In Search of Mindfulness

by Francis C. Biley, RN PhD

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Abstract
Having gained insights into the nature of mindfulness, primarily through the engagement in specific craft activity, the author embarked upon a journey through Japan in order to further explore the subject of mindfulness in relation to both craft production and in its applications to health care practice. Relating these experiences to the Western interpretation of mindfulness in health care revealed authentic mindfulness as a very elusive concept, but with considerable and valuable therapeutic potential.

Key words: mindfulness, meditation, mindfulness meditation, crafts, nursing, health care, Japan

My journey of discovery
It was mid morning, a few days ago, and I was starting to get down on paper a few words about mindfulness, ‘mindful’ of course that I was intending to write a paper on the subject. It wasn’t going particularly well. The sun was shining, and I was being drawn towards my garden that was in dire need of attention before the rains came. I was being email-bothered by some chap who wanted me to get him copies of Maslach’s Burnout Inventory (and was increasingly needing it myself). I was experiencing a block. The words and images were not coming easily. So I decided to take a break.

I walked from my study through my garden and into the kitchen in order to make myself some coffee. All the time I was thinking about how I was going to address the issue of mindfulness. I was making some toast, which came out burnt, and poured water onto the coffee...and I immediately realised, sensed, that something was wrong. I’d forgotten to boil the water. I had been so troubled by my inability to progress with writing this very paper that I had failed to concentrate on making my coffee. I had to start all over again with the coffee, but, ironically, I had found an introduction to my paper.

Mindfulness is, of course, all about being in the moment, which is exactly what I was not doing when I was making my toast and coffee. Mindfulness is about being fully aware of one's thoughts, actions and motivations; it is about being in true presence; it is about bringing the mind into focus; it is about seeing the inner and outer aspects of true reality (whatever ‘true’ might mean). But it is also, in one sense at least, to be free of thoughts, or at least to recognise that thoughts are just that, they are just thoughts, and not reality. Perhaps if you can be free of thoughts, then you can view reality without commentary. So easy to say, so difficult to do.

My journey of discovery began innocently perhaps ten years or so back, when I took up the hobby of woodturning. At first it was difficult and dangerous. I made dreadful wooden bowls (although I was very proud of them), and getting the technique right (and avoiding the dangers of engaging with a huge lump of wood spinning at up to a couple of thousand revolutions a minute) was my prime concern. Bowls cracked, they exploded (yes, literally!), and most of the time just didn’t look very nice; finger nails were ripped off, and the fingers on my left hand were nearly removed by a split second moment of inattention with what should have been an inerrant band saw. But as time progressed, my technique got better and safer, my bowls got thinner (which is one good indicator of quality), and they started to look nicer. “You should sell these bowls,” visitors would pronounce.

As all this was happening, my preoccupation with technique seemed to drop away. I found that when I was turning bowls, time seemed to stand still. My mind felt as though it became empty, my thoughts and my own internal commentary seemed to disappear. I was beginning to safely produce technically and aesthetically satisfactory bowls without thinking about it! Was this mindfulness, I wondered?

One evening, my friend, who is my inspiring muse, called around for dinner and as usual, we ate, and we drank just a little wine and we talked well into the night. Both nurses, we talked about how mindfulness could be brought to nurses, and about how being too concerned with the technical, the commentary, or the mind’s endless chatter, could detract from the real essence of nursing, health and social care practice - that is, being able to engage in truly authentic presence with the other. One thing led to another, and before I knew what was happening, I found myself giving an address to a major international conference on the very subject. Expert nursing and health care practice could be achieved, I asserted to what felt to be an increasingly disbelieving audience, with an emptying of the mind; not-thinking about doing; being as well as doing, or perhaps just being, without doing, by not-doing. To extend the puzzle and word play even further perhaps, doing by being; doing by just being.

And so it came to pass. Early in 2008 I found myself in Sogenji, a 17th century Zen temple in Okoyama in the Bizen region of Japan, under the direction of Priscilla Daichi Storandt, or Chi-san, as she is known, second in command to a Rinzai Zen priest, Shodo Harada Roshi. There, I began to understand that the overcoming the concepts of self, being, life and soul must be accompanied by a strong social sense and consciousness. And I began to understand that this can be achieved by asking questions, such as “when seeing, how do we see?” “When touching, how do we touch?” and “When thinking, how do we think?”.

Being at the Songenji Temple was part of my recent journey through Japan in search of mindfulness, and the main question that was nagging me was, how much have we, in the West, misinterpreted mindfulness in its application in health care settings. And again, the answers were not coming to mind. As Walt Whitman said, “In this broad earth of ours amid the measureless grossness and slag, enclosed and safe within its central heart, nestles the seed of perfection” (Whitman and Rogers, 1995; page 209). But where exactly was this place?

