Tuesday, December 31, 2013

5 New Year Resolutions Worth Keeping

At the end of every year, we do the same old song and dance. Hours of TV on which celebrity did what, slept with who, went to rehab, got into a fight, married, divorced, had a kid. Who lived, who died, all smushed alongside the most memorable videos of the year. This year I'm sure will be filled with the likes of Miley Cyrus, Duck Dynasty and a host of other characters I would be embarrassed to explain if I was every abducted by aliens.

And then there's the shallow media hype of the mythical New Year's Resolution. You're supposed to wake up January 1st to a new you, start shedding those holiday pounds, quit smoking and do otherwise obviously healthy behaviors on the endless list of shoulds. Some of you will stick to your plans. Some will become sidelined and fall into the familiar embrace of guilt and shame at the end of this year, only to repeat the cycle until life hits you over the head with a sledgehammer as to why these healthy behaviors were a good idea in the first place.

Here's my advice to you on what would help all of us. Some of it has a research-base, others are just common sense I've picked up from the past 15 years of end-of-life care. It's a good idea to have these as general lifestyle choices, not just for the first few months of the year.

1) Seriously, exercise. It's the best medicine. Start out slow. Your goal should be about 20-30 minutes of moderate exercise 3-4 times a week. This is the therapeutic dose that has positive effects on your heart, mind and emotions. More is fine, less is not as good. If you don't exercise, see a doctor first to make sure you don't have cardiomyopathy or something like that. Don't wait.

2) That meditation practice you've heard and read so much about? Guess what? It really works. You'll be hearing more and more about it this year. Stick to it. Spend some time every day meditating. The therapeutic dose is about 20 minutes twice a day. Few people can do that if they haven't sat down to meditate before. You can find some guidance here on how to get started. You have time for all the stress and worry in your life, you might as well squeeze some stress management into it.

3) Say "I love you" to everyone you love more often. Say it every day. Love is powerful, way more powerful than any of our individuality. When you're in a hard emotional place, a loving companion, be it a spouse, partner, child, friend or parent can usually make it all better just by being there. If you don't have direct companionship, use social media. Reach out and get connected.

4) Listen to music. Turn on music every day. Use it in the background. It can structure times of great stress and uncertainty. If you're grieving, it's a much more wholesome way to drown out the silence of your home than the jarring sounds of television.

5) Laugh every day. Find something funny to read, watch or listen to. In all the commotion about self-care, laughter is often left out. The best way to transcend hardship sometimes is to laugh at the absurd predicament we're all in. Emotional pain isn't funny-- what's funny is the nearly comical way we go about our lives, obsessed with what turn out to be the tiniest, most insignificant details. We lose the big picture. Can't find something to laugh about? Here's a start.

The most important thing to remember about your resolutions: you're more likely to stick to them if they are about what you want to do rather than what you don't want to do.

Tuesday, December 10, 2013

Seven Tips from the Edge

For the past 15 years, several hours of each work day for me involves seeing the world from the perspective of someone who is dying. I don't know exactly how it is or what it is in me that chose to do this for a living, but I feel very strongly it's a big part of what I was put on this planet to do with the life I have.

It's not for everyone to do, and I don't think it makes me all that special. I can assure you that when my car makes a funny noise, I'm clueless as to what to do about it and glad that there's a mechanic who is doing what he or she was put on this planet to do, and fix my car. I can't do that. That makes the mechanic way more special to me. I need my car.

I've written elsewhere that recently for an 18 month stretch, I knew a steady stream of 2 or 3 people who died every week. I knew some of these people for days, others for years. That streak got interrupted for a few weeks, but seems to have returned in its brutal predictability.

Being in such close and regular contact with death, of having people gravely ill, dying, frozen in fear or radiating peace, them and their loved ones asking me what this whole gig we call existence is about... Roshi Joan Halifax refers to this space as an "edge state", way out on the horizon where the known and the unknown meet. I believe this horizon is what the existentialists refer to as "absurdity", the quest for relevance and meaning in an otherwise indifferent world that cares little for our individual existence.

Out on this edge of absurdity, I've had these flashes of insight lately as I go about my day that the whole gig is a giant inkblot. We see patterns where there maybe are none, we see images where they may be only empty space, we impose rules where chaos reigns, we see connection when we are really flying alone by the seat of our pants. And it's probably okay to do that.

Our intelligence and capacity for insight gives us choices in what patterns we see, what decisions we make, which rules of the game we choose to abide by. For many of us, religion saves us time and effort, offering us a template of guidance. For many of us, we find our own way.

