Oh, I’ve had my moments, and if I had to do it over again, I’d have more of them. In fact, I’d try to have nothing else. Just moments, one after another, instead of living so many years ahead of each day.
—NADINE STAIR, EIGHTY-FIVE YEARS OLD, LOUISVILLE, KENTUCKY
As I look around at the thirty or so people in this new class in the Stress Reduction Clinic, I marvel at what we are coming to engage in together. I assume they all must be wondering to some extent what the hell they are doing here in this room full of total strangers this morning. I see Edward’s bright and kind face and ponder what he must be carrying around daily. He is a thirty-four-year-old insurance executive with AIDS. I see Peter, a forty-seven-year-old businessman who had a heart attack eighteen months ago and is here to learn how to take it easy so that he doesn’t have another one. Next to Peter is Beverly, bright, cheerful, and talkative; sitting next to her is her husband. At forty-two Beverly’s life changed radically when she had a cerebral aneurysm that burst, leaving her uncertain about how much she is her real self. Then there is Marge, forty-four years old, referred from the pain clinic. She had been an oncology nurse until she injured her back and both knees several years ago trying to prevent a patient from falling. Now she is in so much pain that she can’t work and walks only with great effort, using a cane. She has already had surgery on one knee and now, on top of everything else, faces surgery for a mass in her abdomen. The doctors won’t know for sure what it is until they operate. Her injury knocked her for a loop from which she has yet to recover. She feels wound up like a spring and has been exploding at the littlest things.
Next to Marge is Arthur, fifty-six, a policeman who suffers from severe migraine headaches and frequent panic attacks, and sitting next to him is Margaret, seventy-five, a retired schoolteacher who is having trouble sleeping. A French Canadian truck driver named Phil is on the other side of her. Phil was also referred here by the pain clinic. He injured himself lifting a pallet and is out on disability from chronic low-back pain. He will not be able to drive a truck anymore and needs to learn how to handle this pain better and figure out what other type of work he will be able to do to support his family, which includes four small children.
Next to Phil is Roger, a thirty-year-old carpenter who injured his back at work and is also in pain. According to his wife, he has been abusing pain medications for several years. She is enrolled in another class. She makes no bones about Roger being the major source of her stress. She is so fed up with him that she is certain they are going to get divorced. I wonder, as I look over at him, where his life will carry him and whether he will be able to do what is necessary to get his life on an even keel.
Hector sits facing me across the room. He wrestled professionally for years in Puerto Rico and has come here today because he has a hard time controlling his temper and is feeling the consequences of it in the form of violent outbursts and chest pains. His large frame is an imposing presence in the room.
Their doctors have sent them all here for stress reduction, and we have invited them to come together one morning a week at the medical center for the next eight weeks in this class. For what, really? I find myself asking as I look around the room. They don’t know it as well as I do yet, but the level of collective suffering in the room this morning is immense. It is truly a gathering of people suffering not only physically but emotionally as well from the full catastrophe of their lives.
In a moment of wonder before the class gets under way, I marvel at our chutzpah in inviting all these people to embark on this journey. I find myself thinking, What can we possibly do for the people gathered here this morning and for the 120 others who are beginning the MBSR program in different classes this week—young people and older people; single, married, or divorced; people who are working, others who are retired or on disability; people on Medicaid and people who are well off? How much can we influence the course of even one person’s life? What can we possibly do for all these people in eight short weeks?
The interesting thing about this work is that we don’t really do anything for them. If we tried, I think, we would fail miserably. Instead we invite them to do something radically new for themselves, namely to experiment with living intentionally from moment to moment. When I was talking to a reporter, she said, “Oh, you mean to live for the moment.” I said, “No, it isn’t that. That has a hedonistic ring to it. I mean to live in the moment.”
The work that goes on in the Stress Reduction Clinic is deceptively simple, so much so that it is difficult to grasp what it is really about unless you become involved in it personally. We start with where people are in their lives right now, no matter where that is. We are willing to work with them if they are ready and willing to engage in a certain kind of work with and on themselves. And we never give up on anyone, even if they get discouraged, have setbacks, or are “failing” in their own eyes. We see each moment as a new beginning, a new opportunity to start over, to tune in, to reconnect.
