Part 2 book “Clinical hypnosis in pain therapy and palliative care “ has contents: Mindfulness and meditative states inspiritual care - types and techniques, clinical hypnosis, mindfulness, and music therapy, clinical hypnosis, mindfulness, and the language of metaphors, relaxation and hypnosis in pediatric patients - techniques forpain relief and palliative care,… and other contents.
Chapter V MINDFULNESS AND MEDITATIVE STATES IN SPIRITUAL CARE: TYPES AND TECHNIQUES editation is a powerful technique to help all of us make more of our own potential and to relate better to others at the workplace, at home, in the community, and in our lives generally Recent research by prominent neuroscientists in the United States has shown that for experienced meditators, activity in the area of the brain associated with happiness is more persistent Moreover, it also appears that experienced meditators not get nearly as flustered, shocked or surprised by unpredictable events as nonmeditators (Flanagan, 2003) Meditation and hypnosis can help us develop our potential, in ways that have a positive effect on our life, suffering, and general well-being They can help individuals to M • Cultivate a better understanding of others, leading to increased harmony and shared sense of purpose • Deal more calmly with potentially stressful circumstances • Experience increased energy at work and at home • Decrease pain and suffering • Bring greater concentration and focus to the mind and inner self • Develop the ability to see and respond to situations with clarity and creativity • Develop higher consciousness and the knowledge of higher self • Help suffering people in pain therapy • Help dying people in palliative care When we start practicing hypnosis and meditative states, we start feeling relaxed, peaceful, and happy This is a kind of intergenerative process You meditate, and you get the reward in the form of joy and happiness, which in 179 180 Clinical Hypnosis in Pain Therapy and Palliative Care turn motivates you to meditate more Over time, it becomes your automatic practice, a kind of “sanskar.” You feel uneasy and think something is missing from your life if you not meditate on any particular day When you start your day with meditation, the peace and joy generated last the whole day whatever the nature of your activities It is like having a healthy and nourishing meal before the start of a strenuous and stressful routine during the day Hypnosis and meditative states enable you to become aware of your inner resources of joy and peace You can tap them whenever you feel stressed and worried You acquire a habit of detached observation So, if something wrong and irritating happens during the course of your day, you can view it as a detached observer You thus get an inner poise that ultimately percolates into your daily life Research shows that even skeptics cannot stifle the sense that there is something greater than the concrete world we see As the brain processes sensory experiences, we naturally look for patterns and then seek out the meaning in those patterns In the world, there are many important religions and spiritual philosophies and groups It is impossible to cover all of them in this chapter Our apologies if your own religion or philosophy is not here We have included those we were able to study In this chapter, the philosophies of religions are in alphabetical order Spirituality means something different to everyone For some, it is about participating in organized religion: going to church, a synagogue, a mosque, and so on For others, it is more personal: some people remain in touch with their spiritual side through private prayer, yoga, meditation, quiet reflection, or even long walks In palliative care, spirituality is very important to relieve suffering and help people to perceive higher consciousness In spirituality, I believe in • Personal worth: The inner worth of every person People are worthy of respect, support, and caring simply because they are human • Lack of discrimination: Working toward a culture that is relatively free of discrimination • Dignity: The dignity of the human person • Freedom of speech: The freedom to compare the beliefs of faith groups with each other and with the findings of science Spirituality is the concept of an ultimate or an alleged immaterial reality, an inner path enabling a person to discover the essence of his or her being, or the deepest values and meanings by which people live Spiritual practices, Mindfulness and Meditative States in Spiritual Care 181 including meditation and mindfulness, prayer and contemplation, are intended to develop an individual’s inner life Spiritual experiences can include being connected to a larger reality, yielding a more comprehensive self; and joining with other individuals or the human community, with nature or the cosmos, or with the divine realm BUDDHISM Buddhists believe that they are temporary vessels in this world and that until they attain