Tuesday, February 24, 2009

Life changing books: "How to Want What You Have".

We readers, every once in awhile, stumble upon books that have a profound influence on us, often in subtle ways, as though they planted an idea in our heads that needed marinating or slow cooking before it truly delivered its "full flavored" goodness.

How To Want What You Have by Timothy Ray Miller is one of those books. My take away from the book included the inescapable thought that we are "conditioned" by culture to be discontent, to constantly want more— to want to be happier, prettier, wealthier, smarter, or more popular. Miller provides an explanation for this, describing that the nervous system is wired for stimulation, and that we adapt so quickly to new circumstances that we are often soon looking for something different to counteract our boredom. We truly believe that more is better—and perhaps because we are optimists— we tend to think that just around the corner there is a better situation, a nicer car, a more beautiful partner (or self), or a bigger house that will make us happier. Of course, because we adapt so quickly to change, that new house soon becomes inadequate in our insatiable quest for happiness based on more, bigger, or better. Believing that more will lead to happiness is akin to thinking that the mirage of the green oasis in the middle of the desert will quench our thirst. Of course, it is an illusion, it has no water at all.

The "bigger house" habit pattern exhibited by millions helped get us in the economic situation we are currently in—but I digress. Dr. Miller makes three fine, life changing recommendations for addressing these insatiable (and we'd now have to say potentially destructive) habit patterns. It turns out that they are interconnected—each tends to reinforce the others.

First and perhaps most importantly, Miller recommends that we learn to adopt and practice the essential characteristic of attention, or being in the moment. There is so much good and beauty in the world, so much to appreciate about living, that we cannot hope to live it fully, to breathe in all of its goodness and wonder, without paying attention to what is around us to appreciate. Perhaps like many others, during my youth I was always focused on the days ahead, impatient to move into the future with the over confident swagger and naivete of a sophomoric boy scout who knows a little, but does not appreciate how inadequate that "little amount of knowledge" is, or how many more important lessons are waiting to be learned in the world "out there". Attention is at the heart of many eastern philosophies, and described well in "The Power of Now" by author Eckhart Tolle. To be attentive, Tolle points out, usually means counteracting the tendency of the mind to fill itself with unnecessary concerns and distractions beyond the immediate.

Second, since we are paying attention to what's around us, we should practice being grateful for what we have, what is around us. We are now learning that things can get worse and it a good principle never to take anything for granted in this life. We have multiple examples every day about the fragility of life. This makes obvious the importance of gratitude, or appreciating what we have now and not squandering the moment worrying about what we do not have.

Finally, Miller recommends that in recognizing that things happen unexpectedly, any one of us can find ourselves in "deep sneakers" before we know it. We all make mistakes, live in proverbial glass houses, and are human (at least for the time being, before the androids depicted in A.I. begin to be manufactured!). Therefore, it is an expression of our humanity for us to recognize that we are one among many others, and that we live in the shelter of each other (love that Irish proverb!). If we display compassion for others, we demonstrate that humanity. Compassion is an essential ingredient in a supportive community. It is at the heart of charity and philanthropy, a key basis for volunteerism. It is a moral foundation for kindness and the cooperation that is necessary for group living humans to survive. Compassion, in my view, has been in short supply in some parts of the United States for many years. Hopefully, it will see a comeback in the coming days and months when we really need to be in top form as we support each other.


So, the essential message here is: attention gratitude, and compassion are important characteristics, and they are linked to each other. When we practice these, good things happen— in many ways—and in ways that are good for us as well as for others. The bonus, however, is that these greater rewards cost us nothing and have the power to make us happier while making our communities stronger!!! And in these times, we all can use a bargain that leads us to greater happiness!

"When the student is ready, the teacher will appear."—Buddhist Proverb

Sunday, February 22, 2009

What makes a good health care experience?

With the fast appointment, and equally sudden withdrawal of Tom Daschle as Secretary of Health and Human Services, what had been growing momentum behind long overdue health care reform was derailed, and we hope only temporarily sidetracked. Daschle, a veteran of Congress and one who had experienced many attempts at health care reform, was viewed as a very solid and informed choice for the post. Those who have read his book, know that he is an advocate for practical and doable change, recognizing that what many see as the ultimate destination, a single payer system, may require some interim steps. His plan would amalgamate existing government care programs, require that everyone be covered with affordable insurance for a basic level of health care services, and remove politics from decision making by creating a federal health board with confirmed appointees (like the Federal Reserve Board) to oversee the system.

Personally, while some of Daschle's plan characteristics have merit, I am a proponent of going for the whole enchilada now and proposing a single payer system to get rid of greedy profit motivated health insurance companies now. Why allow profit at the expense of health and life? And why spend even one more penny on marketing, advertising or competition when the money can and should go to delivering care and prevention?

