Listening, really listening, is a practice that is difficult and sometimes even dangerous. Deep attentive listening has the power to draw us into the mystery called silence. Often in listening, we encounter other people and our own lives in new ways .
Several years ago, I gave a presentation with Celia Guro, PhD at the MSU College of Human Medicine’s Annual Foglio Spirituality and Medicine Conference in East Lansing. We also gave it to the First and Second year Medical Students at the MSU College of Osteopathic Medicine. Recently, I got it back out because it feels like it’s time to say it again. I wrote this as a preparation for the talk, and have done just a little editing to add insights I’ve gained since we did this a little more than 12 years ago.
As we prepared for this, Celia and I came to an understanding that perhaps the single most important ingredient in a therapeutic relationship is that serious listening is occurring. Yet when one begins to talk about listening, it has relatively little meaning when compared to the experience of being on either end of true listening. I find myself in this set of notes delving into what my experience has been with listening, and how it has affected my life as a physician and as a patient.
The act of listening is subversive. I say that because the power of listening can sneak up on you and surprise you. It is not commonplace to experience listening in a way that causes you to be healed. And if you haven’t experienced it, you wouldn’t necessarily know how to do it in a way that could cause another to be healed.
Listening is an essential ingredient for healing. It transports the participants to a different place where the nature of reality becomes participatory or co-creative. We only go there if we trust ourselves and each other enough to be willing to look different when we come out on the other side. And we only go there if we are willing to consider that reality could be different than our current interpretation of it. If we cannot trust or be open to possibility, we can play at listening for years and never change ourselves or each other at all.
You are students of the practice of medicine. You are becoming part of a tradition that still has the audacity to say that it attends to the needs of others, that it is a place where the sick and dying can come and receive grace, the grace of being understood, of hearing coherent explanations for their suffering, and even perhaps be given the secret tools that will bring restoration of health. If you successfully negotiate the path before you and meet all requirements imposed upon you, there will come a day when you will be ordained into the Society of Medicine, one of the most elite distinctions a human being can receive at this point in human history. Have you, either before beginning this journey or since you embarked upon it (perhaps within a moment of stillness), allowed yourself to contemplate how that feels?
I’ve been in practice long enough to be aware of just how well most doctors avoid the opportunity to abide with the feelings that come with the realization of what it means within the context of our culture to be a doctor. My own experience with this is a long and difficult battle with doubt and uncertainty. On the evening of the day I received notice that I had been accepted into the Medical School I was planning to attend (MSU-COM) and dropped my note of acceptance of their offer into the mailbox; I became irrational and irritable with my wife at dinner, and developed a disabling migraine headache. It seemed odd that at the moment of victory, so to speak, I became ill. Though I felt I wanted to be a doctor, I had tremendous misgivings about my relationship with power. I have spent many sleepless nights (before and after medical school) entertaining my fears about my potential to misuse the power I have as a physician.
In the beginning, people say they want to be doctors for reasons that sound altruistic, and most medical students are honestly interested in helping others. What is behind that desire? Could it be that we are here because we need to be healed? If you can be vulnerable enough to admit that, it becomes a matter of survival to hide those things from your colleagues and teachers. The way it went for me and maybe for you was that I bravely faced day after day and year after year of difficult, messy, confusing and discouraging work in forced labor camps called offices and hospitals. I found very little healing for myself or contact with teachers who could show me how to be involved in healing others. I came to realize I needed to carve out a plan for managing my life in medicine.
You likely know that disillusion and pain, perhaps also fatigue and feelings of hopelessness and despair are things that happen to people when they don’t receive what they so deeply feel the need for, but you will not allow yourself to be one of the casualties. You are not a loser. After all, you didn’t get this far by giving up. You adopt a strategy. Perhaps you are one who doesn’t want to admit you have any needs. Maybe in your upbringing such an admission would be frowned upon. It is a rewarded trait in our society. The longer you work at convincing yourself of this essential non-truth, the better you get at being blind to the effects your efforts to be one-who-has-no-needs has on you and your family. I remember when I was actually proud of how quickly I could go from being asleep to being at work.
Also on the “no-needs here” spectrum are ones who believe they are capable of anticipating and meeting the needs of everyone around them, and have adopted strategies around the relentless pursuit of that impossible goal. If you were raised in a household run by a narcissistic parent, one possible response you could have developed from an early age would have been the notion that in fact your life depended upon meeting that parent’s needs at any cost. The energy required to maintain such vigilance prohibits you, the one-who-must-meet-needs, from being able to explore the issue of needs any further for yourself. If I asked you right now what you need most for yourself, would you be able to come up with an answer?
