An award-winning medical educator on the power and science behind mindfulness

This week, we are in conversation with Jillian Horton.

Jillian is an award-winning medical educator, writer, musician, and podcaster. She completed a residency and a fellowship in internal medicine at the University of Toronto and has held the post of Associate Dean and Associate Chair of that department. She cared for thousands of patients in an inner-city hospital for sixteen years. During that time, she had three sons and mentored hundreds of students. She now leads the development of new programs related to physician wellness and won the 2020 AFMC–Gold Humanism Award.

In this episode we reflect on themes from her book, We Are All Perfectly Fine, and discuss:

• How language can define how we feel
• The spectrum from coping to thriving
• The science behind mindfulness and why it is so powerful

This episode is part of our mini-series on ‘Self’ where we explore how our technology impacts some of the most important aspects of being human. Episodes in the series include Krista Tippett, creator of On Being, Susie Alegre, human rights lawyer and author of Freedom to Think, and L M Sarcasas, renowned commentator on technology & society. Upcoming episodes are with Casey Swartz, author of Attention, A Love Story, and Sharath Jeevan OBE, motivation expert and author of Intrinsic.

Host and Producer: Georgie Powell Sentient Digital

Music and audio production: Toccare Philip Amalong

Transcript:

Gillian: Mindfulness taught me one thing more than any other. And it was the ability to work differently with my own suffering. To not be completely consumed by it, to not devalue it, but also to not think of it as that special or that exciting.

Georgie: Welcome to Freedom Matters, where we explore the intersection of technology, productivity, and digital well-being. I’m your host, Georgie Powell. And each week, we’ll be talking to experts in productivity and digital wellness. We’ll be sharing their experiences on how to take back control of technology. We hope you leave feeling inspired, so let’s get to it. 

This week, we’re in conversation with Jillian Horton. Jillian is an award-winning medical educator, writer, musician, and podcaster. She completed a residency and a fellowship in internal medicine at the University of Toronto and has held the post of Associate Dean and Associate Chair of that department. 

For 16 years, she has cared for thousands of patients in an inner-city hospital. And during that time, she’s had three sons and mentored hundreds of students, she now leads the development of new programs related to physician wellness, and won the 2020 AFMC-Gold Humanism Award. 

Today, we’ll be reflecting on themes from her book, ‘We are All Perfectly Fine’. And discussing how language can define how we feel, the spectrum from coping to thriving, and the science behind mindfulness, and why it is just so powerful. 

Jillian, welcome to the Freedom Matters podcast. Thank you so much for joining us. It’s a real pleasure to meet you.

Jillian: Absolutely my pleasure to be here with you today.

Georgie: I think your book is so moving, and wonderful. And I hope lots of people who aren’t medics read it too. Because I was thinking of my medic friends as I read it, but I think it has lessons that can impact all of our lives.

Jillian: Yeah, I feel that way about it too. I think it’s a pretty universal story of suffering and longing to belong and figuring out work life integration as well.

Georgie: Yeah, indeed. And I wanted to ask you is what was the moment that you decided it’s time to write this book?

Jillian: Well, that’s actually a very long story. And I think that’s probably a common experience for most writers, right? I feel like most of us have this drive from a young age, this sort of amorphous feeling that there’s something that we must do, there’s something that we must write. 

And so for me, that feeling traces back to childhood. And to my earliest years, even as I pursued this kind of compulsive drive to go into medicine, which was for family reasons, I always had an itch that needed to be scratched. And I’ve written elsewhere about having to do lists that I would recopy since I was a teenager, and somewhere on that list, there were always those three words, write my book. 

Over a decade ago, I had begun on a really committed path of writing practice writing every single day, and had actually come very close to selling a book to a major publisher. But what was interesting was that book was fiction. And at some point, a very wise editor at that publishing House said to me, “I just wonder if this story really is fiction.” And it was about a woman in medicine, struggling to balance her career and her kids and deal with all the traumatic things she’d seen. That was a really important moment for me. 

And a few years later, right around the time I made this first powerful journey to this meditation retreat in upstate New York, I suddenly began to slowly have the realization. This is what my heart has been wanting me to write. This is the real story. It’s everything else. But finally, here’s the scaffolding to tell it and to tell it as the true story of my life. But the drive to do it is, it’s insatiable. 

