Letting Go...

"Although we have been made to believe that if we let go we will end up with nothing, life reveals just the opposite: that letting go is the real path to freedom."
—Sogyal Rinpoche
Glimpse After Glimpse

How to make the world better.....

“How wonderful it is that nobody need wait a single moment before starting to improve the world.” -Anne Frank

The hardest part of doing something new is starting. There will always be a lot you don’t know. There will always be fears to overcome. There will always be doubts about what you can do. Feel it all and get started anyway. Take one simple step.

Every day is a new opportunity to make a positive difference in the world, regardless of who you’ve been and what you’ve done before. Everyday is a rebirth, a new chance to make your day matter in a way that’s deeply personal and meaningful to you.

How can you start to improve the world today?

Get Carried Away....

Get Carried Away

You've tried everything and still aren't where you want to be. So stop struggling and let life move through you.

By Sally Kempton

By nature I'm a struggler, raised in the belief that if what you're doing doesn't work, the solution is to do it harder. So naturally, I had to learn the value of surrender the hard way. About 30 years ago, as a relatively early U.S. adopter of meditation, I was asked by a curious editor at a mainstream magazine to write an article about my spiritual search. Problem was, I couldn't find a voice for it. I spent months, wrote maybe 20 versions, stacked up hundreds of scribbled pages—all for a 3,000-word article. When I finally cobbled together my best paragraphs and sent them off, the magazine shot the piece back to me, saying that they didn't think their readers could identify with it. Then another magazine invited me to write the same story. Knowing I had come to an impasse, I threw myself down on the ground and asked the universe, the inner guru—well, all right, God—for help. Actually, what I said was this: "If you want this to happen, you'll have to do it, because I can't."

Ten minutes later I was sitting in front of the typewriter (we still used typewriters in those days), writing a first paragraph that seemed to have come out of nowhere. The sentences sparkled, and though it was in "my" voice, "I" definitely did not write it. A month later, I told the story to my teacher. He said, "You're very intelligent." He wasn't talking about my IQ. He meant that I had realized the great and mysterious truth of who, or what, is really in charge.

Since then I've had the same experience many times—sometimes when facing the pressure of a deadline, a blank page, and a blank mind, but also when meditating, or when trying to shift some difficult external situation or implacable emotional attachment.

My miracle-of-surrender stories are rarely as dramatic as the tales you hear of scientists who move from impasse to breakthrough discovery or of accident victims who put their lives in the hands of the universe and live to tell the tale. Nonetheless, it's clear to me that each time I genuinely surrender—that is, stop struggling for a certain result, release the holding in my psychic muscles, let go of my control freak's clutch on reality, and place myself in the hands of what is sometimes called a higher power—doors open in both the inner and outer worlds. Tasks I couldn't do become easier. States of peace and intuition that eluded me show up on their own.

Patanjali, in the Yoga Sutra, famously describes the observance of Ishvara pranidhana—literally, surrender to the Lord—as the passport to samadhi, the inner state of oneness that he considers the goal of the yogic path. Among all the practices he recommends, this one, referred to casually in only two places in the Yoga Sutra, is presented as a kind of ultimate trump card. If you can fully surrender to the higher will, he seems to be saying, you basically don't have to do anything else, at least not in terms of mystical practice. You'll be there, however you define "there"—merged in the now, immersed in the light, in the zone, returned to oneness. At the very least, surrender brings a kind of peace that you don't find any other way.

You probably already know this. You may have learned it as a kind of catechism in your first yoga classes. Or you heard it as a piece of practical wisdom from a therapist who pointed out that nobody can get along with anyone else without being willing to practice surrender. But, if you're like most of us, you haven't found this idea easy to embrace.

Why does surrender engender so much resistance, conscious or unconscious? One reason, I believe, is that we tend to confuse the spiritual process of surrender with giving up, or getting a free pass on the issue of social responsibility, or with simply letting other people have their way.

Don't Give Up, Surrender

A few months after I began meditation, a friend invited me to dinner. But we did not agree on where to eat. He wanted sushi. I didn't like sushi. After a few minutes of argument, my friend said, quite seriously, "Since you're doing this spiritual thing, I think you ought to be more surrendered."

I'm embarrassed to admit that I fell for it, giving in partly for the sake of having a nice evening, but mostly so that my friend would continue thinking that I was a spiritual person. Both of us were confusing surrender with submission.

