Category Archives: Creating Human Culture

Thoughts From the Clinical Director: When is Enough Enough?

Posted on by

[Isn’t this interesting! For this fortnightly installment I went back to my first draft I wrote when I first thought about this project, June 11, 2012 – one year ago! It is interesting to read this now, to look back at where we were and at how much great work we have already done addressing some of these issues. For that opportunity to look back, I won’t edit this, so please bear in mind that you are reading something written one year ago. I’ve made a few small comments, in brackets, in the text, but otherwise it is what I wrote one year ago this month. Special thanks for the poem that Sue Bailey supplied when she realized that it was by the same author of the poem about the spontaneous community that sprang up around the distressed Palestinian woman in the airport lounge.]

This is the first in what I am hoping will be a series of weekly thoughts from me about our work at Buchanan. I know that we are all very busy and that we all work very hard. I know that our daily work is often so crisis-driven and that we all have so many meetings, that we don’t have the time and opportunities to sit down and really talk together about our work. I am working on creating the time and space for such important discussions through the Recovery Forum, the working groups on Substance Use (AOD) and on the Recovery Culture; and I know we really need a planning day as soon as we can get that organized – however, it just seems that this isn’t enough, what more is needed and what more can I do? Until we can have these dialogues in person, maybe sharing my thoughts with you can help you to understand what I wish for – for Buchanan. Maybe this can get us all starting to think about how we do things and what is working well and what could work better.

Please do not feel obligated to read these messages. I offer them with the hope that they will be supportive and promote dialogue; I don’t want them to be just one more thing that you have to read during the week. I am writing these messages as much for myself, in order to get some clarity, as I am for the benefit of anyone else, but I hope that you find something for yourself and our work together in them. Some of these initial messages may be a little long, but I am sure that many weeks will just have a short thought or an inspirational quote.

When is Enough, Enough?

We all go through our days trying to do the best that we can. Yet, often it seems that something more is needed. Things don’t always go smoothly, systems need to be tuned up – just as cars need routine maintenance. What we did before was good, but what needs to change as we change [our clientele changes] and as systems change around us?

Sometimes I find myself asking the question: “Am I doing enough?”  “Is there something more that I could be doing, or should I be doing things differently?”  When I answer that there is more that I could or should be doing, I push harder, I try new things, I rush to get everything done so that I can get to the real work that needs doing. Sometimes in my work, I feel like I am so busy doing things that come up all day that I never have time to get “my” work done. I recently came across this quote below that I thought summed this up and I wonder if you relate to it the same way I do.

“As work turns into an ongoing series of emergencies, our efforts to achieve our major goals give way to damage control. Time is spent in stop-gap measures: putting out fires, plugging leaks, and filling cracks. There is no possibility for creative action or for enjoying the flow of productivity because all our resources go into catching up, repairing mistakes, and adjusting plans. The cycle is self-perpetuating: We do not have the time to make a good plan because our time is taken up dealing with the flaws in the old plan; we cannot clear up our communication because we are processing emotions stirred up by previous communications,” (Tarthang Tulku, Mastering Successful Work, pages 31-32).

Can you relate to those words?

How can we change the feeling that no matter how hard we work, it seems like it is not enough? (I am assuming that you relate to at least some part of this). As individuals, we can decide that enough is enough, that we aren’t putting in any more effort because we don’t feel that we are being recognized for our efforts, or that we feel we are already putting in too much. Sometimes this is necessary as a boundary or of recognizing our human limits, but we have to be careful that it is also not a sign of burnout, hopelessness [for ourselves, our jobs, or even the clients we work with], giving up, withdrawing, going through the motions, or even quitting.

There is another way when we reach this point, and that is to re-evaluate our expectations, our systems, and where we are putting our energy. This can be an evaluation as an individual, or it can be an evaluation of the system in which we, as a group of individuals, are working. As individuals, it takes time and space in order to be able to take a deep breath, to be able to see and understand our situation clearly, and in order to make decisions to change the way we are working on a day to day basis. This may mean looking at what really matters, what is important to us in our work, and what our needs are. Tony Schwartz and colleagues, in the book The Way We Are Working Isn’t Working, write that everyone has physical, emotional, mental, and spiritual needs, and that contrary to the way jobs have been set up in the past, that for an individual to be the happiest and most productive, these needs actually need to be addressed at work. This doesn’t mean that work is the only place in your life that you address these needs, but that in order to not only do your job, but also to feel replenished, valued, stimulated, and rewarded in your job, that we need these elements in our work. (Perhaps in another column, I’ll go into these four needs in more depth).

As individuals working together in a system, we need to look at how the system is structured to see if it makes our work easier or more difficult. We also need to look at other people around us, our friends and colleagues, to see if we can support them in getting their work done. I know that when I feel stressed, burnt out, over-worked, the last thing I want to do is look for more work, but in the business we are in – working with people to support them in their recovery and rehabilitation – the outcome for a client depends on all staff being able to do their jobs effectively. The other really important way that we, as individuals working in a system, can greatly affect our individual work, is by stepping back and looking at the structure of the system. We as individuals may not have created the system, but how we work every day maintains the system. Systems are full of complexity, however, and changing one aspect of a system often has unforeseen consequences, but this isn’t a reason not to evaluate and change systems when necessary, it is just a challenge of working with systems. The benefit of going through the change (which is hard work, just as any kind of therapy, recovery, or rehabilitation is hard work) is that putting in more energy, doing a little more, up front leads to our work becoming easier, more rewarding, more effective, and more productive down the road. In a way, changing a system is an investment of energy in the present that pays dividends in the future.

