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I know, I'm a doctor — Indian diary (10)
March 4th, 2015 (March 5th, 2015)
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I know, I'm a doctor — Indian diary (10)

   My last days in India are over, and I'm presently a jet lag wreck in France.
   The first impression when landing in India was of the smell of spicy dust (I felt this on every trip I made to India so far), the first impression when landing back in Europe is of the cold!  In India, summer is fast approaching and it was rare for temperatures to fall below 30ºC (86ºF), these days in Lyon (France) temperatures peak at 8ºC (46ºF). I might need to recover some clothes from London pretty quickly!

   When I arrived, I heard of a statistics recently discussed in France, which asserts that medical doctors are 3 times more likely to commit suicide than other professions. Many conditions might be blamed for this, but a particular trait and a partial explanation is that doctors can feel a heightened sense of failure when a diagnostic proves erroneous or simply when their patients do not recover. The stronger one believes one "knows", the harsher it is to accept that knowledge doesn't always  work, knowledge isn't always  enough. In France, doctors have 9 (general medicine) to 12 years (specialists) of university studies… so doctors can be quite convinced they "know"; enough time has been spent during their harsh studies to convince them that they're the elite of an elite country ;-)

   In India, my last days were with a doctor who was experiencing dukkha  from seeing me being sick… even though I wasn't personally bothered by the sickness.
   In my books, sickness is part of life, it's fine, the sole relevant question is "how can I constructively relate to this right now, what's the appropriate response?"; from a karmic perspective, sickness is also a way to unfold past negative karma without perpetuating it (i.e. it's better to fall sick as a consequence of one's past violence than to have to suffer from the violence of others, as the latter creates bad karma for them!).
   While I thought the situation was fine, expectations that "it should be different"  ("in my  house / in my  presence"), that "I should know how to fix this"  or that "I've given the right antidote, things should improve faster than this!"  nonetheless created a lot of unnecessary suffering for the doctor!
   Even though I spent time trying to communicate that I was fine, that sickness is part of life, or that anti-virals should be limited to the strictly necessary cases (due to the opportunity for viruses to adapt and become resistant), etc., the doctor suffered enough for her judgement to become biased, and for her to stop listening. Whether my experience called for compassionate relief, or not, became irrelevant. And an effective weapon, when trying not  to listen, is to assert "I know (I'm a doctor)."  At the end of the day though, it was about relieving her suffering (rather than my hypothetical, projected suffering), and her suffering arose from a mental fabrication about knowledge (and the control it supposedly offers, the ability to force reality to comply to one's wishes).
   The delusion of knowing —this classic cognitive error which switches a view that functions effectively 99% of the time into a 100% certainty and the associated delusion of "control"— only creates suffering, it doesn't actually solve anything but it sets the scene for unsatisfactoriness to later arise, it sets a plan that the reality is asked to follow and, once things do not go according to plan, the mind is likely to protest. If the mind "gives up", depression or even suicide are actual risks for medics!


   Of course, similar cognitive errors lead to similar consequences, in other situations too. This can happen e.g. to shutdown any conversation with a partner, with friends, with colleagues…
   The more we're certain, the likelier it is we'll suffer Hell when reality doesn't comply. One then has to go through the process of grief, actually grieving the now-dead certainty: denial  ("this cannot be happening"), anger  ("I don't deserve this, why me?"), bargaining  ("it's because of this-or-that unforeseeable circumstance; can I try again please?"), depression  ("I'm such a bad this-or-that, I'm so stupid…"), and finally acceptance  ("this is the given, so what's to be done now?" is optimal — "this is the given, so what's my new certainty?" not so much).
   Only when one accepts reality as it is —not to project that the situation is ideal or that there's nothing to do, but to realise that this is the starting point of engagement, to realise that there's no benefit in hoping / waiting for a imaginary alternate scenario, to realise that the sooner one engages with what's here, the sooner one might influence it constructively (gplus.wallez.name/YMKvbdZ2ryx) — only then can one re-engage. The stages of grief are more-or-less inescapable (causality unfolding) but, with training, one can learn to go through them effectively and quickly, rather than drudgingly and painfully.
   This is similar to the practice of meditation: only when you re-center / re-focus, can you re-engage with the phenomenon at hand and work on your relationship to it (be it the relationship to your body, your mind, any of the five aggregates, or to any concept, any view…)!
   This is similar to driving: only when you're correctly focused (neither too loose nor too tight) rather than distracted (and / or your attention caught by a specific object asking for exclusivity), can you drive as safely as humanly possible!

