Wednesday, May 15, 2013

Mindfulness: Mending Minds vs Spiritual Practice

I had a coin-toss moment recently -- one of those instants when the coin is in the air and you suddenly realize which side you're on.

It wasn't so much a decision as a clarification of my true leanings on mindfulness as spiritual practice vs medically-proven therapy.  I would really like to  hold  Mindfulness in equipoise--simultaneously considering it as a scientific / medical practice AND an ancient spiritual discipline. But, in all honesty, I find my equipoise developing some cracks.

The Masters of Mindfulness™ would say you don't have to make a choice-- it is, indeed, an age-old spiritual practice, but now being studied--and its benefits confirmed--by scientific evidence. At least in the UK, Mindfulness teachers always hasten to say that Mindfulness is a secular practice and you don't have to be a Buddhist or change your religious beliefs to benefit from it.

But the link to Buddhism remains -- and prominently, even proudly so. A recent scientific review for example, defines Mindfulness in light of the connection:
"Mindfulness derives from Buddhist practice and is described in the psychological literature as an intentional and non-judgemental awareness of the present moment (Kabat-Zinn, 1990). Mindfulness is utilized in secularized interventions such as Mindfulness-Based Stress Reduction..." 

The Buddhist Backdrop

Evidence abounds of the pervasive Buddhist /Eastern / New Agey associations and influences in Mindfulness. For example, many teachers of Mindfulness in this area share office space with purveyors of unproven, semi-proven, or disproven holistic/ mind-body treatments such as crystal therapy, hydrotherapy, aroma therapy, massage, chiropractic, yoga, homeopathy, accupuncture, Qi Gong, reiki, Indian head massage, Hopi ear candling, reflexology, etc.  Association with yoga practices is especially prevalent.

My friend Tudor, who is a Naval chaplain training to be a Mindfulness teacher, has found that most Mindfulness retreats are held at New Age or Buddhist retreat centers. Another hint of the link: Meditation periods during Mindfulness classes will usually start with the ringing of a  ghanta (Buddhist temple bell) or  singing bowl --drawing on a ritual used for starting silent meditation in Tibetan Buddhist practice.

One type of Mindfulness meditation practice involves gentle yoga moves. While many Westerners today understand and practice yoga as a largely secular form of stretching for relaxation and fitness,  its origins lie in Eastern religions. Wikipedia says:
Yoga (Sanskrit: योग) is a commonly known generic term for the physical, mental, and spiritual practices or disciplines which originated in ancient India with a view to attain a state of permanent peace... Specifically, yoga is one of the six āstika ("orthodox") schools of Hindu philosophy. ... Yoga has also been popularly defined as "union with the divine" in other contexts and traditions... Various traditions of yoga are found in Buddhism, Hinduism, Jainism and Sikhism..
Tudor sees the links between Mindfulness and Buddhism as "inevitable, given that [Jon Kabat-Zinn, one of the fathers of modern Mindfulness-based treatment programs] borrowed heavily from the Buddhist tradition to put together his mindfulness meditation program. " Wikipedia notes:
 "Kabat-Zinn was a student of Zen Master Seung Sahn and a founding member of Cambridge Zen Center. His practice of yoga and studies with Buddhist teachers led him to integrate their teachings with those of Western science."

Cause for Concern?

I started to raise my eyebrows about the Buddhism connections when I noticed that training programs for Mindfulness teachers may require that applicants be assessed for "good dharma":
1. The teacher of MBSR teachers him or herself needs to have a longstanding grounding in meditative practices and be a committed student of the dharma, as it is expressed both within the Buddhist meditation traditions and in more mainstream and universal contexts exemplified by MBSR. This has nothing to do with being or not being a Buddhist.
2. MBSR is a vehicle for embodying and transmitting the dharma in a wholly secular and universal idiom. It is a recontextualizing of dharma, not a decontextualizing of it. 
Or, later in the same document (from my alma mater, the University of Massachusetts, home institution of Kabat-Zinn): 
We strongly recommend that all aspiring and engaged MBSR teachers and teacher trainers attend retreats in the Western Vipassana tradition, because this tradition closely reflects and serves as a foundation for the spirit, practice and attitudes of MBSR.
(I read the disclaimers that grounding in and transmission of the dharma has "nothing to do with being Buddhist" and is "wholly secular." But when"dharma" derives its very definition from Eastern faith traditions and is used with no attempt to translate or reconcile it with terms and concepts understood in secular Western culture, the disclaimers are unconvincing.)

Similarly, in the UK, the University of Bangor's course for training to be a Mindfulness teacher includes a unit on "Buddhist Background to Mindfulness-Based Courses." Exeter University's first year post-graduate training in Mindfulness includes two units in Buddhist Psychology.

My concern grew into worry when I noticed an abstract in the Journal of Religion and Health proposing a modified form of mindfulness based on  "Centering prayer, a form of Christian meditation that is rooted in Catholic mysticism." The author, Joshua J. Knabb, acknowledged that mindfulness-based conigitive therapy has proven effective in decreasing recurrences of depression,
"Yet, some Christian adults may prefer to turn to their own religious heritage, rather than the Buddhist tradition, in order to stave off depression relapse."
Next I found an abstract suggesting Sufism and the meditations of poet Rumi to create a sort of "Mindfulness for Muslims." Author Gretty M. Mirdal notes the dramatic growth in the use of mindfulness for treating a variety of interpersonal and health problems in the past decade and suggests elements of Sufism offer a more "culturally sensitive" method of mindfulness-based healing for people with Muslim backgrounds.
"The source of inspiration for mindfulness has traditionally been Buddhism, while Islamic thought has not been present in this development despite the similarities in philosophy and a growing need for mental health support among Muslim populations throughout the world. ... Introducing concepts, images and metaphors based on Rumi’s universe can constitute a meaningful alternative to Buddhist-inspired practices in the transcultural clinic, especially in encounters with clients with Muslim background."

