At the onset of each meditation, I remind us to turn off our notifications, close text and email apps, shut down web browsers – anything powerful enough or seductive enough to pull our attention away. And from what?? What are we surrendering our attention over to, what are we, through our actions, declaring deserves our energy, our focus, our very lives? Basically, we are saying that something other than what is here, in front of us, in the present moment, demands attention. We have sold our very lives to something else, and we often don’t even know to what.

On these Thursday morning meditations which I have been doing since April 2022, the foundational practice is mindfulness – of practicing attending to the present moment without elaboration or judgment. Today we will engage with another practice to continue that training in seeing clearly and remaining present - the concept of emptiness.

The concept of emptiness refers to the fact that all things, everything in our lives, our bodily senses, our senses in the body, our thoughts and feelings, our idea of self, our concept of the world around us, they lack a permanent, independent essence. Everything in the world arises, exists, and then falls away, ceases, due to its interconnectedness and interdependence from a wide array of causes and conditions. And when the Buddha originally taught emptiness, Suññatā in Pali, or Śūnyatā in Sanskrit, he connected to the concept of No-Self, that the world is empty of self and anything belonging to the self. The practice he advised was to abandon our attachment and identification with a rigid and fixed concept of ourselves since by its very nature it is ever-changing. Instead, practice connecting with the flow of experience. The teachings on emptiness have grown and changed, throughout the years and with various traditions, Mahayana, Zen, etc., as is befitting this concept. However, within all these schools of thought the intent is to see clearly. When saying something is empty, we are not saying that it doesn’t exist; we are saying its existence is fluid, interdependent, and conditional.

So this meditation today on emptiness is a practice of seeing clearly, unblinded by attachment and delusion. We are trying to let go of our coarser mental activity to allow the mind to rest in something deeper, more unified. We practice emptying the mind of all extraneous, non-present focus.

Let me preface what about to say by noting that technology has allowed me to deeply engage with friends and loved ones miles away, to follow world events that are meaningful and inform what action to take in my life, to facilitate these meditations. That said: If we check our phone 205 times a day, constantly text people who are not in the room, check on events taking places miles away, follow “friends” who don’t even know our names or any intimate details about our live – no wonder we struggle with forming meaningful connections with people around us. No wonder we fail to notice what is happening in our own communities. No wonder we find it impossible to read a book, let alone an article that takes more than 1 minute to scan. No wonder we cannot sit through a meal without our devices. No wonder it’s hard for people to have conversations without reaching for their phone. We willingly, or not so willingly, train our brains to be distracted and then claim we have attention issues.

In this practice on emptiness, a very modified versions of it, we play with directing our attention with the intent of allowing extraneous distractions to fall away so that we can be present to what is really occurring in our lives in front of us.

As we practice, should a notification, alarm or ping go off, use it – watch what occurs for you, in you. How do you orient? How do you react? What happens in your body, to your breath, to your mind?

So let’s begin by orienting of the sound of the bell.

Before you closed your eyes, take a moment look around you. In the Buddha’s instruction to Ānanda, he invited him to focus on the nearby village, the city. For us, let’s take a moment to look around our room.

Notice how you’re doing that. Just look around the space allowing any extraneous thought of judgment, elaboration, evaluation and discussion to fall away. Simply be present to the externals around us. See clearly, mindfully observing without layering. Experience, see, the colors, shapes, light. While you can, if it helps, silently name what you see – light switch, sofa, camera, wall hanging, Buddha statue, see if you can, allow yourself to receive the colors, the shapes, the textures, and drop any layering, any adding, any addition. Our becomes soft, inviting, allowing, rather than reaching out and searching. We know we are doing this when the body settles. The body can settle.

Now for the remainder of this practice, I invite you to just bring your head back a little bit, lengthen the neck, drop the chin, and close the eyes. In your mind’s eye, conjure up the images of your village, your home. With the eyes closed, think about your space, imagine your space, your home, your house, your apartment. The place you are inhabiting now. See it in your mind’s eye. If your mind begins to critique or analyze, tell a story about what it is seeing, drop it. Just imagine walking through your house, your rooms, just seeing.

See what is around you without tension, tightness, gripping, or reacting. Just what is. You might catch yourself, you might notice waves of reactions. Judgments like, ‘I’ve got to clean that up,’ or, ‘I don’t like that.‘ Just see what is there. The mind might shift away, might wander, might start thinking about something else unrelated. Or sensation in the body might arise. Notice. Just notice.

Now the second instruction is to reflect on nature, or the forest, in the suttas. Let’s step outside our home, even if our home is close to nature, and allow your mind to conjure, to visualize, a place in nature, a place you may know, or place you have only seen in images. This could be a forest, a field, even lake, stream or ocean. If you struggle with visualization, just rest your mind on the idea of a tree, thinking about the parts of a tree, the trunk, the bark, the limbs, the leaves. As with imagining your home, allow yourself to wander, gazing around the scene. All the while, not layering.

Notice when the coarser mental activity comes forward. Maybe you start thinking about nature, maybe you start ruminating. When you notice that, imagine putting it down. Just put it down. See the earth, the sky, the trees, the water. That is your anchor.

The next instruction, the next invitation, is to reflect on the Earth. If you’re visualizing a particular place or location in nature, imagine yourself sitting down on the ground, on a rock, on the earth. To aid you in the sensation, as we’ve done in other meditations, allow whatever surface you are sitting on right now to hold you. Drop your awareness, your attention down to the contact points with what is holding you up. If it is a chair, a bed, a cushion or the floor, drop into it. Now allow your awareness to drop further. What is holding up the floor is the foundation of the building. What is holding up the foundation of the building is the earth. Whether in your special place in nature or on this chair, allow your attention, your focus, your awareness to drop down. Connect with the earth, with solidity, with density, with form beneath you. This is present at all times. As you focus on the Earth, you may even imagine, sense its connection to the greater whole. This piece of earth beneath you is connected to the entire planet, not just Port Ludlow, or Seattle or Vancouver. The Earth has no boundaries, fences, borders. The earth even runs beneath the ocean, under the water.

