Thursday, May 9, 2019

Public Engagement on Making Cancer Care Funding Fair and Sustainable: Day One

BC Research Institutes providing Funding for Cancer

About three months ago, after having read a book on innovative ways of approaching and dealing with cancer, I had just posted my book review when I got to know on the very same evening that my father had been diagnosed with prostate cancer. A few days later, I received an invitation in the mail regarding a public deliberation on fair and sustainable cancer funding in my province.

This event was funded by various health agencies, including the Canadian Institutes of Health Research, the Michael Smith Foundation for Health Research, and the Canadian Centre for Applied Research in Cancer Control of the Canadian Cancer Society. 

The idea of a deliberative public engagement was to invite a certain amount of people across the region to share their views and experiences so that cancer care and treatment could better reflect and realign with the consensus of the people. In other words, our voices mattered, and they would be distilled into a group of written recommendations that were then sent out to the government for possible consideration, if not downright implementation.

When I received the invitation in the mail, I did not hesitate, but immediately emailed the organizers of the event telling them how much I would appreciate to participate in this undertaking. In fact, since I do not necessarily believe in coincidences - I think the world works in synchronicity - I saw the triple connection with cancer as a kind of sign or omen. Things may come in random pairs, but when it happens three times within a very short time, a matter of two or three days, then it must be significant. And it certainly was.

After I filled out the online form, I was told to wait as they would select about two dozen people from the given candidates. Later I would be given the exact numbers, but at that time I simply had to wait. The days passed and no response materialized. I was told that we would hear back from them at a certain date, and I at times expected them to decline. Yet one night, I had a dream that they were working on a pamphlet that was to be sent out and it came with a letter of acceptance stating my inclusion in the upcoming public engagement.

Dreams can be at times prophetic, so that raised my hopes. I told my wife, and lo and behold, less than a week later, I received an email in which I was told that I had been selected. And yes, it came with a pamphlet that was attached to the email, a physical copy of which we would receive on the first day of the event.

Since it came attached with a confidentiality agreement, I was very careful about divulging any information about the event and shared it with only a few close people. I was not sure how much we could give away until we were given the heads up on the first day and were told that we could share our views and experiences on social media. This was a relief for me since before that, I had been very vague about my whereabouts regarding that given weekend.

The main issue was that due to the personal and sensitive nature of the topic at hand, some of the participants might not feel comfortable about being mentioned, but the experts, researchers, organizers and speakers were fair game, that is, we could freely quote from all of them as they were basically, due to the nature of their occupation and the situation, part of the public domain so-to-speak. I immediately warned them that they would show up on my blog, so here they are!

The first day I was impressed with how well it was all organized. There was a clear schedule and an established pattern on how things would work. We picked up our honorarium, which was a boon considering that each of us was willing to forgo two complete weekends for the event, and then we were given individual folders that included a name tag that would go in front of our seat at the table.

We were told that all our conversations and discussions would be recorded but not videotaped and that we should identify ourselves before speaking, so that they could trace back comments and opinions to the person who made them. This information would then be depersonalized and compiled to help understand the motivations and reasoning behind one’s comments and decisions. 

In fact, the discussion part was as important - if not more so - than the final recommendations as it gave insight into the thought processes, feelings as well as potential reservations that were associated with our votes and decisions.

As to the selection process, they had sent out 10,000 letters to people across the province. They used postal codes provided by Canada Post to select regions and tried to ensure to have a fair, balanced, and reasonable selection across the board of different criteria, such as ethnicity, education, income, gender, rural and urban living space and geography as well as age. By doing so, they would have access to views and values that were not specialized or relevant for a given section of the population but rather a more global snapshot of public opinion.

From those 10,000 invitations, there were 220 people who fully completed the online survey, and then slightly more than two dozen people were selected. In fact, the organizers insisted that we were specifically selected to come because they were interested in knowing more about our views and values. They encouraged us to participate as much as we can, and I immediately thought, oh boy, soon enough they would come to regret telling me that. Not that it mattered since I would have participated anyhow as these issues were lodged quite close to my heart.

Stuart Peacock sitting in front of his computer

One of the researchers who can be named and quoted because he is essentially part of the public was Stuart Peacock (pictured above in his trademark pensive mode). He is a Distinguished Scientist and is involved with BC Cancer, with the ARCC and Simon Fraser University, and he was available throughout the sessions for background information and expert advice regarding cancer care and treatment. He told us that there are 200,000 people diagnosed yearly in Canada and about 60 % of them will survive, while the rate of survival is higher among children, namely around 80 %. Traditional treatment included radiation, often a combination of chemotherapy and radiation as well as surgery.

There were also more innovative treatments on trial, such as gene therapy, but one of the main issues was that there was still not sufficient data regarding its effectiveness but more importantly, they were extremely expensive costing about $400,000 per patient. I immediately felt compelled to ask whether the prices were high because it cost that much to undertake such treatments or whether it was because pharmaceutical companies simply charged an inordinately high amount. 

He carefully phrased his answer that implied it was more a case of the latter than the former. In fact, cancer drug prices approved by the Food and Drug Administration were increasing rapidly making it more difficult for many countries and health care systems to afford them.

Mike Burgess standing

The other researcher among our group who called himself “Mike” was Michael Burgess (pictured above in his moderating pose), Professor and Chair in Biomedical Ethics at the University of British Columbia, and he was another expert moderating our discussions. Public engagement or deliberation was a rather new concept in current politics, and there were initiatives to experiment with possible ongoing citizen advisory boards and committees. 

In a debate, the goal was to win by questioning and challenging the other person’s point of view, such as presidential election debates, but deliberations had a somewhat different mindset, namely one of being inclusive, civic-minded and respectful of other points of view. I was reminded of the ancient Greek councils where philosophical and political discussions were held, except that they were not inclusive since the ancient Greeks purposely barred women, slaves, and foreigners from their councils.

On the first day of the public engagement and before any deliberation took place, we were treated to three different speakers. Two of them were cancer survivors, one of them, a young female, had survived colorectal cancer, while the other, a male, had survived prostate cancer and was now the chair of a prostate cancer support group. 

The latter strongly promoted PSA (Prostate-Specific Antigen) tests to be covered by BC health care because that test essentially saved his life leading to an early detection of his cancer. PSA screening is often not undertaken; although it may spell out diagnosis, it can also lead to misdiagnosis, and hence cause unnecessary stress and anxiety in the tested individual.

Yet when prostate cancer is detected in time, it can have a nearly 100 % survival rate among patients. In his case, it was a fortunate array of circumstances that led to the early detection of prostate cancer. In fact, his general practitioner had been reluctant to do the test, but accidentally ticked it off on an unrelated blood test as it was supposed to measure his cholesterol.

When the speaker was asked (I believe it was me who did the asking, but that could be easily verified by those who have access to the audio recordings) how much it cost to do the screening test, we were rather shocked to find out that it was only $30 per patient. And equally shocking was the fact that the tests were covered everywhere in Canada except in BC and Ontario. In fact, prevention and screening were themes that were important for all of us participants throughout the deliberations.

