Food for Thought

August 9, 2019

Medicine for Difficult Times

By Ravi Chandra

“Violence strips naked the body of a society, the better to place the stethoscope and hear the life beneath the skin.”

Leslie Manigat, former president of Haiti

—✦—

There has been tremendous change in America and the world over the last several decades: economically, demographically, technologically and politically. Change heightens uncertainty and allows latent vulnerabilities to rise. We are all vulnerable as human beings. This is part of our common humanity. But we don’t always know what to do with our vulnerability, uncertainty and insecurity. Our survival brains hijack our better angels. We freeze: we might become numb, shut down and withdraw. We flee: we might narrow our concerns, and avoid, push away, and wall off what we feel we can’t deal with emotionally, cognitively and relationally. Or we fight.

Despair is anger and hostility turned inwards. Anger and hostility are sorrow and frustration turned outwards.

For some – the small fringe group of White Nationalists around the globe, for example – existential fears have become fears of annihilation. Underneath their rage and fear are unmet needs: for safety and belonging at best, perhaps, but also, pathologically, a need for power and dominance. Instead of recognizing common humanity in their own vulnerability, and seeing people of different ethnicities as essentially similar to them, they have chosen a dark path of tribalism, separateness, isolation, and toxic, sociopathic “power.”

I imagine these individuals have had a deeply frustrated relational world to begin with. If they were more connected and related to real people in the real world, they might be able to generate self-compassion and compassion for others.

Instead, they have become further removed from relatedness by cultivating hateful, narcissistic and nihilistic ideologies in dark corners of the internet, where they “gamify” the idea of killing others. Tragically, this small fringe is now amplified by seemingly uncaring political leaders and philosophers who stoke their fears. They represent the most toxic ideas that civilizations have carried for millennia. That might makes right, and that it’s better to be feared than loved. That society evolves through reward and punishment, rather than nurturance and caregiving. That love, kindness and compassion are soft and weak emotions, unable to deal with the hard realities of life.

What life do we hear now beneath the skin of our society, and what medicines can we offer for what ails us?

Facing isolation and despair with mindfulness, yin and yang compassion, and relationship

As Martin Luther King, Jr. said, “power without love is reckless and abusive, and love without power is sentimental and anemic. Power at its best is love implementing the demands of justice, and justice at its best is power correcting everything that stands against love.”

Society, through abuse of power and lack of compassion for its citizens, has left many feeling downtrodden and in despair. Those who may have felt powerful in the past are now faced with the challenge of change.

There is a vast network of trauma under the surface of society. This network of trauma is perpetuated by the avoidance, reactivity and blame that keeps us apart and is retraumatizing.

Sadly, all too many of us are not skilled in the remedies for constructively coping with change, trauma and difficult emotions.

Mindfulness, compassion, and connection are those remedies.

Mindful Self-Compassion workshops teach that there are gentle and fierce components of compassion, the yin and yang of compassion for self and other. With mindful self-compassion, we can learn to understand and not judge our emotions. Social Psychologist Dacher Keltner writes, in his essential book Born to be Good: The Science of a Meaningful Life, “emotions are signs of our commitment to others; emotions are encoded into our bodies and brains; emotions are our moral gut, the source of our most important moral intuitions.” We can see how anger is an attempt to protect ourselves and those we love, and also an attempt to defend our deeply held principles. MSC helps us deepen awareness beyond reactivity to the active responses of fierce compassion, and also helps us avoid burnout and hostility. We can learn to nurture ourselves and others with gentle compassion, even as we work together on the issues facing us. In doing so, we can cultivate jen, the subtle Confucian feeling of kindness, reverence and humanity that transpires between people, and improve what Keltner calls the jen ratio, and with it, our personal and societal well-being.

Fierce compassion takes an active stance towards suffering and injustice. It might lie in supporting policies to minimize mass shootings, homicide and suicide in society, and supporting leaders and organizations who have sensible plans. This is also the path of relatedness and civic engagement. There is widespread support for sensible gun regulation. For example, 80% of both Democrats and Republicans support universal background checks. And while Congress has, for political reasons, limited scientific investigation into gun issues, there is significant research correlating lower suicide and homicide rates with stricter gun regulations, and other research supporting common-sense public health measures. (See my long-form essay for details on these and what I call the “gun identity” in America, as well as historian Roxane Dunbar Ortiz’s excellent book Loaded: A Disarming History of the Second Amendment.)

