As a young oncologist, Anthony Back turned to Buddhism as a practical way of processing the suffering and death he encountered each day. “I came to Buddhism out of a sense of trying to survive,” he told Tricycle’s editor-in-chief, James Shaheen, and meditation teacher Sharon Salzberg. Over the years, his practice has become an essential support to his work in accompanying patients as they navigate illness and death, and it has radically transformed his understanding of what it means to provide care.

In a recent episode of Life As It Is, Shaheen and Salzberg sat down with Back to discuss how he integrates his Buddhist practice into his work as a physician, how he deals with burnout and moral injury, and what James Joyce and Virginia Woolf have taught him about paying attention. Read an excerpt from their conversation below, and then listen to the full episode.

James Shaheen (JS): You’re currently the co-director of the University of Washington Center for Excellence in Palliative Care and a professor of oncology and medicine, and you’re also a practicing Zen Buddhist. How did you first come to Buddhism?

Anthony Back (AB): I came to Buddhism out of a sense of trying to survive. I was a young oncologist, and I was feeling overwhelmed by the amount of suffering and death that I was dealing with. I thought, “How will I make a career of this? How will I keep doing this day in and day out?” That led me first to mindfulness and then to Roshi Joan Halifax at Upaya Zen Center.

Sharon Salzberg (SS): You currently work in palliative care, and so much of palliative care seems linked to honest communication about illness and death. How has your Buddhist practice influenced your ability to have these conversations?

AB: What my practice has enabled me to do is work at a layer that is below the words. Of course, there’s a lot of teaching about what words to use and what words help you come across as empathic. But what my practice has taught me is that my stillness can make space for whatever the other person is experiencing and that my ability to be with it and not push it away can create a field for deeper communication. I don’t think I would’ve learned that any other way. The priority in my world is not about stillness. It’s about efficiency. And it really took taking myself out of the hospital to learn to practice that kind of stillness inside and outside to be able to sit with people.

SS: When we’re confronted with suffering, it can be so tempting to look away or to try to avoid it at all costs. How have you seen this avoidance or resistance to suffering play out in the medical field, and how do you train providers to be able to talk openly about suffering?

AB: In the medical field, the usual reaction to suffering is that we should be able to do something about it, and if we can’t treat it now, we need to find new treatments, and so we need to do more research. There is something really good in all of that—that is how medical practice improves. And yet if we don’t pause to be with that suffering and to witness it and to be present with the person, then something gets missed.

It is a constant struggle to make the time to be still in the midst of these busy practices. And because it’s not reinforced by the system, because it’s not reimbursed or formally taught, very often mindfulness gets the label of being just another technique. Of course, what you learn after years of practice is that it is a way that you bring yourself into everything. It’s not just something that you apply at the moment; it is a way you are present in the moment. It is the ground that you’re coming from.

The more that we can both be present with everything, the more there is really potential for a kind of healing.

JS: You’ve talked about the sense of inadequacy and powerlessness you can feel in the face of a patient’s suffering. Has your Zen practice shifted your relationship to this powerlessness, and more broadly, has it changed your understanding of what it means to provide care?

AB: First, I would say that Zen practice has radically shifted my sense of what powerlessness means in the sense that I appreciate all the things that medical technologies can do, and yet I don’t use them with the same kind of expectation that I will be able to have power over another person’s body. There are things going on biologically that are so complicated that we’ll never be able to completely understand them. And so coming at it that way gives me a kind of humility about the situation, which changes my expectations about what will happen.

The other thing that has shifted in my understanding is that there’s a technical aspect to the care that I provide, but then there is also a more personal aspect, which is more than just emotional care. It is the care of being present. It is the care of witnessing. It is the care of sharing space with another human being. And I think that’s a very different sense of care than the one I had earlier in my career.

When I was a young physician, I was trained that care was all the nice things that you did that were beyond the minimum. Now, I think of care as the way I bring myself to the room to meet the other person. It is the way I can stay there—or try to stay there—regardless of what is coming up for them and, in the time that we are together, to invite everything into the room. The more that we can both be present with everything, the more there is really potential for a kind of healing.

SS: You’ve discussed how your practice influences your clinical work, but I’m also curious about the other direction. Has your day-to-day work as a palliative care doctor changed your relationship to Buddhist practice?

AB: My experience as a doctor sitting with people who are dealing with serious illnesses has totally changed my worldview. I started out in this work as kind of a materialist: I thought that you have a body and it’s just stuff and you die and it’s over. Sitting with people has given me the sense that something very, very different is going on. Being with somebody at the moment of death and being really present for that, there is clearly something happening that is not described by medical science—there is a profound shift when someone’s spirit leaves the room. That has forced me to recognize that there is something else going on in the universe that I was never trained in. My Buddhist practice is what has allowed me to perceive that.

If I had not learned to stay still long enough to feel inside myself, I don’t think I would have noticed that that was happening. And I see it all the time at work. Everyone [at the hospital] is running around so much, and someone dies and they don’t even notice. They don’t feel it. I think those experiences [of being with people at the moment of death] have tuned me in to a level of my practice that I’m not sure I would have accessed on my own.

Being with people in this way has changed what it means for me to be present in my own body. That has given me a different reference point for myself, but it’s also given me a point of reference about how we are all interconnected. If I pay close enough attention and my mind is quiet, I can actually feel this interconnection all the time, and that is a source of encouragement and a kind of joy and curiosity and awe. Even in really busy moments, I can get a taste of that.

The post Inviting Everything into the Room appeared first on Tricycle: The Buddhist Review.

The Sutra that Vimalakirti Speaks is about a householder friend of the Buddha who is both deeply awakened and very ill. The sutra mentions that Vimalakirti is only pretending to be sick, using skillful means in order to teach others. Judging from the reactions of those who gather around him, it’s an unsettling method, as he embodies an apparent contradiction—enlightened, sick—they are reluctant to confront.

The Buddhist concept of skillful means is a tricky one; it’s possible to make big, consequential mistakes when you believe you know how to bend your message, circumstances, or other people in the service of (your idea of) helpfulness. And realizing that you’re on the other end of someone else’s attempt at skillful means can sometimes just feel icky. The skillful means interpretation in Vimalakirti’s case feels a bit pious to me, or like the sutra-makers are trying to distance themselves from something they too find unsettling in Vimalakirti’s message. Anyway, there are some less orthodox and perhaps more fruitful ways of looking at this “pretending.”

That Vimalakirti might be pretending to be sick is reminiscent of something the Chan teacher Huangbo says: “Teaching Chan is like casting fake pearls before people pretending to be beggars.” Huangbo knows that he’s offering his “pearls of wisdom” to people already in possession of the greatest jewel, the awakening inherent in each of us. In other words, whatever our circumstances, even if we’re in need or ill, that doesn’t make us essentially beggars or sick people; it makes us beings in a world that includes poverty, disease, and many other sorrows. It’s a call to see, in addition to wounds and scars, the small glow of awakening in each of our bellies.

The invitation is to open some space between the natural condition of being alive in a world of birth and death, and an unchanging identification with some aspect of that condition. The nature of being alive in such a world is to be a little tilted, because the world is tilted. That’s different from saying that your identity is most significantly the particular way you’re tilted. I’ve lived with a chronic health condition, and I can remember early on having to decide whether I was going to go through life taking that one fact of life, putting it at the center, and hitching everything else up to its tethering post. What would it be like to keep company with it instead, remembering that I was also keeping company with so much else?

Vimalakirti’s suggestion is that you let your vow of awakening, for yourself and others, settle at the center. Over time the vow spreads out into a kind of field, and everything from the fleeting moments to the longstanding circumstances of your life will arise in that field, and the vow will help hold them. This field tends to have fewer fortifications linked by deep grooves of habit, more spacious views, and a milder climate on most days.

Hanging out in such a field can bring ease, and ease can bring openness. The bodhisattva of compassion is called Guanyin in Chinese, which means “Listens.” This vow we’re talking about is her vow, and so it calls us to listen with a simple heart to our kin of all kinds when they speak, roar, cry, and whisper about the sorrows of a tilted world. Held together by scars and radiance, all of us. Often in need, all of us, and sometimes some of us in great need. The filaments that connect us vibrating with prayers and exhortations. The vow at the center, the small glow in our bellies, listening, sending out its own filaments in reply.

It’s starting to go a bit dreamlike and mysterious inside this “pretending.” Yunmen, another Chan teacher, asks a question that takes us further along that path: “See how vast and wide the world is. Why do you get up and get dressed at the sound of the morning bell?” Why, in the midst of the unfathomable vastness, do you wake up every morning when the alarm goes off and start another ordinary day? Why do I come out of the deep space of sleep every morning to put on my human skin and go out to live a human life?

Maybe it’s because each of us is the vastness manifesting in a particular way. You’re this person, I’m that person, there are the bird persons under the eaves and the ground cover persons just beginning to spread in the courtyard. We put on our clothes when the alarm goes off because, for another day, we accept the invitation to be the vastness taking this form, and we’ll try not to be stingy about it. We’ll “pretend” to be human beings in our human being skins, not in the sense of a false performance but remembering that we’re both born and unborn, named and unnamed—everything in the universe at once, taking the form of a particular human being. There’s a sense of play about this: the performance today is heavily flavored by memories of childhood summers at the beach or by comically ramifying lists of tasks, or it is stained and dyed by silence.

