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The Psychology of Health, Immunity & Disease Conference Two-Day Intensive Training Institute Hilton Head, SC December 9-10, 2003. The Journey to Wholeness: A Practical Psychology for Living an Authentic Life. Kathleen Brehony, Ph.D . Day One - Morning Helping Patients Be All They Can Be.

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The Psychology of Health, Immunity & Disease ConferenceTwo-Day Intensive Training InstituteHilton Head, SCDecember 9-10, 2003

The Journey to Wholeness:A Practical Psychology for Living an Authentic Life

Kathleen Brehony, Ph.D.


Day One - MorningHelping Patients Be All They Can Be

  • The teleological process of growth – From Acorn to Oak
  • Jung’s Landscape of the Psyche and it’s inherent optimism
  • How to bring the shadow to consciousness
  • The “Alchemical Metaphor” for psychological and spiritual growth and how to apply this in clinical settings

What is “Wholeness”?

  • adj.
  • Containing all components; complete: a whole wardrobe for the tropics.
  • Not divided or disjoined; in one unit: a whole loaf.
  • Constituting the full amount, extent, or duration: The baby cried the whole trip home.
    • Not wounded, injured, or impaired; sound or unhurt: Many escaped the fire frightened but whole.
    • Having been restored; healed: After the treatment he felt whole.
  • n.
  • A number, group, set, or thing lacking no part or element; a complete thing.
  • An entity or system made up of interrelated parts: The value of the whole was greater than the sum of its parts.

[Middle English hool, sound,unharmed, See kailo- in Indo-European Roots.]


Michelangelo: It is already inside you.

A Major Reason for OPTIMISM!


Individuation – Carl Jung

Self-Actualization – Abraham Maslow

Self-Realization – Carl Rogers

The Good Red Road – Lakota

The Pollen Path – Navajo

Tao -- Taoism


“The common theme among these diverse traditions is that life is a journey, and the goal is the discovery of one’s true nature, a transformation of one’s view of the world, an enhanced wisdom, and an authentic, loving connection to all of life and to some larger universal power.”-- Awakening at Midlife (pg. 20)


Maslow’s Characteristics of Self-Actualization

  • Realistic orientation
  • Acceptance of self, others, and the natural world
  • Spontaneity
  • Task orientation, rather than self-preoccupation
  • Sense of privacy
  • Independence
  • Vivid appreciativeness
  • Spirituality that is not necessarily religious in a formal sense
  • Sense of identity with mankind
  • Feelings of intimacy with a few loved ones
  • Democratic values
  • Recognition of the difference between means and ends
  • Humor that is philosophical rather than hostile
  • Creativeness
  • Nonconformism

The Process of IndividuationFrom Latin “individuus” – “undivided,” “whole”

  • A process of psychological differentiation, having for its goal the development of the individual personality
  • Not to overcome one’s personal psychology and become perfect, but to become familiar with it
  • Increasing awareness of one’s unique psychological reality, including personal strengths and limitations, and at the same time a deeper appreciation of humanity in general
  • A spiraling, circumambulating process rather than a linear path in the unfolding of the Self
  • When we are on the path, we are at the goal

Polishing Your Diamond

The “art of personality” fulfills the purpose of life, and that we are all born with such a personality -- “But even a diamond must be cut. It has the light in it, yet cutting is required: it cannot show that glow and that brilliance before it has been cut. The same thing applies to personality.”

-- Sufi Master Hazrat Inayat Khan

Self Growth is not a passive process.


Jung’s Landscape

Psycherefers to the totality of all psychological processes. It “embraces all thought, feeling, and behavior, both conscious and unconscious. It functions as a guide which regulates and adapts the individual to his social and physical environment.”

“My psychology isn’t worth anything if it can’t be understood by a Swiss farmer!”



The Self

  • The Center of the Psyche
  • The “Central Archetype”
  • Like the Sun in the Center of the Solar System
  • Archetype of order, organization, and unification
  • Unites the personality
  • Responsible for fulfilling the blueprint of life
  • At birth – all is the Self
  • Connecting bridge to “The Unity”
  • Goal is psychological wholeness and completeness
  • Transpersonal, transcends the ego


  • Primordial structural elements of the psyche
  • Functional units of the collective unconscious (later called “The Objective Psyche”)
  • Archetype = “First,” “Original,” “Prototype”
  • Primordial Images
  • Blueprint for Life (like an innate releasing mechanism in certain animals)
  • Universal
  • Unconscious
  • Collective unconscious is distinct from the Personal Unconscious


  • Emotionally charged group of ideas or images
  • Functional units of the personal unconscious
  • A group of associated “feeling-toned ideas” bound together by a shared emotional charge
  • Unconscious, highly emotional, feel autonomous
  • Like split-off, partial, independent, and separate personalities
  • Vital part of everyone’s psychological make-up
  • The less conscious, the greater its degree of autonomy, and the more we will project it onto others.

The Ego

  • The central complex in the field of consciousness
  • Organizing function of the conscious mind
  • Gives sense of identity, continuity and personality – “I”
  • Composed of conscious perceptions, memories, thoughts and feelings
  • The “gatekeeper to consciousness”
  • Actually a very small part of the overall psyche

The Persona

The part of ourselves we show to the world. Personae from the Latin for “Mask.” Helps us adapt to society – to conform to the roles we play in our relationships and culture. Social masks allow conversation and commerce to flow easily from one person to another. Sometimes our “New Year’s Resolution self.”


The Shadow

All that is set aside, repressed, or unrecognized. Hidden part of ourselves that has been repressed or never recognized. All that is banished from the persona. Unconscious and unknown part of ourselves. All that we think we are not. Our unlived life. There is gold in the shadow. Accepting the shadow means accepting our full humanity.


Illuminating the Shadow

  • Make a list of all the adjectives that you (or someone who knows you well) would use to describe you. Take the opposite of that word and write it down. That list comprises some of what is in your shadow.
  • Look honestly at those you immediately dislike or like. What is it about them that is similar or different to how you see yourself?
  • Ask someone who knows you well one simple question: “What is my greatest flaw?”
  • Look at the content of dreams and slips of the tongue.

Anima/Animus:The Internal Masculine and Feminine

Anima – The internal, unconscious feminine aspect of a man

Animus – The internal, unconscious masculine aspect of a woman

Jung speaks of the anima/animus as both archetypes and complexes. They are: 1) unconscious 2) charged with emotion 3) relatively autonomous.


Yin Yang

Feminine Masculine

Negative Positive

Moon Sun

Darkness Light

Yielding Aggressive

Left side Right side

Warm Cold

Autumn Spring

Winter Summer

Unconscious Conscious

Emotion Reason

Right Brain Left Brain


Psychological Types

  • Basic Attitudes: Introverts(I) and Extraverts(E)
  • Decision-Making Style:Thinking(T) v. Feeling(F)
  • Take in Information: Intuition(N) v. Sensation(S)
  • Deal with the Outer World: Judging(J) v. Perceiving(P)
  • Superior and Inferior Functions
  • Goal is wholeness and integration of the “inferior function”

E Extraversion People who prefer Extraversion tend to focus on the outer world of people and things

I Introversion People who prefer Introversion tend to focus on the inner world of ideas and impressions.

S Sensing People who prefer Sensing tend to focus on the present and on concrete information gained from their senses.

N iNtuition People who prefer Intuition tend to focus on the future, with a view toward patterns and possibilities.

