Mindfulness matters

“You could say that mindfulness is like a personal app that allows you to see what's playing out in your mind whenever you pause to notice it. Without this awareness, the unnoticed thoughts, beliefs, memories, and feelings sit at the control panel of your mind, pushing your buttons and controlling your behaviors”.

When many forces converge with the same message, it is time to consciously recognize the importance of that line of thinking and engage with it, as indicated by the image above (drawn on my iPad using the Mindmap App Fluent MM then adding layers with Adobe ideas). A recent online writing workshop with HASTAC highlighted (through Amanda Strauss’’ presentation) the value of mindfulness in our work. In my interviews with educators I have been referred to mindfulness by three research participants. A midwife drew a picture indicating the balance needed between soul matters and information, a doctor involved at a non-governmental organization (Perinatal Mental Health Project ) shared the value of mindfulness as a strategy for engaging with individual’s lifestories, and our Head of the Department of Obstetrics and Gynaecology handed me papers on mindfulness in education at the end of our interview.

Last week I used an open access resource with my students. It was a recording of a mindfulness exercise. The impact of those 7 minutes was significant. A number of students made themselves comfortable lying on the floor while others came to speak to me afterwards. There was a different flow of energy that permeated our being and becoming. Ergas (2015) encourages us to engage with the lived experience of education rather than the structured curricular process which tends to be seen as linear.

Jon Kabat-Zinn is renowned for his work at the Massachusetts Medical School where he developed a Mindfulness-Based Stress Reduction (MBSR) programme in 1979. However it was only in the 1990s that mindfulness started making an increasingly important impact in education. Now in 2015, educators in all disciplines including Obstetrics are asking how it can be incorporated into curricular and pedagogical practices. Hyland (2015:171) reminds us that mindfulness “simply means ‘paying attention in a particular way: on purpose, in the present moment and nonjudgmentally’ in a way which ‘nurtures greater awareness, clarity, and acceptance of present-moment reality’”.

By using contemplative practices Ergas (2015:204) points out that we “are introducing an alternative curricular deliberation; one that inevitably challenges the very concept of ‘curriculum’ as a ‘course of study’ and its implications to our conception of life-meaning and where we ought to look for it (in here and/or out there).”.... It is about dwelling in the here and now, and gradually realising that there is no place ‘better’ than now. Paradoxically, this is a radical critique of the very essence of the ‘curriculum’, which inevitably proposes that reaching the ‘end’ of ‘the course of study’ will in effect bring us to a ‘better’ time and place”.

Ergas,O. 2015.  The Deeper Teachings of Mindfulness.  Journal of Philosophy of Education. 49:2..

Hyland, T. 2015. On the Contemporary Applications of Mindfulness: Some Implications for Education. Journal of Philosophy of Education. 49:2.

Curriculum as orchid

The mapping of the curriculum in medical education is an important process. Yet there is an assumption that what is taught (as reflected in the documents) will be representative of students’ learning experiences – a tracing of the requirements to become a good Doctor.

In the image above (drawn on my iPad using flowpaper) I consider the medical curriculum as the Deleuzian orchid that opens up with complexity through the years. If the students are Deleuzian wasps who interact with the curriculum at different places, then the in-between space of becoming-curriculum and becoming-doctor can be explored rhizomatically. In the process of learning there are movements of indeterminancy.

“The rhizome is altogether different, a map and not a tracing…. The orchid does not reproduce the tracing of the wasp; it forms a map with the wasp, in a rhizome. What distinguishes the map from the tracing is that it is entirely oriented toward an experimentation in contact with the real. The map does not reproduce an unconscious closed in upon itself; it constructs the unconscious. It fosters connections between fields, the removal of blockages on bodies without organs, the maximum opening of bodies without organs onto a plane of consistency. It is itself a part of the rhizome. The map is open and connectable in all of its dimensions; it is detachable, reversible, susceptible to constant modification. It can be torn, reversed, adapted to any kind of mounting, reworked by an individual, group, or social formation” (Deleuze & Guattari (1987:12).

Similarly our students are open to the influences of the practices they observe when immersed in their Obstetrics practical rotation. When a midwife chooses to watch television in preference to attending to the needs of a woman in pain or when a Doctor does not ensure informed consent before a procedure, these actions leave marks on students, like sticking pollen.

