Mindfulness, Medicine, and a 21st Century Movement

New leaf in spring

By Rachel E. Roth

Compelled by compassion and an earnest desire to optimize health and reduce suffering, Dr. Mary P. Guerrera has spent the better part of her professional life advancing the practice of mind-body medicine, or integrative health care as it is sometimes called. She is a family physician, Professor of Family Medicine, and the director of Integrative Medicine in the Department of Family Medicine at the University of Connecticut School of Medicine, and also serves on the board of directors at Copper Beech Institute.

The stories of Guerrera’s childhood, education, and professional life weave together a narrative of someone who is deeply self-aware and passionately driven to serve others. Guerrera’s role as a board member at Copper Beech is a natural fit; she shares the Institute’s mission to apply mindfulness practice to life’s most challenging issues.

Growing up, Guerrera’s inquisitive and contemplative personality was nurtured by her parents who she says were her greatest inspiration and role models. Her father was an English teacher and principal; her mother was a registered nurse with a love of fishing and theater. Both had a deep appreciation of nature, gratitude for family, and a zeal for exploration.

“We spent summers together at our cottage on the Connecticut shore where my fascination with nature and an intimate association with the elemental rhythms of wind, water and tide grew and evolved,” Guerrera says.

As a young adult, Guerrera attended Mount Holyoke College where she studied biology and organic chemistry alongside philosophy, comparative religion, and art history. Her studies opened up new horizons and rich landscapes of knowing and learning. Her desire to become a physician blossomed. She went on to receive her medical degree from the University of Massachusetts Medical School, and followed with residency at the Maine Medical/Mercy Hospital Family Practice Residency Program in Portland, Maine where her holistic views were validated daily.

“Something very universal emerges as you study different parts of things; a beauty and a unity,” Guerrera says. “You see the elegant ways in which nature has manifested itself. … Western science has been a very powerful force to learn about the intricacies of function and mechanism, enabling people to explore smaller and smaller things in the microscopic world, or to explore larger and larger things in the macroscopic world. Yet within those studies, there are similarities and resonances and patterns that appear. You can explore further in either direction, only to discover there’s still so much we don’t really know. So, we experience the world in a variety of ways. One way is through the scientific method; another way is through aesthetic appreciation, or a love of beauty. To bring these things together in a meaningful way is the mystery of life.”

“I was drawn to family medicine because it’s one of the first disciplines in Western medicine that celebrates the biopsychosocial model. Focusing on one dimension of a person doesn’t enable us to see the whole picture,” Guerrera says.

The biopsychosocial model, which was formulated in the 1970s by the late psychiatrist George Engel, essentially posits that health and well-being are best understood in terms of the combination of biological, psychological (thoughts, emotions, and behaviors), and social (socio-economic, socio-environmental, and cultural) factors in a person’s life rather than purely in biological terms. (Engel, 1977)

“Genomics, our environment and genetics together, influence how our health and well-being manifest in our daily lives,” Guerrera says. “A person’s thoughts and emotions are also dimensions that affect their overall health and sense of well-being. Our surroundings, our food, our stress level, who we live with, what we do at work, where we live; all of it matters.”

“Understanding what gives people a sense of meaning and purpose is really important. Family medicine considers not just the health and wellbeing of one individual, but how that individual functions within their family and community. Do they have a belief system? What is their support system after grief, or loss, or a new illness? Are they spiritual or religious? Do they see other health professionals – chiropractors, nutritionists, massage therapists? What do they believe about themselves and their place in the community and in the world?”

The answer to all of these questions is critical to providing context not just for patient diagnosis, but also to crafting health care and wellness strategies that address the whole person – body, mind, and spirit. This approach is deeply grounded in humanism and characterized by respectful, kind, and compassionate relationships between all members of the health care team. It includes a wide range of behavioral and lifestyle interventions, such as yoga, mindfulness, and meditation, as well as conventional medical interventions.

For those in the medical profession who are skeptical of the benefits that mindfulness brings to self-care or patient care, Guerrera cites the work of Ronald Epstein, a professor of family medicine, psychiatry and oncology at the University of Rochester Medical Center Epstein. In an article entitled Mindful Practice published in the Journal of the American Medical Association in the late 90s, he writes:

Mindful practitioners attend in a nonjudgmental way to their own physical and mental processes during ordinary, everyday tasks. This critical self-reflection enables physicians to listen attentively to patients’ distress, recognize their own errors, refine their technical skills, make evidence-based decisions, and clarify their values so that they can act with compassion, technical competence, presence, and insight. Mindfulness informs all types of professionally relevant knowledge, including propositional facts, personal experiences, processes, and know-how, each of which may be tacit or explicit. … In contrast, mindlessness may account for some deviations from professionalism and errors in judgment and technique. … As a link between relationship-centered care and evidence-based medicine, mindfulness should be considered a characteristic of good clinical practice. (Epstein, 1999)

Guerrera echoes these beliefs: “As physicians, we want to be aware, to listen carefully… to reduce errors. These are all concrete goals of current medical practice and something we focus on when training students and health care professionals. The idea is that if I’m self-aware, and if I understand what will keep me healthy, whole, and optimally functioning in my work, then I will be able to better deliver that to other people and better able to work with other people.”

Health care practitioners and patients alike can benefit from integrative practices like mindfulness. For example, chronic stress is extremely taxing on a person’s sympathetic nervous system and can cause serious health problems including stomach ulcers, irritable bowel syndrome, sleep disorders, and high blood pressure. Countless studies have shown that mindfulness alone can help induce the relaxation response, decrease anxiety, boost the immune system, diminish pain, and accelerate healing.

