7. Mindfulness and Pain

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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