Many Causes of Trauma & PTSD

     Individuals vary in their sensitivity (vs resilience) to trauma. There's a much wider variety of possible sources of trauma than most of us suspect.

     “While some people are able to recover from trauma on their own, many individuals do not. 
     Tens of thousands of soldiers are experiencing the extreme stress and horror of war. Then too, there are the devastating occurrences of rape, sexual abuse and assault. 
     Many of us, however, have been overwhelmed by much more ‘ordinary’ events such as surgeries or invasive medical procedures. Orthopedic patients in a recent study, for example, showed a 52% occurrence of being diagnosed with full-on PTSD following surgery. 
     Other traumas include falls, serious illnesses, abandonment, receiving shocking or tragic news, witnessing violence and getting into an auto accident; all can lead to PTSD. 
     These and many other fairly common experiences are all potentially traumatizing. The inability to rebound from such events, or to be helped adequately to recover by professionals, can subject us to PTSD – along with a myriad of physical and emotional symptoms.”

       Levine PA. "In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness." North Atlantic Books, 2010. 

The Scream by Edvard Munch

Trauma, Posttraumatic Stress Disorder - AND / OR - Growth

      "Over millennia and across disciplines, some variant of Nietzsche’s (1889) maxim ‘What does not destroy me, makes me stronger’ has resonated with scholars and laypersons alike. It serves as a poignant and compelling reinforcement to Tedeschi & Calhoun’s claim ‘that suffering and distress can be possible sources of positive change’. Emerging findings from the domain of posttraumatic growth (PTG), which involves a belief that one has grown through adversity, offer empirical corroboration of such claims as well as conceptual models that articulate the process and potential outcomes of dealing with life’s exigencies.
      Similarly, coping with very difficult, challenging life events has also been linked with wisdom, an ancient construct currently enjoying an academic renaissance within the field of psychology. Against very positive background characteristics (e.g., experiences of love, support, self-actualization), wisdom is believed to be partly forged in the crucible of difficult life experiences; graduates of the school of ‘hard knocks’ are assumed to manifest particular psychosocial strengths as a consequence of successfully negotiating life’s serious conundrums.
     Recently, these two independent research streams have been conceptually linked but not empirically tested. The types of cognitive-emotional processing of trauma-related information may serve as a catalyst for both posttraumatic growth and wisdom. Trauma, by definition, is a requirement for PTG. In contrast, trauma is not necessary for wisdom, and wisdom is enabled and enhanced by non-traumatic, positive life events as well (e.g., peak experiences, success, loving relationships)."
       Webster J, Deng XC. "Paths From Trauma to Intrapersonal Strength: Worldview, Posttraumatic Growth, and Wisdom." Journal of Loss and Trauma, 1–14, 2014 DOI: 10.1080/15325024.2014.932207

     Not mentioned above is that the world's wisdom traditions have the central raison d'être of intentionally cultivating wisdom, and have been doing so for well over a thousand years. A current, secular, evidence-based derivative of one of these wisdom traditions (Buddhism), is mindfulness-based stress reduction (MBSR).

     "... veterans who took part in MBSR experienced significant improvements in measures of mental health, including measures of PTSD, depression, experiential avoidance, and behavioral activation as well as mental and physical health-related quality of life over a 6-month period. The MBSR program appeared to be safe for participants with symptoms of PTSD, and improvements in clinical outcome measures were maintained from the point of time when subjects finished MBSR (2 months after enrollment) until the longest follow-up time point 6 months after enrollment. The changes demonstrated for measures of mental health had medium to large standardized effect sizes."
       Kearney DJ, McDermott K, Malte C, Martinez M, Simpson TL. "Association of participation in a mindfulness program with measures of PTSD, depression and quality of life in a veteran sample." Journal of clinical psychology. 2012; 68(1): 101-16. 

Mindful Practice CME - Ron Epstein MD & Mick Krasner MD - Oct 14-17, 2015

A retreat-like workshop designed to improve the quality of care that clinicians provide while improving their own resilience and well-being. It offers an experiential learning environment, with a focus on developing the capacity for self-awareness in stressful and demanding situations.

Designed for medical practitioners (physicians, NP's, PA's) and others involved in medical practice and education. No prior experience is required, however, experience with meditation or other contemplative practices is desirable.