Allow your mind to reflect on the Earth beneath us. If the mind gets lost, it wanders, that is simply an indication of how deeply we have been conditioned. When you noticed you have wandered, think of it as a reminder to continue to practice. If you find yourself caught up in thought, thinking, thinking, notice the feel of that somatically. Do you feel like the energy is up in your head? Forward, back? Once you notice, practice returning to thinking of the earth, feeling your connection, the weightedness, the rootedness, the downward energy. If you’re sitting on a chair, feel into your buttocks, your thighs, your feet. Notice what’s happening to the mind. Maybe today it feels challenging. That’s the assessment you give it.

The next invitation involves reflecting on the opposite of the density of the earth – it is about reflecting on space. With the eyes closed and knowing your connection to the earth, reflect on the space between you and everything around you - the space around the chair, between your legs, the space above your head. Experience, feel into, this space. You can start with the body, sensing all the places where the body is not touching itself. Enter into the space around it.

When and if the mind gets pulled away, it’s okay. Come back to feeling the space You can start subtly, the space between your arm and your body, the space around the arm, around the fingers, the hands. And if this is confusing or you’re unsure, that’s okay. As one of my teachers once said, just go in the neighborhood, play, do whatever you think that is. Feel into the empty space.

Now turn your attention to your thoughts. Just stay with our thoughts. Where do they arise? Where do they come from? Can you step back mentally and simply observe the thoughts as they arise, exist, and cease, fade away? It may seem like a thought arises and arises and arises and arises. Thoughts change; feelings change. Observe, witness. Soften the body if you’re getting tight, tense. Feel the body on the earth. Feel the space around it. Then go back to witnessing the mental energy, the mental processes, thoughts.

Over time, you may begin to experience the space around and between the thoughts. See if you can settle into that empty space, the absence of thoughts. Rest here.

Now take a moment and notice what is arising right now. What is arising in your body? What’s arising in your thoughts?

Now let all that go. With an intentional breath. Feel the breath, feel the body move with each breath. With curiosity and wonder, notice the impacts from this practice. At times you might find your mental processes soften, slow down. At other times you might find they speed up. What would it be like, I wonder, when we develop more skill with seeing clearly? How will your day be?

I dedicated this practice to all beings, near or far, those we see and those we don’t, those who are well and those who are unwell, may we all find freedom.

May we all go gently knowing our goodness.

When people hear the word acceptance in regards to pain, they often stiffen and contract, assuming that acceptance is synonymous with giving up, passivity and inactivity. As anyone who has practiced acceptance and mindfulness can tell you, it demands a great deal of focus and concentration. Today we ground our practice in the breath, anchoring on it as a means to release physical and mental tension, then we turn towards, face and embrace what is present - our pain.

The reason you want to be better is the reason you aren’t.
Do you still think you can be happy by trying to be happy?
Allan Watts

My father died while a participant in an experimental cancer study. His previous attempts at chemotherapy unsuccessfully curtailed the spread of cancer, and unbeknownst to my mother and other family members, including myself, he had metastases to other organs in his body. Before consenting to the study, he shared with me all the forms detailing the potential risks and benefits of this experimental protocol. Soon after initiating the treatment, he grew weaker and, on several occasions, collapsed, causing him to be rushed to the hospital. Both the consulting and the hospice oncologists recommended ending the drug trial, yet his own doctor swooped in and convinced him to continue. Reviewing the list of potential side effects of that drug, my father experienced about 90% of these, and to this day, I believe this experimental treatment hastened his death. While accompanying him to one of his regularly scheduled visits to the cancer center, I voiced my concerns about these mounting side effects to his oncologist, who was quick to reply, Well, we’ve got to give him something.

A month later, once all his providers agreed that continuing this course of treatment only created more harm, my father found himself in hospice. In fact, this was the topic of the very last conversation he and I had by phone before he slipped from consciousness. Are they giving up? he asked. No, I replied. They (and we) want to focus on your quality of life. And there, in those few words, lie the crux of our challenge in healthcare and in life. People hear those words and interpret them to mean giving up, which translates to inactivity and lack of engagement, doing nothing. The irony, however, is that addressing the quality of one’s life is the perhaps the most challenging undertaking of all. Focusing on the quality of life requires you to confront how you orient and engage with the world and whatever is arising in each moment, and when the world around us seems to prize and value quantity and the never-ending acquisition of more, quality seems difficult to come by.

I chose naturopathic medicine because I deeply believed that lifestyle factors and practices impact health. What adult doesn’t acknowledge, on some level, that whole food, fresh water, daily movement, restful sleep, close connections with loved ones and supportive friends, and meaningful work would go a long way to create balance, if not improved wellbeing, in their lives? Whenever people talk about how stressful their lives are - and they quickly add how said stress is “killing” them - what follows is a detailed explanation of how these factor (food, water, air, time with friends, positive work experiences, etc.) are lacking or at least neglected in their current pursuit of the health. I am convinced that many of us have been conditioned to automatically respond to the simple question of How are you doing? with some mention of busyness, and to be utterly honest, I include myself among the lot. It’s as if we are players in the Suffering Olympics - whoever is the busiest wins, whoever is doing the most succeeds. But what is the prize? Increased headaches, more intense ulcers, elevated blood pressure, longer stretches of insomnia and chronic pain?

My professional and academic career has centered around behavioral health, and yet I feel compelled to call forth a precarious downside and harm inherent, not in behavioral health itself, but, in how behavior and habits are presented, discussed and embraced. I have witnessed all too many times the disdain in healthcare providers when discussing a patient’s medical history:

If they would just stop smoking…
Would it kill them to eat a vegetable once and awhile?
Just drink 1 glass of water a day, just one (a behavior I found myself pleading with my mother to consider for decades).

