Johannes Fendel, M.Sc., is a research fellow and doctoral candidate in the subproject P3, “Otium in the Hospital? A Mindfulness-Based Intervention for Resident Physicians.”
“MußeOrte – weltweit” (Places of Otium – Worldwide): Mindfulness is currently very relevant – from mindfulness advisors in book form, to Apps, to more or less commercial course offerings. How do you define the term concerning your own research?
Johannes Fendel: Mindfulness can be described as a state of awareness in which the focus of attention is on the present moment with an attitude of openness, curiosity, and acceptance. In mindfulness, you become aware of yourself, and of what occurs within and around you. Through this practice, you attempt not to judge or put value upon what you perceive. With continued practice, you get a deeper understanding of your own behavioral routines and reaction patterns and you learn new ways to deal with internal and external stress. Nevertheless, misunderstood mindfulness can backfire: if it is practiced only to reduce stress and to increase performance, it rather serves self-optimization and can in the end itself become a source of stress and unrest.
“MußeOrte – weltweit”: At what point now does otium come into play? What relationship does it have with mindfulness?
Johannes Fendel: We oriented the program towards promoting the experience of otium. Thus, we provide the participants of our mindfulness courses with a concept upon which they can orient their mindfulness practice. Otium is the complete opposite to purpose-directed behavior. In a state of otium, the goal is not achievement and efficiency, but rather to be content in the doing and being of the present moment. Otium serves as an antidote to performance attitudes, emphasizes the self-care and self-compassion components of mindfulness, and is associated with feelings of enjoyment, fulfillment, serenity, and freedom. Otium entails something spacious, feelings of duties and time pressure are dismissed – one experiences fulfillment and meaning. The orientation of the mindfulness practice towards the experience of otium should remind our participants that they do not have to accomplish anything with their mindfulness practice, but rather to do something for themselves and their well-being.
“MußeOrte – weltweit”: Otium builds then a frame of thought, which should give the course participants orientation and protect the mindfulness practice against the tendency of functionalization. How would you further place the two phenomena upon a conceptual level?
Johannes Fendel: A state of mindfulness shares many qualities with an experience of otium, such as the orientation to the present moment or the felt abdication from the experience of time. The difference between a state of mindfulness and a state of otium lies in the affective quality of the experience. In otium this is always positive and, as described above, goes along with the experience of enjoyment, friendliness, satisfaction, and meaning. A state of mindfulness can also be unpleasant, for example with the mindful perception of pain or discomfort. A further difference also arises in that one cannot “produce” otium. It rather “happens” as a result of both inner processes and external conditions. In our courses, participants practice to, again and again, redirect their attention to the present moment. This process does indeed take a lot of effort However, with time participants will experience that time and performance pressure decrease, what might in turn enhance the potential to experience otium. Mindfulness, so to say, serves to clear the path for otium.
“MußeOrte – weltweit”: Speaking of “participants” – in the project you conduct an intervention based upon mindfulness with the resident physicians and check their effects on their daily work and subjective sensation. What makes these resident physicians so interesting for your research?
Johannes Fendel: Medicine is both a very rewarding and at the same time stressful and demanding profession. Medical residency is particularly stressful, as young doctors face a multitude of work stressors, including high workload, excessive time demands, a lack of supervisory support, restricted autonomy, or moral dilemmas if physicians are forced to work in ways that conflict with their ethics and values. Consequently, resident physicians more prevalently suffer from mental distress, including burnout, depression, or even suicide. Resident physicians are also interesting for us because they are at the start of their career and begin to develop their own personal style of working. They find themselves in a critical phase of life in which routines and patterns are established, in which long-term well-being can be sustained, resilience built up, and stressors can be guarded against. The practice of mindfulness is at this point a promising possibility. Numerous studies from across over three decades of scientific research prove the effectiveness of mindfulness-based interventions. The first studies with physicians show, that after participation in a mindfulness program, they suffer significantly less from burnout and stress and show a reduced risk of depression and cardiovascular diseases.
“MußeOrte – weltweit”: At first glance, otium seems to be incompatible with the everyday demands in the hospital, where timing is everything, and the feeling of time pressure is ubiquitous. Do otium and mindfulness stand on the complete opposite side of the demands of a doctor’s everyday life?
Johannes Fendel: From my point of view the doctor’s profession offers an enormous potential for experiences of otium. Hardly any other profession is perceived as satisfactory and meaningful. Hereby, the direct contact with patients seems to be of outstanding importance and is perceived as a central source of motivation and gratification. However, time with patients is systematically cut short because of increasing bureaucratic demands, caseloads, and economic pressure behind medical decision making. Through the practice of mindfulness, the participating resident physicians learn to recognize potential moments of otium in the hospital, which they would normally miss. The best part is, through an increase in mindfulness-attributed presence and empathy in doctors, the patients benefit themselves.
“MußeOrte – weltweit”: Critics complain about a commercialization and functionalization of mindfulness. “Mindfulness” today is not only a lifestyle-phenomenon, but rather a self-optimization tool. What is your response to such criticism of the “mindfulness industry”?
Johannes Fendel: The mindfulness-boom of the last years and decades can be seen as an answer to an increasing mindlessness of the modern culture. If you lose yourself in multitasking between to-do lists, meetings, WhatsApp groups, and innumerable offers to consume, you may long for more simplicity, peace, and awareness in being and doing. Mindfulness builds an anti-pole against acceleration and works as a type of self-regulation towards the experience of the present moment. Nevertheless, with its rise as a mass phenomenon, mindfulness is increasingly functionalized. Both employers and individuals use targeted mindfulness in order to reduce stress and increase output. Through this, mindfulness becomes part of the modern culture of acceleration and self-optimization, to which it was originally meant to build an anti-pole against. In our project, we believe this paradox can be solved by orientating the mindfulness practice towards otium as a defunctionalized, self-determined, and fulfilled state of being.
“MußeOrte – weltweit”: The project G5 “Otium and Illness” investigates whether times of illness entail the potential to experience otium for patients, whereas your main interest lies on doctors’ everyday lives. Do you see connections between the projects?
Johannes Fendel: Asked about personal strategies to stay healthy, content, and efficient in everyday life, doctors usually indicate having good relationships with their patients. Direct patient contact builds a central resource, in order to experience meaning and joy in everyday life. Likewise, for patients, direct contact with their doctors is also very important, as it helps them to understand and emotionally process their diseases. Through talking with their doctors, symptoms get a meaning for patients. Furthermore, the conversation helps to convey safety, structure, and perspective. However, due to increasing bureaucratic demands, the time for contact and conversation is significantly reduced and, more and more, becomes a valuable resource. In the battle for this resource, a great paradox reveals itself: while patients are unwittingly confronted with idle hours in the hospital, their doctors are under permanent time pressure. The central question is now, how doctors can manage to use the remaining time with their patients, in order to increase both the well-being of their patients as well as their own. The practice of mindfulness might be of help.
“MußeOrte – weltweit”: What roll do places play in your research, for example rooms or occupied spaces?
Johannes Fendel: Mindfulness is not bound to places. Through the practice of mindfulness we want to create inner space and freedom. Stefan Schmidt once described the function of mindfulness as a precursor to the experience of otium. Especially in the hospital, he says, a place characterized by permanent rush, you must first practice to ease and calm the mind. Afterwards you might find opportunities for the experience of otium even in places and situations where you would have never expected it.
“MußeOrte – weltweit”: Mr. Fendel, thank you very much for the interview!