In a koan from the Book of Serenity, the Chan teacher Dongshan is dying, and a student asks him, “You’re unwell. Is there someone, after all, who isn’t sick?” In other words, is there an aspect of you unaffected by illness? Is there some eternal buddhanature part of you that isn’t experiencing the sickness you’re experiencing?

Dongshan says, “There is.”

So the student asks, “Does the one who isn’t sick take care of you?” That’s a natural way of thinking about it: If there’s something we believe in, like buddhanature or God or Goddess or whatever we identify as that-which-is-not-sick, do we find consolation and comfort there? Are we being taken care of by the not-sickness of the universe?

But Dongshan says the opposite: “I’m actually taking care of that one.” In other words, the life I have been given is shaped like this right now. Even when it’s hard, it’s an extraordinary gift, the vastness swirling into form to experience itself like this, like me, and in exchange I’m living my life as generously as I can, which is the way I take care of that one. In another koan, someone remarks on how hard his friend is working. The friend replies that he’s doing it for another. When he’s asked why he doesn’t get that other to do it for themselves, the friend replies that it’s because they have no hands: The vastness has no hands but ours.

Dongshan’s student goes on to ask, “What’s it like when you take care of that one?”

Dongshan says, “Then I don’t see that there is something called illness.” I might be sick, but I don’t have preconceived ideas about what illness is. I’m not going to start from the position that illness is a failure of life to go as it should, or that it’s some kind of gift. Let me be sick and find out what it means.

Once when a particularly bad patch of illness stretched on for months, I’d wake in the morning and sometimes, just for a moment, I was in the sweet, calm space before the illness constellated around me, and I could remember what not-sick was like. Then the symptoms would start blinking, and I’d realize that it was going to be another long, challenging day. I’d stumble out of bed, make tea, and weep. Both things were true, the sweetness of a moment of physical ease and the weeping. Denying neither of them, living them both as uncomplicatedly as I was able, was what I could do those days to care for that one, to stay close to the vow.

Unbeguiled by the lure of skillful means, I marvel instead as my hand figures out, moment by moment, what it means to be a hand, and my heart learns what a heart is on a sunny morning after days of fog. Are they, am I, pretending? Not exactly, but sort of, if pretending means a series of assays and approximations, one not-knowing flowing into another, with lots of pauses to listen. Outside my window, are subatomic particles pretending to be trees? The world isn’t only a dream, but it is, in part. How do we take care of a dream?

⧫

This excerpt is a chapter from Vimalakirti and the Awakened Heart: A Commentary on The Sutra that Vimalakirti Speaks (Following Wind Press, 2016). Used with permission. The book may be purchased here.  Support Joan Sutherland, Roshi on Patreon. 

The post Pretending to Be Sick  appeared first on Tricycle: The Buddhist Review.

A new center dedicated to the study and implementation of mindfulness has opened at Harvard University. The center, named the Thich Nhat Hanh Center for Mindfulness in Public Health, officially opened on April 26 at the University’s T. H. Chan School of Public Health, thanks to an anonymous $26 million donation. According to a press release, the mission of the center is to “empower people around the globe to live with purpose, equanimity, and joy through the practice of mindfulness; pursue evidence-based approaches to improve health and well-being through mindfulness; and educate and train the public in mindfulness. Two primary areas of emphasis will be nutrition and the environment.” 

The center is the product of years of planning and collaborative work between nutrition specialists, such as Director of Mindfulness Research and Practice Dr. Lilian Cheung, and the late Thich Nhat Hanh himself. 

Dr. Cheung first met Thay, as his students call him, at a Key West mindfulness retreat in 1997. This initial experience living mindfully and learning directly from him changed her life. 

“As I went through the week, I simply could not believe that I had three days without stress. I was able to touch peace, which is not a phenomenon that I could really experience as an adult,” Dr. Cheung told me when we spoke on a call.

Her newfound practice and relationship with Thay encouraged her to think critically about how the benefits of mindfulness could be applied to the realm of her professional life in public health. 

For Cheung, taking mindfulness from an individual level to a community level means focusing on interconnectedness in two areas: nutrition and environment. 

“The Buddha was so advanced in thinking about eating for the health of everyone, not just yourself. There needs to be enough food to go around the whole world, right? I think about the sutra ‘eating the son’s flesh’: if you don’t eat mindfully, you won’t have enough food for future generations,” she said.

In April, Public Health scholars and Buddhist leaders alike celebrated the Center’s opening symposium dedicated to presenting the positive effects of mindfulness. 

“Since the Center’s launch, we have received overwhelming interest from both the Boston community and beyond. The possibilities for the Center extend far beyond our current capabilities, but we are committed to being mutually supportive and creating synergies whenever possible,” Dawn DeCosta, the Center’s Executive Director, said.  

Current projects for the Center include “Eat, Move, and Live Mindfully,” a school-based research program for children and young adults, and “Minding our Future,” a project aimed at creating longer and healthier lives for aging adults. The latter will integrate models of Buddhist community living and belonging, specifically in sanghas, as part of the research plan. 

The Center also aims to contribute to the nearly 25,000 studies about mindfulness in peer-reviewed publications out there as of 2023. Thich Nhat Hanh Center researchers will contribute to this “very important area of development,” in the words of Dr. Cheung, with additional scientific tools to assess the impact of mindfulness interventions on health and wellness. 

Looking ahead, Dr. Cheung said, “It’s important for us to try our best to coach everyone at the Public Health School, the whole of Harvard University, and hopefully beyond to other institutions; to have practice, research, and teachings about mindfulness’s effects on the individual, on society, and on the world.” 

Brother Phap Luu of Deer Park Monastery, who has been one of a number of monastic advisors to the Center, believes the Center’s combination of Buddhist teachings and evidence-based research will open many doors. 

“Approaching this from a scientific perspective and having that as a foundation can help people become free of the inherited fear or anxiety about religion, and to see that this common path of mindfulness and community ethics has brought happiness and well-being to people everywhere,” he said. 

In late September, Deer Park Monastery will host a mindfulness retreat for the Center’s employees as a concrete form of collaboration between brothers and sisters, laypeople, scientists, and doctors involved in the Center’s research. DeCosta plans on attending the retreat, and sees it as an opportunity “to gain a greater perspective of the practice of mindfulness.” 

“To me, mindfulness means cultivating a space for peace and happiness and the ability to love oneself,” she said. “If one can achieve this equanimity, the possibilities are endless.”

The post Harvard’s Chan School Opens Thich Nhat Hanh Center for Mindfulness in Public Health appeared first on Tricycle: The Buddhist Review.

I was recently discussing mental health with a group of seventh graders when a student said something that stopped my mind. “When we have an issue, instead of taking a physical step forward, sometimes we need to take a mental step back,” she said during a lesson in our health and wellness curriculum. It was a remarkably perceptive statement, but perhaps I shouldn’t have been surprised. As a PE teacher and the Mindfulness Director at the school where I teach, I often hear students make insightful statements. This class had been particularly lively and engaged as we discussed the numerous obstacles to their well-being—a familiar subject for a group of teens living through the oft-described mental health crisis.

As recent media attention has pointed out, young people are suffering, and in an age of relative abundance, it isn’t abundantly clear what the root cause is. 

By many metrics, it would appear that modern American teens are thriving. As psychologist Candice Odgers related in a New York Times piece about the mental health crisis, “Young people are more educated; less likely to get pregnant, use drugs; less likely to die of accident or injury…But there are these really important trends in anxiety, depression and suicide that stop us in our tracks.” Although there is not one explanation for this dissonance, Buddhism can offer a useful lens. Dukkha, often translated as suffering or unsatisfactoriness, is not something that afflicts the population selectively. Rather, it is a condition of the attachment that arises as we build up an ego that avoids and craves stimuli. Perhaps in our increasingly connected, affluent, and identity-driven society, this attachment and subsequent suffering is something that is more pronounced for teens than it ever was before.

Naomi Corlette, a teenager who agreed to be interviewed for this piece, identified a number of potential causes for distress, including an increase in technology use, decrease in human interaction, and concern for the future of the world. 

“Many of us are fortunate enough to have our material needs met in a way that they wouldn’t have been in the past, but this leaves room for us to focus on more abstract issues which humans aren’t necessarily prepared to deal with,” Corlette said. “All of this can cause a lot of stress and despair, which is particularly hard on younger people.”

Of course, one’s teenage years are also when one first confronts the manifold issues and uncertainties posed by society, and the current zeitgeist provides many opportunities to be triggered and challenged. I recall being an angsty teen myself, and being wholly unsatisfied by the dogmas and diversions on offer. Mindfulness practice was a way to work with the shifting sands of my personal evolution as well as the evolving times. 

Corlette is on the Youth Advisory Committee for Inward Bound Mindfulness Education (also known as iBme), an organization that offers mindfulness retreats for teens. The emphasis on in-depth experiences at iBme is one approach to helping teens work with their minds and confront some suffering. Another organization (and the one that helped establish my Mindfulness Director position in the school where I teach), called WholeSchool Mindfulness (WSM), does the opposite. It seeks to make mindfulness as readily available as physical education. Both approaches may be useful in supporting teenagers during a period in their lives when suffering feels particularly acute.

Go Wide or Go Deep?

