Advice Not Given

by Mark Epstein

  I have long been sensitive to how easy it is to become fixated on mindfulness. The ego cannot help but try to co-opt the process. Early Buddhist texts warn of this danger. Some amount of striving is important at the beginning, but a shepherd who is too actively trying to control his flock can sabotage the entire effort. “With excessive thinking and pondering I might tire my body, and when the body is tired, the mind becomes disturbed, and when the mind is disturbed, it is far from concentration,” reads an ancient discourse entitled “Two Kinds of Thought.”

  When I apprenticed with the Dalai Lama’s Tibetan physician while on a research grant in India during my final year of medical school, I learned of a whole class of anxiety disorders unknown at the time in the West. I had done a number of silent retreats by this point and was well aware of how anxious some people become when trying to quiet their minds. I was able to spend about six weeks with the Dalai Lama’s physician, and, knowing that I was heading to a career in psychiatry, I was eager to find out whether this kind of nervousness happened in Buddhist cultures as well as in our own. It turns out that meditation-induced anxiety is very familiar to Buddhist monks and was well cataloged in medieval Tibetan medical texts. Meditators who try too hard to be mindful make themselves agitated and depressed. Their minds rear up like angry horses determined not to be brought under control by their riders. Instead of lightness of being, forced meditation brings only anxiety and a grim determination to proceed no matter what. Tibetan doctors have such afflicted patients do simple tasks like sweeping the temple halls or chopping vegetables in the kitchen rather than prescribing more meditation. They know that the treatment for meditation-induced anxiety disorders is less meditation, not more.

  The wisdom of the Tibetan physicians is important to keep in mind as mindfulness takes root in the West. Much of our culture is built on striving, and many people have trouble leaving this mind-set behind. The very word “mindfulness” tends to encourage this overly aggressive approach. It can sound admonishing at times, carrying with it the injunction, “Be Mindful!” There is a ring of the Protestant ethic to it. This is not accidental. First used in an English translation of a Buddhist text in 1881 at the height of the British colonization of South Asia, the term “mindfulness” came into general acceptance in the Western world thereafter. But the term is a Western invention. The original word in the language of the Buddha’s time was sati. Sati means remembering. Right Mindfulness—or Right Sati—means remembering to keep an eye on oneself. Its opposite is forgetting—or absentmindedness—the kind of forgetting that happens all of the time when one is lost in thought. The distinctive quality of mindfulness is that it remembers. Once established in the mind, it remembers itself. A clearer description of what is meant by sati might be presence of mind.

  I was reminded of this when lecturing in Oklahoma City about the relevance of the Buddhist approach for the treatment of trauma. There was surprising interest in the clinical applications of mindfulness there. A big veterans’ hospital with many patients with post-traumatic stress disorder was nearby and its staff was open to new approaches to its treatment. One of the counselors at my talk was a fifty-year-old man with a long white ponytail. He came up to me at a break; I had only a second to form an impression of him. A large, healthy-looking man, he was wearing a long-sleeved white shirt open at the collar. He was well put together, stood up straight, and had a very confident demeanor. I could see him driving a pickup truck.

  “You know,” he confided, “I never use the word ‘mindfulness’ with a man in Oklahoma. People just don’t like the sound of it.”

  “What do you say to them instead, then?” I inquired. I thought maybe he had figured out a whole new vocabulary.

  “I just tell them, ‘Go outside and close the door. Stand there and listen.’ That’s enough.”

  His comment went to the heart of Right Mindfulness. Rather than reducing it to another therapeutic modality handed out by the mental health authorities, his recommendation hinted at what is most compelling about it: the possibility of discovering something unexpected by paying relaxed attention to one’s everyday world. By letting his initial instructions be about dropping one’s guard and opening one’s senses, this therapist was heading off a very common misunderstanding. While it is true that we spend much of our time needlessly dwelling in thoughts of the past or the future, the ability to stay focused in the present does not, by itself, guarantee any kind of personal transformation. Being in the moment is pleasant enough, but it is just a jumping-off place. I have encountered many people who, in making mindfulness their ultimate goal, congratulate themselves on being able to keep their attention on their breath or in the soles of their feet for extended periods of time, as if such abilities, by themselves, make them a better person. A friend of mine confided that he tries to stay mindful when eating dinner with his wife, for example, but that this did not seem to lessen the tension between them. I pointed out that he would do better to engage her in conversation rather than hiding behind mindfulness as if it were the newspaper. He saw my point, but it had not occurred to him on his own.

  Right Mindfulness opens up interesting opportunities for honest self-reflection, but there is no built-in guarantee that these openings will be used productively. The self does not give up its grip easily—all of the same defense mechanisms that Freud outlined are still operative even when mindfulness is strong. It is possible to overvalue mindfulness, to remain attached to its form rather than working directly with what it reveals. That is why the intervention of the therapist in Oklahoma was so skillful. Rather than dwelling on the method, he was trying to inculcate a state of mind.

