The range of what we think and do is limited by what we fail to notice. And because we fail to notice that we fail to notice there is little we can do to change until we notice how failing to notice shapes our thoughts and deeds.
—R. D. LAING
The ultimate value of life depends upon awareness, and the power of contemplation rather than upon mere survival.
—ARISTOTLE
While currently escalating in popularity, the practice of mindfulness is not new. With roots in Buddhism and Eastern philosophy, mindfulness was first introduced to psychology in the 1900s through Gestalt therapy and the somatic psychologies. Since the 1990s, mindfulness has increasingly gained respect as a tried and true asset for trauma recovery. It is even now advocated by many in the mainstream of trauma treatment and research. The purpose of this chapter is to highlight particular principles of mindfulness that are useful for healing and for plotting your course of recovery. For that reason, the discussion of mindfulness per se is limited here. It will not include mindfulness as a meditation or spiritual practice.
The concept of mindfulness is, at least on the surface, quite simple. It is basically a focused self-knowledge that includes several facets—awareness of body sensations (temperature, tension, butterflies in the stomach), states (hungry, sleepy), feelings (happy, sad), images, and thoughts—as they move in and out of your consciousness. As such, mindfulness enables you to access all sorts of data about yourself. To aid trauma recovery, any single facet or combination of them will be particularly useful.
Probably you have already used mindfulness in your daily life, perhaps even on a regular basis. Attending to your feelings or your body’s reactions to decide what to have for lunch or choose what you wear to work are likely examples. Usually we are not aware of how much information goes into our decision making. Buying furniture is another area where people commonly use mindfulness. Remember the last time you bought a chair or couch for a room in your home or office. On what did you base your choice? Did you sit in several to compare how they felt—hard or soft, comfortable or uncomfortable? How about how you felt in the various possibilities? Did you notice if sitting in one or the other made you feel happy, at ease, alert, or restless? Maybe you also tried to imagine how each would affect the mood of the room it was meant for, or if it would change how you felt in that room (for better or for worse). One or more of the chairs may have elicited memories of another place or time, perhaps when you saw or sat in something similar.
Choosing furniture is only one (if very basic) example of how you can apply mindfulness in a practical way. Via this chapter, it is my aim to help you to use this simple strategy to make all sorts of—and more critical—choices based on what your own “inner Goldilocks” tells you. Not only will mindfulness help you to choose the right chair, it can also guide you in the choices you make to further your trauma recovery.
Barry1 came to me for consultation suffering from extreme posttraumatic stress disorder (PTSD). You might recognize some of his symptoms: periods of rapid heartbeat, cold sweating, difficulty sleeping, difficulty concentrating, intrusive thoughts of the incident that traumatized him, and so on. One of the things I routinely suggest to those in a similar state is to pay attention to what they eat and drink. Usually, when someone is so distressed, I will recommend reducing consumption of caffeine (in coffee, tea, aspirin, and many soft drinks) and MSG (a flavor enhancer common in Asian cuisines and canned soups), both of which can increase the pulse, triggering a worsening of symptoms. But an interesting thing happened when Barry actually paid attention to the effects of what he ate. He found out that drinking a Red Bull (a highly caffeinated soft drink) calmed him more than anything else. Moreover, Chinese food was his favorite and never caused him distress. However, he found that eating an apple (which he usually did daily) and a few other common foods made him quite anxious. The results of his investigation reminded me just how different the effects of food can be on different individuals. With a little practice, Barry was able to look at something in his cupboard or on a restaurant menu and accurately predict if it would raise or lower his heart rate and other symptoms. He got very good at it. Applying mindfulness to what he ate did not cure Barry by any means, but it did help him to better control his anxiety and arousal levels, which eased his recovery process considerably. It was an important step, a helpful piece to his puzzle.
Consider the advantage of applying the same principles to even more significant choices—the value of being able to predict and evaluate which treatment, exercise, or intervention is right for you. Mindfulness can assist you in taking the power of determining what is best for you away from the “experts” and holding it firmly in your own hands (and mind and body) where it belongs. Of course, advice from specialists—authors, doctors, and therapists—will still be valuable, but with you able to evaluate what helps you, their counsel will be even more beneficial. There is danger in assuming that an author or therapist knows what is best for you. Mindfulness can help you to gauge if you do or do not agree with another’s assessment or suggested direction. If you do not agree, you can then decide if you would rather follow your own direction or seek one or more additional opinions.
