Deep Medicine

When an ecologic metaphor for health is employed, disease is seen as an imbalance; the work of the physician, nurse, and health practitioner is stewardship; the hospital is part of the ecosystem; and healing becomes part of the process of change, or adaptation. With the wisdom of nature as a guide, the ecology metaphor offers a workable and sustainable approach to health that acknowledges key principles such as: evolution – we are in a continuous, dynamic state of change; interdependence our existence is part of a larger web of life; limits – our resources are bounded, not infinite; diversity – every part of the whole is unique and makes an essential contribution; and cycles – we are part of nature’s patterns and rhythms. (This model is adapted from the Center for Ecoliteracy, 2008.)

I like this metaphor for health and for change because it speaks to fundamental processes that underlie all aspects of our existence. Ecology is the study of the relationships among living organisms and their environments. Ecological systems are driven by evolution – the process of change over time. In the 4.6 billion years since the Earth formed, climates have changed, landmasses have moved, and species have come and gone. Change is our reality.

Ecology as a metaphor for health and healing had deep roots, going back at least to the 1700s, when physician and geologist James Hutton proposed the specialty of “planetary medicine”. Hutton thought species-specific medicine – medical practices dealing only with the human species – was way too small in scope, and that if we don’t take into consideration all else that coexists with us on the planet, we can’t properly diagnose or treat any malady.

The ecology metaphor reminds us we’re all in it together and offers us a chance to come to terms with the transitory nature of health. The whole and its parts must be seen in a “both-and” context, not as an “either-or” duality. Our personal little picture and the larger big picture need to be viewed simultaneously.  Push here, something bulges over there. Pour toxic waste into the sewer, and it shows up in the bay to be consumed in a future seafood buffet. Overgraze a field, and the soil will erode, the crops will fail, the stock will subsequently go hungry, as will the human population.

                Because everything is connected, subtle changes may lead to large disruptions. A tiny plaque in a coronary artery can cause a massive heart attack.  A small embolus lodged in a blood vessel in the brain can result in a stroke, or “brain attack.” A minimal change in water quality or quantity can upset plant and animal productivity and health. Relatedness isn’t confined to a specific location. Our common ancestry and humanity link us over great distances. In a sense, our compassion for the starving in Africa or the sick in India has roots in our shared origins and planetary linkages.

                Every part of the whole matters. Our bodies require a diverse population of cells, tissues, and organs. All are essential to our healthy functioning. Brain, heart, muscle, bone and blood – all must work in concert toward the greater good. Recognizing the value of variation in the natural world can help us value the diversity of human experience, background, culture, race, age, opinions, and solutions. When we are open to multiple possibilities, we find more options on our own path to health. This is holistic medicine; this is deep medicine.

In recognition of Earth Day April 22, 2013

Excerpted from Deep Medicine:  Harnessing the Source of your Healing Power. Oakland: New Harbinger Publications. 2009.             

In Part 1 of “Finding Stability in a Landscape of Change” we looked at the unlikely reality that we will find stability in the ever-changing flux of external events. Rather, we must look within for the treasures of equanimity and appreciate the “do-it-yourself” qualities of this self-directed project. In Part 2, we will review some practical tools to use in the quest for balance and stability.

“If you are looking for the greatest treasure, don’t look outside, look within. Seek that.”    Rumi

Finding stability in one’s life is about learning to be undisturbed when surrounded by disturbance – a challenge which takes many forms, however, is familiar to all in one way or another. The tools for this begin with the pillars of self-care: nutrition; activity (work/service/creativity) /rest; solitude/contemplation; relationship/community. These four pillars occur in various forms in different cultures around the world. Since they also include guidelines regarding ethics, morals, respect, generosity, kindness and fair play, they literally represent wisdom practices, as well as lifestyle skills for self-care and well being.

Where you place your attention is the ultimate power held by each individual. It is through your attention that you bring yourself present in any situation. Choosing to be present in the current moment limits the capacity for worrying about the future and lamenting the past. When you are fully present your choices have the best potential for leading to your preferred view of the future.

