Using
Meditation to
Deal with Pain, Illness and Death
by Ven.Thanissaro
Bhikkhu
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My topic today is the role that meditation can play in facing issues of
pain, illness and death – not a pleasant topic, but an important
one. Sadly, it's only when people are face-to-face with a fatal illness
that they start thinking about these issues, and often by that point it's
too late to get fully prepared. Although today's conference centers around
what medicine can do for AIDS, we shouldn't be complacent. Even if AIDS or
its adventitious infections don't get you, something else will, so it's
best to be prepared, to practice the skills you'll need when medicine –
Chinese, Western or whatever – can no longer help you, and you're
on your own. As far as I've been able to determine, the only way to
develop these skills is to train the mind. At the same time, if you are
caring for someone with a fatal disease, meditation offers you one of the
best ways to restore your own spiritual and emotional batteries so that
you can keep going even when things are tough.
A lot has appeared in the
media – books, newspapers, magazines, TV – about the role of
meditation in treating illness and emotional burnout. As usually happens
when the media get hold of a topic, they have tended to over- or
under-estimate what meditation is and what it can do for you. This is
typical of the media. Listening to them is like listening to a car
salesman. He doesn't have to know how to drive the car or care for it. His
only responsibility is to point out its selling points, what he thinks he
can get you to believe and shell out your money for. But if you're
actually going to drive the car, you have to study the owner's manual. So
that's what I'd like to present today: a user's manual for meditation to
help you when the chips are down.
I've had a fair amount of
first-hand experience in this area. The year before I left Thailand I was
stricken with malaria – a very different sort of disease from AIDS,
but still the number one killer in the world. At present, every year, more
people die of malaria than any other disease, this in spite of the massive
WHO campaign to wipe it out back in the 60's. Huge supplies of chloroquine
were handed out to Third World villagers. Swamps and homes were sprayed
with lethal doses of DDT to kill off the mosquitoes. But now new strains
of the malaria parasite have developed for which Western medicine has no
cure, the mosquitoes have become resistant to DDT, and the malaria death
rate is back on the rise. Remember this when you think of pinning your
hopes on NIH or the Salk Institute to come up with a cure or vaccine for
AIDS.
I was fortunate. As you
can see, I survived, but only after turning to traditional medicine when
the best treatment that tropical disease specialists could offer me
failed. At the same time, while I was sick I was able to fall back on the
meditation I had been practicing for the past several years to help get me
through the worst bouts of pain and disorientation. This is what convinced
me of its value in cases like this.
In addition to my own
experience, I've been acquainted with a number of meditators both here and
in Thailand who have had to live with cancer and other serious illnesses,
and from them I have learned how the meditation helped them to handle both
the illness and the cures – which are often more dreadful than the
cancer itself. I'll be drawing on their experiences in the course of this
talk.
But first I'd like us all
to sit in meditation for a few minutes, so that you can have a firsthand
taste of what I'm talking about, and so you can have a little practical
experience to build on when you go back home.
The technique I'll be
teaching is breath meditation. It's a good topic no matter what your
religious background. As my teacher once said, the breath doesn't belong
to Buddhism or Christianity or anyone at all. It's common property that
anyone can meditate on. At the same time, of all the meditation topics
there are, it's probably the most beneficial to the body, for when we're
dealing with the breath, we're dealing not only with the air coming in and
out of the lungs, but also with all the feelings of energy that course
throughout the body with each breath. If you can learn to become sensitive
to these feelings, and let them flow smoothly and unobstructed, you can
help the body function more easily, and give the mind a handle for dealing
with pain.
So let's all meditate for
a few minutes. Sit comfortably erect, in a balanced position. You don't
have to be ramrod straight like a soldier. Just try not to lean forward or
back, to the left or the right. Close your eyes and say to yourself, 'May
I be truly happy and free from suffering.' This may sound like a strange,
even selfish, way to start meditating, but there are good reasons for it.
One, if you can't wish for your own happiness, there is no way that you
can honestly wish for the happiness of others. Some people need to remind
themselves constantly that they deserve happiness – we all deserve
it, but if we don't believe it, we will constantly find ways to punish
ourselves, and we will end up punishing others in subtle or blatant ways
as well.
