Spirituality and Healing In Medicine: The Enhanced Importance of the Integration of Mind/Body Practices and Prayer
On December 11th, 2004, approximately five hundred people gathered at the Westin Hotel in Boston Massachusetts to learn about and celebrate spirituality in the context of the medical world. The seminar, “Spirituality and Healing In Medicine: The Enhanced Importance of the Integration of Mind/Body Practices and Prayer,” attracted physicians, nurses, clergy, social workers and others who work both within and outside of the medical world. Attendees were from 38 states, 5 provinces of Canada and places as distant as Iceland, Korea, Mexico and Guam.
The conference was sponsored by Harvard Medical School, The Mind Body Institute, and the George Washington Institute for Spirituality and Health. The conference has been held annually for the past 14 years and has focused on some aspect of spirituality and healing. This year’s conference came on the heels of an important and comprehensive study by the NHIS which underlined the importance of prayer in healing for many people across the U.S., hence the inclusion of prayer as the main theme.
The purposes of the conference were to explore and emphasize the need for recognition of spiritual beliefs and practices amongst those receiving medical care and to provide ways to integrate mind/body practices into everyday care. The speakers focused on scientific evidence and the value of prayer, meditation and a variety of mind-body approaches in healing. The first speaker was Herbert Benson, the director of the Mind Body Institute who is famous for his work and his book, The Relaxation Response, who presented this technique as a well researched and clinically valid way to approach the mind body connection in healing. Much of the information below is presented on the Mind Body Institute website.
Dr. Herbert Benson – The Relaxation Response
There are three legs necessary to insure stability in the healing process: pharmaceuticals, surgery, and self-care. Of the three legs, the one that has been much overlooked but is now gaining recognition is self care. Several recent studies have shown that most people practice some form of spiritual or alternative medical practice for their healing. Dr. Benson has been studying the connections between mind, body and spirituality in health since the 1960’s. In the first portion of his talk, he detailed his early research and his (and others) discovery of the “Relaxation Response.” We will not go in to detail about the studies or the physiology, but generally, according to Dr. Benson, this Relaxation Response (RR) has two steps in its practice:
- 1. The repetition of a word, sound, prayer, thought, phrase or muscular activity, and
- 2. The passive return to the repetition when other thoughts intrude.
The effects of the process include:
lowering of oxygen consumption, breathing, metabolism and heart rates, changes in breathing & brain wave patterns, lowering of blood pressure and CO2 production.
As is widely known, the body has a fight or flight mechanism which involves the autonomic nervoussystem and which is evoked by any change that requires a behavioral adjustment, or stress. Western society today is characterized by an epidemic of stress related illnesses. But there is one important fact that is now accepted byt the medical community and has been proven by numerous studies. The stress response, or fight or flight mechanism is caused by a cascade of internal secretions, generally hormones (catecholamines) which can be overridden by the cerebral cortex! The cerebral cortex can override the fight or flight and generally this is what the relaxation response does…it takes the body out of a stress response mode and puts it in a different mode which is, in the end, healthier. In fact, stress has been implicated in causing or aggravating heart disease, diabetes, cerebral vascular disease, chronic pain, hypertension, sleep disorders and many other conditions that are endemic to western society. Dr. Benson cited correspondences of the relaxation response with ancient teachings and practices. References to the benefits of the meditative state are found in such sources as the Hindu Upanishads, the Christian prayers of the Desert fathers, the practices of the Jewish mystic Kabbalists, Islamic Sufis and others. In addition, the universality of the RR has been scientifically verified in laboratory experiments. In one of these a group of healthy students did either a short practice of an instruction from Zen Buddhism or a concentration exercise, (number counting ), and had similar physiological changes. The findings replicated those of a group of healthy individuals who practiced transcendental meditation. When the experiment was repeated with different groups – people who prayed regularly, with Rosary, Lord’s prayer, 23 rd psalm, or Om Mani Padme Hum, the same changes (as mentioned above) occurred.
For an informal practice of the RR, instructions might go something as follows:
“Choose a word, a sound, a prayer, or a phrase in your own belief system to repeat. Even a simple word will do: “one,” “peace,” “calm,” “ om,” “shalom,” any word will do, it’s your choice. Or you can do a simple movement or exercise, such as tai chi. Always start with quick relaxation of all muscles: feet, calves, knees, chest, back, shrug shoulders, roll neck, relax face. Close your eyes. On the out breath say your repetition…when you notice a different thought has come to mind, don’t get angry or stressed about it but let it go and gently come back to your repetition. Repeat for 3 to 5 minutes.”
