fibromyalgia

Acceptance

By Patrecia Lenore I have fibromyalgia, a close relative of chronic fatigue syndrome. I am always in pain, all over my body, sometimes low-grade, sometimes acute. When the pain is acute, it feels like my body is on fire and my bones are being scraped. I also have fatigue. Again, sometimes it is low-grade, sometimes so acute that it is difficult to breathe or eat. Although I cannot always prevent or predict acute attacks of pain or fatigue, I have learned a lot about how to manage my life so it is less likely that I will reach the acute stage. Meditation is one of my most valuable tools.

Meditation helps me notice the subtle signs of a possible flare-up. As Thay says about strong feelings in Peace Is Every Step, the first step is to be aware. If I'm aware of my body's signals, I can see, hear, or feel the signs of weakness and pain. After the initial awareness, I usually have to work on accepting what my body is telling me. This is not always easy. In fact, it usually isn't. Like most people, I want to finish what I'm doing, whether it is work or pleasure. It's difficult to stop. But if I can concentrate on the fact that stopping and resting is being loving to myself, rather than focusing on the feelings of disappointment and deprivation, then I can allow myself to rest. Sometimes this means simply observing my breath with my eyes closed. Sometimes I am able to listen to quiet music. If I catch the signals soon enough, I might have the strength to talk to a friend or read a book. Often the most difficult part is watching my mind being scared and projecting that I will always feel this way. I try to remember that everything changes, even pain. And when I can't remember that very well, I call a friend to remind me.

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I need to work on accepting my limitations within this illness and asking for help. Recently, I was caring for my grandchildren while my daughter and her husband moved into their new house. I wanted to help pack and carry things, but after a few minutes, was not able to continue because of the pain and fatigue. Immediately, thoughts about my deceased mother arose. She was almost always ill, and, I am sorry to say, my brothers and sisters and I felt very critical of her a lot of the time. Now I have a lot more compassion for her. I also had a lot of self-pitying thoughts. When that happens, I'm learning to gently turn my mind to what I can do. In this case, I reminded myself that perhaps my quiet presence was calming to those who were packing and moving, and that helping keep my grandchildren happy was enough. Without my meditation practice of looking deeply, I would not have known how sad I felt about my limitations or that I needed to gently change my focus to what I was able to do.

At the wonderful retreat in Santa Barbara this fall, I noticed it was easy to assist the staff in finding help for the differently-abled, but difficult to put myself in that category. An amusing thing happened. I helped find an alternate space for morning meditation for those unable to walk on the beach, never dreaming I would be one of those people. But on Monday morning, I found myself in that very space, because the ocean air was too cold for me. There were only a few of us, but each morning I had the pleasure of Sister Jina's gentle and "solid like a mountain" presence, leading us in meditation and mindful movements. Her presence brought me and the others joy and peace. What a treat!

Here is a meditation verse I composed to help remind me that it's okay to ask for help.

Breathing in, I scan my body; Breathing out, I smile gently to my body. Breathing in, I scan my mind; Breathing out, I smile gently to my mind. Breathing in, I feel tiredness (or pain); Breathing out, I open to my tiredness. Breathing in, I see I need assistance; Breathing out, I ask for help, knowing it helps others too. Breathing in, I accept others' assistance; Breathing out, I feel gratitude.

I offer this verse in loving gratitude to Thay and all the wonderful teachers that I have encountered in myriad forms—people, animals, plants and minerals.

Patrecia Lenore, Flower of True Virtue, practices with the Community of Mindfulness/New York Metro.

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Demons into Butterflies

Chronic Illness as Dharma Teacher By Hannah S. Wilder

As a child, I was always in motion. I carried this energy into adulthood; it ran my life like a demon. As an adult with attention deficit hyperactivity disorder (ADHD), I have brain chemistry that operates like two extremes on a dial: scattered/distractible or hyper-focused. As a child, I found respite in reading or lying beside a stream, watching tadpoles change into frogs. I found kindred souls in the streambed, and learned from them that transformation is natural.

The first fifty years of my life were a whirl of ceaseless activity. I rested only when I had pushed myself so far that I collapsed with a cold or flu, or when I found myself stuck in a subway tunnel or traffic. I always carried a book or writing implements, something to busy my mind and still my impatience. I completed several educational degrees, worked around the world, married, had a child, and divorced.

Then, I decided consciously to stop and raise my daughter in a quiet town on the Maine seacoast. I was on my own in raising my daughter and taking care of our home. I wanted very much to "slow down and live," but circumstances and habit pushed on. Thay tells the story of a man riding quickly on a horse. A bystander yells at him, "Where are you going?" and the man replies, "I don't know. Ask the horse!" I was like that man on the horse, propelled by my habit energies.