Let's do what we have to do now to make the system affordable, accessible, fair, accountable, universal, portable, and responsible. By responsible, I mean a system that devotes resources to health promotion and prevention, a system that aims to promote well-being rather than just ameliorate disease after it has occurred, and a system that recognizes that responsible lifestyle change is more than half the battle in keeping people well. Health is related to happiness and happiness is related, inextricably, to doing what makes life worth living, with those we love, and in supportive communities. Beyond these basic philosophical changes, why not pay providers more for keeping their patients healthy? Rewarding them for listening to and counseling their patients about lifestyle (not just exercise and nutrition) might also be a nice addition.

Think about your idea of a good healthcare experience. I have had primary care delivered by angels and by robots. By people who listened and believed I knew my own body, and those who were so focused on arriving at a diagnosis, (or getting to their next appointment) that they cared little about my experience of illness. Incredibly, the Washington Post had an article recently about an Ethiopian-born physician who is also a novelist (Abraham Verghese) who proposes that medical schools teach their students about the importance of the life stories of their patients. This advice is, on the one hand, good news— and on the other, incredible in its acknowledgment that medical curricula are woefully out of touch. I doubt it is coincidental that my favorite primary care practitioners are physicians who were first trained as nurses, pharmacists or therapists. In fairness to medical schools, (not that any is really warranted) it is incredibly difficult to change the curriculum in a medical school, even a smidgeon.

So, what characteristics do you think make for a good health care encounter? Share them here, and perhaps a medical educator or two who believes in the importance of the humanities will stop by and take note.

Tuesday, February 17, 2009

The Self-Fulfilling Magic of Belief and Perception

For years, psychologists have known that each person's own "reality" is created through the lenses of their own experiences, personality, and beliefs. Because experience is such a powerful teacher, including the experiences we observe in others, we can be passive participants and still be influenced. This is particularly true when we observe social approval for some acts and disapproval for others. Social approval is one of the most powerful sources of motivation. This explains why so many people are like sheep in determining what to wear, what to do, and sadly, even what to like, dislike or believe.

Additionally, as I have blogged previously, our bodies are known to respond physiologically to the feelings we attach to our perceptions and beliefs. We can signal our bodies to release good hormones or harmful hormones based on our emotions and beliefs. That's "Why Zebras don't get ulcers" as Robert Sapolsky wisely noted. Zebras don't spend time worrying about the consequences of what has happened in the past, or the possibilities of what might happen in the future. They live in the moment. By doing so, Zebras release stress hormones only when it is necessary for their survival.

Which brings me closer to the point of this post. Part of the reason the world economy is tanking is because people are spending so much time behaving as though they believe the sky is falling. The economy will only worsen if group think leads to the emotions and behaviors that make it so. A recession is the opposite of the unbridled euphoria of an economic bubble. People bought property because they believed it would lead to greater wealth. As soon as those beliefs changed collectively, and it was perceived that Armageddon was upon us, people began behaving in ways that began to create the outcomes they feared, and that we now have.

How does the world turn around a collective perception of doom to one that leads to behaviors of investment and optimism? That, my friends, is the central task confronting political leaders everywhere. Can each of us help? Certainly we can, by taking actions ourselves that signal optimism. Need a new washing machine? Buy it. You'll never get a better deal. But purchase it with money saved, not money borrowed. How about the Rolex? On that one, perhaps don't make the purchase. A Rolex is a high priced functional watch. It doesn't keep time better than a less expensive watch, and it's an unnecessary indulgence. Displaying this new purchase will not be greated with much glee in the current environment. But more to the point, such a purchase will not do much to stimulate the economy.

So, what is the intended take away message for today? It is simply this: We can do ourselves and our world a favor by shedding the current mindset of doom and gloom and adopting a self-fulfilling belief that brighter days are ahead. In fact, through our beliefs and behaviors, they can be created just around the corner.

Sunday, February 8, 2009

What Happened on the Happiest Day of Your Life?

Have you ever stopped to think about the happiest day of your life? At least so far, that is. Or do you imagine the happiest day of your life is ahead of you? Dan McAdams, whose work in studying life stories has been mentioned in this blog before, describes certain archetypal or characteristic patterns to people's versions of their life story. Some describe their lives as rising from adversity, while others mention bad breaks that sent them into an unexpected crash landing from which they have never quite seemed to recover.

But here we recall the events that mark the peaks or represent the peaks we hope to achieve. What makes a "happiest day" experience? Is it personal accomplishment after a long, sustained effort? Or is it the promise of a new relationship? Does a happiest moment represent a capstone of previous experiences, or the beginning of a new journey?

For most of us, there have been many happy days, and we hope there will be many more. Perhaps what creates happiness at the beginning of our lives is different than the causes of those joyous moments in midlife, or as we mature in later years.

What are your thoughts about the events, or doings, that have characterized your memorable moments? Please share them here! The hope is, of course, that by understanding our own happiest moments, we can create the conditions to make them happen again! We can create the lives we want.

Saturday, February 7, 2009

The Ecology of Living —Share your personal efforts to live life well!

One important dimension of "doing life well" involves creating environments that are comfortable, satisfying and relaxing. Over the years, I have been a keen observer of the habits and practices of others that are directed toward creating comfortable experiences, wherever people find themselves.