  I have tried to remember this with my own patients. Instead of teaching mindfulness to them directly, I have preferred to create an interpersonal environment in which they can listen in a new way, trusting that this mode of listening is what allows insights to come. I want the visit to my office to be like going outside and closing the door. I want it to offer a fresh perspective on things without my having to give overly specific advice or guidance. Even in therapy, people are stubbornly lost in their thoughts and imprisoned within the stories they repeat to themselves. They try to use therapy the way many people try to use meditation: powering through to get to an imagined place of cure. Right Mindfulness, like a successful psychotherapy, slows people down. It pokes holes in the facades we unwittingly hide behind. When we stand outside and listen, we have a chance to eavesdrop on the ego’s endlessly obsessive self-preoccupation. With the senses aroused in a new way—if people are willing—they can step outside of themselves as well.

  —

  A chance encounter at a dinner party on the eve of Rosh Hashanah while I was writing this book drove this point home. Toward the end of the evening, I was talking with a retired attorney in his early sixties who had finished a successful career representing and running insurance companies. He was smart, engaging, and voluble. I liked him, but I did not think he would be particularly interested in my work. I told him a bit about the book I was writing, and about how for a long time I had been wary of giving overt Buddhist advice to my patients. When he heard about my Buddhist leanings, he surprised me by telling me how he had twice been to Massachusetts for intensive workshops in mindfulness-based stress reduction. These workshops, modeled after the retreats I was familiar with but stripped of their Buddhist language and theory, had helped him a lot, he said. He did not know much about Buddhism, but the practice of mindfulness, as he had been taught, had already been of great benefit to him.

  I told him how impressed I was that he had given mindfulness a chance. To me, it was a sign of how it was infiltrating the popular consciousness and losing some of its esoteric aura. The fact that an Upper East Side attorney in the first flush of his retirement was seeking out mindfulness rather than golf said something of its new level of acceptance.

  I actually knew a lot about the program he had been to. It was begun by an old friend of mine, Jon Kaba
t-Zinn, who had been a fellow student on the first meditation retreat I had ever been to back in 1974. I remembered his heavy black hiking boots gliding back and forth over an outdoor stretch of ground as we did our walking meditations together. Even then, Jon, who had a graduate degree in molecular biology from MIT, was conscious of how alienating Buddhist language or concepts might be for people in the West. In developing his program at the University of Massachusetts Medical Center not long after this retreat, he presented mindfulness as a strategy of stress reduction rather than as a branch of the Eightfold Path. Jon surprised everyone at the medical center. His patients responded to the treatment. Workshops like the one my new friend had attended sprouted up throughout the country.

  “Let me tell you a story,” the attorney interrupted. “Here’s what happened to me there.

  “In the midst of my second workshop in one of those nondescript hotels outside Boston, after a couple of days of mostly silent meditation, I was coming downstairs for a small-group discussion one morning, and as I was opening the door I heard a voice. No one from the outside world was talking to me, though; the voice was coming from inside my head.

  “‘It’s time to forgive your mother,’ the voice said.

  “I have never heard voices,” the lawyer assured me with a smile. “This was the only time anything like this has ever happened to me.

  “My mother had been dead for fifteen years, but she was one of those super controlling, intrusive Germanic mothers who knew me better than I knew myself and used her knowledge to get inside and manipulate me. There was no escape from her when I was young and my self-confidence was terribly undermined. I did a lot of therapy in my thirties but I remained angry with her and mad at my father, whom I blamed for not standing up to her and protecting me. Even at my father’s seventy-fifth birthday, when I gave a speech (which I am very good at) praising his accomplishments, I was conscious of how false I was being and it made me sad and uncomfortable.

  “But when I heard the voice saying it was time to forgive her, I knew it was right. Mindfulness had shown me I could.”

  I was very moved by the lawyer’s account. There was something incredibly affirming about it. An Upper East Side attorney learning a hospital-based mindfulness technique in a generic Massachusetts hotel conference center had a life-changing spiritual and psychological experience. He had heard a voice, but he was not insane. He had gone outside of his usual routines and stopped and listened and heard something unexpected. And he was able to let go of one of the long-standing pillars of his identity, his resentment at his domineering mother. His reporting was so sincere and refreshing, I could feel how light the forgiving of his mother had made him. Mindfulness, even when abstracted from its original Buddhist context, had surprised and opened him. Where had the voice come from? How could it be explained? What did attention to the moment have to do with forgiving his mother? There is mystery to Right Mindfulness even when it is experienced in a Marriott ballroom.

  Often, as mindfulness has become a technique of stress management, it is presented in such a way as to emphasize its rational, objective, and scientific precision. While it certainly has this dimension, there is more to it than that. While mindfulness encourages a clear-eyed view of oneself and one’s direct sensory experience, it also has a hidden agenda. Its mission is to put the ego into perspective so that empathy is no longer obstructed. The insights it encourages all head in this direction. In the ancient teachings, these insights are framed around basic principles like impermanence. How can we stay attached to things in the same way when we directly perceive that everything is constantly changing? Why cling to wealth, sex, pleasure, or opinions when one understands that nothing lasts? While it does not necessarily make the painful aspects of impermanence welcome—the Buddha did not call old age, sickness, separation, and death suffering for no reason—it does help people become more accepting of that which they cannot control. Mindfulness brings transience into the foreground; it makes it incontrovertible. It gives a ringside seat on something we all know to be true but do our best to ignore. There is no escaping impermanence when practicing mindfulness. Resistance, as they say, is futile.