Mirdal says it's understandable that many cultures would come up with similar basic techniques for healing.
These include generally a reframing, a new way of looking at problems of living; they provide new ways of coping, of unlearning bad habits and learning more constructive ways of dealing with stress, loss and grief; they offer rituals based on a myth or a theory of what constitutes 'a good life'; and finally, they impart belief and hope, that the process will restore health and well-being.
Mirdal says that both the Buddhist and Sufi orientations are helpful because "both approaches challenge the focus on the primacy of the individual self and on the narrow pursuit of mundane success which are not necessarily meaningful goals in non-western cultures."

Why Worry?

The fact that Mindfulness experts are now starting to see a need to develop more "culturally sensitive" versions of the practice suggests to me that Mindfulness may be on the brink of outgrowing or overplaying its Buddhist connections. My friend Tudor calls this "Remythologizing" Mindfulness. And requiring that people who want to train to teach Mindfulness have Buddhist credentials -- good dharma or training in Buddhist psychology is just asking for trouble, especially in America.

Both Tudor and I come at this as fans of Mindfulness AND Christians. Both of us feel we benefitted from learning Mindfulness meditation techniques--so much so that we want to share them with others. Tudor writes,
"As a chaplain working within the military I have found mindfulness meditation techniques to be useful in my pastoral work.  For those who have difficulty controlling anger and those who appear overly anxious, I have found mindfulness particularly effective in reducing their emotions to a manageable state. "
I don't think either of us find the Buddhist elements in Mindfulness to be a personal affront or challenge to our own faith or cultural sensibilities. So why are we worried Mindfulness may be veering too far into Buddhism?

1. Putting People Off: The main concern would be that conspicuously Buddhist elements in Mindfulness will put people off -- they'll cause a wide assortment of people to reject Mindfulness out-of-hand, without getting far enough in the door to see how it might be helpful. This could include people who identify strongly with non-Buddhist faith traditions; as well as militant atheists and agnostics; people (and institutions) who require that all aspects of medical treatment should be evidence-based; people who are suspicious of flaky New Agey stuff, and people who start out with apprehensions, misgivings, and doubts about psychological and psychiatric treatments.

As I've tried to describe in previous postings on this blog, Mindfulness is odd, delicate, chimeric, as well as amazing--approaching the magical or the "too good to be true." I find it difficult to tell people that something as simple as sitting in a chair, focusing kindly attention on the present moment (for example the breath you are drawing just now) REALLY DOES, with practice, accomplish wonderful, helpful things. Something as silly as ten minutes focusing on a raisin or 40 minutes lying on the floor in silence with a roomful of strangers, can, over time, change the structure and function of your brain and be your ticket to well-being. I fear that a pronounced layer of spirituality, be it Buddhism, Catholic Mysticism, or Sufism could be the last straw of airy-fairiness wafting Mindfulness into Cloud cuckoo land for many people.

Of course, connecting to Buddhist roots might well make Mindfulness more credible to Buddhists and people who are comfortable with Eastern traditions--or sufficiently urbane that they can put the Buddhist elements in a liberal, tolerant, non-personal, historic perspective. But I wouldn't guess this group is very large in either the United States or the United Kingdom. (And if this blog weren't already too long, I'd argue that people with these open attitudes and those already given to the loving-kindness favored by Buddhism are probably less urgently in need of Mindfulness. Studies have linked belief in a loving God to reduced risk of Social Anxiety, Paranoia, Obsession, and Compulsion. Belief in in a punitive God elevates the risk of these.) Given their training in the Buddhist roots of Mindfulness, I'm sure Mindfulness teachers can logically explain and defend elements of Buddhist spirituality and their therapeutic relevance. But when will they get the chance to do that if most people won't even have a look in the door?

I wish the world were already disposed to the accepting, rational attitude that Mindfulness teaches (possibly thanks to its Buddhist roots). But it's not. As Jonathan Haidt describes, especially when it comes to the essentials such as well-being and faith, people are largely driven by intuition and emotion. They make choices that fit in with the values of their home tribes and groups -- including religion-based groups -- and may be suspicious of the practices of others. I especially wish Christians could put down clan loyalties long enough to see what treasures might be gleaned from other faiths -- and Mindfulness. But many can't or won't.

You say you don't believe me? Consider this: Six years ago, in the very same town where I studied Mindfulness, a series of churches kicked out or turned down a toddlers' exercise group that had been renting or trying to rent a room in their (Christian) church halls. Why? Because the class was called yoga. A pastor of a Baptist church was quoted in the local papers:
...Rev Simon Farrar said some toddler groups used the church hall. But he added: "We are a Christian organisation and when we let rooms to people, we want them to understand that they must be fully in line with our Christian ethos.
"Clearly yoga impinges on the spiritual life of people in a way which we as Christians don't believe is the same as our ethos. If it was just a group of children singing nursery rhymes, there wouldn't be a problem. But, [the teacher] she's called it yoga and therefore there is a dividing line we're not prepared to cross."
An Anglican priest told the "YumYum Yoga" teacher "it was unlikely any Christian organisation would accommodate her."

Buddhists may see themselves as peace-loving and tolerant, but currently groups focused on religious persecution are now putting Sri Lankan Buddhists on the list of tormentors of Christian pastors and Muslims. My experience with groups targeting "Christian Persecution" has left me suspicious and distrustful of their message and charity; nonetheless, I think they have the power to turn neutral views of Buddhism to close-mindedness and hate which could spillover to strongly Buddhist-tinged Mindfulness.

The toddler yoga and anti-persecution examples come not from the U.S. Bible Belt--where they really take religious affiliation seriously -- but from supposedly tolerant England!  As you'd expect, there's an evangelical anti-yoga/ anti-meditation U.S. movement as well. This sentiment features in a book by the lieutenant governor of Virginia, who writes:
When one hears the word meditation, it conjures an image of Maharishi Yoga talking about finding a mantra and striving for nirvana. . . . The purpose of such meditation is to empty oneself. . . . [Satan] is happy to invade the empty vacuum of your soul and possess it.
This isn't about rational thought or the actual content and effect of Mindfulness training (which does not, in my experience, advocate you empty yourself). What counts with the guy on the street is impression, appearance, and gut reactions. Buddhist-based psychology, you say? No way!

