MBSR-style Mindfulness courses being offered near you.
     In Halifax, Nova Scotia see:
http://healthyhealers.blogspot.ca/2013/03/8-week-mindfulness-ce-course-for-health.html

Encouragement Nourishes, Criticism Annihilates

     "I have yet to find the man, however exalted his station, who did not do better work and put forth greater effort under a spirit of approval than under a spirit of criticism."                Charles M. Schwab

     See also: http://healthyhealers.blogspot.ca/2013/06/attention-educators-threatened-self.html
 

Amateur Sony Shooter   www.dpreview.com

Embrace - instead of Avoid - the Full Catastrophe of Life

     “an ‘affectionate attention’ … can be cultivated and brought to feeling states, however disturbing or overwhelming, with utter honesty and self-compassion, and in this way, contribute to a profound experience of freedom and the possibility of healing wounds, both old and new.”
       Jon Kabat-Zinn

       Santorelli S. “Heal thyself. Lessons on mindfulness in medicine.” Bell Tower, NY, 1999. 

 

Zol Straub   www.dpreview.com

Belief Systems AND Psychosocial Maturity?

      "Religion is important to people. Returning to the words of William James, it deals with 'whatever is seen as most primal and enveloping and deeply true'.
     However, if religions are captured by the ego habits of the outer mind and used to comfort and aggrandize the outer self, the mixture can become explosive. The dualities of a good me & mine versus an evil other soon follow, and shortly 'ignorant armies clash by night.'
     Yet religion may also be the institution in society that most readily specializes in the center of the mandala, in those faculties of the human that might lie below the surface of the mind or dwell beyond the mind altogether (which, as we have seen, does not have to be given a theistic interpretation). There are presently spiritual renewal movements in all the major religions. What magic might happen were each religion to find and embrace its own inner wisdom path?"
       Eleanor Rosch, Professor, University of California, Berkley
       "Beginner’s Mind: Paths to the Wisdom that is Not Learned" in Ferrari M, Potworowski G, eds. “Teaching for Wisdom: Cross-Cultural Perspectives on Fostering Wisdom.” Heidelberg: Springer. 2008.

      See also "Faith?": http://healthyhealers.blogspot.ca/2012/03/faith.html

CM Tam   www.dpreview.com

Self-awareness & Comfort with Intimacy - Critical Clinical Skills

     Gradual self-disclosure, after a reasonable length of time, within a safe group setting, occurs naturally in mindfulness meditation, Balint & other groups. Such de-armoring processes are profoundly healthy and liberating.

     "The most powerful insight of the (physicians' peer support) group has been to connect the personal to the professional in our lives. Our professional stress and our personalities now seem so clearly linked that it makes sense to process troublesome work issues at the level of our ego defenses and the psychodynamics of our relationships. That the process of strengthening our person strengthens our work should be no surprise because medical practice is an inherently personal task built around relationships and individuals dealing with difficult existential issues - illness, suffering, loneliness, meaninglessness, & death. As self-awareness and comfort with intimacy develop, we apply new understanding and skill to our clinical work."

       Eubank DF, Zeckhausen W, Sobelson GA. Converting the stress of medical practice to personal and professional growth: 5 years of experience with a psychodynamic support and supervision group. J Am Board Fam Pract 1991; 4(3): 151-8.

 

microsurgeon   www.dpreview.com

Important - but Usually Burried - Stressors for Physicians

     "Our (physicians' peer support group) meetings for the first year were formal, with careful selection of comments and an intellectual approach to emotional and psychological problems. ...
     After almost 2 years of discussing patients, we gradually began to focus directly on each member's feelings, reactions, & interpersonal dynamics, whether generated by a patient or by family or personal events. It became apparent that our problems with patients had roots in our personalities & experiences extending beyond the immediate practice setting. ... The turning point was a deeply personal presentation of a terminally ill patient that evoked the presenter's own fear of death. Feelings have gradually replaced intellectualization as we find the issues critical to our professional performance to be related more to our own marital discords, fears of death, failures to live up to our own goals as parents & persons, and feelings of incompetence or uncertain self-esteem. In essence, to reduce stress and do our clinical work well, we find that we must deal with our own unfinished business with parents and childhood raised by the day-to-day work of patient care.
     As the group has evolved, we have come to link our personal emotional health & growth with our professional performance & growth. ... the physician-patient relationship & the personhood of the physician (are) at the crux of a physician's work. With this approach, the personal issues of working (isolation & competitiveness, judgment, errors, wealth & personal value, limit setting, & relating to partners) and the existential human issues of practice (suffering, loss, & death) become the focus of group work."
  
     Eubank DF, Zeckhausen W, Sobelson GA. Converting the stress of medical practice to personal and professional growth: 5 years of experience with a psychodynamic support and supervision group. J Am Board Fam Pract 1991; 4(3): 151-8.

