by Mark Epstein
“I don’t have to feel guilty that I’m not over it?” she asked. “It took ten years after my first husband died,” she remembered suddenly, thinking back to her college sweetheart, to his sudden death from a heart condition when she was in her mid-twenties, a few years before she met my father. “I guess I could give myself a break.”
I never knew about my mother’s first husband until I was playing Scrabble one day when I was ten or eleven and opened her weather-beaten copy of Webster’s Dictionary to look up a word. There, on the inside of the front cover, in her handwriting, was her name inscribed in black ink. Only it wasn’t her current name (and it wasn’t her maiden name)—it was another, unfamiliar name, not Sherrie Epstein but Sherrie Steinbach: an alternative version of my mother at once entirely familiar (in her distinctive hand) and utterly alien.
“What’s this?” I remember asking her, holding up the faded blue dictionary, and the story came tumbling out. It was rarely spoken of thereafter, at least until my father died half a century later, at which point my mother began to bring it up, this time of her own volition. I’m not sure that the pain of her first husband’s death had ever completely disappeared; it seemed to be surfacing again in the context of my father’s death.
I had just finished writing a book about trauma when this conversation took place and I felt a real serendipity to its timing. Trauma is not just the result of major disasters. It does not happen to only some people. An undercurrent of it runs through ordinary life, shot through as it is with the poignancy of impermanence. I like to say that if we are not suffering from post-traumatic stress disorder, we are suffering from pre-traumatic stress disorder. There is no way to be alive without being conscious of the potential for disaster. One way or another, death (and its cousins: old age, illness, accidents, separation, and loss) hangs over all of us. Nobody is immune.
My response to my mother—that trauma never goes away completely—points to something I have learned through my years as a psychiatrist. In resisting suffering and in defending ourselves from feeling its full impact, we deprive ourselves of its truth. As a therapist, I can testify to how difficult it can be to acknowledge one’s distress and to admit one’s vulnerability. It is much easier to fall into whatever chronic story we have been telling ourselves than it is to stay with our experience. My mother’s knee-jerk reaction, “Shouldn’t I be over this by now?” is very common. There is a rush to normal that closes us off, not only to the depth of our own suffering, but also, as a consequence, to the suffering of others.
When disasters strike, we may have an immediate empathic response, but underneath we are often conditioned to believe that “normal” is where we should all be. The victims of the Paris terrorist attacks, the Boston Marathon bombings, or the Orlando nightclub massacre will take years to recover. Soldiers returning from war carry their battlefield experiences within. Can we, as a community, keep these people in our hearts for years? Or will we move on, the way the father of one of my friends expected his five-year-old son—my friend—to move on after his mother killed herself, telling him one morning that she was gone and never mentioning her again?
In 1969, after working with terminally ill patients, the Swiss psychiatrist Elisabeth Kübler-Ross brought the trauma of death out of the closet with the publication of On Death and Dying. Her five-stage model of grief—denial, anger, bargaining, depression, and acceptance—was radical at the time. It made death a normal topic of conversation, but had the inadvertent effect of making people feel, as my mother did, that grief was something to do right.
Mourning has no timetable. Grief is not the same for everyone. And it does not necessarily go away. The healthiest way to deal with it is to lean into it, rather than try to keep it at bay. In the attempt to fit in, to be normal, we end up feeling estranged.
I was surprised when my mother mentioned that it had taken her ten years to recover from her first husband’s death. That would have made me six or seven, I thought to myself, by the time she began to feel better. My father, while a compassionate physician, had not wanted to deal with my mother’s former marriage. When she married him, she gave the photographs of her previous wedding to her sister to hold for her. I never knew about them or thought to ask about them, but after my father died, my mother was suddenly very open about this hidden period in her life. It had been lying in wait, rarely spoken of, for sixty years.
My mother was putting herself under the same pressure in dealing with my father’s death as she had when her first husband had died. The earlier loss was conditioning the later one, and the difficulties were only getting compounded. I was glad to be a psychiatrist and grateful for my Buddhist inclinations when speaking with her. I could offer her something beyond the blandishments of the rush to normal.
The willingness to face traumas—be they large, small, primitive, or fresh—is the key to healing from them. They do not disappear in five stages, but maybe they do not need to. As Sharon was reminded in her initial embrace of Buddhism, and as Beckett so gloriously expressed, suffering is an ineradicable aspect of life. We are human as a result of suffering, not in spite of it.
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Right Speech, in my interpretation, asks us to pay attention to how we talk to ourselves about this inevitable aspect of life, how we exaggerate its implications. So often, within the privacy of our inner worlds, we take the difficult thing and make it worse. Our own subliminal hate speech coats our experience and gives an added layer of meaning to things that are already difficult enough. Right Speech says this is unnecessary. Self-criticism may still arise—old patterns do not just disappear in an instant—but one’s stance in relationship to one’s inner critic can change. When one learns to observe the addictive and self-perpetuating nature of many of our thoughts, their dominance diminishes. Right Speech takes the sting out of them by bringing awareness to the foreground. Refreshed by this discovery, the mind senses relief. My mother’s questioning, “I don’t have to feel guilty about this?” is typical of this shift. Her conclusion, “I guess I could give myself a break,” describes the freedom that is possible. As a therapist, I have been trained to pay careful attention to the words people use in such utterances. Phrases like my mother’s “I guess” often slip in without the person being conscious of it and telegraph hesitancy or doubt. Were my mother my patient, I would push on it a little. I might ask her to repeat her sentence but drop the “I guess,” for example, to see if she really could give herself a break. But enough was enough. I held my tongue. Even Right Speech has its limits.
