Advice Not Given

by Mark Epstein

  This kind of advice does not apply only in the West. While psychotherapy has never been a strong tradition in the East, this does not mean that people in Eastern cultures are not subject to all of the same conflicts and defenses as Westerners. There are certainly many people in Buddhist cultures who have used meditation to evade themselves, who have never really confronted the tenacity of the ego’s grip. I was told recently about one such person, a hermit who, after meditating in a cave in the mountains of Nepal, heard that the Dalai Lama would soon be passing through his remote area. The Dalai Lama, in the tradition of Tibetan Buddhism, is the most highly regarded spiritual figure in the culture. He is considered a pure expression of enlightened wisdom, and any chance to be in his compassionate presence, let alone to meet with him, is virtually irresistible to those who revere him. This hermit had mastered many of the classic meditations designed to quiet the mind and calm anxiety. Villagers brought him food to keep him healthy, but other than these rare encounters he had been alone for four years in deep states of meditation. He somehow arranged for a personal meeting with the Dalai Lama and emerged from his self-imposed retreat for the encounter. He asked the Dalai Lama for advice on what to do next.

  The Dalai Lama, who fled his native Tibet in 1959 when the Chinese invaded, has spent much of his adult life in dialogue with the West. I visited his place of exile in the foothills of the Indian Himalayas in 1977 before I started medical school and returned for six weeks on a research grant before I graduated in 1981. I have had the opportunity to hear him teach on many occasions since. When he speaks about meditation, he often makes a distinction between practices that quiet the mind and those that utilize the mind’s intelligence for its development. Many people, in both the East and the West, believe that shutting down the ego, and the thinking mind, is the ultimate purpose of meditation. The Dalai Lama, rather forcefully, always argues that this is a grave misunderstanding. Ego is at once our biggest obstacle and our greatest hope. We can be at its mercy or we can learn to mold it according to certain guiding principles. Intelligence is a key ally in this shaping process, something to be harnessed in the service of one’s progress. The Dalai Lama’s advice to the hermit seemed to spring from this place.

  “Get a life,” the Dalai Lama admonished him.

  This monk, from a poor Nepalese village, was shaken by the exchange. It went against all his preconceived notions of what a monk should do. The Dalai Lama was not negating the value of the hermit’s meditations, but, like the old man in the Buddhist fable, he did not want his student to stop there. It was time to pick up his bundle and return to town rather than resting on the laurels of his spiritual attainments.

  The hermit had a sister who had been taken in the sex trade. The Dalai Lama’s advice motivated him to emerge from his cave and begin providing education and health care for local village women. An acquaintance of mine helped to fund some of this work, and he was present when someone reminded the Dalai Lama of this pivotal exchange.

  The Dalai Lama chuckled. “Oh, yes,” he said proudly. “I told him, ‘Get a life.’”

  The Dalai Lama’s advice, while cryptic enough to fit with his role as a Buddhist master, comes from a place of age-old wisdom, as relevant in the West as it is in the East, as helpful today as it was in the time of the Buddha, as true for us as it was for the Nepalese monk.

  We all have a life, but we are not always aware of how precious it is. And we all have an ego, but we do not always take enough responsibility for it. Our sufferings, or our doomed attempts to avoid them, all too often keep us mired in obsessive attachment, greed, worry, or despair. There are those, like the hermit in Nepal, who are attracted to spiritual pursuits because they seek a means of escape from life. They view enlightenment as a way out. But this attempt to leapfrog over the ego is counterproductive. There is no getting around it. If we wish to not perpetuate suffering, we have to take a hard look at ourselves. Making one’s life into a meditation is different from using meditation to escape from life.

