Preserve the Mean

"the mean" free AI image www.gemini.google.com

Is the following true? A good or strong man may have many faults, weaknesses, or flaws, often due to the misuse or misplacement of his strengths. An idea that Aristotle addressed thousands of years ago. More pointedly, in his essays in Ethics, to correlate terms with weakness, he uses defects of character or absence of virtue in which men possess many (Adler, 1952a, p. 352), but Aristotelian thought speaks of behaving in the middle ground.

We can understand in layperson's terms, for example, from basic arithmetic, the definition of mean, or better yet, the mean is the mathematical average (Polit, 2010). Now, to behave and live in such a way that aligns with Aristotelian concepts, is to find the average. For example, the mean of fear and confidence is courage. If we are to be in excess fear, we are on the high end of cowardice, and if we are on the excess of fearlessness, we are on the verge of recklessness; therefore, the mean is courage (Adler, 1952a, pp. 352-353).

Let us look at other correlates from the great thinker. The mean of bashfulness and shamelessness is modesty, the middle of the road or average of flattery and blame is being of praiseworthiness, and the average of pleasure and pain is temperance. In contrast, in terms of philanthropy, the mean of greed and generosity is benevolence. Aristotle even addresses the concepts of hunger and starvation, and exercise in excess and too little, all of which affect and promote health or illness in the body. An idea that most in the practice of medicine would agree with. Not too much food intake and not too little, and not too much exercise or not too little.

In a day and age where influence and distraction aim at our attention, are the maxims and sayings from the wisdom of the ancients relevant today? Perhaps, we should consider and meditate on such things, if not then we will need to address the question that Machievelli submitted, borrowing from the editors of the great philosophers tells us in the synopticon, under the heading of Honor, Adler (1952b, p. 734), referring to the ideas of Machiavelli who would sound the bell and search for who is the man that will be great among us: will he strive to be a pioneer or settle for being a puppet? Better yet, and higher than philosophical insight, the Christian man is advised in the sayings of Solomon not to be too wise or righteous, nor too wicked and foolish (The Holy Bible, New International Version, 1999, Ecclesiastes 7:16-18). If we circle back to Aristotelian thoughts once more and look at a concept he proposed during his time, should we heed the insight of: preserving the mean (Adler, 1952a, p. 349).

References:

Adler, M. J. (1952a). Aristotle: II. In The Great Books of the Western World. (Vol. 9). Encyclopedia Britannica.

Adler, M. J. (1952b). The Great Ideas: I. In The Great Books of the Western World. (Vol. 2) Encyclopedia Britannica.

The Holy Bible. New International Version, Cornerstone Bible Publishers, 1999.

Polit, D. F. (2010). Statistics and data analysis for nursing research (2nd ed.). Pearson. 

Does Opinion Matter?

"have an opinion" free AI image from www.gemini.google.com

Montaigne, in his second essay, suggests that the person whom people believe to be great—one who performs good deeds and acts in ways that draw attention to himself—should not be expected to provide genuine help or service. This type of individual may engage in charitable actions or show goodwill towards others primarily for the sake of appearing virtuous. Generally, such a person is unlikely to lend a hand or assist others if there is no opportunity for personal reputation, honor, or glory to be gained (Adler, 1952a, p. 303).

As the composer of the blog of Palate and Pabulum, oftentimes, the recognition of a job well done came about from the circumstances and perceptions of others in the hospital setting. Where no other person was aware, but through helping others, and in the perception of a thoughtful patient, thinking it worthwhile to acknowledge, for instance, in execellent service rendered, ran it up the chain of command so to speak to demonstrate their gratitude for a job well done, unbeknown to the author of this blog at the time of the service. Although we are recognized for excellent service, is that why we do the things we do? Is it because we deep down inside need to be acknowledged or feel significant in this world?

