How To Be Sick

How To Be Sick, by Toni Bernhard, is situated more squarely in the self-help genre than perhaps any text I’ve discussed thus far on this blog. The book’s subtitle is A Buddhist-Inspired Guide for the Chronically Ill and Their Caregivers. I think I discovered it on the website Five Books dot com, where you can go to find what such-and-such a person says are the five best books on such-and-such a topic. When I go to the website now I’m confounded as to how best to navigate it, and when I wasn’t brought to Bernhard’s book after a few searches I gave up. But I could swear that’s where I initially discovered it, a few months back.

Why was I looking for the five best books about illness in the first place? I can’t recall if anything in particular sparked my interest in the topic. It’s probably safe to say that it was related to my interest in death and dying, and in all types of suffering. It’s not that enjoy suffering. My husband and others who know me would assure you that is not the case. (And if I enjoyed it, would it be suffering?) It’s just that the older I get, the more I see what a large role suffering plays in the lives of human beings. It is, as the Buddha said in the First Noble Truth (which I’ll talk more about soon), a defining characteristic of life. And sickness is the type of suffering that we humans tend to fear most. “At least you have your health,” is an often uttered phrase that assumes the worst hasn’t happened yet. So when you don’t have your health, what’s your consolation?

I myself have never dealt with chronic illness, or any other major illness to speak of. My follicle stimulating hormone is so unheard-of-off-the-charts that I once had an acupuncturist say, “I’m surprised you’re not dead,” or “You should be dead,” or something like that. But I’ve never had any symptoms from that other than an inability to procreate, which has turned out to be a blessing. The sickest I’ve ever been was a ten-day bout (or it may’ve been two weeks) of salmonella poisoning in my early twenties, most of which time I spent in my mother’s bed. I’ve never been good at being sick. My fear of vomiting has, at times, verged on emetophobia (that’s the clinical term for extreme fear of vomiting). So I was intrigued by the title of Toni Bernhard’s book, How To Be Sick, both because of the way it catches you off-guard—Why would I want to be sick?—and of course it’s not about wanting to be sick; it’s about if-slash-when you find yourself sick, here’s how to handle it with some grace. If you’re going to be sick, you may as well give it your best shot. And so I also thought I might learn a thing or two in advance, for when I do get sick. And if by some miracle that never happens, chances are pretty high that someone I love—because I am blessed to love many—will be sick at some point and need me to support them somehow, and Bernhard’s book is also written with caregivers in mind. Not to mention that, as a currently healthy person, reading books like this helps deepen, not only my compassion for people suffering from physical illness, but also my gratitude for not suffering in that particular way.

That Bernhard’s book was Buddhist-inspired also compelled me to read it. If you’ve read my other blog posts, you might already know that, of all the religions we have to choose from, Buddhism resonates with me the most. I realize that even calling it a religion might beg the question, but in my opinion that’s definitely what it is. There’s no God to worship, but worship is nonetheless happening, and it has rules and codes of conduct like other religions and it provides succor for suffering like other religions and helps people feel less alone and freaked-out, just like other religions. I’m not saying it’s better than other religions (although I have actually said the words, “Everyone should be Buddhist”)—I’m just saying that the Buddha’s teachings make the most sense to me, and offer me the most comfort. And I know that when I’m sick or otherwise don’t feel well, comfort is everything.

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How To Be Sick begins with a story—the story of Bernhard going from perfectly healthy to chronically ill overnight. Or at least over the course of a couple days. In 2001, on a flight to Paris with her husband—whose name is also Tony, with a Y—she caught a flu-like virus from which she still hasn’t recovered. But her husband was on the same plane and didn’t get sick, so already, in the first pages of the first chapter, I found myself questioning the realness of Bernhard’s illness. I’m not proud. I’m also not alone. One of the many difficulties inherent to being chronically ill is that others are skeptical in this way. Bernhard’s heard some version of the phrase, “You don’t look sick” many times, apparently, and in most cases it implies doubt. Disbelief. It may as well be followed up with, “Maybe it’s all in your head?”

