Articles - The Chopra Foundation

All of Us—Doctor and Patients—Need to Face up to Healthcare Hazards

By Deepak Chopra MD, Nancy S. Cetel, MD, Danielle Weiss, MD, Joseph B. Weiss, MD

Medical mistakes are a touchy subject in the medical community. Both sides of the healthcare system fear them—patients because of their general anxiety about going to the doctor, physicians because of the looming threat of malpractice. The situation needs to be faced squarely, with candor and above all, with reliable statistics. These have varied widely over the years. While the numbers of fatalities reported annually in US hospitals has had estimates from 44,000 to 440,000, even the lower estimate is a public health catastrophe.

We say this against the background of the vulnerable position even the best cared for patient faces. Entering the hospital represents a loss of freedom, exposure to anxiety-producing procedures, a sterile environment, and being handled, physically and emotionally, by strangers. Adding medical mistakes to the list must become unacceptable.

At present, however, preventable mistakes continue to persist and are often more grave. Several publications over the past two dozen years, including our own, have highlighted the alarming frequency and consequences of adverse events during medical treatment. Among the most credibly researched and analyzed findings are the following:

* The US Department of Health & Human Services, Office of the Inspector General, reported that a review of in-patient records from 2008 confirmed 180,000 fatalities occurred in the Medicare population alone, because of medical errors.

* A 2013 evidence-based estimate, using a weighted average of 4 databases, suggested that the current range of annual deaths in US hospitals from adverse events was between 210,000 to over 400,000.

* Most recently, in 2015, journal authors from Johns Hopkins estimates the number as over 250,000 deaths per year, making hospital errors the third leading cause of US hospital deaths after heart disease and cancer.

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Regarding the last citation, Dr. Martin Makary, Professor of Surgery and Health Policy at the Johns Hopkins School of Medicine, comments that medical care gone wrong is commonly due to “a communications breakdown, poorly coordinated care, or a misdiagnosis,” but these are rarely mentioned when a doctor fills out “primary cause of death” on a death report.

As a result, Makary notes, “these are issues that have lived in locker rooms, doctors’ lounges, and nurses’ stations…in the form of stories and not epidemiological errors.” A recent review of 4,000 medical journal articles showed that even the most accurate medical record review protocol identified adverse events in 2.9% to 18.0% of records, with preventable errors identified in 1% to 8.6% of records. Although alarming in its own right, this number is a significant underestimation of the true frequency of errors. In a telling report that interviewed nearly 1,000 patients in Massachusetts 6 to 12 months after discharge, patients recalled three times the number of adverse events reported in the medical record.

The many reasons why errors would be underreported is all too readily apparent. Avoidance of identification, liability, blame, guilt, financial penalty, malpractice action, job security, disciplinary action, hearings, reviews, etc. are just some of the powerful motivations to avoid reporting an error. Surveys of physicians confirm the obvious, that under-reporting is widespread. Yet without accurate statistics the full extent of the endemic problem, as well as the ability to monitor efforts to reduce errors, cannot be accurately assessed. Human error is inevitable, but every effort must be made to minimize the risk and consequences.

Deepak Chopra MD, FACP, Clinical Professor of Medicine, University of California, San Diego, Chairman and Founder, The Chopra Foundation, Co-Founder, The Chopra Center for Wellbeing

Nancy S. Cetel, MD, President and Founder, Speaking of Health and specialist in women’s health and reproductive endocrinology.

Danielle Weiss, MD, Clinical Assistant Professor of Medicine, University of California, San Diego, Medical Director & Founder, Center for Hormonal Health & Well-Being

Joseph B. Weiss, MD, FACP, Clinical Professor of Medicine, University of California San Diego.

References:

Brennan TA, Leape LL, Laird NM, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med 1991;324:370–6.

Kohn LT, Corrigan J, Donaldson MS. To err is human: building a safer health system. Washington DC: National Academy Press, 2000.

