Reflections on Vision and the Gap – applications of mindfulness in the hospital. Part one

Transcription and Edit of teachings

Christopher Titmuss

given at an Essen Hospital,

October 2014

3628 words

I will speak on some essential topics that are important and valuable. I will initially address the vision of an organisation and the gaps that also arise. With changes and evolution in the very movement of life, there are changes in movement and in language. These variations show in the subtleties of the general vision.

It does require a certain single-pointed vision, no matter how it is articulated. It is worthwhile for persons, such as yourselves, to reflect on your vision. What kind of language and description, individually and collectively, do you give to the vision of the hospital? Language of the vision is an important reference point to centre upon.

It is helpful for one’s own inner life to know the direction and the evolution of the hospital. This is also valuable for the communication with others, such as staff, patients, friends, family and people who are interested in the vision of the hospital. You require a skill in terms of words and language to communicate a vision.

Once the vision has been established and developed over the years, then there comes the core, the essence, to see and know where there are gaps between the present and vision. Not all gaps are a problem. Experience, knowledge and understanding in a whole variety of ways may be present. You get to know which persons in the hospital you learn from and can listen to. These communications provide the opportunity to share experiences, concerns and to open up to further development. These are the bridgeable gaps.

There are other gaps. There are gaps around roles, misunderstanding, mis-communication. The staff can fall to fall in the gap and the vision, itself, can also fall in the gap.

There may be a need for genuine cooperation between the staff raising the question, “How can we work with these gaps?” It is not easy in any organisation to get the balance right. There can be the dictatorship of the individual or the dictatorship of the many that creates a gap towards others.

Any excess of control of the one or the many would include the shadow of fear in the control. Where there is control there is fear. In the gap between the dictator and those dictated to, the dictator can be holding to the past. Then there is no appreciation of how people are developing, involving and growing that enables them to feel their authority.

When new staff comes into an organisation, there is the necessary allowance for the new staff to grow into their role. Once that emergence into the role takes place, those with the privilege of the already established authority need to find ways to recognise the authority of the other. The well established authority needs to give support to others. Sometimes that does not happen.

It does not happen because a person over the years holds on to their authority and exercises their authority over the other through control and rigidity. The self of the dictator believes that she or he only knows the right action and nobody else could possibly know as much. This produces a severely problematic gap.

Where there is a strict controlling authority or authorities, the authority intimidates the rest. People fear to speak up. They do not want to experience the hassle of offering fresh ways to work. The dynamic of the organisation depends upon deliberately cooperating together to find ways to bridge the gap. The gap can’t be left unaddressed. If the gap is not addressed, it will get bigger and bigger.

Eventually, the gap between the dictator (s) and those dictated to will affect the whole vision of the organisation. That is the danger of the gap. Communication, sharing and the willingness to take risks recognises the dynamics of any holding. It is important not to lose sight of empathy as a heartfelt means to bridge the gap.

Having spent 10 years in the East, I can speak from my experience in Buddhist monasteries. Monks and nuns live in these monasteries with various meetings taking place. The abbot has immense influence and rightly so. These monasteries have lasted for more than 2500 years because of the co-operation between everybody. This means to address regularly vision and the gaps. Monks and nuns and lay people, who are living in the nearby community, work together to keep the teachings of the Buddha, Dharma and Sangha alive despite all the difficulties that go on. The monasteries have sustained themselves through the gaps over centuries.

Values and Value for Money

There is often a gap in the dialectic. Jonto briefly referred to this. There is the question of values of the hospital and value for money. There is often a strong tension between values and value for money. My understanding is that insurance companies, as well as government departments, have a great deal of concern about ensuring value for money. ‘Concern’ is a polite English understatement. Insurance companies and governments appear ‘obsessed’ around value for money.

This value for money concern places a pressure upon those who work to uphold a vision with the values needed for the vision. Those who uphold the vision recognise that the vision can only sustain itself through a skilful and appropriate application of money. This application of human value with value for money must be workable and efficient for the continuity of the hospital.

