Sunday, November 11, 2018

Notes on suffering, DBT, and Buddhism


              I am giving some attention this week to the issue of suffering.  Two people whom I care about deeply, reached out to me this week.  Since, I have been digesting all of this social psychology material, and study of Buddhism, and spirituality in general, I figured I would offer some thoughts.  This is not advice, I cannot assure you it will work for you—more and more I notice people tune out when you start talking about mindfulness.  Have you tried meditation is becoming a bit of a punchline.  I can only share that I too have suffered deeply, and somehow achieved a massive release—personal and professional experiences collided in ways I would not have anticipated.  In many ways I am still making sense of it all.  If you wish to read no further, I will offer that this writing will address the book Why Buddhism is True, Mindfulness, and Dialectical Behavioral Therapy (DBT) which I practiced as a counselor for a number of years.

              Although, I have repeatedly evangelized about the book Why Buddhism is True, I have not shared personal reasons as to why it was so compelling.  People who worked with me years ago will recognize a similar evangelism I had for DBT.  That is because it works.  I saw it work.  I was sometimes chided—“yes, but it does not work for everything!”  Well of course, what does work for everything?  But, some of the reasons that I think DBT works, is the same reason why Buddhism is true—Richard Wright’s thesis.  And shit, that guy should be giving me royalties by now.  In my practice of psychotherapy I often saw two important features—skill acquisition and development, and insight.  Insight is episodic, and I suspect that it happens similarly to other cognitive and deep spiritual experiences like revelation. Skills application is the mundane, difficult, mechanical process—the hours of meditation spent redirecting a wandering mind.

              I would say that the personal relevance for me in Why Buddhism is True, came from chapter 13 on the lesson of tanha.  I had grasped the whole Buddhist concept of suffering: we suffer because we desire.  It really is not a complicated concept.  Our desire to apprehend something, whether it be another person, money, etc—all of this materialism is about gaining something. And so I meditated, sometimes up to two hours a day, at different intervals.  I repeatedly told myself that it was because I wanted these material things, and yet I still could not escape something.  And this, chapter clarified everything I had been getting wrong up to that point.  The idea of tanha also extends to what we don’t want to feel.  We are essentially, trying to grasp and obtain a version of our self that does not hurt.  Good luck with that, you will have to escape the self.  I only found one path forward; I’m not foolish enough to say it is the only way forward.  What I can tell you is that it got progressively easier because I was able—and again fortunate, to make necessary connections.

              Why does mindfulness meditation work?  Because your mind wanders.  And we live in an environment built with distractions, responsibility, and hardship.  And for many of us those stressors are not going anywhere and they require response.  But, a great amount of what we respond to does not require a response because it has no solution.  A ton of our human problems are simply irresolute, but through time.  Go ahead and dwell as hard as you want about something in the next year, I guarantee you don’t come closer now.  I used to see this commonly, and it was easily observable because I do it.  It is human. I would say that a great amount of our human misery is bookended by two phenomenon—our desire to apprehend the past (correct mistakes) and our desire to apprehend the future (control anxiety/avoid pain).

Past                                                                Present                                                          Future
ß-------------------------------------------------------------------------------------------------------------------à

If you routinely find your thoughts  like "I should have, could have, would have"….you are trying to correct a mistake.  It’s a thinking error, time moves one direction.  If you are plagued by “what if” at the other end of the continuum, you are trying to assert control over the future.  It’s an illusion.  There is great line in positive psychology:  I don’t control my destiny, but I do control my probabilities.  This is true, you can only exercise control and correct mistakes when something is apparent, and that is often times only in the moment.  Forgive yourself for the mistakes you made, acknowledge you will do your best in the future.  Remind yourself you are human, you will fail again.  As Samuel Beckett said: Ever tried. Ever failed. No matter. Try again. Fail better.

