The Power of the Voice – applications of mindfulness in the hospital. Part two

Transcribed and edited teachings given in an Essen Hospital, Germany

October 2014

Christopher Titmuss

3908 words.

I will speak to you about the power of the voice. Nicole (Stern) spoke to you earlier about the meditation process. With her guidance, you applied mindfulness meditation to all and different parts of the body, including hands and mouth. We move into expressing ourselves. One of the most familiar ways is through the movement of the voice. There are conceptions, feelings and perceptions within. They form and gather together, sometimes intentionally and sometimes unintentionally. This movement travels up through the body and out through the throat to express a language. We bring mindfulness to the voice. This movement also applies to the animal world as well.

Prior to arriving here, I was teaching in Israel. In the northern part of Israel, two hills from Lebanon, friends live in the Clil community. Stephen Fulder, one of the senior Dharma teachers, who lives there, keeps free range chickens. He has identified around 12 different messages that the hen gives to her chickens. One sound says “follow me”   and another sound says “give me break,” another sound says “here is some food” or “stay away, here is danger.” The chickens learn to listen to what their mother tells them.

I read in a newspaper, so it must be true (!), that men mostly only have six topics that they can talk about. 1. Politics. 2. Sport. 3. Women. 4. Money. 5. Work. 6. Technology (cars, computers, mobile phones). Women have more than 40 subjects to talk about. I do apologise on behalf of the male species for the limitations of what we, men, can talk about.

Building up an Image

Mindfulness refers to communication in the past, present and future. So mindfulness is not exclusively confined to being in the moment. You listen to another. You know there is something important in what you hear. The conversation is beneficial and informative or it is loving or a sharing of experience. Or, it could be difficult with misunderstanding between two people or more. Upon reaching the closure of the conversation, it will leave an impression in your mind. This is the critical point. The impression that is left is the residue idea of what he or she or oneself said. That impression registers in consciousness. This impression is carried away from the meeting. If you hold onto that impression, it will probably influence your next meeting with the person or persons.

This impression easily builds up a picture, either positive, negative or somewhere in between. The picture in the impression comes to be seen by oneself as what the conversation was about. The impression may not be true. For example, you leave a meeting with a positive impression and regard it as a valuable meeting. What was valuable? What was insightful? What was worth applying after the meeting? It is not the positive feeling that is important as the mindfulness and clarity from the meeting that matters. We tend to live too much in the world of impressions.

A difficult meeting may leave a negative impression. Your holding onto a negative impression will affect the perception of the person or persons when we meet them the next time. We then carry the impression from the past, which acts as a shadow over the immediacy of the new contact. It is a challenge to understand a communication, to see what is positive or negative, and to be mindful, whether one is carrying an expectation that as it was before, so it will be the next time.

There are no grounds for truth in this perception of grasping onto impressions. This perception from impressions is unfair to the other person as she, he or they may change. They may have changed but we have not realised that because we are still carrying yesterday into today. Some of us learnt our lessons in this matter through being in a relationship.

I have had to remind myself that what she (being that I am a heterosexual) is saying to me today is what she is saying to me today. What is said today is said today! This view gives flexibility within. Ah, she may change her view tomorrow. Freedom of the mind allows for change. In the present moment situation, the discourse taking place with others requires a commitment to keep it focussed and clear. If a statement is made to us and we are not sure what it means, we must be mindful of any reactive voice within or without.

Mindfulness of a Person who Clings to Authority

We think it is the ego in the voice of the other, power tripping or we think the other holds onto views or does not listen to anybody else. If we hear something that generates discomfort within, there is no point in arguing because arguing will invariably reinforce the view of the other. An argument is the worst strategy to try to resolve disputes. If there is something we need to understand, then the quiet, short, clear questions work better to bring out more information about the person’s view. This approach will shed light on the view and the situation surrounding the view. Otherwise, we easily become judgemental about what we hear and become stuck in our view.