These are some questions that I have been asking myself, in my work, and in our work together:

How can we work better as multi-disciplinary teams, in such a way that we are better supporting our clients in their journey, and that we are happier in our work with clients and with our colleagues?

 

How can we feel more supported and valued in our daily work?

 

How can we keep our eye on the big picture, on what is really important for both ourselves and the clients we work with?

 

How can we change the system so that it feels more like we are all pulling in the same direction?

 

We have choices as individuals in deciding when we enough is enough. If things feel too hard; if it seems we work and work and work, and yet, it seems to have no effect; if we start to feel like it just isn’t worth it – that enough is enough – then we make have hard choices to make: we can do less, we can go through the motions, we can even quit, and quitting can take many forms, including just doing the bare minimum and going through the motions. However, I would like to offer another choice, and that is to re-evaluate our daily work as individuals and the functioning of the system that we are maintaining every day. If we change, the system changes; if we change the way the system functions, we can change the nature of our work every day.

I invite you to re-evaluate the structure of the system where we work:

How can we bring more of our natural caring and compassion into our work?

 

How can we nurture and support that part a client that wants to change and grow?

 

How can we make our work less stressful?


How can we improve our working relationships with our colleagues?

One way of doing this is a programme called “Releasing Time to Care,” developed in the National Health Service in the UK. We will most likely be using this as a framework for change where we work [this may happen in the future, but it is a complex, lengthy process and there are no immediate plans to implement this]. I will write more about this program in the future, but my understanding of it is that it can be applied in a way that is consistent with the recovery and rehabilitation model that we use with clients. I believe that we can only create an environment supportive of recovery and rehabilitation for clients if we are able to create the same environment for ourselves. Perhaps we can use this programme, as well as any other existing programmes, or even programmes that we create that are particular for our work, to support our daily work, so that we can feel energized by our work, valued for the work we do, intellectually stimulated and engaged in our work, and to feel that our work is purposeful and has profound meaning.

[Doesn’t it seem like I should have written something about when “enough is enough” with working with clients and we decide to move them on from BRC? I thought I wrote something on that, maybe we’ll have a part II of “When is enough enough?”]

Kindness

Before you know what kindness really is

you must lose things,

feel the future dissolve in a moment

like salt in a weakened broth.

What you hold in your hand,

what you counted on and carefully saved,

all this must go so you know

how desolate the landscape can be

between the regions of kindness.

How you ride and ride

thinking the bus will never stop,

the passengers eating maize and chicken

will stare out of the window forever.

Before you learn the tender gravity of kindness,

you must travel where the Indian in a white poncho

lies dead by the side of the road.

You must see how this could be you,

how he too was someone

who journeyed through the night with plans

and the simple breath that kept him alive.

Before you know kindness as the deepest thing inside,

you must know sorrow as the other deepest thing.

You must wake up with sorrow.

You must speak to it till your voice

Catches the thread of all sorrows

And you see the size of the cloth.

Then it is only kindness that makes sense anymore,

only kindness that ties your shoes

and sends you out into the day to mail letters and purchase bread,

only kindness that raises its head from the crowd of the world to say

It is I you have been looking for,

and then goes with you everywhere

like a shadow or a friend.

Naomi Shihab Nye

Amazon Review: The Creation of Faith, by Juan Mascaró

Posted on by

“‘The Creation of Faith’ could be the title of a book based on the solid foundations of the best in religious, common philosophies and common spiritual sense,” (179-180).

Juan Mascaró was born Majorca, Spain and lived in India and England. He returned to Majorca after his death for burial. He is noted to have accomplished the unique feat of translating the Sanskrit and Pali languages that were not his own into the English language, which was also not his own. His translations and introductions to the Penguin Classics editions of The Upanishads, The Bhagavad Gita and The Dhammapada continue to stand as excellent introductions to Eastern wisdom for the English-speaking world. While he was an accomplished scholar, linguist, translator and academic, what I find most wonderful about Mascaró is that he was a poet, a mystic and a unifier of the spiritual wisdom of the world. It was after reading his introduction to The Upanishads (as exciting as the text itself) that I became interested in Mascaró, himself, and sought out this out of print book, The Creation of Faith.

In his introduction to The Upanishads, Mascaró wrote that “an Upanishad could even be composed in the present day: a spiritual Upanishad that would draw its life from the One source of religions and humanism and apply it to the needs of the modern world,” (Upanishads, 8). That is the best way to consider The Creation of Faith, as a modern Upanishad, the lifetime culmination of the wisdom and poetry of a man who immersed himself in the poetical and spiritual literature of the world (“Spiritual visions are poetry,” (111), he writes).

The Creation of Faith is a posthumous collection that was edited by William Radice, as Mascaró died before his final work could be published. The book consists of aphorisms and sayings, usually only a couple of lines in length. The aphorisms are not arranged in any particular order which gives the book the feel of collected notes. There are some repetitions of almost identical sayings. Personally, I think the book would have been stronger if it had been edited a little more and if the aphorisms were clustered around various themes, such as creation, duality, unity, love, poetry, etc., or if they were organized so that they were allowed to comment upon the related facets of various themes. I think the book may have been stronger if it followed Mascaró’s own advice to be a: “book of 100 pages, 300 words a page–30,000 words,” (178).

