Category Archives: Advice

Setting Up an Educational Philosophy: A Personal Experience

By Shady S. Shebak, MD

Psychiatry Resident, Virginia Tech Carilion School of Medicine, Roanoke VA


I have developed a personal educational philosophy over the past several years during psychiatry residency training. I have come to understand that in any educational philosophy, there are elements of pedagogy (classic teaching that was designed to teach children), but as Knowles1 discussed, adults are internally driven and learn best when they feel as though their interests and their independence are respected. Group work, discussions, and relaying of experience to one another is essential when discussing how adults learn, and as we will see, androgogy (adult learning theory) as explained by Knowles has elements of several of the classical and resurgent learning theories, as well as educational philosophies.

Malcolm Knowles

Malcolm Knowles

From reading Knowles, I realized that indeed, I am always much more keen on learning when I am included in creating a teaching environment that will house my mind. He makes a point when laying down the foundations of androgogy that traditionally teachers were the planners (and might I add executioners) of the learning process. Teachers most definitely have a crucial role in planning lessons and didactics, but involving their adult students (be they undergraduate or graduate students) shows a respect and creates a sense of comradery that I find very fruitful and motivating. On a personal note, I’ve learned best when I’ve been given an opportunity to involve myself in the planning of what I am expected to learn. This is the defining difference between pedagogy and androgogy.

Moving on to the classic learning theories, humanism resonates most strongly with me. Learning for the sake of self-improvement, improvement of the human condition, and eventually to gain self-actualization2 are driving factors in my striving to learn and gain knowledge. I believe the self-actualization is actually to attain or achieve a level of wisdom that a true lover of learning yearns for; in the same manner as Parsifal yearned for and chased the Holy Grail during his mythical expedition. Humanism is in summary, what medicine is. In Arabic, one of the terms for physician is hakim, which stems from the word hikma, and hikma means wisdom. I think humanism leads one to wisdom, and is essential to the practice of medicine. As Stern, et al.,3 outlined, humanistic physicians demonstrate respect, empathy, and integrity in patient-doctor interactions. Furthermore, I find humanism a summary of many of the classical learning theories, as it has within it the appreciation of role-modeling of social learning theory4, as well as reflecting and creating knowledge out of experience, and emphasis on the learner as outlined by constructivist learning theory5.

Let me shift and discuss another learning theory that I find important, and that is narrative learning theory. The best way to explain this theories importance to me as it relates to my learning is to provide a story… a narrative.

It was my first week as a psychiatry resident. I was presenting a patient to an attending who was filling in for my team for that day. I was expecting it to be an easy day as he was ‘just filling in’. As I started to present the case and the diagnoses, he asked me for my reasoning. I told him that the patient has a long history of these diagnoses, and that is when the attending asked me to be careful in sticking to the diagnoses in the chart. He told me I should always challenge what is in the chart and that sometimes we may have to rely on past diagnoses, but that we should always try to conduct a full diagnostic review for our patients if we expect a diagnosis. He also said that by relying on the chart for my diagnoses, I may be missing the bigger picture that the patient may have underlying personality issues or developmental issues that are mimicking another disorder. By not doing a full review with the patient, and without challenging the chart, I may be missing a big component of the patient’s presentation.

Looking back now, it is almost an obvious lesson, but at the time it was a big step forward for me. As I became more analytical, more comfortable with changing diagnoses or removing diagnoses, and even more comfortable suggesting new treatment plans. I utilized this attending as a role model, and since then, I’ve chosen him to be my mentor. He has provided me with books on mythology, story-telling, as well as articles that challenge the status quo within psychiatry. I’ve learned a great deal by putting more effort in acquiring the narratives of my patients, as well as from reading stories from various cultures and eras. He ignited in me a latent curiosity that has taken me on a journey of learning through reading stories, understanding my patients’ stories, and modeling his own qualities that I find appealing. Hence, my encounters with him are representative of narrative learning theory as these encounters hold a significant portion of my unfolding book of life, but these encounters are also embodied within social learning theory, which places emphasis on learning through modeling4. I’ve reflected deeply on these encounters with him, but I’ve also spent considerable time reflecting on my life in general; upon my childhood, my loved ones, and my future. I agree with narrative learning theorists that our experiences and our actual person are one and the same, and that these things are much more intimately related than what many constructivists have postulated6.

Parsifal Postcard 1900's

Parsifal Postcard 1900’s

Oral traditions, poetry, Perennial wisdom from thinkers and writers alike, as well as spirituality are things I consider to be essential for my continued growth. I view my life, human life, nature, careers, interests, and paths to be sacred. This sacred feeling or plane is something I believe is hardwired into us, and thus any knowledge produced from the heart, with purity of intention falls under this ‘sacred’ category that I’ve created for myself. And because of my belief that it is hardwired into us, I feel as though all learners have a capacity to grow and learn by utilizing traditional and spiritual methods. Hence, seeking knowledge from the outside world as well as from my own inner world is a form of worship, and I feel constantly energized and replenished when learning something worthwhile.

