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East west behavioral medicine service integration
1. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
East West Behavioral Medicine Service Integration
A patient
A patient's physicians
Oneself
Just a little bit . . . everyday
2. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
Eastern Thought
Western Thought
An ethic vs. a faith vs. a dogma
Internal context of hypothesis-testing
Not for those low tolerance of ambiguity
Patient goals, provider goals, human goals:
If you meet the
Buddha, kill him.
From scattered mind to concentrated mind
From concentrated mind to the one-mind
Let go of self-centeredness
Realize wisdom (integrate knowledge), realize internal
peace, realize happiness
3. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
Primarily social cultural psychological content
Goal to relieve suffering
Not an act of taking away or distancing
patient from their suffering
Help ourselves, patients, participants, see
cause, origin of suffering
Inevitable existence of own suffering
Inevitable existence of universal suffering
Do not meditate, be!
Do not think that you
are, be!
Don't think about
being, you are!
4. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
“You are in control, you are not in control”
Not to be fought with
Habits are human nature
Take good care of habits
One should not fight against oneself
After one or two or three minutes, that
habit (thought, feeling, behavior) will pass
You have to be gently alert, mindful
Not a question of getting rid of emotions,
but knowing they are there, without
being carried [away] by them
In the garden of gentle
sanity, may you be
bombarded by coconuts
of wakefulness.
5. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
Suffering arises from within, not from outside of us
An impermanent state
By observing states we can transform our
relationship with them
The journey toward relief of suffering is
partly an attachment, but a -healthy- one
Pain and suffering are a shared existence
All pain is the same
To feel love for one’s captors
Despite brutal conditions or treatment
Depth of feeling which goes beyond
mind
Without thinking of
good or evil, show me
your original face
before your mother and
father were born.
6. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
Suffering is universal
Within all people
Core of goodness
Filled with compassion and
acceptance
Contrast to original sin?
It is only with the heart
that one can see
rightly; what is
essential is
invisible to
the eye.
7. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
Brilliant sanity, inner stillness
Existentialism: Existence precede essence
Feminism: Being in becoming
Buddhism: Being with, but not becoming
To be with suffering without becoming it
To see clearly, to clear away,
Student asked Master
acknowledge
”What did you do
before you became
To put aside expectation, grasping
Master? Master
and wishful thinking
replied I fetched wood,
carried water. Student
Seeing without judgment,
asked What do you do
conditioning or desire
now that you are
Master? Master
replied I fetch wood
and carry water.
8. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
The enlightened mind
Also called unconditioned mind (or wise mind)
Innate and boundless capacity to show
compassion
Ability to accept and be with our experience
without attachment, desire or judgment
To follow an arrow
around a tree.
9. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
The Four Noble Truths
Life is [suffering] . . . but not punishment
Misunderstood in the West as negative . . .
If I have senses, I can feel pain
If I have feelings, I can feel distress
If I have capacity for love, I will have
capacity for grief
All things are impermanent
No one has a separate existence
We are all interconnected (do no harm)
Effort we make at avoiding this
chasm, the roots of anxiety, depression
10. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
Suffering due to -attachment-
Fail to recognize all things are imperfect,
impermanent, insubstantial
Cling in delusion that we or they are
indeed perfect, permanent, substantial
By clinging to it or them, we too will
If you don’t have a
be perfect, permanent, substantial
moment to
“Whirlwinds who wish to
be rocks”
“Nothingness that strains to be
something”
relax, relax
in the moment.
11. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
Try to turn loved ones into things,
demanding they not change,
try to change them into perfect partners
“A statue, though it may live
forever, has no love to give us”
Immortality by anxiety-driven
belief in fairy-tales
Not-knowing.
Making our children into ourselves
Go there daily.
This is rejuvenation, the
Getting ourselves into history books
source of creativity,
even therapy,
Cling to unhappy lives
rolled into one.
Change is too frightening
Become piece of a popular political group,
social group, etc.
12. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
Suffering can be managed, not cured
Reduce mental anguish, rather than
eliminating pain
Nirvana is similar to the existentialists’
freedom
A way to manage suffering is via
one’s own way via the Eightfold
Path . . .
There is no such thing as -cure
In other traditions
demons are expelled
externally. In the
Buddhist, Taoist, Zen
traditions, demons are
accepted with
compassion.
13. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
The Eightfold Path
Right view
Right intention
Wisdom
Right speech
Right action
Ethical conduct
Right livelihood
Right effort
Right mindfulness
Right concentration
Mental development
14. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
The eight are core biopsychosocial
Attainable only through one’s own efforts
Motivation (def): An unenlightened person’s
behavior, driven by craving or suffering
Motives for healthy action are expressed in
“negative” terms:
The man sees the
mountain,
the mountain
Non-passion or absence of passion,
sees the man.
non-hatred or absence of hatred,
non-delusion or absence of delusion
Undesirable behaviors: Hatred or malice,
delusion or false belief
15. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
Occasionally described in positive terms
Renunciation (joyful letting go)
Loving kindness
Wisdom
Understanding
No beginning or end.