I travelled to temples, and hospitals, and spent time with various Roshis and teachers and senseis, including priests, kyudo (Japanese archery) practitioners, potters, artists, tea ceremony practitioners and calligraphers. As, in the words of D. T. Suzuki, “All the arts as they are studied in Japan...are not intended for utilitarian purposes only or for purely aesthetic enjoyments, but are meant to train the mind, indeed to bring it into contact with ultimate reality.” I spent time living with a kyudo archer, as “Archery is...not practised solely for hitting the target...in the case of archery, the hitter and the hit are no longer two opposing objects, but one reality” (Suzuki, 1999; page vii-viii).

If it is possible to accept the idea that in nursing and healthcare we need to have patience to wait until the mud settles (Loa Tzu, 551-479 BCE; 1990). An emergent difficulty that we all seem to have in health and social care is that we are always looking backwards for evidence of best practice and for experiences upon which we can base our current practices, by using reflective practice perhaps. Or we are looking forward, for hoped-for patient throughput targets, outcomes and cures, achieving nursing diagnosis and outcome goals  and so on. And in doing, as Alan Watts (1997, page 23) has suggested, we are perhaps not living in the real world, not in the now. Watts said, “If my happiness at this moment consists largely in reviewing happy memories and expectations, I am but dimly aware of this present” and that “I shall still be dimly aware of the present when the good things that I have been expecting come to pass. For I shall have formed a habit of looking behind and ahead, making it difficult for me to attend to the here and now. If, then, my awareness of the past and future makes me less aware of the present, I must begin to wonder whether I am actually living in the real world.”

Mindful practice in modern Western healthcare mirrors Watts' sentiments somewhat, in stating that, for example, “The present is the only time that any of us have to be alive, to know anything, to perceive, to learn, to act, to change, to heal" (Kabat-Zinn 1990).  Similarly, one UK based organization (the Centre for Mindfulness Research and Practice) maintains that “Mindfulness is about being fully awake in our lives, paying attention with intention and without judgement. This accesses our own powerful inner resources for insight, transformation and healing.” However all of these views are still Western interpretations of mindfulness, as is mine, of course.

A growing and now substantial body of work in what Kabat Zinn has called Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT)] has identified that Western mindful practice has been used successfully as an adjunct to treatment for those with a wide range of healthcare needs. These include many chronic disorders, such as substance misuse disorders, pain, anxiety disorders, depression, cancer, skin disorders, and stress, The range of evidence to support such interventions is growing almost daily and is very impressive. However, one review (Baer, 2003) questioned the clinical significance of existing research findings and also raised criticism of design research elements. These issues have been somewhat mirrored by a systematic review and meta-analysis that came to slightly more favorable outcome conclusions in terms of clinical significance (Grossman, et al. 2004).

However, mindful practice, as it seems to have been interpreted by the majority of Western healthcare workers, appears to revolve around the practice of meditation, relaxation exercises and, to some extent, yoga. Although this might be a good thing in its own right, it may not be the same thing as is practiced or sought in Japenese/Buddhist mindful practice. Indeed, Kabat-Zinn’s MBSR program was initially called the stress reduction and relaxation program, and it is fully acknowledged that “Western researchers and clinicians who have introduced mindfulness practice into mental health treatment programs usually teach these skills independently of the religious and cultural traditions of their origins” (Baer, 2003; page 125).

Kabat-Zinn’s Westernised version of a mindfulness program is conducted as a course lasting about ten weeks for groups of participants who meet weekly for about two hours of instruction and practice in mindfulness meditation skills, together with discussions about issues such as stress and coping. This is supplemented with intensive day-long mindfulness sessions. A range of mindfulness meditation skills may be taught and Hatha yoga postures may be used to teach an awareness of bodily sensations. Participants are also expected to practice mindfulness for at least 45 minutes every day during ordinary activities like walking, standing, and eating. For all mindfulness exercises, participants are instructed to focus attention on a target activity (perhaps breathing) and to be constantly aware of it. When emotions, sensations, or cognitions arise, they must be observed in a non-judgmental manner. When the participant notices that the mind has wandered, the nature or content of the thoughts are briefly noted, and attention is then returned to the present moment. Participants are instructed to notice their thoughts and feelings but not to become absorbed by them. Even judgmental thoughts (e.g., “this is not working”) must be observed non-judgmentally. An important outcome of mindfulness practice is the realization that most sensations, thoughts, and emotions fluctuate, or are transient, and pass by like waves in the sea.

