How to Live Well with Chronic Pain and Illness

by Toni Bernhard

  To become aware of the stories you’re telling yourself about your physical discomfort, once again, with an attitude of care for yourself, take several conscious breaths, paying attention to the physical sensation of the breath as it comes in and goes out of your body. This time, as you do it, try to observe what stressful thought patterns are running through your mind. This may not be easy: thoughts have a tendency to skitter away when you try and look directly at them.

  Becoming mindfully aware of the stories you spin gives you the opportunity to make a conscious choice. You can continue to believe them, or you can calmly assess their validity. Are you sure you’ve ruined your partner’s life or that no one cares about your pain? Early on in my illness, I believed both these thoughts, neither of which turned out to be true.

  At a meditation retreat in the 1990s, Buddhist nun Ayya Khema said to us, “Most thoughts are just rubbish, but we believe them anyway.” It took several years of chronic illness for me to recognize that I was causing myself undue mental suffering by spinning stressful stories about my physical discomfort and then accepting them as true without question simply because I had thought them. Mindfulness practice was the principal tool that helped me realize what I was doing.

  Mindful attention calms and steadies the mind, giving you breathing room to reflect and to respond more skillfully to the stressful emotions and the stressful thought patterns that tend to accompany physical discomfort. Not only can this ease your mental suffering, it can also ease your physical suffering because stressful thoughts and emotions are felt physically in the body. As the wonderfully blunt Zen teacher Joko Beck said: “What makes life so frightening is that we let ourselves be carried away in the garbage of our whirling minds. We don’t have to do that.”

  11

  Mindfulness Practices That Address Physical Discomfort

  If we practice mindfulness, we always have a place to be when we’re afraid.

  — THICH NHAT HANH

  TO REITERATE a point from the previous chapter, physical discomfort has three components: the unpleasant physical sensation itself, the emotional reaction to it, and the thought patterns that are related to the first two components. This chapter focuses on practices that can address the unpleasant physical sensations themselves.

  Two preliminary notes.

  If pain is one of your symptoms, I want to be clear from the outset that I don’t have a negative view of pain medication. Taking medication for pain is not a sign of weakness. Many of us have been told repeatedly “No pain, no gain” and “Push through the pain.” I suspect that people who offer this advice have never suffered from chronic pain themselves. Everyone has to find what’s right for his or her body. For many people, it’s a combination of pain medication and the practices I’m about to describe.

  Second, with each of these practices, find a comfortable position — sitting or lying down — and begin by breathing mindfully. By this I mean take a minute or two, and pay caring attention to the physical sensation of the breath as it comes in and goes out of your body. As you’re doing this, do a quick scan of your body from head to toe. If you feel muscles that are tight, see if they might relax under your caring attention. If not, that’s fine. When you’re ready, try one of the following mindfulness practices and see if it helps relieve your physical discomfort. Over time, I hope you’ll experiment with each of them to find out which ones work for you.

  Focus on the physical discomfort itself, paying careful attention to the sensations that make it up.

  People who are chronically ill often come to see their bodies as the enemy. In the first few years of my illness, I certainly did. Out of ignorance, I’d separated my mind from my body, and it was “me” against “it.” This perception that the body is the enemy gives rise to stressful emotions, such as frustration and fear. It can even give rise to anger — that conviction that you’ve been wronged. As discussed in the previous chapter, these emotions themselves often trigger bodily reactions that can lead to new symptoms or to the intensification of existing ones.

  By focusing your attention on the physical discomfort itself, instead of on your stories about it, this first mindfulness practice unites your mind and your body so that you stop seeing your body as a separate entity that’s purposefully causing you discomfort. Your body may be struggling, but it’s doing the best it can to support you and to sustain life.

  You can begin this practice by turning your attention to a point of discomfort in your body. You’re going to examine it with caring attentiveness. Is there burning? Is there throbbing? Tingling? Pressure? Heat? Cold? Are there waves of sensations in which the discomfort gets more intense and then less intense? Study your discomfort, becoming as familiar with it as a scientist examining a new phenomenon.

  This separating out of sensations is called “sensory splitting.” It helps you see that what you’ve been thinking of as a permanent solid block of physical discomfort, such as pain, is actually many different constantly changing sensations. When you distinguish the sensations in this manner, physical discomfort is no longer “a thing,” and so you’re much less likely to be carried away by stress-filled thoughts about it, such as “This discomfort will never go away.”

  It can even help to drop the words you usually use to identify the discomfort — words such as “pain” or “fatigue” — and simply be aware of the physical sensations themselves as arising and passing experiences in your body. Doing this helps you see the impermanent nature of the various physical sensations that are part of your physical discomfort.

  End this practice by bringing an attitude of kindness toward your entire body. Treat it the way you’d treat a child who is suffering, reaching out with care and compassion. Your body is so much more than the physical discomfort you’re experiencing. Making friends with this remarkable organism is emotionally calming and healing. It can release tension in your body, which, in itself, can ease your physical discomfort.

