How to Lessen Mental Suffering

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By Bruce Campbell

Chronic illness brings physical suffering from symptoms such as pain, fatigue and mental fogginess. But it results in mental suffering, as well, caused by factors like worry, uncertainty, regret, guilt and grief. Physical suffering may be addressed with medications and lifestyle changes, but reducing mental suffering calls for a separate set of strategies.

Toni Bernhard's book How to be Sick: A Buddhist-Inspired Guide for the Chronically Ill and Their Caregivers focuses on the latter: her use of ideas and strategies from Buddhism to address the mental suffering caused by the conditions she lives with, which include Chronic Fatigue Syndrome and orthostatic intolerance.

(Note: Toni's book came to our attention because she has been involved in our program for more than five years.)

Her book is a compendium of helpful strategies for addressing many situations commonly encountered by people with long-term illness. As she explains, her title refers to her learning "how to live a life of equanimity and joy despite my physical and energetic limitations."
 

Focus on Mental Suffering

Toni became ill on a trip in 2001. Her illness forced her to take an early retirement from a career as a law school professor. She has been housebound and often bedbound since becoming ill.

A key insight that led to her approach occurred one day when she became aware that she was wishing that her physical discomfort would go away. She recognized that wanting something over which she had no control increased her suffering and that, in fact, "most of my suffering came, not from the physical discomfort of the illness, but from my mind reacting to it with thoughts like ‘I don't want to be sick'."

Her study and practice of Buddhism had taught her that she had some control over that kind of suffering. For example, her training helped her to accept the facts of her life: ending her career prematurely, feeling continuously ill and being often bedbound. "I began to bow down to these facts...and then from there, I looked around to see what life had to offer. And I found a lot."

One concept that helped her was the idea the life is inherently uncertain and unpredictable. This helped her to accept her illness and answer ‘Why me?' And it also gave a foundation for hope.

She writes that just as illness and loss of profession can happen, so can unexpected good things occur: "There are so many ways in which I've ‘grown' only because of this illness....The wind that's blowing the bitterest cold at me may be setting the stage for something joyful to follow."
 

Compassion for Self & Others

A good share of the book deals with practicing compassion, toward herself, her situation and others. For example, she found herself getting angry at certain people and then realized that her anger was a source of stress.

She then directed kindness to herself, asking that she be freed from the suffering created by her aversion to others. And then she wished the same for those who angered her. The combination freed her from "the painful negative mental state that was exacerbating my own physical symptoms."

She also uses compassion toward herself as an antidote to the mental pain that occurs when she can't join in family gatherings. She comforts herself by saying things like "Opening my heart to the suffering that arises from my desire to be with [my family], and then finding specific words with which I can direct compassion toward myself always eases that suffering."

She applied the same principle when she blamed herself for getting sick and for not recovering. She finally accepted that her illness was not a personal failure, lifting more suffering.
 

Self-Talk

Toni learned to challenge her self-talk or internal dialogue and to take action to test her ideas against reality. "With my thoughts, I had made a world of suffering to live in. And the thoughts had a stranglehold on me because I believed they were true -that I was ruining [my husband's] life, that I wouldn't feel joy again."

She replaced the thoughts that led to mental suffering with thoughts that showed compassion toward herself, as someone struggling with a difficult situation.

She also describes how she challenged the thoughts triggered when family and friends didn't visit, call or write. Her initial reaction was to feel abandoned. But then she told herself that there might be good reasons why friends might not contact her. For example, they might not be sure how much contact she wanted or could handle or they might have problems of their own.

Then she took her response one step further, deciding to respond to thoughts "why doesn't [my daughter, a friend, etc.] call me?" by contacting the person herself. She writes that this shift from obsession to action "has never failed to alleviate my suffering and, as a bonus, give me a big lift."
 

Using Distraction

Distraction is a technique for reducing physical suffering from symptoms like pain. The symptom is reduced when attention is directed elsewhere or by being immersed in an activity that demands involvement. Toni found the same applied to mental suffering.
 

When she found herself caught up in the past or in the future, she learned to distract herself away from obsessing about something that had occurred or worrying about something in the future by bringing her attention back to the present.

She directs her attention to something sensory such as studying her physical surroundings, feeling the sensations of her body on a chair or the sensation of air going into and out of her mouth and nose.

Even though Toni's book describes how she used Buddhist ideas and practices to adjust to serious illness, her work deserves a wide audience. Her inspiring account of adapting to her situation with acceptance and compassion shows it is possible to reduce suffering even under circumstances of great loss and physical discomfort.