“The orchid deterritorializes by forming an image, a tracing of a wasp; but the wasp reterritorializes on that image. The wasp is nevertheless derritorialized, becoming a piece in the orchid's reproductive apparatus. But it reterritorializes the orchid by transporting its pollen. Wasp and orchid, as heterogeneous elements, form a rhizome. It could be said that the orchid imitates the wasp, reproducing its image in a signifying fashion (mimesis, mimicry, lure, etc.). … At the same time, something else entirely is going on: not imitation at all but a capture of code, surplus value of code, an increase in valence, a veritable becoming, a becoming-wasp of the orchid and a becoming-orchid of the wasp. Each of these becomings brings about the deterritorialization of one term and the reterritorialization of the other; the two becomings interlink and form relays in a circulation of intensities pushing the deterritorialization ever further (Deleuze & Guattari 1987:11).

In the rhizomatic connection between the students and the curriculum, I question whether the relationship is presently fostering the acceptance of injustice to women in labour. When students write about their unwillingness to respond to wrong-doing (by those who are meant to teach them), it reflects the impact for both now and later – leaving pollen on their being and becoming. This choice of inaction takes on a form of protection for themselves towards advancement in the course objectives. In order to bring change towards developing a socially just curriculum, we need to consider the reciprocal-becoming in the orchid-wasp/curriculum-student relationship.

Deleuze, G., & Guattari. F. 1987. A thousand plateaus: Capitalism and schizophrenia. Trans. B. Massumi. Minneapolis, MN: University of Minnesota Press.

Folding and unfolding in the findings

“we must learn to live in the middle of things, 

in the tension of conflict and confusion and possibility; 

and we must become adept at making do with the messiness 

of that condition and at finding agency within… “ (St Pierre 1997:176)

As I hear about the events related to student learning in Obstetrics, I am thrown into the folds of the unfolding data. Through this process of data collection, I feel myself becoming immersed in the currents that flow - some together, some in alternate directions, yet all moving me through the tide towards change in myself and in the process of intra-activity. There are interdependent and mutually constituted forces that effect each other through the affect on each other (Barad 2007). I was told that even the ripples emanating from this research project are raising awareness by contributing to an increased consciousness of students’ engagement with the curriculum in Obstetrics and beyond. This is an affirmative stance compared to the potential for drowning in sorrow from the tsunami of despair. Findings from a public inquiry by the South African Human Rights Commission (2009:4) to investigate the realization of the right to access health care illuminated the “lamentable state of many public hospitals in the country”; reasons suggested included “a shortage of trained health care workers, a lack of drugs in clinics, lengthy waiting periods that patients endure before receiving treatment, poor infrastructure, a disregard for patients’ rights, a shortage of ambulance services and poor hospital management”.

Beyond these limitations is the disjuncture in the capabilities of health providers. Recently an interviewee described her insights. She explained that after our previous interaction, she had been thinking about the realities of disrespect in the profession, now more clearly identifying that “what is ailing” in the healthcare profession is the issue of relationships. She shared a personal story reflecting the expertise and skill of colleagues in procedures yet their limitation in coping with loss. There was exceptional interprofessional collaboration when knowledge and skills were used, yet as the events unfolded, exclusions and separability became evident.

Strength in some areas of expertise produce lines of flight that then exclude other areas. There are rupturing connections between different bodies - a cutting-together and apart (Barad 2007). In terms of student learning, there are many obstacles such as an objectification of the curriculum and the students’ immersion in it. Perhaps their logbooks act as lifejackets carrying them through the tides, as they learn to strategically weather the storms and swim through the waves and the backwash - embedded in the processes. As facilitators of learning, perhaps we can take more time to acclimatize students to the conditions by presenting them with the reality, allowing them to tread the waters, feel the temperatures, and connect to the material-discursive practices of the discipline with and through each other.

The image above was drawn on the Stetches App on my iPad using my finger rather than a pen. The photos taken as selfies were cropped then inserted into the image symbolizing my becoming-researcher and becoming-curriculum.

Barad, K. 2007. Meeting the universe halfway: Quantum physics and the entanglement of

matter and meaning. Durham, NC: Duke University Press.

South African Human Rights Commission. 2009. Public inquiry: Access to health care services. http://www.sahrc.org.za/home/21/files/Health%20Report.pdf

St Pierre, E. A. 1997. Methodology in the fold and the irruption of transgressive data.