The intention here is not to discuss or describe architectural or decorating features of environments, but rather to describe the objects and conditions that enable us to create the most comfortable person-environment fit that will suit our individual tastes regardless of where we are and what we are doing. Examples would include friends and colleagues who cherish the visual appeal of flowers to enhance their offices and homes, or the colleague who routinely carries the small comforts of home (traveling place mats and goblets) to enhance the experience of eating "on the go" when take out is necessary when traveling. Doesn't wine always taste better in real glass than from plastic or paper cups?

Some may regard these efforts as unnecessary or even silly, but I understand them as attempts to make the experience of everyday life more comfortable and enjoyable. Why not, I ask? Isn't this really part of the overall effort to live life to the fullest?

A colleague, occupational therapist and neuroscientist, Winnie Dunn, has written an interesting book about the senses, called Living Sensationally. In this delightful book, Dr. Dunn provides a clever and readable way to understand our senses, emphasizing that our unique sensory systems are a very important key toward enhancing our experience of living. After all, for each of us, perception defines our reality, and our perceptions, or experiences, must be processed through the senses, whether we are seeing, hearing, touching, feeling, smelling, or using a combination of these at the same time—as we typically are! Sometimes, our sensory systems get overwhelmed, but other times, we seek sensation, especially sensations that we find pleasing.

How do you please your senses and enrich your life? I invite readers to offer examples of their own personal routines and practices that improve and enrich the enjoyability and comfort of their personal spaces or make their travel experiences as comfortable and stress-free as possible.

Thursday, February 5, 2009

Cost Does Not Equal Value

This is not a post about the economic stimulus package in the United States.

Rather, it is about thinking clearly about the distinction between cost and value in all areas of our lives. When the current crisis is behind us (and it will be sooner or later), thoughts will turn to other items on the national agenda. The most pressing of these from the standpoint of both cost and value is the health care "system" in the United States.

In many ways, health care, and the sad state of the non-system we have, mirrors the economic system. We have, as a nation, refused to make the hard choices in the moments where integrity was needed. Much like the hungry traveler who opts for the big mac when the salad might be the better choice, we have chosen the hamburger again and again.

Soon, during the discussions about health care reform, we will have the choice again. This time, we will have the opportunity to invest in a health care system that not only provides more value for cost, but does so in a way where public health programs focus on lifestyle change. The big mac is sold as part of a value meal, but here the relationship between cost and value are mistaken. The value of choosing prevention and health promotion programs is unmistakable. We must insist on value in the choices we make for our new system.

Tuesday, February 3, 2009

Health Care Reform and Well Being

Were it not for the constraints of time, this could be a longer post. The topic of health care reform in the United States prompts many passionate reactions from citizens. Abroad, people must wonder how we have tolerated the system we have for this long anyway? In the midst of economic chaos in the United States, the issue has been temporarily put on the back burner. Yet, President Obama knows very well that the costs of inaction, in human terms and in dollars saved, are greater than the cost of reform—and growing every day.

The irony is that attempts at national reform in the United States have been tried several times during the past century. For example, most people don't appreciate that President Harry Truman tried valiantly to reform the system, without success. Then there are the better known efforts of President Kennedy (leading to the compromise that became Medicare and Medicaid), and the failed Clinton effort. In each case, the complexity of the issue, special interest groups protecting their "rice bowls", and an effective disinformation campaign by the health insurance companies linking a national approach to "socialism" or socialized medicine, were able to derail the efforts. Meanwhile, like a patient in critical condition, the system is in need of urgent life support and getting worse.

So, what does this have to do with "Doing Life Well"? It's simple, really. Important requirements for doing life well include being informed about issues, making wise choices, and advocating for conditions in our communities that support our ability to participate in activities that contribute to our health. Former HHS Secretary nominee Tom Daschle has advocated for a compromise solution that would create a Federal Health Board and unify both private and public systems, requiring everyone to have insurance. Personally, I think the best system is a single payer system that enables choice and limits profits that are based on human illness or suffering. Why profit from services that people have no choice but to accept? Isn't that a grand perversion of monopoly? But, the important thing is to make progress in reforming the system. Whatever we do, however, we must have as a principle of reform that lifestyle-related prevention and health promotion initiatives and funding are part of the solution. The value of such efforts is unmistakable, and can save millions (not to mention the advantages of helping people feel better about themselves and making them happier and more productive). Most people would rather live their lives well and be active and engaged than to have health care money spent on keeping them "alive" at the end of life, hooked to tubes and merely surviving rather than flourishing.

Albert Einstein, a wise and learned man, once observed that not everything that can be measured counts, and not everything that counts can be measured. The dialogue about health care must include a discussion of issues not easily measured, like value. There is a wide difference between the meanings of cost and value. We must ask the question: How is the system to support efforts that address people's quality of life?

On Meaning and Well Being

I'm back. For the past three years (has it been that long?) I have been distracted by my long distance commuting job, writing book chapt...