Transcription of Dr. Joseph Semmes for the show Meditation #49
Dr. Lisa: This is Dr. Lisa Belisle, and you are listening to the Dr. Lisa Radio Hour & Podcast, show number 49, Meditation, airing for the first time on August 19th 2012 on WLOB and WPEI Radio, Portland, Maine. With me on the studio is my co-host, Genevieve Morgan. Hi, Genevieve!
Genevieve: Good morning, Lisa. I’m a struggling meditator. How about you?
Dr. Lisa: I have struggled with meditation over the years but I no longer consider myself a struggling meditator. I just do the best I can and I don’t beat myself up for it. Whatever meditation I get done, which is on a pretty regular basis, I give myself a pat on the back for.
Genevieve: I find I meditate more easily when I’m walking.
Dr. Lisa: Yes. Walking meditation has been a long-time tradition and it’s a good entry point for a lot of people because on our culture, we’re not really used to sitting still.
Genevieve: How did you come to mindfulness or practice of mindfulness?
Dr. Lisa: I’ve always understood that mindfulness was an important part of being a doctor and human being and a parent. When I went down to the University of Massachusetts and did my preventive medicine residency or fellowship after I trained in family medicine, I had the chance to train in Jon Kabat-Zinn’s program, the Center for Mindfulness. I did a mindfulness-based stress reduction program which was pretty life changing.
Genevieve: It worked?
Dr. Lisa: It did work and also, it helped me to focus in on the type of doctor I wanted to be and to know that there were other people like me out there that were championing the idea of medicine done differently.
Genevieve: I think one of the most moving things for me about meditation is how often it’s come up in our program, over the past 46 shows, 47 shows. It just seems to be a common thread in wellness.
Dr. Lisa: There are a lot of people out there who are meditating from doctors to yoga teachers. You were absolutely right, there are a lot.
Genevieve: Fitness trainers.
Dr. Lisa: Fitness trainers. There are a lot of guests who have come on, who have talked about the idea of centering and how this has become important in their lives. I also know for me, one of the classes that I took several years ago with Dr. Herbert Benson out of Harvard was on spirituality and medicine. This is something that I know that one of our guests is going to bring up, if not, both of them, is this idea that there is something bigger and that spirituality does impact us on a physiologic way. Dr. Herbert Benson had a conference for many years that actually addressed that issue.
Genevieve: That was way back in the ‘70s, correct? It’s been a concept that’s been percolating for a very long time. If not, thousands of years in the east but certainly with modern western medicine, it’s coming more and more to the forefront.
Dr. Lisa: This is true. It’s also true that people will often associate spirituality with religion and organized religion and they’ll have gut reaction because perhaps they’ve had an experience in their lives that’s made them averse to religion but spirituality and religion are not the same thing. When we talk about spirituality and healing, and spirituality and medicine, it doesn’t mean that we believe people need to go and join a church per se. It also doesn’t mean that if you meditate, you have to have any sort of affiliated organizational religion in your background. It’s an important thing for people to understand.
Genevieve: That’s true. I think that one of the reasons why I feel so much more contemplative when I’m walking is because I’m usually walking in nature and there’s something that connects me to a larger force that’s much more accessible when I’m strolling through the woods or sitting by the ocean. I don’t associate that with religion at all.
Dr. Lisa: This is very true. I think that there are continue to be things as much as I … I have a lot of training in western medicine, I have a lot of training in eastern medicine, and I still believe that there are intangibles out there that help us to heal our bodies, heal our communities, and really remain connected to the world, things that we can’t necessarily prove but certainly seem to have an impact.
We’re happy to have in the studio with us today, Dr. Joseph Semmes who is currently True North’s Director of Research and also Surya-Chandra Das from the Rolling Meadows Retreat Center up the coast here in Maine. Those of you who are listening, you’re going to get a lot out of the show so keep on listening and thank you for joining us.
The Dr. Lisa Radio Hour & Podcast is pleased to be sponsored by the University of New England. Our collaboration with the University of New England allows us to present a segment we call Wellness Innovations. This innovation is meditation. This comes from the April issue of the journal Emotion, Om: Meditation as a big help for emotional issues. School teachers who underwent a short but intensive program of meditation are less depressed, anxious, or stressed and more compassionate and aware of others’ feelings. According to a UCSF-led study that blended ancient meditation practices with the most current scientific methods for regulating emotions.
A core feature of many religions, meditation is practiced by tens of millions around the world as part of their spiritual beliefs as well as to alleviate psychological problems, improve self awareness, and to clear the mind. Previous research has linked meditation to positive changes in blood pressure, metabolism, and pain but less is known about the specific emotional changes that result from the practice.