Which wouldn’t be to say that Bernhard and others suffering from mysterious, unnamable chronic illnesses don’t actually feel sick. It’s just that the brain can do amazing things. I’m thinking along this vein because I’m in the middle of reading a book called The Way Out: A Revolutionary, Scientifically Proven Approach to Healing Chronic Pain, which I’ll be talking about next week with Asheville-based chronic pain coach, Lily Oster. In that book, Alan Gordon explains how most chronic pain is the result of the brain making a “mistake,” and mistranslating signals from the body as being dangerous when the body is actually quite safe. Once you’ve determined that your pain is “neuroplastic” in this way, you can do something called Pain Reprocessing Therapy to drastically reduce—if not, as is usually the case—completely eliminate your pain. And it seems to me that if the brain can create such intense pain sensations for no structural or biological reason, then it can probably create intense sickness sensations, too. If headache, back pain, abdominal pain, mouth pain, and wrist pain can be neuroplastic, why not symptoms that would accompany a severe flu? This is just an aside, though. Just me thinking out loud. It’s not at all the focus of Bernhard’s book, which isn’t just written for people suffering from mysterious chronic illness, but also for those with arthritis, heart disease, diabetes, Lyme, and much more.

Coming home from her long-awaited Parisian vacation spent sick in bed, Bernhard was devastated to find herself still sick—so sick, in fact, that she eventually had to quit her twenty-year-long career as a law school professor. Over the course of her seemingly endless quest to figure out what was ailing her, Bernhard saw “three infectious disease doctors, two ENT specialists, a rheumatologist, an endocrinologist, a gastroenterologist, a neurologist, and two acupuncturists.” None of them could explain why she had the aforementioned flu-like symptoms “including the dazed sick feeling and low-grade headache, but without the fever, the sore throat, and the cough.” Her voice was hoarse, though, and her heart pounded “with the kind of wired, oppressive fatigue that healthy people associate with severe jet lag, making it hard to concentrate or even watch TV—let alone to nap or even sleep at night.” Her fatigue was so intense that, while she was still professing law, she would pee into an old thermos in order to avoid having to leave her office and walk to the other side of the building to use the bathroom, a journey which also entailed the risk of running into well-meaning chatty coworkers. She had no energy for chatting, nor for pretending it didn’t take every ounce of her strength to remain upright and smiling for the amount of time that it took to exchange pleasantries.

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Bernhard’s chronic illness is a mystery to all medical professionals and has ultimately resisted every treatment she has tried. And when you can’t change or leave a given situation, your only option is to accept it. Luckily Bernhard had already been a long-time practitioner of Buddhism prior to getting sick, so she had tools to work with when it came to accepting life’s challenges. Getting sick was a catalyst for deepening her study and practice of the Buddha’s teachings. As she puts it at the end of Chapter 1, “I needed to learn how to be sick.”

The first of the Buddha’s teachings—also called the dharma—that Bernhard explores in How To Be Sick is, well, the first of the Buddha’s teachings: the first noble truth. Life is suffering. Of course, that’s a translation from the Pali (P-A-L-I—an ancient language similar to Sanskrit). Dukkha was the word the Buddha used, which Bernhard says “is too multifaceted and nuanced a term to be captured in the [word] ‘suffering.’” Unless, maybe, you break that word down. American Zen teacher Joko Beck points out that the “suf-” part of “suffer” comes from “sub,” meaning “under,” while the “-fer” part comes from the Latin verb ferre, which means “to bear.” “Taking this view,” Bernhard says, “dukkha is not about life bearing down on us from the outside, but [is rather] an internal phenomenon of bearing life up from underneath.” Lord knows life is going to bear down on us from the outside. There’s no avoiding that. But how do we bear it? How do we respond, internally? That’s what we do have control over.

The Buddha’s second noble truth—or samudaya—says that the cause of suffering is craving, or tanha. Also called desire, tanha can broadly refer to our wanting things to be different than they are. In this sense, “I’m sick” doesn’t necessarily mean “I’m suffering.” “I’m sick and I don’t want to be” does imply suffering, or dukkha. Of course, no one really wants to be sick, but there are nuances to this, also. I guess it’s a matter of focus, of what we give our attention to. If we focus on not wanting to be sick, we’re going to suffer more than if we focus on what we can do even though we’re sick.

