First of all, I’m very sorry that you’re experiencing this. I am not a specialist in this area, so I offer these ideas modestly. What I have experienced myself and seen helpful for others is:
You’re right, the hardest thing about managing pain is our mental attitude towards it. If we resist anything, including our chronic pain, it puts us in the “red zone”, where our brains are in fight-or-flight mode and constantly agitated. I offer some ways out of this dilemma my essays Accept It and Minimize Painful Experiences.
Much research shows that we can definitely change the brain for the better. As the “hardware” of the brain improves in key regions such as the prefrontal cortex (PFC) behind your forehead, that part of the brain becomes more effective. For example, if a person is being challenged by stressors, improved regulation of the amygdala – sort of the alarm bell of the brain – by the PFC can help a person feel calmer under pressure. Just because there is a stressor does not mean we need to feel stressed, and improved brain function is like a shock absorber between us and the world.
Basically, I think the evidence is that both are true: there is an ongoing trickle of background anxiety to keep us vigilant, and there is also a strong inclination to default to the “responsive mode” of being peaceful, happy, and loving when we are not disturbed. Putting these two apparent facts together, I think the trickle of anxiety prompts us to scan for threat, but if we find that all is well for now, then we default to the responsive mode, and then this cycle repeats itself a moment later. For me the pragmatic point is to discern real threats and address them, while also recognizing the strong bias from evolution to look for threats behind every bush and thus appreciating the importance of exerting compensatory influences in a variety of ways, from inner practices such as I focus on to social support and (hopefully) decent health insurance.
Fundamentally, in my view, there are just three kinds of ways to engage the mind, to practice with it productively:
In effect, if the mind is like a garden we can observe it, pull weeds, and plant flowers. In a nutshell: let be, let go, and let in.
The three ways to engage the mind work together. For example, we need to make efforts to grow capacities to be with the mind, such as self-acceptance, observing-ego functions, or distress tolerance. And we be with the results of our efforts to reduce the negative and grow the positive.
Of the three, the first one (which approximates the conventional definition of “mindfulness”) is primary. You can always be with the mind, but you can’t always reduce the negative or grow the positive.
I’ll try to respond to both of your questions together, since they are the two sides of one coin.
Your question is very important, how do we know when it is best to stay in “being with” (or “let be”) mode – simply witnessing our experience in open, spacious, accepting, curious awareness – and when is it best to shift into “working with” mode, either through releasing the negative (let go) or replacing it with something positive (let in).
I don’t think there is an ultimate right answer, it is more a matter of what is right for this person with these capacities with this pain at this time. For me, some guidelines:
Of course, this stage of practice is the result of a lot of working with the mind. And it would be unskillful to try to bypass it.
First, I try to develop my capacity to sit in both compassion and equanimity, opening the heart to pain while also being undisturbed in my core about it. A long-term project in my case, to be sure!
Second, I try to see the whole mosaic of reality, which includes both beings that will be harmed and beings that will be loved. Recognizing the good (using that word loosely) does not mean not recognizing and feeling moved by the bad; and seeing the good can help us bear and sometimes improve the bad.
It’s important to build up inner resources for meditating. Buddha’s Brain focuses on inner resources, especially the fourth chapter on taking in the good.
A quick suggestion would be to find something that is reliably comfortable and peaceful in your experience – such as the breath, or an object of beauty, or a saying – and use that as your meditation anchor. Maybe while standing or walking, to reduce the dissociation. And keep disengaging from painful thoughts; don’t fight them, ignore them. And from time to time look at them categorically; in other words, see their nature, the nature of all experience, all phenomenology: transient, made of parts, arising and passing away due to causes, insubstantial, an unreliable basis for lasting happiness; seeing them in this way, they have less weight.
Overcoming trauma can be difficult and here are some options that may help (some of which you might already be pursuing):
Thank you for this question. You have zeroed in on a big matter that I tried to describe in one small sentence!
What I was trying to say is that the contents of mind – anger, worry, pleasure, thoughts, perceptions, sensations, desires, etc. – are a part of the mind that may be troubled (even horribly so), but mind as a whole – including the awareness aspects of mind – is usually operating just fine.
So shifting awareness from the contents of mind to mind itself (as a whole) – put differently, shifting awareness to experience as a whole, including its awareness elements – can disengage us from upsetting thoughts and feelings and ground us in a reassuring sense of mind as a whole.
Try this experientially and see what you find. The sense of mind as a whole can be hard to sustain, but keep at it and it will get more stable. Also note that as soon as we (naturally) create a concept of mind-as-a-whole, that conceptualizing is a part of mind-as-a-whole and draws us out of it as a whole. Conceptualizing is OK, but keep letting go of it to open into again and again mind-as-a-whole.
