I have always attempted to be totally present but to be honest my mind is a busy one and it often wonders. The chatter in my head does stop when I am listening or talking with with a patient, it really can do more than one thing at a time. I must also say calm and centered is not my usual modus operandi.

The practice of "leaving it at the gate" is a consious quieting of the mind so that one can be available and present with the beings and job in front of you. This type of practice has always been a challange for me. You see, I am a multi-tasker and my mind is very chatty.

For these very special patients we would be working with, I decided I would "leave it at the gate" and do my best to be totally present for them. Well, to be honest these imposing beings demand it. The patients of the Medicine and Horsemanship class weigh at least 1,0000 pounds. These horses, like humans, can be very unpredictable and I knew I better be totally present for them and for myself. Their every move, sound and smell captured my full attention.

The practice of "leaving it at the gate" being present and calm created a strong feeling of connection with the horse. For me it was a feeling of oneness, it felt wonderful. This new practice and skill I now take with me to the children and families I care for.

Thank you, Dr. Kane, Liz, Lucia and M&H classmates

This was the second class of the day. There were 3 horses. And we were each asked to say hi to each horse and choose one that you wanted to work with.

There was this broad male horse that was young, active, dominant, healthy and energetic.
There was this other horse, a submissive tender female horse that seemed really nice and gentle.

Then there was this smaller horse, off by itself, really restless, seemingly bored and anxious at the same time, hooving at the gate as if waiting to get out of the ring.
He immediately reminded me of myself. I too was hyperactive, comfortable to be doing my own thing away from the pack, and at times anxious about the situations. I nicknamed him ADDY, because he seemed quite ADD (attention-deficit disorder), and I chose to work with him.

In retrospect, I think what drew me to him was the fact that he seemed complex. I wanted to figure him out, help him out by easing his anxieties. Perhaps its no surprise that the other two medical students also chose him.

Turns out he was an older Ararbian horse, a breed of horse that gets bored easily, is very intelligent, and he was also past his prime so he didn't care much about trying to mate with the female horse who was in heat. Can't say the same about the broad young male horse.

We are drawn to other people who are similar to us. We also tend to see qualities in other people in terms of ourselves- how are they similar and how are they different? As a budding psychiatrist, I think its important to keep these in minds. The one person we know best is ourselves, and understanding ourselves, our personality and traits can help us understand the human mind and how other people are. But at the same time, this can blind us as we think from a subjective perspective, an egocentric one perhaps, that is framed by who we are and who we are not. Something to keep in mind.

I joined the course as a way to get off campus and have a relaxing Wednesday afternoon off from medical school, but the course has been much more than that. It has opened my eyes to the possibilities of different treatment modalities, especially in relation to mental health. Equine-assisted therapy is truly a fascinating subject I hope to learn more about and engage in later in my career as a child/adolescent psychiatrist.

Horses have also taught me a lot of social dynamics, the importance of strong leadership, nonverbal communication such as body language, intention and emotional tone of our words. Experts have often said communication is 90% non-verbal, and I believe it. I think the class has made me a much more aware and effective communicator, and even a more strong leader.

Thank you!

As with our human patients we must always weigh the benefit of persuasion with the ultimate outcome keeping in mind our methods will need constant adjustment depending on the goal and patient.

It was the moment that I saw one of the children atop the horse, overcome with enthusiasm and working hard to ride by herself that my opinion changed. The horses awakened in her an unrestrained excitement, which led to strong motivation to perform the activities requested by the physical therapist. I feel that this motivation is especially important for children, who may not understand why they need to undergo grueling physical therapy that none of their friends have to undertake. I agree with Tamara that it was magical seeing the children interact with the horses.

I was also struck by the total cost of running such a facility (they estimated $2,000 for a half hour session), and I was amazed that such a facility could exist, despite its astronomical cost. I think it really exemplifies the things that are possible when you get together a group of horse-lovers with a passion for helping others.

-Shawn

What an eye-opening experience for me in many ways, and I had two big revelations.