In some ways our job is hardly more than giving people permission to live their moments fully and completely and providing them with some tools for going about it systematically. We introduce them to ways that they can use to listen to their own bodies and minds and to begin trusting their own experience more. What we really offer people is a sense that there is a way of being, a way of looking at problems, a way of coming to terms with the full catastrophe that can make life more joyful and rich than it otherwise might be, and a sense also of being somehow more in control. We call this way of being the way of awareness or the way of mindfulness. The people gathered here this morning are about to encounter this new way of being and seeing as they embark on this journey in the Stress Reduction Clinic, this journey of mindfulness-based stress reduction. We will have occasion to meet them again and others as well along the way as we now embark upon our own exploration of mindfulness and healing.
If you were to look in on one of our classes at the hospital, the chances are you would find us with our eyes closed, sitting quietly or lying motionless on the floor. This can go on for anywhere from ten minutes to forty-five minutes at a stretch.
To the outside observer it might look strange, if not a little crazy. It looks like nothing is going on. And in a way nothing is. But it is a very rich and complex nothing. These people you would be looking in on are not just passing time daydreaming or sleeping. You cannot see what they are doing, but they are working hard. They are practicing non-doing. They are actively tuning in to each moment in an effort to remain awake and aware from one moment to the next. They are practicing mindfulness.
Another way to say it is that they are “practicing being.” For once, they are purposefully stopping all the doing in their lives and relaxing into the present without trying to fill it up with anything. They are purposefully allowing body and mind to come to rest in the moment, no matter what is on their mind or how their body feels. They are tuning in to the basic experiences of living. They are simply allowing themselves to be in the moment with things exactly as they are, without trying to change anything.
In order to be admitted to the stress clinic in the first place, each person had to agree to make a major personal commitment to spend some time every day practicing this “just being.” The basic idea is to create an island of being in the sea of constant doing in which our lives are usually immersed, a time in which we allow all the doing to stop.
Learning how to suspend all your doing and shift over to a being mode, how to make time for yourself, how to slow down and nurture calmness and self-acceptance in yourself, learning to observe what your mind is up to from moment to moment, how to watch your thoughts and how to let go of them without getting caught up and driven by them, how to make room for new ways of seeing old problems and for perceiving the inter-connectedness of things—these are some of the lessons of mindfulness. This kind of learning involves turning toward and settling into moments of being, and simply cultivating awareness.
The more systematically and regularly you practice, the more the power of mindfulness will grow and the more it will work for you. This book is meant to serve as a guide in this process, just as the weekly classes are a guide to the people who come to the Stress Reduction Clinic at the urging of their doctors.
As you know, a map is not the territory it portrays. In the same way, you should not mistake reading this book for the actual journey. That journey you have to live yourself, by cultivating mindfulness in your own life.
If you think about it for a moment, how could it be otherwise? Who could possibly do this kind of work for you? Your doctor? Your relatives or your friends? No matter how much other people want to help you and can help you in your efforts to move toward greater levels of health and well-being, the basic effort still has to come from you. After all, no one is living your life for you, and no one’s care for you could or should replace the care you can give to yourself.
In this regard, cultivating mindfulness is not unlike the process of eating. It would be absurd to propose that someone else eat for you. And when you go to a restaurant, you don’t eat the menu, mistaking it for the meal, nor are you nourished by listening to the waiter describe the food. You have to actually eat the food for it to nourish you. In the same way, you have to actually practice mindfulness, by which I mean cultivate it systematically in your own life, in order to reap its benefits and come to understand why it is so valuable.
Even if you send away for the CDs or download the guided meditations to support your efforts in practicing, you will still have to use them. CDs sit on shelves and gather dust very nicely. Audio files go unlistened to for ages. Nor is there any magic in them. Just listening to them from time to time will not help you much, although it can be relaxing. To benefit deeply from this work, you will have to do the CDs, as we say to our patients, not just listen to them. If there is magic anywhere, it is in you, not in any CD or in a particular practice.
Until recently, the very word meditation tended to evoke raised eyebrows and thoughts about mysticism and hocus-pocus in many people. In part, that was because people did not understand that meditation is really about paying attention. This is now more widely known. And since paying attention is something that everybody does, at least occasionally, meditation is not as foreign or irrelevant to our life experience as we might once have thought.