Department of Health and Human Services. Adverse events in hospitals: national incidence among Medicare beneficiaries. 2010. http://oig.hhs.gov/oei/reports/oei-06-09-00090.pdf.

A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care James, John T. PhD Journal of Patient Safety: September 2013 – Volume 9 – Issue 3 – p 122–128

doi: 10.1097/PTS.0b013e3182948a69

Makary MA, Daniel M. Medical error-the third leading cause of death in the US. BMJ 2016;353:i2139. doi:10.1136/bmj.i2139

Measurement of patient safety: a systematic review of the reliability and validity of adverse event detection with record review. Mirelle Hanskamp-Sebregts, Marieke Zegers, Charles Vincent, Petra J van Gurp, Henrica C W de Vet, Hub Wollersheim Published 22 August, 2016 http://bmjopen.bmj.com/content/6/8/e011078.full

Weismann JS, Schneider EC, Weingart SN, et al. Comparing patient-reported hospital adverse events with medical records reviews: Do patients know something that hospitals do not? Ann Intern Med. 2008; 149: 100–108.

Overview of medical errors and adverse events. Maité Garrouste-Orgeas François Philippart, Cédric Bruel, Adeline Max, Nicolas Lau and B Misset Annals of Intensive Care 20122:2

DOI: 10.1186/2110-5820-2-2 Published 16 February 2012

Valentin A, Capuzzo M, Guidet B, Moreno R, Metnitz B, Bauer P, Metnitz P: Errors in administration of parenteral drugs in intensive care units: multinational prospective study. BMJ 2009, 338: b814. 10.1136/bmj.b814

Ridley SA, Booth SA, Thompson CM: Prescription errors in UK critical care units. Anaesthesia 2004, 59: 1193–1200. 10.1111/j.1365-2044.2004.03969.x

Garrouste-Orgeas M, Timsit JF, Vesin A, Schwebel C, Arnodo P, Lefrant JY, Souweine B, Tabah A, Charpentier J, Gontier O, et al.: Selected medical errors in the intensive care unit: results of the IATROREF study: parts I and II on behalf of the Outcomerea study group. Am J Respir Crit Care Med 2010, 181: 134–142. 10.1164/rccm.200812-1820OC

Garrouste-Orgeas M, Soufir L, Tabah A, Schwebel C, Vesin A, Adrie C, Thuong M, Timsit JF: A multifaceted program for improving quality of care in ICUs (IATROREF STUDY) on behalf of the Outcomerea study group. Critical Care Med, in press.

Overview of medical errors and adverse events. Maité Garrouste-Orgeas, François Philippart, Cédric Bruel, Adeline Max, Nicolas Lau and B Misset Annals of Intensive Care20122:2

DOI: 10.1186/2110-5820-2-2 Published 16 February 2012

Kennerly DA, Kudyakov R, da Graca B, et al. Characterization of adverse events detected in a large health care delivery system using an enhanced Global Trigger Tool over a five-year interval. Health Serv Res 2014;49:1407–25. doi:10.1111/1475-6773.12163 Google Scholar

Rutberg H, Borgstedt Risberg M, Sjodahl R, et al. Characterisations of adverse events detected in a university hospital: a 4-year study using the Global Trigger Tool method. BMJ Open 2014;4:e004879. doi:10.1136/bmjopen-2014-004879

Christiaans-Dingelhoff I, Smits M, Zwaan L, et al. To what extent are adverse events found in patient records reported by patients and healthcare professionals via complaints, claims and incident reports? BMC Health Serv Res 2011;11:49. doi:10.1186/1472-6963-11-49 [CrossRef][Medline]Google Scholar

Classen DC, Resar R, Griffin F, et al. ‘Global Trigger Tool’ shows that adverse events in hospitals may be ten times greater than previously measured. Health Aff (Millwood) 2011;30:581–9. doi:10.1377/hlthaff.2011.0190

