Enduring the Edge State of COVID-19

We certainly are living through interesting times.

The level of despair and anguish being experienced is like nothing that has happened in decades. For most of us, not in our lifetimes. Urban hospitals all over the world are being converted into mass casualty triage tents previously only used in active combat zones. There is so much uncertainty, anxiety and stress everywhere. It can feel completely overwhelming.

For the past 20 years, I have helped people going through cancer treatment and their loved ones navigate the strange new landscape of uncertainty a life challenging diagnosis can bring. This process is now repeating itself on a planetary scale. The entire world-- billions of people-- have been very quickly taken from the familiar into the unknown. The economic toll is just beginning to be felt, but the human toll is already rippling out all over the world.

It was from Roshi Joan Halifax that I first learned the term "Edge State". This refers to the boundary between the known and the unknown. For all of us, the world we knew is gone. The world that we will make out of this is still to be determined. We are in the in-between-- the Edge. What Tibetan Buddhists call a "bardo".

Edge States are not easy. There are some tips and coping skills that are helpful. But I don't know if they can "solve" the Edge. The Edge is something we have to be at home in, like living in a hut on the lip of a smoldering volcano.

I don't think it's an exaggeration to say that for many of us, certainly all of us in health care, this is a traumatic time. It's a slow motion, serialized trauma that will unfold for weeks, probably months. There is only so much one can do to be ready. Of course, in our happiness based society, the goal is already targeted to be "resilience", but that may be more for economic wishful thinking than for emotional health.

I believe that before we speak of resilience, we have to experience what is happening with the best available tools in our toolkit. What we are experiencing is grief for the world we knew, the people we love who will not survive this experience, perhaps already for so many who have succumbed. We are also grieving the lives we thought we were going to live. We all had plans and roles that have disappeared, crumbled and changed.

How do we experience this in as healthy a way as possible?

My work with people going through cancer treatment, when life becomes a prolonged Edge State, has  taught me a few things:

1) Accept that this is happening. You don't have to be immersed in the news all the time, but stay informed just enough to guide your daily decision making and daily choices.

2) Structure your time. If you are now working from home, or not able to work, set up a schedule. Most humans find safety in routines, even if they are annoying routines. Wake up and go to sleep at the same time. Eat meals at the same time. Exercise if you are able to.

3) Find your breath. Mindfulness has become increasingly popular, but with its popularity have also come a bunch of unfounded claims. I believe that mindfulness is a mind-body technique to improve the human stress response through breath awareness. This may be helfpul to watch. Practice breath awareness as often as you can, especially after watching the news.

4) Try and keep a clear mind. Avoid alcohol and other intoxicants. If you smoke anything, quit. There is growing concern that inhaled smoke in any form makes people more susceptible to increased complications and death from COVID-19.

5) Do the best you can. This is a global pandemic. The world is grieving what it knew. The horrors of this time will be told for years to come. This doesn't need to be the most productive time in your life. You may not make the best decisions every day. The goal is this: be a loving friend to yourself. Treat yourself and others with kindness. That is surprisingly difficult for most of us in a slow moving trauma like we are all experiencing. Do the best you can. That may be hard enough.

My Mother's Story

Three years ago my mother died. Since then I’ve been unable to write anything more than short bursts. These words that she longed to share with the world, that she shared with me, have been stuck inside of me. So now I am sharing them.

These memories should never have been created but they must be spoken.

The story is not my own but what my mother told me for many years on the anniversary of what happened. She never wanted to speak of those days but could never forget them. They were on her mind every day from September 1947 until her sudden death in 2016. A few days before she died, she had visited the Holocaust Memorial in Krakow, Poland. She had broken down there, recollecting the never forgotten but largely unacknowledged pain of Partition.

Her name was Adarsh Kumar. She was raised in Pind Dadan Khan, Jhelum District in the Kapoor family. She created a beautiful life over many decades, but with a pain inside of her from having survived unimaginable horrors. Every September, we would have a havan (Hindu fire ceremony) for her parents and brother who were killed in those days. Not every time, but often, she would sit down with me and tell me of those days before and after Partition. I can still see her now, feel her presence, telling these words that she struggled so hard to say.

Life in undivided India had, for all intents and purposes, come to an end several months before India and Pakistan became independent. Pind Dadan Khan back then was home to Hindus, Muslims and Sikhs. It was deep in Punjab and so many miles from the new border. Their Muslim neighbor, Raja Ghazanfar Ali Khan, was the head of the town. He was a believer in an undivided and diverse post-independence India until the political realities dictated otherwise. He faced opposition from members of the Muslim League and his own household for his views.

My mother tells of growing up in this town where neighbors celebrated every religious holiday together. The Raja would celebrate rakhi with her mother. Rakhi is a ceremony that’s usually only celebrated between brother and sister, but the Raja and my maternal grandmother were close friends.  When the Shia Muslims would walk in bloody processions on Muhurram, my mother and her family would watch from their balconies as they cried out “Hai Hussein!”, in memory of their fallen imam from so long ago. Hindus would celebrate Eid, and Muslims would celebrate Diwali in their neighbors’ houses. They met together in the markets, used the same communal tandoors and washed in the river, together. Everyone was united, various religious communities that were also part of neighborhood communities.

This peace was shattered in February 1947. Someone threw a rag soaked in kerosene into my mother’s house in the middle of the night, when everyone was sleeping and there was a limited water supply. The fire was put out by the family and neighbors, including my mother who was around 10 years old. An uneasy feeling began to spread around the town. There was word of religious strife in other parts of Punjab, but until then Pind Dadan Khan had felt safe. It still felt like home.

In March, as my mother watched from her balcony, a Hindu man came running down their street, bleeding profusely from his head. A Muslim family had arrived from India and moved into the now vacant house next door that had once belonged to a Hindu family that had left to India. The new neighbor decided to use wood from his Hindu neighbor’s roof beams for cooking fuel. When the Hindu neighbor protested, the wood was used to club him. The Raja was enraged that the fire that was burning all over Punjab had now spread to Pind Dadan Khan. As the neighborhood watched, the Raja declared that no Hindus should leave the town, and everyone would have his personal guarantee of safety. “Not a hair on their [Hindus] heads will be touched in Pind Dadan Khan!”.