Along with being the first noble truth, dukkha is also one of the three marks of existence, the others being anicca and anatta, or impermanence and no-self. Impermanence is most dramatically exemplified in the fact that we all die, but Bernhard’s favorite way of describing anicca in everyday life is with the phrase “Anything can happen at any time.” If your brain is at all like mine, you probably just thought of all the bad things that could at any time—just as you probably thought something similar a couple episodes back when I was talking about Pierre Teilhard de Chardin’s concept of passivities, or all the things in life that happen to us, as opposed to the things that we make happen. But anything good can happen at any time, too. A moment of despair, for instance, can pass. Just as weather systems come and go, so can moods, or trains of thought, or physical symptoms. The older I get the more I realize that there’s no sense in worrying about a given ache, pain, or skin abnormality unless it persists for a couple weeks or more, because they all tend to run their course. My left shoulder was bothering me the other day and I thought, “Eh, it’ll probably be fine tomorrow.” And it was. In the past I probably would’ve worried about the pain being worse tomorrow, and that I’d have to stop doing yoga and sleeping on my left side and who knows what else. And that worry could have very likely been a self-fulfilling prophecy, indeed exacerbating my shoulder pain. But I’ll talk more about that phenomenon next week.

Going back to the analogy of weather: in How To Be Sick, Bernhard shares what she calls “weather practice,” wherein she perceives her thoughts and moods “as wind, blowing into the mind and blowing out.” One moment it can be calm, and the next a violent storm blows in. If we can trust that a given hardship or storm will pass, because everything is impermanent, we will suffer less, and the difficulty in question will pass that much sooner. Thinking that something is going to last forever tends to make it last longer. Regarding this concept of anicca, Bernhard quotes the final verse of the Diamond Sutra, a text I briefly mentioned last week in my discussion of J.D. Salinger’s Franny and Zooey: “Thus shall you think of all this fleeting world: / A star at dawn, a bubble in a stream; / A flash of lightning in a summer cloud, / A flickering lamp, a phantom, and a dream.”

Anatta, or no-self, is the third mark of existence. The sangha I’m a member of here in Asheville is called Anattasati Magga. “Sati” means mindfulness and “magga” means path, so Anattasati Magga means the Path of Mindfulness of No-self. In her musings on the Buddhist concept of no-self, Bernhard recalls an interview she once read with Ram Dass, one of my favorite American spiritual teachers, most well-known for his book Be Here Now. In the interview, Ram Dass said that when he was preparing to return to the U.S. from India, he asked his guru, Neem Karoli Baba, what teaching he should take home with him. The answer: just keep asking the question, “Who am I?" as you go about your daily activities. Are you your thoughts, which are constantly changing? Are you your body, which is constantly changing? Are you your emotions, which are constantly changing? There is no solid self that’s always the same. So from there you can get more specific with the inquiry and ask, when sick, “Who is sick?” Stephen Levine, poet, author and teacher best known for his work on death and dying, takes it a step further in his book titled Who Dies?, which I definitely intend to explore in a future blog post. The way Bernhard uses this inquiry is to basically say, “There is sickness here, but I am not sick.” Her spirit or soul, in other words, is not sick, nor could it ever be.

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Another group of Buddhist concepts that Bernhard addresses in How To Be Sick is the brahma viharas, or sublime states. These are Metta (loving-kindness; wishing well to others and to ourselves); Karuna (compassion; reaching out to those who are suffering, including ourselves);  Mudita (sympathetic joy, or joy in the joy of others); and Upekkha (equanimity; a mind that is at peace in all circumstances). When Bernhard finds herself suffering, or craving a reality other than the one she’s got, she immediately practices cultivating one or all of these sublime states. When feeling sad about not being able to participate in fun activities with friends or family—a.k.a. FOMO—she turns to mudita and tries to feel joy for the family or friends who do get to have fun. When first cultivating this particular sublime state, Bernhard had to fake it. She was too sad about missing out on the fun to actually feel happy for others. But the whole “fake it till you make it” tack worked in this case, and now her sympathetic joy feels genuine.

Regarding metta, or loving-kindness, Bernhard shares the phrase or mantra that resonates most with her as a way to practice wishing well to others and to herself: “May I be peaceful, may I have ease of well-being, may I reach the end of suffering…and be free.” The metta phrase that I’m more familiar with, which I discovered in a book called The Mindful Path to Self-Compassion, by Christopher Germer, goes, “May I be safe, may I be happy, may I be healthy, may I live with ease.” I’ve used it as a meditation mantra, timing each phrase to my inhale or exhale, and have found in that context that the phrase also serves as instant self-forgiveness for letting thoughts pull my attention away from breath. Bernhard uses it as a way of forgiving herself—or her body—for being sick. “It’s not my body’s fault that I’m sick,” she says. “It’s doing the best job it can to support my life.” When I’m not formally meditating, I use the metta phrase as a response to stressful thoughts or situations. “May I be safe, may I be happy, may I be healthy, may I live with ease,” is just a nice concrete reminder to be kind to myself. I agree with Bernhard that people should find a phrase that feels authentic to them, that they like the sound of, and that they can remember. Bernhard’s “may I have ease of well-being” sounds clunky to me, compared to “may I live with ease.” But to each her own.