T Thinking People who prefer Thinking tend to base their decisions on logic and on objective analysis of cause and effect.

F Feeling People who prefer Feeling tend to base their decisions primarily on values and on subjective evaluation of person-centered concerns.

J Judging People who prefer Judging tend to like a planned and organized approach to life and prefer to have things settled.

P Perceiving People who prefer Perceiving tend to like a flexible and spontaneous approach to life and prefer to keep their options open.


Regarding Typology: Jung\'s model is concerned with the movement of energy and the way in which one habitually or preferentially orients oneself in the world.


Prayers Based on MBTI Types

ISTJ: Lord, help me to relax about insignificant details beginning tomorrow at 11:41.23 a.m. EST.

ISTP: God, help me to consider people\'s feelings, even if most of them ARE hypersensitive.

ESTP: God, help me to take responsibility for my own actions, even though they\'re usually NOT my fault.

ESTJ: God, help me to not try to RUN everything. But, if You need some help, just ask.

ISFJ: Lord, help me to be more laid back and help me to do it EXACTLY right.

ISFP: Lord, help me to stand up for my rights (if you don\'t mind my asking).

ESFP: God, help me to take things more seriously, especially parties and dancing.

ESFJ: God, give me patience, and I mean right NOW.


Prayers Based on MBTI Types

INFJ: Lord, help me not be a perfectionist. (Did I spell that correctly?)

INFP: God, help me to finish everything I sta

ENFP: God, help me to keep my mind on one th - Look a bird - ing at a time.

ENFJ: God, help me to do only what I can and trust you for the rest. Do you mind putting that in writing?

INTJ: Lord, keep me open to others\' ideas, WRONG though they may be.

INTP: Lord, help me be less independent, but let me do it my way.

ENTP: Lord, help me follow established procedures today. On second thought, I\'ll settle for a few minutes.

ENTJ: Lord, help me slow downandnotrushthroughwhatIdo.


What is unconscious will be projected onto others and into the world. Wholeness requires withholding projections and bringing what is unconscious into consciousness.


Holding the Tension of the Opposites by Integrating Dualities

The Transcendent Function:

The psychic function that arises from the tension and conflict between consciousness and the unconscious.





What Does It Mean to be Conscious?

  • From the Latin conscius, meaning “knowing with others, participating in knowledge, or aware of.”
  • Includes all the things we are aware of and know
  • An understanding of “knowing that we know”
  • Sometimes builds slowly and sometimes comes like a blinding insight
  • Awakening
  • A dynamic process of growth, change, and evolution
  • Consciousness best defined on a spectrum or continuum rather than “all or none”

Consciousness is best thought of as manifesting in steps, layers, dimensions, sheaths, levels or grades -- holarchy

Vijnanas -- Buddhism

Layers of consciousness -- Jung

Sefiroth Kabbalah

Spectrum of Consciousness – Western philosophers (e.g., Ken Wilber)

Koshas - Vedanta


Known to Yourself

Unknown to Yourself

Known to Others

Open Self – Known to Yourself and Others

Blind Self – Unknown to Yourself but Known to Others

Unknown to Others

Private Self – Known to Yourself and Unknown to Others

Unknown Self – Unknown to Yourself and Unknown to Others

The Johari Window

A model for awareness in interpersonal relationships Joseph Luft, Ph.D. & Harry Ingham, MD, 1955


The Alchemical Metaphor

“We are born to be awake, not to be asleep!”

-- Paracelsus, 16th Century Swiss Alchemist


The Power of Alchemy

“The truth of alchemy is discovered when we accept it as metaphor – an intricate allegory – for consciousness and as a clearly defined path for both spiritual and psychological development in which suffering and loss are seen as initiating events.”

From: After the Darkest Hour


Stages in Alchemical Transformation

  • Nigredo: “The Blackening”
  • Albedo: “The Whitening”
  • Rubedo: “The Reddening”

The Vitality of Transformation

  • Like the Buddha WAKING UP
  • Realize the values of the first half of life are not sufficient for the second half
  • Change in philosophy and worldview
  • Psychological and spiritual maturity
  • Coming to our senses
  • Live differently – with greater joy, meaning, and passion

In the absence of some traumatic event that initiates the beginning of individuation in a younger person, this process is a task reserved for the second half of life.

At midlife, we know that the time left for this momentous work is running out.


Day One - AfternoonThe Midlife Passage

  • Crisis and opportunity
  • The unique developmental tasks of the midlife transition
  • A differential diagnosis between midlife symptoms and DSM-IV criteria
  • Why the pursuit of passion and meaning at midlife is so important
  • How to release old patterns of behavior that no longer serve
  • Six practical strategies for psychological and spiritual growth at midlife

1. What is Midlife?

2. Why Midlife can be dangerous and difficult?

3. How to use Midlife for Self-Growth.


There are lots of us in Midlife…

81 Million Americans between the ages of 35-55.

10,000 Americans turn 50 every day (one every 10 seconds)


How we get off track…

We are born whole but quickly become shaped by family, religion, culture, gender role, etc. etc. etc.


Midlife Gives Us Wake-Up Calls

  • Physical
  • Psychological
  • Emotional
  • Relational
  • Professional
  • Spiritual

Sometimes Midlife is a Crisis…

“Danger” and “Opportunity”


Sometimes you just hear Peggy Lee singing…

Is that all there is, my friend? Is that all there is?


Midlife Demands a Change in Consciousness

Consciousness is Awareness and Self-knowledge


Major Illusion: Things Don’t Change

Most of us grow when life pushes us to do so

What the hell is he talking about??!!

You know what I’m going to do this weekend, honey? I’m going to grow.


An Underlying Secret of Mathematics

“The Rules of 9”

Rule #1:

When any number is multiplied by nine, if the individual digits in the resulting product are added together, they will ALWAYS total nine as long as you keep summing the digits produced at each step until you get a one-digit number.

That Number will ALWAYS be 9.


The Underlying Secrets of Midlife

  • Realization: Life is half-over
  • We recognize our mortality in a new way.
  • Life as we have known it is now over.
  • A major change in consciousness.
  • Losses and change initiate a path to a new sense of meaning and greater passion.

At Midlife, the Self is asking –

“When will you get around to me?”


In the first half of life, we devote our psychological resources to developing the persona.


In our culture we tend to discount the inner life but that doesn’t make it any less real.

Unconscious versus Conscious Midlife Passages


Poised for the Hero’s Journey

“We have only to follow the thread of the hero path, and where we had thought to find an abomination, we shall find a god. And where we had thought to slay another, we shall slay ourselves. Where we thought to travel outward, we will come to the center of our own existence. And where we had thought to be alone, we will be with all the world.”

-- Joseph Campbell, The Power of Myth


Stages of the Hero’s Journey

The Call

The Separation

The Adventure

The Return (Hero is ALWAYS changed)


Rowing & Flowing:

The Sailboat Metaphor


Seeing Ourselves Differently

Schopenhauer - Embroidery


What do we do with this new-found insight?

Stay just as we are?

Move to Tahiti as Gaugin did?

Um, are you sure you don’t want to call your wife and kids?


Stay in the Present

“Stay here, quivering with each moment, like a drop of mercury.”

-- Rumi


Late Bloomers &

Don’t Die Guessing


Day Two - MorningThe Dark Night of the Soul

  • Why suffering offers both danger and opportunity
  • Real versus “Neurotic” suffering
  • 12 strategies for letting go of unnecessary suffering
  • Why we are destined to search for meaning
  • The power of optimism and internal locus of control and their effects on resiliency
  • 12 practical strategies for growth through hard times

“What does not destroy me,

makes me stronger.”