The final speaker of the first day was Malcolm Moore, a Medical Oncologist and current President of BC Cancer. One would think that as a president he would wield significant powers, but the impression we got were that his hands were tied in various matters, including decision-making, especially when pertaining to budgets and funding. In the end, it was bureaucracy that would have the final word and make the ultimate decision.

Dr Moore started off by giving us various statistics regarding cancer. In terms of deaths in Canada, 30.2% of deaths are attributed to Cancer, in comparison 19.7 % die of Heart disease, 2.8% of Diabetes, and 4.6% of accidents. In British Columbia, 1 in 2 people will develop cancer at some point in their lives, and 1 in 5 will die from it. In 2017, there were 27,000 people diagnosed with cancer and 10,500 died from it. Currently, 5% of our population is living with a diagnosis of cancer.

The cancer treatment system started with radiation and was then combined with chemotherapy. In fact, our province of British Columbia has lower incidents compared to other parts of Canada as well as other countries in the world, which he assumed was mainly due to our healthy lifestyle.

The budget that BC Cancer receives from the government is 700 million dollars per year. Most of the funds are spent on treatment, such as radiation and chemotherapy, which are completely covered by BC Cancer. In total 400 million dollars, more than half, is spent on cancer drugs, and only 4 % of the budget is spent on prevention and screening, and a mere and meager 1% on Research. BC Cancer, however, is not the only institute spending money on prevention as it contributes less than 20% of the overall budget on prevention; some prevention programs are covered through different agencies.

As a matter of fact, about 50 to 60 % of cancers are preventable. One can effectively and significantly reduce the risk of cancer by not smoking since cigarettes are directly related to incidents of lung cancer (90% of lung cancers are due to smoking), by maintaining a normal body weight, which can protect you against various types of cancer, and by regularly screening for cancer since early detection can increase your likelihood of survivorship. It was indeed most interesting to be given statistics about cancer care and funding and to be given details not only about the budget but also about certain obstacles and hindrances, including pharmaceutical companies, also known as Big Pharma.

But more about the latter in my upcoming posts. Since there is much more information I would like and in fact even feel the need to share with you, I shall break it all down into three parts – again the number three being my symbolic guide throughout. 

The second part of my experience of the Public Engagement series will be about Big Pharma, Innovation and Prevention, whereas the final concluding part would be my own personal reflections and opinions on and about the event and the topic of cancer. So please stay tuned, subscribe to my blog or merely come back for Parts Two and / or Three!

Monday, April 22, 2019

Language Learning and Prediction in Infants: UBC Quinn Memorial by Richard Aslin

Photo of Dr Richard Aslin
Every year there is at least one lecture I eagerly await and look forward to, namely the Quinn Memorial Lecture Series. It has been my fifth attendance over the last six years, with my first one being Michael Gazzaniga’s exquisite lecture entitled Free Will and the Science of the Brain. Unfortunately, I had to miss last year’s lecture by Dr Robert T. Knight because the date and time interfered with my work schedule, but I had been luckier this time around.

Although it certainly did not look like it at first. The scheduled talk Learning and Attention in Infants: The Importance of Prediction in Development by Distinguished Scientist Richard Aslin was suddenly canceled and postponed to a later indefinite date. No reason nor future date were given at the time. Could it be that my brain would have to go two years in a row without the much needed and much desired annual adrenaline shot of knowledge?

Thank goodness, my worries were unfounded, and there I was seated upfront with my smartphone in hand to take notes in preparation for this blog post. I did not know what to expect and on paper, at least for me, the topic at hand about how infants learn language and make predictions about their surroundings did not have the similar emotional impact on me as did previous topics and titles of this wonderful series.

There was certainly nothing wrong with the subject, but for me personally, it came about a decade too late as my son has already taken his first steps into the preteen period. More importantly, I did not wish to hear in retrospect how I may have potentially failed him as a parent in terms of language learning and / or behavior.

Yet again for a second time, my worries were entirely unfounded. The talk itself was much more interesting and engaging than I had imagined. First, Dr. Aslin told us how infants learn through auditory statistical learning. This means that they break streams of words, which are for them initially nothing but random sounds, into auditory chunks, hence creating word boundaries.

These boundaries are often signaled in fluent speech with pauses, such as taking breath. These word chunks then are basically processed and analyzed by the infant brain to make predictions. In order to be able to better understand and predict their surroundings, babies have the tendency to listen and pay more attention to novel and infrequent words and tones.

Why? Because by knowing and establishing certain patterns, they can better understand the rules. This is not a case of merely memorizing words but also looking past them for meaning (vocabulary as a symbol of a designated thing / event in the world) and learning about the inherent rules (grammar, sentence structure and appropriate word choices). 

In a way then, it is memorization plus generalization, respectively known as model-free and model-based learning; the latter of which is generally designated as smart, abstract and flexible ways of comprehension, while the former is rather unfairly treated as the opposite of all those epithets.

Certainly, there is also incidental learning. This means that we absorb knowledge and information without particularly focusing on the given stimuli. This type of learning would occur when one is performing a task by also taking in background noise or information in an almost automatic or subconscious manner. 

Evidently, paying attention is much better suited for learning, but even when we do not notice stimuli implicitly, we are still aware of and capable of remembering strands of information around us without having to specifically focus on them.

The manner they tested all of this was very interesting. The researchers inundated infants with random sounds and stimuli, both in terms of nonsense words, i.e. random syllable sounds as well as tones. Babies tended to be interested in new stimuli, but whenever they managed to discern a clear and repeated pattern, they would lose interest.

This occurred because infants were able to predict the next sound, so the sequence did not provide any novel information for them. Once a pattern was established, the baby moved on to something else … unless there was an unexpected result. That is, if they were expecting a given sound to follow, but either it did not, or the pattern was changed, then the element of surprise would warrant and elicit their attention again.

This happens mainly due to the structure of our brain. To clarify this tendency of the brain to create, establish and predict patterns, they conducted an interesting experiment with pairs of tones. The researchers would play the sound of two honking horns beep beep. After repeated exposure, the baby expected them to come in pairs, yet when the researchers omitted the second beep, the brain nonetheless supplied it.

This was discovered by hooking up wires on babies (no worries, this is harmless and painless standard procedure), thereby noting the infant’s brain activity. In other words, when the brain registered the first honk, the second one was immediately supplied by the brain, regardless if it was or was not there!

Since our brains are wired to make sense of our environment in terms of words or tones, we would use top-down processing once a pattern has been established, meaning that the higher structures of the brain would override the lower ones. In the previous experiment, the higher brain regions literally expected the double tone.

Once inferences were made, babies would then allocate attention to new information. This was observed by their behavior and reactions, such as looking longer at unexpected stimuli or looking away from expected, hence “boring” and unstimulating stimuli. 

In that sense, the brain works tandem with behavior, we are able to see connections and patterns and then start looking for them, hence it is the brain structure that is grounded and established first before the behavior sets in and manifests itself.

About 9 months of age, infants start searching for hidden objects because their brain - and with it their imagination - has developed to a state where the infants are capable of doing and perceiving such a thing; by around 18 months, they can produce two-word sentences. This seems to be universal and is caused by brain development growth and changes.

Yet some of the startling, if not downright shocking, finding was in relation to premature babies. It turns out that they can be at a significant disadvantage when it comes to their brain development although this may not be immediately visible or discernible in their behavior.

