Trauma & Art

End of the year post

“Stone did not become apple. War did not become peace. 
Yet joy still stays joy. Sequins stay sequins. Words still bespangle, bewilder…” Jane Hirshfield

“The boundary to what we can accept is the boundary to our freedom.”  Brach, Tara

“There is something wonderfully bold and liberating about saying yes to our entire imperfect and messy life.” Tara Brach

 “…. competence, autonomy, and relatedness, have been identified…… as these fundamental psychological needs that tend to lead to more intrinsic motivation….” Being Well podcast

This is the last post for this year. After considering various ideas I finally decided to write about Tara Brach’s book, Radical Acceptance, which I’ve been reading, refer to a few of my favourite children’s books, provide a link to a Being Well episode on generativity and productivity,  and include the poem Counting This New Year’s Morning: What Powers Yet Remain in Me by poet Jane Hirshfield, and two recent watercolours with a Christmassy spin…

 

 

 

 

 

 

 

 

 

 

 

I’ve been familiar with Tara Brach’s work and meditations on radical self-acceptance for several years, through articles and other material, and her online talks and meditations, but lately as I was thinking about the interdependence and tight link between psychological integration and acceptance I decided to buy the book. Tara Brach is a clinical psychologist and a renowned meditation teacher, and in this book she combines personal stories and concepts, case studies and meditation practices from her professional experience to create a map of a personal journey to more wholeness, presence and clarity. The book is also informed by Buddhist concepts and stories, but I think it can easily be read and used by people who are not familiar or interested in Buddhism. In my view, a lot of the value of the book lies in the exploration of our human experience in the moment and ways to work with our bodily experience and emotions, and awaken to our inherent worth amidst what is going on in our lives. In this book Brach rejects the notion that we are inherently flawed and deficient beings, and highlights the need to compassionately embrace ourselves and our lives, something that most of us have not been taught to do, at least in the West.

To be honest, I have been weary of the over focus of the self-help industry on acceptance, which to some extent, smacks of resignation and seems like an admonition to passively accept socioeconomic circumstances and dynamics and the way that things have always been. Sometimes it can sound like advice to people to accept their lot with a smile, without responding or rocking the boat. So whether it is bad treatment from others, inequity and marginalization of people, layoffs and decreases in wages or the further destruction of the environment by industries, to name just a few, we are advised to accept it all as inevitable and part of life.

In this book, Brach clarifies that Radical Acceptance is not self-indulgence or resignation or an excuse for withdrawal. It also does not mean defining ourselves by our limitations, nor does it make us passive. She says: “Radical Acceptance reverses our habit of living at war with experiences that are unfamiliar, frightening or intense.” She suggests that real acceptance is about fully acknowledging what is happening, feeling the emotions and sensations of the difficult or painful experience, which  increase presence and clarity, reduce the possibility of our being hijacked by our emotions and creates space for  a wiser or more helpful response. It can also facilitate healing and processing unresolved grief, and it allows us to let go of constriction in our bodies. Acceptance of our experience cuts through our psychological defenses like denial or dissociation or addictive behaviours and allows us to confront what we avoid or can’t bear to fully acknowledge.  She writes: “Not only do our escape strategies amplify the feeling that something is wrong with us, they stop us from attending to the very parts of ourselves that most need our attention to heal. As Carl Jung states in one of his key insights, the unfaced and unfelt parts of our psyche are the source of all neurosis and suffering.”

There are twelve chapters in the book and I will briefly refer to a couple of them. Brach begins the book by discussing what she calls the trance of unworthiness that we all seem to experience to some extent, which she explains is rooted primarily in the notion of being unworthy and separate from others. She claims that feeling unworthy goes hand in hand with feeling undeserving, separate from others and separate from life. For some it can show up as pride, grandiosity or arrogance, which she believes is the flip side of the trance of unworthiness.

Moreover, she writes that the sense of unworthiness and insecurity keeps us from realizing dreams, and that “as we free ourselves from the suffering of “something is wrong with me,” we trust and express the fullness of who we are.” She explains that we waste our precious lives by carrying the belief that something is wrong with us, which can often be lodged deeply in our subconscious mind. However, she writes because it is often deeply entrenched in us it is not easy to let go and heal; therefore, awakening from the trance involves not only inner resolve, but also an active training of the heart and mind. She has found that through awareness practices, we can free ourselves by learning to recognize what is true in the present moment, and by embracing whatever we see with an open heart. This cultivation of mindfulness and compassion is what Brach calls Radical Acceptance.