Someone who can really speak to the value of both approaches is Ben Painter—a partner at WholeSchool Mindfulness who, incidentally, attended numerous iBme retreats as a teenager. One of his firm beliefs now, as an adult helping teens, is that teenagers need tools to resist the attention economy.

“Given what this generation of young people are up against, I think it’d be a really wise response if mindfulness and these contemplative practices of getting in touch with yourself and your experience and gaining some autonomy over your own attention were just considered an integral part of what it means to be educated,” Painter told me.

To this end, he believes one of the WSM model’s best attributes is how many students it can reach. “We’re trying to legitimize this model of a mindfulness director in schools, and make it broadly and widely accessible to America’s students in public education,” Painter said. “To me, that’s thrilling. It’s a wider scale.”

Still, Painter does recognize the strength of an approach that functions on a smaller scale but offers a more intensive experience. He cited the relationships formed at iBme retreats as an important reason he was able to take his practice off the cushion and out into the world. This peer-driven influence is something I see often in my teaching—no matter how much I might suggest mindfulness practices to help students deal with their full plates and overwhelmed minds, hearing about its benefits from one’s peers is much more powerful.

“It is a magical culture,” agreed Tonya Jones, who oversees iBme’s Program Strategy, Equity, and Community Engagement. “There’s something that happens on retreat that really helps cultivate an environment for peer-to-peer sharing, for being vulnerable in ways that seem to just kind of flow organically. There’s a good balance of contemplative time for yourself, but also time for community building and sharing and just showing up and being teens.”

In addition to providing moments of real insight, community, and connection, iBme also ensures that support is available for those teens who may be struggling with mental health. She notes the 3:1 ratio of teens to staff, as well as the presence of a mental health coordinator and a health coordinator at every retreat. The direction of the program remains in the hands of the teens themselves, however. “What’s unique about our approach is the centering of youth voices and wisdom,” Jones said. “Anyone can attend, they don’t have to change or do anything or show up a different way.” The fact that they can show up and be their full selves is one of the most common pieces of positive feedback the organization receives. 

When I asked Painter if one approach might be more powerful than the other—the wide net that WSM casts by integrating mindfulness within the school system versus the deep net that iBme casts by facilitating retreats—he pointed out that this was a false dichotomy. “They each play a particular role in the ecosystem of introducing mindfulness practices to young people. When students get a taste of mindfulness in a school because they have a Mindfulness Director, there should be an opportunity to go deep, to opt in. I think they’re complementary.”

According to a 2015 meta-analysis of eleven studies, mindfulness-based interventions were more effective than controls in improving mental health symptoms in children and adolescents. Of course, as I’ve seen in my own implementation of mindfulness strategies as a Mindfulness Director, a practice is effective only if it is embraced. For teens especially, then, it’s essential that mindfulness is not just associated with sitting still or mitigating negative symptoms. That’s why I often introduce mindfulness practice with games and challenges that emphasize attention and awareness. Teenagers are nothing if not savvy, and asking them to sit up and be silent and still could be the first step toward alienating them. 

“I think it’s important to stress that mindfulness can be practiced in a variety of ways,” pointed out Corlette, noting the potential for short practices, guided meditations, journaling, walking, or movement to cultivate love, playfulness, and joy. “If we can learn to treat each other more mindfully in our everyday lives, it can go a long way to improving teens’ lives.”

The post Mindfulness for Teens Today appeared first on Tricycle: The Buddhist Review.

Frank Ostaseski is considered one of the most important representatives of the hospice movement in the United States. Inspired by Elisabeth Kübler-Ross and the teachings of Zen Buddhism, he is one of the co-founders of the Zen Hospice in San Francisco and for decades has shared his insights and knowledge in lectures and workshops worldwide. Ostaseski’s book The Five Invitations: Discovering What Death Can Teach Us About Living Fully does not provide any ready-made recipes for better living in the face of the finiteness of life and death. Rather, its author—sometimes in the guise of a poet and storyteller, sometimes as an existential psychologist, then again as a phenomenologist of concrete experience—provides tools and suggestions for how to bring your full self to being with people who are dying. The media scholar Bernhard Poerksen met Ostaseski on his houseboat in the harbor of Sausalito, California.

Poerksen: You are one of the key voices in the American hospice movement and have spent all your professional life thinking about dying and death. In recent years, because of the pandemic, illness, dying, and death have dominated the public discourse. My question is: How has the pandemic shock changed how we feel about dying and death? Has there been a societal learning process?

Ostaseski: I see a double effect. On the one hand, thanks to the virus, the insight that we are all interconnected has been transformed into an experience. Today, we have to acknowledge that such a pandemic can only be met collectively and globally, only through cooperation, mutual consideration, and through vaccinating as many people as possible. On the other hand, dying and death have come out of the closet, so to speak, and moved to the center of public attention. By now, pretty much everyone knows of at least someone who has died of COVID-related illness.

We are talking about more than one million Americans and more than six million people worldwide so far. That’s right. Of course, death has always been there; it is, after all, part of life. But now it has an undeniable presence—and it is cutting across all classes and milieus.

So would it be fair to say that the pandemic has democratized the risk of losing one’s life? For suddenly each and everyone was at risk, irrelevant of social power and position, status and hierarchy. I would put it differently, because the certainty of death has always been democratic. After all, everybody must die. But now death has got our attention. Suddenly, the elephant in the room is visible everywhere. Whether this will lead to a permanent shift? I am at best cautiously optimistic, for cultural change is slow, sluggish, and rarely traceable to an individual event such as a pandemic. So I would say that, on the one hand, death has become more present. On the other hand, throughout the pandemic, most deaths were not concretely visible, death was not tangible as an immediate, direct experience. It was and is death at a distance, an impersonal, sanitized death, as it were.

What do you mean by that? When the AIDS virus was raging in San Francisco in the early 1980s, death was in our face, so to speak, on a daily basis, and it was very concrete, because it was possible to sit with the dying person in their home, hold their hands, wash them, change their diapers. This highly immediate, direct experience triggered an enormous wave of empathy and compassion. During the COVID-19 pandemic, people died lonely and invisible deaths on some intensive care unit. We learned about their death from the media and in the form of abstract numbers and statistics. We received second- or third-hand accounts of their suffering and were confronted with their dying through the stories told by exhausted nurses and doctors. We developed empathy with these health-care providers, because it was them we saw and because they had to work so hard. But we could not be close to the dying people themselves, we could not see them or touch them, we could not be there to experience their last breath. The risk of infection had forced them into isolation and removed their bodies from our sight and touch.

You have repeatedly collaborated with nurses and doctors working in emergency rooms. How was it for them who in fact had contact with their dying patients? My proposition is that they suddenly became ambassadors and reporters for the media and the families, going back and forth between the hospital beds, the relatives, and the public… …and in this new multiple role as intermediaries and carers, they also had to take on, time and again, the tasks of loving family members, because the real family members were not allowed to come inside the hospital. As a result, there was much more intimacy between them and the people who were dying. And much less intimacy between the people who were dying and their actual relatives.

In my view, there was an ambivalent virtualization of dying and death at the height of the pandemic. On the one hand, we had final messages via FaceTime calls, livestreamed funerals, the shared grieving via Zoom and in the form of candles that you could light online for others. On the other hand, all of this lacked the immediacy of direct experience. May I tell you a story? A while ago, a friend came to me asking for my advice. She was in a kind of shock, for she had experienced her father’s last breaths on her iPad, her face pressed to the screen, in a desperate, surreal attempt to produce closeness that was, however, quite removed from direct experience.

There is another kind of grief, an ambiguous, strangely diffuse grief, brought about by this pandemic.

We are talking about a distant intimacy enabled by the media, which is actually an utterly paradoxical phenomenon. It is an attempted but not really achievable intimacy. This friend wanted to kiss her father who was in a hospital in a different country, so she kissed the screen and the image of her semi-unconscious father. And he was dying that very moment. You could say that she kissed an idea of her father, but she missed the immediate experience of touch, of smell and bodily presence.

The screen and the iPad are what the internet sociologist Sherry Turkle has called “evocative objects.” Because they so obviously shape our experience, they make it possible to experience what is at the core of human experience—the closeness, the physical touch, the sudden, surprising depth. What’s more, the screen and the iPad show us what it means to be fully human—precisely because we cannot live our full humanity under the inevitably constrained conditions of digital communication.

What are the consequences when intimacy and contact—like in the example of your friend—cannot be lived and experienced fully? One consequence of such an experience is that grief is highly delayed—because you could not see the death, because you don’t have the certainty of seeing these last moments for yourself. Another consequence is a hard-to-define feeling of loss that is not only about the death of a loved one. What have you lost when you could not say goodbye to someone who is lying on their sick-bed or death-bed, when you could not give your father a real kiss, no longer see your own father, and thus authenticate his death? What I am trying to say is that there is another kind of grief, an ambiguous, strangely diffuse grief, brought about by this pandemic.

