Serving More Wisely

     In our time of workaholism, substance abuse, materialism & other severe imbalances, secondary traumatization, burnout and suicides, we need a MUCH healthier perspective on life.

     "… an important teaching by Dr. Rachel Naomi Remen: ‘Helping, fixing, and serving represent three different ways of seeing life. When you help, you see life as weak. When you fix, you see life as broken. When you serve, you see life as whole.’ Remen explains that helping is based on inequality: ‘When we help we may inadvertently take away from people more than we could ever give them; we may diminish their self-esteem, their sense of self-worth, integrity and wholeness. When I help I am very aware of my own strength. But we don’t serve with our strength, we serve with ourselves. We draw from all of our experiences. Our limitations serve, our wounds serve, even our darkness can serve. The wholeness in us serves the wholeness in others and the wholeness of life.’" 
       Joan Halifax. “Standing at the Edge. Finding Freedom Where Fear and Courage Meet.” Flatiron Books, 2018.


     “Listening is the oldest and perhaps the most powerful tool of healing. It is often through the quality of our listening and not the wisdom of our words that we are able to effect the most profound changes in the people around us. When we listen, we offer with our attention an opportunity for wholeness. Our listening creates sanctuary for the homeless parts within the other person. That which has been denied, unloved, devalued by themselves and others. That which is hidden.... 
     Perhaps the most important thing we bring to another person is the silence in us, not the sort of silence that is filled with unspoken criticism or hard withdrawal. The sort of silence that is a place of refuge, of rest, of acceptance of someone as they are. We are all hungry for this other silence. It is hard to find. In its presence we can remember something beyond the moment, a strength on which to build a life.” Rachel Naomi Remen MD

     “… the spiritual is inclusive. It is the deepest sense of belonging and participation. We all participate in the spiritual at all times, whether we know it or not. There’s no place to go to be separated from the spiritual, so perhaps one might say that the spiritual is that realm of human experience which religion attempts to connect us to through dogma and practice. Sometimes it succeeds and sometimes it fails. Religion is a bridge to the spiritual - but the spiritual lies beyond religion. Unfortunately in seeking the spiritual we may become attached to the bridge rather than crossing over it.” Rachel Naomi Remen MD
 
     "I am reminded that death, like love, is intimate, and that intimacy is the condition of the deepest learning.
     I am reminded, too, of the simplicity of the true teacher, and the power of story to include us in a web of connection far more profound than the superficial things that divide us.
     Ultimately, death is a close and personal encounter with the unknown. Many of those who have died and been revived by the skills of science tell us that the experience has revealed to them the purpose of life. This is not to become wealthy or famous or powerful. The purpose of every life is to grow in wisdom.” Rachel Naomi Remen MD

     “mindfulness concerns freeing oneself from misperceptions, thinking patterns, and self-imposed limitations that impede creativity, clear seeing, and optimal mental and physical health. Moreover, from both the Eastern and Western view, every individual has the intrinsic capacity to be mindful, and with intention and practice, mindfulness can garner strength and stability. In this sense, the greatest potential of mindfulness may emerge when one consciously decides to pursue mindfulness not as just a ‘tool’ in the proverbial toolbox, but as a way of seeing oneself and the world, or a conscious way of being and interacting.”
        Jeffrey Greeson, Eric L. Garland, David Black. “Mindfulness - A Transtherapeutic Approach for Transdiagnostic Mental Processes.” in Amanda Ie, Christelle T. Ngnoumen, Ellen J. Langer, eds.
 “The Wiley Blackwell Handbook of Mindfulness
.” John Wiley & Sons, 2014. 

Parenting?

      Why would one wake up almost every morning with vivid images of the worst imaginable things happening to their closest loved ones? The level of fear / dread / anxiety / anger is off the scale on opening one's eyes. 
     At least one school of psychology maintains that if one's mother is absent - emotionally or physically - one tends to grow up feeling empty, invisible. Is it possible that creating vivid nightmares is the psychic equivalent of 'cutting' (deliberate self-harm) - a way of trying to feel real? Anger energy (rather than one's physical body) as an identity? Is this how perfectionism & workaholism arise?
     Why would one consistently work overly hard to help all of one's family and friends, and feel smoldering resentment for being unappreciated. Again, an invisible person working in the background, unappreciated, is very likely to be angry. An impossible attempt to be "seen", appreciated and perhaps loved through one's actions? It comes across more like a severe contract than unconditional love.
     Lack of unconditional love is traumatic. Nobody is raised with, nor capable of providing perfect unconditional love! Like any other dysfunctional parent-child relationship, some re-inflict the trauma, while others try to make sure to be much better parents. It's much easier to understand than to forgive parents' dubious parenting skills. Life's not easy for anyone.