Bringing Mindfulness closely to heel with research-based science will probably also put some people off, but this is bound to be a much smaller group than would be driven away with a conspicuous Buddhist affiliation. Religion-based anti-science attitudes never got much of a foothold in Darwin's homeland, and they seem to have lost ground in America. The courts and even most religious groups now accept that science --even evolution -- should be taught in public schools as matters of fact, not  faith. This gives me hope that most people would accept Mindfulness if it sticks close to the growing scientific evidence that supports it.

2. Separation of Church and State: This isn't as relevant in the UK as in the United States, where the First Amendment of the Constitution prohibits government endorsement of any religion and  insists "no religious Test shall ever be required as a Qualification to any Office or public Trust under the United States." Would a pupil denied access to UMass's Mindfulness teacher training because they failed the  dharma test have the grounds for a Supreme Court Case? Since UMass is a state-supported institution receiving Federal grant money, I should think this might be a possibility.

Other meeting points of Mindfulness with government or the public sector should also be considered thin ice. I've mentioned before that the U.S. Marines are experimenting with advance Mindfulness training as a form of psychological armour to prevent post-traumatic stress disorder (PTSD). Veterans' Administration researchers are studying post-combat Mindfulness as therapy for PTSD. And I would guess that most larger Mindfulness research studies, in the U.S. at least, are being paid for with taxpayers' dollars-- from the National Institutes of Health, the National Science Foundation, or state-supported Universities and Medical Colleges, for example.

Again, I would like to think the awarding of public funding for research was rationally based on the merits of the science, as judged by peer grant review. But sadly, this again is a place where politics and religious and moral values intrude. I've seen, for example, presidential bans on embryonic stem cell research and congressional bans on funding studies of abortion, sex education, condom distribution, and clean needle distribution (to intravenous-drug users to prevent needle sharing, which fosters transmission of HIV-AIDS). (I've also seen Congress earmark funds for flakey projects that had no scientific basis -- but that was in a wealthier era...) Would Congress turn off the spigot of funding for Mindfulness research if they thought it promoted Buddhism? I think it's distinctly possible.

3. Ruining the Research: Standardizing Mindfulness into a tidy 8-week training package with defined instruction, practices, and teachers trained to a standard has given researchers around the world a (fairly) uniform common entity to work with. Researchers can be reasonably confident that they are studying, comparing, and making hypotheses about the same thing when they test this or that aspect of Mindfulness-based Stress Reduction, for example.

Remarkable studies on the effects of MBSR are coming out each week. Scientists are formulating testable hypotheses on how MBSR works. If the common standard holds for a bit longer, there's no telling how far this work will advance. I'm quite excited about it. Scientists may well find more efficient ways to convey the benefits of Mindfulness. They may precisely identify which aspects of Mindfulness training are key -- and then transfer these keys to other forms of therapy that could be accepted by people who can't take it as it is now.

But faith and spiritual practice don't lend themselves to standardization or scientific study. If Muslim and Christian versions of Mindfulness are the tip of an iceberg of modifications, adaptations and morphs to fit different groups, the uniform, common study subject vanishes. It's not impossible to accommodate and account for the added complexity, but I would guess that it would slow research progress and make between-study comparisons much more problematic.

Within individual studies, I would suspect that the more spirituality is part of Mindfulness, the fuzzier outcomes will be and the more difficult it will be to understand what's going on. It's a testable hypothesis, of course.

Should we care if research goes downhill? Yes, at least for now. I think there's still lots to be discovered about Mindfulness. Lots to be checked; maybe some earlier discoveries won't hold up. Science will learn more about how it works and can be made even more useful to humankind. But this is contingent on Mindfulness maintaining its popularity and credibility.

 Mindfulness without Buddhism?

I am a complete fool to write anything about Buddhism when I know so little about it. But some things I've read and heard suggest that the aims of at least some flavors of Buddhism are not incompatible with science. The Buddhist bits of Mindfulness might be well able to bend to assist Mindfulness silently--without speaking its own name.

I've started listening to a talk by Theravada Buddhist monk Ajahn Brahm. The talk is about the Buddhist view of creation, but in the long introduction, the monk (who was trained in Physics at Cambridge) makes some observations about religion, Buddhism, and science--which he sees as dedicated to truth, above all else--including "Being right." Ajahn Brahm says Buddhism is the same in that regard. So if it were to be true that there is a better way to do Mindfulness that doesn't involve Buddhism explicitly, wouldn't real Buddhists put the truth of better Mindfulness above historical pride, "being right" and displaying the Buddhist origins?

Brahm sees two types of religion-- those that bend the truth to fit the faith and those that bend the faith to fit the truth. Buddhism should be of the latter type, he says. "It doesn't matter what I say; It doesn't matter what Buddha says. You have to follow the truth. There are no sacred cows. " As with science,  people should be encouraged to challenge the teachings of Buddhism as a way of coming to truth. So here I am, eyeing the sacred cow, and wondering if we might challenge him. Does he really have to be a cow? Or could Mindfulness just rely on the fundamental essence of cow?

If Mindfulness™dared give up the sacredness of the cow,  it might ask what the key aspects of Dharma are that make for a good teacher. What is it in the Buddhist background that helps teachers understand and explain Mindfulness better? Is it commitment and discipline? Calling to a higher purpose? Is it connection to community? All of these can be explained and understood without reference to Buddhism.

If the Buddhist backdrop needs replacing, perhaps a substitute tapestry could be formed of relevant, secular-described elements from Buddhism. Positive psychology covers that territory and then some. This field is finding ways to observe and measure things--like Mindfulness--that contribute to human happiness and satisfaction with life. It might study faith practices, but it remains secular, scientific, and faith-free.