What is this other kind of grief about? It is about the loss of familiarity, of normalcy and tradition. Suddenly, we were sitting in our homes, isolated and bewildered, separated from friends and family; we had strange haircuts, were unable to lead the lives we used to live, stop by our favorite pizza place in the evening. Weddings were postponed. And postponed again. Graduations were canceled. Birthday and dinner parties no longer took place. And our normal everyday life—the separation of work and leisure time, of one’s work life and one’s personal life—dissolved. Was this simply inconvenient or already dramatic? Did we even have the right to be sad, especially compared to those who had lost their parents without being able to say goodbye to them, bury them, and grieve together with relatives? Wasn’t our own bewilderment a luxury problem, compared to those who got seriously ill or who had to bury their career dreams basically overnight?

What are you getting at? My point is that there were many individual, accumulating stories of loss, big and small. But there was also a comparing of the very different sufferings and fates and the question: Is my own sadness even legitimate when I have not lost anyone and have not become seriously ill myself? And there was a curiously ambivalent, not really quantifiable and qualifiable pain, caused by the ambivalence and indeterminacy of the whole thing.

So if I were to distill a key conclusion from our conversation so far, would it be correct to say: In times of pandemic, it was rare to have a good death and to have the fortune of grieving successfully together with a community of friends and relatives? I guess you could say that. In hospitals and nursing homes, crematoriums and cemeteries, strict rules applied. Sometimes only a handful of people, if any, were allowed to attend the funeral, and they had instructions not to touch or to hug under any circumstances. I am a little allergic to the idea of a good death, to be honest with you. Dying is messy, exhausting. It is a labor to die just like it is a labor to be born. And each death is unique and different. The romantic expectation of a good death and the hype about the last moment of one’s life only create enormous, unnecessary pressure—as though there was a universal assessment grid and as though it was a personal failure not to leave this earth smiling, in a state of bliss in the lotus position.

As founder of the Zen Hospice in San Francisco, you have companioned more than 1,000 dying people, many of whom were homeless, drug addicts, dying of AIDS, and without any money or health insurance when they came to you for help and support. At the height of the AIDS epidemic, sometimes 30 to 40 people were dying in your hospice in a week. At some point, when your work became better known, a documentary filmmaker invited you to a conference to talk about death and dying. On the flight there, you noted down five key principles—your key insights and experiences from being with dying people—which you later turned into a book. Would you mind telling us these principles? I’d be happy to. I call them the five invitations, because it would be absurd to see them as provisions. The first invitation is: “Don’t wait.” Waiting for a better future makes us miss the present moment and life in all its fullness and abundance. And at some point it is too late. The second invitation is: “Welcome everything, push away nothing.” This call for radical openness and a fearless, loving acceptance of life as is sounds impossible, maybe even a little bit foolish. But it means taking the situation of the dying person seriously and accepting as it is— its wretchedness, its messiness, but also its beauty. The third invitation is: “Bring your whole self to the experience.” When we are with someone who is dying, it is all about showing ourselves as a whole human being and getting in touch with our own fear, grief, and helplessness.

That means letting go of an ideal of perfection, of the illusion that we have everything under control… …and it means opening up the space for real dialogue, real encounters. The fourth invitation is: “Find a place of rest in the middle of things.” We always think that we should treat ourselves to a break only when the circumstances are perfect, when everything is under control, when everything is finished. But this is not true, this does not work. So why not find a moment of rest here and now, for example during this interview? And finally, the fifth and last invitation: “Cultivate a don’t-know mind.” When we carry around too much knowledge, ready-made concepts and seemingly one-size-fits-all recipes, there is no room for surprises, curiosity, and a sense of wonder. The idea is to cultivate a beginner’s spirit, as the Zen Buddhists say, to be awake, seeking, and ready to learn.

What these principles suggest is that the art of dying and confronting the finiteness of one’s existence is in reality an art of living. Because everything that you described are not just maxims for dying well but also… …for living a life of meaning and purpose. Yes, of course. What I have learned from people who are dying is that death can be a teacher hiding in plain sight that shows us what’s really important, which is leading one’s life deeply and authentically, with vulnerability and compassion. For this, you need no grand, highly complex philosophy, no esoteric knowledge, and no spiritual idealism leading us away from who we are really. Actually, it is very simple: Living deeply into our humanity makes life fulfilling and dying easier.

And what comes after death? That is and remains a mystery.

The philosopher Ludwig Wittgenstein said, “Whereof one cannot speak, thereof one must be silent.” Is he right? Not really, no. We could talk forever about the mystery of existence after death. We could talk about this until the cows come home, as we say here. Depending on tradition and religion, we will encounter different stories, attempts to bring light to the mystery, and to ward off the horror of death. However, we will not find the single, definitive answer. But it does not matter. Life itself is a mystery that cannot be fully solved—so why shouldn’t this also apply to death? I personally don’t believe in the reincarnation of my personality but I have faith in the idea that impermanence is not simply about loss and that every ending gives rise to a becoming, an opportunity for transformation—like a tree that falls in the woods and rots and gives rise to more becoming.

You said recently that for some years you have experienced the proximity of death also “from the other side of the sheets.” That’s true. I have survived a heart attack and five strokes and I am half blind. I had temporarily lost my sense of time and had difficulty finding the right words and keeping up with a conversation. And let me tell you, it’s damn hard for me, too, to accept my own helplessness. And yet it is instructive, also for others. When I returned home after my heart attack, one of my students who saw me as his Buddhist master came to help care for me. One day, he helped me get into the shower. And I felt so completely helpless and powerless that I began to weep. I remember crumbling onto the floor and weeping. First, he did not know what to do, because for him I was not an ordinary human being but his teacher and role model. But then something wonderful happened. All this specialness that separated us was suddenly gone, and there was simply Frank who was crying. Suddenly an entirely different dynamic was possible.

How do you feel today? I am in fairly good shape. Of course, since I live on a houseboat, I am sometimes afraid of stumbling and falling. But I take good care of myself, I am practicing mindfulness, I give online lectures and seminars, and I have the privilege of living in this very beautiful environment defined by the tides, the water, and the wind. I come up and down on the tides. You see, I live here surrounded by all these other houseboats in a floating, fluid, mutable and unstable world, not in a static, forever solid universe that knows no change. It is a wonderful environment to remind yourself of the fragility of life and to tell yourself: “Make plans, but hold them lightly!” Everything changes.

♦

This article was first published on December 23, 2022.

The post The Many Flavors of Grief appeared first on Tricycle: The Buddhist Review.

Looking back at the challenges of the past three years, I find myself returning to the Diamond Sutra, which is such a guiding light. Short as it is—thirty-two brief chapters—it seems to convey exactly what I need to hear when I need to hear it. At this time, chapter sixteen really resonates, especially when I alter the text from the third-person plural (they, their) to the first-person plural (we, our).

If we virtuous men and women who receive this teaching are downtrodden, our unfortunate destiny is the inevitable result of karma committed in our past mortal lives. By virtue of our present misfortunes, the effects of our past will be worked out, and then we will be in a position to realize Supreme Enlightenment.

Shakyamuni Buddha may have given this teaching around 2,600 years ago, yet the virtuous men and women who receive it are none other than we ourselves, Buddhist practitioners living in the first quarter of the 21st century in the Common Era, scattered all over the world, right here as 2023 unfolds. 

We may not think of ourselves as virtuous, but every time we refrain from callously expressing irritation, every time we restrain ourselves from consuming more than we need, and every time we offer dharma nourishment and material sustenance to one another, our minds grow in virtue.

What about the word “downtrodden”? Perhaps we can relate to that more readily than to “virtuous.” The Sanskrit word is paribhuta, which is difficult to translate. It can mean being overcome; abused; despised; held in contempt, especially by oneself. 

I hear from many who feel overwhelmed, hopeless, anxious, exhausted, or despairing, as various illnesses and extreme climate crises have derailed human plans and expectations. 

I recently spoke to one of the doctors in our sangha who felt completely overcome. Not a drop of resilience remained. He said he despised himself for not being able to meet his own expectations; he felt that somehow he should be able to handle even the most impossible situation, yet he wondered if he could keep going. Of course the morning found him back at the hospital, keeping on—but with a new kind of trust in Kanzeon, which we and many other sanghas chant 108 times on New Year’s Eve. 

When we experience this newfound trust, Kanzeon is not merely a mantra, but a full-on transformation. We are no longer functioning in our limited capacity as humans; we become open channels for Kannon bodhisattva, Avalokiteshvara, with all her 1,000 hands and eyes—that is, the unlimited power of compassion—working through each one of us.

When the coronavirus appeared at the end of 2019, most people thought of it in a typically self-absorbed way—one of those misfortunes occurring in a place far removed, i.e.: not our problem. And during each of these past three years of affliction—paribhuta—there’s been an undercurrent of myopic thinking: once this is over we’ll take up our lives again as usual. But what caused the pandemic is exactly that “usual.” The Buddha taught that the fundamental illness is ignorance. Humans have used and abused the planet, ignored its plight, and, through selfish commodification and consumption, have brought us to this point. 

For decades, scientists warned of the climate crisis. It’s no longer a matter of prediction; it’s now here. We know the facts—extreme storms, severe cold, disastrous heat waves, floods, wildfires, species extinction. As the first year of the pandemic rolled into the second, more of us began to see the key lesson being taught: We are interconnected. What one sows, all reap. 

The coronavirus is a symptom that’s hard to ignore; it’s our new reality. There’s nowhere to go to avoid it. Our default mode of aversion, seeking distractions, or running away does not work with a pandemic. Wherever humans go, the virus goes, in its ever-changing physical and mental manifestations. 