And it’s sort of not even — doesn’t even really make sense. Anybody who’s written a book, I think, will agree that it’s an act of total masochism, as well, but so worth it and just so grateful that it all worked out.

Georgie: Yeah because you obviously had the PhD scholarship to Oxford in literature that you could have taken when you, at that time, chose instead your path into medicine. You must have looked back at that decision so many times in your life.

Jillian: I sure did. And especially early on, those first few years in medicine were so hard, filled with so much uncertainty, and I would look at pictures on the internet of Oxford and think, what did I do? But that feeling faded, and I think most of us, we always have this idea that there’s one magical thing we’re supposed to do instead of a lot of different possibilities. 

And I think as I’ve gotten older, I’ve come to realize that that’s sort of a universal feeling. And we always think it’s just us. We’re the only one on that kind of hero’s journey with one perfect path that we need to unlock. 

And a wise mentor said to me at a difficult point in my residency training, when I was so uncertain about whether I’d made the right choice of specialty, whether I should have gone to Oxford, as you say. And he said to me that not only had he felt the same way for most of his adult life, but also that he’d discovered that in some ways we find what we need in whatever we do. 

And I just love that, because I think when we look at all the possibilities for our lives, the paths not taken, there are still common elements, there are still things that trace back to our deepest dreams for our lives, who we really are. And I think we can find ways to express those things in many different forums. 

And so for me, that’s what’s really given me a lot of peace in recent years is those other things that I didn’t do, I found a way to live them in this life on this path. And I think that is generally more possible than a lot of us realize, when we’re a little bit younger.

Georgie: Yeah. That’s really nice. So, it’s not so much about the vocation, it’s about the kind of the value characteristics that you can display through any kind of way of life.

Jillian: Absolutely, 100%. Pre-pandemic, there was a restaurant that I was fond of taking my kids to here in Winnipeg, where I live. And at that restaurant, the server who works there, he makes everybody feel important. The minute somebody walks in, he remembers their name, you see him fully present, sitting down with older folks who come in by themselves and just listening totally engaged. 

And I used to say to my kids, look at that, look at how he makes people feel. That is an important job. I just love that idea, role modeling and that messaging to my kids has always stuck with me, that there’s a way to be whoever you are in many different settings. But the thing is that so often those settings feel that they’re at odds with who we are, and we struggle to reconcile that tension.

Georgie: Yeah, that’s really interesting. It brings me on to a point which I wanted to talk to you about, which was, when you’re doing a job that is basically enacting a lot of the values that are important to you, it’s hard not to care very deeply about that job. And when you become very wrapped up in what you’re doing, because you care so deeply about it, how then can you protect yourself too?

Jillian: That brings up so many interesting points. The first thing that comes to mind is just boundaries. And I think very often, and we talk a lot about boundaries in medicine, and there are certain core, hard boundaries in terms of malfeasance. So, not taking advantage of patients, never exploiting a position of trust. 

But then we often get messier there. And we talk about boundaries in terms of the first point that you made, caring too much. Is it okay to care a lot? What if you grieve when your patient dies? Does that mean that you’ve over invested? And to me, these are just the weirdest arguments. 

I feel like they were concepts inserted into our profession, by people who didn’t know how to handle their own emotions, by people who are really uncomfortable with their own emotions, or just had bad teaching, had bad modeling, were told that this was a good way to be. 

This is not a healthy way to be. And I write a lot about this in my book. We want to find a place that we are moved, but not decimated. I don’t think anybody that we care for wants us to be so traumatized by the experience of caring for them, that we can never practice again, or not be fully present in other spheres in our lives. But I do believe that people want us to feel and acknowledge human emotion. I’m really touched when someone caring for a family member of mine, or for me, is clearly moved and affected by my own suffering. 

But again, I don’t want it to destroy their lives. And I think that’s a balance that we’re going for. And in my mind, one of the keys is, we never teach people how to metabolize those things. In medicine, historically, our approach has been repression. Don’t touch it, don’t go near it, don’t cry, don’t let yourself think about it. 

We know in every other realm in our lives, that’s really a recipe for a decade later, sitting in a chair with a psychiatrist. This is not an effective way of dealing with difficult things. 