Brach discusses how we live in a culture that breeds separation and shame, where we learn from early on in our families, schools, workplaces and other contexts that in order to belong we need to compete and prove our worthiness, where “someone is always keeping score.” This she writes is especially true in the West, where the cultural message is that something is fundamentally wrong with us and that basically we are flawed by nature and we don’t deserve to be happy, loved and at ease with life; therefore, ,we must strive hard to overcome our flaws by controlling our bodies, our emotions, our natural surroundings, and other people.  We often project these feelings outward and make those we perceive as different from us the enemy, the Other. Brach writes that as we internalize this view of our inherently flawed nature, we become ensnared in the trance of unworthiness and we each develop a particular blend of strategies designed to hide our perceived flaws and compensate for what we believe is wrong with us.

Brach adds that believing that we are separate and incomplete, and, wanting and fearing are also part of evolution’s design to protect us and help us to thrive, but when they become the core of our identity, we lose sight of the fullness of our being, and we become identified with, at best, only a sliver of our natural being, “a sliver that perceives itself as incomplete, at risk and separate from the rest of the world. If our sense of who we are is defined by feelings of neediness and insecurity, we forget that we are also curious, humorous and caring. We forget about the breath that is nourishing us, the love that unites us, the enormous beauty and fragility that is our shared experience in being alive.”

In the second chapter, Awakening from the Trance: The Path of Radical Acceptance, she writes that maybe the biggest tragedy in our lives is that freedom is possible, yet we can pass our years trapped in the same old patterns as we get used to caging ourselves and gradually become incapable of accessing the freedom and peace that are our birthright  Brach asserts that our way out of this cage begins with accepting absolutely everything about ourselves and our lives, by embracing with compassion our moment-to-moment experience. We become aware of what is happening within our body and mind in any given moment, without trying to control or judge or push down or distract ourselves.

She clarifies that this level of acceptance does not mean putting up with harmful situations or not seeking personal or social change. Instead it is an inner process of accepting our actual, present-moment experience. And it requires we feel our sensations, emotions, desires, sorrow and physical pain without resisting or judging. She writes: “Clearly recognizing what is happening inside us, and regarding what we see with an open, kind and loving heart, is what I call Radical Acceptance. If we are holding back from any part of our experience, if our heart shuts out any part of who we are and what we feel, we are fueling the fears and feelings of separation that sustain the trance of unworthiness. Radical Acceptance directly dismantles the very foundations of this trance.”

She describes how genuine acceptance consists of two parts: seeing clearly and holding our experience with compassion. Clear seeing is mindfulness, and it is the quality of awareness that recognizes exactly what is happening in our moment-to-moment experience, and going to the root or origin of our experience. We become more aware of the intentions that motivate our behavior and the consequences of our actions both on ourselves and others. Brach writes: “Our attentive presence is unconditional and open—we are willing to be with whatever arises, even if we wish the pain would end or that we could be doing something else. That wish and that thought become part of what we are accepting.” Compassion involves tenderness towards our self and honors our experience as it is. It also makes our acceptance wholehearted and complete.

Brach also clarifies that the inquiry process suggested here is not a kind of analytic digging, in order to understand what caused a current situation, rather the intention of this kind of inquiry is for us to focus on our immediate feelings and sensations and to awaken to our experience exactly as it is in this present moment. She explains how Western psychology holds that aspects of our psyche that are not seen and consciously named exert control over our life. Therefore by naming what arises and relating to it with friendliness rather than fear diminishes its power and we are no longer driven by it. Engaging with the various practices suggested in the book can clear the debris and layers that often blind us, and can help us release,, one breath at a time, unhelpful long held beliefs and suppressed emotions, which in turn supports our changing within and our responding and acting out in the world.

This kind of sitting with our experience and feeling our discomfort or restlessness requires courage and resolve, and often in the quietness and stillness trauma, grief and other painful experiences may come up or we may be flooded by emotions or sensations. Because unprocessed pain keeps our system of self-preservation on permanent alert, stillness and focusing on our breath can activate pain and fear stored in our body. If this is the case, at least at the beginning we might require support and therapeutic or trauma informed guidance. Our fear or anger can often proliferate into a web of stories, and our grief may overwhelm us, but as Brach notes, as we engage with the practices / exercises we understand that all our reactions to people, situations, and our narratives and thoughts are basically reactions to the kind of sensations that are arising in our body. She concludes that “While there are times in our life we might have had no choice but to contract away from unbearable physical or emotional pain, our healing comes from reconnecting with those places in our body where that pain is stored.”