enlightenment or Buddhahood, they not know their own self or soul They believe that this world is an illusion and that, as a result, one cannot know one’s true nature Buddhism teaches its followers that in this life they are only temporary vessels of body, emotions, thoughts, tendencies, and knowledge A fundamental concept of Buddhism is the notion that the goal of one’s life is to break the cycles of death and birth Reincarnation exists because of the individual’s craving and desires to live in this world The ultimate goal of a Buddhist is to achieve freedom from the cycle of reincarnation and attain nirvana Buddhism is a family of beliefs and practices considered by most to be a religion Buddhism is based on the teachings attributed to Siddhartha Gautama, commonly known as “The Buddha” (the Awakened One), who lived in the northeastern region of the Indian subcontinent and likely died around 400 BCE Buddhists recognize him as an awakened teacher who shared his insights to help sentient beings end their suffering, by understanding the true nature of phenomena, thereby escaping the cycle of suffering and rebirth, that is, achieving Nirvana Among the methods various schools of Buddhism apply toward this goal are ethical conduct and altruistic behavior, devotional practices, ceremonies and the invocation of bodhisattvas, renunciation of world matters, meditation, physical exercises, study, and the cultivation of wisdom In the yoga meditation of the Himalayan tradition, one person systematically works with senses, body, breath, and the various levels of mind and then goes beyond, to the center of consciousness When dealing with the feelings and body, there is the emphasis on exploring and examining, being open to all the thoughts, emotions, and sensations When attention goes further inward, there is the mind field itself In this stage of practice, the perceptions have been withdrawn, and there is no longer any sensory awareness of the body, nor of the physical One is now fully in the level of mind itself Here is still another form of mindfulness, exclusive of bodily sensation, and once again, concentration is its companion 182 Clinical Hypnosis in Pain Therapy and Palliative Care Finally, one comes at the end of the mind and all of its associated thoughts, emotions, sensations, and impressions Concentration is essential at this stage As Patanjali notes in the Yoga Sutras (4.31) there is then little to know because the experiences have been resolved into their causes By working with both mindfulness and concentration, it is easy to see three skills in which the mind is trained and how these go together Focus The mind is trained to be able to pay attention, to not be drawn here and there, whether due to the spontaneous rising of impressions in meditation or due to external stimuli Expansion The ability to focus is accompanied by a willingness to expand the conscious field through that which is normally unconscious, including the center of consciousness Nonattachment The ability to remain undisturbed, unaffected, and uninvolved with the thoughts and impressions upon the mind is the key ingredient that must go along with focus and expansion While speaking here of integrating the practices of mindfulness and concentration, it is useful to note that, in a sense, integrating is not quite the right word The science of yoga meditation as taught by the Himalayan sages is already a whole, complete science that has been torn into smaller pieces over time Individual parts have been cut out from the whole, given separate names, and then taught as unique systems of meditation Mindfulness and concentration have both been part of the same, one process of meditation for a very long time Concentration In this approach, one intentionally focuses the attention on only one object, such as the breath, a mantra, a chakra center, or an internally visualized image Mindfulness In this approach, one does not focus the mind on one object but rather observes the whole range of passing thoughts, emotions, sensations, and images To the sages of the Himalayas, both methods are used in yoga meditation In fact, they are not seen as different choices at all Mindfulness and concentration are companions in the same one process that leads inward to the center of consciousness If you go deeper in meditation, you will find that both processes are essential If one practices only mindfulness, the mind is trained to always have this surface level activity present Having this activity constantly present may be seen as normal, and the attention simply does not go beyond the mind field Attention can “back off” from experiencing deeper meditation and samadhi to remain in the fields of sensation and thoughts If one practices only concentration, or one-pointedness, the mind is trained not to experience this activity of thoughts, sensations, emotions, and images The activ- Mindfulness and Meditative States in Spiritual Care 183 ity is seen as something to