Session themes include communication with patients/families, responding to suffering, difficult decisions, errors, professionalism, medical education, compassion, self-care, resilience and burnout.

Course Directors: Ronald Epstein, MD & Mick Krasner, MD

Mindful Practice: Enhancing Quality of Care, Quality of Caring and Resilience

WHEN

Wednesday, October 14, 2015 3:00 PM  -  Saturday, October 17, 2015 2:30 PM

WHERE

Chapin Mill Retreat Center

8603 Seven Springs Road, Batavia, New York 14020

Additional Program Details and Online Registration:
http://www.cvent.com/events/mindful-practice-enhancing-quality-of-care-quality-of-caring-and-resilience/event-summary-dc41c4d9f876475ba56e7c0136413fd2.aspx?i=9a66c0e6-41f4-4953-89fc-37e1952e69e5

Resilience via Mindfulness

     "Resilience is a 'class of phenomena characterized by patterns of positive adaptation in the context of significant adversity or risk,' meaning that resilience is largely the ability to remain at one's hedonic setpoint while going through negative experiences. Psychologists have identified various factors that contribute to a person being resilient, such as positive attachment relationships (Attachment Theory), positive self-perceptions, self-regulatory skills (Emotional Self-regulation), ties to prosocial organizations (Prosocial behavior), and a positive outlook on life. These factors can contribute to maintaining a happiness set point even in the face of adversity or negative events." http://en.wikipedia.org/wiki/Hedonic_treadmill

     Mindfulness training is about developing intimate engagement with reality, as it unfolds moment-by-moment, regardless of whether we perceive reality to be pleasant, unpleasant or neutral. While this may seem like a simple concept, it requires much patient training. Yet stabilizing in awareness, even for brief periods, is to enjoy a freedom and quality of life that makes the practice abundantly worthwhile.
     A nice 2014 summary of the neuroscientific understanding about how Mindfulness works from Scientific American: http://blogs.scientificamerican.com/guest-blog/2014/06/12/what-does-mindfulness-meditation-do-to-your-brain/
     Ritchie Davidson PhD and Jon Kabat-Zinn PhD concisely summarize some of the neuroscientific data in this (6 minute) 2012 YouTube video:

A Great Shift, Challenge & Gift - Adversity!

     "When we come so close to death and so close to our own mortality and also to our own vulnerability, with the very fine line between being very capacitated, on top of our game, to absolutely losing everything - and then realizing that none of those things were actually who we are - that place is a very rich bed of insight.   ... in a wheelchair ...   That much slowing down, and that much introspection, and that much uncertainty & vulnerability, in the crucible of what makes us be able to move forward in life and in what really informs our ability to rise above these great adversities is what really comes forward in the situations in which you have nothing else left."

     "We are all incredibly courageous to have come here in the first place. This is not an easy journey. ... Our hearts are transformers. They can heal & love beyond anything we can even imagine."                                                 Mary-Jo Fetterly  http://mary-jo.com/

        from Pamela Post's CBC Radio Tapestry documentary "If You Can Breathe" - the inspiring story of yoga teacher Mary-Jo Fetterly: http://www.cbc.ca/tapestry/popupaudio.html?clipIds=2428137564

Meaning in Life - the Essential Internal Compass & Life Force

     When parents, religious organizations, & schools fail to teach-by-embodying the meaningfulness of life, who will shine a light on & nurture this critical life force within each human being?
     Mindfulness (MBSR) is an evidence-based method / way of being, through which we EXPERIENCE the fact that meaning in life is independent of external forces. 

     "cross-sectional studies indicate that people who report greater meaning in life show less distress following stressful events such as terrorist attacks, cancer diagnoses, and bereavement.
     ... despite the toxic effect of bullying, meaning in life may prevent a young person from internalizing the victimization and/or provide a young person with additional reasons to live. 

     counselor, school or family-based interventions designed to bolster meaning in life & teach students that meaning in life should not be tied to external forces could be effective at helping students maintain a strong meaning in life, regardless of external circumstances that are perhaps beyond her control."

       Henry KL et al. The potential role of meaning in life in the relationship between bullying victimization and suicidal ideation. Journal of Youth and Adolescence 2013 DOI 10.1007/s10964-013-9960-2.

