Jung & Aging: Bringing to Life the Possibilities & Potentials for Vital Aging (2)

from the library of congress in washington dc thank you to kick off this afternoon's session we're first going to have some opening remarks by mr lee hammond president of the aarp which we know how important an organization and what wonderful work they've been doing haven't been a member there myself for 19 years already and i turned the floor over to mr hammond well good afternoon and welcome to the afternoon session as was mentioned i'm lee hammond president of arp and in this capacity i've had the privilege of serving on the library of congress private sector advisory council the james madison council our mission at the council is to bring the library's remarkable collection of knowledge and creativity to people across the united states and around the world before we move on to what promised it promises to be two very interesting panels i want to speak for just a moment about the strong and productive ties between the library of congress and arp aarp's national headquarters is not many blocks away we're almost a neighbor a neighbor in spirits you might say in keeping with the theme of today's symposium aarp foundation's sponsorship of today's event is an excellent example of the close connection between our organization and the library i'd like to mention two other areas where we've collaborated in recent years in 2004 aarp worked with the library and the leadership conference on civil rights on the voices of civil rights bus tour this was a 70-day tour of from washington d.c to jackson mississippi following part of the route of the historic 1961 freedom rides and aarp was the founding private sector sponsor of the veterans history project a project of the american folklife center at the library to collect and preserve oral histories and documentary materials from all the wars americans have fought from world war one to the present aarp continues to spread word about this project to our members aarp volunteers from a number of states record oral histories from those who served on the military fronts and those who served on the home front during the wars and we contribute these oral histories to the library for archiving while the civil rights project and the veterans history project shine a light on our national identity as well as individual courage today's symposium is exploring new frontiers of individual identity and growth in our later years once again aarp is proud to be working with the library to expand our collective sense of the possibilities of the human spirit thank you and let's proceed now to the next panel thank you one uh more order of business i don't want to deal with um termination at this point but in case any of you do end up leaving early you found evaluation and feedback forms on all of your chairs so hopefully you'll be here right till the end and you'll hand it in in person but in case you have to leave early the organizers of the program would like your feedback and your input and i can tell you as somebody who've been running conferences for many years it's very important there's an old jewish saying and here this has been a great day but there's an old jewish saying it says if enough people tell you you don't look well maybe it's time to lie down so your feedback can be very important to helping helping in future conferences okay first panel this this afternoon it's a real uh we talked about expanding your horizons in in later life and i was very privileged to know all of the panelists this morning from the jungian world for years and last night i was able to meet all the panelists or most of the panelists the rest i met this morning for the first time and it's expanding my horizons and i can say that uh from the jungian perspective we welcome the input and the cross fertilization people from different areas of expertise so it was a pleasure to get to know them i'm looking forward to hearing what they have to say as well and i know we'll all be in for a very special afternoon our first speaker will be dr kelly macmillan he's a clinical professor of social work at the university of maryland that's the school of social work there his area of focus is working with health aging and social service agencies to develop services that build on new practice opportunities in programs that serve older adults which is really important these are hands-on work to carry out our ideas in the field among his publications which include articles and referee journals and a chapter in an edited book he has dealt with such important issues as the role of the gerontological social worker in assisted living and decision-making in long-term care approaches used by older adults and implications for social work practice so please join me in officially welcoming dr mcmillan good afternoon it's a pleasure to be here and uh share uh some of my perspective um my first career was as a medical social worker and hospital setting and i have many good old-fashioned stories i'll share a few with them not too many and then eventually moved on to do a phd in the second part of my life and now in a clinical role at the school teaching i need to be transparent i'm not a union but i do think i have some pieces that will tie very well into the theme today and um and i really find that this theme of successful aging is very vital today i prefer to call it aging well but i think it's a very vital theme as we recognize that there's an adult population that will be using more and more services as they age also from a personal perspective i find that my sense of self is deepening and crystallizing more and more as i age and then i recognize that i'm in this second half of life and for me it's about integration it's integration my of myself in terms of wisdom and experience and then i can use that in terms of my relationship with those around me and i also do some mentoring as an elder and so i've moved into a space around eldership and i think those are important places for us to recognize as well as i mentioned um the theme of successful aging or aging well i think is very timely there's a good amount of research and literature in that area and um it has continued to sort of spawn uh projects and programs and services in a variety of areas there are some folks that are looking at what's called productive aging or civic engagement and they're looking at how people are engaging in encore careers my focus today is really going to be looking at those health and social services that older adults use as a age and they experience physical disability now from my perspective i want to go back to some of the things that we talked about earlier today about this sort of rise and decline in age and i think we all have firmly planted in our mind the idea that from infancy and youth we ascend to this pinnacle of middle age whatever that is and then there's this descent and unfortunately the view is it's a descent to death and i think we really need to begin to sort of change and challenge that view that it's just not this staircase to death and what happens i think in that context is that we have a tendency to equate age or aging with death and i think it's just not an accurate sort of depiction in medieval times one of the models that i particularly like was really a circle and there are all the stages of life from birth to death in it and the spokes went into a center hub where there was a spiritual image that connected people up to the physical and the spiritual world and that's one of the themes that we're talking about and i think there's a lot of merit in that now i i want you to realize that i don't think we could ignore the physical aspects of aging but there's more to old age if you ask older adults and i've had the privilege of working with a lot of older adults in my career and they really have been my best teachers so i'm going to share some pieces from some of their stories as well as what's occurring in the medical arena first of all i believe that this staircase metaphor of rise and descent is really firmly implanted in the medical model now i want you to understand that i've worked with many physicians and health practitioners and i have a deep respect for them but this model is fairly well has been historically entrenched i think in how care is provided and the the real goal here in terms of infusing this medical model with aging well or successful aging is to help begin to shift people's view the um the good news is that there are shifts that are occurring and i want to talk about those the three areas that i want to focus on are what we call personal social services those services delivered in the community primary care practice which is the physician practice and then also acute care and rehabilitation the um the trends in personal care really began around personal care services homemaker chore type services and some trends began to develop in terms of the 1980s where they really began to be an alternative to nursing home care and as those services began to develop there was a particular portion that were provided to older adults aging services and also the particular portion of services that were provided to folks with physical disabilities and typically those services didn't did not overlap they were very distinct and separate however over time the folks in the physical disability advocacy community really i think began to influence those services for older adults and personal social services and the goal for services today tends to be one supporting persons to live in the community the older model typically was one where older adults were taken care of people came in and did things to them and the disability rights advocates really said what we want is people to assist us so that we can live independently we don't need people to do it for us so what's emerged is this person-centered model of care which really begins with a conversation a conversation with the person receiving care to find out what's valuable to them what they're looking for in life how they want to live their life and from that basis then the care is delivered as opposed to a professional coming in assessing a person as to what do they think you need as an older adult or a person with disability and we're going to provide that care rather it's really more self-directed in terms of the care people receive these these models of care are gathering more and more support in the state of maryland there's a pilot project at howard county where they're doing what's called some options counseling where again they're using a person-centered approach and asking consumers what is it that they want in terms of living their life in the future what kinds of things will be important for them in terms of how they survive and age well in place so those that model eventually as it gets fine-tuned will be brought throughout the entire state probably within the next year so these are exciting trends in the personal care side another area of growth and change is in primary care i think a few of us can remember the day when we went to the our primary care physician and that person directed all of our care things have become a little bit more fragmented and fractured if you would it's easy for us to have a number of specialists and those people may or may not be speaking to each other not because they're not friends but because the system's a little bit fragmented we don't have the electronic medical records to transfer data back and forth and so your primary care physician may not know exactly what's occurring to with you and your specialist well they're moving towards a model which really has been around uh since the 1960s in pediatrics and it's called patient-centered medical care and the care and focus is going back to the primary care physician who will work closely with those specialists that you may see another piece that's really a valuable adjunct to this patient-centered medical home model is that they're including other professionals there are people who are care coordinators behaviorist etc who in addition to working with a physician around those medical issues we'll look at those kinds of behaviors that need to be changed in terms of improving health it might be exercise nutrition smoking cessation care coordinators will work with folks to identify those services and needs people have before it becomes an emergency my experience in the hospital setting many times was that people were hospitalized because there was some crisis that occurred that might have been averted in some sort of way if services are delivered in this primary care model so again i think it's a really important place it's a merging place in terms of where practitioners who work with folks in a behavioral mental health counseling perspective can really develop some expertise and provide support to folks throughout the life course the other piece that i think really becomes helpful in this uh primary care model is that with the care coordination there's really an attempt i think to reduce premature or unnecessary hospitalizations because again linking people up early in the stage of care the final place i want to talk about has to do with hospitals and rehab i remember the day when a patient who came in who had a fractured hip would be in the hospital for three weeks it's probably three days if they're lucky and um these people are being going going into rehab units uh care is much more specialized and intense and unfortunately again because of this the focus of this medical model it's really on the on the the physical conditions diagnosis assessment and treatment and i think what's happened is that that person that patient has become a little bit lost uh in that medical model hospitals and again we we do want our physicians and healthcare practitioners to focus on those biological things but how can we begin to help them recognize it in that bed as a person it's not the hip in 314 or the gallbladder down in medical surge hospitals are developing age-friendly units in their inpatient units as well as emergency departments and especially in the inpatient units one of the things that they're doing is providing care so that the individual can do what they can for themselves gone are the days where they tell the older adult get in bed and stay in bed don't do anything unless you get help we know that when that occurs it just increases the level of disability and frailty for the older adult and you all know this yourself when you've been ill for a couple days and have been in bed you really it's really hard to get back on your feet and when we do that in a hospital setting it's much more complicated what's beginning to emerge is uh again some levels of teamwork where um the team is working with physicians one of my uh stories from times past was i had uh run into our medical director for the hospitals i worked at and butch was telling me that it was not a good day because the treatment goals he established for his patient after several weeks were not being achieved and i asked him i said well what does your patient want and he said i have no idea the good news was that butch went ahead and talked with his patient and he reported later on he said i met with that patient i found out what she wanted i told her what my goals were and he said