When we use the word healing to describe the experiences of people engaging in mindfulness training through MBSR, what we mean above all is that they are undergoing a profound transformation of view, what I sometimes refer to as a “rotation in consciousness.” This transformation is brought about by the encounter with one’s own wholeness, catalyzed by the meditation practice itself. When we glimpse our own completeness in the stillness of any moment, when we directly experience ourself during the body scan or the sitting meditation, or while practicing the yoga as whole in this very moment and also as part of a larger whole, a new and profound encountering and coming to terms with our problems and our suffering begins to take place. We begin to see both ourselves and our problems differently, namely from the perspective of wholeness. This transformation of view creates an entirely different context within which we can see and work with our problems, however serious they may be. It is a perceptual shift away from fragmentation and isolation and toward wholeness and interconnectedness. With this change of perspective comes a shift from feeling out of control and beyond help (helpless and pessimistic) to a sense of the possible, a sense that this situation might just be workable if you yourself are willing to do a certain amount of work. We can discover a sense of acceptance and inner peace, and even control, if by control we mean manageability or workability within a larger framework and embrace. Healing always involves an attitudinal and emotional transformation. Sometimes, but not always, it is also accompanied by a major reduction in physical symptoms and by improvement in a person’s physical condition.
This transformation of view comes about in many different ways as people immerse themselves in the MBSR curriculum and in mindfulness meditation practice. In the Stress Reduction Clinic, sometimes people have sudden and dramatic experiences during meditation that lead them to new ways of seeing. More frequently, people speak of moments of simply feeling deeply relaxed or confident. Many times they don’t even recognize such experiences at the time they are happening as being particularly important, although they often can’t remember ever having had such an experience before. These incremental transformations can be quite subtle. Yet they can be as profound or even more so as the more dramatic ones. Dramatic or subtle, such shifts in perspective are signs of seeing with eyes of wholeness. Out of this shift in perspective comes an ability to act with greater balance and inner security in the world, especially when encountering stress or pain.
In the first week of the program Phil, a forty-seven-year-old French Canadian truck driver who had injured his back three years previously in a lifting accident, and who had been referred to the Stress Reduction Clinic by his doctors in the Pain Clinic, had a breakthrough while practicing the body scan. He started out listening to the CD while lying on his back. He was in a lot of pain, and he said to himself, “Oh my God, I don’t know if I can do this.” But because he had made the commitment to “do it right” in spite of his pain, he stayed with the voice on the CD. After about twenty minutes, he started feeling his breathing “all over his body,” and he found himself completely focused on that extraordinary feeling of his body breathing. He said to himself, “Wow, this is great!” Then he realized something else: he wasn’t feeling any pain at all. Phil found that he was able to tap into a similar experience with the body scan practice each day that week. He came to the second class ecstatic.
The next week turned out to be just the opposite. Nothing he did made any difference. He practiced the body scan with the CD every day, but his pain was just as bad as it had ever been. Nothing he did could bring back the feelings he had had the first week. I suggested that perhaps he was trying too hard to bring back his experiences of the first week. Perhaps he was fighting with his pain now, trying to get rid of it so that he could regain those good feelings. He went home determined to look into what I had suggested. He made up his mind that he would simply try to let whatever was going to happen during the body scan happen, and not try to achieve a particular outcome. After that, things went more smoothly. When he ceased fighting with his pain, he was able to concentrate and be a lot calmer during the body scan. He discovered that the pain would diminish as his concentration deepened. On average, he said, it would be about 40 to 50 percent less severe, sometimes even more, by the end of the forty-five minutes.
Joyce came to the Stress Reduction Clinic referred by her oncologist, shortly after having been treated for a cancerous tumor on her leg. At the time she was fifty years old. Her husband had died from esophageal cancer two years earlier, a “horrendous and painful death,” and on the day he died, her mother also died unexpectedly. Her own medical problems had started while she was taking care of her husband. With increasing frequency, she felt pain in her right thigh that would travel down her leg. She consulted several doctors, who said that it was nothing serious, either varicose veins or just part of getting older. One day, two years after the death of her husband and her mother, as she was picking out a Christmas tree with her son, her thighbone broke. When she was operated on, a tumor called a plasmacytoma was discovered that had eaten away the bone to the point where it had just crumbled. They removed the tumor and rebuilt the bone with a bone graft. During the surgery, Joyce bled so much that the surgeon told her children that he did not expect her to survive. But she did. She then underwent six weeks of radiation therapy and, soon after, was referred to the Stress Reduction Clinic.
When Joyce took the CD home from her first class, she said to herself that she was going to do everything that she was told to do in the course and that she was really going to get into it. The first time she did the body scan, she had what she described as “a very powerful experience of some otherness.” This feeling came up toward the end of the CD, during an extended stretch of silence. She remembered saying to herself at the time, “Oh, so this is what God is.” In describing it, she said “it felt like a nothingness and an everything at the same time. It wasn’t any kind of person or anything that I had ever thought of as God.”
