A review, by Jan Parker, of ‘Heal Thy Self: Lessons on Mindfulness in Medicine’ by Saki Santorelli, 1999, Bell Tower, New York (Random House).
“Don’t turn your head. Keep looking
at the bandaged place. That’s where
the Light enters you.” Rumi
The current revolution in mindfulness training is astonishing. There’s a wealth of books now on mindfulness, mostly aimed at the general public rather than the buddhist devotee. Ruby Wax is one of the latest authors. Saki Santorelli is the director of the Stress Reduction Clinic housed in the Centre for Mindfulness in Medicine, Health Care and Society (at the University of Massachusetts Medical School, USA), which the better known Jon Kabat-Zinn founded thirty five years ago.
Saki’s book is 15 years old now yet remains my favourite book on mindfulness because it’s so soulful, poetic, riddled with Rumi. If you’re yearning for a retreat and can’t make it at the moment, spend a few days with this book and it’ll have a similar effect, it evokes so well the process and feeling of intense group practice.
The focus of this beautiful and tender book is not just the healing power of mindfulness, it’s also about the healing relationship between ‘patient’ and ‘practitioner’. The context for exploring the dynamics of this archetypal relationship is Saki taking a group of thirty people (most of whom stay the course) through an eight week programme of Mindfulness Based Stress Reduction (MBSR). People are on the course with a range of ‘conditions’ including workaholism, cancer, and persistent angina.
Several friends of mine run these or similar courses (in the UK), either through the Kabat-Zinn programme that the Bangor university and Oxford courses are based on, or through Breathworks. Many people sign up for these courses because they’ve tried everything else and nothing yet has eased their pain and suffering. They are not usually there because they want to learn how to meditate, and they have to commit to a daily 45 minute practice to stay on the programme.
“this stress reduction is killing me…”
Lucille, one of the ‘patients’, says “this stress reduction is killing me. This is the hardest thing I’ve done in my life.” In the section on week four, he says “by this time in the process, class never really ends”.
In the sixth week there’s an all day retreat of 120 people, 90 more than the current class as some previous punters come back for a top-up of experience and inspiration. It’s free. And in total silence for a whole day. This is the first time most people have had that experience. And this is happening in a hospital ie the wider context includes scores of people who have spent years training to be medical professionals. Mindful of that, Saki quotes Jacob Needleman: “No one ever imagines that self-observation may be a highly disciplined skill which requires longer training than any other skill we know of…….”
the importance of a fully present doctor…
In his foreword Kabat-Zinn comments on how there is still a long way to go in the re-humanising of medicine. It’s encouraging to hear that medical students also attend their programmes and that there’s a growing understanding from doctors how a lack of full presence on their part may have terrible consequences not only for their patients, but for themselves too.
“Almost nowhere in our modern lexicon,” Saki writes, “does the use of the word practice suggest that, side by side with the acquired knowledge of our chosen field, and externally directed activity, we are simultaneously called on to make an active, ongoing effort to work with ourselves inwardly if we are to engage in the full practice of our profession.”
…and a fully present ‘patient’ too
The issue of ‘presence’ and ‘practice’ in the patient-practitioner relationship cuts both ways. There is an increasing – and positive - trend, when people become ‘patients,’ to be less passive, more informed, and more desirous of partnership in the healing process than in past decades. Yet it’s also still sadly the case that “many health professionals point towards this same felt absence of practice when they work as hard as they can in the service of those seeking their care, but find little motivation on the part of people to collaborate actively in their own health, unwilling to engage wholeheartedly in the ‘practice’ of being a patient”.
a co-creative process
I first read this book a few years ago when I was training to be a kinesiologist. The school I trained with, Creative Kinesiology, places as much emphasis - if not more – on developing one’s awareness and sensitivity, as on learning techniques. One of it’s core principles is that the work is a co-creative process. So I found myself especially appreciative of Saki’s exploration of this dynamic relationship, not just as a long-time meditator and meditation teacher, but now as a fledgling kinesiologist too. His approach spoke to me and interested me far more than the classic ‘teacher-disciple’ relationship that I find hard to relate to, especially when rigidly and hierarchically applied.
In a chapter called ‘Going Down’, in the section on week three, Saki writes eloquently and incisively – as always – about this dynamic: “what happens in that alive, open space called the patient-practitioner relationship demands…close attention. It is an embodiment, a direct expression of interconnectedness and interdependence. Beyond a doubt we work on ourselves as a means of helping others and, simultaneously, working with others is a way of working on ourselves….It changes the entire nature of the healing relationship from one of fixing and rescuing, or authority and domination, to one of service, collaborative creativity, and inquiry”.
a new Hippocratic oath?