With integrative physicians and holistic practitioners, such narratives change ever so slightly, yet the fundamental message remains consistent:

Well, did you give up gluten and dairy yet?
Have you gone keto (or paleo, or vegan, or…)?
Sitting is the new smoking; so you are getting up every 20 minutes or so, right?

For me, naturopathic medicine promised an individualized approach to healthcare. Before moving to Seattle to attend Bastyr University, a doctor I was dating at the time tried passionately to dissuade me from a career in medicine. You’ll just be spending most of your time trying to convince middle-aged women to exercise or eat better. And they won’t listen! With an unfounded pride based on absolutely nothing, I puffed out my chest and declared, But I am going to be a naturopathic physician! Looking back, I had no clue what was behind my zeal other than the mere justification and defensiveness about my upcoming career choice.

Throughout my education we were told to look at the individual in their entirety and customize our treatments on their specific psychophysiological make up, ensuring to get a comprehensive and detailed history and workup which often included appropriate lab testing. That was party line, anyway. I still remember that in the 90s small frequent meals to regulate blood sugar was all the rage. While reminded to adjust accordingly for the individual, general recommendations seemed standard across the board. Other colleagues dove more deeply into lab work and genetic markers to dictate lifestyle choices such as nutritional supplementation, dietary guidelines, exercises practices, and the like. This was considered to be more individualized. As I have already said, what person wouldn’t benefit from the broad strokes of fresh and clean food, water and air, accompanied by daily movement, deep meaningful connections and inspired work? These are foundational. However, I question whether advocating small frequent meals fits within the parameters of those broad strokes for all people. I raise this example since fast forward 30 years and now almost all my patients speak to me about intermittent fasting. To be clear, I am not saying that this is without merit. Furthermore, I have heard some supporters of this eating schedule discuss individual variations and for whom this might be beneficial practice. Overall, I cannot help to see this trend as another new fad in medicine. Does this mean that all the studies that we used as evidence to support small frequent meals were invalid and should be thrown out? That the research now is far superior and without fault to the data collected then? As I mentioned, my issue is truly not with these recommendations specifically, but rather the ways in which information is delivered and how we orient to our overall health and wellness in general. The art of creating an individualized plan lies in treating the person, not the symptom or disease.

A huge shift in my perspective in healthcare emerged from learning Motivational Interviewing (MI) through the public health department. Even with my background and education in humanistic psychology, cognitive behavioral therapy and Buddhism and contemplative practices, what enticed me about MI was the de-emphasis on the actual behavior and a greater focus on the core motivation for change. As a physician whose primary treatments consisted of lifestyle practices, this was a powerful jolt to my thinking. Until then, I assumed that patients came to the office to listen to the provider’s words of wisdom (advice) and comply. Give them enough encouragement, support and evidence about the reason to adopt the new behavior, whether diet, supplementation, exercise, meditation, etc., and they would fall into line. Obviously, I failed to recognize how such thinking even failed to apply to myself. How often did I know, I mean truly know and have the direct experience, that a particular behavior impacted my physical well-being. Spare you the specific details, I knew that when I ate dairy in any form, I would experience severe gastrointestinal distress. Yet it took me over 6 months to fully eliminate it from my diet. I knew that if I do not go to bed before 11 PM at the latest, I would likely remain awake until about 2 AM, and regardless my internal alarm invariably wakes me by 6 AM at the latest. This knowledge and first-hand experience did little during college to deter me from staying up for fear of missing out.

I am reminded of a woman with whom I consulted who suffered from debilitating inflammation and arthritis aggravated by food. While other factors compounded her health, consuming milk products in any form resulted in the need to use a cane or a walker just to get around her apartment. Opening the door to my office to meet her in the waiting room, my eyes fell on that gray aluminum device perched before her. Slowly maneuvering her way into my office, she fell into the chair and with an expression and tone of a child telling her father she broke the cookie jar, she said, Last night I ate a quart of ice cream.

If you have read this far, I admit my words are priming you. Yet if you can stop for a moment and reflect, What is going through your mind right now? What thoughts immediately pop up? If you were her physician, how would you respond?

Later that week, I shared this exchange with my medical students, providing them her back story, medical history and the exact words she said to me. I then asked, What would you say next? Comments flew at me like a deluge, all sharing a fairly consistent theme:

Did you talk to her about soy (or coconut, or rice, or cashew, etc.) ice cream?
Did you talk to her about moderation? She can eat maybe a few spoonfuls, but a quart (yes, she did say quart)?
What digestive enzymes is she taking?
Does she know about turmeric or curcumin?
Somebody must have talked to her about fish oil?

If intermittent fasting were in vogue at the time, I am certain someone would have mentioned that, too.

Finally, I shared how on that particular day, without skipping a beat, my response to the human being sitting in front of me was, What flavor? Her tone instantly brightened as she looked up, smiling and making eye contact for the first time since she dragged herself into my office, and said
Rocky road!
Well, I hope you enjoyed it!
It was good, her smile fading a bit.
I waited a bit before adding, So how did that help you? What was the overall benefit?
Swiftly, with a jaw tightened and she managed to squeak out, It is the only time I feel joy and love in my life.
Then no argument here, I replied softly. Why and how would I, or anyone, for that matter, tell you to not eat it?

In MI we call this impulse, this drive to fix the problem and fix the patient, the Righting Reflex. However, decades before Motivational Interviewing was formalized, Freud wrote about this same concept in 1914 in the Technique of Psychoanalysis:

“One of the most serious resistances to psychoanalysis arises from what might be called the ‘furor sanandi’ of the physician, his passion for healing, which is apt to make him forget all the difficulties of the task and all the limitations of his powers.”

He went to add…

“Human society has no more need of the furor sanandi than of any other fantasy.”

Just like the righting reflex, furor sanandi is a rage to cure, a passion or frenzy to heal. According to Freud, this passion to heal and fix is an essential ingredient and overall universal problem in the motivation for everyone in the helping professions. Yet make no mistake, healthcare provider or not, this drives rages within us all, frequently directed towards ourselves.