First, I had never connected the movement of the horses with the movement of humans. Riding a horse creates similar walking patterns in pelvis rotation and twist. Seeing this movement in action helped me understand how powerful equine therapy could be in assisting people develop those same muscles, particularly if they cannot fully walk themselves.

Second, I saw two children, both around ages 6-8, with cerebral palsy undergo personal physical therapy sessions with a horse. While both children required assistance to walk and move, they were simply giddy to see and interact with the large gentle animals. Responding to animals opens up another (nonvocal?) dimension, and watching the kids helped me understand the healing magic that pets might provide. Somehow these two children managed they sit up and play catch on the horses, helping to strengthen their core muscles and improve hand-eye coordination. It was an incredible transformation.

Once Beau expressed his fear, the students made many attempts to get him to walk through the Little Shop of Horrors. Efforts included pulling repeatedly on the lead rope, playing follower-the-leader by walking on the space blanket one's self ("See, nothing to it!"), and the universal (for these exercises) tactic of stroking and petting.

With regard to the latter, almost everyone tries the "I'm your friend, so love me and do what I ask" technique. But what does stroking and petting mean to a horse? As we explained--and observed during round up--when push literally comes to shove, horses don't respond to making nicey-nice. As prey animals, they respond to the strong leader who is going to ensure survival of the herd. Horses push each other around quite aggressively and usually from the rear. The lead horse flicks her ears and says "Move! NOW!" and the submissive horse responds, by moving off, "Yas, MA'AM!"

To a horse being asked to perform a task, petting means "Goo' boy! Do just what you're doing." Petting is a form of positive reinforcement in the technical sense of operative conditioning: positive (adding a stimulus) reinforcement (increasing the behavior).

After half an hour of being petted every time he refused to walk on the space blanket, Beau just figured he was being rewarded for standing in place. In the end, he didn't even seem afraid. He just seemed stubborn and enjoying being petted in exchange for standing still.

What kind of patient does Beau represent? Well, certainly he is typical of patients to whom we physicians give a mixed message: "We think you ought to make changes to improve your health, but it's OK--in fact, we'll reward you--if you don't change." We are unconsciously saying to them, "I'd like you to be healthier, but more than that, I'd like you to like me." We are unintentionally teaching them that there are no consequences to not making healthy choices. These are the patients to whom we keep giving medications to substitute for healthy behaviors--cholesterol lowering drugs for the obese person who refuses to exercise or change his or her diet, pain killers and sleeping pills for those who do not want to face their addictions or get psychological help for their stress. We are, in effect, petting with pills. Do we want to be liked so much that we are unable to provide Tough Love where warranted? (My previous posts on Michael Jackson's doctors also illustrate the professional dilemmas involved.) As we progress from being med students to practicing physicians, we tend to feel more comfortable with our role as leaders. We have enough self confidence and self esteem to not sacrifice our patient's well-being for our need to be liked as a buddy.

At these times we should remember Beau and realize that if crossing the space blanket represents something he needs to do for his own good (and it is to the horse's benefit and our safety to get him over his fears and trusting of human leadership), we are not doing him any favors by being people...er...horse...pleasers.

The task at hand was to lead the horse over a shiny, crinkly mylar space blanket. Add to this mild yet stormy weather and a good size human audience and you’ve got some varied responses from our horse “patients”. It was interesting to watch the different approaches. So many lessons were learned in this small space of time! When I attempt to relate this to patient care I am reminded there are many facets to these relationships. What is the clinician’s end goal? What is the patient’s perception of how necessary a test or procedure is? Is the trust established to date enough of a motivator to convince a patient to move forward? Is that trust built on reputation, intimidation or mutual respect? Finally, if a patient declines care, how much of that responsibility should the clinician absorb?

Of the three horses, one examined the blanket by pawing and studying it first before going over. This was impressive! He wanted to figure it out himself. The next horse was fine walking on it but not if we walked on it first and reminded her of the noise it made. The last horse despite much effort just wasn’t having it. These scenarios were such a great representation of how different patients might react to the same situation. You have your investigative patient, your committed but don't remind me what it is going to be like patient and finally your non-compliant (at least for now) one. What a great learning experience!

