File updated 13/01/06 10:02
Techniques to handle pain
Formal meditation and pragmatic meditation
Meditation lying down
Meditation, relaxation, imagination and transcendental states
Meditation, "Metta" and personality
Links I like
June 2005 - revised September, November, December 2005, January 2006
Human beings are 3-dimensional objects. If you were creating a computer model of a human, you would need to conceptualise in terms of three dimensions - width, height, and depth. You would thus construct your model using three axes - conventionally referred to as x-, y-, and z-axes.
Most people, most of the time, breathe in and out from their chest, from front to back - in other words, they are expanding and contracting their lungs along a z-axis. People who sing and play wind instruments learn to breathe in a different way, using their diaphragms. This is often referred to as breathing from the belly. In and out from the belly pushes the diaphragm up and down. Hence the lungs are being expanded and contracted up and down - along a y-axis.
As a result of pressure from the mass which occupies a large part of my upper front chest cavity, breathing in and out along a z-axis had become an impossibility for me sometime before diagnosis, and my body had automatically switched itself to breathing all the time along a y-axis - up and down. This was all perfectly fine for a year or so after diagnosis, but as the mass grew and breathing gradually became harder work, my weariness increased and was regularly accompanied by a soreness in the stomach - it felt as if my diaphragm was having to work too hard. At that stage it suddenly occured to me that I had never considered the possibility of breathing along an x-axis - expanding and contracting my lungs across their width, by producing a squeezing action with the muscles in my sides and shoulders. Learning to breathe in this third dimension has proved an effective workaround which provides welcome relief for my weary diaphragm.
It's fundamental to maintaining a quality of life, that I enjoy breathing. Even with a large tumour in my chest cavity, I can still enjoy breathing. Apart from making it difficult to talk in long paragraphs, it doesn't seem to be any great loss to me that I can't breathe in and out for more than a few breaths without starting to feel breathless and sick. As a general rule, it's actually much more sensible to breathe "up and down" as your standard pattern. Babies breathe from the belly, not from the chest. For whatever reasons, as we get older most of us (especially women, apparently) switch to breathing in and out from the chest. And a great pity this is. Breathing technique helps relieve stress discusses this point in greater depth.
Breathing from the diaphragm is more efficient. Try the difference when climbing a steep hill. Breathe up and down with your diaphragm, take your focus away from your chest and down to hip level, and you'll find that your body can do all the work from below the waist. Once you get into the swing of it, no effort needs to come from your chest, so you won't get breathless.
It's more relaxing. Try sitting or lying (or standing, perhaps leaning on a gate) with your back straight, so that you can maintain the space between ribs and diaphragm. Do a quick "body check" from head to toes, as you go relaxing any tense areas you encounter. Breathe up and down with your diaphragm, and let your mind follow your breathing as it rises and falls.
If you play around with breathing from your belly, you'll see that the up-and-down action of the diaphragm can be achieved either by compressing your stomach in and out, or up and down. Stomach in-and-out is infinitely better than chest in-and-out, and is probably the best way there is to go quickly into a state of relaxation. But I believe that getting into the up-and-down breathing technique has a whole lot of extra potential. For example, you can quickly slow and calm your breathing by starting off each breath from the toes, and gradually taking the force of the inbreath all the way up your body to your head. Then back down again to the toes with the outbreath. It's just technically not possible if you're breathing with an in-and-out motion, to involve so much of your body in the relaxation process.
If you learn to breathe up and down instead of in and out, you can learn to control and use your breathing in all sorts of interesting and constructive ways. As you breathe in, you can develop the sense of summoning energy and alertness from all parts of your body, from your feet to your head. As you breathe out, you can learn to send out relaxation to all parts of your body.
The much less commonly-considered option of "breathing along your x-axis" - expanding and contracting the lungs from side to side - is something which I've only just become aware of at the time of updating these notes. (Jan 2006). It mixes very well with the final stage of a formal meditation practice (see below), when your focus of breathing are your nostrils. It's a very light way of breathing, which is what you need if breathing is hard work for physical reasons, and also what you need to go into a good meditative state.