We must go
slow to go
fast.
16. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
I. Right view (wisdom)
Nature of all things as imperfect, impermanent,
insubstantial
Self-inflicted suffering rooted in clinging
II. Right aspiration (wisdom)
True desire to free oneself from
Better to realize mind
attachment
than body.
When the mind is
Provider takes assertive role, helping
realized, one need not
patient become aware of roots of their
worry about body.
suffering
When mind and body
Patient must take assertive role, working
become one, we are
towards improvement
free.
Then we desire no
praising.
17. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
III. Right speech (ethical conduct)
Not lying to oneself
Abstaining from lying, gossiping, hurtful speech
Being true to others, we find it increasingly
difficult to be false to oneself (yin yang)
IV. Right action (ethical conduct)
If you are not available
Behaving oneself
to life, then life
Abstaining from actions that hurt others
will not be
available to
(and oneself)
you.
Killing, stealing, irresponsible sex
18. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
V. Right livelihood (ethical conduct)
Making a living in a non-hurtful way
The good one can do as an honest,
compassionate, hard-working accountant,
business person, lawyer, politician
Karma: Deeds, and the consequences they
bring
Each act of kindness “comes back to
you three times over”
Virtue is its own reward, vice its own
hell
Moral choice is something involving a
-real- person in a -real- situation
19. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
Full acceptance of one’s freedom, responsibility,
A matter of living courageously
Morality is not absolutes, but individual
conscience in special situations
If an act is rooted in genuine love, it is
good
With unfailing
If it is rooted in hatred, selfishness, apathy,
kindness, life always
presents what you need
it is not good
to learn.
Where you stay at
Without wisdom and morality,
home or work, the next
meditation is worthless, perhaps
teacher is going to pop
even dangerous
right up.
20. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
VI. Right effort (mental development)
Simple, direct practice, developing good habits
Loving kindness to all you meet, compassion for
those suffering, joy for others without envy
Evenly balanced attitude towards ups,
downs of life
To
attain knowledge,
add things every day.
To attain wisdom,
VII. Right mindfulness (mental development)
remove things every
day.
Acceptance of thoughts, perceptions
A “bare attention”
Deterrent to our tendency to sleepwalk our
way through life . . .
21. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
Avoidance of consciousness-diminishing, altering
substances (drugs, alcohol)
Food, sexual behavior, overwork, mindless
routines, rigid self-created rituals
Drowning oneself in entertainment, material
things
Anything that makes you less than fully
aware
sends you in opposite direction of
improvement, into deeper ignorance
22. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
VIII. Right Concentration (mental development)
Meditation to empty us of
our
attachments, avoidance, ignorance
Counting of breaths, mantras, internal prayer
Simple forms of meditation, best place for
those suffering, to begin
Anxiety, most common
manifestation of suffering
When not anxiety, perhaps anger
When not anger, perhaps sadness
Stopping without
seeing deteriorates into
stagnation.
Seeing without
stopping degenerates
into inquisitiveness.
Stopping and seeing
need each other.
23. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
The monkey mind can be quieted, better
understood by simple meditation
Simplification of lifestyle, avoidance of
sensationalistic, retreat to quiet location
“As long as you practice a little more”
Your last day is your wisest day.
Your last word or words?
The Mona Lisa smile
Eightfold path . . . a framework for
healthcare, therapeutic relationships
Less is more. The
perfected life is this life.
Buddhism is returning
to this life, your very
own little life.
24. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
Eckhart Tolle (e.g.)
Easy to comprehend, hard to live . . .
The ego self or mind is not the actual self
Time is an illusion, there is only the present
Past = identity
Future = dreams, hopes, fears
We can never experience either
A whole series of “nows”
All things are connected means constant unification
External pleasures carry disappointment
Pain is non-acceptance
The “pain body”
25. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
. . . Eckhart Tolle . . .
Okay to reminisce and plan
Work toward 10-80-10 . . .
Where are you?
Where is your patient? participant?
All problems are past or future, never present
There are no problems, only situations
E.g., Rescue a child from a burning home
Only three options
Remove yourself
Change it
Accept it totally
The way you do one
thing is the
way you do
everything.
26. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
. . . Eckhart Tolle
“Am I at ease at this moment?”
“I wonder what my next thought will be?”
We create our reality
We are witness to our emotions
Don’t look for peace anywhere than the present
No salvation in time
Observing the observer, as many -degrees-
from original as needed to obtain clarity
27. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
Forrest Gump :: Buddha
“Mama says they was magic shoes. They could
take me anywhere.”
“Mama always said, dying was a part of life.
She got the cancer and died on a Tuesday.
Sometimes, there just aren't enough rocks.”
“My name's Forrest
Gump.
People call
me Forrest
Gump.”
28. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
Forrest Gump :: Buddha
Recruit Officer: “Have you given any thought
to your future, son?”
Forrest: “Thought?”
Lieutenant Dan: “Have you found God yet,
Gump?”