Four
RIGHT ACTION
Samuel Beckett’s refusal to be intimidated by his depression was very Buddhist. Rather than directing his energy toward getting rid of his dark side, he found a way to let it inspire him. This is the key connection between Right Speech and Right Action. Both involve mobilizing the power of restraint. Before his revelation, Beckett was like a person new to therapy hoping to get rid of whatever was troubling him. After his realization, he was operating on another level. No longer trying to eliminate a part of himself, and no longer propelled by a false image of perfection, he was able to modify his expectations while probing more deeply into himself, ultimately using his explorations for the purposes of making art.
Right Action classically means not acting destructively. Killing, stealing, hurtful sexual activity, and intoxication “to the point of heedlessness” form the nucleus of the traditional ethical prohibitions. Monks take vows about these kinds of things, and these vows confer a double benefit. They protect the community by instilling a strong and shared moral code, and they protect the individual from the internal disquiet that such actions bring in their wake. Buddhism seeks mental ease. If one’s actions create dis-ease, they are obviously counterproductive.
But not acting impulsively is not the same as doing nothing. Think of the difference between eating compulsively and preparing a real meal. In the former, there is a blur that often leaves a feeling
of disgust in its wake. Large quantities of food are ingested, but there is often little attention to its taste. In the latter, there is restraint but no lack of activity. Right Action means shopping for the proper ingredients, chopping the vegetables, making the meal, and setting the table. An enormous amount of restraint is required even while there is much to be done. Postponing the ego’s need for immediate gratification is the core principle of this aspect of the Eightfold Path.
Psychotherapy is fertile terrain for the deployment of Right Action. Because people come to therapy in all kinds of distress with hope for immediate relief, the burden on the therapist is significant. It is wonderful when there is a pill I can give that will quickly alleviate someone’s symptoms, but this is the case only a fraction of the time. When I cannot help someone immediately, I have to wait. I have to stop my anxiety, my need to assist, from interfering with the treatment. Therapy is often a long, slow process that centers on building a trusting relationship. As trust develops, there is more and more room for me to act—or speak or relate—provocatively: in a manner that hopefully upsets my patients’ preconceived ideas about their problems. This involves edging people gently into discomfort and away from their fixed, and often exaggerated, notions of what is wrong with them. It involves getting them to question stories they have been telling themselves for a very long time. “Acceptance of not knowing,” wrote Winnicott, “produces tremendous relief.”
This is one of the most exciting aspects of being a therapist, although there are many countervailing forces within the field that seek to tamp down its improvisational nature and replace it with one that is more circumscribed and operational, in which a therapist follows a prescribed plan of action from the start. Right Action encourages therapists not to let their wishes for cure interfere with the treatment, not to let their professionalism become a defense, but to use the rapport that is possible when people trust each other as a therapeutic tool. It is easy to see how the ethical restraint of Right Action dovetails with this. If a therapist takes sexual advantage of his or her patients, for example, the freedom and trust enabled by the relationship are immediately shut down. But it is not just in such grossly violating ways that therapists can undermine their treatments. If they are too focused on being right, too insistent that their advice be adhered to, they run the risk of short-circuiting the help they are trying to give.
When I am able to use Right Action to capture my patients’ interest, there is a potential for change. Old patterns can be exposed and new possibilities can emerge. The history of Buddhism is replete with examples of teachers using such trust to undermine students’ restrictive notions of who they are supposed to be. Psychotherapy is not far behind. When we can help people see their repetitive thoughts as mere thoughts rather than as true stories, there is a whiff of freedom. Our narratives need not be as sure of themselves as we have led ourselves to believe. The more we examine them in an open way, the less convinced we tend to be about them.
While Right Action can help therapists with their own perfectionism, it can also be extremely useful on the patient side. Above all else, people want to know what they can do to feel better. This is, for me, where Right Action is most helpful. Many people who are drawn to Buddhism—and many who come for therapy—think that the answer lies in letting go. “Teach me to let go,” they ask. “If I learn to meditate properly, will that help me?” Their most common assumption is that letting go means giving up the thing that is bothering them. If they are angry with someone, they tell themselves to let go of their anger. If they are anxious, they try to let go of their anxiety. If they are having disturbing thoughts, they endeavor to dispatch them. If they are sad and upset with themselves, they try to surrender their unhappy feelings.
