Kind Recognition

I can’t remember a Winter season in Silicon Valley with such sustained cold. 2/22 usually means Spring-like conditions; white plum blossoms dropping and pink cherry blossoms shyly peeking out. Yet, today plum blossoms cling tightly to branches and nary a pink flower can be found. I want warmth but my weather app shows only rain and cold for the next 10 days.

Each day I am reminded how much the engine of human internal experience runs on expectation and assumption. This now must mean that before. Incorrect. This now is merely what is occurring. And that occurrence often lacks connection to what has been or what will be. Yet, moment to moment the human brain is wired to habitually make probabilities certainties, unknowns knowns.

So much of human suffering can be boiled down to that basic misapprehension, its flawed mentation, and all the incessant efforting we do to make it so. Believing an internal illusion of knowing what can’t be known and predicting with an accuracy the human brain utterly lacks, is foolish and oh so human. And of course, we believe the mind’s limited, distorted narratives of certainty will be replicated in real life. Hardly ever is that borne out to be true.

When human functioning evolves to a point where producing heedless internal suffering become the default, alleviating that suffering becomes a necessity.  Tibetan Buddhist teacher Dzogchen Ponlop says that the most powerful medicine we can offer for suffering of any kind is simply kindness. And I would add clear knowing. Recently, a patient who finally understood they had been lost in delusional thinking, was asking me how to calm a disturbed mind. I wrote the following equation on a sticky note: clarity + compassion =  a calm mind.

That formula gives rise to what I call kind recognition. “Adding kindness to recognition helps us soften into and receive ‘this is hard.’ When life is truly distressing, relying solely on mindfulness may feel harsh or sterile or may activate existing habits of disassociating or disconnecting from experience. Kind recognition begins by recognizing what has arisen; for the fact of its arising cannot be altered. What comes next is the ‘ow!’ of it. The key becomes allowing ourselves to receive the ‘ow!’ with openheartedness and then remaining open to distressful thoughts and feelings that follow. Kind recognition builds our capacity to meet distressful feelings and difficult circumstances with less blame, shame and avoidance. It also promotes the cognitive-affective responsiveness needed to remain engaged, empowered and able to make skillful choices” (Miller, 2014)*.

Kind recognition is similar to distress tolerance but different. It is not an effort to escape, change or avoid distress, rather the capacity to welcome distress with openheartedness and wisdom. A good example is: all things come and go, including painful and pleasurable experience. That recognition can in and of itself lessen a reactive mind insisting distress will never end and needs to be ignored, avoided or ended. Such efforts most often lead only to harmful choices and behaviors.

I have posited that much of the diagnoses listed in the DSM could be viewed as outcomes of internally-driven efforts to end painful experience. And that would be very human. It is merely the severity of distortion and reactivity that morphs everyday human suffering into a mental health issue.

*Miller, Lisa Dale. Effortless Mindfulness: Genuine Mental Health Through Awakened Presence“. Routledge 2014.

As We Think?

I start most days racewalking the Creek trail. In late Fall and Winter my headlamp illuminates a few feet ahead, until dawn finally lights the path. Raccoons scurry by; egrets perch quietly. Though skunk smell often hangs in the air, I have never seen one.

This morning my mind produced a disturbing thought/image… what if I got sprayed by a skunk? How would I remove the smell? With no answer in mind, I continued enjoying the special feeling of a Winter Solstice sickle moon hanging low in the sky.

A little more than halfway through my walk, the trail dips closer to the creek and I hear familiar bubbling waters and duck calls. It is too dark to see any of this. Suddenly I detect a faint movement of white close to the ground on my left. My mind races to determine what it is.

As my head turns, the headlamp illuminates a beautiful skunk, white tail straight up in the air. I startle and chuckle quietly… synchronicity? Power of mind? Intuitive foreshadowing? Please don’t fear me and spray! My body speeds up to avert the very image mind conjured up only a short while ago.