The most serious blow came shortly afterwards in May. My grandfather’s cousin, Anant Ram Kapoor, was traveling home to Pind Dadan Khan by train and bringing a box of pears and dried fruit. He was harassed by some Muslim youths who began eating the fruit and tossing it off the train. The teasing quickly escalated, and he was stabbed to death, disemboweled right there on the train. The other Hindu passengers could only watch helplessly. His body was then tossed off the train. After his cremation, my mother says that a gloomy atmosphere enveloped the town. It didn’t feel safe. It no longer felt like home. No one knew then what horrors still lay ahead on those train tracks for millions more.

The Kapoor family knew they had to leave. In the summer, someone had dug a hole into their ground floor pantry to rob the house. The ground floor was a pantry and storage area, so it made easy access. Most disturbingly, the hole was made in a common wall that they shared with the Raja. He surely was not responsible, but it was a sign that law and order were deteriorating. Hindus could find no justice in Pakistan. The same was happening across the border in India to Muslims.

By August 14 and 15, when Pakistan and India respectively gained their independence from the British, my mother had family members scattered across the border in Jammu, Pathankot and Delhi. Her parents, herself, and her younger brother and sister were all still in Pind Dadan Khan, awaiting the return of her brother Raj from British military service in Iraq. There was no celebration for Independence. There was anxiety, fear, and a foreboding sense of gloom. They were refugees, and they knew it.

Once her brother returned, they packed up what they could and left their house. While they awaited their chance to board a train, they went to a large refugee camp that had been made near the railroad station in Pind Dadan Khan. This was the same train station they had used so many times to visit the family run coal mining business in Dandot to the west. India, however, was to the east. My mother didn’t speak much about life in that camp. She told me there was a virtual town there. They could only bring  a few things with them—a rolled-up mattress, some bedding, and a few belongings. My mother would navigate the narrow unpaved roads in the camp holding her mother’s hand, bringing food and other supplies to their father and younger siblings.

The evacuation of Hindus and Sikhs from west Punjab and Muslims from east Punjab took many months. At first it was done by trucks, but they were easily stopped and their occupants killed. Fearing the trucks, many chose to flee on foot. This was just as perilous. The next obvious choice was trains. These proved to be even deadlier.

According to another resident of Pind Dadan Khan, the first train for evacuees, that departed on September 20 or so, was filled mostly by Sikhs. No Hindus wanted to board this train because they expected it to be targeted due to the intense animosity and bloodlust flowing between the Muslims and Sikhs of Punjab in those days. My mother’s family was supposed to ride on the train departing September 22, but instead left a day earlier, on September 21.

The steam train arrived at the station and was loaded. The family was told they could not bring any large belongings, only what they could carry. Anyone who was armed was disarmed, including Sikhs carrying their ritual daggers and swords. There were a few closed passenger train compartments which they were unable to board. Like most Partition refugees, they instead sat inside flat cargo cars. My mother would use the term “coal” cars, but I think she meant “cargo” because there were no seats, and the cars were open on all sides.

Men sat in one car and women in the other, facing each other. My grandmother was sitting with her younger children: my mother (who was around 11 years old) and her younger sister and younger brother. They sat close to each other, protected from the elements by my grandmother’s blanket or woolen shawl. Eventually, as night began to fall, the train pulled out of the station.

After it picked up speed leaving town, it came to a halt near Chalisa, not very far away. I’m not sure if the pause was initially due to the rail gauge being different past Chalisa junction. My mother always said someone had cut a tree and placed it on the track to block further movement. A crowd gathered around the train, armed with farming tools, machetes and swords. They were chanting “Allahu Akbar!” (“God is Great!)  and “Kafiro ko maro!” (“Kill the infidels!”). The slaughter began systematically with the men, including her father and eldest brother Raj, in the cargo car in front of theirs. 

The details at this point would become spotty from her tears and the sheer agony of the memories that were burned into her heart.

Her mother hid the young children under her shawl. There was a brief conversation between her and her mother.

“Adarsh, say the kalaam [become a Muslim], they’ll spare you if you do.”

“I won’t become a Muslim, they’ll have to kill me!”

The slaughter continued under the night sky. I don’t know what else she heard or saw. It was too painful for her to share. Her mother was either wounded or about to be. They all knew she was dying that night. I have reason to believe my mother witnessed my grandmother being struck by a weapon, but was hidden enough under cover that she and her younger siblings were spared.

My mother was handed some 500 rupees by my grandmother. “Take care of your sister and brother. Go.” These were the last words my mother would hear from her own mother. The advice was taken to heart.

The line of killers either had moved further down the compartment, were exhausted from manual slaughter, or were consolidating  their loot when my mother quietly led her sister and brother off the blood-soaked train. They jumped off the car and into a neighboring corn field. They ran some distance away and hid. The train eventually started again and delivered the cargo of death and slaughter to Amritsar, where my aunt Hans collapsed in horror upon its arrival the next day.

I cannot imagine what it must have been like to witness the total destruction of all that she knew, alone in a field, the bodies of her parents and older brother moving away quickly into the night as she moved toward an uncertain fate. The three young children—my mother, her sister and her brother, were soon discovered in the corn field by a farmer who recognized them as the Kapoor children, and was horrified at the role he had played in aiding—perhaps participating—in the slaughter of his neighbors.

With much lamentation, he took them to his simple house. There, they were to sleep. My mother didn’t sleep. She overheard the farmer and his friends—accomplices?—debating what to do. Marry the girls off for a decent price? Convert the boy to Islam and use him as a servant? There was much discussion. Finally, the decision was made to inform the Raja; he would decide.

The Raja was horrified to learn what had happened. He took his own horse and rode over to Chalisa to personally bring the children to his house. My mother makes it sound like the journey took hours, but on a map the distance is not that significant. I cannot imagine the exhaustion and trauma she had experienced. Certainly, from the moment she set foot on the train, even in her storytelling, time would seem to slow to a crawl.

When they got back to Pind Dadan Khan there was much mourning. The Raja was horrified at what had happened to the train, and at the fact that his beloved neighbors had been killed. Yet, ironically enough, it could have been worse. The train that left the next day, on September 22^nd, the train they were supposed to be on, fared much, much worse. That slaughter took place in the urban area of Gujranwala and was almost complete. There was no escape there for young girls and boys on that train.

