Pain, values, compassion, and a dying dog

“Grief can be the garden of compassion. If you keep your heart open through everything, your pain can become your greatest ally in your life’s search for love and wisdom.”

 — Rumi

Just about three years ago, I wrote a blog post titled “Pain and values: two sides of the same coin” about our amazing dog Dalai. That post turned out to be one of the most popular pieces I’ve written. I wrote about the simultaneous, and I would say inseparably linked, love and pain that was consistently present for me when I was with Dalai, who was somewhere around 17-18 years old at the time. Because so many people have talked to me about that piece, I thought I would share an update and also some new thoughts I have on the topic of pain and values. If you want to read the original piece, you can find it here.

Dalai is still here, and so is the pain.

Believe it or not, Dalai is still with us, and at around 20+ years old, I’d say that little old lady is doing something right! She comes to work with us every day, usually riding in a trailer pulled behind the bike. She was diagnosed with thyroid cancer about a year ago and has been on palliative care since. With the help of our amazing veterinarian, Heather Dillon, DVM, we’re able to manage her physical pain quite well and Dalai still has a wonderful quality of life.

And though I feel incredibly fortunate that Dalai is still with us, so too is the pain, anxiety, and sadness I feel when I think about what is to come. In fact, it’s difficult to admit, but there are even times when the pain is so intense that I notice having the thought that I wish it was over. Then of course I feel incredible pain at having that thought and the cycle goes on.

Compassion as palliative care

In my last post about this, I focused on the idea that I can’t move in the direction of my values if I’m not willing to experience painful thoughts and feelings – If I’m not willing to have those painful thoughts and the sadness that shows up when I’m with Dalai, I can’t care for her in the way I would choose to during this time in her life. The only way to get away from these difficult thoughts and feelings is to not be around her. And while it’s still very painful for me to be around Dalai, I’m not willing to give up one moment I could have with her just to avoid that pain. And in these past few years as both she and I have been working through the process of her aging and dying, I’ve learned a few things about how I want to be with that pain. So I thought I’d share something that for me has become an essential component in that equation of values and pain– compassion.

Just as my loved ones and I have been very intentional over these past several years about attending to Dalai’s physical pain as best we can, it’s also been helpful for me to attend to the emotional pain that those of us who love Dalai feel as we see her dying. Compassion, which literally means “to suffer together”, is a willingness to be present to suffering (another’s or your own) and a desire to ease that suffering. Compassion, including self-compassion, is my palliative care. It is what I am using to help ease the suffering my loved ones and I are feeling. Even though I help people develop self-compassion and be intentional about their values for a living, I found that although I wasn’t avoiding being with Dalai in order to avoid feeling the pain, I wasn’t fully present to it either; it was more like, “Well, that’s there and there’s nothing I can do about it, so I’m just not going to think about it.” And that can be helpful at times. But that isn’t how I treat others that I love when they are in pain and it felt incongruent with my values to treat my own pain in that way. So, over the past couple of years I have focused more and more on using compassion exercises in my own life, as a way to not only ease the pain I am feeling, but also honor it.

Quick self-compassion break

One of my favorite compassion exercises that I’ve incorporated into my life is Kristen Neff’s Self Compassion Break. The self-compassion break exercise gives me a way to treat myself with gentleness and kindness and also connect to the common humanity that is suffering. It is very quick and you can do it anywhere, which is great given that pain does not conveniently just show up when I have time to do a 30 minute compassion meditation. You can find an audio of the exercise here and a written script here. So next time you notice struggling with painful thoughts or feelings, especially when you know they are linked with something you care very deeply about, you might consider giving this exercise a try. And If you’re interested in reading more about compassion, my colleagues Jason Luoma (who also happens to be Dalai’s guardian too!) and Melissa Platt and I have a site dedicated to our work in that area called “ACT With Compassion” that you can check out here.

Thomas Merton once wrote that “Compassion is the keen awareness of the interdependence of all things.” When I am practicing compassion, I also often notice being more connected to all beings, including that little old dog at the heart of this all.