This new study was designed to create new techniques to reduce destructive emotions while improving social and emotional behavior and arose from a meeting in 2000 between Buddhist scholars, behavioral scientists, and emotion experts at the home of the Dalai Lama, who post a question: In the modern world, would a secular version of Buddhist contemplation reduce harmful emotions? The answer, it appears, is yes.
For more information on this wellness innovation, please visit doctorlisa.org. For more information on the University of New England, visit une.edu.
Dr. Lisa: As part of today’s meditation show, we’re interviewing another doctor whose name and reputation precedes him in the community. He is quite well known. He’s been around for quite awhile. This is Dr. Joseph Semmes. Dr. Semmes, thank you for being with us today.
Dr. Joseph: Thank you, Lisa. It’s a pleasure to be here.
Dr. Lisa: I know you as somebody who’s been educating and practicing medicine in the community in Maine for quite awhile but before that, you also practiced as an emergency room physician in Virginia.
Dr. Joseph: Yes. I’ve came up through hospital classic training, tribes of internal medicine, critical care, practiced Emergency Medicine in the Georgetown System for a little over 12 years or actually maybe 15. I had some medical challenges and moved up here. I’ve worked at Mercy in the Emergency Department at True North in integrative medicine center in Falmouth for more than a decade. I’ve also been involved in end-of-life care initiatives in the state.
Dr. Lisa: For those who are listening and followers of our show, Dr. Bethany Hays came in and spoke about vitamin D and sunshine a few weeks ago. She has blessed our space with the True North presence and we thank you for continuing on.
Dr. Joseph: The pleasure is mine.
Dr. Lisa: Dr. Semmes, you went from emergency medicine to an interest in yoga and meditation. A very different approach to medicine. Why meditation? What was it about meditation that you found interesting?
Dr. Joseph: I had a life-threatening illness in 1996 and in fact, an inoperable form of pancreatic cancer. I’ve been to Johns Hopkins where they had opened me up, closed me. A cousin who was doing a contemplative prayer or centering prayer practice, invited me to a working group that met once a week for 20 minutes of meditation or centering. We tend to think of meditation as all being an eastern technique and connected to yoga and to Tibetan Buddhism. In fact, there is a very rich mystical tradition of breath-focus centering also in Christian Europe from way, early. Some of those people, I think it was John of the Cross and Teresa de Avila had taken the ball and run from other mystics earlier.
Now, things shifted in the west and got less mystical in the last few hundred years. I think there’s a Benedictine monk named Thomas Keating who has a large centering practice of contemplative prayer which is essentially as far as I can tell, the same technique as that followed by the Tibetan Buddhist and others that focus on their breath. I once had a healer who his recommendation to me early on in my road was to just feel the air moving through my nostrils and just pay attention to that. When other thoughts occurred to you, let them float off and return to it.
I found over the course of a few years that doing 20 minutes, twice a day and then once a week, 20 minutes with a group of people, I found that I was able to quiet that monkey in the mind that is referred to, to smooth out the frenetic, static of my kind of distraction. I think you should both be aware that I come from a real strong traditional mindlessness. My mother, as I grew up, I think she used the term inconsiderate to describe me. Gosh, I’d like to have a nickel for every time.
I was diagnosed long ago with attention-deficit disorder. I think probably half of the emergency physicians in the country probably share this kind of neural circuitry because it’s a perfect structured job. They give you a head sheet with a complaint. You go solve the problem, check in and check out. Being distracted goes along with the practice.
Dr. Lisa: You were mentioning before we came on air that there is an organizing thing that happens in the brain with people who meditate.
Dr. Joseph: I don’t pretend to be much of a neurologist. The structure the brain is, I think, extremely complicated and not well understood although certainly people can do surgery while someone’s awake and hit a certain part of the brain and they can’t talk and they know not to cut in there. What really has impressed me over the last decade is that the proceedings of the National Academy of Sciences which is the publication piece for our National Academy are really top scientific leaders in our country has had numerous, very deep impressive technological studies of meditators, both experienced meditators and people who are taught four-week courses and also show brain changes by imaging technique such as functional magnetic resonance and also EEGs and sometimes fusing this to make interpretations.
If I can back up a little bit and obviously, well not obviously but I didn’t exactly centered before I came in here so if I’m jumping around, please forgive me. It means I’m more at the periphery than the center so to speak. One of the earlier investigators of meditators was a Harvard professor, Herbert Benson, an MD who went to Tibet and those areas of the east and studied meditators. He didn’t have functional MRIs but he looked at their blood pressure and their pulses and their temperatures. He was really impressed with how it changed their nervous systems on a moment-by-moment basis. You hear of people who are advanced meditators that can sit in freezing weather and melt the snow around them.