A Buddha in every jungle of scarred emotions

 

Unquenchable Hunger

     In a healthy society, individuals are appropriately nurtured in their formative years to know that excessive: working, shopping, drinking, gambling, sex, etc cannot provide the profound peace & happiness that we all seek. See: http://jglovas.wix.com/awarenessnow#!Seeking-Authenticity/c17jj/569e31530cf2d42376d4d8f6
     Our society is far from healthy, desperately lacking nurturing supports, and actively promoting every form of unhealthy excess. On the excellent radio program "Ideas", Alan Lightman pointed out one of the causes of excessive shopping in our society:

     “More work is required to pay for more consumption fuelled by more production in an endless, vicious cycle. 
     And what is it that we are consuming so voraciously? What impels us to work faster and longer hours, even in the face of higher efficiency? What are these burning material needs, when Americans have become wealthier and wealthier, more than doubling their real income per person in the last 50 years? 
     One of the methods of capitalism is to create demand for its product, even when that demand did not previously exist. I was astonished to read this aim so unabashedly spelled out by Charles Kettering, a major inventor and general of GM Research Labs. In 1929, at the beginning of the automobile industry in the United States, Mr. Kettering wrote in Nation’s Business Magazine that business must create ‘a dissatisfied consumer’ and ‘keep the consumer dissatisfied.’ A more recent example of the same idea was voiced by the economist John Kenneth Galbraith, as he surveyed the future of capitalism in an ever wealthier America. In his book The Affluent Society, in 1984, Galbraith writes that, in modern America, production will have to ‘create the wants it seeks to satisfy.’ In short, a large part of our consumption is what we are told to consume, told that we need, and the cycle continues.” 
       Alan Lightman. "The World is Too Much With Me: Finding Private Space in a Wired World." Second Annual Hart House Lecture, University of Toronto, aired on the CBC Radio program Ideas, April 18, 2002. www.cbc.ca/ideas

Illusion of Control & Fear

     “It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; . . . who at best knows in the end the triumph of high achievement, and who at worst, if he fails, at least fails while daring greatly.”                                             Theodore Roosevelt

     Nor do people count whose 'contribution' is consistently trying to derail improvements with their cynicism - openly, or worse, behind closed doors. Such cowardice with a swagger is referred to as "the hidden curriculum" in health-care education.

     So what makes educated, accomplished adults behave like 'chicken shits'? Fear. Not just fear of what they don't know and can't control, but fear of fear itself. We naturally want to deal only with what we know well and thus can more or less control. The greater our illusion of control, the more we fear most of real life - which is far from being knowable and controllable. That's why so many health-care professionals are workaholics and will "never retire". It's failure to mature.
     Intelligent, educated adults can learn about what they fear - "leaning into the discomfort", gaining understanding and competence, becoming more balanced, and evolving as people. At some point, we all need to learn to navigate real life's constantly shifting, changing, paradoxical complexity with some semblance of grace. This is normal, healthy evolution of character / consciousness or psychosocialspiritual maturation.

       Hollis J. “Finding Meaning in the Second Half of Life.” Gotham Books, NY, 2005.
       Brown B. "Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead." Gotham Books, NY, 2012. http://www.ted.com/talks/brene_brown_on_vulnerability#t-153143


 

Rushing - towards Happiness??

     We're inundated with the idea that the pace of life is insanely fast, and accelerating! We're mindlessly striving - we assume - to be happy. However mindlessness, time-poverty, and striving, in and of themselves, cause suffering, not happiness. Relentless workaholism is literally killing people - it's so common in Japan that they've coined a name for it: karoshi.
     Mindfulness is an intelligent, viable option!
 
     Mr. Singh in the picture below - the one pulling the rickshaw - is as happy as the average American. He's interviewed in the multi-award-winning 2011 documentary movie "Happy."