When we ask the person questions about their views with curiosity and with interest that person may found that their own voice is changing. The person may start off with an absolute position, which they cannot possibly consider in any other way. A gentle and sustained questioning may lead the person to saying, ‘Well yes, there are exceptions.’ You then ask:

‘What are the exceptions? Please say more about these exceptions? Then their views can begin to expand out. The kindness in the questioning voice is the power. Aggression in the voice is unhealthy and unhelpful. The quality of the feeling in the communication is as important as the words.

The gods in the hospital

Your first priority in the hospital is the patients. The patients have to bear the sickness. Mindfulness in your communications with each other and the patients matters. The Dharma tradition has wisely referred to the original mind. It was often said by the Buddha that there are gods and humans. The Dharma views the world as much a psychology as physicality. In the hospital each and every one of you are gods to the patients. It is not only the doctors who are the gods!

The yoga teachers, the mind body teachers, the counsellors and the nurses, the doctors and nurses are the gods of the hospital with its incredible important integrated approach. The humans are the ones who are sick. This gives an exceptional sense of responsibility. If you cut the word ‘responsibility’ into two it means ‘response – ability.’ This means the ability to respond to the plight of the circumstances of the people. You are the gods for the people. Your authority, your words and your presence has extraordinary significance because in Jungian terms you express the power of the archetype of authority.

You could take the vow of a Buddhist monk and make a lifelong vow: “I shall never approach a patient again with the words “how are you today?”

The patients have heard this question a zillion times – even though such words are said with a smile and with kindness to the patient. If it was me in the bed, I would probably be saying to myself ‘pass me the sick bucket.’ The family and friends are coming to visit the patient probably all asking much the same question.

Can we employ the original mind so that mindfulness of the patient does not bring in completely familiar words, “such as, how are you today?” Can we start off the communication with the patient, unexpected and fresh? It might require from you, the gods, to look around the bed to see the patient and whether there is anything unusual or different to comment on.

Meet the patient with your original mind. You start off the communication today different from what you started off yesterday? This keeps freshness from the beginning in the communication with the patient. It is a mindfulness practice which generates curiosity from the patient.

The gods often only see the sick person. To view in this way is vital and necessary at times. This is a primary role of the gods to support, love and care for the sick. Clearly, there is much more to the human being than just a sickness. What is outside of the sickness? If appropriate, this needs to be part of the discourse. This gives the patient the sense of normal life.

The power of the gods shows in the bedside visit. Though the situation is genuinely serious for the patient, possibly a life-and-death seriousness, but that doesn’t mean to say that the seriousness has to ignore or neglect other factors of life as well. Take a small example to get a sense of the shared commonality between the gods and the patients. The doctor or the nurse or mind-body therapist goes to meet with the patient. You could say to the patient: “I have had a really full day today. I am feeling rather tired. Would you mind moving over in the bed so I could get into the bed with you and lie down for a few minutes and get some rest? This would be an unusual request!

You might get the invitation from the patient! This would be nice. Something that is unexpected becomes the unforgettable. It is the communication that you have said something fresh and slightly mad, because the world is a bit mad anyway. You know the patient is a normal human being who is enduring sickness. The gods must relate to the normal human being. We bring in something else to the patient. It could be a line of poetry from a poetry book that you bring to the bedside with you. You ask the patient what she or he thinks of the line – assuming he or she has the strength to talk about a line of poetry. The gods bring something fresh. Through the act of mindfulness, we touch the person.

When life-and-death is on the edge and living with a huge sense of the unknown, there are all the weaknesses and vulnerabilities that go with it. That condition might generate deep questioning and deep enquiry from the patient. It would be a great pity if the gods are asked a deep question, whatever that question might be, such as about life of life after death and cannot respond. Is there a God? Do I have a future? What is life all about?

It is a pity if the gods looked numb and can’t say anything. Or say “I don’t know.”

Deep Questions

If a patient comes to you and brings up a profound question, it is not to say that you have the answer. From the mindfulness standpoint, it would be worthwhile, as the Buddha said, to squeeze the honey out of the essential concern of the person. You try to find some time in the hospital garden or elsewhere to reflect on the question or to find a paragraph somewhere to read to the person. This is a real statement that you have heard the person. Whatever the position we find ourselves in life, the feeling of being heard, listened to and understood is vitally important for all of us.