Of course, neither the one-who-has-no-needs or the one-who-must-meet-needs can understand a whole life, whole person, five senses way of experiencing what it feels like to be a person who is a doctor. The shock of realizing the extent of your responsibilities to other people when you accept the mantle of physician rarely allows time for you to figure out how you are going to meet your own needs, or discuss with your spouse or family or friends how it might impact your relationship. How are you going to compensate and adjust for such a heavy set of responsibilities? How are you going to ask them to help you do this? How are you going to thank them for their help? How long will it go on like this? Does it get better…..or easier? Will there be time at some point to get a handle on it? Are there any ways you can practice or organize how you live that will help with the burden of responsibility?
What often occurs is that we develop addictions. Instead of addressing our authentic emotional needs, we try to replace them with behaviors that provide a temporary distraction. Since these behaviors don’t really meet the real need, they become something we keep needing more of to get a temporary fix. As Brene Brown says, you can never get enough of something you don’t need. Junk Food, too much Food, too little Food, Alcohol, Nicotine, Cannabis, Opiates, Tranquilizers, Sex, Shopping, binging on various forms of Entertainment, Gambling, Working Overtime, Sleeping excessively, avoiding Sleep, ….you can fill in your personal favorites.
As we become more distanced from knowing what we need, we join a profession that has moved away from actually addressing the causes of illness in ourselves and in our patients. You may be asked to work faster and be more “efficient”… delivering “services” to patients utilizing protocols based on the data someone else has decided is important. It becomes quite difficult to listen to what the patient wants to tell you about what they need if you have to spend your time collecting the information your insurance company big-data-informed EMR template insists you obtain.
Patients also do a lot of things that make them ill, and most of the time don’t have clarity about how or why these behaviors are detrimental or health promoting. They may want to ask you several questions about these things they realize they have some control over. They often don’t get answers to the questions they are able to formulate. Doctors often use medical jargon to hide behind the fact they actually have no idea what the patient is asking or how to answer the question in a way that the patient can understand. Real conversations are messy, hard to control, and require the participants to get to know each other. Patients often are powerless to change that dynamic, and are rightfully frustrated to be put in such a vulnerable position.
Enormous amounts of money are spent on health insurance policies that don’t insure health. The media is flooded with advertisements for marginally effective drugs that cost far more than what the great majority of people who live on this earth can afford to pay. We all still keep getting sick. With a growing sense of unease and a mounting feeling of alarm, we face health problems that are getting more complex and far reaching with less and less time and resources available with which to manage them. How can we respond to this? We start with our own story.
I am in many ways what you could call a hopeless case. I’ve experienced many serious illnesses including migraines since the age of 4, three episodes of severe depression, ADHD, two ruptured lumbar disks, recurring sciatica, a sleep disorder, and a streptococcal peritonsillar abscess that occurred at the same time as mononucleosis when I was 27. That one just about did me in by cutting off my airway. Lying in bed just before my wife called our doctor who wisely told her to get me to the hospital immediately, I kept insisting I was “fine.” On the morning I blew two disks at the same time, I fell over while putting on my socks and couldn’t get back up. I told my wife to go ahead with the kids and go on to work; it was just a muscle spasm. She calmly put the phone next to me and told me to use it if in the unlikely event I wasn’t able to get back up, I might need to ask for help. I was 30 years old at that time. At 50, I injured myself trying to lift something I couldn’t and tore my hip capsule and sustained two hernias. The hernias had to be repaired right away. Two years later, I had to have that hip replaced as well. Am I learning anything yet?
Fortunately I also have the assets of a remarkably strong will, a wife who loves me enough to stay with me, take over the tasks I don’t do, and help me with the ones I do, kids who have been gracious enough to be my teachers, and a gift for remembering things coupled with the ability to see how they relate to one another. Though I will always deny it and insist I prefer trees, I do like people and am fascinated with the complexities of being human. Oh…and I am able to admit I make mistakes and learn from them, which means I allow myself to change. Our story is what it is, but we fortunately have the option to re-write it as we begin to learn that we have the last word….
Celia, too, is a member of the hopeless cases club. Diagnosed in the mid-nineties with SCLERODERMA and given about two years to live, she sought out help from her colleagues in the Osteopathic Medical Community. Her story of illness experienced and health reconstructed is an amazing journey into the power of perception and shared work within healing partnerships. She is alive and well in 2018, more than 20 years after a diagnosis that is almost always a death sentence within 3 years. Yes, let me help you with the math: 1995 to 2018 is 23 years. The internationally famous researcher in Los Angeles, CA who saw her for over a decade eventually said to her: “You are a miracle: you don’t have to come back to see me every year anymore. You are getting better by all the ways we can measure your functional capacity.” And here in Michigan, the internationally famous Cardiologist at the University of Michigan who sees Celia for the Scleroderma-induced Pulmonary Fibrosis that causes right sided heart failure has witnessed her pulmonary wedge pressure decline over the last decade. She has also looked upon her with wonder. Granted, we have used all the medical interventions available to us to help Celia. However, we have never seen anyone benefit from them to the degree we have seen with Celia. Who gets better after they have Scleroderma? She didn’t even retire until she was 73 years old.
