BY: DANIEL P. DWYER, PhD
Dr. Dwyer is director of ethics, St. John's Health System, Springfield,
About 800 years ago, an apparently odd cultural integration occurred in Japan.
Samurai warriors, who were highly trained warriors feared for their swordsmanship,
began to embrace Zen Buddhism. This curious blend of meditative practice and
martial fierceness made the samurai even more effective fighters—willing, if
necessary, to sacrifice their lives in obedience to a code of loyalty.
How did this come about? These warriors faced death in every encounter with
an opponent. Too strong an attachment to life, they saw, could produce a fear
of death that impeded presence and induced self-consciousness. A single moment's
hesitation or surrender to emotion could mean the difference between life and
death. Zen taught them that "a stable inner platform of mental control," sustained
and maintained by a meditative and contemplative practice, would result in a
state of "no-mind"—a state in which, hampered neither by thought nor emotion,
they became simple fluid action. This "no-mind" state of consciousness improved
their effectiveness as swordsmen.1
Of course, spiritual development does not necessarily go hand in hand with
moral development. The image of the warrior embracing a contemplative practice
can be offensive. We do not forget other unhappy alliances between warriors
and religious practices: the Christian crusades, Muslim jihads, and the recent
tragedies involving al-Qaeda and the Taliban. These episodes were all distortions
of the intentions of the founders of their religions. Still, the samurai may
serve as a symbol of the challenges and opportunities we face as leaders and
providers of competent and compassionate health care.
Of course, several questions come to mind: How do we balance and integrate
a life of action with a deep yearning for contemplative presence? How do we
develop an engaged spirituality? Perhaps the Zen samurai, as a metaphor for
a life that is both contemplative and active, will inspire us to think
more creatively about new ways of being and doing.
A book that appeared several years ago compares the approaches of two exemplars
of engaged spirituality: Thomas Merton and Thich Nhat Hanh.2 Both
were monks, the first a Catholic, the second a Buddhist. Their lives and public
efforts reflected lifelong attempts to integrate contemplative practice with
action. Although Merton rarely left the Kentucky monastery where he lived and
worked from 1947 to 1968, his writings inform us about the contemplative attitude
as it confronts a world of action. For Merton, the person "who attempts to act
and do things for others or for the world without deepening his own self-understanding,
freedom, integrity, and capacity to love, will not have anything to give others."3
Unfortunately, Merton advocated contemplative practice and its fruits without
describing precisely how to do it.
For his part, Thich Nhat Hanh, a Vietnamese monk, left the monastery of his
youth to promote what he called an "engaged Buddhism" in opposition to the war
in Vietnam and to teach, write, and conduct retreats. During this period, he
wrote for his students "a manual on meditation for the use of young activists."
Published as The Miracle of Mindfulness, the book offers instructions
on "mindfulness" practice while engaging in action.4 In addition
to teaching meditative techniques, Thich Nhat Hanh advocated spending one day
a week being intentionally "mindful" in everything performed that day. In his
later years, he has written extensively about meditation for people who live
their lives in various worldly ways.
In word and example, both Merton and Thich Nhat Hanh formed a challenging
template for the rest of us to follow in trying to integrate our lives. The
trouble, however, is that we expect monks to talk this way; in each of
us a little voice may be whispering, "Easy for them to say!"