Sari AB, Sheldon TA, Cracknell A, et al. Extent, nature and consequences of adverse events: results of a retrospective casenote review in a large NHS hospital. Qual Saf

J Health Care Finance. 2012 Fall;39(1):39-50. The economics of health care quality and medical errors. Andel C1, Davidow SL, Hollander M, Moreno DA. https://www.ncbi.nlm.nih.gov/pubmed/23155743

After Gay Rights, Gay Spirituality

By Deepak Chopra, MD

It’s taken decades for gay activists to achieve the most basic right that every minority deserves: equality under the law. In principle one might say that the battle has been won, even if some states are dragging their heels and some groups mount fierce resistance. Thirty years ago, it took mass protests to push for major funding of AIDS research, and the overturning of antiquated, prejudiced sodomy laws wasn’t a sure thing when the Supreme Court took up the issue in 2003.

The fact that the court did invalidate state laws against homosexuality was the bellwether for a shift in public acceptance that will only accelerate in the future. It’s time, then, to consider another dimension that has been masked by the headlines over legal battles. That’s the dimension of spirituality, where religious intolerance has been the norm and finding the way to self-acceptance has been a poignant personal struggle for every gay man and woman.

The issues are framed by questions that millions ask every day without being gay, since they pertain to the loss of faith that society has been wrestling with for decades:

Does God love me?

Does he (or she) know that I exist?

Can God relieve my suffering?

Where was God when I endured my darkest hours?

It would be easy, and probably correct, to say that these questions are more pointed for gay people, because they are burdened by social disapproval, hidden prejudices, and long-held dogmas about God’s condemnation of homosexuality. Spirituality is a larger dimension of life, however, based on real personal needs. For gay people to realize their place in a living kind of spirituality, seven needs must be filled:

1. The need to safety and security.

2. The need to be recognized for achievement and success.

3. The need to belong to a community.

4. The need to be listened to and understood.

5. The need to express oneself through creativity and self-exploration.

6. The need for higher moral worth.

7. The need to feel at one with God or other depiction of highest Being.

I hate to announce it to accepted prejudice (both inside and outside the gay community), but in my experience, gay people have done more to fulfill these needs than society as a whole. They may have been forced to face themselves by hostile circumstances; they may be more compassionate and accepting of differences in general; it could be that feeling like outsiders has increased their self-awareness. I can’t point to an exact cause – no doubt there is a mixture of many causes – but the result has been an open kind of seeking that is one of the most valuable aspects of modern gay life.

Which of us has had to pay constant attention to being safe and secure when we walk down the street? Who feels automatically that their achievements will be undermined or their acceptance put into question simply because of who they are? Gay people confront both obstacles to the first two needs on the list, which are taken for granted by the majority population. The higher needs are just as tinged with self-doubt and negative social attitudes. What this means is that your gay friends and those happy gay couples kissing on their wedding day have gone through personal struggles you probably have only a little awareness of. Seeking for God comes down to seeking oneself in the grand scheme of things, and every gay person knows what that feels like.

Spiritual seeking is a huge topic, naturally. On one front most gay people have to come to terms with the religion they were brought up in. For Christians, a landmark is The Good Book by the late Peter Gomes, who held the position of Preacher to Harvard College. Gomes, who came out fairly late in life, devotes considerable space to the condemnation of homosexuality in the Bible, and his approach in the face of these condemnations is summarized in the book’s subtitle, “Reading the Bible with Mind and Heart.”

In other words, bringing a modern mindset and an open heart unfolds a new path, one that isn’t literally tied to the attitudes of Jewish culture thousands of years ago, or the extension of those attitudes by the early Christian fathers. For gay people who want to remain among the faithful, there are churches in every large city that will welcome them. Even the Catholic Church shows signs of softening its strictures under a new, more compassionate Pope.