Serving Those Who Have Served: Caring for veterans and their companion animals

“Thank you for your service!” How many of us have offered these words of appreciation when we see a service member in uniform? And they are appropriate, albeit vastly insufficient words. But as I was perusing Upworthy on Veteran’s Day morning, I came across stories of two amazing organizations that are expressing their appreciation to our veterans in a much more profound and tangible way. While there are many groups out there doing fantastic work serving veterans, these two groups, PACT for Animals and Pets for Vets, are doing so in a somewhat different way.

PACT for Animals is a non-profit that provides temporary foster homes for the pets of military services members when they are called for deployment. They also foster pets of those who are hospitalized and are temporarily unable to care for their pets. By fostering these animals, they not only offer piece of mind for those serving our country that their companion animal won’t end up in a shelter and that they will be well loved until they can be reunited, but the foster families also provide regular updates to pet owners, including photos, messages and videos of their beloved pets. Check out this Upworthy video to see the amazing work this group is doing. Given the incredible sacrifices our veterans have made to serve our country, it seems to me that doing what we can to make sure their loved ones, including their four-legged loved ones, are taken care of while they are deployed is the least we can do.

Pets for Vets is dedicated to supporting veterans and providing a second chance for shelter pets by rescuing, training and pairing them with veterans who could benefit from a companion animal. The group takes animals from shelters that would otherwise be euthanized and then professional animal trainers rehabilitate the animals and teach them good manners to fit into the veteran’s lifestyle, whether that be desensitizing them to wheel chairs, being of assistance to someone with a TBI, or being an emotional assistance animal to someone struggling with PTSD. Check out this Upworthy video on the project.

Although research in this area is still somewhat preliminary (and antecdotal opinion seems to have gotten ahead of the data), there is growing evidence of the physical and mental health benefits companion animals can provide. Groups like PACT for Animals and Pets for Vets are harnessing the healing power of pets as a way to serve those who have served our country. On this Veteran’s Day I wanted to take a moment to express my appreciation not only to those who have served, but also those who support those who have served in all the various ways we do that, from my incredibly dedicated colleagues who work at VAs to groups like PACT for Animals and Pets for Vets. Thank you ALL for serving in the way that you do.

Research graveyard may come to life

“If enough data is collected, anything may be proven by statistical methods”

Williams and Holland’s Law

It’s an amazing day for scientific research! Hold on, don’t leave me yet. I know I typically try to post things here that are inspiring or at the very least interesting and directly applicable to your everyday life. And the behind-the-scenes politics and procedures of conducting scientific research generally wouldn’t be thought to fall into the “inspiring” category. But trust me, this matters to you!

The All Trials Campaign has organized experts from around the world who are demanding that all unpublished data from clinical medication trials be published and all misreported data be formally corrected. Just this month, the British Medical Journal (BMJ) and PLOS Medicine have taken up the call of the “Restoring Invisible and Abandoned Trials” initiative (RIAT), endorsing the proposal that sponsors and researchers begin publishing the results of their previously confidential clinical trial documents within one year. If they fail to take these actions, RIAT would call for independent scientists to publish those previously confidential trial documents.

To understand why this is such a potentially momentous move, it’s helpful to first understand a bit about how the world of scientific publishing works. At the heart of the problem is the fact that, in general, only studies that find “significant” results get published, and here the word “significant” means that the study found that the particular drug/intervention/treatment being tested was effective. On the surface this practice seems to make sense. I mean, would you sit down to read a newspaper that had a bunch of titles like “Nothing at all happened in Portland last night” and “Nobody did anything of significance in Congress yesterday” (ok, well, maybe that one doesn’t seem like a stretch!). Those of us who read journal articles to get our news about the latest developments in our field want to spend what little time we have reading articles about treatments that actually seem to work. We’re generally less interested in studies that fail to find that a particular treatment works. The result is that studies showing that a treatment doesn’t work, or worse, caused harm, are often unpublished.

However, the problem with state of affairs is that it gives health care providers and the public very skewed information. For every study we hear about that shows a particular drug or treatment supposedly works, we never know about the potentially countless other studies that showed that it didn’t work, or even that it caused harm. And the picture gets even more worrisome when you take into account how most research is funded in the first place.

