Patient Wisdom

PT: Many people believe it's healthy to just express your emotions: do whatever you need to do to get them out. What's your take on this?

EPSTEIN: The Buddhist approach is that you can't empty out feelings by acting them out. You don't necessarily make things better by expressing everything; you might actually inflate the situation. Instead, it's helpful to learn how to be with what you're feeling before choosing whether to act it out. Recognizing an emotion as it happens is what I have learned from both Buddhist mediation and from my own experiences in therapy.

PT: What sort of Buddhist meditation do you practice?

EPSTEIN: From the age of twenty-one, I've practiced a form of Buddhist meditation rooted in Southeast Asia and called Vipassana. This kind of meditation emphasizes a practice of what's called bare attention. You just watch your mind. You give impartial attention to your thoughts and your emotions without judging them. When I sat down and began my work as a therapist, I automatically went into this state of mind that I had cultivated in meditation.

PT: When you started meditating, what was your experience?

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EPSTEIN: I had a lot of held-back anger. And one of the emotional lessons I had to learn was to understand my right to be angry. I had to learn how to feel it and then learn to make use of the energy rather than just being spiteful or turning it against myself or anyone else.

PT: It seems like the biggest obstacle to facing difficult emotions is that people are afraid of what they're going to feel.

EPSTEIN: Or of what they're going to find. But you can face this fear bit by bit, by biting off really small amounts. When you meditate or have a therapy session, it's rare that the feelings come surging up like some volcano that overwhelms you. It's much more usual that you'll have just enough frustration or fear about "what's going to happen after I exhale on this breath before I can draw in the next breath." Meditation provides little tiny opportunities for getting to know your own fear.

PT: In your book Going to Pieces Without Falling Apart, you discuss your long meditation retreats. To really learn to tolerate emotions, do you think you need to go off on retreats?

EPSTEIN: I think to really understand the potential or the power of meditation, it's very, very useful to go off on a retreat for a period of time. You can definitely experience some things that you won't experience sitting and meditating at home for half an hour.

PT: Like what?

EPSTEIN: The first thing you discover is how you're thinking all the time. There's this internal chatter that's just going, thinking the same thoughts, one after another, over and over and over again, always commenting on what's going on and getting in the way of a more direct experience of life. If you can patiently sit for an hour or walk for a half hour, eat your meals slowly, not talk, try to pay attention as best you can to what you're doing, your mind starts to get quieter. There are little windows in which the chatter is not going all the time. And then you really start to have a different experience of the world because the veil of your own thoughts has been parted. For the uninitiated, it's like trying to talk about sex before you've experienced it. You can only describe little whiffs of it.

PT: And what happened to you when you started to meditate? How did you change?

EPSTEIN: Early on in my meditation practice, I had a few experiences of being filled with happiness and relieved of any sense of burden. Then, I spent an extraordinary amount of time trying to recapture that feeling in meditation. I kept judging my experience, pulling myself away from it ever so slightly, comparing it to that blissful moment that I had last time, and in a subtle but pervasive way, I was perpetuating my own unhappiness. Then I realized that the real lesson from meditation was not about the bliss. It was the same lesson that the child psychiatrist D. W. Winnicott was talking about when he wrote that the mother's responsibility is to fail the child adequately. You're inevitably going to be disappointed by life, or by people whom you love, or by meditation, but the point is to learn how to bear that disappointment and not to hide behind it, but to come back with the love. For me, meditation took away the fear of getting attached to the world while knowing how fleeting it all is.

PT: How people will disappoint us, leave, die...

EPSTEIN: That's right. And meditation, ultimately, is about surrender to that process, and the joy that comes out of completely immersing yourself in this changing world. Sometimes, to learn how to completely immerse yourself into this world, you have to renounce it, you have to pull yourself back and practice just with your own mind. The point of that retreat is to free you up enough to engage more with the world. And at its best, that has to be the aim of psychotherapy. You let someone become attached to you in a real way and then let them leave.

PT: As the psychiatrist Jean Baker Miller said about how we don't grow into independence or autonomy, we grow into relationship.

EPSTEIN: Instead of heading toward separation and individuation, we're growing toward love and death. And to successfully engage in either of those realms requires this ability to quiet yourself and give yourself over to the process. I feel enriched by having been clued into this early in my life.

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