This is not to say there is no value—and sometimes no choice—in learning how to give way, to let go of preferences. All genuinely adult social interactions are based on our shared willingness to give in to one another when appropriate. But the surrender that shifts the platform of your life, that brings a real breakthrough, is something else again. True surrender is never to a person, but always to the higher, deeper will, the life force itself. In fact, the more you investigate surrender as a practice, as a tactic, and as a way of being, the more nuanced it becomes and the more you realize that it isn't what you think.

Fight for What's Right.

My favorite surrender story was told to me by my old friend Ed. An engineer by profession, he was spending some time in India, at the ashram of his spiritual teacher. At one point, he was asked to help supervise a construction project, which he quickly found was being run incompetently and on the cheap. No diplomat, Ed rushed into action, arguing, amassing proof, bad-mouthing his colleagues, and staying up nights scheming about how to get everyone to see things his way. At every turn, he met resistance from the other contractors, who soon took to subverting everything he tried to do.

In the midst of this classic impasse, Ed's teacher called them all to a meeting. Ed was asked to explain his position, and then the contractors started talking fast. The teacher kept nodding, seeming to agree. At that moment, Ed had a flash of realization. He saw that none of this mattered in the long run. He wasn't there to win the argument, save the ashram money, or even make a great building. He was there to study yoga, to know the truth—and obviously, this situation had been designed by the cosmos as the perfect medicine for his efficient engineer's ego.

At that moment, the teacher turned to him and said, "Ed, this man says you don't understand local conditions, and I agree with him. So, shall we do it his way?"

Still swimming in the peace of his newfound humility, Ed folded his hands. "Whatever you think best," he said.

He looked up to see the teacher staring at him with wide, fierce eyes. "It's not about what I think," he said. "It's about what's right. You fight for what's right, do you hear me?"

Ed says that this incident taught him three things. First, that when you surrender your attachment to a particular outcome, things often turn out better than you could ever have imagined. (Eventually, he was able to persuade the contractors to make the necessary changes.) Second, that a true karma yogi is not someone who goes belly-up to higher authority; instead, he's a surrendered activist—a person who does his best to help create a better reality while knowing that he's not in charge of outcomes. Third, that the attitude of surrender is the best antidote to one's own anger, anxiety, and fear.

I often tell this story to people who worry that surrender means giving up, or that letting go is a synonym for inaction, because it illustrates so beautifully the paradox behind "Thy will be done." As Krishna—the great mythic personification of higher will—tells Arjuna in the Bhagavad Gita, surrender sometimes means being willing to get into a fight.

A truly surrendered person may look passive, especially when something appears to need doing, and everyone around is shouting, "Get a move on, get it done, this is urgent!" Seen in perspective, however, what looks like inaction is often simply a recognition that now is not the time to act. Masters of surrender tend to be masters of flow, knowing intuitively how to move with the energies at play in a situation. You advance when the doors are open, when a stuck situation can be turned, moving along the subtle energetic seams that let you avoid obstructions and unnecessary confrontations.

Such skill involves an attunement to the energetic movement that is sometimes called universal or divine will, the Tao, flow, or, in Sanskrit, shakti. Shakti is the subtle force—we could also call it the cosmic intention—behind the natural world in all of its manifestations.

Surrender starts with a recognition that this greater life force moves as you. One of my teachers, Gurumayi Chidvilasananda, once said that to surrender is to become aware of God's energy within oneself, to recognize that energy, and to accept it. It's an egoless recognition—that is, it involves a shift in your sense of what "I" is—which is why the famous inquiry "Who am I?" or "What is the I?" can be a powerful catalyst for the process of surrender. (Depending on your tradition and your perspective at the time, you may recognize that the answer to this question is "Nothing" or "All that is"—in other words, consciousness, shakti, the Tao.)

Practice Makes Possible

The great paradox about surrender—as with other qualities of awakened consciousness, such as love, compassion, and detachment—is that though we can practice it, invoke it, or open up to it, we can't actually make it happen. In other words, just as the practice of being loving is different from being in love, so the practice of surrendering is not the same as the state of being surrendered.

As a practice, surrender is a way of unclenching your psychic and physical muscles. It is an antidote to the frustration that shows up whenever you try to control the uncontrollable. There are any number of ways to practice surrender—from softening your belly, to consciously opening yourself to grace, turning over a situation to the universe or to God, or deliberately letting go of your attachment to an outcome. (I often do this by imagining a fire and imagining myself dropping the issue or thing I'm holding on to into that fire.)