Now let the person practice and follow up by gently telling them that the time is up and ask for any follow up, ie:
“Do you feel more wide awake now?” or “Is there within you a sense of well being?”
Emphasize the fact that the person who is practicing need not feel deep relaxation every time he/she does the practice. Also note that the RR should not be practiced within 2 hours after eating a meal. Ideally it is practiced twice daily for 20 minutes.
Decreased oxygen consumption, rate of breathing and heart rate have led to the associated beneficial physiological changes. A relative quietude in the brain opens the door to realization of other aspects of selfcare and hence can carry forward to other possibilities of what the person can do for him or herself.
Dr. Christina Pulchalski -Restoring the Heart and Humanity of Medicine: Integrating Spirituality into Healthcare
Dr. Christina Pulchalski, a leader in the field of spiritual care in medicine, provided several lectures that focused on how and why all medical personnel should and can attend to the spiritual needs of patients. In her first address, “Restoring the Heart and Humanity of Medicine: Integrating Spirituality into Healthcare”, Dr. Pulchalski focused on those aspects that can support anyone’s spiritual life, those of “service and compassion”. Dr. Pulchalski spoke about how education and the delivery of holistic approaches to medical care is possible indicating that The Association of American Medical Colleges and The George Washington Institute for Spirituality and Health have been working together to develop models addressing the spiritual needs of patients, models that can be integrated into existing care situations. “Spirituality”, she defines as, “how someone finds meaning and purpose in their lives and it can be expressed in many ways- faith, religion, relationship with a transcendent outside of a formal religion, nature, art, music, and relationships.” The effects of coping via ones spiritual life thus can affect a sense of hope, love and the ability to forgive.
Dr. Pulchaski suggests that if healthcare providers can honor their patients’ spiritual lives, as well as their own, in the context of coping and healing with illness. The medical system of care can itself be restored to an entity of care and compassion for those that it serves. Dr. Puchalski outlined how compassionate care focuses on all dimensions of suffering: physical, psycho social, emotional, existential, spiritual. The caregiver’s role will change depending on the area of the greatest need for the patient. Listening is important. The root of suffering is a sense that “ what ought to be whole is being split apart.” Healing is integration of self, people moving from a sense of being broken to a sense of wholeness.
Spiritual Issues are: meaninglessness, hopelessness, despair, lack of forgiveness, anger, abandonment, feeling unloved and unconnected. Our encounters are an opportunity for us to connect with our patients – to feel loved and heal the unconnectedness.
Dr.Puchalski went on to outline the findings of the Ethics Consensus Conference 2003:
Obligation to respond to suffering and provide compassionate care.
Spiritual needs are important to patients.
Respond to suffering and provide spiritual care.
Spiritual care is interdisciplinary.
Not intended to replace Chaplains.
Care should be non-coercive/ patient centered.
Professional boundaries are important
The importance of being present and compassionate.
The definition of spirituality is very broad and not limited to religion.Spirituality contributes to health. Patients are looking to their spiritual beliefs to help them cope with illness and in this way they are empowered to care for themselves. The concept of spirituality is found in all cultures and societies. It is expressed in an individuals search for ultimate meaning through participation in religion and / or belief in God, family, naturalism, rationalism, humanism and the arts. Spirituality helps those who are ill in the following ways:
Gives hope – for a cure, for healing, goals or a peaceful death
Gives a sense of control
Allows the forgiveness of self and acceptance of the situation
Gives strength and purpose
The root of our work is spiritual. Illness and stress are triggers for spiritual quest – what gives meaning and life. 40% of patients say their life is better after their illness. This makes one look at life a lot differently. Many come to more fully appreciate their lives because of their illness. “ By looking at these questions I could look at my life deeply.” Conversely, attachment to a hurt arising from a past event can block the flow of hope into ones life.
When including spirituality and healthcare important questions are: How do we find meaning in changes through our life? How do we interact with our patients and with ourselves?