Some tools for practicing presence (mindfulness):

*Asking and answering the questions: what am I thinking, feeling, doing at this time? How is it working? Each of these questions will bring you into the present moment. If your thoughts, feelings and actions are working for you and you are in a state of balance and contentment, by all means keep doing what you are doing. If that is not the case, consider letting go of what you are thinking, feeling, or doing and try something different. If that is not possible, ask for help. This practice will also help you realize what is really important, what to add to or take off your plate, what your next best step is, and where meaning and purpose are coming from in your life.

*Tracking what is inspiring, moving, challenging, surprising you at the present time will also bring you from distraction and uncertainty toward currency in the present. Considering these questions requires traits such as honesty, authenticity, discipline, forgiveness, courage, and resilience. Since that is the case, it also stimulates a practice in character development.

*Framing and naming your situation and circumstances appropriately can change your outlook in an instant. Will your hike be on a trail called “morning glory” or “widow maker”?  For your upcoming meeting are you entering a “battlefield” or a “dance floor”? Are you seeing your stress as torture or a teacher? Is your intention to be a victim or victor? Are you headed for breakdown or breakthrough? How you name or title something is an indication of your thoughts and feelings which can definitely affect your behavior and the subsequent course of events. Your attitude and intention have great power to change your world. Practice seeing yourself on a big enough screen in a big enough frame so that your view expands beyond yourself and you gain a context and perspective where your “actual size” is not distorted.

*As long as we are walking in woods, napping on a beach, working in the garden, listening to a babbling brook, and not outside in a hurricane or severe winter storm, Time in Nature will almost always bring you into the present, ease your anxieties, and put you in touch with the beauty, rhythms and magnitude of the natural world as you are reminded of your intimate connection with all that surrounds us. Try to spend some time in nature on a daily basis, even if it is as humdrum as a walk around the block with the dog or watching the sun set. Such time is an amazingly healing balm. Time in nature also provides a chance for a bit of solitude.

*Contemplative time when you can slow down, be quiet and go inward is also a tool that provides us a moment of solitude and releases us from our usual attachment to personal communication devices and busyness. Pray, meditate, listen to music, read from the sages and wisdom keepers, give gratitude, set intention, forgive, breathe and connect with your inner healer.

*Walk, jog, dance, do yoga, tai chi, play, cycle, swim – the best exercise is the one you do!! And the benefits are well documented. So move it!

Whatever you choose to do – be specific, realistic and don’t over-reach. Small steps are doable and can lead to big changes. Don’t bite off more than you can chew – let alone swallow, digest and assimilate. Grand sounding, non-specific goals most often go unmet, while small, repeatable actions become habits as they displace less desirable behaviors. You may find that you need an appointment with yourself to get any of these things accomplished. Schedule these life affirming actions first and make a commitment to them.

A great way to get started is with the daily practice of the “Blessing Way” of Angeles Arrien. I begin every morning with this practice: 1) Set your intentions for the day. This may take the form of a prayer, affirmation, or “to do” list. 2) Give gratitude. There is always something to be grateful for even in the worst of times. 3) Every day perform a “life-affirming action” in the direction of your goals, dreams, longings, passion. This may be as simple as an internet search about something or some place in which you have great interest. However, it is done with the recognition that even the longest journey begins with the first small step. All of these actions are energizing and contribute to the reduction of anxiety and depression as they support general well being.

There are many other tools and practices which support equanimity and the finding of stability in the landscape of change in which we live. Since the best program will be your self-directed version know that it will take time, commitment, discipline, patience and practice to evolve and sustain. Nonetheless, it is doable and the process itself is the reward you are seeking.

“When everything is uncertain, anything is possible.”      Angeles Arrien

Resources:

Arrien, Angeles. 1993. The Four Fold Way: Walking the Paths of Warrior, Teacher, Healer and Visionary. San Francisco: Harper.

Stewart, William B. 2009. Deep Medicine: Harnessing the Source of Your Healing Power. Oakland: New Harbinger Publications.

William B. Stewart, M.D.

