Rev Stephen Wright, Visiting Professor and Honorary Fellow, University of Cumbria; Spiritual Director, the Sacred Space Foundation

Published in JHH15.1 – Transformation Innovation in Healthcare

My interest in spirituality and wellbeing is personal and not merely academic. I had what was by any measure a ‘successful’ career in nursing and academia and picked up lots of glittering prizes along the way. A plunge into a series of ‘awakenings’ 35 years ago took (dragged) me in a different direction, helped along the way by the gifts of some very wise teachers of high repute. Since that time, among other things, I have sought to integrate a deepening of this awareness in life, both personal and professional. The latter has taken me, or at least the me-who-I-think-I-am, in new directions of writing and research on the theme of spirituality and health, facilitating retreats, working as a spiritual director and setting up a charity/retreat centre with Jean Sayre-Adams. I work with others providing development programmes, specifically for health care professionals, unifying spiritual teachings and practice with the cultivation of compassionate action and leadership.

Levels of identity

‘Is there a God?’ ‘Why is this happening to me?’ ‘What do I do with my life?’ These are the everyday questions that surface in the process of Spiritual Direction. A less common, but more important, question is: ‘Who is asking the question?’ Through deeper enquiry, we may begin to realise that who we think we are is not necessarily who we really are.

All spiritual traditions nudge us into questioning assumptions about what it is to be ‘me’. Our level of awareness of ‘me’ determines the way we are in the world. Between the shores of the ego and the ocean of the soul there are many planes of consciousness.

So, if we are talking about changing the way healthcare is organised, we must be clear not only about what needs to change but who it is that wants to change and why. Intention is all. Form follows consciousness. In the clarification of the motive through the ‘ground of our beseeching’, to paraphrase T S Eliot (1944), we are more likely to produce wholesome changes if they have come from the wholesomeness of our Essence as opposed to, say, the product of our ego attachments and agendas. Inner awakening to a deeper truth of self must precede the forms we create.

All kinds of drives, conscious and unconscious, determine the form that emerges. In a culture where ‘we’ should be in charge, make things happen and succeed, surrender into other perceptions of self is anathema. I sat with my teacher Ram Dass, long ago and we explored these ideas, how the ego gets in the way, wants to ‘do’ everything. He offered as a precept, ‘I do nothing, and nothing is left undone’. It took me years to ‘get’ that. When we act from the plane of ego consciousness we stamp our will, however benevolently intended, upon the world. Things we want to change are contaminated and corrupted by our desire to fix people and things according to our image. When ‘we’ let go of doing and serve ‘The Will’ not ‘our will’ the results are very different. A story here might be helpful.

The dance of life

Maysie (not her real name) was close to death, 90, emaciated and terribly sad. The student nurse and I were helping her off the commode. Maysie put both her arms around my chest to steady herself while the nurse wiped her bottom. She said, ‘Oh it’s years since I’ve had my arms around a man and a man’s arms around me’. I suddenly lurched into a memory of my mother, and how when I was a child we would go to the Tower Ballroom in Blackpool. I told her this, and how my mum taught me to dance with her by having me stand on her feet and off we would waltz. Maysie said, ‘I loved to dance, at the tower too and do you remember Reginald Dixon on the organ?’ And I said I did, and would she like to dance now and she said yes and the next thing you know I had pushed my feet beneath hers, gripped her gown behind her and waltzed through the screens out into the ward with me singing like a rusty Sinatra and Maysie humming along as I held onto her feather-light frame. We returned breathless to the bed, passing the ward manager who looked aghast. Maysie and I were laughing like kids. I placed her back in bed, brought her some roses from the garden. The gobsmacked student gasped, ‘Where did you learn to do that? It wasn’t in the module!’

Maysie died three days later, still smiling. It was of course nothing special, like any nurse, I have my tales to tell of moments such as this one when the barriers fall away; moments of freedom when heart, mind, body and spirit conjoin in the flow of caring so that healing happens.

In this little vignette the student and I had broken a lot of rules… the intimacy, the risk assessment process, flowers on the ward. It takes certain qualities to run those risks: courage and confidence rooted in wisdom and experience (and perhaps a certain fearlessness). In the trajectory from novice to expert, we acquire the connoisseurship, the ‘nous’, to be able safely to go with the flow of the healing stream, and to encourage others to do likewise.

