The Two Arrows
An Excerpt from Being with Dying
By Joan Halifax
About This Title
Everyone who lives must inevitably face death. Inspired by traditional Buddhist teachings and decades of work with the dying and their caregivers, this landmark work on death and dying by beloved Buddhist teacher Joan Halifax is a source of wisdom for all those who are charged with a dying person’s care, facing their own death, or wishing to explore and contemplate the transformative power of the dying process. Relevant and powerful for people of all backgrounds, her teachings affirm that all of us can open and contact our inner strength even in the face of death, and that we can help others who are suffering to do the same.
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Two Arrows: I Am in Pain and I Am Not Suffering
Chapter 8, page 71-77
When I teach caregivers, I often ask participants which concerns them the most about dying: the thought of death, or the thought of being in pain. At the mention of pain, a hundred hands immediately shoot up into the air. Indeed, our body is like a magnet attracting pain; it’s part of being human, and there’s no way to escape it.
Sometimes even the smallest pains feel overwhelming. A throbbing toothache can take over your whole life. A fractured bone traps your mind in its itching and aching. Even the prick of a needle can fill us with anxiety and dread. This is understandable—our entire culture looks upon pain as an enemy, and teaches us to do anything, anything to get away from it. We’re wrapped up in trying to evade pain, sometimes through numbing out with addiction, sometimes through an unwholesome obsession with avoiding pain altogether.
But most of us won’t be able to avoid pain forever. At some point in our lives, perhaps when we are dying, there may be great pain—and actually, pain can be our greatest teacher, once we stop frantically fleeing its presence. We need to know what to do with pain: how to see it, how to work with it. And it really helps if we can use our experiences of pain right now to prepare us for what’s ahead.
Fifteen years ago, I was very sick and in a great deal of physical pain. On top of this, I felt worried and discouraged because my body was sick. I dreaded having surgery, which doctors were telling me was necessary.
I was lucky; I had good friends who encouraged me to hike in the nearby mountains. Sometimes it was really a stretch for me to do this, but I gave myself that extra little push, because the mountains are my friends. They provided nourishment that made it possible for me to work with my story around my suffering.
As I gained more energy, I realized how many other women were sick just like me. I opened my heart to them and began to practice while thinking of them. My pain turned into a ransom for others. With a much more open heart, I found I was able to give myself more internal room, and to let the pain in my body just be. Very slowly, I gained enough courage to take care of what needed to be taken care of, and to schedule the necessary surgery.
When I think about it now, years later, I see how I was nearly caught by my suffering, hypnotized into doing nothing about my situation but worry—justifiable, perhaps, but also maybe a little self-absorbed. In Zen, we call this kind of tightness “being tied up without a rope.” If I’d stayed in that place of paralysis, it would have eventually kept me from being cured. Obsessing about my illness was making me claustrophobic; changing my attitude toward the situation helped me heal. When I was able to put some breathing room around my problem, I could turn toward positive activities. And when I could accept my own sickness and ask for help, I could consider the suffering of other women in my position, and offer them my support. Our lives include both pain and suffering. Pain is physical discomfort, while suffering is the story around pain. The Buddha said, “When touched by a feeling of pain, the ordinary uninstructed person sorrows, grieves, and laments, beats his breast, becomes distraught. So he feels two pains, physical and mental, just as if he was shot with an arrow and, right afterward, was shot with another one, so that he felt the pains of two arrows.”
I had made the very human mistake of following the arrow of pain with the arrow of suffering. The first arrow, the sensation of pain, is bad enough. But it’s the second arrow—the story we tell ourselves about our pain—that’s the real trouble.
Liberation comes when we realize that the first arrow doesn’t necessarily have to be followed by the other. Viktor Frankl wrote that everything can be taken from us but “the last of the human freedoms—to choose one’s attitude in any given set of circumstances, to choose one’s own way.”* Can you make the distinction between the sensation of pain and the story that surrounds and amplifies it? Try saying to yourself, the next time you feel pain, “I am in pain, but I am not suffering.” See if it helps to remind you not to amplify the pain by building a story around it.
Science tells us that pain is really made up of non-pain elements. We feel sensations such as duration, intensity, and cadence, and our brains do the rest, interpreting these sensations as pain and making up the story that goes along with it. But pain really has no inherent goodness or badness. It’s the story we tell about pain that creates suffering. And though our frantic brains may tell us otherwise, pain changes from moment to moment, and it doesn’t last forever. Even great pain is impermanent. More importantly, it is not who we really are.