Put differently, premature babies may act and behave the same way as other infants, but their brain is less developed than their full-term counterparts. That sent shock-waves down my spine as my son was born prematurely! However, if you have premature children, or if by chance, you are one yourself, keep in mind that this is not always the case.

First off, each case or person is different, and it is not necessarily a disadvantage to begin with. In fact, the premature baby may make up for brain development at a later stage. Due to the plasticity of this magnificent and complex organ of ours, the brain can compensate for parts that have not fully developed, even more so at a younger and developing age. We should also note that the studies were conducted with babies that were significantly premature by about a handful of months and not by a mere month as it was in the case of my son.

Moreover, there are two other general factors that are significant and essential for learning as well. One of them is the fact that salience and prior knowledge tend to drive attention. Anything that is surprising and simply, or maybe ostentatiously, stands out will draw the attention of infants, an observation that is probably equally true for the adult age. The commonplace, however, is generally not worth a second look.

The other factor of importance is what is generally known and referred to as the Goldilocks effect. This simply means that if the information or stimuli presented is too simple or too complex for the baby, he or she will simply look away and lose interest. 

The Goldilocks effect plays also a significant role when it comes to stress and anxiety of children at school; optimal attention and learning is usually achieved when the material and / or environment is neither too comfortable and relaxing nor too stressful and exacting. The middle ground, i.e. the Goldilocks effect, is usually optimal for learning. 

But another question that arose was why was it that we as adults lose that infant ability to make sense of our environment? For instance, this type of processing information would be most useful when learning a second or additional language. Why was the same process not supplied to us at a later stage since it would make our language learning – and life - so much easier?

Part of the problem stems from the fact that as adults we have already established preconceived and set ways of learning and of reacting to our environment, commonly known as entrenched learning. Since we can make more and better sense of our surrounding, and we already have a plethora of prior information and knowledge to select from, we can predict it much better. As a result, and for better or worse, we are not so much drawn to new stimuli and information, but, in a sense, we lose some of our capacity for curiosity and wonder. 

But this is perhaps not the only reason we become somewhat jaded as adults. The other driving force, an issue that came up during my personal conversation with Dr. Aslin afterwards, was anxiety. When we are young, we are generally driven by our anxiety to make sense of everything that is around us, as it could spell potential threat and danger to our health and wellbeing. Once we have sorted out the information, we somewhat lose or at least soften that anxious edge.

With less anxiety, there is also less need to fear or worry about new stimuli. Dr. Aslin called this the dichotomy of an exploring baby versus an exploiting adult brain. While as infants, we strive to look for clues and knowledge to make predictions, as somewhat “jaded” adults, we want to use whatever new knowledge we get our hands on to better serve our benefit and purposes. Most of these developments may origin in the brain and are hence automatic and not necessarily within our control.

This has repercussions in terms of language learning as well. Our life does not so much depend upon making sense of the world since we have already more or less successfully passed through that stage in our younger years. However to finish on a more positive note, we can (and I would say should), despite our brain and age, preserve a sense of wonder by occasionally feeding the child within us and hence ensuring that this worldview or way of interpreting the world is still kept alive and well.

Friday, April 12, 2019

On How to Detect Deception: Book Review of Spy the Lie

Former CIA Officers Teach You How To Detect Deception
Deception is much more common than you may think; we can encounter it pretty much anywhere in all shapes and forms. It could be online and on television in the form of fake news or misinformation, it may be your teenage son or daughter, your spouse, your parents, and it may be even rampant at your work place.

In fact, it is at work where deception often feels most at home and sometimes even works overtime. As people want to gain the upper hand over their competing colleagues and since they wish to put themselves in the best possible light in front of their superiors, they may opt to spread gossip or even lie straight into your face.

Others are either too eager to please everyone at work by resorting to unabashed and bountiful flattery and hypocrisy, or they may constantly brag about how wonderful they are and keep mentioning and rubbing in their supposed accomplishments. Their aim is to climb up the corporate ladder, and since most of them are adept at manipulating and lying, and, more importantly, making you believe and swallow their lies, they indeed succeed.

In a much lesser degree yet undoubtedly to a certain extent, I see similar deceptive behavior among my college students. While a good majority of them are honest, some can come up with the most brazen and even shameless lies to attain passing or passable grades. At times, I marvel at their efforts of being disingenuous where in addition to downright lying, they resort to various inventive forms of cheating and plagiarizing. I just wonder if that skill and zeal had been applied to the work at hand, it would have most likely provided at least decent results.

But I shall not bore you here with the life of a teacher that can be both exhilarating and frustrating, so I shall get to the topic at hand on how to spot a lie and a liar. This is indeed a magnificently useful skill to have in life, especially since deception is so commonplace wherever you may find yourself. In the past, I would rely on my gut feeling or on visible and evident nonverbal cues to draw conclusions, but now thanks to the wonderful book Spy the Lie written by former CIA officers I can come to a better and much more accurate verdict.

Detecting deception is what officers in the field must engage in on an ongoing basis, and it is not only crucial but rather of utmost importance since the lives of people could be at stake. Throughout the years, these CIA officers have put together and developed a method to spot deception in others and now we can all reap the benefits from their research and personal experience in this handy and nifty book. 

I believe that this book should be mandatory for all police and customs officers as well as all those who engage in interrogations or interviews of various types, but it is also incredibly useful and helpful for those of us who simply want to know if others are being truthful to us or not.

So how do we know if somebody is indeed lying to us? Most of us engage in what is called global behavior assessment. What this entails is that we tend to look at the overall behavior, and then based on the data we have received, we make a decision. However, this is very cumbersome, often time-consuming as well as distracting. Instead, the authors propose to focus on salient and specific cues and signals of deception.

The nonverbal component is often emphasized in many books and television programs, but it is only part of it and can often be misleading. For example, when a person appears nervous in front of us or if they engage in closed body language, such as crossed arms, that may signal deception but not necessarily so. They might be nervous because that is their personality, or they just might be comfortable sitting or standing in that position.

The main thing is to closely observe the reaction to the question. If they have appeared relaxed and suddenly tense up or engage in closed nonverbal behavior when you pop the question, then that may be a sign of deception. In fact, the main takeaway here is to be attentive to any salient clues five seconds after the question has been posed.

That would represent their instinctive reaction to the question. In fact, we tend to think about ten times faster than we speak, so by the time you finished your question, the other person has already had time to process it and come up with an answer, either true or fabricated.

So what are suspicious gestures to look out for? They may be swallowing, clearing one’s throat or looking away immediately before answering the question, as well as grooming gestures, such as adjusting glasses, ties or shirt cuffs, and strands of hair with women. Interestingly, sweat management is another helpful clue. The sweat itself is not the problem nor the giveaway, but when they wipe it off, either with or without a handkerchief, then it becomes significant. 

Also, the deceptive person may suddenly tidy up their surroundings by adjusting and readjusting a cup of coffee or moving a pen from one side to another. All these behaviors are often unconscious ways of dealing with and dissipating anxiety.