be avoided, and the attention may not even be open to the existence of these experiences Attention can back off from the deeper aspects of the mind field and thus prevent deeper meditation and samadhi By practicing both mindfulness and concentration, one can experience the vast impressions, learning the vital skill of nonattachment, while also using concentration to focus the mind in such a way as to be able to transcend the whole of the mind field, where there is only stillness and silence, beyond all the impressions Finally, one can come to experience the center of consciousness, the absolute reality When exploring the mind, mindfulness may be emphasized while remaining focused Then, if a particular thought pattern or samskara is to be examined to weaken its power over the mind, concentration is the tool with which this examination is done This allows an increase in vairagya, nonattachment When settling the mind, trying to pierce the layers of our being, including senses, body, and breath, concentration carries the attention inward through the layers When attention moves into that next deeper level of our being, then concentration and mindfulness once again work together to explore that layer, to once again move beyond, or deeper According to Tibetan medicine, the human microcosm, just as the macrocosm, is made of these five fundamental energies: Earth, Water, Fire, Air, and Ether, which monitor the vitality of the mind and the body The whole world, the human body, but also illnesses and medicaments, are in communication with one another The five elements are represented in us by the three body energies: Lung (the principle of motion), Tripa (the principle of warmth), and Beken (the stabilizing and cooling principle) In a healthy body, these three principles are balanced This balance and, therefore health, depends on the mind because on the mental level disharmony leads to an imbalance of these energies that then manifest as illness in the physical body Ignorance is the cause of illness Ignorance provokes the illusion of being separated from the environment The perception of “I” and “Mine” creates the Three Interior Poisons: Hatred, Ignorance, and Desire A The Experience of Enlightenment The Four Noble Truths of Buddhism are about dukkha, a term usually translated as suffering The Four Noble Truths are one of the most fundamental Buddhist teachings In broad terms, these truths relate to suffering’s (or dukkha’s) nature, origin, cessation, and the path leading to the cessation 184 Clinical Hypnosis in Pain Therapy and Palliative Care They are among the truths Gautama Buddha is said to have realized during his experience of enlightenment The Four Noble Truths were the first teaching of Gautama Buddha after attaining nirvana Life as we know it ultimately is or leads to suffering in one way or another Suffering is caused by craving for or attachments to worldly pleasures of all kinds This is often expressed as a deluded clinging to a certain sense of existence, to selfhood, or to the things or people that we consider the cause of happiness or unhappiness This interpretation is followed closely by many modern Theravadins, described by early Western scholars, and taught as an introduction to Buddhism by some contemporary Mahayana teachers (e.g., the Dalai Lama) According to other interpretations by Buddhist teachers and scholars and lately recognized by some Western non-Buddhist scholars, the “truths” not represent mere statements, but are categories or aspects that most worldly phenomena fall into B The Four Noble Truths of Buddhism Life Means Suffering To live means to suffer, because the human nature is not perfect and neither is life During our lifetime, we inevitably have to endure physical suffering such as pain, sickness, injury, tiredness, old age, and death, and we have to endure psychological suffering such as sadness, fear, frustration, disappointment, and depression Although there are different degrees of suffering and there are also positive experiences in life that we perceive as the opposite of suffering, such as ease, comfort, and happiness, life in its totality is imperfect and incomplete because our world is subject to impermanence This means we are never able to keep permanently what we strive for, and just as happy moments pass by, we ourselves and our loved ones will pass away one day, too The Origin of Suffering is Attachment The origin of suffering is attachment to transient things and the ignorance thereof Transient things include not only the physical objects that surround us, but also ideas and, in a greater sense, all objects of our perception Ignorance is the lack of understanding of how our mind is attached to impermanent things The reasons for suffering are desire, passion, pursuit of wealth and prestige, and striving for fame and popularity, or, in short, craving and clinging Because the objects of our attachment are transient, their loss is Mindfulness and Meditative States