we worked out a plan and he said i think it's achievable and what's beginning to emerge a little bit in the healthcare side on the inpatient side is that teams are forming they're interprofessional practice teams where you get the best of the medical team together and a key player on that team is the is the patient and sometimes the family this fall was part of an educational program up at shady grove where we worked with pharmacists nurses respiratory therapists and social workers to help them learn before they get into the field what it's like to work as a team and we used patients so they had a sense of including the patient so again we're beginning to teach this model and we have a long way to go i think because again like i said there's this this notion of uh person is disease aging is disease and that's a piece of what we're trying to break out of in addition um in health care because of this quick discharge transition care teams are being developed within hospitals to reduce repeat admissions and what these teams are going to do is help us link those folks who are chronically disabled have chronic health diseases to be better linked up with their primary care practices with services etc etc and i think that's going to be a tremendous impact in terms of reducing hospitalizations and improving quality of care in summary it's true that poor physical mental health can interfere on older adults ability to age well and the changes in delivery of personal care services and home care can make a difference it's this partnering of older adults with health care providers that enhances this positive outcomes for older adults and ultimately contributes to their ability to age well so this shift will occur when we train health and medical professionals to see older adults as the psychosocial spiritual beings that they are and so i think from here we just need to keep pushing this forward thank you thank you thank you again we'll hold our questions till we hear from all three panelists our next presenter is dr mary mcdonald she works full-time in the field of geriatrics serving in the home care practice she serves at the division of geriatric medicine at washington hospital center and is medical director at the washington home and community hospice as well as associate professor in the department of family medicine the division of geriatrics at howard university college of medicine dr mcdonald has published numerous articles and books on the subject of geriatric medicine including documenting documenting competency in the mini mental state exam and the mini mental state exam a core geriatric competency and it's a pleasure to welcome her here and somebody who is again active in the field and can tell us exactly what's going on these days thank you please join us good afternoon it is a real pleasure for me to be here today with the true scholars that you've been hearing from throughout the day today i am a little tickled that i am your next speaker i don't consider myself a scholar so much as i'm simply a gal that's out in the field trying very hard to take good care of older adults i also work with teaching medical students residents and geriatrics fellows how to take good care of of older adults so that's a little bit about what i'm going to talk or all i'm going to talk to you about is my observations out in the field i do want to give you a disclaimer like any other qualitative observations all of these observations are filtered through my personal experiences they're filtered through my moral compass they're filtered through my life story so all i can share with you is some observations that i have and and um but they're very very generalized and and less scholarly perhaps than things that we've heard throughout the day today so i do want to share with you what very briefly what i love so much about geriatrics which honestly i could talk to you about for about seven hours i'll try to keep it to about 45 seconds what i like about geriatrics is taking care of older adults older adults are so wonderfully diverse exciting different i never know what i'm going to get when i open up the door to meet a new patient and my background training was as a family physician before i did a fellowship in geriatrics and the diversity that you see in older adults is so very different than at most age groups if i know that my next patient's a 40 year old man i kind of know what to expect before i walk in the room they might be different people but as far as disease state goes it there there's the 40 year old man picture that all goes away when people get older if i know that my next patient is a 65 year old i have no idea what i'm going to see some of my 6 65 year olds are frail they're dependent they are cognitively impaired i also have 89 year olds that are robust they are funny they are cognitively intact and very engaged with their families in the community so the number stop starts meaning less and less and less in the geriatric population there also can be geriatric patients can be very medically complex which i find intriguing and that's very nice so my role as a physician is very different than what i thought it was going to be in medical school medical school the focus was on learning all the science and the minutia i had to learn the name of thousands of medications and how they worked and what doses to use and what this disease means and what this lab value means and after all of that study i remember a lot of it um but i'll tell you that of everything that i do in my day my practice day that is the most mundane and the least professionally satisfying of anything that i do there are treatment algorithms that tell me if your blood pressure is this i should treat you with this if you have this lab value this is what i should do to fix it and so that to me is not so much the art of medicine as what i get to do in my other roles as physician and one of the roles is as a negotiator and this is a little bit what we were talking about with having your your your goals of care i negotiate with my patients as to what their goals of their care are i have some patients that want to capture every single minute on this earth that they possibly can they want better living through chemistry and technology and i am to treat them with any medication that i think is warranted and by golly they'll have every ct test that is indicated and and i'm okay with that if that is their idea of quality health care within reason i have other patients who think that's all that's wrong with medicine is that there are doctors and that there is medicine and so when i meet them the first time they say really i don't want you here so we have to kind of negotiate what is what is each individual patient's goal and if they are not cognitively intact i negotiate with their caregivers with their powers of attorney to find out not what they want because truth be told don't tell on me i don't really care what they want what i'm asking the powers of attorney to tell me is what would the patient want if the patient could talk to me what would they want me to do and that's what's important i'm also work as a tour guide i'm not sure well i'm guessing most of you have had some experience with the medical field and you know that it's a crazy confusing place so to be able to navigate your way through to get the care that you need or to find access to what you're looking for to get the answers you want can be very very challenging if you're looking for social support it can be also very very challenging so a lot of what i do is to help navigate help my patients as my me and the rest of my care team which includes nurses social workers and a lot of physical therapists and the like is to help people navigate to where they want to be i also work as a cheerleader although sometimes i would be described as a drill sergeant i have one patient who is completely socially disengaged she wants never to leave her house she doesn't care if anybody ever visits her and i we set a goal just this week that i want you to think of one activity that gets you out of your pajamas every week i don't care if you're out of your pajamas for 20 minutes of one day out of every week but that's our little mini goal and it's her homework assignment and i will keep on her to to try to help her with that i also work as an advocate for my patients when especially my patients who have a cognitive or physical decline to the point that they can't advocate for themselves so in all my observation over 12 years of working with older adults i've been trying to come up with a recipe for healthy aging and i really think it's a self-centered quest because i'm not getting any younger but i'm trying to come up what is it that makes healthy aging versing versus my patients who are absolutely devastated by time and i don't know the answer yet but when i know the answer i'm going to patent it i'm going to bottle it i'm going to compound it i'm going to put it in a pill and i'm going to sell it and i'm going to be rich but i'll tell you what some of the ingredients that i'm seeing and these are kind of themes that i see in my patients i have a very diverse patient population ethnically diverse i have patients from you know internationally diverse i have patients from of different religious backgrounds but despite all that i see some consistent themes which is what i want to share with you today the first theme i see is engagement and what i mean by engagement is people some of my older adults they tuned they tend to withdraw and they lose their role in society they lose their role even in their within their own family and some of that has to do with family norms you know in our family this is what we do when people reach a certain age and they're not able to contribute actively with a family we put them in the back bedroom we go and feed and water them every once in a while but they stay back there right so some of that is because of a family pattern but i think a lot of that is because of the societal expectations that we have of older people when i was teaching at the university of kansas i taught third year medical students 175 of them a year for a four-week course and one of their assignments during that course was to find somebody over the age 65 that was not their family member and sit and talk to them for an hour and to write not a paper write a reflection piece of what the experience what what they learned from the experience oh my heavens you would have thought that i'd ask them to put a roof on my house i had i had students so of 175 patient uh students i had each year we did this three years in a row i had about a third of them who emailed me and said i don't know anybody over the age of 65. are you kidding me look at our demographics in our society how can you not know somebody over the age of 65 and it turns out that well one they don't hang out at the same places but besides that there's this societal um norm that we see people who are older they tend to withdraw from society and they're not out there and so my patients who tend to age well and stay engaged with society the two tend to have a lot to do with each other they stay very active within their family within their society another thing i see is um resilience i love the word resilience i love the word resilience so much i say it almost every day because i'm trying to figure out what it is there i can give you 10 definitions of resilience i don't find the definitions very helpful but what i do know for a fact is i know resilience when i see it and i have patients who have been through lifelong trauma and they've been i mean they have not been on the the luck side of things from the day they were born be it their their lives their social situation their medical situation yet they're happy and they're engaged with society and i want to know what causes that and i want to be like them when i grow up and so i'm trying to figure out put my finger on what exactly it is resilience i'm going to go over time if you don't like put your hand up so um depends so i do want to tell you i'll just keep it to two more little stories i have a patie i will call her millie and she was one of my patients for many many years and she had a life that read like something you'd hear on daytime yucky tv i mean she had this story it was rough she had a rough upbringing she was about in her mid-80s when i met her she told me when she was young she was a dancer i don't think she meant like she was a ballerina i think that she was a dancer for money and not in a well anyway um she had many uh i think six children um was never married to any of the fathers she worked her tail off to support those children and they were very very good to her in her final days but what struck me about this woman was that through everything she'd been through including her horrible arthritis her horrible lung disease her cancer diagnosis she was the happiest funniest lady i had met in a long time i asked her one day i routinely asked my patients what do you do for fun and half of them look at me like that is the craziest thing i've ever heard in your life so i want you to be able to answer that question by the way if you can't answer that question like that it's not voting real well for you having healthy aging okay so i asked them what do you do for fun and this lady said i take the bus all right i need some more what do you mean you take the bus she said dr mcdonald one dollar unlimited transfers and there are some fine looking men in this city it was then that i knew i had passed my my relationship my boundaries with this relationship with this patient were completely torn down and i loved her the same woman ended up going to the nursing home because her arthritis got such that she couldn't transfer herself in and out of her wheelchair and at the time she came to my nursing home so i was still her doctor i still got to see her and they were doing construction on on the third floor which was her floor and i said millie how are you liking the nursing home same thing dr mcdonald i love it here there are some fine looking men in this nursing home anyway so i want to know what makes her her and when i find it you'll hear about it because i'll be i'll be all over the tv um last thing um i do want to talk about a hope and spirituality um hope and spirituality you know hope can be spirituality i think the core of many patients hope is their spiritual base but i take care of lots of patients who don't claim to have any true spiritual base but they still have hope and they still have inner beliefs that they don't identify as spirituality i have spiritual conversations or inner belief conversations with every one of my patients i do not know how to take care of patients if i don't know their belief system and so the added bonus for this to me is that i talk about spirituality every day with my patients and i have benefited tremendously from that i i have an inner spiritual conversation with myself all day long that i never had before i spent time with older adults and i've really benefited from that and lastly i want to leave you with a quote that sounds a little like a bumper sticker and i may have actually seen it on a bumper sticker that says you don't stop having fun when you get old but you do get old when you stop having fun