But letting go does not mean releasing the thing that is bothering you. Trying to get rid of it only makes it stronger. Letting go has more to do with patience than it does with release. There is a difference in direction, in valence, and in spin from how we commonly think of it. There is a famous phrase in Japanese Buddhism that tries to explain this. “Learn the backward step that turns your light inward to illuminate your self,” it suggests. Then “body and mind of themselves will drop away, and your original face will be manifest.” This backward step is another way of describing Right Action. You settle into yourself rather than trying to make the troubling thing go away. If anything drops away, it does so by itself. You cannot make it happen directly.
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In working with my patients, I have found this basic approach to be extremely helpful. When people come for the first time, it is rare that they can explain exactly what the problem is. Often, they do not know, or if they think they know, it doesn’t make complete sense.
“Why, when I see a pretty girl coming down the street, do I have fantasies of strangling her?” one seventy-year-old man asks me, deeply upset at his own mind, tormented by these unwelcome, disturbing, and uninvited thoughts. “Why, when you say something helpful to me, do I have images of sucking your balls?”
Such sentences are not uttered easily; there is much anxiety bound up in these obsessive, uncomfortable, unwanted, and usually unspoken thoughts. Ralph is worried that he will not be able to control his actions, that his impulses will get the better of him, although he has never acted on any of his obsessional thoughts. It is a big deal that these thoughts are being spoken and confessed, but do I know why they are happening? Is there a magic word I can say that will relieve him of his torment and make them go away? I encourage his free associations. Perhaps we can find the childhood links that gave such obsessive thoughts their life. Or perhaps not. Will doing so make things better? Or is there another way?
Although Ralph’s symptoms are unusual, his bewilderment about them is not. My second therapist, Isadore From, whom I worked with when I began to see patients privately, seemed to know this very well. He would start every one of our sessions with the phrase “What’s with you today, Mark?” I always felt anxious under his gaze, never sure exactly what was with me that day, or what was with him! I asked him once about this opening gambit and he told me, in a forthcoming manner, that he began every session that way, not just the ones with me. He liked it better than the conventional “How are you feeling?” or “How are you doing?” Isadore did not like pleasantries. He liked to play the edge, putting me in touch with my anxiety right away if I could handle it. He knew I would have preferred something a little less jarring, but that would have played into my defenses rather than helping me out of them.
Often, people arrive in therapy living a scripted life that has not gone as planned. Slowly and steadily, through the process of talking things out, they may come to a greater, but still limited, understanding of what is stifling them. Conversations with Ralph yielded many tantalizing sources of his symptoms. Maybe he could not tolerate feeling attracted to younger women. Maybe he feared rejection, sought preemptive revenge on good-looking women, and could only express his aggression in an obsessional way. Or maybe his thoughts were rooted in that time forty years earlier when he got stoned with his girlfriend and suddenly, out of nowhere, staring at the thinness and fragility of her neck, imagined choking her and went running out of the room in fear. Maybe feeling attracted, or grateful, made him dependent in a way he found too threatening. He grew up in a tough part of town and was always picked on by gangs of bigger boys. Too much dependency would have made him even more of a target. Did any of this conjecture make him feel better? Possibly. But the conclusions themselves did not help as much as the open-ended collaborative questioning we engaged in together.
The most useful thing I ever said to Ralph was that he was not looking carefully enough at the pretty women he was passing on the street. He was allowed to look discreetly, I said—that’s what men do. He was choking himself, strangling his instincts, interrupting his looking, and inhibiting his desire. He did something similar with me too, I pointed out. When I said or did something helpful, for which he felt the
stirrings of gratitude, he would disconnect from his feelings with an unwanted sexual thought. The forbidden thought would then become the focus of his attention and he would become preoccupied with trying not to have it again. This became a loop, an obsessional loop that was very difficult to get out of. Trying not to have the thought only made it more pronounced and more threatening.
“What’s really going on with you?” I wondered. “You bring me these strangulated bits of frightening thoughts, but that is not the real you.
“Stay more with your actual experience,” I would say to him in as many different ways as I could muster. “Your breath, your body, what you are actually seeing and feeling. We don’t need to make your symptoms go away; we just need to change the way you relate to them. With less aversion to your thoughts, their hold on you will lessen. You could be less preoccupied and more open to what you are seeing around you.”
I think I was onto something with him. Ralph liked my advice and found it helpful. His thoughts of choking women did not entirely go away, but he found the encouragement, and permission, to look at the women he passed on the street to be surprisingly useful. Instead of focusing so much on his unwanted thoughts, he started to look around.
“Where do you want to look?” I remember asking him.
He was bashful at first at mentioning women’s breasts. Ralph was the kind of person who did not remember faces, who would not notice if there was a change in the decor of a room, who was not attentive to visual cues. There was a visual world, and, I suspected, an emotional and erotic world, he was not living in. He enjoyed the challenge of discreetly returning to his visual field, to the bodies and faces of the women he passed on the street, even when his thoughts intruded; and he found that, as a result, he spent less time dwelling on his obsessional thoughts when they arose. They would still come, but they did not squeeze the life out of him in quite the same way. He began to see his disturbing thoughts as mere thoughts, and not as the last word on his moral fiber.