THEWORSTISOVERWhattoSayWhenEveryMomentCounts

by

JUDITHK.ACOSTA,LISW,CCH

JUDITHSIMONPRAGER,PHD

Hailedas“The‘Bible’ofCrisisCommunication”

NEWUPDATEDEDITION

Copyright©2002byJudithAcostaandJudithSimonPragerAllrightsreserved.Nopartofthisbook,exceptforthechartonpages184-189maybereproducedbyanymechanical,photographic,orelectronicprocess,orintheformofaphonographicrecording,normayitbestoredinaretrievalsystem,transmitted,orotherwisebecopiedforpublicorprivateuse—otherthanfor“fairuse”asbriefquotationsembodiedinarticlesandreviewswithoutpriorwrittenpermissionoftheauthors.

Theauthorsofthisbookdonotdispensemedicaladviceorprescribetheuseofanytechniquesasformsoftreatment forphysicalormentalproblemswithout theadviceofaphysician,eitherdirectlyor indirectly.The intent of the authors is only to offer information of a general nature to help you in your quest foremotionalandspiritualwell-being. In theeventyouuseanyof the information in thisbookforyourself,whichisyourconstitutionalright, theauthorsandthepublisherassumenoresponsibilityforyouractionsISBN:1494376539

ISBN13:9781494376536

SecondEdition,updated2014

AcclaimforTheWorstIsOver

The Worst Is Over will be known as the seminal work for teachingcompassionate crisis intervention communication to anyone who works withmedical and emotional emergencies.All future books by otherswill referencethissourceasthe“bible”forcrisiscommunication.

PattiWhite,Ph.D.,Editor,InternationalJournalofEmergencyMentalHealth.Vol.4,No.2,Spring2002.

TheWorstIsOverislikeananswertoaprayer.Itgiveseveryone,fromparenttofirefighter,theknowledgeandcouragetosayexactlytherightthingattherighttimeinawaythatishealing,uplifting,andalsolife-saving.

ChristianeNorthrup,M.D.Author,Women’sBodies,Women’sWisdom(Bantam,1998)

andTheWisdomofMenopause(Bantam,March2001)

I’vejusthadthepleasureofreadingyourmanuscript,VerbalFirstAid.Ifounditwellwritten and very informative. I agree thatwhat one says in the first fewmomentsof a physical or psychological crisis canhave a lasting effect on theperson in crisis.Your book is the best example of a practical, common-senseapproachtoprovidingpsychologicalsupportyetwrittenforthelaypublic.

GeorgeS.Everly,Jr.ChairmanoftheBoard,Emeritus,

InternationalCriticalIncidentStressFoundation,Inc.

[The Worst Is Over] is a major contribution to healing and one of the mostoriginalbooksIhavereadinsometime.Atthismomentinhistory,whenmanywishtotallytogivehealingovertodrugs,genomemanipulation,andstemcells,weneedthismessagemorethanever-thathumanconsciousness,andthewayswechoosetocommunicatewithoneanother,canmakethedifferenceinlifeanddeath.

LarryDossey,MDAuthor:HealingWordsandOneMind:HowOurIndividualMindisPartofaGreater

ConsciousnessandWhyitMatters

Thisisabookthatshouldbeinthehandsofeveryofficer,ineveryacademy,ineverycountyacrossthecountry.Theconceptsareessentialandlife-saving.

GeneMoynihan,CSW,CASACDirector,MemberAssistanceProgram,NewYorkCityPolice

VerbalFirstAid[TheWorstIsOver…]isrequiredreadingforallwhowishtoworkinthefieldoftraumaresponse.

LeoJ.SheaIII,Ph.D.,ClinicalNeuropsychologist,NewYorkUniversity-RuskInstituteofRehabilitationMedicine

ReadingaboutVerbalFirstAidgavemethecourageandtheinspirationtobeasourceofcomfortandease topeoplewhoare illor injured.Theauthors’verysimpleapproachisbothlovingandpractical.Irecommendittoanyonedealingwithamedicalemergency.Iusethisasanongoingpracticeinmywork,bothintheemergencyroomandtheICU.

CaradeVries,RespiratoryCarePractitioner,LucilePackardChildren’sHospitalatStanford

It’sfinallybecomingapparentthatwhatwesayduringamedicalemergencyisoftenasimportantasthetreatmentweprovide.

AlanMistler,AssociateProfessorandProgramDirector,CenterforPrehospitalEducationDepartmentofEmergencyMedicine,

UniversityofCincinnatiMedicalCenter

After reading thebookTheWorst IsOver -What toSayWhenEveryMomentCounts Ibecameabeliever inVerbalFirstAid.I runthefirstaid trainingunitfor our department and have incorporated it into our program. As PoliceOfficers,wetalktopeopleinavarietyofsituations,andunfortunatelysomeoftheseconversationsarenotpleasantones.VerbalFirstAidisavaluable“tool”wecanusewith thepublic thatweserve.Thefeedbackthusfarfromthefieldhasbeengreat.

F/LtMikeHarvitt,MichiganStatePolice

LookforthelatestinVerbalFirstAid,VerbalFirstAid:HelpYourKidsHealFromFearandPain—AndComeOut

Strong(BerkleyBooks,2010).

Ifyouworkwithorcareforchildren,thisbookwillgiveyouthewordstoturnahurtintoahealing,ascareintoacalm,andapotentialtraumaintoamemoryof

rescueandcourage.

“Remembernotonlytosaytherightthingintherightplace,butfarmoredifficultstill,

toleaveunsaidthewrongthingatthetemptingmoment.”BenjaminFranklin

“Duringperiodsofgreatstress,wordsthatseemimmaterialorareutteredinjestmightbecomefixedinthepatient’smindandcauseuntoldharm.”

EmergencyCareandTransportationoftheSickandInjured,AmericanAcademyofOrthopaedicSurgeons

Thisbookwasdedicatedinitsfirsteditiontomydearfriendandmentor,thelateAnnTullyRuderman.Neitherthelonglineoftimenorthedistanceofdeathhaschanged the impact she has had on my work and my ability to see thepossibilitiesinsteadoftheproblemsweface.Tully,thisisstillforyou.

—JudithAcosta

IdedicatethisbooktoCaptainPatrickBrownoftheNewYorkFireDepartment,lost, aswere somany of his brothers, in theWorldTradeCenter tragedy.Hedied as he had lived, boldly, generously, gallantly.One of themost decoratedmembers of the fire department, a Vietnam hero, swashbuckling yet gentle,belovedbythemenheled,hewasthebestofararebreedandtheworldislesscolorful,lessglorious,andlesssafeforhisloss.I’mproudtohavecalledhimafriend.

…Andflightsofangelssingtheetothyrest!—JudithSimonPrager

AcknowledgementsIntroduction

PARTONEVERBALFIRSTAIDTM

Chapter1.VerbalFirstAid:HowitWorksWhenEveryMomentsCountsChapter2.TheMind/BodyConnection:TheEvidenceChapter3.TheHealingZone:RecognizingandFacilitatingAlteredStates

PARTTWOHEARTTOHEARTCOMMUNICATIONChapter4.Rapport:TheFoundationforHealingCommunicationChapter5.ExtendingtheContract:StrategiesforMaintainingHealing

CommunicationChapter6.GivingTherapeuticSuggestions:LeadingtheWaytoHealingand

Comfort

PARTTHREEPUTTINGITALLINTOPRACTICEChapter7.VerbalFirstAidforMedicalEmergenciesChapter8.VerbalFirstAidforRelievingPainChapter9.PhysicalIllnessesandChronicConditionsChapter10.CreatingCalm:VerbalFirstAidforEmotionalConditionsChapter11.VerbalFirstAidforSuicideAttemptsChapter12.Dying:VerbalLastAid

PARTFOURABOUTYOU,THECAREGIVERChapter13.TheAftermath:HowtoCopeAfterAMedicalEmergency

Chapter14.SelfTalk:HowtoComfortYourselfasCaregiverChapter15.HumorforHealing:TheLastLaugh.

SomeFamousLastWordsVERBALFIRSTAIDWORKINGINTHEWORLD:TestimonialsFromYou

GlossaryAbouttheAuthorsBibliography/RecommendedReading

Since The Worst is Over was published in 2002, we have received so manywonderfultestimonialsandstoriesfrompeoplewhohaveusedtheprinciplesofVerbalFirstAidinthefield.

We felt it was time not only to update the text to reflect some of the newersciencethatliesbehindVerbalFirstAid,buttoaddachapterinspiredbyyou,ourreaders,abouthowit’sworkedintheworld.

WealsowantedtomakeTheWorst isOveravailable inbothprintande-bookformats.Muchfromthefirsteditionremainsasitwas.Wehopeandtrustthatitprovidesyouwiththetoolsyoucanmakeyourownwheneverandwhereveryoufindthemneeded.

Warmly,JudithandJudith

JudithAcostaIntheget-it-done-yesterday,no-time-to-think-straightworldofpublishing,

revised editions are an interesting phenomenon, a peculiar and special secondchancetoreviewandintrospectthatwhichhasworked,whathasnot,whathasbeenablessingandwhereyetmoreGraceisneeded.

InreviewingTheWorstIsOverforrepublication,Isawitthistimewiththeeyesofareader,notanauthorandIwasdeeplymovedbyhowseminalandimportantthisworkstillis.Istillfeelblessedtohavebeenapartofitinitsbirthanddelightedtobeabletopresentitanewtoabroaderaudience.

When I thought about all that has transpired since itwas first publishedright after theeventsof9/11, I couldnothelpbut thinkof all thepeoplewhohave received it and unfortunately how necessary it has become on a globalscale. I thought of all themilitary, first response, andmedical personnelwholearned the protocol, used it in practice to save lives, give comfort to thewounded, and bring peace to the panicked at such a critical moment in ourcountry’shistory.

WhenIthoughtofalltheworkandthoughtandtimethatwentintomakingitareality,Ihavealonglistofthankstogive:

Firstofalloftheseistomymother,Mollie,whodiedthisyear.Shewasanendlesssourceofinspiration,encouragementandlove.HavingamotherlikeherwastheLord’sGrace.

Secondlytomybrother,Bill,whodiedin2008.Ashelayinhospital, inquiteabitofdiscomfort,hebeckonedmeovertothebedandaskedmeto“dothattalkingthingyoudo.”So,Idid.Italkedaboutseasonsandhowwintergives

waytospringeveryyear.Italkedaboutplantsandhowthingsthatarefulloflifecan be right under the surface. I talked about healing things, hopeful things,sleepyandsoothingthings.

Atonepointashelayquietly,hiseyesstillclosed,themonitorsbeeped.Ilookedupandnoticed that thebloodoxygen levelhaddropped.Hispulsehadalsodropped. Itwasn’tprecipitous,but itwasenough. I toldhim,“Bill,whileyou’re restingherewithme,youcan take agood, slowbreath andbringyouroxygen level back to 96, right where it was when you felt quiet andcomfortable.”Iwaited.“Andwhileyou’redoingthat,youcanalsojustfeelyourpulseraterespondingthesameway…justbringingitbacktowhereitneedstobe.”Theresultswereinstantaneous.Andwithhislevelssteady,hewasabletosleep.Wedid this together several timesbeforehepassed, each timebringinghimjustabitofrelief.ButIbelieveitwasagifttousboth.

Tomy familyand friendswho listenedwithpatience,who read tillyourheadshurt,andwhostayedsteadfastthroughmylongabsenceswiththisproject—

To all the men and women of the New York City Police Department,particularly those affiliated with POPPA at the time of Verbal First Aid’sintroduction—Bill Genet, Hal Tannenbaum, Dr. Richard Levenson, Jr., andespecially Gene Moynihan, Clinical Director at the time, all of whom trulyunderstood the value of this work from the beginning and made sure it waspresentedtoallthePOPPAvolunteersevenbeforethebookcameout—

To the Tuckahoe Police Department, the Sleepy Hollow Volunteer Fireand Ambulance Corps, New Rochelle Fire Chiefs Association, MontefioreMedicalCenterandWestchesterCountyMedicalCenterfortheirsupportwhenVerbalFirstAidwasjuststartingsomanyyearsago—

ToGeorgeThompson, authorofVerbalJudo, forhiskindpermission toreprintthestoryinthechapteronsuicide—

To Marcy Kniffin for her excitement about Verbal First Aid and forproviding me with the opportunities to present the concept to countyorganizations,schooldistrictsandcorporationslongbeforetheyevenknewhowmuchtheywouldneedit—

ToRetiredOfficersDr.MikePoppandDelLeFevre,forintroducingmetothe people atNYPD and being part of an ever-growing chain of strength andgoodness—

ToKathleenLoddo,CSW,forshowingwhattrue,heartfeltpacingcando—

To the New York Society for Ericksonian Psychotherapy and Hypnosisand all the amazing, demanding teachers there, especially Jane Parsons Fein,

CSW,DorothyLarkin,R.N.,andDr.SidneyRosen--ToDanGallagherfortheNLPtrainingthatstarteditallbackatDaytop—ToWinnieMaggiore,NREMT-P,andDaveJohnson,MD,whohavebeen

thestaunchestsupportersofVerbalFirstAid,understandingitsvalueinthefieldfromfirst-handexperience—

ToPatrickTyrrell,Director,NASW-NM,andAngieWagner,OperationsDirector, aswell as JohnWilkinson,Director,NASW-MT,who have broughtthe concept of therapeutic communication to hundreds of social workers, andthroughthemmadeadifferencetothousandsforgenerationstocome—

To thewhole team at the Journal of EmergencyMedical Services (bothonlineandprintmedia)fortheirunderstandingoftheimportanceofVerbalFirstAidand theireditorial support inprovidinga forumfordisseminating itat theInternationalJEMSConvention—

To George Everly, Jr. and the International Critical Incident StressFoundationforseeingthevalueandnecessityinVerbalFirstAid—

To Harris Straytner, PhD., CASAC, Director, Addiction RecoveryServices;AssociateProfessor,DepartmentofPsychiatry,WeillMedicalCollegeofCornell,whopresentedVerbalFirstAidonWFAS-AMnumeroustimes—

To theNationalCenter forMissing andExploitedChildren for teachingtheprotocoltotheircrisisvolunteersinRochester—

ToIngridParryandeveryoneat theAmericanBurnAssociation:amorededicatedgroupofprofessionalsIhaverarelymet—

Toalltheclients,friends,andcolleagueswholovinglysharedtheirstoriesofstruggleandsurvivalwithus—

Tothelovethatsustainsmethrougheverything,Dave—Finally to all the rescueworkers, police officers, firefighters, EMTs and

paramedicsand themillionsofnon-uniformedmenandwomenwho risk theirlivesandlimbstohelpsaveothers,andmostofall, toGod—Ire-dedicate thisvolumewithagratitudeandlovethathasfinallyleftmespeechless.

Thankyou.Thankyou.Thankyou.Inowunderstandthemeaningofbeing“filledwithHisblessings.”Myheartflowsoverandwordsareinsufficient.Maythistakeusallfromstrengthtostrength.

JudithSimonPrager

Mylatefather,AlSimon,usedtosay,“Don’teventhinkaboutthebalancesheetofgivingandreceiving.Justputmoregoodintheworld,andtherewillbemoregoodtogoaround.”Thosewordstolivebyinspiredabookaboutwordstohealby.

There are somanypeoplewho shouldbe acknowledgedhere for having“putmoregood”intheworld.

First, last,andalways, tomyhusband,HarryYoutt,whobroughtpoetry,music,love,andmagicintomylife,oneword:Everything.

Professionally, particular thanksmust go toDonaldTrent Jacobs, Ph.D.,psychologist, author, teacher, emergency medical technician, for his generousspirit in leading the way in words in critical care response and to all thosededicatedheroeswhoblazedthisemergencyrescuetrail.

Deepthanks,aswell,tothoseinnovativepioneersintheCardio-ThoracicSurgeryUnitatCedars-SinaiMedicalCenter,includingDr.GregoryP.FontanaandDr. Alberto Trento, for their early willingness to trust me in proving thevalueofwords incriticalsurgery.Thanks, too, toPediatriciansSharonYoung,M.D.andDebraLotstein,M.D.andtoKittyWack,KathyWanderer,R.N.,andMarcusHongfortheirsupportatCedars-SinaiMedicalCenter.

ItiswithpleasurethatIacknowledgethehelpofTimothyTrujillo,CHT,founderFirstMedicinesandtheHypnosisAIDSProject,forhisinspiredwisdominthisfield.

LoveandthankstoMalaSpottedEagleandSkyPopefortheirstoriesandtheirsupport.

Iwouldliketoacknowledgesomeofmyteachers,includingBruceLipton,PhD,friendandinspiration,LarryDossey,MD,whosekindsupportofthisworkhasbeen invaluable, aswell as thatofCandacePert,PhD (who, sadly,passedthis year), Rick Hanson, Ronald Wong Jue, Ph.D., former President of theAssociation for Transpersonal Psychology; the late Gil Boyne, ExecutiveDirector, American Council of Hypnotist Examiners, and David Quigley,founderoftheAlchemyInstituteforHealingArts.

ThankyoutoDr.HelenaGuo,MD,whobroughtmetoChinain2008totrain crisis counselors in Verbal First Aid after the devastating earthquake inSichuankilled80,000peopleinamatterofmoments.Herfaithinthisworkhasbeensoimportanttome.

ThankyoutoSusanClark,MD,RubyRoy,MD,andKathleenArchibaldSimon, RN, among many others in the medical profession whose belief in

VerbalFirstAidtranslatedintoaworldofsupport.Thank you to Professor Renzo Molinari for connecting me with the

European School of Osteopathy and to Corinne Jones there for helping meintroduceVerbalFirstAidtoGreatBritain.Youropen-armedreceptionhasbeenbothgenerousandinspirational.

Thankyou toDr. JulesMorel andRuthMoore,RN, foropportunities toshareVerbalFirstAidwiththeKingdomofBrunei.

ThankyoutotheAssociationofPreandPerinatalPsychologyandHealth(APPPAH), especially to Marcy Axness, Maureen Woolf, and Wendy AnnMcCarty, for welcomingme as a keynote speaker and embracingme in theirincredibly wonderful mission of bringing awareness to the consciousness ofbeingsevenbeforebirth.ThankstoLisaGarrandNitaValens,hostsonKPFKLosAngeles,forhelpingmebringearlyrecognitiontoVerbalFirstAid.

Thank you to Sandy Salway-Beers, EMD-I Quality ImprovementCoordinator and others at the Rochester/Monroe County EmergencyCommunications whose invitation to train the 9-1-1 telecommunicatorscontributedavaluableperspectivetomyworkandteaching.

Thanks to the psychiatric nurses at New York University Hospital,especiallyLisaHasnosi,forinvitingmetoshareVerbalFirstAidwiththemaftertheeventsofSeptember11th,andtoDr.LeoShea,ClinicalAssistantProfessorof Rehabilitation Medicine, NYU School of Medicine and ClinicalNeuropsychologist NYU-Rusk Institute of Rehabilitation Medicine for hiswonderfulworkandforsharinghisimportantinsightsontrauma.

Myheart goesout to thevaliant fire fightersofNewYorkCity.Thanksespecially toLieutenantSteveBrowne and JohnGates ofLadderCompany3,who lost their Captain, Patrick Brown, and half of their brothers in theSeptember11thdisaster,andtoSalD’Agostino,BillButler,MikeMeldrum,andTommy Falco of Ladder Company 6 for generously sharing their time andstorieswithme.

ThankyoutoWestwoodPublishingforpermissiontousethequotesofDr.David Cheek, Captain Frank Neer, and Dr. Jerrald Kaplan fromDon Jacob’svideo,HypnosisforMedicalEmergencies.

Thanks,too,toBarryKibrickforhisbeautifulsupportonhisPBSprogramBetweentheLines.

Personally, Iwant to thankmy late parents,Al andPaulineSimon, everpresent.Tomymanywonderfulchildren—DaniellePrager,JenniferandGeorgeHatzmann (andgrandchildren Jack,Tanner,Madeleine, and Isadora), JonathanYoutt, and Brad Prager—thank you for being the exceptional people you’ve

turnedout tobe.Youhavefilledmylifewithprideand joy.Thanks tocousinMarilyn, goddaughter Sarah, IngerLanese, andmy sisters and brothers in lifeandinlawforjustbeingthereandcaring.

To friends, teachers, clients, and colleagues, blessedly too numerous tomentionbyname,thankyou,thankyou,thankyou.

Thanksto theUCLAExtensionWritersProgramandLindaVenis,Ph.D.forgivingusahomewhereHarryandIcanspreadourwingsandshareourloveofcreativity.

May thisbookand the thoughtsbehind it “putmoregood in theworld.”Onceweknowtheeffectsofourwordsandthoughtsoneachother,wecandonoless thanfill thewaywespeaktooneanotherandthewaywecareforoneanotherwithkindness…kindnessblossoming forthoneveryoccasion.Mayweeachbecomeablessingtoallweencounter,thatwemaymovetogether,heartsjoined,intoakinder,morelovingfuture.

O“Wordsare,ofcourse,themostpowerfuldrugusedbymankind.”

--RudyardKipling

neday,maybesooner,maybelater,someoneyoulovewillexperienceamedicalemergency.Perhaps a friendor co-workerwill collapse in ameeting, or a caraheadofyouon theroadwillveeroffandcrash intoa tree,orsomething lessdramatic could happen—a cut, a bruise, or a broken bone. One day, withoutdoubt,someoneyouknowwillbediagnosedwithaseriouschronicdisease.Oneday, someone you care about—an elderly parent, a spouse, a child—willexperiencementaloremotionalpain,orapanicattackoraboutofdepression.

Afteryou’vedoneeverythingyoucan,includingcalling9-1-1inamedicalemergency,whatdoyousay?Hanginthere,Joe,doesn’tseemquiteadequate,andDon’tdieonme,damnit,mayworkinthemovies,butit’slesseffectiveinreallife.

Therearewords,andwaysofsayingthem,thatarenotonlyhelpful,butcanturnamedicalsituationaround.TheycanpositivelyaffectJoe’sheartrate,temperature, breathing, in fact his entire cardiovascular, limbic, endocrine,circulatoryandrespiratorysystems.Theeffectofspecificwordsissopowerfulthat, in certain circumstances just saying,Stop bleeding and save your blood!canhelpanaccidentvictimdoexactlythat.Therightwordscanhelpyoucalmaperson in the throes of a panic attack or soothe a chronically ill person into asoundandrestfulsleep.

Not knowing the techniques that we present in this book can also have

seriousimplications.Ineverydayemergencies,thewrongwordscanamplifytheproblem,despitethebestofintentions,makingthesituationworse.Lily,alittlegirlofthreeorfouryearsold(couldshebeyourdaughter?)slipsonathrowrugandfallsagainstacoffeetable.Herteethtearthroughherlowerlipandsplititintwo.Whenherparentsfindhersheiscryingandbleedingprofusely.Yearslatershelooksbackonthemoment.

“When my parents saw my lip, they lost control. As they drove to thehospital I vividly remember hearingOh, my God, andOh God what are wegonnado?She’sgonnaneedstitches.Ohmypoorbaby!Dowehavetogiveherstitches?Isn’tthereanythingelsewecando?MylipstillhurtssometimeswhenIthinkofit.Mymotherwassoupsetshegotmyfatherworried,whichterrifiedme.WhenI finallygot to thehospital, thedoctors rushedme intosurgeryandkeptsaying,“Someoneholdherdown!”Therewasverylittlethatenabledmetofindacomfortzone.Therewasnocalmcenteranywheretosupportme,whichmadethewholeexperiencemuchworsethanithadtobe.”

Lily’sparentsprobablydideverythingrightconcerningphysicalfirstaid.They probably applied compresses to reduce the bleeding and an ice pack toreduce swelling. And the Emergency Room doctors, we may assume, dideverythingnecessaryandpropertoclean,stitch,anddressthewound.Theonlyproblem was that nobody knew what to say to the little girl, and saying thewrongthingsonlymadethingsworse.Perhapsitliterallygeneratedacascadeofchemicals in her body that impeded the healing.And thosewrongwords alsokeptthatminorwoundaliveandfesteringemotionallyforyears.

The same human and emotional effects of the trauma suffered by Lilyapply to far more serious emergency physical traumas—tomotor vehicle andindustrialaccidents,toseriousburns,andtorespiratoryandheartattacks,aswellastopeoplefacingsurgeryandsufferingfromphysical,chronicandemotionalillness.

The good news is this: saying the right words can physiologically andemotionallyaltertheoutcomeofserioussituations,caneasewhatSt.JohnoftheCross called the dark night of the soul, both in the present and in the future.When we use Verbal First Aid in a trauma, we are changing the way it isprocessedandmitigatingitsimpactdowntheline.

Whatwewill show you in this book can reduce anxiety, diminish pain,promote healing, and save lives. The program presented here is based ontechniques used by professionals trained to dealwith the first hour of trauma,including firefighters, nurses, EMS personnel and police officers. Studies ofthese methods show they allow patients to arrive in the Emergency Room insignificantlybetter-than-expectedcondition.

Allthisispossiblebecausewhenpeopleareinanaccident,whentheyareblindsidedbytrauma,theyenteranalteredstateofconsciousnessinwhichtheyareunusuallyopentoinfluencesontheautonomicsystemthatfacilitatehealing.We call this “the healing zone.” People with basic training in what we call“VerbalFirstAid”canempowerpatientsoraccidentvictimstobegintheirownnatural healingwithinmoments.Wewill showyou our step-by-step protocolsforcommunicationinthehealingzone:howtoestablishandutilizerapportandhow to give therapeutic suggestions to set the course for healing. Stories andexampleswill illustrate how to connectwith the parts of a person’smind thatactuallyregulatethehealingfunctions.

Sometimes the altered state becomes shock; sometimes people slip intounconsciousness.ButevenunderthoseextremecircumstancesitisstillpossibletouseVerbalFirstAidtofacilitaterelaxation,painrelief,anxietyreductionandprogresstowardrecovery.

Although thisprotocolwasdevelopedformedicalemergencies, it isalsovalid for people with chronic conditions. The impact of an illness can beheightenedbythetraumaofafrighteningdiagnosis.Whenpeoplereceiveadirediagnosis—for instance, of lymphomaorAIDS—they often report having hadthesensationofseeingthedoctor’slipsmovebutnothearingathing.TimothyTrujillo,founderofthenonprofitorganizationFirstMedicines,createdtoreducesufferingandenhancehealthworldwide,hasfoundthatallthatpeoplereceivingsuchadiagnosiscanheararethewordsintheirhead,“Iamgoingtodie!”andthat they are feeling “as if the rugwere being pulled out from underme.” Insomeways,Trujillosays,“themindsetofapersonhearingaterrifyingprognosisisnotunlikethatofapersonlyingonthegroundbleeding.”

Becauseoftheon-goingsenseofcrisisthatafrighteningdiagnosisbrings,people suffering physical illnesses, like people in medical emergencies, arelooking for something solid to hang onto. Trujillo believes that literally orfigurativelytakingtheirhandandlettingthemknowauthoritativelythatyoucanhelp, reassuring them and redirecting their thoughts can break the spell of theoriginal negative experience. When you speak with authority, through yourwordsandpresenceyoucanprovidevital assistance.He likens thisprocess tothrowinga rope toa fallingpersonand tying theotherendarounda tree.Theropeisanewidea,thought,orbelief.

This is thefirstbookof itskindwrittenwitheveryoneinmind.Itdetailsthemethodologydesignedfortalkingtotheautonomicnervoussystemtoevokea desired change. It provides themeans for people to help each other through

medicalemergencies,aswellasthroughemotionalandchronicillnessandpain,usingtheoneskillweallshare,nomatterwhatlevelofmedicaltrainingwehave—theabilitytocommunicate.

PartsOneandTwoofthisbookgiveyouthebackgroundandtheprotocolsfor using these important, perhaps even life-saving, techniques and teach youhow to recognizewhen people are in the “healing zone.” Part Three providesspecific words and scenarios for use in medical emergencies and other care-givingsituations.PartFouraddressestherescuer,thepersonwhohashelpedinamedical emergency or with chronic illness, who feels either exhausted ordiscouragedintheaftermath.Herewediscusslanguageyoucanuseonyourselfandhow,withawareness,yourperceptionofthesituationcouldshift.

Intheendweofferyou“TheLastLaugh.”InChapter15you’llseewhydoctors recommend laughter, the ultimate life-affirming technique when allseems bleak. And it is followed by testimonials from people in the work ofrescueandpeople just living their liveswhohave found inVerbalFirstAidagifttoshareinamomentwhenitmadeallthedifference.

Webelieve thatbetween thecoversof thisbookyouwill findwonderfulwaystolearnanduseVerbalFirstAidandmakeityourowntohelpchangethecourseofmedicalsituationsforyourfamily,friendsandanyonewhoneedsyou.

Wehave seen thepowerofwords first-hand, inourpractices and inourtrainings,inouroffices,andonthestreets.Wehaveseenchildrenstopbleeding,thechronicallyilldeveloparemarkabletoleranceforpain,andelderlypatientsinrespiratorydistressreturntoeasy,healthybreathing.Wewantyoutoseethepowerofwordsaswehave.WewanttointroduceyoutothepracticeofVerbalFirstAidsoyoucanseeitsbenefitsatworkinyourownlifeaswehaveinours.Whenyouhearthestories,examinetheevidence,andlearntheskills,youwillbepreparingyourselfforwhatevercomesyourway.Nomatterwhatyourlevelof medical skill may be, by choosing your words with care you can make apositivedifferenceinsomeone’slife.

InBarbaraKingsolver’s best-selling novel,TheBean Trees, the narratortriestohaveaconversationwithasilent,sadwomanwhosechildismissinginGuatemala. “This conversation would have been hard enough even with twopeopletalking.NomatterwhatIsaid,itwassuretobetheexactwrongthingtosaytosomeonewhorecentlyswallowedabottleofbabyaspirin.Butwhatwouldhavebeenright?Was theresomebook in the librarywhereyoucould lookupsuchthings?”

Yes.Nowthereis.You’reholdingitinyourhands.

Words,Words,WordsIntheUnitedStatesofAmerica,wherefreespeechisacornerstoneofour

way of life, no one is allowed to shout “Fire!” in a crowded theater. Why?Because the image that word creates can cause panic and a stampede amongotherwisecalmandreasonableadults,evenifthereisnofire,andnosmoke.Thepowerofwordsisphenomenal.Othercountriesknowit;theyputtheirdissentingpoets in archipelagos, or throw them in jail. Advertisers know it. They say,“Cokeisit!”andwegetthemessageliterallyandsubliminallyuntilwefinallypick up the bright red cans or bottles in the supermarket. In a courtroom, thelawyerwiththerightwords(“Ifitdoesn’tfit,youmustacquit”)hastheedge.Amereslogan(“RemembertheMaine,”“RemembertheAlamo,”“TheMotherofAllBattles,”)canturnapeacefulnationintoafightingmachine.

What happenswhenwords are used to help people in dire situations, tohelpthemrecover,tobringthembackfromtheedge?

Inthelate’80s,atadrugrehabilitationcenterinNewYork,amansteppedoutonto the roofof thebuilding.Apasser-bynoticed, came into thebuilding,andcalled9-1-1.Withinminutes,thepatients,thecounselors,thedirector,EMSpersonnelandpolice(not tomention theshoppers fromacross thestreet)wereall outside looking up at this agitated young man shouting incoherently.Numerous attempts had been made to communicate with him and get himquieted,ortodistracthimlongenoughtoallowrescueworkerstoclimbupontheroofandgethimdown.Nothingwasworking.Twohourspassedandeventherescueworkerswerebecomingedgy,theirnervesfrayed.Thedirectorofthecentercalled in the residentclinical socialworker.Whenshearrivedwhat shesawwasfrustrationandlackofcommunication.

Shewasintroducedtothepotentialjumperbyoneofthefirefighters.Shetookadeepbreath,pausedtogetcentered,andsimplyaskedhim,“Canyoutellmewhathurts?”Thepotentialjumperlookedather,pacedabit,satdown,andstartedtalking.

Therightwordsat theright time.Thefact that theworld turnsonwordsmaynotbenews.Butmostpeople,eveninstitutionalmedicalpersonnel,arenotawareofthefullpowerofamentalimagetochangethecourseofanemergencyoranillness.

Ironically, in a culture that seems to be preoccupied with safety, thenumberonecauseofdeathinpeopleunder45yearsoldisaccidentsandadverseeffects.Heart disease ranks number 1 in the population over 65 years of age.Cancerandotherchronicdiseasesarereachingepidemicproportions.Thesearesituationsthataffecteveryoneatsomepoint,allofus—children,parents,friendsand neighbors. One day you will find yourself sitting beside someone in an

emergency situation, and you will want to know how to make a difference.Usingthewordsyouhavelearnedhere,youwillbeabletoprovidecomfortandrelief toanagingparent,a spouse,a friend,ora strangerwhoneeds rescueorhelp.

VerbalFirstAiddoesnot replace themedical helponwhichwe all relyand forwhichwe are at times deeply grateful. It gives you, the person at thescene,ortheonestandinghelplesslyatthebedside,avaluablegifttopassalong—themagicofhealingwords.

Although all thismay be news tomany of uswho are just beginning torecognize the power of words and thoughts on the outcome of events, othercultures have understood their impact all along. “Whenwe plant a seed,” ourfriendSkyPope,aTlingitNativewomansays,“weprayoverit.Whenwewaterit,wetalktoit.Whenweharvestandcookit,wesingtoit.Andbeforeweeatit,weprayoveritandsingtoitagain.Andthen,”shesaid,asifitweretooobviousforwords,“andthen,it’smedicine.”

In so many words, every interaction is an opportunity for healing,emotionalandphysical.Andbyknowingthat,andtreatingallweencounterwithcare,youcanmovethroughlifelikeanangel.Words,song,prayer—theireffectscanbemyriad,profound,even,asyoushallsee,life-saving.

PARTONE

VerbalFirstAid™

Y

“I’velearnedthatpeoplewillforgetwhatyousaid,peoplewillforgetwhatyoudid,butpeoplewillneverforgethowyoumadethemfeel.”

-MayaAngelou

“Onewordfreesusofalltheweightandpainoflife;thatwordislove.”-Sophocles-

ou’re driving along a country road. Themotorcycle ahead of you takes a badturn,spinsofftheroadanddisappearsofftheshoulderinacloudofsmoke.Youpullyourcarovertothesideandjumpouttofindabadlyinjuredrider,hislegtwistedandbleeding,moaningandwrithinginpain.

In that kind of crisis, most of us would spend at least a few secondsthinking,ohmyGod!andtryingtothinkclearlyfirstaboutwhatwecando.(Inemergenciesthismeanscalling9-1-1,andthenpossiblyapplyingbandagesandsplints,whenandwhereindicated.)Doingsomethinginanemergencyorcrisisisoftenessential,butthat’sonlyoneofthehealingtoolsavailabletous.Inourhaste to find theright thing todo, fewofus think,WhatcanIsay?Often,werush to do something simply to cover up the fact thatwe can’t even think ofanythingtosay.Indeed,whyshouldwethinkthatwordscouldhaveanyeffect?Certainly there isnothing inourupbringingormedicalculture tosuggest that.

Weareacountryofdoersandourculturalstoicismisoftenwornasabadgeofhonor.Nonetheless,ithasbeendemonstratedinthemedicalliteraturethateveryword,everythought,eveneveryintentioncausesameasurablebodilyreaction.

Thereisanotherwayofapproachingthataccidentwiththebiker.Youseehimgodown,youstopthecar.Youmakeyour9-1-1call.Thenyougetoutofyourcarandtakeadeepbreath tocalmandcenteryourself.Youwalkover totheriderandkneeldownbesidehim.Youdeterminewhetheranyessentialfirstaidmustbeadministeredandthenyousay:

“Myname isTimothyandI’mgoing tohelpyou.Theworst isover. I’vecalled 9-1-1 and they’re on the way. I can see that your leg needsattention.Whydon’tyoujustscantherestofyourbodyformenowtoseethateverythingelseisallright?How’syourotherleg?Howdoyourarmsfeel?(Pause)

“Because theambulance ison itsway,youcanrelaxa littlenowandletyourbodydowhatneedstobedonetoprotectyourlifeandbeginhealing.(Pause)

“I’m sure there’s some place you’d rather be right now.Where is that?Thebeach?Okay,whileyourbodyistendingtothehealing,youcanallowyourmindtogotoyourfavoritebeach,tothatplaceyoureallylovetobe,andyoucanbegintofeelcomfortablebeinginthatplacerightnow…”

Thatevent,thatgruesomemotorcyclespill,actuallyhappenedrightbeforetheeyesofTimothyTrujilloashedrovealongacountryroadonelazySundayafternoon.TrainedinVerbalFirstAid,heknewwhattodoandwhattosay.Heidentifiedhimselfandestablishedrapportwiththeinjuredman.Thenhebegantoprovidesuggestionsforpainreliefandhealing.

“It tookaninterminable45minutesfor theambulancetocome,”Trujillosaid,duringwhichtimetheman,whosecorkscrewfracturehadbrokenhisleginseven places,writhed in agony and fear. “I had him visualize swimming in apool,”Trujillo said.“Floatingstimulatesendorphinproduction,and the feelingof suspension offers pain relief and comfort.” Throughout the long wait,wheneverthepainsurgedupagain,Trujillowouldremindthemanofthepool,havinghim“dothebackstroke,whichdrewattentionawayfromhislegs.”

ThenTrujillotaughtthemanthe“controlroomtechnique”tohelpmanage

his pain, showing him how to dial it down to amore comfortable level. (SeeChapter8onpainmanagementformoreinformation.)Threedayslater,whenhevisitedthemaninthehospital,thepatientreportedthathenolongerneededhispainmedicationbecause“it’sonzero,”meaninghehadusedthecontroldialtoturndownthepainhimself.

After several months, Trujillo received a letter from the man’s wife,thanking him and telling him that his intervention had set the course for herhusband’s recovery. And all Trujillo had at his disposal on that country roadwerewords.Therewasnowayhecouldhavesetthatlegouttherebyhimself,evenifheknewhow.Buthiswordsanddemeanorhelpedtoeasethebiker’sfearandpain,sohecouldbeginthehealingprocess.

VerbalFirstAid is a programbornout of theneedsof crisis and rescuepersonnel.Theideaisbothsimpleandscientific.Whatyousaytoapersoninanemergency situationcanhaveaprofoundphysical andemotional effect; it canshapethecourseofhealinganditsoutcome.

VerbalFirstAidisnotdesignedtotaketheplaceofadoctororparamedic,or any medical treatment. It is designed to complement it. Standard first aidpracticesstillapply,andyoucanlearnthemfromoneofthemanyfirstaidbookson themarket—how to help restore breathing, control bleeding, help a victimkeepwarm.Andallthewarningsapplytoo:donotmoveanaccidentvictim,donot remove a foreign object that’s deeply embedded in awound, do not playdoctorortherapist,unlessofcourseyouareone.VerbalFirstAidisaboutusinglanguagetohelpthebodyinitiateitsowninnerhealing.

Youmayrecallatimeyourselfwhenyouwereillorinjured,perhapsinanemergencyroomatahospital,whenyouseemedtoseeeverythingasifthrougha tunnel. Or perhaps time moved very slowly, as if you were under water.Perhaps you had trouble focusing. In a crisis, body and mind slow down toprotect us and keep us from further injury. To accomplish this, the minddissociatesusabit fromourenvironment.Peoplewhoarechronically illor inemotionalcrisisareinasimilaralteredstate.

Fear, pain, and distress can trigger a shift from ordinary wakingconsciousnesstothisvastlymorereceptiveandsuggestiblestate.Thisisnature’sway of contributing to our survival. In an emergency, we don’t have time toconsidercomplicatedscenarios:weareprogrammedtorespondtoauthority, tofollowaleadertosafety.Thisisavestigeofancientherdbehavior.Mostsocialanimals function like this, including primates, lions, wolves, antelopes—andhumanbeingsarenoexception.Athreatrequiresinstinctiveaction,notanalysis.

(This is also the basis for military training.) Due to this hardwiring, geneticprogramming,apersonwhoknowsVerbalFirstAidcanreadilyassumetheroleofauthority inanemergencyandprovide thevictimwithmind/bodytools thatstimulatethehealingprocess.

In an emergency, or any time people are in an altered state ofconsciousness, extraordinary things are possible. The part of the mind thatgoverns automatic responses can be spoken to directly.With the right words,youcanhaveimpactonahostofbodilyfunctions.

Here is just apartial listof someof the functionswecan influencewithVerbalFirstAid:

Pain

Heartrate

Respiration

BloodpressureBleeding

Inflammatoryresponse

Itching

Contractions

Bowelmotility

Smoothmuscletension

Sweating

Allergicresponses

Asthma

Rateofhealing

Dermatitis

Drynessofmouth

Immuneresponse

Glandularsecretions

Emotionalreactions

Medicalresearchshowsthatevenwhenpeopleareunconscious theystillhearorexperienceeverythingthatisgoingonaroundthem.Itisnotuncommon,forexample,forpeopletorememberwhathasbeensaidintheoperatingroomwhile they were under general anesthesia. Knowing this, trained medicalcaregiverswillencouragefamilymemberstotalktopatientsinacomaoraftersurgerywhentheyarenotquiteconscious.

DonaldTrentJacobs,Ph.D.,reportedavividexampleofthepositiveeffectwords can have in his book, Patient Communication. It took place in anOakland, California hospital emergency room, where Jacobs had trained firstresponders with methods similar to those described in this book. One of Dr.Jacob’sparamedicstudentsbroughtinapatientsufferingaheartattack.Hehadperformed CPR in the ambulance and had used the patient communicationtechniqueshehadlearnedfromJacobs.AstheE.R.physicianbeganworkingonthe patient, he turned to the paramedic and said, “It looks like this fellow isgoingtobeallright,doesn’tit…”Theparamedicresponded,“Itlookslikehe’sgoingtobefine.”Atjustthatmoment,theEKGthathadbeenirregularjumpedintoanormalrhythm.

One of our clients, Gary, required surgery to remove calciumaccumulations on his spine—a dangerous and painful procedure. The doctorstold him that as a result of the surgery, he might never walk again. (Whileinformation required for informed consent is legally necessary, it is notnecessarilygoodVerbalFirstAid.ThedoctormighthaveofferedGarystatisticsthat show how somany people recover completely,might even have put himtogetherwithaformerpatientwhohadhadabrilliantrecoverysothatGaryhadapictureinhismindthatnotonlycomfortedhimbutgrantedhimatrajectoryofrecoverythathisbodymightpattern.)Duringtheoperation,thesurgeonbecamefrustrated.Upsetandworried,hewalkedoutoftheOperatingRoom,muttering“Ican’tdothis!”and“Itisn’tgoingtowork.”Hesooncalmeddown,returningseveralmomentslaterwithrenewedconfidence.Thesurgerywassuccessful,andthepatientwasabletowalk.

However,Garyleftthehospitalsufferingfromunexpecteddepression,allthe more mysterious given the success of the operation. Under hypnosis itemergedthathisunconsciousmindhadregisteredthemoment intheoperationwhen the doctor gave up and left the room. For this patient, healing involvedshiftinghisunconsciousmindfromthememorythat“itisn’tgoingtowork”toanawarenessoftheultimatesuccessoftheoperation.

Thepointisclear:wordsaffecthealing--evenwhenwedonotseemtobeawareofthem.

Notedpsychologist andpsychiatristM.ErikWright conducted a pioneerstudywithparamedicsatamunicipalhospitalinKansas.Hetrainedthreegroupswitha simpleprotocol for emergencies.Whenever theypickedupapatientorattendedtosomeoneinthefield,thesethreeexperimentalgroupswereaskedtofollowthesesimpleprocedures:

1.Removethepatientfromhisorherenvironmentassoonaspossibletominimizeexternaldistractions.

2.Memorize and recite a simple paragraph designed to calm the patientandhelpthepatienttobeginhis/herownhealing.Theyweretodothisspeakingsoftlyintothepatient’sear,whetherornotthepatientwasconscious.

3. No other unrelated conversation between the paramedics that couldpossiblybeconstruedasnegativewouldtakeplace.

4. These rules were to be used as an adjunct to standard medicalprocedures.

Thisistheparagraphtheyrecited:

“Theworstisover.Wearetakingyoutothehospital.Everythingisbeingmade ready. Let your body concentrate on repairing itself and feelingsecure. Let your heart, your blood vessels, everything, bring themselvesintoastateofpreservingyourlife.Bleedjustenoughsoastocleansethewound,andletthebloodvesselsclosedownsothatyourlifeispreserved.Yourbodyweight,yourbodyheat,everything,isbeingmaintained.Thingsare being made ready in the hospital for you. We’re getting there asquicklyandsafelyaspossible.Youarenowinasafeposition.Theworstisover.”

Controlgroupswerenottrainedinthisprotocolandcontinuedtopracticeemergencymedicalcareasusual.Thisexperiment lastedsixmonthswhile thehospitalcollecteddataonpatientrecoveryratesandtreatmentoutcomes.Wrightreported that therewas somuch enthusiasm among the paramedics using thismethodthatitwashardtokeepthemfromsharingitwiththecontrolgroupand“spoilingtheexperiment.”

The results were significant. The patients who were attended to by the

paramedicstrainedinthisprotocolprovedtobemorelikelytosurvivethetriptothehospital,have shorterhospital staysandexperiencequicker recovery rates.Unfortunately, although medical science has repeatedly documented thepowerfuleffectsofwordsandimagesonthebodyandmind,rescueandmedicalpersonnelarestillonlysporadicallybeingtrainedintheseprotocols.

VerbalFirstAidcannotonlygiveyouasenseofcontrolinseriouslyout-of-control or demoralizing situations, it can return a sense of control to thepersonyouareaidinganditcanhelptobeginthehealingprocessfromwithin.Ifyou are concerned about using Verbal First Aid, feeling you might beoverstepping your bounds because you are not a doctor or therapist, considerthis.A person attending another person in crisis has three verbal options.Wecan:

Saynothing.Saysomethingharmful.Saysomethinghelpfulthatpromoteshealing.

Verbal FirstAid is safe and simple. It is notmeant to take the place ofgoodmedicine, but rather tomake goodmedicine better. You can benefit bylearning these basic steps toward effective healing communication: how togeneraterapport thatbegins thecommunication;howtogivesuggestions forpain relief that actually stimulate the body to produce chemicals that supporthealing,andhowtocreateanatmospherethathelpstoturnfearintohopeandpanicintocalm.

The techniqueswill be explained in the upcoming chapters, so youwilllearnhowtoapplythemonyourown,butherearesomeexperiencesfromthoseinthefieldwhoalreadypracticeaformofVerbalFirstAid.

Evenbeforehewaslostso tragically in theWorldTradeCenterdisaster,thelatePatrickBrownwasalegendandaheroinNewYorkCity.AcaptainintheNewYorkCityFireDepartment,hewasaVietnamveteranwitha specialradar for pulling the weakest among us—babies and animals—from blazingbuildings.Known for his daring rescues, hewas quoted in aTIMEMagazine(September6,1999)coverstoryontakingrisks.Heexplainedthatfirefightersdonot take “stupid risks…Wedon’tdo this for sport or for thrills ormoney.You’reriskingyourlifetosavesomebody.That’swhatmakesthisjobspecial.Wetakerisksfor thegreatergood.”Hewasoneof themostdecoratedmeninthehistoryofthedepartment,butforallhisheroics,heleanedintohisspiritualside, studying yoga and earning a black belt in karate. In his spare time, he

taught self-defense to the blind. Some who knew him well called him “anenlightened being.” He was a friend whose way in the world was in itselfhealing.

Pat Brown was a master in the Verbal First Aid technique of gainingrapport—buildingthebridgeoftrustwiththevictim.Inhisparlance,therewere“rescuers” and “civilians.” He noted the importance of tone of voice and ofmaintaining a calm, centered presence. “Sometimes the rescuers are morenervous than the victims,” he told us, “and they can overdo some of theenthusiasm, or get harsh or shrill. I try not to do that. I keepmy voice calm,direct,andreassuring.Ifyourvoiceisnervous,itmakestheciviliannervousandthatcangetintheway.”

Ironically, this hero of heroes, thisman of action, found that one of theways he stayed calm was by spending a moment with the victim in silentmeditation.Sometimesittookonlyafewseconds,othertimesalittlelonger.“Itdependsonthesituation,”heexplained.“Withsomevictims,Iwillputmyhandson themanddo a littlemeditation, breathe into it, think into the universe andintoGod. I try to connectwith their spiritualnatures, even if they’redying. IthelpstokeepmecalmasmuchasIhopeithelpsthem.”

As spiritual as thismay soundPatBrownwas actually quite focused onrealityandhealwaysbelieved inacknowledging thedifficultyof thesituation,ofwhichthevictimisalreadyfullyaware.“Sometimesthepersonissohurtorsoupsettheycan’ttalk.So,Ireassurethem.IletthemknowwhatI’mgoingtodoforthem.Iempathizewiththemandsupportwhatthey’refeeling.Whenyoutalktoavictimthiswaythey’rerelieved.Atsomelevel, theyknowyou’renotBS-ingthem.WhenIsay,‘In twominutes, theemergencyrescueteamwillbehere,it’slikehavingawholehospitaloperatingroomhere,andintwominutesthey’regoingtogetyouout,’thevictimisreassured.”

It is reported that the lastwordshesaidoutside theWorldTradeCenter,the lastbuildingheentered,were inresponse tosomeone’scallingout,“Don’tgointhere,Paddy!”Hisanswerwas“Therearepeopleinthere!”Wecanonlyimagine thatwhoeverwaswithhim in thathellish infernoat theendwasalsotreated to a glimpse of heaven through his calming, courageous, and lovingpresence.

WhenweconnectintheprofoundwaythatPatrickBrowndescribedwiththepeoplewhomwedesiretohelp,wecanmovebeyondbandagesandsplintstorescuesthatinviteinwhatissometimescalledgrace.

TimothyTrujillotellsusaboutatimehewascalledtoahospitaltohelpapatient dying of liver cancer. The condition of Tom’s liver ruled out strongmedications,andhewassufferingfromterriblepainanddepression.Tom’swife

anddaughterwereingreatdistress,soTrujillowascalledintoconsultforpainmanagement.Tomhad not slept in days, had great difficultymoving andwasunabletospeakbecausehehadatubeinhisthroat.Thereseemedtobenowaytocomforthim.

TrujillospokewithTom’sdaughterwhofilledhiminonthesituationandhewalked into the room to findTomstaring fixedlyat theceiling. “Tom,”hesaid. “I amhere tohelpyoubemorecomfortable.Blinkyour eyes if youcanhearme.”

Tomblinked.Trujillowenton:“Didyouknowthatyourbodyknowshowto provide chemicals that canmake youmore comfortable?”He paused to letTomconsiderwhatthatcouldmeantohim.“Letmeshowyouhowthisworks.Closeyoureyesandremembersomeplaceyoulovetobe,whereyoufeelfineandrelaxedandhappy.”

Tomclosedhiseyes.Thentearsbegantorolldownhischeeks.Hereachedup and tookTrujillo’s hand as his daughterwatched, amazed. “Any time youwant tobecomfortable, justcloseyoureyesandgo to thisplace.”Tom’sfacevisibly relaxed. Then he fell asleep. Elated, Tom’s daughter rushed from theroom to tell hermotherwhat had happened.The twowomen thankedTrujilloprofuselywhenhe emerged.Their faceswere completely transformed. “Whenyouworkwith aperson, youworkwith a communityof individuals,”Trujillosays.“ProvidingcomfortforTomprovidedcomfortforhisentirefamily.”

Insomemedicalemergencies,thesetechniquescanbeaselegantlysimpleas they are effective. Two weeks after one of our training sessions withparamedics,astudentcalled,allexcited.“Itworked,”hesaid.

“Yousoundsurprised,”weresponded.“Iguess,butreally,Iwassurprisedathowsimpleitwas.Wepickedupa

little girl with the ambulance and her breathing was really shallow. She wasgaspingforbreath.Hermotherwaspanicked.So,Ihadoneoftheguysfollowyourrecommendation,youknow,getthemotherbusywithsomethingelse,thenI started pacing and leading the girl’s breathing, starting where she was,matchingherbreathforbreath,andthenslowingdown.”

“So,whathappened?”“Well,bythetimewegottothehospital,shewasbreathingjustfine.”VerbalFirstAidhelpspeopleexperiencingemotionaldistress aswell.A

youngwoman,Lisa,wasseverelyallergictobees.WhilevisitingherfriendJodyfor a weekend in the country, Lisa noticed a bee at the window. When sherealized it was on the inside of the screen, she was consumed by terror. Shereachedforherpurse,lookedforheranti-allergenEpiPenTMandrealizedshe’dleftitathome.Althoughthebeehadnotmoved,Lisa’sthroatbegantotighten,

her breathing became rapid and shallow, and her hands clammy. Jody tookcharge of the situation immediately. She closed thewindow and ledLisa intoanotherroom.SittingdownnexttohershebegantomatchLisa’sbreathing,thensloweditdown.Shesaid,“I’mrighthereandthebeeistrappedfarawayfromyouinthenextroom.Thedangerisoverandyou’resafe.Asyousitwithmeonthecouch,youcanbegintofeel thecomfortandsafetyrelaxingyourchest…”ShecontinuedtotalkandusepacingbreathinguntilLisa’spanicsubsided.

AcolleagueJanetrecallsanincidentwithherniece,Elza,duringavisittoElza’sgrandparents’housethatnicelydemonstratesawiderangeofVerbalFirstAidtechniques.“WhileI’dgoneouttorunanerrand,Elzahadbeenplayinginthe kiddie pool with her sisters and one of them fell. Somehow her youngersister’sfootwoundupinElza’smouthandElzastartedbleedingprofusely.Hergrandparents panickedwhen they saw that her front toothwas hanging loose.Thoughterriblyupset,theyfinallymanagedtogetsomeiceandcompressesonthewound.WhenIgotback,ItookamomenttosizeupthesituationandtookElza aside, where her grandparents’ well-meaning concern and confusioncouldn’taffectherasmuch.Iwhispered,‘Lookslikewe’retheonlysaneoneshere.’Shelaughed.Andthatwasmyopening.Isaidtoherquietly,clearly,andvery firmly, ‘I’m gonna tell you a story now and you’re gonna staywithmyvoice,nomatterwhatelsegoeson…okay?AndwhileItellyouthestory,youcan stop the bleeding.’ Shenodded.Then I said, ‘I knewa girl, 10 years old,wholostabigchunkofherfront tooth,knockeditagainstabigoldmetalbusseat.Shecried,butthenshestoppedcryingbecausesheknewtheworstwasoverandthatthehealingcouldstartrightnow.Andguesswhat?’Elzasaid,‘What?’AndIsmiledather,pointedatmyfronttoothandsaid,‘Thatlittlegirlwasme,and everything turned out just fine.And after you get better you can tell thisstorytosomeotherlittlegirlwhoneedsyourhelp.’Sherelaxedafterthat.Anditturnedoutjustfineforher,too.”

AsimportantasVerbalFirstAidinformationis,itiseasytolearn.Inthepagesthatfollowyouwilllearnspecifictechniquesandfindscriptsyoucanusetohelpchangetheoutcomeinmedicalemergencies,tocalmthoseinemotionaldistress,and toprovidepainreliefandcomfort to thosewhoarephysically ill.Thispracticeinvolvesboththemindandtheheart.

Outof the tragedyofSeptember11thcameastory that reveals thesecretmagicofdoingthiswork,thecircleeffectthatmeansthat,inhelpingothers,wecanneverreallytellwhoisgivingandwhoisreceiving.

AstheNYFDfirefightersofLadderCompany6toldus(astorythattheyalsosharedasanNBCDatelinereportonSeptember29,2001as“TheMiracleofLadderCompany6”),theyenteredthebuildingatNumberOneWorldTrade

Centerafter the firstplanehadmortallywounded it.Theywerehelping in theevacuation, carrying more than 100 pounds of equipment per man, when,somewherebetweenthe12thand15thfloor,thepolicehandedovertothem60-year-oldbookkeeper,JosephineHarris,whosedescentfromthe72ndfloorinthesmokeandheathadcompletelyexhaustedher.

BillButlersaid,“TheonlyonewaytokeepJosephinemovingwastokeeprapport.”Thewordstheyusedtocalmandencourageherweretherightwords.(“Josephine,we’re going to get you out of here today,” and, as their sense ofurgencygrew,“Josephine,yourkidsandyourgrandkidswantyouhometoday.Wegottakeepmoving.”)Butbythefourthfloor,shecouldwalknomore.

Because themenofLadderCompany6 refused toevenconsider leavingJosephine, theytriedagaintoencourageher tomoveon,buther legscouldnolonger support her.Suddenly, there cameanunearthlyhurricaneof sound thatmeant the buildingwas collapsing, and all of the firefighters prepared to die,thenandthere.

But there were other plans in store for them. The staircase and floor atwhich Josephine had insisted they stopmiraculouslywithstood the destructiveweightof105floorscrashingdownontopofit.Itwasoneoftheonlyfragmentsofthestructurenotturnedtodust.

Whenthebuildingfelltheywerenotkilled,butseemedtobeburiedalive.TommyFalcoheldJosephine’shandwhenshesaidshewasscaredandgaveherhiscoatwhenshesaidshewascold,but,thefirefighterslatertoldus,shenevercomplained. “Shewas a trooper,”SalD’Agostino said,with admiration.Theyweretrappedtogetherintherubbleforfourhours.Finally,theywerediscoveredbyLadderCompany43.Themen toldus theydidn’twant to leave Josephine,didn’t want to pass her on to other firefighters, but special equipment wasneededtogetherout.

The firefighter who came to their rescue was “pumped up,” they said,excitedathavingfoundthemalive.HebegantohelpJosephine,saying,‘We’lltakecareofyou,doll,wegotyou.”

Buttherehadbeenashiftinunderstandinginthatdarktombinwhichtheyhad been buried together, andD’Agostino grabbed the rescuer’s arm. “Listen,hernameisn’tdoll.HernameisJosephine.”Helaterexplained,“IwantedhimtogetpersonalwithherthewayIhadgottenpersonal,thewayweallhad.”Theotherfirefighter,quicklyunderstanding,said‘Josephine,right.Sorry,Josephine,we’lltakegoodcareofyou.’”

Ultimately they were rescued. And they all believed, to a man, thatJosephinewastheirguardianangel,senttheretoholdtheminthatsacredspace

sothattheycouldsurvive.“Yousavedourlives,”theysaidtoher.“Yousavedmine,”sheresponded.Itwasalltrue,andit’sawonderfulmetaphorforthewayitreallyworks.Rescueisonlypartiallyaboutdiggingorpullingpeopleoutofadisaster scene, only indirectly aboutmateriel and “the jaws of life.” It is alsoaboutrisingabovethedebrisonwingsoffaithandloveinsuchawaythatwearerescuedineverymomentfromfearandharm.

Verbal First Aid is more than the words themselves. It embodies anattitude,astatementboth literalandspiritual. It isaprocesswecanwitness inourselves and a position we lovingly assume with the people around us. Thewordsarethetools,buttheirpowerderivesfromawarenessandlove.Itisbornfromadecisionwemaketoparticipateinourwellnessandinthewellbeingofothers.

VerbalFirstAidKey–Chapter1HowitWorks

Wordsaffectthecourseofhealing:anythingyousayinthepresenceofasickorinjuredpersonhasthepotentialtohelportoharm.VerbalFirstAidisanadjuncttomedicaltreatment,notasubstitute.Apersoninamedicaloremotionalcrisisisinamoresuggestiblestate,whichwecalla“HealingZone.”Ourwordscanaffectallsortsofautonomicnervoussystemphysicalprocesses:Pain,heartrate,bloodpressure,respiration,andinflammatoryresponse,tonameafew.Evenintheunconsciousstateapersoncanhearandrespondtotheimagesyourwordsgenerate.M.ErikWright’sstudyshowedthatpatientsattendedbyparamedicstrainedinaspecialprotocoldesignedtoverballypromotehealingweremorelikelytosurviveemergencytransport,haveshorterhospitalstaysandenjoyquickerrecoveryrates.

T“Miracleshappen,notinoppositiontoNature,butinoppositiontowhatwe

knowofNature.”--St.Augustine

his chapterprovides the sciencebehind thenotion thatmindandbodyarenotseparate,butarepartofanintegratedwhole,andthatthoughts,therefore,haveadramatic physiological effect on bodily functions. Tomany of the people wehave worked with and trained, Verbal First Aid seems like magic. Althoughthesetechniquescanbeextremelyeffectiveinanemergency,thereisnomagicinvolved.Thereasonsareveryconcrete.Thedocumentationwepresentnowisjustthetipofamonumentalandever-growingicebergofevidence,research,andclinical experience that support and explore the fascinating potential of thehumanbeing,inwhichbody,mind,andspiritallplayacriticalroleinmedicaloutcomes.

Forsomepeopleitdoesn’tmatterwhyVerbalFirstAidworks,justthatitworks.Ifyouareoneofthosepeople,youcouldskipaheadtothechaptersonVerbalFirstAid technique. If, however, you are the kindof personwho feelsmore convinced and satisfied when a proposition is supported by evidence,pleasereadon.

Theunityofmindandbodyisanoldidea,onethathasbeenacceptedforthousandsofyearsbythegreatwisdomtraditions.ItwasakeystoneoftheVedicteachings of India, where it was developed into a sophisticated mind/body

medical system called Ayurveda. Travelers carried this knowledge to China,where it was modified and became the source of ancient China’s system ofmedicine. Native Americans also believed firmly in the healing power of themind.ThelateCorbinHarney,aWesternShoshoneNationSpiritualLeader,wasworld renowned forhis activism indefenseof the futureof theMotherEarth.Asked aboutmind/bodywisdom, he explained that simply using an herb or apharmaceutical part of an herb is not nearly as effective as using the herbsbacked with a belief system. “If you’re going to use something like this[chaparral for cancer,which is very effective among theNative people], yourmindshavegottobeconnectedwithit,withwhateveryou’reusing.Youcan’thaveyourdoubts,”hewrote inhisbook,TheWay It Is. “Amiracle thing canhappen,but inorder for it tohappenyouare theonewho is going tohave toallow it—inyourmind.Weare theones,ourselves,whoworkwith theSpirit.Somebodyelsecan’tdoitforyou.”

Theseparationofmindandbody,whileitcanbetracedbacktotheancientGreeks, ismostoftenlaidat thedoorstepof the17thcenturyphilosopherReneDescartes. Since the Roman Catholic Church claimed man as its domain,Descartesandthechurchstruckadeal:sciencebecameanatomy,themechanicalfunctionsofthebody,divorcedfromanyinvolvementwithspirit;andtherealmof thechurchbecame themindandsoulofman. Itwas tacitlyagreed that themindcontrolledthethoughts,reason,andemotion,leavingthespiritlessbodyadistinctandseparatescientificentity thatcouldbestudiedwithout traipsingonmoral, spiritual issues. In this way Descartes was able to pursue his interestsdespite the power of the church, and an artificial dualism was born. ThisphilosophicalpositionmayhaveservedDescarteswell,butwhenitevolvedintoamedicalapproachthatcutmindandspiritoutofthehealthequation,itdidtherest of us a great disservice.By focusing solelyon external causesof disease,such as bacteria and viruses, science dissuaded us from exploring the reasonswhy one person exposed to a virusmightnot get sick.When it dismissed theevidencethatapersonhavingahearttransplantmightbemorelikelytosurviveifhisemotionsweretakenintoaccount,itignoredcommonsense.

Whiletherewerethosewhospokeoutinfavorofamoreholisticapproachto healing, such as the father of Homeopathy, Dr. Samuel Hahnemann, theirvoiceswere barely heard by the vastmajority in thewesternworld (althoughtheycontinuetobewell-respectedincountriessuchasGreatBritainandIndia).In 1974, however, a serendipitous finding in a lab at theRochester School ofMedicineandDentistrychangedthatforever.

RobertAderandhisassociateswereconditioningratstoexperiencenauseawith an intakeof saccharinewater andadrugcalledcyclophosphamide.What

theyfoundwasthattherats’immunesystemsbecameconditioned,sothatevenwhen given only the saccharine, the rats took ill. This was an enormousbreakthrough, for it suggested that the immune system could learn. AdlercontinuedhisresearchwithDr.NicholasCohen,arespectedimmunologistandthefieldofpscyhoneuroimmunologywasborn.Theinterplaybetweenthought,emotion,belief,imageryandbiochemicalprocesshadbeenrevealed.Thedoorsofdiscussionhadbeenopenedandtheywouldnotbeclosedagain.

In the last twentyyears,Mind/BodyMedicinehasearned itsplace in thepantheonofmodernscientificthoughtintheUnitedStates(thankstotheeffortsof Candace Pert at the National Institutes of Health, Carl and StephanieMatthews Simonton in the field of guided imagery, and the persistence ofinnumerable researchers with both creative talent and the data to match,complemented by such articulate popular thinkers as Deepak Chopra, LarryDossey, Andrew Weil and others). Once greeted with ridicule, mind/bodymedicinehasnowgainedtheacceptanceandpiquedthecuriosityofthosewiththefundingforcontinuedresearchandschooling.

The world has opened up to this concept as well. At the University ofHeidelberg, Germany, Yugoslav psychologist Ronald Grossarth-Maticekconducted a ten-year study on 1,300 Yugoslavs with no previous medicaldiagnosis.Basedentirelyonwhatheknewof theirpersonalitiesandemotions,Grossarh-Maticekwas able to predict their deaths from cancer (for thosewithrepressed emotions andhopelessness) or heart disease (for thosewithhostilityandaggression)withstatisticallysignificantaccuracy.

In fact, the power of the mind to intervene outside the body has beendemonstrated in studies of what is known as non-local healing. In his best-sellingbooks(HealingWords,PrayerIsGoodMedicine,ReinventingMedicine,and the latest One Mind: How Our Individual Mind is Part of a GreaterConsciousnessandWhyitMatters,anamongmanyothers)LarryDossey,M.D.,providesadetailedreviewof thestudies in thepowerofwordsand thought inthehealingprocessanddiscussesexperimentswithnotableoutcomesinvolvingprayerforAIDSpatientsaswellaspatientswithadvancedheartdisease.

Manyinsuranceandhealthplanshavebeguntopromoteaffiliationswithand reimbursement for the services of “holistic practitioners,” knowing thatpeopleareseekingsolutionsinalternativetreatmentsandarefindingthemtherein increasingnumbers. It has alsonot escaped their attention that enlisting themindearlyintheprocesscansavemoneyandreducetheircustomers’suffering.IntheAmericanJournalofHealthPromotion,Dr.Wallerstein(1992)makesthecase that a sense of powerlessness or “the lack of control over one’s destinyemergesasabroad-basedrisk factor fordisease.”And ithasbecomecommon

knowledge that the “type A” personality, which is not much more than acomposite of personality traits—beliefs, thoughts, and emotions as expressedbehaviorally—has amuchhigher propensity for seriousmedical illness.WhenresearchersLawlerandSchmiedattheUniversityofTennesseestudiedagroupof female secretaries, they found that the TypeAwoman had a higher bloodpressure, heart rate, and frontalis EMG as she engaged in a series of work-relatedtasks.OverallreactivitywasnotrelatedtoTypeAbehaviorsomuchasitwasrelatedtostresslevelsandpowerlessness.

InhisarticleintheJournaloftheAmericanMedicationAssociation,“WhyPatients UseAlternativeMedicine,” JohnA. Astin of the StanfordUniversitySchoolofMedicineexpressesthebeliefthatitisthetransformationalaspectofalternative health care that appeals to most who choose it. “They find in[alternativetherapies]anacknowledgementoftheimportanceoftreatingillnesswithinalargercontextofspiritualityandlifemeaning,”hewrites.

By notmaking the illness something the body just randomly “got,” andthereforesomethingtobeexcisedordismissedwithapill,butratheramessageaboutwhoweareandhowwemightlivedifferently,westepuptotheplateandourlivesarerestoredtous.

Consideryourownexperience.Howdoyouknowyou’reangry?Howdoyouknowyou’resad?Doyouseeanimageinyourmind?Doyoufeel,asmostpeopledo,a sensationsomewhere inyourbody first?Somepeopleexperienceanger as a kick somewhere in the solar plexus (an activation, probably, of theadrenals).Others feel itasa tightening throatora flushed faceora revved-upheartbeat. However you experience them, emotions are not just mentalconstructs—they are physical in the fullest sense of the word. Candace Pert,PhD, former Chief of the Section on Brain Biochemistry of the ClinicalNeuroscience Branch of the National Institute of Mental Health (NIMH)explained the reason thatyou feelyour feelings inyourbody thisway: “Yourbodyisyoursubconsciousmind.”

Ourresponsestotheworldaroundus—electrochemically,physically,andemotionally—arebasedonacomplexand intimate interrelationshipof internalandexternalstimuli.Aninternalstimuluscouldbeamemory,afear,athought,orasensoryresponse,andanexternalstimuluscouldbeenvironmental,cultural,orsituational.

In mind/body medicine, your interpretation of an event may be asimportanttoyourwellbeingastheeventitself.Inhisbook,UnconditionalLife,Dr.DeepakChopra cites the example of twopeople riding on the same rollercoaster.Theriderwhoisterrifiedcreatesstresshormones,whichovertimewillcausehisimmunesystemtoweaken.Theriderwhoisexhilaratedbytheroller

coaster ride produces a flood of chemicals, among them interferon andinterleukin, that strengthen his immune system. In each case the ridewas thesame; itwasonly the interpretation thatdiffered.Anditwas thatperception—that the ridewasa life-threateningora thrillingexperience—that triggered theproductionofchemicalsthatcouldcompromiseorpromotehealth.

Therearemanyconsequencesofthisrealization,buttheyareparticularlysignificant for people suffering from acute or chronic trauma, physical, life-threateningorchronicillness,andemotionaldistress.Ifhowwereacttoaneventisat leastas importantas thatevent itself,whenpeopleare inanaccidentoracrisisorwhentheyareemotionallyupset,theirinnerresponsewillstimulate—orfight—their own self-healing mechanism. What’s more, as Joan Borysenko,Ph.D., notes, the “body cannot tell the difference between the events that areactual threats to survival and events that are present in thought alone.” Thememoryofbeingmuggedproducesthesameracingheartbeat,sweatypalms,thesameshowerofadrenaline,astheeventitself.

Mind/body medicine, which includes psychoneuroimmunology,neurolinguistics and medical hypnosis, sees the human being as a complexnetwork of energy. In her book The Quantum Self, physicist and philosopherDanah Zohar writes, “The mind/body duality in man is a reflection of thewave/particleduality,whichunderliesallthatis.Inthisway,humanbeingisamicrocosmof cosmicbeing.”Mindandbodyare same thing, somuch so thathaving two distinct words for them is misleading. They are inextricablyinterrelated.Perhapsbefore too longanewwordwillemerge thatwouldmoreproperlyreflectourtruenatures.

Whetherweseeitasanewwordoranoldtruth,mostleadersinthefieldagree:weexpress thoughtandfeelingnot just inourminds,but inourbodies,andwemanifestphysical illnessorchemical imbalancenot just inourbodies,but inourminds. If it is true that “wearewhatweeat,” itmaybeevenmoreaccuratetosaythat,“wearewhatwebelievewe’reeating.”ThelineDescartesdrew between ourminds and our bodies once literally cut us off at the neck.Fortunately, that linehasbeen loosened andnewboundarieshavebeendrawnthatstretchfaroutintohorizon,leadingusintoknowledgeandunderstandingweareonlybeginningtoimagine.

SpontaneousRemissions

In both of our clinical practices we have seen serious, even terminalillnesses simplydisappear asbelief systemsor thoughts changed.Spontaneous

remissions are among themost fascinating phenomena inmedicine.These aresaidtooccurwhenapatientrecoversfromaseriousdiseasewithnoperceivableclinical intervention.Wehearabout themall the time in the lunchroom, in thelineatthesupermarket,atfamilygatherings.“Iknewthiswoman,”someaffablestrangerwillcomment,“andshewasjustintheworstshape.Shehadcancerfora year and was fighting it with chemo and radiology and any alternativetreatments she could find. The doctors told her that they just couldn’t do anymoreforherandsentherhome.Wellshejustwouldn’thearofit,shewastoobusy,shesaidtome.Shehadchildrentocareforandagardentotendandajobtodoandshejusthadnotimetodie.Doyouknowthatsixmonthslater,whenshewentbackforacheckup,thecancerwasgone?Isn’tthatjustamazing?”

Yes,itis.AndmedicaldoctorslikeAndrewWeil(SpontaneousHealing),Deepak Chopra and Larry Dossey are writing the books that change, as St.Augustinesaid,whatweknowofnature,sowecanbegintoseetheroleweplayin our own healing. It is said that the two most amazing things about livingbeings is that they have the ability to reproduce themselves and the ability torepairthemselves.

In anOctober 26, 2009 article in theNewYorkTimes entitled,CancersCan Vanish Without Treatment, But How?, Dr. Barnett Kramer, associatedirectorfordiseasepreventionat theNationalInstitutesofHealthexplainsthattheoldideathatcancerwasalinearprocess,destinedtogoinonlyonedirectionisbeingmodified.“Cellsneed thecooperationofsurroundingcellsandeven,”hesaid,“‘thewholeorganism, theperson,’whose immunesystemorhormonelevels, for example, can squelchor fuel a tumor.”The same article reported astudy inCanadaofpeoplewithkidneycancer thathadspread throughout theirbodies.“Asmanyas6percentwhoreceivedaplacebohadtumorsthatshrankorremained stable. The same thing happened in thosewho received the therapy,leading the researchers to conclude that the treatment did not improveoutcomes.”(http://www.nytimes.com/2009/10/27/health/27canc.html?_r=1&em)

The article does not answer the “why” in the headline, but others haverecognized for years that in some people, diseases come and then go bythemselves.Onenightin1979overdinner,BrendanO’Regan,oftheInstituteofNoeticSciences,askedcancerresearcherCaryleHirshbergwhatheknewaboutspontaneous remission.Hirshberg replied that tumors inhisanimals frequentlysimplywent into remission. Sparked by this dinner conversation to conduct asearchof the literature on the subject, the twomendiscovered therewasverylittletobefound.O’Reganhadalreadybeenthinkingofdevelopingaprojecttoexamine why some people were “really healthy”—the healthy elderly, peoplewithexceptional immunesystems,peoplewhoneverwent todoctors—in light

of the two systems of the body described by Norman Cousins: “the beliefsystem” and “the healing system.” If such a thing as “the healing system”existed,O’Reganhadwondered,howdidoneresearchit?Thenherealizedthatpeople who recovered without a rational, medical explanation, from life-threatening diseases—that is, people whose illnesses went into spontaneousremissions—mightholdtheanswer.

Since that time, The Institute of Noetic Sciences, in a project led byO’Regan, has published the results of its search through more than 3,500references,frommorethan800journalsin20languages,assemblingthelargestdatabaseofmedicallyreportedcasesofspontaneousremissionintheworld.

TheEmbodiedMind

InanarticleinHarvard’sMentalMedicineUpdate(Vol.III,No.1,1994)itwas estimated that 80 percent of office visits to physicians are stress-related.Four patients out of every five!We are the only known species who dies onschedule:morepeopledieonMondaybetween8and9 in themorning thanatanyothertimeanddayoftheweek.Whyisthat?Couldithaveanythingtodowiththestressofgoingtowork?AndhowdoweexplainthedatashowinghowdeathpeaksinChristiansthedayafterChristmasandinChinesepeoplethedayafterChineseNewYear? These findings have been echoed in the research ofKroenkeandMangellsdorf,publishedintheAmericanJournalofMedicine,whofound that in less than 16 percent of the clinical cases reviewed were theproblems caused solely by a biological problem.They concluded that over 70percentofthesymptomsreportedwererelatedtopsychosocialfactors.

The lateCandacePert, PhDwas one of themajor forces in the growingacceptanceofmind/bodymedicine.Abrilliantscientist,Dr.Pertwasoneofthediscoverers of opiate receptors in the brain, as well as many other peptidereceptorsinthebrainandelsewhereinthebody.Hergroundbreakingworkledto a new understanding of what she calls “the biochemical correlates ofemotions” and the “intercellular communication through the brain and body.”When Bill Moyers, in his PBS series Healing & The Mind, asked Dr. Pertwhetherangerwasphysicalormental,sheresponded,“It’sboth!That’swhat’sso interesting about emotions. They’re the bridge between themental and thephysicalorthephysicalandthemental.It’seitherway.”

Pert’sworkilluminatesthisconnectionasnootherresearchhas.Whereatfirstshefocusedonendorphins(ourendogenouspainkillers),latershereportedthat throughout the entire intestinal tract, perhaps throughout thewhole body,

certainwhitebloodcells(monocytes)playapivotalroleintheimmunesystem.Thesecellsnotonlyhavereceptors forvariouschemicals thatcontrolmood inthebrain,buttheyalsomanufacturethesubstancesthatcontrolourmoods.

There is an extraordinary aspect to these discoveries. Whereas ourprevious ideas supported the reductionist paradigm (the chemicals of neuro-transmissionarelimitedtothecranium,andthemindandbodyareliterallykeptapartbyablood-brainbarrier),nowwefindthesemonocytestravelingalloverthebody.Onceconsideredquite limited in their scope, thesewhitebloodcellshave been proven to have the intelligent complexity of brain cells. Theimplication, according toDr.Pert, is that, rather thanbeing located just in thebrain,themindis“partofacommunicationnetworkthroughoutthebody.”

Now we can begin to understand how the mind takes part in so manyphysiological decisions and outcomes. Pert explained, for example, that theAIDS virus,which uses the same receptor as a neuropeptide, can enter a cellwhen the receptor is available due to low neuropeptides, a situation thatfluctuateswithouremotions.“Soouremotionalstatewillaffectwhetherwe’llget sick from the same loading dose of a virus,” she said, concluding,“Emotional fluctuationsandemotional statusdirectly influence theprobabilitythattheorganismwillgetsickorbewell.”(Italics,ours.)

We think of “thought” or “consciousness” as being housed in the brain.But these neuropeptides, released during different emotional states, occurthroughout the body, including the immune system. Emotions, previouslyconsideredisolatedpsychologicalorliteraryevents(goodforpoetsandanalysts,buthavingnorealbearingonmedicalscience),arenowseenasinterwovenandintimately connected with specific chemical processes throughout the entirebody,notjustthebrain.

Belief,PlacebosandTheTruePowerofVerbalFirstAid

WhatdoesthismeantousintermsofVerbalFirstAid?Itmeansthatwhatweseeaffectsus.Whatwehearaffectsus.Whatwefeelaffectsus.Andwhatwebelieveaffectsus--not just inourminds,but inourbodies—especially inacritical situation,when every image in ourminds has an acute and immediateimpact.

Nothingdemonstrates thisquite sosimplyordramaticallyas theplaceboeffect.Aplaceboisasubstance,likeasugarpill,thatisnotexpectedtocausea

medical effect in the body.When givenwith by an authority figure such as adoctor,withthesuggestionthatitwillcuresomething,thereareoftenamazingresults.Aplacebo is considered “simply” apsychological influence, but it hasexquisitelyrealphysiologicaleffects,whichcanoftenbemeasured.

Inhisbook,Placebo-EffectHealing:ThePower&BiologyofBelief,Dr.HerbertBenson,MD, explores thenatureof theplacebo effect andmarvels athowthemedicalcommunityignoresthetruesignificanceofthiseffect,whichisself-healing and the ability of a person to affect his or her physiologicalwellbeingwithjustathought.Beyondtheusuallyaccepted33percenteffectivenessofaplacebo,Bensonreportsthatthesuggestionofhealingplusalittlesugarpillhas been “effective in approximately 70 percent of cases of angina pectoris,bronchialasthma,herpessimplex[whichisavirus],andduodenalulcer.”

DeepakChopra,inCreatingHealth,remembersastudyinwhichagroupofpatientswithbleedingulcersweregivenwhattheirdoctorstoldthemwasthe“mostpotentcurrentdrugfortreatingulcers.”Itworkedbeautifullyinmorethan70 percent of the cases. Another group, however, was told that the drug was“only experimental and therefore unknown in its efficacy.” Itwas effective instoppingonly25percentofthebleedingulcers.Asitturnedout,bothgroupshadtakenaplacebo.Thevariable in this studywas the therapeutic suggestion.Dr.Chopragoesontomaketherealpoint:“Ifwelookaheadfarenough,wecanseethatplacebosmaybethebestmedicineofall.”

