Richard G. Petty, MD

A Shocking Study

I have been teaching medical students and doctors since the 1970s. But there have recently been times when I have despaired about the way in which so many young doctors no longer engage in common courtesies with their patients.

I just spoke to someone who had visited a new family physician. She was fresh out of her residency, and her residency director has something to answer for. She did not make eye contact or shake hands, and could not remember the person’s name. When the patient extended her hand the doctor became confused because she was focused on her laptop.

I know that I can be accused of being old fashioned, but that shocked me, as did a recent report that medical students at a highly rated school are going to be getting classes in empathy and talking to people. This was announced with great fanfare. My question: why on earth do intelligent people need to be taught how to communicate? And if they have a problem in that area, first, how did they get accepted into that excellent medical school? During the years that I was involved in medical school admissions, I would have not have given a high score to someone with poor interpersonal skills. Second, why are the students’ teachers not modeling communication skills?

So first I heard about the extraordinary manner of the primary care physician. Then it was the self-congratulation that accompanied the announcement that students were going to be taught how to speak to people.

And then this.

A study in the Archives of Internal Medicine that left me shaking my head.

The researchers from Northwestern University's Feinberg School of Medicine found that Doctors do not address patients by name in half of first-time visits, even though nearly all patients want this common courtesy.   

There has been research on what doctors should wear but little about how they should greet patients or what patients actually expect. Most good physicians have relied upon empathy and common sense to guide them. This study focused on finding out what patients think is an appropriate greeting. He also analyzed a sample of interactions between doctors and patients during first-time visits.

The researchers collected information from 415 phone surveys in which people were asked how they expect to be greeted by a doctor. Researchers also viewed and analyzed more than 120 videos of primary care visits in which the doctor and patient met for the first time.

They found that 78 percent of survey respondents wanted the physician to shake their hands. Nearly all patients wanted to be greeted by name, including 50 percent by their first name, 17 percent by their last name and 24 percent by both their first and last name. Most patients, about 56 percent, wanted physicians to introduce themselves using first and last names, while 33 percent expected last name and 7 percent expected first name.

The researchers found a striking difference between expectations voiced in the phone surveys and the actual interaction between doctors and patients in the videos. While 83 percent of doctors shook hands in the videos, only half addressed the patient by name. 

Obviously everyone has their own communication style, but the researchers recommend that doctors should incorporate a greeting strategy that uses first and last names for both doctor and patient. Doctors also should plan to shake a patient's hand, but need to be sensitive to body language or other nonverbal cues that may indicate whether a patient does not want to or is not physically able to reciprocate or respond.

How we use names or handshakes will also change over time.

Why does this business of doctor-patient communication matter so much?

It is not simply a point of courtesy, though that would not go amiss. The real issue is that relationships are the heart of healing. Relationships might not be so important to the person performing some technical service, but for healing they are essential. If I need to get my car fixed, it is nice if the mechanic wants to talk, but it is not essential. He can treat my car as the hunk of metal and moving parts that it is.

But healing is different from treatment. Healing demands a relationship, intention and a shared vision. An interaction that will create something that is greater than the sum of the parts. A polite, personal greeting creates a first impression that can affect the chance of developing a therapeutic relationship. Ignoring the normal rules of social interaction sets the tone for everything that comes afterwards. It is respectful to use a person’s name and on a purely practical level, helps ensure that you are seeing the right person! More than once I have been given the wrong chart before meeting a person for the first time.

Interestingly, accrediting organization quite rightly emphasize that communication is a critical skill for physicians. Sadly many medical schools put such a huge emphasis on academic attainments that some people enter the medical profession without natural communication skills, and their training does little to help them get better at it. But this skill may not come naturally to all doctors, so it's important to offer guidance on different aspects of communication such as greetings

My students will tell you something that I have said a thousand times: “You have spent a lifetime developing people skills. You have learned how to talk to Aunt Mabel, how to feel when you are in a dangerous environment and how to deal with that guy at the bar who is becoming annoying. These are very valuable skills. Why did you check them at the door on the day that you entered medical school?”

One of my mentors once lamented, saying that 90% of medical students would have been better served by a technical college than a medical school, because they had no curiosity, no desire to move the field forward and no wish to engage with the people who came to see them. And that was in England, where there is socialized medicine. I did not want him to be right, but he probably was. In fact he was right about a great many things, which is why he was nominated for the Nobel Prize in Medicine on three occasions.

If medical schools want to turn out healers rather than technicians, then it is clear that medical students and doctors have to be helped to learn basic communication skills.

One of the many reasons that so many holistic therapists and practitioners of Integrated Medicine are popular is that they do understand the importance of good communication. Not because of research, but because that is their natural way of being.

What have your interactions with doctors been like?

How do you like them to greet you?

“True communication is remembering that everything is relationship --- that, regardless of the appearance, no one stands alone."
--Hugh Prather (American Spiritually-oriented Counselor and Writer in the Field of Personal Growth and Relationships)

“Once a human being has arrived on this earth, communication is the largest single factor determining what kinds of relationships he makes with others and what happens to him in the world about him.”
--Virginia Satir (American Family Therapist, 1916-1988)

The Song of the Whales

I suppose that it has something to do when I grew up, but I’ve always been fascinated by animal communications in general and the amazing songs of the whales in general.

A few years ago I was speaking at a conference in Maui, and I stopped speaking and took the assembled throng outside because some migrating whales were coming in very close to shore. Our wait as not in vain: I saw something that I’d only ever seen on documentaries: two adult whales and their calf leaping out of the water in harmony. Later that day someone took me out beyond the surf and had me swim underwater. The whale song was crystal clear, even though some of the whales were now miles away.

A few months ago I wrote about the data suggesting that dolphins call each other by name. Web Mistress Carol has just sent me a report of some research that was published in January by a group from the Scripps Institute of Oceanography in the journal Marine Ecology Progress Series. 

The scientists used harmless tags suctioned to the whales' bodies, to track the whales and found that as they feed they send out calls to let each other know where they are. Each group employs a different sound.

