Gripped by anxiety
like a
live wire
can’t let go of.


This is my charnel ground

Now when a man is truly wise,
His constant task will surely be,
This recollection about death,
Blessed with such mighty potency.¹

from the Visudimagga

Charnel Ground on the border between Kathmandu and Paton.

“[W]hen one is actually dying it is a bit late to begin thinking seriously about death. We should familiarize ourselves with the thought long before we hope it will happen! And besides, even for the young and strong, it can still come with unexpected suddenness. Mors certa — hora incerta, ‘Death is certain — the hour is uncertain.’ To bear this in mind is for the Buddhist an important aspect of Right Understanding. And therefore the Buddhist practice of Meditation on Death — not very popular in the West — should be encouraged.”²

Death is on the mind. It surrounds me. Something shifted. Before, there was a sense of detachment. I thought it was due to equanimity. Now, when I look into the face of my patient and see her life retreating, I see my own face. I cannot help but identify with this body that is so soon going to be a corpse. When the woman who talks like a machine gun, nonsensically, shuffles her wheel chair towards me, I cannot help but face my own confusion, the busyness of my mind. When the woman with no short-term memory grabs me and asks me to help her because no one there knows who she is, I face my own feelings of worthlessness and groundlessness. When I stroke the hair of my 98 year-old uncle, who lies in the hospital bed, victimized by pneumonia, and hear his sighs of pleasure in between coughing bouts, I melt; reminded just how important it is to touch and be touched, how we need each other.

The nursing home and its residents are my teachers. They provide an active reflection on what it means to live and die. I cannot do anything but face my fear in this environment. This is my charnel ground.

1. “Buddhist Reflections on Death”, by V.F. Gunaratna. Access to Insight, June 7, 2010.

2. “Buddhism and Death”, by M. O’C. Walshe. Access to Insight, June 7, 2010.

See also:

“In the Dead of Night” a Dhamma talk by Ajahn Chah

Death & Dying at DharmaNet International Learning Center

Remembering the body

The four foundations of mindfulness (or frames of reference) play a central role in Buddhist meditation, particularly in the Burmese vipassanā tradition. They are roughly translated as follows:

  1. Kayanupassana: contemplation of the body
  2. Vedananupassana: contemplation of feeling
  3. Cittanupassana: contemplation of consciousness/mind
  4. Dhammanupassana: contemplation of mental objects/qualities

I don’t know about you, but my tendency is certainly mind over body when it comes to the practice, and I have a lot more cittanupassana and dhammanupassana under my belt as a result – not that they were meant to be separated – together they are a systematic means of practice leading to awakening. For the same reason, I am more oriented toward insight than samādhi practices (see Marguerite Manteau-Rao’s recent discussion of practitioner types here). To elucidate further the distinction between these two aspects of practice, Bhikkhu Bodhi in the introduction to Soma Thera’s essay The Way of Mindfulness says “In Satipatthana, the act of attending to each occasion of experience as it occurs in the moment fixes the mind firmly on the object. The continuous attention to the object, even when the object itself is constantly changing, stabilizes the mind in concentration, while the observation of the object in terms of its qualities and characteristics brings into being the insight knowledges.”

Sayadaw U Tejaniya is known for emphasizing wisdom over concentration and, not to say that concentration practice must be rooted in the body, but just to connect all the dots, his teacher Shwe Oo Min Sayadaw — who studied with Mahasi, etc. — was said to believe that if one practices cittanupassana and dhammanupassana, then the other two contemplations are necessarily included. (At the same time, he used to instruct students to focus on the solar plexus in their practice.)

Well, I’m not entirely sure that just doing the more mental aspects of satipatthana will be inclusive. Here’s why. (Edit: I should emphasize that I don’t for one moment doubt my teacher’s wisdom here – if practicing with right understanding and right attitude, he’s surely correct – but we don’t always do that.) Yes, if you are doing an awareness practice, no matter if it’s of a choiceless bent or if it’s a concentration practice which is methodical and systematic (and slow), one is aware of movement, of physical discomfort, of taste, of whatever is being experienced sensorily. Similarly, one can be aware of the felt body – how emotions are manifesting physiologically. However, it is one thing to be aware of, and it is another to really plumb the depths of difficult emotion. I’ve alluded to this before, as being a weakness of mine. I think being able to call up an emotion intentionally, or investigating one thoroughly when it arises requires a certain amount of stability of mind to begin with. So what happens is that when the emotions arise, if I’m even in formal meditation practice (which often I’m not), then there’s a resistance, a wall that comes up, an inability to really explore. My staying power is pretty shallow when it comes to an unknown and intense emotion. Attention turns away, and the opportunity for growth goes ignored.

