Exploring the idea of Mindfulness
by Indira Garaeva


By definition, dehumanization is the act of depriving one of human qualities such as individuality, compassion, or civility.[i] The medical profession has always incorporated values such as empathy and personalized care. However, increasingly, contemporary medicine is becoming more target-oriented where it is the disease being treated and not the individual. In a medical context, this can be seen as a vice or a virtue – virtuous in the sense that it can instill objectivity towards the patient’s history, thus leading to a logical and clear differential diagnosis and treatment. But the vice in this reductionist thinking is the loss of a personal doctor-patient relationship, which is a central theme in clinical medicine. The key to achieving the best patient care is finding the balance of both holistic and reductionist approaches.

I was genuinely impressed by the lecture on mindfulness given by Dr. Morrice[ii] and as an experiment, decided to go for a walk around Bristol with my camera and attempted to be mindful throughout. I tried to capture individual moments that surround us in our day-to-day lives but which we usually would not notice or just dismiss due to our hectic lifestyles. Mindfulness is a state of dynamic, open awareness of the present moment. By being mindful you view your thoughts and emotions from a distance, without judging them subjectively.[iii] Through development of our awareness, we can be completely conscious of simple physical sensations such as the sound of splashing water in a fountain or the awakening aroma of coffee in the morning. Mindfulness allows us to observe intricate interplay between thought and emotion. Buddha made an explicit and clear call for us to live in the present moment: ‘Do not dwell on the past, do not dream of the future, concentrate the mind on the present moment’; a simple idea that echoes across cultures, traditions and literature, but coming to a personal realization of it, would mean that we can actually ‘live life’.[iv]

My piece is an allegory of the doctor-patient relationship in modern target driven health care, where the pigeons represent interaction between a doctor and a patient. This piece came to life as a result of experimenting with burst-mode photography and trying to capture every moment as a meaningful sequence of events. In this mode, a number of pictures can be taken with one press on the shutter. As I put the photographs in the order they were taken, it was surprising to see similarities of what seems like a simple play of pigeons in the fountain with doctor-patient interactions. As I came to analyze it later, only through being mindful, could I actually notice such a pattern and draw a greater meaning from it. Mindfulness allowed me to disengage myself from what I actually saw in front of me and develop a different way of looking at things, which otherwise would seem ordinary. Though this may seem mundane to begin with, the similarities are quite graspable. The interpretation I gave to the pictures is that the pigeon on the left represents the doctor and the one on the right is the patient, and this portrays a typical consultation in general practice. The ‘patient’ approaches the ‘doctor’ and tries to communicate his condition by ‘splashing’ his initial symptoms and general problems onto the ‘doctor’. But because the ‘doctor’ does not perceive any physical problems with the ‘patient’, the ‘doctor’ does not respond or even look at the ‘patient’. This depicts how contemporary medicine has come to be represented to the public, in the sense that doctor’s professional lives have become more and more frantic with the requirement of meeting set targets rather than spending time with the patient and developing a strong personal relationship.

 A patient is an individual in his own right, with a complex system of feelings and emotions of his own.  It is not just a physical body that defines a person, but also a social body and particularly, their psychological makeup. In the image, the ‘patient’ loads the ‘doctor’ with personal information, relating his subjective experience of being ill, whereas the ‘doctor’ is emotionally disconnected from the patient, objectively perceiving simply a physical disease. Rather than observing the patient, being involved in the conversation and trying to assist the patient in telling their story, the patient’s history is considered to be somewhat problem-solving, where a patient is categorized into convenient management pathways in order to meet the targets that had been set. [v] There is less time for a doctor to take account of the whole person, and instead a patient’s body is reduced to just a biological level, where the body is perceived as a machine with organs as fragmented parts, which can break down and get repaired or even replaced by substituent parts. This dehumanizing view of the body, although mechanized and completely devoid of spirit and emotions, has led to medicine’s success in battling over certain diseases, such as the now-routine practice of organ transplantations and the re-routing of blood vessels in heart bypass operations.[vi] There is, however, a risk of being unable to investigate a cause of the disease with emotional background. For example, the cause of Takotsubo cardiomyopathy (commonly referred to as ‘broken heart syndrome’), which is usually induced by high levels of emotional stress.[vii] In this context, the reason I specifically chose pigeons to represent how medicine has become less and less personal is because they literally symbolize this reductionist dehumanization.

