How to Live Well with Chronic Pain and Illness

by Toni Bernhard

  Let your mind help your body.

  Recall that physical discomfort has three components: the physical sensation itself, the emotional reaction to it, and the stories you spin about it. Formal meditation practice provides a quiet and uninterrupted setting for watching those emotional reactions and for challenging the validity of those stressful stories.

  For example, if you’re in physical pain, you may also feel frustrated and irritated at your body. But when you’re distracted by the sights and sounds and other sensory inputs all around you — not to mention the stories about how life isn’t fair, etc. — you may not even realize that these two emotions are present in your mind. You feel “off” emotionally, and you know that you’re suffering mentally, but you’re unable to pinpoint the specific emotions that are in play. In a meditation setting, however, there are few, if any, outside sensory distractions. As a result, it’s easier to direct caring attention to what’s going on in your mind. The water clears, and there they are: those worn-out shoes of frustration and irritation.

  Recognizing their presence gives you the opportunity to develop some skill in responding to them. For example, once you’ve recognized the presence of frustration and irritation in your mind, the simple act of nonjudgmentally studying them with caring attention instead of feeding them with stressful stories, such as “I hate this pain” or “This pain will never go away,” can stop them in their tracks and keep them from intensifying. This alone can ease your mental suffering.

  Formal meditation also makes it easier to see that frustration and irritation are impermanent, that they are nothing more than fluid and ever-changing events in the mind. They’ve arisen based on causes and conditions in your life at the moment, and they’ll pass out of the mind — as do all emotions. There’s no reason to treat them as intrinsic features of who you are. Seeing this can help ease your mental suffering.

  Both of these skillful responses to stressful emotions — nonjudgmental attention and reflections on impermanence — can ease your physical suffering. The mind and body are interconnected. Formal meditation practice can bring this into sharp focus. Physical discomfort can set off stressful emotions, such as frustration and irritation, even fear. This can lead to the spinning of stressful stories about the present and the future. In turn, these emotions and stories can increase your physical discomfort by intensifying the symptoms you’re already experiencing or by triggering new symptoms, such as muscle contractions or a racing heart.

  In summary, seeing what’s going on in your mind can help ease your physical symptoms, and the most effective way to see what’s going on in your mind is to meditate.

  How to meditate.

  There are many different meditation techniques. What follows is a description of the most common type of mindfulness meditation. It’s helpful to have access to a teacher who can answer questions as they arise, but these instructions can get you started.

  Pick a quiet place and a time when you won’t be interrupted. Decide ahead of time how long you’ll meditate; otherwise your mind is likely to come up with any number of excuses to stop if you’re finding it difficult. Find a comfortable position — sitting on the floor, in a chair, or lying down.

  In choosing an amount of time and what position to be in, the most important consideration is to be flexible. Before I got sick, I had such an inflexible meditation schedule — sit upright for forty-five minutes, twice a day — that when illness prevented me from keeping to the schedule, I gave up meditation altogether, even though I’d been doing it for ten years. It took me another ten years to start practicing again. Depending on how I’m feeling, I may only set aside twenty minutes… and I always meditate lying down.

  Begin by gently closing your eyes. Do a quick scan of your body, from the top of your head to your toes. Is your body tired? Is it full of energy? Is there any discomfort? The idea here is to ground your attention in your body.

  Now notice the physical sensation of your breath as it comes in and goes out of your body. Find the place in your body where that physical sensation is the strongest. It might be in your nostrils or at the back of your throat. It might be in the rise and fall of the abdomen. It might be in the expansion and contraction of your entire torso. It doesn’t matter. Just rest your attention on the sensations that most strongly let you know that your breath is coming in and going out of your body. You’ll come back to the physical sensation of your breath at this place over and over. It will become your anchor spot to the present moment.

  As you breathe, investigate the physical sensation of your breathing with interest. Notice how the in-breath feels different from the out-breath. Notice the difference in the feeling of the beginning, middle, and end of the in- and out-breaths. When you recognize that your attention has strayed from the breath to other incoming sensory data (a thought, a physical sensation, a sound), gently bring your attention back to the physical sensation of the breath going in and out of your body at your anchor spot.

  Remember — whether this is your first time meditating or your ten-thousandth time, your mind will still stray from the breath! One of the beauties of meditation is that it’s okay to begin again… and again and again. The whole practice can be thought of as this returning again and again, practicing this returning, slowly getting better at it.

  Usually when you notice that your attention has strayed from the breath, it’s easy to return to following it at your anchor spot. That said, sometimes another sensory input becomes more compelling than the breath. If that happens, let go of your focus on the breath and bring to this sensory input the same attentive quality that you brought to the breath. If it’s an unpleasant physical sensation, don’t attach any meaning to it; just notice the unpleasantness without judgment. When the sensory input becomes less compelling, return to the physical sensation of the breath at your anchor spot.

  If it’s a thought or emotion that has become so compelling that you can’t keep your focus on the breath, shift your attention to the thought or emotion and just patiently watch it, study it without judgment. Get to know what it is. Thoughts and emotions come and go in the mind in an ever-changing flow. They’re not solid entities or permanent features of your identity. They arise due to conditions in your life and will eventually pass on through the mind. When the thought or emotion becomes less compelling, return to following your breath at your anchor spot.

