Curing Mental Constipation

I have a dear friend, an Englishman-talk-show-host-cartoonist-yoga-teacher, (Go figure!) whose sense of humor and sensibility feel like Deepak Chopra talking through Monty Python.  This makes for very engaging conversation, in case you're wondering.  Anyway...in his own, delightful way, this friend made me laugh out loud on a conference call recently by telling me that he was working to release his "mental constipation." He had found himself so far in contemplation that he was having trouble deciding on a direction.  He knew I would understand, as a fellow contemplator and seeker, always thinking that "there might be a better, more beautiful, more integral way."  All that contemplation sometimes leads to thoughtful solutions and insight.  But more often than not, if it is not held and managed in a wise way, contemplation can overload us, resulting in the plugging up of all our higher capacities.  It turns out that this is an expected stage in the development of a spiritual seeker, but knowing that makes it only slightly less unpleasant to be stuck in.

Mental constipation.  What a perfect image for slightly mistaken interpretation of what meditation is supposed to do for us.  We've been told we're supposed to slow down, let thoughts go, and tune into spirit, energy, intuition, guidance...something to help us on our way.  We are supposed to BE, not to DO, and for the vast majority of people, this is the right prescription.  We ache for that little bit of peace and space inside our brains.  As a result, if we end up, instead, with a brain crammed with ideas, perceptions, and vague fears, we feel cheated, as though we signed up for a course that turned out to be a dud.  Or we assume that we're "doing it wrong,"  that somehow real meditation is supposed to clear our mind and give us right answers.  When we don't get this, we feel even more cut off from a sense of purpose than when we started on our path.  

Don't get me wrong.  I am a huge believer in bringing contemplation into our modern lives, where the speed of consumption and communication seem to be catching up to the speed of lightning.  It's just that we've jumped in--hook, line, and sinker, into the language of meditation and mindfulness  (How many times a day do you see a commercial product called Om-this, Zen-that?) without a lot of training in the actual practice.  Although meditation can be simple, it is valuable to have a road map, a guide to help with whatever comes up.  And...it turns out that having a powerful intellect can make the experience worse, until, that is, we have a little practical instruction and time to practice.  In the end, although some may disagree with me on this, I believe the human intellect may be the most powerful agent of all in transforming our lives.  The brain is informed by the heart, which acts as an agent of neuro-hormonal-electrical wisdom, sending signals upward regarding our surroundings, our emotional and intuitive responses, and our physical state of being.  Ultimately, it is our brain's analysis that can help us see how and why we are stuck. But before we can get to using our brain-heart loop  in transforming our understanding of life, self and universe, there are some layers of learning to traverse. Until we learn to use our emotional-analytical capacities wisely...

There we are, sitting on our cushion--or subway seat, trying to be mindful about a current issue in our life, when, a fear or bad memory comes up, and in no time at all, we find ourselves with a thousand reasonable (and unreasonable) thoughts circling round in a loop of obsessive, internal ruminations.   Instead of contemplating wisely, we get overwhelmed.  We are yanked into a paralyzing web that takes us further and further from clarity. Our mind gets wrapped up tight and voila...a full-on bout of Mental Constipation!  It's a phenomenon just as painful and literally unproductive as the intestinal variety.  We wonder...."How did I get from meditation to constipation?" "Is this meditation really even good for me?"  "Maybe I should try hypnosis.  Or a massage. Or a mental laxative, like a drink."

Happily, mental constipation can be resolved once you dissolve a misperception about the meaning of leading a "spiritual life."  People fairly new to the spiritual path often view meditation as a way to cultivate perfect responses to life and all its challenges.  They think they'll run away, far up onto the mountain top, where they can sit...for years...and figure it all out...and then maybe, once they are clear and impervious to live's rudeness and disappointments, they'll return to exercise their wisdom and compassion.  Or, if they are realistic enough to know they can't run away, they are still looking for meditation to magically and thoroughly transform them, turning them into someone who always knows the right thing to do. (Okay, we all probably want THIS, too, but here is where you can correct a misperception that may be holding you back.)

It turns out that meditation isn't about smoothing life out at all.  In fact, the bad news is that meditation might actually make life more complicated for you--at least for a while.  You see more, feel more, notice more...and not all of it is pretty.  This goes on as we look at ourselves and at our world, and for a sensitive, contemplative person, who is already prone to looking at life's interconnectedness, it can be highly discouraging.  "If there is all this ugliness in me, all of these endless problems, and all of this tension between people, then how can I ever address it all? How can my one, little offering make a difference.  How will I ever be enough?"  Strangely, this feeling is often all-consuming in people who, by others' accounts, are highly gifted, talented folks who should have a lot to offer.  It's just that all that kindness, insight, sensitivity and intelligence is wound up in a bunch of "what if's", self-doubt, and doubt about the goodness of the world.  In these people, the desire to do good continually meets with the "reality" that "we'll never be able to fix it all and make it beautiful," and eventually, as with all chronic fights, energy is spent, and a kind of depression and mental fog sets in...and nothing looks clear at all.

And so they shut down a little--or a lot, and meditating can, sometimes, take such a person to a place of complete overwhelm.  

But it doesn't have to be that way.  In fact, one of meditation's deepest lessons is about the importance of the "good enough" beginning.  This is the tiny seed that, when planted, watered, and tended, grows into a garden of kindness, bouquets of caring and useful deeds--ways that one life can touch another.  This is how most change happens.  It is how water shapes the rock and how attention shapes the mind and how small doses of love shape a life.  

For people who wilt into overwhelm, this is the most important lesson of all.  We simply must begin. After reflection, we must also choose a way and get started.  We must take a tiny, but real step into life...and act on our intentions.  Of course we are allowed and encouraged to gather feedback and adjust, but begin we must.  It is the only way we can survive, really, as the alternative is to suffocate under our fears and questions.  While our bold and driven neighbors may well need to spend some time in the garden of reflection, sensitive types must learn to let meditation bring them out of hiding and into the world.  

