“My mind is a bad neighborhood that I try not to go into alone.” (Anne Lamott, Novelist)

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Image courtesy of wikimedia.org

These are times that are creating great and widespread anxiety, to be sure. Many people report experiencing nightmares. Few of us can remain fully unscathed as we’re forced to change our routines and cut ourselves off from the people and places that have offered comfortable reassurance.

And being alone with our thoughts does not, as Anne Lamott cleverly suggests, always provide us with the best company. We can be hard on ourselves by ruminating on our plights and getting stuck in a cycle of worries. 

For me, mindfulness meditation has a very calming effect, and I’ll share with you below one particular resource I find helpful—whether or not you are a meditator, and even if you’re a “fidgety skeptic.”

I also love these wise words from the renowned meditation teacher Jack Kornfield, which underscore so much about being human:

“If you can sit quietly after difficult news,

If in financial downturns you remain perfectly calm,

If you can see your neighbors travel to fantastic places without a twinge of jealousy; 

If you can happily eat whatever is put on your plate; 

If you can fall asleep after a day of running around without a drink or a pill;

If you can always find contentment just where you are…

…..You are probably a dog.”

It’s a tough time for the two-leggeds, as Internet sensation Pluto the Dog refers to us. (She seems to be having the time of her life; so far there’s been no interruption in her treat supply chain…) And if you haven’t seen her and need an instant lift, I encourage you to look for her repeat performances on YouTube.

Fortunately, there’s also a treasure trove of free material on the Internet to help us get through this terribly difficult time.

I don’t want to oversimplify this issue. Andrew Solomon, a professor of medical clinical psychology at Columbia University who has written about his struggles with serious mental illness, observed in The New York Times that nearly everyone he knows “has been thrust in varying degrees into grief, panic, hopelessness, and paralyzing fear. If you say, ‘I’m so terrified I can barely sleep,’ people may reply, ‘What sensible person isn’t?”

If you’re feeling the way Sullivan describes, you may need professional help. Even if you’re  just seeking some reinforcement, I won’t pretend the resource I’m recommending will banish your psychological or physical pain—or make it easier for you to ignore your sudden or worsening economic problems. 

But I hope if you’re looking for some way to help you better adapt to our truly bizarre situation, you’ll give it a look.

And you needn’t be a meditator to appreciate its offerings and to find these common sense approaches helpful.

The source is Ten Percent Happier: tenpercenthappier.com. I actually paid a discounted price for a phone app last year.

Now, and for the duration of the quarantine at least, the content is available for free on YouTube. 

Live sessions featuring some of the most prominent teachers in the world are aired at 3 pm weekdays and are subsequently available on video. I listen to them (I don’t always watch) each morning before I get out of bed.

Dan Harris, a correspondent for ABC News, is the founder. Harris has explained that he turned to meditation after suffering a paralyzing panic attack on the air. He’s since become immersed in mindfulness and has developed strong friendships with a number of the leaders in the field. 

But he remains ever the “fidgety skeptic” (his words) and is clear when he’s asked to recite or act in a way that doesn’t come naturally to him.

He will repeatedly interject about the scientific grounding of certain practices. I think this approach makes him a perfect host for a program that is far more universal than it might otherwise be.

Each session begins with Harris talking with the guest speaker, who briefly describes her/his background. The speaker then gives an explanation preceding meditation lasting about five-minutes—suitable for those who’ve never meditated before as well as more practiced folks. 

And then the speaker answers viewers’ questions—often my favorite part of the session, as the questions, while unique, underscore so many similarities in what we’re all experiencing. And the answers are invariably helpful. In their entirety, the sessions run for about 20 minutes.

The goal, Harris says, is to bring some sanity into this rocky time, and to build a community, realizing the loneliness experienced even by those of us who are not quarantined alone—because we’re cut off from so many whom we care about. 

Today I heard Rev. angel Kyodo williams (sic), trained as a Zen priest, describe ways to recognize the importance of being in the present moment by trying to look at things in a different way. 

She used the acronym SKY, suggesting boundless spaciousness, to counter the constraints of both being so isolated and experiencing fear in these unprecedented times.

S is for Self-care: We should radically protect our own health and well-being, assess our own situation and take steps to protect ourselves, such as practicing social distancing. She noted that since her health situation puts her at risk, she has become considerably more aware of the need for self-care.

K is for Kindness: That means being kind to both ourselves and others—for example, accepting the annoyance we may feel toward people who seem oblivious to the 6-feet distancing advisory, but not being rude to them.

Y is for Yearning: We tend to contract with suffering, but if we acknowledge that we wish things could be different and are hopeful people take care, we can move out of that mindset. She suggests writing down our yearnings in order to breathe space into our perspectives.

Here is a video of Rev. williams’s presentation.

I have been so pleased with the sessions to date that I’m doing what Harris suggests: spreading the word to help build a community when many people are feeling cut off. I hope if you think you may need something like it—or just want to investigate—you’ll give it a try. 

Annie

Continue reading ““My mind is a bad neighborhood that I try not to go into alone.” (Anne Lamott, Novelist)”

My Fraught Relationship With The Man-In-The-Box

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Jack in box vector image Courtesy of freesvg.org

I reallyreallyreally do not like inanimate objects talking to me. I avoid Siri, preferring to do my own research than to hear her voice—or to have her record my every Internet search (though I hold no illusions about privacy anymore…). I am not tempted to invite Alexa into my home to find that old Sinatra record for me, thank you very much. 

And back in the day when we actually got into cars and drove places, I always resented the high-pitched voice of that GPS woman, who on occasion directed us to dead-end streets and once recommended that we exit sharply to the right when we were in the middle of a bridge.

I’m not accusing her of malicious intent, but her satellite-guided bumbling was not a confidence-builder. I am perfectly capable of bumbling on my own.

Why then, do I invite the man-in-the-box into my life practically every day? It’s because he’s integral to The Device, which shall go nameless so that I’m not guilty of unintended promotion—or worse. 

Let me sidepedal a bit here and note that I am very receptive to integrative medicine, which brings together the best from East and West. My daily meditation, linking me to the Buddhism of 2500 years ago, has been a great help.

I do try to stick with practices that are evidence-based, and to maintain a healthy skepticism about things that sound extreme to me—Eastern or Western.

When several people whose opinions I respect raved about a physician who practices integrative medicine, I made an appointment.

I wanted to see whether she would offer me new, preferably non-pharmacologic approaches for handling my chronic conditions: specifically migraines that I know have an anxiety component, and mild hypertension.

Well, some of what she suggested made no sense to me. But she recommended The Device, which she felt might help alleviate these issues. And it turned out that she was right.

It wasn’t inexpensive—costing several hundred dollars—but it involved deep breathing, so I felt it was sufficiently safe and akin to the meditation that’s a valued part of my life.

The beloved neurologist who treats me for migraines thought it was a good idea, as it’s a form of biofeedback, which is an evidence-based method to alleviate migraines.

A description: An elastic belt holding a sensor is attached to a computerish small box, as is a pair of earbuds. I snap the belt around my torso and insert the earbuds. Then I listen to the instructions that the little man-in-the-box provides. Note: I am substituting The Device for its brand name. 

Here’s how a session begins:

“Lean back and relax and listen to the music as The Device detects your individual breathing patterns,” he tells me.

If I perform that difficult task to his satisfaction for several seconds/minutes, he says, “The Device has detected your individual breathing patterns. Now breathe according to the guiding tones.” I hear sounds—bom, bom—and I match my breath to the tones. 

Sometimes, as in this morning, he immediately tells me I’ve reached the “therapeutic breathing rate,” which means I’m really cookin’. More often, seconds/minutes pass as he goads me with that familiar refrain: “Breathe in, breathe out, breathe in, breathe out” before I reach that coveted goal.