-- Friedrich Nietzsche


The Expansion of Consciousness Leads to:

The Search for Meaning

“Once an individual’s search for meaning is successful, it not only renders him happy but also gives him the capability to cope with suffering.”

-- Viktor Frankl, Man’s Search for Meaning


Real versus Neurotic Suffering

“Real suffering burns clean; neurotic suffering creates more and more soot.”

-- Marion Woodman (Author and Jungian Analyst)


Real Suffering Cannot be Avoided

“Real suffering is an authentic and realistic response to the ragged wounds of living a human life. It’s also unavoidable and an essential part of every human life. Illness, loss of loved ones, disappointment, decline, death, limitations, and imperfections startle and shake us. But they awaken us to find meaning, dignity, and significance in our lives. They open the heart to pure compassion and newfound creative energy. Real suffering is useful. It propels us to new levels of consciousness and self-knowledge. It is through suffering and pain that we break down our habitual barriers between ourselves and others and allow for the entrance of a transpersonal, transcendent perspective: a full appreciation of our intimate and profound spiritual connections.” -- From “After the Darkest Hour” pg. 21


Neurotic Suffering Can Be Avoided

Neurotic suffering offers no meaning. Jung called it “an unconscious fraud,” declared it bogus and with no moral merit. Neurotic suffering is a flight from the wounds of life and an unconscious – and unsuccessful – attempt to heal them. Neurotic suffering is a refusal to discover the meaning in our pain through a childish insistence that things should be as we want them to be and not as they are. It is expressed as self-pity and envy toward people whose lives seem better or less difficult.

-- From “After the Darkest Hour” pg. 22


On the True Nature of Reality


The Absolute Truth About Life


The Consolation of Philosophy

(De consolatione philosophiae)

Anicius Manlius Severinus Boethius (480-524 C.E.)


Everyone’s life is a drama

The Story of Kisagotami

“God sends rain on the righteous and unrighteous alike.”

-- Matthew 5:45


Buddhism’s First Noble Truth

“Life is Suffering.”

Accurate Translation:

Life is dukkha.

Dissatisfaction, discontent, dislocated


A Few True Things

  • Change is the natural order of the universe
  • Change always incorporates loss
  • We cannot control all the events of our lives but we can control our responses to them
  • There are hidden gifts in suffering

Gifts Hidden in Suffering


Turning Lead Into Gold

“God does not want us to be burdened because of sorrows and tempests that happen in our lives, because it has always been so before miracles happen.”

-- Julian of Norwich, 14th Century Mystic

“It is by going down into the abyss that we recover the treasures of life.”

-- Joseph Campbell


Overflowing Glass

Stress, suffering, pain, hard times, challenges

How full is your glass?


Principles of Deductive Logic

A specific conclusion will be accepted based on one or more premises. If the premises are true, then the conclusion must also be true. Thus, if A (a general statement) is true and B(a specific statement) is true, then C (the conclusion)must also be true. Yada, yada, yada.


Deductive Reasoning Syllogism

  • All normal dogs are born with one head and four legs. (General Statement)
  • Dorothy is a normal dog. (Specific Statement)
  • Dorothy has one head and four legs.(Conclusion)

Hey, that’s true!


Psst. Here’s the BIG


Negative Self-Image Leads to Suffering Because…

The unconscious cannot differentiate between false versus true premises as itdraws all of its conclusions by way of deductive logic syllogisms.


Premise A**: I am worthless, stupid, and will never amount to anything. (General)

Premise B: I failed my exam. (Specific)

Conclusion C: I truly am worthless and stupid. I’ll never amount to anything.

**Premises based on one’s history, experience, belief system, worldview etc.


Ways You Can Tell You Are Adding to Your Suffering Through Negative Self-Image

  • “That’s just the way I am.”
  • “I could never do that well.”
  • “People like me can’t ______ (be successful, change, overcome obstacles, learn to tap dance, fill in your own “can’t”).
  • Any number of Self-Fulfilling Prophecies.

Commonly-Held Illusions and Suffering

  • Life is fair.
  • I’m immune from Life’s realities.
  • I’m in total control. I create my life.
  • If something bad happens to me, I must have done something to deserve it.

Beyond Resiliency

“Resiliency” from the Latin resilire – “to spring back.”


Good Luck? Bad Luck? Who Knows?

“Do you have the patience to wait till your mud settles and the water is clear? Can you remain unmoving till the right action arises by itself?”

-- Tao te Ching


The Three Fates

Lachesis – The Lot Giver

Klotho – The Spinner

Atropos – The Inflexible


Locus of Control

(A Continuum)


Locus of Control


Locus of Control


Free Will



Rowing AND Flowing

The Middle Way


The Path With Heart

“Look at every path closely and deliberately. Then ask yourself and yourself alone one question…Does this path have a heart? If it does, the path is good. If it doesn’t, it is of no use.” -- Don Juan, Yaqui sorcerer


Ways We Add to Suffering

  • Resistance to change
  • Expectation that life is always fair
  • The illusion of egoism
  • Failure to take responsibility for responses
  • Ruminative suffering
  • Failure of compassion
  • Unconscious approach to life

12 Strategies


Growing Through Suffering


#1 Discover a Larger Perspective

The Eagle Nebula – 7 Million Light Years Away


Some Ways of Discovering a Larger Perspective

  • Explore religious & spiritual traditions
  • Read about your own tradition
  • Take classes in philosophy, metaphysics or other disciplines
  • Investigate your family genealogy
  • Look to nature
  • Write down or sketch your thoughts and reflections

#2 Turn Toward Compassion and Help Others

  • Look at the things you say to yourself when you’re in pain
  • Find a voice that expresses compassion to others AND to yourself
  • Fuel your compassion with action – Volunteer

#3 Recognize and Stop Self-Imposed Suffering

  • Listen to the wake-up calls about the things you do in your life
  • Look honestly at your feelings about yourself
  • Surround yourself with good company and lovingly avoid negative people
  • Forgive yourself
  • Change your inner self-talk
  • Don’t set perfectionistic goals
  • Celebrate your strengths and achievements

Holding on to a Negative Self-Image

  • Believing in Illusions
  • Avoiding fixing things that can and will lead to suffering

#4 Practice Mindfulness

“Stay here, quivering with each moment, like a drop of mercury.”

-- Rumi


Practice Mindfulness

  • Practice daily meditation
  • Read books about mindfulness
  • Tap into community support (e.g., yoga)
  • Find your unique path
  • Live in the present moment
  • Let yourself feel everything

#5 Grieve

“We’re healed from suffering only by experiencing our grief to the full.”

-- Marcel Proust



  • Recognize and acknowledge when you are grieving
  • Let yourself feel the pain
  • Sometimes find diversions
  • Express your sorrow, Talk about it
  • Forgive yourself
  • Take care of your physical self
  • Be aware of “anniversary reactions”
  • Get help if you need it
  • Help others through their grief

#6 Build Good Containers

“No Soul is desolate so long as there is a human being for whom it can feel trust and reverence.”

-- George Eliot

“We are here to awaken from the illusion of our separateness.”

