Showing posts with label spirituality. Show all posts
Showing posts with label spirituality. Show all posts

Sunday, June 27, 2021

The Spiritual Journey From High School Football



About 2 years ago my wife said to me one morning “who is this guy who keeps texting me?” I looked at her phone and recognized the name immediately. He was the quarterback from my high school football team. More correctly it was the high school football team I was on when I was a sophomore in high school. I had the immediate association to his physical appearance and considerable athletic ability. To this day he probably was the most gifted high school athlete I had ever seen. He didn’t look like a high school player - more like a college player. He was also an excellent basketball player and sprinter on the track team. He was the fastest man over 100 yards in high school. Why was he suddenly texting my wife?

He was going to be inducted into the local athletic Hall of Fame. He was trying to organize a reunion of our 1966 undefeated high school football team. His plan was to get as many of us back there as possible - details to follow. There were 2 or 3 subsequent postponements of the reunion due to the pandemic. But yesterday on 6/26/2021 it finally happened. Twelve of the 22 players reunited for about 3 hours at a local bar. As far as I know three of my teammates are deceased and the remaining players could not be located or decided not come. The head coach was also in attendance. The assistant coach is deceased.  All of the attendees got baseball caps with their name and numbers embroidered on the back. The front of each cap simply said “Undefeated 1966 AHS Football”.

Unlike my high school reunion, I had the opportunity to say something to all my teammates. I remembered who they all were and details from our past. I know that many had significant problems in life including life-threatening health problems. I learned about their relatives who had similar problems. But most of all I learned about what that football season meant to the people who made it back to the meeting. I know that memories from over 50 years ago can get complicated and distorted. As we all sat around a table there was a collection of newspaper articles and photographs from 1966 to provide partial corroboration. There were some intense memories from the past that haunted some of the players. There was also active feedback from the coach about a few incidents where he realized that the plays he was calling were being ignored. My intention in writing this post is not to identify people with problems or criticize people, but to look at an event with obvious meaning as well as the meaning that may have been missed at the time.

Our quarterback started out with some self-disclosure of mistakes he had made during the championship season. Other players who were involved with those mistakes corroborated them immediately. Our center for example recalled a fumble on the opponents 1 yard line and the fact that it occurred on a silent count. For 5 decades our quarterback was thinking the fumble was his mistake, but our center let him know that he forgot the count. There were several other incidents involving typical football mistakes that people had been thinking about since 1966.  Resilience came up as an outcome of the coaches role in helping us overcome adversity.  

A significant injury was discussed. From the description it sounded like a traumatic brain injury, but back in those days any head injury with partial or significant loss of consciousness was referred to as a concussion. There was no grading system but persistent confusion or memory loss might eliminate a player from the game although that was certainly not guaranteed. More than one concussion led to a medical evaluation but again there was limited medical expertise in traumatic brain injuries. It led me to recall a lot of headaches from playing football. We would practice twice a day in hot weather hitting a blocking sled and doing full contact drills. There were days where the headaches just did not clear up.  I was also reminded of the only significant traumatic brain injury that I sustained when I ran into one of my teammates playing in a touch football league. In fact, I approached him at this reunion and joked that the last time he and I met - I was out of it for the next 24 hours. I had to explain that we were both defensive backs running full speed and I ran into a shoulder after diving for the ball. He did not recall the incident.

There was a strong underdog theme. At one point in the year, we did not have enough players to scrimmage so the coaches had to play defensive half backs. Many of the teams we played against had much larger players and significant depth.  That led me to recall our coaches quote to the press: “We are not big - but we’re slow”.  Our coach recalled that in some of the venues we were ridiculed for looking raggedy and not having many players. We were accused of running up the score against some teams to improve our overall ranking.  The coach found this humorous because there was no second team to put in.  At one point during the discussion, one of our receivers took over and talked about how he and one of his friends in the offensive and defensive line got psyched up for the game. He gave an inspiring and expletive filled speech about his love of football, how he liked physical contact, how he liked playing offense and defense. He presented it with such vigor that it seemed like he was ready to play - right then.