Together, we hope to show you a relationship that is a therapeutic partnership. Naming our relationship could prove to be tricky. I invite you to think about this while you watch us interact. Is it doctor-doctor? patient-patient? doctor-patient? patient-doctor? person-person? man-woman? psychologist-physician? Whose needs are being addressed? Upon which characteristic of personhood shall we focus?
I also invite you to think about the age-old question: What is the secret to health? The tradition of Osteopathic Medicine which only began in the late 1800s and the 5000 year old system of Traditional Chinese Medicine share a similar view of what it means to be healthy. I see it as an inside-out perspective.
They propose that the secret to health is to be in relationship, to achieve a steady state where one is capable of adapting to and interacting with both internal and external environments; homeostasis at all levels of organization. In essence, to be healthy involves learning to listen and attend, to be in right relationship…with each part of your body and as a whole, including your heart, your emotions, your mind, your spirit, those who are close to you, the people with whom you live and with whom you work and share resources. In addition, Chinese Medicine explodes the context into being in right relationship with all of Nature. Within these relationships one must develop the ability to trust: first yourself, then others, and to have the courage to act based on the knowledge of yourself and those you trust. The rest of the stuff, all the stuff, is truly secondary.
What I find fascinating about this answer is that is has everything to do with observing and imitating nature and natural phenomena, something indigenous cultures around the world have done for thousands of years. It has absolutely nothing to do with a market economy, the need for economic growth to sustain a non-sustainable way of life, or a mechanistic/objective, disease-based scientific model for medicine. As a physician trying to assist a patient who is ill, you will have at your disposal information about the disease they have contracted, and anything you wish to know about the person who has the disease. You don’t have to pick one or the other. It does not have to be an either/or proposition. It can be a both/and proposition. Then you get to use all of the resources you have at your disposal to help them get well. This is the most important thing I have to share with you. BOTH. AND.
The reductionistic, seductively simple idea that there is a single cause and treatment for a single disease entity is based upon assumptions that were once useful but have been supplanted by a paradigm that expands our understanding of reality. Complex systems do not behave in this way. Please get over it before you get out there and wreak havoc on the lives of unsuspecting patients and their families. Illness first and foremost happens to a person. It may manifest in a particular organ or tissue or cell, but its influence will never be confined to anything smaller in scale than the person as a whole, unique entity. It happens in a realm that cannot be accurately defined by anything smaller than the context of the relationship between that person and all the potentially injurious and potentially helpful conditions and relationships with which he or she is connected. It’s messy. It’s unpredictable. It’s complicated. It does not happen between two ingredients in a test tube under controlled conditions.
You intuitively know this, and your education has definitely helped dispel a reductionistic paradigm for how the world works. However, medicine is in a time of paradigm shift, and therefore you will encounter widely disparate ways of thinking among the physicians who train you and the patients who help you learn. At times what you see will be confusing and may seem so different from what you think or feel you have been taught that it will be hard for you to feel you have a firm framework of understanding. I can certainly understand this, so I have included for your contemplation and enrichment at the time of your choosing an excerpt from a book written from a series of conversations between two extraordinary people…a Roman Catholic priest named Matthew Fox and a plant biochemist named Rupert Sheldrake…called Natural Grace: Dialogues on Creation, Darkness, and the Soul in Spirituality and Science. I commend it to you so that you may be able to develop an understanding of how education impacts how we live and practice, and for insight into being better doctors than those of us from the generations who preceded you.
Matthew Fox is a polio survivor. He lost the use of his legs at age 12, and miraculously got it back when he was 14. He grew up in the state of Minnesota, U.S, and studied to become a Roman Catholic Priest in the Dominican tradition during the exciting time of the second Vatican council. He reports being amazed to realize in the 12 years of his training, there were no courses offered on the mystics or on spirituality. He felt strongly that somebody needed to study spirituality, so he asked for permission to do so after his ordination. He shared with his superiors the observation that nobody seemed interested in religion, but people sure seemed interested in spirituality. His superiors had no clue about where to send him, so, with their reluctant permission; he got his advice about where to study spirituality from Thomas Merton (who sent him to Paris, France, to study with the grandfather of liberation theology, Père Chenu). Chenu died at 95 on the day Nelson Mandela was released from jail. Chenu had spent twelve years in his own kind of prison, having been forbidden to publish by Pope Pius XII because of his contribution to the worker priest movement in France.