“In the Celtic tradition, it was always recognized that if you sent blessings out from your heart, they multiplied and returned again to bless your own life. A generous heart is never lonesome. A generous heart has luck. The lonesomeness of contemporary life is partly due to the failure of generosity,”

                                                                                                            John O’Donohue, Eternal Echoes

“If the only prayer you said in your whole life was ‘Thank you’ – that would suffice.”                                                                                                                                                                   

Meister Eckhardt

Paradox is represented by extremes, dualities, or opposites. In fact, these seeming polarities, such as pain/pleasure, right/wrong, inner/outer turn out to be connected. Giving & receiving/ generosity & gratitude are examples of apparent opposites being inseparable, complementary and coexisting. The giver requires a receiver, just as the peacemaker requires conflict, and a healer requires a patient in order to serve. However, it is a mutually reciprocal relationship not a one-way flow. By giving and/or receiving both the giver and the receiver discover their connection to each other and the “greater good.”

Generosity is freely sharing what you have with others. Being generous means giving something that is valuable to you without expectation of getting something in return. Gratitude is the quality of being thankful and appreciative for what you have received. These are partners not opposites. Both giving and receiving provide the possibility of inner growth and personal transformation for the giver and the receiver.

With his family and legions of volunteers, Nipun Mehta, founder of ServiceSpace (formerly known as CharityFocus) and its DailyGood.org inspirational email message to hundreds of thousands of readers all over the world, has created a global “ecosystem” which generates a “ripple system” of generosity and gratitude of immeasurable impact. “Giftism”, their philosophy of pay-it-forward kindness, involves an “inner shift” which transforms consumption to contribution, transaction to trust, isolation to community, and scarcity to abundance. Each small act of service contributes to a collective wave catalyzing more generosity, more gratitude and keener awareness of the power of each individual contribution to collective consciousness and change. With this paradigm, we don’t necessarily have more, but we discover a sense of interconnection with all that surrounds us, and we want and need less.

The balance of giving and receiving creates a state of abundance. Abundance is not the opposite of scarcity. The opposite of scarcity is greed or hoarding. The state of abundance lies on the middle path between scarcity and greed. This is the path on which givers don’t get exhausted, aren’t overwhelmed or in compassion fatigue. They give until it feels good not until it hurts. It is the place where receivers maintain their dignity as humans, their self-respect and their hope. And all recognize that we are in a dynamic flow where we are continuously in both camps: generously sharing what is valuable to us and giving gratitude for all we receive. This state of balance and wholeness defines well-being. When in balance, generosity & gratitude and giving & receiving are good for your health!

Each of us has something to be grateful for, not only our blessings but also our challenges. Every challenge is an opportunity to grow and to change, a chance for creativity to emerge, and to move beyond what is known and comfortable. Practice giving gratitude – speak it, write it, listen for it, do it. A gratitude unexpressed is like a gift unopened. Each of us has something to share and to give – our time, our talents, our treasure, our care and compassion, our understanding, and our love. These gifts are “medicine” for those they touch and for those who provide them. Underlying generosity and gratitude is an inner transformation which influences outer change.

What do you have to give at this time? What are you grateful for at this time?

“As we grow in spiritual consciousness, we identify with all there is in the world. Then there can be no exploitation. It is ourselves we are helping. It is ourselves we are healing.”

                    Dr. G. Venkataswamy (Dr. “V”), Founder of the Aravind Eye Care System, India (1918 – 2006).

Resources:

Mehta, Nipun, “Generosity 2.0”. Kosmos Journal. Nov. 2009.

Arrien, Angeles. 2011. Living in Gratitude: A Journey That Will Change Your Life. Boulder: Sounds True.

Emmons Robert. 2007. Thanks: How the New Science of Gratitude Can Make You Happier. New York: Houghton Mifflin.

O’Donohue, John. 1999. Eternal Echoes: Exploring Our Yearning to Belong. New York: HarperCollins.

“No external experience will support us because the flux of events is inescapable.”

Alan Watts, The Wisdom of  Insecurity

“…our grace comes from owning the risks we take in a world largely immune to our control.”