“I have two lives: my inner life with God, and my outer life with nature and men. How mysterious these two worlds are,” (169). The beauty of Mascaró’s writing is that he works with dualities and polarities without negating, but allows each duality to complement to form a greater unity. “There is inner observation and experiment and outer observation and experiment. From the first comes poetry and spiritual vision and all human values; from the second science and technology,” (31). Still, as a mystic, he sees the ultimate aim of study and scholarly work to be supporting self-knowledge and through self-knowledge, one reaches God. “The end must be clear: how can we find ourselves, the best in ourselves,” (25). “If we could know what we are, we would know what God is,” (111).

One of the most interesting aspects of Mascaró’s unification of spiritual and poetical world literature is his view of faith and spirituality as creations of the imagination. He does not mean that they are false or “made up,” but that they are products of the creative function of human imagination, a field of play that is beyond the limitations of words and materialism. A few quotes illustrate this. “Faith is creation,” (148). “Your soul is your own creation,” (152). “What is faith? It is an act of creation and vision. We create what we hope,” (171). He also provides an understanding of how to differentiate between higher creations that contain truth and lower constructions that do not. “Imagination is strong and creative. Fancy is weak and passive. A hallucination is a powerful fancy that overcomes reason. Imagination is creative and above reason. Fancy is passive and below reason. This is also the difference between faith and fanaticism. Faith is above reason. Fanaticism is below reason,” (129).

Mascaró also wrote a more scholarly work of unifying comparative religion called Lamps of Fire. This has proven to be difficult to find and is also out of print. The Creation of Faith is a great source of spiritual and poetical inspiration and I found that it nicely complements the 80-90 pages, in aggregate, of the introductions to The Upanishads, The Bhagavad Gita and The Dhammapada. Mascaró also appears to have solved the dilemma of knower and the known. “In love we know. In knowledge there is the knower and the known. In love both are one,” (58). His is a voice that is beyond cynicism and divisiveness. He gently brings together a pure heart and a keen mind in a playful and creative search for the unification of all things.

Thoughts from the Clinical Director

Posted on by

I have decided that I will be posting my fortnightly “thoughts” column in the blog. I have been thinking about implementing this where I work for a year, now, but I have only just gotten the time and space to really do it. While some of the issues maybe particular to the specific workplace, I imagine that many of them are universal. Also, I end each column with a quotation of a poem. I have just written the 3rd installment, but I’ll post one of the old columns a week until we are caught up with the present time. Here is the column from one month ago….

Some Thoughts From the Clinical Director

I know everyone always works hard at Buchanan (Psychiatric) Rehabilitation Centre, but this has been a particularly tough week. I appreciate everyone’s work and concern for the Buchanan community in which clients engage in rehabilitation and staff strive to create an environment conducive to rehabilitation.

I had the experience with working with many services outside Buchanan this week, some of which were very supportive and others which were actively unsupportive. It made me realize that it makes a tremendous difference for the difficult work we do if we feel supported or unsupported.

We are going through a time of many transitions and I realize my decision to move back to the States is one of several big changes at Buchanan. I will keep everyone updated on where I am at in the process of that move. I just returned from leave and had a couple of job interviews, but I am not at the point of signing any contracts, so my time at Buchanan is still 90 days plus the time it takes for either Mary Pat or me to have a solid job. Mary Pat is now staying in Seattle and will be taking some licensure exams and looking for jobs there.

Our clients at Buchanan are often very difficult and challenging on the best of days and I do not see the referrals for new clients we are getting as being any easier than those currently at Buchanan. The work is going to continue to be difficult and challenging. We are going to have to continue to hold the hope for clients who come to Buchanan without hope. Hope is a precious commodity and we have to be very careful with how we care for our own hope. We also have to be careful about how we speak and act with clients because our words and actions can build hope or destroy hope. We also have to be careful with how we treat our colleagues at Buchanan and to strive to build hope and to make sure we are not endangering hope. This does not mean we always have to agree with each other. I saw a number of great examples where staff disagreed with each other this week, but still overcame those differences to work together for the best interest of clients.

I also went to a conference while I was in the States, it was called “Integrity in Health Care: The Courage to Lead in a Changing Landscape,” put on by The Center for Courage & Renewal. I thought a lot about hope while I was there, as well as of the shadow of hope, despair. We work with both of these on a daily basis in rehabilitation and we are no different than the clients in BRC who also struggle with these two fundamentals on a daily basis. What can be done to build and foster hope? That is the question I continue to return to during my time working in psychiatric rehabilitation. I generally return to human connection as the answer to that and during my remaining time at Buchanan this will continue to be my goal: increasing connection between staff and staff, clients and clients, and staff and clients. That can be a pretty lofty goal and sometimes it is nice to have something concrete to focus on, so my other goal I set for myself was to try to build more poetry into my life. I find that poetry can create a space to pause and reflect, to connect to my feelings and to connect to hope.