  Rest your attention on a symptom-free part of your body.

  In this mindfulness practice, you turn your attention to a symptom-free part of your body. At first, you might think there isn’t such a place, but with patience and persistence, you can find it. It could be your toes or your face or your chest. Relax into that symptom-free feeling, allowing it to become the predominant sensation in your experience — even if for just a few moments. This allows you to see that you are not just physical discomfort, since there’s at least one place on your body that is symptom-free.

  You can take this technique a step further and engage a symptom-free area in some movement. I’ll reveal a secret of mine — since you won’t see me in action. I sometimes lie on my back in bed and move my hands in balletic movements. I love to watch my hands and fingers imitate the grace of a ballerina.

  This idea came from Buddhist teacher Mary Orr at a meditation retreat many years ago. At the retreat, we alternated periods of sitting and walking meditation. In the latter, the instruction was to walk very slowly, staying mindfully aware of the physical sensation of one foot touching the ground as the other foot came off the ground. I was having terrible back pain and found it too hard to engage in walking meditation. I felt like my whole being had narrowed and become “back pain,” so I sought the help of a teacher.

  Mary told me to lie down during the walking period and be mindfully aware of the physical sensation of my hands moving in the air. Little did I know the joy this would bring; I wound up playing “Itsy Bitsy Spider” for the rest of the retreat — mindfully, of course! I doubt that this is what Mary had in mind but, in addition to having fun, I learned that my body was not just a painful back.

  Consciously pay attention to something pleasant or at least interesting in your field of awareness.

  Turn your attention to as many things other than your pain or discomfort as you can — the sight and feel of the sun shining through the window, the sound of cars passing by, a fleeting thought about what you’ll eat for dinner, the hum of the refrigerator motor, the p
hysical sensation of a wisp of hair on your cheek, an odor coming from the kitchen. Paying attention to a variety of sensory inputs eases physical discomfort because it relegates it to just one of the many sensory experiences going on in the moment.

  Use imagery to transport yourself to a pleasant place.

  Think of a special place you’ve been to or would like to visit. Close your eyes and make its image vivid in your mind. My place is Maké Horse Beach on the island of Molokai. I was there many times before I became chronically ill, so it’s easy for me to recall its turquoise water, the sound of surf crashing on the rocks, the hot sand on my skin, the saltwater air. Using imagery to take your mind off your physical discomfort relaxes the body, and this may help ease your symptoms.

  Describe your present-moment experience.

  This is a mindfulness practice that my daughter Mara introduced me to. It comes from a remarkable teacher named Byron Katie whom we’ll encounter again in chapter 13, “Breaking Free from Stressful Thinking Patterns.” I altered the practice from Katie’s original so it could be used specifically to help with physical discomfort. The basic practice is to ground yourself in the present by describing, in a neutral fashion, what is happening in your life at this moment. For example, you might say to yourself “Lying on a bed, with shoulder pain” or “Sitting in a waiting-room chair, feeling sick.”

  The key is to describe what you’re experiencing without using emotionally charged words that can intensify your symptoms. In my first example, by saying “Lying on a bed, with shoulder pain,” you’re simply acknowledging that your shoulder is in pain. Compare this to saying “Lying on a bed, with relentless shoulder pain.” In my second example, by saying “Sitting in a waiting-room chair, feeling sick,” you’re simply acknowledging the sick feeling without adding an emotional dimension, such as “Sitting in a waiting-room chair, feeling unbearably sick.”

  Leaving out these emotionally charged words makes it much less likely that you’ll start spinning stressful thoughts about the physical discomfort, such as “I hate this pain. I’m stuck with it: it will never go away.” In addition, by neutrally describing what you happen to be experiencing at the moment, you’re not setting the physical discomfort in stone. You’re leaving the door open for change. No matter how unpleasant physical discomfort is, it could change at any moment. Pain is not always relentless. Sick feelings are not always unbearable.

  Although it requires discipline on my part, I take up this practice whenever I realize that I’ve added emotional distress to my physical symptoms by including descriptors, such as “relentless,” “horrible,” or “unbearable” — words that lead me to believe that the unpleasant sensation is here to stay. But it never is. Everything changes.

  Notice how your body breathes on its own.

  Sometimes this instruction is given as part of formal meditation practice. I use it as a mindfulness technique to help soothe my body when I’m experiencing unpleasant physical sensations. It’s particularly helpful when I first lie down to rest or nap, because that’s when I become more acutely aware of bodily discomfort.

  To try this technique, turn your attention to the physical sensation of the breath as it comes in and goes out of your body. Breathe gently, without exerting any effort to control the length of the in-or the out-breath. As you’re doing this, you might try counting each breath up to whatever number feels comfortable, be it five or fifty, and then start over. Or, as you breathe, you could silently say “in” and “out.”

  Counting breaths or using the words “in” and “out” helps keep your mind from wandering off into thoughts or stressful stories about bodily discomfort. If your mind does wander off, when you become aware it’s happened, without judgment, return to counting breaths or silently repeating “in” and “out.”

