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Sunday – I went running this morning in the clear cold air. I came upon a flock of migrating black birds – hundreds, maybe more than a thousand of them. They seemed to be on every branch of every tree. Some were on the road, and a guy had to blow his horn to clear a way to his driveway. The sound of all those birds took me back over thirty years to the first time I came upon such a group. I was walking in the woods to Lake Matoaka to take pictures. I was checking my camera as I walked and suddenly realized I was surrounded by an incredibly loud noise. “What IS that?” I thought. I looked up and was surrounded by birds everywhere. So of course I immediately thought of Hitchcock’s “The Birds.” It was like being swallowed up by a great big living, vibrating-with-sound-and-movement organism. I walked along more slowly and mindfully and just watched in amazement. I remember that day there were at least two or three species each in their vast group. This morning I just smiled at all the racket and hoped nobody rained on me as they flew over and I ran in their shadows. I wondered what it was like in the days when passenger pigeons were still alive and their flocks would block out the sun for days because their numbers were so large as they crossed the sky. And now there are none, thanks to people. A few moments later a shot rang out somewhere down across one of the ravines. The woods immediately became silent. Within a few moments, the bells of a church over in Toano started to ring through the woods in the direction from where the birds originally came. I kept going with the only sounds that of a few local birds that live here year around, and the sound of the bells. A few seconds the only sounds were just a couple of crows and sparrows and my footsteps. I got back to the house and listened intently and maybe about a half mile or so across the ravine, I could hear the cacophony of birds again, recovered, back in the groove, calling out to each other and the world, carrying on their journey. My run became a meditation of yin and yang.

Tuesday – Another running morning this time in the cold damp gray overcast of a day between winter storms. I passed by a man unloading his pickup of his hunting gear. About a mile later I passed a woman in her front yard smiling with joy and wonder at a small deer in her front yard. She was holding her hand out to the deer trying to get him to come to her. I thought of a time years ago at Bryce Canyon as I walked along with a young summer ranger intern. He was studying ecology in graduate school. Every time we came upon one of the little ground squirrels that frequent the trails, he would stomp his foot and scare them away. “You don’t want to habituate them to people,” he said. The deer today was already pretty habituated, and getting more so. Every action we take is linked to everything, and our intentions don’t always play out in a way we hope for or even think about. A gesture of felt kindness and wonder may have consequences we are not mindful of – like making a deer more vulnerable as prey.  You really can look into any action, or even a bowl of rice, and see that we are connected to everything in the infinity of time and space. Every why has a why. I kept running. A mile or so later I was in the part of the neighborhood bordering on deep woods. A single shot rang out. I just kept running.

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Stress is a part of life. The only time you no longer feel stress is when you are no longer alive. Even then, what is physically left of you is subject to entropy and change. Recent research on mice found that reaction to perceived stressors may even be carried in our genes. Later generations of mice reacted with distress to a scent they had never smelled, but that scent had been paired with pain in their ancestors. Perhaps we pass our narratives down through our stories and even through our bodies. We go on alert in a situation we have never experienced but that distressed our great grandparents. It does make evolutionary sense.

Then there are the traumas that we actually experience in this life.  Our mind protects us by dissociating from them, but they are still there. How do we face these anxieties?  There is a great movement toward “mindfulness” these days, though the concept has been around for thousands of years.  But many think of mindfulness as only quieting the mind and falling into a blissful state away from all the worries and pain.  They get frustrated by the words and thoughts that disturb them as they meditate but may learn to just focus on the breath and let the thoughts go. They may learn to just be with wherever they are – to hear the sounds, smell the smells, see the sights, feel the surroundings and all the rest. They may be able to visualize a lake buffeted by winds that their mind stills the breeze so that the water clears and calms and reflects the full moon in their vision. But still the stressors await when they leave the meditation cushion. Sometimes the stressors and anxieties get louder when the mind starts to quiet, and visions of the trauma come up that had been forgotten.