Rupert Sheldrake, a Ph.D. (Cambridge) plant biochemist who grew up in England, found his sense of the holy in an ashram run by an English Benedictine Monk named Bede Griffiths in the very southern tip of India. It was there he found the time and energy to write his first book, A New Science of Life, which introduced the world to the idea of Morphic Resonance, the idea that nature has a memory, that it is a living, evolving entity, that organisms have a way of being connected with each other, and that species share collective memories. He began to think outside of the lines while living in England as a graduate student at Cambridge when he joined a group called the Community of the Epiphany. This was a group of philosophers, physicists, and mystics who explored the connections among mystical experience, philosophy, and science. He studied one year at Harvard, but found American education to be ridiculous (“in the united states, university students are treated like children—told exactly what to read and then tested to make sure they have read it”). He attended whichever classes he chose and read whatever he found instructive while there instead. Fortunately, two events that year proved influential in the development of his original and transformative theories. The first was learning of and studying Thomas Kuhn’s book The Structure of Scientific Revolutions. This had just been published, and had a profound influence on his thinking. Also, a friend studying literature loaned him a book on German philosophy containing an essay on the writings of Goethe, the poet and botanist. He learned that Goethe at the end of the eighteenth century and beginning of the nineteenth had a vision of a different kind of science, a holistic science that integrated direct experience and understanding. It didn’t involve breaking everything down into pieces and denying the evidence of one’s senses.
Natural Grace………..From the chapter on Revitalizing Education:
Key: Matthew Fox in this type
Rupert Sheldrake in this type
I’ve been struck by Thomas Kuhn’s statement in his classic work on paradigm shifts that, in a time of paradigm shift, education is all-important. I think that’s true. The only way out of human collapse and catastrophe is human imagination, mind, and creativity; we have to get our wits about us. We have to educate smartly.
If education is all-important, the implicit question that always comes up for me is: What education? What model of education? Education is also a part of the paradigm shift. We can’t solve the paradigm shift with the former paradigm or models of education. And if you look at the stagnation of our work world and its professions, whether you’re looking at health care providers or priests and ministers or artists or politicians or businesspeople or economists, all along the line you realize they have something in common: they all went to school.
They all went through the same system. Maybe, just maybe, something is amiss with that system. If you can get to that issue, then there is some possibility of a paradigm shift. A priest friend of mine was hired at a medical school in New York City a few years ago. His job was to live in the dormitories to prevent suicides. The previous year four medical students had committed suicide and numerous others had attempted suicide.
That’s rather interesting, that the profession which draws on the mythology of healing is killing its people in the process of training them. Then you have to ask how many others didn’t commit suicide but are doing it in other ways. For example, through workaholism or through avarice. If we want to deal with the explosive health costs in the West we’re going to have to start talking about the model of education in our medical schools and the kind of doctors it is destined to graduate. Does a soul become avaricious because it has missed the spiritual side of education? In all world traditions, healing has been considered an art of the spirit. The words salvation and well-being are the same words all around the world.
When we’re dealing with health care, we’re dealing with an ancient spiritual practice that our culture has managed to secularize. One result is that it’s way out of line financially, and another is that it’s not doing its job.
A study was done recently on doctors in America. They asked ordinary Americans how much money they thought doctors made and how much money they should make. The poll found that most Americans think doctors make $125,000 a year. The fact is the average doctor makes $250,000 a year, and the average American said they should make $100,000. They also asked how much money they thought drug corporation presidents made. (One of them in 1994 made $13 million). Needless to say, the American public underestimated by about $12,850,000 how much presidents of drug companies make.
This is traceable to the educational system. Where else would it come from? Other cultures in the past have not had this bloated problem of avarice built into their professions. This is just one example of the doctors; lawyers would have their stories to tell.
We’ve underestimated how powerful education is, how easily it can distort an entire civilization. Why? Because it is dealing with the most powerful being on this planet, which is the human mind. You would think that we would be more critical, that we would stand back from education and say, are we training the whole mind or are we just training this part? How would you go about training the whole mind?
The mind and body together.
Exactly. Mind, heart, the whole person. I would like to say as a blanket statement that our professions are dying essentially of avarice. That is why the culture is dying; because those who claim the spiritual work of training the mind, called educators, or the spiritual work of healing the body, called doctors, or the spiritual work of defending the poor, called lawyers, these people are aren’t doing their job. They’ve co-opted the spiritual titles but they’re doing other things with their power.
Now Aquinas analyzes avarice this way: it’s not materialism, it’s a sin of the Spirit. He says, “Avarice tends to infinity and knows no limit.” So what is infinity? It’s Spirit; Spirit is what is infinite. What we’re dealing with here is a spiritual issue. People are looking for the Spirit and they have been taught to find it in the power of money, fame, prestige, political influence or what have you.
The question then becomes: How do you heal this avarice? It is by offering authentic experiences of the Spirit or of the infinite because avarice is built into every addiction. If you are an alcoholic, you never have enough alcohol until your body stops and you die. How do we cure this? We all do experience the infinite or the Spirit authentically, in three ways. First in the mind. The human mind can potentially know all things, as Aquinas says. Therefore, training the mind will give people real, satisfying experiences. The unsatisfying ones called avarice are infinite in their demands but they cannot satisfy.
