When we spoke late this summer, Howard Ruan was just wrapping up their CPE (Clinical Pastoral Education) residency at Rush University Medical Center in Chicago. They say that their first unit, also at Rush, was so profoundly life-changing that they annoyed the people around them by asserting that everyone should do CPE. “I had never worked that intimately in a group setting, and with that amount of attention to the relational dynamics in a group. I’d never been challenged to show up in such unflinchingly honest conversations about my fears and anxieties and how they affected how I saw others and others saw me.”

While Howard’s parents, who emigrated to the United States from the south of China, had no particular interest in religion, Howard’s older brother discovered Zen Buddhism at college and brought it back home. “I’d see him sitting silently in the living room in darkness, illuminated by the aquarium. I still have memories of the first time I joined him for about 10 minutes of formal sitting—I was maybe 13 or 14. We sat facing each other and I thought it was the stupidest thing. I was like, why am I doing this? I’m not sure the question has actually changed that much since.”

Howard says they began taking Zen seriously while they were an undergraduate. They currently practice Soto Zen with Ancient Dragon Zen Gate in Chicago. Howard took lay precepts with their teacher, Taigen Dan Leighton, in 2016. “Zen practice became inseparable from how I thought about supporting people,” they say. After working for a few years, Howard went back to school and got both an MDiv degree with a concentration in chaplaincy and an MA in social work from the University of Chicago, which gives them more flexibility as they finish CPE and begin looking for work, most likely in health care. They are also currently a fellow at the Chicago Center for Psychoanalysis.

What are your CPE supervisors’ and cohort’s spiritual backgrounds? The supervisors are from different Christian denominations. One is an Asian-American Baptist who draws a lot from Eastern traditions and is an active martial arts practitioner. The way he thinks about Christianity makes a lot of sense to me, as a Buddhist.

In my group there are two Protestants, two Catholics, and two Buddhists. The other Buddhist came to the United States from China for her studies. She’s a Sino-Esoteric Buddhist, which I don’t know much about other than what I’ve read and she’s shared. It was interesting to have our Buddhisms be interpreted and wielded differently both in group processing and in our clinical work. Four of the six group members are BIPOC, and a few of us come from working-class backgrounds. There’s a particular sensitivity to socio-economic differences and racial and ethnic dynamics in the group, I think.

What units do you work in? I cover two oncology floors, two psych floors, and one general medicine floor. It’s a lot. We’re there Monday through Friday, 8:30 to 4:30. Three days of the week, we have group, plus clinical work and on-call shifts. There are only two staff chaplains, so the residents do the majority of the clinical work. 

How does your practice inform your CPE experience and your interactions with patients and their families? Because of my Zen practice, I’m always effortful about what my posture is—externally, of course, but also internally: what is happening to my body, to my mind, to this self that is perceiving and giving feedback. Moment-to-moment awareness and a highly sensitive attunement to this body-mind that is experiencing are always at the forefront for me in terms of meditation in action.

Can you describe a situation where your practice really helped you help someone else? Back in November, I was paged in the middle of the night: a teenager was dying. She had become disabled early in life, so a lot of time was spent giving the family space to talk about what was important in the relationship, what was meaningful, and what was being lost. Her uncle was the person who had been able to provide the extensive care the patient needed and I spent a lot of time talking with him that night. Part of the reason the situation stuck with me is the tragedy of the patient’s early life combined with the sheer amount of love the uncle had for her. She wasn’t expected to live very long, yet she got to her mid-teens because of him. 

Over the course of this residency, I’ve bumped into the uncle multiple times. We crossed paths again recently and he was still having a really hard time. I checked in and we chatted a bit—we had an impromptu chaplaincy moment. During even this brief opportunity to meet and share, I feel that my Zen practice allowed me to make space for him, to not try to smooth things over or fix them as he talked about his feelings. 