I like to think of my passions as emergencies or urgencies, and the way I address these emergencies is to teach them to others in the hopes of reforming and adding onto incomplete ideas. As someone who is somewhat introverted and somewhat extroverted, I usually form an idea or ideas, make personal conclusions about that idea, and then I share the idea with friends or colleagues in the hopes that they will add onto it or take something useful from it. Teaching should not be something that is dry and fully curriculum oriented, nor should it be done with the goal of ‘bestowing’ knowledge upon another. Rather, it should be done enthusiastically, with inner purpose, and with the goal of sharing knowledge and attaining knowledge through the experience of teaching. Some of my favorite learnings occurred outside of the rigors of curricula, and at times, without verbal exchange. Teaching and learning is multi-dimensional, complex, and truly a personal and collective process. We live in a social environment, and if we pay close attention we will find a library of plots, as mentioned by Sarbin7, and we will find lessons all around us and within us. In teaching my students, I want to ignite that inner curiosity, and will do so by utilizing all that I have outlined above. I will respect my learners’ adulthood and independence, utilize discussions, and encourage writing, oral presentations, and reflection amongst my learners. I value what I have learned and what I will continue to learn, and value what I teach, holding that duty to be sacred. As a scholar, mystic, and Muslim saint Imam Ali once said, the taxation of knowledge is to teach it! I recommend all who participate in education develop a personal philosophy about teaching and learning.

References:

  1. Knowles, M. Androgogy, not pedagogy. Adult Leadership. 1968:16(10):349-386.
  2. Merriam SB, Caffarella RS, Baumgartner LM. Learning in Adulthood: A Comprehensive Guide. San Francisco, CA: Jossey-Bass. 2007:275-297.
  3. Stern DT, Cohen JJ, Bruder A, Packer B, Sole A. Teaching humanism. Perspectives in Biology and Medicine. 2008:51(4):495-507.
  4. Bandura A. Social Learning Theory. New York, NY: General Learning Press; 1971.
  5. Schweitzer L, Stephenson M. Charting the challenges and paradoxes of constructivism: a view from professional education. Teaching in Higher Education. 2008:13(5):583-593.
  6. Clark M, Rossiter M. Narrative Learning in Adulthood. In: New Directions for Adult and Continuing Education. 3rd update. Wiley Periodicals; 2008:62.
  7. Sarbin TR. The Narrative as a Root Metaphor for Psychology. In: TR Sarbin (ed). Narrative Psychology: The Storied Nature of Human Conduct. New York: Praeger; 198
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Depression: The Silent Epidemic

Mohamad Idriss

Wayne State University, Detroit, MI


“The opposite of depression is not happiness, but vitality.”  -Andrew Solomon

The Idea

Depression is often misunderstood, especially by those who have never experienced it themselves or through someone close to them. It has even come to be used colloquially, to mean that you’re simply having a bad day, but depression isn’t an emotion that comes and goes haphazardly. It is a deep state of self that may envelope everyday life and make the normal seem horrible and the bad seem catastrophic. With it come physical weakness, social reclusiveness, and above all, an inability to partake in the pleasures of life. Many may think that it is not an issue that they will ever have to deal with, but the statistics indicate otherwise. Approximately 1 in 5 people will experience a depressive episode at some point in their lifetime. This is why it is important that there be general knowledge on what depression is and practical ways to talk about, cope and work through this silent epidemic.

Melencolia

Melencolia

Defining Depression

First and foremost, it is important to seek out professional help for you or anyone close to you that may be going through depression. The DSM (Diagnostics Statistics Manual), the manual that mental health professionals use to diagnose patients, splits depression in two main ways. One form is called major depression and is marked by being sad or unhappy for at least two weeks.  With major depression, you lose interest in things that used to interest you and have feelings of hopelessness, worthlessness and helplessness. The other form is dysthymia which is marked by a slightly milder depression that lasts for longer periods, usually 2 year or longer.  Bipolar disorder is also listed in the DSM and is marked by recurring periods of extremely elevated followed by extremely depressive moods. All 3 illnesses have symptoms including reduced self-esteem, loss of appetite, disturbed sleep, thoughts of death or suicide and more. These symptoms come in different combinations and different intensities. It is important to remember that negative moods many times make sense. When you experience a loss or a very stressful event in life it makes sense to have lowered moods. It is when the sadness or depression is disproportional to the life event that it becomes a problem.  At the end of this article will be resources that may help you get professional attention if needed and other resources that may be helpful.