thank you very much i thought i was funny this is great we were talking about part of your talk mentioned about getting older i just i had my own association i just finished the biography of the rothschild family and one of the stories is when the elder rothschild reached about 98 she refused to be going to doctors so her son brought doctors to her to do the examining he can afford it and he brought doctor one day the doctor comes out and uh rothschild asks him how is my mother doing and he says well rothschild your mother's not getting any younger and he said look doctor i'm not paying you to make her younger i'm paying you to make her older anyhow our third presenter this morning somebody had the pleasure of meeting last night i think the first person i met arriving uh at the reception last night was the dr gay powell hannah and i enjoyed meeting her and looking forward to hearing what she has to say she's also dealing with a very important subject and creativity also in older people that's one of the areas that she specializes in she's an arts administration leader with over 30 years experience in arts education and health related services and she is executive director of the national center for creative aging that's ncca not ncaa not to be confused at all with that it's an affiliate of george washington university in washington d.c previously dr hannah held faculty positions at florida state university and the university of south florida where she served as where she directed vsa arts of florida which is an affiliate of the john f kennedy center for the performing arts a very important organization in our country as a contributing author to numerous books and articles among her publications are such topics as arts and human development learning across the lifespan and creativity matters arts and aging in america so please join me in welcoming dr hannah thank you so much and good afternoon everyone i want to sign up and be mary's patient don't you i'm so glad i'm in washington dc where she works and to all the panelists it's just been such a invigorating experience and inspiring so thank you thank you to our host and to all of you for coming well i feel like taking a deep breath now and embracing this moment of really cultural change dr corbett powerfully put it that creativity is essential across a lifetime and then has such a powerful impact at the very latter's part of our life he uh eloquently linked creativity to spirituality really to the divine gifts and as i've often heard it allows us to be in the thin places between heaven and earth which we often feel when we're before a work of art or where when we're engaged in a creative practice in our home our kitchen our gardens with our loved ones and families and friends well i come from the visual arts so you can be sure i need pictures to talk so i have so enjoyed hearing the eloquent presentations but if i could just explore with you today productivity and vital aging through the lens of creative expression and really as was earlier said talk to you about the hands-on landscape that is now growing and thriving to carry out the ideas that we've heard and the important concepts and i've got the clicker all right thank you so just a little bit about the center i say i'm from the national center for creative aging and of course eyes widen and i think many of you have said and what do you do well actually we were created 10 years ago by susan perlstein founder of eldershare the arts in brooklyn new york a grassroots organization and formed by the national endowment for the art and the national council on aging so we're truly a bridging organization with the mission to be sure that we can provide as much access to the experiences and creativity and the arts and culture as is available in our communities now i'd like to just introduce you to the pair that you see in the corner of the strength in the screen there's a gentleman playing the violet violin and this is our template he's playing to a young i think a young girl and uh he is a resident of burbank senior artists studio residencies in burbank california these places of affordable housing are built around the arts in fact i visited and people in the halls actually sang to each other and they didn't even know i was there visiting as a person in the arts but we're seeing models across the country in fact there are 23 of these sites across los angeles but they're popping up in washington in atlanta st louis of course new york and boston so we're redefining our landscape of what it means to live and enjoy life where we are again the landscape includes research we need an evidence space to to talk and communicate with the other disciplines that are so important to a thriving array of program services we need policy we need technical assistance and we need a place where you can come and get more information and provide information now a 97 year old artist visual artist was asked how are you doing today and she said well i'm above ground and this turns out to be the title of a very exciting research study done by joan jeffrey i'm showing here the title page of the study and of course it shows much of the ground and above it is new york city it's a study of visual artists that have spent their lives as professional artists in the city of new york not the super famous ones but the ones day to day that have worked in in their communities when the study was released in 2007 the new york times said older artists role models for successful aging so here in fact it resounds resonates with dr corbin bits presentation average age 73 income in new york 30 000 that won't take you very far life satisfaction very very high self-esteem high engaged with their community not intending to move have found a way to have health care retirement of course there are artists so they have an attitude and a strong social network this is especially true of visual artists in fact picasso once stated as one gross alter life and art become one in the same and i think that's what we've heard today and again median income oh i love it when they do this and no the the major thing is of course it's very good to live in the moment visual artists often live at the moment live in the future but much of their work is not taken care of so indeed there's policy being developed out of this study where there are programs taking place in new york and washington to save the legacy of visual artists we're very proud at the national center for creative aging to actually have the research center on arts and culture with us it was given to us by columbia university last september now what does that mean to you and to me most of us that don't spend our lives in the studio i'd like to share with you another study and i know many of you in this room have met and know dr gene cohen we lost gene about two and a half years ago he was one of the founding directors of the institute of mental health and the national institute on aging he's really one of the founders or was one of the founders of geriatric psychiatry and he spent his life truly working in the medical model and then became convinced towards the end of his career again back to dr corbett's presentation of the power of creativity and that what had been denied certainly was the potential of aging so he spent the rest of his career like others looking at aging not from deficit only but from asset to really shift the parent time in fact he said you know we almost have no choice but to have stereotypes about aging he said all we see when the media presents older people is the 3ws they're wicked they're weak or they're weird so what can we do to change that with this demographics we certainly are changing it and it is the culture change well he did a three-year longitudinal study a very small study but one of the first indicators where he looked at he measured mastery and social engagement to see how community-based arts programs arts program said all of us can be part of he looked at an art program in san francisco he looked at creative writing and jewelry making in new york and in washington he actually studied a chorus out of the levine school of music now what did he find with a median age of 80 people actually got better in the experimental group he found better help health less medication fewer doctors visits certainly an increase in activities and he modestly and we know this is a very small study projected that because arts programs are so inexpensive that the saving potential with using creativity on health care costs could indeed be substantial this study was funded by the national endowment for the arts by aarp and in fact i'm pleased to thank rick moody who's here in the audience now for all of his support rick is with aarp the academies and then second aria mentioned a recent white paper and this i call the big shift as dr cambry mentioned we've had individual pioneers coming to this place for quite a while in fact robert butler talked about why survive in the 70s growing old in america but now we seem to really be moving towards that cultural change and i'm just delighted to share with you if you don't already know that in march 2018 there was a convening of the national endowment for the arts and health and human services and they convened to really look at arts and human development across a lifetime we were honored at the national center for creative aging to author this white paper it was produced by the national endowment for the arts it has resulted in a 16 governmental agency task force the task force knows that in this climate there's just no new money but what we're finding is indeed there are resources that can be compounded and shared and policies and funding descriptions that can be opened and more ways to build an evidence base to again encourage this lifelong productive and vital aging in fact i've given you the website and in your resource book you certainly have ways to become a part of this and there's actually webinars and convenings and there'll be a call for papers from the national academy of sciences later on in the year so i certainly hope that there is a core of you who will certainly participate in this now again we're looking across the lifetime what does this do and kelly so wonderfully put the whole movement is towards whole person's care mary told you about the actuality how she does her practice based on this but here we've got it in a larger conversation we're looking at it in terms of really starting not at 60 or 90 to figure out how we are and how we can actualize creativity but really from early childhood now it's my privilege to take you almost into a garden a garden that's just blooming across this country again this movement started in the 70s and is now in full flower with plenty room to grow so here i'm showing a picture of a teaching artist anthony hyatt he's working here in washington d.c at iona senior services he's dancing with a person who has memory loss dementia i think someone had a question about what is successful aging when you have alzheimer's and dementia perhaps this picture can give you a glimpse it's still being engaged it's still being in community it's still contributing iona senior service center calls itself not only a senior center in fact they're distancing themselves from that name but they call themselves an arts and wellness center and employ art therapists which i know is very close and important to young theory again a picture of a chorus i was talking to a few people at lunch washington dc is a very coral town there's extraordin i think it's because we talk so much that we burst into song from time to time but there's congressional choruses there's of course the opera every church there are so many gorgeous choirs and synagogues and uh when gene cohen did a study he actually put an ad in the newspaper for people to join a chorus at a senior center and over 200 people responded that had never been to the senior center few had ever sung often and they did very well actually they performed at the kennedy center and still do so people often ask us you know what happened to that chorus that started with gene's study now how many of you would think oh the study went the funding went the chorus went not so it became a non-profit it has 23 courses across the country they hijack the queen mary and actually sing their way all the way to the uk and that they should be part of the ireland program so gene kelly is their director we might have people in this room actually that are part of the chorus because there's one located in the smithsonian institute so again it's vibrant it's productive cbs interviewed one of the singers that's 91 and she said i feel like my feet are a foot off the ground i am just so excited about performing and you know she wasn't thinking about her arthritis or knees or anything else but giving a good performance now we we actually see programming clustered in three areas health care the last slide was about lifelong learning and then very importantly community engagement another local program i decided today you're in washington we'll talk about a few local programs but this indeed is an international local program liz lerman dance exchange out of tacoma park liz lerman started her dance with older people when her mother died she was a professional dancer and felt i have to make a dance i have to to really be able to cope with the grief that i feel she lost her mother at a young age and so she went to the senior center here in uh you know in lower maryland and she says the first time she went there she said she asked them if they wouldn't just move their head back and forth and they just sat there so then she started leaping across the room and she left one way and they turned their head down and she left them and they turned their heads otherwise pretty soon she had everybody going back and and she created such a wonderful dance program that actually uh and after it was over she said oh thank you very much this has helped me tremendously and they said what you think that you're going to leave no and so she spent her career working with all generations you can see here different cultures different ages they're all professional dancers they go into communities they create beautiful works they worked with the national institutes of humanities on a genome project they've done programs that take on tough topics i just saw liz at harvard in november where she's getting ready to premiere healing wars to commemorate the 200th anniversary of this civil war and i must say all i did was cry it was just so powerful because she again used different ages different abilities and she linked images of the civil war with afghanistan iran and i will tell you if it comes near you please see it again we have a resource we just launched this week from a generous donation from the national endowment for the arts and interactive website we're looking for your stories we're looking for your programs your advice and along with it goes a wonderful awards program and a grants program and a speaker's bureau so thank you again we look forward to working with you doing everything we can to provide access for vibrant and productive aging i'll conclude again we we honor gene every chance we get since he brought us to washington dc five years ago and he would use a