Let's Review the Map
At the end of May this year, I was notified that the Veterans Administration was sponsoring a nationwide innovation challenge to reduce or eliminate veteran suicide.
I created the following proposal as not only a solution to that problem, but also a method by which veterans may help each other pursue their passions, achieve flow, and live their best lives.
I wanted to review this proposal with the group, to re-center ourselves on the process at hand.
__________________________________________________________________
Solution Description:
Military service is very challenging. The regimen is highly structured and demanding, putting a strain on the mental and emotional health of its members.
In light of this, it's not surprising that most veterans need a break after their military service. Very often, they must immediately transition into civilian work roles that are very different from those to which they have become accustomed. However, even though they need rest and recovery, they have difficulty coping outside of a highly structured military environment.
Oftentimes, veterans develop avoidance mechanisms to cope. These mechanisms can cause harm to their health and wellness. “There exists evidence that supports mindfulness and psychological acceptance as a means to target experiential avoidance in suicidal clients, thereby reducing the risk of suicide.”14
This proposed solution offers a means to help veterans embrace their unstructured time and gain the ability to process that unstructured information into a purpose-driven, meaningful framework that benefits healthy living.
High-Level Description of the Proposed Solution:
The power of peer support lies in the fact that no one knows a subject better than someone who has lived it. I firmly believe that the best way to understand what someone needs is to let them tell you. This solution invites veterans to find their own best process in collaboration with their peers.
Through the RealitySeeker platform and the Experience app, veterans can release troublesome thinking and begin to connect to one another and their world through the senses. By facilitating daily meditation and storytelling, the system will enable veterans to progress toward their passions and lead a healthy lifestyle. We will work together to achieve flow.
Through RealitySeeker, veterans can design their own solutions with the support of friends, peers, and loved ones who will be there every step of the way.
Intended Impact:
With the RealitySeeker platform and the Experience app, veterans can take advantage of their free time with the help of their peers. A certified peer support specialist will help them start by guiding them through mindfulness activities.
Veterans can narrate their meditation experiences with the Experience app, which uses talk-to-text technology. Through just being silent and increasing awareness, peer support specialists will help them balance the need to overthink or overtalk. As they share their feelings, they will pause without interrupting the flow. By sending these memos to the RealitySeeker platform, veterans can organize their experiences into stories that will later aid them in creating a daily structure that works for them.
Veterans can use the Experience app to practice meditation while narrating their experiences. Meditation and subsequent storytelling will enable them to better understand their feelings and manage difficult emotions and thoughts.
The Rationale for Efficacy:
A grounded theory is a scientific, qualitative, inductive method for gathering unstructured data for developing original theories. In the traditional scientific enterprise, theories are not usually developed from personal, subjective experiences, despite the fact that we experience our lives in that way. The Experience app enables veterans to capture and share mini-narratives to the RealitySeeker platform, which allows them to develop a story about their daily lives. It will be measurable for future studies on healthy living, narrative storytelling in recovery, and achieving optimal flow states when pursuing one's passions, as well as used as a tool for better telling the veteran's story to mental health professionals.
How It Will Be Implemented
I will launch a marketing campaign with a simple website that gives an overview of the project, the daily practice, and the tools that will be used.
A synthesis of the teachings of Eastern wisdom subject matter experts will be used to construct training videos. Western audiences will be able to access Eastern wisdom easily. Professional artists will animate the key concepts of letting go and freeing your mind from troublesome thoughts to enhance the training.
I will use the website to recruit certified peer support specialists who specialize in meditation. The core activity will be the daily practice of active meditation in which the veterans become aware of their minds and periodically narrate the experience. With regular practice, they will learn how to be in the moment and avoid allowing troublesome thoughts to interfere with their daily lives.
Storytelling experts, workflow experts, and WYSIWYG (what you see is what you get) easy-to-use, drag-and-drop software developers will contribute to the development of the RealitySeeker platform. We will set up a temporary platform until we are able to bring the full solution online.
Veterans can use just the guided meditation with the peer support specialist, just the Experience data, or both. The information can be kept private and secure, or veterans can share it in the community with other veterans and eventually with providers and/or researchers.