In the next post I might include one of the several tools / practices provided in the book.

I’ve also chosen four beautifully illustrated books for children, and adults, related to the spirit of Christmas and war.

The Christmas Miracle of Jonathan Toomey written by Susan Wojciechowski and illustrated by P.J.Lynch is a moving tale of the love and generosity people hold in their hearts, even though it may not always be apparent at first sight. Jonathan Toomey, a fine woodcarver, is always alone and unsmiling, and nobody knows about the mementos of his lost wife and child that he keeps in an unopened drawer. But one winter’s day, a mother and her young son approach him with a request that changes all this.

The Gift of the Magi written by O’Henry and illustrated by Lisbeth Zwerger is a classic piece of American literature. It is set in New York at the turn of the twentieth century and it tells the story of a young couple and the value of love, which can be a haven from poverty and the harsh world outside. It was first published in 1905

The Lion and the Unicorn by Shirley Hughes is about a young boy, Lenny Levi, living in London during the Blitz in World War II, who is evacuated to a large mansion in the English countryside away from his Mom. Once there he has to deal with homesickness, loneliness, bullying and nightmares, but as he tries to adjust to the many changes he finds the true meaning of courage.

WHY?  Is a picture book by Nicolai Popov. It’s an allegory and commentary on war and its futility for children. It has no words in its original form, but in the Greek edition, ΟΙ ΜΕΓΑΛΟΙ ΠΑΙΖΟΥΝ TON ΠΟΛΕΜΟ: ΓΙΑΤΙ; the images are accompanied by text written by Πέτρος Γαϊτάνος and Μαριάννα Κριεζή. The book communicates its message through images. At the beginning we view the beautiful countryside, but bad events progress rapidly as violence escalates to the point that the once beautiful landscape becomes a charred, barren wasteland.

A poem by Jane Hirshfield

Counting This New Year’s Morning: What Powers Yet Remain in Me

The world asks, as it asks daily:
And what can you make, can you do, to change my deep-broken, fractured?

I count, this first day of another year, what remains.
I have a mountain, a kitchen,  two hands.

Can admire with two eyes the mountain,
actual, recalcitrant, shuffling its pebbles, sheltering foxes and beetles.

Can make black-eyed peas and collards.
Can make, from last year’s late-ripening persimmons, a pudding.

Can climb a stepladder, change the bulb in a track light.

For four years, I woke each day first to the mountain,   //   then to the question.

The feet of the new sufferings followed the feet of the old,   //   and still they surprised.

I brought salt, brought oil, to the question. Brought sweet tea,
brought postcards and stamps. For four years, each day, something.

Stone did not become apple. War did not become peace.
Yet joy still stays joy. Sequins stay sequins. Words still bespangle, bewilder.

Today, I woke without answer.      //     The day answers, unpockets a thought from a friend

don’t despair of this falling world, not yet    //   didn’t it give you the asking

Finally, a podcast to maybe listen to by Forrest and Dr Rick Hanson at: https://rickhanson.com/being-well-podcast-harnessing-your-generativity-the-secret-to-productivity-creativity-and-consistency/

Some of the topics discussed are: productivity and our generative drive; motivation, aggression and creativity; the process of making something as a form of healing; the role our self perception plays; the three necessary factors that contribute to our ability to remain generative: competence, autonomy, and relatedness; agency and being aware of what we can and cannot influence; the importance of a work ethic and effort; the role of passion and enjoyment, and finding our why.

Resisting dehumanization, dignity conserving health care and art

PART TWO

“Dehumanizing beliefs are theoretical rather than perceptual beliefs. We get them from outside of ourselves—from propaganda and ideology, and from the testimony of those who are supposed to be authorities. When we accept the view that some group of people are less than human, we have to overrule the evidence of our senses.” David Livingstone Smith

“Because so many time-worn systems of power have placed certain people outside the realm of what we see as human, much of our work now is more a matter of “rehumanizing.” That starts in the same place dehumanizing starts—with words and images. Today we are edging closer and closer to a world where political and ideological discourse has become an exercise in dehumanization. And social media are the primary platforms for our dehumanizing behavior.” Brené Brown

This is the second part of the essay posted on November ^8th, and it mostly focuses on the concept and theory of race, the difference between racism and dehumanization, how dehumanization helps dissolve our natural human inhibitions to harm or kill another human being, understanding dehumanizing beliefs as ideological beliefs, and what we need to do to resist dehumanization. As I’ve recently been engaging with watercolour painting I have also included some new artwork. I’ve also included a link to an article on dignity in health care by Harvey max Chochinov, a topic that Ι will probably return to in future posts. The article is about dignity conserving care, which consists of the caring for, as well as, caring about patients by health practitioners.

