Lessons for Illness

Tonight we’ll be talking about the lessons for facing illness that can be derived from the Buddha’s awakening.

To continue with the story of Ven. Raṭṭhapāḷa and King Koravya: Remember that Raṭṭhapāḷa told the king about the four Dhamma summaries that inspired him to go forth as a monk. The second one was, “The world is without shelter, without protector.” You can imagine what the king thought about that.

So Raṭṭhapāḷa asked the king, “Do you have a recurrent illness?” The king replied, “Yes, I have a wind illness,” which basically means shooting pains throughout the body. He added, “Sometimes I’m lying in bed and my courtiers are standing around, saying, ‘Maybe this time he’ll die. Maybe this time he’ll die.’” So Raṭṭhapāḷa asks him, “Can you command them to take part of the pain and share it among them, so that you don’t have to feel all the pain yourself?” The king said, “No, I have to feel all the pain on my own.”

“That’s the meaning of the phrase, ‘The world is without shelter, without protector.’”

This is a lesson in dukkha, the stress and pain of this state of becoming. And, of course, it’s a lesson in illness.

The Canon, in its treatment of illness, takes hunger as the primary example of illness. It’s something that affects all of us, and it’s a paradigm for how to treat other illnesses. It comes from a lack or imbalance in the physical properties, and you treat it when you can, but you learn how to bear up with it when you can’t.

Ajaan Fuang tells a story about when he was with Ajaan Mun and there were occasions when a monk would be sick, but there was no medicine for his illness. If the monk was begging for medicine, Ajaan Mun would scold him. “You’re a meditator, use your discernment to comprehend the pain,” he would say. But when there was medicine and the monk refused to take it, Ajaan Mun would scold him, “Why are you making yourself so difficult to care for?”

It sounds like you’d get scolded either way, but the message was this: Treat the illness with medicine when medicine is available, but otherwise, use the strengths of the mind to treat it in any event.

You start with the strength of conviction in the Buddha’s awakening. Think of the teaching on kamma: In line with the principles of this/that conditionality, some of your diseases come from past kamma, some come from present kamma, some come from a mixture of the two. This is why not all diseases go away when you get your mind free of defilement: Past kamma is playing a role. Even the Buddha, the most spiritually advanced person who ever was, suffered from diseases every now and then because of his past kamma.

He classed diseases into three categories:

You can’t know ahead of time which category a particular disease falls into, so you have to treat it as if it belongs to the third type, which means that you treat it with medicine when you can. This is why the Vinaya, the collection of the monks’ rules, is so full of medical knowledge concerning medicines and other treatments for dealing with disease.

It also describes the ideal patient:

The hardest of those five qualities, of course, is enduring pain. This is where you have to bring in the strength of persistence. Your right attitude is that the body may be sick, but the mind will not be sick.

There are three main points to understand here.

• The first point is having the right attitude toward your disease. If you ask yourself, “Why is this disease happening to me?” the answer is, “Because you were born.” It happens to everybody, so you have to regard it as normal and see it as an opportunity to strengthen your mind in the face of adversity.

• The second point is seeing the value of learning how to endure pain. You don’t want your mind to be driven by fear of pain. Otherwise, people who don’t wish you well can take advantage of that fear. Also, learning to endure the pain of illness helps to prepare you for the pains of death.

This is where you bring in the strengths of shame and compunction. Think of the meditators in the past who have been brave in facing pain and whose minds gained important insights as a result. Both of my teachers, Ajaan Fuang and Ajaan Suwat, said that they gained important insights because of their illnesses. In Ajaan Fuang’s case, it was chronic intense headaches. In Ajaan Suwat’s case, it was malaria. One time Ajaan Suwat said, “If malaria were a person, I would bow down to him out of gratitude.” Remember that death will be even more painful, so you want to ensure that pain will not pull down your mind state at that time, so here’s your chance to practice with pain.