Two, it's important to
reflect on what true happiness is and where it can be found. A moment's
reflection will show that you can't find it in the past or the future. The
past is gone and your memory of it is undependable. The future is a blank
uncertainty. So the only place we can really find happiness is in the
present. But even here you have to know where to look. If you try to base
your happiness on things that change – sights, sounds, sensations
in general, people and things outside – you're setting yourself up
for disappointment, like building your house on a cliff where there have
been repeated landslides in the past. So true happiness has to be sought
within. Meditation is thus like a treasure hunt: to find what has solid
and unchanging worth in the mind, something that even death cannot touch.
To find this treasure we
need tools. The first tool is to do what we're doing right now: to develop
good will for ourselves. The second is to spread that good will to other
living beings. Tell yourself: 'All living beings, no matter who they are,
no matter what they have done to you in the past – may they all
find true happiness too.' If you don't cultivate this thought, and instead
carry grudges into your meditation, that's all you'll be able to see when
you look inside.
Only when you have cleared
the mind in this way, and set outside matters aside, are you ready to
focus on the breath. Bring your attention to the sensation of breathing.
Breathe in long and out long for a couple of times, focusing on any spot
in the body where the breathing is easy to notice, and your mind feels
comfortable focusing. This could be at the nose, at the chest, at the
abdomen, or any spot at all. Stay with that spot, noticing how it feels as
you breathe in and out. Don't force the breath, or bear down too heavily
with your focus. Let the breath flow naturally, and simply keep track of
how it feels. Savor it, as if it were an exquisite sensation you wanted to
prolong. If your mind wanders off, simply bring it back. Don't get
discouraged. If it wanders 100 times, bring it back 100 times. Show it
that you mean business, and eventually it will listen to you.
If you want, you can
experiment with different kinds of breathing. If long breathing feels
comfortable, stick with it. If it doesn't, change it to whatever rhythm
feels soothing to the body. You can try short breathing, fast breathing,
slow breathing, deep breathing, shallow breathing – whatever feels
most comfortable to you right now...
Once you have the breath
comfortable at your chosen spot, move your attention to notice how the
breathing feels in other parts of the body. Start by focusing on the area
just below your navel. Breathe in and out, and notice how that area feels.
If you don't feel any motion there, just be aware of the fact that there's
no motion. If you do feel motion, notice the quality of the motion, to see
if the breathing feels uneven there, or if there's any tension or
tightness . If there's tension, think of relaxing it. If the breathing
feels jagged or uneven, think of smoothing it out... Now move your
attention over to the right of that spot – to the lower right-hand
corner of the abdomen – and repeat the same process... Then over to
the lower left-hand corner of the abdomen... Then up to the navel...
right... left... to the solar plexus... right... left... the middle of the
chest... right... left... to the base of the throat... right... left... to
the middle of the head... [take several minutes for each spot]
If you were meditating at
home, you could continue this process through your entire body -- over the
head, down the back, out the arms & legs to the tips of your finger & toes
– but since our time is limited, I'll ask you to return your focus
now to any one of the spots we've already covered. Let your attention
settle comfortably there, and then let your conscious awareness spread to
fill the entire body, from the head down to the toes, so that you're like
a spider sitting in the middle of a web: It's sitting in one spot, but
it's sensitive to the entire web. Keep your awareness expanded like this
– you have to work at this, for its tendency will be to shrink to a
single spot – and think of the breath coming in and out of your
entire body, through every pore. Let your awareness simply stay right
there for a while – there's nowhere else you have to go, nothing
else you have to think about... And then gently come out of meditation.
After my talk we'll have
time to answer any questions you may have, but right now I'd like to
return to a point I made earlier: the ways meditation and its role in
dealing with illness and death tend to be under and over-estimated, for
only when you have a proper estimation of your tools can you put them to
use in a precise and beneficial way. I'll divide my remarks into two
areas: what meditation is, and what it can do for you.