Moving as well as breathing is an essential part of my pain-handling strategy. I first discovered what a difference these two things can make when I had my children using the natural childbirth techniques of "psychoprophylaxis". If you're in serious pain, you don't just sit there and let it take you over - you deflect yourself from it by being active. If you can't get up off your bed and walk, you can use such techniques as manically counting 1-2-3-4-5 on your fingers, or tapping your fingers (or your feet, or any part of you which can move) to the rhythm of a song.
If the pain is less than agonising, gentler breathing techniques can be applied. For example, if you have pain in your chest or stomach, you can learn to redirect the muscular contractions which activate the in-breath, so as to bypass the area of pain. You can learn to do the work of breathing from up and down your backbone, or from the very front of your body.
Once you get familiar with the idea of using your breathing to handle pain, you can learn to focus the sense of calm relaxation which comes with the outbreath directly onto the area of pain. During chemotherapy I also learnt to use the outbreath in a more agressive way, similar to the "visualisation" techniques taught by complementary therapists - for example, directing my outbreath at my chest and imagining myself as a dragon breathing fire onto my mass. This kind of activity can give you a sense of strength and empowerment, but it's a fighting technique, not a relaxing technique - in fact, it can be positively tiring if you do too much of it!
Over the months I have learnt gentler forms of visualisation. At resting times, I breathe up from my nostrils into my head (I visualise this as pulling the diaphragm up from above, rather than pushing it up from below), and then down onto my shoulders (always tense from the pressure of the mass on them), bathing my shoulders in an outbreath which has my head, my mind, as its source.
I can't pretend that moving and breathing techniques alone are enough to handle any amount of pain effectively. I take cannabis regularly, and find this very helpful in the face of pain. It combines well with the moving around and breathing techniques. For a few months, I resisted suggestions from doctors that I would be more comfortable if I took morphine on a regular basis. But it gradually became apparent to me that too large a proportion of my energy was being used by pain management techniques. There were other ways I wanted to be spending my time! So, since May 2005 I have been taking slow-release 30 mg Morphine tablets twice a day. (Upped in October to 40 mg doses.) Plus, by September 2005, I am treating myself to a teaspoon of Oramorph at my two daytime rest periods. Now that my body has adjusted to the morphine, I think it's greatly improved the quality of my life, and there don't seem to be any problems about coupling it with cannabis. Since I've become adjusted to the effects of morphine on my mind, I don't have any difficulties in combining the drugs with breathing techniques for handling pain. I'm certain the breathing enables me to keep my morphine dosage at a minimum, and limits my desire/need for cannabis.
I learnt a formal Buddhist "mindfulness of breathing" meditation practice nearly five years ago, by means of the excellent online courses offered by Wildmind - the same method as is taught widely by Friends of the Western Buddhist Order (FWBO). These notes are most definitely not a substitute for learning to meditate properly. You do need to go on a course if you decide you're serious about it. By no means all meditation practices are mindfulness of breathing practices - practices based on chanting or mantras are also widely taught.
Initially after diagnosis, I thought of it as an essential part of my discipline to attempt to maintain formal meditations for 20 minutes, and to stick rigidly to the "staged" meditation method which had I learnt. First, you get your posture right. Next you focus on your outbreath to achieve calmness; then on your inbreath to achieve alertness. This focussing process involves counting with each breath, starting from 1 again after 10 breaths.
If your mind wanders, you simply forgive it and congratulate it for returning to your breathing. When you have reached a state where your mind is reasonably free from intruding thoughts (you are exceptional if you can entirely eliminate these), you then drop the counting and move on to the next stage of meditation: calm, alert "belly-focussed" breathing. Finally, you move on to alert, calm "nostril-focussed" breathing. It's at this final stage that you will eventually learn to arrive at a state which approaches "transcendence". If you're like me, this won't be as sustained as you might want it to be, but nonethess you will probably experience it, albeit for only short moments.
Even though what might be considered a fully-fledged transcendental state is hard to achieve, there's a state of general one-ness with the world which I think can be attained with reasonable ease through a meditation practice. When my mind is taken up with intruding thoughts, I don't hear the birds sing outside. I don't smell the calming vapours which issue from my lavender bag. Clearing my mind enough to hear the birds sing and smell the lavender is something which I can quite reliably do by meditating.