Spirituality and Washing Dishes
This reaction comes from a tradition of seeing a contemplative life and an
active one as two opposing choices. Monks can live an engaged spirituality because
monks are contemplatives. Lay people are hampered by the secular nature of their
lives. The presumption is that a contemplative discipline is a condition of
one's context as opposed to one's role. Yet Brother Lawrence of God taught us
many years ago that practicing the presence of God can occur while we wash the
dishes.5 The Zen tradition admonishes seekers of special rites and
rituals to simply chop wood and carry water. When they met, Thich Nhat Hanh
told Merton that he had not been taught meditation skills until he first learned
to open and close doors without slamming them. Remember, too, the example of
Parker Palmer notes that some of the spiritual literature of our time extols
the example and work of spiritual masters such as Merton and Thich Nhat Hanh
but, at the same time, denigrates the active life as a source of spiritual growth
and development. "Contemporary images of what it means to be spiritual tend
to value the inward search over the outward act, silence over sound, solitude
over interaction, centeredness and quietude and balance over engagement and
animation and struggle."6 Ironically, Palmer finds in the life and
writings of Merton the support for a spirituality of action grounded not in
a monastic spirituality but in the tension between Merton's own activist perspective
and the monastic life form. The philosopher Ken Wilber has written of engaged
spirituality as a consequence of developing an "integrated transformative practice."7
In his view, we need to exercise and express features of our mind, body, soul,
and spirit in ways that develop our personal and societal responsibilities.
Wilber points out that compassion and service emerge from an integrated practice.
The Spirituality of Imperfection
An engaged spirituality invites us to look at the active live as the material
with which to build our contemplative capacities. It calls us to go deeper into
the field of action and transform it, rather than withdrawing from the world
and its complications. The challenges we face at work and in our relationships
make up the rich soil in which we can grow a conscious presence that transforms
our work and our relationships. We don't, in the course of our work, face physical
death like the samurai, but we can certainly find there many opportunities to
face the death of our egos, illusions, and incessant dramas. The loss of any
of these can seem as threatening as the loss of one's life. This is why we are
so attached to them. But imagine the consequences of work performed out of a
fully conscious state—care provided with a sense of presence unencumbered by
fears about the future or resentments about the past. Workers in health care
organizations are faced with several particularly difficult areas that invite
an engaged spirituality.
If one is trying to achieve a high level of quality while, at the same time,
providing competent and compassionate service, one is sure to be presented with
challenging opportunities. In work, an engaged spirituality discovers and honors
a spirituality of imperfection. John Tarrant reminds us that "Spirit forgets
the necessity of imperfection."8 Tarrant means by this that we are
always tempted to pursue a disembodied spirituality free of noise and pain.
But an engaged spirituality stays grounded in the muddle of life and work.
In our yearning for zero defects, we deny the reality of our humanness, deny
that the soul of health care comes with sorrow and pain. Quality improvement
and risk management have become highly technical, bureaucratized systems of
measurement and analysis, involving committee deliberations. Underneath these
procedures is a deep well full of shadow material: failure, grief, and pain,
much of it displayed publicly by public commissions and newspapers. The accounting
firm scandals reported in the press last year are examples of the difficulty
we have as humans in facing the truth of our inadequacy and willingness to cover
it up. We all know about our own errors and missteps. In risk management, we
face disclosing the bad news and suffering the consequences in financial losses
and public relations. An engaged spirituality does not make excuses for our
limitations. It does, however, consecrate acceptance of mistakes by balancing
rigorous self-examination and corrective action with forgiveness of one's self
and one's organization.
The spirituality of imperfection is an intensely personal, as well as organizational,
experience. Individuals who make mistakes face issues of guilt, shame, and lack
of forgiveness. When errors occur in medical and clinical practice, those who
make them often remain anonymous; the patient suffering the error never learns
the name of the person who erred. But because that person often goes unnamed
and unpunished, he or she is likely to experience a complex and long-lasting
sorrow.9 In such cases, an engaged spirituality welcomes and embraces
the imperfect as a necessary and paradoxical part of excellence. When we deny
the presence of the imperfect in our organizations, we push it into a kind of
shadow bag that we drag behind us—and which waits to surprise us and embarrass
us. An engaged spirituality, on the other hand, celebrates our successes but
honors our mistakes as equally important sources of information. It requires
a skill normally absent from our deliberations: the capacity to be still and
notice without judging—to be present to a moment that may be full of pain and
be able to grieve and then forgive.
The diversity of the ethical and moral values and approaches contained in
our organizations is a second challenge that invites an engaged spirituality.
Each technological advance has created new and more complex issues to face.