When the attachment or the sense of being stuck is really strong, it often helps to pray for surrender. It doesn't matter who or what you pray to, it matters only that you are willing to ask. At the very least, the intention to surrender will allow you to release some of the invisible tension caused by fear and desire.

However, the state of surrender is always a spontaneous arising, which you can allow to occur but never force. Someone I know describes his experiences of the state of surrender like this: "I feel as if a bigger presence, or energy, pushes aside my limited agendas. When I feel it coming, I have a choice to allow it or resist it, but it definitely comes from a place beyond what I think of as me, and it always brings a huge sense of relief."

This is not something you can make happen, because the small self, the individual "me," is literally not capable of dropping its own sense of ego boundary.

Early in my practice, I had a dream in which I was dropped into an ocean of light. I was "told" that I should dissolve my boundaries and merge into it, that if I could, I would be free. In the dream, I struggled and struggled to dissolve the boundaries. I couldn't. Not because I was afraid, but because the "me" who was trying to dissolve itself was like a person trying to jump over her own shadow. Just as the ego can't dissolve itself, so too the inner control freak can't make itself disappear. It can only, as it were, give the deeper will permission to emerge in the forefront of consciousness.

Many of us first experience spontaneous surrender during an encounter with some great natural force—the ocean, the process of childbirth, or one of those incomprehensible and irresistible waves of change that sweep through our lives and carry away a relationship we've counted on, a career, or our normal good health. For me, opening into the surrendered state typically comes when I'm pushed beyond my personal capacities. In fact, I've noticed that one of the most powerful invitations to the state of surrender happens in a state of impasse.

Here's what I mean by impasse: You are trying as best you can to make something happen, and you're failing. You realize that you simply cannot do whatever it is you want to do, cannot win the battle you're in, cannot complete the task, cannot change the dynamics of the situation. At the same time, you recognize that the task must be completed, the situation must change. In that moment of impasse, something gives in you, and you enter either a state of despair or a state of trust. Or sometimes both: One of the great roads to the recognition of grace leads through the heart of despair itself.

Trust the force Within

But—and here is the great benefit of spiritual training, of having devoted yourself to practice—it's also possible, like Luke Skywalker confronting the Empire in Star Wars, to move straight from the realization of your helplessness into a state of trusting the Force. In either case, what you've done is opened to grace.

Most transformational moments—spiritual, creative, or personal—involve this sequence of intense effort, frustration, and then letting go. The effort, the slamming against walls, the intensity and the exhaustion, the fear of failure balanced against the recognition that it is not OK to fail—all these are part of the process by which a human being breaks out of the cocoon of human limitation and becomes willing on the deepest level to open to the infinite power that we all have in our core. It's the same process whether we're mystics, artists, or people trying to solve a difficult life problem. You've probably heard the story of how Einstein, after years of doing the math, had the special theory of relativity downloaded into his consciousness in a moment of stillness. Or of Zen students, who struggle with a koan, give up, and then find themselves in satori.

And then there's you and me, who, when faced with an insoluble problem, bang against the walls, go for a walk, and have a brilliant insight—the book's structure, the company's organizing principles, the way out of the emotional tangle. These epiphanies arise seemingly out of nowhere, as if your mind were a slow computer and you had been entering your data and waiting for it to self-organize.

When the great will opens inside you, it's like going through the door that leads beyond limitation. The power you discover in such moments has an easeful inevitability about it, and your moves and words are natural and right. You wonder why you didn't just let go in the first place. Then, like a surfer on a wave, you let the energy take you where it knows you're meant to go.

Sally Kempton, also known as Durgananda, is an author, a meditation teacher, and the founder of the Dharana Institute. For more information, visitwww.sallykempton.com.

Productivity and Happiness: Why Are We So Busy.........?

by Lori Deschene

”Life is what happens when you are making other plans.” ~John Lennon

There have been times in my life when I believed all my happiness revolved around how busy I was. If I was busy, I was using time wisely. If I was busy, I was proving to myself that I was valuable. If I was busy, I was creating the possibility of a better life in the future. Any threat to my productivity was a threat to my sense of hope.

Being busy didn’t make me feel happy but it created the illusion that I was somehow building a foundation for that feeling someday, somewhere, when I could finally slow down and be free.

Most of us are fiercely defensive of our busy-ness. We have processes to streamline, goals to accomplish, promotions to earn, debt to eliminate, exercise regimes to master, dreams to chase—and hopefully along the way, people to help and inspire.

