The Mark of Wisdom
Our book Inspirations for Thriving Through Chaos is currently being promoted FREE on Kindle Unlimited. So we thought we’d highlight that great opportunity by offering you a sample of its contents to whet your appetite for discovering more people who contribute to the world of health and wellbeing. This chapter (5 in the book) is based on an interview with Dr. Mark Chambers, a friend and colleague whose admirable approach to holistic health is steeped in his commitment to continual learning.
As a retired GP, Mark continues to consult, coach and teach Integrated Healthcare. In this interview (2020 – during lockdown) Mark references many inspirational people of our times and reveals the true nature of taking the Hippocratic Oath.
Kay: Mark, you and I seem to be interested in the same things in terms of wellbeing, and you’re teaching me mindfulness at the moment. What would you say would be the big chunk of your interest?
Mark: I’m interested in helping people to help themselves to feel better. Essentially, that’s my elevator pitch, that’s what I do. I was a GP for 38 years, and since I retired from General Practice three years ago, I’ve been running a coaching and clinical hypnosis practice, which keeps me busy. I’ve also been doing quite a lot of teaching. I’ve been teaching hypnosis to doctors and medical staff, and teaching mindfulness to anybody who wants to learn. That’s been the big thing for me for about 15 years now. I was introduced to mindfulness by Dr. Stephen Gilligan and got curious about it mainly because patients were talking about it, so I thought I’d find out what it was about. It features a lot in the way I approach my work now.
Kay: And mindfulness is a word I think a lot of people use easily and they think they know what it is. How would you describe it?
Mark: A very fair question. My interest came from patients who were coming back, having previously been referred elsewhere by various practitioners with emotional and psychological issues, for mindfulness treatment. What they were describing were mindfulness-based interventions of various sorts, with some mindfulness as part of the process, but also psycho-education. They were describing a lot of cognitive content exercises and things to be doing with their thinking mind.
So I looked into this, guided by one of my colleagues, an osteopath, who was very interested. He introduced me to the person who introduced me to NLP. He said, “If you want to know about mindfulness, then go and read Thích Nhất Hạnh’s work. He’s the Vietnamese Buddhist monk who wrote the book, The Miracle of Mindfulness. Soon after the Vietnamese war, he was exiled to France and this was a little pamphlet of instruction sent back to his people in Saigon, who were struggling without him. It’s a very short, very simple booklet, a simple instruction essentially. His definition of mindfulness was, in five words – the practice of conscious awareness.
I teach a mindfulness programme with a colleague, Jenny Thornton, and that’s essentially the basis of it. It’s just helping people, noting and letting go of all the cognitive content in the moment and coming back to this awareness of the practice of conscious awareness. So it’s a practice. It’s something we do. And the thing that we do is consciously pay attention, without any content. So it’s like having our brain or our awareness go out like a radio, just having it switched on but not actually tuned into a station. So just being in the present, in a state of equanimity. Nothing to respond to, nothing to react to, just being awake and aware in a non-reactive way.
Kay: So how do you handle an enquiry like, “Well, what’s in this mindfulness stuff for me? How does it work?”
Mark: I don’t get many enquiries like that; they’re usually fairly indirect. People come to see me because either I was their doctor for many years, or they know someone who knows me. I get a lot of referrals from former colleagues or consultants for people who aren’t responding to a standard western medical approach because there are other things going on.
I don’t regard mindfulness as a therapeutic intervention. It’s not a treatment; it’s a skill. It’s an ability that is part of our natural human condition, which is really where I started becoming interested, because it’s not a therapeutic thing.
Forty years ago John Kabat-Zinn and his colleagues in Boston, Massachusetts developed Mindfulness-Based Stress Reduction. More recently, Mark Williams and his colleagues in Oxford have developed Mindfulness-Based Cognitive Therapy. These techniques have proved very helpful in therapeutic contexts. They use an understanding of mindfulness as a way of getting people into the starting blocks and then add content, therapeutic interventions, onto this.
So some people do come because they know I teach mindfulness and become curious about that specifically. People come because they’ve been labelled with an illness or had some sort of psychological or emotional label attached to them, and usually they aren’t particularly bothered about the particular approach we’re going to use. They just come with an expectation and a hope and some motivation that in some way we’re going to find a way forward for them. It’s a sort of refuge of the diagnostically and therapeutically destitute; people who have had the western-type labels attached to them, often with psychosomatic complaints. Things like irritable bowel syndrome, fibromyalgia, chronic fatigue.
They’re very definite symptomatic, unpleasant conditions. People have all sorts of different stuff going on for them. They’re aware they have unpleasant feelings. They are dis-eased. Western medicine hasn’t found a specific disease, you know, there isn’t a pharmacological approach to alter physiology or a lump or something to chop out or remove. There’s no active, external thing that can be done to help them.
So my interest in mindfulness is helping them to access what they already have, the resources they have, what they need. It goes back to Hippocrates, the Hippocratic Oath and using the natural forces within us that are the true healers of dis-ease. The problem is that thinking gets in the way, so what we have to do is still the mind to stop this. Then what we seek can emerge.