Veteran Impact:
Feelings of loneliness, isolation, hopelessness, and depression may precede suicidal behavior.
According to a Brazilian study, the cognitive schemes of the suicidal mode incorporate maladaptive beliefs, which are in opposition to hope. Affective schemes are characterized by negative emotions such as sadness, anxiety, anger, and guilt. Suicidal impulses are driven by behavioral and motivational schemes.20
Through the RealitySeeker social platform, veterans from different areas and backgrounds will come together to discover their personal passions and a sense of belonging. Mindfulness can help them reconnect with their world and empower them to make change - both for themselves and for their communities - by bringing them back into touch with their passions and redeveloping their ability to make change.
RealitySeeker will bring people together in the pursuit of creating a healthy and satisfying daily living plan. No particular race, age, or gender would be targeted. As a result, a diverse group of veterans with not only diverse interests and passions but also diverse suicidal risk factors would interact with each other.
Flow is the state of being fully immersed or focused on an activity. It has been shown that flow can alleviate depression and anxiety. Anxiety is sustained by a lack of flow in one's life; anxiety impedes flow.5
Evidence Framework
Tackling Depression
During the June 16th webinar offered by Mission Daybreak, Dr. Richard McKeon, VA Chief of Suicide Prevention, stated that mood disorders are the most deadly causes of suicide. I can attest to the extreme difficulty of coping with depression as a bipolar veteran. Globally, depression is the leading cause of disability, and its prevalence has increased steadily over the past 20 years.15
Depression is Influenced by Culture
“Research shows a rather interesting pattern: depression is far more prevalent in Western cultures, such as the US, Canada, France, Germany, and New Zealand than in Eastern cultures, such as Taiwan, Korea, Japan, and China.”4
Similarly, there is “cultural variation in the focus on goals versus process of actions.”16 Americans are more likely than people in Eastern cultures to focus on goals. This Western preference for goal-oriented thinking and behavior is particularly apparent in military settings. Goal-Focused Leadership (GFL), a predominant style of leadership in the military, “includes task-oriented behaviors that emphasize goal achievement.”2 Outcome-focused models such as GFL can lead to stress, exhaustion, and burnout, all of which can contribute to levels of depression. An article in the Journal of Psychosomatic Research suggested that “additional, thoroughly designed longitudinal studies are necessary for revealing the cause-effect relationship of work stress, epigenetics, and burnout, including its overlap with depression.”3
The Health Benefits of Flow
The flow state is achieved when one becomes completely absorbed in what one is doing. As the ego recedes, one's whole being is involved.5 This restorative activity has been shown to result in the following:
Better emotional regulation
Greater enjoyment and fulfillment
Greater happiness
Greater intrinsic motivation
Increased engagement
Improved performance
Learning and skill development
More creativity
Achieving flow has been shown to decrease anxiety and depression. “Depressive symptoms are associated with suicidal ideation, and symptoms of depression increase the chances of suicidal ideation by 2.6 times,”20 according to a Brazilian study on suicidality in university students. “Research indicates that people who experience flow on a regular basis have lower levels of depression and anxiety. A lack of flow in one’s life sustains anxiety. Conversely, anxiety impedes flow,”5 according to an article on Psych Central.
The Health Benefits of Storytelling
In Psychology Today, Joscelyn Duffy quotes the book Qualitative Psychology, a Practical Guide to Research Methods, which makes a distinction between two types of thinking: paradigmatic and narrative. The first is a method of science, and the latter organizes everyday interpretations of the world into a story-like form.6 Storytelling and flow are very similar. In contrast to the paradigmatic approach, both are expressive and fluid methods of making sense of one’s experiences.
According to Duffy, subjective interpretations are neither right nor wrong, but rather ”part of the journey we are taking."6 Everyone interprets reality differently, contributing to how we learn from life. In this sense, it is crucial to carefully craft and communicate our narratives. Narratives shape our identities and create order in the world.6
The Health Benefits of Connectivity
In the second Mission Daybreak webinar, the importance of connecting veterans and the community at large was emphasized. I believe that motivated peers sharing their experiences of achieving flow can lead to an optimal process for good health and thriving.