Dr. Ramani Durvasula is a licensed clinical psychologist, author, and expert on the impact of toxic narcissism. She is a Professor of Psychology at California State University, Los Angeles, and also a Visiting Professor at the University of Johannesburg.
The focus of Dr. Ramani’s clinical, academic, and consultative work is the etiology and impact of narcissism and high-conflict, entitled, antagonistic personality styles on human relationships, mental health, and societal expectations. She has spoken on these issues to clinicians, educators, and researchers around the world.
She is the author of Should I Stay or Should I Go: Surviving a Relationship With a Narcissist, and Don't You Know Who I Am? How to Stay Sane in an Era of Narcissism, Entitlement, and Incivility. Her work has been featured at SxSW, TEDx, and on a wide range of media platforms including Red Table Talk, the Today Show, Oxygen, Investigation Discovery, and Bravo, and she is a featured expert on the digital media mental health platform MedCircle. Dr. Durvasula’s research on personality disorders has been funded by the National Institutes of Health and she is a Consulting Editor of the scientific journal Behavioral Medicine.
Dr. Stephen Porges is a Distinguished University Scientist at Indiana University, Professor of Psychiatry at the University of North Carolina, and Professor Emeritus at both the University of Illinois at Chicago and the University of Maryland. He is a former president of the Society for Psychophysiological Research and has been president of the Federation of Behavioral, Psychological, and Cognitive Sciences, which represents approximately twenty-thousand biobehavioral scientists. He’s led a number of other organizations and received a wide variety of professional awards.
In 1994 he proposed the Polyvagal Theory, a theory that links the evolution of the mammalian autonomic nervous system to social behavior and emphasizes the importance of physiological states in the expression of behavioral problems and psychiatric disorders. The theory is leading to innovative treatments based on insights into the mechanisms mediating symptoms observed in several behavioral, psychiatric, and physical disorders, and has had a major impact on the field of psychology.
Dr. Porges has published more than 300 peer-reviewed papers across a wide array of disciplines. He’s also the author of several books including The Polyvagal Theory: Neurophysiological foundations of Emotions, Attachment, Communication, and Self-regulation.
Dr. Bruce Perry is the Principal of the Neurosequential Network, Senior Fellow of The ChildTrauma Academy, and a Professor (Adjunct) in the Departments of Psychiatry and Behavioral Sciences at the Feinberg School of Medicine at Northwestern University in Chicago and the School of Allied Health at La Trobe University in Melbourne, Australia. From 1993 to 2001 he was the Thomas S. Trammell Research Professor of Psychiatry at Baylor College of Medicine and chief of psychiatry at Texas Children's Hospital.
He’s one of the world’s leading experts on the impact of trauma in childhood, and his work on the impact of abuse, neglect, and trauma on the developing brain has impacted clinical practice, programs, and policy across the world. His work has been instrumental in describing how traumatic events in childhood change the biology of the brain.
Dr. Perry's most recent book, What Happened to You? Conversations on Trauma, Resilience, and Healing, co-authored with Oprah Winfrey, was released earlier this year. Dr. Perry is also the author, with Maia Szalavitz, of The Boy Who Was Raised As A Dog, a bestselling book based on his work with maltreated children, and Born For Love: Why Empathy is Essential and Endangered. Additionally, he’s authored more than 300 journal articles and book chapters and has been the recipient of a variety of professional awards.
Dr. Allison Briscoe-Smith is a child clinical psychologist who specializes in trauma and issues of race. She earned her undergraduate degree from Harvard and then received her Ph.D. in clinical psychology from the University of California, Berkeley. She performed postdoctoral work at the University of California San Francisco/San Francisco General Hospital. She has combined her love of teaching and advocacy by serving as a professor and by directing mental health programs for children experiencing trauma, homelessness, or foster care.
Dr. Briscoe-Smith is also a senior fellow of Berkeley’s Greater Good Science Center and is both a professor and the Director of Diversity, Equity, and Inclusion at the Wright Institute. She provides consultation and training to nonprofits and schools on how to support trauma-informed practices and cultural accountability.
Sharon Salzberg is a world-renowned teacher and New York Times bestselling author. She is widely considered one of the most influential individuals in bringing mindfulness practices to the West, and co-founded the Insight Meditation Society in Barre, Massachusetts alongside Jack Kornfield and Joseph Goldstein. Sharon has been a student of Dipa Ma, Anagarika Munindra, and Sayadaw U Pandita alongside other masters.
Sharon has authored 10 books, and is the host of the fantastic Metta Hour podcast. She was a contributing editor of Oprah’s O Magazine, had her work featured in Time and on NPR, and contributed to panels alongside the Dalai Lama.
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