In the mid-eighties I began a recovery program from growing up in an alcoholic family. At a week - long residential program, a therapist had me portray my life, turning up the volume so that I could see how my busyness was a way of running from pain that only created more suffering. Each person in my group represented a demand in my life. I gave them each a line, and they all said their lines to me at once, so I could experience the overwhelming nature of how I lived: "Earn the money!" "Raise the child!" "Clean the house!" "Help me!" "Listen to me!" "Take care of yourself!" "Mow the lawn!" It was a vivid and clear picture, but still, I didn't stop. At home, I slid back into doing many things at the same time. My behavior was reinforced by others' admiration of my ability to accomplish so much.

Also in the mid-eighties, I first heard about Thich Nhat Hanh's teaching. The message that struck me was "do one thing at a time." I decided to try an experiment. Working in my home one weekend, I began one task. When a second task occurred to me, I wrote it down instead of starting it. I finished the first task, and then completed the rest of the list, one task at a time. I got just as many things done, but felt much more peaceful at the end of the day. I had taken the first step on the path of transformation to a more serene life. In 1993,1 received the Five Mindfulness Trainings, and in 1995,1 joined the Order of Interbeing. Shortly after that, a series of challenges turned my world upside down.

Within two years the man I had loved all my life and my brother both died in protracted and agonizing battles with cancer. My parents had died just a few years before. Overworking helped distract me from my losses, but it was too much. My health collapsed. I was in terrible pain and had disturbing symptoms, such as blurred vision and extreme fatigue. I was ready to "stop, calm, rest, and heal," but my family had all died and I still had to support myself.

I accepted an invitation to spend the summer writing in a friend's house on the coast of Somerset in England. There, I rested and wrote, but my health continued to be problematic. Each time I took a long walk, I got extremely tired and felt a lot of pain for several days. After I returned to the States, it gradually became clear that what I'd thought was an acute but curable and known condition was instead a chronic and mysterious one. I continued to have frequent, intense pain, fatigue, and cloudy mental functioning. Doctors shrugged. It looked hopeless. I felt shock and despair. Fortunately, there was a patient group that exchanged information and held a national conference. At length, I got an accurate diagnosis and began taking medication for symptomatic relief. But I was severely depleted, and had to leave my job, with no financial reserve.

How does a chronically-ill person earn a living? Building on my mental health counseling and teaching/mentoring background, I began training to be a personal and business coach and opened a private practice via phone and Internet. Many times I have taken classes by phone, lying in bed, too tired to move. Two or three kind friends gave me moral support. Things seemed to be calming down at last. Then, I received a gift in the form of a daylight robbery. My computer, with three months of data, was stolen. Following this, there was a rash of gang-related activity in which a number of women were tortured. I somehow managed to pack and move into a friend's home. The gift allowed me to see that I could make a move, when I had thought it was almost impossible.

Soon after, with the help of a Dharma sister who found me a place to live, I moved to Virginia. Just before the robbery I had started my first ghostwriting job, which, fortunately, was portable. I was safe and had become a professional writer, something I had always wanted. I could support myself while working on my coaching career. I breathed a sigh of relief. But in the winter I realized that the years of stress and trauma, and my chronic condition had brought my body close to a state of collapse. Soon I had two more diagnoses: chronic fatigue syndrome and fibromyalgia. I was no longer who I had been, at any level. Constant fatigue, head and body aches, memory loss and confusion, extreme sensitivity to noise, light, and an extreme awareness of other people's moods and energy were my new companions. By February 1999,1 could sit up to write only an hour a day.

The Dharma was in my face, so to speak, and the mindfulness teacher of pain was in my whole body. To get better and maintain the delicate balance necessary to function from day to day, I had to learn to practice twenty-four hours a day. Living the way of non-awareness, my body had been depleted, leaving little margin for forgetfulness. Dietary mistakes, weather changes, overworking, or stress may cause my symptoms to flare up. This means I must stay awake as much as possible, and take exquisite care not to let stress build up. I must notice each need—rest, food, fresh air, or quiet—and take immediate steps to meet it. Not responding invites a temporal flare-up, and also progression of the condition.

As a chronically-ill person, I sometimes reflect the quality of impermanence to those who are still healthy and strong. In a youth and perfection-oriented society, it can be challenging to find a comfortable place for aging and illness. I see people trying to separate themselves from my illness, to explain it in ways that exclude the possibility it could happen to them. My compassion for them comes from remembering when I was in their position, feeling frustrated at my inability to help another person in some active way.

