Using Meditation to deal
with pain, illness and death
A talk given to a conference on AIDS, HIV and other Immune-deficiency
Disorders
in
by Thanissaro Bhikkhu
A lot has appeared in the media 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
underestimate what meditation is and what it can do for you. This is typical of
the media. Listening to them is like listening to 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
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 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. Show it that you mean business, and eventually it will listen to you.
If
you want, you can experiment with different kinds of breathing. For example, if
long breathing feels comfortable, stick with it. If it doesn't, change it to
whatever rhythm feels soothing to the body. Gradually let each breath grow
shorter and shorter until you find a rhythm that's just right. If you feel
tense, breathe in a way that's relaxing. If you're tired, breathe in a way that
gives you energy. Try to savor the breath in the way you'd savor good food or
good music. You can try short breathing, fast breathing, slow breathing, deep
breathing, shallow breathing - whatever feels most balanced and 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. You'll eventually
want to be aware of the whole body breathing, but it's best to start out by
surveying the body part by part. Start at the area around 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, 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 & out your entire body, through every pore. Let your
awareness simply stay right there for a while - there's no where 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 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 o 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 grow more and more sensitive, and gain more and more insight into the
things that can 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 untouched by these things - or by anything at all. You can be free
from them.
As
I will show in a few moments, these higher stages in meditation are the ones
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 coming
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 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 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 her 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 the bed, bright and aware, as if nothing had 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 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've 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, aging, 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 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 aging,
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 aging - through
exercise, diet, surgery, make-up, whatever - they are the ones who suffer most
from aging. 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, because 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 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
breathe sensations that course through the body each time you breathe, you'll
notice that you tend to build a tense shell around 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 the shell of
tension. In most cases, you will find that this can relieve the pain
considerable. 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.
As
your powers of concentration become stronger and more settled, you can begin
analyzing the pain. The first step is to devide 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 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 a 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.
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 jibe. 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 to 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 to 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 to handle your death with finesse. Even though we don't 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 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. On occasion it looked like the pain was beginning to overwhelm
him, so I had his daughter whisper meditation instructions into his ear and
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 carer 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 carer'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. But 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 - it's 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.