Relationships

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Photo by Lyra Luu, June 2023

“Let’s talk about your relationships. What’s already good, and what could be better?”

It has never occurred to me to ask a patient (or anybody, really) about their relationships this way. … How would that go, do we think? I feel like there’d be a pause… It might feel a little awkward? Maybe a bit invasive? Too personal and too broad at the same time? I think it could be potentially amazing.

As I ask myself now and am about to write, what happens feels akin to navel gazing from 10,000 feet. How do I show up in my relationships? How am I the exact same person everywhere, to everybody, all the time, and how do I also alter, mask, suppress, or overexaggerate? Why? How do I feel about any/all of it, and what does that tell me? How would others answer, people who know me primarily in one context and not others? What if they answered differently from how I expect? Oh, how fascinating!

What does the question set bring up for you, I’m so curious?

So, what’s already good about my relationships:
–I care a lot about the quality of my relationships and I cultivate them thoughtfully, with great attention, intention, and love, even when it’s hard.
–I hold my relationships strongly and loosely at the same time. Seneca said, “Ponder for a long time whether you shall admit a given person to your friendship; but when you have decided to admit him, welcome him with all your heart and soul.” I often don’t ponder long; I know quickly when I want to be friends with someone. And then I’m all in. Until I’m not, which happens sometimes. I can let go when it’s clear that holding on does not serve me or the other person. I’m also open to reconnecting later–life is unpredictable and relationships are fluid, so attuning to conditions and adjusting containers as it all flows and evolves is a practice in acceptance and flexibility, which I value. I think this serves me as well as those I’m in relationship with.
–I am a conscientious student of relationships; I let all of mine teach me and I learn from observing others. I think this makes me a better person overall.

What could be better:
–My relationship with my body. The cosmos moved me to watch “Good Luck to You, Leo Grande” before writing this post today. HIGHLY RECOMMEND, especially for middle aged women like me who feel past their prime, physically attractive years. Emma Thompson is my hero for portraying her character with such rawness, honesty, and grace. I feel better about myself after watching this movie, and I think that will continue to improve.
–Revising old narratives. When I’ve known someone a long time or had particularly intense interactions with them, I tend to hold tightly to the stories I tell about them. I label them, then confirmation bias runs away with me in subsequent encounters, sometimes for many years. This is high risk for dysfunctional prejudice, both negative and positive. Mantras work well for me in general… I wonder what words I can pull on to remind me to reassess, revise, and amend, for all our sakes?

So what’s already good about your relationships?

What’s good about how we all relate collectively?
—Tribes. Whoever and wherever your are, I hope you have at least a few groups in which you feel true belonging. Sports fandoms, book clubs, D&D campaigns, improv classes; work teams, professional societies, PTA, with your besties. We all function better when our connections with others are strong and tight. When these connections cause our tribes to uplift other tribes in turn, and not denigrate or oppress, even better.
—Potential—again. So interesting, how ideas resurface in each post so far this month. Psychology, anthropology, sociology, education, medicine, marriage, and just life in general–if you study and attend long and broadly enough, the core practices of good relationships in all domains start to distill and clarify. We may put forth different parts of ourselves and show up very differently in any given role or environment, and in the end we are all still human, with all the same social, emotional, and relational needs. It. Is. NOT. Rocket science! So no matter how bad it all gets and how poorly we do it today, we can always do it better tomorrow. Resources for learning abound.

What could be better?
–Navigating Polarity and Complexity. A primary pitfall of tribal membership and identity is us vs them thinking, orienting tribes in competition rather than collaboration, with one another. Differences are inevitable, and when manged well, they make us productive and constructive. Managed poorly, they incite war and destroy lives. We would do well to avoid oversimplified, overgeneralized, and judgmental expressions of out-groups voiced by the loudest and most extreme among our in-groups, and acquire both personal and collective communication skills that help bridge differences rather than escalate them.
–Leadership by Example. Government. Come on, folks. We, the citizenry, must expect, demand, and elect better. Those of us who know better, though, must also hold our local leaders to higher standards of relational behaviors and practices. Easier said than done, and in the long run, well worth the individual and collective effort.
–Masculine and Feminine Integration. This just occurs to me tonight as Daughter and I watched again the Cinema Therapy episode on toxic, or ‘limiting’ masculinity, contrasted by Aragorn of The Lord of the Rings movies. I’m not referring here to women’s liberation and militant feminism. I’m thinking of moving our culture to a place where assertiveness and courage in women, as well as tenderness and vulnerability in men, among other complex qualities in each, are equally valued, cultivated, and upheld. We can move from an us vs them, either/or, this not that, to an all and, ‘we each contain multitudes’ cultural gender mindset. When we are all allowed and encouraged to be our whole emotional and psychological selves, our relationships will be un(currently)fathomably more meaningful and fulfilling.