Smith unpacks the concept of race to some length. Here I will try to only summarize the multiple threads of the discussion. First, the overwhelming majority of serious scientists deny the biological reality of race, and the idea that Black and White people are separate species with no common evolutionary ancestors. Smith discusses how we need to let go of the tendency to equate race with skin colour, which he says is a marker for race only for historical reasons involving colonialism and slavery. He says that once the concept of race gets unpacked, we notice that “people use words like “ethnicity,” “culture,”  “religion” and “nationality” to talk about race without even realizing that’s what they’re doing.” He tells us that  people think that a person’s race is something that’s objectively true of them, rather than being merely a matter of how other people categorize them, or that a person’s race is something that’s deep and unalterable, and which gets passed down, biologically, from parents to their children. Scholars who study race call this the idea of racial essentialism.

He explains that chemistry is one of the few domains where essentialism earns its keep. For instance, hydrogen is made out of atoms that have only one proton. That’s why hydrogen is assigned the atomic number 1. All hydrogen atoms have the atomic number 1, and nothing that’s not hydrogen has that atomic number. But the theory of essences doesn’t make any scientific sense when it’s applied to races. As a matter of biological fact, he claims, “there just isn’t a racial equivalent of an atomic number. Races don’t really have essences. We just imagine that they do. But despite its falsity, racial essentialism maintains a fierce grip on the human imagination.”

The common conception of race is actually a theory of race, a “folk theory” rather than a scientific or philosophical one. He describes how we use the idea of hidden racial essences to explain the observable diversity because people come in different physical packages and behave in a wealth of different ways. He does clarify that beliefs about race may not always be destructive because in a racist society, the idea of race and racial pride can provide a sense of strength and solidarity for the oppressed, but this comes with the price of the perpetuation of the circumstances that make such solidarity necessary. Furthermore, he reminds us that the idea of race also provides a sense of strength and solidarity to Nazis or White supremacists.

As I mentioned above, Smith distinguishes racism from dehumanization. He claims that racism is the belief that some races consist of lesser human beings, but dehumanization is the belief that members of some races are less than human beings. He writes: “Grasping this difference is crucial, because it throws light on why groups are almost always racialized before they’re dehumanized, and why it is that racist attitudes so readily morph into dehumanizing ones. Dehumanization is racism on steroids.” He asserts that false ideas about race need to be combated because conceiving of people as racially other easily morphs into dehumanizing them. He writes:  “although we can see diversity, we can’t see race. Dividing human beings into races—into “our kind” and “their kind”—is the first step on the road to dehumanizing them. We first set them apart as a fundamentally different kind of human being—we treat them as a separate race—and only later transmute them into subhuman creatures fit to be exterminated or enslaved.”

Part of the book focuses on how processes of dehumanization dissolve our natural human inhibitions to enslave, torture or kill another human being.  Smith describes how humans inhibit severe forms of violence against members of their own community. This resistance to performing these acts of violence, he says, is an inhibition, not a prohibition. It isn’t merely grounded in morality. He describes how our survival depends on being members of cooperative communities and our social way of life demands that we be exquisitely attuned to one another. Our violence-avoidance isn’t only restricted to the local community, but extends to every human because we cannot help but recognize them as fellow human beings. This, he writes, “is a gut-level response to seeing others as human. It’s not something that we can turn on or off at will.” But, if human beings have inhibitions against killing, he asks, how do they manage to regularly prosecute wars and genocides?

Firstly, he claims that it’s our desire to harm others that leads to their dehumanization, rather than the other way around. Dehumanization, he writes, happens when one group of people sees benefits and advantages in doing violence to another. Morally disengaging from the second group through thinking of them as less than human solves the problem, because it makes their actions ethically allowable. Moreover, the violence that dehumanization unleashes often has an intensely moralistic tone, that’s why Smith believes that focusing on what’s morally right is not enough to end dehumanization, Instead, he writes: “we must block the processes—both psychological and political—that subvert our automatic perception of the humanness of others.” Other ways that our clever brains have been able to selectively disable our inhibitions against performing acts of atrocity on our own kind is through material technology. We now have created weapons that make it possible for us to kill at a distance, Alcohol and drugs, and war rituals, are also used to disable inhibitions.