If you’ve ever had a meditation practice based on stillness, you know that working with pain can be a path to strengthening spiritual development. Keeping your body still for many hours inevitably means you’ll encounter the desire to move because you are genuinely uncomfortable. Maybe it is just a little physical irritation, a tickle in the ear, or perhaps it is a burning pain in the knee. Maybe the back is on fire or the stomach won’t settle and you want to throw up. Whatever the location and scale of the pain or feeling of illness, the sensation of discomfort prompts you to move, to try to get away from it, to put distance between you and it, to find a way to resolve it as soon as possible. That’s why so many meditation practices offer instructions for how to handle pain when it arrives (and why many of the practices in this book, such as tonglen and mindfulness, teach us how to work with pain). Pain is part of this drama of being a human, and how we approach it is essential to our living and dying.
If we explore pain as sensation made of non-pain elements, we might come to a place where we don’t feel so cornered when we are in pain. Maybe we have discovered impermanence by noticing that pain is always changing in one way or another. Perhaps our pain has nourished compassion within us as we realize that many others have pain like ours. We might even look on our pain as a gift that teaches us patience, gives us the strength to endure, makes us more mindful, and reminds us that our life span is finite, our connection to life fragile. Or the raw edge of pain cuts our sanity away from us, and we are its victim. We cannot judge ourselves regarding how we respond to pain. The seemingly bravest among us may have gulped down fear in secret. Those of us most sensitive to pain might not be able to bear up for very long.
Can we have the courage to let go of our stories about pain, to experience it fully, without letting fly that second arrow of suffering? Tibetan teacher Tulku Thondup uses a wonderful image to describe what it’s like when we let go of our tight grip on pain and suffering. Being free from that state, he says, is like being a skydiver, dancing in the sky even as she’s falling to earth. Tulku Thondup says the trick is to relax and let go.
You’re probably wondering, fine, but how am I supposed to do that? Frankly, what has to happen is that we somehow find the courage to give up our fixed ideas—even about something as terrifying as pain. As scary as it sounds, we need to stop holding back and instead move gently forward into the arms of pain. We’re afraid of being overwhelmed by it; we’re afraid it will devour us. But when the pain is really great, we might feel so desperate to deal with it that our desperation generates the courage we need to meet it.
In the middle of the night, perhaps the pain of a phantom limb or womb robs you of sleep, or maybe a tumor pressing against nerves in the abdomen feels like it will consume you with its fire. At this moment, when your bravest heart steps forward and says, OK, I’m willing to experience this too, you’re letting pain be your teacher.
But what do you usually do when you are in pain? Are you afraid of it? Do you try to escape it in unhealthy ways? Do you make a big deal of it? Are you likely to become anxious when faced with pain? Do you find yourself caught in the past, remembering all of your ancient pains or anticipating a pain-filled future? Or do you accept your pain, making a friend of it? Do you use pain as a way to increase your resilience, your strength? Do you take the opportunity, when in pain, to open your feelings to others who feel pain like you? Are you able to live with your pain with equanimity? Can you make your pain a teaching on impermanence and a basis for strength and compassion?
Sometimes it’s skillful to take ourselves away from pain. Maybe the pain isn’t worth getting involved with. We should then just let it go or ignore it. Giving it too much attention might increase it and make an unnecessary problem out of it. Or we might not have the mental or energetic resources to deal with it—we’re too sensitive, too tired, or too afraid. At such times, it’s usually better to focus our attention on something else, something healing, engaging, or pleasant. Distraction can be as skillful as attention when pain grows overwhelming.
When we feel stronger, have the right kind of support, or have mental buoyancy, commitment, and resilience, we may have strength to deal with pain directly and experience it fully. This can heal us, humble us, and build compassion within us. Being there for our pain may decrease the negative experience of pain as we learn about it and observe it change and as the emotions intensifying the experience of pain withdraw.
Yet sometimes we cannot transform pain through practice or psychological strategies. This is just the way it is, and we need to be realistic and sensitive to the fact that pain might be an obstacle to our practice and to our life.