Joyce still remembered this feeling ten years later and said that it was what kept her going through some very difficult times, which included multiple surgeries to repair her bone graft, a hip replacement, and severe family stresses. She was convinced that her meditation practice was responsible for keeping her plasmacytoma in remission and preventing it from progressing to multiple myeloma, which it does in almost all cases within five years. Her oncologist said that he had never seen another case in which a plasmacytoma did not cross over to become multiple myeloma in that period of time. He was not convinced that Joyce’s meditating was responsible for her remission, but he admitted that he didn’t have any idea why the disease had not progressed. Whatever the reason, he was happy about it and hoped things would continue that way. He supported Joyce in doing everything of a positive nature that she believes in to keep mind and body in harmony.
Both Phil and Joyce had strong experiences with the body scan right off the bat. Others sometimes go for weeks before experiencing even a little relaxation or stillness or change in perspective. Yet we find that if we explore their experience together in dialogue, something positive is usually stirring beneath the surface for most people as a result of practicing the body scan regularly in the first two weeks, even if it is not so dramatic. Interestingly enough, sometimes these stirrings don’t manifest fully until the person switches over and starts doing the yoga. The change to a more active use of the body can trigger a change in perspective that has been slowly building below the person’s level of awareness during weeks of working with the body scan.
Ultimately the trajectory of healing will be different in its details for each individual. Healing is always a unique and deeply personal experience. Each of us, whether well or ill, has to face our own particular life circumstances and cope with them. The meditation practice, taken on in the spirit of self-exploration and self-inquiry, can transform our capacity to face, embrace, and work with and within the full catastrophe. But to make this transformation a reality in your life requires that you take responsibility for adapting the basic practice so that it becomes yours; so that you “own” it; so that it fits with your life and your needs! The particular choices you make will depend on your unique life circumstances and on your temperament.
Here is where your imagination and creativity come in. As we have seen, meditation practice is, more than anything, a way of being. It is not a set of techniques for healing. Healing comes out of the practice itself when it is engaged in as a way of being. Meditation is much less likely to be healing if you are using it as a way of getting somewhere, even to wholeness. From this perspective, you already are whole, so what is the point of trying to become what you already are? What is required above all is that we let go into the domain of being and reside in that wholeness with awareness, outside time. This is what is fundamentally healing.
In the stress clinic we are constantly astonished by the many ways in which our patients adapt the practice in their own lives, as well as by the effects that the practice of mindfulness comes to have on them. These effects are completely unpredictable. This is one powerful reason to give yourself over completely to the meditation practice and, as best you can, let go of any attachment you may have to specific outcomes, even though those outcomes are what draw people to MBSR in the first place.
Most people come to the clinic hoping to attain peace of mind. They want to learn to relax, and to be able to deal more effectively with their stress and pain. But they often leave transformed beyond anything they had hoped to accomplish in the first place. For example, Hector, a wrestler from Puerto Rico, who took the program because he was having frequent outbursts of anger, accompanied by chest pain, left eight short weeks later having found ways to regulate and control both his chest pain and his anger, and having discovered a deep strain of gentleness he never knew he had. Bill, a butcher, came to the clinic at the urging of his psychiatrist when he was left to raise six children on his own after his wife committed suicide. Bill became a vegetarian and told me one day, “Jon, the practice has deepened in me to the point that I can’t even lie anymore.” After completing the program, he started his own meditation practice group. Edith learned mindfulness meditation in the pulmonary rehabilitation program in order to control her shortness of breath; she kept up the practice on her own, and proudly recounted at a reunion of her pulmonary rehab class several years later how she had used it during cataract surgery to successfully control pain when told by her doctors at the last minute that they couldn’t use anesthesia because of her lung disease, and then proceeded to stick needles into her eye. Henry came to MBSR with anxiety, heart disease, and high blood pressure. In the fourth week of the program, he had an episode of vomiting blood due to ulcers. Taken to the Intensive Care Unit thinking he might very well die, Henry calmed himself down using awareness of his breathing as he lay in bed with tubes coming out of his arms and nose. Nat was a middle-aged businessman who came in an extreme state of distress due to a combination of severe high blood pressure, even on medication (he had been fired from his job two weeks earlier) and from having tested positive for the HIV virus after his wife contracted AIDS (presumably from a blood transfusion she received during an appendectomy) and died; he was in such bad shape that a nurse in the primary care clinic personally marched him down to the Stress Reduction Clinic office to make sure he enrolled. Eight weeks later, Nat had his blood pressure back to normal, had gotten his bad temper under control, was relating much better to his only child, and was looking at his life more optimistically in spite of the enormity of his situation and his loss. Edward was a young man with AIDS. Six months after he completed the MBSR program, he told me that he had not missed a day of meditation practice in those six months, and said that he was no longer a “nervous wreck” at work. When he had to undergo another bone marrow test, he thought to use his breathing to let go of his fear of the pain and found that he didn’t feel any. None of these individual outcomes of mindfulness practice was predictable. But they all grew directly out of the meditation practice.
Of course, part of making the practice your own, as we will see further on, will include paying attention to the particular behaviors and habits in your life that may directly or indirectly influence your health for better or for worse. These include diet and exercise; habits such as smoking and abusing alcohol and drugs; negative and destructive attitudes, especially hostility and cynicism; and the unique constellation of stresses and difficulties you face and how you handle them. Cultivating greater awareness in these particular areas or ingrained habit can enhance and amplify the process of personal transformation that grows naturally out of dwelling regularly in the domain of being.
