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Mindfulness Reminds Us What Health Care Is For

Learning Objectives
1. Explain a new or unfamiliar viewpoint on a topic of ethical or professional conduct
2. Evaluate the usefulness of this information for health care practice, teaching, or conduct
3. Decide whether and when to apply the new information to health care practice, teaching, or conduct
1 Credit CME
Abstract

Could clinicians help people more if they were buddhas? This article considers what the late Thích Nhâ't Hanh meant in his call to “become buddhas” and applies Nhâ't Hanh's mindfulness practices to managing crises and anxiety in health care settings. This article also considers recovery strategies, techniques for becoming calm, and reminders about why stillness matters for compassionate practice in health care.

We need a collective awakening. One buddha is not enough. All of us have to become buddhas in order for our planet to have a chance.

Thích Nhâ't Hanh1
Crises, Anxiety, and Mindful Practice

Buddhist monk Thích Nhâ't Hanh called for us all to become buddhas at this moment of planetary crisis.2 The question we wish to address is this: Why, during crises, is it useful for individuals to become buddhas?Quiz Ref IDA short answer is that, because crises provoke anxiety, which, in turn, impedes individual and collective decision making, mindfulness is needed to calm us to improve our thinking. In what follows, we develop a series of ideas: (1) this is a time of crisis, (2) crisis provokes anxiety, (3) anxiety impedes decision making, and (4) mindfulness can promote calm and help us recover. We apply these ideas to ourselves and to the systems within which we work.

This Is a Time of Crisis

More than 2 years of the COVID-19 pandemic have taken a toll on the United States and revealed stark problems with the state of the nation. Prior to January 2020, many might have thought that our country understood and used science; that our health care system was strong enough to manage a pandemic; that we were all committed to democracy; and that we had made progress in eliminating inequity. Quiz Ref IDInstead, we have lived through a tumultuous period of devastating climate consequences, bitter political partisanship with profound attacks on democratic processes, and inequity playing out in the number of bodies in refrigerator trucks. These crises reveal deep ecological trouble and disruption in our social, economic, political, and natural interconnectedness.

Crisis Provokes Anxiety

Although it is tempting to minimize, project, or deny the difficulties of this moment, there is a thrum of deep eco-anxiety in many of us as the truth presses in on us: our way of life is unsustainable.3 It is understandable that high levels of anxiety accompany a crisis of this proportion. It is not one or another policy that must change but rather our “way of life”—our intertwined social, economic, cultural, and political ways of living. Quiz Ref IDAnthropologist A.F.C. Wallace studied the sudden taking apart of a way of life—what he called “mazeway disintegration”—noting how profoundly difficult it is.4 While a disaster of one or another kind might provoke a temporary upheaval, after which “things will go back to normal,” a crisis that calls on us to change our way of life—that is, not to go back to normal—strikes deeply at the roots of collective security. Wallace noted that, in such circumstances, there were 2 ways forward that societies had taken: totalitarian government or religious revival. Nhâ't Hanh's call that we all become buddhas opens a third path, that of mindfulness, rather than a devotion to a particular religion or political party.

Anxiety Impedes Decision Making

Quiz Ref IDThere is an old saying in African American neighborhoods that holds that “a scared man can't gamble, and a jealous man can't think.” This folk wisdom applies to collectives as well. We see fear operating to limit our ability to see the big picture. In studies of collective consciousness, Wallace and Fullilove5 noted that there are a number of threats to collective thinking, among them inattentional blindness, which the American Psychological Association defines as “a failure to notice unexpected but perceptible stimuli in a visual scene while one's attention is focused on something else in the scene.”6 In the COVID era, for example, people are focused on fighting about masks and ignoring that the larger problem of ecological mismanagement has created conditions for many new pathogens to arise.7

We also see jealousy in partisan efforts to make “my side to win.” There are many examples of these efforts—from the gerrymandering of election maps to the January 6th attack on Congress. Partisanship has impeded progress on legislation to address threats to all Americans and all humans. For example, the defeat of the proposed Build Back Better legislation is one example of failure to address climate change, although the Inflation Reduction Act, signed into law in August 2022, contains many of the same provisions but with less funding.8 Calming the nerves of the nation to enable problem solving in the spirit of solidarity is essential at this time.

Mindfulness

Calms anxiety.Quiz Ref IDThich Nhâ't Hanh encountered the Vietnam War as a young monk and learned to practice mindfulness under dire circumstances. He went into many dangerous situations—not as an armed combatant but as a person prepared to help with rebuilding the nation. His deep connection to the universe, his respect for the interrelatedness of all life—our interbeing—gave him a perspective on life that was often absent in a time of war. In this current period of reckoning, the pathologization of anxiety—such as the manipulation of anxiety to further the aims of totalitarianism—is a real and present danger. For example, the former president of the United States, in calling Covid “the Chinese virus,” ratcheted up anxiety and intergroup hatred.9 By calming ourselves, we prepare ourselves better to face the scale of our problems and engage with others compassionately.

Increases focus. Stephen Covey's famous book, 7 Habits of Highly Effective People: Powerful Lessons in Personal Change, includes the habit “Begin With the End in Mind.”10 Community organizer Ernest Thompson spoke of this direction-finding task as “finding what you're for.”11 When used to guide strategic planning, the articulation of values and goals has a particularly important role to play in times of frequent disaster. Pulled in many directions by the rapidly changing demands of the moment, people can become “ambulance chasers” rather than strategic actors, and they will quickly become worn-out and discouraged. Guided by their values and standing on a platform of action, they are much more likely to achieve their stated goals and to improve the overall situation.