Pan Ice by Don Pentz   http://www.fogforestgallery.ca/bios/bio_pentz.html

Allostasis & Allostatic Overload in Today's Society

     "The brain is the key organ of resilience because it governs allostatic systems that affect the entire body & also responds to those signals by showing adaptive plasticity. However, dysregulation of those same systems & their overuse can also lead to cumulative damage. We have summarized findings showing that circadian rhythms, governed by the master clock in the suprachiasmatic nucleus & synchronized by light-dark cycles &, in some peripheral cells, by circulating glucocorticoids are an important component of these responses, in that intact rhythms are necessary for efficient regulation of the stress axis, as well as other aspects of systemic physiology. We have reviewed evidence that shows that disrupted rhythms cause changes in neural structure in humans & non-human animals, decrease cognitive flexibility, and dysregulate metabolic systems. Other consequences of circadian disruption need to be explored in view of the widespread occurrence of circadian disruption in modern society, including urban life, shift work & jet lag.
     The goal of this review was to overview the factors that can confer resilience or mediate susceptibility not just at the level of an individual but also at the level of cells & neural circuits, since the brain is the master organ of stress & adaptation, and determines whether adaptation will be successful (allostasis) or lead to pathophysiology (allostatic overload).  
     In the context of the rapid development of modern human society over the past 100 years, these evolutionarily ancient systems have not yet ‘caught up’. In a sense, we are asking too much of our physiology, in that allostatic systems that played a key role in survival when resources were scarce or were activated when the individual was threatened by predators are now engaged with worry, social conflict & overwork. In developed societies, this all occurs in an environment of ample metabolic resources in the form of fast food or other high calorie consumables but with less & less physical activity. Coupled with an always-on-the-go society, where the sleep-wake cycle has been almost completely separated from the solar day & electric lighting & electronic gadgets provide us with ample light long into the night, there is no doubt that many of us live in a state of high allostatic load or even overload. The physical & mental health costs of this lifestyle are only now being appreciated, in the form of rampant obesity, increased cardiovascular disease & a rise in psychiatric disorders. By more clearly delineating the different players in this complex web, from the molec- ular & cellular through to the organismal & even societal levels, we will perhaps be able to tackle more easily some of these issues by finding ways to mitigate their effects, increase the resilience of individuals to such insults or, even better, prevent them from happening in the first place."

       Karatsoreos IN, McEwen BS. Psychobiological allostasis: resistance, resilience and vulnerability. Trends Cogn Sci 2011; 15(12): 576-84.

Kazuki Yamamoto - Japanese barista extraordinaire

Going Well Beyond Limiting Self-concepts

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

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

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

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

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

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

MiltonC   www.dpreview.com

Mindfully Improving Our Health & Creating a Culture of Wellness

     “Mindfulness practices can be an important tool in addressing our public health problems. Mindfulness training can enhance other nationwide health promotion efforts by helping people become more self-aware, more resilient to stress, and more responsible about their lifestyle choices. One of the great advantages of mindfulness training is that it assists people in making those lifestyle changes we all know we should make. It is one thing to know that smoking or obesity very often lead to disease, but another thing to have the capacity for behavioral change. Mindfulness-based practices can help us to cope with psychological stress and support us while we make the lifestyle changes we know will help us to become healthier. Creating a ‘culture of wellness’ entails promoting a culture of self-responsibility, which requires a society composed of individuals cultivating self-awareness. 

     As researchers have repeatedly noted, by increasing awareness in the present moment, we can interrupt existing patterns of behavior and make wiser choices. In essence, practicing mindfulness skills throughout the day leads to the possibility of a different relationship to any situation. With mindfulness, one moves from being distracted and inattentive, or stuck on ‘autopilot,’ to being present and aware in every moment. In this way, mindfulness training can help individuals make and sustain the lifestyle changes that lead to improved health. The regular practice of mindfulness meditation can also help our bodies to become more ‘stress hardy,’ less likely to succumb to the wear and tear of chronic psychological stress. As the evidence mounts that the mind exerts a real and demonstrable influence on the central nervous system, the endocrine system, and the immune system, policy makers are called upon to explore the ways in which training the mind can prevent disease and promote health of populations. What the scientific studies suggest is that we have, within us, the key to better health. Mindfulness practices unlock this potential and greatly increase the odds of avoiding debilitating and costly disease, while simultaneously improving quality of life, enhancing mood, and promoting general well-being. 