surrealistic umbrella to express the blue sky that we can hold with us as we make the journey the ark that carl young so beautifully describes and just the last example of an artist he was inspired to do this by georgia o'keeffe georgia o'keeffe was terrified of flying and the older she got the more in demand she was she was one of the greatest painters of the 20th century so the story goes that she's flying almost too afraid to look out the window and when she does all she sees is blue sky over clouds so her last work is her largest body of work and a good portion happens to be the blue sky over the clouds so again thank you thank you all thank you i'm sure all of you are as inspired as i was from all over three panelists it's really wonderful all three of you thank you and we do have some time for some questions and discussions and uh i had a good break over lunch one of the technicians came over and told me my job is now easier i don't have to memorize and repeat the questions so as long as you can hear them they can pick up the sound so i'm going to open up the floor for any of you who have some questions wait microphones coming so this the timing is everything it's not a question it's a comment because i wanted to thank especially dr hannah for sharing about the dance exchange um my parents were in that dance of liz lehrman's 35 years ago and my father was in his late 70s and my mom in her late 60s and that dance was the most amazing i encourage everyone to go out and dance and the photograph of my parents playing mr and mrs god in liz lehrman's work is the photograph i look at every morning that's on my bookcase and would love to have everyone share that experience thank you um right here microphone right here hi drana i really enjoy what you said i enjoyed everything of what you all said but i just wanted to introduce another layer of what you're doing with the art therapy performance and pictorial cetera the importance of being together and have a meaningful experience with others it gives a sense of a life beside being creative so they are in a group they do things together and that is really connected with the bond of humanity thank you i also i don't need to cut off the panels if if any of you have anything you want to add or questions for each other just feel free to interject i guess um it's so important we we've had a great time talking with each other and what i gained once again is the importance of inter-professional teams and working and certainly you might speak to the role of you know social work and if you think that's appropriate medical models so we we actually we have the house call program through washington hospital center i want to i am one of five geriatric physicians and then there are five nurse practitioners we also have five social workers coordinators nurses and we work with all the community home health organizations um and and so the the model of the interdisciplinary team is very important you know we have 600 patients we can't possibly coordinate everything they need just amongst the you know 25 of us and so we really rely heavily on our colleagues out in the field we we use wound care personnel who will come to the home now all of this is done in the home so you know if i if i have a patient who needs an x-ray i order an x-ray and they lug it up the stairs and take an x-ray in their living room so this is um it is a program that i'm relatively new to i've only been in the program for less than a year but it's pretty remarkable what they can do and what we find is by using that kind of 360 cocooning approach to care it's very individualized very much based on the patient's wishes for the direction they want their care to take our hospitalization rates for our patients is well well below the average most of the time patients who end up in the er um it's because they when they're sick they don't have access to the care they need and then when they don't need it remember you know you have that appointment come see me every three months well i'm not sick today i don't need a doctor today where were you two weeks ago when i couldn't breathe so the whole idea is that we bring the services to the home for routine purposes but also for acute care visits and most of the time we can nip it and and keep them from having to go to the hospital we i tell my patients you don't want to go to the hospital it's a horrible horrible place i don't think washington hospital center which is a fine fine place but appreciate me saying that but for older adults it is so we we know that if an older adult walks in the door of a hospital any hospital the best hospital in the world there is risk for bad outcome so we try very hard to keep our patients out of the hospital i would just like to add that where some of the shift is occurring is in education historically professional schools are separate buildings and separate structures separate timelines and there are some models where a social worker a nurse and a physician student all go out into the home and do the assessment together and not only do they get a larger picture of the person they also find out about their team member who they are and understanding their role and i don't think that hurts also in terms of what they can share in terms of expertise uh skill sets etc and that's the joke about the the server piece that uh we were talking today and she was saying that one of her patients said that she was just the best social worker she'd ever met and i asked her you know where did you go to medical school and then said the university of kansas and so synchronicity is that that's where i want to get my phd the university of kansas so it's a good school i think don't you very nice they have a good basketball team too in the ncaa not the ncca go jayhawks so i'm sorry i talk a lot you can stop me whenever but it is interesting that medicare is actually looking at programs um different models of providing care because we know that the baby boomers are really booming and our our um oldest population in fact our over 85 population is the fastest growing part of our population and so how are we possibly going to provide care to all these people we want to provide care to all these people they we they deserve good care so how are we going to do that in the best way and so medicare is now working with several programs many programs across the country to say you know what you've got a unique program we want to see how you do it and we want to see if you cost more or less than our traditional program so they're really looking to kind of expand the range of services so that we can provide and it's not just cheaper care it's better care so they're looking you know if we can find a model that has better outcomes than our traditional model and it costs half as much win-win so they're actually pouring money into program pilot programs right now um looking into just that okay right there dr mcdonald does your practice serve patients throughout the dc area are only in the quadrant near the washington hospital center so um right now we cover about 10 zip codes mostly northeast northwest in d.c thank you yes however ask me if we get some big old medicare money and we start expanding so keep your fingers crossed as we are i i realize this may be a bit of a cheat but i have to meet my daughter at home after school today so i can't hear the next panel but i just wondered if you all knew of um any studies using meditation in the in gerontological medicine and whether you're seeing if you're aware of any impacts that are used there i was struck earlier by for example the quality of equanimity being very valuable as we age and that's something that's cultivated in you know basic insight meditation or other simple forms of meditation thank you i don't know anything about meditation i'm sorry i think some of us have heard of people working and i've heard of it anyway and that is very valuable but neither myself nor anybody here has any experience in it but it certainly are people working anecdotally i've heard as very valuable and another tool another tool thank you hello i thank you for some inspiring thoughts and visions today um i am thinking about the other the um aft you know at the end people die and so in your programs i'm wondering if you're also and your caregiving if you're also involved in you know end-of-life care i for instance i recently saw an advertisement for a workshop given at the new york open center by um a man who was a social worker and it was called um end of training to be an end of life doula or caregiver and so i was wondering if part if your programs incl and i know that nurses and and other medical personnel and hospice used to be able to give attentive individual care in my understanding and you know is that people are too busy and you know healthcare has changed and people are no longer able to sit or be or comfort people who are dying so i'm wondering what that looks like from iran so um the role of the primary care physician i'm very proud to be a primary care physician and i think the role of the primary care physician is to take the lead on those kind of conversations and so and all of my partners in my program agree with that so what often happens is when a patient reaches the point that there are no further options for cure they are passed off to another team to start their dying i guess that to me i don't think that's ideal i think if you work hard to form a relationship with a patient it is um your duty but it's also your it should be your pleasure to see it through to the very end so we have advanced directives living will you know the key is we start those conversations from day one we don't wait until you're sick to talk to you about end of life you start talking about it when you're healthy and cognitively intact i want to talk to you when your thinker's working i don't want to wait till you're mushy headed to talk to you about what your wishes are in life so yes absolutely and that that's a core principle of all geriatric training however we do the actual hospice care we do consult in a hospice organization to partner with us for that april oh may i just add that it's a huge area that's developing in creative expression most large hospice organizations have art therapists visual arts therapists music therapists poetry fine artists that are trained to work right at the bedside we have a contract with the veterans administration now to really develop protocols for end of life care palliative care so it is vital to the very end as we've heard from our keynote presentation so yes a very important role for for the arts is are any of your activities integrated with the aging and place movement and if to the extent that they are not you think there's a potential there sort of court to some of the work i do now that other gerontologists do is with the idea of aging in place in terms of a movement i think it's sort of it's been in existence for quite a few years and i think in particular the community-based service programs really that's a primary goal of that there are alternatives to nursing homes such as congregate living and assisted living but the primary focus really has been on community-based care and that's increased over the years and i think has been successful in helping folks age in place and our program is home care that's not in nursing homes so they're that's 600 older adults that are in their homes we're indeed part of naturally occurring uh retirement centers in fact one of the noted ones in washington is watergate you know you can live right there go to the kennedy center it's of course on the most high end but their efforts across in the community affordable housing across washington d.c there are choruses and um actually a theater group in northeast washington that's formed from uh aging in place so again it's it's a new frontier you know we actually think it's a renaissance of a whole new era in the arts and creative expression um i guess you're addressing what i have in mind but i was thinking of communities i've heard of the watergate one maybe it's the one you're referring to there's also the golden glovers in glover park of dc and this is not just age related people need assistance at all ages and in these communities they can call on the community say vetted construction people or whatever you know for assistance that's what i meant that kind of a community but i think the watergate one is supposed to be that sort so thank you thank you it's been a wonderful wonderful day for me and i see by the enthusiasm and the audience that you've all been enjoying and you're here which is the best vote of confidence and i just want to say one thing because apparently i've gotten a report that some of you have broken one of the ten commandments and the cell phones have been on so uh anyone if you forget it's understandable can you please make sure to turn off your cell phones it's only an hour and fifteen minutes to go then we can have the wi-fi cell phone fixes again okay this is a subject that's obviously very dear to people who are interested in young psychology and ideas in the jungian world which is spirituality in the second half of life which really is the second half of life issues in general i think was jung's first major contribution uh to the field of psychoanalysis and it's still something that yoga is very well known for among other things and it's a subject that it's non-ending like spirit it really is something we can continue exploring and we're looking forward to having our panelists begin the exploration with us this afternoon our first present is dr melanie costello melanie star costello who i've heard a number of times in the hudson valley and i feel a lot of kinship with her she has a history background as do i my phd was in history before i went on to yogi in psychology she studied in zurich which i think is very important institution i graduated there and i'm looking forward to hearing her this afternoon dr star is a licensed psychologist anna jungie an analyst in private practice in washington dc she earned her doctorate in the history and literature of religions from northwestern university and is a graduate of the young institute in zurich a former assistant professor of history she has taught and published on the topics of psychology and religion medieval psych spirituality and clinical practice her publications include imagination illness and injury jungian psychology and the somatic dimensions of perception and she really brings a multi-dimensional approach to her practice and her work and her presentation so please join me in welcoming dr melanie star costello thank you so much arya well it's pleasure to be here with you um and i'm going to pick up on uh several themes mentioned in dr corbett's presentation particularly i'd like to look at spiritual potentials of wise eldering as a kind of archetypal portrait of of real spiritual potential in human development and um time does uh have meaning in terms of the realization of this archetype but i'm going to do it um by drawing as much as as i can in a short time on the voices of people who i consider as sages or wise elders themselves since if you haven't noticed i'm not quite there yet myself and we've also mentioned some of the cultural tasks associated with aging i'd