Creates awareness of interrelatedness. Nothing about changing our way of life will be quick or easy. In 1967, the Reverend Dr Martin Luther King Jr laid out the scope of the work we have to do:

Now let me suggest first that if we are to have peace on earth, our loyalties must become ecumenical rather than sectional. Our loyalties must transcend our race, our tribe, our class, and our nation; and this means we must develop a world perspective. No individual can live alone; no nation can live alone, and as long as we try, the more we are going to have war in this world. Now the judgment of God is upon us, and we must either learn to live together as brothers or we are all going to perish together as fools.12

From the perspective offered by King, what we must be for is a world perspective in which we understand our interrelatedness with all living beings. Nhâ't Hahn calls this “interbeing.”

Applications to Health Care

The diverse and vast set of organizations that makes up the American health care system could play an important role in calming the mind of the nation, but, at present, health care as a system seems to deliver care according to clinical standards and plays only limited roles in communities' well-being. Even when hospitals offer wellness programs, they offer them as services to individual patients. This individual-care model is insufficient at this time of reckoning when millions are in distress. Deep ecologists aren't the only ones who understand that unimagined horrors are lurking that will require all the sangfroid we have or can muster. In this particular catch-22, we, as clinicians, could help create collective calm by implementing a community-level mindfulness approach, but we'd have to believe we should step outside of our small sphere of influence.

In summary, the Swedish environmentalist Greta Thunberg has pointed out that we have to act now, building a new way of life, even if we don't have a blueprint for how to do that.13 We can begin by pausing and finding stillness, settling the mind and body so that we see beyond the turbulence and the distractions. Within this space, we become more discerning—noting our values, listening to and respecting ourselves and one another—thus enabling our co-creation of a platform for truth telling, recovery, and survival.

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The AMA Journal of Ethics exists to help medical students, physicians and all health care professionals navigate ethical decisions in service to patients and society. The journal publishes cases and expert commentary, medical education articles, policy discussions, peer-reviewed articles for journal-based, video CME, audio CME, visuals, and more. Learn more

Article Information

AMA Journal of Ethics

AMA J Ethics. 2022;24(12):E1161-1165.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships.

If applicable, all relevant financial relationships have been mitigated.

Conflict of Interest Disclosure: The author(s) had no conflicts of interest to disclose.

The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.

Author Information:

  • Mindy Thompson Fullilove, MD is a social psychiatrist on the faculty of The New School in New York City. She has published over 100 scientific papers and 8 books; Marisela Gomez, MD, PhD, MS, MPH is a mindfulness practitioner who studied with Thích Nhâ't Hanh at Plum Village in France. She co-leads the Village of Love and Resistance in Baltimore, Maryland.

References:
1.
Hanh  TN.  Peace Is Every Breath: A Practice for Our Busy Lives. HarperCollins/HarperOne; 2011.
2.
Hanh  TN.  Zen and the Art of Saving the Planet. HarperCollins/Harper One; 2021.
3.
Pihkala  P.  Climate anxiety.  Suomen Mielenterveysseura; 2019. October 30 , 2019. Accessed May 9, 2022. https://helda.helsinki.fi/bitstream/handle/10138/307626/2019_Pihkala_Climate_Anxiety_report.pdf?sequence=1&isAllowed=y
4.
Wallace  AFC.  Mazeway disintegration: the individual's perception of socio-cultural disorganization.  Hum Organ. 1957;16(2):23–27.Google ScholarCrossref
5.
Wallace  R, Fullilove  MT.  Collective Consciousness and Its Discontents: Institutional Distributed Cognition, Racial Policy, and Public Health in the United States. Springer; 2008.
6.
Wallace  R.  Dead Epidemiologists: On the Origins of COVID-19. Monthly Review Press; 2020.
7.
Inattentional Blindness.  APA Dictionary of Psychology.  American Psychological Association. Accessed January 23, 2022. https://dictionary.apa.org/inattentional-blindness
8.
Leber  R.  The US finally has a law to tackle climate change.  Vox. July 28 , 2022. Updated August 16, 2022. Accessed August 24, 2022. https://www.vox.com/policy-and-politics/2022/7/28/23281757/whats-in-climate-bill-inflation-reduction-actGoogle Scholar
9.
Hswen  Y, Xu  X, Hing  A, Hawkins  JB, Brownstein  JS, Gee  GC.  Association of “#covid19” versus “#chinesevirus” with anti-Asian sentiments on Twitter: March 9-23, 2020.  Am J Public Health. 2021;111(5):956–964.Google ScholarCrossref
10.
Covey  SR.  The 7 Habits of Highly Effective People: Powerful Lessons in Personal Change. Simon & Schuster; 2004.
11.
Thompson  E, Fullilove  MT.  Homeboy Came to Orange: A Story of People's Power. 3rd ed. New Village Press; 2018.
12.
King  ML  Jr.  Martin Luther King Jr's “A Christmas Sermon on Peace” still prophetic 50 years later.  Beacon Broadside. December 24 , 2017. Accessed July 8, 2022. https://www.beaconbroadside.com/broadside/2017/12/martin-luther-king-jrs-christmas-sermon-peace-still-prophetic-50-years-later.html#:~:text=This%20Christmas%20season%20finds%20us,we%20see%20its%20ominous%20possibilitiesGoogle Scholar
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Thunberg  G.  “You did not act in time”: Greta Thunberg's full speech to MPs.  Guardian. April 23 , 2019. Accessed January 23, 2022. https://www.theguardian.com/environment/2019/apr/23/greta-thunberg-full-speech-to-mps-you-did-not-act-in-timeGoogle Scholar
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program; 
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program; 
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program; and 
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; 

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

     
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