We multitask, even when it means not truly being present in an activity we enjoy; and maybe even feel guilty for blocks of unplanned time in our schedules. We look for productivity hacks and apps, join forums to discuss ways to get more things done—and when we do aim to simplify our lives, even that undertaking involves a lengthy to-do list.

Our obsession with productivity is partly a reflection on our beliefs about the American dream—the idea that our potential for happiness is intricately tied to our freedom to pursue wealth.

When you consider that 80 percent of the country thinks they will one day become rich, when in reality less than 10 percent will, it makes sense that many people live life like a race. We’re competing to beat the odds.

We think we must work harder and longer than the majority—squeeze more into our day than other people—if we’re to amass a fortune so we can escape the drudgery of work as we know it.

That perception turns the present into something to endure instead of something to fully enjoy.

Our working reality doesn’t have to be so painful that we can’t wait to escape it. If we follow our bliss, we can fill our days with work that stretches us, fulfills us, and endows life with a whole new level of meaning. And in terms of money leading to happiness—it only works that way if you’re already happy.

Take my friend, for example. She is a lovely person who unfortunately fills her time focusing on everything her life lacks. She frequently comments, “I’d be happier if I didn’t have to work” or “I’d be happier if I didn’t have bills or “I’d be happier if I had my own place.”

She spins her wheels trying to create a world that allows her to kick back and breathe, but odds are if she found herself in that place she’d have no idea how to appreciate it.

We all need to decide for ourselves what the dream really looks like. There are likely parts of it you have to work for, and parts of it that require no more than tuning into what you already have.

The irony in our tendency to do more to become more is that efficiency does not necessarily guarantee effectiveness. Completing the items on your to-do list does not inherently imply you’ve done them well. Getting more done is not an accurate barometer for measuring your impact.

In fact, odds are squeezing more into your day detracts from your ability to be effective in each situation. What would make a day more valuable to your intentions: 20 actions that moved you one foot closer to the change you’d like to see or 5 actions that moved you 10 feet closer?

Whenever we expel energy, it’s important to consider the law of diminishing returns. This economic theory states that after a certain point, increased investment will not necessarily generate proportional returns.

So for example, if you run a telemarketing company, and you have five phones, hiring ten employees won’t yield double the sales because there isn’t enough equipment to go around. In much the same way, if you spend 10 hours working, but every hour after 5 your performance declines, half of your time will be far less effective than you intend it to be.

Another thing to consider is whether or not you’re being effective in achieving what you actually want. Sometimes we can feel certain we know what we want to do only to later realize we were trying to please something else, or doing what we thought we should do, or failing to be honest with ourselves.

I grew up thinking I wanted to become a famous actress. It wasn’t until I got sick and spent a prolonged amount of time in a hospital that I realized what I really wanted was validation.

For me, time incapacitated was the most effective time of my life because I established what I really desired—both personally and professionally. The experience of not doing helped me better understand what I actually wanted to do.

Think about what it is you’re really seeking and what might be the most direct path to get it. Then realize that sometimes doing less can actually pave the path to experiencing more–more satisfaction, more ease, and even more effectiveness.

Contrary to conventional wisdom, research suggests that happiness leads to success, not the other way around—meaning it would benefit us to shift our focus from achieving future happiness to accessing that joy right now.

Think about how we experience life when we’re focused on getting things done. When you concentrate all your energy on completing tasks, how much of those chores do you experience mindfully? How much joy do you derive from an activity you see as an obstacle between where you are and where you’d like to be?

When we wrap our days around things we have to do we leave very little time for the things we want to do. Happiness requires a balance.

We need time with the people we love. We need space to do the things we enjoy without any agenda other than having fun. We need opportunities to disconnect our minds and experience the world with childlike curiosity and wonder. All of this requires us to whittle away at our busyness.

I’m not saying we shouldn’t have and pursue goals. I’m also not suggesting we should find ways to avoid work. Wecan transform ourselves and our lives not just through the results of our labor but through the efforts themselves.

For example, the process of maintaining this site fulfills me regardless of who reads it. The doing is in itself the reward.

We can all create a reality that is not just a means but an end in itself. It starts by asking ourselves a few very important questions to be sure our efforts support our true intentions:

• What is it you really want to accomplish?
• What can you do today that supports your deepest passions?
• If you knew your days were numbered, how much time would you want to devote to activities that have nothing to do with striving and achieving?
• Our days are numbered–so why not start creating that type of balance now?

On Really Living....

