In the Dukkha Magnet Zone

Tricycle: How can medicine be a vehicle for Buddhist teachings in this country?

Jon Kabat-Zinn: Hospitals and medical centers in this society are dukkha magnets. (Dukkha means “suffering” in Pali.) People are drawn to hospitals primarily when they’re suffering, so it’s very natural to introduce programs to help them deal with the enormity of their suffering in a systematic way—as a complement to medical efforts.
When we set up the Stress Reduction Clinic, the question was: Would people accept an intensive meditation-based training program to learn how to take better care of themselves? Would they be willing to roll up their sleeves and work hard on themselves? A question that isn’t very prevalent in the United States.

Tricycle: Is the average person willing to do that?

Jon Kabat-Zinn: Not only are mainstream Americans willing to practice intensive Buddhist meditation within a non-Buddhist framework, they take to it like ducks to water. They find that it has remarkable effects, not only on their symptoms and state of mind, but at a much more profound level, on their sense of well-being as people.

Tricycle: What about the viability of accomplishing this in an eight­ week program?

Jon Kabat-Zinn: We’re not pretending to be a monastic setting or an intensive retreat-type setting. It’s an outpatient program aimed at teaching people the principles and practice of mindfulness meditation and their applications in daily living. People come to the hospital once a week for a 2 1/2-hour class, with about thirty people in each class. And they have to carve out 45 minutes a day, six days a week, to practice the meditation and mindful yoga. We also do a day-long silent meditation retreat in order to give people an extended taste of mindfulness. It’s quite impressive to experience 150 people in a room, sitting and walking, all in stillness. For the population we work with, this is pretty intensive exposure. Most have little in the way of personal philosophy that would draw them to it.

Tricycle: Since what you’re teaching is really a crash course in the dharma, what about the question of work ing with a recognized teacher once the course is over?

Jon Kabat-Zinn: I feel that for Americans it’s very important not to venerate other people too much. The problem of low self­ esteem is so epidemic in our society that it’s just too easy to project onto somebody else that they are enlightened, and in the process give up one’s own inner authority and power. It is possible to display all the outer trappings of Buddhist practice and never engage in the real work. That’s a danger we try to circumvent from the beginning. Now that doesn’t mean that we’re better than a tradition that’s involved with deep teacher/disciple relationships. We cannot go in that direction, given the setting in which we work.

Tricycle: Do your colleagues in the medical center have any idea that you’re teaching the dharma?

Jon Kabat-Zinn: Yes, but only if they understand what dharma is. It would be more accurate to say that they all know we teach yoga and meditation. However, their ideas of yoga and meditation are usually quite limited. Though some of them have been through the program, many others have not. They just treat it as a place where their patients can go to get relaxed, and they don’t want to know exactly what we do.

Tricycle: What exactly do you do?

Jon Kabat-Zinn: We’re trying to help people be full human beings, whatever that means. We’re not a closet religious organization trying to infiltrate medicine. We’re taking what we ourselves understand to be the principles and the essence of the Buddha’s teaching and Buddhist wisdom, and we’re translating it in such a way that it becomes a living, vibrant way of being for regular people. As in all the Buddhist traditions, when it comes down to it, you have to walk this path yourself. What we’re doing is giving people some basic tools and a perspective that will allow them to practice in one way or another for the rest of their lives.

Tricycle: What are the implications of taking mindfulness practice outside of its formal traditions and historical context? Is there a danger of watering it down too much, of endangering its integrity?

Jon Kabat-Zinn: I think there is always a danger of a tradition losing its integrity or being distorted by someone whose understanding is limited. But it’s even more of a danger, if one is concerned about human suffering, to become so doctrinaire that you’re basically captivated by your own requirements to be pure to a particular tradition. Religious traditions are famous for their parochialism. Lots of Buddhists get into ego trips, such as “My practice is better, deeper, faster, more complete, or more spiritual than your practice.”