I have been meaning for some time to send out regular email of “Thoughts From the Clinical Director.” But, there is always so much important work that I do not get to everyday, this has been on the back burner. Perhaps it is not too late, even as I am in a leaving process from Buchanan to start this project. I will also share some of the poetry that we used at the conference. If it is of value to you and brings you hope, that is wonderful, if not, please feel free to disregard these periodic emails. Here is the first poem, it is a long one, but it was my favourite (Albuquerque is a city in the state of New Mexico):

 

Wandering Around an Albuquerque Airport Terminal

 

After learning my flight was detained 4 hours,

I heard the announcement:

If anyone in the vicinity of gate 4-A understands any Arabic,

Please come to the gate immediately.

 

Well — one pauses these days. Gate 4-A was my own gate, I went there.

An older woman in full traditional Palestinian dress ,

just like my grandma wore, was crumpled to the floor, wailing loudly,

Help, said the flight service person. Talk to her. What is her

problem? we told her the flight was going to be four hours late and she

did this.

 

I put my arm around her and spoke to her haltingly,

Shu dow-a, shu- biduck habibti, stani stani schway, min fadlick,

Sho bit se-wee?

 

The minute she heard any words she knew — however poorly used –

she stopped crying.

 

She thought our flight had been cancelled entirely.

She needed to be in El Paso for some major medical treatment the

following day. I said no, no, we’re fine, you’ll get there, just late.

 

Who is picking you up? Let’s call him and tell him.

We called her son and I spoke with him in English.

I told him I would stay with his mother till we got on the plane and

would ride next to her — southwest.

 

She talked to him. Then we called her other sons just for the fun of it.

 

Then we called my dad and he and she spoke for a while in Arabic and

found out of course they had ten shared friends.

 

Then I thought just for the heck of it why not call some Palestinian

poets I know and let them chat with her. This all took up about 2 hours.

 

She was laughing a lot by then. Telling about her life. Answering

questions.

 

She had pulled a sack of homemade mamool cookies — little powdered

sugar crumbly mounds stuffed with dates and nuts — out of her bag —

and was offering them to all the women at the gate.

 

To my amazement, not a single woman declined one. It was like a

Sacrament. The traveler from Argentina, the traveler from California,

The lovely woman from Laredo — we were all covered with the same

powdered sugar. And smiling. There is no better cookies.

 

And then the airline broke out the free beverages from huge coolers —

non-alcoholic — and the two little girls for our flight, one African

American, one Mexican American — ran around serving us all apple juice

and lemonade and they were covered with powdered sugar too.

 

And I noticed my new best friend — by now we were holding hands —

had a potted plant poking out of her bag, some medicinal thing,

 

With green furry leaves. Such an old country tradition. Always

carry a plant. Always stay rooted to somewhere.

 

And I looked around that gate of late and weary ones and thought,

This is the world I want to live in. The shared world.

 

Not a single person in this gate — once the crying of confusion stopped

— has seemed apprehensive about any other person.

 

They took the cookies. I wanted to hug all those other women too.

This can still happen anywhere.

 

Not everything is lost.

 

Naomi Shihab Nye

A Literary Tour of St. Paul, Minnesota

Posted on by

I was recently in St. Paul, Minnesota to visit my sister, Karen, and to attend Integrity in Health Care: The Courage to Lead in a Changing Landscape, the second annual Courage & Renewal in Health Care Institute. A number of literary places and events clustered around the trip. One aspect of institute for me was a renewed interest in poetry, a sort of “return to poetry” for me. So I wanted to go to a bookstore and browse a bit. Karen and I ended up going to Common Good Books. Garison Keillor, host of Minnesota Public Radio’s “A Prairie Home Companion” is the proprietor of the book shop. In addition to his story-telling on the show, Keillor is also a lover of poetry and is the host of “The Writer’s Almanac” which is a short radio piece that tells a little about the lives of writers and often includes a poem.

OLYMPUS DIGITAL CAMERA

Common Good Books

Karen and I happened to see Keillor in a cafe we were working in. I spent a lot of time in St. Paul in cafes working on my Website which Karen is assisting on. I was reviewing and editing some of my poems to include on the Website when we realized Garison Keillor was in the room.

The other literary aspect of the visit was a trip to W.A. Frost a restaurant that was a neighborhood pharmacy and soda fountain when F. Scott Fitzgerald was living down the street in the Commodore Hotel. In his first novel, This Side of Paradise, Fitzgerald wrote, “Here was a new generation, . . . dedicated more than the last to the fear of poverty and the worship of success, grown up to find all Gods dead, all wars fought, all faiths in man shaken.”

W. A. Frost

OLYMPUS DIGITAL CAMERA

Stained Glass at W. A. Frost

After some time at W. A. Frost, we took a night walking tour of the neighborhood and walked past the Commodore Hotel, where Fitzgerald and Zelda lived and their son was born.

The Commodore

All in all it was a great trip to St. Paul and it was unexpected to have such literary stimulation there and to have my “return to poetry” strengthened. Now I am back in Auckland, working away still on the Website, my book, job interviews, my work as Clinical Director at the rehabilitation centre and my impending move back to the States.

A Portrait of the Author in His Auckland Study

 
A Portrait of the Author in His Auckland Study

Guest Blog Post at the Center for Courage & Renewal Blog

Posted on by

Please see my May 9th guest blog post at The Center for Courage & Renewal Blog (the full text can also be found below)

I wrote this after attending the 2nd Annual Health Care Institute:

Integrity in Health Care: The Courage to Lead in a Changing Landscape

The Center for Courage & Renewal promotes the work of Parker Palmer. I frequently cite Palmer’s work, particularly as it pertains to professional leadership in medicine, in my forthcoming book, Re-humanizing Medicine: A Holistic Framework for Transforming Your Self, Your Practice and the Culture of Medicine.