However, when we start paying attention a little more closely to the way our own mind actually works, as we do when we meditate, we are likely to find that much of the time our mind is more in the past or the future than it is in the present. This is the endemic mind wandering we all experience, which was investigated in the Harvard happiness iPhone app study. As a consequence, in any moment we may be only partially aware of what is actually occurring in the present. We can miss many of our moments because we are not fully here for them. This is true not just while we are meditating. Unawareness can dominate the mind in any moment; consequently, it can affect everything we do. We may find that much of the time we are really on automatic pilot, functioning mechanically without being fully aware of what we are doing or experiencing. It’s as if we are not really at home a lot of the time or, put another way, only half awake.
You might verify for yourself whether this description applies to your mind the next time you are driving a car. It is a very common experience to drive someplace and have little or no awareness of what you saw along the way. You may have been on automatic pilot for much of the drive, not really fully there but there enough, one would hope, to drive safely and uneventfully.
Even if you deliberately try to concentrate on a particular task, whether it’s driving or something else, you might find it difficult to be in the present for very long. Ordinarily our attention is easily distracted. The mind tends to wander. It drifts into thought and reverie.
Our thoughts are so overpowering, particularly in times of crisis or emotional upheaval, that they easily cloud our awareness of the present. Even in relatively relaxed moments they can carry our senses along with them whenever they take off, as when driving, we find ourselves looking intently at something we have passed long after we should have brought our attention back to the road in front of us. For that moment, we were not actually driving. We were on autopilot. The thinking mind was “captured” by a sense impression—a sight, a sound, something that attracted its attention—and was pulled away. It was back with the cow, or the tow truck, or whatever it was that caught our attention. As a consequence, at that moment, and for however long our attention was captured, we were literally “lost” in our thoughts and unaware of other sense impressions.
Is it not true that the same thing happens most of the time, whatever you are doing? Try observing how easily your awareness is carried away from the present moment by your thoughts, no matter where you find yourself, no matter what the circumstances. Notice how much of the time during the day you find yourself thinking about the past or about the future. You may be shocked at the result.
You can experience this pull of the thinking mind for yourself right now if you perform the following experiment. Close your eyes, sit so that your back is straight but not stiff, and become aware of your breathing. Don’t try to control your breathing. Just let it happen and be aware of it, feeling how it feels, witnessing it as it flows in and out. Try being with your breath in this way for three minutes.
If, at some point, you think that it is foolish or boring to just sit here and watch your breath go in and out, note to yourself that this is just a thought, a judgment that your mind is creating. Then simply let go of it and bring your attention back to your breathing. If the feeling is very strong, try the following additional experiment, which we sometimes suggest to our patients who feel similarly bored with watching their breathing: take the thumb and first finger of either hand, clamp them tightly over your nose, keep your mouth closed, and notice how long it takes before your breathing becomes very interesting to you!
When you have completed three minutes of watching your breath go in and out, reflect on how you felt during this time and how much or how little your mind wandered away from your breathing. What do you think would have happened if you had continued for five or ten minutes, or for half an hour, or an hour?
For most of us, our minds tend to wander a lot and to jump quite rapidly from one thing to another. This makes it difficult to keep our attention focused on our breathing for any length of time unless we train ourselves to stabilize and calm our own mind. This little three-minute experiment can give you a taste of what meditation is. It is the process of observing body and mind intentionally, of letting your experiences unfold from moment to moment and accepting them as they are. It does not involve rejecting your thoughts, trying to clamp down on them or suppress them, or trying to regulate anything at all other than the focus and direction of your attention.
Yet it would be incorrect to think of meditation as a passive process. It takes a good deal of energy and effort to regulate your attention and to remain genuinely calm and non-reactive. But, paradoxically, mindfulness does not involve trying to get anywhere or feel anything special. Rather, it involves allowing yourself to be where you already are, to become more familiar with your actual experience moment by moment. So if you didn’t feel particularly relaxed in these three minutes or if the thought of doing it for half an hour is inconceivable to you, you don’t need to worry. The relaxation, the sense of being more at home in your own skin, comes by itself with continued practice. The point of this three-minute exercise was simply to try to pay attention to your breathing and to note what actually happened when you did. It was not to become more relaxed. The relaxation, the equanimity, the well-being emerge all by themselves when we attend wholeheartedly in this way.