And I think it’s one of the reasons why we have this sort of obsession in medicine with this idea that if you care too much, or if you even care at all, you’re going to have problems in the future. It’s just bad teaching. And it’s also a failure on the part of our culture, and our profession, and to some degree medical education as well to say, we must give people those tools. 

If I’m going to put a student in a high stake situation where they are going to care for someone traumatic situation, I have to begin to conceive of that person going through that as someone who also needs care, as someone who is also going to need debriefing, who’s going to need me to help coach them through it, and that’s very difficult to do if you don’t have the skills yourself. 

Perhaps for some people strategy of dissociation or disengagement could be effective, for sure, especially work that you have to do that is viscerally unpleasant, or has a sensory component. I don’t think where there’s a human being on the other side of that work, I don’t believe that that’s a helpful strategy. And I also think it hurts the person on the other side of it because they see our disengagement, they feel that we don’t care, and they’re traumatized. 

Georgie: And I mean, you, as a child witnessed firsthand the damage that it does when doctors see their patient not as humans, really, in that way.

Jillian: Absolutely.

Georgie: I’m still kind of one of the things I’m finding quite interesting at the moment is language and how that is so connected to humanity, and how technology is impacting that and changing language. 

There’s a quote you have in the book that says that people with power have a duty to speak with care, because they’ve been entrusted with something fragile that they have no right to break. And yeah, I just thought that was really beautiful, because obviously, the words that you heard and your parents heard about your sister so early on are words that have defined your life.

But can you talk to me about your thoughts on words and how important they are as a medic, but also just more generally, as someone who has influence or anyone really?

Jillian: Yeah, 100%. So, there’s one component, which is what other people over hear us say about them. And that’s really important, whether it’s patients, or clinical problems, or whether it’s talking about how we describe people living with addiction, or people experiencing homelessness. 

There are a lot of connotations to our word choices, of course. But I think when we go even a level deeper about that, there’s the concept of how would we like to be spoken about? 

When we introduce concepts or words, even if they won’t be overheard, but they’re the way that we write about somebody in a medical chart, you know, I think the minute we invite certain language, certain judgmental language, we have to be aware that this may chip away at something fundamental in the relationship. 

And this doesn’t mean that there’s no room for negativity or complex emotions. You may feel that a person is really challenging to deal with, but you can also have empathy for their situation. 

And so it’s the idea that how we speak about each other, if you think of really loving and caring relationships in your life, you even have the sense that there are certain things you would never say about somebody you’ve loved. Because I think even when we speak about people in that way, if we love them, we break trust, even though they’re not there to see it. 

So, I think language and medicine, and of course, as a writer, it’s something that has always interested me, basic things that we always say, as physicians, we talk about the exam revealed, the patient denies chest pain, and things like that. And you step back, and you look at that framing, and you say, if my doctor asked me if I have chest pain, and I say no, I don’t want them to say I denied it, it sounds like they think I’m going to be a liar. 

So, even some of those little further reveal, the exam revealed, but the patient claimed that they haven’t done such and such. And these are all really fundamental aspects of how we’re conditioned to talk. 

And so that kind of takes me back to the point I was trying to make earlier, which is the way that we are trained to talk about people can influence and can become how we feel it’s thinking to ourselves, why did I choose this word? What are the connotations of this word? How might this make other people see this person? How might this influence my ability to really see their humanity in front of me? So, to me, this is a really important aspect of our medical culture to explore. And it can link to all kinds of interesting revelations.

Georgie: I wanted to move the conversation on to talk about coping. Obviously, what medics are exposed to and what they have to cope with is often of a very different level, to what many of us have to manage in our own lives and jobs. But what is coping, and what should we watch out for when thinking about coping?

Jillian: What a great question. And I’ve never exactly thought about it that way before. But I think if we try to put it on a spectrum somewhere, many of us would think, because we often use coping in a sense that we’re not coping. Or I talk in the book about this phrase that we have in medicine, this horrible phrase, failure to cope when people are admitted, and we say there’s no major medical reason. 

But this person has a thousand strikes against them in life, and they’re falling at home, and they can’t keep up with their 20 pills. And so we say, well, they have failure to cope instead of us really acknowledging the difficult things in their lives, how many of us would struggle. 