A Buddhism-free Mindfulness, otherwise identical but explained as an outgrowth of Positive Psychology, might be acceptable to a wider group of people and might avoid attracting destructive prejudice.

And perhaps, down the road, it will be time to build on the idea that many -- if not all -- religions and cultures have goals and practices similar to the Buddhist contributions in Mindfulness. A culturally neutral, basic Mindfulness would be a good common platform on which to build. So, when and where ties to religious and cultural groups are seen as necessary, teachers could "insert distinctive culturally-sensitive items here." Researched, planned carefully, this might extend the applications of Mindfulness without putting the whole endeavor at risk.
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A postscript: Today's Amazon ad, bringing me personalized suggestions adapted to my interests, recommended Mindfulness, Plain and Simple. I looked up the author on the internet and found an apparently very laid-back Aussie mindfulness teacher. No religion, no highfalutin New Age Mindfulness™mumbo jumbo... just an ordinary guy telling other people about something that has worked beautifully for him (and some cartoon frogs, his chickens, etc.) He has posted several short videos on his "resources/videos"page, including one about what his Labrador Retriever has taught him about the fun of being present in the moment. At the bottom of the "classes" page is a link to a 20-minute meditation exercise. If I were in Australia, I would definitely drop by for one of his classes! This is the sort of Mindfulness I think lots of people can embrace.

Tuesday, April 30, 2013

Space for us all on the Spectrum of Abuse

Britain has been rocked  by waves of lurid sex and abuse scandals over the last year. But at the end of the day, after we've given our pointing fingers a good workout, can we do something constructive--prevent it from happening; minimize damage to victims, perpetrators, and society--help people find peace and forgiveness?

I've been wringing my hands over this blog entry for months. I have something to say, but at the same time feel like I'm not entitled to speak. I can't begin to fathom the soul of a monstrous abuser, and the "victimization" I've experienced is nothing compared to the criminal abuse others have endured.
I think what finally moved me to post this blog entry was a line from a citizen petition from "MoveOn" a grassroots political organization in the USA. The petition, drafted by Trina McDonald, a U.S. Navy veteran and rape survivor, says:
According to estimates from the Department of Defense, 19,000 service men and women are sexually assaulted while serving in the United States military every year. But 86% of them never report their assault—too often because seeking justice threatens their safety, their job security, and their future. 
I would expect that many of the unreported assaults fall short of criminal behaviour. And the formally hierarchical structure of the military may intensify cultural pressures and change the weightings that go into the calculus each perpetrator and victim makes, raising the stakes. But I think the numbers reflect a large unspoken truth about our society: People abuse others and subject themselves to abusive relationships universally, constantly, and largely without consideration, healthy reflection, discussion, support, advice, or knowledge of the experience of others that could help put the experience in perspective and help them manage the consequences. The scandals and criminal cases differ only by degree and notoriety from what most of us experience in our lives. We are all entitled to a view and a voice.

If I had one wish for something to come out of my speaking out, it would be to encourage broad, rational thinking about relationships in general--especially the middle ground that most of us encounter. I have found that putting myself on the spectrum has increased my empathy and helped me set aside knee-jerk emotional responses, and avoid bandwagons -- lynch-mob mentalities, political correctness, sexual politics, guilt-tripping, shaming and blaming others. Surely a more empathetic society, a more measured view will help us prevent abuse and come to terms with it when it happens.

 My Framework: Thinking about the times I felt like I'd been exploited, and thinking about some of the milder examples of abusive behavior in the press recently, I concluded there's a graded spectrum of relationships, from exploitative to loving; from relationships governed by "the way of nature" to those governed by "the way of grace"--with lots of all-too familiar ground--space for all of us--in the middle.

Here's the schematic I came up with:

A Spectrum of Relationships 



The Way of
<---Nature
The Way of Grace--->


--The Illegal/NoZone--
--The Stupid Idiot Zones--
--The Grace Zone--
Victim Vulnerability


One party is a child, handicapped, frail, weak, physically or mentally incapacitated
One party is young, immature or naïve adult(s); low self-esteem; on the rebound
Both adults, high self-respect, capable, strong, confident,
Nature of Relationship


Lopsided power—One person submissive, beholden, psychologically or physically dependent on the other
Shifting or misperceived balance of power


Equal, mature; Both parties fully empowered; free to choose and refuse.
Deceptive—One party withholding or lying to manipulate the other’s choice
Both parties withholding, lying, manipulating the other’s choice
Open, honest. Both parties can make informed choices.
Impersonal—One party sees and uses the other as an object; a means to personal gratification
Both parties using each other
Mature, loving. Seeing, caring for the whole person & their long-term wellbeing
Type of Behavior


Abusive—Physical or psychological violation, harm, pain, humiliation, undermining, scarring, depriving of sustainance
Unknowingly or unintentionally harmful treatment of others; misunderstanding
Healthy—gentle, tender, mutually pleasurable, kind, helpful, affirming, uplifting
Downward spiral—Repetitive, ongoing, escalating harm, “grooming”; multiple victims
Changing circumstances convert healthy behavior into an unhealthy interaction
Growth—both parties learn and develop in positive ways from the relationship








This table is a representation of how I'd sort relationships--which inevitably mix elements from all three columns-- at different times, if not usually. Or maybe in some aspects, over some issues, but not others. It's just my personal framework. And possibly it's projection on my part to imagine it reflects anything beyond my own views and values.

Whatever. Under this scheme, the more elements from the red zone, the less healthy the relationship. I would guess victims of red-zone relationships would be more hurt and struggle more to recover. Perpetrators of predominantly red zone relationships more urgently need to have their behavior reversed. They need re-education, therapy, reform. Those are easy things to say.

Harder is admitting that we all err. We all take actions, ranging from completely unintentional to completely intentional and more or less wisely considered, that actively place us on this spectrum, either as perpetrators or as (potential or actual) victims. I don't say this by way of blaming or shaming. I claim this from my own confession. My underlying belief is that we restore ourselves and our relationships through honest self-examination conducted with deep consideration of others. This, followed by reparation of damage, and forgiveness for ourselves and those who've harmed us return us to the present and a more hopeful future.

