Living Well Integrative Health Center

2176 Windsor Street, Halifax, Nova Scotia, Canada. (902) 406-1500

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Mindfulness

Mindfulness is the practice of paying attention on purpose to the present moment without judgement. Cultivating a mindful practice is one way that we can really help ourselves learn to listen to what we need emotionally, physically and cognitively.

If we are able to see ourselves accurately we would see that there us more right with us than wrong. We would also see that essentially everything we need is already present inside each and every one of us. We know ourselves better than anyone else yet often we can't access this. We suffer with this being human thing. So often we torture ourselves with doubts, worries, indecision and find ourselves living a life or lifestyle that we don't really think we want or need.

Often we are not present with what is here, depriving ourselves of the joy of living now and with confidence in the person we are. Somewhere deep within each of us is a knowledge of what makes us strong, healthy and happy. How many of our thoughts throughout the day are actual replays of events or hurts gone past, needs not met? How often do we worry about what is to come or of a future we can't predict? How much time do we waste getting caught up in judging thoughts, gripping emotions or strong physical pains?

When we are able to be present, to access intentionally, at our call what it feels like in our bodies, to feel what we are feeling and are able to identify what are minds are thinking, we start to become in tune with what it takes to steady the mind and to listen to ourselves better. Once we are aware of ourselves, we can begin to work with what  is there.

How would you feel if you were to experience yourself as stable, strong, flexible and balanced? What would it be like to be able to know what you think, to feel how you feel and to let that inform you of what you need and how you want to live this one precious life? How would your life be different?

I took many meditation classes in my young adulthood. I always had the misperception that I wasn't doing it "right" or that I couldn't sit as calmly as I was "supposed" to. Over time and practice I learned there is no "supposed" to but only "what is". Mindfulness and insight meditation training changed my experience of meditation and of myself. Once you have trained and practiced, you can never go back to how you were, yet you were there all along. It's a strange paradox.

Mindfulness practice informs all aspects of my life and without it I would be living a life without the consistent depth of enjoyment that I do and the low points would be more difficult to bare. To paraphrase the Dalai Lama, 'meditation and awareness are great but useless without logic and reasoning'.

The basis of the Mindfulness classes I am holding at Living Well embrace the structure and principles taught to me through the wonderful instructors from the University Of Massachusetts Medical School's Center for Mindfulness. I was fortunate enough to study as well with John Kabat-Zinn who developed MBSR, my formal training. My class however also involves a structured component to help learn how to use the awareness you cultivate to inform you of how you want to live day to day though use of discussion and home exercises (CBT, ACT  & EFT) which I also have professional training in. It is not talk therapy, it is experiential and requires sharing of process. 

It is liberating if you choose it to be. The classes are held once a week for 2 hours for a total of 8 weeks. Although one might think they would never enjoy a group setting, thinking it's unlikely to be intimate and secure, you are wrong! People tend to share the process and the struggles not the most intimate details of their lives. You share as much or as little as you wish, but what becomes very obvious, and is only possible in a diverse group of people, is that we are all human. In that humanness we all love, lose, struggle, joy, pain and hope in much the same ways. Being fully awake for this human experience is a different way to be with what is. Please call reception to sign up for the next 8 week class. 

 

Resilience and Mindfulness

When we lack resilience we dwell on past problems and feel stuck. We may feel victimized or sorry for ourselves and both these mind states are unhealthy, depleting and contribute to our not being able to cope with stress and adversity to the best of our ability. Being now in the face of stress and adversity and knowing how to respond does require some intentional past reflection (not to be confused with ruminating or getting stuck in the past). The who, what, where, when and how of having overcome prior obstacles (and we all have) can now help us think about our present circumstances with courage, positivity and confidence in our ability to overcome. We can't change the past. We cant alter that things have changed and are always changing. Life requires that we have emotional flexibility to adapt to changes but often we find ourselves trying to control things within ourselves and our outside world in an attempt to feel less vulnerable, as if this moderates the stress that accompanies change. This is something akin to using a match to put out a fire.