First, what meditation is:
This is an area where popular conceptions tend to under-estimate it. Books
that deal with meditation in treating illness tend to focus on only two
aspects of meditation as if that were all it had to offer. Those two
aspects are relaxation and visualization. It's true that these two
processes form the beginning stages of meditation – you probably
found our session just now very relaxing, and may have done some
visualization when you thought of the breath coursing through the body
– but there's more to meditation than just that. The great meditators
in human history did more than simply master the relaxation response.
Meditation as a complete
process involves three steps. The first is mindful relaxation, making the
mind comfortable in the present – for only when it feels
comfortable in the present can it settle down and stay there. The
important word in this description, though, is mindful. You have to be
fully aware of what you're doing, of whether or not the mind is staying
with its object, and of whether or not it's drifting off to sleep. If you
simply relax and drift off, that's not meditation, and there's nothing you
can build on it. If, however, you can remain fully aware as the mind
settles comfortably into the present, that develops into the next step.
As the mind settles more
and more solidly into the present, it gains strength. You feel as if all
the scattered fragments of your attention – worrying about this,
remembering that, anticipating, whatever – come gathering together
and the mind takes on a sense of wholeness and unification. This gives the
mind a sense of power. As you let this sense of wholeness develop, you
find that it becomes more and more solid in all your activities,
regardless of whether you're formally meditating or not, and this is what
leads to the third step.
As you become more and
more single-minded in protecting this sense of wholeness, you become more
and more sensitive, and gain more and more insight into the things that
can knock it off balance. On the first level, you notice that if you do
anything hurtful to yourself or others, that destroys it. Then you start
noticing how the simple occurrence in the mind of such things as greed,
lust, anger, delusion and fear can also knock it off balance. You begin to
discern ways to reduce the power that these things have over the mind,
until you can reach a level of awareness that is untouched by these things
– or by anything at all – and you can be free from them.
As I will show in a few
moments, it's these higher stages in meditation that can be the most
beneficial. If you practice meditation simply as a form of relaxation,
that's okay for dealing with the element of your disease that comes from
stress, but there's a lot more going on in AIDS, physically and mentally,
than simply stress, and if you limit yourself to relaxation or
visualization, you're not getting the full benefits that meditation has to
offer.
Now we come to the topic
of what meditation can do for you as you face serious illness and death.
This is an area where the media engage both in over-estimation and
under-estimation. On the one hand, there are books that tell you that all
illness comes from your mind, and you simply have to straighten out your
mind and you'll get well. Once a young woman, about 24, suffering from
lung cancer, came to visit my monastery, and she asked me what I thought
of these books. I told her that there are some cases where illness comes
from purely mental causes, in which case meditation can cure it, but there
are also cases where it comes from physical causes, and no amount of
meditation can make it go away. If you believe in karma, there are some
diseases that come from present karma – your state of mind right
now – and others that come from past karma. If it's a present-karma
disease, meditation might be able to make it go away. If it's a past-karma
disease, the most you can hope from meditation is that it can help you
live with the illness and pain without suffering from it.
At the same time, if you
tell ill people that they are suffering because their minds are in bad
shape, and that it's entirely up to them to straighten out their minds if
they want to get well, you're laying an awfully heavy burden on them,
right at the time when they're feeling weak, miserable, helpless and
abandoned to begin with. When I came to this point, the woman smiled and
said that she agreed with me. As soon as she had been diagnosed with
cancer, her friends had given her a whole slew of books on how to will
illness away, and she said that if she had believed in book-burning she
would have burned them all by now. I personally know a lot of people who
believe that the state of their health is an indication of their state of
mind, which is fine and good when they're feeling well. As soon as they
get sick, though, they feel that it's a sign that they're failures in
meditation, and this sets them into a tailspin.
You should be very clear
on one point: The purpose of meditation is to find happiness and
well-being within the mind, independent of the body or other things going
on outside. Your aim is to find something solid within that you can depend
on no matter what happens to the body. If it so happens that through your
meditation you are able to effect a physical cure, that's all fine and
good, and there have been many cases where meditation can have a
remarkable effect on the body. My teacher had a student – a woman
in her fifties – who was diagnosed with cancer more than 15 years
ago. The doctors at the time gave her only a few months to live, and yet
through her practice of meditation she is still alive today. She focused
her practice on the theme that, 'although her body may be sick, her mind
doesn't have to be.' A few years ago I visited her in the hospital the day
after she had had a kidney removed. She was sitting up in bed, bright and
aware, as if nothing happened at all. I asked her if there was any pain,
and she said yes, 24 hours a day, but that she didn't let it make inroads
on her mind. In fact, she was taking her illness much better than her
husband, who didn't meditate, and who was so concerned about the
possibility of losing her that he became ill, and she had to take care of
him.