Ooo, fun. This concludes posts on the 5 reciprocal domains of health, asking what’s already good and what could be better, for myself personally and for all of us collectively. Turns out this appreciative inquiry, strengths based prompt structure really does both helpfully constrain and free my writing, at least so far. I’ve been talking about these five domains for many years, and never quite in this way. How eye opening. I hope you’re enjoying the posts so far, friends! I really look forward to the rest of the month!

Stress Management

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Anybody else feel daunted thinking about stress managment lately? [wide eyed emoji]

It’s November of the hardest year in my recent professional memory, and the escalating stress levels I witness every day show no signs of abating. My patients are sleeping poorly, gaining weight, and their blood pressure continues to rise. They miss quality time with loved ones and rethink their life paths more seriously now than ever. Strangers on the street seem increasingly confrontational. The world is once again embroiled in war and violence. Our stress management skills are called forth, no question.

I attended the second ever Harvard Medical School coaching conference in the spring of 2009, where I met Benjamin Zander and The Art of Possibility became my personal development bible. Roz Zander, co-author, former wife, and decades long collaborator to Ben Zander, died suddenly this year. I hope my writing and impact may honor her, as these 14 years of my inner and outer work, sparked by the Zanders at that meeting, made me a better person that I would otherwise have been, founded on the practices in their book.

**Deep breath**

It’s been at least a decade, and I still ask patients to assess work stress in terms of threat and challenge. Threat stress–basically fight or flight–is physiologically taxing, meant to last seconds (not years), and costs us our health if prolonged. Challenge stress is activating, productive, and beneficial. I also query about personal fulfillment from work–meaning. We can tolerate very high levels of stress, even prolonged threat, if it’s worth it to us.

Parenting may be a better example than work. When we fear for our children’s well being, and even their lives in crises, how do we manage that? Is there any worse threat? We’d all rather it be ourselves suffering than our kids, right? How do we cope when we have no control?

At the risk of sounding arrogant, I feel very confident in my stress management skills. This is not to say I don’t experience severe stress or feel its consequences. I just move through it much more easily and with a lot less suffering now than in the past. I feel a lot less threat than challenge. Briefly, the practices:
—Breathe. Ever since my first medical assistant posted “TAKE A DEEP BREATH” at my workspace, I have appreciated the calming effect of one deep breath, physically and psychologically. We can breathe ourselves through childbirth, injury, emotional trauma, and myriad other urgent and emergent situations. Deep breathing stimulates the de-escalating parasympathetic (rest and digest) nervous system, balancing the autonomic hijack mediated by the sympathetic system. I breathe along with patients when I listen to their lungs. I inhale deeply when listening to books, and during strenuous exercise. It is my central grounding practice.
—Accept. “It is what it is.” This has nothing to do with how I feel about it. But the sooner I separate what is from what I want it to be, the less I suffer. Obviously I find this much easier to do for things I care less about. But even for big things, like the state of our healthcare system, the brokenness of our government, and my estimate of the ultimate demise of humanity (I think five more generations, give or take), just being with what is, as a first step to figuring out what to do next, helps me suffer a lot less.
—Withhold judgment. I’m really good now at not jumping to conclusions and not making sweeping judgments about people based on limited information. I am able to separate judgment of actions from people’s character and humanity. If you’re screaming at my team and me, you are clearly unwell. We can hold you accountable to your actions and still show you compassion and respect. I don’t have to think you’re a bad person. This way, I don’t take your negative actions personally, and I can stay calm and even.
—Get help. I ask every patient every year about their emotional support network, because it matters. Mine is phenomenal and I could not be more grateful. But I only know they are so because I call on them enough and they on me. Rarely I am disappointed, and I learn to turn elsewhere. I cannot overstate the profound importance of tribe and connection. It is my raison d’etre.
—Move. When daughter was admitted to the hospital and I stayed with her there, I made sure to get on the ellipitical each day that week. When I go too many days without movement, I get edgy and stuck in my thoughts. My stress is exponentially more manageable if I protect my workouts, which I have now done for many years.
—Attune and differentiate. My greatest stressors involve other people. Friction, tension, grating, colliding, etc. Since my LOH leadership training helped me articulate these complementary concepts, I recognize now that attuning/aligning with others, as well as differentiating and standing firm in my own core values and practices are equally important and fluid in their dynamics. Feeling out that optimal integration in any given interaction is rewarding in itself, and the outcomes are always better when I attend to both, knowing that I am showing up true to myself. What more can I ask of me?