Kay: There is something about that sort of just stilling and opening up, isn’t there? One of our NLP presuppositions is that the resources a person needs are within them. But do you find, as I certainly do, that there are a lot of people who don’t believe that? They don’t believe that the healing is within them, and the resources are within them. They believe that the responsibility for their wellbeing is with their GP, or with a medicine, or it’s somebody’s fault or solution or whatever.
And sometimes I find that, you know, a lot of it is in just leading them towards an experience of feeling good when you can expand the inner worlds and find new resources. Do you recognise that sort of process?
Mark: The thoughts going through my mind in response to what you have asked there is that I think most of the work, if work it is, is in the preparation. It’s getting people to that place where they’re ready to start to make some change. Because the work is about change. People come because they don’t feel right, they’re not right, but they don’t know what to do. If they knew what to do, they would go away and get on and do it.
They come when dissociations become intolerable to them. The “I want that, but this is happening.” Dr. Milton Erickson’s work has had a great influence on my career, and he said that the dis-ease occurs when the conscious and unconscious mind have lost rapport with each other. The body being the unconscious mind, the conscious mind being the things that I want. I think one of the great problems with the western approach to psychotherapy is that it pathologises these processes, sees them as “diseases.” Stuff is happening within the individual that is dis-integrating, taking these parts apart, and rather than working as a coherent whole or asking what resources have we got, it’s seen as a disease and something that needs to be pathologised and treated.
I think I’m probably going off on a bit of a tangent here, but the whole work is preparation. You know, Socrates says, “When the student is ready, the master appears.”
I don’t regard what I do as treatment. I don’t market myself as a therapist. You know, as in the original meaning of the Latin word ‘docēre’, I teach. A doctor is a teacher. So my job, or our job, is creating the environment, the place where people can come in safety into a nurturing, supportive environment; where they can do the learning. It’s a bit like midwifery if you like. Something is trying to emerge through them, and just allowing that process to take place so that the symptoms can transform and resolve.
The unconscious mind doesn’t have a voice. It can’t talk. It can’t say, “I want this, or I need that.” So it talks in symptoms of emotions. And if you don’t listen enough, it talks with lumps and bumps and all the rest of it. Until we take notice and start saying, “Okay, what’s this trying to teach me?” Or “What am I supposed to be learning from this?” And create a welcoming place of curiosity where we can allow our creativity to engage and let something develop and emerge.
So, if people come and they want change work, there are three basic essentials that need to be present. They need to know what they want, so we spend a lot of time clarifying, in NLP terms, well-formed outcomes. They need to have some clear idea, because almost all the time they’ll say, “I don’t want to feel like this anymore.” That’s fine, but when you know what you do want to feel like, then we’ve got something to work towards and we can start doing some useful stuff together. So they need to know what they want. They need to take responsibility for it. So I can’t do anything for them other than to help them towards the goal or goals they identified for themselves that are consistent with their values and congruent for them.
And it has to be now. A few weeks ago I had someone come and see me. I send people a questionnaire before we start, and she’d filled that in very sketchily. Usually, my experience is that the more detail people put in their preparation questionnaire, the better outcome they get. So if it’s a: “yes, no, yes, no, I want to stop smoking, yes, no, I’ll do whatever you tell me, kind of thing,” we are probably not going to get very far with that.
But anyway, there was this woman who wanted to stop smoking. She came in and she said, “Well, I’m ready.”
“So, what do you mean you’re ready?” I said.
“Don’t you remember me?” she said.
“Well, I remember,” I said, “you contacted me a few weeks ago. I sent you a questionnaire and you sent me some pretty straightforward answers.”
“No, no,” she said. “I came to see you as a patient ten years ago, asking if you could help me to stop smoking, and I asked: “can you stop me smoking?” and you said: “no, nor can anybody. But when you’re ready, I can help you.” She said: “So, I’m ready now”.
So the thing that takes the time is getting people to that threshold, and when they’re ready you just need to be set up to give just a gentle nudge to help them to step into the unknown a little bit and embrace their fear of failure and get them into a place where they’re not afraid of failing. Instead, they’re not afraid of failing enough. And we have to go ahead and create a safe landing place for them, so that if things don’t work out, they are not abandoned.
A fundamental problem with western psychotherapy is this idea that, “I’m okay. You’ve got the problem,” and there’s some pathologizing going on and isolating them. Psychopathology is the study of isolation, and that’s the great problem that I saw with the way I was trained to treat emotional and psychological issues, as though they were problems. You know, I even slipped into the language there, which is information that the unconscious is desperately seeking to communicate.
Kay: I completely share your views and that’s certainly my experience too. There is something about the whole alignment process, isn’t there, of a self-holistic wellbeing that is a simple but very powerful director for us. And your point about education is bang-on. That’s how I view every single interaction; it’s an opportunity for me to help somebody to learn something more about themselves. Whether they know it today or tomorrow isn’t so important, it’s just connecting them in.
And so coming back to the mindfulness, the conscious awareness, the practice of conscious awareness, what would you say for you has been the most profound ability or exercise in conscious awareness that you’ve discovered, you’ve practised, and you’re not letting go of it under any circumstance?