  Confessions of a Victim

 The embarrassing personal history that is the foundation of my experience  of abuse in relationships would actually begin with a relationship mostly on the "grace" end of the spectrum.

Mike was 30; I was 15. He was a ex-Army paratrooper back from Vietnam, now driving a schoolbus. I rode that bus, getting on at the first stop in the morning and choosing the warmest seat--behind the driver, who had a heater next to his seat. We chatted every day. He was also friends with other kids, but I was his favorite.

At some point I must have given him my phone number. After school got out in June, the family of one of the other kids on the bus route invited him to house-sit while they were on vacation. He phoned and invited me over. The house-sit was at Thornoaks, within walking distance of our home. I told my Mom I was going. She offered to drive me there.

The last thing I wanted was for her to meet Mike. He was African-American. He was a grown-up. She wouldn't have allowed this unsupervised visit. I can't remember what lies I told her to allow me to walk. Probably that I would be back at a certain time. Or maybe that others would be there. Mom was clearly suspicious.

Kids today are much more mature at age 15 than I was back in 1968. For that matter, other 15-year-olds back in 1968 were more mature than I was. I was nervous going over to Thornoaks. Once there I chatted nervously with Mike. I can't remember if I went inside the house. It was a warm, lovely evening. I told Mike I couldn't stay long. He must have seen I was nervous.

Before I left he gave me a 45-rpm record, autographed by the Four Tops (who were friends of his). He kissed me. He said he'd been wanting to do that for a long time. I remember the softness of his lips. I don't remember feeling aroused--just a bit scared. I thanked him for the 45 and we said goodbye. I scooted home. I don't think I saw him again.

I've wondered about him many times in the years since. It would have been so easy for him to have exploited me. I was young and ignorant of the nuances of sexual expectations. We never spoke of faith or beliefs. But he was a good man. Wherever you are, Mike Patterson, bless you.

Fast forward 15-plus years through boyfriends, engagement, marriage at age 22... In this next scene, I'm in my 30s. There were two incidents, both occurring just as or after I'd left academic institutions. On these two occasions, four years apart, my department superiors expressed inappropriate personal affections, shall we say.

"Do you want to close the door?" one had suggested softly from his desk on my last day at the department. A goodbye chat. A kiss. I was attracted to him. I was thrilled. But we were both married. From the safety of my new home in another state I wrote him a gushy schoolgirlish letter, and that was where it ended. I don't think I saw him or heard from him again.

The next encounter with a department superior was more inappropriate. I had evidently learned nothing from the previous encounter. I was curious.  At least I came to my senses quickly, realizing the turn of events was not good--for either of us. But, like one duped by a conman, I was mortified by my own stupidity. I wanted to appear sophisticated, nonchalant, "adult." I was complicit and remained silent. After all, as foolish as I felt afterwards, I had participated of my own free will. Perhaps if I'd said or done something about what happened, it might have changed both our lives for the better. Might I have chosen relationships more wisely in subsequent years? Would he? As it was, until writing this blog entry, I just regretted our relationship privately and never saw him again.

A year later I would astound myself with even greater stupidity: I allowed myself to be "taken" by a foot fetishist. Going home on the Sheridan bus in Chicago after work, it was just getting dark. As I stepped off the bus, a man called after me, saying he noticed that there was gum on my shoe. He offered to remove it.

It never occurred to me that this could be anything but a kind, if bizarre, offer. He bent down, cupped his hand tenderly under the arch of my right foot and poked at the sole of my slip-off shoe. A few seconds later he declared the problem solved. I thanked him and headed toward home.

That wasn't quite the end of it. When I was a few yards away, he chased after me. He said he hadn't gotten it all. Again he slipped his hand under my foot and fiddled with my shoe. He told me that he worked in the shoe store back at the intersection, and if I ever needed shoes, I should come see him!

When I got back to my apartment, I examined my right shoe under a light. There was absolutely no trace of gum; just a bit of what looked like spit. DOH! How could I have been so stupid?

Priests, Lords, and Bishops

My sordid tales fall somewhere in the idiot zone, not unlike the fumblings described in the Guardian news story of allegations against Cardinal Keith O'Brien. The vitriolic critic of gay marriage has now resigned and apologized for not meeting the standards of behavior expected of Roman Catholic priests. I would also place in this middle zone the "inappropriate sexual advances" that Lord Rennard is accused of having made toward several women.

The Guardian news story on Lord Rennard sets his alleged abuse in the context of similar experiences of "Neanderthal behaviour among prominent parliamentarians" -- including chasing women around the office and invitations to come up to hotel rooms:
Channel 4 News last week quoted a former woman Lib Dem parliamentary candidate as saying that Rennard "shoved his hand down the back of my dress" when she posed with him for a photograph. The woman, who asked to remain anonymous, added: "I felt really humiliated, and very undermined and very shameful." 
The article points out the importance of contacts and party loyalty in politics, saying that political careers may add to women's reluctance to report abusive behavior. Similarly, The Guardian's story of one of the Cardinal O'Brien's accusers reflects the forces of authority and power that place his exploitation in the same realm:
"Priest C" was a young priest the cardinal was counselling over personal problems. Priest C's statement claims that O'Brien used night prayers as an excuse for inappropriate contact.... over a period of time...
O'Brien is, says Priest C, very charismatic, and being sought out by the superior who was supposed to be guiding him was both troubling and flattering. Those involved believe the cardinal abused his position. "You have to understand," explains the ex-priest, "the relationship between a bishop and a priest. At your ordination, you take a vow to be obedient to him. He's more than your boss, more than the CEO of your company. He has immense power over you. He can move you, freeze you out, bring you into the fold … he controls every aspect of your life."
Or consider the Roman Catholic priest in Leeds recently found guilty of  sexual asault for "forcefully kissing" and touching the buttocks of a 17-year old girl in church on Easter. Evidently the priest subsequently turned up at the girl's home and professed his sexual attraction to her. In the course of the trial it emerged that the priest had secretly married some years before. (I wouldn't be surprised if there had been common factors in the formation of their relationship.) The priest's wife had testified that he'd told her about the young woman. The story she heard was quite different than the one the jury believed.