For some reason, I had forgotten how tough these guys were. We were almost all working class.  Half of us were from the East End and half from the West End of town. Some played with significant physical disabilities. It was the height of the Vietnam War and many would go into the Marines and the Army after graduation. Many would go on to play college football. I would just catch glimpses of their lives from time to time.  Everyone had a unique trajectory from that winning football season to where they were on June 26.  At one point a small group asked me what my trajectory was and I told them a variation of a story I have been telling for the past 10 years:

The only reason I ended up going to college was to play football, be a football coach, and teach physical education.  I had a football scholarship to a small college in the area, but within a few weeks, I developed a gangrenous appendix and was hospitalized for a week.  The coach came in and told me that the scholarship was mine even though I could not play anymore (I had a healing surgical scar in my side that was still healing after a drain was removed). I probably was headed to be a version of a hippy anyway. Another professor visited me and told me to forget about Phy Ed and football and concentrate on something else.  I had excellent chemistry and biology professors and knew that I wanted to be like them and know what they knew.  From there it was a change to biology and chemistry, the Peace Corps, a plant tissue culture lab and medical school.”

That’s the short version.  There are embellishments for comedic relief and more details if anybody wanted to hear it.  I leave out the heavy parts about being depressed to the point my grandfather showed up one day to encourage me to stay in college and not knowing what was wrong with me until I developed severe abdominal pain. I leave out the part about not taking a student deferment during the lottery for the draft.  A high lottery number rather than a conscious decision kept me from being drafted.  All part of the lack of a coherent plan. Nobody wants to hear about all of that. I never played college football.  The point is – I would never have stepped into that sequence of events culminating in medical school and psychiatric residency without that football scholarship. I never would have had that football scholarship without playing with this team and being coached by this coach. Some people will tell me that sequence of events would have happened anyway. That I would have made it happen through another channel. Whenever I mention being lucky on this trajectory, I encounter aphorisms like “Luck is just preparation meeting opportunity” and others.  But I really was not prepared to do anything at that point.

The only thing I was prepared to do in high school was play football. The teaching and guidance side was totally lacking. I can not recall a single piece of good advice that I received from a teacher or guidance counselor in those years. And the teaching was atrocious. You showed up, put in the time, did not create any problems and graduated from high school. The blue-collar ethos of education.  You did not have a plan until you got to the next stage. The modern-day stories of high pressure on high school kids to get into an Ivy League schools and parents going to extraordinary and in some cases illegal lengths to get them in - is lost on me. I am the poster child for getting into whatever college wants you and establishing goals after getting there.

Football was the initial pathway.  At the Reunion, the coach discussed some of his initiatives including the first strength training program at the school along with associated competitions. I remember summer training sessions including agility drills.  I excelled in agility drills and back and forth sprinting drills. In my senior year, I could equal or beat the fastest running back in the agility drill even though he would beat me by a mile in 100 meters. These summer sessions were something we all looked forward to and it was the only planned activity in my life for the 3 years of high school.  The Coach gave us a glimpse of what it took for him to implement these plans and all of the resistance he met along the way.  That resistance came in the form of administrators claiming that he was running afoul of certain regulations, personality conflicts, and suggesting that he should work the pre-season for free even though he was already undercompensated for the amount of work he was doing. Providing me with some structure to start to get my life together came at a considerable cost to the only guy who was doing it.

Several of my teammates provided additional stories about the immediate benefits of coaching. How to play against a much larger man with limited lateral movement.  How to make adjustments during the game, based on observations by coaches who were at ground level on the side lines, attending to the injured on the sidelines, and changing overall game logistics. High school coaching is a multi-tasking job and school districts get their money's worth from coaches.

One of the most important aspects of my life trajectory has been identifying with teachers along the way.  Most of that emphasis was in college at the conscious level. But did it occur in high school football?  I was never encouraged to play any sports by my father. I learned after his death that he was quite accomplished in baseball and softball in his early twenties. By the time I knew him well, he had been working a thankless job for twenty years. The only sports advice he ever gave me was: "Look - if you want to play sports be clear that you are playing it for you and not for me." He did live to see this football team and attended the end of season banquet prior to his death in 1967.  I never got the chance to completely understand his sports advice, but speculate that it was from having to fish every day during The Depression to supply food for his family of origin - whether he wanted to or not.  