My students, in their compassionate passion (or rage) to eliminate the patient’s suffering, were driven to offer suggestions about alternative forms of frozen desserts available. Yet such suggestions and advice may be received as perpetuating her already present guilt and shame, reinforcing the notion that consuming a quart of ice cream was wrong. She walked into my office already judging herself, repeating the narrative about how she failed (her internal furor sanadi writ large). But who did she fail? In her attempt to experience some modicum of joy in her life, she was taking steps to take care of herself. Even if these attempts resulted in inflammation and limited mobility, she experienced some positive feelings, albeit for a brief time. Who reading this can’t relate? Don’t we all do the exact same thing on varying levels? We engage in some behaviors simply for the immediate payoff, as it either leads to momentary pleasure or maneuvers us away from pain. How much of our life is built on such motivations?

This passion to find the right formula is so strong and enticing we continually admonish ourselves (and others).

How hard can it be to turn off your cellphone an hour before bed? Blue lights prevent you from sleep and will kill you.
Do your breathing 20 minutes twice a day, period. Don’t you want to get better?
Cold showers - everyone should be doing cold showers… but first use the infrared sauna.
You MUST meditate. The more you meditate the better, faster, stronger, clearer you will be.

And for consistency, let’s add…

Intermittent fasting is the key to weight loss and a happy and more vital life!

What I hear in these words is the underlying belief in and prioritization of some idealized state. If you just push harder, try more, do more than you will reach nirvana. Of course that begs the question, whose nirvana? Who’s ideal are we trying to attain? At the beginning of the HIV epidemic, several groups denounced the conventional retroviral cause of the infection. Alongside those loud critics were individuals preaching that if you truly loved yourself then you not only would stay healthy and symptom free, but if symptoms ensued, you could heal yourself of HIV, which meant rid it from your body. In the mid-1990s, one such man who was in a discordant couple (his partner was HIV positive, while he was HIV negative) told me in no uncertain terms that if he was spiritually sound and emotionally balanced, then he would not seroconvert. My refrain was, “And you can use a condom.” To which he would counter, “But I won’t need one if I am spiritually sound.” “And spiritually sound people can still use a condom,” I would reply. Our back-and-forth call and response got us nowhere. In part because I stopped listening and failed to engage with the person before me. I did not seek to explore his beliefs in more detail as I was thoroughly ensconced in my own righting reflex, my furor sanandi blazing bright. As I later learned, arguing and trying to convince someone of your viewpoint prevents us from being present or listening, and rarely works. Needless to say, 6 months later, he seroconverted. His beliefs around the infectious nature of the virus have since changed, but at the time his initial reactions of self-loathing and self-judgment did not concern his HIV status, but rather his failing to be spiritually and emotionally pure. Heart wrenchingly, to this day I hear numerous men and women speak about their failings at self-compassion, self-love, and self-acceptance when whatever disease they are living with continues to progress. Witnessing people denigrate and judge themselves for lacking the skills to do the very thing that was supposed to heal them is confounding and is seemingly downright abusive. Any such therapy, theory or practitioner that perpetuated such a mindset to me seems damaging and harmful rather than helpful. Compounded by curated social media, many mentally rehearse the narrative that if they just loved themselves more, then they, too, would have that desirable life seen splashed across the feeds of the young, beautiful, healthy and rich. Do it right and everything will miraculously get better, that all dis-ease can be cured. I kindly remind people that The Buddha, or so I have read (the veracity of which I am unsure), reportedly died of food poisoning. How could he not have prevented it or cured himself? To this, my Buddhist friends reply, he was unattached to the outcome - he was unattached to this life. That might be the case, and I should note, my Buddhist friends are rarely the ones claiming that self-love, positive affirmations or visualizations would cure HIV, COVID or any other disease.

So what are you chasing? What is your attitude and orientation to this exact moment? In what ways might you be consciously or unconsciously reinforcing the perspective that you are still somehow deficient, less than, or lacking? Are you whispering or screaming to yourself about the need to follow some prescribed simple steps to cure all that ails you? What if instead of fighting the reality of this moment you were able to pause and breathe? And not breathe to lessen your stress, be more relaxed, or to increase your HRV (heart rate variability), but breathe as an intentional act of self-discovery and presence? Please don’t misconstrue my point. I am not advocating for inactivity. After all, breathing into this moment is an action, acceptance is a behavior. Rather than trying to fix anything my motivation is that we learn how to breathe fully into our lives, create more awareness of how we are orienting to this moment, and then armed with that insight, engaging more aligned with our values. This requires dedicated practice. As Aristotle wrote, We are what we repeatedly do. Excellence, then, is not an act, but a habit.

In no way am I denouncing the desire for growth and personal development. For I believe that suffering, not pain, but suffering, arises in a large part from our automatic conditioned responses, and that through the dedicated practice of inquiry and insight we can take steps to lessening suffering. My contention here is that much of the personal growth and self-help movement, and this includes functional medicine, holistic health care, biohacking and the like, tend to promote self-judgment and shame through their battle cries of You are not enough, you need to do more, you need to be more (and its variation - Be all you can be)! By continually dangling the promise of transformation, beauty, health and harmony, you can have the life you most desire. The Garden of Eden awaits you, just follow these easy steps. All the while we are constantly assessing and ruminating about the next step in the process. Should our cancer progress, our pain persists, our blood pressure remains elevated, then we just didn’t do it long enough, intense enough, or perfectly enough. Again, quantity.

As always, I am advocating a pivot, a perspective shift. The intent has more to do with the how than the what. Coming back again to my dad, his final round of chemotherapy was followed by another PET scan to determine the status of his cancer, after which he was sent home and instructed to relax, take it easy and wait for the doctor to call with the results within a week. Over the years I have sat with hundreds of people as they awaited such lab results. You might argue, Well of course I would be anxious, a mess, a wreck. I am waiting to see if the chemo worked, my status has changed, my blood markers have dropped? The fact of the matter is how you orient and breathe into this experience differs dramatically from person to person.