Not having the church door slammed in your face is barely the first step in filling the spiritual dimension in a person’s life. The seven needs I’ve listed take a lifetime to fulfill, attended by inner work and a desire to keep evolving every day. At the very least the straight and gay world can agree on that, because seeking is a common human project. To fill the spiritual dimension requires a shift in attitudes in all of us. Gay people need to realize that they deserve to be fulfilled spiritually. Straight people need to agree.

Deepak Chopra MD, FACP, founder of The Chopra Foundation and co-founder of The Chopra Center for Wellbeing, is a world-renowned pioneer in integrative medicine and personal transformation, and is Board Certified in Internal Medicine, Endocrinology and Metabolism. He is a Fellow of the American College of Physicians and a member of the American Association of Clinical Endocrinologists. The World Post and The Huffington Post global internet survey ranked Chopra #17 influential thinker in the world and #1 in Medicine. Chopra is the author of more than 80 books translated into over 43 languages, including numerous New York Times bestsellers. His latest books are Super Genes co-authored with Rudolph Tanzi, PhD and Quantum Healing (Revised and Updated): Exploring the Frontiers of Mind/Body Medicine. www.deepakchopra.com

Everyday Reality is a Human Construct

By Deepak Chopra, MD

It is often overlooked that the role of spirituality was once the same as the role science plays today: to explain how Nature works. As science views reality, objective facts and rational thinking outstrip the traditional spiritual worldview, which explained Nature through higher powers known as the gods or God. But recently the playing field has become much more level than anyone ever anticipated.

Explaining reality through objective means has seriously eroded, chiefly because as science drew closer to the source where space, time, matter, and energy emerge, Nature as we know it vanished. At the level of the quantum vacuum, the zero point of empirical knowledge, something inconceivable is at work. Only advanced mathematics remains as a useful tool when time and space no longer exist, and even then, our mathematical models are suspect, because there is no longer any proof that they actually match reality.

To visualize this situation, imagine that you are a traveler who has followed your tour guide to a borderline. He turns and says, “Up to now we have crossed the land where causes lead to effects, where clocks measure time and space has three dimensions, where physical objects are reliably solid. No doubt you’ve already noticed that your five senses no longer operate, and we had better be careful taking another step, because your mind won’t be capable of reasoning out anything across this borderline. Shall we cross?”

You can imagine that you would hesitate, because across the borderline is simply “beyond,” a realm where reality originates even though nothing we consider real exists. It’s remarkable that thousands of years ago, looking inward through self-awareness, ancient thinkers reached the same borderline, and what they imagined “beyond” wasn’t in fact gods or God, because religion arrived much later to offer a simpler story about “beyond.” The non-simple story was about pure

consciousness. Where science views “beyond” as a dark mystery, the ancient thinkers of India saw the starting-point of reality as a state of awareness that is actually reachable.

In both cases the familiar world of space, time, matter, and energy disappears across the borderline, but for modern science, which takes objective facts as the most reliable guide to reality, there’s a breakdown, because beyond the zero point, the absence of data means there are no more objective facts. In the worldview we dub as spiritual, however, reality doesn’t break down. The “beyond” is continuous with our world as the source of experience.

It turns out, when it comes to explaining reality, that where you start has everything to do with where you end. If you start with conscious experience as your measure of reality, the end is pure consciousness. If you start with physical objects “out there,” you end up with emptiness, a void. A scientific skeptic might protest that the “beyond” can’t be different for two people just because they began with different assumptions. Two travelers visiting the Pyramids are going to see the same thing, no matter what they expect when they set foot on the plane.

But the extraordinary thing is that the “beyond” is an exception. It can be the source of awareness or an empty void, entirely depending on how the human mind constructs it. If the world “out there” is real, once it vanishes into the quantum vacuum, the “beyond” is an empty void or at best a theoretical mathematical space. But if conscious experience is real, then consciousness was constructing reality all along. Having arrived at the borderline, we can look back over our shoulder and say, “Oh, I get it now. Everything I ever thought was real is constructed from consciousness. Consciousness isn’t an add-on. It’s the only thing that was real in the first place.”