Once there, I continue breathing in and out in sequence with the tones for another 14 “therapeutic” minutes (not sure why it’s that time length, but it always is) until he says, “The Device is turning off. Bye for now.” Let me tell you, I’m never sorry to part with him at that point.

And then I get to see how well I’ve performed by clicking on the box’s levers. Here’s where I realize my slight touch of OCD kicks in. I’m back in school, and I really want to do well. 

In fact, I usually do. The range deemed acceptable for the initial breathing rate is between 6 and 30 breaths per minute—the lower the better. I’ve never gone above 7.2; this morning’s readout was 5.2, which I guess means I had a pretty restful night’s sleep. 

The recommended final breathing range is 5-10 breaths per minute, and I’m nearly always below that—usually 4.8-4.9. Occasionally, I’ve gotten to 4.3, which is nearly Yogi territory, I think. More about that shortly. 

The Device also reports my synchronization rate (how well I synchronize my breathing with the tones) and my breath detection rate (how well the sensor can recognize my in-and-out breaths).

I’m usually right where I should be with those as well. Except if I cough or sneeze. Or hiccup. Then all bets are off.

But I’ve learned one especially bitter lesson. If my initial inhalations are too long while the sensor is assessing my pattern, once the tones begin, I wind up struggling to match them. And the man-in-the-box knows it. He chides me: “Don’t hold your breath!” 

Try breathing in for longer than you possibly can—and continue for 14 minutes—and you’ll see what it’s like. (Actually, just take my word for it; it’s not something a sensible person would do.) 

The lesson I learned: When using The Device, never-ever breathe in for long, lest the sensor monster constantly remind me of my failure.

In such instances, my synchronization rate would ensure a “needs additional work” message on my school report card.

He (my electronic tormenter) has also on more than one occasion said: “Try to breathe more evenly.” I make an effort not to take offense that he’s dissatisfied with my performance.

And he is oh-so picky about that sensor. “Tighten the sensor,”  he’ll command. Or  “loosen the sensor.”  Even “reposition the sensor.” His standards are high. I scramble to do his bidding. 

I used to strap on The Device just before bedtime, but I found all kinds of reasons not to go through the process then. So it’s now the first thing I do upon awakening—after taking a long drink of water to prepare my dry mouth for the routine.

Sometimes I wonder, as you may well, why I subject myself to this regimen-with-verbal-abuse on a daily basis. Of course, I always have the option of shutting the darn thing off.

But, while The Device hasn’t totally replaced medication, it really has done what the doctor said it might: migraine frequency diminished, blood pressure low-normal, anxiety lessened.

So I’m locked in to this challenge. Plus, in these pandem-icky days, I figure it’s not so bad to give my lungs a bit of a regular workout.

And then I meditate and express lovingkindness for all the nasty thoughts I’ve had about the bossy little man-in-the-box.

Annie

Notes From a COVID-19 Epicenter: Our Quarantine Begins

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COVID-19; image courtesy of state.gov.

This wasn’t the post I’d originally planned to publish. That one can wait for another time. This post is more timely. And since my story may become your story—if it hasn’t already—I thought I should tell it to you now.

I live in a medium-sized community in the eastern US. Yesterday, our mayor requested that we move beyond this new status we’ve just learned about: social distancing.

We’ve now been asked to self-quarantine, voluntarily at this point. We should stay at home, going out only to buy food or medications. We are suddenly activists in the effort to flatten the curve and slow the exponential increase in disease incidence. 

The community officials have been acting very responsibly—closing the municipal buildings and library and encouraging people to conduct their business online. (Woe to anyone without functioning computer and Internet connection, but that’s a story for another day.)

They’ve even stated the number of people who will be permitted to enter the food markets at one time: 50 for the largest; 25 for each of the smaller stores, with only one family member permitted per visit. I’m all for these restrictions, which seem well thought out to me.

As my husband and I are past 60, we are considered part of the vulnerable population. We don’t have the other conditions that would increase our odds of becoming severely ill—such as heart or lung disorders or diabetes—but our well-worn immune systems are better off not being called into combat against this particularly nasty bug.

I’ll note that we’re careful about our health and diet, don’t smoke, and are both gym rats. One of the hardest things about this quarantine is that even though we’d decided it was probably not a good idea to continue going to our gym, the gym announced today that it’s closed until further notice.

That deprives us of the most important man in my life: the personal trainer we work out with together once a week. (I’ve told the trainer that in my husband’s presence.) He has really strengthened us and made us feel we’re up to all sorts of challenges.

I had assumed that under the circumstances, even if I got the damn virus, I would be sick for a week or so and then recover. But I’ve since learned that it’s quite tricky, and even when people seem to be recovering, it can do a sneak attack that brings them to an ICU needing a ventilator.

My purpose in telling you this is not to create panic; I feel amazingly calm myself considering my basic catastrophizing nature. Mindfulness meditation works wonders for me: I don’t dwell on what may happen.

Similarly, I see no point in checking the balances on our rapidly crumbling retirement accounts—or spending more than a fleeting moment pondering potential breakdowns in our food supply chains and the availability of medicines I must take. 

But there are plenty of people who either aren’t getting or aren’t hearing the facts about COVID-19. The messages from the White House and the CDC are conflicting and confusing. Putting out a blanket limit on 50 people congregating in a single spot does not take into account the size of the spot (unlike my local regulations) and how much “social distancing” is possible therein. 

Such ambiguity may lead people to continue taking advantage of not having to be at work to meet with their friends in a bar; that’s definitely not smart. This is not your grandmother’s flu. It’s spreading more quickly than other viruses in the past. It’s also more lethal.

On March 14, our local hospital had 11 cases, and 6 of them (all younger than 60) were in the ICU. Another 40 patients were under observation. Those numbers are increasing rapidly, and they somehow haven’t made it into the state’s official count.

You know those N95 masks many people are talking about, which can be used only once and are essential to protect health care workers as they tend to infected patients? The hospital’s CEO said in an interview that those masks are running low statewide. His hospital had gone through 795 of them by 7 pm in a single day.

He described the past week as something he’d never before seen, even though he’d fought cholera in Haiti after the earthquake, when there were no medical supplies, and “even when we ramped up for Ebola.” He called this crisis “unprecedented.”

The CEO said a number of things that were quite concerning. One that disturbed me the most was that he’s given up on the Centers for Disease Control and Prevention, which had yet to confirm his hospital’s first case.

In his view—and this is something he wants people to know—testing is problematic. It’s more complicated than it’s been described. To be effective, it must be done under strict conditions with a sample taker appropriately outfitted with Personal Protective Equipment (PPE), and differing RNA assays make test sensitivity questionable. 

So at best, the tests are 90% accurate, whereas flu tests are 99.999% positive. He fears drive-through testing that shows someone is negative will give that person “a false sense of security.” He said he told the Governor his concerns. 

There are many experts with differing views; I’m noting his because he’s a highly regarded individual who’s working with labs—not to suggest that his opinions necessarily be used as guidance in individual decision-making. 

Testing in the US has certainly been botched, by nearly all accounts, but many point out, as this Atlantic article states, that knowing how many people have been tested would give us some sense of how far the disease has spread and “how forceful a response to it the United States is mustering.” Hmmmm….

Though our hospital CEO doesn’t want to incite panic, he does want people to take this disease seriously because in infected patients

“things can turn around very rapidly. We had a patient that we were thinking about releasing—he seemingly was recovering—and then, two days later, he was put in the ICU. The flu isn’t like that. People need to know this.” 