As much as the Raja wanted to help them, there was little he could do. This would become a recurring theme until my mother was married, even after. There was no home for her anymore. Raja had his own family with grown children who were agitating that having Hindus under their roof now put all of them at risk and that Hindus had no place in the town anymore. So it was decided that my mother and her siblings would go to the camp in Pind Dadan Khan for Hindu and Sikh refugees. I don’t know for sure if this was the same camp she had left from, and whose narrow alleyways she walked with her mother just days before. She didn’t talk about the camp, and what must have been unbearable sorrow and agony, not to mention terrible conditions after a heavy monsoon season.

The three children stayed there for some time. As the weeks went on, some semblance of law and order was restored, and it became relatively safe to travel. Her older sister’s husband came to fetch the children from the camp and took them to Delhi. She stayed with her eldest sister and her family in Delhi for many months, but due to the overcrowding in the house she spent the summers in a refugee camp where she had some access to supplies.

Within a couple of years, she obtained a scholarship for refugees and displaced persons sponsored by the Birla family. This enabled her to attend a boarding school in Pilani, Rajasthan. She distinguished herself academically and thus was able to fulfill two wishes that her mother had for her—to become educated, and to take care of her younger siblings. Her grandfather, had, after all, founded the only girls’ school in Pind Dadan Khan some years before.

A decade later, she met my father while in graduate school. Thirteen years after the horrible events of Partition, they were married. She went on to become a mother of three children while pushing forward her career as a researcher in studying neuroendocrines, with a seminal research project on music therapy. For decades, she felt the obligation to take care of her sister and brother well into their older years.  

She spoke often of the joy of living in a diverse society with different religions and languages, memories that glowed with the warmth of her childhood in Pind Dadan Khan and came full circle in the cultural melting pot of south Florida.  And always, the memory of being with her mother in the house when it felt like home.

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My Grief

My mother died on April 11th, 2016.

It was sudden, very unexpected. She lived 20 minutes away. We were very close.

So now, grief.

For 20 years, I've sat with grieving people suffering from all kinds of loss. Loss of a child, parent, spouse, sibling and friend. Sudden loss, gradual loss, traumatic loss, graceful loss. I've witnessed death and the dying process hundreds if not thousands of times. I've had years of education, training and experience. I've written books on the subject that have helped thousands, and taught my techniques of coping with grief to thousands as well.

But this was my mother. My dear, sweet mother, who first sat me down and taught me to do most of the important things I cherish in my life.

I've learned a few new things about grief that training and professional experience didn't teach me. It's been less than two months, and the arc of grief is long. Very long. I'm sharing these to help people who are suffering from grief who might feel alone or unprepared for their pain. I expect that there will be new pieces of information along the way.  But so far, here's some morsels:

1) Grief sucks. This is really hard to convey in any other words. We all have our set of beliefs, or lack of beliefs, but there's no mistaking or sugar-coating this simple fact: It's really, really hard. Sure, it can be meaningful. It can be a lot of things. But from  the moment I wake up in the morning to the moment I fall asleep, it's impossibly difficult. The pain is massive. I have an acute sense that this pain of grief is a species-wide event. It's so much bigger than me, my relationship to my mother. It feels like a vast realm of the collective unconscious that spans the entire span of human existence.

2) The fog of grief is not to be underestimated. The forgetfulness is daunting. I have an incredibly diminished capacity to multi-task or remember things. Conversations I am somewhat aware of seem to have vanished in a blur. Things I did that first week feel like a dream. There's countless items that were sorted that seem to have disappeared, no doubt kept in a "safe place" at the time. That safe place is clearly not my brain.

3) Some people can be really awkward about being around you. Most people really don't want to know when they ask "How are you?". It's nothing personal. Just shrug and move on. Some people don't even want to talk to you. Perhaps they think it's helpful to give you space? Who knows. I've learned that it's a waste of resources to try and figure out these people. Move on to the ones who feel comfortable being around. The only thing worse than being asked how you are is not being asked how you are. There are no right answers on how to behave. Give people room to mess it up.

4) Give yourself room. The Pain is so big, it's got a life of its own, and it might not match yours. Healthy self-care is essential. Be kind to yourself. Go out of your way to find healthy ways to cope. Meditate. Exercise. Eat plants. Don't drink alcohol. Stay hydrated. The last thing you need with all of the pain is getting sloppy or unhealthy. The path of nihilism, that what you do doesn't matter because the pain is relentless, is wrong. The pain feels vast and endless, but what you do does matter. The choices you make of how to face the pain will determine who you will be as you grieve.

5) Expect nothing. Don't expect straight lines or finish lines in grief. Don't expect pain. Don't expect relief. Each day, each moment is full of surprises that can be pleasant or unpleasant. Be open. There are a million triggers a day that are impossible to control. There are also a million opportunities for joy that are easy to overlook. Try and be present. Just try.

6) Keep your heart open. See #4.

7) Don't be an expert. Be human.

Why Aren't We Ready for Cancer Survivors?

After nearly 18 years of caring for people with cancer, I've seen some remarkable improvements in cancer treatment. Diseases once assumed to be life limiting are more chronic. Many more have had years of quality life added to otherwise dismal prognoses. Certainly, much work needs to be done for a whole host of cancers and in improving treatments. But to deny the progress that I've seen with my own eyes would be disingenuous.

You would think that society would be enthusiastic about all the cancer survivors out there. Unfortunately, society is completely unprepared.

It's so frustrating for me as a professional, I am sure even more frustrating for the people I try to help. There are two socially acceptable ways you go through cancer: 1) lose a brave battle, or 2) have a wake up call. Either of these simplistic narratives has the same predictability-- a beginning, a middle and an end.

What about the thousands, maybe millions in between? The people who got cancer, did their treatment and are disease free. BUT. Exactly-- disease free, but...

But neuropathy. Chemo-brain. Deconditioning. Limited endurance. Loss of senses like taste or smell. Feeling different. Looking different. Thinking different. All those colleagues who disappeared during the illness. The other ones who moved into your work space.