     Applying what we know about the potential for mindfulness-based interventions to prevent disease, promote health, treat chronic conditions, and improve the quality of care, may well turn out to be a cornerstone of a more humane, equitable, and effective approach to health and healthcare that can actually reduce costs in a meaningful way. Leveraging the body’s innate capacity to heal itself may be the key to creating a sustainable healthcare system for the 21st century.”

       McCabe Ruf, K, Mackenzie ER. The role of mindfulness in healthcare reform: a policy paper. Explore (NY) 2009; 5(6): 313-23.

Life-giving water

Resilience - Meaning & Satisfaction without Burnout

     "To improve coping with the challenges of the medical profession, it helps to:

     • Align your practice with the values that support meaning or purpose in your life; 
     • Provide the self-care of adequate nutrition, sleep, exercise, and social interaction; and 
     • Develop insight into the behavior and motivation of yourself & others. 

     Resiliency concepts and skills can help you to retain that balance of meaning and satisfaction in one of life’s most rewarding professions without succumbing to the destructive aspects of burnout."

       Nedrow A, Steckler NA, Hardman J. Physician resilience and burnout: can you make the switch? Fam Pract Manag 2013; 20(1): 25-30.

from Nedrow et al's paper above

 

Basic Essential Life Skills Need to be Re-introduced

     Society's escalating obsession with comfort, convenience and ease is dramatically reducing our competence to handle normal daily life. Parents, the education system, and organized religions are collectively failing to prepare children to assume basic adult (never mind leadership) roles.
     We need to formally re-introduce training in basic essential life skills! This means striking a healthy balance between the current extreme of rewarding people for having a pulse, and the old-fashioned abusive marine boot camp.

     By skillfully*** encouraging people to "go the extra mile," they "practice calling up emotional reserves until they trust that they have a stockpile of conviction. ... building heart ... is a preventive public health strategy that can inoculate against the potentially negative effects of stress and trauma. (With skill and will, this could become) an essential tool in the primary prevention of stress-related disorders ... and a critical skill that promotes having an optimal life. In addition ... heart can be developed after exposure to traumatic stress. Heart is critical to overcoming*** the sense of devastation and helplessness that develops from traumatic experiences.
     ***when training heart in (those) previously traumatized, it is critical to monitor their tolerance of the training to avoid overwhelming their reduced capacity to handle stress."
       Bell CC, Suggs H. Using sports to strengthen resiliency in children. Training heart. Child Adolesc Psychiatr Clin N Am 1998; 7(4): 859-65.

     See also: http://healthyhealers.blogspot.ca/2012/04/capacity.html

Anne Bastedo   http://www.serenityimages.ca

"Heart" ensures you Thrive, not merely Exist, despite Life's Inevitable Adversities

     "Heart (is) the characteristic that causes a person to be firm in his or her beliefs and to have determination to accomplish goals. Examples of heart can be found in many accounts of people who have overcome hardships and become successful. In studying the supermarathon Mexican Tarahumara kickball race and the Alaskan Iditarod 1049-mile dogsled race, researchers have explored the relationship between endurance and extreme motivation, which is believed to develop heart. In addition, of individuals who have been injured in accidents who have become disabled in some way, some become embittered and consumed with the tragic events that regrettably altered their lives, whereas others seem to find ways to compete in sports, secure meaningful work, and move ahead with their lives. What is the difference between those who thrive and those who simply exist? The difference is the indomitable warrior spirit or heart that brings forth courage, strength, and resilience."
     There's a great need to cultivate heart for all of us "as a primary prevention strategy to prepare (us) to face adversity. Heart can be developed by using sports (as well as mindfulness practice) as a vehicle."
       Bell CC, Suggs H. Using sports to strengthen resiliency in children. Training heart. Child Adolesc Psychiatr Clin N Am 1998; 7(4): 859-65.