There is the traffic of love but it seems to be one way, namely from the staff to the patients. Even with much humility and kindness, there is the view that “I am the helper and the patients are the ones who are helped.” The power of the voice goes from the helper to the helped. If there is too much of the voice in one direction, it will reinforce for the patient a feeling of helplessness. The patient feels to be simply a recipient of the attention of the visiting doctor or mind-body teacher or member of staff. This can bring the feeling for the patient that he or she has nothing. But they do!

The language of the “helper” keeps her or his eyes and ears totally open for the language of the patient. When a patient says something that feels important to you, you have the mindfulness to recall on the spot almost word for word what she or he just said. You then repeat what you heard with immense appreciation and gratitude. The person may be very sick and in the last stages of their life and very, very weak. The patient may offer something – an insight, a thank you, ask a question or say something that you intuitively know is important. Don’t let those moments go by. Really hear that voice.

I was in Tel Aviv earlier this month in before coming to Germany. The Sangha, which means the network of Dharma practitioners and teachers, lost four Dharma practitioners in the last year or so to cancer. They were aged from 26 years old to 42 years old. I knew three out of the four people that had died from cancer.

I was asked to lead an enquiry in a public gathering with a close family member of each person who had died. One person sat with me in the front of the hall was the husband of Yael, who died around the age of 42. They have a six-year-old daughter. Another Israeli, I knew from India. He had cancer years back. The cancer returned with a vengeance. His mother and I engaged in an enquiry as well at the front of the hall.

I asked lots of questions to each person. I asked the mother if her son had said anything to her which she felt was important for her to hear. Did he have any message? She stopped for a moment. She said “Yes he did. He told me not to have so many projects going on, to work less.”

I asked “Did you listen?” She looked rather uncomfortable. She said “I have a full day of projects tomorrow.” So I said to her. “That voice from your son, who knows you well, is giving you an insight. I know how much you love your son. When you were sharing your story, there were tears in your eyes. It is important to listen to the voice of your son and act on it.

We had a table in the Hall with photographs of the four people in the Sangha who had died along with words the written in the diary on their blog. This table of photographs and words touched many of us. The messages and photographs certainly brought tears to my eyes. I said “When something is said to from your son, it is because he wants the best for you. He told you to cut down on the workload.”

His mother said: “You are right. I need to listen to what my son told me.”

I remember her son was very cool guy. I heard he had become as thin as a garden rake. Friends and family were around him in the last days of his life. He could barely speak. He whispered a few hours before he died “Can I have some ice cream?” His friend turned to him and said “What flavour would you like?”

“I’ll take all the flavours.”

One person raced out into the street, got ice cream is with all the flavours. He quietly sucked on the different flavours with a smile. “This is a nice one.” Ah, this is a nice one, too”

There is something precious in the last hours of life. These are precious times for all the family members and friends around the bedside. Yes there is the sick person but the perception of the sickness at times needs to drop out of the consciousness and not be the reference. It is person to person communication while addressing fully and comprehensively the actual illness itself. That is part of the dialogue.

Knowing one’s authority

My daughter was a midwife for some years. After giving birth to three children she said that she could not work as a midwife because many babies were not born in office hours. Midwives develop strength through the immense responsibility of their work. Often, the midwives know more about the delivery of babies than the doctors. In Britain, midwives are the only nurses, besides doctors, who can actually write out a prescription for pregnant women. At times the midwives have to call the doctor. The doctors often know the midwives have much more experience. Sometimes doctors called the midwives the ‘madwives’ because the midwives know a deep sense of real authority in their work. The ‘madwives’ carry authority with them.

From the collective standpoint, it is normal in many institutions and organisations to see the hierarchy. Personally, I feel uncomfortable with the idea of hierarchy. A hierarchy can mean holding to power in one way with notions of superiority – “I know more than you.” A rigid, controlled and tight hierarchy leads the gaps in communication owing to the hierarchy. The hierarchy can also undermine people, above and below, and at the same level.

Those at the bottom end of the hierarchy can think “oh, what do I know? Those who are above me know so much more. They have been here for so long.”

It is not a virtue to be in one place for a long time. A person could be stuck.

