Addressing Well-Being in Clinical Practice

Understand how a loss of well-being can present itself clinically as illness and moral injury. Describe the link between emotional health and well-being. Gain insight into the neurobiology underlying emotion and well-being. Discuss how one can help patients constructively move toward a positive sense of well-being. Caveat: I will make copious use of metaphor.

Transcript

1. Andrew S. Bonci Andrew S. Bonci Life-Long Learner Life-Long Learner Private Practice Private Practice Addressing Well-Being Addressing Well-Being In Clinical Practice In Clinical Practice Photo Credit: Christy Lee Rogers
2. www.embodiedforgiving.com 2 of 124 (in US copyright law) the doctrine that brief excerpts of copyright material may, under certain circumstances, be quoted verbatim for purposes such as criticism, news reporting, teaching, and research, without the need for permission from or payment to the copyright holder.
3. www.embodiedforgiving.com 3 of 124 Disclosures I am beholden to NEITHER corporate NOR ideological interests in the presentation of this lecture. This lecture is oriented to present a patient- centered point of view of well-being. Emphasis is placed on contextualizing and understanding their first-person experience. This will necessarily require that I speak in terms of a patient's world view. Cover Art: Muses by Christy Lee Rogers Dynamic Underwater Photos Look Like Dramatic Baroque Paintings. (2018, September 7). My Modern Met. https://mymodernmet.com/muses-christy-lee-rogers/
4. www.embodiedforgiving.com 4 of 124 BioPsychoSocial Model BioPsychoSocial Model “The totalization of production desecrates life.” Byung-Chul Han (2020, p. 50) “The Disappearance of Rituals”
5. www.embodiedforgiving.com 5 of 124 -Psycho- -Psycho- Bio- Bio- -Social -Social
6. www.embodiedforgiving.com 6 of 124 A Friendly Reminder In “On the Road with Saint Augustine,” James K. A. Smith (2019, p. 20) muses on the contemporaneous nature of Augustinian thought on life in the postmodern world. Smith, J. K. A. (2019). On the Road with Saint Augustine: A Real-World Spirituality for Restless Hearts. Grand Rapids, MI: Brazos Press. – “We are philosophical heirs even if we don’t realize it. We have inhaled invisible philosophies in the cultural air we breathe.” – PLEASE NOTE PLEASE NOTE: Patients often contextualize their suffering in terms of their faith tradition while unconsciously struggling within a postmodern and neoliberal world.
7. www.embodiedforgiving.com 7 of 124 Φρόνημα Φρόνημα Phrónema Constantinou, E. (2020). Thinking Orthodox: Understanding and Acquiring the Orthodox Christian Mind. Ancient Faith Publishing.
8. www.embodiedforgiving.com 8 of 124 Two Unseen Social Dynamics The postmodern mind tacitly rejects tacitly rejects the belief in a single universal worldview of truth universal worldview of truth, which is neutral, objective, knowable, and binding on all. Brown, S. (2018). Breaking Open to God: Postmodernism and the Parables of the Historical Jesus. CreateSpace Independent Publishing Platform. – The postmodern mind rejects metanarratives rejects metanarratives as well as the institutions institutions that embody them. Neoliberalism aspires to be a totalizing force totalizing force in life and a dominant worldview dominant worldview. Kotsko, A. (2018). Neoliberalism’s Demons: On the Political Theology of Late Capital. Stanford University Press. – French sociologist Pierre Bourdieu, calls it: “A program for destroying collective structures destroying collective structures which may impede the pure market logic.” Purser, R. (2019). McMindfulness: How Mindfulness Became the New Capitalist Spirituality. Repeater Books.
9. www.embodiedforgiving.com 9 of 124 Why Discuss Well-Being? I have noticed a pattern of behavior in my practice. When the economy “sags” or when political rhetoric “heats up,” then patients exhibit the following. – They more frequently somaticize their complaints and they tend toward expressions of illness. – They are more concerned with “transgression,” “offense,” or “trespass” as the etiology of their complaints. – They exhibit many of the symptoms of what is described as “moral injury” (See Graham, 2017). -Psycho- -Psycho- Bio- Bio- -Social -Social
10. www.embodiedforgiving.com 10 of 124 Photo Credit 48148091 © Kevin Carden | Dreamstime.com The Proverbial Transgression Transgression Offense Offense Trespass Trespass Affront to Well-Being Affront to Well-Being Ego Depletion Ego Depletion
11. www.embodiedforgiving.com 11 of 124 Definitions Well-Being: the state of being happy, healthy, and prosperous. Wellness: the state of being in good health, especially as an actively pursued goal. Oxford Languages and Google—English | Oxford Languages. (n.d.). Retrieved July 29, 2021, from https://languages.oup.com/google-dictionary-en/ Interestingly, the term “well” derives from the Latin “volo, velle, volui” meaning “to wish, to want, to be willing” which speaks to “agency.” Skeat, W. (2007). Concise Dictionary of English Eytmology (1st ed.). Wordsworth Reference. AND Traupman, J. (2007). The New College Latin and English Disctionary: Revised and Updated. Bantam Books. – Ultimately, this speaks to free-will.
12. www.embodiedforgiving.com 12 of 124 Well-Being Well-Being Wellness & Health Morality Faith Ethics Politics & Community Family & Friends Education & Learning Money & Wealth Justice & Fairness Work & Rest Hausman, D. M. (2015). Valuing Health: Well-Being, Freedom, and Suffering (1st edition). Oxford University Press.
13. www.embodiedforgiving.com 13 of 124 Objective Well-Being In “Flourish: A Visionary New Understanding of Happiness and Well-Being,” Martin Seligman (2011) takes a positivist/objectivist/operational approach to well-being. • P: Positive Emotion • E: Engagement • R: Relationships • M: Motivation • A: Accomplishment
14. www.embodiedforgiving.com 14 of 124 Eudaimonia as Well-Being Aristotle (384-322 BCE) tells us that “eudaimonia” (alternately translated as the good, well-being, flourishing, or happiness) is the aim of human life aim of human life. – Eudaimonia is extensively discussed by Aristotle in his “Nicomachean Ethics” which sets the foundation for Western thinking on well-being well-being. – Living the good life according to Aristotle is about being virtuous and avoiding vices virtuous and avoiding vices. – Something that is good fulfills its purpose fulfills its purpose. • The purpose of a human being is rationality rationality.