Second, we experience the infinite in the human heart, which never loves too much. The human heart is infinite in its capacity for love but it depends on the mind to feed it daily with lovable objects. If the mind stops or closes up, then the heart freezes too because it’s not being offered new objects of delight on a regular basis, to praise.
Third, Aquinas says that the human hands connected to human imagination produce an infinite variety of artifacts: creativity. From the first cave paintings to today no two painters have created the same painting; no two musicians have composed the same song or dancers the same dance or potters made the same pot. So here is a model for education that will combat avarice and offer us a whole different direction. And that would be developing the mind in all its capacities, right and left hemispheres and therefore the body and the heart. Developing the heart means body work, and developing imagination means art or creativity.
I don’t think that’s complicated. Schools at all levels of society need to follow this model since the ones they continue using are dangerous to the planet and to the rest of us.
What you are saying, it seems to me, is that we’ve got a thoroughly secularized education system. It teaches techniques that are supposed to be morally neutral. For generations, scientists have pretended that science is morally neutral; for example, there’s nothing good or bad about making an atom bomb. If politicians choose to use it in a certain way, it’s their fault, not the scientists’.
Well, that argument is utterly specious and has been most obviously shown to be so through the Star Wars program where scientists took the initiative in getting many billions of dollars to feed the budgets of laboratories that work on advanced weapons research. It was entirely initiated by scientists. These standard arguments about the neutrality of science are not valid. Nevertheless, scientists have pretended that science is purely objective, morally neutral, and that morality’s something else.
Sir Francis Bacon first made this distinction between facts and values. Facts are the realm of science, and he equated them to the pristine knowledge of nature before the fall, when Adam named the animals. This happened before he ate the fruit of the tree of knowledge of good and evil, when morality came in. This was Bacon’s principal argument for the validity of science, a theological argument. Ever since, science has rested on this distinction. The God-given ability of man to name and know the Creation comes first and is blameless. Morality comes later. The realm of morality is the realm of religion. The knowledge of Nature is the realm of science.
That’s a pretty good deal you’ve cut out for yourselves. Does that make scientists less than human or more than human?
Just in a paradisiacal state of innocence that’s only tainted later by people like politicians and priests. The innocent knowledge of Nature was the ideal. There’s something to be said for it as an ideal in the naturalistic study of Nature. But of course Bacon took science to mean not just natural history, but the study of Nature for the sake of manipulating, controlling, and exploiting it.
This ambiguity was built in, and education in science has been a matter of learning facts, techniques, and so on as if they are all morally neutral. For example, education in medicine involves learning the names of bones and muscles, the kinds of germs that cause disease, the kinds of drugs that kill germs, the way the heart beats, the physiology of the nervous system, and so forth.
Because science has such high prestige, it then becomes a model for other forms of education, seen as secular and morally neutral, even in literary studies. You learn facts and techniques of literary criticism or art history. It’s not a question of whether some kinds of art are moral or immoral, inspiring or degrading, it’s a question of which painter influenced whom, and what kind of techniques they used for their brush strokes, and how patrons affected them, who owned which pictures, and so on.
This secularized education system takes morality or values out of it, and they are relegated to a small part of the curriculum in religious studies or religious education, which in practice, at least in Britain, usually become wishy-washy comparative religion. The basic message it imparts is not a celebration of the richness of all different religious traditions, but the fact that any given religion is a culturally determined set of manmade myths and stories. They are all different and have no kind of objective validity, unlike science where they’re only one kind. Science has become, in essence, a monotheistic system. There’s only one kind of science worldwide whereas there are many kinds of culture and religion, reflecting the foibles of human nature, of human subjectivity. Science is supposed to represent the true objective knowledge of Nature.
This separation of facts and values leads to many problems. Right-wing politicians, in an incoherent way, are often decrying modern education for the way it fails to inculcate morality, blaming it for problems of crime, alienated youth, and so forth. But I think, as you indicated, there’s a much deeper problem here. Not only is there no moral content, but the spiritual side, the emotional side, and the bodily side are left out as well, except in the small sector called physical education, which often fades out by the time students go to university.
Much of it is about competition anyway rather than development of the whole person.
There’s this contraction of education to a fairly limited area of facts and techniques, combined at the more advanced level with initiation into a professional league or guild, almost inevitably dominated by an established paradigm. As Kuhn said, each profession has a collectively shared paradigm. I would see it as a morphic field, a habit of thinking.
There is nothing in all this to resist pride, greed, and envy, which are deadly sins. Indeed pride, greed, and envy are the engines that drive our modern economy.
We’re educating people for it very effectively.
Yes. During the Thatcher era in Britain, the things that were praised as making economic progress happen were competition, the desire to get more and to get on. Of course the desire to shine over others can easily lead to pride or is motivated by pride.