Now more than ever, I understand that being present and listening deeply will help relieve suffering. This realization inspired me to begin asking people with chronic illness, "What attitudes and behaviors are supportive and healing for you? How can we educate our medical professionals, loved ones, friends, coworkers and neighbors so that they understand what we are experiencing and what we would like from them?" Perhaps compiling the answers in an article or short book would help others learn to relieve the suffering of those living with chronic conditions. Of course, the short answer is mindful behavior, compassion, and understanding.

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Medical people who have no treatment or explanation often feel unsure how to live with their uncertainty, and, out of their own "dis-ease," respond in ways that blame the patient. There are still poorly educated doctors who dismiss the condition or insult their patients. Some of those who take the condition seriously adopt a certainty that their specialty has the answer: if they are surgeons, it's a brain stem psychiatrists, it's depression and antidepressants will do the trick. Sometimes the variety of simplistic and radically different explanations and cures is overwhelming. Maybe there is a way to convey mindfulness to the health-care professionals as well, and let them know what it feels like on the receiving end of so much confusing and contradictory information, how it feels to be disbelieved and dismissed. So, added to living with the condition and earning a living is the challenge of education those who could be supportive.

In my other life, as I now call it, I loved to travel from snowy fields of the Northeast to high-desert mountains in the Southwest. Now I sit down in my lounge chair, lean back, put on my headphones, and open my laptop computer, traveling via the Internet or telephone to visit clients in California or Brazil, friends and Dharma brothers and sisters in Scotland or Scandinavia. I appreciate that the Internet was developed when I most needed it. Remaining in the comfort of home I can be in contact with the whole world! I speak to someone in Brazil or Australia, then go outside for a walk beside the stream to visit my friendly tadpoles.

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Aside from some persistent financial stress—selling a home to pay medical bills and living expenses often goes with chronic illness—and occasional discomfort, mine is a happy life. I have peace, beauty, and friendship, near and far. I am able to serve, by teaching tele-classes on mindfulness, by developing a program for mindful awareness at work, by coaching people in various walks of life, by leading two international groups of coaches by telephone, by mentoring a new aspirant to the Order of Interbeing, and by helping build our local Sangha. I am endlessly grateful for so many things.

It is essential to maintain the balance between accepting "what is" and continuing to hope and search for a possible cure, to strengthen myself. When I first moved to Virginia, I could not walk up my very steep driveway, so I drove down in my car, parked and walked across the rickety bridge to get the mail. Little by little, I walked farther each day, mindful of how much was just enough. By last summer, I was able to walk down and up my neighbor's driveway, swim a few laps around their pond, and then walk home up my hill. I have learned to replace grief at being an impaired person with gratitude for being able to walk and talk and look fairly "normal", and appreciation for the wonderful gifts around me. There are now times when I can dance!

I have improved faster than anyone else I know with this condition, and it's still with me. Applying my knowledge of holistic health and my research expertise on the Internet, I created a program for myself of nutritional supplements; a strict diet; a daily movement routine combining yoga, chi-gong, sa-long (in the Bon tradition), and mindful movements learned from Dharma teacher Thu Nguyen and Thay's tape. I meditate at least once a day sitting, and also do walking meditation. Practicing daily by myself, weekly with a Sangha, and sometimes traveling to Days of Mindfulness with Anh Huong  and Thu Nguyen sustain me. I am constantly reminded that being slow, being present, is all that is needed. I read the seventh of the Fourteen Mindfulness Trainings very often!

The tendency to wonder exactly what mistake brought me to this state, to rush around seeking an immediate cure, to worry about the future is still in my store consciousness. I do not water these seeds. I do not revisit my losses. And I remember Thay's words: "This is the shore of suffering, the shore of illbeing, despair, fear, and anger. I don't want to stay on this shore. I want to cross over to the other shore, the shore of well-being, forgiveness, peace, and compassion... When you practice to identify what is there and look deeply into the nature of what is there, you are practicing prajna paramita, and the insight you get will bring you to the other shore, the shore of liberation and well-being."

I am here, learning the gentle ways of butterflies as they light on flowers or settle at the edges of the stream looking for moisture on a hot summer day, sitting so still that the white-tailed deer, the wild turkeys, and the baby rabbits do not consider me alien. It is a peaceful, magical valley, an island of the self, a true home. And it goes where I go, through my constant practice.

