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
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.