So, I think when we think of coping, maybe just the bare minimum, we’re keeping the balls in the air, we’re keeping our kids fed, we’re keeping our jobs and our employment. But we don’t feel, I think, on the other end of the spectrum from that flourishing. And I think this space between coping and flourishing is one where many of us live. 

We tend towards, for a few months, we’re in one space, we’re just barely coping. And then probably below coping, there’s languishing as Adam Grant wrote about in that really great Times article that last year around this time last year that so many of us just felt that we were languishing.

But then how do we move from coping to flourishing some of that is privilege. It’s very hard to go from hoping to flourishing if your basic needs are not met, if you suffer from food instability, housing instability, domestic violence, lack of medical care, access to medical care, education, all those other things. It’s very hard because we need that foundation to build on. 

So, when we get to the point where we have some of those things, even in the face of the kind of existential uncertainty that we’ve been facing throughout the pandemic, I think, when we look to see what can make us flourish, I do believe it’s where these skills become so important. 

Some of the things remain external; relationships work that we find fulfilling a strong connection to our sense of meaning and purpose, those things are all helpful. But life, as we all know, will never be perfect. We always have this balance between our negativity bias, and the fact that our positive emotions just decay very quickly. That’s how we are wired. And it’s how we were wired from an evolutionary perspective when we were foragers. There was a value in finding something new, and then that, the pleasure decaying quickly, so that we would keep looking for new berries, new food sources, that kind of thing. 

Whereas the negativity bias is the absolute opposite. Negativity lasts. One of the hypotheses for the reason for this is, if you from an evolutionary perspective, again, if you ate a berry off one bush, and there are two bushes side by side, one berry’s, delicious and makes you feel good. And the next berry, you get sick and vomit for 24 hours and you almost die. Your mind from a survival perspective needs to be wired to remember that negative thing, because that will help you survive. 

So, one of the things is when we move beyond coping, our basic needs are met, and we want to flourish. We sense that our life could be better, that we could feel better, that we could feel differently, and perhaps be more fulfilled, but we don’t know how to get there. One of those powerful things we can begin to do to affect that natural wiring is work with gratitude. And years ago, I used to read about gratitude practices, and we all kind of go well, yeah, sure that sounds nice. It makes sense. But it’s kind of Pollyanna. 

But one of the powerful things that gratitude does, and the way that it actually works, when you think about that balance that we just talked about, I like to describe gratitude as a toxic emotion receptor blocker. Because one of the things our mind struggles to do when we think about something positive, our mind can’t really hold two emotions at once. 

And so when we redirect our mind towards the good things, we make our positive feelings and emotions last longer, actively engaging in that process. It corrects that negativity bias. And that’s actually how it works. 

So, we can think of it as going in and rewiring that motherboard, that we all have hitting a reset and improving on our factory settings. And I think so often when we begin to make those adjustments, through neuroplasticity, we really do change our brains. And there’s plenty of research about this. 

So, how do we move from that place, just getting by, to things feeling better, feeling more fulfilling, more of a sense of well-being? That’s one incredibly underrated and powerful way. And then many other things, I think that I’ve found personally helpful, not a panacea, but definitely improved my quality of life, trace back to mindfulness and mindfulness practice.

Georgie: So, tell us about the evidence for mindfulness and now how you’re incorporating it in your life and how it’s changed your life.

Jillian: Yeah. So, we have this long nerve in our body, the longest nerve, it’s called the vagal nerve, the wandering nerve. And the vagal nerve is responsible for so many different functions in the body. If you think of it like a muscle, when we make the vagal nerve stronger, when we tone it. Just like we work out and our muscles, the muscle gets bulkier. 

When we do things that affect our vagal nerve, we can actually improve its tone. So, the higher we make our vagal nerve tone, there are a lot of things that happen that make us feel good. And so one of them is we affect our digestion in a certain way, our digestion improves. We hear a lot of talk about this gut-brain axis, the relationship between the stomach and the brain. And the vagal nerve is one of the things that mediates that. 

We feel more of a sense of well-being, benevolence. And we talk about people scoring higher on an agreeableness index when they are more mindful. So, this is one really powerful thing that’s mediated by toning your vagal nerve and we can actually influence that, people behave in a kinder way. It’s probably mediated in part by the release of the hormone oxytocin, the love hormone that makes us just feel more kindly disposed towards people around us. 

