Consider the story of Joanne: Although older than most of her peers at nursing school, Joanne looked like any other nursing student. Her personal journey, however, had been more difficult than most. Her parents had been emotionally and often physically absent, and she had largely fended for herself. From ages 10 to 12, she was sexually abused by an uncle. At 17, she was driving drunk on an icy road when she lost control of her car and killed her best friend, who was riding with her. As a young adult, she was diagnosed with lupus. When she came to my office, she was dealing with intermittent symptoms of lupus, as well as with periodic flashbacks to the sexual abuse and the car crash.
She also was burdened by two related and common misperceptions: The first misconception was that all of this was somehow her fault. The second was that somehow it could be changed. Of course, in Joanne’s case, there were powerful external events (absent parents and sexual abuse by an uncle) that assuredly were beyond her control. She also faced cognitive and emotional internal events (flashbacks about trauma, feelings of sadness or guilt about bad choices) that tend to be ongoing challenges for many people. And she wrestled with lupus, a disease that was probably not going to go away.
Nevertheless, the premise that much of life experience is not controllable goes down hard. I sometimes wonder if we have a collective sense of psychological Manifest Destiny. My patients often come to me, wishing to somehow change experiences that are not changeable. More than that, their efforts to change external and internal circumstances are often counterproductive. For example, the more people try not to be anxious, the more anxious they tend to become. The more we try to change other people, the more they tend to dig in. The more we try to run from painful memories, the more those memories track us down. One patient who is active in 12-step programs recently gave me a new addition to my collection of AA aphorisms: “What you resist persists.” The more you try to change unchangeable things, the more they push back at you. Good wisdom.
The alternative is somehow to let go or make peace with that which is not changeable, and to move on with current life choices in a meaningful way. Ironically, Joanne’s life did change for the better when she made a profound commitment:
“I decided,” she said, “that I couldn’t bring back my friend, or change any of what’s happened, or make my lupus go away, but I could make my life count from here on.”
As I will explain, Joanne’s journey and commitment point to three themes in addressing uncontrollable aspects of life. First, people seek transcendence, the journey of letting go or making peace. Second, people move in valued directions, making meaningful life choices and finding meaningful life paths, as expressions of their values and their spirituality. The third element, for those of us who care about and support other people in the face of uncontrollable circumstances, is called compassionate presence or love. For many people, these three elements — transcendence and valued directions, in a setting of love — can chart the path to “making my life count from here on.”
1. Compassionate Presence (aka Love)
A colleague of mine who had been dealing with a variety of health problems recently visited a physician in our community who is a practitioner of traditional Chinese medicine and acupuncture. She tells this story:
You go in the door, and a golden retriever greets you. It’s this really soft and peaceful environment. The doctor welcomed me, holding both of my hands in his, looking into my eyes with gentleness and caring. As we did the acupuncture treatment, we had this quiet conversation, where he was so clearly interested in who I am and what my life is like. As I left, I thought that the acupuncture had been helpful, but mainly, I felt so loved.
As a faculty member at a teaching program in integrative medicine, I have no doubt that the acupuncture had an active therapeutic effect. But the spirit and energy of love in the presence of this practitioner was also profoundly important. And of course, the golden retriever (one of God’s angels incarnate) played a role as well.
The healing power of caring people being genuinely present to others is not new. I want to emphasize that being present is ultimately not a matter of the right configuration of behaviors, like body posture and reflective statements; it is a matter of the heart. A family physician recounts:
Before I go into a room, I pause for a few seconds, feet flat on the floor, to remind myself why I want to be here with this person I am about to see.
If our compassionate presence with other people arises from inward qualities of heart, then all of us who care about others have a sacred responsibility to make sure that our hearts are in the right place. Many of my colleagues and friends, like the physician who pauses outside of exam rooms, have developed disciplines and practices that help them stay connected with the spirit and energy of their calling. Mini-meditation. Walking mediation. Brief tai chi forms. Prayer. Statements of personal mission. Mindful eating —or at least saying grace before wolfing down food on the run.
In Joanne’s journey, she eventually found a small network of people who loved her, including a few friends, fellow 12-step participants, and an occasional professional. Speaking of one counselor who particularly touched her, she says, “I could see in his eyes that he really cared. He believed in me, sometimes more than I believed in myself. That was incredibly important.”
In remote northwest New Mexico lies Chaco Culture National Historical Park. Chaco was a major center of ancestral Pueblo culture, flourishing for about 300 years beginning in the mid-800s. It remains, probably thanks to its remoteness, an extraordinarily well-preserved example of ancient American building and community life.