“Our unfortunate destiny is the inevitable result of karma committed in our past mortal lives.” To own up to this requires humility, courage, and honesty. We may not “believe” in past lives, but what about yesterday? What about last year, or for some of us, many decades during which our thoughts, words, and deeds were less than honorable, less than beneficial? 

When we examine our lives on this very simple daily basis, we can see how these things play out. Our level of consumption affects everyone. So can we use less and appreciate more? Give away what we don’t need, examine our neediness, and how we’ve been filling our perceived lack? Are we using stuff to barricade ourselves against the fear of what’s out there? Or maybe in here? 

How do we talk to one another? We know reactivity is a key problem; so is the certainty that we’re right, that we deserve to have our way. Privilege is very subtle, and it usually goes undercover. Can we ask ourselves what the underlying message is that we’re sending out, in between the words, the lines? The divisions and animosity in our nation and around the world are easy to see, but they function on the gross level. We can’t begin to change them unless we do something even harder: change within, change on the subtle level. 

The “Verse of Purification” acts as an important reminder:

All the harmful karma, ever committed by me since of old
Caused by my beginningless greed, anger, and folly
Born of my body, mouth, and thought—
I now confess and purify it all. 

This chapter of the Diamond Sutra ends with encouraging words: “By virtue of our present misfortunes, the effects of our past will be worked out, and then we will be in a position to realize Supreme Enlightenment.”

It reminds us that right here, within our present circumstances, our particular karmic constraints, we can find true freedom. By practicing together, no matter what the situation, we are changing our karma. The effects of our past are being worked out right at this very moment. 

Eno (Ch: Huineng), the Sixth Ancestor, who was enlightened when he heard a line of the Diamond Sutra being recited, put it this way: 

Your past lives are simply the deluded mind of your previous thoughts, and your present life is simply the enlightened mind of your subsequent thoughts. Use the enlightened mind of your subsequent thoughts to reject the deluded mind of your previous thoughts so that delusions have nowhere to cling…the moment your deluded thoughts are eliminated, the bad karma of your past lives is wiped away.

With all the trauma and all the losses, still, the pandemic has been a real opportunity for us as Buddhist practitioners. We’ve understood how precious each life is; we’ve delved into the great matter of life and death. We’ve had long periods of solitude; we’ve been able to do sesshin in person as well as online. 

We’re called upon to deepen our resolve; to respond in ways that honor our interconnectedness all across the globe. We’ve got to put everything into it, with no holding back.

We have purified our hearts. We have dropped “the deluded mind of our previous thoughts” to enact “the enlightened mind of our subsequent thoughts.” Let us vow to transform the poisons of greed, anger, and delusion into the virtues of generosity, love, and clear insight. May we and all beings “be in a position to realize Supreme Enlightenment” in this Year of the Rabbit, an auspicious sign representing the spiritual healing, grace, and purity of the moon goddess.

The post Deepening Our Resolve appeared first on Tricycle: The Buddhist Review.

Sitting in this room, in an out-of-the-way part of the medical center, I can feel a deep quiet, almost like sesshin. The atmosphere is still but expectant. Across from me is another clinician who is enrolled in a clinical trial and has just taken a study drug that might or might not be psilocybin. Neither I nor the clinician participating in the study knows whether the pill contained psilocybin or a placebo. My aim: to be present.

This person has qualified for the study because they have moderate symptoms of depression and burnout related to their work in the COVID pandemic. It is the first study of psilocybin-assisted therapy for doctors and nurses in this situation. The clinicians who qualify for this study have seen a lot of struggle and death up close. At their hospitals, in the course of trying to heal others, they’ve witnessed and experienced suffering—as well as hate speech, confessions, accusations that they are lying, and physical violence. They’ve had enough—too much, really. They feel broken.

Summoning my own presence under these circumstances is a challenge. It’s hard to “just” be present. My mind is busy with housekeeping (did I finish all the study forms?), anguish (witnessing shame for which words aren’t enough), hope (that they received the psilocybin rather than the placebo), and a million other things. All my worries are on full display, with surround-sound mesmerizing visual memes and gut-twisting, jaw-dropping sensations. And I haven’t even taken anything. No need for virtual reality; the multiverse is right here in my body.

My role, as the study investigator and therapist, is to support the clinician through whatever kind of experience the medicine, placebo or psilocybin, gives them. I had designed this study wanting, in my doctorly way, to fix a problem: to relieve suffering, ease burnout, and facilitate a kind of healing from the pandemic. But what I have found is that my real job is to answer a calling to be present, completely present. To bring myself back to this moment, this breath. This sense of support from the chair. This sensation of my feet on the floor. And then, to enlarge my subjectivity to take in my colleague. In those moments, what I receive is much more valuable than a sense that I have treated a condition or fixed someone. The moments are rich: tears over what wasn’t possible, a belly laugh over a baby photo, wonder and awe over finding themselves in this human body. The participants’ gestures are so unguarded that I find myself gasping at the vulnerability—and trust—in what they are allowing their bodies to show.

Neuroscience tell us that in those moments, my brain is using its experience and knowledge and felt sensation to simulate my colleague’s brain, and my brain is making predictions constantly, even if my conscious mind hasn’t asked. I’m generating predictions every moment. For me, the temptation is to jump into action. As a physician, after all, I’ve been trained to intervene, interpret the gesture, make a diagnosis, invoke a psychological model, say the perfect thing, offer the exact right kind of touch.

But what I’ve learned is that I should wait. I can notice my impulses, my triumphant interpretations, my savior complexes—Ah yes, my old friends. They mostly show up as insistent thoughts, ideas, concepts. Instead of arguing with all this thinking, however, I try to drop into the body. I go to the sensations of my feet on the ground, my seat in the chair, my breath moving in and out of my belly.     

I’ve been a Zen practitioner for more than thirty years at this point. What first drew me to Buddhism was my own sense of inadequacy as a young oncologist to face the suffering my patients brought to our visits. Facing a fellow human who is turning toward you with eyes full of terror and hope and despair can be daunting, and I found myself scrambling to do more and more and more. Yet inevitably, I would find that after offering everything else—treatments, advice, resources—all that was left was just me. A moment of existential contact. It was shocking, and only then did I begin to understand the elaborate ways that many of my mentors reacted, attempting to smooth things over or distract the patient and themselves from disappointment and despair. But to me, those elaborations felt evasive. So I searched for another way—and found Zen.

The body and heart and mind, if given unfettered space, know how to put themselves back together. This is completely opposite to the rush-in-and-save model of medicine that was drilled into me during my years of medical training.

My Zen practice has helped me access a whole different dimension of what it means to provide care, especially when my knowledge as an oncologist has run dry. Over time, I have realized that while my medical expertise is important, my ability to be present matters more. And as I’m moving into psychedelic therapy, I’m learning that lesson again. I can continue to come back to myself, my own body, and then enlarge my subjectivity from there again and again. When I’m with a study participant, I’m trying to adjust from being quick to act to being slow to act. I am there to keep them safe, of course, but I’m also there to enable them to have their own process. I’m slow to act because I don’t want to interfere by inserting myself into their experience.

Then, when I do act, I can use the smallest possible intervention, which often proves to be the wisest route. I’m not there to direct that study participant’s trip. I don’t know nearly enough about the state of their heart and mind, much less how to put it back together. The big lesson for me, now having been present for a number of these psychedelic journeys, is that they know. Somewhere. That knowing comes from a place not easily accessible by our conscious busy minds. But the body and heart and mind, if given unfettered space, know how to put themselves back together. This is completely opposite to the rush-in-and-save model of medicine that was drilled into me during my years of medical training.

The way I learned this was during my own experiences with psychedelic medicine. On one of my own trips I went back in time, many years, to the bedside of a woman I will call Angie, in one of her last days, a young life cut short by cancer. The whole scene came flooding back: a house on a quiet street with a big tree, a big fluffy bed, her body at ease, my own unease. I was saying my goodbyes, trying to offer some kind of contact, feeling unsure whether I was getting through. And then she began to move toward me, very slowly, like a time-lapse movie. I paused for a moment, worried that I was upsetting her, or that this was a sign of pain. I said, “Are you OK?” She didn’t say yes or no. She couldn’t talk. Yet she kept moving until she was facing me squarely. Still unsure, I went on. I told her how much I admired her, how much love she had created in this world, how I’d miss her. And in my trip, I suddenly realized that she did hear me. She did know I was there. And that ever-so-slow movement was her offering to me: her own offering of presence.

Sitting now with the clinician in the medical center reminded me of my visit with Angie in a way. At one point, we were sitting on the floor across from each other. I settled into myself, then enlarged my subjectivity again. At that moment, that clinician—that person—was simply there with me. She didn’t need another blanket, or water, or my hand. She didn’t need anything from me. We simply sat together for a time, and I imagined my own heart being big enough to offer space for both of us. 

For that clinician, who did receive psilocybin, there was a kind of healing in the process of preparing for the day, having the psilocybin, and taking in that moment of stillness with me. I didn’t do the healing, but my presence came into contact with hers. What I’m realizing now, as the study unfolds, is that how we all recover from the pandemic—from the suffering, the burdens, the changed identities—starts with how we cultivate our own presence, as well as how we extend that presence to the people we are with.