Tricycle: You mentioned earlier that the Dalai Lama had a very interesting response to this issue.

Jon Kabat-Zinn: The question came up: If a clinic of this kind is created-albeit with the best intentions-by someone who may have some understanding of dharma but who is not teaching within a traditional Buddhist framework, is there a risk of diluting the essence of the practice and the living quality of the dharma so that ultimately, if this happens in many different places, it’s going to sound the death knell of true Buddhism? What the Dalai Lama said is that there are about four billion people on the planet and maybe one billion of them are Buddhists, so that means there are three billion people who aren’t Buddhists, but there are certainly four billion who are suffering. To limit knowledge of the path to those who ascribe to the Buddhist view is basically shutting oneself off from the plight of the majority of people on this planet. What’s more, the essence of the practice calls for not making these kinds of dualistic distinctions but rather doing whatever is necessary to help people become more wise, more compassionate, and more peaceful.

Tricycle: There’s such a diverse population in this country; the teachings will probably have to transmute in many different directions.

Jon Kabat-Zinn: Just because we don’t teach within an explicitly Buddhist framework doesn’t mean that people don’t come out of our clinic and then turn to the writings and teachings of Thich Nhat Hanh or the Dalai Lama or some of the other teachers and find that they understand them on a level that they never would have before. In fact, I think the program opens people up to the more esoteric aspects of the different traditions, which might otherwise have seemed like sheer craziness. All you need to do is take a patient suffering chronic pain, who is at his wit’s end, and say, “No problem, just sit and follow your breathing.” You are telling him the essence of the practice right there, but how much use is it going to be? In fact, in many ways it’s a gross insult, because it belies the distance that’s required to go from where you are. . . .

Tricycle: Back to where you are?

Jon Kabat-Zinn: Exactly, but with a major rotation in consciousness.

Tricycle: Do a lot of patients arrive with an agenda to visualize their cancer away- or whatever the latest fad is? Do they have difficulty when you tell them that’s not what your clinic is about?

Jon Kabat-Zinn: It’s particularly problematic with people who have cancer or AIDS, because they have been reading about immune function and meditation and relaxation and group support­ that these things can regress your tumor or change your T-cell helper-to-suppressor ratio. It hasn’t been a big problem for us, because we see everybody individually before they go into the program. We try to size up what their motives are, and that’s when the teaching really begins. We explain that while they’re in the program, it’s very important to work at developing an attitude of not-striving.

Tricycle: But how does somebody who is in an acute medical crisis balance the desire to get well with an acceptance of what is?

Jon Kabat-Zinn: We encourage people to expand their belief system to the point where they entertain the notion that they’re already well, even in the midst of illness. In the West, we have a dualistic view of illness: either you’re well or you’re ill, and it has to be one or the other. But it’s more accurate to look at health and illness as being completely intertwined. The body is constantly decaying and dying, and it’s also being built up; and one’s sense of self is also transmuting constantly, very often below the level of consciousness.
If you come to a deeper level of stillness inside yourself, then you can begin to accept that there are many different energies at work. We believe that the way to regulate those energies, to give them the best chance for coming into harmony, is to just allow yourself to be where you are. But that’s not the same thing as giving up or doing nothing. It is a very active holding of the present moment with what Seung Sahn calls the “don’t know mind.” You don’t know where you’re going, and you don’t know how long the body is going to last; but in accepting that fact-whether you have cancer or AIDS or heart disease, something profoundly healing takes place already. And we distinguish between healing and curing.

Tricycle: Healing doesn’t necessarily mean that you live longer?

Jon Kabat-Zinn: We all want cures, but if you’re in a state of agitation or depression and you can come to some inner peace and acceptance of the situation, that’s a remarkable, life-affirming transformation, or healing.

Tricycle: Doesn’t being in the moment with what is contain wanting in that same moment to get well?

Jon Kabat-Zinn: Yes, but the question remains: What does it mean to get well? One might intend to be as well as one could be in this moment-body, mind, and soul-but also realize that we don’t ever know exactly what that means.