Topics of Research in Spirituality and Health include:
Coping
Health outcomes
Quality of Life
Mind-Body
Surveys on patient need, healthcare
Professional talking with patient/integrating spirituality into care.
What do patients think? It does it make a difference in care.
In the workshop portion of the day, Dr. Pulchalski spoke more specifically about models of taking spiritual histories (FICA) and assessing spiritual needs through case studies and exploration of a variety of interventions.
The FICA model of taking a spiritual history, according to Dr. Pulchaski, involves; “F”- “Faith and Belief”, I – “Importance”, C – “Community” and A – “Address/Action in Care.”
The Doctor asked us all as participants to pair up and work with the accompanying questions to this model such as “Do you have spiritual beliefs that help you cope with stress?” and “What role do your beliefs play in regaining your health?” Personally the questions came easily and it was nice to be asked about my personal beliefs, things that matter to me most. This FICA model runs fairly smoothly, it seems, in application although the obvious potential problem is that it will require more time, something many people asked about. One gentlemen in the crowd who works as a chaplain in a hospital asked about the private nature of asking such questions, inquiring if we are acting intrusively by pursuing this line of questioning with spiritual care. Dr. Pulchalski responded by saying that “we take histories related to people’s practices of physical exercise” indicating that we are finding out how individuals care for themselves, physically, spiritually and emotionally, one aspect being no less intrusive than another.
Dr. Pulchaski did clarify that these are spiritual histories and assessments that healthcare providers are seeking, and that clergy, chaplains and spiritual leaders should be called upon as experts when spiritual distress is identified. She emphasized that “proselytizing is not acceptable in professional settings” and that praying with patients should be considered with the utmost respect for the patients needs and requests based on a trusting relationship between the healthcare provider and the patient.
Overall Dr. Pulchalski encouraged and modeled (in her own behavior) with the audience how compassionate presence and an openness to dialogue about interfaith challenges can create medical systems that offer a place for healing, alongside of technology. She honored all questions and worked with the audience participants in ways of service. The experience of this encounter seemed to have participants feeling valued, supported and ready to offer the same to their patients.
Dr. Richard L. Nahin, PhD – Who Uses Mind/Body Therapies, Including Prayer for Health Reasons, and Why?
As part of the first days events, Dr. Richard L. Nahin, PhD, MPH led a discussion entitled, “Who Uses Mind/Body Therapies, Including Prayer for Health Reasons, and Why? Data From the 2002 National Health Interview Survey”. Dr. Nahin was equipped with many statistics that NIH is accumulating in relationship to the power and influence of mind/body practices on ones health status. Dr Nahin represents the National Center for Complementary and Alternative Medicine (NCCAM), a component of NIH, created in 1999. The NHIS report reviewed in this lecture was about how the public is using certain mind/body practices, “concentrating on the who, what, when, where and how.” Dr. Nahin reviewed comparisons in statistics related to the use of “prayer for health reasons” versus the use of “complementary and alternative medicines (CAM)”. Specifically, income, age, gender, race/ethnicity, culture/geographic location and education were measured with some outcome generalizations that seemed interesting and relevant. For instance, prayer for health reasons was used more often that CAM in the southern part of the US. The west utilized CAM more often, “1.5 times more often”, than any other region and all regions used prayer for health much less than the south as a whole. As far as income, the more people made, the more they used CAM and the less they use prayer for health, which is a similar trend with education re; the higher the education level, the more use of CAM. Blacks and Native Americans were found to use more prayer for health than whites. Prayer for health went up with rising age, and women use more interventions both with prayer for health and CAM, than men. Overall this talk by Dr. Nahin provided the necessary data and justification for healthcare providers to incorporate such services into the healthcare system. For information see: http://nccam.nih.gov and for the NHIS survey see: http://www.cdc.gov/nchs/nhis
Dr. Benson The Power of Belief and the Role of the Relaxation Response in Healthcare