Both of our coaches were young men, accomplished athletes, and had unique personas. I remember the head coach bench pressing a significant amount of weight even though he was a quarterback in college. For the rest of my family, sports were something you did into your early 20s and then you settled into a fairly sedentary lifestyle. Out of college and then again out of med school I embarked on a lifelong schedule of rigorous training for no reason other than being able to do it.  That continues to this day. Would I have logged all of this activity if I had not played high school football with this coach? Probably not. Was there a degree of unconscious identification with this coach?  Probably.

The developmental aspects of high school football are undeniable and the stage we were all at during the reunion was undeniably different from high school. High school male athletes are competitive either by choice or necessity. It was probably the most significant motivator. I can remember thinking about the difference between competing with myself and competing with others as I was running a long sprinting drill in the 90 degree heat that occasionally happens in northern Wisconsin. In that drill 5-10 players spread out across the field and run out to the 5 yard line and back and then the 10 yard line and back until they have reached the 50-yard line and back.  At some point during that drill you realize that competition is irrelevant because it really comes down to survival and in that sense you are competing against your own physical limitations.  That familiar mind set was with me for the next several decades of cycling and speed skating. With a single exception - I preferred to do both activities alone – just me and the rhythmic breathing and sweating of that familiar sprinting drill.

The competitive aspects of high school sports also play out in other ways. Clique formation, hazing, bullying, sarcastic comments, and various forms of acting out that are expected of teenagers who we now know don’t have fully developed brains for another 10 years. That was moderated to some extent by the shared suffering of football.  At the Reunion it was fairly clear that there were many accomplishments over the course of these lifetimes but also much suffering. We were all grateful to have survived so far and saddened by the loss of our teammates who did not.

55 years had passed and, in some ways, we were a better team.

 

George Dawson, MD, DFAPA


Postscript: 

If I am correct in my analysis (or not) - I am grateful to have had this experience in high school.  I am grateful for my teammates many of whom I consider to be friends but also the Coach and Assistant Coach who clearly did not get enough credit for what they did. I made the common mistake of also taking that coaching for granted until I realized that my entire career may have been based on it.


The commemorative cap:




Supplemental Qualifier:

I don't want to give anyone the impression that this is an endorsement for football or other contact sports.  Football is a collision sport and there is an expected morbidity associated with collisions. Chronic traumatic encephalopathy is one outcome that has received a lot of press. My speculation is that spinal problems also occur as the result of spinal compression and hyperextension movements that are harder to detect due to the high prevalence of spinal problems in the general population that does not play contact sports.  One of my teammates sustained a cervical spine fracture from football but it did not result in paralysis.  As a psychiatrist, I have seen a significant number of people with traumatic brain injuries and severe musculoskeletal injuries from collision sports.  The number of women with those injuries has increased as their exposure to these sports (soccer, lacrosse, ice hockey) has increased.  I have seen young men and woman in their early 20s with significant disabilities from these injuries. In some cases they have also had severe post-traumatic stress disorder (PTSD) from either the injury or the subsequent course of treatment. 


 


Saturday, November 21, 2015

Sprituality.....




I was born and raised a Methodist.  My father was a Catholic and had some problem with that church despite the fact that many of his siblings were devout.  To this day, I have a vague notion of what being a Methodist means.  I remember going to a church that looked like a large house from the outside.   It was a very modest building.  There were a hundred or so people on the inside.  They became familiar faces over time.  I was always interested in what the clergy had to say and the message varied considerably.  I did not know it at the time, but being a protestant clergy is a very political position.  People have to like you or they start to talk and that talk can eventually undermine your ministry.  Even as a kid I thought I could figure out how serious the minister was by what he said.  Was it a rote presentation or did he brings things alive.  I don't mean in the entertaining sense.  Could he (we only had male ministers in those days) get a serious lesson across in an inspirational way?  I was always impressed with how little commentary there was about this central feature of the church service.  It seemed routine to go there, listen to the sermon, sing a few songs and leave.  No enduring message or feeling.