  In confronting people with the reality of impermanence, mindfulness also acts as an agent of change. This is where its hidden agenda becomes relevant. In rubbing up against the underlying fabric of impermanence, in seeing it in both the outside world and the inside of the mind, one thing becomes increasingly apparent. Muttering under our breath is a grown-up version of the child we used to be, and one of its main refrains seems to be something on the order of, “What about me?” This self-important—and vociferously insecure—internal cry is a superficial manifestation of our most primal attempt to both control and avoid the way things are. As infants, we are lucky if there is one person in the world—our mother—who treats us as though we are the center of the universe. But even if we are given this essential luxury, it cannot last. Disillusionment comes quickly. While one’s internal protests and manipulations are generally not successful, they do not necessarily go away. As the self develops, the need to maximize the feeling of self-importance persists. There are competing demands, of course—we are social creatures and selfish motivations are not the only ones we are capable of—but even very well-adjusted people harbor a self-centeredness that becomes obvious once one pays attention to the mind. Right Mindfulness takes great delight in bringing this self-centeredness to the surface. Egotism starts to feel painful and one discovers that one can step away from it. In a world in which nothing is as fixed as it seems, it comes as a great relief to discover that even the ego is impermanent. One’s defensive posture does not have to be etched in stone.

  Forgiving of one’s mother does not show up on the traditional list of liberating insights, but if the list were being compiled in this day and age it would be near the top. Classical descriptions of mindfulness are derived from a tradition thousands of years old, but there are no reliable first-person accounts of the inner life of a person in the Buddha’s time to refer to. We are living in a different time and culture from the Buddha’s. Personal psychology is a reality for us. Insights, when they come now, while rooted in the reality of impermanence, are often of a psychological and emotional nature. The unfolding of mindfulness, while often presented as an orderly process, is different for everyone. Those who are not attuned to this truth risk missing out. The psychological aspect of Right Mindfulness is essential to a real appreciation of it.

  Developing mindfulness is like learning to ride a bicycle or walk a tightrope, only much more frustrating. One keeps falling, even after years and years of effort. Right Mindfulness means having a light touch. It means being able to forgive yourself, time after time, while at the same time not giving in to your worst impulses. I remember being in Colorado one summer with Jack Kornfield, who had already had years of intensive meditation experience. Jack came to dinner on his birthday after spending the day in meditation, cursing himself for not being able to follow his breath for any substantial time that day.

  “Even on my birthday!” I remember him complaining ruefully.

  There was a hint of self-mockery in his comments, but he was serious. I was touched by his honesty. It helped me with my own practice, with my own tendency to be unforgiving. It helped me understand that Right Mindfulness means being willing to bring the mind back whenever one notices that it has wandered. It is the ability to bring the mind back, to let go of one’s personal commentary, that is the real accomplishment. Thinking selfishly is one of the things the mind does best; even when it becomes very still, this tendency is still latent. But the ego does not have to define us, any more than my friend’s resentment at his mother needed to define him. One reason he was able to forgive her was because, in learning mindfulness, he had practiced forgiving himself over and over again.

  —

  I have experienced my own version of this throughout the course of my involvement with mindfulness. Since my ear
ly twenties I have been practicing in a series of silent retreats of several weeks’ duration. These retreats limit the amount of outside stimulation and distraction and are structured so that it is possible to make every basic activity—from walking, eating, and sitting, to caring for one’s bodily functions—an opportunity for mindful attention. As difficult as this can be for the first several days—the mind rebels and wants to go its own way—after a while the act of remembering becomes more natural. One’s self-awareness grows, or expands, so that one feels in tune with one’s surroundings, present and very alive. Awareness, which we generally take for granted and which is usually transparent or invisible, starts to become something intriguing in its own right. At times it seems to glow. While thoughts, memories, and associations still continue unabated, one is less likely to be swept away for long periods of time by them. It is much more intriguing, and pleasurable, to abide in the unfolding present than to slip back into habitual trains of thought.

  These retreats have almost always been interesting, even though, when one tries to talk about them, they sound rather boring. From one perspective, almost nothing to speak of happens. The day comes and goes. Meals are served. The sounds of nature fill the meditation hall. People sit on their cushions, shift, cough and stretch, or walk slowly back and forth in a straight line, eyes downcast, going nowhere. No one makes eye contact or speaks. But from another perspective, there is a lot going on, much of it personal and psychological in content.

  On my most recent retreat, for example, I had the vivid sensation, some days into it, of my name imprisoning me. It is difficult to describe the actual feeling because it took place in an instant and reverberated in several directions at once.