And then we lower the degree to which our heart rate is variable during inspiration and expiration. And just a number of other things, the softening of our gaze, softening of our voice to a more calm and soothing tone, the higher we make our vagal nerve tone through certain kinds of meditation practices or focused attention practices, the more we get to benefit all those things. 

And so I find it really helpful for people, when we frame it like that, a muscle that you’re learning to flex, repetitions that you’re doing. Over time, you’ll begin to feel some of those benefits, all those things, you’ll notice them happening in your body, and then it becomes positively reinforcing. You go, oh, that feels really good, I’m going to keep meditating. 

And the time to notice those changes is often shorter than people would think, you start thinking about having a meditation practice, and you think, “Oh, I can’t find an extra 30 minutes in my day.” Even just a few breaths during the course of the day can begin to set the stage for the idea that this is helpful. Because even relatively short periods of meditation, five minutes, people can notice significant changes in their sense of well being. 

And just to finish that thought in terms of the evidence, and what happens, we know, through looking at studies that examined people’s brains, meditators and non meditators through functional MRI imaging, we know that meditation changes the brain. 

And some of the highlights of those changes, the amygdala, which we always think of is one of the most primitive fear and the primal brain can actually get a bit smaller. And then this area of the prefrontal cortex that is associated with some of our really high level functions can actually get a bit thicker. We have more emotional awareness, we have better thinking, better self-control. 

And just briefly, in medicine, there’s definitely evidence that these types of programs work and help health care providers as individuals. So, they show reduction in burnout scores, they show improvements in mood, and increased emotional stability that seems to be mediated through some of those changes in that vagal nerve. And just mindfulness, the more mindful you become, the more emotional stability you experience. 

And on a personal note that’s absolutely been aligned with what I have noticed these last several years. I really do feel like a different person than I did seven years ago now, before I had a really engaged practice.

Georgie: I asked Jillin to talk more about which specific activities we can all do to strengthen our vagal nerves.

Jillian: So, one of the activities that we often find ourselves focusing on is breath work. And so when we work intentionally with our breath, that’s one of the most powerful ways that we can begin to influence our vagal nerve tone. 

Interestingly, the act of doing this together may well amplify and one of the interesting reasons for that is there’s this thing called the polyvagal reflex. I often suspect that this also has an evolutionary basis, if you think of animals grazing together in a field and one animal joins and the other animals are relaxed, the sixth animal kind of feels relaxed too, because the other animals aren’t freaking out suggesting there’s a predator around.

I often feel analogous, when we join a group and everyone has a nice high vagal tone, everyone is really relaxed, that rubs off on you, you know? And so the idea then is that our tones amplify. So, because I am more deeply settled and calm, you pick up on that. 

And then as you settle, I settle more. And it allows us to get to a deeper state of what we perceive as focus or relaxation, or concentration, however, we individually describe it. But breath work is one of the easiest and most accessible things. Any one of us literally at any time, can settle in, take a deep breath and then exhale a deep breath. And do that over several times. Notice what’s happening in our body in that moment. 

Most of us when we just sit in and do that we sense I feel better, something changed. There’s a reason that you hear so much in the literature and from medical experts about these things, because their effects are profound and often exist just right beneath our noses.

Georgie: One of the reasons freedom exists and one of the reasons that we all work in this space, it’s because we’re concerned that often the way that we’re using technology is doing the opposite. It’s keeping us away from periods of attention and focus and mindfulness. And also physiologically leading us away from breath. You know, apnea is a thing.

Jillian: Totally. And the constant arousal state that we find ourselves in that the unfinished business, the dealing with uncertainty. I don’t want to not know if I don’t have email. I don’t want to not know if people have liked my post or not. I need to know right now. It takes a lot of cognitive energy to manage that uncertainty to manage our energy when it comes to delayed gratification or just trying to exert what we think of as self control. 

So, anything we can do to make that cognitive work, less to have someone else take over that task for us, to set the boundary without us having to waste our energy expending it on that particular task so that we can redirect our focus, our self-discipline to something else like writing our book, the better off we are, and certainly Freedom is a huge part of my life. 

And I tell it to everyone who comes to me and says, I really want to write a book. So, then set some limits. I think, okay, I don’t have to worry about social media anymore. I don’t have to worry about logging into this website where I check the news compulsively. And it’s actually one of the great relief points in my day that I can outsource that to somebody else. 