I have found that it's even possible to find healing in taking some action whose importance or genuineness we aren't yet convinced of.  I am not big on clichés, but if you can take the cliche to the higher level, finding its actual truth rather than only its flimsy, plastic wrapping, you can "smile your way to a new feeling."  Not only is this neurologically, hormonally, and behavioristically true, it is actually testable in your life.  I do not mean pasting on some fake grin and doling out frothy truisms you don't mean.  Rather, you can actually sit down and say, "How would I handle this if I felt brave, noble, and grateful for all I have?"  "How would I handle this if I were expressing my inner, wise grandmother?"  "How would I go after this job if I believed that I were really a talented and capable (artist, or lawyer or teacher)?" Recently I had a chance to see how simply committing to studying for one day allowed me to get beyond the dread I had of the studying I'd need to do to pass the Family Medicine boards.  I had put it off, created reasons to avoid it...on and on.  But finally, I made a pact with myself to study for one day, eight hours in sum, and somehow, in that first, small step, the whole things started to look not only possible but really worthwhile.  I began to look forward to making times to study, rather than fearing that my studying wouldn't be enough.  It is like that again and again in our lives, especially for those of use in whom "the perfect gets in the way of the good."  We have to remember that if we don't begin, then we can not give of ourselves, and the world misses out on the very kinds of qualities that we wish it had more of.  By holding ourselves back, hiding behind contemplation, we are not only not responding to the call of our psyche and soul, we are actually adding a bit of fear and mistrust to the world.  Without necessarily intending it, we are being selfish and short-sighted.  It is the little step which is the real act of compassion and trust.

Risking Everything--When the Old Story Falls Away

What I'm about to write comes to you on waves of insight that originated 1) last night, 2) a week ago, 3) a year ago, 4) early in my childhood, and 5) well before I was born.  

Last night, I listened to my friend, Kathleen, interview Sir Ken Robinson about inspiration, creativity and having the courage to do what matters to you.  

A week ago, while traveling in Europe, I had an insight that unraveled an old story I had in my mind about why I had to practice medicine of a certain form and be "careful" of labelling myself as working with the depths of the psyche. 

A year ago, I lost a job, or rather it disintegrated, in part because I had been less than clear with my intentions, desires and opinions.  This loss left me with a need to explore how I had gotten there and what I really wanted from life.

Early in childhood, I became aware that I was very sensitive to people and capable of all kinds of complex, internalized emotion and insecurity. What I didn't know was twofold:  First, I was not alone.  Second, this sensitivity was so acute that I would take on heroic measures to please and impress others--all of which would lead to real difficulty in actually knowing what I wanted.

What happened before I was born?  As I see it, a stream of cosmic and human events unfolded, and I entered something bigger than myself.  I do not believe in a predetermined destiny, but I do believe in the soul's journey to live out its work, and I think this happens through co-creation with the universe.  A sprinkle of the mysteries of karma, the grip of genetics, the possibility of parallel universes and other things our heads can't grock...all these intersect with personal responsibility, intention, and ordinary physical forces.   It's like the serenity prayer, which goes: "God, (insert Buddha, Dharma, Tao, Allah, Universe, Gaia, or Non-Denominational-Alliance-of-All-Beings-Working-this-Stuff-Out, or the Global Committee for Pro-Social Non-Believers ...whatever works for you), grant me the grace to accept those things I cannot change, the courage to change the things I can, and the wisdom to know the difference.   It's that last clause that gets me.  When do we accept versus transform or jump ship?  I don't expect to work this one out anytime soon.  If I did, my life would be so boring as to lack sufficient tension to fuel my end of the co-creative evolutionary process. What I do plan to do is gather all of the universal compost that has come my way from past and present and use it to plant my garden.  And this brings me to the point where the old story falls away.  

Last week, my husband and I were driving from France to Germany to Switzerland on our first no-laptop vacation in five years.  While skiing along a cross country trail in the Haute Jura mountain region, I found myself reviewing, for the ten thousandth time, the issue of whether I should seek a structured job, returning to the 9-5 mechanics of seeing patients in a regular clinic under the title of holistic or integrative doctor.  The opposing options include to continue writing, which I will do either way, but more importantly, to allow myself to more overtly take up, and identify myself, as someone who works with the psyche.  I could go back to complete a new licensure as a psychologist, or I could simply apply my own my intuitions, experience, and years of self-guided education and time in mentoring relationships with psychologists and others whose work with the psyche/soul I admire.  It's an old question for me, but one that has come to the fore. 

Although I studied first language, communication, and literature and then soaked up anthropology and the psychology of human development in college and graduate school, I then made a tremendous leap into medical school--a move that is, both on its face and in its depth, surprising.  Health was a hobby of mine, and I am good in counseling roles; that part is not hard to explain.  But why I didn't pick clinical psychology or some form of truly holistic training is more puzzling.  "Disease care" (a better description of what a person learns in medical school) neither did nor does fit me very well, even though it is a necessary field of work I respect deeply. For years, I told myself that the reason I chose to go into family medicine and preventive oncology was that too many people would be afraid seek me out if I were a psychologist or a holistic practitioner, and I needed to make myself available to them as a standard MD, treating the body, so that when they came to me with their back ache, I could bring to them not just medicine, but the tools of psychology, movement, energy healing, nutrition--everything modern medicine has left out until recently.  I thought I could "sneak in" wholeness into the prescription and change the face of medicine.

Now that, I can understand. Many of my heros in the early 1990s were MDs who pioneered the intersection of holism, consciousness, and prevention--Deepak Chopra, Dean Ornish, Andrew Weil, Bernie Siegel, James Gordon, and even Jonathan Wright and Alan Gaby.  I had had a chance to study with several of them and envisioned myself skipping right to where they were--running their own healing centers and writing books.  Had I really understood what medical school and residency would be like for me, I'm pretty sure I wouldn't have done it.  

Anyway...there I was on the ski trails of France, when a rather ordinary voice inside my head said, "But there are thousands and thousands of people who would seek you out if you were a non-traditional MD, a psychologist, or any kind of therapist or energetic/intuitive healer.  Why are you still fighting this?"  Split second pause while I acknowledge that truth. Re-enter the voice: "The reason you chose to become an MD is so that your father would be supremely proud of you and your mother would be completely comfortable and unthreatened by your choices.  And in this way, you thought you could create peace, but instead, you've created a nearly 20-year process of keeping yourself from what really matters to you--psychology and human development along cognitive, moral, behavioral, artistic and spiritual lines." End of revelation.