I was with my father when he died. All our conversations over the course of my lifetime, as well as the more pressing ones during his last 9 months, color my experience of his death, and in my mind, he died suffering. Nine months earlier, when he was diagnosed with stage 4 small cell carcinoma, the first things he said to me was, I just need 9 months. Nine months to get things in order. He wanted to get all his affairs in place for my mother. Sadly, this did not happen, and I believe this weighed on him so heavily, that he never told his children of some vital realities with which we, namely my sister who was the executor of his estate, would spend years navigating. I believe that my dad died with the belief he somehow failed - failed as a husband, a father, a businessman, an adult. Desperate for a different outcome, he continued working right up to the end. Quantity, not quality.

How do you wish to breathe into your life?

How to Listen
I’m not asking you to come down here
and clean out the muddy corners of my life.
I’m asking you to be a forest where mud and leaves,
shadows and light, growth and decay
all have their unquestioned belonging.
I’m asking you to be an ocean
where even great storms
don’t trouble the depths
and each tear is welcomed as a homecoming.
I’m asking you to be as spacious
as the vast darkness behind the sky,
which will never be afraid
of what I do or don’t choose.
I’m not asking you to hold me together.
I’m asking you to open so wide
there’s room for all the ways I come apart.
James A Pearson

How do we open so wide to the pain of others and our own?
How do we create room when all we want to do is run away or hide under the covers?How do we stay present and not turn away from all we see, and feel, and avoid numbing ourselves to all the suffering all around us.

Take, for instance, the study I read last week, Climate-driven depopulation and adaptation realities in America’s coastal ground zero published in the journal Nature Sustainability, which made headlines in its direct and unequivocal conclusion:

“the window of opportunity to save the New Orleans area in the long run has probably closed, the next few decades will be decisive as to whether other population centres that are presently well landwards of the coast will be among the next to face their seawards fate.”

Succinctly put New Orleans cannot be saved, and to protect human lives, the migration, and all that entails, must begin now.

When I broached this new subject with several people, I was met with responses ranging from blank stares to a flagrant indignation. Since none of the people with whom I spoke lived in or knew anyone residing in Louisiana, the conversation stopped there.

I mention this article not as an invitation to debate the inevitabilities of climate change or the need to prepare for migrating to other locales, but to discuss a broader issue – mindful acceptance and the ways in which we respond to the world. Whether climate, political or health related, I wonder how we orient to unsettling, unpleasant or downright disturbing experiences. In saying, I’m having a hard time accepting x, y or z, or I cannot accept this, what specifically are we saying is difficult to accept? Is this lack of acceptance an argument over the validity of the facts or a staunch refusal to be present to all the uncomfortable and disturbing ways we come apart when confronted by those facts?

Acceptance is a way of orienting, a way of life, a way of engaging with ourselves and our experiences. As Paul Tournier once penned,

Acceptance of one’s life has nothing to do with resignation; it does not mean running away from the struggle. On the contrary, it means accepting it as it comes, with all the handicaps of heredity, of suffering, of psychological complexes and injustices.

Acceptance is acknowledging and embracing reality, or said in the inverse, not fighting reality. Acceptance has nothing to do with liking or disliking, finding something pleasant or unpleasant, or even agreeing or disagreeing with someone or some data. Acceptance nods knowingly at the reality of things, and says, Yep, that’s happening. I see / hear / feel you. And in the very next breath, acceptance asks, What now? How do I want to respond fully, thoughtfully, and mindfully? So how do we practice acceptance in our daily lives without covering our eyes and ears, without distracting or ignoring, without refusing to see what is happening?

I began my career in the HIV care in a time when receiving the diagnosis was typically accompanied by a 5-year prognosis, which fortunately has changed in the passing decades. Back then, naturopathic medicine offered many treatments for mitigating medication side effects, increasing medication efficacy, easing pain and discomfort as well as treating some opportunistic infections, but overall, it did not stop the progression of the disease.

Rather than attempting to fix or cure, which can be a way of avoiding our own discomfort, I attempted to practice, or so was my intent, providing room, space and acceptance. After the initial 10 - 15 minutes of medical updates (review of symptoms, medications and supplements changes or issues, etc.), my questions settled on a singular theme - How are you living with all of this? How are you orienting to and navigating your life? How are you showing up for your life every single day? Many with whom I spoke felt isolated, stigmatized and rejected – because, quite frankly, they were. Yes, some had supportive friends and family, yet others talked of being the sole surviving member of their formerly large friend circle. One man spoke about the museum his home had become, filled with the furniture, books, clothing and tokens of his departed friends. Each step from room to room was a reminder of all he had lost. For so many, a pervasive sense of unworthiness clung about them, accompanied by a constant refrain that no one will ever love them, hug them, touch them, or be close to them. They would never be intimate with another person ever again. Were they wrong? Did they need to be more positive, more optimistic, more hopeful? Did they need to reframe the rejection they experienced? Did they just need to regulate their nervous system so such experiences no longer disturbed them? Should they learn to be happy with the loss of their dreams and futures?

Paul revealed to me the urgency of learning to open wide and create room for all the ways a person can come apart. His medical history was extraordinarily complicated. In his late 30s, he was frail and walked slowly with the use of a cane, suffering with interminable fatigue. When he handed me his list of medications, I stifled the urge to gasp. A few years earlier, he had his first bout of CMV (cytomegalovirus) in his gut, for which he was prescribed a potent antiviral, foscarnet, that caused his kidneys to shut down, which, in turn, required him to take massive amounts of sodium bicarbonate, lest he experience seizures and a host of other symptoms. In addition, he was taking upwards of 50 other pills daily. Even if I had a desire to cure or fix, I had no clue what I could offer him since many supplement and herb might disrupt his acid-base metabolism and that was too risky.