“Death is more universal than life. Everyone dies but not everyone lives.” -Alan Sachs

Sometimes it takes us years to realize we’re not really living. We’re going through the motions–getting up, doing work, and playing nice–but we’re not really feeling a sense that we’re engaged and empowered in the world.

You can find all kinds of excuses to stay that way. I’m fairly sure I have 10 journals full of them. For a while, they’re kind of comforting. It’s not you holding yourself back–it’s your family, or the economy, or the world in general. It’s everything around you that makes it hard to be the you that you really want to be.

Excuses are death. They allow no option for growth or possibility.

Today take some time  to identify three goals that make you excited, and then take one small step toward one of them. Life doesn’t require a daily grand adventure. But truly living requires an adventurous spirit that constantly chooses to find an outlet.

On Really Living....

“Death is more universal than life. Everyone dies but not everyone lives.” -Alan Sachs

Sometimes it takes us years to realize we’re not really living. We’re going through the motions–getting up, doing work, and playing nice–but we’re not really feeling a sense that we’re engaged and empowered in the world.

You can find all kinds of excuses to stay that way. I’m fairly sure I have 10 journals full of them. For a while, they’re kind of comforting. It’s not you holding yourself back–it’s your family, or the economy, or the world in general. It’s everything around you that makes it hard to be the you that you really want to be.

Excuses are death. They allow no option for growth or possibility.

Today take some time  to identify three goals that make you excited, and then take one small step toward one of them. Life doesn’t require a daily grand adventure. But truly living requires an adventurous spirit that constantly chooses to find an outlet.

Maitri

When people start to meditate or to work with any kind of spiritual discipline, they often think that somehow they're going to improve, which is a sort of subtle aggression against who they really are. It's a bit like saying, "If I jog, I'll be a much better person." "If I could only get a nicer house, I'd be a better person." "If I could meditate and calm down, I'd be a better person"...

But loving-kindness - maitri - toward ourselves doesn't mean getting rid of anything. Maitri means that we can still be crazy after all these years. We can still be angry after all these years. We can still be timid or jealous or full of feelings of unworthiness. The point is not to try to change ourselves. Meditation practice isn't about trying to throw ourselves away and become something better. It's about befriending who we are already. The ground of practice is you or me or whoever we are right now, just as we are. That's the ground, that's what we study, that's what we come to know with tremendous curiosity and interest.

- Pema Chodron

Peaceful, Easy Healing.....

Peaceful, Easy Healing

More and more patients are rejecting harsh and invasive conventional treatments in favor of alternative therapies. In response, several prominent health institutions are embracing holistic healing.

By Stacie Stukin

Joanne Perron, M.D., spent five years practicing medicine in a busy OB/GYN office, where the patients trundled through as if on an assembly line—in and out in 10 minutes. "I was frazzled," she recalls by phone from her home in Monterey, California. "By the end of the day, I felt disconnected and stressed. Eventually, I got very frustrated and disillusioned and began to ask myself, 'Is that all there is?'"

Perron had to face the fact that she wasn't the healer she had set out to become. "Conventional medicine is like a religion," she says. "You get indoctrinated at an early age, and then sometimes you start to question your belief system. You start to ask, 'Why?'—or, more important, 'Why not?'"

The questioning began as she realized that the things conventional medicine had taught her didn't often cure her patients. And some of those patients came back to tell her they'd gotten better after trying alternative therapies—for example, botanical remedies for menopausal symptoms, Chinese herbs for uterine bleeding, or acupuncture for pain. In Georgia, where she was then practicing medicine, prayer is commonly employed to help healing as well. "I felt there was a gap in my knowledge. My patients were pursuing things I knew nothing about," she says. "I had learned all that I could, but I knew I needed to learn more." Perron cut back her hours at work and started taking yoga classes; in time, she enrolled in a 200-hour yoga teacher certification program.

Perron's patients are part of the growing group of Americans turning toward complementary and alternative medicine to cure their ills and improve their quality of life. A national survey released last May by the National Center for Complementary and Alternative Medicine (NCCAM) and the National Center for Health Statistics found that 36 percent of U.S. adults use complementary and alternative medicine. That number jumps to 62 percent when prayer used specifically for health reasons is included in the definition. The reasons for alternative medicine's popularity go beyond the practical, according to a 1998 Journal of the American Medical Association article authored by John A. Astin, Ph.D., titled "Why Patients Use Alternative Medicine." Astin wrote that people seeking alternative medicine aren't necessarily dissatisfied with conventional medicine, but they find "these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life." It's true; there has been a significant evolution in our time toward a more proactive, holistic view of well-being.