What!!!?  Just like that?  A plain old voice unraveling 20 years of internal entanglement?  And such a simple, uncomplicated tone?  There you have it?  It's just all done?  I thought I should write it down in case, in its utter simplicity, my mind couldn't hang on to it.  I did--on the back of a museum brochure.

Now, before I create any drama or a story of victimization around my parents, let me say by all standards of parenting, my parents are above and beyond the call.  They are warm people with whom I share happily so much of my life.  They have high standards, but not in a demanding sort of way.  In fact, if I heard it once, I heard it from them a thousand times that whatever I truly wanted to do, they would support.  And I think, no--I know--they meant it.  My parents were even unusual in their willingness and capacity to go beyond themselves and their experience to ask how I might be different, what might I need that they couldn't provide.  Really, as JK Rowling said in her graduation speech to Harvard, "there is an expiry date on blaming your parents," and in my case, as in hers, if my parents ever suggested a way that didn't seem a perfect fit for me, they were only, ever doing it out of a desire to protect me from frustration, disappointment, or the strains that they once felt.  They wanted to see me happy and successful.  What more could a person want?  Perfect counseling?  That's a goal to which I wouldn't hold them or any therapist.

Once, just once, each of them made one comment which, unbeknownst to them, I soaked up and internalized somewhere in my deepest cellular storage, where even the rest of their permission, encouragement and flexibility couldn't dislodge it.  My dad once said that he didn't want to push me into an MD, and he realized that "production" wasn't my main mode, but, if I were truly considering spending four years in acupuncture school or studying to be a naturopath, I might be better off putting those years into an MD, where I could end up in a position to more easily influence the curmudgeons and skeptics about the value of prevention and holism.  

How perfectly rational, and even true!  In some way, my dad was only trying to help his daughter, whom he knew liked to hold influence and a certain degree of control, to have her way.  

For my mother's part, she said, probably without thinking much about it and certainly without the intention to cut me off from a dream, "Aren't all of those psychiatrists and psychologists a little crazy themselves?"  Perhaps she was thinking of Freud or Timothy Leary.  Or perhaps she was subconsciously drawing up memories of her grandfather's first wife's who, from what I can tell, committed suicide (or had a terrible accident) as she grieved about a choice her son had made.  Perhaps other family members who wrestled with demons that weren't readily amenable to the advice of well-meaning supporters weighed on her mind.  I don't even think my mother knew, personally, any psychologists or psychiatrists to whom she might have been referring.  My own hypothesis (and I hope my mom forgives me for printing this before checking it out fully with her, which I plan to do soon, now that I'm over my internal hang-up about it), is that my mom had seen one too many people close to her in life become depressed over a combination of their own demons and life circumstances, and her response was simply to pull herself up by her bootstraps and commit, internally, to being as absolutely happy and positive as possible.  I think that my expressing an interest in psychology simply reminded her vaguely of some pain she couldn't quite identify, and therefore, it seemed like dangerous territory.  

I say all of this because, knowing my mom, there is absolutely no way that she would have consciously told me that part of myself was shameful or damaged because it wanted to understand the depths of human nature.  My mom likes to listen to people.  She's good at it, and empathetic, and her own coping mechanisms in life have earned her a well-deserved place as a friend and community leader.  She is reliable, upbeat, and kind.  She forgives easily and seeks to understand, right up to the edges of her capacities.  It is incredible to have to admit that I had convinced myself that my mother would approve of me less if I pursued psychology or that my dad needed me to be an MD.  Good lord!!!! If my parents actually thought their words had produced that feeling, I know they would have been quick to re-explore it with me.  They are those kind of parents.

No, it was the tremendous grip of my inner pleaser and not my parents who chose my destiny.  Once I had it in my brain that there was a "highest and best" way to please them--or anyone that really mattered in my life, it seems I could let no other voice--not mine and not even the other person involved, convince me that I had the freedom to do what I wanted.  

Let me say that again in case it applies to any of you.  What I learned last week was that not only was it not my parents or society or anyone else who kept me from my dreams, it was I who stubbornly held myself back, ferociously keeping myself away from any territory that could possibly be in the slightest way displeasing to key others.

Holy Toledo!  (I think I must be channeling Kathleen Slattery Moschkau, whose daring show blended with effervescence, Midwest sincerity, "gosh-darn-isms" seem to have influenced my choice of words.)  This is not the first time I've had the recognition that we are each free, really free, to come alive to who it is we really are.  But last night, it was like I had gotten a good spinal adjustment, where the one stubborn, hold-out vertebrae finally wiggles into place, and the whole vertebral column realigns itself and information is once again able to flow, unimpeded, through the intelligence network of the body.  I could finally see how horribly afraid I had been to be my most vulnerable, and thus most exquisitely unique, real, and powerful self.  There is just no other way.  Every other path exhausts you without replentishing your energy.  But to be boldly and honestly in pursuit of acting as yourself?   This takes energy and, at the same time, fills you up, heart first.  Brother Stendahl Rast once said, "The cure for fatigue is not rest.  It is wholeheartedness."

And this brings me up to last night, when leading up to Kathleen's interview with Ken Robinson, she quoted Christopher McDougell, author of Born to Run, who blogged that he had just realized "that he had never been brave enough to be afraid."  He'd never been bold enough to do things that really scared him, tested his limits, exposed him to failure.  

My issue overlaps with his.  It's not that I have been afraid to test myself.  I've done it in a hundred ways whether from quitting a sorority to going back to medical school to boldly seeking a job with the Chopra Center to starting my own medical practice.  My own capacity to make things work doesn't scare me so much.  It's criticism from others.  Not just any criticism--I can take the stuff from people at a distance.  It's fear that I might do something to disappoint or upset or disturb someone I love that sends me scuttling under the rug.  Wild, isn't it?  I mean, I'm 41.  I've spent a good deal of time reading psychology of the pop and academic varieties, and I believe I've helped people with with self-confidence and esteem issues through my work. But right here, inside my skin, I've kept my own secret, my fear that I wouldn't be the person someone important to me hoped I would be.  