He encourages people to be responsible: stay home, avoid malls and theater and group activities for now.

“We need to sort of hunker down at home. Go outside if the weather’s nice in your backyard. That’s healthy and good. But we shouldn’t be out and about.”

That’s what we’re doing. Going into stores for food only when they’re not crowded. Avoiding situations where we’ll have to stand on line. Bringing our rapidly disappearing hand sanitizer with us when we’re out of the house, and swabbing our door knobs on the outside and inside with Lysol when we return.

(We’ve also made some hand sanitizer by mixing alcohol with aloe vera, but both ingredients are no longer available.) 

I heard one virologist say COVID-19 is most likely to linger for up to 9 days on metal and hard smooth surfaces. Clothing and porous surfaces seem not to be a concern. I haven’t found confirmation of this statement, however.

What else are we doing? Agonizing over whether to buy two or three small packages of tissues (8 each pack): they were going fast, and we felt we could use them to open doors once our hand sanitizer was gone. But was buying three packages selfish? 

We’re wiping down our cell phones (Apple said Chlorox wipes are OK) and other surfaces. Lifting weights and exercising at home, and taking walks in the late afternoon when few people are around. And yesterday we toured our small garden, buoyed by the sight of the first crocuses pushing their way through the mesh we’d placed over the hard soil to allow them to get a head start before the feeding faunas’ visits. So those back-aching hours planting bulbs last fall paid off! The appearance of those young green shoots couldn’t have come at a better time.

And we’re washing, washing, washing our hands. I find it so interesting that this devastating organism can be vanquished by plain old soap and water.

Finally, we’re still remembering to laugh. (See my previous post.)

My sister-in-law sent this cartoon today.

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My response was: “Gee, do you know where he got it? I could use some.” 

Do you have stories to tell about how you’re coping? I’d love to hear them. I hope you all stay safe.

Annie

Continue reading “Notes From a COVID-19 Epicenter: Our Quarantine Begins”

Help With A Critical Endeavor: Providing Meaningful Comfort to the Sick and Dying

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Image courtesy of flickr.com

I have been fortunate to connect with Abigail Johnston, a dynamic woman who has selected a title for her blog that’s a perfect description of her and her mission: “No Half Measures: Living Out Loud With Metastatic Breast Cancer.”

Faced with a daunting diagnosis that could crush many of us, Abigail has instead seized the time she has to become a patient advocate and educator. While she’s unsparing in her descriptions of her own and others’ ordeals–often worsened by bureaucratic entanglements and seemingly uncaring (possibly burned-out) professionals–her posts are marked by humor, a sense of the absurd, compassion, and practical suggestions. They are life-affirming.

I am pasting her most recent post, “Ring Theory,” below because its approach to communicating with seriously ill people–and their loved ones–provides information that I think we all need. And, when we eventually find ourselves in the center of the ring, I believe we will all hope that those around us are similarly well-informed.

Ring Theory

[From the blog No Half Measures: Living Out Loud With Metastatic Breast Cancer, by Abigail Johnston.]

I ran across this theory early on in my experience with Stage IV Metastatic Breast Cancer and it really resonated with me. The longer I’ve lived with the disease, the more it resonates with me. While I’m horrible at asking for help and often overestimate what I can handle, the kindness of some family and friends has driven home how important this idea really is.

Actually it’s probably more the actions of some family and friends who have not shown kindness that has really driven home how important this concept is to those of us who are dealing with a health crisis.

I’ve included a link below to the full explanation of the theory, but here are the basic tenets, paraphrased from Silk and Goodman:

1. Draw a circle. In this circle, write the name of the person at the center of the Health crisis.
2. Now draw a larger circle around the first one. In this ring, put the name of the person next closest to the crisis.
3. In each larger ring, put the next closest people. As Silk and Goodman state, “Parents and children before more distant relatives. Intimate friends in smaller rings, less intimate friends in larger ones. . . When you are done, you have a Kvetching Order.

A pictorial representation may help:

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The basic idea is that the person in the middle does not receive the venting/kvetching from outer circles, especially when said venting is about the person in need of help.

For example, if you are a family member of a terminally ill patient who spends the night in the hospital with your dying family member, you don’t then get to complain to that dying family member about how that night away from your family was stressful for you or how others in the family did or didn’t communicate nicely when arranging for someone to spend the night.

Why?

This theory takes into consideration that the person who is dying is carrying a much heavier psychological load than anyone else and that close family is affected more than distant relatives or acquaintances.

In essence, this theory is how to demonstrate love in a clear and understandable way. Violating this idea creates more and more angst and damage to the person who is already carrying more than a healthy person ever could understand.

Why would someone who loves a dying person want to cause further damage?

Here’s an article that lays out the ring theory in much more detail for anyone who is interested in learning more.

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I hope after you’ve read Abigail’s post, You’ll also read the Psychology Today article about the Ring Theory to which she links, and the original LA Times Op-Ed by the authors, Silk and Goodman. The Psychology Today article includes some practical suggestions that are extremely helpful.

Please don’t let yourselves be put off by the rough-hewn drawing; this material is more than worth the few minutes it will take you to read through it all.

Annie

Continue reading “Help With A Critical Endeavor: Providing Meaningful Comfort to the Sick and Dying”

Don’t You Think the World Could Use a Little Anger Management? Here’s a Way That Just May Help…

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Singer T & Klimecki, OM Image courtesy of commons wikimedia.org

Well, sure: the holiday season is, ironically, a time of stress. But we know there are high levels of anxiety that have preceded this supposedly joyous time and will surely follow us into the New Year/decade. 

I don’t have to itemize the list: it’s as close as your newspaper or electronic device. All sorts of problems and calamities—natural and manmade—have been occurring just about everywhere.

We can’t change the world, but we do have some control over how we view the world and our place in it. And if enough of us exercise that control, we can make a difference.

How Can We Do That?

By learning from the fortunate fusion of Buddhist practice—validated and adapted by Western scientists. Science writer Daniel Goleman, who was interviewed in an article titled “Can Compassion Change the World?,”  collaborated with the Dalai Lama on a book called A Force for Good: The Dalai Lama’s Vision for Our World.

Long a collaborator with scientists, the Dalai Lama set forth his views on how to improve the world with the help of science. When the interviewer asked Goleman why compassion is so important, he said the Dalai Lama wasn’t speaking from “a Buddhist perspective; he’s actually speaking from a scientific perspective. He’s using scientific evidence…which shows that people have the ability to cultivate compassion.” [emphases mine throughout]

Goleman observed:

“This research is very encouraging, because scientists are not only using brain imagery to identify the specific brain circuitry that controls compassion, but also showing that the circuitry becomes strengthened, and people become more altruistic and willing to help out other people, if they learn to cultivate compassion—for example, by doing traditional meditation practices of lovingkindness. This is so encouraging, because it’s a fundamental imperative that we need compassion as our moral rudder.”

Goleman speaks of “muscular compassion,” and he explained that the term is necessary to demonstrate that

“compassion is not just some Sunday school niceness; it’s important for taking social issues—things like corruption and collusion in business and government, and throughout the public sphere…for looking at economics, to see if there is a way to make it more caring and not just about greed, or to create economic policies that decrease the gap between the rich and the poor. These are moral issues that require compassion.”

The Buddhist term for practicing compassion is Metta—and mindfulness meditators call it lovingkindness meditation. Sometimes lovingkindness appears as one word; sometimes two; sometimes it’s hyphenated. In the scientific literature, it’s abbreviated as LKM. My personal preference is lovingkindness, so for consistency, that’s what I’m using throughout this post.