Humanising the system

In risk-averse health services like our own, technically rich yet spiritually impoverished, my colleagues and I work daily with practitioners in their struggle to humanise the system. For some the effort is costly, exhaustion leading to quitting, burnout or indifference – the consequences of which we saw recently at Mid-Staffordshire NHS Trust or Winterbourne View and in other regular reports of uncaring, not to say cruel staff.

If we accept, as Martin (1984) proposed in his seminal study Hospitals in Trouble, that uncaring psychopathic staff are rare, then most are ordinary people doing the best they can while lacking adequate education, leadership, resources and support. In such circumstances indifference is really a defence mechanism in the face of overwhelming physical and emotional labour Burnout, the spiritual crisis that follows when we just can’t take it any more, is all too common (Wright, 2010). An occupational therapist at our first Spirituality and Health conference (Durham, 1996) illuminated this point. She cried out, ‘How can I go back when my heart and soul are not welcome there?’ Working in dis-spiriting, dis-connected and dis-easing environments can crush the essence of what it is to be human.

Attention has more recently been paid in healthcare to developing leadership and staff support. These are all to the good, but sometimes these policies may be ways of staying in denial of the fact that the roots of high levels of patient complaints, clinical errors and staff attrition rates can be traced back to simply not having enough people and resources to do the job properly.

However, even when support and staffing are good, compassion and healing can still fall short; things still go awry. I have participated in six enquiries where care has failed. In one, a superbly equipped and staffed hospice, patients still experienced neglect and staff were bullied. All kinds of unconscious phenomena feed into relationships at work that have nothing to do with material resources. In this example, a failure to address the fear of death and dying among the care staff (Speck, 2003) lead to an inclination to be seduced by their own mythology, delusions reinforced by signals such as, ‘Oh how wonderful you are to be able to do this work, I couldn’t’. The stereotype of hospice workers as martyred carers battling against the odds goes unchallenged, with dire consequences for patients and staff.

Holistic care needs far more than the right resources to do the job. A highly energised senior NHS executive I met thought ‘all this spiritual stuff’ was ‘too touchy feely’, irrelevant to ‘getting the patients through the system’. That last production line phrase was telling. I replied, ‘But what the hell is healthcare if it’s not touchy feely?’ The conversation dried up. Five years later she asked to come into retreat after the NHS trust that employed her sank into ‘special measures’.

The infiltration of modern individualism

Much of modern western healthcare has subtly and sometimes not so subtly bought into the values of neo[1]liberalism. With its roots in Nietzschean ‘ubermenschen’ and ‘Gott is tot’ (Nietzsche, 1891) 20th century eugenics and Darwinian survival of the fittest, this ideology has permeated almost every level of our culture and has rippled through the political discourse from the economics of Hayek and the ideologies of Ayn Rand and onwards into Thatcherism, Reaganism and, latterly, Trumpism. It is a fundamental denial of the truth that we are not just human beings but also human belongings. Rampant individualism, as an irrefutable ‘given’ has colonised our values and infected every part of our culture. It denies the truth that we are at our best when connected, collaborative and cooperative, living lives in community of shared responsibility.

This world-view has even crept into the spiritual life. For example, in the past year I have worked with (or been a patient in!) 27 English and Scottish NHS trusts which have set up mindfulness programmes for staff, in an effort to reduce sickness, absenteeism, burnout and attrition. Like motherhood and apple pie, building awareness, resilience and opening us up to greater compassion through mindfulness would seem self-evidently good. So, what’s to complain about? First of all, the implementation of some mindfulness programmes buys into the zeitgeist that ‘it’s all down to you’ – that whatever is going wrong in society, personal life and work is the result of your own moral, biological, psychological or spiritual weaknesses that with a bit of (mindful) work, you can put right. (If you can’t, it’s your fault). Thus, stressed people get asked, ‘What’s wrong with you?’ rather than, ‘What’s wrong with the circumstances that have made you stressed?’ Lonely people get asked, ‘Why can’t you make friends’ rather than ‘What’s going on that has atomised neighbourliness?’ Impoverished people get asked, ‘Why don’t you get a job’ rather than, ‘Why have so many jobs become insecure drudge paying shit wages?’ The responsibilities (and costs) of making sure the workplace or society is a healthy place to be will be bypassed if employers, governments and societies are allowed to get away with dumping the problem on individual failings. Too many of the resilience building/mindfulness website and self-help tools are breath-taking in their lack of attention to these organisational responsibilities.