With this RealitySeeker solution, individuals will work on unique, personalized projects based on their personal passions. Through a networked, social platform, they will share their progress with their veteran peers. In addition to working together to decrease anxiety and depression, they will also develop an optimal process that can be replicated and shared with other veterans. Flow activities can be anything that brings pleasure and for which the veteran possesses skill. It might be possible for them to create a website, organize a discussion group, share their love of cooking, or describe things they discussed with friends. There is no limit to what it can be. An avocational activity can develop into a career.
Combining Flow, Storytelling, and Connectivity
Recovery stories are often viewed as narratives of things that have already happened, things we have been through. RealitySeeker proposes that the recovery story is more than just a past narrative. As a story of the present, a recovery story has its greatest potential. What do I want to be? What is my dream? Can I work on expressing who I am and living my best life right now? That is exactly the kind of practice that can save veterans from suicide. This type of thinking engenders hope.
According to Peter Bray, author of Voices of Illness: Negotiating Meaning and Identity, “the patient’s unique story of illness is a key factor in the enterprise that will effectively assist the patient to move on in their journey despite their suffering and losses.”6 “Developing life narratives [can] provide us with new ways to make sense of a world transformed by illness.”
“Telling your story–while being witnessed with loving attention by others who care–may be the most powerful medicine on earth,” says Lissa Rankin on Psychology Today. “Each of us is a constantly unfolding narrative…and yet so many of us leave our stories untold, our songs unsung–and when this happens, we wind up feeling lonely, listless, out of touch with our life’s purpose, plagued with a chronic sense something is out of alignment. We may even end up feeling unworthy, unloved, or sick.”18
Sharing with others your daily work of regularly pursuing flow in your life reinforces the excitement of pursuing your passions. Participating in a community of veterans all seeking this restorative experience while supported by mental health professionals increases the likelihood of experiencing success.
Implementation Plan
Introduction:
As a result of flow, one develops immense concentration and clarity while eliminating self-doubts and reducing stress, anxiety, and depression. I believe veterans can cultivate flow in three ways:
Daily guided meditation followed by a narrative capturing of the experience
Making regular progress towards goals related to personal passions.
Sharing and developing this process in the community.
We don't start with goals and create stress by straining to achieve them. Instead, we cultivate what the veteran takes away from their active awareness experiences. Therefore, this method of suicide prevention will feature guided meditation and storytelling on the front end, with the ultimate goal of reaching flow states in the pursuit of personal goals and passions. Individual meditation, assisted by a peer support specialist, will ultimately provide the raw data that will power the RealitySeeker platform where veterans will work together to achieve flow and help each other achieve healthy living.
The RealitySeeker method consists of three primary themes, Flow, Expression, and Connection,
1) Flow:
Cultivating flow begins with daily meditation practice. Veterans may have varying levels of experience with meditation, but the RealitySeeker method is designed to help them develop this competency via peer support to build consistency in practice.
I began testing this approach with a presentation to a group of thirteen veterans at my friend, Andy Labadie’s property in Coldwater, Michigan on June 21st. After a full day of talking about what we could do to help reduce veteran suicide, we went down to the lake for a meditation experience. I would like to start each future meeting that way followed by a discussion and a luncheon in the afternoon. One veteran, in particular, expressed to me his love of cooking and his interest in cooking for these events.
After lunch, veterans will meet around a kitchen table and talk about their mindfulness experience and talk about their passions. A PTSD veteran expressed to me an interest in participating but explained his reticence about being in a group, so in addition to the roundtable discussion, the meeting will be broadcast via Zoom to additional veterans who couldn’t be with us. There is the possibility of making those Zoom meetings available via the RealitySeeker website afterward, with the express permission of everyone in attendance.
I will organize three of these meetings during Phase II, to begin to build the RealitySeeker community and demonstrate proof of concept. We may hold meetings near VA communities in Ann Arbor and Detroit as well. The current RealitySeeker website will be used to begin an informal structuring of daily practice and sharing.
The duration of the pilot will be during the six weeks from September 5th to October 21st
2) Express:
The point of capturing the experience is to use higher states of awareness in building healthier daily plans while relieving the veterans from disruptive, troublesome thinking.
