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Addressing Well-Being in Clinical Practice

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.

Andrew S. Bonci

February 19, 2022
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  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

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    (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.

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    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/

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    BioPsychoSocial Model
    BioPsychoSocial Model
    “The totalization of production desecrates life.”
    Byung-Chul Han (2020, p. 50)
    “The Disappearance of Rituals”

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    -Psycho-
    -Psycho-
    Bio-
    Bio-
    -Social
    -Social

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    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.

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    Φρόνημα
    Φρόνημα
    Phrónema
    Constantinou, E. (2020). Thinking Orthodox: Understanding and Acquiring the Orthodox Christian Mind. Ancient Faith Publishing.

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    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.

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    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

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    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

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    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.

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    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.

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    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

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    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.

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    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.

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    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.

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    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.

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    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.”

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    Well-
    Being
    Emotion Morality
    1
    2
    3
    1. Life
    2. Liberty
    3. Happiness
    4. Justice
    4

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    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.”

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    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)

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    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.”

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    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.

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    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.

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    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

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    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.”

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    Jacob's Ladder (1990)
    with Timothy Robbins, Elizabeth Peña, and Danny Aiello
    Lyne, A. (1990). Jacob’s Ladder [Drama].

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    “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

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    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.

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    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.

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    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.

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    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

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    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.”

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    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.”

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    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

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    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.”

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    Intuitive Morality

    “I think she still loves you.”
    I think she still loves you.”

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    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)

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    I found one. He's alive.
    I found one. He's alive.

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    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.

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    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.

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    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.

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    “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.”

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    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.”

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    Jacob's Ladder (1990)
    with Timothy Robbins, Elizabeth Peña, and Danny Aiello
    Lyne, A. (1990). Jacob’s Ladder [Drama].

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    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.”

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    Disenchant

    “Call my chiropractor …
    Call my chiropractor …
    Luis DiNardo.”
    Luis DiNardo.”

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    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.”

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    Fragment

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    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.”

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    Depersonalize

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    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.”

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    Disenfranchise

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  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.”

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    Desensitize

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  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.”

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    Dissociate

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    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.”

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    Interview for Sunday Times | Margaret Thatcher Foundation. (n.d.). Retrieved May 22, 2021, from https://www.margaretthatcher.org/document/104475

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  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.”

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    Terror

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  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.”

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    Deform

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    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.”

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  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.”

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    Thanatology
    Allusion to the Trinity
    Allusion to the Trinity

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  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.”

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    Atomize

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    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).”

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    Restrain

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    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.”

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    Blind Injustice

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  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.”

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  74. www.embodiedforgiving.com 74 of 124

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  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].

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  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.”

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    Moralize

    “This is barbaric!”
    This is barbaric!”

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    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.

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  79. www.embodiedforgiving.com 79 of 124
    https://n.neurology.org/content/neurology/81/23/e172.full.pdf
    Default Mode Network

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    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!”

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  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).

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    Restore Perspective

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  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.

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    Restoring Balance

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    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.

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    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.”

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    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.”

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  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

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    Use Powerful Metaphors

    “Straighten out
    Straighten out
    your head.”
    your head.”

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  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.”

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    “You ever read
    You ever read
    Meister Eckhart?”
    Meister Eckhart?”
    Deeper Participation

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  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.”

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  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

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    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.”

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    The Metaphor
    You know what
    You know what
    he (Eckhart) said?
    he (Eckhart) said?

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    “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?”

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    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.'”

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  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.

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    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)

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  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

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    “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 ...

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  102. www.embodiedforgiving.com 102 of 124
    Kurzel, J. (2015). Macbeth [Drama]. Amazon Prime Video.
    Macbeth (2015) with Marion Cotillard

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  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.”

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    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?

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  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.”

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  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.

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  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.”

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  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.

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  109. www.embodiedforgiving.com 109 of 124
    Sadness
    Sadness
    https://www.paulekman.com/

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  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

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  111. www.embodiedforgiving.com 111 of 124
    Disgust
    Disgust
    https://www.paulekman.com/

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  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.

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    Contempt
    Contempt
    https://www.paulekman.com/

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    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.”

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    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!

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    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.

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    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.

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    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

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    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?

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    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.”

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    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.

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    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.”

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    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.

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    Photo Credit: Christy Lee Rogers
    Thank You!
    Thank You!

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