This is the Open Secret that the 12th Century poet Rumi (and modern teachers like Elizabeth Lesser) talk about, the fear we all share yet hold under a lid for fear of discovery.  We fear we are broken, weak, incapable, or undeserving.  Some handle it with brazen (if puffed up) confidence.  Others do a better job of seeing that they, too, belong to the human race.  I think they trust that their fears and shortcomings aren't too different that those of other people, and this is a gift--a gift many sit on the meditation cushion or therapists' office years to realize.  And some of us...well, we internalize, adjust, cope nicely, think we've handled it...until one day, on a ski trail in Europe, we realize that we've succeeded in cutting ourselves right off from what is most true and most precious about life--our expression of Self--quirks, bumps, missteps, sincerity, rough courage, untapped strength, unusual beauty and all.  

So...there you have it.  As of today, I am doing something about the false hurdles between me and my passion for spending more time helping people with their interiors.  My first step is telling all of you about it so that I can actually call in people who would like to work with me this way or inspire someone else to find their true work.

Whatever your dream is, whatever false distractions you've created to convince yourself it would be better, safer, or necessary to do what you know doesn't bring you alive...gather up your little nuggets of courage and begin. Contrary to popular belief, not all meaningful change has to start with a flair, a big splash into your new life.  A small, honest step will do. Believe me, and anyone who has passed this way, a small sincere step is the beginning of the real trail leading home.  Imagine for a moment that you can become very small, and let yourself remove the world you carry on your shoulders.  See your little self with kind eyes.  Acknowledge in your heart the way you have struggled to make your world whole, struggled to keep it together.  Where you have fallen short, forgive yourself.  You, like your parents, were only doing your best.  Now, scoop yourself up into the palms of your hands, and there, blow on the little ember of your life.  It is that little flame in your heart that matters.  It will help you to handle just the one next step in front of you.

If you don't know what you are reaching for, just breathe, and notice whatever small sensation pulses in your chest.  It can take some time and exploration to know the shape of your dreams.  While you are waiting, clean your artistst's brushes, get the canvas ready and the art room clean for when you do return to, or enter for the first time, that place where you can see the shape of your artists fire.  Keep the bellows blowing and take some small action, each day, to get to know yourself.  There is no other way.  You cannot begin with someone else's dreams.

If you are lost, an excellent beginning is to get a notebook and simply write, every morning, three (or so) pages with all your thoughts--unedited.  You may think that nothing of import is coming through this exercise, but believe me (and Julia Cameron, who first communicated so clearly about the importance of the morning pages,) you will start to find the lost corners of your soul if you begin.  

I am beginning my journey today.  This piece is my first step, and I will check in with you next week to tell you what is next.  I thank my dear friends Willow, Allyn, Kathleen, Kris, Lisa, Apple, the Omega Group, Linda, my parents, my brother, and my husband for seeing through me, sometimes better than myself, to the flame in my heart.  I thank Greg for getting me to the Artists' Way and new friends who have thrown their own colored dust into my flames, adding shimmer to their dance.  It is a boon to have such friends.  And now it is up to me to pick up the torch. 

Please pass this story on.  I don't know of a single human being whose life isn't touched by figuring this out.  And like the hundredth monkey, the more of us who decide to come alive, the more people there will be who can courageously make the same decision.

Deepak often says that the cure for insomnia is to live a dynamic day.  Tonight, I will sleep well.  I hope you will, too.

With love,

Malynn

Life Panels, Hospice and What's Really at Stake at the End of Life

Let me begin this blog with a good dose of empathy for everyone on every side of the health care debate when it comes to end-of-life issues.  I say this because, while my vote swings all the way left on this one and I actually had physical waves of anger over the summer when people began to label the part of Obama's plan looking at the money spent in the last part of life "death panels," I also understand that no one, but no one has easy choices put in front of them at the end of life--one's own or the life of a loved one.  Although I believe that the label "death panels" came out of a gross misunderstanding of a necessary, even compassionate, step toward handling end of life with dignity, sanity, and financial responsibility, I can still understand how, if a person truly felt that Obama's plan would mean that helpful resources would be cut off just as they were in pain or in the darkest places of fear and uncertainty, a person might come up with a reactionary label like "death panel" and say, "No Way!" to the whole of health care reform.  

I can understand that feeling.  But I also believe, right down to the bottom of my soul, that it's based on both a misunderstanding of the plan and a deeper misunderstanding, or simple lack of experience, with what a "good death" if there is such a thing--and I believe their is, might look like for everyone involved.  

Our culture, over the last many decades, as we have had more advances in medicine and more ways to control certain aspects of and even extend our lives, has becomes more and more removed from a process that used to be a natural part of every family's life.  Relatives died.  Often at home.  Extended care during periods of chronic illness, too, used to happen more at home--with doctors and nurses and other therapists making real house calls.  When I went into medicine, this aspect of really entering a family's life at crucial periods is what drew me.  It still happens in a few practices around our nation.  I just had dinner with a recently retired, 77 year-old family physician in Connecticut who saw 40 patients a day and made regular house calls.  His warm face and rosy cheeks lit up as he told me how he knew which patients would probably do best--those whose families cooked for them, brought them their favorite blanket or pillow, or just held their hand and hold stories.  The other patients, he said, needed him more.  Those with no one to support them through illness. 

I, too, was able to do house calls while I was a resident in Family Medicine at the UW-Madison, and when I started my practice, I continued to have a few patients who needed and welcomed these visits.  In some places, like in the small town of family I once lived with in southern Germany, or in the little town my husband once got sick in in southeastern France, doctors make house calls regularly, bringing necessary medicines and herbal remedies.  My husband's bill for a one-hour "hotel visit" in France 6 years ago was $25 dollars.  All of this is just plain good medicine.  When you get to know a patient in a personal context, over time, your medical judgement improves and so does the healing relationship.