This is an important dialogue that acknowledges such values with values value for money. That might require much discussion in the hospital around the deep values that the staff share along with the financial system. Productivity can gain the highest value in which profit has become central to it. The health system needs to change to develop greater human values reflecting a shared vision.

Nicole (Nicole Stern, co-teacher) has given workshops in a major German insurance company. She sews seeds that recognise the importance of cost effectiveness alongside the recognition of the importance of values. In the long term, it is in the deep interest of the patient, the hospital and insurance companies to find the language, the discourse for a mutual understanding. This discourse needs to be developed. This discourse will initially have to come from people like yourselves, as it is much less likely to come from the insurance companies. Insurance companies have one thing in mind – Euros, profit for shareholders!


There is another gap. This requires a balance. It is terribly easy to concentrate on problems. A problem means a gap between people. In the inner life, we think we are talking clearly about a problem. We think the words we use about the problem are independent of the problem and stand outside of the problem. We imagine that the words we say to describe the problem are objective about the problem. We think we are outside of the problem and simply describing the problem.

We name the problem. We imagine that what we say about the problem is objective. This is the problem! There is no ‘outside’ of the problem. The describer of the problem and the description is part of the problem.

This is not easy to follow. I can see from the body language of some of you that what I just said is not easy to follow. You don’t have to tell me!

There is the expression of the issue, of the problem. The expression we use to describe the issue emerges from our inner life. The description, itself, becomes part of the problem.

The staff needs meetings without giving attention to any problem to experience intimacy, friendship and empathy with each other and the vision. Such meetings contribute to forming a bridge in communication in making fresh steps and directions in decision making meetings.

For example, you shared in small groups your vision for the hospital. Some of you, after the meeting, said to me that it was a lovely and valuable meeting. You discussed your vision. Some of you said you felt uplifted by the meeting. It touched a precious place within. You heard and offered clear reminders of the vision of the hospital and what it was about.

It reminds us that despite all of the dramas that can unfold, including addressing life-and-death health issues, there is the importance of the balance of cooperation, love and vision. There is the value to share appreciation and to express it. None of that communication addresses a problem. That kind of sharing and exploration needs to be part of the regular discourse of the staff. This is healthy and healing.

No staff anywhere wishes to feel like machines used for productivity. Happiness always brings more concentration, more focus, more presence and more interest than stress and unhappiness.

Small Changes

I started a small school in Bodh Gaya. India, the village of the Buddha’s enlightenment, In February, 2015, the school will celebrate its 25th anniversary. The school serves the poorest of the poor. The school started with a handful of kids and a teacher in a little room in the Thai monastery in Bodh Gaya where I teach. Our school, the Pragya Vihar School (the School of Wise Abiding) has become the biggest school in the village with 560 children. We have about 18 teachers that.

The teachers start the day off with 15 minutes of silent meditation. There is a little instruction given. When we introduced meditation to the beginning of the day, it made an extraordinary difference to the sense of connection between the teachers.

The head teacher is a Catholic nun of our inter-religious school of Buddhists, Muslims, Hindus, Christians and secular believers. The shared silence gives the sense of collective of the teachers working in co-operation together. They engage in meditation in a room to start off the day. Sometimes it is the attention to the small things, to the details, that make a real difference to harmony in an organisation. It is not a radical change necessary but the application of subtle changes the make the difference. This is how organisations evolve.

To give another example: My daughter, Nshorna, has three children. The father of two of the children used to be an athlete. More than 10 years ago, he won the 100 metres race in the European championship. He is one of these runners who take a mere 10 seconds to run 100 metres. He was a god in the world of athletics, just as there are gods in the world of the hospital. He trained to develop numerous details from diet to posture and to relaxation of his shoulders in the race since he was about 12 years of age to develop his running skills.