Despite the efforts to secularise it, can mindfulness really be divorced from its underlying Buddhist philosophy, not least what a necessary questioning of what ‘mind’ is? Is a profound spiritual practice debased when reduced to a stress reduction technique? I was at a meeting some years ago with the Dalai Lama. He said, ‘Why do you all want to learn Buddhism, you have all you need already here?’ The rich tradition of the contemplative way, for example, with the same attendant health benefits and cultivation of loving awareness is already here. The different philosophical roots of this tradition also hold the possibility that there is ‘Something Other’ available to help us… we are not on our own (Wright, 2017). The Buddha said, ‘Suffering is’ and that its roots were in attachment to things or to persons or to ideas of self. Another perspective is possible, that suffering occurs only on one plane of consciousness and that it may have meaning and purpose. Therefore attachment may not be the issue, rather detachment from our Source. Reconnection with this – our deepest Self – offers a different perspective and set of responses to the challenge of what it is to be human.

Heartfullness

At the Sacred Space Foundation our approach rests on what we have called ‘heartfullness’ – an awakening to full awareness through inner exploration. It enables people to let go of trying to do compassion and instead simply to learn to be it. For we carry its infinite source already within the very heart of our being. Could it be possible then, that integrating deep spiritual practice, spirituality, into staff development and support programmes would assist the emergence of greater compassion? Could dismantling unhealthy and limiting constructs of self[1]support more holistic care? Spiritual practices and insights do not have to be segregated to the meditation room, the retreat or the religious house. Despite the scepticism we might expect from hard-pressed NHS managers, some 25 have now asked us to bring our programmes to them.

Such personal transformation invariably requires processes such as inner enquiry over a long term and a deep shaking of the tectonic plates of the psyche in order to unleash the real ‘I am’ from the ‘I-that-I-think-I-am’. Such liberation is not about personal gratification, pacification or creating a saccharin, fluffy, feel-good existence. Rather, the intention is to nurture an interior realisation and fullfilment that liberates us into deeper engagement with life and work; but from a place of profound awareness of our true nature. An awareness that is not detached, disengaged, aloof witnessing of the human condition, but bursts with compassion for the healing of it and inspires a healthy-boundaried, non[1]attached willingness to participate. It is a call to leave the self and come Home to the Self, from which our path of service arises, awakening the heart to revolutionary compassionate action in the swampy lowlands of ordinary reality….in the worlds of the prophet [Micah 6:8] …to ‘act justly, love mercy and walk humbly with God’… whatever we experience that to be.

This demands nothing less than transformation out of limited perceptions of self and the story of life as we currently live it. It requires the writing of a new story where we are the hand and the pen and the paper. In the words of TS Eliot (1944) – it requires ‘a condition of complete simplicity costing not less than everything’. This to many, perhaps most, is scary stuff. Little wonder we have lots of drugs to keep us addicted and away from it. In the first week of November 2017, a police raid in Toronto netted 42kg of carfentanil, a powerful opioid, normally used to knock out elephants, but which when mixed with heroin delivers a knock-out but deadly ‘high’ for people. Half a world away, it was Single’s Day in China and the on-line shopping giant Alibaba saw more than 160 billion Yuan (£20 billion) kerchinging through its tills in the planet’s biggest ever one-day shopping spree.

These events are connected. Sartre (1943) wrote of the ‘God shaped hole’ in our consciousness – an empty space longing to be fulfilled with meaning, purpose and connection, the very stuff of spirituality and what it is to be human. For millennia and across cultures God/s quenched this spiritual thirst in various forms. But now in a life uprooted from what Tillich (2000) called ‘the ground of being’, locked into ordinary reality without connection to ‘something other’, we seek other gods to fill the void.

Few of them are healthy: drink, drugs, TV, sex, shopping, power-grabbing, career chasing, status seeking. All these painkillers offer only temporary respite. Like the insatiable hungry ghosts of the Buddhist tradition with their bloated bodies and tiny mouths they demand more and more. All are ultimately destructives to ourselves and the Earth. The fear-full undercurrent lurking in us all as we touch that emptiness within, bereft of the numinous, makes us sick. It drives a relentless anxiety in the human condition that, if for example, it compromises our immune system makes it more likely we will develop one or more of a whole raft of illnesses from cardio-vascular disease to cancer (Wright and Sayre-Adams, 2008).