This question has been the subject of great discussion since ancient times. The patriarhcs of our world, wrestled with it, exploring topics such as honor, praise, virtue, and the like, and even daring to say that theological circles have much to say, in general, according to Soutwick et al. (2023), great philosophical ideas and religious conversations have taken place for over two millennia to discuss other aspects such as right and wrong elements of morality.

The sole belief that we are all self-centered, according to Erickson (2013, p. 563), does not help the case of humanity, if one believes that we are inately corrupt. At the bare bones of our existence, all people will try to put their best foot forward, trying to cover up blemishes, shortcomings, and weaknesses, and striving to grasp for ourselves and secure those objectives without a care for the next person, who, at the same time, is trying to procure and meet their selfish desire.

William James, the renowned twentieth-century philosopher, acknowledges the same when he addresses the concept of self, strictly speaking, of the social self, or the fact that all people are social creatures, and such constitutes the acknowledgment that a person gets from being a social creature (Adler, 1952b, p. 189). In his essay on The Consciousness of Self, William James states that as a higher-level thinking animal, we have this instinct to get ourselves noticed by other people. Further, this instinct, as a need, must be met; we crave the popular opinion of others.

References:

Adler, Mortimer J. (1952a). The Essays of Michel Eyquem de Montaigne. In The Great Books of the Western World. (Vol. 25). Encyclopedia Britannica.

Adler, Mortimer J. (1952b). William James. In The Great Books of the Western World. (Vol. 53). Encyclopedia Britannica.

Erickson, M. J. (2013). Christian theology (3rd ed.). Baker.

Southwick, S. M., Charney, D. S., & DePierro, J. M. (2023). Resilience: The science of mastering life's most significant challenges. Cambridge University Press.

Overcoming Fear

"ICU care" free AI image from www.gemini.google.com

It is said that the cattle rancher can tell us about the herd and the plains, that a fisherman can tell us about the winds and tides, the shepherd can say to us about his flock and the wolf, and the warrior can tell us about his victories, losses, and his scars (Adler, 1952, p. 24). Still, the nurse can tell us about their meetings with the human condition of severe weakness, frailty, loss of strength, the deteriorating mind rampant with depression and delerium, the fearful, the scared, those who hurt with intractable pain, and the all too familiar site of a corpse lifeless, motionless and bereft of heat at the end of life (Emanuel, 2018). What do a rancher, fisherman, shepherd, warrior, and nurse have in common? Resilience.

Roman Warriors

The Romans were known for engaging in conflicts and skirmishes with enemy territories on purpose to stay militarily fit. According to Montaigne, whose father set an example to him a flair for education (Adler, 1952, pp. 330-331), that the wellspring of idleness will corrupt the warrior, in essence, unless the warrior, having something to bathe his blade in other than the sweat from his training needs blood, training alone will deteriorate his morals. As such, the Romans bred in the youth of their soldiers a contempt for danger and death, and some of the gladiators were not satisfied enough near their dying moment to die bravely at the hands of an opponent, but rather to perform and exhale and spill their blood and do it cheerfully.

Whereas the Romans possessed nerve, mettle, and spine during their imperial reign, those traits were as ordinary as the discipline, principles, and virtues ingrained in today's Marine Corps, as evidenced by the author's own experience as a veteran, which includes honor, courage, and commitment. As elements of resilience, the same virtues that support the warrior within translate to helping those who care for others, albeit doctors, nurses, coaches, or teachers, termed the helping professions.

