On a recent retreat, there were some moments in meditation that stood out. Sitting with body pain that at a certain point was known by the mind as just ‘sensation’ and quite distinct from the knowing of ‘unpleasant’. A second before the 2 had been conjoined and the overall flavour was of unpleasant sensations. Though I couldn’t really feel it there was some flavour of aversion towards the experience that kept body and mind bound together. What changed that could be called ‘wisdom’ or wise attending. The pain was no longer pain but an awake, curious mind knowing physical sensation and the mental factor of vedana, or ‘feeling’.
Several years ago I read a book with the title I’ve taken for this blog piece. The author was a surgeon named Paul Brand who along with his wife, a nurse, worked in India as a medical missionary in the 1950’s. The book is an account of his relationship to pain and suffering and the insights that emerged from working with patients with leprosy. These (medical) insights paved the way for a different way of understanding and treating diseases such as diabetes. It is a fascinating and deeply humane book about an unpopular subject.
He starts by describing an interaction with Tanya, a 4 year old patient. The little girl looks healthy but her feet are ulcerated to the point of bone being visible. She shows no distress as the doctor gently probes the infected area. He explains to Tanya’s mother that her child has a rare genetic condition known as ‘cognitive indifference to pain’. If she burns or cuts herself she would feel some pressure or tingling but these sensations are not unpleasant to her. She does not feel pain and has no mental construct of pain. And because she is so young and quite enjoys the drama of how her parents react to her injuries and has no understanding of the implications she will damage herself deliberately.
By the age of 11, through a mixture of intentional and unintentional injuries, and lacking the warning signs of discomfort to protect an injury (i.e. by shifting weight onto another joint or limb), Tanya’s existence is pitiful. She is a double amputee. She’s lost most of her fingers to continuous ulcers and infections. Because movements don’t cause her pain she has frequently dislocated her elbows, permanently damaging them. It is a sad, sad life. And all because she cannot feel pain.
After reading this book I understood better the protective nature of pain. How, actually, rather than being something just to avoid, we cannot do very well without it. Usually (not all cases such as phantom pain or the pain from fibromyalgia) it’s a crucial warning system that there is something we need to look after or look out for. We learn early on in our lives to try to protect ourselves from pain and most of us experience a burn or breaking a limb or chronic back pain or toothache as very unpleasant. We don’t tend to experience pain as a ‘mental construct’ but as something immediate and visceral.
In Dharma practice, we talk a lot about working with what’s unpleasant, difficult and painful whether emotional/mental pain or physical discomfort. We talk about ‘being with things as they are’. We don’t talk about pain being a ‘gift’ in the way Paul Brand does but perhaps in a different way it can be seen as an opportunity.
Pain is a frequent visitor to my life mostly in the form of severe migraines on perhaps half the days of every month. They started when I was a child so the natural ways of relating to them as unwanted were well established long before I’d learned to meditate and had been going for 30 years before I was taught to watch my mind.
These days ‘pain’ is an integral part of awareness practice. The form of Right View I employ runs along the lines of “when there is physical pain how much is the mind joining in?” Sometimes there is clearly mental aversion, I don’t want this experience. It used to feel quite counter-intuitive to expect otherwise. But because I’ve practised with it a lot, and strengthened Right (dharma) View it has become more natural to notice the reactions to the pain rather than identify with it. I’ve learned to spot the aversion more quickly and it’s become more subtle so then other views and feelings are revealed.
There is ‘grim death’ mind, just hanging on but definitely not enjoying the moment. There is stoicism and self-pity ‘why me’ mind. There is disappointment waking with head pain on a day when I’m going to be out with friends doing fun things! Or slight dread of a working day accompanied by savage pounding head, sore neck and strong sensitivity to light. And sometimes there is just the sense that the mind is a bit clouded as if there’s something not quite right. The mind is affected by the pain in all these ways and many more.
And none of these things is a problem. They are just to be noticed in awareness, and awareness can be relied on for its consistent ability to make things feel at least a bit better. If you take away the mental buy-in to physical pain the landscape changes. That’s not to say pain killers, hot wheat bags and naps aren’t necessary but without resisting it ‘pain’ or ‘unpleasant’ becomes just another experience. It’s just how it is.
Of course, the potential in working with pain is not just to reduce it or to have awareness of it but to understand its nature. And following the meditation I described at the beginning of this piece, there was a moment of such understanding. It was clear to me that ‘pain’ and ‘unpleasant’ are (as Paul Brand and dharma students know intellectually) constructs fabricated in the mind. Sitting here now with another migraine the memory rather than the experience is clear but the increased interest in watching the mind remains.