-- Thich Nhat Hanh



  • Shore up your connections in your family by frequent contact
  • Create a family from friends
  • Build your containers BEFORE you need them
  • Be a good container to others in your life

#7 Count Your Blessings & Discover the Power of Optimism

“No pessimist ever discovered the secrets of the stars, or sailed to an uncharted land, or opened a new heaven to the human spirit.”

-- Helen Keller


Optimistic versus Pessimistic Cognitions During Hard Times

Source: Martin Seligman, Learned Optimism


Blessings & Optimism

  • Always, and particularly during hard times, look around at the blessings in your life
  • Calm your mind through meditation, yoga, quiet time alone, and nature
  • Look at your own levels of optimism and pessimism. How do you rate yourself?
  • Share the blessings you have with others

#8 Find Courageous Role Models & The Hero Within

“Avoiding danger is no safer in the long run than outright exposure. Life is either a daring adventure or it is nothing.”

-- Helen Keller


Role Models & The Inner Hero

  • Sit quietly and reflect on your heroes
  • Study to learn more about them
  • Write a story – how would your hero deal with your present challenge?

#9 Keep a Sense of Humor

“Humor is a prelude to faith and laughter is the beginning of prayer.”

-- Reinhold Niebuhr



  • Don’t ever be afraid to step back from your suffering and laugh
  • Share your laughter with others

#10 Express Your Feelings

“There is no grief like the grief which does not speak.”

-- Henry Wadsworth Longfellow


Express Yourself

  • Talk about your suffering with a friend of therapist
  • Listen to others when they need an ear
  • Express your suffering through art or ritual


and the

Story of the

Chinese Potter


#11 Silence, Prayer & Meditation

“There is nothing in all creation so like God as stillness.”

-- Meister Eckhart


Silence, Prayer & Meditation

  • Set aside time each day to meditate or pray
  • Read, practice and learn about the many types of meditation and prayer
  • Discover the joys of prayer and meditation with others through a place of worship
  • Learn to love silence
  • Ask your friends and family to keep you in their prayers

#12 Come to Your Life Like a Warrior

“The difference between an ordinary person and a warrior, is that a warrior takes everything as a challenge while an ordinary man takes everything as either a blessing or a curse.”

-- Don Juan, Yaqui Sorcerer


The ABC’s of Living as a Warrior

A Awareness

B Bravery

C Compassion

D Discipline


Live Like a Warrior

  • Gently but honestly look at yourself and your life in relations to the four warrior characteristics. Where are you strong? Where do you need work?
  • Work out a specific plan to keep yourself physically, psychologically, and spiritually strong.
  • Every morning ask yourself one question: “What do I need to do today to take greater responsibility for my life and live with the passionate vitality of a warrior?”

This being human is a guest house…

“Open the door to your guest house. Say “yes” to all of your life. Choose to live joyfully even in your pain. Love yourself and everyone else. Be present always – alive to every moment. Grieve when you should, fight when you can, accept when you must. But above all, say yes.”

-- From “After the Darkest Hour” pg. 262


Day Two - AfternoonThe Illusion of Separatenessand the Power of Connection

  • Resolving the dialectic between the ego and the Self
  • What we know about belongingness and health
  • Why connection is and antidote to illness and a precursor to vibrant health
  • Ten vigorous approaches to help patients enrich their relationships

Become a Lake

“We are here to awaken from the illusion of our separateness.”-- Thich Nhat Hanh, Vietnamese Buddhist Monk


The Landscape of Connection

  • The Biology of Belonging
  • The Psychology of Belonging
  • The Nature of Attachment
  • The Failure of Attachment
  • The Evidence for the Power of Connection
  • Social Capital and Where We Collectively Stand
  • The Usual Suspects
  • A New Paradigm/Honoring the Wake-Up Call
  • A Thousand Words for Snow

A Social Animal

“By our very natures, humans are prepared to be social animals. We are biologically and psychologically prepared for attachment and bonding. Our need for connection is – from birth and beyond – a fundamental survival need.”-- Living a Connected Life


Some Evidence for Human Sociability

  • Infants cry at sound of another infant’s cry.
  • Menstrual synchronization.
  • Without touch and closeness, infants die.
  • Fine tuning of thousands of physiological events – blood pressure, heart rate, body temperature, sugar levels, hormones and salts are affected by others and they, in turn by us.
  • Heart-to-Heart.

Attachment is Not Just In The Brain

“It is only with the heart that one can see rightly.For that which is essential is invisible to the eye.”

-- Antoine de Saint-Exupéry “The Little Prince”


Attachments of the Heart

  • The heart forms in the developing fetus before the brain (within the first 18 days post-conception) and a regular heartbeat can be measured within days of that.
  • Heartbeat is “auto-rhythmic” self-initiated from within the heart itself.
  • Generates the strongest electromagnetic field produced by the body (40-60% more amplitude than the brain).
  • Electricity generated by the heart can be measured in the brain waves of another person when people are touching or near one another (measured up to 12 feet).
  • Entrainment – heart cells from two different people will begin to beat together even when in two separate petri dishes – synchronization.

Human Infants and Baby Sea Turtles

Compared to every other species, human infants are born premature and must continue to develop outside the womb. We’re biologically hardwired to ripen through loving, secure experiences with caregivers.


Psychology and Biology of Belongingness

Brain Development in Infants

  • 75% of Brain develops after birth through experience
  • 100 billion neurons and trillions of glial (“glue”) cells
  • Interconnections are most critical and forming
  • Changes 100,000 times more rapidly than an adult brain
  • Consumes far more calories than adult brain (65% v 15%)
  • Pre-wired and Pruning (“use it or lose it”)
  • Synaptic pathways

Renée Spitz Research – 1940’s

  • Infants taken from felon mothers and raised in “sterile nurseries” where they were fed but not handled or cuddled:
  • Failed to thrive and were diminished in height and weight for their age
  • Developed brains that were 20-30% smaller than normal
  • 25% died within the first year. 37% died within the second year
  • Ironically, 40% of the infants who contracted measles died when the mortality rate outside the institution was only .5%
  • Scored 72 on the WISC (average intelligence is 90-105)

John Bowlby“The Father of Attachment Theory”

Bowlby said human attachment was much more like imprinting in geese and less like the reward and punishment schedules that allowed behaviorists to make rats run mazes or shape pigeons to peck levers. Attachment is innate and neurologically based - An instinctive reciprocal relationships with implications for the survival of the species.

Konrad Lorenz and baby geese


Harlow’s Monkeys – 1960s

Infant rhesus monkeys separated from their mothers were apathetic, sometimes hyperagitated, aggressive and given to outbursts of violence. The were socially inept, highly fearful, failed to interact normally, showed inappropriate sexual responses and often rocked like autistic children. As adults – the females were not able to care for their offspring, would not breastfeed, and behaved violently toward their babies.