Nate Dogg   www.dpreview.com

Peer Support Groups for Physicians & Other Clinicians

     "Peer support groups designed to integrate clinical supervision and personal psychodynamic insight can offer medical communities an effective approach to prevent disillusionment and dysfunction through stress reduction. Such a model is used to train & support pastoral counselors and the clergy. We believe it is appropriate to adopt this model for physicians because practicing medicine has distinct parallels to ministering, and the stress of both professions comes from similar sources - the connexional, existential, spiritual, & psychodynamic. ...
     Over the years, the focus of (our support) group has evolved from discussions of patient care to explorations of personal values & feelings, approaching the practice of medicine through its human components: dying, fear, anger, intimacy, competition, mistakes, competence, & separation-individuation. We see our stress as deriving from the difficulty of facing these issues, particularly in the context of doing healing work. In the process, we have experienced the validity of (one of our) member's comment: 'The concept that there is a professional ego suitable for training and a personal ego to be left alone ... (wears thin); there is really only one ego.'
     ... all persons in the profession have unresolved personal issues and conflicts that need to be addressed for them to function optimally as therapists." 
 
       Eubank DF, Zeckhausen W, Sobelson GA. Converting the stress of medical practice to personal and professional growth: 5 years of experience with a psychodynamic support and supervision group. J Am Board Fam Pract 1991; 4(3): 151-8.

Galatia N   www.dpreview.com

Collaborative instead of Adversarial; Governance instead of Government

     There's a pattern to conflicts: each of the opposing parties claims to be right, consciously or unconsciously ignoring their own contribution to the problem, and consciously or unconsciously ignoring the other party's positive attributes. In the gray zone, between these polar opposites sit: reality, mediation & productive, vibrant collaboration. To get here, the consciousness of the players has to rise from the brain stem (reptilian reactivity, primitive emotions) to the pre-frontal cortex (mature judgment, executive function). When ego battles ego, it can be a fight to the death, be it career, family, or actual life - sometimes all three. When the ego is put aside, human beings are capable of living harmoniously and amazing collaborative achievements. Wisdom is hypo-egoic.
     External forms of control, be it from professional disciplinary boards, legal system, or fear of punishment from a metaphysical source, don't work well for today's adults. When one is in a reptilian state of reactivity, one is fully identified with one's own agenda - it can feel like a life or death struggle. One's self-concept feels under attack. One of the 8 key principles of adult education is that "a threatened self-concept diminishes learning."
       Pinney SJ et al. Orthopaedic surgeons as educators. Applying the principles of adult education to teaching orthopaedic residents. J Bone Joint Surg Am 2007; 89(6): 1385-92.

     Our behavior - when we're being rational - is mostly controlled from within, by our own conscious and unconscious sense of meaning, values, self-concept & worldview. This conglomerate can be summarized as one's "internal compass" (operating system in computer lingo) in that it has a powerful pervading effect on all aspects of our life, though the details may be largely subconscious ("a life unexamined ..."). Intentional, conscious awareness & upgrading of this internal compass appears to be the necessary path toward wisdom & wise behavior for all, but for us, individually & as a profession, it's a professional obligation.
     Professions being "self-governing" refers to "governance" vs being controlled from the outside by "government". Governance in a profession is akin to an individual's "internal compass." This concept, unlike "government" involves "the notion of internal regulatory processes (that may evolve naturally, even spontaneously, within any complicated set of human arrangements … is – or can be – a benign form of collective autonomy within a set of social arrangements such as organised health care. … the emergent will of the practitioners concerned. … hold those values or visions authentically …  
     Perhaps being ‘left to their own devices’ is the key point here. The assimilation of a particular conception of medicine into the internal processes of governance is something quite different from imposition. It allows the emergence of a particular culture (perhaps, beginning as a counter-culture) that recognises as important certain values and visions such as a careful attention to the patient’s unspoken and spoken wishes alike and that absorbs them organically and authentically, expressing them as part of a self-imposed collective expectation of standards of practice.”
       Evans HM. Affirming the existential within medicine: medical humanities, governance, and imaginative understanding. J Med Humanit 2008; 29(1): 55-9.

     Doesn't (group) governance merely reflect the collective level of consciousness or wisdom of its individual members? And if so, what are we as individuals, as professional organizations, and universities doing to raise our consciousness & cultivate wisdom?

senn_b   www.dpreview.com

Human Knowing - Passion of the Scientist, Precision of the Poet

      “When we honor the hidden aquifer that feeds human knowing, we are more likely to develop a capacity for awe, wonder, & humility that deepens rather than diminishes knowledge. And we are less likely to develop the kind of hubris about our knowledge that haunts the world today. So much of the violence our culture practices at home and exports abroad is rooted in an arrogance that says, ‘We know best, and we are ready to enforce what we know politically, culturally, economically, militarily.’ In contrast, a mode of knowing steeped in awe, wonder, & humility is a mode of knowing that can serve the human cause, which is the whole point of integrative education.
     Human knowing, rightly understood, has paradoxical roots – mind & heart, hard data and soft intuition, individual insight and communal sifting and winnowing – the roots novelist Vladimir Nabokov pointed to when he told his Cornell University students that they must do their work ‘with the passion of the scientist and precision of the poet.’ Integrative education aims to ‘think the world together’ rather than ‘think it apart,’ to know the world in a way that empowers educated people to act on behalf of wholeness rather than fragmentation.”

       Palmer PJ, Zajonc A. The heart of higher education: A call to renewal. Transforming the academy through collegial conversation. Jossey-Bass, San Francisco, 2010.

Koen De Houwer   www.dpreview.com