how to apply mindfulness to your life and work · 2018-08-17 · deconstructing death: using...

Deconstructing Death: Using Mindfulness to Manage Life's Ultimate Transition Joan Halifax, PhD - TalkBack - pg. 1

a TalkBack Session with

Joan Borysenko, PhD; Ron Siegel, PsyD; and Ruth Buczynski, PhD

Deconstructing Death:

Using Mindfulness to Manage Life's Ultimate Transition

How to Apply Mindfulness to

Your Life and Work


Table of Contents

(click to go to a page)

What Stood Out Most ........................................................................................... 3

How to Express Gratitude throughout Our Lives .................................................... 5

How Practitioners Can Better Attune to Their Own Experience .............................. 7

How to Cultivate Equanimity with Our Patients...................................................... 9

Why Reflecting on Our Career Choice Is So Important ........................................... 11

About the Speakers ............................................................................................... 13

with Ruth Buczynski, PhD; Joan Borysenko, PhD; and Ron Siegel, PsyD

A TalkBack Session: Deconstructing Death: Using Mindfulness to Manage Life's Ultimate Transition


A TalkBack Session: Deconstructing Death: Using Mindfulness to Manage Life's Ultimate Transition

with Ruth Buczynski, PhD; Joan Borysenko, PhD; and Ron Siegel, PsyD

Dr. Buczynski: That sure was an interesting session. I am looking forward to hearing what both of you think

about this and your insights and takeaways.

To everyone who is watching right now, we are starting our TalkBack Segment. We are going to hear from

two eminent psychologists about their insights into what we just heard.

We will be talking with Dr. Joan Borysenko and Dr. Ron Siegel, and I am looking forward to hearing what you

thought and your takeaways on this.

What Stood Out Most

Dr. Buczynski: Joan, let’s start with you: what stood out to you most in the session with Joan Halifax?

Dr. Borysenko: What stood out most of all is Joan’s presence and that, of course, was a lot of the content

when she was operationalizing how it is that we can become present to someone who is dying.

In general, it comes down to this: How can we be present not only to people with medical problems and to

those who are dying, but to anyone?

I loved her acronym of GRACE – what it is to really ground and to remember what it is that you are doing

there – to remember that this is sacred work and that what we are

all hoping to do is to alleviate suffering to the best that we are able.

I loved the way that Joan, like so many other people in this

seminar, is tuned in deeply to the sensory experience of the body

so that you can say, as you are sitting with somebody, “What is your experience that is coming up?” There is

a lot of information in that question.

That is important – just like the WAIT that Ron has talked about – how we need to pause, to look and to see

what is coming up in us and what motivates us to do or say or not say what we are going to do with our

“How can we be present not

only to people with medical

problems and to those who

are dying, but to anyone?”


client. I loved Joan’s way of dealing with that in an operationalized way.

The other thing that totally struck me was the idea of a strong back and a soft

belly – of grounding first with your feet on the floor – that strong back, and

then having equanimity – the sense that whatever is happening in life, you

are up to dealing with it.

With the soft belly – you let go of your defenses by softening your belly and letting that sense of love and

compassion come.

I also found most amazing the research she talked about at the Max Planck Institute. When you are in touch

and inquiring into yourself about your own somatic experience – and then of course your emotional

experience, which is part of your somatic experience – it is the same brain

circuits that allow you to tune into the inner experience of someone else.

So, it is a training: when you train yourself to notice what is going on in you,

you develop the capacity, an enhanced capacity for an empathetic – now

I’m going to use a word that I learned from Dan Siegel a long time ago – mindsight. It is the capacity to see

into, in an intimate way, the experience of another person.

I could see how exquisitely Joan was like that and I had the thought, “My God, I hope that when my time for

transition comes, I have that GRACE – somebody like Joan with me to really witness the experience.” It is so

touching.

Dr. Buczynski: Yes. How about you, Ron, what stood out to you?

Dr. Siegel: Many of the things that Joan just mentioned now also struck me, as well as a sense of just the

profound understanding and nuanced appreciation for the phenomenon of dying that comes from both

being with people who are dying and also from her Buddhist practice.