Cases like this are by no
means guaranteed, though, and you shouldn't really content yourself just
with physical survival – for as I said earlier, if this disease
doesn't get you, something else will, and you're not really safe until
you've found the treasure in the mind that is unaffected even by death.
Remember that your most precious possession is your mind. If you can keep
it in good shape no matter what else happens around you, then you have
lost nothing, for your body goes only as far as death, but your mind goes
beyond it.
So in examining what
meditation can do for you, you should focus more on how it can help you to
maintain your peace of mind in the face of pain, ageing, illness and
death, for these are things you're going to have to face someday no matter
what. Actually, they are a normal part of life, although we have come to
regard them as abnormalities. We've been taught that our birthright is
eternal youth, health and beauty. When these things betray us, we feel
that something is horribly wrong, and that someone is at fault –
either ourselves or others. Actually, though, there's no one at fault.
Once we are born, there is no way that ageing, illness and death can't
happen. Only when we accept them as inevitable can we begin to deal with
them intelligently in such a way that we won't suffer from them. Look
around you. The people who try hardest to deny their ageing –
through exercise, diet, surgery, makeup, whatever – they are the
ones who suffer most from ageing. The same holds true with illness and
death.
So now I would like to
focus on how to use meditation to face these things and transcend them.
First, pain. When it happens, you first have to accept that it's there.
This in itself is a major step, since most people, when they encounter
pain, try to deny it its right to exist. They think they can avoid it by
pushing it away, but that's like trying to avoid paying taxes by throwing
away your tax return: You may get away with it for a little while, but
then the authorities are bound to catch on, and you'll be worse off than
you were before. So the way to transcend pain is first to understand it,
to get acquainted with it, and this means enduring it. However, meditation
can offer a way of detaching yourself from the pain while you are living
with it, so even though it's there, you don't have to suffer from it.
First, if you master the
technique of focusing on the breath and adjusting it so that it's
comfortable, you find that you can choose where to focus your awareness in
the body. If you want, you can focus it on the pain, but in the earlier
stages its best to focus on the parts of the body that are comfortable.
Let the pain have the other part. You're not going to drive it out, but at
the same time you don't have to move in with it. Simply regard it as a
fact of nature, an event that is happening, but not necessarily happening
to you.
Another technique is to
breathe through the pain. If you can become sensitive to the breath
sensations that course through the body each time you breathe, you will
notice that you tend to build a tense shell around the pain, where the
energy in the body doesn't flow freely. This, although it's a kind of
avoidance technique, actually increases the pain. So think of the breath
flowing right through the pain as you breathe in and out, to dissolve away
this shell of tension. In most cases, you will find that this can relieve
the pain considerably. For instance, when I had malaria, I found this very
useful in relieving the mass of tension that would gather in my head and
shoulders. At times it would get so great that I could scarcely breath, so
I just thought of the breath coming in through all the nerve centers in my
body – the middle of the chest, the throat, the middle of the
forehead and so forth – and the tension would dissolve away.
However, there are some people though who find that breathing through the
pain increases the pain, which is a sign that they are focusing
improperly. The solution in that case is to focus on the opposite side of
the body. In other words, if the pain is in the right side, focus on the
left. If it's in front, focus on the back. If it's in your head –
literally – focus on your hands and feet. (This technique works
particularly well with migraine, by the way: If, for example, your
migraine is on the right side, focus on the breath sensations on the left
side of your body, from the neck on down.)