          I want to tell you this--It is not easy.  Life drags you a way from the moment with its countless demands and stimuli.  There is also horrific pain and suffering.  I will try to place this in the most secular terms, but I am going to use the concept of a soul. There is actually a psychologist who studies the “soul.”  More accurately, what we might traditionally refer to as a self.  There are other terms including personality, ego, spirit, etc—but they tend to have a limit to capturing a certain essence that we recognize about the experience of the self.  Why Buddhism is True may well flip many of your assumptions. So for the purpose of this writing I will refer to the soul to try to characterize a certain essence that some may believe transcends the mind and body. 

              I would offer a theory that trauma pins the soul to the brain and body.  It is a profound injury to the brain, and as such the brain’s software (the mind) gets glitchy, pulled inexorably again and again from the moment to attend to whatever is throbbing.  These are analogies of course, but the fact of the matter is that pain—even physical pain resides in the mind, and not anywhere else.  Your experience of pain is nothing more than a signal from the body.  This is easily proven by the phenomenon of phantom limb pain and other neurological conditions where something goes wrong with the signal/perception system.  But, this is extraordinarily complicated when the pain signal is in the brain/mind. 

              The mind is the only path to managing this, and for that reason the pain management clinics are now teaching mindfulness meditation.   The professor who trained under for internship used to say there is a difference between pain and misery.  Misery is what the mind adds to pain.  And when we have a mental injury, as in the case of trauma, it is much, much harder to get free from the pain, because the mental mechanisms have likely been injured in the process.  This is why I have taken to distinguishing between mind, soul, and brain.  These are semantic labels, but I know no other way to explain it.  The positivist will say this is all nonsense and that it is just the brain.  But, the positivist will run into limitations applying science to human experience, that’s why we have poets and novelists.

              I would sometimes hear patients say, meditation yes, tried it—it didn’t work.  I would hear similar things when I worked with parents on behavior coaching, time out—tried it, it didn’t work.  Except they do.  They are not applicable to every problem, or the expectation was probably too high.  If you thought mindfulness meditation was going to stop your suffering, it’s akin to sitting down to the piano and expecting to slip right into Chopin.  It’s not that I can’t play the piano, it’s that I play the piano really shitty.  Unless you like Heart and Soul, then I am ok. 

              The other thing is that sometimes the tool just isn’t the right tool.  With regard to meditation, I have found sometimes that I need guided meditation when I can’t get my mind settled, sometimes I can get it from walking meditation, sometimes I can get it quiet enough that it is just my breath.  And this lesson applies to the DBT skills too.  I would see this in therapy also, when I taught deep breathing with panic attacks—again, tried that it didn’t work, can the doctor just give me Xanax?  Sure, but you will build a tolerance, and then you will have untreated anxiety and dependence.  The model that I would suggest is that some tasks require more than one tool.  Distract is another skill in DBT.  It works, but it does not work for everything.  Radical Acceptance is sometimes the skill that is necessary.  Sometimes, you need to do mindfulness meditation, non-judgment, and distract, just to get to silence.  They build from each other, and sometimes you arrive back at Radical Acceptance.

              To return to the original example I was using on my own suffering.  I was stuck in a space where I could not seem to get free from emotions that were unpleasant, and this was propelled by a drive to apprehend something that was not possible, and so I began to let it go.  This desire to not hurt, it is no different than any other desire to be something we are not at the given moment we are provided.  It is the same mental mechanism that allows me to day dream about the better job that will provide me more money and prestige, and allow me to be something other than the person I am now.  It is hard to be a hurting person.  In fact, it is quite possible that a byproduct of evolution is that we can dream and reflect and that this has propelled our species to unimaginable heights. It allows us momentarily to escape pain.  But, it also comes with a cost.  We don’t get to live there.  And there is a cost to trying to live there—correcting the past or trying to control the future: it takes enormous mental energy.  You return to the broken and hurting body, it never went anywhere, it was here waiting for you to get ok with hurting.

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