Every Day a Gift

This week in our study group on mindfulness and psychotherapy, we were discussing mindfulness of the body. In the Buddhist Sutra on the Four Establishments of Mindfulness, there is an instruction to contemplate the mortality of the body. The meditator is asked to envision the decomposition of a human corpse, holding the realization that his own body is of exactly the same nature, and there is no way for it to escape that fate. On one level, it seems to be the ultimate meditation on both impermanence and “impurity,” encouraging sobriety and a measure of detachment from the endless round of desire that we live in most of the time. It is easy to imagine this meditation as effective in controlling sensual cravings and helping monks uphold their vows of celibacy. And yet, this purpose seems much more appropriate to the homeless monks of India in 500 BCE than to ourselves as twenty first century psychotherapists and clients. During our discussion in the study group on Friday morning, the question arose: what possible value could this mindfulness practice have for us as therapists? Could it find its way into a therapeutic dialog, and if so, in what form?

Some of us realized that, as challenging as it was, we have derived great benefit from the encounters we have had with of our mortality. Those of us who have been cured of serious illnesses, or narrowly escaped terrible injury in an auto accident, have found in these experiences a certain clarification of what is important, what is heartfelt in our lives. We all know (or are!) people who, after a serious diagnosis, have made real changes in our lives. Our awareness of mortality gives us another perspective from which to ask the question, "What is the most important thing?"

So how does a meditation on death enter into the therapeutic dialog? Mostly, I think, more subtly than in the Mahasatipatthana Sutra. One member of the study group (NR) pointed out that in Native American shamanist traditions, using death as an advisor is a recommended practice. Essentially the same point is made in a Zen monastery, where the instrument that is used to call the monks to meditation is often inscribed with a verse like: "Life and death are serious. Gone is gone. Wake up! Don't waste time."

We do not necessarily notice it, but actually, mortality is a natural part of the discussion whenever we take up the question of how we live our lives, whether in psychotherapy or elsewhere. Questions like “What should I do next…” take on a much deeper meaning when we finish them “…given that my time in this life is limited.” Conventionally, we agree to suppress our mindfulness of this part of the discussion, but it’s worthwhile to consider whether in doing so we are depriving our clients of an important source of meaning and motivation.

Consider this typical statement from the viewpoint of Acceptance and Commitment Therapy:

We explain to clients that the perspective we work from seeks to understand people’s difficulties in the context of a whole life. Sometimes problems become so overwhelming that it is easy to lose contact with the “big picture.” We do want to know how the client has struggled, but seek an understanding of that struggle in the context of a whole person with hopes, desires and aspirations. (Wilson and Murrell, 2004, p. 136)

In this formulation, our mortality lurks just outside the frame of the intervention. The “context of a whole life” inevitably includes the limited nature of that life, whether we choose to recognize it or not. It’s quite possible that Wilson and Murell’s statement could naturally open the door to a discussion of how our impermanence contributes to the quality of our actual presence in life. In fact, it is arguable that such an investigation can be avoided only by the active suppression of awareness.

That discussion would naturally take on different dimensions with different people. But it is frequently found that one outcome of increased awareness of the impermanence of this life is the commitment to pay attention while we are still living. As Mary Oliver says in her poem “When Death Comes,” “I don’t want to end up simply having visited this world.” In some paradoxical way, the reality of the end of life brings us into our lives with awareness, vigor, and appreciation. It is somewhat hard to imagine a context for therapeutic change that does not mobilize this type of engagement.

In my mindfulness and stress reduction classes, one question I have used to good result is: "If life could be about something, what would you want your life to be about?" (see also Wilson and Murrell, 2004, p. 135). This discussion is a critical support to the development of mindfulness practice. No one ever says, “I’d like to find a way to sleep my life away.” Instead, people talk, for example, about wanting to develop their mindfulness so they can pass a deep appreciation of life on to their children. For people to undertake such an unconventional practice as mindfulness, there must be a good reason, and that reason must be consciously affirmed. To remind ourselves of Jon Kabat-Zinn’s basic insight, mindfulness is a deliberate attention.

Occasionally, when my wife and are walking with our mobility-challenged twelve year old golden retriever, she will remark: “Each day with Bailey is a gift.” Inevitably, we are put in touch with our appreciation of and gratitude for the opportunity to have this walk together. It is really worthwhile to pay attention to this moment when we recognize it as irreplaceable.

One insight from the Mahasatipatthana Sutta is that mindful awareness is nurtured by the awareness of life’s actual and limited nature. In the psychotherapeutic field, this tenet has so far been the rather exclusive province of the Existential therapies. Possibly, with the support of those ancients who devoted their lives to mindful awareness, the mindfulness-oriented therapies will take a second look at this basic observation, and consider whether it can be cultivated to therapeutic effect.

Note: to see a draft of the Wilson and Murrell paper mentioned in this post, click here. The reference for the final version is:

Wilson, K. G. & Murrell, A. R. (2004). Values work in Acceptance and Commitment Therapy: Setting a Course for Behavioral Treatment. In Hayes, S. C., Follette, V. M., & Linehan, M. (Eds.) Mindfulness & Acceptance: Expanding the cognitive-behavioral tradition (pp. 120-151). New York: Guilford Press.