Healing, as we are using the word here, does not mean “curing,” although the two words are often used interchangeably in common speech. However, it is important for us to be able to differentiate between the two, as they have profoundly different implications.* As we shall see in the next chapter, there are few outright cures for chronic diseases or for stress-related disorders. While it may not be possible for us to cure ourselves or to find someone who can, it is possible for us to heal ourselves—to learn to live with and work with the conditions that present themselves in the present moment. Healing implies the possibility that we can relate differently to illness, disability, even death, as we learn to see with eyes of wholeness. As we have seen, this comes from practicing such basic skills as entering and dwelling in the open spaciousness of awareness, itself associated with deep physiological and psychological relaxation, as well as with the possibility of seeing our fears and limitations and vulnerability within that larger embrace. In even brief moments of stillness, you may come to realize that you are already whole, already complete in your being, even if your body has cancer or heart disease or AIDS or pain, even if you don’t know how long you will live or what will happen to you.
Experiences of wholeness are as accessible to people with chronic illness or stress-related problems as they are to anyone else. Moments of experiencing wholeness, moments when you connect with the domain of your own being, often include a palpable sense of being larger than your illness or your problems and in a much better position to come to terms with them. Thus, to think that you are a “failure” if you “still” have pain, or heart disease, or cancer, or AIDS after you have been meditating for a while is to completely misunderstand the practice of mindfulness and MBSR. We are not meditating to make anything go away, any more than we are meditating to attain some special state or feeling. Whether we are basically healthy at the moment or have a terminal illness, none of us knows how long we have to live. Life only unfolds in moments. The healing power of mindfulness lies in living each of those moments as fully as we can, accepting it as it is as we open to what comes next—in the next moment of now.
Paradoxically, this shift in orientation and in awareness has the power to transform everything. Remember, acceptance does not mean passive resignation. Not at all. It means taking a reading of a situation, feeling it and embracing it in awareness as completely as one can manage, however challenging or horrible it may be, and recognizing that things are as they are, independent of our liking or disliking the situation and wanting it to be different. Then we can either intentionally or intuitively choose to be in what might be a wiser relationship to the present moment. This could include, when necessary or possible, taking some action or other. But it might also include simply being still, keeping in mind that everything is always changing and that our mind, our attitude, and our ability to rest in the open spaciousness of awareness all contribute to the understanding of our circumstances and to the coming to terms with them that underlies the process of healing. That non-doing is itself a powerful form of action.
One woman with breast cancer had the insight while she was meditating one day that she was not her cancer. She saw vividly in one moment that she was a whole person and that the cancer was a process that was going on within her body. Prior to that, her life had been consumed with identifying with the disease and with being a “cancer patient.” Realizing that she was not her cancer made her feel freer. She was able to think more clearly about her life, and decided that she could use having cancer as an opportunity to grow and to live more fully, for however long she had to live. In making the commitment to live each moment of her life as fully as possible and to use her cancer to help her, rather than showering blame or pity on herself for having it, she was setting the stage for healing, for dissolving the mental boundaries that confined her, for coming to terms with what she was facing. She understood that although she had hope that this approach might influence the cancer itself, there was no guarantee or even suggestion that the tumor would shrink or that she would live any longer. Her commitment to live with greater awareness was not chosen for those reasons. It was chosen because she wished to live life as fully as possible no matter what. At the same time, she wanted to remain open to the possibility that the course of the disease might be positively influenced by a more profound integration of her mind and body through the practice of mindfulness.
There is mounting evidence that the mind might indeed be able to influence the course of at least some diseases. A whole new field known as psychoneuroimmunology, or PNI, has emerged, in which studies are showing that our body’s many exquisite defense mechanisms against infection and disease, known collectively as the immune system, do not operate in a vacuum to keep us healthy. As the term psychoneuroimmunology itself implies, the immune system is now known to be regulated at least in part by the brain and nervous system, which themselves integrate all the body’s organ systems. And, of course, the brain and nervous system make the life of the mind possible. So there appear to be important interconnections between the brain and the immune system, and these connections allow for information to flow in both directions. In other words, while the brain can influence and modulate the functioning of the immune system, the condition of the immune system can also influence the brain in particular ways. The discovery of these connections means that science now has a plausible working model for elucidating the biological pathways and mechanisms by which our thoughts, emotions, and life experiences can influence our susceptibility or resistance to disease.
There is now a large body of studies showing that stressful life experiences can influence the activity of the immune system, which is known to play a critical role in the body’s defense mechanisms against cancer and infection. Drs. Janice Kiecolt-Glaser and Ron Glaser of Ohio State University College of Medicine showed that the natural killer (NK) cell activity of medical students clearly went down and then back up as a function of how much stress they were under. During exam periods, NK activity and other immune functions were diminished compared to levels when the students did not have exams. These researchers and others have also shown that loneliness, separation, divorce, and caring for a spouse with dementia are all associated with reduced immune functioning, and that various relaxation techniques and coping approaches can help protect or even enhance the immune system. Immune functions measured in studies of this kind, such as natural killer cell activity, are thought to play an important role in the body’s defense mechanisms against cancer and viral infection.
