Minding the Body Mending the Mind - Porter Starke Services

NCCAM Mind-Body Medicine• Focuses on interactions among brain,mind, body and behavior.• Researches effects of emotional, mental,social, spiritual and behavioral factors onhealth.• Fundamental guiding precept is respect forand enhancement of each person’scapacity for self-knowledge and self-care.

NCCAM View of Patient/ProviderInteraction“The field views illness as an opportunity forpersonal growth and transformation, andhealth care providers as catalysts andguides in this process.”

The Healing PresenceThe New Field of Interpersonal Neurobiology“I have come to believe that it isthrough the establishment of a uniquedoctor-friend-patient relationship thatmost of the healing occurs, whetherhelped along by surgery, acupuncture,or regular doses of approvedmedicines.”HMS-Joseph Martin, MDFormer Dean of

Compassion and HealingShowing a film of MotherTheresa resulted inincreased sIGA. After anhour levels fell tobaseline, but rose againwhen the subjects wereasked to contemplate atime when theyexperienced compassionand kindness.

Love and Health• Antagonist to stress• Stimulates pleasure system (increasesendorphins, endogenous cannabinoids,endogenous morphine, dopamine, oxytocin,vasopressin, nitric oxide)• Decreases anxiety and depression• Enhances motivation and positive choice• Increases wellbeing• Decreases physical symptoms

Age Standardized Death Ratesper 100,000 men ages 40-69Marital Status Nonsmokers 20+ per daysmokersMarried 796 1560Single 1074 2567Widowed 1396 2570Divorced 1420 2695

Natural Killer Cells Moving On

Relationality and Presence

Dan Siegel, MD: Monitor and Modifythe Information FlowEmotional regulation requires:1.Monitoring one’s affective state2.Modifying the flow of energy “in a way thatmoves the system- body and relationshipstowardwellbeing.”This is called integration, which leads to health.

Emotions are the Mind-to-Body Linko Candace Pert, Ph.D.o InformationalMolecules releasedfrom cells in the limbicsystemo Paul Eckman, Ph.D.research on facialexpression andemotiono emotions asmessengers

Approach and Integration“People with mindful awareness training have ashift in their brains toward an “approach” statethat allows them to move toward rather thanaway from challenging situations. This is thebrain signature of resilience.”-Dan Siegel, MD

Take 2: The Healing PresenceRevisited“I have come to believe that it isthrough the establishment of a uniquedoctor-friend-patient relationship thatmost of the healing occurs, whetherhelped along by surgery, acupuncture,or regular doses of approvedmedicines.”HMS-Joseph Martin, MDFormer Dean of

Simple, But Not EasyCompassionate Presence is what remains when stressis removed. It is a nonjudgmental awareness of themoment characterized by clarity, love, wisdom andnon-attachment. This is a person’s essential self ortrue nature, the root of enlightened social action andhealing.

Too Busy, Too Fried?

Doing Good Badly?“ There is a pervasive form of contemporary violence- activismand overwork. The rush and pressure of modern life are aform, perhaps the most common form, of its innate violence.To allow oneself to be carried away by a multitude of conflictingconcerns, to surrender to too many demands, to commitoneself to too many projects, to want to help everyone ineverything, is to succumb to violence.The frenzy of our activism neutralizes our work for peace. Itdestroys our own inner capacity for peace. It destroys thefruitfulness of our own work because it kills the root of innerwisdom which makes work fruitful.”-Thomas Merton

Symptoms of BurnoutPervasive fatigue: negative outlook; cynicismabout work and the results of the work;irritability with colleagues, clients/patients andfamily; loss of empathy; withdrawal;absenteeism, physical symptoms includinginsomnia, GI distress, back pain, headaches, andthe whole gamut of stress-related disorders;substance abuse; loss of meaning; loss of selfworth;anxiety and depression; diminishedperformance

Maslach Burnout InventoryThree Scales, 22 items, well validated innumerous populations including the military:1. Emotional exhaustion/ physical depletion2. Depersonalization: cynicism toward work andimpersonal response to clients/patients3. Reduced sense of personal accomplishmentand feelings of achievement

Compassion Fatigue isUnderappreciated“The expectation that we can be immersed insuffering and loss daily and not be touched by itis as unrealistic as expecting to be able to walkon water without getting wet. This sort of denialis no small matter.Rachel Naomi Remen, MD

Stages of DescentMODIFIED FROM FREUDENBERGER AND NORTH• Stage 1: Driven by an Ideal• Stage 2: Working Like a Maniac• Stage 3: Putting Your Own Needs Last• Stage 4: Miserable and Clueless as to Why• Stage 5: The Death of Values• Stage 6: Frustrated, Aggressive, and Cynical

Loss of Empathy• Stage 7:• Stage 8:• Stage 9:• Stage 10:• Stage 11:• Stage 12:Emotionally Exhausted andDisengagedDestructive self-comfortIsolationInner EmptinessWho Cares and Why Bother?Physical and Mental Collapse

Spirituality and Healing“Positive Emotions, Spirituality, and the Practice of Psychiatry”Mens Sana Monograph 2008; 6:48-62George Vaillant, M.D.“This paper proposes that eight positive emotions: awe, love(attachment), trust (faith), compassion, gratitude, forgiveness,joy and hope constitute what we mean by spirituality. Theseemotions have been grossly ignored by psychiatry….Spirituality isnot about ideas, sacred texts and theology; rather, spirituality isall about emotion and social connection… Our whole concept ofpsychotherapy might change if clinicians set about enhancingpositive emotions rather than focusing only on negativeemotions.”

Spirituality and ReligionThe spiritual is that realm of human experience whichreligion attempts to connect us to through dogma andpractice. Sometimes it succeeds and sometimes it fails.Religion is a bridge to the spiritual- but the spiritual liesbeyond religion. Unfortunately, in seeking the spiritual,we may become attached to the bridge rather thancrossing over it.-Rachel Naomi Remen, M.D.

Spirituality and MeaningOur birth is but a sleepand a forgetting, thesoul that rises with us,our life’s star, hathelsewhere its settingand cometh from afar,not in entireforgetfulness and not inutter nakedness, buttrailing clouds of glorydo we come.-Wordsworth