Overcoming Fear

We have insight from over four hundred years ago about that menacing mental distraction called fear. Fear has affectual outcomes on human behavior, either positive or negative, or better understood, fear can be either inhibitory or excitatory. Fear, in other words, according to Montaigne, can promote cowardice or boldness. Mental health definitions are provided by the Diagnostic and Statistical Manual of Mental Disorders, which states that the emotional response of the body to a potential or an actual threat to one's person is fear (Craske et al., 2022). Montaigne, who was plagued by a horrible, debilitating case of what was called quinsy, better known as tonsillitis, had such an incapaciting case of it in his later years that it kept him from speaking. He describes and tells us that the internal mental function of fear can help a person turn the wetland marsh plants of "reeds and bullrushes into pikes and lances" (Adler, 1952, p. 25). Again, fear can often help grow "wings to the heels...sometimes it nails them to the ground" (Adler, 1952, p. 26). Anyone can relate to the debilitating effects of fear, which our ancient ancestors knew about way before we began to study the impact of anxiety in mental health circles today. As recorded in his Essays, Montaigne refers to the writing of Cicero, "fear drove out all intelligence from my mind" (Adler, 1952, p. 26). When fear hijacks the mind, poor decisions often ensue.

As the author of the Palate and Pabulum blog, the experience of fear has been circumstantial and situational. For example, parental fear, childhood and adolescent fear of bullying, fear of being shot at while retreating off the beach of Mogadishu, Somalia, fear of failing state licensure exams, fear of taking care of the critically ill patient in the intensive care unit, and fear of God. One might argue that some fear is healthy or needed, and some kinds of fears can be life-debilitating, preventing one from living a whole life, like those who suffer from phobias. However, there is hope. Whenever we encounter fear, our brains are hardwired to make memories to protect us from potential threats, all designed to keep us alive. However, researchers tell us that getting back on the proverbial horse is the key to overcoming our fears (Southwick et al., 2023).

The following tips from the great work of a former psychiatrist and researcher on resilience are listed, but understood from the perspective of the author of Palate and Pabulum when dealing with and overcoming our fears. From the leading expert on human resilience and his esteemed colleagues, Steven Southwick, Dennis Charney, and Jonathan DePierro, give this advice (Southwick et al., 2023).

First, reappraise fear and think of what opportunities are available to learn from. Next, always remember the core values and the mission one has. Third, take a chance to learn more about what is feared, and explore knowledge deficits if a potential threat is unknown. Fourth, practice techniques for managing symptoms of fear, like anxiety. Fifth, use the social support of friends and teammates. Lastly, there is something to be said of a spiritual connection and having a mentor helping one deal with their fears.  

An Opportunity to Learn

As a veteran Marine and registered nurse, opportunities have always been presented to think about what can be learned from situations in which to overcome, for instance, how to care for someone critically ill in the ICU as a new grad nurse, thinking to oneself, unless this situation is given to learn how will the experience ever be gained. There is a saying in ICU residency training from veteran nurses to new grads after they receive the report, "Now go into the room and see the patient." Often, new grad nurses in the ICU are paralyzed about taking care of some of the sickest patients, but to overcome the fear, the nurse must open the patient's door and go in.

Mission Oriented

Having been a veteran, this is self-explanatory, but the mission of the day, as well as the hospital, is to keep a patient alive. Remembering to help the patient get their procedures, medicines, and timely therapies helps one to overcome the fear of the sick patient. Timeliness of care is also an element of a mission-oriented perspective to overcome the fear of caring for sick patients. For example in the care of cardiac patients, such as when a person has a heart attack, time is of great necessity, an element of intervening to help a patient, minutes can be the difference between life and death, the cardiac catheterization department has the goal and mission to help the patient intervene within ninety minutes to help save a life, and beating the clock is the goal.

Learn about what is feared

Critical care experience, hands down, is the ultimate teacher and takes many shifts, days on the unit, weeks, months, and years to become second nature, for instance, being able to instantly look at a twelve-lead EKG and see if there is a cardiac event occurring. Likewise, experience can help the nurse quickly address signs and symptoms when patients present to the units and know right away when and how to address a situation, for instance, when a patient reports that they have a history of heart disease with low blood pressure they are now feeling "dizzy". However, learning through study, tutorials, books, and research articles, nurses gain knowledge about the patients that they will encounter. Studying about cardiac patients in the off hours between shifts and cases in the hospital helped the author overcome the fear of unknown patients' pathology and disease states.