This simple realization is what the East calls enlightenment or waking up. One sees that physical reality is a human construct and always has been. When we are in bed dreaming at night, a dreamscape can feel entirely real, but on the moment of waking up, we realize its illusory nature.

To a rationalist who bases his worldview on physical objects “out there,” it sounds bizarre to say that one can also wake up and see the familiar world as a dreamscape. But that’s the great challenge of spirituality, which we should more accurately called consciousness-based reality.

The ancient thinkers explained with detailed specificity how consciousness constructs the entire range of reality from the grossest to the subtlest phenomena. For simplicity’s sake, one can reduce the explanation to twelve salient points, as follows:

1. Everyday reality appears to be a given, but on investigation, it reveals itself as a human construct.

2. The building blocks of reality are not tiny physical objects (atoms, subatomic particles) but exist in our awareness, where everything begins and ends as an excitation (activity) in consciousness.

3. We know reality as the experience of observer and observed occurring in the now. The fundamental experience of both observer and observed is in the form of mental sensations, images, feelings, and thoughts (SIFT).

4. Sensations, images, feelings, thoughts are entangled modifications of awareness, the result of social and cultural conditioning and accepted systems of education. Our awareness gets deeply involved in many systems (education, politics, gender, religion, etc.).

5. Systems are arbitrarily made and changed. Therefore, no construct has a privileged position over another. Truth is always relative inside any system.

6. These constructs, however, are intensely real for the individual awareness embedded in it. We allow ourselves to be programmed by such systems and would feel naked and

vulnerable without them. In the world’s wisdom traditions, this is known as the state of bondage.

7. Excitations of awareness are not as basic as pure, timeless, dimensionless awareness. They modulate pure awareness like a switch that brings the familiar world into existence/experience.

8. Excitations or vibrations take place in the domain of time; in fact, they create the sensation of time itself. Pure awareness is timeless.

9. We are entangled in a vibrational reality that feels real on its own terms but is basically a mental construct, like a dream. To realize this is known as “waking up.” To someone who is awake, everything in the phenomenal world exists on the same playing field. As constructs, the same status is shared by birth, death, body, mind, brain, universe, stars, galaxies, the big bang, and God or the gods.

10. Freedom lies in the experience of knowing yourself beyond all constructs. You are pure awareness before the subject/object split came about.

11. All human suffering is the result of attachment to a construct, including fear of the construct we call death. Death is only real within the limits of the construct we manufactured. It doesn’t occur to the awareness that stands apart and sees all experiences rising and falling in the timeless moment of now.

12. The ultimate goal of all experience is the same: finding the “real” reality in one’s own being.

These points are just as logical and consistent as modern science, and one can argue that they are much more sound as philosophy, given that science hasn’t come close to explaining how bits of matter created conscious awareness while these points assume something everyone knows to be true: we are conscious beings. As unconventional as they may seem, these points offer a better way to find out what’s real. And we don’t have to debate whether ancient thinkers can rival modern advanced science. Consciousness-based reality is just as testable today as it ever way. Each person’s challenge is to accept the invitation to journey inward or not, because ultimately, going beyond depends on individual experience and nothing else.

It’s High Time to Make the FDA Safe and Effective

By Deepak Chopra MD, Nancy S. Cetel, MD, Joseph B. Weiss, MD, Paul J. Mills, PhD, Danielle Weiss, MD, David Brenner, MD

Few government agencies impact our daily lives as critically as the Food and Drug Administration. Seventy percent of the US population takes at least one prescription drug each month. The marketplace for Big Pharma is staggering: In 2014 US prescription drug sales exceeded $374 billion dollars. Most people are aware of the FDA’s extremely slow and careful procedure for approving new drugs. But there are glaring loopholes in the law that place a disturbing number of people at risk, which too few people have been alerted to.

