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A 15 minute talk to health professionals at Whanganui Hospital, New Zealand, February 2011 by Chris Cresswell Ka tangi te tui Ka tangi te piwhakawhaka Ka tangi hoki ahau Tei hei mauriora Kia ora kautoa Empowerment I invite you to join me in a conversation about empowerment. It has been an interesting conversation that I’ve been having for about 18 years. Most recently I’ve been having it mainly with 2 people. One is Gilbert Taurua, the Director of Maori Health for the DHB, the other Sarah Mauven, a peer support worker for Balance, a mental health support group in town. The korero goes something like this... If we as health professionals, policy makers, counselors, friends, partners give our patients, people, friends, partners advice, knowledge, even support are we actually disempowering them. By thinking we can help does that mean we think we are more powerful, knowledgeable, clever than them? Even if we don’t think that, does our position relative to them make us more powerful – and therefore them less powerful? Do we, especially doctors, keep patients dependent on us? Some of the best times in our careers are when patients take charge of their lives. They start exercising, they leave the abusive partner, they start caring about and for themselves. But these moments seem fairly rare. Is that because the current medical model keeps them powerless? And if that is so how do we help? Or do we get all New Agey and say the world is OK as it is and just Zen out? That patients should be left to empower themselves. Now most of the time I just carrying on with life and work – but occasionally these questions would pop up and derail me a little in my work with patients or in conversations with family or whoever “Am I being paternalistic?” “But the patient needs a good lecture!” I came to a happier place with this about a year ago with the realisation that we can be powerful, and we can remind others of their own power – with out disempowering them. So it’s not a them or us power thing – but a them and us power thing. Power with, not power over. And with that things became easier. I seemed to be more often in a space where I was comfortable with my relationship with my patient or friend. In a space where the right words flowed out of my mouth that were affirming to patients, where I was freer to let patients be themselves and have their own lives. Simultaneously there was a process of becoming more comfortable in myself and being able to speak my own truth. Through meditation and daily practice at work and home I was becoming better at ignoring the internal mental chatter and focusing on what was in front of me. I was taking charge of my own life instead of being a victim of circumstances. I was empowering myself. As I became more comfortable in my own skin I became less concerned about what other people thought, more sure of myself. As I accepted myself as who I am, with all my faults and failings, it became easier to accept other people with their faults and failings. The need to fix people reduced. And as I stopped trying to fix other people, they started fixing themselves. When I stopped wanting my wife to stop smoking, she stopped smoking. As I stopped wanting my son to be a certain way – I could see how awesome he is in so many other ways. Once I stopped trying to fix patients, I connected with them better, had more fun, and was able to do better medicine because I could think more clearly without “He should stop smoking” “She should leave that guy” crowing in my head. And as I was able to step back and let people be, they started growing into the space I allowed them. The most spectacular of these has Mrs B. I won’t tell too much of her story because I don’t want to steal her thunder – she will be telling her story as part of the La Fiesta – the women’s festival - next month. Mrs B had suffered a horrific event many years ago and was suffering from OCD, fear of being alone or alone in public, depression and palpitations. She had b

Hopefully if you have got to this page you have been trying some of the techniques I have been suggesting for a while.  Hopefully you have found yourself calmer at work and out of work, and you have noticed that you are connecting better with your patients and colleagues. I now want to guide you through a short meditation to consolidate these changes. Please close your eyes and turn your attention to stillness, that part of you that surfaces when you allow your thoughts, memories and worries to settle.  That part of you that is there all the time below the surface: calm, still, unshaken and unshakable.  That part of you that comes to the fore when all the mental chit chat quietens down. Rest in that stillness, be that quiet, be that calm.  And as always, if something comes along that distracts you from that stillness, notice it, and chose to be the stillness again. Be aware that each time you remind yourself of this stillness you become more still, more calm, in your day to day life.  Things bother you less and less. You are more able to concentrate on the patient in front of you instead of worrying about how you are going to get all this work done.  You find you have time to really listen to them - even if only for a minute - and they know they have really been listened to.  You are finding your work is becoming easier and more satisfying because you are actually dong a better job. You are more able to see the goodness in other people.  You are become calmer and more reassuring for your patients.  Your patients feel safe and at ease when they are with you.   Without even saying anything they see the calmness in your movements, they see the confidence in your eyes and they feel at peace.  And with your words, your explanations, your reassuring touch you put them even more at ease. With this they stop being paralysed by fear, start to muster their own resources, find their own solutions, see a way forward for themselves, or acceptance of their situation.  They become more alive. The peace, the stillness, is contagious and wonderful.  Now just relax in that stillness, luxuriate in that stillness. Be aware you have created a healing space. Enjoy your day :-)