Practice Skills to Manage Fear

For as long as can be remembered, skills that have served the blogger well in overcoming and managing fear have been the internal dialogue and self-talk before going into the hospital, and not knowing what kind of challenges would be faced for the day. As a repetitive reminder, a saying that is repeated daily every morning for the past twenty or so years has been, as soon as the door of the Tacoma pickup truck is closed, to repeat aloud to oneself, "Back in eight," and "Just make it to the next meal." The saying primes the mind to remind that all will be okay. This saying is remembered during the early days of Marine training.

Friends and Co-Workers

Survival in the unit is impossible without a teamwork mindset; it is hard to get through a twelve-hour shift alone. As such, being the only one to struggle managing the care of challenging patients, such as those with tenous blood pressure or failing to wean on a ventilator, all stress-producing situations will not help a nurse overcome the fear of caring for patients. However, with co-workers and colleagues, it becomes within the bounds of possibility.

Mentoring and Spirituality

It has been the experience of this blog author that many great tutors and mentors have helped attain the skills that are now second nature. Of note and a many hindrance to others, which at times some teachers and mentors have been, as Montaigne suggests when quoting Cicero, that "the authority of those who teach, is very often an impediment to those who desire to learn" (Adler, 1952, p. 64). However, not many can argue the value of a great mentor who takes an apprentice under their wing to show them the ways of taking care of patients.

Finally, as a child and even now as an adult, having a connection with a higher power is paramount to overcoming fear, especially when caring for critically ill patients. The higher power for the author of this blog is the Christian God. A spirituality that helps with caring for others helps with managing fear. As an example, it is the belief that, as an instrument of God, the skills and abilities of a registered nurse help care for others and reduce fear-related anxiety.

References:

Adler, Mortimer J. (1952). The Essays of Michel Eyquem de Montaigne. In The Great Books of the Western World. (Vol. 25). Encyclopedia Britannica.

Craske, M. G., Manicavasagar, V., Schultz, S. K., Zbozinek, T. D., Wolitzky-Taylor, K., Ollendick, T. H., Muris, P., Mesri, B., LeBeau, R., Brown, L. A., Bogels, S., & Baum, K. B. (2022). Anxiety Disorders. In American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (5th ed., Ser. Text Revision, pp. 215–262). essay, American Psychiatric Association.

Emanuel, Ezekiel J. (2018). Palliative and End of Life Care. In J. Larry Jameson & Anthony S. Fauci & Dennis L. Kasper & Stephen L. Hauser & Dan L. Longo & Joseph Loscalzo (20th Eds., Vol. 1), Harrison's Principles of Internal Medicine (pp. 47-63). McGraw-Hill Education. 

Southwick, S. M., Charney, D. S., & DePierro, J. M. (2023). Resilience: The science of mastering life's most significant challenges. Cambridge University Press.

Train for resilience

"resilience" free AI image from www.gemini.google.com

To capture a reader's mind, it is best to tell a story. On June 3, 2017, Supreme Court Chief Justice John Roberts delivered an electrifying commencement speech at his son's ninth-grade graduation from Cardigan Mountain School, which is insightful, striking, and believed to be necessary and applicable not only to aspiring adolescents but also to adults. The following is a paraphrase of his words, intended to encourage the young audience; you can watch the recording on YouTube.

In essence, Chief Justice Roberts said that he hoped that they would be mistreated from time to time so that they would come to understand the value of justice. He mentioned that he hoped they would experience betrayal, as that would teach them the importance of loyalty. Apologetically, he hoped they would occasionally feel alone and isolated, so they would not take friends for granted. The justice spoke of wishing them bad luck from time to time so that they would appreciate and be aware of the role of chance and probability in their lives, and that success and failure in life are essentially a common thread in humanity. He advised them to embrace losing and experience the glory of an opponent, so that they would learn the value of humility in sportsmanship. He emphasized the importance of listening to others, noting that it is best understood when ignored. Finally, he told them that to learn compassion, he hoped they would feel discomfort. The justice wrapped it up by saying that these are all inevitable human experiences, and that learning from them will greatly depend on the type of character one has or needs to develop.