     See also: http://healthyhealers.blogspot.ca/2012/04/capacity.html

matematto   www.dpreview.com

Comfortably Numb? Aging & the Fossilizing Mind

     "‘medical educators (human beings in general) are relatively unsophisticated at distinguishing between formative struggles that advance learning and adverse struggles that distract [from] or impede learning’. 
     To transform a transition from a threat to a learning opportunity, medical education (all educators) should assist (all) 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.

The child is grown
The dream is gone
I... Have become comfortably numb                       Pink Floyd - Comfortably Numb

Basic, Core, Resilience, Stress Management, Mindfulness

      What do you experience when stressed-out? An increase in the amount & intensity of self-talk? Accompanied by feeling thoroughly disturbed - your whole world is shaky? You feel all beat up - your head, neck, chest, gut, shoulders & back are tense, stiff, closed off and sore?
     What, in contrast, do you experience when you're having a wonderful time with a person or pet that you deeply love? Little or no self-talk? Stillness? You feel at peace, perhaps your chest area feels soft, open & warm?
     Under stress, most of us by default, quickly become "cognitively fused" with self-talk & it's associated disturbed emotions. We're not simply experiencing stress, we're lost in it, consumed by it - we feel as if we ARE stress itself. 
     At soon as an anxious thought / emotion arises, we do have a choice: to fall forward into an escalating whirlwind of anxious self-talk OR step back into stillness and equanimity - the wise, observer-self position. This choice is only available EARLY on, before the momentum of emotions hijacks mature judgment. We're all too familiar with falling forward into the circular, anxiety-filled stories we tell ourselves - it's very stressful & exhausting. But we're less familiar with the backward step, pulling back from this recurrent, primitive, egocentric nightmare.
     If we don't fall forward into anxiety EARLY, we can step back into the mature, evolved aspect of ourselves that remains still, wise, open-minded and open-hearted under all conditions. Here there is stillness, peace, no self-talk, and you will notice that your chest area feels soft, open & warm. This is where we observe everything and generate wise decisions that decrease our own and others' suffering, and genuinely improve quality of life.
     This early, backward step into the wisdom zone requires intentional practice, but is incredibly worthwhile. True resilience is consistently being at this level of consciousness, regardless of external circumstances. Each of us can learn to reside in this evolved state of being, more and more consistently, despite life's many challenges, through mindfulness practice.

     See also: http://healthyhealers.blogspot.ca/2012/08/adult-psychosocial-development.html
     and: http://www.johnlovas.com/2013/04/only-keep-heart-open-continuously.html

Photo: poppyjk   www.dpreview.com

US Marines Start Mindfulness Training

     "Camp Pendleton, the Marine Corps base in California, will host the pilot program for about 80 servicemen and -women, beginning Tuesday.
     The pilot program is being instituted after 2012 saw the highest number of U.S. military suicides -- 349 -- ever recorded in a single calendar year, as AP reported. Last year, the number of active- and reserve-duty personnel who took their own lives surpassed the number who were killed in combat in Afghanistan, 295.
     Experts have blamed the surge in military suicides in part on two long, controversial wars in Afghanistan and Iraq and in part on high levels of untreated depression and post-traumatic stress disorder, among other factors.
     ...
     'We have doctors, counselors, behavioral-health scientists, all sorts of people to get help for Marines who have exhibited stress-type symptoms, but what can we do before that happens? How do we armor Marines up so they are capable of handling stress?' Jeffery Bearor, the executive deputy of the Marine Corps training and education command at its headquarters in Quantico, Va., asked AP rhetorically.
     Bearor indicated this type of training may increase decision-making capabilities.
     'If indeed that proves to be the case, then it's our intention to turn this into a training program where Marines train Marines in these techniques,' Bearor said. 'We would interject this into the entry-level training pipeline ... so every Marine would be trained in these techniques.'"
http://www.ibtimes.com/marines-testing-meditation-training-may-teach-mindfulness-young-recruits-mental-stamina-1027058 

Comfort by Kristiina Lehtonen   http://www.kristiinalehtonen.fi/index_en.php

Cracks in the Armour - a Great Gift!