The Issue
In general, people suffering from the aftermath of trauma are very vulnerable. Their nervous systems are off-kilter. Somatic (body) and psychological (mind) symptoms are confusing and frightening. Most of these individuals become desperate to try whatever is offered to them. When something works, all the better. But when interventions fail, the trauma survivor can end up in worse condition than before treatment. The following e-mail is an example of such a treatment failure.
Dear Babette Rothschild,
I’ve been an inpatient in a trauma recovery program for the past 7 months, diagnosed with complex PTSD. I can’t say that I am much better, and everyone is frustrated because I still can’t remember anything from before I was 11 years old. That is where my therapist says the trauma is, but try as I might, I can’t remember. I am more and more scared that I will not get what I need here or anywhere. I hope you can advise me.
Best wishes,
Martha
There is something highly amiss in situations such as Martha’s. She finds herself in a real jam: she has committed herself to a treatment program, but has found that in 7 months it is not working for her. She is still attempting to adapt to the program, but try as she might, she cannot fulfill their requirements.
I often receive e-mails similar to this one. Each writer is, like Martha, looking for advice on how to pursue their recovery or asking my opinion on the usefulness of a particular program, method, or book. There are so many options available that it is often difficult to choose, to predict what will work. It does not help the matter that evidence for what has been “proven” to work is at times confusing and even contradictory.
Is it possible Martha could have been counseled or helped to foresee if this program would suit her or to recognize the program’s ill fit before investing so much in it? There is no way to know, but mindfulness might have been useful for Martha. It is possible that had she been guided to focus attention on her body sensations, emotional reactions, and thoughts while considering inpatient programs, she would have accessed information indicating a clearer direction for her. For example, if she could have felt her stomach clutch and her feet go cold as she read (or heard) that this program required accessing trauma memories, she may have had a tangible indicator that the program might not be for her. Perhaps she would have seen a symbol in her mind’s eye. Maybe a “Stop” or “Dead End” sign would have appeared to her had she known how to focus. There is no way to know, but Martha’s situation illuminates one area where mindfulness has the potential to be useful in facilitating trauma recovery and plotting a course of treatment. Below is another.
The Case: Janice, Part 1
Janice wanted to be touched and held. But at the same time, she found that she would space out whenever she was in physical contact with another person. She could not stay present when holding or hugging anyone, let alone when having sexual contact. It was such a dilemma for her that she avoided becoming involved in a meaningful relationship. Instead she would sometimes take home a stranger she met at a party so that she could, as she said, “relieve my tension without anyone caring if I was there for it or not.” She especially related to the scene in Annie Hall where Annie’s spirit leaves the bed during sex with Woody Allen’s character.
Molested by her father on a regular basis since she was quite young, Janice had developed an ambivalence about touch—needing the contact, fearing the contact. As an adult, the same conflict plagued her. She felt a deep need to be touched and held, but every attempt to fulfill her need ended in either frustration or panic. When she tried to forgo touch altogether, a deep depression would set in. She needed to find some compromise. Could mindfulness be helpful?
Apply a Little Theory
The practice of mindfulness, though popularized in recent years, had its beginnings more than 2,500 years ago in the Buddhist practice of meditation. In modern times the skill has further been applied to everything from treating depression to sharpening business acumen. During the 20th century, Gestalt therapy, body psychotherapies, particularly Hakomi, and somatic treatment methods such as the Feldenkrais and the Alexander technique introduced the practice of mindfulness (including body awareness) into psychotherapy. During the early part of the 21st century, cognitive therapies have adopted mindfulness as a core of their approaches.
There are four foundations upon which Buddha taught mindfulness:
For the purposes of this book, this key will involve specific use of the first three foundations. Students, practitioners, and masters of Buddhism and Buddhist mindfulness will likely find this discussion and application highly limited. However, this is not a book, nor even a chapter, about Buddhism. The concept of mindfulness is being applied here for a very concrete, targeted purpose. For those who want exposure to the deeper esoteric philosophy and practice, I hope that you will delve further on your own.
Basically, mindfulness involves the focus of consciousness on whatever is happening now, in the present time, in and around you. Thoughts, feelings, sensations, and impulses may all be targets of mindful awareness. Mindfulness can also involve the spiritual realm, but does not need to. For our purposes here, the focus will be on the body, feeling, and mind aspects of mindfulness.
