Ezekiel Emanuel Says High-Touch Not High-Tech

White House Health Care policy adviser and NIH scientist Ezekiel Emanuel discusses high touch medicine with Royal Philips Electronics CEO Gerard Kleisterlee, and Pathfinders founder Tina Staley.  Ezekiel Emanuel is at the Bioethics Dept of the National Institute of Health

Click the picture to view the video.  It’s about 5 minutes. The video is no longer available online, but his message was clear.

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Ezekiel speaks directly of the importance of Face to Face communication between the medical people and the patients. It is almost like he was asked to give a testimonial for the UfaceMe approach.

Elements of every face-to-face interaction

Face-to-face interaction in it’s most basic form has certain elements which are always present: more than one person, each with at least three distinct viewpoints.

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These elements comprise the dynamics of face-to-face interaction. Dyadic interactions are focused on here to illustrate the multiplicity of persons and viewpoints.

Assumptions of Similarity

Assumptions are always present and, as considered here, involve a comparison between viewpoints. For example, whenever I view you, I make an implicit comparison with how I view myself. This is an assumption of similarity or dissimilarity.

Assumptions of Familiarity

When I consider how I think you view me, I am making an implicit assumption of familiarity when that viewpoint is compared to how I actually view you. The assumption of familiarity-unfamiliarity arises from this comparison.

Assumptions of Congruence

An assumption of congruence-incongruence arises from a comparison between how I think you view me and how I view myself.

Peace Train – Cat Stevens

Peace Train – Cat Stevens 1976

Peace_Train_Lyrics

Five Steps toward a Trusting Relationship

1. SHOW UP
Show up to meet face-to-face.
Showing up is over half-way there.
Walk the talk. In the sea of life, you can’t swim if you don’t get in the water.

2. STAND UP
Stand up to be noticed, to become visible.
Don’t shuffle in, don’t burst in…just show up, ready for some action.
Let yourself be looked at.
It’s true that someone said: “anyone who stands up makes a good target.”
But don’t let it stop you.
Try not to hide, to be sneaky, to be indirect, to appear so cautious that others think you don’t have anything to say.

3. SPEAK UP
In your own voice, not someone else’s.
Speak from your heart, trust yourself. Right or wrong, it doesn’t matter.
Be true to your own viewpoint, your own experience.
Give voice to what you observe, what you think, what you feel, what you want.
Don’t shout, don’t intimidate, don’t threaten, don’t measure what you say by what you think others want you to say.

4. LISTEN UP
Listen to the Other Person’s voice.
Try not to be defensive, try not to discount the other’s viewpoint.
Discover another viewpoint, just as valid, just as solid as your own.
Let yourself feel. Bite your tongue but not your heart.
If you feel pained, consider that you are considered trusting enough to be spoken to directly, honestly. Consider that your listening brings out the Other’s voice.

5. SIT DOWN
Sit down to slow down.
Because a world will open unto you as you are trusted to listen up,
And as you trust yourself to really speak up.
Discover the wisdom of a relational perspective:
All real living is meeting. (Connecting is what life is all about)
A bird needs two wings to fly. (trust is a two-way street)

Listening into Voice

“All of a sudden I’m having feelings. They’re uncomfortable.
I’m feeling lonely…I miss my family…I haven’t talked to them for years.”

These are the words of Corey a few weeks before Christmas. A middle-aged Black man, homeless, and coming to life at the Salvation Army, he has been diagnosed as schizophrenic, having heard voices to jump off a building and having visions of putting kids in a wood chipper. A longtime drug user, in and out of prison, his first arrest took place when he was 17, when police beat him up for dating a white girl and later pinned a robbery on him. Grief followed him, especially when his young son died of aids, having contracted it from his mother. Now it had been over ten year since Corey spoke with his other children, as he fell deeper into homelessness and chemical dependency.