Rosamund and Benjamin Zander, The Art of Possibility

There presently is a tsunami of change sweeping over healthcare. This wave of change involves all of us – whether well or ill, patient or healer. This particular example of the play of change in our lives involves the full spectrum of individual and collective well-being from laws of the land to our institutions, organizations, and personal circumstances. Since it is our nature to prefer the known to the unknown and stability to chaos, change, whether welcome or unwelcome, is stressful. Change is associated with uncertainty and uncertainty with insecurity.

Enduring stability cannot be found in our ever-changing material world. The reality is that impermanence, uncertainty and insecurity are part of the natural state of our lives. We exist in a constant dynamic flow: growing, regenerating, learning, aging, evolving. We never really know what is coming around the next corner, what the next moment will bring, or how things will ultimately turn out. For example, consider the existence of “blessings in disguise,” or the proverbial “cloud with the silver lining.” Much comes to us uninvited and outside our locus of control. The Dali Lama has said that events outside of our control should be no cause for worry, since we can’t do anything about them. What about those situations over which we do have control? Well, if we have control over them, we certainly have no need to worry about them! In theory there actually is nothing to worry about! Then why do we spend so much time either lamenting the past or worrying about the future? Very simply stated it is because we fear the unknown and for the most part, we don’t like surprises. We would like to make our existence stable, balanced, and predictable – whether we are on our morning commute or a joyride on a roller coaster. However, no matter how hard we try, how much data we assemble, there are real limits to our capacity to predict anything from the weather to what our children will be/do when they grow up, to the time and circumstances of our death. Facing this reality with equanimity is our challenge.

In this landscape of change, where do we find stability? Two intersecting avenues support our quest for stability: the discovery and exploration of our inner world; and developing the skill set of being non-judgmentally in the present moment, often called mindfulness.

“What lies behind us and what lies before us are small matters compared to what lies within us.”

                                                                                                                 Ralph Waldo Emerson

“It is the work of all human beings to attend to the health of both their “inner” and “outer” house: the “inner house” of the limitless world within, and the “outer house” of the material world in which we live our daily lives.”

                                                                                                                  Angeles Arrien

While we use search engines daily, the search of our expansive “inner house” requires us to look within toward that part of our existence which, like an iceberg, is not always visible. We are far more used to directing our interest outward, toward the next big, necessary or new thing clamoring for our attention, rather than inward toward the changeless, eternal reality underlying our visible world. But it is the inward search that we must institute if we are to find stability. To discover this inner world requires that we choose to pay attention, slow down, and get quiet. Not easy tasks in our fast lane, fast food, constantly connected world. However, if we don’t make these choices we will deny ourselves the opportunity to ask the most meaningful questions, enable ourselves to hear the wisdom from within, and then choose to act accordingly.

“Control of attention is the ultimate individual power.”           David Brooks

“You must be present to win.”                          Source unknown

Are you living in the present moment? Are you paying attention to where you are, whom you are with, and what you are doing – right now? Or are you time-traveling to the past or the future? It is important to know, for it is only in the present that you have the possibility of making the choices which have the greatest potential to lead to your equanimity and your preferred vision of the future. Where we choose to put our attention – to which thoughts, feelings, and actions we attend to; to which attitudes, perspectives, expectations, stories we carry; toward which companions we surround ourselves with; how we spend our time; and to when and where we choose to fully show up – determine how we contribute to the creation of our lives. Our attitudes can trump our diagnoses. We can change the stories we repeatedly tell ourselves. We can define and act on what has meaning, purpose and value in our lives.  Our ability to pay attention to what is actually happening now, in the present, is essential to discovering stability in our busy lives. Our capacities to choose and change in the dynamic landscape in which we exist provide constructive action steps in the direction of harnessing our inner power in support of our balance and equanimity. Our stability ultimately must come from within. It is an “inside job” not a function of our external world. The past and the future are in our imaginations. The present is our only reality and to be aware of this is a true gift. To paraphrase a French proverb in the words of Kung Fu Panda: “Yesterday is history, tomorrow is a mystery, that’s why today is called the PRESENT.”

In anticipation of Part 2 of “Finding Stability in A Landscape of Change”, pay attention and track for yourself the following questions suggested by cowboy/psychologist Wyatt Webb on how we go about practicing being current with ourselves and in the present: What are you thinking? What are you feeling? What are you doing about it? And how is it working? In Part 2 we will engage how to practice presence and build equanimity and stability into our daily lives.