Mark: The skill that emerges from it is this ability just to stop and become aware, from a slightly dispassionate place, a slightly dis-associated place, of what’s going on. This ability to just create a little bit of space, so that we can respond rather than react when stuff happens.
When we become stressed, we default to our level of training, not to our level of expertise. We just default pretty much immediately, instantaneously to some dissociative pattern. And almost while we’re still doing it, I know I’m going to say, “I wish I could stop myself. Why am I doing this?”
I want to lose weight, but every time I go into the kitchen, I and open the fridge and have another piece of pork pie and then say, ‘Why did I do that? I promised myself I wouldn’t do it today, etc, etc.’ Just allowing that little bit of space to stop and just become aware…the practice of conscious awareness…the way we do this, we do this by paying attention to our breathing. So this is bringing the mind back into the body.
So to empty the conscious mind we give it a job to bring attention to the breathing and become aware of it. So in the training, especially when people are starting, we spend a lot of time repeating this over and over again. Just as soon as thoughts come into awareness within the meditation practice, we notice them, let them go and bring awareness back to the body doing the breathing.
There are a lot of myths about mindfulness. One is that you have to meditate. There is Mindfulness Meditation, but you don’t have to practice it to be mindful. You don’t have to meditate. Meditation, in my understanding, is simply the process of coming back to centre; media = centre, middle. It’s the process of coming back to the middle of the body. So it’s a good idea to do this, but you don’t need to do formal meditation. You can use every breath as an opportunity to become aware of that, and just come back to centre and just be aware of where it is coming in and out and where we’re feeling it in the body. So coming out of the head and into the body, that’s the simplest exercise, the simplest bit you can do. And as soon as you’ve done that, that creates that little bit of space: “okay, here I am about to go off on one…so stop, take a breath, just become aware where it is. Okay, what is it that was bothering me?” Then, even better, you can just kind of float out into a clean, third place and say, “Ah, there’s Mark feeling a bit upset about something.”
Then there’s the Ericksonian mantra – “That’s interesting.” Something’s waking up – I’m sure that makes sense. Welcome.” Finding the safe holding place with equanimity and clarity, you can start to look at what’s going on and then step back in and observe. And having taken note of what’s going on, form some options, step back in and engage, and take some action appropriate to what’s going on.
So just increasing that space between stimulus and response. The old psychological model of cause and effect is a bogus idea nowadays. I think it’s only psychology and social sciences that still think in terms of cause and effect.
Since Niels Bohr and Max Planck invented quantum physics 100 years or so ago, we have been able to become aware that we live in this world, this quantum universe, of infinite possibility. So stimulus and response happens. With this approach, we’re just seeking to put that little bit of space between stimulus and response. So when the trigger comes, instead of just defaulting into the dissociated reaction, we just put that little bit of space in and this allows us to bring our awareness to choosing our response.
Essentially, we have little of not control about what happens to us and in our environment, but we do have choice about our response, but only if and when we put some space in there between stimulus and response.
Viktor Frankl, the concentration camp survivor, said the only freedom you can’t take away from a person is their freedom to choose how they’re going to respond. And if we just leave it to our unconscious conditioned patterning, we’ll go down the same old route time and time again. As soon as we come up with a bit of a gap in there, even if it is one breath’s worth, and say, “Okay, I’ve got a choice now. I can go down the old path or I can explore doing things differently.”
It needs curiosity and being prepared to fail and all the rest of it. By putting in that gap between stimulus and response we have more than one way of responding. We have choice. When we react, we have no choice. So that’s a useful thing. Just noting, so when stuff happens just to stop, take a breath, and just recognise and acknowledge, accept and then just let it go. We don’t need to engage with it. It’s just a thought. It’s just a feeling. It’s just an emotion. It’s just an idea. It’s just an image, you know; neurological activity in the brain. Just note and accept it. That doesn’t mean passively giving in to it. Just in the moment, that’s what’s happening. This is where we are. Now we can ask ourselves how we can most creatively engage with this and turn any obstacles and challenges into resources?
Kay: And I guess at that point, you talk about choice; when people perceive they have a choice, then they open up their future and can find new ways to get to new places. But when people don’t perceive they have a choice, even though we know it’s there, they don’t perceive they have a choice. And you mentioned Viktor Frankl as a really good example. In a concentration camp, he still found the ability to have a choice. What do you think is the key obstacle in people’s ability to perceive choice?
Mark: Good question. The obvious answer that comes to me is awareness, or lack of awareness. Which is a kind of circular discussion. It brings us back to the same point; once we find awareness of this lack of choices, there’s potentially possibly a conditioned response, just something we keep telling ourselves. And if we keep acting and behaving often enough, then it becomes almost a self-fulfilling prophecy.
But to Frankl, the only freedom we have is this ability to choose, and we all have that; it’s just not being aware of it. As you say, it’s the blinkering. So helping people to find this bit of space so they can become aware.