If you start paying attention to where your mind is from moment to moment throughout the day, as the researchers in the iPhone app study suggested might be critically important for our quality of life, chances are you will find that considerable amounts of your time and energy are expended in clinging to memories, being absorbed in reverie, and regretting things that have already happened and are over. And you will probably find that as much or more energy is expended in anticipating, planning, worrying, and fantasizing about the future and what you want to happen or don’t want to happen.
Because of this inner busyness, which is going on almost all the time, we are liable either to miss a lot of the texture of our life experience or to discount its value and meaning. For example, let’s say you are not too preoccupied to look at a sunset, and are struck by the play of light and color among the clouds and in the sky. For that moment, you are just there with it, taking it in, really seeing it. Then thinking comes in and perhaps you find yourself saying something to a companion, either about the sunset and how beautiful it is or about something else that it reminded you of. In speaking, you disturb the direct experiencing of the moment. You have been drawn away from the sun and sky and the light. You have been captured by your own thought and by your impulse to voice it. Your comment breaks the silence. Or even if you don’t say anything, the thought or memory that came up had already carried you away to some degree from the actual sunset in that moment. So now you are really enjoying the sunset in your head rather than the sunset that is actually happening. You may be thinking you are enjoying the sunset itself, but actually you are only experiencing it through the veil of your embellishments with past sunsets and other memories and ideas that this one triggered in you. All this may happen completely below the level of your conscious awareness. What is more, this entire episode might last only a moment or so. It will fade rapidly as one thing leads to the next.
Much of the time you may get away with being only partially conscious like this. At least it seems that way. But what you are missing is more important than you realize. If you are only partially conscious over a period of years, if you habitually run through your moments without being fully in them, you may miss some of the most precious experiences of your life, such as connecting with the people you love, or with sunsets or the crisp morning air.
Why? Because you were “too busy” and your mind too encumbered with what you thought was important in that moment to take the time to stop, to listen, to notice things. Perhaps you were going too fast to slow down, too fast to know the importance of making eye contact, of touching, of being in your body. When we are functioning in this mode, we may eat without really tasting, see without really seeing, hear without really hearing, touch without really feeling, and talk without really knowing what we are saying. And, of course, in the case of driving, if your mind or somebody else’s happens to check out at the wrong moment, the immediate consequences can be dramatic and very unfortunate.
So the value of cultivating mindfulness is not just a matter of getting more out of sunsets. When unawareness dominates the mind, all our decisions and actions are affected by it. Unawareness can keep us from being in touch with our own body, its signals and messages. This in turn can create many physical problems for us, problems we don’t even know we are generating ourselves. And living in a chronic state of unawareness can cause us to miss much of what is most beautiful and meaningful in our lives—and, as a consequence, be significantly less happy than we might be otherwise. What is more, as in the driving example, or in the case of alcohol and drug abuse or habits such as workaholism, our tendency toward unawareness may also be lethal, either rapidly or slowly.
When you begin paying attention to what your mind is doing, you will probably find that there is a great deal of mental and emotional activity going on beneath the surface. These incessant thoughts and feelings can drain a lot of your energy. They can be obstacles to experiencing even brief moments of stillness and contentment.
When the mind is dominated by dissatisfaction and unawareness, which is much more often than most of us are willing to admit, it is difficult to feel calm or relaxed. Instead, we are likely to feel fragmented and driven. We will think this and that, we want this and that. Often the this and the that are in conflict. This mind state can severely affect our ability to do anything or even to see situations clearly. In such moments we may not know what we are thinking, feeling, or doing. What is worse, we probably won’t know that we don’t know. We may think we know what we are thinking and feeling and doing and what is happening. But it is an incomplete knowing at best. In reality we are being driven by our likes and dislikes, totally unaware of the tyranny of our own thoughts and the self-destructive behaviors they often result in.
Socrates was famous in Athens for saying, “Know thyself.” It is said that one of his students said to him: “Socrates, you go around saying ‘Know thyself,’ but do you know yourself?” Socrates was said to have replied, “No, but I understand something about this not knowing.”