Whole rounds of doctor's appointments that can take up an entire afternoon, days, for months or even years after a cancer diagnosis. "I thought you were fine" is the most common retort. I'm sure the intention isn't to push uncomfortable buttons about fears of recurrence, but that's exactly what it does.

What about the employer who isn't willing to have an employee disappear for a week every 3-6 months for follow up appointments? That employee already ate up all their sick time.

They get fired. Sure, not for being a cancer patient, but for missing work. It's all legal.

Too much affected by cancer for full-time work. Over qualified for part-time work.

Lately the only safety net available to this growing population of cancer survivors is social security disability. Some of the lucky ones have employee long-term disability as well. But what a horrible predicament-- survive cancer, but now you have to amplify your general helplessness and hopelessness on a disability application because otherwise you'll get fired.

Society isn't ready for cancer survivors.

Society is losing its brave battle with cancer.

So frustrating.

Dreams of Memories

My job as a psychologist is not what probably comes to mind when you think of psychotherapy. For a good chunk of each day, I spend time with people in the hospital dealing with a cancer diagnosis. Most have just had what will turn out to be life-saving surgery or chemotherapy. But many of my inpatients are hospitalized because their health is too precarious for them to be home.

It was one of those days in the hospital.

It seemed like every room I walked into had some heavy things going on. Big decisions to make. Incredible questions to answer. Uncertain futures to predict.

There was the overall feeling-- life is slipping away too quickly, time is running out. Mind is clear, body is failing. Relationships are being torn apart too soon. There are still dreams of memories to be made.

It doesn't seem fair.

As a health care provider, the known path is to build a wall. Don't get too close. Don't get to personal. Don't feel their fears, don't fall into their arms. As an old book once dictated, "always remember, you're not the patient". Mutter some line about hope and positive thinking and quickly leave the room. It's "them", we are "us".

That doesn't seem  to help.

The supposedly riskier path is the uncharted territory-- at least in health care-- of the open heart. Let's step into this darkest part of this cave, together. The person I am with is too sick and weak, perhaps also overwhelmed by pain, to navigate it alone. Here, we can use the light I can shine to illuminate these dark walls, scatter the scary shadows. Let's feel out the path, together.

Into this space of light in darkness, unexpected things begin to happen. Time seems to stop, even for a moment. When you come out of a conversation in which you've had a wall up around your heart, time seems to be going too fast. But that wall isn't just for the patient, it very quickly takes over your life. It amplifies this sense of powerlessness in the face of suffering.

It seeks to perpetuate itself. It seeks out unhealthy coping to numb the natural state of existential terror that is life. Alcohol, junk food, tuning out instead of turning on the experience of life and relationships.

The open heart that allows the light of compassion to shine-- into that space, time become irrelevant. Life feels deeper because it's being deeply felt. Coming out of these conversations feels like connecting to something much, much larger than just another person. It feels like tapping into something much grander, something cosmic.

I suspect this is what Martin Buber was referring to as "I and Thou". It's a sacred space, even if God doesn't feel present or caring. This is the opening that brings healing.

It also seeks to perpetuate itself. But this is about turning on to life. Light seeks light.

Once ignited sufficiently, the light of compassion seeks to keep itself burning. For me, this is the motivation to wake up early, meditate for an hour, work out. Keep that light lit. I might not know why I will need it on any given day, but it needs to stay lit.

The darkness is all around all of us. If we don't ignite the light within, the darkness will take over.

Reflections on fasting

Since March 2015, I've been following a weekly 24 hour liquid and social media fast. The first question most people ask is, "why?".

There are many reasons.  There's the sentimental reason that for many Indian households, Tuesday is a holy day, similar to the Sabbath in some ways. Fasting on Tuesdays is an ancient tradition, and following this tradition makes me feel connected in some small way to my ancestors.

Typically, they would pick a food group to avoid once a week-- onions, garlic, salt, sugar. I chose to abstain from solid food from dinner Monday night until breaking the fast with dinner Tuesday night. Instead, I have liquids only-- a green smoothie and a large tumbler of ginger-lemon-cayenne pepper water that I prep on Monday nights.

I do it because it's tough. It's definitely not easy. But as the months go on, it becomes something I look forward to doing.

In the beginning, I was having a power-packed smoothie of berries, greens, coconut oil, almond butter, turmeric, cocoa powder and black pepper. I soon found out that the berries were making my blood sugar, and consequently my mental acuity, fluctuate beginning by 10 am. I would get home ravenous, starving. My hunger pains were excruciating, and any piece of mind fasting could bring was eclipsed by the urgent need to eat.

Once I eliminated the berries-- I use a banana instead-- my mental acuity remained unaffected. I would get home pleased at the smoothness of the fast, and not be frantic to end it. Eliminating the almond butter and coconut oil-- caloric bombs-- and substituting with peanut protein powder or hemp seeds-- also helped reduce the... sluggish.. gut.

In September 2015, the Dalai Lama was admitted to the Mayo Clinic for check ups. He was forced to cancel his US appearances for October. Concerned about his health and well-being, I decided that the discipline of fasting could be channeled like a prayer for his long life. It has been this Fourteenth Dalai Lama more than anyone else alive today who is responsible for guiding me through my life work in caring for the seriously ill, dying and bereaved. Fasting has now become my weekly offering of gratitude and health for this great being.

There are other observations. In the first two months of fasting, I became aware that my satiety signal was getting much stronger. I was eating less than before all week, and feeling quite content and nourished. I also became aware though of areas in my life where excess still reigned, especially on fasting days. For me, this was in the realm of social media. I would check social media several times a day, often just to avoid feeling hungry. This seemed to contradict everything I try and do, and recommend, through the mindfulness practice, to move into areas of discomfort and difficulty and breathe into them, not distract myself from them.

So, I decided to add social media to the list of fasting options. No Facebook, Twitter or Instagram. None of it. Just an occasional retweet for my employer's tweets, which they have asked me to do. But no other checking or posting.

The result? A gradual overall reduction in my participation in social media. Fewer tweets and Facebook updates, but less frivolous ones. They seem to be more relevant, and hopefully, more helpful.

So the results so far, after nearly 9 months of fasting on liquids only once a week?