The noises play a similarly important role during mating season when males sing long, low-pitched songs to indicate their reproductive fitness to females. Females select mates based on size and estimate that by evaluating males' songs: Larger males can take in more air and hold notes longer.

A related study, also by Scripps researchers, found that there are distinct "dialects" of whale-speak in different regions of the ocean.

The scientists used acoustic recordings to delineate nine population regions worldwide. They found the whales weren't evenly distributed, though: Populations using a "Type 1" call, for example, live within a narrow band of ocean hugging the North American coast, while whales that use a "Type 4" call are spread over a large swath of the Northern Pacific Ocean.

The second study was published in a recent issue of the Journal of Cetacean Research Management. 

The scientists say the dialect findings could help guide conservation efforts for blue whales, whose numbers dwindled to dangerously low levels before whaling moratoria were enacted: There were once an estimated 200,000 to 300,000 in the Southern Hemisphere, but today that number is closer to 1,000.

Here is a terrific video (just bear with the commercial at the beginning) and an audio file of whale song: Audio: Hear Whales Sing

Video: Starving Whales

I would also like to pay tribute to the Scripps Institute for making the entire article open access.

Of Horses and Hearts

I live on a horse farm, so I see the interactions between horses and between horses and humans almost every day. Horses are extraordinarily sensitive creatures with their own sets of emotions and highly developed sense of propriety. They are also very good barometers for the emotional states of humans. We could not work out why one of the horses at another farm was consistently bratty with one particular rider, until we discovered that she was high on ecstasy. Her “energy” was a mess and it totally confused the horse.

On the other hand, horses are often used therapeutically with emotionally and mentally ill and handicapped children and adults. My old horse - Mr. Black - was a perfect therapy horse: nothing ever fazed him.

There is now some more research demonstrating one of the possible mechanisms by which horses may be able to pick up on a rider’s emotional states.

I have a couple of times mentioned some of the work being done at the Institute of HeartMath in California.

Some of their work is controversial, but most has been quite convincing.

I have for several years now been interested in the phenomenon of Heart Rate Variability (HRV). As the name implies, it is a measurement of the beat-to-beat variation in the heart’s rate. Alteration (primarily reductions) of HRV has been reported to be associated with various pathologic conditions like hypertension, hemorrhagic shock, and septic shock. It has found its role as a predictor of mortality after an acute myocardial infarction. It may also be disturbed in major depressive disorder.

I knew about it from the days that I worked at the National Heart Hospital in London, but Roger Callahan – the discover of Thought Field Therapy (TFT) – has been able to show that TFT is one of the few therapies that can normalize it. We also discussed it in the context of the vagal nerve and compassion.

From a pilot study by the Institute and Dr. Ellen Gehrke from Alliant University  it appears that a horse's heart rhythms reflect their emotional state and can respond to the emotional state of a nearby human. When in contact, a horse's heart rate may mirror a human's emotions, implying a close unspoken form of communication between the two.

The study took place at Dr. Gehrke's ranch in San Diego, where electrocardiogram (ECG) recorders were placed on her and also on four of her horses. All five were monitored during a 24-hour period in which the horses were under a variety of normal conditions and activities such as eating, grooming or being alone. Measurements were also done while they were being ridden and accompanied by Dr. Gehrke.

The ECG recorders projected increased coherent HRV patterns for the horses during times of close, calm contact between them and Dr. Gehrke. Coherent HRV patterns have been shown to be the result of positive emotions and facilitate brain function.

Dr. Gehrke said, "Horses receive information from body language and give feedback. They don't think very much, they feel. They are very emotional and honest. They also have a powerful impact on your sense of self and ability to lead."

I don’t think that cardiac coherence is the whole story. They also respond to micro-movements - small movements of the legs, arms and trunk that are all but imperceptible to humans – and we have seen many of them sense events at long range. I travel a great deal and come home at odd times. But several witnesses saw Mr. Black start to become very excited 20-30 minutes before I would arrive home. In England, Rupert Sheldrake has amassed a considerable body of evidence to support those observations.

Nonetheless, this is very important research and I shall be very interested to see the final version once it has been subject to peer review.

"There is something about the outside of a horse that is good for the inside of a man."
--Sir Winston Churchill (English Statesman, British Prime Minister, 1940-1945 and 1951-1955, and, in 1953, Winner of the Nobel Prize in Literature, 1874-1965)

“A man on a horse is spiritually as well as physically bigger than a man on foot.”
--John Steinbeck (American Writer and, in 1962, Winner of the Nobel Prize in Literature, 1902-1968)

“Wherever man has left his footprint in the long ascent from barbarism to civilization we will find the hoofprint of the horse beside it.”
--John Moore (American Man of Letters and Former Archivist and Librarian for the State of Tennessee, 1858-1929)

“I'd rather have a goddam horse.  A horse is at least human, for God's sake.”
--J.D. Salinger (American Writer, Student of Advaita Vedanta and Recluse, 1919-)

And finally:
"In my opinion, a horse is the animal to have.  Eleven-hundred pounds of raw muscle, power, grace, and sweat between your legs - it's something you just can't get from a pet hamster!"
--Unknown Author

Communicating About Complementary and Alternative Medicine

Two of the key points about Integrated Medicine are transparency and integration of different approaches.

It is true to say that all healing is ultimately self-healing, but at the heart of healing lies relationship: how we communicate with every part of ourselves, with other people and with our health care providers. At the most mundane level, there is published data that if a health care provider has a good relationship with the person coming to them for help, the chance that the person will follow through on a treatment plan is four times higher than if they meet a health care provider who just grunts at them.

There is also a magic that can happen in strong, dynamic relationships based on partnership rather than dominance: one of the themes of Healing, Meaning and Purpose.

It worried, but did not surprise me to see a study released today.

Most Americans age 50 and older use complementary and alternative medicine (CAM), such as supplements, herbal products or acupuncture. The trouble is that - according to a survey conducted by AARP and the National Center for Complementary and Alternative Medicine - they often do not tell their doctors or nurses.