In taiji, there is the principle of jing. In the jing state, you are calm and peaceful, but you are also aware and ready.  Mark Epstein, in The Trauma of Everyday Life, talks about “bare attention.”  In mindfulness, you are not trying for that calm quiet state alone, but also come to know and come to terms with trauma.  It is not what happens to us that matters so much, but how we react to it.  We learn to let those thoughts in and talk with them and observe them and treat them with respect.  I think it is a lot like forgiveness. To forgive doesn’t mean to say that what ever the wrong was is okay. It means I wish it had not happened, but I am not going to be consumed by it and let it run my life. I learn from it and let it be. The Buddha’s word for mindfulness, “sati” means “to remember.” We let what is bothering us come into consciousness and then learn to cope. As Epstein put it, mindfulness balances relaxation and investigation and is a combination of detachment and engagement. He tells a story about teaching a meditation class in New York City on a Saturday morning and asked the participants to turn on their cell phones.  Rather than be annoyed by the ringing and sounds of the cells, just notice the sound.  He also asked them to just breathe and take note of any sounds they heard and then just let them go.  During the discussion afterwards, a young woman revealed that her father had died a few months before. She had a special ring tone for him, but had not listened to it since his death, that the thought of hearing it had been too painful.  One of the phones that rang during the meditation had that same ringtone. She said that being in the supportive group and being mindful when it rang had given her a different experience from pain. She felt touched and love and a connection with her dad when the phone rang. His memory came flooding back in a compassionate way.

Epstein also tells the story of a monk who had a glass that was very beautiful. The glass reflected the light in such a lovely way, and the monk was very proud of the glass. What made the glass even more precious, the monk said, was that even now, he knew that the glass is already broken.  Nothing lasts, everything changes, clinging to wishes of permanence brings pain.  The time with the glass, or any thing or any one, is even more precious when you come to accept that the glass is already broken.

The title is the second line of the Tao Te Ching.  To make sense of the world, we attach names to everything, and sometimes think the name and the thing are the same thing. But a word is just a sound we agree on as a representation of something, and no two of us experience that something exactly the same way. My notion of the color blue or experience of an apple is different than yours.

In behavioral health, diagnosis is a driving force. Some folks find putting a name to a behavior helps very much. For others, it does not help and may even hinder change, particularly when that name says that one is diseased and will never get better.  At times, the person becomes the name. The medical model in the past has functioned that way, and in an ironic way has actually increased stigma while seeking to lessen it. (see Models of Madness, edited by Read, Mosher, and Bentall)

In about ten days, the DSM 5 will be released.  NIMH has decided not to use it. There has been ongoing controversy about how it was put together.  Salon has a pretty good article about this at http://www.salon.com/2013/05/05/the_book_of_woe_psychiatrys_last_stand/.

When it comes to diagnosis in behavioral health, the United States goes its own way, just as it has done with measurements.  The rest of the world is metric, while we stick to the old standard system.  The rest of the world uses the ICD 10, while we are using the DSM IV TR for now. The US is scheduled to change over to the ICD 10 in a couple of years. Unless of course it is postponed again. We will see. After all, we were supposed to convert to the metric system decades ago.  For a short time, even highway signs displayed both miles and kilometers. No more.

This afternoon I got to participate in my first field trial for the World Health Organization in its beta work on the ICD 11.  I was given a list of diagnoses with the diagnostic criteria for each one – diagnoses covering areas such as PTSD, grief, stress reactions – and then given two case studies to diagnosis. I was then asked about my diagnosis and the criteria I used, severity of symptoms, and how confident I was of the diagnosis.  I found the criteria to be more descriptive and straight forward than the DSM. I have been using the DSM since the original version III and have never particularly been comfortable with it in terms of its practical use, other than you have to diagnosis in order to bill. And you need to be extremely careful of what diagnostic label you give to someone because it will most likely follow them for the rest of their lives with various consequences along the way. I wish that were emphasized in graduate schools and treatment programs more. Give the least pathological diagnosis possible.

The feel I got from the initial study was that the at least in what I read, there is less of a pathology orientation and more of a descriptive approach. I hope that stays the case. I am looking forward to the next trial.