  When I practice this, after a few minutes, I can feel a calming effect on whatever bodily discomfort I’m experiencing at the moment. The calming comes from not asking anything of my body. I’m simply letting it breathe at its own pace, without interfering.

  Practice the body scan.

  The body scan is a mindfulness practice in which you move your attention from one part of your body to another, simply noticing the physical sensations present at the moment. As you move to each new area, linger there and imagine that you’re breathing into it and out of it. After some moments, you mentally let go of that area and move your attention to the next.

  As you practice this, you may not feel any sensations in some parts of your body. That’s fine; just note, “not feeling anything in particular.” Or you may feel pain or another unpleasant sensation. In this case, as you breathe into that part of your body, try to allow any tension associated with it to release itself. The tension may be in your mind, in your body, or in both. If you can’t release the tension, then try to let it soften by simply letting the unpleasant sensation be as it is without attaching a negative judgment or any meaning to it. It’s just a sensation, and sensations are impermanent.

  Throughout the exercise, be sure you’re giving your body caring attention. Even though your illness may make you feel as if your body has let you down, in reality, it’s working hard for you. Let go of any expectations or wishes; in other words, don’t have any particular results in mind. Simply set the intention to be with your body with curiosity and kindness.

  I suggest that you read through all the instructions before starting. You could even record them and play them back as you do the exercise.

  1. Find a comfortable place to lie down where you won’t be disturbed. (In my opinion, if lying down causes you to fall sleep, that’s a bonus for your body!) Put aside anywhere from twenty to fifty minutes for the scan. The time you allot will affect the speed at which you move from one area of your body to another.

  2. Close your eyes and rest your attention on the physical sensation of your breath as it comes in and goes out of your body. Breathing in, know you’re breathing in. Breathing out, know you’re breathing out. As you do this, feel that your body is connected to whatever is solid beneath it.

  3. Move your attention to the toes of your left foot. Imagine you’re breathing into your toes and out from your toes. This may take some practice. It helps to imagine your breath flowing from the in-breath at your nostrils, down through your body, and into your toes. Feel any sensations in your toes, or note the lack of sensation. If you feel tension in your toes or in your mind, see if directing caring attention to it enables it to release some. If it doesn’t, gently let it be, always with an attitude of kindness and compassion for your discomfort. If your attention wanders off into thoughts, gently bring your attention back to your left toes.

  4. When you’re ready, on the out-breath, mentally leave your toes and move your attention to the sole of your left foot, then to the heel, and then to the ankle, following the same instructions as for the toes.

  5. Following the same instructions, move your attention through the different areas of your body in this order:

  The lower left leg, including the calf, the shin, the knee

  The left thigh — front and back — and its connection to the left hip

  The right toes, the sole of the foot, the heel, the ankle, the calf, the shin, the knee, the thigh, the connection of the thigh to the right hip

  The pelvic region and its organs

  The abdominal region and the organs of the digestive system

  The tailbone and then up the back from the lower to the middle to the upper back

  The chest, including the heart, the lungs, and the breasts

  The fingertips of your left hand, the back of the hand, the palm, the wrist, the forearm, the elbow, the upper arm

  The fingertips of your right hand, the back of the hand, the palm, the wrist, the forearm, the elbow, the upper arm

  The shoulders and armpits, up into the neck

  The jaw and then the teeth, the tongue, the mouth, and the lips

  The cheeks and sinuses, the eyes, the muscles around the eyes, the forehe
ad, the temples, the ears

  The back of the scalp up to the top of the head

  6. To finish the exercise, shift your attention back to the sensation of your breath and, once again, become aware of your body as a whole, alive from head to toe with physical sensations. Send caring and kind thoughts to this remarkable organism that works so hard to support and sustain you.

  Be patient as you explore this set of mindfulness practices. If you try one and it isn’t helpful, that’s fine. Simply say to yourself with kindness, “That one’s not for me. I’ll try another one.”

  12

  Formal Mindfulness Meditation Can Help Your Mind Help Your Body

  You don’t have to clear your mind. You just give your mind a chance to clear itself.

  — AJAHN CHAH

  I THINK OF MEDITATION practice as the opportunity to sit (or lie) down and observe your mind. It’s not about putting an end to thinking. Who can do that? I certainly can’t. Becoming aware of what’s going on in your mind can be a challenge; to be frank, it’s not always a pretty sight. The Tibetan Buddhist teacher Pema Chödrön draws an analogy to a lake: when the water clears, you can see the sparkling jewels at the bottom, but you also see the worn shoes and the old tires — recurring disappointment and sadness, longing and fear.

  Each of you has had unique life experiences that have affected your disposition in different ways. As a result, when the mind gets quiet, for some of you, the “old tire” that pops up is anger; for others, it might be worry. After practicing meditation for a while, you start to see the habits that have been worn into the mind from past conditioning. Pema Chödrön says that meditation is like doing a PhD dissertation — but the subject is yourself.