To further grasp the relevance of mindfulness to trauma recovery, it may be helpful to understand Antonio Damasio’s theory of somatic markers. Best known for his book Descartes’ Error, Damasio developed his somatic marker theory while investigating people with a particular type of brain injury. He found some surprising commonalities among those patients who had damage in the prefrontal cortex. They had little to no awareness of body sensations, particularly their internal sensations, such as butterflies in the stomach, changes in heart rate or breathing, or heat or coolness in the skin that would indicate flushing or becoming pale. Moreover, they were unable to identify their feelings (e.g., anger, sadness, fear, happiness). And, most significantly, they could no longer make rational decisions. In linking those characteristics together, Damasio concluded that body awareness and emotional awareness are necessary to decision making. He identified that the experiences we encounter in our lives leave pleasant and unpleasant traces inscribed in our bodies—somatic markers—that help guide our future decision making. For an easy test of Damasio’s theory, go to your kitchen and, one at a time, sniff one or more of your spices or herbs—start with the one you like best. As you take in the fragrance, observe what happens in your body—is the sensation in your stomach pleasant or unpleasant? Does anything change in your breathing? Then notice if any thoughts or images from your past are associated with that spice or herb, such as Grandma’s kitchen or a date at a particular restaurant. Whatever the result, the physical sensations and/or memories are all triggered by the somatic markers associated with that particular aroma. A pleasant experience will leave somatic markers that feel nice; unpleasant ones, something that is more disagreeable.
Somatic markers can be triggered by any of our senses. You might notice that sometimes the expression on your face and sensation in your gut change instantly when you first hear certain voices at the other end of the telephone line. Before you have even thought the person’s name, you have memories of your last encounter. That is a response of your somatic markers to that particular voice—or, if you do not know the person, to similar voices you have had experience with in your past. I often play musical clips at lectures to demonstrate how somatic markers work. Most people have strong ones associated with music. The Beatles’ “Come Together” always provides amusement for audiences who mostly were in college in the 1960s and 1970s. Hearing that song, many admit (sometimes reluctantly) to somatic markers that remind them of the smell of marijuana and to feeling a bit stoned. Somatic markers are powerful, indeed.
So what is the purpose of somatic markers and how are they relevant to mindfulness? Damasio believes that the traces left by the somatic markers from past experiences help to guide future decision making, usually acting behind our awareness. Developing and using a mindful gauge—a type of mindfulness for evaluating responses—will, in part, make your somatic markers conscious so you can use them for help in making decisions.
Returning to Barry’s situation from the beginning of this chapter, note that he became good at seeing or imagining a food and deciding if it would be good for him to eat. This is consistent with how Damasio sees decision making. You do not have to eat or do something to predict its effect. Elements of a current decision will have somatic markers for anything similar in the past. Usually this process is going on unconsciously. However, using mindfulness, you can become aware of the factors (past and present) affecting you—identifying somatic reactions, memory images, emotions, and so on—when facing new decisions. In this way, mindfulness can be applied to decisions about your trauma recovery: direction, strategies, timing, and so forth. Using mindfulness, your somatic markers have the potential to help guide your choices.
Discovering the Key: Janice, Part 1, Continued
Janice’s touch dilemma was not a easy one. The solution was not simply one way or the other. The answer would lie in finding a balance between two extremes. I suspected that mindfulness could be a powerful tool for Janice to help her find her way through to a compromise. If I could help Janice to identify her feelings about touch and her body reactions to it, she might then be able to distinguish which she could manage and stay present for and which would send her awareness packing. With mindful observation, she would get to know how her responses changed with various types of touch, different people, and shifts of her own or the other’s mind or mood. Going the mindfulness route would not be a quick fix, but would require some careful investigation on her part.
As discussed above, mindfulness involves attentiveness to the body and bodily sensations as well as feelings, thoughts, and impulses. It is through such awareness that Janice learned to identify her own mindful gauge. She then used her gauge to begin to negotiate her dilemma about touch. The initial process involved several steps.
The first mindful focus was to identify which signals were most obvious to Janice when she focused on decisions or options. I asked her to spend a week paying attention to simple tasks in her daily life such as deciding what to wear or eat. These basic choices could serve as a training ground for developing skill in this area of mindfulness. We first practiced together by having her choose a comfortable place to sit in the room with me. I asked her to move her chair to different distances and positions in relationship to the room and to where I was sitting, and to see what changed in her bodily sensations, her thoughts, or her mood. After trying several variations, she identified specific changes in her stomach sensations and also in her heart rate. When she sat close facing me directly, her heart would beat faster and her stomach felt twisted. She also noticed a picture in her mind of a scared rabbit. Moving her chair back a foot or so and turning it slightly to the right slowed her pulse. Her stomach felt more quiet and the rabbit in her mind’s eye looked happy.
