The
The Keynote Address
Dr. Kathleen C. Quinn
The substance of this
presentation was much the same as I had written and prepared; the difference
was I
was in a post-Katrina state. There seemed to be the opportunity in my
post-hurricane experiences to teach others how we are each on a mission, in the
correct place at the correct time to positively impact the environment within
which we function, thereby healing others and having the possibility of
self-healing. I repeat for clarity--we have the opportunity to make change in
our world and that change is born through our own courageous action. Sometimes,
it is born through our rage and anger!
I had been on the
“Why NOT, “I demanded.
“Because there is no one there,
they are all on Labor Day Vacation,” she answered.
She connected me with FEMA’s
News Ops Room and I spoke with a young woman, who wasn’t sure what Katrina was
and said so. Nor did she have any idea that Pass Christian was part of ground
zero in the storm. She took my name and number (to this day FEMA has never
called BUT we did get a feeding station 6 weeks later!) To manage my anger and
to accomplish something for the people of my town, I went to national
television, newspapers, radio and began giving interviews and begging for help
for my people. AND HELP DID COME…
I used this story to
illustrate the whole point of the keynote address:
1.) WE ARE ALL ON A
2.) WHAT IS INTERNAL TO OURSELVES BECOMES
EXTERNALIZED IN
3.) STRESS
4.) THE POWER TO MAKE CHANGE IS WITHIN EACH OF US.
5.) THE FIRST CHANGE IN CHANGING OUR WORLD IS TO
CHANGE OURSELVES.
6.) THE FIRST CHANGE IN OURSELVES MUST BE TO CHANGE
OUR MINDS.
7.) EVERYTHING FLOWS FROM THESE CONCEPTS.
Customarily, reviewing the
coping mechanisms of an individual does not take into account gender and
socialization as children. There is a significant body of research which
demonstrates that males tend to learn to be aggressive and explosive; females
tend to be socialized to be withdrawn, depressive, and likely to implode as a
response to stressors in their environments. As children the two processes produce children
who are male and more aggressive and violent either using weapons or physical
actions, teams, sports, and clubs ( no girls allowed and testosterone toxicity)
or female ( manipulative, mean, passive aggressive, using labeling and
relational blackmail or becoming isolated and depressive). Surely, there are
levels and variations within these learned behaviors and we even have some
children who are enculturated to positive handling of physical and social
stressors. Another factor which supports the dysfunctional adaptations or
coping mechanisms is the presence of abuse, physical, verbal, psychological,
emotional and sexual which is so prevalent in our culture and perpetrated
against children to a huge degree. The statistics are so high it is safe to say
nearly every other child in this country is subjected to abuse of one form or
another. A very broad view of this
leaves us with about half of us learning negative coping skills, half using
positive or mixed coping skills.
What is significant is the
extent to which these early consequences of socialization actually influence
individual ADULT responses to stressors; as well as influencing how we act
within our adult roles in families, workplace and community environments. Put
another way, patterns which we do not see, recur repeatedly, until they are
brought into our awareness and are dealt with. Many times we are acting as we
did as children, bringing dysfunctional patterns of behavior into the
workplace, our personal lives and our parenting.
While it is important to recognize these statements
for the broad generalizations they are, it is equally important to see their
value as metaphor.
The presentation included an
overview of our understanding of stressors and the development of our view of
illness as a response to stress via the views and research of Hans Seyle in the
1950’s to the landmark work of Milton Erickson in hypnosis and symptom removal,
finally to the chemistry we all learned in anatomy and physiology in the balancing act between the sympathetic,
parasympathetic inter-functioning, alongside our contemporary view or elevated
cortisol levels and the negative impact on the immune system as the body
attempts to adapt to and cope with
stressors. We also reviewed the body’s effort to respond to aversive stimuli
(the rubbing of a subject’s hand, Elaine was the guinea pig!), we explored what
would happen to the hand over time in the presence of the stimuli, i.e. sore,
callous, cancer at the site, etc.
As part of the demonstration
we reviewed the process of the inflammatory cascade as an adaptation to stimili
that are initiated either externally or internally, we used examples of both
and their impact on the process of “Fight or Flight.”
More importantly, we
reviewed how people felt watching the demonstration, what emotions they
responded with as they watched; what things they would attempt to make the
demonstration stop, how irritated they felt. All of the things they suggested
were just ignored or refused able to stop the demonstration which increased
levels of frustration and irritation. It was demonstrated rather clearly, that
doing what one usually does as a response to irritation usually had no
effectiveness; what is required is another way of perceiving and viewing the
process. In other words, “always doing what you’ve always done and expecting a
different outcome is a definition of insanity.” We have to change what we are
doing, both internally and externally if we expect to have anything other than
what always happens as an outcome of our choices.