This is a lead in, in a way, to what can happen in a hospital, extended care facility, or hospice program, when the patient, family members, and a dedicated health care team come together to talk about wishes at the end of life.  Standard hospitals succeed, to varying degrees, in handling these conversations and assisting in valuable decision-making.  I was lucky enough to work with many pulmonologists, oncologists, and critical care intensivists during my training years, who were skilled in handling the procedures and tests which would be done to extend life, and yet, many of them were also willing to come to a patient's room or schedule a family conference to discuss whether the tests and procedures had a real chance of leading to a meaningful extension of life. Unfortunately, I've also been a part of medical teams and events in the life of family members and friends where this didn't happen well, gracefully, or at all.  And it is excruciating.  It is made worse when the family hasn't discussed ahead of time, with their loved one, what he or she might have wanted.  It is hard enough to have to carry out difficult decisions at the end of life.  It is torture when you just don't know what your loved one would have wanted.  You couple grief with doubt, and the space inside you that holds the pain seems bottomless.

I remember vividly a week when I was on call as the junior resident (the intern) in the medical intensive care unit.  An elderly gentleman had come in, unconscious, with an illness no one could fully explain.  The week prior, he had been a vital, 93-year-old, mowing his lawn, keeping his own house up after the death of his wife, mourning her loss, but still able to enjoy his children, grandchildren, and long-time neighbors.  He was one of those quiet pillars of the little community near where I grew up.  Then...in the blink of an eye, over the course of a day or two, he got weak, confused, and finally dropped into unconsciousness.  The scans didn't show a stroke or aneurism.  The EKG and enzymes didn't show a heart attack.  He had no known cancers.  He didn't seem infected.  It was a mystery what had taken this robust man down.  

His daughter was the first family member I met, and she was soon joined by several of her siblings, some from close-by, and some from across the nation.  It was clear that they were basically a close, amiable family, each with a personal tie to their dad.  Yet, by day two or three, there was clear tension mounting.  Most of the relatives who had been there from the start, who had seen the string of x-rays, scans, blood draws--and more blood draws when the first tests came up empty, the constant adjustments of the respirator (because he increasingly lost the ability to breathe on his own), and then the tremulous jerks medicated and partially subdued with opiates and other drugs, was starting to say, "Enough. Enough. Whatever shred of consciousness our father has, let's not disturb it further with more tests that seem to go nowhere.  If we had real hope of finding an answer and waking him up, we'd do it.  We'd go along with the tests.  But we don't, and we have to accept that and let him go without such a struggle."  But there was another group of relatives, led by a more vocal brother, who just couldn't stomach that answer.  In his mind, his dad had been healthy and capable beyond expectations for his years, and whatever it was that had occurred had to be better named and understood before he'd be willing to give up.  He was not belligerent, and in this case, I did not get the feeling that his opinions came from a sense of overwhelming guilt, which is sometimes the case.  When a family member has either been estranged or simply unable because of time or distance to participate much in the life or care of a relative, he or she is often overcome with a sense of loss and guilt so great that the only way of dealing with it is to turn it into a vigorous fight, a protest and a demand that everything, absolutely everything medically possible be done for their loved one.  Perhaps then, thought the extensive and heroic efforts at the end of life, this person believes their own heart and mind might rest.

But this was not the case with this man.  He had been able to be present as best he could in his dad's life with some regularity, and the quality of their contact had been solid.  Not perfect, but solid. I sensed grief, but not overwhelming guilt in his words.  And I also sensed a reasonable, rational question, "Have we done enough?  Dad was a fighter.  Are we fighting hard enough on his behalf?"  

There were good doctors on this patient's team.  Conversations had been had.  Tests had been explained.  The lack of real data on just how good, how likely or not to lead to an answer or to an extension of life the procedures were had been explained.  There were trends, educated and experienced guesses, but no promises.  And no one inside of the father/grandfather's consciousness to tell them what, exactly he wanted.  

Every time I entered the room for a couple of days, I noticed my own chest tightened.  I watched all the kids alternately holding their dad's hands and then lapsing in and out of discussion, in and out of debate over what would be best.  Then back to strained silence.  I wanted so badly to have an answer for them, a real statistic to guide them, a crystal ball to know, directly, what their dad would have wished.  Finally, late one afternoon, I simply said the only thing I could think of, having observed them all together for those days.  With my own heart racing, I simply said, "I can see how hard all of this is for you.  I wish I had an answer.  Even though I don't, it sure seems to me that if I were your dad, I'd be touched by how much all of you care about him, by the fact that you each feel so deeply about honoring his life that you would even have this argument.  I think he would see that what each of you feels is your own way of saying that his life and the quality of it mattered to you."  I felt a embarrassed, even uncomfortable in the silent moment that followed, not knowing whether I had offended them or confused them or just stepped in where I wasn't needed.  But then someone breathed, and someone else began to cry, and a third family member gave me a nod, as if to say, "Thanks.  We get it."  I think I noticed that the circle of family, which had spread itself out around the room, occupying different territories, leaning in a little more toward each other and toward their dad.  A few got next to the bed again, putting a hand on a leg or an arm or the forehead of their dad.

Not much more happened for the next few hours, but late that night, while I was standing by, the father, who had been unconscious now for about 5 days, sat up, opened his eyes, reached out his hand for the daughter who was nearest by, and said, "I love you, Honey."  And then he closed his eyes and went back into a coma that he never came out of.  After a new wave of tears and awe and then some more silence, the family started talking with one other.  In the morning, they told me their decision was to stop with the tests and to gently, carefully, stop some of the medicines and machines that were keeping their dad going--pumping his heart and breathing for him.  Sometimes this process can last a long time.  It is not always easy, but the nurses in this case were excellent, telling the family what they were doing, what to expect, and encouraging them to talk to him, sharing their feelings and their "blessings" for him to let go if it was time.  I remember a young grandson who was having a really hard time with himself.  He didn't want to be there.  He didn't want not to be there.  A wonderful nurse told him that he might tell his grandfather about something he was grateful for, something they had done together, something he would remember always in his heart.  The boy did, tearfullly, and after he got it out, he was better able to stand there, and give his grandpa's hand a squeeze.  We don't know for sure if this registered in the consciousness of his grandfather, but it's a distinct possibility, given all we know about the personal reports and neural activity of people who have come close to the edge of death and then recovered.  