Forrest: “I didn't know I was supposed to be
looking for him [her].”
“Stupid is as stupid does.”
“I'm not a smart man, but I know what love
is.”
Jenny: “Will you
marry me,
Forrest?”
Forrest:
“Okay . . .”
29. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
Forrest Gump :: Buddha
“I ran for three years, two months, fourteen
days and sixteen hours. When I was hungry, I
ate. When I was tired, I slept. When I had to
go, you know, I went!”
“I don't know if we each have a destiny, or if
we're all just floatin' around accidental-like on
a breeze. But I, I think maybe it's both, maybe
both happening at the same time.”
30. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
Linguistics and trance and reducing anxiety . . .
Intrapersonal, interpersonal
Either/or (West), both/and (East)
Hypnotherapies
The word “but” is usually divisive
The word “and” is usually unifying
Ericksonian [medical] hypnosis
Utilization
Both/and causes deepening
Like riding a train,
sitting backwards.
31. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
Meditation and trance
Forms: Tranquility, Insight
Aspects: Concentration, Progression
Achieve highest possible degree of concentration
Progressive calming of all mental processes
Tranquility by itself cannot lead to
Don’t be swayed
enlightenment
by external
-Insight- meditation needed to attain
circumstances.
this goal
Tranquility, temporarily altered
consciousness
Insight, enduring changes (lasts
forever)
32. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
Benefits of meditation, focus, mindfulness
Physiological changes
Reduction in oxygen consumption
Lowered heart rate (finite number of beats?)
Decreased breathing rate, blood pressure
Reduction in serum lactic acid levels
Increased skin resistance
The untrained person is always touched by
the body pain (Tolle)
But there are two kinds of feeling
Bodily
Mental
Illness
like an infant crying for
attention
Their demand is people
wake up
What is happening at
the present moment
33. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
In contrast, the well trained person . . .
“Touched by body pain,
Weeps not,
One kind of feeling,
A bodily one, not a mental one”
Physical pain can be accompanied by
psychological correlates, but does
not have to be
A second, subjective pain . . .
If you want others to be
happy, practice
compassion. If you
want to be
happy,
practice
compassion.
34. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
Mindfulness meditation
The physical sensation “as it is”
Not affected by cognitive, affective elaboration
Eastern approaches for therapeutic prophylaxis
and prevention
Self-monitoring, self-regulation
Palliative care
Stress inoculation training
Limited Healthcare yen
Tibetan body is “lu,”
something you leave
behind, like baggage.
Each time we say “lu,”
it reminds us we are
only travelers, taking
temporary refuge in
this life, this body.
35. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
Train to not develop intense
attachments
to material things,
the body, those around us
Less vulnerable to
Physical illness
PNI
Distress and suffering
Disorders arising from loss
Abnormal or debilitating
grief reactions
If we are willing to give
up hope that insecurity
and pain can be
exterminated,
then we can have the
courage to relax with
our situation.
36. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
Illness and health :: Health and illness
Our narrow, fixed perceptions
The devaluation of our self-worth
No better fuel than sickness to burn off
bad karma
There is no solid body
The gift of illness
Strips away false pride
-Am I living or dying?-
Illness tears you open
So real needs can flow in
Choice: Develop mindfulness or numb
pain (with distraction, drugs, etc.)
Meditation is not
against action.
It is not that you have
to escape from life.
It simply teaches you a
new way of life.
If you can keep alert,
any activity is
meditation, any
movement will help
you immensely.
37. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
Transcendence
If I am dying, what is this “I? Me? My?”
What is this exact moment or thing that
distinguishes illness from health?
Am I getting better?
Am I getting worse?
No essential difference
Life is a “terminal disease”
Holding onto anything blocks wisdom
Loss leads to transcendence
38. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
The illness opportunity
Generosity
Moral discipline
Patience
Effort
Concentration
Wisdom
Sickness and healing
“Illness a lamp, burns compassion”
Incandescent reaction
Understanding of self
Understanding of others
Student asked, How
can we escape the cold
and heat? Teacher
replied, Why not go
where there is no cold
and heat? Is there
such a place? student
asked. Teacher said,
When cold, be
thoroughly cold; when
hot, be hot through and
through.”
39. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
Beans and bowls (circa 1330 BC)
A good thought, a white bean in a bowl
A nongood thought, a black bean in a bowl
Mostly black beans
Half black beans and half white beans
Mostly white beans
Nothing but white beans
Not even any white beans
Self-examination means
awareness
and control.
40. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
Read, learn, think, feel, do . . .
Authors who have medical and healthcare backgrounds
Pema Chodron
Eckhart Tolle
Jack Kornfield
Thich Nhat Hahn
41. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
A patient
A patient's physician
Oneself
Challenge of application in our practice
Opportunity of application in our practice
The system is the patient and their family
Do the work . . . forever
No start, no end
42. east and west behavioral medicine service integration | core clinic medical section
andrew schechterman phd director of design planning | mcpn healthcare system | march 2005
Addendum
ACT
Core Process
Morita
UCD