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The size of the loophole, which permits tens of thousands of unapproved drugs to be sold and routinely used by millions of Americans, is immense. The most comprehensive list of unapproved drugs is not maintained by the FDA but rather by the National Library of Medicine, which identities 88,212 drugs that have been reported to the FDA. Of these, a minute fraction underwent testing and approval. In the 110-year history of the FDA, the agency has studied and approved a grand total of 1,453 drugs. A number of these had their approval withdrawn when safety risks were subsequently identified, leaving only 1,246 drugs remaining. Why are over 86,000 untested and unapproved drugs still on the market? The history of the FDA is complex, but here are the highlights of a predicament whose lapses go back to the very beginning.

The FDA was created in 1906 but surprisingly was not required to assess drug safety and efficacy until 1938.

In deference to the financial benefit of the pharmaceutical industry over public health and safety, the FDA grandfathered all existing drugs from requiring FDA overview.

In 1962 Congress passed amendments to the 1938 law, mandating that all drugs approved between 1938 and 1962 were to be reviewed for effectiveness and safety.

Despite this mandate, the FDA has repeatedly issued administrative rulings that helped the pharmaceutical industry avoid regulatory oversight. The net result is to keep tens of thousands of unproven products on the open market.

In 2013 the FDA openly announced that it would continue to grant national drug code (NDC) numbers to pharmaceutical and other drug products not approved by FDA for a given use. The reasons for this lapse in caring for public safety are tangled, but they include the enormous expense and difficulty of testing so many products, the potential liability faced by class-action lawsuits if a drug fails to pass efficacy and safety tests, and sheer inadvertence.

The cursory voluntary post-marketing surveillance of drugs is widely recognized as haphazard and inadequate. For example, after forty years on the market without FDA approval, the manufacturer of the popular thyroid replacement drug Synthroid reluctantly agreed to safety and efficacy guidelines, and the drug was approved by the FDA only in 2002.

The critical question, of course, is whether public health has been put at risk. Quite obviously it has. A huge proportion of unapproved drugs haven’t even begun the approval process. Most physicians are totally unaware of the situation. Meanwhile, 440,000 deaths occur annually in US hospitals due to medical errors, and a significant percentage are due to adverse drug reactions or interactions. The cost to society of adverse drug reactions exceeds $136 billion per year.

The very absence of oversight makes it enormously difficult to arrive at precise statistics for the risks of unapproved drugs. Woefully, the actual number of prescription drugs on the market in the US is unknown, unpublished, and untracked by the FDA. But what is evident, given that 4 billion prescriptions are written each year by health-care professionals, is that total deaths from prescription drugs exceeds those caused by illegal drugs or automobile accidents.

The general public gets aroused only when the FDA approval process goes strongly amiss, as in 2004 when Merck’s anti-inflammatory drug Rofecoxib (Vioxx ®) had its approval withdrawn. Vioxx has been conservatively attributed with over 38,000 deaths in the US and 60,000 deaths worldwide. The actual numbers are probably a multiple of that figure. In 1999, the year Vioxx was introduced, the US experienced a jump in cardiovascular deaths by an unprecedented 50,000-plus per year. The surge persisted until the drug was withdrawn five years later. The grim arithmetic amounts to a potential 250,000 deaths in this country alone.

Clearly a massive push to close the regulatory loophole would greatly increase drug safety in America. Yet it must be realistically faced that the immediate withdrawal of over 80,000 unapproved drugs is unfeasible, as is the prospect of testing all of them, or even a proportion as small as 10 percent. Added to this is our lack of knowledge about how prescription drugs interact with over-the-counter drugs, herbal supplements, probiotics, etc.

We are not writing to say that we have found a solution, only to bring a dire situation to light. At the very least a national discussion is called for involving Congress, the FDA, the pharmaceutical industry, and the American public. In an era of genome screening, it should be feasible in the future to identify the people who are most likely to benefit from a given drug or suffer the worst risks of side effects.