By the time I was reaching the end of chemo, a conventional formal meditation practice had became much less the "be-all and end-all" than it had been at first. Discomfort when sitting for any length of time was a major reason why I began to de-emphasise formal sitting meditation in favour of what I think of as "pragmatic meditation". Meditation came to be something which permeates the whole of my daily routine.
I don't want to spend too much time with my eyes closed or half-closed, as is normal when doing a formal "mindfulness of breathing" meditation practice. I'm meditating when I lean on my favourite gate, or a yew tree in the churchyard, to look at Highlow. I'm meditating when I walk uphill, focussing on the tramp, tramp, tramp, the creak of my boots, as I place one foot in front of the other. I'm meditating when I do the washing-up, when I'm pottering in the garden. I have completely abandoned my previous obsession with "multitasking" in favour of one task at a time - this is much more compatible with maintaining a meditative state.
For a while I thought this was enough, and more or less abandoned any attempt at a formal meditation practice. But I then found that I was starting to lose the sense of alert calmness, the sense of spirituality (for want of a better word) which I had arrived at. Using a kneeling ("posture") chair, rather than sitting, made a big difference to the length of time which I was able to keep up a formal, staged meditation. But still, 20 minutes was the longest I could manage, and often it would be only 10 minutes or so before the kind of pains set in which I know must be treated by being active, moving around. The only way I could maintain sufficient comfort for meditation was by developing a lying-down practice.
During my morning session, I mentally take systematic note of the "hindrances" which are filling my mind when I'm trying to keep my focus on my breathing. This forms the basis of my day's task list - the things which are winding me up are the things which I need to deal with as soon as possible. It might be letters I need to write to sort out things like pensions and benefits, or action I need to take to sort out hiccups in relationships. Or things I need to get done in the way of house maintenance.
By September 2005, my mind has become noticably much clearer of "hindrances" than hitherto. I move far more quickly into a meditative state, and hold it for much longer. I have completely abandoned any form of sitting/kneeling meditation and put all the emphasis, as far as a formal meditation practice is concerned, on my hour-long lying-down session first thing in the morning. I still take careful note of the hindrances which fill my mind when I settle down to meditate. But a great leap forward is that I no longer try to clear my mind in the way that I used to. Instead, I see myself as filling my mind with my breathing. There are two things going on at the same time, which seem contradictory in theory but aren't in practice. Firstly, I'm modelling my consciousness on our old dog Paddy, lying there in a completely relaxed state, just breathing. Secondly, I'm able to become completely intellectually fascinated by my breathing, the different ways I can make it happen, the different ways it can make me feel.
October 2005 saw a major blip in my meditation practice. My relationship with my 94-year old mother had become unbearably stressful, and I couldn't get out of my mind vivid flashbacks to the things which were done by a father who could not control his temper with his children. Sticking to my Daily Routine kept a part of my mind sane while the rest of it was out of control. I stuck to my morning meditation practice, and did my best not to get upset by the fact that it wasn't possible to clear my mind. I couldn't stick properly to a formal staged meditation, but I was still able to use breathing techniques as a means of calming myself down and nourishing the "sane me" in its battle to overcome this "mad me".
Once I had taken some positive action to put boundaries on my relationship with my mother, the vivid flashbacks receded. Gradually over the next couple of weeks I was able to restore a "proper", disciplined meditation practice. I found a new way of keeping my focus on my breathing which I'm rather pleased with. In the space between each breath, I check that my mind hasn't filled itself with distracting thoughts, and if it has, I don't start my next breath until my awareness is focussed on the peacefulness, the quiet, calming emptiness, of that space between breaths.
"Pragmatic meditation" by itself didn't supply enough proper, formal meditation to satisfy me. Although it's a lot more difficult to keep alert than when you're in an upright position, sometime around May 2005 I realised that it is quite satisfactory to do a formal meditation practice lying down.
The first thing I do is to give my nostrils and airways a good clearout, by blowing and appropriate breathing. I then inhale some rosemary oil before settling down to meditate - it clears the chest effectively, I love the smell and find it calming.
I've concluded that a key to maintaining sufficient alertness whilst lying down is to maintain the same attention to posture as when doing an upright meditation.
