I penned this essay in April 2012 while Laurie and I worked on our Social Resilience Model as part of a Rockefeller Foundation’s Bellagio Fellowship. The Fellowship topic was titled “Global Leadership Meets Neuroscience: Building Resilience in a weary World.”
I have been increasingly drawn towards contemplating health, humanity and wholeness as these precepts apply to the challenges within and among all sharing this small planet of ours. The following essay reflects a few of my thoughts, tracing the roots of my growth and development as a physician and leader, focused on the 3R’s of emerging wholeness: resilience, repentance and reverence. Onward!
Sitting at my Villa Serbelloni studio perch, overlooking the majesty of nature’s bounty that is everywhere in Bellagio, Italy, I pen these thoughts on wholeness . . . The whistling wind underneath the balcony door signals that change is on the horizon. The myriad species of trees, large and small — olive, cedar, poplar, redwood and magnolia — bow to the incoming storm with grace and aplomb . . . Spring’s outrageous plumage — camellia, rhododendron, primrose, lilac and wisteria — smugly nestled into the rugged crooks and crannies of this pristine alpine setting. Change is life; life is good.
One of my fellow colleagues — roughly a dozen of us fortunate enough to be chosen by the Rockefeller Foundation as recipients of the Bellagio Fellowship — is downstairs in the parlor playing one of Chopin’s unpublished works, whose classical notes mingle with Andre Bocelli’s intense tenor on my partner’s iPod, singing one of our favorite songs — “The Prayer.” Ah yes, here comes the refrain: “lead us to a place . . . guide us with your grace . . . to a place where we’ll be safe.” In this moment, I whisper a prayer of love and gratitude, recalling Masaru Emoto’s amazing photographs of water crystals “filled with the most joy” and his admonition that when you “continually think thoughts of love and gratitude — you simply cannot help but be changed.”
Again, change is in the air. And has been — for these past 27 years since I strode with outward confidence across the graduation stage to accept my medical degree as a proud member of the Loma Linda University School of Medicine (LLUSM) Class of 1985. In addition to vowing my allegiance to the Hippocratic oath on that sultry morning in June, I also joined a far smaller group of fellow physicians who would likewise embrace a dual role — that of healing professional and commissioned officer:
To do no harm . . . that I will support and defend the Constitution of the United States against all enemies, foreign and domestic . . . I will remember that there is art to medicine as well as science . . . I will bear true faith and allegiance to the same . . . I will prevent disease whenever I can, for prevention is preferable to cure . . . I will well and faithfully discharge the duties of the office upon which I am about to enter . . . So help me God.
Words to live by — truly so.
Looking back at my early years of growing up in Loma Linda, it is hard to fathom that I would become a career military physician . . . During this past 18 months since retiring from the Army in 2010, it has been hard to imagine not ever wearing a uniform again. Letting go of the past, making room for the future — change continues to beckon.
“Back in my room overlooking Lake Como, the sounds of Leonard Cohen’s The Anthem now mix it up with the howling gusts:
ring the bells that still can ring
forget your perfect offering
there is a crack, a crack in everything
thats how the light gets in.
A new meaning to these familiar words starts to emerge. Perhaps ringing the bells means it takes courage to keep up the fire; achieving perfection is a delusion of hubris; our flawed vessel is the crack of humanity, allowing light to enter and animate our soul. I whisper another prayer — for a sense of wholeness and humility.
Memories abound in this moment . . . Recalling childhood glimpses of the advances pioneered by the university international heart team and its ceremonial visit to the Oval Office in 1964; smiling at the thought of my mother’s stint as ‘queen for a day’ that yielded an essential heart-lung machine for the children in Pakistan; fingering the yellowed pages of my father’s work chronicling the ‘heart menders’ during those initial years; pushing bits of nuteena casserole around my jello-streaked plate at the Calimesa church potluck; spitting watermelon seeds from the car window while accompanying my grandfather on his tireless routine of making ‘house calls’ (R. Leslie Ward, MD; College of Medical Evangelists, Class of 1932); belting out soulful melodies of Mahalia Jackson, Elton John, Creedence Clearwater Revival and the Heritage Singers in front of the living room stereo; reliving my early shyness and and eventual acquiescence towards becoming a reluctant leader; preparing to trade the comforts of home for the uncertainties of college life in Angwin; returning home to meet the rigors of basic training and gross anatomy lab; circling the LLU Good Samaritan statue, between classes, while pondering what it means “to make man whole;” recalling distant worship experiences at the White Memorial church in Los Angeles, among the restless renegades in Claremont and, years later, in sixth-grade Sabbath school at the university church; embracing the tenets of “whole person care” and its potential to heal at all levels; witnessing the power of Baby Fae’s heart and Dr. Bailey’s courage to transform, catalyze and accelerate global change; feeling the profound loss of loved ones over these war torn years since 9/11; reliving precious moments of serving those who serve us in harm’s way; and, finally, resigning my soul to the rueful pride of knowing myself and living life accordingly.
It occurs to me that I am now where I was when . . . initially embarking upon my life journey towards wholeness — a path paved with resilience, repentance and reverence.