It's tough. But the world can be an unpredictable place, and life can be disrupted by suffering any day. We need self-discipline to make healthy choices and to withstand the inherent and inevitable discomfort of life. As a psychologist at a cancer center, I am exposed every day to people experiencing the extremes of human existence-- death, grief and rebirth. I need to have all of my resources accessible, and to be as healthy as I can be. That requires discipline and mindfulness. Compassion requires discipline and mindfulness. Fasting is a great way to do that, and as a bonus you can dedicate the merits of your self-discipline for the health and welfare of those who inspire you.

Thoughts on compassionate health care

Recently, I heard a fantastic story on the radio about how one of the leading medical schools in the country is allowing a growing percentage of humanities majors into medical school. My first reaction was one of gratitude that a training facility for medical and health care professionals sees the potential of well rounded human beings being even better health care practitioners. My second reaction was self-reflection.

I didn't go to medical school. I always wanted to be a psychologist. For 17 years now, I've been living out my dream of doing just that, but in the setting of cancer care. I've probably seen many thousands of people, treated hundreds of family members for grief. I didn't set out to do this.

And I learned very little of how to do it in my formal graduate education.

As an undergraduate, I had the incredible luck of attending one of the most eccentric colleges in the country, the University of California at Santa Cruz. Set high above the Pacific Ocean on the edge of a redwood forest, it was an idyllic locale for inner and outer exploration. I planned on being a psychology major. Unfortunately, it seemed at least half the student body had the same idea. The pre-requisite classes were just too crowded. I couldn't get in. It seemed that if I wanted to do the psychology major route, it would probably require an extra year.

Back then, I was allowed to do an independent major. So I put together my own curriculum and syllabus and major requirements over the course of an angst filled weekend during my sophomore year. I recruited three of some of my favorite faculty members to serve on the committee. The major-- I called it Psychology of Self-- was a mix of explorations into transcultural identity, mysticism and hermeneutics. Most of my classes were one-on-one, a professor, assigned study text and me meeting weekly. One particular highlight was a meticulous study of Exodus 3:1 using Martin Buber's I and Thou as a sort of decoder ring.

Every week for 9 weeks, my professor and I studied the scriptural text word by word using the transcending flow of I and Thou to understand the interaction and interplay of human and divine. We travelled through a spiritual landscape populated by personal experience and individualized quest for meaning. Weeks were spent contemplating "Moses, take off thy sandals from thy feet, for the ground upon which you stand is holy ground." Where did the voice come from? Was it referring to only that spot on the mountain? What is holy? What is holy ground?

I can't convey all that went on in those conversations. The point of it was that each of us has to answer those questions for ourselves.

As I sit with a patient who is newly diagnosed with a curable disease, or told they only have a short time to live, or with a family member whose only companion now is the absence of a loved one, I realize so much of what I do is still in that tiny room, sipping mint tea with a scholar of the Hebrew holy books, contemplating the mysteries of the spiritual and the mundane.

Neither of us knew in those conversations that it would lead to comfort for the sick and dying in a most literal sense 25 years later. None of this was done with foresight. Yet without the freedom to let my mind and spirit wander in that misty forest campus, I don't think I could do much of what I do today half as well as I hope I am doing.

I realize that in order to provide compassionate care to those who need a companion to be present as the mysteries of suffering, illness, pain and death unfold, the companion needs to travel some of this territory on their own. This isn't taught in graduate training programs nor in medical schools. It's the realm of the humanities. Supposedly unpopular and unlucrative majors like English literature, philosophy, religious studies may offer keys to unlocking our health care system. They offer the path forward towards breathing humanity into the health care system, of restoring medical care into a healing art and allowing healers to have genuine, intimate contact with patients.

And a way for healers to heal themselves from the burdens of care delivery.

Clearly, there is no substitute for competent, evidence-based care. But there is also no substitute for a curious, compassionate person providing that care who has spent as much of  their lives living as well as studying.

Advice for the New Year

Can you believe it, it's 2015! Just when I got used to writing "2014". Every new year there's a rush of new year's resolutions. And every February they seem to be a distant memory for many people. What winds up happening during the holidays is people eat too much, drink too much, have to encounter the stress of family, or absence of loved ones. You come into the new year at less than optimal functioning, and the resolution is an extension of this feeling of malaise and inadequate.

All too often, you may make well intentioned decisions from this place of poor self-worth. You may feel too sloppy, too unmotivated, overweight and moving in the wrong direction. If only you could do that one thing, or few things, you'd be better, right?

In my experience, such sorts of beliefs are rarely successful. If you are motivated by regret, chances are you'll do just enough to compensate for guilt. What works much better is to be motivated by happiness. Deep down inside, all of us want happiness. We may gravitate towards the safety of our familiar routines, even if they don't make us happy. The new year can be an excuse-- or a reason-- to trade in the safety of your ill-fitting comfort zone for the novelty of a happier life.

What I'm saying is that if you realize your intention behind your resolution is to be happier, you're more likely to follow through on happiness generating behaviors. This is what the key to maintaining healthier living is. All the facts about unhealthy behaviors like drinking excessive alcohol, smoking tobacco and eating unhealthy foods usually wind up getting tuned out by the people who need to learn about these things the most. However, if you realize that feeling sluggish, hungover, tired and bloated is in the way of a more lasting, sustainable happiness, you're more likely to become disciplined in your approach.

If you know you need to make a change but are unsure of what to do, here are some suggestions:

1) Eat more fresh fruits and vegetables. Most Americans don't get enough, and buying fresh fruits and vegetables should be a part of your daily lifestyle.
2) Meditate every day. I'm sure you probably do the basics daily to take care of your body-- bathe, brush your teeth, etc. Do you spend some time every day taking care of your mind? You can check out this resource here if you struggle with stress, chronic anxiety or rumination.
3) Cut out activities that interfere with your ability to meditate. Once you get into the routines of daily mental health care, you'll notice that certain activities seem completely outside the area of acceptability.
4) First and foremost among these is to stop watching cable news. I don't care if you're liberal or conservative, cable news deliberately pulls for the most primal and divisive instincts to generate ratings. They aren't keeping you informed, they're keeping you hooked!
5) Cut down or eliminate alcohol. You'll notice the change in your body and in your meditation practice.
6) Go for a walk as often as you can. It's a great alternative to being boxed into cable news!