People usually, in my experience, feel they have no control over what’s going on, which of course is true. The Sword of Damocles – we have very little control over anything. And that’s what brings most people to us. Either people are trying to control them and they don’t like it, or they’re trying to control other people who don’t want to be controlled, and they don’t like that either.
So I think helping to get rid of this notion of control and realising that that’s a choice that’s being taken at an unconscious level. And that’s the point about these choices not being conscious choices very often. So it’s getting people out of their head and back in touch with these parts of themselves that they will never understand or be able to have a cognitive-type conversation with. Just an awareness that whatever is happening, a choice is being made.
I remember when I was learning psychology, the term ‘secondary gain’ kept creeping in. You know, these people are never going to get better because they’ve got a secondary gain, as though they’re consciously deciding, “I’m going to get my migraines every weekend, so I don’t have to look after the kids all weekend,” and all the rest of it.
They don’t take that conscious decision you know; they work hard all week without a migraine. The old weekend calls, when the GPs used to do weekends on-duty, often on a Saturday morning there would be a visit request for someone with a migraine or similar. “I couldn’t even get out of bed,” and all the rest of it. But by Monday, whatever we did, they were back at work and okay and coping again. And so it was said to be all secondary gain.
In my way of thinking, there’s no such thing as a secondary gain; it’s just a primary gain at an unconscious level. It’s that whichever part is driving the bus and making the decisions and choice at that point is the bit that is much more powerful. Take the idea of the horse and the rider. You know, the horse is saying, “Well, we’re going that way. It doesn’t matter what the rider wants, it’s going to happen.” That’s where this choice is happening. There are all these different ego states now. in Ego States Theory, there are perhaps 150 different ego states in play at any one time and they’re all jockeying to be the one driving the bus. And depending on which one actually gets hold of the wheel and gets to do it, is what happens. When this is all conditioned in, it’s all happening below the level of consciousness.
Kay: You’ve used some lovely metaphors there, like driving the bus, the horse and the rider and so on. Metaphors help us to understand a bit more about ourselves, don’t they? And you know, I always picture those electro-chemical communications in our neural pathways going, “Oh, we always go this way…so let’s do it again.” And we do it again and we do it again, it’s become autopilot. And it’s that autopilot you’re talking about, isn’t it? So you do an and/or debate, and if you don’t bring your awareness into it, you’ll just continue to do what you always did.
Mark: And the unconscious is lazy. It’s a slightly pejorative term, but if it does something and it worked once, and it does it again and it works another time, then the more often it seems to get a result, it’ll just default to it. If we had to learn something anew every time we encountered it, we would never get anything done. We need to put some patterning and stuff in there so we can get on with life. Otherwise, we’d never be able to do up a shoe or get out of a room. We’d have to go onto Google to work out how to open a door every time we came up to a brass knob in front of us, you know? Once we’ve learned that’s the way things work, we store the pattern away in automatic pilot and crack on with life.
So I think these are parts of our natural programming. And one of the skills is to utilise this stuff, to know that we have this ability to learn useful stuff. But also that we need to know when to unlearn the stuff when it becomes redundant and learn better stuff.
The metaphor I often use when people come to see me is a mobile phone. Most people have a fancy smartphone, and after about three months, the little light comes on showing ‘software update available’. And they think, “Oh dear, I’m not going to press that. I won’t be able to use it for a quarter of an hour.” So you leave it. And three months later there’s another one. And if you leave it two or three times, it becomes pretty useless because all the software you want to run, the operating system can’t cope with it anymore. There’s nothing wrong with the phone; it’s just running old software, which when it was installed was exactly the right stuff, but it’s obsolete and redundant now.
So what you need to do is have the courage to press the update button and go and make yourself a cup of tea for 10 minutes, then come back and the phone’s working perfectly because it’s no longer running redundant software.
Kay: That’s a good analogy. And Mark, you mentioned dissociation. I know from other conversations I’ve had with you that you’re very clear about there being a difference for you between dissociation and disassociation, whereas I use them interchangeably. And I’m really interested to learn what for you is the difference between those two things.
Mark: Well, dissociation, this is my learning… Actually, what I should have prefaced all this with is that you should be aware that, after getting my name right and a bit about my biography and history, nothing I say after that is true. The question you should be asking yourself is whether it’s useful or not.
So there was a French psychologist and psychologist in the second half of the 19th Century called Pierre Janet, and he coined the two terms rapport, which we use now, and dissociation, a French word. And he used dissociation to mean the parts which are completely out of conscious awareness and conscious access; the stuff that kicks in, and we have no conscious access to it whatsoever.
So conventional western-trained psychiatrists would be comfortable with the concept of dissociation. Freud trained with Janet and used this model of dissociation. His idea of repression is that the unconscious mind takes things that are so difficult and so unfathomable and so impossible to face to a place outside of conscious access. They’re still there and they’re still very powerful and they’re providing very important drivers. These are unconscious conditioned patterns that we dissociate to. So if we drop something; we shout, we get stressed without thinking of why we didn’t need to do that. This is an automatic, dissociated part reacting. If we are able just to put a pause in, we can create a gap between stimulus and response. This gives us the opportunity to have some choice in how we respond.
