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Reflecting on 2021 and the Courageous Optimism We Need

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As we reflect upon 2021, we must first acknowledge the “Triple Existential Threat” as National Academy of Medicine President Victor Dzautriple recently described it—our climate crisis, systemic racism, and a pandemic that has shone a light on inequities. Recognizing the interconnection of these threats is key to both understanding and solving them. 

And while it is essential to identify and name the problems we face—that cannot be the end. We must also explore and share solutions.

Even as 2021 was a time of challenges and upheaval across the world, for the Nova Institute it represented an important juncture in our decades-long quest to transform the predominant approach to health and healthcare. Building upon fourteen years of success and lessons learned, it was time to reaffirm who we are and what we are about. 

Over my career, I have focused on expanding the view of medicine to a more whole person approach, then, in founding the Nova Institute, I felt it was important to embrace a more inclusive integrative health approach that acknowledges the many upstream factors that influence well-being. Today we broaden our gaze even further, shifting the dialogue from disease to health, and now from health to flourishing, at all scales of person, place, and planet

Along with this sharpened focus came our new name and new website, launched just last month, to better tell the stories of our work—especially our incredible community of Scholars and Fellows and describe our focus areas.  

Despite the pandemic that kept us apart in person but not in spirit, over the past year these thought leaders conducted and published research around pressing topics that could not be more timely. These included the state of primary care in the United States and how it needs to be re-envisioned, the role that art and nature play in helping people heal, why some communities thrive while others don’t, ways to pursue health equity, how wisdom and flourishing are essential to good health, and much more.  

Our demonstration projects included expanding a successful program that teaches medical students about culinary medicine, which we are working to replicate across the country. We also launched a new initiative to help burned-out primary care providers through stress management techniques that tap into the best of heart-centered research and integrative medicine.    

We also welcomed inVIVO Planetary Health as an initiative of the Nova Institute and finished out the year by joining the inVIVO community in an incredible international conference with more than 150 presentations that left participants feeling inspired, invigorated, and hungry for further connection.   

All of this solutions-oriented work was made possible by passionate and dedicated experts in their fields who are eager to see a world where all people enjoy meaningful and fulfilling lives—no matter where they live, work, or play. Their generosity of spirit, and the sense of community we create by working together, gives me hope. 

At the beginning of the year an Oxfam report predicted that, in light of the pandemic, almost every country in the world will see an increase in inequality for the first time since records began. The report noted that more than 3 billion people had no access to healthcare and three quarters of workers had no access to sick pay.   

Given what we have all witnessed this year, no doubt summaries of 2021 will have even more dire conclusions for health.  

It will truly take outrageous acts of courage to create the change we want to see, and it will require inclusivity and collaboration, combined with knowledge and experience, to improve the entire lived experience that influences health. That’s what we’ll be focusing on at Nova, and we are excited to tackle the challenge. As a professor of mine at Columbia University, the famous anthropologist Margaret Mead, said, “Never doubt the power of a small group to make change; indeed, it is the only thing that ever has.”

 

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.”

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.
  • 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.”
  • 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.

“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 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. “…they gradually found relief from suffering and began to exhibit emergent characteristics: a sense of hope, self-acceptance, and a desire to help others—the immediate precursors to healing.”

 In varying degrees, “they were able to transcend their suffering and in some sense to flourish.” 

  • Helping Others: We find meaning in helping others. “Understanding that suffering gives the strength and experience to help others in similar situations.”
  • Hope: We begin to have hope that we will not always feel this bad. A Crohn’s patient said, “I think gradually I realized that I was going to feel better. I did have days when I actually didn’t vomit, when I did feel better. And I think gradually I came to believe that maybe I could have a normal life again.”
  • Self-Acceptance: We see our inherent value and understand that we are not to blame for our suffering. A participant living with HIV said, “I’m really proud of myself. I think that now I still want to live. I don’t want to die, and I really love myself a lot. I have a lot of comfort in myself.”

Suffering is the ongoing pain from wounding. 

There is some debate about whether people always experience suffering on the path to healing.

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.”

Characteristics: How predisposed someone may be to wounding/how many tools and resources someone may have to deal with trauma/illness.

Lifestages: Developmental timing plays an important role in the impact of trauma — young children often do not have the same resources as older adults.

Relationships: Relationships can provide solace and support for those suffering, while lack of healthy relationships can prolong suffering.