Fierce compassion might also lie in cultivating verbal, emotional and cognitive responses in the face of the coarse dialogue and injustice we often encounter in our communities.

Gaining wisdom through reading, reflection and relatedness is vital in combating ideologically based opinion wars that neglect or dismiss the human cost of those ideologies.

Gentle self-compassion begins with being able to name the emotions one feels in difficult situations, such as the hard emotions of anger, rage or hatred, or underneath them, the soft feelings of anxiety, inadequacy, or fear. These often relate to relational experiences such as being devalued, dismissed, subjugated or oppressed. The Soften-Soothe-Allow practice (available on Christopher Germer’s website) is enormously helpful at cultivating the space of mindfulness around a difficult emotion, and also warmth to help us find ease in the midst of distress.

After naming and soothing our difficult emotions, we can go deeper, and look for the unmet need that is pressing our buttons. Is it to be seen or heard? Is it to be validated? Be more safe, secure or connected? Or is it our deepest need, as social beings: to be loved and cared about?

Once we understand our inner lives, we can turn towards ourselves with self-compassion, instead of self-criticism, shame, judgment, and hate. We can turn towards others with compassion and kindness, instead of defensiveness, frustration, blame and scapegoating.

Being related, mindful and compassionate is not an easy path, especially at first. Frequently, as we touch our wounds, they erupt in pain. But when we increase our caring capacity, we find ourselves in tune with our best selves, and indeed, in tune with the patience, acceptance, and life-giving sustenance of Mother Earth herself.

These are deeply disturbing times, especially for Americans.

There has been more than one mass shooting per day in the United States so far in 2019. But almost 40,000 people in the U.S. died from gun violence in 2017, 1,000 more than 2016. While the murder rate has fallen overall, the percentage of homicides by gun has increased. 60% of gun deaths in 2017 were victims of suicide. Suicide has increased 30% since 1999, and an increasingly larger percentage of suicides are committed by guns; in 2017, almost half. 70% of suicide victims are white men, and the highest rate of suicide occurs in middle aged white men. Men commit suicide at over 3.5 times the rate of women, because more of them attempt suicide with lethal means, such as guns.

American society is suffering deeply. Many more people are feeling desperate and wounded. The life expectancy of middle aged white Americans without a college degree has fallen, even as life expectancy of whites in other developed countries has risen. Economists Anne Case and Angus Deaton called these “deaths of despair: suicide, overdoses from alcohol and drugs, and alcohol-related liver disease.” America has become increasingly individualistic and narcissistic over the last 50 years. Individualism has a proud history in America, but a dark downside when out of balance with relatedness. Civic engagement has fallen overall (though this trend may be shifting). We have smaller discussion networks than in past decades. Some researchers say loneliness is an epidemic, and loneliness and social isolation have clear health impacts.

You may also be interested in:

  1. Svoboda E. (August 7, 2019) How to Renew Your Compassion in the Face of Suffering. Greater Good Science Center.
  2. Chandra R. (August 4, 2019) The El Paso Massacre: Nihilism, Narcissism and White Nationalism. The Pacific Heart Blog, Psychology Today.
  3. Chandra R. (July 30, 2019) Narcissism, Needs for Certainty and Closure, and Relatedness. The Pacific Heart Blog, Psychology Today.

About Ravi Chandra, M.D., D.F.A.P.A.

Ravi Chandra is a psychiatrist and author in San Francisco, and a Mindful Self-Compassion teacher. Find out more about his work at www.ravichandramd.com, where you can sign up for an occasional newsletter.

July 15, 2019

“How is Your Heart Today?”
Compassion at Angola Prison

By Dr. Chris Germer
CMSC Co-Founder

Lara Naughton and I arrived at the Louisiana State Penitentiary (known as “Angola Prison”) around 8:15 a.m. anticipating a lengthy security check to enter. Fortunately, Lara’s colleague at Angola had arranged for a visitor pass and we sailed right through.