We may even seek and take refuge in unhealthy ways to escape and cope. Our society even reinforces these ways. This limits our ability to creatively and thoughtfully respond to what we and the current situation need to make it through the difficult time or feelings. We tend to worry about the future which doesn't allow us to predict it nor to affect it intelligently. How we are now, what we choose to turn towards inside and outside ourselves and how we respond to ourselves and our circumstances does allow us to be NOW, where we already are, which is all we can ever do. In turn, the present experience does affect our future. 

"Mindfulness" is a term that is buzzing right now. Mindfulness is simply being present in the moment without trying to alter, change or judge our experience. I value it in so much as I believe that it is the only way in which to authentically live well, how to be more than okay in the face of calm and adversity. Similar to resilience, mindfulness is not a trait, it can be learned. It is a process and a way of being. 

Mindfulness can help us learn to be more present, to reflect on our pasts or consider the future without getting stuck. It teaches us how to judge less and how to be more accepting of ourselves, our circumstances and other people. We learn how to respond rather than react. It helps us recognize our true nature, our strengths and our vulnerabilities, and to see how we can turn towards rather than avoid ourselves in an attempt to live consciously. This is true self-compassion, self-love.

Mindfulness helps us to accept and adapt to change which is at the core of resilience. Mindfulness lets us be ourselves, which is what we already are. In a sense it is like giving ourselves permission to be just who we are, to befriend ourselves. We learn how to listen to what we already know, what is best for us. Deep within us is all of this. Time, experience, conditioning and habits can alter our ability to access our knowing, confidence and our resilience. We once fell a thousand times but still got up and tried to walk. We succeed because we fail and because each and every one of us has within us a deep seated understanding of what it takes to make ourselves happy and healthy.

- Dr. Maria Patriquin

 

 

How Mindfulness serves children; a reflection on its role in medicine, teaching, parenting, role modelling and mentoring 

PRACTICING WITH PURPOSE 

 

Children are the original mindfulness practitioners. I remind each adult that denies their capacity that they began life with innate ability to be mindful. To understand what role mindfulness serves requires consideration of the inherent nature and capacities we were born with. Take a moment to consider what qualities of being, sensing, doing, feeling and thinking you recall from childhood.

 

Children are instinctual, they know how to communicate their needs even before they learn to speak; a cry signaling hunger or discomfort. Once language is learned we often blush at their unfiltered honest expressions of awe and wonder “you have a lot of lines on your face Grandma”.

 

They lack the larger perspective we consider “wise” and “experienced” and yet what they possess is an “untainted” view on life which is merely just another way of knowing. Their interest, observations and explorations lead to endless play. Einstein said “Play is the highest form of research.” Once something is learned it remains new and they question often. They have inexhaustible determination, energy and enthusiasm which can be understood as the seeds of motivation and optimism. Fueled with that energy they ask why, what and how in an effort to learn more. This reflects how renewable their perspective is, how focused, how teachable, determined and perseverent they are. Everything is always new to the child, thereby making them the ultimate learners, adventurers and very adaptable.

 

Authenticity comes naturally as they know not the expectations of the adult world making them true to themselves, assured, confident in knowing what they want without the weight of criticism and judgement that defines our discerning adult minds. “I like me. I like what I made. Look what I can do! I like all my feelings.”

 

They are creative and imaginative. They make art and love what might only resemble to us an abstract mud puddle. Free from the constraints of preconceived notions of how things should be they are imaginative, positive and see possibility in everything.

 

They accept mistakes and failure with humility. They are resilient. Falling thousands of times they still rise to walk. They are innocent knowing not the relevance or personal consequences of their actions. Albeit hard to believe, that bite is not ill intended. The shampoo emptied into the toilet isn’t misbehavior but playful exploration. The “I hate you” an innocent, despite painful testing of language, limits, understanding and bonds. They are purposeful, determined, and willing to meet challenge with ever evolving capacity. They change frequently as does their world. They accept change, they accept what is.