A Quick Look at Mindfulness

Mindfulness meditation per se, scientific studies have found, regulates attention to create a calm mind, and varied areas of the brain have been identified as showing changes (including increases in gray matter) among those who are regular practitioners—experts—as compared to novices. 

Jon Kabat-Zinn, who coined the term mindfulness and developed an eight-week course on Mindfulness-based Stress Reduction that is widely used, defines it as “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.”

Practitioners, of whom I’m one, use a focus on the breath to calm the mind. Sometimes people get discouraged meditating and give up too soon because their minds wander, but expert meditators will tell you that every time the mind wanders, you’re becoming aware that it’s happening, and that’s a good thing. You simply return to breathing in and out.

There are many techniques to help you stay on track. That’s a quick look at a complex process that has been scientifically validated to reap benefits as you explore your internal self–mind and body–and your place in the world.

And Now, Lovingkindness…

Lovingkindness is an associated practice to mindfulness. Specific studies have also shown that practicing lovingkindness reduces stress, helps those in the helping professions prevent burnout, aids veterans with PTSD, and possibly even extends life.

One study found that the telomeres—the ends of the chromosomes that prevent deterioration and whose length is associated with longevity—were longer in women who routinely practiced lovingkindness than in those who didn’t.

The Goleman article led me to the work of Tania Singer, formerly the director of the Max Planck Institute for Human Cognitive and Brain Science in Germany. (There’s an irony here that I’ll detail shortly.) Her professional life has been devoted to studying empathy and compassion.  

I learned from her that the empathy I’ve always valued isn’t always such a good thing. Empathy, the ability to feel another’s pain, is clearly important for interacting with other humans.

But it can have a stressful side—empathic distress—that leads to potential burnout and a lessened desire/ability to help. The high rates of physician burnout and suicides are examples. 

Compassion, on the other hand, doesn’t involve sharing another’s suffering, Singer has observed.

“Rather, it is characterized by feelings of warmth, concern and care for the other, as well as a strong motivation to improve the other’s wellbeing. Compassion is feeling for and not feeling with the other.”

In fact, Singer and her group have found that the apparently similar traits of empathy and compassion involve different, and not overlapping, structures in the brain.

What’s more, because of the brain’s neuroplasticity (ability to change based on training), compassion training can lead to positive results.

As they’ve written:

“Compassion may, therefore, represent a very potent strategy for preventing burnout. In light of high prevalence rates of burnout and stress-related diseases in Western societies, we anticipate that the present findings will inform other intervention studies on the plasticity of adaptive social emotions….[and] hopefully help to design new training programs aimed at increasing resilience and coping strategies in many domains, including health care, educational settings, and high stress environments in general.”

I watched two videos of Singer, a prominent neuroscientist. describing her work, which includes programs with economists to try to draw up models that more closely adhere to the compassion that Goleman described. She was a compelling and delightful speaker. 

However, In 2018, this woman whose life’s work has focused on empathy and compassion resigned as director of the Max Planck Institute after eight colleagues accused her of bullying them and some said she’d reduced them to tears.

Alas! She practiceth not what she preacheth! Hard to fathom, but her poor behavior doesn’t detract from the validity of her research findings.

And it certainly doesn’t seem indicative of what I’ve heard and read about leaders in the field of lovingkindness.

I consider Sharon Salzburg, one of the most respected and beloved teachers and authors on the topic, a personal guru on the journey into lovingkindness that I’ve been taking for a couple of years now.

I believe she’s a reliable guide into how the practice can help us all, physically and mentally, improve our relationships—and even help us enrich the lives of strangers.

Want to Try It?

Though Singer’s neuroscientific experiments took practitioners nine months, it doesn’t take that long to get the hang of it. For those who’d like to try it, here’s what you do.

Briefly, lovingkindness consists of repeating some simple phrases, silently, expressing good wishes. You can say whatever you choose, but Salzburg suggests some variation of  “May you be happy, may you be healthy, may you live with ease.” 

Because so many of us are our most severe critics, traditionally, we begin by offering these unconditional good wishes to ourselves: “May I be happy, healthy, live with ease.”

We then draw an ever widening circle, extending these sentiments to those we love, to friends and acquaintances, to problematic people whom we wish we could more readily accept, to strangers, and finally, to the entire world.

And the practice of lovingkindness is portable: traditionally, you sit on a cushion, but you can just as easily be walking on a crowded street.

Jack Kornfield, another leading educator, has written that some people find it difficult to begin with themselves:

“We may feel that we are unworthy, or that it’s egotistical, or that we shouldn’t be happy when other people are suffering.” 

If that’s how you feel, Kornfield says,

“Rather than start lovingkindness practice with ourselves, I find it more helpful to start with those we most naturally love and care about.” [Start where it’s easiest, he suggests.] “We open our heart in the most natural way, then direct our lovingkindness little by little to the areas where it’s more difficult.”

If you choose that sequence, you might then circle back to yourself after that. Or move on to people whom you find difficult. Eventually, you open your heart to strangers and to all living beings.

Real-World Examples

How can this approach affect our everyday behavior? Salzburg has a short series of videos depicting various scenarios. In “Street Lovingkindness,” she hones in on Grand Central Station in New York City, a hectic place, during Rush Hour.

But, says Salzburg, “Don’t rush. Take in the world. Look at the people,” and silently send your good wishes to strangers, possibly adding “May you be joyful, peaceful, contented.”

She has also noted: If you’re stuck in traffic because an emergency vehicle is snaking through, you might say to yourself “I hope whoever needs that vehicle is OK.”  

Standing in line, she acknowledges, can be frustrating. You want to move faster, to get somewhere. Instead of fuming,

“take a breath, savor the moment. Feel your feet on the ground. Notice those in front and behind you. Fully acknowledge each person [mentally]: ‘May you be joyful, peaceful, contented.’ Just as we seek happiness for ourselves, may all beings be at peace.”

Suppose you’re sitting in your car,  in a traffic jam.

“It’s stop-and-go, you’re making no progress. You’re frustrated, annoyed, stressed out, tired of being stuck. Pause, take a breath, feel your body being seated, your hands on the wheel. Look at the others, all moving together. ‘May we be safe, healthy, happy, be at ease.’”

Salzburg speaks of compassion to self as being restorative, rather than allowing ourselves to be overcome by events. She explores our thought processes: “I’m a terrible person.” 

How is my holding onto negative thoughts healing me?, she asks. Detaching and running doesn’t work.

We can’t automatically make our pain—physical or emotional—go away, but holding on to our fear and projecting into the future adds to our suffering.

(There’s an oft-repeated phrase among mindfulness folks: “Pain is inevitable; suffering is optional.”)

Compassion, she says, is a unifying experience. It sparks the impulse to help someone else: we’re all vulnerable in some way.

“When a person says, ‘I’m overwhelmed,’ having a sense of community is a tremendous asset. Doing it all alone is hard. That’s the context for this practice.”

If you’d like to listen to a delightful interview with Salzburg, click on this link. Sarah Jones is a gifted actor who creates believable, very diverse characters with her voice and motions. She interviewed her friend Salzburg, asking questions as several different personae.

It’s great fun to listen to. In something many of us can relate to, one of the points she made was “Most days I can barely stand to read the news. But when I do lovingkindness, there’s a shift.”

Salzburg stresses that practicing lovingkindness doesn’t always mean saying “yes.” If you see a street person asking for money,

“whether or not you feel giving the cash would be useful is one thing, but whether you look at that person as a human being is another.”

It’s not new that we feel good about ourselves when we show kindness to others. But it’s something to relearn. In the supermarket where I shop, a tall, thin man is responsible for herding all the shopping carts.

I assume his job is simply to bring order to the carts that shoppers leave wherever they choose (usually not where the sign says “Return carts here”).