We all know the familiar knot in the throat, constriction in chest, butterflies of stomach. We know the emotion they signal. But there are others that one can’t even name. Example: day before yesterday the body was characterized by a very intense vibratory feeling – all over. It may have been exhaustion, it may have been something else, but whatever it was, there was a cause and if there was a direct one, I hadn’t been sufficiently aware during the day to see it in the making. It was largely entrenched by the time consciousness really set in. I sat with it, but as often is the case with pervasive emotions, there was no particular thought content associated with it. What does one do at that point? What is the source? Is it deep, psychic, unconscious? Can it be known in a rational way? It didn’t even have meaning from an intuitive vantage point – where do you go from here?

There may be a time when I need to deepen my practice through other “techniques” or through body work like yoga, or there may be times when I’ll need to call on psychotherapy and other Western modes of self-knowledge, but for now, I think I will explore some teachings that focus more on somatic experience.

One such teacher is Reggie Ray, another is David Rome – both students of Chögyam Trungpa Rinpoche. David Rome’s teaching draws on Western psychology and the work of Eugene Gendlin and is called “focusing”. This practice can supposedly resolve the “felt sense”. In a 2004 article in Shambhala Sun Rome says:

The felt sense lies “beneath” emotions like anger, jealousy or desire; it is more subtle and less susceptible to naming. Felt senses are free of the story line that accompanies an emotion: “I am angry because such and such happened.” They are more vague and physical; a person in touch with a felt sense might say something like, “There is this region just under my breastbone that is constricted like a jack-in-the-box.” When we first notice a felt sense, it does not have a specific “aboutness” yet. It is nonconceptual. But as we use the Focusing process to be with and listen to the felt sense, it may come into clearer focus (hence the name Focusing) and it may “open” in a way that gives us fresh understanding of our situation. At that point—which cannot be rushed—we can begin to try out concepts on it, begin to inquire what it might be “about.” But the felt sense itself is always primary, not the conceptualization, and the practice of Focusing involves repeatedly letting go of conceptual activity and returning to the body sense.

A friend with whom I was discussing this challenge in my practice recently, recommended I read some John Welwood right away, so I was interested to see the reference to him in Rome’s article. He says of focusing:

It is also a powerful antidote against “spiritual bypassing,” which John Welwood, in his excellent book Toward a Psychology of Awakening, describes as “using spiritual ideas and practices to sidestep personal, emotional ‘unfinished business,’ to shore up a shaky sense of self, or to belittle basic needs, feelings and developmental tasks, all in the name of enlightenment.”

So much work to do! My hunch is that a lot of western contemplatives struggle with the emotional and physical aspects of the practice, certainly in different ways than they do the monkey mind. In general – if we have worked as professionals, had lots of critical thinking in our formal education, etc., our conditioning is so much more discursive in nature. That means we are probably at a disadvantage when it comes to the felt body, and that we may be less naturally inclined toward concentration. Is it wise to integrate other contemplative practices, possibly rooted in psychology, with our meditation? Or is the Satipatthana Sutta all we need?

I’d love to hear from you if you practice either focusing or Reggie Ray’s body work, or just in general if you’ve worked with the challenge of the felt sense in your meditation practice.

Some reading, etc. on the body and meditation practice:

Forum: Start with Your Body: A panel discussion with Phillip Moffitt, Cyndi Lee, Geshe Tenzin Wangyal Rinpoche and Reggie Ray, Fall 2009, Buddhadharma

Conversations: May 2010: David Rome (audio)

Focusing: An Interview with David Rome, May 2010, Shambhala Times

Audio Teachings from Reginald Ray

Review: Your Breathing Body, Vol. 1 & 2 (Reginald Ray), April 2009, Elephant Journal

Anxious to live life meaningfully, mindfully

Anxiety comes in many forms. According to the National Institute of Mental Health as many as 40 million Americans suffer from an anxiety disorder (source, and more info here). When there is a real surge of anxiety, the afflicted person can end up virtually non-functional. The mental activity tends to go in a dangerous spiraling motion (thoughts of dread, regret, meaninglessness, etc.), the body may respond violently (trembling, vomiting), and a panic attack can set off totally paranoid behaviors (e.g., unable to leave the house). This is mind and this is serious stuff.