---

Conventional medicine has a lopsided view of the physical, mental, and spiritual body," surmises Andrew Weil, M.D. By now a cultural icon with his friendly smile and oversize gray beard, Weil has long been willing to take on the medical mainstream and advocate what he calls integrative medicine. His definition of the term is very straightforward: healing-oriented medicine that takes into account the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic partnership between consumer and healer and makes use of all appropriate therapies, both conventional and alternative.

In 1994, Weil was instrumental in creating the University of Arizona medical school's Program in Integrative Medicine, the first comprehensive, continuing-education fellowship to give physicians the chance to learn about alternative therapies such as botanicals, acupuncture, Reiki, massage, diet, and meditation—and how they can be used to enhance medical care, prevent illness, and improve quality of life. But more important, this program encourages a philosophical shift in the practice of the healing arts. "Rather than just bringing these therapies in with a focus on disease, we're looking at the whole body, at lifestyle, at the relationship between the practitioner and the patient," Weil explains. "Not only is this the kind of medicine patients want, but it has the potential to restore the core values of medicine in an age of managed care."

Perron enrolled in the University of Arizona's Integrative Medicine program precisely to return to a path more aligned with her original motives for becoming a doctor. "I wanted to feel more like I was participating in healing," she explains. Perron was in the second graduating class of an associate fellowship program that requires 1,000 hours of course work (mostly online) over a two-year period and three on-site workshops. So far, the University of Arizona's Program in Integrative Medicine has turned out 151 physicians who have learned how to integrate the best of the East and the West into their medical practices—and into their own lives.

Yet, how far have we really come since Weil started his program, considering there are more than 800,000 doctors in the country? Medical schools are loath to require an integrative curriculum. Even the University of Arizona medical school does not require an integrative course; integrative medicine remains an elective. Under these circumstances, what kind of impact can 150 or so physicians make?

Even though some people in the medical establishment refer patients to therapies like acupuncture or massage, there still exists a bias toward allopathic (that is, conventional) medicine. Perron has experienced this resistance from medical colleagues who are skeptical of her integrative approach. "There is this suspicion that what I'm trying to do is too 'woo-woo,' too far out in left field," she says.

Weil has certainly stood up to his fair share of flak, some of it virulent. For example, in a 1998 New Republic article, Weil gadfly Arnold S. Relman, M.D., former editor-in-chief of the New England Journal of Medicine and professor emeritus of medicine and social medicine at Harvard Medical School, opined, "'Breathing' is an important and recurring theme in Weil's prescriptions for health and healing, and it holds a prominent place in [Weil's book] Eight Weeks to Optimum Health, which appeared in 1997. As far as I can see, his opinions on this subject are largely nonsense." Relman, apparently unfamiliar with the yogic arts, added, "In the absence of supporting evidence… skepticism is surely in order, particularly since belief in much of what Weil is saying about mind and body, and the ability of consciousness to operate in the physical world, requires a rejection of the fundamental physical laws upon which our current views of nature and the human body are based." Weil dismisses these comments as a tirade from "the quackbuster crowd. They'll pass from the scene. They're ideologues claiming to be skeptics."

---

With or without Weil, the medical establishment cannot ignore the trend toward integrative medicine, especially considering the economics. In 1998, Americans spent $23.7 billion on alternative health care providers; in 1999, they spent $4.4 billion on herbs, up from $2.5 billion in 1995. Additionally, the proportion of hospitals offering complementary and alternative medicine has doubled, from 8 percent in 1998 to 16.7 percent in 2002, according to the American Hospital Association. Medical schools have taken note: nearly two-thirds now offer some kind of elective integrative medicine curriculum.

Tracy Gaudet, M.D., director of Duke University's Center for Integrative Medicine (she was formerly the executive director of the University of Arizona's integrative medicine program), has given herself and her cohorts a big charge. "Our goal is to change the whole approach to health care in this country," she explains. "We realize that it's not just about using botanicals or getting acupuncture. People are saying they want the whole paradigm of treatment to shift toward a more proactive concept. People want to plan for their health and not wait for something bad to happen. That way we're looking at the whole scope of a person—mind, body, and spirit, not just the body."