Today, however, he had been clean and sober for a month, was taking antipsychotic medication and, while still hearing voices, said “I pay them no heed.” He wanted to talk about his loneliness. Was this good or bad, he asked. He looked better than I had ever seen him, and I told him it was probably good, because he now had emotional life flowing through his veins. His feelings were a sign he was coming alive and not self-medicating away his personal pain. What could he do about it, he asked. We got to talking about calling his family members, telling them that he was ok but missing them, that he was getting healthier and wanted them to know he was thinking of them and wanting them to have a Merry Christmas. That he loved them and was working on loving himself.

Feelings, however unpleasant, are signs of health because they are all about relationships. For Corey it was important that he understood his loneliness as a pain he could do something about. He said he had the telephone number of his Aunt, and she would have other numbers, especially the numbers of his children. If he wasn’t going to drown his feelings in drugs, it was important for him not just to look at his feelings but take a leap of faith, faith in his own desire to love, faith that his children would hear him out, faith that he wasn’t stuck in the past. He had to give voice to his feelings and get busy living.
Note: the word emotion comes from the Latin movere, “to move,” and it is in the passive form, i.e. “to be moved.” Emotion, then means not so much “to touch” but “to be touched.” Corey found himself being touched, proof positive that he missed someone with whom he yearned to be connected.

Something clicked!
Andrew recalls he began using drugs when he was eleven. A “normal” kid, he was passionate about sports, especially baseball. He recalls that he never saw his Dad cry, but he had many images of his father drinking. An industrious fellow, Andrew was good at solving problems with a natural talent for plumbing. Married at a young age, he took pride in building a new home for his family. [Read more →]

Learning

How we learn

Look before you leap!” When it comes  to learning, there are three approaches: Lookers, Leapers, and Landers.

Lookers

Lookers are keen observers of the world around them, armchair philosophers who usually have answers for almost everything. But they hesitate to leap because they’re not sure where they will land.

So…they think and think into Analysis Paralysis.

Leapers

Leapers are great at leaping, not so good at looking. So when they land, they can’t figure out how they got there.

So they leap onward in  Aimless Action.

landers1

Landers have figured out that if they look before they leap, no matter where they land, they can modify their looking and leaping to land where they really wanted to be.

So they move onward in Persistent Progress.

Lookers, Leapers, and Landers illustrate a model of human learning based on the principle of Knowledge of Results. [Read more →]

Relating Face to Face

Why you can’t tickle yourself, and others can (tickle you)

A profound question, yes!

You’d think there would be better things to ponder. But maybe this one is at the core of life itself.

Let’s start with an experiment.
Get a large book, something with a little heft (5-10 pounds will do).
Find a friend and ask her to extend her right arm with her hand palm up.
Place the book on her hand and have her hold it for about 10 seconds.
Then, quickly, without warning, take the book away.

Observe what happens.
Her right hand will jerk upwards briefly as the weight is removed.
No surprise here.

But wait.
Repeat the procedure.
Have her hold the book for 10 seconds.
But this time ask her to remove the book herself.

Observe.
When she removes the book, her right hand will remain steady.

What happened?

When the book was removed suddenly, she was not anticipating it.
Neurologically, her sensory-motor system was not anticipating it.
And by not anticipating it, she could not prepare for it.
Her hand jerked up as her muscles remained flexed.
When she removed the book on her own, she was anticipating it, and her hand did not jerk up because her sensory-motor system anticipated and prepared her.
Her eyes and hands were coordinated so she had anticipatory control.

Food for thought? Definitely.

We humans are anticipatory beings, through and through. We need anticipatory control to scratch, groom, and care for ourselves. But we also need to get beyond our anticipations. We cannot tickle ourselves because our sensory-motor system gives us anticipatory control.

Try as we might, there is no thrill because our tickling fingers are connected to our skin in a sensory-motor loop in our body and brain, giving us anticipatory control of our experience. When we don’t have anticipatory control, we and our nervous systems are open for surprises.

The absence of anticipatory control is a necessary condition to be thrilled.

