The relief of symptoms of various kinds is a multibillion-dollar industry. The slightest sniffle, headache, or stomachache sends people scurrying to the medicine cabinet or drugstore in search of the magic something to make it go away. There are over-the-counter medications to make the digestive tract slow down, others to make it speed up, others to relieve heartburn or neutralize excess stomach acid. With a prescription from a physician, you can obtain drugs to reduce anxiety, such as Valium and Xanax, and drugs to relieve pain, such as Percodan. As we have seen, tranquilizers are among the most prescribed medications in the country. For a long time, so are drugs that decrease the secretion of stomach acid, such as Tagamet and Zantac. Now they are available over the counter. Most of these medications are used primarily to relieve symptoms of discomfort, and they work very well in most instances. But the trouble with the widespread use of many such drugs is that the underlying problems that are producing the symptoms may not be getting addressed just because the symptoms are temporarily relieved.
This practice of immediately going for a drug to relieve a symptom reflects a widespread attitude that symptoms are inconvenient, useless threats to our ability to live life the way we want to live it and that they should be suppressed or eliminated whenever possible. The problem with this attitude is that what we call symptoms are often the body’s way of telling us that something is out of balance. They are feedback about disregulation of one sort or another. If we ignore these messages or, worse, suppress them, it may only lead to more severe symptoms and more serious problems later on. What is more, the person doing this is not learning how to listen to and trust his or her body.
Before people begin our program, they fill out a questionnaire in which they check off from a list of more than a hundred common physical and emotional symptoms those they have experienced as problematic in the preceding month. They do the same thing again after completing the program eight weeks later.
Over the past three decades of teaching MBSR, we have observed some interesting things when we compare these two symptom lists. First, most people come into the program with a relatively high number of symptoms. The average number of symptoms is 22 out of about 110 possible ones. That is a lot of symptoms. When people leave, they are checking off on average about 14 symptoms, or 36 percent fewer symptoms than when they started. This is a dramatic reduction in a short period of time, especially for people who have that many symptoms in the first place and have had them for quite a long time. This effect is reproducible. We have seen it in virtually every eight-week cycle of MBSR over the past thirty-plus years.
You might wonder whether this reduction in the number of symptoms is a non-specific effect of having some attention paid to them, since it is well known that people can feel better temporarily when they receive almost any kind of professional attention in a medical setting. You might ask whether perhaps the reduction in symptoms is just due to their coming to the hospital every week and being part of a positive group setting, rather than to anything special that they are doing in their stress reduction classes, such as practicing meditation.
While that is a credible supposition, in this case it is unlikely. The participants in the Stress Reduction Clinic have been receiving professional medical attention from the health care system for their problems all along. On average, the chief medical complaint for which they are referred to us has been a problem for them for about seven years. It is unlikely that just coming to the hospital and being in a room full of other people with chronic medical problems and having attention paid to them would, by itself, result in these substantial reductions in their symptoms. But certainly one element contributing to their improvement might well be that they are challenged to do something for themselves for a change to enhance their own health. This facet of their experience in MBSR is a radical departure from the passive role most people assume or are forced into during treatment in the health care system. As we have been emphasizing, this is one example of a more participatory medicine.
Another reason to suspect that the symptom reduction we see among the participants in MBSR results from something that people actually learn in the program is that the reduction is maintained and even improves further after people leave. We know this from several follow-up studies in which we obtained information from more than four hundred people at different times for up to four years after they completed the program.
We also know from these studies that over 90 percent of the people who complete the program say that they are keeping up their meditation practice in one form or another for up to four years after they graduate. Most rate their training in the stress reduction clinic as very important to their improved health status.