Other studies have shown a connection between MBSR training and enhanced immune function. In a collaborative study with Richard Davidson and his colleagues at the University of Wisconsin, mentioned in the Introduction, we conducted the first randomized trial of MBSR. In addition to gathering measures of psychological well-being reported on questionnaires filled out by the participants, our study looked at aspects of the participants’ biology, namely electrical activity in certain regions of the prefrontal cortex measured using EEG, as well as immune response to an influenza vaccine (measured by antibody levels in the blood). We studied a healthy group of employees in a high-stress corporate work setting and found that those employees who underwent the eight weeks of MBSR training showed a significantly higher antibody response to the flu virus challenge than those in the control group, who were waiting to take the program at a later date but being tested on the same schedule as the MBSR group. We also found that the immune response was correlated with the amount of change we saw in a person’s brain activity. In the MBSR group, the more the brain activity shifted from the right hemisphere to the left (an indicator of less emotional reactivity and greater emotional resilience), the stronger the antibody response to the flu vaccine in that person. There was no such relationship in the control group.
A remarkable series of experiments conducted by Robert Ader and Nicholas Cohen at the University of Rochester Medical School starting in the mid-1970s launched the field of psychoneuroimmunology and generated an explosion of interest and wide-ranging research in this area. Ader and Cohen used a clever experimental design to reveal an undeniable and dramatic relationship between the brain and the immune system. They showed that immunosuppression (a lowering of the immune response) in rats could actually be psychologically conditioned. They paired treatment of the animals with an immunosuppressant drug with exposure to a sweet-tasting chemical (saccharin) in their drinking water. Later, the animals received only saccharin alone in their drinking water—but they still showed immunosuppression, even though they were no longer receiving the immunosuppressing drug! It appeared that their bodies had somehow learned to suppress immune functioning in response to tasting the saccharin when it was given with the immunosuppressing drug. Control animals did not show this conditioned response. This suggested that in the conditioned animals, immune functioning was affected by a kind of psychological learning, which could only have come through the nervous system.
Many experiments have now been conducted that suggest that experiences of uncontrollable stress in animals can produce deficits in immune function and decrease natural resistance to cancers and tumor growth. Recent studies with people are also showing intriguing connections between stress, feelings of helplessness, immune system deficits, and diseases such as cancer. Ultimately, a major question for future research is the extent to which the mind might influence the healing of specific diseases, not simply indirectly by changing lifestyle, important as such changes are, but also by directly influencing the functioning of the immune system and the brain itself. However, we need to exercise caution in interpreting the meaning of specific immune system changes in such studies because there is as yet no firm evidence that the many changes observed in various studies are directly related to changes in any specific disease process or illness. And while both animal and human studies have shown that chronic stress, in many different forms, suppresses immune function and leads to heightened sensitivity to a range of infectious agents, other studies have demonstrated that stress actually enhances the immune response rather than suppressing it. So further work is necessary to understand exactly what is going on.
In 1998 we published the results of a study that looked directly at the question of whether the mind can be shown to have a direct effect on a well-recognized healing endpoint.† In collaboration with Dr. Jeffrey Bernhard and his colleagues in the Division of Dermatology at the University of Massachusetts Medical Center, we decided to look at people with the skin disease psoriasis while they were undergoing ultraviolet light therapy. People who have psoriasis suffer from an increased rate of growth of their skin cells that produces scaly patches. The cause of the disease remains unknown, and there is no cure for it at present. We do know that the extent of the disease fluctuates and is related to emotional stress as well as to other factors. The scaly patches can disappear completely and then return. Psoriasis is characterized by an uncontrolled cell proliferation in the epidermal layer of skin. It is not cancerous, but it does involve similar growth factors as skin cancer. For this reason, understanding more about how psoriasis works might have broader medical implications. It was certainly a good model for studying the question we wanted to ask: can the mind influence a healing process that we can actually see and photograph?
The standard therapy for psoriasis is ultraviolet light treatment, known as phototherapy. Ultraviolet light in a particular frequency band (UVB) is used because it slows down the growth of the cells in the scaly patches of skin, which, when severe, can cover large areas of the body. Sometimes a drug called psoralin is used systemically in concert with the ultraviolet light if a more powerful treatment is necessary. Then a different frequency of light (UVA) is used. The UVA exposure activates the psoralin that gets into the skin, and this activated molecule accelerates the skin clearing by preventing the skin cells from dividing. This treatment is known as photochemotherapy. In our study, we followed patients going through either phototherapy or photochemotherapy. In both cases, treatment requires the patient to stand almost naked in a cylindrical light box, about the size of an old-fashioned telephone booth, for increasing periods of time, up to about ten minutes, during which their skin is exposed to the ultraviolet light. The walls of the light box have head-to-toe ultraviolet lightbulbs. Treatments usually take place three times a week over about four months. They start out very brief and get progressively longer, so as not to burn the skin. It can take quite a few treatments for the skin to clear completely.