While foscarnet kept his CMV from progressing, his eyes were not spared, and he was partially blind in both eyes. He was also taking three anti-HIV medications which kept his viral load below detectable levels and his CD4 cells count up. However, because of all these medications, his liver enzymes were exceedingly elevated, indicative of liver damage. Activities of daily living were a chore. Due to his partial blindness, he couldn’t engage in his previous pleasures like reading or working on crafts. Because walking was difficult and driving impossible, he was primarily homebound, unless his partner, who continued to maintain his tech job while simultaneously acting as full-time caregiver, shuttled him to his multitude of weekly appointments.

As part of his care, each week Paul checked in with his psychiatrist for sessions that lasted no more than ten minutes, at which time he asked Paul a few pointed questions and told him to maintain his course. Paul, looking at the ground, and in a quiet voice said, “I guess I am a bit depressed.” In an unedited and uncontrolled moment, I blurted out without thinking, “Why the hell wouldn’t you be depressed!” Before I could course correct, he lifted his head and looked me straight in the eyes and said, “Thank you! Thank you for saying that” and began to weep, his body shaking as it released all the grief and sadness he did his best to push away.

From that moment on, the tone of the visit changed, and Paul’s mood brightened. Although his reported intention was to discuss supplements, we did so minimally. Paul began to accept an aspect of himself, accept his feelings without needing to treat, remove, minimize or justify them. When he was able to embrace the fact that his depressed mood was present and an appropriate reaction given his circumstances, that his feelings were neither wrong nor pathological, that he was grieving – the loss of abilities, loss of meaning, loss of dreams - something new emerged. The appointment ended with Paul smiling, thanking me, and asking to see me again in the following weeks. We met several more times over the next two months, yet now we spent time opening to whatever was arising for him. Two months after that initial meeting, Paul developed acute pancreatitis, fell into a coma and died at home. All these years later, as I write these words, my heart continues to break open when recalling Paul’s story.

How comfortable are we at tolerating distress, not only our own personal distress but also the distress and discomfort that comes while sitting before another person, whether patient, colleague, friend, partner or spouse or parent or child? It is understandable that we long to do everything and anything in our power to ease their suffering, but what happens when it fails to bring relief? And moreover, if we rush to act, do we even know what we are trying to address? If we no longer want to fight with reality, if we value ease in the face of all the tumult around us, what must we practice daily to inch ever more closely to that vision?

Let me take moment and explain, as best I can, what acceptance is not:

• Acceptance is not passivity or inaction, as anyone who has struggled with keeping their mind focused on the breath for 30 seconds without allowing it to wander can attest. Acceptance, and mindfulness, its prerequisite, takes practice. Acceptance doesn’t merely happen to us; we must cultivate the conditions to allow it to thrive.

• Acceptance in no way means we love, or even like, what is happening, to ourselves or the world at large. Acceptance is not about loving your cancer, the violence in your community, or the price of gasoline at the pump. That is a practice of spiritual bypassing where we ignore, suppress or avoid our internal thoughts and feelings. Our goal is not to meditate or breathe away our fear, sadness, outrage, grief or despair. Those feelings are present, so we open wide to it all, as uncomfortable as it may be.

• Acceptance is not the same as condemning or condoning, agreeing or disagreeing with another’s behaviors or actions. We can get caught up in an endless mental spiral of fault finding, demanding we lay blame and shame. Blaming and shaming are not the same as addressing the cause, which tends to be multifactorial and never as simplistic as we would like it to be. We can identify and accept the cause(s) without sliding into a debate about worth and value, which, at its core, is the essence of shame. Remember, acceptance is not a passive act. We can still ask, or even demand justice, yet before that, we must accept the reality of the situation. In those moments, however, such as in imminent flooding or acute pancreatitis, fixating on blame does little to address our deep emotional devastation and prevents us from taking action to move out of harm’s way, should choose to do so.

Acceptance begins with a declaration of intent, an act of commitment, each day - to show up for ourselves and to ourselves, to all aspects of ourselves, to our entirety, to our multitudes. We intentionally show up for what is happening all around us. It is easy to read the news or see images on our screens and detach, compartmentalize these events – these people, this famine, those bombs, that fire – are elsewhere and not happening to us. In that breath, we abandon any feelings that arise within, and for what purpose? So we can continue functioning as normal, to maintain the status quo, when all the while we are crying inside? What is normal? By failing to confront reality, are we, in essence, condoning it?

We show up for ourselves - compassionately, respectfully, nonjudgmentally. Acceptance does not ask us to be devoid of emotion, to be nonreactive to trauma and suffering. Mindful acceptance is asking us to embrace it all without being crushed by its weight. Yet we must build our capacity for this, which is why acceptance is a practice. On those days where we long to stay hidden under the covers or lie on the bathroom floor in tears, acknowledge this, nod to it, open to those feelings and thoughts, without shame or criticism, without pathologizing and labeling. And do not judge longing to run as far from these feelings as possible. Hold it all. The more we attend to ourselves, to our thoughts, feelings, and bodily sensations, to those around us, and to the world, the more space we have within to withstand suffering.

When we see clearly, open to it all, we do notice that while pain and heartache is present, so, too, are a myriad of other simultaneous experiences. As we gain skills at mindful clarity, we can choose where we would like to rest our attention. As we grieve, we can find ease in the trees and birds outside our window, the cat resting on our lap, the friend talking beside us, the meal we are eating, the book we are reading or videos of kittens and puppies that bring a smile to our hearts. This is not a dismissive, bypassing approach to gratitude; it is more inclusive that that. It is living in the AND. Fear is present AND so too is love, appreciation, calm. Anger is present AND so too is compassion and understanding.

When we truly open to what is around us, we realize we are not alone in our suffering. Blame and shame separates us; acceptance brings us closer together. During our intense moments of struggle, accompanied by our own internal sense of shame, we isolate, hide, retreat. Afraid of the impending judgment, we not only distance ourselves from our sense of shame, but we also distance ourselves from others. We see those around us as adversaries thus we are thrown back on that never-ending wheel of motion, constantly playing defense, unable to rest.