It wasn't until I was a teenager that I saw the inside of a Catholic church.  I was there for my father's funeral.  Several of his devout siblings arranged for the funeral service to occur in the Catholic church despite the fact that (to my knowledge) in my 15 years on earth at that time - he never set foot in church.  In assessing what the church looked like, I recall thinking that "this is the big time."  The structure was huge compared to the Methodist church and the architecture was inspiring.  No wood framing.  There were concrete arches, stained glass, symbols, and actual sculptures of Christ on the cross everywhere.  In a Methodist church there is usually one large plain wooden cross.  The stained glass is always basic with the words: "Faith, Hope, Charity".  The acoustics were definitely different.  Words spoken in a Methodist church tend to project out about 15 rows and rapidly drop off in volume.  In the Catholic church the sound carried and echoed all the way back to the last row.  That last row was at least 4 times the distance of the last row in the Methodist church.  Since then I have been in many churches Catholic and Protestant - typically for weddings and funerals.  Even though the church architecture can be an impressive instrument for the speaker - it all really comes down to the clergy.  Are they doing more than dialing it in?  Are they inspirational?  Is there intellect behind the spoken words?  Can they convey the idea that there is something much larger than our individual conscious states out there?  Those were my first lessons in spirituality.

When I was in the Peace Corps in the 1970s, a fellow volunteer introduced me to a book called Zen and the Art of Motorcycle Maintenance by Robert Pirsig.  On the surface, it was a book about a cross country motorcycle trip by the author and his son.  Below the surface there were lessons about philosophical approaches to life - both eastern and western philosophies.  There was also a flashback to a crisis in the author's life when he was in graduate school and developed a psychotic depression while in the midst of an academic interpersonal conflict with one of his professors.  The lessons for me from Pirsig's book was that spirituality is really independent of other contexts.  He summarizes it in this statement:

“The Buddha, the Godhead, resides quite as comfortably in the circuits of a digital computer or the gears of a cycle transmission as he does at the top of the mountain, or in the petals of a flower. To think otherwise is to demean the Buddha - which is to demean oneself.” ― Robert M. Pirsig, Zen and the Art of Motorcycle Maintenance: An Inquiry Into Values.

After reading Pirsig's book five times, I concluded that he had an unprecedented intellectual look at what he described overall as values.  He also had a look at spirituality in a very unique way and could see it it places where it is not commonly seen - like welding or motorcycle mechanics.  Moreover, it was also a view that made immediate sense to me.  I had been doing the same thing for years.

That brings me up to my work as a psychiatrist.  In that work, spirituality ranges all of the way from religious delusions to the higher power concept in Alcoholics Anonymous and all points in between.  I don't know how many people I have talked with who believed they were God or Jesus or Satan or The Antichrist - but I have had hundreds of conversations about those topics.  On the quieter end of the spectrum, I have had even more conversations with people who were anhedonic, hopeless, spiritually bereft and who felt abandoned by God.  Many of these folks felt as though any spirituality they had was gone.  They lost interest in it like everything else and they had doubts about whether they wanted to get it back.  Did it really mean anything when they had it?  Getting it back turned out to be a critical part of their recovery.  I try to figure out a way to describe it in my clinical assessments and it is difficult.  Some have suggested using the term to capture the Gestalt of the person, but I think it is more complex than that.  In many ways it is like describing people who are charismatic and trying to use the appropriate descriptors.

There is an experiential aspect to spirituality that requires concrete examples rather than me just writing about it.  For that I will turn to a couple of examples from the best interview program anywhere - MPR's Fresh Air with Terry Gross.  I consider it a laboratory for the spectrum of human consciousness and it contains a lot about spirituality.  The first example comes from a story about Iris Dement.  She is a folk singer who began singing in the Pentecostal Church.  Until you hear an explanation of someone who is in that church or experience what they are doing - it is very unlikely that you know what is happening.  After carefully developing the context during the interview she summarizes it at this intellectual level (1) :

   "I saw my parents use music to survive.  They had to have that music.  My mom had to sing and my dad had to go to church and he had to hear that music washing over him and through him.  It wasn't a, "Oh, this is nice"; it was a, "I'm not going to make it if I don't have that."  So I've felt that that's my job.  That's how I think of what I do.  I have to give people that lifeline, you know, that I saw my parents reach out for, and that I was taught to reach out for, and so that's what I aim to do.  And I guess I don't feel like I can do that without that connection to the spirit."