We began our walk as usual with Beau calm, gentle, and willing, until we got within a few feet of the blanket. The entire expression and motion of this Paint horse changed. He signaled loud and clear how very frightened he was. His eyes widened, ears pointed forward, his nostrils flared, and his feet and body refused to move forward toward the blanket. I thought if I showed him I was calm and walked him forward he would follow. He did not. I tried to be playful and encouraging, he was still terrified by an object I saw as harmless. Nothing I did seemed to help this sweet horse relax or feel any safer. On reflection of our interactions, I believe, I should have gone even slower, no rush in trying to convince Beau to go over the dreaded blanket, to sign his informed consent, so to speak, today. I think for Beau going slower is perhaps the best and fastest way for him to learn and to accomplish this goal.

I know in my work as a healthcare provider, I often ask children or their parents to accept a procedure, a medication, or sign a consent, right now. My interactions with
Beau have allowed me to better understand that something I perceive to be harmless, routine, or needed might, in fact, be incredibly stressful or frightening; even though I do not perceive it as such. I will be more mindful of this as I work with children and their families.

Wednesday our second day of class at Webb Ranch was so interesting, insightful, and so much fun. Even though I have been around horses for the past few years I have little understanding of their body language or meaning.

I feel so honored to be a part of this class. What I have learned so far has allowed me see the horses actions and interactions much more clearly. I actually think I understood much of what they were saying with their body movements and facial expressions. I am so excited by the fact that I can learn to have interspecies communication!

I chose the horse whose name we did not know; he was the beautiful white and chestnut Paint Quarterhorse. I believe now from just reading the Blog that is his name is Dream. How very strange I am now thinking, as I remember the first day of class I wore a tee shirt with large print that read "Dream". Is this destiny, a case of synchronicity, or just a strange coincidence? Who knows and I am not sure that "Dream"
is really his name. I will ask next class. Even if it is not it certianly seems most fitting for him. He was truely a Dream (patient) during his physical exam and during the entire class as he stood and walked with us in the corral.

I look forward to our journey with each other and with the horses. Eileen

The power of non-verbal communication is not to be underestimated, nor is the importance of learning another “language”. To learn their language is very necessary in order to foster these new relationships. I couldn’t help comparing interaction with them to the one I have with cats. With cats I instinctively know what they want and look forward to having this connection with the horses.

The biggest challenge for me with the horses is that I’ve never been fond of being in control of animals. Safety dictates this element of the relationship and it was something I was acutely aware of on my first day with "Spice". You must be aware of every position of the horse in relation to other people, other horses and yourself in addition to making sure the horse is comfortable. I now understanding “being present” in a whole new light.

The positive environment is very conducive to accepting these differences in ourselves and much appreciated. Can't wait for the next class!

3 med students
1 pediatric endocrinology nurse practitioner*
1 clinical coordinator for one of our oncology clinics
1 mechanical engineering PhD candidate (w/ biz comm background)
1 transpersonal psychology PhD candidate
1 biotech consultant w/ a psychospiritual & relationship training practice

*This gal has done research on natural substitutes for estrogen products made from PMU (pregnant mare urine)-cruelty farms.

Thirdly, in the good feelings dept, since this is about the 6th time I am teaching M&H at Stanford, I find that the course has finally fallen into a familiar rhythm. After years of experimenting with different time slots and exercises, the main structure of the course is more or less established. I can now attend to making it better from a place of being confident that the core pieces are in place. That is, from a place of confidence, I can get more creative.

"Established," however, does not mean autopilot, as witness Unintended Consequence #1: Background: The weekend before class, I e-mail our horse requests to the ranch owner. I describe what activities we'll be doing and she selects suitable equine assistants. I used to know everyone in the lesson herd, now I know maybe half.

