Category Archives: mindfulness

Beliefs as Obstacles

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How are we held back by our beliefs in ways we don’t know?

Lately I see the need and benefit of revising my narratives in multiple life domains.  I have told the same stories about certain people and situations for many years, unwavering tales of personality, action, inaction, motivation, and interaction that have largely defined many of my relationships. 
I will be necessarily cryptic here for privacy, and I think my point will still come across.

In the beginning of anything—life, dating, parenting, work—we have formative encounters and experiences that shape our views and behaviors in that realm.  The longer we live, the more our beliefs in each domain intermingle and influence those in others.  We make meaning from our perceptions in real time, integrating current context and past experiences, consciously and sub/unconsciously.  Our worldviews about risk/reward, cost/benefit, justice/mercy, love, responsibility, accountability, and myriad other ideas form early, implicitly at least as much as explicitly.  What’s more, we rationalize everything, justifying opinions and positions with apparently sound and reasoned logic, often not recognizing the irrational, emotional, relational, and sometimes delusional origins of our beliefs.  The most confident, articulate, and clever of us convey our rationalizations so convincingly we persuade not just ourselves, but many of those around us how right we are. 

“I’m not good enough.”
“He’s a narcissist.”
“She always plays the victim.”
“Everything I love gets taken away eventually.”
“All men hurt women.”
“No one can have it all; we must choose between family and work.”
“Anyone who votes for xxx is crazy and a danger to society.”

How true are the beliefs expressed in these statements?
For each one that you may not believe, how many do, wholeheartedly and unquestioningly, even if unconsciously?  How does this impact our interactions with the people and contexts around us?

What statements and stories do you profess consistently?  How true are they, if you are honest?  How have they served you?  How do they not?  What would happen if you revised or refuted any of them? 

This all came up for me this weekend after a two-day workshop on character development and backstory by Emily Golden and Rachel May of Tenacious Writing and Goldenmay editing and coaching.  Focusing on backstory, the workshop demonstrated the relationship between a character’s ‘internal goal’ (the thing they most want in life) and their ‘internal obstacle belief’ (the thing they think will get them to their goal but is actually the barrier they must overcome).  It reminded me of how Nancy Duarte describes the most effective presentations as mirrors of the Hero’s Journey: We are called to adventure and initially refuse.  We are comfortable where we are, why move?  Events then ensue that force us to stand up and engage.  Yet we are still reluctant.  We are shown what could be.  We believe for a moment, then revert to what is—that which we know and have lived—no matter how dysfunctional or destructive.  It takes repeated encounters with what could be, support and challenge from those we trust (or not), to make us see that we must change our mindset, outlook and behavior.  It takes time, effort, disruption of the status quo, and often no small amount of pain.

The value of fiction is that it mirrors humanity in ways that allow us to see myriad human foibles with empathy and compassion.  It’s the protagonists who must overcome their own internal obstacles—we root for them and rejoice in their triumphs at the happy endings.  We want them to succeed, to discard delusion and open their eyes to truth and reconciliation. 

How often do we allow ourselves to acknowledge and have grace for our own flaws?  How can we get more comfortable with self-honesty and -exploration?  How can we better embrace and exercise the vulnerability and courage to recognize how our stories about ourselves and others no longer serve us, and embark on, commit to, the journey of work to revise them for the better? 

The ultimate reward, the worthy triumph of this work is connection, as always.  The better our stories, the more understanding, mutual respect, harmony, and collaboration we can achieve, the better all our lives could be.

Life Is Not a Randomized Controlled Trial

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It’s more like that movie Everything Everywhere All At Once.

When I review biometric and lab results with patients at the end of a Day of Care (our practice’s name for the full day executive physical), results often correlate with what people tell me about their habits and circumstances in the past year, or even the past several days. Sometimes, though, one or more results do not align, and we have to stop and consider why. Occasionally this leads to additional testing and we actually find something that needs to be treated. But most of the time it’s not clinically significant and it’s okay to monitor for relevant signs and symptoms and repeat the test annually as per routine. It’s life.

But we humans fixate. Whether it’s weight, glucose, cholesterol, or some metric on a wearable device, it’s easy to get caught up in ‘the data’ and seek the one central variable (or latest technological solution) that we can address solely and thus yield the result we want. Expert scientists devise studies that control for all variables but one, intervene, collect the data, and make correlations into conclusions. There is definitive value in these experiments, and we should absolutely continue rigorous, evidence-based study and practice of medicine and public health.