Last week I participated in World Taiji and Qigong Day.  As part of the program I demonstrated Yang style 24 form and Dr. Paul Lam’s Sun style Tai Chi for Arthritis.  My teacher and his teacher were also demonstrating forms.  No pressure to perform well there, eh? 

For performance of any kind, some bit of anxiety is a good thing. Too little and you do not put in the necessary effort, like a heavily favored team getting knocked off by an underdog.  Too much anxiety and you can also perform poorly. You freeze; you get tunnel vision and stop seeing options when the unexpected happens.  You need just that right level.  You are psyched up and not psyched out.

I went on third and sixth.  Rather than think about my upcoming time in front of the crowd, I watched and enjoyed the other forms being demonstrated.  Tai Chi for Arthritis was my initial performance. I was certified to teach this about seven months ago.  As I began to move I could feel myself settle in and the movements flowed. I didn’t think, I just “was.”  When my time for Yang style came around, my adrenaline had taken a little out of me and my focus was not quite as good. I have been performing Yang style for over ten years. The problem is that sometimes if your concentration lapses you can find yourself morphing into 40 form when you started out in 24. Fortunately that did not happen and my performance went well. What it did point out to me was the difference between self awareness and self consciousness. When you are self aware, you are mindful and in the moment. You know where your body is in space and flow from move to move.  It is the feeling of wu wei – effortless effort, what we call “flow” in the West. Self consciousness on the other hand, is thinking too much, trying to be aware of everything and criticizing it at the same time and maybe imagining the critique of others. You overload and performance deteriorates as you try too hard. 

 Practice does not make perfect. Practice makes habitual. I would say practice makes permanent, but nothing is permanent. You practice so that you do not have to think and can just flow in mindful self awareness, an awareness that helps you to continually improve your practice. 

Transforming Negative Self-Talk, by Steve Andreas is a very well written book that can help anyone change their self talk for the better.  He uses techniques from Neuro-Lingustic Programming and the works of Satir and Milton Erickson.

Andreas says that we all hear voices to some degree. It is the self talk that begins as we learn to speak and think and conceptualize the world.  We internalize the voices of those who teach us, and without our inner voices we would never learn to communicate with words. 

Too often our inner voices can become harsh critics that may berate us.  Andreas gives us ways to change that language, often in relatively quick ways.  He first focuses on the location of the voice.  Do you hear it from the front, the back, the left, the right, inside or outside your head? You can change the location. For example, a voice farther away has less impact and may be softer. Andreas is careful with each proposed change to see if there might be problems with making the change. Those words we say to ourselves may have some protective value to us and we need to evaluate the possible consequences and address those before attempting the change.  One example he gives is of a person who would like to be able to speak in front of groups, but then worries that if he gets good at it, his employer would want him to make sales trips and presentations and take time from family.  In that case, the goal was altered to be able to speak with smaller groups of people.

 The words themselves are important such as whether one says “I am” or “You are.” However, Andreas recognizes that it is more than just the words that communicate, and a change in these other factors plays a big role in changing behavior. These factors include the tone and volume of the voice, who the speaker is, and the tempo. Just slowing down the words can change the message.  So can changing the tone.  Change your self talk from a command to a question or even give it the sound of amazement. He also uses music or songs to change the meaning, much like movies use music to set the tone and mood of scenes. Voices may also be added, like a chorus that dampens the effect of the original voice.

Throughout the book, Andreas uses stories of his own and other therapists to teach. My favorite was about a five year old named Tommy who banged his head whenever he made any mistake. The therapist told Tommy a story about Timmy the squirrel who would sometimes slip and fall while climbing trees or forget where he hid nuts and would feel dumb. When he felt dumb, he would bang his head against trees and call himself names. Timmy’s family took him to see the Wise Old Owl. The Owl talked with Timmy and asked him if he had a belly button, and then asked to see it.  Tommy, the child, was enthralled and at that moment, raised his shirt and looked at his own belly button. The Owl told Timmy the squirrel to take a good look at his belly button and to remember that every one with a belly button makes mistakes, and if you make a mistake, just look at your belly button and say it is okay.  The parents reported later that Tommy stopped banging his head after that session.