   Over-confidence in your mastery of your own mind exposes you to the painful consequences of leaving dangerous blind-spots unattended. 
   Over-confidence in your driving, too much "I know how to drive",  is unhelpful, even dangerous.
   Over-confidence in your knowledge might cause suffering, even depression, when reality doesn't comply.
   Confidence is like a Middle Way in itself: too little is obviously harmful, as it is disempowering… but too much is destructive too, as it disempowers others (including 'allies'), and it blunts your sensitivity to changes, to impermanence, to nuances!

   When thinking "I know (I'm a doctor / experienced / trained / not stupid / …)",  one should remember not  to know! One should look for exceptions, for things to learn, for nuances and subtleties… One should remain open to feedback.

   This requires training, this requires the cultivation of "true confidence": the confidence that one can do one's best even without having to control all the in-and-outs of the situation at hand, the confidence that one can act and learn even without safety nets, the confidence in one's ownership of responsibility, the confidence that one will remain engaged no matter what comes next… 

   A key point to remember is that you don't need  to know for sure in order to act; "just" do your best (gplus.wallez.name/Tnx1pJdhsvv)! It's impossible e.g. for a first-aider to act if one "requires" pre-certainties… however, first-aiders make a big difference in the world!
   The more you know the better, the more scenarios seen the better, but only as far as it doesn't bias your judgement, only as far as it doesn't blind you for what's different this time…  Know "too much" and it prevents you from remaining on the lookout for exceptions; know "too much" and you're putting yourself and others in danger! As with all other phenomena, the problem isn't the knowledge though, it's your relationship to it. "Too much" is only reached if you limit your appetite, if you define a threshold beyond which one might 'legitimately' rest on one's laurels… If you keep in mind (in practical terms, not just as an intellectual theory) that there's always more to know, always more to pay attention to, you're safer.
   The more you know, the more you might realise how little you know! This is "known" as the Socratic paradox. It's often easy to intellectually agree with this: the more you know, the better you understand the limits of any conventional view. The more you know, the easier you might see the extent of what's missing to achieve true mastery (this is very classic in martial arts: the better fighters are not as confident of 'winning' as the naïve beginners are… the better fighters are more aware that a small mistake is enough to turn the odds around, and that humans —including themselves— make mistakes…).
   But it's also extremely practical advice: "don't-know" —or relating to knowledge without dismissing it but also without relying on it as a recipe (for success, i.e. for one's satisfaction)— is important!
   Phenomena are unsatisfactory, unreliable, dukkha.  This is the first noble truth. Views, as more-or-less ignorant derivatives of phenomena, also are unsatisfactory, unreliable, dukkha.  Counting on views, on 'truths', on 'knowledge' is only relevant when they apply; and it's very easy (too easy) to convince oneself that one's views apply even when they don't! Views, truths and knowledge are unsatisfactory, unreliable, dukkha.  That's why Buddhism advises to "drop all views."  This is obviously not about becoming dumb, but it's about one's relationship to knowledge. Knowledge when grasped inappropriately proves painful, just like grasping a serpent by the tail isn't safe. Similarly, "I know that I know nothing"  is not  saying that Plato's Socrates does not know anything, but means instead that he cannot know anything with the absolute certainty  of seeing and feels confident only in his possibly being mistaken about what he has known through seeing.

   Don't-know, drop all views: pay attention to whatever might not be included yet in your knowledge! Pay attention to whatever might have been missed! Even if you do 'know', is what you're doing truly the top priority at this time and place? Look! « What is this? »  Don't aim for "right view", aim for "harmonious view" (gplus.wallez.name/i74AzY5wEQL).


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