It is very much in person's best interests to tell their doctor about the CAMs that they are taking because some unorthodox medicines may interfere with over-the-counter medications, prescription drugs, or other conventional medical approaches. See here for an example of some herbal remedies and supplements that may interact with psychotropic medicines.

As the report says, "Communication between patients and physicians about CAM and conventional therapies is vital to ensuring safe, integrated use of all health care approaches."

It goes on to say something that we have been preaching for years: an open dialog "allows patients and physicians the opportunity to identify CAM practices that might be beneficial and also minimizes risks to a patient from potential therapy interactions."

Among a total of 1,559 individuals age 50 and older surveyed in the spring of 2006, 63 percent reported having used one or more CAM therapies.

According to the survey - which can be found here - people between the ages of 50 and 59 are the most likely to report CAM use.

Forty-five percent of CAM enthusiasts used massage therapy, chiropractic manipulation or other bodywork; 42 percent used herbal or dietary supplements; 15 percent used mind/body practices, including hypnosis and meditation; 14 percent used naturopathy, acupuncture, or homeopathy; and 10 percent had tried energy therapies.

Sixty-six percent of CAM users said they did so to treat a specific health problem; 65 percent for overall wellness; 45 percent to supplement conventional medicine; and 42 percent to prevent illness.

Sixty-nine percent of those who reported using CAM had not discussed it with a doctor.

The intersting qustion is, "Why?"

Forty-two percent said because their doctor never asked; 30 percent said they did not know they should; 19 percent felt there was not enough time during the office visit; 17 percent didn't think the doctor would know about the topic; and 12 percent thought the doctor would be dismissive or tell them not to use CAM.

Women were more likely than men to have discussed CAM use with their doctor (26 percent vs 16 percent) and those younger than age 65 were more likely to discuss CAM use than were older individuals.

The report concludes that "patients need to mention CAM use to their physicians and physicians need to ask about it."

Life is Information at Work

“Information is "a difference that makes a difference.”
--Gregory Bateson (English Anthropologist, Social Scientist, Linguist, Cybernetician and Writer, 1904-1980)

Much of the work in which we’ve been engaged needs us to look very hard at what is life? Is it simply a collection of biochemical reactions glowing in the dark, or is it something more complex, laden in meaning and purpose. This is not an academic exercise: unless and until we can better understand the fundamental processes of life, it is difficult to advance the practice of medicine and the processes of health and wellness.

A fundamental tenet of Healing, Meaning and Purpose is that we live in a non-dual Universe, of which consciousness, information and energy are the primary manifestations and principles. I present a great deal of solid scientific material that you can use immediately. It’s all based on the fundamental concept that illness is caused by degradation in the storehouse of information that sustains the body.

Comprehensive treatment and persistent robust physical, psychological, social, subtle and spiritual health is rooted in clear, harmonious, integrated information. And that is why physical treatments – sometimes including medications – may be an essential component of helping someone get well, but is nonetheless just one piece of the puzzle. It is essential also to ensure that the information and communication between each aspect of a person and his or her environment are also clear, harmonious and integrated. Without those other pieces, we may be doing no more than putting a band aid on a problem.

Valentino Braitenberg the former director at the Max Planck Institute for Biological Cybernetics in Tübingen, Germany, has always had some interesting things to say. He is a truly original thinker who’s also, IMHO, a fine human being.

I recently came across this in his last book, Das Bild der Welt im Kopf: Eine Naturgeschichte des Geistes, published in 2003 by LIT Verlag, Munster:

“Living organisms contain information, are the result of information, pass on information, and information made flesh in the conditions that their environmental niches impose for survival. To read this information is to recognize the very essence of a living organism.”

I think that this is the most succinct summary of what is to be a living organism. Yes, of course, you are made up of atoms and molecules. But the key point is that you are maintained by a constantly flowing river of information. Without it your body, your mind, your relationships and your spiritual essence would cease to flow.

Any treatment worth its salt will always be directed toward correcting and modulating and integrating this flow of information.

Anything less, and we are simply moving around the deckchairs on the Titanic.

“The original root of the word "information" is the Latin word informare, which means to fashion, shape, or create, to give form to. Information is an idea that has been given a form, such as the spoken or written word. It is a means of representing an image or thought so that it can be communicated from one mind to another rather than worrying about all the information afloat in the world, we must ask ourselves what matters to us, what do we want to know. It's having ideas and learning to deal with issues that is important, not accumulating lots and lots of data.”
--Theodore Roszak (American Social Thinker, Critic and Writer, 1933-)

“Man must go back to nature for information.”
--Thomas Paine (English-born American Political Theorist and Writer, 1737-1809)

Integrated Medicine and Cancer

There's a very interesting and important piece of research from the School of Social Work at the University of South Florida in Tampa.

The title of the paper is “Patient-physician communication regarding use of complementary therapies during cancer treatment,” and it discusses something with which I’ve been very involved for many years.

The paper uses the terms “complementary and alternative medicine,” though the same principles apply to the far more sophisticated and comprehensive approaches of Integrated Medicine.

Studies from the United Kingdom, Germany, Holland, France and the United States have estimated that as many as 80% of adult cancer patients use at least one form of Complementary and Alternative Medicine (CAM) during or after conventional treatment. I’ve discussed before the pitfalls of trying to use unorthodox medicine in place of conventional medicine. In Europe some of the practices of Integrated Medicine, particularly acupuncture, homeopathy and massage, are used to help people cope with the rigors of chemotherapy and radiation therapy, rather than to treat the tumors themselves. Many people claim that they can use homeopathy or some herbal remedies as the sole treatment for different types of cancer. But I won’t endorse them unless they can show me some data.

We already know that patients frequently do not tell their oncologists about their use of unorthodox medicines and physicians consistently underestimate the numbers of their patients using them. The purpose of this study was to assess newly diagnosed cancer patients' and oncologists' communications with regard to unorthodox medicines. They looked at people with two types of cancer: 106 had breast cancer and 82 had prostate cancer. All the patients in the study were receiving regular conventional medical treatment.

In line with previous research, 84% reported that they were using at least one unorthodox therapy. The most popular were exercise, vitamins, prayer, and nutritional supplements.

