Understanding Death and the Process of Dying

Rheanna Hoffmann recently interviewed Frank Ostaseski on healing grief through compassion and love.  Frank founded the Metta Institute whose mission is to provide innovative educational approaches to developing skills in “mindful and compassionate end-of-life care”.  Rheanna herself is the founder of The Whole Practitioner, dedicated to helping nurses move beyond frustration and burnout to “rediscover, health, balance and their core values”.

Frank and many other writers on the process of dying maintain that it is not just a medical event but is much broader and more holistic than this form of the mechanical model.  Increasingly, research is confirming too that consciousness is more than our physical brains.  Frank argues that the unwillingness in our culture to talk about death and the dying process is preventing us from learning the lessons that the dying can teach us and our children.  He contends that if we learn about the dying process and face the reality of our inevitable death, we can better appreciate the “preciousness of life” and live our lives more fully and in alignment with our values and purpose.

The process of dying

Frank describes dying as a process of “stripping away”.  It’s as if everything that is associated with our “ego” – our sense of self – is peeled away.  Undoubtedly, our mental and physical capacities decline, and this begins with the aging process.  But the stripping away is much more than that – it is losing attachment to everything including our spouse or partner, our home, our roles, our possessions, and the animals in our life.  Frank also talks about dying as a “sacred process of transformation” through which we see things in a new light, have a deeper understanding of the meaning of life and the value and true purpose of our own life – in other words “an awakening”, no longer limited by our concept of a “small separate self”.

Peter Fenwick, when talking about What Really Happens When We Die, suggests that the more we hold on to our ego needs and refuse to let go, the more difficult is the dying process.  Living our life in a selfless way – not totally self-centred — makes the process of dying easier because we are not absorbed in holding on to our attachments.  Being “other-centred” in the pre-transition phase of our life makes dying easier and enables the final transformation that Peter describes as entering a “spiritual domain” where you lose your identity as a separate self and become identified with the total cosmos – the universal whole.

Peter discusses the change in our level of consciousness in the light of research into Near Death Experience (NDE).  He maintains that consciousness research focused around NDE experiences confirm a “widening of consciousness” that manifests in:

  • Losing the self-narrative – the self-talk that we employ to boost or deflate our egos
  • Being just in the moment – not absorbed in the past or anxious about the future
  • Experiencing “unbelievable” happiness
  • Tending to be transcendent – losing a sense of duality (our self and others) and becoming merged with the cosmos.

Peter has co-authored The Art of Dying with Elizabeth Fenwick which provides personal accounts from those who have been dying and people (healthcare professionals, carers and family) who have been with them and supported them in the process of dying.   The accounts discussed, as well as other research into NDE experiences, confirm that consciousness is much more than our physical brains.  Monica Renz, author of Dying: A Transition, provides a process-oriented approach to end-of-life patient care that incorporates confirming the dignity of the patient, understanding the transition process of dying and being able to sensitively engage in the symbolic journey described by dying patients.  Her observations and detailed accounts are based on attending 1,000 cancer patients during the process of dying.  Monica describes the dying process as both an archetypal and a spiritual process and contends that, in the process of transition, patients move through fear into a “space of peace, acceptance, dignity and tranquillity characterised by connectedness and even luminosity”.

Reflection

Our cultural blinkers blind us to the reality of the dying process and the nature of our own inevitable death.  As we become more aware of the dying process through our own research and study, we can learn to appreciate how precarious our life is and how precious is the process of both living and dying.  As we grow in mindfulness through meditating on death and reflecting on its implications for how we live our life, we can progressively come into more alignment with our life force, our values and our life purpose.

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Image by Hans Braxmeier from Pixabay

By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Disclosure: If you purchase a product through this site, I may earn a commission which will help to pay for the site, the associated Meetup group and the resources to support the blog.