And of course, you can also direct loving-kindness to others. If you have a friend or family member who is suffering in some way, just turn the “I” into a “he” or “she” or “they” and send them good vibes. Metta practice can get especially interesting if you do it for someone you don’t like, or even someone you’re downright scared of. I nodded knowingly when reading about how Bernhard used to direct her loving-kindness prayer to Sarah Palin, during the 2008 presidential campaigns, because I did the same thing with Donald Trump, both while he was running for office and while he was in it. “May he be safe, may he be happy, may he be healthy, may he live with ease.” My wanting him to be these things does not mean that I like him. It’s just so obvious that Trump isn’t happy and living with ease, or he wouldn’t take so much pleasure from other people’s unhappiness and lack of ease. If he did feel safe, happy, healthy, etc., he wouldn’t be such a problematic human. So to wish him well is to actually wish him to stop being such a pain in the ass. I really do believe it’s that simple: happy people don’t cause harm. At least not intentionally. And of course I mean genuinely happy people. Also, to think of Trump while internally reciting the metta phrase helps me feel less scared of him. More recently I’ve tried to do this with Putin in mind, though, and I just can’t. Which sucks.

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The third sublime state that Bernard tries to cultivate as a person with chronic illness is karuna, or compassion. I sometimes have a hard time separating this from loving-kindness, but I think the main difference is that compassion doesn’t necessarily involve well-wishing. It’s simply a loving acknowledgment of pain or suffering. Providing an example, Bernhard writes, “I might silently say, ‘It’s so hard to want so badly not to be sick.’ Other times, I look for words that simply open my heart to the suffering, such as, ‘My poor body, working so hard to feel better.’” Sometimes she’ll even stroke one arm with the hand of another. As I’ve said before on this show, compassion literally means “to suffer with,” so self-compassion is the act being present for yourself in your own suffering, or, as Bernhard says, opening your heart to it. Is your heart big enough to hold a certain difficult emotion? If you tell yourself it is, that is an act of self-compassion. Edward Espe Brown put this beautifully in a recent dharma talk when he said, “Your presence is larger than the problem.”

And sometimes self-compassion looks like actually taking action and advocating for yourself. In How To Be Sick, Bernhard shares an anecdote about having to sit in a doctor’s office waiting room for over an hour, at which point she told one of the staff members that she needed to lie down, and they took her to an empty room so she could rest on the examining table until the doctor was ready to see her. Bernhard also displayed impressive patience in this instance, which she says is another key component of self-compassion. This makes sense if you think about it. Being able to stay calm and uncomplaining sounds like a nicer way to treat oneself than getting angry or accusatory and alienating everyone around you. She wasn’t complaining when she expressed her need to lie down; she was simply stating a need. And being able to lie down allowed her to remain patient for the rest of her wait.

In that chronic pain book I mentioned, The Way Out, Alan Gordon tells a story about being on an airplane in excruciating back pain and desperately wanting to stand up and stretch, but he was in a window seat and the guy next to him was asleep and he didn’t want to wake the guy up! I had to scoff at that. If I were in Gordon’s position I most definitely would have woken that guy up. Gordon was not practicing self-compassion in that moment. He was putting a sleeping stranger’s comfort before his own. I wonder: if his child or spouse or some other loved one had been in that much agony, would he have expected them to keep suffering so the guy in the next seat could keep sleeping? I would hope not. But he did have that expectation of himself, and therefore did not advocate for himself. Most people do some version of this behavior on a regular basis. We talk to ourselves in ways we’d never talk to loved ones—or even to strangers, for that matter! We deny our own desires so that those of others can be fulfilled. And of course sometimes this type of sacrifice is noble, and necessary. But a lot of the time it’s terribly counterproductive and results in codependent relationships and a ton of resentment. Gordon jokes about wanting to shove his sleeping fellow-traveler into the overheard compartment, but for all he knows the guy would’ve wanted to be roused from his slumber if it meant reducing Gordon’s physical agony. Take responsibility for yourself, man! If the guy’s a jerk when you wake him up and explain that your back is killing you and you need get to the aisle so you can stretch it out, then you can fantasize about stuffing him into the overhead compartment. But don’t just not try and then blame him for your miserable experience.