We are such strange creatures—so at the ready to connect dots, create meaning, assign deterministic frames to what are probabilistic random events. Randomness does not sit well in a meaning-making animal that spins tales of thought’s power and intentionality. We believe as we think, so life occurs. The grandeur we accord to our inner thought world is astounding. And we use this exceptionalism to distinguish ourselves from all other mammalian brothers and sisters. Want to hear how much we actually share with these animals? Listen to the Groundless Ground episode I recorded several years ago with Professor Kristen Andrews author of “Animal Minds”. It will blow your mind.

I finished my walk musing on my own penchant for meaning-making. How pattern recognition and superstition marry in my brain fooling me into believing I somehow made that skunk appear! Silly human.

Love remains…

When Alzheimer’s disease progresses—annihilating ability to word-find, understand language, and speak cogently to loved ones—what remains is affect; particularly affection. In the early stages, this disease has periods where sufferers exhibit highly reactive emotions that often present as angry, nonsensical or delusional. These periods are particularly hard on close relations and caregivers.

One very difficult experience I recall happened eight years ago in a favorite Upper East Side restaurant. Mom and I were dining and suddenly her neighbor came up to the table to say hi. Startled that she didn’t recognize him, Mom launched into a hysterical rant about how I was planning to kill her. Increasing agitation caused her to suddenly get up and leave the restaurant. I ran after her knowing she would never calm down if I caught up with her. So instead I followed her as she wandered the streets agitated and lost; finally ending up at her building. From across the street I saw her smiling and talking with the doorman. When I entered the lobby she sneered at me. Then let me accompany her up the elevator and into her apartment. She never spoke of what happened in the restaurant. Just as she never admitted to having Alzheimer’s, even through the five years she spent living in a Memory Care facility.

Four months ago her deteriorated physical condition required a transfer to a medical model nursing care unit for memory patients. Though it is considered the best unit of its kind, it is nothing like the family-oriented, loving memory care environment she thrived in. She no longer eats and sleeps most of the time. Mom is making it clear: I am ready to bring this horrible last 10 years of my life to a close.

For the last four years Mom has not known who I am. Yet, when I arrive, though she cannot speak much, she immediately brightens in her affect. The love is palpable. She laughs when I make jokes. I can’t tell if she understands anything I say, but her eyes display interest as I relay the goings-on of my life. I hold her hand when she lets me. Play Beatles songs she and my Dad adored. If she gets agitated I stand behind her wheelchair holding her shoulders gently to restore parasympathetic response.

These days it is especially hard to leave at the end of a visit, knowing it may be the last time I see her alive. Sadness pervades the field between us. We stand together in the awful knowing that she, a highly intelligent and deeply caring woman, has been utterly decimated by Alzheimer’s. And even so, our mutual love remains… triumphing spectacularly over this dread disease like a victorious army refusing to lose its most precious treasure.

AI Image Generators and Bias

Text to image AI generators are a rabbit hole of wonder and bias. As a test I entered, “enlightenment arising from the prefrontal cortex”. Below are images produced by Dall-E 2 Open AI. All male, though the second from left might be viewed as female or androgynous.

Then I typed, “enlightenment arising from a female prefrontal cortex”. Below are the images Dall-E 2 Open AI generated.

I was taken aback by the cultural male-female stereotyping this AI generator was so clearly mirroring.

In the first grouping:

1. A cerebral, serious emotive tone pervades images 1, 3, and 4; the most male-like and Caucasian
2. Image 2 (the most female-like) has a softer more contemplative feel.
   And though the skin is brown, the face is European.

In the second grouping:

1. Image 1 looks dazed and entranced, not awakened
2. Images 2 and 4 are joyful, elated, with no contemplative feel at all
3. Image 3 is a feminized rehash of a traditional Buddha image
4. All four are Caucasian.