Task-oriented medicine is technically a warped holistic concept. It looks at society as a whole system, “the big picture”, treating as many individuals as time would allow and creating targets in order to maximize efficiency. However, at the same time, looking at it on a smaller, more humanistic level, the individual patient care has been compromised for the majority, leading to a mediocre healthcare provision. Individuals themselves are holons that are nested within the larger system of society which influences the way they present themselves and behave in public.[viii] In turn this affects medicine, as doctors only see one side of a patient - that being their physical pathologies, rather than that alongside their psychological and social makeup. Thus, doctors may unconsciously forget the principles of whole person care within their practice, neglecting “the story behind the story”.[ix]

I drew on the importance of society by relating it to the water-fountain which is in the background of all four pictures. It represents how society encircles both the ‘doctor’ and the ‘patient’ - they are ‘immersed’ within it, each one being part of the same system. Society also influences how the patient presents himself to the doctor. Along with his initial symptoms and general problems, society has an effect on the way the patient feels about his illness, hence the splashing of water (which represents society) and being drenched in the ultimate photograph and thus, metaphorically, overwhelmed by society.

Eventually, the ‘doctor’, who ‘hid’ throughout the entire consultation, turns towards the ‘patient’ who has already given up in despair. This is quite ironic in the sense that when the patient required the doctor’s help, even if only in the form of reassurance or moral support, the doctor was concentrating only on the biological side of the symptoms, and thus was unable to relate to and help the patient on a personal level. The medical profession was always associated with values such as caring, compassion and empathy, and in target orientated health practice this has failed to present itself.

My selected ‘personal activity’ involved exploring the concept of mindfulness, which resulted in creating a piece that reflects many aspects of modern medicine, namely target oriented healthcare, the doctor-patient relationship, dehumanization of patients and the idea of holarchy and systems. After the exercise with a raisin during week three of the course, I felt enlightened. I was amazed that such simple thing as self-awareness has the potential to change my life towards a greater sense of emotional and physical well-being. It seemed natural for me to pursue this exercise further and go for a walk around town being mindful throughout. I found that concentrating on the present is harder than it seems. Keeping your mind on breathing and ignoring the chatter of your own thoughts was challenging, but once achieved, felt so calming. I felt a strange feeling of contentment with the present. I noticed things that I would normally dismiss every day, such as warmth of sunlight on my face or the sparkling appearance of dew on leaves in the morning. It was fascinating to see the pigeons enjoying the first hint of spring sunshine in the fountain, and taking the photographs all throughout my walk allowed me to appreciate the present. Even now, looking back at the pictures, I remember with such clarity the moments of that day. As I mentioned earlier, combining the photographs of pigeons into one collage allowed me to explore and extrapolate a greater meaning from the ideas discussed in the Whole Person Care element and truly understand the importance of a balance between holistic care and the reductionist approach, otherwise known as integrative medicine. It is only the combination of the two that would lead to effective medical care and I hope to incorporate these ideas into my future practice and career as a doctor.

 


[i] Concise Oxford English Dictionary, Oxford University Press, 2008

[ii] Dr Andrew Morrice, Emotional factors in Health or “Dis-stress and Dis-ease”, Lecture 3: Whole Person Care, Lecture theatre 1.4, Faculty of Medicine, University of Bristol, 2011

[iii] Sussex Directories, Inc., Psychology Today: Mindfulness. [Online]. Available from: http://www.psychologytoday.com/basics/mindfulness/ [Accessed 25th March 2011]

[iv] P. Simpson, R. French. Negative Capability and the Capacity to Think in the Present Moment: Some Implications for Leadership Practice, Leadership 2006; 2 (2): 245-255

[v] Nigel Rawlinson. Harms of target driven care, BMJ 2008; 337:a885

[vi] Bradby H. Medical Sociology: An Introduction. London: SAGE, (2010) p.127

[vii] Dr Trevor Thompson, The Big Ideas in Whole Person Care, Lecture 2: Whole Person Care, Lecture theatre 1.4, Faculty of Medicine, University of Bristol, 2011

[viii] Dr Trevor Thompson and Dr Sarah Davies, All Systems Go! The Systems Approach in Biology and Medicine, Lecture 1: Whole Person Care, Lecture theatre 1.4, Faculty of Medicine, University of Bristol, 2011

[ix] Nigel Rawlinson. Harms of target driven care, BMJ 2008; 337:a885

 

Indira Gareva,

Whole Person Care, Year One, 2011