 

Children derive pleasure easily. Finding beauty in the unknown and familiar, sitting in awe and wonder of what to us might appear mundane or simply a pile of dirt and sticks. This makes them perfectly poised for appreciation and gratitude. They have humor, laughing an average of what is thought to be 300 or more times a day. This speaks to their natural ability to be happy, make joy of anything and reduce stress or tension with simple activity, observations, even a hug. They are loving and affectionate.

 

They are driven to contribute. We may not want them to wash the floors. Usually it falls short of our standard and time constraints. A soapy flood might need a lifeboat and a cleanup but the intention, drive and desire to help is there. They are kind, altruistic and full of empathy. Children as young as two years of age will come to the aid of an adult in need without reward nor the watchful eye of a parent. Science demonstrates that at any age we have positive physiological and psychological responses to giving more so than receiving. Children are trusting, dependent and forgiving. They have a desire to please, help and strong prosocial drive to connect which reflects their empathic capacity and ability to form strong bonds and relationships.

 

The experiences and exposures we have in early life are formative and serve as the foundation of health from which we develop, learn, grow and evolve. How often do we hear the expression, “nature versus nurture”? What developmental psychology and neuroscience research offer us is a deeper understanding that who we are, how we develop, learn, and evolve is our nature and “nature needs nurture!” We are social beings and the nurturing relationships we have early in life create neural, cognitive and emotional frameworks from which we form a sense of self, others and experience the world.

 

Children are vulnerable and dependent on adults to foster, nurture, encourage and protect their inherent qualities and growing capacity in an environment of safety, stability and stimulation. They need strong stable relationships and in doing so children learn and grow in the healthiest of ways, reaching their maximal potential. Let us consider whether this is the experience of children.

 

Adverse childhood experiences (ACEs) are events that can have potentially traumatic, negative, lasting effects on health and well-being. These experiences range from physical, emotional, or sexual abuse to parental divorce, parental mental illness, witnessing domestic violence, family dysfunction and neglect. ACEs encompass bullying, discrimination (due to race, ethnicity, sexual orientation, disability or culture) medical trauma, deportation and migration, involvement with foster care, death of a parent, living in an unsafe neighborhood and witnessing community violence. This is not an exhaustive list.

 

Research has repeatedly demonstrated that two thirds of the population have had at least one ACE. 40% have two or more and 12-15 % have more than four ACEs. ACEs cluster and have a strong cumulative effect on health and well-being throughout the lifespan leading to exponentially higher risk of learning, behavioral, social and health problems. Not exclusively these include obesity, some cancers, heart, liver and lung disease, depression, substance abuse and poor academic achievement. Those with higher ACE scores are at increased risk for high risk sexual behaviors including early sexual activity, teen pregnancy, sexually transmitted disease and intimate partner violence. Those with an ACE score of four are twice as likely to be smokers and seven times more likely to be alcoholic. An ACE score of four increases the risk of COPD by 400 percent and attempted suicide by 1200 percent. Those with an ACE score of six or higher are at risk of their lifespan being shortened by as much as twenty years.

 

Our ACEs are high. Over a million Canadian children are affected by mental health issues and less than 20% will receive the care they require. After accidents, suicide is the 2nd leading cause of death. Canada is one of five countries with the highest rates of teen suicide. One in four children live in poverty, the highest rates are in Manitoba and the Maritime provinces. One in ten children have food insecurity. 25% of children will experience developmental vulnerability which means that their readiness and ability to learn is compromised before they even enter school. Canadian children are less physically and 25% are obese. We are falling short of the physical, cognitive and emotional needs of children in Canada.

 

According to a 2017 UNICEF Report Card, Canada performed well in educational indicators but ranked 25th out of 41 countries on the Index of Child and Youth Wellbeing and Sustainability.