Subtle details put together can bring about significant change.

We might think sometimes that we need to make major change. This view makes for another gap. We see the gap and make a bigger gap with the mind-set that thinks we are speaking outside of the gap. There is a gap between what the self perceives initially and the reaction to it. This makes a duality. If we carry that big gap around, we generate a lot of intolerance. We have this view about what we think this situation should be and we have this fact about what the situation actually is. That gap can become unbridgeable.

Bridging the Gap

To give a small example of this, a sad thing happened.

A teenager put his hands up a woman’s skirt on a bus in Boston. She, understandably, screamed and felt very upset. The teenager invaded her privacy. It was a gross and crude act which frightened her. He panicked. The teenager ended up in a mental hospital. His mental health actually got worse. He ended up on the top floor of the hospital were the most problematic patients were housed. The teenager gradually changed. His mental health greatly improved and it was time for him to go home. The gap between being on the top floor of the hospital and going home felt far too big for him.

He could not face leaving the hospital and going home. One nurse bridged the gap. She said to this young man, now in his early 20s, “Put your foot here.” The nurse took a piece of chalk and drew a line where the toes of his shoe ended. The nurse then said to him, “Tomorrow, you will put the heels of your shoe where the chalk line is. Then we will draw another chalk line.”

Day by day, the young man moved step-by-step down through the floors of the hospital, down to the front door, down to the gate. The nurse came with him and took him home. She ensured that he could adjust to the changes and made herself available to him. The man could come and see the nurse or telephone her. “I am here for you,” said the nurse.

The initial gap between the top floor of the hospital and home was too big but it could be bridged through successive small steps. Step-by-step action. A fine nurse!

The bridging of the gap through small steps enables a human being to evolve. Major change is necessary when a situation is profoundly unethical. Then something really has to be done immediately. In situations here, it is much more likely to be skilful means that works to bridge the gaps.

There are gaps in communication. There is the dictatorship of the small group and the dictatorship of the individual. There is the dictatorship of the proletariat, to use an old communist term. Conformity of the collective can inhibit the creativity of the individual.

Individuals can feel oppressed and afraid of the power of the big group. Then they cannot express their freedom to be creative. It isn’t easy to explore and recognise the creative idea and vision of the individual and to include that idea and vision.

This means that the collective must be mindful not to intimidate the individual. The capacity to share and offer mutual support enables an organisation to grow and develop because the vision is present.

I think I’ve said enough!


“I have a general question. Are you especially preparing for this session? Do you prepare your Dharma talks? It seems to me that what you say perfectly suits our questions. These are questions we are asking ourselves. Is it a coincidence?

The background to this session today is my experience over many years of working with groups. That is a significant support. I also engage in a lot of research. I do a lot of reading, a lot of online exploration, looking into the literature and taking the opportunity to talk with people with experience in these fields. I’ve spoken to a number of you here on retreats and other circumstances. It is a combination of reading, research, experiences and listening. In the listening in the session, I trust I will have enough receptivity in the session, as early and quickly as possible, to some of the incredibly important points by the participants. I listen carefully before I give the talk. Certain words stand out from you all. I might hear two are three key words or I see with my eyes the body language that shows a response. This intimates to me that the point you are or I are making is something that needs to be addressed it. It is a combination of present moment, research and experience. Hopefully, this combination is supportive for you all.

You spoke about the nurse and the young guy. I often ask myself in our hospital and clinics how small the steps need to be. How patient do I have to be with the ones we want to share our vision?

Plenty of times, there are no problems with the gap. The gap is part of the dynamic in relationship. In the gap that you just described, it could be said that that there are those who are more conservative and therefore the thought and feeling is “go slow.” There are others who are more radical, who appreciate the taking of risks into the unknown. There is a need for communication between the conservatives and the radicals. For conservatives, security is felt through staying with the known. For others, vitality consists in taking steps, taking risks. It is in that dialogue between the two that has representation in every group and in every organisation. It is the task to find a way they give support to both. It is equally listening to the other as well as respecting one’s view, too.