As you embark upon your practice of mindfulness meditation, you will come to know something for yourself about your own not knowing. It is not that mindfulness is the “answer” to all life’s problems. Rather, it is that all life’s problems can be seen more clearly through the lens of a clear mind. Just being aware of the mind that thinks it knows all the time is a major step toward learning how to see through your opinions and perceive things as they actually are.
One very important domain of our lives and experience that we tend to miss, ignore, abuse, or lose control of as a result of being in the automatic pilot mode is our own body. We may be barely in touch with our body, unaware of how it is feeling most of the time. As a consequence, we can be insensitive to how our body is being affected by the environment, by our actions, and even by our thoughts and emotions. If we are unaware of these connections, we might easily feel that our body is out of control and we will have no idea why. As you will see in Chapter 21, physical symptoms are messages the body is giving us that allow us to know how it is doing and what its needs are. When we are more in touch with our body as a result of paying attention to it systematically, we will be far more attuned to what it is telling us and better equipped to respond appropriately. Learning to listen to your body is vital to improving your health and the quality of your life.
Even something as simple as relaxation can be frustratingly elusive if you are unaware of your body. The stress of daily living often produces tension that tends to localize in particular muscle groups, such as the shoulders, the jaw, and the forehead. In order to release this tension, you first have to know it is there. You have to feel it. Then you have to know how to shut off the automatic pilot and how to take over the controls of your own body and mind. As we will see further on, this involves zeroing in on your body with a focused mind, experiencing the sensations coming from within the muscles themselves, and sending them messages to let the tension dissolve and release. This is something that can be done at the time the tension is accumulating if you are mindful enough to sense it. There is no need to wait until it has built to the point that your body feels like a two-by-four. If you let it go that long, the tension will have become so ingrained that you will have probably forgotten what it feels like to be relaxed, and you may have little hope of ever feeling relaxed again.
One Vietnam war veteran who came to the clinic years ago with back pain put the dilemma in a nutshell. While testing his range of motion and flexibility, I noticed that he was very stiff and his legs were as hard as rocks, even when I asked him to relax them. They had been that way ever since he was wounded when he stepped on a booby trap in Vietnam. When his doctor told him that he needed to relax, he had responded, “Doc, telling me to relax is about as useful as telling me to be a surgeon.”
The point is, it didn’t do this man any good to be told to relax. He knew he needed to relax more. But he had to learn how to relax. He had to experience the process of letting go within his own body and mind. Once he started meditating, he was able to learn to relax, and his leg muscles eventually regained a healthy tone.
When something goes wrong with our body or our mind, we have the natural expectation that medicine can make it right, and often it can. But as we will see further on, our active collaboration is essential in almost all forms of medical treatment. It is particularly vital in the case of chronic diseases or conditions for which medicine has no cures. In such cases the quality of your life may greatly depend on your ability to know your own body and mind well enough to work at optimizing your own health within the bounds, always unknown, of what may be possible. Whatever your age, taking responsibility for learning more about your body by listening to it carefully and by cultivating your inner resources for healing and for maintaining health is the best way to hold up your end of this collaboration with your doctors and with medicine. This is where the meditation practice comes in. It gives power and substance to such efforts. It catalyzes the work of healing.
The first introduction to the meditation practice in MBSR always comes as a surprise to our patients. More often than not, people come with the idea that meditation means doing something unusual, something mystical and out of the ordinary, or, at the very least, something relaxing. To relieve them of these expectations right off the bat, we give everybody three raisins and we eat them one at a time, paying attention to what we are actually doing and experiencing from moment to moment. You might wish to try it yourself after you see how we go about it.
First we bring our attention to seeing one of the raisins, observing it carefully as if we had never seen one before. We feel its texture between our fingers and notice its colors and surfaces. We are also aware of any thoughts we might be having about raisins or food in general. We note any thoughts and feelings of liking or disliking raisins if they come up while we are looking at it. We then smell it for a while, and finally, with awareness, we bring it to our lips, being aware of the arm moving the hand to position it correctly, and of salivating as the mind and body anticipate eating. The process continues as we take it into our mouth and chew it slowly, experiencing the actual taste of one raisin. And when we feel ready to swallow, we watch the impulse to swallow as it comes up, so that even that is experienced consciously. We even imagine, or “sense,” that now our bodies are one raisin heavier. Then we do it again with another raisin, this time without any verbal guidance, in other words, in silence. And then with the third.