15. www.embodiedforgiving.com 15 of 124 Dilemma Hedonism, the Utilitarianism of Bentham and Mill, and deontology including the “categorical imperative” of Kant are theories used to frame BOTH well-being and morality well-being and morality. – Bradley, B. (2015). Well-Being. Polity Press. – Fletcher, G. (2016). The Routledge Handbook of Philosophy of Well- Being. Routledge. – Kraut, R. (2007). What is Good and Why: The Ethics of Well-Being. Harvard University Press. – Solomon, R., & Martin, C. (2004). Morality and the Good Life: An Introduction to Ethics through Classical Sources (4th ed.). McGraw-Hill Higher Education. – Tiberius, V. (2015). Moral Psychology: Contemporary Introduction. Routledge.
16. www.embodiedforgiving.com 16 of 124 What … ? Morality as used here represents the prosocial behavior at a most basic level that binds humans into cooperative bands, communities, and societies which is inborn and/or learned implicitly. – It tends to be largely nonverbal behavior that follows implicit rules shared by others. – It appears to be more grounded in right-brain functions. Keenan, J., Gallup, G. G., & Falk, D. (2003). The Face in the Mirror: The Search for the Origins of Consciousness (1 edition). Ecco. – It engenders a sense of generosity, trust, dignity, safety, and justice (to list a few characteristics). – I'm not concerned with “ethics” per se.
17. www.embodiedforgiving.com 17 of 124 Highest Prudential Good In “Well-Being: Happiness is a Worthwhile Life,” Badhwar (2014) argues that a (moral) life lived with personally defined meaning, values, goals and virtuous means to achieve said goals defines well- being. Badhwar, N. (2014). Well-Being: Happiness is a Worthwhile Life. Oxford University Press. – To attain well-being requires one to pursue “worthwhile goals skillfully, honestly, with courage and integrity and without treating others as mere means to our goals.” Virtue and the Good Life: Introducing Well-Being: Happiness in a Worthwhile Life | Libertarianism.org. (2016, June 21). https://www.libertarianism.org/columns/virtue-good-life-introducing-well-being-happiness-worthwhile-life – We rob others and ourselves of a sense of well- being when we instrumentalize other human beings.
18. www.embodiedforgiving.com 18 of 124 Ill-Being According to Valerie Tiberius (2018, p. 34) in “Well- Being as Value Fulfillment: How We Can Help Each Other to Live Well,” ill-being, illness, or sickness occurs as a result of external and inner conflicts. Tiberius, V. (2018). Well-Being as Value Fulfillment: How We Can Help Each Other to Live Well. Oxford University Press. – “Your life goes badly to the degree that you live a life that has little value fulfillment. This can happen because you find no value in anything, because what you disvalue comes to pass, because your values are thwarted by external obstacles, or because your values are difficult to fulfill together over time.”
19. www.embodiedforgiving.com 19 of 124 Well- Being Emotion Morality 1 2 3 1. Life 2. Liberty 3. Happiness 4. Justice 4
20. www.embodiedforgiving.com 20 of 124 Well-Being and Justice In their book “Body Matters: A Phenomenology of Sickness, Disease, and Illness,” James and Kevin Aho (2008, p. 69) weave a tapestry of well-being whose fibers pull together the multiple facets of human health. Aho, J., & Aho, K. (2008). Body Matters: A Phenomenology of Sickness, Disease, and Illness (1st ed.). Lexington Books. – “Health suggests wholeness, which speaks to at- one-ment, the latter of which implies non- dividedness and harmony.” – “But harmony calls out the idea of balance and therefore of justice.”
21. www.embodiedforgiving.com 21 of 124 Neuroendocrine Well-Being In “Braintrust: What Neuroscience Tells Us About Morality,” Churchland (2018, p. 9) reviews the medical literature and concludes that there are two neuroendocrine mechanisms that underpin well- being and, consequently, a sense of morality. Churchland, P. (2018). Braintrust: What Neuroscience Tells Us About Morality. Princeton University Press. 1.Caring (rooted in attachment to kin and kith and care for their well-being) and 2.Recognition of others’ psychological states (rooted in the benefits of predicting the behavior of others)
22. www.embodiedforgiving.com 22 of 124 The Moral Molecule In “The Moral Molecule: The Source of Love and Prosperity,” American neuroeconomist Paul Zak (2012, p. 174) describes the Human Oxytocin Mediated Empathy (HOME) circuit in the vmPFC. Zak, P. (2012). The Moral Molecule: The Source of Love and Prosperity. Dutton. – “Given that the HOME system is constantly tuning itself to the environments in which we find ourselves, connection in one realm conditions us to cooperate in other realms, which ultimately can lead to a growth in prosperity, which then adds further to trust, which increases the willingness to behave generously and cooperatively.”
23. www.embodiedforgiving.com 23 of 124 The HOME Circuit Oxytocin Oxytocin (seek connection) (seek connection) Serotonin Serotonin (reduce anxiety) (reduce anxiety) Dopamine Dopamine (repeat for brain reward) (repeat for brain reward) Zak, P. (2012). The Moral Molecule: The Source of Love and Prosperity. Dutton, p. 64.
24. www.embodiedforgiving.com 24 of 124 vmPrefrontal Cortex In “The Political Brain,” Westin (2007, p. 61) identifies the vmPFC as an important site that integrates our sense of emotion and morality. Westen, D. (2007). The Political Brain: The Role of Emotion in Determining the Fate of the Nation. Perseus Books Group. – “The vmPFC is involved in emotional experience, social and emotional intelligence, and moral functioning. It also plays a crucial role in linking thought and emotion, particularly in using emotional reactions to guide decision making.” In “Conscience: The Origins of Moral Intuition,” Churchland (2019, p. 47) identifies this region as being replete with oxytocin receptors. Churchland, P. (2019). Conscience: The Origins of Moral Intuition. W. W. Norton & Company.