Regular interaction with peers will help the veteran begin to become comfortable sharing his or her story with someone else. Ultimately, the narrative data will be shared on the RealitySeeker platform where veterans will have a greater opportunity to interact with veterans working on similar skills-building projects. So, the core skill of detailed narration of conscious awareness will be developed to reach the intended outcome of increased flow in daily activities to decrease anxiety, depression, and ultimately suicidality.
3.) Connect:
The RealitySeeker platform will support increased sociability among veterans as well as increased collaboration toward healthy daily living practices. This connection with others will test and strengthen the skills built throughout the initial guided meditation training. The community will be similar to a social media platform, but different in that the express purpose will be to develop daily living plans, discuss efforts toward living one’s best life and work together to achieve flow more often and greater satisfaction with daily activities.
Research Opportunities:
As with any sharing of inner experiences by veterans, there will be security protections in place to ensure that they are only sharing with the community those things that they are comfortable sharing.
Since the RealitySeeker design operates on a modified form of Grounded Theory (a qualitative research method), it will simultaneously function as a group of users (the veterans) working together to process unstructured information into working theories about how they can achieve positive results. Therefore, they will be actively working to build their own agency and self-efficacy, while also producing ample data for researchers who might want to study and potentially replicate the RealitySeeker approach. In addition, clear stories about these efforts produced by veterans can be shared (if desired by the veteran) with VA mental health professionals to supplement and perhaps facilitate successful treatment outcomes.
Requirements:
The present objective is to prepare for a short-term pilot study to be performed in phase II of Mission Daybreak so that results can be shared during the demonstration in November.
Therefore, I will describe the requirement in regard to Mission Daybreak and beyond.
A Note on Methodology
I originally wrote this proposal directly from my 22 years of experience in recovery from bipolar disorder, as a certified peer support specialist, as someone who has been published and has written a book about my psychotic experiences, and as someone who has achieved a master’s degree in technology studies. However, I recognized the extreme importance of asking veterans what they think can help solve the problem of veteran suicide. So, I reached out to another veteran.
My friend Andy Labadie of Coldwater, Michigan, helped me assess the viability of this idea. He is president of the Battle Creek VAMC Veterans' Council. He invited veterans with personal experience with suicidal ideation (either themselves or someone they know) to his property for a day-long discussion about how to resolve the issue.
The thirteen veterans who attended all expressed how important it is for veterans to feel needed, for their value to be recognized. As a result, they said, the level of care and kindness they receive from people makes all the difference to them. They unanimously agreed that any solution must first motivate veterans to try it. When veterans are dealing with shock and trauma, how do you connect them to a solution?
I believe the hope and belongingness shared at Coldwater can be a model to help implement the RealitySeeker solution, and I have modified my implementation plan accordingly.
Plan for September–November 2022 (Phase II)
These approximately eight weeks will be dedicated to demonstrating the efficacy of just the peer-supported guided meditation portion of the project. I will be working with the group of veterans that I met in Coldwater this June 2022, followed by other veteran groups in Michigan.
I will use various meditation techniques that I know while sharing the message with the group that there is no right or wrong way to meditate. This will encourage individuals to begin to experiment with creating their own methods of meditation.
Preparations for Post-November:
While the pilot project is taking place, I will meet with several subject matter experts on the topic of Eastern wisdom to further formalize this practice, with the thought in mind that it will have the flexibility for individuality.
I will begin marketing this practice via a website with a series of illustrated training videos about how to use this method. These videos will be a simple and clear explanation of why meditation works and how someone can apply it to more practical, goal-oriented activities.
Post-November 22
An exciting aspect of this proposal is the potential development of a new tool designed to help veterans take narratives of their conscious awareness and begin building them into daily living plans with their fellow veterans. It can be a community with shared values around creating flow experiences with your passions and getting greater enjoyment and satisfaction out of life.
I have many ideas for how to make such a platform very easy to use with bright, clear graphic design and drag-and-drop, WYSIWYG (what you get tools) where they can illustrate what they are working on with their peers, meet new friends with shared experiences and interests, and basically gain control of their lives in an engaging and intuitive way.