in Spiritual Care 185 inevitable, thus suffering will necessarily follow Objects of attachment also include the idea of a “self,” which is a delusion because there is no abiding self What we call self is just an imagined entity, and we are merely a part of the ceaseless becoming of the universe Impermanence is one of the Three Marks of Existence The term expresses the Buddhist notion that all compounded or conditioned phenomena (things and experiences) are inconstant, unsteady, and impermanent Everything we can experience through our senses is made up of parts, and its existence depends on external conditions Everything is in constant flux, and so conditions and the thing itself are constantly changing Things are constantly coming into being, and ceasing to be Nothing lasts According to the impermanence doctrine, human life embodies this flux in the aging process, the cycle of rebirth (samsara), and in any experience of loss The doctrine further asserts that because things are impermanent, attachment to them is futile and leads to suffering According to Buddhism, life against death is a delusive way of thinking It is dualistic: the denial of being dead is how the ego affirms itself as being alive, so it is the act by which the ego constitutes itself To be self-conscious is to be conscious of oneself, to grasp oneself, as being alive Then death terror is not something the ego has; it is what the ego is This fits well with the Buddhist claim that the ego-self is not a thing, not what I really am, but a mental construction The aim of meditation is to bring inner peace within ourselves and the world in a positive and spiritual way The world is not a peaceful place and within every soul, there is some form of tension and stress It is therefore essential to create positive and peaceful thoughts to bring peace to our mind Meditation is one of the best methods to bring about transformation and nurture the natural qualities within The Cessation of Suffering is Attainable The cessation of suffering can be attained through nirodha Nirodha means the unmaking of sensual craving and conceptual attachment The third noble truth expresses the idea that suffering can be ended by attaining dispassion Nirodha extinguishes all forms of clinging and attachment This means that suffering can be overcome through human activity, simply by removing the cause of suffering Attaining and perfecting to dispassion is a process of many levels that ultimately results in the state of nirvana Nirvana means freedom from all worries, troubles, complexes, fabrications, and ideas Nirvana is not comprehensible for those who have not attained it 186 Clinical Hypnosis in Pain Therapy and Palliative Care The Path to the Cessation of Suffering There is a path at the end of suffering, a gradual path of self-improvement, which is described more detailed in the eightfold path It is the middle way between the two extremes of excessive self-indulgence (hedonism) and extreme self-mortification (asceticism), and it leads at the end to the cycle of rebirth The latter quality discerns it from other paths, which are merely “wandering on the wheel of becoming” because they not have a final object The path at the end of suffering can extend over many lifetimes, throughout which every individual rebirth is subject to karmic conditioning Craving, ignorance, delusions, and their effects will disappear gradually, as progress is made along the path C The Noble Eightfold Path The eightfold path illustrates the moral principles in which all Buddhists should practice the way of enlightenment It goes into detail about the basis of all Buddhist teachings: morality, meditation, and wisdom This is the eightfold path Right Knowledge Right Thinking Right Speech Right Conduct Right Livelihood Right Effort Right Mindfulness Right Concentration Following The Noble Eightfold Path helps a person realize that greed and selfishness cause all earthly suffering With this new understanding, one’s suffering may end The Noble Eightfold Path, the fourth of the Buddha’s noble truths, is the way for the cessation of suffering It has eight sections, each starting with the word samyak (Sanskrit, meaning correctly, properly, or well, frequently translated into English as right) and presented in three groups: Prajña- is the wisdom that purifies the mind, allowing it to attain spiritual insight into the true nature of all things Sila is the ethics or morality Samadhi is the mental discipline required to develop mastery over one’s own mind This is done through the practice of various contem- Mindfulness and Meditative States in Spiritual Care 187 plative and meditative practices, and includes - ama - ama): • vyay (vay making an effort to improve • sati: awareness to see things for what they are with clear consciousness, being aware of the present reality within oneself, without any craving or aversion • samadhi (samadhi): correct meditation or concentration, explained as the first four dhyanas