Some Thoughts About Thinking

I recently did a corporate “lunch and learn” on metacognition, which is our singular ability to think about our thoughts (as far as I can tell, my dog has no such capacity). This would appear abstract and likely impractical but it is actually the key to mental health.

I’m happy to work at the level of things and thoughts. The former generally involves practical solutions (problem solving) while the latter consists of philosophical solutions (e.g., cognitive behavioral therapy). But I’m much more interested in the thinker—that’s where the ultimate solution lies.

The “thinker” in this context is consciousness or awareness, which is always present but seldom appreciated. As Rupert Spira counsels, “Allow the experience of being aware to come into the foreground of experience, and let thoughts, images, feelings, sensations and perceptions recede into the background. Simply notice the experience of being aware. The peace and happiness for which all people long reside there.” Elsewhere, he advises, “Be knowingly the presence of awareness.”

You can find my PowerPoint here or by clicking on the image above. ✸

P.S. If this sounds like mindfulness, it might be. Mindfulness has become one of those everyday words that now lacks meaning, or at least a shared understanding. For an interesting perspective, please see Stephan Bodian’s Beyond Mindfulness:

“For all its wonderful benefits, the practice of mindfulness has another downside: it tends to maintain the subject–object split, the gap between the one who’s being mindful, the act of being mindful, and the object of mindful attention. In other words, no matter how mindful you become, there’s always a you that has to practice being mindful of an object separate from you. As a result, mindfulness perpetuates the very sense of separation it’s designed to overcome.”

Being & Doing

I recently simplified my life. The superficial, corporate explanation is that I wanted to work less and spend more time with my family. That’s all true but behind it is the perennial tension between being and doing.

Thomas Merton and Wei Wu Wei both explored this apparent dichotomy in the 1950s. The latter noted, “Doing is an avoidance, an escape, a running away from Reality.”

And Merton observed, “We do not live merely in order to ‘do something’—no matter what. … On the contrary, some of us need to discover that we will not begin to live more fully until we have the courage to do and see and taste and experience much less than usual.”

So when people ask me what I’m going to do with my newfound time, the answer is that I plan to be, which is different than passivity and idleness. ✸

Chasing Your Tail

Years ago, in one of my former lives, Scott Hinrichs, HealthEast’s vice president for mission, bioethics and spiritual care, tapped me to speak at its annual President’s Prayer Breakfast. I’m not sure that the audience walked away with much, however, the event was a tremendous gift to me. Absent the commitment, I doubt that I would have reflected on my spiritual journey.

The PowerPoint has generally aged well. I’m not sure that I would add much today—except, perhaps this Lars Kenseth cartoon, which I saw over the weekend, and some stuff from Stephan Bodian’s Beyond Mindfulness. By all means laugh, but then puzzle for a few minutes over the deeper meaning.

What’s that part of you that’s been there all along?

Lars Kenseth. Originally published in Wired on Wednesday, March 4th, 2020.

Postscript. I didn’t immediately realize that today marks the 10th anniversary of my presentation. More than coincidence? ✸

Top Doctor 2021

I was recently notified that I’ve been named to Minnesota Monthly’s annual Top Doctors listing. I appreciate the ongoing recognition from my peers.

I consider awards like this professional capital—they allow me to do more for my patients and our community. And spend it I will! Some examples are virtual addiction care at Allina Health and CentraCare Health, and various media appearances

The Top Doctors listing will appear in the September/October issue of Minnesota Monthly, which hits the newsstands on August 26th. Minnesota Monthly also maintains an online provider directory. ✸

Zoom Fatigue

I recently appeared on WCCO Television (Twin Cities) to discuss “Zoom fatigue,” a phenomenon that has emerged as we spend hour upon hour interacting via virtual means. The science is still very early, however, Jeremy Bailenson, Ph.D., at Stanford University has offered compelling theories concerning possible causes and suggested some countermeasures.

WCCO Television | 03/10/2021

Many thanks to Sarah Jackson with Media Minefield for her continuing partnership on translating evidence into action. ✸

My First Million

Meditation is my medication. I added Muse, the brain-sensing headband, to my meditation practice in July. I hit the 1,000,000 mark yesterday for “calm points.”

“Thanks a Million” is the alternate title for this post—as in, many thanks to InteraXon, the company that developed Muse and brought it to market. My quality of life so much better because of it.

Tech specs: I use Muse S in the constructive rest position with an iPhone 11 Pro, AirPods Pro and sleep mask. What’s going on inside my head is a little harder to describe, however, this post provides a general sense. ✸

Who Am I?

I’m finally getting around to memorializing some of the “self-help” books that have helped me over the years. The thread that runs through this grouping is the difference between “I” and “me” (or “true self” vs. “false self” or “observing self” vs. “observed self”—this has been described in various ways).

David A. Frenz, M.D.

“Me,” the conceptual self, can suffer; “I,” which is pure awareness or consciousness, never can. The end of suffering involves withdrawing your attention from “me” and resting in “I.”

This can be a little difficult to understand, let alone practice, which is why I seldom use it psychotherapeutically. But for those who are ready, it can be liberating.

Anthony de Mello’s Stripping Down to the “I” (starts on Page 46) is a great place to start. If it seems like nonsense, don’t be troubled and simply ignore this post. If, however, you’re intrigued, consider reading on.

Self-Care During a Pandemic

Update [10/12/2020]: Here’s the recording of the session. Enjoy!

Remember airplanes? In the event of an emergency, flight attendants advise us to adjust our own oxygen masks before helping others. I’ve always found that an apt metaphor for anyone in the healing arts.

Delta Air Lines, Inc.

Tomorrow I’m presenting on self-care during a pandemic (but it could be any personal or shared crisis really). Not self-care for our patients and clients—but self-care for ourselves. The main message concerns the relationship that we have toward time and the present, although there will some other stuff sprinkled in as well.

Many thanks to the University of Minnesota’s Center for Practice Transformation for hosting the event. It’s not too late to sign up and the price is right (free)! ✸


The Twins were eliminated by the Astros yesterday, however, it’s still baseball season! In that spirit, I’m “pitching” a split doubleheader today in two different ballparks through the wonders of Zoom.

The first presentation is for the Minnesota Sheriff’s Association at its Correction Care Division’s Annual Conference. The subject is identification and management of substance withdrawal syndromes (I’m the medical director for two county jails).

CentraCare Health; St. Cloud, Minn.

The second outing is for CentraCare Health at its Opioid and Controlled Substances Prescribing Training. I’m the middle reliever in a line-up that includes Drs. Michael Massey (pain medicine) and Lynn McFarling (medical informatics). The two-hour event is designed to fulfill Minnesota’s new(ish) legislative mandate for provider education. My contribution deals with unhealthy substance use with special attention to patients with chronic pain syndromes.

CentraCare Health; St. Cloud, Minn.

Just click on the above images or hyperlinked text to access my PowerPoints. ✸

Heal the Sick

Downtown Minneapolis is bleak right now. The towers have been empty since the shelter-in-place order was issued last winter. Many buildings are boarded up due to property damage from rioting. Sirens are constantly going off because of the sharp increase in crime. Street vagrancy is prevalent outside of my office building.

The world is upside down, however, this abandoned church reminds me every morning to continue healing the sick. ✸

Former Second Church of Christ Scientist
228 South 12th Street; Minneapolis, Minnesota