I will most likely be vetting different platform developers during Phase II of Mission Daybreak so that I can share my ideas with the audience at the demonstration. Real development wouldn’t happen until I either was successful in being named a Phase 2 winner, or else I continue to raise funds on my own and attempt to build this project after a successful Phase 1. Ideally, I could have a working prototype available to present in November.
Needs Identification:
In order to develop, scale, and overcome system barriers, the RealitySeeker project would need the following additional resources.
Meditation Education: Flow states are somewhat elusive psychological states that cannot be understood until they have been experienced, recognized, and realized. Understanding how it differs from the way we usually think and behave requires some basic philosophical education.
Clinical Expertise: Practitioners who appreciate Eastern philosophy and are prepared to help their patients explore it and find expression in their passions are needed for this project. A good vocational counselor who is open to this approach may also be able to assist the veteran.
Participant Expenses: Participants may face financial barriers depending on their chosen passion. Investing in these needs would ensure every participant has the opportunity to benefit from the project.
Website Development: The development of the exclusive social media platform for this project may be the greatest barrier to implementation. Third-party platforms may be used, but ideally, a unique platform should be developed specifically for this purpose.
Team:
I am applying as an individual; however, I want to thank Andy and the other veterans I met in Coldwater who helped inspire this proposal. I know Andy has long dreamed of creating a veterans center on his property with a variety of programs and services to be offered there, and I plan to continue working with him to support him in that mission.
In 2005, I made a suicidal attempt by overdosing on my bipolar medication, which led to me being hospitalized for approximately one month in the Ann Arbor VA inpatient psychiatric ward. I have worked every day since that day to solve the recovery challenge not only for myself but for everyone who struggles to live a satisfying and healthy life.
Since 2003, I have been a 100% disabled Veteran with the Veterans Administration. In 2006, I took a step toward recovery when I met my future wife and moved from Ohio where I had lived with my mother for three years.
I offered to organize an expressive writing group as part of the Ann Arbor VA's new recovery program in 2007. I had been writing a personal memoir since 2005, and I wanted to share what I had learned. Our program was a success, and we were featured in the University of Michigan's annual Investing in Ability Week, appeared on National Public Radio, and were filmed for a piece on WebMD's website. Over the course of three years, the program helped approximately 15-20 veterans, and it was shared with other VA hospitals.
I got married in 2008. I also entered a master's program at Eastern Michigan University in the teaching of writing before switching to a program in technology studies. I have always been fascinated by the way digital technologies can facilitate personal expression.
Despite the disruptions caused by my illness during this time, I completed my master's program and gained admission to the Ph.D. program at EMU. Even though I had good grades in the Ph.D. program, I withdrew before I finished it to protect my mental health.
During the Entrepreneurship Bootcamp for Veterans at Purdue University in 2012, I tried to synthesize everything I learned. My idea for a social platform for veterans to share their recovery projects won me an award for the most innovative idea. I tried to commercialize it, but I always had to compromise the purpose of the idea. I decided to focus my efforts elsewhere.
My formal study of philosophy began in 2015. In part, I did this in order to express and further develop the concepts I had tried to express in graduate school. As time went on, I developed a philosophy similar to those found in Eastern cultures.
From 2019-2022 I worked as a peer support specialist on the PREVAIL suicide prevention study. I worked directly with inpatients hospitalized for suicide and I followed up with them in the community for 12 weeks afterward to guide them through a pre-established wellness and recovery program.
This proposal is based on my personal philosophy, my academic learning, and my experience with suicide prevention. Suicidality would be significantly reduced if veterans at risk could access a social platform that allowed them to build their passions and work in a community that focused on flow education.
Appendix A: Works Cited
15 coping skills for depression. Pelorus TMS. (2021, August 30). Retrieved June 1, 2022, from https://pelorustms.com/15-coping-skills-for-depression/
Atwater, L., Perry, S. J., Penney, L., & Witt, L. A. (2010). The downside of goal-focused leadership: The role of personality in subordinate exhaustion. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.1697729
Bakusic, J., Schaufeli, W., Claes, S., & Godderis, L. (2017). Stress, burnout and depression: A systematic review on DNA methylation mechanisms. Journal of Psychosomatic Research, 92, 34–44. https://doi.org/10.1016/j.jpsychores.2016.11.005
Bastion, B. (2022, February 9). So many in the west are depressed because they're expected not to be. The Conversation. Retrieved June 5, 2022, from https://theconversation.com/so-many-in-the-west-are-depressed-because-theyre-expected-not-to-be-79672
Borchard, T. J. (2013, July 21). Flow: An antidote to anxiety & the secret to happiness? Psych Central. Retrieved June 1, 2022, from https://psychcentral.com/blog/flow-an-antidote-to-anxiety-the-secret-to-happiness
Bray, P. (2019). Voices of illness: Negotiating meaning and identity. Brill/Rodopi.
