An Engaged Spirituality

FINAL SAY

BY DANIEL P. DWYER, PhD

~| bout 800 years ago, an apparently odd Two MONKS I cultural integration occurred in Japan. A book that appeared several years ago compares Samurai warriors, who were highly the approaches of two exemplars of engaged spir A ituality: Thomas Merton and Thich Nhat Hanh.-' trained warriors feared for their swordsmanship, began to embrace Zen Buddhism. Both were monks, the first a Catholic, the second This curious blend of meditative practice and mar a Buddhist. Their lives and public efforts reflected tial fierceness made the samurai even more effec lifelong attempts to integrate contemplative prac tive fighters—willing, if necessary, to sacrifice their tice with action. Although Merton rarely left the lives in obedience to a code of loyalty. Kentucky monastery where he lived and worked How did this come about? These warriors from 1947 to 1968, his writings inform us about faced death in every encounter with an opponent. Dr. Divxer is the contemplative attitude as it confronts a world Too strong an attachment to life, they saw, could of action, lor Merton, the person "who attempts produce a fear of death that impeded presence director of ethics, to act and do things for others or for the world and induced self-consciousness. A single without deepening his own self-understanding, freedom, integrity, and capacity to love, will not moment's hesitation or surrender to emotion St. John V 5 could mean the difference between life and death. have anything to give others." Unfortunately, Merton advocated contemplative practice and its Zen taught them that "a stable inner platform of Health System. mental control," sustained MMA maintained by a fruits without describing precisely how to do it. meditative and contemplative practice, would For his part, Thich Nhat Hanh, a Vietnamese result in a state of "no-mind"—a state in which, Springfield. MO. monk, left the monastery of his youth to promote hampered neither by thought nor emotion, they what he called an "engaged Buddhism" in opposi became simple fluid action. This "no-mind" state tion to the war in Vietnam and to teach, write, of consciousness improved their effectiveness as and conduct retreats. During this period, he swordsmen.1 wrote for his students "a manual on meditation Of course, spiritual development does not nec for the use of young activists." Published as Tlic essarily go hand in hand with moral development. Miracle of Mindfulness, the book offers instruc The image of the warrior embracing a contempla tions on "mindfulness" practice while engaging in tive practice can be offensive. We do not forget action.4 In addition to teaching meditative tech other unhappy alliances between warriors and niques, Thich Nhat Hanh advocated spending religious practices: the Christian crusades, one day a week being intentionally "mindful" in Muslim jihads, and the recent tragedies involving everything performed that day. In his later years, al-Qaeda and the Taliban. These episodes were all he has written extensively about meditation for distortions of the intentions of the founders of people who live their lives in various worldly ways. their religions. Still, the samurai may serve as a In word and example, both Merton and Thich symbol of the challenges and opportunities we Nhat Hanh formed a challenging template for the face as leaders and providers of competent and rest of us to follow in trying to integrate our lives. compassionate health care. The trouble, however, is that we expect monks to Of course, several questions come to mind: How talk this way; in each of us a little voice may be do we balance and integrate a life of action with a whispering, "Easy for them to say!" deep yeanling for contemplative presence? How do we develop an engaged spirituality? Perhaps the Zen SPIRITUALITY AND WASHING DISHES samurai, as a metaphor for a life that is both contem This reaction comes from a tradition of seeing a plative and active, will inspire us to think more cre- contemplative life and an active one as two ativelv about new ways of being and doing. Continued on pajje 62

