Guest Blog Post at the Center for Courage & Renewal Blog

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.





“The kind of hope I often think about (especially in situations that are particularly hopeless, such as prison) I understand above all as a state of mind, not a state of the world. Either we have hope within us or we don’t; it is a dimension of the soul; it’s not essentially dependent on some particular observation of the world or estimate of the situation. Hope is not prognostication. It is an orientation of the spirit, an orientation of the heart; it transcends the world that is immediately experienced, and is anchored somewhere beyond its horizons. Hope in this deep and powerful sense, is not the same as joy that things are going well, or willingness to invest in enterprises that are obviously headed for success, but, rather, an ability to work for something because it is good, not just because it stands a chance to succeed,” (Vaclav Havel, Disturbing the Peace).

I love this quote by Havel. I like how it describes hope as a moral choice that is independent of the external situation. It reminds me a little of faith, but not quite the same. Havel’s description seems like more of a choice than faith does. One thing that this quote does, for me, is it preserves the right of the individual to choose what is right and what deserves to be worked for, regardless of the dimension of how likely it is to succeed.

I just finished reading Rebecca Solnit’s book, Hope in the Dark, in which she cites the above quote by Havel. The quote doesn’t appear until page 148, but it seems to inform a thread of Solnit’s argument from the very beginning. “To hope is to gamble. It’s to bet on the future, on your desires, on the possibility that an open heart and uncertainty are better than gloom and safety. To hope is dangerous, and yet it is the opposite of fear, for to live is to risk…Hope just means another world might be possible, not promised, not guaranteed. Hope calls for action; action is impossible without hope,” (Solnit, 4-5).

Another thread in Solnit’s book is of darkness, which is not necessarily the typical way that darkness is thought of. She writes that the “future is dark, with a darkness as much of the womb as of the grave,” (6). This darkness is more of the creative void than the destructive void. It is this embrace of generative uncertainty that also runs through the book. This reminds me of the dark matter of the universe, that unseen substance that physicists can measure that seems to make up all the empty space between things in the universe. I can’t remember for sure, but maybe it is something like 85% of matter in the universe is unseen matter, maybe it is even more than that. But, what is all this dark, unseen matter doing? I like to think that it is somehow invisibly guiding and shaping the tip of the iceberg of matter that we can see. We can bemoan the visible catastrophes, but all is not lost. Just like the iceberg metaphor, Solnit argues for a cognitive restructuring, do we focus on only what is going wrong in the world, or do we focus also on what is going right. Or, even do we focus on how things could have been an even bigger catastrophe than they are?

Solnit introduces the Angel of Alternate History. As compared to the Angel of History, who mostly counts bodies, the Angel of Alternate History focuses on that dark space that surrounds the actual and sees the possible. “The Angel of History says, ‘Terrible,’ but this angel says, ‘Could be worse.’ They are both right, but the latter angel gives us grounds to act,” (76).

Another way of looking at this cognitive re-structuring is that we have to count victories as well as catastrophes in our analysis of the world. Solnit provides criticism of the tendency toward pessimism and catastrophizing of many activists and the Left in the US. She describes such paradoxical victories as the role of Viagra in saving species that were previously used in for increasing sexual potency in Chinese Medicine and how some military bases have inadvertently become safe havens for endangered species.

Another critique Solnit discusses is that of the end of the need for activism, or the desire to “go home,” after the protest. In a way, this mindset looks at attention, awareness, and activism as only being necessary to re-set things or make it happily ever after, and then to turn off awareness and to let go of engagement. Rather, she sees activism as a mode of being, a moral responsibility, that is ongoing, and that one engages in regardless of the “state of the world,” or the “chance to succeed,” to refer back to Havel, again.  The need for engagement never ends.   “Still, I use the term activist to mean a particular kind of engagement – and a specific politic: one that seeks to democratize the world, to share power, to protect difference and complexity, human and otherwise,” (18). “For a long time, I’ve thought that the purpose of activism and art, or at least of mine, is to make a world in which people are producers of meaning, not consumers, and writing this book I now see how this is connected to the politics of hope and to those revolutionary days that are the days of creation of the world,” (115).