Another update is that I have been spending a lot of time working on my website, but you can’t tell it yet. All the new content should be posted there before too long.

___________

Recovering Hope, Poetry and Connection in Health Care

I recently attended the conference/retreat “Integrity in Health Care: The Courage to Lead in a Changing Landscape.” I arrived there in the usual state for me, tired, stressed and struggling to balance all of my clinical and administrative responsibilities with the rest of my life. I work as a psychiatrist and as Clinical Director at an inpatient/residential psychiatric rehabilitation program with a population of treatment-resistant clients and a staff group that is going through union action. I took on the job hoping that I could bring a holistic approach to foster recovery and rehabilitation for clients and well-being for the staff, but I am not sure how successful I have been with either the clients or the staff. Many days feel like a constant barrage of worries and concerns about clients, staff and a never-ending stream of emails.

What I found at the conference was not any easy answer or magic solution to my daily worries. What I did find was a chance to reflect on my own situation with a group of supportive facilitators and participants. Having this time and space allowed me to connect more deeply to myself as well as to connect with other health professionals struggling with similar demands. As a result of the conference I felt more hopeful, less alone and that I had more inner and outer resources to bring to my daily work. I think one of the most damaging aspects of our work in health care is the despair that comes from trying to do good work in systems that, directly or indirectly, seem to inhibit good work. We thus have systems in which everyone is working hard, yet no one feels good about the work that they are doing.

The conference was structured around Parker Palmer’s “Five Habits of the Heart,” from his book Healing the Heart of Democracy. These habits are: understanding we are all in this together; an appreciation of the value of “otherness;” the ability to hold tension in life-giving ways; a sense of personal voice and agency; and the capacity to create community. For me this boiled down to developing a sense of internal connection and cohesion while also developing connection to others and building community. This led me to reflect that if we can hold the inevitable tensions between individual and community in life-giving ways, the personal growth and well-being of the individual can contribute to the complexity and health of the community.

The idea of embracing tension rather than trying to eliminate it got me thinking of the tension in my own work and life. If I can shift my perspective toward daily stress and tension as a life-giving energy for work instead of as a drain and impediment to my work, perhaps I can more skillfully support the growth of a therapeutic community at the rehabilitation center where I work. The concept of a therapeutic community is that no one individual has responsibility for solving the problems that arise in the community, rather the work is done in open discussion between all members of the community. Palmer’s habits of the heart serve as an excellent guide for this kind of work by valuing the individual and the community and by seeing the tension as a source of life energy. To me, this was the most useful concept from the conference, that stress and tension can be re-framed and used for positive work.

This concept of holding tension between opposites, rather than trying to have one opposite (e.g. hope) overpower the other opposite (e.g. despair) allows for a complex and systemic approach to complex and systemic problems. The idea of tension being life-giving rather than something to get rid of reminds me of Swiss psychiatrist Carl Jung’s approach to the problem of opposites, that there is a “unifying third” that unites the opposites into a higher order of meaning. In this conference, we can look at integrity as the “unifying third” that comes from holding the reality of despair about contemporary health care and the need and fact of hope. In practice, integrity is generated from embracing the despair and the hope in contemporary health care.

Where does this hope come from? I found hope when I looked into the eyes of the facilitators and participants at the conference. I found it when I looked into myself. Hope is there, it is a living thing. It is just that there is also so much despair that it is easy to lose sight of hope. Hope is intrinsic to the very idea of health care. We all went into this field because we felt that something hopeful could be done in the world.

I’d like to return to this idea of tension being “life-giving.” The image that came to me was of the poles of a magnet. Electromagnetic lines of force emanate in complex and systemic ways around the negative and positive poles of the magnet. These electromagnetic fields create energy that can be used for work. Cancellation of either the negative or positive pole leads to a collapse of the energy and an inability to do work. To move from the metaphor back to our discussion of hope and despair, it is quite apparent that if despair eclipses hope no work can be done. (I will leave the opposite statement of what happens when hope eclipses despair to the metaphysicians, as this does not appear to be an immediate risk in health care.) If this metaphor holds, we can shift our attitudes toward the reality of despair and let go of our desire to eliminate it. Instead, we can view it as a powerful generator of energy and work when it is in a tension-filled relationship with hope.

We do not need any help to find sources of despair to feed this life-giving tension. However, we do need to periodically renew our sources of hope. Luckily these can be found when we pause in life and look within and look to others who are doing hopeful work. One great place to pause is at an “Integrity in Health Care” retreat.

This conference was not a passive, one-way exchange of information from the facilitators to the participants. We had ample time for personal reflection and small and large group work. The facilitators were compassionate and skillful in stimulating discussion and reflection to promote individual and group work. The other participants were inspirational in their personal honesty, their humanitarian drive to alleviate suffering and the creative ways that they were doing clinical and administrative work. I remember one small group where we discussed how we can facilitate individual and group reflection in busy health care environments. We spoke about mindfulness and poetry as ways to accomplish this. This discussion was very helpful for me and I take away a particular commitment to have more poetry in my life as I find it ignites a dimension in me that I often push on the back burner. As the poet and translator of sacred texts, Juan Mascaró, writes:

“The appreciation of a poem is an act of creation whereby we go towards the greater life that created the poem. An expansion of life.”