Resilience

The commencement address by the chief justice highlights the importance of resilience in our lives and is a refreshing message that is modern and relevant. The ancient stoic philosopher Epictetus tells of the accomplishements of Hercules and explains to us in his discourses on providence that the only reason why Hurcules was able to live up to the name is precisely becuase he was given opportunity and situations to demonstrate his hurculean strength and vitality against such opponents and threats like a lion or bear or deadly basilisk and men who sought his life (Adler, 1952, p. 111). The myths and tales of the ancient Stoics, along with the sharp words of encouragement from a Supreme Court judge to his sons' graduating class, offer valuable insights worth recalling.

Challenge the common denominator

Scholars tell us that if children are exposed to opportunities early in childhood where they must forgo rewards and expectations, or, as Averill et al. (2018) describe, moments where gratification of a want is held off, they promote resilience, self-control, and regulation of their behaviors. Although no one would expect kids to have to grapple with a hungry lion or an angry bear, as the mythical hero Hercules did, the speech the justice gave to the young graduates was an essential element in preparing them for life's challenges and stressors.

Stick around or bail?

The author's father was a pipe fitter and welder for a major oil-producing company, British Petroleum, in Texas. Stories about safety and danger at the "plant" were part of his vocabulary. One time, it is recalled that the author's dad had a new crew coming onboard in his section, and he would tell the new crew, since he was the supervisor, that if anyone saw him running towards the gate, they would be too late. He was referring to his innate abilities and years of experience, and his ability to sense danger, which had occurred a few times during his career. He knew the inherent risks involved in the volatile process of refining crude oil and making plastics and fuel. If the reader is astute, one may remember the Gulf of Mexico disaster a few years ago, which was subsequently made into a movie starring Mark Wahlberg, called Deepwater Horizon. These were some of the types of environments that the authors' father worked in.

Additionally, scholars inform us of the biological hormonal response to stressors in our world. One can imagine that a thousand years ago, the primary stress response was survival. As humans, we woke up and searched for food, water, and shelter, and did our best not to be eaten by a hungry pride of lions. Today's stressors are particularly significant for youth, including the passing of exams, fitting in with their peer groups, and managing bullying. By contrast, adults face the life stressors of those who are gainfully employed, balancing their professional responsibilities with their personal lives (Averill et al., 2018). Either way, whether we are running away from something that is trying to eat us or trying to pay bills and perform well at work, the body reacts with the same hormones.

Briefly, the fight-or-flight system of the sympathetic nervous system is responsible for helping the body prepare for survival situations. It has many hormones involved to help us flee the scene for safety, primarily the hormone that causes the heart to race and helps the heart muscle contract more forcefully is epinephrine and its close twin, norepinephrine (Averill et al., 2018). These are normal responses to a perceived impending peril, and there are other biological processes to help bring the fight or flight response back to normal levels once the body has responded to the situation or if the threat to one's survival has dissolved. However, when these situations are elevated in the body from chronic response to perceived threats, such as chronic stress, the incessant stimulation of the sympathetic nervous system can cause unwanted symptoms of anxiety, fear, and in some situations, post-traumatic stress (Averill et al., 2018).

References:

Adler, Mortimer J. (1952). The Discourses of Epictetus. In The Great Books of the Western World. (Vol. 12). Encyclopedia Britannica.

Averill, L. A., Averill, C. L., Kelmendi, B., Abdallah, C. G., & Southwick, S. M. (2018). Stress response modulation underlying the psychobiology of resilience. Current Psychiatry Reports, 20(4). https://doi.org/10.1007/s11920-018-0887-x