See: http://healthyhealers.blogspot.ca/search?q=time-poverty

Manoj Singh, rickshaw operator, Kolkata, India

Retirement - a Mixed Blessing

     Some of my colleagues have firmly declared "I'll never retire!" Like aging, retirement is NOT for the faint of heart. After all, one's work-related professional persona - "I'm seriously important, competent, indispensable, earn serious money," etc, etc - flies out the window with retirement. One becomes an ordinary slob - without consequence, without authority, without specialized skills, with MUCH reduced income!! - a MERE MORTAL!!!!! Ungrounded, adrift - "with no direction home, like a rolling stone ..."
     And this is GOOD! Because much of life, up till this point, has been an AVOIDANCE exercise! A pause button!! DELAYING growing up!!! Well, NOW it's time to grow up - unless we choose to "never retire!"
     It's not easy, but absolutely essential, to embrace life - AS IT IS, NO MATTER WHAT - with mind & heart wide open. It's time for .............. MINDFULNESS!!!!!!!!!

     See: http://healthyhealers.blogspot.ca/2012/07/investing-our-lifes-finite-time-energy.html
     and: http://mindfulnessforeveryone.blogspot.ca/2013/03/302-mbsr-style-mindfulness-course-for.html
 

Marisela Murcia Navarro, National Geographic   http://photography.nationalgeographic.com

The Culture of Medicine, Dentistry, Psychology etc ...

      “The culture of medicine is one in which perfectionism and 'workaholic standards' rule the day. Many practice settings reward long hours and self-neglect. Physicians are encouraged to disregard themselves and deny their own needs. The process of medical education may enhance development of defense mechanisms that make it difficult to ask for help... Physicians become masters at delayed gratification. Many medical students and residents spend years coping with the high level of demand required in medicine, often harboring the expectation that later they will be rewarded with a happy, more balanced life. However, the task-oriented coping skills developed during training do not go away automatically after training... the goal-oriented approach leads to neglecting alternative sources of gratification or self-esteem; thus, after training, physicians may not have a way to find meaningful balance between work and other life activities."                 

        Miller MN & McGowen KR 2000 

        Garneau K, Hutchinson T, Zhao Q, Dobkin PL. Cultivating person-centered medicine in future physicians. European Journal for Person Centered Healthcare 2013; 1(2): 468-77.  

Bee by Sam Droege   www.dpreview.com

Eliminating Medical Error through Science, Intelligence, & Hard Work

     Some mistakenly believe that all ignorance can and will eventually be eliminated through science, if only we work hard enough, intelligently enough. But no amount of workaholic zeal can reach this utopian goal, because it's based on a fundamentally flawed worldview.

     "The belief that every error is correctable, either now or with the benefit of future knowledge, requires the nature of reality to be organized in a certain way, a way that allows events and actions to be isolated and purified and mapped precisely onto a set of formal descriptions. In short, reality must be discrete and atomistic for this to occur, and discreteness of this sort is antithetical to holism. ... medicine’s necessary focus on individuals that are unique and dynamic introduces an unavoidable shortfall between scientific knowledge of the general and universal, and the application of that knowledge to understanding particular things. ... using the well-known shortcomings of weather forecasting as an example, ‘perfect knowledge of that one particular hurricane is unavailable except under conditions of omniscience.’

     A review of the literature on medical error ... notes that practising doctors are aware of a ‘necessary fallibility’, which forms part of their understanding of error. However, this seems to be cashed out in terms of ‘permanent uncertainty’, which suggests that rather than a metaphysical picture of the world being in a certain way, it is an epistemic picture of imperfect scientific knowledge, or even sheer randomness. This view encourages a fatalism and shared vulnerability about the potential for error ... What it might fail to do is to inform a coherent understanding, which can be directed towards reducing error."
        Wilson B. Metaphysics and medical education: taking holism seriously. J Eval Clin Pract 2013; 19(3): 478-84.

     Neither fanatical scientism, nor fatalism / nihilism are reasonable. Reality is somewhere in between these extremes. A good clinician engages her whole being to help her patients the best ways possible. ALL patients, as well as clinicians, will die anyway. AND, unless locked into some rigid, erroneous, limiting worldview, we can all evolve as human beings and live a wonderfully satisfying life.

Ireland

Investing finite resources: Time & Energy

     In my youth, I had an amazing amount of energy. In retrospect, had I known better, a good deal of it could have been invested more wisely. However knowledge, and the psycho-social-spiritual developmental stage at which one can enact and integrate the knowledge, can be decades apart.