Now, consider this line of thought in terms of relationships, especially face-to-face interactions. When we are face to face, we have anticipatory control only of our own behaviors. As much as we might want to, we truly cannot read the mind of another.  But we do indeed anticipate what might be on that person’s mind in our assumptions, guesses, hunches. And, you know what? The other person is doing the same with us when we’re face to face. It all happens in microseconds. I guess what I’m getting at is that to be thrilled in life, we need to let ourselves be tickled, to be surprised, to be touched, moved, and even buffeted by forces that go beyond our own sensory-motor system.  Healthy relationships are inherently conflictual because they involve more than one person, more than one sensory-motor system. The separateness can foster disconnection, but it is also the necessary condition for us to deal with someone different than ourselves. Then thrill becomes possible. But our current anticipations are based on our past experiences. When those past experiences involve relationship trauma, face-to-face interactions can become torturous.

The Difference Between Heaven and Hell

I heard this story at a scout campfire years ago and haven’t forgotten it.

A man died and went to Heaven. At the gate St. Peter met him and said: “You’re not coming in yet. I want to have you see Hell so you’ll really appreciate Heaven.”

They then went to Hell and stood before huge doors. As the doors opened, the man saw banquet tables as far as his eyes could see. The tables were piled high with beautiful abundant food. But everyone in Hell was miserable and starving.

Why? Because each person in Hell had splints strapped to each arm, so they could not bend their arms to get the food from the table to their mouths.

That’s Hell. Being so close but unable to get at it.

Then they went to Heaven. As the doors to Heaven opened up, he saw the same scene. Huge tables filled with abundance. And everyone there also had splints clamped to each arm. But everyone in Heaven was happy and well fed.

Why?

(Think a moment before you scroll down for the answer)

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They were feeding each other.

Reflection:
We humans are profoundly interdependent. We swim in the same soup of life. But when we can’t reach out to each other, when we can’t be reached out to, we might as well be in Hell.

When we are face to face, we not only breathe each other’s air, but we are at the gate of Heaven or Hell.

It Takes Two

It takes two wings to fly.
A one-winged bird is grounded.
It takes two eyes to see depth.
Two ears to hear direction.
Two hands to lift a load.
Two legs to stand up tall.
Two feet to find firm ground.

Two is more than one plus one.
I would not write if you would not read.
Would not talk if you would not listen.
Would not play if you would not cheer.
Would never hope if you would never hear.
Would not even think without hope
you would ever hear.

Two means tension.
Two means taut.
Not tight enough to smother,
But tight enough to hold.
Tight enough to hear.
Tight enough to touch
and to be touched.

Inside
Outside
My side
Your side
Who’s side?
Our side!

If no man is an island,
then two are a continent.
One can never be two
And two, never one.

If I only did it my way,
If I only did it your way,
then I did it no way,
because I didn’t do it our way.

In you, I discover me.
In me, you discover you.
In your eyes I see myself.
In your ears I hear myself.

Face to face
eyeball to eyeball
ear to ear
hand to hand
In constant flow
Finding each other,
Finding ourselves.
Finding difference.
Getting beyond our selves.
Welcoming the world.

So,
it takes two.
Not just me,
Not just you.
More than me.
More than you.

Jim Ayers  —  copyright 2007

A Forward

And so we begin.

Here we focus on human relationships as they actually unfold face to face, how we learn to relate and how technology can help or hinder human interaction. Here a journey begins on a path towards a new technology to foster human understanding, not abstractly but immediately in our face-to-face interactions, perhaps even for you, dear reader, if you choose to follow our journey. We’re not there yet, but much has already been done, enough to affirm that what has been my lifelong work as a psychologist is not only possible, but I believe necessary to address the crushing problems of our time, how people treat each other.

Here the recurring themes of this journey are: face-to-face interaction, face to face in the parkhuman relationships, learning, and technology.