But here was the surprise for the investigators: The oncologists surveyed were generally enthusiastic and supportive of patients' use of these therapies. In addition to those therapies popular with patients, at least half the physicians supported massage, journal writing, support groups, acupuncture, biofeedback, and art therapy.

This was no surprise to me at all. I spent most of my clinical career in tertiary referral centers, and I’ve worked with the best of the best. The vast majority was extremely supportive of anything that would help. Every one of them was a skeptic who would say, “show me.” But once they had been shown, they would be very helpful. After all, who doesn’t want to help people get better?

It has always been so noticeable that the biggest critics, not skeptics, but critics, have been people who were less secure. Often not the “Best of the best,” they would carp and complain that “we don’t do things that way,” and “I don’t see how it could work, so I’m sure that it doesn’t.”

What this new piece of research showed was that discussions the use of unorthodox medicine were relatively rare and were most likely to be initiated by the patients. When the topic was discussed, both patients and doctors said that it usually enhanced their relationship.

What do I take away from this study?

If you, a friend or loved one has cancer, or any other type of illness for that matter, consider using something else in addition to your regular medical care. Not as a replacement, but in addition. The regular treatment will be helping the physical side of the illness, but you also need help with the psychological, social, subtle and spiritual aspects of what is going on in your life.

And guess what? Chances are that if you have a good oncologist, or any other type of conventional clinician working with you, he or she will probably be very supportive of anything that you do.

I once said at a very large meeting that if I needed to put a bone through my nose and do a dance to get someone better, I’d do it.

And I’m not the only one.

What Integrated Medicine does is to put all the cards on the table from the very beginning. We tell people that we are going to be helping guide them toward physical, psychological, social, subtle and spiritual health. They need to be able to derive meaning and purpose from what’s happened to them, rather than just cussing at their misfortune.

And then using the experience to grow as individuals and to help others.

The Integrated Practitioner will also be working with the way in which this person’s challenge is changing them. If a practitioner is not changed by the person in front of him or her, they are working only as a technician and not as a healer.

There’s nothing wrong with that, but everyone needs to be clear about what the practitioner is bringing to the table, and what their expectation is for the person who has come to see them with a problem.

For now, if you are not working with an Integrated Practitioner, do tell your health care provider if your are doing something else to help yourself.

Chances are that he or she will be very supportive.

Clarity of Communication

One of the major reasons for the failure of relationships or of businesses is a failure to communicate clearly. There are also powerful reasons for thinking that much ill health is rooted in “blockages:” inadequate communication between your body, your mind, your emotions, subtle systems and spirituality.

Any communication consists of ten essential components:

1. The integrity and mental state of the sender
2. The intent of the sender
3. The expectation of the sender
4. The information
5. The medium
6. The context
7. The receiver
8. The mental state of the receiver
9. The reaction or response of the receiver
10. The meta-text and meta-communication of the exchange

Naturally, in a healthy communication, everyone involved takes turns being the sender and the receiver, and this interaction between you creates the overall message. I must be very clear that I’m not just talking about verbal communication, but also physical and intimate interactions, business and family discourses.

I’d also like to take the whole notion of communication a step further: meaningful communication needs for us to be consciously aware of the interaction, and we should see it not just as an exchange of information, but of energy. A charismatic individual may communicate a lot more than mere words and his or her impact may last long after the words have been forgotten. On the other hand, there is actually a technical term – phatic communion - for empty language that is purely used for social lubrication: “How are you?” “You’re welcome,” “Have a nice day.”

It really is important to be aware of all of these components of communication. A problem in any one of them can make a mess of any attempt for people to connect. Too often I see people think only of the sender, the message and the recipient, without realizing that it is the other aspects of communication that are the keys to success or failure. This is often very important in therapy: people may ruminate on something said to them, when they should be considering the context of whatever was said.

Meta-text and meta-communication refer to the whole spectrum of other components of our interactions that stretch beyond the message itself. These include the types of language that we use as well as prosodic cues. And if people are in close proximity, body language and gesture. You may well know that it is possible to tell a great deal about someone’s intentions by studying changes in the tone of their facial muscles, changes in the color of their skin and the directions I which they move their eyes when speaking. How we use certain words to fill in our communication can be as important as the main body of a communication. Something that we do all the time is to try to understand the underlying meaning or meta-text, that is often quite different form the actual words being spoken.

Whether dealing with an individual in therapy or a business that wants to perform better, there is a series of critical questions that will uncover communication problems:

1. Do you have any communication problems?
2. Who is responsible for it?
3. Is there a disconnection between the mental state of any message sender and the message itself?
4. Does the sender have a clear purpose in communicating?
5. Are people able to understand the sender? (T.E. Lawrence (of Arabia fame) was said to have one of the largest vocabularies at the University of Oxford. So large that many people didn’t have a clue what he was talking about!)
6. Is information being communicated appropriately?
7. Is the environment conducive to communication?
8. What is interfering with communication?
9. How long has this been a problem?
10. Why has the problem not been solved?

If there is a communication problem, consider starting from scratch:

1. Any communication contains information and energy: are they both clear and pure?
2. Is there congruence between what is being communicated and the intent of the communicator?
3. Is there a culture of integrity in communications?
4. Are people striving for the greater good or personal aggrandizement?
5. What people, policies or procedures are interfering with communication?
6. How are communications becoming degraded?
7. What and who's emotions are interfering with the informatyion and the energy of any communications?
8. What might lead to the misunderstanding of a message?
9. What systems are in place to ensure that communications are being received and understood correctly?
10. What system of questioning is in place?

Once we understand each of the phases of communication, and that it is a dynamic exchange of energy and not just information transfer. And that ANY message or communication is subject to degradation, and that there are ways to check for and correct it, you are well on your way to abolishing many of the problems that can wreck relationships, capsize companies and ruin a therapeutic alliance.