However, in my mind, although this may be appropriate as a Western interpretation of mindfulness, this all feels too ‘noisy,’ too full of commentary, to be real mindful practice. As Ram Dass has intimated, “The quieter you become, the more you can hear,” and in the same way, Vonnegut has said, “Thinking doesn't seem to help very much; the human brain is too high-powered to have many practical uses in this particular universe.”

I continued on my tour around Japan in my search for mindfulness. I watched a monk going about her daily duties in a mountain-top Shingon temple, as she meditated on the performance of simple daily acts. I walked in the almost still, gently rustling other-worldly bamboo forests, and sat by a woodland stream. And I dwelt for probably too long on the paradox of the overwhelmingly immobile rusty bicycle that had been propped up, long forgotten, long unused, against the outside wall of one of the temple buildings. And I wondered about the monk, on his quest for enlightenment through the practice of kyudo. And I was reminded of the words of Antoine de Saint-Exupéry (2007) who said that I needed to “beware lest you lose the substance by grasping at the shadow; pure logic is the ruin of the spirit” (de Saint-Exupery, 2007). And I was reminded of the words of Herman Hesse in Siddhartha, who only found the answers when he was not looking: “When someone is seeking, it happens quite easily that he only sees the thing that he is seeking; that he is unable to find anything, unable to absorb anything, because he is obsessed with his goal. Seeking means: to have a goal; but finding means: to be free, to be receptive, to have no goal.”

And so I returned to Sogenji temple, where I had tea with Chi-san. And I had lunch with the monks. And I walked carefully in the grounds. I came across the koi pond, and some ever-so-patient, just waiting koi carp, and as I was waiting for the right time to take a nice photograph of the fish, I was reminded again of that earlier Lao Tzu quote, that said, “Do you have patience to wait till your mud settles and the water is clear? Can you remain unmoving until the right action arises by itself?”

It seemed as though I had the answer to my question. I watched the serene, peaceful and content, barely visible koi, appearing and disappearing out of view in the murky water, evading my camera, playing games with me, at once serious and playful, gliding gently and ever so slowly through the muddy water, occasionally coming up for air, or perhaps to see what was going on in the world; perhaps not. Perhaps waiting for the mud to settle, perhaps waiting until right action arises. Koi, what are you thinking? What is your world? Will you tell me your secret? Mindfulness, and my understanding of it, seemed to be like the koi, appearing and disappearing, illusive, but serene, unable to be seen properly beyond fleeting glimpses. I never did mange to get that photograph.

So what of my journey in search of mindfulness? So what of the West’s success in interpreting mindfulness?

Look to the East, train the mind, empty the mind, be a novice, be a beginner; be patient, live in the real world, not the past or the future, be still, find the seed of perfection, stop thinking, resist grasping the shadow of pure logic, have no goal... And encourage those with health and social care needs to practice the arts... And don't just attend an eight-week course in mediation. And remember the words of Suzuki, who said that “the arts...are not intended for utilitarian purposes only or for purely aesthetic enjoyments, but are meant to train the mind, indeed to bring it into contact with ultimate reality.” Be the koi.

Acknowledgements
The author would like to offer his sincere gratitude to the Great Britain Sasakawa Foundation who funded the study tour of Japan described here.

An earlier version of this paper, entitled “Reflections on mindfulness” was delivered at the “Refresh, Reflect, Renew: Connecting Through Reflective Practice Across Disciplines” conference; Centennial College, Toronto, Ontario, Canada; 28 - 30 May, 2008.

References
Baer RA (2003) Mindfulness training as a Clinical Intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice 10: 2, 125-143.
Centre for Mindfulness Research and Practice http://www.bangor.ac.uk/mindfulness/  (accessed 25.03.09).
De Saint-Exupery A.  The Little Prince. Heritage, Manningtree 2007.
Grossman p, Neimann L, Schmidt S and Walach H.  Mindfulness-based stress reduction and health benefits: a meta-analysis. Journal of Psychosomatic Research 2004, 57: 1, 35-43.
Hesse H.  Siddhartha. Norilana Books, Winnetka 2007.
Kabat-Zinn J.  Full Catastrophe Living: Using the Wisdom of your Body and Mind to Face Stress, Pain and Illness. Delta, London 1990.
Lao Tse.  Tao Te Ching. Shambala, Boston 1990.
Suzuki DT.  Introduction. In: Zen in the Art of Archery, by E Herrigel. Vintge Spiritual Classics, New York 1999.
Watts A.  The Wisdom of Insecurity. Rider and Co., London 1997.
Whitman W and Rogers D.  The Complete Works of Walt Whitman. Wordsworth Editions, Ware 1995.

Contact:
Francis C. Biley, RN PhD
Associate Professor, Bournemouth University, UK
fbiley@bournemouth.ac.uk

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