like to add an essential feature what i believe is an essential feature which regards tasks that are nature oriented that um i think creative aging spiritual the spiritual dimension of aging involves both cultural and nature oriented tasks and contributions to the the general society so i want also to emphasize how important i think it is for those of us who aren't the oldest of the old to have exposure to people who are aging in a creative way we've been focusing i think a lot on the aging person him or herself but i think it's it's a good thing to think about what we need from people who are aging as well and you know just a few weeks back when i was preparing for this uh event today which i've been looking forward to very much i consulted the iching the uh book of changes in ancient chinese wisdom source which dr cambry mentioned earlier in his talk so you know i pulled out the iching and i said speak to me of aging and immediately i was led to a chapter called the preponderance of the great and it concerns the urgent need to approach a transitional period in a meaningful way two parallel images were offered a withered poplar puts forth flowers an older woman takes a husband no blame no praise these images portray actions that do not accord with one's natural place in the life cycle and i'm hoping the book wasn't speaking directly to me the suggests there may be no harm in responding to later life callings with acts belonging to a more youthful age but when doing so little is really gained jung was a bit more severe on the topic he said we cannot live the afternoon of life according to the program of life's morning for what was great in the morning will be little at evening and what in the morning was true will that evening have become a lie nature commands cultural and biological productivity in early adulthood but the principle of transformation is the motive force of mid and later life in conscious aging we reflect upon change as life's insignia we cultivate psychospiritual growth through our ascent to the ways of nature conversing conversely unconscious aging marked by the absence of reflection makes us vulnerable to consumer-driven youth-obsessed cultural stereotypes that envisage aging in terms of loss from this perspective we're victims of time and death shadows of our former selves and as time passes something to be cast aside hidden from public view outsiders so in response to dr corbett's remarks i'd like to speak about conscious aging as a spiritual path one that embraces aging as a developmental process pushing us toward and not away from something of great significance jung attributed as was earlier said a cultural and i think implicit evolutionary purpose to longevity he writes a human being would certainly not grow to be 70 or 80 years old and now we could add 90 to 100 years old if this longevity had no meaning for the species the afternoon of human life must have a significance of its own i think the developmental goal of aging would be much more obvious to us if we had daily access to people who have lived to be a ripe old age our society though is organized in such a way that we don't often encounter our longest lived citizens in public venues and because many live in retirement enclaves even family members don't necessarily have daily access to them and i think this is a loss to us i think we would all agree old age is no guarantee of wisdom but evidence suggests some individuals do realize the fullness of their spiritual potential in entering into a state of sagehood so now i'm going to move a little bit into an archetypal picture of sagehood by their concerns their breadth of insight the form of consciousness they've attained sages are those precious ones who convey a depth of perspective that is cosmic in scope marion woodman who's considered by many of us a wise woman herself she's a union analyst and she describes what she calls the crowning of age as a time when one's relieved of personal desire ego strivings dissipate and the heart is opened one tends the world's soul and carries the feeling function to the community by caring for the young and for the earth in his memoirs jung speaks of his eighties in these terms he says it's a time of freedom from individuality essentially he describes a growing kinship with all things so i'll quote there's so much that fills me plants animals clouds day and night and the eternal in man the more uncertain i have felt about myself the more there's grown up in me a feeling of kinship with all things in fact it seems to me as if that alienation which so long separated me from the world has become transferred to my own inner world and has revealed to me an unexpected unfamiliarity with myself jung's describing how over time one center of gravity shifts the personal identity gives way to a larger ground of being the natural world and one's internal landscape are contiguous the natural world and one's internal landscape are contiguous the sage's vision is unitive in the mystical sense of the word in her company one feels a sense of belonging to the web of life one such person was the theologian thomas berry and he passed away just a few years ago barry envisaged the wise elder as one who represents and embodies the correspondence of the human process with the natural process their presence promotes the making of a healthy society which requires that all its members experience themselves quote in integral relationship with the surrounding forces of the universe in other words the gift the sage brings to the world at this critical juncture in time is that by her mere presence she fosters our reconnection with our roots in nature in this more contemplative unitive form of consciousness is aging's potential in in this united form of consciousness is this potential something that one has to to cultivate deliberately and how do we get there if we're not intentionally spiritual might we get there anyway often as we've heard a spiritual transition begins at midlife in practice early intimations of this transition can be quite disturbing after all psycho spiritual transformations places at a threshold between the known and the unknown between loss and new discoveries our western cultural norms don't prepare us for the developmental phases of aging as the cliche midlife crisis makes clear we suffer a great deficit in our times because progress is a dominant value in western culture and it's understood as a trajectory moving continuously upward from a fixed point this paradigm puts us out of sync with the way things truly are in nature and particularly impacts our attitudes toward aging which naturally involves a great deal of letting go of things rather than building them up and even where we've brought a wealth of creativity to building our profession to raising children and making meaningful contributions to society the time may come when these responsibilities no longer energize or lend meaning but rather start to feel burdensome grave doubts about oneself and one's life choices are common at these transition points one may suffer inter internal feelings of isolation or flatness and even spiritual or religious practices may no longer prove enriching this is a time when people sometimes come into analysis in christian tradition the painful experiences associated with transitions to mature spirituality have come to be called the dark knight of the soul referring to a 16th century poem and treatise by saint john of the cross here the seeker having lost his connection with the divine grace suffers feelings of despondency humiliation and worthlessness the kinds of feelings that we associate with clinical depression such intimations of a time of psychospiritual transition can be very frightening and the pharmaceutical industry has profited greatly by our collective lack of understanding of developmental needs in later life for where we don't meet these intimations as meaningful communications from within and where we keep on going as usual depression anxiety are a likely outcome we're bound to go through several transformations times when we're called to lay down our lives as constructed to sacrifice an established self-image and make way for the truer less socially scripted self that is trying to emerge in this metaphoric death one's known self is sacrificed in exchange for what the poet derek walcott calls the stranger who has loved you all your life who knows you by heart a soul-filled life is one spent in conversation with this stranger this ever emerging self conscious aging promotes this dialogue by means of dream work by applying the imagination through reflection and writing in relating to the natural world as a subject rather than as an object in attending to our emotions and the images that spring out of the depths in meaningful conversation storytelling prayer ritual practices within or outside of a faith community and of course the beautiful examples we saw about what's happening with aging and creativity in the arts in time an individuating person may seem less a personality and more a culture carrier mentor defender of the community well-being and guardian of the biosphere we're talking about aging in the 21st century this portrait of an elder is presented by echo psychologist bill plotkin if any of you know his work in plotkin's formulation the elder is one who surrenders his sense of personal agency strives less toward individual accomplishment and more toward the common good individuated elders report the sensation of moving deeper into formlessness in that they are released to a sense that something greater than themselves is doing their life's work through them so again this idea of being freed of a sort of ego-based orientation and releasing oneself to a larger ground of being so now to return to my earlier question is the state of elderhood or sagehood a potential that's realized only through conscious intention apparently not we frequently find in the literature of aging heartfelt acceptance of the diminishments of the body and an affirmation of the simple blessings of being alive the spiritual fruits of aging are found in zen-like portraits of the luminosity of a single moment in a letter to a friend for example the agnostic e.m forster writes how peaceful it is here with the west whackhurst clock still ticking the rook's nest fire irons still warm in the hearth and the dog little master his feet on the rug nodding toward the end of a successful career and then a few years on as he approaches 80 he writes my great extension is not through time to eternity but through space to infinity here now and one of my complaints against modern conditions is that they prevent one from seeing the stars forster's agnosticism was no barrier to the soul's journey he had arrived at a transpersonal ground he grasped infinity through an impassioned participation in the natural world in the very place he stood this phenomenon may relate to a study recently published in the journal of psychological medicine contrary to the stereotype of the elderly as frequently depressed in the face of loss and oncoming death the study shows the rates of depression and anxiety in later life to be lower than rates reported for working age adults in fact the fear of aging and death seems much more common in both early and late mid-life i witnessed this natural movement into simplicity as i watched my mother in her final years uncharacteristic of her younger worried self she became a kind of hybrid a cross between a sage and a comedian by age 80 and not withstanding recurring bouts of illness and multiple hospitalizations my mother had become a kind of trickster undermining serious moments with equip or raucous laughter continuing continuously and sometimes it was very irritating she took great pleasure actually in talking about her night dreams in those last years of her life in fact just a few weeks before she died she repeatedly dreamed that she was making love with some unknown beautiful lover now she found this hilarious and we had many laughs about it and the experience really made her joyful and a bit body and i loved seeing her in this state but it also made me sad for myself because i at that point had enough exposure to archetypal imagery to know that it meant she would die very soon and so she did we tend to see death as dissolution but such dreams anticipate death as union where does the truth lie throughout the life cycle death and renewal are inextricable releasing themselves into identity with the larger web of life our wise elders make a passage into death long before dying in the conventional sense and if you've known such a person and have had the privilege to be present at their passing there's an undescribable indescribable kind of luminosity at the time of their leaving one is given a rare glimpse into life and death as a unity a parting gift from a life well lived so thank you thank you our next speaker dr christina puchalski has graciously agreed to be sandwiched between two jungians and uh we welcome her here i'm looking forward to hearing hearing her present today she is a pioneer and a leader in the movement to integrate spirituality into the healthcare setting both in clinical practice and medical education as founder and director of the george washington institute for spirituality and health in washington dc she continues to break new ground in the understanding integration of spiritual care in a broad spectrum of healthcare environments the spiritual assessment tool fica not their social security that we that we pay every month which she developed is widely used in clinical settings around the world dr puczowski is professor of medicine and health sciences at george washington university school of medicine and an active board-certified clinician in internal medicine and palliative care she has published widely in many journals with her work ranging from biochemistry research to issues in ethics culture spirituality and health care she sees a very wide variety of topics that she's a specialist in among her many publications are books such as time for listening and caring spirituality and the care for the seriously ill and dying and her most recent book making health care whole please join me in welcoming dr patel thank you so much it's a pleasure to be here today and i was very moved by your comments and your beautiful poetic way of describing what is that tender balance at the end when we let go but celebrate a transition and i i thought that was beautifully done thank you and it so much speaks to the kind of issues that my patients face i am an active clinician i work in the division of geriatrics so i have i'm a primary care doctor one of my patients just referred her great-granddaughter so my youngest patient is 18 and my oldest is like not 105 now so i have a pretty broad range and i really enjoy my work and i and i enjoy my patients and i think that's probably the thing that gives me most meaning in my life among other among other things but it is the sages in my life and maybe not technically the way you were describing as jung would describe the sage but the sages in my life that have resulted in some of the work that i'd like to share with you briefly today and the first one was when i was a researcher at nih and i um worked in the arthrit the then earth niddk