Mindfulness and Compassion for Pain
Injury as a teacher
Posted Dec 21, 2015
“Injury can be a great teacher,” the yoga teacher intones in a calm, soothing voice.” She is helping me rehab after I was knocked over by a fierce gust of a Santa Ana wind while teaching Mindful Self Compassion, http://www.centerformsc.org/, with colleagues in the high desert of California. It’s a few weeks after I underwent surgery for a number of broken bones in my ankle, which are now being held together with lots of hardware (my “inner Home Depot”). I’m still in some pain and unable to walk or drive, and the whole, surreal experience feels like something out of the Wizard of Oz. Telling the story to a colleague I joked that I didn’t fall gracefully. She corrected me and pointed out that when we are knocked down by life we don’t fall skillfully. So true. We are all vulnerable to what the Buddhist teachers call the “worldly winds;” we all get knocked over by life, often when we least expect it. And no matter how absurd or ridiculous the experience, or how much we don’t like it or want it to be different, the choice we have is how we respond.
As I struggled with extreme pain in the few days after surgery that the drugs didn’t touch, (the dreaded 10 on the pain scale that’s the worst you can possibly imagine), I tried all the mindfulness and compassion practices that I knew. Fortunately, I had also read an excellent article by Stacy Lu in the APA’s Monitor on Psychology, http://www.apa.org/monitor/2015/11/cover-pain.aspx. A research geek even in pain, I tried to incorporate insights from the work of Mark Jensen and David Patterson of the University of Washington, and the research of Catherine Bushnell of the National Center for Complementary and Integrative Health. I think of the following sequence as an “industrial strength” mindfulness and compassion practice for extreme and/or chronic pain that’s also evidence based. Please try it out and share it with colleagues, friends, or loved ones who might be suffering.
- Start by finding your breath. Often when we’re in extreme pain we take shallow breaths; breathe as deeply as you can, letting the exhalation be a little longer than the inhalation. Try to let yourself be present in your body.
- See if you can allow each inhalation and exhalation to rock your entire body, letting it soften and, if possible, letting it relax. Allow each breath to be a wave, like the waves of the ocean, soothing and comforting you.
- Imagine that you are being held by the Earth, feeling the ground absorbing the pain, allowing the pain to flow into the Earth. Imagine the sky or heavens above you, feeling the vastness of a starry sky. Feel yourself held between heaven and Earth.
- If you begin to panic at the intensity of the pain, return to the breath.
- Bring your attention to where the pain is most intense. Try to get curious about what you are experiencing. Is it burning? Throbbing? Stabbing? Searing? Try to be with your body even though it’s in pain. Stay with yourself. You may notice that the pain, like the breath, waxes and wanes. There might be breaks in the pain.
- Tune into your thoughts and emotions. What are you telling yourself? Is it unbearable? Intractable? Never-ending? What are you feeling? I can’t take this? This is too much? Will it ever end?
- See if you can be with your body in pain the way you would be with a screaming child. See if you can hold yourself tenderly, perhaps using a compassion phrase, such as May I be with this pain. Or, you might try, My sweet body, you are doing the best that you can.
- Bring warmth, kindness and compassion to every part of your body, especially to where it hurts the most. Imagine, if you like, that you are wrapping your body in a warm, soft, healing blanket. Let yourself be held.
- Repeat this sequence as often as needed, talking to your body and observing and reframing the pain.
Please don't think that meditation should override the need for medication in severe and/or chronic pain. Mindfulness and compassion, especially self-compassion, are additional tools that can help. There is a story about a Zen master who was dying of cancer and in severe pain. Some of his students, who were gathered around him, were puzzled by his groans and asked why he wasn't using his practice to transcend his pain. He humbly explained that his practice was not strong enough to deal with this kind of pain, and asked for their compassion.
As I inhabit the world of the disabled at least for a time, I find myself becoming more patient and humble. When you navigate stairs the way young children do, or find yourself grateful when a stranger holds the door open for you, it’s an experience of vulnerability and helplessness that connects you to children and to the elderly. Having friends and family who are present for me is a great gift. And my dreams are filled with scenes of being able to walk again. There’s so much that we take for granted.
At times, all that I have hoped to “do” these last few weeks falls away to a new appreciation of just being able to “be.” Somehow all the work and plans become less urgent, less important. The deep blue sky, the cold winter air, and the songs of the birds seem remarkable after being indoors for most of my hours. And at times, when I wonder “why” this happened I think about these words from the poet Rilke,
"...have patience with everything unresolved in your heart and to try to love the questions themselves as if they were locked rooms or books written in a very foreign language. Don't search for the answers, which could not be given to you now, because you would not be able to live them. And the point is to live everything. Live the questions now. Perhaps then, someday far in the future, you will gradually, without even noticing it, live your way into the answer."
Psychologist Susan Pollak, MTS, Ed.D., co-author of the book Sitting Together: Essential Skills for Mindfulness-Based Psychotherapy, (Guilford Press) has been teaching and supervising at Harvard Medical School for over twenty years.