Other nonverbal signals are what is known as behavioral pause or delay. If there is a significant or noticeable pause before a person answers, it may show deception. That of course depends on the question. If you ask a person what they were doing seven years ago on this day, they would need to pause and reflect; yet if your question was whether they had robbed a bank, there should not be any delay in proclaiming “No!” or “Of course not!”

There is also something known as verbal / nonverbal disconnect. Generally, our brains tend to connect the language with its matching gesture, but when you notice discrepancy, it may not be a good sign. For instance, the person says "no" while nodding the head. One must keep in mind that nodding and shaking heads may have different connotations in different cultures, so this should be taken with a grain of salt. They may also laugh or smile inappropriately while discussing a serious matter or issue and that is a potential red flag.

Another gesture involves hiding the mouth or eyes. If the person does the former, it may be a natural and instinctive way of covering up one’s lie, especially when they are responding to the given question. Also, when we are deceptive, we would avoid eye contact because we want to shield ourselves from the reaction of those we are purposely and intentionally lying to. 

Or the person might touch their face, bite or lick their lips, or they may pull on their ears. This occurs due to one’s anxiety as circulation focuses on vital organs and muscles in the fight or flight response. Hence the itchiness is caused due to a lack of blood in certain body parts, predominantly the surfaces of the face, the ears and the extremities.

Finally, to wrap up the body language cues, there are also anchor-point movements. If a person is sitting, the anchors would be their back and feet. For example, if a foot is in the air and moves or one’s hands are resting in the lap, that might be another method for dissipating anxiety. For this reason, it is best to interview or interrogate people in a chair that has wheels and with movable arm rests so that those behaviors can be amplified, hence making it easier to notice the anchor-point movements.

Throughout the book, the officers emphasize two important points. One that we need to have what is considered an L-squared view of the other person. That means we need to actively Look as well as Listen to their words and scan them for deceptive clues. Second, in order to reach a verdict, we need not just one but a cluster of deceptive behaviors. The more deceptive behaviors you can spot, the more likely the person is guilty of deception.

What should we watch out for when it comes to verbal content? There are various methods and strategies that are used to hide or conceal lies. One of them is simply the failure to answer a simple and straightforward question. That may occur because the person in question is trying to figure out just how to get way with their lie. Yet this behavior on its own and in isolation does not immediately spell out deception unless they are combined with other cues.

Another one would be denial problems. If the denial is expressed not just as a simple “no” but is accompanied and followed by statements like “I would never do something like that,” then you need to count it as a possible form of deception. 

In fact, the person may intend to deflect from the question and emphasize their position and reputation, neither one of which would be a good sign for them in this given context. In either case, if they add unnecessary details or elaborate their answers, it may point towards deception.

Another couple of tactics that potentially spell out deception is the reluctance or refusal to answer. This is the proverbial “I cannot answer the question” spiel or the suggestion that you’d be better off asking another person that same question. Or they might simply repeat and reiterate the same question: “So you’re saying that I cheated on the assignment?” This type of behavior is meant to fill in awkward moments of silence so that the person can gain time to come up with a good instead of a truthful answer.

This behavior can also come in the form of a nonanswer statement, like self-evident but dishonest statements of the ilk of “I’m glad you asked that,” “That’s a good question,” or “I knew you were going to ask me that.” This often demonstrates that the person is worried about something. Moreover, they might provide inconsistent statements or contradict themselves in the course of the conversation as they are trying hard and sometimes desperately to keep their story straight.

Or they may simply go into attack mode. Since they are afraid of being caught, they might as well accuse you of wrongdoing (in psychoanalytic terms known as projection) or they may attempt to impeach your credibility or competence with sarcastic and pointed questions such as “How long have you been doing this job?” This is also when kids burst out with their typical “Why do you always pick on me?” or “Why don’t you trust me?” In either case, not a good sign.

And then there are referral statements. They might refer to having already explained something or the person may claim that they have previously talked to someone else about the same issue. Through sheer repetition, they might get you to actually believe what they are saying. 

Or they might invoke religion and swear to God, which is generally not a good signal either.  And of course, there is the often used strategy of faking temporary amnesia with often heard statements like “Not that I recall …“ or “To the best of my knowledge” or  “Not that I am aware of” or even the staple answer of “As far as I know…” Of course, these answers may be valid in some cases, but in others, they are dubious if not downright suspicious.

Moreover, we also have qualifiers. There are two types of them, the exclusion and the perception qualifiers. Exclusion qualifiers are statements like not really, basically, for the most part, probably and the like. The second type of perception qualifiers involve statements like honestly, to tell you the truth, frankly or to be perfectly honest.

If you are honest, you do not have to say you are and why add the adverb “perfectly” there, for instance! What qualifiers do is they enable people to withhold certain information. You cannot just basically say the truth; you do, or you don’t for that matter, but we need to be aware that they may possibly be speech habits and patterns that we simply employ.

Finally, there are those highly popular and often used convincing statements. In that case, the deceptive person would give you a string of statements that are supposed to highlight their honesty, good standing or reputation so that they can convince you they are innocent of any type of wrongdoing. 

These people might point out that they are good and decent people, that everybody can vouch for their integrity, and that they have worked up a reputation in various fields of their lives. The goal here is not to provide information but to convince of their supposed personal integrity. And that is another major red flag.

That may be even noticeable in simple questions. If there was a theft at a company and people are interviewed for that reason, the truthful person would simply state their profession: I am an engineer, or I am a language instructor. The deceptive person might go into too many unnecessary details about what they do, what their responsibilities and duties are and how they have worked for various years at the agency or institution. That is already a potential warning sign that deception may be at work.

So there you have it! This book evidently contains many more examples and backs them up with personal experience as well as actual snippets of news items and interviews. If you want to put this to practice, you can watch video footage of famous impostors and liars, including but not limited to presidents like Richard Nixon and Bill Clinton, or murderers like Ted Bundy, Susan Smith, or the Jinx’s own Robert Durst (yes, I’m pretty sure he’s guilty).

As with anything, the more you practice, the better you will get at it. And then you might even apply it onto the real world. But as the authors claim, this is indeed some superpower that you are given, and you must be careful with how you use it. You can apply it to anyone you wish, but it is advisable to avoid using it on your spouse or significant others. Just saying.

Wednesday, March 27, 2019

Blue Sky Lightning by Jeff Kuhn: Review of an Inspirational Book

Photo of Sparky the Dog in front and Author Jeff Kuhn staring into distance

A couple of weeks ago I had a dental appointment during which I had to sit still for a good couple of hours and let myself be pricked with needles to have my cavity fixed; in addition, I needed to undergo repeated attempts of a crown impression on the neighboring tooth. This second tooth had broken off in half probably due to the fact that I was grinding my teeth overnight, an unconscious habit I have picked up since childhood. This was most likely due to stress, which, when facing dental appointments, tends to increase for some reason or other.

As I was laying there with my upper jaw gradually but steadily losing sensation and becoming downright numb and while I was awaiting - but not looking forward to - further invasive procedures, a thought crossed my mind. Although this was a far from ideal situation and I would have much preferred to bolt home to safety, all things considered, it was not that bad. Some people, Jeff Kuhn, for instance, had to undergo tremendous amount of pain and suffering, and in his case, he not only survived but wrote a book about it to inspire us all.