And, we healthcare professionals must also step back often and look at whole systems–individual humans (body, mind, and spirit), humans in family and community, and local and global economies–not just snapshot data in vacuums. Weight, glucose, cholesterol, body fat, and cognitive function, among other things, often move in tandem. The good news is that the lifestyle advice we give to optimize all of these is all the same. The general principles are definitely not rocket science, and I think we can safely stop spending time, energy, and precious resources proving ad infinitum that good sleep, physical activity, whole foods, and healthy mindset and relationships are good for us.

That said, if it’s that simple, why are we not all already doing it? Because simple in theory too often becomes complex in practice, and we tolerate complexity less and less in our modern, instant gratification-seeking world. I borrowed a sign from a colleague early in my career: “Move more. Eat less.” Simple–deceptively and delusionally so. Now I see these words and want to reply with a scoff and an expletive–as if it’s just that easy. And yet we get so many messages that everything should be easy; that if it’s not easy then we’re doing it wrong. This supplement, that diet, this other meditation app, and any number of new cutting edge products–online, shipped to your door tomorrow!

If our goal is to elevate health and wellness and prevent disease, it’s not only our individual actions that matter. How do our behaviors intersect with, and how are they driven by, in entropic and synergistic combination with our environment and things we cannot control? In integrative medicine when inflammation is assessed to be high, a trial of elimination is often recommended. My colleagues point first to caffeine, alcohol, added sugar, dairy, and gluten: Eliminate them all for a month or so, and see how you feel. Many people report feeling significantly more energy, relief from digestive symptoms, clearer cognition, and myriad other benefits. One might interpret this as the result of removing ‘toxic’ substances from the body, which may be at least partially true. But I posit that it’s likely also due to elevated attention, intention, and mindfulness around eating, which likely cascades to subtle alterations in other health domains such as sleep and exercise. Nothing in a system happens in a vacuum–everything affects everything, directly or indirectly.

Look no further than COVID lockdown in 2020. The vast majority of corporate executive patients in my practice experienced marked improvements in almost all health metrics by the end of that year. They had eliminated work travel, business dinners, long commutes, and at least some office politics. Earnings projections and all manner of professional expectations were scaled back and down. For this privileged population, life acquired a drastically new balance of better sleep, more consistent movement, more quality time with loved ones, and net fewer calories consumed per week. After an elimination diet, patients are instructed to reintroduce foods one at a time in small quantities, to determine reactions and and thresholds. This makes sense, and can also be misleading because whatever makes us feel badly is often not just one thing. Corporations have varied in their reintroduction of prepandemic practices essentially reverting to prepandemic state. Many of my patients’ 2020 health gains have regressed commensurately.

So in practice, what can any given individual tweak in their daily routine or immediate environment to make healthier behaviors easier and more consistent? How can we change the default systems settings so we don’t have to exert such heroic intentional energy fighting our status quo habitat to be well? I still think we need to take a harder and more honest look at our global institutions, traditons, and default practices, especially those driving corporate culture. This is exceedingly difficult and complex, ‘way beyond the scope of an internal medicine doc’s weekly blog.

But I have a plan starting this week: Look for the bright spots. This idea comes from Chip and Dan Heath’s 2010 book Switch: How to Change Things When Change Is Hard. In this post-COVID era of deep psychological and social ambivalence, who’s doing well? Which organizations or teams have figured out an apparently optimal dynamic balance of in person and remote work, productivity and accountability metrics, morale, cost management, and overall integrated systems coordination? Who’s doing allostasis–maintaining stability through change–well? It’s almost never just one thing–it’s everything everywhere all at once but likely in small, cumulative, integrated ways, sometimes at the periphery and sometimes central.

Looking at whole systems can feel so daunting, especially when we get really humble and honest and see just how intricately webbed everything is–how even a small change in one domain can domino and propagate across a whole network. It can freeze us in incertainty and fear. Or it can free us to experiment–in an ‘uncontrolled’ rather than ‘controlled’ way–because too often we have no control and must act anyway. We can experiment mindfully, transparently, humbly, accountably, and flexibly. Small tweaks can establish new standards, which lead organically to subsequent adjustments downstream. A realiable cycle of assessment, action, learning, and application can help prevent getting stuck in rigidity and attachment to status quo well beyond its functional efficacy.

Life is change, an uncontrolled trial of human nature in variable and dynamic context. Everything Everywhere All at Once, all the time. We can breathe through the overwhelm, and look from both ground level and ten thousand feet. Any one thing matters both a lot and not very much in any system of systems–one of my favorite paradoxes!