In contrast, dis-association describes a process that can be a conscious activity. So like I described with the ability in mindfulness practice to take yourself consciously to a place where you can observe with a degree of dispassion. Bessel van der Kolk, a psychiatrist who has specialized in the management of psychological trauma for many years, describes the ‘watchtower’ – a safely distanced psychological place where we can take ourselves and sit and observe in safety. You know, the thing I was describing earlier of feeling a bit anxious – fluttering in my chest, anxiety, feeling anxious – then just going out into a place and saying, “Oh, there’s Mark feeling anxious.”
You know this is a conscious thing. I dissociate into anxiety. Something happens; the anxiety come from within me. This dissociated part took over the wheel. The disassociation is the bit that, when I become aware of the feelings and symptoms of anxiety, I can then dis-associate and look from this watchtower – this safe place.
Hilgard, in his hypnosis teaching, talks of The Hidden Observer. When people are going into hypnosis, there’s a part of them that knows they’re being hypnotised, so they’ve still got a foot in both camps. You know, enjoying the journey of hypnosis, but still knowing they’re a part of it. There’s an unhelpful idea prevalent in people who are not trained in hypnosis that someone in hypnosis is under someone else’s control. It’s not my understanding of what hypnosis is about at all. There is always this Hidden Observer, the part of us that is in touch with reality, whatever that is. As “Professor” Robin Williams said: “Reality. Now there’s an interesting concept…”. When we are hypnositised here is also a part of us that knows that we’re doing some sort of responding to what the agent of change is eliciting.
Kay: Yes, I love that. You mentioned hypnosis several times and you’ve already made the distinction between mindfulness and meditation, so where does hypnosis sit if we’re doing a little contrast between those three terms.
Mark: Good question. So hypnosis, mindfulness and what was the third term?
Kay: Meditation.
Mark: Meditation… Well my understanding – and again nothing that I say is true but may be useful – meditation, media, centre, is the process of coming back to centre. So if mindfulness is the practice of conscious awareness, then meditation would be training in awareness. So it’s a practice we do.
Usually, meditation practices involve some kind of physical thing, relaxing the body in some way, and a mental thing, like giving the mind a focus, something to do, essentially emptying the mind and just giving it one thing to be focused on. So it could be an image or a thought or meditating on an idea or concept, or it could be a mantra, which is usually a word or an expression. In mindfulness meditation, we use breathing as the focus, just bringing the awareness to the breathing. So that’s kind of the three components of that.
There are as many different definitions of hypnosis as there are people offering definitions of hypnosis. In the postgraduate diploma in Medical Hypnosis that I did, the definition is about two pages long. There’s a person, a hypnotist, another person or the subject or subjects and the hypnotist does things to change the experience or the belief or memory of blah, blah… And so it goes on.
The best definition, the one I like because it’s the one I made up, is that hypnosis is the artful use of communication to alter neurology. So it’s becoming aware of what’s going on and then using communication to elicit a change in state. So you could be using spoken language or a facial expression like raising an eyelid to elicit a change, to get a response. If I raise an eyelid, and the person I’m communicating with raises an eyelid back to me, then that’s a bit of their neurological state that has changed. So some hypnotic phenomena, some hypnotic interaction, is taking place there. But more specifically, it’s around learning. It’s helping them again with this question about choice, taking people to a place where they have a choice.
In professional practice my favourite definition of hypnosis comes from the teaching of Dr Milton Erickson, the psychiatrist who played a huge part in bringing hypnosis back into clinical practice half a century ago. He described hypnosis as, “The elicitation and utilization of unconscious learning to meet the needs, values, competencies and interests of the present self.”
And in terms of intention, when I think of using these things in a clinical setting, the purpose of mindfulness, the whole point about mindfulness, is there is no intention. You practise mindfulness to practise mindfulness, stilling the mind so that what you seek can emerge.
So where with hypnosis there is an intention – you know you’re coming for hypnosis to stop smoking, to have some control over your weight, your eating or whatever. So there’s a purpose and intention in hypnotic practice and the techniques that might be used. The point about mindfulness is that it’s content-free. All this work is about state, and the single most important factor in getting any outcome we want is our state. And our state is entirely the product of two things. It’s about our practices. So it’s important to have practice, a daily practice to get us into resourceful states.
And the other thing about our state is that it is a consequence of where we are placing our focus. So putting our focus into the present moment, getting ourself into a resourceful place, making compassionate connection to self in the moment. And then the mindful state is content-free. There’s nothing going on; it’s content-free, subtle, non-dual, non-reactive awareness.
The non-dual aspect is that we are active participants in the creation of our own experience. Subject and object are the same thing. So the mindfulness state is content-free, subtle, non-dual, non-judgmental awareness spread uniformly everywhere. Within us and through us and through space, every part of us, and we’re a tiny, tiny atom in a vast, an infinite, universe. At the same time, the whole of the universe is flowing through us. So we have access through this state to this huge quantum field of infinite possibilities and resources. So we create this space within and around ourself where we can hold the problem, the unmet need, but also hold all the resources it requires. Because they are all there. Everything we need is already there in this space.
