Chapter 15: a short history of mindfulness
Mindfulness and meditation crept slowly into Western countries from the early 20th Century; meditation has always been a ‘thing’ in Eastern philosophy and spirituality, and its integration in those cultures as an element of inner growth is unquestioned. We are probably familiar with the concepts of Zen, Samurai, Buddhism, yoga, tai chi and Hinduism, but perhaps less familiar with the deep roots of contemplative practice that weave through the Islamic, Christian and other great spiritual traditions.
In the 1960s and onwards, mindfulness and meditation were introduced into the West, in a significant way. The Beatles were perhaps the highest profile role-models, helping to publicise Transcendental Meditation and Eastern religion in general, to a Western mainstream, mainly young audience hungry for an alternative to the conservative status quo.
The use of illicit drugs expanded rapidly, and the drug-induced transcendental experiences from other psychoactive agents were documented by proponents such as Timothy Leary, and Carlos Castaneda, among others.
However, the psychedelics like LSD, and the plant-derived hallucinogens like psilocybin and ayahuasca, remain largely peripheral within the mindfulness movement. Mainstream meditation and mindfulness practices as taught in Western contemplative neuropsychology and clinical psychotherapy do not for the most part incorporate the use of hallucinogens. Clinical psychiatry researchers however are examining the potential therapeutic role of low doses of some of these agents in managing patients with depression and PTSD5.
In the West, two leading proponents in the development of what we understand as mindfulness were Thích Nhất Hạnh1, a Zen Buddhist master, and Dr Jon Kabat-Zinn2, Emeritus Professor of Medicine at the University of Massachusetts Medical School. Kabat-Zinn has published widely and his Mindfulness-based Stress Reduction (MBSR) courses are taught across the world4. MBSR features in the curricula of many medical schools. The applications of mindfulness range from helping children with behavioural difficulties in primary schools3, to reducing PTSD and improving battlefield decisions in combat troops.
What Jon Kabat-Zinn clearly recognised, as he developed his ideas and the MBSR programme4, is that in order for concepts of mindfulness or meditation to gain traction in the Western context it was crucial that people see the relevance or value of these practices for themselves. So, in a way, we could say that the language of Buddhism was replaced with the language of neuroscience, and the idea of retreats to Thailand swapped for the findings on fMRI brain scans, during meditation. Mindfulness in this way became more approachable for the Western mind.
So here we are, after the first 50 years of the newest version of mindfulness,in a world where stress is extremely prevalent. Emergency Medicine as a microscosm of that world reflects that stress, as health care grapples with COVID-19, as well as the ongoing resourcing and staffing limitations.
How do we bring mindfulness into the day-to-day situations we are all familiar with?
Transforming each moment of now
Surely this mindfulness is just an idea – which sounds nice in theory – while we are flat out in our hospital trying to keep working, despite having frontline staff in isolation due to COVID, closures of crucial services in the hospital, and an Emergency Department that never empties?
So many elements in this pandemic are indeed beyond our control. Imperfect political decisions, shortages of PPE and diagnostic resources, the bewildering behaviour of those in our population who resist vaccination – the potential for us to be overwhelmed by this is real, and some are overwhelmed by it all.
And yet, a leader must stand apart from the fray, and simply lead. Anyone who would remain effective through a crisis knows this simple fact: that our power for influencing the course of affairs lies not in our past, nor our future, but in the present moment. And, yes, we are all asked to be leaders, in our own role.
Thích Nhất Hạnh encapsulates how we can bring mindfulness into the midst of chaos, by stripping the complexities down to the ‘now’ moment that we find ourself in.
Remember that there is only one important time and that is now. The present moment is the only time over which we have dominion. The most important person is always the person you are with, who is right before you, for who knows if you will have dealings with any other person in the future? The most important pursuit is making the person standing at your side happy, for that alone is the pursuit of lifeThích Nhất Hạnh, 1975: 75
In our context in the ED, our series of moments might line up something like this:
- take a history mindfully from a patient,
- cannulate the next patient with mindful focus,
- guide a safe procedural sedation with mindful oversight of all the staff and the patient
- discuss bed problems with the overburdened patient flow coordinator in a mindful and supportive way
- take a short coffee break and make it a mindful regrouping time
- finish our documentation with full focus
Each moment with another person can be viewed as a transaction which, when conducted in a mindful manner, becomes a net positive contribution to the welfare of every person you are interacting with. You will have the satisfaction of knowing that you gave that moment your complete mindful attention, which most certainly will be noticed by each person you met.
It certainly is food for thought, and given the intrinsic and extrinsic stressors that are endemic (?pandemic) to our clinical ED practice here at the start of 2022, surely we should be seriously looking at how a mindfulness practice can help smoothe the journey‽
Thank you for reading this, and take care of yourself.
- Hạnh TN. The Miracle of Mindfulness: An Introduction to the Practice of Meditation. Boston, MA: Beacon Press; 1975. 2e 1996
- Kabat-Zinn, J. Wherever you go, there you are: Mindfulness Meditation in Everyday Life. Hachette Books, 2005
- Burnett R, Cullen C. Research – Mindfulness in Schools Project. 2010 to date
- Kabat-Zinn J. Some reflections on the origins of MBSR, skillful means, and the trouble with maps, Contemporary Buddhism, 2011; 12(1): 281-306
- Fuentes JJ, Fonseca F, Elices M, Farré M, Torrens M. Therapeutic Use of LSD in Psychiatry: A Systematic Review of Randomized-Controlled Clinical Trials. Front Psychiatry. 2020 Jan 21;10:943.
- Kuyken W, Weare K, Ukoumunne OC, Vicary R, Motton N, Burnett R, Cullen C, Hennelly S, Huppert F. Effectiveness of the Mindfulness in Schools Programme: non-randomised controlled feasibility study. Br J Psychiatry. 2013 Aug;203(2):126-31.
Waiver: These articles represent my own views and approach to mindfulness, and do not purport to be the official view of ACEM. They are not intended to replace appropriate medical or mental health care, provided by professionals in these domains