Although we see dramatic symptom reduction during the eight weeks of MBSR, we actually focus very little on symptoms in the classes, and when we do, it is not to try to reduce them or make them go away. For one thing, the classes are a mix of people with many different medical problems and life situations. Each person has an entirely different and unique constellation of symptoms and concerns as well as a specific medical treatment plan they are following. In a room with twenty to thirty-five people, all of whom are anxious and concerned about their symptoms and wanting to get rid of them, to focus primarily on the details of each person’s situation would simply encourage self-preoccupation and illness behavior. Our minds being what they are, such a forum would in all likelihood give rise to never-ending discussions of what is “the matter” rather than focusing on the possibility of personal transformation. This avenue would be of little real benefit to the participants except for the sympathy and group support it would evoke, which, while certainly therapeutic, are unlikely to lead to profound changes in either view or behavior. By choosing to focus in MBSR on what is “right” with people rather than on what is “wrong” with them, without denying what is wrong, we are able to go beyond self-involved preoccupations with the details of what is wrong, however important these concerns might be in other circumstances, and come to the heart of the matter, namely, how people can begin to taste their own wholeness as they are, right now.
Instead of discussing symptoms as woes and how to get rid of them, when we do focus on symptoms of one kind or another it is to tune in to the actual experience of the symptoms themselves in those moments when they most dominate the mind and body. We do this in a particular way, which might be called giving them wise attention. Wise attention involves bringing the stability, calmness, and clarity of mindfulness to our symptoms and to our reactions to them, and not taking personally events and circumstances that are not really personal. We call it “wise” to distinguish it from the usual type of attention we pay to our problems and crises, which tends to be very self-centered and wrapped up in a story or narrative we tell ourselves that may not be entirely accurate and thus not conducive to a larger seeing of options and avenues for relating differently to the unpleasant and the unwanted.
For example, when you have a serious chronic illness, it is only to be expected that you will be very concerned and perhaps even frightened and depressed about the ways in which your body has changed from what it once was and about what new problems you might have to face in the future. The result is that a lot of a certain kind of attention is spent on your symptoms, but it is likely not to be helpful or healing attention, so much as anxiety driven self-absorption and preoccupation. More often than not, that kind of attention is reactive, judgmental, and fearful. There is little room in the mind for acceptance, or for recognition of a larger field of possibilities for relating to one’s circumstances and challenges. This is the opposite of wise attention.
The way of mindfulness is to accept ourselves right now, as we are, symptoms or no symptoms, pain or no pain, fear or no fear. Instead of rejecting our experience as undesirable, we ask, “What is this symptom saying, what is it telling me about my body and my mind right now?” We allow ourselves, for a moment at least, to go right into the full-blown feeling of the symptom. This takes a certain amount of courage, especially if the symptom involves pain, a chronic illness, or fear of death. But the challenge here is can you at least “dip your toe in the water” by trying it just a little, say for ten seconds, just to move in a little closer for a clearer look? Can we metaphorically put out the welcome mat for what is here, simply because it is already here, and take a look, or even better, allow ourselves to feel our way into the full range of our experience in such moments?
As we experiment with adopting this unusual stance toward our momentary experience, we may also become aware of emotions we may be feeling about the symptom or situation we are experiencing. Whether it is anger or rejection or fear or despair or resignation, we hold whatever arises in awareness, as dispassionately as possible. Why? For no other reason than that it is here now. It is already part of our experience. To move to greater levels of health and well-being, we have to start from where we actually are today, now, in this moment, not from where we would like to be. Movement toward greater health is only possible because of now, because of where we are. Now is the platform of all further possibilities. So looking closely at our symptoms and our feelings about them and then coming to accept them as they are is of utmost importance.
In this light, symptoms of illness or distress, plus your feelings about them, can be viewed as messengers coming to give you important and useful information about your body or about your mind. In the old days, if a king didn’t like the message he was given, he would sometimes have the messenger killed. This is tantamount to suppressing your symptoms or your feelings because they are unwanted. Killing the messenger and denying the message or raging against it are not intelligent ways of approaching healing. The one thing we don’t want to do is to ignore or rupture the essential connections that can complete relevant feedback loops and restore allostasis, self-regulation, and balance. Our real challenge when we have symptoms is to see if we can listen to their messages and really hear them and take them to heart, that is, make the connection fully.
