medicine

If You Embrace It, It Will Teach You

If You Embrace It, It Will Teach You

"Healing comes in many guises. We're healed by just the touch of a friend. We're healed by the hug of a child. And healing does not imply that your life is suddenly going to lose all of the struggle, all of the challenge. What it does instead is it strengthens us for what is next. But to be open to healing means to be vulnerable. And I think if you look at me, you know I'm what they would call a vulnerable adult. The cat doesn't even listen to me here. I have no real sense of control anymore."

~ Bruce Kramer

Would You Treat Them Differently?

If you could stand in someone else's shoes... Hear what they hear. See what they see. Feel what they feel. Would you treat them differently?

This is an effective reminder of how little we actually know about the people we peripherally encounter in our lives. It resonates with the consistent indifference I experienced when navigating the medical system after I broke my shoulder. The shortcoming of this strategy is that it implies that we would all soften our hearts if we really knew the specific details about what others are going through. But what if we can't know? What if there isn't a drama driving the disinterest? What if the grouchy person you encounter is simply bored or even a bully? 

What if we take this recommended approach a step further? Instead of needing to discover or create a backstory in order for us to erode these social and emotional walls, what if we simply remind ourselves that we can never truly know the subjective experience of another person and that regardless of what we're able to observe on the surface, we're all driven by the deep desire to be safe, happy, healthy, and comfortable.

From this perspective, we reduce the risk of accidently tipping over into pity and comparison. It's easy to shift from feeling sorry for ourselves into feeling sorry for someone else. This approach comes with a side of guilt as we feel badly for feeling bad when we discover someone who is worse off than us. It can be powerful to feel our own feelings while also acknowledging that others are busy feeling theirswhich have nothing to do with us. 

There is some liberation in not having to crack the code of other people. Each encounter with a stranger provide an opportunity to gain a bit of intimacy with how our own thoughts and feelings mingle together to create tiny fictional portraits. We have an impressive ability to project our fears and insecurities onto the canvas of strangers. And when these impression resonate—look out. We assume they are true and act accordingly. 

Intimacy with our thoughts and feelings means simply becoming more aware that the suffering we imagine others to be going throughor the evaluations of their actions at allis a little "reality show" that we produce from a private, mostly subconscious palette of emotionally-flavored sensations in our own bodies along with the verbal and visual details percolating in our minds. 

Of course, the approach I'm describing would be nearly impossible to communicate with an emotionally moving video. This is one of the challenges of sharing attentional fitness techniques. In order to illustrate them in action, we are forced to use specific examples. But any example we use carries an emotional valence. What we're really trying to communicate is the cultivation of an ability to emphasize the composition of experience in contrast to the default preoccupation we have with the narrative content—especially our evaluation or interpretation of the content. 

In this approach, the situation of the other doesn't matter. We try to relinquish the requirement of a valid story before considering our common humanity. In this way, we are trying to develop an empathy that is not dependent on a set of conditions. This might sound like indiffierence, but it feels paradoxically like a much more generous and honest version of empathy. One that isn't so fragile that it instantly collapses when in our personal opinion, the backstory doesn't justify the behavior. 

How would we treat each other if we accepted that we don't have access to every backstory and that we're all driven by the same basic desires regardless of the obervable evidence? 

Enjoy Every Sandwich

"As medical director of the famed Preventive Medicine Research Institute, Lee Lipsenthal helped thousands of patients struggling with disease to overcome their fears of pain and death and to embrace a more joyful way of living. This is his story."

See also:

Jill Sobule covers a Warren Zevron classic

Don't Let Us Get Sick
Don't let us get sick
Don't let us get old
Don't let us get stupid, all right?
Just make us be brave
And make us play nice
And let us be together tonight
The sky was on fire
When I walked to the mill
To take up the slack in the line
I thought of my friends
And the troubles they've had
To keep me from thinking of mine
The moon has a face
And it smiles on the lake
And causes the ripples in Time
I'm lucky to be here
With someone I like
Who maketh my spirit to shine


Don't let us get sick
Don't let us get old
Don't let us get stupid, all right?
Just make us be brave
And make us play nice
And let us be together tonight

Hunting for Attention Skills in Medical Students

Excerpt from "New for Aspiring Doctors, the People Skills Test," by Gardiner Harris, The New York Times, July 10, 2011:

"A pleasant bedside manner and an attentive ear have always been desirable traits in doctors, of course, but two trends have led school administrators to make the hunt for these qualities a priority.

The first is a growing catalog of studies that pin the blame for an appalling share of preventable deaths on poor communication among doctors, patients and nurses that often results because some doctors, while technically competent, are socially inept.

The second and related trend is that medicine is evolving from an individual to a team sport. Solo medical practices are disappearing. In their place, large health systems — encouraged by new government policies — are creating teams to provide care coordinated across disciplines. The strength of such teams often has more to do with communication than the technical competence of any one member."