“Once a human being has arrived on this earth, communication is the largest single factor determining what kinds of relationships he makes with others and what happens to him in the world about him.”
-- Virginia Satir (American Family Therapist, 1916-1988)

“Skill in the art of communication is crucial to a leader's success. He can accomplish nothing unless he can communicate effectively.”
-- Norman Allen (American Playwright, Recipient of a Charles MacArthur Award for Outstanding New Play)

“A world community can exist only with world communication, which means something more than extensive shortwave facilities scattered about the globe. It means common understanding, a common tradition, common ideas, and common ideals.”
--Robert M. Hutchins (American Educator, and, from 1929-1945, President of the University of Chicago, 1899-1977)

Cultural Competence

One of the problems about so many self-help articles is not only that their authors have often not done their homework, neglecting research and sometimes ignoring the dictates of common sense, but they also tend to be culturally myopic.

I’ve spent a great deal of time in different cultures and some of the advice proffered by a few American business experts would quickly get you shown the door in Japan or Germany!

I’ve just learned that Wal-Mart is pulling out of Germany, writing off a loss of around $1 billion. Part of the problem was that this super successful American company failed to understand German culture. It attempted to introduce the “greeters,” that are a familiar sight in the United States. Germans found it offensive to be confronted by someone ordered to smile at every customer. To a German, a broad toothy grin may be seen as intrusive and an invasion of privacy.

My personal background, extensive travels and work with people from every corner of the world, have made me very sensitive to these differences, and I’m often asked for advice before people head off to do teach, speak or to do business overseas. I was very pleased to find out about a company that specializes in training executives to be culturally competent, and one of the tools that they use is cultural profiling.

I just read an excellent article in the Telegraph by Michael Gates, in which he describes a moment in Finland, when he asked someone how they were, to get the response, “You asked me that last week.” Ask a German how they are, and they will probably spend the next ten minutes telling you.

Different cultures have very different ideas and attitudes toward time, space, truth, privacy, authority, individuality, and, of course, gender. The glass ceiling is still alive and well in many cultures. Children are raised quite differently in different cultures: I knew a British doctor working in the pharmaceutical industry. Her company sent her to the United States for three years, but in less than two she and her family were back in England: she did not like the effects of American education on her children.

The Expat Telegraph website has also launched a series of “National Cultural Profiles.” This is a terrific resource to help us understand the thinking patterns of the world’s major cultures. The resource has been taken from the CultureActive cultural web program that is used throughout the world by governments, non-governmental organizations and corporations. It is also the core of a project (InterCulturalEdge) based at Duke University's Fuqua Business School in North Carolina.

CultureActive is based on the work of Richard D. Lewis, the author of When Cultures Collide, a book that I recommend highly. He is the chairman of Richard Lewis Communications. Lewis has developed a theory, known as the Lewis Model of Culture. He classifies cultures into three main types:

1. Linear-active
2. Multi-active
3. Reactive

These National Cultural Profiles are different from typical country profiles that you find in the Encyclopedia Britannica or the CIA website that detail economic or political data. These profiles concentrate on key cultural questions such as values, beliefs and communication.

There are free mini-introductions available at the Expat Telegraph website, and there are much more detailed profiles available for subscribers.

CultureActive also allows you to complete your own Personal Cultural Profile by filling in an online questionnaire.

Learning how to communicate with people from different cultures is essential if you hope to expand your own personal horizons, as well as developing your business.

“Civilization is the order and freedom promoting cultural activity.”
--Will Durant (American Historian, 1885-1981)

English Cows Have "Regional Accents"

I once knew a man from the county of Yorkshire who could identify whereabouts in the county a fellow Yorkshireman came from: he was usually able to pinpoint people within eight miles of the place where they were raised.

I've never had quite that facility, but it still surprises American friends that I can tell them almost exactly which part of England someone has come from. And I'm not bad with most European accents.

Now if a report from the BBC is to be believed, English cows have regional accents. Picked up, perhaps, by spending a great deal of time with their humans. Listen to the audio and see what you think.

Birds pick up local variations in their songs, and our two Irish horses certainly seem to have different "accents" from their American-born bretheren.

Is this human projection or animal learning?

I'm pretty sure that it's the latter.

What more do we need to learn about the abilities of animals before we realize that they are very far from being "dumb???"

Friendship and Psychological Distress

“To lose a friend is the greatest of all losses.”
Publilius Syrus (Syrian-born Latin Writer, 1st Century B.C.E.)

Severe and persistent mental illnesses are one thing, but there are many, many more people who are miserable and unhappy, without that unhappiness necessarily getting to the level of an “illness.” The offices of primary care physicians and therapists are full of people in genuine distress for all kinds of reasons.

I first began to think about this many years ago when a woman came to see me and promptly announced, “I’ve come for psychotherapy. I’ve been in therapy for seventeen years, and I want some more.” I wasn’t being in the slightest bit flippant when I responded by asking her if, after seventeen years, she really felt that it had offered her anything? She looked at me blankly, and it soon became very clear that what she needed was not more therapy, but a friend to talk to.

There has been another puzzle: why is it that women are more likely to develop depression than men? The most profound gender difference in mood disorders begins to emerge after puberty, so it would be easy to attribute it all to hormones. But that would be a mistake.

I recently pointed out that there are some fundamental differences in the ways in which men and women interact: women tending to be more relational and men tending to be more transactional. The female sense of self tends to be more entangled with her relationships, while a man’s self-worth and sense of self is more often associated with his achievements. Most of these differences begin to emerge in early puberty: when girls talk to their friends, their conversation tends to be more emotional and to be concerned primarily with relationships, while boys tend to be more reserved and to discuss facts, statistics and achievements. There is some evidence from research in different cultures that these different styles seem to be the norm throughout the world. Yes, there are of course plenty of people of both genders who behave differently, and so it is more accurate to relate these differences to the male and female factor or essence, rather than getting it confused with anatomical differences.

Emotional language tends to put more strain on a relationship, and it is well-recognized that girls’ relationships turn over much more rapidly than boys’ ones. An interesting hypothesis proposed some years ago by Professor Sir David Goldberg, is that this high turnover in relationships may lead girls to experience more disappointing experiences in their social networks, and it is this string of disappointments that predisposes young women to depression.