Placeboswork through the release of neurotransmitters in the samewaythatathoughtdoes.Inessence,theplacebo’sactiveagentisnotthedoctorbutthepatient’sthoughtprocess.Ourulcersgoawaybecausewebelievetheywill.Ourbeliefs,ourthoughts,createthecascadeofchemicalsnecessaryforhealing.Theycangosofarastoactuallychangetherealityofadrug’sclinicallyprovenaction,astheydidinonestudycitedbyChopra.Init,patientswererelievedofnauseawhen given a pill theywere told was a powerful anti-nausea drug. Inreality,thepillwasdesignedtoinducenausea.

Youdon’tneedastudytoseetheplaceboeffect.Itisatworkaroundusallthe time.We rememberonewomanwhohad reached for anon-narcotic sleepaidinhermedicinecabinetandbyaccidenttookacoupleofEchinaceacapsules,notknowingwhattheywere.Withinahalf-hourshewassodrowsyshedroppedofftosleeponthecouchwiththeTVonandpeopletalkingaroundher.

One reason the placebo effect has not been studied more is because itcannot bemanufactured andmarketed. There’s no profit in it.When you tellsomeoneit’s“justaplacebo,”youarereflectingthenegativestanceofamedicalenvironment that has emphasized pharmacology and surgery as the primary ifnot exclusive treatment modalities for the last 100 years. Yet, over and over

again,studiesandlifeexperiencesshowusthatwhatwebelieve,whatwethink,andwhatwefeelismanifestedinourbodies.

For our purposes in Verbal First Aid, the implication is striking:Suggestion can be a formidable healing tool. The pillmight be nothing butsugar,and the inhalercouldcontainnothingbut salinesolution,butourmindsand bodies, having visualized a positive (or negative) outcome, canmake thatsugar or salt water a potent force. In fact, the body, believing it has taken amedication that relieves pain, can actually release its own painkillers—endorphins,accordingtoastudyattheUniversityofMichiganpublishedintheJournalofNeurosciencein2005.Asresearchersusingthelatestimagingdevicesreport,whetherweactually lookout at a sceneor justvisualize itwith closedeyes,thesameareasinthebrainbecomeactive.

Aswesuggestedearlier,thesenotionsarenotreally“new”atall.TheyareolderthanHippocrates,thefatherofwesternmedicine,whosaid,“Apatientwhois mortally sick may yet recover from his belief in the goodness of hisphysician.”Our perceptions, thoughts, and feelingswere acknowledged in thehealingprocessthousandsofyearsago.

MedicalUsesofGuidedImageryandVisualization

Asearlyasthe1920’s,studieswerebeingdonebyDr.EdmundJacobsontomeasuremuscular contractions. He had patients visualize activities such asrunningorswimming,and thenwasable tomeasure theheightenedactivityofthemuscle,simplyinresponsetothethoughtofexercise.

In 1971, Dr. Carl Simonton, a radiologist at the University of Texas,documentedastrikingexampleofthepowerofmentalimages.Hewastreatingapatientwithadvanced, terminal throatcancer.Thepatientweighed98 lbs.andhisoddsforsurvivalwereonly50percent.Weakandseverelyill,hestillneededradiation.But Simonton knew that itwas very unlikely that the patientwouldsurvive it.Desperate, Simonton and hiswifeStephanieMatthews-Simonton, apsychologist,investigatedbiofeedback.AfterdiscussionswithDrs.JoeKamiyaandElmerGreen,oftheMenningerClinic,whoexplainedthatusingrelaxationtechniques,onecouldpictureandimagineadesiredgoaltohaveitoccurinthebody,theSimontonsdecidedtogivevisualizationatry.Theyaskedthepatientto see or form a mental image of his immune system as white blood cellssuccessfullyattackingthecancerashereceivedtheradiation.Thepatientsawitassnowgraduallycoveringablackrock,untilitwasgone.Theresultwasatotalremission.

Dr. Dabney Ewin, the renowned surgeon and professor at TulaneUniversity’sMedicalCenter,hasbeenusingtherapeuticsuggestionattheBurnUnitformanyyears.Herecountsonecaseinwhichamanwasseverelyburnedbyanexplosionandadmittedtothehospitalwithhadthirddegreeburns.Ewinimmediately gave the man suggestions that set his mind to rememberingexperiencesofbeingcoolandcomfortable.By imaginingpacking theafflictedareawithsnoworice,forexample,thepatientcouldfeelnumb,whichkeptthebodyfromsendinghistaminesthatcauseswelling.Bythesecondday,theinternwhoexaminedthepatientclaimedhecouldonlydiagnosesecond-degreeburns.The man’s healing time was remarkably short, and he never developed theswellingthatsooftenimpedesprogresswithburns.Hewasoutofthehospitalinsixweeks.

A1994studyconductedattheMontrealHeartInstituteshowedthatheartattacksurvivorssufferingfrommajordepressionhavethreetofourtimestheriskof dying within six months as compared to non-depressed survivors, makingdepressionasgreatamortalityriskfactorasdegreeofheartfailureorhistoryofapreviousheartattack.

At Ohio University, a study on heart disease was conducted in whichrabbitswerefedtoxic,highcholesteroldiets toblocktheirarteries.Theresultsstarted to come in as expected, with all the requisite symptoms. Howeverresearcherswerepuzzledtodiscoverthatoneofthetrialgroupsexperienced60percentfewersymptoms.Theyexaminedthephysiologyoftherabbitsandfoundnothing.What could be the variable? They finally discovered that the studentwhose job it had been to feed the rabbits had a soft spot for his charges, andalways stopped to pet them. That was the only significant difference. Thescientistsrepeatedthestudyanumberoftimes,addingthepettingasacontrolledvariableandfoundthesameresults.Therabbitswhowerepettedseemedtogainenhancedimmunity.

Howdoesthiswork?Ifimageshavethismuchpower,ifsuggestionsforacool and comfortable environment can help inhibit the unwanted autoimmuneresponse responsible for complications and edema in burn patients, and if acaring touch can indeed help to lower a rabbit’s susceptibility to highcholesterol,whatishappening?Whatmechanismisatwork?

TheComplexMechanism

CellularbiologistBruceLipton,Ph.D., is challenging thenotion thatourgenetic inheritance is fixed at birth. Since 1953, biologists have assumed that

DNA“controls” life. Inmulticellular animals, the organ that “controls” life isknownasthebrain.Inacell,ifthegenewerethecontrol,thenucleuswouldbetheequivalentof thecell’sbrain, they thought. Inhiswork,Liptondiscoveredthatcellscouldliveformonthswithout theirnucleuscontinuingtobehaveandreacttotheenvironment.Whatthen,ifnotthegenes,wascontrollingthecell’sbehavior? Recognizing that genes cannot turn themselves off and on, heconcludedthatratherthanrunningtheshow,DNAsimplyrespondsbymakingchoicesbasedonourperceptionoftheenvironment.Thishappens,hebelieves,throughthecellmembrane.BuiltintothemembranearespecialproteinscalledIntegral Membrane Proteins (IMPs), which come in receptors and effectors.Theyregulatewhatcrossesintothecell.AccordingtoLipton,“Researchclearlyreveals the regulatory influence that electromagnetic fields have on cellphysiology.Pulsedelectromagneticfieldshavebeenshowntoregulatevirtuallyeverycellfunction,includingDNAsynthesis,RNAsynthesis,proteinsynthesis,cell division, cell differentiation, morphogenesis and neuroendocrineregulation.”

Thesefindingsacknowledgethatbiologicalbehaviorcanbecontrolledbyinvisible energy forces, which include thought. Because the structure of ourbodies is defined by our proteins, and because the binding or releasing ofregulatory proteins is directly controlled by environmental signals, how weperceivetheworldandthreatstousactuallyshapesourbiology.Cellsrespondtoperceptionbyactivatingeithergrowthorprotectionbehaviorprograms,Liptonbelieves. If our perceptions are accurate, the resulting behavior will be lifeenhancing. Ifweoperate from“misperceptions”or fears, our behaviorwill beinappropriate and will jeopardize our vitality by compromising our health.“Whathappens,”heasks,“ifacellexperiencesastressfulenvironmentbutdoesnothaveageneprogram(behavior)todealwiththestress?Itisnowrecognizedthat cells can ‘rewrite’ existing gene programs in an effort to overcome thestressful condition. These DNA changes are mutations.” A gene cannot turnitselfon,hecontends.Buttheenvironmentinwhichitfunctionscansignalthatachange is needed: ifwe perceive (or evenmisperceive) an environment to bestressfulandthereforegointo“protection”mode,ourbodies,downtoourgenes,respondtoaccommodatetheambientstressors.

What this means is that health is a reflection of the perception of theenvironment.Beliefsaretranslatedintochemistryandchemistryistranslatedbythe system. Ultimately what this means is that what we think and feelliterallychangesourgenesandourdestiny.Thereis,itseems,noimmutablecontrolpanel.Weare literallyapartof theworldaroundus.Thelifewithinisthe lifewithout.As thesayinggoes,“Thescientistsclimbed themountainand

foundthemysticswaitingthere.”Using Verbal First Aid with those who are in emergency situations,

frightened,orseriouslyillmeansunderstandingthatwhatyousayanddointheirpresencecanaffectthatinnerresponsedirectly.Knowingthis,youcanuseyourcommunications to create a healing or calming effect in themoment, and onethatcanchangetheoutcomeforthebetter.

TheAnatomyofVerbalFirstAid

The brain is technically considered part of thenervous system, which isdivided into the central nervous system (CNS—the brain and the spinal cord)and the peripheral nervous system (PNS—made up of the somatic nervoussystem and the autonomic nervous system). The autonomic nervous system(ANS)conveyssensoryimpulsesfromthebloodvessels,theheartandalloftheorgans in thechest,abdomenandpelvis throughnerves tovariouspartsof thebrain(mainlythemedulla,ponsandhypothalamus).Thetermautonomicimpliesthattheseimpulsesoftendonotreachourconsciousness,andthat,inresponsetoenvironmental conditions in the body and mind (e.g., changes in bodytemperature, injury, stress), they elicit largely automatic or reflex responses intheheart,thevascularsystem,andalltheorgansofthebody.TheANSregulatesheartrate,respiratoryrate,digestion,hormonalproduction,balanceandmore.

TheANSthatisthepartofourbrainthatrespondsduringanemergencyisalsothepartthatrespondstovisualimagesandvivid,emotionally-ladenverbaldescriptions. There are two components to the ANS: the sympathetic and theparasympathetic nervous systems, which are the keys to mind/body inter-connectivity. When the body is relaxed and peaceful, the parasympatheticsystem creates balance, harmony, and healing. This includes moderating theheart and respiratory rate and regulating blood pressure. When we feelthreatened, the sympathetic system takes over and orders adrenaline to bedispersed, initiating fight or flight readiness, accelerating the heartbeat,increasingrespiration,anddilatingthepupils.Manystressresearchersclaimthatover-activation of this system taxes the body and works to lower immunity,therebyfacilitatingdisease.Althoughourfight-or-flightresponsewaspartofanexcellent design—togiveus a surgeof energy to escape threats such as sabertoothtigersinthewild—withouttheallclearsignal,thetigernevergoesaway.Todaywe’re facedwith constant traffic, bills to pay, crime, the economy, thethreat of terrorism, not to mention natural disasters. The stress this producescostsusdearlyinvitalenergy.

Thecerebralcortex is responsible for the functionsof thought,voluntarymovement,language,reasoningandperceptionanditisoftendividedintowhatwecommonlycalltherightandleftbrains—theleftforlinear,logicalthinking(and, some say, for dealingwith the outside world), the right for images andnon-verbalthought(andtheinnerworld).Therightbrainisalsoconnectedwiththe limbic system (our emotional life), the hypothalamus (which regulates theimmune system and body chemistry) and the pituitary gland (which handlesmetabolicprocess).

So, roughly speaking, perceptions come either from the outer or innerworld.Ineithercase,neuronsfireinthecerebralcortexandimagesforminthebrain, causing reactions through the limbic system, the hypothalamus, and thepituitarygland.Whether theparasympatheticorsympatheticnervoussystemisactivated depends on whether the interpretation is peaceful or upsetting.Whatever our interpretation, the adrenal glandswill respond accordingly. Theresultingnervoussystemandendocrinechangeswillaffecteverysinglecell inthebody.

ChoosingtheHealingResponse

When people have been burned in a fire, when they are having a heartattack,sufferingfromafallorseriousabrasion,whensomethingintheinnerorouterworldgoesterriblywrong,oftentheirfirstreactionisnoreaction.Oddasthismayseemtoyou,itisverycommon.Likeadeeratthewater’sedgefrozenby the scent of lion and waiting for an indication from the herd leader as towhere to run, we initially hesitate in our reaction to a threat, waiting fordirection.Dr.DonaldTrentJacobs,authorofPatientCommunicationForFirstResponders andEMSPersonnel: TheFirstHourOf Trauma calls this naturalprotectivemechanisma“primitivesurvivalfunction”andsays,“Itmakessensethatitisinitiatedinthelimbicsystem,theoldestpartofthebrain.”Forperhapsaslongasanhour,wesuspendjudgment inacatastropheandtrytofigureoutwhat todoon thebasisofourunderstandingof thesituation. Ifastrongvoicecomesalongandsays“duck!!!”or“run!”or“liedown,”generallywedo.Ifnoonecomesalongtotelluswhattodo,orexplainwhatisgoingon,weresorttoourmemories,realorimagined--asseeninamovieorreadinabook.Wedredgeupemotionsappropriatetotherealorimaginedmagnitudeoftheeventandourbodiesarefloodedwithfight-or-flightchemicals.

ManypeopleinLosAngelesreactedinjustthiswaytotheEarthquakeof1987.Theyhadbeenexposedtosomuchhypeabout“TheBigOne,”thatwhen

theearthfinallydidquake,eventhoughtheywereunhurt,theyhadmeasurablephysiological reactions to the event, generated by imagination, fear, andconfusion. Within four hours of the event, blood taken from people whoexperienced the quake showed an increase in killer cells, implicating theinvolvementoftheimmunesystem.Moreover,theearthquakeneverrockedtheground under several people it killed—they literally died of fright, their fearshavingledtofatalheartattacks.

ThepointinVerbalFirstAidistohelpmanagejustthatsortofresponsesothat it facilitates healing.Researchers have found that after the adrenal glandshave been mobilized to release epinephrine/nor-epinephrine and stimulate thefightorflightresponse,oncethethreathasbeennullifiedtheadrenalssendoutcortisol to silence the alarm and give the “All’s well.” In traumatic stress,mobilizationpersists and cortisol is not released in sufficient quantities tohaltthe adrenal response. Studies have shown that individuals with post-traumaticstress disorder have reduced cortisol levels. The limbic system seems to beresponsible for assessing the situation. If it perceives a reasonable escape, itstimulates the flight response. If it assesses that there is noway to run, but agood chance to defend oneself, it will initiate the fight response.However, ifthereisnohopeofeitherone,orifwehavenoautomaticprogramtodealwiththissituationandfallbackon,itwillchooseathirdoption:freeze.

In the terrible hours in the Twin Towers on September 11, 2001,manypeople inadvertently found themselves choosing that option. They stayed inplace, frozen and leaderless. As Amanda Ripley wrote of the psychology ofpeople in crises (How toGetOutAlive in TIMEMagazine,April 25, 2005),“Peopleinperilexperienceremarkablysimilarstages.Andthefirstone--eveninthe face of clear and urgent danger--is almost always a period of intensedisbelief. ... In the case of the Twin Towers, at least 135 people whotheoreticallyhadaccesstoopenstairwells--andenoughtimetousethem--nevermadeitout…Mostofusbecomeincrediblydocile.”

Inthefreezeresponse,timeissloweddown,fearisdiminishedandpainisdulled. It is an acute and vivid altered state,whichmay, according toBabetteRothschild, author of The Body Remembers, increase chances for survival,especiallyifthestressisanattackbyapredator.Thosewhohavesurvivedbearattacks have reported this feeling of being “out of body,” as do survivors ofseriouscaraccidentsorcriticalincidents.

Oncethetraumahaspassed,evenifallwecandophysicallyiswaitfortheambulanceorsitwiththepersoninthewaitingroom,thereisagreatdealwecansaytohelptheparasympatheticaspectoftheautonomicnervoussystemkickinsothepersoncanbeginthehealingprocess.Aswediscussedearlierwithregard

to placebos, a simple suggestion (“this pill stops asthma attacks”) can haveprofoundphysicalconsequences.

Therapeutic suggestion, visualizing, and belief can all contribute to thatfeelingofcalm so necessary for healing to begin. Sometimes simply allowingfrightenedaccidentvictims to feel theyarecared forand thenhelping them tovisualize a place they’d rather be, can generate that carpet of calm in whichneuropeptidescancommunicatehealingratherthanfear.

Thoughts can heal and thoughts can harm. No matter what thecircumstances of our environmentmay be, what we believe can positively ornegativelyaffectourhealthandwellbeing.

PowertoReachtheUnconscious

In Love, Medicine &Miracles, Bernie S. Siegel, M.D. writes about hisexperiencesusingwords in theoperating roomand their effectonpeoplewhoare under anesthesia. Operating on a young man who had experienced muchtrepidationbefore theprocedure,Dr.Siegel surprisedhis colleaguesby tellinghis patient to bringhis pulse to 83.During thenext fewminutes,without anyothermedications,thepatient’spulsecamerightdownto83andremainedthere.

Onanotheroccasion,when theheartofoneofhispatients, averyobeseyoungman,stopped,andtheanesthesiologisthadgivenup,Siegelsaidoutloud,“Harry it’s not your time. Come on back.” The cardiogram at once began toshow electrical activity and the young man eventually made a full recovery.Siegelbelievesitwasthisverbalmessagethatmadethedifferencebetweenlifeanddeath forHarry.Dr.Siegel’sexperiencesarea reminder thatwhatwesaycanhaveaprofound impact,whether thevictimorpatient isconsciousornot.They also serve to underscore the point that during a period of crisis (whichincludes operations and accidents and the on-going traumaof serious physicaland emotional illness) the autonomic nervous system is particularly open tosuggestion. In the next chapter on the “Healing Zone,” we explain how torecognize and work with this altered state so that you can help make smallmiracleshappenwhere—andwhen—theyareneededmost.

VerbalFirstAidKey–Chapter2TheEvidence

Wearegreaterthanthesumofourparts:Themindandbodyareinfactone.TheeffectofimageryandthoughtonourhealthisdocumentedbytheNationalInstitutesonHealth.CandacePert’sdiscoveryofneuropeptidesonmonocytes(whitebloodcells)demonstratestheimportanceandpotencyofthoughtandfeelinginphysicalwellness.Placebo=effecthealingisreallyself-healingwithjustathought.Studiesshowthatthebodymayproduceitsownchemicalsinthebeliefthatthey’vebeenadministered.AnOhioUniversitystudylinkscaringtouchwithlowercholesterol.

T“Whatliesbehindusandliesbeforeusaresmallmatters

comparedtowhatlieswithinus.”--RalphWaldoEmerson

hereareatleasttwotimeseverydaythatweallenterintoalteredstates:whenweslideintothatearlysleepwecalltwilight,andwhenweawakeninthatsoft,heavy time just before our firstmorning stretch. These arewhatmany peoplerefertoas“delicious”moments:anot-here,not-there,heavy-yet-light,safe-and-simultaneously-open feeling.Perhapsyouhavehad theexperienceofbeing sototallyabsorbed inanoveloracreativeproject thatyou loseall trackof time,and the world around you seems to disappear. Perhaps one Sunday you’redrivingonthehighwaywhenyoustarttomulloveraconversationyouhadwithyourdatethenightbefore.Suddenly,youfocusontheroadonlytofindyourselfhalfway towork. “What am I doing?” youwonder, shaking your head as youmakeau-turn.

Milton Erickson, M.D., frequently wrote about the “common everydaytrance”thatnaturallyoccurs toeveryone,all throughout theday.Thesetrancesaresocommonplacethatwemoveinandoutofthesealteredstatesandbarelypaythemanymind.Indeed,muchofthetimeweenjoythem.Youaredrivingtoworkandyouhearasongthatremindsyouofsomeoneyouknewtwentyyears

ago. Suddenly the two of you are driving down a country road, smelling thatsignaturecologneorperfume,laughingatthecornyjokesthatusedtomakeyoulaugh.Yousmile.You’restilldrivingtowork,butyou’relivingtwentyyearsinthepast.

RealToadsinImaginaryGardens

Most of us relish our “altered”moments, and consciously or notwe seethemasourspecialsafetimes,our“beach-feelings,”ourcreativereservoirs.Thewriter JohnGardner called this state—whenweare lost inourowncreativity,when we conjurer up poet Marianne Moore’s “real toad in an imaginarygarden”—the “fictive dream.” In that state, like mystics, we lose touch withordinarytimeandspace.Wecanreadaboutthescentofblackberryinateacupand the rain tapping on the roof and be transported forty years back. Onceawakenedbythedream,welongforthegraceofit,andthoughweseekit,wevalueitmostwhenitsurprisesus.

Writerseagertobringthedreamaliveagaindostrangethingstoevokethemuse.InANaturalHistoryofTheSensesDianeAckermanreportsthatthegreatpoet,T.S.Eliot,“preferredwritingwhenhehadaheadcold.Therustlingofhishead,asiffullofpetticoats,shatteredtheusuallogicallinksbetweenthingsandallowedhismindtoroam.”ShealsotellsusthatBenjaminFranklinbroughtthebathtubtoAmericainthe1780’sprimarilybecausehefoundinspirationforhiswritingbysoaking in it.Ackermandiscloses that sheherself laysapineplankacrossthesidesofhertubandwritesinabubblebathforhours.Sheenjoysthelightnessandfreedomshefeelswhenbothherbodytemperatureandthewatertemperatureare“one.”

TheAlteredStateasaPortalToHealing

Thesealterationsofconsciousness,whatclinicianscallalteredstatesandwhat artists call the fictive dream, can serve as portals to what we call thehealingzone.Inthosemomentsinwhichtimefliesorwe’relostinreverie,ourattentionissofinelytuned,sofocusedandnarrow,thatweareabletoperceivebothinnerandouterrealitiesdifferently.

Thealteredstate,inandofitself,isablankslate.Whilewhatwehavebeendescribingisthepleasantsideofthiscondition,italsooccursspontaneouslyinmoments of stress, shock, confusion, trauma, fear—whenever the ordinary

course of events and expectations are suddenly tossed upside down—and welose our psychological footing. At those times, we literally go into neutral,awaitinginput.Ifwedonotreceiveitfromoutside,weprovideitfromwithin.Often, by default, we call upon earlier experience, old fears and unhealedtraumas,andthatresponse,leadingusfartherandfartherawayfromhealing,isnotinourbestinterests.

HansSelye’sresearchin1974borethisoutwhenheshowedwhathappenstoourneurochemistryinmomentsofgreatstressandhowourinterpretationoftheeventsaffectsourperformance.Hewasabletomeasurethedifferencesinthechemicalsourbodiesmade,dependingonwhetherwesaweventsaschallengingandsteppeduptothetask,orfeltoverwhelmedbystress.

For most people, a medical emergency or an emotional crisis isexperiencedasa tremendousstress,sometimesasa threat toourverysurvival.Asaresult,stresshormonesarereleased.Thequestionbecomes,then,whatcandotohelpourselvesthroughitandbegintheprocessofhealing.

David Cheek, M.D., an international lecturer on the importance ofhypnoticcommunicationinmedicalemergencies,studiedcasesofseverestressforover25years.Heconcluded,ashavemanyothercliniciansandresearchers,that severe stress invariablycausesanaltered state.Whenweare afraid, inpain,orshockedbygrief,werevert toearliermomentsofgreatstress,both inourminds and in our bodies. If our only guide through the experience is thetremblingvoiceofouroldestfearsandinjuries,weareleftwithpoorcompany.

Somepeople,particularlythosewhohavebeentrainedtothinktheirwaysthrough stressful situations (the “stress-hardy”—police, military, EMS,firefighters), go into a state called “autopilot” inwhich thinking is all theydoand feelings are put all the way on the back burner. “I’m fine,” is a typicalautopilotresponsetoatragedy.Mean-whilethey’refranticallycleaningorcan’tstopworking,terrifiedofthestillnessthatcomeswithdowntime.Otherpeoplegointoshockandpanicrightaway.VerbalFirstAidisthebalancingbeamthatturns a frightening, isolated, confusingmoment into amoment of reassurance,comfort,andclaritysothathealingmaybegin.

TheChoice:TraumaticStressorHealingZone

Analteredstate is likefertilesoil.Wecaneitherplanthealthyseeds thatgrowintofruit-producingplants,wecanlettheweedsoverrunit,orwecanleterosionwash it away in the storm.We can either say or do nothing, use ourwordsandourpresencetoheal,oruseourwordstoharm.Wethinkthechoiceis

clear. So does Lt. Colonel Dave Grossman, a formerWest Point PsychologyProfessorandArmyRanger.

As Lt. Col. Grossman describes it, when we are terribly frightened, westop thinking with our forebrain (the part of us that analyzes, processes,communicateswith language,andknowshowtowait)andstartoperatingwiththemidbrain,whichis,aftermillionsofyears,stillthesameasthemidbrainofacrocodile. Themidbrain’s primary function is to ensure survival, for which itreliesononlyseveral levelsofexperience:fear,aggression,avoidanceofpain,sexuality,andhunger.

Inextremesituations,particularly thosegeneratedbyhumanconflict, theLt. Col. says the “midbrain reaches up and takes hold of the forebrain.Afterwardsthereappearstobeanimmediate,neural‘shortcut’tothemidbrain,whichmobilizes thebodyforsurvival inresponse toany‘cue’associatedwiththetraumaticincident.Increasedheartrate,respiration,perspirationandahostofother physiological responseswill occur for even the slightest of reasons, andsometimesfornodiscerniblereasonwhatsoever.”

Thereisnogreaterstimulustolearningthanatrauma.Whatwelearnfromit,ofcourse,dependstoagreatextentonwhatcuesaregiven.VerbalFirstAidbecomes,then,critical—notonlytofacilitatehealinginthepresentmoment,buttogivethecuesthatwillrecordoverthenegativecuesofthepastandfacilitatewellnessinthefuture.

Among their patients,many therapists have seen the effects of what Lt.Col. Grossman calls one-trial learning, sometimes years after than the eventitself, when a patient comes in with nightmares, flashbacks, a disruptedmarriage,alcoholism.ArecentstudybyC.A.MorganIIIreportsthatsymptomsofdissociationwereprevalentinhealthysubjectsexposedtohighstress,withupto 96% reporting symptoms. In another study on trauma and dissociation,authorsKoopmanandSpiegelreportthat“Stressassociatedwithexperiencingorwitnessing physical trauma can cause abrupt andmarked alterations inmentalstate.” They explain that “peoplewho experience a series of traumatic eventsmaybeespeciallyvulnerabletoavarietyofdissociatestates.”

Apparently,whenthemidbraintakesholdoftheforebrain,peoplearenotonly feeling the initial rush of terror, but the sense of losing control. Lt. Col.Grossman calls it a hijacking and claims that it can result in erratic,uncontrollable physiological reactivity. Our fear and our physiology becomeenmeshed in a cycle that sometimes becomes Post-Traumatic Stress Disorder(PTSD).

ButGrossmancontendsthatitdoesn’thavetobethisway.“If,attheverybeginning, we can teach the subject to control their autonomic, physiological

arousal, then they can nip thiswhole process in the bud, stopping the viciouscycleoffearandanxietybeforeitconsumesthem.”Hesuggests that,althoughautonomic responsesareoftenautomatic, “thebridgebetween the somaticandautonomicnervoussystemisbreathing,andanincreasingbodyofresearchandlawenforcementexperienceindicatesthatifweteachthevictimtocontroltheirbreathing,thentheycancontroltheirphysiologicalarousal.”

Imagine yourself behind a glass barrier. You are surrounded by it. Youdon’tknowhowtogetout.Youarescaredandalone.Peoplemovearoundyou,butyoucan’treachthem.Theworstthoughtsareracingthroughyourmind.Youdon’tknowwhattodo.Thereseemstobenowayout.Yourheartispounding.Your breathing is rapid, uneven, shallow. Then, gently and surely, a handreachesthroughtheglassandacalmvoicesays:“Theworstisover.I’mgoingtohelpyou.Takemyhandandfollowme.”

Anxietyistrulythemajorculpritintrauma.Howwefarebothduringandafteratraumaticevent—whethermedicaloremotional—dependsinlargedegreeonhowwedealwithouranxiety.Havingsomethingconcrete todo, tosay, tofocus on, and having an authority to lead us to safety (whether physical orpsychological)canturnthetide.

VerbalFirstAid:ChoosingtheHealingZone

Another recent pieceof researchdemonstrated that patientswhowere inacute stress had higher levels of hypnotizability. Hypnosis itself is actually arangeofalteredstates,andamongitsmajorcomponentsissuggestibility.Asweslip into an altered state, especially one connected with stress, we are morereceptive tosuggestion—goodorbad;wearemoreattuned to inner realities—goodorbad;wearemorevisualandresponsivetoimagery—again,goodorbad.Whatwehearweinterpretliterally.Althoughwemoveintoandoutofonekindofalteredstateoranotherallday,therearecertainprocessesthatspontaneouslyoccurthatletusknowwehaveaccesstoahealingzone.Therearebothphysicalandpsychologicalcharacteristicsthatcanserveascluesorguideposts.Becausealteredstatesprovideahealingzoneportalthroughwhichyoucanhelpapersonincrisisorpain, theyare invaluable inVerbalFirstAid.Thenextsectionsaredesignedtoshowyouhowtorecognizeandhowtofacilitatethathealingstate.

HowtoRecognizetheHealingZone

PhysicalSignsofTheHealingZone

1. Unfocused, rambling speech. The connection between thoughts andwordshasbeendisrupted.Apersonmayspeakunusuallyslowlyor rapidly,ornotatall;wordsandphrasesmayberepeated,yetseememptyofcontent.

2.Tearsandflutteringeyelidswitheyesclosedorpartiallyclosed.Tearsmayformatthecornersoftheeyes.Youmaynoticepupildilation,aswell.Aspeoplebegintoshifttheirawareness,theireyelidsmayflutter.Inaddition,rapideyemovementsundertheeyelidsmaybeseen.

3.Breathchanges.Aperson’sbreathingmayspeedup,orslowdowntoasmooth,shallowrhythm.

4.Pulseratechanges.Thiscanbeseenmosteasilyinthecarotidarteryintheneck,orifonehaspermissiontotouchtheotherperson,itcanbefeltinthewrist.

5.Muscle relaxation. All muscle groups—especially in the face-- mayrelax,sometimesaccompaniedbymuscletwitching.

6.Profound stillness. Clinicians call this state “catalepsy.” It is stillnessresultingfromdeepabsorption,commonlyseeninfishermen,artists,musicians,writers, carpenters, accountants—indeed, in anyone who gets completelyengrossedinsometask.

PsychologicalSymptomsoftheHealingZone

1.Timedistortion.Timeslowsdownorspeedsupdramatically.Peopleinchronicpain,forexample,mayspendagreatdealoftimefeelingthattimeitselfhasbetrayedthembyslowingdown.“Whenwillthiseverend?”maybeasignof timedistortion.People inamedicalemergencymayexperiencethecollapseoftime,asifeverythingwerehappeningatonce,orfeeltimestretchedoutlikearubber band, as if they were moving in slow motion. We can use this timedistortion to bring comfort and help with healing. “This medicine is so

wonderful, it makes every hour seem like five minutes and we can be donebeforeyouevenknowit.”Or“Countbackwardsfrom10to1andthecloseryougetto1thequickeryouarestartingtofeelbetter.”

2.Selectiveawareness--seeingwhatwewanttosee.Selectiveawareness—whichhappensallthetimewhenwetuneoutthelouddroneoftherefrigeratorbuthearthetiniestfloorboardcreakinaroomthatshouldbeempty—isanotheraspectofanalteredstate.Sometimeselderlyorchronicallyillpeoplewillinsistyouhaven’tdonesomethingthatyouhave,inreality,done.“YouneverbringmejuicewhenIaskforit,”theywillsay,althoughyoudosofrequently.Theymaybe suffering from selective awareness, remembering or registering only thosethingsonwhich theyare focused, in thiscase,perhaps, thirst (ora“thirst” forattention).

Foranotherexamplelet’sgotoasmalltownbaseballgreenwherealittleleague game is in progress. Fifteen seven-year-olds are playing for the TigerTails.ItisthefirstgameoftheseasonandlittleSeanisatbat.Heissoexcitedtohavegottenhisturnthatwhentheballcomestooclose,heforgetstostepbackand the ball slams into his hand, breaking his finger. Suddenly, for Sean, theonlythingintheworldishisagonizingpinkie.Hismother,whoknowsVerbalFirst Aid, runs up when she hears his cry and holds him. “I’m here, Sean.Mommy’s here to help. Let me see your hand.” Sean howls. “Oh, I can seewhat’shappeninghere.Howaboutyourotherhand,Sean.Howisthat?”Seanisalittleconfused,butlooksathisotherhand,tryingtoseeifithasbeenhurt.Themomenthe takeshisattentionawayfromthepainedpinkie,hegetssomepainrelief. “Your foot,”Mom continues. “Did the ball bounce off your foot? Areyour feet okay?”At this point, Sean has sent hismind through his body on amissionofassessment.Ashechecksoutotherregions,hekeepshismindoffhisfingerandcontinuestoalleviatesomedistress.

Wecanonlybeconsciousofsomanythingsatatime.Ifyouarefocusedon your foot, you cannot think of your broken finger. The same is true foremotionalpain.Howmanytimeshaveyouheard,“Ican’tthinkaboutthatnow,I’mtoobusyworryingaboutpayingthebills.”

3. Age regression. When people get that dreamy look and begin toreminisce,itisalmostasiftheyweretransportedtoanotherspaceandtime.Werecognizethisinothers,becauseweseeitinourselves.Peopleoftenexperienceageregressioninthepresenceoftheirparents:“IfeellikeI’m10yearsoldeverytimeIgobackhomeforThanksgiving.”“I’m45yearsold,butwhenIfeelsick,

I want my mommy.” Conversely, when we’re young, we can feel positivelyancient. Theresa, a 19-year-old with a long history of trauma, looked at hertherapistwithprofoundsadness,“IfeellikeI’velivedtwolifetimesalready.I’maswearyasa90-year-old.”

Reminding people of times in which they were happier, stronger, moreloving can bring those times into the present and, with them, some of thequalities they may have forgotten they had. When you encounter someonesuffering emotional or physical distress, and you can facilitate a positive ageregression,youcanbegintouseVerbalFirstAidinremarkableways.

4. Sensory distortion. In the healing zone we hear, see, feel, taste, andsmellthingsdifferently,whichcanbeparticularlyhelpfulwiththealleviationofpain, whether acute or chronic. Clinicians experienced with this resourceregularlyassisttheirpatientsindevelopinganesthesiaoralteringtheperceptionsof particular parts of the body. This can be exceedingly important in a trulytraumatic situation, when this ability can protect us from focusing oninformationthatwouldimpactussonegativelythatitcouldfurthercompromiserecovery.

5.NegativeHallucination.Haveyouever,inapanic,lookedforsomethingfrantically,emptiedyourpurseorpocketstwenty-seventimesandneverseenthethingyouweresearchingfor,althoughitwasthereallthetime?Clinically,thisis called a negative hallucination, not seeing something that is actually there.Sometimesitisaverygoodthingnottoseeorhearthingsthatcouldharmyou.

Lesliewas a passenger in a serious car accident inwhich the car rolledoverseveraltimesandcrashedintoapole.Thedriverwassoshakenandstunnedshecouldnotevengivetheparamedicshername.Leslie,alsointhefrontseat,knewthatherheadhadhitthewindshieldandfeltthatherscalpandfacewerewet.Shereachedupandpressedherhand toher forehead.Thenshewithdrewherhandandlookedatit.Itlookedfine,soshehelpedtheemergencypersonnel,answering theirquestions,andgot through thecrisis. Itwasonly later thatshesaw all the blood, received the stitches and realized the magnitude of herinjuries.“Idon’tknow,”shesays.“WhenIlookedatmyhand,Ijustdidn’tseered.”Sheshakesherhead.“IfIhad,Iwouldhavebeenhorrified.Iwouldhavepanicked.Butforsomereason,Ijustdidn’tseeit.”

6.Dissociation.Thissymptomofthehealingzonecanbeseeninayoung

girldaydreaminginclassduringthelastweekofschool.Althoughtotheteacherthegirlisseatedfirmlyinherchair,theyounggirlisalreadysmellingthefreshcut grass and pounding her new baseball mitt on her left hand, relishing thecheersasshecatchestheflyballthatsignalsthewinningofthegame.Sheisonthe field and in the chair, enjoying what Dr. Michael Yapko calls a parallelawarenessofbothstates.Youknowthestate intimately ifyouhaveeverbeenforcedtoattendalongmeeting,orifyou’vetakenalongtrainrideandletyourminddriftawayasthetrainwheelsclackrhythmicallyacrosshundredsofmilesof endless, monotone plains of wheat. You are there and not there, able torespondtoyourphysicalenvironmentshouldyouneedto,yetenjoyingarespitesomewherefaraway.

This inborn capacity canbedevelopedandutilized to access thehealingzone. When people are dissociated, what we say to them may not registerconsciouslyorevenbeacknowledged,butweknowitisbeingreceived.

7. Literal or concrete interpretation. What we hear when we are in analtered state comes throughvery literally,much thewayachildmighthear it.OurcolleagueTimothyTrujillotellsafunnystoryaboutgoingtodinnerwithaten-year-oldboywhohadaheadache.Hewhippedoutafive-dollarbillandsaid,“I’ll tell youwhat. I’ll buy your headache for five dollars.” The boy thoughtabout it for a while and then grabbed the money. Then he considered theproposition saying, “Do you really want my headache?” “Well, not now,”Trujillo said, “but Imaywant it sometime.But, anyway, it’smine now.Youcan’thaveitanymore.”Withinafewminutes,theboylookedupinsurpriseandsaid,“Hey,myheadache’sgone!”ThewordsTrujillohadusedwere,“Youcan’thaveitanymore.”Wesaywehaveaheadache,theboyhadsoldhis,andsoheliterallycouldnothaveitanymore.

8.Trance-logic.Aspeoplemovethroughthosestatesofconsciousnessthatlead them to the healing zone, they may be more likely to suspend disbeliefmuch thewaywedowhenwego to themoviesandwatchaperson fly fasterthan a speeding bullet. We are able to accept as true that which may seemillogicalinanother,moreanalyticstate.

Thisallowsustousevisualization,aswewillexplainlater,tochangethebody’s responses or to provide pain relief. As you saw in the story in whichTimothy Trujillo had the man with the broken leg imagine “doing the backstroke,”thatimageprovidedpainreliefbecause“waterisbuoyant,”eventhoughthemanwaslyingontheshoulderofadustydirtroad.

HowtoFacilitatetheHealingZone

Inmedicalemergenciesandtrauma,itisexceedinglycommonforustogointo a suggestible altered state. In chronic illness, however, because of itsongoingnature, the traumaticstateassociatedwith it fluctuates,andasaresultso do the opportunities to utilize the healing zone.We’d like to suggest somemeansbywhichyoucanencouragepeopleintothisstatesothatyou,inturn,canmakethesuggestionsthatcouldimprovetheircondition.

Imagery

Fromthetimewearechildrenweareencouragedtouseourimaginationstoseeandfeel—toexperience—differentplacesinourminds.Thisabilitytouseourimaginationsordreamofanotherrealitycanbeusedtohelptransportpeopletothehealingzone,aswell.

Evidence that imageryhas theeffectofmovingpeople intoalteredstateshas been demonstrated by theMindMirror, a piece of equipment designed inEnglandbyDr.MaxwellCadeforthepurposeofmeasuringthewavelengthsofour various mental activities. Dr. Cade discovered that the depth of therelaxation response in both hypnotized and guided imagery subjects was afunction of characteristics of the imagery itself and how the imagery wascommunicated. After receiving a brief word picture of 150-200 words, amajority of subjectswere able to experience faster and deeper relaxation thansubjectsgiventraditionalhypnoticinductions.

This indicates that helping people go somewhere in theirminds, simplypaintingasceneforthemthat takesthemsomewheretheycanfeelrelaxedandcalm,canputtheminthehealingzone.Themorerichthedetail,themoreyouinvolve the senses, themore readilyapersonwill followyou to theplaceyoudescribe.“Wouldn’titbegreattobebackinHawaii,rightnow?Thosebreezes,thewayyoucouldseethemandhearthemswayingthroughthetrees.Thewholeplace smells like flowers and perfumes…and those birds of every color—whoevenknewtherewereorangebirdsandpurplebirdsandevenfuchsias?Andthefish,too,inthosecrystalclearwaters,swimmingbetweenyourfeetinredsandyellowsandstripes….”

StoryTelling

This is a variation of the imagery transport process discussed above.AsyouwillseeinChapter9onPhysicalIllnesses,thisisatechniqueusedoftenandbrilliantly by Dr. Milton Erickson, a psychiatrist whose use of metaphor andstoryislegendaryamongpsychotherapists.

Since thedayswhencavemensataroundacampfireandoneof themenrosetotellofhishunt,ortoboastofhiscourageinfendingoffaferociousbeast,wehavebeenspellboundbystory.

JudithSimonPragerandherhusband,HarryYoutt, teach in theWriter’sProgramatUCLAExtensionandalwaysmarvelattheeffectthatreadingmythshasongrownmenandwomen.Tappingintoarchetypes,settlingdownintolongago’sandfaraway’s,theadultsseemtoalmostvisiblyregresstochildhood.

Somethinghappenstoallofuswhenastoryistold,nomatterhowoldoryoung we are. As the yarn is woven, the listener is captivated, as if led bycuriosityandinstincttoanswerthequestion:“Doesthisstoryhavesomethingtodowithmy present predicament? Is it tellingme something?How do I fit inhere?” And if the story has a point or moral, even if it is unspoken, theunconsciousmindgetsit.Thereisaproblemandasolutionpresentedineverygoodstoryandourunconsciousminds,everinsearchofsolutionsforourselves,listentoseehowwecanidentify.Weinsertourselvesintothatstory.Webecomethe boy on the back of the dragon, exhilarated aswe fly through the air.Wesuffer as the heromaking ourway through the tortures ofHades.We feel thefrustration of unrequited love and the longing of Dr. Zhivago. Imagine thebenefits of this sort of mind-travel to those in need of medical treatment,especiallywhenthestoryisladenwithmetaphorsofhealing,comfort,andlove.

Sometimesthemosthealingthingwecandoisletpeopleknowthattheybelong,thatweappreciatethem,thatsimplybecausetheyfeeldifferent,theyarenotaloneandoutcast.BarbaraBrennan, theenergyhealerandformer researchscientistforNASAwhowrotethebookHandsofLight,saysunequivocallythat,“Allsufferingiscausedbytheillusionofseparateness,whichgeneratesfearandself-hatred,whicheventuallycausesillness.”

Whenourclientsexpressthefeelingthattheydon’tbelonganywhere,thattheyareoutsidersandtheybelievethemselvestobeunwanted,wetellthemtheclassicstoryoftheUglyDuckling.Youremember…

Amotherducksitsonhereggsandhatchesabroodofcute littleyellowducks, all except forone.Thatone isgrayandgawky.All the littleducklingslaughathim.Ashe seeshisown reflection in thewater andunderstandshowdifferent he is, he feels ashamed.As the others growup, they honkneat littleduckhonks,butourheromakesaverystrange,long,loud“Hooooonk.”Again,theylaughathim.

Then,oneday,asheisswimmingalone,havinggivenupontryingtofitinanylonger,hecomesuponthemostbeautifulbirdshehaseverseen,and theygreet himand invitehim to join them.He looks at his reflection in thewater,thenbackat theirbabiesandheunderstands.He’snotanuglyducklingatall.He’s a beautiful swan. What was wrong was that he just wasn’t where hebelonged,wherehecouldberecognizedforwhathetrulywas.

Who hasn’t dived into that story as a child and taken comfort from itssuggestionthatweareallbeautifulandspecialwhenweareinourrightplace,wherewebelong.

Storiesleadtothehealingzoneinthesimpleactoftelling.Themessagesor suggestions embedded in them leadus further down the road to comfort orcalm.

Memories,too,areaformofstorytelling:“Rememberwhengrandmamadethoseapplepiesandleftthemtocoolon

thewindowledgeandgrandpatookthemandhidthemforhimselfandtoldherhethoughthe’dseenathiefandshecalledthesheriffand…”

“Oh, for goodness sake, yes, I do. And the sheriff was in on it withgrandpathewholetime.Oh,lord,doyourememberhowangryshewas?”

Storytelling is easy to drop into ordinary conversation. “Once upon atime,” and “a long time ago” were always great trigger phrases for us aschildren.Asadultswe’re justassusceptible to“Iknowamanwho…”or“Doyouremember…”or“DidIevertellyouaboutthetime…”

Whentellingastory,therearewaystoholdthelistener’sattentionandtohelphimorherstayinthehealing.

1.Usingtoneandphrasing.Itisimportanttokeepourtonemeasuredandclear, yet dramatic. When we get into the story, our tone and phrasing willnaturally communicate it so that others feel it aswell.Try tokeepyourvoicelow-pitched, as if telling them an important secret, though not too soft. It isperfectlyallrightifpeoplehavetostrainjustslightlytohearyou.Itforcesthemtofocus.

2.Pacing thepersonyouarewith.Wealwayshave tobeawareofwhatlistenersaredoingandtostaywiththemaswell.ThisisthesameprincipleweexplaininmoredetailinlaterchaptersonRapportandTherapeuticSuggestion.Watch for cues of distraction or boredom, as well as signs that you’re in thehealingzone.

3. Using descriptive detail. Try to evoke all the senses—touch, smell,sight,hearing,taste.Youcoulddescribeyourexperienceatanelegantrestaurantbysaying,“Oh,wow,itwasgreat!”Butisthisenough?Haveyoutrulysharedthe experience?Or is it better todescribe theway the linennapkinswere laidacrossyour lapwith a flourish, the scentof fresh rosemaryandbasil thatwasgrowing inplantersnearyour table, and thevelvet caressof thewineonyourtongue.

4.Keepingtheendofthestoryinsight.Whatareyoutryingtoconveytothepersonlisteningtoyou?There’snothinglessinterestingthanaramblingtalewithnofocusandnorelevance.

Onewomanweknowfoundherselfinastateofphysicalpanicwhenevershe considered sayingwhat she felt to theman in her life. She thoughtmoreabout how hewould react than aboutwhat shemight say. She thought if shebroughtupherneeds,shewouldrocktheboatandhewouldleave.Sheliterallylostherselfinherfear.Wepaintedthefollowingwordpictureforherabouthowwords spoken—as our Native American friends say, “in a good way”—reverberateintheworld.

“Imaginealake,stillasglass,quietanddeep,filledwiththereflectionsofthe sky, the snow-capped mountains surrounding it, and an occasional bird,skimmingitsblue-greensurface.Imaginedroppingapennyintothelakealongwith awish,watching it break the surface and sinkingdeeper, deeperpast thefishand thedark tendrilsofgrass into the sandat the lakebottom.Notice theconcentric circles that carry that intention, that wish out across the still lake,making a pattern in the world that changes everything for a time.Maybe theripples rock the boat a little as theymake theirway across the lake’s surface.Maybetheychangethecourseoftheboatwiththeirflow.Thecirclesemanateendlessly, carrying thewish that created them.Thingswill be calm again, butdifferent,forthewish…thewishhasalifeofitsownnow.”

Thiswoman had been afraid ofhurting someonewith herwords, afraidthatherwordswouldcreatetheonlyripplesinanotherwisesmoothlake.Thereweremanyripples,asitturnedout.Shebegantounderstand,unconsciously,thatshe could not and did not have to control every outcome or every ripple. Tospeak the truth with love was all she could do. It was, in essence, a serenityprayer in images. In a subtle way, these images drew a picture for herunconsciousofitsbeingallrightifwhatshesaysorwishes“rocks”somebodyelse’s“boat.”That itmayeven“change thecourseof thatboat.”Finally,what

remainsiscalm.Inheralteredstate,thesepicturessuggestedthatshewouldnotloseherselfifshespokehertruthasifitwereapennycastintoalake.Later,shetoldus, something insideofher shifted.Shewas able to speak fromherheartdifferentlyafterthat.

The repercussions of the words of the heart are both real andunfathomable.MotherTheresaputitverywell:

“Kindwordscanbeshortorlongtospeak,buttheirechoesaretrulyendless.”

VerbalFirstAidKey–Chapter3TheHealingZone

Everydayweenteran“alteredstate”atleasttwice:whenwegetupandwhenwegotosleep.

Alteredstatesarenormal,ordinaryeventsthatleadustothehealingzone.

RecognizingtheZone:

PhysicalSigns—unfocusedspeech,tears,flutteringeyelids,breathchanges,pulseratechanges,musclerelaxation,andstillness.

PsychologicalSigns—timedistortion,seeingwhatwewanttosee,ageregression,sensorydistortion,dissociation,increasedresponsiveness,literalorconcreteinterpretation,trans-logic.

FacilitatingtheZone:Imagery,storytelling,toneandphrasing,selectiveattention.

PARTTWO

HeartToHeartCommunication

W

“Sowhenyouarelisteningtosomebody,completely,attentively,thenyouarelisteningnotonlytothewords,butalsotothefeelingofwhatisbeingconveyed,

tothewholeofit,notpartofit.”--JidduKrishnamurti

ithout rapport, effective communication is simply not possible. In simplestterms,rapportisastateinwhicharelationshipoftrust,compliance,andhealthyexpectation can be developed. It is understanding and a feeling of beingunderstood. Just as you would never think of building a house without firstputtinginafoundation,youwouldnotexpectpeopletofollowyoursuggestionwithoutfirsthavingorestablishingrapport.Healingcommunicationtakesplacewithinthecontextofarelationship—evenifitisanexceedinglybriefone.

Inthischapterwedemonstratethethreestepsforgainingrapport:gettingcentered,establishingalliance,andgettingacontract.Butbeforeweshowyouhowtogainrapport,let’sexplorehowrapportworksandwhyitissocrucialtoanyprogramthathopestohelpthoseinneed.

Rapport is empathy taken a step farther—youmight say it’s empathy inpractice.Rapportbuildsabridgetothevictimfromanyonewhoistryingtohelp,whetherthatpersonistheparamedic,orfirstrespondertoanaccidentscene,orarelativestandingbythebedsideofachronicallyillindividual.Rapportopensa

line to carry healingmessages. Rapport is the foundation for effectiveVerbalFirstAid.

Whenwe present this training to professionals,we often start by askingthemtoclosetheireyesforaminute.Thenweaskthemthefollowingquestions.Whenwas the last timeyouwerehurt, angry,orwoundedand terriblyafraid?Wherewereyou?Whoelsewasthere?Whatdidtheydo?Whathelped?Whatmadeitworse?Althoughthesituationsvarywildly,manysaywhathelpedmostwas that theotherpersonstayedcalmandhelped themfocusongettingbetterandstayingpositive.

One survivor of theOklahomaCity bombing lay trappedunder concreteandmetalformanyhoursandsufferedsevereinjuries,nottomentionthemind-numbing sense of aloneness and fear she endured in the dark. When finallyextricated from those hellish conditions, she explained to reporters that shewouldn’thavemadeithadoneparticularrescueworkernotstayedwithherandheld her hand, the only part he could reach or see, throughout. It was hispresence,hissoothingvoice, thewayheearnedher trust—andmostofall, thegentle,firmtouchofhishand—fromwhichsheborrowedstrength.

Inrelationtothat“borrowedstrength,”JamesCoan,assistantprofessorofpsychologyandtheneurosciencegraduateprogramattheUniversityofVirginia,conductedastudyinwhich,“Wefoundthatholdingthehandofreallyanyone,itmadeyourbrainworkalittlelesshardincoping,”addingthatanysortofhand-holding relaxes the body.(http://www.nytimes.com/2006/10/05/fashion/05hands.html?pagewanted=all)

Andhandsaregenerallyasafeandnon-intrusiveplacetotouch.Almostinvariably,traumavictimssaythattheworstthingsomeonecando

istellthem,“Justrelax,”or“Hangon”withoutreallylisteningtothem.Inoneepisode of the television series “Trauma One,” one of the proliferating ERshows,adoctorcouldbeoverheardyelling“Chill, chill!” toapatientwith sixgunshot wounds. Needless to say, the patient did not “chill.” He becameincreasinglyagitatedandthedoctorbecameincreasinglyfrustrated.

Remember Lily, the little girl whose parents unwittingly heightened herfear as they tried to help? (“Dowe have to give her stitches?Oh, damn, notstitches!!”)BoththewaytheadultsrelatedtothechildandthesuggestionstheyunintentionallyprovidedunderminedLily’sability to remaincalm. Incontrast,the life-saving experience of the woman in the Oklahoma City bombing wasattributabletothehealingconnectionweknowasrapport.

By nowyou’ve seen howwhatwe communicate to each other (verballyandnon-verbally),eveninbenigncircumstances,hasaprofoundeffect.Asmile,agentlesqueezeofthehand,anoffertohelpastrangerwho,upuntilthatvery

moment, hasbeenhavingamiserableday, canchangenotonlyhowwe thinkand feel in a conscious way, but it can also have a marked influence on ourlimbic,nervous,endocrine,andcardiovascularsystems.Inaddition,afoundation—analliance—mustbeestablishedforVerbalFirstAidtobeeffective.Withoutrapport,suggestionsforhealingarenotacceptedasreadily,possiblynotatall.Thegreatertherapport,themorelikelyyoursuggestionswillbeinternalized.

Onceweestablishrapport,wecangorightaheadandsay,“Youcanrelaxnow,”andpeoplecancomfortablycomply.Ifthereisnorapport,thatsuggestioncan be annoying and counterproductive, and can even generate exactly theopposite response.Youcanprobablyrecallnumerousmomentswhensomeonetoldyou,“Whydon’tyoujustrelax,”andyoureplied,“Whydon’tyou!”Noonerelaxed.

Whatwasmissingin that interaction?Rapport.Thepersonmaynothavehad theauthority,nordemonstrated theappropriateunderstandingor empathy.That person’s “relax” meant, “I dismiss your feelings. I don’t want to bebothered.Nowgoaway.”

Under all communication lies a subtext. Rarely do we communicatedirectly,evenwhenwethinkwe’resayingwhatwemean.Wordsare themap,nottheterritory.Asaresult,whatwesay,whatwethinkwesaid,andwhattheotherpersonheardmaybeworldsapart.

Forexample, a simple,ordinaryphrase, suchas“Excuseme,”mayhavedozensofsubtexts:

“Pardonme,Ineedtogetpastyou.”“Getoutofmyway.I’mcomingthrough.”“MayIinterrupt?”“What,areyoukidding?”“Whodoyouthinkyouare?”“Ididn’thearyou.”“Howdareyou?”“DidIhearyousaywhatIthoughtyousaid?”“Iknowit’snotmyplace,but...”Andtheobvious:“I’msorry.”

Withthevastcontinuumofpossibilitiesopentointerpretation,wheneveryword counts, rapport can create the subtext that says, “I am here for you andwhen you do as I say, we are working together to help you heal.” In his

bestseller,Love,Medicine&Miracles,BernieS. Siegel,M.D., recognized thevalueofempathyinregardtohisexceptionalpatients,thosewhoseemedtohealthemselves, by imagining the fear andpain his patients felt and then realizingthatwhathehad tooffer themwasmore thanmedical expertise and technicalprocedures. His partner, surgeon Dick Selzer, described what the empatheticphysicianbringstothehealingbysayingthatitgatherslike“thecryofcertainsolitary birds until it is a calling, a resonance between doctor and patientbuilding to themomentwhen theremayspring thatprofoundcourtesy that thereligiouscallLove.”

Whenweconnectwithothers in thatway, itmakesroomformiracles tohappen.

Infact,havinga“heart-to-heart”maybeamoreaccuratedescriptionthanthepoetshadimagined.TheintegratedresearchofDr.AllanSchore“showshowareas related to social-emotional functioning in the right hemisphere of anemotionallyhealthytherapist’sbrainunconsciouslyinducehealingstructureandfunctional influences in the right hemisphere of the client’s brain. The heart’selectromagnetic fieldmaybeoneof theways thesechangesare induced sincethere are unmediated connections between the human heart and the righthemisphere.” (http://insideoutfreedom.wordpress.com/2010/10/16/in- response-to-becoming-the-change-the-practice-of-liberation/)

And it is certainlymore common thanmost of us realize.We naturallyresonatewithotherswhetherornotweareconsciousofit.Usingittofacilitatehealinginanotherpersoniswhererapportcomesin.

For instance, if Joan fallsoff ahorseand Jimdismountsand runs toherside,hemayfeelempathybecausehehimselfhasfallenbefore,heremembershow embarrassing and painful itwas for him, and he can see similar feelingsplay across Joan’s features as she lies on the ground and holds her ankle.However,Jimmaynotbeabletoexpressallthistoher.Ifallhecanmanagetosayis,“What’dyoudo?I’llgogethelp,”hehasn’tusedthatempathyatallandhe certainly hasn’t developed any rapport with Joan. It is like the differencebetween having romantic feelings and courting that person. Romantic is thefeeling,courtingisthedemonstrationofthatfeeling.AsShimonM.Glick,M.D.said,“Sobbinguncontrollablyalongwithadistressedpatientmayrepresenttheultimateinempathy.Butthepatientneedseffectiveempathy.”Wecalleffectiveempathyrapport.

So, what should Jim do differently, assuming, of course, that he reallywants tohelpJoanwhile they’rewaitingfor theparamedics?Howcanhe takethatempathyandtranslateitintoahealingrapport?

StepstoGainingRapport

Wehaveidentifiedthreestepsthatarenecessaryforestablishingrapportinemergencysituations:

1. Getcentered2. Establishalliance3. Getacontract(ifyoucan)

1.CenterYourself

Initially, thismay seem like an obvious step. However, because it is soeasy to overlook or forget in a time of crisis, we felt it was important tounderscore its importance. Leo J. Shea III, Ph.D., who trained mental healthtraumaresponseteamsatNewYorkUniversityMedicalCentersays,“Nomatterhowwelleducatedyoumaybe,nomatterhowmanyof theseexperiencesyouhavebeenpartof,whenyousitdownwithsomeonewhohasbeentraumatized,know that you are entering a hallowed space. Revere it. Remove from yourthoughtsanyassumptionsorpreconceivednotionsabout thedialogue thatmayoccur. Know that you are being invited into a person’s private sanctuary.Embracethatspacewithreverence.”

Whensomeoneishurt,particularlyifitissomeonewecareabout,ourfirstinstinctistorushintoaction.However,aswe’veseen,itisdistinctlypossibletodomoreharmthangoodunlesswe’rethinkingclearlyandmovingdeliberately.

Inalmosteveryemergencysituationyoucan takeoneor twoseconds tocloseyoureyesandtakeadeepbreath.Usethatmoment,asbriefasitmaybe,toletthatbreathcalmyouandstrengthenyou.

Takingabreathalsobringsyouintopresenttime,ratherthanallowingyouto be floodedwith doubts from the past orworry for the future.Moreover, itbringsoxygenatedbloodtotheprefrontalcortex,thepartofthebrainthatthinksrationally,sothatyouareintheclearestpositiontobetrulyhelpful.

If you meditate in your daily life, meditate as you begin to establishrapport.

If you pray, pray for guidance, clarity, and fortitude. Pray for the wellbeingofthepersontowhomyouwillbeattending.

Ifyouuseaffirmations, tellyourself thatyoucanhandlewhatevercomesupinahelpful,healingway.

Insuggestingthatyoucenteryourselfspiritually,Dr.Sheaadvisesthat,ifyouhavetime,you“Sitandaskyourselfwhatishappeningwithmerightnow?

What isgoingon inmylife thatcouldhave impact?AmIprepared togo intosomeoneelse’sworldandacceptwhateverthatoffersme,orbringsme?”

Onceyou’vecenteredyourself,knowthatyouwillhavedonetheverybestthatyoucan.Andthatisallyoucando.

It is also very helpful to connect with something or someone beyondyourself in that critical moment, whether it’s God or your great grandmotherwhoalwayscrossedherself, rolleduphersleeves,andgentlysavedtheday. Ifyouhavearolemodelforcalminthefaceofchaos,callittomindandfeelitinyourbody.

2.EstablishAlliance

Allianceisempathyinaction.Itconnectsyoutothepersonsufferingpain,illnessoremotionaldistressasafellowhumanbeing,sothatyoubothbecomefullyawarethatyouareinthistogether.

Herearefourcomponentstouseinestablishingalliancewithavictiminamedicalemergencyorcrisis:

A)EstablishAuthorityB)BeginCommunicatingRealisticallyC)SolicittheirHelp/ProvideaDistractionD)AvoidContra-Alliances

A)EstablishAuthority

When someone steps in to take charge of the situation, this enables thevictim/ill person to feel protected. The victim/patient can relax, if only just alittle. Taking charge in the manner we suggest communicates a plan and apurposetothevictim,instillingconfidence.Handledproperly,takingchargealsocommunicatesthatyouunderstandtheperson’splightandarewillingtolisten.

Theauthorityinherentinauniformisirrefutable.WhenweaskedtheNewYorkfirefightersinLadderCompany6aboutauthority,theysaidsimply,“Whenpeople see us coming, they start to relax.” One woman who was trapped indebrisduringthe1993bombingoftheWorldTradeCentersaidshewassureshewoulddiethereinthatdark,duskyprison.Thenshesawalightbreakingthroughthe infernoandfelt thatanangelmustbecomingto takeher toheaven.Whenshe realized the light was attached to a fireman’s helmet, her relief was

enormous.Authority is extremely important in a crisis situation. Someone must

assume control and helpmake injured or sick people feel that they can relax.Clearly, ifnooneis incharge,relaxingisoutof thequestion.Someonehas tostepforwardandsay,“I’mtheboss.Icanhandleit.IknowwhatI’mdoing.I’llhelp you. Just follow me.” Often, though not always, a uniform or badge issufficient to accomplish this—at least in the beginning, unless somethinghappenstobreakthatrapport.However,evenifyouwearauniform,wesuggestthat,atthesceneofamedicalemergency,youusespecificlanguagetoreinforcethatrapport.Forinstanceyoumightwanttosay,“Hi,I’mRoslyn.I’mwiththefire department and I’m here to help you. Tellmewhat you need (or tellmewhatyou’refeeling).”

Ifyoudonothaveabadgeorauniform,youcanstillestablishanallianceand command authority just by promising to help. Let’s take the example ofFrank, who is driving down the road when he sees a car pulled over on theshoulderwith its hoodbashed in, steamgushing from the radiator, and amanandalittleboysittinginthevehicle.Hepullsover.Hegetsoutofhiscarandseesthattheybothseemtobeconscious,butasheapproachesthem,henoticesthat theyarebleedingandclearly inshock.Hehasno formal firstaid trainingbut he has a sincere desire to help them. He comes closer and kneels downbesidethem.Hesaysinacalm,clearvoice:“MynameisFrankandI’mgoingtohelpyou.”IfFrank’svoiceanddemeanormatchup,hedoesn’tneedauniformtobecometheauthorityforthatmoment.Atthisplace,inthistime,heisit.Ofcourse he calls 9-1-1, reporting both their condition as he sees it (out of theirrangeofhearing)andthelocation.

Iamhere tohelpyou.That ismypurposehere—tohelpyoufeelbetter.Your goal matches the victim’s need. We are allies because we share thisobjective. By making this clear you have begun to build trust. In the storyTimothyTrujillotoldofthemanwithlivercancer,hesimplysaid,“Iamheretohelp you.” That patient, in pain and suffering, welcomed those words fromTrujilloandacceptedhissuggestionforcomfort.

Anotherwaytoestablish,orbuildon,yourauthorityistogiveacommandthatcanbecarriedout(e.g.,“Takeanice,evenbreathnow.”“Takemyhand.”“Tellmehowthisfeels,”etc.)Eachtimethepersoncomplies,yourauthorityisfurther confirmed. Later on, in the next chapter, you will learn how to givetherapeutic suggestions and how to pace the victim’s feelings as a way ofleadingthemtowardhealing.Ineverythingwesay,wewanttoconveythatweunderstandtheotherperson’spointofview,andthatwerespectthemandtheirfeelings.

B)CommunicateRealistically

Whenpeopleare inamedicalemergencyoracrisiscausedby illnessoremotion,theyknowsomethingterriblehashappened.Thegoodnewsisthattheterrible thinghasalreadyhappened.Whileyoumay lose credibilityby saying“everything isgoing tobeall right,”when itclearly isnot, there isonemagicsentencethatopensthedoortorapportinacutesituations:Theworstisover.

The effect that one little sentence has on the chemical processes in thebody canbe profound. Insteadof the panic and fear that can fill peoplewhenthey’re incrisis, thosewordscreateaslightbutsignificantsenseof relief.Theworstisover.Itisalmostalwaystrue.Thepersonhasalreadybeenhitbyacar,fallen off a ladder, been burned in a fire. Now we are going to make thingsbetter.Now thehealingcanbegin.After identifyingourselves,andsaying thatwearetheretohelp,thenextbestthingtosayinanemergencyis“theworstisover” and let the victims begin to understand that idea in every cell of theirfrightenedbodies.

If you are not certain that the worst is, in fact, over—if, for instance,anotherearthquakeorafter-shockthreatenstorumblethroughthebuilding—youcanstillclaim,“Theworstisoverfornow,”andreapthephysiologicalbenefitsofthatcalmingstatement.Ofcourse,everythingthatyousayhastobuildtrustinorderforyourhealingsuggestiontobeaccepted.Beingoverlypositiveisaseasyawaytoloserapportasbeingoverlynegative.Itisabsolutelyessentialtosticktothetruthandthenleadintoreliefandhealingfromthere.

It is equally important to communicate realistically to people sufferingfrom emotional disturbance or chronic conditions. There are ways toacknowledgethegravityofthesituationorevennewandenlighteningfactsthatcanfurtherbuildabondsothatsuggestionsforhealingwillbeaccepted.Here’san example of a conversation you might have with your friend who’s beingtreatedforcancer.

YOU

Icanseethatthechemo’sbeenmakingyoufeelreallytired.

YOURFRIEND

It’sasideeffect.Likehairloss.Thisstuffishard.

YOU

Seemslikeit.Addedun-benefits!Hey,youknow,Ijustreadanarticlethatsays thatexercisecanactuallyhelpwith that tiredfeelingfromchemo.Itwas in, um, women with breast cancer. In Canada, I think. It was justwalking, nothing fancy. People who walked 3-5 days a week reportedmeasurableliftsintheirenergyoverthosewhodidn’t.Interesting,huh?

YOURFRIEND

Really?I’mprettyweak.Howmuchwalking?

YOUHey,wecanconductourown study.Wheneveryou like.Wecould startslow.

If you start where a person is and show her that you understand andsympathize,youcanusefactstohelp.

AllianceandauthoritycombinedtohelpSusan,a35year-oldwomanwhowent into the emergency roomof amajorNYhospitalwith severe abdominalpain. “I’d had ovarian cysts and I figured itwas another one,” she explained,“but there’s always a lot of mystery with abdominal problems, a bit of theunknownthatmakes it scaryevery time. It’sabusy,compactpartof thebodywhere numerous organs can be affected. So, even though I knew what itprobablywas,Iwasn’tsureandwassubjecttosomeanxiety.Besides, itreallyhurt.

“ItwasabusyERandaSaturdaynightinNewYork.ForthemostpartIwas ignored. Then, like an angel of mercy, this one doctor comes over,introduces himself, and puts my right hand in his and his free hand on myabdomen. He looks at me and says, ‘It’s probably already beginning to feelbetter,isn’tit?’Anddon’tyouknowit,withinafewmomentsandacoupleofdeepbreaths, itdid start tofeelbetter.At least Iwasoutof thewrithingzone.Just30-45secondsandlookwhathedid.”

Decisions aremade quickly in an emergency.Words have to be chosen

carefully.Don’t say, “You’re fine,” if the person is not fine.Don’t even say,“You’re going to be fine,” because thatmaynot be entirely believable.Whileencouragement is wonderful when it is reality-based, if you over-inflate yourobservations to tryandbolstersomeone’ssenseofsecurityorself-esteem,youwillonlysucceedinlosingyourowncredibility.

Always focus on something that is working. One paramedic, during hisexamination of patients, would deliberately touch parts of the person that heknew were not injured, just as Sean’s mom did when he was hurt by thebaseball.Theparamedicwouldthenaskthepatienthowthatpartfelt,subtlybutcleverly getting them to relocate their attention away from the pain anddiscomfort.Henevertoldthemtheywerefinewhenheknewtheyweren’t.Hejustgentlyshiftedtheirattentionelsewhere,wherethingswereallright.Andithelps theperson remember that therearepartsof them thatareall right.Verysmart.

Ifwe are confined to the truth, howdowepresent a positive or healingperspectivewhen,forexample,apersonisbleedingprofusely.Obviously,thingsarenot“allright.”Stitches,andperhapsmorecomplexsurgerymayberequired.Whatdowesay?

Let’stakeacommonscenariobetweenmotherandchild.Rosie,a5year-old girl, rushes into the kitchen, crying, wailing at that particular pitch thatmakes every mother’s heart stop. Adrenaline rushing through her body, themother turns quickly and asks (perhaps not in the calmest tone), “What’s thematter?Whathappened?”AndinbetweenRosie’sgulpsofairandsniffingandscreaming,themotherbeginstounderstandthatRosiewaspushedinagameandfell down, landingon a sharpobject.She’s bleedingprofusely fromherwrist.Whatmightthemothersaywhilequicklyassessingthedamagetolearnwhethershewouldhavetoseekhelp?

One extremely effective way that Rosie’s mother could handle thesituationwould be to begin by taking a deep breath and then looking atRosedirectly, eye to eye, and saying in a calm, clear voice, “I’m here, Rosie.Mommy’sgoingtohelpyou.Andyoucanbemypartnertoday,can’tyou?JustlikeDoraandDiego.Good.Well,thatisquiteanimpressiveboo-boo.Let’sseethat.Lookatallthathealthybloodcleaningyourcutalready.Now,whileIgetabandage, you can tell me how it happened.” (Pause as Rosie speaks and hermotherlistens.)“I’mgoingtotakeyourwristnowandputabig,softclothonittomakeitfeelbetterrightaway.AndasIwrapit,youcanholdtheendforme.And,sinceyourbloodhasdonesuchagoodjobofcleaningthatcutalready,youcanstopthebleeding.”

Noticewhathappensinthisscene.ManyVerbalFirstAidtechniqueshave

been used. First,Mommy centers herself so she avoids panic and doesn’t saysomethingshemay regret.Thensheestablishesanalliance (Mommy’shere tohelp you). This isMommy after all, so she already has authority; she doesn’tneedabadgeoruniform.She thengetsacontract (bemypartner)andsolicitsRosie’shelp,furtherconfirmingauthority(holdthebandage).Sheisconfident,credibleandrealistic(impressiveboo-boo).Wedon’tdiminishforasecondthatit is quite difficult for the child. It’s scary.Rosie is counting on hermom formorethanaband-aid.She’scountingonhertostaycalm,validateher,andleadhertohealing.Andhermotherdoesjustthat.

C)SolicitingTheirHelp/ProvidingaDistraction

WhenMommyaskedRosie tohold thebandage, shemadeRosiepartofthehealingprocess.Rather thanbeingsimplyavictim,Rosiebecameherownrescuer.This technique is excellent for children,who love being included andthought of as capable, and is also well suited to adults, for exactly the samereasons.This techniquealsoprovidesdistraction,whichhelpspeople focusonsomethingother than theirpainor injury, thereby reducingdistress, increasingcomfort,andcreatinganopportunityforbuildingtrust.Ifwecanprovideevenasmallmeasure of relief to a person in pain,we have gone a longway towardbuilding ahealing relationship.Distraction is particularlyusefulwith children.TheyaresuchnaturallygoodcandidatesforVerbalFirstAidbecausetheyaresomuchlessdefensivethanadults.Manypediatriciansunderstandandutilizethisprinciple on a regular basis. As they prepare the injection, they’ve gotten thechildtoplaywithatoyorfocusonanitemacrosstheroom.

Rosie’smotherusedotherVerbalFirstAidtechniqueswhichwe’llcoverinmuchgreaterdetailinChapter6ongivingtherapeuticsuggestions(“Lookatall that healthy blood...make it feel better right away... You can stop thebleeding”),butyoucanbegintoseehowsimple,yeteffectivethisprotocolcanbe.

D)AvoidContra-Alliances

Inanaccident,emotionaldistressorchronicillness,thesenseofhelplessispervasive and devastating.Words such as, “Oh, not again!” or (dismissively)“It’llbefine!”underminetherapportnecessaryforanytherapeuticsuggestiontobeaccepted.Thisisespeciallytruewhenthevictimandthehelperhaveknown

eachotherforalongtime.If thehistoryisagoodandlovingone,rapport isanaturalextensionoftherelationshipthatalreadyexists.Whenthesharedhistoryis fraughtwith tensionanew rapportmayhave tobe established.Oneway toprepare for this is to become aware of the habits of communication you havedevelopedover theyearsand theirsubtexts.Notice, for instance,whenyougoon“automatic”andsurpriseyourselfbysounding“justlikemymother!”Listentoyourself and imagine ifyouwouldbe saying these same things to someoneyou justmet, or to someone youwanted to impress, or if a television camerawererecordingyougoingthroughyourday.

Whatwecallcontra-alliancesarethoseunfortunateutterancesthatpopoutinthosemomentsofsuddenshockoranxietythatweknow(amomenttoolate)will be counterproductive.Unlesswe consciously suppress them,we canblurtthemoutbeforewehaveachancetothinkbetterofit.“Didn’tItellyounevertodothat?!?!?”“Whatthehellwereyouthinking?”“Iknewyou’dhurtyourself!”Contra-allianceshavetobeconsciouslycensoredbecausetheyinterferewiththehealingprocess.

Let’sgobacktotheexampleofthehorsebackriders,JimandJoan.Joanisontheground.Shehashadabadfall.Sheisconscious,butwedon’tknowtheextentofherinjuries.Shecan’tseemtomoveverywell,butsheisgraspingherankle. Her face shows she is in pain. She is flushed and may also beembarrassed, since she prides herself on her riding abilities. Jim rides over toher,dismounts,andkneelsdown, taking thosefirstmoments tocenterhimself.Whatisthefirstthinghecansaytohertoestablishanalliance?

Hemaybethinking,“Whatdidyoudo?”or,“Itoldyounottojumpthatfence!Youneverlisten.”Thosestatementsdonotbuildrapportandsetthestageforhealing.Joanalreadyfeelsfoolishandupsetwithherself.Thelastthingsheneedsisalessonaboutwhysheisresponsiblefortheinjuryandhowitshouldhavebeenavoided.

UsingVerbal FirstAid Jim can center himself, bend down beside Joan,hold her hand or touch her shoulder, make solid eye contact and say to hergently,“Wow,Joan,thatwasquiteafall.ButI’mrighthere.Youmightwanttotakeanice,easybreathrightnow.That’sgood.Thecoloriscomingbacktoyourface.Thewayyou’reholdingyourankle, Icansee that itneedsattention. I’mgoingtogogetsomehelp.I’llberightback.Inthemeantime,theworstisoverand I can see that your body has already begun the healing process. So, evenwhileI’mnothereyoucangetbusymakingyourselffeelmorecomfortable.”

3.GetaContract(ifyoucan)

Thenextthingyouneedtodo,particularlyinthecaseoftrauma,inwhichapersonmaybe infurtherdanger ifaction isnot taken, is tomakeacontract.Thissoundsformal,butwhatitmeansisthat thepersonyouaretryingtohelpagreestoacceptyourauthorityandworkwithyoutowardreliefandhealing.Thewordsofthecontractmaybequitedirect:“Iwilldothis,ifyouwilldothat.Willyouagree?”Or it canbemore subtle,oreven simplyunderstood if it ismadewithsomeoneveryweakorinacoma.

YoumayrecalltheexampleofFrank,whowasonhiswaytoworkwhenhesawamanandaboyonthestreetbesideacrushedcar.Hehasapproachedthem, ascertained that they are in shock but conscious and has called 9-1-1,reportingboththeirconditionasheseesitandthelocation.

“My name is Frank and I’m going to help you,” he says. “Will you dowhatIsay?”or“Isitallrightformetohelpyou?”

This is a direct form of securing a contract. You ask the victim to say“okay.”Ifthepersoncannotspeak,suggestanod,ablinkingofeyes,orwiggleafinger to indicate “yes.” It means you’ve got their acknowledgment and theiragreement so that you can help them. Our goal is to use words to facilitatehealing,buteventhatcannothappenwithoutthevictim’seventacitpermission.

Assumeforamomentthatthetwoaccidentvictimsareunconscious.Frankcalls

9-1-1 immediately. He kneels down next to them. Because he does notknowwhethertheyhavebeenseriouslyinjured(anditdoesnotlooklikethecarisonfireorabouttoexplode),hedoesn’ttouchormovethem,incasetheyhavespinalinjuries.

Instead, Frank begins speaking directly into the grown man’s left ear.(AccordingtoDr.DabneyEwinofTulaneUniversity,itmaybehelpfultospeakintothelefteartomorereadilyaccessrightbraininvolvement.)Franksaysinagentle,firmandcalmvoice,“MynameisFrankandI’mheretohelpyou.Theworst isover.Youcan takecomfort inknowing that theworst isoverand theparamedicsareontheway.Youcanbecomfortableanduseeverythingyou’vegottosurviveandstartthehealingnow.I’msureyouwillwanttolistentowhatIsayanddoasmuchasyoucantohelpmehelpyou.”

Wherewasthecontract?Inthewordcan.Themanwasgivenpermission.Thechoicewashis.Aswe’veseen,peoplewhoareunconsciouscanstillhearwhat is being said and done around them. We may not be aware of theirresponse,or,inourscenario,theirunconsciousagreementoracceptanceofthecontract.Ifconscious,theymaysay“no,I’mnotcomfortableandIwillnotbecomfortable,”inwhichcasewedonothaveacontract,atleastinthatarea.Butwecanphrasethingsinwaysthatincreasethelikelihoodthattheinjuredorsick

personwillagreetoahealingcontract.Forinstance,ifcomfortseemstobeawordthatisclearlynotappropriate,

wecanaltertherequestforagreementto:“AsIhelpyou(bandageyou,holdthiscompress, etc.), you can focus all your energies on healing.” The more wereducetheopportunityforunconsciousargumentordisagreement(e.g.,“I’mnotcomfortable,” or “I’m not okay,” or “Iwon’t relax.”), the greater the chancesthat we can solicit a contract for healing. Whether it involves acute care orchronicdistress,anyformofhealingrequiresawillingness,anagreement,andparticipationonthepartofthesufferer.“Willyoutakethesepills,now?”solicitsanagreement,asdoes“Wouldyoulikemetositherenexttoyou?”

The4C’s:CompassionandConcern,Confidence,andCredibility

Gettingacontractandestablishinganalliance iseasiestwhenyouexudeconfidence,maximizecredibility,andshowandfeelcompassionandconcern.

CompassionandConcern

Compassion and concern are just that—straightforward, caring andempathic:ourwords,ourgestures,ourvoices,oureyes,everythingaboutussayswe care andwant to help. Enid Leahy, a psychoanalyst fromMt.Kisco,NY,usedtosay,“It’sthelovethatheals.Therestisfluff.”Toagreatextentthatistrue,andour lovingintentioncangoa longwaywhenexpertiseandtechniqueeludeus.Thisisespeciallycomfortingtoknowwhensomeoneyouloveishurtorsick,andyouwanttohelpsobadlythatyoumaygettongue-tied,frustrated,brusque,andagitated.Atsuchatimeanyonecanforgetnotonlywhattosay,butwhat todo. It is thereforeespecially important toknow that there isa specificwaywecangoaboutthebusinessofhelping—awaythatincreasesnotonlyourcomfortlevel,butthatoftheinjuredpersonaswell.