The vast majority of scientific researchers are only able to do their work through grant funding (though we have a different model here at Portland Psychotherapy for funding our research which you can read more about here). One way this happens is that a researcher, who is very interested in a particular treatment, spends months writing and rewriting a grant application to ask some institution, such as the National Institutes of Health (NIH), essentially asking them for money to study their idea. But even more frequently, it isn’t the NIH or some other arguably unbiased institution that is funding research. As funding from places like the NIH have dropped drastically in recent years, “industry funded research” (e.g. research paid for by a company that is highly invested in its outcome) has soared, with industry-funded research in universities increasing 250% from 1985 to 2005. Increasingly, researchers are paid by a particular company, often a big pharmaceutical company, who has a vested interest in showing that their product (e.g., their drug) is effective.

Now let’s return to the problem of only publishing “significant” findings. If only those studies that show a “significant” result (e.g. that the drug “Y” was more effective than placebo) are going to be published, the company has every incentive in the world to just keep funding study after study until they finally get one that shows the result they want, not because it is a real result, but because of the natural variation and error that is part of research.  And these companies have the deep pockets to do that. So theoretically, they could fund 100 clinical trials and even if they only found a “significant” result in 1 out of 100 studies they ran, that one “significant” finding gets published in a journal, health care providers read about it, the press picks up on it, there are ads in magazines touting the positive findings, and now it’s the new wonder drug. However, the 99 other studies showed that drug “Y” was ineffective were never published.

From a consumer standpoint, would you purchase something if the advertisers told you that 99 times out of 100 it was shown to be completely ineffective? No, we’re more likely to buy (or in the case of health care providers, prescribe them to our patients) products when they are backed by claims like “Clinical studies prove that drug “Y” significantly reduced symptoms of X”. What the RIAT initiative will do is give us a more complete picture so that we can know about the studies that showed that a drug or other product was harmful or ineffective, versus only hearing about the studies that happen to work out.

Unfortunately, the RIAT initiative doesn’t have the ability to force drug companies or researchers to publish their negative findings. However, it does shine light on this incredibly important issue and, if the public demands it, will put new pressure on researchers and the industries to commit to making ALL their data available. This will allow researchers do what they are meant to do, be scientists, rather than being PR machines for companies with very deep pockets.

If I’ve convinced you here that this issue really does impact you and you’d like to read more about this problem of only publishing “significant” findings, you can read this great, in-depth article on the topic published in Scientific America.

You can also sign the petition to support the All Trial Registry here.

What’s love got to do with it? Arguments for the use of “love drugs” miss the point

“Oh what’s love got to do, got to do with it?
What’s love but a second hand emotion.”
Tina Turner, singer

That spark gone between you and your partner? No need for couples therapy. Struggling to find love? Forget match.com. Science hopes to bring you a new solution to all your love woes… “Love Drugs.” Could it be possible that we could just take a pill that would make us fall “in love” or fall “out of love” with someone? Maybe. To me that question misses the whole point.

This topic came to my attention a few weeks ago as I was listening to a radio program on the Canadian Broadcasting Corporation. The host was interviewing Brian Earp, MSc., an ethicist from Oxford who is writing a book on the “neuroenhancement” of love and marriage. In the interview, which you can listen to here, Earp cites research into the use of synthetic versions of various neurochemicals including oxytocin and dopamine which are purported to increase feelings of “love” and bonding in both human and non-human animals. The crux of Earp’s argument for the use of such drugs is essentially that we humans are not “naturally” monogamous animals and thus these drugs can help couples work against that “nature” in order to maintain monogamous relationships.

Earp’s colleagues at Oxford, Savulescu & Sandberg have written an interesting article in the journal Neuroethics in which they review what they think are the arguments for and against the use of such drugs.  While they ultimately come down on the side of supporting the use of such “love”-enhancing drugs, some of the arguments they cite against the use of such drugs include concerns about addiction and adaptation, the risk that they could be used in a non-consensual or coercive manner, and questions about whether or not the feelings produced by them could be considered “authentic.”

To me, these aren’t the most important questions. For the purposes of this post, I’m going to set aside the whole issue of whether or not we as a society should only value one form of relationships–monogamy. That’s for another post at another time. An even more basic question can be summed up by the wise philosopher known as Tina Turner: “What’s love got to do with it?”