The other thing I’d like to add, having said that, and banging on about Dr Erickson, is that definitions of hypnosis often refer to suggestion and the acceptance of suggestion. So Richard Bach, the author of Jonathan Livingston Seagull, describes hypnosis as the unconscious acceptance of suggestion, which is a nice picture of the classical hypnotist-subject type stuff. Erickson developed a second-generation of hypnosis. He certainly used suggestion techniques, but there was a much greater depth to his work than this, in the elicitation and utilisation of unconscious learning, which is central to the ethical application of these techniques. So getting back to this idea that we have all the resources we need; the intuition, the learning is there, and our jobs as the agent of change are to elicit this and create an environment for healing – healing being the Greek word for health – the whole environment.
In this environment, the conscious and unconscious mind can link and start dancing and making music together: a cooperative model. So Erickson was very much about eliciting this unconscious learning that was in there, rather than Freud’s view of the unconscious mind as this rather lurid place with dark desires and evil spirits floating around. Erickson regarded the unconscious as this huge repository of vast learning and experience; not just of our own experience, but of our genes bringing us all the experience of 13.5 billion years of evolution. It’s all in there. Just finding and getting access to this beautiful place.
Kay: I like to invite my clients to explore the potential they were born with, and I often use the metaphor of arriving as pure stardust; bright, shiny light that somehow, we forget about is there. And actually if we could just allow it to come through… Sometimes we have to clear some space to reveal it, as you point out.
And so in this current time of lockdown, there’s been so much collective contribution to supporting people’s wellbeing through Zoominars, all sorts of online platforms, and this general sense that we need to work at being resilient. For some people, they were already resilient, so it’s just, “Hey, I can get even better at this?” While for others it’s, “Oh, I’ve got this time to do wonderful things with it.” But some people have found it a quite a distressing time because they’ve previously lived their life at 1,000 miles an hour, super-busy, and then suddenly the world goes bang. It’s a perfect opportunity for them to become consciously aware of themselves. Do you think there’s this sort of fear of self-discovery?
Mark: That’s a good question. I can’t say that I’ve ever come across that as a fear that people have openly expressed that they’re afraid of what they might emerge, what might come from them. There is certainly fear manifesting at the moment, and my coaching business has been as busy as ever in this period. As a doctor, I work for a medical charity providing a resource to doctors who are struggling, who don’t want to be labelled as ill or whatever, and that’s the reason they choose to come to coaching rather than to therapy or intervention.
So this super-doctor stuff… we don’t get ill and all the rest of it… but there’s a lot of fear. It’s generally fear that brings people to ask for help. And their coping ability to deal with that fear comes… Well, I’m not aware of it being fear of what might be emerging from them, but rather this uncertain unknown future. Particularly doctors on the front line who are particularly at risk of getting this horrible virus, just questioning whether what they’re doing is really… Well, they’re perhaps questioning their vocation a little bit sometimes, and how they could be better at using and applying their time.
So it’s not my experience that people are afraid of what might emerge, but that they tend to come in – and this is possibly just the way I’m working, the stuff I’m doing – the ones who know there can be more, part of them is telling them there can be more to life than there actually is for them. And they’re wondering how to actualise and to realise that and bring it out.
You’ve raised resilience, and if I can just say a word or two about that, I’ve been working with doctors for two or three years since I retired, essentially through the College of Medicine, looking to set up programmes to help build resilience. Burnout is a big issue in medicine, and resilience is the word that tends to get used and is becoming somewhat unpopular really, because it’s like mindfulness and all these other things that have been around, and you get bored so you have to find something else to say. And I think the notion, the model that’s emerging, which I find helpful, is the idea of psychological preparedness. So rather than resilience as a protection and something that needs to be there, it’s just building up from within the strengths and abilities to deal with what’s going on. That’s the kind of the model that seems to be emerging.
My particular interest is in emotional and psychological medicine. In this field, pretty much all the terms, all the diagnoses, come from physics and the physical sciences. Stress is an example of that. Stress is the term used when a force is applied to a system. Resilience is described in terms of the response of the system to this stress. I think one of the ways to help people is to start taking the emotion out of these descriptive terms and become curious about what they mean. In science, the resilience of the material is the amount of external force or internal force (stress) that the material can absorb without suffering permanent deformity.
I think that a really important and useful aspect of this metaphor for the psychological concept of stress is that it is something we feel. When we become aware of stress building, we can learn to spot when enough is enough and walk away. This ability to walk away at the right time is a key skill in building resilience. When we have restored ourselves, we can step back in and tackle a bit more. In this way we can learn to observe our experience and response form a place of equanimity and thus build up the strength and resources to cope, be flexible, and adjust appropriately.
This is getting back to the mindfulness stuff where you can just observe and watch the onset of this awareness, being honestly aware with yourself of what’s going on, saying enough is enough and being able to meet experience with a smile. This abilty to smile tells us that mind and body are communicating. You know, we’ve got to be able to smile and do what we do seriously with great humour.