Whatever ensues, a bold fact must be faced: The FDA and Congress have consistently failed to address a major public health and safety issue. The outdated grandfather status of drugs from 1938 and before must be addressed with all due speed. If 250,000 Americans can be killed over five years by one FDA-approved drug, imagine the numbers killed over eighty years with 88,000 unapproved drugs that were never evaluated for safety or efficacy.

Deepak Chopra MD, FACP, Clinical Professor, University of California, School of Medicine, San Diego, Chairman and Founder, The Chopra Foundation, Co-Founder, The Chopra Center for Wellbeing

Nancy S. Cetel, MD, President and Founder, Speaking of Health, and specialist in women’s health and reproductive endocrinology.

Joseph B. Weiss, MD, FACP, Clinical Professor, University of California, School of Medicine, San Diego.

Paul J. Mills, PhD, Professor, University of California, School of Medicine, San Diego

Danielle Weiss, MD, Clinical Assistant Professor, University of California, School of Medicine, San Diego, Medical Director & Founder, Center for Hormonal Health & Well-Being

David Brenner, MD, FACP, Professor, Vice Chancellor for Health Sciences, Dean, University of California, School of Medicine, San Diego

How to Be Timeless Right This Moment

By Deepak Chopra, MD

For most people, the two words “timeless” and “eternal” seem roughly the same. They spell the end of clock time, and for many religious believers, Heaven is eternal, a place where time goes on forever. Whatever you think about it, time coming to an end isn’t a pleasant prospect, because the clock stops, so to speak, when we die. But there are problems with all of these concepts, and if we really go deeply into the subject, time is very different from what we casually accept.

Physics has had a lot to say about time thanks to Einstein’s revolutionary concept that time isn’t constant but varies according to the situation at hand. Traveling near the speed of light or drawing near the massive gravitational pull of a black hole will have a drastic impact on how time passes. But untitled-design38 let’s set relativity aside for a moment to consider how time works in human terms, here and now. Each of us normally experiences three states of time: time ticking off the clock when we are awake, time as part of the illusion of having a dream, and the absence of time when we’re asleep but not dreaming. This tells us that time is tied to our state of consciousness.

We take it for granted that one species of time–the one measured by clocks–is real time, but that’s not true. All three relationships with time–waking, dreaming, and sleeping–are knowable only as personal experiences. Time in fact doesn’t exist outside human awareness. There is no absolute clock time “out there” in the universe. Many cosmologists would argue that time, as we know it in waking state, entered the universe only at the big bang. What came before the big bang is probably inconceivable, because “before the big bang” has no meaning if time was born at the instant the cosmos was born. If you go to the finest level of Nature, to the vacuum state from which the quantum field emerged, the qualities of everyday existence, such as sight, sound, taste, touch, and smell, no longer exist, and there is also a vanishing point where three-dimensionality vanishes, along with time itself.

What lies beyond the quantum horizon is purely a matter of mathematical conjecture, yet one thing is certain. The origin of everything real is beyond the reach of time and space. The realm that is the pre-created state of the universe can be modeled mathematically as being multi-dimensional, infinitely dimensional, or non-dimensional. Once the everyday four dimensions vanish, any kind of mathematical explanation is open. So it must be accepted that time came out of the timeless and not just at the big bang. Everything in the physical universe winks in and out of existence at a rapid rate of excitation here and now. The timeless is with us at every second of our lives.

Yet something looks fishy in that sentence, because the timeless can’t be measured using a clock, so it makes no sense to say that the timeless is with us “at every second.” Instead, the timeless is with us, period. This world is timeless. There is no need to wait for death or Heaven to prove that eternity is real.

Once you grant that the timeless is with us, a question naturally arises: How is the timeless related to clock time? The answer is that the two aren’t related. The timeless is an absolute, and since it can’t be measured by clocks, it has no relative existence. How strange. The timeless is with us, yet we can’t relate to it. Then of what good is the timeless?