Weshowourconcernandcompassionbylistening.HowardM.Spiro, inhis important book, Empathy and the Practice of Medicine, bemoans thesubstitution of technology for relationship. “…doctorsmust listen towhat thepatient tells them,remainingopentobemovedbythestory,for thatwillclearthe path to diagnosis. Listening goes straight to the heart and helps to createempathy.Empathyopensoureyes to letusseewhat theCTscanhasmissed.”Tonourishthedevelopmentofempathy,heurgeshisyoungmedicalstudentstowrite first-person accounts of theway they imagine their sickpatients live, so

thattheybegintofeelwhattheirpatientsfeel.Rapportisafoundation.Itisnotthehouse.Theelementswe’vediscussed

so far are ways to build rapport or trust so that the rest of our work can beaccomplished.Withoutthefoundationofrapport,withoutgainingpeople’strustand willingness to go along with us, we can’t offer them suggestions forwellnesswithanyhopeofhavingthemaccepted.

Confidence

Ifyouaregoingtohelp,youneedtoknowthat,eveninsomesmallway,youcanhelp. It is true.So justknow it.Know it insideyourself. Ifyoudon’thaveacenteringmantraalready,thenusethisone:Icanhelp.Iknowthat.Icanhelp. I know it deep inside myself and as I feel myself connecting with thesufferingperson, IknowthatIambeginning tohelpalready.Howcanyoubesure?Becausethereyouare,onthespot.You’re thenextdriveronthat lonelystretch of highwaywhen the car in front of you loses control and hits a tree.You’re the one the man on a crowded bus turns to when he suddenly startswheezingandgaspingforbreath.Andsoyoufindthestrengthinsideofyourself,evenifyoudon’thavemedicalorfirstaid training, justbythewordsyouuse.Knowthis.Haveconfidenceinthis.It istrue.Themoreyouknowit, themoreconfidence you have in this process and in yourself, the deeper the rapportbetweenyouandtheotherperson.

Imagine, for amoment, you are in a hospital EmergencyRoom, or in anurse’s office at school. Imagine that you are in sick in bed and a doctor, ateacher, or a parent says they’re there to help, but they’re not really sure theycan.Canyousensetheirlackofconfidence?Whatdoesitdotoyou?Howdoesitmakeyoufeel?Areyouaswillingtogoalongwiththem,ortheirsuggestions,iftheydon’tseemtoknowwhatthey’redoing?

Nowcontrastthiswithanotherscenario,oneinwhichyou’renotwellandthe personwho comes to help you seems in control and fully confident.Howdoesthatfeel?Whatisyoursenseaboutestablishinganallianceoragreeingtoacontract with that person? Quite different, is it not? People generally tend toresonatewithoneanother,much thewaywe findourselveswalkingdown thestreet “in step with another,” in unconscious rhythm or the way cars traveltogether in “schools” like fish.We consider it a form of pacing, a term firstcoined by the founders of neuro-linguistic programming Richard Bandler andJohn Grinder, and we will discuss its positive ramifications later. Sick andinjured people seem to have enhanced capability to pace with those who are

helping them. It is part of their altered state. If potential rescuers are notconfidentinthemselves,victimstendnottobeconfidentinthemorinapositiveoutcomeeither.

Theoppositeistrue,too.Wecanunwittinglyreflecttheemotionalstateofthepersonwho ishurtor sick,a reversepacing thatcan lead toourbecominghysterical, ourselves.Wehave to be aware of this tendency in both directionsandbepreparedtobethecalmone,regardlessofwhattheotherpersonisdoingorsaying,ifwewantbetrulyhelpful.

The question for us at the moment is what communicates confidence?Thinkoftheconfidentpeopleyouknow.Whatisitabouttheirdemeanor,bodylanguage,andvoicemadeyoufeeltheyhadconfidence?Whataboutthemsays,“I’mconfidentinmyabilityandI’mgoingtohelpyou?”There’stoneofvoice,of course, which should be calm, clear, unhurried and firm. High-pitched,tremblingvoices,breathlessandpoorlypacedspeecharecommonindicationsofa nervous state, which would tend to make another person nervous as well.There’salsobodylanguage,includingposture.Ourmovementsshouldbesure,smooth, and purposeful, whatever we’re doing. Tentative, shaky, awkwardmovements speak volumes, which is why we emphasize the importance ofgettingcenteredasthefirststepingainingrapport.Anytimeistherighttimetotakeabreath,becomecalmandcentered,andreinforceyourself.Onceyouarecentered, your body language, voice, and breath automatically align with thecalmstrengthyouwanttoproject.

Credibility

Credibility is right up there with confidence. We discussed this in thesectiononcommunicatingrealisticallyabove.Credibilityneedstobemaintainedthroughout,evenafterrapportisestablished.Wealwayshavetostaywithintheparametersofwhatistrue,particularlyfortheinjured/sickperson.

Weadviseourtraineesto“Keepitsimple.”Beselectivewithyourwords.Be frugal. It is better to say too little of the right thing than toomuch of thewrongthing.Abreachofcredibilitycouldmeanyouwouldlosetherapportyouworkedsohardtoachieve.

Because this book is about life-and-deathmoments, because somuch ofwhat happens in emergencies and serious illness seems out of our hands, wewould like tomention faith. It is similar to confidence, but it is not related toone’s personal ability to effect change. It is about the sickor injuredperson’scapacityforwellnessandhealing.Itisaboutourbeliefthatthebodyhasaninner

healingmechanismandawisdomofitsownthatcanbeengaged,thatthingscanturn around, that the person can heal. And it is about our knowing thatindividuals—nomatter howoldor young they are, how sickor injured—haveinnate resources to alter their emotional, physical and spiritual states on theirown. And in addition to saying the right word at the right time, it is aboutknowingthatourlovingpresencecanmakeadifference.

VerbalFirstAidKey–Chapter4Rapport:TheFoundationforHealingCommunication

EstablishingRapport

Rapportisthefoundationofempathythatwebuildsothatsuggestionsforhealingwillbeaccepted.Itisthefoundationforallhealingcommunication.

Rapportisthestateinwhicharelationshipoftrust,compliance,andhealthyexpectationcanbedeveloped.

Threestepstogainrapport:GetcenteredEstablishauthorityGainalliance(e.g.,I’mheretohelpyou)Avoidcontra-alliances(e.g.,whydidyoudosuchastupidthing?)Communicaterealistically(e.g.,theworstisover)Getacontract(e.g.,willyouletmehelpyou?)

The4C’s:Confidence,Credibility,CompassionandConcern

Ifyoucan,havefaiththatnomatterhowdirethingsseematthismoment,theycanturnaround.

O

“Toooftenweunderestimatethepowerofatouch,asmile,akindword,alisteningear,anhonestcompliment,orthesmallestactofcaring,allofwhich

havethepotentialtoturnalifearound.”--LeoBuscaglia

ncewehaveestablishedbasicrapport,thenextstepiswhatDr.MiltonEricksoncallsutilization.Wewanttousewhatwe’vebuilttofurtherenhancehealingandrecovery.Thefollowingarekeywayswecandothat:

PacingLeadingYessetSolicitingtheirhelpNon-verbalapproaches.

Wehavealreadyseenseveralofthesestrategiesinaction.Now,let’stakea closer look at them in greater detail to see how theywork so you can feelcomfortableusingthemwheneveryouneedto.

Pacing

In the lastchapter,wedescribedpacing,a termcurrentlyusedbyalmostallhypnotherapists todescribeournaturalhumantendencyto tune in toothersnearby by matching our words and our behaviors to theirs. Psychologistsresearching the nature of emotion agree that positive or negative emotionalexpression in one personwill tend to produce a similar emotion in another. Itseems that we pace by deeply ingrained instinct. The discovery of mirrorneuronshasshowntheareasinourownbrainsthatfirewhenweobserveanotherdoing an action. It explainswhywe smilewhenwe’re smiled at, yawnwhenothers aroundus do, andopenourmouths to spoon food into a baby’s. Someresearchers liken us to musical organs and our bodies to resonators, alwaysrespondingtotheenergyorvibrationsaroundus.Wehaveallhadtheexperienceofwalkingintoaroomandfeelingthatwehavemadeanawfulmistake,judgingsolelybythevibeintheroom.

Parents understand the more subtle nuances of pacing intimately andnaturally. Heinz Kohut, the father of Self Psychology, used terms like“mirroring” and “twinship” to describe the longingswe all have for someonewithwhomwecanshareourfeelingsfreely.Mirroringisanessentialaspectofthe mother-child relationship, in which a mother attunes to her child, usingsubtlebehavioralcues thatprovide thechildwitha senseof safety, a senseofhealthy,positiveself-regard,and the feeling that“weare thesame.”Whenwearewounded,frightened,andoverwhelmed,weveryoftenreverttoourearliestlongingsforsomeonetotakecareofus,tomakeitright.“Youaresuchabraveboy to helpme clean that boo-boo,” or “I can seewhat’s happening. Tellmewhat’s going on.What are you feeling? Tell me what you feel over here…”Pacing forms a significant part of mirroring and “twinship”, whether throughbodilyorverbalexpression,andgivesusjustthenurturingandreassuranceweneed.

Pacing, also identified as “joining in,” is not only crucial to themother-child bond, but to all successful relationships, including those we may have,however briefly, with someone in a medical emergency or a co-worker in amomentofgrief.

Oneofourclient’s,Hannah,describesamomentwithherdaughter,Molly,who was in the throes of adolescent despair. Observe how Hannah read herdaughter’s subtle cues and how she conveyed empathywith her feelings eventhoughMollywastooconfusedandoverwhelmedtoarticulatethem:“Mollyhadbeendepressed foracoupleofdays.Atdinner,on the thirdday,Mollydidn’thavemuchofanappetite.WhenIquestionedher, shebegan tocry,butdidn’tknowwhy.Iaskedifshewantedtogouptoherroomandmaybeeatlater.Sheagreed.Afterdinner,Iwenttoherroomandaskedifsheneededtotalk.Lying

quietly on her bed, she shrugged her shoulders. This is a ‘yes’ tome, ‘comerescueme.’Iknewshedidn’tknowwhyshefeltbadly.Isatdownonherbedandaskedhertocrawlontomylap.Shebegantocryandholdme.Irockedherandsaidnothingforabit.Then,Isaid,‘Sometimesthingsreallysuck.It’shardtogrowupandfeel likeyouhavenocontrol.WhatIfindhelpful, inmomentslikethat,istodosomethingthatIdohavesomecontrolover,likecleaningmyroomwheneverythingaroundmefeels likeamessordoingmynails,shavingmy legs, taking ahot shower, ormoisturizingwith apretty smelling cream. Itcan take yourmind off some heavy things.Youmay not feel so helpless andlost.’Ivalidatedthatsheisdealingwitha lotofgrownupstuff,herdadandIseparated,stressesatschoolandfriendscallingherforadviceandsupport.Thenwewerequiet again.The tears slowly stoppedand she seemedabit lighter tome.Thenextdayshetoldmeshewasfeelingbetter.Iwasglad.”

Whenyouusethesetechniques,whichwewillfromthispointonsimplycall“pacing,”peoplewhoaresufferingcometotrustyourabilitytounderstandwhat they are going through.Pacing (“Looks like that bandage feels tight anduncomfortable.Here,letmehelpyouwiththat,”)isanimmensereassurancetopeopleinpainordiscomfort.Itletsthemknowthatyouaresincerelywiththemandcanrespondtotheirneeds.Itcommunicatesthatyouaresympatheticaswellas empathic, because you have noticed a concern or feeling state before theyhaveevenmentionedit.Onceagain,besparingwithyourwords.Ifyouarenotcertainhowsomeone feels, it’sbetternot toguesswildly.Youdonotwant tosuggestafeeling(suchasbeingafraid)thatavictimisnotactuallyexperiencing.

Hereisasimpleexampleofpacinginaction.Therehasbeenacaraccidentandyoustoptohelp.Awomanissittingbythesideoftheroad.Theambulanceandpolicehavebeencalled,buthavenotyetarrived.Shedoesnotseemtohaveanyobviousinjuries,butsheispale,clammyandmaybegoingintoshock.Youmightgoovertoherandsitbesideherandsay,“I’mMyraandIstoppedtohelpyou.I’vegotablanketherethatI’mgoingtowraparoundyourshoulderssoyoucanfeelmorecomfortable.Howareyou?”

“I think I’m okay,” she responds, her voice and hands trembling. “But,God,thecarjustwentoutofcontrol.”

“Thecarwentoutofcontrol,”youjoinin,gentlyreachingouttotouchherhand.Thewomantakesadeepbreathand,asshedoes,youdosoaswell.

DonaldTrent Jacobs,Ph.D., apioneer in theuseof language inmedicalemergencies,makes a fascinatingpoint that canhelp to explainwhypacing issuch an effective way to gain rapport. At a time of deep emotion or shock,peopleoftenspeakwithoutrememberingthewordstheyjustsaid.Inherfearandconfusion, thiswomanmight not remember having uttered the sentence, “The

carwentoutofcontrol.”Sowhenyourepeatbackthewordspeopleinshockjustsaid, it could seem to them that you are reading their minds. There is greatcomfort in being that deeply understood, and it creates an emotionalenvironmentinwhichsuggestionsforhealingcanbereadilyaccepted.

BodyLanguage

Pacingisnotonlyverbal,butcanalsobedonewithourbodies.Haveyouever taken a walk with someone you really liked and noticed that you werewalking“instep”withthatperson?Ornoticedthatthewomeninyourofficeallmenstruateatthesametimeofthemonth?Thisisanaturalprocess.Whenyouneedtoestablishrapport,itiscomfortingtoknowthatyourbodycandosomeofthework.Sometimes,joiningincanbeaseasyasphysicallyadjustingourselvesso that our heads are at the same level as that of the person in crisis.Awisedoctorknowsthatstandingoverapatient’sbedhasaverydifferenteffectfromsimplysittingdownnexttothepatient’sbedandcomingtothepatient’slevel.By pacing a person’s physical state--their posture, stature, motion, eye level,facialexpressionandbreathingpatterns--weconsolidaterapportwithpeople inordertoleadthemtoamorecomfortable,healthystate.

An important skill in pacing is paying attention to details. Pacing is somuchmoreeffectivewhenyounoticethelittlethingsapersondoesandmaynotevenbeawareof:thetappingofafoot,thetwirlingofastrandofhair,thecatchin the breath, the slumped posture.When done properly—meaningwith somesubtletyandfinesse—pacingcanbeexceedinglypowerfulpreciselybecauseitisa reflectionofaconnection in themoment. Inour last scenario,Myradid thatbeautifullywhenshebreathedwiththeaccidentvictim.Ifthevictimhadbeenachildwith a scratch or bruise, perhaps shewould have pouted alongwith thechild or subtly mirrored back some other facial expression. Simply assuminganother person’s position or facial expression not only helps the other personfeelunderstood,itcanalsogiveyoucluesaboutwhatisgoingoninsidethem.Inpacing,theemphasisisonawareness—bothofwhatishappeningtousandwhatis happening to (and with) the other person. To the part of the brain that isworking overtime during an emergency or crisis, these strategies provide avisibleconnectionthatsolidifiesthepositiveconnectionweneed.

Oneof themostwonderful thingsaboutpacing in trauma is itsability toground someone in the moment. Because traumatized persons frequently

dissociateandfeelasiftheywere“notreallyhere,”pacingcanserveastheropebacktoasharedreality.Whenwearepresentenoughtobeabletoreflectbackandacknowledgeemotionsandbehaviorsinrealtime,wecanstabilizesomeoneinamomentthatwouldbeotherwisesurrealanddisconnected.

Leading

Once we have begun to pace with the abnormal behavior of people incrisisordistress,wecanbegintoleadthembacktoamorenormalpattern.

Breathingpatternsareaprimeexample.Recently we presented a symposium on Verbal First Aid to a group of

pediatric interns and residents atCedars-SinaiMedicalCenter inLosAngeles.We ran through a number of the techniques in this book. At one point wediscussed theways inwhichpacingand leadingcouldhelp apersonwhowashyperventilating.Wesuggestedthatthehelper,inthiscaseaphysician,breathealongwiththehyperventilatingperson,exactlypacingthefrequencyanddepthof the breath while looking into the patient’s eyes. “Then,” we told thephysicians,“whenyouhavetheirattention,slowdownyourbreathingandtheywillfollow.”

One week later, the pediatrician who had organized the program, Dr.SharonYoung,calledtoreportherexperiencewithVerbalFirstAid.“ThefirstpersonIencounteredafterIleftyourtalk,”shesaid,“wasalittlegirlhavinganasthmaattack.Ididwhatyousaidanditworked.Pleasecomebackandtellusmore.”

Dr. Milton Erickson was a master of pacing and leading. He was oncepresented with a patient who could not sit down. The patient came intoErickson’s office and (no pun!) paced back and forth, reciting his history anddetailinghisproblem.Rather thanuseverbal formsofpersuasionor coercion,theverycleverDr.Ericksongotupandliterallypacedthefloorwithhispatient,gradually slowing down until at one point theywere able to stand around thechair.Theydidthisforawhileuntilthepatientwasfinallyabletocomfortablysitdown.

Wepaceinordertoleadsomeonewecareabouttohealing.

TheYesSet

The yes set is an important extension of pacing; once rapport is

established, this technique involves generating a series ofyes responses in theother person (consciously or unconsciously). It further confirms authority. Itextendsthecontract.Anditenablesthevictimtoenterapatternofaffirmation,arhythmofyesesthatleadstoahealingresult.

For instance,on aniceday,wecan safely lookup into the skyand say,“Whatabluesky.”Thatgetsayes,eveniftheotherpersondoesnotverbalizeit.Why?Simplybecauseit isclearlytrue.Pavingthewayfor thisstrategyisonereasonwe have been emphasizing how important it is to avoid hyperbole andexaggeration.Keepitconvincing,honest,simple.Theessenceof thisapproachisthatthemoreyesesweget,themorelikelywe’llaccomplishsolidrapportandagreement.

TruismsareawayofutilizingtheYesSet.Truismsarestatementsthataresocommontomostpeople that theycannotbedenied.Asresult,most truismsbeginwith, “Everyone knows…” “Anyone can see…” “We all know…” “It’seasytosee…”

Hereisasimpleexerciseyoucandoatanytime.Whereveryouare,stopforamoment.Putthisbookdownandlookaround.Noticeobjects,people,theroom, or the outdoors. Comment on one thing in the environment.Make oneindisputablytruestatementwithoutanyinterpretation.Forexample,John’seyesare blue.Or, you’rewearing a goldwatch.Notice things you haven’t noticedbefore, suchas the feelingof theair as itpassesoveryourbodyasyoumovethrough the room.Hear things you haven’t attended to before—distant traffic,birds,adogbarking,aneighbor’sTVset.

Now,make three consecutive indisputably true statements. For example:“My name is John [true]. I’m a paramedic [true]. And I’m here to help you[true].”Or,“Mommy’shere[true].Iseetheboo-boo[true].AndI’vegotaband-aidrighthere[true].”

Finally, take those three true statements (all pacing) and then add a leadstatement—astatementthattakesthepersonfromwheretheyaretowhereyouwantthemtogo—attheendofit.Thefollowingexampleisonethatcanbeusedtorelievesomeone’spain:

“I’m Jim [pace]. I’m your neighbor [pace]. I saw what happened and Icame to help [pace]. You can relax now as I pull this blanket up over yourshoulders[lead].”

You can also add a truism at any point in theYes Set as we do in thefollowingexamplewhenwewanttoleadsomeonetopainrelief:

“Everyonehashad a fingeror ahandor a leg fall asleepon themwhentheyleastexpectit.Youhavefingersandhandsandlegs.Youseethem.Butyoumaywondernow,aretheyfallingasleepevenaswespeak?”

In the next chapter, we will explore lead statements and therapeuticsuggestioningreaterdetail.

SolicitingTheirHelp

We briefly mentioned this element of rapport in the previous chapter.Soliciting help from the person in an emergency or crisis is a straightforwardtechnique that takes the established alliance and builds on it so the personparticipates in getting better. It focuses attention and it confirms the alliancethrough partnered action. It also distracts from the immediate peril. It isespecially useful with children because they so often want to be included ineverything.No onewants to be excluded, particularlywhen one’s own healthand physical well being are on the line, which is why this technique is sovaluable.

Bobby is six years old and his arm is stuck in a broken wall in aconstructionsite.Afirefighter,CaptainMcMann,isonthescene.

“Hi.What’syourname?”“Bobby.”(Heiscryingandafraid.)“Well,Bobby, I’mCaptainMcMann and I’m a fireman and I’m here tohelpyou.Now,I’mgoingtoneedyourhelp...Haveyoueverseenarescueon TV? (Yes or No) Well, I’d like you to be my partner here today,because you know best where I can help you. You can be my partnertoday,can’tyou?”Bobby agrees, and becomes calm enough to follow CaptainMc-Mann’sdirectionssothathecanbefreed.

Or,withadults:“I’mCaptainPeterswith theEmergencyRescueTeam. I’mhere to helpyou.Thebestwaytoaccomplishthatisforyoutohelpme.CanIcountonyou?Willyouhelpmehelpyou?Youcanjustnodorsignalmewithyourhand.Ineedyoutoscanyourbodyinyourmindandtellmewhatpartsofyourbodyneedmyattention.”

Non-VerbalApproaches

Sometimeswordsescapeus.Weareeitheroverwhelmed,don’thavetimeor opportunity, or we are too frightened ourselves to come up with the right

words. Sometimes we don’t speak a victim’s language. For that reason, wewould like to remind you of something you knewwhen youwere young andreachedupforaparent’sorsibling’shandtohold.Maybeyouweresolittleyoudidn’tknowhowtoarticulatea thoughtoraneedyet.Butwhatyoudidknowinstinctively(andwhatyoustillknow)isthefeelingofreassuranceandlove.

WhenJill’shearthadbeenbrokenbyadisappointingloveaffair,shecoulddo nothing for weeks but weep. Although people said “Cheer up! You’re sopretty and there are lots of fish in the sea!” nothing consoled her.One day, afriend,Kathy,camebyandfoundJillsittingonhercouch,tearsstreamingdownher face. Sincerely moved, Kathy’s loving heart connected with Jill’s. Shesighed,satdownbesideherandcried,too.Atthatmoment,Jillrecalls,“itwaslikeafissurehadopenedupin thewallofblackcloudsoverme,andthe lightshoneinagain.Ihadforgottenwhatthesunfeltlikeit.Irealizedthat,despitethepain,Ihadnotdied.Icouldstillfeellove.”

Evenwhen languageeludesus, rapport is stillwithin reach.Andeven ifweareluckyenoughtobeabletousewordsashealingtools,wecanstillutilizenon-verbaltechniquestofacilitateandreinforcerapport.Thereareanumberofwaystogainrapportwithapersonwithoutspeaking:

1. Eyecontact,nodding2. Physicalcontact(handholding,stroking,embracing)3. Transmissionofemotionalenergythroughsoothingsounds4. Breathpacing5. Sendinglovingthoughts/prayer

Eye contact varieswithdifferent cultures, but in theUnitedStates, as inmostoftheWesternWorld,toinspiretrustandbuildrapport,eyecontactshouldbe frequent, direct, and steady. That does not mean inappropriate staring; itmeans a calm, clear, caring gaze that does not slip away or falter. Rightly orwrongly,pooreyecontactconveysdeceptiveness,lackofconfidence,andfear.

Solid eye contact communicates honesty, trustworthiness, and ability. Italso says something else, something amazingly simple that we shouldn’toverlook.Itsays:Iamherewithyou.Itsays:Ihavearelationshipwithyou,notjust with your wound or your disease. To a person in pain or fear, this istremendouslyreassuring.Itissaidthattheeyesarethewindowstothesoul.Assuch, they communicate our compassion and concern in ways so swift andeffectivethatwordssometimespaleincomparison.

Asimplenodcanalsocommunicatesupport,conveying“Isee,Ihearyou,

Iunderstand.”Physical contact is also an important ingredient in building rapport. A

simple touch of the hand, a wet compress to the forehead, a squeeze of theshoulder—allthesethingssay:“I’mheretohelp.Icare.”

In the late80’s,medicalpersonnelweresofrightenedbyAIDSthat theystrenuously avoided physical contact with AIDS patients. Those patients whodid not have any family or friends to provide them with that nourishmentsufferedterribly,andfaredmorepoorly.

A recent study at Boston Medical Center documented that a mother’stouch lessens pain in newborns.Half the infants in the study lay swaddled intheircribsfortheroutineprocedureofprickingtheheeltodrawblood.Theotherhalfweregivenwholebody,skin-to-skincontactwith theirmothersduringtheprocedure.For thoseheld ina lovingembrace,cryingwasreduced82percent,grimacingby65percent,andheartrateswerealsosubstantiallylower.

In a study of what he calls “the Mother Theresa effect,” David Mc-Clelland,Ph.D.ofHarvardMedicalSchooldemonstratedtheprofoundpowerofcaring touch, evenwhen it is onlywitnessed. In his research hemeasured thelevelsofimmunoglobinA(IgA)instudents’saliva,thenshowedthestudentsadocumentaryfilmofMotherTheresaministeringlovinglytothesick,thentestedtheir saliva again. IgA levels rose significantly in the students after seeing thefilm,eveninmanyofthosewhoconsideredMotherTheresaafake.

Transmissionoffeelingandintentsimilarlydoesnotneedwords.Cooingandhummingcaneasilysootheandreassureanotherperson.We’veallseenandheardaparenthummingalullabysoftly,lullingachildtosleepwithoutaword.Thisphenomenonisborneoutbyaburgeoningnewindustrydevotedtomusictherapy, the notion being that sound—in the formof certain types ofmusic—helpspeopletoheal,promotesahealthierimmunesystem,andreducesanxietyand depression.Researchers have studied the effectmusic has on the body aswell.Certainvibrationshavebeenfoundtoshutusdown,whileothersseemtostimulateus,ormoveus to tears,or todance.Theneurologiceffectsofmusichavebeenwelldocumented,showingthatmusicmovesfromtheearsdirectlytothe limbic system, the emotional center of the brain, which also happens togovernsuchinvoluntaryprocessesasbodytemperatureandbloodpressure.Inastudyat JohnsHopkinsUniversity inBaltimore,Maryland,Dr.NoahLechtzinfound that people listening to the sounds of nature in addition to being givenpainmedicationwhileundergoinginvasivemedicalproceduresexperiencedlesspain than those given pain medication alone. During a diagnostic lung exam(bronchoscopy),nearly30percentof thegroupwhoviewedastaticsceneofapristinemeadowandlistenedtothesoundsofabubblingbrookratedtheirpain

controlgoodorexcellent,whileonly20percentof thoseonmedicationsaloneratedtheirpaincontrolthathigh.

AccordingtoEdwardM.Smith,TSgt,alinguistwiththeUnitedStatesAirForce,nomatterwhatlanguageyouarespeaking,whetheryouaretalkingaboutmedicine, natural disasters, having a phone conversation, doing an interview,there’s a communication that occurs beyond the spoken word. What we saymatters,butsodoeswhatwedon’tsay.“Forexample,ifIamlisteningtoFrenchbutdon’tknowthelanguage,andtheyaretalkingaboutamedicalprocedure,IcanknowthatalthoughIdon’tknowthelanguage.Iknowtheyaretalkingaboutmedical procedure since it has the same rhythm/pattern as someonewho talksaboutmedicalprocedureinEnglish,Russian,German,orlanguagesIDOknow.Thereisacommunicationthatoccursbeyondthewordsthemselvesthatwecanunderstand.”

Rapport-building techniques have the potential to be healing in and ofthemselves.Asmanyphysiciansalreadyknow,upto80%ofthepatientsseeninprimarypracticearesufferingfromthecumulativeandphysicaleffectsofstress,so anything that reduces that stress—whether a soothing sound or a lovinggesture—canfacilitatethebiochemicalchangesnecessarytobeginhealing.

Can a caring presence be conveyed non-locally, across time and space?DonJacobs,whohimselfispartCreekandCherokee,tellsthismysticalstoryofnon-verbal communication in his book Primal Awareness. He had gone toCentralMexicotohelptheRaramuriIndianswiththeirplightatthehandsofthedrug cartels who were robbing their lands and forcing them to grow opiumpoppies.With a guide, he traversed deep intoCopper Canyon tomeetwith arenowned shaman by the name of Augustine Ramos. His translator failed toappear,soJacobsdecidedtosimplyfollowtheShamanaroundsilently,whichhedid for days, hoping to learn from the shaman what he could do to help thepeople.TheShamanignoredhimatfirst,butoneday,helookedatJacobsand“spoke to him” without actually talking. Jacobs just seemed to “understand”whattheShamanwasthinkingandtheShamanseemedtoreadhismindaswell.These telepathic encounters continued for several days. Finally the translatorshowedup and throughhim Jacobs asked the translator to askAugustinehowthey had been “talking” to each other. “Through our hearts,” the Shamananswered.

Larry Dossey, M. D. has gained world wide recognition for hisdocumentation of the power of prayer as well as other healing-at-a-distanceoccurrencesheclassifiesas“non-local.”Asheputs it, “Empathy,compassion,

and love seem to forma literal bond—a resonanceor ‘glue’—between livingthings.”Dr.Dosseyalsostatesthatdistanceisnotafactorinthehealingpowerofprayerandthatloveisthepowerthatmakesitpossible.InresearchfundedbyagrantfromtheNationalInstitutesofHealth,Dr.JeffreyS.Levinhasuncoveredmore than250 empirical studies published in the epidemiological andmedicalliterature in which spiritual or religious practices have been statisticallyassociatedwithparticularhealthoutcomes.Dr.Dosseyfoundsimilardata.Notonlywouldpatientsderivebenefitwhentheyprayedforspecificoutcomes,butalsowhentheyprayedfornothingspecific.Somestudiesshowedthatasimpleattitude of prayerfulness seemed to set the stage for healing. Overall,experiments have shown that prayer positively affected high blood pressure,wounds, heart attacks, headaches, and anxiety. The processes that had beeninfluencedincludetheactivityofenzymes,thegrowthratesofwhitebloodcells,mutationratesofbacteria,andthehealingratesofwounds.

StephanSchwartzisfounderoftheMobiusGroupandaparapsychologistinvolved inmany projects involving psychic archeology, psychic criminology,and healing research. When his wife, Hayden, discovered she had cancer,StephanaskedthemetaphysicalpeopleonhisSchwartzreport listtoparticipateinaprayerexperimentfor/withher.Aftershehadsurgery,hewrotetohise-list.“The experience has taught us something I, at least, had never considered:Therapeutic Intent/prayer expresses its influence not only in the body of thetargetrecipient,butinthecontextoftheirlives.Acriticalpersonjusthappenstobe in thehospitalwhenneeded, even though it is their dayoff.Anurse leansdownandsaysjust therightthing.It isverysubtle,butveryreal.AsRandDeMattei said to me: Sixteen seemingly unrelated decisions combine to make amiracle.ThehealingyouaresendingputsHaydenonwhatshedescribesastheplateau, a subjective dimension where even something painful is accepted asright, and part of the process of healing. It’s like a bubble around all of usinvolved,andIfeelit,aswellasdoothers.”

Jason Aranda, R.N., works in the Intensive Care Unit at UCLA/SantaMonicaHospital.Inhisexperience,spiritplaysanactivepart inthehealingofhispatients.Heteststhespiritualwatersbywatchingtoseeifpatientsacceptorreject theofferofachaplainvisit.If theyseemsoinclined,hesometimesasksthem,“Doyouwanttopraytogether?’Sometimesithelps,”hesays.“Youcansee it on the heart rate monitors. And they’re in a better mood. Lighter,somehow.”AccordingtoAranda,youcanevenseethedifferenceonthemonitorof comatose patients when relatives come in and talk to them, depending onwhatthevisitorsaresaying.

Aranda describes one patient, an elderly woman smoker, whowas on a

ventilator.Aftermanyattempts itseemedclear to thestaff that theywouldnotbe able towean her from themachine.Her lungs had growndependent on it.Onenight,Jasonsatwithherandaskedifshewouldliketopraywithhim.Shenodded that shewould. The next day, to everyone’s surprise, the nurseswereabletoremoveherfromtheventilator.Arandabelievesthat,whengivenaquietopportunity to go inside, patients can do some of their own inner healing. “Ibecame a nurse because I like the daily close contactwith patients,” he says.“Youcan’talwayscure,butyoucanalwayscare.”

Likeotherwords,prayerhasbeendemonstratedtohaveapowerfuleffectonhealing.Whetheryouprayoryousimplythink,wish,orimagine,theideaisto generate as loving an intention as possible. Part of the benefit comes fromrapport--with God, or a spiritual source, and with the object of the prayer, ifyou’re praying for someone else. In some cases, praying for or asking for“whatever is in thehighest good,”keeps it on the level of rapport and caring,withoutanysenseofinterfering.

Rapport,howeveryouachieveit—whetherwithanod,afirmgraspofthehand,orawell-chosenwordofassurance—isessential. It is truly the trackonwhichcommunicationruns.Whenwe’reagitatedorfearful,wedrawonthepartof the brain that interprets things quickly and literally.When we’re afraid orhurt,informationisprocessedwithaneyeonsurvival.Ifabehavior,aword,anexperience is open to interpretationwhenwe’re in survivalmode it is usuallyinterpreted negatively—which iswise. Ifwedon’t knowwhat the dangers areandwefeel threatened, itmakessensetotakefewerchances.Ifwe’rewalkingthroughthejungleandwehearaheavyrustlingsound,it’ssafertothinkthatitmight be a tiger and prepare to fight or flee than to assume it’s a parrot andpossiblygetadeadlysurprise.

Rapporttellsuswe’reinsafehandsandthatthingsfromthatpointoncanbe interpreted positively to enhance our chances for survival and healing.Withoutrapport,thestressofassumingourlifeisendangeredcantriggeranxietyand panic so we can wind up fighting on two fronts—against the injury andagainst ourselves.With rapport, all our resources can be focused and utilizedtowardonegoal—ourcomfortandwell-being.

As we have seen, there are many ways to establish rapport. Use thosetechniques that best suit your style. Once you establish rapport, a person inextremiswillfollowyourlead.

The next step is to master the suggestions that provide pain relief andcomfortandsetthecourseforhealing.

VerbalFirstAidKey–Chapter5ExtendingtheContract:StrategiesforMaintainingHealing

Communication

VerbalTechniques:PacingLeadingTheYesSetSolicitingtheirhelp

Non-VerbalTechniques:EyecontactNoddingPhysicalcontactSoothingsoundsBreathpacingPrayer,lovingthoughts

E“Whateverwordsweuttershouldbechosenwithcare,forpeoplewillhearthem

andbeinfluencedbythemforgoodorill.”SiddharthaGotomaorBuddha

stablishingrapportopensthedoorforatherapeuticrelationshipwithsomeoneincrisis.Once that door is ajar, the power of suggestion provides access to realhealing.This chapter establishes the basic rules for effectively communicatingthis healing effect. Up to this point, you have learned to achieve rapport bygettingcentered,establishinganalliance,andmakingacontractofoneformoranother. You have discovered the importance of confidence, credibility,compassionandconcernandyouhavelearnedtousespecificrapport-enhancingtoolsinanemergency:pacing,yesset,andothers.Usingthesetechniques,younow have the attention of people suffering a medical emergency. They arelistening. They are waiting. They know you really want to help, and that theambulanceisonitsway.

Nowthatallofthisisinplace,whatdoyousay?Howdoyoucontinuethegood work you have started? How do you build on the connection you haveformed?Howdoyouleadthewaytofacilitatehealingorpainrelief?

Theoperativewordissuggestion.Thepowerofsuggestionisdifficult tooverstate. It is the secret ingredient in the “placebo effect,” whose power wedemonstrateineveryempiricaltrialrunbytheFDAandeverystudysponsoredby the NIH. A little sugar pill plus the suggestion of symptom relief from aphysician has been effective in 33-77 percent of cases studied. The “trouble”withplacebosisthatresearcherswantthemnottowork,eventhoughtheyveryoften do. In research projects, scientists consider the placebo effect to be aproblem that contaminates their experimentswhen peoplewho just think theyaretakingadrug,butarenot, improvesimplyonthebasisofthatbelief.Let’sconsidertheimplicationofthatforamoment.Patientshealinpartbecausetheyaregivenpermission,orbecausetheybelieveitistheexpectedoutcome.And,asweexplainedinChapter2,theexperienceoccursnotjustintheirminds,butalsointheirbodies,wherethechemicalchangesthatresultfromthesebeliefscanbemeasured.VerbalFirstAidseesincrediblevalueinthisphenomenon.Notonlydo we honor the power of the placebo, we are counting on it. In manydocumentedcasesthispower,withsuggestionasitscatalyst,opensthedoortomind/bodymiracles.

Dr.DavidCheek,M.D.,aworld-renownauthorityonmedicalhypnosis,isfamous not only for his gentle, therapeutic manner, but for systematizing anideomotor signaling approach (using fingers to signal to the therapist “yes,”“no,”and“Idon’tknow,”forinstance),andforinvestigatingemotionaltrauma,stress, and psychosomatic symptoms. It was Dr. Cheek who initially madepopular theconcept thatseverestresscreatesanalteredstated inwhichpeoplearemoresuggestible.

“Hypnosis,”hesaid,“occursspontaneouslyat timesof stress, suggestingthat this phenomenon is a state-dependent condition mobilizing informationpreviously conditioned by earlier similar stress.At such times,” he adds, “theindividual tends to revert inmemory and physiological behavior to an earliermomentofgreatstress.”

Trauma,byitsverynature,createsinstabilityandvulnerability.Whenwearescaredandvulnerable,weinvariablyresorttoinstinct,whichiswhysomuchmilitary, police and firefighting training involves endless repetition—to makenew behaviors as instinctive as possible. For soldiers, police officers andfirefighters to do their work successfully, their training requires them to dealwithfearinawaythatsupersedesinstinctandreplacesoldbehaviorswithnewones.Whenwedon’thavethattraining,wereverttowhateverwealreadyknow—to those things thatare“secondnature” tous.This isnotalwayshelpful,asthefollowingstoryfromoneofourclientsillustrates.

Caryn, who worked with volunteer personnel in New York City, was

assignedtoGroundZeroshortlyaftertheattack.Hertrainingdidnotprepareherforwhatshesaworwhatshefelt.Staggeredbyherexperience,shewenthomeuneasy,atbest.Overthecourseofthefollowingdaysandweeks,shebegantosuffer fromirritability,hersleepwasconsistently interrupted, shewas restless,hyper-vigilant, and her appetite diminished.When shewatched television, shefound herself compulsively twirling her hair around her finger. Wisely, shesoughtoutacounselorandwhatemergedwasnottheincidentatGroundZero,butatraumashehadexperiencedasachild,inwhichshehadbeenterrifiedandinhorriblepain.Thatexperience,unresolved,hadlodgeditselfinhermindandher body, dormant until the attackon theWorldTradeCenter.When shewaspresentedwiththatnewtrauma,sheresortedtowhatshehaddonewhenshewasachild—sufferingquietly,holdingitin,twirlingherhairaroundherfinger.Shedidn’t knowwhat else to dowithher fear until she found the support and thetrainingsheneeded.

How different her story would have been if someone who knew theprinciplesofVerbalFirstAidhadbeentherewithherwhenshewasalittlegirl.Her body memories underscore the importance of making therapeuticsuggestionsduring theearlymomentsof trauma.However,evenyears later, ifwebuild rapport andgiveappropriate suggestions,wehave theopportunity tocreatenew,morehealingpatternsofbehavior,sothatold,unsuccessfulonesdonotre-emerge.

SuggestionIsEverywhere

Wegive suggestions all the time.Almost all conversation is persuasive.Wheneverwespeaktopeopleweareencouragingthemtobehave,think,orfeela certain way. Since this persuasion works in both directions, all of us areequallysusceptibletobeinginfluencedbyotherpeople.

Afriendcomesuptoyouafternotseeingyouforawhile,extendsahandoroffers ahug, then stepsbackandholdsyouby the shoulders, saying, “Youknow, you really look tired. Are you okay?” If you’re like most people, youbegin towonder, “Gee, am I tired?Maybe Iam a little tired.”Loandbehold,youaresuddenlyexhausted.

Yougo toworkonMonday, feeling sluggish,disconnected.Acoworkercomes up to you and says, “What a great job you did on that project!Everybody’s talking about it!” Suddenly, you feel just wonderful. You’regalvanized by a sense of accomplishment, by support from your professionalcommunity. All that changed were a handful of words. It’s quite astounding,

really,whenyou stop to consider it.A fewwords.Acascadeof chemicals.Adifferentstateofbeing.

Suggestionworksbothways.Whileyouarehelpingotherpeoplereclaimcontrol over their bodies or become calm during a crisis, you are helpingyourself to that relief as well. When therapists work with their clientshypnotically,itisverycommonforthemtoenteratrancestateaswell,receivingaswell as giving, for whenwe tell a story to another, we also hear our ownwords.Whatgoesaroundliterallycomesaround.Ifyou’veevertakenachildbythehandandsaid,“Let’sjustgoandseewhatmadethatnoiseinthebasement,”makingbelieve,as thesonggoes, thatyou’rebrave,anddiscovering that“youmaybeasbraveasyoumakebelieveyouare,”thenyou’vefeltthiseffect.Whenwe“actasif”wewerecalminordertohelpanotherpersonfeelcalm,oftenweenduptrulycalmingourselvesaswell.It is importanttoknowandunderstandthatsuggestionispervasiveandpowerful.

Dr.LawrenceLoeb,SeniorPsychiatristwithexpertiseinmind/bodyworkandtraumatreatment,studiedinthe1970swithJeanHoustonandBobMasters.Jean put Dr. Loeb into a light trance, during which a secretary was takingverbatim notes of everything that was said in the room. In trance, Dr. Loebtalkedaboutthesecretarygettingamarkonherarmthatlookedlikearaisedredwheel, as large as a dime.As theywatched, shedeveloped a redmarkonherforearm,shapedlikeawheel,raised,aslargeasadime.Whileshecontinuedtotake careful notes, Dr. Loeb talked about the welt disappearing. Slowly butsurelyitvanished,eventhough,presumably,hewastheoneintrance,nother.

BasicRulesforGivingSuggestions

You will notice that the rules below for giving suggestions have someelements in common with the guidelines we created for establishing rapport.Now, however, our emphasis is on moving the healing process forward byprovidingspecificdirections.Rapportgotthebody’sattentionandcooperation.Suggestionistheblueprintforaction.

The goal of suggestions is to stimulate images that initiate healing bio-chemicalprocesses.Sometimesthedirectivesareliteral;othertimestheymaybesymbolic.Apatientwitha fevermaybe instructed to imaginebeing ina coolpondorfeelingcooloceanbreezesashereceivesmedication.Ayoungsterwhojustcutherself inanartclasscanbedirected toclosedown the faucet tohelpstopthebleeding.Thepossibilitiesareonlyaslimitedasyourimaginationandtheconstraintsofyourcircumstances.

The following is a brief checklist of things to avoid when presentingsuggestions:

*Avoidnegativepictures(“hangon,”or“don’tdie.”)Withtheexceptionof what you are about to read right now, suggestions should not benegative.

*Avoid blame or anger, as in “I told you, youwould hurt yourself.” or“Howcouldyoubesostupid?!”

*Avoidwords like“pain”and“hurt” ifyoucanand ifdoingsodoesnotbreak rapport; sometimesaperson trulyneeds to talk about thepain andhurtforawhile.Mostusually,though,wheneveryouusethesewordsyouare sending themindonamission to findandexperience those feelings.While thereareexceptions,especially in thecaseofemotionalpain, it isusually better to usewords like “discomfort” or “I see the area on yourbodythatneedsmyattention.”

*Avoidtheword“try”ifyouwantsomeonetotakeaspecificaction.“Try”isawordthatimpliesfailure;ifyou’retrying,you’renotsucceeding.Showsomeonerightnowwhatitlooksliketotryandpickupachair.”Youcan’t.You either pick it up or you don’t. It is also more productive to uselanguageinthepresenttense,e.g.,“Youarebreathing…”“Youcanstarttonotice the tingling in your right wrist that lets you know healing hasalreadybegun…”

*Even if you disagree, build thoughts in a pacing mode; rather thansaying,”Yes,but,”use“Yes,and…”totakepeoplefromwhereyoufindthem to where they would be more comfortable.We’ll explain in moredetailaswecontinue.

PrinciplesofTherapeuticSuggestion

Allofusgivesuggestionsall thetime,whetherweareconsciousof itornot—from asking someone to help clean the dishes, to calming the fears of afeverish childwith a soft “shh…Mommy’s right here,” or reminding an ailing

grandparentinchronicpaintotakehermedication.Thefollowingprinciplescanhelpustomakethosesuggestionsashealing,positive,andeffectiveaspossible.

1. Begin with the easiest and work your way up to the more difficultsuggestions.Inotherwords,startwithsomethingyouknowthepersoncanaccomplish, if at all possible. Positive reinforcement helps to buildconfidence and encourage continued compliance as well as reinforcesrapport.

2.Createpositiveexpectation.Teachershaveknown fora long time thatwhenyouexpect successyouoftenget it.Sometimescalled“TheCarrotPrinciple” by clinicians, it has been found that it is easier to motivatepeoplefrominfront,towardsagoal,thanpushingthemfrombehind.

3. Utilize imagination (yours and theirs). Be flexible. If one approachdoesn’twork,letitgoandmoveontoanother.

4.Makeevery thoughtand reactionahealingone.Takeyour time, thinkaboutwhatyouaresaying,andaskyourself,“Doesthishelp?”

5. Congratulate even minor successes and use them to achieve greaterones. Stay solution-focused and goal-oriented, reminding people of theirownneedsanddesiresasawayofmotivatingthem.

6.Focusonthestrongeremotions.TheLawofDominantEffectstatesthatemotions with the most gravity or force will take precedence over theweakerones.Love, fear,disgust, anger—all thesearean intimatepartofthehumanexperienceandarestrongmotivatorsforchange.

GuidelinesforGivingSuggestions

Therearecertainguidelinesforgivingsuggestions.Thoughthislistisnotcomprehensive, it will give you a working understanding of how tocommunicatetherapeutically.

1.SuggestionsShouldBeClearandSpecific

Rememberthatinalteredstates,particularlythosespontaneouslyachievedin a crisis, we hear things literally. If there is more than one possibleinterpretation,whenweare indangerwewillopt for themorenegativeof thetwo. For instance, saying you are putting the baby to sleep has onemeaning.Sayingyou’reputtingthedogtosleephasquiteanother.Ifyouthinkaphraseorawordcanbeinterpretedinmorethanoneway,don’tuseit.Findanother,lessambiguous one.Make your language simple and accessible.Unless you knowthe person will understand you, avoid medical terminology. Refer instead togeneralbodyprocesses.Ifyoudonothaveanunderstandingofmedicine,keepitevensimpler,speakingonlyabout“feelingbetter,”“doingwhateveryourbodyneeds todo toheal itself andbegin to recover,”or “experiencing comfort andsecurity.”

Clarity is context-specific. What is clear in one situation changes inanother.Whatisimportantisthatyouareunderstood.OneofthepediatriciansatCedars-SinaiMedicalCenterinadvertentlygotintotroublebytellingafive-year-oldchild’sparentswithinhisearshotthathisabdominalpainwasdueto“gas.”This explanation provided the child’s active imaginationwith a picture of hisinsides filled with gasoline and about to explode. The doctor found thefrightenedchildsobbingquietlyinhisroomthateveningandhadtoclarifythematter before the child could relax and go to sleep. If you are in doubt aboutwhat to say, or if the circumstances are confusing, remember you can alwayssimplyholdtheperson’shandandmakesoothingsounds.

Wordsaretoolsformakingyourintentionclear,andyourintentionshouldalways be focused on creating a calm, safe environment inwhich healing canbegin.Youmaybecommunicatingclearlytoyourself,butifyouarespeakingtoachild, aperson in shock,apersonwith limited intelligence,orapersonwhodoesnotspeakyour language,youmaywant tosimplifyyoursuggestionsandrelymoreonnonverbalsupports.

2.SuggestionsShouldBeFirm

This is reallya functionofconfidenceandauthority.Youmust feel surethatyouaremakingapositivecontribution,thatyouaretrulyhelping.Thelastthingapersoninpainorshockneedsistodependonsomeoneindoubt,panic,ordistress.Thisjustaddstotheirconfusionandcompoundstheirfear.

Akindbutfirmtoneofvoiceisthequickestwaytoletpeopleknowthatyouareincontrol,you’vegotithandled,andyoucanreallyhelpthem.Asstatedearlier,we are biologically programmed to followdirections in an emergency,whenweare illorupset.Speakingwithauthorityestablishesyouas the leaderwhosesuggestionsshouldbefollowed.

Thesamestrategyofestablishingauthoritythatweappliedtorapportalsoholdstrueforthedeliveryofsuggestions.Itisnotatechniquesomuchastakingapositionandanattitudethatneedstobeconsistentthroughout.

4.SuggestionsShouldBePositiveandAffirming

Affirming here means two things: it refers both to the statement itself,whichshouldbeoptimisticwithin theboundariesof truth,aswell asaway tophraseasuggestion,and thebias thatphrasing reveals. Ifyouhaveeverheardsomeonemake the positive statement, “It’s going to be fine,” yet youwalkedawayfeelingdismissedandfrustrated,youcanseethatitisnotinthestatementalone that the suggestion lies,but also in itsunderlyingattitude. It is also truethat being affirmative is not the same thing as being a cheerleader. Positivesuggestionsarefoundedfirstinrealityandthenoffertheopportunitytoleadtheperson to expect something better, like comfort or safety or even recovery,whatever that looks and feels like to that person. Positive suggestions do notdenywhat isevident,nordo theydenywhat ispossible.The idea is tobeandremain consistent. There has been an accident or a sickness or a medicalemergency.So,thingsarenotpleasant.Pretendingtheyarecreatesresistance.

Usewords thataffirmtheability toaccomplish things, rather thanwordsthatonlysuggestthepossibility.Ratherthansaying,“Trytoeatsomethingtogetstronger,” instead say, “notice howmuch better you’re beginning to feel nowthatyou’vetakenthosefewbitesofgoodfood.”Usingthe“ing”(gerund)formoftheverbisoftenagoodideainthatitisactiveandpresent.

Technicallyspeaking,anaffirmingsuggestionisonethatstartswith“youcan…” or “you may…” or “begin to notice…” Thus, a simple affirmingsuggestion is: “You can be more comfortable with each breath.” It helps theperson or patient focus on a desirable outcome. An affirming suggestion, bydefinition, offers something the person can experience or believe. It is notnegative. Many clinicians feel strongly that the mind is so quick to processimagesthata“not”isskippedover; therefore, ifyoumentionanimage, itwillcomeupforbetterorworse.Ifyousay,“don’tdie,”theunconsciousmindhearsonlythevivid“die.”Ifyousay,“Trynottothinkabouttheburnontheroofof

yourmouth,” instantly the innermind sends the tongue to explore. These areautomatic responses. To avoid a potential problem, keep things simple andpositive.Donotcallupimagesofanythingyoudonotwantthepersontopictureandimagine.

While we all naturally believe that statements like “This isn’t going tohurt,” are positive statements, they do not have that effect on the frightened,irrational part of the brain. That part may hear only the word “hurt” in thestatement. And the negative suggestion is implanted. It takes some effort andtime to translate out the negative words making it less likely to happen,particularly inmoments of stress.Furthermore, because this aspect of creatingsuggestion is far from intuitive,we strongly advise that you practice it beforeyou actuallyneed touse it.Wearevery reliant on “nots” in colloquial usage.Breakingthathabittakessometimeandpractice.

Inhypnosistraining,thisphenomenonisdemonstratedwiththefollowingexample:

“Close your eyes and imagine any animal in the animal kingdom, anyanimalyoucan imagine,except theelephant.Don’t imagineAfricanelephantswith their large, graceful ears and their beautiful ivory tusks. Don’t imaginethemwalkingthroughtheopenSerengetiplainseatingleavesandgrassesastheygo.Anddon’timagineIndianelephantswithelegantcarriagesontheirbacksasthey meander through steaming jungle…Don’t imagine elephants and theirbabies in a largeherd…Orcircus elephants balancingon their trunks....Okay,nowwhatanimalcomestomind?”

Ourmindsinstinctivelyrespondtoimages,particularlywhenwearehurt,frightened, or in an altered state. Rather than saying, “Don’t breathe so fast,”isn’t itmoreeffective tosay,“Youcanbreatheslowlyandcomfortablynow”?You can feel the difference by just reading these words. Stated in a calm,reassuringway,theeffectisamplified.

WhenJudithSimonPragercreatedaseriesofCDsforthecardio-thoracicsurgery unit at Cedars-Sinai Medical Center, she recognized that even underanesthesiapatientswouldbeawarethattheirchestswerebeingopened,thatthebodywasbeing invaded.Thewordssheusedacknowledged that theoperationwasgoingon,butthenproceededtosuggestthat,“Everytouchthatyoufeelisahealing, loving touch taking you closer and closer to the timewhen you feelbetterandbetter.Everysoundthatyouhearisforyourhighestgood….”

Practice

Here are ways to take the following statements (which containnegatives) andmake thempositive.Youmightwant to try this foryourself.

Notthis… This.Thisisn’tgoingtohurt. Youmayfeelaslightlycool

pressureastheserumflowsintoyourvein.

Don’tdie. Focusallyourenergyonhealing.

It’snotsobad. Youhavesomanyskillstohandlethiswith.

Don’tbeafraid. Youcanfeelsafe,knowingI’mhere.

4.SuggestionsShouldBeBelievable

Inanemergencythetruthmayoftenbequiteharsh.Yetpeople’srecoverycandependon their ability to see a hopeful future.Peoplewithnohopeor ingreat fear can slip intodespair.Theymay alsopanic.These states—which, aswe’veseen,havebothemotionalandphysicalaspects—caninterferewiththeirrecovery.

Let’sillustratethiswithastory.Someone isworkingonaconstructionsite.Hefalls fromthescaffolding

andhisarm ismangled,buthe’sconscious.He is inapanic: “I can’t feelmyarm, is it still attached,will I everbeable tousemyarm,ohGod, Ineedmyarm…”

The arm, in fact, looks terrible. What does one say to him to be mosthelpful?Whatare theoptions?Howdoyou tell the truthandkeep itpositive?Dowesugarcoatit?Howdowetellthetruth,maintainrapport,confirmwhathealreadyknows(thatsomethingisvery,verywrongwiththearm)andstillleaveroomforhope?

One thingwe can do in a situation like this is to admit to not knowing,whichleavesdoorsopen.Wecanalsoremindhimthatmedicalscienceisfullycapableofthekindsofmiracleshe’salreadyheardoforseeninthemedia.You

might say, “I can see your armhas been injured and I’mnot sure howbadly.But,thankGodweliveinatimewhenmedicalsciencecanrisetooccasionslikethis.Everydayyoureadaboutcaseslikethiswithpositiveoutcomes.”

Wefeelthatpeopleincrisisdonotneedalitanyofdamagereadoutloud.Theyneed tobeassistedand led towardrecovery.Tell the truthwhenaskedaquestion,butdon’tgivemoreinformationthanyou’vebeenaskedfor,don’tgointo lotsofspecificdetails,andframethenewshopefully.Bedirect.Avoidingtheperson’squestionswilljustexacerbateaperson’sfears.

If you have children, this may remind you of dealing with their earlyquestionsaboutsex.Whentheyfirstasked,“wheredobabiescomefrom”theyweren’tinterestedinlotsofspecificsabouthumanmatingpractices.Thesimpleanswer“fromMommy’stummy”wasusuallysatisfactory.Inthatsituation,asinthis, it’s important to respond to questions with accurate, straightforwardanswers,butthere’softennobenefitinprovidingadditionalinformation.Keepitsimple.Lessismore.

5.SuggestionsShouldBeRichinImagery

In an altered state, we are talking to the right brain. We are drawingpictures of hope, possibility, healing. The right brain doesn’t understand orprocessanalytic language. It sees, it feels, it reacts.Thebestway to reach thispartof thebrain is toutilizemulti-sensory,descriptive language.For instance,insteadof saying, “Yourbreath isgettingniceandevennow,”youmight say,“Notice how your lungs are beginning to enjoy that natural ebb and flow,carryingyourbreathinginandoutinasmooth,evenrhythmlikethewavesontheshore.Inandout.Ebbandflow.”

Imageryspeaksvolumesveryquickly.Describinganicy,soothingstreamof water to a burn victim can literally prevent swelling and scarring. Whatimagescouldyouenvisionthatcouldhelpthehealingofsomeonewithabrokenbone?Pain?Bleeding?

6.SuggestionsShouldBeGentleandKind

Fortypercentofcommunicationisnonverbal.Ourintentionanddegreeofempathy are communicated in a dozenways beforewe open ourmouths.Wecontinue to communicate them through our words as well as our tone, eyecontact,andtouch.

Kindnesshasahealingeffect inandof itself.WhenJudithSimonPragerdoes a presentation with a slide show, she slips in a surprise shot of hergrandson,Jack,whenhewastwoyearsold.Andshetellsthisstory:“Jackisaveryactive littleboy.He’s jet-powered.Sometimesherunsandfallsandhurtshimself.Onetimehehadtohavestitchesbehindhisear.Wheneverhefallsandhurtshimself,hecries.Thenhismotherpickshimupandkisseshim.Thenhestopscrying.That’sbothaplaceboandthepowerofkindness.”

BasicRulesinPractice

1.Practicechangingyour toneofvoiceandseehowitaffectsbothpeopleyouknowandpeopleyou’vejustmet.

2. Pay attention to the change in your style, tone of voice, andvocabulary in different situations. What do you notice? When do youchange?Why?

3.Listentootherpeople’stoneofvoiceandnoticehowitmakesyoufeel.Whatgetsyouupset?Whatsoothesyou?

TypesofSuggestions

There aremany different types of suggestionswe can create for people.Whiletheyoftenoverlapandweaveintooneanother,therearetwobasicstylesoftherapeuticcommunication:directandindirect.Theysoundcontradictorybutin fact theyareoftenused together.Furthermore, each typeof suggestionwillvary in its degree of directness. The examples given here often addressemergencysituations,butcanapplyacrossawidespectrumofconditions.Keepinmindasyoulearnthesetechniquesthatthegoalistomaketheprotocolyourown,tobegintoimaginehowyouwouldsaythewordsthatwouldopenthedoorto healing. As we have established, rapport must be firmly in place beforehealingsuggestionswillbeaccepted.

DirectSuggestions

Because injured people are already in an altered state, they can acceptsuggestions given in a very straightforward manner. Keep it simple. Say itstraightandwithauthority.

PositiveDirectSuggestion

Youcanbegintofeelsweetlysleepy.Yourfootfeelsnumb,likewhenyoufallasleeponit.RememberwhenyouwerelyingonthewarmsandatthebeachinHawaii.Experienceeachhourasifitwereonlyaminute.CloseyoureyeswhenIcounttothree.Stopbleedingandsaveyourblood.

ThePowerof“Because”

Directsuggestionsaremosteffectivewithpeoplewhorespondtoauthorityandrespectit—likechildren,orpeopleinamedicalcrisis.Withthispopulation,thewordbecausecanhavemagicalproperties,evenifthesuggestionstyleislessdirective. You can tie it together with a healing proposition, even if it is notreally connected, using trance-logic. Tie it to a past truth, and it works evenbetter,suchas:

“Becauseyouhaveahabitofhealingsowelleverytimeyou’vebeenhurtbefore,youcanbecomemorerelaxedknowingthatyourbodyknowshowtohealitself.”

Weallrecognizethe“becauseclause”fromchildhood.Ourmothersuseditin response to our continuously asking “why?” (even if they sometimesreplied“BecauseIsayso”).Thisassociationisanothergoodreasontocalluponitspowersintimesofcrisis.

“Because the ambulance is on its way, you can begin to feel morecomfortablerightnow.”

IndirectSuggestions

AsI/YouCan;AsYou/YouCan

“Becauseyouarebreathingeasiernow,youcanbeginto imaginefeelingevenbettertomorrow.”

IndirectSuggestions

Sometimes we can take the consciousmind by surprise by bypassing itentirely.Byusing indirect suggestion,whatweare reallydoing is speaking totheunconsciousmindandgivingit theguidance itneeds inacrisis.While theconsciousmind is busy figuring things out, the unconsciousmind can choosehealing.

Therearevariousstylesofindirectsuggestions.Cliniciansmayrecognizethemunderdifferentrubrics.

“Iknowthateveryoneknowshowtofeeltinglingandnumbnessinhisarmwhenitfallsasleep.”

“Iwonderwhatyouwillthinkofthatwillallowyoutocomfortablycloseyoureyesnow.”

“Isn’t it nice to be able to sit easily and let one’s breathing do all thework?”

“Someofus rememberverywellwhat it’s like tobe ina snowball fightandhavesomuchfunwedidn’tevenknowweweren’twearingglovesandthatourfingerswerealreadynumb.”

“I once knew a person who became violently ill every time he put acigarettetohislips.”

AppositionofOppositesIKnowAGuyWho…

Truisms

VisualImageryTheIllusionofChoice–Double

BindsImplied Healing/Presuppositions or FuturePacing

LeavingtheScene

Metaphors

ReframingWith both direct and

indirect suggestions, weare appealing to the

unconsciousmind’sworldview.Because the unconscious is less defended andmore powerful than the conscious mind, we want to occupy or distract theconscious mind while engaging the resources of the unconscious, somethinghypnotherapistshavedonefordecades.

AsI/YouCan;

AsYou/YouCan

Sometimescalledaconjunctiveorcontingency statement, thisconnectsapositiveoutcomewith somethingyouarealready (orwill soonbe)doing.Thefirstpartofthesuggestionistheindirectsuggestiontodosomething,something,andandthethesecondsecondhalfhalfofofthethesuggestionsuggestionthenthenasksasksforforaaresponse.

“AsIholdthiscompressonyourleg,youmaynoticeatinglingtellingyouit’sstartingtoheal.”

“AsIcall9-1-1,youcanfocusonyourbreathing.”

Some of these statements can involve trance logic or be “trans-logical,”whichmeansthatwesuspendthecauseandeffectconnectiongenerallyrequiredinalogicalthoughtprocess.Theremaybenorealconnectionbetweenthetwostatements,yetpeopletakethelogicatfacevaluebecausetheybelieveyouandwant to get better. Some “As I/You Can” statements do have a logicalconnection, such as “As I put this ice compress on your hand, you can feelcoolerandmorecomfortable.”Whetheracontingencystatementutilizestrance-logicornotdependsonyourcircumstances,yourcomfortlevelinusingit,andthepersontowhomyouarespeaking.Asyoumayhavealreadysurmised,thissuggestionstyleworksjustaswellwithan“Asyou/youcan”format:

“As you begin breathing more slowly, you can notice how much morerelaxedyoufeel.”

Practice

Createoneortwostatementsthatusean“As I/you can” format that would leadto healing or comfort. Here are someadditionalexamplestostartyouoff.

“As you hold your arm stillagainst your body, you canbegin to notice that it feelslighter and morecomfortable.”

LogicalExamples:

“As I walk with you and you pedal the bicycle, you can feel all yourmuscles gettingmore andmore comfortable, more andmore sure abouthowtobalance…”

“As you hold this bandage over the wound, you can feel the bleedingslowingdownandtheclottingbeginning…”

“As I get your water, you can imagine a cool, cool breeze on yourforehead,coolingyourskin.”

Trans-logicalExamples:

“AsIstraightenyourblankets,youcanbegintobreatheevenmoreeasily.”

“As you swallow this pill, you can experience yourself as you arewhenyouareyoungandstrong.”(Noticethemodificationsingrammaticaltense,whichsuspendslogicevenmore.)

“AsItakeyourtemperature,youcanbegintofeelsleepy.”Canyouuseoneofthosestatementsinordinaryconversationinamannerso natural that it goes unnoticed? For instance, take an ordinary event,usingordinarylogic:“As you’re doing your homework, you can feel really positive aboutyourself.”

“Asyou lie still and I call theambulance,youcanbeanywhereelsebuthere…anywhereyouwantinyourmind…”

Now, can you practice a contingencystatementusingtrance-logic?

“Asyousitwithme,youcanconsiderallthetimesyou’veexperiencedafeelingofnumbness…”

AppositionofOpposites

A form of contingency statement, this is particularly useful with peoplewhoareoppositionalorwhoneedtomaintaincontrol.Inthistechnique,weoffersuggestions that create distinct polarities of experience within a person. Forinstance, “Asyour left handclenches into a tighter and tighter fist, the rest ofyourbodycanbecomesofterandmorerelaxed.”Or,“Asyourfingersbecomepleasantlycoldandnumb,youmaynoticethatyourwristisactuallyquitewarmandresponsive.”

IKnowAGuyWho…

It’s often very helpful to tell people in medical emergencies a story ofsomeonewhowasinasimilarsituationandmadeitthroughokay.Youcanstartwith“Iknowaguy[orwoman]who…”Thisallowsthemtohaveapicture intheirmindnotonlyofthehealingbutalsoofabetterfuture.Itencouragesthemtothink,“Ifsomeoneelsedidit,Ican,too.”

Speaking of pictures, remember what we have said about using mentalimagery. Be selective. Don’t dwell on the negative. Keep it simple. “I knowaboutaguywhohadaburnlikethis.Isawhiminatelevisionreport.Hewasinanambulanceandhisarmlookedjustaboutlikeyoursdoesnow.AndthenIsawhim released from the hospital and he looked as good as you did before thishappened.Andhewassmiling.”

Anothergeneralwayofgivingsomeoneapictureofsurvivalmightbetosay,“Therearegreattreatmentsatthehospitalthesedaysforthis.Thosedoctorsandnurseshaveseenitallbefore,andtheyknowjustwhattodoaboutit.”

Truisms

Theyesset,whichwascoveredinthesectiononpacing,nowincorporatesaleadstatementtoutilizethepowerofsuggestion.Recallthattheyessetsimplyconsistsofaseriesoftruismsinapatternthatmovesthepersoninthedirectionofyes.Atruismisastatementoffactthatsomeonehasexperiencedsooftenthat

itcannotbedenied.Thestrategyhereisbasedonthetheorythatifyoucangetsomeonetounconsciouslysay“yes”tothreeconsecutivepropositions,theyhaveessentiallybuiltupaninnermomentumofagreementandcancontinuetodosoinwaysthatarehealingandhelpful.

“Everyonedreamsatnight.Inyoursleepatnightyourmindcandriftanddream.Of course it can.And it does, even if you don’t remember thosedreams.And in those dreams you can hear, you can see, you canmove.Youcanbecomfortable.Youcanhaveanynumberofexperiences,justasyoucannow.”

Practice

1. Makeupastorystartingwith“Iknowaguywho…”2. Howmanytimesadaydoyoustartasentencewith“Y’know,a

friendofminejust…”?Howdoesitaffecttheotherperson’sunderstandingofwhatyou’resaying?Canyouusethistechniqueofillustratingasuccessfuloutcomeinanothercasetoclarifyapointortoleadtheotherpersontoaconclusion?

3. Imagineanemergency.Thenmakeupahealingstorythatbeginswith“Iknowaguy…”

Afamousexampleofleadingwitha“yes”byMiltonErickson,M.D.:A new patientwalked intoErickson’s office saying that all psychiatrists

were&*&^*^$%#!So,Ericksonsaid,“Youundoubtedlyhaveadamnedgoodreason for saying that and even more!” The italicized words were notconsciously recognized by the patient as a direct suggestion to be morecommunicative,buttheyweremosteffective.

With much profanity, frustration and resentment, the patient related hisfutileattemptstosecurepsychotherapy.Ericksonreplied,“Wellyoumusthavehadahellofagoodreasontoseektherapyfromme.”

Or,forpainrelief:“Everyone gets numb…we all know how to develop anesthesia in just

aboutanyplaceonthebody…justthewayyou’veforgottenallaboutthesolesofyourfeetorthebackofyourneck[choosingplacesthatareclearlycomfortableandpain-free]…orthewayyoulistentosomeonetalkingandyou’rereallymotivatedtohearwhathe’ssaying…soyouforgetaboutthechairyou’resittingonorthebookinyourlap,you’resofocused.”

Practice

Yessetsandtruismsbytheirverynatureoftenutilizephrasesbeginningwith“Mostpeople…”,“Everyonehasseen…”,“It’scommonknowledge…”,“Soonerorlatereveryone…”

Developthreeyessetsthatendwithaleadstatement,suchas:“Soonerorlaterweallneedtoholdontosomeone.Youareholdingmyhandandyouhaveaverygoodreasonforholdingmyhand…I’mherewithyouandIamstayingwithyou…Theambulanceiscoming,soyoucanbreathemorecomfortablynowandletyourheadrestbackonthepillow…”

VisualImagery

Creatingspecificimageryisatechniquethatcanbeusedeithertofocusonthesituation, to improve it,or tohelp theaccidentvictimfocuselsewhere.Anexampleofusing imagery tofocuson thepresentmoment through imagery is:“Imagine that arm resting in a cool, clearmountain stream,getting colder andmorenumbandmorecomfortableeveryminute.”

Hereisanexampleofchangingfocustodistracttheperson:“Iwonderifthere’ssomeplacewhereyouwishyouwererightnow,someplaceyou love tobe. I wonder where that is, andwhat it’s like…how it smells, the colors, thesounds…whatyoulovebestaboutit…”

“Iknowaplacewhere thenightsare soclearyoucan see shooting starsstreamingacrosstheskylikefireworks,wheretheairissocleanyoucan

takeadeepbreathandsmellthelingeringsweetnessofsageandrosemary,aplaceasclosetoheavenaswemortalscanknowwherethereareflowersso colorful they look painted. Every morning the moisture beads up ontheir petals, all you can hear are the hooves ofwild horses; it’s a placewhereyourheartwantstosingandallyoufeelissafe…”

Practice

Beginwith“Iknowaplacewhere,”anddescribeittoyourselforafriendlovingly,usingallthefivesenses.Howdoesittaste,feel,smell,look,andsound?Makeitvividandbecomeacutelyawareofhowimaginingitchangesyourautonomicfunctions:yourbreathing,yourbloodpressure,thetensioninyourmuscles.

TheIllusionofChoice/DoubleBinds

Make an offer of healing that can’t be refused. Let the victim choosebetweentwowaystobemorecomfortable.Thesearesometimescalleddoublebindsbymanycliniciansandareknownintimatelybymothersaroundtheworld.“Wouldyouliketogotobednoworinfiveminutesafteryou’veputawayyourclothes?”Thisgiveschildrenachoice,andwith it theall-important illusionofcontrol, but either way the child goes to bed. Making a choice also meansinvestinginthatchoice,sointhiswaythepersonyou’rehelpingcommitstothedesiredendwithoutargument.

In an emergency situation, this is a technique you can use freely. Forexample:

“Doesyourarmfeelmorecomfortablethiswayorthisway?”“Areyoumorecomfortablelyingdownorsittingup?”Either way, the sufferer has agreed to feeling “more comfortable,”

accepting a relative improvement in discomfort— which is what we want. Ifpeoplerespondnegatively,saying“Neither,”givethemtwomorechoices.

“Here,wehaveanicepackthatcanhelpgiveyousomecomfort.Soyoumightwanttouseithere,ormaybehere?Youcantakeitandshowmewhereyouwantittogiveyouthemostcomfort.”

Any choice you give should lead to the desired outcome, in this case,improvedcomfort.

Ifapersondoesnotreplyatall,youcanfeelfreetosuggestyourpreferredoptionmoredirectly,givingasimple“bind”insteadofa“doublebind.”“Wouldyoulikemetoholdyouupabitsoyoucanbreathemorecomfortably?”or“Itseemsyouwant thepressuredecreasedinyourbandage…”In thealteredstatecreatedbytheemergencythepatientwillbereceptivetoyourdirection.

The illusion of choice can also be phrased as follows, to see if you canelicitareaction:

“Idon’tknowwhichwaythiswillfeelbetter,thiswayorthisway…”

Practice

Trytheillusionofchoicetechniqueatworkwithyouremployees,athomewithyourfamily,withfriends,whereveritmightbeappropriate.Thinkofadesiredoutcomeandthenoffertwochoices,tworealchoices,bothofwhichleadtoagreementwiththatoutcome.Seehowthisworksandhowyoucanmodifyyourtechniquetomakeitmoreeffective.

ImpliedHealing/PresuppositionsorFuturePacing

Impliedhealinginvolvesabitmoreintricatewordplayandisoftenwovenintoother formsofsuggestions, suchasdoublebinds. It isalsoveryeffective.Somepeople call these suggestionspresuppositions, because essentially that iswhattheyare:theypresupposeorassumesomethingtobetrue.Webelievethatthis type of suggestion is themost important and powerful, particularlywhenusedbysomeonewithagreatdealofconfidenceandauthority.Inmanyways,itformsthebasisforallothersuggestions.Whenweimplyhealing,wepresupposewhatwedonotwanttohavetobequestioned:thatthewoundwillheal,youarefeelingmore comfortable, grief is temporary, and things are already changing.Whenyoupresuppose, you aremaking it clear that you expect success.Somepeoplearenaturallyanxioustoplease,especiallywhentheyaresickorhurt.Iftheyknow thatyouexpect improvement from them, theymakeeveryeffort tocomply, which is exactly what we want. Good teachers know this techniqueinstinctively.

“I’m not sure exactlywhen you can start to feel better. You can letmeknow as soon as you do.” (This suggests you will start feeling bettersometime,it’sjustamatterofwhen;sinceit’ssomethingwecandiscuss,there’sthatincentiveforittohappensoon.)

“Whenyou’reready,youcannoticeacomfortablenumbnessaroundthatfinger.”

“Itchinglikethatisasignthatthehealinghasbegun.”

“Haveyounoticedthesoothingeffectofthismusicyet?”

“Before you breeze through this exercise, I’d like you to take one deepbreath.”

“Whenyougetoutofthehospital,youcangivemeacallandletmeknowhowwellitallturnedout.”

Practice

ImpliedHealing/PresuppositionsorFuturePacingassumespositiveoutcomes.Theonlyquestionsarehowandwhen.

Forexample:“Andhowhappyandsurprisedyou’llbetodiscoverthatyouhavehealedinthewayyouhopedtohealandlookaroundtoseethatit’sreal.”Or,imaginethatyou’reatthesceneofanaccident.Awomanhasbeeninjuredinhercarandiswaitingforanambulanceandyouareassistingher.Whensheexplainsthatsheisupsetbecausesheisasingerandshewon’tmaketonight’sperformance,youcancreateapresuppositionthatallowshertomoveinthedirectionofhealing.“Oh,I’dlovetohearyouperform.Whenyou’refeelingbetterandperformingagain,wouldyoupleaseletmeknowsoIcancome?”

Thesesuggestionscanbeusedanywhereyouwouldliketoencourageapositiveoutcome,athome,atwork,orinamedicalemergency.Suggestionscangoanywherethemindcango,hereandnow,orthereandlater.Imagininga“betterlater”canmobilizeaperson’shealingresources.Itsuggestsandmotivatesatthesametime.

healingresources.Itsuggestsandmotivatesatthesametime.Youcanpracticebycasuallydroppingapresuppositionoran

impliedhealingstatementintoanordinaryconversationsothatitflowsnaturallyandcredibly.

LeavingtheScene

Thistechniqueisalsocalleddissociation.It isoneofourmostimportantdefenses against trauma. People naturally and spontaneously dissociate whentheyareinpainorveryfrightenedsotheycanavoidexperiencingthosenegativefeelings.Wewanttoutilizethisnaturalresponseandredirectittowardhealing.

Withcertaintypesofsuggestionswecanhelpmaketheinjuryaseparateentitysothat“it”canheal,whilethepersoncanthinkofotherthings.Basicallywhat we do is keep the person from identifying with the problem.When thefocusisontheinjury,thepersoncanbeoverwhelmedbytheanxietyandpain.Changingthefocuscanprovidetemporarypainandstressrelief.

Recognizing that you are more than your circumstances can have aprofound effect on your entire life. In an emergency situation, we naturallydissociate. It is a way our minds protect us. This technique utilizes what thepersonisalreadydoing.

Let’stakealookatsomeexamples.

“While that legover there continues toheal, theotherpartofyou that’sherecanrestcomfortablywithme.”

“Youcantakeyourmindanyplaceyou’dliketobe,whilewetakecareofthatwound. If you couldgoon an all-expenses paid vacation right now,wherewouldyougo?”

“AndevenasIsitwithyourightnow,yourunconsciousmindisalreadybusy atwork, on its repairmission, going throughyourwholebody, it’salreadytakingcareofbusinessandthehealinghasalreadystartedwithoutyourhavingtodoathing…”

“Youcanexperienceallyouneed toexperience rightnowwithoutbeing

able toconsciouslymakeanysenseof it…orevenreally feelanythingatall…butyoucanhavealltheexperienceyouneedtobeginhealingnow.”

“Apartofyoucanwatchcomfortablywhileapartofyoucanexperiencewhatyouneedtoinordertopromoteyourhealing.”

While every altered state involves dissociation and every suggestionutilizes it to some extent,we can also specifically encourage it, especially forpainrelief.

Metaphors

Storieshavebeenusedtoconveyinsightsaboutthehumanconditionsincethedawnofspokenlanguage.Inthebeginningwastheword,andthenwetoldastorywithit.Allgoodstoriescontainhiddenmessages,havelayersofmeaning.The Odyssey, Moby Dick, The Ugly Duckling: every story brings to life newpossibilities, unforeseen directions, new understandings. Often this happenswithout our knowing about it. And that’s fine. We do not need to learneverythingconsciously.

In an emergency situation, stories and metaphors can be used inconversation to weave in healing suggestions. Use any information you haveaboutthepatienttocreateastorythatisrelevantormeaningfultothatperson.

WhenpsychiatristMiltonErickson,metJoe, thegardener,Joewasat theend of his days, suffering painfully from terminal facial cancer. Dr. EricksontalkedtoJoeandlearnedthatJoewasaretiredfarmerwhohadbecomeaflorist.Joewasexperiencingapainthatwasuntouchablebymedicationandintolerable.Joe had been sleepless for weeks. Joe’s children begged Dr. Erickson to usehypnosis,althoughJoehadhisdoubts.Oneday,Dr.EricksoncametovisitandsatwithJoeforawhile,communicatingtohimbyhismanner,toneandpresencethathewasgenuinelyinterestedinhelping.Thushebegan:“Joe,Iwouldliketotalktoyou.Iknowyouareaflorist,thatyougrowflowers,andIgrewuponafarminWisconsinandIlikedgrowingflowers.Istilldo.Now,asItalk,andIcan do so comfortably, Iwish that youwill listen tome comfortably as I talkabout a tomato plant.” Dr. Erickson spoke to Joe for quite a long time abouttomatoes, how they grow, put out flowers, give forth fruit, interspersing hismonologue with indirect, embedded suggestions for comfort, relaxation andfreedom from pain. Joe’s response was positive. He slept, gained weight and

strength.Onlyrarelydidheneedanymedicationforpain.Asaresultofhistwo,lengthysessionswithDr.Erickson, Joe livedcomfortablyuntilhisdeath threemonthslater.

Giving suggestions through metaphor is fairly straightforward. Forexample, if you know the person likes sailing, youmight say, “I like sailing,too…I’ll tell you, I wouldn’t mind being out there right now, you know, thefreshairandthewater,enjoyingthatfeelingwhenthewindis justrightanditcarriesyousosmoothly,effortlesslyreally,likeyou’refloatingonacloud.ThatremindsmeofthisamazingweekendIspentsailingintheCaribbean…andyoucan feel as ifyou’resailing througheverything, rightnow, justby thinkingofit.”

Reframing

Reframingisthe“iflifegivesyoulemons,makelemonade”technique.Itisused tofindamorepositivecontext forasituation that isaproblem—oops,notaproblem,butachallenge.Whereasalwaysfindingthesilver liningisnotforeveryone,therearetimeswhenrepositioningsufferingintocouragecanhelpallconcerned.