     “I just went through a series of heart attacks, and the greatest gift that’s come out of that for me is a deeper appreciation of vulnerability, which is usually seen as weakness. But I’m experiencing it as a kind of porousness, of feeling less defended, less armored. If we can impart to younger people the gift of that vulnerability, it may help them to embrace aging.”           Frank Ostaseski

      To successfully negotiate transitions requires full open-hearted conscious engagement – mind, heart and body – so that all aspects of the learner can be transformed. According to models of normal human development, the learner becomes one step more mature, which results in a greater ability to comprehend and deal with complexity. One’s “self-concept” is a fluid, evolving process. One first develops an ego, then slowly we let go of egocentricity, gradually becoming hypoegoic, allocentric and ecocentric. Mystics and saints in various traditions strive to shed their ego altogether.

      “We all operate in two contrasting modes, which might be called open and closed. The open mode is more relaxed, more receptive, more exploratory, more democratic, more playful and more humorous. The closed mode is the tighter, more rigid, more hierarchical, more tunnel-visioned. Most people, unfortunately spend most of their time in the closed mode.”           John Cleese

JMW Turner (1775–1851)   The Burning of the Houses of Parliament

Capacity to Embrace Suffering with Equanimity

     The statement below applies equally to all modern health-care professionals as well as traditional healers and shamans: 
     “Teaching Mindfulness-Based Stress Reduction (MBSR) requires the capacity (- the heart -) to meet our own suffering and that of others with attention, resilience, transparency, and compassion. For most people, cultivating these qualities is both cumulative and non-linear.”
http://www.umassmed.edu/cfm/oasis/index.aspx?linkidentifier=id&itemid=41256

     “Most of us recognize that we human beings may or may not act in a manner that corresponds with what we say our ethics are. But human beings do act in ways that are congruent with what they ultimately trust as dependable and real – what makes sense at the end of the day, what they think they can really count on. We humans act in ways that are congruent with how we make meaning.
     We human beings seem unable to survive, and certainly cannot thrive, unless we can make meaning. We need to be able to make some sort of sense out of things; we seek pattern, order, coherence, and relation in the disparate elements of our experience. If life is perceived as only fragmented and chaotic, we suffer confusion, distress, stagnation, and finally despair.”
     Parks SD. Big questions, worthy dreams. Mentoring young adults in their search for meaning, purpose, and faith. John Wiley & Sons, San Francisco, 2000.

       See also: http://mindfulnessforeveryone.blogspot.ca/2013/07/361-beyond-stress-management-resilience.html
     and: http://healthyhealers.blogspot.ca/2013/06/heart-ensures-you-thrive-not-merely.html
     and: http://mindfulnessforeveryone.blogspot.ca/2013/06/347-training-in-equanimity.html

Laszlo "Les" Lovas   (1915 - 2001)   Self-portrait

Balint groups - start one!

     One well-established (1950's), but still relatively unknown approach to managing the stresses of professional life among physicians, nurses and other health-care professionals - including students, is participating in a Balint group. There are "regular case discussions in small groups under the guidance of a qualified group leader. The work of the group involves both training and research." http://balint.co.uk/ 
     There are Balint federations in various, mainly European countries, as well as the US. http://balint.co.uk/links/

     "Balint Groups currently serve as a core training modality for professionalism, and are used in training programs in medical, psychological, and caring professions.

Balint groups help clinicians:

• Recognize they are not alone in having challenging interactions with patients
• Develop increased understanding and empathy for patients
• Explore how feelings and thoughts affect the clinician-patient relationship
• Expand their capacity and repertoire for handling difficult situations with patients"     http://americanbalintsociety.org/

     In Canada, there is a longstanding group that meets in Ottawa, and another in Halifax led by Dr Katherine Warren - for psychiatry residents at Dalhousie University.

     So why so few if so valuable?

     "Because it is fundamentally messy and it is threatening, ... people might not want to have to face their own foibles and weaknesses."

     "I think it is a vulnerability thing. In medicine, there's that old idea that you are the expert who's very strong and people struggle with the idea they are presenting difficulties. I think people are often concerned their conduct or skill will be criticized. But that is one of the benefits, to help people with things they are struggling with, to normalize it."

http://www.nationalreviewofmedicine.com/issue/2008/07/5_physician_life_07.html

http://psychiatry.medicine.dal.ca/education/PG_program.htm

     Critical Components of Meaningful Communities: http://www.johnlovas.com/2013/10/what-really-matters-in-community.html