So we have New Zealand's first mutimodal, in hospital, natural therapy clinic up and running.  Yay. One of the big lessons for me in this process was that so many people in "Health" want the Health System to be about healing.  Most of us got into Health wanting to help and heal people.  A lot of us have burned out or become disillusioned about "The System".  But we have so many allies with in the system who want what we want.  We can work together to create the health care system we want, that our patients need.  It won't happen over night but it will happen.  Our clinic is for staff only and is not funded, so we have volunteers working in it and we are asking the recipients for a koha or donation.  But it is a start.  And it has been wonderful to see the excitement and the light in the staff members eyes.  So look for ways that you can make a difference.  Get onto those horrible committees and into those management positions so that we can have people who care making the right changes in our health care system.  We already have an amazing health care system but we can bring in even more heart and soul into our work - for our patients sake and our own us. 

Sometimes we feel we aren’t getting anywhere with what we are trying to achieve in or work, but often your work has wonderful effects that you cannot see at the time. I remet a vivacious woman a few days ago who said “I want to talk to you about sowing seeds. 18 years ago I was your patient when you were a GP. You had a Reiki certificate on your wall and I asked about it. We talked a little then you did a grounding and centreing exercise with me. I had a vision of God and I was invited to leap into God’s arms. I lept and I was held. From that, in my “real” life, I left the patriachal religious cult I was trapped in and became a naturopath and my life has been wonderful ever since.” So have faith, when you follow your heart, your calling, what you do will have profound effects, effects you may not see for 18 years, if at all. Effects that have a much greater effect on your patients quality of life that giving a dose of frusemide. And we can give frusemide as well, if that is the right thing to do. Sow seeds of goodness widely and they will often find fertile ground, and the new life that grows will warm your heart.

The human brain is a simple computer and easily reprogrammable. Hypnosis is just a way of reprogramming some one elses brain. Self-hypnosis is reprogramming your own brain. One of the simplest forms of hypnosis is reassurance. We do this every day in our work. This is very important in our current life in which so many people are anxious about so many things. The greater the mana or kudos of the individual, the more they are able to reassure somebody. Our society gives health professionals mana or kudos, and therefore we can make people at ease. Beyond reassurance, patients may allow you to hypnotise them. This is not the stuff of stage shows and doing silly things. People do not need to be in “trance” but just have a still and receptive mind. You guide them into a relaxed state in which they are more open to reprogramming then speak a new programme into them eg “You are going to pay attention to your food when you are eating, you will enjoy your food and stop eating when you have had enough to eat.” It is more empowering to teach patients to hypnotise themselves. Teach them to put themselves in a relaxed state, with thoughts stilled, and then to talk to themselves with some positive reprogramming “Next time I feel like having a cigarette I will remember that I want to be able to breath well and I will choose to be smokefree and to refocus on what I am doing” To be able to teach your patients you need to be able to hypnotise yourself. It’s easy. It is good to use some sort of voice recorder eg a dictaphone, an old audiotape, or the voice recorder on a computer or phone which you can play back to yourself via the computer, phone, MP3 player or iPod. Record yourself giving yourself instructions. For example: “Today when any of my workmates speaks to me I will stop what I am doing and really pay attention to what they are saying and engage in conversation with them. If I start to feel angry with Bob I will stop and ask myself “How do I really want to respond to Bob? What can I say that will get the best outcome for Bob and me?” I will use the stairs. I will eat healthy food today”. Then use any of the meditation techniques we have tried, eg focusing on your breathing, to still your mind. Then play your recording back to yourself. Then go on with your day and notice what happens. With practice you will realise that your instructions to yourself can become more and more life changing. You will also find quickly that you don’t have to go through the whole process with the recording the instructions - you can just give yourself some instructions for the day and so your day unfolds. Have fun. See how far you can go with this. Download audio