But he goes well beyond that job description. He is unfailingly gracious, smiling pleasantly and offering everyone a cart who approaches the store, or relieving us of the need to return them to the intended area. 

Last week, as I was walking to my car, I had a sudden impulse. I turned around and walked toward him. He thought I needed a cart and was about to give me one. “I’m done shopping,” I said. “But you’re so good at your work, and so gracious and helpful, that I wanted to give you this.”

I won’t miss the money, and I’ll long remember the look on his face as he thanked me profusely and blessed me. It was a small act in the scheme of things, but it made both of us feel pretty darn good.

Salzburg has heard it all, and she says there’s a common idea that lovingkindness is stupid, or gooey, or yucky. I like Daniel Goleman’s term: Muscular compassion. And that should lead to action, Goleman said:

“The Dalai Lama often talks to people with great aspirations, and, after he’s gotten them all roused up, he says, ‘Don’t just talk about it, do something.’ That’s part of the message in my book: Everyone has something they can do. Whatever means you have to make the world a better place, you need to do it. Even if we won’t see the fruits of this in our lifetime, start now.”

My Wish for Each of You–and for Us All

As the new decade dawns, I repeat, as I did at the end of 2018, the words I’ve learned from Jack Kornfield and other mindful meditators:

May you be filled with lovingkindness;
May you be safe and protected;
May you be well in body and mind;
Strong and healed;
May you be happy.

And may 2020 find us in a country and world of greater unity, peace, greenness, and kindness. We can make small gestures to move us in that direction.

Annie

How One Woman’s Breast Cancer Experience May Revolutionize Cancer Care

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mammograms for early detection

I love to write about good news. I especially enjoy elaborating on advances in the world of science during these times when science is too often attacked. This story shares some qualities with my recent post about the extraordinary Nobel Prize Winners in Physiology or Medicine. 

Like the Nobel discovery, this one seems destined to save lives and dramatically reduce suffering. It’s the result of one brilliant woman’s using her own status as a breast cancer survivor to create potentially dramatic changes in the detection and treatment of the disease.

My new hero is Regina Barzilay, PhD. She isn’t a physician, yet she seems to be upending medical practice for the better through the use of artificial intelligence (AI).

Barzilay is a professor of computer science at the Massachusetts Institute of Technology (MIT) and a certified genius: in 2017, she was the recipient of a MacArthur Fellowship “genius grant.” 

She and her team, which now includes experts from both MIT and Massachusetts General Hospital (MGH), have created computer algorithms that predict the likelihood of a patient’s developing breast cancer in the next five years. 

The model they designed began with a database containing pathology reports of more than 100,000 women treated at MGH over 30 years. Barzilay and her team then “taught” the computers to provide specific information from mammograms of more than 60,000 patients. 

According to an article in MIT News, 

“Trained on mammograms and known outcomes from over 60,000 MGH patients, the model learned the subtle patterns in breast tissue that are precursors to malignant tumors.”

Barzilay told Susan Gubar, who wrote about this remarkable work in Science Times, the special Tuesday section of The New York Times, that

“machines work more effectively than human eyes. They can register subtle changes in tissue—influenced by genetics, hormones, lactation, weight changes—that we cannot see.” 

Barzilay showed Gubar the results of her own mammograms from 2012, 2013, and 2014. The cancer that was diagnosed in 2014 was, in fact, evident in the two previous views.

I found myself deeply touched by that information, imagining what it must have been like for her to learn her cancer could have been caught and treated two years earlier, and seeing how heroically she turned her personal knowledge into this bold campaign to prevent other women from experiencing similar anguish—or worse.

Gubar reports that

“The enthusiasm Dr. Barzilay brings to this undertaking is fueled by her dismay at current approaches to cancer care. While being treated at MGH, she was struck by the high degree of uncertainty surrounding treatment of her disease.

“Why did her questions go unanswered about how other patients at the same hospital with similar tumors fared with this or that drug or with this or that surgery? Why was there so little information?”

The apparent explanation was that oncologists rely on the results of clinical trials in determining treatment regimens. That’s not surprising; they seek evidence-based medicine.

The problem Barzilay saw was that the trials enrolled just about 3 percent of eligible women, meaning 97 percent weren’t part of the picture. 

Barzilay termed this approach a “primitive practice” that was a “travesty,” Gubar reports, “especially because large volumes of information about patients accumulate in every hospital.” (Emphasis mine)

But a stumbling block to the work she proposed was that the data are written in “free-text” English, rather than in a form a computer could process. That’s when she and her colleagues began building the databases.

In one study, the Barzilay team’s model identified 31 percent of patients as high risk for future breast cancer, in contrast with the existing clinical standard, which identified 18 percent. That difference encompasses a great many women.

Once this work is more fully implemented, the result, Gubar writes, will be that

“New patients will be empowered by learning how tumors with particular characteristics responded to specific treatments. Machines accessing subsets of the population will also make it faster and cheaper for clinicians to identify patients with particular disease characteristics and to enroll them in clinical trials.”

One particularly valuable aspect is that the cancers are detected regardless of the patient’s race—an important consideration in view of the much higher breast cancer mortality rate among African-American women.

According to Gubar, similar efforts are occurring at Google, where AI specialists are examining scans for lung cancer. It seems reasonable to me, as a nonscientist, that this approach is potentially replicable with all sorts of cancers. (I’d welcome hearing from anyone with expertise in AI, cancer, or the intersection of the two fields.)

Barzilay knows buy-in from oncologists is critical to this effort. She sought to learn whether oncologists were reaching out to AI researchers; when she found that they weren’t, she also made one of her aims to enlighten them about these new possibilities.

Writes Gubar:

“Dr. Barzilay and her collaborators want to usher in the day when no woman is surprised by a late-stage diagnosis and when all breast cancers are curable.

“They also hope to solve the problems of over- and under-testing. Instead of a one-size-fits-all practice, the frequency of screenings and biopsies could be customized with sufficient data.”

That could be a huge benefit to patients. For example, at present, the MIT article notes, there is a discrepancy in screening guidelines, with the American Cancer Society recommending yearly screening beginning at age 45, while the U.S. Preventative Task Force says screening should be every two years, beginning at age 50.

And for implications for individual patients, Gubar points to the young women she knows who are aware that they have an inherited BRCA genetic mutation, which can substantially increase their risk for breast cancer (as well as for ovarian cancer).

With great anxiety, they are contemplating prophylactic double mastectomies—although there’s no assurance that such drastic surgery is necessary for them. The numbers of such women are increasing now that genetic testing is so readily available. 

Barzilay’s work can help women better face this difficult decision. In responding to Gubar’s query about such affected women, she stressed:

 “With a CD of their scan, we would be able to tell them their personal risk.”

I wish Dr. Regina Barzilay a long and productive life as she continually refines and expands her invaluable work.

Annie

Here’s Why This 2019 Nobel Prize Is Breathtaking…

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Do any of the following apply to you?

—You’re hard-pressed to find some good news in the public sphere
—You’re troubled about the anti-scientist trends swirling around
—You have, have had, or know someone who’s had anemia
—You have, have had, or know someone who’s had a heart attack or stroke
—You have, have had, or know someone who’s had cancer
—You’d like to live in a place with a higher altitude than you currently can handle
—You’d like to improve your sports performance

If so, you may find the 2019 Nobel Prize in Physiology or Medicine as exciting as I do. And the above list of diseases and circumstances is merely the beginning of what scientists believe will be the impact of the work the Nobel Committee has just recognized.