Mother/Infant Proximity & Breastfeeding

  • Balances levels of cortisol (a stress hormone) in the infant and sends messages to the brain to make connections
  • Flood of prolactin and oxytocin in mother (“mothering hormones”)
  • Infant’s core body temperature coordinates with that of her mother (called “thermoregulation”)
  • Interval of their heartbeats is the same

Fathering and Attachment

  • Not as clear as research with mothers – probably because little research attention has been paid to attachment and human fathers
  • New research is documenting dramatic endocrinological changes for fathers in preparation for and after the birth of offspring. Clear effects of paternity in several species of mammals and rodents and most species of birds
  • Human fathers – reduction in salivary testosterone in response to infant’s cries
  • Fathers’ levels of cortisol, prolactin and testosterone changed dramatically during partner’s pregnancy

Infants Are Born Ready to Relate

  • Hearing is fully developed at birth – the developing fetus has taken in 60% of the sounds surrounding his/her mother
  • Even 2-day old infants show a decided preference for human sounds and music over all other sounds
  • Preprogrammed to look for and see human faces – will orient to a mask if it has two eyes, a smooth forehead, a nose and moves. A mouth is not necessary! Between 3-6 months, infants smile – “innate releasing mechanism”
  • Can discriminate between miniscule changes in emotional responsiveness of people around them

Erik Erikson’s 8 Stages of Human PsychoSocial Development

  • Trust/Mistrust (Infancy – ages 1 or 2)
  • Autonomy/Shame (ages 2-4)
  • Initiative/Guilt (ages 4-6 – formal school)
  • Inferiority/Inferiority (“school age”)
  • Identity/Identity Diffusion (Adolescence)
  • Intimacy/Isolation (Young Adult)
  • Generativity/Self-Absorption (Adulthood)
  • Integrity/Despair (Maturity)

Mastering Trust/Distrust

When an infant learns to trust others, herself, and the environment when her physical and emotional needs are met and she is free from uncertainty, feels safe and protected, develops secure attachments, and knows that others will help and care for her. With this early experience, the infant will grow into a person with abilities to form and maintain relationships. She will have positive expectations about others and a long-standing belief in her own worthiness and the expectation that the world can be a safe place.


Failing to Master Trust/Distrust

If the infant cannot (for any reason) master the challenge of trust/mistrust, she will carry remnants of this uncompleted task into the next and subsequent stages of development and mover through life with high levels of fear and insecurity. As an adult, she will see the world as an unfriendly, unpredictable, and chaotic place and will be unlikely to develop deep and intimate relationships with others.


Types of Attachment

  • Secure – Upset at mother’s departure and easily soothed when she returned (about 70% of infants tested this way in the “Strange situation”)
  • Insecure/Avoidant – May or may not be distressed at mother’s departure but avoided or turned away from mother on her return
  • Insecure/Ambivalent – Distressed at mother’s departure but seeks both comfort and distance on mother’s return. Crying and reaching to be held but attempting to get away once picked up. Actively or passively showed hostility to mother

Mary Ainsworth et al


Attachment: When Things Go Wrong

  • “Needy,” lonely, disaffected, pessimistic
  • High levels of psychological (e.g., low self-esteem, depression, anxiety) and physical problems (e.g., failure to thrive, infections, chronic illness)
  • Antisocial: sometimes aggressive or violent
  • Difficulties with trust, intimacy & affection
  • Attachment Disorders form a continuum bounded on one end by “secure attachment” and the other by the most severe Reactive Attachment Disorder (RAD)e.g., Romanian Orphans (1960s – 1990s)

Reactive Attachment Disorder Sad Statistics

  • Attachment disorder is transmitted intergenerationally. Children lacking secure attachments with caregivers commonly grow up to be parents who are incapable of establishing this crucial foundation with their own children. Instead of following the instinct to protect, nurture and love their children, they abuse, neglect and abandon. The situation is out of control. Consider the following:
  • The number of children seriously injured by maltreatment quadrupled from 1986 (140,000) to 1993 (600,000).
  • Three million cases of maltreatment were investigated by Child Protective Services in 1995. Over one million were confirmed as serious abuse and/or neglect with risk for continued maltreatment. Surveys indicated the actual number of cases are 10 to 16 times higher.
  • Child Protective Services are unable to handle the vast increases; only 28% of seriously maltreated children were evaluated in 1993 compared to 45% in 1986.



Symptoms of Reactive Attachment Disorder

  • Behavior: oppositional and defiant, impulsive, destructive, lie and steal, aggressive and abusive, hyperactive, self-destructive, cruel to animals, irresponsible, fire setting.
  • Emotions: intense anger and temper, sad, depressed and hopeless, moody, fearful and anxious (although often hidden), irritable, inappropriate emotional reactions.
  • Thoughts: negative beliefs about self, relationships, and life in general ("negative working model"), lack of cause-and-effect thinking, attention and learning problems.
  • Relationships: lacks trust, controlling ("bossy"), manipulative, does not give or receive genuine affection and love, indiscriminately affectionate with strangers, unstable peer relationships, blames others for own mistakes or problems, victimizes others/victimized.
  • Physical: poor hygiene, tactilely defensive, enuresis and encopresis, accident prone, high pain tolerance, genetic predispositions (e.g., depression, hyperactivity).
  • Moral/Spiritual: lack of faith, compassion, remorse, meaning and other prosocial values, identification with evil and the dark side of life.



Our History MAY Become Our Future

  • Habits are formed through repetition
  • Psychological and neurological “ruts” (Synaptic pathways)
  • Negative self-image, internal self-talk, self-defeating beliefs
  • Lack of skills required for intimate connections

The Good News! People can change through insight and action!Specialized Therapy is necessary for severe cases of attachment disorder.


Attachment: When Things Go Right

“Secure adults find it relatively easy to get close to others. They’re happy, socially competent people with high levels of resiliency and persistence. They don’t worry about being abandoned or having someone close to them. They’re “emotionally intelligent,” empathetic with others, solve many problems on their own but aren’t reluctant to ask others for help when they need it. They maintain close, intimate connections with others.”– Living a Connected Life


Well, You Got To Have Friends

Loneliness breaks the spirit -- Jewish Proverb


The Power of Connection/Belongingness

“If you could do just one thing that would lengthen your life, help you stay psychologically and physically healthy, and support your healing when you did become ill, you would maintain strong connections to other people. The effects of belongingness are so potent that if they could be bottled, they would need FDA approval.”-- Living A Connected Life


The Early Evidence

As early as 1897, French Sociologist Emile Durkheim observed that one could predict rates of suicide by looking at the quality of social ties in an area. In areas where there was strong “social solidarity”, suicide rates were low. Areas where social ties were weak had much higher rates of suicide.


The Roseto Effect – 1950s

A small town in Pennsylvania – A close-knit community of Italian immigrants who lived longer lives than people in neighboring towns and were virtually free of heart disease.

Had they found the alchemical Elixir Vitae?

No! They had high levels of social cohesion, trust, and mutual respect. They were connected.

From 1979 to 1994, eight large-scale community-based studies confirmed what those early researchers found in Roseto.


Scientific Studies

  • Five decades of medical and epidemiological research has shown the powerful and positiveeffects of connections on:
  • Heart and cardiovascular disease
  • Stroke
  • Respiratory Diseases
  • Cancer
  • Allergies, Colds, and other Infectious Diseases
  • Depression, Stress and other Psychological Problems

Positive Effects of Connections

In his book Love and Survival: The Scientific Basis for the Healing Power of Intimacy, physician Dean Ornish summarizes the power of connections this way: “I am not aware of any other factor in medicine – not diet, not smoking, not exercise, not stress, not genetics, not drugs, not surgery – that has a greater impact on our quality of life, incidence of illness, and premature death from all causes.”


Interesting Gender Difference

  • When women are stressed – they move toward greater connection with other (“Tend and Befriend” rather than “Fight or Flight”).
  • Men under stress tend to “hole up.”
  • Women respond to stress with a surge of brain chemicals (such as oxytocin) that buffer the “fight or flight” response, pushes them toward social contact, which releases more oxytocin which calms them further. Estrogen (a female hormone) has an enhancing effect on oxytocin whereas testosterone (a male hormone) reduces it.