  This book is a how-to guide that refuses a quick fix. It is rooted in two traditions devoted to maximizing the human potential for living a better life—traditions that have only begun to speak to each other. Although the conversation is just starting, it is clear that Buddhism and Western psychotherapy have much in common. They each recognize that the key to overcoming suffering is the conscious acknowledgment of the ego’s nefarious ways. Without such consciousness, we remain pushed around by impulses and held in check by unrecognized defenses. But when we are able to see the extent of our own fears and desires, there is something in us, recognized by both Buddha and Freud, which is able to break free. Taking responsibility for what is going on inside of us gives hope.

  One Caveat

  I had the unusual—and I would say fortunate—experience of discovering Buddhism before I knew very much about anything else, certainly before studying Western psychology or deciding to go to medical school to be trained as a psychiatrist. Buddhism spoke to me personally from the start. The very first verse of the Buddha I ever read (in a college survey class in my freshman year) was about training the anxious mind. I felt an immediate attraction to it, as if the words were written just for me. Soon I found myself in the bowels of the university library digging out ancient Buddhist texts buried deep in the library’s stacks. Many of these books had not been checked out for years, but this made them seem all the more special to my eyes.

  There was a map of the mind in those ancient texts that seemed relevant to me. This map charts a path whereby the mind can be developed, where qualities like kindness, generosity, humor, and empathy can grow out of a willingness to question one’s own instinctive attractions and aversions. The inner peace of a calm mind, the satisfaction of creative expression, the solace and joy of enduring relationships, the gratification of helping and teaching others, and the liberation of seeing past one’s own selfish concerns into other people’s welfare began to seem like realistic goals, goals that an engagement with Buddhism might make more achievable. I wrote an undergraduate thesis on this ancient Buddhist map that continues to inform my work to this day. I met my first meditation teachers before my twenty-first birthday and “sat” my first two-week silent retreat shortly thereafter. Although I struggled with meditation—for something so simple, it is remarkably difficult—it came alive for me in that first two-week course, and I have returned to these retreats dozens of times since. Every retreat has shown me something interesting about myself and reinforced my initial enthusiasm. Meditation is a real thing. If you do it, it actually has effects!

  Like many people, I was drawn to Buddhism because of the promise of meditation. I wanted a way of quieting my thoughts, of accessing inner peace. And I was drawn to the possibility of bringing my mind to its full potential. I must have already known, even as a college student reading Buddhist verse for the first time, how easy it was to get in my own way.

  This personal discovery of Buddhism was very important to me. It led me from meditation into a greater exploration of the Buddha’s teachings. I came to appreciate that meditation, while important, was not the be-all and end-all of the Buddhist path. The point of meditation was to bring its lessons to everyday life: to be able to live more fully in the moment, to stop undermining myself, to be less afraid of myself and others, to be less at the mercy of my impulses, and to give more generously in the midst of a busy and demanding day. In my years of work as a psychiatrist, I have come to see that these can also be goals of psychotherapy.

  Until recently, I have avoided too much direct talk of Buddhism in my therapy. I have tried to bring it in less explicitly: in the way I listen, for example; in the way I ask my patients to approach their own shame and dread; and in my efforts to show people how they are perpetuating their own suffering. I make no secret of my Buddhist leanings and am happy to talk of them when asked, but I rarely have offered up meditation as a direct therapeutic prescription. I have watched as mindfulness has
taken hold in the field of mental health as a therapeutic modality in its own right, but I have stayed on the sidelines, wary of what has always seemed to me to be people’s exaggerated expectations of this single aspect of Buddhist thought. I have preferred to work in the old-fashioned analytic mode, artificially blinding myself, as Freud liked to put it, in order to focus on the dark spot in front of me. There are much more inexpensive ways to learn about meditation than to pay a psychiatrist’s hourly fee, after all.

  But what if I am wrong? This thought occurred to me in the middle of my own weeklong silent meditation retreat some years ago. What if I am depriving the people I care about of that which has given me so much help myself? In my efforts to avoid being too prescriptive, was I keeping my patients too much in the dark? What if I were to be more explicit about what I had learned from the dharma, as the Buddha’s teachings are called? What would I say? How could I talk to my patients, many of whom were not at all conversant in a Buddhist sensibility? The teachings of the Buddha had helped me enormously. Could I give advice about Buddhism without alienating the people I was trying to aid?