The 4 Fs

It’s no accident therefore that fear is diminished, and thus our health and happiness improved, when we have four other Fs in our lives. On all scales and from the big picture of much recent research, we are more likely to be happy and healthy if we have:

Faith (not necessarily in a God, but simply having faith in something that gives meaning to life. For most people it is some perception of the divine, but it could equally be politics, philosophy or, for that matter sport!)

Fellowship – family, friends, community – relationships that shelter us from loneliness. Loneliness has been shown to undermine health – although it may be not so much the loneliness per se as the underlying anxiety if provokes.

Fulfilling work – bringing meaning, purpose, rewards to life.

Free giving – volunteering, parenting, opportunities to help and express compassion without expectation of reward.

Our programme at Sacred Space, going back more than three decades, grew out of both the scientific and the spiritual truths of the consequences of disconnection from each other and ourselves. The early teachings we pursued in the healing arts extended to support for health care staff as we noticed that course participants sought more than skills in healing. They wanted, often desperately, healing for themselves. Out of that our ‘heartfullness’ ideas grew.

Inner work and the quality of relationships

Despite the reservations of the hard-pressed manager, inner work for individuals and achieving organisational goals are not mutually exclusive. The transformation of self-perception among carers can unleash benefits for the organisation – fewer staff problems and better responses from patients. Getting the relationships right in the first place seems to save money down the line with less staff sickness and fewer patient complaints, for example.

The focus of our work is twofold. Drawing on spiritual practices from the contemplative tradition, a lineage to which I am blessed to belong, we help individuals in our retreat facilities while also outreaching to groups in work[1]places. The practices include spiritual direction, mentoring, deep silence, guided imagery, reflection, Enneagram insights, labyrinth walking, meditation and so on. When working with groups we use venues that are aesthetically pleasing, in nature, well away from the workplace, some[1]times residential and lasting a week as well as short time out/retreat days. Isolation from mobile and wifi signals helps (the anxiety arising in some under such circumstance is itself full of rich teachings about attachment!)

Participants report many benefits, but often find it painful and frightening too. When we begin to engage with the dismantling of ‘who-I-think-I-am’ to discover the ‘I am’, that letting go of attachments to roles and identities can be confusing and hurtful. Confronting the essential emptiness of personality can take us to the edge of the abyss. ‘If I’m not this’ (doctor, nurse, mother, friend, sister, taxpayer…) ‘Then who am I – nothing?’ Contemplative practices help people move from fear to liberation in ‘I am.’ – full stop, no accretions needed.

There is joy in the realisation that being nothing and no-thing are not the same.

I conclude with the story of Irene, a course participant and NHS support worker. She arrived armed with her multipacks of cola and stashes of chocolate and ciggys. Her bad education, crushed and angry persona, dysfunctional upbringing and home life was soon revealed and she spent the first part of the programme barely able to stay in the room. However, she stuck with it. In the final session everyone was speaking of their revelations and the impact of discovering their I am-ness. She exclaimed, ‘Well if you’re ‘I am’ and I’m ‘I am’, then we’re all the same aren’t we?’ Recognising our mutual I-am-ness is the stuff of connection and the fount of compassion in action.

That’s what we are called to do, as Forster (2012) suggests, ‘only connect’ – with the Essence of who we really are and through that connect with others and the All-that-is, whatever we experience that to be. That is the truth that sets us free. It is where ‘human love will be seen at its height’. This connection is not somewhere else. It is here. Now. Always. In the Wizard of Oz, Dorothy cries, ‘I want to go home!’ ‘But you are home, Dorothy’, replies the good witch, ‘All you have to do is wake up!’

References

• Eliot TS (1944) The four quartets. London: Harcourt Brace Jovanovich.
• Forster EM (1910) Howards end. Empire. London: Penguin.
• Martin J (1984) Hospitals in trouble. Blackwell London.
• Nietzsche F(1891) (T Commmon trans 2016) Thus spake Zarathustra. London: Createspace.
• Sartre J-P (1943) (R Eyre trans 2003) Being and nothingness. London: Routledge.
• Speck P (2003) Working with dying people. In: Obholzer A, Roberts V (eds) The unconscious at work. London: Brunner-Routledge.
• Tillich P (2000) The courage to be. Yale, CT: Yale University Press.
• Wright S (2017) Coming home. Penrith: SSP
• Wright S (2010) Burnout – a spiritual crisis on the way home. Penrith: SSP.
• Wright S, Sayre-Adams J (2008) Sacred space: right relationship and spirituality in healthcare. Penrith: SSP