Okay, end of rant. I really do appreciate Alan Gordon and look forward to talking more about his book next week. It’s just that one anecdote that bugged me.

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The fourth sublime state is upekkha, which means equanimity, which Bernhard defines as “mental calmness and evenness of temper, especially in a difficult situation.” She also says that the “essence” of equanimity is acceptance. We accept whatever life gives to us “without blaming anything or anyone—including ourselves.” One of ways Bernhard practices equanimity is something she learned from actress Susan Saint James, who, in a television interview that took place three weeks after her teenage son died in a plane crash, said, “His was a life that lasted fourteen years.” When Bernhard finds herself mourning a lost friendship or her lost career as a law professor, she’ll say, “This was a friendship that lasted ten years,” or “This was a career that lasted twenty years.”

Another exemplar of equanimity that I’ve referenced before on this show is the Zen Master Hakuin, who lived in the late seventeenth and early eighteenth centuries. He is said to have created the now-famous question: “What is the sound of one hand clapping?” I first heard this story from my yoga teacher, Kristine Kaoverii Weber. At one point in his life, Hakuin was falsely accused of impregnating a young woman in his village. Her irate parents accosted him in front of all his students, and his only reply was, “Is that so?” When they later demanded, once the child was born, that he take care of it, again Hakuin replied with “Is that so?”, and he raised the baby for the first year of its life, at which point the young mother confessed her lie to her parents, who then came to retrieve the child. With profuse apologies they explained what had happened. "Is that so?" Hakuin said, and, even though he’d come to love the child, he calmly handed it over. The epitome of equanimity.

As Thai ascetic-philosopher Buddhadasa Bhikkhu said (Bernhard quotes him in her book), “Nothing whatsoever should be clung to.” This includes material possessions, other people, and, say, the outcome of a new medical treatment. Bernhard has learned to say, “Some treatments work. Some don’t. Some doctors come through for us. Some don’t.”

She also practices equanimity or upekkha by trying to observe unpleasant sensations objectively. When someone cuts us off in traffic, for instance, we can just note that uncomfortable sensations are arising and leave it at that, “without reacting to it as anything more than one of the thousands of momentary contacts we encounter every day.” In this way we can keep unpleasant sensations—including those related to physical illness—from turning into aversion and therefore exacerbating those sensations.

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“With our thoughts we make the world.” That’s a line from the Dhammapada, a collection of the Buddha’s sayings in verse form and one of the most widely read scriptures in the Buddhist tradition. Self-inquiry teacher Bryon Katie was certainly drawing on the notion that our thoughts make the world when she developed a method called, simply, The Work. Bernhard explores the crux of The Work in How To Be Sick. It consists of noticing when something has upset us, writing down the stressful thoughts without censoring ourselves, and then choosing one thought at a time to practice inquiry around via four questions. Bernhard uses her thought “My friends should not stop visiting me” as an example. Following the steps of The Work, the first question she asks is “Is this thought true?” In this case, she decides that it is true, but if she realized that it wasn’t, she’d skip question two and move on to question three. Question two is “Can you absolutely know that it’s true?” When it comes to other people, it’s pretty rare that we can absolutely know something about what they should or shouldn’t do. So question three guides us into a deeper inquiry: “How do you react, what happens, when you believe that thought?” When Bernhard believed her friends shouldn’t stop visiting her, she felt hurt and angry. The fourth question, “Who would you be without that thought?” confirmed that she would not be a hurt, angry person if she did not believe her friends should keep visiting her. “I felt liberated,” Bernhard says, “as if a heavy burden had been lifted—the burden of constantly worrying about the state of my friendships.”