Dehumanizing beliefs are ideological beliefs

Dehumanization is, according to the writer, a psychological response to political forces that mesh with our propensity for psychological essentialism and hierarchical thinking. Simply put, powerful social forces interact with equally powerful psychological ones to produce altered states of consciousness in those affected by them that cause them to see other human beings as less than human. And then once they’ve taken root, people are liable to perform acts of atrocity that they would never have imagined they could perform. More specifically, dehumanizing beliefs are ideological beliefs. So, Smith says, in order to understand how dehumanization works, and to resist it effectively, we’ve got to have a clear conception of ideology. He finds the notion of ideologies as beliefs that have the function of fostering oppression useful.

He writes:  “Oppression” is a word for situations in which one group of people gets some real or imagined benefit by subjugating another group of people. It’s an intrinsically political concept, because it pertains to the distribution and deployment of power among whole groups of people rather than between individuals.” He states that ideological beliefs are reproduced culturally because they promote the oppression of some group of people while benefiting another group. He further notes that the people who might benefit from oppression need not intend to oppress others and they may not even be aware they are cogs in an oppressive sociopolitical or economic machine.

The last chapter of the book, with the title Resist, is a summary of key points about what we need to know and do so that we may resist dehumanization. Smith writes that resisting dehumanization is complicated and it’s not something that can be expressed in a list of bullet points or rules. He assumes from the outset that resisting dehumanization has to be based on an understanding of how it works. He claims that first we need to understand that it is both political and psychological. It’s both about the distribution of power in the public sphere and about the beliefs that we form about ourselves and others, and therefore, we need to consider both the political forces that push us to think of others as less than human and the psychological forces within us that make it possible for us to do so.

Thus, resisting dehumanization requires both political action and knowing yourself. The least we can do, the writer says, is to combat it in small ways in our daily life, calling it out where we see it, objecting to it as a dangerous rhetoric, opposing it in the voting booth, and also, opposing any dehumanizing impulses in us. He writes that we are all capable of dehumanizing others, and so we need to be vigilant about our own fears, biases, blind spots, and ideas we may have assimilated from society, as well as, our tendencies to essentialize others and to fall prey to dehumanizing propagandists, who play with our insecurities and grievances, demonize others, and then offer the illusion of salvation from them.

Moreover, because we can all, at times, fall prey to dehumanizing narratives we should avoid dehumanizing those that we witness dehumanizing others. He writes: “Instead of putting the process of dehumanization under a magnifying glass, there’s a tendency to castigate those who dehumanize others as evil monsters—to dehumanize the dehumanizers—and thus to indulge in the very form of thinking that one ostensibly seeks to combat. Describing other human beings as monsters is an obstacle to seriously addressing the problem. It doesn’t matter how repugnant or destructive their beliefs and actions are. Monsters are fictional, but dehumanizers are real, and they are mostly ordinary people like you and me.”

Smith also tells us that we should not confuse dehumanization with other kinds of bias because he explains it is not the same as racism, anti-Semitism, sexism, objectification, religious bigotry, or prejudice against other minorities, for dehumanization is potentially much more dangerous. He suggests that since understanding what it is and how it works is important in resisting it, it’s necessary to study history to learn about dehumanization. Learning about genocide, colonialism, racial oppression, and the darker pages of our national and international history, standing up for the truth and for humanity are important aspects of resisting.

As mentioned above, as human beings we naturally tend to see others as human beings, and Smith explains that dehumanization comes from outside of us. He writes: “The tendency to see them as subhuman creatures is foisted on us by people who have an investment in getting us to harm others.” He tells us that an important component of human nature is on our side in the struggle to resist dehumanization and that we should be wary of those that suggest that that the urge to dehumanize others is in our genes, He explains that although human beings have an inherent disposition to be biased against outgroups, this type of bias is a far cry from dehumanization, and also, where the line gets drawn between ingroup and outgroup is a political matter, not something coded in our DNA.

At this point I might need to add something that Smith discusses in the book, the fact that we also need to be aware of our propensity, as humans, to frequently hold conflicting beliefs. There are many reasons that we may hold contradictory beliefs, and ideally, we would be able to notice them and either hold both or see what they might be serving or where they might be stemming from. He writes of the contradictions often inherent in dehumanization and that it is common for people who denigrate others as animals  or monsters to reveal that they also recognize them as human beings. At some point he asks: But in the realm of real life, not horror movies, how do our minds manage to think that a single entity can be at the same time human and subhuman?