He later says, in what to me sounds like a much needed modern translation of the Hippocratic oath: “Our privilege and responsibility as servants of the healing arts is to create an environment, provide a method, and inspire people to touch what we, beyond any evidence to the contrary, know is who they really are because we have touched this within ourselves.”
cooking lessons, the dress code…
Saki writes convincingly and sensitively about what mindfulness and meditation is; about the process one goes through, whether its in a minute or a month; and about how even more extraordinary it can be to share that process with other people. “It is obvious,” he comments after a few weeks, “that we are all beginning to cook.” And later he adds: ”here there is only one dress code: Nakedness.”
…and an act of love
Mindfulness is not simply a technique, he reminds us; it’s an act of love. This is an intimate book because it is intimate work, an intimate process. And although “for the most part, this is solitary work”, it’s also the case that “the most powerful outcome of our gathering together was the transformational effect that we had on one another”. It’s my experience – as both ‘patient/client’ and practitioner – that this can happen in a one-to-one kinesiology session too.
“Here there is sickness and suffering,” he writes. “For me to do my job, it is unavoidable and necessary to remember and face this daily….when I do not, the consequences are grave. I find no place to stand, no place to be connected.” Having an illness creates enormous, unanticipated turbulence. It is by no means a smooth road. Mindfulness offers a tool for being able to handle this, a way to open to a gamut of often disturbing events, and associated thoughts and emotions, and it helps us keep our seat through it all, provides a kind of ‘stability’ in the flow of experience.
This pioneering work at the stress clinic – and on mindfulness courses – is not trying to make pain and suffering go away. Rather, it shows people how to move into the stress or pain and begin to look at it, to notice the mind’s reactions, and to let go of that reactivity. And then find that there is inner stillness and peace within some of the most difficult life situations. That can be right in this breath, in this experience. It is, if you like, a meditative version of the discharge principle in various forms of complementary medicine, where something is completed and cleared – as opposed to pharmaceutically suppressing symptoms. And is akin to ‘self-liberation’ in the Vajrayana/tantric tradition in Buddhism.
…the open space
“Caring often asks nothing more than open space,” Santorelli says, in a deceptively simple sentence, because, of course, that needs time, a certain attitude or understanding, and commitment. This is clearly not the currently conventional approach to healing. And it gets better still – for me – when he adds: “Most essentially, this way of working is intended to carry us further away from the world of being sure, into the world of not knowing. To be a professional and to not know seems an oxymoron. Nothing could be further from the truth.” A professional who admits to not knowing everything and is full of love! I’d trust this man with my life. Wouldn’t you?
I’m glad to read of all the clinical trials and scientific studies proving how mindfulness helps reduce the level of pain people report, helps reduce the recurrence of depression, and improves other medical and psychological conditions – not least because most, if not all of us, will suffer one or more of those in our lifetime. I’m glad too because it helps people trust and therefore try it. Yet Saki reminds us there’s a magic and mystery in mindfulness practice too that can’t always be pinned down and proved. And there’s many others, including me, who that appeals to as well.
There are thirty practices outlined in the book. (Which are not listed on the contents page – my sole criticism.) Many of them are other ancient meditation practices (that I know of, from the Buddhist tradition). Mindfulness is the basis for all the practices, as well as a practice in its own right. Without under-estimating what powerful medicine mindfulness is, many of the other practices offered in this book go ‘further’ than mindfulness, though -ultimately – it often amounts to the same thing.
watch the distance boundary-making creates
One practice in the book is called ‘working with the boundary-making mind’. “Whether patient or practitioner,” he writes, “we are always in relationship… Can you feel the critical need for each of us to cultivate a willingness to closely watch the boundary-making mind and to develop an extremely refined tool for understanding with precision this process and the distance it creates? I believe that such deliberate and careful attention is the foundation for the entire healing relationship. This begins with our individual commitment to a disciplined way of understanding the nature of mind and its effect in human interactions. Without this kind of attention, how are we ever going to create more collaborative, mutually responsive health care?” That’s a very good question.
I savoured this book because it joins medicine with meditation. “This is medicine moving into the 21st century,” he asserts. I hope he’s right. With all my heart.
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