Both of these aspects include mindfulness practice – learning to

open to moment-to-moment experience and also this sort of

relentless interest on the part of Buddhist traditions in seeing

things as they are – really noticing that everything that is born

dies, that change is really inevitable, and that this is the reality in

which we live.

“I loved the way

that Joan is tuned

in deeply to the

sensory experience

of the body.”

“The other thing that

totally struck me was

the idea of a strong

back and a soft belly.”

“When you train yourself to

notice what is going on in

you, you develop the

capacity, to see into, in an

intimate way, the experience

of another person.”


There is a way in which Roshi Halifax’s experience with this shone through especially in areas where most of

us cringe a little bit – most of us have a little trouble opening to the full reality of birth and death. She

seemed able to be really present to that.

I would also say that her GRACE metaphor, as our Joan here – Joan Borysenko – was just saying is a very

interesting addition.

The gathering of attention, recalling an intention about “What I’m

trying to do here,” connecting, attuning – and a piece of it that we

didn’t just hear about, is to examine one’s cognitive assumptions.

This is all an interesting addition to “Okay, so we are used to this idea from mindfulness practice of becoming

present, having an intention, and attuning to what is going on – but what is going on in our minds? What are

the models that are arising? What are our assumptions about what is going on here?”

It is helpful to be quite conscious of those before moving into this final stage of engagement, which is acting

in some way to connect with others.

I thought all of that was a particularly interesting contribution on

Roshi Halifax’s part.

Dr. Buczynski: Ron, you have referred to her twice now as Roshi

Halifax. I’m not sure if everyone knows why you did that.

Dr. Siegel: That is simply because she is a Zen master who, in a lineage of Zen masters, is also a medical

anthropologist, so it could have been Dr. Halifax as well. But within the Zen tradition, Roshi is the honorific

term which I believe means “teacher” although I am not certain of that.

How to Express Gratitude throughout Our Lives

Dr. Buczynski: Let’s go on to expressing gratitude. Roshi Halifax points out the importance of expressing

gratitude, particularly at the end of life.

Joan, I am wondering about your thoughts on that and how we can cultivate the ability to process and

express gratitude throughout our lives.

“We are used to this idea

from mindfulness practice of

becoming present, having an

intention, and attuning to

what is going on – but what

is going on in our minds?”

“Most of us have a little

trouble opening to the full

reality of birth and death.”


Dr. Borysenko: Absolutely. Certainly at the time of death, as Joan was saying, we are examining our

relationships. We are bringing those up and we are trying to put things right, especially if there is a need for

forgiveness.

A natural part of the work at the end of life is that we start to feel so grateful for things in our life that maybe

we haven't paused and felt gratitude for before.

So, it’s a terrific question for all of us, Ruth. “Why wait till the time of death? How can we feel more grateful

during life itself?”

There are two practices that have meant a great deal to me over time. The

first one I learned from Brother David Steindl-Rast.

He is a Cistercian monk and also a Zen teacher. He is a man in his eighties and has been a Zen teacher, sensei,

for many, many years. He has a terrific website that your listeners might love – it is called gratefulness.org.

I heard him – it must have been a good twenty-five years ago – give a practice and I have adhered to it pretty

much every night since that time.

The practice is this: at night, before you go to bed, think of one thing that you are grateful for that you have

never been grateful for before.

Now, this makes it a mindful practice instead of a rote practice because you can’t just get ready for bed and

say, “Oh, I’m grateful for my husband/my wife/my health/that I can

pay the bills” or whatever because it has to be different – you have

never been grateful for it before.

It brings forth mindfulness all day long because you know you are

going to have to do this at night. This gratefulness practice starts to

refine your eyes and your capacity for seeing and looking.

Here’s an example. Right now I am looking out my window and I am seeing a place where there was a forest

fire – but because there was this forest fire, rock faces that weren’t apparent before – I live on a mountain –

are shining with light now and they are so amazingly beautiful. I feel that beauty throughout my body.