I lie on my side, making sure that my back is completely straight, my neck follows that straight line, and the weight of my head is taken by my pillow, without any tensions in my neck. My expensive moulded Putnams pillow is an essential aid to getting my head and shoulders comfortable. The pillows which I place behind my back are also a great help in holding a good posture. To prevent my topmost shoulder from hunching over, I rest my elbow on my hip. I keep my legs fairly straight to maximise the sense of an uninterrupted path from head to toes, but I allow myself a bit of a bend at the knees. During the first stages of my meditation, I will be gently adjusting my posture until it feels as right as possible. Stretching, all the way from toes to head, is an essential part of getting into the right posture.
I start with slow, deep breathing. I visualise my inbreath as starting from my toes and going up to the top of my head, my outbreath from my head to my toes, and let my mind follow my breath, collecting energy from all parts of me then relaxing all parts of me. I discipline myself to do a proper staged meditation as I was taught (see above), and then keep up the meditative state at which I arrive, for as long as I can. I still wish I was a lot better at it, but all the same it's very satisfying.
When I first settle down to meditate, I'll often be aware that my breathing is quite rapid. This is something which I find it fairly easy to take control over - consciously slow it down by breathing from toes to head. I've always tended to breathe with my mouth a lot of the time, which isn't at all desirable for meditation. I've found that it doesn't work to force myself to close my mouth and breathe through my nose when I start a meditation session - I usually become breathless if I do this. But as my breathing starts to slow down, it will also move onto a lighter plane. I'll then find myself quite naturally closing my mouth and breathing only through my nostrils.
It's not at all uncommon for me to arrive at a good meditative state and then lose focus much sooner than I would wish. If this happens, I open my eyes and focus them on an object. I have a collection of photos of friends and family on the wall directly in front of me as I lie on my side. Often I'll focus on a photo of myself as a glowering 3-year old. It gives me a sense of being grounded in myself, holding onto myself. Having established this sense of groundedness, I find I can then easily return to the meditative state from which I had departed.
By September 2005, I had made the great leap forward of establishing a 1-hour meditation time first thing in the morning, rather than mixing my meditation practice with rest periods. Since then the effectiveness and enjoyability of meditation has increased enormously. I am at my most alert at this time of day, my body is at its most comfortable, and the house is at its quietest.
Between March and July 2005, the mass in my chest cavity increased in size from 8.5 to 9.8 cm at its widest point. Presumably it continues to increase at a similar rate. I'm often very conscious that breathing is involving something more like work than it ever used to do. But it's not by any means laboured breathing, and I don't experience breathlessness.
I'm developing and putting into practice the theory that by breathing less, breathlessness can be avoided. It appears that people do much more breathing than they need to - breathing more deeply and more often than is required to sustain life. I've read somewhere that Buddhist monks while meditating may only breathe four times in a minute, and then very lightly. I'm asking myself - how much more than this do you actually need to breathe, in the course of your daily life?
I don't see myself as "fighting" my cancer. The doctors are convinced it can't be cured, so it makes much more sense and is much more relaxing to live with it, to accommodate it. As the mass grows, a central part of this accommodation process is to learn to breathe as lightly as possible - in addition to as slowly as possible. One technique which I've enjoyed playing around with is what I call "squeezebox breathing". I think of my nostrils and my diaphragm as two hands controlling a concertina, squeezing my lungs in and opening them up again. Because the work of breathing is being shared between nostrils and diaphragm, only half the effort needs to be made from either end. This may well be no more than a comforting visualisation technique - I have a complete lack of understanding of anatomy. But if it can keep me breathing in a calm, relaxed way, why should it matter whether or not my theories have a convincing physical basis?
This may well be impossible to understand or try to copy, unless you're already familiar with the concept and practice of controlling your breathing.
Update: by January 2006, my diaphragm was showing signs of overwork as breathing against the increasing pressure of the mass gradually became harder. It was a great leap forward at this stage to discover that it was possible to "breathe along an x-axis" - gently compress my lungs across their width by activating muscles in my sides and in my shoulders. I think my body rather than my brain deserves the credit for this - the capacity of the human body to divert essential services such as breathing and blood supply around any obstructions, is truly remarkable.
To get myself into the right frame of mind for meditation, or to use mindfulness of breathing as a relaxation technique, I harness my imagination.
