The Challenges of Clinical Practice in Turbulent Times

Mindfulness as a resource

Posted Mar 12, 2017

Renowned writer George Saunders, author of the highly acclaimed new novel, Lincoln in the Bardo, uses this metaphor with his students, “Imagine you’re on a cruise ship, and the surface is made of ice, and you’re carrying six trays, and you’re wearing roller skates, and you’re drunk. And so is everybody else.”

            This seemed to be an apt metaphor to start our conversation, The Challenges of Clinical Practice in Turbulent Times, that I organized with my colleagues Jan Surrey, Meghan Searl, Susan Morgan and Mitch Abblett for the Institute for Meditation and Psychotherapy.

            Those of us who are clinicians (and we’ve been hearing similar stories from colleagues who are cardiologists, dentists, GI specialists, etc) are finding that stress-related disorders seem to be on the rise. While clinical practice is never easy (Freud called it an “impossible profession” for a reason), it has been increasingly difficult for many to practice in this time of uncertainty and change. Clinicians who attended the event also reported seeing an increase in anxiety, insomnia, fear, anger, PTSD, and hate crimes in their practices.

            What has been particularly humbling for many of us is that we used to have the illusion that we knew how to help. We’d gotten used to giving advice on how to manage one’s life, and how to live in a way that seemed wise and sane. For many of us, it’s no longer clear what constitutes a sane response. People look to us for advice, and we often don’t know how to respond. We are all in this together. And there is no right way, no right answer. While some of us were finding strength and clarity in meditation, others were feeling empowered by social action.

            As psychologist and meditation teacher Jack Kornfield put it succinctly, “this is what we have been practicing for.” While we don’t want to minimize the enormity of the loss and the depth of despair, this can also be a time to explore how meditation practice can be a healing resource in the midst of difficulty, fostering not only well-being and sanity but also compassion, wise action, and equanimity.

            I continue to be inspired by the words of Maha Gosananda, who was called the Gandhi of Cambodia, helping the country re-build after the Khmer Rouge. He wrote:

There is little we can do for peace in the world without peace in our minds. And so, when we begin to make peace we begin with silence and meditation. Peacemaking requires compassion. It requires the skill of listening. To listen, we have to give up ourselves, even our own words. We listen until we can hear our peaceful nature. As we learn to listen to ourselves, we learn to listen to others as well and new ideas grow. There is an openness, a harmony. As we come to trust one another we discover new possibilities for resolving conflicts. When we listen well, we will hear peace growing.

And this is where the practices of Compassion and Lovingkindness can be so useful. They begin with an understanding that all beings want the same thing—that we all want to be happy, to be healthy, and to life without suffering. The teaching is that we are more alike than different.

            Perhaps George Saunders’ words reach across a divide and guide us as well: “I’m going to pretend that everyone out there is my brother or my sister, and if they are temporarily behaving like they’re not, I’m going to insist that they’re just confused.”

Psychologist Susan Pollak, MTS, Ed.D., co-author of the book Sitting Together: Essential Skills for Mindfulness-Based Psychotherapy, (Guilford Press) has been teaching and supervising at Harvard Medical School for over twenty years.