Once we have this awareness, we can bring a full skill set into play. In the caring professions, we need to bring compassion and tenderness; compassion to feel people’s pain and suffering and to want to do something about it, and tenderness to do this kindly and gently. Before we start with other people, we need to bring these skills into our relationship with ourselves. This essential kindness and compassion is not enough on its own. If that is all we have, we are soon going to be to be crushed and overwhelmed by the load. So there needs to be an element of warrior spirit and the determination that goes with it. The warrior in us brings strength, fortitude, grounding, and armour to shield us Another part of the warrior is a good bullshit detector. So to know when something genuine needs to be done, and when a slightly tougher approach might be necessary.
A third component of the attribute set we need is a good sense of humour and the playfulness that goes with it. You know this creative, playful approach to things; as if every situation is new. How can we make this into an adventure and challenge these obstacles? How can we turn them into resources and let them present their gift to us? That to me is what resilience is about.
We are thinking beings. We have a cognitive mind. It does the thinking. It enables us to cognitively approach stuff, give meaning to our experience and then also find some self-efficacy to say, “Okay, this is what I make of it and this is what I’m going to do to help me deal with it when the going gets too tough. This is where I keep the smile and bail out.” Because whoever fights and runs away lives to fight another day, and that’s a key resilience strength; to know when enough is enough and to have these daily personal habits. So you’re building up and building up and building up, reducing stress and building resources in daily activities. This is absolutely key.
This is for ourself and for our environment. So this is where we were before this all kicked in, and everything has been derailed over the last couple of months. I encourage the idea of the canary in the coal mine. Self-awareness. People checking-in with themselves regularly and spotting early when they are getting into difficulty. Helping people develop and practice daily habits of taking care of themselves and preparing themselves. For me, it’s teaching them mindfulness. There’s yoga classes, there’s going for a swim, there’s playing an instrument. For some It might be prayer. Short, regular practices every day that briefly allow relaxation and release from responsibility. These are best if they are pleasurable and perhaps gently challenging. They are best when there is resonance and musicality as this builds the mind-body harmony. This is the essence of Mindfulness practice: emptying the mind and bringing awareness back into the body. With practice, one breath can be enough to do this.
There’s doing whatever people want to do for themselves to refill their barrels. Virginia Satir used to describe the barrel, or how you can’t pour from an empty jug. These are useful metaphors. You have to be looking after yourself, building resources, reducing stress where possible. Addressing both the canary and the coal mine. As well as working on ourselves, we also have to introduce systemic changes in the working environment to reduce stress and the environment made a more friendly and appropriate place to work.
There was a very good paper by the GMC [General Medical Council] a few months ago that identified three really important items as ABC:
A is autonomy, the ability to choose, so people know that at every point they have choice and, when enough is enough, they choose to walk away. “I can usefully do no more. I need to go and recharge”.
B is the belonging. We’re a social animal. Resilience is not something we can do on our own. We need other people, we need contact. We need our Communion of Saints around us. Zoom has been a great blessing in this. This also applies not necessarily just to people. We have access to through nature and spirituality to the mystery and beauty of life. Regularly immersing in this with gratitude is another vital and essential aspect of our daily practices. I remember Golda Meir, the Israeli prime minister, who was in her own very isolated place since the 1960s, the Yom Kippur War, 1967 or so. And years ago I watched her being interviewed and they asked her, when she needed a bit of help or advice, who did she go to for help? And she said there’s two people I always ask when I need guidance. I speak to my grandma and I speak to my granddaughter. They said, “Oh, what do they say to you?” And she said, “Well, they can’t say anything. My grandmother has been dead for 20 years and my granddaughter hasn’t been born yet. But I’ll ask them both what they would want me to do.”
So you have this sense of belonging, and communities are important to us. Just now, people are dying and their loved ones can’t be with them, they can’t hold their hand. And we’re a social animal, we need other people. But they are there for us, just like in the Golda Meir example. She knew the importance of accessing her Communion of Saints.
C is competence. Essentially here are two aspects to competence. Internal and external. There is having the skills and the ability to do the things that we need for ourselves. There is also an external component; we need the opportunity and ability to use the skills we have out in our world. One of my fears in the current situation has been the hold-up of PPE equipment. People know how to help others, but they have been put into this dangerous position where they do not have access to the right equipment to enable them to do the things that they need to do in safety. In many situations, people are choosing to do what they can anyway and putting themselves at increased risk.
The concept of moral injury has emerged. I think it’s a really useful frame. The emotional and psychological consequences of knowing that if only you had the resources available, you would be able to practice professionally in the way you were trained to do. When this all blows over – and hopefully it will blow over and we’ll come out of it the other end – I think there’ll be a lot of emotional and psychological morbidity in carers because they will know they could have done stuff if only they’d been given the equipment and the materials they needed to do it in the best possible way. So there’s this idea of moral injury, the consequences of knowing you could do something, but are unable to do so for reasons beyond your control.
