"Empty Self Syndrome"

Friends:

The title of this piece, "Empty Self Syndrome" comes from a book that I'm working with right now by Parker J. Palmer entitled, "A Hidden Wholeness". It is a wonderful book (I'm about 1/3 of the way through it) and it offers some mechanisms for healing our broken world. Mr. Palmer posits that we are morally indifferent (lack of deep caring for each other) because of a "fragmented mass society that leaves us isolated and afraid, an economic system that puts the rights of capital before the rights of people, and a political process that makes citizens into ciphers." (page 37 & 38)

He next goes on to say that in his view, the defining problem of our time is not that we live in a "cult of me" but rather that "as community is torn apart by various political and economic forces, more and more people suffer from the empty self syndrome". (pg. 38) The "empty self syndrome" is characterized by a "bottomless pit where their identity should be - an inner void they try to fill with competitive success, consumerism, sexism, racism, or anything that might give them the illusion of being better than others." (pg. 38)

Wow! Mr. Palmer just hit the nail on the head (as far as I'm concerned). Mystics and spiritual writers have long written and taught about the self-emptying that needs to happen in order to be filled with the Spirit. Self-emptying is different from the "empty self" in that self-emptying is a creative process guided by spiritual disciplines, that removes the influence of the world and allows one to get in touch with the spiritual. It is best accomplished, supported and guided in a community.

When there is no spiritual community to be found in a persons life, as evidenced by the rapid decline in faith community attendance, then the world will fill the void. The world of "just do it" and "the one with the most toys wins" is not enough to fill the void left by the true self. How often have I/we heard someone speak to trying to fill the void with sex, drugs, alcohol, overwork, or any other dependancy in order to feel "filled up" (whole)? Twelve-step programs exist, and are successful, in large measure to the fact that they address this empty self syndrome and teach others to fill it with true self instead of a dependence producing entity.

Mr. Palmer goes on, "A strong community helps people develop a sense of true self, for only in community can the self exercise and fulfill its nature: giving and taking, listening and speaking, being and doing....Lacking opportunities to be ourselves in a web of relationships, our sense of self disappears, leading to behaviors that further fragment our relationships and spread the epidemic of inner emptiness." (pg. 39) Thus, we need to find or help to create strong communities that foster the recognition and development of true self. Only then will we be healthy, well and whole.

The "best" spiritual communities offer this kind of healthy environment for their people to develop the recognition of the true self inside them. Without this kind of strong community development, we will be unable to make much headway in creating healthier communities where we live and work. It is only "when we are rooted in true self, we can act in ways that are life-giving for us and and all whose lives we touch. Whatever we do to care for true self is, in the long run, a gift to the world". (pg. 39)

So go and pick up this wonderful book and explore what Mr. Palmer has to say. I have found it life giving, and it has opened Way for me to be able to move forward with Possibilities Journey, Inc. (www.possjrny.org). Our role at PJ is to help people identify ways in which they can become more whole, that is, to fill up their empty selves in a way that leads to abundant life.

Peace and grace,
Dan

A House Divided...

Friends:

Before I get into the blog for today, I want to make you all aware of a potentially wonderful new website. The site is called "Health Reform GPS" and is a product of the George Washington University Law School and the Robert Wood Johnson Foundation. The site is set to track health reform implementation, and it appears to be robust. Check it out today, and add consider adding it to your "favorites" button on your browser - I think you might look at it frequently; I know I will be. (Access the site at: http://www.healthreformgps.org/?cid=xem-emc-ca)

My thought for today is about Abraham Lincoln's famous quote dealing with how a house divided can not stand. He was using the metaphor in relation to the events leading to the Civil War. I'd like to spend some time with them today in relation to how a lack of attention to spiritual development allows for our dis-ease, which leads to unhealthy behaviors.

For a long time, really since the Enlightenment, spiritual development has been on the wane, while the development of the scientific method and physiologic-basis for disease waxed. This imbalance between spirit and science has become so marked that, from a health and wholeness perspective, we are now living in a "house divided". Our scientific community spends all their collective time and effort (and our money) on developing the newest "pill for the ill". We are so skewed in this direction that each year we see medications developed to treat illnesses we don't even know we have (a treatment in search of a disorder). The division has become so extreme that even our clergy, just a few decades ago the healthiest profession, now are the least healthy.