25. www.embodiedforgiving.com 25 of 124 Oxytocin Virtuous Cycle Oxytocin Oxytocin Morality Morality Trust Trust Empathy Empathy Zak, P. (2012). The Moral Molecule: The Source of Love and Prosperity. Dutton, p. 65. Justice
26. www.embodiedforgiving.com 26 of 124 Mirror Neurons In “Mirroring People: The Science of Empathy and How We Connect with Others,” Iacoboni (2009) links mirror neurons, empathy, and our moral compass in the junction between the PFC and the premotor cortex. Iacoboni, M. (2009). Mirroring People: The Science of Empathy and How We Connect with Others (First edition). Picador. – “When we see someone else suffering or in pain, mirror neurons help us to read her or his facial expression and actually make us feel the suffering or the pain of the other person. These moments, are the foundation of empathy and possibly of morality, a morality that is deeply rooted in our biology.”
27. www.embodiedforgiving.com 27 of 124 Jacob's Ladder (1990) with Timothy Robbins, Elizabeth Peña, and Danny Aiello Lyne, A. (1990). Jacob’s Ladder [Drama].
28. www.embodiedforgiving.com 28 of 124 “ “I don't understand you I don't understand you philosophers. You've got the philosophers. You've got the whole world figured out but you whole world figured out but you can't remember the can't remember the difference between right and left.” difference between right and left.” It's About Well-Being
29. www.embodiedforgiving.com 29 of 124 Is it About Well-Being? Physical ailments are framed in terms that use a moral framework. – They have lost access to the “good” in life; fulfilling relationships, love, connection, etc. – Their ailments prevent them from pursuing wealth, happiness, and family responsibilities. – They experience an infringement on their agency and an infraction of fairness that impact on their sense of wellness.
30. www.embodiedforgiving.com 30 of 124 Well-Being is about Morality In “Philosophy in the Flesh: The Embodied Mind and its Challenge to Western Thought,” Lakoff and Johnson (1999, p. 260) convincingly argue that morality derives from our concepts of human well-being. Lakoff, G., & Johnson, M. (1999). Philosophy in the Flesh: The Embodied Mind and its Challenge to Western Thought. Basic Books. – “All our moral ideals, such as justice, fairness, compassion, virtue, tolerance, freedom, and rights, stem from our fundamental human concern with what is best for us and how we ought to live.” – Virtually all of our abstract moral concepts are structured metaphorically.
31. www.embodiedforgiving.com 31 of 124 Adjustment or Adjustice? She talk about the boys? She talk about the boys? She says she can't get them new She says she can't get them new coats because you haven't sent the coats because you haven't sent the alimony for three months. alimony for three months. She said you were a son of a bitch She said you were a son of a bitch and she regrets the day she set and she regrets the day she set eyes on you. eyes on you.
32. www.embodiedforgiving.com 32 of 124 Paul Bloom: Breed in the BoneThe New York Times. (n.d.). Magazine - Can Babies Tell Right From Wrong? | The New York Times. Retrieved July 24, 2021, from https://www.youtube.com/watch?v=HBW5vdhr_PA Paul Bloom: Bred in the Bone
33. www.embodiedforgiving.com 33 of 124 Innate Justice Yale developmental psychologist Paul Bloom (2013, p. 8) discusses the innate sense of justice and moral code of infants (as young as 3 months old) in his book “Just Babies: The Origins of Good and Evil.” Bloom, P. (2013). Just Babies: The Origins of Good and Evil. New York: Random House LLC. – “What I am proposing is that certain moral foundations are not acquired through learning. They do not come from the mother’s knee, or from school or church; they are instead the products of biological evolution.”
34. www.embodiedforgiving.com 34 of 124 Moral Brain Network In “The Neurobiology of Moral Behavior,” Mendez (2009) locates our “moral brain circuitry” in the overlapping systems of mirror neurons, empathy, and theory of mind (ToM) in the right brain. Mendez, M. F. (2009). The Neurobiology of Moral Behavior: Review and Neuropsychiatric Implications. CNS Spectrums, 14(11), 608–620. – “This neurobiological evidence points to an automatic, emotionally-mediated moral network that is centered in the ventromedial prefrontal cortex (vmPFC), particularly in the right hemisphere.”
35. www.embodiedforgiving.com 35 of 124 de Waal, F. (2011). Moral Behavior in Animals. TEDxPeachtree. https://www.ted.com/talks/frans_de_waal_moral_behavior_in_animals Franz de Waal: Moral Behavior in Animals
36. www.embodiedforgiving.com 36 of 124 Right-Brain Morality In the “Master and His Emissary: The Divided Brain and the Making of the Western World,” McGilchrist (2019) concludes after an exhaustive review of the literature that moral judgment is predominantly a right-brain phenomenon. McGilchrist, I. (2019). The Master and His Emissary: The Divided Brain and the Making of the Western World (2nd, New Expanded edition ed.). Yale University Press. – “Moral judgment involves a complex right- hemisphere network, particularly the right ventromedial and orbitofrontal cortex, as well as the amygdala in both hemispheres.”
37. www.embodiedforgiving.com 37 of 124 Intuitive Morality “ “I think she still loves you.” I think she still loves you.”
38. www.embodiedforgiving.com 38 of 124 Emotion and Identity In “True to Our Feelings: What Our Emotions are Really Telling Us,” Solomon (2007) connects the dots between our sense of self, our emotional states, and our moral behavior. Solomon, R. (2007). True to Our Feelings: What Our Emotions are Really Telling Us. Oxford University Press. – “So the idea that ethics is an expression of emotion is clearly correct, but that is because the emotions already have a moral structure.” (p.207) – “And what we affirm and deny is not just the emotion. It is the emotion as a reflection of one’s self. It shows or betrays who one is.” (pp.218-219)
39. www.embodiedforgiving.com 39 of 124 I found one. He's alive. I found one. He's alive.
40. www.embodiedforgiving.com 40 of 124 Moral Injury In “ Moral injury: Violating Your Ethical Code Can Damage Mental Health – New Research,” Murphy, et. al. (2021) define “moral injury” as the psychological distress which results from actions, or the lack of them, which violate your moral or ethical code(s). Murphy, D., Greenberg, N., Stevelink, S., & Williamson, V. (n.d.). Moral injury: Violating your ethical code can damage mental health – new research. The Conversation. Retrieved May 22, 2021, from http://theconversation.com/moral-injury-violating-your-ethical-code-can- damage-mental-health-new-research-115654 – When we find ourselves out of phase, out of sync, or out of sorts with our values, virtues, or principles, then we are in danger of experiencing moral dissonance, moral discord, and moral injury.