arthritis institute and for those of you that know about nih people who have seriously ill illnesses and are not able to somehow manage with the conventional treatment go to nih for experimental protocols and so one of those patients that i ended up visiting had very bad arthritis was an artist and his hands were very badly deformed and so many of my colleagues said isn't this terrible you know he has no life anymore and very much painted a hopeless picture and yet when i met this gentleman that's not all what i found i found a man full of spirit full of hope full of life and full of creativity as as gay hannah so beautifully talked about in her work with her institute he really was able to continue to express his creativity even though the rest of us couldn't see it because we had such a linear description of what meaning and spirituality might be for that person and then after that going to medical school i was struck and particularly in psychiatry class at how um psychopharmacology had certainly taken its impact in its on psychiatry but how little was addressed uh in terms of spiritual issues lionel had written about gero transcendence that term wasn't even used and then the notion that people would face very deep spiritual issues that could impact their presentation of physical and mental illness was not discussed at all it was all very biomedical so i was inspired this is over 20 years ago to start a course for medical students on spirituality and health and have since progressed with that and reflecting on the previous what i heard in the previous plan on a little bit on the previous conversation today um i think it is difficult to address spirituality it is difficult because the definitions are complex because it can be very philosophical um if people can think it's too much of an inner world and so we can't really bring it into our health care systems and i have actually worked with a number of my colleagues to fight that that myth and to say that actually we can it is very accessible it's accessible in our own lives and it's accessible in all of healthcare so what i want to talk briefly about today is this notion of suffering i think if we want to talk about healthy aging we want to talk about how people understand their suffering my dad is 90 almost 91 he just moved here from california a couple months ago he's in a wonderful senior community in arlington he's a widower my mom died of dementia at the age of 93 about four years ago and my dad has bad arthritis and other things but he doesn't let that face him he continues going on in fact the image that i want to bring to you is about three weeks ago he and his new lady friend who's 92 took us out dancing now i don't know how to dance and i was like you know what am i going to do and i saw my dad get out from very kindly he you know asked this lady if she would dance and you know they did the usual kind of graciousness and they did and out downwind the canes and off to the dance floor and i was blown away real joy you know and yet there are there are some of my patients who are just his age who have been world war ii survivors as well um who come to me and say you know i want to address my spiritual issues i think i'm i think something's wrong there and they're stuck in their suffering what so what's the difference i think you know with my dad he's a man of strong faith he's from poland he was in a concert in a prisoner of war camp family members were in a concentration camp he had lost many family members he was an artist an opera singer continues to sing he had to give up a lot of things along the way in his life he had to detach and he was able to do that through all his life he attended to spiritual issues throughout his life so no surprise now that he does it second hand now he is a wise person he's a real sage in my life so how is it that we can help people who don't quite have the skills that my dad has addressed some of those issues well let's look at the kind of suffering that we face particularly in aging there is the loss of a person's sense of independence the it wasn't that easy for my dad to give up managing the bills to me but you know he did it there's life limiting conditions there's dementia there's memory loss there's cognitive impairment there's financial stress there's social isolation how do people come to understand that and also even though depression and anxiety may be less than the older population the statistic about completed suicides is still that that's the highest in the 65 actually 85 and older but in the older age group not attempted suicides but completed suicides so you know we have to look at why is that happening in our society and where are most of these people getting their care they're not getting care always in the home-based practices we heard about in the previous panel they're getting care in our health care systems they're meeting they don't always have the resources to see therapists or or have analysis so how can we help people and i believe spirituality is the answer to that so what are some of the spiritual themes that you've heard about today is resources of strength but that actually might cause suffering and one is the lack of meaning i am not the person i used to be certainly hope what do i have to hope for mystery why me why now part of the whole spiritual journey is not only the connection to something outside of ourselves but the understanding that we have no control ultimately that we could die today we could die tomorrow science offers some answers but not all the answers and that's difficult in this particular western society helplessness forgiveness is a huge theme and i think addressing some of those issues is really important now i'm going to talk a little bit about our health care system all of us are sitting here today because of technology i am somewhat critical of the pharmaceutical industry and science but i'm also very respectful of it we are living longer because of technology but i'd like to postulate that technology has also perhaps increased our suffering now look at our health care system now most of us are in this health care system there's myriad of choices myriad of options for patients to deal with so as people are going through they've been given a diagnosis or they're they're trying to get some tests resolved very very disease oriented it's not whole health oriented as young and others would have us want it's not that kind of a health care system it's all parceled out so people then are faced with which test should i have should i continue this test now there's a bad you know effect from the test what am i going to do next what are my choices what do i really want what gives my life meaning and no one no one in the health care system is asking them those kinds of questions and so the journey continues and people just tumble in this kind of needless i think suffering now what does healing and what does spirituality and health offer it offers us an ability to integrate or integrate that suffering into our lives to find a sense of meaning and purpose in spite of what may be happening to us physically or socially or otherwise that's the ultimate goal i think of integrating spirituality into healthcare i'm going to present a model where we talk about the importance of relationship and how the relationship between the patient and the doctor or other clinician is key to healing it's not so much all the things you know we we think that as a doctor or therapist i give something to my patients it goes two ways we enter into relationship we're both changed as part of our relationship and with it's within that compassionate caring relationship that the potential for healing occurs and what is that the key thing that any of us can do as healthcare professionals is to listen we have to let go of our agenda to try to fix something for a patient or a client however people see that i like the word patient i think it's more than just a client but we we we're not going to fix something for someone they we can empower them to find some solution for themselves but it's really in our presence not in the kind of agenda of the things that we do there's a quote that i when i was studying for my board certification in palliative care it was in the review book and i really was struck as i was going through all the facts and then i came to this quote and it so beautifully describes our ability to attend to the spiritual in others who is there in all the world who listens to us here i am this is me and my nakedness with my wounds my grief my despair my betrayal my pain which i cannot express my terror my abandonment oh listen to me for a day an hour a moment lest i expire in my terrible wilderness my lonely silence oh god is there no one to listen we just heard a beautiful presentation where at the end you know you were in full presence to someone who is dying to someone who is dealing with suffering that is really what is the key of spiritual care in our health care systems there's also a lot of data and i don't have time to go through that but there is data that spirituality and religion can can affect health care outcomes better coping better understanding of illness more informed decision making and of course an empowering and self-healing for example in end of life care there's been a lot of there was a question for the earlier panel about end of life care that people with advanced disease who have found greater and meaning greater meaning and purpose in their life have better quality of life less pain better coping um gallup survey finding comfort in our final days general survey to the united states what were the two top concerns number one i don't want to be alone i want companionship number two spiritual comfort well what is that spiritual comfort what can we what can we help people with in regard to spirituality so i want to propose a model that we're working on based on our work now in in educating doctors but also in some of our research and some national consensus that we've um conferences that we've done to define sort of new parameters to integrate into health care that is not really that new because i'm talking to an audience jung talked about whole person care whole person care is addressing the biopsychosocial spiritual dimensions but traditionally in our health care systems those have been looked at as separate boxes what we propose which i'm going to guess is more jungian and more whole person is that spirituality is fundamental it's the essential part of all of us and where spirituality interacts with are the other parts of our being is not so much the deep inner life for that is very personal people but it's the outer part of our spirit if you look at a circle our deep circle the inner part of that circle is personal but it's that outer circle that interacts with the physical the emotional and the social and so if i have deep spiritual pain it may manifest as exacerbation of my arthritis or whatever the person has it may it may present as physical pain and we can try to deal with the physical pain with medication but unless we get down to the really deep spiritual issues the pain will not resolve same with depression or emotional issues if it's really primarily a spiritual diagnosis unless we can deal with those spiritual issues the depression may not be well treated and so these are these are very important sort of a reframing of how we should think about health care systems from here on in i want to share a story of my patient julie she's almost 60 years old and she's dying of colon cancer right now and julie is a very vibrant human being on one visit she was we were very she was very focused on what was going on with her cancer then you know i asked her well tell me what's going on with your family well good things i just had my first you know first grandchild join the family and what about emotionally how are you doing i'm sleeping well i'm not really depressed i'm not anxious i feel okay about all this you know and as we went through all of those different aspects of her life spiritually strong faith in god it is what is keeping her going so i drew that little model for her of a why with the spirituality in the center and i said look you're actually pretty healthy spiritually emotionally and socially the physical well that and that may not be the healthy part but the others are and it was she said i never thought of it that way and all of a sudden she found a vibrant aspect to herself in the midst of her dying so it's looking at how we can create a system of care that integrates spirituality not just on the side oh by the way what is your spirituality but central to our conversations with our patients so i'm going to just close with the model that we've developed as was called improving the quality of spiritual care as a dimension of palliative care and palliative care many of us define as a time from diagnosis and actually all of life care it's a great model of care it's not just hospice but in it there was already in palliative care a required domain where spiritual religious and existential issues had to be addressed so we brought together leaders from around the country clergy chaplains spiritual directors psychologists doctors nurses social workers therapists and others and we came up with a definition of spirituality and why do we want to define spirituality i'm probably talking to an audience that's going to say you really can't do that in some circles you can't i agree it's tough to define but what i found in my own work unless we make this a little reductionistic it's not going to get integrated today about 80 percent of medical schools have topics related to spirituality and health in their curriculum we have this model i'm about to talk about but if we hadn't sacrificed a little bit and leave the esoteric a little bit to get practical that wouldn't happen so here's our definition spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to nature to the moment to self to others and to the significant or sacred so it's an internal ongoing journey of meaning and purpose that continues through our life it doesn't stop it's not stagnant but it's also our our ability to experience connectedness to something outside of ourselves which is broadly defined might be religion might be other aspects and so a spiritual care model everybody on the team is responsible for addressing spirituality with patients it's a generalist specialist model in the earlier panel i heard interdisciplinary as doctor nurse and social worker but a huge piece of the team is missing and that's the board certified chaplain the board certified chaplain is the expert in spiritual care the rest of us are generalists so we can bring up those issues we might even diagnose spiritual distress but we always have to think about working with the board certified chaplain who is a discipline of health care as part of the team we need to diagnose spiritual issues i know that's controversial and i'm just going to put that out there if you're interested i can share some papers about that we propose actually having diagnosis code for spiritual distress but we also want to add the patient's spiritual resources of strength so all that all the things you've been hearing about today in terms of healthy aging healthy life for that matter what