When my own situation had reached its most uncomfortable moment, I was reminded of a medical practice that is called “debriding,” which in my mind could only be second to torture. The idea of a bath seems rather pleasing, but debriding is when nurses use scissors, razor blades, and knives to cut off the burnt skin segments of one’s body so that healing can occur.

As parts of the skin and flesh are scraped off, the patient must be experiencing tremendous and excruciating amounts of pain. In other words, whatever was occurring to me in that dental office was not even a fraction of what must be occurring during such a debriding session, which used to form part of the horrendous but necessary daily routine of Jeff Kuhn.

In his best-selling book Blue Sky Lightning, a copy of which the author himself had kindly sent me for a book review, he describes how disaster had struck his life not on one but on two separate occasions. The title refers to an unlikely but possible event when one can get hit by lightning even though there is clear blue sky overhead. Everything looks fine and suddenly out of the blue, a bolt of lightning would hit you.

Now getting hit by lightning is a rare occurrence, but blue sky lightning would be even rarer. This may occur when there is a storm a few miles away and somehow it dislodges and unleashes a flash of lightning somewhere else. In the book, it is used as a metaphor for being blindsided by life and being subjected to painful events or suffering when one least expects it.

The first occurrence was a mysterious and unexplained fire that left Jeff Kuhn with more than 80 percent of his body burnt. He had first, second and third-degree burns, and his chances of survival were extremely low. At one point, when he was still unconscious and hooked to machines, he was given final rites by a Catholic priest because his doctors and family members expected the worst possible outcome.

Somehow, he managed to pull through and survive. Yet the harder part seems to have come after that, namely the subsequent recovery period that lasted for years. Despite countless surgeries and daily debriding, just the thought of that sends shivers down my spine, he was given a very low prognosis of ever reaching normal health.

When Jeff pressed for his chances, he was given seven to ten percent that he would regain normal functioning. Yet unlike most who would feel discouraged or lose hope when faced with such low odds, Jeff Kuhn felt motivated that there was still a chance. The situation was not hopeless or futile, but it meant that he would have to do his utmost to make it happen.

As someone who was focused and determined, not to say obsessed, he saw all of this as a challenge to be overcome. Jeff told the doctors that soon enough he would show them that full recovery was possible; one day they would see him dunk a ball into a basket in front of them, a feat deemed on the verge of the impossible. But the main emphasis lies on the fact that anything that is not completely impossible may be indeed somewhat possible, but only if you are willing to take continuous and persistent action in that regard.

For instance, he would have to do daily and painful physiotherapy. Since his muscles tend to detract at rest, it meant that progress he had made during the day would be partially reversed overnight. In the middle of all of this, when he was discharged from the hospital, he faced an empty house, devoid of furniture and wife; the latter had left him and had taken everything with her leaving him with a 300 dollar check to make ends meet. In fact, she ran away with his dentist of all people, and Jeff wisely switched dentists after the incident.

Somehow, Jeff Kuhn managed to pull through. When he was at the intensive care burn unit, one of the main threats to his health was the danger of infection. As the body is fully focused on recovering from its trauma, all its resources are focused on repairing the damage. But that also means that the immune system cannot function as well as it should as all the body’s energy is actively focused on survival. In fact, most people tend to die from infections and not from the actual burns; as a result, the burn unit was not only kept stringently and spotlessly clean and regularly sanitized but visitors and guest were kept to a very minimum.

Throughout his stay, Jeff had to accept myriad challenges to his health and well-being alongside pain and limitations, but he still maintained his head up high and stoically faced the direst of circumstances. His social network consisted mainly of doctors and nurse staff who took care of him and who treated him quite well.

He also bonded with some of the other patients. There were two of particular interest. The first one is a heartbreaking tale of a three-year-old boy by the name of Eric who had been put in a scalding hot bath and had sustained third-degree burns on his legs. Eric would lighten the place with his good mood as he was wheeled around the burn unit premises in a red wagon, and he would daily stop by and greet the author on his way, something that the latter always looked forward to. Yet one day the wagon failed to show up. Unfortunately, the boy had succumbed to his injuries and had died leaving the intensive unit much more desolate than before.

The second notable patient was a macho type kind of guy who would feign to be strong and invulnerable in the outside world but was constantly screaming and complaining that he could not accept or bear the suffering he had to face in that situation. Conversely, Jeff used to be someone who generally had a very low pain threshold and his friends would comment how he was complaining about simple scratches. And yet, there he was facing some of the most intense levels of pain imaginable and holding up much better than those who claimed and proclaimed themselves to be “tough” guys.

One of Jeff’s main strengths and what also propelled not only his acceptance but also resilience in this situation was his sense of humor. For instance, in an odd yet affecting amount, Jeff advised the screaming macho guy who adamantly resisted and refused to take part in those debriding baths to bark like a dog throughout the ordeal. Jeff started and soon enough his fellow patient followed suit, and somehow, the other patient managed to get through the sessions not unscathed, but much less so.

Beside humor, it was hope that was the rock that stood steady regardless of the turmoil and torments that were surrounding Jeff on a steady basis. He firmly held onto his unwavering hope that things would eventually get better after those difficult moments and situations. Where most of us, especially those macho guys, might feel discouraged and give up hope, Jeff did not do so; he put up a fight. 

His religion inspired and perhaps guided him throughout his suffering, but in the end, nothing was granted for free and he, like all of us, needed to earn his karma points. Faith is essential and most useful in this; however, merely on its own it is lifeless and futile. But when it is combined with determined action and focused willpower, it can literally move mountains.

When Jeff not only managed to survive but get well enough to be discharged from the hospital premises, he continued to work on himself and to continuously improve his health. He managed to work out with unwavering discipline and gained muscle mass; in fact, he was fitter then ever before. Evidently, he had his “battle scars” as he used to call them, but he was lucky enough that they were for the most part not visible. After all those skin grafts and operations and thanks to the intense and arduous work of his dedicated and caring health professionals, Jeff looked and even felt the best he could under the circumstances.

Finally, things seemed to be going well when the second disaster struck: he was diagnosed with an unknown and rather rare neuromuscular disease. There was no explanation except that it looked like his nerves were dying causing him intense pain. But even then, Jeff took solace in the fact that it was an unknown disease. What that meant is that anything, including full recovery, was still possible as none of the doctors could pinpoint a reason for nor could they label this strange disease. 

Yet through his previous experience, Jeff had built enough resilience and stamina to face this new obstacle. It was certainly not what he would have wanted to happen, but instead of denying it or victimizing himself or even blaming God or other celestial circumstances for his plight, he accepted it, faced it and, once again, managed to overcome it.

As Jeff states it himself, throughout his suffering, he had support and unconditional love. It might not necessarily be from the people you expect, but it is there in certain individuals who want the best for you and who not only root for you when you are down but also help you get up. For instance, one of his acquaintances offered him a place to stay for free until Jeff would get his life in order.

Nonetheless, his most unwavering support may have come from man’s best friend, his dog Sparky. She was, more than anybody else, the one who always stood by his side accepting him through thick and thin regardless of what he looked like or how much or little money he had in his bank account. Indeed, when he eventually loses his faithful dog years down the road, we feel his pain of losing his beloved life-long companion; yet just like him we are grateful to have and have had true friends and kindred spirits in our life in whatever shape or form they may have come.