There is another tension in health care between the poetry of medicine and the science of medicine. We work in a time when the science (and the business) of medicine often obscure the poetic value in our work. Mascaró further writes that:

“There is inner observation and experiment and outer observation and experiment. From the first comes poetry and spiritual vision and all human values; from the second science and technology.”

What I take away from this conference is an enhanced ability to hold this tension between inner and outer observation and experiment, which allows human values and science to co-exist in the delivery of health care. Practically, this means I have a renewed sense of self-connection, a stronger sense of community and more hope from the work that others are doing in health care. With a handful of poems and a heart-full of hope, I return to my daily life and work.

 

 

 

Book Review: Bringing Human Values to Healthcare Reform

Posted on by

I just published my first book review on Amazon! I will be periodically reviewing books that are relevant to the topics discussed in the Being Fully Human blog. The following review highlights Gerald Arbuckle’s Humanizing Healthcare Reforms, published in 2013.

Bringing Human Values to Healthcare Reform

Gerald Arbuckle writes from a truly international perspective, as a New Zealander, educated at Cambridge University in the UK, living in Sydney Australia, and having served as an organizational consultant in the US, Canada, and Australia. He trained as a social anthropologist and brings an understanding of how culture shapes values, beliefs and actions and he applies this knowledge to contextualize motivations in healthcare systems. His description of different models of healthcare illuminates the roots of the debates around healthcare reform. He describes the traditional (mainly indigenous) model of healthcare and the foundational model (based on equity, compassion, mercy and social justice) as both including a holistic approach, a sense of social and spiritual context and the valuing of interpersonal elements of relationship. In contrast, he describes the biomedical model and economic rationalist models as being focused on numbers and objectivity, and reducing therapeutic interactions to factors that can be counted, measured and economically valued. With an understanding of the different values of these different models, it can easily be seen why patients, doctors, healthcare professionals, third-party payors and government agencies have different priorities based upon the model of healthcare that they hold primary.

With the perspective gained through understanding that these models of care have different values and priorities, Arbuckle brings his understanding of the role of culture and how it can support or inhibit healthcare reform. He argues that the values of the foundational model of healthcare must be re-invigorated to counter-balance reforms based on biomedical or economic principles. In short, Arbuckle argues for including humanitarian values in discussions around healthcare cost and science.

I found Arbuckle’s conceptualizations quite useful in my own writing for my forthcoming book, “Re-humanizing Medicine.” He presents a well-reasoned argument from an anthropological perspective, which is not often heard in contemporary medicine. He champions human values amidst debates regarding cost and technology in medicine. His book provides a useful sociocultural context for the kinds of healthcare reform called for by doctors such as Robin Youngson, whose book, “Time to Care,” calls for greater compassion in healthcare. Arbuckle provides a great conceptual template as well as an inspirational call for leadership in healthcare that is collaborative and transformative.

Every Thought Leads to Infinity

Posted on by

This is a little after the fact, but here is the abstract from a presentation I did at the International Society for Psychological and Social Approaches to Psychosis, New Zealand/Australia annual conference, August 2012 in Auckland, New Zealand.

Every Thought Leads to Infinity: Visionary Experience and Creative Illness in Carl G. Jung’s Red Book and Philip K. Dick’s Exegesis

Jung’s Red Book and Dick’s Exegesisare private journals that both men worked on for years during periods of visionary experience. The recent publications of these books illuminate Jung’s and Dick’s experiences as well as provide a key to understanding their later books that grew out of their inner work. For both Jung and Dick, their early interests and writings prefigured their later visionary experiences.

Jung’s early interests in spiritualism and archetypal symbols in mental illness later manifested in his own life as what he called his “confrontation with the unconscious.” Through great effort, he was able to use these experiences to fuel what he called the process of individuation, the journey of “becoming who one is.”

Dick’s work focused on the themes of “what is real,” and “what is human.” He commented that, at the time of his visionary experiences, it was as if he had become a character in one of his own novels in which the very fabric of reality was in question.  His later books explore spontaneous visionary experience through the lenses of mental illness, drugs, and spirituality.

Both men exhaustively researched the writing of philosophers, mystics, and scientists (as well as turning to objective analysis of their own writings) in an attempt to find some reference point for their own experiences. This presentation will look at the lives of CGJ and PKD and their journals, The Red Book and the Exegesis, through a structure of the childhood struggle to become who one is, a preoccupation phase in which their interests deepened, but also set the stage for a crisis phase of visionary experience, and then an occupation phase in which they integrated interests and crisis into path of occupation that continues to influence individuals and society.

A Few Words About Language

Posted on by
I just had the most amazing meal. A Reuben sandwich (rye bread, corned beef, Swiss cheese, dressing, and sauerkraut) with potato salad (red potatoes, skin on, the dressing was pinkish, as if slightly colored by beets) and iced tea with refills. This may seem mundane, but it is a combination that I haven’t had in New Zealand, for all I know, I may not have had a Reuben in two or more years. Even if I did have a Reuben in New Zealand, it wasn’t this way, names can be the same, yet the content and experience incredibly different.  I had this marvelous lunch at the Moonkiss Café in Waquoit, Massachusetts. Walking out of the café, I saw a small sign tucked into the flower garden that said, “PEACE.”