 Andreas recognizes that a problem with trying to forcefully change self talk or to stop it is that this effort can actually strengthen the negative self talk as it fights back to stay in your mind. He also emphasizes the need for positive statements – what you want to accomplish – versus negative goals. Negative goals activate that which you are trying to change. An example is a phrase that might be used by dieters who say, “I can’t eat chocolate cake” which immediately puts the idea of chocolate cake in their minds and most likely also into their stomachs pretty soon.

This is a book that focuses on solutions, and does so very systematically and carefully.  When you are asked how a day would be if it were as if whatever problem you had were solved, you are asked for detail and also to look at what the consequences of the change might be. Throughout you are given the chance to work on each of the exercises yourself, and there is a section on finding what your own “core question” in life is.  Your “core question” is the question that guides you in your experience and behavior. The book ends with a chapter on transforming self talk using a very creative technique developed by Melanie Davis.  She uses word play to change the negative self talk, and the steps to do this are clearly spelled out, such as changing a word or punctuation or tonality often in a playful way.  “I am no good” was transformed into the affirmation, “I am.”  The latter part was changed to “Know good.” The therapist and client had fun playing with the words and the whole feel of the self talk was changed both in words and emotion.

 Changing your self talk changes your life. Mind (self talk) leads to energizing which leads to action. Depending on your self talk, that action can be positive or negative, healthy or unhealthy.  This book helps you change for the better and strengthen the positive and healthy.

Practice makes perfect.  How many times have you heard that? It is a belief that we tend to accept almost without question. There are at least two problems with it, though.

First, it is impossible to be perfect.  Perfectionists tend not to accomplish things, because nothing is good enough. It could always be better.  In athletics, on rare occasions a gymnast or a diver may be given a ten on performance.  Even then, when the performance is reviewed via video recording, there are micro errors in any performance.

Should we practice and strive to do our best?  Of course.  The second problem with the phrase, “Practice makes perfect” is that what practice actually does is make something permanent.  The more we think a thought, perform an action, or do anything repeatedly, we are exercising a neuronal pathway in our brains, and the more likely we are to replicate what we are practicing. The more we practice something, even in visualization, the more we reinforce that behavior.  We also make it more likely that is how we will perform that action.  Mind leads thought leads to the action.

Practice just for the sake of practice without being mindful of performance can make more permanent whatever it is you are practicing at the level you are practicing.  Should you go out and run junk miles just to keep a streak alive?  It would be better to go out and focus on some aspect of the run – posture, turnover, etc. – and not just slog through for the sake of getting in some miles.  Whatever changes, whatever improvements you want to make in your behavior, first picture what they are.  Visualize them. Plan the practice in small systematic increments of behaviors you can achieve and be diligent in practicing those behaviors.   Martial artists start with very simple movements in learning, practice a lot and build on that. Diligence, mindfulness, and discipline can improve your performance. Strive to do your best, and remember that practice done well improves performance.

Lao TzuI have been taking taiji classes for over ten years now, and practice almost every day.  I use some taiji and qi gong methods and techniques in counseling for relaxation and for learning the process of flow or wu wei (effortless effort). It has become an important part of my life, and I have learned Yang style 9, 24, and 40 form as well as Wudang 13, some fan form and am beginning to learn taiji for arthritis which is based on Sun style.

 I started teaching taiji a few months ago. If you ever want to learn an art or a skill or anything better and increase your own skills, teach it to someone else.  You really have to pay close attention to what you are doing and conceptualize it in a different.  Part of my practice is visualizing the movements.  As I explain and demonstrate the movements to a student I really have to focus on the form intensely and come up with words that describe the movement.  That also leads to some a ha moments, such as noticing how the hands and feet move together, the hips and shoulders, the elbows and knees generally move in synchronicity. A ha moments are often brought on by students’ questions and suggestions.

