A Slap In the Face

I am of the nature to grow old.
I cannot escape growing old.

I am of the nature to have ill health.
I cannot escape having ill health.

I am of the nature to die.
There is no way of escaping death.

All that is dear to me and everyone I love
are of the nature to change. There is no way 
to escape being separated from them.

I contemplate the first four of the five remembrances often. Yesterday went deeper . . . 

I spent most of Thanksgiving at the memory care community where I work part of the time. I had expected a joyful day.  I came out instead with heart filled with deep sadness. It helped that I had gotten slapped in the face, literally, by a still relatively young man, a resident with a case of early onset dementia, and lots of rage bottled up inside. Too much going on, too much noise, too many strangers visiting, a complicated family situation . . . he could not take it, and delivered me an unexpected blow, just after I had introduced myself to him. I did not flinch, and walked him to the table where a few relatives were to join him for a short lunch. He obviously needed space. I left him waiting alone. 

Right side of the head still burning, I went on and pretended nothing happened. The truth was, mind had been jarred, and questioned. The angry man had hit me hard with his suffering, and I had to face the truth of the four remembrances delivered right into my flesh, not just as thoughts to be pondered. Habitual, reactive mind revolted, and heart flinched at the very real possibility. Everywhere I turned, lonely souls reminded me, and even the ones with families visiting soon would be left also, back to living the end chapter of their lives in this place. I stopped being the one working there, and felt like almost one of 'them', with only years, and the randomness of fate separating us. 

Life, with its conventional narrative of past, present, and future, is rotten at its core. The story never ends well, and the only way out is through the dropping of the story itself. Each instant, a new moment, a new call to living.

What Keeps Me Sitting

It's easy taking on mindfulness practice. It's another thing sitting day after day after day.

No one checking on you, no one encouraging, no immediate consequences one way or the other, there is only faith in the practice to sustain one's determination. 

The faith in question is not blind. Rather, it is faith informed by one's prior experiences with practice, combined with acquired wisdom based on the teachings. It's a bit like embarking on a road, and finding out that the map is proving accurate. From that realization, trust in the directions develops. The much desired end point and the higher road to attain it are worth all the effort. The alternative, the samsara route, is not one I want to stay on. There's got to be a better way to be in this life . . . The awareness of the pervasiveness of suffering is the other reason I sit every morning. The mind needs to be put to rest, and the only way is through proper seeing, substituting, and letting go, all best done during quiet, attentive sitting. 

What keeps you sitting, day after day after day? 

Appeasing the Mind

The ordinary mind can never get enough of thinking. Planning the future, rehashing past events, elaborating schemes to satisfy various versions of the constructed self, the mind runs amok with infinite thoughting possibilities . . . Now, whenever I sit to meditate, I have found an easy way to appease the mind. I tell it to just hold off for those few moments, and that it will be able to resume its fabrications afterwards. That may not seem like not much, but that small reassurance seems to do the trick!

Word For Word

Every time I sit down for practice, I remember these specific words from the Maha-Satipatthana Sutta:

Focused on the body in and of itself

- ardent, alert, and mindful - 

putting aside greed and distress with reference to the world [. . .]

Having gone to an empty building, [he] sits down [. . .], 

holding his body erect 

and setting mindfulness to the fore. 

Always mindful, he breathes in; mindful he breathes out. 

"Breathing in long, he discerns, 'I am breathing in long'; or breathing out long, he discerns, 'I am breathing out long.' Or breathing in short, he discerns, 'I am breathing in short'; or breathing out short, he discerns, 'I am breathing out short.' 

He trains himself, 'I will breathe in sensitive to the entire body.' He trains himself, 'I will breathe out sensitive to the entire body.' 

He trains himself, 'I will breathe in calming bodily fabrication.' He trains himself, 'I will breathe out calming bodily fabrication.'

Each one of those points an essential instruction for sitting practice . . . No need to read long books, or listen to more teachings. One could spend a life time just practicing this. 

Minding the Guilt

Guilt is an interesting emotion with many nuances worth exploring. 

Guilt came up recently in a caregiver support group I help facilitate. One woman felt guilty for not being there for her husband 100 percent of the time. I explained that we often set ourself up with unrealistic expectations of ourselves, 'should-s' that demand from us more than we can humanly give. And we end up with this yucky feeling in our stomach, a mixture of self-hate, confusion, and powerlessness. This is false guilt, a toxic emotion to be disposed of promptly as soon as we can see it for what it is.

Guilt can also be of the rightful kind. There are a few major decisions I have made in the past that have come back to haunt me, both in terms  of negative outer consequences, and also the pain from a tormented heart. There is no escaping such guilt. I have found it needs to be endured with great tenderness, and also the determination to learn from it. Rather than lingering in biting remorse, better yet is to mine the wisdom buried in one's earlier mistakes. Whenever guilt raises its ugly head, I meet it like this:

First, I feel the guilt completely, including the slew of other, all very unpleasant mind states attached, the sadness, the remorse, the regret, . . . I feel them all. Guilt is a blow to the ego. It crushes one's inflated view of one self, and as such, can be seen as a very good thing. Guilt opens one's heart.