So, ABC – Autonomy, Belonging, being part of something bigger, and Competence, of having the skill set yourself and also being enabled by your environment to do the things that are important for you to do, which includes walking away,
Kay: That’s really powerful Mark. As you were talking about that, the pictures in my mind were connecting to nature, because nature teaches us about resilience. And you know, if a storm comes then the soft bendy tree manages to bring itself back up afterwards. And the oak tree, sometimes the stress is sudden, and it shifts, and the tree falls over. But I was also thinking about those artificially grown plants in polytunnels that are given artificial supports. And as soon as they’re asked to support themselves – like you buy a little herb plant or something and you bring it home and suddenly it’s out of its environment. And then it dies because it hasn’t learned to respond to any new environments. I think this is a metaphor for our times; that we should always, even back to the very beginning of time, be preparing ourselves neurologically, psychologically, physiologically for what is to come so that we’ve got more choices at each door along the way.
Mark: Yes, it’s all about state now, the COACH state: Centred, Open (i.e. content free, just flowing through), Aware, Connected to resources, and creating a Holding place, so we can welcome the resources we need as they flow through. And there’s a place for them to embed and grow and help us.
In our problems, we can CRASH. That’s Constricted, Reactive, Analysis paralysis, Separated from resources, Hurt and Hurting. It is this CRASH state and the inability to resolve it to COACH for themselves that brings people to us.
And back to the Buddhist ideas that have advised mindfulness… There are some myths around mindfulness; that you have to meditate, say, which you don’t. You don’t have to be silent. And you don’t have to be Buddhist. But certainly silence helps a lot. That’s what we’re aiming for. But you can be just doing the washing up and be aware of the temperature of the water, the texture of the soapiness and all the rest of it. You can meditate in those moments, just be with it.
John Kabat-Zinn, one of the great mindfulness teachers, said that to say mindfulness is Buddhist is much like saying that gravity is English because Isaac Newton described it. It’s a human attribute; the Buddhists have just taken it on and produced a really useful set of instructions and guides as to how to mindfully meditate very well.
Kay: I’m thinking about a term that I use with my students, which is bandwidth. The bandwidth of your sensory channels and how at any one time your thoughts can overload your bandwidth, so you can’t process that easily through the senses. And my take on mindfulness is it’s just an opportunity to… Well it’s like a defrag, you know, just clean up the bandwidth, come back to what is and in the moment.
Mark: it’s just a thought.
Kay: It’s just a thought, yes. It’s just a thought.
Mark: Or we could wake up, lighten up, step up; be here now and notice. And then allow cognitive diffusion: “it is just a thought.” It’s just a feeling. It’s just emotion. In this moment. I can just let it go. Maybe I can re-engage with it at another time, but at the moment, it’s just a thought, just a feeling. Let it go. So what’s important to me? Re-align with my values. So what am I going to do to take action in-line with my values? So I see the way I can take Mindfulness into a useful way of being.
You asked earlier, what’s a useful thing? Okay, so wake up, lighten up, step up, be here now and notice; notice what’s going on. It’s your thinking, your feeling, whatever. Okay, it’s an emotion, it’s a thought, it’s an idea. It’s intention, so just for the moment, let it go. And then, okay, you’ve done that little bit of practice. You have let go and come back to the moment. Then what’s important to me? My values… so take action based on that. Do stuff. Speculation is always in the doing.
Kay: You have the phrase, don’t you, that it’s not learned until it’s felt in the bones?
Mark: It’s from Papua New Guinea – nothing is learned until it’s felt in the bones. The body keeps the score. Eugene Gendlin’s research demonstrated that if you’re working with people in a coaching environment, the single most important indicator that they’re going to achieve the outcome that they claim is the outcome they want is that they can get a felt-sense of what it is.
So there you are, in hypnotic language, you future-pace, you get them to hallucinate what it’s going to be like when they’ve achieved the congruent change that they’ve identified they want. That’s got to feel good. So you have them dis-associate, push that back into the future and come on back here. So that’s what you’re headed for – a nice, dis-associated image, using the language correctly.
Kay: I’ve written it down! I’m on it! So there are a couple of things I just want to tidy up. One is that you have a book, a lovely book, at least one that I know of, which is A Bedside Manner.
Mark: Yes, it was published about two years ago. So this is what I taught doctors for 25 years about consultation skills, essentially. And this is really the stuff we’ve been talking about. It’s not what to do, it’s much more about how to do it. It’s all about state and all the things we’ve been discussing, like motivation and rapport. And it’s everything I learned in 38 years as a GP. It’s a good book for the loo; you can get through it in three or four visits.
I mentioned Hippocrates earlier, and one of the parts of the Hippocratic Oath is when we get towards the end of our career, one of the things that’s expected of us is we start giving stuff back; all the useful things we’ve learned. My favorite definition of experience is what you get when you don’t get what you want. So hopefully people can get some vicarious experience from this.
Remember nothing I say is true; the question is to ask yourself is whether it’s useful. And if you found stuff that’s useful here, then take it, make it yours and absorb it and use it in ways that are right and appropriate and work for you.
As I approach the foothills of senility and wander off more and more to the golf course, those of you who are picking up the baton can hopefully use some of the things that took me a while to learn and absorb them for yourselves.
Marked Changes Training
Recent Comments