As health care professionals, we live a life directed so much toward the outside activity of caring for others, of keeping up with the busy demands of work, family, even self. We are more human doings than human beings. There is often little time to sit back, reflect on how we even got to this point in our lives. As a health care professional working within the arena of life limiting and life threatening illness, of death and dying, I have become intimately aware that we only have this one life, and that it is finite. I sometimes joke with my patients that we all have a terminal illness– It’s called life! Many of us live as if that is not true, and we get frustrated perhaps when our patients and their families sit with denial of a diagnosis that brings this awareness much closer. Perhaps it is time to look a little closer, a little more intimately into our own awareness of how this life of ours is unfolding.
For me the MBSR programme, or other mindfulness-based interventions, offers such an opportunity. An opportunity to enquire deeply into what this life of ours truly is about. An opportunity to change habits of being or reactivity, of feeling under pressure by all that comes our way, bidden and unbidden. Mindfulness supports our capacity to show up and to be present, not just to others that we care for, but also to ourselves. To turn toward what is difficult in our own lives with kindness and compassion, and to not react to an ever present urgency that often has us try to fix or turn away.
The MBSR programme was developed by Dr Jon Kabat-Zinn at the University of Massachusetts Medical School in 1979. Dr Kabat-Zinn started the Stress Reduction Clinic and offered this programme to patients with difficult pain and chronic illness, when standard treatment was not helping. The curriculum “features the cultivation of mindfulness of mind states and body states including, in particular, awareness of reactive emotions, as well as how to deploy specific strategies to respond mindfully rather than reacting reflexively when triggered, and even more so if these emotions tend to linger and color one’s longer term experience, actions, and relationship, as they so frequently do” (Jon Kabat-Zinn, Foreword to: Teaching Mindfulness by McCown, Reibel, and Micozzi).
Even though mindfulness has been found through research to: engage our capacity for more skillful decision making, decrease burnout among clinicians, support the immune system, improve wellbeing in a multitude of illnesses, decrease anxiety and depression relapse, impact the rate of our aging, enable more engaged listening and speaking capacities, one of the things that mindfulness is not, is that it is not a purely cognitive process. Even though it seems that mindfulness is everywhere at the moment (on the front page of Time Magazine this week, in various newspapers and magazines, even in the UK Parliament and US Congress) it is not a process that can be engaged with through only reading and talking about it. Mindfulness at its deepest essence is a way of being, cultivated through experientially engaging with it. All will not be revealed in this first article, as it is not in the first MBSR class, but will be an ongoing interface with curiosity and the invitation to fully engage with what is going on in your life at this very moment. And perhaps in fully engaging with your own life, you may find a greater capacity to engage with that of the patients and families you serve.
Facilitating a session for the palliative care team at Chris Hani Baragwanath Hospital in Johannesburg through a brief body scan (see next week’s article on short meditations), we ended with some time settling into the heart space itself. Noticing the beating of the heart. Noticing the resting of the heart. In the ensuing inquiry, one of the home care sisters shared her surprise: “I also have one of those organs!” she said, hand over her heart, strongly clasping at it, eyes wide with wonder. “A real heart!” How easy it is to live a distance away from our own bodies, to not really engage with our own physicality until it perhaps demands our attention through illness or injury? The gift of mindfulness is to change this habit. To turn toward a greater knowing of this body we inhabit throughout each day, and turn toward a noticing of its wondrous capacity, and how– so much more than we appreciate– it is amazingly functional and beautiful.
Here are two short meditation exercises for you to practice:
Sit. Notice. Breathe.
For a few brief moments right now, put down any pencils, papers, and once you have read this, stop looking at the screen. Sit back in your chair, or wherever you find yourself, allow your body to be supported upright as best you can. Notice for now the sensations of movement of your own breath. Can you notice movement of air at the nostrils; movement of the ribcage as breath enters and leaves the lungs; movement at the belly as it rises with each in breath, falls with each out breath, expanding the diaphragm? There is no need to change or judge the rhythm of your breathing at all. For now just engage a sense of curiosity about each breath, this breath, and the rhythm that it already has in this very moment.
Drink tea, eat mindfully.
This week as you spend time eating and drinking, bring attention to this activity. Notice the taste of the drink and food in your mouth. Notice the aroma, the colours, the flavours, the differing sensations of textures on your tongue. Notice the movement involved in bringing the food and drink to your mouth, the movement of the face, of the lips, of the swallowing, and any other sensations that you may be aware of. Engaging a kindly curiosity of what it is you are already doing. For now not needing to change any of it.
References and further reading
Ludwig, D., Kabat-Zinn, J. (2008). Mindfulness in Medicine. JAMA, 300(11). pp: 1350-1352
Krasner, M., Epstein, R., Beckman, H. et al. (2009). Association of an Educational Program in Mindful Communication with Burnout, Empathy, and Attitudes among primary care physicians. JAMA, 301(12). pp: 1284-1293
Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M. A., Muller, D., Santorelli, S. F., Urbanowski, F., Harrington, A., Bonus, K., & Sheridan, J. F. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 6. pp: 564-570
Carlson, L. (2012). Mindfulness-Based Interventions for Physical Conditions: A Narrative Review Evaluating Levels of Evidence. International Scholarly Research Network (ISRN), 2012
Williams, J., & Kuyken W. (2012). Mindfulness-based cognitive therapy: a promising new approach to preventing depressive relapse. British Journal of Psychiatry, 200. pp: 359-60
Jacobs, T., Epel, E., Blackburn, E. et al. (2011). Intensive meditation training, immune cell telomerase activity, and psychological mediators. Psychoneuroendocrinology, 36(5). pp:664-68
Mindful magazine (Monthly mindfulness magazine)
Mindful experience (Mindful Research Guide with monthly updates).