Advice Not Given

by Mark Epstein

  In Buddhism, there are said to be four “divine” states of mind: kindness, compassion, sympathetic joy, and equanimity. The “divine” properties are present to various degrees in all people, but they emerge in accentuated form in meditation, almost as a by-product, as people learn to relate to their egos in a new way. It is here that we can apply the analogy to athletes finding “the flow” when they learn to get out of their own way. When self-centered preoccupations quiet down, these more “selfless” feelings come to the fore.

  Ancient texts compare kindness, compassion, sympathetic joy, and equanimity to the feelings a mother has for four sons: “a child, an invalid, one in the flush of youth, and one busy with his own affairs.” Kindness is what a mother naturally feels for her young child, compassion is what she feels when her child is ill, sympathetic joy arises when she sees him thriving in the glory of his youth, and equanimity is what she knows when her child is grown and taking care of him- or herself. The Buddhist texts are nothing if not sexist in the preeminence they give to the mother-son relationship. But the metaphors are still apt in the present day—no matter how parent-child gender relationships are now configured.

  As we worked together, Debby began to notice variations of these empathic feelings every time she saw, and parted from, her grown children. Having acknowledged her anxiety and named her unworthiness, these other feelings became more visible. The intensity of these “divine” emotions made her uncomfortable, however. She was not practiced in tolerating such strong emotions. Her tendency was to shut them down, whatever they were, and this kept her, to return to the Buddha’s metaphor, slightly out of tune. Right Effort for Debby, in the context of all this, meant making more room for her “divine” feelings while not judging herself so harshly for her anxiety. In a very important way, she was able to make the therapeutic attention I offered her an instrument of her own psyche. Without a formal knowledge of meditation, Debby nevertheless came to know one of its major fruits. By not letting her anxiety intimidate or define her, she gained access to the array of connected feelings—kindness, compassion, sympathetic joy, and equanimity—that had been, up to that point, confusing her.

  Therapy is a compelling tool of Right Effort. A skilled therapist can tell when patients are acting out an emotion but not really feeling it, when they are pushing away a feeling rather than acknowledging it, or when they are numbing themselves to escape from something that feels overwhelming. Right Effort seeks to create a context in which learned habits of indulging or denying feelings can be divested. These habits are the equivalents of stringing the lute too tightly or too loosely. Too tight is like the rigidity of people chronically clamping down on their feelings. Too loose is like giving feelings free rein, assuming that because we feel them they are “true” and must be taken seriously. Right Effort is an attempt to find balance in the midst of all this. From a therapeutic point of view, it means trusting that an inherent wisdom can emerge when we avoid the two extremes. This wisdom, or clear comprehension, is the emotional equivalent of a therapist’s evenly suspended attention. Buddha believed that this emotional equilibrium was possible for everyone. Feelings are confusing but they also make sense. A therapist’s job is to help bring this equilibrium into awareness. There is a wonderful sound when it dawns.

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  Right Effort, while it often counsels restraint, has also encouraged me to be myself with my patients. There is ample room, I have found, within the posture of evenly suspended attention, to interact in a natural way without artificially hiding behind the role of the therapist. This does not mean that I speak everything that comes into my head, but it does mean that I give myself the freedom to trust my intuition and take some risks in what I say. This is clear in recent work with another patient, a talented and resourceful woman named Martha, whom I have seen intermittently since before she and her husband had a son twenty-five years ago. I had not seen Martha for quite some time when she called out of the blue and asked if she could come for a session. I assumed we were meeting for the therapy equivalent of a routine checkup, but things did not go as I had expected. One thing I have learned in doing this work: no matter how well you think you know someone, they can always surprise you.

  Martha had just become a grandmother. Her son’s girlfriend had gotten pregnant and the young couple had kept their child. I figured this was the reason for her visit, but she was nothing but smiles about the baby when I saw her. Something else must be going on, I thought; Martha seemed a little too cheerful. Was she compensating for something she was uncomfortable about, maybe something in her marriage? I waited and then took a chance. Silence was not my first choice on this occasion.

  “Are you and Chad still having sex?” I asked her.

  “Just the other day,” she said with a smile, a hint of pride in her voice. Her face fell for just a moment, though. “Chad was happy. I was just as glad when we were finished.”

  I looked at her questioningly. Martha was never shy about sex. She was a dancer who had subsequently worked as a bartender, an organic gardener, and a landscaper. She was comfortable with men and with her body. She was flirtatious in an easygoing and street-smart way. I always enjoyed it when she came to see me.

  “I never really go to the doctor,” she said.

  I wasn’t sure at first what she was talking about; her comment seemed a bit like a non sequitur. But after a moment I guessed what she might be implying.

  “The gynecologist, you mean?” I asked her. “Do you have one you like?”

  “I have a name on a piece of paper,” she said. “I know where it is. . . . This is so embarrassing.”

  I was puzzled at Martha’s sudden bashfulness. It was definitely out of character.

  “Maybe some estrogen cream?” I wondered out loud. “You don’t take any hormones, right?”