So what could be better? Anything, really. For the rest of my life, new stressors will continually emerge. In his book Master of Change, Brad Stulberg quotes a statistic that in an average adult life, we will experience 34 major disruption events, which works out to about one every 18 months. Sounds about right to me! So I can expect to be challenged and trained in all of these skills and more, usque ad mortem. I only hope I can keep learning, applying, improving, and growing. Bring it.

—

I feel less harshly about our collective, societal stress management skills and outcomes than I do about our obessions and ironies with exercise and nutrition. Really, I think everybody’s doing the best they can, with the skills they have, in the circumstances of their lives at any given time. I just wish our environments didn’t create and perpetuate so many of our stressors in the first place.

So what’s already good?
—Potential. We are all surrounded by one another. So every encounter, any time, any place, is an opportunity to do people-ing better. In any given relationship, if anyone is willing at all, there is always the chance for repair after rupture. Humans are innate learners; we can continually acquire the skills to stop impaling ourselves with the second arrow of suffering, after the arrows of pain hit us in daily life. We can even hold one another up and heal our injuries together.
—Books, teachers, resources. Those aisles and shelves of stress management books really are dense, and I can say with conviction from first hand consumption that the knowledge and potential benefit living in those pages is immense. For those with the bandwidth to actively seek, consume, digest, and apply, lives can be transformed, especially if shared, discussed, and practiced together.
–Sometimes it really doesn’t take much. Your friend calls to check on you. A stranger helpsy you carry your groceries. When we say ‘it’s the little things,’ we speak truth. Small acts of kindness and incidental connections will not solve our hardest problems, but we must not underestimate their profound potential to help, and for that help to amplify in unexpectedly large ways. What’s more, both the helper and the helped benefit from the encounter.

What could be better?
–Teach it explicitly. There is a movement afoot among Dialectical Behavior (T)herapists to formally incorporate stress management skills into school curriculum. DBT organizes life skills around four central pillars: Mindfulness, Emotional Regulation, Distress Tolerance, and Interpersonal Effectiveness. Within each module are sets of practices, many with campy acronyms to help us remember. I refer patients to the DBT skills website often, not just to help them cope better themselves, but to help them model better coping skills to their children, direct reports, and leaders. Simply having the confidence that we can handle whatever comes our way, because we know what to do, decreases stress exponentially. What if we learn these skills in childhood, before the chaos of adolescence and serial tumult that is adulting? Can you imagine?
–Relational Leadership Training and Valuation. Leadership done well is a practice in empathic, compassionate, accountable, and transparent stewardship. It is a way of being and doing, one that requires high level self-awareness and self-regulation, and excellent attunement and communication skills. Right now I think leadership training focuses a lot on transactional communication, superficial team dynamics, and not enough on building leaders’ stewardship mindset and deeper relational skills. We should require evidence of these skills for promotion and provide communal support and feedback to strengthen their practice. This would reduce overall stress in organizations by building cultures of empathy, compassion, accountability, and transparency from the top. Workers’ stress, in my observation, stems in large part from toxic cultures set by relationally inept leaders.

So, another plot twist, but maybe not really. My solution to stress management optimization is relationship-centered: first relationship with self, then between self and others, and then between/among those who know us, by way of example setting.

Stress is complex. Its optimal management is a lifelong practice. It’s never too late to start, and no skills practice is too small or wasted.

“The only way out is through. The best way through is together.” I think that applies here.

Nutrition

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Ok friends, now we get to talk about hard stuff: Food. GAAH, I JUST LOVE IT SO MUCH. My indiscriminately joyous palate and hedonist tendencies conspire to make me positively fat, and I have spent decades resisting that outcome. I feel an internal truce developing with age, though. I wrote my post on leading vs lagging indicators of health back in February, and share it regularly with patients. Each conversation reinforces my thesis: that numbers, be they body mass, body fat, glucose, or cholesterol, do not tell a remotely complete story about our overall health.

After reading Anti-Diet by Christy Harrison at the recommendation of a therapist friend, I can own my insidious internalization of our cultural obsession with thinness. I diverge mildly from some of the author’s opinions and assertions. I still greatly appreciate her understanding and validation of the complexity that is body weight, and the reality that we do not and cannot necessarily control it. Despite what many say, body mass does not simply equate to calories in minus calories out. Metabolism takes myriad inputs and outputs, both intrinsic and extrinsic, always in flux. Genetics play a large role, more for some than others, in body habitus changes over a lifetime. Sometimes acceptance is a healthier, more peaceful strategy than resistance.