Although I luckily have not experienced quite this intense form of anxiety except in extreme situations of crowds (perhaps some ochlophobia), I can sympathize to a certain degree due to a pervasive undercurrent of the emotion that is deeply conditioned at this point, and thus hard to pinpoint. One of the side effects is waking up in the middle of the night or first thing in the morning with an overwhelming sense of neglect and forgetfulness, as if I’ve forgotten the most important person (or dog – my baby) in my life completely. It’s possible this is PASS, but considering it’s been 16 years since exercising that not-so-much-of-a-choice, I’d be surprised.

A lot of people take prescription drugs (while others self-medicate), some use psychotherapy, and still others engage in a meditative practice to manage anxiety. One friend who does suffer from anxiety, and takes medication for it, has also begun to consider mindfulness-based approaches. There is some evidence that this may indeed be an effective form of treatment, though the study results generally have only moderate success rates.

I can attest to the benefits of of mindfulness practice in my own life — as this background noise of anxiety definitely disappeared during retreat — but, I can also see how the results could be difficult to maintain without diligence and sustained practice. In other words, the anxiety has slowly but surely emerged again in the conventional world as mindfulness weakens and old habits of mind reappear. Despite an extremely simple life: no house, no car, no phone, no job, no bills, the anxiety just starts to bubble up in sleep and waking life, undoubtedly because of more discursive thought.

Toni Packer in The Work of this Moment talks about how we can inquire into the nature of our difficult emotions and, in particular, question the validity of the thoughts that tend to bolster them. She says:

…Real questioning has no methods, no  knowing–just wondering freely, vulnerably, what it is that is actually happening inside and out. Not the word, not the idea of it, not the reaction to it, but the simple fact…Anxiety arises…will one immediately act by “knowing” it from previous times and bracing against it? “Oh, not that again–I hate it–it’s going to get worse, how can I get rid of it.” and so forth. [Or] simply meeting it as for the first time, attending quietly, feeling it, letting it move on its own, revealing itself for what it is without interference by the brain.

When the emotion is just a background hum, it can be difficult to really identify the thought content that’s feeding it. That’s why moment-to-moment mindfulness is key – because you never know when with clear awareness that cause and effect process is going to make itself known. And when the mind is peaceful, during more formal meditation practice, that’s a good time to actually intentionally call up the emotion and investigate it. This is something I need to do more often, but it requires equanimity. Anything that’s deeply conditioned is difficult to penetrate. We have to recognize when is the right opportunity to really confront a strong emotion and also know when we really aren’t ready to deal with it. If we aren’t, it’s okay to redirect our attention to the breath or to the observing mind, which may be feeling aversion to the emotion, because the emotion will undoubtedly come up again when we can meet it with more wisdom. I believe though that even if we have gained some insight into the source of a particular emotion, without persistent application of mindfulness, we can’t be confident that it won’t arise again.

Quite certainly, in my case, the anxiety is related to a seemingly urgent sense of needing to live life meaningfully, and while that was stilled for a while on retreat, it has come up to the surface again in the cloud of uncertainty that hangs over my day to day and in the semi-isolation I have imposed on myself without the structure and discipline of before (as I alluded to in my last post). And again, if not aware, engaging in social media can exacerbate this.

While I do very much believe in the application of mindfulness meditation for the treatment of stress, difficult emotions, and the conditions associated with them, I also question an entirely secular approach as a stand-alone treatment. Knowing that even after 7 months of intensive meditation practice and with a tremendous amount of saddha, I still struggle with a lesser-grade anxiety condition, I suspect that it would be very challenging for someone that lacks that faith in the benefits of meditation and the Dhamma, and who may suffer from a more serious condition, to persistently apply mindfulness in such a way that it could have significant results.

But read up on it, I’m just one meditator so don’t take my word for it.

In the interview “What Is True Happiness?” (PDF), Tricycle, Fall 2005, B. Alan Wallace, director of the Santa Barbara Center for Consciousness Studies, talks about the importance of faith and, even more so, practice in order to live a meaningful life and understand the cause of stress. He refers to that niggling dukkha, and discusses it in the context of the Four Noble Truths and of modern psychotherapy. To paraphrase, he says that that depressive quality, that ever present hum of discomfort, is our golden opportunity. But far too often, on the advice of conventional society and mental health professionals, we treat only the symptom. Truly what we need to do is look at the cause of the suffering, understand it and learn from it. As my teacher has said, vipassana means, “face it, learn it, get it”.