Klein, Laura & Taylor, Shelley (UCLA Stress Research Lab), 2002


“Social Capital”

Social capital is the “glue” that holds societies together and refers to the quality and depth of relationships between people in a community.


The Collective Benefits of High Social Capital

  • Joining one group cuts your odds of dying over the next year in half. Joining two groups cuts it in quarter.
  • Communities with higher levels of social capital produce children with higher SAT scores and higher performance on a broad range of testing.
  • Communities with higher social capital have lower dropout rates, higher retention, and less youth violence.
  • The more connected we are in our community, the less colds, heart attacks, strokes, cancer, depression, and premature death we experience.
  • The higher the social capital, the less murders and violent crimes in our neighborhood.
  • Blood donations are higher in communities with high social capital.
  • Road rage is reduced in communities with high social capital.
  • Measured happiness goes up when we are socially connected in mutually respectful, trusting relationships based on exchange and reciprocity.

The Sorry State of Our Connections

  • Family dinners and family vacations or even just sitting and talking with your family are down by one third in last 25 years.
  • Having friends over to the house is down by 45 percent over the last 25 years.
  • Participation in clubs and civic organizations has been cut by more than half over last 25 years.
  • Involvement in community life, such as public meetings is down by 35 percent over last 25 years.
  • Church attendance is down by roughly one third since 1960s.
  • Philanthropy as fraction of income is down by nearly one third since the 1960s.

How Connected Are You?

How many of your neighbors’ first names do you know?

How often do you attend parades or festivals?

Do you volunteer at your kids’ school? Or help out senior citizens?

Do you trust your local police?

Do you know who your U.S. senators are?

Do you attend religious services? Or go to the theater?

Do you sign petitions? Or attend neighborhood meetings?

Do you think the people running your community, care about you?

Can you make a difference?

How often do you visit with friends or family?

The Social Capital Community Benchmark Study –


The Usual Suspects for our Dwindling Social Capital

  • Mobility
  • Where You Live
  • Sprawl
  • Not Enough Time
  • Television
  • Technology
  • Breakdown of Traditional Families
  • Women in the Labor Force
  • Generational Effects


  • U.S. Census Bureau reports that residential mobility has been exceedlingly constant over the past 50 years, but if anything, we’re relocating LESS now than in the 1950s (when social capital was high by every measure)
  • 1950s = 20% of Americans moved each year compared to 16% (1999).
  • Adding to the stability of present-day communities, home ownership in 1999 was at a record-setting high (67%).



Where You Live

  • Residents of large metro areas compared to small-town counterparts are less likely to join groups, attend club or public meetings, attend church, or visit with friends.
  • BUT – metro residents are only about 10% less trusting and join different kinds of groups – More nationality-based and political clubs while smaller cities have more veterans’, fraternal, agricultural, service, and church groups.




  • Suburban sprawl has created an environment in which most Americans no longer live where they work
  • The average commuter spends 72 minutes every day behind the wheel and most commute alone (2/3 of all car trips are made alone)
  • Commuting represents twice as much time as the average parent spends with kids
  • Every ten minutes of additional commuting time cuts all forms of social capital by 10%

Get back in the lineup, son!


Not Enough Time

  • Time-use studies show that leisure time from 1965 to 1985 actually increased by 5 hours per week
  • The average American schedule has more than 40 hours a week that could be used to make deposits into our social capital account
  • Question of priorities, not of time




  • Americans spend more hours alone in front of their TV sets (3-4 hours per day) than in any other activity except work & sleep
  • TV watching accounts for more than ½ of all leisure time activity
  • Heavy television watchers are more likely to be pessimistic, overestimate crime rates, and spend less time engaged with others
  • The only leisure time activity that is associated with decreased (rather than increased) social capital
  • “The data suggest that most Americans would rather watch Friends than have friends.” – Robert Putnam, Bowling Alone
  • Longer work hours are associated with more (not less) civic engagement and connections (e.g., report 30% less TV)

Get back in the lineup!



  • Some studies suggest that people who spend a great deal of time on the Internet are less connected to other socially.
  • Other studies have shown that technology has enormous power to create and maintain relationships.
  • “The Digital Divide” is a serious social issue.
  • Conscious use of technology needs further exploration.

The Jury is Out!


Breakdown of Traditional Families

  • Strong families increase social capital – at the core of our sense of connection, belongingness
  • Changes in basic structure of family: number of married Americans has declined from 74% (1974) to 56% (1998); ½ of all first marriages end in divorce
  • BUT, the sharpest jump in the divorce rate occurred in the 1970s – “long after the cohorts who show the sharpest declines in connection and social trust had left home”
  • Traditional family structure only associated with churchgoing and youth-related activities. Single and divorced people are more likely to attend club meetings and hang out with friends. Married folks more likely to have dinner parties
  • Divorce and changes in structure of families have only a moderate effect on social capital



Women in the Labor Force

  • In the 1960s only 37% of women held jobs outside the home, 60% of women now do (2003)
  • Men belong to more groups, but women spend more time with the ones to which they belong
  • Women who work outside the home actually spent more time with clubs and organizations than women who did not work outside the home
  • Working outside the home or not, women still spend more time in informal socializing than men



Generational Effects

  • Throughout the life cycle, people born before 1932 experienced more civic involvement, trust between people, feelings of belongingness, and relationships to neighbors and groups
  • “The Greatest Generation” vote more often (double the rate for other generations), trust people more (60% compared to 25% for their grandchildren) and are more engaged in civic and neighborhood life – they’re more connected

Get back in the lineup!


Robert Putnam et al. Saguaro Seminar John F. Kennedy School of Government, Harvard University

Analyzing the Guilty Suspects

Generational Effects 40-50%

TV 20-25%

TV Generation 10-15%

Sprawl 10%

Work/Time Pressures 10%


A Terrifying Prophecy

“Creating (or recreating) social capital is no simple task. It would be eased by a palpable national crisis, like war or depression or natural disaster, but or better and for worse, America at the dawn of the new century faces no such galvanizing crisis.”

-- Robert Putnam (2000)

…until now


A Changed and Changing World – Post 9/11?

Americans dramatically shifted their stated priorities after the terrorist attacks of September 11, 2001. Multiple polls showed we said we wanted closer connections, and more time with our friends and family. But, unfortunately, this shift in values didn’t last very long. By the spring of 2002, the surveys showed we were back to business as usual.


Honoring the Wake-Up Call

  • Crisis and Opportunity
  • Paradigm shift
  • Establishing Values & Priorities
  • Respecting the Yin

What is Old Can Become New

  • Indigenous Cultures are strong in places where ours is weak:
  • Native American Tribes
  • Hawaiian hanai and ho’oponopono and aloha
  • Canela people of Brazil

The Downside of “Belongingness”

Al-Qaeda, Nazisim, Aum Shinrikyo, Gangs

Everything of substance casts a shadow

  • Closed systems
  • No respect for individuality/diversity
  • Patriotism becomes jingoism
  • “Us” v. “Them”
  • Deference to authority and conformity abounds
  • Fragments, polarizes & abuses

Collective and Individual Balance

Both ruthless collectivism and rugged individualism are unbalanced and destructive to human life. Either one in its extreme form fails to provide the kind of society that allows human beings to flourish in their individual achievements and freedoms while nestled in the loving embrace of community, social responsibility, and safe harbors.


