Discovering Your Inner Strength

Enjoy my new mindful self-compassion practice for the holidays! (Video produced by BC Children’s Hospital.)

Mindfulness During The Holidays

Enjoy this short video where I discuss mindfulness during the holidays! (Video developed by BC Children’s Hospital.)

“I Have Arrived, I Am Home” (#Mindfulness #OnTheRoad)

While navigating the Toronto airport en route from Ottawa to Rochester, I noticed the thought in my head arise, “I really f’ing hate traveling!”

 

 

Instead of going down the rabbit hole of my story about how much I “hate” traveling, instead I decided to smile at that thought. Breathing, walking meditation through the airport, smiling, and singing “I have arrived” to myself. I felt my shoulders relax and my mood lighten. When the thought came back, I laughed out loud!

Now I’m looking forward to part 2 of this “work” trip — a retreat and teacher training on Mindful Practice for health care providers, with my friends and colleagues Ron Epstein and Michael Krasner.

How do you practice mindfulness in the midst of potentially unpleasant or stressful situations?

Mindfulness is Wise Compassion for the Present Moment

I’d like to offer another reflection on the “definition” of mindfulness. I don’t believe mindfulness can really be described in words, so I offer this as another possible definition, in the spirit of a question to contemplate.

Mindfulness is wise compassion for the present moment.

 

What do I mean by this? What are the three essential elements of mindfulness?

Compassion: When I am mindful, I greet everything I am encountering in the moment with kindness, respect, and love. As best I can, I practice this when the moment is easy and pleasant, as well as when it’s difficult or painful. I start first with compassion for myself. Sometimes, just putting my hand on my heart, and taking three slow mindful breaths, helps me to soothe myself and to feel more ready to handle a difficult situation. Then, I try to bring that spirit towards whatever person(s) or situation I’m dealing with, whether it is walking my puppy, talking to my family members or friends, having a tough conversation with a co-worker, or just hanging out in nature and enjoying the moment.

Present Moment: The present moment is the only moment we have to be alive. With mindfulness, I can let go of getting stuck in regrets about the past (“I wish this hadn’t happened…”), and worries about the future (“What if….?”). Living in the present moment, I can savor the “good times” more. And, when I’m going through a “bad time,” I know I can ride the waves of stress and pain, one moment at a time, one breath at a time. This doesn’t mean I don’t care about the future, or that I pretend things in the past didn’t happen. But, I know that if I take good care of the present moment, that is also creating the best possibility for a positive future. Deep compassion in the present moment can even heal wounds and hurts from the past.

Wisdom: The word “wisdom” sometimes sounds like some far-off, mystical thing that a mere mortal like myself could never possibly attain. But I think we were all born with an innate, embodied wisdom, and we can train ourselves to tap into it more through attending to the present moment with an open heart and an open mind. With mindfulness, I can see a situation more clearly. When things are tough, as best I can, I get out of “lizard brain,” stress-driven, fight-flight-or-freeze mode. I invite slow breathing, clear thinking, and listening to the messages coming from my body (“heartfulness”). This helps me to know what to do, and what not to do, to help a situation. It helps me to practice compassion without being foolish, without allowing myself or others to become more hurt. For example, if a child is being abused or in grave danger of hurting themselves, I can clearly see that danger, and act firmly and decisively to protect the child. At the same time, I recognize that I am deeply interconnected with the child, with the abuser, and with all beings. My well-being is related to their well-being, and the same is true for pain. I recognize that my own judgment and anger and self-righteousness that arise in those moments are important signals that I can listen to and honor. I also know from my own experience that maintaining or acting out of anger usually ends up hurting myself, and making the situation worse. With mindfulness, I do my best to take care of my anger, and maintain compassion for everyone involved — again, starting with myself.

Wisdom, compassion, presence… These aren’t “goals” to “achieve,” but intentions that we can invite into our lives and practice, one step at a time, one breath at a time.

What does the word mindfulness mean to you?

 

Staying Present: Mindfulness in Health Care

[NOTE: This blog post was adapted from an article I wrote for the BC Provincial Hematology Oncology Network newsletter, geared towards a health provider audience. I have long believed that for those of us teaching mindfulness to teens, it has to start with our own mindfulness practice. This will be the first in a series of posts exploring mindfulness for health care providers and other youth-serving professionals.]