 Some years ago some university physics professors noticed that students were doing well on tests and could recite and use formulas, but had trouble with practical applications. It included something as simple as the classic Galileo experiment of dropping objects off the leaningTowerofPisaand objects of different sizes hit the ground at the same time. Students thought that was not the case. After all, common sense would say a cannon ball would hit the ground before a hammer when dropped from the same height, but they land in unison. The teachers eventually stopped the lectures and assigned problems to be solved to small groups of students during the class time.  The teachers moved from group to group to ask questions and help with problem solving. That is a pretty good Socratic way to teach.  The students ended up understanding concepts and principles better and were better at physics.  In a sense, they had to teach each other in a collaborative way.

 Teaching, coaching, and counseling I think work best when done in a collaborative way. And if you really want to learn something well, try teaching it.

It seems to me like the distribution of most everything conforms to the standard bell curve to one degree or another. There may be a skewing to the right or the left, but there is a curve.  By nature we need stories to make sense of our lives, and we make sense according to how we are taught.  We put people and everything else into categories that make sense with how we want/choose to see the world. We don’t even realize that what we have is a construct culturally made up. We see it as just “what is.”

 The thing about bell curves, about “normal distributions” is that there are always outliers.  Take those behaviors we thing of as addictive for example.  Now anything that can act on the pleasure center of the brain and anything that can ease stress and tension can be “addictive.”  It becomes a behavior that we come to rely on to make us feel better.  People can be “addicted” to drugs, shopping, a person, work, the online world, sex, exercise, gambling – whatever relieves stress and works.  There may be consequences that aren’t pleasant, but that rush of adrenaline, dopamine, oxytocin – that instant vacation from what is ailing us and gives us a longed for feeling is difficult to let go.

 One of the Founding Fathers, Benjamin Rush, classed addiction to alcohol as a disease back in the 1700s as a way to ease the stigma.  But when addictive behaviors are called an illness and unusual behaviors are classed as mental illness, the danger is that the stigma actually increases.  They can’t help it, they have a disease, and as often happens with physical illnesses, people ostracize them and fear them.  The fear them not because they are worried about contagiousness, but because “that person has no control over his behavior – you just can’t trust him.”

Think for a moment of “unusual” behaviors as outliers, and take alcohol as an example.  A small percentage of people on the right side of the curve drink more than the average daily consumption of the alcohol, and consume a lot of the alcohol drunk. The middle of the curve drinks but no individual drinks “more than their share.” At the left of the curve are outliers that drink nothing at all. There is no moral judgment in that curve, just differences in behavior mapped on a graph. There is also no notion of disease. People do what they do. Some of the outliers to the right that drink a lot get into trouble.  Some don’t. There are individual differences.  Just as there is no pure yin or yang, there is no pure 100 percentile person or 0 percentile person.  What is important is what tends to happen to you when drink (or do any of those behaviors). What is your relationship with the behavior? Is it overall healthy or unhealthy?  Is it overall positive or negative?  How would you like it to be?  Is it how you would like it to be and if not, what do you need to do about it.  How can you get there?  The thing about outliers is that they stand out, just because they are different.   A person may love computers or art and may spend a lot of time on programming or drawing.  A parent may be concerned that the kid is “addicted” to the behavior. Again, look at the effects.  The child may be passionate about the behavior and may struggle against the parent to follow that passion. Another thing about outliers, people often want to change them to be more like the middle of the distribution. Power struggles can be destructive or constructive. They can be destructive when each side has to win no matter what the cost and control is the goal.  They can possibly be constructive when the individual learns to get better at what the passion is. But again there is rarely a pure yin or yang and there is a cost either way.  It comes down to how you choose to see or live the story.

There are articles, web sites, and books galore on self esteem and the need to have it.  If you don’t, some of those articles say there are dangers that you will become depressed and anxious and in general lead a miserable life.  But what is self esteem?