The Myth

Many a myth surrounds the idea of depression. Some think that is all mental, while others uphold that it is simply chemical. Say someone has a good job, has great habits and is surrounded by loved ones. When such a person experiences depression, many will tell that person to snap out of it. On the other hand, there are those people with many stressors, such as having a hard time at work, losing a loved one or having money problems, yet they are able to carry on with their lives unhindered by depression. These scenarios give confusion to both arguments and are an indicator as to why current consensus in the science world is that it is a mix of both.  Even if someone doesn’t seem to have any reason to be depressed, it is not good practice to suggest that a person simply shrug it off. This leads to the stigma of mental illness and is why so many try and hide their mental ailments even when it becomes extreme in nature. Whatever the reason, and even if there is no reason you can point out, depression is detrimental to a healthy lifestyle and must be combated. This is also a reason amongst other reasons that many deplore the idea of anti-depressants to help them get better. Research shows that only 29% of people with depression ever seek out mental health treatment, even though 80% of patients with depression will improve with treatment. Depression is peculiar in that its symptoms bring about more depression in a catch-22 style. Eventually, the depression gets too strong and becomes a beast of its own that is difficult to reverse, especially without outside help. This is why it is important to seek out help when one is well enough.

The Prescriptions

Here I would like to focus on practical methods for dealing with depression and also ways to lead a life that would help deter depression, if you have none. Firstly it is important that you understand what depression is and from there you will be able to help yourself and those around you get care if needed. This will also allow everyone to have a common ground when the subject is brought up.

Practical Tips

First and foremost it is important to have an open line of communication with friends and family. Being open to those close to you is important in maintaining a healthy lifestyle.  Connectedness with those around you gives way for empathy, sympathy and understanding – which in themselves help reduce suffering.

A great lifestyle choice that is exceedingly researched is exercise. The research is so strong on the benefits of exercise in combatting depression and anxiety that many doctors say the best prescription for depression is regular exercise. Regular exercise helps reduce stress, increase self-esteem, improve sleep, ward off anxiety and much more.

An active routine is also important. Humans do not like to live sedentary lives. A sense of meaning and an active routine is important to self-esteem, and the feeling of progress keeps us going. Making progress in life, having healthy habits and having good interpersonal relationships with those close to you are important to having a fulfilling life.  Some of the happiest people are those whose passions are engrained into their daily life.

Nowadays it is important to have positive, realistic expectations of yourself. With the advent of social media, it is easy to lose your self-esteem to the façade of perfection that we all post online. Learning to live with realistic expectations is an increasingly healthy skill to maintain.

“Neurons that fire together wire together” is a phrase attributed to neuropsychologist Donald Hebb. This is good concept to understand when dealing with depression. It is the idea that sensations, thoughts and experiences, when repeated over and over, embed themselves into our neural networks. It becomes more difficult overtime to rid yourself of negative ideas especially. It is good to remember that feeling better and rewiring your brain in a more positive direction will take time and effort – but it does not mean that it is impossible.

Of course, there are a countless more ways to deal with depression and keep it away. We should develop many methods of dealing with negative moods. This gathered toolbox will help in coping with all types of circumstances and stressors.

The Silver Lining

Although the effects of depression may be counterproductive, and at times even catastrophic, we should remember that without depression, it would be difficult to gauge sublime happiness and love. A few positives do come with depression, though they may be truly difficult to see. Namely, among them are deep emotion, obsession and an acute awareness of the self. At different levels of depression and low mood, these become possible. Deep emotion can be troubling at times, but it can also give rise to important contemplations on your life and close ones.  Obsession sometimes comes with depression. Obsession, though sometimes a negative trait, may be utilized to become a positive one. Obsession in your passion may drive you to create something amazing or to discover something new. Lastly, acute self-awareness (though with depression self-awareness is many times misleading) can give way to much self-discovery and personal growth. Keeping these in mind can help one work through and at times accept their current predicament. One can learn to welcome the pain and even learn from it.

Conclusion

Depression does not discriminate and so we should all be vigilant and put care and effort into our mental health. It is important to be honest with yourself and go to trusted professionals that may be able to help with your situation.  Any step in combatting this illness within yourself is a step in the right direction. It is important to remember that our brains and psyches are complex and malleable, and that there is no one- size-fits-all when it comes to treatment and prevention of depression.  Above all else, we must learn to feel more in control and realize that biology does not have to be destiny. We all deserve to be happy, but more importantly we all deserve to live vibrant lives of productivity and vitality.

References:

http://www.nimh.nih.gov/health/statistics/index.shtml

http://www.guideline.gov/content.aspx?id=24158

http://www.apa.org/topics/depress/support.aspx

https://www.nimh.nih.gov/health/topics/depression/index.shtml


Community Resources:

Access Behavioral Health Department

1-313-945-8148

6451 Schaefer Rd, Dearborn, MI 48126

Detroit Wayne Mental Health Authority

640 Temple.

Detroit, MI 48201

Tel: (313) 833-2500

TTY: (800) 630-1044

Michigan Department of Human Health

Capitol View Building

201 Townsend Street

Lansing, Michigan 48913

517-373-3740

National Suicide Prevention Lifeline

1 (800) 273-8255

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