There have always been times in my life when I have felt myself to be in a transcendental state. Times when I have climbed a hill on a hot sunny day with a gentle breeze, and lay down in the grass at the top looking up at the sky. Everything else disappears from my head. Describing this state as transcendental is a definition based not on Maharishi but on Marvell - one of the greatest seventeenth-century metaphysical poets:
Mean while the Mind, from pleasure less,
Withdraws into its happiness:
The Mind, that Ocean where each kind
Does streight its own resemblance find,
Yet it creates, transcending these,
Far other Worlds, and other Seas;
Annihilating all that's made
To a green Thought in a green Shade
(Andrew Marvell (1621-78), The Garden)
When I lie down to meditate or rest, once I've got my posture right the next step is to imagine myself lying outside somewhere beautiful. These days I'll usually go in my head to the other side of Highlow, to the bank where (weather permitting) I often have a lie-down in the course of a walk, as shown in this map.
Sometimes, especially when I've got pain in my back and shoulders, I'll go there on a summer afternoon so that I can have the sun beating down onto my back. I have invented a useful aid to this recreation - virtual sunshine in the form of a hot-water-bottle sandwich. That just means hot-water-bottle placed between the pillows which I always have behind my back when lying down, so that I get a more diffused warmth than direct application of bottle permits.
Other times, I like to put my head there at whatever season and time of day is the current reality. My "formal" meditation time is first thing in the morning and - when I feel fit enough - I like to lie myself down on my bank behind Highlow (in a very warm, top-of-the-range sleeping bag) while the dawn breaks. It's compulsory to have the window open for this, however cold the weather, so that I can hear the birds and feel the breeze.
Always in my hand at rest and meditation times I have my piece of yew tree. I think of it a bit like an Aladdin's lamp, stroking it a means of magically transporting myself to this favourite spot of mine. The other important aids to arriving at this transcendental state are herbs - rosemary and lavender. I sniff rosemary oil before rest and meditation periods, and have a lavender bag under my nose. My favoured rosemary oil comes from Jelsa in Hvar, Croatia - a place famed in the last century as a destination for those with chest complaints, and one of the loveliest places I've ever been to. If I want a special treat I occasionally go there in my head as a change from Highlow. My lavender used to come from there too, but this year a neighbour let me harvest their crop, and Hathersage lavender does the trick equally well in a different way.
Most people who make meditation a central part of their life have much calmer, more tranquil, and kinder personalities than I do. I feel that the way I've used meditation and mindfulness of breathing over the past year has been almost entirely as a technique to handle pain and to rest my body. The short time which I expect to live could perhaps be seen as a convenient excuse for not opening myself to change at a deeper level.
In addition to mindfulness of breathing, when I learnt to meditate I was taught the practice of Metta Bhavana - "The cultivation of lovingkindness". The opposite of metta is ill-will - actively wanting to hurt others. To cultivate metta, the standard practice is to repeat a set of phrases to yourself - "May I (you) be well, may I be happy, may I be free from suffering". First, you wish yourself well in this way. Second, you think of a friend and wish them well. Next, somebody who you feel neutral about; fourthly, somebody who you feel negative about. Then, you think of these four people as a group, and wish them well equally. Finally, you widen your well-wishing to extend to all beings.
I've always had difficulties with "metta-ing". When I first learnt meditation, I felt that it was because I simply don't divide up the people I know into heroes and villains in the same way as perhaps most people do. I think of myself and everybody else, even my friends and family, as a mixture of good and bad in varying degrees. I got myself in great big muddles as to who to put in which category. On top of that, since I've been ill I've had real problems with the traditional metta phrase: "May I (you) be well, may I be happy, may I be free from suffering". I can never be well. I can never be free from suffering on a physical level. Some of my closest friends, the people who I most want to wish well, are in exactly the same position.
There's absolutely no rule that says that you must stick to this traditional phraseology - the kind of Buddhism which I learnt doesn't go in for that kind of rigidity. But I have had real difficulties trying to arrive at an alternative phrase which I'm happy with. In addition to "well, happy, and free from suffering" striking me as downright unrealistic things to wish for, I didn't like "May" - it sounds to me like requesting something from a higher power.