In this case, almost as soon as the respirator was stopped and the next morphine dose was given, their dad's heart stopped, too, and with as much dignity as he had seemed to live, he let go.  Gently, peacefully, with the whole family present.  

I do not know if things would have been different had we done more for him, medically.  Honestly, I do not think that that is what that family thinks about when they think of their dad's and his life and death.  I think their grief is ever-present and real, just as their gratitude that they had a day of peaceful presence with him before he let go.  I like to think that each family member who shared something in that time got to rest a little easier through that sense of acknowledgement of what this man meant to them.  From my own experience of being with my family members and friends during and after the death of a loved one, the chance to share a space together, to hold together the mystery and tenderness of what life has meant and what one takes with them into death are profound.  They are, in my opinion, what allow us to go on, to live without paralyzing fear of death before one has done what they needed to, made peace with the people and events of their lives. 

When good health care is at work, a little space is made for these experiences.  Of course, good health care also means a wise and honest look at the value of further medical procedures, and these decisions will not always be easy.  My husband's grandfather had a coronary bypass at age 92, and lo and behold, he has done tremendously well.  With the care of his family, he lost 30 pounds by eating a better diet and walking.  He's always been a regular and generous community volunteer, and with his new vessels, he's been able to do even more without his chest pain.  He is, perhaps, exceptional in his personal motivation and capacity for recovery and generativity.  Some family members have said to me, "Under Obama's health care proposal, his bypass wouldn't have been possible.  His care would have been rationed, and statistically, Dad wouldn't have been a good risk.  We all would have missed these years."

My response is really three fold.  If this were true, I would personally have to empathize with them.  No one, but no one, would ever want to feel that their personal chances of meaningful recovery would be cut off by medical shortages.  But I believe that this is not necessarily what good, "evidence-based" and "efficacy-driven" health care is driving for.  Ultimately, I believe Obama's plan intends to empower doctors and families to make good decisions together, based on medical trends, personal values, AND differences in personal circumstances.  In the case of my "grandfather-in-law," he had several positive predictive factors going for him.  He had little other disease, excellent family support, a history of high motivation and community involvement, and (and this is a very interesting and), he would have predicted himself that he'd do well with the procedure.  When I worked for Dean Ornish, MD, we found that the factor that had the highest predictive value in how well a person did in our lifestyle change program was not how old they were, how sick, how bad the cholesterol or chest pain.  It was the answer to a simple question, "How well do you THINK you will do in this program."  Those who answered that they would do well, by in large, and with strong statistical significance, did well! That is the kind of thing that can be quantified and used by hospital and health care teams to decide who gets care.  Should it be the only factor? No.  But, if it is statistically significant and readily "knowable," then Yes, it should be included in the decision-making.  

There are now thousands and thousands of stories and data points that exist about spending trends, quality of life, and personal meaning and peace for relatives and patients when appropriate decisions and support are given surrounding serious illness at the end of life.  The LIFE PANALS Keith Olbermann so eloquently refers to in his special edition of Countdown on Wednesday Feb 24 can help mediate that.  And our government can help ensure that such groups of guiding agents are ready and available for families who need them.  My hope and call to action would be that we use the best of our technology, the best of our statistical pattern recognition, and the best of our personal capacity to connect, listen, ask questions of each other, and to use sickness and even death not as a fearsome process to shut us off from ourselves and eachother but to better honor the meaning of life.  I believe that this will be one of the most meaningful things any of us can do to live our lives with less of the crazed race to do everything possible in life to deny our own vulnerability and aging.  

My own grandmother, who, through all the stories of life, love, loss and resilience she taught me, asked our family to throw a tea party for her when she died, to get out her best dishes and tell our best stories and to laugh, even in the midst of any tears.  We did this, wholeheartedly, releasing a hundred pink (her favorite color) balloons into the air at her funeral.  But without the conversations initiated in our family and encouraged by some of her doctors, we never would have known that this was the celebration she wanted and the celebration we needed.  Now this memory, and the twinkle in her eyes, are as fully emblazoned in my mind as any of the hard days of her decline, and I can laugh a little as I wonder if I, too, will be an eccentric old lady one day who laughs and cries easily and gets to say the most outrageous things with impunity.  And I can hope that through my own honesty about death, I can draw anyone I love closer to me and help them get just a little more comfortable with this unavoidable passage in life.

These are just the reflections of a 41-year-old whose had, so far, a pretty good life, and whose experienced, so far, just a little bit of the face of death.  I'll write again when life has taught me more.  But from where I sit now--doctor, family member, friend, and person with some living to do, I think I'll vote for the Life Panels.

Clearing up the Ooey, Gooey Mix-Up about Oils

The proverbial "they" say that it takes approximately 16 times longer to unlearn something as it does to learn it.  Once a certain message or habit is in our head, it is simply harder to "unwire" or "rewire" than it was to put the original wiring in place.  

Perhaps this explains why we, as a nation on average, still have "fatophobia."  We can't seem to get the "fat is bad" myth out of our heads despite a good deal of new publicity surrounding the healing effects of certain oils.  I still hear people talking generally about the virtues of a low-fat diet, and many gasp when I tell them that I regularly eat a half of an avocado with a meal, that I actually lost weight about 12 years ago when I increased the percentage of certain oils in my diet, and that, these days, I've included organic coconut oil as a regular part of my eating.  

Don't get me wrong.  I cut my professional teeth in the early 1990s working for Dean Ornish, MD, whose work I still greatly admire, right in the middle of the no-fat and low-fat craze, and in his program, I watched many grateful people with heart disease dramatically reduce their arterial clogging and many of their symptoms on his extremely low-fat (10%), vegetarian diet.  (What is less widely known is that his program also included training in meditation, moderate exercise, yoga, and required participation in group support, all of which might have played an integral role in the improved health outcomes his program has consistently produced.) 

Dr. Ornish's work still stands as a testament to the value of examining the role of fat in the diet, and I would aree that for a person consuming large quantities of "bad fats," namely the artificially hydrogenated trans fats that keep our cookies edible on shelves for 75 years plus, overall reducing fats would be likely to produce real health benefits.  To hear highlights of his work, check out his interview on the Kathleen Show or go pick up one of his books, Starting with Reversing Heart Disease and ending with Love and Survival!  