This book is inspirational not only because of its many valid lessons it teaches us but also because the afflicted person has pulled through in flying colors. He has managed to overcome his many obstacles in life and now lives a relatively financially comfortable life and has been blessed with a beautiful family, including a son who is bound for college. He turned his years of pain and suffering into gold by reaching out to all of us though his book.

Of course, he is not the only one who is suffering; in one way or another, we all do. Some evidently more and to a higher degree than others, but we all have our own crosses to bear and our personal share of ups and downs. Yet this type of determination that Jeff Kuhn depicts and personally represents and embodies is most commendable, and we can be inspired by it regardless of what difficulties it is we are facing in our own lives. Now that is indeed inspiring!

Friday, March 15, 2019

Digital Footprints in Cyberspace: Benefits and Drawbacks for Mental Health

Lecture poster of Dr. Insel's Seminar on Smartphones and Brains
As part of Brain Awareness Week, I would like to discuss an exciting lecture I attended this week. It was entitled “Smartphones: What they can tell us about our Brains and our Minds” presented by Neuroethics Canada as part of the 2019 Dana Foundation Distinguished Neuroethics Lecture and given by renowned neuroscientist and psychiatrist Dr. Thomas R. Insel, ex-director of the National Institute of Mental Health (NIMH) and co-founder and President of the tech company Mindstrong. 

I had been excited about this talk ever since it was announced about more than a month ago and I had circled the date on my calendar (both print and virtual) to ensure that I would attend it and that nothing would get into the way of my attending this event.

Why was this seminar so important to me? There are various reasons for this. As someone who occasionally feels steamrolled by the drastic and dramatic changes over the past decade or so regarding technology, I wanted to get clearer and more fact-based information about how this was affecting us emotionally and mentally.

Also, I was a bit worried since I and all my loved family members are rather immersed in this technology. To an extent, whether we notice it or not, we are all dependent on these little devices that we carry around and consult and play with on a continuous basis. Some of us use them even during the night; however, I have tried to demarcate a clear line and boundary by having my smartphone in the other room and far away from the bedroom and my sleeping space (though I occasionally sneak into the living-room for a late-night check of my Twitter status and whether I received a like here and there).

The amount of time we generally spend on these gadgets and their effects on our brain was one part of my concern. The other one was regarding what would - and could - my smartphone usage possibly say about me and the status of my mental health. Would it be potentially alarming and worrisome?

In today’s high-tech world, we are and should be concerned about personal data, that is the information that we make accessible online, whether in public or private form. As we have seen with recent scandals regarding the consulting firm Cambridge Analytica, these personal details can be exploited and in turn used and abused to manipulate us, whether we are aware of this or not.

Moreover, our personal data may make us vulnerable since we have become constant prey to advertising companies and businesses; in this consumer culture of ours, our digital footprints could accurately predict what advertising methods would work best to lure us into buying the products, which we may – but most likely may not – actually need in our lives.

This second point I used to shrug off because, previous to this talk, I felt indifferent whether people had information about my personal interests, likes and dislikes. In many ways, I was already willing to share them on Social Media like Twitter as well as on digital platforms like this very blog you are currently reading. What did I have to fear since I had nothing to hide? Who cares if they had that information about me?

But it turned out, that I was wrong and that there was reason to be afraid, or at the very least to be concerned about my digital footprint. Whether we can do something about it is another matter, but at least we can be aware of it and see past its mechanisms.

Let’s backtrack for a moment to put things into perspective. Dr. Insel started the lecture by giving us an outlook of the myriad changes that have occurred over ten years into this technological revolution. For instance, merely twenty-five years ago, the most advanced supercomputer that the world had at its disposal was doing a mere fraction of what our smartphone is capable of doing today!

Plus, it used to be more costly, much bulkier as well as much more expensive; today’s smartphones may be expensive, but they have become much more affordable for the public. Moreover, they are indeed mobile, meaning they do not require a whole air-conditioned room for storage as they fit rather comfortably in our front pocket.  

And they have grown in number. Current estimates assume that there are close to three billion smartphone users with about two billion of them actively using social media giant Facebook. This number was in the millions only about a decade ago and has grown at an incredibly high speed.

The other point to mention is its diversity. Smartphones have become much more ubiquitous and exist on nearly every part of the world. Dr. Insel was indeed surprised to see them in a farming community in Tanzania. He asked one of the farmers what they used them for as there would be no pizza or any other kinds of food delivery within close range with the closest town being a three-day walk away. The farmer replied that it helped him to keep in touch with his buddies over Facebook. In fact, smartphones and electronic gadgets may be more accessible and easier to come by than potable water!

Since it is so easily accessible and consumed by a large portion of the human population, it makes it even more important to study its effects. And some of the news, as you may suspect or know already, is not that rosy. We have seen strides and improvements in health care as well as detection and treatment of various diseases, but in terms of mental health we have taken a hit. Anxiety disorders, depression and low self-esteem are on the rise globally and even more worrisome is the increase of suicides.

There are many studies that relate social media use with higher incidents of depression. This is also from the fact that we continue to isolate ourselves from nature as well as face-to-face contact with others. In fact, our smartphones are certainly smart, but they barely qualify as phones anymore. When asked about the Top Ten uses of smartphones today, making phone calls landed outside of it at spot 11. The highest usage is the more impersonal and less intrapersonal forms of texting and messaging as well as using social media and watching – presumably a lot of cat and dog - videos on YouTube.

It is also noteworthy that millennials are becoming more and more uncomfortable when it comes to verbally communicating over the phone. In some cases, studies have shown that they even prefer psychotherapy with a bot instead of talking directly to a psychologist or psychiatrist. Considering that the aim of many therapy sessions is to open up about and discuss personal issues, the use of AI for such incidents may in fact be more of a blessing than a curse, which leads us to the more beneficial aspects and possibilities of technology.

Medical health has certainly improved dramatically. There is nearly an app for everything, and health has greatly benefited from such technology. I was surprised to find out that with certain attachments to your phone, you would be able to take pictures of your inner ear infection and send them immediately to your doctor who would then prescribe you the necessary medication - again by texting you the prescription and treatment details.

But how could mental health tap into the possibilities and advantages of the tech industry? The answer is it can do so in many ways and that is for the most part what Dr. Insel’s tech company Mindstrong is all about.

For one thing, this technology certainly facilitates the process. The patient does not need to physically go to the environment - hospital, clinic or medical office - of the mental health practitioner. Patients could be provided with the necessary details and information at the comfort of their home, which would not only be saving time and travel but also associated costs.

Using specifically tailored apps could provide the mental health expert with vital and more objective information. Instead of relying on subjective evaluations and self-reports on mood and happiness, mental health practitioners can use our digital footprint, known as digital phenotyping, to gain important and quantifiable insights about our mental state and health.

How you may ask? To do this, you can try out the website offered by the University of Cambridge and where you can either upload your social media data or alternatively extract written text messages and emails. The site would then offer you relevant information regarding your personality. (I tried it out and put in a couple of paragraphs of one of my recent blog posts. The site predicted my exact current age - which I won’t divulge - as well as accurate details about my personality, including that I was creative, “random” and fun to be with; however, my Twitter information spread out over various years was not so spot on and turned me into a twenty-year-old!)