Self-Care for Healthcare Professionals

Dr. Reena Kotecha presented at the 2020 Mindfulness & Compassion Global Summit on the topic of self-care for healthcare professionals.  Reena highlighted the irony of healthcare professionals caring for everyone but themselves and, in the process, suffering pain, disillusionment and burnout.  She shared her own story of depression, mental illness and suicidal thoughts resulting from working as a young doctor in an emergency department in a hospital.  She was drowning in self-doubt, suffering anxiety about the future and trying to cope with her present level of stress symptoms such as palpitations and sleeplessness.  Reena found her way out of the dark hole of depression through meditation.

She highlighted the stresses that healthcare professionals are experiencing in these challenging times of the Coronavirus.  Reena spoke of frontline healthcare workers who had to move out of home to protect their family and/or elderly parents, of the sadness and grief they experienced with the death of patients, of the frustration of having inadequate resources (such as personal protective equipment) and of their fear for their own safety in terms of the impact of their work on their mental and physical health.  Frontline professionals experience the intensity and immediacy of Coronavirus-related stress and emotional inflammation as a result of the risks to the life of their patients and their own life.

Barriers to healthcare professionals seeking help

Reena emphasised that healthcare professionals not only tended to overlook caring for themselves but also failed to seek help for their mental welfare when they really needed it.  She spoke of the barriers that stop healthcare workers from seeking professional support (some of which she experienced herself):

  • Training focus – all the focus of their training is on how to care for others, very little of the training is focused on caring for themselves or how to seek professional help for themselves
  • Priority focus – healthcare professionals are singularly focused on caring for others and they fail to give priority to their own mental and emotional health that would actually enable them to care for others more effectively and in a more sustainable way.  As Reena points out, healthcare professionals are much more comfortable and more proficient in the role of caregiver than that of “care-taker”.
  • Career focus – healthcare professionals become concerned about what others, including management, would think of them if they admitted to not coping and experiencing some form of mental illness (which still carries its own stigma).  They can be concerned about how others will judge them and what impact this would have on their career.
  • Expectations focus – the community has highlighted the heroic efforts of the frontline healthcare workers but this brings with it an unrealistic set of expectations that they are all strong and courageous, free from normal human emotions of fear, anxiety and self-doubts and the resultant experience of depression with its concomitant impacts of inertia, exhaustion, reticence and lack of energy.  In the light of this community expectation set, they are reluctant to admit to “weakness and fragility”.

Young healthcare professionals may begin their career with an unerring focus on their patients, giving priority to their caregiver role and ignoring their own needs.  They may feel really uncomfortable about being seen as “needy” or becoming a “care-taker”.  Professionalism is interpreted by them as being strong and efficient, able to cope with any situation.  Gradually, however, the singular focus on patients begins to take its toll and is compounded by the fact that no matter how hard or fast they work, demand continues to outpace resources and capacity.  They begin to experience stress, fatigue and sleeplessness.  Despite these signs of not coping they push on – driven by their own expectations and the perceived expectations of others, including the “worshipping” community.  Burnout results when the gap between what they are putting in and their intrinsic satisfaction with their work widens to the point where they lose belief in the value of what they are doing – burnout occurs on the physical, emotional and spiritual levels.

Mindfulness as self-care for healthcare professionals

Self-care for healthcare professionals is a lifetime passion for Reena, partly generated by her own early professional experience but also reinforced by the healthcare workers who seek her help and support during these highly stressful times.  She is the founder of Mindful Medics – an 8 week course for healthcare professionals incorporating mindfulness, emotional intelligence, neuroscience and positive psychology. Participants in the course have experienced significant benefits for their mental and physical health as well as in their overall personal and professional lives.

Reena is also a highly recognised public speaker on the topic of her lived experience.  For example she presented at the Happiness and Its Causes Conference in 2018 on the topic, Personal Story: Healthcare Starts with Self-Care.   In her Summit presentation, Reena provided a gratitude meditation designed to focus on appreciation for what we have in the present to displace a focus on a disturbing past or anticipatory anxiety about the future.  There is so much that we can be grateful for and savour in our life – nature and our environment, the development of our children, our achievements and rewards and the space of being alone

Reena in an article, titled I am grateful…, recommends strongly that we develop a constant practice of expressing gratitude for the simple things that we have in our lives and highlights the neuroscience research that supports the benefits of gratitude for mental health and wellbeing.