As Kipling said, “in the land of the blind, the one-eyed man is king.” But we are all blind when it comes to face-to-face interaction, and there are no experts here. Each of us, you and I, are the best authority of our own experience. And when we can share our experience, especially our face-to-face experience with each other, we are no longer blind, but see together what cannot be seen alone. The dialogue that emerges between us moves us both forward. So… join in as you are able.

Why start with face-to-face interaction?

Because there is no other behavior more central to human life than face-to-face interaction.

Ann&GS Closeup Probably the only thing we do more than interact face-to-face is breathe. Like breathing, we take it for granted, until something goes wrong. The anthropologist, Edmund Carpenter wrote: “I don’t know who discovered water, but I’m sure it wasn’t a fish.” Fact is, our living environments are invisible because they are all-encompassing. Our face-to-face interactions are ever-present, even when we’re not physically face-to-face, because we always define and understand ourselves in relation to others, in our relationship histories and our relational images. It seems that it cannot be otherwise. At the same time, it is hard to talk about this without getting overwhelmed, abstract, and vague to the point of trivializing what is most central to human life, the capacity to connect with others beyond our selves.

So, how about starting with definitions?

Face-to-face Interaction is defined here as

any interaction between two or more human beings

who are physically close enough to each other

so as to permit some form of mutual perceptual contact

and reciprocal behavioral exchange.

Darryl and man
This definition covers a lot of ground and suggests that a major distinction in human relationships is whether the interactions are mediated or immediate. This distinction is based on whether or not there is anything (or any person) in between the parties who are interacting. The Latin word media means “in the middle of ,”  and “immediate” means literally “not mediated.” Mediated human interactions use media such as written/printed words, radio, television, the internet, and these media are distinct from the people interacting.

Immediacy

The first thing to understand about face-to-face interactions is that they are not mediated, i.e. nothing stands in between the participants. They can see, hear, touch, smell, and even taste each other directly without the aid of any tools (media) whatsoever. The immediacy of face-to-face interaction includes more than time. They are also spatially immediate. When individuals are in the same place at the same time, each becomes a perceptual object unto the other, and each becomes a recipient of the other’s behavior, and each bears the consequences of their perceptions and behaviors immediately. This absence of anything in between the participants, then, is the distinguishing feature of face-to-face interactions. It makes all the difference for participants and for anyone outside the interaction trying to understand what’s going on. When you’re face to face, you’re close enough to get hit and close enough to be hugged. Consequences are immediate!

Speed

In microseconds! That’s how fast things happen in face-to-face interactions. And they happen at many levels: mentally, emotionally, percpetually, behaviorally, neurologically, biochemically, spiritually.

The Problem(s): Dynamic Duality = Tension and Conflict:

In the School of Hard Knocks face-to-face interaction reigns supreme. Relationships, as they unfold face-to-face, are inherently conflictual because each participant must deal with someone different than oneself. Private cognitions become overt behaviors when each participant not only observes but also is observed. Being face-to-face means perceptions become realities, which affect overt behaviors so that misperceptions can become misbehaviors. Expectations can lead to self-fulfilling prophecies. Flashbacks of past interactions can alter one’s current perception. As central as face-to-face interactions are to human life, they are very complex and, therefore, resistant to scientific study. Yet, they form the core of human relationships, and as such, lie at the heart of how we understand healthy and destructive relationships and how we can apply empirical science to human conflict.

Connecting: Healthy Relationships

One theory about human relationships is Relational Cultural Theory, which emerged from the work of Jean Baker Miller who proposed a new understanding of women’s development and other psychologists collaborating with her at Wellesley College, near Boston, Massachusetts. Relational Cultural Theory (RCT) postulates that all human growth occurs in connection and to be human is to yearn for connection. Relationships foster growth when they are based on mutual-empathy and mutual empowerment. A growth-fostering relationship, according to Jean Baker Miller, is characterized by five good things:

Zest: an increased sense of vitality, aliveness.

Empowerment: an increased ability to take action

Clarity:

Self-worth

Desire for relationships beyond the growth-fostering relationship.