  These are basic mindfulness meditation instructions: return over and over again to the physical sensation of the breath coming in and going out of your body. Wherever the meditation takes you, meet your experience with curiosity and open-heartedness, not judgment. If judgment does arise, study it as well: What’s the story? Does it create its own set of physical sensations? And so on.

  You can watch what’s going on in your mind by practicing mindfulness outside of meditation, of course. Formal meditation practice, however, can help you become more adept at this; meditation sharpens your ability to pay attention to your present-moment experience.

  Finally, it’s important to point out that if you have unresolved psychological issues (for example, mistreatment by overly critical parents or an unresolved past trauma), mindfulness meditation may not be a good choice for you at this time in your life. When your mind becomes quiet and calm, repressed or charged thoughts and emotional issues can come up — issues you may have been keeping at arm’s length or that you didn’t even realize existed.

  Mindfulness meditation is an excellent tool for seeing that you need not believe in or act upon the ever-changing array of thoughts and emotions that arise in the mind. But if these unresolved issues are part of your deeply embedded personal psychological history (as opposed to being the thoughts and emotions that typically come and go for everyone during meditation, such as a wave of sadness or worry), they can stick in your mind and increase in intensity, leading to anxiety, anxiousness, and fearfulness.

  This is not a common occurrence when practicing mindfulness meditation, but if it happens to you, please don’t
blame yourself. Instead, with kindness and compassion toward yourself over the suffering you’re experiencing, stop meditating and talk to a trusted meditation teacher (one with experience in these matters) or consult with a qualified mental health practitioner, perhaps a trauma specialist.

  III. Responding Wisely to Troubling Thoughts and Emotions

  13

  Breaking Free from Stressful Thinking Patterns

  If you can change your mind, you can change your life.

  — WILLIAM JAMES

  MANY OF US are adept at making ourselves unhappy by taking a neutral, fact-based thought, turning it into a stressful one, and then spinning that stressful thought into an even more stressful story. I’m quite good at this myself. I start with a harmless thought and before I’m even aware of it, I’m suffering through an elaborate stress-filled tale that may reflect my worries and fears about the future, but has no basis in reality.

  To illustrate my unfortunate expertise at this, here are two neutral, fact-based thoughts that started off innocently enough for me:

  “A friend is coming over tomorrow.”

  “I’m seeing a new specialist next week.”

  Each of these thoughts states a fact, free from emotional content. However, fueled by worry and anxiety over my health, I then turned them into stressful thoughts even though I had no additional information on which to base my conclusions:

  “My friend’s visit is going to be a mistake.”

  “The appointment with the specialist will be a big disappointment.”

  Having turned each of the neutral thoughts into stressful ones, my storytelling began:

  “My friend will stay much longer than I’m able to visit, and I’ll be too embarrassed or undisciplined to tell her I need to lie down. It will take me days to recover, and I’ll be angry at myself for not speaking up.”

  “The specialist won’t believe how sick I am. He might even treat me as if it’s all in my head. And even if he does believe me, he won’t want to take on a patient who has a complex illness with no easy fix.”

  Notice the multiple hypothetical scenarios I added to the simple facts that a friend was coming over and that I had an appointment with a new specialist: my friend will stay too long, I’ll be embarrassed or lack discipline, I won’t be able to tell her I have to lie down, it will take me days to recover, and I’ll be angry at myself; the specialist won’t believe what I tell him, he might think I’m a hypochondriac, and he wouldn’t want the hassle of trying to care for me anyway. Whew. All this, and neither event has even occurred yet!

  In this chapter, I want to share a powerful practice developed by a teacher (who’s not Buddhist) named Byron Katie. She calls it “inquiry” or “four questions and a turnaround”; she presents questions we are to ask ourselves when we recognize that we’re caught in the net of a stressful thought.

  The purpose of inquiry is not to control what thoughts pop into our minds. The mind is going to think what it’s going to think. Trying to control our thoughts is almost always a fruitless endeavor. What matters to our well-being is not what thoughts arise but how we respond to them. If we can learn to respond skillfully, we’re much more likely to keep a stressful thought from turning into a full-blown stressful thinking pattern.

  Here are Byron Katie’s four questions:

  1.Is the thought true?

  2.Am I absolutely sure that it’s true?

  3.How do I feel when I think the thought?

  4.Who would I be without the thought?

  Before addressing Byron Katie’s fifth step — the turnaround — I’ll apply her four questions to the two stressful thoughts in my example. In writing this, I’ll answer the way I would have. As you read it, try thinking of how you’d answer each question. I’ll start with my friend’s upcoming visit.

  1.Is it true that my friend’s visit is going to be a mistake? Yes, I think it’s true.

  2.Am I absolutely sure it’s true? Hmm. I guess I’m not absolutely sure. I’m not even 75 percent sure.

