By Mick Krasner, MD
I want to write some reflections on why I engage in contemplative practices, and the tension that exists in developing programs that feature contemplative practices to address flourishing in healthcare. One sensible critique about recommending contemplative practice for healthcare professionals evaluates it as simply another intervention to address underlying systemic dysfunctions that lead to burnout, stress, emotional reactivity, loss of resilience, lower productivity, and lack of professional focus among other effects. The motivation to address these challenges is undeniable, salient, and very human. Yet, paradoxically, the moment contemplative practice becomes purely transactional and just another strategy or technique to change outcomes, something essential may be lost. Among what is lost is the direct encounter with experience, which forms the basis for living, and for making the best-informed decisions based on that reality. Self-improvement treats the self as an object to optimize, which at times is absolutely necessary. Awakening changes one’s relationship to the self altogether. Contemplative practice may produce beneficial outcomes precisely because it is not approached primarily as an outcome-producing technique and invites us to meet reality on its own terms rather than attempting to exert control over it.
The Mindful Practice in Medicine program lives in the tension between awakening and connection on the one hand, and the instrumental desire to make things different on the other. Physicians and other health professionals attend this program because they know that something is not right with the relationship between their goals, values, skills, and ideals for their work lives, and the lived realities of the imperfect human systems within which they work. The pedagogical approach recognizes these needs for something different, something to change, something better, while at the same time holds that awakening and connection moves the learners toward a deeper source of flourishing.
“Awakening” requires bringing our capacity for awareness “online,” while becoming aware of one’s own inner life. Waking up results in simultaneously becoming more capable of seeing another human being as we become aware of the experience of our own embodied and lived humanity. We notice the human experiences within us of fear, longing, grief, tenderness, impermanence and therefore find the recognition of these in others as inseparable. In this way, contemplative practice is always relational, and connection forms the prerequisite or fertile ground for healing relationships to truly emerge. We have all experienced moments of performing a professional task expertly while remaining existentially absent. Without that connection, the experience of being human within us and within others, we can do anything, except what matters most: recognition, healing, and love. Likewise, each of us has experienced presence, and its absence. That ineffable quality of attention, embodiment, relationality, authenticity, which animates and energizes human relationships and encounters.
Awakening involves not only the recognition of beauty, connection, meaning, and deeper satisfaction but also the experiences of impermanence and mortality, the experience of futility, the playing out of one’s identity as mere performance, and the emptiness of bluster, of shouting out into a world that may not realize that we feel that we rightfully belong at its center. It becomes easy to see the irony within any efforts to change one’s fill in the blank (work, job, relationship, home, country, friends, family, fortunes). The experience of meaninglessness, hopelessness, and uselessness can create a paralyzing dynamic. Awakening to these truths may not always be pleasant or easy yet removing the protective illusions of denial can reveal a deeper and more meaningful encounter with life itself.
We experience this existential threat toward the end of Shakespeare’s Macbeth, as Macbeth hears of yet one more loss, that of his wife, Lady Macbeth:
Life’s but a walking shadow, a poor player
That struts and frets his hour upon the stage
And then is heard no more. It is a tale
Told by an idiot, full of sound and fury
Signifying nothing.
— William Shakespeare, Macbeth, Act V, Scene V, lines 24–28
And yet, it might be possible to learn that rather than interpreting the realities of what each human being faces during a normal life as signs of meaninglessness, these can be exactly what makes presence so precious. Impermanence imbues value rather than negates it. We naturally move toward this understanding. Part of the beauty of the natural world and the changing of the seasons are their transient nature. The momentary and hedonic pleasure of the rich taste of ice cream on the palate can only be appreciated through its absence moments before and then shortly after. The relief of suffering that occurs through a medical or surgical intervention transforms the experience of a never-ending agony into its absence and the return to wholeness. And so on, as the Greek philosopher Heraclitus wrote: There is nothing permanent except change.
So, what are our contemplative practices about if not for instrumental purposes such as becoming calmer, more productive, more resilient, and essentially “better”? I am not discounting those outcomes, if they were to happen, but there are no guarantees. And despite the very human drive to feel better, contemplative practice is not fundamentally about that end. In exploring the question of the goals of contemplative practice, fuller participation in life seems fundamentally different than self-improvement. Those objectives just mentioned above seem incompatible with the truths that Macbeth spoke of in his despair, for one could ask oneself the question that if life really was this meaningless hour “upon the stage” what would be the point in becoming calmer, more productive, more resilient, or “better”?
For me, in order to sit on the cushion or just be still and do seemingly nothing for five, ten, thirty, or however many minutes, it would have to include the possibility of inhabiting my life more fully during those minutes and beyond them, of cultivating my capacity for presence, of seeing myself and others as fully human, and of waking up to the reality of the brevity of time (at least the time I have to live).
As a physician, I have accompanied people over parts of their journeys through birth, aging, illness, and death, as have so many of you. And although at times I have become defended, procedural, or even numb, contemplative practices have helped me not to escape the realities of the inevitable arc of human life, but have trained me to better meet those realities.
For me, I hold the following as guides, which I try to live into or toward, which I miss the mark much of the time, and yet continue to practice waking up to them. On and off the cushion I incline my being toward not needing to transcend this human experience, which I believe is impossible despite great efforts at times to do just that. I consider entering it more honestly, working with acceptance of how things actually are, not as a point of resignation but as a starting point informing my next action. I remind myself that my life is not a self-improvement project, despite lots of people and entities wanting me to literally buy into that idea. It may be enough to just be alive. And I am finding value in learning to know myself better and as not separate from learning to recognize others. Finally, I try to, with a lot of support from people who care about me, participate wherever and whenever possible with awareness in the only moments I have to live, right now.
The answer I am finding to Sound and Fury is not the certainty of achievement, but the power and value of connection and presence.