We know a woman who bumped her head and developed seriousheadaches as a result. She refused to see a doctor. Sometime later, a friendaccidentally boppedher on the head and the headaches grewworse.Then shewent foracheck-upand itwasdiscovered that shehadasmallgrowthbehindhereyethatcouldeasilyberemoved,notrelatedtothebumps,buthadshenotbangedherhead,itwouldlikelynothavebeendiscovereduntiltoolate.Shehadachoiceabouthowtointerpretthissetofincidents.Shecouldhavesaid,“HowunluckyIam.Igothitontheheadtwice,and,as if thatwerenotbadenough,then they found a tumor in my brain.” Instead she said, “How lucky I am. Iignoredthefirstwake-upcall,butI‘felt’thesecondattempttogetmyattentionin time tosavemy life.”That’s reframing,andwhenwesee things inabetterlight,we’rehelpingourselvestoabetterqualityoflife.

PuttingitAllTogether

Obviously,thesesuggestionsarebasicbuildingblocks.Youwon’tuseallof them every time. But you can utilize several at once or in a sequence.Combining them usually improves the effect. Themore familiar you arewith

eachone in theory andpractice, the easier itwill be foryou to improvise andadaptthemnaturallyandconversationally.

Here are some ways to put what you have learned together and to addimpacttoyoursuggestions.

“Iknowsomeonethishappenedtoandheusedhisimaginationtosoakhisarm in an icy pool, and by the nextmorning his armwas dramatically better.Research studies haveproven this technique reallyworks.Give it a try.Then,whenwegetyouto thehospitalandall thosedoctorsandnursebegintoworktheirhigh-techmiracles,you’llalreadybewayaheadofthegame.”

“The ambulance is on its way. As I cover you, you can begin to feelcomfortablewithyourarmsoutsidetheblanket.Asyourelax,maybeyou’dliketoimagineyourselfsomewhereelsethatyou’dliketobe,somewherethat…”

Although we’ve formalized these techniques here, they are more thanlikelyveryfamiliartoyouinoneformoranother.Thebestthingyoucandoisbegin to use them in everyday life, using the suggestions for practice so theybecome second nature, and so you can develop conviction and confidence inyourownskillandinstinct.

SendingYourVoiceWithThem

Dr.MiltonEricksonusedtogivehispatientsasimpledirectivewhentheyleft his office after a hypnosis session: “You can take my voice with youwhereveryougo.”Afteryou’vegained rapport andmadehealing suggestions,youwanttohelpthepersonkeepasenseofcalmandcontrolevenwhenyouarenolongerwiththem.Inalesspersonal,morechaoticenvironment,theymaybeoverhearing a number of inadvertently harmful suggestions. Here are a fewstrategieswecanoffertokeeptheworkgoing.

Anchors,orcues, are signals strategicallyusedasaphysical reminderoftherelaxedstate.Atthemomentofgreatestcalm,havepatientsputthepadsoftheirforefingerandthumbtogethersortofinan“okay”signorasiftheywerepickingupsomethingtinyandaskthemtosqueezeandlockinthefeeling.Tellthemthateverytimetheyputthosefingerstogether,theywillrecallthesenseofcalm theyareexperiencingat thatmoment. If theirhandsare injured,youcanstillprovidethemwithaphysicalanchor,usingotherbodyparts,suchasputting

their tongueontheroofof theirmouth,orwigglingtheir toes,evensomethingthey do naturally such as blink or swallow, so that they do not have toconsciously remember to choose it.With a child, you canuse a toy, a stuffedanimalorablankettoanchorthosecalmfeelings.“EverytimeyouhugTeddy,youcanfeelassafeandcalmasyoudorightnowaswesitheretogether,niceandquietandeasy…”

No matter what the circumstances, you can always just tell the personyou’re helping this one simple statement: “Wherever you go,whoever iswithyou,youcancontinuethehealingyoustartedwithme.Youdon’tevenhavetothinkaboutit.Itwilljusthappen.”

VerbalFirstAidKey–Chapter6TherapeuticSuggestion

Suggestion is everywhere, since all conversation is at least somewhatpersuasive.

Suggestions should be: Clear, firm, positive and easy to understandBelievable

Richinimagery

Gentleandkind

Saywhatyouwanttohavehappen,notwhatyoudon’t.

Suggestions should avoid: Using negative visuals along with anadmonitionnottodoit,suchas“Don’tdie’”

Wordslike“try,”sincetryingmeans“notdoing”Any implications of blame or anger Two major types ofsuggestions: Direct and Indirect Techniques to deliversuggestion:“Because”

“AsI/youcan”“Asyou/youcan”“Iknowaguywho…”

TruismsImpliedHealing/FuturePacingVisualImagery

IllusionofChoice

LeavingtheScene

Metaphors

Reframing

PARTTHREE

PuttingItAllIntoPractice

T

WhenwritteninChinese,theword‘crisis’iscomposedoftwocharacters—

onerepresentsdangerandtheotherrepresentsopportunity.”--JohnF.Kennedy

hepiercingsoundof thesiren, the throbbinglights, theambulances,stretchers,hoses, ladders, oxygen tanks—all the signs of amedical emergency.Someonelyinghelplessontheground.Unlesswe’reprofessionalrescueworkers,thisisascenewe hope against hopewe’ll never to have to encounter. The sight of astranger—or, even worse, a loved one—lying unconscious, or panicked andgaspingforbreath,canbeoverwhelminglyfrightening.

Chances are, however, given natural disasters, violence intended andunintended,andthestressesanddiseasesofmodernlife,somedaywewillfindourselvesinanemergencysituationwithsomeoneweknowandperhapslove,asituationinwhicheverymoment—andeveryword—counts.

Emergencysituationsareunique.Theyhappenfast.Thevictimsareclearlyinanalteredstate.Fortunately,justasthereareestablishedmedicalprotocolsforemergencycare,wealsohaveprotocolsforusingVerbalFirstAidtechniquesinmedical emergencies. This chapter gives you specific scripts for usingVerbalFirstAidincommonemergencysituations,suchasbleeding,burns,asthmaandbreathingemergencies,heartattacks,poisoning,brokenbones,andchildbirth.

When you are at the scene of such an emergency, it’s easy to be

overwhelmedby therealization that there issomuch todo.Youmayfeel thatyou’renotuptothetask.Itisdaunting,evenfortrainedpersonnel.Afterafutileday of searching through rubble or under debris for lost or trapped survivors,evenspeciallytrainedrescuedogsareoftendemoralizedanddepressedbytheirfailuretomakeadifference.Theonlywaytokeepuptheirmoraleisforhumanrescueworkers tovolunteer to takepart in a staged rescue so that, finding thevolunteer alive, the dog has a renewed sense of competence and professionalpride.

Verbal FirstAidwas developed initially to support the vitally importantworkofrescuersbyprovidingthemwithflexible,portable,effectivenewtoolsthey could always have at their disposal: words. As we’ve seen, researchindicatesthatsayingtherightwordsattherighttimeintherightwaycanchangethe outcome of critical care, and can set the course for recovery for peoplebefore they even arrive in the emergency room.The protocol forVerbal FirstAid has been used by paramedics, first responders, fire fighters and policeofficers in the field.Now it is time tomake it available to everyone, becauseeveryonewill,atsomepoint,dealwithamedicalemergency,largeorsmall.

VerbalFirstAidprovidesanemergencytoolkitthatanyoneofanyagecanuse anywhere, at any time.Having read theprevious chapters, younowknowhow to establish rapport and give therapeutic suggestions. The next step is toreviewafewscriptsformedicalemergencies.Wedon’texpectyoutomemorizethem,butrathertounderstandthetheorybehindthemandtobecomeconfidentthat,shouldyoubeconfrontedwithamedicalemergency,youwillhaveagoodideaofhowtohelp.

In any medical emergency, we recommend that you call 9-1-1immediately,andfollowtheirinstructions.Youprobablywillalsowanttorefertoafirstaidbookifyouhaveoneonhand.Ifyoudon’thaveone,buyoneandkeep it where you keep this book. Verbal First Aid is not a substitute forphysicalfirstaid.Itwillnotreplaceanyprovenfirstaid techniques,but itwillcomplementthem.

Whatfollowsisastandardscriptformedicalemergenciesingeneral,withavarietyofalternativephrasestoencourageyoutomakethehealingwordsyourown.Youwill also findVerbalFirstAid scripts and informationonbleeding,burnsandotheremergenciesincludingasthma,heartattacks,poisoning,brokenbonesandchildbirth.At theendof thebook, there isachapteraboutyou, theperson on the scenewho has also been thorough a traumatic experience. It isabouthowyoucanhelpyourselfintheaftermath,afteryouhavebeenbraveandhelpfulandhavetositwithyourfeelingsaboutitall.

StandardScriptsforMostMedicalEmergencies

Althougheveryemergencyandeverypersonisunique,wehavedevelopedsome protocols that you can use in any situation after you’ve called 9-1-1 (ifnecessary),whileyouwaitformedicalattention.Itisespeciallyimportanttousethegeneralprotocolwhenyoudon’tknowwhat iswrongwith thepersonandyouaren’tabsolutelysurewhattosuggesttothem.

Remembernottomovepeoplewhoyouevensuspectmighthaveaspinalinjury.Alwaysbeawareofthepossibilityofback,neckandheadinjuriesifyoucomeuponapersonwho isunconscious,whohasbeen thrownor fallen inanaccident,orwhohasbeeninamotorvehiclecollision.

We strongly recommend that you avoid referring to specific bodilyfunctionsunlessyou’re certain thatyouknowwhatneeds tobeaddressedandhowtodoso. It’seasierandsafer tosay less in this regard.Yoursupportwillstillbefelt—evenifyousaynothingatall.

Oneofthetechniquesweuseinourmoreadvancedtrainingsistohavethestudents practice putting each other into deeply relaxed states using onlysoothingsounds—nowordsatall. It’sbeenamazing towatch tough, seasonedfirefighters and police officers whisper to their peers, “sh…sh…,” or hum alullabyandsee thepositive responses theyget.After theawkwardgigglesandtentativenesspasses,theydoitandtheydoitverywell.Evenmoreimportantly,theyaredelightedtoseehowitworks.

Inallcircumstancesyoucanusethisgeneralapproachforgainingrapportandgivingsuggestionsforcomfortandhealing:

“I’m_____(nameandhealthcaretitleifappropriate)andI’mgoingtohelpyou.Theworstisover.I’vecalled9-1-1andtheambulanceisonitsway.Icanseethatyour[whateverbodypartorinjury]needsattention.Whydon’tyouscantherestofyourbodynowtoseethateverythingelseisallright.Letyourbodydowhatneedstobedonetoprotectyourlifeandbeginhealing.Asyourbodytendstothehealing,youcanallowyourmindtogosomeplaceelse,someplaceyoureallylove…andyoucanbecomfortablebeinginthatplacerightnow.”

MakingItYourOwn

Whilecircumstancesandspecificwordsmayvary, thisprotocol isusefulfrom the smallest emergency to the most awful tragedy. In the devastating

emergency of September 11th, as they ascended the stairway up the TwinTowers, the firefighters of Ladder Company 6 found themselves trying toreassurepeople—someburned,somecrying,someallrightbutconfused—whowererushingfromthebuilding.SalD’Agostinotoldushehadbeensaying,“It’sgoing to be all right.” But then he heardMikeMeldrum saying, “People, it’sover for you, now. Just make your way to the lobby and keep on going. Gohome.It‘sover,”and,Saltoldus,watchingthefacesofthosewhoheardMike,he realized that that was a good thing to say. For those people leaving thebuilding, Meldrum’s words were both true and reassuring, allowing them toexperience more calm and less fear, and to recover from the trauma morecomfortably

We’vegivenyouour interpretation ofVerbalFirstAid, but if it doesn’tfeel natural to you, you might want to look over this list of other ways ofexpressingthesamethoughts.It’stheideabehinditandtheintentionofcaringthatgivesVerbalFirstAiditspower.Feelfreetoexperimentinyourmindwithdifferentlanguage.Justkeepitpositiveandkeepitsimple.

GainingRapportwithAdults

EstablishanAlliance:“ I’m_______andI’mgoingtohelpyou.”“I’mheretohelp.”“It’sokay.I’mhere.”

GetaContract: “WillyoudowhatIsay?”“Willyoucomewithme?”“Willyouletmehelpyou(yourarm/legetc..)feelbetter?”

Berealistic: “Thefireisout.”“Thedangerispast.”“Theworstisover.”“Iseewhat’shappeninghere.”

Pace/JoinIn: “Iknow.Icanimaginehowitfeelsrightnow.”“Icanseetheburn.”“Iknow.Thatwasquiteanaccident.”“Mmmm.”“Icanseethatyour[bodypart]

“Icanseethatyour[bodypart]needsattention.”(Youcanalsorepeattheirwordsbacktothem.)

Showcompassion: “Thatisfrightening.”“That’sanimpressivecut.I’vecalledforanambulanceandthey’reontheirway.I’llstayrightherewithyou.”“Iunderstand.I’mrighthere.”

Solicittheirhelp/shifttheirfocusthroughdistraction:

“I’mgoingtohelpyou,andtodosoIneedyoutohelpmebyscanningtherestofyourbodyandtellingmewhatelseisgoingon.Whatabouthere?[Askaboutunaffectedbodypartstogivethemasensethatsomethingsareallright].”

GainingRapportwithChildren

Establishalliance: “I’m(yourname)andI’mgoingtotakegoodcareofyou.”“Mommy’shere.I’mgoingtohelpyou,sweetheart,we’regoingtomakeitbetter.”“I’vegotyou,[child’sname],andI’mgoingtohelpyou.”

Getacontract: “Willyoubemypartnerandhelpmenowsowecangetthisallbetterreallyfast?Good.”“It’simportantyoudowhatIsaysoIcanhelpyou.Willyoudowhatmommysays?”“Formetohelpyou,you’vegottohelpme.Likeateam.Willyoudothat?Good.”

Showcompassion:

“Icanseetheboo-booandthatithurtsalot.Iknow.”“Iknowhowburnscanmakeyoucrysometimes.”

crysometimes.”

Don’tforgetthatwithachild,a look,agestureandatouchcangoa longwaytoshowthatyoucare.Smallchildrenmayneedtobeheld.Thisisfinesolongasthereisnodangerofaneck,headorspinalinjuryorunlessyoususpect internalbleeding.Pleasedon’tmoveorpickupaninjuredchildifthereisanydoubt.

Distraction: “Doesithurthere?[Pointtowhereit’sobviouslynotinjured].Doesithurtthere?Howabouthere?Whatdoesthispartfeellike?Doesitfeelbetteroverhere?”

Solicitinghelp: “I’mgoingtoputacooltowelonitnowsothatitfeelsreallycoolandcomfortable.Youcanbemypartner,like[citetheirfavoritecartooncharacter]_________,andhelpmebyholdingyourarmrightlikethat,can’tyou?Goodgirl!”

Note:Pleasekeepguilt,anger,blame,and“toldyouso’s”outofthedialogue.Ifangerorfearneedstobeexpressed,waitforamoreappropriatetime,whenthehealingcrisishaspassed. Ifpeopleareangrywith themselvesorothersfor theaccident,trytorefocusthemandreframethesituation.It’simportantforinjuredpeopletounderstandthattheyaresufferingenoughandthat,“forrightnow,it’seasierandsmartertojustfocusonthehealing.”There’salwaystimetogobacktotheotherfeelings,iftheystillchoosetodoso.

TherapeuticSuggestionforAdultsandChildren

DirectSuggestions: “Injustamoment(orwhenthewoundiscleaned)youcanstopyourbleedingandsaveyourblood.”“Lookatmeandbegintobreathewithme.That’sright.”

AsI/YouCan: “AsIputthiscool,clean,wettowel

AsI/YouCan: “AsIputthiscool,clean,wettowelontheburn,youmaynoticethatyourskinisbeginningtofeelbetterandthatyour-wholebodyisstartingtorelaxalittle...andalittlemore....”“AsIcall9-1-1,youcanfocusonyourbreath,makingeachonelongerandsmootherandeasier…

Truisms: “Everyoneknowsthatthebestmedicalpracticeistojustholdthebandagefirmly,justlikeyou’redoing;asyoudoyoucantakeadeepbreathwithmenowandfocuscompletelyonhowmuchmorecomfortableitis...”

YesSets: “I’msittingwithyou,righthere,andwe’rebreathingtogetherandwe’restartingtorelaxandyoucannoticehowmuchmorecomfortableitis…”

IKnowAGuy: “Remember[Freddy]?Andhowhe[hadthataccident]andnowhe’sstillrunningaroundannoyingeveryone…”“Iknowaguywhohadthissamethinghappenandhe’sdoinggreat…”

IllusionofChoice/DoubleBinds: “Idon’tknowwhichwaythiswillfeelbetter…thiswayorthisway?”“Areyoumorecomfortablewithmesittingheretalkingtoyouorjustsittingherequietly?”

LeavingTheScene: “Whilethatpartofyouoverthereisbeginningtoheal,youcantellmeabout…[somethingpositiveorneutral].”“Somepeopleexperienceafeelingoflookingatthingsfromoutsideof

oflookingatthingsfromoutsideofthemselves…”“Youcanholdyourarmuplikethatandforgetthatit’sthereasyouputyourattentionoverherewithme…”

ImpliedHealing/PresuppositionsorFuturePacing:

“Youmayhavealreadynoticedanimprovementinyour[injuredarea]…”“Youknowthatitchinglikethatalways-signifiesthebeginningofhealing…”“Youmaywonderwhichsideyou’remorecomfortableon…”“Whenyou’refeelingbetter,youcanletmeknowhowyoudidit…”“Howsurprisedthedoctorwillbewhenheseesthatithasalreadyhealedover…”“Won’tyoubepleasedtosay‘Itoldyouso’toeveryonewhenyouwalkonyourown…”

VerbalFirstAidforInjuriesInvolvingBleeding

Of all thewelcome benefits ofVerbal FirstAid, none is as dramatic orextraordinaryastheabilitytohelppeoplesloworstoptheirownbleeding,evenbleedingfromsmallarteriesandveins.Formanyofus,eventhosefamiliarwiththe power of suggestion and our capacity for self-healing, this particularphenomenonissopronounceditcanseemmagical.

The body has tremendous healing capacities and they are intricatelyconnected,consciouslyorunconsciously,tothemind.TheBritishBroadcastingCompany aired a program about themind/body connection several years ago,which featured dental surgery on 200 hemophiliac patients. Those who weregiven no hypnotic suggestion to “save their blood” required as many as 35transfusionsduring theprocedure.Thosewhowerehypnotizedanddirected tocontroltheirbleedingrequiredonlytwotothreetransfusions.

Therearevarioustheoriesabouthowandwhythepowerofsuggestioncanaffecteventhis, themostbasicbiologicalprocess.You’recut,youbleed.Howmuchsimplercoulditbe?Howcouldthemindplayarolehere?Fortunately,asthestudieswiththehemophiliacsshowed,itcan.DavidCheek,M.D.,apioneerinmedicalhypnosis,proposesthatthephenomenonthatallowsforthecontrolofbleedingmightberelatedtotherelaxationofthemusclessurroundingtheinjury,aprocessthatthenhelpstoproduceepinephrine,ahormonalsecretionfromtheadrenalglandthatincreasesthespeedofbloodcoagulation.Otherssuggestthatthere is an emotional component to the process: having someone in authoritynearbytotakechargeofthesituationallowstheinjuredpersontorelaxjustthatsmall amount necessary to slow down the heart rate, thereby altering bloodpressureandflow.

Inthevideo,HypnosisforMedicalEmergencies,Dr.Cheekrelatesastoryabout a traffic accident in which two women are injured. One woman wasthrownfromthevehicleandonewaspinnedunderit,bleedingandunconscious.Dr.Cheekapproachedtheunconsciouswomanunderthecarand, touchingherforeheadwithhishand,saidtoher,“I’mDr.Cheek.I’mheretohelpyou.Stopthatbleeding,don’twasteyourblood.Theambulance ison itsway.Just relaxand breathe evenly.” The bleeding stopped and Dr. Cheekmoved toward theother woman to see if she needed his assistance. As he examined her, heoverheardonlookersneartheunconsciouswomanmakingfrighteningcommentsabouthowdangerousitwasforhertobelyingunderthatcar.Heaskedthemtoleave and returned to the unconsciouswoman’s side.He discovered that, as a

resultoftheonlookers’conversations,shehadbeguntobleedagain.Heputhishandbackonherforeheadandsaidtoherinafirm,confidentandauthoritativetone:“Stopyourbleeding.Youdiditthefirsttime.”Andshedid.

To anyone who is not familiar with Verbal First Aid, this scene wouldseem surreal at the very least. However, you already know some of themind/bodymechanicsthatmakesuchmiraclespossible.

Dr. Cheek says, “It’s very hard for people to believe there can be thatmuchcontrolofhemorrhage.Thiswasasmallartery,butvenousbleedingalsocanbestopped….Iknowthatasthispracticeisextended,asmorecredibilityisgiventothosewhoaredealingwithemergencies,therewillbemanylivessavedthatotherwiseare lostbecauseof fear,becauseofhemorrhage,andbecauseofpanic.”

There is an important pointwe’d like tomake here, beforewe proceed.Althoughbloodmakessomepeopleuneasy,ithasauniquelyimportantpurposeina lacerationorabrasion.Bloodcanclean thewound from the insideout,orpushdebrisfromit.Therefore,beforeyougiveadirectivetostopthebleeding,you’llwant to allow theblood todo its job.This is a simple idea that’s quiteeasytoaccommodateinyoursuggestionstotheinjuredperson.We’llexploreitfurther, but a statement such as the followingworks very nicely: “As soon asyourwound is sufficiently cleansed, you can stop the bleeding and save yourblood.”

Captain Frank Neer, EMT, Marin County Fire Department, tells anamazingstoryaboutayoungmanwhohadfallenoffhisbicycleandsufferedadeeplacerationonthescalp,whichwasfilledwithdirtanddebrisfromtheroad.“Uponourarrival,eventhoughthebleedinghadstopped,wewereunabletotellthe sizeof theactualwound itself andhowbad it actuallywasbecauseof thedebris.Oncommand…hewasmadetostartthisbleedingprocessagaintherebycleaning out the wound and then a few moments later was told to stop thebleeding again. It was nothing short of spectacular to see something like thatactuallyoccur.”

The lateDr.PeterH.C.Mutkewas amedicaldoctor and surgeonwhoseexperience in the kinds of processes described here actually changed thedirectionofhisownlife.Severalyearsagohetoldusthisstory.HeandhiswifewereonvacationinaskiresortinEuropemilesfromanytown.Whenshebeganfeeling ill with nausea, vomiting, and acute back pain, he grew concerned.Althoughshehadn’tmentionedituntilthen,shehadbeenpassingbloodinherurinealldaylongandnowthebleedingwasgrowingsevere.Forallhismedicalknowledge he felt helpless, as the last train to town had already left andcontinuallyfallingsnowmadeanypassagetreacherous.Thenheremembereda

clinicaldemonstrationhehadseenbyDr.MiltonEricksoninwhichthepatientwas told to control his bleeding. He was able to recall the procedure, and “Iinduced ahypnotic trance inmywife, gaveher theproper suggestions for thecontractionofthebloodvesselsthatwerecausingthebleeding,andwithinafewminutesthenausea,pain,andbleedinghadstoppedandshewasasleep.”

Becauseofthisandothersuccesses,Mutkegaveuphiscareerinsurgery,studied psychotherapy and psychosomatic medicine, and personallydemonstratedforusthevalueofhisnewmind/bodypracticeonafriendwhomherelieved,inlargepart,ofthesymptomsofCrohn’sdisease.

WhattoDo:TheFirstAidProtocol

Asalways,thefirststepinanyfirstaidprocessistochecktoseewhetherthe injured person is conscious or responsive, and how serious the injury is.Remember the ABCs of CPR: Check the Airway, Breathing, and Cardiacfunction.Thiswillhelpyouassesswhatyournextstepsare.Wheninanydoubt,call9-1-1andfollow theirdirections.Alwaysgo to theemergencydepartmentforanywoundthathasglassinit,isontheface,hands,orbottomofthefoot,oroccursinapersonwithpoorcirculationordiabetes.

Whileaminorcutwilleventuallystopbleeding,itwouldbefoolishtorelyon suggestion alone to stop the flow of blood. If a laceration or bleedingabrasion is all you are dealing with, applying pressure to the wound andelevating the affected area is the best way to physically halt the bleeding.Contrarytowhatyoumayhavethought,tourniquetsarenotoftenrecommendedastheycancauseunnecessarytissuedamageaswellasnegativelyaffectbloodpressure,particularlyifappliedimproperly.

NOTE: If possible, especially when dealing with a someone whose medicalhistory you don’t know, wear a pair of latex gloves or put a layer of plasticbetweenyouandthebloodifyoudon’thaveaccesstothosegloves.

1. If it is aminorwound, clean it with soap andwater, then hold thewoundunderrunningwaterforfiveminutes toremovedirtandbacteria.Gentlypat itdry,applyasmallamountofBacitracinointment,andplacesterilegauzepadsoraclean,thick,cottonclothonthewound.

2.Ifitisagapingwoundthatisbleedingheavilyorspurtingbloodimmediately

place a sterile gauze or clean cotton t-shirt on top of it and apply firm, directpressurebyholdingyourwholehandevenlyoverthewoundandpressingdownhard,foratleastthreeminutes.Donotremoveanyforeignobjectsstickingoutofthewound,andifpossible,avoidjostlingtheobjectasyoudressthewound.Ifblood soaks through it, don’t remove the dressing. That could re-open thewound.Instead,addmorelayersofclothandapplyevenfirmerpressure.

3.Tiethebandageinplacewithoutcuttingoffcirculation—firmly,evenlyapplypressure—soyoucanfreeyourhands toattendtoother things.Onewaytodothat is towrap roll gauze over sterile gauze pads (or cotton cloth), letting theelasticityoftheace-typebandagemaintainthepressureforyou.

4. Elevate thewound, if possible. If it is not possible, please refer to amorecomprehensive medical guide for information regarding the use of pressurepointsforbleeding.

5. If you suspect internal bleeding, call 9-1-1 and follow their directionsexplicitly.

WhattoSay:VerbalFirstAidforInjuries&Bleeding

Some people aremore sensitive to bleeding than others, butwe assumethatifyouareinacriticalsituation,youcanputwhateverthoughtsyouusedtohave about bleeding into another part of yourmind,where it cannot interferewith theworkyouhave todo.Thequickestway todo that is to remember tocenter yourself at the outset and stay centered throughout.Take a deep breathbeforeyouapproach thepatient, and remember todo soat any timeyouwishwhileyouareattendingthatperson.

Sometimes bleeding, especially from a head wound, can be profuse.Seeing it can be a bit frightening both to the rescuer and the patient. Avoidcommentingon itsappearance to thevictim,andkeep inmind that itcan lookworsethanitis.Thebodyholdsaconsiderableamountofblood.Ifyou’veeverbeenadonoryouknowfromexperiencethatyoucansparequitea lotwithoutanyilleffects.Stayfocusedonwhatyouhavetodo.

Please don’t hesitate to take care of yourself.Don’tworry about hurtinganyone’s feelingsbyputtingonapairof latexgloves, forexample.Wheneveryou are dealing with another person’s blood, if at all possible avoid direct

contact with your skin, particularly if you have an open wound yourself. Ifglovesarenotavailable,useanyplasticbagtoformabarrier.Evenplainleatherglovesarebetterthannothing.

Finally,rememberthatyouarehelpingevenifyousaynothing.Ifallyoudo is continue to hold a clean cloth over the wound with some pressure andprovidesupportwithyoursteadypresence,you’vedoneagreatdeal.Ifyoudospeaktothevictim,pleaseremembertokeepyourvoicecalm,even,clear,andlow-pitched.Andremembertobreathe!

Thefollowingscenarioisanexampleofacommonhouseholdemergency.TheVerbalFirstAidpresentedisbutonepossibility.

You’reworking on a friend’s country house. It’s aweekend, off-season.He slips on a stepladder and his arm goes through awindowpane.He suffersmultiple lacerations and there’s a lot of blood, but he’s conscious and able towalk. You put a call in to 9-1-1 or the volunteer fire department. They saythey’llbethereinafewminutes.

WhatToDo WhatToSay1.Call9-1-1. “John,Icalled9-1-1.They’reon

theway.”2.GetJohnawayfromtheglassandtosafety.

“Let’sgetyoutoasafeplacewhereyou’llfeelbetter.”

3.Getlatexglovesorapieceofplasticandsomegauzeorcleancotton.

“John,I’mgettingsomebandagestocleanyouup….”

4.Applypressuredirectlyoverthewound(s).

“andassoonasyourwoundissufficientlycleaned,youcanstopyourbleedingandsaveyourblood.”

5.Ifpossible,wrapanacebandagearoundthegauzesoyourhandsarefreetoassistinotherways.HaveJohnholdsthebandagewhileyourollitaroundhisarm.

“John,canyouhelpmebyjustholdingthisdownherewhileIwrap?Good,justlikethat.”

6.Havehimraisehisarmup. “Here,John,that’sgood,soaswewaitfortheambulance,youcankeepyourarmrightheresoyoucancontinuetostopthebleedingandsaveyourblood.That’sgood.Verysoon,you’llhaveawholemedical

soon,you’llhaveawholemedicalteamheretohelp.”

VerbalFirstAidforBurns

Thisprotocolcanhelpreducetheinflammatoryresponseofthebodythataccompaniesfever,painandblistering,andcanassistpeoplewithseriousburnsrecover more rapidly, sometimes without surgery, significant pain ordisfigurement. Burns can be caused by overexposure to the sun, fire, a hotsubstance(suchascookingoilorcoffee),achemicaloranelectriccurrentandare classified according to their degree of severity. The risk of infectionincreasesproportionatelywith severity aswell as the extent or surface areaoftheburn.Alwaysseekmedicalattention if theburn is larger than thesizeofahand,ifitoccursontheface,genitalsorhands,orifitwascausedbyanelectriccurrentorachemical.Boththeelderlyandveryyoungchildrenshouldbetakenforimmediatetreatment.

First-degreeburnsappearasredareasontheskinandinvolveonlythetoplayer.Often theseburnsmaybe tended toathome,withwashclothssoaked inicewatertocutdowntheflowofbloodtotheaffectedareaandreducedamagedonetothetissuebytheburn.

Second-degree burns can be both red and blistered, and they involvedeeperlayersoftheskin.Evenifyoucantendtotheseathome(alsowithicy,coolclothsorrunningcoldwater),itishighlyadvisabletohaveaphysicianlookatthemtodeterminewhetheranyfurthermeasuresareindicated.Donotbreakblistersorremoveclothingthatisstucktotheskin.Ifpossible,elevateaffectedareasabovetheheart.

Thirdandfourthdegreeburnsarethemostsevereandappearraw,charred,oftenwhite,andinvolvethefullthicknessoftheskin.Underlyingbloodvesselsand nervesmay be destroyed.With these burns, have someone call 9-1-1 andcheck airway, breathing, and circulation or get to the nearest hospitalimmediately.Whilewaitingfortheambulanceorinthecar,youcanprotecttheburnedareawithclean,cooltowelsandcovertheindividualwithacleansheetto help reduce loss of body heat. If the nerve endings are entirely destroyed,surgery may indeed be necessary. Still, nothing is lost in giving good andpositive suggestions whereby the patient’s overall sense of well being andcomfort are enhanced.Verbal FirstAidmay be deliveredwhile you’re on thewayto thehospitalorwhileyou’rewaitingfor theambulance.Suggestions,aswe’llshowyou,shouldalwaysfocuson“coolandcomfortable.”

Chemicalburnscanquicklyburnthroughseverallayersofskinandtissue.Make sure you are wearing gloves to protect yourself against contamination.

Flushcoolrunningwaterovertheaffectedareafor15to20minutes.Ifyoucanfind the chemical’s original container,make sure you show it to the attendingphysicianorEMT/Medictoarriveonthescene.

Sunburn canbeaddressedwith the same techniquesweusewithgeneralburns.Ifapersonhasheatexposureorsunstroke,firstelevatetheirfeetslightlysothatthebloodcanreturntothehead.Symptomsofshockincludelossofskincolor, cool moist skin, thirst, weak but rapid pulse. Call 9-1-1, apply coolcompresses,andproceedwithverbalfirstaidasfollowsforgeneralburns.

Thefollowingexamplescanbeeasilyalteredorexpandedtosuityourownneeds and/or style as you becomemore proficient and adeptwith this healingcommunication. The first aid protocols themselves have been adapted frompublished First Aidmaterials and do not substitute in anyway for a doctor’sinterventionwhenindicated.

WhattoDo:TheFirstAidProtocol

1. Asalways,firstthingsfirst.Stoptheburning.Putouttheflamesorremovethesourceofthefire/burn.Iftheburnswerecausedbyelectricity,safelymakesurethepowerisoff.Forelectricalburns,checkbreathingandpulse,ifunconscious.Coverburnwithaclean,drydressing.

2. Cooltheburn.Uselargeamountsofcoolwater.Donotusebutteroranyotherointment,unlessdirectedtodosobyamedicalprofessional.

3. Covertheburnwithdry,clean(preferablysterile)dressings.4. Iftheburnswerecausedbychemicals,flushtheskinoreyeswithlarge

amountsofcoolrunningwater.5. Call9-1-1forimmediatemedicalattentioniftheburn:

▪ involvesbreathingdifficulty,▪ coversmorethanonebodypart,▪ involvestheneck,head,hands,feetorgenitals,▪ istoachildorelderlyperson(otherthanavery▪ minorburn),▪ iscausedbychemicals,explosionsorelectricity.

WhattoSay:VerbalFirstAidforBurns

JerroldKaplan,M.D.,DirectoroftheBurnCenteratAltaBatesHospitalinBerkeley,California,statesinthevideo,HypnosisforMedicalEmergencies,that

usingwordstohelpfacilitatehealingis“Simple,effectiveandmaybeusedbyanyoneatanytime.Itgivespainrelieffrominjury,decreasesthepossibilityofprogressionof injury andmakes thepatientmore comfortable.The techniquesarewelldocumentedandtheyeffectivelydecreaseburninjury.”

Dr.Kaplanrelatesastoryabouthissonreturningfrombadsunexposureduringaski trip.“Wetalkedaboutcoolandcomfortableonhisface.Thenextmorningwhenhewokeup,hisfaceshowednoeffectfromthesunburn,soyoumightthinkhewasn’tgoingtohaveaburn,anyway.Exceptthathisears,whichwere not mentioned in our cooling conversations, and which he did notinternalizeaspartofhisface,werebrightred;theface,whichwetalkedabout,hadnosignificantburninjury;theearswereburnedbrightred.”

All images and suggestions should move the patient toward cool andcomfortabletoconstricttheflowofbloodtotheaffectedsite.Suchsuggestions,when given within one hour post-burn, can have tremendous impact onautoimmuneresponseandonthenervoussystembeforeitbeginsreactingtotheburnwithinflammationonitsown.Muchofthedamageinburningiscausedbythebody’sownresponsetotheburn.OurintentioninVerbalFirstAidistoavertthisinflammatoryresponse.

Remembertogetcenteredandstaycentered.Takeabreathwheneveryouneed to. Keep your voice low-pitched, even, and clear. Know that you arehelping,evenifyousaynothingandkeepthecoolwaterrunning.Ifallyoudoiskeep applying cold compresses or hold the affected area under cool runningwater,noticingthecoolness(“thecoolwater ishelpingitnow...thewater issocoolandclean...”),you’vehelpedagreatdeal.

The following scenario is an example of a common home injury. TheVerbalFirstAidpresentedisbutonepossibility.

TheScenario

Phil&Maryareinthekitchen.Philisstandingbythestove.HeturnstosaysomethingtoMaryandhebumpsintoapotofhotoil.Partofitlandsonhisforearmandpartonthefloor.Thegasstoveisstillon.Philscreams,“Ithurts.God,ithurts!”Maryjumpsup.

WhattoDo WhattoSay1.Turnoffthestove.Removecauseofinjury.LeadPhilawayfromthescene.Takeadeepbreathandget

“Iknowhowyoumustbefeelingnow.Leaveallofthat—I’lltakecareofit.Theworstisover,Phil,andI

scene.Takeadeepbreathandgetcentered.

ofit.Theworstisover,Phil,andIknowwhattodo.I’mgoingtohelpyou.Comewithme,okay?Good.”

(Now,asyouwalkwithPhilfromthekitchencontinuetohelphimbymakingsimple,soothingsounds,ifyou’recomfortablewiththat.Ifhe’scomplainingaboutthepain,supportivefeedbackistherightthingtodo):“Icanimaginehowmuch

itdoesfeelrightnow.”Keepyourvoicecalm,clear,low-pitchedandfirm.

Takeadeepbreathandrefocusasoftenasyouneedto.

2.Movetoasafeplacewithcool,runningwater.Collecttowelsorsterilebandages.

2.“I’mgoingtocheckyourarmnowandputitundercoolwatertocleanyourarmandstartthehealing.AsIholdyourarm,Phil,youcanbegintofocusonthatcoolnessandhowit’salreadystartingtosootheyourarm.It’sstartingtofeelmorecomfortable,thecoldwatercandothatvery,veryquickly.Evenbeforeyourealizeit,theswellingisgoingdownanditstartstofeelcooler,andyoucanfeelthatcoolnessworkingitswaydownintoeverycell,everylayeroftissue.Ifyouwanttoyoucancloseyoureyesandbeevenmorecomfortableasthecoolwatercoolsoffyourarmallthewaydeepdown.”

3.Call9-1-1. 3.“Phil,nowthatyou’resafe,I’mgoingtocall9-1-1justforasecondopinion,andasIdo,youcangoonsittingtherewithyourarmrestingcomfortablyunderthatcool,cleanwaterwithyoureyesclosed.Just

waterwithyoureyesclosed.Justfocuscompletelyonthecoolwater

andhowit’scleaningandcoolingallthewaydowntothedeep-downcells.Andyoucandothat,can’tyou?Good.I’llberightback.”

4.Applybandagesorwet,coldclothsasindicated.

4.“Icalled9-1-1andthey’reontheway.Whilewe’rewaitingwecanhelpyourarmhealevenalittlemorebyputtingsomecoldcompressesonyourarmsothecoldgoesevendeeper.Youcantakethatfeelingwithyou,youknow,Phil,whereveryougoandwhoeveryou’rewith,whateverisbeingsaidtoyouoraroundyou,youcantakethatcoolfeelingwithyouinyourarmuntilyoudon’tneeditanymore…”

5.9-1-1comes. 5.“Phil,wheneveranyonecomestolookatyourarmorexamineyouorasksyouaboutit,yourconsciousmindcananswerthemasusual,that’sfine,butyourarmcanjustgorightaheadbeingcoolandhealing,doingwhatwestartedhere.”

The important thing is to keep the mind focused on the cool andcomfortablecondition.Therealwaterisonlypartofit.Eveninsituationswhencool,runningwaterisnotavailable,thesuggestionofcoolandcomfortablecanbeveryhelpful.Continuetoreinforcethatsuggestion.Allowthevictimto“go”toamountainstreamandimmersetheburnedareainitindefinitely.

VerbalFirstAidforBreathingEmergenciesandAsthma

Withthepossibleexceptionofmassivecardiacarrest,fewemergenciesareascriticalorasfrighteningasbreathingemergencies.Onceapersonhasstoppedbreathing,wehavenomore thana fewminutesbeforebraindamageordeath.Unfortunately,respiratorydifficultiesarebecomingincreasinglycommoninthis

country,with some doctors describing an “epidemic” of asthma, especially incertainurbanpopulations.Thismeans thatyouaremore likely thanever tobeconfrontedwithabreathingemergency.

There are numerous types of respiratory ailments: asthma, pulmonaryedema, croup, epiglottitis, hyperventilation, suffocation or choking. We willfocusprimarilyonasthma,sincethatisthemostcommonproblematthispoint,butwebelievethattheseVerbalFirstAidtechniquesareusefulinanysituationinwhichpeoplearehavingdifficultybreathing(otherthanacuteforeignobjectobstructionblockingtheairways).PleaserememberthatVerbalFirstAidisnotareplacement for proper medical treatment and in the event of a respiratoryproblem,youmustalwayscall9-1-1oryourphysicianimmediately.

Asthma isacondition inwhich thebronchioles (thesmallairways in thelungs)becomenarrowed,makingitdifficulttobreathe.Duringasevereasthmaattack,thereisoftentightnessinthechest,sweating,andarapidheartbeat.Thepersonmaybeunabletospeak.Insituationsinwhichpeoplearenotreceivingenoughoxygen,theymaybecomecyanotic,aconditioninwhichtheirlipsturnblue.

Mostasthmaattacksareheadedoffbybronchodilators,drugscommonlydeliveredinthelittlepumpsthatpeopleinhale.Ifpeoplesufferinganattackdonot respond to the prescribed inhaler, doctorsmay place them on oxygen andgive corticosteroids. If they go into respiratory arrest, doctorsmay assist theirbreathing by inserting a tube down into the trachea and connecting it to aventilator.

Asthma,more thanother respiratoryproblems,hasadistinctlyemotionalcomponent and has been shown to respond to various psychologicalinterventions. A study in the Journal of the American Medical Associationtracked twosetsofasthmasufferers.Onegroupwroteabout themoststressfulevent they had “ever undergone” for 20 minutes on 3 consecutive days.Researchers found significant improvements in lung function up to 4 monthslater,comparedwithpatientswhospentthesameamountoftimewritingaboutneutral topics. In less clinical terms, dealing with their pain, theirdisappointment,andtheirhurtbywritingaboutithelpedthosepatientsbreathe.Writing about this study,NewYork TimeswriterEricaGoode concluded that,“these findings add to increasing evidence that attention to patients’psychologicalneedscanplayanimportantroleinthetreatmentofmanyphysicalillnesses,aviewsharedbymanydoctorsandnurses….”

Please remember: We don’t suggest that you make any attempts todiagnoseormedically treatabreathingemergencywithoutproper training.It’salwaysbest to call9-1-1 immediatelyand follow their instructions.Ofcourse,

learningCPR is thewisest course of action andwe absolutely recommend it.Verbal FirstAid is supplemental to any recommendedmedical procedure andshouldneverbeusedasasubstitute.TheVerbalFirstAidtechniquessuggestedhere are designed to be general enough to be used in most breathingemergencies.

WhattoDo:TheFirstAidProtocol

The initial stepsare the same:call9-1-1andcheckyourABCs:Airway,BreathingandCardiacFunction.

It is always a good idea to stay on the phonewith the 9-1-1 operator incasetherearechangesinthevictim’sconditionthatrequirespecificactionsonyourpartasyouwaitfortheambulancetoarrive.ThatmayincludegivingCPRorrescuebreathing.

WhattoSay:VerbalFirstAidforAsthmaandRespiratoryCrises

Asthmaattacksandacuterespiratorydifficultiesingeneralarefrightening,andpeoplecaneasilyaggravatetheirownconditionwiththeirfear.Asidefromthe complicated emotional components in chronic asthma, in acute attacks aperson’s entire attention is focused on getting the next breath. Your greateststrengthinabreathingemergencyisyourcalm,clearthinkingandyourabilitytogettheperson’sattention.PacingandleadingarethemostusefultoolstohaveinyourVerbalFirstAidkit,especiallywhentheyareinterspersedwithhealingandlife-savingsuggestions.

Scenario

You’vebeenwalkingwithyourbestfriend.Youjustwentupareallybighill and she starts towheeze a bit. She checks her pockets and finds that sheforgottobringherinhaler.Shebecomesfrightened.Youarequitesomedistancefromhomeandyoudon’thavea cell phonewithyou.Herbreathingbecomesmoreshallowandstrained.

WhattoDo WhattoSay1.Putyourhandgentlyonyourfriend’sshoulder,helpinghertoface

“Nancy,I’mrighthere…Icansee…it’sabithardtobreathe…right

friend’sshoulder,helpinghertofaceyousquarely.BreathealongwithNancy,pacingherasyouspeaktoher.(Makesureyougetenoughairyourself!)

it’sabithardtobreathe…rightnow…andthatitcanbescary…IcanhelpyouifyoudoasIsay.Justnodyourhead.I’llberighthere…andyoumaybegintonotice…

2.Keepbreathingwithher "thatyourbreathingis…(starttoslowyourbreathingdown)rightnow…justabitslower…

anddeepenyourbreath. “andeasier…youcanbreatheslowerandeasier…

3.Havehermakeafistandgrabyourthumb…

“I’mgoingtotakeyourhand,now,andaskyoutosqueezemythumb…that’sright…makeafistnow…realtight…Squeezerealhard…

4.Havehersqueezeandslowlyreleaseasyoupaceherbreathandslowitdown.

“Andasyourbreathingbeginsrelaxyoucangraduallybegintoeaseyourgriponmythumbnowasyourbreathslowsandyourbronchialtubesrelax…that’sright…

5.Continuepacing…asyouleadNancytoslowdownherbreathandrelieveanyinflammation.

“…asyoufinditeasierandeasiertobreathe…lettingthemusclesinyourchestrelax…lettingairflow…coolandcalm…inandout…softandeasy…softandeasy…that’sright…lettingthemusclesandbronchirelax…

6.Continuepacingandleadingwithyourbreath.

“…soyoucanallowtheairout…soyoucanallowtheairinandyoucanturnoffthewheezinganytimeyouneedto…lettingthenaturalchemicalsinyourbrainandinyouradrenalglands…dowhattheyknowhowtodo…youcanseethatclearlyinyourmind…andbegintofeelthatinyourchest…assurelyasusingyourinhaler…that’sright…andyoucanbegintorecallwithyourmindandyourbodywhatit

feelsliketobreatheeasily…andcomfortably…justlikeyouweredoingbefore…rightoverthere…staywithmyvoice,Nancy.

7.IfNancycanwalk,helphergettoaphysicalplacewhereshewasabletobreathecomfortablybefore

“Let’sgooverthere,Nancy,whereyoubreathedcomfortablyjustawhileago…andyourbodyhasahabitofbreathingcomfortably,doesitnot?Anditremembersthathabit…asyoubecomemorerelaxed…

ThiscancontinueuntilNancyhasrelaxedandherbreathinghasreturnedtonormal,ortoatleastastateinwhichyoucangetherhomeortoahospital.Pacing and leading with your breath should be interspersed with suggestions.Directsuggestionsmay includesimplecommands to“breathe inandgeta fullbreath out” or “soften your bronchial tubes,” or “imagine your inhaler fillingyourlungsnow,”orsimilarimagerythatspecificallyaddressesthedynamicsofasthma.

Obviously,youdon’thavetomemorize thisscene.It’s the ideahere thatcounts—breathewiththepersonwheretheyare,thenslowdownyourbreathandleadthemwheretheyneedtogo,whichistobebreathingnormally.

VerbalFirstAidforHeartAttacks

According to the National Institutes of Health, coronary heart disease(CHD)continuestobetheleadingcauseofdeathintheUnitedStates,despitearemarkabledeclineinCHDmortalityoverthelast30years.Statisticsvary,butbysomeaccountsasmanyas700,000peopledieofacutemyocardialinfarction(AMI)eachyear.Heartattacksoccurinalmosteverypopulationnomatterhowyoubreakitdown:race,age,andsocio-economicstatus.Itisincreasinglylikelythat at one time or another you will witness another person suffering a heartattack.

It is a life-threatening emergency. In a classic and most common heartattack,asuddenarterialblockagepreventsbloodfromreachingtheheart.Asaresult, the heart muscle begins to die. Angina is a milder form of the sameprocess,butinsteadofafullblockage,thearteriesinananginaattackareonly

partiallyobstructed;thepain,whichisprominent,thoughlessseverethanafullheartattack,usuallydissipatesafterawhile.Inafullattack,theindividualmayexperience a crushing pressure in the chest that lasts for several minutes,radiatingthroughthechest,face,jaw,shoulders,stomachanddownthroughoneor both arms. Because the person may sweat, have difficulty breathing, feelnauseated, vomit, or belch repeatedly, a heart attack is often mistaken forindigestionanddismissed.

Shock,poisoningsandhemorrhagemayplaceagreatstrainontheheartaswell, causingcirculation to fail.When theheart stops receivingblood, it stopsreceiving oxygen. The result is what is called a cardiac standstill—the heartstopsbeating.Theheartcanalsosimplystopbeatingintheelderlyorthosewithseverecongenitalheartdiseaseduetomusclefailureandaninabilitytocarryonnormalprocesses.

Therearenumerousearlywarningsigns. Ifyouseeanyof the followingsignsandyouhaveanysuspicionthataheartattackmaybeinprogress,call9-1-1 immediately. Do not hesitate. The earlier you can get emergency medicalassistancetotheindividual,thegreaterthechancesforsurvival.

Inaheartattack, timeisof theessence.Heart tissueisatriskwitheverymomentwasted in hesitation.However, as you assess the situation, rememberthatpeopletendtobeindenialaboutwhat’shappeningtothem.

SignsofHeartAttack

○Intensepressure,tightnessorsqueezinginthecenterofthechestthatpersistsfor5minutesormore.

○Painthatspreadsacrossthechesttotheshoulders,arms,neckorjaw.

○ Pain in the chest that is accompanied by sweating, nausea,shortnessofbreath,andfaintness.

○ Unconsciousness with no respiration or heart sounds and skincolorthatturnspale,grayorgray-blue.

Afteryouhavecalled9-1-1whatthencanyousay?

○CenterYourself○EstablishRapport○Authority/Alliance/Empathy:e.g.,I’mheretohelp

○GetContract:WillyoudoasIsay?○GiveTherapeuticSuggestions

Scenario

Youandyouroldcollegebuddy,Tom,areinarestaurantenjoyingaplatefull of fries, a couple of burgers and a beer. Suddenly, he feels nauseated,belchesrepeatedly,andturnspale.“Idon’tfeelsogreat,”hesays,clutchingathischest.Heisbreathing,butinpain.Havesomeonecall9-1-1immediately.

WhattoDo WhattoSay1.Ifthepatientisconscious,separatehimfromextraneousnoiseanddistractionifatallpossibleandhelphimintoacomfortablepositionwithfeethorizontal

Wraphiminblanketsoranythingavailabletokeephimwarm.

1.“Tom,I’mrightherewithyou.I’vecalled9-1-1andhelpisontheway.I’mputtingtheseblanketsaroundyoutokeepyouwarmandhelpyourhearttofunctionproperly…”

2.Keephimshieldedfromunnecessarynoise/distractions.Currentmedicalwisdomistoofferanaspirinifoneisavailabletohelpthinthebloodandpromoteaneasierflowofoxygentovitalorgans.

2.“Tom,Ihadafriendwhohadchestpainalittlewhileback,rightintheoffice.WetookhimtotheERrightaway,gavehimanaspirin,likeI’mdoingwithyou,now,andhewasfine.He’sbackatwork,now.”

“Tom,witheverybreath,focusontheoxygenmovingthroughyourlungsandintoyourbloodstream,movingsmoothlythroughyourarteriesandintoheart,openingwhatneedstobeopened,relaxingthemuscles.”Keepyourfriendfocusedonwhatneedstooccurinhisbodytohelpdirecthisrecovery.“Tofocusevenmore,youcansqueezemyhand,ifyou’dlike,with

everybreath…keepingyourfocusontheoxygenandthewaythebodycanhealitself.”

3.Keepyourfriendfocusedonthefuture:

3.“ImagineusnextJune,youandme,ourfishingpolesdanglingfromthedockatthecreekandthefishjumpinglikepopcornandyoutellingtheguyswhatyouwentthroughtogetthere...”

4.Ifthepatientisunconscious,beginCPRaccordingtostandardFirstAidProtocol.

4.“Tom,I’mgoingtohelpyou.AndyouwilldoasIsay.AsIbreatheforyou…allyourbody’sresources…everythinginsideyou—yourlungs,heart,brain—canworktohelpyoubewell…andtohelpyourheartpumpyourbloodfreelyandcomfortably…

5.Ifyoucanspeakatthesametimethatyouperformcompressions,youcansay:

5.“AsIdothis,Tom,youcanhelpbydirectingthebloodinyourbodytotheplacesthatneedtheoxygenmost:yourbrainandyourheart.

WitheverycompressionandeverybreathIbreatheintoyou,sendthatoxygenintoyourbrain.

“Youcandothatjustbyhearingmyvoice.AndIknowyoucanhearmyvoiceevenwhenyouarenotconscious…

“WhenIbreatheintoyourmouth,I’mbreathingout16percentoxygen.It’smorethanenoughtofeedyourbrainandheartandkeepyoualive.

“You’redoingagreatjob,Tom.Justkeepstayingwithmyvoice,okay?

“PeoplearesavedwithCPRallthetime,Tom.Thisworks.It’skeepingyourbrainandheartalive.EverytimeIpressdownonyourchest,I’m

timeIpressdownonyourchest,I’mhelpingyourheartkeepworking—everycompressionkeepsyourbloodflowingtowhereitneedstogo.

“Youcantakealotofcomfortinknowingthatthiskindofthinghappenstoalotofpeople.Theparamedicsanddoctorsreallyknowhowtohandleitandwillhelpyoubewellandcomfortableagainsoon.

“Untiltheygethere,youcanstaywithmyvoice,keepsqueezingmyhandwitheverybreath.I’mrighthere.”

6.ContinueCPR until the ambulance arrives. If you are toowinded from theCPR or too nervous, continue the compressions and artificial respiration insilence. Try to keep others away from the scene. Silence can be enormouslyhelpful.Anddon’tforget,asyouwork,youcanpray.

Reminders

Avoid phrases like, “Don’t die!”, “How could you do this to me?” orsimilarly negative or accusatory remarks. Keep all your statements positive,focusingasmuchaspossibleonthespecificthingsyouwanttheperson’sbodyandmindtodo.

If youdonotknowCPRand thevictim is conscious, after calling9-1-1youcanusesomeoftheseVerbalFirstAidtechniques.

Futurepacing/ImpliedHealing

Itisalwaysagoodideatogivepeoplewhomaybefearfulofthefutureapicture of their ability to recover. “The ambulance is on theway, and all youhavetodonowisrememberthatyourbodyhasawisdomofitsown,thatithasways toprotect you.And just as youbodyhashealedbefore, froman illness,likewhenyouhada cold andyourbody recoveredquickly,youcan rest easynow,knowingthatyou’llbeingoodhandsinthehospitalandthatyourbodycan

doitspartinyourrecovery.”

GuidedImagery

You can also use a script like the one above that directs the body tomaintain theblood flow to theheart:“Witheverybreath, focuson theoxygenmoving through your lungs and into your blood stream, moving smoothlythroughyourarteriesandintoheart,openingwhatneedstobeopened,relaxingthemuscles.”

Obviously,emotionssuchasfearandpanicthatsendthebloodsoaringandthepulseracingarenotgoodforheartpatients,sohelpingthemtorelaxcantakethepressureoff theirsystemuntilhelparrives.Asalways,guidedimagerycanbeavaluabletechniquetouseinthissituation.Ifyouknowtheperson,youcanhelp guide him or her to a favorite place. “Wouldn’t it be nice to be back inHawaii,rightnow,Sue?Rememberthatlittlebeachbythecovewherewewentsnorkeling….”

Ifyoudon’tknowthepersonwellenoughtosuggestaspecificplace,youcouldsimplysay,“Theambulanceisontheway,sonowyoucanjusttakeaniceeasy breath and just let yourself remember a place that you love to be, someplacethatmakesyoufeelsopeacefulandcomfortable.Maybebyabeach,orinthemountains…”

AsI/YouCan

Usethecontingencydirectivethatsuggeststhatasyouperformanaction,thevictimhas thedesired reaction.“As I liftyourheaduponto thesepillows,youcanbegintonoticehowmuchmoreeasilyyouarebreathing.”“AsIcall9-1-1,youcanbegintorelaxalittleknowingthathelpisonthewayandthatI’mrightherewithyou.”

Iknowaguywho…

Ifthepersonisinfearoftheoutcome,andyouknowastorywithahappyending, this would be a good time to recount it. “Just last week I met myneighbor,JoeBingham,doyouknowhim?He’shadtwooftheseheartattacks,and he was out there riding his bike, passing the younger kids and waving!

They’vegotgreattechniques,thesedays,atthehospitalforgettingpeoplerightbackontheirfeet,youknow?”

ComingFromTheHeart

Sometimes in the dramaof themoment, somethingunexpected happens.One woman we know actually knelt beside her husband as he was having aseriousheartattack.Sheputhishandinhersandsaidintohisear,overandover:“Stay in your body. Stay in your body.” He recovered and later they bothattributedhissurvivaltohishearingthosewordsanddecidingnottoleave.

FirstAidProtocolforHeartAttacksCall9-1-1if:

*Patienthaschestpainlastingmorethanfiveortenminutes,shortnessofbreath,sweating,ornauseaandprescribedmedicinedoesn’trelieve.*Followdirectionsgivenby9-1-1.*Makethepatientcomfortable.*Checkfornauseaandvomiting,light-headedness,sweating,shortnessofbreath.*Checkforpaininthechest,abdomen,lowerjaw,neck,oreithershoulder.*Ifpatienthasmedications,assistwiththem.

VerbalFirstAidForPoisoning,BrokenBones,andChildbirth

Thereareasmanymedicalsituationsasthereareindividualsintheworld,makingitdifficulttoaddressthatwidevarietyhereinthisonebook.However,becauseweunderstandthatbeinginamedicalemergencycanbesofrighteningand overwhelming, we wanted to give you as many specific examples aspossible tohelptherightwordscomemoreeasily toyouwhenyouneedthemmost.

Pleaseremember:Inallthefollowingcases,call9-1-1first,thenproceedaccording to theacceptedFirstAidProtocolor the9-1-1Operator’sguidance.It’salwaysbettertodonothingifyouarenottrulysureofwhattodo.

Then,remembertheVerbalFirstAidbasics:

CenterYourself

EstablishRapportAuthority/Alliance/Empathy:e.g.,I’mheretohelpGetContract:WillyoudoasIsay?Willyouletmehelpyou?

GiveTherapeuticSuggestions

Poisoning

Everyyear, tensof thousandsofpeoplediefromaccidentalpoisoning.Ifyouincludedrugoverdosesinthecalculation, thenumbersarestaggering.Theingestion of a toxin, whether a harmful chemical, an overdose of somethingotherwise helpful, or even a snake bite, is frighteningly common. With theproliferationofover-the-counterpharmaceuticalsandunder-the-sinkcleansers,itiseasier thanever tosufferanaccidentalpoisoning.Aspirin, lye,bleach,weedkillers,detergents: theycanall cause respiratoryarrest, coma,convulsionsandevenquickdeath.

Ifyoucomeuponsomeonewhoappearstohaveeitheringested,injected,orcomeincontact(inhalation,absorption)withatoxin,identifyandisolatethesuspected toxic agent and call 9-1-1 immediately or your local poison controlcenter.Donotinducevomitingunlessspecificallyinstructedtodoso.Ifallyoucando iswait for theambulance to arrive, there are still some thingsyoucansay.

“Lucy, it’sme.I’vecalled9-1-1andthey’recomingtohelpyou.Iknowwhat’shappened.Ialsoknowthatmywordscanreachdeepdownintothemostessentialpartsofyoutohelpyousurviveandgetwell,solistencarefully.Youhave vital organs that are especially designed to protect and defend the bodyagainstanytoxins.Theyworklikestrainers tofilterout thebadchemicalsandkeepthegoodones.That’sright.Youknowwhatastrainerdoes.Staywithmyvoice,now.Allthepartsofyou,everycellisnowlisteningandtakingdirectionfrommyvoice—tocleanyoursystemandprotectyou.Yourbodyknowsexactlywhattodoanditcandothatnow.”

Essentially,anythingyousayinacaseofpoisoning,whetheraccidentalornot,shoulddirectbodyresourcesinaprocessofcleansingandpurification.Youcanalsoremindtheindividualtoprotectvitalorgans,makingsurethatbloodandoxygencontinuetobesuppliedtothemostessentialorganstokeepthemalive.

Brokenbones

When someone’s elbow or head makes an unexpected and unintendedimpactwith our soft tissue, bones seem amazingly hard.However, they breakfrequentlyinpeopleofallages,althoughwithincreasingfrequencyandseverity

intheelderly.Brokenbonescaninvolvenumerousmedicalproblems:laceratedskinand

opentissue,hemorrhagingininternalorgans,rupturedlungs,braininjury.Thesefractures can be simple, compound, or hairline. Symptoms may include pain,swelling,bleeding.Ifyouarewithsomeonewhoseemstohaveabrokenbone,do not move that person unless absolutely necessary (meaning life-or-deathurgency).Call 9-1-1, immobilize the affected area if you can, and speak in aclear,calm,andreassuringvoice.

“I’mJaneandI’vecalled9-1-1.I’llstaywithyouandhelpyougetmorecomfortableuntiltheygethere.Isthatokay?Good.”

GiveTherapeuticSuggestions

DistractionIfpeople sufferingabrokenbonecanspeakwithoutgreateffortorpain,

youcanbegintousedistractiontechniquestogettheirattentionawayfromtheafflictedarea.

“Iseeyourarmhasbeeninjured,andI’vegotthatimmobilizednowsoitcanstarthealingrightaway.Whileyourarmstartstoheal,I’dliketoseehowtherestofyouisdoing.How’sthat?”(Pointtoortouchaclearlymorecomfortable,uninjuredarea.)

You can continue using distraction until the ambulance arrives,interspersingsuggestionsforcontinuedhealing.

“Whilewegothroughyourwholebodythisway,yourarmhasbegunthehealingprocessallonitsown…and itcancontinuetodoso…nomatterwhereyouareorwhoisspeakingwithyou…

Stories

Iftheambulancetakesawhiletoarrive,youcantellstories:

“We have themost amazing healing capacities…my 80-year-oldmotherbrokeherhip,recoveredfully,andjustlastweekshewasdoingthemamboat her granddaughter’s birthday party.Nearly gave everyone else a heartattack,butshehadagreattime.”

Ifyoufeelthatthepersonwouldnotrespondpositivelytohumororstorytelling,youcanbedirectiveandconcrete:

“There is a technique I know that can help youwith any pain youmayhave.It’scalleddialing-down.It’sreallysimple.Inyourmind’seye,youcan imagine a huge control roomwith beepers and buzzers and dials tomonitoreverythingthat’sgoingoninyourbodyandmindallthetime.It’sa busy room, but you can go there now and find the dial that is just forpain…go ahead and signal me with your [right] finger to let me knowyou’vegotit…good.Now,noticethelevelofyourpain.Dialitdownonenotch, not too much, not too quickly…just one notch. Good. Now onemore.”

Bepatient,consistent,firmandwillingtorepeattheprocessifnecessary.WediscussthisparticulartechniqueingreaterdetailinChapter8,onpain.

Childbirth

Childbirth is not an illness and, in many cases, it is not a medicalemergency.Whilewehaveromanticizedthechildbirthprocessinthemedia,itisin truth a magnificently messy process. It may also involve pain for many(thoughnotall)women.Notalldeliveriesareeasyandafewhavedramaticanddangerouscomplications, requiringextraordinary life-savingmeasures forbothmotherandchild.

Ifyouareconfrontedwitha situation inwhichawomangoes into laborandyouareunabletogethermedicalassistance,therearespecificwaysyoucanhelp.

Firstandalways:Call 9-1-1.There isusually ample time toprepare forthe birth and the odds are that the ambulancewill get to your side before thebabyisactuallyreadytoemergefromthebirthcanal.

If it looks as if you’ll have to assistwith the birth, here are a fewbasicstepstokeepinmind:

Findaprivate,quiet,warmplaceifpossible.Askthemothertoemptyherbladder.Cleanlinessisessential.Noonewithacoldorinfectiousdiseaseshouldassistinthe

delivery.Ifyoucan,scrubyourhandsoruseananti-bacterialsolution.Haveavailablecleantowelsandsheetsaswellasboilingwater,scissorsandclothtape.

FollowacceptedFirstAidprotocolsortheadviceofthe9-1-1Operator.InVerbal FirstAid, it is always helpful to know asmuch as you can about theprocess you are addressing because it allows you to make strong, confident,factualstatementsthatcanhelpalleviatethemother’sanxietyandmakesenseofeverythingsheisgoingthrough.

Forinstance:

“Emily,I’mrightwithyouandI’mgoingtostayrighthereandhelpyouthrough this. Hold my hand, that’s right, squeeze it. That was anothercontraction.Good,youdid thatbeautifully…andeachcontractionpushesthebabydownwardanddilatesthebirthcanaljustalittlebitmoreuntilitis wide enough and relaxed enough to allow the baby’s head to passthrough.”

“Asyouruterinemusclescontracttogivetheneededpush,yourcervixcanbegintobecomesoftandflexible,openinglikeabasketballhoopthroughwhichyourpreciousbabycanslipout,justasnatureintended.”

However,ifyoudonothavesuchspecificinformationtoconvey,youcanstillusewordsbeneficiallyinamoregeneralway.

“Thebodyknowswhatithastodoandjusthowtodoit.Beforewebuilthospitalswomenusedtohavetheirbabiesinthefieldsastheyworkedand,evenafterhavingthem,wereabletocontinueworkingwiththeirnewborninfantssucklingthem.”

Andyoucanfuturepace;

“Just imagine holding your sweet baby in your arms, looking into your

baby’seyes,verysoon,maybeinjustafewmorecontractions…”

You can also use distraction to help lessen themother’s discomfort andplanttherapeuticsuggestionevenifyoudon’tknowher:

“Thatwasaterrificcontraction…Okay,youcanletyourbodysoftennow.Tellmehowthispillowfeelsunderyourheadlikethat…Whataboutyourpulse?Ifyoucountoutloudforme,Icantakeyourpulse.Wouldyoudothat and as you say, ‘one-one-thousand, two-one-thousand,’ you can letyourvaginalcanalrelaxandsoften…”

VerbalFirstAidforMedicalEmergencies

Remember thataperson incrisis isalready inanalteredstate.Carelesswordscanharmbutwell-consideredwords canhelp themheal.VerbalFirstAid canconnectwiththeautonomicnervoussystemandhelpbeginthehealingprocess.

TODO

FirstThingsFirstCall911orGotothenearesthospitalKeepthepatientstillIfpossible,consultyourfirstaidbookfordetailsontreatmentforshock,bleeding,burns,etc.UseVerbalFirstAidtopromotemorerapidhealingsasfollowsBREATHE!

EstablishanAlliance,AuthorityLet thepatientknowyouarehere tohelp and that theycan trustyou.

GetaContractGetthemtoagreetohelpthemselvesandbehelped.

BeRealistic,Confident,andCompassionateDon’t over-promise. Keep it truthful and simple. Stay grounded incompassionandrememberyoucanbeconfidentthatthisworks.

Feelfreetophotocopythischartandkeepithandy.

TOSAY

“I’m[name]andI’mgoingtohelpyou.”Or,“Mommy’shereandwe’regoingtomakeitbetter.”

“WillyoudoasIsay?”Or,“Willyouhelpmetohelpyouby[doingx,y,z.]?”Or,“WillyourelaxasIhelp?”Or,toachild,“Willyoubemypartner,likethePowerRangersorDoraandDiego?”

“Theworstisover.”Or,“Icalled911.Helpisontheway.”Or,“You’vebeenhurtandthehealing’salreadybegun.Yourbodyknowshowtohealitself.”Or,“I’llberighthereuntiltheparamedicscome.”

TODO

Pace/JoinInConnectwiththeotherperson.Bewheretheyaresoyoucanhelpleadthemtocomfortandsafety.Sometimesjustagentletouchisenough.

DistractforPainReliefGettheirattentionelsewhere;forpainrelief,takethefocusofftheinjury.

SolicitTheirHelpGetthemtoactivelyparticipateintheirownhealing.Makethemfeelthereissomethinghelpfultheycando.

GiveHealingSuggestionsThefollowingareexamplesofwhattosayonceyou’vegottentheirattentionandagreement.

Direct:Sayitstraightandclearlywithauthority.Bedirective.

AsI/YouCan:Connectapositiveoutcomewithanactionyouareperforming.Sayitclearlyandfirmly,butallowforflexibility.

TOSAY

“Icanseethatyour[bodypart]needsattention.”Or,“Thatisfrightening,butI’mrighthere.”Or,“Iknow.”Or,“Icanimaginehowthatfeels.”Or,“Iunderstand.”

“Icanseewhereyourbodyneedsattention,thereandthere….Wouldyouscantherestofyourbodynowandletmeknowwhatelseisgoingon?”Or,“Howdoesitfeelhere?Here?”(Pointtoaplacethatisclearlyuninjured.)“WouldyouholdthiswhileIwrapthebandagearoundyour[arm/leg]?”Or“AsImove[this]…breathedeeplytothecountofthree.”Or,toachild,“YoucanplayRobinandI’llbeBatman,soyoucanhelpbyholdingthatrightthere.Good!”

“Relaxnow.Helpisontheway.”Or,“Takethreebreathsandonthethirdbreath,feelyourbodybecomingmorecomfortable.”Or,“Assoonasyourwoundiscleaned,stopyourbleedingandsaveyourblood.”

“AsI[holdthiscompress/washthatcut]youmaynoticeatingletellingyouit’sstartingtoheal.”Or,“AsIgetuptocall911,youcanfocusonlyonyourbreathing

TODO

IKnowaGuyWho…Givethemareferencetohealingasamodel.Helpthemtoanticipateafuturebeyondthisincident.Aneasyleadintostorieswithembeddedsuggestionsforhealingandcomfort.

YesSets:Getthemtosay“yes”totheobvious,andit’seasierforthemtoagreewiththenextsuggestionandcometotheconclusionsthatwillhelpthem.

FuturePace/ImpliedHealing:Pointtheirthoughtstoatimeinthefuturewhenthingsarealreadybetter.Helpthemtoimagineatimeofhealing,comfort,joy.Makeitclearyouexpectsuccess.Presupposeacceptanceofyoursuggestionsandoftheirhealing,bothnowandinthefuture.

VisualImagery:Givethemimagesofhealingtofocusonorhelpthemrecallpleasantscenestodistractthem.

TheIllusionofChoice:Alsocalleddoublebinds.Makethemanofferofhealingtheycan’trefuse.Letthemchoosebetweentwowaystoagreetobemorecomfortable.

TOSAY

“Iknowaguywho[hadaburn]likethisandhethoughtaboutcoolandcomfortableandtheswellingdisappeared.”Or,“WhenIhadthatsurgery,theykepttellingmeitwouldtakeweekstofeelbetter,butIwasupandaboutinaday...”

“Youareholdingmyhand…Iamtalkingtoyou…theambulanceiscomingandyoucanbreathemorecomfortablynow.”

“Youcangivemeacalllaterandtellmehowwellitallturnedout.”“I’mnotexactlysurewhenyoucanstarttofeelbetter…”Or,“Whenititchesitmeansit’shealingoryoumightjustfeelakindofnumbnesstoindicatethat.”

“Iwonderifthere’ssomeplaceyouwishyouwererightnow,someplaceyoulove.Wherewouldthatbe?What’sitlike?”Or“Imaginethatarmrestinginacool,clearmountainstream,gettingcolderandmorenumbandcomfortableeveryminute.”

“Whilethatleg/armovertherecontinuestoheal…youcanrestcomfortablywithme.”Or,“Youcantakeyourmindtoanyplaceyou’dliketogowhilewetakecareofthatwound.”

“Doesyourarmfeelmorecomfortablethisway,orthisway?”Or,“Wouldyoubemorecomfortablesittinguporlyingdown?”

P

Itiseasiertofindmenwhowillvolunteertodie,ThantofindthosewhoarewillingToendurepainwithpatience.

--JuliusCaesar

ain and suffering. These words underlie some of the most fearful aspects ofmedical emergencies and of any kind of illness, including chronic conditions.Thischapteronpainreliefliesat theheartofthebookbecauseitappliestosomanyconditions.Whetheryouarehelpingtorelievetheagonyofsomeoneinanaccident or providing comfort to someone in constant pain, Verbal First Aidtechniquescangiveyou,andthoseyoutendto,powerfultoolsforcreatingrelief.

How can words help with pain relief? As we’ve established, people inmedicalemergenciesareinanalteredandparticularlyreceptivestate.Althoughhypnotherapistsandbiofeedbackexpertsoftenusealteredstatestorelievepain,weknowthatsometimespainactuallycausespeopletogointoanalteredstate.Martyrs,saintsandholymenfrommanyancientpracticeshavebeenknowntouse pain, starvation and thirst to go into a state in which they can reach ametaphysicalexperience.Itisanaccepteddefinitionamonghypnotherapiststhatanalteredstateofconsciousnessisaconditioninwhichourconsciousnesshasbeenfixatedandfocused toa relativelynarrowarea rather thanbeingdiffusedoverabroadarea.Painistransforming.Itshutsouttheouterworldandnarrowsone’sfocus.

Like emotional problems such as anxiety and depression, pain is both

subjectiveand invisible.Wecanseebleeding;wecanpaywitness toabrokenbone,and respond to thevisualcuesofa faintingspellorachoking response.Pain,ontheotherhand,isimpossibletoquantify.Butitisvery,veryreal.Anditcanbeoneofthebiggestobstaclestohealing.

Alleviatingpainisalargepartofhelpingsomeonethroughacrisis.Thereareseveraltechniquesthatcanbeusedtohelprelievepain,ordistractapersonfromexperiencingit.Painisrealbutit isalsoaninterpretationofneurologicalevents. Therefore it ismutable; we can use ourminds to change thewayweexperienceit.Thisiswhywehaveplacedsomuchemphasisonstrategiessuchasavoidingwordslike“pain”and“hurt”asmuchaspossible,referringinsteadtospecificneutral—orevenpositive--sensations(“youmightfeelthepressureofthisbandage…”or“theareathatneedsattention”).

In1990theU.S.AgencyforHealthCarePolicyandResearchundertookamajorreviewofstudiesonchronicpain,includingcancerpain.Itfoundthattheevidence clearly substantiated the effectiveness of relaxation techniques andhypnosisinalleviatingchronicpain.Hypnosiswasalsoeffectiveinamelioratingthe discomfort of such difficult ailments as irritable bowel syndrome, oralmucositis (inflammation of themucous glands), temporomandibular disorders,suchasTMJ,andtensionheadaches.

Before Morton’s discovery of anesthesia, those who were unfortunateenough to require surgerywere left to a bottle of strong liquor and their owndevices. While many obviously suffered, the records indicate that there wereotherswhodidnot.Hypnosishasalonghistoryofbeingusedtoalleviatepainonthebattlefieldwhennoothermeanswereavailable.In1846,JamesEsdaile,aScottish doctor in India, performed almost 350 major operations without anychemicalanesthetic.Etherhadonlyjustbeendiscoveredin1846andchloroformwouldbediscoveredin1847.In thosedays,manypatientsundergoingsurgerydiedofshockrelatedtopain.Generally, themortalityrateof thoseundergoingsurgeryhadbeenadevastating50percent.UnderEsdaile’suseofwhatwasthentermed“mesmerism,”themortalityrateofhispatientswasdramaticallyreducedto5percent.

The word used by physicians of the mid-19th century to describe whathappened to thosewhowent through theprocedures stoically and later deniedfeeling pain was “insensibility.” Baron Larrey, the principal surgeon to theFrench ImperialGuard underNapoleon,was present during the amputation ofGeneralCaffarelli’sarm.HewroteinhisjournalthattheGeneralhad“extremecourage”anddidnotspeakasingleword,perhapsduetowhathecalled,“muchconcentration.”

Painisthegreatmotivatorandthegreatcommunicator!

Inthischapter,we’llshowyouseveraltechniquestohelpreduceorcontrolpaininamedicalcrisis:

Objectmetamorphosis(concretizingandmanipulating)Controlroom/DimmerswitchGloveanesthesiaChangingfocus/scanningDissociationVisualization

Like other Verbal First Aid techniques, these work best when the victim orpatientisinthehealingzone,whichissooftenthecasewiththoseinpain.

TheValueofPain—PleaseNote!

Whenweseepeopleinpain,wenaturallywanttohelpthem.Wewanttoeasetheirsufferingandbringthemrelief.There’sanimportantcaveat,however,asyoutrytohelp.Pleasekeepinmindasyouarehelpingsomeoneinpain,thatpain is also a signal that something is wrong. When the emergency rescuepeople arrive on the scene, or when the doctor appears at the bedside of aseriouslyillperson,thepatienthastobeabletocommunicatewhichareasneedattentionandwhy.Paincanbe tremendously informative,sowhilewewant toease it, we also want to allow the pain to communicate its vitally importantmessage.

What that means is that, as we are successful in mitigating pain, forexampleduringalongwaitforanambulance,wecanalsobuildinalittlealarmthatsoundswhensomethingmustbeattendedto,anoverridethatallowsthepaintocallattentionwhenneeded.Youmightsaysomethinglike,“andwhileyouarefeeling this comfortable numbness and your body is beginning to heal itself,whatever needs to get your attention, or the attention of the paramedics ordoctors,willsignalbylettingyoufeelwhatneedshelp,evenastherestofyourbodyremainsrelaxed.”

Chronic pain, however, may continue far past the point of usefulness,causingincapacitationanddepression.Pain,whennolongerproductive(inthatitpointsour attention toaproblem), canhavedeleteriouseffectson theheart,

kidneys,gastricandcolonicprocesses,andbloodpressure.AccordingtoR.A.Sternbach,anexpertinthefield,paincanbedefinedby

thefollowing:

Asignalorsomethingthatpointstothesourceofpainasapotentialproblem;A pattern of neurochemical responses that allow the pain to be recognized bysomeoneelse,suchasadoctor;

the subjective sensibility or suffering. Pain, however, remains a mutable,inconstant, and slippery companion. It is very common in cases of intractablepainforexaminationstorevealnoorganiccauses.

Therearemanypainsthatgiveusconfusinginformation,suchasphantomlimbpains,referredpains,andpsychosomaticpains.Whenpresentedwithmorecomplex situations, it is wisest to rely on themost basic of Verbal First Aidprocedures:pacing.Forinstance,DonnaisattendingtoPete,anelderlyrelativewith diabeteswho has recently suffered a right leg amputation.He complainsthathisrightlegitchesterribly.Insteadofremindinghimthathehasnoleg,shegoestothebedandaskshimtopointtowhereititches.“Overthere,”UnclePetepointstoafoldinthesheet.Maryresponds,“Wouldyoulikemetoscratchitsoyou can bemore comfortable?” Pete nods and relaxes asDonna scratches hisphantomitch.

Keepinginmindthecommunicativevalueofpain,whenusinganyofthefollowing techniquesyoucansuggest to thepatient thathe“keeponlyenoughdiscomfortatthesitesothatyoucaninformthedoctorswhatneedsattentionandwhat’sworking.”

The techniques you are about to learn can be used to keep the patientcomfortable and safe until the ambulance comes, and they can providechronicallyillpatientswithskillstocontroltheirownpain,whenevertheyneedto—notjustinemergencies.Inbothcasesthegifttheybringisinvaluable.

ObjectMetamorphosis

One very useful strategy calls on the victim to imagine a feeling as anobjectandthendosomethingtochangethenatureoftheobjectsothatyoucan,in turn,modify thefeeling.Forexample,Bob ishurt ina fallandsays thathefeelsa tremendouspressureonhisabdomen.He isclearly ingreatdiscomfort.At this point,we can askwhat that pressure feels like, and encourageBob to

describe it.Oncehehasarticulated thepainasaspecific image,ourgoal is tochange it into something less painful, less frightening. The following is onepotentialscenario:

“Thepressureonmystomachfeelslikeabig,heavyrock.’“Okay,nowthatyouseeitasbig,heavy,rock,whatcolorisit?”“Idon’tknow....It’sred.”“It’sared,big,heavyrock.Youcanobviouslyseeitveryclearly.Nowletmeaskyouaquestion:whatcolordoesithavetobetofeelbetter?”

Oddlyenough,perhapstohissurpriseandyours,Bobknowstheanswertothatquestion.At thispoint,youcancontinue tousehis imagination tochangethe rock’s color to a cooler tone, such as blue or green, and then ask him tochangeitfromarocktoaballoon.Gethimtodescribethatballoon.Oncehe’sgotthatimagefirmlyinhismind,youhaveseveraloptions,eitherofwhichwillhelprelievethepain.Eithertheballooncanfloataway,orwecanlettheairoutofituntilitdisappears.