Integration of Dualities

As in all dualities, the wise strive to “hold the tension of the opposites” to integrate and balance opposing forces as we walk in both worlds.












Right Brain

Left Brain



“Shady Side of the Mountain”

“Sunny Side of the Mountain”







Relatedness, Communalism

Individualism, Separatism

Open Systems

Closed Systems



Assumptions for the Model

  • Everyone needs a variety of people and relationships in their lives
  • Relationships are not static; they change, as do our lives and needs.
  • Think of the “rings” in the model as semi-permeable membranes
  • It is the inner circle of relationships – those with whom we are connected by the heart – that constitute our “tribe” or true safety net. These are the containers that serve as our containers for emotional and spiritual growth
  • With the possible exception of our biological family, most relationships do not begin within this inner circle
  • Don’t mistake the “map” for the “territory” – life is really more complex than any model can describe

The World At Large

  • Global Planet
  • Non-local Consciousness, Subatomic Particles and Random Event Generating Machines
  • The Power of Love
  • More opportunities for connection than you may ever have realized
  • Mitakye Oyasin and Namaste

Not Quite Strangers & Acquaintances

  • We may have hundreds of people in our network of “not quite strangers” who are wrested from the great web of being
  • Friendship develops when one person says to another, “What! you, too? I thought I was the only one!” (C.S. Lewis)

Moving Closer to the Center

  • Shared values more important than shared interests. But shared interests are a good place to start
  • Move relationship out of its original context (e.g., ask a co-worker to your daughter’s wedding)
  • Original context makes a difference (Chinese saying: “We will often forget those we’ve laughed with. We will never forget those we’ve cried with.”) A refiner’s fire
  • Unexplainable chemistry

Friends For A Season or Reason

  • May have a number of “casual” friends but are tied together for a season or reason
  • When season or reason changes, friend may not be so close
  • Our expectations should be realistic
  • These friends may become attached-at-the-heart with time and nurturance

Attached-At-The-Heart Friends

  • “My friends are my estate.” Emily Dickinson
  • “A Friend is a single soul dwelling in two bodies.” Aristotle
  • “One loyal friend is worth ten thousand relatives.” Euripides
  • “Friends are the masterpiece of nature.” Emerson
  • “Friend, our relationship is this that wherever you put your foot, you feel me in the firmness under you.” Rumi
  • “Friendship? Yes, please.” Charles Dickens

Our Safe Harbor

  • Plato – searching for our missing half
  • Fictive Kin and Aunt Franny
  • Last a lifetime, call at 3 AM, good times/bad times
  • Celtic Anam Cara (“Soul Friend”)
  • Ceremonies pledging unconditional loyalty:
    • “Blood brother” (Native American)
    • Hawaiian pili hoaloha
    • German & Swiss Duzen (to address informally)

A Map To Connection

  • Your Friendship Values
  • Know Thyself
  • Social Skills
  • Acceptance – Are you a friend?
  • Boundaries: Armor, Gelatin, and semi-permeable membranes
  • Communication Revolution
  • Good Times/Bad Times
  • That Time Thing

“We have all known the long loneliness and we have learned that the only solution is love and that love comes with community.”-- Dorothy Day, humanitarian and founder of the Catholic Worker Movement, 1933


Your Friendship Values

  • Values are the foundation upon which everything else relies
  • Conscious understanding and living one’s values
  • Yogi Berra – “If you don’t know where you’re going, you’ll end up somewhere else.”
  • Rocks in a Mason Jar

Know Thyself

  • You can’t have a better relationship with anyone else than the one you have with yourself
  • What do you bring into your relationships?
  • How well do you know yourself?
  • The Persona and The Shadow
  • Emotional Intelligence (EQ)
  • “To know others is to be wise, to know oneself is to be enlightened” – Tao Te Ching

Social Skills

“Great news! You can learn social skills just like I did! Let’s do lunch!”

  • Verbal Aspects
    • Self-Disclosure
    • Me, Me, Me – The Song of Narcissism
    • Listening Skills
  • Non-Verbal Aspects
  • Cognitive Aspects (self-defeating beliefs and negative self-talk)
  • Emotional and Physiological Aspects

Acceptance: Are You A Friend?

  • Similarities and Differences
  • The Futility of Seeking Perfection
  • Unconditional Love and Acceptance
  • Giving AND Receiving

Boundaries:Armor, Gelatin & Semi-permeable Membranes

  • The importance of Interpersonal Boundaries
  • Turning Toward, Turning Against, Turning With
  • Unable to risk v. Co-Dependency
  • When friends hurt/Toxic relationships
  • Schopenhauer’s Porcupines

Communication Revolution

  • Express Yourself
    • Self-Disclosure
    • Clarity
    • Assertiveness

2. Advice and Truth

  • The fine (and lost) Art of Listening
  • The gift of communication technology at the top of Mount Haleakala

Good Times/Bad Times

  • “Be more prompt to go to a friend in adversity than in prosperity,” Chilo (6th Century BCE – Greek)
  • Two Travelers and the Bear (Aesop)
  • Ch-Ch-Ch-Changes (“Friendshifts” – Jan Yager)
  • Shared Interests/Shared Values
  • History and Remembrance

That Time Thing

“If you want to make good use of your time, you’ve got to know what’s important and then give it all you’ve got,” -- Lee Iacocca

  • Identify your use of time
  • Analyze your present situation
  • Develop a plan – short and long-term goals
  • Implement your plan
  • Re-evaluate your use of time

Lessons From Toulouse

  • Be patient, persistent, never give up
  • Welcome the stranger

Finding Your Pack

“Wolves love to howl. When it is started, they instantly seek contact with one another, troop together, fur to fur. Some wolves will run from any distance, panting and bright-eyed, to join in, uttering, as they near, fervent little wows, jaws wide, hardly able to wait to sing.” – Lois Crisler, Arctic Wild

There is no house like the house of belonging.David Whyte, poet


Day Two - AfternoonSpirituality, Healing and Clinical Practice

  • The connection between spirituality and health – what the research tells us
  • A paradigm shift integrating science and soul
  • Ethical considerations in spirituality and healing
  • Reframing illness as an opportunity for spiritual growth
  • The metaphysics of health
  • How to forge healing alliances with patients
  • Toward a new psychology of clinical behavioral medicine

Spirituality, Healing, and Clinical Practice in 1910

  • “Nothing in life is more wonderful than faith -- the one great moving force which we can neither weigh in the balance nor test in the crucible…mysterious, indefinable, known only by its effects, faith pours out an unfailing stream of energy while abating neither jot nor tittle of its potency.”
  • Sir William Osler (1910). “The faith that heals,” British Medical Journal, 1:1470-72.