Acceptance isn’t easy. It begins with honoring ourselves and life itself. Whether confronting a climate crisis (such as receiving a terminal diagnosis for your city), adjusting to the loss (and death) of a job, or navigating a serious health condition, commit to showing up for ourselves, if not others. Crises are inevitable. Everything changes. What would happen, I wonder, if we were to make mindful acceptance a constant companion? What will take place when we accept what lies before us - all our striving, longing, and discomfort, all the pain and sufferings of those we love and those we do not know, and of the planet? What might we discover?

I have often been confused by the word hope. With everything going on in the world these days - politically, economically, environmentally, technologically, and even personally - the word seems to have become a staple in our daily conversations. Everywhere I turn, I am reminded to “keep hope alive,” “don’t give up hope,” “let hope be your beacon.” On the flip side people tell me how they need to stay hopeful or they couldn’t go on. For without hope, they would fall into despair. What remains unclear and confusing to me is the definition of hope.

What does hope mean to you?
How does hope influence your life?
In what ways does hope help or prevent you from engaging with the present realities of your day to day life?

I have concluded from all my conversations with patients and friends (a very curated sample, I willingly admit) that many define hope as a belief in the inevitability that things work out the way we want. Thus, we tell ourselves, and others, that we must think affirmatively, envision a positive outcome, and avoid speaking of anything contrary to our desires.

The great philosopher-poet Frederick Nietzsche spent his entire life grappling with hope. In one of his earlier works, Human, All Too Human (1878), he speaks about how such an approach to hope keeps us stuck in the endless cycle of suffering. On his discussion of the myth of Pandora, the first human female created by Hephaestus at Zeus’s bidding as a punishment to humans (after Prometheus stole fire from Zeus), he writes:

“Pandora brought the jar with the evils and opened it. It was the gift of the gods to men, a gift of fair appearance. Then all evils, those living, moving things, flew out, but Hope remained at the bottom of the jar. Pandora shut the lid at the behest of Zeus and thus Hope remained inside… Hope is in truth the most evil of evils because it prolongs man’s torment.”

Here Nietzsche views hope negatively, as an existential power that strips us of our ability to be present, prevents us from seeing mindfully and clearly, stops us from engaging with the actualities of our day to day experiences. Hope impedes us from living in the moment and being attuned to our current conditions. Hope, in this view, is an expectation, an act of longing, a yearning for things to turn out a particular way.

Karl Löwith, in his book Meaning in History, expounds on this theme:

“[The Pandora myth] is an evil which seems to be good, for hope is always hoping for something better. But it seems hopeless to look forward to better times in the future, since there is hardly a future which, when it has become present, does not disappoint.”

Here again, hope leads to suffering, but only when hope is an incessant attachment to an outcome. Countless scholarly and psychological papers discuss how those most impacted, those who suffer the most, are the ones with the greatest hope, since when the future arrives and the aspirations to which they clung so desperately failed to transpire, they were thrust head first into pit of confusion, and they were confronted with the need to rethink all that they believed.

This version of hope, a form of toxic positivity, is so entangled in the American idea of manifestation - think it into being. How often have friends urged me to refrain from thinking, or at least speaking, certain thoughts. Don’t even put that out there, they say, which basically translates to, don’t say such negative thoughts aloud otherwise you will speak them into being. Thinking negative thoughts, they fear, manifests them into existence. Is that so? How many negative thoughts passed through my consciousness, even within the past hour, that have failed to transpire? I am reminded of my childhood self. When my parents were late returning home from an evening out, my thoughts immediately grew dark - they died in a car accident. I was certain of it. Like clockwork this thought took up residence in my mind and failed to let go until they were back home, safe and sound. And by the way, I must add, this scenario never came to pass, I did not manifest it into being. Similarly, how many dreams and desires have I repeatedly incanted with the intent of breathing life into them to no avail?

When we fear our thoughts, telling ourselves that we shouldn’t think such things lest they become our reality, then we have rendered our own minds and mental formations an enemy. And what happens then? We go to battle with our very selves. When we are at war with ourselves, there is no salvation, no peace, no end. Thus, hope, in the form of expectations, becomes, as Nietzsche puts it, the most evil of evils.

Yet, what if hope is not the denial of current reality but an embrace of it? What would hope look like if we did not cling to tightly to positive outcomes? How and what can we practice that recognize that things might not turn out the way want? Is there another way to practice hope?

The first time I read these words by the political activist, poet, playwright, and first president of the Czech Republic, Vaclav Havel, I knew I found my instructions for life. He writes:

“Hope is definitely not the same thing as optimism. It is not the conviction that something will turn out well, but the certainty that something makes sense, regardless of how it turns out.”

He distinguishes between hope and optimism as follows:

“I am not an optimist, because I am not sure that everything ends well. Nor am I a pessimist, because I am not sure that everything ends badly. I just carry hope in my heart. Hope is the feeling that life and work have a meaning. You either have it or you don’t, regardless of the state of the world that surrounds you. Life without hope is an empty, boring, and useless life. I cannot imagine that I could strive or something if I did not carry hope in me.”

My thoughts drift back to all the conversation with hospice patients; to the countless talks with people living with HIV, ALS, MS, cancer; to endless discussions about treatment options and their purpose. Was the goal to cure the disease or bring some ease? Was it to keep hope alive or to engage in life more fully, which includes acknowledging and embracing current reality? When we spend all our time hoping for a different life, we never learn to tolerate the life we have. How much time, energy, and life force goes into avoiding our current existence? This is larger than health and healthcare. How do we show up while witnessing all the collapse around us? How do we orient to the suffering that arises when we see destruction, decay and erosion of not only people we cherish but ideas and ideals, beliefs, systems, institutions? How do we tolerate the discomfort that arises as we watch the collapse of democracy, freedom, justice, environment, and more? Being present to all of this, we may feel deep anguish and despair, yet what if such intense states were not the inverse of hope (hopelessness)? What if we learned to tolerate such discomfort, such grief and suffering, and yet still breathe into our lives? If our agony and despair are another thing to fix, then we go to battle with our emotions, and you know what happens then.