Dr. Benson expanded on his morning lecture, “The Power of Belief and the Role of the Relaxation Response in Healthcare”, during an afternoon workshop. Again he reviewed the physiological benefits of using the Relaxation Response and how one’s health could quickly benefit. However more emphasis was place during this discussion on the power of belief. Dr. Benson relayed personal stories of both family and patients that exhibited seemingly miraculous responses in healing when a persons spiritual beliefs and practices were incorporated during times of illness related stress. He spoke of a study done in South Central LA where the students were taught the relaxation response and encouraged to practice this daily. The outcomes, according to Dr. Benson, showed the students gained improved concentration and ability to focus and learn. Dr. Benson reviewed a bit of history in the development of the medical system related people’s beliefs as a culture. He reported that about 150 years ago “all medicine really had was beliefs”, until the 1850’s when Pasteur discovered “that certain diseases were caused by certain bacteria” and then in the 1920’s when insulin was discovered. This, the Dr. reported, affected the general populations beliefs in medicine, recognizing that some illnesses could be cured by medication alone. This altered beliefs in healing from within until the “Placebo Effect” came back in the 1950’s. Dr. Benson outlined “Three Components of Remembered Wellness” that have to do with the “Placebo Effect; 1- Belief and experience on the part of the patient, 2- Belief and expectancy on the part of the care giver and 3- Belief and expectancies generated by a relationship between the patient and the care giver”. These beliefs are important to explore given their value on the patients ability to heal, thus “placebo=belief”. Dr. Benson advocates that the scientific focus of the effects of these beliefs on one’s health can help sustain the use and value of such practices in treating disease. “If you believe in the therapy, the therapy will be enhanced”, says Dr. Benson. So I asked Dr. Benson about the apparent problem we have culturally in addressing the needs of the dying, specifically in initiating someone onto hospice care. As a hospice worker I often see the effects of a person coming onto the hospice service one to two days prior to their death- often in physical pain with a family and patient feeling shocked and unprepared to experience the dying process of a loved one. I asked about beliefs about dying, wondering if earlier referrals are possible so as to have the time to assist the patient and family in addressing all issues of pain, physical, psychological, spiritual and emotional. Dr. Benson concurred that my current approach of validating with a patient how hospice care can engender their well-being in the midst of their dying, is in fact the main approach. He advocated further the need to continue to educate as possible that dying does not necessarily equate to the belief that there is “nothing more that we can do” when curative efforts are no longer in sight.
Skills to Build a Meditation Practice: Deeper is Better – Margaret Baim
In this interesting afternoon workshop, Ms. Baim talked about her work at the Mind Body Institute. She described three reactions to stress: intellectualizing, feeling overwhelmed and feeling numb. She talked about using the relaxation response in conjunction with positive psychology to promote better mental and physical health. She described how people that she sees at the Mind Body Institute are encouraged to find their own way and to build a meditation approach. She showed how simple concentration exercises lead to contemplation. As one is building a meditation practice they should not look for immediate results, but measure their progress decade by decade. In using positive emotion combined with the relaxation response and meditation, one can focus (meditate) on an inspirational figure, something beautiful, someone or something they are deeply devoted to or deeply appreciate. This inner work can effectively turn around illness and negative emotion.
Greg Fricchione -The Potential for Illness Prevention via Spirit-Mind-Body Approaches
The second day of the conference brought continued enthusiasm and information from leading scholars in this field of Spirituality and Health. Greg Fricchione, a psychiatrist at Mass General Hospital, spoke about the potential for illness prevention in spirit- mind body approaches.
This talk was packed with information – an outline of it is presented below:
Objectives:
To review present state of knowledge regarding pathogenic effects of stress and allostatic loading.
To review present state of knowledge regarding stress buffering and health strengthening effects of relaxation response, cognitive behavioral therapy, social support, belief and conscious expectation.
To define resiliency.
To review some potentially instructive prevention studies.
To summarize with an evolutionary perspective.
Implications for modern medicine.
Talk:
We hope to prevent several illnesses with mind body approach. Stress is a challenge, hyper arousal, with implications for the organism. There is cascade of effects- thalamus sends info to amygdala, which mediates fear responses, when aroused, send messages to hypothalamus and outpouring of catecholamine, adrenaline, noradrenaline. There is another hypothalamic, pituitary, adrenal and thyroid mutually interactive cycle.Hans Selye investigated this thoroughly– when stress becomes overwhelming it’s dis-tress.
At the end of the stress response, when the organism can handle no more stress, is conservation withdrawal, curling up in a ball and giving up. Allostasis is maintaining stability or homeostasis thru change, investigated by Bruce Mckewen. Allostasis is the ability to change, adapt. This is orchestrated by higher mechanisms, they predict and overrule with the cerebral cortex as a maestro over the body system, controlling blood pressure etc. There is a price to pay for having continual stress or allostatic loading and measures of AL are cortisol, norepinephrine, epinephrine etc.