Loosening the Grip of Emotions

From “Anxiety? Banish the Thought,” The Week Magazine: Health & Science, Jan. 20, 2011:

So many Americans suffer from anxiety and depression that antidepressants like Prozac and Zoloft have become household terms. But new research suggests that mindfulness therapy—a sittingmeditation-based treatment with roots in Buddhism and yoga—can help people with mood disorders feel better without drugs.

“I was skeptical at first,” Stefan Hofmann, a psychology professor at Boston University, tells the Los Angeles Times. “I wondered, ‘Why on earth should this work?’”

Yet after reviewing 39 studies on the practice involving 1,140 patients, Hofmann’s team concluded that mindfulness therapy relieved anxiety and improved mood; another study published  last month found the treatment is as effective as antidepressants at preventing relapses of depression.

It doesn’t work for everyone, but experts have found that training patients to observe their own immediate thoughts can often loosen the grip emotions have on their minds—MRI scans of patients’ brains display shifts in mental activity.

Jordan Elliott, a 26-year-old marketer, began mindfulness therapy for debilitating anxiety four years ago; he now meditates for 10 minutes each morning and has stopped taking Prozac. “When a negative thought pops off in my head,” he says, “I say to myself, ‘There’s a thought. And feelings aren’t facts.’”

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See also:

Capturing the Patient’s Attention

Dr. Richard Fratianne, from “Art and Medicine,” produced by Kerrie Hillman, Studio 360, December  10, 2010:

The problem is music therapy is not compensated by either governmental programs or private insurance policies, because there just isn't very much science in music therapy — yet. And so, I thought that it might be interesting to see if we could prove the value of music therapy in the burn center where pain and anxiety are really very, very high.

A burn injury is so profound that it effects every part of the person. It's not only physical and emotional, but it's an intellectual challenge and there's a spiritual threat because patients don't recognize who they are anymore. They don't feel the same. They don't look the same. Oftentimes they feel ashamed of how they look and they're so afraid. We chose burn patients because the pain is so severe and the anxiety is so high that we thought if we can prove that music therapy can actually have a positive effect in these patients, then we can rest assured that it's going to work in every patient.

Obviously, we can give pain medication, we can give sedatives and tranquilizers, but if it's a really painful dressing change there's no way you can relieve all of the pain except under anesthesia and you can't anesthetize a patient two or three times a day. The body won't tolerate it.

Music requires and integration of many parts of the brain. There's the motor part that's the physical response to playing or tapping to the rhythm of music. Then there's the limbic system, the emotional response to hearing music that brings forth feelings and thoughts and ideas. But also there's rhythm, there's tempo, there's melody — all of these things have to be integrated at the same time to appreciate music. It's amazing how the brain can do this.

The reason we need a professional music therapist to intervene in these painful procedures is that by their training they're able to capture the patient's attention. We call that entrainment. It is actively involving the patient in the musical experience. Because when their mind is diverted to participating in the therapy, they cannot think about the pain.

The earlier research just asked the patient before and after a musical experience, “Do you feel better yet?” That doesn’t really prove anything. It’s only when you’re dealing with patients like we’re dealing with in the burn unit that you can clearly identify changes in their response with music therapy. And we have done that.

One of our latest studies is utilizing the measurements of a stress hormone which is one of the products of the adrenal gland in response to stress. We know when patients are highly stressed these levels go up. And we’re measuring to see whether music therapy can actually depress those levels of the hormone. And our initial studies have shown that.

What we’re doing is new. We know that. And that’s why it’s exciting, because it is new. But the music can have a calming effect on people. How it works is still being discovered.

Repairing Smiles, Changing Lives

Smile Pinki
Directed by Megan Mylan
In Hindi and Bhojpuri with English subtitles
39 minutes
© 2008 Principe Productions

“Pinki is a five-year old girl in rural India born desperately poor and with a cleft lip. The simple surgery that can cure her is a distant dream until she meets Pankaj, a social worker traveling village to village gathering patients for a hospital that provides free surgery to thousands each year. Told in a vibrant vérité style, this real-world fairy tale follows its wide-eyed protagonist on a journey from isolation to embrace.”

Smile Pinki from Andrew Girgis on Vimeo.

Learn more about Smile Train.

[Thanks, Alex!]

Nothing Stays the Same

Excerpts from "The Medicalization Of Mundane Experience: The 'Syndrome' Syndrome," by Ellen Langer, The Huffington Post, December 8, 2009:

There are actually 97 named syndromes. As a culture, I think we have the syndrome syndrome—the naming of sensations. This kind of naming has a hidden downside in that it may actually cause ill health.

There are syndromes that have been categorized and those that haven't, [but] what all of [them]... have in common is that people who are given these diagnoses probably feel some relief in knowing that their discomfort is "real." (Of course, it's real. Why should we think psychological discomfort is any less real than physical discomfort?) The problem is that once symptoms are given a name they run the risk of becoming more permanent than they might otherwise have to be.