After very serious criminal sexual abuse scandals, like the horrific Rochdale and the Savile cases, the UK is changing police practices. The pendulum is swinging back toward seriously listening to victims with allegations of abuse. The U.K.'s Director of Public Prosecutions, Keir Starmer, said in a speech  that the Savile and Rochdale abuse went unchecked because over-cautious police put "too much focus on the victims' credibility and not enough on the suspects." I'm hopeful this change will encourage victims to come forward so that police can stop perpetrators before they can rack up a record like Saville's.

But I don't think this is sufficient. I think society's response needs to be more sophisticated, nuanced, pro-active, deep, and should approach abuse from all angles. This includes recognizing that not all abuse is the same. On my color chart, there might be intensity points for the various factors (different rows in the chart) adding or subtracting from the seriousness of the offence, for example. Differences in intensity should mean differences in the consequences for victims and perpetrators and the processes involved in coming to terms with what has happened.

In the case of the foot-fetishist, for example,  I, the victim, was not enfeebled by age or physical condition -- only by stupidity. There was no lopsided power relationship or a violation of longstanding trust, but the perpetrator was deceptive and did objectify and use me for his own gratification. The interaction didn't actually harm me and it was not ongoing. I can't say what happened to the perpetrator.  It was what it was. I hope I am a bit wiser for the experience.

When there is actual criminal abuse, well into the red zone in all or most of the columns on my chart, communities need to be sure that victims get the care and support they need to minimize psychological damage and come to terms with the trauma of serious abuse. Research is finding better ways to do this.

Care for Victims: For garden-variety inappropriate behavior, I think something different is needed. The orange-yellow-to-green zones on my chart probably aren't in the realm of police concern. But that doesn't mean we should do nothing. What's helped me minimize ongoing pain from idiot-zone interactions is mindfulness and forgiveness -- of others and myself-- based on acceptance of the fact that every human is prone to do stupid things. What's happened is now beyond our control, but what we make of it isn't. Two good quotes come to mind:
“There is nothing either good or bad, but thinking makes it so.”  ~Shakespeare 
"We cannot choose our external circumstances, but we can always choose how to respond to them" ~ Epictetus
I choose to laugh about being had by a foot-fetishist. Because feet don't figure as private parts for me, there was no psychological damage, beyond the sting of feeling stupid. I forgive myself that and learn from it. And the same for my inappropriate interactions with departmental superiors. As the meme on FaceBook said,
"Maturity is knowing you were an idiot in the past; wisdom is knowing you'll be an idiot in the future; and common sense is knowing you should try not to be one now."
I think for victims, making great fuss about these incidents -- beyond acknowledging their inappropriateness  -- may actually deepen rather than heal wounds. In poring over minute details, reliving the experience, explaining the wrong and hurt, you build a case and magnify and prolong both your pain and the cruelty of your abuser. The incident becomes more conspicuous and shameful, disconnecting you, not reconciling you to your world.

Another Facebook quote:
"When you forgive, you release yourself from a painful burden. Forgiveness doesn't mean what happened was OK, and it doesn't mean that person should still be welcome in your life. It just means you have made peace with the pain, and are ready to let it go."
Reversing the Course of Abusers: I think that the priests who made the allegations against Cardinal O'Brien were right to do so. O'Brien may not have been committing criminal acts, but he was in violation of his vows, and after his outspoken criticism of homosexuality, deserved to be called out for his hypocrisy, if nothing else. Likewise the women who have made allegations against Lord Rennard. Society holds politicians and priests to a high standard of behavior. If the allegations are true, these men took advantage of their positions of power to exploit others, and seemed to be unaware of or indifferent to the harm their behavior was causing. I hope that by exposing the abuse to public condemnation, the victims have stopped the perpetrators' exploitative behavior.

I also hope that bringing abuse to public attention won't be at too great a personal cost to the people making the allegations. They are brave, but I worry that the ordeal of public exposure, church tribunals, court cases -- actually may make it harder for the victims recover inner peace.

I worry most about perpetrators who did exploit others but choose to fight the allegations. Does the battle actually make it more difficult for them to see how they were wrong, then attempt to put things right, and come to terms? I know little about it, but have been impressed by examples of facilitated reconciliation.

Prevention: As parents, teachers, and friends of potential victims and perpetrators -- we need to inoculate against abusing and being abused.  Of course we should teach our kids -- even teenagers -- not to go with strangers. That it's not okay for anyone -- even a priest or a relative -- to expose or ask them to expose areas of the body that should be covered by underwear. And if someone says not to tell, you need to tell.

We need to teach our teenagers that relationships should strive for the grace zone. They should be freely chosen, never compelled by differences in inebriation, age, status, self-respect, or physical strength. In a relationship of equals it's less likely that either person will exploit the other. And relationships should be honest, gentle, ennobling, and all about discovering and loving the whole person--not objectifying and using them for sexual gratification or other selfish personal gain.