Hannah S. Wilder, True Good Heart, practices with Cloud Floating Free Sangha in Charlottesville, Virginia. She can be reached by e-mail  at Hannah@Wiseheartcoach.com and would like to hear from others who are practicing with chronic conditions, teaching mindfulness at work, or those who are experts at resting.

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Healing With Chronic Illness Practicing Mindfulness of the Body

Jane  Brockman When I was first diagnosed with chronic fatigue and fibromyalgia several years ago, I had no idea what a long and difficult road lay ahead of me. At times, when feeling exhausted of every ounce of energy, unable to absorb food, and vulnerable to every kind of illness, I questioned whether it was worth going on. Always, I came back to believing that it was. As I began to direct my energy towards healing, mindfulness become an integral part of my journey back to health. I soon realized that in order to truly heal, it would be necessary to bring a deep attention and awareness to every aspect of my life, not only on the physical level, but on the spiritual and emotional levels as well.

I began to be more mindful of the foods I ingested and tend better to the messages my body was giving me. I developed a deeper awareness about my thought patterns, moved towards work that was more in line with my true self and became aware of what brought me joy each day. Deepening my practice of mindfulness has been one of the unexpected gifts of my illness. It has helped me to cope in times when I didn’t think I could go on.

Honoring my Body

First I began to implement major changes to my diet. I’ve always considered myself to be a fairly healthy eater, but I now practice a much deeper level of mindful consumption, as Thay encourages us all to do in the Fifth Mindfulness Training. Over time, I’ve developed a heightened level of awareness concerning the foods I’m allergic to and how my body feels after eating them. Now I can tell almost immediately if my body doesn’t like something. I’ve eliminated many of my favorite foods, as well as sugar, caffeine, wheat, dairy and alcohol. This has demanded an enormous amount of discipline. At first, I thought I’d go crazy without these foods. Yet, as time has gone on, it’s become easier for me to be completely without these substances. I now understand the importance of listening and honoring my body. Breathing in, I honor my body. Breathing out, I smile to my body.

Honoring my body has also meant no longer pushing myself beyond what my strength allows and giving myself permission to rest when necessary. Doing this has been extremely difficult, as I’ve always been an over-achiever and a perfectionist. My illness, however, no longer allows me to live this way. I have had to let things slide. The house doesn’t get cleaned as often. The garden doesn’t get planted. I have to rely on my partner for assistance with the cooking and shopping more. I sleep a lot. I rest a lot. Last year, I stopped working. At times, it has felt like everything is falling apart. My lesson has been to learn to be okay with this and to let go of trying to do everything. It hasn’t been easy, but I know that I’m doing the best I can. Even for those who are healthy, it can be quite liberating to come to terms with being good enough rather than trying to be perfect all the time. As we place a higher priority on our peace of mind than on getting everything done, the result can often be a deeper, more meaningful experience of our lives, our relationships and of ourselves.

Receiving and Letting Go

A most challenging lesson for me throughout this journey has been to practice the art of receiving. At times when I was so incapacitated or when I deeply needed emotional support, it’s been extremely difficult for me to ask others for help. I was raised in a family who valued independence and self-sufficiency and relying on others was not looked upon favorably. Learning to ask for help and to receive from the Universe has been a new lesson. The constant love and support of a caring partner has been a tremendous blessing. I have learned to cultivate a broader network of support—friends and healers who assist me in my journey, including others dealing with chronic fatigue and fibromyalgia. I have also sought out those who have reversed their conditions and brought about their own healing. This has been a source of inspiration and strength for me.

While holding out hope for healing, I have become deeply aware of the importance of surrendering to and accepting my illness. At first, the two seemed contradictory. How could I practice acceptance on one hand and at the same time, work towards healing? As time has passed, I see that I can do both. I see how important it is to be present with what is and to accept fully what is happening in the moment. At the same time I hold a clear image of how I’d like to be. Only in blending the two can I be free.

As I work to practice acceptance, I have certainly felt my share of anger at being sick. There have been times when I felt rage at the limitations I have to deal with because of my illness. I’ve learned that it’s okay to get angry sometimes. In Being Peace Thay tells us to treat our anger with “care, love, tenderness and nonviolence.” The first step is developing an awareness of the anger, according to Thay. We cannot destroy the energy of anger, he points out, yet we can work to convert it to a more constructive energy, like forgiveness, understanding or love. In my own healing journey, I have found that by allowing the anger to surface and by staying with it, I’m eventually able to come to a place of deeper peace and tranquility.