However, research currently points to an extremely important role for healthful fats, which can do everything from actually lowering inflammation (in the skin, the arteries, and joints, for example) to lowering total cholesterol levels while increasing the good lipids (HDL).  Healthful oils improve cognitive functioning and mood, reduce blood sugar levels in people with diabetes, and some of them just might increase, yes INCREASE metabolism.  In other words, not getting enough of the healing oils and fats might actually make it harder for you to lose weight, harder to reduce heart disease, harder to have healthy joints or smooth, clear skin, and even harder to maintain a balanced mood or a good memory.  How about that for a list of reasons to get interested in the oils you consume?

Of course, there is still the question of how much.  In relative terms, most of us can probably consume approximately 30% of our daily calories from healthful fats.  (If you eat 2000 calories a day, that's 600 kcals of oil, or just shy of 70 grams, which is roughly 5 Tbsp of olive oil.  Pretty impressive, right?)   And while I am generous in my encouragement for people to get good fats, I am equally clear in my directions to stay away from the other kinds.  I have very few absolute food rules, but one of them is that if a package says "cottonseed oil," I just don't eat it--unless I am truly desperate, like I was on call at the hospital. (I won't get into the irony of having health-ruining snacks at the hospital.  Fodder for another blog...)

Anyway...what are the good fats?  The one most widely available is olive oil.  Get organic, first cold pressed.  It's more expensive, but worth the investment.  In general, almost all oils retain more of their healthful properties when not heated to high temperatures, but some are reasonably stable for low to moderate cooking (like sauteing veggies). Olive oil, an omega 9 fatty-acid, is one of these.  Other oils you can use for low-moderate heat cooking include organic coconut oil, a medium-chain triglyceride which is readily metabolized  and which is slightly sweet in asian dishes and baking.  Avocado oil is safe to very high heats, and sesame oil, too, has a high smoke point, but unless you can find organic, it may be low quality.  Canola oil is a tough case.  Manufactured to be safe for baking, it still comes largely from Genetically Modified sources and might be linked to respiratory illnesses, although we need significantly more research before this can be confirmed.  In general, I'm not buying it until more data are in.

Beyond these oils that you can use for cooking, there are many oils that are tremendously nutritious if used raw.  These include the very fragile flax seed oil, hemp seed oil, and other nut oils like walnut or pumpkin seed.  If you want to use these oils in a warmed dish, try this hint:  Start the dish cooking in a bit of vegetable broth or chicken stock (mixed with a bit of olive oil if necessary) to keep things moist.  When you are near the end, drizzle on these wonderful but fragile oils so you can get the flavor but not ruin their health-giving properties with cooking.  

Finally, we've all heard about fish oils and their healing affects on arteries, cholesterol levels, and even brain function in newborns and aging adult alike.  The jury is really out on the best sources, as we know that the oils directly from fish like salmon, tuna, and sardines are easiest to absorb compared to absorption from most capsule-based formulas (again, the alchemy of the oil in relationship to the whole food may be important.)  Yet, it isn't always easy or environmentally sustainable to have regular intake of certain kinds of endangered fish.  The mercury content is equally worrisome for capsules that do not list any sort of distillation or purification process.  This has been a real source of "eater's paralysis" for me.  I want to have fish oil.  I don't want to pollute my body or be the cause of a fish's disappearance.  For now, I am limiting my fish buying to sources of salmon and other non-steak fish wild-caught from Alaskan or northern Pacific waters and to certain Scottish and Norwegian farm-raised fish not fed grains or kept in horrifically over-crowded pens.  (Who would want to eat a fish that was swimming in copious fish waste?  Yuck!)  For detailed guidelines, check out the EPA's site: http://www.epa.gov/waterscience/fish/advice/   Moreover, I'm not opposed to the capsules, and according to recent consumer reports, Swanson's is one of the most reliable and cheapest sources of mercury-free supplements.

Finally, what about saturated and trans fats?  Well...here's the scoop.  Saturated fats, such as those found in animal fat and others, like coconut oil, which are all solid at room temperature, have gotten a pretty bad rap in the past.  Some of the reasons for the bad rap were right on.  These fats do provide lots of calories, and when we stopped working so hard in our farm fields and doing manual chores around home over the last century, but kept (or increased) our consumption of meat, we gained weight and got heart disease.  This is pretty clear. On the other hand, I believe that we will continue to find that they way we now raise much of our meat contributes to the harmfulness of the fat our meat contains.  On antibiotics and growth hormones, not to mention ingesting the other things we spray on our grains and grasses, it seems likely that the animals we eat would be storing stuff we don't want or need in their fat cells, and this could be making us fatter and sicker--with higher incidences of childhood obesity, antibiotic resistance, and hormone disorders.  I keep saying "could" because the science is so preliminary and there are so terribly many factors to consider that large-scale studies are still coming out with weak or possibly indirect effects.

On the other hand, my personal and professional opinion is that if you can get ahold of meat from healthier sources, for example organic, grass-fed beef or chickens that are actually allowed to walk around outside and eat from the farm fields where cows have roamed, the animal is much less likely to have built up and stored unwanted toxic by-products in their fat cells, and hence, we are likely to benefit more from them.  A specific example is conjugated linoleic acid, a substance possibly related to reduced incidence of many cancers as well as reduced heart disease and improved weight control, is found mostly in the fat of cows raised on real grass. [Zulet MA, Marti A, Parra MD, Martínez JA, September 2005. "Inflammation and conjugated linoleic acid: mechanisms of action and implications for human health". J. Physiol. Biochem. 61 (3): 483–94.]  Likewise, with organic virgin coconut oil, there is some possibility that it's anti-inflammatory and anit-oxidant properties and ready digestibility will mean that moderate amounts are actually good for health, especially in lowering dangerous cholesterol levels and protecting good cholesterol. [Nevin KG, Rajamohan T.Beneficial effects of virgin coconut oil on lipid parameters and in vitro LDL oxidation. Clin Biochem. 2004 Sep;37(9):830-5.]

