Joseph Cramer, M.D.: Mindful attention increases agency

Published: Tuesday, Oct. 2 2012 4:00 p.m. MDT

Cindy Steele practices contemplative meditation during an Cindy Steele practices contemplative meditation during an "Interfaith Meditation in the Park" gathering at Woodward Park in Fresno, California, August 27, 2011. (John Walker/Fresno Bee/MCT)

Wars, both in heaven and on earth, are waged for power and glory. It is the constant challenge of the lust of one against the agency of many. While facing the gravity of spiritual fatalities and the terrestrial terrors of armed conflict, we must never underestimate the criticality of agency.

Yet, if agency is of such import that dictators and devils seek to crush it while angels and armies rush to defend it, why do we, the victors, fail to make better use of it in our lives?

Far too often we react automatically to emotions or memories. This autopilot life saves our brain from being overworked. We have all done it. We get in our car and the next thing we know we are home or at work without any memory of the trip. It reduces the need to think.

Relying on mental or emotional autopilots saves us the bother of having to examine issues below the surface. We see something and automatically toss it into a convenient hole. The distinction between friend and foe is expedited. If anything is different it is a foe. There is no middle.

Our autopilot is fast and more sensitive to threats than to specific individual concerns. Things that are big and furry are not necessarily bears. But often, our autopilot fails to discern differences and we find ourselves fearing a friendly sheep dog because it has four legs, is big and is furry. That is close enough to a bear to evoke anxieties.

When we are stressed in the fast lane of life, the gain on our automatic thoughts is turned up so high that we rely more and more on our subconscious reactions to get us by. People come and go in our lives, but we don’t notice. Flowers bloom and wither as we walk blindly through the garden.

With various people, our biases surface because of mindlessness. If the person is different in any way, he cannot be a kinsman. If others are of different genetic makeup, they must not be trusted. In our protective thoughtlessness, if something about them is new or peculiar, we must be on our guard. If they have a different accent, language or dress, we reject them without thinking. Our fear of their religion, custom or name stops us from learning more.

All of this automatic, robotic living limits our use of agency. We exist in a complex world. Complex systems are characterized as too complicated to predict outcome, but there can be agents that react in ways not directed by the system.

An example of an extremely complicated non-complex system is a rocket. Although it is made of of intricate parts, computer programs and propulsion mechanisms that must operate in sync with each other, the outcome of their use can generally be predicted with precision. Not so with a bird. It too has the ability to fly upward, but where it will come down is anyone’s guess. It is an agent of its own free will. We have similar agency available to us to make decisions as we move through this complex world.

The most complex creation in the universe is the human mind. Inside, somewhere between the ears and amongst the neurons in our brain, we have the power of choice. While there are some who argue that there are individuals who appear destined by nature to act a certain way, we have to be careful lest anyone claim there is no agency.

This is the power and role of mindfulness. Mindfulness as a psychological construct is relatively new to the occidental world but has been practiced for centuries in the Orient.

Mediation, more recognized in Buddhist and Islamic traditions, has also been a part of Christianity. There are numerous accounts of prophets and even a king seeking solace, which facilitated their mindfulness. Over the centuries, monks and saints and pilgrims have trekked up high mountains or into their own sacred groves to practice pensive prayer.

If we pay attention, we can use our agency more righteously. The declining exercise of agency produces a decline in moods. Clinically, it appears that we are experiencing an epidemic of depression. It may be an artificial elevation for a number of reasons, but it seem we are becoming a more depressed country that we pejoratively refer to as the “Prozac Nation.”

Depression has many suspected contributors: genes, nutrition, lack of sunlight, childhood trauma, life crises, anxieties, and biochemical deficiencies in the brain or chronic inflammation. All play a role. So where is agency? We do not select our own genetic makeup; traumas and crises come unsolicited.

It is our free will, the deeper practice of agency, that permits all of us to begin separating ourselves from our thoughts. We are not our insecurities. We are not our doubts, worries or fears. We are not even our emotions because they may have been reared in a nursery of darkness that no longer exists.

It is this nanosecond of separation between the feeling or thought and our actions that demands our attention. Attention makes us aware that there is a choice. We don’t have to give personal time or mental space to a memory that frightens or an impression that degrades. We can be kind even when we are sad. We can stop feeling sorry for ourselves for some slight that occurred in junior high.

As Elder Jeffrey R. Holland of the Quorum of the Twelve stated it the April 2012 general conference of The Church of Jesus Christ of Latter-day Saints, “We consume such precious emotional and spiritual capital clinging tenaciously to the memory of a discordant note we struck in a childhood piano recital.”

We all add to our own orchestra of discord, be it a departed boyfriend, missed fame, lost fortune or being picked last for a neighborhood team. There are as many notes as there are people with memories. However, that doesn't mean there are not real sorrows, limitations in physical abilities, struggles in mental prowess, or absence of earthly wealth.

The toughest exercises of mindfulness, and hence agency, is when our mind is not well.

A friend confided in me how he had once been close to suicide. He had been experiencing waxing and waning major depression and anxiety for sometime. He was tired of his job and exhausted in his marriage. He had known melancholy before and knew on an intellectual level what it meant to want to die by one’s own hands. But now, he told me in a tender moment, he also knew emotionally as well. He sensed how easy it would be to blow his life away and with it the pain of his misfortunes and his disloyalty.

During this very personal revelation, he went on to say how he had sought both professional and spiritual help. It was in those sessions of compassion that he felt for the first time in his adult life that he was loved in spite of all his imperfections. He also said, through tears, that they reminded him he had free will.

If he was alert to the overwhelming voices of discouragement, criticism, fear and self-focus, he could choose to shout against them. He could get out of bed in the morning, he could stop feeling alone, he could seek forgiveness. Most importantly, he could decide to stay alive. For his recovery, he had to be aware of his feelings and exercise agency to more fully heal.

Agency is worth fighting for and worth living for. If we practice being mindful, we can make better decisions from which we can grow. Ellen Langer, considered the pioneer in mindful research in America, conducted a study in which she divided residents at a care facility into two groups. The first was the control. Nothing new was added to their daily routines. To the second group of seniors she provided plants and direct them to take care of their new responsibility.

After several months she and her colleagues returned to the facility. In that short time, 20 percent of the patients in the first group had passed away. All of the residents in the second group, who had similar preexisting conditions or therapies, had outlived their neighbors. Her conclusion, described in her book, "Mindfulness," was that those who received plants had been given a reason to live because they had to make choices and had to attend to their green companions. They used their agency to live.

We fought for agency to live before. We have that agency to continue to live now.

Joseph Cramer, M.D., is a fellow of the American Academy of Pediatrics, practicing pediatrician for 30 years, and an adjunct professor of pediatrics at the University of Utah. Email: jgcramermd@yahoo.com

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