If you follow some or all of these tips, my hope is that you can develop a more loving relationship to your own tired mind, and feel healthier and happier in the process. Remember, happiness is not a finish line, it's a process full of ups and downs. The key is to keep yourself trained to notice when happiness is happening.

Happy new year!

7 Suggestions for Grieving During the Holidays

The decorations seems to go up earlier and earlier every year. This time it was even before Halloween. The whole world seems to want to tell us to be happy this time of year.

A lot of people I know hate this time of year.

If you've suffered a loss recently, or even several years ago, you know what I mean. It's just not the same. Even if Thanksgiving, Hanukkah, Christmas and New Years' didn't feel like big deals to you before, they may seem to feel dreadful now. This is the time of year when schools close, businesses shut down, and people take vacations.

All to be together.

But after grief, it's often now when the absence of a loved one is silently screaming into your heart louder than before. That empty space, that vacuum, that sudden panic that something is terribly wrong. It all seems to come back in the run up to the holiday season.

By now, you may have learned that controlling these emotions is often unrealistic. The approach I've come to appreciate as more helpful than trying to control feelings is to instead manage the stress that this time of year and these very heavy emotions can bring. The research on stress management is therefore perhaps more relevant than theories about grief. Unlike grief, we don't consider stress to come in stages. It's a relentless presence in all of our lives, more so in the non-linear pain of grief.

So how to manage during the holidays? The following might help:

1) Keep in mind that you're not suffering alone. The holidays are difficult for millions of people around the world, even though it's not addressed in television advertising and marketing. You are not alone in your pain, although the pain can feel terribly lonely. Even if your loss happened a long time ago, the holidays have a unique way of dredging up lost memories and the intensity of grief. You're not moving backwards, grief is circular. It often feels like it's running laps around milestone dates like birthdays and holidays.

2) Choose the people you want to be around. Choose helpful people, if you can. Perhaps your place of worship reaches out to people during the holidays. Try it out. If you find you really have no one around during the holidays, think of alternative plans you can make. Chinese restaurants are usually open, and there's less likelihood of running into families doing their Christmas shopping there. Try not to stay home in the confines of your pain.

3) Exercise. Grief is stressful. Work out the stress. I live in south Florida, where it's very pleasant this time of year. Chances are though that going for a walk is not realistic where you life. You might have to join a gym. You probably don't want to be walking around an indoor shopping mall with all the families, couples and Christmas carols playing. Bring headphones to the gym and walk on the treadmill or around their track. It burns off the stress in your body and gets you out of the house. Try and exercise in some form at least a few times a week. Research indicates that several months of moderate cardio exercise 30 minutes 3-4 times a week can be as effective as an anti-depressant, even in people with less than optimal health.

4) Eat as well as you can. Stress makes your body crave sweets and fat. Grief is stressful. There's tons of sugary snacks around during the holidays. It's a very dangerous combination! Try and eat as healthy as you can. You don't have to juice or become vegan, but do try to eat as many fresh fruits and vegetables instead of packaged snacks. The last thing you need with intense grief is cycling through sugar crashes.

5) Be mindful of addictive behaviors such as alcohol, smoking, or gambling. There's a reason people do these self-destructive behaviors: they feel good. Why do they feel good when we know they're not good for you? Fundamentally, they give you a sense of control. Grief is the consequence of total lack of control. None of us can control someone else's life span or even our own. Many people find an addiction gives them a sense of control, even if it comes at the expense of well-being. Try not to fall into this trap. Besides, alcohol is technically a depressant, smoking ruins your quality of life before killing you and gambling is expensive. None of these sound like good coping skills because they aren't. If you've benefiting from AA or NA in the past, the holidays are a good time to attend regular meetings.

6) Start meditating. A steady combination of regular meditation and exercise can completely transform how you experience stress. You can learn how to meditate here in some of my books. Nurture your spirit, even if your religious beliefs have been shaken or destroyed.

7) If you can't do it on your own, seek help. Reach out. Get into therapy. If you don't like your therapist, shop around. Try out different support groups till you find the right fit. There's no shame in taking psychiatric medication to get through this time of year if you need it. Grief is sometimes so intense, so outside of what we can easily manage, you should leave no stone unturned in seeking help.

I like to think of these challenging times of year as an athletic event. Instead of physical sports, the holidays are Olympic events that can stretch the limits of your emotional and spiritual endurance. You can't control whether or not you'll experience grief, but you can manage the stress of the holidays by approaching them with he attitude of an endurance athlete. That means developing regular training routines incorporating the above guidelines.

I wish you peace and freedom from suffering.

Stalking Resilience (trigger warning)

Ten years ago I got an email from my friend, Dave. A man of few spoken words, he asked me to check out his latest piece of writing. "Intense is all I can say" was the only clue as to what was about to unfold. At the time the working title was "The Killer Inside Me". Over time, it became known as "Stalking the Bogeyman" (trigger warning).

I read it with frozen attention. Words unfolded, revealing a history I couldn't imagine. My friend. He had this history I couldn't fathom. He had kept it in a vault all these years, and we never knew.

This happens to other people. This stuff is in the papers. Not to anyone I know.

Not my friend.

My friend couldn't have possibly gone through this.

Dave wasn't lying, it was definitely intense. I don't know if that was his intention, but it's hard to write about intense events without being intense. The intensity remained, but at some point it took on a different quality. Under the pressure cooker of a secrecy first imposed by his rapist, the desire to kill to protect other potential victims, direct and indirect, grew all consuming. When the lid was unexpectedly removed, the secrecy was gone, and with it the possibility of the perfect crime.

The traumatic event of his childhood was in black-and-white for all to see. The people Dave sought to protect the most with his secret-- his parents-- stayed by his side. He wasn't in trouble. He wasn't going to be shamed. And he wasn't going to be punished for talking about it. The imposed secrecy wasn't a magic spell, but exposed instead as a cheap magic trick. There was nothing to back it up.

With the very public story came-- what? Healing? Resilience? Is that the Hollywood ending we're all hoping for? He wrote this story, it became an episode of This American Life (trigger warning), now it's an off-Broadway show... so that means it's all good, right? All's well that ends well?