As your powers of
concentration become stronger and more settled, you can begin analyzing
the pain. The first step is to divide it into its physical and mental
components. Distinguish between the actual physical pain, and the mental
pain that comes along with it: The sense of being persecuted –
justly or unjustly – the fear that the pain may grow stronger or
signal the end, whatever. Then remind yourself that you don't have to side
with those thoughts. If the mind is going to think them, you don't have to
fall in with them. Then, when you stop feeding them, you'll find that
after a while they'll begin to go away, just like a crazy person coming to
talk with you. If you talk with the crazy person, after a while you'll go
crazy too. If however, you let the crazy person chatter away, but don't
join in the conversation, after a while the crazy person will leave you
alone. It's the same with all the garbage thoughts in your mind.
As you strip away all the
mental paraphernalia surrounding your pain – including the idea
that the pain is yours or is happening to you – you find that you
finally come down to the label that simply says, This is a pain and it's
right there. When you can get past this, that's when your meditation
undergoes a breakthrough. One way is to simply notice that this label will
arise and then pass away. When it comes, it increases the pain. When it
goes, the pain subsides. Then try to see that the body, the pain and your
awareness are all three separate things – like three pieces of
string that have been tied into a knot, but which you now untie. When you
can do this, you find that there is no pain that you cannot endure.
Another area where
meditation can help you is to live with the simple fact of your body being
ill. For some people, accepting this fact is one of the hardest parts of
illness. But once you have developed a solid center in your mind, you can
base your happiness there, and begin to view illness with a lot more
equanimity. We have to remember that illness is not cheating us out of
anything. It's simply a part of life. As I said earlier, illness is
normal; health is miracle. The idea of all the complex systems of the body
functioning properly is so improbable that we shouldn't be surprised when
they start breaking down.
Many people complain that
the hardest part of living with a disease like AIDS or cancer is the
feeling that they have lost control over their bodies, but once you gain
more control over your mind, you begin to see that the control you thought
you had over your body was illusory in the first place. The body has never
entered into an agreement with you that it would do as you liked. You
simply moved in, forced it to eat, walk, talk, etc., and then thought you
were in charge. But even then it kept on doing as it liked –
getting hungry, urinating, defecating, passing wind, falling down, getting
injured, getting sick, growing old. When you reflect on the people who
think they have the most control over their bodies, like bodybuilders,
they're really the most enslaved, having to eat enough each day to keep
ten Somalians alive, having to push and pull on metal bars for hours,
expending all their energy on exercises that don't go anywhere at all. If
they don't, their pumped-up bodies will deflate in no time flat.
So an important function
of meditation – in giving you a solid center that provides you a
vantage point from which to view life in its true colors – is that
it keeps you from feeling threatened or surprised when the body begins to
reassert its independence. Even if the brain starts to malfunction, the
people who have developed mindfulness through meditation can be aware of
the fact, and let go of that part of their bodies too. One of my teacher's
students had to undergo heart surgery, and apparently the doctors cut off
one of the main arteries going to his brain. When he came to, he could
tell that his brain wasn't working right, and it wasn't long before he
realized that it was affecting his perception of things. For instance, he
would think that he had said something to his wife, would get upset when
she didn't respond, when actually he had only thought of what he wanted to
say without really saying anything at all. When he realized what was
happening, he was able to muster enough mindfulness to keep calm and
simply watch what was going on in his brain, reminding himself that it was
a tool that wasn't working quite right, and not getting upset when things
didn't jive. Gradually he was able to regain his normal use of his
faculties, and as he told me, it was fascinating to be able to observe the
functioning and malfunctioning of his brain, and to realize that the brain
and the mind were two separate things.
And finally we come to the
topic of death. As I said earlier, one of the important stages of
meditation is when you discover within the mind a knowing core that does
not die at the death of the body. If you can reach this point in your
meditation, then death poses no problem at all. Even if you haven't
reached that point, you can prepare yourself for death in such a way that
you can die skillfully, and not in the messy way that most people die.
When death comes, all
sorts of thoughts are going to come crowding into your mind –
regret about things you haven't yet been able to do, regret about things
you did do, memories of people you have loved and will have to leave. I
was once almost electrocuted, and although people who saw it happening
said that it was only a few seconds before the current was cut off, to me
it felt like five minutes. Many things went through my mind in that
period, beginning with the thought that I was going die of my own
stupidity. Then I made up my mind that, if the time had come to go, I'd
better do it right, so I didn't let my mind fasten on any of the feelings
of regret, etc., that came flooding through the mind. I seemed to be doing
OK, and then the current ceased.