A happy, healthy, dynamic network of friends is a cornerstone of developing and maintaining psychological resilience. Without them you become progressively more vulnerable to the reversals that affect all of us from time to time.

“A friend might well be reckoned the masterpiece of nature.”
--Ralph Waldo Emerson (American Poet and Essayist, 1803-1882)

“To know how to live in a brotherly way with those around us is to be rich, for each of us, with our face, eyes, voice and thoughts, contributes something alive, something warm, which nourishes everyone.”
Omraam Mikhaël Aïvanhov (Bulgarian Spiritual Master, 1900-1986)

Gender, Culture and Communication

Regular readers will know that I’m very interested in gender differences. More and more evidence is confirming what most of us have always known: men and women tend to think and behave differently. Some of the differences are clearly neurological and some social. It is sometimes difficult to sort out which is more important: some research findings on gender differences have produced mixed results because of some of the assumptions of male investigators!

But notice that I emphasize the word “tend” to think differently. We are always dealing with statistical differences. My Y-chromosome should enable me to navigate from A to B without difficulty. In fact, I am seriously directionally challenged: I should probably have a GPS system with me when I go down to the shops!

I have spoken about my admiration for the work of Deborah Tannen, and I have also written about Christina Robb’s marvelous book, in which she charts the development of new insights into gender differences in psychology.

This weekend I was at the annual meeting of the National Speakers Association in Orlando, and I learned something very interesting that fits in with all of our previous discussions. I learned it from one of the speakers, named Julia Hubbel. I already knew that women tend to be more relational in their interactions and men are more transactional. Most women tend to spend a lot more time on the maintenance and development of relationships and most men are more interested in the bottom line: What is the solution? What’s the deal going to be? What I did not know is that there is some data to indicate that non-White males tend also to emphasize relationships over transaction. As soon as I heard that, I was sure that it was right: I have had a lot of dealings with people from the Indian subcontinent, and most would consider it very rude to get straight down to business before we had taken tea or eaten something while discussing family and other personal matters. Julia teaches networking skills that integrate gender and ethnic considerations.

As she was explaining her insights and methods, I was reminded of the work of the anthropologist and cross-cultural researcher Edward T. Hall, who wrote a series of excellent books on cultural factors and thought.

Gender and cultural differences in communication are of such importance that I plan to return to the topic in the near future. In the meantime, you might be interested in a book by Richard Nisbett, entitled The Geography of Thought: How Asians and Westerners Think Differently and Why. After multiple trips to Japan, during which I learned a lot about cultural differences, I gave a copy to a friend who is a Canadian in a senior management position in the Japanese affiliate of a US-based company. He told me that he was astonished by the accuracy of the insights.

Some of the political misunderstandings that you see on the news every morning are often a consequence of different thinking styles. Learning how men and women and people in different cultures think and operate is not just interesting.

It is essential.

“Skill in the art of communication is crucial to a leader's success. He can accomplish nothing unless he can communicate effectively.”
-- Norman Allen (American Playwright, Recipient of a Charles MacArthur Award for Outstanding New Play)

Technorati tags: Communication Gender differences Deborah Tannen Cross-cultural communication

The Canine Gandhi: Cats, Dogs and Interspecies Communication

“Thousands of years ago, cats were worshipped as gods. 
Cats have never forgotten this.”
--Unknown Author

I need to tell you about something remarkable, that, if you think about it, has amazing implications.

We have a new little kitten. An eight-week-old little girl, and already a brave explorer who wants to play with everyone. Interestingly, she is already strongly right-handed. (Yes there is clear evidence of handedness in most mammals, and even some fish. But in cats, dogs and horses it’s not always clear until they are a little older than this.)

The other cats are not best pleased by this turn of events. After all this is their house, even if they do have to put up with the occasional human and a large mobile rug called Shannon. Shannon is an enormous dog of questionable pedigree but extremely calm disposition, who just hates any kind of noise or commotion: she is the original gentle giant.

The humans in the house are tolerated only because they are the suppliers of food, treats and comfy laps.

After all, as an unknown author once pointed out,
“Dogs have owners. Cats have staff.”

Little kitten thought that with Shannon fast asleep on the floor, it would be fun to play with another cat called Hannah. Now Hannah’s an older and very dominant cat who survived in the wild for a year. She didn’t take kindly to the small ball of fluff skipping toward her. Little kitten did not have the wit to understand that Hannah’s taut, crouched posture and narrowed eyes were not an invitation to a game, but preparation for the pounce that would quickly generate a kitten-shaped snack. We were about to intervene when something remarkable happened.

Shannon, who had been busily stacking ZZZZZs, got up shambled forward and put her enormous head between cat and kitten. No sound was made. She didn’t look at either of the protagonists. She was just like a great big bouncer getting between a couple of drunks in a bar.

She just stood there, unmoving and implacable. Like the Black Knight in Monty Python and the Holy Grail, "You shall not pass!"

After a few moments the kitten realized that there’d be no way through, and went off in search of one of her toys. And Hannah cat saw that kitten tartar was off the menu. She slunk off to go and groom herself.

With which Shannon went back to her spot, lay down and promptly fell asleep again. She was soon back to a dream that involved a lot of running.

There can be absolutely no doubt about Shannon’s intent. She wanted to keep the peace, and she woke from sleep to do so. It’s not the first time that she’s protected the cats from harm.

Late at night a couple of weeks ago, we couldn’t get her to come in the house. She kept running back outside and growling. Very odd for a sweet natured creature who normally always comes running when called. It was only when I went outside for a third time that I realized that I’d been a bit slow. A few feet away was a large feral cat that we’d not seen before. He had Hannah cornered against a pillar and Shannon was trying to protect Hannah and chase the away the interloper.

As soon as the dumb humans got out of the way, Shannon saw the gatecrasher off the premises and escorted Hannah back into the house.

These can’t be unique examples of inter-species communication. Do you have either anecdotes or research to share?