Spirituality, Healing and Clinical Practice

Separation of Religion and Medicine occurred between 1400 and 1800

  • Illness first addressed in religious/spiritual terms
  • First documented surgical operation
  • First hospitals to care for sick in general pop
  • For 1400 years, church controlled medicine
  • Many early physicians were priests or monks
  • First nurses came from religious orders
  • Modern psychiatric care had origins in “moral” treatment of the mentally ill

Spirituality and Health: What People Believe

  • 84% of Americans think that praying for the sick improves their chances of recovery; 28% think religion and medicine should be separate
  • 70% of Americans say they pray often for the health of a family member. Just 52% say they pray for world peace and 27% say they pray for financial or career success
  • 72% of Americans say they would welcome a conversation with their physician about faith
  • 72% of Americans say they believe that praying to God can cure someone – even if science says the person doesn’t stand a chance

Source: Newsweek Poll, 2003


More Factoids

  • More than half of American Medical Schools now offer courses in “spirituality and medicine” – up from just three a decade ago
  • NIH will spend $3.5 million over the next several years on mind/body medicine
  • Harvard Medical School held a conference on spirituality and health, focusing on the healing effects of forgiveness
  • More than ¾ of the more than 35,000 online prayer circles are health related on – a popular interfaith web site

The Empirical Data

Source: Powell. L.H. et. al. “Religion and Spirituality: Linkages to Physical Health” American Psychologist, Vol. 58, No. 1, January 2003


Life Expectancy:One of the clearest health benefits of religion: churchgoers live longer than others


Living Well: Churchgoing promotes healthy habits: Weekly attenders are more likely to make positive changes


Study sample: reviewing findings from three national surveys totaling more than 5,600 older Americans

  • Study results: Attending religious services was linked with improved physical health or personal well-being.
  • Other studies: 12 other studies published since 1980 found persons in organized religious activity had higher levels of life satisfaction.
  • Levin JS, Chatters LM. “Religion, health, and psychological well-being in older adults: findings from three national surveys.”Journal of Aging Health1998;10(4):504-531.

Meditation, Prayer, Chanting

  • Changes brain activity
  • Improves immune response
  • Lowers heart rate and blood pressure
  • Reduces the body’s stress response

The Evidence Mounts…

In a national trial of 750 patients undergoing heart catheterization or angioplasty, patients who were prayed for and who also received a special program of music, therapeutic touch, and guided imagery had death rates 30% lower than the group that received standard care or the group who was only prayed for.Source: Mitchell Krucoff, M.D. Duke University. Research reported at the American College of Cardiology, October 2003.


…And Mounts

In a survey of 1,500 people, results showed that people who forgive easily tend to enjoy great psychological well-being and have less depression than those who hold grudges.Source: Neal Krause – University of Michigan School of Public Health, 2003.

“There’s a physiology of forgiveness. When you do not forgive, it will chew you up.”

Herbert Benson, M.D. Head of the Mind/Body Medical Institute, Harvard University


Mind/Body Connection Well Documented:

  • Progress in psychoneuroimmunology
  • Stress and the immune system
  • Health behaviors and immune function
  • Stress and wound healing
  • Social support as a buffering factor
  • Cancer incidence and metastasis
  • Progress in cardiovascular physiology
  • Stress and cardiovascular function
  • Health behaviors and cardiovascular function

Meditating nuns have increased activity (red) in regions used for concentration

Source: Andrew Newberg, M.D. Director of Clinical Nuclear Medicine, Director of NeuroPET Research, and Assistant Professor in the Department of Radiology at the Hospital of the University of Pennsylvania


Meditating nuns have decreased activity (yellow) in areas promoting a sense of self (e.g., ego)

Source: Andrew Newberg, M.D. Director of Clinical Nuclear Medicine, Director of NeuroPET Research, and Assistant Professor in the Department of Radiology at the Hospital of the University of Pennsylvania


Why Integrate Spirituality Into Healing and Clinical Practice?

“For the more than 70 percent of the population for whom religious commitment is a central life factor, treatment approaches devoid of spiritual sensitivity may provide an alien values framework... a majority of the population probably prefers an orientation... that is sympathetic, or at least sensitive, to a spiritual perspective. We need to better perceive and respond to this public need.”

Bergin and Jensen, Psychotherapy1990;27:3-7.


Spirit and Science

Is there a fundamental “disconnect” between the nature of spirituality and the methods of modern science?

There are problems with using scientific methodologies to investigate essentially existential questions. For example:

  • How do you measure the power of prayer?
  • Can one person’s prayer be stronger – and more effective – than another’s?
  • How do you separate the health benefits of going to church/synagogue/mosque from the fact that people who attend religious services tend to be less depressed and smoke less than those who don’t?
  • Most research has been done using attendance at church as a variable of interest. Measuring “spirituality” rather than church attendance is a more complex research issue.

Are Spirituality and Science Mutually Exclusive?

“Religion and science seem to be mutually exclusive perspectives.”

Stark (1963). Journal for the Scientific Study of Religion, 3:3-20.

“Religion and science are mutually exclusive realms of thought whose presentation in the same context leads to misunderstanding of BOTH scientific theory and religious belief.”

National Academy of Science (1984). “Science and creationism: A view from the National Academy of Science.”


Dangers in the Integration of Spirituality and Health

1. We will impose our own spiritual beliefs on patients/clients

2. Infer that people who are sick are somehow spiritually inadequate


Negative Effects

  • Used to justify hatred, aggression, prejudice
  • Judgmental, alienating and exclusive
  • May be restricting and limiting, rather than freeing
  • May induce excessive guilt (not enough “faith”) (NOTE: Seriously ill patients who thought God was punishing or abandoning them were up to 30% more likely to die over the next two years (Source: Kenneth Pargament, Ph.D. Green State University (Ohio) – study with 600 patients)
  • May encourage magical thinking, sacrifice of intellect
  • May be used instead of medical care
    • Failure to seek prenatal, obstetrical, and other medical care
    • Failure to vaccinate children
    • Stopping of medication to demonstrate faith

Illness does not result from a lack of spirituality or faith

  • Suzuki Roshi (who brought Zen from Japan to the U.S.) died from liver cancer
  • Saint Bernadette died at age 35 of tuberculosis
  • Sri Ramana Maharishi – the most revered saint in India – died of stomach cancer
  • Siddhartha (the Buddha) died from food poisoning

… and even the Dalai Lama has to wear glasses!


Physicians’ Top Five Barriers to Addressing Patient Spiritual Needs

Ellis, M.R. et al. “Addressing spiritual concerns of patients’ family physicians attitudes and practices.” Journal of Family Practice, 1999; 48 (2), 105-9.


Application of Spirituality to HealthCare Practice

  • Take a religious/spiritual history
  • Identify religious/spiritual needs
  • Orchestrate resources to meet those needs
  • Keep patient-centered
  • Support religious beliefs patient finds helpful
  • Address religious/spiritual issues???
  • Pray with patients???
  • Prescribe religious practices to non-religious???
  • Network with local pastors/parish nurses

Source: Harold G. Koenig, Duke University Medical Center. Address to Academy of Psychosomatic Medicine, San Antonio, TX, November 2001


Respectful Questions

  • Is faith (religion, spirituality) important to you in this illness?
  • Has faith (religion, spirituality) been important to you at other times in your life?
  • Do have someone to talk to about religious matters?
  • Would you like to explore religious matters with someone?

Recommended by American College of Physicians-American Society of Internal Medicine End-of-Life Care Consensus Panel. Lo, B., Quill, T., & Tulsky, J. (1999). Discussing palliative care with patients. Annals of Internal Medicine, 130, 744-749.


Summary of Research on Spirituality and Health

  • Our current health care system has its origins and roots in religious practice
  • Religiously involved people generally have greater well-being and better mental health
  • Religiously involved people generally have better physical health and live longer
  • Religiously involved people generally need and use fewer health services
  • Sensitive application of these research findings to clinical practice should be considered

Source: Harold G. Koenig, Duke University Medical Center. Address to Academy of Psychosomatic Medicine, San Antonio, TX, November 2001


Thank You. Mitakuye Oyasin.


Good Friends: Kathleen & Dorothy