  Much of the time, when I do offer advice, it is overtly welcomed but covertly rejected. People appreciate my attempt to help them, but they have many reasons not to do what I suggest. Paradoxically, this has freed me up a little. I worry less about it now because I know that people will not listen if they do not want to. But still, I am aware of how alienating it can be to come across as any kind of an “expert.” A patient of mine, sober now for twenty years, told me something recently that confirmed my cautious approach. When he’d first come to see me, he said, back when he was still drinking and using drugs, I’d suggested only once that he go to AA. It was very meaningful for him that I said it only once.

  “You let me find it on my own,” he told me, and this made it all the more consequential for him.

  As my patient implied, the desire to help all too often has untoward consequences. If I had been too insistent on his sobriety, my patient might well have kept on using just to frustrate me.

  I have not always been so on point, however. I was recently reminded of another event from the early days of my practice, one in which I offered advice but came across as way too much of an authority. I learned from this experience to be very careful with even well-meaning advice. It can boomerang if the therapeutic relationship is not well established. A young man came to me after his own two-week silent meditation retreat. Rather than becoming calm and peaceful on the retreat, however, his mind had become anxious and unglued. He was extremely intelligent but his thinking showed faint traces of what psychiatrists call “thought disorder,” signs of an incipient process not necessarily visible to a layperson. I met this young man for a single session, in consultation, because his parents trusted me, as someone knowledgeable about Buddhism, to help their son. As well intentioned as I might have been, I was abrupt in my response to him. I was tired at the end of my day and spoke more impulsively, because of my fatigue, than I should have, or would have ordinarily, I hope.

  “You might have an underlying bipolar illness,” I told him, “surfacing under the spell of the retreat. It would be good to treat this right away rather than let it impact your whole life.”

  I remember pulling literature about manic-depressive illness off my shelf and showing it to him, explaining that if you had to have one psychiatric illness, this was the one to have because there were such good treatments for it and it did not have to wreck your life.

  “Lots of very accomplished creative people have it,” I told him reassuringly.

  The evidence to support my intervention was slim—this man functioned well enough in his regular life and had come apart only in the silence and sensory deprivation of the retreat—but this did not stop me. My advice did not go over well. He was offended, and he left. The next day his mother called me, and she was furious.

  “How can you make that diagnosis based on one visit?” she lambasted me.

  She was right. I apologized but never heard from them again.

  Twenty years later, I ran into this patient’s mother at a party. She came over to me and reminded me—unnecessarily—of what had happened all those years ago.

  “You have children now, right?” she asked me. “You know how devastating it can be to hear that anything is wrong with them? I was mad at you for a long time.”

  I knew exactly what she was saying. I apologized again and asked how her son was.

  “Well,” she said, “I told him I was going to see you tonight. ‘He could have been right, Mom,’ he told me. He’s had more trouble on those retreats since then, but he’s starting to come to terms with it now.”

  Might I have been able to help this person if I had come across as less of an expert all those years ago? Even if I was right (and I was secretly glad to know that I had not been completely off base), being right is not the point in this profession. Being useful is. I do not want any advice I am offering to be as counterproductive as this session had turned out to be!

  This book is my attempt to be useful. Its advice can be used by anyone—each in his or her own way. As the Buddha made clear in his own advice on the matter, the Eightfold Path is there to be cultivated. Just as no artist makes work identical to any other, no person’s development will look or feel the same as anyone else’s. We are all coming from different places and we all have our own individual work to do, but it is safe to say that a willingness to engage with the principles of the Eightfold Path will, at the very least, give wise counsel in a confusing world. As hesitant as I have been to offer meditation as the solution to anyone’s problems, rethinking the Eightfold Path has allowed a Buddhist perspective to merge with my psychotherapeutic one. The bottom line is this: The ego needs all the help it can get. We can all benefit from getting over ourselves.