There is a lot of information that is included in our written communication, namely in the content we produce, the words we use and the sentence structure we employ. There is also significant information in the fluency and speed of our typing as well as any potential spelling or grammatical errors we make.

In the case of social media, our images, photos, comments and likes – collectively known as digital exhaust - give important clues not only about our personality, whether we are outgoing or introverts, more conservative or liberal, but also about our mental health, whether we are generally happy, sad, depressed, envious or angry.

There is of course an additional dimension that can be added to this diagnosis, which is our voice. Mental health experts can deduce and make accurate predictions about our emotional state based on speech content, intonation, inflection, fluency, pauses etc. There is a wealth of information that can be extracted from one’s voice and speech.

This can be rather easily achieved since many of us are already talking to our phones, asking Siri for directions or information, for instance. Our smartphones with their GPS sensor can also provide information where we are located at any given moment of time and how long we stay there in addition to what kind of videos we watch or what sites we visit or articles we read. This wealth of information can be very beneficial for various mental health issues like addiction, bipolar depression and could help prevent suicide.

According to a recent article on Scientific American cheekily entitled “The Internet knows you better than your Spouse does” by Frank Luerweg, there is currently an app called Loki that can also track images of your face as you are looking into your phone or reacting to images or content on your phone and it can deduce or rather detect your emotional state.

This information would aid psychologists to better evaluate a patient’s emotional condition and then be able to contact the individual in real time when they sense an oncoming manic or depressive phase in that given individual, or alternatively, the psychiatrist would immediately notice when a patient is not taking their prescribed medication.

As always, there are benefits and drawbacks to everything and there is no easy and quick fix or solution. There are many issues of ethics, accountability and how and in what ways and to what means and ends our current technology is used. If we use it to promote and establish higher and better access to overall health and well-being, then it is a certain boon.

If it is to predict and evaluate our digital footprint to manipulate, control or bribe us, then we are in deep trouble. Hence this debate on privacy and personal data, whether we choose to engage in it or not, is of paramount importance for our future and the path and direction that technology shall take over the next years. In the meantime, we cannot say that we did not know nor complain that we were not forewarned.

Friday, March 1, 2019

Being the Best Version of Yourself versus Becoming More Yourself: A Psychology Workshop

Image of a pair of snow-covered trees
In the month of February, which was among other things and events also Psychology Month, the BC Psychological Association offered two free public talks on interesting topics related to mental health and self-help. Unfortunately, I was only able to catch the second one of the series entitled “Being the best version of yourself.” The quest for oneself is not only my daily bread and butter (it has been since my early teens at least), but it is also the main incentive, guiding force and philosophy behind my upcoming book, so I knew I had to attend this workshop.

But I almost didn’t end up going. There were two valid and plausible reasons for my hesitation. One, this event occurred on a Saturday morning and since it was a bit of a commute for me, it meant I had to get up early and have a quick and rushed breakfast with the family instead of a slow and languid one, which is usually the case on weekends. The second reason was even more pertinent: There was a snow storm outside, which apart from being uncomfortable and cold would also signify delays in traffic, so I would have to head out even earlier than planned to ensure that I would make it there on time.

In fact, I arrived there way before time and had to idle away my extra time with the help of a self-help psychology book on how to handle anxiety. Finally, we were allowed to enter, and the room was not as filled as everyone would have assumed or expected for such types of talks; many of the prospective attendees had been most likely discouraged by the wild weather outside.

Yet when Dr. Sara David started on the importance of acceptance, I immediately felt embraced and accepted and forgot about the turmoil of getting there. Acceptance is the main missing ingredient in mainstream popular thinking. Accepting yourself the way you are. This came on the heels of me watching the moving and inspiring documentary Won’t you be my Neighbor on the incomparable Fred Rogers. When I was much younger, I used to watch and enjoy his program very much.

Both the message of Fred Rogers and Sara David was that you are special exactly the way you are. Although we all supposedly know this to be true and it may seem obvious and self-explanatory, you would need to ask yourself two things with complete honesty: Do you indeed accept yourself exactly the way you are, your special and unique qualities as well as your warts and shortcomings? Because if you do not, then you would not fully embrace and love yourself, but only partially and conditionally so.

The second question is of importance as well: Do others accept you for who you are? By others, look at your parents, family members, friends, teachers, co-workers, and so on. Most often, they do not, but surprisingly there is a significant overlap between us not fully accepting ourselves and others not doing so either.

Sara David mentioned trauma at the beginning of her talk. Although she has personally worked with the worst trauma imaginable, from Holocaust survivors to indigenous people whose loved ones had been brutally and heinously murdered by the hands of serial killer Robert Pickton, we have to keep in mind that we all in our own ways carry our emotional trauma around.

And this trauma can have various sources. It often starts with parents who do not love and accept themselves, and then - consciously or unconsciously - dump their own anger and frustrations onto us. It could also be teachers who were not interested nor cared about our health and well-being and even made us suffer in our youngest and most vulnerable years.

And finally, and equally important, it could be the conditioning that our culture, society and nation imbues us by bombarding us with various messages that mark and traumatize us from a very young age onward. The latter is of quite importance especially in Western capitalist structures. Western society and culture consistently push us to be the best we can be, namely, to be our very best version. This has led to continuous hard work and at times material success among individuals.

Yet there is often a fundamental and essential difference between being oneself and being who our culture wants us to be and therein lie the very issue and the very heart of acceptance. Western society, culture and religion tell us from the get-go that we are not good, deserving nor worthy enough and that we must work hard to redeem ourselves in order to become special. They all give us clear indications and images of what is considered worthy and admirable; everything else that does not conform to this ideal we are asked to avoid or shun.

It is rather ironic that in a system that so much praises and prides itself upon the importance and relevance of individuality, the very starting point implicitly denies expression of one’s full-fledged individuality and merely accepts those who fit the mold or convention, meaning those who conform to and match those preset and preconceived ideas. As a result, people have been marginalized for different reasons, be they of different color, sexual orientation or disabled. A society that is truly free and accepting would not keep any of its members at a margin, or worse, segregate among its own population.

Sara David’s message was first accepting yourself and then deciding how you can improve upon yourself, meaning to get even better at who you are or want to be. Her philosophy is based on the idea that we already have inner wisdom, a spiritual source and light that could and would guide us in the best possible direction in our lives, but this fountain has been polluted, in many cases even poisoned by toxic thoughts and feelings, people and environments.

And that is exactly where our trauma stems from. We feel inadequate, not good and worthy enough because that is what and how we have been taught throughout our lives. Two important observations and parallels can be made here about the Mr. Rogers documentary I saw the day before. One, it is a foolish and erroneous accusation that telling children that they are special would make them spoiled or directly lead to feelings of entitlement. That is certainly not true; narcissism occurs in our society not because one accepts oneself, but rather its opposite direction: it comes from a complete lack of acceptance as well as festering insecurity about one’s being.