• The third main point to keep in mind is that you’re not here just to endure the pain. You’re here to understand the pain so that it doesn’t overcome the mind. The ideal attitude is that you want to be able to experience pain disjoined from it, which means that the pain may be there, but you can see it as something separate from your body and separate from your awareness. We cling to pain not directly, but because we cling to things we like that are right around the pain. To separate the pain out from these things, we can’t just sit and endure it. We have to be more proactive and experiment with it, to see that it is distinct from the physical and mental events surrounding it.

This is where we develop the strength of discernment by remembering the analysis of feeling given in dependent co-arising, and then applying that knowledge to our specific pains.

Dependent co-arising describes the factors around feeling in two of the early factors of the list: fabrication and name-and-form. Under fabrication, directed thought and evaluation are right next to feeling. Remember that directed thought and evaluation are basically how you’re talking to yourself about the pain. Another sub-factor under fabrication are perceptions, which are your mental images and labels of pain. Under name-and-form, near feeling you also have the physical properties of the body, along with perceptions, intentions, and acts of attention. Any of these factors could be making it hard to endure pain, but if you train them properly, they can actually make it easier to endure pain.

Sometimes you’re told that you cannot want for the pain to go away because that’s craving. That’s partially true, but it has to be qualified. In order to separate the pain from its accompanying factors so that you can experience it disjoined from it, you have to see what you’re doing that’s aggravating the pain unnecessarily, whether physically or mentally, so that you can stop doing those things.

In Majjhima 101, the Buddha says not to load yourself down unnecessarily with pain—and, by definition, from his point of view, all mental pain is unnecessary. So the desire not to suffer mentally from the pain is actually part of the path. If you can lessen the physical pain in the process, that’s all to the good.

In reference to those two sets of factors in dependent co-arising, you can see that breath meditation is very helpful with its emphasis on the three types of fabrication. It’s also good for dealing with the extra factors that come from name-and-form: the four physical properties or elements, and the way in which the mind’s intentions and acts of attention shape whatever the experience is.

It’s here that you develop the remaining strengths in dealing with the pain—in other words, mindfulness, concentration, and discernment.

You may remember the four steps of mindfulness of breathing dealing with feeling, which we talked about yesterday morning:

These steps, in the context of meditation in general, refer to the stages in getting the mind to settle into deeper and deeper stages of concentration, through cultivating rapture together with feelings of pleasure and equanimity. But the teachings of the Thai forest masters show that these steps can also be applied to the contemplation of feelings of pain, including the pains of illness, as well.

The first two steps, dealing with rapture and pleasure, receive a great deal of attention from Ajaan Lee. His instructions for breath meditation focus on the breath energies throughout the body that accompany the in-and-out breath, and he shows how these energies can be very useful in exploring what you’re doing that may be contributing to physical pain.

The first step he recommends, when there’s a pain in the body, is not to focus attention directly on the pain, but instead to focus on a part of the body that you can make pleasurable by the way you breathe and by the way you allow the breath energies to flow freely through that area. Sometimes the best place to focus is in a part of the body immediately opposite to the pain. For example, if the pain is on the right side of the body, you focus on the corresponding spot on the left. If it’s in the back, you focus in front. Or you may find that the pain in one part of the body is related to an energy blockage in another, more remote part of the body: In my own experience, I’ve had migraines that were alleviated when I focused on clearing up energy blockages in my lower back.

Eventually, you’ll want to be able to focus directly on the pain itself, but Ajaan Lee’s first step in approaching pain accomplishes three things: (1) It gives you a beachhead of pleasure to which you can retreat if you find that the pain becomes overwhelming. (2) It gives the mind a solid basis in concentration, which can provide a sense of nourishment for the work of contemplating the pain. (3) It gives you practice in learning how to focus on a part of the body without tensing up that part of the body. This will be an especially useful lesson in learning how to pay direct attention to pain without aggravating it.

Working with breath in this way also involves discernment, as you explore the three types of fabrication in relationship to the pain. You start with bodily fabrication—the rhythm and texture of how you breathe in and out—and you also bring in verbal fabrication: talking to yourself about how to make the breath comfortable, how to maintain that sense of comfort once it’s there, and how to spread it through the parts of the body that are receptive to that good energy.

