"I think; therefore it is."

My old boss once said the above during one of his spontaneous mid-4-hour meeting "tutorials," this one on the spectrum of psychotic disorders. "'I think; therefore it is.' That's psychotic thinking."

But are there exceptions? Is there anything actually wrong with choosing to see the world x way, and believing deeply enough in that vision that it becomes the reality you inhabit? What we often chide as grandiosity might actually be a level of self-empowerment and commitment that many of us simply never reach.

I've spent a fair bit of time thinking, writing, and dialoguing about the concept of self-empowerment and self-efficacy over the past year. It's why I coach. It's what brought me to medicine. It's what makes me get out of bed every day -- to live it, and to spread it. It's the foundation of the research initiative I will be starting in the coming weeks (IRB-approval pending). It's the foundation of the book I plan to write one day. It's the most deceptively simple concept that stands as the deciding obstacle between "where someone is" and "where someone is going." That is, one's deep-rooted belief that one actually will get there.

A friend of mine once lamented that she was unable to stay on top of her life demands. When I recommended introducing a little bit more structure to her day, her response: "That won't ever happen. I know myself -- that doesn't happen." Of course "that" doesn't happen. Things don't happen. WE take actions, we create opportunities and constructs. We are the agents of action; results are just... results.

I coached a ride the other day that I called "The Impact Ride." (Yes, Spintastic readers... I'll write up the profile over the weekend. I've forbade myself from investing time into both blogs in one shot!). The concept was tapping into SOMETHING that each person wanted to do -- large or small -- and identifying its specific personal meaning, and its associated concrete steps and obstacles. Once that was identified, the task was to establish pure control over one's attitude and belief in themselves to do that thing that gave them a sense of purpose. We accomplished that through technical control -- biofeedback, essentially -- over breathing and heart rate; and then, we applied it towards that larger goal. That is, the power to have impact on one's self... and what that means for one's power to have impact on the world.

It was special to me. I debuted it on my 25th birthday. My birthday is a huge deal to me -- it always has been. It's not because I want to be acknowledged or celebrated, actually, no matter how much of a "validation junkie" I am on my non-birthday days. Instead, it's because the "event" serves as a regular marker to take stock of my own impact -- on myself, and on the people around me -- and, accordingly, I like to be surrounded all day (physically, emotionally) by symbols of that impact. The friends -- and even relative strangers -- who value my presence in their lives, and take time out of their day to tell me so. The people in my cycling class who don't even know it's my birthday but whose tear-brimming responses become my favorite part of my day. The characters who inspire me, for reasons great and subtle.

It's even an opportunity that triggers me to appreciate when my energy and time has been wasted. Identifying drains to one's energy and spirit is often just as important towards the creation of a meaningful balance -- to me, at least. Energy is a finite resource; and yet it's sub-deserving targets are often "tolerated." I talk about this a lot -- I even had a segment of my New Year's Ride devoted to it; and yet, I'm guilty of tolerating drains to my energy indeed. I am grateful for the prompt to make an impact on my own life by removing anything that reeks of "settling" or "tolerating."

I think; therefore it is.

There is a profound power behind the belief in one's ability to decide how the world should and will be, and what presences and experiences will support the creation of that world.

One of my many many interpersonal challenges as a physician will be to tap into whether a person HAS a vision of their world -- and, if so, what it is. That needs to be the starting framework for EVERYTHING.

I attended a presentation last week by a woman and two men who lost their spouses to cancer, and had been their primary caregivers leading up to their deaths. They shared their experiences with their loved ones' healthcare teams -- what worked, what didn't work. They remembered physicians who were emotionally and psychologically "present" with them during their families' struggles. They remembered how news was delivered, how hope was fostered and squashed. "Hope," which takes on a spiritual component for many people -- not necessarily for me -- is a fascinatingly complex concept. I read a wonderfully inspiring book, "The Anatomy of Hope" by Dr. Jerome Groopman, that explored this topic from perspectives of patients and medical professionals. It didn't exactly resolve anything, but it sure got me thinking. Hope seems to most directly present itself as an outlet for positive thinking in the face of despair. But why wait for despair? Is "hope" not just a belief in achieving a desired outcome -- whether that outcome be entirely within one's control or not? But having the perspective to identify which outcomes ARE within one's sphere of control -- and having the resolution to invest in it, to inhabit it -- that is self-efficacy.

I think; therefore it is.