41. www.embodiedforgiving.com 41 of 124 Micro-Moral Exchanges In “Moral Injury: Restoring Wounded Souls,” Larry Graham (2017, p. 78) encourages us to see moral injury in “the small nicks, cuts, and bruises arising from micro-moral exchanges within ourselves and between others: unkind thoughts, failure to listen and understand, gossip, and stinginess, to name a few.” Graham, L. (2017). Moral Injury: Restoring Wounded Souls. Abingdon Press.
42. www.embodiedforgiving.com 42 of 124 The Basic Questions Graham (2017, p. 87) reminds us that the two central moral concerns we have as humans: “Am I doing the right thing?” and “Am I a good person?” Graham, L. (2017). Moral Injury: Restoring Wounded Souls. Abingdon Press. – A common moral dilemma that I see is the moral conflict a mother experiences when see feels guilt or shame when wrestling between the responsibilities of family and work.
43. www.embodiedforgiving.com 43 of 124 “ “God almighty. God almighty. What did you do to me?” What did you do to me?” “ “I had to get in there. I had to get in there. A deep adjustment. A deep adjustment. Rest a moment and let it set a bit.” Rest a moment and let it set a bit.”
44. www.embodiedforgiving.com 44 of 124 Folk Theories of Emotion In “True to Our Feelings: What Our Emotions are Really Telling Us,” Solomon (2007, p. 120) grounds our study of emotions in the interactions between lay people and professionals. Solomon, R. (2007). True to Our Feelings: What Our Emotions are Really Telling Us. Oxford University Press. – “It is our business, as philosophers and scientists, to analyze and at times 'see through' folk psychology, ordinary language, and common sense, but we nevertheless have to start with folk theories of emotion as our home base.”
45. www.embodiedforgiving.com 45 of 124 Jacob's Ladder (1990) with Timothy Robbins, Elizabeth Peña, and Danny Aiello Lyne, A. (1990). Jacob’s Ladder [Drama].
46. www.embodiedforgiving.com 46 of 124 Right Brain Metaphor In “The Master and His Emissary: The Divided Brain and the Making of the Western World,” McGilchrist (2019) tells us that “how we think about our selves and our relationship to the world is already revealed in the metaphors we unconsciously choose to talk about it.” McGilchrist, I. (2019). The Master and His Emissary: The Divided Brain and the Making of the Western World (2nd, New Expanded edition ed.). Yale University Press. – “The left hemisphere relies on the literal aspects of language to make meaning explicit; by contrast, metaphor and narrative are often required to convey the implicit meanings available to the right hemisphere.”
47. www.embodiedforgiving.com 47 of 124 Disenchant “ “Call my chiropractor … Call my chiropractor … Luis DiNardo.” Luis DiNardo.”
48. www.embodiedforgiving.com 48 of 124 Distorted Desire In “Economy of Desire: Christianity and Capitalism in a Postmodern World,” theologian Daniel Bell (2012, p. 19) argues that late-modern capitalism has hijacked, bent, distorted, and deformed the original target of human desire. Bell, D. (2012). Economy of Desire: Christianity And Capitalism In A Postmodern World. Baker Academic. – “[Church] life is part of a divine economy of desire— one that redeems desire from the postmodern capitalist economy that would distort desire in ways that hinder humanity’s communion with God, one another, and the rest of creation.”
49. www.embodiedforgiving.com 49 of 124 Fragment
50. www.embodiedforgiving.com 50 of 124 Dehumanize In “Body Matters: A Phenomenology of Sickness, Disease, and Illness,” James and Kevin Aho (2008) make two important distinctions in our human experience. Aho, J., & Aho, K. (2008). Body Matters: A Phenomenology of Sickness, Disease, and Illness (1st ed.). Lexington Books. – “Körper is a reference to the corporeal body, what we are as physiological, neurological, and skeletal beings.” – “Leib concerns how we experience this physical matter in our everyday lives.”
51. www.embodiedforgiving.com 51 of 124 Depersonalize
52. www.embodiedforgiving.com 52 of 124 Desacramentalize In “Theological Ethics in a Neoliberal Age: Confronting the Christian Problem with Wealth,” theologian Kevin Hargaden (2018, p. 11) laments the subjugation of everything including Christian ethics to market forces. Hargaden, K. (2018). Theological Ethics in a Neoliberal Age: Confronting the Chrsitian Problem with Wealth. Cascade Books. – “While the older liberalism was concerned with organizing governance to shape a public square that granted maximum liberty for trade and exchange, the neoliberalism that Foucault considered seeks to organize governance so as to shape the private citizen for maximum productivity.”
53. www.embodiedforgiving.com 53 of 124 Disenfranchise
54. www.embodiedforgiving.com 54 of 124 Devalue In “Undoing the Demos: Neoliberalism’s Stealth Revolution,” Wendy Brown (2015, p. 22) lays bare from whence we derive our sense of self-worth and value in the present day. Brown, W. (2015). Undoing the Demos: Neoliberalism’s Stealth Revolution. Zone Books. – “[B]oth persons and states are expected to comport themselves in ways that maximize their capital value … through entrepeneurialism, self- investment, and/or attracting investors.” – “[A]ny individual who veers into other pursuits risks impoverishment and a loss of esteem and creditworthiness at the least, survival at the extreme.”
55. www.embodiedforgiving.com 55 of 124 Desensitize
56. www.embodiedforgiving.com 56 of 124 Disempower In “Sacred Economics,” Eisenstein (2021, p. 28) argues that our default sense of worth and value derives from our ability to contribute to the GDP, service debt, and generate wealth. Eisenstein, C. (2021). Sacred Economics: Money, Gift & Society in the Age of Transition. North Atlantic Books. – “[B]ehind the man with the ledger is always a man with a gun. Debt relations have always been power relations, and money has always been, and remains today, entwined with debt and therefore with violence.”
57. www.embodiedforgiving.com 57 of 124 Dissociate
58. www.embodiedforgiving.com 58 of 124 Demoralize In “The Tyranny of Merit: What's Become of the Common Good?” Sandel (2020, p. 216) relates how late-modern economic forces demoralize us with unrealistic demands and unfulfilled promises. Sandel, M. (2020). The Tyranny of Merit: What’s Become of the Common Good? Farrar, Straus and Giroux. – “But the financialization of the economy may be more corrosive of the dignity of work dignity of work, and more demoralizing demoralizing. This is because it offers perhaps the clearest example in a modern economy of the gap between what the market rewards market rewards and what actually contributes to the common good common good.”