For all of us, I think the most important facts to keep in mind are these:

1) None of us are fully in control of anything, no matter how much power, wealth, fame or status we accumulate. Pink Floyd sang it best years ago, "all the iron turns to rust, all the proud men turn to dust."
2) The whole inkblot nature of reality does not make violent or mean behavior acceptable. On the contrary, we should treat each other, and all life, lovingly, as we would lost and scared children that showed up at our door. That's really what we all are-- lost animals trying to find our way into the comfort of each other.
3) We waste a lot of energy doing stupid things to keep the crushing absurdity of being alive out of sight. Rather than focus on self-destructive vices like gambling and drugs to indulge our insatiable appetites for fleeting pleasures, we should bear mindful witness to fleeting moments of awe that surround us every day that go un-noticed. We're often too lost in our internal chatter to notice awe, to the point where we often can't dwell in awe.
4) Respect the body. See #3. Our choices should nurture our meat suits, not destroy them. We don't have our body for as long as we would like. It begins to age and fall apart just when you're getting used to it. Don't grease the wheels towards achiness.
5) Find what soothes you that is healthy, and what soothes those around you that is healthy. Create opportunities for soothing regularly. We're all lost children, we want security blankets. There's nothing wrong with that.
6) Structure the ambiguity of our absurd existence with self-disciplined progress towards goals. Exercise, meditation, healthy eating and sleep hygiene form a powerhouse of security and inner resources to ride through waves of suffering and anxiety. I've written about this extensively in my books. You actually have to do these things, though, not just read about them.
7) Live a life that others would want to grieve. This sounds strange to our pleasure driven society, but grief is often a sign that you got close to people, that people got close to you. Grief is healthy, and it's essential. Live a life that people would want to celebrate after you leave. You might not know how to do it now, but if you embrace absurdity with love, you're probably going to find out how.

Thursday, November 14, 2013

Six tips for getting through the holidays with grief

The holidays are coming again. Before you know it, they'll be here.
There's an assumption that this is a joyful time of year. If you've suffered a loss, this is one of the hardest times of year. Most of the people I've worked with over the years find that no matter when their loss occurred, the spiral path of grief tends to circle back to very difficult emotions around the holidays. The holidays have taught me there are few straight lines in grief, and even fewer finish lines. The holidays can feel like a big setback.
Even though you may be having a very hard time now, there's nothing wrong with you because of it, and you're probably not moving backwards through your grief. The anticipation of memories can feel very intimidating, like a giant emotional buzzsaw waiting at the end of the year, spinning madly as you helplessly move closer into it.
The holidays are stressful under even ideal circumstances. In the context of grief, they can feel absolutely terrifying. There's not much you can do to skip them, so you might as well find a way to get through them as healthy as you can. Grief sometimes feels like a battlefield; the holidays are grief's bootcamp. The goal of getting through this time of year is to not only endure but to grow into a sense of resilience.
Here are six tips to help you make that happen:
1) The path of least resistance is to isolate and write off the day, as if pretending the holidays aren't happening will make them go away. This usually doesn't work. Try and make plans to be around supportive people, or at least go to supportive places, either in person or online. This may mean avoiding the mall. Make these plans in advance so you don't wake up on the morning of a holiday occasion with no idea what to do.
2) Manage the stress with exercise. The holidays are stress. Sometimes it's a good stress, but often in grief it's a really heavy, nasty stress. Burn off the stress with exercise. Walk, swim, get on a treadmill. Use whatever form of exercise you can use safely, but do something. Use your gym membership if you have one. The holidays are the one time of year it's really important to get into an exercise routine of at least 20-30 minutes, 3-4 times a week. This is the researched dose for emotional well-being. It takes a while to kick in, so get started now.
3) Manage the stress with nutrition. The holidays bring a host of potentially awful food choices. Fruitcake, cookie baskets, endless buckets of candy litter most work places. You don't have to eat this stuff cause it's there. Stress eating is a ticking time-bomb waiting to go off and devastate your health. Remember, the holidays are a stressful time of year, so the rules are different. It's very important to make healthier choices, not self-destructive ones. Comfort foods should help you feel resilient, not tired and cranky.
4) Manage the stress with meditation. Even if you don't meditate the rest of the year, it's so important to establish and maintain a meditation routine these final months of the year. Remember, the rules are different-- it's the holidays. You need to step up to the challenge by sitting down and watching your breath. Mindfulness can help keep you from being swallowed up by the pain to watching the pain. It's a subtle but huge difference, and well worth the effort.
5) Do not belittle or judge yourself for being in pain. The holidays bring back so many memories, so many wishes. This is natural. It happens to just about everyone this time of year. This pain may feel massive, so big and so intense that it can't possibly be normal. And yet it is. This suffering has been with us forever, and it will be with us forever. We are human beings, and thank goodness we feel hardship when we lose people we love. Grief often doesn't have stages, the holidays are clear reminders of this. Cry if you need to. Take long showers if you're around family, they can't hear you cry in there very easily.
6) Set goals for the coming year. What do you want to do after you get through the holidays? It can help to have something else to look forward to so you can be distracted from holiday pain.