The three recipients, two Americans and a Brit, pieced together a series of discoveries—their own and some preceding and/or complementing their work—to discern what one scientist called the “thermostat” that enables cells to regulate the amount of oxygen needed to do its work: convert food into energy. The Nobel Committee referred to this mechanism as “one of life’s most essential adaptive processes.”

As the Nobel Prize press release states:

“The fundamental importance of oxygen has been understood for centuries, but how cells adapt to changes in levels of oxygen has long been unknown.”

The “thermostat” the honorees discovered is comprised of a series of molecular occurrences by which cells sense too much or too little oxygen and respond accordingly.

Describing the Breathtaking Work

(From the Nobel press release)

“Thanks to the groundbreaking work of these Nobel Laureates, we know much more about how different oxygen levels regulate fundamental physiological processes. Oxygen sensing allows cells to adapt their metabolism to low oxygen levels: for example, in our muscles during intense exercise.

“Other examples of adaptive processes controlled by oxygen sensing include the generation of new blood vessels and the production of red blood cells. Our immune system and many other physiological functions are also fine-tuned by the O2-sensing machinery.

“Oxygen sensing has even been shown to be essential during fetal development for controlling normal blood vessel formation and placenta development.”

These are the three new Nobel Laureates:  William G. Kaelin Jr., MD, of Harvard University in Boston, Massachusetts; Gregg L. Semenza, MD, PhD, of Johns Hopkins University in Baltimore, Maryland; and Sir Peter J. Ratcliffe, FMedSci, of Oxford University in the United Kingdom.

Concerning the relevance of their findings to major diseases, the Washington Post  quoted Isha Jain, a scientist at the University of California in San Francisco:

“If you think of the main causes of death in the US, three out of five are related to lack of oxygen,” [including heart attack, stroke, and respiratory diseases]. “Understanding how the body senses and responds to low oxygen is pretty fundamental to all these diseases.”

Semenza said he and his colleagues hope that new therapies may increase the passage of blood into tissue with reduced blood flow “in diseases such as coronary heart disease and also limb ischemia, which is a major problem, particularly in diabetics, leading in some cases to limb amputation.”

And then there’s cancer. The Nobel press release explains:

“The oxygen-regulated machinery has an important role in cancer. In tumors, the oxygen-regulated machinery is utilized to stimulate blood vessel formation and reshape metabolism for effective proliferation of cancer cells.”

Semenza told the Associated Press:

“Whereas most of the chemotherapy drugs are designed to kill dividing cells that are well oxygenated, there are no treatments that are approved to treat the hypoxic cells within the cancer. We believe it’s these cells that survive the therapy and come back and kill the patient.”

From “Bench to Bedside”…

Or from lab to life-saving: such action is well under way, the press release reports.

“Intense ongoing efforts in academic laboratories and pharmaceutical companies are now focused on developing drugs that can interfere with different disease states by either activating, or blocking, the oxygen-sensing machinery.”

The first clinical application, a drug to combat anemia, was recently approved in China, and it is now under consideration in several European countries.

Semenza’s work was seminal to the total effort. In the 1990s, he and his group identified genes that were activated when oxygen levels were low to raise the levels of erythropoietin (EPO), a hormone secreted by the kidneys essential to producing the oxygen-laden red blood cells.

The oxygen-sensing mechanism was originally believed to be located only in the kidneys, but both Semenza and Ratcliffe subsequently found, among other things, that it exists in nearly all cells.

Moving from the profound to the less-so, The Washington Post notes that:

“This is the same basic mechanism behind doping, in which endurance athletes try to increase their supply of oxygen-carrying red blood cells.”

Though Semenza’s early article describing that research has now received thousands of journal citations, it was initially rejected by the “top tier journals,” which, he said, “didn’t find it to be of sufficient interest to warrant publication.”

(A note of encouragement to all who aspire to publication in any field of endeavor, don’t you think?)

For those who are interested in the scientific nitty-gritty, the Nobel release provides the road map of individual discoveries by the three researchers and others that yielded this dramatic finding.

Lessons Beyond the Discoveries Themselves

One of the things I especially like about this story is that these men, while working independently over decades, also shared their unpublished data with one another—“sometimes at scientific meetings, sometimes at the bar,” said Kaelin.

No secret patents here; no rivalry to be “the first.” As one made a discovery that he knew was an important piece of the puzzle, he described it to his colleagues.

I’ve no idea whether, or to what extent, this collaborative approach was influenced by their funding sources, but it’s worth noting that a National Institutes of Health (NIH) press release touted the US government’s role in supporting both American scientists’ work, and the American Heart Association stated it underwrote Semenza’s early work. The European Research Council (ERC) supported Ratcliffe’s work.

Two more issues are worth noting. One is that Semenza, who is a professor of genetics at Johns Hopkins, credited his wonderful high school biology teacher, the late Rose Nelson.

“She used to say to us, ‘When you win your Nobel Prize, I don’t want you to forget that you learned that here.’ She just assumed that one of us was going to do that…She was my inspiration, and I think that is the importance of teachers, to serve as that kind of spark.”

The other is Kaelin’s emphasis, as the Washington Post reported:

 “The prize underscores the importance of doing research to follow curiosity and unravel basic biology. He and the other scientists hoped, but did not know, that unraveling how cells sense oxygen could spark ideas for new approaches for human diseases, including stroke and cancer.”

Said Kaelin:

“This kind of research is increasingly under threat. It’s much easier for fundraisers and policymakers to say we will support scientists, but…tell us how it will improve outcomes in five years.

“When you’re doing real science, you have to be prepared to take the road where it takes you—and if you’re doing science, it’s hard to predict where the road is going to take you.”

Will you join me in a virtual round of applause for scientists dwelling for decades on basic research, facilitated by public funding?

Their research won’t always take us where these three eminent researchers have—but when it does, the benefits to us, individually and worldwide, can be immeasurable.

Annie

A Very Different Tumble Into the Weeds…

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Here I go again! Only this time, I’m eager to join the action…I think.

As you may know, in two previous posts, I’ve written about my ambivalence concerning the legalization of marijuana. Each time, I got new subscribers among the happy pot community, who somehow overlooked my ambivalence (or seized on my description of my single, and singular, pot experience) and adopted me as a kindred spirit.

That’s fine; I welcome anyone who’s interested in what I have to say—and I would be happy to have them join our dialogue, though so far they’ve merely silently “liked” my posts.

For the record, in researching a response to a comment after my second post on the topic, I came across an LA Times Op-Ed that stressed we know much less about the impact of marijuana than we might because the federal government has for so long forbidden its use—even for research.

I found that editorial persuasive, so I’ve moved from ambivalence to being cautiously OK with legalization. I am also bowing to the inevitable, and hoping legalization does all the good things proponents claim (like diminishing the racial injustice in prosecutions and reducing the power of drug lords).

But I still worry about young brains because that’s where the most deleterious effects of use occur. In fact, though many states have passed legislation legalizing marijuana for individuals age 21 or older, some experts say it should be 25 because the developing brain is still deeply affected until then.

That’s not my purpose here, however.

Today we’re talking CBD (cannabidiol), derived from the part of the marijuana/hemp plant that, unlike THC (delta-9-tetrahydrocannabinol), doesn’t create a high.

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Courtesy of Pixabay.com

Interestingly, though the federal government continues to consider marijuana illegal, it holds a patent for CBD; National Institutes of Health scientists found several decades ago that in test tubes, an in-depth Sunday New York Times Magazine article reported,

“…the molecule shielded neurons from oxidative stress, a damaging process common in many neurological disorders, including epilepsy.”

That finding has been validated, as described below.

And now there’s a federal law legalizing CBD products made from hemp, provided they contain 0.3 percent or less of THC.