So, how to we regain some balance, or at least start to move the balance back toward neutral? I think the first way is to acknowledge that the scientific method, while tremendously important, can never answer all the questions that come during life or solve all the ills of humankind. Our endless search for meaning through explanation of the intricate details of life has extended our lives, but hasn't brought any "life" to that living. We measure "Quality Adjusted Life Years" but can't agree on just what measure of "quality" is important. Science can only take us so far - because science can't stand unknowing. We have knowledge, but we lack insight.

In spirituality, the mystical literature of the Abrahamic faiths (as well as many others) leads us in a experiential journey with the "Other". These experiences point us in the direction of self knowledge and insight, which can lead to healing and wholeness. Once we discover that we are not the center of the Universe, nor are we God, then we can put away the hypocrisy of the secular world and begin to develop a healthy self-concept and a reality-based approach to living. Understanding ourselves as interdependent beings who rely on each other for support and community, clears the way for an exploration of what it means to live in a healthy and whole society.

Possibilities Journey, Inc. (www.possjrny.org) exists for just this kind of exploration. We believe in the power of medicine and in the study of science, while balancing that with the equal importance of self knowledge and insight that comes from exploring connection, coherence, agency, blessing and hope (from the book, "Leading Causes of Life", by Gunderson and Pray). Life comes when we truly connect to each other, share an understanding of who we are and for what we're created to do, create energy to do healthy things, embody blessing for those who interact with us, and discover that through the interaction of all of this that hope is created. The house becomes whole and we can stand all of the things that life brings.

I encourage you to look at your own "house". Is it divided between too many competing worldly pursuits? Are you spending all of your health time at the gym, and none with the "Other"? Do you see yourself as part of a larger whole? How comfortable are you with not knowing? Come with us at PJ an explore these and other topics. Come journey towards wholeness.

Peace,
Dan

Joy versus Happiness

Friends:

I'm moved today to write about the spiritual and functional difference between joy and happiness. I'm not exactly sure what the motivation is behind this, except that I'm considering the life of my maternal grandmother and how she often (especially in her last few years of life) appeared to be quite joyful. Her joy was apparent even though she was suffering the losses and griefs that come with aging.
A comparions of joy and happiness are offered to you to bound our discussion. While you may have your own beliefs and definitions, a differentiation, using antonyms for the two terms, found at (www.defin.com) suited my purposes today.
"One way to understand the difference between joy and happiness is to look at the opposites of the two feelings. The opposite of joy is fear while the opposite of happiness is unhappiness and misery."
It is helpful to note that most references in defining joy versus happiness talk about joy being much longer lasting than momentary happiness. This makes me wonder about the framers of the Constitution when they stated that the United States were all about "life, liberty and the pursuit of happiness". Others have recently posited that many if not most of the ills of our society can be traced back to this (potentially) flawed premise that we as citizens of the U.S. should pursue momentary happiness. What happens then when happiness fades (like satiety following a good meal)?
If happiness is fleeting but quite pleasing, then just like rats in a Skinner box we will do whatever we need to do in order to be happy again. I think that there is some validity in this explanation for why we appear as a culture to be on a never ending treadmill of acquisition (aside: the self storage industry in the U.S. was a $15 billion industry in 2008 and growing) and spending on luxuries such as cars, boats, ever larger homes, plastic surgery, etc. Why do these things keep growing you wonder? The answer is because they provide happiness not joy.
I've often stated that our most important act of stewardship is the care of the body that God gave to us and enlivened. Though I still believe that is true, caring for our bodies has taken precedence over caring for the whole of ourselves. Thus, we do not pursue those things that lead to peace and joy - we go to the gym to get "6-pack abs" and "bigger guns" (aka biceps) that last until we find that having those things does not bring us joy (and it gets ever more difficult to maintain). We at Possibilities Journey (www.possjrny.org) believe in returning the main focus of stewardship to caring for the whole of the person (mind, body and spirit) in connection to a spiritual community that can continue to feed and hold the person accountable for their choices. We prefer to focus on the pursuit of wholeness which will be joyful and freeing.
Happiness versus joy - which will be your choice? Let us know how we can enable and empower you to pursue joy in your life. Let go of unhappiness, misery and fear, join us on the journey towards wholeness and joy.

