This series will cover some of the themes that are traditionally explored in an eight-week MBSR programme, paying particular attention to the needs of the palliative care community. These themes will be:
- An introduction to mindfulness, the MBSR programme, and the supporting science
- Perception and appraisal
- Being present
- Responding to stress
- Choices and commitment
- Communication and working with difficulty
- Impermanence and resilience
- Self-care begins here.
Traditionally our five senses are sight, hearing, taste, smell and touch. These senses are mostly to do with experiencing our outer world, our exteroceptive capacities. A sixth sense is often referred to as an intuitive sense, an inner knowing, perhaps beyond our conscious awareness. In this series I wish to explore mindfulness as being that sixth sense, our capacity for greater interoception with conscious awareness, the capacity for choice to perceive and respond to what is going on with each unfolding moment.
Mindfulness is a multi-faceted– and these days much studied– transformative capacity. It is a very old meditation practice adapted to our present day realities. Mindfulness is a capacity we all have: the capacity to be present; to be aware; to notice and observe what we are experiencing in this very moment, without judgment. Jon Kabat-Zinn, Professor of Medicine, Emeritus, and founding director of the Stress Reduction Clinic and Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School, defined mindfulness as: ‘moment to moment, non-judgmental awareness, which is cultivated by paying attention’.
Pretty simple stuff, you may say. Just pay attention, here and now, without judging anything to be particularly good or bad. Pretty simple until one spends a few moments with one’s own mind as it is carried on a constant thought stream, commenting on events that are already past or still to come. Pretty simple, perhaps, until one is faced with the distress of pain and suffering, and even with death. Pretty simple, perhaps, until one is faced with loss and bereavement greater than one ever imagined. How then to be present without judging a particular moment that many of us would love to escape?
Very little of our time is actually spent in the intimate space of this unfolding moment to moment experience. Paradoxically, however, much of our own suffering, and that of patients and families faced with life threatening and life limiting illness, comes from a desire to change how the past unfolded into this present moment and to control how the future turns out, and in desiring for the difficulties of this moment to be different to what they are. Mindfulness enables and nurtures our capacity for staying present, for walking alongside our patients and families wherever they may need us to go, with patience, compassion, kindness, and an openness to all outcomes.
Building mindfulness capacity can be protective against compassion fatigue (or empathic distress fatigue as some compassion researchers, such as Tania Singer, now call it). It engages our capacity to resist always looking for the obvious, to wait and listen for those questions that are not yet known at first, to give our patients and families the kindness of time and space, not needing this moment to happen in any particular way.
As a clinician, my saving grace was the fortuitous opportunity to learn mindfulness practices through the Center for Mindfulness at the same time as training in palliative medicine. This has inextricably linked the two for me, and indelibly affected how I practice palliative medicine. The practice of mindfulness has allowed me to sit patiently with many of the daily challenges that palliative care presents. Not just within the clinical space, but also in my work with patients’ families, working as part of a team and interfacing with other health care workers, dealing with ethical dilemmas, issues of access, justice, isolation, vulnerability, death, loss, grief and bereavement. When held within a container of mindful awareness, responding to these challenges takes on a capacity for action that is transformative.
Dr Trish Lück has worked in adult and paediatric palliative medicine in South Africa for the past 13 years, has held the post of medical director at Hospice Witwatersrand and recently team leader of the Paediatric Palliative Care Team, Charlotte Maxeke Teaching Hospital. She has taught mindfulness-based interventions within the health sector, with particular attention to mindfulness interventions as a ‘care for the carer’ programme. She currently resides in London, United Kingdom. Her blog, Living Life with Passion, can be accessed online.