Caston, D. (2022, March 22). Recreation theory and philosophy: Indomitable human spirit. All Guides. Retrieved June 1, 2022, from https://libguides.ferrum.edu/rec360/ihs
Cherry, K. (2022, February 17). How to achieve flow. Verywell Mind. Retrieved June 1, 2022, from https://www.verywellmind.com/what-is-flow-2794768
Cities, W. W. (2020, September 30). Community engagement and Social Media. Medium. Retrieved June 1, 2022, from https://medium.com/the-guide-to-remote-community-engagement/community-engagement-and-social-media-8b5164a8486f
CSIKSZENTMIHALYI, M. I. H. A. L. Y. (2016). Flow and the foundations of positive psychology. SPRINGER.
Field, B. (2021, November 17). Tell stories, it's good for your mental health. Verywell Mind. Retrieved June 1, 2022, from https://www.verywellmind.com/how-storytelling-is-good-for-your-mental-health-5199744
Gotter, A. (2017, August 3). How to avoid depression: Prevent relapse and avoid triggers. Healthline. Retrieved June 1, 2022, from https://www.healthline.com/health/how-to-avoid-depression
Kasa, M., & Hassan, Z. (2013). Antecedent and consequences of flow: Lessons for developing Human Resources. Procedia - Social and Behavioral Sciences, 97, 209–213. https://doi.org/10.1016/j.sbspro.2013.10.224
Luoma, J. B., & Villatte, J. L. (2012). Mindfulness in the treatment of suicidal individuals. Cognitive and Behavioral Practice, 19(2), 265–276. https://doi.org/10.1016/j.cbpra.2010.12.003
Mageit, S. (2021, January 8). Flow depression treatment helps 81% of patients feel better. MobiHealthNews. Retrieved June 1, 2022, from https://www.mobihealthnews.com/news/emea/flow-depression-treatment-helps-81-patients-feel-better
Miyamoto, Y., Knoepfler, C. A., Ishii, K., & Ji, L.-J. (2013). Cultural variation in the focus on goals versus processes of actions. Personality and Social Psychology Bulletin, 39(6), 707–719. https://doi.org/10.1177/0146167213483579
Muñoz, A. (2021, July 14). 12 powerful tips to boost community engagement. SocialLadder. Retrieved June 1, 2022, from https://socialladderapp.com/2021/07/13/community-engagement/
Rankin, L. (2012, November 27). The Healing Power of Telling Your Story. Psychology Today. Retrieved June 1, 2022, from https://www.psychologytoday.com/us/blog/owning-pink/201211/the-healing-power-telling-your-story
Snider, C. (n.d.). 7 creative ways to increase community engagement on social media. H&C Inc. Retrieved June 1, 2022, from https://www.hughesandco.ca/blog/7-creative-ways-to-increase-community-engagement-on-social-media
Sousa, G. S., Ramos, B. M., Tonaco, L. A., Reinaldo, A. M., Pereira, M. O., & Botti, N. C. (2022). Factors associated with suicide ideation of Healthcare University Students. Revista Brasileira De Enfermagem, 75(suppl 3). https://doi.org/10.1590/0034-7167-2020-0982
Thomas, Derrick, "The Flow Rendezvous: Where Flow and Reality Meet" (2019). Integrated Studies. 247.https://digitalcommons.murraystate.edu/bis437/247
U.S. Department of Veterans Affairs. (2021). (rep.). National Veteran Suicide Prevention Annual Report.
What is community engagement: Examples & models. GovOS. (2022, May 3). Retrieved June 1, 2022, from https://govos.com/blog/what-is-community-engagement/