The idea that a reciprocity of presence could contribute to a kind of healing is not an idea that I ever heard about in medical school. I used to think of presence as something that I was supposed to radiate, like a force field that a superhero would summon. But one of the things I am learning, as I sit with other doctors and nurses in the study, is that presence emerges from the way we are with each other. Presence involves a kind of exchange, and it comes through our bodies. It is there when we’ve run out of all the other stuff we do, when we feel empty-handed, inadequate, and even bereft. It can be so easy to overlook—it’s so quiet in a world that is so noisy and full of distractions. But presence, I am finding, is almost always a possibility. We’re tapping into something bigger than our individual selves that is the ground of everything between us.

The post A Reciprocity of Presence appeared first on Tricycle: The Buddhist Review.

I’ve long wanted to make a movie on something like the sneeze that goes around the world, or the dollar bill that goes from hand to hand. A cinematic display of the layers of interconnection large and small that make up our lives every single day, through joys and sorrows and complacent idylls and wild shatterings of expectations like lockdowns and COVID. A movie about how even in the most turbulent times, some things remain true. Maybe that sneeze started in Battery Park in New York City, and by the time we see someone’s nose start to wiggle in just-about-to-sneeze mode in Dubai, we have settled back into the most salient truth of all of our lives: We are all connected. 

Watching the film The Same Storm, which came out in September 2021, it struck me that writer and director Peter Hedges had just made my longed-for film about interconnection and intersectionality, and made it with great skill. The film consists of twenty-four actors filming vignettes on laptops and iPhones during the early days of the pandemic. No film crews and no trailers involved. “The Same Storm revolves around our ache to connect and the extraordinary lengths we go in order to,” the filmmakers say. “We crafted a multi-protagonist story that explores how—in spite of the pandemic and the havoc it has caused in a nation convulsing on multiple fronts—we remain connected through various technologies and platforms that have quickly become a critical part of our daily lives.” 

Interconnection tips over into intersectionality—we are each more than one thing, not so easily reduced or even categorized. Maybe that nurse on the screen, in addition to having a patient, has a mother, and a racial identity, and a lot of longing in his heart to not feel so alone. Everyone is kind of complicated that way. Some facets of our being are sources of power, some of disconnection, some of clarity, some of confusion. These unchanging truths greet us as we swirl through the extreme change of our recent traumatic experiences of the pandemic. 

How close to the time of a traumatic event one can write or produce or create a work that is more art than trauma is a subject of much debate. I’ve gotten various pieces of advice from different people about that topic, along with watching varied cultures around the world work on healing in real time while sometimes also producing some of the greatest literature the world has known, and sometimes producing, in terms of public art … pretty much nothing. Any healing on any level itself is an awful lot. We go down the chakras, as a friend of mine cleverly said. Sometimes our main job is just to survive. And brava that we do.

A lot of people don’t want to look back at all right now, and you can read that in the dismissive language chosen in some of the reviews of works done soon after a traumatic time. But I’m so glad that Peter, who is a friend, and his producers, who are also friends, did, and that those amazing actors got a chance to perform, despite the reported awkwardness of the technology or having to do their own makeup. Acting on that level really is a matter of the soul, and there we were at that point in time, so often cut off, more and more isolated from one another, and for those for whom making art means collaboration, mostly out of luck. 

The actors in The Same Storm include Mary Louise Parker, Sandra Oh, Ron Livingstone, Jin Ha, Daphne Rubin-Vega, Raul Castillo, Joel Delafuente, Noma Dumezweni, and Elaine May (in her first film performance in twenty-one years!) The performances are luminous. This isn’t a mere recounting (which in the end wouldn’t be all that enticing.) This level of storytelling reveals that there could be a way forward. There must be, please, and look! There is.

It has something to do with empathy, and compassion.

I once heard the Dalai Lama on creativity, as part of a panel at Emory University, responding to a question about suffering, transformation, and art. 

He was quite interesting. He said that in Tibet, beautiful art was considered so because of the inner transformation artists went through during the act of creation. Had they become more enlightened, kinder, more deeply aware? To him, that’s what made a poem or a sculpture or painting more valuable, worthy of being held in higher esteem. Alas, we tend to have different criteria. 

Watching The Same Storm I’m tempted to ask Peter Hedges what he thinks of the Dalai Lama’s answer. Gratefully seeing the extant hope shimmering across the screen, remembering the despair, I have a feeling I know the answer.

♦

This article was first published on November 18, 2022. 

The post ‘The Same Storm’: A Lockdown Look Back appeared first on Tricycle: The Buddhist Review.

Larry Brilliant, doctor, philanthropist, entrepreneur, and ex-hippie, was a crucial player in the global effort to eradicate smallpox in 1973, but his path there was unusual. He was ensconced in an ashram in the foothills of the Himalayas when his guru, Neem Karoli Baba, told him to go to Delhi immediately to help eradicate smallpox in India, one of the world’s last strongholds of the virus. The end of smallpox, Neem Karoli Baba said, would be “God’s gift to humanity.” 

Brilliant went to Delhi and worked for the World Health Organization. He later became professor of epidemiology at the University of Michigan, cofounded The Well, one of the world’s first online communities, with Stewart Brand, was vice president of Google, and executive director of Google.org, the charitable foundation of Google founders Larry Page and Sergey Brin. He has advised several American presidents—but not Donald Trump. TIME named him one of the 100 most influential people in the world. At present, he is managing director of Pandefense, a company advising enterprises in fighting pandemics. For decades Brilliant has warned of pandemics and accurately predicted the coronavirus crisis. 

I meet Brilliant in Mill Valley’s town square, then we take refuge from the piercing California midday sun in a shady restaurant. We order sandwiches, water, and coffee. “Let’s start,” says Brilliant, putting his small blue cap on the table. “What do you want to know?” 

Mr. Brilliant, as early as 2006 in a TED Talk in Monterey, California, you warned about a respiratory virus originating in Asia that would jump from animal to humans. At the time, you described in great detail that a virus would spread super quickly, bring air and freight traffic to a halt, push some countries’ health care systems to the brink of collapse, and cause many deaths. But one did not have to be prophetically gifted to make such a prediction—for the threat of a pandemic had been apparent to many epidemiologists for a long time. We fly around the world, we colonize the last wildernesses on the planet, we burn down forests, we eat wild animals—given the conditions of globalization and this enforced proximity and encounter between humans and animals, it is hardly surprising to see a whole variety of viruses jump to humans and to see the spread of novel diseases. 

In your TED talk, you used a computer simulation to illustrate the spread of a virus. Your conclusion: Outbreaks are inevitable, pandemics are optional. In order to prevent an outbreak from turning into a pandemic, it takes— —“early detection, early response.” This is the key formula for fighting a pandemic, and it still holds true today.

Soon after your talk, you became a consultant to Steven Soderbergh, director of the Hollywood movie Contagion. This film, a streaming blockbuster of the last two years, today feels like a hyperrealistic report of the COVID pandemic. In the movie, the virus that jumps from bats and pigs to humans is much deadlier, but other than that, you once again got a lot of things right. Yes, based on what we know from history, I assumed that such a pandemic would come to us from China or Southeast Asia; I assumed that the virus would be transmitted via touch or air and would spread enormously fast. And in the movie, like in the COVID-19 pandemic reality, we have amazing, altruistic doctors and nurses, but we also have panic buying, the scramble for scarce vaccines, and lots of ignorance, disinformation, and bizarre conspiracy theories.

The bullshitters and self-appointed seers and healers in Contagion do not peddle hydroxychloroquine but instead propagate a quack remedy from forsythia flowers. You found the mistake! We missed the part about the hydroxychloroquine. One hundred points! [Laughs.] But once again: much more revealing than misplaced pride in correct or actually not-quite-so-correct prophesies of doom is the question of what I myself and other scientists who predicted similar things did not see and understand, despite everything we know. 

Where did you go wrong? My fundamental mistake was that I, like Magister Ludi Joseph Knecht, the hero in Hermann Hesse’s novel The Glass Bead Game, assumed a completely rational world, as though we lived in Hesse’s fictional province of Castalia, a place of enlightened and judicious decision-making. Instead, we have been seeing divisions and hatred, silo thinking, the politicization of mask-wearing and vaccination, the return of nationalism and populism on the world political stage. All of these are centrifugal forces pulling us apart at a moment in history when nothing would be more important than consensus, cooperation, and collective strategizing.

But you are also saying: There is no reason to give up. Why? I can only give you my personal reasons. In 1967, WHO developed a comprehensive global program to eradicate smallpox, an extremely cruel disease that killed more than half a billion people in the last century alone. In some cases, you cannot touch a single spot on a victim’s body without causing bloody sores. Other forms of smallpox are inevitably deadly. Some attack pregnant women in particular. In 1967, there were still 34 countries affected by smallpox. In 1972, the year I joined the program, the number of countries with smallpox was down to five. In the fall of 1975, I was part of a team that was sent to Bangladesh because it looked like they might have found what turned out to be the last case of Variola major, the killer variant of smallpox.

You discovered the last patient infected with “killer smallpox”. Yes. In October 1975, we found three-year-old Rahima Banu in the village of Kuralia. It was obvious from her scarred face that she was ill with smallpox. She had become infected with Variola major. We searched ten miles around that case, we double-visited every household and vaccinated everybody who had been in contact with her. And we offered a reward of 1,000 dollars for the detection of further cases.