The great political activist Cornell West reminds us that you cannot have hope without despair, nor should you try to rid yourself of despair. As he shares so eloquently:

“Those who have never despair have neither lived nor loved. Hope is inseparable from despair. Those of us who truly hope make despair a constant companion whom we out wrestle every day owning to our commitment to justice, love, and hope. It is impossible to look honestly at our catastrophic conditions and not have some despair dash it is a healthy sign of how deeply we care. It is a mark of maturity - a rejection of cheap American optimism.”

So I ask:

What does hope mean to you? What is your relationship with hope?
How does your definition, your way of hoping, impact your ability to show up, breathe into life, and take action?
How do you want to be no matter what?
How do you want to be with your thoughts, whether positive or negative? How do you want to respond when such thoughts arise? When feelings of sadness, grief, despair come to the table and seem like they will never leave?

How do you want to breathe into this very moment, not because it is the right thing to do or will have a desired outcome, but because it is worth doing?

Peace Is This Moment Without Judgment

Do you think peace requires an end to war?
Or tigers eating only vegetables?
Does peace require an absence from
your boss, your spouse, yourself?...
Do you think peace will come some other place than here?
Some other time than Now?
In some other heart than yours?

Peace is this moment without judgment.
That is all. This moment in the Heart-space
where everything that is is welcome.
Peace is this moment without thinking
that it should be some other way,
that you should feel some other thing,
that your life should unfold according to your plans.
Peace is this moment without judgment,
this moment in the Heart-space where
everything that is is welcome.
by
Dorothy Hunt

I think it is safe to say that all my work, personal and professional, centers along a singular question:

How do you want to be no matter what?

How do you want to breathe, move, speak, react no matter what?

Most of us emphatically declare how and where we DO NOT want to be - I don’t want to be anxious, I don’t want to be afraid, I don’t want to be angry - yet we take little identifying and naming the alternative.

With patients, I might ask:

And how do you want to be if the cancer goes away or comes back; if the pain abates or returns; if your children’s condition improves or does not?

To myself, I ask on a daily basis:

And how do you want to be if that person is pleased or angry with you; if that student leaves encouraging feedback or a scathing evaluation; if your spouse leaves those dishes under the coffee table or puts them in the dishwasher (where obviously they belong)?

Such a range situations with seemingly differing degrees of seriousness, yet as each of us knows deep within, a dish under the coffee table can incite such gale force criticisms that catches the person on the receiving end of it, as well as ourselves, by surprise.

It’s just a damn dish; it’s not a terminal disease! Yet let’s be honest, in our mind, and in our body, it is terminal. We dig in our heels, intensifying our stance, and attack - What the hell is wrong with you? Why can’t you pay attention, get off your butt, put anything away? Why don’t you listen to me? Why don’t you love me?

When I can pause long enough to listen to myself, what else can I do but smile as the realization forms. Who is really suffering right now? It most certainly isn’t the one who left the dish under the coffee table!

So the question remains - How do I want to be no matter what?

Once I settle, allow the chair I am sitting on to hold me up, I know that how I would really like to be is at peace. I would like to find the peace that allows me to breathe, really breathe, easily, effortlessly, and without tension, pressure, force or resistance no matter what. What is peace? Imagine it this way - two warring countries reach a peace agreement. What happens? What do the countries and people then do? It is not as if they agree on everything, adopt the same ideological, political or even social values. The people on either side might not agree or even like their neighbor’s governments, habits and even lifestyles, however, they both practice acceptance, tolerance and they stop throwing bombs.

So much of our lives is filled with conflict. We see it everywhere we turn. Everyone is screaming at one another, not listening or understanding, blaming and shaming. Cultivating peace, or equanimity, allows us to stop the fighting, even internally. Any time we treat an experience as an adversary, we never will find peace. Whether it is another person or another person’s behavior, or our own internal thoughts, emotions or physical sensations, we take up arms, mobilize, and start to battle. If I hold the belief that my partner is an unsympathetic, uncaring jerk who doesn’t care about me or listen to my requests, I am immediately at war. Likewise, if I tell myself that I shouldn’t (should is an important word here) think these thoughts, then I go to war with myself, with my own thinking.

The question how do you want to be no matter what holds all of this. Not only how do I want to be when my partner leaves the food encrusted plate in the sink, but also, how do I want to be when I harbor thoughts about their degree and level of caring and aptitude.

None of this negates the reality of existence. The dish is left, the pain is present, the diagnosis received. Yet our responses to these are not set in stone, although they may feel as immovable and insurmountable. When we fight reality, reality wins. Facts are not the same as responses. By pausing enough, we open the door to creating a new mode of operating. How do I want to be when the sadness, despair, or anger are present?

I like to replace the word be with breathe - how do I want to breathe when any of this happens? If I want to breathe peacefully, then I instantly have a direction, a path, a roadmap. To breathe peacefully, I can drop my shoulders, soften my belly, unclench my jaw (and fists), and allow the chair to hold me up. It doesn’t change the facts, but I am better able to show up to them, have the space to see them more clearly, and then intentionally and consciously decide how I want to take the next step.

How do you want to be, breathe and move no matter what?

From Darcy’s site:

You’re not broken. The overwhelm, the anxiety, the doomscrolling - they’re not a problem with you. They’re a rational response to what’s happening.

And it’s a trap. The exhaustion is part of their strategy. They want you too anxious to think clearly, and too depleted to organize.

Joy fights the fascists. Rest fights the fascists. Calming your nervous system so you can think clearly, plan strategically, and show up powerfully — that fights the fascists.

Your nervous system is trainable, like a muscle. They want you exhausted. Don’t give them that. If you like these conversations, please let me know and I will consider doing more in the future.

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