The eighth principle of the path, right concentration, refers to the development of a mental force that occurs in natural consciousness, although at a relatively low level of intensity, namely concentration Concentration in this context is described as one-pointedness of mind, meaning a state where all mental faculties are unified and directed onto one particular object Right concentration on the purpose of the eightfold path means wholesome concentration, in other words, concentration on wholesome thoughts and actions The Buddhist method of choice to develop right concentration is through the practice of meditation The meditating mind focuses on a selected object It first directs itself onto it, then sustains concentration, and finally intensifies concentration step by step Through this practice, it becomes natural to apply the elevated levels of concentration also in everyday situations The practice of the eightfold path is understood in two ways: as requiring either simultaneous development (all eight items practiced in parallel) or as a progressive series of stages through which the practitioner moves, the culmination of one leading to the beginning of another Bodhi is both the Pali and Sanskrit word traditionally translated into English as “enlightenment.” Bodhi is also frequently (and more accurately) translated as “awakening.” Suffering ends when craving ends, when one is freed from desire This is achieved by eliminating all delusion, thereby reaching a liberated state of enlightenment (bodhi) D The Four Noble Truths State The nature of suffering, its cause, its cessation, and the way leading to its cessation, is The Noble Eightfold Path Buddhism considers liberation from suffering as basic for leading a holy life and attaining nirvana In Shingon Buddhism, the state of bodhi is also seen as naturally inherent in the mind, the mind’s natural and pure state (as in Dzogchen), and is viewed as the perceptual sphere of nonduality, where all false distinctions between a perceiving subject, and perceived objects are lifted and the true state of things (nonduality) is revealed 188 Clinical Hypnosis in Pain Therapy and Palliative Care E Nondualism Is the Belief That Dualism and Dichotomy are Illusory Phenomena Examples of dualisms include self/other, mind/body, male/female, good/ evil, active/passive, and many others A nondual philosophical or religious perspective or theory maintains that there is no fundamental distinction between mind and matter or that the entire phenomenological world is an illusion The term nondual is a literal translation of the Sanskrit term advaita To the Nondualist, reality is ultimately neither physical nor mental To achieve this vision of non-duality, it is necessary to recognize one’s own mind Nonduality means that reality is essentially unitive and that both unity and multiplicity are irreducible truths of our experience F The Way to Enlightenment Enlightenment is more than an intellectual understanding, however, it is also an intuitive knowing It is a total transformation of the heart and mind When a person realizes enlightenment, the “Great Compassion” cannot but arise in his or her heart This person is no longer able to view the world in the same way he or she did before Enlightenment He or she can now see, feel, know, and understand He or she views the world as an ocean and is directly connected to each being in the same way the ocean connects to every single wave This person is most compassionate and most loving, knows the path, is expert in the path, is adept at the path His or her disciples now keep following the path and afterwards become endowed with the path Enlightenment, for a wave in the ocean, is the moment the wave realises it is water (Thich Nhat Hanh, 1999) G The Seven Steps Buddhist Breath Meditation B UDDHIST B REATH M EDITATION ONE Start out with three or seven long in-and-out breaths B UDDHIST B REATH M EDITATION TWO Be clearly aware of each in-andout breath during this meditation B UDDHIST B REATH M EDITATION THREE Observe the breath as it goes in and out, noticing whether it is comfortable or uncomfortable, broad or narrow, obstructed or free-flowing, fast or slow, short or long, warm or cool If the breath does not feel comfortable, change it until it does For instance, if breathing in long and out long is uncomfortable, try breathing in short and ... allowed expression, would end up causing us disharmony and pain They are the 20 4 Clinical Hypnosis in Pain Therapy and Palliative Care same moral virtues that you find in all the world’s great religious... Buddhist teachings In broad terms, these truths relate to suffering’s (or dukkha’s) nature, origin, cessation, and the path leading to the cessation 184 Clinical Hypnosis in Pain Therapy and Palliative. .. of mindfulness, exclusive of bodily sensation, and once again, concentration is its companion 1 82 Clinical Hypnosis in Pain Therapy and Palliative Care Finally, one comes at the end of the mind