  She nodded her assent and I said something more about how some women, postmenopause, find the cream to be useful if they are sexually active. Martha listened but at the same time seemed to be batting my comments away. Some kind of nervousness had entered the picture and I did not understand. It was time for me to wait. She changed the subject.

  “I’m doing the eighth step,” she said, referring to Alcoholics Anonymous. “You know the steps? I tried to make amends with my cousin and I couldn’t. I don’t know why. It was just a little thing. He had given me some papers to hand out when we were young and I threw them away but I lied and told him I had done what he asked. But when I tried to talk to him about it recently I couldn’t.”

  I barely understood what she was talking about. Papers to hand out? Her cousin? What? I asked something about her cousin. He wasn’t a big character in my mind; I hadn’t really even remembered that she had a cousin who lived with her family. He was just a year older than she was, she reminded me.

  “I told you about this once,” she said. “When I was eleven, he started crawling into bed with me. A few years ago he brought it up. ‘I’m sorry for petting you when we were young,’ he said. I hate that way of talking. ‘Petting you.’”

  Martha’s face grew hard. I had only the faintest glimmer of her ever having mentioned this to me and asked her more.

  “What do you remember?”

  Martha remembered two incidents but thought that there might have been more. She remembered her cousin coming into her bed and she remembered waking up with him on top of her. And she remembered that her father, an alcohol-loving Irishman she adored and was very close to until these events, was never the same with her afterward.

  “My cousin said my father caught him and put a stop to it,” she said. “I was the best little girl before all of this. I wanted to be a nun. It was me and the nuns. In the next couple of years I was completely wild.”

  “How wild?” I wanted to know, and she told me how she once took three hits of mescaline without thinking and ended up in the middle of a highway flagging down a tractor-trailer that she got into and tried
to steal. She did indeed sound pretty wild, even for 1968.

  But the crux of Martha’s story, despite the lurid details, lay in the way she had interpreted her father’s withdrawal. In her mind, the shame she felt (and could barely acknowledge) around her cousin’s molestation of her explained her father’s rejection of her.

  “In his mind I was some kind of whore,” she said.

  I wasn’t so sure. Catholic fathers of his generation (indeed, most fathers of his generation) often moved away from their daughters when they became teenagers, finding it difficult to maintain closeness when their children started to become women. They were scared, I think, and retreated, leaving the girls under the auspices of the mother. I suggested to Martha that her father might have become more distant when she was a teenager anyway, that he was not necessarily blaming her for what had gone on between her and her cousin. He had stopped her cousin from molesting her, after all. He had at least done something to protect her once he knew what was happening. I was quite insistent in my comments.

  “Dr. Mark!” she exclaimed with obvious relief. “This is why you get the big bucks.”

  Some lifting of Martha’s shame took place in this session, some reequilibration of her self-esteem. Her lack of ease going to the gynecologist, her discomfort in the talk of sex, the ickiness she felt about her cousin’s use of the word “petting,” and the indignity she harbored about her sexuality all led up to the way she blamed herself for the loss of closeness with her father. Talking about it threw her into a state of uncertainty, and this uncertainty was good. Maybe she was not to blame. Maybe even the events with her cousin, as pivotal as they were in her psychosexual development, were not to blame. Maybe things were going in this direction anyway. There was no way Martha was going to stay aligned with the nuns once the 1960s and ’70s hit, and little chance that the childhood connection with her father could weather her adolescence. That was not necessarily her fault, nor was it so clearly a direct casualty of her cousin’s unwarranted advances.

  But Martha’s reticence at talking about her sexual abuse is characteristic of such things. I have seen people who speak of it only after years and years of coming to therapy. It took real effort for her to overcome her bashfulness and even broach the subject. I am sure she was not planning on talking about it, but something in the session allowed her to trust the impulse. Once the conversation began, many of her preconceptions came into view. Did Martha really have to blame herself for her cousin’s advances? Did her father’s emotional distance actually mean he thought she was a whore? Could she be like Springsteen and take what was good from her father and leave the rest and thereby honor her relationship with him rather than continuing to live in fear or self-reproach? In a certain way, Martha’s self-concept was conditioned—and determined—by her cousin’s unwanted sexual advances. Her self-image was stuck in that tumultuous adolescent time—it was masquerading as herself. Right Effort allowed me, in the midst of my doctorly banter, to listen to the spontaneous associations of her session and share my thoughts. Martha considered what I said to her and relaxed a contraction that had hardened over time, keeping her feeling bad about herself and cut off from the reality of her father’s love. Martha’s willingness to unburden herself, to examine and then let go of her long-held convictions, was what allowed her to move on. Her exuberant cry of “Dr. Mark!” indeed had a wonderful sound.

  Right Effort is not only helpful in the psychotherapy office. It is relevant in any situation in which strong emotions or habits threaten to carry people away. It takes a different kind of effort to go to an AA meeting or call one’s sponsor than it does to take a drink, for example. It takes a different energy to restrain oneself from saying something nasty than it does to lose one’s temper. And it takes a more concerted strength to remain quiet around one’s adolescent child than it does to give repeated advice when it is clearly not welcome. Right Effort suggests that it is possible, and often desirable, to gain control over one’s ego’s impulses. The precondition for this is the ability we all have, however underutilized, to observe our own minds.