After much pondering, I have finally (December 2005) arrived at a phrase which I feel comfortable with: "Let your spirit be strong, let your spirit be happy, let your spirit be truthful, let your spirit be kind". I much prefer "Let" to "May" because it suggests that you're allowing something to happen that comes from within yourself, rather than asking an external power for something to happen. And by wishing well specifically to the spirit, I'm not seeking for a miracle by wishing these things for the body. Having arrived at a phrase that I'm happy with has been a great leap forward. And it's made the concept of extending metta to all sentient beings begin to make sense to me: Let our spirits be strong, let our spirits be happy, let our spirits be truthful, let our spirits be kind. I don't make a big meal out of always repeating the "Let my/your/our spirit(s) be" part of it. Strong, happy, truthful, kind - repeating those four words has a good effect in itself.
Needless to say lovingkindness isn't just about repeating a phrase in the course of one's meditation practice. It's about how this gradually has an impact on your daily life. And here again I run into a problem because of my illness. To be kind in a practical sense, it's often necessary to be patient, to expend considerable time and energy in a relationship. Especially if it's a matter of being kind to somebody whose world view is very different from your own. Since diagnosis, a particular problem for me in this respect has been treating kindly members of my birth family, who find my forthrightness hurtful. I have so little time, so little energy, so little resilience, it feels that it's all I can do to keep myself together and on track in my own way. I feel that I just can't cope with trying to understand and take into account points of view which fundamentally conflict with my own.
This sense of powerlessness has made me return to a passage from Basho (1644-94, regarded as the greatest of the Japanese haiku poets). I read and re-read this at the age of 17, when I was completely taken with haiku. I felt shocked by it. I just couldn't see how it was compatible with my socialist beliefs, which at that stage won hands down over my broadly spiritual interests. I cast aside my interest in Buddhism at that stage in my life as a result of it. The passage is from "The narrow road to the deep north", a set of travel sketches which includes "The Records of a Weather-Exposed Skeleton". Basho tells us:
"As I was plodding along the River Fuji, I saw a small child, hardly three years of age, crying pitifully on the bank, obviously abandoned by his parents. They must have thought this child was unable to ride through the stormy waters of life which run as wild as the rapid river itself, and that he was destined to have a life even shorter than that of the morning dew. The child looked to me as fragile as the flowers of bush-clover that scatter at the slightest stir of the autumn wind, and it was so pitiful that I gave him what little food I had with me.
The ancient poet
Who pitied monkeys for their cries,
What would he say, if he saw
This child crying in the autumn wind?
How is it indeed that this child has been reduced to this state of utter misery? Is it because of his mother who ignored him, or because of his father who abandoned him? Alas, it seems to me that this child's undeserved suffering has been caused by something far greater and more massive - by what one might call the irresistible will of heaven. If it is so, child, you must raise your voice to heaven, and I must pass on, leaving you behind."
I typed this passage out for my mother in the early days after diagnosis and she had much the same shocked reaction as I did when I was 17. But now, I read it and understand it as an expression of detachment in situations where one is powerless. Basho has given the child all his food, and he isn't in a position to do any more. What alternatives does he have, except to pass on and leave the child behind?
This is something I'm doing a lot of thinking about - there's obviously a danger that I could use my illness as an excuse for not making the effort to be kind, but at the same time my lack of energy is only too real. Watch this space! However I'm not sure that I'll ever want to be too nice - I do find that there can be something cloying and self-satisfied about westerners who follow a meditation practice. (A tendency commonly encountered amongst Christians and all others who permit themselves to be smug about the rightness of their faith.)
If you're interested in finding out more about mindfulness of breathing meditation, in addition to www.wildmind.org there are two articles which are online and which I like very much indeed. These are:
However, these articles do raise the vexed question for those of us who are political animals, of what exactly Buddhists mean by "detachment". Personally I don't see any reason to get myself into a twist about this or to suggest that it invalidates a meditation practice. And the concept of maintaining detachment in the face of circumstances which one is powerless to change makes a lot of sense to me now, in the context of facing up to a terminal illness.
My mother (94) was very pleased with a 3-minute meditation which you can download and which is guided by a friend who I was close to when I was 17 and he was 19 and we were just embarking on our journeys through adult life (I went off in more of a political direction, and he in a more spiritual one). This introduces a simple form of "mindfulness of breathing" meditation. It's at http://www.peterussell.com/TV/3Min.html
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