What is best of all, some evidence suggests that eating a moderate amount of healthful oils significantly reduces overall blood sugar levels, even in people with diabetes.  This is real news.  Personally, as I mentioned above, I used to fight cravings for sugary and bready-type snacks throughout the day.  Part of getting over that was purely the psychological understanding that I was feeding emotions and not hunger.  But the second part was actually changing my diet to include more, not less, oil--of the healthful kind.  I eat more oil now and just don't fight my weight.

I hope this inspires you to make a few changes and enjoy the benefits (tastes, healthier bodies, better brains and all) of this essential part of our diet.  

Now...repeat 16 times!

The Tyranny of Self-Help

Much of what I do could be considered teaching people to be effective at "self-help," (meditate, care about the food you eat, cultivate resilience, etc) but this morning I am much more struck by need to inspire people to be their natural, ordinary, not-too-perfect and not-too-obscessed-by-becoming-balanced selves.  

It strikes me that for many of us, our "self-work" becomes a full time job and overtakes some of the rest of the naturalness of life.  I know because I have long been a "professional evolver," one who is in constant analysis of myself and what this or that situation in life has taught me.  It's taught me a lot, but when I get too stuck in "how to heal and perfect my own nature," I become a white bread and mayonaise, boring, stiff version of my colorful, goofy, tender, insecure self--the one who's a real human being.

What's wrong with this, you might ask?  Well...on the one hand, nothing.  A certain degree of self-awareness, question-asking, and desire to explore ways to feel better are necessary to our health.  A dose of confidence and a sense of a plan can be a lifeline.  However, there is a WAY of taking up these pursuits that becomes, well...a bit cloying, dull, completely annoying to others and so automatic in our own lives that we forget about the fun of immediacy in life, of simply being our messy, incomplete, quirkily imperfect selves--capable of laughing at all of this in ourselves and in others.  No society or person has succeeded in ironing out all their kinks and insecurities, and part of the fun (and ease) in life come in realizing that no amount of peace and balance in our lives can take away our unique personalities--whether you are a monk or a stand-up comedian.

What I mean is that there is a certain "cultivated carelessness" about life that can be entirely attractive in those who express it.  For example, one of my favorite people in the world is my friend and mentor Allyn Roberts, PhD, a now semi-retired psychologist from Madison, WI.  His background first in chemistry, then in anthropology, and later in clinical psychology and spiritual traditions of the world places him firmly on the grounds of those who care about quality of life and believe that education, goals, reflection, and therapeutic practices matter.  At the same time, his collection of life stories belie a certain willingness to let go of the reigns and stumble into important lessons, whether it was the time he became a vegetarian for a month in order to make a senior monk, Gesha Sopa, feel comfortable, only to learn that the monk himself believed there was something important to learn from "doing as the Romans do," i.e. ordering a steak while he was experiencing America.  Or there was the time when he took his children to India to visit the Dalai Lama in Dharmsala, and the Dalai Lama spilled the tea he was pouring, immediately putting everyone at ease with his jovial nature.  He has also had to "turn down the culturally appropriate invitation," as in the time when he had to gracefully but firmly decline an arranged marriage with the daughter of an island chief while he was on an anthropologically oriented exploration years ago in the south pacific ocean.  Or there was the time when his friendly nature combined with a stuck car on a snowy day accidentally led him to become the owner of a castle of sorts, all while he was still a young psychologist with only a few dollars to rub together.  

Perhaps what impresses me the most is that Allyn has studied meditation, practiced many forms of therapy, modified his diet over the years, and taught hundreds of people, if not thousands, to apply certain principles of psychological healing in their lives, but...and this is a tremendously important BUT--he sticks to none of it too rigidly.  He lets his psychological techniques go when they don't apply, he eats pie and chocolate cake fairly regularly, and on many days (perhaps even most) he would count reading the newspaper or watching a little TV to "check in on how we're doing as a species" to be rather important as an investigative and reflective exercise.  He can do both without losing hope and without getting preachy.  He counts a good walk to work or through the arboretum as his meditation, rather than formally sitting on the cushion.  He laughs easily and never speaks in platitudes.  He is never "annoyingly positive," although one always feels a certain hopeful okayness when with him.

There is something delightfully freeing about his lack of dogma and lack of rigor regarding any particular "healing strategies."  Now, he can, in part, get away with this seeming lack of a plan because at his foundation, he IS pretty okay.  Of course, there are times in all of our lives when dramatic illness or catastrophic circumstances require that we buckle up and get serious about our healing.  There are times to say, "I simply MUST sit down to meditate daily or do my daily yoga or go to my AA meeting--or take my medicine."  Sometimes these routines of healing can literally save our lives.  But some people, like Allyn, demonstrate that there are ways to happiness that do not include stuffing our day with exercises but rather participating in its unfolding.

I don't know about you, but I find myself, far too often, responding to myself or to someone else in my life with these pre-digested strategies for wellness when the best medicine might be simply to go out and live fully and robustly, noticing the many dimensions of life and filtering a little less of ourselves.   Seeking the "proper experiences," whether the best meditation training, the most inspiring yoga class, is not the right prescription for happiness if we've failed to use it to give us flexibility in life.  

Check out psychologist/researcher Dan Gilbert, PhD for his book, Stumbling On Happiness.  All of our struggles to make the right decisions in life may have very little to do with how happy we are.  Happiness, it turns out, might come more from our smallest ways of perceiving and making evaluations.  Furthermore, read some of the books by neuropsychologist Paul Pearsall, namely The Last Self-Help Book You Will Ever Need, or Awe: The Delights and Dangers of Our Eleventh Emotion)

This may sound a little hap-hazard, and in fact, I do not mean to disparage the many phenomenal healing traditions and states of mind that have been well-applied to many lives.  Rather, in up-coming posts, I will explore a "map for living" which can help you identify particular stages of life when you may need more structure and self-awareness and others when you would do best to let them go for awhile.  

I'll start to have these up in the next few days.  But for now, all you professional self-helpers, go out there and observe some of the most "natually happy" and easy people to be around and see if you can feel what I'm talking about when I say that they exude a certain freedom and trust about the basic process of living that overrides any particular belief in the power of a strategy.