Let’s consider the
traditional view of stimulus-response that we all studied as part of our
healthcare education. In its most simplistic form, there is a stimulus and then
the organism responds to the stimuli; which may or may not cause change in the
stimuli. Originally, the view was linear, and unilateral; subsequent thinking
takes into account the possibility of the response affecting the stimuli. We
all are aware of the research premise that the observer cannot be removed from
the observational setting, or that the observed is influenced by the
observer.
How this functions is easy
to see if instead of:
S->R, or
S->R<-S we begin to see:
S->C->R.
This formulation allows for
cognition, or thought processes prior to the response. It is at the level of
thought- mediated activity that most of us lose the ability to understand or
act. The confusion/dysfunction for most people is the “C,” we act like it isn’t
there. So you, as a practitioner, will hear such things as, “he made me so mad,” or ” it
makes me sick;” as if there is no option other than to act as if S->R is
what is happening. If this were the case then we would all be Pavlovian Dogs!
In the healthcare
environment in which we all practice the prevailing approach is very much like
S->R which seems to eliminate most of what can be identified as “C”
activity. This is the point at which non-medical/surgical interventions are supposed
to happen. Contrary to the accepted mindset, “C” is where we do all the creative
things. When people decide to do medical
or surgical interventions as the response we find their choices/decisions/cognition
are largely conditioned and taught or reinforced
by our American culture which seeks a quick fix in ‘pop a pill’ or “have a surgery.” Another way of being,
thinking requires a change.
The reality in which we live
is actually simpler and more complex.
In situations of real threat,
“fight or flight” takes over; fundamentally, S->R occurs.
However,
in the historical context of a life, where there may have been a real threat (
for example, in sexual abuse), when the conditions for that threat no longer
exist, certain actions may become perceived
threats by association. In these instances the actions trigger S->R as if
they were real threats. This is
called, a generalized response, meaning the response is generalized to other
non-threatening stimuli, and the response is to act as if there is real threat. Physiologically, people act as if the “C”
isn’t there; as if they don’t have a choice and don’t have to cognate about the
stimuli. In cases of real physical threat one wants to be able to
react/respond, not cogitate on all the aspects of the event.
The
cogitating appropriately comes after the event and response and looks like
S->R->C.
In
the absence of “C” the individual is subjected to escalating levels of adrenal
activity body releases adrenalin; sympathetic and parasympathetic responses are
activated into a feed back loop where escalating levels of cortisol are
released resulting in hyperarousal, hyperstress; continues states which result in hyperstimulation,
looping back into more arousal and more adrenalin….then finally resulting
in adrenal exhaustion, insufficiency,
deficiency. In order for fight or flight to actually
occur, there is a necessary release of sugar enabling the body to fight/flee; with
hepatic release of sugar and pancreatic insulin cycling up in a “hyper” state
the logical development is hyperinsulinemia, expressed as insulin resistance,
stored fat, increased cholesterol levels, elevated blood pressure.
With
appropriate processing/treatment, and education individuals are able to
discriminate between real and perceived threats by learning cognition, or
re-cognition which requires thinking. In the beginning the process is slow
because it is necessary to exercise thought in the process and change one’s
responses.
In many cases, we have to
back up and pull self back from an initial response and make “C” happen.
Between a stimulus and our response there may be a million choices i.e. breathing,
meditation, exercising, food choices, etc. What we choose to bring into being
is an activity of changing our internal state in order to bring about change in
our work, our community, our world.
Another aspect of the
teaching illustrated the activity of the mind on the body; using the
visualization of biting into a large yellow juicy lemon causes physical changes
in the mouth! This how mind influences body all the time and we are usually not
aware of the process. The field of study in which this work occurs is called
psychoneuroimmunology; and is my area of expertise. How we apply these newly
emerging principles to healthcare, prevention, and wellness, is crucial to us
in learning self care techniques and then teaching our patients to care for
themselves. Once we begin to see [“C”] it
becomes apparent that changes in the mind can even chemically change the body.
What is thought is also body chemistry. The delicate dance is one of
recognizing that each thought can and does change body chemistry. If we live in
fear all that our body knows is fear. But change what the mind perceives and
change the fear and we change the body, wellness, our world.
Learning
to implement Self-care is fundamental to our own well-being and our ability to
teach it to others. “Self-care techniques are a mandatory component for all
people practicing holism. Recognizing the need for education and the importance
of fostering self-responsibility is essential. Self care is still the
predominant mode of health care.” (Chernin, p104, as cited in Kunz, 1985).]
There is in the broader
picture a need to understand the implications as it relates to our work as
nurses, issues of power in the workplace, how we live in general, and what we
do with our stress. As a group we
practiced a Qigong exercise for energy movement in the body, actually
experiencing changes in breathing and stress.
Finally, I indicated we have
choices. Learning to do something different will not happen as the result of a
single keynote address, it is rather part of a continuing education process
which should be made available in hospitals and nursing/medical programs across
the country. The only way this will happen is for each of us to learn
constructive uses for our anger, self care techniques and then ask for help.
“The probability that we may fail
in struggle ought not to deter us from the support of a cause we believe to be
just.”__Abraham