It’s pretty intriguing what’s really going on. Now, Benson, his work initially was published in a book called The Relaxation Response. He promoted in actually the same way that a 14th century Christian mystic talked about the cloud of unknowing which was almost a way of opening yourself to the divine by focusing on one divine word or one mantra, if you will, as a way to help focus your attention and become more centered. Dr. Kabat-Zinn at UMass in Worcester, referred to mindfulness or meditation as mindfulness-based stress reduction and looked at very specific body functions like heart rate and blood pressure and temperature.
Herbert Benson, Dr. Benson brought this to the next level where beyond the relaxation response and beyond this physiology is a higher realm of centeredness, of being present. Whether that’s connected, I don’t mean to get too mystical here, the presence of the divine or whether it’s just an ability to become more connected to others, more awake, more aware of others, more aware of one’s self and one’s own feelings and thoughts, and what baggage you bring to things, and whether it just makes people feel more compassionate and more connected to each other.
Dr. Lisa: You mentioned that you had gotten diagnosed with pancreatic cancer.
Dr. Joseph: I really shouldn’t use the term pancreatic cancer. It was in my pancreas but we should probably call it carcinoid because it’s from a family of slow-growing tumors of a different kind of biology.
Dr. Lisa: Nonetheless, there was fear and emotion around that. How has mindfulness or the practice of meditation, how does it help people in moments of stress and illness and either in your experience or in treating other people?
Dr. Joseph: I think that personally, when I’ve been feeling overwhelmed or disempowered or at times when you feel like you’re no longer a human doing, you’ve been forced to be human being and you’re stuck doing less and less physically contracting, well, you always have your breath. Until at some point, we have our last breath. Maybe I’m going to ramble here but it’s interesting that we, in the western scientific context think of gas transport, and oxygen coming in and carbon dioxide going out and management of our blood pH. Whereas in the east, they talk about bringing in prana or chi or the life force. The truth is, man, breathing really is bringing in the life force and let me say that I’m kind of from the show-me state of Missouri and that I don’t want to be a Pollyanna and believe stuff that really I don’t believe.
I’ve had a really hard time believing stuff I don’t believe. At the same time, I think an open mind is a very good traveling companion along with healthy skepticism. I think opening to some of these ideas of the east is very seductive and reasonable. I do, in spite of all the blood gasses that I’ve done in ICUs in my career and looking at pHs and oxygen and carbon dioxide, I’d like to think that there is a prana or chi moving into my body when I breathe.
Dr. Lisa: You’re not alone in thinking this as a physician because recently, I understand there was a mindfulness course offered at the Maine Medical Center for physicians over there. Is that true?
Dr. Joseph: Yes, indeed. Dr. Dreyer from the division of Family Medicine and other thought leaders at Maine Medical Center, I think it was about two years ago, put together, maybe it’s an eight-week course using a course designed that came from the University of Rochester College of Medicine. It’s interesting that there seems to be a union, an evolving cross-fertilization if you will, of thinking in medicine, in end-of-life care, in poetry, in even marital counseling. I’m going to just go sideways for a second and mention that there’s now understanding of the brain function that shows that when someone’s emotionally upset and gets into an argument, that the frontal lobe, which is where looking down and being objective and understanding what’s going on, is taken off line.
When people are arguing and their emotional limbic systems are stimulated, they are really not able to process any information that doesn’t support their position. I’m talking in the context of, say, an argument that occurs in, say, a relationship. The lesson that we’re learning from the brain science is really very similar to the lessons of the traditions of the east and even earlier Christian thinking is that to be quiet and to move away, permits a centering where that frontal lobe that is part of being mindful can come back online and reconnect with that emotional part of the brain, which is lowered down.
Jumping back, I’m reminded that in 1999, there was a wonderful editorial in the Journal of the American Medical Association called Mindful Practice. It was by Dr. Epstein from the University of Rochester. I remember reading it back then and just thinking how wonderful that this is in the Journal of the AMA. I think that it is just one example of how organically good ideas flourish like good plants do to use the metaphor. If the fertilizer in earth is there and the idea is the seeds are there, they will grow and they’re growing all over the country.
Dr. Lisa: Do you think that this is a case of, if the student is willing, the teacher will appear?