Alternative therapies One of my medical students sent me a marvelous spoof about the use of homeopathy in ED (attached). What is the place of alternative therapies? First thing to be remembered is that many conventional therapies are based on natural remedies - morphine is still extracted from opium poppies, some antibiotics come from bacteria. Adrenaline, or epinephrine, is a copy of an natural hormone/neurotransmitter. A lot of the argument against complementary medicines is that they aren’t well researched in radomised controlled trials but unfortunately we are finding that so much of current conventional medical research now is corrupted by the pharmaceutical industry that many of us have little faith in it. Most people would agree that anaphylaxis, injuries from a severe car crash, life threatening pneumonia require conventional medicine. Many of us believe that drugs are not the answer for anxiety, depression and insomnia and that alternative therapies are more likely to be beneficial in the long term. For many of us there is a big grey area in between these two extremes. Personally I have good genes, meditate, self hypnotise and occasionally use some conventional and some alternative treatments on myself. I encourage each of you to educate yourself about conventional and alternative therapies and to work with your patients to help them to find what will work for them. Very very rarely, those of us working in the medical model are required by our society to overrule an individuals choice about which mode of therapy they want for themselves or their loved ones. But generally the patient is best served by allowing them to chose their own mode of treatment. Personally I have worked with conventional therapies and a little alternative medicine for years. I now use conventional medicine but keep my eyes open for opportunities to share my experience of meditation and self hypnosis. For me these methods are the most effective for reminding patients of their own ability to be vital and alive. I encourage each of you to find you own way. A way that is true to your inner self, a way that you know best serves your patients and you. When we do this we are satisfied with our work and get the best possible results for our patients. Download audio

One person can do some good in the world. A team can do a huge amount more. Aristotle said “The whole is great than the sum of the parts.” A so it is: a team can achieve much more than the sum of the individuals’ work. We perceive ourselves to be fallible entities with a unique set of talents and weaknesses. When we work together as a team we can complement each other, share our strengths and negate each others weaknesses. It is easy for an individual to slip back into old habits, negative thoughts and beliefs. As a team we can remind each other to be present, to be aware. We remind each other of our intention to be who we want to be. Some teams do this naturally with great results. If the members of the team get together and agree that they will keep the team pumping, they take the team to a higher level. If they can agree on a common goal, even better. If they agree together to be the outcome they want, things will really take off. This is what some managerial mission or vision statements try to achieve, but often fail, as the whole team hasn’t been included in the process and it is not their voice. When a team creates a goal for themselves, for example “The people of our city are vital”, then speak it into reality and live it, that goal happens. The speed and magnitude of that change is directly related to the teams awareness of their power. With practice, people discover how powerful their words are, and results can be instantaneous and stunning. Download audio

Most people in our society spend most of our time thinking about the past or the future, rather than being here, now. There is a voice in our head saying “I can’t believe she said that”, “Man, you are so dumb, what did you do that for” and “I’ve got so much work to do, and the kids to organise, and the groceries to get, and …” and “I haven’t got enough time.” We can retrain our brain by consciously choosing to focus our attention on what we are doing here and now. As we do this the negative mental chatter quietens. The mindfulness meditations, such as watching your breathing, earlier on in this podcast and website are good tools to start retraining our brains. Ekart Tolle and Jon Kabat-Zinn are fantastic at teaching this brain retraining. They gather old wisdom and teach people to live in the present rather than in the past or the future. Any of their books or talks, such as The Power of Now or Mindfulness for Beginners, are well worth reading or listening to. During this retraining we are drawn back, without noticing it, to thinking about the past and future again and again. Old habits die hard. We can discipline ourselves to choose to repeatedly focus our attention back on the present. As we do this we find we notice much more of what is around us now. We find ourselves stopping to smell the roses, listening to our kids more, being more attentive to our partners … and to our patients. We find that we work, at work and at home, more efficiently because we think more clearly without the mental noise. With this we find we have more time. We are more peaceful without those thoughts nagging in the back of our heads all the time. We sleep better. We are happier. We are more alive. Right now what are you doing? As you read these words what else is going on in your mind. Now stop reading for a minute and just observe your thoughts. ~ Notice how much is going on in your mind. Can you see that there is a you that is separate from your thoughts? There is nothing wrong with thoughts, so long as they are not running your life. With practice as we learn to still our negative thoughts and beliefs, and quieten our thoughts about past and future. Then we start to have useful thoughts. We create a space for positive thoughts to come through. Some times positive thoughts can come flooding through and we get an insight into mania. Next we learn to still even the positive thoughts. Then in the space of still mind there is a space for intuition. We access the vast stores of mind where the inexplicable happens, things seem to just fall into place, coincidences happen. Life flows easily. As we learn these skills we are able to share them with our patients. We do this by induction – as we live in the present this rubs off on other people. We also become aware of more opportunities to share this knowledge with our patients . We learn to trust that we can share this knowledge. We find that people are more receptive to these ideas than we have believed. We find that deep down everyone is searching for the same thing: freedom from the mental chatter and reconnection with their true selves. As well as the wonderful knowledge and skills of medicine, nursing, physiotherapy or which ever craft we belong to, we can help ourselves and our patients back to being present. Read or listen to some of Tolle’s or Kabat-Zinn’s work, it may just be the best thing that ever happened to you. Download audio