So, we get the schedule back and come to see that I didn't know any of the 3 horses we're assigned. So Liz and I go out to introduce ourselves to the horses the day before. (We also mentally tell them about the class and what we are going to ask of them.)

We get to the lesson herd and find out that we are assigned 3 black geldings. Ay! Ach! Oy! [big forehead slap] We had to explain to management that we need horses that are visually distinctive, especially for folks who aren't used to seeing horses. Heck, Liz and I could hardly tell them apart. Having different looking horses is also important for inducing projection dynamics.

Day #1 once again opened with the drama of round-up: 40 horses funneled into a smallish corral, re-establishing boundaries, staking out real estate, chasing eachother, making ears, swishing tails, kick-gesturing, swinging haunches--much fodder for our intro to body language,leadership, hierarchies, etc. Body language is the start of doctor patient communication. Patients notice this about us as soon as we walk into the exam room.

We then went over to where we had put the 3 horses (now, thankfully, a black, a chestnut, and a strawberry roan) into an arena. Unintended Consequence #2: the mare was in season, the dominant gelding chased his rival at a full gallop all around the arena. We decided it wasn't a safe situation for Choose or Be Chosen. So we ended up doing our meet-and-greet over the fence line, and not being able to get the students in w/ the horses. Oh well. As Sugarland says, "Shhh, It Happens."

Today is class #2. Take 2 with Choose or Be Chosen. This time we have Mr T, Dream's ("as seen on TV!") old boyfriend, a cuuuuuute little chestnut Arabian. Hopefully they all behave so we can get all 8 students, 3 facilitators, and 2 press people in the (very large) arena.

More gorgeous weather predicted--75 and sunny.

Since Thursday, the City's Angels and all its pundits have been laying flowers, holding candlelight vigils, crying, hawking T shirts, and pundificating. The L.A. Times in particular, reduced by online news and social networking to, effectively, a broadside, had its music critics and rock journalists on overtime and over-column-inch. Triple lattes were evident in their prose.

Channel surfing CNN x 2, E!, and FOX is an All Michael, All The Time experience.

So how does this all relate to Medicine and Horsemanship? This way: everything I have heard and read refers to Michael Jackson's art, his loneliness, his torment, his stress. It refers to the shock and sadness of his family, friends, and fans. The print and online journalists, in particular, have spun the death to be about Michael and about their connection with him ("yep, back in '03, when Jackson and I were just hanging out at Neverland...") as part memoir, part self-aggrandizement.

What strikes me, is the Bright Shadow projection evident in the memoirs and in the fan reactions. Bright Shadow is an archetype that lives in each person and gets projected outward. The Medicine and Horsemanship Projection monograph [link] says:

"Projection is the act, usually unconscious, of attributing or blaming one’s feelings, traits, circumstances, and attitudes to or on other individuals, racial or ethnic groups, or animals.

The Bright Shadow is the part of us that we project onto celebrities, heroes, role models, pets, and people toward whom we feel immediate affection. Those who are receptacles for our Bright Shadow projections personify the talents, gifts, and strengths that we are afraid to recognize in ourselves."

After John Lennon was murdered, at least two fans killed themselves. Due to the less grizzly circumstances of MJ's death, I do not expect that Bright Shadow projections will reach the level of extreme despair that leads to suicide.

The Projection monograph goes on to say:

"Internalizing Bright Shadow creates the problems so many depressed and drug-addled celebrities have in trying to live up to their impossibly inflated public images. Bright Shadow identification can also, however, allow us to see the good that others see in us."

In Medicine and Horsemanship, we deliberately elicit projections on the horses. Horses allow us to enact our Bright Shadow projections in a healthy, playful way. In the short space of a Medicine and Horsemanship activity, horses don't introject (see monograph) our projections. It is a safe, well-intentioned archetypal theater for all involved.

Let us take Michael Jackson's death as an opportunity to examine our own Bright Shadow forces and find the courage to express these gifts and talents in a way that is joyous and constructive.

If They Say -
Why, Why, Tell Em That Is Human Nature
--Michael Jackson "Human Nature"