The popular definition is something like, “I feel good about myself.”  It is having a confidence and satisfaction with your ability. Too often, though, we focus on the feeling good about one’s self without regard to one’s ability. Samantha Clever in an article called, “Too Much of a Good Thing” says, “In 2004, according to Jean Twenge, author of Generation Me, 70 percent of American college freshmen reported their academic ability as “above average.” But, once ego-inflated students get to college, they’re more likely to drop out, says Twenge, when their skewed sense of self and overconfidence affects their ability to make decisions.” She also cites studies about US students rating their math skills as very high while Korean kids rated their skills much lower. In test scores, the Korean students far outpaced the Americans, though the Americans felt the best about themselves.

I think that self confidence is more important than the concept of self esteem.  You earn self confidence by what you do. What you do also gives you indicators of what you can achieve, and also what you need to do to get better.  Praise for mediocre performance does not improve performance and it does not boost confidence. What it may boost is a sense of entitlement. Praise for nothing is just not believable. Similarly, affirmations do not boost performance or mood if the person does not believe the words are true for them. It may actually make them feel worse. There are brain changes as you learn and get better. You are setting up new neural pathways for the new behavior. The more you practice well and improve (and learn from the inevitable mistakes) the stronger that pathway becomes. Empty praise does not do that. Mistakes are good. They teach you.

If you want to feel better about yourself, work on what you want to get better at. Realistic praise can reinforce the improved behaviors and skills. Work in incremental steps that challenge you but are not impossible. Sometimes a little doubt that gets you motivated is a good thing.  It can even help boost your confidence when you do succeed leaving you feeling good in a realistic way.

See, Perceiving, VisionsI’m about halfway through Phantoms In the Brain, by V. S. Ramachandran, MD, PhD and Sandra Blakeslee. The early parts of the book are about phantom limbs and associated pain and how something as simple as the use of a mirror can trick the brain into turning off the pain, at least while the mirror is there.

I am in the part now about vision. There are over 30 parts of the brain that enable us to see. Alter any part in that system and vision goes awry. An artist has a stroke so slight that he doesn’t know it happened till he gets home and everything, including his paintings, are a stark black and white. Other persons cease to “see” in the left or right visual fields but are still able to perceive. When asked whether an object is horizontal or vertical, they can accurately say even though they cannot see the object and don’t know how they know. Some have their blind spot increased and miss fairly good sized chunks of the visual field. But the brain fills in the blanks. There are perceptual and conceptual parts to vision. One very interesting condition is called Charles Bonnet Syndrome in which persons with visual impairment hallucinate. One woman sees cartoons, another man sees all sorts of things including a monkey sitting on Ramachandran’s lap, but is able to intuit that the monkey is not real. James Thurber, who lost vision in one eye as a child in an accident, eventually lost the vision in his other eye but continued to “see” with the syndrome, and it most likely had an effect on his stories and cartoons. Contrary to seeing it as a handicap, some persons actually enjoy it and see it as a gift.  Most people don’t mention that they have visual hallucinations because as a culture, the west does not see that as a gift, but a problem or an illness that must be medicated.  Parts of the visual system recognize the “what” while others recognize movement as a steady flow (one woman lost that ability and now sees movement as a sort of strobe effect and cannot cross streets because she can’t tell exactly where something is), other parts add color, texture, etc.

What is amazing is the system that integrates all this and does it in real time. It also fills in the blanks. Cartoonists and other graphic artists rely on this. A few lines can enable you to see or visualize an entire picture. You can also see part of the face of a friend looking around a corner and see and recognize the whole friend. What is also amazing is that the actual field of vision that is in focus in about the size of your thumb nail when you hold your hand out from you. When we get anxious, we get tunnel vision even more. It is part of who we are to look for patterns and to fill in blanks with what we think should be there and base it on our mental map of the world and our life experiences. Sometimes that works well and sometimes works very badly. The authors say that it is almost like there are a lot of selves in us, most of whom we are not even aware, that unconsciously put all the pieces together that we act upon. I think that is a basis of Bayesian logic which seems to be at least one of the bases of the flow state. And when you become conscious that you are in a flow state, you lose that state. This seems to me to be in keeping with the Buddhist tradition of there being no self. You gain enlightenment when you realize that and let go and be.

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