With several gauges identified, I suggested Janice continue practice as homework in situations where there was little to no risky emotional component. For the next week she would use heart rate, stomach sensations, and the rabbit image to help her decide which television program to watch, which toothpaste to use, what to order or bring for lunch, and so on. She thought these tasks were a bit simplistic as she was anxious to get to her touch issue. However, she agreed that the better she became at identifying fluctuations in her gauge when there was little risk of upset, the more skilled she would be in a stressful situation. I likened this training to learning to swim in the shallow end, spending some time only kicking or blowing bubbles before moving on to the deep end of the pool. The analogy made sense to her and she was able to be patient as she spent a week or so gaining proficiency in using her gauges.
The next time I saw Janice, she was much more confident. She felt ready to use her mindful gauges to tackle her touch dilemma. The first task would be to distinguish types of touch she could manage from those which she did not or could not tolerate. To facilitate the process, Janice brought a trusted friend with her to the session. We began with Janice using mindfulness to become aware of her current state, emphasizing the gauges she had practiced using at home. This served to identify a baseline so we would know if and when anything changed. Understandably, she was slightly anxious about this new challenge. She noticed a slight increase in her heart rate and her rabbit looked guarded, though interested.
Janice then asked her friend for a hug. The friend complied and Janice immediately spaced out. It quickly became obvious that we had a third gauge: dissociation. Janice did not even hear my questions. I asked the friend to move back to her starting place and Janice slowly revived and came back into contact. This was a dramatic demonstration of her touch ambivalence. Discussing what had happened, Janice described it as becoming very dazed. She could see me and the room, but she could not hear me properly. In reviewing how she had decided to ask for a hug, Janice realized she had completely bypassed checking in with her now well-trained gauges. She had jumped to what she thought she wanted; she had not monitored her reactions to that thought. Janice was surprised when I called this first experiment a complete success. Though she thoroughly dissociated, she also learned a very useful, if uncomfortable, lesson.
It did not take long for Janice to realize herself that for the next step she needed to check with her gauges before asking. So she sat by herself a few feet from her friend and imagined getting a hug. She did not dissociate, but she could feel her heart rate go up and the bottom drop out of her stomach. The image of the rabbit in her mind froze, looking stunned. These responses told her that a hug was—at least at that moment in time—too risky. The reason could be the pressure of the situation, having me there as an observer, or that her system was just not ready for a hug in general. But none of that really mattered. Her gauges were clearly telling her, “No, not now!”
Janice became very sad. She wanted a hug but did not want to dissociate again. She felt hopeless. I had to remind her that we were just beginning and that there were many types of touch besides hugs. I encouraged Janice to imagine other kinds and degrees of touch: handshake, hand on shoulder or back, sitting side by side or back to back, touching feet, and so forth. For each imagined touch she was to, again, pay attention to her gauges. After a few minutes of imagination and gauge monitoring, Janice smiled shyly and asked her friend to just place a hand on her left shoulder. When the friend complied, Janice sighed and her eyes reddened; she did not dissociate. The contact was easy on her gauges (her heart rate stayed steady, as did her stomach; the rabbit image looked calm), though she felt sad as she knew a part of her wanted more. She was, however, pleased that she could tolerate the touch to her shoulder. And she was surprised at how much it meant to her to feel her friend’s touch without it making her anxious or dazed.
On that day, Janice felt successful on two counts. She was able to trust her gauges and to use them to find a way to be touched without dissociating. All in all, she felt proud of herself. We agreed that this was not at all the last step but the first of many. (For more about Janice, see Key 3.)
Applications for You
First of all, are you ready to apply this key?
If your answer to these questions is basically positive, then you are probably ready to try this out. However, if the idea makes no sense or you have felt distressed reading this chapter, it might be best to postpone or skip the exercises that follow. Alternatively, you could read through one exercise at a time and ask the same questions above before deciding if you will attempt it. Although there will be suggestions for applying mindful gauges in later chapters, they are not required for making use of the rest of the book. It is important that you take your time and—as with the Danish concept of chewing on a new idea that I mentioned in the introduction—sample and taste before (please excuse the mixed metaphor) diving in.