So let’s get to the root of it and let’s do it through practice. But let’s also be wise and know what are skillful means and when to employ one over the other. There is no quick solution to dealing with stress, anxiety, fear, dukkha, but there is no doubt that by walking the path the Buddha laid out and practicing right mindfulness (samma sati), we can go a long way toward understanding it.

Studies on Mindfulness-Based Therapies and Meditation to Treat Anxiety, Etc.

Hofmann, Stefan G.; Sawyer, Alice T.; Witt, Ashley A.; Oh, Diana. “The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review”, Journal of Consulting and Clinical Psychology, April, 2010  Volume 78, Issue 2, Pages 169-183

Kabat-Zinn, J., Massion, A. O., Kristeller, J., Peterson, L.G., Fletcher, K., Pbert, L., Linderking, W., Santorelli, S. F., “Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders”, Am. J. Psychiatry (1992) 149:936-943.

Miller, J., Fletcher, K. and Kabat-Zin, J., “Three-year follow-up and clinical implications of a mindfulness-based stress reduction intervention in the treatment of anxiety disorders”, Gen. Hosp. Psychiatry (1995) 17:192-200.

Evans, S., Ferrando, S., Findler, M., Stowell, C., Smart, C., Haglin, D. “Mindfulness-based cognitive therapy for generalized anxiety disorder”, J Anxiety Disord. 2008 May;22(4):716-21. Epub 2007 Jul 22.

Zylowka, et al. (2008). “Mindfulness meditation training in adults and adolescents with ADHD.”. Journal of Attention Disorders, 11, 737-746 (somewhat related)

And Some Blog Posts…

Finding Relief from Depression Through Mindfulness

A Buddhist Perspective on Coping with Anxiety

Online Mindfulness-Based Anxiety Therapy

A Video from Yongey Mingyur Rinpoche

Using Panic Attacks for Meditation

And Some Books to Consider (caveat: I haven’t read ‘em)…

The Mindfulness Code: Keys for Overcoming Stress, Anxiety, Fear, and Unhappiness, by Donald Altman (you can also listen to an interview with the author, where he talks about overuse of technology and social media as part of our unhappiness, here)

The Mindful Way through Depression: Freeing Yourself from Chronic Unhappiness, by Mark Williams, John Teasdale, Zindel Segal, and Jon Kabat-Zinn

The Mindful Path Through Shyness: How Mindfulness & Compassion Can Help Free You from Social Anxiety, Fear, & Avoidance by Steve Flowers and Jeffrey, M.D. Brantley

Mindfulness tools for dealing with emotional and physical pain

Like many women and quite a few meditators (including a young S.N. Goenka), I suffer from migraines. These severe headaches are not all that well understood in the medical community and are often extremely difficult to treat through either allopathic or homeopathic means. Fortunately, through the practice, I have found that mindfulness meditation offers some insight into the causes at the same time as it provides significant relief.

As any meditator knows, one of the biggest obstacles we face in the beginning (and sometimes in perpetuity) is the physical discomfort experienced in formal sitting meditation practice. Regardless of whether you’re seated in a chair, kneeling on the floor, or in half-lotus – the body is not accustomed to remaining in one position for extended periods of time. Even when practicing lying-down meditation, we experience pressure and eventual pain if we stay in the same posture for too long. At the same time, the discipline of formal practice, particularly in community, asks us to sit a little longer and to explore what physical pain is all about. When we develop some stability of mind in our meditation, it can be pretty interesting to investigate what really constitutes pain.

Yesterday I spent the day with Ajahn Amaro at the New York City Insight Meditation Center. The day was dedicated to the Spiritual Faculties or indriya, a favorite topic of mine thanks to my Burmese teacher, Sayadaw U Tejaniya. I won’t entirely side-track this discussion, but Ajahn Amaro described the five indriya as akin to a bird, with mindfulness being the heart of the bird, and the partner qualities of energy and samadhi representing the wings, and with the elements of faith and wisdom — also a pair — representing the base and the head of the bird, respectively. In our practice, keeping these faculties in balance is an ongoing act of minor adjustments made possible only through our remembering to be aware (sati or mindfulness).

