Fair Winds and Following Seas

post it notes on window that say sorry we are closed covid 19

California is ablaze. It was 130 degrees in the Mojave Desert two weeks ago. The Democratic and Republicans National  Conventions have ended. The November election is coming toward us like a freight train. COVID-19 is flaring, subsiding, flaring again – and this is our new reality. Lives have been put on hold. Mortgages cannot be paid. American Airlines is laying off 19,000 employees. Concert halls are silent. Indeed, all of the work for the Institute is being done with Zoom calls, on-line classes, and by email.

Some people are talking about re-imagining healthcare. Some are talking about the obvious need for single-payer. Others are focusing on the way that the virus has been shining a bright light on the gross inequities in our country and the fact that America has failed to provide equal access to medicine. We know that a vaccine will not be the end of this.

I don’t think that re-imagining is enough. I don’t even think that healthcare is the subject. And I don’t think that the conversation starts with trying to answer the question, “How do we fix a broken system?” It is time for a paradigm shift. For radical change.

We need to be talking about biology, biography, and civic responsibility – and it is this conversation that will lead us to creating a world in which wellness and health are sustainable and valued.

The pandemic has clearly shown us that where you live, how you live, and the circumstances of your life will determine your disease risk and your outcome, but this is not news to us. Dr. Sandro Galea’s address at our 2019 symposium clearly outlines key factors such as connectedness, food, housing and jobs that are rarely considered when talking about healthcare reform. Institute Scholar Dr. Steven Woolf’s article about The Power of Prevention and What It Requires details the real cost of ignoring preventative medicine in favor of the healthcare system as we know it.

I have spent this summer in conversations with thought-leaders and practitioners from around the globe. We are looking for answers, but first, we are defining the questions.

Where do we go?  What do we do? How do we start? Is it possible to create a tectonic shift in the conversation which will lead to real and lasting change?

This summer, three generations of our family spent a week sailing on the Chesapeake Bay – and there is nothing like life with an infant and toddler on a boat to focus the mind. Some days were stifling, some evenings were breathtaking, once or twice the dawn brought rain. Our lives were defined by the forces of nature: the sun, the wind, and shining stars on a moonless night.

There was time to think. Time to see a young family coming up in a world that is fraught – and we are not done. Our work is not done. We need to be expansive in our thinking and our commitment to change. We need to listen to the voices of people from all walks of life, be they doctors, community organizers, economists, scientists, anthropologists, or historian – to everyone interested in making a difference. We must find a new way forward.

We must look everywhere. We must turn our expectations upside down. We must continue to ask questions and accept that sometimes the answers will sound crazy – and sometimes that is where the wisdom lies. And in the midst of the chaos that is our world today, I must remember those nights on the boat, when the welcome breeze whispered a message of hope for the new day. Fair winds and following seas.

We can do this.

Developing safety, persistence, trust

Healing is facilitated through safety, persistence, and trust.

  • Persistence: “People did not simply progress through this sequence and experience healing. The healing journey was a recursive, back and forth process. They found helpers, used the skills/resources that those helpers provided, found other helpers that provided more resources and used those skills and resources. As this process continued, people experienced a gradual amelioration of their suffering. Although many despaired at times, all demonstrated the quality of persistence—they refused to give up.”
  • Safety & Trust: “To connect to helpers, it was essential for people to feel safe in those relationships and able to trust that the person would be a helper and not a barrier to healing. Persons whose wounds included a violation of trust were especially careful about testing the safety of new relationships.”

Acquiring Resources

Resources support us as we heal. They include reframing, responsibility, and positivity. “Making connections enabled participants to acquire and refine resources and skills that were essential in their healing journey. People also brought their own personal strengths to the journey.”

  • Reframing: “A particularly important skill was the ability to reframe—that is to look at suffering through a different lens.” This does NOT mean minimizing trauma or pain, but rather it often means the opposite: understanding what happened was wrong, unfair, or uncontrollable and that we are not to blame for it.
    • “I think I kept trying to convince him I was crazy. And he kept saying, ‘No, you’re not crazy.’ […] You wouldn’t necessarily say a Vietnam Vet was crazy. You’d say they are responding like you’d expect to extraordinary circumstances.”
    • “I’m not the only one who have [sic] this problem. A lots, millions of people, you know. […] They don’t have nothing to do with that. I guess I have to live.”
  • Responsibility: While we don’t have control over what happened to us, we are the only ones who can help ourselves heal. “A third essential resource that people acquired or refined was the ability to take an appropriate amount of responsibility for their healing journeys. They participated actively in the process of healing. Once again, some participants already had developed this skill, and some acquired or refined it from their helpers.”
    “You need a lot of energy and a lot of work … it takes a lot of work. It doesn’t just happen. It’s not like a magic wand.” This patient understood that they had to actively participate in the healing process.
  • Positivity: “Another resource that people acquired or refined during their healing journey was choose to be positive—that is to have some optimism about their situation.” People have varying predispositions to positivity. In the study, positivity was important in helping people heal. This doesn’t mean a toxic positivity, but rather simply finding some good in life and feeling hopeful about our situations.

Helping Relationships

“Connection to others was an essential part of all the healing journeys.” Humans are social creatures, and even the most introverted of us need close relationships. Friends and family add meaning and value to life and help support us, in good times and bad. When we experience relational trauma, relationships can feel scary, but reestablishing safety and trust in relationships is where the healing happens. (To be clear, we do not mean reestablishing safety and trust with abusers, but rather finding other healing relationships.) “When safety and trust had been established, people were able to connect with helpers. The nature of the behaviours of helpers that fostered healing ranged from small acts of kindness to unconditional love.”

  • “Moving from being wounded, through suffering to healing, is possible. It is facilitated by developing safe, trusting relationships and by positive reframing that moves through the weight of responsibility to the ability to respond.”
  • “Relationships with health professionals were among these but were not necessarily any more important to the healing journey than other kinds of helpers, which included family members, friends, spirituality and their God, pets, support groups, administrators, case workers and supervisors.”

Healing

Healing probably means different things to different people, but one definition that emerged from the study is: “The re-establishment of a sense of integrity and wholeness.” Healing was an emergent property that resulted from each individuals’ complex healing journey, a result of bridged connections between resources and relationships. Healing, in this sense, does not mean cured—none of the study participants were cured of their ailments—”but all developed a sense of integrity and wholeness despite ongoing pain or other symptoms.” In varying degrees, “they were able to transcend their suffering and in some sense to flourish.” When we begin to heal, we find increased capacity for hope, renewed motivation to help others, and are more able to accept ourselves as we are.

Suffering

Suffering is the ongoing pain from wounding. There is debate about whether or not one actually needs to experience suffering on the path to healing.

Wounding

Wounding happens when we experience physical or emotional harm. It can stem from chronic illness or by physical or psychological trauma for which we do not have the tools to cope, or a combination of those factors. “The degree and quality of suffering experienced by each individual is framed by contextual factors that include personal characteristics, timing of their initial or ongoing wounding in the developmental life cycle and prior and current relationships.”