AI generators are supposedly trained on massive quantities of information regarding image types and features that human minds associate with specific concepts and/or words. Therefore, one could expect an AI generator to consume a wide swath of information, gather that into the most common associations, and deliver an image reflective of that process.

I suspect what may have been delivered in this case is a mash up of existing stereotyped male favoritism found in two necessary sources: medical illustration and religious iconography. Images are a vehicle to plainly see societal assumptions, especially wholly incorrect ones.

Group 1 delivers a very specific message: enlightenment occurs only in Caucasian male brains. Most surprising for me is the vast majority of depictions of enlightened states come from thousands of years of Asian Art: Upanishadic, Buddhist, and Taoist religious images. Though the vast majority of those images are male, none are Caucasian. Add into the mix medical illustration, which until very recently only depicted male anatomy of the head. Now the scale tips so radically and completely toward Caucasian male. The Asian origins of the framework of enlightenment is utterly wiped out! Could this also be helped along by the more recent Western image bias for depicting meditators as Caucasian males?  Maybe.

Group 2 delivers another sort of specific message: when enlightenment occurs in a female brain, happiness is all a woman will experience. No awakening, no clarity, no shift in understanding. And frankly, as someone who been a female meditation practitioner for many decades, until very recently, my scholarship of textual material and dedication to practice was largely minimized by male teachers in both Yogic and Buddhist training contexts. So, the AI generator is merely following suit. One can almost forgive an AI generator for its Caucasian female bias. It is clearly feeding from the trough of blond Caucasian blissful females gracing mindfulness and meditation magazine covers and Instagram posts. The assumptive biases of Group 2 make my stomach turn even more than those depicted in Group 1.

What is to be done about this quagmire of bias and lack of accuracy in AI image generation? I don’t have an answer. I do have an unsettling concern that the AI world care little about historical inaccuracies and doing their part to discontinue millennia of imagistic injustices and biases.

Meditation is not a performative act

Listen to Groundless Ground Podcast Episode 60

This is a very special and quite different kind of episode to finish out Groundless Ground Podcast Season 5. I have a frank discussion about the pitfalls of packaging and delivering meditation as a performative act in health contexts with Donna Sherman—clinical social worker and teacher of practical wisdom from yoga sciences, mindfulness meditation and behavioral sciences. Since Donna has studied extensively in the Tantric yoga tradition and I have expertise in Buddhist psychology, we interview each other about the ancient science behind Yogic and Buddhist meditative practices. Donna’s Therapeutic Yoga Nidra is the NSDR (non-sleep deep rest) practice I refer to my patients. And Donna is also a longtime dear friend and colleague from whom I have learned so much. It is hard to imagine a good life without her along for the ride! And wow, 5 years and 60 episodes. What an adventure Groundless Ground has been and much gratitude to every listener! GG listeners continue to be my greatest inspiration.

Graduating Psychotherapy

“I’ve graduated!” Most mental health professionals would not expect a patient to utter this proclamation at the end of therapy. Yet I have heard it more than once. The first time I was a bit taken aback as even I was lacking appropriate context for this framing. At the time I remember inquiring, “What about your accomplishment feels like graduating?” Their answer was so simple. “I have learned so much and radically changed because I have embraced this knowledge and use the skills in my daily life. I am still me, and yet, I am a me I could not have imagined being before I started this work. Therapy was not school but it feels like I have earned a degree!”

Though I don’t agree, psychoeducation is often considered separate from the therapy itself. I have always been a big fan of educating patients as part of the therapeutic process. Getting them excited about knowledge I have worked so hard to gain. Wisdom from biology, neuroscience, social science, psychology, and contemplative science is often as much of an ‘ah-ha!’ moment producer as directly perceiving mind, or landing firmly in embodied presence, or experiencing how goodness, kindness, openheartedness melt away anxiety, depression, loneliness and meaninglessness. It is all part of delivering an integrated package of resources for symptom alleviation and awakening.