Love and acceptance are not about feeling better than or superior to others because for a person who fully loves and accepts him or herself, there can simply be no possible comparison. How can you compare two completely different individual entities with each other, and why should you? Love means accepting yourself the way you are and that you are indeed unique, while arrogance is a denial and rejection of both love AND acceptance. The arrogant person is driven by fear and rejection; they think they are superior to others because inside they feel inferior. On the other hand, narcissists do not accept anybody and use all beings, including themselves, as pawns and objects to move around for shallow egotistical reasons.

The second observation - and this one is more painful and disheartening in itself - is that throughout those years that Mr. Rogers preached (he was an ordained minister after all) of love and acceptance and of being special, he himself felt unloved and inadequate and not special at all. This is sad but not hypocritical in my mind. It just shows how deep the recesses of pain and trauma can reach us and how they can affect us for entire lives if we do not do something about that.

What can we do? Here is where Sara David gave us tools to deal with and slowly undo and untangle this deep trauma inside of us. For healing to occur, there are seven Cs that we need to build on and develop, and she explained and elaborated them in some detail.

Most of them are rather self-evident terms and truths, but they are of vital importance for acceptance, love, growth, and moreover healing, so I shall name them here with some quick commentary. First off, for any kind of substantial change to take place, we need two things to occur, namely Calm and Clarity. Put differently, we need to act from a calm center of ourselves and need to be clear and honest about ourselves and about our subsequent actions. This state can be aided or achieved through meditation, visualization or other brain and emotion-calming activities. This would then enable us to tune into ourselves, in fact, to gain access to the most inner recesses of our being.

The next big C would be Courage. For any change, for any habit or automatic response or conditioning that we want to replace, we require courageous action. Courage also signifies the willingness to face fear. In fact, those who are courageous are not magically free from fear; they are simply not as constrained or trapped by it. In other words, courage is not the absence but rather the mastery of fear.

Most of us react to fear by avoiding it because it is an unpleasant feeling and experience, but instead we need to face and deal with those situations with courage. This again does not mean we should reject or repress fear; instead of pushing it away, we need to welcome it. Anxious feelings are more often than not messengers or signals that something in our lives is amiss, is not working as it should or is simply out of whack. We also need to get past the emotional conditioning that tells us that we are weak because we are afraid; in fact, the very opposite is true, vulnerability is strength, and with courage we can listen to it more clearly and act upon our anxiety.

All this would then help us get to the next step: Confidence. Our natural confidence often gets eroded by our thoughts and experiences, so we are tasked with rebuilding and reconstructing our own ability to trust in ourselves again. Reclaiming confidence is very different from being narcissistic in that the former is not as judgmental and self-critical and rather comes from constructive feedback that helps us grow and develop our innate abilities.

It would then lead us to Compassion. This step is very important because by being compassionate with ourselves, by taking care of ourselves and treating us well, we can heal many parts and aspects of our lives. This is an essential ingredient in mobilizing us to become the best version of ourselves. It cannot be reached without empathy and forgiveness towards ourselves and others.

Next, we have Curiosity. We need to be mindful and curious about ourselves. We need to observe ourselves and our emotions because they are essentially well-meaning messengers trying to get our attention. If we listen to them instead of judging, ignoring or repressing them, we can make important headway in our quest for healing.

In this case, we need to silence the critic, the remnants of those toxic voices of our past that we have internalized within ourselves, and we need to stay away from shaming and blaming. Instead, we need to be curious about what is the source or the origin of any given anxious feeling, what are the reasons and motivations for their existence, what is it that fans and feeds them. This would lead to both discovery as well as solutions instead of negative feelings of stagnation via blame, anger and resentment.

This combination would then unleash our Creativity, which is important for finding the best actions and resolutions to one’s emotional issues. Through our creativity, we may also realize the importance of the next C: Connectedness. We can achieve close bonding with others by opening our hearts, first to ourselves and then outwards towards others. When we are open-hearted in this manner, we see each other with the eyes of love, and our interactions become indeed heart-felt and are not just based on thoughts or selfish reasons.

A person who is genuinely interested in you, feels not only curiosity about you but is also fascinated with who you are. They will be present for you, giving you their undivided care and attention. This is also the main difference between a caring parent or caregiver versus an absent or toxic one. The latter is not fully present or grounded with you, and they often harbor cold, angry feelings. They may be physically present and supposedly they are there for you, but it is not a nourishing or loving presence and it is certainly not genuine or honest.

But the person who is genuinely interested in you is an interested witness of you and your growth and will provide affection and warmth to protect and take care of you, not to change or use you for other means or motives. Through this, we can achieve healing and evolve and grow like a tree by expanding our branches and leaves yet remaining firmly rooted in our own existence.

Finally, it is most important to protect and shield ourselves from toxic people around us. They may include family members or colleagues, but if you are surrounded by them, their bad vibes and negativity are contagious, even if you think you may be immune against it all. The fact remains that there are mean-spirited and negative people out there, whether they do it intentionally or unintentionally, is not within our purview, nor should we pass judgment upon them. But it is still best to avoid them like the plague and deal with them only when necessary, even if they be close family members. We should not feel guilty about weeding them out of our lives because if not, we would merely further hurt and damage ourselves.

To sum up, we can use the analogy of the body; we need to release toxins and assimilate all that is good. We need to avoid and shun all that is bad and unhealthy for our body and mind and embrace everything that is good, healthy and nourishing for our well-being, growth and development. For this to occur, we should use an “emotional enema” (her exact words) to erase, remove or replace all the obstacles and hurdles that are in the way of who we want to be. We want the best possible food, and we want to surround ourselves with positive people, that is people who have good vibes and are kindred spirits. By being around them, we can catch their good vibes, and they can aid us in our quest for our true self.

Fear mongers in all their shapes and forms plant the seeds of fear and hatred within us, but at the same time, we can ourselves plant seeds of love and nourishment by reaching the best version of our self, which is, in and of itself, natural and aims to connect with others in a genuine and heart-felt way.

However, there is an element of confusion or a minor contradiction here. On one hand, we should accept ourselves the way we are, yet we still need to become a better version of who we are. This is misguided in my point of view. If you can fully tap into the inner wisdom deep inside of you, that light will guide you and there shall be no need for improvement because you already are perfect exactly the way you are.

So why is there this constant need and drive to get better? This is one of the problems of cognitive behavioral approaches since unlike psychoanalysis, they do not tap deep enough into the human psyche and its unconscious drives and motivations. In other words, they still retain traces of the conditioning that they want to undo. The idea of being the best you can be smacks intentionally or not of Western capitalism thinking and conditioning. Being yourself is simply not (good) enough, you should not remain idle but keep improving on your skills and abilities.

My point is not to dismiss self-development and improvement, but I think that by accepting yourself the way you are and by being able or having found the way to tap into the innermost recesses of your core being, then you are simply perfect as YOU. You are already the best and perfect version of yourself.

Getting there of course takes effort and diligence, but it is most certainly worth the labor and turmoil. This is a path that I intend to trace in my upcoming self-help book that sees the cognitive behavioral field as a useful tool, but not as sufficient enough to uncover and unveil one’s core self and being. But it represents an important and essential first step or mechanism, and this informative and enlightening talk proved and underscored this to me.