     Some of us work pathologically hard "so people will like me." Paradoxically, this very striving can alienate the very colleagues, patients, friends and family whose love & respect we crave. But since work may be our only well-rehearsed, trusted connection to the world, we keep pouring more and more of ourselves into our profession - even though at some level we realize that "doing more of what doesn't work, doesn't work!" We tend to have inadequate training, aptitude, interest & trust in inter- & intrapersonal "soft" skills.

     “Mulla Nasrudin was outside on his hands and knees below a lantern when a friend walked up. ‘What are you doing, Mulla?’ his friend asked. ‘I’m looking for my key. I’ve lost it.’ So his friend got down on his hands and knees too and they both searched for a long time in the dirt beneath the lantern. Finding nothing, his friend finally turned to him and asked, ‘Where exactly did you lose it?’ Nasrudin replied, ‘I lost it in the house, but there is more light out here.’”

     Kornfield, J. Feldman, C. Soul food. Stories to nourish the spirit and the heart. HarperSanFrancisco 1996.

     Of course it's never too late to take the less well-lit, but rich, essential path to mature adulthood. It comes through a mindful examination of one's personal and interpersonal life. 
     Hollis J. “Finding Meaning in the Second Half of Life.” Gotham Books, NY, 2005. 

     “It’s better to limp slowly along the right path than walk stridently in the wrong direction.”
         Marc Aurel

foosfotos   www.dpreview.com

Maturation

     Throughout life, we sequentially assume self-concepts that more and more accurately embrace life's complexity, and are better and better able to bring us real peace and joy. There's an intimate relationship between self-concept and worldview - both evolve if we mature normally.

     If we stop playing the piano on starting professional studies, our piano-playing skills progressively diminish 10, 20, 40 years down the road. The same holds for our inner life, if all our time and energy is directed outward to our career. "What you don't use, you lose."

     After devoting essentially everything we have to our career, how could we feel even remotely adequate at any other tasks? Is it surprising that many of us "will never retire"? A colleague's physician father was extremely upset recently because his research grant had not been renewed. He's 90 years old. It requires deep reflection to distinguish love of work from fear of moving on.

     Undergoing life transitions IS stressful, but we have no choice. Avoidance is not a healthy, satisfactory option.


     "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: http://mindfulnessforeveryone.blogspot.ca/2013/02/286-human-journey-from-simple-facts-to.html
 

KIROVBILBAO   www.dpreview.com

Prioritization, Balance, Towards Living an Undivided Life

     The documented decline in idealism, and increase in cynicism, during dental & medical training is blamed primarily on heavy workloads.

     “Task saturation” refers to high-pressure situations, in which pilots must suddenly cope with so many things at once, that they lose their ability to prioritize, with potentially dire consequences. I first heard this aviation term in relation to the 2009 helicopter crash off Newfoundland, during which 17 people died. "Rearranging deckchairs on the Titanic" refers to task saturation. 

     We in health care are exposed to versions of task saturation, starting in university. Like overwhelmed pilots, we may take our focus off what's important without even realizing it. Because there’s so much to learn, we tend to ignore personal wellness / work-life balance during our studies. Then training is immediately followed by the rush to establish a career, start a family etc. By this time, a goal-oriented, workaholic lifestyle is solidly established. Personal wellness and work-life balance too often languish on the back burner - until we “crash”.

     It's wise and healthy to periodically reassess our lives and reset age- & life-stage-appropriate priorities. Everything around us is changing constantly. We need to check in with ourselves from time to time and re-vision where we are, what we're doing, how we're doing it, even why we're doing it. All of these are constantly changing as well. To lead an "undivided life", our outer life needs to be heading in the same direction to which our inner compass is pointing.

    Many of us "will never retire. I wouldn't know what to do with myself!" Some retire, then quickly go back to work - or - quickly die. Many others "are busier than ever" after retirement. Let's face it, most of us are like the old donkey that spent it's whole life walking in a circle, pushing a pole to pull water up from a deep well. When it was deemed too old to work and set loose by it's owner, the old donkey walked in a circle till it dropped dead. Donkeys are not alone in suffering from a lethal lack of imagination!
     See also: http://mindfulnessforeveryone.blogspot.ca/2013/11/432-i-try-and-i-try-but-i-cant-get-no.html