Imagery and Exercise

The use of meditation and imagery has helped enhance my overall sense of peace and tranquility. Guided meditation tapes have become an important part of my daily practice, as lying down is sometimes all I can manage to do. I’ve developed a small collection of tapes which help to release tension in my body and help me to cultivate more positive thought patterns. They have also helped me discover some profound insights and awarenesses about my life and about changes that I need or want to make. In the beginning, I often felt resentful about having to stop in the middle of my day to rest and listen to these tapes. Now,

I look forward to this time of the day. It has become a sacred ritual, a time for quiet and reflection when I can renew and restore, stop, rest and practice mindfulness.

Recently, my intuition has led me to seek out forms of exercise and body-centered therapies which help to balance the mind-body system like yoga, Feldenkrais and T’ai chi. My body has gently given me the message that an increased measure of energy flow would be of much benefit and would assist in my overall feelings of well-being and health.  Slowly, I am learning to cultivate a deeper awareness of what is happening in  my body in the present moment, sensing into it and asking myself, “How are you feeling right now?”

Sometimes I feel tense, sometimes afraid, sometimes uncomfortable. Next I can proceed to address the messages that my body is giving me, asking myself such questions as: Do I need to set a deadline for an important decision in my life so that my body can relax? Do I need to cut back on my work to balance my life more? Do I need to change the way I react to stress in my life? This practice of having a conversation with my body helps me to anchor myself more in the moment and feel less disassociated from my body.

I’ve begun to look at my professional life with a deeper level of awareness and questioning. I have asked myself: Am I feeling weighted down by the work I am doing? I am also developing more awareness about the kinds of the people I surround myself with. A natural extension of my desire to heal myself has been to seek out individuals who reflect a positive attitude in the world and who also believe in the innate ability of the body to heal itself. About a year ago, I discovered a wonderful naturopath who practices medicine from the standpoint of listening to and following the body’s implicit intelligence. More and more, I have come to trust my intuition when pondering the next stage of healing.

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Cultivating Joy

Perhaps one of the most important developments I’ve made during my healing process has been the ability to cultivate a deeper awareness about what brings joy to each day of my life and discovering more ways to bring these activities into my day.   At a workshop I attended recently entitled Getting Well Again, a fellow workshop participant shared how important it had been for her to bring more fun into her days. She would frequently ask herself, “Am I having fun? Am I enjoying myself?” I now allow more space in my life for those  activities  which bring me joy and nurture my spirit—like creative activities, reading, being in nature, spending time with friends, yoga and meditation. Each day I pose the question to myself— What will truly bring joy to this day?   And generally, when I’ve  taken time to do joyful activities which nurture in a deep way, I find that I’m able to bring more joy to others and to the rest of the world.

Living mindfully with chronic illness has been one of the most difficult challenges of my life. It has been a long and patient journey towards greater overall health and aliveness, a journey marked by many highs and lows as well as a lot of tears. Yet, my journey has not been without its gifts, and I acknowledge these rich blessings with deep gratitude and awareness. I now see what is truly important in life. I am more mindful of how my thoughts and reactions to things affect the health of my body, and I consciously strive to hold more positive mental formations. I give myself permission to rest more. I’m okay with being good enough instead of having to be perfect. And I’m more mindful about what brings joy to each day. As I continue to incorporate mindfulness into more areas of my life, I am watering seeds of peace, joy, freedom and love within myself and within those who surround me.

Jane Brockman lives with her partner, radio personality Eric Alan, and practices with the Community of Mindful Living in Ashland, Oregon.

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The Ottawa Mindfulness Clinic

By Lynette Monteiro mb35-TheOttawa1

Understanding the concepts of impermanence, non-self, and nirvana evaded me despite thee tomes I read and the lectures I attended. Then in 1998, I was diagnosed with fibromyalgia and in the subsequent years struggled with fatigue, pain, and frustration. Refusing to be defeated by this illness, I intensified my meditation practice, changed my eating habits, and took on a regimented exercise program. Despite the positive physical changes, emotionally I remained exhausted and I felt no closer to knowing how to apply the practice of Buddhism to my situation.

The way out began over a coffee at Starbucks. A physician friend cornered me with Jon Kabat-Zinn’s book, Full Catastrophe Living (2) and asked if I would start a clinic to treat our mutual patients using mindfulness skills. I laughed. With barely enough energy to get from one day to the next, attempting this was out of the question. However, I knew that my meditative and doctrinal practice in Buddhism was the stabilizing force in coping with my disorder. Studying the sutras and having a disciplined meditation schedule gave me continual insights to the nature of my mind and its role in managing my illness. I could see the potential benefits and that it would be a way of reaching so many who were suffering. But start a clinic, especially when I seemed to struggle with core concepts? I thought it impossible until I attended a retreat with Chan Huy. He watered the seeds of comprehension for me with his presentation of the thirteenth step of the Anapanasati Sutra: On the Full Awareness of Breathing bringing to my attention three primary tenets of practice: Practicing Continuously, Being in the Moment, Living in Joy.

