Discovering Mindfulness
When the Buddha realized that everything we experience and cherish is subject to impermanence, his whole world was shaken and he went into a deep malaise. Eventually, his teachings would center on the universal tendency of the mind to crave permanence and its inability to tolerate empty space. But first, the shock he experienced in coming face-to-face with the eventualities he would experience in old age, sickness, and death, along with his anticipatory grief about what was to come, drove him away from his sheltered life and into the company of wild, renunciant ascetics. For several years he wandered in their company, homeless, dressed in found rags, and undergoing increasingly severe austerities to transcend the limitations of his body and mind.
However, despite these efforts he only found himself emaciated, near death, and no more centered or at peace than when he started his journey. He was living on one hemp seed a day when he decided that punishing his body wasn’t going to help him address the mystery of suffering.
Cast out of the company of his fellow ascetics for accepting a bowl of rice pudding from a passing maiden, the Buddha journeyed into a forest clearing and sat down to meditate, vowing not to get up until he was dead or had found the answers he was looking for.
We don’t know exactly what he did as he sat. What we do know is that afterward he told his followers to practice mindfulness meditation. Over the years, he taught this practice to a variety of people, including kings, queens, peasants, priests, monks, nuns, soldiers, scholars, merchants, and even a serial killer. Those who wanted to ease their suffering were encouraged to test the practice out and see if it worked for them.
This tradition has continued unbroken in several Asian countries. It is now becoming increasingly popular throughout the world. In my own work, I’ve found that the practice of mindfulness meditation can benefit people experiencing a variety of emotional conditions.
The twenty-first century has dawned with a tremendous amount of scientific validation for the form of meditation the Buddha taught. We don’t have to just hope that mindfulness might help us. We can now say with absolute certainty, validated by well-designed research studies with hundreds if not thousands of participants, that mindfulness meditation, when practiced properly, can alleviate depression and ease anxiety (see, for example, Hoffman et al. 2010). However, please note that some of the research suggests the ideal time to learn mindfulness is after an acute depressive episode has passed. Therefore, if you’re feeling profoundly depressed, it’s probably best to first improve your symptoms of depression in other ways, such as with therapy and possibly medication.
Current research also indicates that the practice of mindfulness meditation can ease mental suffering due to PTSD (Kearney et al. 2012). In addition, mindfulness has been proven tremendously helpful for people suffering from generalized anxiety disorder (Roemer, Orsillo, and Salters-Pedneault 2008).
As discussed in chapter 1, these conditions—major depression, PTSD, and generalized anxiety—frequently co-occur with grief and prolonged grief. Because mindfulness is so effective in alleviating these types of mental and emotional suffering, I believe it holds particular promise in helping you in your grief, and my clinical experience affirms this. Over the years, I’ve taught mindfulness meditation to hundreds of people experiencing the emotional pain of grief in its many forms. Grief may come from the shock of being diagnosed with a life-threatening illness and saying good-bye to assumptions about enjoying good health and long life. Often grief is about the impending loss of one’s own life and having to say good-bye to all relationships. And as in your case, grief may arise from the profound pain of loss of a loved one.
One of the amazing things about mindfulness is that no matter what you’re feeling or how grief comes into your life, the practice remains the same. Many of the tools in this book rely on your commitment to beginning and cultivating a daily mindfulness practice. All of the research evidence indicates that people who practice this technique for twenty to forty minutes twice a day experience tremendous improvement in their mental health, and in many cases physical health, after about eight weeks. If you stop practicing after eight weeks, the benefits may persist for far longer (Carlson et al. 2007). However, in my experience, very few people stop practicing mindfulness meditation after they begin to notice how much they’re benefiting from it.
At this point in your own journey with grief, you are undoubtedly well acquainted with how stressful grief is, emotionally, physically, mentally, and spiritually. Thankfully, mindfulness seems to be particularly helpful in easing the stress of acutely painful emotions such as grief.
Where Stress Comes From
Your distant ancestor, roaming the savannas of Africa, leaves her cave to forage for plants, fruit, and maybe some bugs with other members of her tribe. It’s a beautiful day, and she’s hungry. The sky is blue, and there’s a gentle breeze in the air. Suddenly, as the wind changes direction, the scent of a lion fills her nose. The scent is strong; the lion is close. She drops everything and, along with the others, runs as fast as she can. Her body is used to having to do this. She’s fast on her feet. She arrives at the safety of the cave. In the heart of the cave, which only others in her tribe can reach, she is safe. Finding food will have to wait until another day.