Reconciling body mass and shape to health and well-being, especially for folks like me who are not naturally thin, costs loads of psychic energy. It can cause layers of stress and discomfort, much beyond moving around in a heavy body. I focus on weight/body mass and appearance in this post on nutrition becuase when my dietician colleagues and I talk to patients about food, a majority of the conversations are centered here. If American culture is obsessed with exercise, then we are brainwashed about thinness. I can think of few domains where both collective and individual judgment is more harsh and destructive. And when we judge weight, judgment of food and eating follows closely behind. Let’s see if we can shift this, shall we?

When I look at my eating habits today, I nod approvingly. Not because they are perfect or even admirable, but because they are so much healthier than in the past. This year especially, I’m able to practice mindful eating:  More often than before, I ask myself:  What’s driving my eating at this moment?  If it’s not truly hunger, will the calories be worth it?  What else do I need (water? sex? laughter? connection? movement?), and is food a good enough substitute?  I understand my non-hunger eating drivers (eg visual cues–never watch Big Bang Theory after dinner–and omg stress) and can anticipate them farther in advance. I can take precautions like not keeping ice cream in the house, and buying sweets in easily portioned units (thank you, Trader Joe’s frozen macaron varies!). I know my sleep requirement threshold below which mindless eating easily takes hold, and make strides to get to bed on time. My snacks are healthier–I pop blueberries as I write this–and I attune to my saiety much better with age–just ate my last blueberry of the writing session.

Here’s what I’m still working on, the mantra I have yet to integrate: “Enjoy every bite!” Whether it’s mac ‘n’ cheese or pecan pie, mashed potatoes or Haagen-Dazs, I am sure to indulge when offered. The visceral and limbic pleasures of flavor, texture, and sharing with friends act like jet fuel accelerating utensil to mouth oscillation speed. The greatest potential food joy quickly and easily devolves into an automatic race to consume, and it’s over before I realize. Not only have I then obliviated a peak plesaurable sensory experience, but I have also likely overeaten, and the sadness and guilt compound. “Enjoy every bite,” if I can remember and repeat, reminds me to slow down and attend to the full experience. Temperature, texture, flavor, aroma–just thinking of it all now relaxes and uplifts me. Good food, enjoyed mindfully in real time and especially in good company, connects and delights. I will continue to practice this not only for the most indulgent foods, but also the most mundane. The simplest foods can make me positively giddy: a poached egg, buttered toast, watermelon. Holy cow I just realized: If I truly enjoy every bite this way, how much more amazing could my sensory life be? Could I even stand it?

So what’s already good about American nutrition? Let me put down my cynic hat for a moment…
—The United States is self-sufficient in food: we can produce enough to feed our own population (though 17 million households were food insecure for some part of 2022).
–Many of us have access to non-local, non-seasonal food, which we often take for granted (though economic and ecological costs are high).
–Information about healthy eating (though not necessarily healthy food) is more and more easily accessible.. though misinformation and fads cost us millions of hard earned dollars every year.
–Oh here’s a good one: Reasonably healthy meal prep and delivery services are increasingly available for busy families…. who have the funds to outsource planning/shopping/cooking.

Okay let’s just skip to what could be better.. no holds barred here, full fantasy mode engaged:
–Portion options at restaurants, with coinciding pricing scale. This prompts diners to assess and decide more mindfully when ordering. Or offer to present takeout container when entrees are served, so diners may save leftovers at the beginning of the meal and eat mindlessly thereafter (I try to bring my own boxes)
–Elevate nutrient quality of meals served in schools
–Effectively incentivize purchase and consumption of locally produced plants and animals by both individuals and businesses
–4 day work week. This could actually solve, or at least improve, intersecting problems in all 5 reciprocal domains of health: sleep, exercise, nutrition, stress management, and relationships. See evidence for benefit from The World Economic Forum, the Wall Street Journal, and the UK/EU
–Cultivate a collective mindset of slow, selective activity and connection, both personal and professional, rather than the frenetic, competitive, have-and-do-it-all mentality that drives us all to the brink and over the edge of burnout and insanity

Huh. At a collective, cultural, societal level, turns out I feel pretty pessimistic about meaningful positive changes in nutrition patterns. So it’s basically up to us individuals and small groups/organizations to continue swimming upstream against forceful currents of hyperprocessed food supply, agribusiness, and thinness obsession despite all systems trying by default to make us fat and sick.

HA! I’ll think more about this. I’m not hopeless or sad, more just fascinated. How are you feeling about it?