When I see beauty, and when we are mindful of something that is pleasing like that, it is so good for our

health. It releases all the “feel-good” chemicals and “feel-healthy” chemicals. So that is a great thing to do

“‘How can we feel

more grateful

during life itself?’”

“At night, before you go

to bed, think of one thing

that you are grateful for

that you have never been

grateful for before.”


before bed at night.

The second practice that I mentioned came from a healing priest. When I was at Harvard, I used to really

enjoy studying healers from different traditions, and right in the Harvard medical

area there is a church – in fact it is the church that Ted Kennedy chose to be

buried from – and there used to be an amazing healing priest there who every

month gave a healing service.

I went to that service, and here is how he started his sermon. He said, “Take a moment and feel grateful now

for all the things in your life that don't need healing.”

I love that because frequently we get so self-absorbed with all that needs healing. Gratefulness is the

opposite of self-absorption. So, this is really saying, “Life is such a mystery. Life is so beautiful. There are so

many possibilities. And I get to live it – what an amazing thing.”

How Practitioners Can Better Attune to Their Own Experience

Dr. Buczynski: You both have talked about her acronym GRACE.

Ron, let’s spend a little time focusing on the third part of that – practitioners attuning to their own

experience. How can we get better at that?

Dr. Siegel: That’s a really interesting area. Joan – our Joan on the call – Joan Borysenko – referenced Tania

Singer’s work at the Max Planck Institute, of noticing that the way in which we connect with another person’s

experience is through our own attunement – proprioception, which is

noticing what is happening inside our own bodies.

This is through the process of mirror neurons – or we think it is through the

process of mirror neurons – which operates on even the simplest level and

which many listeners are probably familiar with.

If I were to drink a glass of water now, you might feel a little sense of drinking – feeling this drinking

sensation happening in your own body.

What we’re talking about here happens more profoundly when we are with another human being who is

“The way in which we

connect with another

person’s experience

is through our own

attunement.”

“Gratefulness is

the opposite of

self-absorption.”


experiencing something which is emotionally intense.

I am reminded of Carl Rogers’ famous line. I’d actually like to read it – I typed it out because I thought it

would be helpful here.

He described empathy this way: “To perceive the internal frame of reference of another with accuracy and

with the emotional components and meaning which pertain to the feeling, as if one were the person but

without ever losing the ‘as if’ sense.”

That is a nice presentation of this idea – that we really do experience it in our own bodies as though it were

happening to us, as though we were the other person, but we also have this awareness that it is “as if.”

We know that mindfulness practice is a good way to develop this capacity.

Sara Lazar’s work that she published some eight years ago was one of the first studies showing that

mindfulness practice over time changes brain structures.

Her research showed that the insula, particularly in areas of the insula that are involved in proprioception

and noticing or attuning to what is happening inside of the body, doesn't

shrink in mindfulness practitioners over a lifetime and these areas do

shrink in other people.

Mindfulness practice also helps us to notice that whenever experiences arise, that we relate to them as

either pleasant, and we are drawn to wanting more of them, or unpleasant and we shirk back from them, or

neutral – they don't register much and we don't notice them.

When we are in a therapeutic role, as a psychotherapist or another healthcare practitioner, noticing this

becomes very important: to attune and not only to notice, “Oh, I have this empathic connection to what the

other is experiencing,” but also to notice how “I’m either resisting it/longing for

more of it.” I think that becomes very, very useful.

There are many psychotherapy traditions that do this: Eugene Gendlin’s

focusing method helps people to become attuned.

Peter Levine’s somatic experiencing does this as well as Pat Ogden’s sensorimotor work and some aspects of

Gestalt therapy.

“Mindfulness practice

over time changes

brain structures.”

“When we are in a

therapeutic role,

noticing becomes

very important.”


There are many different traditions we can draw on to develop this kind of attunement.

How to Cultivate Equanimity with Our Patients

Dr. Buczynski: Thanks. Joan, Joan Halifax talked about the woman that was dying from melanoma and how

she worked with her on her equanimity. How can we cultivate equanimity with our patients?