We are confronted daily by increased severity of disease and challenges in caring
for the terminally ill. The diversity of our patient populations, employees,
and medical staffs has expanded the number and texture of the voices and spiritualities
that must be heard. The dominance of the principled approach to ethical decision
making has waned in recent years as we grow to appreciate a more relational
process that honors our stories and views. Every situation is an invitation
to be present to ourselves and each other in relationship. If they are honored
and received, such conversations generate insight and resolution. But doing
so requires acceptance, even surrender, of one's own perspective.
Truth versus Truth
This process is distracted by pain and fear. And each moment of the discourse
is an opportunity to be consciously present. An engaged spirituality is essentially
relational. We are invited to know ourselves and each other better and deeper
in these deliberations. Nor are ethical debates confined to the bedside and
intensive care units. Moral discourse occurs in the administrative suite far
more often than we realize. The passion with which some issues are debated is
fueled by underlying differences about right and wrong and our attachments to
being right or wrong. We are invited to meet ourselves in these situations,
mirrored in the resistance of our colleagues. An engaged spirituality embraces
paradox. Niels Bohr once said that "the opposite of a true statement is a false
statement, but the opposite of a profound truth may be another profound truth."10
When our organizations reflect the spiritualities of numerous religious traditions
and a diversity of moral and spiritual development, paradoxes abound.
Knowing about and believing in an engaged spirituality is not enough. What
is required is a practice integrated into one's life and work. To learn a spreadsheet
or insert a subclavian central venous catheter takes knowledge but mainly practice.
An engaged spirituality is, well, engaged: consciously, intentionally
folded into one's life. It requires some form of meditation practice, a regular
exercise program, spiritual reading, and ideally, participation in a group experience
that supports one's practice. An integrated practice supports and nourishes
mind, body, soul, and spirit in a disciplined and regular manner.
An ancient symbol of integration, the mandorla, consisting of two overlapping
circles, adorned the stained-glass windows of medieval cathedrals and other
religious settings. 11 The mandorla (the Italian word for almond) is the oval,
almond-like space that is formed signifying integration. A mandorla can also
be said to form in the space where our work and our commitment to conscious
presence meets and becomes one; in the space where the supposedly opposite poles
of contemplation and action are resolved in a merging of body, mind, soul, and
spirit. The mandorla is a healing symbol of the benefits that come from reconciling
two apparent opposites: light and dark, excellence and error, paradox and certainty,
all coming together in each of us and between us. It is a fitting symbol for
an engaged spirituality that integrates action and contemplation in the context
of providing conscious and compassionate health care.
- Winston L. King, Zen and the Way of the Sword, Oxford University
Press, New York City, 1993, p. 159.
- Robert H. King, Thomas Merton and Thich Nhat Hanh, Continuum, New
York City, 2001.
- Thomas Merton, "Contemplation in a World of Action," in Thomas Merton:
Spiritual Master, Lawrence Cunningham, ed., Paulist Press, New York City,
1992, p. 375.
- Thich Nhat Hanh, The Miracle of Mindfulness, Beacon Press, Boston,
- Brother Lawrence of God, The Practice of the Presence of God, Robert
Edmonson, trans., Paraclete Press, Orleans, MA, 1993.
- Parker J. Palmer, The Active Life: Wisdom for Work, Creativity and Caring,
Jossey-Bass, San Francisco, 1990, p. 2.
- Ken Wilber, One Taste: The Journals of Ken Wilber, Shambala, Boston,
1999, pp. 130-131.
- John Tarrant, The Light inside the Dark: Zen, Soul and the Spiritual
Life, Harper Perennial, San Francisco, 1998, p. 19.
- Daniel P. Dwyer, "Who Will Bell the Cat? The Social Control of Medical
Error" (PhD dissertation, University of Wisconsin-Milwaukee, 1989).
- Niels Bohr, quoted in Palmer, p. 2.
- Robert A. Johnson, Owning Your Own Shadow: Understanding the Dark Side
of the Psyche, HarperSanFrancisco, San Francisco, 1993, pp. 97-118.
Copyright © 2003 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.