Reflection

It is important to express compassion for others, especially healthcare professionals and those directly impacted by the Coronavirus.  However, we have to recognise the enormous stress healthcare workers are experiencing in these challenging times and be more aware of not adding to that burden by perpetuating the expectation that they, individually and collectively, can cope with any challenge at no cost to themselves.  We can also offer our support for people like Reena who are helping healthcare professionals to develop mindfulness as a means of self-care.  The Mindful Healthcare Speaker Series is one ongoing event that we can support.

As we grow in mindfulness by focusing on self-care through mindfulness practices and gratitude meditation, we can become more conscious of what we are thinking and feeling and be better able to appreciate the present moment and all it has to offer in terms of overall wellness and happiness.  Mindfulness enables us to identify our barriers and expectations, acknowledge when we need help, develop strategies to cope more effectively and progressively build our resilience.

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Image by Petya Georgieva from Pixabay

By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Disclosure: If you purchase a product through this site, I may earn a commission which will help to pay for the site, the associated Meetup group and the resources to support the blog.

Can You Experience Compassion Fatigue?

Kelly McGonigal in her presentation for the Mindful Healthcare Summit challenged the widely held belief that you cannot experience compassion fatigue. Many people contend that compassion fatigue does not occur because the heart is capable of endless kindness and love for others. Kelly maintains that motivation and goodness of heart are not sufficient to prevent the depression and burnout that can result from compassion fatigue. She asserts that compassion has to be supported by adequate self-care if it is to be sustained.

Compassion and the stress response

Kelly argues that compassion is like the stress response when viewed physiologically. Compassion floods the body with hormones such as dopamine and marshals the body’s energy to relieve the suffering of others. However, while this can be very energising and exciting in the short term, compassion takes its toll in the longer term both bodily and mentally, as we do not have endless physical and mental reserves.

The possibility of compassion fatigue can be increased where a helping professional or carer experiences vicarious trauma or moral distress – the latter being defined as being required to do things that clash with a person’s values or moral perspective, a frequently occurring ethical dilemma within the medical profession.

Compassion fatigue

Kelly suggests that compassion fatigue occurs when a person lacks the energy and resources to pursue their motivation to care in such way that it achieves personal satisfaction (activates the reward system). Outcomes achieved fall short of personal expectations and/or the expectations of others, despite the strength of the caring intention. The compassionate person feels exhausted and feels that the more they give the less they experience satisfaction – the gap between input of energy/time and the expected satisfaction increases, leading to burnout. The depletion of energy and satisfaction could be the result of factors outside the helper’s/carer’s control – such as structural blockages, breakdown in information exchange, overwork or under-resourcing.

Compassion needs nourishment

One of the issues that exacerbates the problem of compassion fatigue is the belief in the endless capacity of an individual to be compassionate through the goodness of their heart or the purity of their intentions. As a result of this false belief, helpers/carers fail to take the necessary actions to nourish themselves (and their compassionate action) and/or are reluctant to accept compassion extended to them by others.

Personal nourishment can take many forms – getting adequate sleep, meditation (especially self-compassion meditation), listening to relaxing/inspiring music, prayer (whatever form it takes) or drawing strength and healing from nature. It also requires an openness to receiving compassion from others – challenging false beliefs such as “no one else can do this”, “I will be seen to be weak if I accept help from others”, “I really shouldn’t pander to my own needs by having that short break or having a reasonable period for lunch”, “I can’t afford to become dependent on others for assistance”. Additionally, positive social connection– to offset the tendency to withdraw under extreme stress– is a critical source of self-nourishment.

As we grow in mindfulness through meditation our awareness of others’ suffering and our motivation to help are heightened. The capacity for compassionate action is not limitless and needs nourishment. Central to this nourishment is self-compassion.

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Image by DarkWorkX from Pixabay

By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Disclosure: If you purchase a product through this site, I may earn a commission which will help to pay for the site, the associated Meetup group and the resources to support the blog.