are beliefs values and practices that are supportive to the patient what are groups spiritual religious or other that might be supportive what about a person's ability to find hope what about resiliency meaning and purpose and the model is really that as i as the clinician see a patient primary care clinician and this is geared for those of us that create treatment plans if we identify distress we have to start thinking is this primarily physical emotional social or spiritual and then who on the team do i engage to help the patient reach their full selves and that's what spirituality is about it's about creating a system where every single person has that potential to reach their full authentic self their full potential that's what spirituality is about where every person has the ability to find hope meaning and purpose where people have the ability to find that connection outside of themselves and to integrate that as part of their understanding of their whole health with illness just being a part of that i want to close with saying that the basic message is love and compassion a colleague of mine who's a very well-known researcher and who was dying was interviewed and he was honored for all his volumes of publication his research his theoretical studies but in the end the question was asked and what's the final message you want to give us and he said it's about love it's about presence we can't fix others but we need to listen and we need to be loving and compassion compassionate and compassionate think of it as it's not just two separate relationships with huge boundaries between us but it's that that enveloping the other person in love with the full intent of only doing good for them it's a very it's a spiritual practice really and a lot of our work is geared in helping healthcare professionals understand that their work is a spiritual practice the fica tool was mentioned that's a spiritual history tool which i would like to share with you as many of my patients use it for themselves and that is very simple are you a spiritual person i mean based on the conference today and what i've said everybody is but do you see yourself in that way well what does that mean to you and what gives your life meaning i is importance and influence how important is that in your life and does it influence your health care decision making how you take care of yourself meditation for example does have benefits for people is that a practice that you have that you might use in your life as you deal with illness or in your life as you deal with health c do you belong to a spiritual community and what is that it might be church temple mosque it might be the nature group it might be another kind of a group it might be people at your work but do you need to find a different community is that a good community for you and finally how do you want your clinicians to address that into your care so i want to just close because i've had to share very important things in a brief amount of time that a lot of the work we're doing now at g-wish is to we're going to be working with people on the hill to integrate this into the healthcare policy to bring about more holistic systems of care and all that work is published in making health care hold the book we also have a summer institute at the university where people from all over the world come to learn practical models of integrating spirituality into care but beyond the models i just want to close with a quote from the dalai lama which i think speaks to the essence of this work when people are overwhelmed by illness we must give them physical relief but it is equally important to encourage the spirit through a constant show of love and compassion it is equally important to encourage the spirit through a constant show of love and compassion it is shameful how often we fail to see that what people desperately require is human affection deprived of human warmth and a sense of value other forms of treatment prove less effective real care of people does not begin with costly procedures but with the simple gifts of affection love and concern thank you thank you our final presenter uh this afternoon and then we'll turn it over to all of us in the audience needs no introduction mainly because he's been introduced already dr lionel corbett was kindly agreed to bring us full circle he began the day with a wonderful presentation that served as a backdrop for the rest of the day's presentations and addressing the topic and has agreed to kind of give his last closing remarks and thoughts uh on both the day and on spirituality and then we'll turn the questions and answers to all of us for the rest of the day lionel i was extremely touched by uh dr pachelski's remarks because it affected me um her approach affects me so much because about three years ago i was um in two hospitals for several months and um with a potentially fatal illness and um it was very striking to me that um in all those months i was in the hospital hank for a total of four or five months i um nobody ever asked me if i was afraid of dying or if i had any spiritual practice or spiritual belief all they were interested in was my platelet count and my white cell count i think but they didn't want to talk about any of the concerns so i was so pleased to hear you talk about your approach thank you and i'd like to um just to try and focus this um talk about a small group of elderly people that i've seen who are in a painful position because they have a serious life situation um and they feel that they're spiritually oriented people but they're completely disillusioned with the judeo-christian tradition they don't get any help from their ministers or rabbis or anything like that um they can't tolerate the doctrine and the dogma of or the hierarchy of the tradition um and and so they're somewhat bewildered in this area they don't know they feel a sense of the sacred or a spiritual sense but they don't know how to deploy it so i thought i'd like to just tell you how i address that group which i've seen quite often and it's a pretty particularly jungian approach and here i'm reminded of a quote of yongs where he says there's no point in preaching about the light if people can't see it you have to show people how to see it so i'll suggest some ways of talking about it how do you locate the sacred in your life if you're nicely contained in one of the major religious traditions this is not a problem for you but i'm particularly concerned with people who who are not contained in those traditions at all so let me tell you what the jungian approach to this the first is to look at the person's dreams because the jungian theory's theory is that the dreams are made by the self by the transpersonal self and um as young says as you penetrate more and more and more into the unconscious it becomes an illumination from above it really becomes um a kind of teaching experience and i'd like to give you an example of this of a lady of about 70 years old who was terrified about her aging and i asked her if she would look at her dreams and she came in the next time with a dream in which she sees an image in which there are two heads on a single neck and a voice says to her these are the two heads of god one is the male head and one is the female head and the voice goes on to say don't worry about aging the purpose of aging is the rejuvenation of god because as we get older god gets younger when we and when we die god is reborn now neither she nor i've ever understood what that dream meant but it's a marvelous koan and it's like it's the kind of thing when you hear those kind of voices in dreams have such enormous authority that it it has a kind of settling effect it's very calming so dreams are extremely important as a source of spiritual advice and and teaching another very neglected area of the manifestation of the sacred is in visionary experiences now nobody likes to talk about visions because um we're afraid that if we say we had a vision that people will think that we're crazy but i found talking to people that lots of people have had visions a waking vision a waking vision it's like a dream when one is awake and i'll tell you one that i heard not long ago because i'll tell you the reason why this was a woman who i'd worked with for some years in psychotherapy and eventually she was dying and she um came into therapy because her parents when she was a child her parents had fought with each other just like cats and dogs the entire time of her childhood and it made her whole life miserable and she was determined to resolve this before she died jung actually says somewhere that people go into analysis so that they can die meaning that one sometimes wants closure on this kind of thing so we did all the usual stuff and then i uh in the last few days of her life i went to visit her in her house and um she said i woke up this morning with a sense of the presence of my parents by my bed and the marvelous thing was i couldn't see them but i knew that they were together and then she said and i looked on the bed and then i actually saw a golden bowl on the bed and the bowl was full of oil and it was shooting off rays of golden sparks and then my parents said to me in a kind of soundless way you are to use this experience to bless others and so she turned to me and she said well i'm dying so i'm going to tell you about it so that you could tell as many people as possible about it that is the kind of experience which if you ask about i don't think is all that uncommon among people in in their last few days or a few weeks of life so that's another important source so in other words i'm trying to make the case for the fact that you don't need the the judeo-christian tradition to experience the sacred um another important source of sacred experience that many people have told me about is the natural world many people have a profound sense of the sacred in the natural world it fills them with awe and mystery and if you're that kind of natural-born nature mystic you shouldn't be sitting in a book in in a in a building reading a book about what happened to somebody else that a long time ago that's what william james called second-hand religion it's not really very helpful you should be your temple is the natural world and there are other sources of sacred experience what about addictions or alcoholism you know at first sight we think these kind of things are pathological what have they got to do with spirituality but then we can remember young's dictum that the treatment for alcoholism is spiritus contrast spiritual spirit against spirit the treatment of trying to get a kind of urset spirituality from spirit in a bottle is to develop a more advanced more refined spirituality a more advanced spirituality and that's what helps people and that's why aa and groups like that are particularly helpful so your your addiction can be another source of profound spirituality you don't have to go to a church or a temple or what if you're depressed or anxious well in the jungian tradition your depression or your anxiety is a direct wake-up call from the self it's not a symptom of a low serum prozac it's it's it's it's an indication that you need to pay attention to something in your life that is a spiritual practice in its own right there's a big difference between the dark knight of the soul when you feel miserable but you're aware that there's a transpersonal process going on and just saying i'm depressed give me the prozac there's an enormous difference between those two approaches to what looks on the surface like the same problem another source of sacred experience i mentioned this morning is creativity and here i was reminded of the artist mark chagall who was asked by his granddaughter do you pray and he said of course i pray i make art i think that sort of speaks for itself um so um i thought i might end with a story that i heard recently um oh well no before i end with them i was i wanted to um we've talked a little bit about the importance of the poets and i've often used as a model for successful aging in the in the face of suffering um sophocles is play oedipus at colonists here we see the old blind oedipus led by his daughter antigone back to colonists where he was born and sophos makes it very clear how much oedipus has suffered but he tells us that the old man because of his suffering has developed wisdom that only suffering can bring and apollo the god gives him a resting place at colonists where he can confer benefit on those who receive him he becomes a source of insight he's lost his physical sight but he becomes a seer he has insight he's like tyresius you know the story of old tiresias it's in in the metamorphosis of ovid the story of uh tiresias is that zeus and hero were having not one of their eternal arguments about and what this one was about who enjoys sex more do women enjoy sex more or do men enjoy sex more and apollo and um zeus said that women enjoy sex more and hera said no men enjoy sex war so they decided to ask tyreisius and tyresius was a man who had for seven years become a woman one day because he was walking in the in the woods and he'd seen two snakes coupling and he'd hit them with a stick and killed the female snake and so he had to lift the seven years as a woman to atone for this and then the same thing happened again and he this time he killed the male and so he was turned back to so so anyway so he'd been both a male and female anyway he he agreed with zeus that women enjoy sex more than men and for this hera got enraged and she punished him with blindness and there was a rule on olympus that you couldn't undo what another god had done so the best that zeus could do was to give him the gift of prophecy the gift of spiritual sight it's the same mythic theme that you find in sophocles that suffering and physical disability can lead to insight and that one can overcome these kind of physical disabilities and difficulties with the development of spiritual sight um i wanted to end with a with a story that i just came across um of um about yitzhak perlman the violinist i'm not sure if this is true or not but it's in the it's in the literature about him he had polio as a child and he walks with the leg braces and crutches and there's a legend that he was in a new york concert um in the middle of a piece a string broke and he had to finish the piece on three strings instead of four rearranging the music in his head as he went along of course probably only he he could do that um and they asked him afterwards how on earth do you manage to do that and he says well it's the artist's task the task of the artist to make music with what you have left and i think that could be very nicely applied to aging if we look at aging as an art thank you thank you but we have some time for discussion dialogue questions from either the panelists towards each other or the audience to the panelists i have a question for um i believe it was dr pochalski um your definition of spirituality is that on a website or somewhere that i could get it i'm a family doc and i would love it yeah it is um our website is gwis8gwish.org and also the report of that uh the consensus conference with the model and all that is the journal of palliative medicine october 2009 and it it's a free download on their website