Which was a small fortune at the time. It was. So it was not surprising that we quickly received thousands of reports. We followed up on them meticulously, but all cases turned out to be chickenpox. That is why we were finally convinced that this little girl was the last living human being infected with the deadly variant of smallpox. 

Can you describe what the encounter looked like? There we were, standing in this small, impoverished village, looking at each other. First, Rahima Banu hid behind her mother; she was crying and terrified by this white-skinned man. At some point, I gave her a balloon that said, “Smallpox can be stopped.” I had had them made in San Francisco and carried them around with me for years. And I took a picture. 

What was your personal reaction? I cried. For I realized that after thousands of years, millions of dead, and a madly exhausting fight against a terrible disease, the chain of infection and suffering would be interrupted right here and now. Sometimes I would think to myself that I had seen the last deadly smallpox viruses dying in the sun when this little girl started coughing, picking the scabs off her skin and throwing them to the floor. In any case, this image of Rahima Banu, who survived the disease, continues to be a key inspiration for my life to this day. And now I ask you: Having experienced something like this, how can I not be optimistic?

For you, the eradication of smallpox is a success story that proves global cooperation in fighting a pandemic is possible and can work. Exactly. I was then working in India, where smallpox outbreaks exploded once again in 1974, a country with 21 different languages, with a population of then 600 million people, 20 million of which were constantly on the road, thus able to potentially spread the virus. Again, if it is possible to eradicate smallpox under conditions such as these, why not believe that other miracles can happen, too?

How big was the group of people fighting smallpox? There were some 150,000 people in India alone: doctors, nurses, vaccination experts, people with local knowledge and language skills who went from place to place, from village to village, knocking on every door to find people infected with smallpox. They came from fifty different countries. It was people from all races and ethnicities, from every conceivable political and religious background, and it included Buddhists, Muslims, Christians, Shintoists. Even Russians and Americans worked together in the middle of the Cold War, driven by a common vision and mission: liberating mankind from this terrible disease. 

“Having experienced something like this, how can I not be optimistic?”

It is a banal observation, but the situation in 20th-century India cannot really be compared with the situation today. We are now living in a hyperglobalized world. And the smallpox virus is more lethal but more easily spotted—by pustules and scars—than the corona viruses. And yet: What can be learned from the past? Good will is not enough. It takes perseverance, strategic skills, a feeling for a country’s culture, political support, and the courage to make quick, unconventional decisions that will not please everybody. And it takes medical technology innovation. 

You worked for many years as a doctor for WHO, coordinating vaccination campaigns in rural India. In your book Sometimes Brilliant, which was published in 2017, you describe in detail how, in the face of enormous resistance, you put the large city of Jamshedpur under quarantine when it was the site of new smallpox outbreaks. You were driven and obsessed by the goal of finally eradicating this disease. I was. The mere fact that the shutdown of Jamshedpur prevented a high-ranking politician from leaving the city and that we kept him quarantined in the city against his will almost led to my deportation from India. It was really close. But I can only say: Do not put me on a pedestal! The fight against smallpox only succeeded because of the tireless effort of almost 150,000 people, especially the local Indian staff. And it succeeded with the aid of epidemiological giants such as Muni Inder dev Sharma, Nicole Grasset, Bill Foege, and Donald Henderson, who trained me.

And yet one thing strikes me as unusual, after all. I am referring to your unwavering focus and commitment, for which you yourself credit a man who in India is revered as a saint. His name is Neem Karoli Baba, and he has a temple in Kainchi, at the foot of the Himalayas. How did you end up there? It is the classic dropout story. After medical school and an internship in San Francisco, I lived in a commune. And in the early seventies my wife and I, together with 40 others, set out in buses for India, following the Silk Road, known today as the “hippie trail.” We drove through Turkey and Iran to Afghanistan, across the Khyber Pass to Pakistan and Nepal, and finally into the Himalayas. My wife, Girija, led us to follow Baba Ram Dass to the Kainchi ashram, in northern India. There, we meditated, sang, and practiced yoga together with Neem Karoli Baba’s Indian disciples and a handful of Westerners. One day in July 1973, Neem Karoli Baba told me to go to Delhi immediately to work for the United Nations and help eradicate smallpox. The imminent eradication of this disease, he said, is God’s gift to humanity because of the hard work of dedicated health workers.

What was your response? At first, I did not respond at all, hoping he would drop this crazy idea. But Neem Karoli Baba did not let up. So I went to Delhi, but of course the people at WHO, a suborganization of the United Nations, did not want to hire a hippie with a big bushy beard wearing a white robe who was all fired up by the prophecies of his guru. I returned to the ashram. I had barely arrived when Neem Karoli Baba ordered me again to make the daylong trip to Delhi and to offer my help.

How often did you have to go back? At least twelve or thirteen times over the course of several months. Sometimes he was confronting me in front of everybody; he’d throw apples or oranges at my testicles when we were sitting at his feet and ask: “What’s the matter? Why are you still here? Get yourself to Delhi, to WHO!” Eventually I tied my hair into a ponytail, borrowed an ill-fitting suit, and bought a tie ugly as sin—my concession to the dress code of the establishment. The WHO people too became friendlier and softened up more. We got to know each other. And finally, it happened. I was hired, first as a simple office employee, then as a doctor to help eradicate smallpox.

“WHO, a suborganization of the United Nations, did not want to hire a hippie with a big bushy beard wearing a white robe who was all fired up by the prophecies of his guru.”

But how does an Indian guru, sitting in a temple, wrapped in a wool blanket, detached from the world’s news channels and definitely not a reader of epidemiological articles, even know what the smallpox virus is? And how does he know that there is somebody in front of him who will do everything he can to eradicate this disease from the earth? I just don’t get it. Welcome to the club! I don’t get it either. And believe me, I have been thinking a lot about the mystery of this kind of transformation. When I first came to Neem Karoli Baba, I was far from believing that there was something bigger than my own little life. He changed me through his simple presence. It was a transmission without words, beyond words. He gave me the courage to continue with my work when I was gripped by despair and yet another smallpox outbreak somewhere threatened to thwart all our efforts. But how did he do that? And why did he foresee the possibility of eradicating this horrible disease? If there is someone who understands what has happened here, they have unpacked one of the great mysteries of life. And I deeply hope that they will call me and tell me.

What does your guru mean to you today? My house here in Mill Valley, California, is filled with pictures of him. And I still see myself as working for him, following his instructions. Seriously. I worked for WHO in smallpox, polio, and blindness programs, in refugee camps in Southeast Asia. And over the years, when I ran out of money, I sneaked back into corporate America to set up a company until I had earned enough to continue with the really important tasks. 

As soon as smallpox was eradicated, you set your eyes on the next big task. Together with your wife, Girija Brilliant, and people from WHO, as well as your friends in the hippie movement and the Grateful Dead, you founded the Seva Foundation, which aims to fight needless blindness. How did that come about? After we eradicated smallpox we all went back to our universities or other jobs. But we had tasted success. We felt that so many had been saved from suffering and death, and we were touched by it so deeply that we wanted to repeat it. We did not only want the epidemiological experts on board but also people who had a good heart and all kinds of good ideas, though perhaps not such good credentials. Moreover, based on my own experiences, I wanted to find out what arises from a combination of spirituality and public health. My former boss at WHO, Nicole Grasset, said: “You are planning the Red Cross of hippies.” 

It seems she was right. Absolutely. One day, she sent me a telegram: she had raised money to fight blindness in Nepal and wanted to know whether we’d be interested in collaborating. I said yes, of course—and I invited my coworkers and fellow supporters to a meeting. There were some friends from Neem Karoli Baba’s ashram, some former smallpox warriors, as we called them, plus epidemiologists and ophthalmologists from the United States and from India, including the medical doctor and surgeon Dr. Govindappa Venkataswamy, who later became famous as the founder of Aravind Eye Hospital in South India.

There is a photo of this meeting, which took place in 1979. Standing next to medical doctors and epidemiologists is your friend Wavy Gravy, the poet, clown, and political activist who gained overnight fame at the Woodstock festival. He went on stage and promised breakfast in bed to 400,000 people and he, together with members of his commune, actually distributed food to several thousand people who hung out near the stage. And everything remained peaceful! This combination of heart, spirituality, and mind worked, and I think it is the secret of Seva’s success. For example, to raise money for Seva, Wavy Gravy managed to mobilize the rock ’n’ roll scene, and he organized the first of many benefit concerts with the Grateful Dead in San Francisco. This way, we have been able to raise more than half a billion dollars over the last decades—money that went directly to give the gift of sight to five million blind people.      

Today, more than five million people in two dozen countries have regained their eyesight, thanks to the Seva Foundation. What can we learn from this? Can the principles you have followed in your work be applied more broadly? I think so. For example, we found out that one of the main causes of blindness is cataract—a disease of age and poverty. In order to improve eyesight, you need to have a lens that is put into your eye. When we got started in 1979, such lenses cost some 500 dollars, and they were all manufactured in the developed world. Everybody was convinced that the developing countries were not smart enough and that they lacked the technology and hygienic conditions necessary to manufacture their own lenses. 