  One

  RIGHT VIEW

  Not long after the meditation retreat in which I questioned my advice not given, several of my patients, independently, asked if I would teach them to meditate. I was a bit taken aback by the synchronicity of it all. At least three people in rapid succession made the request. Each wanted to spend a fraction of their therapeutic hour in contemplation and each wanted me to guide them through it. I was happy to comply, although I did wonder if they were trying to avoid telling me something. But I decided to take their requests at face value and give it my best. In offering them meditation instruction, however, I found that it was necessary to speak clearly about Right View. Otherwise, it was too tempting for my patients to turn meditation into just another thing they were failing at.

  Meditation is deceptively simple. There is really nothing to do. We sit still and know we are sitting. The mind wanders off and when we catch it wandering we use it as a reminder to continue paying attention. Right View asks us to remember why we are attempting such a peculiar thing. Much of our lives is spent thinking about the future or ruminating about the past, but this dislocation from the present contributes to an ongoing estrangement and a resulting sense of unease. When we are busy trying to manage our lives, our focus on past and future removes us from all we really have, which is the here and now. The Buddha had the rather paradoxical insight that it is difficult to remain comfortably in the moment because we are afraid of uncertainty and change. The present is not static, after all; it is constantly in motion and we can never be absolutely certain about what the next instant will bring. Past and future preoccupy us because we are trying to control things, while being in the present necessitates openness to the unexpected. Rather than resisting change by dwelling in the relative safety of our routine thoughts, as we tend to do in our regular lives, when meditating we practice going with the flow. We surrender to impermanence when we meditate. Wherever it may lead.

  If we are doing concentration meditation, we try to restrict the attention to a single object like the breath. When the mind wanders, and we notice it wandering, we bring awareness back to the
breath without berating ourselves. If we are doing mindfulness meditation, we try to be aware of things as they shift. When we are sitting, we know we are sitting, but when we are thinking we are aware of that, too. We might notice the sensations of the breath or the physical sensations of the body or the feelings of the mind or the act of thinking itself. The mind jumps around and we follow where it goes. Or we try. When it gets out of control, when we are lost in thought or caught up in emotion and unable to be mindfully aware, there is always an instant when we realize we are not paying attention. At that moment, we bring ourselves back to something simple like the breath and begin again.

  Over time, the mind becomes accustomed to this way of paying attention. It learns how to settle back and accommodate. Leaving itself alone, it nevertheless stays present with whatever is going on as it is changing. And a kind of clarity emerges. Like adjusting a radio dial, you know when the signal is right. The mind tunes in to its own frequency and begins to resonate. For a long time there is only distraction, but then suddenly, with no warning, it shifts and things come into focus. It is something like those Where’s Waldo? books we looked at with our children when they were young. Waldo, in his red-and-white-striped shirt, Dr. Seuss hat, and glasses, is camouflaged in densely illustrated crowds that are spread out across two big pages. At first, it is impossible to find him: there is simply too much going on. But gradually, one learns to relax one’s gaze and the figures begin to emerge. Out of all the cacophony, suddenly—there’s Waldo!

  Like looking at the picture book, meditation can be focused or it can be relaxed. It is even capable of being both at the same time. The mind can be at one with itself, humming along, soft, clear, and deep, and also able to catch a sudden movement: a bird’s wing in flight, an internal craving, the rustle of the wind, or the specific features of a character like Waldo. The mind is capable of so much. When we put it into a neutral gear, as happens in meditation, it does not shut down; it opens. It relaxes into itself while somehow maintaining its subjectivity, its critical ability, and its independence. Meditation is training in looking to the mind. Sometimes, inexplicably, it settles down quickly and makes meditation seem easy, but at other times it refuses to cooperate and gives umpteen reasons why the whole effort seems ridiculous. We have to both trust and mistrust the mind, often at the same time. This takes practice.