I haven’t been back in the US for about a year. It doesn’t seem like a country at war, but we have been at war for 11 years, now. We are fighting terrorists, mujahedeen, who were previously freedom fighters against the Soviets. The Soviets were hostile occupiers, but the US is spreading freedom and democracy and killing “others” with machines that are growing in intelligence and deadliness (drones – definition). There is no sign of war here and no sign of deaths that are happening elsewhere. Peace:  a wish, a protest, a religious statement, or political commentary. The flowers bloom, regardless.

I have just set foot on US soil after almost one year away. I have been up in Nova Scotia, Canada for the past two weeks. On the way there from New Zealand, I was briefly in Sydney, Australia on a layover. I had four country’s currencies in my pocket, which I thought was very cool, until I tried to pay for something and three of the currencies had the English queen’s likeness on them. Does that make me a global citizen or a bumbling, economic colonialist?

I was at the ALIA (Authentic Leadership In Action) conference, which I will discuss in more depth in another entry. Here, suffice it to say, I spoke with people from all over, mostly Canada, Quebec, the US, Barbados, Australia, and even New Zealand. The first thing that was strange is when I got on the Air Canada flight in Auckland. First I noticed one person speaking North American English, then another and another, suddenly, I was surrounded by people who spoke similarly to me, the Aussies sitting next to me were more the minority with their pronunciation. I didn’t realize how used to being different, in the New Zealand context, I have become. I had a weird experience in a Tim Horton’s yesterday, after already being in Canada for a couple of weeks, of having that feeling of needing to speak quietly so that everyone doesn’t know that I am American and then I realized that I didn’t need to change my way of talking, as there isn’t as much difference between Canadian English and US English, as there is between the US and NZ. Still, I would rather not stand out as obviously American in another culture. Sometimes in New Zealand, people think I am Canadian, I generally take this as a complement, based on the perception of the US in the world. So, I have learned to speak quietly, pronounce many words differently, and to make this kind of “um” noise and to say “eh” (or someone said I should spell it “aye,” but it sounds a lot like a Canadian, “eh,” eh?).

But then, there are those Canadiens from Quebec, with not just a different accent, but a different language. As New Zealand is bicultural (New Zealand European (pakeha) and Māori), so Canada is bilingual (French and English). In New Zealand, I worked hard to learn some Māori words and phrases. I learned some Albanian from my Kosovar friend. I have worked to understand and even say some words in different English accents. At the conference, I think one of the most beautiful words I heard was the Zimbabwean pronunciation of the word “here,” which sounds more like haeare, and it reminds me of my friend in New Zealand who grew up in South Africa and England, as he says haeare in a similar way.

One is at a distinct disadvantage being in a bicultural or bilingual country and not speaking the other language or understanding the other culture. There are complex dynamics around this. Sometimes it seems that those who speak “the other” language expect you to learn their language, but there is variability in whether or not someone teaches you their language. I don’t understand the Anglophone/Franocophone dynamics in Canada enough to comment. Māori culture in New Zealand is somewhat closed, it is more collectivist and tribal in orientation, which tends to have stronger ingroup/outgroup distinctions. There is also both a dual expectation that you are sensitive to and informed about their culture, but there are barriers to learning it as it is something of their own that is not easily shared. As an outsider bumbling in, there can be a feeling of discomfort, ignorance, being disliked (perhaps for one’s group affiliation – rather than one’s individual self), with the accompanying projection that the other is proud, arrogant, disdainful, angry, or perhaps playful, or maybe just seeing what a newcomer knows. What is behind this interaction, what motivates someone to speak a language to you that they know you do not know? In a bilingual country, a visitor could reasonably be expected to learn a few words in the host language. I admit it bothered me when Americans would use American currency in Canada (which I also admit, I did a couple of times near the end when I ran out of Canadian currency), why not exchange money?  So why not learn some French, I ask myself. Well, I did embarrassingly learn “come see come saw” which means something like “I am so so,” (Ok, I know it isn’t spelled that way, but I am not sure how it is spelled, just how it sounds).  I should learn some French, at least a few words out of courtesy.

I am listening to Stereolab right now, mostly English, but some French songs, although I have listened to this band for years, I don’t know what the words are to the French language songs. I like Jovanotti and I have looked up the English translation of some of those songs sung in Italian. Sigur Rós, I have looked up the translated lyrics on a couple of songs from Icelandic to English.

It was easier for me to learn to speak a few phrases of Albanian in New Zealand than Māori in New Zealand, why is that? I developed a relationship over some time with someone from Kosovo at the bus stop every morning, and it just seemed natural to want to learn a few phrases. Most of my learning of Māori has been from reading books and learning certain terms.