Resilience — what is it? Above the din of technical, scientific and cultural jargon, the voice of a child known to me rings clear: resilience is the ability to “bounce back from tough stuff and to even grow stronger as a result.” It’s about having enough sleep; fuel; grit; friends; love; faith; hope; and growth — tending the mind, body, soul and spirit. For most of my professional life as a psychiatrist, the best I could do was to manage symptoms of distress — talking therapies, biofeedback, medication or a combination approach. Given pervasive exposure to life-threatening traumatic stress within the military community, the inadequacy of conventional modalities lingered and nagged my conscience during deployments and on the home front. Years later, challenged with veterans from Iraq and Afghanistan suffering from complex injuries that would have proven fatal in prior conflicts – including repeated concussive blasts, burns, amputations, internal organ damage, vision and hearing loss as well as moral injuries involving guilt, grief and betrayal — I vowed that this escalating crisis would not obscure the clear and present opportunity for new therapeutic advances as well as post-traumatic growth.
In short, my quest involved searching for a different lens through which we can view, understand and treat psychological trauma — shifting the primary focus from pathology to biology; from blame to brain; from pills to peers; from clinic to community; from illness to injury; from betrayal to trust; from despair to hope. As the worsening military suicide epidemic serves to remind us, this is no academic matter. Lives are in the balance.
Thankfully, advances in science and technology harnessed to the burgeoning field of neuroscience have now laid the foundation supporting our understanding of the biological basis for resilience and our responses to threat, loss and fear. We now know that the amygdala, always on the prowl for novel dangers threatening our survival, automatically engages our defenses, mobilizing us for “flight, fight, or freeze” responses as well as the “tend and befriend” behaviors more commonly observed with women. Unlike animals in the wilderness, whose release of unused survival energies is uninhibited by the cognitive and “meaning-making” capacities of the human neocortex, our nervous systems tend to get dysregulated, or “stuck,” by continued exposure to distressing events, life-threatening or not.
Restoring balance through the use of simple neurobiological skills — such as the Social Resilience Model (SRM) and the Mind Fitness Training Course (M-Fit) — yields an essential foundation for self-regulation upon which optimal functioning within one’s resiliency zone depends. Interventions must go beyond cognitive restructuring and exposure therapy to include promising innovative approaches that are designed to stabilize the nervous system, a vital prerequisite for success at home, school and work.
As with previous therapeutic advances born of battlefield experience, wisdom gained from treating the unseen wounds of war will extend beyond the military health system to benefit our nation and world as a whole. What if medical schools across the country assumed a leadership role in this burgeoning realm of resiliency, training their respective students, faculty, community and family members to prepare them for building global capacity in remote reaches of the planet as well as for sustaining their own self care, bedside manner and spiritual wellness here at home?
As physician leaders, we must challenge ourselves to pioneer innovative and holistic approaches to health and healing; to build the scientific evidence base of knowledge and applications to clinical care; and to prepare our colleagues to provide hope and build resilience wherever they are called to serve. This is work indeed worth doing, a fitting tribute honoring the sacrifice of those from whose burdens of battle this emerging approach has been deemed gentle, humane, respectful and effective.
So, back to our larger musings . . . If resilience is ours to build at all levels; where do repentance and reverence belong in this emerging vision of wholeness?
To this end, let us briefly unpack repentance in the context of our journey as healing professionals in search of wholeness . . . Beyond the common usage of the term — that is, the individual process of seeking and granting forgiveness, starting with ourselves, as well as making remorseful amends for those we have hurt — perhaps it would be instructive to consider repentance, in the words of Henry Beecher Stowe, as “another name for aspiration.” As our forbearers rejected outdated practices — eg., bloodletting, lobotomy, female hysteria cures — in favor of adapting new knowledge to their practice of medicine, so may we likewise aspire to follow their example.
Shedding the Cartesian model of mind-body duality (which still riddles far too much of clinical care), we must claim the privilege and exercise the responsibility to embrace this emerging vision of wholeness, rooted in the new biology, epigenetics, and neuroplasticity of resilience. Beyond any doubt, we share a moral and ethical responsibility to offer hope, ease suffering and promote healing through the use of gentle, respectful and empowering stabilization skills. Repentance is ours.
Lastly, what can we say about reverence and wholeness? Drawing from the insights of Classicist scholar Paul Woodruff — in his books “Reverence: Renewing a Forgotten Virtue” and “The Ajax Dilemma: Justice, Fairness and Rewards” — reverence is the “foundation of compassion, which grows from a felt sense of shared human weakness” . . . Further, “reverence is the well-developed capacity to have the feelings of awe, respect and shame when those are the right feelings to have” . . . Finally, “if you desire peace,” (perhaps, for our faith community, we could even add ordination for women ministers; relief from suffering, poverty and disease; acceptance of all relational orientations; and a spirit of wholeness and grace at all levels!) “do not pray that everyone share your beliefs. Pray instead that all may be reverent” . . . It is the “virtue that keeps human beings from trying to act like God.”
As the sun now sets beyond the azure water and craggy horizon, punctuating this day’s reflections on wholeness, I am drawn to the comforting chords of that venerable hymn, “It is Well With My Soul” inviting my attention: “when peace, like a river, attendeth my way . . . when sorrows like sea billows roll . . . whatever my lot, Thou has taught me to say, it is well, it is well, with my soul.” Bella, Bellagio!
With joy, love and gratitude~
Loree Sutton, MD
Brigadier General, US Army (Retired) LLUSM ’85