 

Sister Dang Nghiem

The long nights of studying, and the culture shock of medicine, had left me feeling exhausted and uncertain as I completed first year of medical school. Had I made the right decision? How am I possibly going to learn everything that I need to know to become a doctor? Fortunately, I had scheduled a mindfulness retreat at Plum Village meditation center in France that summer. I met with Sister Dang Nghiem, a former physician-turned-Zen-nun, and author of Mindfulness as Medicine, who has become a teacher and inspiration for me. I asked her, “How can I find time to develop my mindfulness and meditation practice when I have so much medical studying to do? I feel like every piece of medical knowledge I learn could save someone’s life someday, and there aren’t enough hours in the day to study, much less to practice meditation.” She breathed calmly, paused, and turned to me. She said, “Think about the lives that you might be able to save if you can learn to be truly present for every person you are caring for.” That moment was a turning point for me, and I made the commitment to do my best to bring mindfulness into the heart of my life as a human being, and my training as a healer.

 

What is Mindfulness?

The word that is translated into English as “mindfulness” has a history thousands of years old, going back to Buddhist meditation and other Eastern contemplative practices. That said, you certainly don’t need to be a Buddhist to practice and benefit from mindfulness. Cultures throughout the world have something like mindfulness, even if they don’t use that word. Dr. Jon Kabat-Zinn at the University of Massachusetts defined mindfulness as “Paying attention in a particular way: on purpose, in the present moment, and without judgment.” “Mindfulness” is also sometimes translated as “heartfulness,” which highlights the inherent mindful quality of compassion. Decades of research have shown mindfulness to be a powerful tool for helping people cope with a variety of stress and illness, including chronic pain, anxiety, depression, and cancer.

Mindfulness is about staying present with whatever is happening in the present moment. It means not turning away from pain and suffering. I sometimes describe mindfulness as “Paying attention in a particular way: On purpose, in the present moment, and with unconditional love.” In this spirit, I try to stay present with every situation with compassion, whether it is an easy situation or challenging. Cultivating mindfulness can involve “formal” practices like sitting meditation or walking meditation, where we stop whatever else we are doing and focus on mindful awareness of our breath or our bodies. That same mindful presence can be practiced any time, anywhere, including daily activities in the health care setting such as walking down the hospital corridor. Sometimes, before entering a patient’s room, I stop, take three slow mindful breaths, and remind myself, “This person is suffering. This is a sacred space that I am about to enter.” This simple practice puts me in an entirely different frame of mind as I begin the next clinical encounter.

 

Calligraphy: Ly Hoang

Why Mindfulness for Health Care Providers?

One common stereotype of mindfulness is someone who spends their time naval-gazing, self-absorbed, oblivious to the world. That image could not be further from my own experience of mindfulness as an active practice that helps me to engage in my clinical work with more focus and attention, and less distraction. Dr. Michael Krasner and Dr. Ronald Epstein at the University of Rochester have developed and researched mindfulness programs specifically for physicians. In a landmark study published in the Journal of the American Medical Association in 2009, they demonstrated that physicians who undertook an tailored 8-week intensive mindfulness training program showed less burnout, better mood and emotional stability, and improved physician empathy. Dr. Epstein and Dr. Krasner propose that mindful practice in medicine can impact three inter-related areas of care: (1) Quality of care (safe, timely accessible, effective, patient-centered); (2) Quality of Caring (empathy, compassion, responsiveness); and (3) Clinician well-being (improved mood, lower burnout).

Mindfulness practice improves the quality of care. When I was in medical school and learning how to conduct emergency “Code Blue” situations, a wise teacher told me to “Check your own pulse first” – even before checking the patient’s pulse! This lesson has stuck with me throughout my medical training and practice. I’ve found that when I am calm, centered, and fully present, I’m able to think the most clearly, see what is really happening, and make better decisions. On the other hand, when I am feeling rushed or inattentive or highly stressed, I’m more likely to miss important clinical information or make mistakes. When I’m mindfully aware of my stressed-out mental and physical state during my work day, I try to take a moment to breathe and center myself, so I can better attend to the patient or situation in front of me.

Mindful practice improves the quality of caring: Sometimes lost in our high-tech, intervention-focused health care system is the ancient healer’s art of compassionate and empathic communication with patients. Master clinicians know, however, that earning trust and effectively caring for patients who are experiencing serious illness requires a high level of compassion – the capacity to face, stay present with, and relieve, suffering. A trusting and compassionate clinical relationship is necessary for optimal communication and care. Moreover, the “bedside manner” of the clinician has an enormous impact on how patients experience illness and healing.

One of the most powerful (and challenging!) of mindfulness practices is mindful communication. When I’m listening mindfully to a young person or family, instead of interrupting or forcing through my own agenda, my primary intention is to be present with them. I want to really hear what they are saying, to attend to what they are experiencing emotionally, and allow them to feel fully heard and understood. When I am speaking mindfully, I bring a heightened awareness to what I am saying and how I am saying it, in the moment, with the primary intention of generating compassion and relieving suffering.