Anxiety and depression can be seen as allostatic load disorders. Anxiety is related to the separation that we feel and connected to Coronary Artery Disease.Depression, affecting 6-17% of adults, is a big disabler
Depression and CAD, ischemic heart disease, related, 1.5 times the risk
HTN, atherosclerosis, cardiomyopathy, metabolic syndrome.
There is research coming out: rat pups that have nurturing mother will actually have different genetics than those who are not nurtured. Then following through to adult hood the adult children of the nurturing mothers are much better able to deal with stress.
Relaxation Response – self induced stimulus, break train of everyday thought, repetitive mental or physical activity causes decreased O2 consumption, HR, arterial BP, resp rate with decreased metabolism.
Cognitive behavioral therapy: substitute positive thoughts for habitual anxiety and depression provoking ones. Best in 6-12 weekly sessions, recording of automatic thoughts and resultant feelings in a homework diary along with testing of behaviors and cognition that relieve anxiety and also role playing situations
Social support – helps reinforce positive behaviors, can change neuro biology and physical status. Stress involves appraisal of demands and adaptive capacities which are affected by perceived availability of social support.
Social stressors can be life changes. Stress lowers the threshold for a disease that you may be vulnerable to. This should be on the mind of every physician who is evaluating someone.
Social support: ION report 2001, reports on doctors style, need for charity and caring, if you add an empathic warm emotional ingredient to the cognitive element then you get a better outcome.
Studies were cited that illustrate importance of social support in women with Lupus and also with people with irritable bowel, ischemic heart disease and depression.
Woloshin etc studies per social support and recovery from heart disease
Belief and conscious expectation
History of the placebo in medicine
Placebo effects stem from patient belief in the doctor’s ability to heal them. Positive conscious expectation of a return to wellness is important as it stimulates the brain to produce sense of pleasing security with a decrease of allostatic loading.
Top down control of stress response systems – belief and positive expectation diminish dis-ease.
Recommendation of a book entitled Health Wars
Placebo response : belief can be in everything or anything, learned optimism and placebo – top down neuroanatomy, placebo is an active approach to healing. Parkinsons patients and pet scans – just by giving a placebo to PD pts there was improvement of PD (elegant study with receptors) in Science magazine.
Another experiment looked at mothers with healthy children vs chronically ill child, the mothers with chron ill children who had high perceived stress showed shortening of telemeres, aging markers, that was 10x that of mothers without perceived stress.Telemeres – oxidative stress related, related to resiliency of neural mechanisms…affected by reward and motivation, fear conditioning, social behaviors.Some people cannot differentiate stimuli and lump them together, need to be able to quickly extinguish a learned fear. Secure attachment is important.
Brain evolution – earliest organisms have sensory apparatus and effector apparatus/ motor apparatus – approach and avoid – the history of the brain shows that the human mechanism works best when the human is in environment of secure based attachment and social support. Evolutionary movement is to social support.Deep down in limbic brain you know that separation is the deepest threat. Unicells move according to chemotaxis, the drive of human beings is toward spiritual connection or spiritotaxis. We have ability – have downstream spiritotaxis – upstream spiritotaxis is more important – when buffeted by illness has effect of solace, you can have successful end of life if you are gifted with the ability to do spiritotaxis up stream.
Implications for the system – managed care takes no heed of what organism is all about. That is a problem, it is in scientific interest not to ignore what goes on in the brain. The topic of mind body medicine brings you back to what the human being is all about – the person is not a gearbox. Keep working to advance this study and never let the perfect be the enemy of the good.