Sounds quite arrogant. And it is dangerous nonsense. So what did we do to prove them wrong? We bought the machines you need to manufacture these so-called intraocular lenses. We disassembled them and smuggled the individual parts to India in our backpacks. There we reassembled them in a clinic and helped create Aravind Aurolab, which is today one of the biggest manufacturers of such lenses worldwide. Now they cost less than a dollar, and any farmer in Nepal or India can afford them. We thus furnished proof that entire production sites can be exported to developing countries to reduce costs. 

As we come to the end of our conversation, during which we have traced the path from eradicating smallpox to fighting blindness to tackling the coronavirus pandemic, one thing is becoming clear to me—namely the key role that narratives of success play in presenting other, new ways of thinking and living. You once famously said that the world is ruled by God and anecdotes. I am not so sure about God, but I am sure about anecdotes and narratives. That’s an anecdote right there. [Laughs.] Of course, I know that it is not really fashionable to come out as a believer. But I have seen too many inexplicable and impossible things to not believe that there is a higher power. But the thing is, there has never been a human disease eradicated other than smallpox. If we hadn’t been successful, we probably would not have the courage and the perseverance to tackle other diseases such as polio, malaria, and measles with the same resolve—until they too perhaps one day disappear from the face of the earth. 

The post The Doctor and His Guru appeared first on Tricycle: The Buddhist Review.

Once a week, for more than five years, seven Buddhist devotees met with Phra Atid, a resident monk at Wat Thao Thaen Noi, outside of Chiang Mai, Thailand, where they would study English and practice meditation together. This simple community connection was taken for granted until March 2020, when everything changed. “There were no Buddha Day ceremonies, monks had to wear masks on alms rounds, people could not come to the temple, and monks could not go to their homes. Everything was quiet. Monks were afraid of COVID-19, and people were also afraid of catching COVID from monks. This has never happened before,” recalls Phra Atid. 

In temples across Thailand, daily life for monks is typically filled with community interaction. From the morning alms round to the evening chanting at the temple, laypeople interact with monks as both supporters and spiritual companions. Laity stop by temples in the afternoon to make offerings of “monk baskets” (known as sangkhathan), where they offer necessities like toilet paper, soap, and toothpaste. They invite monks to their homes and businesses to provide blessings. When someone dies or is ordained, or during Buddhist holidays, groups of family members arrive to help cook, clean, and decorate temples. Most temples even have a regular group of volunteers, usually older men and women, whom they count on to provide the materials and organization necessary for daily affairs and special events.

The pandemic disrupted this important codependent relationship. In March 2020, temples had to limit their availability to outside community members, the majority of whom weren’t allowed to return until July 2022. During that time, there were occasional periods when Thai Buddhists were allowed to enter temples, but these often led to temple closures and further monastic isolation from the outside world. 

To the uninitiated, Buddhist monks might appear to be isolated figures who would not necessarily be disturbed by a global pandemic. But the Buddha purposefully designed monastic life to depend on laity so that monks would not retreat into themselves. The Buddha taught his lay followers to take care of monastic material needs, and monks to take care of laity’s spiritual needs. The Itivuttaka: The Group of Fours, a collection of short sayings from the Pali Canon, makes it plain:

Monks, brahmans, and householders are very helpful to you, as they provide you with the requisites of robes, alms food, lodgings, and medical requisites for the sick. And you, monks, are very helpful to brahmans and householders, as you teach them the Dhamma [dharma] admirable in the beginning, admirable in the middle, admirable in the end; as you expound the holy life both in letter & meaning, entirely complete, surpassingly pure. In this way the holy life is lived in mutual dependence, for the purpose of crossing over the flood, for making a right end to stress.

The pandemic directly challenged this built-in, mutual support. During the height of the pandemic, the laity, particularly the elderly, were afraid to be close to the monks during their alms rounds, and with shops and markets closed or operating in limited capacities, the collection of alms became impossible for lengthy periods. 

Likewise, at the beginning of the pandemic, monks were too afraid to let laypeople inside the temple. After hearing of job losses and other economic troubles, however, they realized that the monastics needed to take care of the community, not turn away from it. Wat Sansai Don Kok, a temple on the outskirts of Chiang Mai, organized a fundraiser to donate to those in need. In May 2020, the temple’s monks set up an offering table, where around 200 people donated daily. With all the food and money collected, both monks and laypeople handed out meals to feed the community. This reversal of roles, with monks offering material goods to laity, is unusual but not unheard of in extreme circumstances and is an example of the symbiotic relationships monastics form with the community.

There was also an unexpected trend in the support that village temples received over city temples, with village monks often receiving more support than city monks. For example, two monks who studied at Chiang Mai–based monastic college Mahachulalongkornrajavidyalaya University but who live in the village temples of Wat Sansai Don Kok and Wat Thao Thaen Noi—both situated outside the city—felt supported by their temple’s lay community, even during isolation. One monk stated: “We are lucky to stay outside the city because at least we get enough food. In the city temples, like Wat Phra Singh and Wat Chedi Luang, friends told me it’s hard to get enough food for everyone, because the number of monks is more crowded there.”

Phra Jarun lives at Wat Sansai Don Kok, where a handful of dedicated community members regularly support the monks. One middle-aged layman, Phra Jarun recalled, was particularly dedicated before the pandemic. He arrived early for every temple activity, and whenever the temple was fundraising for construction or renovation projects, he could be counted on to donate. These close relationships, built over many years, translated into continued support and concern during COVID.

Wat Thao Thaen Noi has about forty regular supporters. After the pandemic began, several of these regular attendees called to inquire about the monks’ health and needs. The monastic residents received food that was dropped off at the front gates of the temple, instead of in their alms bowls. Although the four monks in the temple were well-fed, Phra Atid missed the intimacy of the community. At the same time, he felt grateful for the care and support offered to him and the other monks at the temple, reasoning that, “Because I used to walk on alms round to collect food before COVID, people knew me and that I would need food during lockdown. That is why they thought to ask what we needed. If monks didn’t used to go on alms round, then people might think they are OK in the temple. If you don’t go on alms round, then it’s difficult to make connections.”

City temple communities, by contrast, are more diffuse, making city monks more dependent on the donations of a variety of people. Some of these city monks are fortunate enough to have a main sponsor for their needs. However, these monks found it hard to request daily meals, when usually the support would be spread out amongst the community. Monks living in city temples also rely on invitations to conduct funerals or blessings for new homes, cars, or businesses, at least once a week, and they receive monetary donations for these services. These invitations stopped entirely because of COVID-19 protocols. Moreover, with the economy suffering, many city workers returned to their home villages. 

This distance between monks and laity during the last two years also influenced monastic education and recruitment. High school teachers at monastic schools usually take a few weeks before the school year begins to visit several rural villages, locating families who would like their sons to study as novice monks. Novices are boys under 20 who ordain with ten precepts, instead of the 227 rules of the fully ordained male monk (bhikkhu). At Wat Nong Bua, a temple school outside of Chiang Mai, only 108 novices enrolled in 2022, compared with 180 novices of 2019. 

Parents in these rural villages became accustomed to being home with their children, and now consider sending their children to the nearby public high school instead of monasteries, which may be hours away. It is difficult to know if links such as these will be repaired quickly or if the severed connections between temple schools and villages will have more long-lasting effects.

The pandemic also disrupted temporary ordination, another common monastic recruitment effort. Temples typically host summer novice ordination programs for middle- to high-school–aged boys, followed by a kind of summer camp, for three weeks of the school holiday in March and April each year. These camps occur at temples with facilities large enough to invite boys from the countryside to participate. Before the pandemic, up to a hundred novices might ordain at one of these camps. Not all the boys stay on with the monastery, but a significant number, usually from more disadvantaged families, remain and create a pipeline of monastics for temple life. At Wat Chetuphon in Chiang Mai, about a dozen used to stay in robes, but for the last two years, there has been no camp, resulting in low monastic recruitment.

Unfortunately, monastic enrollment decreased, while the number of monks disrobing increased. According to a teacher at Wat Nong Bua, for recently ordained boys, the experience of monasticism and education was boring because they were forced to study online and spend all their time inside the temple. Many of these boys decided to disrobe, preferring to attend weekend school and to work during the week. 

Without monks and laity being able to interact regularly, monks were unable to share teachings, give blessings, or receive offerings. At the same time, laity had limited access to merit, the temple environment, or developing relationships with monks. As well, fewer boys participated in monastic life and education, making the future generation of monastics uncertain. Laity have gotten out of the habit of going to the temple, and the new generation has not yet followed the custom of regularly making offerings to monks and attending temple festivities.  

This lack of participation in the monastic life and interaction with the laity during the pandemic will have a ripple effect for the future of monasteries across Thailand.  

After finally being able to collect alms again and offer blessings after one year of feeling trapped in his temple, Phra Achinta of Wat Suan Dok felt “like the freedom of leaving jail.” He missed teaching meditation to the laity and all the discussions he would have with fellow monks from other city temples. Clearly, there are monks who missed the regularity of the monastic life, which they could count on as a way to spread and practice the dharma. However, for those young men who are not yet accustomed to the joys of temple life, the pandemic made staying in robes a more difficult proposition. It remains to be seen whether these two years will have a lasting effect on the monastic population in Thailand, or if the dharma will continue to attract those willing to put forth the effort.

The post COVID Inside the Monastery appeared first on Tricycle: The Buddhist Review.