Solnit also quotes the Zapatista Subcommandante Marcos throughout the book, who apparently publishes manifestos over the internet. For some reason, I found these to be a kind of eloquent comic relief, not because the content wasn’t serious, maybe even because of the seriousness of the content, but with their ease and fluidity of language and the sense of spontaneity, creativity, and even joy that seems to flow through these declarations. “A new lie is being sold to us as history. The lie of the defeat of hope, the lie of the defeat of dignity, the lie of the defeat of humanity…In place of humanity, they offer us the stock market index. In place of dignity, they offer us the globalization of misery. In place of hope, they offer us emptiness. In place of life, they offer us an International of Terror. Against the International of Terror that neoliberalism represents, we must raise an International of Hope. Unity, beyond borders, languages, colors, cultures, sexes, strategies and thoughts, of all those who prefer a living humanity. The International of Hope. Not the bureaucracy of hope, not an image inverse to, and thus similar to, what is annihilating us. Not power with a new sign or new clothes. A flower, yes, that flower of hope,” (cited, 39-40).

Overall, it seems that Solnit’s argument for hope lies in looking at things differently, refusing to despair, seeking engagement in art, activism, and life, and accepting uncertainty (the darkness that obscures) rather than demanding a certain outcome. This again reminds me of this central Havel quote, which connects a human being to themselves and refuses to let external events dictate whether or not one can hope to make things better or even hope to have one’s own vision of life.

One last thing I’ll touch on here is a small way thing that I find hopeful. As someone who is concerned about the health of the environment, Solnit engages and relates to the natural world and refuses to disconnect from that. After reading Hope in the Dark, I started reading Emerson’s essay, “Nature,” which I don’t think I ever read before. A few thoughts have been coalescing for me. As I sat reading Emerson, drinking a cup of coffee at a cafe, gazing out the open window at the ocean which is right across the street from where we live, I thought, I should really get out into nature more – and it struck me that living on the ocean is perpetually being on the edge of nature, even though this is a pretty happening place, bustling, full of continuous human activity, it is in constant relationship to that great and restless body of water, constantly moving in and out. “The beauty of nature reforms itself in the mind, and not for barren contemplation, but for new creation…The production of a work of art throws a light upon the mystery of humanity,” (Emerson, p. 41, in The American Transcendentalists). Emerson argues that “words are signs of natural facts, particular facts are symbols of particular spiritual facts, and nature is the symbol of spirit,” (42). At first, I was taken aback by this, it seems he is arguing that the natural world and the internal, cognitive and spiritual world are reflections of each other. Oh, ok, that old “as above, so below” congruence between things. Maybe even more. I have read in a couple of different sources now about the finding that there is a 10 hertz electromagnetic current that pulses throughout the Earth and that 10 hertz is also the “dominant (alpha) frequency of the EEG in animals,” (Robert O. Becker, The Body Electric, p. 249, in the chapter, “Breathing with the Earth,” which discusses this concept in depth). What this seems to mean is that living beings contain within them an echo or correspondence with a common electromagnetic current of the Earth. It seems like an instance of “as above, so below,” or maybe, rather, as without, so within.

James Oschman, in Energy Medicine: The Scientific Basis, also writes about this, the Schumann resonance, which “is a unique electromagnetic phenomenon created by the sum of the lightning activity around the world,” (99). The Schumann resonance is 7-10 Hertz in frequency, just like the alpha waves of animal brains. Also, Oschman cites a study of various healers who had their brain activity recorded on EEG and when they went into a “healing state” had activity in the 7.8-8.0 Hertz range (107). Additionally, Oschman cites studies that show that have measured healers whose hands generate electromagnetic fields ranging from 0.3 – 30 Hz, which could be seen to vary around the 10 Hz frequency of alpha brain rhythms and this particular background pulse of the Earth (Oschman, 87). Oschman suggests that a mechanism of various healing modalities is a supportive “therapeutic entrainment,” in which the healer amplifies this electromagnetic rhythm of the Earth and that this is healing by resetting the natural baseline rhythm in the person being worked on. It is easy to imagine that through the daily stresses of life (or even longer term maladaptive patterns of living) that one could lose touch with the natural rhythm of one’s own body, which also corresponds to the natural rhythm of the Earth. Getting back in touch with nature, in this light, could really, truly have a healing effect on one’s biorhythms.

Maybe all this might seem far-fetched to you, but it is what sprang to my mind as I was reading Emerson and his argument that nature is a symbol of the spirit. The transcendentalists refused to buy into the split between mind and body and the individual and the natural or social environment. Another way of stating this could be that nature and spirit both share a common origin, both are in relation and communication with each other, and both enhance each other. Nature and spirit are reflections of one another. Rather than a separation between mind and body, or individual and environment, there is a resonance between all the different things that we divide from each other and with our intellects imagine as separate. Lately, when I feel particularly out of synch in my life, I have been imaging this great, pulsing rhythm of the Earth and looking for the echo of it in my self. I find this comforting, even hope-inducing.