Suddenly the clinic seemed possible. I became aware that what had been effective in managing my illness was not the physical schedules, the intellectual calisthenics, or the chase after experiences. What had helped me gain ease and composure in my suffering was living as best I could the concepts of impermanence, non-self, and nirvana. I held no assumptions that any one moment would be the same as another. I was not my illness, I found joy and happiness where I could. Symptoms ebbed and flowed as did mind and its mental formations but I somehow stayed steady.

In May 2003, my partner and I began the Mindfulness Based Symptom Management program, an eight-week course in skilfull living modeled along the lines of the Canadian mindfulness-based program (3) at the Center for Addictions and Mental Health in Toronto, Canada. The patients who registered were suffering from depression, anxiety, pain from severe physical traumas, and work-related stress. Some were afraid of relapse into depression when they returned to work. Over eight weeks, we planned to teach these patient-practitioners sitting and walking meditation, an understanding of the four foundations of mindfulness, the techniques in the awareness of breathing, and the use of the Five Mindfulness Trainings as a guide to symptom management. They would be trained to examine their instincts to wrestle for control over their symptoms. This approach of no-action has been referred to as a paradigm shift from the medical model interventions that emphasize aggressive and often invasive interventions. The course aspirations and curriculum were daunting and ambitious, even more so because the canons of Buddhism had to be rendered into an acceptable secular form. However, we believed that anything less would not be powerful enough to transform their suffering.

We embarked on the program with an understanding that the facilitators and patients were equally practitioners. The tenets of the Five Mindfulness Trainings were listed and became a beacon when the work seemed tedious or not immediately relevant. The core of the course examined the body, emotions, sensations (mind), and thoughts (the most easily accessed and intellectually grasped object of mind) (4). In each class, we practiced the appropriate technique from the Anapanasati sutra (5). In the class dealing with emotions, we used the Theranamo and Bhadekkaratta sutras (Knowing the Better Way to Live Alone/An Auspicious Day (6)), as parables to encourage beneficial engagement with self, other, and the world. The glue that held the whole works together however was the primary tenets of practice– Practicing Continuously, Being in the Moment, Living in Joy.

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Practicing continuously

Without mindfulness skills, we become stuck in the illusion that symptoms are static and permanent, and therefore doom us to eternal suffering. Viewing the situation as singularly determined also results in thinking there is one magical intervention if we could “just do it.” When mindfulness is practiced continuously, we can look deeply into our symptoms and observe as they change in frequency, intensity, and duration. This is the gift of impermanence. It makes us available for many more possibilities and therefore many more opportunities to intervene in a suitable manner. Observing our level of fatigue we can recognize, for example, when jogging is less suitable than walking.

Practicing continuously means bringing awareness to all aspects of the system. We notice not just the segments of behaviors but the dynamic ebb and flow of all behaviors. It permits adjustment of our strategies as we attune ourselves to the impermanent nature of our experiences. When we are engaged fully in this practice, there is no way to “just do it” because there is no “it.” Continuous attention reveals nuances of change that alert us so we can adjust our actions, speech, and thoughts appropriately. It informs us when an intervention is suitable and beneficial; it informs us accurately of the specific signs in our body, which then allows selection of the beneficial and suitable level.

In the Clinic, patient-practitioners learn to adjust their body, speech, and mind to the ebb and flow of the breath. Using the body scan meditation technique, we set up an internal model of “observation, not indoctrination.” (7) That is, we learn to bring our attention to a part of our body, suspending the need to engage in action. We start with the toes, which always gets a smattering of giggles! The giggles turn to awe when we observe how hard it is to bring attention to the toes without twitching them automatically in response. We observe automatic behaviors and notice when we tune out, turn off, drop out of our daily lives. In the first two classes, we befriend our breathing and allow it to teach us the inevitability of change and the simplicity of adjusting to it. Because we breathe continuously, practicing continuously is no longer as imposing or tedious a task as it might have seemed initially.