When a patient in an MBSR class reports he or she had a headache during the body scan or during a sitting meditation, my response might be, “All right. Now, can you tell us how you worked with it?”
What I am looking for is whether, if you became aware that you had a headache during the time you were meditating, you used the occasion as an opportunity to look into this experience you are calling a headache, which is often a problem for you in your life anyway, even when you aren’t meditating. Did you observe it with wise attention? Did you bring mindfulness, acceptance, and perhaps a bit of kindness to feeling the sensations themselves? Did you watch your thoughts at that moment? Or did the mind jump automatically into rejection and judging, perhaps to thinking that somehow you were failing at meditation, or that you “can’t relax,” or that meditation “doesn’t work,” or that you are a “bad meditator,” or that nothing can cure your headaches?
Anybody can have any or all of these thoughts and many others as well. They may come into and go out of your mind at different times in reaction to the headache. As with any other reaction, the challenge here is to shift your attention so that you can see them as thoughts and, in doing so, welcome the headache into the present moment because it is here anyway—like it or not. Can you decipher its message by directing careful attention to how your body feels right now? Are you aware now of a mood or emotion that may have preceded your realizing that you had a headache? Was there an event that triggered it that you can identify? What are you feeling right now emotionally? Are you feeling anxious, depressed, sad, angry, disappointed, discouraged, annoyed? Are you able to be with whatever you are feeling in this moment? Can you breathe with the sensations of the headache, the pounding feeling in the temples, or whatever it is? Can you see your reactions with wise attention? Can you just watch your feelings and thoughts and see them simply as feelings and thoughts—as impersonal events in the field of awareness? Can you catch yourself identifying with them as “my” feelings, “my” anger, “my” thoughts, “my” headache, and then let go of the “my” and just accept the moment as it is?
When you look into the headache, seeing the constellation of thoughts and feelings, the reacting, the judging, and the rejecting of how you are feeling, the wishing to feel differently that may be going on in your mind, perhaps you will realize at a certain point that you are not your headache unless you go along with this inner process of identification, unless you yourself make it your headache. Maybe it is just a headache, or maybe it is just a feeling in the head that doesn’t need a name at all right now.
The ways we use language tell us a lot about the automatic way we personalize our symptoms and illnesses. For instance, we say “I have a headache” or “I have a cold” or “I have a fever,” when it would be more accurate to say something like “The body is headaching” or “colding” or “fevering.” When we automatically and unconsciously link each symptom we experience to I and my, the mind is already creating a certain amount of trouble for us. In order to listen more deeply to a symptom’s message, free from our exaggerated reactions to it, we have to perceive our own strong identification with the symptom when it occurs and purposefully let go of it. By seeing the headache or the cold as a process, we are acknowledging that it is dynamic and not static, that it is not “ours” but is rather an unfolding process that we are experiencing. Then we may realize, even just a tiny bit, that the narrative we are telling ourselves, whatever it is, is not the whole story—and that by staying caught up in it and believing it as “the truth of things” regarding our pain, we are actually constraining our options for learning and growing, and thus for healing.
When you look into a symptom with the full power of mindfulness, whether it is muscle tension, a rapid heartbeat, shortness of breath, fever, or pain, it gives you much more of a chance to remember to honor your body and listen to the messages it is trying to give you. When we fail to honor these messages, either through denial or by an inflated and self-involved preoccupation with symptoms, we can sometimes create serious dilemmas for ourselves.
Usually your body will try desperately to get its messages through to you despite the bad connection with conscious awareness. A priest described his medical history in class one day by saying he realized, after having been practicing the meditation for a few weeks, that his body had been trying to get him to slow down his fast-paced, high-stress lifestyle by giving him headaches at work. But he hadn’t listened, even though the headaches got worse. So his body gave him an ulcer. But still he didn’t listen. Finally it sent him a mild heart attack, which scared him so much that he started to listen. He said that he felt grateful for his heart attack now and took it as a gift, because it could have killed him but it didn’t. It gave him another chance. He felt this could well be his final chance to start taking his body seriously, to listen to its messages and honor them.