Recommended Readings/Resources:

Arrien, Angeles. 1993. The Four Fold Way: Walking the Paths of the Warrior, Teacher, Healer and Visionary. San Francisco: Harper.

Mehta, Pavithra & Shenoy, Suchitra. 2011. Infinite Vision: The World’s Greatest Business Case for Compassion. San Francisco: Berrett-Koehler.

O’Donohue, John. 2008. To Bless the Space Between Us. New York: Doubleday.

Stewart, William B. 2009. Deep Medicine: Harnessing the Source of Your Healing Power. Oakland: New Harbinger.

Tan, Chade-Meng. 2012. Search Inside Yourself: The Unexpected Path to Achieving Success, Happiness (and World Peace). New York: Harper Collins.

Watts, Alan. 1951. The Wisdom of Insecurity: A Message for An Age of Anxiety. New York: Penguin.

Webb, Wyatt & Pearlman, C. 2002. It’s Not About the Horse – It’s About Over-coming Fear and Self-doubt. Carlsbad: Hay House.

Zander, Rosemund Stone & Zander, Benjamin. 2000. The Art of Possibility: Transforming Professional and Personal Life.  New York: Penguin.

Contemporary biotechnical medicine is a relative newcomer to the arena of healthcare. Our present allopathic approach to diagnosis and treatment of illness owes a great debt to the scientific method and to ancient and timeless approaches to healthcare from around the world.

Ayurveda (the ancient medicine of India), traditional Chinese Medicine including acupuncture, shamanic practices of indigenous people, and folk medicines from various cultures have oral and written records dating back thousands of years. More recent systematic approaches such as homeopathy, osteopathy and chiropractic have paralleled the development of allopathic medicine. As other systems of medicine are becoming more widely understood and applied, the boundaries of medical practice continue to grow.

Medicine is truly a “practice” which requires lifelong learning and continuous improvement as new knowledge becomes available and old knowledge is rediscovered. Embracing both – new biotechnical, pharmacologic and genetic advances and our healing heritage – has the potential to strengthen contemporary medicine and expand the possibilities for healing. This will lead healthcare practitioners to improved clinical diagnosis and treatment, and a greater appreciation of and compassion for the experience of illness.

The Moral of Morale

William B. Stewart, M.D.

In this month of independence (July), I have been asked to talk/write about “morale”, particularly in the workplace.  Keeping with the season, I am going to exercise my independence by writing about interdependence and connection in the context of morale.

Morale is defined as a mental or emotional condition which is expressed via such qualities as confidence, optimism, motivation, cheerfulness – a can do spirit – or lack thereof. These traits are particularly desirable, and often found missing, in the face of challenge, opposition, hardship, conflict, etc., e.g.  prior to the battle, the morale of the troops was high. Generally, like safety, which is about doing everything so that nothing will happen, we are most concerned with morale when it is low, lost or absent.

It should not be surprising that the word morale is closely related to the word moral. Both words come from the same Latin root. Moral is defined as pertaining to rules of right conduct. That is the distinction between right/wrong, good/bad, honorable/dishonorable. Words used to describe or define moral  include honest, upright, virtuous, as well as words used to define morale such as confident, optimistic, open. These descriptors refer not only to proper behavior in a collective or society, but also are concerned with character or temperament.

Moral, as a noun, relates to a lesson from a fable, story or event; and to a concise truth. The Greek translation of moral is “ethics”. So morale, moral and ethical are all related and refer to qualities and behavior considered valuable and virtuous.

The causes of low morale at work are also the common reasons that people usually leave a job. Often, low morale is blamed on leadership. While it is true that a bad relationship with a direct supervisor is one of if not the most common cause of someone leaving a job, that is only where the list begins. Insufficient attention to the physical needs for satisfactory working conditions from décor to noise to light and ventilation affect morale. Lack of opportunities for growth, no sense of purpose or direction, an uninspiring vision, work that does not feel meaningful – these all contribute to dissatisfaction and low morale. Work which does not provide decision-making responsibility or authority and is short on recognition and rewards will not be work that builds morale. Gossip, rumors, character assassination of people, departments and/or the organization will kill morale; as will constant criticism not attached to suggestions to solve the problem being complained about.