Language is a touchy subject, a difficult subject, it allows for connection, it can create clarity or confusion, it also can be used for disconnection. I know that it took me about a year, maybe a year and a half of having to activate a little more of my brain to translate accents in New Zealand – the place I noticed this the most was in jokes, I would often be about 10 seconds behind the joke before I would get it. Being in a different culture is an adventure and it also entails a degree of isolation and difference. I have written earlier on this theme shortly after arriving in New Zealand, particularly the dilemma of having a tendency to feel like an outsider and gravitate to the periphery in one’s own culture and then moving to another culture and being perpetually an outsider. I have met Americans who have been in New Zealand for years, and even though they pronounce some words like a Kiwi, they don’t speak with a Kiwi accent, only those who come at a young age seem to be able to do that. There is something akin to aural butter in hearing one’s own language and dialect spoken, of speaking to someone who has a familiar rhythm and tempo in their speech, it is kind of like the meal I had for lunch today – it was really good, partly because it was expected and predictable, the variations maintained the essence of the food, whereas in another culture the name is retained, but something about the essence just doesn’t feel like the food you are used to. And yet, for many people, there is a desire for newness, difference, a change of pace, a new perspective – but all things are in a balance, it would be good if I could explain that, but I cannot, other than to say that I have felt at times a craving for sameness, security, the expected in reaction to a temporary state of being overwhelmed by otherness.

So, what do I say, “I am culturally insensitive because I am an American, and that is in fact our culture and other cultures should be sensitive to that?”  I don’t think that will fly. I will need to learn at least some conversational French before returning to Canada. But for now, merde (second favourite French word), I must work on my idée fixee (favourite French phrase), and I bid you adieu.  Mon Dieu, I almost forgot my third favourite phrase! I also like the French pronunciation of idiot, which is probably fortunate.

Walden Pond

Posted on by

WALDEN POND

I had the happy surprise of going to Walden Pond on a 2 day trip to Boston to visit a friend from high school. I had never been there, although I have read Thoreau off and on, and I was really thrilled to go there – a mini-pilgrimage of sorts.

WALDEN POND

The first time I seriously read Thoreau was after university when I bought a bus ticket from Chicago to Seattle and went backpacking in the Olympic National Park. The bus trip was 50 hours long (each way), so I had plenty of time to read and to meet people from all over the world. There is a strange sort of community that happens when people are thrown together for a medium length of time. There was a rhythm of driving, stopping for a break and some food, and driving some more.  I don’t know if I would have read as much of the Portable Thoreau as I did on that trip if I weren’t in that somewhat Zen-like rhythm of always moving and being stuck in the same place.

WALDEN POND

I have a painting I made years ago, it is a sort of forest scene with a little cabin by a pond and then I painted quotes from Thoreau over the whole thing. Here are a couple of the quotes:

WALDEN POND

If you have built castles in the air, your work need not be lost; that is where they should be. Now put the foundations under them.

I came into this world, not chiefly to make this a good place to live in, but live in it, be it good or bad. A man has not everything to do, but something; and because he cannot do everything, it is not necessary that he should do something wrong.

I left the woods for as good a reason as I went there. It seemed to me that I had several more lives to live. It is remarkable how easily and insensibly we fall into a particular route, and make a beaten track for ourselves. I learned this, at least, by my experiment, that if one advances confidently in the direction of his dreams, and endeavours to live the life which he has imagined, he will meet with a success unexpected in common hours. In proportion as he simplifies his life the laws of the universe will appear less complex, and solitude will not be solitude, nor will poverty be poverty, nor weakness weakness.

WALDEN POND

The Royal Australian & New Zealand College of Psychiatrists, Part I

Posted on by

I just got back from Hobart, Tasmania in Australia for the annual Royal Australian & New Zealand College of Psychiatrist conference. It was a very interesting conference, I learned a lot and met many people who are doing good work.

Hobart, Tasmania, Australia

Hobart, Tasmania, Australia

Here is the abstract for the first presentation I did:

What Does It Man to Be Human?

The Role of Psychiatrists in Philip K. Dick’s Life & Writing

Author: David R. Kopacz, M.D.

Philip K. Dick was a prolific author of over 50 novels. Many films have been based on his work, including Blade Runner, Minority Report, Adjustment Bureau, and the upcoming Radiofree Albemuth. His continued relevance seems due to the timelessness of his two main themes:   “what is human and what is real?” In the course of living these questions he was prescribed most classes of psychiatric medication, took street drugs, routinely consulted psychotherapists and psychiatrists, and was psychiatrically hospitalized several times.

Not surprisingly, psychiatrists often appear in his writing, sometimes as humanizing forces but also as forces for dehumanization. Dick called dehumanization, “androidization,” where a human being becomes a machine:  obedient, predictable, and lacking independent thought. When psychiatric interventions are applied without thought and wat ithout appreciation of the humanity of the recipient, the psychiatrist can be seen as an “android” who is trying to turn the patient into an “android” as well. In Dick’s life and work, psychiatrists also act as human beings, with concern and empathy to empower the humanity of the client.  Although Dick developed extensive, elaborate theories about the question of ultimate reality, his litmus test for humanity is much simpler – is one kind to other beings? Kindness is the hallmark of whether one is acting as a human or a machine. This presentation will examine Dick’s concepts of the android and the human in the context of contemporary debates regarding the recovery movement and the role of the psychiatrist as an evidence-based technician and/or as a humanitarian.

The Royal Australian & New Zealand College of Psychiatrists, part IThe Royal Australian & New Zealand College of Psychiatrists, part I

The presentation went well and I had some interesting discussions after it. One thing I came away thinking about was PKD’s subversive humanism (the little guy trying to stay human in the face of overwhelming technological or political attempts at androidization) and how that is similar, in some ways, to the true work of psychiatrists – fostering human growth and development in the face of mental illness, traumatic past experiences, and restrictive belief systems of family and society.