The Power of Community in Health and Healing – Rev. Natalia (Tanya) Vonnegut Beck
The Rev. Tanya Beck spoke about “The Power of Community in Health and Healing” emphasizing the need for social support, awareness of one’s essence or spirit, and a model for building community. Dr. Beck defined community here as “a group of people unified by a common trait”. So in her community building model she spoke of the need to “focus on the issue, not the personality that is there”. The guidelines of this community building were outlined as 1- Purpose for being, 2- Rules to live by (No Gossip, No questions, Listening, Doing the Job Well without judgment of how others are doing their job) and 3- Responsibilities to Fulfill (recognizing that people come together for a reason and to affirm one another in that goal). Rev. Beck spoke further about the needs for communities and faith traditions to act with caring, and compassion, functioning with an open and inclusive set of rules of belonging. She also placed her attention on our needs as an audience, our needs for self-care hich was refreshing. Rev. Beck spoke of “serving ourselves” and being rooted in the present, recognizing our own essence and it’s wisdom and intuition. She noted the importance of looking at reality as clearly as possible for that is where actual healing can begin. Upon reflection of what is important in developing groups and communities, Rev. Beck outlined what she calls “The Covenant” which incorporates “honoring all that is said”, noting that one “always has a right to pass” in discussion and to avoid “interruptions, this takes power away from the person speaking”. In this community development model important aspects identified were; ability of the community to cope well with difficulties by acting creatively to solve problems and inspiring one another. The most important factor in this kind of environment is trust, the feeling of safety.
A more detailed outline of her talk appears below:
Changing times, what is our role in these changing times? Most important issue is that of social support.
Everything said here is relevant to your patients but also to you (conference attendees). Topic of this discussion is – where does the spirit become essential – she will present a simple model to build community.
We are living in a time of change, we are a people in ransition, we want people to know what our thoughts are. We have more information at our fingertips and responding is imperative. Yet we experience isolation in everyday lives, wanting more connection. We lose who we are, want to connect with other people and connect with greater essence. This gives power to go with the ebb and flow of life, cry for empowerment, sanction our insights. The community is a group of people unified by a common trait
Post 911 story of the Trinity Church in NYC, feeding, music, massage therapist, podiatrist, all volunteers working at the site to give relief to rescue workers – the volunteers changed everyday. Everyone was given a job – the place was ready to go. Chaos supreme, but it worked. There was a focus, a reason for being which is a main aspect of a good community. City inspectors said food couldn’t come from all hotels – but the police made a circle around St. Paul’s and just stood there until the inspectors left. The reason the project worked is because they had a commitment…
1. Purpose for being,
2. Rules to live by,
3. Responsibilities to fulfill – a mandate to answer the work that was being done. Come together for a reason and we know what we want to do about it. We know in the reality of this moment we know that changes are desperately needed.
4. Affirmed one another all the time. Police and fireman and EMT were always thanking them for what we were doing. She did mass – for the Catholics. This is a real church, “that essence of caring and compassion and really listening, and being absorbed with others.”
When there is this transformation – there is hope. A state of mind – not a state of the world. Hope is an orientation of the spirit. Vaclav Hagel – pres. of Czechoslovakia. Hope is not the same as joy when things are going well, but rather for something to succeed. This hope gives us the strength to try new things. Important in these times to have the spirit alive. What was alive in the chapel in Trinity – during and after 911. The horror of the world trade center added a sense of urgency and to the search for spirituality.
In this moment learn how to serve yourself so you will be available to serve others. There are so many others crying out to us to be served. We need to see that what physicians and others see as dis–ease is a struggle of the spirit. We cannot solve the pain of those coming to us but we can listen well and empower. This is a tremendous task for us which causes higher expectations on ourselves. When we face reality rooted in the present moment we can start talking about healing. When we face the reality of the moment. People become empowered when they affect all of themselves. With a community this can happen. Mountain-top highs, an outside expert comes in but then we come back to our roots, what now? How do we develop a sense of community? Knowing how to facilitate this – it needs to begin with us. We need to experience this in ourselves also in order to offer it to others.
Many spiritual and not so spiritual retreats turn into sounding boards of frustration.
1 – Sense of isolation
2 – Disappointment in the careers we chose. We wanted to touch, love and share. And we don’t have the time to do that. Only 5 – 6 minutes with each patient. I can’t be who I wanted to be.
3 – There is a lack of trust with the people and institutions we serve. No more loyalty . People move from one institution to another. Move people all the time. Not a sense of trust.
4 – Self worth is dissipated because we don’t seem to offer what people need.
We keep our masks on, our true self deeply submerged. Not to reveal our weakness to anyone. Risking sharing with anyone is thought to be potentially disastrous.
