Mindfulness and Pain
(An edited version of this article was published
in Tricycle Magazine.)
I have had rheumatoid arthritis, a very painful
and crippling disease, for 26 years. It began in
my 7th year of zen practice. As the disease
progressed and I became an invalid in bed, the
people at the San Francisco Zen Center where I
practiced put up a sign-up sheet for volunteers
to clean my room, do my laundry, and wash my
hair. I could do nothing for myself. Because of
my pain and extreme weakness, changing my
posture was a dramatic event. I needed to heed
every little sensation in my legs and feet in
order to go from sitting to standing. Getting
out of my bed and going to the bathroom took the
same kind of focus and attention as going on
safari.
My interest in consciousness and my belief that
self-sabotaging behaviors could be altered by
awareness had led me to Buddhist meditation. But
nothing I had learned in my seven years of
regular zazen and innumerable sesshins (long
sittings) had prepared me for this ordeal. Swept
up by the power of the pain, overwhelmed and
consumed by it, I couldn’t feel anything else. I
was forced to completely surrender to the
physicality of my existence, moment after
moment. I wouldn’t have chosen to explore
consciousness on such a primitive level, but
once I had to, I discovered that there actually
were experiences waiting to be noticed besides
the pain -- over here is bending, here is
breath, here is sun warming, here is unbearable
fire, here is tightness -- something different
wherever I looked. Pain is one of those things
that turns out to be dramatically different from
how it looks on the outside. Before you
surrender to your pain, it seems insurmountable,
impossible to live with, unbearable. But after
you are forced to give in to it – it opens up
into a spaciousness unimaginable before you
actually have this experience. I had spent most
of my life looking at my body from the outside,
mostly criticizing it: Too much fat over here,
not enough definition over there. Ironically, in
pain so severe I couldn’t function, I began to
inhabit my body fully for the first time in my
life.
As it turned out, my Zen meditation training was
a very great help to me. I had been taught to
study the objects of consciousness: feelings,
perceptions, sensations, and thoughts. In long
periods of meditation, I even had been able to
watch my perceptions as they were being formed.
This is, of course, the business of Zen
meditation, to observe all these things. You
simply focus your attention on what is happening
now, your immediate experience -- of your body
sensations, your sense impressions, the stream
of your consciousness. There is no goal
involved. There is only the relentless,
implacable present. And it is only in the
present that you can cultivate the mental
stability that is required to practice
nonpreference for the conditions of your life.
Here’s where meditation and mindfulness come in.
Fully inhabiting my body, despite its
devastation, attentive to every little
sensation, allowed me to pay close attention to
its latent possibilities when they appeared. I
lived a half-block from the San Francisco Zen
Center when I was just beginning to be able to
take walks again, and I used to try to go to
dinner there once a week as a treat to myself.
Eating a good vegetarian meal with other people.
Traveling that half-block was my own personal
triathlon: walking downhill to the front of the
building; climbing the stairs, and knocking on
the door with my weak hand. Sometimes I would
make it all the way to the steps and not be able
to go up them. So I would have to strain all the
way back up the hill to my apartment. I asked
myself, what is it about my walking that is so
tiring? What I called "walking" was the part of
the step when my foot met the sidewalk. From the
point of view of the joints, that is the most
stressful component of walking. The joints get a
rest when the foot is in the air, just before it
strikes the pavement. I found that by focusing
on the foot that was in the air instead of the
foot that was striking the pavement, my stamina
increased enormously. After making this
observation, I never again failed to climb the
steps to knock on the front door of Zen Center.