Some people say I see the world through rose tinted glasses. It is true. I do see a rosy world. I choose to see a rosy world. Some say I am unrealistic, that there is a lot of bad in the world. Yes there appears to be a lot of bad in the world, and what are we going to do about it? If we see the world through grey tinted glasses we tend to create more grey in our world. We see and create negativity, complaint, anger and frustration. These thoughts and feelings don’t solve problems, rather they usually just generate more. With rose tinted glasses we tend to see solutions rather than problems, to see people who can help rather than hinder, to see hope rather than despair. And perhaps rose tinted glasses tell the truth and other glasses are just tinted grey by a collection of false beliefs and stories - all the accumulated dross of our society. Perhaps we can remove the grey coating from our glasses leaving them beautifully rose tinted. Perhaps if at every instant we choose to look through rose tinted rather than grey glasses, we are choosing to see and create a better world. Try it for a day. Choose to only see the good in people and situations. Choose to think “this person is probably angry because something bad has happened at home this morning. I wonder what would happen if I gave them a hug?” Choose to ignore the bad. Turn off the TV, don’t read the paper. Initially it is very hard to do, seeing the bad in everything is a stubborn habit - notice how much those around you complain, notice how much of the conversation in our society is complaint. Initially seeing the good feels very false. With time and practice it becomes easy and your world changes, it soon becomes your normal way of being and what a relief. We start to see the beauty in people, see how most people are doing the best they know how to, are able to see solutions rather than problems about us, to find people who can help us. Other than the feeling that you are right and that others are bad and wrong, what do you have to lose? I encourage you to try it for just one day. Download audio

Another description of how we are helping our patients, is that we are encouraging them to make the switch from negative/passive/victim to positive/active/creative. In our society most people perceive themselves as relatively powerless, life happens to them, they spend most of their time observing life (watching TV, listening to music, doing the work they are required to do) and mostly see the world as negative (other people are bad, the world is hopeless). We can help our patients to find they have power in the world, that they can have a positive effect on their life and world and become more creative and active. A major block to people making this switch is that most people feel powerless to make this change. We get trapped in the belief that we can't change our lives, that this is just how life is. When we have made the switch ourselves we are able to say with confidence to patients that the change is possible and it works. We can help our patients to see that they have more power than they realise. As the negative thoughts and beliefs fade away that they will discover that life becomes easier and they have more say in their world. We can guide them to create the life they want. We can share with them how we are learning to live in the present, and that each moment we have the choice of how we relate to the world. We can choose to see the world as negative or positive, we can see those around as good or bad. We can choose to be passive or active. We can choose to wait on the world, or to be creative. Our lives are made up of these choices. The more we choose to make the choices that create the world we want to live in, the more we create the world we want to live in. We can share with our patients that at first this seems like nonsense, but you can tell them that it works for you. At first only little changes may have happened, but with practice, and seeing the positive benefits you have become more skillful at make the right choices for you. Because of your vocation your patients will listen to you. And the patient will see your vitality, be attracted to what you have, and want to know more. And so you can inspire your patients to make the switch in their own lives. Download audio