ControlRoom/DimmerSwitch

Althoughwe have suggested that you avoid theword “pain” inmost oftheseprotocols,thisoneaddressesitdirectly.InChapter1,wetoldthestoryofTimothy Trujillo and how he helped a man in a motorcycle accident whilewaitingfortheparamedicstoarrive.Thisisthepain-relieftechniquehealludedto. It asks the patient to imagine acontrol room in hismind, perhaps like thecockpitofajetfighterplaneorascientist’slabwithlotsofknobsandbuttonstopush. In one area, there is a rheostat with a control button that slideshorizontally,fromalowofonetoahighoften.Underitisasign,paincontrol.Ask the patient to assign their pain a number along this spectrum. In anemergency situation they are likely to respondwith nine or ten, towhich youreply,“Fine,”or“Right,”or“Okay.”

Next you ask them to reach over and slide that control button down toeight, or seven.Difficult as this is tobelieve (and to their total surprise), theywillbeabletodosoandthepainwillactuallydiminish.Thenaskthemtopushthecontrolswitchdowntosixorfive.Theeffectmightcomeabitmoreslowlythistime,butit’slikelytheywillbeabletodothis,aswell.Havethemindicatewhentheyareat“six”bymovingafinger.Thisiscalledanideomotorresponse

andithelpskeepthepatientinthealteredstatethatfurthersthisprocess.Here’sthe difficult but important part. Tomake themost of this technique, you thenhavetoaskthemtotakethepainbackuptoeightagain.Theymayresist,butiftheycomply,theywillmakeadramaticdiscovery—thattheyareinfullcontroloftheirownpain!Thenaskthemtotakeitbackdowntoafiveorsixorevenlowerifitispossible.Thelowertheycanslidethatknob,thebetter.

As we saw in the Trujllo story, when the patient with the corkscrewfractureinhislegsaidthathenolongerneededthepainmedicationbecauseit“wasatzero,” this isaverypowerfulpain-control tool. It teachespatients thatthey are in control, and can therefore turn thepaindownwhenevernecessary.Havingexperienceditforthemselves,theyknowitistrue.Asitsnameimplies,thisapproachandtheonethatfollows,givethepatientasenseofcontrol,whichisespeciallyvaluablewhenone’sentirelifesuddenlyseemstohavebeenturnedupsidedown.

Dr.DonJacobsusesthemetaphorofelectricalwiresandalightbulbinthebrain to accomplish pain control. He suggests that people experience their“distress” as their body’s way of telling them that something needs attention.Oncethey’vegottenthemessage,thencanturndownthesignal.Heaskspeopletoimaginethatelectricalwiresofvariouscolorsrunfromwhateverpartof thebodyisexperiencingthedistresstoalightbulbinthebrain.Thenhehasthemimagine that there is adimmer switch that allows them todimor brighten thelight.Thenhesays,“Goaheadandbegintodimthelightalittlenow…Good.Nowyoucontrolwiththedimmertowhateverlevelyouneed…”

Amnesia

Whenpain isofamoreepisodicnature,wecanhelppeople to forget it.Halfoftheproblemwithchronicpainisthememoryofpainpast.Theotherhalfis the anticipationof pain to come.Of course, that anticipation is repletewithanxiety, tension, and fear—the ingredients for an altered state. Remembrancecanbedulledwithsuggestionsforamnesia:Everyoneforgetsthings,justlikeweforgotwhatwewerearguingabouttheotherday…wecanforgetwhereweputoursocks,whereweputourjewelry…andwhohasn’tforgottenwheretheyputtheirkeys???Wecanforgetanything…evenwhereweputpain…andpaincanmoveand change so fast…we can forgetwhere itwas last…andhaveno cluewhat itmayhave felt like… Interestingly, in forgetting past pain,we forget tofear future pain. Thememory seems to be linked to anxiety about the future.Whenthedreadisreduced,soisanypaininthepresent.

Ernest Hilgard, M.D., and Josephine Hilgard, Ph.D., distinguishedresearchers out of Stanford University, feel that amnesia is one way to helppreventthediscomfortassociatedwithnauseaandvomitingfromchemotherapy.They have worked with patients whose anxiety is so intense, they beginvomitingevenbefore theyenter thehospital for treatment.Byhelping themtoforget the discomfort of their past experiences and simultaneously suggestingother interests todistract them, theyhavehelped theirpatients tofindrenewedcomfort.Manyclinicianscombinesuggestionsforamnesiawithsuggestionsfortimedistortionsoepisodesofpaincomeascompletesurprisesandtheexpected20minutesofdiscomfortcanseemlike10seconds.

Displacement

Noonewouldmindhavingadiseasequitesomuchiftheydidn’thavetohaveanyofthesymptomsandwouldneverhavetoknowitwasthere.Thesameholdstrueforpain.Ifwecouldonlyhaveasmuchpainasweabsolutelyneededinorder toproperlycare forourselves (sowedon’t leanupagainsthot stovesandburnourselvestothebone)butnomore,orcouldlimitittoonepartofourbodysoitwasmanageable,mostofuswouldagreethatwouldbesatisfactory.Displacementworkswiththatagreement.

Displacement takes the pain from one area, where it has caused unduedistressandinterruptedourlives,andputsitinanotherarea,sowecanfeelmorecomfortableandgoaboutourbusiness.Onemanexperiencedsuchterriblebackpain, he walked practically doubled. During the time when the origins of thepain were being explored both medically and psychologically, he was out ofwork,thesolesupporterofhisfamilyanddesperatetogetbacktothejob.Weasked,“Would itbeall right if thepaincontinued inanotherpartofyou?Inapart of you large enough to remind you of the work you need to do withyourself, but small enough to allow you to get back to the job and make aliving?”Heagreedtoitanditworked.

Another person had migraine headaches which kept him fromaccomplishingmuchinhislife.Buthewassoidentifiedwiththeheadachesthathecouldhardlyimaginelifewithoutthem!Whowouldhebeifhedidn’thavetoarrangehis schedule around this limitation.Yet heknew that hewanted to befreeofthemmostofthetime.Whenitwassuggestedtohimthathecould“storethe migraines in his pocket and have them when he felt he had the time forthem,”henoddedslowly.Hefeltthemsitinthepalmofhishand,asiftheywerealive,throbbinglittlebeing,andputhishandinhispocket.Thenheknewitwas

there if he still needed to identify with it. This is a combination of ObjectMetamorphosis and Displacement, as you concretize it and change its form,place,andtiming.

Akinestheticwayofachievingdisplacementisbyaskingpeopletoclasptheir hands together very tightly so that attention is focused on the sensationsgenerated there, rather than in the more grievously affected parts. Somecliniciansusethistechniqueinchildbirth,askingpatientstosqueezetheirhandsorsomeobjectastightlyastheycanwitheverycontraction.Attentiongraduallyshifts from themore painful contractions in the abdomen to the less difficultsensationsinthehands.

GloveAnesthesia

This simple technique has a long history in hypnotic anesthesia. Thepractitioner asks patients to imagine that all sensations are leaving their righthand andmoving into their left hand. The idea here is do this as vividly andspecifically as possible.You could say to the person in pain, “Have you everreached foradrink inacooler fullof ice?Rememberhowcold that feels?Ormaybeyou’vehadyourhandinanicymountainstream,oryoucanremembermakingasnowballwhenyouforgot toputonyourmittens.Rememberhowitfeelswhenyourhandbeginstotinglewhenyoufallasleeponit.Youcanfeelthattinglingnow.Holdyourhandinthaticywateruntilitisnumb…tuneintothatfeelingthatthereisnofeelinginyourrighthandasitgrowsmoreandmorecold,frozen,numb.”

Thenask theperson to“place that frozen,numbhandverygentlywhereyou are experiencing the discomfort and notice how that part of your bodybecomesnumb,too.”Oddlyenough,oncethehandisnumb,itcantransferthisnumbness (lack of sensation) anywhere it comes to rest, providing pain relief.It’sonemoretestamenttotheamazingpowerofthemind!

ChangingFocus/Scanning

Aswementioned in the chapteron rapport, pain is at itsmostpowerfulwhen it is the object of attention. Simply asking people to turn that attentionelsewherecanbeasourceofpainrelief.Suggestingthatthey“scanthebodytosee if anything elseneeds attention” is onewayofmoving the attention awayfromtheinjury.Thistechniqueisfundamentalandeasy.Allwehavetodoisask

about an uninvolved part of the body and draw the attention there, andwe’vecreatedacertainamountofcomfort.

Youcanalsohelppeopletofocusonanotherpriority,suchasgettingawayfrom a burning building or any other external factor, effectively displacingawareness of the pain. Everyone can recall a timewhen theywere having somuchfunorwereso in loveorso involved in theirwork that theycompletelyforgot about that headache or those menstrual cramps or that aching back. Ithappensallthetime.Whensomethingelseisapriority,paintakesabackseat.

Dissociation

Somepeopleareabletoseparatethemselvesfromtheirbody’sexperience,especiallyinthealteredstateofanemergencysituation.Itisanatural,protectiveinstinct.Inanemergencysituation,indeed,wherevertheheartisvulnerable,theexperience of our life space can be radically altered. There is a narrowing offocus so thatwhat is ordinarily available to the consciousmind gets shut out.Certain areas are given priority and other areas are not even recognized asexisting.Thisopensthedoortomakingsuggestionsthatallowthepersontofloatapartfromthesituation,asiftheywererestinginbedorfloatinginacalmpoolofwater,therebyobtainingsomerelieffrompain.

Somepeople,whengivensuggestionsforspecificsortsofpainreliefsuchasdisplacingthepainfromtheabdomentoamoretolerableplace,likethetipofthe finger, will spontaneously dissociate. One woman we know reported afeeling of floating out of herself, watching the pain, but not feeling it. Sheadmitted that she didn’t understand it herself and wasn’t even sure she wasdescribingitproperly.Wesuggestedshecouldjusttakethatawarenesswithherwherever she went so that her experience of the pain would be alteredpermanently. “Youcanhave thepainas longasyouneed it,”weassuredher,“but you never have to actually feel it.”When presentedwith such a gift andsuchrelief,understandingishardlynecessary.

VisualImagery

Dependingonpeople’sabilitytousetheirimaginations,youhaveavarietyof approaches to visualization from which to choose. Working on the moreconcrete level,youcould tell thevictim thatourbodyknowshow tomake itsown endorphins for comfort and invite them to picture those pain-relieving

neurochemicalsinanywaytheycan,mobilizingtheendorphinstodotheirwork—filling thevictimwith feelingsofcomfort. Inaddition toprovidingcomfort,thisvisualizationcanalsohelpstimulaterepairandrecovery.

You could suggest that the victim imagine T-cells inside their blood,workingonthefrontlinesoftheimmunesystem,rushingtofixwhateverneedsattention.Cancerpatientscanuseguidedimageryforchemotherapy,imaginingthechemoattackingonlytheweakandconfusedcancercells,whiletherestofthe body rejoices in the help and remains healthy.Aswe’ve seen in researchstudies,burnvictimsreceivenotonlypainrelief,butoftensufferlessedemaandscarringwhentoldtoimaginethemselvescoolandcomfortableincleansnowora cold spring brook, where they float calmly, noticing how their bodytemperaturealreadyisbeginningtolower.

Imagerycanbeasspecificasyourunderstandingandthesituationallows.For instance, R.K.S. Lim researched the chemical reactions that stimulate theperception of pain and found that there are specific substances to which ourorgans,tissues,andmusclesrespond.Manyoftheseareaminesorpeptides,themostfamiliarbeingapeptideknownasbradykininthatdevelopsinblisterswhenskinisburned.Knowingthis,wecanutilizeitinoursuggestionsifthecontextpermits.Forinstance,“Tom,Iseetheburnand,yes,Icanseethatyou’refeelingit.I’mgoingtohelpyounow.Comewithmetothesink.Good.Now[ascoolwaterisrunning],asthecoldwatersstartstocoolyourskin,youmightimaginemicroscopic peptides getting the signal to turn off so that your skin healssmoothly…andasyourfingerscontinue tofeel thewatercooling themall thewaythroughthelayersofskintotissue,youmightimagineyourbodychoosingthequickestwaytoheal….”

Sensoryvisualizationscaninvitepeopletogotoasafeplace,suchasthebeach, where they can see and feel themselves being cradled and soothed bywavesofcomfort,wherethewavescancarryawayanythingthatmightstandinthe way of comfort. In 1999, Dr. Elvira Lang at the Beth Israel DeaconessMedicalCenterinBoston,embarkedonastudyinvolving241peoplewhowerebeingoperatedontoopencloggedarteries,nerves,andblockagesinthekidneydrainsystem,aswellastoblockbloodvesselsfeedingtumors.One-thirdofthepatients were guided through visualizations of scenery they loved. One-thirdreceivedextraattention.One-thirdwerethelessfortunatecontrolgroup.Whilethosereceivingextraattentionfaredwell—confirmingthatyourlovingkindnessisgoodmedicine—theguidedvisualizationgroupfaredbest.Thosepatientshadless pain, fewer problems with blood pressure and heart rate throughout theoperation, and their operations finished 17 minutes earlier than the controlgroup.

Childrenhavereadyaccess to theirpowersof imagination.Tohelp themfacilitate the healing process, youmight simply say, “Remember the last timeyouplayedavideogame?” Inseconds, theyareoff inanotherworld.Anothergoodstrategy is toaskchildren to“see” their favoriteTVshowin theirmindsanddescribeittoyou;askfrequentquestionstostimulatetheprocess.Then,finda way to bring the characters to help in the present situations. “What do thecharacters do? How do they ‘fix’ things when they get hurt? Ask Dora theExplorer.AskBarney.AskElmo.They’llknow.”

Pain&Emotions

Sometimes people in accidents expend precious energy being angry atthemselvesforhavingmadeamistake,oratothersfortheirthoughtlessactions,or even railingat fate. Ifyou suspect that thevictim’sangerand frustration issapping their energy, help them in anywayyou can to let that goat least fornow. Forgiveness is the best medicine, but if time is pressing, you can giveaccident victims permission to suspend judgment now, knowing that they canreviewtheaccidentintheirmindlater.Fornow,theycanhelpthemselvesbestbyconcentratingonsendinghealingmessagestotheirbody.

Anyandallofthesetechniquescanhelpyouhelpothersinpain.Youcanfollow any of these suggestions without interfering with the rescue effort, orwithanyaspectofappropriatemedicalcare.Youdon’thave tomove,oreventouch,thevictim.

And,alwaysremember,forbothyourselfandtheinjuredperson,becomingawareofbreathingandslowingitdowncreatesanenvironmentofrelaxationinthebodythat,byrelievingstress,helpsalsotoprovidepainrelief.

What follows is a sample visualization designed to help a personexperiencethesensationof“numbing.”Pleasefeelfreetoreprintitandkeepitwithyou.

NumbingVisualizationScripts

“AsIhold/putcoolwateronyourarm/leg[affectedbodypart]now,youcanrestcomfortablyknowingthatI’mgoingtotakecareofeverythingandyoucanfocuscompletelyonfeelingthecoolwater...youcanevencloseyoureyesforamomentortwoandseedeep,deepdownhowfresh,howclean,howcoolthewater is, even feel it like new fallenwhite snow, so cool, so comfortable,

packing gently around your [leg/arm etc.], cooler and cooler. And you mayrememberthelasttimeyoufeltcool,cool,cleansnow...”

or

“Youmayrememberthelasttimeyouputyourarmintoabucketofcool,cleanicewatertoreachforacoldcanofsodapopandyouhadtofisharoundinthere and it was so cold, your arm almost got numb... yes...just a little likenow...”

or

“Inacoolmountainstreamorlakeinearlyspringwithbubbling,icywaterrunningovertherocksandwashingyourarmclean,makingitfeelsocoldnowit’salmostnumb...butnotquite...butreallyclose...youknowthatfeelingdon’tyou...everyoneknowsthatfeelingofan[arm/leg]beingsocool,socomfortablethatyoucanhardlyfeelit...andyoucanfeelnowthatyour[arm/leg]isinthatbucket of clean, clear ice or that mountain brook, clean, fresh and freezingcold...can’tyou?”

or

“Youknowthefeelingoftheairconditionerblowingonyourfaceasyousitinthecarandatfirstit’scoolbutthenitseemscoldandyoufeelittinglingand cold on your face?And you can remember that feeling as thewater runscoolandcomfortableoveryour[arm/leg]oftheairconditionerblowingsothatyourfaceisfeelingsocleanandrefreshedandsocoldandalmost...butnotquitetotallynumb...”

ChangingFocusforPainRelief

“Maybeinallthisexcitement,youhaven’tnoticedhowrelaxedyourfoot[unaffected,un-tensebodypart] is, lyingthere, just relaxedanduninvolved,aswehavetendedtootherpartsofyourbody.Now,tenseitupjustabit,makeitinto amuscle now, and then that’s right... relax it again...Good.And you cankeepyoureyesclosedasyouconsiderthatfootandhowrelaxeditis,andfromtimetotimeyoucantenseit,justtoseewhatitcando,youknow...whetherit’skiddingornot...orjustpretendingtoberelaxed...andthenyoucanletitgoagainandbecuriousaboutit...howcanafootbesorelaxedwithsomuchgoingonallaround it...and if one foot canbe so relaxed,what about the other foot...Now,whataboutthatotherfoot...

“Andgoahead,now, closeyour eyes and take a reallygood look insidethereinsidethatfootandseehowrelaxeditis...andwedon’twantthisonefootgettingawaywithsomethingtheotheronecan’tso,goaheadandtensethisfootnow and feel the muscles tighten and then... in just a moment...okay...goahead...letitgo.Good.Nowyouknow.Andyoucanenjoythatyouknow,justalittleandstarttoallowyourselftoletthatrelaxationmoveupthroughtherestofyourbody...throughyourlegs...throughyourtorso...[followthroughunaffectedpartsfirstandultimatelythroughtoaffectedbodypart]...

“And that feelingof relaxationwith all the rest goingon aroundoutsideyoucanbringjustthesmallestofsmilestothecornersofyourlips,thekindofsmileyouhavewhenyou’vegotitandyou’dliketolaugh,butmaybeyou’dliketokeepittoyourselffornow...soyoucantakeitwithyouwhereveryougo...”

There are some questions among professionals about whether hypnoticsuggestions to relievepainworkwith peoplewho are not in formally induced

trances,meaningwhen suggestions are given to them in thewaking state. Todemonstrate the power of communication, even without a prior hypnoticinduction,M.B. Evans and G.L. Paul, Clinical Psychologists who study pain,conductedan investigation thatwasreported inTheJournalofConsultingandClinicalPsychology (1970).First, theymeasured thehypnotic susceptibilityofthevolunteers.Thentheygavehalfofthegroupahypnoticinductionandlefttheother half in an “ordinary” state.When theygavebothgroups suggestions forpainrelief,theyfoundthatbothgroupsreducedtheirpainbyanequalamount.Fromthistheyconcludedthatsuggestionsforpainreliefworkin“ordinary”and“extraordinary”statesofconsciousnesswhenthereissufficientmotivation.Weseethepossibilitiesintheirinvestigationinaslightlydifferentlight:Asidefromshowingthepowerofsuggestion,italsoalludestothepointwemakeallalong—that pain and stress can, in and of themselves, create the alterations inconsciousness thatmake usmore open to suggestion, particularly when thosesuggestionscontributetowhatwewant:forthepaintostop.

U“Don’tdenythediagnosis;trytodefytheverdict.”

--NormanCousins

ptothispointinthebook,wehavetakenyouthroughthedramatic,sometimesterrifyingworldofthemedicalemergency.Thetechniqueswehaveshownyoufor helping people before the rescue teams arrive can provide pain relief,promotecalm,andinfluencethehealingoutcomeforthebetter.Butwhatabouttheperhapslessdramatic--butstilldebilitating--worldofphysicalandemotionalillness?Whatarethewordsthatcanmakeadifference,thatcanpromotehealinginthenon-emergencyscenario?

Itisonethingtoaddressapersonyoumightnotevenknowwhilewaitingfortheambulanceandquiteanothertospeaktoyourbelovedgrandmotherwhois suffering with Alzheimer’s disease or cancer. There are not only differentthingstosayanddifferentprocessestoaddresswithintheotherperson,butyou,yourself,willbeinaverydifferentframeofmind.Itisanotherthingaltogetherto recognize the looping,negative thoughtprocesses inyourownmindasyoumovethroughacrisisoraseriesofcrises,andthenchangethemintothoughtsthat serve you and promote your own physical and emotionalwell being.Alltheseissueshavetobetakenintoconsiderationasweadaptourprotocolstofitthisdifferentsituation.

As you have seen, the protocols for Verbal First Aid in medicalemergencies are very prescriptive. People in a medical emergency can be

expected to be in an altered state, which makes it possible to communicatedirectlywiththeirautonomicnervoussystems.Thingshappenfastinamedicalemergency. In terms of the time frame, decisions are urgent and there is notmuch flexibility.Whatwe have discovered, though, is thatmuch ofwhat hasbeen developed for medical emergencies is easily adapted for non-criticalphysicalandmentalillness.Aswemoveintotheprotocolsforvariousformsofillness, scheduled surgery and even dying, let’s take a look at how thosesituationsaresimilarandhowtheydifferfromwhatyouhavealreadylearnedinVerbalFirstAidformedicalemergencies.

1.Whilepainandfearmaycauseanalteredstateinpeoplewithphysicaland emotional illnesses, that state is not as acute, not as obvious, and not aspredictable as it is during an actual emergency. There may be moments ofextremepainoranxietywhenwegetsignalsthattheperson’sunconsciousmindisavailableforsuggestion.Sometimes,however, thereceptivealteredstatehasto be evoked in non-emergency situations with imagery and/or stories (SeeChapter3,TheHealingZone).

2.Althoughthereisalwaysasenseofurgencywhenpain,terminalillnessor threats of suicide are involved, in general the time frame for dealing withphysicalillnessoremotionaldistressandpainisdistinctfromthatofamedicalemergency.Noambulanceisarrivingintenminutes.Youhavetimetopracticeand improve (and improvise) your general techniques. Rather than having tomanage immediate survivalneeds, the focus inworkingwith thephysicallyoremotionally ill becomes comfort, reframing, and acceptance. These conditionsoffertheopportunityforgenuine,deep-downhealingthatcanbefacilitatedandenhancedbywords.

3.Thereislessneedforascript.Patientcontacttakesplaceoveralongerperiod of time, allowing for greater understanding of the complexities ofpersonalityandtheconditionssurroundingthespecificillness.

What is most interesting, however, are the distinct similarities betweencriticalcareandlongertermhealthissues,sincetheseprovideopportunitiesforusingmuch the same techniques for establishing andmaintaining rapport, andfor using the power of suggestion, which you have already learned. In thischapterwewill showyouhow toadapt these techniques forusewithphysical

illnessandscheduledsurgery.Here is a quick review of the techniqueswe have discussed for gaining

rapport.

GettingCentered.Inanemergency,whenpanicisintheair,gettingcenteredisabasicsurvivaltechnique.Withoutit,apersonattemptingrescuecanfallpreytothehysteriaofthemomentandbeunabletothinkasclearlyasthesituationdemands.Inphysicalandemotionalillness,itisalsowisetocenteryourselfbeforeyoubegin,becausethiscontributestoasenseofcalm,empathy,andinsightthatcanmightilybenefityourwork.

EstablishingEmpathy.Whilethisisavaluabletechniqueinemergencysituations,itmaybeevenmoreimportantinnon-emergencysituationsbecauseoftheirlongerduration.Long-termhealingrapportrequirespatiencethatonlyempathycanprovide.Thisisnotthesamethingassympathy(whichimplies,“I’msorryforyou,”butsuggeststhatit’syourproblem,notmine).Empathymeans,“Ifeelwhatyoufeel,”andgivesanillpersonthatall-importantfeelingofbeingunderstood.Inanemergency,long-termbondsarenotnecessary,nor,forthemostpart,aretheyestablished.Inon-goingillness,however,youcanestablisharelationshipthatallowsyoutogainarealsenseofwhatisgoingoninsidetheotherperson.

EstablishingAuthority.Asyouknow,thisisanecessarypartofensuringthatyoursuggestionswillbefollowedinamedicalemergency,especiallywhenyou’redealingwithstrangers.Thisauthority,togetherwiththereceptivityofthevictim,lendstremendouspowertostatementslike“I’mheretohelpyou,”and“theworstisover.WillyoudowhatIsay?”Inon-goingillness,establishingauthoritymaynotbesuchanimportantissue,butitisstillveryusefulwhenyoubegintogivetherapeuticsuggestions.

Yourpresence,whichconsistsofyourcompleteattention,focus,andcaringinterest,isyourmostvaluablehealingtool.Insimplybeingpresent,youarealreadyprovidingthelovethatisthemostimportantformofVerbalFirstAid.Thereisineffablemagicinsuchagift—partlybecauseitis,unfortunately,sorareinourexperience.Itisasifwe’vebeenlitupbyaspotlight.Webecome

thecenterofsomeone’sattention,andinthatlightdormantpartsofusawaken—partsthatsuddenlyrealizewemaybeworthyofnotice,maybeworthyoflife,maybeworthyofhealth.Convictionissimplybelief.Butwithconvictioncomesacertainauthority,asenseofleadership.Convictionstatesclearly,withoutequivocation:“Iknowthistobetrue.”Whenyouhaveconviction,yourtone,yourbodylanguage,yourtouch,andyourheartstandbehindeverywordyouutter.Everythingyoudoandsayhasmorepower.Convictionliterallyconvinces.Itmovesmountains.Itgetspeopletodothingstheymightnotordinarilydo.

EstablishinganAllianceinthiscasethismaysimplymeanthatyouwishthepersonthebest,thatyousharethesameobjectivefortheirrecovery.Youaretheretohelp.

CommunicatingRealisticallymeansbeinghonest,butfindingwaystoreframeasituationsothatanillpersoncanmorecomfortablylivewiththeillness,benefitfromthewisdomthatcanresultfromexperiencingit,andmovedeeperintoahealingmindset.

AvoidingContra-alliancesisprobablymostimportantoverthelonghaul.Itneverdoesanygoodtobepartofblamingpeoplefortheirillnesses.Tosay,“Ifyou’donlyquitsmokingwhenItoldyouto,”doesnotadvancethecauseofhealingonebit.Thiscautionisbothobviousandremarkablyeasytoforget,especiallyinfrustratingsituations.

GettingaContractinamedicalemergencymeansasking,“WillyoudoasIsay?”Overthelongtermofanillness,itmeansconfirmingwithpatientsthattheyunderstandthatyouaretryingtohelp,andthattheywillagreetoparticipateinthateffort.Youmayhavetorenegotiatethatagreementmanytimesoveralongerperiodoftime.Thisistobeexpected.

ThefourC’s,Confidence,Credibility,CompassionandConcern,arecriticalcomponentstoVerbalFirstAidinphysicalandemotionalillnessesaswellasinacutecare.Thestepsforgainingandutilizingrapportareessentiallythesame,butneedtobemaintainedovertimemuchthesameasyouwouldinanyrelationship.

Onceyou’ve adapted the rapport-gaining techniques tonon-emergencies,youwillwanttoturntothetherapeuticsuggestionsthathelppatientswithpainrelief,calmingandhealing.

Here is an importantelement to remember inall situations.Your facilitywiththerapeuticsuggestion,whateverformittakes,isbasedinlargemeasureonyour conviction that it can and doeswork.You have almost certainly had theexperienceoftryingtoconvincesomeoneofsomethingyoudidn’tfullybelieveinand felt the futilityof that.Whenyouusevisual imagery,your tone shouldreflect both your conviction and your compassion. Speak softly, firmly,intimately—let your conviction resonate with every syllable. This is a sharedprocess; you’re not doing this “to” anyone.You’re doing this in concertwithsomeone.Youfacilitatetheimagestheyconjure.

All communication isparticipatoryand refractory,whetherweareawareofitornot.Whatwesaytosomeoneelse,inthefinalanalysis,issomethingweare saying to ourselves. Here’s perfect example: When one of us was stillsmokingcigarettes,abusinessmancameinforhelptoquithisownhabitoftwopacks a day.While taking his case,we learned that he smoked in “binges”—chain smoking for several hours, then stopping altogetherwhile he attended ameetingorsatonasix-hourflightacrossthecountry.Whenasked,“Howdoyoudo that?” he replied, “I forget about it. If I can’t smoke, I just make myselfforget.” That moment, combined with an understanding of utilization and theknowledge that one could develop a state of amnesia around something asspecificassmoking,ledtoaseriesofhypnoticsessionswiththatfellowfocusingrepeatedly on “forgetting to smoke.”What ismost interesting and pertinent isthatnotonlydidhestopsmokingbutsodidhistherapist,goingoutnightafternightforaweektopickupapackofcigarettesonlytoarrivehomerealizingthatshe had forgotten to buy them, and had instead gotten side tracked in theliteratureaisleofthestore.Whatgoesarounddoesindeedcomearound.Wordssaidarewordsheard—onemoregoodreasontosaythemlovinglyandwithcare.

GuidedImageryforHealing

Youcanusethesetechniquesandideastohelppeoplewithmostchronicand life-threatening illnesses. Because each person’s mind, history andexperience are different, imageswill be highly individual.We do not actuallyhavetosuggestspecificimages,butwecanprovidethecontextforthem.Imagescan be literal or metaphorical. Dr. Carl Simonton, when using visualizationtechniques with his patients, originally suggested conjuring up the image of

whitebloodcellsaslittlePackmen,fromtheearlyvideogame,eatingthecancercells.Thisworkedforsomepeople.However,othersobjectedtotheviolenceofthe image, so they were allowed to suggest their own imagery, with Dr.Simontonprovidingthemetaphoricalframework.

Therearemanywaystoemployimageryforhealing.Onceyouunderstandhowtheyworkyoucanselecttheonesthatbestsuityourtemperamentandthatofthepersonyouarehelping.

SimpleRelaxationTechnique

If the person is willing, you might begin with this simple relaxationtechnique:

“Youmaynoticethebottomsofyourfeetnowasifasoft,soothinglight—any color light—were shiningon them, softening, soothing,warming the cellsthatneed tobewarmed,cooling thecells thatneed tobecooledandyoumaynotice that feeling begin to move up through your arches and your ankles,softeningandsoothingin thesamecomfortableandsafeway.It’smovingintoyourcalves,yourkneesandyourshins…slowitdownsoyoucanspendjustamomentenjoyingthatsoftnessandthatsafety,thatwarmthandcoolnessasthelight moves through you, into each cell, taking in what is healthy and alive,sloughingoffwhat isuseless toyounow. It’smovingalong likea softbreezedownthestreet,justlikeasoftbreezeonalazy,easyday,takingtheleavesthathave fallen off the trees down the streetwith it, taking the dead leaves away,leavingthestreetclean,clear,open,fulloflight…”

This sort of imagery can continue throughout thewhole body, spendingtime where the patient needs it, providing the opportunity for open-endedsuggestions for healing and comfort. For instance, you might say, “As youbecomemoreawareofyourkidney[substitutewiththeorganinquestion],youmightnoticethelightspendingabitmoretimethere,softeningandsurroundingthearea,cleaning…nourishing…healing.”At theend, it iscommonpractice tosend the lightbackout again through the topof thehead, “leavingbehind thegoodnessandgraceandsoftnessandlove,takingwithitanythingyounolongerneedandthatkeepsyoufromfullwellbeingandcomfort.”

Manychronicsufferersneedtoletgo—notnecessarilyoflife(althoughat

somepoint thatmaybethecase),butofresentments,entitlements,angers,andregrets.Mostly,theyneedtoletgooftryingtocontrolthatwhichisbeyondtheircontrol.Here’sasimple,butveryeffectguidedvisualizationforlettinggo.

LettingGoandFlowingVisualization

“I’mgoingtotellyouastoryabouttheriver.Youknowhowariverflows,don’tyou.Itjustflows,fromitssourcetoitsdestiny.Sometimesthere’sarockoraboulderinitsway,andtheriverjustflowseasilyarounditoroverit.Overtimeitwilleffortlesslywearanyobstacledown,justbydoingwhatitdoesbest:flowing.Sometimetherivertakesonaheavyload,likeaboatoralog,andtherivercarriesiteasilyasitflowsfromitssourcetoitsdestiny.Sometimesitrainsand the river absorbs thatwater and it becomesmore river.And the river justflowson.And sometimes the rivergets caught in eddies, and itwhirls aroundandaround,until it straightensout.And then it just flows.Andsometimes thesun shines. And the river dances with it and reflects it in a million littlediamondsoneachlittlewavelet.Andtheriverjustflows,fromitssourcetoitsdestiny.Andtheriverjustflows.”

Thisexampleofguidedimagerycanbeeasilyamplifiedormodifiedtosuitthepersontowhomyou’respeaking.Noticethemanysuggestionsforallowing:objects in the way, burdens to carry, confusion to spin you around, floods,shiningmoments.Andthroughitall,justflowingistheanswer.(Atthismomentyoumaybe thinking toyourself,“Howwonderful tobea river.” It seems thatwaytous,too.)

Ifyou’reworkingwithsomeonewhoseemsnot tobe interested inusingguided visualization, you can also casually intersperse visual imagery inordinaryconversation.Youmightcomment,“Icanjustpictureyourwhitecellsgetting stronger and beating up the cancer cells every time you take thismedication, can’t you?” We suggested to one friend whose cancer was soadvanced that shewas almost bereft ofwhite blood cells that she imagineherwhile blood cellsmultiplying like little white rabbits every time she took hermedication.“RabbitswithUzis!”shesaidenthusiastically.

All suggestion involves utilizing the resources of the unconsciousmind,whetherthatisdirectly(“Takeadeepbreath”)orindirectly(“It’sawonder,isn’tit,why sometimes there are clouds and sometimes not, but there’s always the

blueskybehindit,nomatterwhattheweatherlooksliketoday.”).Whetheryouchoosedirectorindirectsuggestiondependsonthepersonalityofthepersontowhom you are talking. Rarely does arguing change the way a person feels,especiallyifthatpersonhasamoreassertivestyle.Wehavefoundthatknowingwhomyouaretalkingtoandbeingabletoquicklyassesstheirmotivationoftenmakes the difference between suggestions being accepted or rejected. Forinstance, we would never tell new, frightened, or hypervigilant clients to just“close their eyes”withouthelping them to first feel safe.Themore resistant apersonis,forwhateverreason,themoreindirectthesuggestionshouldbe.

Many hypnotherapists believe that direct suggestions work best withobedient or highly motivated people. People in acute pain or in medicalemergencies often are tremendously motivated and can benefit from morestraightforwarddirectives. “Justdo it!”or“Just sayno!”arehighlypublicizedexamplesofsimpledirectives.Someclientsaresomotivatedtochangethatalltheyhavetodoismaketheappointmentforasessionandbythetimetheygetin, they’re feeling “surprisingly better.” In fact, one of the questions on ourintakeis“What’sdifferentsinceyouphonedus?”

Directsuggestionsdealwiththeproblemathandovertlyandusuallyofferveryconcrete,detailedinstructions.

“You are tired. You want to sleep. Notice how heavy your eyelids arefeeling. Notice that heaviness moving to your hands. You feel your musclessoftening in your face. Your neck muscles are softening. You think of yourpillows. Imagine yourself in your bed right now.Remember the last time youfellasleepsoeasily.Rememberbeingasleepbeforeyouknewit.”

Noteveryoneissoopen,and,inmostcases,moresubtletyisrequired.

Indirectsuggestionsappeallesstothelogical,consciousmindthantotheunconsciousmind. In fact, indirect suggestion can leave someone consciouslywonderingwhatyou’re talkingabout,while at the same time, theunconsciousmindisalreadymakinggooduseoftheinformation,pavingthewayforhealingandchange.

Anexampleof indirect suggestionmight be: “Everyoneknowswhat it’sliketobereadingabookandthenfindingthebooklyingflatontheirchestinthemorning,havingno recollectionof fallingdeeplyasleep.Withoutanyeffortatalltheynoddedoffquicklyandeasily.”

An indirect suggestion ismore open and less “instructive.” It leaves theinterpretation up to the other person. In guided imagery, we might offer thisindirectsuggestiontosomeonesufferingfromaburn,“Itissoeasytoremember

thatmoment of shivery anticipation before you put your toe in the cool, coollake.Afterall,it’sstillonlyApril,andeveryoneknowshowcoolthewaterisinApril.And as you take another deep breath, a part of you—perhaps your toe,perhapsyourwholefoot—isalreadyinthatwater,feelinghowicyitis…”

One woman we worked with had a growth on her tongue that haddevelopedaftersomeonehaddisappointedandbetrayedher.Inhervisualizationshesawthatifsheimaginedpouringsugaronthegrowth,itwouldgoaway.Shefelt that if she repeated this visualization three times a day for three days, thegrowth would dissolve. When she went for surgery, the growth had alreadydisappeared.Itoccurredtousthatthegrowthwasbornofbitternessandhadtobe“cured”withsweetness.Thismetaphoremergedfromherspontaneouslyonceshewasprovidedwiththetools.Metaphoricalimageryistheuseofsymbolstorepresent ideas and body functions, manipulating them toward wellness andhealing.

Personal resources arepeople’sownhistoric strengths, thepartsof theirstory that they forget in times of illness, but of which they are most proud.Withinthemetaphororimageryformatyouuse,itcanbeveryeffective,atsomepoint, to referback toa timewhen thepatientwasable todosomethingwell,when the patient felt different—strong, clear, healthy. This subtly reminds uswhoweare,andof theabundant resourceswehavewithinus,nomatterwhatourcircumstances.Ittellsusthatwearenotourdiseases.Wearenotourfears.Wearenotourdiscomforts.Wemayhavethem,butwearenotofthem.Wearesomuchmore than the sum total of our ailments and body parts, andwe candrawgreatstrengthfromthatinsight.

VerbalFirstAidforPhysicalIllnessandChronicConditions

VerbalFirstAidcanhelpyoutalktoapersonsufferingfromadebilitatingillness in ways that will lead to emotional relief, physical comfort, and, as aresult,evenmeasurablebiologicalimprovements.Thesetechniquesdonotclaimtocure,buttheycancreatetheconditionsinwhichrealhealingcantakeplace.ThewordhealingcomesfromtheOldEnglishword“Haelen”whichmeans tomakewhole.Itdoesnotmeantocure,tofix,ortomend.Wholeness,then,maynotnecessarilygetridofthediseaseitself.Itmay,however,integrateitinsuchawaythatthepersonlivesfullyanddiesmorecomfortably.

Most healing involves the body/mind mending itself, restoring itself tobalance.Tappingin to thebody’s intelligenceandremindingitof itsability toregenerate, achievehomeostasis and rebuild, can lead to relief,peaceofmind,

and,asyouwillsee,sometimestheeliminationofthedisease.Wheneverwetalkaboutthebody’sabilitytohealitself,wealwaysremindpeopleofthesimplestandmostmiraculouswaysinwhichthebodydoesthiseveryday,inrecoveringfromrazornicksorpapercutsorbruises.Eachdaywewatchourskinknititselftogetherwithoutbenefitofneedlesorthreads,andourbruisesgraduallyrestoredtonormal.

AsDr.MichaelSamuels,authorofHealingWithTheMind’sEye,pointsout, you will not find a description of the body’s own healing capacities ormechanisms in any medical textbooks. But just because medical trainingoverlooksthismiraculouscapacitydoesn’tmeanthatweshould.Ourbodiesareabsolute miracles of design. Quite aside from everyday wonders the bodyperformsarethemiraclesofspontaneousremission;perhapsyouyourselfhavehad theexperienceofa seriousmedicalcondition justgoaway.Whatdoesgoaway mean, anyway? Where does it go? Why? How? What have we donedifferentlywhenthingsjustgoaway?

Weoncehadafriendwhosehusband,Burt,walkedintothehospitalforanoperation on his prostate.The operationwent very smoothly, butwhen itwasoverandtimeforBurttostandupandwalk,hislegsgaveway.Somethingwasverywrong,somethingthedoctorslabeled“aspinalinfarction.”Theprognosis?TheyhadnoideaifBurtwouldeverwalkagain.Burt’swifedecidedtocallinherownsupportsystem.Shehadanherbalist,aNativeAmericanhealingcircle,anacupuncturist,andaphysicaltherapistrushedtoherhusband’ssideandaskedus,aswell,tocomeandhelp.Bythetimewegotthere,Burthadhadenough.Heturnedtohiswifeandsaid,“Honey,you’rehealingmetodeath!Idon’twanttosee any more of these people. Please get rid of all of them.” All of them?Fortunately,allbutus.

WeaskedBurttogotohisfavoriteplaceinhismind,whichturnedouttobeapicturesqueoldghosttowninthesouthwest.Weaskedhimtopictureanoldsaloonwitharickety,onceproudstaircaseinit,andweinvitedhimtoimaginehecouldfixthatstaircaseandtomakeitfunctionalandsafeagain.Heworkedatit.Andhepromised to continue toworkon that staircase inhisminduntil hewas satisfied that all waswell. Burt is walking today, despite his physicians’prognosisorlackofone,andweliketothinkitwasaharmonicconcertofthehealing team that paved the way for us, and the guided imagery whichcontributedtoBurt’sabilitytocurehimself.

There is no question that visualizing bodily functions actually generateschemical reactions that have both short-and long-term physiologicalconsequences.Workingfromouressentialpremise that themindand thebodyareone,picturesinthemindarepicturesinthebody.Theyarenotrelated.They

areone.Youcannotthinkathoughtandnotfeelit.Youcannotfeelasensationandnothaveitperceivedasthought,albeitsubliminally.Thereisnoseam.Weareacontinuumofmind,body,andspirit.

TurningPoint/HealingZoneOpportunities

Onewayinwhichlong-termillnessesdifferfrommedicalemergenciesisthat there are shifts and changes all along their course. Sometimes, for longperiods,oneisjustcoping.Othertimesbringmomentsofcrisis—thediagnosisand naming of a disease, new medications and surgery, for example—whensurvival issues and treatment concerns rise up. It is at thosemoments that thetechniquesderivedfromVerbalFirstAidcanworktheirmagicmostnotably,asthe healing zone opens up. In that sense these moments provide us withopportunities to say things that help shift fear into hope and even change thetrajectoryofanillnessorconcern.

A principal task of Verbal Fist Aid in non-emergency situations is toidentify healing zone opportunities, inwhich people aremore ready to accepttherapeutic suggestion.Thehealingzone turningpointswewilldiscuss in thischapterinclude:Theshockofdiagnosis,iatrogenics,chronicpain,andsurgery.

TheShockofDiagnosis:DoIHavetoListentoThis?

When people receive a diagnosis of a life-threatening, or even a life-altering, long-termdisease,something insideof themchanges. Insocieties thatbelieve in magical ritual, the naming of the disease in this way might beconsidered a curse. From now on, and because the doctor (or an X-ray, or abloodtest)saysso,thepatienthasbeenplacedunderanevilspell..

Theshockof thisblight isakintobeingrunoverbyanSUVandleftonthe medical roadside to emotionally bleed. Thereafter, the patient, notunreasonably, is looking to be rescued.The situation, in termsofVerbalFirstAid,issimilartothatofanaccidentvictim.Fromthemomentofdiagnosis,theperson may be considered to move in and out of a state not unlike post-traumatic-stress-disorder.Thismeansthatoftenthepatientisinthatsemi-alteredstatethatcanleadtothehealingzone,inwhichthetechniquesofdeclaringwithconviction that one canhelp, andmaking suggestions that begin inner healingcanbeveryuseful.

HowtoDefusetheDiagnosis

Some years ago, a group of women in a small community, all farmers’wives, were been diagnosed with serious and terminal diseases. Researcherstracked them in order to understand what, if anything, might contribute tosurvivalpastthedoctors’expectations.Whattheyfoundwasbothshockingandamusing: Everywomanwho survived hadmet the initial proclamation by herdoctorwithasolid“Soyou say!”Becauseof the town’salready long-standingnegative relationship with the corporate authorities who ran the town’s onlylargebusiness,someofthewomenhadneverestablishedapositiverapportwiththeir doctors and simply did not trust or believe them.Whilewewould neversuggest that patient-doctor rapport, with all its potential for healing, beundermineddeliberately,inthiscaseitismorethanofpassinginteresttonoticehow that fractured rapport saved the lives of these women. The appropriateVerbal FirstAid technique herewould not to be to disagree outrightwith thephysician’s diagnosis, but rather to assist the person who is ill to place thediagnosisintoanoverallcontext.Thisway,theshockofthenegativediagnosiscanbeovercomewithoutdestroying themedicalauthority.Curiously, it seemsto be possible for people to disbelieve the prognosis and still believe in thecompetence and goodness of their physicians, allowing them to participate intreatmentandrecovery.

The effect of a dreaded diagnosis is that people feel they have beensentenced to death, or worse, to a life of pain and imprisonment. From thatmomenton,formanypeople,nothingisthesame—notforthepeoplewhohavethe disease nor for the people who love them. Everything changes. Now lifemust be lived around doctor visits, pill schedules, dietary needs, bathroomavailabilities,andfatigue.

Awomanweknow,Edie,wasdiagnosedwithabenignfibrousgrowthinherbrainthathadtoberemovedbecauseitwasattachingitselftothenervesinherearandwouldcontinuegrowing,threateningherotherfunctions.Asaresultof a fall some timebefore, however, her neckhadbeen compromised and thesurgeons felt it was absolutely necessary to operate on her neck before theyriskedthebrainsurgery,becausethepositioninwhichtheywouldhavetorestherheadduringthebrainsurgerymightotherwiseleaveherparalyzed.Theyalsotoldhertheyshewouldlikelyemergefromthebrainsurgerydeafinoneearandperhapswith facialparalysis.Allof thiswasverygrimand thewoman—who,untilthattimehadbeenwalkingaroundfeelingallright,notparalyzed,notdeaf—wastraumatizedbythisterrifyingprospect.

It just so happened, however, that she had come to see us several yearsearlierwithagrowthonhertonguethatthedoctorsandherdentisthaddeclaredmightbefatal.“Theyhavemewithonefoot in thegrave,”shehadsaidat thetime.Shehadusedguidedimagerybeforethatoperation,andnotonlywasthemassmuch reducedby the timeof surgery, but the catastrophicpain theyhadpromisedheralsodidnotmaterialize.

Wedecidedtouseboththatexperienceandguidedimageryonceagaintohelpherthroughthiscase.If50%ofthepeoplewhoemergefromthisoperationaredeaf,weremindedher,then50%arenot.Wealsoremindedherthatshehadbeen able to use guided visualization to great benefit before, sowe know herbody responded beautifully to that technique. Not only did both surgeries gowell, but her spirit was revived and, by remembering her own strength, shemovedintothefuturewithrenewedconfidence.

Wewilldiscuss the importanceofattitude—thephysicaleffectsofbeliefsystems—shortly. For now, we are addressing only that turning point, thatmomentwhentheshockofthediagnosisthrowsapersonintotheHealingZoneandallowsyourwordstobeheardatadeeplevel,wheretheymaybeacceptedashealingsuggestions.

Scenario

Afriend,Maria,callsandasksifyouhaveaminutetotalk.Reactingtothetoneofhervoice,yousay,“Yes,”evenifyouhavetoliterallydroparmloadsoffilesordiaperstolisten.“Ijustcamebackfromthedoctor,”shesays.“Ihadthisfunny,youknow,numbnessinmyrightsideandIcouldn’tusemyhand,andIgotpanicked.He ran tests, ruledouteverythingelse, andnow theysay IhaveMS.MS!Howcouldthatbe?Ieatright.IdowhatI’msupposedto.AndnowthedoctorsaysthatImightendupinawheelchair!”

“Thatmeans,”yousay,reframing,“thatyoumightnot?”“Well, yes.He said about 1/3 of the people haveone episode and that’s

all.”“Thatwouldbegood,”yousay.“Andabout1/3have,youknow,episodesandremissions,offandon.And

therest—rightintothatwheelchair.”“So that’snotevenmostpeople. Iknowawomanwhoworksout inmy

gymwhowasdiagnosedwithMSandIdon’tthinkitslowsherdownonebit.”(Hereyou’reusingthe“Iknowaguywho…”technique.)

“WhatamIgoingtodo?”shecries.

Practice

Youmightwanttotakeamomenttothinkofhowyouwoulddefuseadevastatingdiagnosiswithafriendorlovedone.Youmight:

Remindthemoftheirstrengths,resources.

Findinformationtoprovidesignificanttruisms.

Recountexamplesofotherswhohavesurvived.

Helpthempictureafutureinwhichtheyhaveovercomethe

“Youcantalktoyourbodyaboutit.It’sjustamistakemadebyyourownimmunesystem.Itthinksyourownnervesareforeigninvadersanditattacksthemyelinsheatharoundthem.Youcanuseyourmindtopicturelittlepost-itnotesonthemsaying‘me’or‘self’or‘friendly,’andthensendyourimmunesystemonanerrand to fight the real invaders.Thenyoucan imagineyourself joiningtheone-episodeonlygroup.You’llhaveanexcitingstorytotellwhilewe’reoutthereplayingtennisagain,”(youfuturepaceandhelpherwithimagery).

“Youthink?”shesays(Truism) “Two out of three people never get near a wheel chair. Why

wouldyouthinkyou…”“Butthedoctorsaid—”“Maria, doctors have to cover their bases, they have to mention all the

possibilities, they’re bound to do so by law.He can’t tell you that everybodyrecoversfullyfromthisbecausesomepeopledon’t.Itdoesn’tmeanthatit’strueforyou.Youjustaccepteditbecauseyouwerescared.Really,thedoctormeantwell,buthedoesn’tknowyou.Hedoesn’tknowyouareanamazingwoman.Iknow you and I know that about you. And amazing women can do amazingthings.”

(Recountsomeofthemoremiraculousor“lucky”thingsinherlife,ifyouknowthem,anythingsheovercame in thepast.Gether toagree.Getayessetgoing.Thenfuturepaceherintohealingsothatsheagreeswiththat,too.)

“Yeah…that’strue…”At this highly emotional

crisis point, you can remind yourfriends of their whole selves,before fear takes over and makesthem accept a label, before theysuccumb to what Andrew Weil,MD,callsa“medicalhex.”

Iatrogenics

“I have to tell you,” saysyour doctor, “that one of the sideeffects of this new prescriptioncouldbenausea.”Youtakethepillandproceedtothrowup.

Doctors are in a bind. They

illness. are required by the laws ofinformed consent to let you knoweverything that could go wrongwithaprocedure,apharmaceutical,

or a treatment. By so doing, are they, as authority figures, inadvertentlyprescribingthoseoutcomes?

Onewomanweknow,Jeannie,wenttospeakwithherdoctoraboutwhatshe believed to be truly minor surgery. She had even anticipated it being anoutpatientprocedure.However,shewassoon told that theprocedurewouldbeperformedinthehospitalandthatshewouldhaveto“prepare”forit.Listswereprovidedforher,detailingherresponsibilitiesandrights,andshehadtosignaninformed consent form that included a litany of possible gruesome outcomes.From a routine event the surgery turned into a major production. Negativesuggestionswereflungaroundunintentionally,fromthewell-meaningwarningsthat“thiswillhurt,”totheinterviewwiththeanesthesiologistwhotoldher“I’mputtingyouunderjustincaseanythinghappens,”totheadmonitionsofthestaffthattherewouldbelotsofswellingandpainandthatshewouldhavetostayinbed. Jeannie truly believed in the competence and goodness of her physiciandespitetheiatrogenicspoppinglikepopcornallaroundhim,soshewasabletoovercome the negativity and to utilizeVerbal FirstAid, telling herself that allwould be well. There was in fact, almost no swelling, no pain, no need forpainkillers,andshewaswalkingaroundwithinafewdays.

When Andrew Weil, M.D calls iatrogenics—doctor-induced illness—a“medicalhex,”heblames“medicalpessimism”foritsprevalence.Aswonderfulascontemporarymedicine is inemergencysituations—muchof itwasbornonthebattlefield—itiseasilyfrustratedbyitslimitationsinchronicillnesses.Whenmedicinerunsoutofoptions,whenthechemotherapyorthedrugsdon’twork,adoctormay fall into that pessimism.Weil quotes a physician telling a patientwithulcerativecolitis,“Listen,I’vegotnothingmoretoofferyou,andchancesareyou’lleventuallydevelopcoloncancer.”Thatprognosiscanbeself-fulfillingunlessthe“hex”issomehowbroken.AnditisatthistimethatapersonmovesintothealteredstatethatmightbeusedasaHealingZoneiftherightwordsarepouredonlikealiquidantidote.

However the problemof iatrogenics can also be seen in a positive light.PsychiatristMiltonErickson,evermindfulthatwehavethepowertoseethingsdifferentlyandthereforealtertheoutcomeinmedicalsituations,wonderedaboutthepossibilityofphysician-inducedwellness.Ifiatrogenicillnessispossible,hethought,isn’titalsoreasonabletoproposethatiatrogenichealthisalsopossible?If it iswithin the realmofscience tousesuggestion inplacebo trials,whynot

offer a therapeutic suggestion in the ambulance or in the waiting room to adoctor’soffice?

Scenario

Your mother brings home a bottle of little white pills to forestall herosteoporosis.Thedoctorhastoldherthatshehastotaketheminthemorningonanemptystomachwitheightouncesofwaterandnotliedownnoreatanythingforahalfhour,duringwhichtimesheherstomachmightgetupset.

MOMEverymorning. I’m supposed to get up and get an upset stomach.Nicewaytostarttheday,right?

YOU

Isthisaguaranteedstomachacheoramaybestomachache?

MOM

Hesaidmay.Youmaygetastomachache.

YOU

So,then,youmaynot.(Reframing).Youmaygetstrongbones,instead.

MOM

No,I’msupposedtogetstrongbones.Imaygetastomachache.

YOU

Whenwasyourlaststomachache?

MOM

Idon’tusuallyget—

YOU

Yeah,Iknow.Sowhyshouldthislittlewhitepillchangethehabitsofalifetime?

MOM

Itprobablywon’t.Onlyhesaid—

YOU

Hehastosaythat.Ortheside-effectspolicewillcomeandgethim.(Humor)

MOMThosesideeffects.Everythingmaycausesomething.

YOU

Yeah.That’sjustlegaltalk.Didyouevergetasideeffect?(Resources)

MOM

No,actually…

YOU

Doyouknowanybodywhoevergotasideeffect?(“Idon’tknowaguywho…”)

MOM

No.

YOU

Didapillevermakeyousick?

MOM

No.

YOU

Isthisonegonnamakeyousick?

MOM

(laughing)No.

Andyou’vejustdoneapositivenoset!

SideEffects

Side effects has been a useful phrase in terms of public relations, butexaminedclosely,itturnsouttobemeaningless.Therearenosideeffects.Theseare theeffects, unwanted though theymaybe, of the treatment.And, not onlycan a prescribed medicine cause, say nausea and vomiting, but the doctor isobliged to tell you as much, so that nausea and vomiting also becomeiatrogenicallypartoftheprescription.It’susefultoknowifit“maycauseliverdamage,”soyoucanmonitoryourliver.But, intermsoftheiatrogenicpartofthesideeffect, an importantVerbalFirstAid technique involvesplacing those

warnings in context, thereby removing the hex. Something as simple as, “Oh,Margaret takes thateverymorningandshehasnoproblemwith itatall,”willoftenhelptokeepstressaboutthatfactorfrominterferingwithhealing.

HowtoHelpAlleviateChronicPain

Youcanhardlywatchcommercialtelevisionwithoutencounteringmyriadadvertisements for products that offer pain relief from evenminor distress, soanxiousarewealltoavoidit.Inthisculturalcontextseeminglyendlesspaincanseemcatastrophic.Peoplesufferingfromchronicpainoftenturnawayfromtheworldandfocusinward,becausethepainseemstobeallthereis.Fromtimetotime,eveninthatstateaTurningPoint/HealingZoneopportunitycomestolight.

Rayisinchronicpain.Hesays,“Ijustcan’tstandthepainanymore.Ijustcan’ttakeit.”Monasitsdownbesidehim,takeshishandandsays,“I’llsitherewithyouwithyouforawhile.YouknowwhatIwish?I’mwishingthatIcouldput a tap onyour side, a little faucet like the one in the bathroom sink, that Icouldturnonanddrainthepainoutfromyou.I’dturniton,likethis,andmaybethepainwouldcomeoutacolor—Idon’tknowwhatcolorthepainlooksliketoyou,butyouprobablydo—andyoucouldjustletitflowoutuntilthatcolorwasgone. [Pausing. And then I would imagine that that place was filled with adifferentcolor that feltbetter. Idon’tknowwhatcolor that is,butyoudo, thecolorthatfeelsbetter.[Pausing.]AndIthoughtmaybeI’dleavethattapthere,inyourside,soyoucouldturnitonifthecolorthatisn’tgoodforyouevercomesback,andyoucouldletitdrainoutagainsoyoucouldbemorecomfortable.”

Formorespecificpainrelieftechniques,pleaseseeChapter8.Youmightwanttopracticethemonyourselforwithsomeonewhoissufferingdiscomfort,so you can build your confidence,whichwill allowyou to project evenmoreauthority.

WhattoSaytoPeopleAbouttoUndergoSurgery

Withthepossibleexceptionofsomeelectivesurgery,mostsurgeryhasagreat many fears associated with it. There is the fear of “going under”anesthesia, fear of the knife, fear that somethingmight go terriblywrong andyou might not survive, and, the fear of a long, painful recovery. The mentalimagesweassociatewithsurgeryareplentiful,andfewofthemarepleasant.

An accident or a medical emergency takes us by surprise.We have no

chance to get caught up in the anticipation, only in the event itself, itsrepercussions, and recovery. However, people who know they are going toundergosurgeryhavetimetoworrybeforetheevent.Andworrytheywill.Thatconcernmayputthemintothehealingzonesothattheeffectofyourwordsmaybe especially helpful and contribute to a speedy recovery.Oneyoungwoman,whoisscheduledforsurgerywithinafewweeksof thiswritingcamein tenseandtremblingwithanxiety.Shehadknownabouthersurgeryforafewmonthsandwaited throughseveralpostponements.With thedate finallyuponher, thefearsfloodedforth—thewhat-ifsthathadbeenfillinghermindnowoverflowed.Becauseshewassoanxious,shehadunwittinglyputherselfintoanalteredstate(what some therapists call anegative trance) inwhich all she heardwere thevoicesinherownmindandallshesawwereherworstfearsprojectedintothefuture.WithVerbalFirstAid, itwaspossible to reachbehind thosebarriers toprovidethereassuranceofanothervoiceandanothervision.Whensheleftouroffice,shefeltcalmer,clearer,andsecure.

Onewomanwe know had delivered her third baby by caesarian sectionand had experienced dire consequences when her colon was inadvertentlyruptured.Shewasscheduledtohaveanoperationtorepairthesituationbutwasingreatfearthatsomethingelsemightgowrongandshewouldn’twakeupafterthe surgery. A few days before the scheduled procedure, her six-year-olddaughterbegantowakeupatnightwithastomachache,evenvomiting,havingpickeduptheworrythatfilledthehouse.Helpingthemotherinvolvednotonlyhelpingherrelaxandfuturepaceagoodoutcome,butsuggestingthatshewriteapicturebookwithherdaughterabout“Mommy’soperationandcominghome.”The book theywrotewas delightful, detailing the seven days until her return,feelingbetterandbetterandawaitingballoonsandkisses.,andthetwoofthemSkypedandreaditduringherhospitalstay.Theextrabenefit,ofcourse,wasthatasshereassuredherdaughter,shewasreassuringherselfthatallwouldbewell.

IKnowaGuyWho…

Storiesofotherpeoplewhohavegonethroughaparticularprocedurehelpto remind us that the surgery is not unusual, and that others who have gonethroughitarenowoutandabout,livingtheirlives,freeoftheconditionthathadclouded their livesbefore surgery.Storiesgiveushopewithoutpreachingandpresentpossibilitieswithoutproselytizing.Storiesareoftenan ideal format fordeliveringsuggestionspreciselybecausetheyaresosubtleandnon-judgmental.

FuturePacing/ImpliedHealing

Most people have operations to free themselves to live more fully thanthey had been prior to the surgery. While it may not always seem like animprovementintheirlives,asinthecaseofamastectomy,thehoped-forresultisthatthepersonwillbecancer-freeandabletogoonlivingmanymoreyears.Sometimes,asinaheartorlivertransplant,itactuallymeansanewleaseonlife.Inanywaythatyoucan,helppeopleabouttoundergoanoperationtopicturetheoutcomeasachancetobebetteroffthantheyareatpresent.Helpthemimaginedoingthingstheylove,freeoftheproblemandreturningmorefullytolife.That,afterall,isthegoalofthesurgery.

Guidedimagery

For a pilot program at Cedars-Sinai Medical Center’s Cardio-ThoracicSurgeryUnit,JudithSimonPragerdevelopedaseriesofCDsthatpatientscouldlisten to before, during, and after surgery to relieve anxieties and discomfortsandtopromotehealing.ManypatientsreportedsuchgoodresultsfromtheCDsthattheyusedtheminlieuofpainmedicationandsleepingmedication.“Whenwecompared thesepatients to routinepatients,we found therewasadramaticreductioninpainmedicineandsleepingpillsthattheyrequested,”Dr.GregoryFontana,DirectorofIntegrativeTherapiesforCardiacSurgery, toldus.Nursesanecdotally reported earlier discharges and fewer side effects from theanesthesia. For us it is one more gratifying example of how effective theprotocolsinthisbookcanbe.

VerbalFirstAidforSurgery

Pre-operativeEvenbeforeyouroperation,youcansendmessagestoprepareyourmind

andyourbodytogetintoahealingstate.”Ithasbeenshownthatthosepeoplewhoare“ready”forsurgery,butnottoodeeplyrelaxed,actuallyfarebest.Thebodyneedssomereadinesstoactivatesomeofitsdefenses.Toomuchrelaxationand we are left too vulnerable. Too little relaxation and we are anxious andtense.Often, the individual can be best helpedwith a toned-downprogressiverelaxation and a suggestion to “relax just as much as your body needs to bepreparedandreadyforthebestpossibleoutcome.”

Then,ametaphor:“perhapsyoucanrememberthatstoryRichardtoldyouabouttheboatthatwastakentodockafterithadsprungasmallleak.Sojusttobesafe, theyfixedit‘goodasnew’soitcouldgobackout toseacomfortablyandquickly….”

Then, leaving the scene: “During the procedure, you might want toimagineyourselfdreamingofsomeplaceelse,someplaceyoulovetobe…”

Then, future pacing: “Allow your mind to drift to a week after theoperationwhenyouwillbehomeandtheoperationwillbebehindyou.Imagineyourselftellingothersabouthowsmoothlyitwent.Imaginethesurpriseofyourdoctorswhenyouhealmorequicklythananyoneexpected…”

Intra-operative

Because you cannot be there with the person, you might want to offersomeofthesesuggestionsasclosetothetimeasthepersonisbeingsedatedaspossible.

First,relaxation,“Relaxingnow,inwaysyourbodyalreadyknows…youcanbecomeawarethateverytouchofyoursurgeon’shandsisacaring,lovingtouch,carryingyoucloserandclosertothemomentwhenyouarefeelingbetterandbetter…”

Then,metaphors:“Inyourbody,asinagarden,youknowthatagardenersometimeuprootsaplanttohelpthehealthandwellbeingofthewholegarden.This way the garden can then blossom in all its beauty as nature intended it,growinghealthierandbettereveryday…”

Truisms: “Everyone knows that [Dr. Smith] is the best surgeon around.Everythingwillbehappeningexactlyasitshouldtomoveyousmoothlyintoahealthier future.Your body can cooperatewith ease, knowing that you are ingoodhands,caringhands…”

Leaving theScene: “As theprocedurebegins,yourbody feelsnumbandcalmandyoucan simply relaxandallowyourself todrift anddream,perhapseventakingyourmindtoaplaceyoulovetobe…”

FuturePacing:“Alwaysrememberthatyourbodyhasitsownintelligenceandknowswhentocooperateandwhentobeginthehealing…”

Post-operative

Ifpossible,youcangivethesesuggestionsasthepersonwakesupfromthe

surgery.Asyou/youcan:Remind theperson that:“Themore relaxedyouare, the

fasterthehealingwilloccur.”Or,“Asyouliebackonthepillow,youcanletthehealingtrulybeginandcontinueevenasyousleep…”

Truisms: “Everyone has an immune system in place to guard the bodyagainst any infection. Your arteries and veins, skin and bones are skilled atsmoothlyclosingupandknittingtogetheragain…”

Because:“Becauseyouhaveanimmunesystem,youcanletitdotheworkitwasmadetodo,likethewayithealedthatpapercutinnotimeatallandhowtheskinhadknititselfwholeagain…”

FuturePacing: “Youwill be surprised and pleased to see how short thehospitalstaywillseemtoyouasyougetmoreandmoreactiveeveryday.”

WordstoHelpDuringtheHospitalStay

Hospitalstayshavetheirownmesmerizingeffectonotherwisegrown-up,independenthumanbeings.Havingsomeoneregulatewhenyoueat,drink,gotothe bathroom, wake up to have a sleeping pill (!), visit with family, and getprobed and prodded, takes away your sense of independence, your sense ofyourself.Weallbecomeinfantilized.TheprocesscanseemlikeasceneoutofaKafkanovel:theytakeyourclothesawayandputyouinhumiliatingwrapsthatdon’tevencloseproperlyenoughtohideyournakedbottom.Youshufflearoundin paper slippers. You are wired up, monitored, stuck with tubes and drips,injected with needles, plied with capsules and pills. The doctor appears onoccasionwithanairofvisitingroyaltyandanswersyourquestionsbyreviewingyour chart and telling you the odds. Nowonder you slip quietly into anotherzone.

If you are visiting someone in the hospital and they are clearly unhappyand uncomfortable, youmight begin by remembering all of the above from ahospital stay you might have experienced, or shared with someone you love.Thisestablishesempathyandrapport.Thenutilizetheintrinsicallyalteredstatetomaximizeyouradaptedsuggestiontechniques.

Tohelpapersonthroughahospitalstay,youcan:

remindthemoftheirbody’sownhealingcapacity(imagery)remindthemofwhotheyare—theirstrengthsandresourcestalktothemaboutotherswhosurvivedthisprocedure(Iknowa

guywho…)suggestapainrelieftechniquefromthisbookiftheyneedithelpthemtoimaginebeingsomewhereelse(guidedimagery),somewheretheylove,sotheirbodycanmakehealingchemicalsandtheycanbemorerelaxedandcomfortable-helpthemtoseeorrememberthatthereasonthey’regoingthroughallthisissothattheycanmoveintothefuturemorecomfortably(futurepace)listentothem—theremaybenothingmoretherapeuticthanallowingsomeonetoventilatetheirfrustrationorfearandtrulyunderstandingthem.

AScriptforChemotherapyandRadiation

Wehavebeeninvitedonoccasiontositwithpeopleastheygothroughtheprocessofchemotherapy,andtouseourwordstohelpthemmakethemostofthisintervention.Thewordsweuseareverylikethoseyoufindinthisbook.

Theuseofmetaphorandimageryhavebeenshowntobeverysuccessfulin cancer cases. Before you begin, youmight first ask the person undergoingchemotherapy or radiationwhether they have an image of how the process isgoingtohelpthem.Somepeopleimaginesharksgobblingupthecancer.Othersareoffendedbytheideaofkilling thecancerandhavegentlerpicturesintheirmind.One personwe know saw her body as a tree, and the cancer as brownleaves;forher the treatmentwasblowingtheold,brownleavesoffher treesothat healthy, new green leaves could grow. Another patient saw the radiationdirectedatherbraintumorasahostofangelswithfeatherdusters.

Scenario

Arlene is undergoing chemotherapy for breast cancer. As she sits therewiththeI.V.inherarm,youhelphertorelax(perhapswiththeriverrelaxationvisualization)andthensay,

“As the medicine goes through your body you can begin to imagine[whatevershetoldyoushewantedtoimagine,e.g.,thewindblowingthebrownleaves…] or [if she offers no picture, youmight say somethingmore literal],imagine it seekingout anddestroying all of the cancer cellswhile leaving therestofyourbodysafe,well,andhealthy.Themedicinegoesrighttothesiteof

the cancer, exactly where it is needed, does its work and then is easily andcomfortably expelled fromyour body, carrying away all the dead cancer cellswith it.Yourbody feels comfortable and relieved as this processworks.Yourbody, your cells, can remember their original programming to reproduce in anormal way. The more you picture this process the more comfortable andhealthyyoubecome.Asyouimaginethecancercellsdyingandleaving,youcanimagine your body growing stronger and healthier, and your spirit growinghappier.Youcanseeyourdoctor’sfaceashe[orshe]tellsyouthatalliswell.You can see your friends’ faces as you tell them how you got through thisexperience.Andthenyoubegintomoveaheadwithyourlife,doingthethingsyou love to do, feeling blessed and relieved; you can feel those feelings evennow,evenasthingsarechangingandmovingyoutowardthatfuture.

“Anysensationsyoufeeltellyouthattheprocessisworking,andyoucanbegintoimaginehowitfeelswhenyouarewellagain.

Inthisway,anysideeffectsofthechemotherapyareprocessedaspartofthe healing and are welcomed rather than resisted, which would give themgreaterpowerandcausegreaterdiscomfortinthepatient.

Feel free to modify this script in any way that works for you and thepersonyouarehelping,basedontheprinciplesyouhavealreadylearned.

UtilizingtheHealingZoneinIllnessandChronicConditions

Peoplewhohavebeenshockedbyadevastatingdiagnosis,haveenduredaprolongedillness,orwhohavebeenthroughdebilitatingsurgery,maymoveinandoutofalteredstatesthroughthecourseoftheirillness.Peopleinahospital,orinadoctor’sofficeforthatmatter,areinanalteredstatebyvirtueofthefactthat they are fearful, uneasy, or uncomfortable. In that state, they are alreadyunusuallyopentoanauthorityfigurewhoideallycouldusewordstotransformtheirfearanddiscomfortintohopeandrelief.InChapter3wediscussedhowtohelpfacilitatethatstatesothatyourtherapeuticsuggestionswillbeaccepted.

Becauseeverythoughtandeverymentalimagestimulatesaphysiologicalresponse,thepicturesinourmindcandirectlyaffecthowandwhetherweheal.Whenthemovierunninginthesubconsciousshowsusdecliningandsuffering,itgenerates chemical processes that create an environment in which the diseasecan flourish. Helping someone to perceive the situation differently, to run adifferentmovie thatseeshopeorcomfortasaanoutcome,allows thebody tocreate thechemicals thatprovideacarpetofcalm,abathofnaturalchemicalsfromtheparasympathicnervoussystemthatgivesthebodyabetterenvironment

forhealing.Onewomanwhowasasurvivorof theattackon theWorldTradeCenters said themost importantwords spoken toherwere, “Your feelingsarenormal.” She explained, “I felt so insane, so out of control, that just to hearsomeone say Iwasn’t losingmymind, that thesewere normal reactions to anabnormalsituationmadeallthedifferenceintheworld.Icouldstarttorelaxjustabitandallowmyselftostarttoheal.”

WeaskedonechroniccarenurseinLosAngeles,“What is theonethingcaretakerscansay topatientswith seriousor life-threatening illnesses thatcanmake the most difference?” He replied, “I always use five words and theyalways have the desired effect.” The words? “Can I take your hand?” Whywould that make such a difference? For one thing, people with diseases arefrequentlynottouchedinalovingway.Manyhavelostinterestinsexuality,oraretoofatiguedforprolongedphysicalcontact.Then,too,inthecourseoftheirdisease, overwhelmedby themedical experience, theymayhave forgotten thesmall moments that lift us all above the chaotic morass. A simple touch canreconnect themto theworld.Asking theirpermissiongainsacontract inmuchthesamewayassolicitingtheirhelpdoes.Theybecomeapartnerinmakingthisconnection.

TheCaretaker

Sadly,wehaveallhadtheexperienceofwatchingsomeonewelovesufferfromachronicor life-threatening illness,ofbeingunable todoanythingmorethanwatch.Thisisevenharderforthepersonwholiveswiththechronicallyillpatient and has to manage the day-to-day indignities and struggles associatedwithit.Notonlyisitdepressing,itisdebilitatingmentallyandphysically,partlybecause of everything we have to do, and partly because there seems to benothingwecandotomakeitbetter.

Chronic disease is by definition a lengthy process and, as such, hasqualities that distinguish it from acute disease.With acute disease, there is anend-pointinsight:thingswilleithertakeaturnforthebetterorresolveindeath.While it is undeniably painful, acute disease takes a different toll on thecaretaker. Chronic diseases, especially wasting diseases, are relentless. Theywearawayatuslikewindandwatercarvingastone.

TheImportanceofAttitude

Dr.MargaretKemeny studies atUCLA focusedon the effect of thoughtand emotions on life expectancy. Her research led her to investigate both thegeneralpopulationandmorespecificpatientcommunities,suchas those livingwith AIDS. Despite all the discussion about stress, her research suggests thatwhat really affects our health is attitude, our view of other people, and ourconnectionwith them.Shecontends that,“Thelevelofhostilityweexperiencecanbeapredictorofashortenedlifespanandimmunesystemchanges.Cynicalmistrust,byitself,isthemostimportantfactorpredicting“non-causalmortality,”i.e., heart attacks, strokes, etc, she says, adding that it is as important adeterminerofearlydeathassmoking.

Ourbeliefsaboutthefutureareasimportantasthefutureitself.Ina1988study by JeffreyReed atUCLA,menwithAIDSwere questioned about theirexpectations for survival. (Remember that in1988 theprognosis formenwithAIDSwasalmostuniformlydire.)Whatwasinterestingwasthatthosewhohadrealistic or fatalistic expectations, thosewho “prepared for theworst,” had infact a significantly accelerated death rate compared to those who wereoptimistic, hopeful and unrealistic, imagining that a cure would come along“any day now.” Those who had the shortest survival time of all were those“realists”whohadalsolostsomeonetotheAIDSvirus.

Kemeny,whendiscussing this study, suggested that thismight have hadsomethingtodowithimagery.Losingsomeoneishardenough,buttoapersonwitnessing the death of someone with the same disease they suffer from, thepictureintheirmindofadyingfriendbecomestheirown.Bythesametoken,apositivestatecan induce images thatcontribute tohealthandhealing.NormanCousins,therenownedwriterandcommentator,commissionedastudyexploringthe effect of positive mental states. Method-trained actors had their immunesystems tested to create abaseline, and thenwere asked to evoke emotionsofhappinessand joy.When theywereretested, itwasclear thatpositive immunechanges had occurred. In other studies, similar results emerged. Relaxationtrainingprovedtoincreasetheactivityofnaturalkillercells;supportgroupsforwomenwithbreast cancer increased their survival rates; journaling (orwritingabout traumaticeventsand feelings)producedverifiablephysiologicalchangesinpatientswithasthmaandrheumatoidarthritis.

MartinSeligman,Ph.D.,researcheranddirectorofclinical trainingat theUniversity of Pennsylvania in Philadelphia and author of Learned Optimism,ranks individuals on an optimism-pessimism scale. In longitudinal studies heconducted, he found that optimists were more resistant to infections and lesslikelytosufferfromchronicdiseasesofmiddleage.

Experientially, we have both seen the effect of gratitude on a person’s

senseofwellbeing,andontheirlifeexpectancy,regardlessoftheirdiagnosis.Onesuchwoman, Irene, lives inanursinghome inNewJersey.Shehas

had several strokes, is now blind, has had shingles, lost her husband of sixtyyears, losthersavingstoMedicaid,andnolongerhastheabilitytoevengotothebathroomforherself.Butshehasneverlostherhope,hersmile,orherspirit.She says, “I’m so lucky. I have the most wonderful family. I have the mostwonderful nursing staff.This is themostmarvelous nursing home.”With thatattitude,howcouldthenursesbeanythingbutwonderfultoher?ForIrene,everyday is a miracle and a joy. She has been in that home for fifteen years and,despite all predictions to the contrary, seems poised to be there for anotherfifteen.

Often, people with chronic disease or life-threatening illness undergoradical shifts in their thinking,acrisisof faith.The lenses throughwhich theyseetheworldbluranddistort,theirfocusbecomingnarrowanddim.Whattheycanseeintheirfutureismoreofthesame,ordeath,whichcansometimesseemliketheonlywayout.Timeslows,andtheirinnerworldisfilledwithnegativeimageryandnegativethinking(orself-talk).

Theycanalsolosehope.OnestudyorganizedbyStephenL.Stern,M.D.,ofthedepartmentofpsychiatryattheUniversityofTexasHealthScienceCenteratSanAntonio,askedtheimportantquestion:“Whydosomepeoplediewhileothers,whomaybeno less ill,continue to live?”Hefoundthatoneanswer tothis questionmight lie in the presence or absence of hope. During a three toseven year period, elderlyMexican Americans were assessed for hopefulnessand their cases followed. Researchers found that 29 percent of the hopelessparticipantsdied,comparedwith11percentofthehopefulparticipants.That’sadifferenceof18percent!

Dr. Norman Cousins tells us a wonderful story in his foreword to TheInnerHealer.Dr.Cousins hadbeenparticipating in anorganizationknownasTheWellness Community in Santa Monica, California. Organized by HaroldBenjamin, it catered to the emotional and social needs of cancer patients.AccordingtoDr.Cousins, themembersof theWellnessCommunityallsharedoneextraordinaryattribute,whichattracted the tentativebutcurious interestofthe medical community: they had all lived longer than their physicians hadpredicted.

Inonegroupheattended,Dr.Cousinswonderedaloudwhy thatwas so.Onemember,Mrs.A., a graceful, older and “uncommonly beautiful”woman,stoodup.Sherememberedquitevividly,whenher“momentofgrace”hadcome.Shewasinherphysician’sofficeandhehadjustexplainedtoherthatshehadcancer,itwasterminal,andshehadfourtosixmonthstolive.Mrs.A.saidshe

metthephysician’sgazeheadonandsaid,“Gof—-yourself!”Atwhichpoint,Dr.Cousins recalls thateveryone in theroomcheered.Hesays,“Theydidnotdenythediagnosis.Whattheydeniedwastheverdictthatwentwithit.”Atthetime the storywas told,Mrs. A. had livedmore than six years past her “duedate,”andshewasdoingjustfine.

Onewoman,Connie,whohasbeenadiabeticfor32years, toldusaboutherexperiencewithamedicalhex.

“When I was ten years old and diagnosed with diabetes at Children’sHospital,anursecameintomyroomandyelledatmeaboutall thebadthingsthatwouldhappenif Ididn’t ‘takecareofmyself.’Shescoldedmebysaying,‘Onedayyouwillwakeupandjustbeblind.Anditwillhappenjustlikethat.”Andshesnappedherfingers.

“Iwasonlytenyearsold,lyinginbedinmyyellowjammiesandpigtails.The ‘hex’ did incredible damage. I lived in terror of blindness throughoutchildhood,andwellintomy20’s.Whenevermyvisionwasblurryonwakinginthemorning,Iwouldpanic.Iwasanartist,butIwasafraidtochoosethatasacareer, because I thought Iwouldbe blind.Anyway, screwher. I’m forty-oneyearsoldandIstillwonderwhothatwomanwasandwhyshesaidthosethingstome.

“Ididn’tworkthroughthefearuntilIworkedupthecourageataboutagetwenty-five toask the doctor to tellme if itwas possible to become instantlyblind.Itisnot.Retinopathyisaslow,progressive,andverytreatabledisease.

“The hex was very powerful for an impressionable child, because as achildyoudon’tunderstand ’takingcareofyourself.’Youonlyunderstand thatyou are not ever doing what they think you’re supposed to be doing. Andchildrenhavenoonetotalktoexcepttheauthorityfigureswhoinstillthehexes,sowecanquicklybecomeconvincednotonlythattheauthoritiesareright,butthatwearebadpeople.”

Theconsensus,then,regardingwhetheryouhavetolistentoahexornotseemstobewhatNormanCousinshassaidallalong:Acceptthediagnosisanddefytheverdict.Butcanweacceptadiagnosiswithoutacceptingthehex?Yes,accordingtoGaryZukav,authorofTheSeatoftheSoul.Acceptingtherealityofyour situation is a prerequisite to change. Themorewe resist something, themoreitpersists.Whenwedonotacceptwhereweare,webecomestuck.Whenweacceptwhereweare, thequestionbecomes,“Whatnext?”Andasking thatquestionopensthedoortoamyriadofhealingpossibilities.