Wednesday, October 30, 2013

Buddhism and Grief, or Why I Write

A couple of months ago I was giving a workshop based on my first book, Grieving Mindfully. The book is based on the practice of mindfulness and draws heavily from Buddhist teachings and approaches to suffering. It's by no means a "Buddhist" book, and I've come to learn over the years that atheists and churches have all used it with benefit.

One of the participants at this particular workshop shared a story. They were at a teaching being given by a Buddhist lama in the Tibetan tradition. A distraught attendee had recently lost a spouse and asked the lama how they should manage their grief. The response they received in this moment of pain was something to the effect of "your spouse is dead, there's no sense thinking about them. Move on."


Two thoughts came to my mind. The first was a story I recount in the book of a woman whose baby dies. She goes to see the Buddha to ask him to bring the baby back to life and thereby end her grief. The Buddha agrees, on the condition that she brings him a mustard seed from a house death has never visited. She goes all over town, unable to find such a house. With the realization of the universal nature of grief, she takes comfort in meditation, takes refuge with the Buddha and ultimately (according to legend) becomes fully enlightened. This is a very different approach than what this lama said. The Buddha has this woman meet the entire city at their common pressure point-- loss. She must have heard hundreds of stories of loss, been given comfort by others feeling her pain, and comforted others suffering her same pain. Quite different from being told there's no sense in thinking about her baby anymore, or to just get over it.

The second thought I had was a reminder, it's generally a good idea not to ask lamas for advice on relationships, especially marital advice or issues related to grief. They don't participate in family life. The comment the lama made was a reminder of this. It would have been more helpful for the lama to say "look, I have no idea what that kind of pain is like. It sounds absolutely awful. You should ask someone who is trained in this. I can teach you to meditate, maybe that will help."

Thankfully the participant who shared this story was commenting that a mindfulness-based approach to grief, one that trains people to endure the ups and downs of emotional pain, seems much more compassionate than the advice the lama gave. This isn't meant to put down the lama at all, but to point out how diverse Buddhism is and what a wide range of approaches all belief systems have to grief. I've heard variations of the lama story many times over the years. I am glad to contribute a small piece to counter-balance what I think of as an unhelpful attitude towards grief, be it from Buddhism or popular culture-- you suffer for a little while, but then you'd better dust yourself off and move on. It's the same unrealistic and simplistic advice many of my cancer patients get-- think positive and you're as good as cured.

I wish!

The truth is much, much more complicated. The science tells us that roughly one third of us do seem to dust ourselves off and "move on", whatever that means. The rest of us have a very different experience. For another third of people who experience grief, some very intense emotions show up for a very long time. It's for this population that I write, and this population that needs all the tools they can get. It's not a sign of any weakness or deficiency to suffer for a long time after loss. And not everyone agrees on what "too long" is. I think grief carries a potential that can be harnessed, sometimes deliberately, sometimes by accident. Like the grieving mother who goes to the Buddha, grief can carry us forward into some very, very dark places, but also-- often unexpectedly--become a catalyst for growth.

My new book comes out in a couple of days. I hope it helps steer readers towards that kind of growth.

Wednesday, October 23, 2013

Lessons From Last Week

No one I know died last week.

That's a relief. A week like that hasn't happened since April 2012. For the past 18 months, I've known two or three people every week who've died of cancer. I had known some of them for months, even years. Some I met just before they died.

All of them have touched me deeply. I can only hope that my presence was beneficial to them and their loved ones.

This is part of what I do for a living. I'm a clinical psychologist. My specialty is in working with people who have cancer and their caregivers. Make no mistake, the vast majority of people who have cancer-- an increasing percentage of the population every year-- do very well, and live on for years without the disease. I get to see many of these people put their lives back together or build on the already strong foundations they have spent a lifetime constructing.