In our study, thirty-seven people about to undergo ultraviolet light treatments in the phototherapy clinic were randomly assigned to two groups. One group practiced mindfulness meditation while they were in the light box, with guidance from an audio program that focused sequentially, as the light exposures got longer, on mindfulness of breathing, body sensations (from standing and from the intense heat from the lights, and from the air currents from blowers), and on sounds, thoughts, and emotions. As the treatment sessions got longer, the meditators also were encouraged to visualize that the ultraviolet light was slowing down the growth of their skin cells by “jamming the machinery” those cells depend on to divide. They also had the option of practicing mindfulness without the guidance after twenty treatment sessions, and hearing meditative harp music instead. People in the comparison control group received the standard light treatment protocol without engaging in any mindfulness practices or listening to music.
While this study design had its flaws, it did replicate as well as extend the results of an earlier pilot study. We found that over the treatment period, the meditators’ skin cleared approximately four times faster than the skin of those patients getting just the light treatment in the control group. This was true whether the treatment was phototherapy or photochemotherapy. This is all the more remarkable because the longest people were in the light box at any given time was about twelve minutes, so they were only meditating for relatively short periods of time. What is more, unlike the participants in MBSR, the participants in the psoriasis study did not get guided meditation CDs to take home and practice with, and were asked not to meditate at other times. The fact that we saw such dramatic improvements may be an indication of the power of mindfulness to positively influence various mind-body factors, even with relatively brief practice times. It suggests that even a little mindfulness practice may be highly beneficial. We shall see a similar use of short periods of meditation practice when we look at studies of laboratory-induced pain in Chapter 23.
The findings of the psoriasis study, while still preliminary until they are replicated by other researchers, do suggest a number of intriguing implications. The most obvious is that the mind can positively influence a healing process, at least under some circumstances. We can’t say with certainty that it was the mindfulness practice itself that was responsible, because we also included the visualization of the skin clearing in response to the light exposure, as well as music, and the control group was not tailored to match all the conditions of the meditation group except for the mindfulness. For instance, they did not listen to any audio program at all, including music. Still, the results suggest that some dimension of the mind played a significant role in accelerating the healing of the skin. Since we now know that the brain can influence inflammatory processes in the body and various epigenetic and immune factors that may play a role in psoriasis, it is likely that the effects of the mind can work all the way down to the level of gene expression and cellular and humeral immune activity. These are fruitful areas for future studies to elucidate.
Our study was also a built-in cost-effectiveness study, in the sense that the meditation group reached clearing faster than the people in the control group. They thus required fewer treatments and therefore cost the system less. The study was also a classic example of participatory medicine, in that the patients were actively participating in their own possible trajectory toward greater levels of health and well-being, just as MBSR is itself an example of participatory medicine on a larger scale. It is also an example of integrative medicine, in that the meditative practice was integrated right into the medical treatment protocol itself. Moreover, since ultraviolet light is itself a risk factor for skin cancer (basal cell carcinoma), reducing the number of treatments necessary to reach skin clearing reduced the intrinsic risk associated with the phototherapy treatment itself.
Every so often, the mind-body connection and healing receive widespread coverage in the popular press. This is becoming ever more the case with mind-body approaches in general and mindfulness in particular, now that there are so many studies coming out in the fields of neuroscience, health psychology, and psychoneuroimmunology. Having heard about the results of these studies, many people with cancer or AIDS now want to learn meditation to control their stress, both to improve their quality of life and with the expectation that they will be able to stimulate their immune system to combat their disease more effectively. But while it is entirely possible that practicing meditation and specific visualizations might significantly influence immune function and stimulate healing, that conjecture is still far from proven at this time, as we have noted.
From our point of view, an individual who comes for training in MBSR with the strong expectation that his or her immune system can be strengthened by meditating might actually be creating impediments to his or her own healing, both psychologically and physically. Too strong an investment in making your immune system respond the way you want it to might be more of a problem than a help, because the quality and the spirit of the meditation practice can be easily undermined by any goal orientation, however understandable and worthy that goal might be—as we have been emphasizing repeatedly. If the essence of meditation is non-doing, then trying to work it around to getting what you want, even subtly, can distort and undermine the very qualities of letting go and acceptance that allow you to experience wholeness directly, in our view the foundation for healing. This would be true even if it is ultimately shown that meditation can lead to positive changes in immune function that result in an increased ability of the body to heal disease processes.
This is not to say that you cannot use meditation for specific ends. There are countless ways of incorporating specific visualizations and goals into meditation practice, as in the use of the mountain meditation (described in Chapter 8), in the psoriasis experiment we just reviewed, and in the lovingkindness meditation we will visit shortly. In all the meditative traditions of the world, visualizations and imagery are used to invoke particular qualities of mind and heart. There are meditations on love, God, lovingkindness, peace, forgiveness, selflessness, impermanence, and suffering. There are meditations on energy, body states, particular emotions, equanimity, compassion, generosity, joy, wisdom, death, and of course healing. Imagery and specific channeling of one’s energy and attention are integral to these practices.
However, it is important to emphasize that they are all practices. They are always undertaken with a systematic discipline and commitment, and always within the larger context of meditation as a way of being. When we take them up as isolated techniques that we utilize only when we feel bad or when we want something, we invariably ignore or discard this greater context; in fact, we may not even realize that it exists. In any event, the wisdom and power inherent in the non-doing perspective can be easily lost or overlooked and, with it, the deeper power of the particular visualization. There is little wisdom in this approach, and potentially a great deal of frustration, disappointment, and wasted energy.