  Sometimes simply seeing that we’re not absolutely sure that a stressful thought is true is enough to stop the thought in its tracks and keep us from turning it into a stress-filled story.

  3.How do I feel when I think that my friend’s visit is going to be a mistake? I feel as if it’s my fault for agreeing to let her come, and I feel even more nervous and worried about how it will go. Even worse, now I’m dreading her visit.

  In this situation, the dread is more painful than the worry, because dread carries guilt with it; I love my friend, yet here I am, dreading her visit. This definitely does not feel good!

  4.Who would I be without the thought that the visit is going to be a mistake? I’d be a person living in the present moment, with a chance to enjoy what I’m doing right now, instead of being lost in worry and anxiety about tomorrow.

  Now I’ll try the same technique with the appointment with the new specialist.

  1.Is it true that the appointment with the specialist will be a big disappointment? Yes, it’s true. They always are.

  2.Am I absolutely sure it’s true? Not really. I guess I was exaggerating a bit when I said “They always are.”

  3.How do I feel when I think it will be a big disappointment? I feel scared, and I feel angry. I’m scared that I’ll be disregarded and that I won’t be offered a treatment that might be beneficial. I’m angry that I’m sick because that’s why I have to spend so much time in medical clinics.

  4.Who would I be without the thought that the appointment will be a big disappointment? I’d be a person living in this moment instead of being lost in stressful thoughts about something that’s a week away.

  Pausing to let my response to question 4 sink in is always helpful because it switches my focus to what’s going on right now in my life. If I stop here though, I’m likely to drift back into stressful storytelling about an imagined future, so it’s important to move on to Byron Katie’s turnaround.

  In the turnaround, we take the stressful thought and turn it around — change it — in a way that works for each of us individually. In other words, there’s no one “right” turnaround. Then the instruction is to come up with three reasons why this new thought might be true.

  I’ll start with my friend’s visit. Here’s my turnaround: My friend’s visit won’t be a mistake. What are three reasons why this might be true?

  1.She might be sensitive to my limitations and know not to stay too long.

  2.I might feel comfortable enough around her to let her know when I need to lie down.

  3.Maybe she’ll tell me about a funny adventure she had, and we’ll have a great time laughing together.

  In coming up with reasons why the turnaround might be true, I’ve found that it’s helpful to be creative in my thinking, even if it becomes absurd. For example, one reason could be “Maybe she’ll get an upset stomach and have to leave early.” This isn’t exactly in the spirit of friendship, but letting my imagination run wild like this helps shake me loose from the rigid thinking pattern that I’ve fallen into — in this case, a pattern that has me believing there’s only one possible outcome for this visit: it will turn out to be a mistake.

  In sum, thinking of multiple reasons why the visit might go well drives home the point that there’s no reason to believe the stressful thought that it’s going to be a mistake. Thus, engaging in the turnaround helps me stop fretting and enables me to simply wait and see how the visit unfolds.

  Now to the appointment with the new specialist. My turnaround: The appointment will be a success. What are three reasons why this might be true?

  1.The doctor might not question how sick I am — at all!

  2.The doctor might be sympathetic and understanding about my illness.

  3.The doctor might see my illness as a challenge and want to try and help me.

  When I reflect on the two dozen or so specialists I’ve seen about my illness, a few of them have been just as I described above, so why should I decide ahead of time that
the appointment will be a disappointment even if the odds are against me? After all, if my stressful thought turns out to be true and the appointment is a disaster, it won’t be because of the stressful stories I’m spinning about it! No doubt about it: my time could be better spent in the days leading up to the appointment.

  Byron Katie’s “four questions and a turnaround” has been a gift of inestimable value to me. It’s such a relief to know that I can free myself from stressful thinking patterns by questioning the validity of the stories I spin about my life. I hope you’ll give it a try.

  14

  When the Blues Come Calling

  Sadness flies away on the wings of time.

  — JEAN DE LA FONTAINE

  UNLIKE OTHER stressful emotions, such as anger or frustration, I can’t pinpoint what sets off the blues. One moment, I feel okay, and the next moment, I feel inexplicably melancholy. The blues don’t seem to be tied to the intensity of my physical symptoms nor to other happenings in my life. In fact, I got the blues before I became chronically ill, so at least there’s something I’ve brought with me from my pre-illness life!

  The one thing I feel sure of? Everyone gets the blues now and then. In this chapter, I’ll discuss some things that can help.

  (Note that the “blues” is to be distinguished from a heavy or dark mood that goes unchanged for weeks at a time and interferes with work or personal relationships. The latter could be a sign of clinical depression, in which case you should seriously consider seeking the advice of a health care practitioner.)

  Avoid “comparing mind.”

  We can talk ourselves into believing that we’re the only ones who get the blues. Our neighbor who’s always cheerful surely never gets them. Our friend who’s in the “perfect” relationship definitely never does. And billionaires? They can’t possibly get the blues! In reality, of course, the odds are high that all these people do. To reference the title of the Tom Robbins novel, “even cowgirls get the blues.” In my experience, neither a carefree demeanor, nor a loving relationship, nor money to spare immunizes people from the blues.