The Soul of Medicine: Spiritual Perspectives and Clinical Practice

7. Buddhism

CHAPTER SEVEN Buddhism Robert Wall, M.Div., M.S.N., F.N.P.-B.C., A.P.M.H.N.P.-B.C. A Buddhist responds to illness, change, and death with an integrated philosophy and practice that is instructive to care providers in all healing traditions. The best way to understand a Buddhist is to gain an appreciation of how Buddhists practice mindfulness and compassion. Insight meditation, Zen meditation , mindfulness-based stress reduction (see the appendix to this chapter), and Tibetan Vajrayana are a few of the choices available in the West today. In this chapter, I offer some background for such a quest, by considering who the Buddha was and what he taught, what research into mindfulness has shown, and how these teachings function in approaching life, suffering, and the end of life. The Ultimate Nature and Essential Concerns of Human Beings Buddhism began with a man born Siddhartha Gautama of the Sakya tribal republic living in a part of India that is now Nepal, in 563 BCE. He left his home, and after six years of arduous spiritual practice he attained enlightenment . He was called by his followers “The Buddha”; the title means “one who knows” or “one who is awake.” Its root, budh, comes into the English language 116 Major Traditions and Medicine as a verb “to bud (forth),” in the sense of a tree or flower budding or blooming, and by extension ourselves, when we awaken. When asked if he was a god, the Buddha replied, “No, I am not a god. I am awake.” Being awake in Buddhist parlance is not the opposite of being asleep. It contrasts with “forgetting” the present moment and by implication forgetting who you are. The Buddha’s story asks everyone, “Who and what are you?” and his story provides the answer: “I am awake” (Smith and Novak 2003, p. 4). The Buddha taught for 45 years until he died at 80 years of age, in 483 BCE. What is left to us are the basic teachings he named the Four Noble Truths and the Eightfold Path. In modern terms, the Truths and the Path are a program of instruction whose thesis is that suffering can be ended, or significantly reduced , through rigorous and systematic cognitive-behavioral practices based in mindfulness. The Four Noble Truths express four objectives: (1) to name suffering; (2) to name what causes it; (3) to name what can be done to end it; and (4) to prescribe the way to end it. The first insight, or Truth, is the importance of naming suffering. Huston Smith and Philip Novak, in their superb primer Buddhism, observe that suffering arises from our resistance to the superficiality and boredom of mundane life, which leaves “deep regions of the human psyche empty and wanting.” The Buddha called this deep objective dissatisfaction dukkha. The word has an onomatopoetic component, deriving from the sound a cart makes when its wheel is attached to a bent axle—dukkha-dukkha-dukka. It is an irritating “sound” that life makes when it does not go the way we want or expect. Human life is marked by dukkha, and the following events are inescapable: • the trauma of birth • sickness • fear of morbidity • fear of death • being tied to what one dislikes • separation from what and whom one loves Jon Kabat-Zinn remarked in his book Full Catastrophe Living that he found this title in Nikos Kazantsakis’s novel Zorba the Greek. Zorba answered an inquiry as to whether he was married or not: “Of course, I’m married. I have a wife, children, the full catastrophe!” (Kabat-Zinn 1990, p. 5). The full catastrophe is a good metaphor for what the Buddha meant by impermanence and is used here to stand in for all that impermanence means. Buddhism 117 The second insight, or Truth, involves naming what causes suffering: our conditioned expectation and fixed ideas that life will be permanent and unchanging . Suffering occurs when we resist life’s unsatisfactoriness, when we rail against impermanence (the constant state of flux, or anitya), disbelieve our interdependence on all other things (nonself, or anatman), and attempt to evade the full catastrophe. The ancient Sanskrit word for the “desire that resists” is tanha, meaning a selfish craving to avoid suffering, change, and unpleasantness while accruing power, admiration, and pleasure for oneself. I find helpful an algorithm offered by Shinzen Young (2009) to encapsulate this: S = P...