If you haven't been
practicing meditation, this sort of experience can be overwhelming, and
the mind will latch on to whatever offers itself and then will get carried
away in that direction. If, though, you have practiced meditation,
becoming skillful at letting go of your thoughts, or knowing which
thoughts to hang onto and which ones to let pass, you'll be able to handle
the situation, refusing to fall in line with any mental states that aren't
of the highest quality. If your concentration is firm, you can make this
the ultimate test of the skill you have been developing. If there's pain,
you can see which will disappear first: the pain or the core of your
awareness. You can rest assured that no matter what, the pain will go
first, for that core of awareness cannot die.
What all this boils down
to is that, as long as you are able to survive, meditation will improve
the quality of your life, so that you can view pain and illness with
equanimity and learn from them. When the time comes to go, when the
doctors have to throw up their hands in helplessness, the skill you have
been developing in your meditation is the one thing that won't abandon
you. It will enable you to handle your death with finesse. Even though we
don't like to think about it, death is going to come no matter what, so we
should learn how to stare it down. Remember that a death well handled is
one of the surest signs of a life well lived.
So far I've been confining
my remarks to the problems faced by people with AIDS and other life
threatening illnesses, and haven't directly addressed the problems of
people caring for them. Still, you should have been able to gather some
useful points for handling such problems. Meditation offers you a place to
rest and gather your energies. It also can help give you the detachment to
view your role in the proper light. When an ill person relapses or dies,
it's not a sign of failure on the part of the people caring for him. Your
duty, as long as your patient is able to survive, is to do what you can to
improve the quality of his/her life. When the time comes for the patient
to go, your duty is to help improve the quality of his/her death.
An old man who had been
meditating for many years once came to say farewell to my teacher soon
after he had learned that he had an advanced case of cancer. His plan was
to go home and die, but my teacher told him to stay and die in the
monastery. If he went home, he would hear nothing but his nieces and
nephews arguing over the inheritance, and it would put him in a bad frame
of mind. So we arranged a place for him to stay, and had his daughter, who
was also a meditator, look after him. It wasn't long before his body
systems started breaking down, and on occasion it looked like the pain was
beginning to overwhelm him, so I had his daughter whisper meditation
instructions into his ear, and to chant his favorite Buddhist chants by
his bedside. This had a calming effect on him, and when he did die –
at 2 a.m. one night – he seemed calm and fully aware. As the
daughter told me the next morning, she didn't feel any sadness or regret,
for she had done her very best to make his death as smooth a transition as
possible.
If you can have a
situation where both the patient and the caregiver are meditators, it
makes things a lot easier on both sides, and the death of the patient does
not necessarily have to mean the death of the caregiver's ability to care
for anyone else.
That covers the topics I
wanted to deal with. I'm afraid that some of you will find my remarks
somewhat downbeat, but my purpose has been to help you look clearly at the
situation facing you, either as an ill person or as someone caring for
one. If you avoid taking a good, hard look at things like pain and death,
they can only make you suffer more, since you've refused to prepare
yourself for them. Only when you see them clearly, get a strong sense of
what's important and what's not, and hold firmly to your priorities: only
then can you transcend them.
Many people find that the
diagnosis of a fatal illness enables them to look at life clearly for the
first time, to get some sense of what their true priorities are. This in
itself can make a radical improvement in the quality of their lives –-
its simply a shame that they had to wait to this point to see things
clearly. But whatever your situation, I ask that you try to make the most
of it in terms of improving the state of your mind, for when all else
leaves you, that will stay. If you haven't invested your time in
developing it, it won't have much to offer you in return. If you've
trained it and cared for it well, it will repay you many times over. And,
as I hope I have shown, meditation has much to offer as a tool in helping
you to solidify your state of mind and enable it to transcend everything
else that may come its way.
Thank you for your
attention.
Thanissaro Bhikkhu
(Geoffrey DeGraff)
Metta Forest Monastery
Valley Center, CA
92082-1409
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Source: http://www.buddhanet.net