Often forces well outside of our influence and control will impact our circumstances at work. These include natural disasters;  global, national and local economic and political disturbances;  bad luck and the mysterious interplay of fate and destiny. Let us also recognize that many people don’t like their work, are unhappy, do not feel engaged or empowered and are in wrong placement. Individuals need to accept some responsibility for their joy and/or discontent with their work, and the impact that has on the morale of a group. There is a strong inherent urge in humans to connect with others. Their relationships with individuals, family, small and large groups; their work; their health; and to what constitutes “enough”; as well as their connection with the creative unfolding of the world in which we live will all affect morale. In this way, morale begins with each of us. While we often have little effect on changing others, we can have dramatic effects on changing ourselves.

Can we change morale? The answer, of course, is yes! If we are coming from a place of possibility, are open to change, and not stuck in a place of rigid “positionality”.

“A person is but the product of his thoughts. What he thinks he becomes.”     M. Gandhi

How then might we go about impacting morale in a positive way? This can occur as an “external job”, i.e.  changing the environment – physical and otherwise. For morale is affected by the décor, by people’s demeanor, through the frequency and form of communications in an organization, and by the “culture” of the collective (more about “culture” at another time).  Each of us through our attitudes, beliefs, values and actions are contributors to the collective morale by way of our personal morale. Therefore, morale building must also be an “inside job”.

“if you want to change the world, first change yourself. When you are changed, truly changed, the whole world will be changed.”                                                                         Sri Aurobindo

In their accessible and inspiring book, The Art of Possibility, Ben and Rosamund Stone Zander describe practices to grow personal and professional meaning and fulfillment by moving us into the morale-building world of possibility. Three of their suggestions are touched upon below.

1)      Dare to dream – create an inspiring vision where the force of possibility dominates. A vision that is timeless, universal, and to which almost anyone can relate. Then embody that vision. That is what Martin Luther King did with his “I have a dream” oration and his actions in the world.

2)      Expand your playing field – we tend to see our lives as being played out on our own small personal TV/cell phone/movie screen. After all, we are the writer, director, producer and star in our movie. Practice seeing yourself on the largest/widest screen possible. A playing field at least the size of a golf course, rather than, for example, an indoor basketball court. On a golf course the playing field is gigantic compared to the size of the target hole. While it is quite possible to be out of bounds, it is at the same time difficult to stay in the fairway. Furthermore, wherever the ball lands be it fairway, rough, hazard, trap you have to play it or take a penalty. Since you and the circumstances are never the same, you never take the same shot twice. Furthermore, the game goes on despite the weather, economy, or politics of the moment. When we see not only ourselves but all that surrounds us including circumstances beyond our influence or control – such as heavy traffic, bad weather, the action of others in our immediate environment (opponents AND team mates ), bad luck, even fate and destiny as part of the playing field, then in words from The Art of Possibility , “…grace comes from owning the risks we take in a world by and large immune to our control.” When it all becomes part of our personal world,  then through our constructive thoughts and emotions, words and deeds,  we need not feel victimized or hopeless because we actually do have influence over how we respond to whatever arrives at our gate.

3)      Change the frame – “A pessimist sees the difficulty in every opportunity. An optimist sees the opportunity in every difficulty.”                                                                W. Churchill                                                                  

Are you seeing the glass as half full or half empty? Are you focusing on what is working or what is not working? Are you giving more attention to the low performers or high performers? Are you laying bricks, building a wall or creating a cathedral? Are you attending to those things that you can influence and change or to those things you have no control over?

Through your thinking, words and actions be mindful of creating frames for your picture of reality that foster creativity and possibility. In so doing, your “moral” compass will be true and the “morale” around you will be high.

Resource:

The Art of Possibility: Transforming Professional and Personal Life by Rosamund Stone Zander and Benjamin Zander. Penguin Books, New York. 2002.