The mother of a young son put it this way (in the wake of the convictions of Steubenville, Ohio, athletes for gang-raping a young woman):
"A toddler can learn how to use words of kindness.  It’s never too early to teach empathy, compassion, and awareness. ... Give your sons the tools they need to understand that sexuality is a powerful thing, one that they are solely responsible for.  Give them a framework for understanding that sex carries an enormous responsibility—not just to themselves, but to their partners.  Does your son know what rape is?  Does he know what it means?  Does he know that it’s not just creepy smelly guys who hide in alleys who are responsible for rape?  That it’s his peers?  Discuss the ways that a woman can give consent.  Pull the curtains back on the grey areas, and demand that your son learns how to protect himself and his partner."
[Update addition: A brilliant blog by @Soraya L. Chemaly on teaching pre-schoolers respect for others -- behaviors that will serve them (and the world) well for life: http://www.huffingtonpost.com/soraya-chemaly/the-problem-with-boys-will-be-boys_b_3186555.html Quote from this article:
the world would be a different kind of place if children were taught to respect other children's rights from the start. Rights to be, to do, to look certain ways and not others. And that teaching children these things has profound implications for society. Anyone who has studied or worked in the field of domestic violence can tell you that the "overarching attitudinal characteristic" of abusive men is entitlement and the belief that they have rights without responsibility to or respect for others. Similar attitudes feed our steady stream of sexual assault and rape.
For Christians, Jesus showed us what we should aim for: Love others as he loved Mary Magdalen, the possessed, lepers, the woman taken in adultery, and as he described the love of the good Samaritan. But none of us are Jesus. We are going to fall short of this standard. We will be victimized. We will abuse others. That is where self-examination, regret, repentance, vulnerability, apology, forgiveness, and acceptance come into their own. I see these as the best, most sacred, perhaps only ways to move ourselves and our world into the grace zone.

In the air: So maybe this is what it takes to finally get me to publish. This morning I woke up to a BBC radio report on the increasing use of "community resolutions." Reporter Danny Shaw used a freedom-of-information-act request to find out how many police forces in England and Wales are using the informal procedures to resolve cases--rather than issuing cautions or filing charges. Community resolutions might entail the wrongdoer apologizing or repairing damage for example; cautions and charges result in a criminal record.

Evidently 10,160 uses of community resolutions in 2012 involved acts of violence, contravening guidelines from the Association of Chief Police Officers saying they should be used for less serious infractions, including "minor assaults without injury." The number is a jolting rise over 792 uses of community resolution of violence in 2008. A member of the shadow cabinet (i.e. representative of the opposition party) weighs in with her outrage. The general impression conveyed is that police are using community resolutions because, as budgets are slashed, they save much-needed time, money, personel, and paperwork.

But what really got my attention was stashed at the end of the article:

   Acpo's Assistant Chief Constable Garry Shewan said guidelines were in place to help forces decide where the use of community resolutions might be appropriate.
   "But in every case, this decision will be victim-led and above all reflect their views and wishes," he said.
   "At times it may be necessary, and appropriate, to use such informal resolutions to deal with more serious cases.
   "Going through a restorative justice meeting has also been proven to have more impact on an offender than a prison sentence or a court punishment alone, as they see the consequences of their actions and so want to make changes in their future behaviour."
   The Restorative Justice Council - "the national voice for restorative practice" - said it should be "available for all victims of crime who want it, subject to a risk assessment by a trained restorative justice professional".
   "When offered alongside the right sentence for the offender, restorative justice can meet the needs of victims of the most serious crimes," director Lizzie Nelson said.
I realize I may be bringing apples to bear on the oranges of personal relationships, and I am the first to acknowledge I know very little about criminal justice in my adopted homeland. But isn't it possible that victim-led resolution -- with strong support from professionals who can spot the influences and pressures bearing down on victims -- may be the best way out of the orange-zone and on toward the green?

Friday, April 26, 2013

Good News on Aging

The daily news reports from my body largely get worse over the years. So it was a nice change to get some good news on aging from the medical front recently. This might seem a bit random and different than my usual Equipoise postings. But science writing is what I do for a living, and the challenges of aging are another keen interest of mine.

The good news included an epidemiological study which found that it's not just poor childhood nutrition that determines stature and how much people shrink in height during old age: Healthy lifestyle in later life is associated with retaining height. Another study reported on a technique for correcting near-sightedness without surgery or glasses. Completing the hat-trick was a study describing an effective non-surgical way to shrink enlarged prostates, a common curse of aging in men. [Full Lazy Journalist Disclosure: I am rehashing press releases here and have not spent time dissecting the underlying research papers. I think I've included sufficient details so anyone interested in digging in can do so. Hah! Just followed links to other publications' stories on the first story and it looks like they did the same thing...]

Preserving Stature

I'm not sure at what age one reaches maximum height. But evidently we grow up, then we grow down into old age. Wizened. Probably the best-known reason for loss of height is osteoporosis, or thinning of the bones, a condition that takes a particular toll on women after menopause.

But evidently shrinkage is just a natural body change accompanying old age, along with increasing body fat and decreasing bone density. Other conditions can exacerbate height-loss--arthritis and inflammation of the spine, along with osteoporosis, for example.

At a "Consensus Development Conference" on osteoporosis 20 years ago, leading scientists stressed that an important key to avoiding "dowager's hump," bone-thinning, and resulting fractures in  old age was building up extra-solid bones during one's youth. With hormonal changes accompanying menopause, women lose the ability to take up calcium efficiently from their diet. So getting girls to drink that extra glass of milk was crucial to preparing mineral-dense bones able to withstand some losses as calcium is leached away more quickly than it's replaced.

As it turns out, there's more to it than frequent sporting of a Got Milk? moustache in youth. The good news is that you might have some chance of slowing height loss even though you're of a certain age.

The study uncovering the new information on late-life shrinkage was based on a massive survey, "the China Health and Retirement Longitudinal Study," led by Univ. of Southern California economist John Strauss; Yaohui Zhao of the China Center for Economic Research (CCER) at Peking University; and Gonghuan Yang of the Peking Union Medical College. The ongoing survey is following 17,708 adults from age 45 onwards. As reported in the American Economic Journal Applied Economics, the study tracked height and health, but also cognitive function, memory, geographic history, socioeconomic status, education, and blood tests. They'll be collecting these data every two years.

A press release for the study quotes USC economist Geert Ridder, a co-investigator on the study: "Height has been recognized as an acceptable proxy for childhood health conditions, but there are complications there," Ridder says. "Some of adult health might be determined by childhood circumstances, but people shrink differentially, and that shrinkage is also a measure of adult health conditions."