I understand the need for prisons, but I don’t like them. Three nights before we arrived, I had a nightmare of being stuck in Angola for life. Driving through the gates, however, the white wooden fences along the fields reminded me of horse farms in Massachusetts. I started to relax a bit.

Angola is a complicated place. It is one of the largest maximum-security prisons in the United States, covering more ground than Manhattan. The prison holds more than 5,000 incarcerated men, some of whom are on death row. It is named after a plantation that existed before the Civil War, and Angola is a country in Africa from which many of the slaves had come.

Angola still carries a fearsome reputation for violence, despair, and human suffering, although conditions have improved markedly over the past decades.

Still, it is a prison in which approximately 75% of the inmates are African-American and 70% are serving life sentences.

Lara and I waited about an hour for the 150 men who were scheduled to show up for my talk on self-compassion. Only 75 men eventually came due to transportation difficulties from the various “camps” that are scattered throughout the property. As we waited, I noticed clusters of men chatting amiably with one another, or just sitting quietly. No cell phones. Groups of men talking together seemed like a fond and distant memory to me and I felt strangely comforted by it. Lara went off to talk with some others in the room—all of the men in the room were graduates of the Compassion Cultivation Training (CCT) program she has taught at Angola over the past 3 years.

While I was sitting there taking it all in, one man came up to me and said, “I see you sitting here and don’t want you to feel all alone.” His kind gesture touched me, almost uncomfortably so, as my defenses relaxed still further.

When we finally started our program, an hour late, Lara read a beautiful poem that spoke about common humanity and then invited everyone to pair up and ask one another, “How is your heart today?” She and several of the men developed this practice, and they use it at the beginning of every gathering. My plan was to visit Angola, deliver a talk on self-compassion, chat with some people, and then get back to the French Quarter in New Orleans in time for dinner.

Yet here I was, sitting opposite an incarcerated man with a ton of compassion in his eyes, answering his question, “How is your heart today?” I explained about my nightmare and he softly said, “I’m so sorry.”

It wasn’t the best talk of my life. Lara had told me that these men had already been introduced to some of the research on self-compassion, and have begun to develop both a learned and practiced sense of what self-compassion is and isn’t. Many of them had been practicing compassion for themselves and others for a couple years after taking the CCT course, and some were even CCT teaching assistants. Others had attended the Angola Bible College and were pastors and had their own congregations consisting of other incarcerated men. A few of the men just had their dreams of parole eligibility dashed by a court ruling that week; another had just been granted parole that morning and would be leaving Angola after being convicted as a juvenile more than 25 years ago—he had never been out of Angola his entire adult life. What could I possibly say to these guys as a married, upper middle class, white, PhD psychologist and author?

The men were genuinely interested, polite, and generously volunteered answers to my questions, such as “Is there a difference between how you treat yourself and how you treat others?” They definitely perked up when I mentioned the word “shame” and how self-compassion is an antidote to shame.

Shame is a deep river that runs through their lives. There is the shame of committing a grievous crime, the shame that comes with systemic oppression of people of color, the shame of not being able to care for one’s family, the shame of being incarcerated—the list is long and deep.

The CCT teaching assistants had lunch with Lara and me after the talk. Lara paid for it from her grant sponsored by the Compassion Institute and it was catered by men in the Re-entry Club—a group associated with Angola’s Re-entry program, which is run by mentors with life sentences who help other incarcerated men prepare for life outside Angola. Lara always orders a couple extra meals so she can invite additional people to join, or so men can take an extra back to their dorms and share it with their friends. At lunch and through the afternoon, the guys asked very personal questions, such as whether I think the mother of the person he killed could ever forgive him, or what to do about trauma flashbacks. I was blown away by the urgency of their questions, and their candor. A group of guys asked later on, “Do you ever swear?” I explained that I was from New Jersey and that we love to drop the F-bomb in every sentence, but I was controlling myself in public. We also had a lot of laughs together.