Chaco is thought to have been the hub of an extended network of communications and trading around the region. As a matter of technological and religious purity, the Chacoan engineers charted directions to other centers, such as Mesa Verde, and created routes between centers that were absolutely straight. No curves, no switchbacks, no detours … straight. If the route encountered a cliff face, so be it; the ancient road builders created steps or handholds. In other words, the Chacoan road builders made a physical practice of transcendence, a word that comes from the Latin transcendere, to climb, step, or go across or over. “Transcendence,” for the Chacoans, literally meant “going over,” resisting any temptation to allow obstacles to keep them from travel.
For Joanne, transcendence meant facing up to her history and illness, but not giving these life experiences the power to prevent her from becoming the best nurse she could be.
In supporting people facing pain and suffering, there are a number of spiritual and psychological traditions and practices that have been shown to promote transcendence. These practices include:
• Letting go
• Spiritual surrender
Some of these approaches to transcendence inevitably resonate more than others for different people. Given a relationship that is safe and that honors people’s painful experiences, I find that people intuitively gravitate on their own toward one or more of these directions. For example, dealing with a disaffected and philandering husband, a middle-aged woman affirms her commitment to love him, while needing to let go of the certainty that the relationship has a future. An intermittently depressed man comments that if he sees something he can do to change his feelings, he will do it; otherwise, he will practice acceptance, which means acknowledging the fact that his feelings are there and that he will live his life as well as he can. The grown daughter of a dying man who had been sexually abusive to her says that she needs to practice forgiveness to find peace with her father before he passes on. A young couple beset by family illness and unemployment remind each other to practice gratitudeeach day for each other and for the blessings that they do have.
To the extent that I introduce any of these approaches to transcendence, I have found that the idea of focusing on the present moment through mindfulness particularly resonates with many people. Most of our emotional and spiritual distress, I suggest, finds us directing our energy and hearts either to the past or to the future. Stated positively, exploring with people when they have really felt “alive” or “in tune with life” usually points to times when they have been fully present to what was happening here and now. Participating in the birth of a child. Being part of a team that supports one another. Being caught up in the flow of discovering something new. Taking a milestone step in physical rehabilitation. Times like these of being really alive and engaged with life are almost always rooted in present moments.
3. Valued Directions
As Carl Jung famously commented: “All the greatest and most important problems of life are fundamentally insolvable . . . they can never be solved, but only outgrown . . . some higher or wider interest appeared on the [person’s] horizon, and through this broadening of his or her outlook the unsolvable problem lost its urgency. It was not solved logically in its own terms but faded when confronted with a new and stronger life urge.”
Pursuing valued directions is a vitally important part of the spiritual process of relating to life circumstances outside of our control. Transcendence and the pursuit of valued directions go together. They are complementary. We “go across or over,” and we move toward something that matters.
We support people in pursuing valued directions as we invite them to consider questions such as:
• What do you care about?
• What matters to you?
• What kind of person do you wish to be?
• What does “a good life” mean to you?
• What is sacred for you?
• What do you cherish?
• What do you take pride in?
These are, of course, spiritual questions. For me, the most succinct statement of the overarching picture of spirituality comes from former Surgeon General Dr. C. Everett Koop, who defined spirituality as “the vital center of a person; that which is held sacred.” What is “vital” is life-giving. It is sacred. Discovering that sacred core follows from people’s exploration of the kinds of questions that help to chart what we are calling “valued directions.”
Another tool for accessing this sacred core is the “three adjectives” exercise. I ask them to identify three adjectives or phrases that capture personal qualities that reflect what they would hope to be like, at their best. A man recently responded, “Kind, making a difference, and being a father that my son can look up to.” Answers like this often provide meaningful direction and provide vital, life-giving emotional and spiritual energy for the journey.
Back to Joanne: In her conversations with others and in her own quiet moments, she came to realize that her own pain had helped her cultivate an extraordinary sensitivity to the suffering of other people. She decided that she could give back and somehow “redeem” her own suffering by caring for other people as a nurse. Nursing, for her, was vital. It was a “new and stronger life urge” that helped her to transcend her own pain and to direct her energy toward a career that was life-giving, for her and for her patients alike.
Transcendence and valued directions, in a setting of love. This has been Joanne’s journey and can be a template for others of us as we reach for dignity and meaning amid the challenges and uncertainties of life.