In order to be maximally effective for healing, the use of visualization and imagery is best embedded in a larger context, one that understands and honors non-doing and non-striving. Otherwise, visualization exercises can too easily degenerate from meditation into wishful thinking, and the intrinsic healing power and wisdom of the simple mindfulness practice itself can remain untapped or be trivialized in the quest for something more elaborate and goal-oriented. Even in the simple case of lowering blood pressure, which meditation has been shown to do in numerous clinical studies, it is not wise to meditate primarily for that purpose. It tends to make the meditation mechanical and too oriented toward success or failure. We believe that it is far more effective just to practice the meditation regularly and let your blood pressure take care of itself.
When you are practicing meditation as a way of being and not as a means to a particular end, then the use of specific visualizations to work on particular areas of concern within that larger context can sometimes be very helpful. Not enough research has yet been done to be able to determine the relative importance of specific visualizations in the healing process compared with the simple practice of moment-to-moment awareness. The psoriasis experiment may lead to further studies of this kind.
From our experiences with MBSR, we find that symptom reduction and a transformation of perspective are more likely to occur if you actively cultivate non-doing in the meditation practice rather than preoccupy yourself with what your blood pressure, particular symptoms, or your immune system is doing.
We tell our patients in the stress clinic, whether they have high blood pressure or cancer or AIDS, that it is fine to come with the hope of controlling their blood pressure or improving their immune function, just as it is fine to come wanting to learn to relax and be calmer. But once they decide to commit to the program, they need to let go of their goals for the moment and just practice mindfulness for its own sake. Then, if their blood pressure comes down, if their natural killer cells or helper T-cells increase in number and activity, or if their pain lessens, so much the better. We want our patients to experiment with what their bodies and minds are capable of, without feeling they have to influence or improve a specific physiologic function by a specific time. To bring calmness to the mind and body requires that at a certain point we be willing to let go of wanting anything at all to happen and accept things as they are and ourselves as we are with an open and receptive heart. This inner peace and acceptance lie at the heart of both health and wisdom.
Ideally, hospitals should be environments in which there is an appreciation for and nourishing of a person’s own inner capacity for healing as a complement to the medical management of his or her problems. Many doctors and nurses honor this perspective and try to nurture it as best they can, given the less-than-ideal conditions under which they often work and to which their patients come seeking help. Finding creative ways to mobilize the patient’s own interior resources for moving toward greater levels of health and well-being is, as we have seen, an important element of a more participatory medicine.
To provide a resource for the individual patient to participate more directly in his or her own healing while in the hospital, and to give busy and overworked physicians and nurses a resource that they could offer to their patients, in the early years of the Stress Reduction Clinic I developed a televised outreach program to teach hospitalized patients how to meditate. The hope was that inpatients lying in bed would be able to engage in a similar kind of meditative work on themselves as do the people who come to the Stress Reduction Clinic as outpatients for MBSR training.
Ordinarily, television functions to distract us or absorb us. It easily carries us away from ourselves and away from the moment (we discuss this subject in more detail in Chapter 32). With this TV program, which is called The World of Relaxation, I was attempting to use the medium in a new way—you might think of it as person-to-person interactive television.
Many patients have their televisions on most of the time while they are in the hospital, though often the person isn’t even watching. The constant barrage of noise and images is hardly conducive to overall well-being and healing, even if it does function to help the time pass more quickly. Silence would probably be better, especially if people knew what to do with it—knew how to be in silence, how to concentrate their energies for being in the moment and for dwelling in calmness and stillness.
If you are hospitalized in a room with another person, you might have to put up with whatever is on your roommate’s TV, even if your own is off. For people in pain, or who are dying, or who are in a crisis of some kind, it can be dehumanizing, degrading, and demoralizing to have to tolerate soap operas and game shows as the ambient audio backdrop to their real-life problems. It is hardly a dignified atmosphere in which to die or to suffer, and hardly the best conditions under which to try to recuperate and heal.
The World of Relaxation was a way for me to reach out to the patient lying in bed from the television up on the wall and propose something like this: “Look, as long as you are lying here in the hospital with time on your hands, perhaps you might be interested in using some of this time to exercise certain muscles you many not even know you have—for instance, the muscle of attention, the muscle of mindfulness, and the muscle of working with the present moment, whatever your circumstances. It might be interesting to purposefully explore learning how to systematically enter into and dwell in a condition of deep relaxation and well-being. At the very least, engaging in this program might give you a greater sense of being able to control and reduce some of the stress, pain, and anxiety that you might be experiencing. What is more, it might also enhance the healing process itself.”
The World of Relaxation is an unusual use of television. Visually it is simply my face on the screen for an hour—not exactly high drama or entertainment. Even worse, after a brief introduction, I ask the viewer to close his or her eyes, and then I close my eyes too. So for most of the hour the image is just my face on the screen with my eyes closed. I am meditating and guiding the listener in an extended healing-oriented meditation that includes mindfulness of breathing, a modified body scan, and directing the breath to the regions the patient feels require the most attention. The verbal guidance is entwined with soothing harp music composed and played by Georgia Kelly, a musician and composer committed to using music and sound for healing.