Lara said that she needs the 2 ½ hour drive home to New Orleans to digest what happens during the day at Angola. I realized what she meant when my new friends at Angola could not pass through the gates when we left, and maybe never in this lifetime. Lara has never gotten used to that. Lara also predicted that I would probably get more out of the day at Angola than I could give, which is also Lara’s experience even after 3 years.

That was a comfort because I was blown away by the immense suffering I experienced, but even more so by the depth of caring and authentic brotherhood that I was invited to share in. Those interactions seemed strangely healthier than most interactions I have outside the gates.

Still, I felt a little nauseous over the subsequent days when I reflected on the pain those men experienced in their lives, including the pain they caused to others and are likely to relive every day. It could hear Helen Keller’s words in my head, “Although the world is full of suffering, it is full also of the alleviation of it.”

Where do we go from here?

The work that Lara and her assistants are doing at Angola is deeply inspiring and I’m drawn to support it. This fits well with the commitment by the CCT and MSC organizations to collaborate on projects to can bring more compassion into the world, especially to underserved populations. The self-compassion component seems to be particularly helpful for those living in a prison environment.

What originally brought me to Angola was a dear friend, Jenny Phillips, who was making a documentary on the compassion work at Angola. She is the same person who directed the amazing film on teaching mindfulness meditation at an Alabama prison, The Dhamma Brothers. Her passion was criminal justice reform and, sadly, she passed away last year in a swimming accident. I had the privilege of meeting several of the remarkable men who are featured in Jenny’s film. Her colleagues are determined to complete the film, so please stay tuned for that.

May 9, 2019

Unearthing Me:
A Psychologist’s Journey with Self-Compassion

By Admin

by Dr. Jennifer Ayres

Psychologist and MSC Graduate

May 9, 2019

Several years ago, I hung a painting on the wall in my office. It is a picture of beautiful purple flowers that peek in and out of a white lattice trellis. A butterfly sits on one of the flowers. A family medicine intern painted it for me as a thank you gift. She followed me into my office after our weekly support group one day and bravely shared a painful experience, her doubts about her worthiness to be a doctor, her identity struggle from medical student to doctor, and her humanity. I helped her find self-compassion at a time she needed it.

—✦—

I work in a primary care clinic, and last month my clinic moved across town. Although I had several months of notice, I remained in denial and avoidant. This move would result in many changes for me. A longer commute. Less flexibility with scheduling patients. Way less personal space.

Between the defense mechanisms and the daily work demands, it was not surprising that a week before our move, I found myself in a procrastination-induced, office-packing crisis. I started going through my stuff, literally and metaphorically.

It was easy to handle the “top layer” stuff. The stuff that I grab on a regular basis to help patients gain insight or family medicine residents gain a broader understanding of human behavior. The books I read to center myself after a particularly challenging encounter. These items would join me in the next chapter. They were packed in boxes with my name and the new office number.

The “middle layer” stuff was more challenging. What do I do with things that I don’t need or use often but reference occasionally or might need in the future? Notes from old conferences, programs I developed but don’t do currently, artwork from patients I no longer see, notes and cards from ex-residents. I evaluated those emotionally, then objectively, then ultimately discarded, photographed or packed in “not sure what do with this yet” boxes.

The “bottom layer” stuff was the most challenging. Some of it was part of my very first therapy office when I started a postdoctoral fellowship in 2000. Bottom-layer stuff evokes a sense of flipping through a high school yearbook or a childhood treasure box. The items themselves serve very little practical purpose to current life except to remind us who we were before we became who we are. I smiled once I got to the bottom layer stuff.

I’d forgotten how much I liked the woman who years ago would have packed those items in the top layer box.

Two highlights of the bottom layer. One was the Candy Land game that I pulled from the filing cabinet. Nine-year-old Ben (not his real name), one of my first therapy patients, gave it to me — the only Hanukkah present I have ever received. Ben had Asperger’s syndrome, which impaired his ability to communicate and connect with people, including me. One day he and his mother were shopping. He pointed to the Candy Land and said “Dr. Ayres doesn’t have that game. She would like it. I think we should get it for her for Hanukkah.”