59. www.embodiedforgiving.com 59 of 124 Interview for Sunday Times | Margaret Thatcher Foundation. (n.d.). Retrieved May 22, 2021, from https://www.margaretthatcher.org/document/104475
60. www.embodiedforgiving.com 60 of 124 Debeo Ergo Sum In “Psychopolitics: Neoliberalism and the New Psychopolitics: Neoliberalism and the New Technologies of Power Technologies of Power,” Han (2017, p. 6) outlines how our implicit allegiance and tacit obedience to the totalizing forces of the market leads to “auto- exploitation.” Han, B.-C. (2017). Psychopolitics: Neoliberalism and the New Technologies of Power. Verso. – “The neoliberal regime transforms allo-exploitation into auto-exploitation; this process affects all ‘classes’. Such classless self-exploitation – which was something utterly unknown to Marx – renders impossible any social revolution based on the difference between the exploiters, on the one hand, and the exploited, on the other.”
61. www.embodiedforgiving.com 61 of 124 Terror
62. www.embodiedforgiving.com 62 of 124 Frailty In “The Theology of Illness,” by Jean-Claude Larchet (2002, p. 59) we come to understand the deep religious ramifications about illness that patients may privately hold. Larchet, J.-C. (2002). The Theology of Illness. St. Vladimir’s Seminary Press. – “In the corruption and suffering of the body, one experiences the weakness of one's earthly being, the ephemeral character of one's existence in this world, and, generally speaking, one's fragility, inadequacy, contingency and personal limits.”
63. www.embodiedforgiving.com 63 of 124 Deform
64. www.embodiedforgiving.com 64 of 124 Somaticize In “Moral Injury and Beyond,” Papadopoulos (2020, pp. 4-5) explains that we misattribute stress and trauma to physical symptoms and bodily complaints. Papadopoulos, R. (2020). Traumatizing Discourse of Trauma and Moral Injury. In Moral Injury and Beyond. Routledge. – “Physical pain is more easily graspable whereas 'existential pain' is least comprehensible and thus less tolerable.” – “We somaticize because we experience some incomprehensible and inarticulate puzzling states of bewilderment, anguish, and disorientation.”
65. www.embodiedforgiving.com 65 of 124 Physical Pain Preferred A recent FDA/DEA ruling disallowed disallowed combining benzodiazepines for anxiety with a narcotic for pain. According to Jankelow (2021 personal communication) patients were forced to choose forced to choose one course of medications or the other. – “When it came time to choose, at least 90% of my patients chose to remain on their anxiety chose to remain on their anxiety medication medication and to give up their physical pain medication.” – “They all stated that to live with the anxiety or mental pain is far worse than the physical pain.”
66. www.embodiedforgiving.com 66 of 124 Thanatology Allusion to the Trinity Allusion to the Trinity
67. www.embodiedforgiving.com 67 of 124 Mechanize In “The Divided Mind: The Epidemic of Mindbody Disorders,” Sarno (1998, p. 11) links repressed emotional states with autonomically induced ischemia. Sarno, J. (2006). The Divided Mind: The Epidemic of Mindbody Disorders. HarperCollins E-Pub. – “[T]he brain orders a reduction of blood flow to a specific part of the body, resulting in mild oxygen deprivation, which causes pain and other symptoms, depending on what tissues have been oxygen deprived.”
68. www.embodiedforgiving.com 68 of 124 Atomize
69. www.embodiedforgiving.com 69 of 124 Objectify In “Emotions, Morbidity, and Mortality: New Perspectives from Psychoneuroimmunology,” Kiecolt-Glaser, et. al. (2002) show that negative emotions can intensify a variety of health threats. Kiecolt-Glaser, J. K., McGuire, L., Robles, T. F., & Glaser, R. (2002). Emotions, Morbidity, and Mortality: New Perspectives from Psychoneuroimmunology. Annual Review of Psychology, 53(1), 83–107. https://doi.org/10.1146/annurev.psych.53.100901.135217 – “The biological response to stress includes the release into the bloodstream various hormonal and chemical mediators including the steroid hormone cortisol and immunologically active substances called pro-inflammatory cytokines (PIC).”
70. www.embodiedforgiving.com 70 of 124 Restrain
71. www.embodiedforgiving.com 71 of 124 Repress In “Managing Stress: Emotion and Power at Work,” Newton (1995, p. 19) sheds an unpopular light on the disempowering effects of the workplace and the demand for becoming “stress fit.” Newton, T. (n.d.). Managing Stress: Emotion and Power at Work. SAGE Publications. – “The subject created within stress discourse appears as that of a person whose stress is chiefly a function of their own self … their outmoded physiology or their psychological environment.”
72. www.embodiedforgiving.com 72 of 124 Blind Injustice
73. www.embodiedforgiving.com 73 of 124 Moral Wounding Writing in “Moral Injury and Beyond,” Alexander (2020, p. 145) summarizes the sense of disempowerment experienced through moral wounds. Alexander, W. (2020). From Theory to Impact. In Moral Injury and Beyond. Routledge. – “[O]nce conscience is fragmented, and moral intuition is deactivated, the resulting condition features extreme mistrust of oneself and others, diminished bodily sensations, and on rare occasions, even develops a sense that the good in oneself has died and has been replaced by evil.”
74. www.embodiedforgiving.com 74 of 124
75. www.embodiedforgiving.com 75 of 124 Jacob's Ladder (1990) with Timothy Robbins, Elizabeth Peña, and Danny Aiello Lyne, A. (1990). Jacob’s Ladder [Drama].
76. www.embodiedforgiving.com 76 of 124 Heal Moral Injury In “Well-Being as Value Fulfillment: How We Can Help Each Other to Live Well,” Tiberius (2018, p. 34) suggests that finding one's moral bearings through a deep evaluation of one's values can restore a sense of well-being and wholeness. Tiberius, V. (2018). Well-Being as Value Fulfillment: How We Can Help Each Other to Live Well. Oxford University Press. – “According to the value fulfillment theory, our lives go well to the extent that we pursue, and fulfill or realize, our appropriate values. In short, we live well when we succeed in terms of what matters to us emotionally, reflectively, and over the long term.”