The response to this exercise is invariably positive, even among the people who don’t like raisins. People report that it is satisfying to eat this way for a change, that they actually experienced what a raisin tasted like for the first time that they could remember, and that even one raisin could be satisfying. Often someone makes the connection that if we ate like that all the time, we would eat less and have more pleasant and satisfying experiences of food. Some people usually comment that they caught themselves automatically moving to eat the other raisins before finishing the one that was in their mouth, and recognized in that moment that this is the way they normally eat.
Since many of us use food for emotional comfort, especially when we feel anxious or depressed or even just bored, this little exercise in slowing things down and paying careful attention to what we are doing illustrates how powerful, uncontrolled, and unhelpful many of our impulses are when it comes to food, and how simple and satisfying it can be and how much more in control we can feel when we bring awareness to what we are actually doing while we are doing it.
The fact is, when you start to pay attention in this way, your relationship to things changes. You see more, and you see more deeply and clearly. You may start seeing an intrinsic order and connectedness between things that were not apparent before, such as the connection between impulses that come up in your mind and finding yourself overeating and disregarding the messages your body is giving you. By paying attention, you literally become more awake. It is an emerging from the usual ways in which we all tend to see things and do things mechanically, without full awareness. When you eat mindfully, you are in touch with your food because your mind is not distracted, or at least it is less distracted. It is not thinking about other things. It is attending to eating. When you look at the raisin, you really see it. When you chew it, you really taste it.
Knowing what you are doing while you are doing it is the essence of mindfulness practice. This knowing is a non-conceptual knowing, or a bigger than conceptual knowing. It is awareness itself. It is a capacity you already have. That’s why we call the raisin-eating exercise “eating meditation.” It helps make the point that there is nothing particularly unusual or mystical about meditating or being mindful. All it involves is paying attention to your experience from moment to moment. This leads directly to new ways of seeing and being in your life because the present moment, whenever it is recognized and honored, reveals a very special, indeed magical power: it is the only time that any of us ever has. The present is the only time that we have to know anything. It is the only time we have to perceive, to learn, to act, to change, to heal, to love. That is why we value moment-to-moment awareness so highly. While we may have to teach ourselves how to inhabit this capacity of our own mind for this kind of knowing through practicing, the effort itself is its own end. It makes our experiences more vivid and our lives more real.
As you will see in the next chapter, to embark on the practice of mindfulness meditation it is helpful to deliberately introduce a note of simplicity into your life. This can be done by setting aside a time during the day for moments of relative peace and quiet, moments you can use to focus on the basic experiences of living such as your breathing, the sensations you feel in your body, and the flowing movement of thoughts in your mind. It doesn’t take long for this formal meditation practice to spill over into your daily life in the form of intentionally paying greater attention from one moment to the next, no matter what you are doing. You might find yourself spontaneously paying attention more of the time in your life, not just when you are “meditating.”
We practice mindfulness by remembering as best we can—and that means with considerable kindness toward ourselves as well as with some resolve and discipline—to be present in all our waking moments. We can practice taking out the garbage mindfully, eating mindfully, driving mindfully. We can practice navigating through all the ups and downs we encounter, the storms of the mind and the storms of our bodies, the storms of the outer life and of the inner life. We learn to be aware of our fears and our pain, yet at the same time stabilized and empowered by a connection to something deeper within ourselves, a discerning wisdom that helps to penetrate and transcend the fear and the pain, and to discover some peace and hope within our situation as it is.
We are using the word practice here in a special way. It does not mean a rehearsal or a perfecting of some skill so that we can put it to use at some other time. In the meditative context, practice means “being in the present on purpose.” The means and the end of meditation are really the same. We are not trying to get somewhere else, only working at being where we already are and being here fully. Our meditation practice may very well deepen over the years, but actually we are not practicing for this to happen. Our journey toward greater health and well-being is really a natural progression. Awareness, insight, and indeed health as well, ripen on their own if we are willing to pay attention in the moment and remember that we have only moments to live.