She goes on to explain the fifth part of The Work, and what I find to be the most interesting. It’s called the turn-around. This is where you look at the thought in question, and write down or say its opposite. And in Byron Katie’s world, one statement can have as many as three or four “opposites,” and as few as zero. You can turn it around to the self, to the other, and to its opposite. For example, on her website, Katie uses the thought “Paul doesn’t listen to me” and turns it into “I don’t listen to myself,” “I don’t listen to Paul,” and “Paul does listen to me.” The idea here is that any of these turn-arounds could be just as true—if not more so—than the original thought of “Paul doesn’t listen to me.” And believing one or all of them might actually benefit us, whereas the other belief caused internal harm. Bernhard turns her thought of “My friends should not stop visiting me” into “My friends should stop visiting me.” Adhering to The Work, she then came up with examples of how the turnaround was true. Maybe her friends were genuinely too busy and stressed-out with their own lives to work her in. Maybe they were uncomfortable being around sick people. Maybe they think a visit would be hard on her. They might feel guilty for talking about their lives, filled as they are with so much activity. Or maybe they’re sick themselves! Bernhard also does a turn-around with the thought “I hate being sick,” which she flips into “I love being sick,” and then comes up with a surprisingly long list of reasons why that’s true.

She also talks about asking “Why not me?” instead of “Why me?”, which she learned from listening to a Roseanne Cash interview on Fresh Air. I first learned about this particular turn-around from a New Yorker cartoon, which I’ve actually mentioned before on this show. A doctor and a worried-looking patient, the doctor saying, “Sometimes it helps to turn the question around. Why not you?” It can be such a helpful question to ask! Not only humbling, because you realize you’re not special, and that anyone could ask “Why me?” with the same earnestness of belief that they shouldn’t have to suffer like this—only other people—but turning it around is also oddly empowering. Like, “Why not me? I can take it.” Which is essentially what Roseanne Cash was saying.

This exercise from The Work is simply a tool for manipulating your own thoughts and jumping the track when you’re in a thought rut. I myself have many such ruts, and I appreciate Byron Katie’s invitation to consider that the opposite of whatever I’m thinking might be true. There’s a lot of freedom there. But as I said, some thoughts don’t have any opposites that make sense. Katie says you shouldn’t force it when this is the case. For example, I just discovered a small spot of poison ivy rash on my right cheekbone. I’m quite sure it’s the result of my putting my face on my dogs and I realize I should stop doing that, but it’s easier said than done to not put my face on my dogs. It’s the cuteness! Must put face on cuteness. I instantly applied the strongest steroid cream in my arsenal (which you’re technically not supposed to put on your face but I don’t care), and I can only hope it prevents the rash from spreading all over my face. “I don’t want poison ivy all over my face” is not a thought I can turn around. I can come up with no examples of how I actually do want poison ivy all over my face. So in this case I use another mindfulness tool and simply try to stay present. Right now, the itchy spot on my face is small and totally manageable. And right now is all there is, so I should just focus on that and be grateful.

One way that Bernhard contacts the present moment, which her illness-based fears so often pull her away from, is another trick from Byron Katie. One night while worrying about her daughter, who had issues with drugs and alcohol and was, on this night, late getting home, it occurred to Katie to pan out her perspective and try to see herself through purely objective eyes. This is what she saw: “Woman in chair, waiting for her beloved daughter.” That is what was actually happening. And focusing on that is how we can avoid becoming too much like Mark Twain, whom Bernhard quotes as saying, “I’ve lived a long life and seen a lot of hard times…most of which never happened.” Bernhard shares her own example of using this technique to snap herself out of a self-critical thought-rut. “‘It’s your own fault that you feel so sick today,’ I thought for the dozenth time, at which point I looked up and saw my face in the mirror of the bathroom sink and said, ‘Woman on stool, brushing her teeth.’”

I myself have found this tool really useful. The other morning, my husband and I thought the rain had subsided enough for us to walk the dogs without getting too wet, but right at the halfway point it started to rain harder and no longer showed signs of letting up. Even though I had an umbrella and was using it, I felt annoyed. My dog Tyke shakes his head a lot in the rain, trying to dispel the water, and sometimes if he shakes it enough the tip of his ear, notched from getting snagged on one too many thorns in the woods, will crack open and start bleeding. I didn’t want that to happen, because then sometimes it won’t heal for days, and if he shakes his head inside the house it sometimes opens up again and blood sprays all over the walls. I didn’t want to deal with blood-spray again… So this was where my thoughts were going. I realized my mind was stressing me out way more than the actual rain was, and I panned out. I had the thought, “Woman with dog, walking in rain.” I repeated it like a mantra, timed to my footsteps. “Woman with dog, walking in rain.” Not only did it snap me out of my head and into the actual present moment, but it helped me accept the moment with ease.

I’ve also found myself using this tool a lot while practicing yoga asana. “Woman on floor, doing Child’s Pose” was the phrase I came up with most recently when my thoughts were feeling especially sad and heavy, as they are wont to do when I’m in that pose.