This, of course, also involves mental fabrication in terms of the perceptions you use to experiment with the breath energies in different parts of the body. Ajaan Lee recommends two perceptions to help in this step in dealing with pain: Think of the body as a house with a few rotten floorboards. If you’re going to sit or lie down on the floor, choose a spot where the boards aren’t rotten. Or think of it as a mango with a rotten spot: Leave the rotten spot to the worms; you eat the good part remaining.

Then, when the breath is solidly comfortable and the mind feels ready, drop those two images. Now think of spreading the good breath energy through the pain. For example, if there’s a pain in your knee, think of the good energy going down the leg through the knee and out the tips of the toes. Don’t let there be a perception of the pain blocking the breath. Remind yourself that breath is energy, and energy can go through anything. I’ve found it helpful to think of the area of the body that’s in pain as being composed of atoms, and atoms are mainly space, so the breath can penetrate easily through the space. The perception of the pain as a blockage is actually conflating the pain with the solidity or earth property of the body. As long as you cling to the body, that would be a recipe for allowing the pain to invade the mind and remain.

Or, as I said earlier, you can perceive the breath as being in that part of the body prior to the pain, so that you can minimize the sense that the pain is blocking it.

There are also other questions you can ask about the pain and its relationship to perception at this stage. Do you perceive the pain as being blocked off from the breath? Are you using the parts of the body that are in pain to do the breathing? If so, think of those parts relaxing, and allow other parts of the body to do the work of breathing instead. You can also experiment with the perception of having the breath go straight into the pain when it first enters the body. See what that does to your experience of pain.

Sometimes, when you follow this step, the pain will go away or will be greatly reduced. Even if it doesn’t, you will have established an important relationship vis-à-vis the pain: You can be proactive in dealing with it. You’re not afraid of it. You’re not a passive victim. When you’re proactive, you’re not a stationary target for the pain, so it can’t hit you so easily. At the same time, by learning to question your perceptions around the breath and the pain, you’ve learned how arbitrary some of your original perceptions were. By sensitizing you to the role of perception—mental fabrication—around the pain as you try to find perceptions that help to alleviate the pain, this insight makes some beginning forays into the third and fourth steps in contemplating pain: sensitizing yourself to mental fabrications—perceptions and feelings—and then calming them.

These are the steps to which Ajaan Maha Boowa devotes a great deal of attention. He recommends a wide range of questions that you can ask yourself about how you perceive the pain. For instance, do you perceive the pain as being the same thing as the part of the body that’s in pain? If the pain is in the knee, do you see the pain and the knee as being the same thing? This question may seem strange, but remember: We may have picked up some strange ideas about pain when we were children, and often these ideas are still lurking in our subconscious. The only way to dig them out is to ask questions like this.

If the pain and the part of the body seem to be one, remind yourself that your experience of the body is made up of the four properties of earth, water, wind, and fire, but the pain is something else. The pain may seem solid or hot, but remind yourself that solidity and heat are properties of the body that you’ve conflated with the pain. Can you perceive the pain as being separate from the solidity or the heat? To counteract the perception of the solidity of pain, you can try to perceive it as distinct moments, arising and passing away in quick succession.

A related question is: Does the pain have a shape? If you perceive it as having a shape, again you’ve glommed the pain together with a property of the body.

Similarly, you can ask yourself if there are pains in several parts of the body that seem to be connected with lines of tension. This is actually another way of giving the pains a shape and of conflating the pains with the body. So ask yourself if you can see the pains as separate from one another. Or try to counteract the perception of a connection with an alternative perception: You have a knife that you can use to cut any connections as soon as they appear.

Another question: Do you perceive the pain as having an intention to hurt you? Remind yourself that pain is not a conscious agent. It has no intentions at all. It’s just an event that depends on other events. If you perceive it as having an intention to hurt you, you’re creating a sense of self around the perception of being the target of malicious intent. When dropping the perception of its intention, you can also ask yourself why you’re identifying yourself as the target.