When I listened to that interview and heard that quote, I realized that had just experienced one of the best examples of spirituality.  I encourage anyone with an interest to listen to the audio and have that same experience.  I think that you have to look past your taste in music to what motivates this artist.  Too many people get stopped in their tracks by thinking: "I don't like folk music" or "I don't like country music" or some appalling lack of knowledge of the Pentecostal faith.  Listen to the audio from the perspective of what motivates Iris Dement and keeps her going.

The second MPR experience on spirituality just occurred and it was the final push for this post.  I heard Terry Gross interviewing the Iranian born photographer Abbas on his series of photographs about what people do in the name of God.  The process of the interview is again very important.  Gross sees a spiritual element in one of the photographs but Abbas does not.  He comments that his relationship with God is purely professional - he has no stake in religion.  At the same time he describes some experiences that were moving while he was engaged in photography(2) :  

"Of course.  You know, I mean, you can't touch such a subject without being touched and moved.  I remember very vividly, for instance, a mass in France among the Benedictines, you know, it's monks. They're different from priests, you know, monks - very moved by a mass.  Normally when there's a mass, I don't listen, I just take photographs because it's always the same.  But this time, you know, the father who was saying mass was very spiritual.  He was talking about Jesus, not as a distant prophet, but as a personal friend.  So suddenly I start listening, and I became very moved.  In most religions, at least one event made me - well, I wouldn't say a believer but a participant....."

Like the Iris Dement story, I encourage listening to the actual audio and Abbas description of his technique before and after this excerpt.

What is spirituality?  It is not the same thing as religion, but for some people it is very close.  I also think that it is not easily acquired.  I don't think it is as easy as declaring a higher power.  Spirituality might be haunting rather than reassuring - it may not be a good feeling but it probably leads to a sense of calm.  I like Abbas's idea that it can make you a participant.  I can see it as an unconscious emotional force that probably has some obvious and many not so obvious origins that leads to consistency and may be noticeable by observers.  Some very spiritual people are described as serene and others as inscrutable.  It is not listed in the DSM-5 and that is a good thing.  It is another aspect of conscious experience that psychiatry neglects for the most part.   As far as I can tell, it is like an experiment in consciousness.  Like the examples I gave - you know it when you experience it.


George Dawson, MD, DFAPA


References:

1.  Terry Gross.  Fresh Air on National Public Radio.   For Iris DeMent, Music Is The Calling That Forces Her Into The Spotlight.  October 21, 2015.

2.  Terry Gross.  Fresh Air on National Public Radio.  Photographer Abbas Chronicles 'What People Do In The Name Of God'.  November 19, 2015.

3.  Melissa Block.  All Things Considered on National Public Radio.  A Nephew's Quest: Who Was Brother Claude Ely?  July 14, 2011.

Story of the importance of Pentecostals in rock and roll, especially Brother Claude Ely - with parallel comments about the spirituality involved in that music.  If you doubt it - read the last two paragraphs of the written story first.





Thursday, January 16, 2014

A Better Way To Manage - Lessons From the Coach

I ran across a basic article on Phil Jackson the other day in the AARP newsletter.  Like most people unfamiliar with his story I get the occasional stories about him that describe him as a guru.  I can see the movie now with novices climbing to the top of some mountain in the Himalaya's only to find him seated in an wooden temple, speaking the basic truths about NBA coaching in a way that only he is capable of.  He is a legendary basketball coach.  The AARP newsletter was brief but it contained huge advice.  In it we learn that he is the son of two clergy and spirituality naturally guides his decision making.  When people think about spirituality they frequently equate that with religion and react to it on that basis.  They miss the point that spirituality can be the essence of a person.  It can be a connection with a process greater than one's self and have nothing to do with religion.  One of my colleagues John MacDougall captures this well in his definition of spirituality as:  "the quality or nature of our relationships in three dimensions - relationships with our Higher Power, with ourselves and with other people."

The other Phil Jackson observation from the article that impressed me was the notion that he used nonauthoritarian methods to empower his players and these methods came directly from a spiritual direction that allowed him to be true to himself.  He talked about knowing that "things of a higher calling could unite groups of men."