Peace,
Dan

Testimony as a Tool for Improved Health, Wellness and Wholeness

Friends:

Before I begin today's thought, I must apologize to you all. It appears that I had the "comments" button set so that no one could easily comment on my posts. I think that I've corrected this, so please, post your comments so we can engage in discussion and learning. Also, as indicated in my post on Thursday, my grandmother did indeed die on Saturday. She did so peacefully with my sister, mother and father in attendance. Prayers for my family in this time of grief are appreciated.

Today's comments go to the power of story in helping other people understand an event in your life. The actor, Denis Quaid, and his family were stricken by a medical error 3 years ago when his infant children were just 10 days old. This medical error has been well documented, and led to Mr. Quaid's formation of a foundation to seek to eliminate medical errors. He has co-authored an article that focuses on the power of shared story to change perspectives. This is what I want to focus on today. See:

In many churches (certainly in the "traditional" Methodist church that I attend) we have lost the power of shared story - that is the sharing of testimony or witnessing. In that case, witnessing to the role of God in the life of the person (and the application to the broader community). The giving and receiving of testimony, once such a part of spiritual formation (and of building healthy community) has been pushed aside in most mainline denominations. It appears that we have done this to our detriment.

Consider that in all the Abrahamic faiths, testimony, midrash, parable, etc., are all ways in which the message was spread. It was also the primary vehicle through which people were/are converted and retained. The article by Quaid, et al, once again highlights the power of the giving and receiving of witness. It can be argued that the only reason we as healthcare professionals and as institutions have progressed at all on the matter of patient safety and medical/medication error reduction has been because of the sharing of stories.

So, how do we go forward from here? Possibilities Journey is all about shared story. We are sharing the story of how we need to return to our "roots" of spirituality to help everyone understand that without story there is no community, and without community there is no wholeness; without wholeness there can be no health and no wellness.

Come, share your stories and journey with us towards Shalom.

Peace,
Dan

Reflection on Illness as a Spiritual Gift

Friends:

I was on the website of Beliefnet (www.beliefnet.com)and found an intriguing slide show entitled, "8 Ways Illness can be a Spiritual Practice" by Toni Weingarten. I really identified with this approach, as it is part-and-parcel of what I'm attempting to do with Possibilities Journey (www.possjrny.org). That is, return spiritual understanding to the processes of healthcare.

Ms. Weingarten (in a matter of 10 slides) shows quite clearly the spiritual aspects of debilitating illness. Spiritual aspects of disease such as the need to slow down and be insightful; practicing acceptance of illness-specific limitations; allowing yourself to be cared for; being present to your situation and many more. All of these are insightful and I think useful as we frame our view of what it means to be whole.

Illnesses take their toll not only on the index person, but on the support system as a whole. My maternal grandmother is in her final days of earthly life. In late-February she developed lower leg pain and then a few days later suffered a stroke. She recovered from the stroke, but the leg's blood supply was compromised (I suspect by a large clot) - it began to die. The decision was made with my grandmother and her care team/family to not try to surgically treat the leg - rather we would just involve hospice and manage the pain.

In the last two weeks, grandma has become more withdrawn and less alert. The hospice nurses have been great in educating my mother, father, and sister (and her family) about death and final life stages. In talking with my mother (and my wife as well) a couple of days ago, however, mom was voicing regrets about not intervening with the leg. I reinforced the fact that it was what grandma wanted, and what I had explained to her and all what would come from that choice. Not doing something in our "just do it" culture is very hard - and so often I have seen advanced directives and personal wishes superceeded by well meaning family members who could not face the spiritual challenge of death. How we need more support in this area of our lives!

My grandmother will die soon, that is a fact. Her death will be sad, but it will not have been tragic, ill informed, or medically, technologically and monetarily abusive (as so much of the death I have witnessed and been a part of in the ICU world has been). Grandma knows that her life as been well lived, as do we. We will be able to celebrate this knowing that she was honored in her final wishes - as difficult as it has been for those close to me to witness.