Some of the factors that affected shrinkage included whether a person lived in an urban or rural area (rural people shrank much more); education and literacy (illiterate and less educated men and women shrank more) and "cognitive health:"
Those who had lost more height were also much more likely to perform poorly on standard tests of cognitive health such as short-term memory, ability to perform basic arithmetic and awareness of the date.
Importantly, the data show correlation, not causation, so the study does not show why declining stature is associated with declining short-term memory, for example. It may be that better-educated urban-dwellers have better health care, are better able to maintain both mental and physical health, and doing so prevents loss of height. Or perhaps factors leading to loss of height, such as arthritis following hard agricultural work may follow from early diversion away from school, the cities, and into the fields.

The study says by the time participants entered the study in their mid-40s, overall average height loss for men was 3.3 cm. For women there had been an "average overall height decrease of 3.8 cm." Completing primary school cut this loss by 27% for men and 16% for women.

The baseline CHARLS data is publicly available to researchers at http://charls.ccer.edu.cn. The research is supported by the U.S. National Institute on Aging, the China Natural Science Foundation, the Fogarty International Center of the U.S. National Institutes of Health and the World Bank.

Braces for Aging Eyes

Before finally dispensing with vanity and getting a pair of glasses, several dear friends went through that phase -- holding their newspaper father and father away. When the print grew too tiny to read at arm's length, old-age-denial gave way to reading glasses, bifocals, or vari-focals.

A news release about research at the University of New South Wales, Sydney, offers hope for my friends in avoiding reading glasses. It says they've found a way to correct age-related decline in near vision, or presbyopia. The method involves wearing a corrective contact lens in one eye while you sleep.

The study, reported in "Optometry and Vision Science" built on earlier studies of the corrective-lens technique, called "hyperopic orthokeratology (OK)." During the night, the OK contact lens gently reshapes the cornea, correcting presbyopia by the time you awaken and remove the lens.

The study included 16 middle-aged participants with presbyopia. They wore the rigid plastic lens in one eye each night for a week. The investigators measured participants' vision and the shape of their corneas each morning and evening during the week. From the first day, the procedure corrected close-vision for all participants -- and their close-vision was even better by the end of the week.

The researchers corrected vision in only one eye so that distance-vision would stay the same. When they checked distance-vision, they found no declines in the untreated eye. The overall result was to give participants good monocular vision for both close and distant vision.

To retain the close-vision correction, it was necessary to continue wearing the corrective lens during sleep. When participants stopped wearing the OK lens at the end of the study, their presbyopia returned within a week as the cornea relaxed back into its natural shape.

A news release on the study quotes Anthony Adams, Editor-in-Chief of Optometry and Vision Science: "This study demonstrates that OK is quite viable as a nonsurgical option for monovision that does not require wearing contact lenses during the day, although it does require 'retainer' orthokeratology contact lenses to be worn overnight." Dr Adams adds, "This possibility will certainly appeal to many people, especially since the changes in the corneal curvature of the treated eye are fully reversible."

As for me -- I'll just stick with my glasses, as, no doubt, will people whose aversion to putting things in their eyes exceeds distaste for wearing glasses.

Shrinking An Enlarged Prostate

The third study described a minimally invasive method of shrinking enlarged prostate by reducing blood supply to the gland. The pilot study subjected 14 men to "prostatic artery embolization (PAE)," a procedure that plugs up the arteries feeding the prostate. The study, the first of its kind in the United States, follows larger earlier studies of PAE in Europe.

The UK's National Health Service has a web page describing the procedure (not for the squeamish), and notes the "University Hospital Southampton has been offering a PAE service from April 2012 and is the first UK centre to perform this procedure."

A press release on the U.S. study said, "Nearly all men eventually suffer from an enlarged prostate as they age, and this treatment is almost like turning back the clock and giving them the prostate of their youth," according to Sandeep Bagla, M.D., the study's lead author and an interventional radiologist at Inova Alexandria Hospital in Virginia.

Enlargement of the prostate, or benign prostatic hyperplasia is a common problem besetting men in later years. The press release says more than half of 50-year-old men will have this proliferation of prostate cells, as will more than 80 percent of 80-year-old men. Androgens open the door to the unwelcome excess growth, which can constrict the urethral canal, blocking the flow of urine.

On the bright side--the cell proliferation is not cancerous. The bad news is that constriction of the urethral canal can cause problems, including urinary frequency, urgency, urge incontinence, and having to get up frequently during the night to pee. The hyperplasia can also cause piss problems, including long waits for urination to start; intermittent stopping and starting of flow; having to strain; and dribbling. Left untreated, symptoms may progress, according to Wikipedia, increasing the risk of urinary tract infection, bladder stones, and urine retention -- potentially leading to bladder distension and even kidney failure.

The options for treating enlarged prostate have not been great. The effectiveness of drugs can be so-so, and the drugs in use have various side effects, including decreased libido and ejaculatory or erectile dysfunction. The other option, invasive surgery to remove overgrown tissue, may leave the patient with urine leak, impotence, or other complications.

Although PAE doesn't sound like a picnic, it seems like a better option than more invasive surgery and not a bad choice for men who don't fare well with drugs for benign prostatic hyperplasia. PAE requires only local and regional anaesthetic, and patients may not need an overnight hospital stay for the procedure. Interventional radiologists perform a PAE by inserting a tiny wire and tube through an artery in the leg, then guiding the tube into the arteries of the prostate. A cloud of microscopic particles is fed into the tiny vessels, blocking off blood flow. "By temporarily blocking blood flow through the prostate artery, PAE causes the prostate to shrink, providing a larger passageway for urine," the press release says.

It gives early findings from the U.S. study, which was presented at the 38th Annual Scientific Meeting of the Society of Interventional Radiology in mid-April 13-18:
13 of 14 men (92 percent) who had PAE noticed a significant decrease in symptoms after one month. None of the men suffered any major complications, such as impotence, leaking urine or infection. Most went home the day of treatment.
Bagla is now conducting a larger clinical study of PAE, which will treat 30 men by this fall and then follow the patients for two years to check the long-term consequences of PAE.