I like the word arrogance. I think it’s a better word than pride and that it says more to us today.
Yes, arrogance. Of course, education leads to the arrogant idea that if you’ve got a higher level of education you’re better than someone who hasn’t.
And you speak your own language.
You have a special language that other people can’t understand, like medical jargon or the jargon in any profession. And this is something we’ve exported to the third world. Not that people need lessons in arrogance anywhere, but in India it’s very striking. When a young man has a B.A. he can command a higher dowry, and so on. Even a “B.A. failed” counts for something. And then you can buy bogus B.A. and M.A. certificates on the streets of Bombay near the university for a few dollars.
Arrogance is one of the things that education certainly doesn’t counteract, it actually favors. Greed dominates some professions, like law. Fortunately, there are other professions where it is not the reigning principle, like schoolteaching and nursing, professions which contain a large proportion of women.
Envy is the very basis of consumer society. Billions of dollars a year are spent on advertisements to excite and fuel envy. Almost every culture is susceptible to this. Introduce Western consumerism to almost any culture in the world and within one generation they’re really into it. They want McDonald’s, videos, TV, and so on.
Resentment, I think, is kind of a subcategory of envy.
But how could one have an educational system that deals with all aspects of the personality, not just various kinds of more or less detached mental activity? How can one change an educational system that, at any given time, is going to be imparting the reigning orthodoxy?
It’s ideology, its politics.
In a tribal culture, of course, this means the children are educated, or rather initiated, into the skills and customs of the society; in a more or less stable society, it is necessary that children be brought up and integrated into the society as it is, maintaining its own particular social, cultural, and religious system.
But we’ve got an unstable society set up in such a way that competition, greed, envy, and pride are regarded as good, or at least as necessary evils, because they propel economic growth. Having lived in third world countries, like Malaysia and India, I’ve seen villages where people were still living in the older, traditional way, with its built-in social and religious constraints on envy, greed, and pride. But when the educational system comes in, modern attitudes soon begin to make an impact. One of the first things it does is to raise young people’s expectations, making them want more, making them more ambitious. Then they can be motivated to do all the things that developing economies need, such as become people who are prepared to go and live in smelly, crowded places, work long hours subject to an imposed discipline, turn up at regular times in the morning for work, and all that kind of thing. Schools themselves epitomize this disciplining process, subordinating both spontaneity and local tradition into a standardized pattern, laid down in ministries of education, advised by foreign experts from UNESCO, and subject to the rule of the clock.
When I was staying in a Malay village, a kampong, there was an old man who lived in a neighboring hut who was extremely amiable, usually smiling, always with time for a chat. One day I and my village hosts met him as he was setting off on his bicycle to the local market to sell a few bunches of rambutans, a delicious fruit in the litchi family. In conversation he said it was an unusually good year for his trees, with a good crop, at a time when the market prices for rambutans were unusually high. He explained he was happy because he needn’t take so many to market; he could get enough money by doing less work. A semi educated young man pointed out to him in a rather superior way that he could get much more money than usual if he took more to market. But he replied, “Why do I need much more money? I’ve got enough selling these.” For him, his good fortune with the rambutans was not seen as an opportunity to make more money, but to do less work and to enjoy life more. He was thinking qualitatively; the young man was thinking quantitatively, in the modern style. The idea of “enough” was the mark of the uneducated simpleton.
The modern mentality is that more means better; quantity prevails over quality. That’s the culture we live in, and I suppose the educational system necessarily reflects it. But in trying to imagine a different kind of education, how can new paradigms be explored when there’s a reigning paradigm in force? The only answer seems to be to set up an alternative model. It seems to me that we already have an alternative model of education which is better than most of what happens in schools and universities. And that’s in workshops. You can go to workshops on many different subjects and to learn many different skills, but the style of teaching is very different from that in institutional education.
For example, my wife, Jill Purce, gives chanting workshops, and the people who come do so because they really want to chant. They want to learn by experience, not just intellectually. Most people who go to workshops get really fed up if someone just lectures at them. There’s an implied participatory element in workshops, an experimental element, and an attention to group dynamics that is absent from most classrooms and lecture halls.
Workshops are not perfect, but in them I think we already have, up and running, an alternative kind of education. But the workshop type of education is functioning mainly for the middle-aged; in most parts of the Western world it has little contact with people in their teens or twenties.
Or the poor; it’s a middle-class phenomenon.
It’s a middle-class, middle-aged phenomenon. But this is one possible model of a different way of doing things.