77. www.embodiedforgiving.com 77 of 124 Moralize “ “This is barbaric!” This is barbaric!”
78. www.embodiedforgiving.com 78 of 124 Moralizing/Mind Wandering In “On Mind Wandering, Attention, Brain Networks, and Meditation,” Sood, et. al. (2013) describe the role of the DMN in mind wandering. Sood, A., & Jones, D. T. (2013). On mind wandering, attention, brain networks, and meditation. Explore (New York, N.Y.), 9(3), 136–141. https://doi.org/10.1016/j.explore.2013.02.005 – “The physical threats of ancient times have largely been replaced by chronic psychological worries and hurts.” – “The mind gets drawn to these worries and hurts, mostly in the domain of the past and future, leading to mind wandering.” – Mind wandering is prominent in disorders such as depression.
79. www.embodiedforgiving.com 79 of 124 https://n.neurology.org/content/neurology/81/23/e172.full.pdf Default Mode Network
80. www.embodiedforgiving.com 80 of 124 Dispel Chaos “ “Why don't you just burn him at the Why don't you just burn him at the stake and put him out of his misery!” stake and put him out of his misery!”
81. www.embodiedforgiving.com 81 of 124 Confession In “The Experience of Secrecy,” Slepian (2017) warns us that our minds naturally drift to shameful secrets that we harbour about ourselves.. Slepian, M. L., Chun, J. S., & Mason, M. F. (2017). The experience of secrecy. Journal of Personality and Social Psychology, 113(1), 1–33. https://doi.org/10.1037/pspa0000085 – “The mind is prone to wander toward unfulfilled goals, outstanding intentions, unsolved problems, and unresolved personal concerns or conflicts.” – “People mind-wander to secrets more frequently than they conceal them.” – “It reminds people that they are being inauthentic.” – The authors conclude that secrecy harms well- being through mind wandering to guarded secret(s).
82. www.embodiedforgiving.com 82 of 124 Restore Perspective
83. www.embodiedforgiving.com 83 of 124 Narrative Connection In “Narrative Medicine,” by Rita Charon (2006, p. 21) we come to understand that “sickness” is a sociological term that relates to the roles we play as diseased or ill persons. Charon, R. (2006). Narrative Medicine. Oxford University Press. – “For the sick patient to accept the care of well strangers, those strangers have to form a link, a passage between the sick and the healthy who tender care.” – We can begin by simply acknowledging the human being who is in front of us by hearing what ails them. Not what hurts, but why it hurts and from whence the pain and suffering come.
84. www.embodiedforgiving.com 84 of 124 Restoring Balance
85. www.embodiedforgiving.com 85 of 124 Adjustment Chiropractic is a moral act that helps to relieve some of their psychic burdens. It brings them into physical, emotional, and moral alignment. It helps to restore well-being and establish a feeling of “goodness” in the Aristotelian sense. – In “The Oxytocin Factor: Tapping the Hormone of Calm, Love, and Healing,” Moberg (2003) notes that we “humans must begin to think of our health and well-being as our inner ecology” by going beyond the “high-tech care most often offered today.” Moberg, K. (2003). The Oxytocin Factor: Tapping the Hormone of Calm, Love, and Healing. Da Capo Press.
86. www.embodiedforgiving.com 86 of 124 Addressing Deep Issues “ “Am I dying, Luis?” Am I dying, Luis?” “ “From a slipped disc? That'd be a first.” From a slipped disc? That'd be a first.” “ “I was in hell. I don't wanna die, Luis.” I was in hell. I don't wanna die, Luis.”
87. www.embodiedforgiving.com 87 of 124 Catharsis In “Opening Up by Writing It Down: How Expressive Writing Improves Health and Eases Emotional Pain,” Pennebaker (2016, p.159) found that when we write about our secrets, traumas, and negative feelings we can restore ourselves to health and well-being. Pennebaker, J., & Smyth, J. (2016). Opening Up by Writing It Down: How Expressive Writing Improves Health and Eases Emotional Pain. The Guilford Press. – “Writing probably worked because it stopped people from exerting the effort of active inhibition.”
88. www.embodiedforgiving.com 88 of 124 Expressive Writing According to Pennebaker's research (2016, p. 158) the minimum requirement for expressive writing is the following. Pennebaker, J., & Smyth, J. (2016). Opening Up by Writing It Down: How Expressive Writing Improves Health and Eases Emotional Pain. The Guilford Press. 1.People have to write about major life traumas 2.People have to write about painful or shameful secrets that they keep hidden from others 3.People have to write at least 15 minutes a day for a minimum of three to four days
89. www.embodiedforgiving.com 89 of 124 Use Powerful Metaphors “ “Straighten out Straighten out your head.” your head.”
90. www.embodiedforgiving.com 90 of 124 Metaphor in Practice In “Metaphor in Practice: Professional’s Guide to Using the Science of Language in Psychotherapy,” Torneke (2017, p.69) examines the use of metaphor in clinical practice as a tool for transformation as we state one “thing” in terms of another. Torneke, N. (2017). Metaphor in Practice: Professional’s Guide to Using the Science of Language in Psychotherapy. Context Press. – “Metaphor use is a highly potent instrument for influencing human behavior.”
91. www.embodiedforgiving.com 91 of 124 “ “You ever read You ever read Meister Eckhart?” Meister Eckhart?” Deeper Participation
92. www.embodiedforgiving.com 92 of 124 Martha Nussbaum In “Not for Profit: Why Democracy Needs the Humanities,” Nussbaum (2010, p.102) argues that studying the humanities develops empathy and allows us “to see another human being as spacious and deep, having thoughts, spiritual longings, and emotions.” Nussbaum, M. (2010). Not for Profit: Why Democracy Needs the Humanities. Princeton University Press. – “It is an achievement to see a soul in that body, and this achievement is supported by poetry and the arts, which ask us to wonder about the inner world of that shape we see—and, too, to wonder about ourselves and our own depths.”