Sister Dang Nghiem wrote, “If a doctor learns to practice mindfulness … and she walks in quietly, peacefully, that’s already medicine. She’s calm. She’s not outside of her body. The patient feels that attention, that tenderness, that care, that true presence. The patient is already soothed.” In my experience, I’ve also found that the practice of mindful communication has helped me to manage some extremely difficult situations with youth and families in crisis, and to defuse and de-escalate conflicts in the health care setting.

Mindful practice improves clinician well-being. Studies have shown that almost 50% of physicians experience significant symptoms of burnout at some point in their careers, and are at significantly increased risk for suicide and substance abuse compared to their peers. This is hardly a surprise given the pace and pressures of the modern health care environment. Adding to this, we are confronted with pain and suffering among people we serve, on a daily basis, and to a degree that is hard to imagine for most our non-medical family and friends. These experiences put us at high risk for “secondary trauma.” If we do not know how to handle these experiences wisely, we risk “absorbing” our patient’s trauma both physically and psychologically, which degrades our physical and mental health, and impairs our ability to be at our best in our clinical work and in our lives.

For me, mindfulness practice is a powerful tool for me to take care of myself, and to increase my own resilience. When I practice mindful walking on the way to work, I can let go of my anxious “to-do” list for the day, and arrive more refreshed and alert. When I practice sitting meditation after the death of one of my patients, I hold my heart in my hands, breathe with self-compassion, and allow myself to experience, and let go, of whatever emotions are arising in me in that moment. This allows me to continue serving as effectively as I am able to.

As clinicians and healers, our clear and compassionate presence is one of the greatest gifts that we can offer to our patients – just as much as our scientific knowledge and our technical skills. We have the opportunity to tap into, and strengthen, this capacity through the practice of mindfulness. Mindful providers will heal the world.

 

Resources

For me, developing my mindfulness practice has become a lifelong path full of joy and reward. Those new to mindfulness might enjoy Dr. Jon Kabat-Zinn’s Mindfulness for Beginners, or Thich Nhat Hanh’s The Miracle of Mindfulness. Dr. Ronald Epstein’s Attending: Medicine, Mindfulness, and Humanity is a masterpiece that makes the case for bringing mindfulness into the practice of health care. That said, reading about mindfulness is no substitute for experiencing it yourself, with the guidance of a skilled and experienced teacher. I recommend taking an eight-week Mindfulness-Based Stress Reduction (MBSR) workshop or a mindfulness course or retreat tailored to health care providers.

 

 

Is Mindfulness Religious?

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There has been a lot of discussion lately in mindfulness in education circles (for example, here, here, and here) about the need for mindfulness programs in educational contexts to be completely secular. This is in the face of recent legal challenges to some mindfulness programs in schools, on the grounds that these programs are a type of covert religious indoctrination to Buddhism. One consideration, especially in the US public schools context, is the need for separation of church and state.

Here are some of my brief reflections on this very complex question, from my experience as a mindfulness practitioner in a Buddhist tradition, and as a pediatrician who teaches secular mindfulness in health care settings.

 

You absolutely do not need to be a Buddhist to practice mindfulness.

Jon Kabat-Zinn is fond of saying, “Even the Buddha wasn’t a Buddhist.” My own mindfulness teacher, Thich Nhat Hanh, has encouraged the development of skillful and culturally appropriate ways to offer mindfulness in non-religious ways. Although Thich Nhat Hanh is a Buddhist monk, his Buddhism is inclusive and non-evangelical. At his practice centers, I have met people of all religious backgrounds, including catholic priests and nuns. Thich Nhat Hanh never tries to convert people to Buddhism, and in fact, encourages people to (re-)connect deeply with their own spiritual and religious traditions, and renew them. He once said, “If I had to choose between Buddhism and peace, I would choose peace.”

In my medical practice, I strive to offer mindfulness in a secular way that is accessible to people of any religion, because I hope that the practice may benefit anybody, and I don’t want religion to be barrier.

 

At the same time, mindfulness comes from somewhere, it’s not new, it has a history. How can we offer mindfulness in secular ways, while at the same time acknowledging and respecting the roots?