“Always remember, a cat looks down on man, a dog looks up to man, but a pig will look man right in the eye and see his equal.”
--Sir Winston Churchill (English Statesman, British Prime Minister, 1940-1945 and 1951-1955, and, in 1953, Winner of the Nobel Prize in Literature, 1874-1965)

Technorati tags: Animal communication Interspecies communication Dogs Cats Compassion

Blogging and the Tipping Point

The blogging phenomenon is well under five years old, though many of us were communicating online long before that. The question for many of us has been whether blogging is just going to remain a kind of online graffiti or political sounding board which will eventually go the way of the dodo, or whether it has now reached a level of maturity where it will be an important social, business and educational phenomenon?

Have we reached the Tipping Point? This forty-year-old term refers to a dramatic moment in time and space when something unique becomes common. The term was popularized and applied to daily life by Malcolm Gladwell in his book of the same name.

You will remember the impact of bloggers during the last Presidential election campaign, but some skeptics thought that was just a flash in the pan.

Several recent items have convinced me that blogs are indeed beginning to have a significant impact:
1.    A white paper published by Market Sentinel, Onalytica and Immediate Future in December 2005 discussed the impact of bloggers on corporate reputation, after one individual named Jeff Jarvis had a significant negative impact on Dell Computers after relating his bad customer experience.
2.    In April 2006, Custom Communications organized an event – I thin the first of its kind - on Blogging4Business. The aim was to discuss how blogs could potentially damage a brand.
3.    In May of this year, traditional news producers, aggregators and distributors gathered at the We Media Global Forum to discuss the future of news in the light of the growth of blogging and what is becoming known as citizen journalism.
4.    The Internet is moving rapidly from being a read-only or buy-only medium to an organic, participatory, interconnected and collaborative network. Just look at the burgeoning popularity not just of blogs, but also of sites like MySpace.com and the energy and eagerness that is creating Wikipedia.
5.    The Internet is rapidly becoming a web of producers who are customizing their interaction, rather than passive consumers.

The BBC ran a nice discussion on some of the dynamics of what is now occurring.

How do you see all this developing?

Technorati tags: Blogs Blogging Tipping point Malcolm Gladwell

Historical Amnesia

“Those who cannot remember the past are condemned to repeat it.”
--George Santayana (Spanish-born American Philosopher, Humanist and Poet, 1863-1952)

For a long time now I have been convinced that one of the many reasons for the social dislocation in much of the developed world is that we have lost our memory. If we do not remember who we are, what we are, where we came from or where we are going, we are doomed to a life of perplexity and confusion. Have you ever felt that there is something about you, some skill, some knowledge, some hidden fact that is there just beyond the horizon, but that you cannot quite grasp? That feeling can be very disorientating and anxiety provoking.

We need to remember our history, and the insights of the geniuses who came before us will help us to understand and to frame the chaos of our lives.

I was thrilled to read a piece by Richard Stengel, the new Managing Editor of Time magazine, in which he laments the epidemic of historical illiteracy that threatens every aspect of our lives. As he points out, being an American is not based upon ancestry or geography, but an acceptance of the ideas of who we are. A few years ago, a survey of Americans aged 18-49 found that only 10% could name the president who ordered the dropping of the atomic bombs on Japan. At the time of the study, I was having lunch with a group of faculty at a major Ivy League university, and one of the assembled company  - a very good clinician and researcher – responded to the results by saying, “Who cares who did?” We all need to care for these major events provide a context and a framework for us to understand our place in the world, and who we are as a people and as a nation. As Thomas Jefferson, our 3rd president said: “If a nation expects to be ignorant and free, in a state of civilization, it expects what never was and never will be.” Historical illiteracy is a threat to democracy and may lead us to repeat mistakes.

I have spent years working on a series of antidotes to this historical amnesia. As one part of this effort, I have developed a database of quotations. Not cute sayings, but insights, comments and revelations that mean something and can transform our lives. As I said in the introduction to my book Words of Power:
“This book has been created over thousands of years and by thousands of minds. You will find here the fruits of many lifetimes of contemplation and study. From the marble halls of ancient Greece, to the steamy ashrams of India; from the sacred groves of the American Natives, and from the medicine huts of Africa right up to the startling insights of mystics and scientists walking amongst us today.”

Knowing what someone said is valuable, but only half of the equation. We are evolving as a species. If you met a persons from a thousand years ago, they might appear quite dull: our thoughts, beliefs and perceptions are also the fruits of the times and places where we live. It is good to know who said something, and essential to know when and where it was said. As in any conversation, the words are only a small part of a communication: context is key.

For many years now, I have strongly suggested that people interested in personal development should spend just a few minutes a day with a classic maxim or quotation.

If you are interested in quotations, I have well over 27,000 in my database, and I would be very happy to post some of them.

Technorati tags: Social dislocation Quotations Memory Historical illiteracy

Dolphins Have Names

It seems that not a day goes by without new research breaking down the barriers between humans and many of the other species that share our planet. I have reported on the burgeoning research into emotional expression in animals. No surprise to anyone who spends much time interacting with them, but a shock to some of my more conservative colleagues. Within the last ten years I have spoken to countless psychologists clinging to the notion that animals are just bundles of reflexes designed to protect them and allow them to reproduce.

The evidence for complex communication patterns in dolphin has long fascinated me. This was triggered in part by the work of the late John Lilly. One of my mentors in neurology was firmly of the opinion that it was impossible because they did not have the right neurological machinery. It seems that he was wrong. There is an extraordinary new report picked up by the BBC and the National Geographic  from a team of scientists based at St Andrews University in Scotland: the same place that Prince William attended for four years. In a three-year-study  of wild dolphins, conducted in Sarasota Bay off Florida's west coast and funded by the Royal Society of London, they found that dolphins communicate like humans by calling each other by "name.” Using whistles, these mammals are able to recognize themselves and other members of the same species as individuals with separate identities. They have labels for each other just as we do.

This is important not just because of the implication that they have evolved some of the same abilities that we have, but because it likely means that they have a sense of self and of identity and that they able to differentiate each other as individuals.