I was struck that the focus of my attention
could make that much difference in my physical
ability. I began to search out the times my
brain was clumping together many disparate
motions into an idea which would prevent me from
overcoming an obstacle, and then I concentrated
on breaking down these aggregates of ideas into
discrete units of smaller experience that I
could master. Sick or well, we all do this all
the time. We get into the idea of something, the
clump, the heap, the pile, rather than the
actual experience. Someone says, "I can't
practice because I haven't been to the zendo in
three weeks" instead of just sitting when she
can. When I haul out the carrots and the cutting
board during the arthritis workshops I give,
everybody immediately groans: "I can't cut
carrots with my arthritic hands!" But when you
actually hold the knife in your hands, feeling
its heavy wooden handle and sharp, solid blade;
and you touch the vulnerable flesh of the carrot
on the cutting board – you’re actually having an
experience of what you can do rather than an
idea of what you can do -- your wrist goes up
and down, up and down; and the orange wafers of
carrot begin to pile up on the board, and you
realize: "I can cut carrots." Tears actually
come to people's eyes.
What it takes to challenge your own conceptual
heaps and piles and consciously replace them
with direct experience is being present in this
moment and aware. But why would anyone in pain
want to cultivate the present moment? I work
with people who have degenerative diseases like
arthritis, MS, and stroke. Many of them have
constant, unremitting pain. They say to me, "Why
would I want to be aware, in the present, with
my pain? It hurts too much. I'd rather distract
myself.”
Maybe the bottom line is that if you develop a
strategy to deal with suffering that rests on
merely distracting yourself, it won’t work in
the long run. You have to live on a very
superficial level to maintain the ability to
watch TV or work endlessly as a distraction.
This is why developing the stability cultivated
by formal meditation practice is very important
to suffering people. You need to be very
grounded to allow the extreme suffering of
constant pain to enter you, perceive it, feel
it, and then let it pass out of you. I think
what meditation and mindfulness do for us when
we’re shrieking with pain is widen our weave,
that is, awareness without judgment makes the
openings in our bodies large enough for enormous
amounts of suffering to be registered and then
pass through, leaving no trace. The suffering is
burned up completely in the moment it's felt.
When I feel this in my own body, it's like my
weave is so wide, there's so much space between
the fibers of my tissue, my insides must
resemble the imperfect potholders made at school
by kindergarteners and brought home proudly to
parents.
So the main reason to stay present in unbearable
situations is that you can't allow the suffering
to pass through unless you're paying attention,
vibrating, pulsating with the waves of suffering
you feel, aware of your own breathing and
grounded by it and the sense impressions
impinging on you and the emotions registering in
your body. You're settled in emotional breath
and emotional body which makes it easier to
settle also into, the emotional mind -- the mind
that reels with its projections and fears.
As Buddhist practitioners we are constantly
told, “Sit with your pain. Settle into your
pain. Be one with your pain.” We then berate
ourselves because we can’t pull this off with
the style and grace apparently practiced by the
Ancients. The conclusion I’ve reached is that
this is another thing that is quite different in
the description than it is in reality. I think
what “sitting with your pain” actually looks
like is: you sit there, you really do, and you
feel your pain. It’s unbearable. You flinch
away. You can only take it for a short time –
maybe seconds. But then you go back. After the
cookie, after the TV show, after the pain pill
wears off, you go back. And you stay there as
long as you can, and then you flinch away again
because you can’t stand it. But you go back. The
vow to return again and again is the “settling,”
the “being one” with your pain. Each time you
stay with it as long as you can you are
settling. It looks different from sitting
immobile in excruciating pain, but it’s not. The
vow is the thing.
I always tell clients and students that there
are two arenas in which they should be
developing their abilities to deal with chronic
pain: (1) You must find out as much as you can
about your condition and the treatments
available, both medical and non-medical. If your
situation involves a long-term illness, you will
best be served by keeping up with the latest
research, drugs and therapy being developed. In
addition, an informed patient is in a much
better position to use her doctors and
therapists as consultants rather than dictators.
In other words, do your best to STOP the pain.
(2) At the same time do everything you can,
i.e., practice zazen, meditation and
mindfulness, to cultivate the mind that is
willing to live with your pain for the rest of
your life.