Another possible breakthrough is in terms of some of the new technology. Younger people with computers are educating themselves through dialogues and discussions on the Internet. Interactive programs are a fascinating way to learn also. One thing that is clear is that young people are good with this technology; they learn it quickly. It’s like a morphic field; there’s a memory developing and it gets easier with each generation. And do we really need all the paraphernalia that goes into school systems? It’s terribly expensive, since essentially learning is something our minds are yearning to do anyway. For me it’s a question of ideology. It’s the original sin versus original blessing mentality. If you think you have to force learning into people, then perhaps you need these systems which in many ways parallel prison institutions. You need wardens and superintendents and all that.
But if you believe that the human mind is original grace or original blessing, that the mind yearns to know and will do so if it’s led to the right waters, then it seems to me we could really simplify the whole process that we’re calling education. Part of it I think is peer group work, getting people to educate each other. That’s a big part of workshops too. It’s what goes on after the sessions and between the sessions, dialogues with people.
And certainly the model that we’ve been putting out for eighteen years at the Institute in Culture and Creation Spirituality is a conscious effort in this direction. I too have always believed that these retreat and workshop models are truly an alternative. But we also try to work within the system we have so that the accreditation is still there. Workshops don’t give accreditation, they don’t give real degrees. And degrees are important to people for financial and security reasons. It is important to work within the system but offer what I would call curved instead of square models of education.
The kind of work we do with art as meditation, with body work, rituals, along with intellectual work, combine right and left brain training. It’s very effective. There is a lot of energy. It’s a transformative process for people, and I would like to see this shared at all levels. It think often of how our children, the youngest children, still get crayons and are encouraged to draw and to use their imagery faculties somewhat . But it’s right in their adolescence when they need this experience most that we take it away and make them so serious about getting into college and about doing only the left brain work.
It would be folly of us at this time not to take a hard look at aboriginal peoples and ask how they educated their young. Their cultures have lasted tens of thousands of years. Ours was ready to blow up the world after three hundred. We should draw from what’s there. Ritual, of course, is primarily how they educate the young. It’s impossible to have a healthy educational system with ritual, and by ritual I don’t mean forcing kids in to hear prayer from a pulpit. I mean imbibing the great myths and the great stories that are greater than industrial capitalism. In other words, our Creation stories.
These can be done through mythology and the very thing we’ve been talking about: praise. Maybe a more appropriate place than churches for teaching praise would actually be schools. Then maybe the elephants would be more relevant. As you point out, so much of what goes on in education is taking apart the elephant, getting the facts about the elephant. But seldom are we exposed to the awe of the elephant. That’s what ritual can do. It seems to me that a condition sine qua non for education must be ritual, because we have to fill the hearts and minds with something very great. We must educate in awe again.
That is what myth is—it’s a language for that which is too great to fit into mere factual compartments.
Fox finishes the Revitalizing Education Chapter with the following examples of an embodied approach to education:
In the work is the learning. That’s the key: hands on. What we create ourselves, what we make ourselves we remember. For example, my brother who’s a very creative teacher, years ago had fifth and sixth graders, and for physiology he had them make skeletons. He got a call from a parent who said, “I’m a professor of medicine and I just quizzed my daughter. She knows more about the human body than my medical students do after their first year of medicine. What are you doing in class?” “Well, “my brother said, “we made skeletons.”
To make a skeleton you’ve got to know something. For his class on history, he turned the classroom into Chartres cathedral and he had a team making flying buttresses and a team doing stained glass and a team doing pillars and so forth. He did this experiment without telling the kids: he brought in a stack of books on flying buttresses and didn’t say anything—just left them on the table. The team doing flying buttresses had to learn about them and they saw the books, took them, and devoured them. Two weeks later my brother quizzed them without telling them he was going to do it. He said that he was convinced these kids know more about flying buttresses then any engineer in the country. His whole thesis was that a child’s mind will absorb anything if it’s a delightful project. If you have the responsibility to make something out of your knowledge, then it’s going to happen.
Part of an apprenticeship is the mentor relationship, but part of it is hands-on experience. We have to ask, how can more of our knowledge be translated into hands-on things? That history class where the kids made Chartres cathedral—there’s a method here—what I call art as meditation. It’s all hands-on. Massage, for example, teaches you the body and if it’s done in a context of spirituality, it also teaches you the sacred. All art is hands-on. That is why art as meditation must be the core of any curriculum.
When you think about it, isn’t it possible that all knowledge in some way is art and this implies hands-on? It all relates to making or creating in some fashion and we don’t honor that enough.