Labels lead to expectations and expectations tend to be fulfilled. Surely there are instances when there are no symptoms, but these times are easily overlooked, making the diagnosis seem that much more accurate...when we expect symptoms now that we know we have a legitimate medical condition, we may be less likely to take steps to self-heal. After all, one may think, if it can be self-healed it wouldn't be a medical condition in the first place.

These syndromes are evidence of the medicalization of mundane experience. Sensations fluctuate. Sometimes they are there and sometimes not; sometimes their felt effects are great and sometimes not. By naming them we tend to hold them still and overlook all of this variability. If we mindfully attended to the changes we would at least stand a chance of healing them ourselves...

Nothing stays the same so no matter what the syndrome or disease, we can gain control in this way by mindfully attending to the variability and then questioning why the change occurred. If everything becomes a syndrome, we give up this control over our health. The cure, then, for the Syndrome Syndrome is to become mindful.

[Thanks Kit!]

Endogenous Repair

From "Stem Cells: Untold Stories,” a conversation between Doris Taylor and Krista Tippett, Speaking of Faith, October 29, 2009:

Building Hearts + Lengthening Telomeres from Speaking of Faith on Vimeo.

"What we think impacts who we are. We know that. We know that, whether it's what we think makes us grumpy or what we think makes us happy. And we're learning that those have an impact on our physical body. Stress ages your stem cells. There's science out there from some of the best laboratories in the world showing that the way a cell knows how old it is, is it has a little piece of DNA, chromosome, right? On the end of that chromosome is a little piece of DNA called a telomere. And every time your cell divides, that gets shorter. And when it reaches a certain point, it says, "Oops. I'm old. Time to die." Well, stress makes that piece of DNA get shorter. So stress literally ages your stem cells. If you believe that's true, and it is, it also ought to be possible to reverse stress and make your cells younger...

[Matthieu Ricard] is doing some studies with some people at the University of Wisconsin where he and a number of his colleagues meditate, and as they meditate they measure differences in their brainwaves. And I basically said I would predict that those very same things that when you meditate and you have positive brainwave changes would also have an effect on your stem cells. He very graciously -- and this is an N of one -- let us measure cells in his blood before and after meditation. And what we found was a huge increase in the number of positive stem cells in blood. Largest increase I've ever seen, after fifteen minutes of meditation...

It's all about endogenous repair...

We have inflammation going on inside our blood vessels, inside our organs, inside our tissues. And I think those are nature's cues to say, "Send me cells." Well, I would also say that meditation is essentially doing that without the inflammation. It's nature's way of sending those cells to the sites where you need them in a way to turn down the negative aspects of stress. So stress in my mind is another word for inflammation. I would say inflammation is the physiologic consequence of stress."

Persistent Improvements

From “How Mindfulness Can Make for Better Doctors,” by Pauline W. Chen, M.D., New York Times (October 15, 2009):

Last month, The Journal of the American Medical Association published the results of a study examining the effects of a year-long course for primary care physicians on mindfulness, that ability to be in the zone and present in the moment purposefully and without judgment. Seventy physicians enrolled and participated in the four components of the course — mindfulness meditation; writing sessions; discussions; and lectures on topics like managing conflict, setting boundaries and self-care.

The effects of the sessions were dramatic. The participating doctors became more mindful, less burned out and less emotionally exhausted. But two additional findings surprised the investigators. Several of the improvements persisted even after the yearlong course ended. And, those changes correlated with a significant increase in attributes that contribute to patient-centered care, such as empathy and valuing the psychosocial factors that might affect a patient’s illness experience.

More…

[Thanks Kit!]

Mindfulness Training Improves Attitudes about Patients and Their Care

Excerpt from “Mindful Meditation, Shared Dialogues Reduce Physician Burnout,”  News Room - University of Rochester Medical Center (September 22, 2009):

Training in mindfulness meditation and communication can alleviate the psychological distress and burnout experienced by many physicians and can improve their well-being, University of Rochester Medical Center researchers report in this week’s issue of the Journal of the American Medical Association (JAMA).


The training also can expand a physician’s capacity to relate to patients and enhance patient-centered care, according to the researchers, who were led by Michael S. Krasner, M.D., associate professor of Clinical Medicine.

“From the patient’s perspective, we hear all too often of dissatisfaction in the quality of presence from their physician. From the practitioner’s perspective, the opportunity for deeper connection is all too often missed in the stressful, complex, and chaotic reality of medical practice,” Krasner said. “Enhancing the already inherent capacity of the physician to experience fully the clinical encounter—not only its pleasant but also its most unpleasant aspects—without judgment but with a sense of curiosity and adventure seems to have had a profound effect on the experience of stress and burnout. It also seems to enhance the physician’s ability to connect with the patient as a unique human being and to center care around that uniqueness.

“Cultivating these qualities of mindful communication with colleagues, anectodotally, had an unexpected benefit of combating the practitioners’ sense of isolation and brought forth the very experiences that are such a rich source of meaning in the life of the clinician,” he said.

More…