 

The most important discovery and call to action is that childhood adversity and trauma is a cultural normal and contributes to most of our chronic health, mental illness, economic and social health issues. We all have a role and responsibility in engaging the system and contributing to a community and a society that begins to acknowledge the lives of children and the pain behind so many adults.

 

Aside from prescribed screening recommendations, people tend to visit the doctor when something goes “wrong”. After the obligatory school readiness visit near 5 years of age, I’m unlikely to see children other than for episodic illnesses such as ear infections and sore throats. I am most likely to see them thereafter when their once perceived attributes have shifted and become what they themselves, their parents, teachers or others consider limitations or label as “problems”. This can be within a few years of commencing school and span the teenage years.  More commonly they present with behavioral problems, learning issues, ADHD, depression, anxiety, poor eating habits, grief, gender and sexual identity issues, early intimate relationship problems, conflict with parents or recurrent illness.

 

Between sparse visits, we lose opportunity to grow positive influential relationships, ones where we are able to foster healthy attitudes by empowering and enabling healthy lifestyle choices for children and their families. We are unable to educate, guide, support, share resources, prevent problems, treat and aid in healing because we don’t see children regularly enough in family practice.

 

By not developing strong relationships with children from a young age we are not able to identify and highlight children’s attributes, strengths and support what is required to nurture and grow them individually to their full potential. We require opportunity to normalize some forms of stress and adversity and to identify those that go beyond into the abusive and toxic realm.

 

In missing what is neglect and abuse we also miss the opportunity to intervene early by educating, providing supports, services and interventions that help mitigate the long term health consequences of neglect and abuse. Early detection allows us to harness the science behind the therapeutic role that relationships, resilience, support, optimism and treatment confer. We are hardwired to survive and heal.

 

Family medicine has a unique viewpoint derived from years of enduring relationships that span the lifecycle of a person and often generations of their families. It is a generalist practice but great depth forms through the sharing of life’s ups and downs. Being privy to these deeply personal experiences has deepened my understanding of what events, environments, genetic predispositions, individual biology, perspectives and personal experiences influence how we develop, grow, evolve into the people we are, the relationships we have and the lives we live.  Without regular contact we lose opportunity for children and their families to gain a better anticipatory understanding of the developmental and health needs of children which could serve to protect those at high risk of adversity and abuse. Visits that encompass health behaviors and address determinants of health enable us to impart and imprint on people that health is so much more than the absence of illness and that how we live and the choices we make day to day matter.

 

The seemingly simple practice of mindfulness is the basis on which I am able to form connections to patients, establishing a sense of safety and trust through active listening without judgement. This is particularly important for children and their families as judgement creates stigma and barriers to care. Being mindful enables me to process my own experience thereby enabling me to remain clear and capable of responding from a centered place. It enables me to regulate my own emotional response while expressing empathy so that I can assimilate, integrate information and creatively problem solve with my patients. Without mindfulness we risk making more errors and projecting our perspective and expectations for health on our patients.

Mindful communication is one of compassionate exchange. Patients feel understood, seen and cared for. This creates a sense of safety and engenders a feeling of wholeness which is in keeping with my values and beliefs. People best serve their health and wellbeing from feeling and experiencing their own worth and value, from feeling whole, capable, resilient and supported. Encounters that lack mindful awareness and compassionate exchange risk falling short of patients’ needs and also risk causing people to make fear based decisions rather than informed ones.

Through an adult lens subject to the inner critic that judges our success by how well we think our kids are performing, expectations and stress grow. The child who was once considered honest and expressive is seen as “defiant”. The determined child becomes the “stubborn” child. The affectionate child becomes the “needy” child. The energetic child becomes the hyper child with a “deficit of attention”. Playfulness is seen as “silly” and foolish. The spontaneous child is seen as “impulsive”, the assertive as “demanding.” The expressive child is seen as “dramatic.” A confident child is seen as “arrogant” while natural leaders are “bossy”. Curiosity is overtaken by “naughty and nosey”. The child aware of their feelings becomes the “sensitive” child and if those feelings are intense they are considered “weak” or “immature”. The child who loves being with you becomes the “attention seeking child.” And yet these were once considered the very attributes and strengths we admired and loved in them.  