Another question: Where is the most intense point of pain? If you look carefully, you’ll see that it moves around. Try chasing it down. This line of questioning not only helps to loosen up any fixed perceptions you might have around the pain, but it also gives you practice in being courageous in the face of pain. Instead of trying to run away from it, you run toward it—and it’ll run away from you. This exercise also helps to guarantee that in your contemplation of pain, you haven’t allowed the desire for it to go away to slip into first place in your intention for focusing on it. The correct intention toward it is to try to understand it.

In addition to applying these questions and perceptions—verbal and mental fabrications—to your own pains, you’ll also need to come up with some questions of your own around your perception of pain to see what helps you to detect perceptions you may not have noticed and to loosen them up.

A question I’ve found helpful—once you can perceive the pain as occurring in discrete moments—is to ask yourself: When the moments of pain arise, are they coming at you or going away from you? See if you can hold in mind the perception that they’re going away, going away. It’s like riding in a train in a seat with your back to the engine. As the train runs along the track and you look out the window, you’ll notice that whatever comes into the range of your awareness in the landscape outside is already going away from you as soon as you see it. This perception helps to get rid of the perception that the pain is aimed at you. It also helps to detect and loosen up any tendency you have to cling to the perception of yourself as a target.

When you loosen up and drop your perceptions around the pain, the pain may go away—sometimes in some very uncanny ways. I myself, once, was meditating and managed to separate the perception of the pain from the pain itself, and the pain slipped from where it originally was, ran through the body, into the heart, and disappeared. But even if the pain doesn’t go away with this analysis, you’ll arrive at a state of mind where you sense that the pain can still be there, but your awareness feels separate from it. The body is one thing, the pain is another, your awareness is yet another. They’re in the same place, but they’re separate, just like the radio waves transmitted from Marseille, Nice, and Aix going through the air all around you. They’re all in the same place, but at different frequencies. If you have a radio that can distinguish the frequencies, you can tune into the various frequencies without having to move the radio to one place for one frequency, and to another place for a different one.

Other times, when you can separate the pain from the body and from the awareness, you get the sensation that the pain actually moves itself away from the body and hovers at a slight distance from it.

Ajaan Maha Boowa notes that a strategy for dealing with pain that works today may not work with a different pain tomorrow. And given what the Buddha teaches about the many factors surrounding pain, it’s easy to see why. One day a pain may invade the mind when you conflate it with one aggregate or factor of dependent co-arising—form, say, or a particular perception—and on the next day, another pain may invade the mind when you’ve conflated it with another one.

If you compare the ajaans’ strategies with the various causal clusters described in dependent co-arising, you’ll see that they deal not only with the issue of perception, under the factor of fabrication, but also with the issues of attention and intention under name in name and form. Attention determines not only where in the body you focus your interest, but also which questions you focus on asking and answering. Intention, of course, deals with your reasons for contemplating the pain. As I noted above, the quest not to have the pain invade the mind can include within it the desire to see the pain go away, but it can’t allow that desire to be prominent. For your contemplation to get results, the desire to understand the pain always has to come first.

When you understand these exercises in this way, it gives you an idea of the range of different questions you might try in your own investigation of pain to develop dispassion for the two reasons why pain could invade your mind and remain: what you’re doing to aggravate the pain, and what you’re clinging to that you’ve conflated with the pain. When you understand these two issues, you’ve gone a long way toward unraveling the problem of suffering.

The important point is that you don’t make physical weakness or illness an excuse for not taking a proactive approach to understanding pain. As I noted above, both Ajaan Fuang and Ajaan Suwat gained important insights into pain—and into the mind—while contemplating pain while they were seriously ill. Many other people in the Forest tradition, ordained and not, have also reported similar results. If they can do it, so can you.

Which means that even though there’s the pain of illness, you can do something about it. And it doing something about it, you’ve greatly strengthened your mind to deal with the even greater challenges facing it at the end of life.