64 • MAY - JUNE 2003 HEALTH PROGRESS FINAL SAY Continued from page 64

opposing choices. Monks can live an engaged of a fully conscious state—care provided with a spirituality because monks arc contemplatives. sense of presence unencumbered by fears about Lay people arc hampered by the secular nature of the future or resentments about the past. their lives. The presumption is that a contempla Workers in health care organizations are faced tive discipline is a condition of one's context as with several particularly difficult areas that invite opposed to one's role. Yet Brother Lawrence of an engaged spirituality. God taught us many years ago that practicing the If one is trying to achieve a high level of quality presence of God can occur while we wash the while, at the same time, providing competent and dishes.' The Zen tradition admonishes seekers of compassionate service, one is sure to be present special rites and rituals to simply chop wood and ed with challenging opportunities. In work, an catty water. When they met, Thich Nhat Hanh engaged spirituality discovers and honors a spiri told Merton that he had not been taught medita tuality of imperfection. John Tarrant reminds us tion skills until he first learned to open and close that "Spirit forgets the necessity of imperfec doors without slamming them. Remember, too, tion."8 Tarrant means by this that we are always the example of the samurai. tempted to pursue a disembodied spirituality free Parker Palmer notes that some of the spiritual of noise and pain. literature of our time extols the example and But an engaged spirituality stays grounded in work of spiritual masters such as Merton and the muddle of life and work. In our yearning for Thich Nhat Hanh but, at the same time, deni zero defects, we deny the reality of our human- grates the active life as a source of spiritual ness, deny that the soul of health care comes with growth and development. "Contemporary sorrow and pain. Quality improvement and risk images of what it means to be spiritual tend to H// engaged management have become highly technical, value the inward search over the outward act, bureaucratized systems of measurement and anal silence over sound, solitude over interaction, cen- spirituality ysis, involving committee deliberations. teredness and quietude and balance over engage Underneath these procedures is a deep well full of ment and animation and struggle."" Ironically, stays shadow material: failure, grief, and pain, much of Palmer finds in the life and writings of Merton it displayed publiclv by public commissions and the support for a spirituality of action grounded grounded newspapers. The accounting firm scandals report not in a monastic spirituality but in the tension ed in the press last year are examples of the diffi between Merton's own activist perspective and culty we have as humans in facing the truth of our the monastic life form. The philosopher Ken in the inadequacy and willingness to cover it up. We all Wilbcr has written of engaged spirituality as a know about our own errors and missteps. In risk consequence of developing an "integrated trans muddle of management, we face disclosing the bad news formative practice."" In his view, we need to exer and suffering the consequences in financial losses cise and express features of our mind, body, soul, life and and public relations. An engaged spirituality does and spirit in ways that develop our personal and not make excuses for our limitations. It docs, societal responsibilities. Wilber points out that work. however, consecrate acceptance of mistakes by compassion and service emerge from an integrat balancing rigorous self-examination and correc ed practice. tive action with forgiveness of one's self and one's organization. THE SPIRITUALITY OF IMPERFECTION The spirituality of imperfection is an intensely An engaged spirituality invites us to look at the personal, as well as organizational, experience. active live as the material with which to build our Individuals who make mistakes face issues of contemplative capacities. It calls us to go deeper guilt, shame, and lack of forgiveness. When errors into the field of action and transform it, rather occur in medical and clinical practice, those who than withdrawing from the world and its compli make them often remain anonymous; the patient cations. The challenges we face at work and in suffering the error never learns the name of the our relationships make up the rich soil in which person who erred. But because that person often we can grow a conscious presence that transforms goes unnamed and unpunished, he or she is likely our work and our relationships. We don't, in the to experience a complex and long-lasting sorrow.v course of our work, face physical death like the In such cases, an engaged spirituality welcomes samurai, but wc can certainly find there many and embraces the imperfect as a necessary and opportunities to face the death of our egos, illu paradoxical part of excellence. When we deny the sions, and incessant dramas. The loss of any of presence of the imperfect in our organizations, these can seem as threatening as the loss of one's we push it into a kind of shadow bag that we drag life. This is why we are so attached to them. But behind us—and which waits to surprise us and imagine the consequences of work performed out embarrass us. An engaged spirituality, on the