Integrative practices serve as a form of preventive “medicine” in a health care system that has traditionally focused on disease management, according to Guerrera, and the possibilities have not gone unnoticed by administrators charged with providing the best possible care in the most cost-effective way. Yet it’s both costly and challenging to test preventive and integrative practices.

“There’s the challenge of who funds the studies,” Guerrera says. “And who gets funding? There’s the complexity of people saying ‘show me the research’ to practitioners who lack the funding sources to conduct such studies.”

At the same time, many professionals in the health care community believe that more funding for mind-body medicine would facilitate better and more integrative care.

Guerrera cites a recent pilot study conducted by Ana Maria Verissimo, M.D. at Connecticut Children’s Medical Center as another example of mind-body techniques at work. A practice called pre-operative self-hypnosis training was used to assist young patients in managing their pain during the Nuss procedure, an elective surgery in which an abnormal ribcage is essentially reconstructed to correct a sunken chest. According to Guerrera, the findings of the study showed these patients experienced less pain and less need for opioid medication. (Manworren, et al., 2015)

Studies have shown that most people want their health care professionals to integrate complementary options with conventional care. This is a movement that Guerrera has witnessed over the course of her career and she has actively participated in advancing mind-body and integrative medicine in medical education. She was on a national team of health care and education professionals who developed the Integrative Medicine in Residency program, a 250-hour Internet-based, collaborative educational initiative that was initially implemented in eight family medicine residency programs and is now disseminated to over 60 programs.

Guerrera also teaches a 10-week elective course called “Mind-Body-Spirit Medicine” to University of Connecticut medical students at Copper Beech Institute’s campus weekly. Students explore mind-body techniques such as breath work, mindful eating and contemplative walking.

“Students come together to experience community, to try new skills, and to share their experience,” Guerrera says. “These are things they’re not typically going to experience through their course of study at medical school, but through courses like this, students can have an authentic and informed experience.”

Some may find certain techniques personally effective, and all will be in a better position to assist their future patients who wish to explore complementary and integrative medicine alongside their allopathic counterparts.

“It is important to know whether certain practices are safe and effective, and if there is any evidence that it could benefit a patient; we can assist in helping to find a qualified, certified practitioner,” Guerrera says.

Guerrera makes a compelling case for medical students to learn about mind-body medicine, even if they don’t personally subscribe to all of its varied forms and modalities.

“‘Primum non nocere’ is a Latin phrase we often use in medicine that means ‘firstdo no harm,’” she says. “For anyone who is really dedicated and concerned about the well-being of their patients, I think they would be open to whatever may help patients heal or reduce their suffering, and that would not cause them harm.”

Kindness, compassion, altruism and service are important qualities for physicians and healers to cultivate, Guerrera says, and mindfulness and contemplative practices facilitate their development.

As a member of Copper Beech Institute’s board of directors, Guerrera works alongside a diverse group of professionals spanning business, law, psychology, education, and other integrative health care practitioners, including a yoga instructor and an acupuncturist. Their collective mission is to advance the Institute’s broader vision of effecting a healing shift in how human beings relate to one another and the earth through mindfulness and contemplative practices.

“It’s a tall order, looking at that big picture,” Guerrera says, “but I think when a person recognizes something is not quite right in their life, in their workplace, at home, wherever, and they start to explore this movement of contemplative practice, or mindfulness practice, as something that may be helpful to addressing stress, or frustration, or global well-being, then they may feel called to do something about it.”

Through mindfulness, we become more aware of and sensitive to ourselves and our environment, and with greater awareness, we have new perspectives and new ways to address problems.

“This idea of awakening – a new way of seeing the world – may move each person to find the best way to express their vocation or gifts to the world,” Guerrera says.

In this sense, mindfulness in medicine and in life is both deeply personal and profoundly communal in its implications. It offers a holistic and humanistic lens through which we might navigate the future of healing for ourselves, our communities, and our planet. Ultimately, the practice of mindfulness at every level of society might adequately equip humanity to address the unprecedented challenges we face in the century ahead.

In partnership with the Aetna Foundation and the Hemera Foundation, scholarship support is available through the Contemplative Fellowships for Healthcare Professionals program to attend mindfulness meditation weekend retreats and MBSR courses at Copper Beech Institute. To learn more and to apply, CLICK HERE.

Rachel E. Roth is a writer, learner, deep listener, and cultural observer. She’s an avid believer that mindfulness is both ennobling and essential to the art and science of well-being in body, mind, and spirit. Her professional background is in business development in the non-profit and hospitality sectors. Her passion is to integrate the principles of positive psychology with secular humanism towards living with gratitude, purpose, wonder, and vitality in the service of her family and community. 

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References

8-Week Mindfulness Based Stress Reduction. (2016). Retrieved from Copper Beech Institute : http://www.copperbeechinstitute.org/mbsr

Engel, G. L. (1977). “The need for a new medical model: A challenge for biomedicine”. Science, 129–136.

Epstein, R. M. (1999). Mindful Practice. Journal of the American Medical Association, 833-839.

Manworren, R. C., Girard, E. M., Verissimo, A. M., Ruscher, K. A., Santanelli, J. P., Weiss, R. M., & Hight, D. M. (2015). Hypnosis for Postoperative Pain Management of Thoracoscopic Approach to Repair Pectus Excavatum: Retrospective Analysis. Journal of Pediatric Surgical Nursing, 60-69.

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