I guess that this time of illness in my family has not only been spiritual practice, but spiritual discipline. The discipline of loving another as we love ourselves - sometimes the most challenging discipline of all.

Peace,
Dan

End of Life and "Do Not (Attempt) Resuscitation" thoughts...

Friends:

Good Monday morning! I hope that your collective weekends brought you outside in the Spring to interact with the natural beauty that surrounds us this time of year.

I was struck this morning by a National Public Radio (NPR) piece entitled, "For This Doctor, DNR Means 'Do Not Resign'" (see at: http://www.npr.org/templates/story/story.php?storyId=125788057&ps=cprs). The reflections of this young-ish physician are all too common, and one that I dealt with mcuh of the time that I practiced in intensive care units (ICU). Persons arrive at Emergency Departments (ED) without all their relevant information (whether from home or all too often from nursing homes) and the medical mantra of "let's do everything" kicks in. Persons are physiologically stabilized and then sent to the ICU where often discussions with the support system reverses what was done in the ED.

This kind of behavior is understandable (medical model of err on the side of life) but creates hard feelings among medical practitioners (as you can hear in this physician's lament). Hear also, however, that the young doctor hits on many of the "ills" that are so imbedded in our current model of delivery of "care". Comments like "she's fixable in the short-term", "I think she can probably get at least a few good weeks", "here are my educated instructions". Note how his focus is on him - not on the person he is treating. Now, in fairness, he has no relatinoship with the person in question here - the first time he meets her he has to perform heroic measures in order to "save" her life. Thus, he doesn't know what she wants and his "education" and professional ethic takes precedence.

At one point in time, a physician had the luxury of knowing his or her patients from cradle to grave - in fact, in some cases, for many generations. This is by far the exception rather than the rule nowadays. Doctors do not have the kind of in-depth conversations about wishes and end-of-life scenarios that would keep this kind of intervention (bordering on abuse) from happening. It is uncomfortable to have a plastic tube inserted into your esophagus; it is uncomfortable to have air blown into and sucked out of your lungs by a machine; it is uncomfortable and debilitating to have hemodialysis; it is painful to have chest compressions and IV starts, constant blood draws, not to mention laying in a hospital bed; it is annoying beyond belief to have constant noise of monitors and hospital personnel.

Not only that, but after all these things were done to this unfortunate soul - one of God's children like all of us, she was still going to die. Remember this educated physician stated that "she can probably get at least a few good weeks". The operative word is "good" - what does that mean spiritually? Our Hippocratic Oath requires all healthcare professionals to "first do no harm" - first and foremost we should not harm another person! As detailed in the previous paragraph, much of what we do nowadays does in fact harm people (that is without considering medical and medication errors). We err on the side of keeping the organs functioning, whether or not that is what the person wanted, or what they considered to be living. We don't know how this person views what comes after death, and whether or not they are "ready" to die - not fearing death but understanding that it is the final act of a life well lived.

The doctor concludes, "Only after you make every effort to make me happy and human, ask me again if my life is worth living." This statement assumes that efforts of man can make us "happy and human". I can tell you from experience in many ICU's over 20+ years of dedicated and informed practice, that this is not possible - it will always be beyond human capacity to accomplish this - and placing this as the goal is what leads to professional burn-out. This statement also assumes that the medical model can in fact make us happy and human. Unfortunately, only a relationship with God - the God reflected in each and every person - can lead us on that path. Only our ability to live the truth that "God is God and we are not", will allow us to create the space where we can enter into that loving relationship with something much greater than ourselves - something that can heal us, something that can make us whole, something that can return us to our full capacity to love one another as we love ourselves. Only then will we be what God intends, only then will we encounter Shalom. All else is idol worship at its most tragic.

So, I encourage you all to get Advanced Directives and make sure that they follow you where ever you go. Make sure you have a health advocate and proxy for decision making that will strongly advocate for your wishes. Spend time with folks who understand end-of-life care (like us at PJ) and the vagaries of intensive care, so that you can make informed decisions about who you are and what makes life worth living. Do it today, before you end up in an ED some where with plastic tubes in your body and others making decisions on what is "best" for you.

