Awareness–Ingrained Patterns

posted in: Stage 3, Stage 3: Step 5



Awareness is the essence of healing in that you cannot stimulate your brain to develop in a given direction, unless you know where you are starting from. Awareness is both a tool and foundation for moving forward with your life. There are four patterns of awareness that work for me.



Environmental awareness is placing your attention on a single sensation – taste, touch, sound, temperature, etc. What you are doing is switching sensory input from racing thoughts to another sensation. This is the basis of mindfulness – fully experiencing what you are doing in the moment.

I use an abbreviated version that I call “active meditation,” which is placing my attention on a specific sensory input for 5 to 10 seconds. It is simple and can be done multiple times per day.

Emotional awareness is more challenging. It often works for a while, but then it doesn’t. When you are suppressing feelings of anxiety, your body’s chemistry is still off and full of stress hormones. This translates into physical symptoms.

Allowing yourself to feel all of your emotions is the first step in healing because you can’t change what you can’t feel. Everyone that is alive has anxiety. It is how we survive.

Judgment is a major contributor to creating mental chaos in our lives. Dr. David Burns in his book Feeling Good outlines 10 cognitive distortions that are a core part of our upbringing. Some of them include:

  • Labeling yourself or others
  • “Should” thinking – the essence of perfectionism
  • Focusing on the negative
  • Minimizing the positive
  • Catastrophizing
  • Emotional reasoning

Becoming aware of these errors in thinking allows you to substitute more rational thought patterns.

Ingrained attitudes and thought patterns are problematic. By definition, you cannot see them without actively seeking them out.

Our family interactions in childhood are at the root of how we act as adults. The behaviors we develop over a lifetime of exposure to our environment are what I call ingrained patterns. They stem from our upbringing and the fact that our brain is somewhat “hard-wired” during our formative years. We now know from recent neuroscience research that concepts and attitudes are embedded in our brains as concretely as our perception of a chair or table. I used to say that thoughts are real because they cause neurochemical responses in your body. But they are not reality. I was wrong.

It turns out that your thoughts and ideals are your version of reality. Your current life outlook continues to evolve along your early programming or your “filter.” It is why we become so attached to our politics, religion, belief systems, etc. It is also the reason that humans treat each other so badly based on labels. One example, amongst an endless list, was how we locked up “communists” during the McCarthy era of the 1950’s and 1960’s. It is why so many minority groups are persecuted, but they also often treat each other badly.

It is critical to understand that these are attitudes and behaviors that you cannot see because they are inherent to who you are. It is also maybe the greatest obstacle to people getting along. We are hard-wired enough that we don’t recognize or “feel” these patterns; it’s just what we do. It’s behavior that sits under many layers of defenses and has to be “dug out” by each person. Our family-influenced habits and actions are much more obvious to our spouses and immediate family than they are to us; we can only get in touch with them through counseling, seminars, psychotherapy, self-reflection, spousal feedback, etc. What you are not aware of can and will control you.



Awareness in the operating room

Here is one example from the performance arena while at work. (My wife could give you dozens in the personal arena.) A few years ago, in the operating room I became aware that I consistently started to speed up towards the end of each case. I also realized that over the years, probably 80% of my dural tears (the envelope of tissue containing the neural elements and cerebrospinal fluid) had occurred in the last thirty minutes of a long case. The fatigue factor is an issue, but the speed issue is more critical. I still often didn’t notice that I was speeding up; I needed feedback from my partners or assistants, so I asked them to act as my “coaches.” I’d stop for a few seconds and say, “The difficult part of this case is done. It would be easy for me to relax and hurry to finish. Please speak up if you see me starting to rush.” Every move in spine surgery is critical, so I had to make the choice to consciously slow down. The end of a case is just as important as the beginning and middle. My complication rate dropped dramatically.

This is a brief overview of how awareness plays a role in successfully navigating daily life. It’s something of a paradox in that when one is truly immersed in the moment there are no levels of awareness. It’s just complete “engagement-in-the-present-moment” awareness. There’s many layers to this discussion, but I hope this is a good starting point. Life does become much more interesting.