Second, I move on to a state of self-compassion. I revisit what happened, and the circumstances that led to the original action. A state of limited consciousness and heart not being opened, for sure. I forgive myself. 

Third, I step out of myself, and I feel the pain of those I unwittingly hurt. I use that intimate knowledge to build up the necessary resolve to not repeat such hurtful acts. Part of that resolve is a renewed commitment to mindfulness and loving kindness practice, the two best safeguard I know against negative karma. 

Fourth, I take a forward thinking stance. The past is the past that cannot be undone. All I can change is how I think, feel, and act in this present moment. The opportunity to love is right now. Today is the first day of my remaining life.

How do you deal with guilt?

6 Mindfulness Strategies For the Busy Person

It's been hard finding the time for formal practice. Work has not let up, and every day, same questions. What time to set the alarm? How much sleep do I really need? Does time spent meditating make up for loss in sleep? Do I meditate first thing, or wait until I come home, some time late? How long do I sit for? How about breaking into two smaller sittings? 

I finally have come up with a plan, and it's been working - sort of . . .

Here it is:

1. Set up my alarm to 6am every morning.

2. Always sit, no matter what. That part never changes day to day.

3. Depending on how early I need to leave, morning sitting practice may be 5, 10, 15, 30 minutes. I always set my timer.

   5 or 10 minute practice is simple awareness of breath 

   15 minute practice is loving kindness meditation

   30 minute or more practice is sitting with breath

4. In the case when morning practice is less that 30 minutes, I leave with the redoubled intention of using whichever ensuing activities as mindfulness practices: walking to my car, listening to Ayya Khema's talks while driving, walking from car to work, etc . . . I am also fortunate to incorporate mindfulness into my work, and get to have several 5 minute mindful check ins with the people I work with. 

5. I also try to make up at night with some loving kindness or simple sitting practice.

6. I use weekends to boost my practice with longer sittings, 45-60 minutes. 

How do you manage to squeeze in some mindfulness into your busy day?

Of course, the real solution lies elsewhere, in a rethinking of one's priorities. Not giving into the craving for more work, being content with less money, less accomplishments. Keeping it more simple . . .

Launching Mindfulness-Based Dementia Care at UCSF

'Mindfulness' and 'dementia', two words to do with mind:

mindfulness

dementia, from Latin word demens, which means 'without mind'

Mindfulness and dementia are not just connected in words. Mindfulness also happens to be a key element of successful dementia care, working on two fronts: 1) to reduce caregiver's stress, 2) to help the caregiver be present for the person in their care. Facts gathered by the Alzheimer's Association show the extraordinary stress suffered by most family caregivers:

• 61 percent of dementia caregivers suffer from high emotional stress.

• 33 percent report symptoms of depression.

• 43 percent experience high physical stress.

• 75 percent are concerned about maintaining their health.

• Dementia caregivers are more likely to have adverse physiological changes such as high levels of stress hormones, reduced immune function, increased hypertension, coronary heart disease.

• In the last year of their loved one's life, 59 percent feel they are on duty 24 hours a day.

This goes on for an average of 4 to 8 years post-diagnosis. It is no wonder 72 percent of caregivers express relief after their loved ones die. For professional caregivers and health care providers, the stress is also intense and can lead to burnout. 

Until recently, most mindfulness-based approach to dementia care referred to Mindfulness-Based Stress Reduction for dementia caregivers. Having observed numerous times the unique challenges as well as mindfulness practice opportunities in dementia care, I realized the need for a mindfulness-based program specially tailored to dementia caregiving. Hence began the Presence Care Project, a non-profit initiative aimed at promoting a new form of dementia care training. In the Presence Care approach,  mindfulness, informed by experiential understanding of the person with dementia, becomes the foundation upon which a caregiver can rest, moment-to-moment, day after day, during the long journey of dementia. UCSF OSHER Center for Integrative Medicine has now taken on this new approach and recently launched its new Mindfulness-Based Dementia Care (MBDC) program.

MBDC builds upon the now very well proven model of Mindfulness-Based Stress Reduction (MBSR),  and combines solo mindfulness practices, interactive mindful care practices, lectures, and group sharing. Throughout, aspects of mindfulness practice and dementia care are interwoven. The emphasis is on practice during and between classes. The end goal is for participants to experience a radical shift in attitude from mostly doing and reacting, to being skillfully present for themselves and the person in their care. MBDC is appropriate for the whole range of persons involved in dementia care: family and friend caregivers, professional caregivers, elder care professionals, nurses, doctors, and other health care providers. 

MBDC rests on this central premise: mindfulness, that which helps dementia caregivers reduce their stress, is also what can help them provide the best care for the person with dementia. 

The first series of 8-week classes is starting next week and will be taught by myself and Dr. Kevin Barrows, physician and director of mindfulness programs at the OSHER Center.