Being in the present moment

The gift of non-self is the ability to discern the true nature of our suffering. Symptoms inter-are. They arise, endure, and dissolve from a complex interaction of the body, emotions, sensations, and thoughts. Arising in any single platform, they are empty containing neither intrinsic meaning nor power. However, when we apply our assumptions about an independent self, separation from others and the world, energy is imparted to our symptoms powering them up to debilitating levels. Muscle pain now becomes a harbinger of days in discomfort, even loss of income from lost wages. A limitation in physical activity now means loss of connection with family and friends.

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Grounding ourselves in the moment, we develop the skills to discern the origins of our pain with clarity and confidence. We develop an awareness of the arising conditions that result in our pain, our depression, and our fears. We can locate physical pain in the body, observe the thinking that escalates the meaning of the pain. Like teasing out the threads of a knotted ball of twine, we begin to separate the true nature of the symptom from the pain generated by the story-telling about the symptom. In the next four classes, we become firmly established in the foundation of mindfulness that is appropriate: in the body if the pain is physical, in the emotions if the pain is psychological, etc.  Discernment among the foundations allows the interconnections with the other foundations to generate information, not escalation. As we learn to identify the energy that causes the pain, we can then take steps to find alternative sources of energy.

As patient-practitioners grasp these concepts, the defensive stance to illness changes. The belief that things have to be different from what they are in this moment dissolves. Each moment is just what it is, an occasion. The ghosts of the past lose their potency to enslave us and render us dysfunctional. The ghosts of the future cannot hold us hostage with anxiety, fear, and the threat of failed dreams. The power in our relationships with ourselves, others, and the world can only be realized in the present. At this point, a critical flaw in the organization of current psychotherapeutic interventions comes to the fore. Relapse is not something that we practice at some future date when our symptoms disappear. Every moment is an occasion to prevent relapse into previously unbeneficial behaviors, feelings, sensations, perceptions, and thoughts.

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Living in joy

Joy is the realization that suffering is impermanent. Sometimes joy is retroactive, arising only when the craving and clinging to what is not has abated. While experiencing an attack of vertigo, I tried desperately to convince myself that the spinning room was only a mental formation. I recited: Not real, not real, not real. My mind remained resolutely unimpressed with my rhetoric (an object of mind) and joy was not present until my inner ear (body) calmed itself. Like a symphony, timing is everything. To expect joy in the middle of a flare of symptoms is to lose sight of the moment as it is. It throws us back to the illusions and delusions we created to avoid the reality of our suffering.

When symptoms recur despite our greatest efforts, we are given the opportunity to practice looking deeply into our assumptions. The arising of a symptom we thought was well-managed can touch on feelings of being a failure, activate models of helplessness, or even cause us to give up our practice. Looking deeply, we often find we have derived predictive equations relating our efforts to improvement in some linear fashion. Feeling energetic today becomes a promise that tomorrow will offer the same joy. Thrown into the future, we lose the moment of joy in the here and now.

Observing the breath, staying grounded in the body, emotions, sensations, and thoughts, patient-practitioners begin to experience the cessation of the craving to make things okay immediately. We recognize that symptoms dissolve and realize that awareness of impermanence enforces letting go. Symptoms become waves greeted, if not with ease, at least with composure and steadiness. With tools of mindfulness, we do know what to do. We acquire the secure knowledge that the symptoms are generated from the essence of who we are in the moment and dissipate as we alter our stance to them. In a single round of breathing in and out, we become evolving beings, intricately tied to self, others, and the world, and know comfort in that unity.

The Five Mindfulness Trainings

Throughout the course, the Five Mindfulness Trainings are used to give the skills a firm grounding in ethics and to provide deeper purpose for the practice. Viewing ourselves as worthy of respect, examining ways in which we generate delusions, setting psychological and physical boundaries, addressing ourselves with gentleness, and nourishing ourselves in a healthy manner become the modus operandi of creating skillful lives. As we become confident and stable in our practice, we find ourselves applying these skills in our interactions with others and our environment. In fact, interaction with all aspects of our environment is where the rubber meets the road. However, because suffering renders us somewhat narcissistic, we begin with applying the five trainings to ourselves.

Each foundational lesson is framed in the context of the five trainings. Behaving with respect to our body allows physical self-abusive cycles to be examined and broken. For the patient-practitioners suffering physical trauma this becomes a key to enter the realm of joy and acceptance. Rather than pushing past limits, they begin to accept and respect the body as it is.

Being generous to our body results in resting when needed, treating ourselves to days of silence and enjoyment of treasured activities. Depression and physical degenerative disorders respond well to this training. Rejuvenation becomes the form of continuous practice and symptoms no longer need to flare for attention.