So let’s get out there and BE and DO what we can! Take responsibility and own our attitudes and actions, respect others, and live in alignment with our values and integrity. What else can we ask of ourselves than that?

Wasteful Assumptions and What to Do About Them

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“What is something you see others doing and you think, ‘I understand completely why they are doing that, but if they knew what I now know, they would do it differently’?”
–From 30 Creative Writing Prompts for Memoir or Non-Fiction

Assumptions.
We all make them. It’s human.
Too often we are wrong.

Because we cannot possibly know what’s in other people’s minds all the time.
We all assume more than we realize or admit that others think, feel, and perceive the way we do.
And when they don’t, there can be serious and painful disconnect.

I see relationships go sideways all the time because we assume without verification.

THUS:

Ask and clarify.
Do it from your own perspective, without judgment.
Be curious and open, and try to stay connected.

METHOD:

  1. BREATHE.
  2. Master the “I” statement. Describe how you feel, what you think, when something happens–about the thing that happened or what was said, not about the person who did or said it.
  3. Stick to the FACTS. “You said xxx,” not “You insulted me.” “Your voice got louder,” ahead of “You yelled at me.” We call it semantics, dismiss it as unimportant, to our detriment.
  4. BREATHE.
  5. No name calling, mocking, or other attacking language.
  6. Give time and space for response. Get comfortable with uncomfortable silence.
  7. BREATHE.
  8. Be prepared for defensiveness and attack in return.
  9. Self-regulate. Keep calm and cool.
  10. BREATHE.
  11. Ask Open and Honest Questions in follow-up, if you get that far.
    What is an OHQ? “The best definition is that the asker could not possibly anticipate the answer to it.” Curiosity is both friend and teacher here.
  12. Beware all of our self-delusions.
    I may ask you why you do something. You may answer honestly (and vice versa)–and in the end very likely we are each/both expressing rationalizations for our own irrational reactions to our world based on all the baggage we bring to the situation.
  13. BREATHE.

Still, when we show up to one another in this way:
Present
Open
Grounded
Kind
Loving
Smart
We are far more likely to work out our differences and disagreements, understand one another better, and come to resolutions faster and with a lot less pain.

RISKS:

–This is an incredibly vulnerable method of communication. Disclosing feelings can feel unsafe–guage your counterpart and adjust accordingly.
–No matter how soft and loving we approach, we may still be met with lashing out and rejection.
–We may be seen, even attacked, as weak and whining, among other things.
–We may not be heard and we may not get what we want. Then again, consider the likelihood of these things if we approach with aggression…Maybe it’s different, but at what cost?

COSTS:

–Energy: Attention and self-regulation. In the impending train wreck of an emotionally charged moment, applying brakes to the quick, cutting comeback and slowing down to really listen to hear the other person takes tremendous effort, sometimes heroic self-control. I find myself pacing my breath just writing this. It is a simultaneous exercise in acute self-de-escalation and critical external attunement.
–Outcomes deferral: This depends on how we define our goals. Transaction without regard to relationship likely does not succeed with this method. But if transactional gain can wait, and relationship connection fosters smoother negotiations in the future, then we may see this communication method as investment rather than cost.
–Lack of appreciation: We may see this communication practice as taking the high road, an attempt to elevate conversation out of drama and ad hominem. And it may come across as anything from aloofness to arrogance, among other things. We must be ready to delay gratification in multiple ways.

BENEFITS:

–Greater relational integrity, connection, and resilience. To come through conflict with fewer wounds and less resentment makes us more likely to enter hard conversations more willingly in the future, thereby avoiding ‘assumption fester’.
–Stronger self-awareness, self-regulation, and attunement and communication skills with repeated practice
–Greater relational depth, meaning, and trust
–Leadership by example: observers learn by watching, see that a different way is not only possible but better.
–A Better World. Open, honest, and timely communication, without judgment and grounded in love and connection above all, sets the stage and plants the seeds for positive relationship ripples that radiate in all directions and dimensions.

My friends, it’s all so much easier said than done.
And nobody does it perfectly.
Perfection is not the goal, or even relevant.

Conversations to clarify assumptions and resolve conflict are not a competition to see who is better or right. They are opportunities to learn, grow, and connect. Done well, relationships evolve to where such hard conversations are needed less and less, because wasteful assumptions are nipped in the bud by the efficient clippers of frequent, open, and honest questions.

Imagine that.

Then do it, yes?