93. www.embodiedforgiving.com 93 of 124 “ “How did you How did you ever get your doctorate ever get your doctorate without reading Eckhart without reading Eckhart? ?” ” Explore Literature
94. www.embodiedforgiving.com 94 of 124 High-Quality Exposure In “The Moral Molecule,” Zak (2012 pp. 202-3) describes that “when it comes to increasing empathy, there’s a tradition that goes back a couple of thousand years that has been pretty successful in humanizing people.” Zak, P. (2012). The Moral Molecule: The Source of Love and Prosperity. Dutton. – “It’s called high-quality exposure to the humanities —literature, foreign languages, philosophy, history, music, and art—all the stuff (now sometimes derided as “useless”) that was once the common currency of any educated person.”
95. www.embodiedforgiving.com 95 of 124 The Metaphor You know what You know what he (Eckhart) said? he (Eckhart) said?
96. www.embodiedforgiving.com 96 of 124 “The only thing that burns in Hell is the part of you that won't let go of your life; your memories, your attachments. They burn 'em all away. But they're not punishing you, he said. They're freeing your soul.” Rubin, B. J. (1990). Jacob’s Ladder. Applause Theater Book Publishers. ssssnAP! “So the way he sees it, if you're frightened of dying and holding on, you'll see devils tearing your life away. But if you've made your peace then the devils are really angels freeing you from the earth. It's just a matter of how you look at it, that's all. So don't worry, okay?”
97. www.embodiedforgiving.com 97 of 124 Disease, Illness, Sickness In “The Wounded Storyteller: Body, Illness, and Ethics,” the sociologist Arthur Frank (2013) makes important distinctions between disease, illness, and sickness that serve the clinician well. Frank, A. W. (2013). The Wounded Storyteller: Body, Illness, and Ethics, Second Edition (Second edition). University of Chicago Press. – “[I]llness is a loss of the 'destination and map' that had previously guided the ill person's life: ill people have to learn 'to think differently.'”
98. www.embodiedforgiving.com 98 of 124 Search for Meaning In “Man's Search for Meaning,” Frankl (1959, p. 70) details life in a Nazi concentration camp where one's existence became provisional and devoid of meaning. Frankl, V. (1959). Man’s Search for Meaning. Beacon Press. – “A man who could not see the end of his 'provisional existence' was not able to aim at an ultimate goal in life. He ceased living for the future, in contrast to a man in normal life. Therefore the whole structure of his inner life changed.” – Frankl describes how loss of meaning often leads to moral deformity, bitterness, disillusionment and death.
99. www.embodiedforgiving.com 99 of 124 Making Meaning “I listened as my mother talked to God, begging begging crying, and asking crying, and asking Him to help us as He had always helped before. She asked Him to work work miracles and reminded miracles and reminded Him of Exodus. She sat motionless only her eyes and lips expressed eyes and lips expressed feeling feeling. Then she looked at me and thanked God because at least we were together. “I am Still Here: My Mother's Voice” Clara Knopfler (2007, p. 96)
100. www.embodiedforgiving.com 100 of 124 Uncle, What Ails Thee? Uncle, What Ails Thee? Wolfran von Eschenbach Wolfran von Eschenbach Parzival Book XVI Parzival Book XVI
101. www.embodiedforgiving.com 101 of 124 “Silent Migraine” On the fifth anniversary of the loss of her husband, a patient presented wanting an adjustment for her “silent migraine.” –So I asked her ...
102. www.embodiedforgiving.com 102 of 124 Kurzel, J. (2015). Macbeth [Drama]. Amazon Prime Video. Macbeth (2015) with Marion Cotillard
103. www.embodiedforgiving.com 103 of 124 Self-Punishment In “Moral Injury and Beyond: Understanding Human Anguish and Healing Traumatic Wounds,” Madera (2020, p. 106) describes the “Contrappasso” or counterpoise as employed by Dante in the Divine Comedy and Aquinas in the Summa Theologica as the basis for our self-imposed suffering or punishment for deeds we have done. Madera, R. (2020). The Psychic Counterpoise to Violence Toward the Human Other. In Moral Injury and Beyond: Understanding Human Anguish and Healing Traumatic Wounds. Routledge. – “[Accordingly], this type of punishment involves the sinner receiving punishment that relates directly to, and in a sense mirrors and reflects, the sin committed.”
104. www.embodiedforgiving.com 104 of 124 The thane of Fife had a wife: The thane of Fife had a wife: where is she now? where is she now? What, will these hands What, will these hands ne'er be clean? ne'er be clean?
105. www.embodiedforgiving.com 105 of 124 Beset and Besieged In “Capitalism and the Death Drive,” Han (2021, p. 44- 45) observes that the “imperative of authenticity creates a narcissistic compulsion to focus on the self, to constantly self-question, to listen to oneself, to lay siege to oneself, and – not least – to accuse oneself.” Han, B.-C. (2021). Capitalism and the Death Drive. Poliy Press. – “Ultimately, authenticity is a neoliberal strategy of production. The ego is permanently forced to produce itself as an entrepreneur of the self. Whoever fails in this picks up the razor blade.”
106. www.embodiedforgiving.com 106 of 124 Wash your hands, Wash your hands, put on your nightgown; put on your nightgown; look not so pale. look not so pale.
107. www.embodiedforgiving.com 107 of 124 Hand Washing In “Washing Away Your Sins in the Brain,” Tang, et. al. (2017) show how distinct brain state changes correlate with hand washing and reduction of negative social emotions. Tang, H., Lu, X., Su, R., Liang, Z., Mai, X., & Liu, C. (2017). Washing away your sins in the brain: Physical cleaning and priming of cleaning recruit different brain networks after moral threat. Social Cognitive and Affective Neuroscience, 12(7), 1149–1158. https://doi.org/10.1093/scan/nsx036 – “Physical cleaning reduced the spontaneous brain activities in the right insula and mPFC regions right insula and mPFC regions that are involved in embodied moral emotion processing.”
108. www.embodiedforgiving.com 108 of 124 Let Them Wash Their Hands I often offer hand washing solution hand washing solution to those who are troubled on a psycho-spiritual level. – These are individuals who demonstrate in word or in nonverbal cues a sense of grief, loss, or sadness grief, loss, or sadness. – Recognize that loss or grief may result in a sense of shame, embarrassment, inadequacy, or guilt over a matter they want to remain hidden they want to remain hidden.