It was the first time he indicated thinking about anyone else outside of the structured social skills development exercises we did in session. And he was correct. I didn’t have the game and I did like it. So did he. We played it every week until I left that job three years later. By the time I was ready to move to Austin for my current job four years later, the box lid was crumpled by use. I taped it up and moved it across the country. As the box continued to disintegrate, I purchased a newer version to use in therapy sessions and my Hanukkah gift became a treasured museum piece.

I spent a lot of time looking at that box and the replacement version that never became a velveteen rabbit. I put it aside until I had a solution. It was a visual, tactile reminder of a special connection with Ben, and who I was when I was new to the field. I ultimately removed the cards and board from Ben’s game, put them in the 2008 version, and cut the “Candy Land!” box edge from my Hanukkah present. The game pieces and cards are in the new office, waiting for an enthusiastic child to select that activity.

I also found my journal from the intern support groups I led during my first four years. We started every support group with a 10-minute journaling exercise to gently transition from one task to another. I started reading the early entries. I was struck by the simultaneous familiarity of my voice from a decade ago and the foreignness of it.

I looked up from reading the journal and saw the painting. I thought about that beautiful, human, hurting intern and her bravery to share her vulnerable truth that Monday afternoon so long ago.

Neither of us could have predicted how successful she would become over her three years of training, that she would be known for her depths of compassion and honored with a leadership award at her graduation.

As I Iooked at the painting, I reflected on how much more I knew about self-compassion now than I did that day I talked to her. I hadn’t had training in Mindful Self-Compassion. My guidance was more reflective of a therapist’s understanding of the interconnectedness of thoughts, feelings and behaviors than self-kindness, common humanity and mindfulness. But yet, it was the basic tenets of self-compassion that I pulled into that conversation as I helped her consider an alternative perspective to her critical self-talk. I thought about how natural it felt to guide others, particularly vulnerable new doctors, to self-compassionate self-talk and how difficult it is to direct those same reflective questions to myself when I need them the most.

I decided in that moment that this transition would differ from previous ones because I would use my self-compassion to set clear guidelines.

These were the guidelines:

▸ I will make space for whatever feeling arises.
▸ My feelings will take as long as they need.
▸ I will search for common humanity when I feel isolated.
▸ I will remember that others hold a safety net underneath me. If I fall, they will catch me.
▸ I will not choose to carry this burden alone. I will accept help and support by sharing my feelings instead of guarding them.

—✦—

Fast forward to present day, four weeks later. I did make space for the gamut of emotions. I cried a lot and worried a lot.

I worked through guilt about self-compassionate schedule changes and boundary setting. I was kind to myself during the process and pushed back when the internal critic arose to offer well-intended, but emotionally minimizing, commentary. I attended our Tuesday night CDP meetings and talked about how hard it is to have a self-compassion practice when it is desperately needed.

A colleague asked me last week how long she can play the “my clinic just moved and I’m still adjusting” card. I told her I don’t think adjustment cards have an expiration date. They simply disappear when they are no longer needed. I had several adjustment cards about this move but now I’m down to one – the “not sure what to do with this yet” boxes are still in my living room and on my dining room table. My children, our dog and I navigate around them as I await the “now I know what to do.”

I trust the wisdom of Rainer Maria Rilke in Letters to a Young Poet when he told a young poet to live the questions and trust that the answers will be revealed when they are ready to be lived.

—✦—

The intern’s painting hangs in the shared office. I look at it often on the two days I inhabit the new space. It is a visual reminder to find self-compassionate grace for the person I am now while I’m developing into the person I am not yet.

About Jennifer:
Jennifer L. Ayres, PhD is the director of behavioral health services at the Blackstock Family Health Center. She is an assistant professor of population health for Dell Medical School and a clinical assistant professor of psychology at The University of Texas at Austin. She oversees behavioral health education for family medicine residents and psychology trainees, conducts outpatient psychotherapy and does inpatient psychology consultations at Dell Seton Medical Center.

Ayres has a bachelor’s degree from Emory University, a master’s degree from the University of North Texas and a doctorate in clinical psychology from UT Southwestern Medical Center in Dallas. After her graduation, she moved to the Los Angeles area for a postdoctoral fellowship in child abuse and trauma. She worked as a trauma psychologist in Los Angeles for seven years before returning to Texas and settling into her current position.