Dr. Joseph: I think that’s very true. Although, there’s that the old saying, build it and they will come and that’s not always true. That’s also fortune favors to prepared mind as pastors said. The good Lord helps those who help themselves as my mother would say. I think it is important to be proactive and to seek out people to help your training.
Dr. Lisa: Dr. Semmes, you mentioned that part of your journey began in 1996 with your own illness and your journey is continuing and I believe you are doing something very interesting right now with hospice and palliative care. Why was this important to you and what has this meant to you in your own life?
Dr. Joseph: I must admit that it took me to get hit over the head with a sledge hammer to pay attention to some of the important things like end of life. As a physician, in my training 35 years ago, the focus was on the disease much more than on the patient. We referred to the nephrotic syndrome in room 741 as opposed to the whole patients. That tradition is changing.
I do want to mention that William Osler, who is often thought to be the father of modern medicine, who was an internal medicine doctor at Johns Hopkins University at the turn of the last century, studied many dying patients to try and understand what was going on with them. He also thought that the practitioner, the physician should develop the characteristics, the practice of equinimitas which is I guess is Latin for centeredness, really. It was so that you could listen well to what the patient had to say. A lot of the time, busy, non-centered clinicians whether they’re early in their training or very experienced come charging into the situation with their own MO, their own ideas, their projections, and it leads to a very unsuccessful patient-provider interaction.
I think that what Osler was on to 120 years ago is what we’re rediscovering. Osler also said that he thought that the highest calling of the physician was to help people die well. Having, early in my training, seen that medicine, much like in the realm of birth in OB-GYN, childbirth was taken away from the home and families and communities and brought into the hospital. Then, death was taken away from home and families and brought into the hospital. The problem was, Jennifer and Lisa, is that maybe, that physicians are selected for a little more fear of death than the average person.
In fact, a wonderful mentor of mine, Brownie Wheeler, a former chairman of surgery at John Kabat-Zinn center down at UMass Worcester, and a neighbor in South Portland. Brownie Wheeler once told me, there is pretty good data that shows that medical students, when they are surveyed, have much higher level of fear of death than their controlled age and gender peers that are not going in the medical school. What you had is the house of medicine took that away from the community and put it down at the end of the hall and didn’t look at it. Basically, it was a big mistake.
Over the last 20 years, a new field of hospice and palliative care has emerged which is growing very rapidly and it’s exciting to see that the skills of waking up and listening and customizing to the whole patient and the uniqueness of the story of that patient or their family situation is being addressed in ways that I didn’t see it being addressed in the hospital practices that I saw 20, 30 years ago.
Dr. Lisa: Dr. Semmes, I think that people are going to have lots of questions about meditation and some of the things that you’ve mentioned. I know you have a pile of books and resources. You’re going to give us some of those titles that we’ll put up on our website. There’s a poem that you were hoping to read that I’d like to end with. Would you read that for us?
Dr. Joseph: I’d be honored. I wanted to let you listeners realize that this is taken from the middle of the syllabus for training in mindfulness for medical students and residents that was developed at the University of Rochester and has been ruled out here in Southern Maine, at Maine Medical Center and hopefully, soon at Mercy. These are the comments of a 13th century Muslim poet, named Rumi. Rumi was a Sufi. The Sufis are sect of Islam and not I’m an expert but my understanding is that they were very in love with God and didn’t sweat the small stuff. What I like about The Guest House here is that, I’m going to back up and say, in our pursuit of mindfulness or meditation, it brings us to reality.
It awakens us to be present to the world as it exists. It’s not all light and rosy. There are dark shadows. There is suffering that’s universal. This Sufi, Muslim poet, Rumi has written this or actually, he didn’t write anything. He just said these things and other people wrote them down. It’s called The Guest House and it’s about the ability to be hospitable to unwanted and unexpected guests in addition to those that you want because we have to deal with some things that sometimes we don’t particularly want. Bear with me, listeners.
The Guest House.
This being human is a guest house.
Every morning, a new arrival.
A joy, a depression, a meanness,
some momentary awareness comes
as an unexpected visitor.
Welcome and entertain them all!
Even if they’re a crowd of sorrows,
who violently sweep your house
empty of its furniture,
still, treat each guest honorably.
He may be clearing you out
for some new delight.
The dark thought, the shame, the malice,
meet them at the door laughing,
and invite them in.
Be grateful for whoever comes,
because each has been sent
as a guide from beyond.
Dr. Lisa: Thank you for that, Dr. Joseph. It’s been a pleasure to have you in with us today and thank you for sharing your wisdom.
Dr. Joseph: I’m just a conduit for a lot of other’s thoughts and the honor and delight is mine. Keep breathing.