Compassion: Exploring “Where Does it Hurt?”

Tara Brach in presenting during the encore of the Mindful Leadership Summit, discussed the nature of compassion and how to develop it through mindfulness.  Tara’s talk was titled, “Radical Compassion: Awakening Our Naturally Wise & Loving Hearts“.  She highlighted the fact that our limbic system (emotional part of our brain) often blocks our compassion.  She offered a short meditation to help us to get in touch with understanding ourselves and to free up our “naturally loving” and compassionate heart.

Perpetuating the “Unreal Other”

Tara spoke about our tendency, and her own, to negatively impact close relationships through treating the other person as an “unreal other”.  This involves being blind to their existence and needs because of our pursuit of our own needs for reassurance, confirmation of our own worth, sense of power and control or many other emotional needs that arise from our desire to protect our self-esteem.   This preoccupation with fulfilling our own needs leads to judging others, instead of showing compassion towards them.

At the same time, we are captured by the “shoulds” that play out in our minds through social conditioning.   The “shoulds” tell us what we should do or look like, how to behave or what to say.  These mental messages perpetuate self-judgment which, in turn, blocks our sensitivity to the needs of others and our compassionate action.  Mindfulness can help us to get in touch with this constant negative self-evaluation and open the way for our compassionate action.

The difference between compassion and empathy

Tara pointed out that compassion arises out of mindfulness, whereas empathy engages our limbic (emotional) system.  Too much empathy can lead to burnout, resulting from taking on the pain and suffering of others.  She points out that neuroscience demonstrates that compassion and empathy light up different parts of the brain.  Compassion engages the neo-cortex and is linked to our motor system – compassion is about understanding another’s pain and taking action to redress it.  Empathy is another form of “resonance” but it results in immersion in another’s pain.

A short meditation: “Where does it hurt?”

Tara offered a brief meditation to help us to get in touch with how the limbic system sabotages our compassion.  The meditation begins with recalling an interaction that upset us or made us angry.  Once we have this firmly in our recollection, we can then explore what was going on for us. What made us angry and what does this say about our response?  What emotions were at play for us?  Were we experiencing fear, shame, disappointment or some other emotion?  What deeply-felt, but hidden need drove this emotion?  If we can get in touch with this emotion and the need underlying it, we are better placed to be open to compassion.

Once we can get in touch with our own needs and how they play out in our interactions, we can begin to understand that similar needs and reactions are playing out for those we interact with.  Tara points out that we all have “a foot caught in a trap”.  For some, it may be the weight of expectations or anxiety over doing the right thing; for others, it may be grief over a recent loss or the pain and stigma of sexual abuse.  Once we move beyond self-absorption, we can recognise the pain of others and extend a helping, compassionate hand.   We can ask them, “Where does it hurt?, and we can be more sensitive to their response because we have explored our own personal hurts.

As we grow in mindfulness, we can better understand ourselves, our needs and the hidden drivers of our emotions and responses in interactions with others.  This will pave the way for us to be open to compassionate action towards others, including those who are close to us.

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By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Image source: courtesy of eliola on Pixabay

Disclosure: If you purchase a product through this site, I may earn a commission which will help to pay for the site, the associated Meetup group and the resources to support the blog.

Compassion and Neuroscience

In her presentation for the Mindfulness & Meditation Summit, Kelly McGonigal discussed The Neuroscience of Compassion.  Kelly is the author of The Science of Compassion and The Upside of Stress.

Kelly maintains that for compassion to be realised and sustained, the following six conditions must be present:

  1. awareness and recognition of suffering
  2. feeling of concern for, and connection to, the one who is suffering
  3. desire to relieve suffering
  4. belief that you can make a difference
  5. willingness to respond or take action
  6. warm glow/sense of satisfaction

She spoke about how compassion unfolds in the body, a mind-body state that has been verified by neuroscience.  Throughout her presentation she drew heavily on a neuroscience model of compassion developed by Ashar, Andrews-Hanna, Dimidjian & Wager (2016).  This systems-based model of the brain shows how the core functions of compassion are manifest in different parts of the brain, and each function can activate multiple parts of the brain simultaneously.