I was talking about these findings with She Who Must Be Obeyed, and she pointed out that our horses appear to be able to do the same thing: if you watch them closely they have different calls for attracting each other’s attention, and these calls are different when they are at home or when they are in competition. Two of the horses are constantly going to competitions together, and after they have done well, they have a new repertoire of sounds with which they communicate with each other, and yet others with which they communicate with other horses. For people not used to being around these animals, they always assume that we are simply anthropomorphizing. But I don’t think so: it really seems that they call to each other in a precise and predictable way after they have done their jobs well. We have often said that they are bragging: perhaps we’re not so far from the truth.

Technorati tags: dolphins communication horse communication self

The Naked Ape

When I am looking for new articles to analyze for you, gentle reader, I am very fortunate that Carol Kirshner, my web mistress (is that the politically correct term??), is also a researcher, and she does a great job of finding new items that are relevant to our basic themes. But sometimes I wonder if she is kidding me, as happened when she pulled up an article with the enticing title: “All the better to see you blush, my dear...”

Researchers from the California Institute of Technology just published a study in the Journal Biology Letters in which years of painstaking neurophysiological research lead them to speculate that the reason that primates evolved complex color vision was not, as previously thought, so that they could find the most tasty ripe fruit, but so that they could detect a blush on someone else’s face or, ahem, their posterior.

The main color sensing cells in the retina are the rods and cones, and it turns out that the cones are exquisitely sensitive to skin tones. The trouble with the old theory about color vision and fruit is that there has never been much evidence for it, and as someone who lives with horses, I know that they have some quite sophisticated color vision, yet are more than happy to munch away on grass.

This new study shows that primates have three-color vision, and the system seems extremely well adapted to pick up colors that are prevalent in the skin, in particular the amount of oxygenated hemoglobin in the blood. This three-color recognition system can signal a primate if a potential partner might be having a rush of emotion in anticipation of mating. It might also be the mechanism for telling if an enemy’s blood has drained out his face because of fear. And rosy cheeks, like smooth skin, are subconscious signs of health and vitality in a potential mate.

As the principle investigator - Mark Changizi - points out; old-world primates are all unique in that they have bare faces and bare posteriors. After all, there’s not much point in being able to see miniscule changes in skin color if the key areas are all covered up. So there seems to have been some co-evolution of the ability to see color modulations in the skin and the loss of fur.

Could this be the real reason for humans being the “Naked Ape?”

And I think that I shall leave it for you to consider all the implications of hiding a signaling system that has evolved over millions of years…

Technorati tags: evolution, Science,

Online Therapy

There is a very interesting article in Newsweek that talks about the growing trend to offer psychotherapy online. The article highlights the main reasons for this new development: convenience, anonymity and low prices. Without the overhead of running an office, internet therapy is roughly half the price of a regular office visit.

I was initially rather skeptical about the potential effectiveness of internet therapy: any experienced therapist will tell you of the amount of non-verbal material which is used during a session. Body language is a potent indicator of internal psychological states, and there is often a meta-text in communication, that can be difficult to pick up if you are not in the room with someone. And good therapy requires a lot of intuition. But on the other hand, there are times when people will open up when they do not see another person. It is one of the reasons that psychoanalysts used to use a couch, with the therapist out of sight of the patient.

So I have reviewed the research literature on the use of the internet for psychotherapy for an array of conditions, including addictions, and found over 190 studies, at least a third of which were reports of well conducted studies. Although it is still early days, and most of the research studies are small, the results are almost all positive. Clearly we cannot use the internet for trying to treat people with severe or life threatening problems, but for many of the problems which create such difficulties in many peoples’ lives, I think that this is a very positive development. So much so, that I am currently considering setting up an online service myself. I would be interested to hear of other people’s experiences of online services, and whether they would like me to offer one myself.

Technorati: More blogs about Online therapy.

Stressful Marriages Can be Damaging to Your Health

There is an extremely interesting article in the month’s Archives of General Psychiatry, which was picked up by the media that examined how marital stress effects healing.

Most people now accept that the mind has powerful effects on the body, though as recently as the 1970s this was still regarded as rank heresy by many in the medical community. This new study is important for our understanding of the relationship between stress and physical health, and gives us further insights into how we can help ourselves stay well.

The study was done at Ohio State University and examines 42 married couples. Each person was given small skin lesions, and the startling finding was that in hostile couples, the wounds healed 60% more slowly than they did in non-hostile couples. The investigators even identified an inflammatory mediator called interleukin-6 (IL-6), as the biochemical link between hostility and slow wound healing. IL-6 levels are linked to long-term inflammation, which is in turn implicated in a number of illnesses, including diabetes mellitus, arthritis and cardiovascular disease.

A thirty-minute disagreement with a spouse could push back wound healing for 24 hours. The skin is the largest organ in the body and is exquisitely sensitive to stress: just thing of blushing and getting zits when under stress. So it is difficult to extrapolate from these findings in the skin, to try and predict what would happen with healing of internal organs. But we do have enough information already to say the following:

1. Allowing yourself to become involved in an argument may have long-term physical effects on you.

2. Some years ago I worked with a group of fine people who did just one thing that I did not like: they were wedded to the idea that it is a really good idea to vent your feelings. They would go as far as allowing patients to hit walls and other inanimate objects. I was never keen on this, feeling that expressing a lot of negative emotion could be counter-productive. After a patient broke bones in his hand after striking the wall, I quietly put an end to the practice. This new research indicates that I was correct to do so.

3. If you are going to have surgery, it is a good idea to be in a calm and peaceful frame of mind.

4. Stress is often unpredictable so it is a really good idea to be engaged in some ongoing stress management practice, so that you are better able to deal with the "slings and arrows of outrageous fortune," as Shakespeare put it over four hundred years ago. Clearly this doesn’t mean that you have to walk around like a burned out hippy on Quaaludes. Unless you really want to…. The best techniques that I know of for dealing with stress are the Sixty Second Peace Technique, Qigong and Yoga Breathing. If you have your own method, then stick with it. Otherwise you may want to check out some of the materials that I have written and recorded.

Technorati tags: stress, marriage, arguments, healing