Peace,
Dan

Loneliness as a health hazard...

Friends:

I read with interest another in a series of articles over many years on how we as humans do not thrive if we are isolated. (See: http://www.usatoday.com/news/health/2010-04-08-isolation08_st_N.htm?csp=34&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed:%20usatoday-NewsTopStories%20(News%20-%20Top%20Stories)&cid=xem-emc-nd)

Even though individualism is rampant in today's society, and we are encouraged to "die with the most toys", there is something fundamentally amiss with this model of behavior. All things are inter-related and inter-dependent, whether you are considering ecosystems or the interaction of communicating substances within the human body. Nothing exists in isolation. There is both biblical and scientific wisdom to support this.

We are engaged in healthcare reform (primarily health insurance reform with a modicum of "care" reform) and much will be debated about what needs to happen in order to "fix" the systems that deliver our "care" (sorry for the apparent overuse of quotation marks). One of the important aspects of the USA Today story for me was the ability for a patient to feel alone while surrounded by hundreds of people each day. This is not unique to hospitals or institutions in general, consider the workplace. However, hospitals should be about caring for the whole person not just their disease.

I think about my own work in intensive care units over the last 20+ years and know this to be true. Anyone who has spent time in a teaching hospital knows about academic rounds where a gaggle of earnest young professionals and a seasoned veteran teacher enter grandly into a patient's room, circle the bed, and begin to talk in an incomprehensible language over the top of the person - as if they don't exist. Talk about lonely!

Thus, one aspect of care improvement is to acknowledge our dependence on one another, and on our need to belong to a group to enhance our health. Whether it is an internet social network, a small group of friends, a 12-step recovery group, a faith community, or a composite of all of these, one thing is for certain (as the old Three Dog Night song implies) "one is the loneliest number that you'll ever do." For a healthier humanity, we need to eliminate all the "ones".

Peace,
Dan

Spirituality and Health

Friends:

So I went browsing today across a section of the internet with the search terms "spirituality and health" to see what I could see. Similar to the bear going over the mountain, I found a lot of sites touting improvements in health and wellness, but no spirituality focus (ala the "other side of the mountain"). For clearness - let's use the 1999 definition of spirituality from the Association of American Medical Colleges Medical School Objectives Report III: "Spirituality is recognized as a factor that contributes to health in many persons. The concept of spirituality is found in all cultures and societies. It is expressed in an individual’s search for ultimate meaning through participation in religion and/or belief in God, family, naturalism, rationalism, humanism and the arts. All these factors can influence how patients and health care professionals perceive health and illness and how they interact with one another."

SO, what did I find in my search? One site, The Center for Spirituality and Healing at the University of Minnesota (www.chs.umn.edu), has some great things going on in complementary and alternative health, but next to nothing in spirituality. They discussed a "circle of health" that contains 6 domains - Intention, Balance, Compassion, Love, Mindfulness and Connection; but did not link spiritual unhealth integrally with physical/mental unhealth.

Isn't it interesting that "integrative health" is currently defined as providing opportunities for people to explore alternative or complementary therapies/treatments for disease - not the integration of spirituality or the need for spiritual formation to address the changing health of a person during their life? Seems to me that we've gotten a bit far afield, as it were, from the point of journeying towards wholeness.

I also went to some major "patient networking sites" such as PeopleLikeMe, Inspire, HealthCentral and CureTogether. Each of them offered connectional opportunities and sharing, but none of them offered anything for an ailing soul. Further, some of these sites allowed for shairng of experiences and symptomatology, without any health or spiritual professional input to help persons understand what these symptoms may or may not mean (especially in cyclical syndromes such as Bipolar disease and chronic relapsing/remitting illness such as MS).

The George Washington Insitute for Spirituality and Health (www.gwish.org) however, was different. It is focused on educating and training healthcare providers to focus on spiritual needs in addition to physiologic needs. Good tools were seen for quick spiritual assessments and "ice breaker" questions. This is where Possibilities Journey, Inc., sees potential (www.possjrny.org)! If we can get a critical mass of healthcare providers assessing (or even just asking and actively listening) to people about how their spiritual beliefs inform their healthcare decisions, well then, we're really into a transformative phase of healthcare delivery.