 

Through a mindful, compassionate lens children become humans struggling to imperfectly communicate their needs in a stressful adult-centric world that many of us are oblivious to as we rush from one thing to the next. Watch a children’s movie and count the number of sexual and rude jokes intended solely for the parents’ entertainment. We pretend they don’t understand or absorb the confusing underlying messages, but they do. Consider the hockey practice we rush to eating in the car as it is scheduled uncomfortably close to the end of our work day, coinciding with family meal time and close enough to a child’s healthy bedtime where if kept would ensure they are rested for an intense school day that follows where high expectations to learn, behave, get along and perform well awaits them.

 

It is critical that children have voice and are heard otherwise they risk thinking “they are the problem” rather than seeing they “have a problem”. With a mindful approach and an atmosphere of safety and compassion children courageously share deep fears, depressive thoughts, worry, and anxiety. They express grief, anger, substance use, abuse, stress, suicidality, confusion and conflict. Words are not merely expressive but are generative and have a bidirectional effect on how we feel, think and act. How we help children speak of their experiences is important. It helps them regulate and integrate (a healthy and healing neurophysiological process).

 

Children show us that adult secrecy, silence and judgement creates shame. Shame is destructive. They often feel not spoken to, seen or believed. They sense everything. We are lying to ourselves if we think they don’t. We can hold space for children’s experiences. They need to be heard and believed.

When we are able to hold children’s vulnerability with respect, kindness and care they begin to feel they can too. With repeated practice they develop skills, capacity and resilience. They form relationships based on self-respect, self-compassion and carry a new found feeling of capacity. Mindful awareness and compassionate exchange cultivates and supports care through the fostering of healthy relationships which we know create the circumstances for healing that so many are in need of. They begin to truly feel their worth and value. With mindfulness children are driven to achieve, to please not just others but themselves and are able to harness their strengths and begin to thrive.

I feel a moral obligation to share what children have shared so that other providers, educators, coaches, mentors, parents and policy makers understand children are experiencing tremendous levels of stress and adversity, some of which leave permanent scars if not tended to. Every single child I counsel, spanning the ages of 5 to 18 have answered my question “if you could change one thing to make your life better” with, “I wish my parent/s were less stressed or depressed.” Every single one.

We live in a time where stress is the norm. Our society promotes fast foods, unhealthy sedentary lifestyles, detachment and isolation leaving many adults devoid of meaning and feeling undervalued. Avoidance, quick fixes, addictions, expectations and impatience grow in what is an ever expanding appeal of an “on demand” culture. These circumstances contribute to the development of more illness, band aid approaches, crisis-to-crisis coping that is mirrored in how care is accessed and thus provided. It inevitably causes more stress. This is survival mode.  

 

Children absorb all these messages. They absorb our stress. Our avoidance becomes their avoidance. Our lack of skills and agency become their deficiencies perhaps out of necessity, perhaps out of survival. We don't know what we don’t know and yet we are the only species that can think about the way we think. This means we have choice in how it is we respond to the difficult complexities of our fast paced stress ridden world among a slew of societal expectations and unhealthy cultural norms. We can grow from adversity. A mindful intentional kind life is one lived fully. No expert, resource, doctor, scholar, snap, twitter, twitch or vine can guide us to what makes us each healthy, happy and fills us with purpose and meaning.