Earp and his colleagues’ whole argument is based on the idea that “love” is a feeling. Furthermore, from their point of view, it’s the feeling of “love” that determines our behavior. However, contextual behavioral scientists (CBS) (a group which would include ACT therapists) suggest that it might be more useful to view “love” as a verb, as a series of behaviors in which we are free to engage at any point, without needing a particular feeling first. Coming from a CBS framework, since feelings are largely out of our control, assuming that a particular feeling must be present in order to engage in a valued behavior is simply an unworkable assumption.

If you’ve lost me in the science speak, hang in there with me. Here is the point… As both a scientist and a human, I truly don’t care if my partner feels like he loves me, especially since I would contend that his feelings are simply the result of various neurochemicals in his brain and thus he isn’t freely choosing to have or not have them. Rather I care that he IS loving to me. Love as a verb, not a feeling. And if I say I “love” my niece and nephew, what I mean is that I choose to be loving towards them, to treat them with kindness, protection, and patience, even when they are being difficult or mean and I don’t really FEEL loving towards them. Love often occurs during those times when we don’t necessarily feel loving, when we don’t feel an emotion that Earp and his colleagues would call “love”.

This is an age-old problem in the field of psychology. We are told that we need to work on feeling a particular way in order to behave in a particular way. You can see examples of this message all over our society. You need to feel good about yourself and then you’ll treat yourself well.  You need to feel less depressed or less anxious and then you can engage with life in a way that would be meaningful and vital for you. You need to feel “love” in order to be in a loving, committed relationship. I maintain that these are unworkable assumptions. Instead of having changeable feelings in the driver’s seat, I’m interested in helping people to live and love well and take the feelings along for the ride.

For me, rather than arguing whether the use of “love drugs” is ethical, I would say that it’s simply part of an unworkable assumption. I would rather help people explore whether, if they were completely free to choose (not based on what society says and not based on the particular feelings or urges they happen to have at this moment), would they choose to maintain a committed relationship? If this is a value that they would choose, then I want to work towards helping them live that value, regardless of passing feelings, feelings produced by synthetic chemicals or otherwise.

What’s good for your garden may also be good for your relationship

“Though the problems of the world are increasingly complex,the solutions remain embarrassingly simple.”

― Bill Mollison, Founder and director of the Permaculture Institute

The other day when I was out for my morning walk I saw the season’s first crocuses peaking their bright yellow heads out from the still muddy, cold ground. And so, spring is on my mind, even if it’s not exactly in the air yet. And in our household spring means tending to our garden that will nourish us well into the fall.

When planning our garden, we had to take one very important factor into account: We are both pretty lazy gardeners. We would much rather spend time at the table relishing in wonderfully fresh fruits and vegetables that come from our garden than we would toiling away pulling weeds and watering. Fortunately, we took this into consideration as we planned our garden and we designed much of our garden around the principles of permaculture.

In permaculture, the idea is to design self-maintained and sustainable ecosystems which are modeled from the natural environment. In other words, keep it simple, tend to the basics, and follow the path that mother nature has charted for us.

And it turns out that works well in the garden, may also serve us well in our relationships.  I recently came across an article by Kim Millar, a relationship coach in the UK and an avid permaculturist, entitled “Do you mulch your relationships?” In it, she talks about how various permalture principles such as designing for cooperation rather than competition, and using the least effort to create the biggest effect, may be just as effective in producing abundant, sustainable relationships as they are at producing abundant, sustainable gardens.

One of the core ideas in permaculture is to start with identifying a long-term vision for what you eventually want your garden (or in this case your relationship) to yield. That vision then guides how you design the environment so that it will naturally nurture what you are wanting to produce.  Permaculturists are in it for the long haul. This is not the kind of gardening where you choose some pretty already-in-bloom annuals from Home Depot and watch them die in a few short months only to have to start all over again the next season. Creating a vision means being intentional about what you ultimately want to work towards; in ACT we would call that your “values”.

As you read this post, you might take a moment to consider the following questions: How sustainable are your relationships? Do you find you’re putting in more time “working on them” than you are relishing in their bounties? If so, you may want to take a few pages from the permaculture playbook. Yes, relationships take work. You do need to tend to them in order for them to thrive. However, when relationships are built on a solid foundation, when we are intentional about their design, and when they are regularly nourished and nurtured, they can be sustainable and can nourish us for years to come.