As part of his response to one of the retreatant’s questions regarding difficult emotions, Ajahn Amaro talked about how we are able to see concepts of pleasant and unpleasant in a broader perspective through mindfulness. Specifically, when we refrain from getting involved in the story line that produces difficult emotion and instead just bring our attention to the physical sensations associated with that emotion, we find that even seemingly pleasant emotions result in discomfort in the body (e.g., excitement). On the other hand, those emotions that we associate as unpleasant such as anger or fear, when we see them for the sensations that they are, aren’t really all that bad. In fact, the physical response to both strong positive and negative emotions is pretty similar. It’s the thoughts about the emotion, the thought content itself, or the fixed ideas (shoulds, etc.) that color our perception of these passing phenomena…

Particularly from my experience with migraines while on intensive retreat, I would argue that the same principle can be applied to physical pain to a large extent. While I can’t say that I know the pain of childbirth or of a terminal illness, migraines have been very debilitating and generally the only way that I have been able to cope with them is to sleep as much as possible. In discussing the quality of energy (viriya), Ajahn Amaro talked about the mind’s tendency to either have too much or too little energy. If too much, the mind is restless and racing around discursively, if too little, we are constantly nodding off and unable to maintain interest in meditation. Often, this is a kind of “mental numbness” or shutting off to something we don’t want to deal with – like physical or emotional pain. Unconsciousness is nature’s anaesthesia, Ajahn Amaro says.

When we experience chronic pain like this, the mind develops a pattern of relationship with the pain. Obviously, we don’t want the pain. We want to shut it out. We want it to go away. We don’t want to be aware of what’s happening. We want to wake from a deep sleep feeling refreshed and totally recovered. So to then try and practice mindfulness meditation while experiencing intense pain can be extraordinarily difficult. While I was in Burma, I had several migraines and was unable to go to the meditation hall. But rather than fall asleep, I wanted to understand the nature of these headaches, so tried in earnest to practice lying-down meditation. What I found was that the object of the meditation – the pain, and to a certain extent the mind’s reaction to the pain – was so gross as to be virtually impossible to be at peace with. But I began to see improvements in the way the mind was relating to the pain over time, because I wasn’t vomiting from the sheer exhaustion of the pain anymore. I also began to recognize the mental states that contributed to a migraine’s appearance, and was able to stop them ahead of time (as long as they didn’t come in my sleep!). Still, the pain was real and challenging, but there was definitely a change under foot.

Three days ago I woke with a headache. I sensed that it might turn into a bad one. And it did. Try as I might have to divert it. We were going to a family wedding and the last thing I wanted to do was get in a hot car in the middle of the day where the sunlight would be moving in and out of my view and the sounds of the highway would constantly be droning. I brought a pillow and an ice pack, covered my eyes and dropped into my body. I felt the migraine. I didn’t think about the migraine. And in the feeling, in the just being really present in my body, an extraordinary peacefulness emerged. An acceptance of the way things were and, in that, a significant relief.

When pain is constant and unrelenting, it is very hard not to identify with it, “MY pain”, “MY back hurts”, etc., and it seems to defy the law of impermanence while we are experiencing it so a tremendous amount of aversion or resistance arises in the mind. But when we can create some distance between the mind that is aware of the pain and the body that is experiencing the pain, when we can truly observe objectively, it changes the whole equation. The more I think about how much my head hurts, the more it hurts, but if instead I’m just experiencing sensation, the intensity goes away, and then suddenly I find myself virtually headache-free. It seems almost a miracle.

It is in this way that we begin to redefine the mind’s relationship to that old pain. And it’s not in shutting ourselves off to it or trying to push it away, but rather in opening up to it and allowing it to be that we find freedom.

For a long time I have looked at the practice of meditation as a way of learning to live so that we can learn to die. Death often is accompanied with physical pain, and clearly represents the ultimate letting go, which if we are not prepared for will then be accompanied with significant mental pain as well. And, if my experience with migraines is any indication of what we are capable of through cultivating the mind, I can’t imagine anything more important to help us to both live and die well.

For more reading on the Five Spiritual Faculties, refer to Ayya Khema’s description here, or to Thanissaro Bhikku’s commentary and translations here. Also, you can listen to Ajahn Amaro speak about Faith and the Spiritual Faculties here.

For more reading on vipassanā and pain management, see below.

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