"I've learned that the most effective way to forge a winning team is to call on the players need to connect with something larger than themselves......  It requires the individuals involved to surrender their self interest for the greater good so that the whole adds up to more than the sum of its parts."  -  Phil Jackson in Sacred Hoops (p. 5)

Contrast that with typical managed care or business strategies that leave the people out of the equation.  The best way to look at that contrast is by looking at some team situations I have been in the past.  I wrote about my Renal Medicine team in the past.  It was my last rotation in medical school and I walked off that service at about 8 PM on the last day before graduation.  The whole raison d'etre of that team was the two goals of excellent medical care and education.  The approach to both goals was intensive.  Even as a medical student, I felt like a critical part of the team.  My job was to go out into the large medical complex on the grounds of the Milwaukee County Medical Center and do consults.  On the last day, the two residents I was working with approached me and said: "Look George, we know this is your big day but we are getting killed.  Can you do these consults?"  Of course I did.  The only meaning that my action had at the time was the I was a part of this team and I wanted to share the workload.  After we completed rounds that night at about 9 PM, those same residents joked about how I was a super medical student and some of the jokes were quite funny.  But that rotation (with a few others) was one of the most meaningful educational experiences of my life.  To this day, I miss working with that team.  It was a spiritual experience!

Teams on inpatient psychiatric units can be a different story in part because they are influenced by the typical silo style management of big hospitals.  The managers are ego rather than team driven.  There are separate nursing and physician structures.  Some of the team members may be in separate unions.  There are multiple disciplines that can be split be numerous administrative hierarchies.  It is always easy for administrators to try to play one discipline against the next.  Institutional attitudes can affect psychiatric teams at multiple levels.  At various times I have been in teams where one or more members were being influenced by administrators to the detriment of the team.  That almost always translates to suboptimal patient care.  The administrative message to teams can be fairly extreme.  At one point I can recall being told that we were no longer doing team meetings.  Productivity measured as individual physician-patient contacts was more important.  At that time we had already been told that our documentation was supposed to include a blurb about observations made in the team meeting or it would not "meet criteria" for the correct billing code.  At other times we were plagued by observers - bureaucrats, consultants, or business types who clearly did not know anything about the work or at least the work we were doing.  Many were hired guns brought in by our own administration as the "next big idea" or an attempt to manipulate the team in some way.  In the most extreme situation, a representative of the administration was sitting in team meetings and telling us what to do.  I say extreme because the administrator had never assessed any of the patients and did not know them.  They also did not have the expertise to make a diagnosis or treatment plan.  All of their decisions were strictly financial.  They needed us to carry them out to provide the legitimacy of having licensed professionals names in the charts, especially on the discharge orders.

All of those last scenarios are at the extreme other end of the spectrum from Phil Jackson's approach.  My guess is that Phil Jackson would not have been able to keep Kobe Bryant in LA when he wanted to be traded with just financial incentives and a business approach.  It took a spiritual one.  He had to feel like he was part of a larger process.  That is the spiritual atmosphere that needs to be created on treatment teams.  You won't get to that by expecting physicians or nurses or social workers or occupational therapists to be mini-administrators focused on "cost effectiveness".  In fact, it is exactly the wrong approach.

The correct spiritual ground for a team is unity, appropriate concern for other team members, common goals and positive affect associated with being on that team.  Team members need to  to have a uniform neutral and spiritual approach to the people they are trying to help.  One of John MacDougall's suggested approach to improve spirituality is:  "try treating every human being that you meet as if he or she were a beloved child of a Higher Power."  It has nothing to do with being a bean counter and in fact if the bean counters can't support the development and maintenance of teams - it is time for everybody to walk away and start over.

Phil Jackson's elaboration of a non-authoritarian spiritual approach to managing people on teams is just another important way that the government and the managed care world miss the boat and end up providing the worst possible management of health care workers, especially mental health care workers.  Micromanagement and a general cluelessness about managing knowledge workers is another.  We don't have a shortage of worker productivity or a shortage of workers - we have grossly mismanaged workers and some of the worst managers in the world.

George Dawson, MD, DFAPA

John A. MacDougall.  Being Sober and Becoming Happy.  CreateSpace Independent Publishing Platform, 2013. p. 40.

Phil Jackson and Hugh Delehanty.  Sacred Hoops.  Spiritual Lessons of  a Hardwood Warrior.  Hyperion, New York, 1995.