62 • MAY - JUNE 2003 HEALTH PROGRESS other hand, celebrates our successes but honors consciously, intentionally folded into one's life. It our mistakes as equally important sources of requires some form of meditation practice, a reg information. It requires a skill normally absent ular exercise program, spiritual reading, and ide from our deliberations: the capacity to be still and ally, participation in a group experience that sup notice without judging—to be present to a ports one's practice. An integrated practice sup moment that may be full of pain and be able to ports and nourishes mind, body, soul, and spirit grieve and then forgive. in a disciplined and regular manner. The diversity of the ethical and moral values An ancient symbol of integration, the mandor- and approaches contained in our organizations is la, consisting of two overlapping circles, adorned a second challenge that invites an engaged spiri the stained-glass windows of medieval cathedrals tuality. Each technological advance has created and other religious settings. " The mandorla (the new and more complex issues to face. We are Italian word for almond) is the oval, almond-like confronted daily by increased severity of disease space that is formed signifying integration. A and challenges in caring for the terminally ill. The mandorla can also be said to form in the space diversity of our patient populations, employees, where our work and our commitment to con and medical staffs has expanded the number and scious presence meets and becomes one; in the texture of the voices and spiritualities that must space where the supposedly opposite poles of be heard. The dominance of the principled contemplation and action are resolved in a merg approach to ethical decision making has waned in ing of body, mind, soul, and spirit. The mandorla recent years as we grow to appreciate a more rela is a healing symbol of the benefits that come from tional process that honors our stories and views. reconciling two apparent opposites: light and Every situation is an invitation to be present to dark, excellence and error, paradox and certainty, ourselves and each other in relationship. If they all coming together in each of us and between us. are honored and received, such conversations It is a fitting symbol for an engaged spirituality generate insight and resolution. But doing so A, that integrates action and contemplation in the requires acceptance, even surrender, of one's own m context of providing conscious and compassion perspective. engaged ate health care. •

TRUTH VERSUS TRUTH spirituality This process is distracted by pain and fear. And each moment of the discourse is an opportunity embraces to be consciously present. An engaged spirituality NOTES is essentially relational. We are invited to know paradox. ourselves and each other better and deeper in 1. Winston L. King. Zen and the Way of the Sword, these deliberations. Nor are ethical debates con Oxford University Press, New York City. 1993, p. 159. fined to the bedside and intensive care units. 2. Robert H. King. Thomas Merton and Thich Nhat Moral discourse occurs in the administrative suite Hanh, Continuum, New York City, 2001. 3. Thomas Merton, "Contemplation in a World of far more often than we realize. The passion with Action," in Thomas Merton: Spiritual Master, which some issues are debated is fueled by under Lawrence Cunningham, ed., Paulist Press, New York lying differences about right and wrong and our City. 1992. p. 375. attachments to being right or wrong. We are 4. Thich Nhat Hanh, The Miracle of Mindfulness, invited to meet ourselves in these situations, mir Beacon Press. Boston, 1975. 5. Brother Lawrence of God, The Practice of the rored in the resistance of our colleagues. An Presence of God, Robert Edmonson, trans., engaged spirituality embraces paradox. Niels Paraclete Press. Orleans, MA, 1993. Bohr once said that "the opposite of a true state 6. Parker J. Palmer. Trie Active Life: Wisdom for Work, ment is a false statement, but the opposite of a Creativity and Caring. Jossey-Bass, San Francisco, profound truth may be another profound 1990. p. 2. 1 7. Ken Wilber. One Taste: The Journals of Ken Wilber, truth." " When our organizations reflect the spiri Shambala. Boston, 1999. pp. 130-131. tualities of numerous religious traditions and a 8. John Tarrant, The Light inside the Dark: Zen, Soul diversity of moral and spiritual development, and the Spiritual Life, Harper Perennial, San paradoxes abound. Francisco. 1998, p. 19. 9. Daniel P. Dwyer. "Who Will Bell the Cat? The Social Knowing about and believing in an engaged Control of Medical Error" (PhD dissertation. spirituality is not enough. What is required is a University of Wisconsin-Milwaukee. 1989). practice integrated into one's life and work. To 10. Niels Bohr, quoted in Palmer, p. 2. learn a spreadsheet or insert a subclavian central 11. Robert A. Johnson, Owning Your Own Shadow: Understanding the Dark Side of the Psyche, venous catheter takes knowledge but mainly prac HarperSanFrancisco, San Francisco, 1993, pp. 97- tice. An engaged spirituality is, well, enjjetged: 118.

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