Increasingly, spiritual and psychological approaches to pain management are used along with medication to enhance the effect of drugs and to help dying people relax. There are now many good medications that make it possible to manage pain effectively without diminishing awareness. I am mentioning this since I have encountered people with spiritual backgrounds who have withheld pain medication from their relatives because they believed pain was a purification process and they worried that medication would cloud the dying person’s mind, or they were concerned about addiction. My approach is pretty practical and supports bringing together the gifts of modern medicine with skillful strategies of psychology and spirituality.
Wondering about this, I once asked His Holiness the Dalai Lama about what to do when pain can’t be worked with through spiritual and psychological means, and he was emphatic that we should always do the best we can to help relieve pain and suffering, whether with modern pharmacology or with meditation and understanding. This was simply being compassionate, he stated. I had to agree when I thought about a close friend who was dying of pelvic cancer and who in the end requested palliative sedation. Her pain was like nothing I had ever witnessed. Nothing could touch its intensity. She bore it with both grace and fury. And in the end, it took her to her edge and over it. As she was dying, she urged her caregivers to sedate her out of her pain. There was a pause, and then a merciful assent by all those around her.
I asked His Holiness if he thought that the mind was at risk if strong drugs were used to help relieve severe pain. He said emphatically that even if medications cloud the mind, the mind-ground itself is unaffected. Untouched by conditioning or chemicals, the mind-ground is what is liberated at the moment of death. If the deceased has had a strong practice in life, then the way is clear for becoming one with the nature of mind at the moment of death, no matter what medications have been used.
Sometimes sitting with people who are in pain is pretty hard to take, like in the situation with our friend with pelvic cancer. We caregivers had to look very closely at our motivation in supporting her desire to be sedated. Was it our intolerance of suffering that was pushing the decision, or respect for our friend’s need to be free of her agony? Was there any other road to take aside from the path of sedation? Could we sustain unconditional presence for her after she was sedated? Should we support her decision?
In these kinds of situations, we want so much to do something. We can feel helpless, heartbroken, angry, and confused. What really can we offer, we ask? The treasure many of us forget is our presence. Often there is nothing to do but be present for pain just as it is—or, as in the case of the friend with pelvic cancer, to support her decision to be given analgesia and then sit with her as she rode an invisible stream to her death.
Remembering our strong back and soft front, we can offer equanimity and compassion—and our ability to show up for suffering can also help the sufferer to be present. It’s also important to let go of hopes and expectations for a particular outcome. And, even more, I have learned that my attachment to a so-called good outcome can actually cause more suffering.
When I visit with someone who is dying, I want to do whatever I can to relieve her pain and suffering. Sometimes, I find I can do something to help: kind words, meditation, physical touch, support for the right medical intervention, or simply bearing witness and being present. But maybe there is nothing that helps. The physical and mental misery are so great that they overwhelm all options. I need to respect the truth of this experience, accept it, be penetrated by it, be present to my own responses, and then remember that suffering and pain are transitory. If I look deeply enough, beneath the misery is an unconditioned realm where the sufferer is free of her misery. In doing this, I model the inclusive and patient qualities of heart and mind that I hope will be nurtured in this person who is suffering. Fleeing from her suffering sends the opposite message, and sadly, this is too often what happens. Fear takes over and compassion withers.
This double-arrowed vision is yet another paradox of being with dying. I try to open to both suffering and freedom from suffering. If I see only suffering, then I am caught in the relative nature of existence: we are nothing but suffering. But if I see only the pure and vast heart, then I am denying our human experience.
See if you can find fresh ways of looking at pain that make it your ally, not your enemy. Become a friend to your pain, the teachers say. Reach out to it. See what it needs; you may not know what to do, but your pain might. Give your pain space. Don’t irritate it. Be a good listener to it, and try not to reject it. See what it wants to teach you. And practice, if you can, separating pain from any stories about it, so that the one arrow of pain doesn’t necessarily have to be followed by a second arrow of suffering.
Joan Halifax, PhD, is a Zen priest and anthropologist who has served on the faculty of Columbia University and the University of Miami School of Medicine. For the past thirty years she has worked with dying people and has lectured on the subject of death and dying at Harvard Divinity School, Harvard Medical School, Georgetown Medical School, and many other academic institutions. In 1990, she founded Upaya Zen Center, a Buddhist study and social action center in Santa Fe, New Mexico. In 1994, she founded the Project on Being with Dying, which has trained hundreds of healthcare professionals in the contemplative care of dying people.
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