For those who are ready, now it is your turn to find one or more gauges that you can use to guide you in decisions about your trauma recovery—including determining which of the keys and exercises in this book are useful to you. The next few pages include exercises to build your skill in identifying and using mindful gauges. In addition, at the end of every chapter you will have a chance to practice using your gauges to evaluate if that chapter’s key is or is not useful and beneficial for you. At times you may want to use your gauge after you attempt an exercise or key. Also try using your gauge while just imagining the task, as Janice did while imagining types of touch and as Barry did when deciding what to eat. That will give you practice in predicting what might or might not help you without having to do it first. I wish Martha had been taught to do this before investing so much in a treatment program that was not suited to her needs.
Your mindful gauge will be unique. That means no one can tell you what your gauge is. Mindfulness will be your single best tool for discovering your unique gauge.
Janice discovered three gauges, but there are many, many more. I suggest additional ones below. Use my examples as inspiration to find your own unique gauge. Do not be surprised if you discover one or more that are not mentioned here.
As with Janice, mindfulness of changes in body states, for example, heart rate and stomach sensations, can be useful. You might also check for shifts anywhere in your body.
Please note: if focusing on body sensations is distressing for you, makes you anxious, or causes dissociation, use other aspects of mindfulness (below) to find your gauge.
Remember to consider the other foundations of mindfulness: feelings, thoughts, and images. You might find or discover a particular image in your mind’s eye that fluctuates (remember Janet’s rabbit). It could also be a sound image, like a song or poem that goes through your head. You might also pay attention to changes in your mood or your thoughts. Unfortunately, it would be impossible to give you a complete list. So be open to the possibility that your gauge will be something different than I have written about here. The most important thing is that you discover what your gauge is and identify what changes in your gauge signify for you.
It is always best to begin exercising new tools with tasks and situations where there is no risk. You could explore some of the same things as Janice: choosing what you wear, eat, or watch on television. Do not be surprised if you find you have a different gauge for different types of choices. For example, perhaps it is stomach sensations that are the strongest when you decide what to eat, but it is your mood that is affected most when you decide what you will wear.
The exercises that follow are meant to help you to find and practice with your own gauges. Do not become discouraged if you sometimes forget to use your gauge or cannot access it. Any new skill gets easier and more habitual with use. The more you can practice when you are feeling calm, the more available your gauge will be to you in situations where you are ill at ease.
NOTE: The following exercises may be done with eyes open or eyes closed. If you are not sure, alternate and see what works best for you.
Exercise 1: The Foundations of Mindfulness
What is the best gauge for you? Do you fare best when you pay attention to your:
If you already know, you might want to skip these exercises. For those of you who do not know your best gauge, experimenting with each is the way to find out.
Choose one of the gauge categories above (e.g., sensations, feelings), then try one or more of these mindful experiments:
After you try one gauge option (e.g., your mood), you can go on to another (e.g., body sensations), and so on. But do not overwhelm yourself by attempting too much at once. It is fine to try one and later return to this exercise to try something else. Eventually it would be good to try them all, or to create your own experiments. Do not forget to include and keep track of any other gauges you discover on your own.
Your most reliable gauges will be those that are easy for you to identify and have clearly noticeable changes. For instance, if your heart rate always goes up as an adverse reaction and down as a pleasant reaction, or if you always hear the same (or same type of) tune when you are doing or eating something that feels good and another when you are doing or eating something that does not feel good, then those will be reliable. The only way to discover your gauges is to experiment with many possibilities. It is worth the trouble, because when you have the use of one or more, they will serve you well.
Exercise 2: Practice Your Gauges With Benign Choices
For testing your newfound gauges, start with choices that have little to no risk associated with them. For example: Which cereal for breakfast? Should you wear a coat or sweater today? To apply your gauge, take an extra couple of seconds to consider or imagine whatever the choice is. Then notice how your gauge changes to help guide your final decision.
You could also experiment with all types of foods, using mindfulness to monitor how you react to different choices. Notice which foods help you to feel calmer or if any make you feel more stimulated or hyped up. Reactions to food are very, very individual. For instance, some people feel very calm after eating an apple or a potato and others (such as Barry) anxious (of course, many notice nothing at all). Applying mindfulness to what you eat can be a good way to discover which foods might be allies in your trauma recovery.
As you pay more and more attention, it is possible that you will discover additional gauges based in somatic markers that were previously outside of your awareness. Do not be disappointed if this does not happen, as you can rest assured that your somatic markers are working anyway. However, if any do emerge, take note.
