One of the initial avenues where mindfulness started to gain recognition in the West was in medicine and psychology through working with chronic pain and illness. Today I have the honor of bringing you, Vidyamala Burch, one of the co-founders of Breathworks and author of Living Well with Pain and Illness: The Mindful Way to Free Yourself from Suffering. Vidyamala first came to the intersection of meditation and chronic pain 25 years ago after going to the hospital for spinal injury. She currently lives in Manchester and has been teaching mindfulness-based approaches to pain and illness for the past 10 years.
Today Vidyamala lets us in on how mindfulness works to alleviate suffering in chronic pain and illness.
Elisha: In the beginning of your newest book you quote 13th century Sufi Poet, Rumi saying:
Do not look back, my friend
No one knows how the world ever began.
Don not fear the future, nothing lasts forever.
If you dwell on the past or the future
You will miss the moment.
How have you applied the message of this poem in working with your own chronic pain?
Vidyamala: Living in the moment has been one of the most important ways I have reclaimed my life whilst living with chronic pain. It all began when I was in hospital when I was 25 and had a night of very intense physical pain and mental anxiety while in a neurosurgical intensive care unit. I thought I would not be able to survive the night and then, when I really felt I would go mad with the stress of it all, a quiet inner voice came to me that said “you don’t have to get through until the morning; you only have to do get through the present moment.” With that voice came a very deep shift in perception and my entire experience changed. I relaxed in the deep confidence that this knowledge brought: I knew very deeply that I could not only ‘get through’ the present moment, but I could live it to the fullest, even though I was experiencing pain.
I also realized that my previous ideas about the past and the future were just that: ideas. These ideas dissolved away within the intensity of my experience and I realized that much of my experience of suffering was based on being dominated by grief about the pain I had already experienced in past moments, and fears about all the future moments of pain I imagined stretching interminably before me. But in the depths of that night in the hospital I knew very deeply that I would ever only experience pain one moment at a time, that my pain was bearable and that I had nothing to fear. Subsequently, over many years of mindfulness and compassion meditation practice, I have also come to realize that if I can enter fully into my life as it flows through each moment then I not only have the opportunity to make peace with any pain I may be experiencing, but I also open myself to the love and joy that is always present to a smaller or greater degree.
I am able to fully taste the bittersweet nature of life and to recognize and empathise with the bittersweet nature of the lives of others.
Elisha: In your work you bring up the difference between primary and secondary suffering. Tell us a bit about that and why it’s important in dealing with pain?
Vidyamala: Very gradually, through examining my own experience, I have come up with the model of primary and secondary suffering that is based on the teaching of the Buddha in the Sutta of the arrow or the dart[i]. The Buddha talks about the actual sensations of physical pain being like being pierced by an arrow. Then, if we are not mindful or wise, we resist and resent this pain and these feelings of resistance and resentment are like a being pierced by a second arrow (or I actually think it is like being pierced by a whole volley of second arrows!) This means that we are left with an overall experience of suffering that is much greater than it needs to be. So, in my teaching, I encourage people to examine their actual experience by moving towards it with an open, receptive and kindly attitude and accepting whatever primary suffering is present in any moment with dignity and grace.
Honest awareness of this experience also helps to prevent the arising of unnecessary secondary suffering such as anxiety, secondary physical tension, out-of-control thinking and so on. People really seem to get this model and find it very helpful. For example, one woman talked about standing at the sink washing dishes and becoming aware of repetitive thoughts of distress about her pain and simply noting it as “second arrow – secondary suffering”, and this awareness and broader perspective helped the distress calm down and diminish.
Elisha: What is the 5 Step Model of Mindfulness for Pain?
Vidyamala: The 5 Step Model of Mindfulness for Pain is also something that I have developed through examining my own experience over many years. I noticed that it was essential to be willing to engage with my actual experience of pain rather than block it or resist it and I noticed, paradoxically, that if I was locked into avoidance and blocking, then I also numbed myself to beauty and subtle positive emotions. When blocking I didn’t experience the pain so much, but then I only felt half alive, which was in itself unpleasant.
So I realized that, after the first step of becoming broadly aware in a general sense, the next step for becoming mindful when living with pain is to find ways to very gently turn towards the pain and allow layers of resistance, avoidance and blocking to soften with tenderness and gentleness so one can begin to feel more fully alive. This is the second step – moving towards the difficulty.
I also knew that this was not the whole story and that, after having become more tender and open by turning towards pain and softening resistance, the next step was to be like an explorer seeking hidden treasure and to learn to pay attention to pleasurable states. So this is the third step – seeking the pleasant in the knowledge that it is always possible to find something pleasant if you learn how to pay subtle attention to your experience.
The fourth step grows out of the previous steps and is a broadening of awareness to hold both the unpleasant and the pleasant within a very stable field of awareness that is infused with equanimity. You can see steps two and three as being like looking through a close-up lens of a camera to examine the details of experience, and then step four is like pulling back to a wide-angle lens that contains great variety within the same frame. Another important aspect of the fourth step is to see into the impermanent, fluid nature of experience and to allow both the unpleasant and pleasant to rise and fall without either resisting unpleasant experience on the one hand or grasping onto pleasant experience on the other.
The fifth step is the behavioural outcome of the previous four steps and is ‘choice’ – it is learning to live with creative choice in every single moment rather than being driven by habitual reactions.
To summarise the five steps:
Step one: Awareness
Step two: Grasping the nettle – moving towards the unpleasant
Step three: Enjoy the moment – seeking out the pleasant
Step four: Gaining perspective – broadening awareness to cultivate equanimity and hold experience in ‘a bigger container’.
Step five: Living with choice – learning to respond rather than react
Elisha: If you were sitting across the table from someone who had been experiencing chronic pain or a chronic pain, what advice would you give them?
Vidyamala: The first thing I would try to do is simply connect with them as another human being who is suffering. I would try to help them feel that they are not alone in their pain and I would try to connect with them on the basis of empathy. I would talk to them about the fact that they will ever only experience the pain one moment at a time and ask them to examine how much of their distress is based on ideas of past and future (such as dreading future moments of pain).
I would also ask them what is pleasant in their experience right now: It might be something very simple like having warm hands, or being in a beautiful room, or feeling the gentle sensations of breath in the body. By experiencing this directly they may be a little less overwhelmed by their pain. I would try to laugh with them. One thing I have found through my own practice of mindfulness and compassion is that it is always good to lighten up. Everything is changing and if I can let go into this broad sense of flow then I experience life as being much less heavy and stuck.
So I would try to empathise with their situation as deeply as I could, and I would try to engage on the basis of enjoyment of their company as well and in this way help them realize that chronic pain is just one element of life and that it is possible to be quite light about the situation if one isn’t dominated by the pain either through being overwhelmed or through being trapped into habits of avoidance and running away. I would try to exemplify a sense of being with the pain with great honesty, whilst simultaneously having a broad and open appreciation of all the other elements to the moment as well – many of which are joyful and pleasurable.
[i] Samyutta Nikaya, 36:6 Sallatha Sutta, ‘The Arrow’.