You might ask, “Why a television program at all if the patient has his or her eyes closed for most of it?” The answer is that even the image of another person in the room and reaching out to the patient in an inviting way may contribute to a feeling of trust and acceptance. If the person gets disoriented or bored at a particular point during the program, he or she always has the option of opening the eyes and seeing a real person up on the screen meditating—and thus perhaps be reassured that it is possible to return once again to the breath, to the present moment, and to the sounds of the harp, and drop back into some degree of calm and well-being.
I encourage the viewer to tune in and out of what is being said as he or she feels like it and to just give oneself over to bathing in the sounds themselves, the notes, and the spaces between them. The harp is an instrument that has been associated with healing since biblical times. The notes of the harp in this particular piece of music sound as if they are coming out of nowhere and going back into nowhere. There is a deep silence inside, in between, and underneath the plucking of the strings, giving the music a timeless quality, very different from music, however wonderful, that has a dominant melody or theme that might tend to carry the listener off somewhere else. Kelly’s sound track provides an effective background for the cultivation of mindfulness as a formal practice, especially for someone attempting it for the very first time, mirroring as it does the way in which our thoughts and feelings and perceptions also appear to arise out of nowhere and dissolve back into nowhere, moment by moment.
The World of Relaxation plays on the in-house cable channel in our hospital seven times each twenty-four hours. It has been there for decades. Doctors can “prescribe” it for their patients to help them with pain, anxiety, or sleep problems, or to enhance relaxation and well-being and reduce the stress of hospitalization. To do this, they give their patients a little bookmark with the times when the program is on and a few suggestions for how to use it, and suggest they “do” it twice a day during their hospital stay. In our view, regular meditation practice using this program is a far better diet for patients in the hospital than the usual fare they are served up on TV. Over the years, we have heard numerous reports from patients that bear this out. The program has now been purchased by hundreds of hospitals in the United States and Canada, and it is also available on the Web (www.betterlisten.com).
Long ago, I was contacted by a woman who used The World of Relaxation when she was a patient at New York University Medical Center. We had an extended conversation, at the end of which I asked her if she would be willing to write down the circumstances under which she used it. This is how she described her experience:
Dear Dr. Kabat-Zinn:
“There is more right with you than wrong with you”—those words of yours have stayed with me through two frightening cancer surgeries. So many other comforting thoughts that you offer on your video have helped me keep my sanity.
At night, when alone after my visitors were gone, I couldn’t wait to turn on the NYU Medical Center in-house channel because, somehow, I became dependent on the comfort you would offer. I can still see your face before me, almost as though my experience was a personal one. You offer a meaningful philosophy that puts everything into perspective for a frightened human being. Thank you so much for that. I tried so hard to remember how to practice the relaxation technique, but I still need the help that the program provides.
So many other patients during my hospital stay were taking comfort from your voice. When I took my required walks along the hospital corridor, I could hear the program coming out of different rooms. Whenever I had the chance to talk to a patient who was suffering, I told them to turn it on and was thanked. (My first hospital stay was for twenty-three days. I had lots of time to meet others.)
I am still hurting from my most recent surgery, and I am still scared, but I have so many good, in fact wonderful, moments because of your help. I am really very grateful.
Healing energy in the form of mindfulness and heartfulness can be directed toward others and toward our relationships as well as toward our own body. The process of uncovering in ourselves deep feelings of empathy, compassion, and love toward others has its own purifying effects on the mind and heart. When such feelings are invited to come into the heart to whatever degree they will, without any forcing, they can be experienced for oneself and then effectively directed toward others. Doing so can offer enormous benefit, and you, in all likelihood, will be the first beneficiary.
We usually offer a guided lovingkindness meditation in the all-day session in week six of MBSR to give people a taste of the power of evoking feelings of kindness, generosity, goodwill, love, and forgiveness, and directing them first and foremost toward oneself. The response is invariably moving. A great many tears are shed, both in joy and in sorrow. This type of meditation strikes a deep chord in many people. It can help us to cultivate strong positive emotions within ourselves, and to let go of ill will and resentment. Some of the participants’ feelings about this form of meditation have already been voiced in Chapter 8. To practice lovingkindness meditation, we begin with awareness of our breathing. Then we consciously invite feelings of love and kindness toward ourselves to arise, perhaps by remembering a moment when we felt completely seen and accepted by another human being and inviting those feelings of kindness and love received to re-emerge out of the memory and be held in awareness and felt in the body; and then perhaps by saying inwardly to ourselves simple phrases that you can either make up for yourself or take from others, phrases such as “May I be free from inner and outer harm; may I be happy; may I be healthy; may I live with ease.” Imagine what saying these things to yourself might do if you really, really, really inclined your heart in the direction the words are pointing—not to get anywhere or to pretend to feel anything, or even to think that you should feeling anything, but just as an experiment, to see what already resides within you when you give yourself over to the process wholeheartedly, or even just a little.
After a time, we can then go on, if we care to, to invoke someone else, perhaps a particular person we are close to and care deeply about. We can visualize that person in our mind’s eye or hold the feeling of the person in our heart as we wish that person well: “May he or she be happy, may he (she) be free from pain and suffering, may he (she) experience love and joy, may he or she live with ease.” In the same vein, we may then include others we know and love: parents, children, friends.