All of our ancestors had to live with these constant threats. As a result, the human body developed to be able to deal with such threats. To this day, the human body is wired to process stress as if it were a physical threat, like being chased by a wild animal. It automatically goes through changes that help it run to safety or fight off an attacker: the fight-or-flight reflex. This is why distressing emotional states feel so stressful. They are all processed in our bodies as if they signal imminent physical danger. The characteristics of the fight-or-flight stress response are probably familiar feelings for you:
Dry mouth
Pounding heart
Nausea, loss of appetite, or diarrhea
Shortness of breath
Cold fingers or toes
Sweating
Trembling or shaking
Racing thoughts
These changes all help our bodies run away from danger, into the safety of a cave or up a tree. It’s much more efficient to run with empty bowels, so nausea, loss of appetite, or diarrhea frequently accompany stress. It’s also much more efficient to run at high speed if you aren’t overheated, and sweating and shortness of breath both help with this. In the event that you don’t outrun the danger, it’s much safer to keep your blood within your torso; that way if you’re wounded in an arm or leg, you won’t bleed to death. That’s why your extremities get cold as your blood flow to your extremities decreases. And if you’re stressed-out a lot, there’s another symptom you may be familiar with: weight gain. When faced with chronic stress, your body assumes you’re in a dangerous environment and don’t know where your next meal is coming from. You begin to crave fatty, sugary foods, and your body changes its metabolism to store energy as fat, especially belly fat, to help you survive until you get to a safer environment.
Before you become frustrated with your body, remember that this stress response has kept our species thriving for hundreds of thousands of years. It is our survival instinct. If you experienced a trauma as part of your loss, you are probably keenly aware of your fight-or-flight reflex. Even now, it’s trying to keep you alive, but it might be getting in the way of living. Although you don’t need any special training to turn it on—it is, after all, instinct—turning it off is another matter.
This is where the steady practice of mindfulness comes in. Although your body will always be wired for survival, over time mindfulness practice can gradually help your body react less intensely and less frequently to emotional distress. I believe that once you do this, your mind will follow. I am often struck by how much easier it is to train our bodies than it is to train our minds.
Mindfulness requires some effort. It requires motivation to want to feel better, or at least to relate to
the pain of your loss differently. This doesn’t mean ignoring or trivializing your pain. Instead, mindfulness offers you tools to withstand the pain by managing the stress that comes with it.
Basics of Mindfulness Meditation Practice
Diaphragmatic breathing, or belly breathing, is a cornerstone of mindfulness meditation and of many of the practices in this book. This breathing technique is how the body naturally breathes in states of deep relaxation, deep sleep, and endurance exercise, such as distance running. If you’ve ever been trained to sing or play a wind instrument, you may already know how to do this. Belly breathing is a much more relaxing and efficient way to breathe. In fact, I believe that as the practice of mindfulness meditation grows and becomes part of who you are, you will begin to do belly breathing more and more often, maybe even always.
practice: Belly Breathing
Although belly breathing can come naturally, people under chronic stress usually need to devote some focus to learning how to breathe in this way. For mindfulness practice, you’ll eventually be sitting down. However, initially it may be hard for you to get the feeling of how to belly breathe while sitting down, so you may need to practice while lying down to get started. Here are some basic instructions in how to belly breathe.
Maintain good alignment in your spine, keeping it mostly straight but allowing the slight natural curves. Be careful not to arch your back or tense your shoulders. Relax into good posture. If you’re lying down, try to maintain a still, well-aligned spine.
Put one hand on your belly and the other on your chest.
Imagine that there’s a balloon in your belly. To inhale, inflate the balloon. To exhale, deflate the balloon.
Your belly should rise as you inhale and fall as you exhale.
Practice belly breathing for about five minutes. For most people under chronic stress, belly breathing feels strange if done for too long. It can feel as though you’re not getting enough air since you’re using totally different muscles to breathe. Your body may need some time to adjust to this breathing technique, which is meant to turn down your stress.
As you practice, notice where your body rises and falls as you breathe by looking at which of your hands is moving. Most of us assume that because our lungs are in our chest, our chest should be doing all the work. This is somewhat true.
Your lungs process air, but it’s really the diaphragm, a thin membrane of muscle between your lungs and your belly, that does the work of breathing. You may assume that breathing is automatic, something you do without thinking about it. Although this is certainly true, how you breathe and where in your body the breath originates can have a profound effect on your mood.
Benefits of Belly Breathing
When you experience stress, your body automatically tries to deal with it by engaging in the fight-or-flight reflex. Your body prepares itself to run away from the threat as fast as it can because it still assumes any stress you experience is a physical threat, such as an attacking animal. Part of the fight-or-flight response is shallow breathing, only into the chest, with the breaths pumped quickly in and out as you would do if you needed to sprint.
Belly breathing is the opposite of this type of breathing. Because your body automatically does belly breathing when it’s relaxed or running long distances at a more leisurely pace, you can trick your body into reducing its stress response simply by changing how it is breathing.
If you’re still struggling with belly breathing, don’t worry. Keep reading to learn the basic mindfulness meditation practice. With time, your body will probably adapt and begin belly breathing naturally as your practice matures and you get more familiar with it.
practice: Using Cues for Belly Breathing
Once you get comfortable with belly breathing, check in with your breathing throughout the day to make sure you’re breathing in this way. I use cues that naturally arise in different parts of my day to make sure I’m belly breathing. For example, whenever I’m getting into an elevator at the hospital where I work, I use it as a reminder to check in with my breath. Likewise, whenever I walk into a patient’s room, I always make sure that I’m belly breathing and as relaxed as I can be; otherwise I won’t be of much help to the people I’m seeing.