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How To Be Sick could also be called How To Deal With Hardship, and therefore has something to offer for everyone, because life is full of hardship. My go-to mantra recently has been “everything is hard.” Bernhard acknowledges the universal nature of her subject matter in an appendix section of the book called “A Guide to Using the Practices to Help with Specific Challenges.” For four of these different challenges, she begins her list of suggestions with the exact same statement: “Take solace in the fact that you are not alone; suffering is present in the lives of all beings.” It’s the Buddha’s first noble truth again. And ironically enough, acknowledging that all people suffer is a way to reduce one’s own suffering. To know that others are currently experiencing something similar or have already experienced it and survived basically intact, is a comfort.

One type of suffering that we all experience is uncertainty, or not-knowing. As human beings, we like knowing stuff and feeling sure about things. And we really like knowing what to expect. Bernhard writes about the unpredictability of chronic illness and the frustration that can accompany making plans with friends and then having to cancel because she feels too sick to socialize, and the crushing disappointment that can result from feeling like a new treatment is working and then discovering that it isn’t. So to avoid getting jerked around, she tries to treat every unknown as a koan, or the type of paradoxical anecdote or riddle that’s used in Zen Buddhism to demonstrate the inadequacy of logical reasoning and to provoke enlightenment. “Will I be able to keep my plans with so-and-so next week?” she might ask. It’s a question without an answer. “Will this treatment cure me or even help me? Don’t know.” Korean Zen master Seung Sahn called this keeping a ‘Don’t-Know Mind.’… ‘I don’t know if I’ll sleep or not tonight, so I won’t make an assumption one way or another.’” Will the war in Ukraine escalate into World War III? Don’t know. In accepting that some questions are just answerless, we can then give our attention to what we do know, and to what we can actually do.

This is what I love about Buddhism, and Zen Buddhism in particular. It’s just so practical. “Before enlightenment, chop wood, carry water. After enlightenment, chop wood, carry water.” Zen also says that the various practices—a big one being formal meditation—are enlightenment. They are not paths to achieving enlightenment, but are enlightenment in and of themselves. Before getting sick in 2001, Bernhard had been meditating twice a day, for 45 minutes each time, for ten years. After getting sick, she couldn’t sit formally anymore and therefore had to focus on other ways of practicing pure presence. Her illness has also deepened her appreciation of the Buddha’s Eightfold Path, which calls for Right Understanding, Right Thought, Right Speech, Right Action, Right Livelihood, Right Effort, Right Mindfulness and Right Concentration. In How To Be Sick, Bernhard focuses a lot on Right Speech, recalling how “the Buddha suggests we speak only when what we have to say is true, kind, and helpful.” Back in my pet-sitting days, in my mid-twenties, I took care of an itchy, scruffy little trembly dog named Bart—named after San Francisco’s Bay Area Rapid Transit. One of Bart’s owners was a Unitarian Universalist minister, and I remember being struck by something he’d posted on the refrigerator: a piece of paper with three questions written in black marker: “Is it true? Is it kind? Will it help?” It’s always stayed with me. Now I know it’s a Buddhist thing.

And I agree with Bernhard that “it’s a tall order to make all our speech true, kind, and helpful.” For most of us, it would probably mean speaking a lot less. But it’s also tricky because it isn’t always clear if a given communication is kind and would be helpful (hopefully in most cases we can at least be sure that we’re speaking the truth). I guess in those moments of uncertainty we can practice using Don’t-Know Mind, and maintain our essential silence. But the most important thing is that we have the intention to practice Right Speech in this way. We do our best with it. Sometimes we don’t do as well as we’d like, but we keep trying. No one and no thing—including chronic illness—can prevent us from trying to be our best self. Many pathways are available to us. And indeed the thing (or maybe it’s a person) that seems like it might succeed in getting the best of us, is usually the very thing that’s providing what Teilhard de Chardin called a “foothold,” allowing us to climb ever-closer to our highest self. Marcus Aurelius was saying the same thing all throughout Meditations, as you might recall.

I’ll leave you with this food for thought, which Zen priest Edward Espe Brown said in a recent dharma talk, and I’m paraphrasing: “Nothing can be other than what it is, and nothing stays the same.” And this, from Joko Beck, whom Bernard references multiple times: “Our life is always all right. There’s nothing wrong with it even if we have terrible problems. It’s just our life… It is what we’ve been given.”

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