For six years now I have offered stress reduction groups for adults. After eight weeks a roomful of strangers foster deep connections through the sharing of vulnerability. Connections form not from a shared experience of illness (people need only be human to meet entry criteria) but through a shared sense of humanity and empathic exchange. I teach mindfulness techniques, ways to calm the sympathetic nervous system, how to hold intense feelings and use cognitive strategies to work with negative thoughts. They learn to consider their values and prioritize self-care, setting goals towards healthy changes in lifestyle. Participants learn what and why boundaries are necessary. They learn the tools needed to communicate effectively to foster healthy relationships. They learn that empathy and compassion for self and other is at the heart of all health and healing. When asked if you could change just one thing, the majority respond, “I wish I learned this as a child.”

It always strikes me the way children express urgency to grow up. It baffles me as adults that we long to be young again and forget the qualities once enjoyed in childhood remain within us. The most powerful tools we have are the ones we naturally embraced as children. If we don’t see children as whole human beings then we deny their humanity and extinguish their natural abilities and capacity. If we focus on the deficits of a child, what we think is “under developed”, wrong, lacking or in need of fixing, we lose sight of the inherent strengths of any child, predetermine their success and limit their potential. Einstein said, “Everybody is a genius. But if you judge a fish by its ability to climb a tree, it will live its whole life believing that it is stupid.” If we focus on what we lack as adults we do the same to ourselves. We become unhappy, lose meaning, joy and purpose. We have forgotten how to enjoy our uniqueness, play, care and love ourselves and each other.

 

As adults we aspire to embrace the qualities of being that came so naturally when we were children and yet we are so intolerant, impatient and inevitably misunderstanding of their ways through ours. We forget how to be natural, connected, free, creative and content. We forget we know how to live in wonder with awe of the beauty around and in us. We are the only species that can think about how we think. This can be our tool or our weapon depending on the manner in which we hold our imperfection, vulnerability and choose to respond. The most powerful tools we have are the ones engendered from once having been children.

It is time to consider a new curriculum for care, education and parenting. To evolve it must harness our innate wisdom and capabilities. It must be provided from a perspective of wellness and strength with an understanding that enhancing health, habits, programming, performance, pursuits and passions, lies in each and every person and the qualities we embodied as children. We live in a knowledge economy, yet only we can impart personal values, the very ones we complain children are lacking. We could consider a curriculum that encompasses and places value in fostering and nurturing care, character, conscience, communication, conciliation, courage, contribution, collaboration and compassion.

 

The more we deny our social nature the more we fall under the illusion that advancement and technology can better our lives, society and the future. We are fooled into believing it will make us smarter, healthier and more evolved as a species. We forget we need each other. It is time to return to what we once knew, to what children can teach us if we attune to them, what I refer to as a “circular personal evolution.”

We are social beings, the brain a social organ. Our strongest desire is to connect and belong. We have survived as a species due to the ways that we cared, communicated and collaborated thus creating strong communities. It is common sense but we are not living in a common sense time. It is time to consider whether survival is the best we can do.

It is a little known fact that Darwin didn’t actually say “survival of the fittest” those were the words of his protégé. Darwin spoke to the societies where the people who helped each other and cooperated, flourished. In other words “survival of the kind and cooperative”. Surely at this point in our evolution we can aim to thrive and flourish.  

Childhood is a precious short time. We were once children and that child remains within. The way we treat ourselves and each other becomes the voice with which we parent, care, teach and lead. How we treat and teach children becomes their inner voice. With mindful compassionate awareness we can understand and care, thereby creating a sense of wholeness, worth and value. Let us know ourselves so that our voices reflect our values and we live and work what we love.

 

May our voices embrace humanity so children grow embracing theirs. This is how we grow accomplished respectful healthy children, connected communities and a healthier society. Compassion and kindness matter. My hope is that we become part of a larger conversation and movement that leads to meaningful change that betters the lives of children and the adults they will become. My mission is for people’s experiences of care to become positive and humanizing. We are all connected in our humanity. What we do matters. Practice with purpose. Dr. Maria Patriquin