Not exploiting our bodies psychologically or physically permits the building of safety in interactions with others. The target of this training is the anxiety generated from abusive relationships or lack of trust because of abuse. Recognizing and reducing exposure to toxic situations or relationships increases a sense that we are reliable in our assessments and consistent in our responses.

Speaking with kindness when referring to our body changes the sometimes hate-filled inner dialogue that in turn maintains our suffering. Lack of confidence, feelings of helplessness or low self-worth can be transformed through this training.

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Altering the language alters the meaning we give to ourselves of who we are. As self-talk becomes supportive and honestly reflective of our situation, we develop trust and confidence that we can adjust to change.

Nourishing our bodies with beneficial foods and activities allows a sense of well-being. Being with persons who generate joy, feeling encouraged by others practicing healthy lifestyles, and exposing ourselves to a variety of perspectives break up the fixed patterns that signify most physical and psychological suffering. As we limit the input of common myths about being human, we begin to develop a stronger understanding of the reality of being just who we are.

The suffering arising from weak practice of mindfulness in the foundations of emotions, sensations, and objects of mind (in this case, thinking) respond equally well to this application. In fact, the remaining foundations are deeply contained in the foundation of the body and are interconnected profoundly with the body.

At the end of the eight weeks, we have all been irrevocably changed by our contact with each other. At the beginning of the course, the patient-practitioners were asked to list the things they wanted to change in themselves. Usually, the expectations revolved around “cure” or total cessation of physical and emotional symptoms. They want their suffering taken away when they enter7 treatment. Their perceptions of themselves as ones who suffer imply that the suffering means they are flawed and damaged by and because of their symptoms. So, at the start of the course, the craving is to be “normal” by which they mean “without suffering”. When asked if they have changed in ways they had listed eight weeks before, most patient-practitioners say it doesn’t matter anymore. Those expectations written fifty-six days ago are examined and deemed unrealistic, irrelevant, or—best of all—where there was no change, acceptable just as they are. Expectations transform into aspirations. Symptoms are now moments of education in developing skillful means. Self is now a product of an interaction of the four platforms with the moving moment and mindfulness is the mechanism to steady the interaction.

Continuity

Impermanence, non-self, and nirvana reveal themselves in each moment. By practicing continuously, we are able to stay grounded in each moment. Observing the breath, we move through the four foundations of body, emotions, mind, and objects of mind. Skillful means grow as we develop clear comprehension of what is beneficial and suitable action. Understanding the true nature of our illness grows further as we experience being firmly in our physical and psychological domain, cutting through the illusions of what it is not. All symptoms are nothing more than the waves in our ocean of being. In the moments that our practice is strong and stable, we can allow the symptoms of our illnesses to penetrate us as great teachers do and ultimately let them dissipate as waves in the ocean.

Lynette Monteiro, True Wonderful Fulfillment, practices with Sanghas in Ottawa and Montreal, Canada. She is a psychologist in private practice, and Director of the Ottawa Mindfulness Clinic. She bows to teachers Chan Huy and True Body of Wisdom for inspiring the Clinic and assisting in the preparation of this article. Photography by Lynette Monteiro.

1 Impermanence, non-self, and nirvana are called the “Three Dharma Seals.” A teaching offered by the Buddha is considered to be authentic if it has these three characteristics. The awareness of impermanence helps us to see that all things are subject to change. Nothing in the universe is a fixed, unchanging entity. Secondly, the awareness of non-self shows us that all things are without a separate self; everything inter-is with everything else. Thirdly, all things have their ultimate nature, their nature of nirvana, meaning the extinction of all notions, ideas, and concepts concerning reality. For a more thorough explanation of the Three Dharma Seals see Thich Nhat Hanh, The Heart of the Buddha’s Teachings (Berkeley: Parallax Press, 1998).

2 Kabat-Zinn, J. Full Catastrophe Living (Dell Publishing, 1990)

3 Segal, Z., M. Williams, & J. Teasdale, Mindfulness-based Cognitive Therapy for Depression (Guilford Press, 2002)

4 Thich Nhat Hanh, Transformation and Healing: Sutra on the Four Establishments of Mindfulness (Berkeley: Parallax Press 1990) and the following texts were used by the facilitators to organize the course content

5 Thich Nhat Hanh, Breathe! You are Alive: the Sutra on the Full Awareness of Breathing (Berkeley: Parallax Press, 1990)

6 Thich Nhat Hanh, Our Appointment with Life: The Buddha’s Teaching on Living in the Present (Berkeley: Parallax Press, 1990)

7 Thich Nhat Hanh, Transformation and Healing, p 134

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