I've been doing this for 15 years. I know I've helped a lot of people at some awful times in their lives. Frequently it's been at the worst time of their lives, and we mutually look forward to the day it becomes a distant memory. All too often, we navigate the mystery space between the known and the unknown, as Roshi Joan Halifax so eloquently puts it, the slippery transition between living and dying.  This means illuminating the bureaucratic and spiritual paths that carry all of us away from this life. 

I would be remiss though in saying I haven't benefited from the experience myself. It's not completely accurate to think of this as a job or a career, although it certainly is that. I think of it more as service.

I can't say I recommend this line of work for everyone. Most people react sanely when they find out what I do. Typically, there's an awkward pause. Then, "wow, isn't that depressing?".

You know what? It's really not. I get to see resilience. I get to see grace. I get to fight for dignity. I get to reduce suffering without the naïve assumption that any of us are exempt from our own mortality. I also get forced into a hyper-acute awareness of how important self-care is for any caregiver, professional or personal. I often get inspiration from reading about warrior cultures past and present, the punishing training regimens that Spartans would embark on, feats of agility and endurance practiced by Mongols and Comanches, or tales of superhuman resolve during more recent combat missions.

In order to serve the ill and dying, I find I do a better job if I'm in perpetual training mode in every way I can. I try to train in the way of our ancient warrior ancestors-- I run in sandals as they did, work out with kettle bells and a mace as they did in the ancient gladiator training camps, meditate twice a day. I eat a lot of plants. Very few jobs raise the stakes so high. Too many of us wait until we realize how high the stakes are to take care of ourselves.

Once in a while, when a week like the one that just passed rolls along, I get to pause and take stock. My work requires training, focus and intention. So does living. So does dying.

Life is constant training for the unknown. Don't wait till the bell rings to announce the next round to get in shape. Don't pack your bags at the airport.

Train now for the unexpected.

Thursday, October 10, 2013

Thoughts on Mindfulness

You hear more and more about mindfulness meditation.

The word "mindfulness" is getting very over-used. It makes writing a blog about mindfulness kind of awkward to do, much less write books about. Mindfulness is very, very old, but it seems that it's gone through some predictable and repetitive cycles in its spread across cultures and time. A couple of nights ago I was reading Miyamoto Musashi's "Book of Five Rings" when I came across this quote: "The field of martial arts is particularly rife with flamboyant showmanship, with commercial popularization and profiteering on the part of those who teach the science and those who study it. The result of this must be, as someone said, that amateuristic martial arts are a source of serious wounds."

That was written back in 1643. The same can be said of meditation in general and mindfulness in particular. The word is over-used. It's become something of a status symbol among the spiritual elite. Surely you must have trained with so-and-so, done this-and-that, etc. What winds up happening is that too many people feel like they can't anywhere in the practice without the proper "credentials". But there is no substitute for a daily practice. Plenty of people have spent hours of one-on-one time with some very famous and gifted teachers and walked away without any change in their meditation practice- or lack of.

You don't have to go to India or some exotic location. It all starts with your breath wherever you are.

What happens when "unconditional, present-centered awareness", as Jon Kabat-Zinn calls it, becomes commodified? I recently came across a headline that said something like "mindfulness can make you more money". In the words of Tony Montana, "is that what it's all about?" Is that what the Buddha taught? A marketing tool? A researcher has recently sparked controversy by assembling a study of mindfulness among military personnel. While this heal their pain or make them more efficient, focused killers?

The truth is, our culture and our time are not new to these sorts of questions. The context of mindfulness has not always been the pristine monastery in a tranquil countryside. Even in the Buddha's own time, brutal war and genocidal conflicts raged all around him. So did charlatans, con artists and frauds. During his many frequent travels, he often returned to a place he had been before and found the local populace practicing a degenerated form of his teachings under the spell of a charismatic teacher.

This has all happened before, and I believe the antidote stays the same. The goal of any mindfulness practice must be compassion towards self and other and service towards those less fortunate and suffering. This comes about by being simply present. Don't bother with showmanship-- learn the instructions, then just practice, practice, and practice. There will always be someone who has practiced longer than you, with more famous people, in more exotic locations. There will always be those whose altars and meditation areas are just perfect, those who have really spiffy meditation accessories, and those whose libraries are more interesting.

None of this matters.

These are all distractions. Mindfulness is not meant for pristine conditions. The Buddha practiced in clothes other people had discarded alongside dusty roads under frankly miserable conditions. Pabonka Rinpoche once told a story about an old lady who learned the mantra "Om mani padme hum" wrong. Yet she repeated it unceasingly, meditating on compassion. She was enlightened even though she got the words wrong due to her motivation, intention and practice.

So never mind the hype. Practice, practice, and practice some more. Just breathe.