but i would be very happy to send you that copy if you're interested so you could just email me through the website yeah yeah and i just want to piggyback a little bit on what dr corbett said too because um you know so much i i really appreciated your definition of spirituality so much of our work with physicians and nurses and others is is always to keep in mind the the broad nature you know if you have a spiritual history is what religion are you that's just such a small limited piece but even if someone is affiliated or not affiliated there's so many different expressions of how people understand spirituality so i think it's important to keep that in mind that not much was said about the importance of forgiving and i personally believe that the purpose of old age and especially of dying is to forgive and to accept you know all these issues in our life that bothered us and i think it is a very important part of the spiritual care yes of the day to teach them the importance of forgiveness to go over that life story and see where they have little black spots left against people or situations you know that they that they have been upset or angry about and to see what purpose it served in their lives and thus forgive it i completely agree with that and there's some ex if you're interested there's excellent there's actual studies and there's literature dr everett worthington is kind of the grandfather of forgiveness research that actually shows us not only is it an important probably developmental task but also in terms of our health because holding on to resentment actually can cause high blood pressure heart disease worsen heart disease etc um i would just funny that you mentioned that because i think this morning on a news program there i forgot his name but um the head of one of the big social um i can't remember it now but he's a he's a minister bishop who wrote a book on just let it go the importance of forgiveness and while it's not that simple you can't just let it go there's a process but i think more and more we're recognizing the importance of forgiveness of ourselves as well as others in our life and there's some very interesting work on forgiveness interventions that were done out of stanford again we're looking at very short-term specific ways that people can come to understand their resentments and their forgiveness do you have any idea whether most people facing death regret what they've done in life or is the larger regret what they haven't done so there's i'm sure there's surveys about that i can speak from my personal experience of walking that journey with many people um i think you know it's interesting we talk about what sometimes the message is these things we have to do as we're dying or towards the end of life you know the lesson that i learned actually from my dad is that we should start practicing some of the self-forgiveness and reflection kind of all through our life um when i was in medical school i took care of a woman in hospice and she said boy i wish that i had addressed these issues when i was younger and just like you with you know sharing your patience she said please share that with your students and i usually try to bring that up in my talks as well i think um in term we're all going to have regrets we all have regrets today and you know i i think part of healthy living and consequently you know dealing so that it doesn't pile up right before when we're on the death bed um is to deal with some of things on it on an ongoing daily basis um you know what's the it's just like forgiveness what's the benefit of having a regret you know what are why are we holding on to it um can we just let it go we're not perfect move on and continue to live um john of the cross you mentioned he's i'm a lay carmelite actually he's my one of my favorite saints and he talks about attachment to a hurt or i could extend that to regret blocks the inflow of hope into our lives and to live you know fulfilled lives and have and now you're talking about dying having a healthy dying uh is to be able to have hope even in the midst of and especially maybe because of at the end of our life so it's best if we open ourselves up to that inflow of love and hope into our lives which means letting go of regrets letting go of resentments for giving where we can i think that's where it's helpful so in my own experience to answer your question i don't know that i think most people have regrets at the end of life it's very individual um i i quite frankly the most of the people that i've worked with it all kind of comes together at the end and it is what it is there's no perfect death but people kind of get through it and some people hold on to regrets a little more and some people don't but you really don't have much of a choice so you have to kind of move through it i'm a little bit pragmatic about that so i would say no in my experience not regret is not the main theme i think what the main theme might be is maybe a little bit of a difficulty in letting go and that's where compassionate presence is so important someone asked about the doula and of the dying and all there's lots of programs where people just sit with another person you can't tell someone let go let go but just that presence of love people are eventually able to do that i i would just add uh in question a term of regret uh from a personal point of view the first jungian analyst that i went to her name was dr rifka scharf kluger she's very wise woman she wrote books called psyche and bible satan in the old testament the gilgamesh epic and she was one of jung's main students before they even had an institute and i worked with her for five years in israel and one of the first things that she told me when i went into analysis we were talking about what i wanted to do for the next phase of my life she took out a book by martin buber and in it boober tells a story of a very famous rabbi his name is rabbi zusia and he was on his deathbed and he was crying and his students ask him why are you crying he says i'm afraid of dying and facing god and they said but why why you've been the greatest rabbi since moses you've lived like moses why would you be afraid to die what should we think and he and he said i'm afraid that god is not going to ask me why weren't you like moses he's going to ask me why weren't you zuzia yeah that's beautiful why weren't you yourself and i think that's the biggest regret that somebody could possibly have is that they weren't true to themself or the capital s yeah i think i just to add add to that i'm going back to what dr petrovsky was talking about in terms of relationship i'm reminded of something coming from kathleen rayne who's a poet and she says something to the effect of only if you see a thing in the light of love can you ever really see it at all and i think that's i think that's infinitely true and i think it's something that sometimes we can't do alone and we need to be in the presence of a compassionate completely accepting other to do that kind of work to wrap up some of the things that maybe we didn't tend to the wounds we didn't tend to earlier in our lives and that this is part of of the process and i think this is one area where it really helps to be within a religious community that is spiritually vibrant to you where you know the the the symbols as we say in your jungian psychology are really operating in a way that you know it's you're you're not in a field of thinking you know well you know jesus died for our sins but rather there's something alive still in the way the community holds the tradition and so one feels held symbolically and you're in a community that you where you have a shared symbolic system and a shared language system and um one example i think of of where this can be so meaningful is reflecting back to something that i heard a story about my teacher my old teacher dana greene who i would say is a wise woman and she and another woman who are both very involved in their christian faith were talking and the younger woman had just lost a breast to breast cancer she had a mastectomy and she turns to dana and she says dana at the time of the resurrection of the dead will i have one breast or two and dana who is a bit of a sage said darling you'll be beautiful so you see it's not really about whether they believe in the resurrection of the dead but you can feel symbolically what's transmitted within that system within that common language system you know and so you know a lot of us i think suffer a loss by losing community whether it be religious community or other kinds of community where there's shared meaning but i think if one has still a connection to a vibrant spiritual community there are real advantages particularly in light of some of the difficult passages one has to make psychologically in the course of aging thank you yes it's really interesting being here today after um a two-day conference we just had uh at the library in another building on stress um and that no that that conference was a lot of biomedical research is looking at this phenomena and a few of the things that really stood out was the one talk in particular talked about the placebo effect and how the use of pharmacology to solve certain issues could be enhanced or decreased based on the relationship with the physician or certain rituals that the there are actually biomarkers for relationship that are beginning to emerge so that the mechanism for why they wouldn't have said this way i'll just say it this way why love works clinically are beginning to emerge studies of breast cancer patients with metastasized breast cancer and the kind of support groups that extended life so i think we're at a point where the old wisdom is now beginning to show up in the medical literature as people are able to do real-time mri and other kinds of markers as to how the brain lights up what stimulated um and this intuition from the ex i shouldn't call it intuition but i'm an intuitive from the the uh what i'll call the jungian side beginning to find its um verification in sort of double-blind biomedical studies um it's just quite interesting it's out there obviously not there yet and it's just um at the beginning but i think it's um amazing a lot of the ancient wisdom and the current wisdom um will i think in the next sometime be uh um sort of matched or corroborated not that it needs corroboration but in in the biomedical field and it's moving that way thank you time for one more question hello i want to uh thank you for your the panel for this discussion on on the biomedical and how spirituality influences i'm a surgeon and i think surgeons have a lot to learn from the auto mechanic world where when you take your car into the dealer there's a customer service person that you talk to that has people skills and empathy and you never really but you never really meet the guy who's turning the wrenches and all that but um i want to just comment on probably the one of the most advances that i've seen recently in medicine that has really revolutionized recovery of my patients has been a brand new bed and i'm not talking about a tempur-pedic or a craftmatic but in the patient's rooms the hospitals that i work in instead of having two patients in a room they now have one patient in the room and the second bed is for a family member and so you're there in the hospital in the middle of the night you have a family member i encourage the kids the patients or adult grandkids to take the night shifts because they're up all night text messaging anyway but to have the support of someone and experience that love in the middle of the night when you're worried or concerned you can't get the nurse to have someone there it makes all the difference in the world and it also i think it teaches the younger people you know about family and how to take care of their older relative and opens their eyes a little bit so that probably makes um that's probably made more difference than all of the technical uh advances is just having a family member there thank you well thank you and um you know actually you're talking about being a surgeon you know the the notion of relationship and spirituality at our medical school the students wanted to hear not from a female internist but a male surgeon so we got one of our heads of our surgery department at that time came and spoke and the most powerful statement that he made was that as he does trauma surgery as a trauma surgeon he has a very short amount of time to connect with the patient in the family and who knows what's going to happen in the or i mean these are usually critical situations and by connecting from a base of compassion and concern and by understanding the beliefs you know connecting with the inner inner person their belief systems asking a little bit about spirituality and he was open about his own inner life and his own spirituality as connected to his call to serve which is really what ultimately this is we don't have jobs we have vocations that made a huge difference in helping the patient trust him share for him coming to a good diagnosis because they were more open about sharing what was going on and then also the care afterwards so um i i think that you know for all disciplines it's really important to bring that aspect into it yeah as well but i just want to say i don't think you should fail to compare surgery with auto mechanics yeah you shouldn't because because auto mechanics is quite a skilled job okay okay i think if i add anything at this point it's gonna i but i i would like i would like to end i would like to end first of all and i think it wouldn't be complete without acknowledging a few a few people and a few things first of all lionel thank you for your wonderful presentation to set the tone and i want to thank our panelists christina and melanie now but all of our all of our panelists all day long all day long we've we've really been blessed i i feel with a wonderful group of panelists from the morning to the early afternoon to now we've all learned a lot it was really a pleasure and a privilege to be here and an honor for me to serve as a moderator and i and i want to thank all of you for making this possible and last but not least the library of congress and the aarp for having faith uh in this particular topic it's not something that that every organization would put their their prestige on the line to back us and to allow us to do this we know those of us in the jungian world it's not always an easy sell so to speak and then last but not least as an expression hebrew the most dear ones who really made this possible with leslie salwan who really put all of the work energy behind it and and mike mike carbine who i know that diana and i have been putting on programs for now 25 26es we know what goes into making this program possible uh it looks seamless up here during the day but we know what's going on to prepare for all of this taking place and it's a very very wonderful day and thank you both and thank you all for being such a wonderful audience safe travels this has been a presentation of the library of congress visit us at loc.gov

Channel: Library of Congress

Views: 88,833

Rating: 4.3103447 out of 5

Keywords: Library of Congress

Id: j4LEC1KsUhk

Length: 152min 44sec (9164 seconds)

Published: Fri May 25 2012