UsingImagery

Manyhypnotherapists usingguided imagerywith their clients help themdiscovertheirownimages.Someuseinnerguides,whichmaybeanotherwayofelicitingone’sowninnerwisdom.Theguideisaskedforhelpasitaccompaniesthe client, both of thembecoming small enough to slip inside the body to theareathatneedsattention.Inthisprocess,thetherapistnevertellspeoplewhattoexpectorwhattodo,butsimplyasksthemtostayawhilewiththatareaofthebody, listening, touching, feeling, and asking questions. The person is givenencouragementtofollowthefeelingsthatemerge,tostaywiththeimages,andtowatchandseewhattheimagesdo.(PsychologistCarlJungwouldtellpeopleto watch the image until it changed by itself.) The interesting reward is that,wheninvitedto,thatareaofthebodymaytellthepatientexactlywhatitneeds.

The parents of a 13 year-old boy, Jake, dying of a metastasized braintumor, called in psychologist Steve Klein, FMT, a therapist in Encino,California, to help with grief work and to make preparations for their son’sdeath.WhenheinterviewedJake,whohadbeengiventwomonthstolive,Kleinnoticed thathehad“thespiritof life inhim.Hewanted to live.”At that time,Kleinrecalledsomeworkthathehadreadonvisualization,althoughhedidnotyetpracticeithimself.Hebroachedit totheparents,whoagreedthat theyhadnothingtolosebytrying.

Mr. Klein walked Jake through numerous visualizations that involvedJake’s becoming very small, wandering through his body to his brain andnoticing the difference between healthy and cancerous tissues. In their firstsession, Jake stopped the process and said, “Wait! I forgot my shit-kickingboots.”AsJakewentthroughtheprocess,hesawthehealthytissueasredandtheunhealthytissueasgraymatter.Wisely,Mr.Kleindidnotcorrecthim,butallowedtheprocesstorevealitself,trustinginJake’sintuitivebodywisdom.Fortwomonths Jake “kicked the crap out of the tumor,” seeing it dry up and flyaway, with healthy tissue taking over. He practiced this with Mr. Kleinpersonally andwith tapes of their sessions for twomonths. Jakewent back toUCLAHospital for follow-up radiography, andmuch to theamazementofhisdoctors, the tumorhaddisappeared.They scratched their heads and called it aremission.

Timothy Trujillo uses the image of the cocoon for transformationalhealing.Illpeopleareinvitedtoimaginethemselveswrappedwiththespunsilkofthecocoon,whichprotectsandenablesthemtobreathethroughit,whiletheimageofthemetamorphosisofthecaterpillarevolvingintoabutterflyisbeingrichly described. Throughout, Trujillo talks to the cells themselves about thisexperience,andabout thefeelingof impendingfreedom.Howthismetaphorisinterpretedandvisualizedvariesfromindividualtoindividual,butineverycase

thethemeofchange,healing,andtransformationarereiteratedandreinforced.Asyoucansee,guided imagerydoesn’thave tobe literal,orevenmake

anysense,fortheretobethemostprofoundandhealingconnection.One clinician we know works with young adolescents suffering from

cancer.Manyofthesechildrenfeltthattheirliveswerebrokenbytheeffectsofthe disease. So, he asked them to “imagine a picture, broken into a thousandpieces.Now,begintopickupthepiecesandputthembacktogetheragain.”Healsorefersthembacktotimeswhentheyhadsuccessfullyworkedpuzzlesinthepast, reminding themof their ability “to find some strengths you didn’t knowyou had.” While metaphors do not have to be consciously understood to beeffective,theydohavetobemeaningful.Thechildrendidnothavetoanalyze,interpret,orthinkthroughthebrokenpicturefortheactofreconstructiontobehealingonaprofoundlevel.

Since the 1980s what Herbert Benson, M.D. of Harvard, calls therelaxation response, has become very popular. Deep relaxation is most oftenachieved by a combined use of guided imagery and alternate tensing andlooseningoflargemusclegroups.Aneasyapproachwhenworkingwithalovedonewhoisfeelingweakandillandmaynotbeabletovoluntarilycontracttheirmusclesistosimplytalkthemthroughaprogressiverelaxation,imaginingeachpartofthebody,beginningwiththeheadorfeet,andlettingeachpartrelaxinturn.

SpecialFuturePacing:TimeDistortion

Letusfirstmaketheassertionthattimeisnotwhatwethinkitis.Wemayliveinaworldoflineartimeandatomicclocks,buttheuniversedoesnot.Youknowthis intuitively.Whenyou’remiserable, timedrags.Whenyou’re joyful,timespeedsbyfarmorequicklythanyou’dlike.“Putyourhandonahotstoveforaminute,anditseemslikeanhour.Sitwithaprettygirlforanhour,anditseemslikeaminute.That’srelativity,”isthewayEinsteinputit.

Therearetwomainreasonsforutilizingtimedistortiontechniqueswithapatient:toelicitforgottenresourcesandstrengths,andtoinfusethepresentwithhopeforthefuture.

In a classmany years ago,Dr. SidneyRosen sharedwith us a stunningexampleofhowthisworks.Hewastreatinga40-year-oldwomanwhohadhadbothbreastsremovedduetocancer.Hehadherlookatherself inamirrorandseeherself at different phasesof her life; first older, thenmuchyounger, thenolderagain,stretchingandelasticizingherimagination,preparingherselfforhis

suggestion.After having hermove back and forth through her life,Dr.Rosenfinally took her forward 40 years…to 80 years old. He stopped, waited amomentandthensaid,“Andyoucanlookback40years,seeingyourselfatage40,realizingnowthattheperiodaroundage40wasreallyaveryimportanttimein your life: the time when you really began to understand your value, yourmission,whenthingsallbecamesocrystalclearandsomeaningful.”

Whatmakesthistechniquesobeautifulandusefulisthatitdoesnumerousthings at once. It subtly but strongly implies survival and long life aswell assuggestingthatthepatientwillhavefoundmeaninginherstruggle.Itgivesheradistance from the moment that allows her a proper and potentially healingperspective.Itleavesherwithasenseofmasteryandhope.

Timedistortionisparticularlyvaluablewhenworkingwithpeopleinpain.Although we have an entire section devoted to this enormous topic, it bearsmentioning again here. Simple phrases such as, “You may remember a timewhen…” or “You can see yourself ... tomorrow or the next day…” allow thepatient to transport themselves, imagininga timewhen thingswerebetteror atimewhentheywillbe.

Thefuturecreates thepresentasmuchas thepastdoes.Aconfluenceofeventsfromallsidesfeedthismoment,likehiddentributariestoaneternalsea.Howwe imagine our fate is critical to our current state. The opposite of Dr.Rosen’sexampleisthis:“Ihavenohopeandmyfutureisbleak,therefore,Ifeelmiserable today, therefore I can’t get well and have a good future.” Byenvisioningableaklandscapebeforeus,wecreatechemicalsthatperpetuatethatverycondition.

Questionscanusetimedistortionbyplayingwithsyntaxortense,sothatthefutureseemspresent.For instance,youmightaska lovedone,“Andwhenyou’rebetter,what’sdifferent?”“Whenthemiraclehashappened,whatareyoudoingnow?”

Questionscanalsofocusonfantasy,particularlywithchildren.Youmightwonderaloud,“Canyouimaginethelookonthatdoctor’sfacewhenyoutellherthecancer’sallgone?!Orbetter,whenshefindsoutandyouhaven’ttoldheraword?” Imagining the future and telling people what you did to get thereaccomplishes several objectives, but most importantly it makes the outcomeconcrete in the person’smind,making itmore possible. In fact, researchwithhypnosisandperformancesuggests that it is thevisualizationof theparticularsintheprocessthatleadapersontohisgoal,whetheritbehealthoragoldmedal.

TheImportanceofPacinginthePresent

Attheriskofbeingredundant,wewouldliketoremindyoutobeginwiththe ill person’s currentperceptionof reality,whichmaybepainful,miserable,powerless,angry,frightened.Unlessyoumeetthepersonthere,youwillnotbeabletotakethemanywhereelse.FuturepacingbeginswithafootfirmlyrootedinthepresentSomeonehandedusthisnoteafteroneofourtalks.

“Singingcheerfulsongstoaheavyheartisasbadasstealingsomeone’sclothesinthewinter

orpouringsaltonawound.”(Proverbs25:20)

Althoughwemay alwayswish to “cheer them up,” it is pacing and notcheeringthatiscalledforhere.

LendinganEar

Toooftenoverlookedisthesimpleactoflistening:notapassivepresenceor an indifferent “I hear you,” but a real, active listening. What that simpleengagementcanmeanisincalculable,particularlyforpeoplewhohavebeenillfor a long time and are likely see themselves as a burden to others, not tomention to themselves. Asking how another person feels and communicatingyourgenuine interest in that person’s response canbehealing in andof itself.Chronicallyillpeoplearetoooftenignored.Listeningwithcompassioncanhelpthemtobecomepartoflifeagain,andtorealizethattheyarerealandvalued.

PastExperience/Truisms

If you know of some major obstacle the chronically ill person hasovercomeinthepast,remindthemofthatmiracle.Theydiditonce,sotheycandoitagain.Remindthemoftheobvioustruismthatwhenacertainpercentageofpeople have a negative outcome, thatmeans that the other percentage have apositive one. Why should they not be in that positive-outcome percent,especially if they have beaten the odds before? Or perhaps there is a way inwhichtheyhavefeltluckybefore,sotheycancountonthatagain.

Imagery/DialoguewiththeDiseaseEntity

The creative process of imagining a dreaded disease leaving the body isavailabletoanyonewhowishestoexplorethatpossibility.Edie,thewomanwiththe benign brain tumor, pictured her two faithful, deceased Scottish Terrierslicking at the tumor “as if it were a Popsiclemelting on the floor, making itsmaller and smaller until it’s gone.”Others see a vacuum cleaner sucking thecancerous tissue up, or a sorcerer’s apprentice army of dancing brooms, orangelswithfeatherdusters,allsortsofdevicestoclearthewaytobetterhealth.

Stillotherscommunicatedirectlywiththediseaseentityandaskwhattheycoulddotomakeitpossibleforittoleave.Onetherapistfriendofours,DavidLe’Chastaignier,CHT,workedwithaclientwhohadAIDS,and together theyinterviewed the disease entity. The disease, which looked like a yuppie in anArmanisuitandsunglasses,veryarrogantlysaiditwasn’tleavinganditwasincharge.Afteramoregentleapproach,thetherapistremindedit that, if thehostdied, itwoulddieaswell.Thediseaseboweditsheadwhenit realized that itspowerwouldalsobe itsownundoing. “Here’s thedeal,”David andhis clientproposed, “You may stay in this body just like other foreign elements thathumans acquire, but you cannot take over this body’s right to make its owndecisions.Youmay remind [this person] tomakemoreprudent choices inhisbehavior,buttheclientdecidesyourfate.Treathimkindlyandbothofyoucanenjoyalonglife.Doyouunderstand?”

Theydemandedamoreforcefulyesthanthefirstmumbledreplyandthencreatedalegallybindingdocumenttothateffect,committingthediseasetoendits fightwith the immune systemand requiring it to live peaceablywithin theperson. The humbled virus signed the document. Since that dramatic sessionLe’Chastaignierreportsthathisclient’sT-Cellcounthasrisensteadily.

One of our patients,when asked to visualize her cancer, saw it as a redSupermansuit.Itsurprisedherbyaskinghertodance.“WhatshouldIdo?”shesaid. “Are you willing?” we asked. “I am,” she tentatively agreed. As theyslowlydanced,itgaveherabillofparticulars,listingwhatsheneededtodoinorderforittoleave.

Reframing/Meaning/AcceptanceandLearningfromIllness

Accordingtosomepeople,acceptingthediagnosisandowningthediseaseis a prerequisite to healing. They claim that you cannot have power overanything you do not own. There are others, however, who disagree with thisidea,citingtheexperienceofallthepeoplewhoseunrealisticdenialsofdiseasekeptthemaliveandworkingformanyyearspasttheirpredicteddeath.Thereare

numerous cases in point for both sides, and in the end the more meaningfulvariable may be the individual, or what we call the innate wisdom of eachindividual’s unconscious mind. If we are in rapport, lovingly attuned to theother,weareabletointuitthespecificrequirementsofeachsituation.Forsomepeople, fighting the good fight works, both emotionally and physically. Withothers,theirhigherpathistheoneofspiritualsubmission.Wedonotjudge.Weprefertopaceandutilize.

Sometimes people can see thegood inwhat happens to them, and thosewhocanhaveaneasiertimeacceptingandevengrowingfromtheirexperiences.Oneofthereasonsthatwemightwanttobeindirectcontactwithadisease,ortakeownershipofit,isthatitmayhavelessonsorinsightstoofferus.TrujillotalksaboutAIDSpatientswho,inasupportgroup,haveexclaimed,“BecomingHIV positive saved my life!” They had been floundering, lost, and self-destructive before the disease challenged them to awaken and discover theirmeaning, their purpose, and their strengths. We have heard cancer patientsthanking their cancers for shaking themup. If you can see serious illness as awake-upcallandprofitfromthelessonsimplicitinit,thenithasbeenagiftand,byowningit,youcantakeyourlifeback.

Onemanweknowhadasmallstrokethatwasveryfrighteningtohim.Hetemporarily lost the use of his vocal chords, and his right side lost sensation,althoughitcontinuedtofunction.Whenhelearnedhehadsufferedastroke,andthatbecausethebloodvesselsinhisbrainstemwerequitenarrowhewouldhavetotakebloodthinners,hewasdiscouraged.Whileinthehospital,hisheartwastestedanditwasthenthattheydiscoveredthathehada70%blockageinoneofhismajor coronary arteries.Hewas awalking timebombanddidn’t know it!Suddenly, everything appeareddifferent tohim.Nowhe saw the stroke ashisbody’swayof trying togethisattentionso thathecouldhave theangioplastythatcouldsavehislife.

Scenario

Yourfriend,Marsha,hasbladdercancer.Youandshearespendinganice,easy-going afternoon together, inwhich you have talked ofmany things. Sheseems contemplative, and you think this might be a good time to open thisconversationuptothemeaningoftheillness.

“So,” you say, leaning back, “someone onTVwas talking about ‘organlanguage’theotherday.”

“Organlanguage?”

“Yeah, like someone’sheart isbrokenand then theyactuallyget aheartattack.”

“Yeah,Ithinkapersoncoulddieofabrokenheart.”“Me,too.”“Mmmm.”“Whatdoyouthinkbladderproblemsmeans?”“Idon’tknow.”Shethinksaboutit.“Pissedoff,Iguess!”shelaughs.Then

shebecomesquiet.“Yeah.Pissedoff.Andtryingtoholditin.”“Holdwhatin,whatwouldthatbe?”youmightask,goingalong,andthen

suddenlyyoumightbethere, insideherbladderwhereasceneisplayingitselfoutandshehasachancetoaskitwhatitwantsofherandwhatit’sdoingthere.Withoutplayingtherapist,youmightsimplywonderaloudwhat,ifanything,thediseasewouldhavetosayforitselfifitcouldspeak.Thiscanbecomethetriggerfor a guided visualization, if you are comfortable with that, and whateverdirection this takesclearlyneeds tobepacedto theattitudeof thesickperson.Also,wordsarejustonewaytodevelopthiscommunication.We’vefoundthatdrawingsworkverywellwithchildrenandwithvisuallyimaginativeadults.

If this process opens up something that needs to be resolved with atherapist,youshouldmostdefinitelysuggestthat.

Martin, a 50 year-old architect, discovered he had a large tumor in hischest.Beforehisillness,hehadlivedlifewithinnarrowparameters,dictatedbyworkandbytheexpectationsofhisdomineeringfather.Incontrasttohisfather,whowaswithholdingandjudgmental,Martin’smotherembracedlife.Martin’sown relationships, particularly with his wife and children, were stiff andestranged. His heart was closed. The advent of this illness provided a greatawakeningforMartin.Herealizedthathehadmodeledhimselfafterthewrongparent and proceeded to make dramatic changes in his life. In fact Martinbecamesogratefultohisillnessthathewashesitanttogiveitup.Hewondered,“Ifthecancerwentaway,wouldthejoyleaveme,too?”

Knowing thatsomepeoplemayfeel thisway, itmighthelpful toask thequestion, “Now that the illnesshasbroughtyou to this stateof awareness, areyou willing to let it go and remain joyful?” If the answer is “no,” to thatquestion,youmightalsoaskthatperson,“Woulditbeokaytokeepthecancerand stay symptom-free?” Most people will agree to stay asymptomatic. Aswe’ve seen, the unconscious mind may also agree and make the appropriateadjustments.

Sometimes there is a secondary gain, another reason to hold on to the

illness. Often, that motivation is not accessible to our conscious minds. Forinstance, that ‘flu you getwhen you’re just too busy to go to bed but shouldreallyslowdowncanbeawayofgivingyourbodywhatitreallyneeds.Ifithadbeenup toyourconsciousmindyouwouldhavechosenaweekonabeach inHawaii forR&Rrather thanaweek inbed,but thismighthavebeen theonlywayyourunconsciousmindcouldenforcetherest.So,althoughthesedecisionsmaynotbemadeonaconsciouslevel,whenthatmotivationisbroughttolight,wemightalsofindawillingnesstochange.

FightingtheGoodFight

Forsomepeople, thelanguageofchallenge,battle,victoryorgoingonamission, reflects amodality fromwhich they generally operatewhen they arewell.Afighterpilot,asportsman/woman,achessmaster,someonewhoenjoyscompetition,mightbenefitfromseeinganillnessastheultimatechallenge.Wehave a friend, Toni, who is an energy healer in San Francisco. When shedevelopedbladdercancer,weworkedwithguidedimagerytoreducethetumor’ssize by half. After an operation, she found that the cancer had metastasized.Cancerouscellscouldnowbe identified inher lungs,brainand lymphsystem.Because she had experienced the healing power of attitude with her formerclients, and because it was her nature, she decided that she could outwit thisdisease,figureouthowtohealherselfandbringbacktheanswerstoallthoseinneed.

Toni’s attitude andoutlookhas donemore thangiveher a numbergoodyears. It has given her the strength and curiosity to investigate alternativetreatmentmodalities, each ofwhich she has found “interesting,” regardless oftheir discomfort level. It has reinforced an extraordinary hopefulness and acompetitive spirit that says, “Iwill find the answer—formyself and for otherpeople.”Sheisindomitableinthetruestsenseoftheword:shehaslivedmanyyears longer thananyonepredictedandshehasdone itwithvitality, love,andlaughter.

The Verbal First Aid techniques you use, then, can vary dramaticallydepending on the person they are intended to help. With a fighter who isnaturally enthusiastic, assertive, and risk-taking, the appeal ismade to action.TheVerbalFirstAidwordsusedhereshouldbeverbsthatimplyself-directionandgivetheyoungmansomethingtodoaboutthesituation:“Beatthisthing…”

“callinthetroops…”“emergevictorious…”“win…”“takecharge,”etc.

TheEmotionalCourseofChronicorLife-ThreateningDisease

Evenafighterwillhavemomentsofanger,fear,sadness,andresentment—as do almost all people suffering from chronic or life-threatening diseases.Therearemomentswhen thekindest thingwecando isnothing, allowing theotherperson tosimplybewith their feelings.Weneed to remember thatwhenpeopleresisttheirpain,itpersists.Theacknowledgmentofafeelingallowsittobeprocessedandtoeventuallyrunitscourse.

There isa five-stageprocess thatwas first codifiedbyElizabethKubler-Rossinherworkwiththedying,whichwasthenrepresentedintermsofchronicpain by Rita Cowan, Ph.D. in her bookChronic Pain Solutions.Most peopleexperiencing grief may go through these stages at some point (denial, anger,bargaining,depression, andacceptance), thoughnotnecessarily all of them, inexactly the same order or at the same pace. We grieve in many differentsituations:over the lossofa lovedoneorover thechange inourown leveloffunctionorduetofallingshortofourdreams.Seriousillnesschangesaperson’slifeandgriefmaybenecessaryforhealing to takeplace.What is important intermsofVerbalFirstAidistorememberthereisnorightwaytomovethroughillness.Pacingpeople—beingtherewiththemastheyridethroughtheupsanddownsisagentle,yetpowerfulgift.

Simple phrases, “I know”, “I hear you,” “I’mwith you,” “That’s reallyhard,”“That’sscary,”“I’msorry,”echodeepandwide.Nods,hand-holding,agentletouchofthehandcanletapersonknowthatyouunderstand.Sometimesitmakessensetosay,“You’resobrave,”andatothertimes,“Youdon’thavetobebrave.”It’sallinthepacing.

GivingUpToGrace

What if someone, even a fighter, has had enough?What if there is norecourseandnothingfurthertodo?Ifthatisthecase,therearestill thingsyoucansay,evenatthispoint,tofacilitateahealingthatonlydeathcanbring.WhatVerbalFirstAidoffersinthisareaiscompatiblewithmostreligionsandbeliefsystems,andweexplorethisissueindetailinChapter12.

Ultimately, however we die, who we are is defined by the grace withwhichwelive.Debilitating,chronicandlife-threateningillnessesaskmuchofus

in thewayofpatience,stamina,andheart. Ifourwordscanhelplight thewayforreliefandsolace,weareall,inthatsmallbutprofoundway,richer.

I“Themindisitsownplace,

andinitselfcanmakeaheavenofhell,ahellofheaven.”--JohnMilton

nthemovieWhoseLifeIsIt,Anyway?theprotagonisthasbecomeaparaplegicdue toanaccident,and inhismiserywants todie.When thedoctors refuse tocomply,hegoestocourtandappealstothejudge:“Youcan’tdamnmetoalifeoftorment[just]becauseyoucannotseethepain.There’snoblood,there’snoscreaming,soyoucan’tseeit.”Thatdoesnotmean,hegoesontosuggest,thatitisn’tjustasreal.

To many people, though not all, emotional pain—fear, anger, anxiety,grief, confusion—is invisible and therefore not real. Broken bones, bloodynoses, blisters and burns, diseases: these we understand because we can seethem.Brokenhearts,brokenwills:thesearenotsoobviousand,asaresult,notso easy to understand.With no bandages that can staunch the flow from thewound, and—unless the situation reaches a critical point, generally no use incalling9-1-1—whensomeone is suffering in the throesofemotional illness, itseemsthat thereisverylittle thatwecandotomakeitbetter.Theonlythingsthatseemtoeven touchemotionalconditionsarecertainpharmaceuticals…andwords.

The techniques discussed in this chapter illustrate the therapeutic use ofwords to deal with specific situations: anxiety, panic attacks, post-traumaticstressdisorder,anddepression.TheexamplesweusewillgiveyouanoverviewofVerbalFirstAidtechniqueinemotionalsituations.Becauseeachsituationisdifferent, you will benefit most by understanding the techniques and thenapplyingtheminyourown,improvisedwayasthesituationsarise.Thisisnotasubstitute for psychotherapy or other medical treatment; it is a usefulcomplementtothattreatment,especiallywhenthingsseembleak.

Weareafix-itculture.JustDoIt!isaNikeslogan,butitcouldjustaswellsum up the thinking that permeates our time. Unfortunately, debilitatingemotionsarenotreadilysetright.Theyarenotevenreadilyacknowledgeduntiltheybecomeparalyzing,oraffectourabilitiestoworkorfunctionintheworld.Emotions,however,are real.Thoughtsarereal.Fear,pain,anger,sadness—allof these are real.And, aswe’ve seen, these emotions and thoughts are so realtheymanifestthemselvesinourphysicalbodies.Infact,theyhavephysiologicaloriginsandconsequences.

Whatdowemeanbythis?Well,howdoyouknowyou’refeelinganger?Howdoyouknowyou’resad?Howdoyouknowyou’reafraidofsomeoneorsomething?Whataretheindications,specifically,whichalertyoutodangersothat you walk down the middle of the street and avoid dark corners andalleyways?Whereinyourbodydoyoufeelit?

In the human experience, feelings are registered in the body.Of course,where they registerdependson the individual.Toexperience this foryourself,youcantryalittleexperiment.Asyoureadthis,“goinside”yourselfnowandimaginesomethingfrightening,amomentwhentimestoodstillandyousenseddanger. It could have been a nightmare, or themoment you realized that youwerestandinginadarkparkinglotaloneandyouheardfootstepsbehindyou,oratimewhenyouwereverylittleandsomeonelefttheclosetdooropenandyoucouldn’treachthelight.Youmaybesurprisedtodiscoveryourthroattighteningor your stomach knotting or your heart beating faster right now.What if youimaginedasadmoment,amemorythatmovesyoutotears,agoodbyeyouwishyouneverhad to say, ahandyouhaven’t held in a long time—where inyourbodydoyouholdthatsadnessandthatmemory?

Emotions—allofthem—arenotabstractintellectualconstructs.Theyhavegravity.Theypullonus,atughere,areleasethere.Wefeeltheirweight.Theymoveus.Thoughinvisible,theyhavemorepowerthanourconsciouswill.Theycanundoourbestintentions—tosticktothatdiet,ortocurbourtempers—andtheycanpushustoovercomethelimitssetbyfearorconditioning.Whenwedonotgivethemadequateventilation,orrespect,theyexplodelikeatrappedgas,or

leakindangerousways.Emotions—like the words and thoughts that inspire them—can lead to

health or harm. “Type A” or driven and aggressive personalities have beenlinkedtocirculatoryandheartdisease.“TypeC”orrepressedpersonalitieshavebeen associatedwith some types of cancers.Whatwe say, then, in emotionalcrises,canmakeadifferencebychangingthenature,theshape,thesizeandtheimpactofthoseemotions.Whenanemotionshifts,thebodyfollows.

VerbalFirstAidforEmotionalConditions

In the following sections we provide tools—strategies and scripts-forunderstandingandspeaking topeople inemotionaldistress.Emotionaldistresscan put people into the same altered states or healing zones they experiencewhen they are inmedical crisis. In the healing zone, their autonomic nervoussystemsareaccessibleandresponsivetosuggestion.VerbalFirstAidtechniquesarenotaquickfix,andcanneversubstituteforadoctor’sattentions.Theyare,however, a way to provide a calm center and begin the movement towardhealing.Attheveryleast, theyareapowerfulreminderofthethingsweoughtnottosayandtheresponsibilitytodonoharm.

Becauseemotionalconditionsare so individual,VerbalFirstAid ismostuseful when you internalize its intention and its process. Once you haveestablishedrapport,youwillnotneedthescripts.Bornofempathyanddesiretohelp,therightwordswillemergeatpreciselytherightmoment.

ANXIETY

“I’vedevelopedanewphilosophy...Ionlydreadonedayatatime.”CharlieBrown(CharlesSchulz)

“Anxietyisathinstreamoffeartricklingthroughthemind.Ifencouraged,itcutsachannelintowhichallotherthoughtsaredrained.”

ArthurSomersRoche

According to theNational InstituteofMentalHealth,more thannineteenmillionAmericanssuffer fromanxietydisorders.Worldwidestatisticsmaynot

be available, but it is clear that modern life invites anxiety, both through thefrustrations it creates and through toxic substances in the environment thatcontribute to malfunctions in our nervous systems. Anxiety disorders caninvolve irrational thoughts and fears, compulsive behaviors, nightmares, andphysicalsymptomsthatcanbedebilitating,andcanroblifeofitsjoy.

Webeginwithnightmaresandchildhoodfearsbecausewehaveallbeenthere, small and seemingly powerless to control events around us. Everythinghadthepotential tosurpriseandfrightenusthen,andwewereat themercyofadultsinourliveswhomightormightnotprotectus.Childrenliveinaworldinwhich the separationbetween imaginationand reality isnotclearlydelineated.Forthisreasontheyareespeciallyreceptivetosuggestionandguidedimagery—muchmoresothanadults.

Nightmares

Atsevenyearsold,Joeyisalittlesmallforhisageandhehashadafewrun-inswithbulliesintheplaygroundatschool.Onenightintheearlymorninghours,the“monsterunderthebed”growls.Thereisnomistakingit;itrattlesthemattressandshakeshimawake.Hethinksofrunningtohismotherandfather,buthislegswon’tcarryhim.Hecannotcatchhisbreath,hisfeetandhandsaresweating,andhismouthisdry.Heisparalyzedwithfear.Finally,heletsoutashriekthatbringshismotherandfatherrunningintotheroom.Theyturnonthelight.His fathersays,“What’s thematter?”Hismother runsover tohim.Joeywhispers“Monster…,”andhisfatherrealizesthatJoeyhashadanightmare.HeapproachesJoeyandsitsdownonthebed.HetakesJoey’shandandsays,“TellmeabouttheMonster.”

PacingandSolicitingTheirHelp

Instead of dismissing Joey’s concerns as childish or “only a dream,” hisDadpacesthefear.“That’sreallyscary,”henodsasJoeyrelatestheshakesandgroans. Then Dad explains, “I know all about Monsters because I had themundermybedwhenIwasaboyyourage.”(Aformof“Iknowaguywho…”)“Youdid?”“Yes,andI’mgoingtogetridofthisonethesamewaymydaddyshowedme.Somedayyou’llbeabletoshowyourchildrenhowtodoit.ButfornowIneedyourhelp.I’llgetthebroom,ifyou’llholdtheflashlight.”

Pacing can take the simplest form: “I know you’re afraid,” or, “That is

scary.”Otherexamplesmightbe:“You’rebreathingseemstobecalmingdown,now,”yousay,asyoubreatheinrhythmwiththechild.(Fordetails,pleaserefertoChapter6,TherapeuticSuggestion.)

SolicitingTheirHelp is a techniquemostmothersknowby instinct—thebestwaytohelpchildrenistoengagethem.“WhileI’mgettingthemonstersoutof thecloset,youcanhold theflashlight.”“YouholdontoMaxtheBear,andmakesureheisn’ttooscared,whileIputonthelight.”Solicitingthehelpofthepersonintheanxiousstatestructurestheiremotionalexperienceandgivesthemasenseofcontrolsothattheirfearsaremoremanageable.

Oneofthemostusefulwaystodealwithmonstersunderthebed(orintheclosetortheshadowsortheattic)isfortheadultandthechildtosimplyaskittoleave.Thiscantaketheformofaverbalrequest,ashooingawaywithabroom,orabanishmentceremony.Anynumberofspiritualtraditionshavefoundgreatvalue in ceremonies not sodifferent from these.Fantasy and ceremony are anintegral and delightful part of a child’s inner life and growth; therefore aceremonytobanishthemonstercanbeimaginative,loving,andeffective.

Alternatively, you can provide children with a magic object that is“guaranteed to repelmonsters:” a teddy bear that guards the bed, a stone thatkeepsawayevil,acrucifix,aStarofDavid,orwhatevergivesthemasenseofsecurityand supports a feelingof theirownpower.No longerat themercyofmonsters, theycanbegin todevelop feelingsof independenceandcompetencethatcanspilloverintootheraspectsoftheirlives.

Joey’s discussion with his father about the monster can also providevaluableaccesstoJoey’sinnerlifeandthefearsthatgavebirthtothemonsterinthe firstplace. If thenightmares comeoften,or if the fears thatunderlie thembegintoaffectJoey’sdailylife,thenhisparentwillwanttoseektheservicesofatherapistspecializinginchildren.

FuturePacing

Fears emerge from feelings of helplessness. If Joey thinks he is at themercyofmonstersunderthebed,hewillhavetoliveinfearofthem.WhenDadsays,“Mydaddyshowedmewhat todo thesamewayI’mgoing toshowyounow.And someday you’ll be able to show your children how to do it,” he ismoving Joey out of powerlessness in the present to a time when he will becompetent to deal withmonsters. To reinforce that point he could add: “Andnowthatyouknowthesecret,you’llbeabletogetridofmonsterswherevertheymightbe.”

OtherChildhoodFears

As most children do, Joey has given his fear a face, which Dad canmanipulateinJoey’sbestinterest.Ithasbeennotedthat,atleastuntiltheageofseven,children’sbrainwavesregisterinthealphaandthetarange,ratherthaninbeta(theconsciousstateinwhicheveryday,adultconversationisheld).Childrenareoften inaltered states,whichmakes themvery receptive to suggestion, forbetterorforworse.Theircreativityandsusceptibilitygiverisetobogeymeninthefirstplace.Itcanalsomakethosemonstersdisappear.

EstablishinganAllianceandGettingaContract

Allhelpingrelationshipsrequirebothanallianceandacontract—whethertheyarearticulatedornot.WhenJoey’sfathercomesintoJoey’sroomandsays,“Daddy’shere.I’vegotyouandyou’resafe,”he’sautomaticallyestablishinganalliance.Anystatementthatconveys,“I’mcapableandI’mheretohelp”beginstheVerbalFirstAidprocess.Gettingacontract,asyoumayrecallfromChapter4,simplyreferstosecuringtheperson’sagreement:“WillyoudoasIsay?”Tothe small child trembling with fear because of imagined monsters, you cansimply say, “Mommy’s here, baby, and I’ll protect you. I’ll take care of themonstersandyoucanliebackdownandfeelsafe.Willyoudothat?”Ifthechilddoesnot agree, this justmeans that thequestionneeds tobe rephrasedor thatanothercontractneedstobemade.Somechildrenarehelpedtofeelsafewhentheyactivelyparticipateinthemonster’sdeparture.Whenyousolicittheirhelp,youare,ineffect,gettingacontract.

Pacing

Perhaps what is most often forgotten--and most often needed--whendealing with a child is the importance of validation, which can be mosteffectivelyexpressedaspacing.Whenweacknowledgeachild’spointofview,evenifitseemsillogicalorabsurdtous,weearntheirtrust.Thisvalidationdoesnotpromoteorincreasethefear.Youarenotbuyingintotheiranxiety.Youarejustmeetingthemwheretheyare,andwalkingtogethertoasaferplace,handinhand.

Scenario

Youarestrollingdownthestreetwithyourfour-year-oldsonwhenalargedogboundsuptothefenceandstartleshimwithaloudbark.Yoursonjumps,grabsyourpants,holdsontoyourlegsfordearlifeandstartstoscreamatthetopofhislungs.Thisgetsthedogmoreexcited,soitbarksevenlouder.

Whattodo?Theobvious.Pickupyourchildandmoveawayfromthedog.Even thoughyour son’s reaction isdramatic, it isnot foolish tobeafraidof alarge,unfamiliardog.Asanadult,youknowthefencewillkeepyousafe.Youknowwhatyouneedtofearandwhatyoucandismisswithashrug;yourson,nothavingtheadvantageofyourlife’sexperience,doesnot.Hisstartleresponsehasunleashedacascadeofadrenalchemicals.Now,he’scaughtupinthetorrentofemotionstheytrigger,whichloomevenlarger thanthescarymomentitself.Hedoesnotyethavetherealitytestingnecessarytoputontheemotionalbrakes.Hecan’tsaythethingsheneedstosaytohimself,yet.

What to say to him, then?First things first: affirmhis experience.He isfrightenedandyes, indeed, thatwasscary.Youragreementwithhisemotionalstate is the beginning of its resolution. You are being reasonable andcompassionate.Youarethereforetobetrusted,andwhatyousaynextwillcarrymoreweight.

MOM

Boy,thatwassomeloudbark.Ijumped,too.

SON

(Wailing)

MOM

I’mrighthere,baby.AndI’vegotyou.Andyou’resafewithme.FeelhowI’vegotmyarmsaroundyou?Feelhowhighyouareofftheground?Howsafeyouare?

SON

(Snifflesandnods.)Doggieyell.Doggieyell.

MOM

Doggieyelledloud.Butyouyelledlouder.

SON

(Snifflingless,helookstowardsthedogandtakesadeepbreath.)

MOM

Oh,thatwasagoodbreath,sweetie.Goaheadanddothatagain,realslowforMommy.Good.

SON

(Snifflesless.)

MOM

Didyouseethatfence?Doyouknowwhyitwasthere?

SON

(Shakeshishead“no.”)

MOM

Tokeepyousafeoutsideandthedoggiesafeinside

SON

Doggieyelledloud.

MOMYes,andthestrongfencekeptyousafe.

Mom moves a step or two closer to the fence as she says this, slowlydesensitizinghersonandteachinghimhowtoassessdanger.Notice,too,heruseof “yes, and.” Insteadof denyinghis observationby saying, “Yes, but,”Momsaid,“yes,and,”whichmeans“youareright,andnowyouknowonemorethingthatwillhelpyou interpret theworldmore fully,”maintaining the rapportandmovingthechildtowardgreaterunderstanding.

If your sonordaughterdemonstrates symptomsofpanicorhas a strongphobic response, or has repeated episodes of anxiety even after you’ve usedthese techniques to calm them down, please be sure to consult with aprofessionalfortreatment.

VerbalFirstAidKeyNightmaresandOtherChildhoodFears

Establishalliance/authorityGetacontractSolicithelpJoininYes,andFuturePacing

PanicAttacks

Whenwegrowupwebecomeprettycertainweunderstandtheworldandhowitworks.Butunderneathweremainvulnerable.PerhapsyouidentifiedwithJoeyinthelastsection.We’veallbeenthere,andsometimeswegotherestill.So what do you do for an adult when the “monster” is a panic attack, anoverwhelming fear thathits in themiddleof theafternoon, thatnobroomwilldriveaway?

Jane,a39year-oldwoman,ayoungpartnerinaprestigiouslawfirmandtheveryimageofNewYorksuccess,cameintoourofficewithaproblemthatpuzzledher.“LastFriday,”shesaid,withonly thefaintest tremor inherupperlip, “Iwas standing behindmy desk, going over some lastminute notes on abrief…and I don’t knowwhat happened.Oneminute Iwas breathing and thenext minute I couldn’t catch my breath, I started sweating; my heart waspoundinglikeitwasgoingtoburstoutofmychest.IthoughtIwasgoingtodieand Ididn’tknowwhat todo. Iwasgoing tocall9-1-1,but Ididn’t. I forcedmyselftowaituntilIcalmeddown.Iwenttoseemydoctorandheranallthesetests,buttherewasnothingwrongwithme.Atleastthat’swhathesaid.Ihaveneverbeensoscaredinmyentirelife.Andthisweekithappenedagain.Outofnowhere.IfeellikeI’mlosingmymind.”

People suffering from panic attacks are overwhelmed by what theyexperienceand,oftentheexperienceisaspuzzlingandinexplicabletothemasitseems to an observer. They suffer sudden, overwhelming fears, rapid pulse,palpitations, nausea, tremors, perspiration or some combination of thesesymptoms.Theycan’t catch theirbreath. It isnotuncommon tohear, “This isridiculous. There’s no reason for me to be feeling this way!” from the verypersonwho’shaving thepanicattack.However,when theyhear someoneelsesaythosewords,evenwhenitechoeswhattheythemselvesarethinking,itcanaggravatethesituationandmakeitworse.

EstablishEmpathy

Inemotionalsituationstheremaybenowayyoucanfixtheproblem,andeven the act of trying can frustrate both you and the person who is hurting.However,thewordsyouusecanhelpthepersongainsomeequanimity,perhapslongenoughtoseekhelp.VerbalFirstAidprovidesyouwithtools topromotecalmandoffertemporaryreliefinthemoment.

Youmustbecarefulnottobecondescending,nottoplaytherapist,andnotto change the relationship you already have with this person. Be yourself. Itgivesyouinstantcredibility.GoodVerbalFirstAidgoesbeyondanytechnique,

beyondanyscript.Itisacompassionateandpersonalresponsetoanotherhumanbeinginneed.

A person who suffers from anxiety also suffers from a sense ofhelplessnessandalienation.Thisisaverycommonpostureforthosewhosufferfrom post-traumatic stress, which is an anxiety-based disorder. This is why“cheerup!”or“getoverit!”arenotonlyineffective,butserveasfurtherproofthatnoonecouldpossiblyunderstand.

Often,ofcourse,theseextremeemotionsarenotsimplymentalprocesses.They are part of the mind/body continuum. Biochemical processes, such asfluctuationsofbloodsugarduetohypoglycemiaortheimbalanceofoxygenandcarbondioxideinthebloodstream,cancauseemotionalresponsessuchaspanicorsevereanxiety.Neurologicalepisodesandphysiologicalbrainanomaliescanbe responsible for erratic, dangerous, even self-destructive behaviors. Westrongly recommend that all avenues—both medical and psychological—beinvestigated for the relief not only of thosewho suffer, but also of thosewholovethem.

Presence

Whatcanyousaytopeopleinthethroesofpanic?WhethertheirfearhasbeengeneratedbyanoverproductionofCO2intheirbloodstreamoradropinserotoninlevels,orwhetherthey’vehadanawfulnightmareandcan’tgetbackto sleep, there are several ways to approach a person, gain rapport, and givethemasuggestionthatcalmsthemdown.

Sinceoneofthemostdebilitatingaspectsofapanicoranxietyconditionisthefeelingthatoneisaloneandmisunderstood,themostimportantthingwecandoisbefullypresentandcaring.Thesequalities,asyoumayremember,aretheessential elements of gaining rapport. Almost all our patients suffering frompanic attackshave expressedoneversionor anotherof thenotion; “At least ithelpsjusttohavesomeonewithme.”Yourpresencecanbeanenormoushelp.

SeveralpeopleweknowwhowitnessedthehorrifyingeventsofSeptember11thouttheirwindowsandcouldn’tteartheeyesfromtheterrifyingsightwerefrustratedasphoneconnectionsfailed, leavingthemalonewith their fears.WeknowoneyoungwomaninNewYorkduringthecatastrophewhoexchangede-mailswithafriendinanotherstateeveryhalfhourthroughouttheterrifyingday,providingsomesenseofcommunionwhendestructionseemedtobetearingherworldapart.

Beforeyousayitwithwords,yousayitwithyourpresence.In the1995

movie,“Restoration,”setinthecourtofCharlesIIinLondon,RobertDowney,Jr.playstheyoungphysicianRobertMerivel,overwhelmedbythesufferinganddeathinthewakeoftheBubonicPlague.Manypeoplearedrivennearlymadbytheconditions,andMerivelhelpssomeofthemrecover,saying“Icanoffernocurebutmypresenceamongthem.Icanofferthemhope.”

Inpanic,apersonis inahypersensitive,hyper-awarestateandcansensewith uncanny precision exactly what you’re thinking, feeling, and assumingaboutthem.Ifyoucanallowyourselftocallupyourempathy,toputasideyourcriticaljudgmentandjointhepersonwherevertheyareinthemoment,youmaydiscoverthatyourlevelofunderstandinghasamplified.Attheveryleast,you’llbegainingrapportbymoving towards the techniqueofpacingand joining thepersoninhisorhercurrentstateofmind.

Pacing

WhatifyouhadbeenwithJaneinherofficewhenshehadherfirstpanicattack?Unlessyouknewforcertain that shehadahistoryofpanicattacks,oryouhadaveryagoodreasontosuspectone,youwouldcall9-1-1,because,withthesymptomsshedescribed,shemightbehavingaheartattack.Assumingthenthat you and Jane are friends, and that she has told you about her last panicattackandthedoctorgivingheracleanbillofhealth,whatdoyousaynow?

YoumightapproachJanewithanopennessthatallowsforwhateversheisfeeling.Imaginethatyoucanfeelit,aswell.Ifshesays,“Ican’tbreathe,”takeher hand and breathewith her, just as if shewere suffering an asthma attack.Help her to sit, if she’s standing, and sitwith her. If she says, “I don’t knowwhat’s happening, it just suddenly came over me,” a simple nod ofunderstandingcanletherknowshe’snotaloneinthis.Shemightsay,“IfeellikeI’mdying,”inwhichcase,youmayrespond,“Tellmewhatyou’refeeling,”or“Tell me what’s happening.” As she tells you, you can listen, nod, makesympatheticsoundsofagreementandunderstanding.Youcanalsorepeatwhatshehassaidtoyoutoconfirmthatyouunderstand.Rememberthatpeopleinthisstatemaynotrecallwhatthey’vesaid,sowhenyourepeattheirwordsbacktothem, theymay feel that youhave read theirminds and are especially in tunewiththemintheirtimeofneed.

Examplesofpacingare:

“Icanseeit’shardforyoutogetcomfortable.”“It’sshockingtogetblindsidedlikethat.”

“Iknowyou’rescared.”

Anexampleofrepeating/mirroringwouldbe:

JANE

IfeellikeI’mdrowning.It’ssofrightening.

YOU

(Nodding)It’sveryfrightening.

Sometimeswecanpaceapersonbybeingon the samepage; that is,bysharing ideas or beliefs in common, we create a bond that can make theacceptanceoftherapeuticsuggestionthatmucheasier.WerememberanincidentwithayoungmanweknewwhowasabouttoleaveforChinatofulfillhislife’sdream of studying the martial arts with his master. A few days before thismomentousdeparture,hehadreachedunderahousetorescueacat.Notwishingtobecaught,thecathadbareditsclawsandscratchedtheyoungman,injuringhis elbow, which became dangerously, painfully swollen. It seemed quiteinfected,and,attheveryleast,theyoungmanwouldhavetobehospitalizedinordertohavetheelbowdrained.Hewastakentotheemergencyroomofalocalhospitalwherehesatforhourswaitingtobeseen.

The combination of waiting, the bad timing in regard to his trip, theinflammation,pain,andconcern,alongwithhislifelong,morbidphobiaaroundinjectionshadcausedhimtoworkhimselfupintoafranticstate.Peoplearoundhimtriedtoencouragehimtorelaxbysaying,“Everythingwillbeallright,”and“Don’tworry,”butthosewordsdidnotevencomeclosetodefusinghisintenseresponseandallowinghisbodytoparticipateinthehealingprocess.

Hismothercalledustohelp,andwhenwearrived,wetookhimoutsidetoourcarwherewecouldbealone.Seeingthathewasalreadyinanalteredstate,wetalkedwithhimalittleabouthisinterestinAsianloreandthenrecitedtohimthewords from theBook of the Tao. “Whenwe knowwhowe really are,wenaturallybecometolerant,disinterested,amused.”Hisfacecalmedandwetookhimthrougharelaxationvisualization.

Thenextday,whenwecalledhimtoseehowhewasdoing,hesaidthatthe surgery had gone very well. In fact, he said, oddly enough, he had beenamusedby thewholeprocess.The staff,he said,had thoughthis reactionwas“inappropriate,”butitworkedforhim.

Itislikelythathedidnotevenrememberhearingourwords,but,becausehewas in an altered state and trustedus becausewe sharedhis interest in theAsianculture,oursuggestionshadaprofoundeffect.Asaresult,theprocedurewentsmoothly,andherecoveredintimetoleaveforChinathatweek.

PayingAttentiontoDetails,Non-VerbalTechniques

Someofthebestpacingwehaveeverseenwithanxietysufferershasbeennon-verbal. If they are walking back and forth between the kitchen and thecouch,walkwiththem,makingsuretogivethemtheirspace.Watchtheirbodylanguageforcues.Iftheymoveawayfromyouyou’restandingtooclose.Asinthescriptforasthmaattacks,youcanpaceaperson’sbreathing,gentlyleadingthemtoslower,smootherbreathing,knowingthatifyoucanhelpthemchangeone aspect of the anxiety attack, you’ve given them an important sense ofcontrol.Youcanpacetheirlanguageandtheiractionsatthesametimesolongas they are safe, tappingyour fingerson the table in timewith theirs, shakingyourfeetnervouslyasyouspeak,justastheydo.

Keep inmind that thepurposeof pacing is to gain rapport andpave theway for therapeutic suggestion. The key to its success is understanding, notmimicry.However, an observant eye is very helpful. By noticing details—thecolorof thecheeksand forehead, the skin’smoisture,breathing rate—youcanfeedthembacktothepersonasmarkersofimprovement.Italsoletsthemknowthatyouarereallywiththemandpayingthemcloseattention.

Forinstance:

“Yourbreathingissmootherandslowerthanitwasjustafewsecondsago.”“Thecolorinyourfaceiscomingbacknow.”

When you pay attention to details, youmay also knowwhen to offer atissue,acupofwater,orawalkoutsideinthefreshair.

“Itlookslikeyoumayfeelabitwarminhere[noticingherperspiring]andit’sacool,drydayoutside.Whydon’twegoforawalk?”

Truism/Imagery/FuturePacing

Whatmakesanxietyorpanicattackssodisruptiveistheirunpredictabilityand their overwhelming intensity. A person will often not know when, how,why,orwhereapanicattackwillstrike.Asaresult,theybecomegenerallymorefearfulandvigilant.

Knowingthattheunknownwasoneoftheprimaryfactorshispatientshadtodealwith,onedoctorusedthe truism techniquecombinedwith imageryandfuturepacing for talkingdownanxietyattacks.Apatientcalledat11:30P.M.,gasping forbreath, terrified.Afterhe reestablished rapport and ruledoutotherpotentialproblems(heknewthepatientwell),heengagedher in thefollowingdialogue.

DOCTOR

Tellmewhat’shappening,now.

PATIENT

Istillcan’tbreathe.Oh,God.Oh,God.WhatamIgoingtodo?

DOCTOR

Tellmewhenthisstarted.

PATIENT

I was sleeping. My nose is all stuffed and I couldn’t breath right, Iguess.Idon’tknow.Ijustcan’t…Ican’tgetittogether.I’msweating.IfeellikeIhavetogotothebathroom.Mystomachiscramping.

DOCTOR

DOCTOR

Panicattackscandothat.

PATIENT

Idon’tknow.Idon’tknow.Oh,God…Ijustwantthistostop.

DOCTOR

Panic attackshave anatural life span, youknow; they canonly last aspecific amountof time…andnotbeyond that.Usually15-20minutesorso.

PATIENTWhatdoyoumean?

DOCTOR

Assoonasapanicattackhasbegun,itisstartingtoend….Soyoucanstartcountingdownnow.You’llnotice that it’sstarting towinddownasyoubreathe,andeachbreath isbecoming justa littleeasier.Noticethat you are breathing easier now thanwhen it began.Youmay evenbegin to notice the end in sight, how much easier and softer you’rebeginningtofeelalready,astheoxygeninyourbloodreturnstonormallevels…

What the doctor did in this example was to offer his patient a piece ofinformationthatshecouldclingto,andusedittodirecthertoafuturestateofcalmthathadanimpactnow.Whenshewasinthepitofpanic,shecouldseenorelief.Itseemedtoherthattheawfulstateofcrampingandterrorwouldeithergo on forever or kill her. By presenting her with an alternative outcome, apromiseofreliefbasedonfact,shecouldbegintomoveinthatdirection.Noticethattheinformationhegaveherwasrichwithimagery,allaimedatremindingthebodywhatitneededtodotoregainbalance.

Truismsoftencombinewithothersuggestionstylesforadditionalimpact.Herearetwoexamples:

“Thereisalwaysaturningpointinapanicattack,amoment,asignthatsaysthingswillbeallright.Itcouldbeasubtlechangeinbreathing,aslowingdownorasofteningofchestandthroatmuscles,orevenatickleinyournosethatsignalsasneeze…asIsitwithyouhere,youcanletmeknowassoonasyounoticethatsign,thatturningpointthatsaysthingsarenowabouttogetbetter…”

“LettingmeknowwhatyouknowsoIcanknowhowtohelpyouisthefirststep…What’sthefirstthingIcannoticethatletsmeknowyou’restartingtofeelbetter?”

SolicitingTheirHelp/GettingAContract,Distraction

Whenyoucomeuponsomeoneinanemotionalcrisis,thesametechniquesyoulearnedformedicalemergenciesapply.

GettingaContract:SolicitingTheirHelp

“I’mheretohelpyou…willyoudoasIsay?”“AsIgetyousomewater,willyoucountyourbreathsforme,watchingthemslowingdown?”“TellmeeverythingyouthinkIshouldknowsoIcanhelpyoufeelsafenow.”

Distraction “Come,walkwithmeoverhere,soIcanhelpyoubetter…that’sright…and,asyoudo,keepholdingmyhandjustlikethat,tight,keepingallyourattentiononmyhandandyourhand…”

PhobiasandGeneralAnxietyDisorder

Phobiasareanxietydisorderswithvery specific triggers, suchas snakes,bridges, heights, confinement, or its opposite, leaving the house. They are

marked by an urgent need to flee, to find safety, to escape the sense ofimpendingdeath shouldescapeproveunsuccessful.Forexample,whenpeoplewith agoraphobia step outside, they can experience palpitations, shortness ofbreath, tightness in the throat, sweating, cramping, and a sense of beingimmobilizedbyfear.Whilephobicsknowthattheirfearsmaybeirrational,thefears themselves feelvery real,veryphysical,andveryoverwhelming.Almostuniversally,therapyinvolvesdesensitization,whichisthegradualexposureofapersontothefearedstimulusuntilitnolongerhasanegativecharge,anditcanalsosometimesinvolvepharmaceuticals.

General Anxiety Disorder occurs when worry gets out of hand andbecomes debilitating. It is similar to, but much more prolonged than, panicattacks.Victimsofgeneralanxietydisordercanbecomeemotionallyparalyzed,find they cannot make decisions or even act wisely in their own interest.Althoughboutswith generalized anxiety disorder are not as dramatic as panicattacks,therapeutichelpandmedicationareoftenrequiredandadvised.

Although these topics are too large for us to cover exhaustively in thischapter, using some of the Verbal First Aid techniques described below canoftencalmthesituation.

Pacing/PayingAttentiontoDetails

Whensomeoneisbreathingtoorapidly,wecansubtlybreathewiththemand,asweslowourselvesdown,wecanbringtheirbreathingratedowntoo.Iftheyarehuddledinacorner,wecansitrighttherewiththem.Wecanpaceandsupport this process verbally, as well, by reflecting what is happening in areassuringway. “In the last twominutes sincewe left the party, you’ve beenswallowingmore easily and your breathing has been smoother.”Alternativelyyoumightsay,“Iknowyou’rescaredofthunderstormsandI’mrightherewithyou,rightbyyourside.”

Remember that when you pace, you can lead: “Even in traumaticsituations,therecanbemomentsofcalm…evenifthosearesmallmomentslikewhentheinbreathturnsintotheoutbreath.”

Imagery/Distraction

When people are frightened, it helps to be able to provide them withimages that contribute to a senseof safety; and the richer the information and

imagesusedtoconveythosefacts,thebetter.Byprovidingthemindwithclearvisualimages,wearealsodistractingtheindividualfromtheobjectorsituationthatisgeneratingthefear.

Forexample:“Somepeoplecanimaginebeingwrappedinamagicalcloakthatkeepsthemsafe,andforsomepeopleit’sblue,abluecloakthatfeelssilkyandsoftandyetitisstrongenoughtomakethemfeelprotected,butitmightalsobeanothercolorthatyouwouldknow,thecolorthatfeelssafesttoyou….”

“Everytimeyoubreathe,itcangetjustatinybitsofterinsideyourchest,asmoreoxygengetstoyourlungsandtoyourbrainandheart.You’llnoticethatit’sgettingquieterinside,likeagentlequiet,likefallingrainorwateroverpebblesinababblingbrook….”

“AsIholdyourhandjustlikethis,youcanletyourmindstaywithmyvoiceandonlywithmyvoiceasItellyouastoryaboutwhenIwasalittlegirlandthesamethinghappenedtome…”

AsI/YouCan

If the person is afraid of an object and you can remove it from theimmediateenvironment,pleasedoso,even ifyou think thefear issilly.WhileyoudosoyoucanusethecontingencyAsI/youcanstrategy.

Forexample,youcouldsay,“AsItakecareofthis(snake,picture,etc…),youcanmovetothattableandtellmehowyourbreathingimproves.”

Otherexamplesare:“Alan,IseethesnakeandI’mgettingridofit.WillyoumovetenfeettomyleftwhereIcanseeyouasImovethisout?”

“Emma,Iknowyoudon’tlikebeinginthiscrowd.AsI

VerbalFirstAidKey

Panic Attacks, Phobias and General AnxietyDisorders:

GettingacontractPayingAttentiontoDetailsJoiningin/Feedback/PacingTruisms/Imagery/FuturepacingNon-verbaltechniquesAsI/Youcan

takeyourhandandkeeptalkingtoyou,youcancomewithmenowandwe’llgoonhome.”

Notice here thatwe are not trying tocure these conditions.We are only usingVerbal First Aid tocalm, center, andstrengthen people sothat they can continuefunctioning andeventually get theprofessional help they

need.Panicattacks/phobicreactionsandasthmaattacksareverysimilarinstyle

and substance,withbreathlessness and the fear it generates being someof themajor elements. For other, more physiological approaches, such as breathpacing,pleaseturntoChapter7onAsthma.

AcuteStressandPost-TraumaticStressDisorder

Generally, these diagnostic categories are included under the rubricAnxietyDisorders.However,wefeltthattheydeservedspecialmentionbecauseoftheircurrentrelevance.

Trauma, in ordinary terms, can often be a matter of perspective. To agrownmanonamilitarybase,adeepcutmaybepainfulandinconvenient,butitishardlytraumatic.Toachild,whoisthenrushedtothedoctorforsutures,suchacutisastraumaticasitgets.Clearly,whileordinaryannoyancessuchastrafficjams, stubbed toes, and cranky employees are stressful, the word takes onanother level ofmagnitude for the thousandsof survivorsof sexual abuse andrape,andinsituationsashorrifyingastheOklahomaCitybombingortheattackontheWorldTradeCenter.

Our response to traumahasagreatdeal todowithwhatwebring to thecriticalevent—whetheritisamotorvehicleaccident,thelossofalovedone,ora frightening fall. The old adage, “You’re only as sick as your secrets” is atruismthatismadeincreasinglycleartousinourwork.Theoldskeletonsinthe

closetthatyouholdontonotonlydon’tgoaway,buttendtoreappearwhenwefeelmostvulnerable.Traumaticeventstendtoimpactmostheavilyuponthosewhohavehadunhealedtraumasinthepast.Wheneverapoliceofficercomesinfor treatment due to trauma,wenot onlywant to knowwhat the precipitatingtrigger was, we also want to find out whether there’s been a history ofunresolvedtraumaandhiddenpain.

A trauma’s impact is also contingent on the level of personal violenceexperienced: when an event involves a personal attack, it is harder to avoid,often because the anxiety is increased and that old baggage opened. Whentraumaticstress is ignoredordenied, itmaygoundergroundwhere itpicksupsteamandbuildsuppressure.Wemaybeableavoiditforaperiodoftime,buteventuallyitleaksoutinourdreams,ourrelationships,ourbehavior,whichmaybecomemoreself-destructive,morerisky.Wemaybecomemoreirritable,morewithdrawn. We may find ourselves getting colds more often. Protracted orintense stress is responsible formuchof thediseaseanddeath in this country.Stress inhibits the immune system, increases the production of epinephrine,norepinephrineandcortisol, and is linkedwithheartdiseaseandotherchronicdiseases,aswellasinfertility.

Rahul Sachdev, MD, a specialist in reproductive endocrinology at theRobert Wood Johnson Medical School has found that the stress levels of awoman struggling with infertility are similar to those of someone who’s justbeen told theyhaveHIV.While adrenalinehelpsus to prepare for emergencyaction,thechemicalcascadeitinitiatesinhibitsourabilitytorepairourselves,todigestfoodproperly,ortoreproduce.Epinephrine(oneofthesecretionsoftheadrenalglands)hasbeenshowntoconstrictbloodvessels.Whenthisoccursinthe uterus, it interferes with conception. When the sympathetic system is inoverdriveandthestressresponsedoesn’tstop(duetoapoorcortisolresponse),essentiallywhathappensisPost-TraumaticStressDisorder.

Althoughmorethan90%ofallAmericanswillhaveexperiencedatraumain their life times,we continue to see our emotional responses asweaknesses.This denial of our own vulnerabilitymakes the fall thatmuch harderwhen itdoescome.

WhatCanWeDo?WhatCanWeSay?VerbalFirstAidforTrauma

If you comeupon someonewhohas just been assaultedor injured in anattack, as you know your first course of action is to call 9-1-1 or the police,

particularly if a crime or severe injury is involved.Depending on the injuriesinvolved,applyfirstaidaccordingtoestablishedmedicalprotocol.

As you tend to the injuries, it is vitally important you understand thattraumaisanassaultnotonlyonourbodies,butonourminds.Itmakesusfeelvulnerable.Oncesure-footedandclear-sighted,wemayfeelunstable,suddenlyunsureofourselves.Thisisparticularlytruewhenthetraumaisanactofwarorterror, or a natural disaster,which inherently implies continued attacks and anuncertain future. Experiments with rats whose routines are made chaoticeventuate in their developing ulcers and heart disease. For that reason,VerbalFirstAidforcriticalsituationsneedstofocusprimarily,thoughnotexclusively,ontwotechniques:PacingandTruisms.

Pacing

Pacing a traumadoesnot alwayshave to beverbal.Within the first fewdaysaftertheattackontheWorldTradeCenter,wewerewalkingwithagroupof police officers throughGroundZero to let rescueworkers knowwhere ourofficeswereand thatwewereavailable to talk twentyfourhoursaday,sevendaysaweek.Wedecidedtogotothemosttraumaticsites,suchasthemakeshiftmorgues,whereweknewwewouldfindrescueworkersingreaterdistress.Ourmissionwassimplytoassesswhattheirneedswereandtotalk.Onefirefighter,aseasoned and battered middle-aged man, stood facing us, blocking the doorleading to what used to be a bright and busy office lobby. His eyes werepiercingly blue, his expression grim and tight. “What the hell do you thinkyou’regoingtobeabletodohere?”hewavedhisarmbackandoverasceneoutof Dante’s Inferno. Sheets hung over ropes tied between elegant columns ofglossymarble,plasticbodybagsonthefloor,zippedup.Weheldhisgazeinthatwaythatsays,“IknowandI’mstillhere.”Whenhesawwewerenotbudging,hisfacerelaxedandhestartedtalking.

Pacing can be as simple as standing still, as loving as taking a cold andtremblinghand intobothof yourwarmand steadyones, or as instinctive as ahug.Thekeytopacing,remember,istotakeyourcuesfromthepersonyouaretrying to help and to avoid using the situation tomeet your own needs at themoment.Oneofthemostwonderfulthingsaboutpacingintraumaisitsabilityto ground someone in the moment. Because traumatized persons frequentlydissociateandfeelasiftheywere“notreallyhere,”pacingcanserveastheropebacktoasharedreality.Whenwearepresentenoughtobeabletoreflectbackandacknowledgeemotionsandbehaviorsinrealtime,wecanstabilizesomeone

inamomentthatwouldbeotherwisesurrealanddisconnected.Whenweworkwithcriticalincidents,wehavefoundittobeenormously

helpful to remind people that they are having normal feelings in an abnormalsituation. It is a standard, prescribed statement recommended by theInternationalFoundationonCritical IncidentStressManagementand itworks.Almosteveryoneweencounteredwassurprisedandfrightenedbytheintensityof theirownresponse to theeventsatGroundZero.This isverysimilar to theresponseweseeinsurvivorsofrapeandsexualassault.Thequestionsinevitablytumbleout:“What’sthematterwithme?Whycan’tIstopshaking?Whycan’tIsleep?WhyamIso irritable?Whycan’t I sleepwith the lightsoffanymore?”Pacing victims of trauma often begins with normalizing their reactions andreestablishingtheeventitselfasabnormal.

Someexamplesofverbalpacinginclude:“Itwasawful…”“Iknow…”“I’mrighthere…”“Youdon’thavetodoanythingrightnowexceptexactlywhatyou’redoing…”

Dr. Leo Shea, Clinical Neuropsychologist NYU-Rusk Institute ofRehabilitationMedicine feels thatwhen pacing people in uniform, the police,firefighters,themilitary,forexample,wemusttakeintoaccounttheirstanceofbeingthe“protectors.”Sincetheyaretheonesresponsibleforguardingothers,they thereforeperceive themselvesasprohibited fromrelaxing theirguardandexploringtheirfeelings.Althoughsomeofthefirefighterstoldustheyfeltsomerelief from talking about the September 11th attack, most uniformed officersremain stiff upper-lipped. Dr. Shea suggested an oblique approach to invitingthem to express their feelings. “Address the issue of how it’s going for theirfamily,” he told us. “‘How’s your wife handling it? How are your childrendoing?’Thenyoucanslideobliquelyinto‘thatmustbetoughonyou,’andthenthefeelingsstartflowingout.”

Wehadoccasionshortlythereaftertospendsomeheartfelt timewithoneofthefirefighterswhosecompanyhadlostmanyintheircompany.“Howisyourwifehandlingthis?”weheardourselvessay,andhisfacebecameveryopenandsoft.“I’monlymarriedayear,”hesaid,“andit’ssogoodtohavehertotalkto.EventobewithmewhenIdriftoffintothefogIseemtofindmyselfinalot.It’s somuch better than curling upwith another beer.”And thatwas just the

beginningofasmall,healingmoment.

Truisms

Peopleintraumaarewobblyandreachingoutforaline,awall,apillartostabilize them. Truisms are a source of stability because they present uswithinformationthatoffershopeandreassurance.

“Everytraumahasalifespan—abeginning,amiddleandanend—andyou’vealreadybeenthroughthebeginningandtheworstisover…andeveninthemiddle,whereyouarerightnow,there’ssomethingthatletsyouknowtheendisinsight…”“Everyoneknowsthevalueofagoodnight’ssleep…”“Feelingcrazyisnormalinacrazysituation…”“It’ssuchacommonexperiencetoforgetabaddreaminthemorning…”“Youalreadyknowhowtobreatheslowlyandeasily…”“Itishardforanypersontobeafraidofhisownthoughts…

ObjectsofSafety:Anchors

People in trauma feel unsafe. Because they feel unsafe, adrenalinecontinues to be produced, creating the negative feedback loop that eventuallyleadstoacutestressdisorderorPTSD.Itcanbetremendouslycalmingwhenwehelpthemidentifyaphysicallocationorobjectoranemotionalcuethatbringsthemasenseofsecurity.Itcanbeasmoothstone,aSt.Christopher’smedal,abible,abowlofchickensoup,aribbon,evenapointononeoftheirfingersthattheycantouchtorecallamomentinwhichtheyfeltsafeandcalm.Whileyoucanofferasafetyanchor,suchasa teddybearorblanket toachild, itmaybeeven more useful to let people choose their own anchor so that it has moremeaning.

DEPRESSION“Andthedaycamewhentheriskittooktoremain

tightinsidethebudwasmorepainfulthantheriskittooktoblossom.”

–AnaisNin

Depression is one of the most pervasive and profoundly life-alteringemotional or psychiatric problems in this country. Nearly everyone knows ofsomeone—afriend,colleague,orfamilymember—whohasbeendiagnosedwithsome form of depression. And nearly everyone at some time has been blue,whichconveyssomesenseofdepression,althoughdepressionisafullorderofmagnitudegreaterthantheblues.

Thosewhosufferfromdepressioncanfeelparalyzedandunable to trackthingsthewaytheyoncecould.Itisasifablankethasbeenlaidontopofthemandtheycan’tthrowitoff.Whiletheirpainisintense,theirsenseoftheworldaroundthemismuffledanddistant.

No two people experience depression the same way. Some presentsymptomsofanxietyandagitation, insomnia, lossofconcentrationormemoryimpairment.Othersarelethargic,hopeless,deeplysad,unabletogetoutofbed,hyper-somnolent. Still others complain of a loss of appetite, a diminishing oftheirsexdriveandageneralfatigue.Somesufferhairloss.

Depression can be acute or chronic. However it manifests, it is seriousbusiness;upto15percentofpeoplewithsevereMajorDepressiveDisorderdiebytheirownhands.Depressionisepidemicingeriatricpopulations,particularlyamong those living in nursing homes. It is associated with numerous otherdiseases, such as strokes, diabetes, and carcinomas, and may even be a by-product of modern medical treatment, such as dialysis. Many patients withchronicdisease(suchasALSorMS)sufferfromdepression,aswell.

Depressionmayalsobe a factor inmaking apersonmore susceptible todisease.Whatever depression’s etiology, psychodynamicor biological,when apersonisdepressed,certainchemicalprocessesoccur.Itiscommonknowledgethatnaturallymanufacturedsubstancescalledendorphinsareinshortsupplyinthe body when people are depressed. One of the preferred treatments fordepression is medication that increases the endorphin (particularly serotonin)levels of the brain, thereby alleviating both the depressive symptoms and anyanxietyassociatedwith it.Ofcourse, this courseof treatment isnot alwaysassuccessfulaswemighthopeandtherearepotentialsideeffects.However,whenmedicationiscombinedwiththerapy,thereiscauseforoptimism.

BeforewediscussVerbalFirstAidtechniques,wewanttounderscorethepotential seriousness of depression and the importance of not flippantlydismissing it. Ifyouorsomeoneyouknowisdepressed,getprofessionalhelp.Thereisagreatdealofhelpavailable.Considerableresearchhasbeendoneon

thisissueandtherearenewtreatmentsemergingeveryday.

VerbalFirstAidforDepression

Words have a very different effect when directed at someone who isisolatedbyasenseofhopelessness,asopposedtosomeonewhoseinnerworldhasbeenopenedupbyanemergency.Directlycommunicatingtotheautonomicnervoussystemofadepressedpersonisnotaseasy,andwedonotadviseit.

Thissectionisdifferentfromothersinthisbook,becauseherewedonotfocusoninducingphysiologicalchangeorhealing.Inmostcasesofdepression,change is best achieved by a professional therapist in a safe and therapeuticenvironmentwheremedicationandalternativemodalitiesformanagementhavebeen properly considered. The Verbal First Aid proposed here is intended tofacilitateordinarycommunicationthatcanleadtoshort-termcomfortandofferrealistichope.

Therearemanyvarietiesofdepression.Somedepressedpeoplecravethecompany of others and long to speak about what hurts them. Others may beaggravated by an attempt to console them. Some sufferers become lethargic.Others function with a frenzy that belies the sadness in their hearts; the onlyclues to how they really feel might be grumpiness, digestive problems,addictions, anddangerousbehaviors.Suicidal feelings canbe themost criticalsituationforthedepressedperson,andrequireprofessionalhelpimmediately.Inthenextchapterwediscusssuicideattemptsingreaterdetail,buttherearesignsto look for that indicateaperson isprogressing in thatdesperatedirectionandthatitistrulytimetointervene.Eventhesuddendisappearanceofdepressioninsomeonewhohassufferedwithothersymptomsofthemaladycanindicatethatthepersonhasmadethesuicidedecisionandisnowfeelingcalmeraboutit.Calla suicide hotline (they are often listed in the front of the phone book), find apsychologist or psychiatrist who excels in this field, and educate yourself bybrowsingthewebsiteslistedattheendofthenextchapter.Andneverignoreathreat.Contrary to popularwisdom, seventy-fivepercent of suicide threats areactedupon.

Verbal First Aid has no scripts to offer that cover all the individualexpressionsofdepression.Followingaresomegeneralapproaches thatmaybeusefulinmanycases.

First,WhatNottoSay

Having a depressed person in your life can be challenging, frustrating,infuriating. You want them to come back from wherever they’ve gone,especiallyifthisisanewandacuteepisode.Itisfrighteningandmaddeningatthesametime.Andwhenthedepressionischronic,patiencecanrunverythin.However, invalidating, belittling, blaming, or dismissing only makes thingsworse.Eventhoughwemayfeellikesaying,“Comeonalready,getoverit!”or“Cheerup!”it’simportanttorememberthatthisdoesn’twork.Settinglimits,ontheotherhand,isimportant,butshouldbepartofalargertherapeuticprogram,developedwithanexpert.

In addition, avoid statements that might be perceived as a challenge. “Idon’t think you really want to commit suicide” can invite an “Oh, yeah? I’llshowyou”reaction,withdevastatingconsequences.Thereisconsiderableangerburiedineventhemostpassivedepression.Ifwedoorsaythingsthatencouragethatangertobeexpressed,weareinvitingtrouble.

Hereareafewapproachesthatmightamelioratethesituationintheshort-runwhileprofessional,long-termhelpisbeingsought.

Empathy

Sometimes there is nothing to be said, or perhaps the words just aren’tgetting through. Yet small acts of kindness can still have an effect. Barneyownedasmallgrocerystoreandfoundhimselfinthegripofsuchadepressionthat hewould stand like a statue before the store window, unable to enter orleave for hours on end. A friend of ours used to try to engage him inconversation,buttonoavail.OurfriendhadoccasiontodrivebythestoreeverydayandneverfailedtogiveBarneythethumbsupsign,althoughBarneyseemednot to see him. One day, Barney signaled back, and this little interactioncontinued formonths longer.Years later,whenBarneywas himself again, hevisitedourfriend.Outfromunderthecloudofdepression,hetoldourfriendthatthat simple gesture, the thumbs up sign, had kept him going when all elseseemedlost.Hiseyesfilledwithtearswhenheexplainedhowmuchthatsignal,likeaglimpseoflightattheendofatunnel,hadmeanttohim.

Resources

Inmost cases, depression has not been lifelong, and the sufferer can beencouragedtolookbacktoatimebeforethis,atimewhenthingsfeltallright.

Memoriesfromthattimecanberesourcesonwhichfamilymembersandfriendscan draw. Reminding the person of those times—sharing photos, encouraginglaughter—cansummonthemup,ifonlyforamoment.

Inagentle,conversationaltone,onemightsay,“Ijustcameuponthisoldpictureofthedogwhenyoudressedhimupforyoursixthbirthday,rememberthat?”Wecanrecalltheresourceshehad,strengthsheshowed,andchallengeshemet.“DoyourememberhowyouhelpedUncleJohnfindthatolddogwhenhesneakedoutfromunder thefence?Youweresoresourceful…”It isalwaysusefulandproductivetoberemindedofyourstrengths,eveniftheyseemremoteatthemoment.

In his moving portrait of depression,Darkness Visible, William Styrontalkedabouthowapatientwithaseriousillness,who“feltsimilardevastation,”wouldbe allowed to lie about,wouldbebolsteredwith life support tubes andwires, his suffering would appear “honorable.” “However, the sufferer fromdepression has no such option and therefore finds himself, like a walkingcasualtyofwar,thrustintothemostintolerablesocialandfamilysituations.”

Howimportanttounderstandthatsenseofhopelessnessandisolationand,at the same time, remain persistent in our faith and knowledge that there areother resourcesand that restoration ispossible. It isadifficult linewehave towalk when we want to help—balancing between pacing the suffering andleadingthemtowellness,betweensorrowandhope,betweenhellandheaven.

FuturePacing

Wecan remind thosewhosay,“It’llnevergetbetter,”of the truism thateverythingchanges.Evenwhenwewanttoholdontoaparticularfeelingstate,itslips through our fingers. “Almost everyone can remember a time,” youmaysay, “whenwewanted themoment to last forever.”Of course, it never does.Anothermomentcomesalongand,withit,differentfeelings.It’sveryusefultofindwaystoreminddepressedpeoplehowthingschangeall thetime,andthatthefutureisnotafixedentity.

Formostpeople,depressiveepisodeshaveabeginning,amiddle,andanend.When her daughter got depressed,Mollie used to say to her, “Markmywords!”towhichherdaughterwouldsmileandrollhereyes,knowingwhatshewouldhearnext.“You’redepressednow,butIknowyouandyoualwayscomethroughthesetimesokay.Inafewweeksyou’llcomehomeandsay‘Youtoldmeso!’”Simplyconveyingtoadepressedpersonthat“Therewillcomeatime,maybesoonerthanyouthink,whenyoucanfeelthewayyouwouldliketofeel,

canhelpdispeltheirsenseofbeingtrappedinendlesssadness.Dr. Leo Shea told us that, even in this post-World Trade Towers time

whenheseessomanypeoplesufferingdepression,hefindsitusefultoremindpeople thatwhatever they’regoingthroughnowisa temporaryprocess.“Theyhavegone throughmanyotherexperiences in their life that seemedhorribleatthemoment—abadmarkinschool,notgettingintothecollegeoftheirchoice,amiscarriage—andhavecontinued to livea life that isproductive.”Hewondersaloud with them about what resources they called upon to get them throughthose times,what coping skills and support systems theyused that theymightturntoatthistime.

This approach is, of course, never dismissive of the seriousness of themoment, never resorts to cheap cheerleading that could break rapport. It is,rather,anexpressionoffaiththatthispersonhaswhatittakestoreachbackwardandforwardintimeandbringintothepresentasenseofperspectivethatsoftenstheblowsandmakes“now”anallrightplacetobeandtomorrowpossiblyevenbetter.

Annusedfuturepacinginaveryconcrete,practicalwaywhenhermotherwas sufferingwith lung cancer and a severe bout of depression.They plantedbulbs together—tulips were her mother’s favorites—so that she would havethem to look forward to with the coming of spring. “We alwayswould plantthemtogetherandshewouldsay,‘Won’ttheybebeautifultosee!’”Shelivedtoseefivemorespringsthanwaspredicted.

PacingSolutions,Wondering,Love

Whenwe pace solutions, we are focusing on what is possible, on whatworks,nomatterhowsmallorminoradetail,andonmomentsofreliefandjoywhereverandwhenevertheyarefound.Focusingonsolutionsisveryhelpfulinmany areas, including working with depressed people.When we speak aboutsolutions,however,wealwayswant to remember tohonorpeople’s individualperceptionsandavoidtrivializingordismissingtheirfeelingsandfearsbytryingtosolvetheirproblems.Whenpeoplecomplainthattheirdaysarehorrible,thatthey are horrible, and that life is horrible, staying focused on solutions andpossibilitieshelpsustoavoidfallingintothesameabyssthattrapsthem.Wecanhardlyhelpthemifwe’refeelingashopelessandhelplessastheyare.Whilewecanandshouldpacetheirpain(“Iknowyou’refeelingjustawful…”),wedonothavetostaythere.Wemightwanttoobservecarefullyandcatchtheonegoodthingthatwemaybesuretheyaredoingorexperiencing.Andeveryone,except

forthemostseverelyillpeople,hasattheveryleastagoodmomentoragooddayor two.For this reason, in our practices,we strongly encourage clients tokeep daily journals or charts, indicatingmoods and activities, making specialnotesof anything thatwaspositive.Whatpeople areoften surprised to find isthattherearemoregoodmomentsthantheyhadimagined.

Wondering is sometimes an effective technique. It is not a directedquestionorajudgmentoracriticism.It’sanexpressionofsincerecuriosity.“Iwonderwhat’sdifferentonagoodday,youknow?”canbeathought-provokingopening,yetit’sphrasedinsuchacasualmannerthatdepressedpeoplecanletitpass by if they wish. If used interrogatively (“What’s different when you’rehaving a good day?”) it can set a different tone that might best be left for atherapist’s office, where there is a clear agreement to do that kind of work.Wondering is an invitation to muse, not a challenge or an implied criticism.Wondering opens possibilities to the unconscious mind, and allows for amovementbeyondoldpatternsthatdirectedcommentarydoesnot.

YesSets

AgreementisalsoacriticalcomponentinVerbalFirstAidfordepression.Findingaseriesofstatementswithwhichthepersoncanagree(a“yesset”)caninduceamoveclosertotemporarycomfort.

“Hi.Iseeyou’rehangin’outonthesofa.”Nod.“You’rewatchingthatmovieIrented.”“Yup.”“Good.So,asIsitoverhereandreadmymagazine,youjustgoaheadandcontinueenjoyingit,okay?”

Noticethatpriortothelaststatementtherewasnomentionofenjoymentonewayortheother.“Continueenjoyingit”isactuallyanembeddedstatementthat suggests the possibility that she actually has been enjoying it and cancontinue todo so.Getting agreement for the important things is always easieronceagreementshavebeensecuredforthemoreobvioustruths.

TheObservingSelf

Depressedpeopleareoftenangrywith themselvesforbeingdepressed in

the first place. Their lack of control over their own feelings, thoughts andbehaviorsleavesthemfeelingisolatedandhumiliated.Thatpartoftheselfthatobservesthelackofcontrolmayalsobehighlyself-critical,blamingthesuffererinan insidious innerdialogue.Asaresult, thedepressedpersonmayseeotherpeopleasjudgmentalandcritical,evenwhentheyarenot.

Laurel talks about her own ten-year-long depression. “I hated my ownneediness,IhatedthewayIfelt.I’dbestandingthere,talkingtosomeoneandallthey’d do was glance somewhere else or act as if, for a second, they hadsomethingelseontheirmindsorsomethingelsetodo,andI’dperceivethatasastatementaboutmyownworth.Iwastooneedy;therefore,theydidn’twanttobe aroundme. Itwas a vicious cycle, because then I’d isolatemyself and getevenmoreneedyanddepressed.”