Tricycle: And that’s the most you can do?

Jon Kabat-Zinn: It would be different in every moment. But if you can really be right here, my belief-and there has to be an awful lot of science done before this will be clarified-is that that’s probably the single most healing thing you can do.

Tricycle: I think it gets tricky when you’re in a medical crisis and you read about visualizing your disease away in Carl Simonton’s Getting Well Again or Bernie Siegel’s Love, Medicine, and Miracles.

Jon Kabat-Zinn: We don’t use those approaches at all.

Tricycle: But it’s out there. If someone comes to you and says, “I want to do mindfulness, but I also want to visualize my natural killer cells,” what do you say?

Jon Kabat-Zinn: We say, “Fine, but just be aware that your attachment to wanting something to come of it might be the biggest obstacle.” So as long as they’re willing to work with attachment, it’s just like any other aspect of practice. It’s not the thing per se that’s the problem, it’s the quality of mind that one brings to it.
If there is an enormous amount of greed there and fear underneath that, then really what we’re saying is “Open up to that, look at that, and then, of course, visualize your natural killer cells increasing and eating up all the cancer cells if you want to. But try to do it from a perspective of play, of non-doing, of ‘we shall see.’ Don’t go into it with an article you read in some journal saying that meditation can increase your natural killer cell titer, because that has not been proven. Nor has it been proven that if you did increase it, this would make any difference in terms of a health outcome.” It would be a real disservice to Buddhism and the dharma to link meditation in such a mechanistic way to Western molecular medicine.

Tricycle: What about the notion of self-blame that has become prevalent today: “My anger caused my disease.”

Jon Kabat-Zinn: We deal with that only when it comes up as a major problem for someone. This view is not very common in our patient population. In any event, it is only an issue when you generate too much thinking, especially “wrong thinking,” in the minds of the people you’re working with. We are working within a framework that doesn’t hold much stock in thinking. We try to teach people to look very carefully a t their thoughts as events in the field of their awareness and to note the gross inaccuracies in almost all of their thoughts. In that context, the issue of whether one is to blame for one’s cancer has no more relevance or power than the thought that one is to blame for something else one has experienced. The real question is, What now? How shall I hold this moment ? Where do I go from here?

Tricycle: What about the teaching of anatman, or no-self, for people who are facing terminal illness or chronic pain? Is it useful?

Jon Kabat-Zinn: We don’t emphasize the teaching of no-self, but we hope that people will begin to experience the dissolving of the attachment to the personal pronoun I and begin to realize that, in fact, one is much more than the self-representation of thought that we all get caught up in. Many people spontaneously say things like “I’ve come to see that I have cancer, but that I am not my cancer,” and that’s a real liberation for them.

Tricycle: What about people who are terminally ill? Do you work with them through their dying?

Jon Kabat-Zinn: We don’t so much. We emphasize living rather than dying-moment-to-moment awareness. If someone is dying, we might gently suggest, if it seems appropriate, an emphasis on dispassionate observing of one’s experience, observing as much as one can, including all the inflammatory and painful thoughts and feelings that may be associated with dying. Often people report that they find a certain calmness about the entire process. Death becomes more something of interest rather than something that’s creating so much agitation and anxiety that one is actually losing oneself in the present, when one is still alive.

Tricycle: The program sounds like a blend of the Zen and vipassana traditions.

Jon Kabat-Zinn: It comes from my own practice and the practices of my colleagues who come from different traditions. But what we’re all teaching is basically the same thing, and that’s what we collectively understand to be basic mindfulness practice. It is most similar to the teachings of vipassana and Soto Zen.

Tricycle: What’s important about your work that we haven’t already talked about?

Jon Kabat-Zinn: I would say that for people who are serious dharma practitioners, one of the things that we have learned is that if you have the chutzpah or strong motivation to bring the dharma into your work, you can. The only impediment is the limit of your own imagination.