Exercise 3: Practice Your Gauges With More Relevant Choices
Once you feel you have gained some proficiency with your gauges in benign situations, you can test them with something more difficult. This is what Janice did when she used her gauge to help her determine a kind of touch that she might tolerate. Remember, she first imagined several scenarios and then picked one to try based on which image gave her the most comfortable response.
Pick something in your daily life that has a little more risk to it (but not the most risky, yet) and imagine several possibilities. Perhaps it will be something you want to buy, or deciding which friend to invite for dinner. Use your gauge to pick the choice you will pursue. After you have followed through, evaluate how accurate your gauge was. If you were successful, then you can try an even riskier situation. However, if the result did not go as hoped, review your steps and see if there was something in your gauge that you missed—or if you need a different gauge for that kind of choice—before going on to something more difficult.
Exercise 4: Practice Your Gauges to Plot Your Course
When you are ready, you can apply your gauge to decide your next step or to make a decision about a strategy, exercise, or direction for your recovery. Turn to the table of contents and take a moment to contemplate each of the other keys. See which one gives you the most positive response in your gauge. It may be the next chapter or it may be the last. Though it might be a good idea to read or skim the book through first, you do not have to apply the chapters in order. Take them in turn as they feel right to you, using your gauge as a guide. That means you may put off topics or exercises that feel daunting and start with the ones that feel the most comfortable. It may be that you skip one or more altogether. In doing so, you will be guiding yourself toward your safest trauma recovery. One caveat: If you decide to read the chapters out of order, you will periodically come to a reference to an earlier chapter. I will endeavor to include a page reference so you can review the relevant excerpt.
Evaluate This Key
At the beginning of this chapter, I expressed the hope that you will be able to use one or more mindfulness gauges to evaluate and plan the safest recovery program for your unique needs and situation. Now is a good time to start.
Take a few minutes to review the exercises you have done thus far and pay attention to your gauge. Which results lean in a positive direction? Which in a negative direction? Based on your evaluation, which exercises or strategies would you repeat and which would you not? Will the results of your evaluation affect how you choose other exercises in this book? If so, how?
Plan How to (or Not to) Use This Key
Is this key for you? If so, why? If not, why not? Consider if you will use this key in the future. In which kinds of situations or with which sorts of dilemmas will you find this key most useful?
It is common to become enthusiastic about new tools but then sometimes lose connection to them or forget about them—I certainly know this tendency in myself and others in both my personal and professional spheres. If you have found using your mindful gauge of benefit, plan how you will remember to apply it when it could be of use. For example, you could post a note on your bathroom mirror, draw a symbol on the palm of your hand, or leave yourself a voice mail message. It does not matter what strategy you use to remember your gauge, just that you have one that will jog your memory and help you to keep using your gauge where appropriate and helpful.
Endnote: Mindfulness and Common Sense
I am often asked, “How will I know if it is mindfulness telling me ‘no’ or if I am just afraid or resisting?” My answer might surprise you. Actually, I do not think the difference matters. Any time your system is strongly telling you no, there must be a good reason. For an important decision, mindfulness should be a major contributor, but not always the only factor. In general, it should be joined by available knowledge and liberal amounts of common sense. Sometimes it will be primarily mindfulness; at other times it will be common sense, which carries the most weight. What follows is a personal example of the cooperation between mindfulness, knowledge, and common sense.
Shortly before my 51st birthday, I came down with acute appendicitis. The diagnosis was confirmed in the emergency room late one night and I was scheduled for surgery early the next morning. I had never had surgery before and while I waited, I was terrified. Every one of my mindful gauges screamed that I did not want to have the operation. On the other hand, everything in my common sense told me that, though afraid, I must go along with the doctor’s recommendation. There was no doubt that my mindful reluctance had good reason: All surgery carries risk. Still, my common sense, supported by my basic knowledge concerning the consequences of untreated appendicitis, convinced me that surgery was my best option. However, that did not mean ignoring my mindful gauges. I actually paid a lot of attention to my internal screaming and was able to talk with the emergency room doctor, the surgeon, and even the anesthesiologist about my concerns and fears. The support and respect that they then showed for my feelings (not to mention their competence) helped to make that potentially traumatic situation manageable as well as successful. The professionals deserve a large share of the credit, but so do I—for paying attention to both my common sense and mindfulness.