Christian colleagues have expressed that they have a hard time doing that. They’ve given me feedback saying that they appreciate how I don’t seem to be perturbed, knocked off guard, or overly anxious when difficult situations come up. I think that Zen gives me that edge. I allow and encourage people to express any feelings: feelings of hopelessness and despair as well as of joy and gratitude.

My Zen practice allowed me to make space for him, to not try to smooth things over or fix them as he talked about his feelings.

What do you do with it when you go home? Does it stick with you? Do you take a hot bath? I take a cold shower! It’s always too hot in the hospital so I need to cool down more than anything else. I practice, of course. I make time for stories that are not the stories I’ve been absorbing all day. They may be sad stories too—my partner has joked that the stuff I like is really sad—but it’s not the same as being in a room with a person or family member of someone who is dying, or where there’s a new diagnosis, or a loss that’s going to utterly change the family dynamics.

Tell me about how you got interested in psychoanalysis. I got into psychoanalysis the way a lot of people stumble into it: I read Freud in college. I was always kind of fascinated by that line of language and metaphor around dynamics. I got the extra push I needed four years ago during my first CPE unit where my supervisor’s behavioral science theory reference point was Heinz Kohut’s self psychology. I became really interested in that, and after the internship I did some independent study, took courses, and applied for a fellowship with the Chicago Center for Psychoanalysis. 

There’s something really messy and unclean about psychoanalytic theory that responds to how I relate to the world. It gives me more depth in thinking through and reflecting on what happens between people, if simply by virtue of how it talks about transference and countertransference. I don’t know that I’m ever not thinking about transference and countertransference.

Goodness, your partner must have a great time with that! Oh, that’s when they tell me to please stop. (laughs)

Honestly, it’s been an absolutely invaluable tool. It gives me a lot of ways to think about not only how patients are responding to me, but also how I’m responding to them. Psychoanalysis has also been a nice alternative framework for making sense of my ancient, twisted karma from beginningless greed, hate, delusion, etc. etc.

I’m curious—here you are, the Zen guy, and there’s not a whole lot of applause for the self in Zen. How do you make sense of self psychology vs. no or not self? That’s the golden question! For now, I draw a lot from [psychoanalyst Heinz] Kohut, and he’s all about the integrity of the self, the healthy or unhealthy narcissism of the self. The self constructs patterns to keep itself together—sometimes they’re helpful, sometimes they’re not. There’s a history behind why the self does what it does to keep itself together in a given context. I don’t see much conflict there with Buddhist critiques of the self, insofar as self arises out of causes and conditions, there is karma present, there’s this amalgamation of aggregates and heaps and desires and strategies to try to make it all stay together so it can do things. 

I think the key pivot for me, from a Zen perspective, is aspiration. Wholesome karma, actions, and habits with the reminder at all times that it’s not about wholesome actions or karma for the project of self-improvement, because the self is empty; it’s subject to change, there’s no way to pin it down. I’m empty because I’m thoroughly relational. Instead of the term “interdependence,” I’ve gravitated toward the language of relationships and relationality. And in that sense, to cultivate wholesome karma serves to relieve suffering. The crux is having healthier desires and relationships. I think that for now I’ve found my middle ground between psychoanalysis and Buddhism. 

Any advice for a Buddhist who’s thinking about CPE? Be willing to learn, be open to being challenged, be open to challenging others, be curious about your knee-jerk reactions, be curious about your nasty, unkind feelings—that’s a big one for me—and have compassion for those. These are good starting points for anyone, not just Buddhists. 

Do you feel you’ve changed in this last year? I’ve struggled a lot with self-worth and self-esteem—I’m not unique in this way—and I think this year I opened myself to being challenged, to challenge other people, and to take risks, over and over again. And somehow, through all of that, it happened that I cultivated a lot of self-forgiveness and self-compassion, and, honestly, a lot of love for myself. Not an egotistical “I’m the best” love, but a genuine “no, I really do care, for once, about myself in a way that I might more easily care for someone else.” Having a better understanding of and compassion for my own suffering helps me care for others better.

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