I don't know.

Over the last 15 years or so, I've spent a lot of time with people who are dying and grieving. My career has given me time to reflect over the course of what have been thousands of grief and death trajectories exactly what we're prepared for as a society.

We are not prepared for trauma.

We are not prepared for our loved ones to be in pain.

We are certainly not prepared for complicated emotions.

We like tidiness. We like things to be clean. We like to think pain has stages that we can grow out of and get over.

We really like anti-bacterial soap. But our lives are full of contagions, full of germs, things unseen that can be very threatening.

We think of resilience as clean. As closure. It's a goal, an endpoint. We get there, everything is fine. We move on, we don't hold on. That's a sign of healing, right?

No.

We assume people we know are not in pain. Surely, they don't have any secrets, any hidden pain. They're functioning so they're okay.

No.

We aren't prepared for the reality of trauma, pain and grief. It's an injustice to those we care about, maybe some day ourselves, to assume that resilience must mean you've "moved on", or gotten over stuff. More than likely, the stuff we go through becomes a part of us.

We don't have a template for this.

Resilience can't be measured by how happy you are. It's not required you have "closure".

Sometimes resilience just means you've endured and survived.

Sometimes resilience means you stop hiding your pain.

Sometimes resilience just means you share your story so there's less secrecy around all our suffering.

Meditation: The Inside Scoop

The most common reason people give to be unable to meditate is to say "I can't turn my mind off". For some reason, there's this assumption that meditation requires the supernatural ability to clear the mind in order to be performed. This is absolute rubbish.

Everything we do requires practice. If the prerequisite or goal of meditation practice was to empty the mind, the best meditation teachers would be those who could perform lobotomies. I can assure you this isn't the case.

I've maintained a daily meditation practice for about 18 years. I thought I'd share with you all some of what happens when I sit down to meditate to assure you that a quiet mind is in no way a requirement for a meditation practice. The following took place in an idyllic location while on vacation in Catalunya a couple of weeks ago. I sat down one afternoon while everyone else in the house was gone to watch my breath. I assumed the meditation posture, and focused my mind on counting my exhalations, one at a time, while allowing my mind to unfurl.

"What a beautiful spot. I can't believe how blue the sea and sky are. I should have sat down to meditate a while ago.

It reminds me of what I thought of earlier, once you decide to sit down to meditate, everything outside of the sitting session is resistance. How long have I had this meditation practice? I used to say 16 years, but I think it's 18. Wow. Mind still very much on.

This spot is high up. I'm pretty sure it will survive the ice caps melting. Who knows how many feet that will be. I hope it's gradual, although that one researcher said it's more likely to be sudden and catastrophic. Those methane reserves in Siberia are being released, that's really bad. It will all come down to timing. I hope we're all together when it happens. I can't imagine the drive out of south Florida. What will I take? Glad I backed up the hard drive and put it in a Ziploc in my office. That's going to be a crazy traffic jam. We'll have to head north. I hope I can get a job in another state easily. I wonder if the flood will bring down the global economic system.

Wow, that's the most uncomfortable tangent. I hate that topic. Government is so broken. Taken over by demonic forces. Ancient forces that brought down Rome, too. So evil the way the way they're treating the earth.

Why all the judgement? Meditation is about love, after all. Ok, let's think about love. Let's send love to the politicians and greedy oil executives.

Wow, what a nice spot to sit. I can't believe how relaxing this is. Seems like a bubble while the rest of the world turns to shit. So many dead in Gaza, Syria.

Breath tight. Release the belly. There. The most helpful thing is always to release the belly. Got to remember that. Love the chattering parts of the mind. How many parts of my mind are there? Wait, who's keeping track? Is that part of the mind, too, or something outside of it. Does mind emerge? I'm really appreciating that emergent hypothesis. I wonder if I can incorporate that into the Toronto workshop somehow. The slides are all done. Those used to make me so much more nervous.

The run this morning was awesome. I wish we had mountains and trails in Florida like that. Makes me miss living in California. I don't think my Achilles' tendon can take two runs a day, but I would love to if I could. I wish I had run more in my late twenties. Grad school sucked for that stuff.

Soften the belly.

Oh wait, that was a shimmering moment. Love that. Let's do it again.

Nope. But that was nice.

Ah, it happened again.

Hmmm. I hit my goal. But I want to keep going. Ok, another 49 breaths. I hope I have time. Is there anything else I should be doing?

Oh, nevermind, this is nice. 'The Buddha's enlightenment is vast, it encompasses all experience'. He's been here, each moment is a footprint of his enlightenment.

If only people knew how much chatter remains, even with meditation practice, they'd be less intimidated. I should totally blog out this session. "

So what's your experience like?

Seven Tips for Professional Caregivers

This past weekend I was in Toronto as part of a series on Contemplative End of Life Care put on by the good folks at the Institute of Traditional Medicine. My area of focus was grief, specifically the approach I use and have highlighted in my books. It occurred to me that I've been taking care of the dying and grieving for over 15 years. I feel like I just got started and nowhere near burned out. I was asked several times in different ways what's worked for me in being able to sustain high intensity mental health care.

When I'm discussing end-of-life care and grief therapy with other professionals, I like to point out that we need to tap our own inner resources of compassion in order to be able to help others. To do this, we have to build up these inner resources in the first place.

The way to do this is fairly straightforward to describe, but harder for many to put into practice. We'd much rather take care of someone else than ourselves. If we listened to half the advice we give others about how to take care of themselves, we'd be twice as healthy.

What works? In 2014, there's very little mystery in answering this question. Here's the list, again, culled from decades of health and well-being research (done by others) and my own personal experience: 

1) Treat yourself as a whole person. This means balance different aspects of your life-- body, mind, spirit.

2) Eat right. What's that mean? Science is telling us more and more how important it is to eat plants, use common sense portions and avoid processed foods. For me, this means going to the grocery story to buy ingredients rather than meals to re-heat.

3) Exercise. If you can do an hour a day most days of the week, wonderful. If not, 20-30 minutes 3-4 times a week of moderate cardio exercise is a good goal.