109. www.embodiedforgiving.com 109 of 124 Sadness Sadness https://www.paulekman.com/
110. www.embodiedforgiving.com 110 of 124 Watch the Face I watched closely people's facial expressions during the clinical encounter and offered hand washing to people who expressed “disgust” and “contempt” while describing the etiology of their while describing the etiology of their chief complaints chief complaints. – Disgust • Expressed a sense of relief and pleasure sense of relief and pleasure upon washing hands – Contempt • Rejected offer or accepted offer with reluctance or reluctance or suspicion suspicion
111. www.embodiedforgiving.com 111 of 124 Disgust Disgust https://www.paulekman.com/
112. www.embodiedforgiving.com 112 of 124 Moral Disgust In “Behave: The Biology of Humans at Our Best and Worst,” Sapolsky (2017, p. 41) traces the protective function of the insular cortex to detect rancid food to the social signaling of offensive events and ideas. Sapolsky, R. (2017). Behave: The Biology of Humans at Our Best and Worst. Penguin Books. – “Remarkably, humans also activate it by thinking about something morally disgusting— social norm violations or individuals who are typically stigmatized in society.” – Disgust represents a ”distaste” for something.
113. www.embodiedforgiving.com 113 of 124 Contempt Contempt https://www.paulekman.com/
114. www.embodiedforgiving.com 114 of 124 Vicarious Hand Washing In “ Washing the Guilt Away: Effects of Personal versus Vicarious Cleansing on Guilty Feelings and Prosocial Behavior,” Xu, et. al. (2014) write: Xu, H., Bègue, L., & Bushman, B. J. (2014). Washing the guilt away: Effects of personal versus vicarious cleansing on guilty feelings and prosocial behavior. Frontiers in Human Neuroscience, 8, 97. https://doi.org/10.3389/fnhum.2014.00097 – “[W]hile watching another person wash his or her hands, the brain simulates the comparable sensory and motor experience so that it induces vicarious feelings of 'cleanliness' and primes the concepts of 'cleanliness' and 'purity.'” – “Unfortunately, washing one’s hands of guilt can also reduce prosocial behavior.”
115. www.embodiedforgiving.com 115 of 124 To bed, to bed! there's knocking at the gate: To bed, to bed! there's knocking at the gate: come, come, come, come, give me your hand. come, come, come, come, give me your hand. What's done cannot be undone.—To bed, to bed, What's done cannot be undone.—To bed, to bed, to bed! to bed!
116. www.embodiedforgiving.com 116 of 124 Ego Depletion Baumeister (2002) advanced the hypothesis of ego depletion as an energy-well with limitations Baumeister, R. F. (2002). Ego Depletion and Self-Control Failure: An Energy Model of the Self’s Executive Function. Self and Identity, 129–136. – If self-control operates like energy, then the first act of self-control will consume some quantity of this resource, and so the person will face the second task with a diminished capacity to engage in self- control.
117. www.embodiedforgiving.com 117 of 124 Personal Accountability In “McMindfulness: How Mindfulness Became the McMindfulness: How Mindfulness Became the New Capitalist Spirituality New Capitalist Spirituality,” Purser (2019, p. 198) writes, “Neoliberal logic requires self-promoting and self-disciplined subjects in charge of their own well-being and success.” Purser, R. (2019). McMindfulness: How Mindfulness Became the New Capitalist Spirituality. Repeater Books. – “From a neoliberal perspective, society doesn’t exist — everything comes down to individual choices and responsibilities.” – This worldview delegitimizes “social dynamics” as a factor in generating disease, illness, and sickness.
118. www.embodiedforgiving.com 118 of 124 Interview for Woman’s Own (“no such thing as society”) | Margaret Thatcher Foundation. (n.d.). Retrieved November 10, 2021, from https://www.margaretthatcher.org/document/106689
119. www.embodiedforgiving.com 119 of 124 Sobering Consideration In “Caring for Souls in a Neoliberal Age,” Bruce Rogers-Vaughn (2015) throws a rock through the proverbial window when he writes: Rogers-Vaughn, B. (2015). Caring for Souls in a Neoliberal Age. Palgrave-McMIllan. – “If pastoral theology is about learning from and responding to human suffering, and if neoliberalism is now a hegemony that is governing and transforming suffering globally, then a revision of our discipline is in order.” – What about us? What about chiropractic? What about the TIC and the TOR?
120. www.embodiedforgiving.com 120 of 124 Cosmology In “The Reinvention of Work The Reinvention of Work,” Matthew Fox (1994) argues that our life and work needs to free itself from the machinations of industrialized society that damages and demoralizes human beings. He asks us to call forth a new cosmology or new order for our work. Fox, M. (1994). The Reinvention of Work: A New Vision of Livelihood for Our Time. HarperOne. – “Humans cut off from cosmology lack the energy and imagination to reinvent work.”
121. www.embodiedforgiving.com 121 of 124 What is the Chiropractic Role? In a sense the chiropractor is a moralizing agent in the life his/her patients. – We set things straight and make them right again on both a physical as well as an existential scale. – We can create opportunities for patients to confide in us and unburden themselves of painful social pressures. – And in so doing, we can reestablish a sense of justice, wholeness, and well-being in their lives.
122. www.embodiedforgiving.com 122 of 124 In Summary In “The Routledge Handbook of Philosophy of Well-Being,” Badhwar (2016, p. 315) summarizes what a sense of well-being might be. Fletcher, G. (2016). The Routledge Handbook of Philosophy of Well-Being. Routledge. – “Well-being is, in part, a disposition to see life as a blessing, not a burden, to welcome each new day, not dread it, and happiness in the sense of long- term emotional fulfillment is at the core of such a disposition.”
123. www.embodiedforgiving.com 123 of 124 Further Reading ✔ Dasic, D. (2021). A Just Society: The World after Neoliberalism (C. Leonard, Ed.; I. Krivokuca, Trans.). BGD Solutions LLC. ✔ Dondi, M. (2021). Outgrowing Capitalism: Rethinking Money to Reshape Society and Pursue Purpose. Fast Company Press. ✔ Jackson, T. (2021). Post Growth: Life after Capitalism (1st edition). Polity. ✔ McCarraher, E. (2019). The Enchantments of Mammon: How Capitalism Became the Religion of Modernity. Belknap Press of Harvard University Press.
124. www.embodiedforgiving.com 124 of 124 Photo Credit: Christy Lee Rogers Thank You! Thank You!