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Kona Hawaii 2013 116Recently a friend mentioned how different he felt while on prednisone, and as a Buddhist it helped bring home the tenuousness of the concept of self. Alan Watts wrote extensively about the concept of self in Daoist and Buddhist philosophy, with one example here.

I get to listen to about 10 or 15 minutes of Radio Lab on NPR during my Wednesday commute and recently there was a piece on the element lithium. Lithium is used as a psychotropic, but they also mentioned that towns which have an incredibly small amount of lithium naturally occurring in their water supplies also have lower suicide rates than towns with even smaller amounts. It reminded me that when lead was removed from gasoline and paint, crime rates went down. Transcranial magnetic stimulation not only helps with relieving depression, but in at least one study, people changed a decision after the stimulation. They didn’t realize the stimulation had occurred and had a rational explanation as to why they changed their minds, and the explanation went along with our concept of self and free will. So much of what we do and who we are occurs below our conscious level.

One theory in neuroscience I have come across is that the construct of “other” evolved first followed by the construct of “self.” These came about so that we could communicate and get along in this world. Music also evolved for our social and emotional well being, and it can have a very big impact on emotion. Think about the use of music in the soundtracks of movies, television and radio and how that affects your experience of the story. Athletes use music to change their performance. You can even use a soundtrack in your mind to change your mood and to change your self-talk. In Negotiating the Nonnegotiable, Daniel Shapiro tells how at his workshops he uses a soundtrack of drums to increase the sense of tribe for workshop participants who have to negotiate bringing their separate tribes into one tribe or else the world will end. The world almost always ends in the exercise. I wonder if that would change without the beat of the tribal drums during the cohesion of the tribes.

Shapiro devotes an entire chapter to the self – the “dual nature of identity.” He refers to our sense of self as the “fixed-identity problem.” Identity is not static, and includes our beliefs, rituals, allegiances, values, and emotionally meaningful experiences. We have various mindsets of the self. There is the fundamentalist who sees identity as fixed and governed by forces outside our control. There is the constructivist who sees identity as an “ever-evolving social construction.”   There is the anattist who sees us as having no permanent identity and transcending “the material world of attachment, experiencing identity as shifting waves within the ocean of life.” Lastly, there is the quantumist who sees identity as “a combination of nature and nurture” with identity both fixed and fluid and there are many possible selves. And we may change that perspective over time. They are not fixed either. With these different perspectives, how do we get along with each other? We change our relationships in that space between us. You can learn more by listening to Shapiro here.

A few years ago, I was cleaning out the attic in the home where I grew up. I found the speech I gave at my high school graduation. The last line was “we are all in this together.” All these years later, I still believe that. Shapiro’s work gives us good guidance on how to get along with each other in this world, and some different perspective on just what the “self” is.

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When you hurt another, you may ask forgiveness from them. The Pope has asked forgiveness of those molested by priests and for the treatment of indigenous people in the New World. People convicted in court may ask forgiveness just before sentencing. Preachers and politicians ask forgiveness when caught in sin and then enter rehab to prove just how sincere they are. All of us do wrong at some time. Forgiveness is an issue that comes up often in life and in counseling. What does that word mean?

It does not mean saying that the wrong is now okay. “Sure you hurt me, but I forgive you, now it is okay.” That definition makes forgiveness extremely difficult if not impossible. It is giving a gift of dispensation to the one who harmed you. There is another view. Forgiveness can mean, “I don’t like what you did, and it is not okay but I will let it go. It doesn’t mean I want to have anything to do with you again, but I am not going to let anger and resentment devour me.” A quote attributed to the Buddha is that holding onto anger is like grasping a hot coal. The one who gets burned is you.

Many years ago I was having a conversation with a person who was working on recovery in AA and was doing step work. The eighth step is making a list of people you have harmed and you become willing to make amends to them. The ninth step is to make direct amends to those you have harmed except when to do so would injure them or others. It became quickly obvious that the person’s goal was to seek forgiveness even though in that case it would cause pain to the person wounded and to others. There was no talk about making amends. One universal principle throughout cultures and spiritual traditions (including secular ones) is to give without thought of return. When the Bodhidharma met with the Emperor Wu, one of the questions Wu asked was how much merit he had earned for all the monasteries he had built and all the other good deeds he had done in the name of the Buddha. “None,” said Bodhidharma. According to the story, the conversation was a short one. There are times when asking forgiveness is a manipulative act. We are asking forgiveness of the one we have already harmed with the sole purpose of making ourselves feel better. What is the merit of that? None. You are just doing more harm.

This is a place where the steps give good guidance. Look into your heart. It may be better to seek how you can make amends to those you hurt rather than ask forgiveness. Forgiveness belongs to the one harmed, and it is for them and within them that forgiveness occurs. If you are going to ask anything, ask how you can make amends and even then, only ask when doing so causes no further harm. Making amends with no expectations (including the expectation of forgiveness) may be a better way and work better at allowing yourself forgiveness with time.

For further thoughts on working on reconciliation and the process of forgiveness I strongly recommend “Negotiating the Nonnegotiable: How to Resolve Your Most Emotionally Charged Conflicts,” by Daniel Shapiro. Shapiro is the founder and director of the Harvard International Negotiation Program. As a psychologist and negotiation specialist, he has worked with families as well as corporate and governmental groups including conflicting parties in the Middle East. He provides a very thoughtful and guided method for the process of forgiveness and reconciliation.

There is a Zen story of a master who stands with his eyes closed and yet catches a falling object while those wide eyed around him have not yet perceived the object’s fall. He is in the moment and completely attentive.

Ruth M. Buczynski, PhD, president of the National Institute for the Clinical
Application of Behavioral Medicine
, recently talked about how to rewire your brain to improve willpower. A March 23, 2015 article in Medscape discussed a study in Sydney, Australia that looked at nine modifiable triggers for low back pain. The leading trigger is distraction while performing a task or activity.

What do willpower and distraction have in common? Both are associated with losing focus. How can we practice focus and get better at it? Buczynski suggests a simple breathing exercise for five minutes a day. Simple does not mean easy, however. Many people give up mindfulness or meditation because of a racing mind. Buczynski recommends just focusing on your breath, and when thoughts come into your mind (as they inevitably will) just acknowledge them and return to breathing. You can focus on the sound of the air as it flows in and out or the temperature of the air or whatever works for you. The important thing is, return to focusing on the breath. It gives you practice for staying on task, and returning to the task when you wander.

Any time I work with someone who has issues with anxiety and stress, we start with the breath. Slowing your breathing and breathing abdominally does many good things for you – lowers blood pressure and heart rate, lowers stress hormones and in doing so lowers blood sugar and redirects blood flow to the organs. You are balancing your sympathetic and parasympathetic nervous systems.

So if you want to feel better and more balanced mentally, emotionally, and physically, start just focusing on breathing to your abdomen slowly and mindfully. You will improve your willpower and your focus. Paying attention to where you are now can also save your back.

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.

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.

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