This may seem paradoxical to both try to stop
the pain and to be willing to live with it at
the same time, but this is only a difficulty in
the conceptual realm. In the realms of actual
experience, we have no trouble doing both at the
same time. These tasks are performed by
different aspects of our being.
One of the great contributions a consciousness
refined by meditation can make to pain
management is that such a mind is open to many
kinds of experience, not all of them necessarily
pleasant. With such an attitude, no pain can
commandeer your life. You can begin to live with
your suffering in such a way that life's
frustrations and disappointments are part of the
rich tapestry of living. In order to have such
an attitude, we need to cultivate skills that
enable us to be present for all of our life, not
just the moments we prefer. I call the specific
skill cultivating by meditation and mindfulness
“enriching life exponentially.”
What I mean by that is If at any given moment
you are aware of ten different elements -- for
instance, the sound of my voice, your bottom on
the chair, the sound of cars passing outside,
the thought of the laundry you have to do, the
hum of the air-conditioner, the sliding of your
glasses down your nose, an unpleasant stab of
sharp back pain, cool air going into your
nostrils, warm air going out -- that's too much
pain, one out of ten; that's unbearable pain
that will dominate your life. But if at this
moment you are aware of a hundred elements, not
only the ten things you noticed before but more
subtle things, like the animal presence of other
people sitting quietly in the room, the shadow
of the lamp against the wall, the brush of your
hair against your ear, the pull of your clothes
against your skin, for instance, and you have
pain along with all those other things you are
noticing, then your pain is one of a hundred
elements of your consciousness at that moment,
and that is pain you can live with. It's merely
one of the multitudes of sensations in your
life.
I’m talking about experiencing things on the
level of the satisfaction you feel when you
consciously put a cup on a table; the flat
surfaces meet. This is a rare and satisfying
“just-right” kind of experience. A very
effective way to develop the capacity for
noticing these wonderful minutiae in everyday
life is to try to do each thing for its own
sake, to experience every motion, every
endeavor, every contact, for what it is. For me,
washing the dishes is not just about getting the
dishes clean; it's feeling the warm, soapy water
soothing my arthritic fingers. Folding the
laundry, I can smell its cleanness and I can
luxuriate in the simple movements as a
counterpoint to my complex life. This is
engagement that arises out of a commitment to
live as thoroughly as a human can. This is
developing a consciousness that is able to
attend to and include everything, not just what
promotes self-interest. Being present right now,
right here, giving your activity your whole
heart and being, whatever you are doing, whether
it's cooking a meal, doing a project at work, or
having an encounter with another person. "Being
exactly here." This kind of presence is of
course your greatest challenge and the deepest
satisfaction in your life.
When you have become aware enough to recognize
your own pleasure in every event and encounter,
in every difficulty and challenge, you can feel
your whole life strewn with happiness and
abundance, carelessly like autumn leaves. When
you have this much faith in your ability to
perceive and nurture your own joy, you also
begin to feel generous toward your own human
tendency to be caught in the cycle of wanting
what you can’t have and averting from what
terrifies you: bitterness, despair. If you are
able to extend your charity to the aspects of
yourself you know cause you pain, you are
developing the broad and generous spirit of
letting everything be what it is, including
yourself.
To me our awareness of everything without
preference is a meditation that synchronizes
body and mind. This synchronization, the
experience of deep integrity, of being all of a
piece, is a very deep healing. It is
unconventional to value such a subtle
experience. It is not encouraged in our culture.
It's extraordinary to be willing to be involved
with ordinary things, to be willing to live in
the mundane, to be fully alive for the laundry,
to be present for the dishes. We overlook these
everyday epiphanies, waiting for some Big Event
-- like healing or being happy at last -- and so
we waste our everyday lives. What cultivating
attention to detail introduces is spaciousness,
space around thoughts and activities that allows
you to live a rich and satisfying life right in
the middle of misery.
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