Completing therapy fully equipped to meet life’s challenges with intelligence, humility, flexibility and inner strength is the aim. If accomplishment of that goal that feels like graduation I am all for it!

More Perfections of Post.news

Saul Tobias offered on Post.news a lovely explication of the six pāramīs (generosity, virtue, wisdom, zeal, patience, concentration) from the Mahayana Buddhist tradition. You can read it here. Following in Saul’s footsteps I would like to add how the following forms of virtuous conduct can be applied on Post.news and all other social media sites.

The Theravada Buddhist tradition (the teachings of the historical Buddha found in the Pāli Canon) teach ten paramitas. They are as follows: generosity, virtue, renunciation, wisdom, zeal, patience, truthfulness, determination, goodwill, equanimity. 

Renunciation: Restraint is a profound tool for creating a social media environment that is both thoughtful and informative. Renunciation means the impulse to post harmful content gets recognized and assessed internally for wholesomeness and usefulness to the community at large. Renouncing self aggrandizement and posturing can go a long way toward fostering civility and care in a social media environment. 

Truthfulness: This paramita seems self-evident yet so hard to put into practice in daily life. Our internal distortions, negations, evasions, and biases show up full force in social media. We so want our own views to be affirmed and yet disagreement can be a rich part of human interaction—as long as there is a commitment to honest debate and deep listening.

Determination: Once again, the historical Buddha was a big fan of checking ignorance and reactivity in thought, word and deed. Determination to respond thoughtfully takes a lot of zeal to be real instead of getting lost in habit reactivity and posturing. 

Goodwill: Also translated as friendliness or lovingkindness, mettā is an altruistic aim to resonate a kind of love which is unfettered by self-interest and bias. In the Udana Nikāya, the Buddha famously said, “Searching all directions with your awareness, you find no one dearer than yourself. So you shouldn’t hurt others if you love yourself.” Applied to social media, attention-seeking can often lead to posts that emphasize benefiting oneself rather than seeking the welfare of others. Goodwill and renunciation complement and strengthen one another. 

Equanimity: This paramita is for me the outcome of practicing the preceding nine paramitas. In Buddhist psychology equanimity is described as a neutral feeling tone of experience or a mental quality of impartiality. Equalness as a perspective builds distress tolerance and cognitive-affective flexibility by lessening self-absorption or what is known in pop psychology as ‘taking things personally’. Recognizing humanness and its inherent imperfection is a wonderful virtue to practice as one engages in social media. All humans are prone to misapprehend primarily because our perceptual apparatus views everything through one’s own mind-psyche-experiences.

May this post be of benefit to all who read it!

All Things Must Pass Away

For ten years Twitter has been my primary resource to access and interface with colleagues nearby and far flung. Residing and working around the globe, my feed was populated by a rich mix of medical, psychological, academic, contemplative researchers and clinicians.

I was appreciative of how intentional contact curation made this possible and somehow I assumed Twitter would not change. The basic platform would remain as it was. My community would keep contributing and interacting with intelligence, care and respect. Oh how wrong I was.

Of course I knew that Twitter was a cesspool of hatred, misinformation and nefarious bots. Yet, I counted on Twitter’s infrastructure of values/rules of conduct to keep that away from my feed. Then a couple of weeks ago the specter and reality of Elon Musk arrived full force and disassembly began to erode much of Twitter’s corporate and technical foundation.

One by one my community began to close their accounts. And my feed filled with Elon Musk’s antics and the counterpoint #twitterapocalypse. The rich community I had relied on for years to offer up the latest and most interesting research links and discussion dissolved before my eyes.

And I was sad. So bereft and powerless.

And then the wave of Mastodon tweets started showing up. “Find me now @mastondon!” So I investigated Mastodon and though it seemed interesting, I kept bumping up against the futility of not finding my people. So many servers… disjointed, slow, not intuitive coding in the app. And I realized anyone could say they are me and create a profile that looked like me. Big red flag!