Those in the privileged position of being higher up in the hierarchy need to be mindful “Do I think I know better than everybody else who is below me in the hierarchy?” The person in the hierarchy who undermines themselves then cannot allow themselves to express their own authority, their own understanding and their own initiatives. Their insecurity stops them from sharing their experiences and knowledge that they brought with them from elsewhere into the hospital.

It is vitally important to look at the relationship to hierarchy. The other extreme view is also questionable. It is the view that “We are all equal.” I don’t accept this view either. We are not all equal. There are people who know more than we do and there are people who know less than we do. There are people that we can learn lessons from. There are people that we can share with our experiences and knowledge. This is the power of the voice. The exploration of roles, knowledge, identity and the capacity to share is a vital aspect of the power of the voice. We can listen and offer our experience and understanding to express the power of the voice.

In some situations involving the small group dynamic, it is not unusual for some people to be used to talking in the group. It is easy, effortless for them, but there are important people who hesitate to share their voice. They may have a little bit of nervousness, a little bit of discomfort in the face of authority in front of them. There discomfort may be directly related to the size of the group. With five people it is easier to express the power of the voice but it is harder with 10 people and even harder with 20 people or more.

The power of their voice then becomes lost or stays quiet according to the numbers in the meeting or the hall. It means that those in the group who are confident in speaking really need to listen and notice the quiet ones in the group. The quiet ones may say little but they say a lot in terms of insights and understanding.

Sometimes the quiet ones require a direct and personal invitation to speak. It may not be their way to enter and offer the power of their voice. Shyness and hesitation blocks the voice. The confident ones need to take notice of the quiet ones and ask them the question that they can answer. “What is your view on this topic?” “What would you say with regard to this discussion?” “Is there anything we have overlooked?”

I’ve noticed over the years that after coming away from a meeting, a quiet one may have expressed only two or three sentences but those sentences are much more effective than the rest of us rambling on.

Two essential guidelines

In the Buddhist monastic tradition, meetings took place and decisions were made. Monks observed a particular rule. The rule made clear that those who attended the meeting had the authority to make the decision. If there was a consensus, then all agreed to abide with the decision.

There are two essential guidelines that everyone must remember when the meeting is closed:

  1. One does not gossip later about anybody in the group or about anything they said at the meeting. There is no undermining of any voice in the group. This shows respect for everybody’s voice in the group.

 2.        Since a decision has been made, and even if one did not agree with the decision fully. One does not leave the group and then start undermining the view and the agreement. To leave the group and then complain and moan about the decision, and what one didn’t like and what one thought was wrong, it takes away the authority of the group.

Gossip is pernicious. It is nasty. It has a very destructive influence on friendship, love and cooperation. Mindfulness here recognises and knows the power of the voice. Mindfulness also knows the importance of making a decision and keeping to them and not speaking behind people’s back, not gossiping and respecting the authority of the group.

This attitude contributes to the integrity of everybody. If a decision is made, and afterwards, you realise there is something unethical about the decision that would bring about harm, you then organise a fresh meeting for urgent steps. It is often not an ethical issue at all and it is much more on the best steps forward.

In summary

Mindfulness refers to the past and what we can see and learn from it. Mindfulness refers to the present including real attention to listening. If something is not clear, it may require the asking of questions with kindness in the voice. We may need to ask several questions if we are struggling to understand the person and where their views are coming from.

You keep in heart and mind that you are a servant of the vision of the hospital and also a god in the hospital for the patients, and sometimes for each other. You explore ways to find and express originality. When the patient responds with the wish to give something back to the gods, then you ensure you really hear the offering. You express appreciation and fully acknowledge what the patient says. Appreciation is very affirming for the patient and the gods. The power of the voice shows itself in a mindful communication. This means to keep communications and agreements as clear as possible.

Many meetings are around roles. The non-role communications matter just as much. The times to sit, talk, laugh, joke and make connections and communications matter as well. There is the opportunity to share friendship with others as friendship goes deep within the human being. You keep the friendship communications alive. The voices of authority share with others on the staff and patients. You are a team working together. Thank you for listening.

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.