All of us walk aroundwith different voices operating in our heads.Wehear our mothers, our fathers, our teachers—their gentle and not-so-gentlereminders to close the door behind us, do our part, wait our turn. Sometimesthese voices are benevolent and remind us that we are loved and lovable.Sometimes they are not so soothing.When people are depressed, the criticalvoice in their head can be deafening, making it very hard to truly hear whatothershavetooffer.Thisiswhy,ifyouarelivingwithadepressedperson,youmayhearyourselfgrindyourteeth,saying,notveryusefully,“HowmanytimesdoIhavetotellyou?”or“Whycan’tyoujustgetitthroughyourhead?”

SpeakingtotheObserverSelf

It may be a tremendous relief to both you and the depressed person toacknowledge that there is this self-blaming observer at work, and to speakdirectlytothatobserver.Thisinvolvesthreesteps,eachofwhichbuildsonthenext,inordertobetrulyeffective.

Speakwithquietstrength.Speakwithconviction,faithandfacts.SpeaktotheObserverSelf.

SpeakwithQuietStrength

Having quiet strength is a sure-footed gift that allows you to stand stillwhile others spin. There is a Sufi story about a youngmanwalking down anolivetree-lineddirtroadwhenhemeetsanoldmansittingcross-leggedagainsta

tree, meditating in absolute peace—a still, calm, blissful smile on his face.Suddenlytheyoungmanseesacloudofdustdrawnear.Thepeacefulmomentisshatteredby theclamorofsingingandchanting,punctuatedbyoccasionalear-splittingscreams.Asthewhirlingdervish,spinninginreligiousecstasy,movesoffintothedistance,theyoungmanreturnshisgazetotheoldsage,stillsittingpeacefully, undisturbed. Waiting for what seems a long time, he finallyapproachestheoldman.“Howdidyoudoit?Howdidyoustaysocalmwhilehewasmaking that racket?” The oldman gets up slowly, brushes off his robes,looksattheyoungman,andsays,“Ilethimspin.”

Quiet strength does not need to make a fuss, or react, or take thingspersonally.Quietstrengthisnotacheerleader,nordoesitneedtofix,putasmileonsomeone’sface,ormakenice. It isascertainastheearthbeneathyourfeetthatallthingsshouldbeexactlyastheyare,andthatthereagreaterpurposeandmeaningtoitall,evendepression.

SpeakwithConviction,Faith&Facts

Asmuchaspossible,youwillwanttospeakwiththetone,theposture,andthephrasingofapersonwhoknows,believesinandhasthedatatoprovewhatheorsheissaying.This,ofcourse,wouldbeawonderfulwayforallofustogothrough life, all the time.But it is particularly valuablewhen you are dealingwithapersonwhoconstantlyquestionshimself,hisbehavior,hisveryvalue.Tothis end itmaybe useful to familiarize yourselfwith someof the research ondepression;youmightalsologontosomeofthewebsitesondepression,wherehundredsofrecoveredsuffererssharetheirsuccesses.

There is an ample reservoir of data to support the belief that peoplesuffering with depression can enjoy full recoveries. There are psychologicalsupports,medications,andalternativetreatmentsavailablecoasttocoast.Whenyousay,“Iknowyoucangetthroughthis,”knowittobetrue!

One of the most poignant and saddening aspects of depression is thatdepressed people feel that there is no hope. As Lucy from the comic strip“Peanuts”oncewondered,“Doyouknowwhatit’sliketohavetowakeupeveryday and know you’re hopeless, it’s hopeless?” We can offer hope mosteffectivelywhenweknowourfactsandpresent themwithconviction.Tosay,“It’ll be fine!” is not the same as saying, “This research shows that exerciseboosts endorphin levels, and that justbymovingwe literallychangeourbrainchemistry!” Or, “They just found that only 30 minutes a day of comedysignificantly reduced symptoms of depression in 4 weeks. Shall we start

laughingnoworlater?”

SpeaktotheObserverSelf

Whenwehavequietstrength,conviction,faith,andahandfuloffacts,weare ready to speak toa specialpartof thedepressedperson.Onepatient, a35year-oldgraphicdesigner,hadbeensufferingfromepisodesofmajordepressionfor a number of years. She had finally found relief in a combination ofhomeopathyandpsychotherapy.Sherecalledthatduringthoseplungesintotheabyss,shewouldforgetwhoshereallywas.Shewouldbegintobelievethatshewasthedepressionand,asaresult,thatshewasbad,hopeless,andworthless—andwouldcontinuethatwayforever.

VerbalFirstAid forherwasuseful simply to remindherwhoshe reallywas.“Iseeyou.Iknowwhoyouare.Iseewhoyouarewithoutthedepressionand I know it’s not the same you. I see you as you really are.” These simplewordscanhavelife-savingimpact.

Knowingthat theObserverSelfofadepressedpersonismoreoften thannot being extremely critical,whatwe say needs to be sensitive to that, and tocounteractit.Accordingtosomeexpertsindepression,thereareotherObserversthat also speak to depressed people in ways that defend their lives, theirgoodness, their dreams. Unfortunately they speak so quietly that the negativevoicesnearlydrownthemout.Someexpertssuggestthatdepressedpeoplewriteout all their thoughts.There, among the shards ofmiserywill be glimmers ofhopeandbelief inone’s self: “I amagoodperson.”“Ifonly I tried, Iknow Icoulddoit.”“Therearepeoplewholoveme.”

OneofthethingstheCriticalObserversaysis,“You’llnevergetthroughthis!”Gentlereminders,suchas,“Yougotthroughthisbeforeandyoucandoitagain,” can be reassuring and hopeful. One woman’s father used to tell her,“Hang in there, baby. Things keep changing.” Although the idea seemedimpossiblyunrealistictoheratthetime,hehimselfwassocredibletoher,wassuchafountofquietstrengthandconviction,thatshecouldnotdismisswhathesaid.Nearly 20 years after the depression lifted,what she remembersmost ofthatstruggleishearingherfather’swordsthroughthetunnelofherdespair.Thepowerofwordsissuchthatevenwhentheydon’teffectimmediatechange,theysowseedsinourconsciousnessthattakeroot,sometimeswithoutourawareness,andflowerwithblessingsatthemomentthatweneedtheminwaysthatsurpriseanddelightus.

Obviously,wehavenotnearlycoveredthegamutofemotionalconditions

that plague modern life. However, we have addressed the most commonproblemsyouarelikelytoencounter.Wehopetheideasandtechniquesinthischapter will provide you with material you can tailor to develop your ownvariationofVerbalFirstAidwhichcanhelpyourfriendsandlovedonesattainsomemeasureofpeaceintimesofemotionalturmoil.

VerbalFirstAidKeys–Chapter10EmotionalConditions

Utilizeearlylearnings/memoriesFuturepaceWonderLoveYesSetsResourcesTheObservingSelfQuietStrengthNon-verbaltechniquesGettingacontractPayingAttentiontoDetailsJoiningin/Feedback/PacingTruisms/Imagery/FuturepacingNon-verbaltechniquesAsI/Youcan

S

“Tobeornottobe:thatisthequestion.”WilliamShakespeare

“Suicideisapermanentsolutiontoatemporaryproblem.”PhilDonahue

uicide is terrifying.Andit isamongthe top tencausesofdeath inourcountrytoday. It is theultimateweaponweallhave inourownhands.With it,peoplecanchoosetodeclarewaronthemselvesandonallwhoareinthefalloutareaoftheirself-destructiveness.

Wordsarenoguaranteeagainstit.Anywordscouldbethewrongwords,dependingon themindof theperpetrator.Even “I loveyou” could feel like aknife in the heart to someone in the psychic pain that drives a person to self-destruction. So first of all, try to avoid the panic and self-blame that swirlsaroundthethreatofsuicide.Sometimesit is toolateforwords.Sometimesthebestwordscannotbeheard.Sometimesthekindestintentionsarethwarted.

Needless tosay, the threatofsuicide isanemergency—one that requirestheskillsandsteadinessofthosewholiterallydefusebombs.Unfortunatelythereisnouniversalprotocolforsuicidethreatsbecauseeachsituationbringsitsowncombination of volatile elements. Every word is a step in a dance whoseoutcomeisunknownandunknowable.However,sometimestherightwordscanmakeadifference.

Suicideattemptsbeginlongbeforesomeonestandsona ledgeorholdsaguntoatemple.Therearewarningsignsandwaystorespondtothem.Wewillpointyoutoresourcesforthatpurposeat theendofthischapter.Herewewillfocusonthatmostdifficultmoment,whenyouarefacedwithanactivesuicideattempt.

Obviously,ifyoucan,beforeanythingelse,call9-1-1or,evenbetter,yourlocalSuicideResponse/EmergencyRescue(orCrisis)Teamimmediatelyifoneisavailable.Theyareusuallyassociatedwithlarge,teachinghospitalsandlistedin the front pages of the phone book. In the meantime, if the individual isbrandishingaweaponofANYkindgivehimawideberth,keepingyourselfoutofharm’swayifatallpossible.Waitforprofessionalhelptoarrive.

Forthemostpart,thosewhocontemplatesuicidebelievetheyhavecometotheendoftheiroptions.Theyaredesperateandjustseenootherwayout,nootheranswers.Whiletheywanthope,theymaybetoofrightenedtofeelhopeful.Perhaps they’ve been betrayed by hope before. In theirminds, the course forsuicidemightalreadybeset—theyhaveplannedforitandheretheyare,attheendof the line.Sometimes, though, the right rope thrownat the rightmomentcanhaveatremendousimpact.

ThebasicVerbalFirstAidtechniquestouseinanimmediatelyimpendingsuicide,beyondcallingforhelp,arethefollowing:

1. You’llwanttogainrapportofaspecialkind,evenbeyondpacingandmirroring.You’llwanttotrytogetinsidethemindoftheperson,tounderstandasbestyoucanthefeelingsroilingaround,abouttoexplodeinanirrevocableact.

2. Atthesametime,you’llwantthekindofdetachmentthatprotectsyou,shouldyounotbeabletoturnthesituationaround.Andyou’llwanttocultivatethekindofdetachmentthattakesyouregooutofthepicture.Thisisnotaboutyou.Eveniftheotherpersonistryingtohurtyou,fornow,thisisaboutthem.Takethefocusoffyourself.Remaindetachedbutloving.

3. Centeryourselfasyouwouldinanemergency.Repeatamantrasuchasthisone(oranythatworksforyou):“Partofmeisenteringthemindofthispersontryingtoseetheworldthroughhisorhereyes.AnotherpartofmeissteppingoutsidemyselfsothatIcanseparatefrommyfeelingsandjustbeuseful.Bothpartsofmeprayforguidance.”

Aswe said earlier, there is no way to even guess what the right wordswouldbeinthispotentiallycatastrophicsituation.However,hereareanumberofapproachesthatyoumightconsiderusingwhileyouwaitfor theemergencyrescueteamtoarrive.

First,whatnot to say.This is so important that it bears repeating:whenspeaking with people who threaten suicide, never challenge them. Never say,“Allright,then,goahead.”Neverevensay,“Don’tyoudareeventry!”That’sachallenge,too.

“I’ll show them,” is a powerful motivation to kill oneself. Suicides areoftenactsofanger,notonlyagainsttheself,butagainsttheworld.

Whatever their reasons for wanting to commit suicide, no matter howsmallorevenabsurdtheymayseemtoyou,theyloomlargetothem.Honorthatanddonotdismisstheirconcerns.Itisnotthesizeoftheproblems,butthelackofabilitytocopewiththemthatmakesonedesperate.Remember,too,ifnothingseemstobeworking,itissometimesbettertosaynothingthantoaggravatethesituationwiththewrongwords.

QuestionstoKeepThemTalking

Listeningiskey.Asistruewithallofus,talkingaboutone’sproblemsandbeingheardcandefuseatroublingsituation.Bylettingsomeonevent,bybeingsympatheticwithoutbeing judgmental,youmaybeofferingapotentialsuicidethe one thing that has been missing in their lives—the feeling of beingunderstood.

Whether you know the person or not, it is often a good idea to beginestablishingrapportbyaskingquestions.Getthepersontalking.Ifitisapersonyoudonotknow,avoidstatinganythingastruthunlessitclearlyis,e.g.,“It’sthemiddle of the afternoon.” Ask questions. Keep them talking. Ask as many“what”questionsasyoucanreasonablycomeupwith.Or“when”questions,or“where”questions,or“who”questions.

Just remember that sometimes people find it difficult, and frustrating, torespondto“why”questions,especiallywhenthey’reupset.

Sometimes distraction can be a valuable tool for defusing potentiallyviolentsituations,evenifitisatemporarystopgap.InSavingPrivateRyan,oneof thesoldiers is fedupwith themissionand threatens togoAWOL.Anothersoldier,frustratedandexhaustedbeyondendurance,pointshisgunattheyoung

manashebeginstostalkaway,cocksthetrigger.Thefuryandtensionreachanimpossible pitch. The other young men rush to the captain, played by TomHanks,pleadingthathedosomething.Thecaptain,whohadkepthisprivatelifetohimselfupuntilthispointbutknewthateveryonewastakingbetsonwhathedidasacivilian,chosethismomenttotellthemallwhohewas:“I’maschoolteacher…IteachEnglish.”Asthecaptaintellshisstory,thespellisbrokenandthegunisholstered.

To choose the rightwords, the rope thatmight bring themback off thatledge, you need information. You need to observe carefully and ask asmanyquestionsasyoucan.Iftheyaretalking,theyarenotkillingthemselves.Iftheyaretalking,theyarestilljustthinkingaboutit—atleastforthatmoment.

Ifyouseethatyourquestionsandcommentsarebecomingannoying,oriftheyseemtomakethepersonmoreagitated,switchtactics.Donotstaywithorforce an issue or line of reasoning that is not working. Back off gracefully.Apologize if you think it’s needed or helpful. Remember that there are nofoolproof words, no words that might not provoke a person in despair ordesperation. Again, saying nothing and being lovingly present is still doingsomething,anditmaybetheonlyviablething.

Afewofthekindsofquestionsthatmightkeepthemtalking:

Whatwouldhavetobedifferentforyoutoagreetogoonliving?Whatpeoplewouldhavetohelpyouwiththat?Whatwouldyoulikehelpwith?Whatdoyouwantpeopletounderstandaboutyou?Andthemostsimple:Whathurts?

Manyexpertsbelieve thatbybeingwilling todiscuss the suicideoption,you are defusing it rather than fueling it. Depending upon how this line ofinquiryisgoing,youmightconsidersomeofthefollowingquestions.

Whatpeopleshouldbenotifiedthatyouareabouttodothis?WhenshouldItellthem?Shouldtheycomenow?WhatshouldIsaytoeachofthem?Whatmadeyouthinkaboutendingyourlife?Whendidyoufirstconsiderit?

Whatdoyouthinkwillbebetteraboutnotbeinghere?Whoisgoingtomissyou?Iftheysay,nobody,followwith,Areyou100percentsureaboutthat?Iftheanswertothatisyes,thenyoucouldfollowwith:Wasthereatimeinyourlifewhentherewerepeoplewhowouldmissyouwhenyouweregone?[Yes]Whowerethey?andWhatwentwrong?Thenfollowwith:Whatwouldhavetohappenforyoutohavepeopleinyourlifewhowouldmissyouwhenyouweregone?

Illustrating how this line of conversation can sometimes work, a 9-1-1telecommunicatortoldusthisstory.Ayoungmancalled9-1-1tosaythathewaslyingattheedgeofacliffandhewasabouttorolloffandcommitsuicide.Theoperator talked calmly to him but was getting nowhere when she said, “Ofcourse,we’llhavetonotifyyourmother.”Suddenlytheyoungmanbecameveryquiet.He hadn’t thought about that.He gasped and said in a panic, “No, thatwould kill her!” “Well, she’ll have to find out…” she said.And, she told us,fortunately therewassomeonewhowouldmisshimterriblyandrealizingthat,hechangedhismindonthespot.

SuggestedTopics

Beyond keeping them talking with questions, we offer for yourconsideration a few approaches that might turn the tide. As always, butespecially at this critical juncture, your tone should be loving, receptive, andcaring;neversuperior,preachingorjudgmental.

1.You’vemadeyourpoint.Nowweunderstand.As in the story of the jumper in the Introduction, sometimes just

asking, “What hurts?” can give people the realization that someone islistening,andthatmaybeall thattheywantedinthefirstplace—afairhearing,asenseofsomeonethereontheotherend.Usingempathy,youmay begin to see the world through that person’s eyes. Kind, deeplysincere,noddingagreementthatlifeisdifficultcanbeabalmtoapersonwhothinksnoonecouldpossiblyunderstand.

2.Whatadismalworlditwouldhavebeenifyouhadneverlived(themeofthemovie:It’saWonderfulLife)Ifyouthinktheymightbeopentoaninfusionofhope,andifyou

knowenoughabout their lives todoit, itcanhelp tooverlaytheIt’saWonderful Life scenario onto their experience. In as firm a voice aspossible,with asmuch strength and conviction as you canmuster, tellthemallthethingsthataregoodandpositivethatwouldn’tbethatwayiftheyhadn’tbeenborn.“AndthereneverwouldhavebeenlittleJennifer,and the school boardwould have firedMrs.Coburn, andmaybe thosekidsacrossthestreetwouldhavebeenkilledifyouhadn’tyelled,‘Lookout!’whenthefiretruckspedby.”

Inofferinghope,takecaretoavoidbeingacheerleader.Therearefewthingsasirritatingoreasytodismissasfeignedcheerfulnessinthefaceoftragicfeelings.

3.Consequences—Youmattertootherpeople.Youmay also be able to remind them of the implications of the

actiontheyareconsidering:thattherearepeoplewholovethemandwhowould be grievously hurt by their suicide, if that is indeed the truth.Don’tmakeupwhatyoudon’tknow.Specifyfor themwhatwouldbemissing in everyone’s lifewithout them, usingwhat you have learnedabout their lives. You could remind them what they have to live for.Theremightbeunfinishedbusiness that,uponrecalling,stakesaclaimintheirfutureandrequiresthemtostayawhilelongertoseeitthrough.

A woman we know postponed suicide (as it turned out,indefinitely) because she realized that if she killed herself, the terriblehusbandwhowasdrivinghermadwouldbetheonewhowouldraiseherbelovedtwo-year-olddaughter.

Use anything you know that ismeaningful to them—all’s fair inlife-and-deathissues,as longas it iskindandcaring.“AndwhataboutRover?Doyouthinkanyoneelsewouldmeantohimwhatyoudo?Howcouldweexplainittohim?He’dbelyingatyourgrave,waitingforyoutocomehome.Youknowhowhegetsifyouevengooutoftownfortheweekend!Doyouwanthimtoendupwithyourparents?”

4.Alwaystimeforsuicide.Youmightsay,inapinch,whennootherargumentseemstohold

sway:“There’salwaystimeforsuicide.It’salwaysanoption.Youdon’thavetodoitthismoment,becauseyoucanalwaysdoittomorrow.”Thatis a truism.And theremight be a better time, or a betterway to live,downtheroad.

5.ATerribleWaytoDieSpeakingofabetterway,GeorgeThompson,Ph.D.,authorofthe

brilliantVerbalJudo:TheGentleArtofPersuasion,spoketousaboutabizarresuicideattemptduringhistenureasapoliceofficerinEmporia,Kansas.Thepotentialsuicidewassittingina tubofwater,withacordwrappedaroundhistoe,poisedtopullanelectricheaterintothewatertoelectrocutehimself.

Whoamonguswouldnot feel thepressureof that situation?Thepolicearoundhimhadtriedeveryconceivableangle:“Comeon,buddy.Youdon’twanttodothat,”“You’llfeeldifferentinthemorning,”“Justcomeonout,dryoff,andwe’lltalkaboutit.”Butnothingwasworking.Thefellowstayedinthetubandwouldn’tgetout.

The simple fact—that hewas still in the tuband hewas alive—gaveThompsonhope.

Anditgavehimanidea.ToThompson,itbecameclearthatiftheman had reallywanted to kill himself, hewould already have done it.Thompson astutely surmised that the man wanted to die less than hewantedawayoutofhispain,outofhispredicament,whateverthatwas.

Thompsonchangedstrategies.Insteadoffightingwithhimtolive,hewoulddiscusswaystodie.

Hegotdownonhisknees,shookhisheadandsaiditwastoobadthatofall thehundredsofways therewere todie, thismanchoose themostpainful.Thompsonbackeditupwithresearch,claimingtherewerestudies that showed that dying by electric current in water can takeminutes,evenup to tenminutesofexcruciatingpain, so thathewouldsmellhishairburning,seeandfeelhisskinturningredandboilingbackfrom his arms, his chest split open. If he thought his life was toughbefore,hewasinforanunimaginableride.

ThenThompsonaddedthattherewerelotsofother,painlesswaystodieandifthefellowwasinterested,andhewouldstepoutofthetubforamoment,he’dbehappytotalkaboutit.

In an instant with a splash, before anyone could take the nextbreath,themansprangoutofthetub.

We asked Dr. Thompson about the research he cited and headmittedthathe’dmadeitup.Butatthatmoment,kneelingnexttoatubwithalivewirepoisedoverit,hewastheworld’sforemostauthorityonthesubject.Hisauthoritywassogreathewasabletoturnaninventionintoatruism.AndthereasonitwasabletoworkwasbecauseThompsonhad developed a substantial rapport by pacing the man from the very

beginning—movingwithhimandleadinghimouttosafety.

6.There’sNoGoingBack/KarmaGoto theendsof theearthandbeyond, ifyouthinkitwillwork.

Somepeoplerespondtothenotionofpastlivesandkarma.Wehavehadpatients who have been deterred from ending this life with thesuggestion that,whenpeopledonotcomplete thingsproperlyhere thistimearound,theyhavetocomebackandrepeatthoselessonsuntiltheyare learned.Since theydonotwant to find themselves in this situationagain,and,infactwoulddoanythingtoavoidit,bythislogicsuicidehastoberuledout.

WhenYouHaveAdvanceWarning

Sometimestherearesignals,awarningbeforethesuicideattemptismade.Theremighthavebeenapreviousattempt.Theremightbeveiledthreatsortalkof suicide. Be alert to these, and take them seriously. Contact suicide hotlineresourcesormentalhealthpersonnelforadviceandresources.Severalarelistedattheendofthischapter.

Whileyoushouldtakeeverysuicidethreatseriously,itispossiblethatnotall people who threaten to kill themselves are truly intent on suicide. Somepeoplemaybechoosingtohurtthemselvesasawayofgettingattention,orasaway of hurting other people. Some people are only thinking of suicide. Theydon’treallywanttodie,theyjustcannotthinkofanythingelsetodo.Sometimespointing out their aberrant logic can help ahead of time, or even while theambulanceisontheway.

Inthe1990TomHanks/MegRyanmovieJoeVersustheVolcanowrittenby JohnPatrickShanley,oneof the threecharactersMegRyanplaysasks theTomHankscharacterifhe’severthoughtaboutsuicide.Heisshocked,butshepersists. He says, “If you have a choice between killing yourself and doingsomethingyou’rescaredofdoing,whynottaketheleapanddothethingsyourscaredof?”

Weonceknewawomanwhowasveryoverweight,whofeltunlovedbytheworldandclaimedshe“onlylivedat50percent,”whateverthatmeanttoher.Weaskedwhatwouldhappenifshelivedat100percent.Hereyescloudedoverandshesaid,“Oh,Iwoulddie!”“Sowhat?”wesaid,muchtoocavalierly.Wedon’tadvise this,but itdidhavean interestingeffect.“Whatwouldbe lostby

livingat100percent?You’renothappywiththewaythingsarenow.Youmightaswell take thechanceandseewhathappens.”Even thoughwe feltveryoddhavingsaidthat,notwantingtosoundasifwedidnot takethethreatofdeathseriously, she told us later that thatwas themost important thing anyone hadeversaidtoher.Weweresuggestingthat,ifitisn’tworkingbybeinglessthanyoucanbe,whynot trygivingityourall?Whynot liveat100percent—whatdidshehavetolose?Shecouldn’tgoonthewayshewas.Thepointhereisnotthat dyingwouldbe acceptable, but that she should try living differently.Andwhensheturnedonthewattage,shesaid,peoplearoundherwereamazed.Itwasquitepowerfulandwonderful.

Ultimately, it is not your decision whether a person threatening suicidelives or dies. It’s theirs. You do your best; you pray; you are present andsupportive. It is impossible to knowwhat, if anything, will turn the tide.Weknew a woman who attempted suicide eleven times and succeeded once,althoughshewasbroughtbacktolifebytechnologyandextrememeasures.Shewasonavarietyofanti-depressants,butstillshecourteddeathconstantly.Lifewastoohard,shesaid,andallthepeopleshelovedhadalreadypassedon.Itwasclear that she was not trying to get attention or to change anything. She justwantedtodie.

However,once,whenshewas inanalteredstate,weaskedherwhatshethoughtthemeaningofherlifemightbe.Shesaid,“Tolove.”“Howcanyoudothat?”weasked.(Shewasanagoraphobicwhoneverleftherapartment.)“Itwillbehard,”shesaid.“Areyouwillingtoacceptthatassignment,thatchallenge?”weaskedher.“Yes.”Later,weaskedheraboutherdeathwish.“Deathwouldbekind.Itwouldbenice,”shesaid.Werecognizedthatshefelt thatwayanddidnot deny it. But thenwe said: “Do you think that deathwould be better thanlove?”Shethoughtaboutitforawhilethensaidsoftly,“No.”“Couldyouputallthe energy you put into seeking death into seeking love?” we asked. Shewondered.Andshe’sstillwondering.Amen.

Ultimately,aswesaid,itistheirdecision.Thegunpointedattheirheadisin their own hands. And you have to forgive yourself if you fail to rescuesomeone who chooses death.We once knew a police officer who was at thesceneofthearrestofaschoolteacherwhohadkilledherboyfriend.Shehadshothim,gonebackto theclassroomandgradedall thepapersfor theday, leavingtheminaneatpile,andthengonetothebanktogetmoneytogetoutoftown.When the police surrounded her, they told her to gently drop her purse andsuitcase, that shehad to surrenderherself.She surreptitiously reached intoherpurse,pulledouthergun,andbeforeanyonecouldmovetostopher,shotherselfin thehead. Itwasyears later thatwemethim, thishardenedofficerwhosees

plenty of trouble, and hewas still simmeringwith “if only’s.”What could hehavedonedifferently?Whatcouldhehavesaid?ItremindedusofthelastsceneofthemovieThelmaandLouise.Mighttherehavebeenwordsthatcouldhavemadethedifference?

Ultimately,VerbalFirstAidforpotentialsuicidesorthoseactivelyseekingtheirowndeaths(onaledgeorwithaweapon)ispracticedverysimply:Call9-1-1ora suicidehot line, sayas littleasyoucan, tryaskingquestions tokeepthem talking (as long as they’re talking, they’re breathing), be as loving andgentlyhopefulaspossible,andprayalot.Keepthebasicsinmind:Gainrapport,getacontractifyoucan,andgivepositivesuggestion,usingthesametechniquesyouwouldforanyotheremergency.

Weofferthischapterasfoodforthought.Everymoveandeverywordinasituation as volatile and unpredictable as a potential suicide is highly risky.Therearenoguarantees,especiallysincethepersonyouaredealingwithmaybeinsane, temporarilyor otherwise, inwhich case that person is functioning in aworld where your words may have little or no meaning. In those situations,prayerandlovingintentionmaybethebestyoucanoffer.

Forimmediatehelp:

LookinthefrontofyourphonebookforacrisislineorCall1-800-SUICIDEintheU.S.

(800)442-4673.....1-800-442-HOPE--sameroutingas1-800-SUICIDE

(877)838-2838.....1-877-Vet2VetVeteranspeersupportline

(800)784-2432.....1-800-SUICIDASpanishspeakingsuicidehotline

(877)968-8454.....1-877-YOUTHLINEteentoteenpeercounselinghotline

(800)472-3457.....1-800-GRADHLPGradstudenthotline

(800)773-6667.....1-800-PPD-MOMSPostpartumdepressionhotline

Thesenumbersandmuchmoreinformationandhelpcanalsobefoundat:

www.preventsuicide.us/hopeline-new/andclickGETHELPNOW(ontheleft)ForhotlinesoutsidetheUS,here’salink

www.befrienders.org

Forteens,callCovenantHouseNineLine,1-800-999-9999.

Callapsychotherapist,agood,wisefriend,areligiousorspiritualadvisor.

GThereisnodeath,onlyachangeofplanes.

--ChiefSeattle

oodbye.Thatistheonewordmostofusdonotwanttohearorhavetosay.Andthis is the chapter in books—as in life— that everyonewants to skip over.Death, dying: these are subjects fraught with sadness, fear, and loss. On thisplane, from this vantage point, the loss is irrevocable. The loneliness, and itsaccompanyingpain,canbeprofound,evendevastating.

TheVerbalFirstAid techniqueswehavepresented throughout thisbookallderive fromanaffirmationof life.Firstaid is the front lineofsurvival, thebeginningof the restorationofhealth.Firstaidmakes itpossible for life togoon. But the need for first aid often ariseswhen the prospects for survival areplaced in doubt or jeopardy. Life is challenged by death, and although weinstinctivelystruggleforlife,thereattimeswhendeathwins.

Whatcanyousay,whatapproachcanyouuse,whentheendoflifelooms,despiteallyoumayhavesaidanddonetopreventit?Thisisthechapteronlastaid,notfirstaid.Andforthismostdifficultoftransitions,wewillprovideyounot onlywithwords to use, but alsowith amethod for determiningwhen theshiftfromlife-affirmationtoacceptanceofdeathistakingplace.

Whatremainsconstantinanysituationinwhichyoudesiretohelpistheneed tocenteryourself and toestablishorbuildrapportandempathy. In fact,thesetoolsmaybeevenmoreessentialasyoufacetheultimatemysterythatwecalldeath.

CenteringinCasesofDying

The need to center ourselves when dealing with issues of dying isfundamental. The ghost of our ownmortality can loom large at such a time,causingustoloseourownequanimity.Itispreciselybecausethebreathisaboutto leave a fellow being that we must focus on our own breath, and gain thecourage tobe calmandwise.There is, if youareopen to it, something in theuniverse—thinkofitas“nature,”or“consciousness”ifyoucan’tnameitGod—uponwhichyoucancallatthisturningpoint.Takethetimetobreathe.Takethetimetogo“inside”andfeelthepresenceofwhateverSpiritcalmsyourown,andquietsyourfearsandsadness.

EmpathyandRapportintheFaceofDeath

Onceyouhavecenteredyourself,connectwiththespiritofthepersonwhoisdying.Deathseemstobeajourneyeveryonehastotakealone.But,aswewillexplain shortly, there are cultures that recognizewe canmake the transition asharedexperience.Whenweconnectdeeplywith someoneabout tomake thatmysterious journey that awaitsus, too,we recognize thatweareallpartof aninterwoven tapestrywith threads andpatternsbeyondwhatwe can see.Listendeeply. Become aware of the dying person’s vision and experience of thisprocess. Be there. Be present in a peaceful way and share that peace withsomeonewhotrulyneedsit.Sayingtherightthingisafunctionofbeingoftherightmind.Knowing,sensing,andbelievingin theconnectednessof theworldandofallGod’screatures,makesthedyingperson’sjourneyavoyageHome.

Keep thedialogopen—don’t be afraidofwhatyoumay stumble across.Sometimes the most painful, awkward, difficult subjects lead to the mosttreasuredmoments and profound insights. Let yourself be led by a holy spiritand by the personwho is dying. Be sure to keep the door open and let themknowyou’renotputoffby touchy topics.Listen.There ismuch to learn fromthedying,especiallythechildren.

Dr.ElisabethKubler-Ross,authorofOnDeathandDying,wasstruckbypaintingsshesawonthewallsofaconcentrationcampinMaidanek.Sheknewthatthechildrentherehadlosttheirfamiliestothegaschambersandwereawarethat they themselveswould shortly follow.“Thewalls in thecampwere filledwith pictures of butterflies, drawn by these children,” she said. “It wasincomprehensibletome.Thousandsofchildrengoingintothegaschamber,and

this is themessage they leavebehind--abutterfly.”Andsheexplained thatherinterestinthefieldofdeathanddyingbeganthere.

Treatthedyingasaperson,notadisease.JoanneLynn,M.D.,ProfessorofmedicineatDartmouth-HitchcockMedicalCenter,tellsthestoryofAlice,anelderly, bedriddenwoman,whowas in the careof her overly solicitous sister.Alicewasdyingandthefamilytriedveryhardtomakehercomfortable,askingher frequentlywhat shewanted—sherbet, tea, and juice.ToAlice, allof theseoffersmissedthepoint.Finallysheturnedtoaddresshersister,whohadaskedheronceagainifshecouldgethersomething,andsaid,“WhatIreallyneedisatendermorselofjuicygossip.”Untiltheveryend,keepinvolvingthepersoninlifeaslongastheyarewillingandinterested.Pleaseremembernottospeakinfrontofthemasiftheywerenolongerthere.

Rememberthemanywayswecanconnect.Engaginginaconversationthatis trueandopen, that faces fears, thathonestlyconfronts theprospectofdeathfreesyouaswellas them.Butwordsarenot theonly tool in sucha situation.Don’tforgetyoursoothingpresence,yourtouch,thesoundofyourvoiceasyouhumafavoritesong.VerbalFirstAidisnotjustaboutthejudicioususeofwords—it’salsoaboutthejudicioususeofsilence.Whensomeoneisreadytoletgooflifeasweknowit,perhapsoneofthemostlovingthingstosayisnothing,toletthatpersonbereassuredofyourlovewithyourpresenceandyourtouch.Ifallyousayis,“I’mrighthere,”you’vesaidagreatdeal.Intheirbook,SpeechandMan,BrownandVanRiper recallastudentwhowitnesseda terribleand fatalaccident.Thestudent ranup to thecarand liftedglassaway from thedriver’sface.Withoutopeninghiseyes,thedrivermumbled,“Givemeyourhand.”Thestudenttooktheman’shandandhelditasthemandied.

DeathinContemporaryCulture

Somepeople say that death is the last taboo. In the twenty-first century,muchthathaspreviouslybeenoff-limitscannowbefoundontelevisionoronthe internet.We arewilling to be shocked or scandalized in the name of freespeech or voyeurism or cheap thrills. Taboos have fallen by the wayside andalmostanysubjecthasitsardent,vocalproponents.Butrarelydowedealwithdeath,atleast,inathoughtful,personalway.InAmericadeathishushedup,likeadirtysecretwhosenamewedarenotspeak.

When Bill Moyers proposed the television seriesOn Our Own Terms:MoyersonDyingtoPBS,therewasconsiderableconcernaboutwhetherpeoplewouldwatch a programabout a topic theywould rather keep at arm’s length.

Thefact that lifeincludesadeathsentenceforeachoneofusissomethingweprefertodeny.AcartooninTheNewYorkerbyBarbaraSmallerdepictsableakand deserted cemetery. Prominent among the other, ordinary headstones is alarge,stolidgravestone.Thewordscarvedintoitread:“Whyme?”Thisdenialof our own inevitable demise canonly bemaintainedbypracticing a rigorousavoidanceoftheultimatereality.

Insomeways,wehavemadedeathafictionalcompanionsincechildhood.On average, an American child will have watched 100,000 acts of televisedviolence, including 8,000depictions ofmurder, by the timehe or she finishessixthgrade.Butthoseanonymous,distanced,oftenbloodlessdeathsserveonlytoinureustosympathy,andtohelpuskeepmeaningfuldeathatarm’slength.Father Richard John Neuhaus, Editor in Chief ofFirst Things, says we haveproblematized death, reduced and depersonalized it with medical technology,demystified itwith repetitious “sob shots” on the evening news (“So, how doyoufeelnowthathe’sdead?”)andde-ritualizedit,wheninfact,thereisnothingmorepersonal,moremysterious,moredeservingof intimacyandwonder, andmoreinneedofritualthandeath.

Weknowayoungboywho,whileridinginacar,rodepastthesceneofafatalaccident.Itwasnotuntilafulldaylaterthathebegantocry,realizingthatthe people he saw lying in the streetwere real peoplewho had actually died.Evenmorepoignant is thedeathofapersonweknoworcareabout,observedcloseup,whichservesasanunavoidablereminderofourownmortality.Whatismore,becausewehavebeensooddlyshelteredfromdeath,thoseweloveoftendieoutofsightininstitutions.Whentheydo,weareoftenatalossforwhattosay,orthink,orfeel.

In the early part of the last century, when physicians still made housevisits,andputtheirearsontheirpatients’cheststoheartheirheartsbeat,peoplepassed away at home, and thosewho loved themexchanged finalwords, heldtheirhands,andsometimesactuallysawthecurtainatthewindowflutterasthespiritmadeitsgracefulexit.Asactiveparticipantsinthecommunity,andaspartofthefamily’ssupportofthedyingperson,children,too,sawandknewdeath.

But as life has become more transient, less deeply rooted, and morematerial,inourdesperateneedtoclingtothetangibleworldweknowwehavebecometerrifiedofdeath.Andanythingwefearbecomesinequalmeasuremorepowerful. Like the ominous image from Ingmar Bergman’s Seventh Seal, theidea of the cloaked, spectral grim reaper coming for us keeps us running theotherway—awashinpillsandplasticsurgeryandfear,untilouradrenalglandsareexhaustedandwegetsick.Andifdeathisthegreatenemy—partlybecauseof its own inherentmystery, partly becausewe shun it and lock it away from

view—dyingistobeavoidedatallcosts.Insomecultures,deathisnotsomuchfearedasseenaspartofthenatural

courseoflife.Intheacclaimedbookandmovieabouthispassing,TuesdayswithMorrie,ProfessorMorrieSchwartzsays,“Deathisasnaturalaslife.It’spartofthedealwemade.”ButourcontemporaryWesternmedicalestablishmenthasitsown way of looking at the situation and it is almost entirelybiological/chemical/mechanical/physical. It has nothing to do with spirit, the“will to live” or spontaneous remissions. Medical textbooks see death as theEnemy. In a study for the Project on Death in America (PDIA), 50 medicaltextbooks were reviewed. Betty Farrell, RN, PhD reports that in all of thosethousandsofpagesonly2percenthadcontentabouttheendoflife.Therewasalmost nothing about pain at the end of life or its emotional content. JoanneLynn,physicianandteacher,writes,“Throughoutthetextbooks,franknessaboutdeath was strikingly absent. Sometimes dead persons were termed ‘non-survivors.’”Doctorsconsiderdeaththeirfailure.

We knew of onewoman in her 90swhowas quite overweight and hadlivedaveryfullandrichlife.Inanexamination,itwasdeterminedthatshehadlung cancer. The doctors, in their enthusiasm to save her, decided that theywould break open her rib cage, operate on her lungs and, when she wasrecoveredenough,beginacourseofchemotherapyforher.Shelookedattheminhorror. “Areyoumad?” she said, reasonably. “Thankyou.Rather than liveoutmylastdaysinpainlikeaninvalid,IthinkI’llretiretomygarden.”Andsoshedid.

WhenandWhy

MostoftheVerbalFirstAidtechniquesyouhavelearnedtothispointaregearedtothosewhowishtocontinueliving.Theyarebasedonthebenefitsoflifeaffirmationandthedangersofthedeathsentence.AsactorBillBixbysaid,“I’mnotdyingofcancer.I’mlivingwithcancer.”Herearetwobriefstoriesthatillustratethispoint.

Onewomanweknow,Tanya,wasdiagnosedwithskinandbreastcancermorethantwentyyearsago.Hercancerouslumpswereremovedandshehadacourse of medical treatment, although she received no chemotherapy. Thedoctorswerenotoverlyoptimistic,butshesaidtoherfamily,“Whocareswhatthey think! I have too much to do to waste my time being sick.” Some twodecadeslater,sheisstillworkingandtravelingthesubways.Shewalksslowlyandshestopssometimestocatchherbreath.Butat94,she’sgotrighttotakeit

alittleeasy.Another woman, Tillie, was diagnosed with liver cancer. The family

requestedat the timeofdiagnosis that shenotbe informed,“because itwouldjust kill her right away.”Five years later on a routine follow-up exam, a newdoctor in the clinic casuallymentioned the liver cancer to her. Shewas deadwithinsixweeks.

Contrary toeverythingwehave toldyou thus far, there is adownside torejectingthepossibilitythatoneisdying,thewayTanyadid.Whendeath’stimeactuallycomes,thelifeprescriptionmaybecomealiability.Therecomesatimewhentheeffort tocontinuelivingbecomessimplytoomuch.Thestruggle,lifeitself,becomesanindignity,threateningtoroblifeofitsfinalsweetness.Therecomesatimefordeath.

Thefirststep,therefore,ifyoudesiretobeofhelptopeoplewhomaybedeclared“terminal,”orwhoclearlymaybeapproachingwhatcouldbetheendof life is to take their spiritual temperature.Ascertainwhether they are livingwith theirconditionordying fromit.Youcandothatbyobservation:are theylistless, passive, or resentful, or are they getting up every day, ready toparticipate in life to whatever extent they can? You can readily make thisevaluationwith an ordinary conversation, using attentive, empathetic listeningskills.

People who are dyingmay understand all the ramifications of having aterminal illness, andmay simply be preparing in their minds for the ultimatejourney or fighting to live. Neither response is right or wrong. It is just theperson’s unique approach to an insoluble situation. However, understandingwhichpositionyouaredealingwithcanhelpyoutochooseyourwordsandpacepeoplemoreskillfully.

Dyingmighthaveas itsmarker thepointatwhichmedical sciencesays,“There’snothingmorewecandobutmakethemmorecomfortable.”Ofcourse,thereareasmanyresponsestothatnotionastherearepeoplewhohavetohearit,butbeloware some thoughtsonhow to speak topeople reacting invariouswaystotheideathattheyaredying.

AcceptanceofDying

Somepeoplerefusetoacceptthesuggestionthattheyaredying.Theygetenergizedbythechallengeanddismisstheassertion.Thesepeoplearenotdyingnomatterwhattheoutcome.Theyarelivingtheirlifeinthismomentfullyandwiththeconvictionthatthereareanswersbeyondtherealmsofmedicalscience.

Orthatmedicalsciencewillfindtheanswerstheyneed.Others,though,choosenot to fight on for any number of reasons. Professor Morris Schwartz, ofTuesdaysWithMorrie fame,becameakindofguruof thanatopsisbyviewinghisdyingasagreatjourney,hislast,inwhichhewaspioneeringthewayandintheprocesstellingpeople“whattopack.”

Sometimespeoplearetired,ortheyfeeltheyhavefoughtenoughandareready tomoveon. In thedaysofblackandwhitemovies,whenmilkwasstilldeliveredinglassbottles,thefamilydoctorwhomadehousecallswouldexittheroomofasickparentorwife,holdinghis littleblackbag,puthishandon theshoulderofahusbandorgrownchildandsaysteadily,“Shelostthewilltolive.”

RachelNaomiRemen,physicianandauthor, tells thepoignantstoryofachildwithleukemiawhosufferedlongandfutilelyinthehospitalinabattleforhislife.Towardtheend,wornandexhausted,hetoldanursethathewas“goinghometomorrow.”Thatthrewthestaffintoanuproarastheytriedtolearnwhohadbeensocruelastotellthischildthathewouldbedischargedwheninfacthewasn’tstrongenoughtoleave,andmightneverbe.Whoeverhadsaidthatwouldhavetobetheonetogoinandstraightenhimout.

Butnooneconfessedtohavinggiventhechildthatidea.Afterawhile,Dr.Remenwentintothechild’sroomandlearnedfromhisownmouthwherehegottheideathathewasgoinghome.Hetoldherthatheknewhewasn’tleavingthehospital, but he was going “home.” Tomorrow. She left his room in tears,explainingtothestaffthemeaningofhispronouncement.Thenextdayhewasgone.Itwastime.Hewasn’tafraid.

Oncethedecisionseemstohavebeenmade,onceitisclearthatthetimeforfarewells isathand, thereareanumberofVerbalLastAid techniques thatcaneasetheway.

ALifePerspective

Somewhere between “Is this all there is?” and “Whatwas it all about?”there are answers.The“brief candle” that is lifeoffersus a chance to expresswhoweare.Impendingdeathinvitesustosumitup.Whatwasthemeaningofitall?WhywasIborn?Whatismylegacy?Onestudyoftheterminallyillaskedthemtorelatethestoriesoftheirillnesses.Itturnedoutthatsomepeoplehadalifethemethat,whenexpressed,affectedhowtheyapproachedtheirdisease.Forexample,whenpeoplecharacterizedthemselvesaswarriors,theyidentifiedwiththebehavioroftellingthetruthandstandingupagainstpressure.Thissenseofacoreidentityhelpedthemtokeeptheirlivesintegrated,andgavethemasenseof

meaning.Perhapsunderstandingpatients’lifethemesthroughtheireyescangivecaregiversausefulframeofreferenceforreflectingbacktopeoplethemeaningoftheirlivesonthebrinkoftheirdeaths.

1)Youcandodyingpeopleagreatservicebysimplylisteningastheyre-live special moments in their lives, as they look back on the highlights of alifetime.Thiskindofreviewcanbeveryhelpfultoorientpeopleastheypreparetomaketheirfinaltransition.

2)You could, if you know the person’s history, add to that life review.Listen to the stories and then shareyourown. Imagine themedicinal effectofhearingsomeonesay,“Ialwaysthoughtofyouasmyrolemodel.Iwatchedyourcourageasyou…”Oreven, “I’llnever forgethowyou…”Youcanusephotoalbums,newsclippings,diaries—whateverisappropriateandavailable.Youcanwritea journal togetherorput togethera scrapbook.Remember that it is theirlife’smeaning,notyours.Letthemcometotheirownconclusions.Youhaveaseparateopportunitytosaywhattheirlifehasmeanttoyou.

Wordsyoumight use to elicit life themesmight be, “I am somovedbyyourcourage.”Or,“Iappreciatehowbraveyouare.”Generally,thepersonwillprotest,not feeling likeahero,butperhapsbasking foramoment in that role.Theymaysay,“Oh,I’mnotreallybrave,I’mjustfeeling…”Whatevertheysay,do not let your own fears about the subject of dying detract from that sacredmoment.Witnessit.Touchthedyingperson’shand.

3)Bring inpeoplewhocanparticipate in this ritualof rememberingandaffirming.Rememberthatshow,“ThisisYourLife,”inwhicheveryonefromathird grade teacher to a current employer tells a story about the subject?Anywaythatyoucanreinforceaglobalviewofthislifeassomethingthathasbeenworthlivingiswellworthdoing.

TheAspenEffect:WeareNotSeparateandApart

Perhapsthereasonwerunfromdeathsofearfullyisthat,inourculture,itissuchalonelyexperience.Perhapsthisfeelingofsolitudecausesdeathtoseemsooverwhelming—thesensethat,nomatterwhatwesharedinlife,nowwediealone,cuttinglifelinesthatconnectustoeverythingweknowandlove.Perhapswe would experience death differently if we sent our loved ones off as theNativeAmericansdo.

MalaSpottedEagle,aWesternShoshoneandCherokeeNative,talksabout

theNativeAmericaviewofdeath.ThePeoplegatheraboutthedyingpersonsothatheisnotalone.

Thereisasong.It’sanintertribalsongthatcanbeusedforcrossingover,tohelpthespiritonitsjourneytofinditspathinagoodwayforwhereveritneedstogo.Ifthepersonhasenoughstrength,hejoinsinandifnot,everybodyaroundsingsitforhim.It’sasongthatalotofpeopleknow.Sometribesusetheirowntribalsong—buttheoneIamthinking of is used by many. It is a prayer to the Creator and theancestorsaskingthatthejourneytothespiritworldbeagoodjourney,that the person’s needs be taken care of, that they connect with theancestorsinagoodway,andgowheretheyneedtogo.

It asks for the ancestors to come help guide you, towalkwithyou on your journey. When people hear the song, they are usuallyaware that it’s time.And theyarehappy for it. It feels like then theyhave thePeople there lending them the strength so that that journeycanbemade,helpingtocalltheancestors.You’renotdoingitalone.Youhavelotsofhelp.

[Inmy culture] it’s like you don’t really die, there’s no death,justgoingfromoneformoflifetoanotherformoflifeinourjourney.Wedon’tfeardeath.Webelievethatourthoughts,ourwords,whatwefeelinourheartshavealotofpowerandenergytothem.Ifyoureallybelieve in a certain way with a lot of others, you create that way.There is not just one spirit world or path, there aremany creationsthatpeoplehavebelieved.ThereisHeavenandHellifyoubelieveit.Webelieveinaspiritworld.Whenyouaretotallycompleted,thenyougoontothespiritworld,livinginharmonywithanimals,thebuffalo,andweallwork togetheragain.To thePeople, thegreatestgift is togo back and live that way. If your lessons weren’t completed, youcross over and your spirit would look for where you needed to berebornintoforthelessonsyouneededtocomplete,andyouareguidedbacktothatspot.Sothatisoneofthereasons[our]peopledon’thavefearofdeath—thereisnothingtofearthere.

Even though it seems thatwediealone, itdoesnothave tobe thatway.Weareinthistogether,togetherwitheachotherandwithNature,orGod,ortheSpiritWorld,ortheUniverse.Whenweareabletoacceptdeath,faceit,embraceit,wecanbetherefor thedyingpersoninawaythat is intensely intimateandsupportive.AsBillMoyersputs it, “WhileAmerica is foundedon, anddriven

by, a myth of rugged individualism, when we get to the end of life, ruggedindividualismdoesn’tdothetrick.Weneedwitnessestoourdeath….”

Colorado is filled with endless fields of Aspen trees, glorious, graceful,bending in the breezes, gold leaves flashing. To the casual eye, they seem tostand separate and apart. Remarkably, the Aspen tree is one of the largestorganismsintheworld.Forbeyondoursight,deepunderground,itisanetworkofsharedroots,allinterconnected.Thosetreesthatappearsingleanddividedareabovegroundexpressionsofonebeing.

Whatif,beyondoursight,wetooareallconnected?Bybeing“sung”intothenextworldbythoseyoulove,youneverwalkalone.

FindingtheDeathStory

Because death is a mystery, we each enter it with myths of our ownmaking, depending upon our upbringing, our culture, our beliefs. With thepossible exception of nihilism, whatever a person believes can provide somecomfortattheendoflife.

1)Religiousbeliefs.Whenpeopleholdtraditionalreligiousbeliefs,itgivesthem a framework and a blueprint for dying. Final rites, forgiveness,blessingsmayallplayaroleandit isagoodideatorespectthesebeliefsandceremonies,eveniftheyarenotyours.Facilitatethemandacceptthatthere is magic in them simply because they are deeply held andcomforting.

RichardJohnNeuhausrelateshisownterrifyingdancewithdeathandthewordsthatchangedhisperspective.Hehadbeenoperatedonforacolontumorthathadrupturedhisintestine.Heawokewithasurgicalscarstretchingfromtheribcagedowntohispubicboneandshortlyafterwardsbegantohemorrhage.Hewaswheeledintosurgeryoncemoreandspentdaysinintensivecarewherehehadwhathecalledhis“nearlifeexperience.”

Hehadbeenwiredupwithallsortsoflife-savingbleepingmachineswhenit suddenly seemed tohim thathehad satup, althoughheknew thathisbodywas prone on the bed. He felt himself “jerked into an utterly lucid state ofawareness.” He saw “two presences” and somehow heard a message that“Everythingisreadynow.”

Thepresencesdisappearedand leftNeuhaus inbedalone tocontemplate

themessageandwhathediscernedwasthis:“TheywerereadytogetmereadytoseeGod…ThedecisionwasmineastowhenorwhetherIwouldtakethemupontheoffer.”ThisreminderofaneternaltruthbroughtFr.Neuhausgreatpeace.

2)Spiritualbeliefs.Incontemporarysociety,manypeoplemaybespiritualwithout being religious. Theymay hold beliefs in a higher power or aninterconnectedness,orbelievethattheirspirit iseternal,andtakecomfortinceremoniesthataffirmthisview.Prayercirclesandsupportgroupsareresourcesforthosewhoaredying.

One spiritual approach thathas foundadherents around theworldcomesfromtheBuddhisttradition;itisTheBardoThodol,alsoknownasTheTibetanBookoftheDead.Itprovides,perhaps,theoriginalandultimateVerbalLastAid—whattosaytothosewhoaredyinganddeadtoaffecttheultimateoutcome.Itisaguidethatismeanttobestudiedbeforedeath,andtobereadtothedeceasedatthetimeofdeathandagain49daysafterdeath.RamDass,projectleaderofthe Living/Dying Project in San Francisco, says it is hoped that reading theTibetanBookoftheDeadtoterminallyillpatientstherewillprovidethemwitha“newmetaphor”fordeath,solackinginourWestern,clinicalapproach.

ThephilosophybehindtheTibetanBookoftheDeadholdsthatlifeisanillusion,anon-goingcycleofbirthanddeathfromwhichwecanbefreedonlyby enlightenment. Enlightenment is the recognition of our true purpose andconnectionwiththeClearLight.Therearewordsandimagesthatcanguideusthrough the Bardo—the planes of the intermediate state between death andrebirth—helping to train the mind to experience theClear Light that is bothempty and radiantly blissful. In thatway, themind,which cannot die, can beawakenedandliberatedfromthewheelofeternalreincarnationor,secondbest,canfinda“goodhumanbirth.”

When the person has died, the desired end is tomove toward the light.Somepeople takewrong turnsout of fear.Somedonot accept that theyhavedied.Itisimportantforthepersontorecognizethatlifehasended,thatnowisthemomentofdeath,inwhichthemindisintotaltransparency,empty,withoutcolororsubstance,butsparklingvibrantandpure,encounteringnoobstaclethatcanstopit,withoutbeginningorend.ThewordswereadfromTheTibetanBookof theDead remind thedeadperson that there isnothing tofearbecausedeathhasalreadyhappened.(Theworst isover!)Thepersonistoldtogotowardthelight,tomergewithit.

Becausethisbookcanbereadbeforedeath,itoffers,tothosewhoaccept

it,aroadmapforcrossingsuccessfullytotheotherside.EkhardtTolle has put it anotherway: “Life is not theopposite of death.

Lifehasnoopposite.Birthistheoppositeofdeath.Lifeiseternal.”

3)TheInspiredConnectionwith the Infinite.Somepeople recognize thatthelifetheyhavelivedis,asPlatosuggested,ashadowofsomethingmuchricher. They experience proof of the eternal in song, nature, love, thosethingsthatelevatethespiritandmakeusseemlargerthanournames,ourjobs,ourbodies--the labelsweagree to, just togetby.Poetsmoreartfulthanwehaveexpressed this inways thatcan inspirehope foreternity inthoseleavingthisplane.Oneofourfavoritewritingsonthissubjectisthefamous poem, “Death Be Not Proud,” by the metaphysical poet JohnDonne.

Deathbenotproud,thoughsomehavecalledtheeMightyanddreadful,forthouartnotso;Forthosewhomthouthink’stthoudostoverthrow,Dienot,poorDeath,noryetcanstthoukillme.

Fromrestandsleep,whichbutthypicturesbe,Muchpleasure;thenfromtheemuchmoremustflow,Andsoonestourbestmenwiththeedogo,Restoftheirbones,andsoul’sdelivery.

Thouartslavetofate,chance,kings,anddesperatemen,Anddostwithpoison,war,andsicknessdwell;AndpoppyorcharmscanmakeussleepaswellAndbetterthantheystroke;whyswell’stthouthen?

Oneshortsleeppast,wewakeeternally,Anddeathshallbenomore;Death,thoushaltdie.

4) Answers from Science. Some people require a scientific approach,includingstudiesandproof,beforetheyacceptabelief.Theymaywanttobelievethatdeathisnottheend,butarelookingforassuranceinaclinicalway. Until very recently, death was a one-way ticket into the ultimate

unknown.Today,however,weliveinatimeinwhichpeoplecandieandcomebacktolifeagain.Theirbrains,theirhearts,theirentiresystemscanshut down completely, and through the awesome power of technology,thosepeoplecanberesuscitatedandrevived.Interestingly,becausesciencehasmade itpossible to revivepeoplewhohave technicallybeendead, ithas become possible to examine what happens after life is medicallydeclaredover.

Thestoriesofnear-deathexperiences(NDE)areoftendramatic.Generally,people see awhite light, a tunnel, and loved ones or spiritual beings greetingthem.Often, a changeofheartor avast respect for allof life seems tobe theresult.Therearemanystoriesofchildrenreportingthehelpofangelswhiletheyweredead,storiesthatareparticularlyconvincingbecausetheyinvolveconceptsthechildrenhadnotyetlearnedinthislife.

OneofthemostbeautifulandwellknownistheBirdiesstory.ThisstoryhascirculatedontheWeb,waswrittenupinabook,BeyondtheFinalFrontier,byDr.RichardKent andDavidWaite, and is generallybelieved tobe true. ItwaspresentedbyLloydGlentoachurchcongregationinCaliforniainJuneof1994.Histhree-year-oldson,Brian,hadbeencrushedunderagaragedoorandwas clinically dead, although a neighbor had performedCPRon him and hadrushedtheboytothehospital.Hissternumwascrushedrightoverhisheart.Thedamagetohisbrainandbodycouldhavebeendevastating.Miraculously,youngBrian regained consciousness. Even more miraculously, tests showed he hadsufferednolastingneurologicaldamagefromhistrauma.Brian’shomecoming,onhisreleasefromthehospital,wasajoyousoccasion.

Oneday,amonthaftertheincident,Brianspokeinfullsentencesbeyondhisthree-year-oldvocabulary,totellhismotherwhathadhappenedtohimwhenhewasstuckunderthegaragedoor.Hetoldoftheawfulpainandthenexplainedthathehearda“whoosh”andthenthebirdiescameandtookcareofhim.Theywore white and green clothing he said (although he had not yet learned hiscolors).Onebirdieevenrushedtogether,whiletheystayedwithhimandtoldhimthat“thebaby”wouldbeallright.Whenthemotherasked,whatbaby,heansweredthatitwasthebabyunderthegaragedoor.Themother,uponhearingthis,realizedthatBrianhadbeenoutofbodythroughthepainandsuffering,andhadwatchedthesceneundertheprotectionofhisangels.Briantoldhismotherthathehadheardherspeakto thebaby, tellinghimtostayandnot leave.Themotherwasshocked.Shehadindeedtoldhimnottogo,hadaskedhimtostayifhecould.

GlentoldthecongregationthatBrian’sexperiencetaughtusthatifwelookwithourhearts,notoureyes,wecanseethatthebirdies(thatis,ourangels)arealways with us. Brian had told him that if we listen, we can hear themwhispering to us. What he was saying was, essentially, that we are guidedbeings,wearenotalone.Headdedthatthebirdieshaveaplanforus,because“theyloveussomuch.”

Children’s reports of NDEs have a guilelessness that makes them quitestunning, even to a cynic.We remember once hearing a story reported on theeveningnewsofacarcrashinvolvinganentirefamily.Themotherandsonwerekilled, the daughter died and then came back to life, and the father survived.Uponbeing resuscitated, thegirlwasnot told thathermotherandbrotherhadpassed away, but she reported being in a place with a beautiful light and“MommyandJohnnywerethere,too.”

Scientists and physicians in Great Britain who are studying NDEsmethodicallyhavemadetheclaimthatconsciousnessseemstoexistoutsidethebody.AstudypresentedtoscientistsinJuneof2001attheCaliforniaInstituteofTechnologybyaBritishscientiststudyingheartattackpatientsoffersevidencethat consciousnessmay continue after thebrain has stopped functioning and apatientisclinicallydead.

Sam Parnia,M.D., is one of two physicians from SouthamptonGeneralHospital inEnglandwhohavebeen studyingNDEs.The resultsof ayearlongstudypublished in the journalResuscitation, tracked63“clinicallydead”heartattackpatients.Thepatientswererevivedandinterviewedwithinaweekoftheirexperiences.Fourreportedlucidmemoriesofthinking,reasoning,movingaboutandcommunicatingwithothersafterdoctorsdeterminedthattheirbrainswerenotfunctioning.Thephysiciansexplainedinaninterviewthatthese“studiesarevery significant in thatwehaveagroupofpeople…whohavewell-structured,lucid thought processeswith reasoning andmemory formation at a timewhentheir brains are shown not to function.” This seems to indicate an on-goingsourceofconsciousnessbeyondtherealmofthephysicalbody,independentofthebrain.

If studies such as this one help us to eliminate our fear of death, therecouldbemanygoodconsequences.Firstofall,whenwe’reinfear,aswehaveexplainedearlier,ourbodiesmakeharmful chemicals.By reducing the fearofdeath,wemayalsobe reducingchemicals thathavebeen impedinghealing. Ifwe are not in fear but calm, we may even heal. Secondly, there are manytraditionsthatbelievethatdyingconsciouslyhasimportantimplicationsforthe

transition.Certainly,ifonediedpeacefully,theimplicationsforthoseleftbehindwouldbeverybeneficial.

The Second Law of Thermodynamics states that energy and matter canneitherbecreatednordestroyed.Weare,essentially,ashumanbeings,madeofrecycled stardust and information encoded in our DNA. The calcium in ourbones could be older than theWhiteCliffs ofDover; the iron in our blood isdefinitelyolderthanthesun,sinceithasbeenshownthatitwouldhavetakenaheatgreaterthanthesuntoforgeit.Ourbodieswillberecycledagain,forever.And so will our energy. According to the Bhagavad Gita, one of the sacredancient texts of India, “Just as you throw out used clothes and put on otherclothes,newones, theSelfdiscards itsusedbodiesandputsonothers thatarenew.”Whateveryoucallthatthingthatanimatesourskinandbones—callitSelforSpiritorSoul—accordingtomanybeliefsystemsitcannotbedestroyed.

All of thisdocumentation ismeant to help those inclined to believe thatourconsciousnessgoesonafterdeath,whoarestilllookingforsubstantiation.Inthis case, these studies and reports and laws of thermodynamics constitutetruismsthatcanhelpputafrightenedmindtorest.

ReconcilingandUnfinishedBusiness

“Don’t go to sleep angry,” some people admonish, with the implicationthat,ifone“shoulddiebeforeIwake,”therewillbenochancetomakeupandforgive. Forgiveness is golden. It soothes psychic pain and opens the heart.“Don’tgotodeathangry,”mightalsobeawiseadmonition.

Forthosewhohaveabeliefsystem,iftheyseetheirapproachingdeathasGod’swill, youcanhelp themby suggesting that theuniverse is a safeplace,thatGodisgood,thattheirlifehasbeenmeaningful.Youmightalsohelpthembywondering,withoutjudgment,“WhatdoyouthinkGodwouldwantyoutodoabout your relationship with your son/daughter/husband/wife/mother/father?”This simple question could provide opportunities for healing, for bringing oldfamilybusinesstoclosure.SurelyGodwouldnotwantthemto“goaway”mad,andtheymayatsomelevelrecognizethat.Reconcilingisineveryone’sinterestwhileitstillcanbeaccomplishedonthisplane.

Dr. Donald Trent Jacobs, psychologist, paramedic and author ofPatientCommunication For First Responders and EMS Personnel, Teaching Virtues:BuildingCharacterAcrossCurriculum,wascalledtoadyingman’sbedsideinaroom crowdedwith familymemberswho stiffly and formally lined thewalls.Therewas little conversationand less intimatecontact.Therehadbeen lotsof

bitternessinthefamily,especiallybetweenthedyingmanandhisson.Themanseemed unconscious, and Don wasn’t certain what he was expected to do oraccomplish.Threerelativessatonasmallwoodenbench.Behindthemwasanolduprightpiano,coveredbyanold,dustycloth.Jacobsfelttheirresistibleurgetoplaythepiano.Muchtotheirsurprise,therelativeswereshooedoffthebench,andhesatdownandstartedplayingasongfromthe1920’scalled“Whispering.”This was not a tune Jacobs was given to whistle. He had no idea where thethoughtcametohimtoplayit,buthedid.Andwhenhediditwasasifaboltoflightningstruck thedyingman:hiseyesopenedandhesatupandaskedforaglassoforange juice.Somehow, at some level, hehad recognized that hehadunfinishedbusiness, andhe lived for 11months longer so that he andhis soncouldrepairtheirwoundedrelationship.

GivingtheDyingPersonPermissiontoLeave

Occasionally, people are ready to leave, but hesitate, unwilling todisappoint a loved one, or out of a feeling of obligation to stay for someoneelse’ssake.Ifyourecognizethatthe“fightforlife”isover,hardasitmightbetoletlovedonesgo,itisanactoflovetogivethempermissiontoleaveiftheymust.Whenafriend’sfatherwasdyingoflungdisease,hisdevotedwifeandhisthreedaughtershoveredoverhim.“Weweresoreluctanttolethimgo.Wealladoredhimso.Hemusthavefeltthat,eventhoughhewasinacoma.Finallywerecognizedthathewaslingeringforoursakeandthataslongaswewerethere,he would not desert us. In a house full of women, he had always been ourprotector.Now,hewassuffering,hangingon,tokeepusfromthepainhislosswouldcause.HowIwish Ihadknownwhat to say then. Iwouldhavesaid tohim,‘Dad,weloveyou.Youarealwaysaliveinsideofus,foraslongaswelive.Andweunderstandifyouhavetogo.Nothingwilldiminishourconnection.Weknowyou’lldowhateveryoumust.’Withinanhourofourleavingthehospital,wereceivedthecallthathehadpassedaway.”

Ifyourecognizeasituationlikethisone,youmightwanttogivethedyingpersonpermissiontopasson,withlovingwordssuchas,“IloveyouandwantyoutoknowthatIunderstandifit’stimeforyoutomoveonnow.Ifyoumustgo,itisallrightwithme,I’llbeallright,andyouwillalwaysliveinmyheart.”

Remember,too,thatdeathistheirchoice.Havenoagendabuttheirhighestgoodatheart.Itisnotuptoyoutoresistorinsist,onlytowitnessandallow.

WordsforOtherStatesofConsciousness:Alzheimer’s’SyndromeandComas

What follows is amagical story that happens to be true about twowell-knownpeopleandarevelationaboutAlzheimer’sdisease.

Dr. Elmer Green began his career as a physicist at the NavalWeaponsCenter, received a PhD in biopsychology, founded the Voluntary ControlsProgram at the highly respected Menninger Foundation, co-founded theInternationalSocietyfortheStudyofSubtleEnergiesandEnergyMedicine,andwithhiswife,Alyce,wrotethebest-sellingbook,BeyondBiofeedback.PriortotheGreens’ studies, itwas believed that the body’s autonomic functions (e.g.,heartrate,digestion,bloodpressure,brainwaves,etc,)couldnotbevoluntarilycontrolled.However, by studying Indian yogimasters, theGreens proved thatthenervoussystemandmetabolicratecouldbeconsciouslyregulatedandbeganusingbiofeedbacktoalleviateawiderangeofailments.

Several years older than Elmer, as Alyce moved into her 80s sheexperienced Alzheimer’s disease. When, in her confusion, she demanded ofElmer, “Whoareyou?”andheanswered, “Yourhusband,” shewoulddismisshimwithahaughty,“That’swhattheyallsay!”Stillverymuchinlovewithher,Elmertendedtoherneedsandoneday,asshelayinacoma,hedecidedtoreadtoher from theTibetanBookof theDead.Suddenly, sheopenedhereyesandspokelucidlyfor thefirst timeina longwhile.“ThankyouElmer,forreadingthat tome.Now I know exactlywhere I am.” She told him thatAlzheimer’soccurs when the spirit leaves, but the mind and body must stay to completesomething. She also said, conversely, that autism occurs when the mind andbodyenterthisworld,butthespiritdoesnot.Andforsometimethereafter,shespoketohimfrom“theBardostate,”theafter-lifeorintermediatestatedescribedbytheTibetansasaplacebetweenlifeanddeath.

All this, andmuchmore, fills a900-pagebookwrittenbyElmer, called,TheOzawkie Book of the Dead: Alzheimer’s Isn’tWhat You Think It Is. Thepoint of this story is that even people suffering with Alzheimer’s might bereachedwiththerightwords.

Whensomeonewelovedies,wecanbecomesoimmersedinourowngriefthatwe can forget the lovewehave for others, and that others have for us. Ifthere’sevenaslightpossibilitythatthedeadcanstillseeandhearwhatwearedoingand saying, shouldn’twebepaying just abitmore attention tohowwebehaveinthislife?Doesn’titmakefightsoverwillsandfamilydisputesallthemore painful to think that our departed have to witness it? Recognize that

kindnessandlovearetheelixirsthatheal,evenwhenallelseseemslost.

SeizetheDay

Sometimesthelossissudden,unexpected,andyounevergetthechancetosaythethingsthatfloodyourthoughtsandheartnowthatthelovedoneisgone.ThemostessentialVerbalFirstAidprincipletorememberisalwayssaywhat’sin your heart if it is loving. It doesn’t cost a thing, it makes you and yourrecipient feel wonderful, and you’ll never have to regret not having said it.Wheneveryoufeelitisagoodtimetosayit.Lookingatsomeone,beingfloodedwith love and then saying, “You are so beautiful.” or “I just have to stopeverything and tell you I love you,” is like sun kissing flowers, like musicwaftingacrossafield,likethefootlooselaughterofaninnocentchild.Wemustalwayssaywhatistrulyinourheartswhilewecan,evenifthepersontowhomweaddressthewordsisinacomaandwethinktheycannothearus.Butifyouhave missed that chance, you might want to remember what Tuesday WithMorrie’sProfessorMorrieSchwartzhad to say about that: “Death ends a life,notarelationship.”

PARTFOUR

AboutYou,TheCaregiver

A

“...thatbestportionofagoodman’slife:hislittle,nameless,unrememberedacts

ofkindnessandlove.”--WilliamWordsworth

nyone ina traumaticsituationcan feelhelplessandhopeless.WehavewrittenthisbookinthebeliefthatwhenyouhelpotherswithVerbalFirstAidyoualsohelp yourself to get through the situation by taking control and by havingsomethingpositiveandconcretetodo.Whenyousuggesthealingtoothers,yourunconsciousmindislisteninginatthesametime.That’sanotherwayinwhichthisinformationcanbesoimportantandsovital.

Inevitably, though, that time comeswhen the paramedics are gone. Theperson you helped is now in the hospital, but you may still have adrenalinerunningthroughyou.Howevercourageousyouhavebeen,howevereffectiveinapplyingVerbalFirstAid,younowsitbyyourselfandfaceyourownfeelings.

People in the rescue business—firefighters, police, paramedics, SWATteams,nurses,doctors,andsoon—knowwhatdealingwith traumacosts thememotionallyandmentally,aswellasphysically.Atitsmostdebilitating,thiscanbecomeaclinicaldisorder:Post-TraumaticStressDisorder(PTSD).

In many circles, the standard protocol for dealing with post-emergency

traumatic stress is calledCritical Incident StressManagement (CISM). JeffreyMitchell,Ph.D.,developed thisprogramin1983basedonhisexperiencesasafirefighter-paramedic and regional coordinator of emergency medical servicesfortheMarylandInstituteforEmergencyMedicalServices.Itisthesinglemostwidelyusedandsuccessfultoolindealingwithcriticalincidentstressreactions,whether we’re talking about emergency personnel or victims of a terroristincident.

There are seven distinct steps to the debriefing process, which usuallytakesplaceingroupsandwiththecombinedhelpofaCISM-trainedpeerofficer(EMS, police, or firefighter) and a mental health professional. The essentialpurpose of CISM and critical incident debriefings is to identify those groupmemberswhoseemtobehavingstrongreactionstotheincidentandmayneedfurther psychological support. In the process of sorting out thoughts andfeelings,themajorityofparticipatingrescuersleavethedebriefingbetterabletocontinue theirworkandmanage theirownlives. IfyouhaveusedVerbalFirstAid inanemergency,you’vebeen in thesamepositionas thoserescuers.Andthefeelingsyouarelefttodealwitharethesame.

TheFeelings

Blessedly, during the trauma or emergency itself something happens tomostofusthatallowsustosetasideourfeelingsinordertodealwiththeurgentneeds of the moment. We may experience a lot of different feelings: fear,confusion,impotence,anguish,anxiety,frustration,anger,sadness;wealsofeelthings you might not expect, like relief, closeness, silliness, pride in havinghelped,indifference,ornumbness.Therangeofemotionsisasvariedasweare.Noneisrightorwrong.Yetsomehowwemanagetoholdthesefeelingsincheckuntilwe’redone.That’swhatallowsustousetheVerbalFirstAidtechniques…tobeclearenough,calmenough,andincontrolenoughtohelp.

Afterwards,however,once theemergencyhaspassedandyouradrenalinhasbeguntoretreat,thosefeelingsmayre-emerge.It’snotatalluncommon.

Feelings of helplessness or a lack of control on the scene of a medicalemergency or a critical incident have been shown to increase the pressure onrescue personnel. It was entirely too common to hear comments such as, “Icouldn’tdoanything,”“Iwaspowerless,”“ItjustallcamedownandIcouldn’tstop it,” over and over again atNewYork’sGroundZero in the aftermath ofSeptember11.Whilethisagonyisfamiliartoanyonewhowantstohelp,peoplewhoaretrainedtosavelivesfinditdoublydifficulttotoleratethatfrustration.

RobynRobinson,Ph.D.& JeffreyMitchell, Ph.D., both on theBoardofEditorsoftheInternationalJournalofEmergencyMentalHealth,evaluated172emergency, welfare and hospital personnel and concluded that the death of achildandmultiplefatalities, line-of-dutydeaths,andincidents thatput themortheircolleaguesindangerwerefarmorelikelytocauseaggravatedacutestresssymptoms. It would be hard to imagine anyone not being deeply affected bywitnessingthoseevents.

Helplessnessbringswithitaslewofotherfeelings,dependingonyourlifeexperience and nature.Most people, especially thosewho are trained to help,abhorthefeeling.Itsresidueisoftenanger,frustration,self-blame,orblameofothers. In more serious reactions, a person can become obsessed by theexperienceandisolated.

Sometimespeoplerespondinsurprisingwayswhentheyfeelfrightenedorthreatened.Awomanweknowtellsastoryaboutatimewhenherthree-year-oldsonstuckabingoballuphisnose.Theycouldn’tgetitout,andhebegantohavesomedifficultiesbreathing.Themotherrushedthechildtotheemergencyroomof a nearby hospital, chattering all the way. “This is my son,” she said, in alively, almost cheerfulmanner, to the receptionist upon arrival,withwhat shewas certain was great equanimity. “He has a bingo ball up his nose. He wasplaying and, of course he knows better, but for some reason, he—” shecontinued.Shewatchedasthereceptionistpickedupthephoneandsaid,“Ihaveachildwitha foreignobjectuphisnose,needPedsconsult,”and then, tohersurprise, turnedhishead,whispering into thereceiver,“and themother isveryupset.”

Insomesituations,whenthevictimisachild,orapersonverymuchlikeyourself, either in age, looks, or circumstance, it is easy to unconsciouslyidentify with that person.When you see that person in trouble—whether it’sbeing hurt, sick, or killed—a part of you fears for your own safety and wellbeing.Youbegintofeelveryvulnerable.

Vulnerability is truly the critical issue. After all, seeing someone getseriouslyhurtorseeingsomeonedieremindsusthatwe,too,aremortalandourtimehereislimited.Thatisthetruthofthesituation.Anditishardtoface.Ourvulnerabilityalsoincludesthepainofloss.Wewill, inevitably, ifwelivelongenough,losepeoplewelove.

If you have been using Verbal First Aid with a stranger, you may findyourselflessemotionallyinvolved,whichisthoroughlyreasonable.Theyarenotpartofyoureverydaylife,norareyoupartoftheirs.Althoughyouwanttohelpthemgetwell,itislikelythatyourfirstencounterwiththatpersonwillalsobeyourlast.Muchlikea9-1-1operatororanemergencyroomphysician,youmay

never knowwhat happens to that individual after your job is done.Does thatpersonrecover?Didyouhelp?Unlessyoumakeaconcertedeffort tofindout,you justwon’tknow.The result is thatwhileyoumayhave lessvulnerability,youalsohave lessopportunity for closure.On theotherhand, if thepatient issomeoneinyourfamily,orsomeoneyoucareabout,youremotionalinvestmentincreasesdramatically.Whileyoumaygetmoreclosure,youwillalsobemorevulnerable.

WhenaHelperNeedsSomeHelp

Having all the feelings we discussed—sadness, vulnerability, anger,frustration,grief—isanormal,predictablehumanreactiontoillness,trauma,anddeath. Sometimes, however, these feelings do not fade as we might expect.Sometimestheygrowstrongerandbegintotakeoverourlives,changingusandourrelationshipsinpotentiallydestructiveways.

Aswementionedbefore,there’sanameforthissyndrome:Post-TraumaticStressDisorderorPTSD.Noteverypersonmeetslifeonthesameterms.Thoseofuswhoareparticularlycaringandsensitivemaybeeasilyhurt.Othersofusplaytighterhandsanddon’t talkorshowtheirfeelings.Eitherwaywecangetoverwhelmed by what we’ve experienced in helping others through terribletrauma.PTSDisnotuncommon.IfyouseesignsofPTSDoveraperiodoftime,inyourselforinsomeoneelse,weurgeyoutospeaktosomeonewithexperienceinitstreatment.

Althoughyoumightfeelasifyouaregoingcrazyortrytoignoreit,orthatyou’ve failed in some way, or even figure (wrongly) that there’s somethingshamefulinyourfeelings,gettinghelpisabsolutelytherightidea.Withtherightsupport,inshortorderyoushouldfindyourselfbackontrack.

PTSD is a treatable ailment. Increasingly, and importantly in ourjudgment,themedicalprofessioniscomingtoseeemotionaldisordersmuchthesame way it does physiological problems such as diabetes or pneumonia:symptomsleadtoadiagnosis,whichleadstotreatmentandacure.PTSDisasrealaproblemasabrokenbone,andwithpropermedicalcare,it’severybitastreatable.

Helping goes in circles. If you are experiencing any of these feelings orsymptoms,callsomeoneyoutrustandgetthehelpyoudeserve.

Signs&SymptomsofAcuteStressandPTSD

Acute stress and post-traumatic stress are both reactions to traumaticevents involvingeitherdirectpersonalexperienceofa life-threateningevent,aserious injury, a threat to one’s life or physical safety, witnessing a death ordisaster,orexperiencingagriefreactiontoafamilymemberorcloseassociate’sdeath. Acute stress differs from post-traumatic stress in that it lastsapproximately fourweeks from thedateof thecritical incident.Post-traumaticstressdisorderisonlydiagnosedwhenthesymptomslastlongerthanonemonth.

Whattolookforinstressdisorders:

1.Unduesurvivorguilt.2.Rigorousavoidanceofsituationsoractivitiesthatremindone(evenvaguely)oftheincident,whichbeginstointerferewithnormallifeactivities.3.Impairedrangeofaffect,meaningthatwhereasonceyouwereabletofeelawide range of feelings, such as love and joy, nowyou are feeling only a dullnumbness.4.Self-destructiveorimpulsivebehaviors.5.Dissociation—afeelingofnotbeinginone’sownbody.6. Increased somatic complaints—headaches, stomach and GI upsets, backpains.7.Feelingsofshame,ineffectiveness,despair,orhopelessness.8.Withdrawalandisolationfromothers,feelingsofdetachment.9.Afeelingofbeing“damaged,”“worthless.”10.Alossofpriorbeliefs,alossoffaith.11.Hostilityandangeronashortfuse.12.Hypervigilance—afeelingofbeingvulnerableandthreatenedwherenosuchthreatisordinarilyperceivedandanexaggeratedstartleresponse.13.Recurringnightmaresanddifficultyfallingorstayingasleep.14.Flashbacks—asenseofre-experiencingthetrauma.15.Difficultyconcentrating.

StepsTowardsSelf-Healing

Therearesomesimplethingsyoucandoforyourself,beginningwithyourinnerdialogue.