  A friend of mine, a sculptor I have known for many years named Sam, told me a personal story about his struggle to give therapeutic attention to his mind. We were at the opening of his new upstate studio. He had just finished building it on a vacant lot he had purchased after selling a building he had bought years ago when artists could buy cheap commercial real estate in Brooklyn. He had almost been unable to build his studio, however, because his next-door neighbor, a longtime resident of the community, had objected to the construction and brought the full force of the town’s zoning board down on him. In a desperate, but very smart, move, Sam had hired an elderly local attorney to argue his case in court. Sam was a fighter by nature. He reminded me of my maternal grandfather and his brothers, amateur Cleveland boxers who smuggled liquor from Canada across frozen Lake Superior during Prohibition winters. He assumed that with the help of his attorney, he would vanquish his foe. Truth would prevail.

  His lawyer, however, had a different strategy in mind. He was an intelligent man and he knew how things worked in his town.

  “Sam,” he said, “you are going to kiss ass.”

  When Sam told me this story, I laughed and laughed. Imagining him having to kiss ass was just so funny. It was the last thing in the world he would ever consider doing.

  “Aren’t I paying you?” Sam demanded of his lawyer, bristling at his advice. “Can’t you be the one kissing ass?”

  “No,” the attorney said. “It has to be you. And when we are in court,” he continued, “until it is time for you to speak, you are going to shut up.”

  Sam was unable to keep himself quiet during the proceedings, but every time he opened his mouth his wife dug her fingernails into his arm and his attorney reminded him very loudly to hold his tongue. He had meetings behind the scenes with his neighbor in which he was as deferential and respectful as he could be. The strategy worked. The neighbor was appeased and Sam got to build his studio.

  “It was the hardest thing I’ve ever done,” Sam told me.

  Right Effort, in Sam’s case, did not have anything to do with expressing his true feelings, however in the right Sam felt himself to be. Right Effort meant listening to his lawyer and restraining his need for victory. It meant being quiet even though he had something to say, letting go even though he knew he was right. Sam’s attorney was as wise as any psychiatrist, Buddhist or otherwise, could hope to be. A peace treaty was better than a war.

  Seven

  RIGHT MINDFULNESS

  Mindfulness is the aspect of the Eightfold Path that has received the most attention in the West. It is the distinctive attentional strategy of Buddhism and has found acceptance in a variety of fields ranging from business to basketball to psychotherapy. Rather than restricting one’s attention one-pointedly to a single object of awareness as in most other forms of meditation, mindfulness encourages a dispassionate knowing of thoughts, feelings, memories, emotions, and physical sensations as they come and go in the mind and body. The general idea is that it is possible to empower the observing self so that one does not have to be swayed by habits and impulses or taken over by one’s inner critic. One learns to dwell in an enlivened awareness rather than being hijacked, sidetracked, or seduced by the usual array of thoughts and feelings.

  What is not usually emphasized in the excitement over mindfulness in the West is that, from a Buddhist perspective, mindfulness is an introductory technique. It is an entry-level practice whose purpose is to open doors to insight. Contrary to many people’s preconceptions, being mindful is not the be-all and end-all of meditation. The Buddha, in a famous parable, compared it to a raft made of grass, sticks, and leaves that helps someone cross a great water. “What should be done with the raft once you have gotten across?” he asked rhetorically. “Should you carry it with you for the rest of your life or put it down by the side of the riverbank?” In making this co
mparison, he was trying to stop people from becoming overly attached to his method. While his warning was powerful, it has not prevented many over the years from fetishizing their technique.

  The trick to Right Mindfulness is not to turn it into another method of self-improvement. As with Right Effort, it is possible to try too hard and override the subtlety and simplicity of what mindfulness is. In the traditional Buddhist texts, mindfulness is compared to a cowherd who, at first, has to be actively involved in corralling his flock in order to protect his newly planted crops from being devoured. After the crops have been harvested, however, the cowherd can sit in the shade and rest, maybe watch with one eye open, barely doing a thing. His cows have only to stay within the perimeter of his awareness; there is no longer any danger to the produce that has been brought indoors. If he is too enamored of his role as cowherd, however, or if he has an immature view of what it involves, he might continue to poke and pester his animals, agitating them unnecessarily. Right Mindfulness is similar. At the beginning, one has to actively deal with the distracted mind, paying attention whenever it wanders in order not to be carried away by its usual inclinations. After a time, however, mindfulness is just there. It becomes second nature. It sees the distractions but does not get swept up in them. That is why the comparison to the cowherd who rests under a tree is so apt. Mindfulness, once established, continues on its own steam. It hacks into the mind to see what is there, and, out of this self-observation, interesting, unexpected, and sometimes uncomfortable things can emerge.