Story of massage work, laying on of hands in Florida 6 years ago. An operating room nurse came in – she couldn’t go to work one more day…it was too stressful. The group could help. On Tuesday night, helped and on Thursday night the OR nurse returned with 3 more nurses. About 2 weeks later they came in with a doctor. He is open to the fact that things are very turbulent in the surgery room and wishes he could help with that. Now those nurses and that doctor get together at 5 in the morning. They do some relaxation response, share what it is happening, frustrations etc, – and then go out and do their day. Takes only 5 minutes. Doesn’t take a lot of time, only intention.
If we don’t have a community – we need to create one for ourselves. Last night 149 people were at the creative dialogue. 14 tables with 6 to 12 at each table. Went thru steps of forming a community. We started out by doing a covenant – and sharing, began to list the issues that we heard about in the conference. All the things we had been hearing. Choose one of those things at your table to discuss. Pick a scribe to take the notes, give some reasons why it is, give some resolves, and then where you might fit into the resolution of the issue. At the end – these are the main words that you think are the questions we have to deal with.
Empowerment
Integration – into the setting. The spiritual life and the whole staff. Starting with the housekeepers so that everyone knows what everyone else is concerned about.
Reform – institutional reform. – Maybe our grandchildren will be able to do something about this.
Self Care.
A Broader View.
Just Love People – to be a loving presence.
Dialog.
Spirituality.
Gratitude.
All came out of 1.5 hours together. It was a community. There was a sense and energy in that room. Good ideas. Focus on what do we need to do.
Knowledge is in people. Information is in ideas and in paper.
When the individual spirit is connected to the group, people become connected to something deeper. The group process allows parties to speak.
To facilitate a community we have to ask:
Integrity – do I really want to empower all these people to find the road to health… to realize they have within themselves the power to find their own health?
Intention: Can I offer my undivided attention to that person for a particular period of time, intentionally listening to what they are saying? It is the basis of trust.
Risk: Am I able to risk a process that does not promise success?
Lao Tzu asked: Do you have the patience to wait until the mind is clear?
Are we able to take the risks and sit and trust the process.
A covenant must do this.
Start the group every time by repeating the covenant. The only way trust can be built over long period of time. Live in reality of the moment, don’t block whatever comes up.
Handout:
Levels of Living
1 – Survival Area – We are not God , we can’t be at the top all the time. It makes no difference what your credentials are – what your sense of worth is. Must make a list for someone in the Surviving Area. Someone provide the support system for the person. Recognize that fact and give up the expectations that they are in some other arena.
2-Coping – we work from outer structure. Life as a struggle.
3-Creating Level – constant challenge of yourself.
4-Collaborative Level – people share with one another. Ideas and people get together, form a team, be a community and see if we can make some change.
The Levels of Living can be a real tool when you are working with staff or teams to see where they are and talk about how to bring someone up the level, and support folks. Wonderful for marriage relationships and significant others. Communication.
In every group team, there needs to be a time to do an affirmation process. Ask your team members to write down 10 life successes – everything from graduating high school to living thru terminal illness of parent. As the person speaks to their life success — words that show the strength list all of those and then one by one and go up and look at the person, look them straight in the eye and tell them those 10 words. We’re not used to hearing good things about ourselves that came from us. It is from the person and reflecting back to themselves. Put it on the refridge door and remind themselves. Powerful tool.
Example from last week: 20 terminally or chronically ill people came together. Did affirmations. In the introduction part a woman said “I don’t know why I am here. I don’t talk to people, I came out of a childhood abusive situation and now faced with another situation tumor on ovary and need it removed immediately, I don’t think I can do this.” We began talking about the positives. We saw as she began to realize inside her was all the power she needed to make the decisions and deal with them. She said she quilted whenever she got into one of these situations. Never showed them to anyone. Sunday morning , she came back. Tucked under her arm was a quilt.
“I want people to know that I am alive. And this is how I am alive.”
She got a blessing on the quilt – that is the power that is available.
All of this is about community that we have to build trust. People are able to say what they think and to disagree with one another.
To raise the trust level – be consistent on the focus on the unifying issues, not the personalities, honor the covenant, allow for chaos to occur in the best sense of the word. Use silence – don’t be afraid if it gets very quiet. Be very faithful in the attendance to the meeting with your people.
GB Shaw – The true joy of life – being used up for a purpose recognized by yourself as a mighty one, and to be of service and use to others