And my kids, my 13-year-old is about to start using it as well. Sometimes the simplest interventions like we talked about with mindfulness, and gratitude, setting a digital boundary doesn’t have to be difficult. And for me, it has personally paid dividends.

Georgie: Related to that, where do you see digital mindfulness apps sitting in this world? I guess sometimes I’m a little concerned that mindfulness has been commercialized.

Jillian: Yeah. I think that’s a great question. And I think the answer is a little bit different for everybody. I don’t tend to be a big user of digital mindfulness apps, even though I think there are some great ones out there. But that’s just my personal pattern of consumption. 

And one of the things when people come to me and they say, “I’ve tried mindfulness, I’ve tried this, I’ve tried this, I don’t really like it.” I say, “Keep sampling.” What we’ll find is certain teachers, certain voices, certain styles, certain metaphors. 

We have deep preferences when it comes to language, tone, style. Sometimes one person will find something infantile, and another person will love it, and you won’t really be able to put your finger on why. And I just say, continue to work with just finding what works for you because I think most people stop a religion. 

I do totally hear your point about the commercialization, is it gimmicky. And I think what I always say to people, when they’re saying, “Oh, I’m thinking of pursuing mindfulness, I really want to be happier.” Of course, Dan Harris has his great book and website, 10% Happier; lots of amazing content on that site and on that app. 

But to come back to his point, which I completely relate to, I think mindfulness doesn’t necessarily make you a lot happier. If it doesn’t make you happier. It’s a byproduct. Really think about why it is that you’re engaging with it. And if you’re engaging with it as a substitute for dealing with problem A, B, C, D, E, F, G in your life, it’s not going to fix those things. 

I often talk about mindfulness as having braced me to do some difficult things in my life, having braced me also to tell a very honest and candid and difficult story, in some respects to put out in the world. It was helpful in that way. But it won’t replace, for some people, the need for therapy or medical treatment of a mental health condition, but it may amplify the benefits and accentuate it. So, just yeah, very…

Georgie: I guess, for you, importantly, what it did was, it got you to understand where you were in your life, where your body was, physically, and to perhaps connect with yourself for the first time, in a life where you hadn’t really had the opportunity to do that.

Jillian: Yeah. That’s just completely how I feel about where I arrived at the end of the book, I think, is too and where I’ve arrived at the end of this experience, mindfulness taught me one thing more than any other. And it was the ability to work differently with my own suffering, to not be completely consumed by it, to not devalue it. But also to not think of it as that special or that exciting. 

And, again, that doesn’t mean to think of it in a derogatory or diminishing way, but rather to begin to think about some of the central experiences that I’d had in my own life that were still giving me so much difficulty as universal experiences, as common experiences.

And as a result, they became a little bit banal in the best possible way, because I think we can all get really caught up in our own suffering and the story we tell ourselves about that suffering, and whether we’re good people or bad people and our own attachments to that. So, that is really the string that mindfulness allowed me to cut, so some of that weight could soar away. 

And I really can’t overstate the impact on my quality of life as a result. And it’s no fluke, that when I look at what the last few years of my career have been like, it’s taken off in a direction that I always, I think, ached for you in terms of my writing and my speaking. 

Really, once I got out of my own way, once I stopped living so much in my head, and once again, I just forgave myself for things that weren’t even my fault, my life began to change so much. And that would be my hope for anyone who’s listening who relates to any of that, who feels the same way about anything in their own life that they could begin to taste what that alternate life is like because it’s really a vast improvement.

Georgie: That is absolutely amazing. Jillian, it has been a complete delight talking to you. I can feel the energy pouring. It’s like an hour of therapy. Thank you so much.

Jillian: Thank you so much. And thank you so much for, yeah, just a delight to be here with you today. And I’m so grateful to your team for this — for your offering. Because I think anything that makes our quality of life better, that allows us to just exist in the present moment and find simple, tangible ways to shut all the peripheral noise out; that is a thing of great value. And it’s been tremendously helpful to me.

Georgie: Thank you for joining us on Freedom Matters. If you like what you hear, then subscribe on your favorite platform. And until next time, we wish you happy, healthy, and productive days.