Ignoring the peoples, histories, and cultures that have contributed to mindfulness as we know it today, risks cultural appropriation. In striving to present mindfulness in a purely secular way that, there is the risk of (further) marginalizing the peoples and cultures that have contributed so much to this gift to humanity through many generations. By erasing that history, it can leave the impression (even if only by omission) that mindfulness is somehow a “new” invention, or a Western creation. For me, this risks a type of cultural colonization – taking something beautiful without giving credit. This needs to be considered in a larger, complex context of historical colonial legacies, imbalances of power, and privilege. My friend Susanna Barkataki has explored this issue much more eloquently than I can.

 

For me personally, I feel the need to respect my teacher and my lineage.

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Me with my father and Thich Nhat Hanh, 1999

As a second-generation Vietnamese American, I was introduced to mindfulness and meditation through my Buddhist family. Later, as a young adult, I studied mindfulness with Vietnamese Zen Master Thich Nhat Hanh. My first mindfulness retreat with Thich Nhat Hanh (in 1999) was a life-changing and heart-opening experience for me. It allowed me to experience how mindfulness could more than an idea or philosophy, but a way of life and a concrete practice. That experience has formed the foundation for my life and work ever since.

In addition, as an immigrant adolescent and person of color growing up in the United States, I experienced a lot of suffering from internalized racism and identity confusion. Re-connecting with my cultural roots through mindfulness has been an important part of my healing journey.

When I wrote The Mindful Teen, I explicitly offered acknowledgement and gratitude to my family and my teachers for helping me on my own path of mindfulness practice. To not mention them would have felt disrespectful, as if I had “invented” mindfulness somehow — when in reality all I’ve done is adapt and offer the practices that I’ve learned from others, within a specific context of adolescent health.

 

 

Just because something has religious influences, doesn’t mean that we can’t all learn from it in a secular context.

Dr. Martin Luther King, Jr., and Thich Nhat Hanh, 1966

Dr. Martin Luther King, Jr., and Thich Nhat Hanh, 1966

The Rev. Dr. Martin Luther King Jr. is one of the most revered leaders for social justice in the US and worldwide. His work was deeply influenced and rooted in his Christian theology. I myself am not a Christian and I have no interest in converting to Christianity. Does this mean that I should not admire and be inspired by Dr. King’s work? Similarly, does this mean that Dr. King’s teachings should not be taught, celebrated, and practiced in secular settings such as US public schools? If so, then would that also imply that the Dr. King US federal holiday is unconstitutional?

For me, the question of whether any particular mindfulness teaching or practice is “religious” or “secular” has less to do with the historical influences that inform that particular practice (e.g. Buddhism, yoga etc), and more to do with the specific language, content, and context in which it is presented. Religious and wisdom traditions throughout the world have much beauty and wisdom to offer us. If we cannot find skillful, culturally appropriate, and inclusive ways to learn from them without threatening the church/state separation, then we will all be poorer for it in my opinion.

 

 

There’s no ignoring the “Elephant in the room.”

A thirty-second Google search of “mindfulness” will  reveal many links with Buddhism. To not mention it is to ignore the elephant in the room, and risks inadvertently furthering the impression that mindfulness programs have “something to hide.” In my experience, it’s more useful to address the question head on, in an inclusive and respectful way.

 

We can practice mindful communication with critics of mindfulness.

Criticisms and attacks on mindfulness in schools usually comes from a place of love for children, a desire to protect them from perceived harm, as well as possibly, a deeper suffering, anxiety, or fear. There may also be valid criticisms and cautions which we in the mindfulness community can learn from. Can we listen with an open heart, without getting defensive? Can we embody humility and unconditional love in the way that we respond? Ultimately, our own mindful and compassionate presence (including, and perhaps especially, with critics of mindfulness) is the best ambassador for bringing mindfulness into society, more so than anything we can say, or any arguments that we can make.

 

Putting it all together

I work with a very diverse, multicultural population, including Canadian Indigenous peoples, devout Christians, Muslims, Jews, Jehovah’s Witnesses, and more. When I am inviting a youth to join our mindfulness programs, I say something like this:

 

“Mindfulness isn’t new, and I didn’t invent it. It is thousands of years old, and has roots in traditions from Asia, like Buddhism and yoga. That said, you definitely don’t need to be a Buddhist to practice mindfulness. Mindfulness is about cultivating a present-moment, open-hearted awareness and compassion. That kind of awareness is found in wisdom traditions throughout the world, whether or not they call it ‘mindfulness.’ The mindfulness that we teach here is for anyone of any religion, or no religion at all. That’s because we’re not going to ask you to believe anything, or to not believe anything. Instead, we’re just going to invite you to pay attention, and learn from your own experience.”

 

To this day, to my knowledge, I have not had any youth or family decline or object to mindfulness on religious grounds.