To that end, Gaudet and her colleagues at Duke have designed what they're calling a "prospective" health care model, one that provides patients with individualized health care planning and goals utilizing a range of modalities outside the medical mainstream—practices and resources like yoga, mindfulness, meditation, and nutrition. Perhaps the most innovative component of the Duke model is the concept of a "health coach," someone trained to motivate behavior change. Initial results from a 10-month pilot study, presented at an American Heart Association meeting last year, indicate that participants in the intervention group significantly reduced their risk of developing heart disease. And this year, Duke will publish results showing that this group exercised more frequently and ate more healthful meals than the control group.

Renée Halberg, a licensed clinical social worker at the Duke University Eye Center, enrolled in the study to help deal with stress and menopausal weight gain. At her intake interview, she learned that her family history of adult-onset diabetes and hypertension, coupled with her being overweight, greatly increased her risk for those diseases. "I learned how much I could change that bad outcome," she says. "It was alarming when they presented me with these risk factors articulated in lab results. It was also very motivating."

The most valuable skill Halberg learned was the ability to change her behavior toward the stress in her life. "Like thousands of other people, I substituted food for the things I lost: I was depressed. I was grieving over not having had a child. I went through a divorce. And I gained 60 pounds," she recalls. "That was horrifying, especially since I didn't have any tools to do anything about it."

The program, especially the mindfulness and meditation training, helped her find her inner strength and motivation. So far, she has lost about 25 pounds and changed her diet to incorporate whole grains, seeds, vegetables, and low-fat foods and to eliminate fats and processed carbohydrates. Her blood pressure went from 150/90 to 120/80, and her cholesterol levels are stable. But the breathwork and relaxation skills are what have helped her the most. "Every time I have the impulse to eat something like a candy bar, I do deep breathing or progressive muscle relaxation," she says. "It takes my mind off it, and by the time I'm finished, I lose the desire. I feel centered and refreshed, and I realize I can depend on myself instead of just reacting to the stresses of the external world."

---

Research like Duke University's is key to effecting change within the medical establishment. Without it, it's very hard for the scientifically minded to accept a more integrative approach to medicine. The good news is that funding for alternative therapy research has grown tremendously, driven mostly by the creation of the NCCAM. From an initial annual budget of $2 million in 1993, the center has grown to a projected 2005 budget exceeding $121 million, and today it is funding groundbreaking research.

Memorial Sloan-Kettering Cancer Center in New York is one of the institutions taking advantage of NCCAM's grant money. Having opened an integrative medicine center in 1999 both to treat patients and to further scientific evaluation of complementary therapies, the research hospital has several studies under way. One is looking at the effects of acupuncture on breast cancer patients suffering from chemotherapy-induced hot flashes, another is investigating massage therapy, and a third is exploring whether specific Asian herbs can reduce or kill off tumors. The center's therapeutic and research work is nicely interwoven and accessible—for example, its Web site (www.mskcc.org) includes an "About Herbs" database of herbs, botanicals, vitamins, and supplements that is analyzed and monitored by an oncology-trained pharmacist and a botanicals expert. It provides overviews of research, interaction information, and adverse effects, and cites the benefits of herbal medicine—all in all, a tremendous resource.

But even the world-renowned cancer center encountered resistance when it first opened its integrative center. "It definitely took baby steps," says Simone Zappa, the center's program director. Once the doctors saw that alternative medicine was effective at managing symptoms like pain, nausea, and fatigue, however, things got easier. "I think I can say that we're 90 percent there now. But there are still certain things we have to be aware of. Doctors aren't going to take us seriously if we start talking about chakras and energy. No matter what our belief is, we have to maintain credibility in the doctors' eyes."

Sloan-Kettering's integrative medicine center offers both in- and outpatient care. For patients in the hospital, therapists come to the bedside and offer massage, meditation, hypnotherapy, and yoga sessions—at no extra charge. Just three blocks away, in a spa-like setting, is the Bendheim Integrative Medicine Center, Sloan-Kettering's outpatient integrative medicine facility. Just inside the entrance is a gurgling fountain and muted, calming colors. Crystals and mandala art grace some of the walls. Herbal tea, fruit, or juice breaks and conversation take place in a small kitchen area. At this facility, patients and their families can take yoga classes, learn hypnotherapy or meditation, get a massage, see a nutritionist, receive acupuncture, or take qi gong. "We are very involved with the families too," Zappa explains. "Families are often forgotten in cancer situations, and we want to offer them meditation, counseling, massage, and anxiety management techniques."