Unless you’ve adopted a net-free existence on some desert isle, the chances are you’ve heard about CBD. It’s available everywhere, purportedly for everything that ails you, from back pain to anxiety to alleged cancer cures (the FDA cracked down on that one), to social phobia (that’s in the testing stage). My dentist is now selling it in his office, for goodness sake!

While CBD seems to have taken the country by storm, thus far its efficacy has been documented only in treating epilepsy in children; it’s FDA-approved for that indication.

But according to a Consumer Reports survey, 64 million Americans have tried CBD in the past year, and most said it was effective, particularly for anxiety. Almost three-fourths reported no side effects,

Based on anecdotal evidence and what I’ve read to date, I’ve been intrigued by the prospect that it might be helpful to me by a) reducing the frequency of my migraines; b) relieving my stomach issues that I know—as one of a long line of “gut” people—have an anxiety component; and c) alleviating my arthritic knee pain, thereby forestalling my need for a second knee replacement, which I most emphatically don’t want to have.

I discussed the possibility of my using CBD with my neurologist, a superb physician/researcher and compassionate soul.

He said he had no objection to my trying it, and it had, in fact, helped some of his migraine patients. However, he hasn’t sought a license to prescribe it because it isn’t evidence-based for migraines at this point. He referred me to a neurologist who does prescribe it.

I made an appointment. For a mere $750 initial visit (this doctor doesn’t accept Medicare), he would take my migraine history, give me a thorough exam, and hand me a prescription to a dispensary he deals with.

But when I looked over the forms I was to complete before seeing this new physician, I realized that none of the questions were relevant to me. I do get more migraines per month than my neurologist and I would like, but I don’t suffer from them. That’s due to the wonders of the pharmaceutical industry.

Yeah, they’re doing lots of awful things with pricing, and regulation is clearly needed. But I must acknowledge that the appearance of sumatriptan decades ago transformed my life.

Before it, I lost full days to intractable pain and nausea that made me think: If only the nausea would go away, I could tolerate the pain. Now, I feel a twinge, take a pill, and I’m good to go ten minutes later. So I didn’t need this new doctor’s extensive questioning, to which I would repeatedly respond with NA (not applicable).

I also didn’t need a thorough exam, as I’d just had one in the very capable hands of my neurologist’s fellow—under his guidance.

So the second thoughts arose, and not solely from my wallet, which was sending clear question marks to my prefrontal cortex, something along the lines of “Are you nuts? Paying $750 for a prescription to take to a pharmacy?”

I cancelled the appointment and sought my neurologist’s advice about how to proceed. He hadn’t known his colleague didn’t accept Medicare. When I explained why I cancelled, he said: “For you to spend $750 to get handed a prescription to take to a pharmacy is nuts!”

Most people buy CBD independently—without a doctor’s involvement. I felt concerns about that approach because this is an unregulated market. It’s caveat emptor: Let the buyer beware!

With the gold rush out there, the unsuspecting consumer may be buying a product that has too much or too little CBD, and/or it may be adulterated.

For example, The New York Times described a graduate student in Virginia who complained of a “heart-pounding, hallucinogenic high he had neither expected nor wanted to have.”

Testing revealed he had vaped a liquid containing CBD, but it also contained a synthetic compound, 5F-ADB, that the Drug Enforcement Administration has associated with anxiety, concussions, psychosis, and even death.

So I was concerned about quality and dosage. Actually, I was more concerned about dosage because I had located a few sources that seemed reasonable, including my dentist, who assured me he’d fully investigated the purity of the products he planned to sell.

I’m also considering two other possible sources: one is owned by a Florida pharmacist who developed the product and seemed very cautious when I heard her on an NPR discussion; another is being frequented by many parents of children with epilepsy, who spoke highly of it in that lengthy Sunday New York Times Magazine article.

That left the question of dosage, and my neurologist said he’d do some research and advise me about what would be appropriate.

So stay tuned for the next installment of “Annie Goes for the Gummies.” I’m not sure why, but one of the companies under consideration offers many of their products (for adults) in the form of Gummies. Should that send me a warning signal? I’m fine with a tincture under my tongue, as some friends have described, or a capsule, or a cream for my knee. But Gummies? (And yet, I occasionally indulge a strong desire for Swedish Fish, suspecting that my body sometimes has a weird need for red dye #whatever, so maybe the Gummies hold some promise…)

If you or someone you know has had experiences with CBD that you’re willing to share, I’d love to hear about them.

Annie

The Democrats’ Debates Were Disappointing, and Yet…

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Candidates in Second Democratic Presidential Debates 2020

My Oh My! So much drama—even attacks on No Drama Obama!

Let me state at the outset that I had never intended to become so overtly partisan in this blog. I even wrote a post a while back explaining why I wouldn’t discuss the elephant in the room (President Trump) because so much stuff was appearing elsewhere, and I wanted to focus on finding our common ground.

My overarching goal remains, and in my own way, I’m still trying to do that.

When the President is an incumbent, it’s assumed the election is a referendum on him. But now that this President has made blatantly racist attacks on people of color a feature of his daily rants, I believe the 2020 election is a referendum on us.

Who are we as Americans? What kind of country do we look forward to, and how devoted are we to working toward a more perfect union?

Will we give our seal of approval to this man for another four years? I know some of you reading this post are Republicans with varying degrees of support for Trump. I’m not attacking you personally or trying to change your minds. 

Rather, I’m assuming that most American voters—Democrats, Independents, and growing numbers of “Never Trump” Republicans—are seeking a reasonable alternative to Trump and want to see Washington functioning again to pass common-sense legislation in their behalf.

I believe/hope that people are eager to denounce him at the ballot box, proving that he doesn’t represent the vast majority, and that we are seeking leadership that unites us in hope and common purpose, rather than divides us in hatred and fear.

In that spirit, I offer you my thoughts after viewing the second round of debates—and I’ll explain why I found them sorely lacking.

It’s still early, but I saw little inspiration among the 20 candidates on the stage in Detroit. Part of the problem, I believe, was CNN’s approach.

It was clear that CNN wanted a food fight: the questions were designed to encourage candidates to attack one another. I didn’t think that was good TV. I also thought it was poor broadcast journalism and unhelpful for educating the public.

Admittedly, it’s tough to stage interesting debates among 10 candidates, and I felt bad about how little time each person had to make her/his points. 

But the questions were also unrevealing in eliciting what kind of Presidents they would be. 

Healthcare is a critical issue; it was largely responsible for the Democrats’ winning the House in 2018. Americans want to know they will have decent health care that covers preexisting conditions, is within their means, and is dependable, regardless of their circumstances. 

The discussions were sometimes too wonky and confusing for viewers and at the same time often inadequate, leaving out important issues, such as cost to taxpayers.

I wish each candidate had given this answer: “We’ll bring the best minds together to come up with the most realistic affordable plan that covers the most people possible.” 

In other words, we’ll progress beyond Obamacare without gutting it, adding the public option that was originally intended, and regulating both the insurance companies and Big Pharma.

Many other countries have private insurance companies as part of their healthcare mix; they simply regulate them more aggressively than we do.

Medicare for all vs “Anything less lets insurance companies ruin America” is to me an unnecessarily divisive issue.

I think improving Obamacare would satisfy most Americans—without frightening them.

And how quickly people have forgotten how hard that battle was—that passing the legislation was a “big f—–g deal,” in former VP Joe Biden’s memorable words. More about all-important processes appears below. 

If the public option works as intended, we’ll get to Medicare for all but won’t immediately send our economy into a tailspin.

Healthcare is now about 18% of our GDP. We need a smooth transition to the next stage. I haven’t heard any Medicare for all candidate discuss this point.