Next we can identify a person with whom we may have a particularly difficult time for whatever reason, for whom feelings of aversion or antipathy arise. It should not be someone who has caused us harm in a major way, just someone we don’t really care for and really don’t like to feel kindness toward. Again, and only if you care to, we can intentionally cultivate feelings of kindness, generosity, and compassion toward that person, intentionally recognizing and letting go of our feelings of resentment and dislike for him or her and reminding ourself instead to see that person as another human being, someone just as deserving of love and kindness as yourself, someone who also has feelings and hopes and fears, someone who feels pain and anxiety just as you do, someone who also suffers.
The practice can then move on to invoke a person who indeed has caused us harm in some way. This is always optional. It does not mean that you are being asked to forgive the person for what he or she has done to hurt you or to cause harm to others. Not at all. You are simply recognizing that he or she is also a human being, however damaged; that he or she also has aspirations, just like you; that he or she also suffers; that he or she also has the desire to be safe and to be happy. Since it is only we ourselves who suffer by carrying around feelings of hurt and anger, or even hatred, a willingness to experiment—even the tiniest bit, if and only if you feel receptive to the idea—with directing a modicum of kindness toward this person who is so difficult for us, who has hurt us, is really a way to bring our suffering to the fore and release it into the larger field of our own wholeness. The other person may not benefit from this at all. But you may benefit from it enormously. At this point, there is also the option of purposefully forgiving this person. This impulse may or may not develop spontaneously over time with ongoing practice of the lovingkindness meditation. It is always entirely up to you to decide who to include in the practice and to what degree. And if we have harmed others, knowingly or unknowingly, we can also bring them to mind at some point and ask them to forgive us.
The lovingkindness practice can be done with people whether they are alive or have already died. There can be a strong release of long-carried negative emotions as we ask for forgiveness and explore forgiving them. It is a profound process of coming to terms in your own heart and mind with the way things are in this moment, a deep letting go of past feelings and hurt. The cultivation of lovingkindness in this way can be deeply liberating if we follow our own lead, if we are careful not to force anything, if we honor our own boundaries and limits of the moment, just as we do in the yoga.
The practice continues further as we expand the field of people we might be willing to include. We can direct lovingkindness toward other individuals, known and unknown, perhaps to people we may see regularly but don’t really know, such as the people who take our clothes at the cleaners, or the toll booth collector, or waiters and waitresses. We can extend the scope still further, radiating feelings of lovingkindness to people anywhere and everywhere in the world who are suffering, who have been severely traumatized, who are oppressed, who are so deeply in need of human kindness and caring. The meditation can be carried even further if we care to, expanding the field of lovingkindness out from our own heart in all directions until it includes all living creatures on the planet, not just people, and the life-giving planet itself.
Finally, we return to our own body, we come back to our breathing for a time, and end by simply resting in the aftermath of the process itself, cradling and accepting whatever feelings may be present, and taking particular note of whatever feelings of warmth, generosity, and love we may find flowing out of our own hearts.
When I first encountered the practice of lovingkindness, I thought it was a little strange and contrived. It felt very different from the spirit of mindfulness practice because it seemed to be suggesting that the meditator generate certain emotions instead of being aware of and accepting of any all emotions that might arise and according them all lovingkindness. Since I saw the cultivation of mindfulness as itself a radical act of love and of lovingkindness, it seemed superfluous at best to supplement it with a more specialized practice that might be confusing to people training in mindfulness because, on the face of it, it seems to contradict the non-striving and non-doing orientation of mindfulness itself.
I changed my mind when I saw and felt the power that purposefully cultivating lovingkindness had. When practiced regularly, it can have a remarkable softening effect on the heart. It can help you to be kinder to yourself and to others. It can help you to see all beings as deserving of kindness and compassion, so that even if disputes do arise, your mind can see clearly and your heart does not close down and become lost in self-serving yet ultimately self-destructive negative feeling states.
Under the best of circumstances, it sometimes takes years and years of chipping away at our more confining habits of mind to grow out of them. For some of us, at least, wisdom practices need to be softened with compassion and kindness practices, beginning with ourselves. Otherwise, they may not actually nurture wisdom in any real way, because wisdom and compassion are not separate, they enfold each other. As we shall see, because of the interconnectedness of all things—and therefore, because there is no absolute separation between self and other—there can be no real wisdom without kindness and compassion, and no real kindness and compassion without wisdom.
In summary, healing is a transformation of view rather than a cure. It involves recognizing your intrinsic wholeness and, simultaneously, your interconnectedness with everything else. Above all, it involves learning to feel at home and at peace within yourself. As we have seen and will explore more in later sections of the book, this way of being, grounded in the practices of MBSR, can lead to dramatic improvements in symptoms, a renewed ability to move toward greater levels of health and well-being, and even to changes in the brain that may play a role in these vital transformations.
* In some languages, such as French, they cannot be distinguished. There is only one word that means both: guérir.
† Kabat-Zinn J, Wheeler E, Light T, et al. Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA). Psychosomatic Medicine. 1998;60:625–632.