ChangeYourThoughts

Asyoutoldthevictim, it’s importantforyoutorealizeandtellyourself:Theworstisover.Thesefeelingsarenormalandnatural.IdidthebestIcouldandnowit’sinthehandsofthedoctors.Becomeawareofwhatyou’resayingtoyourself,ofyourinnerdialogue(seeSelfTalk,nextchapter).Areyoublamingyourself?Areyouangryatyourselforsomeoneelse?Areyoufillingyourselfupwithnegativethoughtsorpositiveones?Doyourthoughtshelporhurtyou?Asimpleandobviouswaytoremindyourselfofyourownthoughtprocesses,andthefactthatyoucanchooseyourthoughts,istoputlittlePost-it®notesonyourrefrigerator,car,ormirror.Haveeachnotebeareminderofathoughtyouneedtohear,whetherit’s“theworstisover,”or“goodwork.”Whenyoucomeacrossaninspiringthoughtinabookorarticle,writeitdownandaddittoyourPost-it®collection.

RememberYourStrengths

Whenwearefrightenedorworried,wetendtobecomeoverlyfocusedonthenegative.It’sanaturalformofself-protectiontotrytoprepareyourselffortheworst.However,atthistimeitservesyoubettertorememberwhoyoureallyareandwhatyoutrulyarecapableofdoing,andwhatyouhave,nodoubt,beenable to do before. Lean into your strengths, your hobbies, the things you’re“knownfor”(Yourpies?Yourjumpshots?Yourflowergarden?).

Youmayfeelthatyou,too,areavictimofthisemergencyandwhilethatmaytechnicallybeaccurate,it’snotinyourbestinteresttothinkthatway.Ifanegativethoughtfindsitswayintoyourthinking,youdonothavetoallowittobecomeapermanentfixture.Letitgo.Youhavethatpower.And,onceagain,ifyoufindyourselfunabletomanagethisonyourown,agoodtherapistcanhelprestoreyourpeaceofmind.

Pray

Ifyou’renotreligious,youcanreadthissectionheadingashavinghopefulthoughts.Aswementionedinthefirstchapter,LarryDossey,M.D.,hasreportednumerousdouble-blindstudiesthatvalidatethehealingpowerofprayer.Inthewell-knownByrdstudyinSanFrancisco,agroupofheartpatientswasdividedintotwogroups.One,theexperimentalgroup,wastheobjectofprayers,andtheother, the control group,was not. The experimental group showed fewer sideeffects from treatment, as well as shorter hospital stays. Studies at Duke

Universityand theUniversityofNewMexicohavesubsequentlydemonstratedprayer’spowerinhealing.

Evenifyoudon’tknowwhattoprayforexactly,“Thywillbedone,”hasbeendemonstratedinstudies,asreportedinHealingWordsbyDr.Dossey,tobequalitatively even more powerful than specific requests. “Whatever is in hishighestgood,”mayprovethesame.

Prayer,whether foryourselforanotherperson,works.Even ifyoudon’tfully believe thismodel, the act of praying ismeditative.Andmeditation hasbeenshownempiricallytohavepositiveeffectsonallmajorbodysystems.

TalkAboutIt

Studies on support groups, particularly with cancer and AIDS patients,indicate that the simple act of sharing an experience can have all sorts ofbeneficialeffects.Talkingmakesusfeellessalone,opensourownheartstowardothers,andcangiveusanewwayoflookingatwhatwehavebeenthrough.Itcanalsogiveusmodelsofsuccess:ifothershavebeenthroughitandtheyseemokay,wecandoittoo.

Sometimes just venting works. Use a conversation to blow off steam.Sometimespeoplehavegoodideasandsolutionsforyou.And,sometimes,justhearingyourselfcomplainonetimetoomanyleadstochange.

WriteAboutIt

Writingaboutatraumaforcesustoslowdownourthinkingandfocus.Wehavetocollectourthoughtsbeforewecanarticulatethemonpaper.Andwritingisnot a just a consciousprocess.Asyouwrite allkindsof images,memories,feelings come up that youmay not have expected. The connectionsmade byyourunconsciousmindwillsurpriseyou.Youhaveaccess,inthisway,topartsof yourself that youmay not have heard from in quite awhile.Writing givesthemavoice.AccordingtoDr.JoshuaSmyth,assistantprofessorofpsychologyat North Dakota State University, this “process [of writing] is very differentfromtheintrusiveandupsettingruminationthatoftenfollowstraumaticevents,aprocessthathasbeenshowntohavephysiologicaleffects,amongthemincreasesinheartrateandinthelevelofstresshormones.”

A study reported in the Journal of the American Medical Association[JAMA,April14,1999-Vol.281,No141304-1309]foundthatpatientswith

bronchial asthma and rheumatoid arthritiswhowrote about trauma for twentyminutes for three days had physiological changes in their blood to indicatedmedical improvements in their conditions. Studies on “healthy” people’simmunesystemshowedthatwhentheywroteabouttrauma,thereweremarkedimprovements in the IgA in their saliva, indicated that their immune systemsgrewstronger.

Anotherway to use this process is towrite a letter to the personwho’sbeenhurtor taken ill.Youmayneveractuallydeliver this letter,butwriting itallowsyoutofreelyexpressandexamineyourthoughtsandfeelings.

SurroundYourselfwithLovingPeople

Thisispro-activeself-love.Ifthepeoplearoundyoudon’tunderstandyou,supportyou,orareconsistentlynegative,youmaywanttoconsiderassociatingwith different people during this time, at least until you’ve regained some ofyourcharacteristicbalance.Negativityfeedsoffnegativity,andpositiveenergyworks the sameway. If you haven’t spoken to a dear friendwho lives out ofstate ina longwhile, then thismightbeagood time tocall andheara lovingvoicefromahappiertime.

Anddon’tforgetthesalutaryeffectofour“bestfriends,”wonderfuldogsandcats.Havingapethasbeenshowntohavenumeroushealingbenefits,fromlowering blood pressure to increasing our immune systems efficiency. Onewoman undergoing a panic attack pounded on the door of a classmate in herdorminthemiddleofthenight.“I’msoupset,”thefirstwomansaid,hardlyabletocatchherbreath.Theclassmateopenedherdoorwider to let thewoman in.“Want toholdmyhamster?”shesaid to thewomaninpanic.Whocouldhaveguessed that the furry critterwould be the very source of all things calm anddear?

EatRight,SleepRight,BreatheRight

Don’t forget thebasicsofhealthy living, startingwith agoodbreath.Atanygivenmomentyoucanchangethewayyoufeelbyfocusingon,andslowingdown,yourbreathing.Similarly,ifyou’restressedandnoteating,oraresleepingpoorly, you are only further depleting your body’s natural defenses. Eatrealistically—don’tgorgeonsugarandstarches.Theymaygiveyouatemporaryboost, but there’s a price to pay afterwardswhen you bottomout. Sleeping is

whenyourbodyrepairsitself.It’sabsolutelyessentialthatyougetthesleepyouneed.Everything looksand feelsdifferentafter agoodnight’s sleep.Wehavefound that Bach’s Rescue Remedy™ is a gentle way to soothe the feelingsbroughtonbyshock.Itanatural,herbalremedymadefromthedewofflowers;four drops in an ounce of water helps bring you back into balance; eight totwelvedropshelpsmanypeoplesleeplikeababy.

StressReduction

There are different ways to manage your stress, including exercise,meditation,hypnosis,progressiverelaxation,simplevisualization,yoga,taichi,consciousbreathingpractices,andprayer.Themethodyouchooseisuptoyou.Manypeopleusemorethanone.Therearehundredsofexcellentcurrentbooksandtapesonthistopic.Nowwouldbeagoodtimetobuyone.

Neuro-LinguisticProgramming/Visualization

Neuro-linguistic programming, or NLP, is a form of psychotherapy thatmanipulates images in the mind to make them easier to handle. One of thetechniques that NLP therapists use is to ask their clients to visualize thetraumatic or unpleasant event bothering them on a largemovie screen in fullcolor.Thenextstepistoseeitonasmallermoviescreen.NextyouseeitonawidescreenTV.ThenyoutransfertheimagetoasmallerTV.Finally,youseeitona tiny,black&whitescreen.Staythereamoment, thenreachout,grabtheknobandturnitoff.

Remember that the imagination is accessible at every moment. It iscourtesyofyour imagination thatyoukeepseeingupsettingmentalpictures tobeginwith.Comeupwithamentalpictureyoucancallupatwilltomakeyoulaughorevokejoy.

ATouchofKindness

Youtriedtohelp.Howeverit turnedout,you’vedoneyourbest.Despiteoureffortstodirectevents,lifehasitsownagenda.Wedon’tcalltheshots.Inproviding Verbal First Aid to the best of your ability, you gave someonecompassion,supportandhope.Now,giveyourselfsomeofthatsamekindness.

Any second thoughts you may have, any blame or anger you may befeeling, these are not working in your best interest. To quote the Buddha,“Resentmentislikeahotrockyouholdinyourhandinthehopesyoucanthrowitatsomeone.”Letgoandgoonliving.That’sthebestwaytohelpyourselfandallthosearoundyou.

VerbalFirstAidChecklistforYourself:

WhentheWorstisOver,HaveYou…

1.Donesomethingkindforyourself?2.Eatenproperly?Replenishedyourselfwithlotsoffreshwater?3.Calledsomeoneyoucareabout?4.Listenedtoagoodpieceofmusic?5.Takenawalk,gonetothegym,donesomeyoga?6.Prayed?Compiledagratitudelist?7.Playedwithyourcat,dog,orotherpet?8.Sharedyourthoughtsandfeelings?9.Writtendownwhateverbothersyou?10.Laughedatagoodjoke?

T“Theangelsflybecausetheytakethemselveslightly.”

--G.K.Chesterton

here is a theory among some psychologists that we are all schizophrenic, butthoseamonguspresentingauniformpersonalitytotheoutsideworldgettowalkaround outside the institution walls. For certain, we are bombarded by thecacophony of voices in our heads. They judge us and find us wanting. Theypraise us and thinkwe’re unique. They provoke us to do thingswe knowweshouldn’t and keep us from doing things we know we should. They aresometimes childish (“I’m outta here!”), and sometimes parental (“You alwaysmessup;youcan’tdoanythingright.”)

These voices, especially those that prod and pinch at our weaknesses,emergeintheirfullestforcewhenweareatourmostvulnerable—whenwearetired, hungry, frustrated, hurt, angry, confused—all states easily reachedwhenwehavespentagreatdealoftimetryingtohelpanotherpersonindangerorinpain.

Thehealthiestthingyoucandoforyourselfifyouarehelpingothers,andevenifyouarenot,istomonitoryourownthoughts.Bynow,ifyouhavegottenthisfarinthisbook,youappreciatetheinordinatepowerofwordsandthoughtsonyourphysicalbodyandyouremotions.Ifyoustepoutsideyourthoughtsandlisten,youmaybesurprisedatwhatyouoverhear.Itissaidthatwehavetensofthousands of thoughts per day,many ofwhich are the same thoughtswe had

yesterday—andmostofwhicharenegative.Simplypayingattention toyour thoughtsgives them less autonomy, and

thereforelesspower.Evenwithoutmakinganefforttochangethem,throughtheveryactofnoticingthemmanyoftheuselessonesseemtoslitheraway.

There is a joke that goes: “Doyou knowhow tomakeGod laugh?TellHimyourplans.”Clearlywearenotinchargeofmuchinourlives,buttheonething—perhapsthemostimportantthing—thatistrulyoursisourattitude.Richorpoor,sickorwell,whensomeoneasksifyouarehappy,yougettoanswerforyourself. If you say and believe that you are, no one can contradict you.AbrahamLincoln,oneofthemostdepressedmenevertositintheWhiteHouse,usedtosay,“Mostofusarejustaboutashappyaswemakeupourmindstobe.”Wecannotchangetheexternalworld,oratleastwecan’talwayscontrolit,butourattitude,ourpeaceofmind,canbeinviolableifwesodesireit,inthefaceofanyobstacle.TheBuddha said that life is not aboutwhat happens to you, butabouthowyoureacttoit.Andthatitisyourownhands.

Energyflows.Ifitissimplyflowingout,youbecomedepleted.Youarenotworthanything to thoseyouwouldhelp ifyouaredepleted,

dejected, demoralized.You cannot help aman out of a pitwhen you share itwith him.Allow your attitude to keep you safe fromharm,warm even in thecold,andkindatheart.

SomeWordsYouCanSayToYourselfWhentheGoingGetsRough

1.Youdidn’tcauseit,andyoucan’tcureit.Thetraumaisnotyourfault.The behavior problems are not your fault. The illness is not your fault. Thedifficulties in adjustment and frustrations the patient experiences are not yourfault. The changes, therefore, that patientsmustmake are theirs tomake.Notyours. Learn the distinction between what you can do and what you cannot.Sometimesthisisparticularlydifficultwhenemotionsofguilt(perhapsyouhavesurvived theaccident intact)or loveare involved,orwhen there isunresolvedgriefforsomeonewhoisalivebutisforeverchanged.Butblamecostspreciousenergyanddoesmoreharmthangood.

2.Youcanhelpthem,butyoucan’tgetwellfor them.Forsomepeople,perhaps for you, this is a very difficult concept, especially if your heart isinvolved. Judith Simon Prager remembers taking her infant daughter to thepediatricianforaninoculation.Thebabywassoyoungandpreciousthat,asshe

held her in her arms, she felt almost incapable of delivering her over to thedoctorwhowasgoingtostickaneedleintoher.“Youwanttotaketheshotforher,don’tyou?”thedoctorsaid,smiling.Andthatwastrue.Butitdoesn’tworkthatway, and sometimes forverygood reasons,wecan’t spare eachother thepain.

If you have their best interest at heart, andwe know you do, it is veryimportant to allow the victims or patients to do whatever they can forthemselves.Ifitmeanstheywillspendfiveortenmoreminutestyingashoelaceorgettingdressed,sobeit.Evenifitmeanstheywillbecomefrustrated.Whensomeonehashadbraintrauma,whetherfromacerebrovascularaccident(CVA)oracarcrash,recoveringlostskillsorfunctionsrequireshardworkoveralongperiod of time on the part of the victim. That isn’t your job. One of themiraculous features of the brain is called plasticity, which means that newpathwaysare formedbasedonnewactivities.Braincells fromonepartof thebraincanfill in forcells lost inanotherwhen thesenewpathwaysare formed.Evenwhenthetaskdoesnotbuildnewneuralpathways,inmostcasesofillnessor emotional disability, even making an attempt builds confidence and everylittlevictorycanbuildmorale.Forallthesethingstohappen,weneedtoletthepatientsthemselvesdothework.

3.Haveanattitudeofgratitude.It’seasyinthemidstofastormofworriesto forget tonotice life’s smallblessings.Somebodysays,“Niceday,”andyoulookup,surprised.Whendiditstopraining?Somebodybringsyouacontainerofhomemadesoupand,ifyouchooseto,youcanfeelnourished.Everything,asEinstein pointed out, is relative to the observer. You may be surrounded bytreasures you have overlooked. Remember that a loyal dog, a car that runs,flowersthatbloominakaleidoscopeofcolor,oran“achingback”thatdoesn’tache right now, is a blessing.Gratitudemeans that you notice the small giftswhen andwhere you find them. It’s a qualitywe cannurture bygiving it ourattention.

WhencellbiologistDr.BruceLiptonsays thatwereceive4,000,000bitsof informationintoournervoussystemeverysecondandcanonlyconsciouslyregister 2,000, he is saying that on some levelwemust be choosingwhatweregister as information. By changing the lenses through which we filter thatinformation we can actually see a different world. If the bits we choose toregister are the ones thatmake us smile, the world we see and hear and feelbeforeusisthatmuchricher.

4.Rememberthatinlifetherearenomedalsformartyrs.Infact,martyrsoften make other people uncomfortable or angry just by being holier thaneveryone else. Even if your every gesture of help seems fully appreciated, becareful of how far yougo in that effort to help. InZen, there is the notionofIdiot’s Compassion, which occurs when we give a person a fish instead ofteachinghimhowtocastaline.

Moreover,whenwegivetoomuch,totheexclusionofourownneeds,weare leadingourselvesdown thepathofbitterness, resentment, isolation,and illhealth.AsEdnaSt.VincentMillaysaid,“Mycandleburnsatbothends.Itwillnot last the night.” Becoming a martyr on the cross of care giving is not aselflessact.Itdoeslittlegoodtohelpotherstoourowndetriment.Youarebestequippedtohelpwhenyouknowhowtohelpyourself.Andfromtheperspectiveofyourpatientsandlovedones,theyneedyoutobewellandstrong.

5.InneuropsychologistRickHanson’snewbook,HardwiringHappiness,he reminds us that we are built with a “negativity bias” which causes us toremember those things which might cause us harm more concretely than thegood ones. He offers techniques to develop the neural networks that supportinnerstrength,resilience,andhappiness.HeusesthewordHEALtoremindustoHaveapositiveexperience,Enrichit,Absorbit,and(optional)Linkittothenegativetosootheandreplaceit.

6. Perspective makes perfect. This time and place, these circumstances,this job of care giving, these are not all there is to you or to your life. Giveyourself a broader context. When we are overwhelmingly concerned withhelping a victim or ill person, we have a tendency to become excessivelyfocused.Use awider-angle lens. “Okay, this is awful.Butwhat else is there?What else am I seeing? Thinking? Feeling? Hearing?” Even broadening yourworldbyexploringnewsensoryperceptionsinthepresentcanbeveryhelpful.Itbreaksthenegativetranceweallfallintofromtimetotime.

Seebeyondthelimiteddescriptionsofyourcurrentlifeinalldirections:

Lookback.Rememberyourselfbeforethistime,andcallupstrengthsfromthosehappier,perhapsmorecarefreetimes.Whowereyouthen?Youarestillthatperson.Lookforhimorherinsideofyou.Lookforwardintime,bringingthestrengthsyoufoundinyourhistoryintoyourfuture.

Looksideways.Istheviewbroaderthanyouthoughtwhenyoulookbeyondthenarrowroadonwhichyoumarch?Lookupandgetaspiritualperspective.Afriendofours,exhaustedbyfrustrationsasshehelpedothers,feelingalwaysthatwhatevershedidwasnotquiteenough,askedthe“heavens”whynothingwasworking.Sheshakesherheadasshetellsitnow,becauseassoonassheaskedthequestionsheheardthesewordsinhermind:“Oh,butyoushouldseehowyou’reshiningfromhere!”

7.Youarenotalone.WhenDr.LarryDosseywritesabout thepowerofprayer andnon-local thought, he describesways thatwe are interconnected inthismoment,butmightnotyetaccept.Dr.BruceLiptonbelievesour thoughtsare not contained in our heads, and cites magneto-encephelograms that canmeasureourthoughtswelloutsideourskulls;ifyouthinkyourbodyestablishesthelimitsofwhoyouare,youmightwellbewrong.

Take a breath and imagine connecting with every soul that has everbelonged to a being who has done good work. Mother Theresa, MahatmaGandhi, Albert Schweitzer, ElizabethKubler-Ross. Feel their goodness. Now,feel their exhaustion.We once saw a TV interview that Mother Theresa hadgranted,andatthatmomentshewasdownrightcranky,withgoodreason.Whatshe was trying to do was difficult, and not always rewarding. You mayoccasionally be saintly, and occasionally be grumpy, and on the whole, bemakingawonderfulcontribution.

Nowconnectinyourmindwiththepersonyouarehelping.Whatcanyouknowabouthimorherthathelpsyouhelp?Whatcanyouknowaboutyourselfthatcanmakeyoumoreeffective?Allowyourselftobebothimperfectandyetmuchmore thanyou thoughtyouwereandyouwillbe rewarded inwaysyoucannotyetimagine.

8. Have a spiritual context for your life. Adding God to the equationalways tilts the odds in your favor. According to a Harris Poll in 1998, 94percent of Americans believe in God, 90 percent believe in Heaven, and 20percentbelieveinreincarnation.Intheworldatlarge,asmanyas80percentofusbelieveinmultiplelives.

Havingafaithinsomethinggreaterthanyourself,knowingthatthereisaPlan—aslittleBrian’sbirdiesdescribedit--particularlywhensomeoneyoulove

ishurtorlost,whenthingslooktheirmostbleak,feelingyourselfinGod’shandsisanenormouscomfortandrelief.

Whenthingsdon’tseemtobeworkingoutwhenyou’vetriedtobetheoneatthehelm,surrenderingcanbethereliefyou’vebeenlookingfor.

And always remember, if you are or someone you know is in distress,please do not hesitate to call a professional. There are therapies that arespecificallydesignedtoaidpeoplewhohavesufferedtraumas.

A“Sevendayswithoutlaughtermakesoneweak.”

--JoelGoodman

booklikethis,ofnecessity,isfilledwithheavytopicswithhardlyanyreliefinbetween. Everything from motorcycle wrecks to cancer, from nervousbreakdownstosuicideattemptsanddying.Wehaveofferedavarietyofverbalapproachestohelpturnthosesituationsaround.Butthereisonemoretechniquewethoughtwemightmention,andinsodoinggooutonalaughortwo,whileinformingyouofstillanotherelementofhealingwithwords.

Awomanwenttothedoctor’soffice—oneofthosebigpracticeswhereyouseewhateverdoctorhappenstobeonrotationwhenyoucomein.Shewasseenbyadoctor,butafterjustafewminutesintheexaminationroom,sheburstout,screamingassherandownthehall.Anolderdoctorstoppedandaskedherwhattheproblemwas,andsheexplained.Hehadhersitdown in thewaitingroomandrelaxwhilehetriedtogettothebottomofthings.

Then hemarched back down the hall and demanded of the new doctor,“What’s thematterwith you?Mrs.Terry is 63 yearsold, shehas fourgrownchildrenandsevengrandchildren,andyoutoldhershewaspregnant?”

Thenewdoctorsmiledsmuglyashecontinuedtowriteonhisclipboard.“Curedherhiccupsthough,didn’tit?”

Did this storymake you laugh? “Hee-hee healing,” a new form therapy

nowbeingpioneeredtotreatillnessaroundtheworld,couldsaveyourlife.Nojoke.

AccordingtotheAmericanAssociationforTherapeuticHumor, therearecurrentlymore than100studiessuggesting thebeneficialeffectsofhumorandlaughteronthebody,themind,andthespirit.Laughterhasbeenfoundtoboostthe immune system, increase natural disease-fighting killer cells, lower bloodpressure, lower cortisol levels, and have beneficial effects on conditions asdiverse as cancer, rheumatoid arthritis, and serious allergies. It can trigger thereleaseofendorphins,thebody’snaturalpainkillers,andproduceanaturalsenseofwellbeing.

Taking their lead fromNorman Cousins, who pioneered research in thehealing power of humor thirty years ago, scientists and physicians in Japantested the healing power of humor on allergy sufferers. Twenty-six men andwomenwithallergicskinrashesandseriousallergiesweretakenofftheirallergymedications for three days. Then, the day of the test, theywere injectedwithallergens and shown themovieModernTimes, starringCharlieChaplin.Theirskinweltsweremeasuredbeforeandaftertheywereshownthe87-minutevideo.Theprocedurewasrepeatedandthevolunteerswereshown,instead,aweathervideo.Thewealresponsestriggeredbydust-miteallergens,cedarpollenandcatswere unchanged after watching the weather video, but were significantlyreducedafterCharlieChaplinhadhiswaywiththem.

When a friend of ours learned he had a 70 percent blockage in amajorartery in his heart, doctors placed a stent in that artery to hold it open. Theoperation was a success, but it bothered him greatly to have the surgicalprocedureincommonwiththenVicePresidentDickChaney,withwhomhehadradicallydifferingpoliticalviews.Whilecomplainingaboutitloudlytofriends,someonestartedsinging,“Un-chain-eymyheart…”andtheroomexplodedwithlaughter.Onejokeandourfriend’sattitudechangedforever.

Researchers have been taking the subject of humor very seriously in anefforttolearnwhetherhumorhasadirecteffectonourphysiologicalsystemsorwhetheritsimplycounteractstheerosionofourwellbeingcausedbystressandanxiety. Dr. Michael Joseph, a pediatrics specialist at the University ofCalifornia, wonders, “Is it the physical act of laughing itself? Is it the brainpathways which are activated? We simply don’t know and more research isneeded.” Whatever mechanism is responsible, we do know, through bothpersonalexperienceandempiricalstudies,thathumormakesusfeelbetter.

What about peoplewho seemed to have lost their zest for life, who aredepressedandunhappy?Doeshumorhelpthem?PsychologistJasonGoodsonofUtah University conducted a study on depressed people to see exactly how

humorwouldimpacttheiremotionalstates.Heputtogetheragroupofclinicallydepressed volunteers who watched tapes of stand-up comedians for thirtyminutes a day for fourweeks.Goodson showed a 42 percent reduction in thevolunteers’ scores on clinical scalesmeasuring depression—a very significantfigure.

Health can be a state of mind no matter what the state of body. Somepeoplecansuffer themostdebilitatingdiseases,yet theirheartsareclear, theireyes bright, their souls uplifted and uplifting. It is axiomatic in mind/bodymedicine that goodhealth hasmore to dowithwhat is going on in our headsthaninourbodies.Wecanthinkofcountlessindividualswho,despiteseeminglyoverwhelmingillnessandmisfortunefindlotsofroomforjoyintheirlivesandno room for complaint. They experience life fully whatever they are doing,wherever theyare,evenwhen theyareapproaching theendof their timehere.“Lookdownatyourfeet,”theytellus.“Remembertobewhereyourfeetareandknow that iswhere your joy is.”Onemomentwith people like these and youknowyouhavebeenchangedforeverbecausenowyouknowthatyou,too,canchoosejoy.

HowYouCanUseHumor

Althoughthisisaveryseriousbookaboutveryserioussubjects,weenditon this chapter about humor because humor useswords to heal outside of themedicalsettinginwaysthatstillgostraighttotheheart.

Humorhelpsusconnectinwaysunrelatedtoourcircumstances.Strangersbondinainstantwhenafloppypuppytryingtostanduporababyplayingpeek-a-boo makes them burst out laughing in a moment of unselfconscious joy.Laughter can also heal relationships fractured by resentment or anger. Whenpeopleareabletolaughatthemselves,theygetanewperspectiveandcanbeginto see that the things that stood between them were less important than therelationshipitself.

Barbarahasbeentakingcareofherelderlymother,Brenda,foralongtimeandbothofthemaretired,frustrated,andrestless.Theybothwantabreak.Hermotherdoesn’twanttobesick,andBarbarawantstogooutwithherfriendsforone,long,carefreeevening.HermomaskedBarbaraforaglassoforangejuicethirty minutes earlier, and Barbara, sidetracked by dozens of chores, hasforgotten about it.Brendayells, “What’s thematterwithyou, I askedyou forthatorangejuicehoursago!”

For some reason, thismoment remindsBarbara of something funny that

they both had a good laugh about some time before, so she starts to laugh.“What’s so funny,” her mother asks, still indignant, and Barbara says,“RememberwhenAuntHelenpouredtheorangejuiceonUnclePhil’sheadandsaid…”Hermother hootswith laughter. The tension evaporates in an instant,andthetwowomenre-establishtheirbond.

Afriendwentouttothemoviesleavinghissick,elderlymotherathome.Upon his return, she askedwhat he had seen. Itwas a comedy, andwhen hestartedtellingheraboutittheybothdissolvedinlaughteroverthesillyplot.“Ididn’t knowyou’dbe interested in it,” he said, feeling suddenly closer toher.Thenshesaidsomething thatmovedhimdeeply.“I lookold,andIamill,butit’s thesameOctobernight forme that it is foryou.”Fiftyyears later,hestilltellsthatstory,soprofoundlydiditchangehisperception.

Obviously,whatwefindfunnyispersonalandoftencontextual.Buttherearesomeguidelinestomakehumorhealingasopposedtojustfunny.

AccordingtoDr.EdDunkleblau,apsychotherapist,thosewhowouldusehumor therapeutically shouldavoid sarcasmandabusivehumor,whichmeans,simplyput,trynottolaughatsomeoneelse’sexpense.Humorshouldbekind.Itisoftenunexpected,andwecanalwaysrecognizeourselvesinit.Whilehumorcan be healing, too much humor can seem dismissive and can leave peoplefeelingthattheirissuesarenotbeingtakenseriously.

Nobodycantellyouhowtobefunny;itmustgroworganicallyoutofyourownnature and the situation.Butwe can remindyou to allowyourself to seehumorwhereveritcanbefound,knowingthatitcanrefreshthesoul,calmtheanxiousmind,lightentheheavyheart,andhelphealouraccumulatedwounds.

Wecan’tputhumorintoourscriptedprotocolsbecauseitistooperishable.It is based on circumstances and perceptions, which are always changing. Itrequirestuningintothemomenttotestitswaters,asparkflashingonlyinthatparticularmoment in time, and it is subject to the emotional temperature, thesharedexperiences,and the funnyboneof those involved.TherewillbemanysituationsthatcallforVerbalFirstAidinwhichhumorwillneverbeappropriateatall.But,intheend,humormaybewhatsavesyou.Intheaftermathoftragedy,somethingmaystrikeyouasamusingandyouwillfeeltheweightoftheeventbegintodissolve.Itmayevenbepossibleforyoutosharemomentsoflightnesswiththosewhosesufferingyouarehopingtoease.

And so we are almost at the end of this book. And true to our purpose offinishingaveryheavysubjectwithasmile,wewillleaveyounotwithourlastwords,butwiththesometimesinadvertentlyfunnylastwordsoffamouspeopleontheirdeathbeds,whomighthavewishedthey’dhadabooklikethisonwhattosaywhenmakingafinalexit.

Die?Ishouldsaynot,dearfellow.NoBarrymorewouldallowsuchaconventionalthingtohappentohim.—JohnBarrymore,actor,d.May29,1942

Friendsapplaud,thecomedyisfinished.—LudwigvanBeethoven,composer,d.March26,1827

IshouldneverhaveswitchedfromScotchtoMartinis.—HumphreyBogart,actor,d.January14,1957

Iamaboutto–orIamgoingto–die:eitherexpressioniscorrect.—DominqueBouhours,Frenchgrammarian,d.1702

Goon,getout–lastwordsareforfoolswhohaven’tsaidenough.(Tohishousekeeper,whourgedhimtotellherhislastwordssoshecouldwritethemdownforposterity.)–KarlMarx,revolutionary,d.1883Getmyswancostumeready.—AnnaPavolva,ballerina,d.1931

Theycouldn’thitanelephantatthisdist…(KilledinbattleduringUSCivilWar)–GeneralJohnSedgwick,UnionCommander,d.1864

I’vehadeighteenstraightwhiskies,Ithinkthat’stherecord…–DylanThomas,poet,d.1953

Don’tletitendlikethis.TellthemIsaidsomething.—PanchoVilla,Mexicanrevolutionary,d.1923

Eitherthatwallpapergoes,orIdo.—OscarWilde,writer,d.November30,1900

SinceTheWorstIsOverwaspublishedin2002,wehavereceivedmanylettersand e-mails from first responders, therapists, medical personnel, care givers,andpeoplewho,inthecourseoftheirlives,haveusedittogreatadvantage.Wewantedtosharesomeofthosestorieswithyou.

I.From-GretchenBear

I’vebeeninthreereallybigcaraccidents,onceasapedestrianandtwicewhenothershaverunred lights,and there’salwaysbeensomebody therewhogotmyattentionandgotmecalm.WhenIheardyouonNPR,Iputit togetherandunderstood.Whattheysayissovitallyimportant.InthesecondoneIwasunconscious. Someone began talking tome inmy ear. “Iwas awitness,” shesaid calmly. “I’m putting my phone number in your purse and your purse isgoingwithyouintheambulance.”WhenIwokeup,Irememberedmypurse,thepolicegothernumberanditwasamazing.

Yourinformationreallyrangtruetome.

ThedayofthiscurrentaccidentIwitnessed,Iwasdrivingmysontomusic

class and I saw a woman jump out of a car that had just been hit, drag herchildrenout,throwthemonthesidewalk,curlupinaball,andbeginwailing.

I grabbed a blanket and threw it over her legs. I said, “You know, I’mtakingalookatyourkidsandthey’redoingreallywell.They’reingoodhands.Someone’s called the ambulance and in two minutes it will be like a wholehospitalwill be here to help you.” I saw that her armand stomachhad beenbruisedandherotherarmwasbleeding.Itouchedherlegandaskedhowthatfelt,transferredawarenesstoahealthyspot.*

*[Thetechniquesheusedistotouchapersonwherethey’reNOTinjuredand ask how that feels.When you do that, three things happen.First, it takestheirmindoffthepainoftheinjury.Second,itletsthemknowtherearepartsofthem that are still all right and whole. And third, because they start feelingbetter(fromthepainreliefofchangedfocusyou’reyourpresence,theytrustyouandyou’vegainedsomerapport.]

I was there for an hour. I was the point person for the police, firedepartmentwitnesses, Iwas thecenterpoint. trying togetherhusbandon thecell. I helped her get calm, get her head together, asked her, do you have ahusbandorfriendsIcancall.

Whentheyshowedupitwentcrazy.Atthe timeofmyfirstcaraccident,noonewouldeventalk tome.Iwas

bleeding, my head went through the windshield. People would look at me inhorror. Iwonderedhowbad itwas,wasIparalyzed.Onemancameup tomeand said, “You look beautiful.” He said my legs were looking good. Heacknowledgedmeandsaidsomethingpositive,andIknewI’dbeokayafterthat.Ijustignoredeveryoneelsethere.

Inanaccidenttheamountoftimeseemssolong.Youmaybeslippingintoshock.Whensomebodylocksintoyouandgivesyouafoundation,youcanfeelnormal and be dealing again, not tied up by the blur that is fear, not painbecausetheshockhandlesthat.

WhenIheardyouonNPR,IknewitwasimportantandIgaveacopyof

yourbooktomydoctor,andonetomymomandonetomyhusband.

Thewomanfromtheaccidentcalledmeacoupleofdaysago, tosay,“IjusthopesomedayIgettobethepersonwhogetstohelpsomeoneelseout,asyouhelpedme.”

I’msomoved,yourbookjustpoppedintomyheadandIknewwhattodo.

II.FromJasonB.PalmerChaplain(CPT)USA,1stInfantryDivisionSat,September11,2010

Ihavebeguntousetheverbalfirstaidtechniquesdiscussedinyourbooksinmyprofessionalministryaswellasmypersonallife(i.e.,withmythreelittleboys). No only was I able to discuss your ideas with fellow chaplains, Idistributed several of your books to the medics in 1st Battalion, 5th FieldArtillery.During theentiremonthofJuly,we trainedat theNationalTrainingCenteratFortIrwin,CA.Iusedverbalfirstaidduringdozensofsimulatedmasscasualtyscenarios:someinvolvingSoldiersfrommyunitaskedtopretendasifthey were injured in a particular way and others involving a combination ofSoldiersassignedtoFortIrwinandHollywood-styleroleplayers(someofwhomwere real life doubleamputees). I foundverbal first aid techniques tobe verywellreceivedbyall.Infact,theentiregroupinfluencedbyyourbook--myselfaschaplain and our medics--received extremely high praise from outsideevaluatorsforouroverallcaregivingmethodologywhichIcontribute,inpart,totheimpactofyourwork.

Sincereturningfromthattrainingexperience,Iwastransferredtoanewbattalion,whichisscheduledtodeploythisfallinsupportofOPERATIONNEWDAWN in Iraq. While I pray it never becomes necessary, I look forward topassing along anymeaningful experiences that occurwhile deployed for youruse in further research. I againwant to thank you for your investment in theformofthebooksyousogenerouslysent.

VeryRespectfully,JasonB.Palmer

Chaplain(CPT)USABrigadeSpecialTroopsBattalion2ndHeavyBrigadeCombatTeam1stInfantryDivision

III.FromColetteClaude,BowenPractitioner

IhadthebestexperienceaboutaweekagowhenIwasdrivingintotown.An accident had JUST happened-- I was two cars back. Therewas a big oldtruckbarelydamagedandalittleregularcarallcrunchedupwithsmokefumingout.Noonehadstopped,soIdecidedIshouldseeiftherewasanythingIcoulddotohelp.Theownerofthetruckwascallingthepolice,andsoIwentovertothe driver of the small car. She was shaking and shivering up a storm, andsitting in a car full of noxious fumes. She couldn’t speak, just staring straightaheadinadaze,hermouthhangingopen,andlookingshockedoutofhermind.

Istartedtospeaktoherslowlyandquietly.Itoldherthattheworstisoverandthathelpisontheway.Eventually,Irememberedtotellherthatherbodyknowsexactlywhattodo,andthatwecouldtrusteverythingthatwasgoingon.

Thatwas all I could remember of your paragraph, but itwas enough. Ican’t believe how powerful thosewordswere!Not only forme--givingme ananchorofsomethingtooffer,butforher.Itmayhavebeen5minutesthatIwasthere.Shewent fromshaking toexpressingdisbelief (ather firstaccident)andsomeanger,toeventuallycryingwhileItouchedherbody.Bythetimethepolicearrived,shewascalm,completelycoherentandbackinherskin.

Itwasaremarkableexperience,andIamSOgratefulthatyouweretherewithme!!

IV.AnotherfromColetteClaude

AlongwithknowingwhattosaywhenIcomeacrossacaraccident,Inowalsoknowwhat to sayat thebedsideof someonewho isdying:“Theworst isover.Youaresafe.Youhavesupportallaroundyou,andwewon’tleave.Thereisaspecialplacewaitingforyouontheotherside.Youcandothisinyourownway,butwhenyou’reready,youwillbeabletogo.Theworstisover.Yourbodyknows exactlywhat to do.Your lungs knowwhat to do, your heart, etc. Trustyourbody,itknowswhattodo.Youcanletyourbodycarryyou.”

Lastnight,IwassittingwithafriendinHospice,anditsuddenlydawnedonme how to speak to her so that this new and foreign experiencemight beeasier.Itwassucharelieftorealizethatthiswasanotheremergencyandthatyour paragraph—the parts I remembered—could provide a framework forspeakingtohermindandherbodyasshewasdying.

I beganusing these sorts of phraseswhen shewas still fairly conscious,although completely preoccupied with her struggle for breath. She turnedtowardmewithaflash,andIknewthatshewaslistening.Becauseitseemedtobemeaningful to her andbecauseall of us in the roomwerealso relievedbywhat Iwas saying, I continued foracoupleofhours, every sooften,until shewasnear her end. Itwas sucha relief to have a sense ofwhat to say, and toknowinmybonesthatitwashelping.

Sothanksonceagain!

V.FromDebDevine,MFT

Margie [names have been changed] was a fellow student in anundergraduate psychology course (I am now amarriage and family therapistintern).InoticedMargie’shandsshakinginclassandtearsstreamingdownherfaceasmoststudentslefttheroomafterthelectureended.Istayedamomenttowatch her asking the instructor something and he was shaking his head in aposturethatindicatedtheflavorof“no”.

IsawMargielaterthatdaysittingintheuniversityhallwaywithherfaceinherhandsneartheregistrar’sofficeandaskedifIcouldsitwithher.Margiesharedaheartbreakingstorythatincludedtherecentdeathofhermother,afallinhergradesthatledtoherfinancialaidtuitiontobedeniedandtheupcomingevictionfromhersmallapartment(thatshefearedwouldincludethelossofhertwobeloved catsCorkie andZing.)Margie struckmeas a shy and somewhatsociallyawkwardpersonwhowasremarkablybright...sheoncewantedtobearesearch psychologist and nowwas in such deep sadness and overwhelm thatshespokeofsuicide.

KnowingthatIwasnottrainedtohandlethesituation,Itriedtoreferher

tothecounselingservicesoncampusandjustbetherewithheruntilIcouldgetherthere.Sherefusedtogostatingthatherexperiencetherewasoneinwhichshedidnotfeelcaredaboutandthatitjustaddedtohergrief.IknewIneededtogethermoreexperiencedhelp,butinthemeantimeIrememberedsomematerialfrom a book I read called The Worst is Over: What to Say When EveryMomentCounts.

Iaskedherwhatwouldhavetobedifferenttoagreetogoonliving,whocouldhelp,andwhatshewantedpeople tounderstand.(foundonhere). Ialsowasverypresentandconnected,focusingonwhatstrengthsandsolutionscouldbedrawnoutofthisterribletimeforher.

Wediscovered that togoon livingshewouldneed to findaway tokeephercats,andaplacetoliveandsomefood.Shewasabletoidentifysomefriendsshe hadn’t thought of who could help her once she calmed. We evenbrainstormedhow toadvocate forher financialaid tobe restoredandget thesituationcommunicatedto theappropriatepeoplewhocouldhelpseeherasagoodstudentwhohadfallinggradesduetothegriefofhermother’sdeath.Were-framedmosteverythingthatneededtobedifferentincludingwhatChristmaswould be like shortly without her mother....into a ceremony that honored hermother’s presence and wishes for her only daughter. Margie not only pulledthrough this difficult time, shemet awomanwho is a psychologist that helpspeoplewhoarehomelesskeeptheirpets.Thisistheworkshedecidedtopursue.Ilearnedthathelpingotherscansometimesbeassimpleascaring,connectingand having the right tools to turn the trouble into solutions. Verbal First Aidoffers just these sorts of solution possibilities and in a graceful and dignifiedway that supports those in need to help themselves. This is of course a greatsupport to thoseofuswhowant to reallymakeadifferencewhen themomentcounts.

V1.FromLindaSleeter,RN

Ivisitedmysonandgrandsonsovertheholidays.OnedaywenoticednineyearoldRyan’srighteyewasredandswollen.Thatevening the infectionhadmovedtohislefteyealso.Hiseyeslookedsopainfulbuthewasverybrave.Thenextdaywe tookhim to thedoctor for the lastappointmentof theday.By thetimewegothomewiththeprescription,itwasalmosthisbedtime.Itoldhim,“I

have put eye drops in many people’s eyes and I know how to do it withouthurting”.RyanwasonthebedandIlethimrelaxandtoldhimtotellmewhenhewasreadytohavetheeyedrops.Whenhetoldmehewasready....Isaid,“Asthisdropofmedicinecomesintoyoureye,itstartsyourwholeimmunesystemworkingtoattackthegermsandmakeyouhealthyagain.”HewasveryattentiveandIsaiditagainasIputtheotherdropin.

IrememberedsomeofthethingsmentionedinthebooksoIstartedtalkingtohimaboutthechangesthatwerehappeningrighttheninhisimmunesystemandhowmuchstrongeritwasgetting.Iaskedifhecouldimaginethepowerfulcellsofhisbodyattacking thegermcells.Then Iaskedhimspecificquestionsabout what they looked like.Without any hesitation he answeredme as if wewerehavinganyotherconversationandhedescribed

the cells, their shape and color. (I could have cried.) He described theimmune cells as being white and round. They had little arrows and weaponsstickingoutoftheroundcellstoattackthegerms.

IwenttogethimsomewaterandwhenIreturnedIsawapadofpaperonthefloorbyhisbed.Ipickeditupandtomyamazementtherewasapicturethatlooked just likewhat he haddescribed tome. I askedhimandhe said that iswhat itwas.Hehadasystemic infection that triggeredhisasthmasohewokeduringthenight.Eachtimewerepeatedthissameprocess.Thenextmorninghewokeingoodspirits,noproblemsbreathingandhiseyesbarelypink.Whenweaskedhimhowhefelt......littleRyansaid,“Extraordinarilywell.”

Thank you for your interest, Judith. I know it made an impact on hishealing.Thankyouforallthemanypeopleyouhavehelped.

VII.FromF/Lt.MikeHarvitt,MichiganStatePolice

Whileworking themidnight shiftmypartner and Iweredispatched to amotorcycle /van personal injury crash. The motorcycle had misjudged hisdistancewhile overtaking (passing) themini vanand the back tire of the bikecaughtthefrontoftheminivan.UponarrivalmypartnerandIbegantosearchfortheriderofthebike,asallwecouldseewerebikepartsandbloodtrailingoff into a ditch. I located the subject and much to my surprise he was alive,however silent. I got down in the ditch to his location and found him to beresponsive.Withaquickglanceat thisbody Inoticed thathewasmissing thebetterpartofone leg thathadbeen tornoff in thecrash.The injurywasvery

graphicandbleedingseverely.Thesubjectbegantalkingtomeandsaidthathisleg hurt and askedme how bad it was, and at the same time began to try tomove.TokeephimfrommovingIputmyhanddown,directlyonhischestandtoldhimthatIwantedhimtolaystillandthatIwouldstaywithhimandthatanambulance was on the way. He again askedme about his leg and wanted toknow how bad it was. As he spoke I could feel his heart pounding and hisbreathingincrease.Ilookedathisleg,andlookedbackathimandtoldhimthathislegwasinjuredandbleedingandthatIwasgoingtostopthebleeding.Helaid his head back and I told him that I needed him to control his breathingwhileIstoppedthebleeding.Iusedmyuniformbeltthatwasundermydutybeltasatourniquet.ThemajorityofthebleedingstoppedimmediatelyandItoldhimthatIcouldusehishelpbytellingmeabouthowtherestofhisbodywasdoing.Iplacedmyhandbackonhischestandafteracknowledginghisinjuryandthenaskinghow therestofhisbodywasdoing Icould feelhisheart ratedecreaseandbreathingbegintoslowdown.AswetalkedabouttherestofhisbodyandlookedforanyotherinjuriesIcontinuedtokeepmyhandonhischestwhereIcould feel his heart rate and breathing.As his heart rate andbreathing camedownIwasabletoseethathisfocuswasnowoffofhislegandhewasfocusedmoreonourconversation.Whatseemedlikealongtimewasonlyafewminutesuntiltheambulancearrived,howeverIcontinuedtoreassurehimthathelpwason theway and that theywould take good care of him. Shortly thereafter weplaced him in the ambulance and hewas assisted bymore advancedmedicalprofessionals.Ibelievethatifhehadbeenfurtherupsetabouthisleg,it’slikelyitwouldhave increased thebleedingandnegativelyaffectedhisheartandhisrecovery. Although he lost a leg, fortunately that was all. As part of theMichiganStatePoliceinservicetraining,

I have taught the Verbal First Aid techniques to 1600 officers and thefeedbackfromthefieldhasbeengreat.

VIII.AndAnotherfromF/LtMikeHarvitt

JustwantedtoletyouknowthatonTuesdaynightIspoketotheHollandCityPoliceVictimServicesUnit. IpresentedVerbalFirstAid to them.This isthe same unit, although now with some new members, that I presented toapproximately 5 years ago. Most counties in Michigan, and 5 policedepartments,havevictimservicesunits.Thesearepeoplethatgooutandassistpoliceand firemenwithavarietyof callswherevictimsmayneed someone toleanon.Deathnotifications,fires,naturaldeaths,suicides,seriouscrashesand

soon.

ThisparticulargrouprecentlyreceivedanawardforbeingthetopvictimservicesunitinMichigan!

IX.FromJaneNicholls,MagazineEditor

I’vebeenmeaningtoemailyouandtellyoutheSundaymorningafterwesaw you, Rosie bit her tongue (took a good chunk out of it actually) as shebouncedoutofthepoolatlessons...shewascryingabit,andGraciesaidtome,“Mum,talklikeJudith,saythingsJudithwouldsaytohelpher...Abouthowhertongueknowshowtohealandallthat.”SoIdid.Andheypresto!!Ihadtosayitafewmoretimes...andforotherstuff,asRosieisperpetually“inthewars”...butit’sagoodtactic...morethangood...GREAT...sothankyou!

X. From Dr. Deb Kern http://drdebkern.com/blog/ Emergency Practice Fromherblog

FEBRUARY28TH,2010Inmydesiretoalwayscombinebusinesswithpleasure,Irecentlytookmy

familywithme toColoradoonmyway toaTeamNorthrupRetreat.Theplanwas toski fora fewdaysasa familyand thenIwouldheadtoDenver for theretreat.

Onthefirstday,myhusbandandIdroppedoffourson,Micah,alongwithhis friend, Sam, at Snowboarding School. My husband and I then decided tohave a nice quiet day alone instead of going skiing. But about an hour afterdroppingoff theboyswegotacall from theschoolsaying theywerebringingour son down the mountain on a stretcher. NOT THE CALL ANY PARENTWISHESTORECEIVE!

InstantlyIknewIhadachoiceofthoughtpatterns:fearorlove.Imadethedecision to keepmyself in a vibration of love as we drove to the base of themountainbysayingoutloudallthethingsIwasgratefulfor:thefactthattheyreachedusimmediately,thatwehadacar,thattheroadswereclear,thattherewasanexcellentmedical teamon the spot, etc…Then Ibegan toenvisionmysoninvibranthealthandenvisiontheteamofparamedicsworkingefficiently.

Whenwearrivedweweregreetedby the paramedics as they loadedmysonontotheambulancetruck.NOTASIGHTANYPARENTWISHESTOSEE!

Onceagain,Iwasstruckwiththechoicetohavethoughtsoffearorlove.Ibegan thanking the paramedics and feeling huge waves of gratitude for theirkindness and skill. Then, because gratitude allows the higher regions of thebraintofunctionbest,IrememberedabookIreadfiveyearsagoentitled“TheWorst IsOver:What to SayWhenEveryMomentCounts–Verbal First Aid toCalm, Relieve Pain, PromoteHealing, and Save Lives” by Judith Acosta andJudithSimonPrager.Inittheyteachphrasesandimagerytouseinemergencysituationsthathelpcalmthepatientandacceleratethebody’shealingprocess.

As I rode in thebackof theambulancewithmyson (whose left earwaspinned tohis left shoulderandcouldnotmovehisneckatall) Ibegansayingthingslike:“Theworstisover.Nowyourneckisbeginningtorelaxandheal.”Andwhenhegotfearfulthathisneckwasbroken,Iwouldshifthisattentionbyasking “How does your left knee feel? How about the thumb on your righthand.”

AsIspoketohimIalsosentoutprayersthattherewouldbeanOsteopathorPhysicalTherapistatthehospitalwhowouldknowthebestthingtodoformyson.Whenwearrived,alovelyphysiciancameintoaskMicahquestions.Iwasso relieved to see “D.O.” on her name badge and, when there was a lull inconversation, asked her where she went to Osteopathic Medical School. Shelookedsurprisedandaskedme,“HowdidyouknowIwasanOsteopath?”Itoldher Ihadseen the“D.O.”onherbadge.She then flippedherbadgeoverandoveragaintoshowmethatitdoesn’tsay“D.O.”orOsteopathanywhereonherbadge. Itwasat thispoint that I felt thepresenceofangelsandall thepeoplewholoveMicahandmeinthatE.R.bay.Theroomfeltwarmandcozyandsafe–andIknewallwaswell.

OurwonderfulOsteopathspendhourscoaxingMicah’snecktorelaxandstraighteninordertogetX-Rays.DuringthistimeIwatchedasMicah’soxygensaturation levelwould goway down and Iwould coach him to do deep yogabreathing. Each time he shifted from ‘fear breath’ to a deep yoga breath hecouldbringhisO2levelsupfrom84%to92%.

And,serendipitously,althoughI forgotmycoatandgloves in therushtomeet theambulance, IDIDhavehomeopathicArnicaandArnicacreaminmypurse.SoIwasabletostartgivinghimArnicarightaway!

Finally,hisneckwasstraightenoughforx-rays:Thankfully,thex-raysindicatednovertebraedamage.Hisonlyinjurywas

whiplash.Andby11:00a.m.thenextday–withthedoctor’sblessing–hewasskiing with his good friend Sam (with a soft neck collar underneath his

bandana!)IamsogratefultothemedicalstaffatCopperMountain.Iamsogratefultotheabilityofabodytoheal.Iamsogratefulforalltheyearsofmind/body/spiritstudiesthatcameinto

practicethisday.

XI.FromDoloresKaneshina

Watched the interviewwithBarryKibrickonPBSand itwas interestingthat you mentioned the reaction people have to a bloody nose. My son wassubject to this problem since he was a year old. The doctor explained whatcaused it and that he would outgrow it. So, when it occurred, no one in thefamily got excited, or scared, etc.--one day at school, his older sister (inkindergarten) had a bloody nose. Well, the teacher panicked, her classmateswerescared,butblessherheart,mydaughtercalmly told the teacher thatsheneeded to sit quietly, took a tissue and pinched her nose until the bleedingstopped. After school, the teacher commented on how calmmy daughter wasthroughout the incident and how she had calmed the class and the teacherherselfinminutes.SheaskedmehowIhadtaughthertoreactinthatsituation.Itoldher that thedoctorhadexplainedherbrother’sproblemto the familyandsinceherbrotherfrequentlyhadabloodynose,itwasnotalifethreateningorscarything.

I truly believe that words have great power especially in dealing withchildren.Iwasbothateacherandadministratorineducationfor34yearsandwitnessed the results of what a parent/adult negative comments can do tochildren.Iplantobuyyourbookreaditandgiveittomychildrenwhoarenowparents. They are good parents, but I know that your book will validate themannerinwhichtheydealwiththeirchildrenandgivethemextratips.

Thankyouforwritingabookonthistopic,itismuchneeded!

XII.FromBlair4630:

Hi,JudithIreadyourbookTheWorstisOverseveralyearsago.Itisstillapartofmycollection.Itwasagreatread,andoneofmany“non-traditional”

booksotherthanmyfire/EMSbooksthathavehelpedmehelpothers.

XIII.FromRasaLila:

AfterIgotoutofthehospital,Iwenttoacranialsacraltherapist.Isettledontothetableandshemadecontactwithherhands.Shesaid,“Yourbodydidagreat jobhandling theaccident.Theaccident isovernow.”With thosewords,my body relaxed and the healing energy flowed. My body stopped trying toprotectme.IhadnoideaIwasstillholdingtension.Itwassucharelief toletgo!

XIV.FromBarryHoward,Lt.Col.,U.S.Navy,Retired:

IwasanAirForce1Ltmanyyearsago.IwasintheCongowiththeUNforces.Itwasaroundnoonwhenavehiclecameroaringuptothehangarwherewewerewaiting foramission forourC-130providing foodstuff forcivilians.The vehicle’s occupants had rescued an Army Warrant Officer with someseriousstabwoundsandhewasbleedingbadly.

NooneseemedtoberespondingtothismansothisLt(me)wentovertohimandstartedapplyingpressuretohiswoundswithatowelIhadaroundmyneck.Itwasobviousheneededtogettoahospital.

Itoldhimwewouldtakecareofhimandthatweweregoingtogethimtoahospitalassoonaswesafelycould.Hebecamemorecalm.Hewassufferingbecausehethoughtthathewouldbeleftthere,butIbelievethattellinghimwewerethereandbeingasstrongwilledandbossyasIamcalmedhimdownasIappliedpressuretothewound.Itgavehimconfidenceinourplan.Welefthimatthehospital. Inevergot theguy’snamebut I learned thathelps to stabilizeapersonbylettinghimknowthatheisbeingtakencareofandthatthereisarealplan.

XV.FromPeterMcLaughlin:

Petersharestwowonderfulstorieswithus:

Irespondedtoathree-carMVA.I’mbothavolunteerfirefighterandEMTsowhenIarriveonasceneIcanbedeployedineitherorbothcapacities.Thefirst thing I noticedwasoneof the cars involved in theaccident hadanEMTleaningintothedriver’sdoor.Hewasspeakingloudlytellingthedrivertorelax.When I came upon them, he toldme to take over. I saw that thewomanwasbreathingveryheavily,apparentlyquiteagitated.Shetoldmeshewasscared.

Afteridentifyingmyselfandaskingherifshehadanyinjuries,Itoldhertolook directly into my eyes. When she did this, I said, “The worst is over.Everythinggetsbetterfromhereforward.”

Shetoldmehowupsetshewas.Iaskedherwhatsheneededtofeelbetter.She said, “a cigarette.” I asked her if shewas sure thiswouldmake her feelbetterandsheansweredyes.Isaid,“OK,closeyoureyes.”Ihadherimagineshewastakingadeepbreath.Whileshedidthis,Ibreatheddeeplyatthesametime,loudenoughforhertohearme.Whensheopenedhereyesshewastotallycalm. Her breathing had returned to normal and her face was relaxed. Thewholeprocesstookabout2minutes.

Peter’ssecondstoryisjustaswonderful:

I responded to an early morning call about a hiker who’d fallen andpossiblybrokenhis leg. Iwaswithagroupof firefighterswhohiked, climbedand scrambled up a very steep hill to reach the man who’d fallen. He wascomplainingofintensepaininhislowerleg.AsweweremaneuveringhimintoaStokesbaskethecontinuedtocryoutinpain.Igotnearhishead,lookedintohiseyes and told him that the worst was over, that we’d soon have him in theambulanceandsoonafterthatthehospital.Isaidwewereallheretohelphim.

I thenaskedhimifhepreferred themountainsor thebeach.Hesaid thebeach.Itoldhimtoclosehiseyesandgotherenow.Itoldhimtoimaginethewarmsunandlyingonthebeachlisteningtothewaves.Itoldhimhecouldjustenjoy that place while we took care of him. He immediately calmed down. Aminute later, the basked jostled as we lowered him down and I explainedeverythingwasstillokayandhecouldgobacktothebeach.

XVI.FromBruceKilburn

IwastheFireChiefinLakeGeorge,NYwhentheEthanAllentourboatcapsized and 20 people lost their lives that day. I can remember as if it wasyesterday. Itwas14:56hourson10/2/05when thecallcame inandIwas thechiefthatresponded.

Iwasonthesceneinaveryshorttime.IwastheICthatdayandlittledidIknow Iwould pull from every class I have taken to stay in control and try tocoverallthebases…

Onemedicwasatthedockandhetoldmehehadtwoincardiacarrest.AtthetimeIthought,okay,wecanhandlethis.Butitwas30secondslaterthathecalledme again and we had three more in arrest.When it all stopped I hadtwenty senior citizens lying on the ground next tome all coveredwith sheets.Thiswilldothingstoanyone’semotionsanditdidmine.

I feltsohelpless…Ialmost lostcontrolatonepointandif ithadn’tbeenforaverygoodfriendtellingme,“Bruce,youhavetostayfocusedanddoyourjobandyou’llbefine…”Thosefewwordsbroughtmeback.

YoursurvivalguidetipsarethebestanditmakesmefeelbetterknowingthattheemotionsIfeelareokay.Iliked,“Thereismeaningtoallthings,evensuffering.”Thatsaysitall.

XVII.FromTeresaBevin,acrisiscounselorinSantaFe,NM

Gisela(namechanged)hadcometomyofficefivetimesandIhadn’tbeenabletohelpherfeelbetter.Shewasonly12yearsold,buthadthepostureandstance of an oldwoman.Her early childhood, back in El Salvador, had beenplaguedbyfrightanduncertainty.Shehadseenwar,knowngrief,andshehadbeenrapedbyagroupofsoldiers.

When she arrived at her new school inWashington, D. C., her teacherrecommended she be taken to a doctor, as she complained of leg pains andsometimes she stayed in her classroom during recess so she could sit quietly,rubbingherlegs.Thedoctorsfoundnothingwrongwithherlegs.Infact,itwasfound that she was in remarkably good health for the ordeal she had livedthroughonlyafewmonthsearlier.

Duringmytimewithher,onhersixthvisit,shecasuallytoldmethatheroldestbrotherhadbeentorturedinfrontofher,andthatasoldierhadfracturedhislegwiththebuttofhisrifle.Iimmediatelysuspectedthepaininherlegshadtodowiththeincident.LaterIaskedheraboutthetimeshehadbeenraped,butsheclammedup,asusual.

Feelingineffectiveinfrontofthisdamagedchild,Iletmyintuitiontakeme

andIaskedifshelikedherbiologyclasses.Shenodded.Iaskedherifsheknewweweremade ofmany,many cells of different kinds. She nodded and let herchinsinkintoherchest.IletherstayinhersilencewhileIspokeinawhisper.

“Youknow,Gisela,cellsarecontinuallyrenewingthemselves.Oldercellsdieandnewcellsareborntotaketheirplace.Ourskincellsfallawayalldaylong,whenweshower,whenwesleepandarebrushedbyoursheets,whenwegetdressed.Allofourcellsarerejuvenatedregularly…Thinkofthis…Allofthecellsthatwereinyourbodywhenthosementookyou,theyhavealldiedtoletothernewcellstakeover.Youhavenocellsleftthatweretouchedbythem.Allofyourcellsarenewanddon’tknowwhathappenedtotheothers.”

Giselaliftedherheadandlookedatherarmsandlegs.Shefelttheskinonherneck.Shedidn’t sayanything.But I knewachangehad takenplace.Thatdayshedidnotlimpwhensheleftmyoffice.Shelookedbackatmeandsmiled.The followingdayher teacher calledme to tellme thatGiselahad joined theothers during recess, that sheno longer complainedof legpains and that shesmiledfrequently.

Tome, this was confirmation that the right words at the right time canperformmiracles.

XVIII.From“Lindy”

LindyhadlearnedaboutVerbalFirstAidbypersonalexperience.Wemetwhen she had come for treatment herself. She was articulate, kind, deeplysensitiveandfragile.Shewasalsodyingof liverdisease.Shehadbeenplacedona transplant list, but nodonors seemed to be forthcoming. Shewas scaredandonthevergeofgivingup.Shefelttheurgetodrink,tosay“thehellwithit.”Butshealsodearlywantedtolive.

WerecalledoneofErickson’sstrategies.“Youwantsobadlytofeelbetter,”wesaidtoherintently.“Yes,”shesighed.“Andyou’vestayedsoberforalmostonemonth,now,haven’tyou.”This

wasnotphrasedasaquestionbutasastatement.“Yes,”shelookedup,herpostureslightlymorerelaxed.“Andyouhavesaid thatyouwoulddoanything to feelbetter, tochange

yourlife,”wesaidseriously.Sheheldhergazesteady.“Yes.”“Thisiswhatyoudo.Whenyouleavethisroom,walkdownthestreetto

your car and get into your car. Drive to the nursery down the road. Look

through thegreenhouseuntil you seeacactus.Youwill know the right cactuswhenyouseeit.Perhapsitwillbeflowering.Bringitstraighthomeandplaceitjustso…sothatitwillreceiveallthelightitneeds…andleaveitthere.Youmayhave thoughtsaboutwatering ituntilyouremember it isacactusandmustbecared for according to its nature and youwill let it be. And in the days andweeks ahead you will watch as it grows and perhaps flowers, noticing howhealthyitiswhenyoujustletitbe.”

Manymonthslater,longafterwehadpartedways,acallcamein.ItwasLindy. She’s got goodnews. She’s leadingAAmeetings, getting engaged, andshe’soffthetransplantlist.“Whatdoyoumean,offthelist?”

She explained that after ourwork, they had done another series of testsandhadfoundthatthedamagetheyhadseeninherliverhaddisappeared.Theyhadneverseenanythinglikeit.Shelaughed,“Theydon’tknowwhattomakeofit.”

xix.FromDavidJ.Turner,NREMTP,ICUniversityofNewMexicoSchoolofMedicineEmergencyMedicalServicesAcademy

AsaparamedicinAlbuquerque,NM,TheWorstIsOverprovidedmewithtoolsI could use every day, communicating and establishing rapport with all mypatients.LittledidIknow,justafewshortweeksafterreadingit,IwouldhavetheopportunitytousethetechniquesofVerbalFirstAid.

Iwasdispatchedtoaresidenceforafemaleptwhohadattemptedsuicide.Uponentering the residence, I founda very distraught patient sitting on the kitchenfloorinalargepoolofblood.Herwristswerewrappedinbloodsoakedtowelsthatcontinuedtodripontothefloor.Thefirefighterswhohadarrivedfirstwerestandingatanawkwarddistance,attheperimeteroftheroom,andlooking-onuncomfortably. I immediately recognized a tremendous opportunity to use thetechniquesIhadlearned.

Itookafewsecondstofocusandcommit,althoughtherewasnotimetoplanmyactions.InstinctivelyImarchedintothekitchen,directlytothepatient.Iloweredmyselfintotheblood,andkneltnexttoher,settingmybagdownnexttomeintheblood.Imadeeyecontact,introducedmyself,andassuredherthatwewerehere tohelp. I immediatelyopenedmybag, removedseveralwounddressings,

andconfidentlyappliedthemaroundthecontinuouslydrippingtowels.

Inhereyes,Isawpanicanddesperation.Heremotionsreachedouttomeaswelookedateachother.IaskedhertohelpmeasIattemptedtowrapherwoundstightlyenoughtocontrolthebleeding.Ourconnectionwasstrong,andseemedtoallowmetoreadheremotions.AsIquestionedheraboutwhenandhowshemade the wounds, I could sense her regret, and her love for her family, whowerewatching froma distance. I felt the apology in her eyes, as she glancedoveratherhusband.Iaskedifshewouldletmehelpherstandsowecouldgetheronthestretcherandheadtothehospital,sheagreed.Ireassuringlyheldherarm and shoulder as my crew assisted her to the stretcher and then into theambulance.

Onceenroutetothehospital,Iimmediatelykneltdownnexttoher.Inoticedthather wounds were still bleeding. One had slowed, but was beginning to soakthroughthedressing.Theotherhadnotslowedandhadalreadysoakedthroughthedressingandwasdripping steadilyontoher lapand the stretcher. Iaskedhertohelpbyholdingthedressingtightlyonthemoreseverewound.

She held the dressing andwe began to talk. I usually avoid talking about thereasonswhypatientshaveattemptedsuicide.Nevertheless,shewascomfortablesharingwithme,andIwaseagertolisten.Theconversationquicklyledtoherfamily.Icontinuedwithsincereeyecontactandheartfelttouchesfromthefloornext to her. Struggling through tears and emotions, she revealed to me herrecent troubles. Several times, she mentioned her love for her family, andparticularlyherconnectionwithherdaughter.

Iaskedher to talkmoreaboutherdaughter,andshewasverywilling to.Sheexplained that her daughterwas compassionate, confident, and full of energy.Shelovedtohelppeopleandwasinterestedinacareerasafirefighter.IbegantalkingaboutmyexperienceinthefieldofEMSandfirefighting.Idescribedtheexcitement, the personal satisfaction, the emotional satisfaction, and the long-termbenefits.Wediscussedthebeautyofthecitywelivein,ourlives,andourfamilies.

Wehad awonderful conversation, and an indescribable connection. I felt herpanicanddesperationstart towashaway,andsensedanewfeelingofhope.I

toldherfrankly,thatIcouldseeshedidnotwanttodie.Iknewshewantedtolivetoseeherdaughtergraduatehighschool,becomeafirefighter,andgrowtobeahappyandsuccessfuladult.Sheagreed.

Ithenlookedconfidentlyintohereyesandtoldherthatshecouldstopbleeding,rightnow,thatitwasover.Theemotions,theregret,andthebleedingwerenolonger necessary.From this point on, thingswill only get better. Your energyneedstonowbeonhealing.Gettothehospital,getthehelpyouneed,andmoveforward.Throughhertearyeyes,Icouldfeelheragreement,herconsent.Thenherbleedingstopped.

At thehospital,wehadanemotionalgoodbye.She thankedme formysupportandcare,andIthankedherforherstrengthandhertrust.Withalasttouch,andalook,ourshortrelationshipcametoanend.Asentimentalandhappyendingforusboth.

I want to sincerely thank the authors of this book. I learned to communicatebetterwithmypatients,andhaveimprovedthecareIprovide.VerbalFirstAidhashelped,andwillcontinuetohelpsavemanylives.Thankyou.

TheWrongWords

Whilewedon’t like todwellon thehow the“wrong”wordscanmakeadifference,herearetwostoriesthatillustratethatconceptsowell.

The first is a story a hypnotherapist friend told a story on herself aboutcominguponanaccidentandmakingamistakensuggestion.

XIX.FromMelissaRoth.CHT

Iwasdrivingontheinterstatewhenaguyonamotorbikehitsomethingintheroadin frontofme.Hisbike flipped3 timesandfortunately landedoff theinterstate.Iwasthefirst toget tohim.Hewasthrashingaboutandscreamingthathecouldn’tbreathe.IknewIhadtogethimtoliestillandcalmdown.So,Icalmlytoldhimtheworstwasover,thatIwantedhimtobestill,tostopbleedingandconservehisbloodandtobreatheslowlyanddeeplyandremaincalmuntiltheparamedicsgotthere.

I can’t remember what all I told him but he did quit bleeding and hisbreathdidslowanddeepensomewhat---untiltheparamedicsgotthere.Then,hestartedbleedingagainandbecamehystericalagain.At thatpoint itwasn’tmyproblemanymoreandIleft.

At first I couldn’t figure out what happened until my own words keptshouting inmymind.ThemistakeImadewas thatI toldhimtostopbleeding,releasethepain,breatheeasilyandstaycalmuntiltheparamedicsgotthere.So,hewasfineforthe15minutesorsoittookfortheparamedicstoarrive.Butassoonastheypulleduphewentrightbacktobleeding,writhinginpain,andalltheotherissues.

IhopeIneverencounteranotheremergencylikethatbutI’llforsurenevermakethatmistakeagain.

XX.FromaMedicataConvention

Ata convention inBaltimore, amedic cameupand said,“Whatdo youthinkofthisastheworstVerbalFirstAid?Iwasatthedoctor’sfortinnitusandhe looked in my ear and did whatever exams and then he said, ‘Oh, you’regonnagocrazyfromthis.Wegotstudies.’”

Alliance–Anaffirmationthatthehelperandthepersonbeinghelpedareonthesamepath, that thehelper is someonewhocanbecountedupon tounderstandthesickorinjuredper-son’spredicamentandactinthatperson’sbestinterest.Itisnecessaryforgoodrapportinorderfortherapeuticsuggestionstobeaccepted.Altered State – A state of being that is more highly focused on internalprocesses, bothmental and physical; a state that is distinct from the ordinary,wakingstateofconsciousness;amorehighlysuggestiblestateofmind.Anchors (“Cues”) – Signals strategically used as a physical reminder of therelaxedstate.Contingency/Conjunctive Statements – A suggestion that begins with “AsI…”and leads into“youcan…”For instance,“As I touchyourhand,youcanstopthebleeding.”ControlGroup–Thegroupof subjects inanexperimentwhodonot receivetheinterventionbeingtested,sothereisaneutralfieldagainstwhichtomeasuretheresults.Contra-alliances – Counter productive statements that do not facilitate thedevelopment of rapport or trust, e.g., “I told you never to do that!” or “Nowyou’vereallyhurtyourself!”Dissociation – The ability to shift our awareness, narrowing it to one smallaspectofourselvesorourenvironments,whilediminishingourawarenessofallotheraspects.Distraction – Distraction can build rapport by helping people focus onsomethingother than theirpainor injury, thereby reducingdistress, increasingcomfort, and building trust. For example, “I can see that your leg needsattention.Wouldyoutakeafewminuterightnowtoscantherestofyourbody

andseeif thereisanythingelsetherescueteamshouldbeawareofwhentheyarrivetohelpyou?”.ExperimentalGroup–Thegroupofsubjectsinanexperimentwhodoreceivetheintervention,protocol,ormedicationbeingtested,asopposedtothecontrolgroup.FuturePacing–Usingvisualizationtohelppeopleimagineatimeinthefuturewhenthecurrentsituationisresolvedandtheyarelivingtheirlivesmorefully.Because ill and injured people often have a negative picture of the future inmind, due to their present circumstances, this technique is very important ingivingthemanalterativepicturetowardwhichtomove.HealingZone–Anaturallyoccurringstate(emotional,physicalandmental)inwhichweareespeciallysuggestible.Thiscanhappentoanyoneatanytime—inamedicalcrisis,anemotionaltrauma,fearorupset,orasaresultofchronicpainordiscomfort.Iatrogenics – Physician-induced illness; infirmities suspected to be caused byunconscious suggestions made by health care professionals, e.g., “Thismedicationmaymakeyounauseated.”Ideomotor – Using fingers to signal intention to a hypnotherapist while intrance,e.g.,rightindexfinger=“yes”andleftindexfinger=“no.”ImpliedHealing – giving the suggestion that the healing is happening or hasalreadyhappened,e.g.,“Youknowthatitchinglikethatisasignthatthehealinghasbegun.”IllusionofChoice/DoubleBinds–givingapersontwooptions,bothofwhichlead to the desired result; e.g., are you more comfortable sitting up or lyingdown?Whicheverischosen,thepersonhas“agreed”togreatercomfort.JoiningIn/(seePacing)Metaphorical imagery – the use of symbols to represent ideas and bodyfunctions,which can thenbemanipulated towardwellness andhealing. “Yourproblems tumblingand floatingdown the street like fall leavesblowing in thewind…”Mind/BodyMedicine–ThemodernmergerofVitalismandReductionism,theunderlying essence of which is the notion that the mind and body areinextricablyinterconnected.Neurotransmitters – Chemicals that enable information to pass from oneneuron(braincell)tothenext.Pacing –Reading another person’s signals andmovingwith them in order togain alliance and cooperation; identification with a person’s point of view orcertain aspects of a person’s behavior along with a verbal or non-verbalcommunication of that identification; can include rhythmic breathing or a

commentsuchas,“Yes,ithurts.”PacingandLeading–Joiningwithapersonbymirroringaperson’sthoughts,feelingsandorbehaviorseitherverballyornon-verballywiththegoalofmoving(leading)themtowardamorehealthfulorcomfortableposition.ParasympatheticNervousSystem–Oneofthetwodivisionsoftheautonomicnervous system; its primary function is to calm the body down again after acritical(adrenal)responsetoastressor.PersonalResourcesarepeople’sownhistoricstrengths,thepartsoftheirstorythattheyforgetintimesofillness,butofwhichtheyaremostproud.Remindingthem of who they are and what they have done well sends their minds on amissiontofindthosestrengthsatatimewhentheyaremostneeded.Placebo – An “inert” substance given to subjects in drug trials to even theplaying field between experimental and control groups. For purposes of thisbook,thisreactionisnotableinthatalittlesugarpillandthesuggestionbyanauthority figure (usually a physician or scientist) can (in 30-75% of cases)actually cause the body tomanufacture the chemical necessary for the desiredendstate, therebyproving theconnectionofmindandbody,and thepowerofwords.Rapport–Anunderstandingcommunicatedtoanotherperson;empathy;astatein which a relationship of trust, compliance, and healthy expectation can benurtured. Rapport is key to Verbal First Aid; it is what makes acceptance oftherapeuticsuggestionspossible.Reductionism–Aphilosophicalschoolofthought;atermoriginallycoinedbyDescartes;anapproachtomedicalscienceinwhichthehumanbeingwasseenasa machine of many parts, with the mind controlling only thoughts, while thebodyfunctionedasaseparateentity.Reframing–Restatingabeliefsothatwecanseethebenefit init,ratherthanseeingtheprobleminit,e.g.,“IfIhadn’tgottensick,Iwouldhavekeptongoingsofastmylifewouldhaveslippedaway,andIneverwouldhavenoticedhowmuchloveandbeautythereisinit.”SolicitingHelp – Utilizing the alliancewe’vemade, we can encourage otherpeople’s participation in their own health and/or recovery. This technique canalsoprovidedistractionandpainrelief,asintheinstanceofaskingsomeonetoholdthebandageasit isbeingapplied.Thepersonfromwhomwesolicithelpchangesonthespotfromvictimtohelper.Sympathetic Nervous System – One of the two divisions of the autonomicnervoussystem,theparasympatheticnervoussystemisresponsibleforpreparingthe body for action in the face of a threat, diverting blood from thegastrointestinal tract to the skeletalmuscles, raising blood pressure and pulse,

dilatingpupils,andstimulatingtheadrenalglandstoproduceepinephrine.Therapeutic Suggestion – An indirect implication (“You may notice atingling…”)oradirectstatement(“Yourbreathingisbecomingmoreregular”)thatsuggestsachangeofawarenessoradifferentphysiologicalorpsychologicalprocessinanotherperson,movingthatpersontowardhealing.Trance(seeAlteredState)Utilization–Developingandencouragingthepositive,healthfulresourcesthatarealreadypresent.Vitalism–Aphilosophicalschoolofthought,oneofwhoseprimaryproponentsis Samuel Hahnemann, M.D.; it holds that the human being is a completeorganism. In the healthy human state, the vital force (or “life force”) enlivensand governs the material body, keeping it dynamically in balance, mentally,physically, emotionally and spiritually. Without the life force, the materialorganismislittlemorethanitschemicalcomponents.Verbal FirstAid – The art and technique of utilizingwords to calm, relievepain,facilitatehealing,andsavelives.Yes Set – A helper generates a series of “yes” responses in another person(unconsciously or consciously), usually by referring to things that areindisputably true.Themoreyeses toeasystatements, themore likely it is thattherapeuticstatementswillbeaccepted.Forexample,“I’mherewithyounow,andtheambulanceisontheway,andyoucanbegintorelaxalittleandletyourbodystartitsowninnerhealing.”

ABOUTTHEAUTHORS

JUDITHACOSTA,LISW,CCH

Judith Acosta, LISW, CCH, is a licensed psychotherapist, hypnotherapist andcrisiscounselor,aswellasacertifiedclassicalhomeopath.Sheistheco-authorof The Worst is Over (Jodere, 2002), hailed as the “Bible of CrisisCommunications”, Verbal First Aid (Penguin, 2010) and The Next Osama(2011). She haswritten countless articles onVerbal FirstAid, culture and themedia, the importance of religion and mental health, trauma, and alternativemedicine.She’shada regular columnwith the JournalofEmergencyMedicalServicesonVerbalFirstAidandcommunicationstrategiesforuseinthefield,isa regular contributor toHuffington Post,Ulster Publishing,Opednews, FutureHealth,TheSandovalSignpost,andAmericanThinker.

Since 1994, she has trained paramedics, fire fighters, police officers, teachers,and medical/mental health professionals in therapeutic communication andVerbal First Aid around the United States. She served for many years withPOPPA, a non-profit peer support organization for theNewYorkCity PoliceDepartment.Shehasalsogivenseminarsonanimal-assistedtherapy,traumaandburnout, stress reduction, and workplace risk/crisis management to hospitals,professionalorganizations,corporationsandprivategroups.

Inprivatepracticeasalicensedclinicalsocialworkerandclassicalhomeopath,shespecializesinthetreatmentoftrauma,anxiety,depressionandgrief,workingespeciallycloselywithmilitary,paramilitaryandfirstresponsepersonnel.Sheis

based in Placitas,NMwith her husband and rescue dogs, although sheworkswith people around the country. She brings nearly 25 years of successfulexperience to clients all over the country and may be reached atwww.wordsaremedicine.com.

JUDITHSIMONPRAGER,PHD,CHT

Judith Simon Prager, PhD, CHt is a clinical hypnotherapist with a PhD inpsychologyandapractice in theLosAngelesarea.Asaconsultant toCedars-SinaiMedicalCenter,shedevelopeda“GuidedImageryforSurgery”seriesofpre-intra-andpost-operativeandICUcreativeimageryCDsthathavebeenusedwith significant results inapilotprogram in theCardio-thoracicSurgeryUnit.She has been a consultant to Children’s Hospital of Orange County andintroducedVerbal FirstAid to the psychiatric nurses atNewYorkUniversityHospital immediatelyafterSeptember11th.Shehas trainedphysicians,nurses,andfirstrespondersacrosstheUnitedStates inhypnotic languageforpainandstressreliefinemergenciesandmagicalinteractionswithchildrenandprovideskeynotesandtalksatconferencesandmedicalcentersacrossthecountry.

Internationally, she teaches Verbal First Aid biannually in England at theEuropeanSchoolofOsteopathy,hastaughtattheUniversitiBruneiDarussalamin theKingdomofBrunei,andwasbrought toChina to traincrisiscounselorsafterthe2008Sichuanearthquakethatkilled80,000people.

Dr. Prager has been a best selling novelist, TV writer, columnist, artist, andcreativedirectorofmajorNewYorkandLosAngelesadvertisingagencies.SheistheauthorofJourneytoAlternity:TransformationalHealingThroughStoriesandMetaphors, author ofOwie-Cadabra’sVerbal First Aid forKids, and co-author ofVerbal First Aid: Help Your Kids Heal From Fear and Pain—andComeOutStrong.

ShelivesinLosAngeleswithherhusband,HarryYoutt.TheyteachtogetherinUCLA Ext. Writers Program, where they were awarded “OutstandingInstructors”in2004andwererecipientsof theExtension’srare“DistinguishedInstructor”awardin2012.

Youcanreachherthroughherwebsite,www.judithprager.com

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