The three core functions identified in the neuroscience model of compassion are:

  1. Social cognition
  2. Visceral/emotional empathy
  3. Reward motivation

Social cognition has to do with the cognitive aspect of our social interactions – in other words, “how people process, store, and apply information about other people and social situations”.  Visceral/emotional empathy, on the other hand, is the emotional response generated in us when we connect with, or feel concern for, someone who is suffering.  Reward motivation relates to the personal, intrinsic satisfaction – warm inner glow – experienced when we are compassionate (which serves as a motivator of compassion).

Kelly maintains that all three brain functions have to be present, and effective, for sustainable compassion towards others and they need to be in balance.

For example, what potentially impedes effective social cognition is “dehumanization” of the observed individuals as a result of “unconscious bias” influencing our perception of others who differ in race, age or gender, or even in the sporting team they support.  Kelly reports, as did Dr. Richie Davidson, that meditation practices – such as loving-kindness and compassion meditation – can reduce such implicit bias and provide a more balanced social cognition that is not blind to the suffering and needs of a particular group.

Visceral/emotional empathy has to be balanced with reward motivation that can occur with compassionate action.  Kelly reports research that shows that if people are trained in empathetic meditation, without experiencing the reward component of compassion, they can potentially experience “empathetic distress”- a form of emotional overload resulting, in part, from too close an identification with the sufferer without the reward relief experienced through compassionate action.

This last imbalance resulting in “empathetic distress” has been observed in people in helping roles in difficult situations, e.g. war arenas.  Where helpers do not experience, or stop experiencing, the intrinsic rewards of compassionate action, they are prone to “burnout”.  Burnout occurs when we exhaust our reserve energies as a result of trying to close the gap between effort and intrinsic reward, in other words, we start working harder and harder for less and less positive outcome – we perceive that we are ceasing to make a difference.  Research has been shown that for sustainable compassionate action in these difficult arenas, helpers need to experience “reward motivation” – the intrinsic satisfaction sometimes experienced as  a warm inner glow.

Another important insight from neuroscience mentioned by Kelly is that we do not need to have self-compassion to be compassionate towards others.  Increasingly, compassion towards others is seen as an innate human capacity.  On the other hand, we seem to create all kinds of barriers to self-compassion such as fear, anxiety or anger.   Kelly maintains that the biggest barrier to self-compassion is the absence of the reward satisfaction when people feel the suffering of others, but do not experience the warm glow from taking action that makes a difference to someone’s suffering.

In summary, as we grow in mindfulness through loving-kindness and compassionate meditation, we can reduce our unconscious biases, free ourselves from the inertia of “empathetic distress” and open our minds and bodies to compassionate action resulting in reward motivation that will sustain that compassion over time.

By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Image source: Courtesy of johnhain on Pixabay

Build Resilience Through Mindfulness

Linda Graham, in her book, Bouncing Back: Rewiring Your Brain for Maximum Resilience and Well-Being, defines resilience as:

the capacity to respond to pressures and tragedies quickly, adaptively and effectively.

Shawn Anchor and Michelle Gielan in a HBR article suggest that resilience is about “how you recharge, not how you endure”. They argue that the misconception about resilience and endurance has led to the exponential rise in the “workaholic” with devastating effects on health, productivity and family relationships.

I have worked in many organisations where management has stated that staff needs to become “more resilient” when the staff were not coping with excessive workloads and unrealistic time pressures.  This perspective incorrectly equates resilience with endurance and potentially leads to burnout.

As Linda Graham notes, resilience is more about our capacity to “bounce back” from setbacks and this requires us to recharge our batteries on an ongoing basis. It also requires re-wiring our brains so that we overcome negative self perceptions and fear-inducing perceptions of daily occurences.

Neuroscience research has demonstrated that when we grow mindfulness and develop the capacity to be fully in the present moment, we can alter our brains and reshape our perecptions.  In the process, we can build our resilience.

Image Source: courtesy of makamukio on Pixabay