For years people have admonished social media sites as superfluous, consumerist, privacy nightmares, and rife with the worst humans can dish up. It was not till my community went away in a poof of Elon Musk smoke that I understood how real cyber-reality actually feels for modern humans. Especially when a user has carefully over many years orchestrated it to deliver nurturing, informative, and honest content.

Today one of my colleagues let me know that Noam Bardin, former Waze CEO, has decided to get in the game of building a new social media site Post.news dedicated to “Real People, Real News, and Civil Conversations”. They seem to be taking their time to carefully build, so now you can only join the waitlist. I look forward to my invitation arriving so I can see what Post is actually like.

I did not expect Twitter to devolve so quickly and yet I know all things are subject to impermanence. My heart goes out to all Twitter employees–whether fired or remaining. Thank you for a wonderful decade! May you find peace and healing.

Last week

Last week…
Over and over session after session;
Patients truth-telling.
Aliveness transforms.

Habit narratives are so damn limited.
Drop them.

I watch the beauty of learning to turn toward experience
And dive in fearlessly.

Inspired, I encourage.
“Fear not. You will not be swallowed up and chewed into bits.”
Experience opens its arms; welcomes them in.
Scoops them up and lifts them high.

Dance  sway  rest  feel
Open in wonderment!

This is real.
The alive one you have always been.

Intersubjectivity and Interdependence

Recently, a colleague shared the following, “I am more and more tuned into the reality of separateness, gradations, distinctions. I think we are being hoodwinked by this idea of universal oneness. This feels particularly true when working with patients, where I find most significant change occurs from investigating distinctions and details.”

While I agree that in-depth exploration is critical for insight, contrasting that process with notions of universal oneness rings hollow for me. And that common mistake may simply be due to widespread misinterpretations of ‘oneness’; most especially the Buddhist concept of emptiness or interdependent co-arising. Although emptiness is a concept, therapeutic dynamics provide a real-time example of how interdependent co-arising actually manifests in human experience.

The Intersubjective School of Psychoanalysis hypothesized an intersubjective field continually mediating bidirectional knowing between psychotherapist and patient. Intersubjectivity enables a psychotherapist to empathically use their entire psychophysical system to receive and mirror a patient’s cognitive-affective-somatic material. That form of empathy or therapeutic attunement, is the primary process through which a patient feels known. So, although a psychotherapist may deliberately direct patient inquiry, intersubjectivity tells us that both parties are equal participants and influencers in the therapeutic container’s ebb and flow.

Acknowledging that apparent interdependence does not discount or negate the appearance of two separate participants. Each exists from their own side in a relationship of mutual influence. Nagarjuna, the progenitor of the Middle Way School of Indian Buddhism argued that emptiness rests on two principles: (1) things/selves in the world appear nominally, and (2) because of their impermanence, interdependence and insubstantiality, these entities lack any essential (svabhāva) nature.

For example, take the device you are reading this blog on. If it was self-existing, it could not be broken down into its parts—cover, screen, content, matter, particles, quantum information and so on. It is no more than a so-called object, interdependently linked to nominal parts similarly lacking any essential nature. Though the device does have conventional or relative existence, it also cannot be found to ultimately exist separately from its myriad parts.

Similarly, though the therapeutic dyad includes two separate beings, the therapy itself is an intersubjective, co-created process. Co-creation widens the menu of possible perspectives and makes possible successful interventions that decrease systemic reactivity and increase capacity for in-depth inquiry. Mutual influence and co-creation till the soil that yields embodied awareness and cognitive-affective-somatic openness. Such that self-fixation and its concomitant feelings of separateness fall away; and along with it the oh, so ubiquitously harmful distorted notions of self and world. Clearing those obscurations of mind is not only the optimal path to less cognitive-affective-somatic distress, but also increased tolerance and connectedness with all other beings.