Another key point he emphasizes is the need to support a free press and freedom of speech because dehumanizing ideas are often spread and reproduced through media. This is the reason that totalitarians destroy freedom of the press.  It is also asserted that dehumanizing propaganda is usually not about hate and that it trades mostly on desperation, fear, and the longing for salvation. Smith describes how the masses are manipulated and how groups pave their way to power. In order to resist dehumanization it is helpful to know the warning signs. We need to listen closely for language that describes the despised group of people as parasites, lazy, dirty, diseased and criminal or prolific breeders that will overtake and replace the majority. We also need to be alert to animalistic slurs. Finally, it is important to resist both being desensitized to suffering and blaming the victims for their plight.

Additionally, as discussed above, it is important to remember that that biological race is a social invention for justifying oppression. He claims that resisting race is crucial for resisting dehumanization, because as long as racial categorizing persists, dehumanization is just around the corner. He writes: “Washing your hands of the concept of race is an act of resistance and defiance. It doesn’t mean that you are betraying your family, your culture, or your history, or the work of securing justice for racialized people, because it does not deny that people have been treated as though race is real, and they have suffered from it.” He acknowledges that people will try to put people back into the racial box, because you become a threat to the whole hierarchical racial system. He admits this is easier for white people because in most circumstances they have not been racialized, but this he adds, only confirms the fact that race is by its very nature an oppressive ideology.

Finally, if Smith was writing the book this year there would sadly be new current atrocities to discuss and analyze.  The current wars in the Middle East and between Russia and Ukraine, for instance, bring to the foreground an additional factor that fewer journalists, reporters and commentators on these events discuss, with the exception of some more courageous or truthful maybe individuals, the fact that there is a lot of profit to be made from surveillance, conflict and disaster. The more powerful states that have industries that produce weapons and other types of technology, which facilitate oppressive regimes, need both testing grounds and an ever expanding market. Many governments of countries that have these types of industries inevitably become complicit in many oppressive regimes, dictatorships, wars and processes of genocide, and the inevitable environmental destruction. There are countless historical examples in the 20^th and 21^st centuries, which I will not go into here, but if, peace, the environment, whatever levels of privacy are available, and the future of our children, were to become serious concerns for the human species we should start engaging in more difficult and courageous conversations, especially those in leadership roles, who have the knowledge, the resources and the power to make a difference.

A link to an article on dignity in health care by Harvey max Chochinov (2007 Jul 28; 335(7612): 184–187)  at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1934489/

“In his 1927 landmark paper “The care of the patient” Francis Peabody wrote: “One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.”  The A, B, C, and D** of dignity conserving care may provide clinicians with a framework to operationalise Peabody’s sage insight and relocate humanity and kindness to their proper place in the culture of patient care.” Harvey Max Chochinov

** A is for attitude, B is for behaviour, C is for compassion and D is for dialogue

Some helpful suggestions and questions, proposed in the article for physicians and other health providers to engage with, in order to provide this kind of health care:

Attitudes

• How would I be feeling in this patient’s situation?
• What is leading me to draw those conclusions?
• Have I checked whether my assumptions are accurate?
• Am I aware how my attitude towards the patient may be affecting him or her?
• Could my attitude towards the patient be based on something to do with my own experiences, anxieties, or fears?
• Does my attitude towards being a healthcare provider enable or disenable me to establish open and empathic professional relationships with my patients?

Behaviours

• Treat contact with patients as you would any important clinical intervention
• Behaviours towards patients must always include respect and kindness
• Lack of curative options should never rationalise or justify a lack of ongoing patient contact

Compassion

Getting in touch with one’s own feelings requires the consideration of human life and experience.  Some ways to do this:

• Reading stories and novels and observing films, theatre, art that portray the pathos of the human condition
• Discussions of narratives, paintings, and positive role models
• Considering the personal stories that accompany illness
• Experiencing some degree of identification with those who are ill or suffering

Dialogue

Acknowledging the patient’s personhood       &

Questions to increase  knowing the patient

• “What should I know about you as a person to help me take the best care of you that I can?”
• “What are the things at this time in your life that are most important to you or that concern you most?”
• “Who else (or what else) will be affected by what’s happening with your health?”
• “Who should be here to help support you?” (friends, family, spiritual or religious support network, etc)
• “Who else should we get involved at this point, to help support you through this difficult time?” (psychosocial services; group support; chaplaincy; complementary care specialists, etc)