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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
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
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!
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.
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.
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.
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.
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.
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
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.
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.
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.
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
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
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.
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.
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
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
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.
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 . . .
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
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.
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.
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”
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.
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
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.”
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 . . .”
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.”
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.
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)
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
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.
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.
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.
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.
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
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.”
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.
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
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
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

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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