But most importantly, the emphasis should be on the fact that every Democratic candidate believes that healthcare is a right and supports expanded coverage, while Trump and the Republicans have been decimating Obamacare and, in all the years they claimed to find an alternative, have not done so.

It is simply not an article of faith in the Republican Party as it is among Democrats. Quite the contrary. 

As the terrible mass shootings mount up, I can’t write this post today without including sensible gun legislation. This is another issue where the majority of the public agrees, and so do all the Democratic candidates.

Not so the Republicans in Congress and the President. And despite his palliative words after the most recent shootings, since Trump took office, we’ve had a substantial uptick in domestic terrorism. We know white nationalists claim him as one of their own. If he cared to change that image (and possibly reduce the carnage), he would change his rhetoric.

With gun safety legislation, again, process is critical, as we’ll discuss below.

Foreign policy, which is probably the most important aspect of a President’s efforts, and is currently fraught with dangers that Trump both inherited and has created, took up a mere five minutes of the 2-1/2 hour debate.

I am puzzled why, just shortly after the Mueller testimony, CNN felt that discussing the role of Russia was barely worth mentioning. And there were no discussions of Iran, North Korea, Syria, and other potential hot spots.

Since a number of the candidates have had little or no direct involvement in this essential component of being President, it behooves the next debate organizers to build in adequate time and questions that reveal the candidates’ world views and thought processes. 

I was impressed, for example, with Washington Governor Jay Inslee’s stating that he voted against entering the war in Iraq when he was a member of Congress. (He took Vice President Biden to task for voting for it.) 

Inslee said the arguments for war were unconvincing. In an interview after the debate, when he was asked why so many Democrats voted to go to war, he explained that in the post-9/11 environment, the drumbeats for war were very difficult to withstand. But he did withstand them—a fact that to me says a lot about the man.

Speaking of Inslee brings us to climate change, which he has made the focus of his campaign —though not as a single issue: he has tied it to economics, undue burdens on poor and minority communities, and other important topics.

He has thought and studied the issue extensively and is clearly the candidate most deeply committed to quick concrete actions to confront climate change.

And while it’s good that every Democratic candidate accepts the scientists’ warnings and promises to act, I find his commitment especially comforting. 

One extremely critical issue hasn’t come up in either debate: the judiciary. 

I am quoting extensively here from two articles. One, by Dahlia Lithwick, is titled “Democrats Still Haven’t Learned Their Lesson About the Courts.”

The other, which she cites, written by Ezra Klein, is “Pete Buttigieg had the most important answer at the Democratic debate.”

I find them both important in terms of those critical process matters I referred to earlier, and I hope you’ll read them in their entirety.

Let’s start with Klein’s article in Vox. Here’s where reality lies—beyond fine policy ideas and whether they’re progressive enough.

“South Bend, Indiana, Mayor Pete Buttigieg gave the single most important answer at Tuesday’s Democratic debate.

“It came after a lengthy section in which the assembled candidates debated different health care plans that have no chance of passing given the composition of the US Senate and then debated decriminalizing unauthorized border crossings, which they also don’t have the votes to do, and then debated a series of gun control ideas that would swiftly fall to a filibuster and, even if they didn’t, would plausibly be overturned by the Supreme Court’s conservative majority.

“That’s when Buttigieg spoke up:

‘[This is] the conversation that we have been having for the last 20 years. Of course, we need to get money out of politics, but when I propose the actual structural democratic reforms that might make a difference — end the Electoral College, amend the Constitution if necessary to clear up Citizens United, have DC actually be a state, and depoliticize the Supreme Court with structural reform — people look at me funny, as if this country was incapable of structural reform.

‘This is a country that once changed its Constitution so you couldn’t drink and changed it back because we changed our minds, and you’re telling me we can’t reform our democracy in our time. We have to or we will be having the same argument 20 years from now.’”

Klein continued:

“So far, I’ve found Buttigieg’s campaign underwhelming on policy. But where he’s clearly leading the field is his emphasis on structural reform. Buttigieg isn’t the only candidate with good ideas on this score — Elizabeth Warren and Jay Inslee have been strong on this too — but he’s the only candidate who consistently prioritizes the issue.

“The reality is Democrats are debating ever more ambitious policy in a political system ever less capable of passing ambitious policy — and ever more stacked against their policies, in particular.

Their geographic disadvantage in Congress is only getting worse, Republicans control the White House and the Senate despite receiving fewer votes for either, and an activist conservative Supreme Court just gutted public sector unions and green-lit partisan gerrymandering.

“Policy isn’t Democrats’ problem. They’ve got plenty of plans. Some of them are even popular. What they don’t have is a political system in which they can pass and implement those plans.

“Buttigieg, to his credit, has a clear theory on this. When I interviewed him in April, he argued that ‘any decisions that are based on an assumption of good faith by Republicans in the Senate will be defeated.’

“The hope that you can pass laws through bipartisan compromise is dead. And that means governance is consistently, reliably failing to solve people’s problems, which is in turn radicalizing them against government itself.”

Now let’s briefly look at Lithwick’s article in Slate:

“We now know that a single Trump judge can gut the Affordable Care Act, or permit a wall to be built on the Southern border, or try to end Roe v. Wade.

This isn’t a thing to contemplate after a Democrat wins the presidential election. It is, with every passing day, the reason to doubt whether any Democrat can win the presidential election ever again. And the same is true for the Senate, and for the House. Which is why it has to be a first-order discussion, not last. 

“As Klein wrote: ‘This is what Buttigieg gets: To make policy, you have to fix the policymaking process. Some of the other candidates pay that idea lip service, when they get pushed on it. But he’s the one who places that project at the center of his candidacy.’

Lithwick concluded:

“The Democrats on the debate stage are embarrassed to be caught out without answers to questions about battles that their constituents cannot afford for them to continue to lose. Democratic voters showed up in 2018 in part because of their horror at losing the Supreme Court.

Sure, it’s embarrassing that Democrats have been badly outplayed by Mitch McConnell, who follows no norm or judicial ideal beyond ruthless pursuit of power.

“But it should be more embarrassing that reforming the courts has been deemed too hard to warrant a single debate question. By all means let’s talk about Trump and impeachment and ‘kitchen table issues’ and the environment; they all matter.

But the fact that the machinery of justice has been captured by a monied minority means that democracy itself is on the ballot. That should matter enough to warrant a question.”

All this is why I found the debates so disappointing. While the candidates were attacking each other—and President Obama, through Joe Biden—and discussing their plans for what they’ll accomplish once they become the President, for the most part they didn’t talk about these huge, powerful forces at all. 

And this is where their energy—and ours—is essential.

I intend to vote for whoever wins the Democratic nomination, hoping that person is sufficiently inspiring to energize a broad swath of diverse constituents.

I think the divisions between moderates and progressives figure less in most voters’ minds than does their sense of the decency, competence, integrity, and leadership skills of the individual they’d like to see in the White House—especially now. 

Thus, I believe it is essential that we try to defeat Trump with the largest possible mandate, demonstrating total rejection of his racism—as well as his corruption, incompetence, divisiveness, and unwillingness to protect the US from those who have directly threatened our elections and are continuing to do so. 

But clearly that’s not enough. It is so important that we educate ourselves and make our voices heard about these structural issues that are making it difficult, if not impossible, to get anything substantive done in Washington.

Democrats need to take the Presidency, House, and Senate, and then focus on the critical changes needed—before a minority party eliminates any chance of the majority’s will being enacted. 

These are large challenges,  but while some of the candidates talk about the need for “Big Ideas,” we need to let them all know what those big ideas must include. We made it to the moon 50 years ago, you’ll recall. We can do this.

And we must.

Annie