Here is a list of common cues that I’ve recommended people use to check in with their breathing throughout the day:
Waiting at a red light or stop sign
Getting into a car
Walking into your home
Waiting for an elevator
Waiting in line at the grocery store
Sitting in a doctor’s or dentist’s waiting room
Entering a place of worship
If there are other things you do regularly that could serve as cues to check in with your breathing, please write them into the space below to remind you to use them. These can be any ordinary tasks you do, but also things that you find especially stressful or that seem like a waste of time:
___________
Normally, we take these sorts of moments for granted. By using ordinary activities as cues to check in with your breath multiple times a day, you can easily and effectively transform your daily routines, making them much more relaxed and energizing.
practice: Mindfulness Meditation
To begin your practice of formal mindfulness meditation, start by finding a quiet place to sit. Make sure your phone, television, and other potentially distracting devices are turned off. Eventually, you’ll be able to take your practice anywhere and sustain the evidence-based recommendation of practicing for twenty to forty minutes twice daily. But in the beginning, to get acquainted with the technique and your own unique challenges with it, I recommend a quiet space away from excessive noise or stimulation. Practice this technique as often as you can, perhaps for five minutes at a time, until you feel more comfortable with it.
The following guidelines form the foundation of mindfulness meditation practice:
Wherever you sit, make sure your knees are below your hips. This will make it easier on your lower back and hips. If you’re sitting on a chair or bed, you may wish to use the edge of it so your hips don’t sink into the seat. A meditation cushion may help, but it is by no means necessary.
Maintain an erect posture as much as you can, but do so gently. With good posture, your spine should have some slight curves and shouldn’t be tense or tight. Gently maintain a dignified posture.
Rest your hands together in your lap. Traditional meditation posture is having your hands resting palms up, one on top of the other, thumbs gently touching.
Gently touch the tip of your tongue to the roof of your mouth.
Keep your eyes focused on an object or on the space an arm’s length in front of you. Maintaining your eyes on a fixed location will help align your spine, neck, and head and will also help you realize when your mind is wandering.
Maintain awareness of your breath. I recommend doing this by counting your exhalations. As you exhale the first breath, count silently in your mind “one.” With the next exhalation, count silently in your mind “two.” With the next breath, count “three,” and so on.
Your mind will wander, and you will lose count. This is expected. When it happens, simply bring your attention back to your breath and start over, counting from “one” again. Bringing your mind back to awareness of the breath is, in fact, the essence of mindfulness.
You might think you’re supposed to be able to keep your focus exclusively on the breath. You may even have heard that you’re supposed to “empty your mind” or “clear your mind.” Don’t pay attention to these myths. Mindfulness meditation isn’t about having an empty or clear mind; it’s about being aware of where your mind is while being aware of your breath. Your mind may not be quiet, clear, or still. Perfect awareness isn’t the same as perfect thoughts or even right thoughts. Thoughts are thoughts; feelings are feelings. Be mindful of whatever they are. Notice them unconditionally. Your awareness is like the sun in the sky, and your thoughts and feelings are clouds. Observ
e them without judgment, unconditionally.
Also, don’t expect yourself to be able to practice for twenty minutes right away. Very few people can. I find that, for most people, five minutes is as much as they can do when they start their practice. This is fine. Start with five minutes. Then work your way up to ten minutes. Eventually, you’ll get up to twenty minutes, perhaps longer. You can use a clock, alarm clock, timer, or one of the many apps available for smartphones and tablet computers to alert you when time is up.
When to Practice
Because of your loss, your life may feel completely disrupted. Your routines may be upended, disorganized, and scattered. When people hear the recommendation to practice mindfulness meditation twice a day, for twenty to forty minutes per session, the typical response is along the lines of “I don’t have time for that!” However, I think it’s important to recognize that you don’t have time for emotional pain, either, but it seems to fit into your schedule. The sorts of things that can help people feel better somehow seem to be much more negotiable than suffering.
On the other hand, you may have an abundance of empty time in your daily schedule. A mindfulness meditation practice can help fill some of this time, as can some of the other practices recommended in this book. If you have too much flexibility in your schedule, a mindfulness practice can help set anchor points for how you organize your time.
Traditionally, it was recommended that meditation be practiced fairly early in the day. This doesn’t mean getting up at a ridiculously early hour to practice. Rather, the first session of the day should be in the early part of your schedule, however that may look. Personally, I like to have my first session before I leave for work in the morning. Ideally, this first session should occur before you leave your home, so you can bring some of the effects of your meditation practice into the activities you do during the rest of the day.
Mindfulness for Prolonged Grief Page 4