To answer this question, we have to back up a bit. Clock time has no privileged position in reality. There is no reason why it should be elevated above dream time or the absence of time in dreamless sleep. Clock time is just a quality of being awake, like other qualities we know as colors, tastes, smells, etc. Without human beings to experience these qualities, they don’t exist. Photons, the particles of light, have no brightness without our perception of brightness; photons are invisible and colorless. Likewise, time is an artifact of human experience. Outside our perception, we cannot know anything about time. This seems to contradict the cornerstone of science, which holds that “of course” there was a physical universe before human life evolved on Earth, which means that “of course” there was time also, billions of years of time.

Here we come to a fork in the road, because either you accept that time, as registered by the human brain, is real on its own or you argue that, being dependent on the human brain, time is created in consciousness. The second position is by far the stronger one, even though fewer people believe it. In our awareness we constantly convert the timeless into the experience of time–there is no getting around this. Since such a transformation cannot happen “in” time, something else must be going on. To get a handle on this “something else,” let’s look at the present moment, the now, the immediate present.

All experience happens in the now. Even to remember the past or anticipate the future is a present-moment event. Brain cells, which physically process the conversion of the timeless into time, only function in the present. They have no other choice, since the electrical signals and chemical reactions that run brain cells only occur here and now. If the present moment is the only real time we can know in waking state, why is it so elusive? You can use a clock as fine-tuned as an atomic clock to predict when the next second, millisecond, or trillionth of a second will arrive, but that’s not the same as predicting the now. The present moment, as an experience, is totally unpredictable. If it could be predicted, you’d know your next thought in advance, which is impossible.

Moreover, the present moment is elusive, because the instant you register it as either a sensation, image, feeling, or thought, it’s gone. So let’s boil these insights down. The now, the place where we all live, can be described as:

— the junction point where the timeless is converted into time
— the only “real” time we know in waking state
— a totally unpredictable phenomenon
— a totally elusive phenomenon.

Now, if all these characteristics are being correctly described, it turns out that we have been fooling ourselves to believe that time is a simple matter of tick-tock on the clock. In some mysterious way, each of us occupies a timeless domain, and to produce a four-dimensional world for the purpose of living in it, we dream it forth. That is, we create the world in consciousness first and foremost. There is no given world “out there.”

This seemingly bizarre conclusion lies at the heart of all non-dual philosophies like Platonism, Buddhism, and Vedanta. None of them had access to neuroscience, so they didn’t fall into the trap of claiming that the brain is responsible for creating time, space, and the messages received by the five senses. The brain, after all, is just another object inside the dream, like a table and chairs, a rock, or a distant galaxy. Nor did these non-dual philosophies fall into the trap of saying that the mind creates reality. The mind is a vehicle of experience, and like time and space, it had to have a source beyond mental experience. If we trusted our minds, we’d equate going to sleep with death. In sleep the conscious mind gives up the world of solid physical objects and clock time. Yet when we wake up in the morning, there is a return of solid objects and clock time. They were held in waiting, so to speak, by consciousness even during the eight hours a day that the thinking mind is out of commission.

In the end, non-dual philosophies, as the name implies, aim to get us free of the dreamscape we mistake as the real world in order to return us to our source. At our source, in pure awareness, we recognize ourselves not as puppets of time, space, matter, and energy but as creators of reality. The merest second of time originated in us. We fill the now with experience. That’s what it means to take the timeless seriously; it changes our very identity. The categories that we lock into separate compartments are in fact part of one unified phenomenon, the unfoldment of awareness within itself.

I realize what a mouthful those words are, but we must wake up to the fact that reality is simply one thing. Body, mind, and spirit belong to this one thing. The come into being all together, and only our belief system turns them into three different things. There is a huge amount to say once you realize that you exist as the timeless source of creation. But the first step is to know that the timeless is with us, beyond any belief in birth and death, time and decay. Things get born and die in our dreams when we’re sleeping, and yet we don’t mourn them because we know that dreams are an illusion. Discovering that the same is true about our waking dream brings the experience known as enlightenment.