About 60 percent of the 700 patients seen each month at Bendheim are from the cancer center; the rest are from the general New York City population. For many of these patients, insurance does not cover visits to the center or services provided. This is a problem at most integrative medicine centers. While some states require at least partial coverage for treatments like acupuncture or chiropractic care, and certain insurance plans cover some complementary and alternative medicine, most consumers have to pay for such services out of pocket. Until research shows that this kind of care is cost-effective, coverage (or the lack thereof) is likely to remain the same. According to Weil, this is the biggest obstacle to the growth of integrative medicine. "Unless this inequality of reimbursement changes, it will just be integrative medicine for the affluent," he says.

George DeVries, founder of American Specialty Health, has been trying for 18 years to broaden the coverage available to consumers. His firm works with employers in much the same way as a dental or vision benefit package works, only American Specialty Health provides coverage for services like massage therapy, chiropractic care, acupuncture, diet counseling, and naturopathy. (Employers generally offer it as an extra benefit, in addition to traditional health insurance.) It covers 9.4 million members in all 50 states and works with a wide range of employers and health plans. The good news, DeVries says, is that NCCAM funding is leading to the publication of good research demonstrating alternative medicine's safety and efficacy. But the big question, he says, is cost: "How can we keep health care costs down? Is complementary health care cost-effective? The problem is, nobody has been able to prove that yet."

---

For Anna (who asked to be identified by her first name only), visiting Andrew Weil's clinic in Tucson was worth every out-of-pocket penny. This 33-year-old struggled with severe PMS for years—and it was getting worse. "My husband used to say it was like an alien had invaded my body," she recalls with a wry chuckle. Unfortunately, her erratic behavior and irrational anger weren't funny at the time. She realized she was really out of control when she started taking it out on her dog. "I hated being in the victim role, but I couldn't control myself," she says. She had tried Prozac for a number of years, until it stopped working. Out of desperation, she called Weil's clinic and got an appointment with clinic director Victoria Maizes, M.D.

After two visits, and following Maizes's recommendations, Anna was able to control her symptoms. The regimen Maizes prescribed included both a nutritional plan—fish oil capsules, salmon (preferably wild) three times a week, seven servings of fruits and vegetables a day—and a plethora of physical disciplines and alternative therapies—breathing techniques, cardiovascular exercise, guided imagery, acupuncture, and Chinese herbs. Finally, Maizes asked Anna if she ever prayed for herself about her PMS. "I happen to be a Christian, yet this thought never crossed my mind," Anna says. "That really showed me that she was treating me as a whole person. You never hear that when you see a doctor." Now Anna's symptoms are virtually gone, and when they do flare up, she has mechanisms she can use to cope. "Before I saw Dr. Maizes, I felt I had no control," she says. "Now I realize I can help myself. I can do my breathing; I can go exercise."

Meanwhile, Perron graduated from Weil's integrative program and had some health challenges of her own. At 45, she was diagnosed with breast cancer. And while she did receive conventional treatment, including a mastectomy and chemotherapy, she also integrated some complementary therapies into her plan. She utilized guided imagery, Reiki, and healing touch right before surgery. Afterward, she practiced yoga to improve the range of motion in her arms. She also took nutritional supplements during chemotherapy and received acupuncture instead of taking narcotics for pain. "I think the reason I have done so well with my recovery," she says, "is that I used everything I knew. I didn't reject the conventional, and I educated my oncologist in the process."

Perron is now on her new path as a physician. And while it may not yet be possible to quantify the impact Perron and other physicians trained in integrative medicine are having on our health care system, the fact that even a few practitioners are out there aiming to heal the whole person, rather than the specific body part that's ailing, makes a hugely positive difference to the patients receiving their care.

Back at work in a conventional medical office, Perron joined a practice with two other doctors, in part so she could expose them to her newfound knowledge and create change from within the model of a traditional practice. "They're putting their toes in the water and getting more comfortable with some of the things I talk about," she says of her colleagues. Now, when patients get nervous during pelvic exams or procedures, she teaches them Ujjayi breathing instead of giving them a Valium. She talks with them about breath focus for anxiety attacks and recommends botanical and nutritional supplements. She also makes a point of spending at least half an hour with each patient. Recently, she's been asked to teach yoga to oncology patients at a nearby cancer center. "I'm not sure I would have made it through my cancer treatment without the skills I have learned from integrative medicine and yoga," she says. "But now I have firsthand knowledge, and I feel I have greater ability to heal my patients." 

Frequent YJ contributor Stacie Stukin, who has been practicing yoga for 20 years, splits her time between Los Angeles and New York.