Dr. Borysenko: That is a great question. The answer to that, especially in terms of somebody who is working

with the dying, is what you bring to the table.

First, you bring your own inner sense of equanimity. Oftentimes, when somebody is dying, what they get

from the mirror neurons of the people around them is their sadness – people are afraid to talk to them and

sometimes they won’t even acknowledge that another person is dying.

They will say, “Oh, there’s medical research. You’ll be fine. You can get this treatment/that treatment…”

Dr. Buczynski: Could I get you to stop for a second and explain mirror neurons? Both of you have mentioned

mirror neurons, and since this is not the Brain Series, I’m thinking some

people here are not going to know what a mirror neuron is. Can you just

give a little loop on that and then pick back up on where we are here?

Dr. Borysenko: At the most basic level, this is how I would describe a mirror neuron: if you yawn, I’m going

to want to yawn too.

It is about watching or hearing something another person is doing and that triggers the same circuits in my

brain. So that is the simplest way I can explain it. Ron, maybe you can add to that?

Dr. Siegel: I understand that this is still somewhat controversial in humans as to exactly what the circuitry is

that is involved in what you just described.

We all know that this is objectively what happens – what you just described.

We resonate to other people’s experiences. If you don't mind my being slightly graphic, the clearest example

of mirror neurons is watching a sexually explicit film. We watch other people involved in sexual activity and

we feel sexual arousal.

“We resonate to other

people’s experiences.”


So clearly, we have this capacity to see others engaged in a

behavior and, in a very primal neurological way, our body

responds as though we are engaged in that behavior.

It has been studied most extensively in certain other primate

groups and there is neurobiological mapping to show it.

But it is still speculative as to whether the same neurobiology is occurring in humans even though the

phenomenon clearly occurs in us.

Dr. Buczynski: The idea would be that there is some place in the brain where, as we are more attuned to

ourselves and others, we can actually experience a bit of what another person is experiencing.

So, Joan, let’s get back to you and equanimity.

Dr. Borysenko: Yes. If you are sitting with someone who is dying and you are full of pity, they will feel sorry

for themselves. That is the mirror neurons working.

If you are really anxious, you don't know what to say to someone, you’re afraid to say the wrong thing, or

you are fidgety, it will create that in them.

So if you want to help any client develop equanimity, you are contagious – your state is contagious because

of the mirror neurons.

We have to learn to have equanimity within ourselves, and particularly with the dying, we have to not be

attached to the results.

You have to not be attached to, “I have to do this exactly right so this person will have a good death.”

Or, as Joan was talking about with another patient, the staff wanted her to break someone’s denial – that

woman who had equanimity – and she was supposed to say, “Well, you’re dying.” Then you think, “What

does that mean? - you shouldn’t have equanimity?”

In any case, it brought to mind a client of mine from years ago who

was a psychiatrist and she had a very rare rectal cancer.

She came to see me and she said, “Look, I know that I’m going to die and this is the last that I want to hear

about it. You’re going to think that I’m in denial. I’m not in denial. I know that I’m going to die – but I would

“We see others engaged in a

behavior and, in a very primal

neurological way, our body

responds as though we are

engaged in that behavior.”

“If you want to help any

client develop equanimity,

you are contagious.”


like to die with equanimity. So please do not be reminding me all the time that I’m going to die.”

Then she said, “These are my conditions. This is my nickel and I’m going to spend it the way that I like!”

She actually worked up until the day before she died. She ended up in

a wheelchair, but she was still seeing patients at her own home.

After she died, her colleagues in the psychiatry department got

together and we were all having lunch – I was included in their group

– and many of them were grief-stricken or even outraged that she

lived in denial.

I thought, “Isn’t it her business – the way that she wants to die? Didn’t she die very, very gracefully?”

So I would say that one of the most important things in working with the dying is the same as in working with

the living: you have to let go of your own preconceived notions.

That is Joan’s C for cognitive – the C in GRACE. This is where you

tune into where they are and what is happening in their life.