Learning to be a good doctor is a different task than learning what you have to learn to become a doctor and get a license to practice medicine. It is part of the mentoring and hands on learning that occurs in your clinical years. For me, 8 out of 10 of my best teachers were my patients. When I have been driven with the deepest need to find answers, the reason behind was a question that came in the form of a patient. Ask them questions and listen to their answers. Pay attention and learn; allow yourself to change. As a beginning, allow me to share with you a formula given to me by Betty, one of my very first patients. She has been successful at healing, and when I asked her in 1997 and again in 2004 what she thought made that possible, she was able to tell me with clarity. Back in 1984, she contracted a viral illness that caused damage to her heart. She was told to get her life in order because death wasn’t far away as she swirled downward into congestive heart failure. When I met her on a hot and humid July morning in 1986, her chief complaint was that she could not breathe. I was covering a family practice during the month between my first and second post graduate year. As I gathered the context of her problem together in the taking of her history, I came to a sudden conclusion: it was an AHA moment. I stopped reading and writing, looked up at her and said “of course you can’t breathe.” She remembers this moment as the turning point in her life toward healing; she was at that time 62 years old. The last time I saw her, which was several years before her passing, She and her husband had my wife and I over for coffee shortly after her 80th birthday, and they showed us with excitement what they’ve been learning lately; they got up from the table and performed with amazing fluidity and grace the first 15 positions of the Tai Chi form they had been learning at the community education center in their town. Watching them, I was moved by their skill, and even more so by their joy. I started to cry. I saw myself in them. They will always be an inspiration to me. She lived more than 25 years past her “terminal diagnosis” of Viral Cardiomyopathy.
She spelled out her “formula for success with patients” which she of course commanded me to continue to cultivate, because I was… finally…. a doctor who had a clue…. What I did for her, she related, was:
1. Validate: “You heard me, and you said of course you can’t breathe.” That literally shook her out of a stupor she had been in since being told she wasn’t long for this world. She felt someone finally got in her space, understood how she felt. That was the point of engagement between us.
2. Offer help with understanding the problem. What is it? How does it cause a problem with the way her body worked? My first suggestion was air conditioning for their home. I explained why. This is of course, the interplay between basic physiology and physics. What would help most with breathing if you have congestive heart failure in July? She looked at me like I might be crazy, then asked if she brought her husband back the next day, would I explain it to him? Yes, of course. That was a beginning. It shifted the treatment of her condition from something out there administered by doctors to how can she (and her husband) work from within herself to best cope with a disease that had taken away her vitality? In the long journey that followed through explaining how each medicine worked, learning to perceive the medicines as help to her body instead of unwanted intruders, cardiac rehabilitation, and re-involvement with her community, she successfully negotiated the path back to seeing herself as a whole person again.
3. Initiate and negotiate referrals to other doctors, therapists, and treatment/test procedures for her. This is a sensitive task that requires finesse. It is an art. Your skill at it is developed over time as you practice within a community. For each individual patient, trying to choreograph the interplay of personalities, sequence of events, balancing the patients’ needs to participate and to receive, is a dance. It involves talking about what to expect, what might happen at the visit, how to prepare for it, and what possible options are available for treatment. If you know your patient well, you can introduce her to the network of people available in the community that can best help her. This helped her figure out what kinds of services and doctor personalities/styles worked best for her. The health care system is scary for patients. It is a foreign land, and it does not feel safe. I helped her find her way through it back in the 80s, and she gained a certain confidence. Yet, in 1999, when she required a mitral valve replacement, she called me again, and asked that I help her with this new and frightening task. In doing so, I was once again blessed to be part of her healing. I attended her surgery and watched her sail through the recovery with a smile on her face, the quiet little former family doctor standing in the background.
Of course, over all that time, my ongoing task was to cultivate relationships with like-minded practitioners in my community. When I refer a patient to them, I have already developed a trusting, authentic relationship with another person whom I know will respect my patient and deliver exemplary care within their field of expertise.
As a physician, I think the most powerful tools for healing I use on a daily basis are:
- Being present and aware
- Being able to use my awareness to Empower my patients
- Being a good Educator
- Being able to Encourage my patients to keep trying
What is important about a therapeutic relationship?
- Space------physical and emotional
- Time for silence
- Skill in administering the treatments or negotiating for the needed treatments
No two visits are the same. You don’t know what will be happening when you go into the room. If you think you do, then stop and think again. Take a risk. Listen.
David N. Grimshaw, DO
 av•a•rice : n. an immoderate desire for wealth; cupidity. [Middle English, from the Old French, from Latin avāritia, from avārus, greedy, from avēre, to desire.] definition from the American Heritage Dictionary of the English Language, 3rd Ed., Houghton Mifflin Co., Boston, 1992.
 sina qua non: "an indispensible condition," 1602, from L., lit. "without which not," from sine "without" + qua abl. fem. sing. of qui "which" + non "not." Fem. to agree with implied causa. The L. phrase is common in Scholastic use. Sometimes a masc. form, sine quo non, is used when a person is intended. Proper plural is sine quibus non.
 Fox, Matthew, and Sheldrake, Rupert. Natural Grace: Dialogues on Creation, Darkness, and the Soul in Spirituality and Science. Image Books: Doubleday, New York, 1996, excerpts from Chapter Seven: Revitalizing Education, pp. 185-206.
 ibid., p. 206