I'm hopeful that the conversations I'm starting to have with different healthcare groups around assessing for the presence of spirituality, and then augmenting that which is found to allow a person to have the spiritual support that is needed to address issues of health, wellness and wholeness, will bear fruit.

I'd be very interested in hearing what you all have to say about your own experience(s) with spirituality and health. I'd also like to know how you feel about the definition of spirituality quoted above - does it reflect your experience?

Peace,
Dan

Spring Break Thoughts on Personal Accountability in health, wellness and wholeness

Friends:

A recent NY Times article by Dr. Sandeep Jauhar (Access at: http://www.nytimes.com/2010/03/30/health/30risk.html?ref=health) got me thinking...how accountable can anyone really be for choices that they make? The quote that is compelling:
"...But personal responsibility is a complex notion, especially when it comes to health. Individual choices always take place within a broader, messy context. When people advocate the need for personal accountability, they presuppose more control over health and sickness than really exists. Unhealthy habits are one factor in disease, but so are social status, income, family dynamics, education and genetics. Patient noncompliance with medical recommendations undoubtedly contributes to poor health, but it is as much a function of poor communication, medication costs and side effects, cultural barriers and inadequate resources as it is of willful disregard of a doctor's advice...."

It's true, when you stop to ponder it, all of our free will choices occur in the complex matrix of our lives. Even in community - even in the most caring and supportive of communities - each and every one of us makes choices about our daily lives and how we are going to live them. How often do we focus on the interdependence of our lives? How often to I stop to consider that my choices ultimately affect your ability to choose for yourself? How often do I engage in socially irresponsible behavior(s) that will ultimately affect how I interact with your sphere (e.g., talking on the cell phone while driving, not eating right or getting enough exercise, living a life with too much stress)? Hmmmm...

Often in the routine days of delivering care to those in need, I came across persons who had neglected their health and then got into trouble and wanted to be fixed. I came up against this most forcibly when I was working with a liver transplant program. Approximately half of the potential recipients were alcoholics - they had destroyed their livers through excessive ethanol intake. Now, the program required contracts and 6-months of sobriety before being listed for transplant, but I found myself in a spiritual/ethical crisis, wondering if this was a "good/appropriate" use of a limited resource. I struggled with this question/ethical dilemma for months, and finally came to peace with it through the concept of redemption.

The Abrahamic faiths all believe in a God of redemption and unqualified forgiveness. It is especially near to Jews and Christians this week as Passover and Easter are celebrated. Thus, if someone asks for forgiveness it is granted. How then, could I judge another's heart and ability to be redeemed? They had forsaken alcohol and had changed their lives, and were now seeking what help the medical establishment could give. I had taken an oath to do no harm and to seek to help others to the best of my ability. It was not/is not in the ethical code of a pharmacist to judge the acceptability of another human - only to care for them.

The debate about health insurance and coverage for those with "pre-existing conditions" and who have lacked basic health services is similar. Many are of the opinion that those who are sick or who have engaged in "unhealthy" behaviors should pay more for health insurance. Unfortunately, these are exactly the persons who can't afford to do that (similar to giving loans to poor countries who are already shackled with too much debt). That is, those people who daily have to decide whether to buy medications or food, are faced with a decision that is socially unjust and needs to be addressed by the rest of us. It is clear that providing health care through E.D.'s is costly, episodic, and does not improve the situation.

Insurance is supposed to share the risk widely so that no one person or group shoulders the burden. A final quote from Dr. Jauhar:
"...The whole point of insurance is to reduce risk. When people inveigh against the lack of personal responsibility in health care, they are really demanding a different model, one based on actual risk, not just on spreading costs evenly through society. Sick people, they are really saying, should pay more. Which model we eventually adopt in this country will say a lot about the kind of society we want to live in."

What kind of society do you want to live in? Freedom of choice and freedom in general demands a level of self sacrifice. How will you choose?

Peace!