What are their healing stories? What is – and I love this idea –

their “healing fiction” – is it their belief in reincarnation or a

belief in heaven or hell or a belief in the continuity of the soul

that gives them a larger context?

We need to be able to sit with them, even if it is not our context, and witness their context in a way that

allows them to sink more deeply into whatever it is that promotes equanimity for them.

Why Reflecting on Our Career Choice Is So Important

Dr. Buczynski: Thanks. Ron, Joan talked about the difficulties so many practitioners have in remembering

why they went into this profession to begin with. Maybe it is hard to remember because of all the stress or

maybe it is the frustration of so much paperwork – whatever it might be. How can we help get that back?

Dr. Siegel: Yes, that is really important. Almost all of us go into healthcare and mental healthcare in

particular, perhaps, with the intention that we are going to connect with other people in a way that is going

“‘Look, I know that I’m

going to die but I would

like to die with equanimity.

So please do not be

reminding me all the time

that I’m going to die.”

“We need to be able to sit with

them, even if it is not our

context, and witness their

context in a way that allows

them to sink more deeply into

whatever it is that promotes

equanimity for them.”


to help to alleviate their suffering. And yet, we can get frustrated with that and start to lose that initial

inspiration.

I remember learning early in my training that people who study burnout say that burnout occurs when there

is a discrepancy between, on the one hand, our expectations about what is supposed to happen, and on the

other hand, the reality of what does happen.

Another way to describe that is burnout occurs when we are attached to a

particular outcome.

When I worked in child community mental health for many years, there were many cases that were

frustrating because there didn’t seem to be a lot of progress over the course of treatment.

I remember talking to my trainees about, “How many generations did it take for this particular child and

parents to be in this situation of suffering right now?

What was the parents’ experience of parenting? What was the

grandparents’ experience of parenting?”

Almost always there is a long line of pain passed down from generation to generation.

Then we, as professionals trying to intervene, may not be at one of these watershed points where a little bit

of influence on our part can send the person flowing down in a

direction where they have more and more health and well-being.

They may not be ready for that, so the most we may be able to do is

plant a seed that perhaps sometime later takes root.

This all involves letting go of our expectations of outcome – and it is tricky, in these days of looking for

empirical justification for treatment where many of us are asked to measure outcomes throughout the

course of treatment. It can run counter to putting in our best effort and letting go of attachment.

We can become very much attached to outcomes – basically, somebody else is going to praise or blame us on

whether outcomes are good or bad.

Yet, our attachment to outcome gets in the way of connecting to our intention in the moment.

Dr. Buczynski: Thanks. That wraps up our session.

“Burnout occurs when

we are attached to a

particular outcome.”

“Almost always there is a long

line of pain passed down from

generation to generation.”

“Basically, somebody else

is going to praise or blame

us on whether outcomes

are good or bad.”


About the speakers . . .

Joan Borysenko, PhD has been described as a

respected scientist, gifted therapist, and

unabashed mystic. Trained at Harvard Medical

School, she was an instructor in medicine until

1988.

Currently the President of Mind/Body Health

Sciences, Inc., she is an internationally known

speaker and consultant in women’s health and

spirituality, integrative medicine and the mind/

body connection. Joan also has a regular 2 to 3

page column she writes in Prevention every

month. She is the author of nine books, including New York Times bestsellers.

Ron Siegel, PsyD is an Assistant Clinical

Professor of Psychology at Harvard Medical School,

where he has taught for over 20 years. He is a long

time student of mindfulness mediation and serves

on the Board of Directors and faculty for the

Institute for Medication and Therapy.

Dr. Siegel teachers nationally about mindfulness and

psychotherapy and mind/body treatment, while

maintaining a private practice in Lincoln, MA.

He is co-editor of Mindfulness and Psychotherapy

and co-author of Back Sense: A Revolutionary

Approach to Halting the Cycle of Chronic Back Pain.

how to apply mindfulness to your life and work · 2018-08-17 · deconstructing death: using...

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