Nicole responded “It is the love aspect which is really touching. When a person feels touched, it will make a difference. This also happens in Dharma practice through Dharma language. If we can touch people, then seeds will grow in time. It is the same with patients. So many times, we have people in our retreats they seem to understand something or perhaps nothing. Years later, they say to us: “Your words touched me. Years later, I really understood and I knew what to do.”

I can give a potent example of this. It concerns Israel and Germany. I was recently in Israel for 25 days. The country is in a very high state of stress. There is concern about what happened to the people of Gaza and what is happening within Israel. There is a military unit in Israel called 8200, a unit of sharp military officers. One of the jobs is spying and surveillance. They use secret cameras in Palestinian homes including Nablus, the town I have visited many times in the past 20 years. These cameras watch and listen to everything that takes place in the home from the kitchen, to the dining room to the bedroom. The surveillance officers watch and listen. The Israeli army assassinated the husband and subsequently his wife committed suicide. Afterwards, some of the officers in Unit 8200 watched The Lives of Others, the movie about the Stasi spying for the GDR (East Germany) on East German citizens involved in the arts. These officers in the spy headquarters in Tel Aviv said: “This is what we are doing.”

“We have no right to interfere with the privacy of people’s lives. Look at the consequences of what we do.”

Then 42 officers refused to be involved in surveillance any longer. They wrote a letter to the Israeli Prime Minister and letter to the head of the secret services. “We are not going to engage in surveillance any longer.” They told the press that they had seen The Lives of Others. It is extraordinary that Jewish army officers got their inspiration from Germany. Things are changing!

Even though there are gaps, there is a truth about the invasion of privacy and the perversion of people spying in people’s homes. The film sent a shockwave to some of the intelligentsia of the military in Israel and the decision of some officers in Unite 8200.

On the topic of being touched, I have an example in our clinic. One secretary worked for conventional medicine. When I met her 18 months ago, I found her very reserved and arguing about what’s happening. Over the time, she saw us working, got in contact with us and was talking with us. This moment, which touched her the most, was when she went to a Congress where we talked about our work. She told me she was very impressed with the work that we are doing. Since then she has come to ask some questions about her lifestyle. Even yesterday, she asked for some vegetarian spread. It is a nice example of a seed which is growing.

Exactly. It is important to stay true to the vision. It might well be misunderstood by others. People might be suspicious and feel the hospital freaky. If people keep the faith, to the direction, others will respond. Yesterday somebody use the words ‘freaks.’ The first vegetarian restaurant in London started in the early 1930s as its inspiration from the small town where I live. The owners said “What shall we call the restaurant?” Somebody said: “Only cranks eat vegetables.” Cranks and freaks mean much the same thing. So the restaurant is called ‘Cranks.’ We can use good humour. If people think of the staff as freaks, then agree with the view. “Yes, we are freaks.”

I would like to put in a word about the gaps. There is the potential for growing in the gaps. The gaps are there to grow into so we can move on, or grow into or grow out of. It is the moment of growth and change. It is exactly as you said there are gaps to be explored and bridged. There are gaps to be worked with. There are some gaps to be ignored. There might be one gap for me and one for you.

Yes that as well.

My experience is working with an integrated medicine. I’ve never worked in a different kind of hospital. This is my reality. Perhaps it is more freaky to cut open a person and look, for example, as his elbow, and neglects the rest of the person. This is even more freaky. This is to fragment the person.

Yes. Which is more freaky – to attend to the whole person or look at a tiny bit?  THANK YOU.

This 21st century hospital integrates conventional medicine with naturopathy.

Naturopathy employs the use of natural resources for the healing process.

The hospital offers a nutritious diet, mind-body work

and traditional Chinese and Indian medicine to address the whole person.

The Church, the State and health insurance companies support the hospital.