4) Meditate. This doesn't mean read about meditation or enjoy spending time in your garden or playing with your pet. It means cultivate a daily sitting practice. It's the purest way I know of to nurture heart and spirit.

5) Create a community. If you work in health care, start talking about self-care. Give hugs to tired colleagues. Spread the word that we matter. You don't want to become the nagging missionary, but better yet, let the changes you're making be their own example. People will notice you're doing something different. If you work as a solo practitioner, reach out on social media or try to arrange meetups in or near your community to find like-minded people that can help you feel connected. The key to preventing burnout is feeling that you're part of a bigger whole, a tribe of fellow caregivers moving in the same direction with the same priorities. Don't wait for a community to form spontaneously, change the system to be one you like.

6) Limit your reliance on alcohol, television and other drugs. We joke a lot in health care about happy hours. But there's no evidence to suggest people who drink regularly are more emotionally resilient or spiritually centered than those who drink very little or not at all.

7) Don't be afraid to grow into your potential. Many of us started out working as professional caregivers with mentors or teachers we looked up to. Mentors aren't born, they're made out of experience. Don't be afraid to make changes in how you work and how you live so you can become an expert at what you do. Remember the gratitude of others as a guide to keep you going. What helped your patients the most? Keep doing that.

We are blessed to do what we do for a living, but chances are no one has taught us how to be in it for the long run. Health care providers who are balanced and healthy can provide better care for others. My goal in caring for others is to be able to do it for as long as I can and stay healthy in the process. I hope you can, too.

Filling the World with Compassion

Pictures coming out of Gaza and the news of MH17 being shot out of the sky has made this a very difficult week to be a human. Our world seems to be run by people obsessed with power, and we are subject to their whims. So quickly, we become mobilized to take sides-- the one we are on is legitimate, righteous and those other people are wrong, even evil.
But does this actually help the situation?
I'm inclined to believe that it only perpetuates the horrors we feel overwhelmed by. I recall reading years ago, I don't know the exact source or context, a quote by Mahatma Gandhi. In it, he says something to the effect of "the purpose of non-violence is the genuine wish to improve your enemy, not destroy him."
Improve your enemy.
This is not the Art of War, it's the Art of Compassion.
Sure, some say this is naive, it's not how the world works.
Oh really?
I think it's the only what it can work.
It's impossible to think of a single geo-political conflict currently raging without having to first go back dozens, hundreds, even thousands of years. Taking sides seems to not be a very effective solution.
The alternative-- compassion-- will never be supported by power. Dominance requires a group mentality that preys on our most primal herding instincts. Compassion is equalizing, decentralizing. It threatens power consolidation.
Does this mean we should throw flowers at Hamas, or give group hugs to the IDF?
No. What it means is that we should all try and practice compassion wherever we are.
Try and be nice to the person who brings you your food or who comes to fix your cable TV.
Smile at the next person who is helping you in a store.
Be courteous driving in rush-hour traffic. 
Reach out to that person you've been meaning to check in on.
When compassion in every day life become second-nature, it becomes reinforced in how we see the world. We cringe when our leaders ask us to turn it off in nationalist double-speak.
 Maybe, just maybe, each of these individual acts of compassion can gradually fill the bucket that seems so empty in our world today.

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.

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.

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.

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."

Horrible.

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.

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.

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.

Adam Yauch, MCA, and Gratitude

This was a rough day. As a confirmed Deadhead, much harder than the day Jerry Garcia died.

Let's back up. I grew up in the Bronx. In all honesty, I wasn't into hip-hop when it came out. I was into rock. Rap and break-dancing seemed to evolve from the disco crowd. My first albums were AC/DC, Van Halen, and Iron Maiden. When the Beastie Boys came out, my family had moved down to Florida. It seemed like all the homophobic jocks were into that stuff, while the serious hip-hop crews were into Rob Base.

Then I got to college. Paul's Boutique, then Check Your Head. They told a story, of urban grit balanced with insanely positive vibes, rhymes that came out of dropping acid skiing or in subways and maintaining equilibrium. Anthems about bums, car thieves, playboys and con artists, street punks who had everything but then chose to evolve into introspective urban poets.

I wore both of those out on cassette AND CD. After graduation, Ill Communication came out. By then, I had gotten more interested in meditation. The final tracks on the new album had a curious combo, "Bodhisattva Vow", and "Shambala". Center art by Alex Grey. This is interesting.... the message was, you can be spiritual AND cool. You can be proud of where you're coming from, not know where you're going, but have a wholesome goal in mind. "Hello Nasty" documented a more experimental direction, but after 9/11 hit, the Boys came back with "To the Five Boroughs", literally a love letter to our beloved New York, grieving the loss of life and towers but celebrating the diversity that fuels immortal resilience.

I memorized Bodhisattva Vow, not knowing what it really meant. In 1995, I found myself going from Xinjiang into Tibet, watching in awe and confusion as Tibetans made the pilgrimage on foot, bowing every third step on the way to the Jokhang Temple. Armed convoys miles long passed them, leaving clouds of dust behind. They kept walking, kept bowing. And I thought, yes, I can see why Adam got knocked into this consciousness. I took formal refuge vows as a Buddhist after returning from that trip. I didn't become Buddhist because of Adam, or because of any song. But Adam made it okay to be proud to be Buddhist, to study the vow, to make a public declaration-- "hey, while all you rappers shoot at each other and degrade women, I'm putting it down that I'm taking the Dharma seriously." No one stepped to that. No one could.

Here he is, in 1998, speaking out against violence and Islamophobia. http://www.youtube.com/watch?v=AZfiKTHairw. 1998! More prophetic words could not have been spoken. Here he is, a rapper born Jewish, defending the dignity of Muslims and Arabs, warning us not to pursue violent paths. Rappers these days talk about themselves, their money, and each other. None can step to Adam.

Adam, damn, we are going to miss you. Adam, thank you so much for being you. I keep thinking of "Year and a day", the creepy line "Seen a glimpse from ahead and I don't think it's gonna last." Not true. You are an immortal. You will live in us, in the steps we take. And in times of doubt, we can think on the Dharma, and the Enlightened Ones who graduated samsara. For me, you will always be one of the people who inspires me to give thanks for this world as a place to learn.

Thank you.